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`' SAN JOAQUIN COUNTY -� ENVIRONMENTAL HEALTH DEPARTMENT __- 1868 East Hazelton Avenue, Stockton, CA 95205-6232 Telephone: (209)468-3420 Fax: (209) 464-0138 Web:www.sigov.org/ehd �LiFORa FOOD PROGRAM OFFICIAL INSPECTION REPORT Name of Facility: Pt Date: / 7 Address: I 71 L f City: f Ir Zip Code: Owner/Operator: f �/• 1 / J /� Telephone: Program Element: Prog m Record: Inspection Type: SB180 Posted ❑Yes ❑ No Permit Posted ❑Yes 0 No Re-Inspection on or After: IN=In Compliance N/O=Not Observed NIA=Not Applicable COS=Corrected on-site MAJ=Major Violation OUT=Not in Compliance See reverse side for code sections and general requirements that correspond to each violation listed below. Ma or violations pose a threat to public health and must be corrected immediatel . Non-compliance may warrant closure of the food facility N wo wn Demonstration of Knowledge our cos Supervisioy 1. Demonstration of knowledge;food safety certificate+ 24. Person In Charge is present and performs duties -- - P:r,, eesHealthrand Hygiene Personal.Clean Lines X Mimi Communicable disease;reporting,restrictions&exclusions 25. Personal cleanliness and hair restraints 3. No discharge from eyes,nose,or mouth;no open wounds _ - General Food Safety Requirements t' Proper eating,tasting,drinking,or tobacco use 26. Approved thawing methods used iineventing Contammation.by Hand 27. Food protected from contamination during storage 5. Hands clean and properly washed;proper glove use 8. Washing fruits and vegetables before use W1016. Handwashing facilities supplied and accessible 29. Toxic substances properly identified,stored,and used Time and Temperature Relationship od Storage/Display/Service 71101.. roper hot and cold holding temperatures 30. Food storage;food storage containers labeled roper use of time as a public health control 31. Customer self-service food protected;individual utensils provided roper cooling methods 32. Food properly labeled and honestly presented roper cooking time and temperatures EqurpmentM/Utensils/Linens roper reheating procedures for hot holding 33. Nonfood contact surfaces clean Protection Frocm Contamination 34. Warewashing facilities maintained;test strips available 12. No re-service of returned food 35. Equipment/utensils approved;installed;clean;good repair 13. Food free from contamination and adulteration 36. Equipment,utensils and linens:storage and use 14. Food contact surface cleaned and sanitized/warewashing procedures 37. Vending machines maintained Food F „Appro a So rce 38. Approved and sufficient ventilation and lighting 7 16. . Food obtained from approved source 39. Thermometers provided,accurate,and easily visible Compliance with shell stock regulations;tags/display 40. Proper use and storage of wiping cloths Compliance with Gulf oyster regulations Physical Facilities Conformance With Approved Proc 1. Plumbing maintained;proper back flow prevention jff� 18. Compliance with HACCP plan or variance conditions 42. Garbage and refuse properly disposed Consumer Advisory 43. Toilet facilities clean,supplied,and maintained 19. Advisory provided for raw or undercooked food 4. Premises;personal/cleaning items;vermin-proofing : eP.- Highly Susceptible Populations a anent Food 20. Prohibited foods not offered at high risk facilities 5. Floors,walls and ceiling are maintained and kept clean Water/Hot Water 6. No living or sleeping quarters inside facility 21.Hot and cold potable water available. Liquid Waste Disposal - 7. Signs posted;last inspection report available 2. Sewage/wastewater properly disposed;toilet facility useable 8. Compliance with plan review requirements 9. Facility operating with a valid health permit 23. No rodents,insects,birds or animals insi acility 1 421 150. Impoundment 51. Permit Suspension Received By/Title: EH Specialist: Phone: j (/ ./� L( Page 1 of Z � t�fJ •"'Q J EHD 16-23 (1st pg) 4/9112 FOOD PROGRAM OR