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a To SAN JOAQUIN COUt� c°c ENVIRONMENTAL HEALTH DEPARTMENT 1868 East Hazelton Avenue, Stockton, CA 95205-6232 �4.. �,P• Telephone:(209) 468-3420 Fax:(209) 464-0138 Web:www.sigov.org/ehd L�FOR FOOD PROGRAM OFFICIAL INSPECTION REPORT Name of Facility: r rn Date: Address: -L.- City: Zip Code: t d Owner/Operator: /� T r1 o-) � �M 1 iY Telephone: - f-T J / � �.� lire t Program Element: Prografn Record: ^ Inspection Type:, c ( IS8180 Posted es N56 Permit Posted es No Re-Inspection on or After: IN=In Compliance N/O=Not Observed N/A=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 eublic health and must be corrected immediate)r. Non-compliance may warrant closure of the food facility n N* VA .`Demonstration of Knowledge 1. Demonstration of knowledge;food safety certificate 24. Person In Charge is present and performs duties Employee Health and Hygiene Personal Cleanliness ; Communicable disease;reporting,restrictions&exclusions 25. Personal cleanliness and hair restraints No discharge from eyes,nose,or mouth;no open wounds General Food Safety RequiTel7ts Proper eating,tasting,drinking,or tobacco use 26. Approved thawing methods used Preventing Contamination try Hands x 7. Food protected from contamination during storage =- �.>._.. .,ten Hands clean and properly washed;proper glove use 28. Washing fruits and vegetables before use Handwashing facilities supplied and accessible 29. Toxic substances properly identified,stored,and used Tittle.. fl .,P .. '_ Proper hot and cold holding temperatures 30. Food storage;food storage containers labeled Proper use of time as a public health control 31. Customer self-service food protected;individual utensils provided Proper cooling methods 32. Food properly labeled and honestly presented 10. Proper cooking time and temperatures i EqWqp ellyLClfsfe l m 1. Proper reheating procedures for hot holding 33. Nonfood contact surfaces clean , 34. Warewashin9 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 boom ource_, 38. Approved and sufficient ventilation and lighting ,4 15. Food obtained from approved source 39. Thermometers provided,accurate,and easily visible 16. Compliance with shell stock regulations;tags/display 40. Proper use and storage of wiping cloths 17. Compliance with Gulf oyster regulations �Aicai dPhFacitities " Conformance With AppravexOCedures 1. Plumbing maintained;proper back flow prevention 18. Compliance with HACCP plan or variance conditions 42. Garbage and refuse properly disposed mer Advisory 43. Toilet facilities clean,supplied,and maintained 19. Advisory provided for raw or undercooked food 44. Premises;personal/cleaning items;vermin-proofing • r y Susceptible 1Populations N140. Prohibited foods not offered at high risk facilities _ j � 5. Floors,walls and ceiling are maintained and kept clean Water/HolWater 46. No living or sleeping quarters inside facility 1.Hot and cold potable water available. r XUz . �. Ugtiid Waste Dtspct'sel 7. Signs posted;last inspection report available 2. Sewage/wastewater properly disposed;toilet facility useable 48. Compliance with plan review requirements r ,: Vermin'' ,`� '- 9. Facility operating with a valid health permit Ktt 3. No rodents,jnsects,bi ds or animals inside facility 0. Impoundment 51. Permit Suspension Received By[Title: ( � EH Specialist: Phone: _ / Page 1 of EHD 16-23 (1st pg) 4/9/12 / FOOD PROGRAM OIR