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SAN JOAQUIN COUNT
<br />ENVIRONMENTAL HEALTH DEPARTMENT
<br />1868 East HazeIton Avenue, Stockton, CA 95205-6232
<br />Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www .sigov .orglehd
<br />FOOD PROGRAM OFFICIAL INSPECTION REPORT
<br />Name of Facility: p &-rVie.P0) Date: y -03--
<br />Address:
<br />/ I _yeP Jd a/I a riv 411/ #'
<br />City: Zip Code: /
<br />Owner/Operator
<br />Cnil tii
<br />Telephone:
<br />Program E lement: 1 Ce 2,1 Pri3gram Record: g C 1 Sil Inspection Type442,a(k..1,t-
<br />SB180 Posted Yes No Permit Posted Yes No Re-Inspection on or After:
<br />IN = In Compliance N/O = Not Observed N/A = Not Applicable COS = Corrected
<br />See reverse side for code sections and general requirements that
<br />Major violations .ose a threat to public health and must be corrected immediateli.
<br />on-site MAJ = Major Violation OUT = Not in Compliance
<br />correspond to each violation listed below.
<br />Non-compliance may warrant closure of the food facility
<br />IN \Demonstratio n of Knowledge ,,pc*., : , mit ,,,,
<br />1. Demonstration of knowledge; food safety certificate ,t.,\
<br />P-
<br />24. Person In Charge is present and performs duties
<br />Personal liij0 '-\; t' ‘ \A Cleanliness
<br />4
<br />. Employe
<br />.
<br />., 60 Yii4e' .
<br />Communicable disease; reporting, restriction & exclusions
<br />"
<br />25. Personal cleanliness and hair restraints
<br />.3 No discharge from eyes, nose, or mouth; no open wounds \ Gsneral Food
<br />26. Approved thawing methods u
<br />seed
<br />. Proper eating, tasting, drinking, or tobacco use
<br />.-
<br />gCo P 27. Food protected from contamination during storage
<br />.. Hands clean and properly washed; proper glove use 28. Washing fruits and vegetables before use
<br />. Handwashing facilities supplied and accessible 29. Toxic substances properly identified, stored, and used
<br />, .,..„ .„„„, , •.,.•-• , -ANT ' 1,, ...-;., 4,---
<br />° - °•T;. '
<br />. Proper hot and cold holding temperatures 30. Food storage; food storage containers labeled
<br />:. Proper use of time as a public health control 31. Customer self-service food protected; individual utensils provided
<br />. Proper cooling methods 32. Food properly labeled and honestly presented
<br />7c Proper cooking time and temperatures ',N..* u 11' ''''' 6',,•,t ,
<br />Proper reheating procedures for hot holding ka ...: h ‘gi 33. Nonfood contact surfaces clean
<br />---.-- .:;* ionf.,Coitamb . - 34. Warewashing facilities maintained; test strips available
<br />12. No re-service of returned food 35. Equipment/utensils approved; installed; clean; good repair
<br />13. Food free from contamination and adulteration 36. Equipment, utensils and linens: storage and use
<br />14. Food contact surface cleaned and sanitized/warewashing procedures 37. Vending machines maintained
<br />_ .,..-.-7Food Fron Appr- ' -,, 38. Approved and sufficient ventilation and Fighting
<br />?C-- ' 15. Food obtained from approved source ... 39. Thermometers provided, accurate, and easily visible
<br />Compliance with shell stock regulations; tags/display 40. Proper use and storage of wiping cloths
<br />s.).17. Compliance with Gulf oyster regulations
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<br />. .. ,.. !...;
<br />conformance.With- _ 41. Plumbing maintained; proper back flow prevention
<br />18. Compliance with HACCP plan or variance conditions 42. Garbage and refuse properly disposed
<br />,..
<br />A 43. Toilet facilities clean, supplied, and maintained
<br />9. Advisory provided for raw or undercooked food 44. Premises; personal/cleaning items; vermin-proofing
<br />.., --, , I . .. -
<br />': Perms Facilities
<br />
<br />.. - ,
<br />0 0 Prohibited foods not offered at high risk facilities 45. Floors, walls and ceiling are maintained and kept clean
<br />Water/Hot _ 46. No living or sleeping quarters inside facility
<br />1. Hot and cold potable water available. . .W I ....
<br />147. .„ Signs posted; last inspection report available it ,1/4f
<br />2. Sewage/wastewater properly disposed; toilet facility useable Compliance with plan review requirements
<br />Vermin:, .4 Facility operating with a valid health permit
<br />.23. No rodents, insects, birds or animals inside facility Impoundment
<br />Permit Suspension
<br />Received By/Title:
<br />,
<br />of EH Specialist: y fit Page 1 '
<br />/12---Z
<br />Phone: 1.I ((I t -1 t Si
<br />EHD 16-23 (1st pg) 4/9/12 FOOD PROGRAM OIR
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