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,q?a.coc SAN JOAQUIN COUNT' <br />�LNVIRONMENTAL HEALTH DEPARTMENT <br />N: < <br />1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br />• cq.. - �;p • Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.s'gov.org/ehd <br />�/POR <br />FOOD PROGRAM OFFICIAL INSPECTION REPORT <br />Name of Facility: V V (' M " E <br />Address: � S n oa 1n <br />Date: WIC/ 14 <br />City: S 1v�1% n Zip Code: n 42 <br />Owner/Operator: ht � v t Lp� � ScNI <br />Telephone: ! ,O S Z� <br />Program Element Pro ram Record:, U'li <br />1 <br />Inspection Type: <br />SB18O Posted Yes No Permit Posted Yes No <br />Re -Inspection on or After: <br />IN = In Compliance N/O = Not Observed N/A = Not Applicable COS = Corrected on-site MAJ = Major Violation OUT = Not in Compliance <br />See reverse side for code sections and general requirements that correspond to each violation listed below. <br />Major violations pose a threat to public health and must be corrected immediately. Non-compliance may warrant closure of the food facilit <br />N N;o wn Demonstration of Knowledge <br />rw., oArr Cos <br />Supervision CUT <br />1. Demonstration of knowledge: food safety certificate <br />24. <br />Person In Charge is present and performs duties <br />Employee Health and Hygiene <br />Personal Cleanliness <br />Communicable disease; reporting, restrictions & exclusions <br />25. <br />Personal cleanliness and hair restraints <br />3. No discharge from eyes, nose, or mouth; no open wounds <br />General Food Safety Requirements <br />4. Proper eating, tasting. drinking, or tobacco use <br />26. <br />Approved thawing methods used <br />Preventing Contamination by Hands <br />27. <br />Food protected from contamination during storage <br />5. Hands clean and properly washed; proper glove use <br />28. <br />Washing fruits and vegetables before use <br />Handwashing facilities supplied and accessible <br />29. <br />Toxic substances properly identified, stored, and used <br />Time and Temperature Relationship <br />Food Storage/Display/Service <br />7. Proper hot and cold holding temperatures <br />30. <br />Food storage; food storage containers labeled <br />16. Proper use of time as a public health control <br />31. <br />Customer self-service food protected; individual utensils provided <br />9. Proper cooling methods <br />32. <br />Food properly labeled and honestly presented <br />10. Proper cooking time and temperatures <br />Equipment / Utensils / Linens <br />11. Proper reheating procedures for hot holding <br />33. <br />Nonfood contact surfaces clean <br />Protection From Contamination <br />34. <br />Warewashing facilities maintained; test strips available <br />12. No re -service of returned food <br />13. Food free from contamination and adulteration <br />35. <br />36. <br />Equipment/utensils approved; installed; clean; good repair <br />Equipment, utensils and linens: storage and use <br />14. Food contact surface cleaned and sanitized/warewash ing procedures <br />37. <br />Vending machines maintained <br />Food From Approved Source <br />38. <br />Approved and sufficient ventilation and lighting <br />15. Food obtained from approved source <br />39. <br />Thermometers provided, accurate, and easily visible <br />16. Compliance with shell stock regulations; tags/display <br />40. <br />Proper use and storage of wiping cloths <br />7. Compliance with Gulf oyster regulations <br />Physical Facilities <br />Conformance With Approved Procedures <br />41. <br />Plumbing maintained; proper back flow prevention <br />18. Compliance with HACCP plan or variance conditi <br />42. <br />Garbage and refuse properly disposed <br />11 Consumer Advisory <br />43. <br />Toilet facilities clean, supplied, and maintained <br />9. Advisory provided for raw or undercooked food <br />44. <br />Premises; personal/cleaning items; vermin -proofing <br />Highly Susceptible Populations <br />Permanent Food Facilities <br />20. Prohibited foods not offered at high risk facilities <br />45. <br />Floors, walls and ceiling are maintained and kept clean <br />Water / Hot Water <br />46. <br />No living or sleeping quarters inside facility <br />121. Hot and cold potable water available- <br />Compliance and Enforcement <br />Liquid Waste Disposal <br />47. <br />Signs posted; last inspection report available <br />22. Sewage wastewater properly disposed: toilet facility useable <br />48. <br />Compliance with plan review requirements <br />Vermin <br />49. <br />Facility operating with a valid health permit <br />3. No rodents, insects, birds or animals inside facility <br />50. <br />Impoundment <br />51. <br />Permit Suspension <br />Received By/Title: <br />r <br />EH Specialist: _ _. <br />Phone: Page 1 of <br />VC 3 <br />EHD 16-23 (1 sl pg) 4/9/12` 1 J FOOD PROGRAM OlP <br />