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��P4 eon SAN JOAQUIN COUNT y-� ENVIRONMENTAL HEALTH DEPARTMENT 1868 East Hazelton Avenue, Stockton, CA 95205-6232 Telephone: (209) 468-3420 Fax:(209) 464-0138 Web:www.sigov.org/ehd 9ll F O k� FOOD PROGRAM OFFICIAL INSPECTION REPORT Name of Facility: , ` _ C Date: _ z Address: Q \ Q d City: �� Y Zip Code: Ci S S Owner/Operator: C _ ( 1�J Telephone: Program Element: 1 Program Record: S '3 1 Inspection Type: ; k B180 Posted Yes No Permit Posted Yes 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. Major violations Cose a fhreaf to public health and must be corrected immediate/ . Non-compBance mgX warrant closure of the food facility �111. Demonstration of knowledge;food safety certificate 24. Person In Charge is present and performs duties ,�. .s.. xx tf#ygl8tie-:- ........... .. �� \` :r....,a, u :"' t 'p x✓yx', Al1M�Irt4�'S" . T, ..,r. �,..-, r - Communicable disease;reporting,restrictions&exclusions 25. Personal cleanliness and hair restraints - 9 Y P ase ,t e No discharge from eyes,nose,or mouth;no open wounds ��- X Proper eating,tasting,drinking,or tobacco use 26. Approved thawing methods used 7. Food protected from contamination during storage . 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 010 a e � v,..... ........ :... .... ..- :.,..,�,< 7. Proper hot and cold holding temperatures 30. Food storage;food storage containers labeled X 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 11. Proper reheating procedures for hot holding 33. Nonfood contact surfaces clean W XDt 1.`iJ14 v.' 34. WarewashIN�WIWOing 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 X 14. Food contact surface cleaned and sanitized/warewashing procedures 37. Vending machines maintained n. _ _ _� _ ..? 38. Approved and sufficient ventilation and lighting 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 W X 17. Compliance with Gulf oyster regulations INS` � Ca0 � at1CClNtth, '' ��6 " �� = 1. Plumbing maintained;proper back flow prevention 18. Compliance with HACCP plan or variance conditions 42. Garbage and refuse properly disposed w Y NOW-' 3. Toilet facilities clean,supplied,and maintained K 19. Advisory provided for raw or undercooked food 4. Premises;personal/cleaning items;vermin-proofing •..�^.. e il a'2,.-S,� ,^ �_ .. _ a ,-"M� x x erma ctl' m- ,.: , I OW .0. Prohibited foods not offered at high risk facilities 45. Floors,walls and ceiling are maintained and kept clean � �" iYater � ta. = 6. No living or sleeping quarters inside facility 1.Hot and cold potable water available. xy � 7. Signs posted;last inspection report available 2. Sewage/wastewater properly disposed;toilet facility useable (\1,7, 48. Compliance with plan review requirements 9. Facility operating with a valid healthpermit 3. No rodents,insects,birds or animals inside facility 50. Impoundment 51, Permit Suspension Received By/Title: EH Specialist:; Phone: Page 1 of ''7 EHD 16-23 (1st pg) 4/9/12 FOOD PROGRAM OIR