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RI II ,op .sAG SAN JOAQUIN COUNTY yA ENVIRONMENTAL HEALTH DEPARTMENT 1868 East Hazelton Avenue, Stockton, CA 95205-6232 Telephone:(209) 468-3420 Fax:(209) 464-0138 Web:www.sioov.oro/ehd FOOD PROGRAM OFFICIAL INSPECTION REPORT Name of Facility: Date: _ Q _ Address: 1_ 1 vs-i` , City: (- C Zip Code: Owner/Operator:'V 1 Telephone: Program Element: Program Record: Inspection Type: SB180 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. MLr violations pose a threat to public health and must be corrected immediate. Non-compliance may warrant closure of the food facility art �n Ira+l Demonstration of Knowledge urr ciT ..s Supervision JX' I1. Demonstralion of knowledge:food safety cerhi cate 24. Person In Charge is present and penorms duties Employee Health and Hygiene Personal Cleanliness 2. Communicable disease: report-nc ie_trictions&exclusions 20 Personal elca thress and hair res',relnts 3. No discharge from eyes,nose,or mouth;no open wounds _s_General Food Safety Requirements Proper eating,tasting,drinking,or tobacco use --{{-- 26. Approved thawing methods used Preventing Contamination by Hands 27. Food protected from contamination during storage '15. Hands clean and properly washed;proper glove use 28. Washing fruits and vegetables before use 1 i 16. Handwashing facilities supplied and accessible 29. Toxic substances property identified,stored,and used - Time and Temperature Relationship'' Food StorageIDispfay/Service �7. 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 Equipment/Utensils/Linens-- 1111_ Proper reheating procedures for hot holding 33 Nonfood contact surfaces clean Protection From Contamination 34. Warewashing facilities maintained;test strips available .12. No no 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 Ito Fooe contact sunaco cleaned and sannizedrwarewashing procedures 37. Vending machines maintained Food From Approved Source 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 1 40 Proper dse ai ) ,I-Dins 17. Compliance with Gulf oyster regulations Physical Facilities 66( Conformance With Approved Procedures 41. Plumbing maintained:proper back flow prevention -_ 16. Compliance with HACCP plan or variance conditions 42. Garbage and refuse properly disposed Consumer Advisory 43. Toilet facilities clean,supplied,and maintained A�19. Advisory provided for raw or undercooked food 44. Premises:personal/cleaning Items:vermin-proofing Highly Susceptible Populations Permanent Food Facilities Prohibited foods not offered at huh risk facilities 46. Floorswalls and ceiling are maintained and kept clean Water/Hot Water - - 46. No living or sleeping ouarers inside facility :21.Hot and cold potable water available. l Compliance and Enforcement Liquid Waste Disposal 47. Signs posted;lastinspectionreport available 22. Seg qe-wastewater properly disposed:toilet facility useable 48. Compliance with plan review requirements Vermin - 49. Facility operating with a valid health permit 1 '23_ No rodents-insects.birds or animals inside facility 50. Impoundment 51. Permit Suspension Received By/Title• H Specialist: Phone: -A I O 2 Page 1 of EHD 16-23 (lst pg) 4/9/12 � J FOOD PROGRAM IRR J