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oc4�t"• SAN JOAQUIN COUNTY <br />w ` ENVIRONMENTAL HEALTH DEPARTMENT <br />1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br />•.aq.,, �,.:;P• Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sigov.org/ehd <br />crFda' <br />FOOD PROGRAM OFFICIAL INSPECTION REPORT <br />Name of Facility:L7 a 7 <br />- <br />Date: <br />Address: .1 A <br />/ " 1 <br />City: <br />Zip Code: �7 orf <br />Owner/Operator: <br />Telephone: <br />Program Element: Program Record: <br />Inspection Type: <br />SB180 Posted Yes D No Permit Posted Yes D No <br />Re -Inspection on or After: S <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 />Ma'or violations pose a threat to public health and must be corrected immediate) . Non-com fiance may warrant closure of the food facility <br />e'onstratlgn of Knowledge <br />1. Demonstration of knowledge; food safety certificate <br />�� <br />24. <br />=Supervision <br />Person In Charge is present and performs duties <br />- o a ealt Hygian <br />5. <br />al Cleanliness. _ <br />Personal cleanliness and hair restraints <br />Communicable disease; reporting, restrictions & exclusions <br />. No discharge from eyes, nose, or mouth; no open wounds <br />pf2. <br />ty Require`"en <br />Proper eating, tasting, drinking, or tobacco use <br />26. <br />Approved thawing methods used <br />Pre a -a a ma Ito- a ! <br />27. <br />Food protected from contamination during storage <br />Washing fruits and vegetables before use <br />5. Hands clean and properly washed; proper glove use28. <br />Handwashing facilities supplied and accessible <br />29. <br />Toxic substances properly Identified, stored, and used <br />a d Te eraIr. Pall <br />0. <br />ca <br />00 Iry <br />Food storage; food storage containers labeled <br />7. Proper hot and cold holding temperatures <br />8. Proper use of time as a public health control <br />31. <br />Customer self-service food protected; individual utensils provided <br />Proper cooling methods <br />2. <br />Food properly labeled and honestly presented <br />10. Proper cooking time and temperatures <br />33. <br />Equipment / Utensils ! Linens <br />Nonfood contact surfaces clean <br />11. Proper reheating procedures for hot holding <br />-M <br />12. No re -service of returned food <br />M <br />34. <br />35. <br />Warewashing facilities maintained; test strips available <br />Equipmentlutensils approved; installed; clean; good repair <br />13. Food free from contamination and adulteration <br />36. <br />Equipment, utensils and linens: storage and use <br />14. Food contact surface cleaned and sanitized/warewashing procedures <br />37. <br />Vending machines maintained <br />o 0 <br />15. Food obtained from approved source <br />38. Approved and sufficient ventilation and lighting <br />39. Thermometers provided, accurate, and easily visible <br />.Z 16. Compliance with shell stock regulations; tags/display <br />0. <br />Proper use and storage of wiping cloths <br />17. Compliance with Gulf oyster regulations <br />1. <br />- 1 <br />Plumbing maintained; proper back flow prevention <br />�­Cooform c Wit WAp laved oc . ui_es - _ <br />`.,,I d. Compliance with HACCP plan or variance conditions <br />2. <br />Garbage and refuse properly disposed <br />-:. Consumer Advisory <br />_ - <br />3. <br />Toilet facilities clean, supplied, and maintained <br />19. Advisory provided for raw or undercooked food <br />. <br />Premises; personalicleaning items; vermin -proofing <br />tghly Susceptible Populations <br />'�20. Prohibited foods not offered at high risk facilities <br />" <br />5. <br />e o e <br />Floors, walls and ceiling are maintained and kept dean <br />- �Later./ Hot Water <br />46. <br />No living or sleeping quarters inside facility <br />21. Hot and cold potable water available. <br />-s spos -= <br />7. <br />Signs posted; last Inspection report available <br />22. sewagehvastewater properly disposed; toilet facility useable <br />48. <br />Compliance with plan review requirements <br />arm <br />49. <br />Facility operating with a valid health permit <br />JIM23. <br />No rodents, Insects, birds or animals Inside facility <br />50. <br />Impoundment <br />51. <br />Permit Suspension <br />Received By/Title: / SC-� S 1'� % A -r P- <br />r'-_/ <br />H Specialist: <br />Phone: , / _ Page lof-5 <br />EHD 16-23 list pg) 419112 FOOD PROGRAM 0111R <br />