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SAN JOAQUIN COUNTY <br />° fo <br />g ENVIRONMENTAL HEALTH DEPARTMENT <br />1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br />c.. .:.p Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sigov.org/ehd <br />4�rF0R� <br />FOOD PROGRAM OFFICIAL INSPECTION REPORT <br />Name of Facility: C <br />Date: 3_ <br />Address: '32'5 City: <br />-1- V\ <br />CO\ C Zip Code: <br />Owner/Operator: <br />Telephone: <br />Program Element: Program Record: s <br />Inspection Type: f--ec <br />SB180 Posted Yes No Permit Posted Yes No <br />Re -Inspection on or After: <br />IN = In Compliance N/0 = 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 <br />ui <br />ry <br />__ <br />n:: Demonstration of Knowledge <br />-_ <br />IslI o IT <br />- <br />.!stip <br />Supervision ..m. <br />11. 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 />g_ Communicable disease: reporting, restrictions & exclusions <br />1,3. No discharge from eyes, nose, or mouth; no open wounds <br />25 <br />Personal cleanliness and hair roshalnts <br />General Food Safety Requt eme�! s <br />i4. 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. Han;ls clean ,and properly washed; proper glove use <br />28. <br />Washing fruits and vegetables before use <br />!9. Ha ndwasning 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 />Proper not and cold holding temperatures <br />30. <br />Food storage: food storage containers labeled <br />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 />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 />t„ .,- :, Protectiotf [ Contamination <br />34. <br />Warewashing facilities maintained; test strips available <br />12. No re -service of returned food <br />j <br />35. <br />EquipmenVutensils 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'wa:ewzshmg procedures <br />37. <br />Vending machines maintained <br />Food Ffoth Approved Source <br />38. <br />Approved and sufficient ventilation and lighting <br />s 1,15. Food obtained from approved source <br />39. <br />Thermometers provided, accurate, and easily visible <br />16. Compliance with shell stock regulations; tags/disptay <br />40. <br />Proper use and storage of wiping cloths <br />17. Compliance with Gulf oyster regulations <br />-'- physical Facilities <br />_I _ <br />Conformance With Approved Procedures <br />41 <br />P u .d:iiia maintained: proper back flow prevention <br />\I18. Compliance with HACCP plan or variance condnicns <br />42. <br />Garbage and refuse properly disposed <br />Consumer Advisory <br />43. <br />Toilet facilities clean. supplied, and maintained <br />\!,I,19. Adv iscry provided for raw or undercooked food <br />44. <br />Premises: personal clearing items: vermin pro fri- <br />Highly Susceptible Populations <br />.Permanent Food Facilities <br />1,20. 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 quartets inside facility <br />^1 t. 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 properlq disposed: toilet be i iv useable <br />48. <br />Compliance with plan review requirements <br />Vermin <br />49. <br />Facility operating with a valid health permit <br />23. No rodents_ Insects, birds or animals inside facility <br />30. <br />Impoundment <br />51. <br />Permit Suspension <br />Received By[Title: - tl �. <br />ll <br />EH Specialist: G` p '� -� <br />Phone:2� Page 1 o] <br />EHO 16-23 (1 St pg) 4/9/12 FOOD PROGRAM OIR <br />�t��r 5v�e<Cell_iCJ C\��jdem�. caro <br />cis <br />