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SAN JOAQUIN COUNTY <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br />Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sioov.orG/ehd <br />FOOD PROGRAM OFFICIAL INSPECTION REPORT <br />Name of Facility: _ /'�J - <br />3A b Date: ( - S - Z <br />Address: ` 51 L'' \ V . 1 `\P t , 1C <br />`N_l. <br />City: <br />Zip Code: pts <br />caner/Operator. <br />r:T <br />J� - <br />Telephone: <br />Program Element: b Program Record: 15 4 <br />Inspection Type: <br />8180 Posted Yes No Permit Posted Yes No <br />Re -Inspection on or After: <br />IN = In Compliance WO = 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 eose a threat to public health and must be corrected immediatel . Non -cora liance ma warrant closure of the food MOW <br />N i112 VA - Demonstration of Knowledge <br />Supervisions an <br />�..:1. Demonstration of knowledge; lend safety cedlficate <br />24. <br />Person In Charges present and performs duties <br />Employee. Health and Hygiene `" <br />Personal Cleanliness <br />i2. Communicable disease; reporting, restrictions & exclusions <br />I <br />25. <br />Personal cleanimts5 and hair restraints_ <br />No discharge from eyes, nose, or mouth; no open wounds <br />_-� <br />General Food Safety Requirements <br />fdT 4. Proper eating, tasting, drinking, or tobacco use <br />26. <br />Approved thawing methods used <br />- Preventing Contamination by Hands <br />_ <br />7. <br />Food protected from contamination during storage <br />s. Hands dean and properly washed, proper glove use <br />28. <br />Washing fruits and vegetables before use <br />Handwashing facilities supplied and accessible <br />X <br />x <br />29. <br />Toxic substances property identified, stored, and used <br />Time and Temperature Relationship <br />- Food StoragelDisplay/Service` <br />7. Proper not and cold holding temperatures <br />30. <br />Food storage; food storage containers labeled <br />8. Proper use of time as a public health control <br />9. Proper cooling methods <br />31. <br />Customer self-service food pmlecied; individual utensils provided <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 />-- rProtection From Contamination <br />34. <br />Warewashing facilities maintained; test strips available <br />12 No ro-service of returned food <br />35. <br />Equipment utensils 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 />... Food From Approved Source <br />:-38. <br />Approved and sufficient ventilation and lighting <br />X 115. Food obtained from approved source <br />39. <br />Thermometers provided, accurate, and easily visible <br />11( 16. Compliance with shell stock regulations; tags/display <br />40. <br />Proper use and storage of wiping cloths <br />X 1T Compliance with Gulf oyster regulations <br />j <br />Physical Facilities - <br />Conformance With. Approved Procedures <br />41. <br />Plumbing maintained; proper back flow prevention <br />i 8. Compliance with HACCP plan or variance conditions <br />42. <br />Garbage and refuse properly disposed <br />Consumer Advisory <br />43. <br />Toilet facilities clean, supplied, and maintained <br />19. 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 />0_ Prohibited foods not offered at high risk facilities <br />45. <br />Floors, walls and ceiling are maintained antl kept Clean <br />Water/ Hot Water <br />16, <br />No living or sleeping quarters inside facility <br />?� I. Hot and cold potable water available. <br />Compliance and Enforcement <br />Liquid Waste Disposal - <br />7. <br />Signs posted: !as: inspection report available <br />j 2. Sewage/wastewater prnperly disposed; toilet facility useable <br />48. <br />Compliance with plan review requirements <br />Vermin ,.... <br />9. <br />Facility operating with a valid health permit <br />P3. No rodents, insects, birds or animals inside facility <br />50. <br />Impoundment <br />1. <br />Permit Suspension <br />Received By/Title: 1 . . l <br />\ \hJ <br />� G a-kc�CN 3r M <br />EH Specialist: <br />Phone: <br />201_ b I 302 Page 1 of .Z <br />END 1&23 its[ pj) 4IY12 <br />FOOD PROGRAM OIR <br />S <br />