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SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 East Hazelton Avenue, Stockton, CA 95205-6232 • Cq., 3 , �P • Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sigov.org/ehd �IfOPa FOOD PROGRAM OFFICIAL INSPECTION REPORT Name of Facility: b ¢� Date: Address:___1�2:s r0^w Zip Code: Owner/Operator: Telephone: Program Element: Program Record: y Inspection Type: SB 180 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 violationsspose a threat to is health and must be corrected immediately. Non-compliance may warrant closure of the food facility Demonstration of Knowledge rear -ut Supervision'-- ciui 7emonstration of knowledgefood safety certificate 24. Person In Charge is present and performs duties Employee Health and Hygiene Personal Cleanliness - _ Com 1 ii able disease rebating, restrictions & exclusions 25. Personal cleanliness and hair res'raints Fs No 1,c uric from eyes, nose, or mouth; no open wounds General Food Safety Requirements 4 P ropef 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 Handwashing facilities supplied and accessible 29. Toxic substances property identified, stored, and used _ Time and Temperature Relationship - Food Storage/Display/Service i. 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 EquipmentJ:Utensils /Linens �1 L Proper reheating procedures for hot holding 33. Nonfood contact surfaces clean Protection From Contamination 34. Warewashing facilities maintained; test strips available 112 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 i14. arewashing proceeures 37. Vending machines maintained Food From Approved Source 38. Approved and sufficient ventilation and lighting N !IS. Food obtained from approved source 39. Thermometers provided, accurate, and easily visible 16. Compliance with shell stack regulations; tags/display40. Proper use and storage o' wiping cloths 17. Compliance with Gulf oyster regulations Physical Facilities Conformance With Approved Procedures If Plumbing maintained: proper back flow prevention a8. Compliance with FACCP plan or variance conditions 42. Garbage and refuse properly disposed - Consumer Advisory 43. Toilet facilities clean, supplied, and maintained n5. Advisory provided for raw or undermaked food iF 44. Premises; personal eleanina items: vermin -proofing -Highly Susceptible Populations Permanent Food Facilities 10. Prohibited foods not offered at high risk facilities I 45. Floors. .,Its and ceiling are maintained and kept clean - : Water / Hot Water 46. No living crsleeping quarters inside facility 121. Hot and cold potable water available. Compliance and Enforcement _. Liquid Waste Disposal 47. Signs posted; last inspection report available Sec ,ed'wastcwater properly disposed. toilet facility useable 48. Compliance with plan review requirements ijk vermin 49. Facility operating with a valid health permit 23. No rodents, insects, birds or animals inside facility 50. Impoundment 51, Permit Suspension Received By(ritle: EH Specialist: ` t \ Phone: 1 t Page 1 of Eh'D 16.23 (1st pg) 4912 ��S�v.c.l • Esc-oL�;P-dC> C comP�ss- FOOD PROGRAM DIP