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SAN JOAQUIN COUNTY <br />)O •`� cAG <br />r' ?a ENVIRONMENTAL HEALTH DEPARTMENT <br />1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br />Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.siaov.org/ehd <br />clFa'a <br />FOOD PROGRAM OFFICIAL INSPECTION REPORT <br />Name of Facility: <br />Date: ) /I 3 z <br />Address: City: <br />Zip Code: <br />Owner/Operator: <br />Telephone: <br />Program Element: Program Record: Q <br />Inspection Type: <br />6180 Posted U Permit Posted ❑Yes ❑ P <br />Re -Inspection on or After: <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 />Major violations pose a threat to public health and must be corrected immediately. Non compliance may warrant closure of the food facility <br />Demonstration of Knowledge <br />A+�ouT <br />-us <br />Supervision <br />�1 Demonsti ation 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 />Communicable disease'. reporting, restrictions & exclusions <br />i <br />25 <br />Personal cleanliness and hair restraints <br />3. No discharge from eyes, nose, or mouth; no open wounds <br />General Food Safety Requirements <br />Propereating, tasting, drinking, or tobacco use <br />26. <br />Approved thawing methods used <br />rev' ming Contamination by`Hands _ <br />Z <br />Footl protected from contamination during storage <br />Hands clean and properly washed proper glove use <br />8. <br />Washing fruits and vegetables before use <br />Handwashing facilities supplied and accessible <br />2 9. <br />Toxic substances properly identified, stored, and used <br />Proper hot and cold holding temperatures <br />30. <br />Food Sforage/Display/Service <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 />2. <br />33. <br />Food property labeled and honestly presented <br />Nonfood contact surfaces clean <br />10. Proper cooking time and temperatures <br />11. Proper reheating procedures for hot holding <br />,Protection From Cpnta_m_ ination <br />12 No re -service of returned food <br />4. <br />35. <br />Warewashing facilities maintained; test strips available <br />Equipmentlutensils approved; installed; dean; good repair <br />i13. Food free from contamination and adulteration <br />36. <br />Equipment, utensils and linens: storage and use <br />14 rood c,.:,tact srir'acr, cl,aineA and sa lit J vaiel,.P.Mi ria a ocedure�s <br />37. <br />Vending machines maintained <br />Food From Approved Source - <br />38. <br />Approved and sufficient ventilation and lighting <br />15. Food obtained from approved source <br />39. <br />Thermometers provided, accurate, and easily visible <br />16. Compliance with shell stock regulations; tags/display <br />40 <br />Proper use and storage of wiping cloths <br />n, Compliance with Gulf oyster regulations <br />Physical Facilities <br />Conformance With Approved Procedures <br />41. <br />Plumbing maintained proper back flow prevention <br />110. Compliance with HACCP plan or valiance candit ons <br />42. <br />Garbage and refuse properly disposed <br />Consumer Advisory <br />43. <br />Toilet facilities clean, supplied, and maintained <br />�19. Advisoiy provided for raw or undercooked food <br />'`4. <br />Premises- persona ltclea ning iterns vermin -proofing <br />Highly Susceptible Populations <br />Permanent Food Facilities ; <br />20 Prohibited foods not offered at high risk facilities <br />41,. <br />Floors, walls and ceiling are maintained and kept clean <br />Water/ Hot Water <br />tG. <br />No living or sleeping quarters inside facility <br />�21 Hot and cold potable water available. <br />Liquid Waste Disposal <br />z7. <br />Compiiance and Enforcement <br />Signs posted; last inspection report available <br />j x"12. Sewage /wastewater properly disposedtoilet facility useable <br />48. <br />Compliance with plan review requirements <br />Vermin <br />49. <br />Facility operating with a valid health permit <br />;I 3. No rodents insectsbirds or animnl inside faulry <br />50. <br />Impoundment <br />1. <br />Permit Suspension <br />Received By/Title: 'IJlJ I S \\"V -C Z <br />/'L <br />O' 2 —� <br />EH Specialist: C <br />r <br />Phone: _ /` Page 1 of <br />EHD 16-23 (1st pg) 4/9112 0 J FOOD PROGRAM OR <br />