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oa4 •". SAN JOAQUIN COUNTY <br />oc <br />?< ENVIRONMENTAL HEALTH DEPARTMENT <br />1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br />�.,. ....e Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.siaov.oro/ehd <br />CIFdRt� <br />FOOD PROGRAM OFFICIAL INSPECTION REPORT <br />Name of Facility: b 9 q a <br />Date: <br />Address: 2 1 City: <br />CA Zip Code: <br />Owner/Operator: 1,J <br />Telephone: <br />Program Element: Program Record: S 3 <br />Inspection Type: <br />SB180 Posted ❑ Yes ❑ Remit Posted ❑ Yes ❑ P <br />Re -Inspection on or After: <br />IN = In Compliance N/D = 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 ose a_ threat topublic health_and must be corrected immediatel . Non-compliance may warrant closure of the food facilit <br />IS= <br />N 5S <br />N':� Demonstration of Knowledge <br />*.u. oar <br />cus' <br />supervision ad' <br />I Dernonsbabon of knowledge. food safety certificate <br />24- <br />Person InChargeis present and performs duties <br />- - Employee Health and Hygiene <br />25 <br />Personal Cieanli <br />Personal cleanliness antl holy restraints <br />General Food SafeTy. Requirements" <br />IN <br />1 �2- Communicable disease, reporting, restrictions & exclusions <br />, <br />�. �3. No discharge from eyes, nose, or mouth; no open wounds <br />^, b. Proper eating, tasting. drinking, ortobacco use <br />26. <br />Approved thawing methods used <br />Preventm &nby _. „ <br />`r 5. Hands clean and properly washed; proper glove use <br />27. <br />28. <br />Food protected from contamination during storage <br />Washing fruits and vegetables before use <br />x <br />Handwashing facilities supplied and accessible <br />29. <br />Toxic substances property identified. stored. and used <br />Time and <br />Food Storage/Display/Service <br />7. Proper hot 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 />11. Prnper reheating procedures for hot holding " " <br />33. <br />Equipment! Utensils:/ Linens <br />Nonfood contact surfaces clean <br />Protection From Contamination - <br />34. <br />Warewashing facildies maintainetl; test strips available <br />12. No re -service of returned food <br />35. <br />Equipmentlulensils 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 />m 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 />o. <br />Prnper use and storage of wiping cloths <br />17. Compliance with Gulf oyster regulations <br />18. Compliance with HACCP plan or variance conditions <br />_ Consumer Advisory ifflwwl <br />- Physical Facilities <br />1. <br />42, <br />Plumbing maintained. proper back flow prevention <br />Garbage and refuse properly disposed <br />43. <br />Toilet facilities clean, supplied, and maintained <br />�'.'19 Pdv7soly provided for raw orundercooked food "i <br />44. <br />Premises. persona /clearing Items. vennln-proofing <br />Highly S `ble Populations <br />Permanent Food Facilities <br />26 Prohibited foods not offered at high risk facilities <br />45. <br />Floors- walls antl ceiling are maintained and kept clean <br />Water/ Hot Water <br />46 <br />No living orsleeping quarters inside facility <br />\ J21 Hot and cold potable water available. <br />Compliance and Enforcement <br />- Liquid Waste Disposal <br />47. <br />Signs posted; last inspection report available <br />N 122 sewagelwastewater 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 />23. No rodents, insects, birds or animals inside facility <br />50. <br />Impoundment <br />51. <br />Permit Suspension <br />r r(� <br />Received By/Title: 5 %N3C��1 , ` r <br />,� n <br />\e (A -s-4. <br />EH Specialist:Phone: <br />_ 1 Page 1 of <br />EHD 16-23 (lst pg) 419/12 <br />FOOD PROGRAM OIR <br />S <br />