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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.si(]ov.org/ehd <br />FOOD PROGRAM OFFICIAL INSPECTION REPORT <br />Name of Facility: ( Q S <br />Date: _ 2 <br />Address: _ XL <br />City. rc,,C Zip Code: <br />caner/Operator: <br />Telephone: <br />Program Element: 2 Program Record: <br />Inspection Type: <br />SB180 Posted ❑ Yes ❑ Hermit Posted ❑ Yes <br />❑ 1, <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 />Mn or violations pose a threat to public health and must be corrected immediatel . Non-compliance may warrant closure of the food facility <br />m rva rvx Demonstratip_..of Knowledge <br />supervision ous <br />1. Demonstration of knowledge; food safety certificate <br />24 <br />Person In Chaffee is present and performs duties <br />EMPIOANK "°" iene <br />Personal Cleanliness <br />communicable disease: reporting, restrictions & exclusions <br />25. <br />Personal cleanliness and hair restraints <br />discharge from eyes, nose, or mouth; no open wounds <br />General Food Safety Requirements <br />14 Proper eating, tasting. drinking, or tobacco use <br />Preventing Contamination by Han` <br />5 Hands clean and properly washed. proper glove use <br />6. <br />7. <br />8. <br />Approved thawing methods used <br />Food protected from contamination during storage X <br />Washing fruits and vegetables before use <br />O. Handwashing taJities supplied and accessible <br />" ,.; Time and Temperature Relationshi <. <br />'7. Proper hot and cold holding temperatures <br />8. <br />30. <br />Toxic substances properly identified stored. and used <br />` Food Storage/Display/Service <br />Food storage; food storage containers labeled <br />Proper use of time as a public health control <br />31. <br />Customer sel!-service food protected; individual utensils provided <br />Proper cooling methods <br />32. <br />Food property labeled and honestly presented <br />10. Proper cooking time and temperatures <br />Equipment / Utensils ILinens m <br />11. Proper reheating procedures for hot holding <br />tE,plq„From Contami <br />12. No re -service of returned food <br />- - 33. <br />4. <br />: 5. <br />Nonfood contact surfaces clean <br />Warewashing facilities maintained; test strips available <br />EquipmenVutensils approved; installed; clean; good repair <br />13. Food free from contamination and adulteration <br />6. <br />Equipment, utensils and linens: storage and use <br />14. Food contact surface cleaned and sarubzeWwarewashing procedures <br />37. <br />Vending machines maintained <br />proved Source <br />15. Food oblamed horn approved source <br />38. <br />39. <br />Approved and sufficient ventilation and lighting <br />Thermometers provided, accurate, and easily visible <br />16. Compliance with shell stock regulations; tags/display <br />17. Compliance with Gulf oyster regulations <br />Confd Pproved Procedures <br />18. Compliance with HACCP plan or variance candilions <br />0. <br />1. <br />42. <br />Proper use and storage of wiping cloths <br />Ph Sical Facilities <br />Plumbing maintained; proper back flow prevention <br />Garbage and refuse properly disposed <br />Consumer Advisory <br />43, <br />Toilet facilities clean, supplied, and maintained <br />19- Advisory provided far raw or undercooked food <br />44_ <br />Premisespersonal/cleaning items. vermin -proofing <br />Highly Susceptible Populations <br />- <br />Permanent Food Facilities <br />'...) 0 Prohibited foods not 0ered at friar, risk facilities <br />45. <br />Floors, walls and telling are maintained and kept clean <br />Water / Hot Water <br />6. <br />No living or sleeping quarters inside facility <br />�1. Hot and cold potable water available_ <br />- Compliance and Enforcement - <br />Liquid Waste Disposal <br />47. <br />Signs posted; last inspection report available <br />I22. Sewagerwastemiatei properly disposed. toilet facility useable <br />48. <br />Compliance with plan review requirements <br />Vermin <br />49. <br />Facility operating with a valid health permit <br />� 3 No mdems. insects, birds or animals inside facility <br />50. <br />Impoundment <br />51. <br />Permit Suspension <br />Received By/Title: _ 11 <br />j _z) � � <br />r\ <br />EH Specialist: _ l �'�7 �. <br />Phone:� _ lotIo ^ 3�2 C Page 1 of <br />EHD 1623 (1st1 419112 <br />FOOD PROGRAM OIR <br />S <br />