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oPast:"• SAN .JOAQUIN COUNTY y:.�'Foc ?a ENVIRONMENTAL HEALTH DEPARTMENT 1868 East Hazelton Avenue, Stockton, CA 95205-6232 4GIFaa�;a Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.siaov.orgi FOOD PROGRAM OFFICIAL INSPECTION REPORT Name of Facility: Date: 20 ddress:City: L Zip Code: si --,Sq - Owner/Operator: Telephone: Program Element: Program Record: Inspection Type: Q__ B180 Posted es ❑ Reninit Posted Yes lip Re -Inspection on or After: IN = In Compliance NIO = 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 violations pose a threat to public health and must be corrected immediate/ Non -coin /lance may warrant closure of the food facilit - _ - Demonstration of Knowledge L Demonstration of kn wledge. food safety certificate Employee Health and Hygiene Communicable disease reporting. restrictions & exclusions 24. Supervision OUT Person In Chai /e is present and poderms Julies 25. Personal Cleanliness Personal cleanliness and hail restraints No discharge from eyes, nose, or mouth; no open wounds General Food Safety Requirements Proper eating. tasting, drinking, or tobacco use 26 JApproved thawing methods used Preventing Contamination by Hands - 27. Food protected from contamination during storage I -lands clean and properly washedproper glove use 28. Washing fruits and vegetables before use Handwasl:inq facdmes supplied and accessible 29- 30. Toxic substances properly identified. storedand used '" oo to;,. play/Servrc Food storage food storage containers labeled " Time and T' "' ,. relationship- r. Proper hot and cold holding temperatures 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 11. Proper reheating procedures for hot holding Equipment I Utensils / Linens _ 33. Nonfood contact surfaces clean Protection From Contamination 34. Warewashing facilities maintained; test strips available 12. No re -service of returned food 35. Equipmentlutensils approved; installed; dean; good repair 13. Food free from contamination and adulteration 6. Equipment, utensils and linens: storage and use 14. Food contact surface cleaned and sanitized/warewash ng Dr�cedores 37. Vending machines maintained .^- Food From ApJW%W9burce ' 38. Approved and sufficient ventilation and lighting ,15 Food obtained from approved sowce L I 39. Thermometers provided, accurate, and easily visible 1If 6. Compliance with shell stock regulations; tags/display 40. 1. Proper use and storage of wiping cloths ,,. Ph sicat Facilities Plumbing maintained; proper back flow prevention 17. Compliance with Gulf oyster regulations Confoance With Approved Procedures "' rm 18. Compliance with HACCP plan or variance conditions2. Garbage and refuse properly disposed Consumer Advisory ' 3. Toilet facilities clean, supplied, and maintained visory 'F 119. Adprovided for raw or undercooked food 44. Premises, personal/cleaning items: vermin -proofing Highly Susceptible Populations Permanent Food Facilities 20. Prohmned foods not offered al high risk facilities 45. Floors, walls and ceiling are maintained and kept clean Water / Hot Water 46. No living or sleeping quarters inside facility I21. Hot and cold potable water available- -- Compliance and Enforcement Liquid Waste Disposal 4, Signs posted, last inspection report available propeily disposed toilet facility useable 8. Compliance with plan review requirements 4:2ev,agelwaslewater Vermin 9. Facility operating with a valid health permit o rodents, insectsbirds or animals inside facility 50. Impoundment 51. Permit Suspension Received By/Title EH Specialist:. a Phone d� / r� J S Page 1 of EHD 16-23 (1st pg) 4/9/12 FOOD PROGRAM OR