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SAN .JOAQUIN COUNTY <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br />cgCiFtiR?,P• Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sigov.org/ehd <br />FOOD PROGRAM OFFICIAL INSPECTION REPORT <br />Name of Facility: <br />Date: Z - <br />Address: <br />City: <br />/ Zip Code: <br />Owner/Operator: <br />Telephone: <br />Program Element: fiW<Program Record: <br />Inspection Type: K_ <br />6180 Posted res ❑ Remit Posted Yes ❑ P <br />Re -Inspection on or After: <br />IN = In Compliance N10 = 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 />Ma/or violations pose a threat republic health and must be corrected immediately. Non-compliance may warrant closure of the food facilit <br />IN � iso wA <br />Demonstration of Knowledge <br />Supervision c� . <br />1. Demonstration of knowledgefood safety certificate <br />f <br />24. <br />Person In Charge Is present and perfomis (ILANS <br />.. Employee hea "' `` <br />ble disease'. reporting, restrictions & exclusions <br />Personal Cleanliness ... <br />25. <br />Personal cleanliness and hair restraints <br />e from eyes, nose, or mouth; no open wounds <br />"�Proper <br />`i:.. <br />General Food Safety Requirementsng. <br />tasting, drinking, or tobacco use <br />6. <br />Approved thawing methods used <br />Preventing Contamination by Hands a <br />5. Hands clean and properly washed. proper glove use <br />7. <br />8- <br />Food protected from contamination during storage <br />Washing fruits and vegetables before use <br />" Handwashing facilities supplied and accessible <br />Temperature Relationsh <br />Proper hot and cold holding temperatures <br />29. <br />30. <br />Toxic substances properly identified, stored, and used <br />bol S[orage/D <br />Food storage', food storage containers labeled <br />Proper use of time as a public health control <br />1. <br />Customer self-service food protected; individual utensils provided <br />Proper cooling methods <br />2. <br />Food properly labeled and honestly presented <br />10. Proper cooking time and temperatures <br />X 11 Proper reheating procedures for hot holding <br />33. <br />Nonfood contact surfaces clean <br />Protection From Contamination '. <br />34. <br />Warewashing facilities maintained; test strips available <br />12. No re -service of returned food j <br />35. <br />Equipment/utensils approved; installed; dean; good repair <br />13. Food free from contamination and adulteration <br />6. <br />Equipment, utensils and linens: storage and use <br />14. Food tosurface cleaned and sanitized,warewasrIng procedures <br />Food From Apprdved Source <br />15. Food obtained from approved source <br />16. Compliance with shell stock regulations, lags/display <br />7. <br />Vending machines maintained <br />8. <br />Approved and sufficient ventilation and lighting <br />9. <br />Thermometers provided, accurate, and easily visible <br />0. <br />Proper use and storage of wiping cloths <br />17. Compliance with Gulf oyster regulations <br />( <br />R siCal FaCilitres. <br />- Conformance Wftt Approved Procedures <br />41. <br />Plumbing maintained; proper back flow prevention <br />i> 18. Compliance with HACCP plan or variance conditions <br />42. <br />Garbage and refuse properly disposed <br />Consumer Advisory <br />43. <br />Toilet facilities clean, supplied, and maintained <br />19. Advisory provided foi raw of undercooked food <br />44. <br />Premisespersonal/cleaning items: vermin proofing <br />Highly Susceptible Populations <br />..... Permanent Food Facilities <br />Promoted foods not offered at high risk facilities <br />45- <br />Floors, walls and ceiling are maintained and kept clean <br />Water / Hot Water <br />46. <br />No living or sleeping quarters inside facility <br />y- ,21. Hot and cold potable water available. <br />Compliance and Enforcement <br />Liquid Waste Disposal ;,1, <br />14T <br />Signs posted: last inspection report available <br />-j22 Sewage/wastewater properly disposed toilet facilty useable <br />48. <br />Compliance with plan review requirements <br />Vermin <br />49. <br />Facility operating with a valid health permit <br />3- No rodents. insects birds or animals inside facility <br />50. <br />Impoundment <br />51. <br />Permit Suspension <br />Received By/Title: - <br />EH Specialist: I\ 1 <br />Phone: r7fl /` /r.�� Page 1 of <br />l <br />EHD 1623 (1st pg) 419/12 1 FOOD PROGRAM OR <br />