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oPa"tK �r SAN JOAQUIN COUNTY _ ENVIRONMENTAL HEALTH DEPARTMENT P 1868 East Hazelton Avenue, Stockton, CA 95205-6232 Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.siaov.org/ehd FOOD PROGRAM OFFICIAL INSPECTION REPORT Name of Facility: 1K_ In 1 Date: City: Address: PAO stwi-.-4-r,N Zip Code: l `-/IV caner/operator: /I Vt TelephoneY„1_ID 7-Z _ f Program Element: Program Record: Inspection Type:✓ n SBI80 Posted XYes ❑ Rermit Posted PZ Yes n P Re -Inspection on or After: N IN = In Compliance N/O = Not Observed NIA = 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 most be corrected immediatel . Non-com liance ma warrant closure of the food facility IN n. Demonstration of Knowledge nay cur cos 1. Demonstration of knowledee. food safety certificate 24_ Person In Charge is present and performs duties ' _. _..ployee Health and Hygiene Communicable disease. reporting. restrictions S exclusions 25_ � . r � nliness ■ Personal cleanliness and hair restraints No discharge from eyes, nose, or mouth; no open wounds Proper eating, tasting, drinking, or tobacco use 26. Approved thawing methods used 7. Food protected from contamination during storage Hands clean and properly washed; proper glove use 28. Washing fruits and vegetables before use Handwashing facilities supplied and accessible 29. Toxic substances properly identified, stored, and used Proper hot and cold holding temperatures 0. Food storage; food storage containers labeled Proper use of time as a public health control 31. Customer self-service food protected; individual utensils provided Proper cooling methods 2. Food properly labeled and honestly presented 10. Proper cooking time and temperaturesNov-,Equipment I Utensils I Linens 11. Proper reheating procedures for hot holding 12. No re -service of returned food 3. 4. Nonfood contact surfaces clean Warewashing facilities maintained; test strips available 35. Equipmentiutensils approved; installed; clean; good repair 13. Food free from contamination and adulteration 36. Equipment, utensils and linens: storage and use 14. Food contact surface cleaned and sanifized/warewashing procedures 15. Food obtained from approved source 37. 38. Vending machines maintained Approved and sufficient ventilation and lighting 39. Thermometers provided, accurate, and easily visible 6. Compliance with shell stock regulations; tags/display 0. 1. 2. Proper use and storage of wiping cloths Plumbing maintained; proper back flow prevention Garbage and refuse properly disposed 17. Compliance with Gulf oyster regulations 5 - 18. Compliance with HACCP plan or variance conditions Cotlsumer Advisory 3. Toilet facilities clean, supplied, and maintained 19. Advisory provided for raw or undercooked food . Premises; personal/cleaning items-. vermin -proofing Highly Susceptible Populations Permanent Food Facilities 0� Prohibited foods not offered at high risk facilities 5. Floors, walls and ceiling are maintained and kept clean 1. Hot and cold potable water available. wage/wastewater properly disposed; toilet facility useable 6. No living or sleeping quarters inside facility MEN E 7. Signs posted; last inspection report available 8. Compliance with plan review requirements 9. Facility operating with a valid health permit 3. No rodents. insects, birds or animals Inside facility 50. Impoundment 51. Permit Suspension Received By/Title: EH Specialist: Phone: - )'1FO Page 1 of EHD 16-23 (1st M) 419/12 ', / FOOD PROGRAM OIR