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9 9 c4m� SAN .JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 East Hazelton Avenue, Stockton, CA 95205-6232vaTelephone: (209) 468-3420 Fax: (209) 464-0138 Web: ww.siaov.oralehd FOOD PROGRAM OFFICIAL INSPECTION REPORT Name of Facility: Date: Address: City: !� 1 Zip Code: V Owner/Operator: n Telephone: �ln/A_!SS' oto '"t Program Element: Progra-mm Record: R. Inspection Type: SB180 Posted CKYes 0 Hermit Posted W Yes ❑ k Re -Inspection on or After: N Pr IN = In Compliance N/O = 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 immediately._ Non-compliance may warrant closure of the food facility Demonstration of Knowledge OUT ous supervision ou-. I Demonstration of knowledge- food safety certificate 24. Person In Charge is present and performs duties Employee Health and Hygiene. Personal Cleanliness 12_ Communicable disease, reporting, restrictions & exclusions 25. Personal cleanliness and hair restraints ',3. No discharge from eyes, nose, or mouth; no open wounds General Food Safety Requirements 4 Proper eating. tasting. drinking, or tobacco uses.. 25. Approved thawing methods used Preventing Contamination by Hands 27. Food protected from contamination during storage 5. Hands clean and properly washed; proper glove use 28. Washing fruits and vegetables before use LHandwashing facilities supplied and accessible9. Toxic substances properly identified, stored, and used MEMO Time and Temperature Relationshi = ' ' Food Storage/Dispiap drvice " 7. Proper hot and cold holding temperatures 30. Food storage: food storage containers labeled 18. per use of time as a public health control 1. Customer self-service food protected; individual utensils provided per cooling methods 32. Food properly labeled and honestly presented per cooking time and temperatures per reheating procedures for hot holding 33. Nonfood contact surfaces clean . Warewashing facilities maintained; test strips available re -service of retumad food 5. EquipmenUutensils approved; installed; dean; good repair Y, od free from contamination and adulteration 012 6. Equipment, utensils and linens: storage and use d contact surface cleaned and sagtized v;arewashmg procedures 7. Vending machines maintained from Approved Source38. Approved antl sufficient ventilation and lightng ad obtained from approved source39. Thermometers provided, accurate, and easily visible mpliance with shell tock regulations; tags/display 0. Proper use and storage of wiping cloths mpliance with Gulf, Vster regulations Ph sical Faciii8eg Conformance With Approved Procedures 41. Plumbing maintained; proper back flow prevention r 8. Compliance with HACCP plan or variance conditions 42. Garbage and refuse properly disposed Consumer Advisory 43. Toilet facilities clean, supplied, and maintained �19. Advisory provided for raw or undercooked food 4. Premises: personal/cleaning items: vermin -proofing Highly Susceptible Populations : Permanent Food Facilities 120. Prohibited foods not offered at high risk facilities 45. Floors, walls and calling are maintained and kept clean Water / Hot Water 46. No living or sleeping quarters inside facility 21 Hot and cold potable water available. Compliance and Enforcement Liquid Waste Disposal 47. Signs posted; last inspection report available 2 Sewage/wastewater properly disposedtoilet facility useable 48. Compliance with plan review requirements Vermin 49. Facility operating with a valid health permit 3. No rodents. insecto. birds or animals inside facility 50. Impoundment 1. Permit Suspension Received By/Title: f r EH Specialist: Phone: —1 n 1 Page 1 of 7- EHD 16-23 (1st pg) 4/9112 v FOOD PROGRAM OR