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11 of W SAN JOAQUIN COUNTY a� ENVIRONMENTAL HEALTH DEPARTMENT 1868 East Hazelton Avenue, Stockton, CA 95205-6232 Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.siqov.orq/ehd �IFOR� FOOD PROGRAM OFFICIAL INSPECTION REPORT Name of Facility: Date: / Z� ZVZ3 Address: ?) S S ' ,r 1 N li City: Zip Code: caner/operator. L Telephone: Program Element: Program Record: 01 1,P0.3e-AInspection Type: y -C - B180 Posted ❑ Yes ❑ Rermit Posted []Yes D P Re -Inspection on or After: IN = In Compliance N/O = Not Observed WA = 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 republic health and must be corrected immediately. Non-compliance may warrant closure of the food facility ' N mo s:a Demonstration of Knowledge r.+=- cu cw Supervision 1 Demonstration of knowledge food safety certificate 24_ Person Iu Charge is present and pedcrms duties Pioyee Health andiene -',;;• Communicable disease. reporting, restrictions & exclusions Personal Cleanliness 25. Personal cleanliness and hair restraints j 3. No discharge from eyes, nose, or mouth; no open wounds w. Proper eating. tasting, drinking, or tobacco use " !Safety Requirements . Approved thawing methods used Preventing. 5 Hands clean and properly washed; proper glove use 7. 8. Food protected from contamination during storage 1K I Washing fruits and vegetables before use 8. Handwashing facilities supplied and accessible ' Time and Temperature Rate 7. Proper hot and colo holding temperatures 29. 30. Toxic substances properly identifiedstoredand used Food StoregefDisplay/Se -_ 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 d property labeled and honestly presented hens tact surfaces clean 10. Proper cooking time and temperatures It. Proper reheating procedures for hot holding From Contamination g facilities maintained; test strips available r57is7 12. No re -service of returned food tensils approved; installed dean; good repair 13. Food free from contamination and adulteration utensils and linens: storage and use 14. Food contact surface cleaned and sanitized/warewashing procedures ding machines maintained 15. Food obtained from approved source 8. 39. Approved and sufficient ventilation and lighting Thermometers provided, accurate, and easily visible 16. Compliance with shell stock regulations; tags/display 40, Proper use and storage of wiping cloths 17. Compliance with Gulf oyster regulations _ onforimi&e`With Approved Procedures 41. Plumbing maintained; proper back flow prevention 18. Compliance with HACCP plan or valiance conditions 42. Garbage and refuse properly disposed Consumer Advisory 43. Toilet facilities clean, supplied, and maintained I jai 19. Advisory provided for raw or undercooked food 44. Premises; personal/cleaning items; vermin -proofing Highly Susceptible Populations Permanent Food Facilities:. Prohibited foods not offered at high risk facilities 5. Floors, walls and ceiling are maintained and kept clean Water/ Hot Water 46. No living or sleeping quarters inside facility j 1. Hot and cold potable water available. Compliance and Enforcement Liquid Waste Disposal Z Signs posted; last inspection report available 22. Sewagewastevialer properly disposed. toilet faality useable 8. Compliance with plan review requirements Vermin 9. Facility operating with a valid health permit 3. No rodents, insectsbirds or animals inside facility 50. Impoundment 51. Permit Suspension Received By/Title: 1� 1 amu- EH Specialist: l Phone: Uf . -v ! lR_I _Ci Z Page 1 of R / t11' EHD 1623 list pg) 4/9112 FOOD PROGRAM OR