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ae+n SAN JOAQUIN COUNTY K ENVIRONMENTAL HEALTH DEPARTMENT 1868 East Hazelton Avenue, Stockton, CA 95205-6232 ad�iFdQa p Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sioov.org/ehd FOOD PROGRAM OFFICIAL INSPECTION REPORT Name of Facility: Date: Address: S { City: Zip Code: Owner/Operator: wo Telephone: Program Element: Program Record: Inspection Type: SB180 Posted Yes Permit Posted a No Re -Inspection on or After: 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. Ma(or violations pose a threat to public health and must be corrected immediately. Non-compliance may warrant closure of the food facility "r.. 71a, wn I Demonstration of KnowledgeSupervision ccs24. our 1. Demonstration of knowledge; food safety certificate Person In Charge is present and performs duties Employee Health and Hygiene Personal Cleanliness mmunicable disease; reporting, restrictions 8 exclusions 25. Personal cleanliness antl hair restraints discharge from eyes, nose, or mouth; no open wounds ANo General Food Safety Requirements per eating, tasting, drinking, or tobacco use 26. Approved thawing methods used Preventing Contamination by Hands 7. Food protected from contamination during storage '.5. Hands clean and properly washed: proper glove use 28. Washing fruits and vegetables before use Ha swearing facilities supplied and accessible 29. Toxic substances properly identified, stored, and used Time and Temperature Relationship Food Storage/Display/Service 7. Proper hot and cold holding temperatures 30. 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 32. Food properly labeled and honestly presented 10. Proper cooking time and temperatures Equipment I Utensils / Linens 11. Proper reheating procedures for hat holding 33. Nonfood contact surfaces clean .Protection From Contamination - 34. Warewashing facilities maintained; test strips available 12. No re -service of returned food 35. Equipment/utensils 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 sanitized/warewashmg procedures 37. Vending machines maintained Food From Approved Source 38. Approved and sufficient ventilation and lighting 15. Food obtained from approved source 39. 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 Physical Facilities Conformance With Approved Procedures 41. Plumbing maintained; proper back flow prevention 18. 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 fond 44. 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 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 22. Sewage/wastewater properly disposed: toilet facility useable 48. Compliance with plan review requirements Vermin 49. Facility operating with a valid health permit 23. No rodents, insects, birds or animals inside facility 50. Impoundment 51, Permit Suspension Received By/Title: EH Specialist: Phone: _ Page 1 of EHD1623 (lstpg) 1103/17 V FOOD PROGRAM OR