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peu ."• SAN JOAQUIN COUNTY ? ENVIRONMENTAL HEALTH DEPARTMENT N: :K _ 1868 East Hazelton Avenue, Stockton, CA 95205-6232 Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.siaov.oro/ehd 9C/FOe� FOOD PROGRAM OFFICIAL INSPECTION REPORT Name of Facility: Date: Address: City: Zip Code: Owner/Operator: Telephone: Program Element: Program Record: Inspection Type: B180 Posted Yes No Permit Posted Yes 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. Major violations pose a threat to public health and must be corrected immediately. Non-compliance mal, warrant closure of the food facility rtu Nxi NIA Demonstration. of Knowledge wo on Gub Supervision <x¢ 11. Demonstration of knowledge food safety certificate 24. Person In Charge is present and performs duties Employee Health and Hygiene Personal Cleanliness ,-.2. Communicable disease; reporting, restrictions & exclusions 25. Personal cleanliness and hair restraints No discharge from eyes, nose, or mouth; no open wounds Proper eating, tasting, drinking, or tobacco use General Food Safety Requirements 26. 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 6. Handwashing facilities supplied and accessible 29. Toxic substances properly identified, stored, and used Time and Temperature Relationship. Food Storaga/Display/Service' 7. Proper hot and cold holding temperatures 30. Food storage: food storage containers labeled 8. Proper use of time as a public health control Proper cooling methods 31. Customer self-service food protected; individual utensils provided 32. Food properly labeled and honestly presented 10. Proper cooking time and temperatures 11. Proper reheating procedures for hot holding Equipment / Utensils/ Linens 33. Nonfood contact surfaces clean - Protection From Contamination 34. Warewashing facilities maintained; test strips available 12. No re -service of returned food 35. Equipmentlutensils approved; installed; clean; good repair 13. Food free from contamination and adulteration 36. Equipment, utensils and linens: storage and use 14 Footl contact sudace cleaned and sanitized/warewashing 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 food 44. Premises; personal/cleaning items, vermin -proofing Highly Susceptible Populations . Permanent Food Facilities 20. Prohibited foods not offered at high risk facilities I clean 45. Floors, walls and ceiling are maintained and kept= / Hot Water - 46. No living or sleeping quarters inside facility 121. Hot and cold potable wafer 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 i' 49. Facility operating with a valid health permit 3. No rodents, insects. birds or animals inside facility 50. Impoundment 1. Permit Suspension Received By/Title: EH Specialist: Phone: Page 1 of EHD 16-23 (1st pg) 1/03/17 FOOD PROGRAM OIR