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SAN .JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 East Hazelton Avenue, Stockton, CA 95205-6232 Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sigov.org/ehd trp0 FOOD PROGRAM OFFICIAL INSPECTION REPORT Name of Facility: Date: Address: �1 p City: Zip Code: Owner/Operator: )Oknna W-5 M IJ1 I f+ . -V Telephoner a Program Element: Program Record: Inspection Type: 8160 Posted Yes ❑ Permit Posted OCYes ❑ P Re -Inspection on or After: i Q 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. Mator violations pose a threat topublic health and must be corrected immediately. Noncompliance may warrant closure of the food facility ro nro KA Demonstration of Knowledge rs>.. ocr cos Supervision 1. Demonstration of knowledge'. food safety certificate 24. Person In Cha,ge is present and perlomis auties Employee Health and Hygiene Personal Cleanliness Communicable disease: reporting. restrictions & exclusions 25. Personal cleanliness and hair restraints General Food Safety Requirements '3. No discharge from eyes, nose, or mouth; no open wounds '4. Proper eating, tasting, drinking, or tobacco use E <.5. Approved thawing methods used Preventing Contamination by Hands 27. Food protected from contamination during storage i5 Hands clean and properly washed. proper glove use 23. Washing fruits and vegetables before use C. I landwashing facilities supplied and accessible Time ,'nship _ 7. Proper hat and cold holding temperatures 29. 30. Toxic substances properly identified. stored. and used Food Storage/Display/Service T 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 / Utensils i Linens 11. Proper reheating procedures for hot holding 33. Nonfood contact surfaces clean Protection From C . Warewashing facilities maintained; test strips available 12. No re -service of returned food 5. Equipmentfutensils approved: installed; clean; good repai 13. Food free from contamination and adulteration 6. Equipment, utensils and linens: storage and use 14. Food contact surface cleaned and sanitized'wzrewash� ng orocecures 37. Vending machines maintained Food From Approved Source ;yFy 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 FaciliBes Conformance With Approved Procedures 41 Pwmbing mantained: proper back flow prevention 18. Compliance with HACCP plan or variance conditions 4Z 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 0 Prohibited foods not offered at high risk facilities 45. Floors, walls and ceiling are maintained and kept clean Water/ Hot Water 46. No living or sleeping quarters inside facility �1. Hot and cold potable water available. Compliance and Enforcement Liquid Waste Disposal. 47. Signs posted; last inspection report available 22. Sewage/wastewater properly disposedtoilet facility tiseabl A8. Compliance with plan review requirements Vermin : 9. Facility operating with a valid health permit 3. No rodents, insects. birds or animals inside facility 50. Impoundment 1. Permit Suspension Received By/Title:, p EH Specialist: Phone: -2MPage 1 of i 16&23 (1st pg) 419112 Cl F0o0 PROGRAM OIR