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age FAG SAN JOAOUIN COUN* ENVIRONMENTAL HEALTH DEPARTMENT 1868 East Hazelton Avenue, Stockton, CA 95205-6232 Telephone:(209) 468-3420 Fax:(209)464-0138 Web:www.sigoy.org/ehd �l�dd FOOD PROGRAM OFFICIAL INSPECTION REPORT Name of Facility: Date: Address: Q_ 0 W city: Zip Code: C7 Owner/Operator: Telephone: V Program Element: 1 b\b Program Record: 502'b iti Inspection Type: =4l-Q_ 8180 Posted ❑Yes ❑ No Permit Posted ❑Yes ❑No Re-Inspection on or After: IN=In Compliance N/O Not Observed NIA=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 immediatel . Non-compliance may warrant closure of the food facility er rm Hc. Demonstration of Knowledge }w our cos Supervision our 1. Demonstration of knowledge;food safety certificate 24. Person In Charge is present and performs duties Employee Health and Hygiene Personal Cleanliness *� J,fN,co mmunicable disease;reporting,restrictions B exclusions I 5. Personal cleanliness and hair restraints discharge from eyes,nose,or mouth;no open wounds General Food Safety Requirementsoper eating,tasting,drinking,or tobacco use 26. Approved thawing methods used Preventing Contamination by Hands - 7. Food protected from contamination during storage Hands dean and property washed;proper glove use 28. washing fruits and vegetables before use Handwashing facilities supplied and accessible 29. Toxic substances properly identified,stored,and used Time and Temperature Relationship Food StoragelDisplay/Service 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 i0. Proper cooking time and temperatures Equipment!Utensils I linens y,11 1, Proper reheating procedures for hot holding 33. Nonfood contact surfaces clean Protection From Contamination 34. warewashing facilities maintained;test strips available 12. No re service of returned food _� . Equipment/utenslls approved;installed;clean;good repair }C I 13. Food free from contamination and adulteration 36, Equipment,utensils and linens:storage and use 14. Food contact surface cleaned and sanitizedhvarewashing procedures 37. Vending machines maintained Food From Approved Source 38. Approved and sufficient ventilation and lighting 15. Food obtained from approved source _ 9. 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 j Physical Facilities _Conformance With_Approved Procedures_ _ 1. Plumbing maintained;proper back flow prevention 18. Compliance with HACCP plan or variance conditions 42. Garbage and refuse property 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 T -Permanent Food Facilities 11 11 0, Prohibited foods not offered at high risk facilities 45. Floors,walls and celling are maintained and kept clean Water/Hot Water 6. No living or sleeping quarters inside facility I 1.Hot and cold potable water available. - Compliance and Enforcement Liquid Waste Disposal 47. Signs posted;last inspection report available j 2. Sewagelwasiewater property disposed;toilet facility useable 46. Compliance with plan review requirements Vermin 49. Facility operating with a valid health permit x I 3. No rodents,insects,birds or animals inside facility 50. Impoundment 1. Permit Suspension Received BylTitle: EH Specialist: Phone: -A[„ a Page 1 of Z EM 16-23 (1st pg) 4&12 `U FOOD PROGRAM OR