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SAN JOAQUIN COUNTN 14: X ENVIRONMENTAL HEALTH DEPARTMENT 1868 East Hazelton Avenue, Stockton, CA 95205-6232 Telephone: (209) 468-3420 Fax: (209) 464-0138 Web:www.siaov.org/ehd �/FOR FOOD PROGRAM OFFICIAL INSPECTION REPORT Name of Facility: r - Date: Address: -� 1 S l' 1 /� City: lnr� \^ Zip Code: Owner/Operator: W 1 \ �Y\- C Telephone: Program Element: \�_` Program Record: > �, ` Inspection Type: 1 SB180 Posted Yes No Permit Posted Yes No Re-Inspection on or After: IN=In Compliance N/0=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. Malor violations i2ose a threat to eublic health and must be corrected immediate) . Non-compliance may warrant closure of the food facility 1N ruo run = :'Demonstration of Knowledge - .naaa our aos ,. Supervision = CUT 1. Demonstration of knowledge;food safety certificate 24. Person In Charge is present and performs duties EEI! Employee Health and Hygiene Personal Cleanliness Communicable disease;reporting,restrictions&exclusions 25. Personal cleanliness and hair restraints No discharge from eyes,nose,or mouth;no open wounds General Food Safety Requirements X Proper eating,tasting,drinking,or tobacco use 26. Approved thawing methods used s Preventing Contamination ;,Hands 27. Food protected from contamination during storage J( Hands clean and properly 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, rvi cepay 7. Proper hot and cold holding temperatures Y( 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 9. Proper cooling methods 32. Food properly labeled and honestly presented 10. Proper cooking time and temperatures Egwpmerrt r J`UYenslls!Limens v .... _ )�11. Proper reheating procedures for hot holding I 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/warewashing procedures 37. Vending machines maintained Food From`A�dSource 38. Approved and sufficient ventilation and lighting x 15. Food obtained from approved source 39. Thermometers provided,accurate,and easily visible '+ 16. Compliance with shelf stock regulations;tags/display 40. Proper use and storage of wiping cloths 17_ Compliance with Gulf oyster regulations r P Y 9 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-Suscep#i#le i?opuiations Permanent Food Facilities' ,,;F✓_- - _.vas.'^... _.. .. 0. Prohibited foods not offered at high risk facilities 45. Floors,walls and ceiling are maintained and kept clean Water!Hot Watery 46. No living or sleeping quarters inside facility 1.Hot and cold potable water available. Compliance avidthtOrCerAent � . Usiuid Waste DisposaL"',-, 47. Signs posted;last inspection report available 2 Sewage!wastewater properly disposed;toilet facility useable " 48. Compliance with plan review requirements Vermin1; � a _ ;_ 9. Facility operating with a valid health permit 1 11 'i3. No rodents,insects,birds or animals inside facility 50. Impoundment 51. Permit Suspension Received Byrritl>°:----_ EH Specialist: - Phone: 1-4 Page 1 of EHD 16.23 list pg) 4/9/12 FOOD PROGRAM OIR