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a"'" SAN .IOAQUIN COON' 4. �+ ENVIRONMENTAL HEALTH DEPARTMENT 1868 East Hazelton Avenue, Stockton, CA 95205-6232 Telephone:(209) 468-3420 Fax:(209) 464-0138 Web:www.siclov.org/ehd LIFOR FOOD PROGRAM OFFICIAL INSPECTION REPORT Name of Facility: Date: Address: i� City: Zip Code: Q. Owner/Operator: Telephone: Program Element: Program Record: b Inspection Type: IS 8180 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. Ma-or violations 2ose a threat to Eublic health and must be corrected immediatel . Non-corn liance may warrant closure of the food facility �N r,o wa Demonstration of Knowledge our cos Super '� 21vislR r 1. Demonstration of knowledge;food safety certificate K 24. Person In Charge is present and performs duties * ..., Personal Cleanliness Employ+ ard.# y9iene-- _ a �a 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 . Proper eating,tasting,drinking,or tobacco use r 26. Approved thawing methods used 7. Food protected from contamination during storage 5. 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 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 E ui menta/utensils d YT-NM 3 11. Proper reheating procedures for hot holding 33. Nonfood contact surfaces clean 34. Warewashing facilities maintained;test strips available �a riyttf f:O1J1y#t 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 procedure ?( 37. Vending machines maintained oo =x 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 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 Advisory43. Toilet facilities clean,supplied,and maintained v( 19. Advisory provided for raw or undercooked food 44. Premises;personal/cleaning items;vermin-proofing Highly Stzsceptibie Populations wz„`Perms i3`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 M( 1.Hot and cold potable water available. Aft pli8nce and ESjforCCmR711 Liquid Waste Disp 47. Signs posted;last inspection report available 2. sewage/wastewater properly disposed;toilet facility useable 48. Compliance with plan review requirements YeiRllfl, ::_ 9. Facility operating with a valid health permit aha. 3. No rodents,insects,birds or animals inside facility 50. Impoundment i 51. Permit Suspension Received By/Title: EH Specialist: v Phone: ` t Page 1 of END 16-23 (1st pg) 4/9/12 FOOD PROGRAM OIR