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SAN JOAQUIN COUNT ., X tNVIRONMENTAL HEALTH DEPARTMENT 1868 East Hazelton Avenue, Stockton, CA 95205-6232 Telephone:(209) 468-3420 Fax:(209)464-0138 Web:www.siQov.orQ/ehd 4CjFORi� FOOD PROGRAM OFFICIAL INSPECTION REPORT Name of Facility: Date: V� Address: �G G City: r.�l�L�� Zip Coder Owner/Operator: /" U � S1V Telephone: (a2A _coc2 .Program Element: �� Program Record• tz �,,�,� } �_'� Inspection Type: �O 6180 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 pose a threat to ublic health and must be corrected immediate/ . Non-com liance maX warrant closure of the food facility 3N VA Demonstration of Knowledge,, - baa, OUT cos Supervision. OUT 1. Demonstration of knowledge;food safety certificate 24. Person In Charge is present and performs duties Employee p yee Health and Hygiene Personal Cleanliness _ / '2. Communicable disease;reporting,restrictions&exclusions 25. Personal cleanliness and hair restraints 3. No discharge from eyes,nose,or mouth;no open wounds General Food Safety Requirements �4. Proper eating,tasting,drinking,or tobacco use 26. Approved thawing methods used Preventing Contamination by Hands 7. Food protected from contamination during storage S. 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 Retationship R" - Food Storage/Aisplr yfService s 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 Li o. Proper cooking time and temperatures Equipme»t I"Utensils!Linens 11. Proper reheating procedures for hot holding a 33. Nonfood contact surfaces clean twill��o j� � ��x �� 34. Warewashing facilities maintained;test strips available 12. No re-service of returned food 35. Equipment/utensils approved;installed;clean;good repair 413. 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 s e- Food From Approved Source_, "` 38. Approved and sufficient ventilation and lighting / 15. Food obtained from approved source39. Thermometers provided,accurate,and easily visible 16. Compliance with shell stock regulations;tags/display 40. Proper use and storage of wiping cloths 7. 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 Faod Facilities " 0. Prohibited foods not offered at� high risk facilities 45. Floors,walls and ceiling are maintained and kept clean Water/Hot 46. No living or sleeping quarters inside facility 1.Hot and cold potable water available. q ompliance and Enforcement Liquid Waste Disposal 47. Signs posted;last inspection report available 2. Sewage/wastewater properly disposed;toilet facility useable 48. Compliance with plan review requirements Vermin 49. Facility operating with a valid health permit 3. No rodents,insects,birds or animals inside facility 50. Impoundment 51. Permit Suspension Received By/Title EH Specialist: t Phone: LIPage 1 of EHD 16.23 (1st pg) 4/9/12 FOOD PROGRAM 0111R