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OFFICIAL INSPECTION RF IT FOR TRANSIENT,SEASONAL OR TEIY 'ARY F06D FACILITIES <br /> DWSoolh Name <br /> Oe-� �1 � Person in Cha;ee z;Tnno r .nrn^ Inspaclion Da?e <br /> I� q z _ j C C <br /> 4.dEr s.l fve t Ftart a Te:epl;o•n_Plumber Fo:low.up 7 6K AAl (c <br /> f. <br /> PR31£V; Errp!oyee 10; Sev a Result Ac17 'ime In At.l Permit EYpi;aP n Oare <br /> 1)669- a I Ph <br /> =r.F.t/1D Program!Urnent" Service Result Aclion TimeOu; Am%kCalego. Charvge <br /> b 10 PMJ 1 2 3 ' 4 <br /> ;ia re a fctr Cert.Provider Ceti.Number �Cerl.Exp`align Date <br /> oneger Ceninzale <br /> See reverse for general requirements corresponding to each violation. <br /> ANY major violation may result in closure of the facility. R&inspections may be subject to additional fees. <br /> ' <br /> Abbreviations: Ma --L4aiorViolation,COS Coirecfed o:r Sire;Minor=Minor violation;In=In Compliance;N10=Not Obsemed;N/A=No!Applicable;h1FF=Mobile Food facility <br /> Viola6onCatedo" 6lajor C.i7S;fftinor,<ltiICINIA'Vfolatiom'Otiseruatiortsand,Re'uired;Go'lrectiv3;Qcuons:�; '- <br /> 1. Demonstration of knowledge <br /> 2. Commuftable d!seasehyound e <br /> 3. E etnoselmoutl(discharge d <br /> 4. Eatin ltastie, Jdrirkin /smoking/tobacco <br /> 5. Hands clean/washed;4-ove use <br /> 6. Handwash facilit•adeouatelaccossible I <br /> 7. Hot/cold hcldm ❑Hot ❑Co!d I _ <br /> 8. Tine as public health control � <br /> 9. Cooling foods j <br /> iO.Cookin lem eraturcltime t <br /> 1.1.Rehcalino for hot holdingr <br /> 12.Returned-and re-service of food i ,p eta Q G j <br /> 13.Food condition oodlsafelunedulteraled <br /> 14.Food contact surfaces clean/sanitized ✓ Z•_6 C3 F <br /> 15.Food obtained from ao roved source + <br /> 16.Shell stock tags/conditionldis la <br /> 17.Gulf oyster regulations <br /> 1S.Consumer advisory:.rawlundercooAed food A <br /> 21.Hot and cold notable water i _ <br /> 22.Sewne,wastewater disoosat I' :•. <br /> 23.Rod=nlsfinsectslbirdslvefminlanima;s I 'u <br /> 24.Pe:son in charge presentlperlorms duties IFT 1 <br /> 25.Personal deanlinessihair restraint <br /> 26.Frozen(codlthar:in <br /> 27.Focd swaratedtprolected/coo6io area <br /> 26.Washing fru isIve etablesx-rr.. <br /> ti <br /> 29.Toxic substances idenlifiedlsilwed <br /> 30.Fccd sloraae:food sterane containers =!* <br /> 3(.Cgnsurner self service <br /> 32.Fccd labelii9fhonest oresentalion j <br /> 33.Nonfood contact sur faces clean s <br /> 34.Wwv:ash fac.i;' maintained;test str:ps ( a J <br /> 35.EQUDmentratensils a orovedlclean;capacityI <br /> 36.Equi mewhitensilsltinen usectstored <br /> 39.VentilaI(oatl(Ohhn <br /> 39.Thermometer crovidedlaccurate <br /> 40,Kping.cloths usedlstofed C :4 <br /> 41.Plumbing:t-ackflo:v device <br /> -12.Gaib2ge dis osea;maintainea <br /> 43.Toilet facilities sup liedlclean <br /> 44.Premises;personal and cleaning items _ <br /> 45.F!corciwallslceilings <br /> 47.Signs posted ( _ <br /> 49.Permit obtained-and available .. <br /> 57.Nutritional Recuirements ,� <br /> 62.Approved commissary/kitchen rental , <br /> 75.First aid kiNfire exlinnuisher MFF only ` Inspection ❑Commissary/Renta; <br /> 101.Gas storage oomainer/cabinet(MFF only) Location: Kitchen Location <br /> Urban Runoff Violation(s): ❑52 Fats,oil,grease ❑53 Wind blown trash ❑54 Outdoorc'eaning ❑55 WARNING ❑56 ENFORCEMENT <br /> Sanitizes. Cooking I Heating Temperatures('F) Holding Temperatures('F) Received by <br /> Gh:otine <br /> (Sgnalufe) <br /> f(Cnppm) I Narre {ice <br /> ❑Cua:emarl <br /> Ammonia ) Speaatisl / <br /> (20 rpat) (s,gna;urel lam/ <br /> ❑Iodine(P5;vmr <br /> pp---- � _� ____ -"--•[print) Fes.. <br /> County of Santa Clara-Department of Environmental Health-1555 Berger Drive,Suite 300,San Jose,CA 95112-(408)918-3400•vnvw.EHinfo.org <br />