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SAN JOAQUIN COUNTY <br />a y� ENVIRONMENTAL HEALTH DEPARTMENT <br />1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br />.cgCrr•oai+k'i Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sigov.org/ehd <br />FOOD PROGRAM OFFICIAL INSPECTION REPORT <br />Name of Facility: <br />Date: I _ 3 -2 <br />Address: 14 <br />f,t( 1, <br />City: <br />Zip Code: <br />Owner/Operatlo-r: <br />Telephone: <br />Program Element: Program Record: <br />Inspection Type: <br />6180 Posted Yes E] Remit Posted <br />Re -Inspection on or After: (il <br />IN = in Compliance NIO = Not Observed NIA = Not Applicable COS = Corrected on-site MAJ = Major Violation OUT = Not in Compliance <br />See reverse side for code sections and general requirements that correspond to each violation listed below. <br />Major violations pose a threat to public health and must be corrected immediately.. Non-compliance may warrant closure of the food facilit <br />In roe ya Demonstration of Knowledge <br />"I", <br />our -0s <br />Supervision cw <br />�1 Demonsu rush of knowledge'. food safety certificate <br />24. <br />Person In Charge is present and performs duties <br />Employee palth and'Hygi <br />Personal Cleanliness <br />�2. Conlrnunicable disease, reporting restrictions & exclusions <br />''. <br />25. <br />Personal cleanliness and hair restraints <br />tlischarge from eyes, nose, or mouth; no open wounds <br />General Food Safety Requirements <br />Proper eating, tasting, drinking, or tobacco use <br />6. <br />Approved thawing methods used <br />Preventing Contamination by Hands <br />; ` <br />7. <br />Food protected from contamination during storage <br />p. Hands clean and properly washed: proper glove use <br />8. <br />Washing fruits and vegetables before use <br />,'.1. Handwashing facilities supplied and accessible <br />Time an87einperature Relationshi <br />Proper hot and cold holding temperatures <br />9. <br />0. <br />Toxic substances properly identified, stored, and used <br />play/Service <br />Food storage; food storage containers labeled <br />Proper use of time as a public health control <br />1. <br />Customer self-service food protected; individual utensils provided <br />Proper cooling methods <br />2. <br />Food property labeled and honestly presented <br />10. Proper cooking time and temperatures <br />11. Proper reheating procedures for hot holding <br />12. No re -service of returned food <br />„g <br />1, <br />3. <br />Nonfood contact surfaces clean <br />. <br />Warewashing facilities maintained; test strips available <br />5. <br />'EquipmenVutensils approved; installed; clean; good repair <br />13. Food free from contamination and adulteration <br />6. <br />Equipment, utensils and linens: storage and use <br />14. Food contact surface cleaned arcs e ee astrng rroced,ues <br />M ;Approved Source <br />15. Food obtained from approved source'. <br />i6. Compliance with shell stock regulations; tags/display <br />37. <br />Vending machines maintained <br />8. <br />Approved and sufficient ventilation and lighting <br />39. <br />Thermometers provided, accurate, and easily visible <br />0. <br />Proper use and storage of wiping cloths <br />1T Compliance with Gulfoyster regulations <br />Physlcat. Facilities <br />' Cbnforrnance With Approved PrOCedures <br />41. <br />Plumbing maintained; proper back flow prevention <br />18. Compliance with HACCP plan or variance conditions <br />42, <br />Garbage and refuse properly disposed <br />Consumer Advisory <br />43. <br />Toilet facilities clean, supplied, and maintained <br />15 Advisory provided for raw or undercooked food <br />44_ <br />Premises: personal/cleaning items, vermin -proofing °": <br />- Highly Susceptible Populations <br />Permanent Food Facilities <br />20 Prohibited foods not offered at high risk facilities <br />45. <br />Floors, walls and ceiling are maintained and kept clean <br />- Water / Hot Water <br />46. <br />No living or sleeping quarters inside facility <br />21. Hot and cold potable water availabe. <br />`Compliance and Enforcement <br />Liquid Waste Disposal <br />47. <br />Signs posted: last inspection report available <br />_ X22 Sewage/wastewater properly ti milet facility useable <br />48, <br />Compliance with plan review requirements <br />Vermin <br />.13 No indents insects biros or animals inside facility <br />9. <br />Facilhy operating with a valid health permit <br />0. <br />Impoundment <br />51. <br />Permit Suspension <br />Received By/Title: <br />C <br />H Specialist r �� <br />Phone: 2 1 b 306 12_- age 1 of <br />� <br />Ei 16-23 (1st pg) 419112 FOOD PROGRAM OR <br />