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aw t. SAN aJOAQUIN COUNTY ?� ENVIRONMENTAL HEALTH DEPARTMENT = a 1868 East Hazelton Avenue, Stockton, CA 95205-6232 Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sigov.org/ehd trrsoa� FOOD PROGRAM OFFICIAL INSPECTION REPORT Name of Facility: S .S Date: Address: .`Z2 $ 2 - City: ,e Zip Code: Owner/Operator: Ne Telephone: Program Element: 1 to L Program Record: Inspection Type: tk. B780 Posted ❑ Yes ❑ Rermit Posted D Yes ❑ P Re -Inspection on or After: IN = In Compliance N/O = Not Observed NIA = 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. Major violations pose a threat to public health and must be corrected immediately. Non-compliance may warrant closure of the food faci/it ruo NA i Demonstration of Knowledge I n+.-=. cir I cos Supervision ou* 1. Demonstration of knowledge: food safety certificate 24. Person In Chcrgo is present and performs duties Employee Health and Hygiene A& Personal Cleanliness 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 Proper eating, tasting, drinking. or tobacco use 25. Approved thawing methods used Contamination by Hands . Hands clean and properly washed; proper glove use 27. 128. Food protected from contamination during storage ' Washing fruits and vegetables before use - Handwashing facilities supplied and accessible 9. Toxic substances properly identified, stored, and used Proper hot and cold holding temperatures 0. Food storage; food storage containers labeled Proper use of time as a public health control 1. Customer self-service food protected; individual utensils provided Proper cooling methods 2. 3. Food properly labeled and honestly presented Nonfood contact surfaces clean 10. Proper cooking time and temperatures It 11. Proper reheating procedure=_ for hot holding Protection From Contamination 12_ No re, service of returned food 4. Warewashing facilities maintained; test strips available 35. Equipmentlutensils approved; installed; clean; good repair :;,- 13. Food free from ccntanunation and adulteration 36. Equipment, utensils and linens: storage and use Ito Food co tact . hace e le ned and sanfhzediwarewash ng procedures 37, Vending machines maintained Food From Approved Source - _ 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 - Physical Facilities Conformance With Approved Procedures 41 Plumbing maintainedproper back flow prevention 1 s. Compliance with HACCP plan or variance condilions 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 Food Facilities 0 Prohibited foods not offered at high risk facilities 15. Floorswalls and ceiling are maintained and kept clean Water / Hot Water 46. No living or sleeping quavers inside facility `r (21 Hot and cold potable water available_ Compliance and Enforcement Liquid Waste Disposal 47. Signs posted last inspection report available �22 Sewage/wastewater properly disposed. toilet facilliy useable 48, Compliance with plan review requirements - - Vermin .. 9. Facility operating with a valid health permit r= 3. No rodentsinsects birds or animals inside facility 50. Impoundment 51. Permit Suspension Received By/Title:L411 Ll EH Specialist: - vv-v,t ,) Phone: -Z&9 . / —jo QaPage t of EHO 16-23 list pg) 4/9112 F0o0 PROGRAM OR