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op sac SAN JOAQUIN COUNTY Z ENVIRONMENTAL HEALTH DEPARTMENT 1868 East Hazelton Avenue, Stockton, CA 95205-6232 Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sicioy.oro/ehd �rFORN� FOOD PROGRAM OFFICIAL INSPECTION REPORT Name of Facility: Date: Address: �O r pI YYl City: Cr N Zip Code: S Owner/Operator: x 1 {-� O Telephone: V1 Program Elemen • Prolg/ram Record: Inspection Type: SB180 Posted Yes No Permit Posted Yes No Re -Inspection on or After: w 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. Major violatio_n_s pose a threat to ublic health and must be corrected immediately. Non-compliance may warrant closure of the food facilit 1u ros'ri,A' Demonstration of'Knowledgeeeai 1 :os Supervision �1. Demonstration of knoruledoe: fond safety certificate _� V 24 Person In Charge is present and performs duties Employee Health and Hygiene Personal Cleanliness j2. Communicable disease, reporting. restrictions R exclusions 25. Personal cleanliness and hair restraints 'y3. No discharge from eyes, nose, or mouth; no open wountls General Food Safety Requirements Proper eating, tasting. drinking, or tobacco use � _ 6. Approved thawing methods used . Preventing Contamination by Hands 27. Food protected from contamination during storage I5. Hands clean and properly washed: proper glove use l 28. Washing fruits and vegetables before use Handwashing faculties supplied and accessible 29. Toxic substances properly identified. stored, and used Time and Temperature Relationship Food Storage/Display/Service 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 presentetl 10. Proper cooking time and temperatures Equipment I Utensils / linens 11. Proper reheating procedures for hot holding 33. Nonfood contact surfaces clean Protection From Contamination'r: 34. Warewashing facilities maintained; test strips available �12. No re service of returned food 35. Equipmentlutensils approved; installed; clean; good repair 1 113. Food free from contamination and adulteration 36. Equipment, utensils and linens: storage and use 14. Rood c�ntact surface cleaned and sanitizeT,arewashlnc 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 116. 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 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 Food facilities% 2' 1 20. Prohibited foods not offered at high risk facilities 46. Floors, walls and coiling are maintained and kept clean Water / Hot Water - 46. No living or sleeping quarters inside facility ,,121. Hot and coldp arable water available. Compliance and Enforcement - Liquid Waste Disposal -_ 7. Signs posted; last inspection report available 1 2. Sewagelwastewater properly disposed: toilet facility useable i 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 'tie: EH Specialist: Phone: 09 _1 nl Page t of EHD 16-23 (1st pg) 4/9/12 -J FOOD PROGRAM CA