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SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 East Hazelton Avenue, Stockton, CA 95205-6232 Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sigov.org/ehd FOOD PROGRAM OFFICIAL INSPECTION REPORT Name of Facility: Q Date: ` Address: 2 City: Zip Code: Owner/Operator: - YY� Telephone:QM -411 _�c r 5 Program Element: 1 Program Record: Inspection Type: 6180 Posted X Yes ❑ Remit Posted RKYes OF Re -Inspection on or After: I J 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. _ Malor violations pose a threat to public health and must be corrected immediately. Non-compliance ma warrant closure of the food facility _ - _ _ r'r h+o ria Demonstration of Knowledge r.+> -r oc ce Supervision I oir 1. Demonstration of knowledge. food safety certificate 24. Person !n Charge is present and performs duties Employee Health and Hygiene Personal Cleanliness Communicable diseaseh, re orting reslnctions & exclusions T 25. Personal cleanli gess and hair r stra rots s. No discharge from eyes, nose, of mouth; no open wounds General Food Safety Requirements �. Proper eating. tasting, drinking, or tobacco use 26. Approved thawing methods used Preventing Contamination by Hands - 27. Food protected from contamination during storage 5. Hands clean and properly washed: proper glove use 28. Washing fruits and vegetables before use I6. Handwashing facilities supplied and accessible 29. Toxic substances properly identified, stored and used Time and Temperature Relationship ` Food sforage/Display/Service 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 property labeled and honestly presented 10. Proper cooking time and temperatures I_ Equipment 1 Utensils /Linens 11. Proper reheating procedures for hot holding Protection.. From Contamination 33. Nonfood contact surfaces clean 34. Warewashing facilities maintained; test strips available 12. No re service of returned food i I, 5. EquipmenVutensils approved; installed; clean; good repair 113 Food free from contamination and adulteration 36. Equipment, utensils and linens: storage and use 114 rood contact surfec, clea.rad and san:bzed wa,ewasnmg 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 maintained. proper back flow prevenuon �18 Compliance wilh HACCP plan or valiance nonddions 42. Garbage and refuse property disposed Consumer Advisory 43. Toilet facilities clean, supplied, and maintained 19. Advisory provided for mw or undercooked food 44. Premises'. personal/cleaning items'. vermin -proofing Highly Susceptible Populations I Permanent Food Facilities �0. Prohlbned foods not offered at high risk facilities 45. Floors. wells and ceiling are maintained and kept clean Water / Hot Water 6. No living or sleeping quarters Inside facility 21. Hot and cold suable watei avwl3ble. Compliance and Enforcement Liquid Waste Disposal 47. Signs posted; last inspection report available �-2. Sewagelwastevralet properly disposed. toile! fauliN useable 48. Compliance with plan review requirements Vermin i 9. 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: Phone: Page 1 of EHD 16-23 list pg) 419/12 FOOD PROGRAM OR