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STATE OF FLORIDA DEPARTMENT OF HEALTH COUNTY HEALTH DEPARTMENT

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REINSPECTION CHANGE OF OWNER CONSULTATION

FOOD SERVICE INSPECTiON REPORT

Unsatisfactory Correct Violations by c:;::::t Next Inspection _. 8:00 AM on:

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r:» ,. i\

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of Report

Yellow

Copy to ~pt

I'URI)OSE:
_ RUUTINE

STATE OF FLORIDA DEPARTMENT OF HEALTH COUNTY HEALTH DEPARTMI ~

=

=

c::::J COCJSTRI'CT C()\lPL\I:sIT VA S\'R\TY

= =

RElNSPITTIO;; CIIANGE

= OTHER

=

= CONSUIT!\lION
Olllf],

or

OWNFR

FOOD SER\'ICE INSPECTION REPORT

pWNER PERSON IN C~RGE

Correct Violations b~ t$3- Next Inspection 8:00 Ai\! on:

=

TYPE
c2J 1051_ otJ d:5I c:5J I2t) c1D125J
c7J I3tll

c2J IOSI!1!!iIIJ otJ ~ c:5J I2t) c1D125J
c7J I3tll

c:b rt:Ot :E'MlL3J tf!li Il'M:

,-t::J L'oung_l' Ci\ic
Movie

.d't1l35l dtJ~

dbi35J dtJ IltOi d:OJ~ I1:11 i50l M

= = = = = = = = =

l lospiial Nursing

Detention

lilt School Rexidcn. Child Limited Other

=
y,'
_v

/('1/1 IIUJlI.I:J I>.!lull' l'iolarf'~/le ~'/lJ.fr.-'''i!ml "f{~/IIJjl/f'","64E~nofth~'F!iJrida AdministrativeCodeand t IIISI hI" r;orrc(/;;;"C~~/"u~d';;c,(lIIDI' of/hula lilt. 1I,.tlwld lIuJJ;ing /h l"(jI7T'~"lions ~ a \'il}/Ulicm (JJChoJ1I~I'64Dl1, Florida Administrative r::ode QlldChap'l'rJ J~l.and J "~.f'oriI/o S/aLUICS. l'ioillfl(l/~~ HlIISI mTTef.kd b)'llu' cWM tIJllllm,., lIlU.rolr:dltllh".ReSldIJ sectIOIl above or an adlllllllslralrve fine or other lega/aelloll ...1lI be mlllolN.

!,!

I

=
~
~

FOOD SUPPLIES
L Sources. etc.

= =

14. Sneeze ?uaros I,). Transportation 16. Poisunous/Toxic offood materials

.

. .,.

FOOD PR()T:~ON

.

/
~

= =

=
._,

27, Design and fahncation lX. Installation and location of equipment

OTHiR"F'-A-C-I-L-IT-IE-'S--j:-/~( x-::;,.-~!~}-:-':-<.,--1. t-\)-...... AND OPER'\T.I.O. NS
I:." ',' ",.
<; "

I!

/ ", 10

__ , 2'1. Cleanliness

~'9.

Other facilitic-, and "I'cnllions

2 Stor$l"tcmpt:ratllle, '-<0 t{;r~hcr -1 rha\\111g.· RawIruits
6. Pork cook in,!!

PERSO:"lNEL
17. Exclusion ofpcrsonucl

=
=
c=J

L(~ljOR,~<t~)(:'IJl" t::

]1J~lclllll(lo/c(1k~tpa""l
FACILITIES

TEi\IPORARY

FOOD\

SANITARY

a:::
Q

IIiPJ IR Cleanliness

=
~ ~

19.Tobaccousc ~O. Hanrlwashing 21 I Iandhng of dishwarc

=
c::::J CJ faci

AND CO:'<JTROLS
31 Water supply

=
~ ~

SER\'ICE

EYENTS

k,\\\( Y: (( \
l_._ /
. {

t\

5,

i~.

-10 Temporary

food.""lO,lcC c\cnt;~~

V~NDINGMACHJNE~'~\«.';\l(c\,
-1-1 Vending machines
.

= 3=:. Icc
JJ. Sewage .14. Plumbing 35, Toilet facilities facilities

.: -.r~~::...2J_
,I

..

t

~~__
(
>-,

./

c:=J 7 Poultry (,ol\kin~ c:=J S. Other allinlall'o~lg: c:=J LJ. Least contact 'Rcp_f:~~Hing liiiiIlO =1 Fuod container

c::::J

MANAGER
..:1-2 Manager ..

CERTIFICATION
certification

EQLIIP\IENT/UTENSILS
c::::J

\... .-; :

J'

c::::>

L Buffet requircmc~'

........

= 23. Sinks

22. Refrigeration

liucs.Thcrrnomerers

liD 36. Handwashing

'iiCil

24. lee storage/Counter-protector 25, Ventilation/Storage/Sufficient facilities equipment

=

= 43. Certificates
c::::J

CERTIFICATESANDfJ;~_1
and fees

!'\ ! ! !( C!
I \.. j"
r

(~

"'-

37. Garbage disposal JR. Vermin co~trol

INSPECTION/ENFORC/Jt~t::
44. Inspection/Enforcement , .\ ~/

t

c:=J 12 Self-service
c::::J

condiments

~

U Reservice

or food

= 2n. Dishwashing

c::::J

I \_V I J /~~f\(! t
(continue

,

(.J

ITEM NllMBERS

COMMENTS

AND INSTRUCTIONS
on attached sheet)

f~ cl

!'fIUV/::

-='---J---,--"--'-"'-j i

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-r'--'""'--"

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STATE OF FLORIDA DEPARTMENT OF HEALTH COUNTY PUBLIC HEALTH UNIT

Date

///1 idUI

(_j

Identification No.DD-DD-DDDDD
! //)I(~Lr
I

Comments and Instructions (Continued from Page 1):

.,-

[(c{: (, it

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7

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Page 2
DH 4104, 4{96 [Sf o ck Number: 5744-000-4104,8)

Inspector

/il{
/

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/id'

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Yellow Copy to Aeceipt·of Report

PURPOSE:

STATE OF FLORIDA DEPARTME~T OF HEALTH COUNTY HEALTH DEPARTMENT

=

= = = =

ROlTINE CONSTRICT
C

()\1i'L".LNT

(),\ SIIR\TY OTIIER

= = = =

RFINSPFCTIO\ CH\N(;E OF OII,\fR

FOOD SERVICE INSPECTION REPORT

CONSI :IT\TION tiTHER

RESULT

= Incomplete = Unsatisfactory
PERSON IN CHARGE _____________
HEGL";" (' END.',:' ct:JiOOI c2JlO:5I= GtJ d:!5J c5:l t20J c&l25J
[:'l:J13Oi

Satisfactory

PHONE

Correct Violations by '1!E Next Inspection

= 8:00 AM

on:

r-'DATE'

ct::J iOOJ c2:J~ill:MJ otJ i!!5I c:5J I2flJ dtn25J
[:'l:J131)

pATE . .'

dJ rI:OJ i£'Ml dJct:tli=

c8:J i35J [SJIlWI cttlJ Ilt!5J ctl:J 1501 ct2J~

c8:::1I35J cSJllWI ct:tli145J ct1:1I50i ct2JM

f

Adminisrrat~ve Code and mUSf b.e corrected. CC:Tl~in. tled.ojJ~,.JJ~JI OJ:';;U,IiJt'Ili :(,,111,.. 1 a violation of Chapter 64E-IhFlonda Administrative Code and Chapters 381, and 386, Florida Statutes .. Flo/nNOIIS lIuu/l"" ".' ':1)"1'<' {cd to_v{hr dOle and rilll.(' jill lie ,'I(!d in the Results section above Dr (Ill adminisrrarhejine or other legal aclion ,viII be initiated". . ..... >'. :,: ..>.'....

r'...,,/1,,111 "'Qkln1l/It(',~e ':tI ·-.m;~k..i;i"h'~'Ul.
FOOD SI.'PPLIES FOOl) PROTECTIO'\

= = = = = ~ = = ( ',,11" = =
( 'j\

05

:'-Jursing
fktcntion
l_(llln~(.,'

06
07

08
otJ c:5:J cttJ otJ=09 c:5:J cttJ

il

\I()\ic

=

Scho()1 R~si<.k'!1

= 11

10 12

rn
c!b

rn=
dt

c!b=13 ,J14

Lnnilcd

lJlIlcr

=

db

on OF BlSI"ESS

ku.. m;: frqiifremel1t:5o,[ Chapter 64E-'1r. 'oftheFlorida

LVII.,

Q",'
I

= ,' =
I~

SIlL'CZL' l.!!lanb

= ,,,

Tr;lIl:.:p(,rtallull

cd I(,)od

P~li,,(ln\HI:; Toxic

matcr i.. d~

I'ERSO'\'\EL

= = = =

27 D",':-;ign and fabricanon .'S lnstallnriou 2q Ck;]lllin(:s.'
3(1. .md locatiou

OTIIER F\('fUTlES
\'\1) OPER.\ T10'lS

(If cqrupructu
l)f

\ktllOds

\\'ashi!l~

TF\IPOR\RY SFR\ICE
q,'\IlI'\(;

FOOl)

S,\,\ITA RY FACILITIES \:--;D CO'-:TROLS
\\'at!..."1" c-uppl)

E\E\iTS \I\CW,\ES CFRTIFICATIO'\
.\'\1) FEES

I~
c::J c::::J

1\;1\\

Jruit-:
c=J c=J
~!)

"
l land-. ;lc-hin~ Il.llldliJl~ of \Il"h\\:!!"~
~I

=

:-:. (HhI...T

;mim;li
,-'Ullu!et

~'\'()klng R\._'hc(Jtjn~

c::::J 'i ! .\._';I'\

1(1 h"ld container

= =
c=J c=J c::::J

EQl'l "'I Eyr/lTE:\SILS

..::.+ ke ~5
2(,

'.!d]";lgC (

ountcr-protcctor Suflicicnt equipment

\·~'!1tlL.lIi(lll

~[{\r(\gc

= = = =
c::=J

=

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Icl"
SC\\

~'gL'

".\'\

..\(;[R

q PIUlllhlll!,! ~< i"r,ikt t;k·illtit:."';
1.6

n.RTIFIC\TES

tr:::I

Iland\\'ash\li~

t~ILr!1tI(,c-

C;"rb~\~t' disp,):-';l! 3X. Vermin control

1)\..:.!n\;,:,hll1g

l:lCiJilic:-':

11[\1 ,\L\IBFRS

CO'I\IE:\;TS \:\D I:\STRlCTIO\S
(continue
OIl

dtUk'hed shed)

c.

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= ('O'iSTRU( = U),\IPL\INT = SUR\L, = ()THlR
(J\

=

PURPOSE:
R{)\'TI"jE

STATE OF FLORIDA DEPARTMENT OF HEALTH COUNTY HEALTH DEPARTMENT

= kFINSI'ECTIU\ = ('IL\~(;F OF ()\\\OII( = CONS\111-\TI()I\ = (HHUZ

FOOD SERVICE INSPECTION REPORT

pr\ 10 3S

OWNER PERSON IN CHARGE DATE' [~)
",',

= Incomplete = Unsatisfactory
PHONE Correct Violations by .,Next Inspection 8:00 Al\1 on:

=

mOO c2Jt05I

c5:J® clhl25l d:Ji3Ol d:b~ [:9:3 i!1OI cttlJ~

~

= Nur~ing = Detention = Lounge =
('i\'il'

'Vjt)\ie

ct1JM
ct:2JM c9:J

= School = Rcsldell. = Child = l.nuucd = Other =
~,

=
PI.ihl fll~11~1 ::-:-'""'--'-,J
i

I I(I:III~;~;;'~;'! h;;;;;:';j;/~te 'he;;;u~",t'J'Jfj # C:h~pfer 4F.;jJb/th{f:'iorida 6

I lI'llh(lUJ
CQIn"£f c=J

m<1kinlf'hopa ()mrClI()~ i. lIvi'o/alcon n/CJ;opl 1':~~r.4J. FfOl',lcfa Admllll,~trallve J b{'!!_t' d":!:_lJrltlllflu' !ndJ~jJl'(dliJthe,R~\I'I:; s<t?olivn above or. an l1dmTlllstratIVejil1e
14.Sneezeguards
I"'. Transportation c:::J

A~I~illiftrdtiJ;e:Co1~ al!!i,iJrl.~stlJt!,lo+~Sle(L,~·f)n~;iuliJJ"OPE!iYi[~~;' Code and Chapters 3~1; and38'?'F7Qrufd :::;''1<1/1110$. Wul(lfrotl& mus; or other legal GO/lOll will be, InTI!o,fC;Ij;". "'~_'

bo .
,},

FOODStlPPLIES
! SOUf;_'t':< dr.

= 27. Design and tabncanon
c:J

OIHf,RfACIUlltSj

ii,'.)

i

o:-foud

2k. lnstalluuon

and location

FOOl) PROTECTION

10. Poisonous. Iov:c materials

=
c:J

=
CJ

PERSONNEL
4 Tha\Vil~g
f •

=,1)

V

2'1,'Clt:anjl.l)s""rc,!pipf}1"lltv, r'! ,......._ i i Melhods III \\;ullln"

.> '

=

AND OPEIL\TJO~S
1')

Other t~ledJtlc.s and ()pcl;~lMs"

TE!\IPOR\RY SERVICE

FOOl)

c::J 5 Rav, ,fP(llt~
C=:J

6 Pork cookint;

'"

r

=
c:::J c:::J c:::J

c:::J

J7

Exclusion of personnel

SANITARY

FACILITIES
supply

En:NTS

IX Cleanliness

19. Tobacco use 20. Handv .vashing 21. Handling of dishware

= 31
c:J c:J

AND CONTROLS
Walel

VENDING MACHINES MANAGER CERTIFICATION CERTIFICATES AN)) FEES

:'2 tee 33. Sewage 34. Plumbing 35. Tuilel iJI.-'llJIICS 36. I Iandw ashing L1Cilitics 37. (jarhagc disposal 38. Vermin control

c::J

'7 POIlJlrv' cooking( I, ' g. Other animal cookjn~.

EQUIPMENT/UTENSILS
Gi}

=
c:J

c=l

tJ. Least ~-ollta('I!RL'h~alin-g'
l\"

c=ll 0, Food cZ;ntfulcr
c:J

L

\

22 Refrigeration 23 Sinks

faciliucs.Thcnnometcrs

c:J c:J c:J c=J

$ c=l equipment c=l

11 Buffet requirements Self-service condiments

24 lee storagc.Coumcr-prorecror 25. Ventitation.Storage/Sufficient 26. Dishw<ishing facilities

INSPECTION!ENFOR('El'tENT
c:J

c=l12. c=ll~.

44_ luspcctionHnforccmcru

Reservicc of food

ITEM NUMBERS

COMMENTS

(continue on attached sheet)

AND INSTRUCTIONS

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UFP4R 7M tAT !,vSPE( fOR
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II}

'tr/-f:--------------------------

OH Forrn 4023. 1!05 [Obsoletes

Prf..>vlou1

'1,/

EOltlollSl

!

ESTABLISHMENT/FACILITY

'.
STATE OF FLORIDA DEPARTMENT OF HEALTH COUNTY PUBLIC HEALTH UNIT

r-.... .-",

.,_ ~l

"

~.,." . ./'~. -.

I

Date----~--~------~
\ fl. \ _.~

-

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Identification No.DD-DD-DDDDD

Comments and Instructions (Continued from Page 1):
I

,

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....

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Page 2
DII<IO •. </?6 [Sf o c k Number 57 <4-000-.10.-8)

Yellow Copy to Receipt of Report

Pl)RPOSE:
_

= ('()NSTRUT = (,()i'-lPL\INT = (_),\ = OTIIER
S{j{{\!"

IWl.'TI:\1

= =

= =

STATE OF FLORIDA DEPARTMENT OF HEAL;rH COUNTY HEALTH DEPARTMENT
kUNSPI('Ti():\ OI.\N(iF()I()\\:\IR C(lNSCLTAIION OTIIER p'"----'-----'---

FOOD SERYICE I:\SI'ECTION REPORT

RESULT

.. _. -

~

= Incomplete = Unsatisfactorv
Correct Violatious by :\ext Inspection

Satisfart(),·y

=

=

i!:()() \;\1011:
"

,'eLi itl:5J !liM! [:2:1 tfi5J

DATE

)'OSITION

=

D ( 2)

r.

cf

III

DATE TYI'£

I

=
c:J c:::J

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rSl d:Ollf'llll L3:J rt!lI 'EM

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;----_ .. .._. .-.-.--.--_ ...• '.:',." .. . ." .. ~-" ; IIt"'l marlicJ 1>1>/"11' "/uull,'llw re_quire'.lIentso/Chapter 64£-1f of th« Florida Adll1illlstraT~ve Cude a,"d IIlIII' be corree!eri Continued operatin« 'if.(hl.~filrifUI ] WI/ho. UIIIIU~I.lIg.'h"'1<' ,'urrec!I."nj IS a violatibn of Chapter 64E-II. Florida Administrative (ode andChnptcrs 381. and _,,~6.Flori1JJDSraiIt.tes 1'i.fJ/allf!n.< I1IU." br .. GlJI"::'~i'd d~~.::~.l.iime-ilidicated in Ih" Results sec/ioll above ur an ildministrative/illc or olher legal action will be luilie/teS ... tt:rl 'l"'i!'.~_~
,,"_.

__

__

14

c9.Jdb

dbdtJ

h.-r

.~~----.----,

!2.!!'."

FOOD Slil'PI.IFS
c:=J

=
c::::I c:::::J

I

I~
16

SlIc'CZe ~Lla",h

=
c:=J

'p

Ilc"~11 and bllflCllinll

OTIIEH
c::::J _~(/_ r

F\C~t:s!)rll-:s
; ;. ,11j(1
(lJl,,-Tttidll:;

i '...:\/ .. r.;.,
<_
~ ..

I Soun.',,·:;.etc.

I 5. lr.m-poruuion l.;"it)(l(J
r\liC)OfHH1:'..

2~. In-;\;·dlali'1I1 and locntiou
t)(

A,"H) ()PERATIO,'\S uhcr
t:I~':-;

·to--)

=~
c:::::J

FO()J) PR(rrECTION S<orcdtemperature

Toxic matcr iai:

c::J :9. Clcanlinc-,-;

PEHSO:--iNEL
18. ClcanlinvsTobi.KCO
\1:-;,,' ~
_~.J ~.

= .10 ,klll"r\;
SANITARY

equipment

orwa,llmg FACILITIES

TE\IPORARY

FOOl)

"j.;

S[I{YICE l:nSIS
c::J

,,__ , ....-:_

c::::J ~. Thawin,e

c:::J

.vxn
CJ
.;

CONTROLS
Water supply

-til. TL'mJlPr<H~' tood :--0-:-::t:-C~/C1~i-.

c:::::J h. Pork cl'oKing
c:::J

.\I

-./=-:::::::~-;-.~
r-'

VE,\DIN<;M.\CIII:\ESt::_c:.-~
c:::::J ~

20 Flando, :1~lting 21 Handling

I Vcndinu nuchiuc-,

c::::J

~)rdi,J~~lrc
faciliric;,.lhennoJl1l.?tcfs

EQlIIP\IE:\T/l'TE:\SILS
.c:::::J

=
c=J CJ equipmcllt c=:l

\I.\,\,·\(;ER
.'-1 Plumbing J_~ Tudet
(;lcilitic:'l

~'ERTlFlC\ho:; AND FEES
:tlld fcl...''';

22. Refrigeration

CERTIFICATES
c:::J

c:::::J 11) Fund cont.uner
_~ (;arb:l~\: ':

·t,. (·l·rtific:l1l"~

it\
NT

di:-:po:"\al

1,\ S PECTlO.\iiE:--i FOHCEi\l£

L

...

c=J

2:'. Vcntilatiou

St()ra~\,_' Sufficient

::·X Vermin cnnlf\l]

ITDI 'Wi\IBERS

COI\{ME:\TS \!\D I:\STRliCTlO,\S
(continue on attaclH.:d sheet")

,,
'.... J
'

....

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I Ii 1\ lilT IN/,

1.\11'/:'17/11<. 1'/1 ;'J)~'.:,,- __ -:-~
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'7'.. ..~ _'."' .I"_;._; ..
.....
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(i/'/T/'I!l1

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O~)iGieles Pf~:;8rr;(~:i~t!()PS)

ESTARI

I<::HMl=tvT'l=lIrli

lTV

cj

CONSTRUCT

~ ~ ~

CHANGEOFOWNER CONSULTATION OTHER

INSPECTION

REPORT

c::::i COTvfPLAlNT

=

QA SURVEY

~

Satisfactory Unsatisfactory

PHONE

~

Lounge

~ ~

Civic Movie

~

15. Tsansportation of food materials

e;I 16. Poisonous/Toxic

,

~

28. Installation and location

OTHER FACILITIES AND OPERATIONS
.... 39.

{0J'(, :5<..::>

4iiiiI 29. Cleanliness of equipment 1iiSI' '30. Methods of washing

PERSONNEL
.. .. 17. Exclusion of personnel 18. Cleanliness

~
~ ~ Other animal cooking 9. Least contactIReheating

19. Tobacco use
20. Handwashing 21. Handling of dish ware

=
~ ~

SANITARY FACILITIES AND CONTROLS
31. Water supply" 32.lce 33. Sewage

TEMPORARY FOOD SERVICE EVENTS
~

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ITEM NUMBERS

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tZOUTINE CONSTRUCT COMPL.-I.INT QASURV[Y

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STATE OF FLORIDA DEPARTMENT OF HEALTH COUNTY HEALTH DEPARTMENT
REINSPECTIO'; CHANGE OF OIINER

FOOD SERVICE INSPECTION REPORT

= CONSULTATION = OTHER

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TE'\IPORARY FOOD SEI{\ICE E\TNTS
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SANITARY FACILITIES

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6. Pork 7 Poultry cooking cooking

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CERTIFICATES AND FEES
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STATE OF FLORIDA DEPARTMENT OF HEALTH COUNTY HEALTH DEPARTMENT

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R()UTINE CONSTRUCl ccnlPLAIN I Q.\ SLJRVI-.l OTHER

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RFINSPECTI()N CH\I'I,c OF O\\'NIR

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SERVICE EVENTS
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31. Water supply 32. Ice 33. Sewage 34. Plumbing 35. Toilet Iaciliucs 36. Handwashing facilities

40 Temporary food service events

VENDING MACHINES
c::::J 41. Vending machines

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CERTIFICATES
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MANAGER CERTIFICATION AND FEES

9. Lear (O~}lactiReh\alii1-g
10. Food contatoer II Buffet requirements 12 Self-service 13. Reservice condiments of food

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22. Refrigeration

faciliries/Therrnornetcrs

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equipment

us.

43. Certificates and fees

= 38. Vermin control

37. Garbage disposal

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INSPECTION/ENFORCEMENT
44. Inspection/Enforcement

ITEM NUMBERS 17

COMMENTS
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AND INSTRUCTIONS

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PURPOSE:
ROUTINE CONSTRUCT COl\WLAINT QA SURVEY OTHER

STATE OF FLORIDA DEPARTMENT OF HEALTH COUNTY HEALTH DEPARTMI

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REINSPECTION CHANGE OF OWNER CONSULTATION OTHER

FOOD SERVICE INSPECTION REPORT

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= 20. Handwashing = 21. Handling of dish ware = 22. Refrigeration = 23. Sinks
EQUIPMENT/UTENSILS
facilitics/Thcrmorncters

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AND CONTROLS.

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42. Manager certificatioI\.

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t"ERTIFICATES AND~·-I
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INSPECTlON/ENFOR~~t:

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ITEM NUMBERS

COMMENTS AND INSTRUCTIONS
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ROUTINE CONSTRUCT COMPLAINT

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STATE OF FLORIDA DEPARTMENT OF HEALTH COUNTY HEALTH DEPARTMENT
REINSPECT ION OF ()\\t'IR

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FOOD SERVICE I.'iSI'ECTION REPORT

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FOOD PROTECTION
temperature cooking/Rapid cooling 3. No further Thawing

= = =

14.SncezeguarJs 15. Trnnsportauon 16. Poisonous/Toxic
O:-t(lOU

=

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5 Raw fruits 6. Pork cooking Poultry cooking Other animal cooking

= = = .1·9 =
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17. Exclusion of personnel 18:Cleanliness Tobaccouse.' ••

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= n. lnstaltati.tn = 29. Cleanliness
SANITARY

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and location of equipment

OTHERFACIO!)I'IES AND OPERATIONS

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TEMPORARY FOOD

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FACILITIES

AND CONTROLS
31 Watersupply 32. Ice , ' ,~ _.

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II Buffet requirements condiments of food 12. Self-service

=
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EQUIPMENT/UTENSILS
22. Refrigeration 23. Sinks 24. Ice storage.Counter-protector 25. Ventilation/Storage/Sufficient 26. Dishwashing facilities equipment facilities/Thermometers

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MANAGER

CERTIFICA-h-ON

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38. Vermin control

34. Plumbing

42. Manager certification

V-; V\ ~..(_
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CERTIFICATES
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AND FEES

4], Certificates and fees

INSPECTION/ENFORCEMENT)!
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ITEM NUMBERS

COMMENTS

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, STATE OF FLORIOA DEPARTMENT OF HEALTH COUNTY HEALTH DEPARTMENT
FOOD SERVICE INSPECTION REPORT

=

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CONSULTATION

$lllisfllctory
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PURPOSE:
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STATE OF FLORm4}" DEPARTMENT OF HiirtTH OUNTY HEALTH DEPARTME~T
REr!"SPECT!O~ CHANG"" Of OWNER CONSULrATlO~

CON5TRUCT.

FOOD SER'\I1CE INSPECT10~ REPORT

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SANITARY FACILrIU:S
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STATE OF FLORIDA DEPARTMENT OF HEALTH COUNTY HEALTH DEPARTMENT
REINSPECTION CHANGE OF OWNER CONSULTATION OTHER

FOOD SERVICE INSPECTION REPORT

Nursing Detention Lounge Civic Movie

= = = = = = = = = = = =

FOOD SUPPLIES
I. Sources, etc.

= =
cooling

14. Sneeze guards 15. Transportation 16. PoisonousIToxic of food materials

FOOD PROTECTION
2. Stored temperature 3. No further cooking/Rapid 4. Thawing 5. Raw fruits 6. Pork cooking 7. Poultry cooking 8. Other animal cooking 9. Least contactlReheating I O. Food container I I. Buffet requirements I 2. Self-service condiments

= =

= 28. Installation

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OTHER FACILITIES

PERSONNEL
17. Exclusion ofpersonnel 18. Cleanliness 19. Tobacco use 20. Handwashing 21. Handling of dish ware

= =

29. Cleanliness of equipment 30. Methods of washing

=

AND OPERATIONS
39. Other facilities and operations

TEMPORARY

FOOD

= = = =

SANITARY FACILITIES

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22. Refrigeration 23. Sinks 24. Ice storage/Counter-protector 25. Ventilation/Storage/Sufficient facilities equipment facilitiesiThermometers

= =

=

= = = = = = = =

AND CONTROLS
31. Water supply 32 Ice 33. Sewage 34. Plumbing 35. Toilet facilities 36. Handwashing facilities

=

SERVICE EVENTS
40. Temporary food service events

= = =

VENDING MACHINES
41. Vending machines

MANAGER CERTIFICATION
42. Manager certification

CERTIFICATES

AND FEES

43. Certificates and fees

37. Garbage disposal 38. Vermin control

= 44. InspectionlEnforcement

INSPECTIONIENFORCEMENT

=13.

Reservice of food

c;diI> 26. Dishwashing

ITEM NUMBERS

COMMENTS AND INSTRUCTIONS
(continue on attached sheet)

COUNTY PUBLIC HEALTH UNIT Identification o.m-~-l2Jf;;d~ N
Comments and Instructions (Continued from Page 1):

DEPARTMENT OF HEALTH

STATE OF FLORIDA

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STATE OF FLORIDA DEPARTMENT OF HEALTH COUNTY HEALTH DEPARTMENT

= = =

CiiiJ REINSPECTION
CHANGEOFOWNER CONSULTATION OTHER

FOOD SERVICE INSPECTION REPORT

Incomplete Unsatisfactory Correct Violations by Next Inspection

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FOOD SUPPLIES
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FOOD PROTECTION
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cooling

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= = = = = = = =

14. Sneeze guards IS. Transportation of food 16. Poisonous!Toxic materials

PERSONNEL
17. Exclusion of personnel 18. Cleanliness 19. Tobacco use 20. Handwashing 21. Handling of dish ware

= = = = =

27. Design and fabrication 28. Installation and location 29. Cleanliness of equipment 30. Methods of washing

OTHER FACILITIES

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AND OPERATIONS
39. Other facilities and operations

TEMPORARY FOOD SERVICE EVENTS
40 Temporary food service events

SANITARY FACILITIES AND CONTROLS
3 I. Water supply 32. Ice

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=

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VENDING MACHINES
41. Vending machines

= 22. Refrigeration

EQUIPMENTfUTENSILS
faciJitiesfThermometers 23. Sinks 24. Ice storage/Counter-protector 25. Ventilation/Storage/Sufficient 26. Dishwashing facilities equipment

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I 3. Reservice of food

= = = =

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34. Plumbing 35. Toilet facilities 36. Handwashing

= 38. Vermin control

37. Garbage disposal

= = =

MANAGER CERTIFICATION
42. Manager certification

CERTIFICATES AND FEES
43. Certificates and fees

INSPECTION/ENFORCEMENT
44.lnspectionlEnforcement

ITEM NUMBERS

COMMENTS AND INSTRUCTIONS
(continue on attached sheet)

PURPOSE:
CiiilJ!'ROUTINE

= =

C(,.\STRU(T COMPLAINT

= QASUR\TY

= = = =

STATE OF FLORIDA DEPARTMENT OF HEALTH COUNTY HEALTH DEPARTMENT
Rf'lNSPECTlON CflANGE OF OWNER

fOOD SERVlCE INSPECTION REPORT

CONSULTATION
OTHER

20ll FEB-8 AM10: 07

r:!tJi20i
1:8J12l!Ii cZJ:3OI c8Ji3~

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AND OPERAT10NS TEMPORARY SERVICE VENDING FOOD

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SANITARY
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FACILITIES

EVENTS MACHINES CERTIFICATION AND n~ES

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MANAGER

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INSPECTION/ENFORCEMENT
.!4. lnspection/Enforccrncnr

25. Ventilanon/Storagc/Sufficient 26. Dishwa.shing facilities

equipmcru

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I1K\1 NUMBERS

COMME~lS

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AND JNSTRljCTIONS

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DEPARTMENT OF HEALTH
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FOOD SERVICE INSPECTION REPORT

PURPOSE:

ADDRESS OWNER

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Items marked below violate the requirements oj Chapter 64E-l/ 0/ the Florida Administrative Code and must be corrected Cc nt.nued operation of this_ without making these corrections is a violation of Chapter 64E-l I, Florida Administrative Code and Chapters 381, and 386, Florida Statutes. Violations n corrected by the date and time indicated in the Results section above or an administrative fine or other legal action will be initiate:' OTHER FACILITIES

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AND OPERAnONS TEMPORA RY FOOD EVENTS ~'V,CHINES CERTIFICATION AND FEES ENFORCEMENT

FOOD SUPPLIES

FOOD PROTECTION SANITARY FACILITIES AND CONTROLS VENDING MANAGER EQUI PMENTIUTENSILS CERTIFICATJ~S INSPECTION; SERVICE

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FOOD SERVICE INSPECTION REPORT

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Items /J1tlr:!tgdbelow via/ate the requirements of Chapter 64E-11 of the Florida Administrative Code and must be corrected. ·(;rmtin~erf'ilfl.f.I'%"'iRI.l,.(jj!ltJ~i2t.cij,iP' wi_tltl!flft{ii![1/?~$",~ij;'e,secorrections a violation of Chapter 64E~/I. Florida Administrative Code and Chapters 3'81. and 38tl;,iFil\>riq£;J;ta'/lifi'ls,i'io.Vof!iJIfSJI'f!iist,be is corr:-6:::ted-oydhedate and lime indicated in the Results section above or an administrative fine or other legal action wil/'lie:Hlfti(ited . FOOD FOOD SUPPLIES PROTECTION PERSONNEL SANITARY FACILITIES AND CONTROLS
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OTHER

FACILITIES

AND OPERATIONS TEMPORARY SERVICE VENDING MANAGER EQUI PMENT/UTENSILS CERTIFICATE:, AND FEES FOOD

• • • • • • • • • • • • •

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EVENTS MACHINES CERTIFICATION

INSPECTION/ENFORCEMENT

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Identification No. ~

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STATE OF FLORIDA
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DEPARTMENT OF HEALTH COUNTY HEALTH DEPARTMENT
FOOD SERVICE

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REPORT

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OWNER

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without ntaMIII,! thcs« <'om'<'III/I., /11/ "10I,11I0il 0/ (lwJltl!l' 64[,· II. Florida .1dIHIIIJ.I/J·al'~'" (qd.·' £111111I1JP/('r~ 381. and .IIUi. Florida Sf<lfuff!.~. 1'fQt(Jli""'~Jtttfgj.:be ( (O)'I\.('('J by lilt' dali' ,11111 lilll<' 111,/.. "I<"riiillJ.' R<''IlIh~ Ji'l'ffI"n"dlJ/J('('i)r-ilii'I.Jllilllr~l;iiIT~·i· /lilt' or o/her k~al Udiollll'i/l he illi(itl,lt!d.., , '.'.,;". ':1." '. ; .. ,:.• ". .,
etc

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18 Clclluli"cs-,

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39. Other raclillic~ and ooerauons

2. Stored temperature

PERSONNEL

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r:::J 'I

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3 No further cookfllg/Rnpld

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= 20 Handwashing
_ 21 Ilandlingofdishware EQUIPMENT/UTENSILS
r""ililicsIThcm,o~lCtc",

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VENDING MACHINES c:J 41. vendmg machioes MANAGER CERTIFICATION FEES
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CERTfFICATESAND
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INSPECTION/ENFORCEMENT
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C::J11. R< cni.c ..

c:J 25. VentilationiStoragc.lSumci(!Jlt equipment c::::J 38. Vennin control

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facilities

ITEM NUMBERS

COMMENTS AND INSTRUCTIONS (continue on attached sheet)

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= CONSTRUCT = COMPLAINT = QASURVEY = OTHER

= REINSPECTION' = CHANGE OF OWNER = CONSULTATION = OTHER

FOOD SERVICE

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School Residen. Child Limited

2. Stored temperature 3. No further cooking/Rapid cooling

5. Raw fruits 6. Pork cooking 7. Poultry cooking 8. Other animal cooking 9. Least contactlReheating

II. Buffe; ;'equirements 12. Self-service 13. Reservice condiments of food

_

= = = = = = = = = = =

15. Transportation 16. Poisonous/Toxic

of food materials

= =
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28. Installation and location 29. Cleanliness of equipment

AND OPERATIONS
-.39. Other facilities and operations

PERSONNEL
17. Exclusion of personnel 18. Cleanliness "9'tTobacco use

30. Methods of washing

TEMPORARY

FOOD
food service events

SANITARY FACILITIES

20. Hiltldwashing 21. Ha~dling of dishware

EQUIPMENT/UTENSILS
22. R~fiigeration 23:Sinks 24. Ice storage/Counter-protector 25. Ventilation/Storage/Sufficient 26. Dishwashing facilities equipment facilities/Thermometers

= = = = = = =
.,

AND CONTROLS
31. Water supply 32. Ice 33. Sewage 34. Plumbing 35. Toilet facilities 36. Handwashing facilities

= 40. Teniporary

SERVICE .EVENTS

=

VENDING MACHINES
41. Vending machines

= 42. Manager

MANAGER

CERTIFICATION
certification

= 43. Certificates

CERTIFICATES

AND FEES
and fees

37. Garbage disposal 38. Vermin control

= 44. InspectionlEnforcement

INSPECTION/ENFORCEMENT

ITEM NUMBERS

COMMENTS AND INSTRUCTIONS
(continue on attached sheet)

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STA TE OF FLORIDA DEPARTMENT OF HEALTH COUNTY PUBLIC HEALTH UNIT

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Date
Comments and Instructions (Continued from Page 1):

Identification No.DD-DD-DDDDD
(J

0370

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Copy of Report Received by' ~ \--=::::::)J\:::::I\ ....,. J
DH 4104, 4/96 (stock Nvmber:

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5744-000-4' 04-8)

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PlIRPOSE:

STATE OF FLORIDA DEPARTMENT OF HEALTH COUNTY HEALTH DEPARTMENT

= = =

~ROVTINI:: CONSTRUCT COMPLAINT QASURVEY

= = = =

RI::INSPECTION CHANGE OF OWNER CONSULTATION OTHER

FOOD SERVICE INSPECTION REPORT

nsatisfactory Correct Violations by Next Inspection 8:00AM on:

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il:1JM
il2i IS!5l

= = = = = = =
=
15. Transportation of food materials

Nursing Detention Lounge Civic Movie Residen. Child Limited

!108School

FOOD SUPPLIES
CJ

I Sources,

etc.

=
cooling c=J

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=
[=:J

27 Design and fabrication 2R Installation 29. Cleanliness and location of equipment

OTHER FACILITIES AND OPERATIONS
C=::l

FOOD PROTECTION
Stored temperature 3. No further cooking/Rapid 4 Thawing Raw fruits 6. Pork cooking 7. Poultry cooking Other animal cooking 9 Least contact.Reheating 10. Food con tamer II Buffet requirements condiments

CJ 10. Poisonous/Toxic

39. Other facilities and operations

PERSONNEL

~

so. Methods

of washing

TEMPORARY FOOD

= = =
c:::J

!7

Exclusion of personnel

SANITARY FACILITIES

I R Cleanliness
19.

Tobacco use

=

AND CONTROLS
31 Water supply

=
c=J

SERVICE EVENTS
40. Temporary food serv icc cv ell"

VENDING MACHINES
41 Vending machines

2{). Handwashing 21. Handling of dishwarc

= = =
[=:J

3.1 Sewage

EQUIPMENT/UTENSILS

CJ 34 Plumbing [=:J)5 Toilet facrlitics 36 I landwashing facilities

= 42. Manager

MANAGER CERTIFICATION
certification

= =
c:::J

22. Refrigeration 23 Sinks

facilities.Thermometers

=

CERTIFICATES AND FEES
43 Certificates and fccs

24. Icc storage.Counter-protector equipment

37 Garbage disposal 3g, Vermin control

INSPECTION/ENFORCEMENT
c::J 44. Inspection/Enforcement

=

12 Self-service

c:::J 25. Ventilation/Stor age/Sufficient ~ 26. Drshwashing facilities

I J Reser vice of food

ITEM NU,\1BERS

COMMENTS

(continue on attached sheet)

AND INSTRUCTIONS

COPY OF REPORT RECEIVED
DH Form 4023. 1/05 (Obsoletes

BY
Editions)

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