FOOD INSPECTION REPORT
SAN FRANCISCODEPARTMENTOF PUBLICHEALTH
ENVIRONMENTALHEALTH BRANCH

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1390 Market Street, Suite 210, San Francisco, CA 94102

www. sfd h. or/d h/eh/food (415)252-3800

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PREVENT CONTAMINATION BY HANDS
19 Inadequate and/or inaccessible handwashing
facilities
TIME & TEMPERATURE RELATIONSHIPS
20 Moderate risk food holding temperature
21 Time as a public health control - Inadequate
procedures or records
PROTECTION FROM CONTAMINATION
22 Reservice of previously served foods
23 Food in poor condition
24 Inadequately cleaned or sanitized food contact

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Food Safety Manager:

SECTION1: High Risk Violations(HRV) 7 Pts Each

5 Improper cooling methods
6 Improper cooking time / temperatures
7 Improper reheating of food
PROTECTION FROM CONTAMINATION
8 Contaminated or adulterated food
9 Unclean or unsanitary food contact surfaces
FOOD FROM APPROVED SOURCES
10 Unapproved food source
HIGHLY SUSCEPTIBLE POPULATIONS
11 Prohibited food served to sensitive population
WATER/HOT WATER
12 No hot water or running water
LIQUID WASTE DISPOSAL
13 Sewage or wastewater contamination
VERMIN
14 Rodents, roaches, flies, or other animals
15 Other high risk violation
SECTION 2: Moderate Risk Violations 4 Pts Each
DEMONSTRATION OF KNOWLEDGE
16 Inadequate food safety knowledge or lack or
certified food safety manager
EMPLOYEE HEALTH / HYGIENE
17 Discharge from employee nose, mouth, or eye
18 Employee eating or smoking

Re-Inspection Date:

LicenseCertificate Class No..

D Permit Posted D Inspection Report Posted
Person In Charge: ^_
HRV disqualifies Symbol of Excellence
EMPLOYEE HEALTH / HYGIENE
1 Communicable disease - Unreported or
unrestricted ill employee
PREVENT CONTAMINATION BY HANDS
2 Hands not clean / improperly washed / gloves
improperly used
TIME & TEMPERATURE RELATIONSHIPS
3 High risk food holding temperature
4 Time as a public health control - Unauthorized or
unsafe use

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The marked violations are California Retail Food Code violations and must be corrected.
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DEDUCTIONS:

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FOODFROMAPPROVEDSOURCES
25 Noncompliance with shell fish tags or display
26 Noncompliance with Gulf Coast oyster
regulation
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D Reinspection FeeApplicableFor Violations No. 1 Thru 15
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Signature:

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Receiv^by:

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 SFDPH, Environmental Health Branch

1390 Market Street, Suite 210, San Francisco CA 94102

SECTION2: (Continued)
CONFORMANCE TO APPROVED PROCEDURES
27 Noncompliance with HACCP plan or variance
CONSUMERADVISORY

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Unclean nonfood contact surfaces

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utensils

44 Improper storage of equipment utensils or

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54 Permit / license / inspection report not posted

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52 Unclean or degraded floors, walls or ceilings

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toilet facilities

53 Unapproved living quarters in food facility
SIGNS & OTHER REQUIREMENTS

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PERMANENT FOOD FACILITES

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51 Inadequate dressing rooms or improper storage of
personal items

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No thermometers or uncalibrated

PHYSICALFACILITIES
48 Improper or defective plumbing
49 Inadequate or unsanitary refuse containers or
area or no garbage service
50 Unclean, unmaintained or improperly constructed

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45 Inadequate ventilation or lighting
47 Wiping cloths not clean or properly stored or
inadequate sanitizer

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42 Inadequate warewashing facilities / equipment
43 Unapproved / unmaintained equipment or

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FOOD STORAGE / DISPLAY / SERVICE
39 Improper food storage
40 Improper food labeling or menu misrepresented
EQUIPMENT/ UTENSILS / LINENS

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(FailureTo Comply MayResult in a Citationand/ or Fines)

Rodents, roaches, flies, or other animals

Other moderate risk violation

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Re-lnspection Date:

The marked violations are California Retail Food Code violations and must be corrected.

WATER/HOT WATER
29 Insufficient hot water or running water
LIQUID WASTE DISPOSAL / VERMIN
30 Inadequate sewage / wastewater disposal

SECTION3: Low Risk Violations 2 Pts Each
SUPERVISION
35 No person in charge of food facility
PERSONAL CLEANLINESS
36 Unsanitary employee garments / hair / nails
GENERALFOODSAFEF^ REQUIREMENTS
37 Improperly washed fruits and vegetables
38 Improper storage, use or identification of toxic

Inspectioci Qate:

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Business Name:

undercooked foods

GENERAL FOOD SAFETY REQUIREMENTS
32 Improper thawing methods
33 Foods not protected from contamination

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Location Address:

28 Consumer advisory not provided for raw or

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(415)252-3800

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55 Food safety certificate or food handler card
not available

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56 Unpermitted food facility
57 Worker safety hazards
58 Inadequate HACCP plan record keeping

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VERMIN

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Rodents, roaches, flies, or other animals

ThePermittee hasthe rightto a heafmgif requested inwritingwithin15calendardaysof receiptofthis noticeto show
causewhythe permitto operateshould not besuspendedor revoked;otherwisethe rightto a hearingshallbedeemed

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Non-service animal

REHS:

Noncompliance with Cottage Food Operation

62 No plan review and/or Building Permit
63 Labor law notifications not posted
64 Other low risk violation

^Citation Issued

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Location Address:

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Business Name:

1390 Market Street, Suite 210, San FranciscoCA 94102

Inspection Date:

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The marked violations are California Retail Food Code violations and must be corrected.

(Failure To Comply May Result in a Citation and / or Fines)

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The marked violations are California Retail Food Code violations and must be corrected.

(Failure To Comply May Result in a Citation and / or Fines)

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