ESTABLISHMENT INSPECTION REPORT of Seats I): Page7__ of Vm'ab'khmm . ?Aim '7 Addm /7?7 137?" Score? 4:27 337 Telephone: Type 0 Retail Type of on. om 759177, Mm mane axempem Fermi-5?13 charge TEEPOWT Caterer Cl Complaint Cl Investigation Inspector ?Wm Wi/f/ 011?? Cl New Establishment A and Protection IVInnagemeot WC 5 Facilities l. PIC mm. :02 4 5 403,404 4 FOOD lnsecta??odonls (+qu 4 2. Food and Wam- rrom mumFood Labeling Icontm'nus 3302.602 1 28? 5-201. 205 1 FOOD PROTECTION . 6?362, 501 2 4. 340I.403.403 4 . Hand- $402,640] 1 5. Focil'm'? hot a: cold holding 3-501 4 . 5501.502 2 a. PHF Coond at cooled 3.501 4 cm: 5202 1 7, 3-301, 302,304 4 62015013406 3. Spottedtoods 3-1m.7ot 2 620mm 2 9. Damaged Foods 6-404 2 . 6402,6403 I to. Pl-[FTltowins 3-501 2 \?cntihtim 4. I ll. Food Protection/Smog: 3-301,305, 306. 6-40- 2 . 6-305 I 12. Food Hm?in; 3401.304 2 Other llFoo-d assuming davicr: 4-204. 201.302 1 JB. McMatcrints 7 2m, [02 4 Persona] Hygienic Practices 39. Comvaisa-y 343m 2 14. Employee Health 220! 40. ?15!?qu ml. 2 15. Employee Hygiene 2401.403 41. $401,202.20] 1 Employer: Clothing 2:3043-402 42. Premise: 6-50l Equipment/Utensils 43 livingmus 5.202 I 17. Sanitation Mathods 4402.703 4 44 ?oat Whmsaa 1 l8. if 4 Pas 6-50] I I9. Foodcontact surfaces 4.202.501. 701 2 Fats, Oil. and Crease Cantu-I Yes No NA 20. Noanood contact surfams 4-IDI. 601 2 lib. 21. Smogcdwiping cloths .47, 22. washing facilities 4-}Dt. 50! .43, Horns: 3-304.4-903 .49 Rmdaingbommu?on 2a. Single son'iccarticlc?Rcuse 3-304.4-so2.9o: 3,9 Mmmw?mhmt?t Minus 20 Pts. (See Reverse Side) Ala/0k kcceivcd his! Non-Critical a Critical 5 r. Score Number DFCriticaJ Violations These items require mitts/1E0 attention rSeaugg??__ FOO ESTABLISHMENTINSPECTION EPOHT A i} ofc M1177 27% hQ/f?pf/ ~29. 074/? Mm MIL 1% ?zz/37L Telephone: 1 Oper??outs): 011ch Type of Inspection: Owner, I ClFood Service El Mub?e ?nw?ne CI 59 DCnlerer DComplninl Inspector: [xi/??777 717.0774 1/ c: Other . ca New Establishment 0 HA . [?ned Protection M?ement 8 Sanitary Facilities - . 2.101. :02 Hr 4 as Sewage 5401401404 -1 FOOD 26. 1:0?me 5-50: -1- 2. 3-201.5-1m 4 27. .. 20015203391? .4 3. Foodlabelinglconlninm 3402.602 1 23 Plumbing $201.33 FOOD 29. 1'0??me 6402.40150l 2 JD. 5-202.le 2 Gmmeidcdisposal 5.501.502 2 32. 00mm 5.202 1 3.30 33. Mddt??ndaukidaWun?m I 34. 2 9. 5-404 35. mm; 62016-303 I I0. par 3-50: 36. \knu'lation - mums-202.30: I n. Foo-d 3.303.305.300. Magma-rm 6-305 12. Food Handling 30301.30: Other dwioc 4-204, 203. 3-02 Practices 13500:! 38. 41. Prunila 16. uipmenUU ?Linen 4-202. 501.on and Grease MOI. 901 4.101.501 3-304. 4-901 3-304. 4-401. 90? . Foodcomanmrl'nm . Non-Foodcomazuurfam cloths . ManuaUMechu-dcnl wan militia . mice u?clulkzuu Homage? Cram: 8 Score Minus 20 Pts. (See Reverse Side) '3 N, . Number of Critical Violations "Dies: items mquixe HVIMEDIATE attention Receiv By 4 ofgem FOOD REPORT Page 4 of m4 a/Ef/i?/ ,2 Add!? jam? ?7 Telephone: 0r Operation?ir Cl Retail Type of Inspection: Owner: 1% [9 Food Service Cl Mobile Routine Cl Relmpection Person urge 19): 0 Temporary CI Caterer Complaint Cl Investigation Inspector: r7 El Other Cl New Establishment Cl HA Food Protection Management I I Facilities 1. Pic 2-10!. 102 4 25. 5-402. 403. 404 4 FOOD 26. [Meets/Rodent; 6-501 4 2. Food and Water approved source 3-2tll. S-IDI 4 Hmcl- 204 4 3. Food Labelinglconlai?ners $302.60?: 1 i 23. 5.201.205 1 FOOD PROTECTION 29. Toiiu Room 6.302.402.501 2 I: PHF Temperatures $401,402,403 4 52016-301 2 5. Facilities hot hcold holding 3-501 4 5-50l.502 2 6. Cooked& cooled 3-50! 4 6-202 Cross contamination J-BDI. 302. 30$ 4 6-202. 5013?206 a. Spoiled foods 1401. 701 2 6-20l 5m 2 9. Dmngul Foods 6-401 2 6-202.6-303 I ID. 3-50: 2 unlmemsm I ll. Food Pmuction?Storngc 2 6-305 l2. Food Handling 3-30l. 304 2 I3.Food'tempemture measuring device 4-204. 203. 302 1 3B. ToucMaterials 7-20l. H12 4 Personal Hygienic Practices 39. 3603 2 14. Employee Health 2-20l 40. HSPanuiremnts 3-801 2 IS. Employee Hygiene 2410!. 403 4 4t. Employ: naming 2-304. 2.40: I 41 mm em I EquipmenUUtensils 43. ?mm #202 17. Sanitation Methods 4.70:. 703 4 44. Linen unmet): I8. Equipmentiutmsil: cleaned sanitized 4-60l. an. 702 4 45. Pet! 6-50] 1 Food comm surfms 4402.501. 701 2 Fats, Oil, and Grease Control Yes No NM. 20. Non-Food contact surfaces 601 2 Spong?hvipingclolhs $101.90! I ?rms: Maimuunnetng 22. MmuaUMerhmical ware washing facilities 4-30l. SDI ?uipmmUme? stoma: 3-30L4-903 anm 24. Single service m?elumeuse 3-304. 4-502. 904 Mm (3mm 1% Non-Critical Critical 3 Score Minus 20 (See Reverse Side) 17 14:11! of Seats REPORT Page_ r? of, Establishment: I a, ?lm/ad a? .1 .r/?Zm ??11 Ad rm: - 9 ?int/(M 3cm" Ii? Ttlephone: I Tfpe of Opemnon(s): El Retail Type of Inspection? LIV . Serv Owner. drizfn??if/ mqm?g?l cod Ice :1 Mobile Wtautinc Person in charge J. 0 '3 Temporary CI Cater-Ir Complaint 0 Investigation I . Other nspec or M??m 7%1 New Establishment CI HA Food Protection Management 5 Facilities I. PIC A?ilnuHKnowledicubldDulJu 2-lUi. [02 4 Scw: 5401403. 4U4 4 FOOD 5501 4 2. Food and Wazcr from approved source 23015-2173. 204 4 3. 3.302.602 I I 5-201 205 I FOOD PROTECTION . ToiIcI Room: 6-302. 402. 5m 2 4. PUP Tcmgigguru ?01.401403 a mum. 5402.630! 2 5. Fuiliu'cl hp! qI 1:916 holdim 3-50] 4 540L502 2 6. PHF kacda-Juulcd mm 5 5-20: I 7. Cross contamination_ 3-301, 302. 304 4 6-312. 501.74% I 3401.701 7: 6-20I.3m 2 5 g. Damaged . 1 6-404 2 . 62016-303 I 10, 2 . th?nl?m +mm.a~202. I ll. FoodetecIionlSlonge 3401301106. MOI 2 Room: 6-305 '12. FoodHIIndh'ng .. 3-30IJD4 '1 13 Food temper-Hum mum-in; device 4-104. 203. 302 35. Toxchachm 1-201. ?12 I Personal Hygienic Practices 39, (hymn-Add?? 34303 2 E4 145:.th Z-ZUI 4 4n, 2 3:11.! - .I 41. Cm?xmmwithACCPle 8?2m.m203 I 16 IWWEL. Ciuthin; 2'304. 2-402 1 41 Pruning 5-561 1 43. 14mm 5-202 1 I 'uIIr clhods . mm m) 4 44- Linc" ?01-30139! 1 #:601 w! 732 4 45- 6-50l I I9. Foodconucuurfam 4-20} 50} q_1 Fats.0il, and Grease CantruL a No NIA 20, Non-Food tonIuI mums 4-IUI, 6m 2 45, clolhu 4401.90! i GranichtmEmMninmang J22 wuhing facilities #305,501 I .1 Gmlamuw?iw 4 23.Equ?pmemlutcnsil storage 3-304. +903 9 Wlmmign Jr 24. Single ?idem-?tense 3-304. 4-502. 904 I Elwin, Item NoNon Guam] (2 Ounce! I: Score nus 20 1? (See Rwerse Side) ate: Li. 8" Number of Critical Violations These ilems require IMMEDIATE attention By of Seats FOOD REPORT Page 5 of 4 ?Mr/147? ?4.45/49 Address. 1/ Scum? Tetaphon?: I I Type of Operationts): a Retail Type 01151506511011: Owner: [ti/Food SEMCO Cl Mobile Woudne Perso ll] charge (919}: C15 [741(- 0 Temporary Cl Caterer Cl Complaint Cl Investigation Inspector 49'; mi 0 Other New Establishment :1 HA c: Food Protection Management - Sanitary Facilities 1. 102 4 25. Sewage 5402.401404 FOOD 26. 6-501 2. Food and Wm: from soul-cc 3-20L5-I01 4 2-3m.5201.204 4 3. Food 1302.602 1 23. Plumbing 5401.205 1 FOOD PROTECTION 29. Toilet Rooms 6.302.402. son 2 4. PHFTempemm-os 3401.401403 4 to. 5402.630! 2 5. Facilldu hotaculdhotding 3-50! 4 5401.502 2 6. PHF Cookul&coalcd 3-51" 4 32. Otnzropmings 6-202 7. Cross canmmimtu'an 3401.301304 33. 6-202. 501.7-206 B. Spoiled foods 3'101. 701 2 34. 6201.501 2 9. 6-404 2 35. Lighn'ng 62026-303 I '10. 3-501 2 36. \Wm 4-202.ml.6-202.301 I ll. FoodProtcctiontStorlgc 1?303.305. 306. 6-40 2 37. DrusingRoams 6-305 1 12. Food Handling 3-301. 30: 2 Other l3.Food temperature ramming (twin: 4-204. 203. 302 I 38. MMatc-dnls 7?20l,102 4 Personal Hygienic Practices 19. ComnuAdet-ory 34503 2 l4. Employcc Health 2201 4 40. 115?qu 3-301 2 15. Emptoyu Hygicn: 2401.403 4 $201,202.20? I I6. Emglorcn Clothing 2-304. 2-402 2. Pttmiscs 6-501 1 EquipmentiUtensils 43. UvingAmts 6-102 1 l7. Sanitation Methods 4-202. 703 4 44. Linen $001,802,803 18. cleaned ksnnitimd 44501.601702 4 45. Pets 6-501 1 19- Foodmnm surfaces 4-102. 501.701 2 Fats, Oil, and Grease Control Yes No NA 20. surface: 4401. 601 2 .15. Spongc?wiping cloths 440L901 I ?m 22. Manual/Mechanical Wm wuhlng facilities 4-30l. 501 1.1.Equipmm?uunsl! ttnragc 3-301. 4-903 1 Won 24. Single set?Vic: uticlest'chs-c 3-304. 4-502. 904 I tent Non-Critical Critical ?turd-un- 'UiAI-xh'nun Score Minus 20 Pts. [See Reverse Side) 0011101? 0, Reins 'on Arid/T of Seats FOOD ESTABLIS NT INSP PCTION REPORT Pa 6_ /f0 1717050? Jr [990/ Adam 73% Kai Sm Telephone: Type of Operatjoms): [3 Retail Type of Inspection: om? 5:3/ 05?3?" 5mm El Person in chargeWC): Cl Cotenr Cl Complaint CI Investigation Inspector: #2271441 Other a New Establishment A 1* Food Protection Management 3 Sanitary Facilities d? 210i iuz a 25 may: _"sdozAbmuJ 4 FOOD 25 imemnadcm 54131 4 2. Food and wm source 3-2ot. s-tm 4 .17.. 2-30i.5-2m.m1 r: 3. 34.02.50: I 1 23 Plumbing 5-2ot.2os I FOOD Pnommon L29, mug: Rooms 3393 103.31. 2 4 Haldane: a 1?3: 53016301 2 s, Flcih?u?dt?cmidhotding ?3-5m 4 2L- ommwwuidemm ?3.501.502 2 5. ?31-5015 4 a; 0mm? 6-202 I 1. ma 33m 30mm 4 33. smasotmm 1 a S??adfoods 3-11); .1, 34. momma 5201,50: 2 room I 64-94 2 35. um? 6202.6-303 IO - ?n 2 3G. Vantilntion t1 1 31. Dmianooms 5305 I ?_Food Handling 1 Other device #2043011?): I 4 3 1bg cMu?Haig 1.201 Personal Hygienic Practices HUI 4 I . r?l_4g3__ z: Cbnt?mnoncewithHACCPle E-ZKHJOLZM l6. zoo-1.2.402 2. mm 5-501 . Li 6202 d- 103 44.]..inm 4.501.302.1103 4-60! Pan $501 $202. 501. ml Fats 4-t01.60l am?, 4- 1.901 3404,4403 I9. Food contact surfaces No 20. Non-Food contact surfm cloth: in. MmuaUMechmicu urn?r: wuhing mitiuu H?quipmu?utcmil 24. Single: mint: Welcmusc Gm . RmbingDoctumnmiou - Non-Critical a Critical 5 Scone Minus 20 Pts. (See Reverse Side) Number of Critical Violations 631 These items require IMMEDIATE attention Reocived By Inspectehy of Seats FOOD ESTABLISH ENT INSPECTION REPORT 14 1 /5 A fags? 0f Establishment: Date: a? /?22 ?7/7 Telephones 1 El Retail Type of Inspection! Owner: 2 Food Service El Mobile El Routine CI Reinspection Pcrso :1 charge? ?919/ a. '3 Temporary Cl Caterer Cl Complaint WW Other CI New Establishment a HA 0 Food Protection Management 5 Facilities 1. PIC Aniand??n-owicdicubldoutics Z-IOI. [02 4 5 403. 404 4 F001) 26. 6-50I 4 2. Food and Wm l'mrn approved snort: 3-201. s-aon Food iconulilum 3-302.601 23. 5-21?, 205 1 FOOD PROTECTION . Toilct Room 6-302. 402. 501 2 4. 3-10l.402. 403 4 Hand: 3202.530] 2 5. Facilities but cold holding 3-501 4 5-501 502 2 E. PHF Cocky! cooled 360i It Om: 6-202 I 7. Cross coonmination 3-301. 302. 304 13, 62012. Sill?o'l?? I 8. Spoiled foods 3-l0l.701 2 6401.501 2 9. Damaged Foods 5-404 2 62016-303 1 ll). 3-50l 2 Ventilm'm 4-20120-l?-201301 I ll. Food Hulmriom'?mlc 3-303. 305. 306. 640? 2 . Ramos 6-305 12. Food Handling 3-30I. 304 2 Other 13.Food tampamum measuring device 4-204. 2133. 302 38. Memorial: 4 Personal Hygienic Practice: 39. Consumzr 3.603 2 l4. Employ? Health 23201 4 40. 3-80] 2 15. Employee Hygiene 2-401. 403 4 41. 11-20120; 203 1 161 Employc: Clothing 2-104. 2-4-02 1 Prum'ses 6-501 I @202 I I7. Sanitation Methods 4-702, 70] 4 4-1. $801,802,803 1 l8. Equipmolfutmsils clawed sanitized i$60] 602. 702 4 6-501 I I9. Foodconmct surfaces 4* 02. 501. 701 2 YES 20. Non-Food contact mom ?01.601 2 11. Spangulwipin; clams $101,901 I 22. Manuallehardcu wan washing facilities 4-31". 50] I Home 3-304. 4-903 1 24. Sing]: service middling: 3-304, 4-502. 904 Non-Grilles] Number of Critical VlOliiLlOI'lS These items require IMMEDIATE attention Critical 5 Score Received By Minus P15. (See Reverse Side) #ofSeaLs FOOD ESTABLISHMENT INSPECTION REPORT Page a of. I (5/7747; 9/742 ?mm" 925-174;" 44/470! . sum? Telephone: 1 I 0" Opemlion(s): Cl Retail Type of Inspecting; Owner: Wood Mobile ?Routine Cl Reinspecuon Person in charge (PIC): 0 Temporary 0 Calem a Complaint Investigation Inspector 7917/12, 0 Other 0 New Establishment El HA. 0 Food Protection Management an] Facilities I. Pl?inm?u?d?u?u 2-I0I. 102 4 25. a $402,403 404 4 FOOD Modem 6-50l 4 2. Food and Wuufmm nppruvcd 5002:: 3401.540] Hand- 2.30; 5. 204 4 3. Food Labeling [containers 3-302. 602 13. mm 205 FOOD PROTECTION 29. Tnilel Rooms 6602.401511] 2 I 4. PHF Tanpualurts 34m. 402. 403 4 mdmda 5202mm 2 5. Facililin ho! acold homing 3-3CII 4 5-501,502 2 6. PHFCoomacooIad MM 4 6-202 I 7. C2055 cunmninuion 3-30l. 302. 304 4 6-102. 501.1206 1 II. Spailadfoods 3-I0I.70I 2 6201.501 2 9. Damaged Foods 6404 2 6202.030: I 10. 3-501 2 maiden 4-202.204.6-202.304 I Food ProtecliowSIm-nge 3.303. 305, 306.640- 2 . Rnoms I Food Handling 3001.304 2 Other Ill-bod mulling device 203. 302 I 38. 70:7ch 1201.102 4 Persona] Hygienic Practices 30. Consumer 34503 2 Id. Employee Hahn 2'20! 4 3-80! 2 Is. Empioync?ygiwe 2-40I.403 I. ?01.202203 I 16. Employa: coming 2.204.2402 I mm 6-50: I EquipmcnuUlens?s 6-202 I I7. smudon Malinda 4 44. Linen 4-00I.802.803 I 18. clawed a: amazed 4-60I. 602. 702 4 5-501 I 19. Food contact surfncu 212202.501. 701 2 Y8 No 20. Non'Foad cmmsurfaus 2 2L Spongum'ipina clolhs 4401.901 I 22. was walking facilities 4?312?, SDI I 13 Equipmmu'ulcruil storage 3-304.4-903 I 50.31: service articleszcusc 3-304. 4-502. 904 I N0. Critical 5 Score Mi 20 P0. (See Reverse Side) Cl Non-Critical Number of Critical Violations These items require MEDIATE altention Received By #ofSeats 1' FOOD ESTABLISHME REPORT of I E?mhuShmeI-il: Date: Address: 1" ?214?, Scorn: :0 Talephone; . . . rT" ?r Type oi? Operation(s): Retail Type of Inspec?iioli: Owner: 5' would Service El Mobile ?ltoutine Cl Person in charged? CI TcmPornry Cl Caterer Complaint Ci Investigation Inspector: 79/7.? 11/ Olhtl? ONew Estuhlislunent HA l? Food Protection i Sauna-j Facilities I 2101 H11 .1 25, Sewage 5402.001404 4 FOOD 20. Mill 4 .. 2 source $201,540! 4 27. 2-30i 5403.201 3 Food Labeling ionntninm 3002.002 1 20. Plumbing 5200205 I FOOD PROTECTION 29. Toilet Rooms 0302.402. 501 2 4 JAOIJDEJOI 4 3o_ Hmui-Wuhihgmc?lmls 5.201_5.3o1 2 5. Facilities holding 3-501 '1 i1. 1 5. l?iiF Cookcdmoolad Mill 4 ,1 gm. 7 Cross conuminlulon $301,302.30: 4 31 Puticidui?oden?depllmion 5.2111501'7.m 3 3491.701 2 34. I 6-20l.sol 2 Damaged Food: 0404 2 35, Lighting 0202.500: ?l lo. 3-50I 2 36. Ventilation +m204.620110t Plotlftion?lomsc 2 11'. . 6-305 1 12. Foodllundlillg 3001.304 2 Other 13.0000 4.201.203.302 1 33. Personal Hz?t?it Practices 39. 3-603 2 i4. Ernpioyee Health 2201 l: 4 40. HSPRequim'nam 3-301 2 rli. Employu: Hygicnc _q 2-401ni03 4 4i. 0201.20L201 10. Employee 2-30-0240: I 41 mm 0501 _1 3. 0-202 -2 I 17 Sanitation Methods 4402.703 4 44. um, 4-001.2..-- 6.50; I 19. Foodcantact sumac: +202. 501. 70! 2 Egigr?sg gal-11ml Yes No 20. Non-Food 4401.60l 2 ?mmur?wlm?ugn 21. cloths 47. 22. MnnunllMuhmiul wan: washing facilities I 4-30l.50i 21EquipmonUulcn-tilttomg: 3-304.4-903 i 49 Mw?mumnuiun 24. Singleun'ice 3-304.4-502.904 I pummel m1 Non-Critical Critical 5 2 Score Minus 20 Pts. (See Reverse Side) Number of Critical Violations These: items require WEDIATE attention #ofSeats i) ESTAB INSPECTION REPORT 5236! 4 of .5 Eliahlishmeut: Date: ?g?iyy? dross Score: 2? 7&Type of Opemu0n(s): 0 Retail Type of Inspection?: Telephone: .r Ovmer: 52/ Food Cl Mobile Mloutlne Reiuspeclion Person to Manage 30.1; 0 Temporary 0 Caterer El Complaint CI Investigation Inspector Mi?? 0 001" New Establishment A Food Protection Managemem 5 Facilities l. PIC mapmuwedgeebmmoes 2-101. I02 4 . 5-402. 403. 404 4 FOOD [moclsf?odenu o-sm 4 2 Food and Wm: from scum: 3.201. 5401 4 . 22.01.5203. 204 4 3. Food 1-302, 602 I 23 5-201, 205 I FOOD PROTECTION Toilet Rooms 6-302. 402. 50! 2 4. Tompcmuns 340i. 402. 403 4 6-301 2 5. Facilities ho: a cord holding 3-501 4 5-50! 2 6, PHF Cooked cooled 3-50I 4 6-202 I 7. Gem comamlnm'on 3-301. 302. 304 4 6-202, 7-206 I B. Spoiled foods 3-101. 2 020 501 2 9. Foods 6-404 2 6- 6-303 I I0. PHI'Thowin; 3-501 2 Won 4202.204. 1 It. Food Bolu?oNSIotagc 3-1D3.305. 306,640- 2 . I I2. Food Handling 3-301. 304 2 Other l3.Food umpemmre measuring dcvicc 4.204.203.1102 I as. momma: 7 _7?201402 4 Personal I-lxgienjc Practices 39 Cmmu?dvisuy 3-603 2 I4. Ernpluym Health 2-201 4 40. 1159:2qu 13m 2 l5. Employu: Hygicno 2-40I. 403 4 41. I Hi. Employer causing 2-104. 2402 I 42. mm 0-501 I 43. mm 6-202 I I7. Sanitation Means 4102.703 4 44. Linen . 4-30I.802.503 I I0. cleanu!& sanitized 4.601. 602, 702 4 45. Pa: 6.5m 1 I9- Food com iurfam 4-202- 501- 70' 2 Fats, Oil, and Grease Control Yes No NM NoneI-?ood comm surfaces 440]. ISOI 2 45 clout; 4-10] . I 4? E2. MonualIMochnnical wm washing faciliLies 4-3CII. 50! I .23 Equipmb?utcnnil stung: 3-304. 4-903 1 .49 service anrcluchusc 3-304. 4-502. 904 1 5g ?Wm?acnmpuln #9030916! I Item Na. 2 - 7? . .424 ?47 20 P45. (See Reverse Side) Non-Critical Critical Score gamma Number of Critical Violations These items require IMMEDIATE attention Received By 01 of Seats INSPECTION REPORT Page?L of 2 Establislunent: ?WjI/i/,l_ E: ?44?22! I Date: Address: 6L Score. Telephone: I i Type of?pemtionm: Type . Owner A Wood Mohllc Mainline El Person In charge 0 Temporary Cl Caterer El Complaint Investigation Impedanm?-?l #0717 c: Other 0 New A Fond Proteclipn Manggeinent 5 Sanitary Facilities I. 2- {02 4 1'5 Sawagc -. 4 i FOOD 26 6601 4 1 Food and 3- 20! 5 ml EL 4- 27. 2.30I.&203.2m 4 3. 3-302 602 I 28 Plumbing 1 ?001} PROTECTION 29. Talk! Rooms 0302. 402. set 2 4. 3401101403 4 30. 54015-3!? 2 :qu holding 3- 501 4 $501.50? 6 PHF Cookcd&toolcd 3-501 4 32. Cummings 6-202 1 7. 3 301. 302. 304 4 33. 0202. 50I.7-206 1 we. Spoifcdfoods 3401. 70: 2 34. 6.201.501 2 9 DamagedFoods .J E49}h_ 2 PM.-- 62016-303 1 ID. 3-501 2 35. Wutilulm I ?ood Mucuowmmge 3.303.105.300.mt 2 W?gnm 0305 I 12. Food Handling - 2301.304 2 Other 13.Food 0204302302 I 33 7.201.102 4 Persona] H?ienlc Practices 3,9 Communm 3,123 2 114?. Empram Health 2.201 4 40 2259:2qu 34101 2 :5 24011403 4 . 16. 2404.240: 1 42. Hanna 0501 I 3. UvingAmas 0202 1 NUMEM i ?02 701 - 1 Miami a 45. Pan 1 l9. ?1mm 4-202. 501.70l 2 F115,Oilla1d Grease Control Yes No 20. Cantu: Iurflm 4-lUl.50l 1 46. . Spongulwiplng cloths 4-IUI.901 1 4.1. 12 4-30L501 I .23, 3604.430} I 49. RmhrinrDommN-alim 24. Single 0min mucxcumm I St]. Item Non-Critical Number of Critical Vtoiations Critical 5 2 Score These items require IMMEDIATE attention Minus 20 Pts. (See Reverse Skit!)El Reins?W Received By Inspected #of Seats FOOD ESTABLISHMENT Mnd?p/ ZZW 7 Adams: 243 571/51/7" Telephone: TYPE 01' OPENUODIST CI new Type of Inspection: Owner: 19/4/4227 mm Smite Cl Mobile WRoudne Cl Reinspec?on Person in charge (PIC): CI Temporary 0 Caterer CI Complaint CI Investigation Inspeclor M4971 7917? 21/ CI Other 0 New Establishment A Food Protection Managemen?t I @011in Facilities? 3.. I. 2 If)" 25. Sewoge 5402401404 FOOL: 26. InsecuIRodcnu 050: 4_ Food and ermmoppmvoosoomo 3201.540: 4' 27. lW?-wuhingfadlid?! mu 4_ Food 3402.002 I 20. Plumbing .. 5.201.205 I FOOD PROTECTION 29? Toilet Rooms 0.302.402.501 2_ PHFTommem 159140.. 403 4 30. mimimmuwds 5.2020301 2 5. Facilities ho:&coldhulding ssof .1, Garbagc?e?uefmuidedispm? 5-50l.501 2 6. PHF Cooked&coo1ed 3-50! 4 32. Qmopenings 15-202 7. Cross 'n 3-JDI.302.304 4 33? 6-202. 501.12% I a. Sponoo 1'0sz 3-I0I.10I 2 34. Woman? 6-20LSOI 2 9. DomuooT?ZooE i ?6404 2 35. Lighting 02020301 I I0. 7? w" 5:537" so. mamas-moo: II. Food PrntuctiunfSIamc 3.301.305.300vo 2 37. mum 0305 I2. Food Handling 3.301. 30: 2 Other I3.Food mcas'?ri?g device 4400.203. 302 I 30. ToxicMmerinls 7-201,qu Personal Hygienic Practices 39. Comm: 3-603 14. momma-mm 2.201 4 40. soon I5. Employee Hygiun: 240:,403 4 Coormmwimmnm I5. Employ-2c nothing 2.3002402 I I 0-501 6-20.! 4-!0l 802.803 6-50l U'Uteusils Sanimdon Medic-d! 44.Linen 4-702, 703 $601,602. 702 4-202. SDIJOI 4-l 601 4-10I. 90! 4-301, 501 3-304. 4-903 3?304, 4?50224? cleaned smiliud Food contact surfaces Non-Food contact surface: cloths ManuallMechnnicnl ware utensil Single service m?clw?ReI-u: . facilities u?o?u?HM?-h NomCrillcal Critical Score Minus 20 Flo. (See Reverse Side?: A kl/n- h, . (H Ilr? I of Seatsmm FOOD ESTABLISHMENT INSPECTION REPORT pagg r' of i . 1? 4:1? A A Establishment/q Dale: 7r Mew/W" Score? my Telepho?t?t'e: 1' . ?Jr/7 We 0" Operationts): 0 Retail Type of Inspection: Owner: $17005 Service Mobile Momma Cl Reinspec?on Person in barge F): 2" I El Caterer El Complaint 0 Investigation Inspector: 1/ Other 0 New Establishment El HA Food Protection Management 5 Sanitary Facilities 1 1, PIC 2405 102 4 15. Sewage $402,403.404 4 FOOD 26. 660] it 2. Food and wine: from approval source 3401, will 4 27. Hand-wn??ngfx??d?lm 204 4 3. Food Labeling {Comm 130:. 602 23. Plumbing not. 205 I FOOD PROTECTION Tuna: Room 5302. 402. 501 2 4. 3-40L402.403 4 30. Hmd-washingmethuis 54016-301 2 5. Facilities but it cold holding 3-50! 4 'll. 5501.502 2 6. PHFCoolted actuated 3-501 4 32. Otueropenings 6-202 1 7. Cross contamination 3-30l.302. 304 4 33? MW?delha?m $201?$134?? 8. Spoiled foods 3-IOI. ?0l 2 34. 6-20LSOI 2 9. Dainajtdt?oods 6-404 2 15, Lighting 62mid-303 10. PHF Thawing 3-50! 2 345. Ventilation 4202.2046-m304 Food Pt?t'il?tt'?ni'Sio'tug: 3-303.sos.3oe.s4o 2 37. 6-305 Food Hendiing 3.301.304 2 Other 3.Food muting device 4?204. 203. 302 38. Millet-?ats 7-201, [02 4 'ersonal Hygienic Practices 39. 3-603 2 4. Employee Health 2-20! 4 40. 3-80l 2 5. Employer.- Hygicn: 2-401, 403 4 41. $201,302.20] 6. Employee Clodiing 2-304. 2402 42. Pumists 6-501 I iqmpmenthtensiis 43. mm 5202 I Sanitation Methods 4?102. 703 4 44. Linen 3. Equipmnmitcit?ls donned 5: sanitized Hill. 602. 702 4 45. Pets 6-SOI I 9. Food nonwuurfuu 4-202. 501- ml 2 Fats, Oil. and Grease Control Yes No Hill 0. Non-Food contact surfaces 4-101, 60! 2 4G. I. Sponsc?nrioina cloths I 47' 2. ManueUMecttonicni won washing facilities 4-30I. 501 43, l?quipmmb'uten?tuorege 3-304. 4?903 .5, 4. Single service nnicineusc 3-104. 4-502. 904 50. Non-Critical Critical 5 store Minus 20 Pts. (See Reverse Side) \i umber of Critical Violations LL these items require IMMEDIATE attention cceived By #ofSeats INSPECTION REPORT fa) of 34/44/71 Jf 671 Telephonr .- . I f? Tm of Opemtionlsh EJ Retail Type of Impoaia?: Owner: ?fly?z??w? Service 0 Mobile WRouune El Reinspecuon Person in charge E) Temporary CI Caterer Cl Complaint Cl Invu?gadon Inspector: I Other Cl New Establishment Cl A Food Protection Management Facili lies I. PIC AssignedJKnowledgooblelDu?es 2-101. 102 4 15. 404 4 FOOD 26. InsecuIRmienu 6-50: 4 2. Food and Want from approved source 3-2m.Food Labeling $302. 602 28. S-ZDI 205 1 FOOD PROTECTION 29. 1mm Rooms 6-302.403.501 2 4. Tempemturrs 3-40I. 402. 403 4 methods 6-30I 2 5. Facilities hol cold holding 3-50] 4 5-50LSOZ 2 6. Cooled cooled 3.501 4 6-202 I 7. Cross conuminotion 3-301. 303. 304 4 6-202. 50l.7-206 B. spoiled foods 3401.701 2 5201.501 2 9. Damaged Foods 6-4-04 2 64016-303 I 10. PHF Thawiog 3-501 2 V?'ltill?m 4-202.20-l.6-202.304 I ll. Food ProtocooruSIoI-agc 3-303. 305. 306. 640i 2 . 6-3-05 I Food Handling 3.301.304 2 Olim- lJ.Food measun'nidevice 4-204. 203, 302 I 38. 7mm 7-201. l0). 4 Personal Hygienic Practices 39. CommAdvisory 3-603 2 Id. Employ-co HeaJIh 2 101 4 40. HSPRequiIemml: 3-30I ?2 IS. Employee Hygiene 240i. 403 CodmoeewimHACCPl?lons 0201.202520] 16. Employee C?lolhing 2-.301 2-402 I 42 Premises 6-50! i EquipmenU'Uionsils 43 UVingAms 6-202 I 17. Sanitation Memos 4402, 703 4 44 Linen I 18. Equipmndulmsil: cleaned 5r. sanitized 602. 702 4 I15 Pets 6-50I I 19. Food canine: surfacm 4-202. 50!. 2 and Comm] Yes No NIA 20. NonvFoo-d contact Mm: 4401.60! 2 Spongedwipin; clout: 90] 01m Mum-2mm: 22. ManuaiIMechmicai won: washing foeililies 4am. 501 i il?quipmemfulemil sioragc 3-304. 4-903 1 24. Single service mieiWReuso 3-304. 4-502. 904 i Side) Re. Minus 20 ?n W??n?nn.n Non-Critical Critical Score x? . #ofScaIs LISHMENT INSPECTION REPORT of ff? 55 ?g 1/ Add? #22; S76 SW {92? Telephone T1, 1 Type or Operatioms): CI Type orInSpection: Owner: .107 ?a Food Service Mobile Mtoutine Reinspecllon Person In It arge 1C 2211' ?3 Cl Caterer Cl Complaint 0 Investigation Inspector: {?801 CI Other CI New Establishment CI A Protection Manggment 3 Sanitary Facilities . 2-101. [02 A '23. garb Lag-402. ?clam 26 6-50] 2. Foodand erfmm source 4 :27. M?whinianhljufgum -. 2-3015-291204 32302.60: 18 Plumbing A 5- 201. 205 '4 . 33 jrouunoocm 6-3014_Oi_5_9t_ 2 PHFTumpemlm: 3403.401403 4 30. 54016-30! -1. 5 Facilities hulacnld holdm; 7 ll Garbagdm?ndauuidcd?nuf? -. 5-SUI.502 6 PHFCookcdaccoolcd 3:54.? 4 32. 0111:1051:an #51202 7. Wucmy??on 3.301.301304 4 33. 5221725013205 I gamma: A mm. 2 34. mow-Imam 6201.501 2 9 Dmugchoods 6404 2 35. um?; mom-303 4_ I '10. 3-501 A I 36. Ventilation 4-m204.6m.304 For?PmIchiWSlomge 3-303.305.30b.64m 2 31. __Dm:i_rIEme Laws I2. Food Handling 34m. 304 17' 2 Duaer Inn-luring devimm - I 4.204.203.302 I 23?3' 4 Personal Hygienic Practices 345m 1 fw?nmm 2.20: 4 34am 2 1.4011403 4 EtoIhi_ng,_ 2-301. 2-402 I 42. 9591..-.--3 EquipmenUUIens?s Live-gm 6212 33 Samarium Mum-5h L?yos 4_ L13 m1 802.303 I WWHM I 45. Pet: .2 b??91_ '9 ?20de mm? 4-201. 501-70! 2 E215, Oil! and Grease Control E- No 71). Nan-Foodcnnucuu?uu 4-IUI.601 2 M, . . 4101.901 I 22 pimuaUMcchanicnl warn [mum 4-301. 501 23.EqqummUuIcnsil Image 34047;; -. _h i? Dmumnlulim 14. Single scwicc nrticlw'Rcuu I Non-Critical Critical Score Minus 20 P13. (See Reverse Side) Number of Critical Violations These items require IMMEDIATE attention Received )1 ed 3' of Seats -- . F9400 ESTABLISHMENT INSPECTION REPORT of Date: $4175,? 35111111511111?? M51255 1:151/ Mm? 51.7% [jg/17% . 7% Telephone. . me of?pemtionm: a 11mm Type or 1115;111:1195: Owner: 6 i3 /72va CI Mobile 31201111112 CI Reinspection Person' 111 arge 0'1??me CI Catcher Complaint 0 Investigation lnsputonmj? My 0 0?31? New Establishment A Food Protection Manggement 1. FIG 2-101. 102 4 F1301) 2. Food and Wm from amps-:11 source 3-201. 5-101 4 3. Food 3-302.602 I 1 FOOD PROTECTION 4. 3.401.402.4113 4 5. Facilities hol k. cold holding 3?51? 4 6. Cooked cooled 3-501 4 7. Doss conh'unimtinn 3-301, 302. 30-1 4 a. Spoiled fuods 3-101. 701 2 9. Diana's-d Foods 6404 2 IO PHF Thawing 3-501 2 ll. 3-303. 305. 306.641} 2 12. Food?lndling 3-301. 304 2 llFood measuring device 4-204. 203. 302 I Personal Hygienic Practices I4. Hullh 2-201 4 15. Employ-:1: 11331131111: 2401.403 4 16. Employ: Clothing 2-104. 2-402 I Eq?pmenWtensiIs I'l. Sanitation Muhoda 43702. 703 4 8. Equipm?ulmulx cluncd ?1 sanitiwf 4-601. 602. 702 4 9. Food mum: Mm 4-202. 501. 701 2 10. Non-Food comm: swim 4-101. 601 2 11. Spungnm?pini cloths 4-101. 901 1 wan: washing Militias 4-30l. 501 I 3.E1.1uipm?u1ens? ?mac 3-304. 4-903 I 4. Single m?ce micluIRcuse 3-304. 4-502. 904 I Non-Critical Critical {umber of Critical Violations Phase items require IMMEDIATE attention Score MI Received By 211 P15. (See Reverse Side) NC 5-402. 403. 404 6-501 . Hand- 2301.520] 204 . 5-201. 205 19. Tune! Rooms 6- 402. SDI mlhods 54015-301 5-50l.502 6-202 6-202. 501.7106 6- SDI 520316-303 4- 201.6202.? 6.305 $201. 102 14503 3-501 5-501 6-202 4301361803 6-50] . Comm 411. 41. Ccufamwiuam?m amiss 44.11am Pm and Grease 01111111 es 511111.111 Wm Dar of Seats FOOD INSPECTION REPORT Page 11/. 12:5? Dali/r/y-? 2 Address: #hrm?i? . Score: Telephone. 3 /2 A I Cl Retail Tyne of lnspec'?ou: Owner: Food Service Mobile ?outine El Relnspectlon Person charge; Air/[M Cl Caterer CI Complaint CI Investigation tor: Other 'Inspec :25, DHACCP Food Protection Management 5 Sanitary Facimi?o 1. PICMIgnod?-Znowlodguhldbuliu 2101.102 4 25. Smog? 3?102. 401?_ FOOD 26. Uncommon 0501 3. {ii-boo and Wm from Ipprovedsourc: 3201. 5-101 4! 4 22 301. 5203. 204 I 3. Food Whil?fmn?im 3.302.602 1 5 201. 205 FOOD PROTECTION 20. 1?0ch Rooms 2 4. PI-{FTompL-mlum 3401.402403 4 30. M?m 5202,1330; 2 5. Facilities hm mom honor-g 3.501 4 31 wamo? 5 501. 502 2 6. PHFCuokod1?cnolod 3-501 4 32. mm 1 7. 3.301.302.3114 4 33. mum 5202. 501. 3200 1 1 a. 3101.201 2 34 Runyon-cams o201. 501 2/ 2_ 9. managed Fm 15-404 2 15. 113111111; 13202.0303 10. 3.501 2 30 1213111112111 4.211220415102301 L- 11. Foodl?ruloctiWSImgc 3303.205. 3013. 6-401 2 32. mensw__ . 51.305 1 12. Food Handling 3301. 304 2 Other l3.Food umpmuurc measuring device 440-1. 203.302 I .38 ThaicMalainls 1201.102 4 Personal Hygienic Practices 39. mm 34103 2 14. Emptoroc Hcalth 2-201 4 40. IEPRoquia-unmls 3.1301 2 15. Employou 11mm.- 2401.403 4 41. $201,202,203 1 16. Bmployco Gaming 2.3042402 1 42 mm 0501 I EquipmenUUtons?s 43. 1.1mm @202 1 17. Sanitation Mclhods 4.702.703 4 44. Linen 4301.1302203 I I8. clmod&saoitimd 4401.601702 4 45. Pm 6-501 1 19. 4-102. 50!. 701 2 F2115, Oil, and Grease Control Yes No NA 20. Non-Foodconmuurfuos 4-l0l.60l 2 415. 4-lDI.90l I 41 22. Mnnuob'Mcchanicol wort. washing facilities 4-101. SDI 1 4g GmWSime Hicwipmcoo'utensil 51m: 3304,4303 49, Rmduing?nwmmim 14. Single service or?clul?cuse 34040-501904 I 5.11 em Non-Critical 2 Critical 5 Score 4'44 2?2! Received By 2 Minus 20 We Rove 2 deo) Number of Critical Violations 11105:: items require IMMEDIATE attention of Seats FOOD INSPECTION REPORT Establishment 47-. ilku/ erM/ 59/ Add? .20 Hm mam-,1 SW- Telephone. of Upemtionts): Cl Retail Type of Inspection!? Owner: J: Food Servin- CI Mobile Wanna: 0 Reinspectlon Person In charge Ht; . '3 Tcmnor?l'y Cl Catam- 0 Complaint 0 Investigation Inspector. W?m Other CI New Establishment DHA Food Protection Mangernent I I 3 Facilities I. PIC lUl -I Swag: ll. 401.401 FOOD 25 Manic-us"? 6-501 Food and Water from approved scumFood Labeling (container: 3-302. 602 I 25. 5-201. 205 I FOOD PROTECTION 29. TuiktRooms 6302.402. 50! 2 4 PHF 340i. 402. ?193 4 5.202.540] 2 5 Facilmrs he: 8: cold holdmg 3 501 4 5.501.502 2 6. PHF Cookcd a cooled 3-50] 4 5.2111 1 7 Cross 3-30]. 302, 30-1 4 5013.205 I 8 590in Food: 3491.3? 1 $201.50] 2 '5 EonTEg-cd 50;; 1 5-404 2 ammo: I PHF'nIawIng 3-50l 2 4-m20452m. It. Food I 37. I I2. 3-30I.304 2 Other Food maturing omen $204. 203, 302 I 7 Fm "3'1 4 Personnl Hygienic Practices 'mumy__ 2 I4 Employ? Health 220! HSPRequ'mmu Hm 2 t5. Employcc MN. 403 8-20l.202.203 I I6. Em_ploiccCInIhIn_g_ 2-304. 2.402 I I 42. pm "3 6-50! I Equipmen?UtensIIs Wm 6-202 1 l7. Sanitation Methods 4?702, 703 4 44? um" $801,302.80] I at momma +601, 602.702 7 6-50! I I9. Food contact-Mm 4-202. 50l- 701 2 Fats. Oil. and Grease Control 33? 33 Yes No NM 20. Non-Food conuctaurfm 4-IUI.GOI 2 46. Guns: cloth: 4401.90! I Gm 22. (utilities 4401.501 Gm stung: 3-304. +903 0??an 24. Single urvic: m?cle?sma 3-305. 4?502. 904 I Auu-gmAI-rnnu-Compllanm Non-Critical Critical Number of Critical Violations so Score These itcms require IMMEDIATE attention Minus 20 Pts. (See Reverse Side Roccived By of Seats FOOD ESTABLISHMENT INSPECTION REPORT Page 4 of .: Score: Type of Routine Complaint New Establishment Cl A 11(5): El Mobile El Caterer We ervice C1 Temporary Other TeIephonc: ec Owner: Petsau charge Inspector: Reinspectlon Invatigntion Food Protection Management. NC Asigna??nowlalguhld?udcs 240:. I02 1 4 5-402, 403 4 FOOD InmuJROd-znu 6-50I 4 2. Food and Water ?um source 3.20:. 5401 4 . Hand 2. 204 4 3. Food Labeling i tannin-:1: 3-302. 602 5-20! 205 I FOOD PROTECTION . Toilet Room 401 501 2 4. 3-4OI.4U2.403 4 SDI 2 5. Fnc?i?u hm cold balding 3-50! 4 502 2 6. PHF Cookcd corded 3.501 4 6-202 7. Cross contMniMlion 3-301. 302. 304 4 6-202, a. Spoiled foods 3- IOI. 701 i 6.201.501 2 9. DamagedFoods 6-404 2 6-303 I 10. PHF Thawing 3-501 2 ?I?cmihm'on 202.201.6102. 304 i Food Mud?ats: 3-303. 305. 306. 6-40- 2 7. 305 I i2. FoodHandling 3-301. 304 2 Other I3.Food lampdalure rrmuing dgvic: 203. 302 I 38. Thxican'nls 7401.111! 4 Pa rsonnl Egg-mic Practices 19. Conwhd?suy m3 2 I4. Employcc Health 2-20! 4 40. 340! 2 I5. Empluym Hygicn: 240i. 403 4 41. $101,202,203 16. EmpInm (Talking. 2304. 2-402 I 4'2. Pmnisu 6-50I I Eq 43. um $202 I Saniulioa Mclhods 4-702. 703 4 44. Linen 8. cleaned smilimd 4-601. 602. 702 4 45 Pets 6-50] I 9- Foodmmci MING 4401. 5m? 70? 2 Falls, Oil, and Grease Control Yes No? NM 0. Non-Foodcaum surfaces 4-]0l. so: 2 4E, I. cloths 4-l0l. POI I 47 mwm?mug ?mumhanim] ware washing facilitics 4-30l. SDI I 45, Cum: 3?304. 4-903 I 4:1 ms 4. SingIe servic: Nels/Reuse 3-304. 4-502. 904 I 50, Mm.) ?Item No. Non-Critical Critical 3 Score - Reverse Side) Rampant, fumber of Critical Violations has: items requim WBDLATE attention red Ev of Seats FOOD INSPECTION REPORT /0f .4 Esmblishment: /7 Date: . ., mm SW 149% 27;: Telephone: I, . TYPE 0" Operations): 0 Retail Type of Inspection: Owner: (sf/r QFood Service El Mobile 3Q Routine Reinspection PersonTIi nchargol??y?: I 0 Temporary El Caterer El Complaint Investigation InspectorM/?m W41, 0 Other [3 New Establishment A Food Protection Management Facilities l. 2401.102 4 . 5402.401404 FOOD Insects/Rodents 6-50l 2. Food and Water from approved some: 3-20], 3. Food Labeling {commas 3?302. 602 Plumbi 5-20l. 2115 FOOD 29- Toilet Rooms 6401401501 4 FHF Temperatures 340i . 402. 403 4 Hand- 54016-301 5. Facilities hot &c0ld holding 3-501 4 5-501 502 6. PHF Cached enacted 3-501 . 6-202 7. Cross contamination 3001101301" 7 .7406 B. Spoiled foods 2 6201.51? 9. Damaged Foods 5404 2 6202,0303 l0. PHF Thuwing 3-503 2 Ventilation II. Food PimecuonISImngc 1-301305. 306. 6-40 2 . L2. Food Handling 3-301, 304 2 Other 11le temperature measuring device 4-20-t. 203. 303 I 33, Tnxiemmims 1.201.100 4 Personal Hygienic Practices 39. CommuAdvisu-y 3-603 2 I4. Employee Health 2-20] 40. ?SPltequiitments 3-801 2 Emoloyee Hygiene 2401.403 4 16. Employee Clothing 2-30?. 2-402 42. Premises 6-50! I 43. UvingAx-ens 6-202 1 I7. Sanitation Methods @762. 103 4 4-4, Linen. 4-30L802.803 1 T6. cleaned a: sanitized 4401.002. 702 4 45 Pets 650i I I9. Food 30th Stations 4?202. 501. 101 2 Fats. 0i]1 and Grease Central Yes No 20. Non-Food 4401.60! 2 411 Spongwwiplng cloths 4401.90! 1 .41 22. MnnuaUMechnoical were washing facilities 4-30l, SDI 43 Game mmSiW 23.5quipmen?utensil 510ng 3-304. 4-903 I 49 RutledngDocummian .- 24. Singlesenrice articles/Reine 50* Wimampm Non-Critical Critical 8 Score Minus 20 Pts. (See Reverse Side) Number of Critical Violations These items require WEDIATE attention Received By 0 Rei nspcelio of Seats FOOD ESTABLISHIMENT INSPECTION REPORT Page of . 1 I I Date: {21/4771 2'7: 427/7 Add? :0 ?at/z Sm?- Telephone: 1' I . 1 A TY!)lie 01? Operation(s): 0 Retail Type ol?InsyecLlon: . Owner: 1/ ?q/y'm cWood Service 0 Moblle Routine Cl Person arge (PIC): Aim 0 Temporary CI Caterer El Complaint Inspector: El other :1 New A Food Protection Management I Sanitary l. I112 4 25 Song: 5-402 4W '3 [coop 25 2 Food npmeasourcc 4 27. 2.3014020120: 4 3. 3002. 602 I Tummy 5-20l.205 FOOD PROTECTION 29. Toilcl Rooms 5-302. 401 so: 2 4 PHF Temper-mum 3-401, 1132.461 4 30' Haul-?0005mm 5.332.530: 2 5. Factllues he: 5: cold holding J-Sol 4 Gubagdm?ndouuldedisponl 5.501.501 2 l5 PHF Cookcd& cooled 3-501 4 .1 (.292 I 7- Cum contamination 3-30L302-304 4 33. 5.210.501.1205 I a. foods J-IQI. 7m 34. 91mg: 5201.501 1 .P- pmg?rm 6-404 35. Liming 6.202.030: 10. 3-501 2 36. 1 $303,305,306. 2 31. M50103. 63% 12 Food Handling 3401.304 2 Other 13.50? muting devica ?204,203.30: 1 10 TomMnm?als 7.2010102 4 Personal Hygienlc Practices 39 3003 2 l4 Employ? Huhh 1-20! 44). EiSl?chuiIcmcnu HUI 2 15 Employez Hygiene 2401.403 4 41. ?0:201:03 I 16. Employee crown; 2404,2402 .12. 6-50I Bf?umgm 6-202 1 n. Sunluuon Mclhods 4.102.003 4 u. Lima 4-30l.802.803 I 4.60I.602.702 3573:] 0501 1 I9. Food m. sum-m 4-202. 501.701 2 FaIs, on, and Grease Control Yes No NA 20. Hun-Food mmum?m 4401.60! 2 4.5, Spongeslwipiug cloths 4401.90l I 47, 22. ManuallMechmlul WIN. Wishing facililics 4401.501 1 4a. ZJ?Equipmcnu?ulmil storage 3-104. +903 1 49 ReminnxDommenwion 24. Single ml? mlclul?ws: 3401.4401904 1 f0 Allugmhwunumt?umplinnm190.00ng I: Non-Critical Number of Critical Violations Critical These items require IMMEDIATE attention 8 Score Minus 20 Pls. (See Reverse Side) W??/Qfm Received By .0 of Seats FOOD INSPECTION REPORT Page of .L gal/?r ?f?r/dm/ MA 527/ Add?: d?yp/I S?m- I f? Telephone; 1 . T3110 0" 0 501$}: Cl Retail Type of [aspen on: El Mobile CI?Routine Cl Reinspection Person in charge [139): gr. 1,2? A Ummn El Caterer Complaint El Investigation Inspector: Other I: New Establishment A 9 11V Food Protection Management Facilities l. PIC 2-10t.102 4 25. 5-402 404 4 FOOD 0501 4 2. Food and Ipprovcd mum: 3-20l.5-101 4 - 2-301 203.204 4 3. Food 3.302, 602 1 FOOD PROTECTION 29. Toiicl Rooms 0302.402. 50: 2 4. PHF MMLUH 3-401. 402. 403 4 Haiti $201630] 2 5. hat a cold holding 3-50! 4 5-50l.502 2 6. PHF Cookcd a: cooled 3-501 4 6-202 1 Cum conmminatinn 3-30l. 302. 304 4 6- 5013-296 I 8. spottud foods 3-101. 70! 2 50) 2 9. Damaged Foods 6-404 2 64436-303 1 ID. PHF Thnwing 3-501 2 'i'cntilmim 2022040202304 I 11. Food 3.303. 205.305. 640i 2 . 305 I Food Handling 3.301.204 2 Other llFoo? ramming device 4-204. 201. 302 I 38. ToxicMuuim 7-201. 4 Personal Hygienic Practices 39. Camnw?tdviwy 3-603 2 I4. Health 2.201 4 40. 3-001 2 15. Employee Hygiene 240L403 4 4t. $201,202.20] 1 l6. Empty: atoning 2-204. 2402 1 2. Pumim 6-50I 1 Equipment/Utensils .43. um 6-202 I 17. Snnitadqn Methods 4?202. 703 4 44. Linen 10. cleaned at snnitizui 502. 702 a 45. Pm 5.5m I 19- Food 4-101. 50"- 701 1 Fats. Oil, and Grease C-nnlrui Yes No NM 20. Non-Food contact 51.0fm d?lOlASOi 2 46. Spangnsiwiping cloth: 440i . 901 47? 22. Manual/Mechanical wan: washing facilitics 4-301. 50] I 43_ WMMEW H.59L?pment?ultnsii nous: 3-304. 4-903 .19_ Single service 3004.4402904 i 50. Immatm Non-Critical Critical 5 Score 0 0 ms. (Sec Reverse Side) In5pected By? ?umber of Critical Violations These items require attention Rec-2i By of Seats I FOOD INSPECTION REPORT Page 5 of Establishment 314.! avid/1 if? .73 Ff 3w?: Ag): 1/ Telephone; [3 Type of Operatfonis): Cl Retail Type of Inspection: OWner: 9 SWIM Mobile Minu?ne Cl Person in charge (PI . TcmPornry Cl Caterer Complaint 0 Investigation ImpactorW/f?Establishment a HA (2 Protection Management I I nullify hi. it 15 Scwagc 3402.403 404 4 FOOD 25 mm 2 Food and Walzr [mm mum: 5- [ill 4 2T. Hmd-xmshingfacihti?pnx?um 4 3. J-aom?zm .- 1 25. Plumbing 5.20:.393 I FOOD PROTECTION 29. Toilcrnoams 6-302. 402. 501 2 4 Hal .. 3.4113 4 Jo, Hme?ng?m 5.202.530] 2 5. _thucshoMtculd holding 3-501 4 I. Gal-bagdrc?udwuldedisponl 5.501.503 1 6 3.5111 4 2. "5.292 7 Cmm?nmmr?m." - 3 301 304 4 33. wasn?t-215 I 8. Spoilcd foods 2 34' 5.301.501 1 DmgedFoods 6-404 2 35. ?am Mama: 1 .10. 3-501 2 3L- 4-202.204.6vzm.3m 1 n. Foodrxomuowsmge 3403.301304ch 2 37 DressingRocm 6-305 I 12 Wn?pg l3.301.304 2 Other [+204.2oa.302 1 33 4 Personal?gienlc Practices 39- ?b?f+r -43; 14. Employer mum {2.20: 44). 33m 1 15. Empfoycc Hygiene f! 2519:?? iConfoqnufty?th-AQCFM .. I6. Empl-ryutlmhing [at-33.1193: 42. 9:101 I 43. uVingAm: - _m I I7. Saniwmn Mthods $791,701 4 44 Lug" I la. Equipm?l?uirmi]! cleaned sanitizzd 4601. 602. 702 4 45 pt? .- 5.5m 19. Food comm surface: +202. 501.701 2 Fats. on. and Grease Control Yes :56 ""riff 20. Non-Food councuurfuu 4-10L60l 2 21. Spenser/wiping mm: 4401.9? 1 d7. - 22. Mmuamumical we Wishing facilities 1' 4.301.5m 1 Gmh?mp?m?ime MI, 34044-90] I 9. ngocumnuuion Fr 24. Sing}: 3.304.4-502.9m 1 panama: a lem Non-Critical Number of Critical Violations These items require IMMEDIATE attention Critical Score Received 3' Minus 20 Pts. (See Reverse Side) #ofSeats 1% FOOD EST BLISHMENT INSPECTION REPORT 1 of 5 z?r 12/1176} ?1/14/71 org/$01 Wm M95417 Add?' 117/5 Ef- Telephone. Type of Operatlomsl: El Rela? Type or Ingpe??iun: Owner/?r?f?/J/JJ/ ?16975 ?Food CI Mobile WRou?ne Cl Rdmpecdon Person? In charge (PIC) ?41,22- 1? mfg/n '3 Tunpornry Cl Caterer Complaint Cl Investigation InapeclorM 3 El Other 0 New Establishment A 'Faod Protection Management I I I1 PIC 2401. :02 5-402. 403. 404 FOOD 5-501 2. Food and W313 from approved source 3?201. 540: 4 . 3. Food leclinpconuinm 3602.602 5.201.205 FOOD PROTECTION Toilet Rooms 5- 402. 501 4. PHP "limp-ammo: 3-40I. 40:1,. 401 4 50026-301 5. Facililics ho: a cold holding 5-50l.502 6. PHF Cooknd a: cooled 3-501 4 5.202 7. Cmcaaumim?an 3.301.302.304 4 momma-20:5 a. sponge: foods 2 0201.501 9. timed Foods 6-404 2 6- 6-303 ?mowing 3-501 2 0202.30: 11. Food prorccxiwslumge 3401301300540 2 6-305 Food Handling 3-301. 304 2 I3.Food umpennmc measuring device 4?204. 203. 302 I 7.2u _ mg Practices 39. 3603 Id. Employcc Halt}: 2:20! 40. 3-801 IS. 2-40L 403 8-20! 202.203 I6. Employ: Cloaking 2-104. 2-402 Prentiss 6-50l nsils Snniznlion Mediums a snuitizod Food contact surfzcu Non-Food contact surfaces cloths 12. MnnunlIMechanicnl ware washing facilities 5. Humsll mange Singl: service 6-202 4-80! . 302.803 GSDI Eq l7. l3. l9. ED. ?Linen Pen 4-702. 70] 4?601. 602.702 4-202. 501. 701 4-10L901 4-301. SDI 3-304. 4-903 3-304, 4-502. 904 Yes No 45. . Guns: and Grease ntrol 0W Doctumntaiou Item 0. Non-Critical Critical 5 Score Minus 20 Pls. (See Reverse Side) 13 \?umber ofCrlu'cal Violations These items require MIRDLATE allanljon Received By Reinspection Inspected 85! of 363% FOOD ESTABLISHMENT INSPECTION Page?L of A HA A Establishment: Date: Address: I . 11" Telephone: Me of Operation(5)' Cl Retail Type of Inspection: . WFood "ice Owner J, Al? ?85711? [12/747 en 0 Mobile Minutine El Reinspection rn arson in charge (PIC): {?24 1?17 L'mpo Caterer Complaint Investigation Other Inspector 12?? i {7191/ El New Establishment A [Farti- Protection Management 5 Sanitary Facilities .1 Z-iUl. 102 4 25 Sense 5402.403. 404 FOOD 26 b-Sill 2 Food and Walcr from approved source 5-101 4 ?27 Hand?waehingfxilmuipmcaiurcs 2-30L5-103JO4 4 3. mumlinymmom 34021602 I I i??umbing 5.201.205 1 FOOD PROTECTION 29. Toilet Room 6302.402. 50! 2 4 34?11?31?? 4 30. Huai-wa??ngmiuh s-meaol 2 5 3-50: 3., ?ohm 2 6 PHF Cookedecuolcd'" Mun 4 51 6-2112 1 7 Cross contamination 3401301304 4 13. MdduIRodminpliMOn 6-731. 50l.7-2U6 B. Spelled food! 3491.701 2 34. WP 5201,5m 2 9. DmgedFood: 5-404 2 35. um mun-303 i0 3-501 2 36. Ventilation il. Food ProtectioIVSlornge L303. 305.306.6404 1 37. ?DiminERoonu 6-305 i 13; Food Handling 3-30I.304 2 Other l3.Food ternpentuxe measuring device 4404, 203. 302 is. TomMumaIs 7.2m. to: a Personal 1351mm Practices 39. CommMrimry Hus 2 14 Employee Health 2-20] 4i}. IiSPReqttiremenLt Mil 2 15 Employee Hygiene 2401.403 4Lanfun?gnt?e?thA9CP?lm - i6. EmpioyeeCloIhing 2-304. 2-402 .12. Ptemise: 6-50! i Equipmentllitemlls 3. UvingAi'eas 6-202 1 l7. Sanitation Methods 4-?02. 703 4 44. Linen 4-8-01.B02.w3 i Iii. Equipmenu?utensiltcleaned a: sanitizzsi 4.601. 602. 702 =1 45, Pm 5.50: 19- 1?thst 2 Fats. Oil, and Grease Control Yes No NM 20. Non-Food mmtturfecet 4-liil.601 2 46. I I 21. Sponges/wiping cloths $101.90" 1 n. 22? ManuaUMechanicel ware washing {utilities 4-10i. 501 I rut. Grease intercepHItSipme BquipmenWtemiiltomge '49 Mammalian 14? 5108!: 3-304. 4-5019? 1 $0 AllugmhwumnmComniianm lyre?: . Item No. .4 A .0101" If if I I 1?3? I . . 5?sz @441 ,1 ?i?gWJ/f 1 - Non?Critical Number of Critical Violations These items require IMMEDIATE attention Critical Score inns 20 Pts. (See Reverse Side) El Reinsyecii Date: of Seats FOOD ESTABLISHMENT INSPECTION REPORT Page Date: Score: Type of losnection: Routine Cl Relmpectlon Complaint El Investigation New Establishment A /0fz A Tel Owner: Person Inspector: CI Retail 0 Mobile CI Caterer Food Cl Temporary Other charge IC): Food Protection Management Facilities I. PIC 2-101. I01 4 5403? 404 F0 on 25. Imcmmu 5-50: 2. Food and Water from source 3-20! . 4 204 3. Fooduhclinglcomainm 3-301.602 I 5401.205 I FOOD PROTECTION . Toilet Rooms 5.302. 402.501 2 4. 3-40L402. 403 4 5.202.53m 2 5. Facilitits hot cold holding 3-501 4 5-50I.502 2 6. PHF Coolant! a cooled 3-50I 4 6:202 7. Cross contamination 3-30I, 302. 304 4 6-202, 1 8. Spoil-ml foods 1.10:. 10! 1 201.50! 2 9. Damaged Foods 6-404 2 A 303 i IO. 2 Wnl?ntim 4-202. 6202.304 1 ll. Food Protectiom?Storun: 3-303.305.306.640 2 . Room 6- I 12. Food Handling 3401.304 2 Other I31Food tcmpemrc maturing device #204. 103. 301 I 33. ToxicMum'als 7-201. I02 4 Personal Hygieaic 39. m3 2 l4. Employee Health 2-20! 4 40. HSPanuim-mts 3-30l 2 15. Employee Hygicnc 2401.403 rt $201,102,203 I 16. Employee Clothing 1-301 2-402 I if). Premises 6-50] I 43, anAm 6-1102 Methods 4-702. 703 4 44. Linen 4401301503 I I8. Equipmcmiutcnsils aimed J: sanitized 4-601. 600. 1'02 4 45. Pm 6-50I I I9. Food contact surfaces 4-202. SDI. 70! 2 Euggiihnnd Grease Control YE No 10. Non-Food induct: 2 .141 it. Spongc?wiping clout: 4401.90! I ll. Mnnuat/Meclmnicnl wan: washing facililics 4-301, SCI 1 Ellaquipmu?utcniil storage 3-304. 4?903 1 l4. Sit-131: tot-vice miclw'llcusc 3-304. 4-502, 90-! I Non-Critical a Critical Score Minus 20 Pts. (See Reverse Side} ?lumber of Critical Violations these items require IMMEDIATE attention Recc' By of Seats FOOD INSPECTION REPORT Page of . Establishment: Dale: Address: 5? Score: (2 I 1/ Telephune: z; I me 01? Retail Type of Inspectioiu Owner: CIT Food Service 0 Mobile CI Perm In charge rm DITempornry CI Caterer Complaint CI lnva?gauon Inspecth'r: Other El New Establishment a BA [Food Pralectiau Management I I Facilities I. PIC Mpmo?dgublafbu?es 2-IOI. I02 25. 404 4 FOOD 6-50) 4 2. Food BndWalu?'nm source S-IUI 4 . 2 $203.204 4 3. Food Lahelinglcontainas 3-302. 502 I 28. 5-20 205 I FOOD PROTECTION Toilet Rooms 6402. 402. 501 2 4. 3-40I. 402. 403 4 meted; 5401.630! 2 s. Faciliti'u ho! a cold holding 3-50I 4 s-soLSIrz 2 Is. PHF Comm: a cooled mm 4 5-202 I 7. Crass contamination 3-301. 301. 304 4 6-202. 501.7-206 1 a. Spoilnd foods 3401.701 2 620L501 2 9. 0:11:qu Foods 6-404 2 62026-303 1 10. ?thawing 3?501 2 mono-mm. I II. Food ?vdeSImgp 3-303? 30:. 106. 540 2 5-305 I 12. Food Hm?ins 3.30:1304 2 13.Food Icmpam Imagining dwin: 4-204, 203. 302 1 38 Mum 2201.102 4 Personal Hygienic Practices 19 3-603 2 14. Health MN 40 WWI: 34301 2 l5. Employ: Hygiene 2401.403 41. 15. Employee mum-.3 2.10:, 2.402 I I In. Premise: am I EquipmenUUIens?s 43 mm 5-202 I I7. Sanitation Methods 4-102. 703 . 4 44. Liam museum I l8. Equipmentfulmsils aimed a sanitized 4-60I. 602l9- 4402- 501- 70! 2 Fats, Oil, and Grease Control Yes No NM 20. Non-Food contacI untrue: 4-IDI. 2 Spongcs'wiping clams 1 ware washing facilities 4.301. 501 I B?dp?nnlfuumii me $304. $903 I Single servlce u?dw?we 3-304. 4?502. 904 I Wmfhaplhm Score Minus 20 P15. (See Reverse Side) '3 Critical Non-Critical Number of Critical Wolau?ons "unhuin- ?than of Seats FOOD ESTABLISHMENT IN Page? /of Establishment: Date: /.:1271. 0/1 Add? '51? mm 4/22? Scum-H7 Adj/?77? Telephone: I TYPE 0? OPENHOMS): 0 Retail Type of Inspechon: Owner 1/ - ?aw/7i M006 Mobile Routine El Reinspection .M. . 10/1: CI Temporary Cl Caterer Complaint El Investigation Inspector 777? Other in New Establishment a A Food Protection Management I ni utilities 1. ?gAssigncd?moMedgeahlemudes 2-101. :02 i 4 25 Sam 54212. 403.2224 2 FOOD 25 nseclsJ'Rodenu 6-511! 4 2. Food and Water from approved source 3-20l. 5-10! I 4 27 facilities. 2-30l.5-203 204 4 3. 3-302.602 I 28. Flu 5.201.205 1 FOOD PROTECTION 29. Toilet Room: ?5302. 402. set 2 1r 2 3401.402403 Mom 54026-301 2 5. Facilltic: hut d: cold holdin. 3:50] 4 5501.502 2 i 6. PHFCuokcd&cooled 3.5m 5202 1 2. C1121: canmnimtion 3-3m.302.394 4 31. 1 a Spailcdfoods .- 3491.201 2 34. 6201.501 2 9 Damaged Food. 2 6-404 2 35. 62016-103 1 10 3?501 2 35. Ventilation +202.201.6-202.30-1 _1 1. ?Food Protectlan?lornge 3-303. 305. 306. 2 37. Room 6-305 I 12 3-30L3o4 2 Other l3.Fo-odtemperm muting detiee 2204.2023222 33. ?gamma; "3.2111302 4' Personal Hyaienlc Practices 34; 3.52.13 2 1 m. haw :eHe-Jth 22m 4 an. 515pr mm 2 I5. mm 403_ 4 $20!.201203 I Lid. Em?uyec?iothln; 2.224 2402 42. 6-50l Equipmentmtensus 43. utmm 5-202 . 1' L. SanitatinnMeLmdl 4.202.223 44. Linen 4.501.30sz I ll! Fr. uizn .nendutemiiscley??yniliud ?15- 650' I 19 Food mum surfaces 4-202. 501.701 1 2 Fats. Oil. and Grease Cuntrol "MW-?ii .. ?No NIA 20. NomFood 4402.601 cloths $101.90] I . Gm Maimumwe ?32. ManunifMechnnicuwam Wishing facilities $301.50i 6mm 24. Single sewice mleleiseuIe 3?304. $502,904 .. Non-Critical Number of Critical Violations These items require attention Critical 5 Scorn Received 3; . (Se Reverse Side) Inspected By of Seats FOOD Eyj?BLjMEl?y REPORT of Establishment: 4/7 Date: gig/z ?I?ll! Address: Score: Telephone: Time of Operatioms): :1 Retail Type of lisii?e?i?n: Owner: ?2 ?lg/?ME Food Service 0 Mobile A Routine Reinspaction Caterer El Complaint Investigation Person I charge Cl Temporary Inspecwn?Zrz l??g @1292], 10 Other CI New Establishment! A 7 rf?r'rr! ll 71 Food mention Management [a l. PIC Assignm?inowkdguhiwuliu 2401. to: 4 FOOD 2. Food and Want from Ipprovcd source 3-201, 5-101 4 3. Food Labeling lconlainers 3?302, 602 1 FOOD PROTECTION 4. 340i. 402.403 4 5, Facilities hot it cold holding 3-50l 4 6. PHF Cookcd amulet! 3601 4 7. Cross contamination 3-301. 302. 304 4 8. Spoil-id foods 3-101, 701 2 9. 00111de Food: 6-404 2 ID. PHF'Hulwing 3:50! 2 11. Food mecnoNSt-ymgc 3.303. 305. 306.6404 2 12. Food Handling 3-301. 304 2 [3.Food lm'Ip-emruru measuring tie-uric: 4.204, 203. 302 I Personal Hygienic Practices 14. Employee Health mm 4 IS. Employer: Elysium 2401.403 Employa: Clothing 2-304. 2-402 1 EquipmenifUIensilS I7. Sanitation Mtlhods 4-702. 703 4 l8. cleaned J: sanitized 4-60I. 602. 702 4 l9. Food conlacl surfaces 4-262. 501. ?101 2 t0. Non-Food contactsurfncu 4-10l.60l 2 2i. Sponswwiping cloths 4-IOI.9OI Manuab?Mechai-licnl wan: washing facililics 4-30l. EOI 'J.Equipm:ndul:nsii storage 4-903 I Ed. Single service uticlw??cusc 3-304. 4-502. 904 Non-Critical a Critical 3 Score Minus 20 Pts. (See Reverse Side} Number of Critical Violations 26. bisecisJRudcnu . Hull!- 28. 29. ToiletRooms 39. 4i. ConfununcawithHACCI?Pims Linen Phase items require attention Received By NC 5-402. 403. 404 6-50! 2.301.540}. 20-1 5-2DI. 205 6-302. 402. SDI 5202.630! $501.50! 6-202 SOUP-206 6-20l.501 62026-103 4-2m.20-1.6-202.304 6- 3-603 3-80! $201,202.20} 6-501 6-202 309.803 6-501 Yes #0151333 FOOD ESTAJELISHMENT 11115250119 REPORT ?Page of a 14 Establistunent: . ?Date: 7 9mm Scam my 12 Telephone: 2 'l?yge ofOpm?onts): 1310:1110 Type ot'Inspection: Dwarf MW and Servlce 1:1 Mobile 915101111111?. :1 Person In charge Cl Caterer Complaint :1 Investtgatlott Inspector 10W 0 Other :1 New Estobuslmm 0 11 A Food Protection Management 1. 01? 3.101.102 Ii 4 54024104111 4 FOOD . 5.501 4 2. Food and WaIer 1mm Ippmved source 3001,5401 11 Handv 20015201201 4 3. Food 3.302. 602 205 1 FOOD PROTECTION Toilet Room: 6-302. 402. 501 2 4 340 402.403 11 0301 2 hot 3.501 :1 5501.502 2 3-501 4 15-202 1 contaminlli? 3?301. 304 4 33. 15-201501.2-200 1 32 1 711 2 34. 3201.501 2 glaucoma. 1 6-404 2 35. 15.202.53.03 1 10. 3-101 2 15. Ventilation 4-202.204.a-202.304 1 It. 3.303.305.3011. 2 57. 1 12. Food 3401.304 2 Other llFood 4-204.203.302 1 35 ToxicMmim 7.201.102 4 Personal 34105 2 - . mpmmu_ 3.1101 1 2 40 3-201.m203 1 111. 2.3012402 42. Ptum'su 6-501 1 .13. 11mm 0202 1 It 11 1'10 m?m?h 0.10.1,201 a 44 Linen m1.w2.303 I 5? 4.5m 60 7.32 a 41*? 6-50] I 19. 4402. 501-701 2 F1115. Oil. and Grease Control Yes No NA 21). 4-IDI.GOI 2 411 Game 21. Spongulwiplug clothe 4-10L90l am 22. Mmunlmlechmlul were washing [utilities 4401.501 1 am 3404.4-903 . 24. Single tervtce 11:11:1th 3-304. $501904 1 St}. Non-Critical Critical re Minus 20 Pts. [See Reverse Sldc) Number of Critical Violations These items require IMMEDIATE attention Received By cted By of Seats F900 ESTABLISHMENT INSPECTION REPORT ?bag: of A 1 Esmbusm'?: 63/44 A ,4 1219 Dam 49/193917 Address: Score: Telephone: A Type of Operationts): a Retail Type of Inspection: 7 Food Service CI Mobile Routine El Reinspecllon Person In charge (PIC: '3 Cl Caterer Cl Complaint Cl Investigation Inspector: ??97 5 1,7143, 0 Other New Establishment Cl HA Fond Pmledlon Management? Facilities l. PIC 2-101. 102 4 5 403.400 4 FOOD 26. 0501 4 2. Food and W010: from approved some 3-20l. S-IOI 4 . llmd- 2-30! 203. 204 4 3. FoodlAbelinycunuimn 3402.602 I 5-2Ul. 205 I FOOD PROTECTION . 101th Rooms 6-302102.50 2 4. PHF'l?empunlwu 3401.401403 4 Hand 5- 03m 2 5. hot cold holding 3-501 4 5-50l.502 2 6. PHF Cooked .2 cooled 3-501 4 0qu 5.202 1 7. Cross contamination 3-301. 302. 304 4 6-202. 5013.105 1 3. Spoilcdlood: 2 2 9. Damaged Foods 6-404 2 0202.030: 1 I0, PHF Thawing 3-501 2 Vemiladm $202,204.6- I ll. Food 3-303. 305.306. 2 . 0305 I I2. Food Handling 3-3OI.304 1 Olher [3.Food tempo-mun: mulling dmricc 4-204. 203. 302 38. Melt/medals 7&0! . IOZ 4 Personal Hygienic Practices 39. WNW 3003 2 I4. Employer. Hum: 2-20! 4 40 HSPquuigu'rmls ml 2 I5. Ewan-ya: Hmim 2401, 403 4 Confumm?lh?um 020:.202103 I 10. Employee Clulhin; 2-301. 2-400 I I Fran-0m 050: 1 Equipmentmleusils 43. {30:3ng 0201 I l7. Snnilnlinn Malhods 4-702. 703 4 44, Liam l8. Equlplnoommu?s cleaned annualized 4-001. 602. 702 4 45. ms 5.5m 1 19. Food comm! Sinful?I 4-202. 501. 70] 2 MLQELEQ Grease Control "as No Nun'Food comm mfaccs 4-]0l . 60l 2 45? 12. Manuall'Mccbanicnl ware washing. militias 4-301. 501 I lliquipmdulamil 3mg: $304. 4-903 1 14. Single service m?cluchuse 3-304. 4-502. 904 I Non-Critical Critical Score {umber of Cn?tical Violations These items require IMMEDIATE attention Received By of Seats F09D ESTABLISWENT INSPECTION REPORT (HP. Establishment: y/I? Date: 6417!} ?71977 1 If Scar;w JV 97%; 7 Telephone: :r Time Of Operation(s): CI Retail Type of lnspectio??: "1 Owner: I Food Service Cl Mobile Mainline Cl Person In if}! r! Cl Temporary Cl Caterer Cl Complaint El Imestlgolion m1/ 0 Other 0 New Establishment A c: {2 Food Protection Management Facilities l. PIC l0? . $402,401.404 4 FOOD lumeodcnu mm 4 2. Food and Walcr [mm approved souxcc mm, 5-101 4 . Hand. 2-30L5-203. 104 4 3. FoodLnbeling/conwlnen 3302.602 1 a . Pl 5-20 205 I FOOD PRQIECTION . Toilcl Rooms 6402.401. 50: 2 at. PHF Tern 3-401. 402, 403 4 MM 54016-301 2 5. llaucs hm coId holdm 3601 a 2 (3. PHF Cooked cooled 3-50l . 4 0qu- 5?202 1 7. Cross contamination 3430] . 302. 304 4 33. 6-30. 501.7406 I 3. roads l. 7g . 2 34. moon/waists? 6201.501 2 9 Fwd! 6-404 2 35. 62016.30} 1 IO. PHF 3-501 2 36. Vom?uion 4-202.104.5-202. 1: Food 3.303.105.306. 2 37. 13min Rooms 6-305 1 12. Food 3-301. 304 2 Other Ill-bod devise 4-204. 203. 302 I 33. TonicMuLa-im 7-20LIUZ 4 Personal Prac?cas 39. OummnaAds'iswv 34503 2 2'20] Ml. Hill 2 5. cc 2-40] 403 M. 8-20l.202.203 I I6. 1-304.2-402 lull. Plum 6-50] I EquipmenWtensils 41. 6-202 1 l7. 1% 44. Liam 4401302303 1 lg. Eguigmenlfulcnsils cleancd 8L Mniliud 4-60]. 602. 702 4 45- Ht! 5-501 1 l9. Feud annual surfaces 4-202. 50L 2 Fatal 01] 9311? Yes No MIA 20. Non-Food contact sulfuu 4-101. GUI 2 421 9/ 2L cloth: I 22. Militias 45, slang: 3.304.4-903 49_ 14' Single mi" ?km? 4'502'904 I $0 AllorgmAwurwcuComplionc-c FWDWIG) Item No. Non-Critical Critical Numbcr of Critical Violations Score These items require IMMEDIATE attention us 20 Pls. (See Reverse Side) I By Reinspco Inspected #of Seats FOOD ESTABLISHMENT INSPECTION REPORT ?Page of I I [aw Date: 1 .7 Adm? jr?? f-?ayy?g?- if5 Telephone: Type of Operation(s): El Remit Type 01' Inspection: Owner: 1% SEW Mobile G?Routine ReinSpection Person in urge J: emtJOI??l?Y Cl Caterer Ct Comptalnt Investigation Weston,? 7947191/ 0 Other New Establishment I3 HA Fond Management 5 Facilities 1. PIC 2-101. 102 4 . FOOD Mammals 2. Food and Wm from apprnund some 3-201. 5-101 4 . 3. Food Labeling tcuntainus 3-302. 1502 I 28. FOOD PROTECTION 29. Toiict Room 4. 3-401. 402. 403 4 Hand 5. Facilities hat cold holding 3-501 4 . 6. PHP Cooked a cooled 3-501 4 Outer 7. Cross contamination 3-301. 302. 304 4 33. 8. Spaiittd foods 3-101. 701 3 . 9. Damaged Foods 6-404 2 35. 10. PHF naming 3-501 2 36. Ventilation 11. Food PmuctiaidSt-arsg: 3-303. 305. 306. 6-40- 2 37. Rooms Food Handling 3-301, 304 2 Other l3.Food Ei?p'emturc mmurinu dnvic: 4-204. 203. 302 33. ToxicMnminl: Practices 39. 14. Health 2-201 4 40. 15. Empluycc Hygiene 2-401. 403 4 CmdmunuwithHACCPPinm . Clothing 2404.241? 1 Premisu menu'Utensils . Sanitation Methods ul cleaned it sanitized . Fond contact names . Non-Food contact surfaces cloths . Wm 4-702. 703 4-60l. 602. 702 4-202. 501. 70! 4?101. 601 4-101. 901 4-301. 501 3-304. 4-903 3-304. 4602.904 facilities . Singleservice miclufikusc [em Nan-Clitical Critical Score Number of Critical Violations These items require MMEDLATE attention 44.13am -n?hI?lI?NHh-& nus 20 Pts. (See averse Side) We Received By NC 5-402 d03.404 6-501 2601,5203 204 $201,205 6-302. 501 5-2016-30l 5-50 6-202 6-202. 501.7006 $201.50! 6-2016-303 6-305 7401.102 3-603 3-801 84.101.202.203 6-501 6-202 4-30 803 15 No a Inspected #ofSeats F9013 ESTABLISHMENT INSPECTION REPORT Page of aria/211% ix 1141/ 22/ [amen/y st gem Telephona i J. Type of 00211000015): :1 Retail Type ol'lnspection: Owner: Mg? gFood Service DMobile a Routine It] Reinspectlan Person In I: urge?! 1/ I t/ ??1me Caterer Cl Complaint CI Investigation Inspector. CI Other 1:1 New Establishment CI HA 0 Food Protection Management I acilitles 2 101 102 4 25. $402,401.40: 4 FOOD ImeerReuenu 5-501 4 2. Food and Want from approved source 4 . 4 3. Food Leheungrcemeen 3.302.602 1 as Plumbi 5.201. 205 1 FOOD PROTECTION 29. Toilet Rom 6-302. 402.501 2 4. 3401.402.403 4 5202.530! 2 S. Facilitic: hot 0 cold holding 3-501 4 5-50I.502 2 0. PHF a cooled 3-501 c1 6-202 1 7. Cross contamination $401,302,304 4 6-102. 501.1206 1 31 Spuilcdl'nods 3401.701 2 MOLSM 2 9. Dunugul Foods 6-404 2 . 0303 1 10. PHF Than-?n; 3-501 2 ?:11de 0202.304 1 11. Food Pmtt?cliuNSmnie 3.303301300114101 2 . 305 12, Foodnamung 3401.301: 2 Other IlFood temperature mmuxing device $204.20}. 302 I 38. 11mm 4 Personal Hygienic Practices :11. 3.503 2 l4. Emplayu Health 2-291 4 4t}. IISP?equiImn-Iu: 2 15. Employee?ygianc 2401.103 4 41. $201,202,203 I M. Emptoyee naming 2.10:. 2-40: I 42. Prcmim 0501 1:1. mm 6-202 1 1'1. Sanitation 1111:0100: +702.703 a 44. Linen +301.301.1103 1 111. 4-001.002.702 4 .15. Pets 15-54:" I 19- Food ?01501-701 1 F1115, Oil. and Grease Control Ya; No NM 10. 4401.60! 2 .th 1/ 21. Spongedwtping cloths ?01,901 I er:+ 22. wm washing facilities 4-30]. 501 I 48. Mim??m? El?quipmmu?uun?l Slums: $304. 4-903 1 d9. 24. sangIe urviceudclufkcuu 3-301. 4.502.904 1 50. [51100091131 1 Item N0. I 0% imi/ '44! Non-Critical Critical 3 Score Minus 20 P15. (see Reverse Side) Number of Critical Violations (EH 0.2 These items require IMMEDIATE attention Receive By ?Linen 4801.80l803 of FOOD INSPECTION REPORT Page?L of ?11/;an n0. 4,4; (59/ ?an? P7 14 scm'l/ Telephone: ?Type of Operational: a mum Type or Im?ect?m?: Owner A [m (74" Hf? 1 Mid/37M DFnod Service Cl Mobile mkoutme El Person In k/ Cl Calerer Complaint 0 Investigation Inspector 5471 7177171, Other 0 New A Fahd Protection Management I 5? Facilities A _W?om1?d??ihlu?uum 34m. 101 25 403 404 FFQOD Inset 6-5n 2 Focgan? ?h?talc: [mm lppluvc? suwcc 11H. Hm '1 2- 10" 3 3402.601 I I 1 20. Plum 5401.105 FOOD 29. Toilet Rooms 6-302. 402._50a .5 WM 3202.030!? 4 5501.502 4 6-202 7 1. 4 13. 2 . 0201.501 9. Foods 6-404 2 35. mom-303 10. 3-50] 2 36. Venu'Jnu?un momma?202.304 Food Protec?onIS 1303. 305.300. 2 . Room: 6-305 l2. Food 3-30L304 2 Other Mood 203.302 1 7.101.102 .0-201.m203 I Club 42 9mm 6-501 I 3. LivingAEm?W 0202 I . 1 1 19. Rod cmmcuurfaca 20. Non-Food contact aurfacu cloths 12?. ManunHMechankll war: washing l?lrilillcs 23 ?ange 14 Single service unlcley'kgum 4?202. 501,701 4-l0l.60 . 4-30l.50 3-304. 4-903 3-304. 4-502. 904 45. Pm 6-50} 315. 0-11; ?ail 46.6mm 16100:: Ya; Non-Critical Number of Critical Violations a Critical Score These items rcquirc IMMEDIATE attention Minus 20 Pts. (See Reverse Side?:1 ReceivcE By g; Impacted By Non-Critical Critical Number of Critical Violations I?the items require WEDIATE attention 2 Score Minus 20 Pts. (See Reverse Side) 0 I Receivc? By of Seats FOOD ESTABLISDMENT INSPECTION FIEPOFIT /of (35/2/5910 #f/ML?D/i?dn/ W7 Address 59/} nyzua?g/ 266.- SW Telephone: .r A 2 2 1 Type of 0912111110118): :1 Retail Type of Ins?peE?o?n: Owner: Food Service [3 Mobile E?Routine Reinspection Perm In charge (PIC): t? 0 1'5me?? Caterer Cl Complaint CI Investigation Inspector: My other a New Establishment :1 HA I: - Food Protection Management Sanitary Facilities?? I F?s? l. 2-IOI, 102 4 25. Scmge .. 5-402. 403. 404 4 FOOD 33. lama/5011235? (+301 2. Foodund W211: from approvcdsourc: 2201,5401 4 27. "Ihzlio?zmm 3. Food 2.302.502 21 flumbing 5201.205 I FOOD PROTECTION 29.121112111001115 0202.402501 2 4. 2401,402403 4 5202,0301 s. Finltiu hot ?01011010211. 3-501 4 31 s-sg.5m_ 6. PHF kacd&caol:d 3.501 4 22.01.1mpg0ngs 6-202 I 7. 3-201.302.304 4 mammdm?ucm .- I a. Spoiled roads 3401.201 2 34. wanna-0132 6-20LSOI 2 9. Damned Foods 6-404 2 gs?w?b? 6202.640} 1" 10. 2.501 2 36. manna: 11. Food 2.202210230012401 2 32. Mingling! 'h 1 12. Food Handling 3401.301 2 Other IlFood .1:va ?04.202302 I 52. 2mm? 7.201.102" 4 ?71? Personnl?ygcnic Practices {33. mum 3-603 7 14. Emproyuucmh 2-201 140. llSPanutmImu 21101 2 Is. Hygicnc 2401.403 41 1 l6. Emptuyn: Clothing 2-304.2-402 42. I?m-miss 650i I Equipmentf?lens?s 43. tivingAmas? 6-202 I 12. Sanitation Methods 4402.203 4 44. [Juan $801,802,503 I 111. 4.001.002.2122 4 '15. Pets 0-501 1 I 19. Food coma-mm 11.202.501.701 2 2215.011, and Grease Comm!? W65 No NM 20. Non-Food contact surfms 2 mm 21. Spangufwipingclo?ts ?-l0l,901 I 7_ ?1an MmuaUMechanicnI wan washing [admits 4-34?. 501 5_ slams: 3-304. 4-903 M. Single service uticlnsikause 3-304. 4-502. 901 ate? Inspected By of Seats FOOD ESTABLISHMENT INSPECTION REPORT Dole: Score. Type of tine CI Reinspectlon 0 Complaint 0 Investigation New Establishment A Page /of 4 Esta A Telephone: El Retail El Mobile El Caterer ood CI Temporary Person in charge Inspector: Food Protection Manuggmenl I I acilities I. PIC 2-IDI. I02 4 25. 403.404 4 FOOD 6-50l 4 2. Food and Wm from approvod mum: 3-201. 5401 4 . 4 3. Food lecling?onuimn $301602 1 28. 5-20L205 I FOOD PROTECTION . Tone: Rooms 6-302. 50: 2 4. PHFTompchI-Ir? 3-40L402. 403 4 5-2lT2,6-30l 2 5. Futili?n holding 4 5.501.502 2 6. Cooked a cooled 3-501 4 6-202 1 7. Cross contamination 3-30I. 302. 304 4 64015013406 I 8. Spoilcd foods 3-l0l.70! 2 6401.1? 2 9. 6-404 2 62016-303 I I0. 3-50I 2 thilalim 202.204.632.25? I ll. Food Pmtoction'SImgo 3-30]. 2 . Roam 305 I 12. Food Handling 3.30:.104 2 Other llFood mmpunna?r. rimming device 4-204. 201, 302 33. 7?201. 102 4 Personal Pmc?cw 39. 3-603 2 l4. Employee Health 2-20] 4 40. HSPRoquhmls 3-80I 2 Employee Hymn: 240L403 a 41, Wmuriml-{ACCPM 3.201.202.2(3 I6. Employoe Clothing 2-304. 2-402 I H. Frames 6-50! I Equ?pmzoo?Un-nsils 41. Livingm 5202 I l7. Sanitation Mclhods $702,703 4 444 Lina-I 4-80l.502.803 I 18. Equipmenu?omll: cleaned sanitized 4-60I. 602. 702 4 45. Pets I 19. Foad contact solace: 4-202. 501. 701 2 Fats, 0g! and Grunge Control Yes No NIA EO. Non-Food contact in?ates 4-101. 60! 2 46. Emmi-"MW 1 4.101.901 1 41 12. facilities I 43_ mummy-us: norms: 3-304. 4-903 I 49 W?mmn Single scrvice rosin/Reuse 4-502. 904 I 511 I Item No. xi AW :14 me?a?? r?W/ if @4ij {7 07* Non-Critical Critical Score :11: [@347 *Iumber of Critical Violations Inapccted By ?new items require IMMEDIATE attention of Seats /7 FOOD ESTABLISHMENT REPORT Page A of Esmbuahmm? If/?r/?qu' ?ay/ck [33.22% 97%. 2:70? 79/ faint?279122 Telephone: Type 01? Opemtlon(s): El Retail Type or [mpecuom Dwarf/(m? #2714117?? Mod Servlce a Mobile Mtouune :l Person in charge (PIC): CI Temporary Ci Caterer Cl Complaint Investigation Inspectortm?m CI Other New El HA rF?Dd Protection ManniJnentm I Sanitary Faculties 1. PIC AulincIUXnowledgcahIMJultcl "r i' lui. I112 4 25 Sewage 5-4112. 403, dud 4 FOOD 215 6-501 4 2. Food and Water from 3-20I,5-l01 1' '71? 27. 2-30l.5.203.2m 4 3. 3402.602 28. Plumbing 5.201.205 I FOOD PROTECTION ?j?kmm 5302. 402. 501 2 4 PilF 3-401. 402. 403 4 3.0. 5.201540] 2 -3 thlics hot&culd 3~50l EL 5.501.502 -.. 2 6. PHF Cookcdl?lcoolcd 3-50] 4 51 out?ow-ling 5.31}; T. Cmucontamination 3301.302304 4 33/ I Spoiled foods 3-?Ipl. 701 34. wmmum 6.201.501 1 9. Dmmamu 5404 2 35. Lighting - $2025.30: to. 3-501 2 16. ?2an +2022m.a~292.301 1 2 37. NEW was I 12. Food Handling 3-301. 304 2 Other L13 Food temp-mam muting dale: 11.204.203.302 as. :02 Personal Hygienic Practices '39 consEFmEq' "3-1503 2 l4 Employu Health 2-21)! 40. 3-8111 2 )5 2401.403 4 TI. 2201.102203 1 l6. 24013-4112 1 42. Pianist: 6-501 1 Equipmenthtensils LivinsAms 6-201 n. Sanitation Mthods $702. 70.1 4 44. Liam 4-801.802.803 13. 22 sanitized $601,602,102 2 41 pm 5.501 I 19. Foodmnmuurfm 4-202. 501.701 2 [fats-L911, Ya No 20. Nan-Food contact surflcu 4-l01. 601 2 21. cloths $101.90] 1 7, Guam 22. wm wuhing [militias 4.301. 501 ?once 3-304. +903 1 9. Win?mien 14, Sing]! service WCIWW 3-304, $502,904 Si], Non-Critical Numbcr of Critical Violations These items require attention Critical 2: Score lin:We1-se Side)CI Received By Date: luspect?d magi of Seats Address: Telephone: Owner- Person In charge (PI Inspector: FOOD ESTABLISHMENT INSPECTION REPORT Service CI Temporary Other Du . Score: 'l?ypeol'I on . Retail Mobllc Caterer CI Complaint Page am of; Cl Reinspectlon El Investigation New CI A Food Prniecuan Management ?ailing Facilities w? SJ 1. 44 25. 335403.464 '7 FOOD - 26. 640i 4 I 2. Food and Watcrl?rom approved source 1 A7. 1 4 1 3. FcodLabeIigi/contalm 3402.602 I I 28. Piumbing 5-201.205 H0 - - FOOD PROTECTION 29 mm Room: 5302402501 2 4 3.401.402.403 4 50. Hurdeud?unw?mb 5.201530] 2 s. huidlng 3.501 J2. 0?.qu 5.202 7' Cwmonuminwon MOI-3013M 4? 33. cymsum?zoe i? 3.3931chf00d5 2 34' W?ml?jp 620L501 .. 1 9. Damagcd?nods I ?57404 2 1.2922; 52025303 1 ID. PPIP?meng 3401 2 36. Ventilation $102.204.6-202.304 1 II. Food mummy: 2 31. Drusiu?tgpnu . 6-305 1 :2 Food Handling 3.301.304 2 Other IlFood meuu?n' device 4.204.203.3132 1 '38 TwamauIs 7.201.102 4 Personal Hygienic Practices 39. ComwAlery ""3421: 2 14. Employcchallh 2-201 4 40. 3-301 3 15- Employcc Hygiene 2401.403 4 4t. 2201.202203 1 I6. Clothing I 2-304.2-402 . 42. Plumb: 6-50! I EquipmenWtensiIs 43. 6.21:2 I :7 Sanitation Mcthods 4401.103 4 44 um. 4-301.am.203 I EquipmentfuLcnnIs ctuncd 5r. tumult-d 4-001. 002, 702 4 2; Eu 6-501 H9. surf-m 4-202. SDI. 7m 2 Fats, Oil. and Grease Control Yes No Eli 20. Non-Food COMICI surface: 4-101.GOI 2 46. Gmm mgarln?ndun Spangw'WIpInn Chili-L 4-103-90' 47. 22, ManuaVMedunIccl ware wuhing facil'niu . 1 3-304. 4-903? 1 t9, mammal 24. Sing]: panic: melcmuu ISO-1.4402304 Itcm No. 2 1/ 211' fhf: "1 I. --dl-I 1 - +4 :1 Non-Critical Number of Critical Violations Critical 8 Score These items require IMMEDIATE attention Minus 20 Pls. (See Revchc Side) C1 Ww% Received 3510 Inspected By Item Non-Critical Number of Critical Violations These items [equine WEDIATE attention C- Critical of Seats FOOD ESTABLISHMENT INSPECTION REPORT Page 4 of I I .372 71;! @520ng Address: A 'v?v TI Score: 1" Telephone: Type of Opem?onls): 0 Retail Type of Inspection: Owner f?f Food 59m? Mobile Routine Person 0 Temporary CI Caterer CI Complalnt 0 Investigation Inspector/Mm other a New Establishment :1 HA (3 Food Protection Management 1 5 Sanitary Facilities l. PIC 2.10:. [02 4 u. Sewage ?02.40191 FOOD 6-501 1 Foodand Walal'rom source 3-201, 5-10: 4 3. FoodLabclinp?cmminm 3-301 602 28. Plumbing FOOD PROTECHON 19. Toilet Rooms 0302. 402.501 4. 3401,402;403 4 30. Hand 5402.030] 5. $50! 4 il_. 3-50I.502 a. pm: 3-501 4 32 Oulunpuunzs _m 1 1. 3-301.3oz.304 4 33 02011-013000 _1 0? Spoilcdl'oml: 3401.701 2 34. WWan MOLSOI I 9. Damaged Foods 5-404 2 35, Lighting 0202.030; 1 10. 3-501 2 . 4.202.204.02m.3m I ll. Food Pmtectiunl?Slornge 3-103. 305. 3061,6401 2 37? Dma?n?ootm 12. Food Handling 3-30t.304 2 Other 11m 4.204.203.302 !33 Viv-201302? Personal Hygienlc Practices ?39 CmmAdv'tsury H03 l4. Employee Health 15. Employee 2401.403 4 4L ConfoumnucwitltI-MOCPPIMB 16. Employ: ?outing. 2604.24102 I 42. Flt-mks 3. LivingAreas (+202 l7 Sanitation Method: ?02.701 4 44. Lincn 4-sm.mso: l8 4 ,45. ms 050: I9 Food contact when 4-202. 501. 70! 2 Fats. Oil, and Grease Cantrol Yes No NE 20 AHDIAOI 2 45. Urns: 2 Spongc?wiping cloth; $101.90! I 7 Guns: 5mm 22. MmuaUMechmicnl ware washing facilities 4-301. 50] I Guns: :3 Equipmmb'utcnsil storage 3.304. 4-903 1 24 service 3-304.4-502.904 Received - [n5 peeled By of Seats FOOD ESTABLISHMENT INSPECTION REPORT 1:513; of 5 . 1 Establishment: 7? 417/ . 1.. Date: [7491 A1 1.5.5.09. ,4 4.02% .56 gm/ Telephone: Type 01' Opem?onm: El Retail Type of Inspection: Owner: Food Service CI Mobile ?noudne El Reinspection Parr-01140? (PIC): Temporary 0 Caterer El Complaint El lnves?gation Ins actor: 0 Other 1 E1 . ?gg?l m/ 0 New monomeo A 11 [Food Protection Manngelent I Facilities 1. 1111: AssignedJKnowicdgaandDuties 2-101.102 4 5-101-10140-1 FOOD Medals 6-301 2. Food 111511 11111151 1111111 01313111311011 source 3-101. 5.101 4 . 2-301.5-203.204 3. Lobc11og1'coo1oiom 3002.602 1 20. 5-201. 205 FOOD PROTECTION 29. 1111151 Rooms 6-301. 402. 501 4. PHFTompo-mums 3401.402.403 4 30. 11101110115 5402.630: 5. Factlidcs be! a cold holding 3-501 4 l. 5- 502 6. 111111 Cooked cooloo 3-501 4 6-202 7. Cross contamination 3-301. 302. 30-1 4 33. 6- 501.1206 3. soon-511 foods 3-101. 701 2 34. 0201.501 9. Damaged Foods 6-404 2 6 6-303 10. 111-111 Thnwing 3-301 2 Wm 4- 6202.301 11. Food P1011301101VS?0rngu 3-303. 305. 306. 6-10 2 1. 6-305 12. Food Handling 3001.301 2 Other ?food 11111111301111.1311: dcvice 41204. 203. 302 I 38. Ta?cMmiAls 7001.102 4 Personal Hygienic P11110606 39. Cmmuhdvhay 3-603 2 14. 5011110300 Health 2-20! 4 4D. HSPunh-mu 3-80l 2 15. Emomyoo Hygienc 2401.403 4 41. 0-201.mzo3 1 16. Empioyu 1211-1111113 2-301. 2-402 1 .11 1115511515 6-501 1 EquipmcnUUtens?s 43. 1.111111319110111 6-202 I 17. Sonimioo Mom 4-102. 703 4 4-1 Linen $001,002.00} 1 l8. Equipmwulmsili cleanedsk sanitized 4-62". 602. 702 4 45. P1115 6-50! I "1 Food comm surfaces 440?. 50!. 701 1? Fats. Oil, and Grease Control Yes No NM 10. Non-Foodconmuurfncu +101.601 2 55, ll. cloths 4400.901 47 Manual/Mechanical ware wuhing facilities 4-301. SDI 43 Gunhauplu'Siyugc 13.0611111111150110511511 310111;: 3-304. 4-903 49, ng?mga?on Sinai-?mice articles/Reuse 3-304.4-502.904 1/ Item N0. .4 . - 1 [Arm/11M 441 14511?rm-m .151? fari- Non-Critical 1251111151 5 Score Minus 20 1115. (See Reva-Sc Side) umber of Critical Violations [11:51: Ltems requlre IMMEDIATE aucnuon Received By Reins #of Seats FOOD ESTA INSPECTION REPORT Page of a 1" (7L . {-21 Dakar 4/9/11? 1' 27L Egg} Imepnant?: Prize of Operationts): Cl Retail Type or Owner: 1/ I 75? Al ?g ?447 Wood Service Cl Mobile Wtouune Reinspection Person 0 charge (MGM ?rm? El Temporary Cl Caterer Cl Complaint El Investigation Inspector: W/i/x) [7935271]! Other :1 New Establishment c: A 1' Fund Protection Management Z-lUl. Itll -l Scwagc .403 FOOD we r? . 2 Food udW?atcrl?mm 3.201.540] a -30L 3. FoodLnbeligglconannan 3002.302 1 5-20l 205 I FOOD PROTECTION . Toilet Rooms 6-302. 402. 501 2 4 340i, 402? 403 4 Hund- method: 5-2016-30l 2 Facilities hot at cold holding 1501 I 5.501.501 2 at PHF Cookcd&cooled 3:50: 4 5.202 I Eonmmim'on 3430:. 302. 30-: a 33. 5.202. 501 7.205 I ?Effect?? 3:101? 701 2 31? ?01,50. 2 w0. Damaged Foods 6-404 2 3s. 5402.030: 1 10. 3.50: 2 Ventilation +102.201.0?202.304 I n. 31. em I I2. Food Handling 2 Other ?food lempcmun: measuring dwinc 4-204. 203,302 38 Toucmmals 7401.101 Personal Willi: Practices mu 2 l4. Hc?lh Z-IUI 4 4i). 3-801 A 2 Ti. Employne Hygiene 2401.403 4 41. 3-201.m2m I lit. 2.304.240: .41 Pmmim Hill I .13, UVingAtm .. 6402 .1 n. Saniuuon Methods 4-102. 703 A 4 44. um momma: I 18. cleantd Jr. stmitizcd 4430!, 602, 702 4 45 Pg? @561 I 19- FwdconW-Imlfw 4401501301 2 F015 Oil. and Grease Control Yes No NM 20. 4-lDI,60l 1 45 11? SmeWIpius cloths 4401.9!" I 47. 22. Mmmumclum'cu Wishing ruumu 4-30l. 501 30004-901 ?m 24. Single sunrise ?Hamlin 3-304. 4?50}. 904 54}. a Non-Critical Number of Critical Wolaticns Critical Score These items requirc IMMEDIATE attention Minus 20 (See ReverSe Side) '3 ?SLaMmZ/?alm Recalled By #of Seats OD REPORT [Page ,5 of Emm'smem'. ?if? if fit/7f 17ng 11.5% r} id?/ Dn?c? 64 i 11:. 1.9: 17 score: 1111; Telephone: 1 Time of Operations): Retail Type of Inspection: Magi/11.1611 111/ {111/1 Person In charge - 11911190er Cl Caterer Cl Complaint Investigation Inspector: 22 other a New Establishment a A Food Protection Mailman! I I. PIC miuc?nmuicdgahidnuliu 2401. 102 4 . $402,403.404 4 FOOD . 6.50: 4 2. Food and Wm from approved source 3.201. 5- It]! 4 . 2-301 5203.204 4 3. Food Labclhaycontuin?s 3-302. 602 I 5-20I, 205 I FOOD PROTECTION mm Rooms 6402.401501 2 4. PHF 3?401 . 402. 403 4 5492.630! 2 S. sziliu?u hot cold how?; 3-50! 4 5-50l.502 2 6. PHF Cooked It cooled 3-50! 4 6-202 1 7. Cross conlaruinuliun 3-30l. 302. 304 4 6-202. SUM-206 8. Spoiled foods 3401.701 2 2 9. Dru-mad Foods 6-404 2 5202.630) 1 10. PHF 3-501 2 Vm?hiion $202.204.&202.304 II. Food 3-303. 305. 306.640I 2 . 6-305 1 12. Food Hmilling 3-301. so: 2 Other Ill-bod mum-Eng dcvicc +204, 203. 302 1 3a TomicMamials 1-201, I02 4 Personal Hygienic Practices 39, Cmnunahdvimy m3 2 Employee Hcallh 2-20] 4 40. 3-30! 2 15. Employm Hygiene 2401,40} 4 4i. 1 l6. Employ: ?ddling 2-304. 2-402 I 42. mm 6-501 I Eq uipmenthteusiJs J. umm 6.202 I7. Sanitation Melhods 4-702. 703 4 44. Linen $301,801,803 I IS. cleaned sanitized $601,602,102 4 45. Pm. 6-50] I I9. Food contact 4-202. 501- 701 2 Fats. Oil, and Grease Control Yes No NM 20. Nan-Food contacuurtam 4-:0L60l I 4.5. cumming b/ H. cloths 4'10]. 90] I 41 WMWIHMWMI MnnuIUMechunicnl war: washing facililigs 4-30l. 501 ag_ ammsw LlEquipmcolfulcmil ?ung: 3-304. 4-903 1 49. Singl: servicc micleszuusc 3-304. 4-501. 904 I 31 Emmy}; No. Nan-Critical Critical 5 Score Minus 20 P15. (See Reverse Side) C1 Number of Critical Violations Wu These items require MIEDIATE attention Received By of Seats F0 ESTABLISHMENT INSPECTION REPORT Page nut-a?ag. .9047 Address. - If Score: 441% Telephone: I Type Of Operation(s): Retail Type of Inspection: Ownert? I a: ?5 5E 33/ 47/7 id) Send? Mobile mltouune Cl Reinspecllon Person in burg} 0 Temporary CI Caterer CI Complaint CI Investigation Inspecmr: If . . m, 1/ Other New Establishment a 1-1 A 1' Food Protection Managiment I 8 Facilities 1. 2401. I02 4 $402,401.40: 4 FOOD 6-501 4 2. Food and Watcr from approve-d source 3-201. S-IOI 4 . 4 3. Food minim/container: 3-302. 602 I 28. 5-201. 205 1 FOOD PROTECTION 29. Toilet Room: 5-302. 402. set 2 4. PHF 3-401. 402. 403 4 5402.64? 2 5. Fuelltucs hot 6: cold holding 3-50l 4 1 5. Cooked s: coolad 3-50l 4 6-201 I Cam canumimuan 3-301. 302. 304 4 6.202.501.7406 s. Spcilcdfoods 3-lul.70l 2 34. 6.201.501 2 9. DamagedFood: 1 6404 2 35. 6-303 1 10. 3-501 2 36. ?radiation 4- I ll. Food PmteclionfStomze 3-30]. 305, 306. 6-404 2 . 5305 11. Food HnndUng 3-301. 304 1 Other 1mm lcmpemum ramming devioc 4.204.203.2102 1 3a. HM Person-[Wane Practlces 2 I4. Em t5 chin-nth 2-201 1 4 40 2 15. Employee Hygicn: 2?401. 403 4 ill. Conronnmecwilhl-{ACCPle I I6. Employoc Clothing 20002-402 1 42. mm Men I 43. U?ng?trw a. . 02:02 I Snuitauun 4-?03. 4 44- 1M I a. snnitiud 4-61?. 602. 702 4 45- Pct! 5-50] I Food cantuzt mm 4-202. 501.101 2 Fuls.0i1, and Grease Control Yes No NM. 10. NonwFood contacuurfnca: 4-10L60l 2 45, 11- Spensedwiplna cloths 4-101. I 47. 22. We Wishing fullilics 4-301. 50! I 4% Gmmyu5?msc llEquipanun-Juil 11mg: 3-304. 4-903 49, 24? Sin?lm?i? "11?13?33"? 3404-4401904 en humans) y? ?15-?51 Non-Critical a Critical Score Minus 20 PIS. (See Reverse Side) Number of Critical Violations If a? These items require IMMEDIATE attention Receivcd By of 5.12313 FOOD ESTABLISHMENT INSPECTION REPORT Page 1 of 4 .4332?; #322114. Date: 11/ ?are? 5 ?zzZ/g/ as? .1 9:2 ?l?eluphati?I:I 1' I I Retail Type of Inspeclicm: Owner: I Mobile Routine Reinspecn'on Person' In chargyPIC): ,0 Caterer Complaint El Inkugauon New Establishment A Food Protection Management 51111ng ?If I ?5 1 PIC 2-101. 1112 11 - I I I I 4133,1104 FOOD - .. . .. 3-3 Imus/Rodents If - - II 3301 '1 IE Fopda?tIinlct fraIm_np_m111reIdI source II {Ill 2301;103:201 I I 3 Feud labelingfcantninc?rs 5,-20l 205 . IFQIOII) .. I I 29.101111112001113 . 3302.101501 II I 4 I 34111 11132433 I 4- I151 Iammgau?Eodj II 332335301 ?if 3 hot&coldhuld1ng "3.311 - 31. I II 6 3~50l EIIlerropcrLinE II 7II @5055 canumiInau'on 303, 304 II I33 I 6-7-01; 59!; 72305 3.5111113111130115 ?310mm 31_ II 13-201. 50__1 2 :3 11?1151;me I 3W 2f I33 1151111nd II 3233,3303 2 222223221 . -- 33723.- 22 22.222221 - - . . -. .2 . II II _32303 305. 306 611 II ?2105 j- IE 35331111131111: I I 3301. 3731? I2 1 9111131- I I "15311111th 11:11:: II _203 I302 1 311. II 7.201.111: 'ersonal HzEenic Practices ?nil 4_E?a1_13?camlm I _I_2.Izgl_I__ :10. 11512113359513 I 3301 5. Employee Hygicnj II 2:01. 4IOI3 II ?l'mz'm 2. 22.211322222222311 - 33333332 ~12. 333323- - 3.231 33 I I 113 6.2133? 7 311111111011 MIclhods_ IDOL 703 -. 4111131__aa2.I11_113 I_l 45. .- .i i_ Food I 21-203. 525. 291? Fats, 0i], and Grease Control .3 . - - 39? {-1722 07232222332212.2232 If 1 - - II. 901_ :13 I M?nm?Mccm.? c_nl wan-.I muting facilitieIs _lrM?l' 501 :11 - II 49 [imam-?muggy. I Single sem?ce artichReuScI 59 mm?m?amm 3590-0091(13) Item No. E. -L. 7' ,ltz/Iy?zw? 1? .. I..- .11 rh-? . . .-. .11 ?25225!? 3 3?2. 1" . ?ma/II my?! 171?. 1. Non-Critical Critical umber of Critical Violations has: items requin: [remit-301MB attention Score Minus 211 P15 Side) Received 33/ of Seats FOOD ESTABLISHMENT INSPECTION REPORT Page of 5 Date: Score: Telephone: 5 [3 Retail Type of Inspection: Owner: and Service Mobile Routine Reinspection Person In 0 Temporary CI Caterer CI Complaint lnvutigation Inspector: . 0 Other El New Cl A Food Protection Management Facilities I. PIC AqignedlKnoerdgcabIdDudI-A 2-IUI. 102 4 Sewage 5-402, 403. 40-1 A FOOD . 6-501 4 2. Ibex} and Water from approved source 1201. 5-l0l 4 . Hand-?mm 4 3. Food ubc?ngleonuinm 3-302. 602 I S-IOI. 205 I FOOD PROTECTION . mm Roonu 5-302. son 2 4. 3401.401.60'i 4 mahoth 3-202.wa 1 5. hm cold hoidlng 3-501 4 S-JDI. 2 6. PHF Cooked a: cooled 3-501 4 @202 I 7. Cross contamination 1301.302. 30-1 4 33. 501.7- I a. sauna food: not. 701 2 34. 620i. 301 2 9. 01:113ngde 1 5-404 2 as. 5.303 I 10? 3:50] 2 36. Vemilation 6- I I I. Food PI-olrctionfSIorage 3-30?1305. 306. sum 2 . Rm 6805 I I1. Food Handling 3-301. 304 2 Other ?food um muting ?Irvine 4.204, 203. 302 I 33 1-201?: 1 4 I'crsoF'aI liy?te?ic Practices 39. ComumuAtivlmy 3-503 2 . I4. ?rm-Inga: Iicaith 212m 4 ilSP anmumu 3-80] 2 Is. Emplomc Imam - 2-4m. 403 I ConfonnmowiIhI-IACIPPIm a-zolmzzos I Emyloycc Clothing mom-402? 42, mm 6-50I I gulpmentmtensils 43. mm no: I IT. Sanimmn Methods 4-702. 703 4 44. Linen #3013013? I uipman?nIcnsils d: so_ni_tizrd 44301. 602. 702. 4 45. 6-50I I 19- ?01501.70! 1 Fm Oil, and Grease Control Yes No NM. 20. Nun-Food contact airfares 4-101. 6m 1 45? 21. Spongw?wiplng :[oIhs 4-101. em I . cmm?mmwi ManuaIJMechmirnl wan: wuhing facilitics 4-301.SOI I 23?Equlpmenifulcnsu image 3-304. 4-903 I 24. Single senior oniclumcusc? mm. 4-501. 904 I Comm? Non-Critical Critical 3 Score Minus 20 Pts. (See Reverse 51ch '3 Number of Critical Violations These items require IMMEDIATE attention #of Seats FOOD ESTABLISHMENT INSPECTION REPORT Page of 5 Date: Score: Type of Routine Ci Reinspec?on Complaint 0 Immigration UNewE?sblishment El HACCP u- 0 Food Service 0 Temporary 00m? Cl Retail El Mobil: 0 Caterer Telephone: Owner: Person ch Inspector: {Pl Wood Protection Managemegt t. PIC Mlpad??wwtodgubld?utiu mm. It}! 4 5-402. 403. 404 4 FOOD 6?501 4 Z. Food and Want from cpprovcd source 3-201. 5-101 4 2-301 204 4 3. FMUbeling/conuinm 3-302. 502 I I 25 5.20: 205 1 FOOD PROTECTION 29. Toilet Rooms 5.302.402.5131 2 4 PHF 3-401. 402. 403 4 112ml- mclhods 54016-301 2 S. Fndlitiu but It cold holding 3.5m cl 5401.502 2 6. PHF Cooked coolod 3-501 4 6202 7. Cross contamination 4 33. 6? 5013-206 1 B, Spoiled foods 341'". 70! 2 ?Mills-Calm 6201.501 2 9. Damaged Foods 6404 2 5202.530: 1 ID. lift} 2 Vm?ntim 4~ once. 1 Food 3-303.305.3015.on 2 . was Food Handling mm. 304 2 Other lifting measm'inn device 4-204. 203. 302 35 McMminls 7.201.192 4 Persona] Hygienic Practices Construct- 3503 2 14. Employee Health 2-201 40. ESP 3-801 2 15. Employu Hygienc 24111. 403 1 l6. Employu Clothing 2-363. 2-402 Prams 6-501 5-202 1 IT. Sanitation Methods 113102.703 4 44. Liam 4401.502.? 1 Iii. Equipmcotlutmsils cleaned a sonitizul 4-150! cm, 702 4 6-501 I 19. Food coolant cut-fans #202. 501.701 2 and Grease Control Yes 20. Non-Food contact sulfa?: 2 Spongodwiping cloths $101.90! 1 MW 23'. Manual/Mechanical were washing facilities 4-301. SOI 1 storage 3-301, 4-903 I 14. Single mic: articlecusc 3-304. 4?502. 904 . Item No. Non-Critical Critical} 5 Score Minus 20 915. (See Reverse Side) [3 Rfyuon I These items require IMMEDIATE attention ccivcd By By Number of Critical Violations of Scats? 0 Address: Owner: Person in Inspector: FOOD ESTABLISHMENT INSPECTION REPORT of Service (3 Temporary 0 Other Food Protection Management 1. PH: Aulgnedrxnowledgeahldnullcs 101 4 FOOD 2. Food and Water from approved source MIDI. S-lt?ll I 4 3. Food unsung Inuktitut: 1-302. so: i won PROTECTION 4. 3-401. 401-103 4 5. Facilities hot a; cold holding 3-501 4 G. PHF Cooked tilt cooled 32501 4 7. Cross contamination 3-30I. 302, 304 4 8. Spoiler! foods vol 2 9. nmged Foods 5.40.; 2 10. Thnwin: 3-50l 2 11. Food 3-301. 301306.640 2 l2. Food Handling 3-30I. 304 2 gfood tuna-alum measuring device 4-204. 203. 302 1 Personal l-l. Employee Health 2-20l 4 15. Employee Hyglene 2401.403 4 . IE. lo cc Clothin 1604,1402 I 17. Sanitation Methods 4-702. till 6 l3. Erwipmtutlutensils cleaned it sanitized 4-60], 602. 702 4 l9. Food contact surfaces 4-202. 501. '70! 2 20. Non-Food ??0,601 2 ?11. Spongwwiping ciolh: 4401. 901 I 12. MortualJMochutictl wore washing facilitics 4-301. 501 B?quipmentlutemll storage 3-304. 4-903 I 24. Single service miclodRcusc 3-304, 4?502. 904 a Non-Critical Number of Critical Violations Critical 5 Score These items require WEDIATE attention Page of Dole: Score: Cl Retail 0 Mobile El Caterer Type or Inspc Mouttne Complaint C1 New Establishment CI Rcinspection Cl Investigation A Facilities washing - . 5-201. 205 6-302. 402. Still 5-2016-30l $501,502 6202 6-202. 501.7406 6-20 . 501 62016-303 4-2172. 204.6- 6-305 28. . Toilet Rooms Ventilation Room: -unp- Other HSPunimmenu 4i. Confommewithi?lACCPle Premisu Linen IEIISE Maintenance Log Grunts Documentation (See Reverse Side) Reinspectio Inspected By #of Seats ?47 F000 ESTABLISHMENT INSPECTION REPORT Page 4 of 5 1/1411. #fz?k/ cc?m/ #14772? 4(7f?/ 1; - Sm?? Telephone? of Operation(s): Cl Retail Type of Inspection: Owner: ??fm Mood Service Mobile WRoutine El Reinspeclion Person charge Cl 1131:1me Caterer CI Complaint CI Investigation Inspector: 13711 I 4444/ Other I: New Establishment HA 1: [Food Protection Management I Sanitary Facilities . 1. p11: 24111.10: 4 25. Sewage 5402.4014114 4 FOOD 26. 6-501 4 2. Food 1nd Witter from approved source 3-201. 5-1111 1 4 27. 2401.5201204 4 J. Food Lobelingi?eootuiom 3-302.602 25. Plumbing 5401.205 1 FOOD PROTECTION 29. Toilet Rooms @302. 402.501 2 4. FIIFTempe-ralmes 4 JG. unmanned.? 5202.630] 2 5. Facilities hot cold holdinu 3-501 4 Wmu?edispmal 5601.502 2 6. PHF (?00de It cooled 3-501 4 32. misreporting 6-202 1 7. Cross contamination 4 3:1. PesticiMRnden?ciMppiicn?on momma-206 1 B. Spoilodtoods 3.101.101 2 34. Maximum 6201.501 2 9. DmagedFoods 6-404 2 35. Liming 6210,6303 10. 3.501 2 36. Wntilneioo I 11. Food FtetectioNStoi-age 2 31. DressingRomu 6-305 I 12. Food Handling 3-301. 301 2 Other l3.Food1empeTam1e meesun'ns device 4-204. 203. 302 1 38. ToxicMuerials 7.201.102 4 Personal Hygienic Practices 39. mam-on 3-603 2 14. Employee Heallh 2-201 4 40. HSPRoqttirm 3-801 2 15. Empioyce Hygiene 2401.403 4 41. ?011!thum 8401302203 1 1a. Emponec Clothing 2404. 24112 1 42 Piemiis 6-501 1 EquipmenUUtensIls 43. livingmm 6-102 1 17. Sanitation Methods $102, 703 4 4-1. Linen 4401.001003 I 15. cleaned ksaniu?zcd 4-601. 1502. 7112 4 45. 9:1: 6-501 1 l9. Foodconmt swim 4401501001 2 Fm, 011, and Grease Cantu-o] Yes No NA 20. Non~Food Contactsurfms 4-10I.601 2 45_ I 1 21. Spongestwiping c1001.; $101,901 1 47. GmhereeplorMnimoanceLog 22. Manual/Mechanical wan: washing. facilities $301.50! 1 43_ Gmhuupriw ILEquipmmtIutemu storage 3-304. 4-903 1 49? MIWW 24. Single service Melt-3111:1141: 353104. $502,904 1 5.0, W?mm megm) d: No. 2-: Non-Critical Number of Critical Wolotions These items require IMMEDIATE attention Critical 5 Score Minus 20 1?15. (560 Reverse Side) Received By nspected By of Seats Address: Owner: Person In charge C): Inspector: FOOD ESTABLISHMENT INSPECTION REPORT Date: Score: Type of Page of 0 Retail CI Mobne CI Caterer 00d ce CI Temporary Cl Other 0 Cl El HA Complaint New Establishment Non-Critical Nu of Critical Violations These items require IMMEDIATE attention Critical Score Cr Minus 20 Pls. (See Reverse Side) @1622 ?ta/j Received By Inapecled Food Protection Management Fucllilles PIC IUI ?1 . Sewage . FOOD Insec $501 2) Food and Water [mm sourtc 3-20l, 5?11? A 4 2 Elm-203.1? 4 3. 3-302. 602 I S-ZOI. 205 I FOOD PROTECTION . Toilet Room: 6-302. 402. 501 2 4. 34101. I102. 403 4 melhoda 5?2016-30l 2 5 Faculties hot cold holdmg Jail? 41 5.5m_502 1 6? PHF Cooked 45?: coolcd 3-5UI 4 6-202 I I canmnimlinn 3 SUI. 302. 30-1 4 I 8? Spoilui feuds 3491.71? 3 6-201.50l 2 ?1 Engaged Foods 5.404 2 5.202.640: 1 l0. 2 Ventilation 20mm. 1 II. Food?m?ow??tnmge 2 I. I2. Food Handling 3-301. 304 2 LEfood lama-alum maria} dcvice - 4-204. 203.30: I 33 Tuanxmals 7-20:. 4 1 Personal Hygienic Prac?ges 34503 2 I4 Emplom 2-201 4 In 3-301 2 l5. Employtc Hygiene ?l-40I 493 "Mug?4 $201.201203 I la. Employee CloIbing 2-304.2-402 I 42. Pumim 550] .13 umm 5202 I H. swuu?on Methods 4402.703 4 u. Linen - 4.501.302363" I lB. Equipmcnu?uumlli cleaned simian-:1 4~60l. 602. 702 4 45. Pen 6-501 I 19- Fonda-1m Mar?cs 4-201. 50l- 701 2 Fats. Oil. and Grease No NM A 20. Non-Food WWI luff?t? 601 2 46 Gmh?ll?'?plm Impgguon . ZI- Sponsuhvipin: cloth: I 4-Iol.90I I 47. 22. Mmuamuhmlul wan: wuhlng [Militias 4-30l.50l 43. storage $304.4-903 49. 24. Single mtcwuclumme 34043?502304 1 so Flam-um of Seats FPOD ESTABLISHMENT INSPECTION REPORT 1' r2 1 2 Page (of i} i 4 m/ Date: 92/51 9747/7 Address: :24? in Score: I) Telephone: . A Type Of Operatiuu(s): D?ala? Type of owner: /77 Ser?ce Mobile URou?ne Cl Reinspecuon Person in 3:30 (BIS): J??fi?f .. UlTemporar! CI Caterer Complaint Dlnvettigatjon 0 Other 0 New Establishment 0 HA Food Protection Management EEHIWFaci??oiw c' l. 2.101.102 i 4 2.1. sow ?mL? 77 FOOD 26.1mctortto0oou .. L4 I F. Food source 3.201.: to: 4 22. 20012201204 1 4? a. Food 3.302.602 23. Plumbing H, S-ZDI.205 FOOD PROTECTION Mqilet?oow . .. 5002402501 _2 4. 4 30. momma-om 5202,6301 5 Facilities hotatcotthordiog 3-501 4 3L 2501.502 2 o. PHFCoohd&coolcd 3-50: 4 32 Otuuopa?ngs 5202 7. contamination 11.301.302.304 4 33 mmaommumon 62025012205 TI 3. Spouooroodo 2 34. non-mm? 0201.501 2 9. DnmgedFoods 6-404 2 31% 10. 350: 2 36. M10600 1202204020230: i 11. Food PrumianiSmng: 3.303.305. 305. 5-10 2 37. Drusing?ooms . I 1.-.: Food Handling 3-30t. 304 2 Other llFood tempomm mowing amt-o $204. 203. 302 I 33. mum-um: 2201.102 4 Personal Hygienic Practices 20. Commomg 3-603 2 I4. Empioyu: Hanlth not 40. 3-301 2 I50 Employa: Hyman: 2-40L403 4 I11, Confmmuimm?m $261,202.23} I ?mpioycc ?aming Pam's: 5.50] EquipmenUUtens?s 43 mum 0202 1 t7. SmitationMuhods 4.702.203 4 44. Lincn 0801.202202] 8. Equipmtfutznsils :luncd&sanitized 4 43. Pets 6-50! I 9- Food contact surfaces 4?202. 501- 701 2 Fats, Oil, and Grease Control Yes No NM 50. Nanv?oodcmtazuurfm 4401.60! 2 4a Spongw?wtping clad-5 4401?in 1 Rhianna? walling [Militias 5101113: 3-303. 4-903 I mm 4. Singlt: service 3-304.4-502.90? I N0. Non-Critical lumber of Critical Violations Critical 8 a Score 1155: items require REMEDMTE attention Minus 20 P15. (See Reverse Side) GQW Received By Inspecmd Poop ESTABLISHMENT INSPECTION REPORT Page_ xorr__ 1 Esmb'kmm? 0/ in 0/1 A?rz?iv?j Fr/lm'f ?at? )3 Address: ?11? ffK??f/?I Score: Telephone: I rf?ype 0f antral??lms): Cl Retail Type of InspeTctfo Owner: Mt?? 114201 Service CI Mobile Cl? Routine Reluspectlon Person In charge (glC): 0 Temporary 0 Caterer Complaint CI Investigation Inspector: ?/1197? #:n?dv I 03?" El New Cl HA 1" Food Protection Management Facilities I. PIC Z-IOI. 102 i 4 5-402. 403, 404 FOOD 2. Food and Walcl' from source. 3-201. 4 204 3. Food uklingrconluim 3-302.602 1 5-201. 205 FOOD PROTECTION . Talk! Room 6402. 401 so: 4. FHF J-dtll 4 5. Facilities hot 51 cold holdm; 3-SDI 4 S-50l.502 6. PHF Cooked cooled 3-501 4 Outer 6-202 7. Cross contamination 4 33. 6-2132. SHUT-206 B. Spoil-ad foods 2 3'4. W?h?ilings 9. ["ny Foods 6-404 1 35. 62016-303 IO. PHF Thnwing 3-50! 2 3d Vcnlilnlion 4-m204.6-202. I I. Food ProtectiunIStorngc 3-303, 30.5. 306. 2 37. Rooms 6-305 12. Food Handling 3-301.304 2 Other 13. Food umjcmum measuring anion 4-204. 203. 302 I 33. Thai: Mammals?v Parsons} Hg?erdc Fractures l4. [Emploiec HcaJth Z-IOL A 3, I IS. Floploycc Huicnc @5103 4 l. CmfummwithHACCPleu a5. Emptoycc 2.304. 2402 mm 6-50! Equipmenthtensils 11mm 6-202 7" n. Sanitation Mcthods 4-702. 703 44. Linen $801,802,303 IB. cleaned 6r. unkind 602. 702 4 45. Pets 5601 .9. Foodcomuurram #202. 50mm 2 and Grease Control Ya No" 20. Non-Food cannot surfaces #101. 601 2 Spongc?wiplng cloths 4401.901 I Guru? 12. won: washing [militia 4-301. SM 1 Gym?- stems: 3-104, 4-903 1 Docummtion 24. Singleton-vice attainment: 3-304. 4-502. 904 I rentsCu-mplizmrc Non-Critical a Critical Number of Critical Violations Score These items require IMMEDIATE attention Minus 20 mi (See Reverse Sidc) Received By Date: By of Seats FOOD ESTABLISHMENT INSPECTION REPORT Page?? of! Establishment: I I 1 Dnin: 1 Adams: 3" 1" .. Score: 7 Telephone: - TYPE 0? Operation(s): Cl Retail Type of Inspection: Owner. 117%?? yam?? 5:59 Mobile Ema?) Relmpection Person In charge 0 Temporary 0 Caterer Complaint El Investigation IDSpector: #1747171, 0111?? New Establishment A Food Protection Management Facilities l. PIC 24m. to: 4 $402,403,404 4 FOOD lmuw?Rodcnu 6-501 4 2. ma?a source mm. 5.10: 4 24015-201204 4 3. 3-302FOOD PROTECTION 29. Tulle: Rooms 6-302. 402. so: 2 a. 3.401.402.403 4 ?otsam 2 s. FndlIn?u ha a cold holding Min 4 2 6. PHF Conknd a cooled 3-501 4 6-202 I 7. Cm conmninalion 3-301. 302. 30-5 4 33. 501.7406 I B. Spailud foods 3-101. 700 2 momma 02m. SDI 2 9. Dnmagcd Foods 0-404 2 6-2015-303 I I0. 3-501 2 chiln?nn I ll. Food PrntulinnI?SIongc 3-303. 305.306.6400 2 6-305 12. Food Handling 3-30I.304 2 Other I3.Fond mmuling dzvitc 4.204. 201. 302 I Ea. TuxicMalniaJs -. Personal Hygienic Practices 34503 2 l4. Emptuycc Health 2-20! 4 40. HSPanuireIraIIs 3-BOI 2 15. 2.40:.403 4 020I,m.203 I I6. Employee ClnIhlng 2-304. 2402 I4 I 42. Pumim I Equipmeutmlens?s 43. 11mm 0202 1 I1. Su?minn Methods 4.702.703 a 44. Liam 4430!.302803 I IS. Equipmcwulcns?s clcamd d: sanitized 4-60l. 601. 702 4 45. Pm 6~$0l I 19. Panama-mamas +202. 500101 2 Fats, on. and T65 Rio NM 20. Nonr?ood 2 116. k/ 21. cloths 4401.90! I 22. Manual/Mechanical wan: washing facilities 4-30I. 501 I 41!. MWSIMIE slums: 3-304.4-903 49_ 24. Single Eel-Vic: miclesIReuse 3-304.4.502.904 I so. WWI I Item No. .I I KM Non-Critical Critical Number of CriLical Violations These items require MEDIATE attenticm Score Minus 20 Pts. (See Reverse Side) Received By #of Seats FOOD ESTABLISHMENT INSPECTION REPORT Page 1' of Date: Score: Type of QfRoutine ReInSpection CI Complaint El Investigation CI New Establishment DHA Adamo-II: Telephone: 5): CI Retail 0 Mobill El Caterer Food Service CI Temporary Down Person In charge Inspector: I Food Protec?on Management Facililies I. PIC Assimxnowiwgmimucs 2.10:.102 4 . 5402. 403. 404 4 FOOD . 5-501 4 2. Food and Watt: app-mull source 3-201. 5-!0l 4 2-301 5203.204 4 3. Food 3-302.602 I 5401.205 FOOD PROTECTION . 6- 402 501 2 4. 3401,4oz.403 4 6-30I 2 5. Facilities hot .2 cold holding $50! II 5401.502 2 6. PHF Coohd :0on 3-50I 4 6-202 I 7. Crassconuminmion mm. 302. so: 4 6-202.50I.7-M I B. Spoiltdfooda 3401.7!? 2 6-20I 501 2 9. Humour-bod: 6-404 2 6-2132.6-303 I 0. 3-501 2 . Won 4-- 2015201304 I. Food Mastic-#510105: 3-303. 105. 306.641? 2 . Drum-m 6-305 1 2. Food Handling 21-30:. 304 2 3.Food temymlun: mounting device 4-204. 203. 302 I 35. TaxicMmInIs 4 'orsonai Hygienic Practices 39. CotmunaAdvisuy 3-603 2 4. Empioyuclluim 2-201 4 40. HSPanuimts MM 2 5. Employee Hygiene 240l.403 4 41. CodamunwimHAOCPI?Im'Is I 6. EmploymCIorhing 2-3oI.2-402 42. mm 6-501 1 Equipment/Utensils 43. mum 6-203 I 7. Sanitation Methods $701703 4 44. Linen I s. Momomm a 45. Pa: MM 1 9- Food conmtw?uu 4301- 501- 70' 2 Fats. and Grease Conloo'l Yes No NM 0. Nun-Food 2 l. 4-IDI.9OI I .37, 2. Manual/Mechanical wan washing facilitics 4-JOI. SDI I .13, mlwsim: J.F.quipm=ndulen3i1 uoruge 3-304. 4-903 I 49? It. Single sen-ice mocks/Reuse 3604.4601904 51], FW-WIGI lem Non-Critical Critical 5 Score Mi us 20 PB. (See Rev; rso Side} Reinspecuo? Da c. IIumher of Critical Violations ['hesc items require WEDIATE attention of Seats FOOD ESTABLISHMENT IN PECTION REPORT Page 4 of Address: Establishment: 1 ?5 a: Date: Ur: Score: Telephone: 1 ?llype of Opern?onm: Cl Retail Type of Inspection: Owner: 199/?? Food Service CI Mobile ?cu?ne El Reinspectton Person in charge (P C): Temporary Cl Caterer c1 Complaint El Inspector 174 79477,, Cl Other I: New Establishment Cl EA 0 [Food Protection Mani-?gment I I 5 Facilities 1. 240:. m: Jan FOOD 1 node erI'Inml $291,540: 4 3. {containers 3602.602 1 FOOD PROTECTION d. 6-404 3-501 3-303. 305. 306. 3-30]. 304 302 l9. Food must 20, Non-Food comm surfacu 21. cloths 21. MmualMechnnie-el 23 lensil 24. Single service m?dc?euee 4-2021 70! 4-101. 60 4.1 l. 90! 4-301. SDI 3-304. 4-903 3-304. 4-502. 904 facilities Non-Critical Critical Score Number of Critical Violations These items require attention . Toll-ll Rooms Minus 20 ms. (Sec Reverse Side) rm Eccrived By NCS 4 404 20-1 5-20 205 6-302. 401. 50] $2412.64!? S-SOIJOZ 6-2112 6-202. 50]. 7-206 SOI n?n?sn?n?NNM?vh 6- #ofScats FOOD cnou REPORT Page 4 or 4 Establishment . 5772/47" ?md ?QZ/ji ?at? 47/ Adm $26? I 19" 1 Telephone: Time of Operatiop(s}: 0 Retail Type of Inspectiem: 5' F000 Service Mobile Moutine Cl Reinspectiou Person it? charge Caterer Cl Complaint 0 Investigation Motto/Mfm DO?:mr DNewEsmblishment DEACCP Food Protection Management Facilities l. PIC ?91 102 4 2.1. 5401401404 FOOD 26. [7 Foodand Wam?nmapptuved source. 3.2m,s.ml I 4 2-3m.$ 204 3. 3402.602 5.201 205 FOOD PROTECTION . Toilet Room 6-302. 50: 4. 3401.401410] 4 methods 5. Fndli?u hat a cold holding 3:501 4 - 5.501.502 e. PHF Cooked a cooled 3-50I 4 5202 7. Crosseonwminntion 3-30l. 302. 304 4 6- 501.1206 Spoiled ?0qu 3.10:. 70: 2 5201.501 9. amt-?e?: 6-404 . 6202.630] m. 3-50; 2 imam. 202.204.5202, Food Ptmecdow?Smge 2 . 12. Food Handling 3-301. 304 2 Other ?Food temp-tum aiming device - 4.204.203.302'1 I as. 1201.10: 4 Personal Hygienic Practices 39. (Sonatina-Min)! mm 2 14. Employee Health 2-20] 4 40. HSFRaIuilmm HUI 2 Employee Hygiene 2401.403 4 4L CudmmeMdIHAmPle s-zonmzoa 1 I6. Employee coming 2.301.240: 1 41 am 5501 Equipment/Utensils 43. Livingmus 54m 1 f7. Sanimtiun Methods 431172.703 4 44. Linen $801,802,803 I I8. Enuipmcwutuuillclemed ?mum 4401.502. 702 4 45. Pet: 6-50! 1 l9. 4-202. 501.701 2 Fats, Oil. and??rms Control Yes No 30. Non-Food contact turfm 4401.60l 2 45? 51185:me ll. Spungwwiplug cloths 47? mwn?nmm 13. Manual/Mechat?ml we washing facilities 4-301, SDI I 43, may 3404,4430] 49. mlmm? smglemiceuucwnem I m. Wmmh?m WWI 1/ J-: Item No. Non-Critical a- Cn'liea] Score Min 21] Pts. [See averse Side) Reinspec . Number of Critical Violations Thaw: item: mnnirp Rrrpiuprf RV of Seats FOOD ESTABLISHMENT INSPECTION REPORT Page17/ Date: AddressType 01' Operation(s): 0 Retail Type of lmpec?on: - Owner ?7 IfFood Service Mobile ?Routine Cl Retnspection Person In charge ?3 Temporary Cl Catemr CI Complaint Inspector. 'W/jy? Other 0 New Establishment A Food Protection Management Facilities l. 91c 2-Iot.102 404 4 FOOD 25. [Woman 6-50! 4 2. Food and Wam- from mum: 3.20:, 5.101 4 . Hand- 2.301.5?2m.2m 4 3. Foodubttinglcontalnm 3402.502 i 1 2a. 5-201.205 FOOD PROTECTION . Toilet Rooms 6.302. 402.501 2 4. PHF Temperature: 3-40I.402. 403 4 mm; 52016-30! 2 5. Facilities hot cold holding 3-50] 4 $501,502 2 ti. PHF Cnokzd a: coated 3-50? 4 6-202 I 7. Cm.? contamination 3-30]. 302. 30-2 4 33. 6- a. Spoilcd foods 2 . FloasM?alNCcitings 6-201.SOI 2 9. Damaged Foods MM 2 64026-303 10. 3-501 2 Wan 4-202. 203.6402. 1 Food Protectiun'smgc 3-303. 305. 306. 6-40 2 . Ram: 5305 12. Food Handling 3-301.3o4 2 Other l3.Foad tempmuun: ramming device 4-204. 203. 302 38. ToxicMuatals 4 Personal Hygienic Practices 39. Colman-Adria)! 34503 2 l4. Empluycc Health 2-20! 4 40. HSl?Rmuimmts 3-80! 2 t5. Employee Hygicnc 240t.403 4 8401201233 1 16. Employ: Clothing 20104.7.? 1 42. Heath: 6-501 EquipmenUUtcns?s 93. um 6-202 I I7. Sanitation mums ?702,703 4 44. Linen 1 4-601. 601. 702 4 45. Pm 6-SOI 1 19. Food Contact sumac: 4-202. SDI. 701 2 Fats, Oil, and Grease Control YE: Nu NM t0. Non-Food contact surfaces 4-10t.60t 2 a. El. SpongWWipinn cloths 4401.90! 1 Wm 12. MnnuaUMachnnica] war: washing fucilitics SOI I 3.Equ.ipmcuttuunsit ?mags: 3-304. 4-903 I Mama 3-304. #502,904 I Wmc?m Nomc??w Critical a Score Minus 20 Pts. (See Reverse Side) Reinspecu?on e: \tumbcr of Critical Violations these items require MEDLATE attention Recciwd By ed By of Seats FOOD ESTABLISHMENT INSPECTION REPORT Page DB A Score: Telephone: 01' 0 Retail Type of Inspection: 1700?! Service CI Mobile Mouth?: 0 Relnspection Person In charge . 0 Temporary 0 Caterer Cl E1 Investigation Inspector: Other :1 New A Food Protection Mmgge_ment Sanitar?ncilities l. 24m. 102 . 15 5402403404 4 FOOD L26 mm 4 2. Food and Walcrt?mm approval scum 4 Hard-whingfuihtiw?pmcodum 20-1 4 3. Food Labeling foomninu: 3-302. 601 28. Plumbing 5.201. 205 FOOD PROTECTION 29. Toilet Rooms 6402.402. 5m 2 4 4 5402.630! 2 5. Facilitics 11018: cold holding,__ 3601 4 540L502 2 6 PHF kacdatcoolcd 3:501 ?t 32. Outcropmings 6-202__m I 7. Cross cunwm'mtion 3-301. 302. 364 MkiWRodmticichp-?imion E?mi?l?-w? a. 3401.101 . 2 it. Emmi 520mm 2 9. Damaged Foods 5.404 2 35. Wm; #9202.st 1 10- 3-50: 2 35. Vcn?lodiga I muanrsuomge 3-301. 305, mm 2 37. mignmnu . was 1 3.301.301 2 Other _13.Food tcmpu?ltnm muting device 4404303302 1 7,201,101 I Personal Hy?lemc Practices .- 34m 2 u. Emplum Hulth um i} 4 4t) HSPuniremu 343m 2 IS. Employee Hilton: 2401.403 4 L1 15. Employee Clothing 2.3044402 I 42. mm 6-50! I 43, 14mm 5.202 "b ??11 swam." Mclhods 4.702.703 4 44. Linen 440me 1 sanitiud 4-60]. 502. 709 4 650i 4 I Food $202. 501. 701 I Fats, Oil, and C'r?osE'Cuntml Yes 20. Non-Food HOLGOI 1 4.5, 2L 47. 22. wan: wuhing fuililiu 4-30I. 43, - 510mg: 3-304.4-903 .9. RmhingDoctunmwiou Li?ingle wicks/Ram 3404' 4402? 904 I 50. Mitrucum-vurrnusCump?anm human} if Item No. a Non-Critical Critical 5 Score Minus 20 NS. {See Reverse Side) ?22? Nombcr of Critical Violations 7 Thus: items require IMMEDIATE attention Received By FOOD NT INSPECTION REPORT 0 eats__ age of F?smblishment: mix" Add?' 73:47:; ivy/?; Telephone: 1/ TYPE 01' OPEHIHOMS): DRem? Type of ?pec?on: Owner ?g 17?" [RFood Service 0 Mobile Routine DReinspection :mp/ Temporary Cl Caterer El Complaint CI Immtigatlon other New Establishment A 9 Food Protection Management Facilities i I. PlCAuizncdenowicdguhldDutim 2.030.102 4 25. Savage _h 5402402404 4 FOOD 26. 3391?? 4 2. FoodandWatufmmapprm-Iw 50m: 2201.540: 1 4 22. 230i. 5-203. 204 4 3. Food Labeling/container: 3-202. 602 '23 gluing?; 201.205 FOOD PROTECTION 29. Toilet Rooms . 6401401501 2 4. 4 m. "mu?mamm? 52020301 2 5. FacilitiuhOIAcold holding 30m 4 31. Wmuidedspmal LT. 2 6. pHFCooudacoaIw 34m 4 32 Dina-apathy 6-200 .1- 7. Cmcontan?mtion 3-30I.302.304 4 33. WMEWQH . 6202.50L7-206 s. Spaikdfuods 3-IDI.TOI 2 34. ?nnWaW?I-Igs 6-20t. 501 2 9. Omad?iods 5404 2 35. Lighting 02020333 I I0. PHF Thawing 3.50: 2 30. Won $202,204. 0202.304 1 ll. Food 3.303.305.3000? 2 32. 3:301 I2. Food Handling 3-20I.301 2 Other measuring device 4.204.203. 302 I 33 TouticMatcriaJs 7-20I.I02 4 f?ersunai [1er000 Practices 39. memhd?su'y 1-503 2 L4. Employc: Health 2-201 4 it}. HSPRequim-nmts 3-8-01 IS. Employecilyaimc 2.40:.403 4 0.201.202.203 I 6. Employ: Clothing 2-30-1340: I 42. mm 6-50I enu?Utensils 43. umm . 0202 . Sanitation Methods 4402.703 4 44. UM 4-801.802.803 I . 4-601.602.TD2 4 45. Pets em I . 4-202. 50L ml 2 Fats, 0i], and Grease Control Yes No NA . Non-Foodcontacuurrw 4401.601 2 .01 mwhwun . Spongur?wi cloths 4401.90! . 4-30L501 43. Gmlmu-FIHSimgc Uutcnli] 3-304.4-903 49, Runningbocmnm?m . Single service m?clu?tcuse 3v304.4-502.904 591 FWIG) Non-Critical C: Critical Score Minus 20 PRLOLW {See Side} El ReinSpectjon i umber of Critical These items require IMMEDIATE attention Received By In I: of #of 3::an FOOD ESTABLISHMENT yspecnon REPORT Page I mf?/f?xx @1074 raj/1? 7 SCOPE: Telephone. J. j, . Time of Operationo): :1 new? mm of Inspect-on Owner: Wood Service CI Mobile Momma Cl Reluspecuon Person in charge [g9 71/, 0 Temporary EJ Cnlerer Complaint Cl Investigation InspectorM/J/m CI Other 0 New Establishment c: A Food Protection Management 8 Sanitary Facilities l. PIC 2-10]. m: 4 25 Sewage 5-102. FOOD 26. 6.501 4 2. Food and W3 from approved soul-cc 3-20l. S-EOI - 27, 1301.3201231 4 3; Foodubelingfoomalnm $302.60: 1 28. Plumbing 5-20l.205 1 FOOD PROTECTION 29. Toilrlkoonu $302,401.50] 2 . 4 PHFT 3401.401401 30. 54916-301 2 5. Focal: shot&cold 3-50l 4 Gubagdrc?udouuidcdisnosal 5.501.502 2 6. PHF &coolcd 3.501 at 32. Outaopcnings 6-202 1 7. (2?is 3-30I 302. 304 4 L3. Mdmm?cld?pplica?m G-MSUIJ-NG 8. food: 2? 34. Wilmihp_ 6-20L501 2 9 Food: 6-404 ?2 35.1mm?; 62016-303 l0. PHP 3-501 2 35. meuon 4-2012015402304 1 H. Food $303.3os.3oo. 2 . was 1 t2. Food Handling 3401.304 2 Other ?Food 4404. 203.302 1 .33. 39. CamumurAdvmg 3w 2 Health 1-201 4n. Hun 2401.403 41. $201,202,203 I I6. until-uh - 42. Prentiss 6-SOI EquipmcnUUtcns?s magmas 5.102 1 l7. SanitalumMcmula 45101.70] 4 44. Linen IS. Fquinmndulnmils cleantd sanilimd 4-601. 602. 702 Eff?i 6-50! I ?ff-w 4-202. 501.701 2 FaLs. Oil. and Grouse Control Yes No NA 20. Non-Foodconmuurfuu 2 um 21. Sponges/wiping cloths 4-101. 901 1 cw Minimums: 22. ware wishing fuillu?u $301.10! I Grease B?quipmenllutcmil along: 3-304. 4-903 I Down-Malian ism}: service omelet/Roux 3-304. 4-302. 904 . Mk: Awmnm Pls. (See Reverse Side) Non-Critical Critical Score Date: Number of Critical Violations These items require NMEDIATE attention FOOD ESTABLISHMENT INSPECTION REPORT I: of Seats 4 Page of A 1/37; 2% Dale: 999'- ?7 Address: /Z/f4,,fi Scam 14/15:, Telephone: 4 I I I II Type of Operation?i): CI Remit Type or Ingpe?euon: Owner: f/I? mood Service a Mobile menu? Reinspec?on Person In charge Ch}, I, 0 Temporary Caterer Complaint 0 Investigation In Other 0 New Establishment. a A or Food Pmtec?on Management 1. AnipedenwledLubldDudu mm. l02 .. 4 5-402. 403. 4114 (FOOD 5-301 2. Foodnnquerfmm [ppmHedIome 3-201. 5401 4 3. Food seam. to: 1 5401.205 6-302. 402. 50] S-MO-EIOI F0 on PROTECTION: 4 3-40] 4-02. 403 3-501 3-301 J-JDI. 302. 304 JJ 70: 9. Food: 6404 no. PHI: mum; 3-501 ll. Food Food 5-SOIJEIZ 6-2112 6-1112. 50! 702% 501 6-303 h?N?anN?hA& [3.Food 4-204. 302 4 2 2.201 2 403 us. 2-402 I Eqdpmen?Ulens?s 1 I2. gimugunmm . +102. 103 4 1 . i &unllized $01,601,102 44 4 19. Foodmnuumfwu 4-202. 501.701 2 20. Non-Fund conuctsurfm HOLGOI 2 Sponguiwlping cloths 4401.901 1 wm ?7 4401.50: I n?qulpmememll Mange 3-304. 400! 1 24. Single service wamuu 3-304. 4-502. 904 1 Score MI 20 Pts. {See use Non-Critical Critical Inspection Number of Critical Violations These items require IMMEDIATE attention Recc?fd By ted #of Seats FOOD INSPECTION REPORT of i 1693 441/ ?at? Add? 44/ .. {95' TelephoneiL' . me of Opemtian(5)= CI Retail Type of Inspection: WFood Service 0 Mobile B'Rauline Cl Reinspecaon Uchmpornry Cl Caterer Complaint Cl Investigation Other 0 New Establishment Cl A Owner: Person in charge (PIC): am 7, Food Protection Management Facilities I. PIC 2.10:. I02 4 5-402. 403. 404 4 FOOD 26 a 5m 4 2. Food and Waltr from source 3-20i . 5~l Di 4 . Hand- 2-3Di.5 203.204 4 3. Food ube?nglconminers 3.302.602 I 23. 5-201. 205 1 FOOD PROTECTION 6-302. 402. 501 2 L4. 3.401.402.403 4 5.202.030: 2 5. Facilitits hot &.c0!d holding 3 so: 4 3501.502 2 IS. PHF Cooked .3. contact 3- SOI 4 6-20: I 7. Cross conumination 3- 30t 302. 304 4 0202. 501.7-206 I 8. Spnlicd foods 3 IOI. 7m 2 6-201. 50: 2 9. Dumas Foods 0404 2 0202.03.03 1 l0. PHF Than-in: 3-501 2 \bnl?n?on I ll. Food Pratcc?urb'Swm?: 3-303. 305.306.640- 2 . 305 I 12. Food Handling um. :01 2 Other 13.Food minimum taunting dcvicc $204.10). 302 38. Tw?cMauinls 7-2Dl. 10.: 4 fix-sang} Hygienic Practices 39. (Sm-mm 3-603 2 l4. Health 2-20I 40. HSP 3801 2 IS. Employee Hrs-inn: 3401.40] CorfmnacwileACC?PPIJIB $20! 202.203 I i6. Empioync ?aming 2.301.240: Pctmiscs 0501 I 3. 5.202 I Methods 4?702. 703 I 4 44. Lima 4.501.002.3433 I Is. Equipmntiutmsib clemw a: sanitizad 4-601. 602. 702 4 Pet: 6-50: 1 I9. Food contact mum 4-202. 501. 701 2 Nun-Food conuIcI surfam 4401.8? 2 cloths 4?l0i. 90! i 12. MmuaVMechmicai were washing militias 4-30I. 50} aliquipmvuicmil slang: 3-304. 4-903 M. Single scrvic: articles/Reuse 3-304. 4?502. 90-1 [em Non-Critical Critical Score Number of Critical Violations I?hcse items require IMMEDIATE attention of Seats 4% FOOD EST LISHMENT INSPECTION REPORT Establishment: 1 Date: C: Address: ?4/17 Score: Telephone: )7 Type of Operalim?s): Cl Type of Owner: Mir/7? [/de Ed 56119:} CI Mobile vellum: DReinspection Persun?l'? charge (PE): ll'Cl Temporary 0 Caterer Cl Complaint CI Investigation Inspector: Mm W/[x '3 Other CI New Establishment A 0 food Protection Max:335: men! 5 Facilities I. 2.101.103 4 25 Saw: 5402,403.404 26 Justus-madam: 6.501 I 2: Food and mumItonrainm .-.-.. 3-392. 1502 I . Piumbi 205 FOOD PROTECTION . 1'01ch Room: 0301402501 4. PI rmEntuE: 0. 3-40] 402 403 4 Hand- medtods 5402.630] 5. Facilities Krauid holding? 3-50! 4 540L502 6. PHFCoakcd &coolcd 3?50! 4 5'71? 0 301303, 304 0 6-202. 501.1200 3. 10 2 620mm 9 Foods . 6?401 12 62016-303 10. PHF'I'hawlag 3-501 2 chilnlion Mined mm 3.103. 305.300, 2 . 0305 12. FoodH 3-301. 300 2 Other 13.Food devic: 41.201.203.302 1 [7507.102 4 39. CommAdvism: 2 4. ?30ng - 4 40. HSPquub-umms um I 1 0 CanfomumewithACCPle I I6. _l 42. Pianist: 6-50! I 43. 5.202 I 17 Sanitation Method: .0702 103 4 44- Linan 4-801-332qu 1 k3 [agi??ngumn?ls cleaned 3.: unilizcd 4.501.602, 1'02 4 Ru 5'5? I 19- Food comm surfaccs 4?202- 501.701 2 F861 Oil, and Grouse Control Yes _No 20. Non-Foodconucuurfuu 2 4f; 5 21. Sgongedwiping cloliu 4-1Ul.901 1 . 22. 4401.501 1 40. 3404.440) 49. R?nlrringn?f?lnlnI-?im 1 24. Single service ?tidal-[Rania 34-04, $502,904 I 50 ?ammAwumeumg?m-u: ?W-Wlu' if} In . 1 1111(mm47/ my. 47?. r/fn? 4:4? ?ax/?zz/L - I d_ 3 Non-Critical Critical Score Minus 20 P13. (Sec Reverse Side} Number of Critical Vioiatians These items require IMMEDIATE attention Received By #of Seats ESTABLISHMENT INSPECTION REPORT Page_ of 975/) M99- 929/ I?m MM #99 994/ 413/ SW 999/9 Telephone: of Opem?ontsh 12mm Type or fm??E?on?: .. a Food Service 1:1 Mobile zrnoudno 1:1 Reinspection 14;??pr Twparnry Caterer Cl Complaint 0 Investigation 0 Other 0 New Establishment El A Food Protection Management l. PIC 2-101. 102 4 . 5402.403.404 4 FOOD InsecuIRodmu 6-50] 4 2. Food and Wm approved source 3-201 . 5-101 r: . 2.301.020.1204 4 3. Food 3-302. 602 1 p1 5201.205 1 FOOD PROTECTION 29. Toilet Rooms 6-302. 402. 301 2 4. Tmpommu 3401.402. 403 4 nuthods 52020301 2 .5. Facilitia hot cold huldinn 3-50! 4 . 5-SOI.502 2 5. PHF Cooked 01 cooled 3-501 4 Dumopmings 02m 1 7. Cross contamination 3-30l.302.304 4 6201501.?406 I a. Spoiled foods 3-101. 201 2 2 9. [imaged Foods 6-404 2 0 0-303 1 10. NW Thawing 3-501 2 Vcnlilntim $202.203.6-202.304 11. Food mammals-mm: 2 2. Rooms 1 12. Food Handling 3001.304 2 Other I3.Food tempinrun: maturing device 4-104. 203. 302'. 38. 1331;1ch Personal Hygienic Practice: 39. CommAdvism-y 14. Empiayec Health 2-201 4 40. 15. Employee Hygimc 2-40I.403 4 l. . Employee Clothing 2-301. 2-102 I 1 2 Prentiss 3, 44. Linm Pa: 41-701703 4-601. 602. 702 4.202. 501. 701 4401.64? $101.90! 4-301, 50! 3-304. 4602.904 . Sanitation Methods sill aimed unkind . Feud contact minced . Nan-Food cenuct Stu-face! cloths . MmuatiMechanlcal wan: "0103.1: Single service admins/Rem tease Control facitilic: Non-Critical a Critical 5 Score Number of Critical Violations These items require DVIMEDIATE attention of Seats ESTABLISHMENT INSPECTION HEPOFIT Page ,Establishment: 4/ Date: a! a? 1/ Score: Telephone: 1 $198 OI Cl Type or l?ecuon: Owner: Mobile )1 Routine Cl Reinspec?on Person In Cl Temporary 0 Caterer El Complaint El Investigation Inspector: Mfr/@171 Mg/ El Other CI New Establishment a A Food Protection Management I 3 Sanitary Facilities: . I PIC Eula?. 4 25 Sewage 5?402. 404 4 FOOD '26 Inmwaodcm m; 4 I and Water so?Jrc: 3-20I. 5:16! 4 IT. 4 3. Fnodubclin; Iconluinm 15. Ptumbing 5-201.205 _H_l_q FOOD PROTECTION 29. ToikIRonnu h? 5-302. 402.501 2 4 3401401401 30. Jams-301 1 5. Faculties hm cold 3.50! 4 EL 1 PHF Cooked t'kcoolcd 3-5U: 4 32- mm? 5.102 7 Crew contamination 3-301. 302. 304 4 31 5.1m. 501.7-2116 3 8. Spoilcdfoods 3491.701 2 34. mwum 2 9. 4 1 6-404 2 35- Lighting ?r TE 3-501 2 36. Venlilmion I I I 1. Food mandating: 3-303. 305. 306. ml 2 37. Dm?nch-mu 6-305 1 12. Food Handling -. 3.301.304 2 Other ?food {amperamre measuring dcvla: 4.204. 103. I 39 TOIIEMMEIS 7-2Ul.102 4 Pcrsoqal Hygienic Practices 19 Commuhdvimry "77507"? i 2 14. Empluycc Huh}! 2-201 4 w. Hspnaquirmmu 1 11 2401.403 4 41. conimmwiuhmcanm ?01.202103 I . l6. Employee Ciolhini 2.304.240: 1 TI 42. Plum: 5501 1 EquipmquUtensils 43. umm 6-202 1 17. Saniunun Memods 4.702.703 4 44. um 4-801.802.303 Food contact mm 4.202.501.70: 2 ?33,101], and Yes No 20. Non-Food contut iurflcu 4401.601 2 46. Spongurwiping cloths I i 22. Mmudmuchanicnl wan: wuhing Militia 4-30I.50l 4.1 "4 SIGMA-901 49, I 24. Sing]: mice mimwluu-e 1 so. {mama Non-Critical a Critical Number of Critical Violations Score These items require IMMEDIATE attention nus 20 Pts. (See Reverse Side) CI are: I Inspected By II ofseats FOOD REPORT page?? ?of .. Dam fom?x SCW x/M 7; Telephone: 2 TYPE of Cl Retail Type of Inspechnn: Owner: d/ ?45?me @Food Service EIMnbile .lP'Routhe Relnspec?an Person' In charge C): 1! FLC O?Tcmpor?rr CI Caterer Complaint Cl Investigation [aspecloy 77W 0 Other I: New Establishment HA Food Protection Management 3 Sanitary Facilities I I. 2401. I02 4 lzs. 5403403404 fl FOOD 26. 6-50l 4? I 2. Foodmd Wuerl'mmappmvedsuurcc 3 201. 3133390 1-30l.5-203.204 I 3 2.. 50_2_ 23. Plumbing 3201.203 l? 29. Toilcl Room 6-302. 402. SDI 3 4. PHFT=mpaquru 4 3o. Hun-mm $202,630: 1 s. Facilitiahotacold holding 3-50! 4 Garbagmmwuidcdispml 3301.302 2 "Wm: Camaacoolea 3-50: 4 I33 Ougcyayngs 7 (>202 7. Cross eonlamimquII 2 2- 3-30l. 301. 304 4 33. 6202.501J-206 72 Spailulfoml; 3401.10: 2 34 0.201.501 2 ?9 0130ng 6-404 2 33. 133mm 6202.63.03 f1" FIFTh-Iwing mm 2 ?36. 'I'cIIn?IaIim 32022030202304 I II. Fund 3-303. 305.306.040I 2 32. Dras?ngRooms . . 6303 3-30I.304 OIher Zak?ism; devicg_ 4?204, 203. 302 IJ 33. ToxicMuctiaLs 7 201.102 Persanal Hygienic Practices 39. tom 3-603 l4. Eur-plum Health 2-20! 4 . HSP 3-80! [5 Empluyc: Hygiene 2-40L403 4 3401301203 16. Employa: 23032-402 I I 2 hum-.3 03m 3 5-202 l7. smwanmm 4002.203 4 44. mm $801,802.80: 18. cleaned sanitized 4-50l, 602. 702 4 Pas 5-50! l9 Food contacum?ces 2 as 20. Non-Food 000th surfaces 4401.60! 2 um 21. Spongu-?wigins cloths 4401. 90l 61:33: 22. Manual/Mechanical wan washing $301,501 I BEqupmmdulcnsil mg: 3-304. 4-903 1 24. 3-304. 4402.904 I Item Non-Critical Critical Score Minus 20 ms. (See Reverse Side) of Seats FOOD EST NT INSPECTION REPORT Page of 5 Date: Addms: iephone: . Cl Retail Type of] Owner: . nice E3 Mobile Manda: El Person in charge 0 Temporary Cl Caterer El Complaint Cl Investigation Inspector: Other :2 New Establishment 1:1 11 A 0 Management I I unitary Facilities .h 1. PIC Assigned/KnowledgeabldDudu 2101.102 4 25 Sewage 5402. 403. 404 4 FOOD 25 6-501 4 2. Food and Watcr from 50110:: 3-201. MOI 4 27. Emil-whingfxi?uiwptmadm 4 . 3. Food 3602.601 I 28 Plumbing 5-201. 205 1 FOOD PROTECTION 29. 11:11:: Rooms 0302402501 2 4 3401 402. 401 a 10. 4 5-2020301 2 5 1101111115 3-501 4 ngidcduponl 5.501.502 2 3.501 4 :12; 00112203111055 6-2112 1 3,301 302. 304 4 33. thodmticmppum 6-2112. 501.2206 1 3-1 1. 1 2 34. Homkuwccump 0201.501 2 5'40? 7 . 5401 1 10. 3-501 2 JG. Ventilation 1 11. Food 2.303.205.1106. 2 5g leanoanu 0105 1 12. Food 3.301.304 2 Other ?food ?04.201302 I 38. 1011:me 7001.102 4 Personal 1 w" 2 .. . 2 2.401 403 41. Cantomwwilhlimi?lnm I 2.304. 2.402 121m 1 menUUiensiis 1 103 1 1 191 Food contact surf-cu 4-202, 501, and, Grease Control A 4-101mm: 4-301. 501 Si 3-304. 1-903 . mammalian 3.304. +502. 904 Non-Foal contact surfacu cloths Mnnuab'Mcchanlul ware wuhl 10. ll. 21. 13. 24. facilities Single service Malamute Non-Critical Critical 5 a Score Minus 0 Pts. (See 0002-50 Side) Number of Critical Violations These items require attention of Seats FOOD ESTABLISHMENT INSPECTION REPORT Page T4 of 5 2513015th 1?4? Lind/y/ 7 Score: yg/cg Telephone. Type of over?ows): :1 man Type of Inspection: Mm, WSW WM Person in chime (010)17/21, O?Tunporary c1 Caterer 1:1 Complaint :1 Invm?gn?on Inspector #fT/t/ Other New Establishment :1 HA (2 9 Food ProtchOn 1. 2.101.102 i 4 25. 5 404 4 FOOD 6-50! 4 2. Food and Wan: tram appruvcd some: 3.201. 5.101 4 . Hmd- 2-3015 204 4 3. Food 3802.601 1 23. 5-201. 205 1 FOOD PROTECTION . Tullet Rooms 6- 501 2 4. 3.401.402.4113 4 named: 54016-30! 2 5. Facilidcs hut cold holding 1?50] 4 $501,502 '2 6. PHFcookedacpoIdd 3.501 4 6.202 1 1. Crossmnun?muau 3-301. 302. 301 4 6202.501.7-206 1 a. Spoiled foods 3-101Dmaged Foods 2 5.303 1 10. PHF Thawing 3-501 2 204.6201. 1 II. Food Protecdon?Slorase 3-301. 30:. 306. 6-40 2 . 305 1 12. Food Handling 3.301.304 2 Other ?Food measuring device 4-204. 203. 302 I 33, 'IhxicMnm-inls 74me 4 Persona] Hygienic Practices 19. 340:1 2 I4. Empluym?callh 2-20! 4 40. [-3951un 3-80] 2 15. Employee 11mm 2401.403 4 41. 0201.200203 1 15. admin. 2-3043402 i I 42. mm 6-501 1 43. 11mm 5-20: I 17. Sanitation Methods 4 44. Linen 4.801.801.3113 1 l8. Equipmu'mmsm cluned?sanjtiml 4-601.602.702 4 45. Pets 6-50] I I9. Food contact surfm 4-202. 501. 3'01 2 Fats, 03,1011 Grease Control ?5 No NA 20. Non-Food Cunucl 1mm 4-10]. 601 2 4.1 if. 4-10]. 901 47. 22. Mmumuhmical ware washing Militias 4-30]. 501 43, Gmh??plm?im new 3-304.4-903 I ~19. Mum 24. Singl: mcemiclwkeus: 3004,0502304 1 s11. 1590009101 Item N: . In I ?74 (?3195/ f? 1 34/" )1416? 2.4? Non-Critical a Critical 5 Score Number of Critical Violations These items require IMMEDIATE attention of Seats FOOD ESTABLISHMENT INSPECTION REPORT of q; Date: ddress: Score: Telephone: 0 Retail Type of Owner: Mobile Reinspectlou Person In 0 Temporary Caterer Complaint CI Invuugauan Insyector: Other :1 New Establishment 1-1 A or Food Protection Management Sanitnq I . l. PIE Z-llIl. 102 4 25 Scwagc 5401401404 FOOD 25 Insects/Rodents 6-50! 2. Food n?d Water from approved source 5~10l 4 27. Hand-washing facilities/procedures 2.301540}, ?ma 4 3. 3-302.602 I 18. Plumbing $201.20! I FOOD PROTECTION 29. Tuilcl Room: 6.30:. 402. so: 2 4 30. 5-2OL6-301 2 _ho.zthL__culd 3-501 1. 5-50I.502 2 1.501 32. cumming: 6-202 I .LC 3.30 302. 33. mama-206 I I 3. 70 34. (401.50: 2 9. Dm_ged Foods 6?404 35. Liming 6.202.640) I 10. 3-501 36. Ventilalion I II. Food 3-301. 303. 306. I 12 Food 3-30L3n4 Other '3 Food 103.301 ?ZLELngicMamials 7.201.102 4 Personal Hygienic 19 Can. mmu'm 2 We: Hum: MCII 4 343m 1 4'5me? 24m?4m 4 8401.101103 I If). Employcc Clomln 2~304.2402 I 42 Pruning 6-50l I Equipment/Utensils .- 43. wingm #202 I [z Saniuljm MthodI 4-702.703 -. ?51 44- ?3?5 I 45 Fall .. I 19. Foodconm 4-201. 501. 70! 2 Fats.0il. and Grease Control Ya No NM 20, Non?Food mnucl lurfacu 4-161. 601 1 ?rm 21. cloths 4?101. 901 I 22. mucwuhing manna 4-30I.50I I 13.5quiprnenlfulensll slang: 3-304. 4-903 1 24. Single un?t: utlclecIuc 3-304. 4-502. 904 tom Non-Critical Number of Critical Violations Critical These items require INIMEDIATE attention Score Minus 20 Pts. (See Reverse Side) Reinspecti may; Inspected By of Seats 3 F900 EST BLISHMENT REPORT Page?L of 417/14 45.427 dig/7 2,141 mm 7 275/ Telephone: ?7 - .. 9 ol? OPEWWMS): DRetail Type of Inspec?orf ?/24 Cl Food Service OMObile El Routine CI Rainspecdon . 1" - I . 1971;?; D'Temporary Caterer CI lnvatlgation I Inspector: 1:5; 7% Other :1 New Establishment A Food PrMecu'on Management ml: Facilities I. PIC 2-I0l. 102 4 2.5. $402.40! 404 4 FOOD 26 as i 4 2. Food Ind Wm:- approved smut: 3-201. 5-101 4 7. 2-30I.3-301201 4 3. Food Labelingicnnlaimrs 3-302. 602 23. 5'201. 205 I FOOD PROTECTION . Toilet Rooms 13.302.402.501 2 r4 3401.402, 403 4 Hand- mctboda 5202.530: 2 5. hat a: cold holding 3'50] 4 5501.502 2 6. Cookzd coolcd 3-50l 4 6-202 1 7. Crass conun?nadun 3130!. 301?. 304 4 6202. a. Spoiiedfoods 3401.70: 2 6-20 501 2 9. DanmgedFoods 6404 2 . 6-2016-303 1 ED. PHF'I'I'Iavn-inz 3-50] 2 Va?lanon 204 5202. i I. Food homuom'mmgc 3-303. 305. 306. 6-10 2 . 6305 I 12. Food Handling 3-301. 30-: 2 Other 13.Food lemperum'c mmurlng device 4?206. 203Personal Hyglem'c Practices 39. 3-603 2 l4. ?mpiuyu: Health 2s2?l 4 40. HSPunimnmu 3-80l 2 15. Employee Hygiene 240L401 4 4] I Employee Clothing 2-301. 2-40? I 42. ham 6-50! I EquipmcnUUtt-ns?s 43 1.5me 6-20: I 17. Sanitation Methods 4??02. 703 4 4-4. Lima $301,502.80? 1 IE. dunui sunilin ml . $1.7m 4 45. Pets 6-50l I 19- Food comm 61:11am ?015011701 2 Fats. 0i], and Grease Control Yes No MA 20. NonsFood contact surfm 6401.64.? 2 21. Spongwwipin; cloths 901 1, Om 2.2. ManuaUMcchanlcal ware washing fantidu 4-30[. 50! I ZlEiquipman?ul-m?! SIDFIIC 3-304. $903 I 14. Slash: service in?eld/Reuse 3-30?1. $501904 1 [em No. Minus 20 Pts. (See Reverse Side) Non-Critical Crin'ml Score Reins Number of Critical Violations 'T'heca item: rennin-1 . nth-Minn Frriur? Ru rho-um?! #of Seats ?a FOOD REPORT Page__ of; Esmb'bmm? 2? (Mix? ,S?v im/W .47 ?dg/ Address: 2% i g! 5 2,091.? Score: Telephone: 1 '1 Type of Operation?h 0 Retail Type of lnspe'i'tion: QFaod Service 0 Mobile (a Routine Rciuspection Temporary Caterer CI Complaint 0 Investigation 0 Other I: New Establishment A 1' Food Protection Management I Somali I. - l-lut. I02 4 25 . 5402.403.? FOOD - 16. $501 4 Z. Food and Wm: from mum: 1-101. 5- it]! . 4 27. 23015-201204 4 3. 3602.602 1 23. Plumbing 5401.205 I FOOD PROTECTION 29. Toilet Rooms 6-302. 501 2 4 l.402,403 JO. Ham-mullingmeunh $-202.6-30 2 . 3. 1 31. magmwoguidcgom 5401.502 2 3-501 32. Mowing: 5-202 7. 1301 302. 364?? 33. o-?msalmzuo I . 34 6401.501 2 9. Food: - 6-404 35. um Mina-303 I 3-501 36. swam omzom?wmm 1 ll. FoodProucdonISiornge .. 3~103.305.306, 37. Drusin;Rotm__u_ . 6-305 1 12. Fondlimdliog 1? 3401.304 Other lled Win: 4404-20139! 7-201.102._ 4 Personal Pr?cuC? 3-603 1 Emnlm; 31-31111 4 3-80l 2 [11. mm mm .3 rg?o?o a I I 42. Pruniau 6-501 1 EquipmenUUtensils 43. 11mm 6-202 1 17 ?guim?gn 4.7021103 :1 51.5151 4-801.302.803 1 4? 7" 4 5?5? 1 19. Foodconucuuxfwu 4-202.SOIJOI 2 F215. Oil. and Grease Control Yes No NA 20. Non-Food contact aurfm $101.60! 2 ?1 an? clodn 4401.901 1 . Gm Wm 21 Mmualmleohaniui mm washing mums. 4-301. 501 1 23. Image 3-304. 4?903 1 24. Single unit: miclw?Reusc 3-301. 4-502. 904 lam Non-Critical Critical Score Minus 20 Pts. (See Reverse Side} Number of Critical 1 These items requirc IMMEDIATE attention 39' fS ts FOOD EST LISHMENTINSPECTION REPORT \Wr/ Dale: .1 Address: V54 Score: I: Telephone: Hoe 01' Operation(s)= a Retail Type of Owner: 1: Food Service Mobile in Routine El Relnspec?on Person in charge IWJC): Temporary Cl Caterer Complaint Cl Investigation Inspector: Other Cl New Establishment A Food Protection Management I Facilities I. PIC 240: I01 4 25, 5-402. 404 4 FOOD 25. lnsecIsJRod-nnls 5-501 4 2. Food and Wm from approved smut: 1201. 5-101 4 2-301 204 4 3. Food LIbcling 3-302. 601 I 23. 5-201 205 I FOOD PROTECTION 29. Toilet Rooms 6-302. 5m 2 4. ?01.401403 4 Hund- 2 5. Facililizs but A: cold holding 3-50[ 4 5-50 502 2 6. PHF Cooked a cooled 3-501 4 0qu 6-202 1 7. Cross conuminmion 3-301. 302. 304 4 6-202. son-206 I E. Spailcd foods 2 6201.50l 2 9. Damaged Foods 5-404 2 6-2016-303 I 10. Thuwirlg 3,501 2 Ven?laxion $202,204.6202304 I I. FOOII 3-303. 305. 306. 6-40- 2 . 6-305 I II. Food Handling 3-301. 304 2 Other I3.Foo?lt?mpmlurt ramming mac: +204. 203. so: as. 'bechmuiaIs 7001.102 4 Personal Hygenic Practices 39. CmmAdviwy m3 2 I4. Employee HcalIh mm 4 40, IISPRuquixmu 3-801 2 I5. Employee Hygionc 2-46?. 403 4 4 I I6. Employ: Clothing 1-304. 2-402 ?52. Promisa 6-50l EqulpmenUUtensils 43. mum 020.! I I7. Sanitation Mama-d: 4-702. 703 4 44. Linen 4401001003 1 I3. aimed a saniliud 4-601. 602.102 4 as. Pals 6-50I I I9. Food 4-202. SCI. 70! 2 Fats, 0H, and Grange Control Yes Nu NIA 20. Nm?Food 60I 2 45. 0/ Spongc?Wiping cloths 4-l0l, 901 I 47. Gimcl??lumwml?? 22. ManuolIMcchAnicol wan: washingracilitics 4.301.501 I 43 Ill-Iquipmlfumnsilslomgc 3404,4303 49' Wamm .24, Single senioe mticlesf?cusc 3-304. 4602.904 1 0' I Newc?umj Critical 5 Score ya; 20 Pts. {See Reverse RemW - 17% 3/111? NltmI-wr of Seals FOOD ESTABL SHMENT INSPECTION REPORT Page ?mum? (gym/M 61/7 ??ryg?f ?mgr/275 Air Addr?s: Score: if Telephone: 4 Type 07 (mammals): El Retail Type of Owne_r: - 1 G?Faod Service Mobile Momma Reinspectlon Person In charge (PIC): 0 Temporary El Caterer Ci Complaint Cl Investigation Inspector:/ #4 1/ Other El New Establishment C1 HA Food Protection Management Facilities PIC 2401. 102 23 Sm: 5402. FOOD 26 lnuclu'Rodcnu 64m 2. Food and Water from mum: 3-201, 5-10] :1 . failmw 20-3 3. Foodubelingfconlulnen 3402.602 I . 5-201. 205 FOOD PROTECTION 29. Tuila Room 6?302. 402. 501 5432.6301 Tc hut holdln :oolcd - ?0292. Gnu: 6-292 33, G-ZIFZ. 501.741? 34. 6-20] SCH 35. 621116-303 36. Venulmlon 9. Food; H). 3-501 l. Food 1?103. 305. 30?. 31. 6-305 12. Food 3.301.304 Olher ?-506 dcvicz 4-204. 203.301 7401,10: a 31.50?? Practices Cons-Emildwm? 3-603 2 - 4H. mu 2 2-40I.403 Confommwilhl-[ACCPle a-zol.m2o3 a 2- 2-402 Praise: 6-501 I Lhrinlhmu 6-202 ~14. Lin-en 4-80l.802.303 45. Pm 6-501 I . Food comm sud-m 4-202. 50!. 701 Fats. Oil. and Grease Control Yes . Nun-Food conmuu?uu 4-l0l. claim 4-1 I. 90!. . Gm . MunuuMcchaniczl wan: washing 4-305. 50f 3-304. +903 . Single service nuclei-Meme 3-304. 4362. 904 Reverse Side) s: Non-Critical 2 Critical 5 Score Mi P857 Number of Critical Violations These items require IMMEDIATE. Received Bv I Reinspeclio Dam: RV of Seats ST BUSHM NT INSPECTION REPORT Pa 6 of; (#119057 WA gig/I 7/ /7 Addm' 2410/7/276/ Score: TelephoneRetail Type or Lgym?: Service a Mobile mousing Cl Reinspecuon f3 Tampons? CI Caterer Complaint El Investigation 0 Other CI New Establishment CI HA Food Protection Management I. mc Anisned/melndguhldbuda 2-101. 102 4 403. 404 4 FOOD . 5-501 4 2. Food and Wm rm. Inn-wed scum: 3.201. 3101 4 . 2-30: 20: 4 3. Food Labeling Jeannine? 3302. so: 3.201.205 I FOOD PROTECTION 6-302. 402. 30: 4. m3 Tunpcnumt: 3-401. 402. 403 4 3. 6-30! 3 5. suntan hm a cold holding 3-503 4 3.303. 302 2 3 mp Cooked a canton 3-30: 4 ma: 3 7. 3.30:. 302. 304 4 501 1-205 I a. Spoilcd foods 3-101. 30: 2 3201.301 2 9. Darn-god Food: 5404 2 303 l0. Thnwing 3-301 3? 6202.304 I u. 3-303. 303. 305. 6-40! 2 0305 1 Food?mdling 3403.304 2 I3.Food temperature mum?ring 4-304. 203. 302 1-301. :03 Personal Hygienic Practices 3-60] 14. Emplo?e. Health 3.3m 4 Employee Hygiene 2-401. 403 4 0201.203203 . 00min]. 2-304. 1-401 1 6-501 6-202 6-50! tensils . Sunlmuon Method: 4?702. 703 4-601. 602. 702 4-202. 501, 701 60! 4-l0l. 901 430i. 501 3-304, 4-903 3-304. donned a: uni?ed . Food comm twice: HonvFood commas-ram duh: ManuaUMuhnic? waning facililiu me . Single service udciafkem ES 2 a Non-C?lical Critical Score Minus 20 Pts. (See Reverse Side) '3 Number of Critical Violations TheSe items require IMMEDIATE attention ewe of Seats _71 F093 ESTABLISHMENT INSPECTION REPORT Pagem of Emm'mm' Saw/A [17% /j - Jag/V Dm' 97:97, 7 Mar-2m my Emir? 2? 4m 7 Telephone: pa of Type orlrupecuon: 3/ UFoud Service :1 Mobile Wltoudu: El Person In charge EPIC): '3 Caterer Cl Complaint CI Invatlga?on Inspector-il/h? 1752/4?; Other Cl New Establishment a A Food Protection I 5 Facilities l. PIC 2401. 02 I1 15 5-402. 403.4434 -I FOOD 25 6-501 4 2. Food and Wain Irom approval source 3-201. . 4 . Hand- xi 4 3. 3402.602 I I . 5.20: 205 I FOOD PROTECTION - . mm Room: 6401402.?! 2 4 PHF Temperatures 3?40! . 402. ?103 4 nulhods $202,540! 2 hot 3. cold holding 3-501 4 5-50l.502 2 G. PIIF Cooked d: 3-501__ 4 6-202 I 7. Cross conlnminmon 3-301. 302. 304 4 33. 5-211 501.74% I 8. Spoilad foods 3405. THE 2 34. 6-211]. SUI 2 omged r304: I 5-40: 35, 6-202!me I 10. 3-501 1 36. Ventilation 4-2012?. 1 II. Food 3-303. 305. 106. 2 37. 6-305 I 12 [food __Handlin3 - - 3-30l. 304 2 Other 13.17004 tamper-aim: mcuurin: device 4-204. 203. 302 .. 38. TbUcMIumais 7-311le 4 Personal Manic Practices 39, mummim 3-6113 2 l4. Emplmec Health 2-21? 4 4t) iiS?chuirrmu 2 IS. Eyplovu Hygicnc 2401.403 4 ConfommwiIhHACCPPIm 3 I6. Employee Cloihlng 2.304.240: I I 42. mm 5.501 1 EqunwnUUMn?b ?.U?mAmn &xn I I7. Sanjlminn 4302. 1?01 4 4-4. Linen 4-301.EOZEO3 I IS. Equipment/ulsnsil'x clan-11:11 milked 46m. 602. 702 4 45. PEG 5-51.? I I9. Rodwmm aurfm 4-202. 501. 70! 2 Fats, OIL and Grease Control Ya: No MA 20. Nun-Food cunmi tux-[m 4-10]. 60! 2 45_ clolhs 4401.901 1 22. warn wishing fuilitiu 4-301. 301 I 23 Equipmmvulemil Horns: 30044-993 Dommnu?on 24. SingJe serving midst-manic 3-304. 4-502. 90-1 I All murmur-51C Non-Critical Number of Critical ViolnLions C: Critical a Score 'I?hcsc items require MMEDIATE attention of Seats FOOD REPORT (14/ d; 1 jig Date: 'A/g?raW/V ?am AW er?dy": 6241??) TelephoneOPEmu??t?h 0 Retail lype ol? [ns?cuom #121131" Food Service 0 Mobile Maurine .- ?4 El Temporary El Caterer a Complaint 0 Investigation . . I DOIher muccr Food Protection Management I I 5 Facilities I. NC 2 IOI 102 a 2.1. H02, 404 4 FOOD 20. Modem $50: 4 2. Food and Wm rm approved laurel: 3-20I.5-10I FF 4 - 23012201204 4 3. ?ndubelinyconmm 3-302. 602 I 5 205 I FOOD PROTECTION . 6-302, 402. 501 2 4. PHFTempemum 341,402,402 4 S-MG-SOI 2 s. Fuc?i?d macaw balding 3-501 4 I. 5.50:.502 2 5. 2212'thch 3.501 4 em I 1. Crew cunnminmion 3-30]. 302'. 304 4 33. 6-202. 5013-206 1 B. Spoiled food: MOLTOI 2 34. 6-20L50l 2 9. maximum 5-404 2 35. 62016-303 I 10. WNW: 3-501 2 new mucus-m I II. PoodFrmec?WSmee 3.303.305.306, 6-10- 2 . 6-305 12 mm; 2301. 304 2 Other urn! Immunmcamdng device 4404. 203. 301 I 3:1 ToxicMnuials 2201.100 4 Personal Hygienic Practices 39. Commuting 3-003 2 I4. Employee Health 2201 4 40 WW 3-501 2 15. Employee Hum: 2401.402 4 8-20I.202203 I 16. Emglayu Clothing zen-1.2402 I 42. mm 6501 I 43. 6-202 I 17. Mam 0102.703 4 4-1. Linen HOLMBIB I IE. cleaned a: sanitized 445m. 002. 4 45. Pm 6-501 I I9. 4-202. 501. 701 1 F015. Oil, and Grease Control Yes No NA 10. 0401.601 2 0E Spongedwipingclauu +?01.90] I 22. MmulJ/Mulw?cn! were washing [mimics HOLSOI ,15, mlmsimg ?ange 3-304. 4-903 1 ~19. 24. Single Mandela-#8202: 3-301. 4402.904 1 541 Foomgw) Item No. 1 . . Non-Critical 2 Critical 5 Score Minus 20 Pts. (See Reverse Slde) '3 ReinsPec Number ofCriu'ca] Violations These items require IMMEDIATE attention Reached Ely #of Seats ?44 1/ FOOD INSPECEION REPORT Page_[_ of 2/262 .rmm Address. 2419/7/07; 3 Score: Telephone: 1 1 I I Type opoera?onm: CIR-mil Type or lnspedioni: {Food Service Mobile aritoutine Relnspecuon Tempoml')? Caterer Cl Complaint 0 [nveelignlion 0 Other :1 New Establishment 0 HA 0 Food Protection Management unitary Facilities I. 2-IUI. [i=2 4 25 Sewage .. 5403.40140?1 4 FOOD 26. insequRodcnu 5-5/0! 4 2. Foodnnd Water from approved source 4 13015-201204 5 4 Foodhbelinglconialncn 3-302002 1 22, Plumbing 5-201.205 1 FOOD PROTECTION 29. Tailet Rooms 6402.402. 501 2 4. PHFT 3401.11022111 30. 5.202.030: 2 5. Fac1l1ueshot6ecold holdin 3-50] it. Guhwcfuw?ouuidcdismal 5601.502 1 mked&cooied 3-501 32. Cummings 02.02 1 3-301. 302. 304 33. 000.501.7206 1 3401.701 34. HonanellstaM 6201.501 Lg? 2 9. 6-404 as, 6202.630} 1 10. PHF 3-501 315. Vm?a?m eznzzomemam 1 @221355552059. .0306? 1 12. Food 3001.304 Other 11qu 4.204.203.1102 31; 1.201102 4 ComumcrAcivigcm 3'60} 2 11 Emma-,1: 11011111 2-7201 HSPRuluimmenu 3-301 '43 2 15 Emplomumcnc 2.401 401 41. ContormmwewimiiACCPPiw $201,202,203 1 16 2404-1403-- 112 Penn-nu: 0501 1 13? 6-202 1 L'Iunn Me heds 103 44- Umn 1 r. 4.501 45. Pen 6-501 i 19. 4.202.501.7111 Fats, 00,5110 (ireECnE?-nl Yes No NA 20. Non?Foed ennueuurfuces #101,601 2 21. cloihs 4-1 901 12. Fr 22. 15101100mech were faciillies 4-30I.50l 4a. Ominlnnepianime 23 3-304. 4-903 T9. RunhingDummennuion 24. Single service widen-films: 3-304. 10502904 Mimic? a: Non-Critical Critical 5 Score Minus 20 Pls. (See Reverse Side) R?ins cticl Number of Critical Violations These items require IMMEDIATE attention Received 1351 Inapeeled By of Seats FOOD INSPECTION REPORT Ifof A ?myg??o ?7 n/4/4' 7 Adm?- 4? :7?ij on 77 4 Telephone: ?w Type 0" Operational): Retail 131m of [n?p?dom 0 Food Service CI Mobile ?Routine Cl Rainspeclion El Temporary 0 Caterer Complaint El Investigation 01h? New Establishment A FOod Protection Management utilities I. PIC 24m, on it 4 404 4 FOOD 6-501 4 2? Food and Wuer from uppmved source 3-201. 4 . 2401,5201?: 4 3. Food uboIingrconIoinm 3402.602 28- s-zomos I FOOD PROTECTION 29. Toilet Room 6-302.402.50I 2 4. PHF Tempumnu 3?40! . 402. 403 4 methods 5-2016-301 2 5. Facilities hot a: cold holding 3-50! 4 $601.50.! 2 5. PHF Coalrzd a: cooled 3-501 4 5202 7. Cross contamination 3-301. 302. 304 4 33. 6202. 5013-106 I a. spoilodroodo 2 14. women 2 9. Damaged Foods 6404 2 35. 6.201630] I In. 3?501 2 delmim mammal I Food Prolnclimu'Smgc 3.303.305.3oe.o4o 2 Rooms 6-305 1 Fond'Hondling J-JOI.304 2 Other 4.204.203.1101 I 4 Personal ygiinic Practices 39. ConsumaAIlvisory . 3603 2 A 14. EmployreLchIldI 2-20! 4 40. 3-50! _1 I5. Employmtl?lcn: 240L403 4 l6. amotoyoo Gaming 2-304. 2402 I mm arm I 1 Equipmcothtens?s 43 LMngAma 6402 I I7. SamueonMeIhodo ?02.703 4 44. Unen_ m1.aoz,soa Foodcomm surram ?01501.70: 2 Foio, on, and Grease Conlrol ""313 20. Non-Foodcnuuctsurfnm 4401.60l 2 45? WWIMW 2l. Spongeslwipingcloms 4-10l.90l I .37, GmhmumM?nmmecms 22. Manual/Mechanical won: wooing facilities 4-30l.501 on. omhowptanimo Lox ll?qnipmmuummil?omo 3-304. 4-903 .49. 24. Single service micluf?cust 3-304. $502304 1 5a Non-Critical Critical 5: Score 20 Po. Reverse SideJD an?v-itinr? ?I'inlntinnr of ESTABLISHMENT INSPECTION REPORT page_ Dole: A, an: Sm 9'4 ?74 Telephone: I TYPE 0? Cl Retail Type of Insl?c'?an: Owner: -/gi?7 F0011 Service El Mobile Routine Cl Reinspecuon Person In charge (NF): 0 Temporary 0 Caterer Complaint Cl Inva?gn?un Inspector: 7&6/574, Other New A Food Prol?qILQLaoIageoILntII I H n? I M?y?lu?s 2 IOI t02_ ?5 Swag: I :5402. 403 404_ FOOD I I :26 mammal; I E: .- 2 _30l 3301.602 . '28 Plumbing __IIingI1_9_ Talk: Rooms 6402. 4 I I 3-401. 402. 403 4 30 Hand -. I II $202,630! Fncil__iu'cs hol&cold holding 3-50! I GI GPilmeudtiIcw? 3.50: a 32. _6202_ . '7 . 4 ?mum 530259.123?? wf TI 3 spungdro??s II 3 I01 7g 2 6201.50I I II 9. gingho'ng II lgzgoig I PHF Thou-ins 3-50] I 36 Vmulanm I 4:292:04 6202.302 TI Roamomr'shim?gg 3.303.305.306mI 2 L37. fl I2I. IFood I 53.. 3301.30: _lJ Olher 13 Food I I 33. 4 Personal Pracllces II 39. Comm 2 l4 Employcc?enlm 2'20! 2 A 2451.240; I. 8-20l.101.203 I I6. C'lolhIiLH I 2401.240: 55'; rum 6.5m I EquipmenUUlensils . 6-202 I n. Sanitation MthOds 4402.701 4 Linm 4-801.mso3 I 18. 4.601.602.102 4 Pet: 6-50I I I9. Food coutul induct; 4.202. 50}. 101 2 and Grease 20. Non-Food contact surfaces 4-10L601 2 4-!0L90l 12. MonunHMechanical warewuhing facilities 4-30I.501 1 B.Equimmdutemil Horns: 3.304. 4?903 1 24. I Non-Critical Critical 3 Score Minus PIS- [599 Reverse Side?j Number of Critical Vlolations Mun-rind Ru These items require IMMEDIATE attention .- of Seats Establishment: Address: '_l_"_c_lephone: in (PI Type of Operation(s): CI Temporary FOOD ESTABLISHMENT INSPECTION REPORT CI Retail Mobile Cl Caterer and Service Olher Pagc__ 0f Daie: Score: of Ins tine nt I-?nmj Proieclian I I I 2* Facilities I ml'lC 3 IUI. I03 1'1 Ecuuq11m] and Imm npmeLLI Jam?L??j 2m. <5 4 Hang 2 1m 5:01 ET): .1 111392.19: I I 1mm; -1 1931.5 - . I FOOD PIEQTECTIQE 111-111me L- Law;- 101?101 :34 3 40L 41"? it) 0W 4 2 9 &cu d? holding 3 Gn?nf?mfuwnuuhkdt?q SMSQIJUZ 3_ i I. PHI- - I1~5m? - Rama in 5.202 I I i i . .. --..- 7 "Elk? ..- I Cross mumnmatmn_ 3 SIM Itswam mods L1 - Ph?icaanc?ities . 9 6 40-1 14 F-?looMV?aIlleciliIlgs Lighting 632016-303 . 1.101.113.1113 (>401: 4 2H 36 thilation 4?2m.1m.6?202.3m I Iunu .1 3? 31 musing?omm 6.305 I I1 Food Immunng .. 4104, 203 302 l_I_ Other t?crsonhl Hygienic Practices -1II 7201.102 l4 Health IIGI 403 tiS?PRaIuImInLnIs 3 SDI I: _Jm [3-402 .. 201; gm 42 Pmmisu -- 6 501 I101 101 :13 LI?nng?mcns? - . IH nautical ?i r. 4-. :11 mel-_ 7 4_ EDI 302 3?03?? cunmct surfaccs I4- 202 50-] 70! 2 45 Pets 50! Hum Fuod :?lepi I I: Fats OH andGr?n?Ie-anuol? Yes -No clot?l1: 4:44 IUI 90! .15 me?mn '22 MmuaL?Mcctunicpl wart facilities 7:4 301. SOI .17 Imff?ccj??l? MaInIsnmm? Li'- _21 slomgg?w 43 Gram: Interceptor Signage 1?14 SIngIc sun/ice nniclciscusc 1-104. 4-502 96-1 .1 i .19 RundIIrIng DgumcmmIO-n 1- =Non-Critical C: Critical S=Score Number nl? Critical Viointions These items require IMMEDIATE attention Minus 20 Pts. (See Reverse Side) [3 "Rica By Reinspection Inspected By FOOD ESTABLISHMENT INSPECTION REPORT - Date: A . Score: Type of Seats Telephone: Owner: Person in charge Inspector: Food Ser?ce El Temporary CI Other Food P?Flec?on Management 5 Facilities 1. PIC AssignedlewledgcahldDulics Z-IOI. 102 4 25. FOOD 2. Food and Wm from approved scum: 3-201, 5401 4 . 3. Food ubclingfconmincts 3-302. 602 28. Toilet Rooms nuhocb FOOD . PHF Tm: . Facilitm hot .9: cold Coma a cooled . Cmascoman?nation foods 3lel. 7m . Foods 6-404 10. PHF 3-50} 3-401. 402. 403 3-501 3-50I 3-30]. 304 ?1 .1 'un nu?ue Complaint New Establishment Cl HA ?on: Page of CJ Reinspection 5402, 403. 4-04 6?50] 2430 204 5-20] 205 6- 50! 530! 5-56 502 62m 6-202. 5013-206 $101.50! 6202,6303 +20; $202.30: NC El Invs?ga?on ll. Food Marriott's 3403. 303. 106. 7. Room 6-305 12. Food?mdling 3.301.304 Other ?food 4404.203. 302 38. McMmials 7-20l. 102 4 19. Commnd'visuy 3-603 2 I4. Hahh 2-201 40. 345m 2 Is 2401.40] 41. CoafmmwithHAOCl?Pim 8-201302203 16. 2-304 2 42. Prams: 6-50! I EquipmenWtensils 43. mm 5202 1 l7. Sm'u?mn'on Methods 4-702. 703 4 44. Linen macaw: i 18. Equipmn?uunsils cicanad a sanitiud 4-601. 602. 702 4 45. Pets 6-50] I Food Wtanfam 4-202. 501-701 1 Fats, Oil. and Grease Control Yes No 20. Non-Food cantmsu?accs MOLGOI 2 45. ?mwmm .- 21, #101,901 I 41 22. Mnnulmleclunicai wm mums l'm?iitiu 4-301. 50) 43_ ?mwmm; ??quipmthIcm?mmc 3-304.4-903 411 ?Minimum 24. 3-304.4-502.904 5.1 hams-1m; Item No. - Non-Critical Critical Number of Critical Vnolations These items require IMMEDIATE attention Score Minus-.20 See gene Side) 13m . aRcceivc-d By 1115chch By of SeaLs/V FOOD REPORT Page ,1 of . Establishment: (41/ 7 Addl?? fgf?v 1/ _f 596%; %1 Telephone: 11 T1115 Cl Retail Type of Owner: A?Foad Service C1 Mobile [valentine Cl Person in char (9,113): 0 Temporary Cnlerer c1 1:1 Investigation Inspector: 191 Ml/ Other 0 New Establishment 1:1 A Fond Protection Management 1 nnilnranclIltlesm 2 .. rS 102 4 25. Sex-1:101: 5-402 403. 464 4 FOOD 26 6-501 2- F0011 Md Walcf [mm mum: 3-201. 5401 4 21. Ham-1111.111 2.3015901 .1 a. I 28. 9111111111111; 5001.205 1 FOOD PROTECTION 29 12:11:1an 6402.110150] 2 3,401 1: 30. Huxl-wd?ngnuthods 5-2010301 2 51:11.1.? 1101011111111 110101211 31501 4 31 Gummnwouu?cdhpoul 5601.503 ML 1-501 4 32. Gum-Openings 6-102 1 3.3111 304 4 33. 0211250122015 1 - 3. 2 34. _mewuwanmps 2 9. Damaged Foods - 6-404 2 35. LEM A 10. 1-115 111111111111,- 3-501 2 3e Venlimuon Hams-2112.304 1 ll. Food 2 37. Druggx?pgnu 6-303 1 11 Food $301,304 2 Other . . . a llFood dam 5-204-203-3172 1 F31 1011;210:1105 "1-201.102 4-1-11 Personal mimic Practices .32. 30113 . vam?t?24311.4?3 4 $291,202.20] I 16. 5111;111:1111: Ctoming 2-304.2.402 1 .12. P12111113 0501 1 Equipmentmtens?s :13. 6-202 1 . .. 4,293?1?33 .1 44, Lin-.11 ?w1.m003 43.Pcu e501 1 19. Food comm 111mm 4-202. 501. 701 2 F015. Oil. and Grease Control Yes No NM 20. Non-Foodmnmumm 4401.60! 2 .111. Gmh?mgglarlmm'jun I 21. Spongcwipingcmuu 4-101.901 1 came 22. ManuaUMochnnicul mmhiug facilities 4?31?. 50] I Grow: ??quipmm?utcmil nor-131: 3-304,4-903 h" ?3131: uniu: macaw: 3-304, 4-502. 904 1 Non-Critical Critical 5 1: Score Minus 20 . (See Reverse Side) [3 . . 1- Dale. Number of Critical Violations These items require attention 1115de #.of Sears. FOOD INSPECTION REPORT ?P_Page I of 4 @2217 7?34 5/44?? Dm- . Address: {921 Score: Telephone: Type of Opem?onm: Retail Type of Inspection! Owner?/In/f?f tit/Food Service CI Mobile Routine CI ReIDSpec?on Personw in chargegi 9319?: 0 Temporary CI Caterer Complaint Investigation Inspector. 1/ %4 A2 Other CI New Establishment a HA (2 11v" F_nud? ProtegITon Management_ - Facilities frith?t adiKnuwluf . 0?99!) InsecufRodems Foodnnd Watcr {tom approved 500m: 3-201. I- .44 Hmd-wuhingfac?i 3-992939499029551 ?faint-60:7 If; . TuiiutRoorns 4. $401,402.40: .?Ll Ham Facilitict hotkcold Itoidtni 3-50! 4 5. PHF Cuoltzd 3501 HP 4? 0qu Cross containing: 3-301. 302 30_4_ a. ?s_poitodtoods_ . 9 33111111;chsz _5-404 m. P?j?n? 1 3-501 tni _I?oodmuctinn!51magc 3.303.305.3055-40 2 12. Food Handling 3-30:. 304 2 I3 _Food lift?lp?'mutc meaning dnvice 4-204. 203. 302 -. _l Personal Hygl_nlc Practices l4 Employer: Health 4 I5 Empiurucllnien: 240L403 4 l6 Emeinzu Bathing .- 2609.240! 4- Sanitation Methods 4-702. 703 4 I8. Equipmnt?uuntils clmad a tuition! 4?601. 602. 702 4 Food contact surfaces 4-102. 50!. 701 2 Fatsl Di], and I0. NonsFood conuttsutfms 2 46. 11. 4401.901 1 cm Manual/Mechanical mwuhing facilitics 5301.501 1 l?qulpmmu'utmuii slung: 3404. 4-903 1 34. Single service mticIuIReus: 33014-501904 I Item Non-Critical Critical Number of Critical Violations Score These items require IMMEDIATE attention us 20 P15. (See Reverse Side) '3 5-402. 403. 404 2. 5' l. 205 302, 402. 501 6-30! 1201.10: 3603 3-80l 5-202 4.801.302.3011 5-50: Yes pact of Seats FOOD INSPECTION REPORT /of 4 Establishment: 6.5, . Data/727?, A ??;mxig/ Score" :7 ration - Telephone . . I . Tim DIODE Email Type of Inspection. Owner: p(Zlaii?ood Service Mobile Manning- El Relnspection Person In 0110 0 CI Temporary Caterer Complaint 0 Investigation Inspector: ??414? 0 Other CI New Establishment A Food Protection Management IN 5 Sanitary Facilities l. PIC 2-ILH, [02 4 25 Scwagc 5-492. 403, 40-1 4 FOOD _w 10. 5.501 4 2. Food and Wale: from approved aourcc 3-20i. 5-:01 4 23015203101, 4 3. Food Labeling Im?f?nc? _r 3-101. 602 28. Plumbing 5-201. 205 1 FOOD PROTECTION 29. mm Room 6302.402. 501 2 PHF Tum-scram!? 4 . 5-202.6-30I 2 ho! cold holding 4 5501.502 2 0. PHF (?00de 8: ?Mind 3-50I a 32. Outamnings 6-202 I 7. Cross contamination 3-30! . 302. 304 33. Pmocidmf?ndcn?cido?ppliwion 6-2132. 501.74% I a. Smile-d good; 34. WWIings 5201.50: 2 9. Damaged Foods 6?4114 2 35. um 62026-303 I ID, 3-501 2 36. Ventilation $202,204.6m304 I ll. Food PmtecdonJSIonge 3603.305. 306. MI 2 37. DrusingRoonu 6-305 1 l2. Food Handling 3-301. 304 2 Other l3.Pood measuring dcvicc 4-204. 203,302 l_ ,4 13. Twang-IE; 102 4 Personal Hygl?enlc Practices 12; W3 2 14- F?inlglig mum, . 2-201 4 an, 3-001 2 i 2.441114?; 1 .1 41. 0.20110qu I I6. Employee CImhing 2*304. 2-401 1 42. Panda: 6-501 I _EiolpmenWtensils 43. mingm 0202 .1le 4402. 703 - mum? c, 4_ .1 45. PEI: 5-501 I I9. Foodcunmuurrm 4-202. 501.701 2 F315, (3i!1 and Grease Control Yes . Moi ISM- 20. NonoFmd mount surfaces 4401. 601 2 46. Spungwwiplng cloth: +l0l.901_ I 47, Gmhm?bhinluummg 22. ManuaVMechanlcd war: wuhingl?acililics 4.301.501 1 40. Gmouhu?canNSIgtI-Isc 23.Equipmcmiulensil storage 3404.430! 1 49. Runninubocumcmliun 24. mam/mm anon-1.301.904 1 so. Imam?: _m Item No. I I 55%? 5/ a Non-Critical Critical Score Number of Cn'tical Violations These items require IMMEDIATE attention Inspect ed By of Seats Address: Owner: Person in charge Insyeclar: FOOD ESTABLISHMENT INSPECTION REPORT Food Service Cl Temporary Other Page 4 of Date: Score: 5 - El Retail 13 Mobile 1.3 Caterer O?Rou?ne El Complain! Type 01' Inspection: Relmpectlon El Investigation C1 New Establishment Cl HA Faad Protection Management Facilities I. PIC mignuifKnuwlalguhldDutins 2-101. 102 4 25, 5-400. 404 4 FOOD 26. Immaodcm 6-501 4 2. FoodnnderI'mm approved suurcc 3*201. 5-101 4 . 2-3015-311204 4 3. ma 3-302. 602 I 23. 5.201.205 I FOOD PROTECTION 29. Toilel Rooms 6-302. 402. 501 2 4. PHF 10mm?: 3-401. 402. 403 mtbods 5402.030! 2 5. Facilities hat It cold holding ?1 $591,502 2 a. (300ka &cool:d 3-501 4 0202 I 7. Crosscunwmnauou 3-301.102.304 4 02025013406 1 s. Spoiled foods 3-101. 7m 2 6701.501 2 9. Damaged Foods 0404 2 52010303 I 10. ?anan 3-501 2 . Wm 4-202. 6-202. I 11. Food Pmrectimu'SIaI-ag: 2 7. Rooms 6-305 1 I2. Food Hmdling 3-301. 304 2 Other 3..Food device 4-204. 203. 302 I 33. TuxjcMamials 1401.012 4 P'ersonnl Hygienic Practices 39. CommAdvisa'y 3-003 2 Employed Health 2-201 40. 3-801 2 I5. Emplayu: Hygiene 240L403 41. Conformw?hHACCPle 84012011303 1 56. Employee 00min; 2-304. 2-402 42. Prunisns 6-501 1 Equipmenlmtensils 43 LivingAn-as 6-202 I 1. Sanitation Methods 4-102. '10] 4 44. Lima $801,802.80! I a. Equipmlfulmsil: cleaned It snni?znd 0001401702 4 45. m: 6-501 I 9. Food 4402- 50 - 701 2 Fats, Oil. and Grease Control Yes No NA 10. Non-Food contact 010-10025 4-101. 601 2 4,1 I. cloths I 41 2. Mmu-IlfMeclunical wan! washing facilities 4-301. 50] 1 411. MWSIM 3-Equipmmvukns?il mm 3-304. 4-903 I 49. 4, 51031: scm'cc articluchusc 3-304. 4-501904 I 51}, FEMIGI 5/ Non-Critical II umber Critical VIolat'Ions Critical Score m?cn Ital-nu: Mann?!- WHIAW Minus 20 P15. Reverse Side) Reinspection USHMENT INSPECTION REPORT 1 .. Dale: FOOD EST Page? /of Cy Ar of Seats 4% 1 Establishment: Address: Score: 5/ Telephone: Type of Operatioms): CI Retail Type of Inspection: Owner: 2" 1/1/12, Mood Service Mobile Routine Reinspecuon Person In?? charge {Pip}: 0 Temporary CI Complaint 0 Invesugauon Inspector: l/ Other New Establishment El A ?l?mtec?un Mane emcnt Facilities I. Ida-nun TM a FOOD 26. 2 Food I'Imn approved Iourtc ?I?m 4 T. 3. Food Labeling 3.302. 602 I I S-ZDI. 205 I FOOD PROTECTION . Talk! Rom-m 6-302. 402. 5m 2 3-401. 402. 403 4 medal: 5-202,6-301 5. FaciI?Iues ho: a: cold holding 3-50] I id: 5-50I.501 2 6 NW Cooked cooled -I 5.102 1 7. Cum contamination 3,391. 302, 364 4 5.21m 5013.105 s. Sporlad foods 3491.791 2 6-ml.sm 2 9, DmgoanodJ 6-404 3M 52016-301 I In. P?melng 3-501 2 ?In?ation +m2m.o-m I II. FoodPrmectionISloragc 3.303.305.306.HM 2 . 0min Rooms was I I2. Food Handling 3.30I.304 2 Other 13 Food umpemun: mum-In; device 4-204, 2:13.302 I ToucMmmals' 7-101. 102 4 Personal Hygienic Practices 39. Commvauory m3 2 I4. Employcc Health 2401 441. HSPRaquimmLI 3-3431 2 15? Empior?cc Hrsicnc 2-401- 403 4 Immune} I 16. Employ? 2404,2402 I 41 mm 6-50! 1 EquipmenIJUtensus .13.. umm 6-202 I r17. Sanitation Mcmods 4-702. 703 4 44, 1 IE. cleaned IE: saniriud 4450]. 602, 102 4 45, 9:15 6-3" 1 I9. Foodconmuurfm 4401501.?? 2 Fals Oil and Grease Central Ya No NM 20. Non-Food comm tux-Inca 4-411]. EDI 2 Spunge?wiplug ctaIIu 4-IIJI.90I I 1 Gm ?gum 22. washing facililies 4-30l.50l I Gm 23 Equipmendutcnsil ?any: 3-304. 4-90] I Umumnmlim 24. Single service micIuIReuIc 3-304. 4-502. 904 1 5-D. I: Critical Non-Critical Score c: Number of Critical Woln?ons These items require IMMEDIATE attention InSpected By of Seats INSPECTION REPORT Page ,5 3V Esmb'm'm? ?ew/MA 797/ 6? 4M (ff/b 2/7 94/ Add? 924'? Telephone: Type of Opemtion(s): :1 Retail Type of Inspection; 7 Owner: @1557?? Food Service Mobile El Routine El Relmpection Person' In charge [3 Temporary 0 Caterer El Complaint Investigation Inspector: W/f Other :1 New Estabtstunem CI A 9 Food Protection Management Facilities l. PIC l-lOl. WI 4 Sewogo 5-402. 403. 404 4 FOOD to, 6-501 4 2. Food and Water from approved some: 3340!, 5. l0: 4 . 24015-101204 4 3 Food ltontaincnt 3-302. 602 23. 5-20l. 205 1 FOOD PROTECTION . Toilct Rooms 6- 402. so: 2 4. PHF Tempe-titans 340l.402.403 4 mints 54016-301 2 5. Facilitill hot cold holding 34m 4 S-SOI 2 6. PHF Cooked a: cooled 3'50! 4 6-202 1 7. Cross contamination 3-3tJl. 302. 301 4 6- 501.7406 8. Spoiled foods 3-l0l. ml 2 6401.50! 2 9, Ottoman! Foods 6-404 6- 303 10. 3?50! 2 204.902.3414 1 11. Food Pmtocti ordStorngc 3403. 305. 306. 640? 2 I 12. Food Handling 3-30]. 304 2 13.Food tentpnuture mounting devlce 4-204. 203. 302 I 7-201. [02 4 Personal Hygienic Practices 39. 3-603 2 14. Employee llcnith Z-ZDI 4 40'. 3-80l 2 l5. Emplo-yoe Hyginnt: 2-40L403 4 Ill. Coofmmwi?tl-IACCPPIW 8-201 1 16. Empluya: Clothing 1304.240: 1 6-50] I Equipmenthtensils 5-10: I I7. Sanitation $702.7? 4 I IS. Equipmeob'utmsils cloned a: sanitized 4-60! . 602. 702 4 640} 19. Food contact surfaces 4-202. Sill. 701 2 YES 20. Non-Food contact 4-10l. 601 2 Sponsedwiping cloths 4-101. 9m 1 22. MonunWlechanicol wu'o washing facilities 4-301. 501 storage. 3-304. 4-903 1 24. Single tervicc Moles/Reuse 3-304. 4?502. 90-1 Non-Critical Critical 5 SCOPE Minus 20 PIS. (See Reverse Side) Rainspec?gn alc: Number of Critical Violations Those items require WEDLATE attention ceive - 'pected By of Seats HMENT SPECTION REPORT Date: Address: Score: 0 El Retail Type of Food Service Mobile Cl Reinspec?on Person Cl Temporary 0 Caterer Cl Complalnl Cl Investigation Inspector: - 9 Other 0 New Establishment A Food Protection Manug?ent Sanitary Facilities _q Li 1. 2-101.102 i 4 25, Sewage 5.402.403.1104 4 FOOD Emacs/110001115" 0501 7 2. Food 111111qu:: from source 3.201.5-101 4 '17. _i 3. FoaIanbelingleontnineu 3002.002 20. Plumbing "Lu 312301.205 1~ FOOD PROTECTION 29. T011111 Rooms 2 1 4. PHFTempemures 3.401.402.1103 30. 2207,0301 5. Facilities holkeold holding 3-501 4 11. $501,502 2 a. Pl-IFCouked&cooled 3.501 4 31 Mama . 6-202 I 7. Crass contamination 21.301.302.301 4 31Meideu'?oh?cide?pp?wim 1 11. Spoiledl?omi: 3.101.701 2 34. WW1 2 9. Damaged Foods 6-404 2 35. Lighting 6302.630! 1 10. 3-501 2 36. Ventilation ., I 11. Food 1-303.305.306.6-1CI- 2 37. 01031031109015 . 6-305 12. Food 10111111111; 3401.304 2 Other ?food 4?204.203.302 I 33 1mm 7.201.102 4 Personal Hygienic Pmetlces 39 Cmuvimy 3-503 2 l4. Employee Henllh 2.20] 4 40. ESPRequhmb 3-801 2 15. Emploree Hygiene 2401.403 4 41 ConfmumwidIHACCP?ms 11.201.202.203 1 115. employee Clown-1L 2004.240: 1 42 mm 6-501 1 Equipment/Utensils 4:1. 11mm 0202 1 17. 5111111110011 1111:0100: 4.102.703 4 4-1. Linen 4.001.002.1103 I 111. 4?601.602.702 4 .15. Fm 0501 1 19. Food 0011th mass 4?202. 501. 101 2 F315, Oil, and Grease Control Ya; No, NM 20. Non-Food conuclsurfecea 4.101.001 :1 Fm 21. 4401.901 1 22. MnnueUMeclmniee! wan 111115111113 facilities 4401.501 1 am 13.Equipmmuruzensll Henge 3-304. 4?903 I mo 24. Single service articleszeusc 3-304. 4401904 1 I o. a Non-Critical 01-10201 5 Score Minus 20 Pts. (See Reverse Side) 13 Number Violations W: These items require IMMEDIATE attention Received By spected By Reinspec 'on of Seats FOOD REPORT Page_ of . I I. 11' I Establishment: Date: m. Am, 4 ., .a 'I?elephu Tu?: 0f Operation(s): El Retail Type Owner: 2; A. 1" fa? QFood Service Cl Mobile )3 Routine a Reinspecllon Person In muf?e}? (A), 0 Temporary El Caterer Cl CI lnvatigatlnn Inspector: #77572/ Other I: New Establishment A 1 - Food ?olecuon Management Facililics PIC 2401? 102 25. Saw 5402,4014!? FOOD . 6-501 2. Food and Water from mum: 340]. 5-10! 4 2-301,5- m4 3. Food Labeling fconlainm 3-302. 602_ I . Flu 5-201. 205 FOOD PROTECTION . Tong: Roonu 6-101. 402-50 ELEPHE Ennigd 1-1111 3-30 302 104 methods 54016-30 I $501,502 6-201 33? 6-202. 501.7406 34. SUI 35. 6202,6403 3a Vannilntion .o-m 37. Room: 6305 Other 9. Pong; 6-404 10. PHI: Thaw 360] ll. Food 1301103306. l2. Food Handling S-JOI. 304 IlFood umpazturc 4-204. 2.03. 302 - ton .izeu 1. Conrummwim?lcc'pmm 3.20:.201203 l6. 2.304 240: mm: 6501 Equipmentfmens?s . 6-202 - [Jam 49.01.302.303 1 Pets 650i 19. 4.20150! 7m Oil and Grease Control 20. Non?Foodcanucuurfm 4401.60: 45., um I mm 21. mm 4401.901 . cam - 21. Mmuamuhanlcuwm militia: $301.50! . Gm mom-901 24. Single service midw?num $304.4-502304 Non-Critical Critical 5 Score Minus 20 pm. (See Revarse Side) Number of Critical Violations These items require IMMEDIATE attention By of Seats -- FIOOD INSPECTION REPORT ?Pl?zme ?0f 5: Zm/ Add?? PM [?g/414 (77 SW '7 1? FT TYPE 0 Retail Type Inspection: Owner: 19, j/ (1, /2f Mood Service Mobile ?uu?ne a Reinspecu'on Persnn in dimrge {Jam}: 0 Temporary Cl Caterer Complaint CI Invadgation Inspector: Other CI New Establishment CI A Food Protection Management @?gg Elli?113$ .. 7 "r I. PIC 2.101.102 4 l_25.s . 5402 403 404 H141 FOOD ?6 . SDI L?i 2. Food and Water from mun: 3-201,5110l 4 ?mi-Mugl'mildw .?mm ??i?zmj? .. 1 3? Food Labelinsfconm?ncrs 3302.602 1 I I 23 I?Iumbmx 5201.205 1 FOOD PROTECTION :9 Tune. Rooms . .. _igmuomoLH? 2 4? 4 3-40L402JU3 .313 - . 5402,6301 5. Facilitiu Plot cold holding 3-50l 4 1! _Euuhagdifiwm?ma] PIIF Cookcd kcoolen? mm 4 i130? I 7. $301,302.30: 4 ?33 206 B. SpmleII foods 3-I01.70l 2 3-1_ 620L501 _g 9. Damaged Foods 5404 ML . 6202,6303 I IO. 3?50l 3 15 V?h?n ll. Food Pm-Icctiun/SIoragc 3-303.305.306.6u10? 2 '3?7 Mim?mny . la. Food Handling 3-3DI, 3m 2 Other I3.Focd umperamrc measuring dcvicc 4-204. 203, 302 38. ToxicMau-rinls I-EDI. 102 4 Personal Hygienic Practices 39. Cmumvim 34:03 2 Id. Employee Health 2?20! .1 3-30] 2 I5. Employee Hygicnc 2-40 . 403 dl. I Employer: Clothing 2404.240: 1 42. Pumas 650i I EquipmendUIensiIs 43 mum mo: 1 Sanitation Mclhods 4703.703 4 44 men IB 1?03 4 45 Pals 6-50] I I I9 Food surfaces 4402.51?. 70 3 Fats. Oil, and Grease Yes No NIA 20 Noanood conmuu?nccs 4401. am 2 4?1 f, 2] Sponges-imam: (1:0th 4-l0l.90i I .37 22 wan: walhmg facilnics SUI 48 23 24 Single MialcsiIIcusc 3-304. 4602 90-1 1 59 A?ummCump?nm (am No. Non-Critical Critical 5 Score Minus 20 PIS. (Sec Reverse Side} Cl Number of Crimea} Violations These items require IMMEDIATE attention I: i ed #of Son-211% 317E F009 ESTABLISHMENT INSPECTION REPORT Page of A I 1' {1/17 Establislunent: Date: Adams: [?oaty/4r? g; 5 3 :2 Telephone: 1 I I ?n Type of Opern?unts): a Room Type of iospec?uoo: Owner: a ,3 Food Service . a Mobile Routine a Reinspoclion Person in charge (116}; 1? 0 Temporary CI Caterer CI Complaint Cl Investigation Inspector: 22 mz Other New Emblishment A 1? Food Protection Management Facilities l. PIC 2-l0l. 102 4 5.401 403, 404 FOOD o-sou F2. Food and approvod scum: 3-20I. 5-I0l 4 . 26015-201204 3. Food Labeling fconlaimrs 3-302. 602 I 28. 3-201. 205 FOOD PROTECTION 29. Toilet Rooms 6-302. 50! 4. 4 "?oods 6-30! 3. hot it cold holding 3-50] 4 5401.502 6. PHF Cooked a cooled 3-501 4 6-202 7. Cross :onlnmina?on 3-30]. 302. 304 4 6202. 501.1206 8. Spoiled food! 3le1.70 2 6401.501 9. Dom-god Foods 6-41}: 2 64016-303 IO. PHF Thnwing 3-50l 2 $202,201,632.? Food Pmmrim??tmg: 3-303. 305. 306. 640 2 6-305 12. Food Handling 3-30l.304 2 l3.Food measuring device 4-204. 203. 302 38. TnxicMalu'ian 4 Persona] yglenic Practices 39. CmAdvisay 3503 2 14. Employ? ?with 2-20: 4 oo. 3.301 2 15. Employee Hygiene 2-401. 403 4 8-20l.201203 Employed Clothing 2-304. 2402 I I 42. 6-60! I EquipmcnUUlcnsils 43. 11mm 5202 I I7. Sanilanion Methods 4-702. 703 4 Linen $501,303,500 $601,602.70! 4 45. Flats 6-501 1 19- Food conmmsurfms 4-202. 501- 70! 2 Fats. Oil. and Grease Control Yes No NM 20. Non-Food contact surfaces 440]. an 2 '21. Sponlwwiping clams 4401. 90! 22. wan: washing facilities 4-301. SDI maniac 3-304. 4?903 24. Single sowing articlesr'Reuse 3304? $502. 904 Non-Critical Critical Score Reinspeclion W%d Flu Number of Critical Violations ?Mm I'lnmc "Innin- WFUI Pagc__ of; of Slants FOOD ESTABLISHMENT INSPECTION REPORT 2 I 47 Establishment: Date%% rQ?/7 ?dw- rawxf? if? Sm Telephone: T1118 01' Operation(s): 0 Retail Type of lnsp'eclion: Omenr?/Jr? U: Food Service Cl Mobile ?Routine CI Relnspection Person In charg; (ZIP . Cl Temparnry Cl Caterer Complaint Cl Inspector: Other CI New A Food Protection Management 5 Sanitary Facilities NC 2-IDI. 102 4 25 Scwagc 5?502, 403. 40-1 4 FOOD 25 Insects/?Rodents $501 4 2 Food and Water l'tom approvcdaourtc 3~20L5~l?? 4 21" 4 3. Fund 3-102. 502 23. Plumbing 5.201.205 1 FOOD PROTECTION 29. Tullnl Roam 5-302. 402. so: 2 4 340i. J02.403 4 30. 54016-3041 2 5. holdmg 3-50! 4 S-SUIJDZ 2 4 .12. Gum-1W 6-202 1 '1 Cross 3-30l. 302.304 4 33. Minimmicmpp?mion 6-211 I a foods 3-1 2.7m 2 34. 64:01.50: 2' 9, Damaged Foods 5-404 2 35. Lighting 6.202.640} I 10. 3-50! 2 36. ?knu'lalion momma-202.304 1 Food 1.103.305.3062. 2 37. mmingkoonu 5305 I ll. Food Handling 3-301. 304 2 Other IlFood 4- 203.302 I 33. ToxicMnmials mum 4 39. 3-603 14. 2-201 44). 3-3111 . 2 240L403 41. CnnfonmnaniLhHACCPP?luu 1 n3. 2- .27. hen-nines 5501 I ll}. lengt?ums 6-202 I 44. Liam 4-50l.801.803 I 1 45. Pct: 6-le I 19. Food comm swim 20. NonAFoo-d. comm suffices 2i. cloths 22. wm 23 ulcmil 24. Single innit: wicks/Reuse I Non-Critical Critical 2: Score Minus 20 P33. (SEE Reverse Side) Dalc: Number of Critical Violations These. items require IMMEDIATE attention Received By facilities 4-202. son. 70: Fats, oil, and Grease Control 4401.60: 4- 1.9m 2.301.521: 3-304. 4-502. 904 7. Gran Mama-L121; Game ML: Alumna-3i Ca I'll inm'l; By of Seats FOOD ESTABLISHMENT INSPECTION REPORT Page of Address: Telephone: Owner Person in Inspecmr: Date: Score: Type of Inspection: Routine Cl Relnspec?on CI Complaint Cl Investigation 0 HA CP CI Retail 0 Mobile El Caterer Food Protection Management I I. PIC AssignedenowIedgeabIefDutiu 2-10]. I02 4 403. 404 4 FOOD 5.501 4 2. Food and Wm: approval some: 3-20l, 5-10! 4 2.3m 204 4 3. Food uhclingfconmitms 3-302. 602 I 5-10I. 205 I FOOD PROTECTION $302. 402. 501 2 4. 3-401. 403.403 4 52016-30! 2 5. Faciliu?a hochtcald holding 3-50! 4 5- 502 2 6. PHF Cooled cooled 3-501 4 6-202 1 Cross contandnutiun 3-301. 302. 304 4 6- 50! 7-206 1 B. Spoilzrl foods 3-101. 70] 2 6-20L50l 2 9. D?mnani Foods 6-404 2 62026-303 I I0. 3-501 2 \Etilatim I I I. Food Protection's lung: 3-303. 305. 306. 6-40- 2 . 12. Food Handling 3.301.304 2 Other I3.Food [cw muting d?itt 4-204. 203. 302 1 33. MM T-ZOI. I02 4 Personal Hygienic Practices 39. CummAd'h-isuy 3-603 2 l4. Emptoyu: Health 2-20] 4 4t}. 3?80] 2 I5. Empluym Hygicnc 240I.403 4 meimHACCPle: 1 l6. Employee. Clothing 2.304, 2-402 42. mm 6-50] I Equipmentmtensils 43 umm 6-202 I I7. Sardmion Muhods $102,703 4 44, Linm 18. Equlpgunmumsils clawed snnitizal 4-60I. 6012.702 4 15. Pu: 550! I 19. Food contact name: ?02.501101 2 Fats. 0H. and Create Control Ya No NA 20. Nun-Food contact surfw 4-101. 601 2 4.5. (31m 21. clams 4-401. 901 I 22. ManuaUMechanical ware washing facilitin 4-30]. 50] Gnu: Starla: 3-304. 4-903 I 24. Single mviou mickd?wse 3-304. 4-502. 904 No. Non-Critical Critical Number of Critical Vlolntions Score These items require IMMEDIATE ananion Minus 20 ms. (See Reverse Side) I3 ReinSpection" ale: Receivad By I 5pc ed By of Seats FOOD ESTABLISHMENT INSPECQON REPORT Page of .- . 1 Establishment: - I I Ir. I Address. I I 7712? Store. Telephune: I . Type of Operation(s): Rclnil Type or Owner: (3 F006 Service El Mobile {manna Reinspectlon Person in barge)?! J: . 0 Temporary E3 Cater" Complaint Cl Inspector: @177 0 0111? New 0 HA Food Protection Sanitary Facilities l. 2-IUI. EU: -I 25 3401403,??! FOOD 16 Imam/Rodents mm a. 2 Food and Water Eromnppum-cdsnurc: 340:. 3'10: =3 2? 5 3. Food mgiwnmi .391 602 28. 5401.205 FOOD 29 Toilet Rooms ?02.402. 50: .1. mums 3-40l 402.401 4 30. Mw?m?wJ? ?54026-301 2 5. Facilities hot 3? COM holdin 3- I 4 3L 5501.502 2 s. PHF kacd a coolcd 3-501 4 31 cum-rim (>202 . Cross cantaminutinn 3-30l. 301. 30-1 4 33. 6-2015013-106 i 1.70] ?2 34. Wis/Ceilings 6-20l.501 2 9. Damgchoods 540-: 1 gs. U?hu?'g 62016-3103 1 to. mm 3.501 2 '36. mm tm?smm 1 Food Hummus. 1 L31. 6-305 12. Food 3-30I, 304 2 Other 13 Fund device 4404. 203.302 1 33 1'1ch mint): .2 Pei-sum] 315mm: Practices 2 Eat-1.1335: llcallJ't a 2220i 4 in 1 2 1,5. ?rm-?ow: Hmiqnc 240L403 Calf-Mm .IG. Wop: Clothing -- Lao-1.2402 2. ?rmisu 5.501 I EylpmenWtensils Am 6-202 1 Saniuliun Methods 4-702.703 4 44. um ?01.8mm 1 donned a: unitiwl 4-60i. 602. 102 -: Pct! l, 19. Food canine surfaces 4-202. 501. 701 2 01] ml 20. Nan-Food conunuwfwu 4-l0l.60? 2 Smngulwiplnl clash: 4-10]. 90] I 22. MmutUMcchaninl mm wuhlng [militia 4401.301 13Equlpmantfutensil slang: 3-304. 4-90} i Wanmim 24, Single union mum?: 3.304. 4-502. 904 i Mummc? NomCritical Number of Critical Violations items require IMMEDIATE attention Critical 5 Score Minus 20 Pts. (Sue Reverse Side) REIDW Received By BY ofSeats Establishment: A Teleplmne: Owner tn Inspector: Food Service 0 Temporary Other FOOD ESTABLISHMENT INSPECTION REPORT )3 Retail CI Mobile Caterer Page Date: Score: Type of Inspection: Routine El Complaint Cl Reluspeedon C'l Inva?ga?on New Establishment Cl HA Food Prulecu'on Management Facilities I. PIC I02 4 2.5. 403. 404 4 FOOD 25. lns-actszodcuu 050: 4 2. Food and Water from approved source 3-10! . 5-10] I 4 . $201204 4 3. Labeling {containers 3402.601 1 ?28. FOOD PROTECTIGN Toilci Rooms 0-302. 50: 2 4. PHF Tanya-04m 3-40I.402. 403 4 Hand- med-rods .5- 6-30! 2 5. Facililim hot a. cold holding 3-501 4 $50!.502 2 6. Coond a cooled 3-501 4 5.202 1 7. Cross conuminntion 3-30I. 302. 304 4 64025013406 1 8. Spoilcd food: 3401. 70] 2 6-20L501 2 9. Damage-d Foods 6-404 2 62016-303 I PHF?RIawlng 3-501 2 Vcn?larion $202.204.6-201.304 I II. Food 2 6-300 1 12. Food Handling 3.301. 304 2 Other l3.Food measuring dcvice +204. 203. 302 I 38. TaxicMauials 7401.102 4 Personal Hygienic Practice 30. CanmmAdvim 3-603 2 Employing Hrallh 2-20l 40. 3-80l 2 15 Empluyu: Hygimc 403 4 4t. 8-20l.m.203 1 i6. Empluync Climbing. 2-304. 2-402 I 42, Misc: 6-601 1 43, {.5th 6-202 I I7. Sanitation Methods $3024 703 4 44. Linen 4-50l.802.803 I 8. duned a saniu'wd 4-601. 602. 702 4 45, his 6-50l 9. Food convict 4-102-50l-791 2 Fats, Oil, and Grease Control Yes No NM. 20. Non-Food 4.101.601 2 45, Wilma-0000mm El. Spanxzy?wiping clams 4401.901 47? Mnnunquhnnian ware washing facililies $301.50! I .53, stomac- 3-304. 4.901 1 40 RmdaingDomnmmion Single 30004-501004 50. Wmanmp-Hnm Puma; Item No. Non-Critical Crillcal Score Slumber of Critical Violations ['hcse items requin: IMMEDIATE attention Minus 20 Pls. (See Reverse Side) Received By By FOOD ESTABLISHME NSF TION REPORT of Seats W7 figo do 03?? Add? #535 1/ 9? Telephone: - I Type 01' Cl Retail Type of Inspection,? Own_.er 1/1! Food Service 0 Mobile Wkoudne Reinspec?on Parse-[Tin charge (Fifi). 0 1311190er 0 Caterer Complaint 0 Investigation InspectoW/ Other :1 New Establishment El A 9 Food Protection Management 1: Sanitary Facilities l. PlCAssipiedlKnowledgeabldDUUes I-IOI. 4 15. Sewage 5402.403.404 4 FOOD 26. 6-50! 4* 2. Food and Wm from uppmved some 3-201, 540: 4 21. 3. Food Labelingfconlainm 3.302. 602 I I as. Plumbing mm. 205 1 FOOD PROTECTION 29. Toilet Rooms 6-302. 402.501 2 4. Tempanmres 14m. 402, 403 4 3o. 5?202. 6-301 2 5. Facilities holdecold holding 3-50] 4 3L Gubagehe?ue/auuidedisposnl S-SOI.502 2 6. PHF Cooked&cooled 3-50I 4 32. Omanpmiop 6-202 II 7. Cross contamination 3.301.301304 4 33. Malibu-206 1 a. Spoilcdfoods 3401.70: 1 34. 5.201.501 2 9. Damaged Foods 5404 2 35. Lighting 5202,6301 I 10. 3?30: 2 36 Vcnmuim 4-2012m.o202.3o: I ll. 2 31. DressingRoonu 6-305 I 12, Food Handling, 3-301. 30-: 1 2 Other 135006 empum mowing device 4?204. 203. 302 vi/ 1 TudeMwials 7.201.1(12 Personal Hygienic Practices 39. Commu- 3-603 Einpiuyee Health 2-20] 4 40. HEP 3-301 Employm H?iem: 240l.403 4 4 Cm?mwuwithHA?fPPlans E-ZOI.202.203 l6. Employee Clothing. 2-304. 2402 Prum'aes 6-50l EquipmenlfUlens?s 6-202 I7. Snniminnh?lelbods 4-702.1m 4 44. Linen 4-80l.802.803 Hi. Equipmnliulensils cleaned smilimd til-60L 602. 702 I1 Pets 6-543] l9. Foodconmelmfaus 2 Yes 20. Non-Food conuctsurim 4401.60! 2 2i. Spunwaipingeiolhs $101.90! I 22. ManuallMeclmical wm washing facilities 4.301.5m Emilipmmoiumuil storage 3-303. 4-903 1 24. Single unicenrtieiesf?euye 3-304. 4-502. 904 Minus 20 . Reinspecliyv??tc: If I Non-Critical a Criticai FOOD EST SPECTI Page 5 of of Seats 45% Date: Address: 1 Retail Type of Inspection: Owner: Food Service Cl Mabllc Routine Reinspecuon Person (P Temporary E1 Caterer Cl Complaint Cl Investigation InspectorFood Protection ManaEgment I I - Fanitary Fucl?tius I I. PIC AHLEEQIL?KMH:rdrcahl?aimnn _w_lu_ 25. Snug: .. 4 FOOD 16. 66m ?2 Fund and Walcr mum: 349]. $405 4 I 37. 26015-201204 ..-3 __FoodLabellngIcmlninen 34102. 602 23. Plumbinsm 5-201.205 1 FOOD 29. TalleIRo-onu 2 d. 52016-30! 2 2 6-202 .. 52m. sum-206 1 34. nmwuwauim . ., 2 9. i 6404 35, man; 6402.640} I 10. PHF 3-50] 36 WnlI'IatI-nn LEMMA-292.301 I 11. Food 3-301.3os.aoo. 17, $305 I . Food Other 11170011 Perswal J-JOI . 304 4-104. 302 Practices 19% 6-501 6-202 L301 650] I. anfommwim Ptcuu 2. Pmmim 44. Linn ?57 Pgu Fa Oil, and Grease Conny! 46. . Gran: Grease 19. 4-202. 501. 701 Yes?_- 4-IUI. 601 901 4-30I. SDI 3.304.430: 3.2m. 4-502. 904 Foodcumut mrlam 20. Non-Food 21. clwu . ManuaU?Mcchanicu wm wuhj Mm facilillca Single [mice wicks/Mun Non-Critical Critical Score Number of Critical Violations 111:5: items require IMMEDIATE auequ'on of Seats FOOD ESTABLISPMENT INSPECTION REPORT f?ofz .Z/fM/Vio? (222 ?at? _?Aon 13/? ?de 62/? was it Kip?rr ?19 7 Telephone: 13116 0" 0 Retail Type of Inspection: Owner: L. Af?/ ?#2401944!? @207? Mobile Routine Relnspectlon Person in charge CI Temporary 0 Caterer CI Complaint Cl Invatlgatlon Inspector: 0 Other CI New Establishment El A Food Protection Management Facilities I. PIC AssIgnedmIowledgcothDuuos 2-IDI. I02 4 . 403.404 4 FOOD . InsectsIRndents 6-50I ?1 2. Food and nous-101 4 pm 2-30I.5-203.204 3, Food labeling/containers 3402.602 1 5.20I.205 I FOOD PROTECTION . ToiletRoums 5-302. 401m 2 4. 3.401.402.403 4 mum; s-zozs-sm 2 5. Facilities hot a: mid holding 4 5-501 502 ti. FHF Cooked a: cooled 3-501 4 6-202 1 7. Cross contamination 3401.301?: 4 6-202.501.7-206 I II. Spoiled toads 3-I0I.70I 2 . 6:01.50: 2 9. Foods 6-404 2 35. mamas L. It). 3-501 2 Ventilation momma-mew 11. Food ProtectionlSlorngc 3.303. 305.306.6403 2 7. 5-305 I I2. Food Handling 3-301. 304 2 Other ?food temperature mum-Io; device $204,203,102 I 38. 7-201.I02 4! Pet-soon] Hygienic Practices 39. Gunman-Advisory 345m 2 l4. Employee Health 2-212" 4 40. 3-80! 1? IS. Employee Hygiene 2410!.403 4 dl. B-QGIJOZJZUJ I I6. Employee Clothing 2-304. 2-40: I I: Premises 6-501 I 43. UVinzAms 6-202 I . Sanitation Methods 4.702.103 4 44. Linen I 4-60l.602.102 4 45. 9:15 6-56? I . Food 4.202. 50L MI 2 F515, Oil, and Grease Control Yes No . 4401.601 2 .15, GMWW clams 47. Gmb?lctceptorMaimmLog A, . wax! facilities 4-30l. 501 43, I mil 3-304. 1?903 49, W?mmn . Single service mticleszc-usc 3-3D4.4-502.904 I FWHISIIG) I No. Non-Critical Ac??oznnl ?Fo-F-ouin_a Critical 5 Score Minus 20 Pts. (Sec Reverse Side) [3 of Seats FOOD [Page 4 of ?de Ltd/1 Esmb?mm? ?/jyy (742/ [av/iflf/?? ?m 07/{47/7/7 Telephone: 1 Person in charge [139: Type or a Retail Type of Iospc??ft?n/ mood Sen'Ice Mobile WRouune CI Reinspectioo DITemponu'y Caterer CI Complaint CI Investigation Cl Other New Establishment CI HA Food Protection Management _m . i. PIC ASE led able/Duties 2-10], l0} 4 FOOD 2 Food and Waterfront approved source 3-20]. 5. l0! It 3. Food Labeling [containers 3-301. 602 FOOD PROTECTION 4. PHFTerupcmtum 3401.401403 4 5. Facilities hat cold holding 3-50l 4 6. PHF Cuckoo a cooled 3-50] 4 7. Cross contamination 3-301, 302. 30* 4 s. Spoiled foods 3-IDI.701 2 9. Dumod Foods wot 2 ID. PHF mm; 3-501 2 11. Food 3.303. 305. 306. 6.40: 2 IE. Food Handling 2 l3.Food temptation: maturing devicc 4-104. 103. 302 1 Personal Hygleolc Practices l4- Emptoyo: Health 2-20! 4 l5. Employee Hygiene 2-401. 403 4 I6. outgrow Clothing not. 2-402 moment?llem?s l7. Emma Methods 4-102. 703 (i -s. :Imut a sanitized 4-601. 502. 702 a Food contact surfocu 4-202. 50]. WI 2 ID, Non-Food contact surfm 601 2 ll. Sponges-Mom: cloths 4401.901 12. ManuolfMechaninl Whirl; facilities 4-301. 505 SMummu?ulzns? storage 3-304. 4-903 I 24. Single sonic: oniclasIReusc $304. $502,904 1 Non-Critical Critical Score lumber of Critical Violations ['he5e items require IMMEDIATE attention 20 Pts. (See Reverse Side) NC 403. 404 6450] 2-3-0 I .5293. 204 5-201, 205 28. 29. Toilet Rooms [hm-washing motto-d: 6- l. Reinspecti .i #of?Seats INSPECTION REPORT Page 2 of 1 Esmh??hmt' KHz-4d 7Z1 67/107,277? 27/1 77% Telephone: Time 0" Opem?a??)? El Retail Type of Inapeit'??on?: Owner [[579 [2(77/ 1700!! Service 0 Mobile Routine Rainspection Pei'smlw In charge 25M- 14/ D_Temporary a Colour Cl Complaint CI Investigation Inspector. #1162 #lf?L/l Other 0 New Establishment a A 9 Food Protection Management l. 2 1m [02 4 5-402. 403 404 4 FOOD . 5-501 4 2. Food and Wm: from umvo?sm 4 2.30 20? 4 J. Food Lab-clinyconininm 3-302. 602 5.201.205 1 FOOD 6302401501 2 4. 3401.402. 403 4 54016-30! 2 5. Pulliu'os hot J: cold holding 3e50l 4 5601.502 2 6. PHF Cooked a cooled mm 4 6-202 1 Cum contamination 3-30I. 302. SM 4 50 7-206 I 3. Spoiled foods 3-101. 2 SOI 2 Damaged Foods 6?404 2 . 5202,6303 I 10. FHF mowing 3-501 2 Valuation 4-202. 204.62%.304 I I. Food ProinctioNSlorop 3-30}. 305. 306. 2 7. Rooms 6-305 I I2. Food Handling 3-301. 304 2 Other l3.Foo-d temperature ramming dovice 4-204. 103. 302 I 38. ToxicMaml?uIs 7 20!, I02 4 Personal Hygienic Practices 39 CoMJMAdvha'y 3-503 2 l4. Employee Huhh 2-20] 4 40. HSPW 1801 2 I5. Ilygiznc 2-40L4OJ 4 ConfununuwithACG?Plam 33101202203 1 5. Employer: Gaming 2404. 2-402 I I I m. mm 6-50l 43 LivingArcu 6-201 I 7. Soniu?on Methods 4-701. 703 4 44 Liam 4-501.me i B. donned sar?dud 4-60I . 602. 701 4 45. PEG 6-50I I 9. Food contact mzfacas 4-202. 501. 701 2 Fats, 01L and Grease Control Yes 0. Nun-Food contact in?ates 4-10I. WI 2 46. I. cloth: 4-101 . 901 I 2. ManuaUMuhnnica] wan: 4-301. 501 3 tonsil 3-304. #903 4. Single swore micleisausc 340?. L502. 904 I Non-Critical Critical 5 Score Min 20 Pts. (See Reverse Side) '3 Rei qumber of Critical Violations Fhese ilcms require IMMEDIATE attention Insocmed Bv of Seats ma: Telephone: Owner: Person charge Inspector: ABLISHM INSP Retail Moblle El Caterer Food Protection Management Facilities 8 2401.102 4 . . PI i ubldDuUu FOOD 1 Food and Wag from approved so_u_mc 3.20:. mm 4 3. Food Labeling (momma 3-302. 602 FOOD PROTECTION . dcvicc .. - Practices l6. 6-404 1-30]. 305, 306. 3-30I. 304 4-204. 203. 302 2-401 Equipmentmtens?s I2 mm.? mm: 4.313.103 19. Rodmnuctm'flm 4-202. 2 10. Non-Food contutwfaces 4-IDI.601 2 Sponges/?rim cloths 4401. 901 I 22. Manual/Mediation] wnre washing mimic: 4-301.5m I 23?qutpmentfutcnsil storage. 3.304. 4-903 I ?24. Single service Muse Non-Critical Critical 8 I: Score . - El 20Pls (Sesgevcrsejtd?e) Type of Cl Complaint New NREPOHT Page of Date: Score: Cl Relnspecdan CI Investigation 0 A NC 8?20l . 332.203 6-501 62M ReinspectionDatc:? 4 A .