STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULA flow = 2 DIVISION OF HOTELS AND RESTAURANTS ! * DEPARTMENT OF BUSINESS AND . wy Din 19 PROFESSIONAL REGULATION pap HAT Tb Fees Petitioner, VS. CHECKERS # 170 License No. 6211880 Respondent. License Type 2010 Permanent Foot! Service’ Case No. 2004042536 A . , OS “1743 ADMINISTRATIVE COMPLAINT The DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION, DIVISION OF HOTELS AND RESTAURANTS, (“Petitioner”), files this Administrative Complaint against CHECKERS # 170, ("Respondent"), and says: 1. Petitioner is the state agency charged with regulating the operation of public lodging establishments and public food service establishments, pursuant to Section 20.165 and Chapter 509, “lorida Statutes. 2. Respondent is, and has been at all times material hereto, licensed by or subject ta the jurisdiction of the Division of Hotels and Restaurants. The respondent's business address of record is 1877 HIGHLAND AVE, CLEARWATER, FLORIDA 33755.The mailing address of record is CHECKERS # 170, at 4300 W CYPRESS ST STE 600, TAMPA, FLORIDA 33607. 3. Inspection of this establishment conducted pursuant to Sec. 509.032, Florida Statutes, revealed violations of the provisions of Chapter 509, Florida Statutes, and / or the rules promulgated thereto governing operation of the establishment. The violation(s) found and applicable law are described in Exhibit “A,” attached hereto and incorporated herein by reference. Inspection documents are attached as Exhibit “B’, incorporated herein by reference. WHEREFORE, Petitioner respectfully requests entry of an Order imposing one or more of the following penalties: administrative fine not to exceed $1,000 per offense; mandatory attendance at Respondent's expense at an educational program sponsored by the Department's Hospitality Education Program: suspension, revocation, or refusal of a license issued pursuant to this pater and/or any other relief authorized by Chapter 509, Florida Statutes, or the rules promulgated ther Signed August 23, 2004 Joe Perez, District Manager By delegatfon of the Director, or desig Division of Hotels & Restaurants Department of Business & Professional Regulation COUNSEL FOR THE DEPARTMENT: Charles F. Tunnicliff, Lead Attorney Florida Bar No. 0153831 Department of Business & Professional Regulation 1940 North Monroe Street Tallahassee, Florida 32399-1007 CERTIFICATE OF SERVICE BY CERTIFIED U.S. MAIL, ARTICLE NUMBER: 7160-3901-89848-3954-3215 | HEREBY CERTIFY that a true and correct copy of the foregoing ADMINISTRATIVE COMPLAINT has been hand served by me on this day of , 2004. Received by: _ Inspector's Signature Operator's Signature Title Title ~ Case Number: 2004042536 Form revised 7/27/04 License Type: 2010 Permanent Food Service District Number: 03 License Number: 6211880 CHECKERS # 170 License Number: 6211880 License Type: 2010 PERMANENT FOOD SERVICE Case Number: 2004042536 Exhibit A “FC” as cited herein references specific provisions of the 1999 Food Code, Recommendations of the United States Public Health Service, Food and Drug Administration, incorporated by Chapter 61C, Florida Administrative Code. “NFPA” as cited herein references specific provisions of the National Fire Protection Association Life Safety Code, incorporated by reference at Chapter 4A-3, “Fire Prevention, General Provisions”, Florida Administrative Code, and 61C-1.004(5), Florida Administrative Code. It is alleged that on August 3, 2004 and August 18, 2004, the licensee was in violation of Florida Statute 509(FS) and/or the Rules of the Division of Hotels and Restaurants, Florida Administrative Code (FAC), in the following particulars. Copy(s) of the report(s) for the above referenced inspection(s) are attached hereto and incorporated by reference as Exhibit B. * 1.45-01 61C-1.004(5) FAC ALL FIRE SAFETY, PROTECTION AND PREVENTION EQUIPMENT MUST BE INSTALLED, APPROVED, MAINTAINED AND USED IN ACCORDANCE WITH CHAPTER 509, FS, AND THE NATIONAL FIRE PROTECTION ASSOCIATION LIFE SAFETY CODE CHAPTER 101, AS ADOPTED BY THE DIVISION OF STATE FIRE MARSHAL IN CHAPTER 4A-3, FAC. OBSERVED FIRE SUPPRESSION SYSTEM OUT OF DATE. LAST TAGGED OCTOBER 2003. * denotes critical violation Exhibit A Case Number: 2004042536 Page 1 License Type: 2010 PERMANENT FOOD SERVICE License Number: 6211880 REQUEST FOR ADMINISTRATIVE COMPLAINT (BUSINESS: _ nara SST NAT NUS SES Checeecs "116 | OWNER: . . LICENSE NO: “necwecs Dr we dina Rest . (or\ I SSO | LICENSE TYPE: 201G [INSP AREANO: ‘@ | DATE: / ] OWNERSHIP VERIFIED BY: os 8D DATE: ‘s PS bs INSPECTION DATA ENTRY | BY: — | DATE: / i CASE HISTORY FOR THIS LICENSEE _ OFFENDER STATUS*: ~ RESEARCHED BY: ~\ DATE:’, <\ ‘huy CASE NO: ; STATUS: CLERKED DATE: / | , CASE NO: STATUS: CLERKED DATE: / / | CASE NO: STATUS: CLERKED DATE: / / i CASE NO: STATUS: CLERKED DATE: / / | APPROVAL SUPERVISOR BY: DATE: I | MRS BY: LW wt Vim DATE: / i DISTRICT MANAGER | BY: DATE: / | INSPECTION CHRONOLOGY TYPE DATE RESULTS ROVTIMNE Gg! fF [2004 WALRINE (SSUEO CALL BIC KA ef ISACTIDY & 1 ¢¢ 1 200Y MOT CMPUEDSAG LEY IST _| ! I | / DEBIT ITEM VIOLATION wad A 4 , ff , H5-O| x oRsewen Tike SupeRessicd System! het 10/Zo003 t wet WR kh : kate Vay [Nek DA pert Ad *THIS CASE PLUS NO. OF ACs WITH VIOLATIONS OTHER THAN LICENSE PAYMENT CLERKED WITHIN 2 YRS Request for AC Page 1 of Revised 09/24/03 DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION LEGAL NOTICE Division of Hotels and Restaurants "CONTROL NUMBER INSPECTOR FOOD SERVICE INSPECTION REPORT Pee trv Pa] ey | Seg ww 7 i t y 1o2 LEE PSC ' [OWNER NAME = Catering | - — : ar. =. =e Sea SAA TOTES =. Vending o \ aE BUSINESS NAME wd t MFDv ° ; vc Theme Park “ Qhue Lees / ? oO Food Cart - woe ADDRESS Cn TE . — ili Temporary B a ty> a 7 - / Bs 7? [tt elt Z AWD At ind cu: Temp, Assoc. - -- ciTy ZIP (Optional) ~ wiPerm. Est ae: . Cp Se te re 4eye 3375S a No. of Sears at General <=: Seating & INSPECTION REASON Failure to comply with this Notice ma: ie an 1S Routine C PB administrative complain: (hat may - suspension or revocation of your license and fines. 3 ©) Complaint 4 © Information INSPECTION RESULTS 5 _. Epidemiological 4 (© ANY VIOLATIONS noted herein must be corrected by the NEXT FIOUTINE INSPECTION DISPOSITION 6 © Pending 2 © WARNING Violations in the operation of your establishment must be corrected by: Date Time. Oo HACCP INSPECTION 4s 3B ADMINISTRATIVE COMPLAINT recommended, —- —| 5 © Seasonal 6 (3 EMERGENCY ORDER recommended based upon a severe end immediate threat to the public. Temperature Food Manager Name ificate Date erse side for explanation of citations. (3 1403 230) a30wie 0m saree 19 2sCj3saf 4255 5269 — CIRCLED ITEMS ARE IN VIOLATION 3 26% 4307) 630 SITE oe FE omens z nn Cis tvet #30; WAREWASHING SANITIZATION: °°. ae P3 270} 3609 4405 *53b9 . Date(s) Sanitizing Concentration ______________ ppm er / a) “3 280) 9709 48M 54 : Sanitizing Temperature _____...__ degrees F. 29f} 3af9 ‘46(3 5513 370} 300 «3903 4709 «56D Cc ° MMENT s d (iE é Str, 203 310 37 # YS FIRE Heed Systen THEE! 2k} 20 5809 be AR ne mes ‘SsuD Ow Rle3/e¥ Ba SITES SUPPRESSION SYSTEMS. I acknowledge receipt of this inspection form and comments. Revipy mare Ware (PLEASE PRINT) Le pamiidlotie Cap Heat mm ASSox MGR. Rrowien: aS Hiatal Chia ton lI Sleu! Evabhviment 2 ephone Date and Time ASC a Chr KS Date “9 Sou - UV BIS SAVY Sa ae State of Florida Control Number Department of Business and Professional Regulation Division of Hotels and Restaurants b2- ye od www. ogpraltyedtucgtion org hee ears ge 5 > a 2 COMMENTS SHEET Page 2 of S Addendum to DBPR Forms HR 5022-005, 5022-014, 5022-015, 5022-082, or 5022-083. For comments to the Lodging, Food Service, or HACCP inspection; Call Back/Reinspection Report, or HACCP Plan Verification. Co iD — eee ava oe 4 ,. CHF ref FS Frize ie od Sy stem TItC-KH EO G.F 2oeak Cn DA \ WAene he ISSvED ON She ifeu SOM Lear Swspecesuw Ko gset Plein &fo ifs Y Not Aum bH S#®. s 2S spe (Me def ieuttan / ° : : 7 - DBPR Form HR 5022-042 MyFlorida.com 2004 November 01 STATE OF FLORIDA Page 1 of 8 DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION DIVISION OF HOTELS AND RESTAURANTS FOOD SERVICE INSPECTION REPORT LEGAL NOTICE Failure to comply with this Notice may initiate an administrative complaint that may result in suspension or revocation of your license and fines. 8/3/04 2:34:19 PM Routine 6211880 SEAT Inspection Date and Time inspection Reason License Number CHECKERS DRIVE INN RESTARANT 170 WARNING: Owner Name CHECKERS 170 Violations in the operation of your tablishment must be corrected by: 9495 Area Code/Telephone Number Business Name 36 inspection Result 08/18/2004 08:00 AM 2/1/05 Number of Units 1877 HIGHLAND AVERAGE Callback Date/Time License Expiration CLEARWATER FL 33775 Address / City / State / Zip / etc. {tem 03: Food Temperatures ltem 53a: Cert. Food Managers item 20: Warewashing Sanitization ttem 45: Fire Extinguishers and | Fire Suppression Systems Dates Chicken, waik in cosler, 34 Degrees F Hotdogs, walk in cocler, 34 Degrees F. Hamburger. cooked, cook line, 162 Degrees F. Manager Name: jason acree Ceniification Date: 6/03 Certified by: Natonal Registry of Food Safely Professionals A Class ABC type Fire Extinguisher, foundiniat kitchen has a cenification cate of 1/04 Manager Name: nina williams Certification Date: 417104 Centfied by: National Regis'ry of Food Safety Professionals Chilli, cook line, 162 Degrees F. NOTE: ttems marked above with an asterisk (*) indicate a violation Inspector's Comments ote hot foods must be cooled in freezer not small reach in cooier under prep line Provided Web Site: www. hospitalityeducation.org. | acknowledge receipt of this inspection form and comments. Deere who. —t- ae 08/03/04 3:16 PM Signature of Recipient Inspector Signature Date/Time Recipient: terrance white For further information please contact Jim Olsen Title person in charge Sanitation and Safety Soecialst 3725W. Grace St, Sute 520 Phone: 727 486 8195 ee STATUS SOURCE STATUS PHF TEMPERATURE CONTROL Yes “01a Approved source Yes *03b Hot food at proper temperature __ | Yes *01b Wholesome, sound condition Yes *03c Foods properly cooked/reheated Yes 02 Original container; properly labeled, date marking _ Yes *03d Foods properly cooled STATUS PHF TEMPERATURE CONTROL Yes *04 Facilities to maintain product temperature No “03a Cold food at proper temperatures during storage, Yes 05 Thermometers provided and conspicuously placed display, service, transport, and cold holding Yes 06 Potentially hazardous foods properly thawed Violations marked with an asterisk are critical violations. !tems marked YES are in compliance. items Marked NO are violations. Specific details of violation are listed on subsequent pages. Items marked N/A are Not Applicable. items Marked as N/O are Not Observed, and were not being conducted DBPR FORM HF: 5022-014 STATE OF FLORIDA FOOD SERVICE INSPECTION LEGAL NOTICE DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION DIVISION OF HOTELS AND RESTAURANTS Page 2 of 8 License Number SEAT 6214880 Inspection Date REPORT 8/3/04 2:36:19 PM Failure to comply with this Notice may initiate an administrative complaint that may result in suspension or revocation of your license and fines. STATUS PHF TEMPERATURE CONTROL STATUS GARBAGE AND REFUSE DISPOSAL Yes 07 Unwrapped or potentially hazardous food not re-served |Yes 3 Containers covered, adequate number, insect and rodent Yes "08a Food protection during storage, preparation, display, proof, emptied at proper intervals, clean service, transportation Yes 34 Outside storage area clean, enclosure properly Yes *08b Cross-contamination, equipment, personnel, storage constructed Yes '08¢ Potential for cross-contamination; storage practices; STATUS INSECT AND RODENT CONTROL \damaged food segregated Yes *35a Presence of insects/rodents. Animals prohibited No Ios Foods handled with minimum contact Yes "35b Outer openings pretected from insects, rodent proof No 10 in use food dispensing utensils properly stored STATUS FLOORS, WALLS, CEILINGS STATUS PERSONNEL Yes 36 Floors properly const-ucted, clean, drained, coved Yes 11 Personnel with infections restricted No 37 Walls, ceilings, and attached equipment, constructed, No 12a Hands washed and ciean, good hygienic practices iclean (observed), alternative operating plan Yes 38 Lighting provided as required. Fixtures shielded Yes *42b Proper hygienic practices, eating/drinking/smoking Yes 39 Rooms and equipment - vented as required (evidence) STATUS OTHER AREAS Yes 13 Clean clothes, hair restraints Yes 40 Employee lockers provided and used, clean __] STATUS FOOD EQUIPMENT AND UTENSILS Yes “41a Toxic items properly stored Yes 14 Food contact surfaces designed, constructed, Yes *41b Toxic items labeled and used properly maintained, installed, located Yes 42 Premises maintained, free of litter, unnecessary articles. yes 15 Non-food contact surfaces designed, constructed, |Cleaning and maintenance equipment properly stored. maintained, installed, located Kitchen restricted to authorized personnel Yes 16 Dishwashing facilities designed, constructed, operated [Yes 43 Complete separation from living/sleeping area, laundry _| 1. Wash 2. Rinse 3. Sanitize Yes 44 Clean and soiled linea segregated and properly stored No 17 Thermometers, gauges, test kits provided _SAFETY Yes 18 Pre-flushed, scraped, soaked "45 Fire extinguishers - proper and sufficient Yes 19 Wash, rinse water clean, proper temperature Yes "46 Exiting system - adequate, good repair “I No *20a Sanitizing concentration Yes ha7 Electrical wiring - adequate, good repair Yes *20b Sanitizing temperature Yes “48 Gas appliances - properly installed, maintained No 21 Wiping cloths clean, used properly, stored Yes 49 Flammable/combustible materials - properly stored Yes 22 Food contact surfaces of equipment and utensils clean STATUS GENERAL yes 23 Non-food contact surfaces clean Yes "50 Current license properly displayed Yes [24 Storage/handling of clean equipment, utensils Yes 51 Other conditions sanilary and safe operation STATUS SINGLE SERVICE ARTICLES "52 False/misleading statements published or advertised No 25 Service items properly stored, handled, dispensed relating to food/beverage Yes 26 Singie service articles not re-used "53a Food management certification valid STATUS WATER AND SEWAGE/PLUMBING. *53b Employee training validation Yes ‘27 Water source safe, hot and cold under pressure 54 Florida Clean indoor Air Act Yes *28 Sewage and waste water disposed properly 55 Automatic Gratuity Notice Yes 29 Plumbing installed and maintained 56 Copy of Chapter 509, Florida Statutes, available yes *30 Cross-connection, back siphonage, backflow STATUS GENERAL _] STATUS TOILET AND HANDWASHING FACILITIES Yes 57 Hospitality Education Program information provided Yes *31 Toilet and handwashing facilities, number, convenient, lYes lsg Smoke Free I designed, installed | No 32 Restrooms with self-closing doors, fixtures operate Total Number of COS Violations: 1 properly, facility clean, supplied with handsoap, disposable towels or hand drying devices, tissue, covered waste Total Number of Repeat Violations: 0 Violations marked with an asterisk are critical violations. Items marked YES are in compliance. items Marked NO are violations. Specific details of violation are listed on subsequent pages. Items marked N/A are Not Applicabie. Items Marked as N/O are Not Observed, and were not being conducted Pp 4 STATE OF FLORIDA age 3 of 8 DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION License Number DIVISION OF HOTELS AND RESTAURANTS, SEAT = 8211880 Inspection Date FOOD SERVICE INSPECTION REPORT 8/3/04 2:34:19 PM LEGAL NOTICE Failure to comply with this Notice may initiate an administrative complaint that may result in suspension or revocation of your license and fines. Warning(s}: 45-17 - Observed hood suppression system tag out-of-date last inspection 10/03 This violation must be corrected by : 8/18/04. 53B-01 - Observed no proof of required employee training. This violation must be corrected by : 9/03/04. Violation(s). 03A-03 - Observed potentially hazardous food cold held at greater than 41 F.cheese 61 chicken 129 stored in reach in cooler below prep area 03A-03 - Observed potentially hazardous food cold held at greater than 41 F.cheese 46 stored on prep line 09-01 - Observed improper use of bowl/plastic food container or other non-handied container for dispensing food.in seasoning bin 10-05 - Observed in-use utensil not stored on a clean, protected location if used with a food that is nonpotentially hazardous. stored on beverage drain board 12A-12 - Observed food employee touching ready-to-eat food with their bare hands. No approved Alternative Operating Procedure in place. Corrected On Site. 17-01 - Observed lack of use of chemical test kit when using chemical sanitizer at three compartment sink. 20a-01 - Observed chlorine sanitizer not at proper minimum strength. 3 compartment sink 21-02 - Observed wet wiping cloth not stored in sanitizing solution between uses. 25-04 - Observed single service articles stored without protection from contamination.cup lids drive thru 25-03 - Observed single service articles improperly stored.on floor in dry storage shed 32-09 - Observed lack of proper hand drying provisions at hand wash sink.kitchen area 37-02 - Observed wall in disrepair.near 3 compartment sink 45-30 - Observed lack of inspection report from licensed equipment dealer on premise.hood surpression system report 53A-04 - Observed no currently certified food service manager noted on duly with four or more employees engaged in food preparation. 56-01 - Observed copy of Florida Statute 509 not available in the establishment

Docket for Case No: 05-001763