STATE OF FLORIDA IO ka DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION = DIVISION OF HOTELS AND RESTAURANTS DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION is Ie 4 Petitioner, vs. License No. 1620450 FRIENDLY LUNCH & DINNER REST License Type 2010 Permanent Food Service Respondent. Case No. 2004054466 / ADMINISTRATIVE COMPLAINT The DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION, DIVISION OF HOTELS AND RESTAURANTS, (‘Petitioner’), files this Administrative Complaint against FRIENDLY LUNCH & DINNER REST, (“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, Florida Statutes. 2. Respondent is, and has been at all times material hereto, licensed by or subject to the jurisdiction of the Division of Hotels and Restaurants. The respondent's business address of record is 2513 N ANDREWS AVE, WILTON MANORS, FLORIDA 33311.The mailing address of record is FRIENDLY LUNCH & DINNER REST, at 2513 N ANDREWS AVE, WILTON MANORS, FLORIDA 33311. 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 Chapter, and/or any other relief authorized by Chapter 509, Florida Statutes, or the rules promulgated thereto. Signed November 09, 2004 S Ker Ken Buck, District Manager By delegation of the Director, or designee 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 9848 5780 1809 __ | 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: 2004054466 Form revised 10/25/04 License Type: 2010 Permanent Food Service District Number: 02 License Number: 1620450 FRIENDLY LUNCH & DINNER REST License Nurnber: 1620450 License Type: 2010 PERMANENT FOOD SERVICE Case Number: 2004054466 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. Itis alleged that on September 21, 2004 and October 25, 2004 the licensee was in violation of Florida Statute 509(FS) ancl/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. 4, 46-1161C-1.004(10) FAC : EXITS SHALL BE CLEARLY MARKED WITH APPROVED ILLUMINATED EXIT SIGNS. OBSERVED EXITS LIGHTS NOT PROPERLY ILLUMINATED REAR. * 2.53A-01 509.039 FS AND 61C-4.023(1) FAC ALL MANAGERS EMPLOYED BY A FOOD SERVICE ESTABLISHMENT MUST HAVE PASSED [THE FOOD SERVICE MANAGER] TEST AND RECEIVED A CERTIFICATE ATTESTING THERETO. MANAGERS HAVE A PERIOD OF 90 DAYS AFTER EMPLOYMENT TO PASS THE REQUIRED TEST. ALL MANAGERS WHO ARE RESPONSIBLE FOR THE STORAGE, PREPARATION, DISPLAY, AND SERVING OF FOODS TO THE PUBLIC SHALL HAVE PASSED A CERTIFICATION TEST APPROVED BY THE DIVISION DEMONSTRATING A BASIC KNOWLEDGE OF FOOD PROTECTION PRACTICES AS ADOPTED IN THIS CHAPTER. THOSE MANAGERS WHO SUCCESSFULLY PASS AN APPROVED CERTIFICATION EXAMINATION SHALL BE ISSUED A CERTIFICATE BY THE CERTIFYING ORGANIZATION, WHICH IS VALID FOR A PERIOD OF FIVE YEARS FROM THE DATE OF ISSUANCE. OBSERVED MANAGER LACKING PROOF OF FOOD MANAGER CERTIFICATION. * 3.53B-01 509.049FS FOOD SERVICE EMPLOYEE TRAINING. THE DIVISION SHALL ADOPT, BY RULE, MINIMUM FOOD SAFETY PROTECTION STANDARDS FOR THE TRAINING OF ALL FOOD SERVICE EMPLOYEES WHO ARE RESPONSIBLE FOR THE STORAGE, PREPARATION, DISPLAY, OR SERVING OF FOODS TO THE PUBLIC IN ESTABLISHMENTS REGULATED UNDER THIS CHAPTER. THESE STANDARDS SHALL NOT INCLUDE AN EXAMINATION, BUT SHALL PROVIDE FOR A FOOD SAFETY TRAINING CERTIFICATE PROGRAM FOR FOOD SERVICE EMPLOYEES TO BE ADMINISTERED BY A PRIVATE NONPROFIT PROVIDER CHOSEN BY THE DIVISION. ANY FOOD SAFETY TRAINING PROGRAM ESTABLISHED AND ADMINISTERED TO FOOD HANDLER EMPLOYEES PRIOR TO THE EFFECTIVE DATE OF THIS ACT SHALL BE SUBMITTED BY THE OPERATOR TO THE DIVISION FOR ITS REVIEW AND APPROVAL. IT SHALL BE THE DUTY OF THE LICENSEE OF THE PUBLIC FOOD SERVICE ESTABLISEMENT TO PROVIDE TRAINING IN ACCORDANCE WITH THE DESCRIBED RULE TO ALL EMPLOYEES UNDER THE LICENSEE'S SUPERVISION OR CONTROL. THE LICENSEE MAY DESIGNATE: ACERTIFIED FOOD SERVICE MANAGER TO PERFORM THIS FUNCTION AS AN AGENT OF THE LICENSEE. FOOD SERVICE EMPLOYEES MUST RECEIVE CERTIFICATION PURSUANT TO THIS SECTION BY JANUARY 1, 2001. FOOD SERVICE EMPLOYEES HIRED AFTER NOVEMBER 1, 2000, MUST RECEIVE CERTIFICATION WITHIN 60 DAYS AFTER EMPLOYMENT. CERTIFICATION PURSUANT TO THIS SECTION SHALL REMAIN VALID FOR 3 YEARS. OBSERVED NO PROOF OF REQUIRED EMPLOYEE TRAINING. * denotes critical violation Exhibit A Case Number: 2004054466 Page 1 License Type: 2010 PERMANENT FOOD SERVICE License Number: 1620450 Page 1 of 4 STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION ‘ i EXH | B IT B DIVISION OF HOTELS AND RESTAURANTS 3 CALLBACK INSPECTION REPORT PAR t/ ioc i) eS LEGAL NOTICE Failure to comply with this Notice may initiate an administrative compiaint that may result in suspension or revocation of your license and fines. 10/25/04 2:38:38 PM Warning SEA1520450 SEAT Callback inspection Date and Time Inspection Reason License Number MEME RAPHAEL And LUCOF JASHIN ADMINISTRATIVE COMPLAINT 5670084 .00 __ Owner Name recommended. Area Code/Telephone Number FRIENDLY LUNCH And DINNER REST Business Name Inspection Result 16 09/21/2004 Number of Units Requested Calfback Date/Time Initial Warning Date 2513 N ANDREWS AVE WILTON MANORS FL 33311 Address / City / State / Zip / etc. Comments ———_— [The following item(s) fave been recommended for Administrative Complaint: iolation: 46-11 PDbserved exit lights not properly illuminated.rear. iolation: 53A-01 Dbserved manager lacking proof of Food Manager Certification. ‘lolation: 53B-01 bbserved no proof of required employee training. LD re 10/25/04 2:56 PM_ Date Signature of Recipient inspector Signature Recipient: JASMIN YOLANDA For further information please contact: Title PIC Femando Williams - Sanitation Safety Specialist 5080 Coconut Creek Phone: 954 567 0422 Pky Ste A Margate,Fi 33063 850 487 1395 DBPR FORM ER 5022-77? Page 2 of 5 STATE OF FLORIDA License Number DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION SEAT SEA1620450 EXH | B IT B DIVISION OF HOTELS AND RESTAURANTS Business Name FRIENDLY LUNCH And DiINNE CALLBACK INSPECTION REPORT . Inspection Date LEGAL NOTICE 10/25/04 2:38:38 PM Failure to comply with this Notice may initiate an administrative complaint that may result in suspension or revocation of your license and fines. | [The following item(s) ere in compliance: iolation: 06-01 Observed potentially hazardous food thawed in an improper manner. iotation: 06-01 Pbserved potentially hazardous food thawed in an Improper manner. iolation: 22-02 Pe buildup of sailed material on racks in the reach-in cooler. iolation: 23-01 Pbserved build-up of crease on nonfood-contact surface. [hood] iolation: 32-02 bbserved lack of handwashing sign at a handsink used by food employees. iolation: 51-05 Pbserved no copy of latest inspection report. DBPR FORM HR 5022 Page 1 of 8 STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION EXH | BIT B 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. 9/21/04 11:53:17 AM _ Routine SEA1620450 SEAT Inspection Date and Time inspection Reason License Number MEME RAPHAEL And LUCOF JASHIN WARNING: Owner Name FRIENDLY LUNCH And DINNER REST Business Name Inspection Result 16 10/21/2004 08:00 AM Number of Units Callback Date/Time 2513 N ANDREWS AVE Violations in the operation of your lish 5670084.00 Area Coce/Telephone Number 01-DEC-04 License Expiration WILTON MANORS FL 33311 Address / City / State / Zip / etc. Item 03: Food Temperatures Item 53a: Cert. Food Managers item 20: Warewashing Sanitization item 45: Fire Extinguishers and Fire Suppression Systems Dates _ | Beef, cooked, hot holding, 159 Degrees F. Chicken, hot holding. 159 Degrees F. Rice, hot holding, 154 Decrees F.[frozen meats} NOTE: Items marked above with an asterisk (*) indicate a violation inspector's Comments IO MANAGER.ONE EMPLOYEE [cook-cashier] YOLANDA JASMIN, NOT TRAINED . A Slass BC type Fire Extinguisher, found in/at kitchen has 2 certification date of 4/04 A 400d Suppression type Fire Extinguisher, found invatkitchen has a certification date of 4/04 Provided Web Site: www.hospitalityeducation.org. | acknowledge receipt of this inspection form and comments. ~~ 09/21/04 12:41 PM a Signature of Recipient Inspector Signature For further information please contact: Fernando Williams Sanitation Safety Specialist 5080 Coconut Creek Pky Ste A Margate,Fl 33063 850 487 1395 PHF TEMPERATURE CONTROL *03b Hot food at proper :emperature *03c Foods properly cocked/reheated *03d Foods properly cooled *04 Facilities to maintair_product temperature 05 Thermometers proviced and conspicuously placed Date/Time Recipient: YOLANDA JASMIN Title Pic Phone: 954-567-0422 STATUS SOURCE STATUS Yes “O12 Approved source Yes Yes {*01t Wholesome, sound condition Yes Yes 02 Original container; property labeled, date marking _ Yes STATUS PHF TEMPERATURE CONTROL Yes Yes *03a Cold food at proper temperatures during storage, Yes display, service, transport, and cold holding 06 Potentially hazardous foods properly thawed 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 Applicable. Items Marked as N/O are Not Observed, and were not being conducted DBPR FORM HR 5022-014 EXHIBIT = STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION DIVISION OF HOTELS AND RESTAURANTS FOOD SERVICE INSPECTION REPORT LEGAL NOTICE Page 2 of 8 License Number SEAT SEA1620450 Inspection Date 9/21/04 11:53:17 AM 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 133 Containers covered, adequate number, insect and roderit Yes "08a Food protection during storage, preparation, display, roof, emptied at proper intervals, clean a _|service, transportation Yes 34 Outside storage area clean, enclosure properly Yes *08b Cross-contamination, equipment, personnel, storage instructed Yes *08c Potential for cross-contamination; storage practices; STATUS INSECT AND RODENT CONTROL | damaged food segregated Yes "35a Presence of insects/rodents. Animals prohibited Yes (09 Foods handled with minimum contact Yes "35b Outer openings protected from insects. rodent proof__| Yes “0 In use food dispensing utensils properly stored STATUS FLOORS, WAILLS, CEILINGS 2 STATUS PERSONNEL Yes 6 Floors properly constructed, clean, drained, coved Yes 441 Personnel with infections restricted Yes 7 Walls, ceilings, and attached equipment, constructed, [Yes *12a Hands washed and clean, good hygienic practices lean | (observed), alternative operating plan Yes 38 Lighting provided as required. Fixtures shielded Yes *12b Proper hygienic practices, eating/drinking/smoking Yes 39 Rooms and equipment - vented as required 4 L_ (evicience) STATUS OTHER AREAS 4 Yes 13 Clean clothes, hair restraints Yes 40 Employee Jockers provided and used, clean | STATUS FOOD EQUIPMENT AND UTENSILS Yes "41a Toxic items properly stored | Yes i 14 Food contact surfaces designed, constructed, [yes frat Toxic items labeled and used properly ‘maintained, installed, located Yes 42 Premises maintained free of litter, unnecessary articles. | Yes 115 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 aa Clean and soiled linen segregated and properly stored Yes 17 Thermometers, gauges, test kits provided _SAFETY Yes 18 Fre-flushed, scraped, soaked Yes "45 Fire extinguishers - proper and sufficient | Yes 19 Wash, rinse water clean, proper temperature [Noha Exiting system - adequate, good repair _| Yes *20a Sanitizing concentration *47 Electrical wiring - adequate, good repair _| Yes *20b Sanitizing temperature Yes “48 Gas appliances - properly installed, maintained Yes 21 Wiping cloths clean, used properly, stored Yes *49 Flammable/combustible materials - properly stored No 22 Food contact surfaces of equipment and utensils clean STATUS GENERAL No 23 Non-food contact surfaces clean Yes *50 Current license properly displayed Yes 24 Storage/nandling of clean equipment, utensils No 51 Other conditions sanitary and safe operation STATUS {_ SINGLE SERVICE ARTICLES Yes. *52 False/misleading statements published or advertised “| Yes 25 Service items properly stored, handled, dispensed relating to food/beverage Yes 26 Single service artictes not re-used No "53a Food management certification valid STATUS WATER AND SEWAGE/PLUMBING. No *53b Employee training validation Yes *27 Water source safe, hot_and cold under pressure Yes 54 Florida Clean Indoor Air Act Yes *28 Sewage and waste water disposed properly Yes 55 Automatic Gratuity Notice _ Yes |29 Pjumbing installed and maintained Yes 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, [Yes 58 Smoke Free __ designed, installed 32 Restrooms with self-closing doors, fixtures operate ae " |property, facility clean, supplied with hendsoap, disposable Total Number of COS Violations: 8 ‘towels or hand drying devices, tissue, covered waste | Total Number of Repest Violations: 0 Violations marked with an asterisk are critical violations. Items marked YES are in compiiance. 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 STATE OF FLORIDA Page 3 of 8 DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION _ License Number DIVISION OF HOTELS AND RESTAURANTS SEAT — SEA1620450 Inspection Date FOOD SERVICE INSPECTION REPORT 9/2104 11:53:17 AM 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. Violation(s): 06-01 - Observed potentially hazardous food thawed in an improper manner. 06-01 - Observed potentially hazardous food thawed in an improper manner. REFERENCE TEXT: 3-501.13 FC : Thawing. Except as specified in Paragraph (D) of this section, POTENTIALLY HAZARDOUS FOOD shall be thawed: (A) Under refrigeration that maintains the FOOD temperature at ..{41 degrees Fahrenheit) or less, or at ...(45 degrees Fahrenheit) or less as specified under Paragraph 3-501.16(C} or, {B) Completely submerged under running water: (1) At a water temperature of ...(70 degrees Fahrenheitf) or below, (2) With sufficient water velocity to agitate and float off loose particles in an overflow, and (3) For a period of time that does not allow thawed portions of READY-TO-EAT FOOD to rise above ..{41 degrees Fahrenheit), or ..(45 degrees Fahrenheit) as specified under Paragraph 3-501.16(C), or (4) For a period of time that does not allow thawed portions of a raw animal FOOD requirir g cooking as specified under Paragraph 3-401.11(A) or (B) to be above ..{41 degrees Fahrenheit), or ...(45 degrees Fahrenheit) as specified under Paragraph 3-501.16(C}, for more than 4 hours including: (a) The time the FOOD is exposed to the running water and the time needed for preparation for cooking, or (b) The time it takes under retrigeration to lower the FOOD temperature to ...(41 degrees Fahrenheit), or ...(45 degrees Fahrenheit) as specified under Paragraph 3-501.16(C); (C) As part o! a cooking process if the FOOD that is frozen is: (1) Cooked as specified under Paragraph 3-401.11(A) or (3) of Section 3-401.12, or (2) Thawed in a microwave oven and immediately transferred to conventional cooking EQUIPMENT, with no interruption in the process; or (D) Using any procedure if a portion of frozen READY-TO-EAT FOOD is thawed and prepared for immediate service in response to an individual CONSUMER'S order. 22-02 - Observed buildup of soiled material on racks in the reach-in cooler. 23-01 - Observed build-up of grease on nonfood-contact surface.[hood} 32-02 - Observed lack of handwashing sign at a handsink used by food employees. 46-11 - Observed exit I'ghts not properly illuminated.rear. 51-05 - Observed no copy of latest inspection report. REFERENCE TEXT: 51-5 509,101(1) FS and 61C-1.002(8)(c) FAC : Any operator ot a pubic food service establishment shall maintais the latest food service inspection report or a duplicate copy on premises and shall make it available to the public upon request. The operator of each public food service establishment shal! maintain the latest inspection report on premises and shall make it available to any consumer who asks to see it. 53A-01 - Observed manager lacking proof of Food Manager Certification. REFERENCE TEXT: 509.039 FS and 61C-4.023(1) FAC : All managers employed by a food service establishment must have passec {the food service manager] test and received a certificate attesting thereto. Managers have a period of 90 days after employment to pass the required test. All managers who are responsible for the storage, preparation, dispiay, and serving of foods to the public shall have passed a certification test approved by the division demonstrating a basic knowledge of food protection practices as adopted in this chapter. Those managers who successfully pass an approved certification examination shall be issued a certificate by the certifying organization, which is valid for a perod of five years from the cate of issuance. 53B-01 - Observed no proof of required employee training. REFERENCE TEXT: 509.049 FS : Food service employee taining. The division shall adopt, by rule, minimum food safety protection standards for the training of all food service employees who are responsible for the storage, preparation, display, or serving of foods to the public in establishments regulated under this chapter. These standards shail not include an examination, but shall provide for a food safety training certificate program for food service employees to be administered by a private nonprofit provider chosen by the division. Any food safety training program established and administered to food handler employees prior to the effective date of this act shall be submitted by the operator to the division for its review and approval. It shall be the duty of the licensee of the public food service establishment to provide training in accordance with the described rule to all employees under the licensee's supervision or control. The licensee may designate a certified food service manager to perform this function as an agent of the licensee. Food service employees must receive certification pursuant to this section by January 1, 2001. Food service employees hired after November 1, 2000, must receive certification within 60 days after employment. Certification pursuant to this section shall — Ore... TMENT OF BUSINESS AND PRU, cSSIONAL REGULATION EXHIBIT Division of Hotels and Restaurants CONTROL NUMBER Fite Number Suf INSPECTOR B [wd¥ ~~ Peeuo asly Cited E Seqgacords TE [esBes} BAeoaeBals BABoasaa {ESE ZS) BB QBQGB3aana BBaggcen BS@Seonoa Baan O@B VI ton [TAMOLS 4 LEGAL NOTI ry FOOD SERVICE INSPECTION REPORT CS DE OSGOOD QR OWMER NAME © Catering ay aL fA HE a at L er OF VAs Ai | © venging z BUSINESS NAME ; / © MFDV oF (nian Lune t Yack | ome ‘ADDRESS : 25/3 MM Mpctdcres ALE | 9 eon ZIP (Optional) 8 rem pA eet ° SEW Baga eg QZsoeoan oO Gereral @® Seating No. iC / VBSenos o Bw fics) DB B® DW @ aw GB Be B/ eo) 8) eo9| see] @|/ Ooo Bes ee B ao BB Be @ a os fase] ica) ir3) BB Bs cr) BS Boe (cc) B OB Be e is) | GB GB BB @ H ® B BB BS NOTE::ITEMS IN-RED AND MARKED WITH 5 2 AN'ASTERISK:ARE OF CRITICAL-CONCERN AND MUST BE CORRECTED IMMEDIATELY. Type of Food INSPECTION REASON 1@ 30 40 5B Routine Complaint Information Epidemiological DISPOSITION 6 © Pending =A: TEM 403: FOOD TEMPERATURES #2020017 * Circled temperatures.are in violation fas) HACCP INSPECTION Temperature Failure to comply with this Notice may initiate an administrative complaint that may result in suspension or revocation of your license and fines. INSPECTION RESULTS 1 eo ANY VIOLATIONS noted herein must be corrected by the NEXT ROUTINE INSPECTION. 2 © WARNING: Violations in the operation of your establishment must be corrected by: Date:——- Time: 3 © ADMINISTRATIVE COMPLAINT recommended, sO Seasonal 6 (3 EMERGENCY ORDER recommended based upon a severe and immediate threat to the public. Certificate Date Food Manager Name As ITEMS ppm degrees F. ALTE ; See reverse side for explanation of citations. —_ ‘otal 0703 1459 23 s30341e “50-0 orb 3 08a] 15a 51 om 16 sO 4203 820 *930('08eL9 1709) «(2609 °35bL 4309 *53: CIRCLED ose Jioee , Sted TER "20: WAREWASHING SANITIZATION ‘o3b(9 0903 «18(9 “2703 43669 4403 53D Sanitizing Concentration 3e(3 1009 1909 2809 970 “480s 546 Sanitizing Temperature “3d *11C} ‘20a 29 389 4855 pat} 128) ‘2060 *3009 «3909 “4703589 COMMENTS oO12C3 2103 309 4003 ‘ae 5703 06M 130 2 RO i 58} SEE CoM] KILLA SIA ZZ ff ADDITIONAL GOMMENTS ON ATTACHED COMMENT SHEET REMINDER: Your license exptres © —~_ /_—" +. 1 acknowledge receipt of this inspection form and comments. Recipient's Name (PLEASE PRINT) Inspecigy AES gfe FT Recipient's Title Title S14 rm TSLEWO LOS MW Inspector s Signature — 7- OO 3 ‘7 lo te cand Time op? Office Te eZ i 9S6 a Vie OX EE Brent OF BUSINESS AND PROFESSIONAL REGULATION Division of Hotels and Restaurants Control! Number | ( . o / OTS LESO ~ — COMMENTS SHEET ]lU- 94 cz page of | 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 | OWEG [ BAL (ee FT LL PEI IAT SEQ (s (O 53h (Yost PALE fv “7 1s AME ACEA _ CZAL (ECC 3 toes tee 20 AT ST Aninen, [J Compa DBPR Form HR 5022-042 MyFlorida.com www.hospitalityeducation.com Revised 2001 July 27

Docket for Case No: 05-002079