STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION : DIVISION OF HOTELS AND RESTAURANTS on dus 9 gx aii DEPARTMENT OF BUSINESS AND aoe f : PROFESSIONAL REGULATION a Petitioner, vs. KATHERINE INEZ POPE License Number 9900000 REAL DEAL GRILLE License Type 2051 Non-Licensed Food Service Respondent. Case Number 2005004815 / (i a4] The DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION, DIVISION OF HOTELS AND RESTAURANTS, (‘Petitioner’), files this Administrative Complaint against REAL DEAL GRILLE, (‘Respondent’), and says: ADMINISTRATIVE COMPLAINT 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 an establishment subject to the jurisdiction of the Division of Hotels and Restaurants. The respondent's business address of record is 75012 JOHNSON LAKE RD, YULEE, FLORIDA 32097.The mailing address of record is REAL DEAL GRILLE at 75012 JOHNSON LAKE ROAD, YULEE, FLORIDA 32097. 3. Based on observation of Respondent's establishment activities and a thorough search of the Division’s licensure records, Respondent was determined to be operating without statutorily required licensure, in violation of the provisions of Chapter 509, Florida Statutes, as described in Exhibit “A" of this Complaint. Respondent was therefore issued an Administrative Determination of Non-licensure on December 17, 2004, attached hereto as Exhibit “B", documenting the activities requiring licensure and directing Respondent to apply for or renew the required license. Respondent thereafter failed to obtain licensure and was issued an Order of Closure on December 17, 2004, pursuant to Section 509.261(3), Florida Statutes, and attached hereto as Exhibit “C”. 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 January 31, 2005 Steve Blt ise— Manager By delegation of the Director, or designee Division of Hotels & Restaurants Department of Business & Professional Regulation Case Number: 2005004815 Form revised 01/12/05 License Type: 2051 Non-Licensed Food Service District Number: 05 License Number: 9900000 REAL DEAL GRILLE 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 8327 THEREBY CERTIFY that a true and correct copy of the foregoing ADMINISTRATIVE COMPLAINT has been hand served by me on this___ day of , 2005. Received by: Inspector's Signature Operator's Signature Title Title Case Number: 2005004815 Form revised 01/12/05 License Type: 2051 Non-Licensed Food Service District Number: 05 License Number: 9900000 REAL DEAL GRILLE EXHIBIT A 1, Based on the foregoing, Respondent violated the following provisions of Chapter 509, Florida Statutes, or the rules promulgated thereto: 509.241(1) FS 509.241(2) FS Case Number: 2005004815 LICENSES; ANNUAL RENEWALS. - Each public lodging establishment and public food service establishment shall obtain a license from the division. Such license may not be transferred from one place or individual to another . . . Licenses shall be renewed annually, . .. APPLICATION FOR LICENSE. — Each person who plans to open a public lodging establishment or a public food service establishment shall apply for and receive a license from the division prior to the commencement of operation. Form revised 01/12/05 License Type: 2051 Non-Licensed Food Service District Number: 05 License Number: 9900000 REAL DEAL GRILLE License Number: NO LIC License Type: 2051 NON-LICENSED FOOD SERVICE Case Number: 2005004815 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 December 17, 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. * 1.03B-04 3-501.16(A) FC EXCEPT DURING PREPARATION, COOKING, OR COOLING, OR WHEN TIME IS USED AS THE PUBLIC HEALTH CONTROL AS SPECIFIED UNDER SECTION 3-501.19, POTENTIALLY HAZARDOUS FOOD SHALL BE MAINTAINED: (A) AT ...(140 DEGREES FAHRENHEIT) OR ABOVE, EXCEPT THAT ROASTS COOKED TO A TEMPERATURE AND FOR A TIME SPECIFIED IN SECTION 3-401.11(B) OR REHEATED AS SPECIFIED IN SECTION 3-403.11 (E) MAY BE HELD ATA TEMPERATURE OF ...(130 DEGREES FAHRENHEIT); OBSERVED RIBS AT 109°F AND CHICKEN AT 97°F. * 2.04-01 4-301.11FC = COOLING, HEATING, AND HOLDING CAPACITIES. EQUIPMENT FOR COOLING AND HEATING FOOD, AND HOLDING COLD AND HOT FOOD, SHALL BE SUFFICIENT IN NUMBER AND CAPACITY TO PROVIDE FOOD TEMPERATURES AS SPECIFIED UNDER CHAPTER 3. OBSERVED HOT BOX ATTACHED TO GRILL UNABLE TO KEEP HOT FOODS AT 140°F OR HIGHER. * 3.50-01 509.241(2) FS APPLICATION FOR LICENSE.--EACH PERSON WHO PLANS TO OPEN A PUBLIC FOOD SERVICE ESTABLISHMENT SHALL APPLY FOR AND RECEIVE A LICENSE FROM THE DIVISION PRIOR TO THE COMMENCEMENT OF OPERATION. OBSERVED NO CURRENT LICENSE FROM THE DIVISION OF HOTELS AND RESTAURANTS, STATE OF FLORIDA, DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION * denotes critical violation Exhibit A Case Number: 2005004815 Page 1 License Type: 2051 NON-LICENSED FOOD SERVICE License Number: NO LIC EXHIBIT B LEGAL NOTICE a Belt p) FOOD SERVICE INSPECTION REPOR? roe ¢ DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION Division of Hotels and Restaurants INSPECTOR —_ File Nurber | Sup OST OB @ Baa at Me dents Lo PRD 6: _ CAL Cone OWNER NAME So AYG Seater | ; Zl mm; COUCGTORS! aa bg Herp. Ze _& Vending ms OBGSea0g»gnwl aa ‘BUSINESS NAME -- | 8 Maro! 7 ip = OVVVeaG aa / J Ch 3 Thema Park f: (2A SA Le. 7 Food Dart =| O@9S0CR0) | 2 | Ges Leal” m/ OFOFS3BB ao zj C3 Temporary AS G6/2 P Toh ankiw A, Ao m| OOSooanna [x3 Ha3) Zz Le _| oO Tomp. Assoc. BWsanag BB - 205 2 | —_ BVoanaaa BB No. of Seats - Banna Ba = = INSPECTION REASON Failure to comply with this Notice may initlate an administrative complaint that may result in 1 6] Routine suspension or revoc: f fT fines. 3 © Complaint Sp ocation of your license and fines. INSPECTION RESULTS ANY VIOLATIONS noted herein must be corrected by tha NEXT ROUTINE INSPECTION, 40 Information 5 © Epidemiolagical DISPOSITION WARNING: Violations In the operation of your establishment must be corrected by: Dote:———_—_—_____ Time: ADMINISTRATIVE COMPLAINT recommended. a Seasonal Pending EMERGENCY ORDER recommended based upon_a severe and immediate threat to the pubilc, ITEM *03: FOOD TEMPERATURES Circled temperatures are in violation NOTE: ITEMS IN RED AND MARKED WITH AN ASTERISK ARE OF CRITICAL CONCERN AND MUST BE CORRECTED IMMEDIATELY. ITEM ‘53a: CERTIFIED. FOOD MANAGER Food Manager Name Certificate Date ~ ARE IN VIOLATION ITER See reverse side for explanation Of citations, Lo AS. “01 079 AO 3 34 “soy LOZ L. ‘O1bE3 “08a y BO 4D 441 5163 Li ora 160 Oa 42 5203 ‘ose Bose 179 26309 aC spy om 0 2 27 4G MO ‘sang 3eL 1009 1909 el} 3769 eo | “03d 1103 200 28 38 8G 046) 1203 2009 300 9D “7 56 058 1259 2B 13 0 8 870 6D 3D 2 2O nt: 5809 EM "45: SION SYSTEMS ig SUPPRES: Sanitizing Concentration Sanitizing Temperature ! acknowledge receipt of this inspection form and comments. —— Kot a Se ( Crk |B Establishment Telephone Date and Time @ R2A_MP Tt Bai ts l/An, Inspector's Name (PLEASE PRINT) x BELL xg LL Office Telephone ate Inspector's Signature Recipient's Signature LALHDIT be State of Florida .. Control Number Department of Business and Proféssional Regulation = a E a “ Division of Hotels and Restaurants foc ote - www.hospitalityeducation.org y J) sy Bo 2 Ar 7 I: 7 COMMENTS SHEET | Page 2 of 2 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. Sil re Fine @ tho a Ale Lan he baya Lze0 on, Ln Le SY AO Larcet LZ Sewses wh Lahice tb hago endl LZ 2S. féa/ UStiy Sfeente Li Let bee he Boer ot wl boa lhe Zberxt Bul at _fauge: teaze St £43 -_ LtAecrey o Ce Aiba ta welt. (229 uu) tel (CBD _ Crees Lens IP* sh IF Athe£ A Lari hoes hoe Lefodyes how fred dhs _ fee ARLE Ait hls boat LS Le, G ‘A-Sf “7, } : LY Sts DBPR Form HR 5022-042 MyFlorida.com G4 2001 November 01

Docket for Case No: 05-002847