Jul 3 2006 12:31 a7/Ga/ 2886 12:28 8584146749 DEPR OGA PAGE 83/14 STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION DIVISION OF HOTELS AND RESTAURANTS DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION Petitioner, Vs. License No. 6301123 WINTER HAVEN DAIRY QUEEN License Type 2010 Permanent Food Service espondent. Case No. 2005007905 / ADMINISTRATIVE COMPLAINT The DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION, DIVISION OF HOTELS AND RESTAURANTS, (‘Petitioner’), files this Administrative Complaint against WINTER HAVEN DAIRY QUEEN, ("Respondent”), and says: 1. Petitioner is the state agency charged with requlating the operation of public lodging establishments and public food service establishments, pursuant to Section 20.165 and Ghapter.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 1702 HAVENDALE BLVD, WINTER HAVEN, FLORIDA 338811224.The mailing address of record is WINTER HAVEN DAIRY QUEEN, at 1702 HAVENDALE BLVD, WINTER HAVEN, FLORIDA 338811224. 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 February 16, 2005 Joe Peréz, District Manager By delegation of the Director, or Division of Hotels & Restaurants Department of Business & Professional Regulation ignee COUNSEL FOR THE DEPARTMENT: Charles F. Tunnicliff, Lead Attorney Florida Bay No. 0753831 Department of Business & Professional Regulation 4940 North Monroe Street . ; Tallahassee, Florida 32399-1007 CERTIFICATE OF SERVICE 7 PS RECOR BY CERTIFIED U.S, MAIL, ARTICLE NUMBER: SENDERS : [HEREBY 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 Gase Number, 2005007905 Form revised 01/42/05 Ligensa Type: 2010 Permanent Food Service Distrlet Number: 03 License Number: 6301123 WINTER RAVEN DAIRY QUEEN a7/Ga/ 2886 12:28 8584146749 DEPR OGA Jul 3 2006 12:32 PAGE 44/18 License Number: 6304723 Licanse Type: 2010 PERMANENT FOOD SERVICE Case Number 2005007905 . . 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 64C, Florida Administrative Code. "NFPA’ as cited herein references specific provisions of the National Fire Protection Association Life Safety Cade, incorporated by reference at Chapter 44-3, "Fire Prevention, General Provisions", Florida Administrative Code, and 61C-1,004(5), Florida Administrative Code, Itis alleged that on January 11, 2005 and January 26, 2005 the licensee was in violation of Florida Statute 509(FS) and/or the Rules of the Division of Hotels and Restaurants, Florida Administrative Gode (FAC), in the following particulars. Copy(s) of the repart(s) for the above referenced inspection(s) are attached hereto and incorporated by reference as Exhibit B. 1,29-16 5-303.13FC ATLEAST 7 SERVICE SINK OR 1 CURBED CLEANING FACILITY EQUIPPED WITH A FLOOR DRAIN SHALL BE PROVIDED AND CONVENIENTLY LOCATED FOR THE CLEANING OF MOPS OR SIMILAR WET FLOOR CLEANING TOOLS AND FOR THE DISPOSAL OF MOP WATER AND SIMILAR LIQUID WASTE. NO MOP SINK INSTALLED AT THE ESTABLISHMENT. * denotes critical viclation Exhibit A Case Number: 2005007905 Pade 1 License Type: 2010 PERMANENT FOOD SERVICE Licensé Number, 6307123 Jul a7/Ga/ 2886 12:28 8584146749 DEPR OGA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION 4 Division of Hotels and Restaurants CONTROL NUMBER INSPECTOR Lic eon a nwa 3 2006 12:32 PAGE 45/148 CQth Lick LEGAL NOTICE FOOD SERVICE INSPECTION REPOR | sal Connry File Number Suk G3 ee LoS [ae “x 4 OWNER NAME ( Catering RAs) Bo 4 pentdh ge ek Pid ote, ate. 2 Vending = BASaaesat 22 RUSIVESS NAME 3 MFDV ea B ane Bay J 7 g) . f . Thema Park = @ : i o aa @a@ ADDRESS ct tee Haven ens a " me = Sole aeee res /Po2 L113 En HA Fe bak” £9 Temporary aqeeneal | e® | fax oe Waimea soc ma * co) c8 8 Oe oo oe a Manis eee No. of Seats OB eae Be [2 General iit Seating ae | Cengage ae Yt coal Se a EP aT MZ I Vo. 20 Failure to comply with this Netice may Initiate an 1 Rautine administrative complaint that may result In ei oel| el ogoe | moe 3 Complaint suspension.or revocation of your license and fines. @l oma | @] oe irr] 4 (3 Information INSPECTION RESULTS Bi seh | a] sa am 8 £9 Epidemiological . 4 ANYVIGLATIONS noted harein must be eslanplelas ae corrected by tha NEXT ROUTINE INSPECTION. aw} wel @ a ag Pending 2 (9 WARNING: ; ala|/ oe (ae cstablohment mist be aang by: Gp... OB. a ne Nene Tine: @ fa] De a HACCP INSPECTION 3 AOMINISTRATIVE COMPLAINT recommended. B @ i bei] ee 5 Seasonal ist} & i fe 6& EMERGENCY ORDER racormmended - bebed upon a eevere and Immediate VIOLATIONS. |_._.iroat.te.the phe —_—____ PEWS TH RED ANG. MARK STERISK/ARE OF CHITICAL CON Food Manapar Name Certificate Data DMUST BE CORRECTED IMIMEDIATELY. ain Peeapematire See reverse side for explanation af citations, ‘wag Ore) 14 23 safe 0d “mbt 18 ME seb oze oan 3 180 25e)¢ase 4269 820 : z rac «17 28 *: 489-5380 —_ IN VIOLATION 0Gn (] "08 267) “365 (9) 538 TER 203 SABE WABI x 8 et 2 36 aap , a a aE aie S cai Sanitizing Gongentration Pp ates! Patel) 10 rT 4 7 4 eo NO aR 97L] 6 CT | conttizing Temperature degrees “gd (CD a1fpsape 28) 38h ae S500 . “oa{T) t2aC zone 300 «28 *a7E S6E COMMENTS 4 Le —_— a | ooh at sO 40m ae or ee eo It ao eo Pe 5a oe - get A poten Me _| l acknowledge recelpt af this inspection form and comments. ADDITIONAL COMMENTS ON ATTACHED COMMENT SHEET : Y REMINDER: Your ticense expires a7 27.0 OV Recipient's ane EASE \en \ as \ Recipient's ~ y Tite VA ape eh Recipient's Signanure Pomgpectar's Name (PLEASE P PP Ga fe Sezes ay (2 Ba \ ee nes ee ee — “ Ot Ze , ee Enablighnenr Telephane - = Bute and Time 2 Telgpione lg VE ee a 4 fen aN Fd Pe fhe > mn Me tT Jul 3 2006 12:32 a7/a3/2886 12:28 ssadiderdg DEPR OGA PAGE 6/16 State of Florida Control Numberesy Department of Business and Professional Regulation . = Division of Hotels and: Restaurants Gb- OL 6 BS & w www. hospitalityeducation.org . ; Page _<* of ( ims HR &022-005, 5022 Food Service, or HACCP Inspeciion; Call BaclReinspection Report, or HACCP Plan Verification. St) wlena fe fit hae basa ts pers d Liste de unde Gaz: 2 ed Aa a Acton) Es Beat at PBPR Form HR s022.042 MyFlocida.cont 2001 November 01 a7/Ga/ 2886 12:28 DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION Division of Hotels and Restaurants CONTROL NUMBER INSPECTOR 8584146749 Jul DBPR OGA 3 2006 12:33 PAGE @7/1a EXHIBIT B LEGAL NOTICE FOOD SERVICE INSPECTION REPOR + INSPECTION REASON File Number Sup. / One Ohehma B isa td O71, ed ll flue OWNER NAME C3 Catering 3 auaeeode! aa Mesh 2 Vending 7 noamoaDpecne os ee 3 Mov 0. moh we mm D Q Theme Park , ot kel Auer Atte Food Cart ti ELLER SPR S PRES] Ba ae nw a aBaneqg me ag 2 Temporary i eajoaman | me | bile Abe no aS BQUsoaan Ba a L S3RR/ ‘S aanan) | oo ce tb RBOmag eo (3 Ganeral & Seating 2 oy eBogg Rn = | al _ = — = mm = — _ _ = = = A , Year |[h oO - ; a not . iva sd Failure to camply with this Notice may Initlate an wee fia | Ll +B Routine administrative complaint that may result In f your Iieense and fines, mi aS l|om) @]/ oes | oem 8 Cl Complaint saenebeiese mm |G | ee | 8] oe @ 4 (2 Information . . a] Ba) ®]| aoe | aan 8 G2 Epidemiplogical 1 C2 ANY ViGL AONE hated Retain imust be : . ey ¥ : corraciad by'ths NEXT ROUTINE INSPECTION. wm Qa @ ap @ aa DISPOSITION Te Tex ; ; , “if fee mm | @ | @ | wae 3 ae 6 © Pending 2 want eS, =, Violation In tha operation af your m/ & a a 2 eetablichyagt shust ba coneeeeh a we | G2 i] 5c ne oc a |————bares Sihe Time: Lh men | Gel (ka) Qe B® oO HACCP INSPECTION 3 ADMINISTRATIVE COMPLAINT recomended. _ i] Be ed} ws | Gol a aa Go Ge § (3 Seasonal mn) bel) BR - wm | 6 EMERGENCY ORDER recommandad : based upon @ severe end immediate = tt kh Hl = ™ OP MUST-BE: CORRES! ; ‘heen wm See revirsd side for explanation of eitanans, Ev me ore ae Oo OD ¥O mm IB) osag 1s a) eC 61 eo —_ onge oon] 1604 seesaw ose CIRCLED ITEMS ARE IN VIOLATION mm O82n ose 7 eC asb am aaa ™ " im) fF 550) me AS Be as Sanitizing Concentration Zz: ppm £ - We OB WO ee ar ee AE Sanitizing Temperatura degrees F, ow wood (Tiana ete eC 88 ‘er spat] an} 20b¢) *20m@® 3s] “a7 s8lt COMMENTS —= ogee al sil 40h ‘ata os7fa = “Oo wu 2M ae li Lia] = : ADDITIONAL COMMENTS ON ATTACHED COMMENT SHEET = l acknowledge receipt of this inspection form and cominents. REMINDER: Your lfrenge expires —< L Lal Recipignts Nante (PLEASE PRINT) . - eS ee - a 's Tite -= ee, Reviny sii ~ ™ V2 ee Cd Egmiilisionens Telephone Bare tnd Tine tae 7" /. ee: a er Se tt bee Jul 3 2006 12:33 DEPR OGA 87/63/2666 12:28 8584146749 a oo Eng Be Chee Ce Be Wd ge Han I Control Numba PAGE 88/18 ™, State of Florida + Departmentof Business and Proféssional Regulation 4 (ob - a2 “op Division of Hotels and Restaurants www. hospitalityeducation.org Page. a of > > Be UL ah Wea) Kasur _brdbafurs chvaray ee Bea a esha hows nef bE c lesire v0 A Deal shess hue! Lowe dh riaal bin cole Aad! hea | —_va ud ie fe 500 pe cmbadirse pel taaer, snide Steck an os £ Cf Biche bar Bs [i $A ot- _ At hn 2Ade c be Ce An Jresrid Lt oa f6C A Cuistel Bas Ad Aas eal C3 ned. fp prom kl fabs al | C3 Lif! #2 LOC mighine 6,5 \ Cchene h, Chak! Berg Ach! on fee thee! pg Lette Yi _F K le. fed pln s beter wa o_O. aE PA A! shel) a bL) Cm fect the deh hen. A aad be beth Ab pal Like wrtelecd” | | (2) Sten wed? 4 sponse dent, chnal! ix adieg”’ handle hucheng ta ; (yi? MyFlorida.com RK 2001 Novernber Ot Lid DBPR Form HR 6022-042 Jul 3 2006 12:34 DEPR OGA PAGE 89/18 Spl JS? Db & pf! Cadntrol Number his ?/@a/2686 12:28 8584146749 State of Florida Departnent of Business and Proféssional Regulation Division of Hotels and Restaurants ar - www. hospitalityeducation. org. Page 2 of ss Oty l Kec a “ j moe Mi mm Es 22-082, or 1 5022 083. For comments to the e Lodging, pection Report, or HACCP Plan Verification. yi 2) bed a pron Ares washed a9 “ets Le Ace b16 25) Sin che use fehe of 1 bons chutad hectic gut fn whe shel 4 32) Oukwh restroom bas Meret KP thors Cots he Z eo url yo f bs Lodbeabedeey tet, § Be aar £3 0 lanne Was Sn (B: Jin teae. srvke irs halle ed rhrbl hovese fmf ~ yes, —despase ge liege tebe Chbdide oD oe a Cate (tele t > 7 a a bho oerg of. ercbudee. glad cle Shoat fs a fe & Lien Dhecae: _ Abe PA ik Lt __ dlbye- DBPR Fortn HR 5022-042 i Zz a MyFlorida.com R iz 2001 Nevembar 04

Docket for Case No: 06-002340