Sep 30 2009 13:15 9/29/2689 87:56 8584146749 DEPR OGA PAGE 83/87 STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION DIVISION OF HOTELS AND RESTAURANTS DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION Petitioner, VS License No 1617381 JASMINE THAI RESTAURANT License Type 2010 esponden Case No 2009015484 / ADMINISTRATIVE COMPLAINT The DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION, DIVISION OF HOTELS AND RESTAURANTS, (Petitioner), files this Adrmnistrative Camplaint against JASMINE THA RESTAURANT, ("Respondent’), and says 1 Petitoner ts the state agency charged with reguiating the operation of public ladging establishments and public food service establishments, pursuant to Section 20 165 and Chapter 509, Florda Statutes 2 Respondent ts, and has been at all times material hereta, licensed by or subject to the jurisdiction of the Division of Hotels and Restaurants The respondent's business address of record is $103 COCONUT CK PKWY, COCONUT CREEK, FLORIDA 330633944 The maiing address of record is JASMINE THAI RESTAURANT, at 5103 COCONUT CK PKWY, COCONUT GREEK, FLORIDA 330633944 3 Inspection of this establishment conducted pursuant ta Sec 509 032, Flonda Statutes, revealed violations of the provisions of Chapter 509, Florida Statutes, and / or the rules promulgated thereto governing operation of the establishment The viclation(s) found and applicable law are described m Exhtbit "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 pragram sponsored by the Department's Hospitality Education Program, suspensian, revocation, or refusal of a license issued pursuant to this Chapter, and/or any other relief authorized by Chapter 509, Florida Statutes, of the rujes pranfulgated thereta Signed March 25, 2009 Ken Buck, District Manager By delegation of the Director, or designee Dwision of Hotels & Restaurants Department of Business & Professional Regulation COUNSEL FOR THE DEPARTMENT Charles F Tunnichff, Lead Attorney Flonda Bar No 0153834 Department of Business & Professional Regulation 1940 North Manroe Street Tallahassee, Florida 32399-1007 CERTIFICATE OF SERVICE BY CERTIFIED U.S. MAIL, ARTICLE NUMBER: [HEREBY CERTIFY that 4 true and correct copy of the foregoing ADMINISTRATIVE COMPLAINT has been hand served by me on this day af , 2009 Received by Inspector's Signature Operator's Signature Title Title Case Number 2009915484 = File Nurnber 104750 District Number O2 License Number 1817381 2040 Farm revised O7 07 07 JASMINE THAl RESTAURANT Sep 30 2009 13:15 aq/29/2889 87:56 8584146749 DEPR OGA PAGE @4/a7 Exhibit 4 License Number 1617381 License Type 2010 PERMANENT FOOD SERVICE Case Number 2009015484 "FC" as cited herein references specific provisions of the Food Code, Recommendations of the United States Public Health Service, Faad and Drug Administration, incorporated by Chapter 61C, Flonda Administrative Code "NFPA" as cited herein references specific provisions of the National Fire Protection Association Life Safety Code, incorporated by reference at Chapter 44-3, “Fire Prevention, General Provisions", Fiorida Administrative Cade, and 61C-1 004{5), Flonda Administrative Code "denotes 4 ortical wolahan It 3 alleged that on September 29, 2008, March 5, 2008 the licensee was in vialation of Florida Stalute 509(FS) and/or the Rules of the Division of Hotels and Restaurants, Florida Administrative Gade (FAC), tn the following particulars Copy(s) of the report(s} for the above referenced inspection(s) are attached hereto and meorporated by reference as Exhibit B * 1 OBA-24-1 9-302 T1(A)(2)FC. (A) FOOD SHALL BE PROTECTED FROM CROSS CONTAMINATION (2) EXCEPT WHEN COMBINED AS INGREDIENTS, SEPARATING TYPES OF RAW ANIMAL FOODS FROM EACH OTHER SUCH AS BEEF, FISH, LAMB, PORK, AND POULTRY DURING STORAGE, PREPARATION, HOLDING, AND QISPLAY BY (A) USING SEPARATE EQUIPMENT FOR EACH TYPE, OR (B) ARRANGING EACH TYPE OF FOOD IN EQUIPMENT 30 THAT CROSS CONTAMINATION OF ONE TYPE WITH ANOTHER IS PREVENTED, AND (C) PREPARING EACH TYPE OF FOOD AT DIFFERENT TIMES OR IN SEPARATE AREAS, OBSERVED RAW ANIMAL FOOD NOT PROPERLY SEPARATED FROM EACH OTHER IN THE HOLDING UNIT DURING PREPARATION...RAW CHICKEN ABOVE RAW SHRIMP IN THE REAGH-IN FREEZER. 2 13-03-1 2-40211FC EFFECTIVENESS (A) EXCEPT AS PROVIDED IN PARAGRAPH (B) OF THIS SECTION, FOOD EMPLOYEES! SHALL WEAR HAIR RESTRAINTS SUCH AS HATS, HAIR COVERINGS OR NETS, BEARD RESTRAINTS, AND CLOTHING THAT COVERS BODY HAIR, THAT ARE DESIGNED AND WORN TO EFFECTIVELY KEEP THEIR HAIR FROM CONTACTING EXPOSED FOOD, CLEAN EQUIPMENT, UTENSILS, AND LINENS, AND UNWRAPPED SINGLE- SERVICE AND SINGLE-USE ARTICLES (B) THIS SECTION DOES NOT APPLY TO FOOD EMPLOYEES' SUCH AS COUNTER STAFF WHO ONLY SERVE BEVERAGES AND WRAPPED OR PACKAGED FOODS, HOSTESSES, AND WAIT STAFE IF THEY PRESENT A MINIMAL RISK OF CONTAMINATING EXPOSED FOOD, CLEAN EQUIPMENT, UTENSILS, AND LINENS, AND UNWRAPPED SINGLE-SERVICE AND SINGLE-USE ARTICLES OBSERVED EMPLOYEE WITH NO HAIR RESTRAINT. * 3 22-22-1 4-601 11(A) FC EQUIPMENT FOOD-CONTACT SURFACES AND UTENSILS SHALL BE CLEAN TO SIGHT AND TOUCH OBSERVED ENCRUSTED MATERIAL ON THE CAN OPENER. * 4 82-01-1 509282(1)FS (1) AN OPERATOR MAY NOT KNOWINGLY AND WILLFULLY MISREPRESENT THE IDENTITY OF ANY FOOD OR FOOD PRODUCT TO ANY OF THE PATRONS OF SUCH ESTABLISHMENT THE IDENTITY OF FOOD OR A FOOD PRODUCT !S MISREPRESENTED IF (A) THE DESCRIPTION OF THE FOOD OR FOOD PRODUCT |S FALSE OR MISLEADING IN ANY PARTICULAR, (B) THE FOOD OR FOOD PRODUCT IS SERVED, SOLD, OR DISTRIBUTED UNDER THE NAME OF ANOTHER FOOD OR FOOD PRODUCT; OR (C) THE FOOD OR FOOD PRODUCT PURPORTS TO BE OR |S REPRESENTED AS 4 FOOD OR FOOD PRODUCT THAT DOES NOT CONFORM TO A DEFINITION OF IDENTITY AND STANDARD OF QUALITY IF SUCH DEFINITION OF IDENTITY AND STANDARD OF QUALITY HAS BEEN ESTABLISHED BY CUSTOM AND USAGE. A. OBSERVED THE IDENTITY OF FOOD OR FOOD PRODUCT MISREPRESENTED...IMITATION CRAB MEAT MISREPRESENTED ON THE MENU. Casa Number 2009015484 File Number 104750 Oatriat Number O2 License Number 1617381 2010 Form revised 07 O7 07 JASMINE THA RESTAURANT Sep 30 2009 13:16 9/29/2689 87:56 8584146749 DEPR OGA PAGE 85/87 B. OBSERVED THE IDENTITY OF FOOD OR FOOD PRODUCT MISREPRESENTED...ESCOLAR MISREPRESENTED AS WHITE TUNA ON THE MENU. Gase Number 2009015484 File Number 104750 Disinet Number 02 Ligense Number 1617381 2010 For revised OF D7 07 JASMINE THAL RESTAURANT Sep 30 2009 13:16 aq/29/2889 87:56 8584146749 DEPR OGA PAGE 86/a7 PUbO 3903 aus 4719 35B4 TO: JASMINE THAI CHINESE REST ING JASMINE THA! RESTAURANT. 5103 COCONUT CK PKWY COCONUT CREEK, FLORIDA 330633944 SENDER: hep: of Business & Prof Regulation Division of Hotels & Restaurants - REFERENCE: License No 1617381 License Type 2010 1 Form 9800, tewery nos 288 No. 2009018484 RETURN | Postage 1 meet Toone : SERVICE Certified Fea _ : Feturo Recept Foe Aeatricied Delvary Total Postage & Fags US Postal Service POSTMARK OR DATE Receipt for a Certified Mail siae/ 7 He treurancs Goverge Prevdid {Dy Net kiss for International Mart 2 Arvele Number TIM PU60 3901 3845 47,39 3584 Rte D tedglary adreat differant framifiem 1? HYVES, enter gebvery actress, a 3 Senice Type GEATIFIED MALL, 4 Restricted Detvery? (Extra Fee) ! 0) Arhele Addreased io tal ors JASMINE THA! GHINESE REST INC °° ro JASMINE THA RESTAURANT = 6103 COGONUT CK PKWY COCONUT CREEK, FLORIDA 330633944 Lic Ne 1917361 2010 Case No 2009015454 eo —_———__—_. PS Form 3811, January 2005 Domashe Raturn Recap! : Case Nutrber 2009015484 File Number 104750 License Number 1617381 2010 peainet Number 02 JASMINE THAI RESTAURANT Porm reveed 97 67 07

Docket for Case No: 09-005334