State of Florida Department of Business and Professional Regulation Division of Hotels and Restaurants DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION Petitioner, vs. License Number 5202430 ORANGE SPRINGS RESTAURANT & GRILL License Type 2010 Respondent. Case Number 2012035699 Administrative Complaint The DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION, DIVISION OF HOTELS AND RESTAURANTS, (“Petitioner”), files this Administrative Complaint against ORANGE SPRINGS RESTAURANT & GRILL, (“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 12991 NE 245 ST ROAD, ORANGE SPRINGS, FLORIDA 32182.The mailing address of record is ORANGE SPRINGS RESTAURANT & GRILL, at 1443 SE 5 AVE, MELROSE, FLORIDA 32666. 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 is 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, 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 August 20, 2012 Michelle Hayngs, District Manager By delegatiow_of the Director, or designee Division of Hotels & Restaurants Department of Business & Professional Regulation COUNSEL FOR THE DEPARTMENT: Marc Drexler, Lead Attorney Florida Bar No. 0487058 Department of Business & Professional Regulation 1940 North Monroe Street Tallahassee, Florida 32399-2202 Certificate of Service BY CERTIFIED U.S. MAIL, ARTICLE NUMBER: 7196 9008 9111 5024 8351 | HEREBY CERTIFY that a true and correct copy of the foregoing ADMINISTRATIVE COMPLAINT has been hand served by me on this day of +2012, : Received by: Inspector's Signature Operator's Signature Title Title Case Number: 2012035699 File Number: 235095 District Number: 05 License Number: 5202430 2010 Form revised 09.10.14 ORANGE SPRINGS RESTAURANT & GRILL Filed November 15, 2012 4:58 PM Division of Administrative Hearings Exhibit A License Number: 5202430 License Type: 2010 PERMANENT FOOD SERVICE Case Number: 2012035699 FC as cited herein references specific provisions of the 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. * denotes a critical violation. [tis alleged that on May 24, 2012, May 25, 2012 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. * 41,28-16-1 61C-1,004(1)(D) FAC:: (1)(D) SEWAGE SHALL BE DISPOSED OF IN A PUBLIC SEWERAGE SYSTEM OR OTHER APPROVED SEWERAGE SYSTEM IN ACCORDANCE WITH THE PROVISIONS OF CHAPTER 64E-6 OR 62-601, FAC, HEREIN ADOPTED BY REFERENCE, WHICHEVER IS APPLICABLE, . OBSERVED SEWAGE ON GROUND FROM FAILED SEPTIC SYSTEM. CLEANOUT LINE CAP REMOVED TO PREVENT BACKUP INTO RESTAURANT. UPON RETURNING TO KITCHEN, INSPECTOR WITNESSED A LARGE AMOUNT OF SEWAGE BACKUP COMING FROM FLOOR DRAIN ON COOKLINE. * 2,35A-04-1 6-501,.111 FC:; CONTROLLING PESTS, THE PRESENCE OF INSECTS, RODENTS, AND OTHER PESTS SHALL BE CONTROLLED TO MINIMIZE THEIR PRESENCE ON THE PREMISES BY: (A) ROUTINELY INSPECTING INCOMING SHIPMENTS OF FOOD AND SUPPLIES; (B) ROUTINELY INSPECTING THE PREMISES FOR EVIDENCE OF PESTS; (C) USING METHODS, IF PESTS ARE FOUND, SUGH AS TRAPPING DEVICES OR OTHER MEANS OF PEST CONTROL AS SPECIFIED UNDER SECTIONS 7-202.12, 7-206.12, AND 7-206.13; AND (D) ELIMINATING HARBORAGE CONDITIONS. OBSERVED RODENT ACTIVITY AS EVIDENCED BY RODENT DROPPINGS FOUND. 50-100 FRESH RODENT DROPPINGS ON SHELVES IN DRY STORAGE ROOM, INCLUDING ON FOOD PACKAGES. * denotes critical violation District: 05 Case Number: 2012035699 License Type: 2010 License Number: 5202430 : File Number: 235095 ORANGE SPRINGS RESTAURANT & GRILL

Docket for Case No: 12-003757