State of Florida Department of Business and Professional Regulation Division of Hotels and Restaurants DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION Petitioner, vs. License Number 6211428 CLEAR SKYZ one q License Type 2010 espondent. Case Number 2013029013 i Administrative Complaint The DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION, DIVISION OF HOTELS AND RESTAURANTS, (“Petitioner”), files this Administrative Complaint against CLEAR SKYZ CAFE, (“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, ticensed by or subject fo the jurisdiction of the Division of Hotels and Restaurants. The respondent's business address of record is 490 MANDALAY AVE, CLEARWATER BEACH, FLORIDA 33767.The mailing address of record is CLEAR SKYZ CAFE, at 419 E SHORE DR, CLEARWATER BEACH, FLORIDA 33767. 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 foliowing 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 ather relief authorized by Chapter 509, Florida Statutes, or the rules promulgated thereto. Signed July 17, 2013 wet Joe Perez, District Manager By delegation of the Director, or designee Division of Hotels & Restaurants Department of Business & Professional Regulation COUNSEL FOR THE DEPARTMENT: Marc Drexier, Lead Attorney Florida Bar No. 0487058 Department of Business & Professional Regulation 4940 North Monroe Street Tallahassee, Florida 32399-2202 a44b 3008 Ill 5023 3 Wab Sener a Certificate of Service nS - BY CERTIFIED U.S. MAIL, ARTICLE NUMBER: | HEREBY CERTIFY that a true and correct copy of the foregoing ADMINISTRATIVE COMPLAINT has been hand served by me on this. day of , 2013. Recelved by: Inspector's Signature 7 Operator's Signature Title Title Case Number: 2013028013 File Number: 216404 District Number: 03 License Number; 6211428 2010 Form revised 01.01.13 CLEAR SKYZ CAFE Exhibit A License Number: 6211428 License Type: 2010 PERMANENT FOOD SERVICE Case Number: 2013029013 Itis alleged that on January 22, 2013, June 20, 2013 Respondent was in violation of Florida Statute 509 (FS); the Rules of the Division of Hotels and Restaurants, Florida Administrative Code (FAC); and/or specific provisions of the Food Code, Recommendations of the United States Public Heatth Service, Food and Drug Administration, as incorporated by Chapter 61C, FAC in the following particulars. Copy(s) of the report(s) for the above referenced inspectian(s) are attached hereto and incorporated by reference as Exhibit B. ** denotes a high priority violation. * denotes an intermediate priority violation. * 4.22-44-4 4-501.114(A) FC High Priority: A chemical sanitizer used in a sanitizing solution for a manual or mechanical operation at contact times specified under Paragraph 4-703.11(C) shall meet the criteria specified under Section 7-204.41 Sanitizers, Criteria, shall be used in accordance with the EPA-registered label use instructions, and shall be used as follows: (A) A chlorine solution shall have a minimum temperature based on the concentration and pH of the solution as listed in the following chart [summarized as follows: Minimum concentration 25 mg/L at 120 degrees Fahrenheit water temperature, pH 10 or less; 50 mg/L at 100 degrees Fahrenheit water temperature (pH 10 or less) or 75 degrees Fahrenheit (pH 8 or less); 100 mg/L at 55 degrees Fahrenheit water temperature, pH 10 or less.] Dishmachine chlorine sanitizer not at proper minimum strength; 0 ppm chlorine observed. District Number: 03 Case Number: 2013029013 File Number: 216404 Form revised 01.01.13 License Number: 6211428 2010 CLEAR SKYZ CAFE

Docket for Case No: 13-003611