Received Event (Event Succeeded) Date: 2/22/2005 Time: 3:57 PM Pages: 5 Duration: 1 min 53 sec Sender: 8504146749 Company: Fav Numbhaor: Suhiact- T: @2/22/2085 15:54 9584146749 DBPR OGA PAGE 83/85 STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION DIVISION OF HOTELS AND RESTAURANTS DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION - Petitioner, i" CFO JULIANS DR License No. 7400355 - Respondent. License Type 2010 Permanent Food Service f Case No. 2004043988 ADMINISTRATIVE COMPLAINT The DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION, DIVISION OF HOTELS AND RESTAURANTS, (“Petitioner”), files this Administrative Complaint against JULIANS D R, (“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 609, 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 86 S ATLANTIC AVE, ORMOND BCH, FLORIDA 321766668. The mailing address of record is JULIANS D R, at 88 S ATLANTIC AVE, ORMOND BCH, FLORIDA 321766668. 3. Inspection of this establishment conducted pursuant to Sec. 609,032, 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 August 31, 2004 ~ fy bdr DAS Valerie Freeman, District Manager By delegation of the Director, or designee Division of Hotels & Restaurants Department of Business & Professional Regulation COUNSEL FOR THE DEPARTMENT: Charles F. Tunnicliff, Lead Attorney Florida Bar No, 0153831 Department of Business & Professional Regulation 1940 North Monroe Street Certified Article Number Tallahassee, Florida 32399-1007 7hbD 350% 9848 S780 7lub CERTIFICATE OF SERVICE SENDERS RECORD BY CERTIFIED U.S. MAIL, ARTICLE NUMBER; THEREBY CERTIFY that a true and correct copy of the foregoing ADMINISTRATIVE COMPLAINT has been hand served by me on this day of , 2004. Received by’, Inspector's Signature Operator's Signature Titte Title Case Number, 2004043986 Form revised 7/27/04 License Type: 2010 Permanent Food Service District Number: 04 JULIANS DR License Number: 7400355 Received Event (Event Succeeded) Date: Pages: Sender: Fay Naumhar: Ty 2/22/2005 Time: 3:57 PM 5 Duration: 1 min 53 sec 8504146749 Company: Suhiact @2/22/2885 15:54 8584146743 DBPR OGA PAGE 04/85 License Number: 7400355 License Type: 2010 PERMANENT FOOD SERVICE Case Number. 2004043988 Exhibit A “FC” as Cited herein references specilic provisicars of the 1998 Food Code, of the United States Public Heakh Service, Food and Orug incorporated by Chapter 61C, a incorporated by Advirastrative Cade, and 61C-1.004(5), Florida {tis alleged that on Aggust 25, 2004 the Scensee was in violation of Florida Statute S09(FS) and/or the Rules of the Division of Hotels and Florida Administrative Code (FAC), in the following Restaucgnts, COBY) OF the Tees) for The above rofererced inepecton(s) are afiached hereto snd Incorporated by * 1.36401 6-501.114 FC TRAPPING DEVICES PEST SECTIONS 7-202.12, 7-206.12, AND 7-206.13, AND (D) ELIMINATING HARBORAGE CONDITIONS. OBSERVED SIX TO EXGHT LIVE ROACHES IN THE GASKETS OF ' THE LINE, TWO LIVE ROACHES UNDER THE SALAD PREP TABLE, SIX LIVE ROACHES IN A BOX cook's OF BAKERY PAN LINERS AND TWO LIVE ROACHES IN THE GASKETS OF THE TRUE SALAD * denotes critical violafion. Case Number. 2004043968. License Type: 2010 PERMANENT FOOD SERVICE License Number. 7460355 Exhitt A Page 1

Docket for Case No: 05-000619