STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION DIVISION OF HOTELS AND RESTAURANTS il a aera u DEPARTMENT OF BUSINESS AND Golo. PROFESSIONAL REGULATION, ag: ie — x G mm Pestoner OS 1154 iS Ha 1b P12 18 SUBWAY # 3389 License No. 6210399 Respondent. License Type 2010 / Case No. 2004024420 ADMINISTRATIVE COMPLAINT The DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION, DIVISION OF HOTELS AND RESTAURANTS, (‘Petitioner’), files this Administrative Complaint against SUBWAY # 3289, (“Respondent”), and en says: Petitioner is the state agency charged with regulating the operation of public lodging establishments and public food service establishments, pursuant to Sec. 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 13819 WALSINGHAM RD, LARGO, FL 33774. The mailing address of record is MACSUB XI INC, 420 PARK PLACE BLVD # 100, CLEARWATER, FL 33759. 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 $1000 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. cee, Joe Perez, District Manager Signed April 23, 2004 By delegation of the Director, or designee Division of Hotels & Restaurants Department of Business & Professional Regulation Counsel for Department: Charles F. Tunnicliff, Lead Attorney Florida Bar No.: 0153831 Department of Business and Professional Regulation 4940 North Monroe Street, Tallahassee, FL 32399-1007 Telephone: 850/487-9656 Facsimile 850/414-6749 CERTIFICATE OF SERVICE BY CERTIFIED U.S. MAIL, ARTICLE NUMBER: _7003-1680-0005-2374-5696 | HEREBY CERTIFY that a true and correct copy of the foregoing ADMINISTRATIVE COMPLAINT has been hand served by me on this day of , 200 Received by: Inspector's Signature Operator's Signature Title Title Case No: 2004024420 Revised 3/17/2004 License No: 6210399 Business Name: SUBWAY # 3389 License Type: 2010 District No: 3 License #: 62-10399 License Type: 2010 Case #: 2004-024420 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 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. It is alleged that on February 23, 2004, and March 24, 2004, 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. 4. *53A-01 509.039 FS & 61C-4.023(1) FAC 2. *53B-01 509.049 FS *denotes critical violation All managers employed by a food service establishment must have passed [the food service manager] test and received a certificate attesting thereto. Managers have a period of 90 days after employment to pass the required test. All managers who are responsible for the storage, preparation, display, and serving of foods to the public shall have passed a certification test approved by the division demonstrating a basic knowledge of food protection practices as adopted in this chapter. Those managers who successfully pass an approved certification examination shall be issued a certificate by the certifying organization, which is valid for a period of five years from the date of issuance. OBSERVED NO VERIFICATION OF MANAGER’S CERTIFICATION AVAILABLE. Food service employee training. The division shall adopt, by rule, minimum food safety protection standards for the training of all food service employees who are responsible for the storage, preparation, display, or serving of foods to the public in establishments regulated under this chapter. These standards shall not include an examination, but shall provide for a food safety training certificate program for food service employees to be administered by a private nonprofit provider chosen by the division. Any food safety training program established and administered to food handler employees prior fo the effective date of this act shall be submitted by the operator to the division for its review and approval. it shall be the duty of the licensee of the public food service establishment to provide training in accordance with the described rule to all employees under the licensee's supervision or control. The licensee may designate a certified food service manager to perform this function as an agent of the licensee. Food service employees must receive certification pursuant to this section by January 1, 2001. Food service employees hired after November 1, 2000, must receive certification within 60 days after employment. Certification pursuant to this section shall remain valid for 3 years. OBSERVED NO VERIFICATION OF EMPLOYEE TRAINING THROUGH A STATE APPROVED PROGRAM. Exhibit A Page 1 of 1 CAtlL Back DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION LEGAL NOTICE Division of Hotels and Restaurants oh CONTROL NUMBER INSPECTOR i FOOD SERVICE INSPECTION REPORT File Number | Suf. pstaict SD SBSSoawn : ¥ a 2 403 a4 a es OWNER NAME © Catering a) VBOOoMDs an © Vending “u Dine ¢ bs L Ine, ao Baaealn| @@ | Tones ul x © MFov oar BBG eoae Boe ( Theme Park Food Cart . BBeseaoasa BB TDDRESS Sd4bway 3339 goa ame BAaaoogaeoes ow. 7) Q © Temporary ‘ -D asaclosaae ae _ 13917 4 (Sing Anus d 1 Temp. Assoc. 2 (Cprional) wiPerm, Est. si BB @ @B Z . L ES DBaAoaos ao ALAGO 332% GBovoovsr Ss Oe CB General 3 Seating Ly 2 OD BOO B INSPECTION REASON INSPECTION DATE Routine Complaint information Epidemiological DISPOSITION Failure to comply with this Notice may initiate an administrative complaint that may result in suspension cr revocation of your license and fines. INSPECTION RESULTS ANY VIOLATIONS noted herein must be corrected by the NEXT ROUTINE INSPECTION. 603 Bo HACCP INSPECTION Pending a7 WARNING: Violations in the operation of your estaislishment must be corrected by: Date: ADMINISTRATIVE COM INT recommended. Me Gwe Ten Seasonal Time: EMERGENCY ORDER recommended based upon a severe and immediate threat to the pu. NOTE: ITEMS IN RED. AND.MARKED WITH. AN ASTERISK’ ARE OF CRITICAL CONCERN AND MUST. BE. CORRECTED IMMEDIATELY. . at) Crcied temperatures’ aré in.violation B Tipe of Food Temperature Food Manager Name pe a | Sa: CERTIFIED FOOD MANAGER Certificate Date See reverse side for explanation of citations. OD 070 40 2302 330 *41at 509 ‘o1bC3 "08a «15 4 ab 5199 o2C3*esb—3 «16C3 25L9'35aL 42 5209 v93a( “08 3 2609-350 353088 CIRCLED ITEMS ARE _IN VIOLATION Ad ITEM 20: WAREWASHING SANTTIZATION: ens si 4 "o3bf3 0909 1803 2709 36(0 44 “53D gB j Date(s) Sanitizing Concentration ppm ‘ac 109 193 280 9700 45D ED Sanitizing Temperature degrees F. 09d O20 299 38D “4809 559 *04f ‘12a ‘20009 13009 39 4709 59 COMMENTS O12 20 310 9 sO sO S3- Observed Mo Usta» feet burns atemployee Ih [ening Arye a oC) 13039 2203 3200 *a9C3 583 | Isemeg) Mo VaaiteahowotMantru fe ADDITIONAL GOMMENTS ON ATTACHED COMMENT SHEET | acknowleage receipt of this inspection form and comments. REMINDER: Your license expires (iy a ae a s . Recipients 's Name a EASE PRINT), Inspector's Name (PLEASE PRINT) 7 De tE Jim Ofsern Recipient's mre Title ia Laypectn —__EXHIBITB Inspector's Signature Dare sand Time, Office vag SZ 4/8 ©) 54a pe 398 Date B-AYOY DISTRICT OFFICE COP’ www. hospitalityeducation.org BBPR Form HR 5022-015 Revised 2001 July 9 o V DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION 4; LEGAL NOTICE Division of Hotels and Restaurants CONTROL NUMBER INSPECTOR ‘a7; FOOD SERVICE INSPECTION REPORT LICENSING Ha OHH Bo | County File Number DISTRICT milo aN 103 bal 4 OWNER NAME a) A Lx Ss b ~ Y! Ne 3 Catering =| ODs®ooegG Og D & @ Vending - BSBEao0n ao BUSINESS NAME : © MrFDv = 23BOeag Boe (9 Theme Park S whew Ae + 33 eS Food Cart m|) OGOGEG080 Be ADDRESS: 4 =| OAoooeas Be © Ternporary = 13819. Walsingham Ad 1 - Besse Be cry ZIP (Optional) =) Pe Assoc. w’Perm. Est. -_ QB B B ap «| plooanal | oa Lange P2004 No. of Seats = Bdgoo8ss B © General &® Seating 1 5 -) =| Coxe coo eo 4h \ TH = = INSPECTION DATE INSPECTION REASON mm | Month Day Year || In Our | ; x} 23 oY ISO Faiture to comply with this Notice may initiate an — 1 @ Routine administrative complaint that may result in B aw ea far] fo) 3 CG Complaint suspension or revocation of your license and fines. so BE 4 © Information INSPECTION RESULTS @®| so |B Be 5 © Epidemiological ANY VIOLATIONS noted herein must be Os a BB DISPOSITION avn ES INSPECTION. @ @B Bes 6 © Pending 2 € WARNING: A Violations in the operation of your 8 Bs estal A be ao 0B, by: B Ba DarleP Poof @B Be B HACCP INSPECTION 3 © ADMINISTRATIVE COMPLAINT recommended. B Ba Ls] B Be 5 © Seasonal Be ee] & 63 BS 6 (3 EMERGENCY ORDER recommended based upon a severe and immediate 3} FOOD TEMPERATURES: peratures are In violation of Food Temperature Food Manager Name Certificate Date Net Acree bith be. See reverse side for explanation of citations. oat 0709 14 3D aC 41aQDB 5009 ‘oOo 150 20 t4bO 510 p23 ‘o8bC3 «1609 25 '35aC «4209 5203 "03a @08e GB 1703 2635 4309 53a ‘ob 0909 1803 ‘2703 36M 4409 5300 ‘3cE3 100 1909 280) 37 SO HO 03d "11 '20a0D 290s 3009 “469 553 nat 12aC 320609 300) 399 4709s 5809) COMMENTS OSM "12} 2188 3109 408) “489 8703 page. | e £ = oe 13090 2@ 320 ie 533 ss! Ah er Bat, ST CIRCLED ITEMS Re (TEM *20: WAREWASHING SANITIZATION |= "2 3 ARE_IN VIO Sanitizing Concentration _2EP ppm Sanitizing Temperature _________ degrees F. ADDITIONAL GOMMENTS ON ATTACHED COMMENT SHEET 1! acknowledge receipt of this inspection form and comments. REMINDER: Your license expires - Ait. es. Recipient's Name (PLEASE PRINT) Inspectors Name (PLEASE PRINT) LO Brdle CY Tim Sls en Recipient's Title Z { Tile SVENC __ Miatagy CK Erspecton. Recipient's Signature r Inspector's Signature . i Z € SO in C— ESiablishment ingens Date and Tinie Office Telephone Daie S¢é- 26 20 2-23-09 GS0-Y$7- 395 A-AB- OY TRBOO Enem ME ADDNIR NiSTRICT OFFICF COPY www. hospitalityeducation.org Revised 2001 July 9 Fim Olsen Subw 2-23-04 43384 State of Florida Control Number Department of Business and Professional Regulation Division of Hotels and Restaurants 62-03 9G www. hospitalityeducation.org COMMENTS SHEET page of & Addendum to DBPR Forms HR 5022-005, 5022-014, 5022-015, 5022-082, or 5022-083. For comments to the Lodging, Food Service, or HACCP Inspection; Call Back/Reinspection Report, or HACCP Pian Verification. 066~ Ohrenwud Cuigws Stoned ox Elocn w We lKe-rm Coven. BE- Dbsenvecl Ble Yeod build-up gv Floor Wiale-w Golen. osn- Obseueol Chicken Si?’ Showed jp. del) Shy Covlen. Kelso _Ast Boot 5S! Cheese 5S Swlgm) 5S Bax Obsenceel Wet westing of Cleau alache Corks wee S S3A- Obsered No Uinhentew of Managras Count turtiov S3B- Observe flo Una frestouws ot winf leqee Tit iw 2G EApearg A State appnised PULE GRAD + ee Al- Obsewe Me Ps zeng Solapior fon iw “fe __ Ug 1-G Joweds , ; 30 - Obsewecl hole in Watt Mean freqister We Obsewed Me Test cbuips fon Soni tyon - Testives 65~ Obsewecl Neo puste bike theammet Aun lable - Me fe, WMirons Cer leyed Mes Josten. va Mote, MMe Bane baud Contre F ow feadey & eat foods foot Bllowsed Sealiinn. 86 Moat Anlls 140" EXHIBIT B 2001 November 04 DBPR Form HR 5022-042

Docket for Case No: 05-001759