srareorrionoa OU S- (7b Uf DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION DIVISION OF HOTELS AND RESTAURANTS DEPARTMENT OF BUSINESS AND fe 4 my PROFESSIONAL REGULATION Eg Petitioner, “s. IMS RAY 1h P95 NEW YORK BRICK OVEN PIZZARIA License No. 2001056 Respondent. License Type 2010 Permanent Food Service / Case No. 2004047881 i.” es bor ADMINISTRATIVE COMPLAINT The DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION, DIVISION OF HOTELS AND RESTAURANTS, (‘Petitioner’), files this Administrative Complaint against NEW YORK BRICK OVEN PIZZARIA, (“Respondent”), and says: 4. 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 2225 B COUNTY ROAD 220, MIDDLEBURG, FLORIDA 32068.The mailing address of record is NEW YORK BRICK OVEN PIZZARIA, at 2225 B COUNTY ROAD 220, MIDDLEBURG, FLORIDA 32068. 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 $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 October 01, 2004 Steve fff ben, 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 Tallahassee, Florida 32399-1007 CERTIFICATE OF SERVICE BY CERTIFIED U.S. MAIL, ARTICLE NUMBER: 7160 3901 9848 5780 9652 | HEREBY 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 Case Number: 2004047881 Form revised 9/8/04 License Type: 2010 Permanent Food Service District Number: 05 License Number: 2001056 NEW YORK BRICK OVEN PIZZARIA License Number: 2001056 License Type: 2010 PERMANENT FOOD SERVICE Case Number: 2004047881 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 July 20, 2004, July 29, 2004 and August 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. * §4.17-01 4-302.14FC SANITIZING SOLUTIONS, TESTING DEVICES. A TEST KIT OR OTHER DEVICE THAT ACCURATELY MEASURES THE CONCENTRATION IN MILLIGRAMS PER LITER OF SANITIZING SOLUTIONS SHALL BE PROVIDED. OBSERVED NO CHEMICAL TEST KIT PROVIDED WHEN USING CHEMICAL SANITIZER AT 3- COMPARTMENT SINK. * 2.35A-02 6-501.112 FC REMOVING DEAD OR TRAPPED BIRDS, INSECTS, RODENTS, AND OTHER PESTS. DEAD OR TRAPPED BIRDS, INSECTS, RODENTS, AND OTHER PESTS SHALL BE REMOVED FROM CONTROL DEVICES AND THE PREMISES AT A FREQUENCY THAT PREVENTS THEIR ACCUMULATION, DECOMPOSITION, OR THE ATTRACTION OF PESTS. OBSERVED BACK DOOR IS NOT SELF CLOSING. 3. 37-02 61C-1.004(6) FAC ALL BUILDING STRUCTURAL COMPONENTS, ATTACHMENTS AND FIXTURES SHALL BE KEPT IN GOOD REPAIR, CLEAN AND FREE OF OBSTRUCTIONS. OBSERVED ATTACHED EQUIPMENT SOILED WITH ACCUMULATED GREASE (GRILL FAN). * 4.47-01 61C-1.004(11) FAC ELECTRICAL WIRING -- TO PREVENT FIRE OR INJURY, DEFECTIVE ELECTRICAL WIRING SHALL BE REPLACED AND WIRING SHALL BE KEPT IN GOOD REPAIR. NO EXTENSION CORDS SHALL BE USED EXCEPT DURING CLEANING, MAINTENANCE AND OTHER TEMPORARY ACTIVITIES. ONLY A WALL SWITCH OR APPROVED PULIt CORD SHALL BE PERMITTED IN BATHROOMS. IN ACCORDANCE WITH THE PROVISIONS OF NFPA 70, THE NATIONAL ELECTRICAL CODE, AS ADOPTED BY THE DIVISION OF STATE FIRE MARSHAL IN CHAPTER 44-3, FAC, UNIFORM FIRE SAFETY RULES AND STANDARDS, SUFFICIENT ELECTRICAL OUTLETS SHALL BE PROVIDED. OBSERVED EXTENSION CORDS IN USE FOR NON-TEMPORARY PERIOD (BY MICROWAVE AND FISH TANK). . * denotes critical violation Exhibit A Case Number: 2004047881 Page 1 License Type: 2010 PERMANENT FOOD SERVICE License Number: 2001056 Page 1 of 2 STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONA: .EGULATION DIVISION OF HOTELS AND RESTAURANTS EXH | BIT B CALLBACK INSPECTION REPORT LEGAL NOTICE Failure to comply with this Notice may initiate an adrninistrative complaint that may resuit in suspension or revocation of your license and fines. 8/24/04 7:16:08 AM Warning SEA2001056 SEAT Caliback Inspection Date and Time Inspection Reason License Number NEW YORK BRICK OVEN PIZZARIA INC. ADMINISTRATIVE COMPLAINT recommended. 904-505-6700 Owner Name Area Code/Telephone Number NEW YORK BRICK OVEN PIZZARIA Business Name Inspection Result 45 07/29/2004 Number of Units Requested Callback Date/Time Initial Warning Date 2225 B COUNTY ROAD 220 MIDDLEBURG FL 32068 Address / City / State / Zip / etc. Comments {The following item(s) have been recommended for Administrative Complaint: Violation: 17-01 Miolation: 17-01 Observed no chernical test kit provided when using chemical sanitizer at three compartment sink. iolation: 21-02 heme, 21-02 [Observed sanitizing solution not at proper strength.NO SANITIZER Melaton: 35A-02 08/24/04 7:30 AM L RP 4 Date Signature of Recipient Inspector Signature Recipient: WILLIAM FILANCIA For further information please contact: Title Dan Fulton OWNER Senior Sanitation Safety Specialist 7960 Arlington Phone: Expressway Suite 610 Jacksonville A. 32211 904 278 1770 850 487 1395 DBPR FORM HR 5022-77? EXHIBIT B rage 202 STATE OF FLORIDA License Number DEPARTMENT OF BUSINESS AND PROFESSIONAL xEGULATION SEAT SEA2001056 DIVISION OF HOTELS AND RESTAURANTS Business Name CALLBACK INSPECTION REPORT NEW YORK BRICK OVEN PIZZAt LEGAL NOTICE : Inspection Date 8/24/04 7:16:08 AM Failure to comply with this Notice may initiate an administrative complaint that may result in suspension or revocation of your license and fines. PAPER HANGING OVER HAND SINK , BACK DOOR IS NOT SELF CLOSING. Niolation: 37-02 Miolation: 37-02 bserved attached equipment soiled with accumulated grease.FAN GRILL. heen 47-01 Miolation: 47-01 {Observed extension cord in use for non-temporary period.BY MICROWAVE. Niolation: 47-01 lofation: 47-01 Does extension cord in use for non-temporary period.FISH TANK. Violation: 53A-01 Miolation: 53-01 {Observed manager lacking proof of Food Manager Certification. WILLIAM ,OWNER 1é following item(s) are in compliance: iolation: 03A-03 jolation: 03A-03 {Observed potentially hazardous food cold held at greater than 41 F.48 F cheese Miolation: 05-04 : folation: 05-04 een ho conspicuously located thermometer. Miolation: 31-11 Molation: 31-11 Observed handwash sink not accessible for employee use at all times. Corrected On Site. STATE OF FLORIDA , EXH | B | DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION B Page 1 of 4 DIVISION OF HOTELS AND RESTAURANTS CALLBACK iNSPECTION REPORT LEGAL NOTICE Failure to comply with this Notice may initiate an administrative complaint that may result in suspension or revocation of your license and fines. 7/29/04 1:51:02 PM Waming SEA2001056 SEAT Caltback Inspection Date and Time Inspection Reason License Number NEW YORK BRICK OVEN PIZZARIA INC. Time Extended 6700 Owner Name NEW YORK BRICK OVEN PIZZARIA Business Name 45 Number of Units 2225 B COUNTY ROAD 220 Area Code/Telephone Number Inspection Result 08/21/2004 08:00 AM 07/20/2004 Requested Callback Date/Time Initia! Warning Date MIDDLEBURG FL 32068 Address / City / State / Zip / etc. Comments [The following item(s) have been submitted for a Time Extension: lolation: 034-03 Pbserved potentially hazardous food cold held at greater than 41 lolation: 17-01 iolation: 21-02 F.48F cheese Pbserved no chemical test kit provided when using chemical sanitizer at three compartment sink. bbserved Sanitizing solution not at proper strength.NO SANITIZER a, co 07/29/04 2:08 PM Date Signature of Recipient Recipient: Title Phone: DBPR FORM HR 5022-777 Inspector Signature For further information please contact: Dan Fulton Senior Sanitation Safety Specialist 7960 Arlington Expressway Suite 610 Jacksonville Fi. 32214 850 487 1395 mil tiLvik Ly STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION DIVISION OF HOTELS AND RESTAURANTS CALLBACK INSPECTION REPORT LEGAL NOTICE Page 20f5 License Number SEAT SEA2001056 Business Name NEW YORK BRICK OVEN PIZZ Inspection Date 7/29/04 1:51:02 PM Failure to comply with this Notice may initiate an administrative complaint that may result in suspension or revocation of your license and fines. iolation: 47-01 Pbserved extension cord in use for non-temporary period.FISH TANK. iolation: 47-01 bbserved extension cord in use for non-temporary period.BY MICROWAVE. iolation: S3A-01 Pbserved manager lacking proof of Food Manager Certification. WILLIAM OWNER The following item(s) are in compliance: Violation: 05-04 Pbserved no conspicuously located thermometer. iolation: 31-11 Pbserved handwash sink not accessible for employee use at all times. Corrected On Site. iolation: 354-02 ELF CLOSING. iolation: 37-02 observed attached equipment soiled with accumulated grease.FAN GRILL. bserved the accumulation of dead or trapped birds, insects, rodents, or other pests, in control devices.FLY PAPER HANGING OVER HAND SINK . BACK DOOR 1S NOT + DBPR FORM HR 5022 EXHIBIT B Page 1 of 8 STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION DIVISION OF HOTELS AND RESTAURANTS FOOD SERVICE INSPECTION REPORT LEGAL NOTICE Failure to comply with this Notice may initiate an administrative complaint that may result in suspension or revocation of your license and fines. 7/20/04 12:48:32 PM Routine 2001056 SEAT inspection Date and Time Inspection Reason License Number NEW YORK BRICK OVEN PIZZARIA INC. WARNING: Owner Name Violations in the operation of your $700 NEW YORK BRICK OVEN PIZZARIA ish . Area Code/Telephone Number Business Name Inspection Result 46 07/26/2004 08:00 AM 06/01/05 Number of Units Callback Date/Time License Expiration 2225 B COUNTY ROAD 220 MIDDLEBURG FL 32068 Address / City / State / Zip / etc. Item 20: Warewashing Sanitization | item 45: Fire Extinguishers and Item 03: Food Temperatures Item 53a: Cert. Food Managers } Fire Suppression Systems Dates___| Cheese, make table 48 Degrees F. Manager Name: BRYANT Certification Date: Sanitizer Type: Chiorine found at concenwation | A Class ABC type Fire Extinguisher, found in/at Pepperoni, cold storage, 40 Degrees F. 5/99 Certified by: The Florida Restaurant of 000 PPM. kichen has a certification date of 4/04 Beef, cooked, cold storage, 41 Degrees F. Association NOTE: Items marked above with an asterisk (*) indicate a violation Inspector's Comments ALL 904 727 5541 ON PLAN REVIEW QUESTIONS / SOFT SERVE MACHINE Water Source: Municipal/Utility. Sewage: Municipal/Utility, | acknowledge receipt of this inspection form and comments. LO ohare a Lo FtALED 07/20/04 1:24 PM Date/Time Signature of Recipient _ Inspector Signature Recipient: BILL FILANCIA For further information please contact: "7 Dan Fulton Title OWNER Senior Sanitation Safety Specialist 7960 Adington Expressway Suite 610 Jacksonville Fl. 32211 850 487 1395. STATUS SOURCE STATUS PHF TEMPERATURE CONTROL *03b Hot food at proper temperature *01a Approved source Yes *0'1b Wholesome, sound condition Yes erly cooked/reheated 02 Original container; properly labeled, date marking “03d Foods properly cooled No Phone: 904 278 1770 Ye STATUS PHF TEMPERATURE CONTROL *03a Cold food at proper temperatures during storage, display, service, transport, and cold holding 06 Potentially hazardous foods properly thawed Violations marked with an asterisk are critical violations. Items marked YES are in compliance. Items Marked NO are violations. Specific details of violation are listed on subsequent pages. Items marked N/A are Not Applicable. Items Marked as N/O are Not Observed, and were not being conducted DBPR FORM HR 5022-014 EXHIBIT B STATE OF FLORIDA Page 2 of 8 DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION _ License Number DIVISION OF HOTELS AND RESTAURANTS SEAT —_ 2001056 ° Inspection Date FOOD SERVICE INSPECTION REPORT 7120104 12:48:32 PM LEGAL NOTICE Failure to comply with this Notice may initiate an administrative complaint that may result in suspension or revocation of your license and fines. STATUS PHF TEMPERATURE CONTROL STATUS GARBAGE AND REFUSE DISPOSAL Yes 07 Unwrapped or potentially hazardous food not re-served [Yes 33 Containers covered, adequate number, insect and rodent: Yes 08a Food protection during storage, preparation, display, proof, emptied at proper intervals, clean service, transportation es 34 Outside storage area clean, enclosure properly Yes "08b Cross-contamination, equipment, personnel, storage constructed Yes “08 Potential for cross-contamination; storage practices; STATUS INSECT AND RODENT CONTROL __| damaged food segregated No 35a Presence of insects/rodents. Animals prohibited Yes 09 Foods handled with minimum contact Yes *35b Outer openings protected from insects, rodent proof Yes 10 In use food dispensing utensils properly stored STATUS FLOORS, WALLS, CEILINGS STATUS PERSONNEL Yes 36 Floors properly constructed, clean, drained, coved Yes 14 Personnel with infections restricted No 37 Walls, ceilings, and attached equipment, constructed, Yes *12a Hands washed and clean, good hygienic practices clean [ (observed), alternative operating plan Yes 38 Lighting provided as required. Fixtures shielded Yes “12b Proper hygienic practices, eating/drinking/smoking Yes __|39 Rooms and equipmert - vented as required (evidence) STATUS OTHER AREAS Yes 13 Clean clothes, hair restraints Yes 40 Employee lockers provided and used, clean STATUS FOOD EQUIPMENT AND UTENSILS Yes "4 ta Toxic items properly stored Yes 14 Food contact surfaces designed, constructed, Yes *41b Toxic items labeled and used properly maintained, installed, located Yes 42 Premises maintained, free of litter, unnecessary articles, Yes 15 Non-food contact surfaces designed, constructed, Cleaning and maintenance equipment properly stored. maintained, installed, located Kitchen restricted to authorized personnel Yes 16 Dishwashing facilities designed, constructed, operated 43 Complete separation trom living/steeping area, laundry 1. Wash 2. Rinse 3. Sanitize [Yes (44 Cleanand soiled linen segregated and properly stored No 17 Thermometers, gauges, test kits provided STATUS SAFETY Yes 18 Pre-fiushed, scraped, soaked Yes “45 Fire extinguishers - proper and sufficient Yes 19 Wash, rinse water clean, proper temperature “46 Exiting system - adequate, good repair Yes *20a Sanitizing concentration [No “47 Electrical wiring - adequate, good repair Yes *20b Sanitizing temperature “48 Gas appliances - properly installed, maintained ——} No 21 Wiping cloths clean, used properly, stored Yes "49 Flammable/combustitle materials - properly stored Yes 22 Food contact surfaces of equipment and utensils clean STATUS GENERAL Yes 23 Non-food contact surfaces clean Yes "50 Current license properly displayed Yes 24 Storage/handling of clean equipment, utensils Yes 51 Other conditions sanita STATUS Yes "52 False/misleading statements published or advertised Yes 25 Service items properly stored, handled, dispensed | relating to food/beverage Yes 26 Single service articles not re-used INo | *53a Food management certification valid STATUS WATER AND SEWAGE/PLUMBING +53b Employee training validation Yes *27 Water source safe, hot and cold under pressure Yes 54 Florida Clean Indoor Air Act _ | jYes "28 Sewage and waste water disposed properly Yes SS Automatic Gratuity Notice Yes 29 Plumbing installed and maintained Yes 56 Copy of Chapter 509, Florida Statutes, available Yes "30 Cross-connection, back siphonage, backflow STATUS GENERAL _| 5 STATUS TOILET AND HANDWASHING FACILITIES Yes 57 Hospitality Education F'rogram Information provided No *31 Toilet and handwashing facilities, number, convenient, 58 Smoke Free designed, installed es Restrooms with self-closin: , fixture: . ves properly, focity clean, suppl wit handsesp depecable 7 Total Number of COS Violations: 1 towels or hand drying devices, tissue, covered waste Total Number of Repeat Violations: 0 —$$$—____._j Violations marked with an asterisk are critical violations. Items marked YES are in compliance. Items Marked NO are violations. Specific details of violation are listed on subsequent pages. Items marked N/A are Not Applicable. Items Marked as N/O are Not Observed, and were not being conducted EXHIBII B STATE OF FLORIDA Page 3 of 8 DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION __ License Number DIVISION OF HOTELS AND RESTAURANTS SEAT — 2001056 Inspection Date FOOD SERVICE INSPECTION REPORT 7/20/04 12:48:32 PM LEGAL NOTICE Failure to comply with this Notice may initiate an administrative complaint that may result in suspension or revocation of your license and fines. Violation(s): 03A-03 - Observed potentially hazardous food cold held at greater than 41 F.48F cheese 05-04 - Observed no conspicuously located thermometer. 17-01 - Observed no chemical test kit provided when using chemical sanitizer at three compartment sink, 21-02 - Observed sanitizing solution not at proper strength.NO SANITIZER 31-11 - Observed handwash sink not accessible for empioyee use at all times. Corrected On Site. 35A-02 - Observed the accumulation of dead or trapped birds, insects, rodents, or other pests, in controt devices.FLY PAPER HANGING OVER HAND SINK , BACK DOOR IS NOT SELF CLOSING. 37-02 - Observed attached equipment soiled with accumulated grease.FAN GRILL. 47-01 - Observed extension cord in use for non-temporary period.BY MICROWAVE. 47-01 - Observed extension cord in use for non-temporary period.FISH TANK. 534-01 - Observed manager lacking proof of Food Manager Cenification. WILLIAM OWNER

Docket for Case No: 05-001764