STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION DIVISION OF HOTELS AND RESTAURANTS anne + DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION . Petitioner, Ata! vs. ARCO IRIS RESTAURANT License No. 3906636 Respondent. License Type 2010 Permanent Food Service Case No. 2004043218 6 A . | 7 ( 4 ADMINISTRATIVE COMPLAINT The DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION, DIVISION OF HOTELS AND RESTAURANTS, ("Petitioner’), files this Administrative Complaint against ARCO IRIS RESTAURANT, (‘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 3328 W COLUMBUS, TAMPA, FLORIDA 336071820.The mailing address of record is ARCO IRIS RESTAURANT, at 3328 W COLUMBUS, TAMPA, FLORIDA 33607. 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 August 25, 2004 ee ycemaes Joe Pereg, District Manager > By delegation of the Director, of 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: 7160-3901-9848-3954-3109 | HEREBY CERTIFY that a true and correct copy of the foregoing ADMINISTRATIVE COMPLAINT has beer hand served by me on this day of , 2004. Received by: Inspector's Signature Operator's Signature Title Title Case Number: 2004043218 Form revised 7/27/04 License Type: 2010 Permanent Food Service District Number: 03 License Number: 3906636 ARCO IRIS RESTAURANT License Number: 3906636 License Type: 2010 PERMANENT FOOD SERVICE Case Number: 2004043218 Exhibit A “EC” 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 August 5, 2004 and August 23, 2004, the licensee was in violation of Fiorida 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, 08A-01 3-302.11(A)(1) FC (A) FOOD SHALL BE PROTECTED FROM CROSS CONTAMINATION BY: (1) SEPARATING RAW ANIMAL FOODS DURING STORAGE, PREPARATION, HOLDING, AND DISPLAY FROM: (A) RAW READY-TO-EAT FOOD INCLUDING OTHER RAW ANIMAL FOOD SUCH AS FISH FOR SUSHI OR MOLLUSCAN SHELLFISH, OR OTHER RAW READY-TO-EAT FOOD SUCH AS VEGETABLES, AND (B) COOKED READY-TO-EAT FOOD; OBSERVED RAW ANIMAL FOOD STORED OVER COOKED FOOD. RAW CHICKEN AND RAW EGGS IN SHELL OVER READY TO EAT FOODS INSIDE WALKIN. 2.14-02 4-202.11 FC FOOD-CONTACT SURFACES. (A) MULTIUSE FOOD-GONTACT SURFACES SHALL BE: (1) SMOOTH: (2) FREE OF BREAKS, OPEN SEAMS, CRACKS, CHIPS, PITS, AND SIMILAR IMPERFECTIONS; (3) FREE OF SHARP INTERNAL ANGLES, CORNERS, AND CREVICES; (4) FINISHED TO HAVE SMOOTH WELDS AND JOINTS; AND (5) ACCESSIBLE FOR CLEANING AND INSPECTION BY ONE OF THE FOLLOWING METHODS: (A) WITHOUT BEING DISASSEMBLED, (B) BY DISASSEMBLING WITHOUT THE USE OF TOOLS, OR (C) BY EASY DISASSEMBLING WITH THE USE OF ONLY HANDHELD TOOLS COMMONLY AVAILABLE TO MAINTENANCE AND CLEANING PERSONNEL SUCH AS SCREWDRIVERS, PLIERS, OPEN-ENDED WRENCHES, AND ALLEN WRENCHES. OBSERVED CUTTING BOARDS GROOVED AND NO LONGER CLEANABLE. (FRONT AND BACK AREAS) 3, 22-07 4-602.12FC COOKING AND BAKING EQUIPMENT. (A) THE FOOD-CONTACT SURFACES OF COOKING AND BAKING EQUIPMENT SHALL BE CLEANED AT LEAST EVERY 24 HOURS. THIS SECTION DOES NOT APPLY TO HOT OIL COOKING AND FILTERING EQUIPMENT IF IT 1S CLEANED AS SPECIFIED IN SUBPARAGRAPH 4-602.11(D)(6). (B) THE CAVITIES AND DOOR SEALS OF MICROWAVE OVENS SHALL BE CLEANED AT LEAST EVERY 24 HOURS BY USING THE MANUFACTURER'S RECOMMENDED CLEANING PROCEDURE. OBSERVED INTERIOR OF MICROWAVE SOILED. 4. 23-01 4-601.11(C) FC +NONFOOD-CONTACT SURFACES OF EQUIPMENT SHALL BE KEPT FREE OF AN ACCUMULATION OF DUST, DIRT, FOOD RESIDUE, AND OTHER DEBRIS. OBSERVED BUILD UP OF GREASE ON NONFOOD-CONTACT SURFACE. (HOOD FILTER BAFFLES) AND (EXHAUST FANS IN KITCHEN) * 528-04 5-403.11FC APPROVED SEWAGE DISPOSAL SYSTEM. SEWAGE SHALL BE DISPOSED THROUGH AN APPROVED FACILITY THAT !S: (A) A PUBLIC SEWAGE TREATMENT PLANT; OR (B) AN INDIVIDUAL SEWAGE DISPOSAL SYSTEM THAT IS SIZED, CONSTRUCTED, MAINTAINED, AND OPERATED ACCORDING TO LAW. OBSERVED EVIDENCE OF MOP/CLEANING WASTE WATER DUMPED ONTO GROUND. MOP SINK HAS EQUIPMENT AND BOXES INSIDE BUT DOES WORK. * denotes critical violation Exhibit A Case Number: 2004043218 Page 1 License Type: 2010 PERMANENT FOOD SERVICE License Number: 3906636 * 6.27-20 5-103.12 FC & 61C-1.004(2)(D) FAC PRESSURE. WATER UNDER PRESSURE SHALL BE PROVIDED TO ALL FIXTURES, EQUIPMENT, AND NONFOOD EQUIPMENT THAT ARE REQUIRED TO USE WATER EXCEPT THAT WATER SUPPLIED AS SPECIFIED IN PARAGRAPHS 5-104.12(A) AND (B) TO A TEMPORARY FOOD ESTABLISHMENT OR IN RESPONSE TO A TEMPORARY INTERRUPTION OF AWATER SUPPLY NEED NOT BE UNDER PRESSURE. PUBLIC BATHROOMS SHALL PROVIDE LAVATORIES WITH RUNNING WATER UNDER PRESSURE. OBSERVED COLD WATER SHUT OFF AT EMPLOYEE HANDWASH SINK IN KITCHEN DUE TO LEAK. 7. 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. A. OBSERVED HOLE IN WALL IN KITCHEN LEFT OF COOK LINE. B. OBSERVED WALL SOILED WITH ACCUMULATED GREASE IN KITCHEN. * 8.45-17 NPFA96, 8-2. INSPECTION. AN INSPECTION AND SERVICING OF THE FIRE- EXTINGUISHING SYSTEM AND LISTED EXHAUST HOODS CONTAINING A CONSTANT OR FIRE- ACTUATED WATER SYSTEM SHALL BE MADE AT LEAST EVERY 6 MONTHS BY PROPERLY TRAINED AND QUALIFIED PERSONS. HOOD SUPPRESSION SYSTEM TAG OUT OF DATE. LAST TAGGED DECEMBER, 2003. * 9. 46-11.1 NFPA 101, 12-2.10 & 5-10.1 MEANS OF EGRESS SHALL BE MARKED IN ACCORDANCE WITH SECTION 7-10. EXIT LIGHTS NOT PROPERLY ILLUMINATED. * 10.47-01 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 PULL 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 4A-3, FAC, UNIFORM FIRE SAFETY RULES AND STANDARDS, SUFFICIENT ELECTRICAL OUTLETS SHALL BE PROVIDED. OBSERVED EXTENSION CORDS IN USE FOR NON TEMPORARY PERIOD. * denotes critical violation Exhibit A Case Number: 2004043218 Page 2 License Type: 2010 PERMANENT FOOD SERVICE License Number: 3906636 Page 1 of 4 STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION 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. 8/23/04 11:03:20 AM Warning SEA3906636 SEAT Callback {nspection Date and Time Inspection Reason License Number GONZALEZ JORGE/LLAUGER HENRY ADMINISTRATIVE COMPLAINT 1357 Owner Name recommended. Area Coje/Telephone Number ARCO IRIS RESTAURANT Business Name Inspection Result 56 08/05/2004 Number of Units Requested Callback Date/Time Initia) Warning Date 03328 W_ COLUMBUS TAMPA FL 336071820 Address / City / State / Zip / etc. Comments —s The following item(s) have been recommended for Administrative Complaint: iolation: O8A-01 Ss bpserved raw animal food stored over cooked food. Poe chicken and raw eggs in shell over ready.toeat foods inside walkin, sf cage gee ee oe — iolation: 14-02 Dbserved cutting boards grooved and no longer cleanable trot and back area). we Qe a 08/23/04 11:36 AM Date Signature of Recipient Inspector Signature Recipient: francisco aguar For further information please contact: ‘ F. Dennis Mirabella Title mgr . eesti i, alt Senior Sanitation Safety Specialist 3725 W Grac2 Phone: 879-1357 Street Tampa, Fl. 33607 850 487 1395 DBPR FORM HR 5022-277 STATE OF FLORIDA DIVISION OF HOTELS AND RESTAURANTS CALLBACK INSPECTION REPORT LEGAL NOTICE Page 2 of 5 License Number DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION SEAT SEA3906636 Business Name ARCO IRIS RESTAURANT Inspection Date 8/23/04 11:03:20 AM et Failure to comply with this Notice may initiate an administrative compiaint that may result in suspension or revocation of your license and fines. ye Boserved interior of microwave soiled. s 4a iotation: 23-01 oO (Observed build-up of grease on nonfood-contact surtace hood filter battle) . exhaust fans in were) oat S) Observed eviderice of mop/cleaning waste water dumped onto ground. Mop sink has equipment and boxes insidegdoes work. & “\ Violation: 3 a 2) apesened hole in wall in kitchen left of cook line. b) Pbserved wail soiled with accumulated grease in kitchen. ——— g) iotation: 45-17 YC, Besered thos suppression system tag out-of-date. Hotei yo 7 Lay tha 4) iotation: 46-11 —_ Prcanedoxi lights not properly itiuminated. occa Saas _———— on a ' >) iolation: 47-01 x polation: 2-86" 77-20 cr. - Pbdserved extension cords in use for non-temporary period. IThe following item(s) are in compliance: iolation: OBA-20 bserved food stored on floor inside walkin cooler. iolation: 21-05 {Observed soiled dry wiping cloth in use. iolation: 23-02 Dbserved residue build-up on nonfood-contact surface. all shelves and racks inside walkin cooler. iolation: 23-02 Observed ice and frozen blood and food particle build-up on nonfood-contact surface inside three stand up freezers. iolation: 31-12 Observed handwash sink used for purposes other than handwashing. ice and glasses inside front hand sink. iglation: 36-03 DBPR FORM HR 5022 STATE OF FLORIDA Page 1 of 3 DEPARTMENT OF BUSINESS AND PROFESSIONAL «E£GULATION 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 8/23/04 11:03:20 AM Callback Inspection Date and Time GONZALEZ JORGE/LLAUGER HENRY Owner Name ARCO IRIS RESTAURANT Business Narne 56 Number of Units 03328 W COLUMBUS and fines. Warming Inspection Reason ADMINISTRATIVE COMPLAINT recommended. Inspection Resutt SEA3906636 SEAT License Number (313)879-1357 Area Code/Telephone Number ” 08/05/2004 Requested Callback Date/Time Initial Warning Date TAMPA FL 336071820 Address / City / State / Zip / etc. Comments Violation: 084-01 fiolation: 14-02 Miolation: 22-67 The following item(s) have been recommended for Administrative Complaint: Observed cutting boards grooved and no longer cleanable. front and back areas. raw animal food stored over cooked food, raw chicken and raw eggs in shell over ready to eat foods inside walkin. 8/23/04 11:22:29 TA AM. Oate Signature of Recipient Inspector Signature Recipient: francisco aguar For further information please contact: Title F. Dennis Mirabella mgr Senior Sanitation Safety Specialist 3725 W Grace Street Phone: 879-1357 Tampa, Fl. 33607 DBPR FORM HR 5022-77? 850 487 1395 Page 2 of 3 STATE OF FLORIDA . License Number DEPARTMENT OF BUSINESS AND PROFESSIONA: xEGULATION SEAT SEA3906636 DIVISION OF HOTELS AND RESTAURANTS Business Name CALLBACK INSPECTION REPORT ARCO IRIS RESTAURANT LEGAL NOTICE inspection Date 8/23/04 11:03:20 AM Failure to comply with this Notice may initiate an administrative complaint that may result in suspension or revocation of your license and fines. (Observed interior of microwave soiled. iolation: 23-01 i observed build-up of grease on nonfood-contact surface. hood filter baffles. Miolation; 23-01 lObserved build-up of grease on nonfood-contact surface. exhaust fans in kitchen. iolation: 28-04 {Observed evidence of mop/cleaning waste water dumped onto ground. mop sink has equipment and boxes inside. does work. iolation: 29-05 {Observed cold water shut off at employee handwash sink in kitchen due to leak, Violation: 37-02 (Observed hole in wall in kitchen left of cook line. Miolation: 37-02 \Observed wall soiled with accumulated grease in kitchen. Niolation: 45-17 i Observed hood suppression system tag out-of-date. This violation must be corrected by : 08/20/04. Wiolation: 46-11 Observed exit lights not property illuminated, Niolation: 47-01 i \Observed extension cords in use for non-temporary period. The following item(s) are in compliance: Violation: 084-20 bserved food stored on floor inside walkin cooler, iolation: 21-05 bserved soiled dry wiping cloth in use. Violation: 23-02 bserved residue build-up on nonfood-contact surface. all shelves and racks inside walkin cooler. { bas 23-02 (Observed ice and frozen blood and food particle build-up on nonfood-contact surface inside three stand up freezers. ! Violation: 31-12 Observed handwash sink used for purposes other than handwashing. ice and glasses inside front hand sink, Violation: 36-03 Page 3 of 3 STATE OF FLORIDA License Number DEPARTMENT OF BUSINESS AND PROFESSIONAL ..EGULATION SEAT SEA3906636 DIVISION OF HOTELS AND RESTAURANTS Business Name CALLBACK INSPECTION REPORT ARCO IRIS RESTAURANT Inspection Date 8/23/04 14:03:20 AM Failure to comply with this Notice may initiate an administrative complaint that may result in suspension or revocation of your license and fines. LEGAL NOTICE \Observed grease accumulated under cooking equipment. Miolation: 36-03 (Observed grease accumulated on kitchen floor. 8/5/04 11:07:37 AM STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION DIVISION OF HOTELS AND RESTAURANTS FOOD SERVICE INSPECTION REPORT LEGAL NOTICE Failure 10 comply with this Notice may initiate an administrative complaint that may result in suspension or revocation of your license and fnes. Routine 3906636 Page 1 of 3 SEAT Inspection Date and Time GONZALEZ JORGE/LLAUGER HENRY Inspection Reason License Number WARNING: Owner Name ARCO IRIS RESTAURANT Violations in the operation of your stablishment must be corrected by: 1357 Business Name Inspection Result 08/20/2004 08:00 AM Area Code/Telephone Number 02/01/05 56 Number of Units 03328 W_ COLUMBUS Callback Date/Time License Expiration TAMPA FL 336071820 Address / City / State / Zip / etc. Item 03: Food Temperatures tem 53a: Cert. Food Managers item 20: Warewashing Sanitization Item 45: Fire Extinguishers and Jrire Suppression Systems Date, Beef, raw, walk in cooler. 38 Degrees F. Chicken, raw, walk in cooler, 38 Degrees F. Ground beef og, walk in cooler, 40 Degrees F. Whole Pork, walk in cooler, 42 Degrees F. Shredded Beef, cocked, hot holding, 178 Degrees F Chicken, roasted, hot holding, 168 Degrees F- Green beans, hot holding, 174 Degrees F. Pork, hot holoing, 178 Degrees F. Rice, hol holding, 180 Degrees F. Manager Name: ursula m gonzalez Certification Date: 06/17/02 Cenlified by: Experior Assessments NOTE: Items marked above with an asterisk (*) indicate a violation Inspector's Comments Water Source: Municipal/Utility. Sewage: Municipav/Utility. | acknowledge receipt of this inspection form and comments. Ueki Ly kg 08/05/04 12:09 PM Employees trained by Serve Safe / safestaft “A Hood Suppression tyae Fire Extinguisher, found in/at kitchen has a certification date of 1403 A Class K type Fire Extinguisher, found invat kitchen has 2 ceniification date of 12/03 A Class ABC lype Fire Exunguisher. found in/at dining room has a certification date of 12/03 Signature of Recipient Inspector Signature Date/Time Recipient: ursula m gonzalez For further information please contact: ; F. Dennis Mirabella Title mgr Senior Sanitation Safety Specialist 3725 W Grace Steet Tampa. Fl Phone: 879-1357 250 487 1385 STATUS SOURCE | STATUS PHF TEMPERATURE CONTROL Yes *O1a Approved source [Yes *03b Hot food at proper temperature Yes *01b Wholesome, sound condition Yes *03c Foods properly cooked/reheated Yes 02 Original container; properly labeled, date marking Yes *03d Foods properly cooled STATUS PHF TEMPERATURE CONTROL Yes *04 Facilities to maintain product temperature Yes *03a Cold food at proper temperatures during storage, Yes 05 Thermometers provided and conspicuously placed | display, service, transport, and cold holding Yes 06 Potentially hazardous foods properly thawed j Violations marked with an asterisk are critica! violations. {tems marked YES are in compliance. Items Marked NO are violations. Specific detaits of violation are listed on subsequent pages. Items marked N/A are Not Applicable. Items Marked as N/O are Not Observed, and were nct being conducted DBPR FORM HR 5022-014 STATE OF FLORIDA LEGAL NOTICE DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION DIVISION OF HOTELS AND RESTAURANTS FOOD SERVICE INSPECTION REPORT Page 2 of 8 License Number SEAT 3906636 inspection Date 8/5/04 11:07:37 AM Failure to comply with this Notice may initiate an administrative complaint that may result in suspension or revocation of your license and fines. GARBAGE AND REFUSE DISPOSAL STATUS PHF TEMPERATURE CONTROL STATUS Yes *07 Unwrapped or potentially hazardous food not re-served Yes 33 Containers covered, adequate number, insect and rodent No 08a Food protection during storage, preparation, display, iproof, emptied at proper intervals, clean service, transportation Yes 34 Outside storage area clean, enclosure properly Yes *08b Cross-contamination, equipment, personnel, storage constructed Yes *O8c Potential for cross-contamination; storage practices; STATUS. INSECT AND RODENT CONTROL idamaged food segregated Yes *35a Presence of insects/rodents. Animals prohibited Yes 109 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 No I36 Floors properly constructed, clean, drained, coved Yes *44 Personnel with infections restricted No 37 Walls, ceilings, and ettached equipment, constructed, Yes '*12a Hands washed and clean, good hygienic practices clean (observed), alternative operating plan [Yes 138 Lighting provided as ‘equired. Fixtures shielded Yes *12b Proper hygienic practices, eating/drinking/smoking lYes 39 Rooms and equipment - 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 “41a Toxic items properly stored No 44 Food contact surfaces designed, constructed, Yes *41b Toxic items labeled and used properly maintained, installed, tocated 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 Yes 143 Complete separation from living/sleeping area, laundn 1. Wash 2. Rinse 3. Sanitize 44 Clean and soiled linen segregated and proper! stored | Yes SAFETY Yes 18 Pre-flushed, scraped, soaked INo 45 Fire extinguishers - sroper and sufficient _ Yes 19 Wash, rinse water clean, proper temperature "46 Exiting system - adequate, good repair __ | Yes *20a Sanitizing concentration Ino a7 Electrical wiring - adequate, good repair Yes *20b Sanitizing temperature Yes 48 Gas appliances - properly installed, maintained | No 21 Wiping cloths clean, used properly, stored Yes *49 Flammable/combustible materials - properly stored No 22 Food contact surfaces of equipment and utensils clean STATUS | GENERAL No 23 Non-food contact surfaces clean Yes [$50 Current license properly displayed Yes 24 Storage/handiing of clean equipment, utensils Yes 51 Other conditions sanitary and safe operation STATUS SINGLE SERVICE ARTICLES 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 Yes *53a Food management certification valid STATUS WATER AND SEWAGE/PLUMBING Yes *53b Employee training validation yes *27 Water source safe, hot and cold under pressure Yes 54 Florida Clean Indoor Air Act No "28 Sewage and waste water disposed properly Yes 55 Automatic Gratuity Notice No 29 Plumbing installed and maintained Yes 56 Copy of Chapter 509. Florida Statutes available Yes *30 Cross-connection, back siphonage, backflow STATUS [_ GENERAL STATUS TOILET AND HANDWASHING FACILITIES Yes 57 Hospitality Education Program information provided j No +31 Toilet and handwashing facilities, number, convenient, [Yes 58 Smoke Free | designed, installed it If-closin: rs, fixtures operate . ves oropery. city ean, supplied wit haneisonp, isponabla Total Number of COS Violations: Q : towels or hand drying devices, tissue, covered waste Total Number of Repeat Violations: 0 Violations marked with an asterisk are critical violations. items marked YES are in compliance. Items Marked NO are violations. Specific detaits 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 Page 3 of 8 STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION License Number DIVISION OF HOTELS AND RESTAURANTS SEAT —- 3906636 Inspection Date FOOD SERVICE INSPECTION REPORT 8/5/04 11-07-37 AM 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 Warning(s}: O08A-01 - Observed raw anima! food stored over cooked food. raw chicken and raw eggs in shell over ready to eat foods inside walkin. 08A-20 - Observed food stored on floor inside walkin cooler. 14-02 - Observed cutting boards grooved and no longer cleanable. front and back areas. 21-05 - Observed soiled dry wiping cloth in use. 22-07 - Observed interior of microwave soiled. 23-01 - Observed build-up of grease on nonfood-contact surface. hood filter baffles. 23-01 - Observed buiid-up of grease on nonfood-contact surface. exhaust fans in kitchen. 23-02 - Observed residue build-up on nonfood-cantact surface. ail shelves and racks inside walkin cooler. 23-02 - Observed ice and frozen blood and food particle build-up on nonfood-contact surface inside three stand up freezers. 28-04 - Observed evidence of mop/cleaning waste water dumped onta ground. mop sink has equipment and boxes inside. does work. 29-05 - Observed cold water shut off at emptoyee handwash sink in kitchen due to leak.” 31-12 - Observed handwash sink used for purposes other than handwashing. ice and glasses inside front hand sink. 36-03 - Observed grease accumulated under cooking equipment. 36-03 - Observed grease accumulated on kitchen floor. 37-02 - Observed wali soiled with accumulated grease in kitchen. 37-02 - Observed hole in wall in kitchen left of cook line. 45-17 - Observed hood suppression system tag out-of-date. This violation must be corrected by : 08/20/04. 46-11 - Observed exit lights not properly illuminated. 47-01 - Observed extension cords in use for non-temporary period.

Docket for Case No: 05-001768