Jul 28 2005 16:45 O7/28/2065 16:42 8584146749 DBPR OGA PAGE 11/27 STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION DIVISION OF HOTELS AND RESTAURANTS DEPARTMENT OF BUSINESS AND a PROFESSIONAL REGULATION ayy YER Patitioner, ( yy t- vs, - License No. 2612718 HUNGRY HOWIES PIZZA #213 License Type 2010 Permanent Food Service Respondent. Case No. 2005027681 f ADMINISTRATIVE COMPLAINT The DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION, DIVISION OF HOTELS AND RESTAURANTS, ("Petitioner’), files this Administrative Complaint against HUNGRY HOWIES PIZZA #213, ("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 8257 NORMANDY BLVD #8, JACKSONVILLE, FLORIDA 32210.The mailing address of record is HUNGRY HOWIES PIZZA #213, at PO BOX 30115, DOCTORS INLET, FLORIDA 32030. 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 ere described in Exhibit “A," attached hereto and incarporated 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 ta 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 May 20, 2005 ad Steve VonBodungery District Manager By delegation of thd Director, or designee Division of Hotels & Restaurants Department of Business & Professional Regulation COUNSEL FOR THE DEPARTMENT: Charnes 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 9296 6075. | HEREBY CERTIFY that a true and correct copy of the foregoing ADMINISTRATIVE GOMPLAINT has been hand served by me on this. day of , 2005. Received by: Inspector's Signature Operater's Signature Title Title Case Number: 2005027684 Form revised 04.10.08 District Number: 05 Ll : nent Food Sarvice leense Type: 2010 Permanent Foo SUKGRY ROWER PIZZA #213 Licanse Number. 2612718 Jul 28 2005 16:46 @7/28/2885 16:42 98504146743 DBPR OGA PAGE 12/27 Licanse Number: 2612718 License Type: 2010 PERMANENT FOOD SERVICE Case Number: 2005027681 Exhibit A "FC" as cited herein references specific provisions of the Food Code, Recommendations of the United States Public Health Service, Food and Drug Administration, incorporated by Chapter 61C, Florida Administrative Gode. “NFPA" as cited herein references specific provisions of the National Fire Protection Association Life Safety Code, incorporated by reference at Chapter 44-3, “Fire Prevention, General Provisions”, Florida Administrative Code, and 61C-1.004(5), Florida Administrative Code. It is alleged that on February 16, 2005 and March 22, 2005 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. Capy(s) of the report(s) for the above referenced inspection(s) are attached hereto and incorporated by reference as Exhibit B. * 4.09-01 3-301.11(B) FC EXCEPT WHEN WASHING FRUITS AND VEGETABLES AS SPECIFIED UNDER SECTION 3-302.15 OR WHEN OTHERWISE APPROVED, FOOD EMPLOYEES MAY NOT CONTACT EXPOSED, READY-TO-EAT FOOD WITH THEIR BARE HANDS AND SHALL USE SUITABLE Doses SUCH AS DELI TISSUE, SPATULAS, TONGS, SINGLE-USE GLOVES OR DISPENSING ENT. OBSERVED IMPROPER USE OF BOWL, PLASTIC FOOD CONTAINER OR OTHER NON-HANDLED CONTAINER FOR DISPENSING FOOD IN BULK BIN. * 2.30-02 5-202.13FC BACKFLOW PREVENTION, AIR GAP. AN AIR GAP BETWEEN THE WATER SUPPLY INLET AND THE FLOOD LEVEL RIM OF THE PLUMBING FIXTURE, EQUIPMENT, OR NONFOOD EQUIPMENT SHALL BE AT LEAST TWICE THE DIAMETER OF THE WATER SUPPLY INLET AND MAY NOT BE LESS THAN ...(1 INCH). OBSERVED SPRAY HOSE AT DISH SINK LOWER THAN FLOOD RIM OF SINK. 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 ATTAGHED EQUIPMENT (EXHAUST HOOD) SOILED WITH ACCUMULATED DUST. * 4534-02 610-4,023(1) FAC EACH LICENSED ESTABLISHMENT SHALL HAVE A MINIMUM OF ONE CERTIFIED FOOD PROTECTION MANAGER RESPONSIBLE FOR ALL PERIODS OF OPERATION. OBSERVED NO PROOF THERE IS A CERTIFIED FOOD MANAGER FOR ESTABLISHMENT. * 5.53B-01 §09.049FS 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 FOOO 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 TO 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 ACERTIFIED 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, * denotes critical violation Exhibit A Case Number: 2005027681 Page 1 License Type: 2010 PERMANENT FOOD SERVICE License Number: 2612718 Jul 28 2005 16:46 87/28/2885 16:42 8584146749 DBPR OGA PAGE 13/27 MUST RECEIVE CERTIFICATION WITHIN 60 DAYS AFTER EMPLOYMENT. CERTIFICATION PURSUANT TO THIS SECTION SHALL REMAIN VALID FOR 3 YEARS. OBSERVED NO PROOF OF REQUIRED EMPLOYEE FOOD SAFETY TRAINING FOR ANY EMPLOYEE. * denotes critical violation Exhibit A Case Number, 2005027681 Page 2 License Type: 2010 PERMANENT FOOD SERVICE License Number: 2612718 Jul 28 2005 16:46 07/28/2085 16:42 8594146749 DBPR OGA PAGE 14/27 DEPARTMENT ~ BUSINESS AND PROFESSIONS _ REGULATION Division of Hotels aia Restaurants EXHIBIT B CALL BACK/RE-INSPECTION REPORT page _| of} | [CO tovane fy Foon senvice Pon [ty fer | Menth [Gay | Your | he Io} C)complied Utes faquasted [2] Not complied Out of businass WARNING OF DIRECT NOTICE: Faflure to bain compliance with this notice at any future inspaction may result ina direct Notice to N | NOTICE TO Ms SHOW CAUSE You will be issued a Notice to | Show Cause why sanctions should not be assessed against your license, A hearing will he held at a time and place to he [1 Pre-conference C]Pre-hearing _ | C0n Stipulation (len Hearing Order CITims extended = = dates Gbkieo KL tik Oi\ _ MOA VAS ~ R AS S19} Ose om Sana leis REGENTS NAME [PLEASE PRINT) Cre RECIPIENT'S SIGNATURE Bs 3 aD! iN PRINT} TANS, TITLE EAGLE T re 4o4 7 ae OBPR Form HR ae Calpe ate semen ane ta Jul 28 2005 16:47 07/28/2005 16:42 9504146749 DBPR CGA PAGE 15/27 betta aan STATE OF FLORIDA Page 1 : er, DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION DIVISION OF HOTELS AND RESTAURANTS www. myfiorida.com/dbpr . iid FOOD SERVICE INSPECTION REPORT ae LEGAL NOTICE . . Fatlara to comply with thie Notice may Initiate an sa¢eutnitrative coveplelat thet may revettin euapension or revocation of your Rrenee 2/16/05 11:40:52 AM , 2612718 NOSsT Inspection Date and Time Licance Number NORMANDY PIZZA INC onnar 7815656 HUNGRY HOMIES PIZZA #213 Area CodefTelephone Number Business Name 0 6/1/05 Number of Units ~ Calback Detaffime A License Expiration 08257 NORMANDY BLVD #8 eehucieets JACKSONVILLE FL 32210 Rddrees 7 City | State 7 Zip 7 et. Ttem 03: Food Ternperatures Item 53a: Cert. Food Managers Tham 20: Warewashing Sanitization Team 45: Fira Extinguishers and Fire Suppression Systems Dates: ‘Chicken: wings, walk in enoler, 38 Degrees F. Sanitizer : Not Set Up found at A Clats AEC type Fire Extingulaher, found In/at Chenme, prep brea, 36 Degrees F. Senifizer Type: Not Sate fer et hoe 8 carats cf {0/08 Pepperoni, eres, 39 Dagress F. Maribel tech mn oboler, 30 Degrees F. NOTE: Itume marked above with en asheriak (*) indicate a violation T acknowledge receipt of thin inupaction form and comments. Cone C gum ‘gna P mana > Signature of Recipient Inspector Signetura Date For further information please contact; Tre 7 Jonet D’Antonio, 585 . mr. 7960 Arington Expressway Rm, 610 Jad@onville, FL Phone: - 7B1 5656 322i . 850-487-1395. service, transport, arid cold holding SO Potential Violations marked with am asterisk are crtics! violations. tame marked YES ara in compliance, itera Marked NO are viokstions, SpaciTkc detalls of violation are listad on subsequent pages. That marked N/A are Not Applicable, tents Marked ea N/O are Not Observed, and were not being conducted at the time of Inspection. OBPR For HR 5022-015 Net bRpeRietntimmn se emt Jul 28 2005 16:47 07/28/2005 16:42 8584146749 DBPR GGA PAGE a | EXHIBIT B 16/27 STATEOF FLORIDA ~~ Poge 2 DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION Ucense Nurnber DIVISION OF HOTELS AND RESTAURANTS NOST 2612718 evew. myflorida.com/dbpr INSPECTION REPORT Tnepection Dat FooD SERVICE IN specs 2/16/05 11:40:52 AM Fallare to comply with thie Notice may infdete an administrative complaint that mey resuit In suspension or revocation of your license PHF TEMPERATURE CONTROL | STATUS GARGAGE AND REFUSE DISPOSAL ; 407 Unwrapped or potertialy hazardous food not re-served Containers covered, adequate number, Insect and rodent a Food during storage, preparation, daphey, [proof, errystied at proper intervals, clean ; pervica, transportation fi Gutside storage area clean, enclosure property constructed Yes O8b Cross-contamination, equipment, personnel, storage Yes "0Be Potantial far cross-contarination; storage practices; STATUS INSECT AND RODENT CONTROL damaged food segragated Yes [35a Presence of insecte/rodants. Anknais pronibited = No POS Foods handied with minimum contact Yes *35b Outer openings protected from Insects, rodent proof Yes 10 In use food dispensing utancits property stored STATUS FLOORS, WALLS, CEILINGS STATUS PERSONNEL Yes 6 Roors properly constructed, dean, drained, coved Yes 11 Personnel with infections restricted No 7 Walle, ceilings, and attached equipment, constructed, clean Ne |*40a Hands washed and clean, good hygienic practices . Kobeerved), akemnative operating plan Yes Ba Lighting provided as required, Phaures shielded yes ~*2b Proper hygienk: practioss, esting/drinking/emoxing Yes 59 Rooms end equipment - verted bs required (evidence) STATUS OTHER AREAS Yes 13 Glean dothes, halr restraints Yes. _ 40 Employee locaws provided and used, clean { STATUS | FOOD EQUIPMENT AND UTENSILS Yes Fin Toxdc hems properly stored Yes 14 Food contact surfaces designed, constructed, maintained, {No tb Texdc Theme Inbeled and used property inaniaae . WO tral helnterorce ecules sy atered, Kisien “THE Non food ni Yes TE Ken id corti brio Giga, consi, reise, runic uttered peeve Yas 16 Dist q facilities designed, constructed, operated i. Yes Completa seperation from living/sleeping arae, laundry: Wash 2. Rinse 5. Senitize Yes Clean and cotied linen segregated and properly stared in No "17 Thermometers, gauges, tact Kits provided STATUS SAFETY Yes 18 Pre-flushed, serapad, soaked ‘Yas P45 Fire extinguishers - proper and sufficient Yor 19 Wash, rince water clean, proper temperature No "46 Exiting system - adequate, good repair Yes 20a Sanitizing concentration Yes 47 Electrical wiring - adequate, good repalr Yes 2b Sanitizing tempertture Yes = property Tnaintained [Yer [2 Wiphig clothe loan, used properly, stored Yes RSS Peninebie/ combustible materials - properly stored _ No 22 Food contact surfaces of equipment and ubensils can STATUS GENERAL Yes 23 Non-food contact surfaces dean Yes. 50 Current teense properly displeyed Yes 24 Storage/handiing of clean equipment, utensile Yes 51 Other conditions sanitary and séfe operation STATUS SINGLE SERVICE ARTICLES Yes 52 Falee/misleading statements pubjished or advertised relating Yes [25 Gervice barns properly stored, handled, clepencad to food/beverage Yes 26 Single service articles not re-used No "53a Food management certification valid STATUS WATER AND SEWAGE/PLUMBING lef '53b Employes tratning validation Yes *27 Weber source safe, hot and cold under pressure Yes S4 Florida Clean Indoor Alr Act Yes "28 Sewage and waste water disposed properly 5 Autometic Gratuity Notice Yes 29 Plurnding inetalied and maintalned & Copy of Chapter 509, Florida Statutes, available No 30 Cross-connection, back siphonaye, backflow GENERAL STATE [TORT AND HaNOWASHAING FACULTIES [Ves 7 say aa rogar Tan D 1Y¥es *31 Tollet and handwashing faciities, number, conventent, Yes, ES Smoke Free designed, instalted ‘ city cen apghel wat heskoer, fiery aed sari Total Number of COS Violations: 4 eying devices, Ussue, covered wasts receptacles Total Number of Repest Viclations: 0 a ‘Violations marked with ani asterisk are critical violations. Terre merkod YES are n compliance. Tame Marted NO are wolitions, Speci: detals of wolation ara Kaaed on subsequent pages. Dre fie A we et. Appa, or Wat we W/O ao Not ery an ware ok beloa Socuce see tame of apes. veo DBA Form WR 5022-015 ‘sg nanep tana naR tte ne ea rete Jul 28 2005 16:47 7/28/2005 16:42 8504146749 DBPR OGA ge EXHIBIT nes PAGE 17/27 STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION Licance Number DIVISION OF HOTELS AND RESTAURANTS NOST 2612718 www. myflorids.com/dbpr Inspection Date FOOD SERVICE INSPECTION REPORT 140: LEGAL NOTICE . 2/16/05 11:40;52 AM Faitare to commly wth thio Notice tuny Inkteta op aciminlvtrative complaint thet mey renuit ln enepansion or ravocetion of yosr eens ‘Warnina(s): 05-02 - Observed thermometer not accurate within +/+ 2 degrees Fahrenheit; using food probe in reech in unit and It reads 180 degrees, 09-01 - Obsarver! Improper use of bow!/plusstic food container or other non-handiad container far dispensing food in bufk bin. 124-12 ~ Chserved food empinyee touching ready-to-est food with their bara hands. No approved Alternative Operating Procedure in place; cutting lettuce for seteds. Cormactad On Site. 17-01 - Obrerved no chemical test it provided when using chemical sanitizer st threa compartment sink, 72-07 - Obeerved interior of microwave Boiled and extertor with sticky build up, 90-02 ~ Observed spray hose at dish sink lower than flood rim of sink. 32-00 - Observed lack of proper hand drying provisions at rear hand wash sink, 3deid - Obeerved lack of handwashing cleanser at rear handwashing lavatory. 32.02 - Observed tack of hancwaching sion et handsink used by food employeas, 37-02 - Observed attached equipment solled with accumulated dust- exhaust hood. 416-02 - Observed unlabeled spray bottle. 46-11. - Observed exft ight nat property iduminated, 530-03 = Observed no liet of certified food service managers available at the establishment. 53-02 - Observed no proof there is 8 Certified Food Manager for establishment. 538-01 - Obverved no proof of required amplayse food safety training. Industry bulletin 2004-02 provided ; 30 days ta comply, 56-01 - Chserved copy of Florida Statute 509 nat avaliable In the actablish ment, Call 1 800 704 1076 for free copy. REFERENCE TEXT! 509.101(Z) FS : Each operator shed! maintain at all times @ current copy of this chapter in the offics of the Ecensed establahment which shell be made avaliable to the public upon request. DBPR Form Hit 5022-015 stir ans ameter iat AA SN

Docket for Case No: 05-002759