Jul 28 2005 16:48 87/28/2005 16:42 8584146749 DBPR OGA PAGE 19/27 STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION DIVISION OF HOTELS AND RESTAURANTS DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION eee Petitioner, Cyr eS Ice vs, — License No. 2611033 HUNGRY HOWES PIZZA & SUBS License Type 2010 Permanent Food Service Respondent. Gase No. 2005029803 ADMINISTRATIVE COMPLAINT The DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION, DIVISION OF HOTELS AND RESTAURANTS, (‘Petitioner’), files this Administrative Complaint against HUNGRY HOWES PIZZA & SUBS, ("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 6677 103 ST, JACKSONVILLE, FLORIDA 322107122. The mailing address of record is HUNGRY HOWES PIZZA & SUBS, at PO BOX 30115, DOCTORS INLET, FLORIDA 32030. 3. Inspection of this establishment conducted pursuant to Sec, §09.032, Florida Statutes, revealed violations of the provisions of Chapter 5089, 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 penatties: 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 June 02, 2005 ) f " Steve VonBodungen, District Manager By delegation of the Director, or designee Division of Hotels & Restaurants Department of Business & Professional Regulation COUNSEL FOR THE DEPARTMENT: Charles F. Tunnictiff, 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 39019848 9296 5962 | HEREBY CERTIFY that a true and correct copy of the foregoing ADMINISTRATIVE COMPLAINT has been hand served by me on this day of , 2005. Received by: Inspector's Signature Operator's Signature Title Title Case Number. 2005029803 Form revised 05.20.05 District Number: 05 License Type: 2010 Permanent Food Service HUNGRY HOWES PIZZA & SUBS Lleanse Number 2611033 Jul 28 2005 16:48 7/28/2005 16:42 8584146749 DEPR OGA PAGE 20/27 License Number, 2611033 License Type: 2010 PERMANENT FOOD SERVICE Case Number: 2005029803 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 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 Cade. Itis alleged that on March 28, 2005 and May 10, 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. Copy(s) of the report(s) for the above referenced inspection(s) are attached hereto and incorparated by reference as Exhibit B. * 1,03A03 3-601.16(B) FC EXCEPT DURING PREPARATION, COOKING, OR COOLING, OR WHEN TIME IS USED AS THE PUBLIC HEALTH CONTROL AS SPECIFIED UNDER 3-501.19, POTENTIALLY HAZARDOUS FOOD SHALL BE MAINTAINED: (B) ...(41 DEGREES F) OR LESS, EXCEPT AS SPECIFIED UNDER (C) OF THIS SECTION AND 3-501.17, 3-501.18, AND 4-204.111. OBSERVED POTENTIALLY HAZARDOUS FOODS COLD HELD AT GREATER THAN 41°F. CHEESE ON PIZZA MAKE TABLE IS 50°F. PEPPERONI, SAUSAGE AND GROUND MEAT AT 54°F, INSIDE UNIT, STEAK 47°F, TACO MEAT AT 50°F. ALL POTENTIALLY HAZARDOUS FOODS WERE REMOVED AND PLACED IN WALKIN. (HAVE BEEN ON AND INSIDE PIZZA MAKE TABLE SINCE 11:00AM). DO NOT USE THIS UNIT UNTIL IT CAN MAINTAIN POTENTIALLY HAZARDOUS FOODS AT 41¢F OR LESS. * 2.04-02 4-501.11(A) FC © PROPER ADJUSTMENT. (A) EQUIPMENT SHALL BE MAINTAINED IN A CONDITION THAT MEETS THE REQUIREMENTS SPECIFIED IN PARTS 4-1 AND 4-2, OBSERVED COLD HOLDING EQUIPMENT IS INCAPABLE OF MAINTAINING POTENTIALLY HAZARDOUS FOOD AT PROPER TEMPERATURES. SEE FOOD TEMPERATURES NOTED IN VIOLATION #3. * 3.06-04 4-204.112FC (A) INA MECHANICALLY REFRIGERATED OR HOT FOOD STORAGE UNIT, THE SENSOR OF A TEMPERATURE MEASURING DEVICE SHALL BE LOCATED TO MEASURE THE AIR TEMPERATURE IN THE WARMEST PART OF A MECHANICALLY REFRIGERATED UNIT AND IN THE COOLEST PART OF A HOT FOOD STORAGE UNIT. (B) EXCEPT AS SPECIFIED IN PARAGRAPH (C) OF THIS SECTION, GOLD OR HOT HOLDING EQUIPMENT USED FOR POTENTIALLY HAZARDOUS FOOD SHALL BE DESIGNED TO INCLUDE AND SHALL BE EQUIPPED WITH AT LEAST ONE INTEGRAL OR PERMANENTLY AFFIXED TEMPERATURE MEASURING DEVICE THAT IS LOCATED TO ALLOW EASY VIEWING OF THE DEVICE'S TEMPERATURE DISPLAY. (D) TEMPERATURE MEASURING DEVICES SHALL BE DESIGNED TO BE EASILY READABLE. OBSERVED NO CONSPICUOUSLY LOCATED THERMOMETER IN MAKE TABLE. * 4.17-01 4-302.14 FC 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 GHEMICAL TEST KIT PROVIDED WHEN USING GHEMICAL SANITIZER AT 3- COMPARTMENT SINK, * 5.36803 6202.15FC OUTER OPENINGS, PROTECTED. (A) EXCEPT AS SPECIFIED IN PARAGRAPHS (B), (C), AND (E) AND UNDER PARAGRAPH (D) OF THIS SECTION, OUTER OPENINGS OF A FOOD ESTABLISHMENT SHALL BE PROTECTED AGAINST THE ENTRY OF INSECTS AND RODENTS BY: (1) FILLING OR CLOSING HOLES AND OTHER GAPS ALONG FLOORS, WALLS AND CEILINGS; (2) CLOSED, TIGHT-FITTING WINDOWS; AND (3) SOLID SELF-CLOSING, TIGHT-FITTING * denotes critical violation Exhibit A Case Number: 2005029803 Page 1 License Type: 2010 PERMANENT FOOD SERVICE License Number: 2611033 Jul 28 2005 16:49 67/28/2885 16:42 8504146749 DBPR OGA PAGE 21/27 DOORS. (B) PARAGRAPH (A) OF THIS SECTION DOES NOT APPLY IF A FOOD ESTABLISHMENT OPENS INTO A LARGER STRUCTURE, SUCH AS A MALL, AIRPORT, OR OFFICE BUILDING, OR INTO AN ATTACHED STRUCTURE, SUCH AS A PORCH, AND THE OUTER OPENINGS FROM THE LARGER OR ATTACHED STRUCTURE ARE PROTECTED AGAINST THE ENTRY OF INSECTS AND RODENTS. (G) EXTERIOR DOORS USED AS EXITS NEED NOT BE SELF-CLOSING IF THEY ARE: (1) SOLID AND TIGHT-FITTING; (2) DESIGNATED FOR USE ONLY WHEN AN EMERGENCY EXISTS, BY THE FIRE PROTECTION AUTHORITY THAT HAS JURISDICTION OVER THE FOOD ESTABLISHMENT, AND (3) RESTRICTED SO THEY ARE NOT USED FOR ENTRANCE OR EXIT FROM THE BUILDING FOR PURPOSES OTHER THAN THE DESIGNATED EMERGENCY EXIT USE. (D) EXCEPT AS SPECIFIED IN PARAGRAPHS (B) AND (E) OF THIS SECTION, IF THE WINDOWS OR DOORS OF A FOOD ESTABLISHMENT, OR OF A LARGER STRUCTURE WITHIN WHICH A FOOD ESTABLISHMENT IS LOCATED, ARE KEPT OPEN FOR VENTILATION OR OTHER PURPOSES OR A TEMPORARY FOOD ESTABLISHMENT IS NOT PROVIDED WITH WINDOWS AND DOORS AS SPECIFIED UNDER PARAGRAPH (A) OF THIS SECTION, THE OPENINGS SHALL BE PROTECTED AGAINST THE ENTRY OF INSECTS AND RODENTS BY: (1) ...(16 MESH TO 1 INCH) SCREENS; (2) PROPERLY DESIGNED AND INSTALLED AIR CURTAINS; OR (3) OTHER EFFECTIVE MEANS. (E) PARAGRAPH (D) OF THIS SECTION DOES NOT APPLY IF FLYING INSECTS AND OTHER PESTS ARE ABSENT DUE TO THE LOCATION OF THE ESTABLISHMENT, THE WEATHER, OR OTHER LIMITING CONDITION. OBSERVED ESTABLISHMENT WITH OUTER OPENINGS THAT CANNOT BE PROPERLY SEALED WHEN NOT IN OPERATION; CAN SEE DAYLIGHT UNDER REAR DOOR. * 6.63B-01 509.049FS 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 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 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 AGERTIFIED 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 14, 2000, MUST RECEIVE CERTIFICATION WITHIN 60 DAYS AFTER EMPLOYMENT. CERTIFICATION PURSUANT TO THIS SECTION SHALL REMAIN VALID FOR 3 YEARS. OBSERVED {NCOMPLETE PROOF OF REQUIRED EMPLOYEE TRAINING. INDUSTRY BULLETIN 2004- 02 PROVIDED. EXAMPLES: VICTOR AND (FRANK) EUGENE HAVE NO PROOF. AT CALLBACK, FOUR CERTIFICATIONS AVAILABLE, H. PHILLIPS, 5. NORRIS, AND S. DUNCAN. NOT CERTIFIED ARE RYAN, MIKE SMITH, KYLE, JILLIAN, BRANDI, HEATHER, AND HALEY. * denotes critical violation Exhibit A Case Number: 2005029803 Page 2 License Type: 2010 PERMANENT FOOD SERVICE License Number: 2611033 Jul 28 2005 16:49 07/28/2085 16:42 8504146749 DBPR OGA PAGE 22/27 Page i _ STATEOFFLORIDA ~~. DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION . DIVISION OF HOTELS AND RESTAURANTS: wrew.myflorida.com/dbpr EXHIBIT B CALLBACK INSPECTION REPORT LEGAL NOTICE Faltora to comply with this Notice may Initiate sn administrative compiaiat thet aay result in suspension or revocation of rour Reonee fines. SAO 3316 PM Waming seazeiiosa SEAT Calfoack Inspection Date and Time Inspection Reson SCSCS*«éMns Nuit 4-1AX ENTERPRSE INC ADMINISTRATIVE COMPLAINT recommended] (904)778-0388 Owner Name Area Code/Telephone Nurnber HUNGRY HOWIES PIZZAAndSUBS Business Name Inspection Result a 03/28/2005 Number of Units Requested Callback Date/Time Inklal Warning Dete 06677 103 ST JACKSONVILLE FL. 322107122 Address /Chy | State? apjer. Comments Verified walk in can hold food at correct temperatures. Mail proof of service on pizza table to Inspector. potentially hazardous food cold held at greater than 41 F. Repeet Violation. Cheese on pizza maka table is 50 degrees F. Pepperoni, sausage and round meat at $4 degrees F. Inside unit, steak 47 degrees, taco meat at 50. All potentially hazzardous foods were removed and pinced In walk in. (Have bean and inside pizza make table since 11 a.m) Do NOT usa this unit until it can maintain potentially hazzardous food at 41 degrees or less. jolation: 04-02 §/10/05 Date Signature of Recipient Inspector Signature . Rectplent: =H, Philipe For further Information pisase conics Janet B'Antonie, SSS Tite shift mgr. 7960 Adlington Expressway Rm. 610 Jacksonville, PL . 32211 Phone: 778.0388 850-487-1395 fax 904-727-5558 QBPR Form HR 9022-005 Jul 28 2005 16:50 7/28/2005 16:42 8504146749 DBPR OGA PAGE 23/27 | EXHIBIT Bose: ~ STAYEOF FLORA ~~ DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION eee seA0611098 DIVISION OF HOTELS AND RESTAURANTS wer. myflorida.com /dbpr Business Name HUNGRY HOWIES PIZZAAndSUBS bn NOTICE R Inspection Date Sf10/05 3:31:16 PM Failure to comply with thia Notice ray initiate an administrative complaint thet may result In suspension or revocation of your Teens . fines. jation: 05-04 fo conspicuously located thermometer in make table, 17-01 Lorene chonkal pe vu wing ra sn ecg i apt tn Molation: 958-03 Observed establishment with outer openings that cannot be properly sealed when not In operation; can eee daylight under rear door, Miolatton: 838-03 ed mcomplete procf of required employee training training. Industry bulletin 2004-02 provided. Examples : Vitor and (Prank) Eugene have no proc. Al drivers certification. At call back, 4 certifications aveilable, H. Philips, $. Norris, and $. Duncan. Not certifad are Ryan, Mika Smith, Kyle, Jilian, Brandi, Heather, [The following item(s} are in compliance: 3: OS-O5 no stem type thennometer provided to measure temperature of food product. Repeat Violation. 3: 10 shelves in walkin nok constructed of matariats that are corrosion resistant, non-absorbent, smooth and easily cleanable, rust noted. Has 2 new shelves,| + Pesredomte rn on ce in: 23-01 [Observed build-up of food debris, dust or dit on nonfood-contact curface on exterior of white buckats with dressing packages Inside and gray containers, Molatlon: 29-04 [Cbserved hot water not provided/shut off at rear employee handwash eink, Violation: 37-02 caling tile missing in rear of store, lation: 37-02 served attached equipment solled with accurnulated dust, fan guards in walk In unit. OBPR Form HR S024-005 Jul 28 2005 16:50 07/28/2085 16:42 8584146749 DBPR GGA PAGE 24/27 EXHIBIT B rm ~ STATEOF FLORIDA ~~ Ucense Number DEFARTMENT OF BUSINESS AND PROFESSIONAL REGULATION SEAT SEA261 1033 DIVISION OF HOTELS AND RESTAURANTS www.myflorids.com/dbpr Business Name HUNGRY HOWIES PIZ2AAndSUBS CALLBACK INSPECTION REPORT Inspection Onte LEGAL NOTICE 5/10/05 3:31:16 PM Failure to comply with this Notice may inflate an edmintstrative complaint that may result in anapension or revocation of your license and fines. 45-26 ee eran cleaning performed by cleaning service; last cleaned 1/04; due 6/04 per sticker. Moolation: 46-11 eodt lights net proparly lduminatad. Repeat Violation. fon: SSA01 manager, Mike Wrubel, lacking proof of Food Manager Certification. Now certified. Molation: 53A-02 : Observed no proof of any Certified Food Manager for establishment. Mike Verubel certified 4/20/05, (GPR Form HR 5022-005 Jul 28 2005 16:50 07/28/2085 16:42 8584146749 DBPR OGA PAGE 25/27 STATE OF FLORIDA Page 1 _EPARTMENT OF BUSINESS AND PROFESSIONAL ._SULATION EXHIBIT B DMSION OF HOTELS AND RESTAURANTS wew.myflonda.com/dbpr FOOD SERVICE INSPECTION REPORT LEGAL NOTICE Fellure to comply with this Notice may initlete an administrative complaint that may result in suspension or revocation of your license and fines. 3/28/05 2:41:32 PM Routine 2811033 SEAT Inspection Date and Time Inspection Reason License Number 4 JAX ENTERPRSE INC Oumer Nama 904)778-03a8 HUNGRY HOWIES PIZZAAndSUBS Z =t by Atea Coda/Telephone Number Businass Name inepection Result 8 04/26/2005 08:GO0AM 8/1/05 Number of Units Callback Date/Time License Expiration 06877 103 ST JACKSONVILLE FL 322107122 Address / City / State / Zip / ate. Item 03: Food Temperstures item 53a; Cert. Food Managers ltam 20: Warewashing Sanitization | Item 48: Fire Exingulshers and “Cheese, white placa, pra anna cooler, 4 a Coe ABE ype Fre rer ford lvet Degrana F hellway has @ certification date of 2/06 patonne, yetow, prep aras cooler, 44 Dagraes “am, prep ree contr, 48 Degrees F, ‘Chickon wings, reech in cooler, 38 Deprees F. (Cheesa, walk In cooler, 39 Dagnaas F. NOTE: hems merked above with an asterisk (*) indicate a violation Inspector's Comments Employeas trained by Serve Sefe Provided Web Sle: www.hospttalityeducation.org, { acknowledge recsipt of this Inspection form and comments. LaI< BS Syed Deets 42805 Signature of Recipiant Inspector Signature Dete Recipient: ron Reed me For further information please contact: tenet D/Artonte, 986 Title driver ‘ 7960 Afington Expressway Ain, 610 Jachsonvili, PL 52211 Phone: 778 0388 850-487-1306 [stars [SOURCE SSSSC~*«dCSTATSS. | PHF TEMPERATURE CONTROL [ves __[*01g Approved source — *O1b holesame, sound condition *03¢ Foods prope cookedihestes a [Noro Facilties to msintein rr tempersture "03a Cold food at proper tamperatures during storage, [No “05 Thermometers provided and consplouously placed _| display, service, transport, and cold hotding \Yes | 706 Potentially hazsrdous foods properly thawed Violations marked with an asterisk ere critical violstions. itama markad YES era In compliance. Items Marked NO ere violstione. Spectic detalis of violation are listed on subsequent pages. Itams marked N/A are Not Applicable, items Marked as N/O are Not Observed, and were not belng conducted at the time of Inspection. DBPR Fomn MR 5022-015 Jul 28 2005 16:50 97/28/2085 16:42 8584146749 DBPR OGA PAGE 26/27 STATE OF FLORIDA Page 2 “-wEPARTMENT OF BUSINESS AND PROFESSIONAL PexSULATION License Narbae IB IT B DIVISION OF HOTELS AND RESTAURANTS SEAT www. myfiorida.com/dbpr (nspection Date FOOD SERVICE INSPECTION REPORT 3/28/05 2:41:32 PM LEGAL NOTICE Fallure to comply with this Notice may initiate an administrative complaint that may result In suspension or revocation of your license and finas. STATUS PHF TEMPERATURE CONTROL [_status_| GARBAGE AND REFUSE DISPOSAL [ "07 Unwrapped or potentially hazardous food not re-served 33 Containers covered, adequate number, Insect and rodent! ee aga Food protection duting storage, preparation, display, proof, emptied et proper Intervals, clean service, transportation 34 Qutside storage araa claan, enclosure properly Yes *O8b Crose-contamination, equipment, personnel, storage constructed Yes *"O8c Potential for cross-contamination; storage practices; f SONTRO damaged food segregated aus 35a Presence of insaetahodents Animals prohibited Yes 709 Foods handled with minimum contact ING ___*35b Outer opanings protected from ingects, rodent proof Yes 10 In.use food dispensing utensils properly stored ~ FLOORS, WALLS, CEILINGS STATUS [| PERSONNEL iY (36 Floors property constructed, clean, drained, coved Yes +11 Personnel with infections restricted Ne Walls, ceilings, and attached equipment, constructed, \Yes 42a Hands washed and clean, good hygienlc practices clean (observed), alterrative operating plan [Yee __[BB Lighting provided as required, Fixtures shlaided Yes "12b Proper hygienic practices, sating/drinking/smoking 9 Rooms snd equipment - vented a¢ required (evidence) STATUS OTHER AREAS Yes 13 Clean clothes, halr restraints Yes 40 Employee lockers provided and used, clean. STATUS FOOD EQUIPMENT AND UTENSILS 41a Toxic tems property stored Yes 44 Food contact surfaces designed, constructad, Yes "41b Toxic Items labelad and used p maintained, Installed, located Yes 42 Premises maintained, free of Iitter, unnecassary articias, No Cleaning and maintenance equipment properly stored. maintained, inatalled, located Kitchen restricted to authorized personnel Yos "16 Dishwashing facilities dasignad, constructed, operated [Yes (43 Complete separation from living/sleeping eres, leund 1. Weeh 2, Rinea 3. Sanitize Yes 44 Clean and solled linen sagragated and properly stored 19 Wesh, tinsa water clean, proper temperature No "46 Exiting a od —€< Sanitizing concentration Yes "47 Electrical wiring - adequate, good re *20b Sanitizing temperature [Yes _|#48 Gas appliances - proparly Installed, maintained Yes 21 Wiping cloths clean, used properly, storad Yes [49 Flammable/combustible matarials - properly stored GENERAL No 22 Food contact surfaces of equipment and utensils clean INo 23 Nor-food contact surfaces clean Yes "60 Current licanse iy displayed Yes 124 Storage/handling of claan equipment, utensils Yes 51 Other conditions sanitary and safe operation STATUS SINGLE SERVICE ARTICLES Yes 62 False/misisading statements published or advertised Yes 25 Service ftams properly stored, handed, dispensed relating to food/beverage Yes 26 Single service articles nat re-used [No____ [53a Food management certification valld STATUS WATER AND SEWAGE/PLUMBING No *53b Employee training validation g 54 Fiorida Clean indoor Air Act Q 55 Automatic Gratuity Notice No 29 Plumbing installed snel msintained Yes 56 Copy of Chapter $09, Floride Statutes, available Yes 30 Cross-connection, back siphonage, backflow GENERAL STATUS TOILET AND HANDWASHING FACILITIES Yes 57 Hospitality Education Program information provided Yes "4 Tollet and handwashing facilities, number, convenient, 58 Smoke Free designed, installed Ri A Yes faciby dean eupp'ed wih hewdeou’, dovoetie teva oa Total Number of COS Violations; 0 Grying devices, tiseus, covered waste receptecies Total Number of Repeat Violations: § | Lo Violaiona marked with an asterisk ere critical violations. hems marked YES ans In compilance. tems Marked NO are violations. Specific detalle of violation ere fisted on eubsequent pages. tems merked N/A are Not Applicable, Items Marked a3 N/O ara Not Observed, and were not belng conductad at the time of Inapaction. DBPR Fonn HR 5022-015 87/28/2085 16:42 8594146749 DBPR OGA STATE OF FLORIDA Page 3 EXHIBIT E . Jul 28 2005 16:51 “DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION _Licenss Number DIVISION OF HOTELS AND RESTAURANTS: SEAT 2811033 wee. myflorida.cam/dbpr inspection Deta 3/28/05 2:41:32 PM FOOD SERVICE INSPECTION REPORT LEGAL NOTICE Failure to comply with this Notloe may initiate an administrative complaint thet mey reault In suspension or revocation of your Ncange end fines. Waming/s): 034-03 - Observed potentially hazardous food cold held at greater then 41 F. Repeat Viotation, 94-02 - Observed cold holding equipment ls incapable of maintaining potentially hezardous food at proper temperanras. Repeat Violation. 05-05 - Observed no stem type thermometer provided to measure temperature af food product. Repaat Violation. 05-04 - Observed no conspicuously iocated thentiorneter In make table. 18-01 = Observed shalves In walk-in not constructed of materiats that era carresian realetent, non-absorbent, smooth and easily cleanable, rust noted, 17-01 - Observed no chemical test kit provided wheh using chemical sanitizer et three compartment sink, Rapeat Viciation. 22-02 - Observed oncrusted material on can openiar. 23401 - Observed butld-up of food debris, dust or ditton nonfood-contact surface on extertor of white buckets with dresalng packages Inside and grey containers. 29-04 - Observed hat water not provided/shut off at mer employee handwash sink. ‘358-03 - Obsarved establishment with outer openings that cannot be properly asaled when not in operation; can see dayiighl under regr door, 87-02 - Observed calling tie misaing in rear of store. 37-02 - Observad atteched equipment solled with accumulated dust, fan guards In walk In tit. 45-26 - Observed no current proof of hood cleaning parfarmed by cleaning service; last cleaned 1/04; due 64 per sticker, 48-11 + Observed axdt Nights not property Illuminated. Repent Violation. 53A-01 - Observed manager, Mike Wrubel, lacking proof of Food Manager Certification. 534-02 - Observed no proof of any Certifled Foad Manager for astablishment. §38-01 - Observed Incomplete proof of raquired employee training. Industry bullatin 2004-02 provided. Examples : Victor and (Frank) Eugene have no proof. All drivers faquire certification, DBPR Form HR 5022-015 PAGE 27/27

Docket for Case No: 05-002760