STATE OF FLORIDA =A DEPARTMENT OF BUSINESS AND PROFESSIONAL REGUANH DIVISION OF HOTELS AND RESTAURANTS 3270 2 G DEPARTMENT OF BUSINESS AND ov Zz PROFESSIONAL REGULATION om Petitioner, —— mu ws OS-dTIL License No. 1620943 SALAD CHEF #2 License Type 2010 Permanent Food Service Respondent Case No, 2004056118 ADMINISTRATIVE COMPLAINT The DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION, DIVISION OF HOTELS AND RESTAURANTS, (‘Petitioner’), files this Administrative Complaint against SALAD CHEF #2, ("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 1400 N E 23 STREET #C-10, POMPANO BEACH, FLORIDA 33060.The mailing address of record is SALAD CHEF #2, at 1418 S POWERLINE RD, POMPANO BEACH, FLORIDA 33069. 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 November 16, 2004 Lom Ua oe 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 1908 | 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 Title Title Case Number: 2004056118 Form revised 10/25/04 License Type: 2010 Permanent Food Service District Number: 02 License Number: 1620943 SALAD CHEF #2 DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION Division of Hotels and Restaurants I CALL BACK/RE-INSPECTION REPORT page_| of | EXHIBIT B INTIAL HASHING DA TE H [EUNSPECTIONDATE |) | INSPECTION TIME | ie SIEENDE ONTROLAOMBER| 10 | 13. Ie | acaus|R | [ES NREAS ON. WARNING OF NOTICE TO Beem C1Complied Faretal be in eompanes You wil bo fenued a Notice to [_]Pre-conference i 7 (C1Pre-hearing BaNot complied Cont of business with this notice at any Show Cause why sanctions Clon Stipulation future inspection may should notbe assessed against (10n Hearing Order (Time extended date. | resultin a direct Notice to your license. A hearing will be Show Cause. held at a time and place to be o Other: jaa time; designated by the director. Owner Name: ASakh. ret Drtew@acindd TRC, Business Name: SHA ae *S Gls NE 3B Aves #CA10 Business City: “REASRGNYD Reach IRE! Business Address: oO > on = xz2 = m>S< 9 oa E no — mane Sao ™“ ay == PAS ae < a 7 — [ony RECIPIENT'S NAME (PLEASE PRINT) _ INSPECTOR'S NAME (PLEASE PRINT) KAAINy "Beep oS RECIPIENT’ SSIGNATUR Pee Y . OFFICE TELEPHONE SC) EST ASLISHME: S54 GET. 1B4IS” G54 Pa BPR 22-005 Revised 5/15/98 BA dnetse Page 1of8 STATE OF FLORIDA _. . DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION DIVISION OF HOTELS AND RESTAURANTS FOOD SERVICE INSPECTION REPORT LEGAL NOTICE Fallure to comply with this Notice may Initiate an administrative complaint that may result in suspension or revocation of your license and fines. 10/42/04 11:09:51 AM Routine NOS1620943 NOST inspection Date and Time inspection Reason License Number SALAD CHEF INTERNATIONAL INC WARNING: Owner Name Violations In the operation of your 8030 SALAD CHEF #2 establishment must be corrected by: Area Code/Telephane Number Business Name Inspection Result 0 11/12/2004 08:00 AM 01-DEC-04 Number of Units | Callback Date/Time Ucense Expiration 1400 N E 23 STREET #C-10 POMPANO BEACH FL 33060 Address / City / State / Zip / etc. ltem 03: Food Temperatures Item 53a: Cert, Food Managers [tem 20: Warewashing Sanitization | Nem 45: Fire Extinguishers and Cheese, cook line cooler, 41 Degraes F, Chicken, roasted-prepped, cook line cooler, 45 Degrees F, ‘Tuna salad- prappad, coak line cooler, 48 Degrees F. Soups, potentially hazardous, hot holding, 150 Degrees F. Sanhlzer Type: Chlorine faund at concentration A Class ASC type Fire Extinguisher, found Infat of not set up PPM, kitchen has a certification date of 10/03 NOTE: Items marked above with an asterisk (*) Indicate a violation Inspector's Comments Inspector Torres cell 954 B02 6569, — Provided Web Site: www.hospltalltyeducation.org. SUsHlHyY Z} 199 So | acknowledge receipt of this Inspection form and comments. LE a iggy PE Gar Cet Fe 10/12/04 11:33 AM Date/Time Signature of Recipient Inspector Signature Recipient: kariny silva For further information please contact: Lary Toras Title pic Sanitation and Safely Specialist S080 Cocunut Creek Parkway Phone: 954 782 1070 Suite A Margate Florida 33063 STATUS Yes SOURCE STATUS Yes *O1b Wholesome, sound condition Yes Yes *03c Foods properly cooked/reheated “03d Foods properly cooled 02 Original container; properly labeled, date markin STATUS PHF TEMPERATURE CONTROL Yes ‘04 Facilities to maintain product temperature *03a Cold food at proper temperatures during storage, No {os Thermometers provided and conspicuously placed display, service, transport, and cold holding Yes PHF TEMPERATURE CONTROL *03b Hot food at proper temperature los Potentially hazardous foods properly thawed Violations marked with an asterisk are critical violations. Items marked YES are in compliance. tems Marked NO are violations. Specific details of violation are listed on subsequent pages. ltems marked N/A are Not Applicable, Items Marked as N/O are Not Observed, and were not being conducted DBPR FORM HR 5022-014 STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION DIVISION OF HOTELS AND RESTAURANTS Page 2 of 8 License Number NOST EXHIBIT B FOOD SERVICE INSPECTION REPORT Inspection Date Nos1620943 LEGAL NOTICE 10/12/04 11:09:51 AM 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 07 Unwrapped or potentially hazardous food not re-served *OBa Food protection during storage, preparation, display, 33 Containers covered, adequate number, insect and rodent! proof, emptied at proper intervals, clean service, transportation *O8b Cross-contamination, equipment, personnel, storage *O8c Potential for cross-contamination; storage practices; damaged food segregated 34 Outside storage area clean, enclosure properly constructed INSECT AND RODENT CONTROL "35a Presence of Insects/rodents. Animals prohibited Yes Yes 09 Foods handled with minimum contact Yes 10 In use food dispensing utensils properly stored STATUS PERSONNEL Yes 11 Personnel with infections restricted Yes *412a Hands washed and clean, good hygienic practices "35b Outer openings. protected from insects, rodent proof FLOORS, WALLS, CEILINGS 36 Floors properly constructed, clean, drained, coved 37 Walls, cellings, and attached equipment, constructed, clean (observed), alternative operating plan 38 Lighting provided as required, Fixtures shielded *12b Proper hygienic practices, eating/drinkIng/smoking 39 Rooms and equipment - vented as required (evidence) 13 Clean clothes, hair restraints FOOD EQUIPMENT AND UTENSILS No OTHER AREAS 40 Employee lockers provided and used, clean "41a Toxic items properly stored 14 Food contact surfaces designed, constructed, *41b Toxic Items labeled and used maintained, installed, located 15 Non-food contact surfaces designed, constructed, maintained, installed, located 16 Dishwashing facilities designed, constructed, operated [Yes 43 Complete separation from Iiving/slaeping area, laund 1. Wash 2. Rinse 3. Sanitize 17 Thermometers, gauges, test kits provided Yes 18 Pre-flushed, scraped, soaked 42 Premises maintained, free of litter, unnecessary articles. Cleaning and maintenance equipment properly stored, Kitchen restricted to authorized personnel 44 Clean and soiled linen segregated and properly stored "45 Fire extinguishers - proper and sufficient 19 Wash, rinse water clean, proper temperature "46 Exiting system - adequate, good repair “47 Electrical wiring - adequate, good repair "48 Gas appliances - properly installed, maintained Yes 21 Wiping cloths clean, used properly, stored Yes "49 Flammable/combustible materials - properly stored Yes 22 Food contact surfaces of equipment and utensils clean GENERAL No 23 Non-food contact surfaces clean Yes 50 Current license properly displayed Yes 24 Storage/handling of clean equipment, utensils Yes 51 Other conditions sanitary and safe operation 7 STATUS SINGLE SERVICE ARTICLES "52 False/misteading statements published or advertised Yes 25 Service items properly stored, handled, dispensed relating to food/beverage Yes 26 Single service articles not re-used 53a Food management cerification valid STATUS WATER AND SEWAGE/PLUMBING "S3b Employee training validation Yes *27 Water source safe, hot and cold under pressure 54 Florida Clean Indoor Air Act *28 Sewage and waste water disposed proper! 55 Automatic Gratuity Notice 29 Plumbing installed and maintained Yes 56 Copy of Chapter 509, Florida Statutes, available *30 Cross-connection, back siphonage, backflow STATUS GENERAL STATUS TOILET AND HANDWASHING FACILITIES Yes 57 Hospitality Education Program Information provided Yes 58 Smoke Free No *31 Toilet and handwashing facilities, number, convenient, designed, installed No 32 Restrooms with self-closing doors, fixtures operate properly, factlity clean, supplied with handsoap, disposable towels or hand drying devices, tissue, covered waste Total Number of COS Violations: 0 it) Total Number of Repeat Violations: 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 Nat Applicable. Items Marked as N/O are Not Observed, and were not being conducted STATE OF FLORIDA Page 3 of8 \T EPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION License Number EXHIB DIVISION OF HOTELS AND RESTAURANTS NOST NOS1620943 inspection Date 10/42/04 11:09:51 AM 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. Warning(s): 534-03 - Observed no list of cenified food service managers available at the establishment. This violation must ba corrected by ; 11/12/04, 538-01 - Observed no proof of required employee training. This violation must be corrected by : 11/12/04, Violation(s): 05-05 - Observed no stem type thermometer provided to measure lemperature of food product. [ a 17-01 - Observed tack of use of chamical test kit when using chemical sanitizer at three compartment sink. Oo o > 2 ps re 23-02 - Observed gaskets with slimy/mold-like build-up.in front prep cooler m= ot pan — 23-01 - Observed build-up of food debris, dust or dint on nonfood-contact surface.inside frant prep cooler = 25 ioe) ET pe 91-12 - Observed handwash sink used for purposes other than handwashing.washing blender In hand wash sink Gq > oO ae = = 32-14 - Observed lack of handwashing cleanser at handwashing lavatory. a ~> : my 42-03 - Observed bathroom doors left open other than during cleaning or maintenance. 9h 32-03 - Observed bathroom not enclosed with tight-fitting, self-closing doors, 46-05 - Observed emergency lighting does no! activate automatically when tested by 3 compartment sink

Docket for Case No: 05-003774

Issue Date	Proceedings
Dec. 05, 2005	Undeliverable envelope returned from the Post Office.
Nov. 14, 2005	Order Closing File. CASE CLOSED.
Nov. 10, 2005	Notice of Voluntary Dismissal filed.
Oct. 24, 2005	Undeliverable envelope returned from the Post Office.
Oct. 18, 2005	Response to Initial Order filed.
Oct. 12, 2005	Administrative Complaint filed.
Oct. 12, 2005	Election of Rights filed.
Oct. 12, 2005	Agency referral filed.
Oct. 12, 2005	Initial Order.