Oct 9 2006 11:05 la/ag/ 2886 = 1e:57 8584146749 DEPR OGA PAGE 3/19 STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION DIVISION OF HOTELS AND RESTAURANTS DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION Patitioner, vs. HINES GERALD M License Number 9900000 JERRY'S BBQ BARN License Type 2051 Respondent. Case Number 2006031312 DMi TIVE COMPLAINT The DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION, DIVISION OF HOTELS AND RESTAURANTS, ("Patitioner’), files this Administrative Complaint against JERRY'S BBQ BARN, (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 an establishment subject to the jurisdiction of the Division of Hotels and Restaurants. The respondent's business address of record is 6104 A SYMMES RD, GIBSONTON, FLORIDA 33534.The mailing address of record is JERRY'S BBQ BARN at 6108 A SYMMES RD, GIBSONTON, FLORIDA 33534, 3. Based on observation of Respondent's establishment activities and a thorough search of the Division's llcansure records, Respondent was determined to be operating without statutorily required licensure, in violation of the provisions of Chapter 509, Florida Statutes, as described in Exhibit “A” of this Complaint. Respondent was therefore issued an Administrative Determination of Non-licensure on May 22, 2006, attached hereto as Exhibit “B", documenting the activities requiring licensure and directing Respondent to apply for or renew the required license. Respondent thereafter failed to obtain licensure and was issued an Order of Closure on May 22, 2006, pursuant to Section 509.261(3), Florida Statutes, and attached herato as Exhibit "C”. 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, revecation, or refusal of a license Issued pursuant to this Chapter, and/or any other relief authorized by Chapter 509, Florida Statutes, or the rules promutgated thereto. Signed June 08, 2005 , strict Manager By delegation of the Director, or designee Division of Hotels & Restaurants Department of Business & Professional Regulation Case Number: 2006031312 Exstrict Nurmber: 03 License Number: 9900000 2051 Form ravised 03.06.08 JERRY'S BOQ BARN Oct 9 2006 11:05 la/ag/ 2886 = 1e:57 8584146749 DEPR OGA PAGE @4/19 COUNSEL FOR THE DEPARTMENT: Charles F. Tunnicliff, Lead Attorney Florida Bar No, 0153834 Department of Business & Professional Regulation 1940 North Monros Street Tallahassee, Florida 32399-1007 Certified Article Number ERTIFICATE OF SERVICE 7UbO F4GL 5849 3032 s25y BY CERTIFIED U.S. MAIL, ARTICLE NUMBER: SENDERS RECORD 1 HERESY CERTIFY that a true and correct copy of the foregoing ADMINISTRATIVE COMPLAINT has been hand served by me on this day of av Received by: Inspector's Signature Operator's Signature Title Title Case Number: 2000021312 District Number: 03 License Number 9900000 2054 Form revised 03,068.06 JERRY'S ABQ BARN Oct 9 2006 11:05 16/89/2866 16:57 B5e4146749 DEPR OGA PAGE 5/19 Exhibit A License Number. NO LIC License Type: 2051 NON-LICENSED FOOD SERVICE Case Number: 2006031312 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 44-3, Fire Prevention, General Provisions, Florida Administrative Code, and 61C-1.004(5), Florida Administrative Code. * denotes a critical violation. it Is allaged that on April 4, 2006, April 5, 2006, May 6, 2005, May 22, 2006 the licensee was in violation of Florida Statute 509(FS) and/or the Rules of the Civision of Hotels and Restaurants, Florida Administrative Code (FAC), in the following particulars. Copy(s) of the report(s) for the abave referenced inspection(s) are attached hereto and incorporated by reference as Exhibit B. * 4A, 5008-1 509.241(2)FS: (2) APPLICATION FOR LICENSE. EACH PERSON WHO PLANS TO OPEN A PUBLIC FOOD SERVICE ESTABLISHMENT SHALL APPLY FOR AND RECEIVE A LICENSE FROM THE DIVISION PRIOR TO THE COMMENCEMENT OF OPERATION. » 1B. 50-07-14 509.241(1) FS: (1) LICENSES; ANNUAL RENEWALS. EACH PUBLIC FOOD SERVICE ESTABLISHMENT SHALL OBTAIN A LICENSE FROM THE DIVISION. SUCH LICENSE MAY NOT GE TRANSFERRED FROM ONE PLAGE OR INDIVIDUAL TO ANOTHER, IT SHALL BE A MISDEMEANOR OF THE SECOND DEGREE, PUNISHABLE AS PROVIDED IN S. 775.082 OR S, 775.083, FOR SUCH AN ESTABLISHMENT TO OPERATE WITHOUT A LICENSE. OPERATING WITHOUT A LICENSE * denotes critical violation Case Number: 2006031312 District: 03 License Number: NO LIC License Type: 2051 JERRY'S BBQ BARN Oct 9 2006 11:04 la/ag/ 2886 = 1e:57 8584146749 DEPR OGA ae gde. 24 HR WARNING ISSUED CO Box gH . omnes ortouet A (keen ied ox FL 335344 EPELATING WE it DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION ‘ Division of Hotels and Restaurants CONTROL NUMBER INSPECTOR BXHIBIT B® * FOOD SERVICE INSPECTION REPORT SE Eile 2027s? eid AL NOTICE PAGE 6/19 Fite Nnber seit OR CE aR (awieR wane . NY GSe 34a ef © Catering " eoaad Gepraip M HINES |G senda f Beano wee BUSINESS NAME ; Oye ~ I (2 MFEV : Solna aang suman t WAe © Theme Park MeReys 838O Baew ( Sanpwicet She Food Cart a Bgaoagaea ADDRESS att 4 agaag a ara (3 Temporary : GIOGA |“ Symmes Rp ote he ' cur ‘ZIP (Qpuanal) wear. Est, u Cibsanton Fu 3 3534 q | No. of Space @® General CI Seating D INSPECTION REASON 1 Routina 3 (2 Complaint 4 C3 Infarmatton DISPOSITION 3 to -@ Panging ee “af “7E “t1bE ‘Dna pat} en) +p See NOTE: ITEMS IN RED AND MAR ‘RISK ARE OF CRITICAL CONCERN See réverse side for explanation of citations, 4 1s wo Ww ITEM ‘03; FOOD TEMPERATURES Cireled remperalures arr ff wiolalion (WITH Failure to comply with this Notice may initiate an administrative complaint thet may reeuit in suapansion oF rayocation of your lense and fines, ANY VIOLATIONS noted hetaln rust be oa) porectect by tha NEXT ROUTINE INSPECTION, WARNING: Violations In the operation of your astabilehment myai be corrected by: ADMINISTRATIVE COMPLAINT recommended. 30 Seasonal EMERGENCY GADER recommended based upon 2 severe and Immedtate threat-to tie pudtilic. 60 Fond Manager Name 2) ss@-de S08 aC ioe ne epty*s5ak aah 62 eC) -3¢bE ant) “S00 ‘abc 49 “qo 10 1 1B] od} T1208 nage 12a 2b sows 1 oo wo 2 ft acknowledge 7} 36) 4863 *sbL aig a7 sme HO ae) ‘40 Sanitizing Concontration., Sanitizing Temperatures COMMENTS wo «wo 7 mi dof) ‘daft a ITIONAL COMMENTS ON ATTAGHED COM! fpt of this Inspection form and comments. on IT SHEET REMINDER: Your licenga expires —_Aynoley __. Mei NR ea ; 26 Anspectar f'Ne ASE PRINT) x et Pate Keripient's Title (AdP Tite ere a lnspectar sig) ‘ - | att Pa ee | Me LEO fen Tete F oles ; G29% beet aH a Pe CHET phe os 2 er Mit bes Oct 9 2006 11:04 la/ag/ 2886 = 1e:57 8584146749 DEPR OGA PAGE 7/19 EXHIBIT BY!" Wert . Ane i State. of Florida Contral Number Ji} Departiieit ‘of Business ‘and Professorial Regulation syne Oy Be, Divisisn.of Mate! sétaurants 39 LS EX nnhosptalyedueation org a Tom Page oda B- “COMMENTS § SHEET Addendum to DBPR Forms HR 5022-008, 5022-014, 5022-016, 5022-082, or 5022-083. For comments to the Lodging, Food Service, or HACCP Inspection; Call Back/Reinspection Report, or HACCP Plan Verification. Obsemead dhe Ae tft ore § Wage! ALL. ~bheue we cade one eine ese acaba, otic“ ~ 3) Misding na me - US” ce fre sa bing wlth ac howe Ve a pa __ [ton Degct receiphs dali afi a3 AEC fire. cectingu isles - fs Wo hood Fite sxepitesaive duystean. 10 i alled es ns saat Ligh tn aE: 4S No oles K eahnguisher fecha Laing atte ~5D = Quasi ssites ao Ucemee. a Neves Zink ithedl 4 Division of Hobeler +. Peshawar foe haageste saatabli shal tal ep SAM feat dibee CH chet “eked 4 Ge 7y pried Apren f a porn ee fe eatiieet leek “he wad lens vee Laie Hal Maca “a Oesaiecries, een, a ? Seed pee ( probe ction DBPR Form HR soak O42 i Sons December 03 — “< Oct 9 2006 11:04 la/ag/ 2886 = 1e:57 8584146749 DEPR OGA PAGE a8/13 EXHIBIT B tHiklbe dee, State. of Florida Control Nurniber ee he epartinent of Business:-and- Professional Regulation . ; . Ben Division of Hotels and Restaurants ah 1S #2 i Mt wy: hospitaltyeducation. org Page _-> of. 3 Addendum to DEPR’ 2OMMENT 503 Sait Lae 5002-062, or 5009-083. For comments to the Lodging, Food Service, or HACCP Inspection; Cail ‘Béch/Reinspection ‘Report, of HACCP Plan Verification. Wren all violahins - atthe call back 4/s/o6 at 3 “le Cp of Fla. Slat S02. L nok arta hee: . —Bhy PRE held atqreater Ham +f 26 (renal be. nina mica out of beng 4 - Cold CiLapjaal dana Noapable 0 of Mairdainine Frbentiell, — __bazardhen. wethons wed sabe pres Herpticachate® __unwdetthy Horderaernes aumdl Wied. epg ac daa = ee Poaten) eumec anebsihe Informations pla Keath patheas 62+ ers casi ste fice addeess andl. nsec EK Cecinc re 0 gs leap mye leases (evi Gus rns divisine 36 hdd + tppbaermats ie ap er *y Health anc oblate Ucense ante Hee. DOP.R Lh Aes sited bag 8. 07 DBPR Form HR $022-042 www, MyFlorida.com 2004 December 06 Me annie ae yet: OdnEne. wi Oct 9 2006 11: 1la/e9/2686 16:57 8584146749 DEPR OGA ve eed LI Lat Eapepat Pets her LE AL NOTICE FOOD SERVICE INSPECTION REPORT Flite Zee: ’ 2 Catering 127 Vending MFEV Theme Park Food Cart aleSSED DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION Division of Hotels and Restaursvits LCENEING Cx CF) a CO fo BUSINESS NAME o0oo0 wes @Te Terys 68Q Barn (sanded Temporary on {OG A SyMMeS - Rp P 7 Temp. Agaoe. BAe (apc wiPern, Eat @ Geroral [© Seating - o 7 INSPECTION REASON oo Fallure ta compiy with this Notice may Inifiaia an Mant 4 + AB Aautine administrative comptaint that may result in 4 Complaint suspension or revocation, of your license and.tines. ta 40 “information @ 5 (2 Epitamlotogtcal, 7 ANY VICLATIONS noted herein must ba = DISPOSITION corrected by the NEXT ROUTINE INSPECTION, 60 Pending 24M WARNING: time enc terr— a Violations in the operation of your on De correrted by: i Bates ring, te A ir] fone] | f —_-MACGP INSPECTION 33 ADMINISTRATIVE COMPLAINT recommended. 152) [F7] ae isi) oo 54 Seasonal a 60 EMFAGENCY ORDER recommended On a geverd and himediote ‘the public. - . based VIOLATIONS throat NOTE: ITEMS IN RED AND MARKED WITH AN ASTERISK ARE OF CRITICAL CONCERN ¢ AND MUST BE CORRECTED WaMEDIATELY. Sex réverde side for explanation of citations. “hal 7 43 wa wth ‘obi eo EO eo 103 xh ene WEF eae, ee} oan 082 Wa nw aoe ITEM "20: WAREWASHING DANITIZATION Oo af Woo wo FP mal Bet a ge 100 1h) ml who 30 ‘wME) 1G ton 2 38h ag BBL woe eo el ar) COMMENTS stiiecl] ac a el eo so bbe paccere om af at Bol wo Ro nm ITFRa "03: FORD TEMPERATURES Circled lemperstuies are in vialotion NGM ‘saa; CENTIFIEY FOOD MANAGER | Rood! Manager Nome Sanitizing Concentration Sanitizing Tamperntura —__—._ degree F. ADDITIONAL COMMENTS ON ATTACHED COMMENT SHEET Lacknowledge receipt of this Intpection form and comments. REMINDER: Your lleense expires 7l-/__¢_ (chee. eee ras EAS rl n'a, " rare LEATE PRINT) i a) "Bronk "S. ae ve Cae . rare at SPELT) Vb OFS: Olo| isso) 4e7- 1345" PAGE 89/19 Oct 9 2006 11:05 DEPR OGA la/ag/ 2886 = 1e:57 8584146749 PAGE 1@/19 . oh Rnitisfenee.” State of Florida Control Number D DET Department of Business and Professional Regulation Hv. Division of Hotels and Restaurants 3 -_5 Bae 9 "www. hospitalityeducation.org . - COMMENTS SHEET Page thf etna deirbethvinhneea aan edie Addendum to DBPR Forms HR 6022-005, 5022-074, 5022-075, 6022-082, or 5022-083. For comments fo the Ledging, Food Service, of HACCP Inspection; Gall Back/Reinspection Report, or HACCP Plan Verification. ener ne tmemen en F) ee aor! HIF Hy etka HE ppl a DBPR Form HR 5022-042 action . wbemans$ www. MyFlorida.com 2004 December 06 Create ot of Sfalee eel eppmedl 7h Phe ode dle aden ber Bad Ma lene aa remnste Ll, ake ERE ROE ERR EERE UCP ERED ERED EE ERED EP ERE EEE ED EE EETE Oct 9 2006 11:05 la/ag/ 2886 = 1e:57 8584146749 DEPR OGA PAGE 11/19 Sew Coping e wi Sug we Peects TAT : wens Seceky EXHIBIPB? |. a7 ; ria DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION LEGAL NOTICE Olvision of Hotels and Restaurants CPNTAGL NUMBER INSPECTOR Coen ete Nooutrer | Sag? 1 FOOD SERVICE INSPECTION REPORT UCENSING + = gp -+ piermier s * *: 4 f “ad lf COUNER NAME fe Catering ee a Cernld rn. kines 2 wt “ TRSINESS NAME vine 2 TP 7 MFDV Thame Park sh " Food Gart ADRESS Q = Temporary ta | OLA Syymenes Bed — Temp. Asoo ZIP (optional) wiParm. Eet, Gibson FL 45) Bia of Seals cay We Generali (3 Seating | Mouth Dav Our . Failure io comply with this Notice may initiate ar 1 @B Rautine adminlatrative complaint that may result in oe | cpap a | on ee oe 40 Complaint susperision or revocatlon af your license and fines. =| ae Go) 43 Information INSPECTION RESULTS a || Gh me in 3 Gt 8 (5 Episemtofogical 7 (1 ANY VIOLATIONS noted hareir rust be - eorracted by ha NEXT ROUTINE INSPECTION, 7) 3 oa 0 oa et ao) Be Ba 6 Pending 2M WaRNING: $7 2e-c a Vidlations in the operation af your 3 ae ebtanll nl musi be earreciad by: fa] Bi pany Tue: @) a he o HACCP INSPECTION 33 ADMINISTRATIVE COMPLAINT renammender. fH a et \— i baz) § {> Seasonal intl} oh — fi Fe) BC} EMERGENCY ORDER recommenced _ 2 @ sl bagred upen a severe and immediate ’ ' TERN OAR PODE TEMPERATIAES? Y 7 ip SO aa TENGEN " oy toledted eripatatules are tn violalion ED, Foup Ms Ay e ‘OTE AIMED! ATELY. . Type of Food Temperature Faad Manager Name Certificate Vaie See reverse side for explanation of eltations, coat) “OAT 1a 2a) aaflaate ‘0 ‘rpc oa} WE} eal] amet orfTh-oabeT) 1603 aeftrasel azt tO] Jame YE} aeiT an 4a sal) som? og del ee gel aa sued Sanitizing Cancentration______._ pam sate (TF NE ee ee 2 5 ° wo} 1a CS aC Oe Sanitlzing Tamperatuté ——____ degrees F ead Teo eT ae a8 a6] (ir a 8 oC wll a7 Oo COMMENTS pst}? aT ai ap we 87 oe at Sa “ “a9 58) a ce ia} 2207} aa ADDITIONAL GOMMENTS OM ATTACHED COMMENT SHEET acknowledge receipt of this Inspection form and comments. REMINPER: Your license expires eqgurnrs Mae (PLEASE PRINT Tnapocrariy ibm (PEASE PRINT) at Sormicy WIN eS i nie rene Tule 4 4 ne Lain + Seopa Spastabit — ns Rovgvona't Tithe eens : E _— #xtantilnteat Teephace ~O Yi cme 1 50 Cifive Tatayrhcste . eae a, / ; | res) CR OS-OAG fF 1/7 ESB) 497 ~ (BGS lb | ol Oct 9 2006 11:05 1e/a9/2886 18:57 sBsadiderag DEPR OGA PAGE 12/19 EXHIBITB 7.4. DBPR State of Florida Controf Number Department of Business and Professional Regulation la rem es Peek jy Division of Hotels and Restaurants 39. IS¥Q4_ www. hospitalityeducation. org COMMENTS SHEET Page Shit Do Addendum to DBPR Forms HR 5022-005, 5022-014, 5022-015, 5022-082, or 5022-083. For comments to the Lodging, Food Service, or HACCP inspection; Gall Back/Reinspection Report, or HACCP Plan Verification. Ne puntocd dos Gllinaing re C/G Ob § {Alarring Te Zeued Coll mel: dite bo Che, ch tie ) re . Sua |e ie J hunbla hadneeacnanke le engin! cade, ” Ae HA PV net” Ts) ad Side time. itch ada to 7 wane: a . : : Laas : a aa a las 65 eda, efc) ‘taadad 7 + Hera femme! plan ltipns eval { Lab vcd Sn Sl Da glam (ifn plage ath tHe Divisun i 9 q Waning t of amesship, Mudie c ze : ng fvitactt _f XA Lt (250) U% 7 -139S “Talal AsSSeX Coll Conta — 7 ind eapeeate ne Change of somtee Licam@ping cpus faa Leena #3915724 Jd ~ _ &. 7 5 izes: ac oe, wnt he. fla 2 inepticharsanade oud ty ly TD BK { business check me ohaf coded. DBPR Form HR 8022-042 yyw, MyFlorida.com 2004 December 06 ED . 1a/ 9/2886 18:57 8584146749 Calif baal - Her I om RT DEPARTMENT OF BUSINESS AND proressioual Recut ation Ps: Division of Hotels and Restaurants LICENSING -., Ente Saiber DISTRIGT =? OR ESER BERENEKK ESA) DEPR OGA taal Coen Fleeced sla lec Oct 9 2006 11:05 PAGE 13/19 1S temonae DTT B LEGAL NOTICE FOOD SERVICE INSPECTION REPORT TARVER MAME, 7] & Catering le Ganaral 11 Seating © Vanding MFpV Thame Park Food Can a Temporary Tamp. Asset, 2 {panel wiParm, Est. 33534 Mo, af Seats | of OT 5 ' Bm ow oh ey @m i oo me Op] 3 3 ee 9 a sion! e| gee! oom alan) #]| am | ag a| ee | ol ogm | eam mi aa | a) om | wo =| wl] al ae aa 3 Pa oe Be jm a] oo @ Pad | m Ho am a 2 an BE i mm = | aR ee a Be fe ma INSPECTION REASON 4 BH Routine 20 Comptalnt 4c} § (2) Epidemiotogicat DISPOSITION information 4 Pending m3 HAGCP INSPECTION [gt a7 FoOb TEMPLEATURES ° ndnviotatlon: i. Failure to comply with this Notice may initiate an administrative complaint that may result tn suspension or revocation of your Heense and fines. ANY VIOLATIONS noted hereln must be corrected by the NEXT ROUTINE INSPECTION, WARNING: Vioiations in tha operation of yout astabliahment must be cerrectad by: Tine: Panes ADMINISTRATIVE COMPLAINT recommended. Seasonal EMERGENCY ORDER tecommonded based upon # severe and immedialo threat to the public, a 12 6 TIFIED FOOD Cumiftcate Date Monagar Name fl wo 23} sal QawO ‘Co ort} “ain sate Lo oa BC 24 scab sc Chios ae sai 4g) san {7} Sanitizing Concantration Sanitizing Temperature —————_.——, degrees F, ARE IN VIOLATION 2 ATEM 148: -_ pUPPHESSION SV STERE, Pintete) pam 4A (2 'SabeT} ‘ase 10173 ‘asf $4) some ME 7? a6} S57] ya 1 bs sani) St} ac} 402) + moo oat) iat ft acknowledge recalpt « of this Inspeation form and comments, r Revitny jn OM EASE PENT Tigpecior’s Bante PLEASE PRINT) er te Nien I bi NLS 7m The PEDURVERRA EGRET ERE AS AREER AT ERE RET EERE RATTLES Rin | 2, Revit Tle —_ . maaen eo sdaliow, and _Sifela Syeciglicl ” Cy ‘2 sa = = ¢ TM the L Tate : meron ys ET ZLZ SS BRO Gp) 447-1295 “Slaa/oe Oct 9 2006 11:07 1la/e9/2686 16:57 8584146749 DEPR OGA PAGE 14/19 eee © ue ec tH heey IMIR tenet eee te STATE OF FLORIDA Page i DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION DEVISION OF HOTELS AND RESTAURANTS waw. myfiortds.com/dbpr : 2 FOOD SERVICE INSPECTION REPORT a LEGAL NOTICE Failure to comply with thiy Notice may Inttiate an administrative complaltt that may result In suspension or revocation ofyour license and flies. 5/22/06 1:17:19 PM . Routine 3918829 NOST inspection Date and Time Thspection Reason License Number HINES GERALD M : NCY ORD fi th . Gwner Name EMERGE! ER of suspension of license, 813-671-8323 . JERRY'S BBC) BARN Area Code/Telephone Number Susiness. Name Trepection Resuit 0 Nunmber of Units Callback Date/Time License Expiration BL06A SYMMES RO . GIBSONTON FL 33534 Andress | Chy / State [zip Tele, ——_—— Ttom 3: Pood Temperstures Them 53a: Cert, Food Managers Tram 20: Warewashing Santization Item 45; Fire Extinguishers and Fira | Suppression Systems Dar ee mets, hast froert, 17 Degrees fF Sanitizer Type! Chiarina found at ane ied Spe Bt cing four Ingat a BEZET, ingTeee F, lu ali eneats, dell rnb table j top of unit, 56 concentration of rot observed, ee pic ase ie Be, vat . dining room has. a certficationdsts of 4/05 Degtaae F ham, dell make table ; bottom of unit, 34 Degrees FL Enos, raw shell, deft make table ; bottom of unit, 5B Dagranb F, hard batted eggs, dell make tabln ; bottom of uni, 54 Degrees F, bbq chicken , home refrigerator #2, right hand side of store toon, 43 Degrees F. Ready to nat PHF, home refrigerati #1, left Hand sda of store coom., 43 Degreck F, . plea, meet @ppings home refiigerator wi, left at inletefuctrata reine Act, Enferm Eater NOTE: Items marked above with an weterisk (*} indicate a violation Inspector's Comments RIGINAL INSPECTION DONE GN 4/4/06 TO NEW OWNER - 24 HOUR CALL BACK CONE ON 4/5/06. CALLBACK FOR PLAN REVIEW WAS COMPLIED ON 5/6 AND. EW INSPECTION REQUIRING LICENSING WAS STARTED THE SAME DAY. NO SERVIGE REQUEST WAS PLACED PRIOR TO CALL BACK DATE OF 5/20/06. SPOKI OWNER IN PERSON ON 6/17/06, REMINDED TO GET LICENSED, OWNER OPERATING ATT T TIME SUT UNABLE TO PROVIDE LICENSING FEES, REQUESTED INSPECTOR. WAIT UNTIL MONDAY - MADE LICENSING APPOINTMENT FOR TODAY. ADMINISTRATIVE DETERMINATION AND ORDER OF CLOSURE ISSUED. OWNER WAS NOT AT RESTAURANT WHEN INSPECTORS RETURNED WITH COPY OF INSPECTION AND ADMINISTRATIVE ETERMINIATION PAPERS. OWNER INE LL CERTIFY MAIL TO LICENSE LOCATION ADDRESS WHICH OWNER PUT AS MAILING ADDRESS ON APPLICATION FOR LICENSING, URANT ‘TO REMAIN CLOSED AND STICKERS NOR REMOVED FROM BUILDING UNTIL ALL VIOLATIONS ARE COMPLIED AND OWNER NOTIFIES THE BIVISION OF HOTELS AND RESTAURANTS: FOR LICENSING. Lacknowledge receipt of this nepection form 2nd comments. 5/23/06 — a y Signature of Recipient Trapoctor Signature / redpient; Carald mM Hines For further Inforrration please contact: Tithe: chaser Oath ee Phone: FIR GTI THES STATUS | ~TSOURCE <7 SATS PHF TEMPERATORE CONTROL) yes *11a Approved source Yes *03b Hot food at proper temperature Yes “““"aO1b Wholesome, sound condition yes fac Foods properly cooked/reheated “T No (02 Orighel container; properly labeled, date marking hs 0d Foods properly covled STATUS PHE TEMPERATURE CONTROL No 704 Paciities to maintain product temperature _| Yes —""t"35 Cold Food at proper temperatures during starage, display, [No g7 Thenmometers provided and consplelously slaced— satvice, transport, and cold holding Yes e068 Potantialy hazardous foods properly thawed "| Violations marked wit af asterisk are critical violations. ftahns Tharked YES arg in compliance. ems Marked NO art violations. ‘Speetic details of violation art listed on subsequent pagne, nd were not holng canducted at the tine of Inspection, frente marked M/A are Not Applicable, Thame Marked as N/Q are Not Gheerved, 2 OBPH Face HR 5072-015 Oct 9 2006 11:07 la/ag/ 2886 = 1e:57 8584146749 DEPR OGA PAGE 15/ 19 EXHIBIT B STATE OF FLORIDA Page 2 DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION License Number DIVISION OF HOTELS AND RESTAURANTS NOST 9915829 www. Inyflorida.comvdbpr . Inspection Date FOOD SERVICE INSPECTION REPORT - 5122/08 1:17:19 PM LEGAL NOTICE Fallure to comply with this Notles may initiate an admitlatrative complaint that may result in susperision or revocation of your licanse and fmes. STATUS FHE TEMPERATURE CONTROL STATUS GARBAGE AND REFUSE DISPOSAL Yes "07 Unwrapped or potentially hazardous food not ra-served No aa Contanars covered, sdequate number, Insect and redent Yes "Toga Food protection during storage, preparation, display, joreof, emptied at proper intervals, clean _panice, transportation 34 Outside storage arae clean, endlosure properly | Yes hOgb Cross-contamination, equiptnant, personnel, storage eonstructed Yes, *08e Potantial for cross-contamination; storage practices; INSECT ANG RODENT CONTROL _| damaged jood segregated _ No 359 Prasence ofinsectsrodents. Animats prohibited Yes +04 Foods handled with minknum contact ves +35b Qutar openings protested ftom Insects, rodent pron! ‘Yas 10. Jn use fond diepensing utensils properly stored STATUS FLOORS, WALLS, CEILINGS _| STATUS PERSONNEL Yas 36 Floors properly constructed, clean, drained, coved es 41 Personnel witt Infectlans fesirictead No 37 Walls, callings, and attached equipment, conetructed, ves "124 Hands washed and clean, good hygienle practices lean (cbservedh, alternative operating plan Mo 38 Lighting provided as required. Fixtures shigided Yas "12b Proper hygienic practines, eating/dtinking/smaking es 89 Rooms and equipment - vented as required |ewoorn staTus | OTHER AREAS ves 13 Clean clothes, halr restraints Yas 40 Employee lockers provided and used, clean STATUS FOOD EQUIPMENT AND UTENSILS yes +4 ta Toxit tems properly storect No 14 Food contacl surfaces designed, constructed, Yes *41b Toxic Items jabeled and used properly maintained, installed, incatacd No 42 Premises maintgined, iree of iter, unnecessary artices. Yes 15 Non-food contact surfaces designed, constructed, cleacing and maintenance equipment properly stored. maintalned, installed, located . Kitchen restricted te authorized personnel Yes *18 Dishwashing facilities designed, constructed, operated [Yea 63 Complete separation from living/sleepind area, laundry 1 Wash 2. Rinse 3, Sanitize yes 4 Clean and soiled! linen segregated and properly stored [iio “47 Therhomaters, gauges, test kite provided {STATUS SAFETY Yes 18 Pre-lushed, scraped, soaked Yes *45 Fire extinguishers - proper arid sufficient Yes _[19 Wash, tinse water clean, propar temperature Yes 46 Exiting system - adequate dood rapatr Yas "20a Sanilizing concentration, No +47 Electrical witing - adequate, good rapalr [Yas “20b Sanitizing temperature pes 48 Gas appliances - properly Installed, maintained No 21 Wiping cloths clean, used property, stored Yes +49 Flammable/sormbustibie materials - properly stared es 22 Food contact surfaces of equipment sng wensils clean STATUS GENERAL yes |24 Non-tood contact surfaces clean No 50 Current pense properly displayed : No 24 StorageMandiing of clean equipment, utensils ho js1 other conditions sanitary and safe qperation STATUS SINGLE SERVIGE ARTICLES Vas 62 Fatse/misleading statements published of advertised No 25 Service items properly stored, handled, dispensed * |ralating to food/everags | yes 26 Single setviee articles not re-used tiled 530 Food management certification valle STATUS WATER AND SEWAGE/PLUMBING No hS3b Employes, tralning validation YES +27 Water soures safe, hot and cald under pressure [ves 54 Florida Clean Indgot Alt Act ‘Yes +28 Sawage and waste water dlsposed properly Yes = Automatic Gratuity Notlce 29 Plumbing installed and maintained No 56 Copy of Chapter 509, Florida Statutgs, available _| +30 Gross-connettion, Hack slshonage, bacidiow. STATUS: . GENERAL STATUS TOILET AND HANDWASHING FACILITIES Yes 57 Hospitality Education Program Information provided Taq Tolley any handwashing factiities, number, convenient, [res 58 Smoke Free _[pesioned, installed at i n iT ty realy TT eat, Bendeoop, depaeeti Te mead | Total Number af COS Vialatlons: 0 drying devices, Weave, covered waste receptactas ‘Total Number of Repeat Violations: 4 J inert markad YES ere In compliance. tems Marked NO are viotalions, Specific details of violniien ere Nisted on Violations markad with ah asterisk are critical viotations. tare ax NID ara Not Observed, and were not being conducind at thé lime of inspection. subsequent pages. Hems marked NVA are Nel Appileabie. items Marked DBER Form HR 5022-018 Oct 9 2006 11:08 la/ag/ 2886 = 1e:57 8584146749 DEPR OGA PAGE 16/19 EXHIBIT B Page 3 Litense Number NOST 975829 STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION DIMISION OF HOTELS AND RESTAURANTS www. nyflorida.com/dbpr Inspection Date 5/2206 019 PM FOOD SERVICE INSPECTION REPORT LEGAL NOTICE Faflure to camply with thle Notlea may Inflate an administrative complaint that may result In suspension or ravocation of your ficanse and fines. Warning(s): 02-07-1 - Ghservad precaased ready-o-8at, potentially hazardous food neld more than 24 hours net property dale marked aflet aprning. 04-01-17 - Celd nolding equipment incapable ef maintaining poanially hazardous food at proper temperatures; make tablefcooler and 2 home type refrigerators. 05-05-4 - Ambient air thermometer in helding uni nel accurate within + 3 degrees Fahranhek. 14.36-1 « Observed gaskela/seals on cold holding uf in poorrepalr, hanging rom doors at dai maka cooler, 17-07-1 « No cheraical test kit provided when using chartigal sanitizer at these-comparimant sinkWwarewashing machine, 21-06-1 - Wel wiping clathe nat faundered dally, murtipla dirly, wet dothes In sormge sree In tall buekel. 24-06-14 - Qhsarved clean utenslis‘aquipinent stored on floor ane \ollet roam, 2501 ~ Observed single-service anicies stored withaut protection from contamination, ¢abine: infested with live roaches In kitenen. 29.121 « Froor drat ever in kitchen Gover missing and erain in visibly clogged with sollds, 33-154 - Observed garbage can lid opan. 94-0841 - Observed onneceseary items stored outside bulling including 2 large piles of aak trae branches. 354.09-1 - Observed dead roaches of premises. 3BA-D8+ » Observed fonch activity 8 evidenced by live roaches found In kitchen cabinet and on and under refrigaratars In store room, AL leact 20 live reaches, Garman ype, cange in size frern naw born to full mature aduits observed warming out and jumping aut of casinat when opened, Full profassionat alze and type bug sprayer in resteurant, Unable to eseertaln H usable tor restaurants. Gwner of restaurant and the buliding ownar both admit hey sprayed fast tight and have been doing own pest contol, 35A-09-1 - Observed the presence of Insects, redants, of other pests; ants on kitchen Hoor neg open floar dain, 37-121» Calling not smooth and easly cleanable; open callings In dry storage. 38-07-41 + Lights missing the proper shield, glaave coatings or covers. 38-1041 ~ Light not funetioning in steta room stering food and 2 refrigerators. 42-1 te4 «Observed urinecessary tems on the premise, Irash outside, piles of ak wood and branches, 7 bikes In front entry, 47-D6-4 - Observed extenslon covtis In use for non-lemporary period. 47-061 » Observed 2 spilttarmult-plog adapter in use In kitchen, 50-08-41 - Establishment optraling without # current Hotel and Reslaurant jicanse, Unatia le complate Heensing iaday due to warnlng stalus. §4-13-1 - No Helmilch maneuver sigh posted, BletG-1 -Mo plan review sybmitiad and renovations In progress, This was praviously complied from inivel warning on AID and tantaurant wes retuned 19 sandwich shop "statue", Today, Ihere Is ennent pad with wood and sereen anelogue containing 8 gas grill, a large barral style bbq smoker and 8 {raller style smokar in parking lol. pacific instructions regarding plan review have been given in provious warning. No food observed cooking at {Ime of Inspection but evidence of cooking found cn grills as well a& parbequed cigken in cooler win ne other enoxag Equipment to prepare. Newly added pizza oven in kithen as well as aletrc burner. Repeal Vintation. 534.011 - Manager lacking proof of Food Manager Cartificatlon, GAPR Form HR 6022-015 Oct 9 2006 11:08 la/ag/ 2886 = 1e:57 8584146749 DEPR OGA PAGE 17/19 vm EXHIBIT B Licenga Number NOST 3915829 STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION DIVISION OF HOTELS AND RESTAURANTS waw. myflorda.com/dkpr Inspection Date 5/22/06 13719 PM FOOD SERVICE INSPECTION REPORT LEGAL NOTICE Fallure to epraply with this Notice may initlate an administrative complaint thet may reaull in susponsion of revocation of your leense and fines. S3E-08-1 - No prodl of required amplayee training provided, All publlt food servic aslabiishments must provide tha divigion whih proof of employes tralning upon recut including, but nat fined to, at the time of any division inspection of tha establishment, Pra 5601-1 - Copy of Flotica Statute 509 nol avallable In the esiablahment, DEPR Form HR 5022-015

Docket for Case No: 06-003875