; STATE OF FLORIDA ‘DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION)» Sep t DIVISION OF HOTELS AND RESTAURANTS loa ; DEPARTMENT OF BUSINESS AND m~ Wye 47 PROFESSIONAL REGULATION O] -Y05 | A oH RtS OH OF Petitioner, Hee ST RAT} VE vs. . ‘CARINGS License No. 1621180 PURE CAFE R dent License Type 2010 espon ha . ’ Case No. 2006067650 ADMINISTRATIVE COMPLAINT . The DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION, DIVISION OF HOTELS AND RESTAURANTS, ("Petitioner"), files this Administrative Complaint against PURE CAFE, ("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 ail 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 5631 CORAL RIDGE DR, CORAL SPRINGS, FLORIDA 33076.The mailing address of record is PURE CAFE, at 1375 HARBOR VIEW E, HOLLYWOOD, FLORIDA 33019. 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 rul $ Pro) Signed December 13, 2006 |] Ken Buck, District 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: | HEREBY CERTIFY that a true and correct copy of the foregoing ADMINISTRATIVE COMPLAINT has been hand served by me on this. day of , 2006 Received by: Inspector's Signature Operator's Signature Titie, Title Case Number: 2006067680 District Number: 02 License Number: 1621180 2010 Form revised 10,10,06 PURE CAFE Exhibit A License Number: 1621180 License Type: 2010 PERMANENT FOOD SERVICE Case Number; 2006087650 “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 Safely Code, incorporated by reference at Chapter 4A-3, "Fire Prevention, General Provisions", Florida Administrative Code, and 61C-1.004(5), Florida Administrative Code. “" denotes a critical violation. tis alleged that on August 2, 2006, November 29, 2006 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 incorporated by reference as Exhibit B, * 4,02-08 3-501.17(A) FC (A) EXCEPT AS SPECIFIED IN PARAGRAPH (E) OF THIS SECTION, REFRIGERATED, READY-TO-EAT, POTENTIALLY HAZARDOUS FOOD PREPARED AND HELD REFRIGERATED FOR MORE THAN 24 HOURS IN A FOOD ESTABLISHMENT SHALL’BE CLEARLY MARKED AT THE TIME OF PREPARATION TO INDICATE THE DATE BY WHICH THE FOOD SHALL BE CONSUMED WHICH IS, INCLUDING THE DAY OF PREPARATION: (1) 7 CALENDAR DAYS OR LESS FROM THE DAY THAT THE FOOD IS PREPARED, IF THE FOOD IS MAINTAINED AT ...(41 DEGREES FAHRENHEIT) OR LESS; OR (2) 4 CALENDAR DAYS OR LESS FROM THE DAY THE FOOD IS PREPARED, IF THE FOOD IS MAINTAINED AT ...(45 DEGREES FAHRENHEIT) OR LESS AS SPECIFIED UNDER PARAGRAPH 3-801.16(C). OBSERVED POTENTIALLY HAZARDOUS FOODS NOT DATE MARKED....WALK-IN GOOLER. * 2,02-13-1 3-603,11 FC:; CONSUMPTION OF ANIMAL FOODS THAT ARE RAW, UNOERCOOKED, OR NOT OTHERWISE PROCESSED TO ELIMINATE PATHOGENS, (A) EXCEPT AS SPECIFIED IN PARAGRAPH 3-401,11(C) AND SUBPARAGRAPH 3-401.11(D)(3) AND UNDER PARAGRAPH 3-801.11(C), IF AN ANIMAL FOOD SUCH AS BEEF, EGGS, FISH, LAMB, MILK, PORK, POULTRY, OR SHELLFISH IS SERVED OR SOLD RAW, UNDERCOOKED, OR WITHOUT OTHERWISE BEING PROCESSED TO ELIMINATE PATHOGENS, EITHER IN READY-TO-EAT FORM OR AS AN INGREDIENT IN ANOTHER : READY-TO-EAT FOOD, THE PERMIT HOLDER SHALL INFORM CONSUMERS OF THE SIGNIFICANTLY INCREASED RISK OF CONSUMING SUCH FOODS BY WAY OF A DISCLOSURE AND REMINDER, AS SPECIFIED IN PARAGRAPHS (B) AND (C) OF THIS SECTION, USING BROCHURES, DELI CASE OR MENU ADVISORIES, LABEL STATEMENTS, TABLE TENTS, PLACARDS, OR OTHER EFFECTIVE WRITTEN MEANS, (B) DISCLOSURE SHALL INCLUDE: (1) A DESCRIPTION OF THE ANIMAL-DERIVED FOODS, SUCH AS "OYSTERS ON THE HALF SHELL (RAW OYSTERS)," "RAW-EGG CAESAR SALAD," AND “HAMBURGERS (CAN BE COOKED TO ORDER),” OR (2) IDENTIFICA OF THE ANIMAL-DERIVED FOODS BY ASTERISKING THEM TO A FOOTNOTE THAT STATES THAT THE ITEMS ARE SERVED RAW OR UNDERCOOKED, OR CONTAIN (OR MAY CONTAIN) RAW OR UNDERCOOKED INGREDIENTS, (C) REMINDER SHALL INCLUDE ASTERISKING THE ANIMAL-DERIVED FOODS REQUIRING DISCLOSURE TO AFOOTNOTE THAT STATES: (1) REGARDING THE SAFETY OF THESE ITEMS, WRITTEN INFORMATION IS AVAILABLE UPON REQUEST; (2) CONSUMING RAW OR UNDERCOOKED MEATS, POULTRY, SEAFOOD, SHELLFISH, OR EGGS MAY INCREASE YOUR RISK OF FOODBORNE ILLNESS; OR (3) CONSUMING RAW OR UNDERCOOKED MEATS, POULTRY, SEAFOOD, SHELLFISH, OR EGGS -MAY INCREASE YOUR RISK OF FOODBORNE ILLNESS, ESPECIALLY IF YOU HAVE CERTAIN MEDICAL CONDITIONS. . . OBSERVED CONSUMER ADVISORY FOR RAW/ UNDERCOOKED ANIMAL PROTEIN NOT POSTED. Case Number: 2006087650 Olstrict Number: 02 License Number: 1621180 2010 Form revised 10.10.06 PURE CAFE * 3,0B8A-20 3-305.11FC FOOD STORAGE. (A) EXCEPT AS SPECIFIED IN PARAGRAPHS (B) AND . (C) OF THIS SECTION, FOOD SHALL BE PROTECTED FROM CONTAMINATION BY STORING THE FOOD: (1) INA CLEAN, DRY LOCATION; (2) WHERE IT IS NOT EXPOSED TO SPLASH, DUST, OR OTHER CONTAMINATION; AND (3) AT LEAST ...(6 INCHES) ABOVE THE FLOOR. (B) FOOD IN PACKAGES AND WORKING CONTAINERS MAY BE STORED LESS THAN ...(6 INCHES) ABOVE THE FLOOR ON CASE LOT HANDLING EQUIPMENT AS SPECIFIED UNDER SECTION 4-204.122. (C) PRESSURIZED BEVERAGE CONTAINERS, CASED FOOD IN WATERPROOF CONTAINERS SUCH AS BOTTLES OR CANS, AND MILK CONTAINERS IN PLASTIC CRATES MAY BE STORED ON A FLOOR THAT IS CLEAN AND NOT EXPOSED TO FLOOR MOISTURE. OBSERVED FOOD STORED ON FLOOR....WALK-IN FREEZER. * 4,12A-08-1 61C-4,010(1)E) FAC: (1)(E) A COPY OF THE WRITTEN OPERATIONAL PROCEDURES MUST BE MADE AVAILABLE IN EACH FOOD ESTABLISHMENT AT ALL TIMES FOR USE BY THE PERSON IN CHARGE AND FOR REVIEW BY THE REGULATORY AUTHORITY.UPON REQUEST. THE OPERATIONAL PROCEDURES MUST BE REVIEWED BY THE OPERATOR ANNUALLY AND MODIFIED AS NECESSARY. A VERIFICATION OF THE ANNUAL REVIEW MUST BE RECORDED AS PART OF THE WRITTEN PROCEDURES. OBSERVED EMPLOYEES NOT WASHING HANDS. 5.13-02 2-402.11FC EFFECTIVENESS. (A) EXCEPT AS PROVIDED IN PARAGRAPH (B) OF THIS SECTION, FOOD EMPLOYEES SHALL WEAR HAIR RESTRAINTS SUCH AS HATS, HAIR COVERINGS OR NETS, BEARD RESTRAINTS, AND CLOTHING THAT COVERS BODY HAIR, THAT ARE DESIGNED AND WORN TO EFFECTIVELY KEEP THEIR HAIR FROM CONTACTING EXPOSED FOOD; CLEAN EQUIPMENT, UTENSILS, AND LINENS; AND UNWRAPPED SINGLE- SERVICE AND SINGLE-USE ARTICLES. (B) THIS SECTION DOES NOT APPLY TO FOOD EMPLOYEES SUCH AS COUNTER STAFF WHO ONLY SERVE BEVERAGES AND WRAPPED OR PACKAGED FOODS, HOSTESSES, AND WAIT STAFF IF THEY PRESENT A MINIMAL RISK OF CONTAMINATING EXPOSED FOOD; CLEAN ST UTENSILS, AND LINENS; AND UNWRAPPED SINGLE-SERVICE AND SINGLE-USE ARTICLES OBSERVED EMPLOYEES WITH NO HAIR RESTRAINTS. 6, 14-02 4-202,14 FC FOOD-CONTACT SURFACES. (A) MULTIUSE FOOD-CONTACT 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/ PITTED AND NO LONGER CLEANABLE. Case Number: 2006067650 District Number: 02 License Number: 1621180 2010 Form revised 10.10.06 PURE CAFE * 7,53B8-01 .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 A CERTIFIED 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, 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 TRAINING PROVIDED, ALL PUBLIC FOOD SERVICE ESTABLISHMENTS MUST PROVIDE PROOF OF EMPLOYEE TRAINING UPON REQUEST, INCLUDING, BUT NOT LIMITED TO, AT THE TIME OF ANY DIVISION INSPECTION OF THE ESTABLISHMENT. . 821-05 4-802.11(E)FC DRY WIPING CLOTHS SHALL BE LAUNDERED AS NECESSARY TO PREVENT CONTAMINATION OF FOOD AND CLEAN SERVING UTENSILS. OBSERVED SOILED WIPING CLOTH IN USE. 9,25-03 4-903.11(C)(D) FC (C) SINGLE-SERVICE AND SINGLE-USE ARTICLES SHALL BE STORED AS SPECIFIED UNDER PARAGRAPH (A) OF THIS SECTION AND SHALL BE KEPT IN THE ORIGINAL PROTECTIVE PACKAGE OR STORED BY USING OTHER MEANS THAT AFFORD PROTECTION FROM CONTAMINATION UNTIL USED. (D) {TEMS THAT ARE KEPT IN CLOSED PACKAGES MAY BE STORED LESS THAN 16 CM (6 INCHES) ABOVE THE FLOOR ON DOLLIES, PALLETS, RACKS, AND SKIDS THAT ARE DESIGNED AS PROVIDED UNDER SECTION 4-204,122, OBSERVED SINGLE-SERVICE ARTICLES IMPROPERLY STORED, * 10,45-01 61C-1.004(5) FAC ALL FIRE SAFETY, PROTECTION AND PREVENTION EQUIPMENT MUST BE INSTALLED, APPROVED, MAINTAINED AND USED IN ACCORDANCE WITH CHAPTER 509, FS, AND THE NATIONAL FIRE PROTECTION ASSOCIATION LIFE SAFETY CODE CHAPTER 101, AS ADOPTED BY THE DIVISOIN OF STATE FIRE MARSHAL IN CHAPTER 44-3, FAC, OBSERVED HOOD REPORT NOT AVAILABLE WITHOUT VIOLATIONS, 11,51-04 §09.213(1)FS | EVERY PUBLIC FOOD'SERVICE ESTABLISHMENT SHALL POST A SIGN WHICH ILLUSTRATES AND DESCRIBES THE HEIMLICH MANEUVER PROCEDURE FOR RENDERING EMERGENCY FIRST AID.TO A CHOKING VICTIM IN A CONSPICUOUS PLACE IN THE ESTABLISHMENT ACCESSIBLE TO EMPLOYEES. -A. OBSERVED NO HEIMLICH MANUEVER SIGN POSTED, B. OBSERVED HELIUM/ CARBON DIOXIDE TANK NOT ADEQUATELY SECURED. Case Number; 2006067650 District Number: 02 License Number: 1621180 2010 Form revised 10.10.06 PURE CAFE * 12.53A-01 509.039 FS AND 61C-4.023(1) FAC | ALL MANAGERS EMPLOYED BY A FOOD SERVICE ESTABLISHMENT MUST HAVE PASSED [THE FOOD SERVICE MANAGER] TEST AND RECEIVED A CERTIFICATE ATTESTING THERETO. MANAGERS HAVE A PERIOD OF 90 DAYS AFTER EMPLOYMENT TO PASS THE REQUIRED TEST. ALL MANAGERS WHO ARE RESPONSIBLE FOR THE STORAGE, PREPARATION, DISPLAY, AND SERVING OF FOODS TO THE PUBLIC SHALL HAVE PASSED A CERTIFICATION TEST APPROVED BY THE DIVISION DEMONSTRATING A BASIC KNOWLEDGE OF FOOD PROTECTION PRACTICES AS ADOPTED IN THIS CHAPTER. THOSE MANAGERS WHO SUCCESSFULLY PASS AN APPROVED CERTIFICATION EXAMINATION SHALL BE ISSUED A CERTIFICATE BY THE CERTIFYING ORGANIZATION, WHICH IS VALID FOR A PERIOD OF FIVE YEARS FROM THE DATE OF ISSUANCE. OBSERVED NO PROOF OF CERTIFIED FOOD MANAGER. * 13.17-01 4-302.14FC 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 TEST KIT NOT AVAILABLE AT THREE-COMPARTMENT SINK. Case Number: 2008067650 _ District Number: 02 License Number: 1621180 2010 Form ravised 10.10.06 PURE CAFE . Q florida fadort... DEPARTMENT OF BUSINESS AND PROFEssioNALREcuLATIN EXHIBIT B Page 1 of Division of Hotels and Reataurants INSPECTION TYPE D1 Unscheduled (ROUT) 1 Licensing (Lic) C1 Complaint Ful (COMP) DBPR LEGAL NOTICE Food Service Inspection Report Pr LICENSE TYPE 1) 2010 Permanent Food Service 2012 Thame Park Food Gat: 0 2013-Catering . (20 2044 Mobile Food Dispensing Vehidle 1 2015 Vending Machine O 2054 Unlicensed Food CO Complaint Partial (CPAR) C1 Disaster Response (OSTR) 1 Service Request (SERV) (1 Quallty Assurance (QA) City, Stata, Zip: ZA) ow [Wit Data Inspector Area 7 | ew Saats/Units: LICENSE NUMBER G2 g 0 REMINDER: Your license expires 0 Training (TRNG) Cit rasan p20 (2 Original Visit Poa back FOR CALLBACKS, ORIGINAL VISIT DATE WAS: ___/___/ [ FOODBORNE ILLNESS RISK FACTORS AND PUBLIC HEALTH INTERVENTIONS The circled letiers to the leff of each item Indicale that item's status at the time of Inspection IN=In compliance OUT = notin compliance N/O=notobserved NiA=notapplicable COMPLIANCE STATUS (Items marked “OUT” of compliance require immediate corrective action) Mark “X* In appropriate box for COS and/or R COS = corrected on-site during inspection R= repeat violation 1 COS [1a [Food obtained from approved source { Approved Source it | NO Ob YIN | Out. 1 NIA | 02-14 Consumer Advisory Wholesome, sound condition Consumer advisory on Tawlundercooked oysters Bie i IN t out” i ‘|_NIA_| 02-13 | Consumer advisory on raw/undercooked animal products | NIA 03a Cold food at proper temperatures during storage, display, service, transport, Potentially N | | and cold holding _. : 1 Hazardous Food _IN N/A | 08b _ Hot food at proper temperature __ oe ee es cee Time/Temperalure IN 03¢__|_ Foods properly cooked/reheated Foods properly cooled Protection from Contamination Personnel operating plan IN |_OUT + 07 __| Unwrapped or potentially hazardous food nat re-served "| Food protection during sto erage breparatn display, service, transportalion | |_Cross-contamination, equipment, personnel, storage eee Food contact surfaces clean and sanilized Foods handled wih minimum contact Personnel with Infections restricted = Hands washed and clean, good hygienic praclices (observed), aliamaiive Chemical Proper hygienic practices, eating/drinking/smoking (evidence LL — Resirooms with self-closing doors, fixtures operate properly, facility clean, { | supplied with hand soap, disposable towels or hand drying devices, tissue, | | covered waste receptacles | Toxic substances properly stored __. Toxle substances properly labeled, used Demonstration of 7 | QUT Fd. {Food management certification valid inte ts ties te Knowledge | OUT [ ‘ Employee Training verification PROGRAM: TEMPERATURE caeRvanon CERTIFIED FOOD MANAGERS ] Temftocation ItemiLocation i emis _ 4. 1m Name oO Oo Administrative Complaint Recammended o Emergency Order Recommended (ACRQ) EOCL Admiistaive Complaint Callback - o Emergency Order Callback - “~_Complled (ACCM) Complied (QCM) q —— anne Complaint Callback - Time oO Emergency Order Galiack Time Extansion (AC! Extension (EOEX) oO Administrative Determination Recommended gd » | (2 Seasonal (SEAS) (Closed ~ Out of Businass (COFB) (ADD Complied Compllad (EON lacknowledge receipt of these inspection forms and comments. Violations mustbecorrected by: sf Sf ‘. Ha AO oeata One oNS 4 Administrative Compiaint Callback ~ Nat a Emergency Order Calback -Not (ACNO) 0} ined Sipnstars §50-4¢7 1346 tiapectors Teephane DBPR Form HR §022-015 www.MyFlorida,com/dbpr : 2006 July 28 DEPA. COMPLIANCE STATUS ENT OF BUSINESS AND PROFESSIONAL REGULATION Division of Hotels and Restaurants LEGAL NOTICE Food Service Inspection ReporE AHI BIT ET "04" Faclities to maintain product temperature 05 Thermometers provided and conspicuously placed [] 34 _Oulside storage area clean, enclosure properly consinicted “-1"36a Presence on Insecis/rodents. Animals prohibited [1 06 Potentially hazardous foods properly thawed ['7"35b Outer openings protected from insects, rodent proof {J "08c Potentlat for cross-contamination, storage practices; damaged food segregated E736 Physical faclilies-floors proparly constructed, clean, drained, : coved ‘ : E10 In use food dispensing utensils properly slored _ L.} 37 Physical facililles-walls, cellings and attached equipment, 113 Clean otathes, hair restrainis L. _. constructed, clean (J 14 Food contact surfaces designed, constructed, maintained, (138 Lighting provided as required, Fixtures shielded _ installed, located |__| [J 39 Rooms and equipment — vented as required C1 15 Non-food contact surfaces designed, constructed, maintained, (C140 Employee lockers provided and used, clean Installed, located : ( 42 Premises malntalned, no unnecessary articles, Cleaning & (J 16 Dishwashing facilites designed, constructed, operated 1, Wash 2. Rinse 3, Sanitize : maintenance equipment properly stared, Kitchen restricted, {_) 43 Complete separation from living/sleeping area, laundry (117 Thermometers, qauges, test kils provided {]_44_ Clean and soiled linen segregated and properly stared CJ 18 Pre-flushed, scraped, soaked 19 Wash, rinse water-clean, proper temperature am) *45 Fire extinguishers — proper and sufficient FIRE EXTINGUISHERS: Dale{s) SUPPRESSION SYSTEMS: Date(s) ‘20a Sanitizing concentration ———_———Phm______j__| ° Fahranhelt 1 '20b Sanitizing temperature 21__ Wiping cloths clean, used properly, stared 23 Non-food contact surfaces clean —— |_ [1 *48 Exiting system — adequate, good repalr ; "47 Electrical wiring - adequate, good repalr —o Cy ping properly, “L124 Storagefhandling of clean equipment, utensils 7 C1 _25_ Service tems proparly slored, handled, dispensad | 26 Single service articles not re-used : ‘49 Flammable/combustible materials ~ properly stored ‘27 Water source safe, hot and cold under pressure [_] *28 Sewage and waste water disposed L]_29 Plumbing installed and maintained 30_Cross-connection, back siphonage, backflow *31 Tollet and hand washing facllitles, number, convenlent, designed, + __installed (_] 33 Garbage containers covered, adequate number, Insect and rodent proof, emptled at proper intervals, clean im Le "48 Gas appliances — properly installed, malntalned im Cj “60_ Current license, properly displayed [1 51 Other conditions sanitary and safe operation Ci 62 Falseimisteading statements published or advertised relating to foad/beveraga Lj 56 Copy of Chapter 509, Florida Statutes avallable (157 Hospitality Education Program Information provided Ba Ae mane Violations ‘cited In this ranort must be corrected x thin the time frames below, or as stated on page 1. Item No, = AE le RR een es saa 223 ‘SB 7) 2. Ba fee _ C Al I AS; 3 |" th Lie A A g A AL O29 2 av, CJ Additional Comments on Attached Sheot Person in Charge ~—S f * Inspector (Signature) i DOBPR Form HR 5022-015 waw.MyFlorida.com/dbpr 2008 May 2 DEPAR™ \T,OF BUSINESS AND PROFESSIONAL REGULATION * : #Division of Hotels and Restaurants R.., LEGAL NOTICE EXHIBN B £4 2010 Permanent Food Service ; Food Service Inspection Report’ - (2012 Thema Park Food Cart 1) 2013 Catering (C1 2014 Moblle Food Dispensing Vehicle {-] 2015 Vending Machine (0 2051 Unlicensed Food EPUEIES Ontar Nana [ra] Unschedulad (ROUT} i" [2] Licensing (LIC) Businose (DBA) Name: {0 Complaint Full (COMP) {- £4 Complaint Partial (CPAR} bus la te t. Tocallo 7 (0 Disaster Response (DSTR}) mn Adres: CG Epidemiological (EPI} City, Slate, Zip: 71 Seivice Request (SERV) eh (J Quality Assurance (QA) + Inspector Ares J Callback D training (TRNG) ood. : ® Sn ji [J Original Visit that ‘ems status at the {ime of inspecton ™ Mark *X” in appropriate box for COS and/or R IN=incomplianca OUT = not In comphance NiO = not observed_N/A = not applicable GOS = conected on-site during Inspaction R= t violation COMPLIANCE STATUS : CN OUT i Ota__| Food obtained from appre source Approved Source “IN NIO O1b | Wholesome, sound condition . IN NfO-| N/A [| 02 _| Original contalner; properly labeled, date marking, shell stock tags, 7 Cansumer advisory on raw/undercooked animal products Cold food at proper temperatures during storage, display, service, transport, and cold holding Hot food at proper temperature Foods properly cooked/reheated Foods properly cooled . |_Unwrapped or potentially hazardous food nat re-served Food protection during storage, preparation, display, service, transportation Cross-contamination, equipment, personnel, storage Food contact surfaces clean and sanitized || Foods handled with minimum contact : Personnel with infections restricted . Hands washed and clean, good hygienic practices (observed), altermative | -geeraina in Proper hygienic practices, eating/drinking/smoking (evidence Restrooms with self-closing doors, fixtures operate properly, facility clean, suppliad with hand soap, disposable towels or hand drying devices, tissue, covered waste receptacles Toxic substances properly stored Toxic substances properly labeled, used Food management certification valid Employee Training verification Consumer Advisory Potentially Hazardous Food Time/Temperature Protection from Contamination Personnel Chemical Demonstration of Knowledge ‘HemLocalion ub ae saat sei ieee ()inspecion Completed No Further Acton (SAT) | C] Cafbock — Camplied (CBCM} C1 fimnistalve Complaint Recommended | 7 Emergency Order Recammended (AL. Warming Given WARK) f)- f» # sf, C2 Gallback— Extension Given (GBEX) Administrative Complaint Calback ~ (oy Emergency Order Callback - Complied ACC Complied (EOCM) [Seasonal (SEAS) oO Galback Ad. Complaint Recommended oO Barninisbaive Complaint Callback - Time oO Emergency Order Callback = Time Extension (EOE (1 Closed ~ Outof Businass (COF8) oO Administrative Determination Recommended oO Administrative Complaint Callback ~ Not g Emesgeney Order Colac ~ No ee . 3 73 Siege? oe Pesson In Chart Name (Pisasa Prinl} Inspector's Name Pease Print} ya if . acon LB ee Talephane inepeciors Siynature inspector’ Telephone Person ln Charge Signatre ' ” igs: DBPR Form HR 5022-015 Ahad - www. MyFlorlda.com/dbpr . 2006 May 2 wi . . ; . . Klovidich future, DEPAt..afENT OF BUSINESS AND PROFESSIONAL REGULATION AHI B IT B Page 2 of DBPR Division of Hotels and Restaurants ere a. se LEGAL NOTICE : a ht Food Service Inspection Report os; Rk | COMPLIANCE STATUS cos (}°04_ Facilities to maintain product temperature {J 34 Outside storage araa clean, enclosure properly consiructed LJ 05 Thermometers provided and conspicuously placed _ |__| 1 °35a Presence on Insects/rodents, Animals prohibited [J"06 Potentially hazardous foods properly thawed [I [1"35b Outer openings prolected from insects, rodent proo! | “E}*08c Potential for cross-contamination, storage praclices; damaged C736 Physical fadltles floors properly constructed, clean, anes 5 food segragated coved Fi 10 _In.use food dispensing utensils properly stored : inva 37 Physical Tadltieswall, callings and attached equipment, [#] 13 Clean clothes, hair restraints, " tt constructed, clean — (CA-44 Food contact surfaces designed, constructed, maintained, LA 38 Lighting provided as required, Fixtures shielded installed, located : . ant (21-39 Rooms and equipment — vented as required () 15 Non-food contac! surfaces designed, constructed, malntained, Ly 40 Employee lockers provided and used, clan _ installed, located . (1 42 Premises maintained, no unnecessary arlicles. Cleaning & (J 16 Dishwashing facllites designed, constructed, operated _ maintenance equipment properly stored, Kitchen restricted, ' 1,Wash 2, Rinse 3, Sanlize LJ 43 Complete separation from living/slaeping area, laundry _—| a 17 Thermometers, gauges, lest kils provided 44 Clean and solled linen segregated and properly slored ct “L118 Prefushad, scraped, soaked “45 Fire extinguishers — proper and sufficient “T19_Wash, rinse water clean, proper, temperature _ FIRE EXTINGUISHERS: Date(s) SUPPRESSION SYSTEMS: Dalats) (1 '20a Sanitizing concentration + .*_ ppm ; ' TP : ‘p LJ *20b Sanitizing temperature. *__*Fahrenhelt__ fe a i: 21 Wiping cloths clean, used properly, stored __. 23_Non-food contact surfaces clean *46 Exiting system — adequale, goad repalr 24 _ Storage/handling of clean equipment, utensils (“47 Electrical wiring - adequate, good repair 25 Service itams properly stored, handled, dispensed | [1 %48_ Gas appliances - properly installed, maintained | “C126 Single service arlicles nol re-used "49 Flammable/combustible materials — properly stored “80 Current license, properly displayed 61 Other conditions sanitary and safe operation 62 False/misleading slalements published or advertised relaling _. ____t0 food/beverage 1184 Florida Clean indoor Air Act Compliance __ _} 55 Automatic Gratuily Notice 56 _Copy of Chapter 509, Florida Stalutes available (1 57 HToyallty Exccaton Prepran Infomation provided *27_Water source safe, hol and cold under pressure : "28 Sewage and wasie water disposed properly 29 Plumbing installed and maintained 30_ Cross-connection, back siphonage, backflow *31 Tollet and hand washing facilities, numbar, convenient, designed, | Installed { i 33 Garbage containers covered, adequate number, insect and rodent proof, anole at proper intervals, clean TT Person in Charge (Signature) - Inspector (Signature) : . Date + DBPR Form HR 5022-015 . www. MyFlorida.com/dbpr 2006 May 2

Docket for Case No: 07-004059