Oct 22 2007 13:29 laf22/28ea7 13:23 8584146749 DEPR OGA PAGE 3/12 STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION ’ DIVISION OF HOTELS AND RESTAURANTS DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION Petitioner, vs, HUNGRY HOWIE'S PIZZA License No. Boaz28 Respondent. ee ee / Case No, 2007032080 . ADMINISTRATIVE COMPLAINT. The DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION, DIVISION OF HOTELS AND RESTAURANTS, ("Patitioner’), files this Administrative Complaint against HUNGRY HOWIE'S PiZZa, (‘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 2835 N MILITARY TRL BAY G, WEST PALM BEACH, FLORIDA 33417. The mailing address of record is HUNGRY HOWIE'S PIZZA, at 2835 N MILITARY TRL BAY &, WEST PALM BEACH, FLORIDA 33417. 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 fallowing penatties: administrative fine not to exceed $1,000 per offense; mandatory attendance at Respondent's expense st 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 pro uigated thereto. Signed June 01, 2007 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 Regutation 1940 North Monroé Street Tallahassee, Florida 32399-1007 GERTIFICATE 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. dayof. Received by: Inspector's Signature Operator's Signature Title Title District Number: 02 Case Number: 2007032080 Form revised 10.10.06 License Number 6012228 2010 HUNGRY HOWIE'S PIZZA Oct 22 2007 13:29 laf22/28ea7 13:23 8584146749 DEPR OGA PAGE @4/12 Exhibit A Licanse Number: 6012228 License Type: 2010 PERMANENT FOOD SERVICE Case Number: 2007032080 “FG” 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 61¢, Florida Administrative Code, "NFPA" as cited herein references specific provisions of the National Fire Protection Association Life Sately 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 alleged that on February 12, 2007, March 13, 2007, May 22, 2007 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, “§4.05-05 4.30212 FC FOOD TEMPERATURE MEASURING DEVICES SHALL BE PROVIDED AND READILY ACCESSIBLE FOR USE IN ENSURING ATTAINMENT AND MAINTENANCE OF FOOD TEMPERATURES AS SPECIFIED UNDER CHAPTER 3. OBSERVED NO PROBE-TYPE THERMOMETER. * 2,292.04 4.602.11(A}FC EQUIPMENT FOOD-CONTACT SURFACES AND UTENSILS. (A) EQUIPMENT FOOD-CONTACT SURFACES AND UTENSILS SHALL BE CLEANED: (1) EXCEPT AS SPECIFIED IN PARAGRAPH (B) OF THIS SECTION, BEFORE EACH USE WITH A DIFFERENT TYPE OF RAW ANIMAL FOOD SUCH AS BEEF, FISH, LAMB, PORK, OR POULTRY; (2) EACH TIME THERE IS A CHANGE FROM WORKING WITH RAW FOODS TO WORKING WITH READY-TO-EAT FOODS; (3) BETWEEN USES WITH RAW FRUITS OR VEGETABLES AND WITH POTENTIALLY HAZARDOUS FOOD; (4) BEFORE USING OR STORING A FOOD TEMPERATURE MEASURING DEVICE, AND (5) AT ANY TIME DURING THE OPERATION WHEN CONTAMINATION MAY HAVE OCCURRED. (B) SUBPARAGRAPH _(A)1) OF THIS SECTION DOES NOT APPLY IF THE FOOD-CONTACT SURFACE OR UTENSIL 1S IN CONTACT WITH A SUCCESSION OF DIFFERENT RAW ANIMAL FOODS EACH REQUIRING A HIGHER COOKING TEMPERATURE AS SPECIFIED UNDER SECTION 3-401,11 THAN THE PREVIOUS FOOD, SUCH AS PREPARING RAW FISH FOLLOWED BY CUTTING RAW POULTRY ON THE SAME CUTTING BOARD. OBSERVED INTERIOR OF ICE MACHINE UNCLEAN, * 3,92-03 6-804.19-202.14FC-1.004(2)(B)FAC PUBLIC BATHROOMS SHALL BE COMPLETELY ENCLOSED AND SHALL HAVE TIGHT- FITTING, SELF CLOSING DOORS OR, ...IN BATHROOMS LOCATED OUTSIDE A PUBLIC FOOD SERVICE ESTABLISHMENT, HAVE ENTRANGES AND EXITS CONSTRUCTED IN SUCH A MANNER AS TO ENSURE PRIVACY OF OCCUPANTS. SUCH DOORS SHALL NOT BE LEFT OPEN EXCEPT DURING CLEANING OR MAINTENANCE. ...EXCEPT THAT THIS [ENCLOSURE] REQUIREMENT DOES NOT APPLY TOA TOILET ROOM THAT IS LOCATED OUTSIDE A FOOD ESTABLISHMENT AND DOES NOT OPEN DIRECTLY INTO THE FOOD ESTABLISHMENT SUCH AS A TOILET ROOM THAT 18 PROVIDED BY THE MANAGEMENT OF A SHOPPING MALL. OBSERVED NO SELF-CLOSER ON EMPLOYEE RESTROOM DOOR. 4.51-14 61C-1.002(5)(B)FAC ANY CHANGES IN THE NUMBER OF SEATS PROVIDED WHICH MAY AFFECT THE LICENSE FEE, THE FLORIDA GLEAN INDOOR AIR ACT, FIRE SAFETY, BATHROOM REQUIREMENTS OR ANY OTHER SANITATION AND SAFETY REQUIREMENTS PROVIDED IN LAW OR RULE, SHALL BE REPORTED IMMEDIATELY TO THE DIVISION BY THE OPERATOR. OBSERVED FAILURE TO SUBMIT PLANS TO HOTELS AND RESTAURANTS....LICENSED FOR ZERO (0) SEATS BUT OBSERVED FORTY-EIGHT (48) SEATS. Gase Number: 2007032080 District Number: 02 Form revised 10.10.06 Licanse Number: 6012228 2010 HUNGRY HOWIE'S PIZZA Oct 22 2007 13:30 laf22/28ea7 13:23 8584146749 DEPR OGA PAGE 5/12 * §,53B-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 TQ 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 REGEIVE 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 THE DIVISION WITH PROOF OF EMPLOYEE TRAINING UPON REQUEST, INCLUDING, BUT NOT LIMITED TO, AT THE TIME OF ANY DIVISION INSPECTION OF THE ESTABLISHMENT, Case Number; 2007032080 . Districl Number: 02 License Number. 6012228 2010 : Form revised 10.10.06 HUNGRY HOWIE'S PIZZA Oct 22 2007 13:30 la/22/2he7? 15:23 8584146749 DEPR OGA PAGE 86/12 Pm - if 48 flouted falurt.. DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULA ‘i te iT B : Page 1 of Division of Hotela and Restaurants LICENSE TYPE? DBPR LEGAL NOTICE fou a Reo Format Food Service Food Service Inspection Report 2012 Theme Park Food Gart INSPECTION TYPE 7 2013 Catering (7 Unscheduled (ROUT) van (21.2014 Mobile Food Dispansing Vehicle (77 Licensing (LIC) 2015 Vending Machine OF Comptaint Fut (COMP) 1 2081 Unticenaed Foc o Comet Partial (CPAR) LICENSE NUMBER ter Reesponde (DSTR) [2] Service Request (SERV) y, State, Zh OV Eo PADAP e > Ci cual Assurance (4) REMINDER: rato a ff 2} Training (TRNG) EELS Original Visit PS Cattoack SEE FOR CALLOACHS, ORIGINAL VIET OATE Waseed._j da? AO?” FOODBORNE ILLNESS RISK FACTORS AND PUBLIC HEALTH INTERVENTIONS (ltama marked “OUT” of compllanca requira immediate corrective action) ] The circled (efters fo the loft of ¢ach Ham indicats thal Hart's status ot the tite of inspéction Mark "x" hh appropriate bax far COS andlor R IN = in compliance OUT = notin lance NiQ = not observed N/A = nota, be COS = coractad on-site during In: fon_R = rapast violation COMPLIANCE BTATUS L¢os R e Approved Source Consumer Advisory Cold food at proper tamperatures during storage, display, service, transport, and cold holding Potentially Hazardous Food Time/Tamperature Protection from Contamination "1 Hands washed and clean, good hygienic practices (observed), altemative operating plan _ Proper hygienit practices, eating/drinking/emoking (evidence) ante Restoms with self-closing doors, fixtures operate property, facility clean, | supplied with hand soap, disposable towels or hand drying devices, tissue, ; covered waste receptacles 4fa__| Toxic substances property stored _ ; _ = 41b_ | Toxic substances properly labeled, used i “ 18a | Food management ee Ss ae Personnel Chemical Demonstration of Knowledge INSPECTION DISPOSITION [71 inspection Completnd ~ No Further Action (ISAT) | 1 Calback ~ Complied (CBCM} Callback — Extension Given (CBEX) Gammack — Admin, Compiaini Recommended ICBNO: oO Administrative Complain! Recommended xine Emergency Order Recommended OC rer Oiler Cato o e ame Oe Calta = =Time Extension (EGE! (2 Waming Given (WARN) hed (ACC o. ‘Administrative Complaint Calback = =Thmna (Seasonal (SEAS) Extenzlan (AGEX) uU Aamnistatve Compt Gale =Rot [poy Emergency Ordar Gatback — Not Comphied (AGNO: Complied (EON) ‘ TOMS & [acknowledge receipt of these inapection forms and comments, Vidlatlons must be corrected by: JJ _____.-s«s AR ABDLTTOREL Mian inCharye OBPR Form HR 5022-015 vn MyFlorida. com/abpr , 2006 July 28 Oct 22 2007 13:31 laf22/28ea7 13:23 8584146749 DEPR OGA PAGE @7/12 aI Bi ponte 2 Alevicielh fadass,.. DEPAn. .cNT OF BUSINESS AND PROFESSIONAL REGULATI DBPR , Olvitlon of Hotels and Restaurants LEGAL NOTICE Re fam Food Sarvice Inspection Report _ COMPLIANCE STAs “04 Facilities to maintain coved CT 37 Physical Tacitiios-walls, cailings and attached equipment, constructed, clean sing utensifa property stored 43,_ Clean clothes, halt restraints C15 Nan- food contact & ingtalied located |} £7 42 Premises manned noun no unnecessary artides, Cleaning & (1 16 Dishwashing faciities designed, constructed, operated maintenance equipment property stored. Kitchen restricted. 1. Wash 2. Ringe 3, Sanitize —_ 43 Complete separation from living/sieeping area, laund 44 Clean and soiled linen stored A : iB. Gul system — adenuale, qpodrepa “47 Electrical wiring - adequate, fepa "48 _Gas appliances — properly installed, nia “49 Flammable/combustible materials — 7 Water source safe, hot and cold under pressure : 8. Sewage and waste water disposed propery 29 Flumbing installed and malnlained | ross-conmention, back siphonage, backfiow eon foe let and hand washing facilities, number, convenient, “dasigned, | installed T 33 Garbage containers covered, adequate number, insect and rodent| | _____ root, emptied at proper Intervals, clean 51 Other conditions sanitary and sata operation 52 False/misieading statements published or advertised relating tem No. Violations ofed fs repo Tust be onTect wil ne ine frames baa, crass pa mT ate Fe Brel Peg FE CO OF fAeTE 4 REALE Re agar EES rd 1S Cede (OR O sears - ORSEEMD bP Saat __ ae Fz ez CRRE ge Zoe Anat de 1S crKecine Hao | eesti Ars See cepSR oa) een Pievee REST Aes as be Probe rig aanareh. AYA AR -7e nee Ko DD Fane Ss asge Aly Pit ae gripleyes od Fe atealnle _| Additianal Comments on Attached Shy Person in Charge (Signature) avi tl wl” : Date 5 = 92-07. Ing F (Skgnature! Date a? eI 7 DBPR Form HR 6022-015 www. MyFlorida. comdbpr : 2006.May 2 Oct 22 2007 13:31 laf22/28ea7 13:23 8584146749 DEPR OGA PAGE 8/12 . DBPR “a * SERRRES ERAT B en . Belt . xy LEGALNOTICE § {i 2 F S12010 Porvent Food Senin om i fi : — Food Service Inspectig (0.2092 Theme Park Food Cart LJ Unscheduied (ROUT) “ee — 12013 Coating 5 7 he PERT | 2.2014 Mobil Feed Dispensing Vehicle Leensing (LIC) Bisiieed (DBA) Name: (07.2015 Vening Machine (CO Complant Full (COMP) {0 2054 Unticensed Food [2] Complaint Partial (CPAR) [17 Disaster Responsa (O57R} 1 Epkiemictogical (EFI) (1 Sandca Request (SERV} C7 Qualty Assunanes (04) {J Trainhg (TRNG) 4 ett Meei£s pate 6a 292 3 REMINDER: Your one emples for sf 7” (CJ Original Vieit ” Kicawaa Misit Tima Ene in appropriate bex for COS andior R COS = corrected on-site dur! COMPLIANCE STATUS, : Ola__| Food obtained from approved source O1b Wholesome, sound condition _ Consumer umer advisory on rawiundercoaked oysters ; | Conéumer advisory on rawlundarcooked animal products Cold food at proper temperatures during storage, display, service, transport, Approved Source Consumer Advisory Potentially LN | OUT NA | 038 and cold holding Hazardous Food == {IN| OUT | NO | NIA_| 03b "| Hot food at prope tiperatire Time/Temperature [IN | OUT TNO N/A | 036 | Fo poet cnet hetisura er nnnaeetneernnen nner sei a ad | Foods p ~~ IN| ouT| |__| _O7 | Unwrapped pean hazardous food nol re-served Protection from IN| OUT. |_ 68a __| Food protection during storage, preparation display, service, fran service, transportation storage Cross-contamination, equisment, personnel Food contact surfaces clean and sanitized Foods handled with minimum contact Personnel with Infections restricted Hands washed and clean, good hygienic practices (observed), alterative Contamination iN | OUT NW] OUT | NO 12a Personnel = (ses Ls 7 Par nN OTTO sol arg eel SPOTS PET eas oe na | IN| OUT {NO 126” [Proper hygienic practices, eating/drinking/smoking (avidence) Restrooms with seli-closing doors, fixtures operate proparty, facility clean, IN | OUT 32 | supplied with hand soap, digporable towels or hand drying devices, tissue, covered waste receptacles INL OUT. _ 4ta_| Toxic substances property stared Ghemical NT ouT |_| {1b —| Toxic substances properly labeled, used Demonstration of IN| OUT | Food management cettfication valid Knowledgs IN | OUT Employee Training verification | | | [worsen a + Recomended ‘Adininist ‘Complaint Caloe [Er someisens) tea Cm S = aan aR FON [ar _ — a — = ay ere ak Set. Vis. ae SEE BE VP) ABTS B es fe, aor Taaphora hang 2006 May 2 OBPR Form HR 5022-015 ww, MyF vid,comvtor Oct 22 2007 13:32 1a/22/2087 13:23 s5ed4l4e749 DEPR OGA PAGE 89/12 . af DEPAR. .“NT OF BUSINESS ANO PROFESSIONAL, REOLIA vi “~ ta oh DBPR,. Division of Hotels and Restaurants! a: Ki rt Sh if! Page 2 of =~ LEGAL NOTICE 7 a at nil ia Food Service inspection Re — "_SONPLIANGE STATUS side stotage area lean, enclosure properly constructed Ly) 38a Presence on Insectsfodients. Animals probibited . “256 Gulér openings protected from insects, rodent 36 Physical facilities-floors properly constructed, clean, drained, coved food ated 10_ in use food disnansing utensils properly stor __ LL) a Physical Tacieswals, callings and attached equipment, 13 _Glaan clothes, half restrain en eral me ggg an HUGE, CI —— 74” Food contact surfaces designed, construcied, maintained, _ 38 Lghtin: rove 5 required. Eure shielded installed, located (J 18 Non-ood contact surfaces designed, constructed, maintained, 40 i Eolores ono novia tae Geen Lo installed, located _. C1 42 Premises maintained, no unnecessary articles, Cleaning & 1 16 Dishwashing faciities designed, constructed, operated maintenance equipment properly stored, Kitchen restricted. 1, Wash 2. Rinse 3, Sanitize _. a | fs 43. Complete separation from livingisieeping area, [aund _ | 44 Clean and soiled linen ated and a 17_ Thermometers, gauges, test kits provided 18 Preflushed, scraped, soaked 01 '45 Fire extinguishers - 49 _ Wash, tinge waler clean, temperature wk. __FIRE EXTINGUISHERS: Date(s) ea ae ae eaiiia seston — adequate, good repaid YY Electrical wiring — adequate, good repalr a “49 _Flammable/combustible materials - properly ainred *50 Current license, property diaplayad 51 Other conditions sanitary and safe operation 52 Falsevmisieading statements published or advertised relating __.tafoodibeverage ee | C] 4 Florida Clean Indoor Air Act Compliance 55 Automatic Gratuity Notice 56 Copy of Chapter 509, Florida Statutes available 4 ot ee Education ane Information provided erly stored, handied, dispanged : gia service articles nol re-used _] 27 Water source sale, hot and cold under preasure Sewage and waste water disposed (1°31 Toilet and hand Ane facilities, number, installed ___ “ED 39 Garbage containers covered, adequate number, Insect and rodent _ Proof, emptied at proper intervals, clean Ade S86" Crete, eal Mr coves Meer aa oO El - ‘ce PAPER TCS fd REST Boar $ es WG PEGE PHERMAEIER, LF MORE Fi CHEE, ADD Ba ____ PEGE of Eetteyile a0 7A Bardem commere BY §~ta~O7 _ Date 3 AT ed OBPR Fann HR 5022-015 www, MyFlorida com/dbpr 2006 May 2 Oct 22 2007 13:32 laf22/28ea7 13:23 8584146749 DEPR OGA PAGE 18/12 (avis Folin. DEPAR. .:NT OF QUSINESS ANO PROFESSIONAE REGULATION’: = =v Diviston of Hotefs and Restaurants LEGAL NOTICE Food Service Inspection e ecene| air Ae 1 ear Lis ‘rar CTS Buzineax (DBA) Name: HHaery ford: wile Spy Location Address: aoe Owner Name: o Leasing {LIC} £71 Complaint Fult (COMP) 2 Complaint Partial (CPAR} [D Disaster Response (0S7R} (1 Epkiemniotogicat (EF1) 1] Service Raquant (SERV) Quality Assurance (04) C1] Training (TRNG) Xn appropri box fr COS enor COS = cortectnd on-site during Inspe COMPLIANCE STATUS ° | Ola | Food obtained from approved source Otb | Wholesome, sound condition __ j IN} OU 02-11_| Consumer advisory on rawlundercooked oysters, Consumer Advisory pine ee Oe Consumer aivisor on rewundercooked animal products [| nwa | 03a | Cold food at proper temperatures during storage, display, sarvica, transport, Potantlally _. {and eatd holdin Hazardous Food "WA | 036 | Hot food at propar temperature — TimefTemperature [IN| OU Wi fWA__| _03c | Foods propery cocked/eheated 77 _ NL OUT I/O ]|” WA | ad | Foods properly cooled CIN] OUT _|_07 | Unwrapped or potentially hazardous food nol re-served Protection from Gy | OuT Ofa__| Food protection during.starage, preparation, display, service, transportation Contamination an | OW] . Gb | Cross-contaminatiog“equipmant, personnel, storage IN| GuP 23 | Food contact surtdces clean and sanitized ON] OUT | NO 09 _| Foods handlad with minimum contact __ Ny OUT | =| 11 | Personne}vtih infections restricted Handg as and clan, good hygienic practices (absarvad), attemative N | QUT 128 | ong éting | Personnel a) oor 'N ee Niab Proper hygieni practices, eatingidrinking/smoking (evmlenca) i =" T Restrooms with saff-clasing doors, fixturas operate property, facility clean, Gi 22 | supplied wih hand sasp, disposable towels or hand drying deviens, tesua, covered wasta receptacles : 41a__| Toxic substancas pv stored Chemkal Quist 415 | Toxic substances properly labeled, usad Demonstration of IN| OUTS | __L_53a__| Food management certification valid : . Knowedge iN () 5y | Employee Training verification | "ORME ‘| [2] inspection Completed — Wo Father Acfon (SAT) | [J Galback ~ Compled {CBCM) To haces Coan earned }O ener Caer recemrendes Eneepney Orta Record SS ———— Caen =F saa — Ma ac - aE ich gow. P? per Oe f5eS Adsé Sil: G 1s i eae BEE AES _. OBPR Fonn HR 5022-015 www. MyFlorida.com/dbpr ; 2006 May 2 laf22/28ea7 13:23 8584146749 eat fo _Themmometers povided. 06 Potentially hazardous f roperty thawed AEPAR._.cNT OF BUSINESS AND PROFESSIONAL, RROULATION: Olvision of Hotels and Restaurants: LEGAL NOTIGE Food Service Inspection rpperstilBIT Oct 22 2007 13:33 DEPR OGA PAGE 11/12 gcc dey ARIE aT “Ofc Potential for eross-contamination, storage practices; damaged food ated C136 Physical faclitles-floors properly constructed, dean, drained, ingtalled, located LJ 76 Dishwashing facities designed, constructed, operated 1,Wash 2, Rinse 3. Sanltize 1 42 Premises maintained, no unnecessary articles. Cleaning & maintenance equipment properly stored. Kitchen restricted. 17 Thermometers, gauges, (est kita provided 18. Prefiushed, scraped, soaked 19 Wash, rings water dean, proper temperature coved : CI 37 Physical tacilties-walls, ceilings and alached equipment, _. . __ |_| en ——---—f2) 42 Compioie separation fomiidnaseepina area ewniry [| __ 44_Clean and soled linen segregated and properly stored __ _ [| [el "45_ Fire extinguishers — proper and sufficient __ “TL FIRE EXTINGUISHERS: Dain SUPPREGSION SYSTEMS: Daas) CL} "20a Sanitizing concentration fogs ppm Lf 20b Sanitizing temperatures: * Fahrenheit of LJ} 2f Wiping cloths clean, used properly, stored |_| 23 Non-food contact surfaces dean la. tequate, good rapalr __ adequate, good repair a Hl equipment, ui 25 Service llems properly stored, handled, dispensed _ [-)*48 Gas appliances - properly Installed, maintained 26 Single servica articles not re-used [ “27 Waler source sate, hol and gold under pressure ‘sO Current license, properly displa [) 28 Sewage and waste water disposed properly 8 “49 Flammable/combustible materials — properly stored [1] 28 “Plumbing Installed and maintained _ 51_ Other candifions sanitary and sate on, 30 _Crogs-onnection, back siphonage, back DO 52 Falsemisteading statements published or advertised relating ve design 1131 Toitel and hand washing facliiies, number, rhs balcw, of a8 stated on page 1. ary. Vix CHEBED ae, Ald see (oBsenve® * SPS fF Pian re Ce 2 AEE ee BEST pep NPE wane) ee a PELE installed _. TT 30 Garbage containers covered, adequate number, insect and rodent _____ Proof, emptied at proper Inlervalis, clean aa emo. | Violations ced in #vs report must be corrected whi the fia fra Ply rag a oe ed AE Freres — * ake aekyses oF NEES ern BO PREF OF CERTHVED aD Peer TR 4Sa2 | ae PRE GE nap bE Kee? Tear’ Mee