Now 12 2008 14:42 11/12/2088 15:42 8584146749 DEPR OGA PAGE 4/14 STATE OF FLORIDA - DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION DIVISION OF HOTELS AND RESTAURANTS DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION Petitioner, vs. License No, 2319092 PACHAMAMMA. ndent License Type 2070 espo , me Case No. 20070647109 ADMINISTRATIVE COMPLAINT The DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION, DIVISION OF HOTELS AND RESTAURANTS, (‘Petitioner’), files this Administrative Complaint against PACHAMAMMA, (“Respondent”), and says: 1. Patitlonar Is the state agency charged with regulating the operation of public lodging establishments and public food service astablishments, pursuant to Section 20.165 and Chapter 509, Florida Statutes. 2. Respondentis, 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 17040 COLLINS AVE, GOLDEN BEAGH, FLORIDA 33160.The mailing address of record is PACHAMAMMA, at 17040 COLLINS AVE, GOLDEN BEACH, FLORIDA 32160, : 3. Inspection of this establishment conducted pursuant to Sec. 509.032, Florida Statutes, revealed violations af 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 offanse; 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 28, 2007 = , \ Shannie Kallas, 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. 0153834 Department of Business & Professional Regulation 1940 North Monroe Street Tallahassee, Florida 32399-1007 cS FIC. OF SERVICE BY CERTIFIED U.S. MAIL, ARTICLE NUMBER: . 7160 3901 9849 9961 4251 { HEREBY CERTIFY that a true and correct capy of the foregoing ADMINISTRATIVE COMPLAINT has been - hand served by me on this, day of , 2007. Received by: Inspector's Signature ' Operator's Signature Title : Title Case Number 2007064109 File Number: 190255 District Number: 04 Licenae Number! 2378092 2070 Form ravised 07,07,07 PACHAMAMMA Now 12 2008 11/12/2808 16:42 8584146749 DEPR OGA PAGE 45/14 Exhibit A License Number: 2319092 License Type: 2010 PERMANENT FOOD SERVICE Case Number: 2007064109 “FC” as cited herein references specific provisions of the Fond 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 Protectian Assoclation Life Safety Code, incorporated by reference at Chapter 4A-3, “Fire Preventlon, Ganeral Provisions”, Flotida Administrative Code, and 61C-1.004(5), Florida Administrative Code. “*" denotes a critical violation. It is alleged that on August 31, 2007, and November 6, 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. Gopy(s) of the report(s) for the above referenced inspection(s) are attached hereto and incorporated by reference as Exhibit B. * 1, 08A-26-1 3-302.11(A)(1) FC: (A) FOOD SHALL BE PROTECTED FROM CROSS CONTAMINATION BY: (1) SEPARATING RAW ANIMAL FOODS DURING STORAGE, PREPARATION, HOLDING, AND DISPLAY FROM: (A} RAW READY-TO-EAT FOOD INCLUDING OTHER RAW ANIMAL FOOD SUCH AS FISH FOR SUSHI OR MOLLUSCAN SHELLFISH, OR OTHER RAW READY-TO-EAT FOOD SUCH AS VEGETABLES, AND (B) COOKED READY-TO-EAT FOOD; OBSERVED RAW ANIMAL FOOD STORED OVER READY-TO-EAT FOOD, *.2.00-04-1 3-301,14(B) FC: (B) EXCEPT WHEN WASHING FRUITS AND VEGETABLES AS | SPECIFIED UNDER SECTION 3-302.15 OR WHEN OTHERWISE APPROVED, FOOD EMPLOYEES’ MAY NOT CONTACT EXPOSED, READY-TO-EAT FOOD WITH THEIR BARE HANDS AND SHALL USE SUITABLE UTENSILS SUCH AS DELI TISSUE, SPATULAS, TONGS, SINGLE-USE GLOVES, OR DISPENSING EQUIPMENT, OBSERVED BARE HAND CONTACT OF READY-TO-EAT FOOD BY EMPLOYEES AND ESTABLISHMENT HAS NO APPROVED ALTERNATIVE OPERATING PROCEDURE IN EFFECT. CORRECTED ON SITE. 3. 10-07-1 3-304.12(F) FG) DURING PAUSES IN FOOD PREPARATION OR DISPENSING, FOOD PREPARATION AND DISPENSING UTENSILS SHALL BE STORED: (F) INA CONTAINER OF WATER IF THE WATER IS MAINTAINED AT A TEMPERATURE OF AT LEAST 135 DEGREES FAHRENHEIT AND THE CONTAINER IS CLEANED AT A FREQUENCY SPECIFIED UNDER SUBPARAGRAPH 4-602. 11(D)(7). OBSERVED IN-USE UTENSIL STORED IN STANDING WATER LESS THAN 135 DEGREES FAHRENHEIT. : Gase Number: 2007064109 File Number: 190255 District Number. 01 License Number: 2319092 2010 Form ravisad 07.07.07 FPAGHAMAMMA : Now 12 2008 14:42 11/12/2808 16:42 8584146749 DEPR OGA PAGE 46/14 * 4. 124-16-1 2-301.14 FO:. WHEN TO WASH, FOOD EMPLOYEES' SHALL CLEAN THEIR HANDS AND EXPOSED PORTIONS OF THEIR ARMS AS SPECIFIED UNDER SECTION 2-301.12 IMMEDIATELY BEFORE ENGAGING IN FOOD PREPARATION INCLUDING WORKING WITH EXPOSED FOOD, CLEAN EQUIPMENT AND UTENSILS, AND UNWRAPPED SINGLE-SERVICE AND SINGLE-USE ARTICLES AND: (A) AFTER TOUGHING BARE HUMAN BODY PARTS OTHER THAN CLEAN HANDS AND CLEAN, EXPOSED PORTIONS OF ARMS; (8) AFTER USING THE TOILET ROOM; (C) AFTER CARING FOR OR HANDLING SERVICE ANIMALS OR AQUATIC ANIMALS AS SPECIFIED IN PARAGRAPH 2-403.11(B); (D) EXCEPT AS SPECIFIED IN PARAGRAPH 2-401.11(B), AFTER COUGHING, SNEEZING, USING A HANDKERCHIEF OR DISPOSABLE TISSUE, USING TOBACCO, EATING, OR DRINKING; {E) AFTER HANDLING SOILED EQUIPMENT OR UTENSILS; (F) DURING FOOD PREPARATION, AS OFTEN AS NECESSARY TO REMOVE SOIL AND CONTAMINATION AND TO PREVENT CROSS CONTAMINATION WHEN GHANGING TASKS; (G) WHEN SWITCHING BETWEEN WORKING WITH RAW FOOD AND ; WORKING WITH READY-TO-EAT FOOD; (H) BEFORE DONNING GLOVES FOR WORKING WITH FOOD; AND (I) AFTER ENGAGING IN OTHER ACTIMITIES THAT CONTAMINATE THE HANDS. OBSERVED EMPLOYEE ENGAGE IN FOOD PREPARATION, HANDLE GLEAN EQUIPMENT OR UTENSILS, OR TOUCH UNWRAPPED SINGLE-SERVICE ITEMS, WITHOUT WASHING HANDS, * 6, 20A-05-1 4-703.11 FC:: AFTER BEING CLEANED, EQUIPMENT FOOD-CONTACT SURFACES AND UTENSILS SHALL BE SANITIZED IN: (4) HOT WATER MANUAL OPERATIONS BY IMMERSION FOR AT LEAST 30 SECONDS AND AS SPEGIFIED UNDER SECTION 4-801.111; (B) HOT WATER MECHANICAL OPERATIONS BY BEING CYCLED THROUGH EQUIPMENT THAT IS SET UP AS SPECIFIED UNDER SECTIONS 4-501.15, 4-601.112, AND 4-501.113 AND ACHIEVING A UTENSIL SURFACE TEMPERATURE OF 160 DEGREES FAHRENHEIT AS MEASURED BY AN IRREVERSIBLE REGISTERING TEMPERATURE INDICATOR; OR (C) CHEMICAL MANUAL OR MECHANICAL ’ OPERATIONS, INCLUDING THE APPLICATION OF SANITIZING CHEMICALS BY IMMERSION, MANUAL SWABBING, BRUSHING, OR PRESSURE SPRAYING METHODS, USING A SOLUTION AS SPECIFIED UNDER SECTION 4-501.114 BY PROVIDING: (1) EXCEPT AS SPECIFIED UNDER SUBPARAGRAFH (C)(2) OF THIS SECTION, AN EXPOSURE TIME OF AT LEAST 10 SECONDS.FOR A CHLORINE SOLUTION SPECIFIED UNDER PARAGRAPH 4-501.114(A), (2) AN EXPOSURE TIME OF AT LEAST 7 SECONDS FOR A CHLORINE SOLUTION OF 80 MG/L THAT HAS A PH OF 10 OR LESS AND A ‘ TEMPERATURE OF AT LEAST 100 DEGREES FAHRENHEIT OR APH OF 8 OR LESS ANDA TEMPERATURE OF AT LEAST 75 DEGREES FAHRENHEIT, (3) AN EXPOSURE TIME‘OF AT LEAST 30 SECONDS FOR OTHER CHEMICAL SANITIZING SOLUTIONS, OR (4) AN EXPOSURE TIME USED IN RELATIONSHIP WITH A COMBINATION OF TEMPERATURE, CONCENTRATION, AND PH THAT, WHEN | EVALUATED FOR EFFICACY, YIELDS SANITIZATION AS DEFINED IN SUBPARAGRAPH 1-201.10(B)(79). FOOD-CONTACT SURFACES AND UTENSILS NOT SANITIZED PROPERLY AFTER CLEANSING. * 639-094 §-205.11(A) FC:: (A) A HANDWASHING LAVATORY SHALL BE MAINTAINED SO THAT IT IS ACCESSIBLE AT ALL TIMES FOR EMPLOYEE USE. ‘HANDWASH SINK IN DISREPAIR. 7, 38-07-1 6-202.11 FC: LIGHT BULBS, PROTECTIVE SHIELDING. (A) EXCEPT AS SPECIFIED IN PARAGRAPH (B) OF THIS SECTION, LIGHT BULBS SHALL BE SHIELDED, COATED, OR OTHERWISE SHATTER-RESISTANT IN AREAS WHERE THERE iS EXPOSED FOOD; CLEAN EQUIPMENT, UTENSILS, AND LINENS: OR UNWRAPPED SINGLE-SERVICE AND SINGLE-USE ARTICLES. (B) SHIELDED, COATED, OR OTHERWISE SHATTER-RESISTANT BULBS NEED NOT BE USED IN AREAS USED ONLY FOR STORING FOOD IN UNOPENED PACKAGES, IF: (1) THE INTEGRITY OF THE PACKAGES CAN NOT BE AFFECTED BY BROKEN GLASS FALLING ONTO THEM; AND (2) THE PACKAGES ARE CAPABLE OF BEING CLEANED OF DEBRIS FROM BROKEN BULBS BEFORE THE PACKAGES ARE OPENED. (GC) AN INFRARED OR OTHER HEAT LAMP SHALL BE PROTECTED AGAINST BREAKAGE BY A SHIELD SURROUNDING AND EXTENDING BEYOND THE BULB SQ THAT ONLY THE FACE OF THE BULB IS EXPOSED, LIGHTS MISSING THE PROPER SHIELD, SLEEVE COATINGS OR COVERS IN WALK-IN COOLER. Gase Number: 2007084109 — File Number: 190255 . Distrlet Number: 04 Licange Number; 2379092 2010 Form revised 07.07.07 PACHAMAMMA, ‘ 11/12/2088 16:42 8584146749 STATE OF FLORIDA DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION DIVISION OF HOTELS AND RESTAURANTS: www myflenda.com/dbpr Now 12 2008 14:43 DEPR OGA Page iota CALL BACK INSPECTION REPORT Faflure to comply with thie Notice may inlet en administrative 14/06/07 02:52 PM Callback Inspection Date and Time Warminy Inspection Reason LEGAL NOTICE ' complaint that may result In suspansion or revocation of your lcanse and finas. 2319092 SEAT. License Number FL GENERAL SERVICES | ING. Owner Neme DELICIAS PERUANAS ADMINISTRATIVE COMPLAINT recommended. Area CodeyTelephone Number Business Name 4B Inspection Result 08/31/2007 Numbar of Units 17040 GOLLINS AVE Requested Cathack Date/Time Initial Warnlng Date GOLDEN BEACH, 33160 PAGE 7/14 EXHIBIT B Addraaa / Gity / State / Zip / ete, Comments he following Item(s) have been recommendsd for Administrative Corplatnt: lation: ABs07=| Jghta missing (he properehield, alsave coalnge or Govere, walking cooler folevion: 93-0944 ndwashalnk In dierapat, Nation: ROAOE=t ood sconlact sudaces end ulenclis not simfiiked propely after cleaning, 11-06-07 Date Signature of Recipient Reclplant: Margot Luque Title Owner . Phona: 3058571980 OBPR Form HF 5027-006 Inspector Signature For further information please contact: Danfel Unold B2d0 NW 52 Terr. #101 Miami, Fi 33168 850-487-1395 ee ek 11/12/2888 DPR Form HR 6022-005 16:42 otto: 12194 jolatton: 0805-4 inlalion: GB-4-1 jotafion: OBA-28-1 iptation; BAB -D4="| lolation: B2OT=4 latadion: 38-61 lolaviore 37-O8-1 latatlon: BBe12-1 lalatlor: IGB-03-7 Now 12 2008 14:43 8584146749 DEPR OGA PAGE ~ Page 2 of 4 Lcange Number STATE OF FLORIDA SEAT aetg0se DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION Business Name OS ON een imionls Se UTANTS DELICIAS PERUANAS . Inspection Date ; CALL et IDAL NOTION REPORT 11/06/07 02:52 PM Fallure to comply with thig Notice may Initiate an administrative complaint that may result in suspension of ravecation of your iicanse and fines. bgerved employes engape In food praperaion, henda clean equipment or Wensils, or touch uiwrapped singla-garvice lloms, withoul washing hands, tolallon: 10-07-1 served Inhtisa wianes atored in standhg water teen thin 1236 dagrine Fohrerihalt, brervad Improper uma of bowliplanite toed contahaf gf othor contsher with nd hand uead lo ditponde food that le Add Mey OL, bseved birt hind éortact af roadystoont food by employees are eatablahrient has ro saproved Ahernaive Cpprating Procedure in alfeet, Conected On Site, bgerved raw erimal food stored over ready-lo-mat fond, [The Following item(s) are in eompfiance: Etmployana have nal racelved training retatiad ta [helr aasigned duties, handwashing procadireas Identity of fone or fond product nitrepreaganiad. Manuiahews cornea and [here ip no corving inprembes, Qwnor says thay are using awal 15h inalead, [Tart (10) feet-candiaa oflieht at laps! 30 Inchaa from finor not provided In cry food storage nines. ‘ Plbserved wall soled with secumubbtod grinse. Kiiohen Rbesrved grapes escumulstad under cooking aqdpiment. ULEF ODANINGE AOL protectadwith aalf-dpaing deort. ———_—$>—$ ae/1d Now 12 2008 14:43 11/12/2808 16:42 8584146749 DEPR OGA PAGE @g/1d4 Page 3of 4 : . Lilconse Number STATE OF FLORIDA SEAT 2318082 DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION Busines Name DIVISION OF HOTELS AND RESTAURANTS. DELICIAS PERUANAS www. inyfiotide, com/dbpr CALL BACK INSPECTION REPORT Inspection Pete GAL NOTICE 11/08/07 02:82 PM Fallure to comply with this Notlos may Initiate an administrative complaint that may result In suspension or ravocation of your lleenge and fines. lolation: 24-08-1 masTved greaBA ch he ground sndior pad round gronse recaplecis lofetton: B2-17-4 andwashhg clasnaer ecking alhandwashing lavatory, jatatorn: 324 G1 nd wash sink lating proper handelrying provisions, loletlon: 22-28-1 jenrved Intern cf raach-in cooler aoiled wilh Becumulation of food! raskius, Inlattary, 221} . baerved solled reechin cootar dhabes, Rapeot Violdtlon iplation: 19-06-1 fo Cleening apant providediin frat compartmant of sink. Washing and rinaing In ams compariment lolatton: O5-{1=4 : bearved Improper Lita af bewi/plastic food contahor or other contalhar with no hands used ja diepanse ready-togat fror, lolation: 08B-09-4 Ingle-uxe gloves not charged aa neadedatiar changhg task orwhendemaged cr solled, lolation: OBA-28-1 IbEBrvad Uncovered food In holding univdry storape ered, lnlatlon: OBAARET Ibearved fond atorad an floar, Nabtatlan: BAS 15-4 served [om patkoges/bags affoad exporing ihe enniarta to conlamnation, Repeat Viclation, Mato OR-O44 Ibatrved potentially hiaandows fondihavaad aL fodrh torparhiuns, fatatlorr: GES] ‘ DSPR Form HR 5022-005 11/12/2808 16:42 Failure to comply with thls Notice may Initiate an administrative complatnt that may result in suspension ar revocation of your Ilcense and fines. Now 12 2008 14:44 8584146749 DEPR OGA PAGE ~ ~ Page 4 of 4 License Number STATE OF FLORIDA SEAT 2319092 DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION Business Name DIVISION OF HOTELS AND RESTAURANTS WW. nyflotide.cof/dbpr DELICIAS FERUANAS GALL BACK INSPECTION REPORT Inspection Pals LEGAL NOTICE 11/06/07 02:52 PM Jalntion: 360931 iglation: 02-13-41 Repent Viclotion, lofotlan: O2:07=1 jolation: 07 B-23-1 Po OBPR Farm HR 6022-005 lo conspicuously located thearmtamialar Ih Prolite ule, otontislly Hazotdous food not hold a 138 dogmas Fobranhelt or above, eblekar neuer Bdveory for rwhnderceokad snimat procucts not provided, baarvad procesdad raedy-te-aat, poseritlally hawardoue feed hald more than 24 houre nok propery date marked ater, onening. Jonexempt figh haa not Undargons proper parasite desirvcion. Fish musi be served cooked ordiacerded, 1a/14 Now 12 2008 14:44 11/12/2808 16:42 8584146749 DEPR OGA PAGE 11/14 Page lata DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION DIVISION OF HOTELS AND RESTAURANTS www. myflotide.com/dbpr FOOD SERVICE INSPECTION REFORT LEGAL NOTIGE j Fatlure to comply with this Notice may Inftlate an administrative complaint that may result In suspension or ravocatian af your licanse and fines. Oa73 1/07 01: Routine 2378092 SEAT. Inspection Date and Time Inspection Reason License Number FL GENERAL SERVICES | ING ADMINISTRATIVE COMPLAINT racammeanded. Owner Name ae Area Cade/Telephona Number Business Name Inspection Result 1470472007 08:00 AM. Number of Units ‘ Callback Date/Time License Expiration 17040. COLLINS AVE GOLDEN BEAGH, 33160 Address / Clty / State / Zip / ete. ; item 46: Fire Extingulshers and Fire Suppreceian Svetems Dates A Class (ype Fire Extinguisher, found kit Richer hae a carilicalion cote of 8/07 4 Hood Suppreadon type Fire Exlinguisher, found inval Kitchen hae a carilficetian date of 407 A Gags ABC type Fre Extingutaher, faund Infal dining room hag eenrtilcation date of B07 tam 03: Pood Temperatures: hem 63a: Cert. Food Managors iter 20: Warewashing Sanitization "Poutiry, Kitchen, 116 Degrees F. Poullry, walk in cooler, 47 Daqrega F, Enya, reach In cooler, 40 Depreee F Seafoeed, whl br esyetir, 40 Dagreea Fi Sauces/grevy, reset hh eootar, 38 Oegrens F, Baaf, raneh bh cooler, 40 Degrees F, Manager Nama: Margot Luque Cartifleatlon Date: 1/21/06 Certified by: National Registry of Food Safaty Profaseianele NOTE: heme marked above with an asterlsk (*) Indicate a violation [Inspector's Comments arvina. showed In menu and there [s no corvina In premises, Qwnar herself geld they are aieng swal fish Instead, Owner algo sald that they tell istomers that corvina is grouper. No Ballar On Site, Facknowledde facelpt of this Inspaction form and comments. 08-31-07 Signature of Recipient Inspector Signature Date Reciptent wor ot Luque ° For further infarmation please contact: . Danial Uneid TH 2 Owner 8240 NW $2 Terr, #101 Miami, FI'33186 Phone: 3059571990 850-487-1308 PHE TEMPERATURE CONTROL *03a Cold fond at proper tamparatures during storage, display, service, *03b Hot food st proper temperatura : *03e Foods properly cooked/reheated SOURCE STATUS. STATUS Violations marked With an asterisk are erticel violations, tars mevtod [Nara In compliance, Items Merked OUT are viclntlans. Specific detalla of violation are Ustad on svbesquent pages, ems marked N/A are Not Applicable, tems Markod an N/O are Not Observed, and were not being canducled atthe time af Inspection. DEPP Form HA 8020-076 STATE OF FLORIDA EXH | BIT B 11/12/2088 16:42 8584146749 LEGAL NOTICE DEPR OGA j STATE OF FLORIDA DEPARTMENT OF BUSINESS AND FROFESSIONAL REGULATION’ DIVISION OF HOTELS AND RESTAURANTS www. tnyfiorida.com/dipr FOOD SERVICE INSPECTION REPORT Now 12 2008 14:44 PAGE 12/14 Pags 2of4 License Number SEAT 23719092 . Business Name Pachamamma Inspection Date 08/31/07 01:44 PM Fallure to comply wih this Notice may Initiate an administrative complaint that may regult In auepension or revocation of your license and fines. STATUS PHF TEMPERATURE CONTROL STATUS GARBAGE AND REFUSE DISPOSAL In YO? Unwrapped or potentially hazardous food not reserved 33 Contalnars covered, adaquata number, inéect and rodent Cut 08a Food protection during storage, preparation, display, proof, emptied at proper Intervals, clean iservica, transportation Out 34 Duteide storage arae clean, enelosura properly Cut FO8b Cross-contaminetion, equipment, persunnel, storage fonsttuctad “O8c Potential for cress-contaminetion; storaga practices; INSECT damaged food sagregatad rdee Presence of Insects/rodents, Animals prohibited: Out "09 Foods handled with minimum contact Out fa5b Outer openings pratected fram insects, rodant proof Out 40 Inuse food dispensing utensils properly stored STATUS FLOORS, WALLS, CEILINGS STATUS ' PERSONNEL Out 36 Floore properly constructed, clean, drained, coved In 44 Personnel with infactions restricted Out 37 Walls, callings, and attachad equipment, constructed, Qut 4128 Hands washed and clean, good hygienic practicas clean (observed), alternative operating plan Out 88 Lighting provided as raquirad. Fixtures shlaldad In "2b Proper hyglenis practices, aating/drinking/emoking 39 Rooms snd equipment - verted as required fevidence) STATUS OTHER AREAS 13 Clasn clothes, halr restraints ‘40 Employee lockers provided and used, clean STATUS FOOD EQUIPMENT AND UTENSILS In "41a Toxie ihama properly stared 14 Food contact surfaces deaignad, constructed, In "41 Toxic Items labeled and used propart meintalned, Installed, located 42 Promises maintained, free of Iitter, unnecassary articles. 15 Non-food contact surfeces designed, constructed, Cleaning and malntenance equipment properly stored. malntalnad, Installed, located Kitchen restricted to authorized personnel Sut “15 Dishwashing faciities designed, constructed, aperated 43 Complete separation. from llving/sleaping ares, laund 1. Wash 2. Rinse 8. Saniize 44 Clean and solled IInen segregated anc properly stored 17 Thermometers, gauges, test klis provided STATUS SAFETY 14 Pre-flushed, scraped, soaked 45 Fire extinguishers - proper and sufficient 18 Wash, ringe water clean, proper temperatura "46 Exiting system - adequate, good repalr Out “20a Sanitizing concentration 47 Elentica) wiring - adequate, good rapalr "20b Sanitizing tamperature "48 Gas appliances - properly ingtallad, maintained 24 Wiping cloths clean, used properly, stored 749 Flammablo/combustibig materials - properly stored Out "22 Food contact surfaces of equipment and utensils clean | STATUS GENERAL ° 23 Non-food contact surfaces clean __|*50 Current icensa properly displayed 24 Storage/handiing of clean equipment, utensils 1 Other conditions sanitary ang safe operation STATUS SINGLE SERVIGE ARTICLES Out *52 False/migieading statements publlahed or advertised 25 Service Items property stored, handled, dispensed relating to food/beverage 26 Single service articles not re-used In 7533 Food management certification valid STATUS WATER AND SEWAGE/PLUMBING Out *53b Employes training validation “27 Water sauree sefe, hot and cold under prassure 54 Florida Clean Indoor Alr Act “28 Sewage and weste water disposed proper! 29 Plumbing installed and maintalnacl "30 Cross-connection, back slphonage, backflow STATUS Out Out TOILET AND HANDWASHING FACILITIES: “31 Toilet and handwashing facliltlas, number, convenlant, designed, Installed *32 Restrooms with self-closing doors, fixtures operate properly, facility clean, supplied with handsosp, dlaposable towels or hand drying devices, tissue, cavared waste 55 Automatic Gratuity Notice 5¢ Copy of Chaptar 509, Florida Statues, available GENERAL Education Pragranm Information provided Total Number of COS Violations: 1 Total Number of Rapest Violations: 3 Viofations marked with an saterisk are critical vislations, Hama marked IN are in compliance, Nama Marked OUT ave violations. Specific detalla of violation ara ilatod on subsequent pages, Items marked N/A are Not Applicable, Items Marked as N/O are Not Observed, and were nat belng cenductod at the Ime of Inepactlon. DBPR Form HR 6022-015 Now 12 2008 14:45 11/12/2808 16:42 8584146749 DEPR OGA PAGE 13/14 Page 3 of 4 License Number STATE OF FLORIDA SEAT 2949092 DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION Businéss Name DIVISION OF HOTELS AND RESTAURANTS " wwwamyflarida.comidbpr ; Pachamamma Ingpection Date FOOD SERVICE INSPECTION REPORT pi LEGAL NOTICE 08/31/07 01:44 PM Faflure to comply with this Notice may initiete an administrative corniplatnt that may result In suspension or revocation af yourlicanse and Anes, Viatatlon{s}: 358-03-1:Outer openings nat protected with salf-cloaing deern, 08-05-1:Observed improper use of bowl/plastle feed cantéiner or alher coniainar with na Handle used to dispenag fond [hat Is noi rendy-to-sal, 32-16-4:Hand wesh eink lacking propor hand drying proviaiona, 32-17-T:Handwashing cleanser lacking at handwashing favatary, 120-18-1:Obaerved employee engage in food preparation, handle clean equipment or uienslls, or taueh unwenpped einglé-service Nema, without washing hands. 08-0¢-7:Obaerved bare hand contact of ready-to-eat food by employees and establiehment has ho approved Altamative Operating Procedure in affaet, Carraciad C4 Site, oe09 No canspleuously located thermamater tn hooking unit, 10-07-1:Cbeerved in-use utensil stored in standing Water loss than 135 dagrape Fahranhalt. 02-07-1-Obsorved processed ready-to-aet, patentislly hazanioua food held more than 24 hours nol properly date marked after opening. O8A-28-1:Observed food stored on floor, 034-28-1:;Observed uncovarad food in holding untidry storage ares. OB8A-26-1:Observed raw animal food storad over readystoeant fond, 038-03-7,Potentinily hazardous food not hald at 136 degroes Fahranhelt of above, chicken 20A05-1:Fandecontact surfaces and utenalls not sanitized properly afer claentng, ‘ 18-08-1:No claaniig agent provided In frateomparimant ofalnk, Washing and ringing In same compartment OBE-O3-1:Singla-uee glovea not changed a needed after changing (asks or when damaged or soiled, 06-04-1:Observed patentlatly hazardous food thowed at room larmporature, OS01 -7:Observad Improper use of howl/plastic food contalnar or other container with no handle used to dispense ready-le-aat food, 31-06-:Handweeh ink In disrepalr. DBPR Form HR §022-015 Now 12 2008 14:45 11/12/2808 16:42 8584146749 DEPR OGA PAGE Pagé 4 af 4 STATE OF FLORIDA eens ode 19092 DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION Business Nam DIVISION OF HOTELS AND RESTAURANTS Pachemammna wow. myflorida.com/dhpr | Inspection Date FOOD SERVICE INSPECTION REFORT . LEGAL NOTICE 08/31/07 01:44 PM Fallure to comply with this Notice may Initiate an adminiettstive complaint that may result In suspansior or revocation of your lcense and finas. 37-08-1;haerved wall solled wih accumulated granag, kitehen 2228+T-Obsarved Intartor of reach-in cooler soiled with accumulation of food rasidua. 38-07-1:Lighla missing the proper shield, sleeve eoalings er covers, walking cooler O2+79-1:Consumer advisory for rawiundercooked animal products not provided, Repeat Vialstien, 018-23-1:Nenexempt flat has not undergone proper parasite destruction, Flah must be served cocked or discarded. REFERENCE TEXT: 3402.17 FC: Paraalta Destruction, (A} Except as specified In Paragraph (6) of thla section, before service or. gale i READY-TO-EAT form, raw, faw-mérineted, partially cookad, or marinatod-parilally cooked FISH other than MOLLUSCAN SHELLFISH shell be fiezen throughout to a temperature of (1)-4 dagrens Fahrenhelt of below for 168 hours (7 days) tn a freezer, or (2) -31 dogroos Fahranhelt or below far 15 hours ins blast freezer, (B) Ifthe FISH are tuna of the epecles Thonnug alalunga, Thunnus albacates (Yellowfin ture), Thunnus atlanticus, Thunrus maceeyl (B}uefn una, Southern), Thutnug obagus (Bigeye tune}, or Thunnue thynnus (Bluefin tune, Northern), tha FISH may be earved or gold in a raw, rawemarinated, or parlally cooked READY-TO-EAT form withoul freezing a specified under Paragraph (A) of this section. Ba-01-1:ldenthy of food or food product misrepresanted, Menu shows corvina and there ls no corving fn pramigas. Cumar gays they are using awal fish Instead, REFERENCE TEXT; 509.282(1) FS: (1) An operator may rot knowingly and willfully misrepresent the Klanthy of any food or food preduct to any of tha palrona of auch, satabllehment. The Identity of food or 8 food product i miscoprosented if; (a) The dascription of the faod or food product Is false or misleading In any particular; (b) The food ‘or food produet is served, sold, of distributed under tha neme of another food or food procfuct; of (¢) The food or foad product purports to be ors represantad eg a food or food product thet dogs not canform to 8 definition of Identity and atandard of quallly if such defintlon of Identity and standard of quatity hes been established by custom and usage. . 53B-04-7:Empleyeas hava not fecalved.tralning réleted to thelr assigned duties. handwashing procedures 34-09-T:Obaorved grease on the ground and/or pad eround graage recaptecle.” OBA-19-1:;Obaarved tom packages/baga of faed exposing the contenis te conterination, Repeat Violation. . 22-1B+7:Observed soied reach-In cooler shelves, Repeat Violation 36-13-7;Observed grease accumulated under cooking equipment. 88-05-1:Tan (10) foot-candlas of light et leeat 30 inches from flor not provided |n dry food alorage ara. BPR Form HR 5022-075 14/14

Docket for Case No: 08-005649