11/23/2809 Ba: 28 8584146749 Now 24 2009 13:44 DEPR OGA PAGE State of Florida Department of Business and Professional Regulation Division of Hotels and Restaurants DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION Petitioner, WS. License Number, 2613871 DAI LO! dent License Type 2010 Respondent. Case Number 2009038911 { ———_— Administrative Complaint The DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION, DIVISION OF HOTELS AND RESTAURANTS, ("Petitioner’), files this Administrative Complaint against DAI LOI, (‘Respondent’), and says: 4, Petitioner is the state agency charged with regulating the operation of public ladging establishments and public fond 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 5808 NORMANDY BLVD #13, JACKSONVILLE, FLORIDA 32205.The mailing address of record is DAI LOI, at 5808 NORMANDY BLVD #13, JACKSONVILLE, FLORIDA 32205. 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 mare of the following penalties: administrative fine notte exceed $1,000 per offense; mandatory attendance at Respondent's expense at an educational program sponsored by the Department's Hospitality Education Program, suspension, revocation, or refusal of a license issued pursuant to this Chapter, and/or any other relief authorized by Chapter 509, Florida Statutes, or the rules promulgated thereto. Signed July 24, 2009 F ( @feven von Bodungen, District Manager By delegation of the Director, or designee Division of Hotels & Restaurants Department of Business & Professional Regulation COUNSEL FOR THE DEPARTMENT: Mare Drexler, Lead Attorney Florida Bar No, 0487058 Department of Business & Professional Regulation 1940 North Manroe 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 2009 Received by: Inspector's Signature Operator's Signature Title Title Case Number; 2009038911 File Number, 225222 District Number: 05 License Number: 2613811 2010 Form revised 05.20.08 DAILLOI 63/86 Now 24 2009 13:44 11/23/2889 88: 28 8584146749 DEPR OGA PAGE @4/@6 Exhibit A License Number; 2613811 License Type: 2010 PERMANENT FOOD SERVICE Case Number: 2009038911 FC as cited herein references specific provisions of the Food Cade, Recommendations of the United States Public Health Service, Food and Drug Administration, incorporated by Chapter 81C, Florida Administrative Code. NEPA as cited herein references specific provisions of the National Fire Protection Association Life Safety Code. incorporated by referance at Chapter 4A-3, Fire Prevention, General Provisions, Florida Administrative Gade, and 610-1 .004(5), Florida Administrative Gode. * denotes a critical violation. Itis alleged that on July 7, 2009, ihe 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 ingpection(s) are attached hereto and incorporated by reference as Exhibit B. * 4, 95A-05-1 8-501.117 FC: CONTROLLING PESTS. THE PRESENCE OF INSECTS, RODENTS, AND OTHER PESTS SHALL BE CONTROLLED TO MINIMIZE THEIR PRESENCE ON THE PREMISES BY: (A) ROUTINELY INSPECTING INCOMING SHIPMENTS OF FOOD AND SUPPLIES; (B) ROUTINELY INSPECTING THE PREMISES FOR EVIDENCE OF PESTS; (C) USING METHODS, IF PESTS ARE FOUND, SUCH AS TRAPPING DEVICES OR OTHER MEANS OF PEST CONTROL AS SPECIFIED UNDER SECTIONS 7-202.12, 7-206.12, AND 7-206.13; AND (D) ELIMINATING HARBORAGE CONDITIONS. OBSERVED ROACH ACTIVITY AS EVIDENCED BY A TOTAL OF 20 LIVE ROACHES FOUND THROUGHOUT THE KITCHEN. LIVE ROACHES WERE FOUND WITHIN THE RESTAURANT AS FOLLOWS: TWO LIVE ROACHES INSIDE A PREP TABLE DRAWER WHERE UTENSILS ARE STORED ON THE COOKLINE, THREE LIVE ROACHES UNDERNEATH THE HANDSINK NEAR THE PREP AREA TABLE, TWO LIVE ROACHES. UNDERNEATH THE PREP TABLE ON THE GOOK LINE, 10 LIVE ROACHES UNDERNEATH THE REACHIN COOLER IN THE KITCHEN COMING OUT OF THE COOLER WHEELS, AND THREE LIVE ROAGHES IN A CORNER COVING AREA NEAR THE REACHIN COOLER ANO TABLE WHERE OFEN PACKAGES OF FOOD ARE STORED. 2.51-40-1 509.032(2(B) FS FOR PURPOSES OF PERFORMING REQUIRED INSPECTIONS AND THE ENFORCEMENT OF THIS CHAPTER, THE DIVISION HAS THE RIGHT OF ENTRY AND ACCESS TO PUBLIC LODGING ESTABLISHMENTS AND PUBLIC FOOD SERVICE ESTABLISHMENTS AT ANY REASONABLE TIME. OBSERVED INTERFERENCE/OBSTRUCTION WITH THE INSPECTOR'S RIGHT TO ENTRY AND ACCESS AT ANY REASONABLE TIME. OWNER OF THE ESTABLISHMENT MADE THREATS TOWARD THE INSPECTOR, STATED HE WAS GOING TO KILL THE INSPECTOR, AND USED FOUL LANGUAGE DURING INSPECTION. POLICE WERE CALLED TO THE SCENE AND POLICE REPORT WAS COMPLETED. * denotes critical violation District: 05 Case Number: 2009038911 : License Type: 2010 License Number: 2613811 File Number: 225222 DAI LOL 11/23/2089 88:28 8584146749 DEPR OGA Bada hepertn y Business Professional Reqguiation lov 24 2009 13:45 PAGE Oivision of Holals and Restauranls District V Office 7960 Arlington Expressway. Suite 510 Jacksonville, Flosa 32211-7467 Phone; 850,487,.1395 « Fax: (04,727.5558 Charles W. Drago, Secretary TO: FROM: Dwayne Busselh SUBJECT: Hand Service Administrative Complaint (2009038911) DATE: September 2, 2009 MEMORANDUM Steven Rivera, ie. aputy District Administrator Charlie Grist, Governor The office has not received notification that the owner/operator has received the Administrative Complaint that was mailed 07/28/09. Please hand-deliver the attached Administrative _ Complaint as soon as possible. Please fill in the blanks below, leave one copy with the operator a Administrative complaint for case number ing return one to me. 2009038911 was hand delivered to O¢:Gthy 6- das 60 {Date) _Nittok Boye hl at SS fan Go HO 8. (Print Name and Title {Recipie Signature) (Date) Ley Fare F~ FrOF inspectors Signature and Title) {Dais) Please verify the mailing address on the Administrative complaint obtain a correct mailing address, complete a Change of Record fo Office. Thank you! LICENSE EFFICIENTLY. REGULATE FAIR WWW.MYFLORIDALICENSE,COM and if itis not correct, please rn and submit to District 85/86

Docket for Case No: 09-006492