Jul 22 2010 9:02 arf2l/20lea @a:42 8584146749 DEPR OGA PAGE State of Florida Department of Business and Professional Regulation Division of Hotels and Restaurants DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION Petitioner, VS. License Number,.3916507 TAKE A BREAK dent License Type 2010 espon a Case Number 2009065661 i ee Administrative Complaint The DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION, DIVISION OF HOTELS AND RESTAURANTS, ("Petitioner"), files this Administrative Complaint against TAKE A BREAK Ui, (‘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, 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 ig 4631 WOODLAND CORPORATE BLVD #105, TAMPA, FLORIDA 33614.The mailing address of record ig TAKE A BREAK II, at 4431 WOODLAND CORPORATE BLVD #105, TAMPA, FLORIDA 33614. 3. Inspection of this establishment conducted pursuant ta Sec. 509.032, Florida Statutes, revealed violatians of the provisions of Chapter 409, Florida Statutes, and for 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 fatlowing penalties: administrative fine nat to exceed $1,000 per offense, 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 mn a Joe Perez Distiet anager ~ By delegation of thé 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 4940 North Monroe Street Tallahassee, Florida 32399-2202 Certificate of Service BY CERTIFIED U.S. MAIL, ARTICLE NUMBER: elt pian iy THEREBY CERTIFY that a true and correct copy of the foregoing ADMINISTRATIVE COMPLAINT has been hand served by me on this day of , 2008, Received by: Inspector's Signature Operator's Signature Title Title Case Number 2009085661 File Number: 223302 District Nurmber: 03 License Number: 3916507 2010 Form revised 10.15.09 TAKE A BREAK I a3/@5 Jul 22 2010 9:02 7/21/2018 83:42 B5e4146749 DEPR OGA PAGE Exhibit A License Number: 3916507 License Type: 2010 PERMANENT FOOD SERVICE Case Number: 2009065661 “EC” 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 81C, 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 alleged that an October 12, 2009, December 15, 2009 the licensee was in violation of Florida Statute §09(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} far the above referenced inspection(s) are attached hereto and incorporated by reference aS Exhibit 6. * 4.034-07-1 3-501.16(A) FC: (A) EXCEPT DURING PREPARATION, COOKING, OR COOLING, OR WHEN TIME IS USED AS THE PUBLIC HEALTH GONTROL AS SPECIFIED UNDER SECTION 3-501.19, AND EXCEPT AS SPECIFIED IN PARAGRAPH (B) OF THIS SECTION, POTENTIALLY HAZARDOUS FOOD SHALL BE MAINTAINED: (1) AT 433 DEGREES FAHRENHEIT OR ABOVE, EXCEPT THAT ROASTS COOKED TO A TEMPERATURE AND FOR A TIME SPECIFIED IN PARAGRAPH 3-401.11(B) OR REHEATED AS SPECIFIED IN PARAGRAPH 3-403.11(E) MAY BE HELD AT A TEMPERATURE OF 130 DEGREES FAHRENHEIT OR ABOVE, OR (2) AT A TEMPERATURE SPEGIFIED IN THE FOLLOWING: (A) 44 DEGREES FAHRENHEIT OR LESS, OBSERVED POTENTIALLY HAZARDOUS FOOD COLD HELD AT GREATER THAN 41 DEGREES FAHRENHEIT; OBSERVED CUBAN SANDWIGHES COLD HELD AT 64 DEGREES F, HARD BOILED EGGS AT 56 DEGREES F AND EGG SALAD AT 51 DEGREES F ON 10/12/09 AND OBSERVED CUBAN SANDWICHES COLD HELD AT 54 DEGREES F AND MILK AT 46 DEGREES F ON 12/18/09. “92017-1141 4302.14 FC: 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. NO PROPER CHEMICAL TEST KIT PROVIDEO FOR MEASURING THE CONCENTRATION OF THE SANITIZER SOLUTION USED FOR WIPING CLOTHS. File Number: 223302 District Number: 03 Case Number. 2009065661 Form revised 10.15.09 Cicanse Number: 3978507 2019 TAKE A BREAK II a4/@5

Docket for Case No: 10-006049