State of Florida Department of Business and Professional Regulation Division of Hotels and Restaurants DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION Petitioner, vs. License Number. 3915964 KAISEN SUSHI R dent License Type 2010 , espon ra . Case Number 2010031937 Administrative Complaint The DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION, DIVISION OF HOTELS AND RESTAURANTS, (‘Petitioner’), files this Administrative Complaint against KAISEN SUSHI, (“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 148441 N DALE MABRY HWY, TAMPA, FLORIDA 33618.The mailing address of record is KAISEN SUSHI, at 2215 W OKALOOSA AVE, TAMPA, FLORIDA 33604. ; 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. e 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, 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 June 28, 201 ~ Joe Perez, Distriot Manager By delegation of the Director, or designee Division of Hotels & Restaurants Department of Business & Professional Regulation COUNSEL FOR THE DEPARTMENT: Marc Drexler, Lead Attorney Florida Bar No, 0487058 Department of Business & Professional Regulation 1940 North Monroe Street ; Tallahassee, Florida 32399-2202 Certificate of Service BY CERTIFIED U.S. MAIL, ARTICLE NUMBER: \3iike: Es | HEREBY CERTIFY that a true and correct copy of the foregoing ADM ie 7160 3902 9448 b710 0312 EASENDE STRATIVE COMPLAINT has been hand served by me on this. day of , 2010. Received by: Inspector's Signature Operator's Signature Title Title Case Number: 2010031937 Fite Number: 195462 District Number: 03 License Number: 3915964 2010 Form revised 10.15.09 KAISEN SUSHI Filed July 8, 2011 2:03 PM Division of Administrative Hearings Exhibit A License Number: 3915964 License Type: 2010 PERMANENT FOOD SERVICE Case Number: 2010031937 “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 Safety 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. It is alleged that on January 20, 2010, June 4, 2010 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, * 4,09-04-1 3-301.11(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 EMPLOYEE AND ESTABLISHMENT HAS NO APPROVED ALTERNATIVE OPERATING PROCEDURE IN EFFECT. 2. 13-03-1 2-402.11 FC:: 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 EQUIPMENT, UTENSILS, AND LINENS; AND UNWRAPPED SINGLE-SERVICE AND SINGLE-USE ARTICLES. OBSERVED EMPLOYEE WITH NO HAIR RESTRAINT. “ 3.20B-03-1 4-703.11(A) AND (B) FC:: AFTER BEING CLEANED, EQUIPMENT FOOD-CONTACT SURFACES AND UTENSILS SHALL BE SANITIZED IN: (A) HOT WATER MANUAL OPERATIONS BY IMMERSION FOR AT LEAST 30 SECONDS AS SPECIFIED UNDER SECTION 4-501.111; (B) HOT WATER MECHANICAL OPERATIONS BY BEING CYCLED THROUGH EQUIPMENT THAT IS SET UP AS SPECIFIED UNDER SECTIONS 4-501.15 AND 4-501.112 AND 4-501.113 AND ACHIEVING A UTENSIL SURFACE TEMPERATURE OF 160 DEGREES FAHRENHEIT AS MEASURED BY AN IRREVERSIBLE REGISTERING TEMPERATURE INDICATOR. THERMOTAPE FAILED TO TURN BLACK TO INDICATE THAT THE SANITIZATION TEMPERATURE OF 160 DEGREES FAHRENHEIT WAS ACHIEVED ON THE DISH SURFACE. 4,24-12-1 3-304.14(B)(2) FC:: (B) CLOTHS USED FOR WIPING FOOD SPILLS SHALL BE: (2) WET AND CLEANED AS SPECIFIED UNDER PARAGRAPH 4-802.11(D), STORED IN A CHEMICAL SANITIZER AT ACONCENTRATION SPECIFIED IN SECTION 4-501.114, AND USED FOR WIPING SPILLS FROM FOOD-CONTACT AND NONFOOD-CONTACT SURFACES OF EQUIPMENT. WET WIPING CLOTH NOT STORED IN SANITIZING SOLUTION BETWEEN USES. Case Number: 2010031937 — File Number: 195462 District Number: 03 License Number: 3915964 2010 Form revised 10.15.09 KAISEN SUSHI

Docket for Case No: 11-003363