State of Florida Department of Business and Professional Regulation Division of Hotels and Restaurants DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION Petitioner, vs. License Number 5603268 FL GOLDEN BUFFET License Type 2010 Respondent. Case Number 2013046788 / Administrative Complaint The DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION, DIVISION OF HOTELS AND RESTAURANTS, (‘Petitioner’), files this Administrative Complaint against FL GOLDEN BUFFET, (“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 a0 FER of the Division of Hotels and Restaurants. The respondent's business address of record is 2680 S FE BLVD, CRESTVIEW, FLORIDA 32536.The mailing address of record is FL GOLDEN BUFFET, FERDON BLVD, CRESTVIEW, FLORIDA 32536. DON it 2680 S 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 of the establishment. The violation(s) found and applicable law are described in Exhibit “A,” atta and incorporated herein by reference. Inspection documents are attached as Exhibit “B”, incorp: herein by reference. WHEREFORE, Petitioner respectfully requests entry of an Order imposing one or more of the following operation hed hereto ated penaities: administrative fine not to exceed $1,000 per offense, suspension, revocation, or refusai offa license issued pursuant to this Chapter, and/or any other relief authorized by Chapter 509, Florida Statutes, Or the rules promulgated thereto. Signed November 15, 2013 Ken Hensdill, 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 Monroe Street Tallahassee, Florida 32399-2202 Certificate of Service BY CERTIFIED U.S. MAIL, ARTICLE NUMBER: 7196 9008 9111 0766 9192 THEREBY CERTIFY that a true and correct copy of the foregoing ADMINISTRATIVE COMPLAINT h hand served by me on this. day of , 2013. jas been Received by: inspector’s Signature Operator’s Signature Title Title Case Number: 2013046788 File Number: 245338 District Number: 06 License Number: 5603268 2010 Form revised 01.01.13 FL GOLDEN BUFFET Exhibit A License Number: 5603268 License Type: 2010 PERMANENT FOOD SERVICE Case Number: 2013046788 It is alleged that on September 03, 2013, September 04, 2013, November 12, 2013 Respondent was in violation of Florida Statute 509 (FS); the Rules of the Division of Hotels and Restaurants, Florida Administrative Code (FAC); and/or specific provisions of the Food Cade, Recommendations of the United States Public Health Service, Food and Drug Administration, as incorporated by Chapter 61C, FAC in the following particulars. Copy(s) of the report(s) for the above referenced inspection(s) are attached hereto and incorporated jby reference as Exhibit B. ** denotes a high priority violation. * denotes an intermediate priority violation. * 4.02C-02-4 3-501.17(A)FC Intermediate: (A) Except when packaging food using a reduced oxygen packaging method as specified under Section 3-502.12, and except as specified in (D) and (E) of this. section, refrigerated, ready-to-eat, potentially hazardous food (time/temperature control for safety food) prepared and heid in a food establishment for more than 24 hours shail be clearly marked to indicate the date or day the food shall be consumed on the premises, sold, or discarded when held at a temperature of 41 pees Fahrenheit or less for a maximum of 7 days. The day of preparation shall be counted as Day 1. onsite and held more than 24 hours not properly date marked, cooked pork. At follow-up insp observed cooked chicken and breaded cooked chicken cooked over 24 hours and no date ma walk-in cooler. Observed Ready-to-eat, potentially hazardous (time/temperature control for safety) food inept “* 2.08A-17-4 3-302.11(A)(2) FC High Priority: (2) Except when combined as ingredients, sopala by which ction ked in ting types of raw animal foods from each other such as beef, fish, lamb, pork, and poultry during storage, preparation, holding, and display by: (a) Using separate equipment for each type, or (b) Arranging each type of food in equipment so that cross contamination of one type with another is prevented, and (c) Preparing each|type of food at different times or in separate areas; Observed Raw animal foods not properly separated from one another based upon minimum required cooking temperature in walk-in freezer - all products not commercially packaged. Chicken over Upon follow-up inspection observed raw chicken over breaded shrimp in walk-in freezer. i pork. * 3.27-04-4 5-103.12FC Intermediate: Water under pressure shall be provided to all fixtures, equipment, and nonfood equipment that are required to use water except that water supplied as specified under Paragraphs 5-104,12(A) and (B) to a temporary food establishment or in response to a temporary interruption of a water supply need not be under pressure. Observed Cold water not provided/shut off at employee handwash sink, not working in dishpit| have to turn off and on at shut off. * 4.27-16-4 5-202.12(A) FC Intermediate: (A) A handwashing sink shall be equipped to provide|water at a temperature of at least 100 degrees Fahrenheit through a mixing valve or combination faucet. Observed Hot water not provided/shut off at employee handwash sink, no handsinks have hotjwater. Upon follow-up inspection observed no hot water at dishpit or waitress area handsinks. “5 41-27-4 7-202.12FC High Priority: (A)(1) and (A)(2) FC: Poisonous or toxic materiais shall Used according to: (1) Law and this Code, (2) manufacturer's use directions included in labeling, and, pesticide, manufacturer's label instructions that state that use is allowed in a food establishment. e. (A) fora Observed Wiping cloth sanitizer solution exceeds.the maximum concentration allowed, waitress area, Chlorine at +200 ppm. . Case Number: 2013046788 — File Number: 245338 District Number: 06 License Number: 5603268 2010 Form revised 01.01.13 FL GOLDEN BUFFET * 6.53B-02-4 509.049(5) FS Intermediate: It shall be the duty of each public food service estab| establishment. The public food service establishment may designate any certified food service mana perform this function. Food service employees must receive certification within 60 days after employ provide training in accordance with the described rule to all food service employees of the public saperto ishment to er to ent. ime of any Certification pursuant to this section shall remain valid for 3 years. All public food service So, ate fr must provide the-division with proof of employee training upon request, including, but not limited to, at the division inspection of the establishment. Proof of training for each food service employee shail includ: of the trained employee, the date of birth of the trained employee, the date the training occurred, and approved food safety training program used. Observed No proof of required state approved employee training provided for employee hired 60 days ago. Upon follow-up inspection observed 1 certificate but incomplete, no other proof the name the more than available and had 3 employees preparing food during follow-up inspection (none of these employees were the incomplete certificate). Case Number: 2013046788 File Number: 245338 District Number. 06 License Number: 5603268 2010 Form revised 01.01.13 FL GOLDEN BUFFET

Docket for Case No: 14-000100