State of Florida Department of Business and Professional Regulation Division of Hotels and Restaurants DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION, Petitioner, vs, Case Number: 2016025503 License Number: 6216878 XU, INC. } } License Type: 2010 d/b/a CS KOBE & ITALIAN, ; . Respondent. File Number: 259065 / Administrative Complaint The DEPARTMENT OF BUSINESS AND PROFESSIONAL REGULATION, DIVISION OF HOTELS AND RESTAURANTS, (“Petitioner”), files this Administrative Complaint against XU, INC. d/b/a CS KOBE & ITALIAN, (“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 13505 ICOT BLVD., STE. 207, CLEARWATER, FLORIDA 33760.The mailing address of record is XU, INC. d/b/a CS KOBE & ITALIAN at 13505 ICOT BLVD., STE. 207, CLEARWATER, FLORIDA 33760. 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 more of the following penalties: administrative fine not to exceed $1,000 per offense, suspensig{, revocation, or refusal of a license issued pursuant to this Chapter, and/or any other relief authorized by CXpter 509, Florida Statutes, or the rules promulgated thereto. Signed May 26, 2016 fel Erdman, District 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: 2 | HEREBY CERTIFY that a true and correct copy of the foregoing A hand served by me on this day of , 2016. Received by: Inspector's Signature Operator's Signature Title Title Case Number: 2016025503 File Number: 259065 District Number: 03 License Number: 6216878 2010 Form revised 04.01.16 CS KOBE & ITALIAN Exhibit A License Number: 6216878 License Type: 2010 PERMANENT FOOD SERVICE Case Number: 2016025503 Itis alleged that on April 06, 2016, April 07, 2016, April 13, 2016 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 Code, 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 by reference as Exhibit B. ** denotes a high priority violation. * denotes an intermediate priority violation. * 1A. 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 held in a food establishment for more than 24 hours shall be clearly marked to indicate the date or day by which the food shall be consumed on the premises, sold, or discarded when held at a temperature of 41 degrees Fahrenheit or less for a maximum of 7 days. The day of preparation shall be counted as Day 1. Ready to eat, time/temperature control for safety food prepared on site and held for more than 24 hours not properly date marked. * 1B. 02C-03-4 3-501.17(B) FC Intermediate: (B) Except as specified in (D) - (F) of this section, refrigerated, ready-to-eat, potentially hazardous food (time/temperature control for safety food) prepared and packaged by a food processing plant shall be clearly marked, at the time the original container is opened in a food establishment and if the food is held for more than 24 hours, to indicate the date or day by which the food shall be consumed on the premises, sold, or discarded, based on the temperature and time combinations specified in (A) of this section and: (1) The day the original container is opened in the food establishment shall be counted as Day 1; and (2) The day or date marked by the food establishment may not exceed a manufacturer's use-by date if the manufacturer determined the use-by date based on food safety. Commercially prepared, ready to eat, time/temperature control for safety food open and held for more than 24 hours not properly date marked after opening. ™ 2.03A-02-4 3-501.16(A)(2) FC: (A) High Priority: Except during preparation, cooking, or cooling, or when time is used as the public health control as specified under Section 3-501.19, and except as specified under Paragraph (B) and in Paragraph (C) of this section, potentially hazardous food (time/temperature control for safety food) shall be maintained: (2) At 41 degrees Fahrenheit or less. Observed time/temperature control for safety food cold held at greater than 41 degrees Fahrenheit. Observed sliced ham held at 47 degrees F, turkey 47 degrees F on 4/6/16. Observed sliced turkey held at 47 degrees F and 47 degrees F, sliced beef 44 degrees F on 4/7/16 and batter held at 50 degrees F, sliced ham 46 degrees F and sliced turkey 44 degrees F on 4/13/16. 3. 08B-38-4 3-305.11(A)(3), (B) and (C) FC Basic: (A) Except as specified in Paragraphs (B) and (C) of this section, food shall be protected from contamination by storing the food: (3) At least 6 inches above the floor. (B) Food in packages and working containers may be stored less than 6 inches above the floor on case lot handling equipment as specified under Section 4-204.122. (C) Pressurized beverage containers, cased food in waterproof containers such as bottles or cans, and milk containers in plastic crates may be stored on a floor that is clean and not exposed to floor moisture. Food stored on the floor. Observed bag of onions on the floor 4/6/16 and 4/7/16, observed container of oil stored on the floor on 4/13/16. Case Number: 2016025503 File Number: 259065 District Number: 03 License Number: 6216878 2010 Form revised 04.01.16 CS KOBE & ITALIAN han _ 4.12B-07-4 2-401.11(B) FC Basic: (B) A food employee may drink from a closed beverage container if the container is handled to prevent contamination of: (1) The employee's hands; (2) The container; and (3) Exposed food; clean equipment, utensils, and linens; and unwrapped single-service and single-use articles. Employee beverage container on a food preparation table or over/next to clean equipment/utensils. Employee beverage container in a food preparation/clean dishware area does not have a lid and a straw or equivalent dispensing mechanism to prevent hand contact with lip contact area of drink machine. * §.22-05-4 4-601.11(A) FC Intermediate: (A) Equipment food-contact surfaces and utensils shall be clean to sight and touch. Cutting boards stained/soiled. Slicer blade soiled with old food debris. Slicer blade guard soiled with old food debris. 6. 31B-04-4 6-301.14 FC and 61C-1.004(2)(c) FAC Basic: 6-301.14 FC: A sign or poster that notifies food employees to wash their hands shall be provided at all handwashing sinks used by food employees and shall be clearly visible to food employees. 61C-1.004(2)(c) FAC: (c) Handwashing signs shall be posted in each bathroom facility used by employees. No handwashing sign provided at a handwash sink used by food employees. * 7.§2-07-4 509.292(1) FS: (1) Intermediate: An operator may not knowingly and willfully misrepresent the identity of any food or food product to any of the patrons of such establishment. The identity of food or a food product is misrepresented if: (a) The description of the food or food product is false or misleading in any particular; (b) The food or food product is served, sold, or distributed under the name of another food or food product; or (c) The food or food product purports to be or is represented as a food or food product that does not conform to a definition of identity and standard of quality if such definition of identity and standard of quality has been established by custom and usage. Establishment advertising White Tuna on the menu. No invoices for White Tuna can be produced, establishment serving escolar as White Tuna. Case Number: 2016025503 File Number: 259065 District Number: 03 License Number: 6216878 2010 Form revised 04.01.16 CS KOBE & ITALIAN

Docket for Case No: 16-003901