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<br />4 TEXAS DEPARTMENT OF HEALTH h .6? ?r t
<br />Division of Food and Drug
<br />Est. County Dist. Est. No. Census Tract Sent Code Yr. Mo. Da Travel Time Inspec.Time
<br />I.D. 17-
<br />[1-10] 11-13 14-1e 22 23-25 26-28
<br />Owner Name:
<br />Address:
<br />PURPOSE
<br />Regular ....... 29-1
<br />Follow-up ....... 2
<br />Complaint ....... 3
<br />Investigation ..... 4
<br />Other ........... 5
<br />ITEM
<br />NO.
<br />Food Service Establishment
<br />Inspection- Report
<br />Zip
<br />Based on an inspection this day, the items circled below Identify the violations In operations or facilities which must be corrected by
<br />the next routine inspection or such shorter period of time as may be specified in writing by the regulatory authority. Failure to comply
<br />with any time limits for corrections specified In this notice may result In cessation of your Food Service operations.
<br />ITEM
<br />WT. COL. NO. WT. COL.
<br />FOOD
<br />Source; sound condition, no spoilage 6 30
<br />Original container; properly labeled 1 ' 31
<br />FOOD PROTECTION
<br /> Potentially hazardous food meets temperature requirements
<br />during storage, preparation, display, service transportation
<br />5
<br />32
<br />01?4 Facilities to maintain product temperature 4 33
<br />05 Thermometers provided and conspicuous 1 34
<br />00 Potentially hazardous food properly thawed 2 35
<br />.07 Unwrapped and potentially hazardous food not re-served 4 36
<br />46 Food protection during storage, preparation, display,
<br />service, transportation 2 37
<br />Ile Handling of food (ice) minimized 2 38
<br />19 In use, food (ice) dispensing utensils properly stored 1 39
<br />PERSONNEL
<br />112 Hands washed and clean, good hygienic practices 5 41
<br />•t1- Personnel with infections restricted S 40
<br />
<br />11 Clean clothes, hair restraints 1 42
<br />FOOD EQUIPMENT & UTENSILS
<br />1+ Food (Ice) contact surfaces: designed, constructed, main-
<br />tainecl, installed, located = 43
<br />u Non-food contact surfaces: designed, constructed, main-
<br />tained, installed, located 1 44
<br />14 Dishwashing facilities: designed, constructed, maintained,
<br />installed, located, operated 2 45
<br /> Accurate thermometers, chemical test kits provided, gauge
<br />cock (1/4' IPS valve) 1 46
<br />112 Pre-flushed, scraped, soaked 1 47
<br /> Wash, rinse water: clean, proper temperature 2 48
<br /> Sanitization rinse: clean, temperature, concentration, ex-
<br />posure time; equipment, utensils sanitized 4 49
<br /> Wiping cloths. clean, use restricted 1 50
<br /> Food-contact surfaces of equipment and utensils clean,
<br />free of abrasives, detergents 2 51
<br />23 Non-food contact surfaces of equipment and utensils clean 1 52
<br />24 Storage, handling of clean equipment/ utensils 1 53
<br />25 Single-service articles, storage, dispensing 1 54
<br />28 No reuse of single service articles 2 55
<br />WATER
<br />27 Water source, safe: hot & cold under pressure 5 58
<br />FOLLOW-UP RATING SCORE 75-77 Type of Est.
<br />Yes .......... 74-1 100 less weight of 76
<br />No ......... .. 2 items violated $Q
<br />'Critical Items Requiring Immediate Attention. Remarks on back [80-1]
<br />Establishment Name:
<br />SEWAGE
<br />Sewage and waste water disposal 57
<br />PLUMBING
<br />01 Installed, maintained ,-Y . 58
<br />41*1 Cross-connection, back siphonage, backflow, 5 59
<br />TOILET & HANDWASHING FACILITIES
<br /> Number, convenient, accessible, designed, installed
<br />1 Toilet rooms enclosed, self-closing doors, fixtures, good
<br />81
<br />42 repair, clean; hand cleanser, sanitary towels/tissues/hand-
<br /> drying devices provided, proper waste receptacles
<br />GARBAGE & REFUSE DISPOSAL
<br /> Containers or receptacles, covered: adequate number 2
<br /> Insect/rodent proof, frequency, clean
<br />34 Outside storage area enclosures properly constructed, 1 63
<br /> clean; controlled incineration
<br />INSECT, RODENT, ANIMAL CONTROL
<br />Presence of insects/rodents - outer openings protected, 4.
<br />no birds, turtles, other animals
<br />FLOORS, WALLS & CEILINGS
<br /> Floors, constructed, drained, clean, good repait, covering 1
<br /> installatlon, dustless cleaning methods
<br /> Walls, ceiling, attached equipment: constructed, good
<br /> repair, clean, surfaces, dustless cleaning methods
<br />LIGHTING
<br />Lighting provided as required, fixtures shielded 1 87
<br />VENTILATION
<br />99 Rooms and equipment - vented as required 1 88
<br />DRESSING ROOMS
<br />F -T
<br />'40 Rooms clean, lockers provided, facilities clean, located 1 89
<br />OTHER OPERATIONS
<br />'i11 Toxic items properly stored, labeled, used 5 70
<br />
<br />42 Premises maintained free of litter, unnecessary articles,
<br />cleaning maintenance equipment properly stored. Author-
<br />ized personnel
<br />1
<br />71
<br />43 Complete separation from living/sleeping quarters. Laundry. 1 72
<br />44 Clean, soiled linen properly stored 7" F3
<br />Received by: name
<br />title _
<br />Inspected by: name
<br />title
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