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En&onm>tal Management Department Environmental Health Division 8475 Jackson Rd # 240 Sacramento, CA 95826-3904 Ph: (916) 875-8440 Fax: (916) 875-8513 www.emd.saccountv.net

2/23/05

County of Sacramento

Date

Retail Food Facility Official Inspection Report

Page 1 of

02 __

iately. Nonsompliance may warrant closure of the food facility APPROVED RETAIL PRACTICES "

' Sbpervision 24. Person In Charge is present and performs duties Personal Cleanllness 25. Personal cleanliness and hair restraints

Minor

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General Food Safety Requirements

6.

Handwashing facilities supplied and accessible

Time and Temperature Relationship 7. Proper hot and cold holding temperatures 8. Proper use of time as a public health control

Accepted by:

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Minor

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44e Facility is equipped to prevent vermin entranceharborage Permanent Food Facilities

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Signature

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3.>7-, Environmental Management Department Environmental Health Division 8475 Jackson Rd # 240 Sacramento, CA 95826-3904 Ph: (916) 875-8440 Fax: (916) 875-8513

County of Sacramento


Date

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Page

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Retail Food Facility

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0 Reinspection 0 Food borne Illness 0 Complaint Investigation Set forth in the California Health and Safety Code commencing with Section 7; 113700. All general requirements that correspond to each violation listed below. Major vlolatlons: Violations that are classifledas "Majorpose an immediate threat to public health and have the potential to cause foodborne illness. All major violations must be corrected immediately. Non-compliance[maywarrant immediate closure ofthe food facility.

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Food ItemlLocationlTpmp'F Documekation

,' . I 1 0 Fmdlequipment impounded or VCD completed (50) I.

'WPhotographic documentation obtained 0 Compliance conference required

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Food safety education required: #of employees

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Print Name.andJitle:

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