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Kappa Kappa Gamma
~ovr1TY pF,Q 7 DALLAS COUNTY HEALTH AND HUMAN SERVICES x ~ , ~ ~r ~ N ENVIRONMENTAL HEALTH DIVISION 2377 N. STEMMONS FRWY. ROOM 607 ~~~"Tf oF T~~'P~ (214) 819-2115 Fax: (214) 819-2868 ~~~ `-Ti~ CITY/TOWN !-~//VC~~f ~~~ U~' ~f~ ~ ~ ~ y~ ` ~ ~~ x '~'1[1~Ft~~~ ~ ~s" ~ a~~~~~ ~ „~ ~ ~~1TEl~~~~~~I` ~ , ~ '~~Til~ `~Ti1Il7~E1' ` ` RIiS~ CA~~Ol~' ~~ 'F~+€r~e ~ , ..~peC~a~n~ ~~Cc~m~a~aaxce .. ... ~_ l~tiuti n~ ' 3-~~~el~ In~s~~n` , ~-Visit 5-Otiaer Establishment: ~~ . /~ - ~'+~,~ Owner: ~L~ (~'S'~~, Physical Address: ~~/ ~~ l~~-. Zip:75~ Phone: ( ~) `7C,g~ ~~3r~~ / 1. Proper Cooling for Cooked/Prepared Food 2. Cold Hold (41 degrees Fahrenheit/45 degrees Fahrenheit) 3. Hot Hold (135 degrees Fahrenheit) o,/ 4. Proper Cooking Temperatures ' 5. Rapid Reheating (165 degrees Fahrenheit in 2 Hrs) Item / Location / Temperature ~'~/~ ~~~ ~~f~`'~ ~~ ~ ~s ~ ~~. ~~ ~~~ . ~*~cr~I ~idli~g/5arur~e 3~~qu~re~+en~, , ' ~~io~aE~~~s,l~~quir~ ~Irnn~ediate .Co~tre~t~v~~ t~~tie~n'~~~ ~ ~ Remarks'~ 6. Personnel with Infections Restricted/Excluded Q/ 7. Pro er/Ade uate Handwashin / 8. Good Hy ienic Practices (Eatin /Drinking/Smokin /Other) 9. Approved Source/Labeling / 10. Sound Condition ~ 11. Proper Handling of Ready-To-Eat Foods ~ 12. Cross-contamination of Raw/Cooked Foods/Other ~,~ 13. Approved Systems (HACCP Plans/Time as Public Health Control) 14. Water Supply - Approved Sources/Sufficient Capacity/Hot and Cold Under Pressure o[rr ~~s It~ Na rto Cos F~ciIf~~.an~ Equti~ment Requirements :; Vic~la~ions R~quire Immediate Carrecrion, Nc~t Ta!Exceed 10 Days Remarks 15. E ui ment Ade uate to Maintain Product Tem erature 16. Handwash Facilities Ade uate and Accessible 17. Handwash Facilities with Soap and Towels 18. No Evidence of Insect Contamination 19. No Evidence of Rodents/Other Animals 20. Toxic Items Pro erl Labeled/Stored/Used 21. Manual/Mechanical Warewashin and Sanitizin at ( )p m/tem erature 22. Mana er Demonstration of Knowled e/Certified Food Mana er 23. A roved Sewa e/Wastewater Dis osal S stem, Pro er Disposal 24. Thermometers Provided/Accurate/Pro erl Calibrated (t2 de rees Fahrenheit) 25. Food Contact Surfaces of E ui ment and Utensils Cleaned/Sanitized/Good Re 26. Postin of Consumer Advisaries (Heimilich/Disclosure/ReminderBuffer Plate 27. Food Establishment Permit subccitai .. ~tl~~i r,'~?i~ila tians = R~ u ix~°'~~ciir~rr~~~~ Actii~n, Nc~t~#o. ~xc~~d 4~1~~?~ ~;~ir~.~~a~ ~~xt ins ectic~n, Whichever C+ ~ 5t ~ _ 4 t ~~~~ ~~ ~ ~F.?i ~ ~ 3t , _ ~ ~otal Inspected by: . Print: ~„~ F/U,~. Received bY:J~~ /r~ ~~"` _ ~_,,,, .,;, Print: //~y1 ,;_' ~~i ~,~,,~- ,. Title: