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DALLAS COUNTY HEALTH AND HUMAN SERVICES
ENVIRONMENTAL HEALTH DIVISION
2377 N. STEMMONS FRWY. ROOM 607
ysT,Tf of �� + "y DALLAS, TEXAS 75207
214- 819 -2115 FAX 214- 819 -2868.
CITY /TOWN 4 1 V
San
Code
Bate
Time In
Thne Out
Establishment Nanuber Permit Number
-�-
Risk Category
Purpose of Inspection:) 1-Compliance 2- Routine 3 -Field Investigation 4 -Visit , 5 -0ther
Establishment:
Owner:
Physical Address: 50(o 4 L�t�L -S ,G��
Zip:
Phone: (21'' (563 — ,-50 0
5 Pts "; ,.
COS
Fooderrhera4ure/Iie Requirements
Violations Require Immediate Corrective Action . Rem,rks
1. Proper Cooling for Cooked/Prepared Food
-�
2. Cold Hold (41 degrees Fahrenheit/45 degrees Fahrenheit)
..�
3. Hot Hold (135 degrees Fahrenheit)
4. Proper Cooking Temperatures
5. Rapid Reheating (165 degrees Fahrenheit in 2 Hrs)
Item/Location/Temperature
pt
�€
NO
"COS
ndl ng/Saurce Requirements
tion . Viol do s Req Remarks
ediate'Correctve Ac
6. Personnel with Infections Restricted/Excluded
7. Proper/Adequate Handwashin
8. Good Hygienic Practices (Eating/Drinking/Smoking/Other)
9. Approved Source/Labeling
10. Sound Condition
✓
11. Pro' er Handling of Ready-To-Eat Foods
12. Cross- contamination of Raw /Cooked Foods /Other
OUT
3 Pts
1N
-'
NA
s"
NO
COS
13. Approved Systems (HACCP Plans/Time as Public Health Control
14. Water Supply - Approved Sources /Sufficient Capacity/Hot and Cold Under Pressure
Facility; and Equipment Requirements�� "N�
Violations Require Iminediate Correction, , ' t. To Exceed 10 Days Remarks
15. Equipment Ade uate to Maintain Product Temperature
16. Handwash Facilities Adequate 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 Properly Labeled/Stored/Used
21. Manual/Mechanical Warewashing and Sanitizing at ) m/tem erature
22. Manager Demonstration of Knowledge /Certified Food Manager
23. Approved Sewage/Wastewater Disposal System, Proper Disposal
✓
24. Thermometers Provided/Accurate/Properly Calibrated ±2 degrees Fahrenheit)
25. Food Contact Surfaces of Equipment and Utensils Cleaned/Sanitized/Good Repair
26. Posting of Consumer Advisories ( Heimilich /Disclosure/ReminderBuffer Plate)
27. Food Establishment Permit
Subtotal
Other Violations - Re uire Corrective Action, Not to Exceed 90 -Da s or the Next Ins "ection, (Whichever Comes First
5pt
4t
3t
Total
Inspected by:
Print: P)
FIU
Yes/No
Received by:
Print:
Title: