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DALLAS COUNTY HEALTH[ AND HUMAN SERVICES
ENVIRONMENTAL HEALTH DIVISION
2377 N. STEMMONS FRWY. ROOM 607
DALLAS, TEXAS 75207
214 - 819 -2115 FAX 214 - 819 -2868
CITY /TOWN
Item/Location/Temperature
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Tota� Inspected by: Print: f� A) N-
F/U Received by.
Yes/No Print: Title:
6. Personnel with Infections Restricted/Excluded
,
-7. Pro per/Adequate Handwashin
8. Good Hygienic Practices (Eating/Drinking/Smoking/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
OUT
3 Pts ;_
IN ",
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-N
. ' : "
NO -
:COS
acilrty a' d Equipment Req nrements
violations Reuire Ixninediate Corectron,, Not fib, Exceed l d lea s Remarks , D',
15. Equipment Ade uate to Maintain Product Temperature
a/
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
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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
I Other Violations - Require Corrective Action, Not to Exceed 90 Days or the Next Inspection, Whichever Comes First
5vt
Tota� Inspected by: Print: f� A) N-
F/U Received by.
Yes/No Print: Title: