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`o o DALLAS COUNTY HEALTH AND HUMAN SERVICES
F ` �y ENVIRONMENTAL HEALTH DIVISION
2377 N. STEMMONS FRWY. ROOM 607
DALLAS, TEXAS 75207
4 -819 -2115 FAX 214 - 819 -2868
CITY/TOWN Lt ,/t/'' 'Z,� ��
Item/Location/Temp erature
i, 6. Personnel with Infections Restricted/Excluded
�^ 7. Proper/Adequate Handwashin
a^ 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
- 15. Equipment Ade uate to Maintain Product Temperature
F 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
v 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)
v 25. Food Contact Surfaces of Equipment and Utensils Cleaned/Sanitized /Good Repair
r/ 26. Posting of Consumer Advisories ( Heimilich /Disclosure/ReminderBuffer Plate)
27. Food Establishment Permit
Subtotal Other Violations Require Corrective Action, Not to Exceed 90 Days or the Next Inspection, Whichever Conies First
Total Inspected by: K Print: 1? A0
F/U }
V—W- Received by,**- ` Prin1t1