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# DALLAS COUNTY HEALTH AND HUMAN SERVICES
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z �, �hrl N ENVIRONMENTAL HEALTH DIVISION
•s 4 n IV -'13 2377 N. STEMMONS FRWY. ROOM 607
17-e o f �� DALLAS, TEXAS 75207
T 214-819-2115 FAX 214-819-2868 Ci" .e
3-2•2:13 CITY/TOWN 21AJ/VE467 l
San
Code Date Time In Time Out Establishment Number Permit Number Risk Category
.
Purpose of Inspection: 1-Compliance 2-Routine 3-Field Investigation 4-Visit 5-Other
Establishment: 4..4 1 ti1.V' Owner: i,0 �� 1'�
Physical Address: `v/1/ cgf Zip: 9V2-1;(5 Phone: ZV - /68-- 3zl f
OUT IN NA NO COS Food Temperature/Time Requirements
5 Pts Violations Require Immediate Corrective Action Remarks
✓ 1. Proper Cooling for Cooked/Prepared Food
✓ 2. Cold Hold (41 degrees Fahrenheit/45 degrees Fahrenheit)
H 3. Hot Hold (135 degrees Fahrenheit)
v, 4. Proper Cooking Temperatures
+/ 5. Rapid Reheating (165 degrees Fahrenheit in 2 Hrs)
Item/Location/Temperature
OUT IN NA NO COS Personnel/Handling/Source Requirements
4 Pts Violations Require Immediate Corrective Action Remarks
Li 6. Personnel with Infections Restricted/Excluded
v 7. Proper/Adequate Handwashing
L'' 8. Good Hygienic Practices (Eating/Drinking/Smoking/Other)
V 9. Approved Source/Labeling
:r- 10. Sound Condition
11. Proper Handling of Ready-To-Eat Foods
✓ 12. Cross-contamination of Raw/Cooked Foods/Other
tr. 13. Approved Systems (HACCP Plans/Time as Public Health Control)
v- 14. Water Supply - Approved Sources/Sufficient Capacity/Hot and Cold Under Pressure
OUT IN NA NO COS Facility and Equipment Requirements
3 Pts Violations Require Immediate Correction, Not To Exceed 10 Days Remarks
15. Equipment Adequate to Maintain Product Temperature
rte' 16. Handwash Facilities Adequate and Accessible
17. Handwash Facilities with Soap and Towels
f 18. No Evidence of Insect Contamination
'o."*" 19. No Evidence of Rodents/Other Animals
20. Toxic Items Properly Labeled/Stored/Used
✓ 21. Manual/Mechanical Warewashing and Sanitizing at ( )ppm/temperature
,� 22. Manager Demonstration of Knowledge/Certified Food Manager
23. Approved Sewage/Wastewater Disposal System, Proper Disposal
i 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)
V. 27. Food Establishment Permit
Subtotal Other Violations - Require Corrective Action, Not to Exceed 90 Days or the Next Inspection, Whichever Comes First
5pt
4pt
3pt
4
JJ Inspected by: r Print: pluipi ( ,p-s
F/U
Yes/No Received by: Print: Title:
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