HomeMy WebLinkAboutSOUL BOWL 2016.11.15s County Health and Human Services -Environmental Health Division
Retail Food Establishment Inspection Report
Ltc J-/JJw 1117 N. STEoONIT~WVnM 6/:ADALLAS •• Tx 752~11'19-21151J: 214-819-2868 ,a '~< 7 . f , 'Uf~,r . . UJ,~.-;fr<~J!Y_ ~ <::__
rr~J5-1& I Time in: I Time out: /' I Liceni!/Pennit # I Est. Type I Risk ~tegory Page J of J_
Purpose oflnspection: L J 1-Compliance rYJ 2-Routine I I 3-Field Investigation L J 4-Visit L J S-Other TOTAL/SCORE
Estab1~~7) UL &wL l.c::Jlntact/Ow~ame: " I *Number of Repeat Violations: __
lTe 4"' · ,;l\\c.\c eht~ .I Number of Violations COS: --0 ~hysical AddN~: \ ) -S'-\ i k . ~lO I -f)~l1u~t~: 1-x--li~f~~ j ~6· I Follow-up: Yes
(\ {l)h,) u~ i & I i~ ......_ .;4 '7fl -1117 &-4 No (circle one)
Compliance Sllltus: Out = not in compliance IJII = in ~ompliance NO = not observed A = not applicable COS =corrected on site R =repeat violation
Mark the appropriate points in the OUT box for each numbered item Mark '.r• a checkmark in appropriate box for IN, NO. NA, COS Mark an asterisk ' * ' in appropriate box for R
Priority Items (3 Points) violations Re uire Immediate Corrective Action not to exceed 3 days
Compliance Sllltus Compliance St11tus
0 I N N c Time and Temperature for Food Safety R 0 I N N c R u N 0 A 0 u N 0 A 0 Employee Health
T s (F =degrees Fahrenheit) T s
..... /' I. Proper cooling time and temperature 12 . Management, food employees and conditional employees;
knowledge. responsibilities, and reporting
""' 2. Proper Cold Holding temperature(41°F/ 45°F) , 13. Proper use of restriction and exclusion; No discharge from
/ v eyes, nose, and mouth
.~ 3. Proper Hot Holding temperature(I35°F) Preventin2 Contamination by Hands v 4. Proper cooking time and temperature I VI I 14. Hands cleaned and properly washed/ Gloves used properly v 5. Proper reheating procedure for hot holding ( 165°F in 2 ~ 15. No bare hand contact with ready to eat foods or approved
Hours) alternate method properly followed (APPROVED y _N_ J v 6. Time as a Public Health Control; procedures & records Highly Susceptible Populations
Approved Source +1 16. Pasteurized foods used; prohibited lood not o!Tered
Pasteurized eggs used when required
/"
7. Food and ice obtained from approved source; Food in
v good condition, safe, and unadulterated: parasite Chemicals
destruction
...... ---
8. Food Received at proper temperature -1 17. Food additives; approved and properly stored; Washing Fruits
& VejlCtables
Protection from Contamination -r I I 18. Toxic substances properly identified, stored and used
!" ~ 9. Food Separated & protected, prevented during food Water/ Plumbing
preparation, storage, display, and tasting
"'~ 10. Food con~t'rfaces and Returnables ; Cleaned and ..... v-19. Water from approved source; Plumbing installed; proper
Sanitized at ppm/temperature back flow device v II. Proper disposition of returned, previously served or / 20. Approved Sewage/Wastewater Disposal System, proper
reconditioned disposal
Priority Foundation Items (2 Points viohltions Re uire Corrective Action witlrin 10 dtiJI$
0 I N N c R 0 I N N c R u N 0 A 0 Demonstration of Knowledge/ Personnel U N 0 A 0 Food Temperature ControV Identification
T s T s
v 21. Person in charge present, demonstration of knowledge, .., v 27 . Proper cooling method used; Equipment Adequate to
and perform duties/ Certified Food Manager (CFM) Maintain Product Temperature
v 22. Food Handler/ no unauthorized persons/ personnel y 28. Proper Date Marking and disposition
Safe Water, Recordkeeping and Food Package 1--f-29. Thermometers provided, accurate, and calibrated; Chemical/
./ Labelin2 Thermal test strips
v 23. Hot and Cold Water available; adequate pressure, safe Permit Requirement, Prerequisite for Operation
o/ 24. Required records available (shellstock tags; parasite ~ 30. Food Establishment Permit (Current & Valid) destruction); Packaged Food labeled
Conformance with Approved Procedures Utensils, Equipment, and Vending
i 25. Compliance with Variance, Specialized Process, and ,..v-31. Adequate handwashing facilities: Accessible and properly HACCP plan; Variance obtained for specialized supplied, used processing methods; manufacturer instructions
Consumer Advisory v >---32. Food and Non-food Contact surfaces cleanable, properly
./ designed, constructed, and used
<1 26. Posting of Consumer Advisories; raw or under cooked v v 33. Warewashing Facilities; installed, maintained, used/
foods (Disclosure/Reminder/Buffet Plate)/ Allergen Label Service sink or curb cleaning facility provided
Core Items (1 Point) ViolatiotiS Require Corrective Action Not to Exceed 90 DQys or Next Inspection, Wlrichever Comes Fint
0 I N N c R 0 I ~ ~ c R
u N 0 A 0 Prevention of Food Contamination u N 0 Food Identification
T s T s
1-v" ~ 34. No Evidence of Insect contamination, rodent/other 1.-v 4l.Original container labeling (Bulk Food)
animals
>'/ 35. Personal Cleanliness/eating. drinking or tobacco use / Phvsical Facilities
"' 36. Wiping Cloths; properly used and stored i-" 42. Non-Food Contact surfaces clean " ' 37. Environmental contamination ...... h 43. Adequate ventilation and lighting; designated areas used
38. Approved thawing method v _,.-44. Garbage and Refuse properly disposed; facilities maintained
Proper Use of Utensils v 45. Physical facilities installed, maintained, and clean
y ~ 39. Utensils, equipment, & linens: properly used, stored. v 46. Toilet Facilities; properly constructed, supplied, and clean
~ dried, & handled/ In use utensils: properly used -I 40. Single-service & single-use articles; properly stored v 47. Other Violations
and used
Received ~v: r L ·~· ':r e \"' Vra \ ~ iltC ~~,~,,~ (signature) nf-9-/ (f;2 1 Prin~~ (Yo,\\"\ \\ .
I_ ~ll..V\. : o: \ t '-\. <--"'--'' . T~le: Person In Charge/ Owner
\N\..ex'
Inspected by: ~1--~--~~~ f~~ Print: r\vDJ. PJ-.b~()) Business Email:
(signature)
Form EH-06 (Revised c19-2015~ v ) ' J I I
COMMISSARY APPROVAL FORi\'1
City of Dallas
MOBILE FOOD VEHICLE INFORMATION
NAME ON VEHICLE _s-'-·-'-Ov--'-\ --'-~-o_I)J_\ ----PERMIT #-------
NAME OF VEHICLE OWNER __ ~....:..~_c._" __ \)_c;.._.\_r_; v._\c __ ~_r-_.1 ______ _
PHONE NUMBER OF VEHICLE OWNER __ 1.:_~_tJ_· _lJ=-'G-~_-___::~_·l_)_q ____ _
C0:\1;\IISSARY INFORMATION
COMMISSARY NAME _____ ~U~)c_· _ _,f._v_::>....::J;_;___-_l_(\J_v_~_·_~ ____ _
ADD RESS_f--'--~~u=·~:----<-A--'-~~~"-~----=c. ~~o.. J_::-. v=-' r___:...f<-...:v::---v--=--_0--="d-_d....=.c ..;._S _....!....[ ___..!Y~].L-..::!..-; ~z. ---LJ~.t}
STREET CITY STATE ZIP
The follO\ving services may be perfonned at my commissary by tho: abov.: mobile food vehicle:
...:::tlave access to facility at all times
_Have limited access to facility. If yes, access hours are:----------------------
~Have access to inside preparation facilities
~Store mobile vehicle overnight
~Wash out truck/cart above a lloor drain
_::::'Wash, rinse, sanitize all food surfaces
~Fill with fresh water
~Dispose of waste water
~Store exct:ss product
~Store products requiring refrigeration
;\IOBILES ARE TO BE STOnED 1:\SIDE THE C0.\1.\IISS:\nY OYER:\IGIIT.
The mobile vehicle listed above has pemission to use my facilities. 0c ,{'
COMMISSARY OWNER'S NAME (please print) '=/ ;(,
COMMISSARY OWNER 'S SIGNA TURE_~/f.:.....[...:fA"--#-~--~-_..::::=. ... ~~=--------
I certify that information provide-d on th1s application is true and correct. I t"urthwnorc understand that providing fals.: or tictiuous inform ation w11l
render this appl ication invalid. I agree to abide by all of the polic1cs. ruks and regulations sd forth by the department. Failure to comply may result
in suspension of the · oump.Qsttlon of a tin~ or both.
Tcx.ts Dnwr Licens.: #
COM~IISSARY OWNER'S SIGNATURE MUST BE NOTARIZED IF THE CO~f~!ISSA RY OWNE R IS NOT PRESENT WHEN APPLYING
Subscribed and sworn before me. thi s the __L dav of ~(? -h:.N\.~ , 20 l (.,., r~~~~~~~~~~~~~~~~~~~~~~~~~ . --~~~~~~~~----~
~ o""~·1 "11b'" JESSIC ESCOBAR ~ ~ :~'; NOTARY PU'3LIC, STATE OF TEXAS~ ~ ';!~'t MY COMMISSIOII EX PIRES s
Stguutllre of .Votary ~ ~ ..... OF@ APRIL 13, 2019 ~
~./~~~~~~~~~ ........ ~~~~./~~ ........ ,/~~~.,/.;
Notary Seal , \) ~)2S''\~ ~~~Cfc. L~c ~c.c:-
L mm iss1on Exptr~s Pnm~cl.\"am~ of,Voran-
:\OTE: .\11 commissaries must be pre-:tpprovcd prior to pcrmittin~ mobil~ food vehicle.
CCS-FR\-I--125 Fifccti1e fl,lt.: l t l3,~1i(' K~\ 3