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UMPHREY LEE 2018.09.10
DALLAS COUNTY DEPARTMENT OF HEALTH AND HUMAN SERVICES Environmental Health Division ZACHARY S.THOMPSON DIRECTOR NON-FOODBORNE ILLNESS FOOD COMPLAINT a q-q~JDate:7-IO-/tJ Time received:11,'I&pJZ Complaint #5 7 Complaint takE;J1by:/7.fJhlL.L;()S Assigned to:t)J(V]'-1.~ c f}~oJ1{'EUonES 7 '2 J - Witness:rl/1c;tf'/C'.!/f'-Daytime Phone #q/if._77t5-8'fcf Address:__________City/Zip: Suspect Restaurant,Day Care,Individual,Other: Date of Incident:Time:------- ObseNation of Witness:/iAE 4;-//--;l2h/lCPC LE-c: List all foods/beverages consumed by above persons at the meal a. b. c. d. Foods/beverages consumed before/after mea REVISED:5-20-14 --1\rue.La II~ Oallas County Health and Human Services -Environmental Health Division Retail Food Establishment Inspection Report 2377:".STDI"O:"S FRWY.,R\1607.DALLAS.TX 75207 214-819-2115 FAX:214-819-2868 ~flO \~I Time in:I Timc out: I LiC~L517~~I J 00 j JLf-vf7 I bt.T)pe I RISk Category Page -or - Po r'\Jose 0'1'Inspection:I I I-Compliance I I 2-Rootine I 3-field InYcsti!!ation I 1~-Visit I I 5-0ther TOTAUSCORE ,st Ib~T)l;a;oL L~o0 J ~FnC,1~lo-+r1\~1 *'lumber of Repeat Violations:__ I rv-(I h'0/'"umber of Violations COS:~/O/rs ~I,-~~Lt~lr1J1 ~(r~&~I01 rDCLfVl~I:Da\as ~B?~I?hf~7b~-4~1V0.I Folhm-up:Yes No (cin.'lc one) Co,hJtiance Slntus:OUI =not in compliance IS=in compliance :\0 ~not ob erved NA =not applicable COS =corrected on site R -repem violation "---'Mark the appropriate points in the OI:T box for each numbered item Mark'0/'a check mark in aooroDriate box for I'\'.1'00.C'l/A.COS Mark an asterisk'*.in appropriate bo"for R Priority Items (3 Points)violations Re,lIire Immediate Correctil'e Actio/J 1Iot to exceed 3 dars Compliance Status Comllliancc Status 0 I N '\'('Time and Temperature ror Food Sarety I!0 I r-'\'c R l'N 0 A 0 (F =d~gree,Fahrenheit)t:'\'0 A 0 Employee Healtlt T S T S ,''V I.Proper cooling tim~and temperature ..,)/I~.Management.food employees and conditional employees::;,.kno\\k(h!~,rL'~Donsihilities,and reoorting.. ~ '. rPP1r~~1{QO~inh'BB~tP;;:rf)v""13.Proper use of re,triction and ~xclusion:No discharge Iromi.eves.no~('.and mOllth ••.l/':f Proper Hot Holding temperature(135'F)~PreYentin~Contamination by Hands ,/4.Proper cooking timc and temperature ,/14.Hand,cleaned and oronerlv IIashed!GIO\·es used properly v'v 5.Proper reheating procedure for hot holding (165°F in ~vi 15.)\0 bare hand contact with ready to eat foods or approved II'Hours)alternate method orooerly followcd (APPROVED Y N ) ./6.Time a,a Puhlic Health Control:procedures &record,Hiphh Suscelltible PODulations Approved Source ~ 16.Pasteurized foods uscd:prohibited food not offered Pasteuri£ed e~gs used \Vh~n rconircd iI'7.Food and ice obtained from appro Icd source:Food in II'good ~ol1dition.safe.and unadulterated:parasite Chemicals "tk'struction 0.1'8.Food Receil ed at proper tempcralUre 1/-1 17.Food additil es:approved and properly stored:Washing Fruits &VeQetables Protection from Contamination ,/18.Toxic substances nronerlv identified."ored and used 9.Food Separatcd &protected.prel"el1led during food Waterl Plumbing /prcparation.storage.displav.and tastin!!, ,/10.Food con'1'tf()lnCCS and R~t"~:Clined and,f vi 19.Water fi'om apprmed source:Plumbing installed:proper Sanitized at PPIQtcmperatu'I)';1.1.1 /,,,uV ~back !low dc,ice II Proper disposition of retumed.previously serl'ed or 0.1'20.Approved SClI"agel\Vastellater Disposal Sy,tem.proper reconditioned di,posal Priority Foundation Items (2 Points)violatiolls ReI ltire Corrective Action within 10 days 0 I N "('R 0 I 1'i "r R t!"0 A 0 Demonstrntion of Knowledge/Personnel t'N 0 A 0 Food Temp,'rature Control/Identification T .S T S VlI< 2 I.Person in charge prescnt.demonstration of knowledge.,/27.Proper cooling method used:Equipment Adequate to and perform duties,Certified Food :Vlanager (CF:VI)Mail1lain Product Temoerature V "Food Handler/no unauthori/ed persons'personnel )(/X 28.PrOner Date .\-Iarking and disDosition Sare Watcr.I{ccordkeelling and Food Package .,/~9.Thermometers prOl ided.accurate.and calibrated:Chemical! /Labeling Thermal test strios 0/23.Hot and Cold Waler available:adequate pressure.safe ~Permit Requirement,Prerequisite ror Operation V 24.Required records a\ailable (shellslOck tags:parasite Iv!30.Food Establishment Permit (Currer§fa'i!J)//20{0vdestruction):Packa!!cd Food labeled Conformance with Approved Procedures Utcnsils,Equipment,and Vending ill It 25.Compliance IIith Variance.Specialized Process.and V 31.Adequatc hant!1I ashing facilities:Acce"ible and properlyHACCPplan:Variance obtained ror speciali/ed V proce::,sin\l mcthod::,:manufacturer instructions suppl ied.used Consumcr Ad,cisor~'Ix 32.Food and Non-food Contact surfnces cleanable.properly ,~designed.constructed.and used 1 26.Po,ting ofCOlhumer Acillsories;ra"or under cooked ,/33.Warell·ashing Facilities:installed.mail1lained.used! foocb rDi,clo,,,relReminder'Buffet Platc)!Allergen Lahel Scn ice sink or curb cleaning facility provided Core Items (I Point)Violatio1ls Rem/ire Corrective Actio",vot to Exceed 90 Days or Nex/l"sDectio1l.Wlricl'l'l'er Comcs Fint 0 I N '\'C R ()I 1\"C R N 0 A 0 Prenntion of Food Contamination t:N 0 A 0 Food Identification T S T S 0.1'34.1\0 EI idence of Insect cOl1lamination.rodenunther 1,/1/oj I.Original container labeling (Bulk Food) 1/animals .",35.Per,onal Cleanlinc,,/eatin!!.drinking or tobacco use /Pltvsical Facilities IY 1/36.Wipin~Cloths:properlv used and "ored VI/4~"on-Food Contact surfaces clean '"I/'37.Environmental contamination 0.1'1.1 43.Adeauate ventilation and Ii!.!hrint!:cicsi)..!I1att?ciareas lIsed II'3~.Approl cd thall in.:method v-I/44.Garbage and Refuse orooerlv disoosed:lacilities maintained Prooer Use or Utensils V 45.Phvsical f:1cilitics installed.maintained.and clean 0.1'3').Ctensils.equipment.&linens:properly ",cd.stored.V 4ii.Toilet Facilities:properly constructed.supplied.and clean ,dried.&handled,In use utensil,:properly u,ed v"40.Slllgie-sel'\ic~&singlc-u,e articles:properly stored ,/47.Other Violations and used Recei\'ed by:11 r-.-rint.-Mu..tJ--~/)IAA!O.s()r\ Titl(i Person In fhargel Owner (sig:natun~)I!drcc .)(_J),,,,,(c M&o!( Inspec d bY:1txN;-~I C"_-c-~-._11't~j'(U t-\ar-ML,9'ArYt.--~/;1-:trs [mail V (~ign:Hurt:- Form EH-06 (Revised O~015)t\U \,.""l;'}- Dallas County Health and Human Services -Environmental Health Division Retail Food Establishment Inspection Report 2377 N.STE:vJ;\-IO:\,S FRWY.,R;\-1607,DALLAS,TX 75207 4-819-2115 A,:~9-2868 Temp Temp License/Permit #Page_cf_ Item/Location OBSERVATIONS AND CORRECTIVE ACTIONS Item AN INSPECTION OF YOUR ESTABLISHMENT HAS BEEN MADE.YOUR ATTENTION IS DIRECTED TO THE CONDITIONS OBSERVED AND Number NOTED BELOW: ~I a>..., '0..., cPCl '"0.. ooo 6 "tlcP>'(ij UcP0:: ooC!co g'~,_0.::-.::.::,_cP Cl>cP .::a1- oo~ C:::Jo(.) xo_Q "'C CI> ell-CI> C Q)Q) <J)<J)ro ro(.)(.) .•.. .::::l ~o'EQ)>.sI-CI>CI>.:.t/) C:::Jo(.) oo~ xo_Q II) -c::so (.) >.•...o-c CI>>C Q) <J)ro(.) ooo o ooo6 ooo C:::Jo(.) 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'1<-co_~ N--'~;j_ WO ILL. 60 W(f)zw ZU<{-u&:-w:ij(f) 0::0 =>0Q._O 0LL. ~82(f) 0>-I-(f) Item Vendor I Vendor Item #I Vendor Item Description Dry Storago \Can Rack \Rack 2·Right PIE FilLING CHERRY SYSCO FOOD SERVICES OF DALLAS (6346134J FILLING PIE CHERRY CRAI'IBERRY SAUCE,JELLIED,OCEAN SPRAY,6/#10:m,_co FOOD :5~RV_ICESO_FDALLAS (4608907J ~Al!.CE CRANBERRY JELLIED CLAMS,CHOPPED,CANNED,SYSCO CLASSIC,12151 OZ SYSCO FOOD SERVICES OF DALLAS (5176763J CLAM OCEAN CHOPPED FCY NO MSG SAUERKRAUT SHREDDED FANCY 6/#10 SYSCO FOOD SERVICES OF DALLAS (4189171J SAUERKRAUT SHREDDED FCY Dry Storage \Can Rack \Fryer OU CHIPS,BULK,CORN,FRITOS,8/1 LB SYSCO FOOD SERVICES OF DALLA~(4073847J CHIP CORN REGULAR SHORTENING,LIQUID,FRYER OIL,CREAMY,ZTF,ADVANTAGE,1/35 LB SYS_COFOOD SERVICES OF DAL!:AS [70410821 SHORTENING LlQ SOY CREAMY ZTF SAUCE MISCELLANEOUS PASTE TAHINI SYSCO FOOD SERVICES OF DALLAS (3494184J PASTE TAHINI Dry Storage \Front Wall OIL,PAN COATING,HIGH HEAT,ZTF,AEROSOL,ADVANTAGE,6/16 SYSCO FOO~SERVICES OF DALLAS (1916081J PAN COATING BEANS,DRY MIX,MEXICAN REFRIED BEANS,VEGETARIAN,SANTIAGO,6/27.088 OZ SYSCO FOOD SERVICES OF DALLAS {6715957J BEAN REFRIED VEGTRN Dry Storage \Front Wall \Racl<1·Rice CORN STARCH,ARGO,24/1 LB SYSCO FOOD SERVICES OF DALLAS {40329911 CORN STARCH RICE,BROWN,WHOLE GRAIN,UNCLE BENS,1/25LB SYSCO FOOD SERVICES OF DALLAS {24512431 RICE BROWN WHOLE GRAIN RICE,WHITE,CONVERTED,UNCLE BENS,1/25 LB SYSCO FOOD SERVICES OF DALLAS {4032900J RICE CONVERTED Dry Storage \Front Wall \Rack 2-Pasta PASTA PRODUCTS GEMELLI SYSCO FOOD SERVICES OF DALLAS {8386609J PASTA GEMELLI PASTA DRY PENNE WG GLUTEN FREE SYSCO FOOD SERVICES OF DALLAS {86119821 PASTA PENNE GLUTEN FREE RICE SPECIALTY JASMINE SYSCO FOOD SERVICES OF DALLAS {37507671 RICE JASMINE RICE SPECIALTY BASMATI CS 2/5# SYSCO FOOD SERVICES OF DALLAS (7818743J RICE BASMATI PASTA PRODUCTS LlNGUINE 10"2/10 LB SYSCO FOOD SERVICES OF DALLAS (4862959\PASTA LlNGUINE 10 IN PASTA,DRY,PENNE RIGATE,100%WHOLE GRAIN,HEARTLAND,2110 LB SYSCO FOOD SERVICES OF DALLAS {19358831 PASTA PENNE RIGATE WHL GRN 100 Inventory Count Sheet -Detailed Page 6 of 31 2018-08-0109:40 Purchase Unit Inventory Unit1 Inventory Unit2 Inventory Unitl Beginning Received TransfersInventory case =6cn#10 @ 7 IO~pound 113.50 cup (6 case cn#10 0.167 0.000 0.000 each) case =6 cn#10@ 101 case cn#10 0.167 0.000 0.000ozwI3.15625 quart case =12 can @ 51 ozw case can 0.167 0.000 0.000 case =6 cn#10@ 106 case cn#10 0.000 0.000ozwI13.50 cup 0.000 case =B bag @ 1 pound case bag 0.000 0.00010.50 gallon 0.000 case =35 pound @ 2.10 case pound 10.000 0.000cup 0.000 case =40 pound case pound 0.500 0.000 0.000 case =6 each@ 16 ozw case each 1.667 0.000 0.000 case =6 bag@ case bag 1.500 0.00027.08800 ozw 0.000 case =24 box @ 1 case box 0.625 0.000 0.000poundI3.54300 cup case =25 pound case pound 4.000 0.000 0.000 case =25 pound case pound 4.000 0.000 0.000 case =2 bag @ 10 case bag 0.000 0.000pound 0.000 case =12 box@ 16 OZW case box 0.500 0.000 0.000 case =2 bag @ 5 pound case bag 2.000 0.000 0.000 case =2 bag @ 5 pound case bag 2.000 0.000 0.000 case;2bag@10 case bag 1.000 0.000pound 0.000 case =2 bag @ 10 case bag 1.000 0.000pound 0.000 Inventory Count Sheet·Detailed Pagellof31 2018-08-01 09:40 Item Purchase Unit Inventory Unit1 Inventory Unit2 Inventory Unit3 Beginning Received TransfersVendorIVendorItem#I Vendor Item Description Inventory Dry 5"""ge \Bakery Flours and Sugars CAKE MIX WHITE BAKERS PLUS case =50 pound case pound 0.500 0.000 0.000SYS£O F009 ?5_':V~C~OF ~AL':AS [550617~)MIX CAKE WHIT~B~K_ER PL!:!_S FLOUR ALL PURP GLUTEN FREE (25LB)case =25 pound case pound 1.000 0.000 0.000SYSCOFOODSERVICESOFDALLAS[8365609)FLOUR NP GLUTEN FREE Dry Storage \Center Back Wan \bakery 2 ICING.VANILLA CREAM.READY TO USE.GOLD MEDAL.2/11 LB case =2 tub @ 11pound case lub 0.500 0.000 0.000SYSCOFOODSERVICESOFDALLAS[4046124)ICING RTU VANILLA CREAM 117.75000 cup------- COOKIES.BULK.VANILLA WAFERS.NABSICO.212LB case =2 box @ 2pound case box 0.000 0.000 0.000SYSCOFOODSERVICESO~DALLA?[0940106)COOKIE VANILLA_~AFER NILLA (~41 each) CRUMBS GRAHAM CRACKER 2/5 LB case =2 box @ 5 pound case box 0.500 0.000 0.000SYSCOFOODSERVICESOF_DALLAS [4091864)CRACKER CRUMB GRAHAM /17.18000 cup JELLY.BULK.GRAPE.SMUCKERS.6/4 LB case =6 container@ 4 case container 0.333 0.000 0.000SYSCOFOO!:'SERVICES OF ~ALLAS [4285458)JELLY GRAPE pound I 5.67000 cup CAKE MIX COFFEE CINNAMON STREUSEL case =6 each@7 case each 0.833 0.000 0.000SYSCOFOODSERVICESOFDALLAS[5913132)MIX CAKE COFF CINN STREUSEL pound----GELATIN MIX.ASSORTED.CITRUS.12124OZ case =12 package @ 24 case package 0.500 0.000 0.000SYSCOFOODSERVICESOFDALLAS[4010344)GELATIN ASSORTED CITRUS ozw-.GELATIN MIX DIETETIC ASSORTED REGULAR case =12 each @ 24 case each 0.500 0.000 0.000SYSCOFOODSERVICESOFDALLAS[4010310)GELATIN ASSORTED RED ozw I 26.25000 II oz EXTRACT VANILLA PURE 6/32 FL OZ case =6 bottle @ case bottle 0.000 0.000 0.000SYSCOFOODSERVICESOFDALLAS[5230057)EXTRACT VANILLA PURE 29.35000 gram I 32 IIoz Dry Storage \Center Back Wall \bakery 3 CEREAL.BULK.GRANOLA.OATS AND HONEY.WHOLE GRAIN.NATURE VALLEY. 4/50 OZ case =4 bag @ 50 ozw case bag 0.000 0.000 0.000 SYSCO FOOD SERVICES OF DALLAS [6690675)CEREAL GRANOLA OATS N HNY Dry Storage \Bakery Rack PEANUT BUTTER.BULK.CREAMY.SALTED.SYSCO CLASSIC.6/5 LB case =6 jar @ 5 pound I case jar 1.333 0.000 0.000SYSCOFOODSERVICESOFDALLAS[40091891 PEANUT BUTTER CREAMY 2.25000 quart MILK CONDENSEO SWEETENED -CSl24 CANS case ~24 can@ 14 OrN case can tBCtm_>0.917 0.000 0.000SYSCOFOODSERVICESOFOALLAS[41066981 MILK CONDENSED SWEETEN EO f 60 teaspoon SUGAR BROWN LIGHT CANE case =12each @ 2 case each 0.000 0.000 0.000SYSCOFOOOSERVICESOFDALLAS[55937021 SUGAR BROWN LIGHT CANE pound /4.12000 cup Dry Storage \Bakery Rack \bakery Right Wall CAKE MIX.DEVIL'S FOOD.GOLD MEDAL.6/5 LB case =6 box @ 5pound case box 0.667 0.000 0.000SYSCOFOODSERVICESOFDALLAS[4045662)MIX CAKE DEVIL FOOD ICING.CHOCOLATE FUDGE.READY TO USE.GOLD MEDAL.2/11 LB case =2 tub @ 11 pound case lub 0.500 0.000 0.000SYSCOFOODSERVICESOFDALLAS[41589291 ICING RTU CHOC FUDGE 117.75000 cup DESSERT BAR MIX LEMON BAR WITH FILLING case =6 box @ 4.04000 case box 0.000 0.000 0.000SYSCOFOODSERVICESOFDALLAS[57634611 MIX DESSERT LEMON BAR W/FILLNG pound CAKE MIX.YELLOW.GOLD MEDAL.6/5 LB case =6 box @ 5 pound case box 0.000 0.000 0.000SYSCOFOODSERVICESOFDALLAS[4045761)MIX CAKE YELLOW BROWNIE MIX.GOLD MEDAL.6/6 LB case =6 box @ 6 pound case box 0.667 0.000 0.000SYSCOFOODSERVICESOFDALLAS[4001947)BROWNIE MIX CHOC 120.01176 cup --...__....___.- '"M.•..o 4>Cl '"c.. 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