}: NEW YORK STATE DEPARTMENT OF HEALTH Temporary Food'Sefvice Establishment el Burts Conmnty Eicon Heats an Fos Pieton Sioa te nsdcen Ropar om _ ESTABLISHMENT NAME: A 5. oe name: | $0 Someahy so et Pag — Ee Li Sot Ge jose luli] TTT TT jfolt] fo] (hig) sues isinln 1 [el[elo| [ele] INSPECTION @ _REINSPECTION ©) PRE-OPERATIONAL ©) HACCP ONLY © COMPLAINT O FIELD VISIT INGIDENT © tNess © Number of Re Violations, Total Red Violations [ Number of Blue Violations [m Reinspection ©) raw O]O| NerSreces”™ | 016 | hee ies rautes < Yes No (CRITICAL ITEM; These is rte desl tar win ba focboe es, Those ame mst receive immediate attontion, (© Feed tram unappreved sources: aditeated: containated: reserved a}, fe (ar.4: 5 20 | Petasatytazadous food nc init proparaon 6), ) 2E| Petoniaty nazarceus tod at improper temperature 4S 14056) 30, (6) ‘| 4D [Petey nzarous fonts ac coke o 10+ rave ep gs 45 ork, 150°; ground meat, 158: pouby, 185 0, ) | 8Q [Tose tems impropaty stored or used 4 “6O | Persons with csease or infection tansited by food ne restcted.16 7© | Food werkers co nt wash hands toroughy (generate Inthe) after containing their hands 16 “8O)| Utensis dongs, spoons, spatulas, sanitary gloves) not used to olminat bare hand contact with cooked or prepared foods Sc) 9) Accurate temamctas not ube cr used.) | . 100) negate sites to maintain ompecatice te): 4; 18 | “11O Peete war impropry tected om an unapproved source 9 “120)| moreper disposal of sewage and uid wast 11 (a) | “THESE ITEMS ARE CONSIDERED IMMINENT HEALTH HAZARDS. ‘SANITATION and MAINTENANCE ITEMS: These tems lato 1 maintenance o food service operaione and deaniness. a 19 [Fett prtetedinvansper, storage, py, serie; packaged gods sean] “wat or unraned ce Sigh ad. 8 142 Fer workers wit nadeaale personal clearness. 15) Surtees net ss lanai, ret clean and sanz 6.7 160) | sre sence arts no proto reed 6) | 170 Hand washing facies inadoqute;.12.16 10 Accurate thermonetr nt ealable in ot and oot feed storage techies 19D Fer, wal, ceing, gntng neque (e314 | 200) insets ne coro 14a), ) 212 | Foos operation ares nt separa from ving are sleeping aus. 18 220 Trash posal inadequate. 0) 23) | Operating without a perms, miscedeneous 17.19 ‘Person ii ‘Comments: 7 anes 7 Fiat) | 80 YIOLATI as isaac MO =o ae EPeay Le ee: Io NEWYORK Sait DEPARTHENT OF HEALTH Temporary Food Sehvcz Establishment a oan Sonny ve Fan a acon Seoateavasains estaouisiaenr ane TT @ sont CAPA oxrors weQan Orsrosiars, _ aedese:tuwe Qc rt Sd" ceuny GE i@ zecow: |Y2Q2 fay a: i fa] cma wale a ei se a ee ve f T | lala TAT Qe aI j LLILL] | Folz| oa] ile] sires ebgssel TT] ee OH OH | war as INSPECTION § REINSPECTION © pre. ‘OPERATIONAL Q HACCP ONLY Q COMPLAINT © FIELD visiT INCIDENT © ILLNESS ©) ‘Number of Red Violations [|] Total Red Violations Number of Blue Vslatone Renspecion Q thea] ] Toots ca lo rcs” © CRITICAL ITEM: Theso toms relate ect to facters which lead to oadbomo nes, These tans must eceve immerse tenon. “1 | Fond tam unapproved sources: acutrated contamina, reserved. fa, "1 |) tai 4:8 | 20 Potty hazardous fod - nto ted preparation (0), (6) 2Q | Pte hacer fod at improper omporatie (25°F - 1405) 3), @) 4 [Potent hazarcous foods ae nt cocked io 40°F or shove except og, 145; | ork, 180°F: ground meat, 188°F: poultry, TEST; Ce), () | | 5Q {Tove ts inpropery sored er used 4 “6O | Persons with cisease or infection transmitted by food not restricted .16 70 | Fewer nox ash nae chy esr er ate conamntng [ror tons''e “8(D)| Utensils (tongs, spoons, spatulas, Sanitary gloves) not used to eliminate bare hand | ~ | conic ih cocks or roar onset I 9Q)| Acaraie ood hearers not vale used 2) 10 Inacoquate tacites to maintain temperature); 4.18, | “1O | Poe waerimpopry tected roman unapproved sence. © t “120 lmorope spol of eowage are iid wast () I (THESE TEMS ARE CONSIDERED IMMINENT HEALTHHAZARDS | _ SANITATION and MAINTENANCE ITEMS: Thess ete maintenance ceed sence operations and canine 10 [Fens preci nvanpon tape, dl seve: pashan pad dean] Oleatroruahosice See nora | 142 | Food workers with inadequate personal cleanness .1 | 18Q| sutacs net casiy enable rt lan rd sanz 6:7 | Site Gk. 180 Sige sone atte nt protected: used 6(4 of 17O Hana wesin faces inadecun 812,16 18) Accurate thermometer not available in hot and cold food storage facilities 4 | 190 Fos wal, ang, iting nadogate i) 19:14 200) nsec 4), 250 | Petpet aes spa om nga her ua, 220) Tas dno neovate 11 (8) 232) Operating win ape niscelanous.17; 19 47082 _—- tekCTY 8) WIN IN | NeW YORK STATE DEPARTMENT OF HEALTH Temporary Food Sefvice Establishment a Bureau of Gommunty Enercrmenal Heath and Food Proacton Subpa 142 hspecton Repo comic Along — spree agmae) — aa : ae eae aga ae sean | TT 1 ] ] T) @] Ono al T | T HTT TTT of LB | Sienlsh belo F] | im sonics aS wa ts INSPECTION @ _REINSPECTION © PRE-OPERATIONAL ©) HACCP ONLY © COMPLAINT O FIELO VISIT © INCIDENT ©) ILLNESS © i [2] "tse To] mmezagyeee | To] mem @ ‘CRITICAL ITEM: These tans relate cect tat wich lad foodborne. Those fo must rece immedi stontion. “1 | Feostrom approved sources deca crane eseved Bbowsee MoT coescany md 20 | Petey hazardous 08 nt of lite preparation.) () | Situs SER ME CONTA NER Nore 3@ Potoniaty hazardous fod atimeropartampeature (a5'F - 40°F) 4b), (e) LAT S2°F, Less THAW 2 Hyves, O | Potent azardus oct ae 10 140° or above coo gs, 145; {Ooi genina SOE par ee ad eee ET Obese. Rie LOCATED Son 52 Toxic toms impeoperty stored or used .4 [Comte ERS TO CHesr PREELER “6Q | Persons wth cisease or ination transmit by fod not esticted 16 | Food workers do net wash hands thoroughly (generato ler) ater contarinaing JAND TURNED ReFewceAqeR Conreec | fetrhands 16 [own An Beusser SPIT Corssetus ‘Oceano tanta | ewan wis 2 fous can 8) Accurate food thermometers not avalabe or used tf) | Be DiscAean: 10@|Inadonuat acites o main ampere fe): 4.18 | “11 Peebe water imropery tected om an unapproved source 8 | v2 pyored “120 | toro depsal ot sovage acid wast Bérass pase. RefeuceAme wy zs (THESE ITEMS ARE CONSIDERED IMMINENT HEALTH HAZAROS. AT SOF. FRuctaroe TE SANITATION and MAINTENANCE (TEMS: Thso tome ete o nahionareo ons senks Seid ou cealngls CATR. 190 [Foss prcectdin wanspor, stave, iy seve: packaged goods axarin ] ‘alr orunraned co Sah Tors '4Q)| Feed worer wth adacute porsona cleanness 1 15D suracs not easy leant nat lean ard sazed.,.7 16Q | single service aricles nat protected reused 6) 17) Hand washing facts inedoqute 83.12; 16 18) Accurate thormometor not aviabe in hot anc eo food storage fecihes.4 19©) Floors, wal, esting, lghting inadequate 6(0);.13;.14 20 | nseots net contaed14(), (0), (6) | 21 | Food operation ares nt soar a ing and sean uate. 16 220 | Trash dspacal aceite .1 fo) 230 | Operating without pert miscolaneous 17:19 ‘Comments: - mec). Stella BREF ISTE Bake MAE 1a) Cock BST a7oe2 — fat