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PLUMAS COUNTY
ENVIRONMENTAL HEALTH DIVISION
FOOD SAFETYEVALUA
HON REPORT
270 County Hospital Rd., ste 127 Cuincy, CA 95971
Phone; (530) 283-6355
FAX (530) 283-6241
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Type of Inspection:
See reverse side for the code sections and general requirements that correspond to each violation listed below
In > In compliance N/0 = Not observed
In
N/A B Not applicable
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N/O-tVAl
MAJ
COS •> Corrected on-site MAJ « Major violation
OUT
CONSUMER ADVISORY
X
PREVENTING CONTAMINATION BY HANDS
PERSONAL CLEANLINESS
C B i a m Fooo SAFETY REQUIREMENTS
i used,ftszenlood
26. Approved thawing a
27. Food separated and protected
28. Washing Iruits and vegetables
29. Toxic substances property Idenlilied, stored, used
FOOD STORAGE/ DISPLAY/ SEIWICE
30. Food storage:foodstorage containers Idenllfied
31. Consumer seH-service
32. FoodpropenyiabeietfailonesBypfesenieo'
EQUIPMENT/ UTENSILS/LINENS
33. Non/ood contact surfaces dean
34. Warewashinq faciilles: Installed, maintained, used: lesi strips
35. Equlpmenu Ulenslls approved; wstalled: clean; good repair; capaeily
36. Equipment, utensils and linens: storage and use
37- Vending machines
38. Adequaie venlkation and lighting; designaled areas, use
Speciallsl (Print)
19. Consumer advisory provided for raw or
undercooked foods
HlgMy Susceptible Populations
20. Licensed hea/lh care facilities/ public & private
schools: prohibiled foods not oHered
WATER/MOT WATER
21. Hot and cold waler available
Temp.^
LIQUID WASTE DISPOSAL
22. Sewage and waslewaier properly disposed
39. Tnennometefs provided and accurate
40. Wipingtioths:property used and stored
PHYSICAL FACIUTIES
41. Phyntung: pfoporfaacWtowOcviCTS
42 Gartrege arid iWuseprtiperty disposed, lacitiestnainiiained
43. Toiiet facifeer. properly construded, supplied, eieened
U. Premises: personaL'deanino Mems
PBaiANEWT FOOO FACIUDES
45. Floor, walls and ceiBngs: bulB, mainlaiiied. and dean
46. No unapproved private homes/ 8wng or steeping quarters
SIGNS/REQUIREMENTS
47. Signs posted: last inspection report avateble
COMPLIANCE & ENFORCEMENT
46. Plan Review
49. Permits AvataUe
50. Impoundmeni
Title
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Received by (Signature)'
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OUT
25. Persona cleanliness and has tesOTWs
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IS. CompEahCe nWih variance, specialized process,
reduced oxygen pacSaging, 4 HACCP Plan
S. Hands clean and properly washed; gloves used
properly
6. Adequate handwashing (acilities supplied &
accessible
TIME ANO TEMPERATURE RELATIONSHIPS
7. Proper hoi and cold holdJig lemperalufes
8. Time as a public health control; procedures 4
records
9. Proper cooling methods
10. Proper coowig lime & lempefalutBS
11. Proper reheating procedufes tot hot holding
PROTECTION FROM CONTAMINATION
12. Returned and rwatina^tood
13. Food in good conrMion. sate and unadulterated
SUPERVISION
MAJ
CONFORMANCE WITH APPROVED PROCEDURES
EMPLOVEE'HEALTH a HYGIENIC PRACTICES
24. Person in charge present end petfatws duties
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15. Food obtaxied from approved source
le. Compliance with shell stock lags, condition, display
17. Compliahce with GuS Oyster Regulalions
2. Communicable disease; reporting, restrictions &
exclusions
3. No discharge Irom eyes, nose, and mouth
4. Proper ealina. tasting, dnnking or tobacco use
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FOOD FROM APPROVED SOURCES
OEMONSTRATitW OF KNOWLEDGE
1. Demoflslfation ot Snoailedge: iooC safely cettificaiMn
Fo^afety eft Name.
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Exp. Date
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OUT"Out of Compliance
Re-inspection Date:
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Re-inspection Date: