Health Department Forms Folder 1179, 1996-2001

NYC-WTC_000138241 NEW YORK CITY DEPARTMENT OF HEALTH FOOD ESTABLISHMENT INSPECTION REPORT ENVIRONMENTAL HEALTH SERVICES CAMIS NUMBER { f° PERMIT TYPE | ESTAB. TYPE PERMIT NO. EXP. DATE RECEIPT NO. { | | ee GG | COMPLAINT CONTROL NO. } i pitistl | | 10) Lip ess ty tyytt | ADDRESS - 9 O18900 FLOORS BORO coToO. ZIP CODE | | | |_| OWNER / PERMITTEE fj j tj | jj} | Lj} | itt | tj | ff | {| | | | jj | |} |} D/AVA | | SAFETY | RISK TELEPHONE NO. (oy DAYS CLOSED SU M TU W TH FR HOURS OF OPERATION {INFORMATION UPDATE) DAVA --- ee De | rer ee I L. SAFETY | RISK -& 4 ° Sea be < Jos ad Jere ye DAYSCLOSED © su MTU W TH FR SA N,.| SA N | | if INSPECTION DATE START TIME STOP TIME ID NUMBER u Lj | |} ft ff | BUREAU PROGRAM INSP. TYPE DOCKET NUMBER | {|_| | |_| HEARING DATE lo 10 / / [=!" | HEARING TIME (AM CPM |_| DECAL NO. VENDOR LIC. NO. fe ed LE | oar VENDING LOCATION: LC) FRONT OF 0 opposite BORO SNR. CTR. FACILITY CODE | CRITICAL ITEMS (See back for explanations) CLASS A VIOLATIONS 1. ADMINISTRATION A B C DB:‘E F G H 4 POTENTIALLY HAZARDOUS FOOD NOT COOKED TO, OR HELD AT OR ABOVE REQUIRED MINIMUM TEMPERATURE “A “B C oD €E F POTENTIALLY HAZARDOUS FOOD NOT COOLED AND HELD AT OR BELOW REQUIRED MINIMUM TEMPERATURE , “A “B Cc FOOD ADULTERATED OR FROM UNAPPROVED SOURCE ‘AB °C OD UE UF OCG FOOD PROTECTION: CONTAMINATION BY WORKER “A ‘B Cc FOOD PROTECTION: CONTAMINATION BY OTHER SOURCE ‘A “B ‘*C "D "E F G FACILITY DESIGN AND OTHER CRITICAL ITEMS “A "Ba +e +p te te G tH 1 BACTERIOLOGICAL [| _ NUMBER OF SAMPLES AND TEST REQUIRED CHEMICAL [ GENERAL ITEMS (See back for explanations) CLASS B VIOLATIONS 8. FOOD PROTECTION: POTENTIAL CONTAMINATION BY WORKEA A BC FOOD PROTECTION: POTENTIAL CONTAMINATION BY OTHER SOURCE A B © DB E F G H VERMIN, ANIMAL CONTROL AND GARBAGE DISPOSAL DISPOSAL: A B C OD DOCUMENTATION A B ¢ CLASS C VIOLATIONS 12. 13, FACILITY MAINTENANCE ‘A B ¢€ DB E F G H CLEANING, SANITIZING, AND OTHER GENERAL ITEMS A B C DO CE CASE NO. Flo} ij | j=) | yey | CLASS D VIOLATIONS 14 SIGNS, DOCUMENTATION, AND NON-FOOD CONTACT SURFACES A B C OD € DISTRIBUTION OF TOBACCO PRODUCTS THROUGH VENDING MACHINES, TOBACCO PRODUCT REGULATION ACT AND SMOKE-FREE AiR ACT SEATING CAPACITY | | | Distribution of Tobacco Products Through Vending Machines: A B Cc D Tobacco Product Regulation Act: E F G K Smoke-Free Air Act: I d K L M N RESULTS: NO. OF CRITICAL ITEMS: {Class A, Letters) PHH OTHER | TOTAL PPS+ NO OF GENERAL ITEMS: (Numbers) CLASS B] CLASS C | CLASSD] TOTAL " UNLESS AN.EARLIER INSPECTION IS DEEMED NECESSARY BY THE DEPARTMENT, YOUR FACILITY WILL BE REINSPECTED ON OR AFTER L l REPORT RECEIVED BY {SIGNATURE} INSPECTOR'S SIGNATURE SUPERVISOR'S SIGNATURE SUP. ID# DATE | j | yo EHS 198€ (REV. 10/97) WARNING: PENALTY FOR FALSE OR MISLEADING STATEMENTS-ORALLY OR IN WRITING-UP TO $2000 PER VIOLATION (NYC Health Code Section 3.19) THE OFFER OF A BRIBE, GRATUITY OR REWARD FOR OFFICIAL MISCONDUCT IS A CRIME. WHITE: Office; CANARY: M.LS.&A; PINK: Establishment; GOLDENROD: Reinspection NYC 9/11 Public Portal Document