The URL can be used to link to this page

Browse Search

Home My WebLink About982190.tiff RESOLUTION RE: ACTION OF BOARD CONCERNING PROBABLE CAUSE HEARING TO CONSIDER REVOCATION OF A FOOD SERVICE LICENSE, ACCOUNT NUMBER 03723840000 - K. W. LIN, DBA NUMBER ONE CHINA BUFFET WHEREAS, the Board of County Commissioners of Weld County, Colorado, pursuant to Colorado statute and the Weld County Home Rule Charter, is vested with the authority of administering the affairs of Weld County, Colorado, and WHEREAS, on November 9, 1998, a Probable Cause Hearing was conducted to consider revocation of a Food Service License, Account Number 03723840000, issued to K. W. Lin, 2435 West 10th Street, Greeley, Colorado 80631, and WHEREAS, K. W. Lin, is the owner of the restaurant located at 2435 West 10th Street, Greeley, Colorado 80631, and WHEREAS, at said hearing of November 9, 1998, John Pickle, Director, Weld County Health Department, advised the Board that K. W. Lin, 2435 West 10' Street is now in compliance, and the Board deemed it advisable to dismiss said matter and, further, to direct Health Department staff to inspect said restaurant once each month for the next four months, then three times per year thereafter. NOW, THEREFORE, BE IT RESOLVED by the Board of County Commissioners of Weld County, Colorado, that the Probable Cause Hearing concerning revocation of Food Service License, Account Number 03723840000, issued to K. W. Lin, 2435 West 10th Street be, and hereby is, dismissed. BE IT FURTHER RESOLVED by the Board that Health Department staff be, and hereby is, directed to inspect said restaurant once each month for the next four months, then three times per year thereafter, taking immediate action on any reoccurrence of violations. The above and foregoing Resolution was, on motion duly made and seconded, adopted by the following vote on the 9th day of November, A.D., 1998. BOARD OF COUNTY COMMISSIONERS WELD COUNTY, COLORADO ATTEST: �( �;R "� 3 ;�� y Constance L. H rbtert, Chair Weld County Clerk nh fu•I��OZ= (12 J Q ��►�►►� �, W. H. bster, Pro-Tem BY: Deputy Clerk to - orge. . Baxter VED AS T FORM: Dal K. Hall o my Att ney di-a2C/L..J ,d/ to arbara J. Kirkmeyer 982190 +. /-(,( GA, it.Li HL0024 Chronological Synopsis of No. 1 China Buffet, 2435 West 10th Street, Greeley Colorado Prepared November 3, 1998 This synopsis will attempt to establish the perpetual lack of compliance with the Rules and Regulations Governing the Sanitation of Food Service Establishments in the State of Colorado by No. 1 China Buffet located 2435 West 10th Street, Greeley Colorado, owned and operated by K.W. Lin. Files maintained by the Weld County Health Department date back to May of 1996. The following history from health department files illustrates the history of noncompliance up to the present time. 4-16-96- The No. 1 China Buffet opens to the public. 5-7-96-. The first inspection by the health department is conducted. The No.1 China Buffet fails due numerous critical item violations. Examples include improper hot holding, employee lunches co-mingled with food intended for the public, blocked handsink, and improperly screened back door to prevent fly entry. The facility is slated for re-inspection on May 11, 1996. 5-11-96- Follow up inspection reveals that nearly all violations are corrected. Two critical items are noted: drinking form unapproved glassware and sanitizer in excess of 200 parts per million. 7-15-96- Routine inspection is conducted and again the facility fails due five critical item violations. Examples include dented cans, improper hot holding, blocked handsink, numerous flies inside kitchen, and storage of toxic chemicals next to vegetables intended for human consumption. This facility was also cited for six noncritical violations. Re-inspection is slated for July 25, 1996. 7-25-96- Follow up inspection reveals that all but one of the critical items are corrected. Dented cans are still observed in the dry storage area. 9-17-96- Routine inspection on the facility finds improper refrigeration of raw eggs (left out on the wok all day) and dented cans in the dry storage area. 12-2-96- Routine inspection is conducted and again the facility fails for the fourth time this year. Dented cans, improper hot holding, and drinking from unapproved cups are noted. Re-inspection is slated for 12-12-96. 12-12-96- All violations are noted to be corrected during follow up. 982190 7-15-97- Routine inspection finds employees drinking from unapproved glassware, excessive flies in kitchen, damaged screen door and numerous noncritical item violations. Re-inspection is salted for July 25, 1997. 7-25-97- Follow up inspection reveals that at all violations are corrected. 8-4-97- Notification of noncompliance is sent to Mr. Lin informing him of his restaurants non compliance. 10-03-97- In response to a citizen complaint, inspection finds four critical item violations. Again they are dented cans, improper hot holding, raw vegetables stored in the mop sink intended for human consumption, and improperly sealed back door to prevent pest entry. Reinspection is slated for October 22, 1997. 10-22-97- Re-inspection finds improper refrigeration, poor hygienic practices, and unlabeled spray bottles. The rest of this year passes with no further incidents. 4-4-98- The first routine inspection for 1998 finds three critical violation and six noncritical violations. Critical items included improper refrigeration, very unsanitary practice of picking up egg roles that were dropped on the floor and then returned to the tray with uncontaminated egg roles, and damaged mesh screen on the back door. Re-inspection is scheduled on April 15, 1998. Mr. Lin is sent a letter of noncompliance, but due to a discrepancy in the address provided to the health Department, Mr. Lin does not receive it until May 7, 1998. 4-15-98- Follow up inspection reveals that sanitation levels are found to be very poor. Five critical items were cited: dented cans, damaged backflow preventer on the mop sink, evidence of rodents, storing ice scoop in standing water, and sanitizer in excess of 200 parts per million chlorine bleach solution. 4-20-98- Mr. Lin is again notified of his establishments lack of compliance by certified mail. 5-14-98- Follow up inspection finds four critical items and again six noncritical items. Critical items cited involved violations of both hot holding and refrigeration temperatures, blocked handsink, improperly sealed back door, and bleach sanitizer in excess of 200 parts per million. June 1998- Inspections are suspended while Mr. Lin takes an extended trip to China during the month of June. 93 19O 7-8-98- Follow up insertions resume upon Mr. Lin's return from China. Five critical items are noted during the inspection: dented cans,poor hygienic practices (unbandaged and ungloved cut on the owners hand), improper hot holding temperatures,blocked hand sink, and evidence of rodents. Re-inspection is scheduled in approximately ten days. 7-10-98- Mr. Lin is notified by certified mail that he is to appear before Jon Pickle, Health Officer, Weld County Health Department, on July 22, 1998 to discuss his establishments chronic violations. 7-13-98- Mr. Lin is notified for the third time this year that his restaurant has failed to comply with the food service regulations. 7-22-98- Health Officer hearing is held at the Weld County Health Department. Mr. Lin is informed that he is to take immediate steps to maintain compliance. He is further informed that any serious future deviations from compliance will result in hearing before the Board of Weld County Commissioners. 9-22-98- In response to a complaint received by the health department, investigation reveals four critical items. Violations consisted of storage of raw chicken above carrots in walk in cooler, numerous rodent pellets along floor in dry storage\hot water heater area, unlabeled spray bottles, and wiping cloth sanitizer in excess of 200 parts per million. 10-27-98- Routine inspection is conducted. Six critical items are noted. Cooked chicken was found to be co-mingled with raw pork, cooked food was stored under handsink (back splash from sink may fall into\on food), rice (67°F) and egg roles (72°F) were held at room temperature, battery operated thermometer was not working due to a dead battery, lack of employee training\knowledge on safe food handling, and excessive numbers of cock roaches under the ice machine. 10-30-98- In response to the critical violations found on 10-27-98, Mr. Lin is notified by personal delivery that he is to appear before the Board of Weld County Commissioners on November 9, 1998 concerning his establishments chronic lack of compliance. Addendum For the record it should be note that Mr. Lin and his wife speak very little English. However, their daughter Jessica, is fluent in both Chinese and English, and has been able to effectively translate health department concerns. Currently, Jessica is attending college in New York state and is not available to help. Interpretation was conducted by a University of Northern Colorado graduate student to insure no break downs in communication during the personal delivery of the notice of the probable cause hearing. 98aigo 470 1.\/ 1st DEPARTMENT OF HEALTH \ 1517- 16 AVENUE COURT GREELEY, COLORADO 80631 Wfige, LDMINIOTECTION (303)353-0635 HEALTH PROTECTION (303)353-0635 COMMUNITY HEALTH (303)353-0639 COLORAD October 30, 1998 HAND DELIVERED Legal Action No.: 98-126 K.W. Lin Number One China Buffet 2435 West 10th Street Greeley, CO 80631 NOTICE OF PROBABLE CAUSE HEARING TO BE HELD NOVEMBER 9, 1998 Dear Mr. Lin: On July 22, 1998, you attended a Health Officer Hearing held by John Pickle, Director, Weld County Health Department. The hearing addressed serious and chronic violations of the Rules and Regulations Governing the Sanitation of Food Service Establishments in the State of Colorado, with respect to the Number One China Buffet, located at 2435 West 10th Street, Greeley, Colorado. Translation during the hearing was provided by your daughter, Jessica Lin. The hearing resulted in an agreement between yourself and the Weld County Health Department. The agreement allowed you to and until August 2, 1998, to correct all violations found on previous inspections; to implement a Pest Control Management Plan; and to make arrangements for all staff to attend a food safety training program (i.e. Weld S.T.A.R). Attached to this letter are copies of a letter dated July 23, 1998, addressed to you which explained this agreement, and a Certificate of Delivery showing that the letter was delivered to you on July 23, 1998. Two recent inspections of your food service establishment reveal that you have not complied with our agreement of July 23, 1998. The specifics of the inspections are as follows: A. Inspection of September 22, 1998: Notice of Probable Cause Hearing October 30, 1998 Page 2 01-c. - Eliminate practice of storing raw chicken above carrots. Separate such foods to prevent cross contamination. i.e. Store carrots above chicken. 07-a. - Increase pest control efforts to eliminate presence of rodents. 08-b. - Properly label all bleach bottles so exact knowledge of contents are known. 08-c. - Wiping cloth water was in excess of 200 ppm; should be 100-150 ppm. 12-a. - Thoroughly clean can opener to remove excessive food debris. B. Inspection of October 27, 1998: 01 - Cooked chicken was co-mingled with raw pork. Store cooked food away from raw food to prevent cross contamination. 02-d. - Eliminate practice of storing food under hand sink to prevent contamination from splash. 02-f. - Provide/obtain training for management and all employees on proper food handling practices. 03-e. - Rice (67°F) and egg rolls (72°F) must be held above 140°F or below 45°F. 03-f - Provide new battery in thermometer to insure accuracy. Battery was dead during inspection. 07-a. - Eliminate presence of cockroaches in kitchen. Several roaches were found under ice machine. 08 - Several spray bottles were unlabeled. Properly label all spray bottles so exact knowledge of contents are known. 10-a. - Eliminate the use of grocery style shopping bags to store food. Use only food grade plastic bags. 11-b. - Install thermometer inside reach in refrigerator. You have previously received three Notifications of Noncompliance concerning your food service establishment license for 1998. The Notifications were mailed to you by certified mail and were dated April 20, 1998, May 7, 1998, and July 13, 1998. w!90 Notice of Probable Cause Hearing October 30, 1998 Page 3 On November 9, 1998, at 9:00 a.m. in the first floor meeting room of the Weld Centennial Center Complex, 915 Tenth Street, Greeley, Colorado, the Board of County Commissioners of Weld County, sitting as the Weld County Board of Health, will hold a Probable Cause Hearing to consider the suspension or revocation of your food service license which was issued on January 1, 1998, under account number 03723840000. At that hearing the Board of County Commissioners will determine if there is probable cause to suspend or revoke the license and, if so, set the matter for a Show Cause Hearing. The Board will consider your agreement of July 23, 1998, and your apparent noncompliance as shown on the above referenced inspections. The Board will also consider your noncompliance with the Rules and Regulations Governing the Sanitation of Food Service Establishments in the State of Colorado. Please be advised that the Probable Cause Hearing will be open to members of the public and press. If you should have any questions concerning this action, please contact Gary Hague at (970) 353-0635, extension 2237. Sincerely, ohn S. Pickle, R.S., M.S.E.H., Director Weld County Heath Department Gary Hague, Env ronmental Health Specialist JSP:BTB/db:Health/Lin Attachments pc: Bruce Barker, Weld County Attorney Jeff Stoll, M.P.H., Director, Environmental Protection Services 9ganD ‘I4tt � DEPARTMENT OF HEALTH 1517 16TH AVENUE COURT GREELEY, CO 80631 ADMINISTRATION (970) 353-0586 HEALTH PROTECTION (970) 353-0635 • COMMUNITY HEALTH (970) 353-0639 COLORADO FAX (970) 356-4966 July 23, 1998 HAND DELIVERED Legal Action No.: 126-98 K. W. Lin Number One China Buffet 2435 West 10th Street Greeley, Colorado 80631 Dear Mr. Lin: On July 22, 1998, a Health Officer Hearing was held with John Pickle, Director, of the Weld County Health Department. The purpose of this hearing was to address the serious and chronic violations of your Food Service Establishment, Number One China Buffet, located at 2435 West 10th Street, Greeley, Colorado. Translation of this hearing was performed by Jessica Lin, Daughter of Mr. K. W. Lin.. This letter is to confirm the agreement between Mr. K. W. Lin and the Weld County Health Department. This agreement allows Mr. K. W. Lin ten (10) days from receipt of this letter to correct all items found on previous inspections; to implement a pest control management plan and to make arrangements for all staff to attend a food safety training program ( i.e. WELD S.T.A.R.). A follow-up inspection to verify whether or not the terms of the agreement have met will be performed approximately ten (10) days from receipt of this letter. In the event that the aforementioned violations have not been satisfactorily corrected or other serious violations are noted, license revocation proceedings will be initiated. Therefore, pursuant to Sections 12-44-205 of the Colorado Revised Statutes the following: 12-44-205. Sanitary Rules and Regulations (2) It is the duty of every licensee to see that the sanitary and other rules and regulations are 9D190 K.W. Lin Number One China Buffet July 23, 1998 Page 2 complied with in the place for which the license is granted. You as the licensee are hereby required to take immediate steps to correct the deficiencies set forth above, so as to comply with Rules and Regulations Governing the Sanitation of Food Service Establishments in the State of Colorado. The Department may seek enforcement if the corrections are not timely made including seeking monetary penalties or a Court order closing your establishment. These enforcement proceedings will include a meeting before the Board of County Commissioners which is open to members of the public and the press. If you have questions concerning this action, please contact Gary Hague at (970) 353-0635, extension 2237. Si ly oTh John S. Pickle, R.S., M.S.E.H. C arlotte Davis, M.P. H Director Program Supervisor Weld County Health Department cc: Jeff Stoll, M.P.H.; Director, Environmental Protection Services Lee Morrison, Weld County Assistant Attorney g8al9b DEPARTMENT OF HEALTH 1517 16TH AVENUE COURT GREELEY, CO 80631 C. ADMINISTRATION (970) 353-0586 HEALTH PROTECTION (970) 353-0635 COMMUNITY HEALTH (970) 353-0639 COLORADO FAX (970) 356-4966 CERTIFICATE OF DELIVERY Undersigned, a person over the age of 18, hereby certifies that the following was hand delivered to: iJ'.t^+44.- (dam C+�-� f" Z4ci uth rO4"-- L.)I Documents livered: - _ 3 c.! l�e � t k@ , ( � 1Y c' t L��if ut.a.Lci p 1_ .CC t/ r`r 1. o %-�i ter- , '# cL 2s?.-=� c fi'�jt ii r� /'Y g�.c�--;;C�prvi "d'lti CV . vn ki h\-L v - 2 J F2J LZLL-i1,-r^,J' 2.jr±Nili 61") 7 .D- 9 << a),t4DATE DELIVERED DELIVERED DELIVERED BY (Signature) Subscribed and Sworn to before me on `1 i day of J U y 199Z-- NO-TAIRY PUBLIC ignature) r- My Commission expires iK3C> l gsat90 TI�TET .D COUNTY ADMINISTRATIVE MANUAL GENERAL ADMINISTRATION Procedure for Probable Cause Hearings Latest Revision Date: May 6, 1996 A. PURPOSE: 1. The purpose of this outline is to provide boards, commissions, department heads, and other administrative bodies in Weld County with a set of procedures for use in probable cause hearings. B. PROCEDURE AND EVIDENCE: 1. The probable cause hearing shall be conducted informally and not subject to strict judicial or technical rules of procedure. A wide latitude in the manner of presenting the respective positions should be afforded the parties. Any person may present evidence at a probable cause hearing. Evidence shall consist of: a. Oral testimony. b. Exhibits and documentary evidence of any kind. c. Statements of the person presenting the evidence. 2. The person against whom the complaint is made may, in rebuttal, present any of the evidence listed in B.1. C. DETERMINATION OF PROBABLE CAUSE: 1. The complaining party shall have the burden of proving that probable cause exists to have a hearing concerning the complaint. "Probable cause" is defined as a reasonable ground for belief in the existence of facts warranting the proceedings complained of: D. DECISION: 1. At the conclusion of the presentation of evidence, the board, commission, department head, or other adniinistrative body shall make an oral decision. The decision shall be to either dismiss the case, continue the case to a time specified in the future, or to set the case for a formal show cause or other type hearing at a time specified in the future. 86 gga‘90 WELD COUNTY ADMINISTRATIVE MANUAL GENERAL ADMINISTRATION Procedure for Probable Cause Hearings Latest Revision Date: May 6, 1996 E. NOTICE 1. Notice of the Probable Cause Hearing shall be sent by certified mail, return receipt requested, to the person against whom the complaint is made at least ten (10) days prior to the date of the hearing. Said notice shall be effective upon the date of mailing. 2. Notice may also be served upon the person against whom the complaint is made in accordance with the Colorado Rules of Civil Procedure at least seven (7) days prior to the date of the hearing. 3. In land-use cases when a Probable Cause Hearing results in a Show Cause Hearing being set, the Clerk to the Board will send 10 day's notice, by Certified Mail, Return Receipt Requested, to the surrounding property owners, as well as the property owner/operator. 87 gXaVID " , tit : doIc - Is r\ tkl -7-41%xt � , .) � ttv Jess 0. A � S .1�L -,`�% � i cJ � , afl . . . � �� R C�bgicch (1))k J cb467) & �/It '(�1 7A22 �\ L kd-_," R tjnii;� q-- 8 .7 4 fc3�� z i/J I ��f 44 gJ7 �`7 i b 3e ) 4 , W(2 �� v 1(, c 2. 4 ?Tj;ttz r 7 3-/_ I°0 o b �` �,� � S D (act- ra lo ,� 1� 1ptfiJ � is, / l fit- I/Cc/ <TM / V h. c(tt) n � Bb 0,7-k,4_41.- /c - i Ar� o / kip .- `i, N -E- I973cifily � , X44( � �(�� I rip )4 20S- 74ke ( - - zus- i' I,-fiz Ls 1 ckl ci ) z 1 *M)T N I China ewf R * 5- `1.g , (2)LiD r ) X54 I0ttk , 44 *;f*01 ilk-4tk Ik0�- *(b' - �'�° �� -- [� R � *A 6>. m/s1 � , 7 � o I '� /C7\-ft_ '4--71,t 1-7-.4- tcg fg )_,, F( . ,a _;-F-kkL--t-22 .ty .. ) , = /.:-A-; --)ki-,9 . 4 : (370 ) �3 -DIRc h n , 223 Y Gin19b rs i DEPARTMENT OF HEALTH 1517 16TH AVENUE COURT 1 GREELEY, CO 80631 ADTION (970) 353-0586 C� COMMUNIHEALTHTY HEALTH TION (970) 353-0635 (970) 353-0639 COLORADO FAX (970) 356-4966 July 13, 1998 Certified Letter# Z 130 100 189 K.W. Lin Number One China Buffet 2435 West Street Greeley, Colorado 80631 THIRD NOTIFICATION OF NON-COMPLIANCE FOOD SERVICE ESTABLISHMENT Dear Mr. Lin: On July 8,1998, Gary Hague of the Weld County Health Department conducted an inspection of Number One China Buffet, licensed by you, K.W. Lin at 2435 West 10th Street, Greeley, Colorado. The purpose of this inspection was to determine compliance with the violations of the Rules and Regulations Governing the Sanitation of Food Service Establishments in the State of Colorado previously noted in the SECOND NOTIFICATION OF NON-COMPLIANCE dated May 7, 1998. The following items were found to be in violation of the subject regulations: VIOLATIONS 01-b One can of soy sauce was leaking in dry storage area. Such cans must be disposed of immediately upon receipt. (Section 2-101) 02-b- Owner was observed to be handling food with an unprotected cut on his finger. All cuts must be bandaged and then gloved. (Section-101) 03-d- Rice was found to be held at 123°F. Rice must be held at 140°F or above or below 45°F. (Section 2-201) 06-b- Handsink was blocked with miscellaneous items during inspection, which made use impossible. Handsink(s) must be accessible at all times. (Section 6-501)(c) 9gak90 K. W. Lin Number One China Buffet Certified Letter No. Z 130 100 189 Page 2 07-a- Numerous rodent pellets were found in the dry storage area. Enhance rodent control efforts to eliminate presence of rodents. (Section 6-701)(a) 10-a- Plastic bowls were used to handle bulk ingredients. Use only approved metal scoops designed for this purpose. (Section 4-101) 12-a- Knives were stored between the crack and crevice along the wall and three compartment sink. Knives must be stored on a magnet or in an approved knife holder. (Section 5- 202)(a). 15-a- Employee jacket was stored on top of dry goods. Jackets and other personal articles must be stored outside of food storage areas. (Section-602) Therefore, pursuant to sections 25-1-107, 25-1-109, 12-44-205(2), and 12-44-212 Colorado Revised Statutes 1973, you as the licensee are hereby ORDERED to correct the deficiencies set forth above as soon no later than ten (10) days from receipt of this letter, so as to comply with the Rules and Regulations Governing the Sanitation of Food Service Establishments in the State of Colorado. Any written statement or data concerning the deficiencies set forth above will be considered by the Department. Failure to comply with the provisions of the THIRD NOTIFICATION OF NON-COMPLIANCE by continued or additional violations of rules and regulations within the category or categories of rules and regulations of which you are notified herein, will subject you, as licensee, to a civil penalty which may be assessed by the Department. The amount of the civil penalty would be no less than five hundred dollars and not more than one thousand dollars. Be advised that under the provisions of 12-44-212, CRS, 1991, that the assessment of a third civil penalty in a calendar year will result in the Department initiating action to suspend or revoke your food service establishment license. If we may assist you in any way in complying with this THIRD NOTIFICATION OF NON- COMPLIANCE or should you have questions related to it, please do not hesitate to contact Gary Hague at (970)-353-0635, extension 2237. Sincerely, Gary Hague, .E.H.S. Charlotte Davis, MPH Environmental Health Specialist Consumer Protection Supervisor cc: Jeff Stoll, M.P.H., Director; Environmental Protection Services John Pickle, R.S., M.S.E.H., Director, Weld County Health Department Lee Morrison, Weld County Attorney Z 130 100 189 UE Postal Service Receipt for Certified Mail No Insurance Coverage Provided. Do not use for International Mail(See reverse) Sent to WW LIN ��C-1� CHINA BUFFET "PdafemcW stiMP$le GREELEY CO 80631 Postage $ Certified Fee Special Delivery Fee Restricted Delivery Fee In rn Return Receipt Showing to Whom&Date Delivered 4 Return Receipt Showing to Whom, a Date,&Addressee's Address _ C. TOTAL Postage&Fees $ M Postmark or Date E 0 U- o_ First r;jass Maii UNITED STATES POSTAL SERVICE111111 Postage&Fees Paid LISPS Permit No.G-10 • • Print your name, address, and ZIP Code in this box • y i • "tiCAAd r itckti-Ae—. I ' i • 1 �I---� i WELD COUNTY HEALTH DEPART h �C�'. .,_, --,�,� .r ,; i 1517-16th Avenue Court T;•, • • Greeley, Colorado 80631 • r'" ' rutlg 1 i I • • q 190 • ai SENDER: • I also wish to receive the • I .O •Complete items 1 and/or 2 for additional services. following services(for an w •Complete items 3,4a,and 4b a •Print your name and address on the reverse of this form so that we can return this extra fee): u card to you. t.❑ Addressee's Address • N •Attach this form to the front of the mailpiece,or on the back if space does not d y permit. en 2.O Restricted Delivery fn a .The Return Receipte"Return twilpt llshowsto whom the ried'on the cleCwase e delivered low the and the dale Consult postmaster for fee. Z. delivered. ) 4a.Article Number 0 3.Article Addressed to: Z 130 100 189 cc E It KW LIN 4b.Service Type � v tz NUMBER ONE CHINA BUFFET Certified ❑ P.egisteied E 2435 W 10TH STREET °u GREELEY CO 80631 O Ex{?r-ss Mail O Insured c i O Return Receipt for Merchandise O COD g 7- ; D 7.Date of Delivery /5",--'9,1K" = ° 5.Received By:(Prix? Name) B.Addressee's Address(Only if requested Y and fee is paid) t CC 6.Sig re: (Addressee or Agent) T X ' 2 PS Form 11, mbe ti A94 tazsss-9a-aa2ze Domestic Return Receipt • 9Sa1q D DEPARTMENT OF HEALTH 1517 16TH AVENUE COURT GREELEY, CO 80631 ADMNISTRATION (970) 353-0586 C. 353-0635 COMMUNIHEALTHTY HEALTH (970)ROTECTION )353-0639 COLORADO FAX (970) 356-4966 July 10, 1998 CERTIFIED LETTER NO.: Z 130 100 188 K.W. Lin Number One China Buffet 2435 West 10th Street Greeley, Colorado 80631 Dear Mr. Lin: On Wednesday July 22, 1998, at 10:00 a.m. an informal hearing will be held before John Pickle, Health Officer of the Weld County Health Department, to discuss your establishments chronic violations. The hearing will be located at the Weld County Health Department Library, 1517 16th Avenue Court, Greeley, Colorado. If you should have any questions in this matter, please call Gary Hague at (970)- 353-0635, extension 2237. • Sincerely, Gary Hague, R.E.H.S. Charlotte Davis, M.P.H. Environmental Protection Specialist Program Supervisor • cc: John Pickle, R.S., M.S.E.H., Director Weld County Health Department Lee Morrison, Assistant County Attorney q%an • Z 130 100 188 US Postal Service Receipt for Certified Mail No insurance Coverage Provided. Do not use tor International Mail See reverse Sent to Str `Wilier CHINA BUFFET Po- 7,""le, "ode _I : I . Postage $ Certified Fee Spedal Delivery Fee Restricted Delivery Fee u) rn Return Receipt Showing to Whom&Date Delivered Q Return Receipt Showing to Whom, < Date,&Addressee's Address O TOTAL.Postage&Fees $ Postmark or Date E cn a_ - % SENDER: " I also wish to receive the a •Complete items 1 and/or 2 for additional services. e) •Complete items 3,4a,and 4b following services(for an y •Print your name and address on the reverse of this form so that we can return this extra fee): card to you. y N •Attach this form to the front of the mailpiece,or on the back if space does not 1.❑ Addressee's Address •c° mpermit. ■Write"Return Receipt Requested"on the mailpiece below the article number. 2.❑ Restricted Delivery (n L .The Return Receipt will show to whom the article was delivered and the date delivered Consult postmaster for fee. ri, o 11 3.Article Addressed to: 4a.Article Number u R{i LIN Z 130 100 188 CC E E NUMBER ONE CHINA BUFFET 4b.Service Type 5 o 2435 WEST 10TH STREET O Registered Certified ¢ GREELEY CO 80631 O Express Mail O Insured c W O Return Receipt for Merchandise O COD ' 7. -D-atte of Delivery y^' }r(� `o L G� ___c, `L U O cc 5.Received By: (Print Name) 8.Addressee's Address (Only if requested Y i H Lt /�.J and fee is paid) e • co to iL 6. Signatur : d ssee or Agent) oo X " H PS For 11, ecember 1994 102595.98.8-0229 Domestic Return Receipt G.$algo 444st DEPARTMENT OF HEALTH 1517 16TH AVENUE COURT GREELEY, CO 80631 WIlie ADMINISTRATION (970) 353-0586 HEALTH PROTECTION (970) 353-0635 COLORADO COMMUNITY HEALTH (970) 353-0639 FAX (970) 356-4966 May 7, 1998 Certified Letter No.: Z 130 100 134 Legal Action No.: 98-121 K.W. Lin Number One China Buffet 2435 West 10th Street Greeley, Colorado 80631 SECOND NOTIFICATION OF NON-COMPLIANCE FOOD SERVICE ESTABLISHMENT Dear Mr. Lin: On April 4, 1998, Gary Hague of the Weld County Health Department conducted an inspection of Number One China Buffet, licensed by you, K.W.Lin at 2435 West 10th Street, Greeley, Colorado. The purpose of this inspection was to determine compliance with the violations of the Rules and Regulations Governing the Sanitation of Food Service Establishments in the State of Colorado previously noted in the NOTIFICATION OF NON-COMPLIANCE dated April 20, 1998. The following items were found to be in violation of the subject regulations: VIOLATIONS 03 Egg roles were being held at room temperature. Internal temperature was discovered to be 50°F. Egg roles must be held at 45°F or above 140° F. (Section 2-201) 12 An employee was observed picking up egg roles off the floor and placing them on a tray with uncontaminated egg roles. Effective sanitation procedures must be used at all times to prevent cross contamination. (Section 3-401)(d) 35 Properly secure screen door against door frame to prevent fly entry. All outside openings must be properly sealed against pest entry. (Section 6-701)(a) Number One China Buffet Certified Letter No.: Z 130 100 134 Legal Action No.: 98-121 May 6, 1998 Page 2 09 Eliminate practice of using plastic cups for scoops to dispense ingredients such as rice and flour. Use only approved stainless steel scoops with a handle. (Section 2-506) 10 Stainless steel scoop handle was touching lettuce in lettuce bin. Handles of scoops must not touch food. (Section 2-506)(a) 21 Wiping cloths were found soaking in 0 parts per million sanitizer solution. Sanitizer solution should be 100-150 parts per million bleach solution. (Section 5-102)(b) 23 Thoroughly clean outside surfaces of all freezers, coolers, woks, and preparation tables to remove excessive grease and grime. (Section 5-101)(e) 32 Hand sink was without paper towels. Single use disposable paper towels must be supplied at hand sink at all times. (Section 6-503) The following items were found in violation of the Rules and Regulations Governing the Sanitation of Food Service in the State of Colorado on April 15. 1998: 01 One dented can of oyster sauce was found in dry storage area. Thoroughly inspect canned goods for dents and discard dented cans. (Section 2-101) 12 Rice scoop was found to be stored in a glass of standing water. Store such scoops in a dipper well or some other sanitary manner. (Section 3-401)(e) 30 Repair vacuum breaker on mop sink, as it is damaged and inoperable. (Section 6-303) 35 Rodent pellets were found in hot water heater room. Thoroughly clean this area • to remove pellets and eliminate presence of rodents. (Section 6-701)(a) 41 Wiping cloth water was in excess of 200 parts per million. Sanitizer should be 100-150 parts per million for wiping clothes. (Section 7-704)(a) 10 Meat cleavers were found stored within the crack and crevice of the wall and three compartment sink. Store cleavers on a magnet or other sanitary surface to prevent cross contamination. (Section 2-506)(b) 21 Old wiping clothes were stored on top of dish drying rack. Dispose of or store used towels in more sanitary manner. (Section 5-102)(b) 38 Properly cover light near dishmachine to protect exposed glass from breakage. (Section 7-402)(a) 9afjb Number One China Buffet Certified Letter No.: Z 130 100 134 Legal Action No.: 98-121 May 6, 1998 Page 3 Therefore, pursuant to sections 25-1-107, 25-1-109, 12-44-205(2), and 12-44-212 Colorado Revised Statutes 1973, you as the licensee are hereby ORDERED to correct the deficiencies set forth above as soon as possible but no later than May 20, 1998, so as to comply with the Rules and Regulations Governing the Sanitation of Food Service Establishments in the State of Colorado. Any written statement or data concerning the deficiencies set forth above will be considered by the Department. Failure to comply with the provisions of the NOTIFICATION OF NON-COMPLIANCE of April 20, 1998 has resulted in this Department's consideration of assessing a civil penalty of not less than two hundred and fifty dollars and not more than five hundred dollars against you as licensee. You will be advised in writing if a determination is made to assess a penalty. Failure to comply with the provisions of this SECOND NOTIFICATION OF NON- COMPLIANCE by continued or additional violations of rules and regulations within the category or categories of rules and regulations of which you are notified herein, will subject you, as licensee, to a civil penalty which may be assessed by the Department. The amount of the civil penalty would be no less than five hundred dollars and not more than one thousand dollars. If we may assist you in any way in complying with this SECOND NOTIFICATION OF NON-COMPLIANCE or should you have questions related to it, please do not hesitate to contact Gary Hague at (970) 353-0635, extension 2237. Sincerely, c c rill y, !` I )� Gary Hague arlotte Davis Environmental Health Specialist Consumer Protection Supervisor cc: John Pickle, R.S., M.S.E.H., Director, Weld County Health Department Lee Morrison, Weld County Assisstant Attorney ggal90 • 2 130 100 134 US Postal Service • Receipt for Certified Mail No Insurance Coverage Provided. Do not use for International Mail(See reverse) Sent to • NO 1 CHINA BUFFET Street&Number • 29,35 W 10TH ST Post Office,State,&ZIP Code GREELEY CO 80631 • Postage $ • Certified Fee •Special Delivery Fee Restricted Delivery Fee in rn Return Receipt Showing to r Whom&Date Delivered _.Q Return Receipt Showing to#tom, < Date,&Addressee's Address O TOTAL Postage&Fees $ • m • uh Postmark or Date • LL 05-07-98 Co a ai SENDER: also wish to receive the a •Complete items 1 and/or 2 for additional services. n Complete items 3,4a,and 4b. following services(for an •Print your name and address on the reverse of this form so that we can return this extra fee): di N card to you. U > •Attach this foram to the front of the mailpiece,or on the back if space does not 1, ❑ Addressee's Address 'o E permit. N •Write Wetum Receipt Requested'on the mailpiece below the article number. 2. O Restricted Delivery Vj j j •The Return Receipt will show to whom the article was delivered and the date «a c delivered. Consult postmaster for fee. .6 ° Zi 4a.Article Number v3.Article Addressed to: cC a NO 1 CHINA BUJFFET 1 130 100 134 4b.Service Type r,2435 W 10TH ST O Registered X Certified 0° GREELEY CO 80631 c ❑ Express Mail ❑ Insured .% : cc ❑ Return Receipt for Merchandise ❑ COD ° o 7.Date of Delive o 8.Addressee's Address(Only if requested 5. Received By: (Print Name) ( Y B4 and fee is paid) CO g 6.Signature:� , �(A�ddresssee or Agent) 1 X t�LTG�1 �O'Y,Y . PS Form 3811, December 1994 ' Domestic Return Receipt gsatclo COLORADO DEPARTMENT OF Page of /O PUBLIC HEALTH AND ENVIRONMENT 4300 CHERRY CREEK DRIVE SOUTH DENVER, COLORADO 60222-1030 LICENSE# PHONE (303) 692-3620 ESTASUSHMENT 'PI 1 C/44,-‘‘C // 4,,_ _ NAME �/J7 `w6REBg A .Y 3 s` l/./"I((/�wGt-/-214�._(�fi/`//F// - /)L�\'I EA'�,s„" LP CODE air-COUNTY E.T.NO. SANG. coot DATE /yy� \JJ+TRAVEL INSPECT. CI�MON TYPE /]( N �YR .Ql/MIo "DAr TIME (nyM��E 1 WSW:- Retell Food �N ! 1 (_ �� V `( ,r I ( `� 0_ 123. r Food Seneca a Food Based on an Inspection this dry,the Edna circled below identify'the NolMbr In wr+lon or� aerreclInspection ed by the mid mdkr knpseoon or such skaM perked of time es nay be specleked In writing by the isgulaary authority. Failureb comply wi t"any time tint tar ca nine speNSed in this macemay result in oassa8 .of sour Food EebMYNnent operations. An opportmity fix appeal ofthe Inspection findings raid time Nnl.sltan vd1 be prodded Pe written request for an edminleeal _hesdtg k Ned with the doped nsut weMn live(5)days folos4ng the dote of the inspection. CRITICAL ITEMS; These turn relate directly to factors which lead to foodbome lines OTHER ITEMS: E left uncorrected,tiro items can become a carious problem. THESE THESE ITEMS MUST RECEIVE IMMEDIATE ACTION. ITEMS SHALL BE CORRECTED BY THE NEXT INSPECTOR OR AS OTHERWISE SPECIFIED. fOOD.PROTEC7101) MiOOD�. .. .. . 01 FOOD 02 Odgk.el Container, Property labeled a. Approved Source. c. Wholesome 05 TAamwrndem Prodded and Conspicuous: Accurate: Probe-type b. Dented,Swollen,Damaged Containers d. Other Q) FOOD TEMPERATURE REQUIREMENTS DURING SERVING, Oi �^ 'Rees done Font Prosody Thawed STORAGE,TRANSPORTATION,DISPLAY,AND PREPARATION /-tr�� Food Protection During Seming, r ,-Tnmprtatlan,Display,and PnpentlonAdrsil -a- wr a. Cwling Proceduros c, Hot Holding Tamp.(140°F) 7 � KindlingProp..tlbmite Prcwld.d and lie" of Food MleknWd, j b. Potentially Hazardous Foods d. ReqWnd Cooltinp Temp, Rapidly Reheated b 185°F ® RddWrebon Temp.(45°P) Fed psnwrnp`Iter�llk'rropoty awed Wlwn b lies „ ( ar 1LG'' the. ADEQUATE EQUIPMENT TO MAINTAIN FOOD TEMPERATURE TS Cl...CYtlrA peak Restraints 07 PREVENTION OF CROSSCONTAMINATION a Unwrapped&Patents Ily Hazardous Foods Not Re-ear-red FO[)tlL A tANI3 b. No Contamination of Cooked with Raw 14 Food Dm)Contact Surfaces: Designed,Constructed,Maintained,ed,tat Id,Located c. Damaged I Detained Fonds Separated is NdieFaad Ceded Surfaces: Designed,CaMnicted,Maintained,Installed,Located PERSONNEL 10 • DNhershkp FadSles: Designed.Constructed,Maintained,Mealld,Operated 11 PERSONNEL WITH INFECTIONS RESTRICTED 17 Mounts Twmanabre Chemical Test lfl Prodded,Gauge on(114•PS%KM) © HYGIENIC PRACTICES a. Hands Washed as.Needed �tcr'T Smoking,Earle.Drinking Restricted 15 Utensils,Equipment Pre-Flushed,Sassed,and Soakedb. Hands Properly Dried, ref No Common Towel Good Hygienic Practice* 415 Wash,Rinse Water, Clear,Proper Tengrdun FOOD.EQUIPMENT AND UTENSILS S (Fri"Gapooke.Stand Raper Use 20 SANITIZATION temperature concentration exposure 22 Food Contact Surfaces rd Equipment and Utensils Clean.Fr of AteasAw,Daterpesb a. Manual Non-Food Cared Surfaces of Equipment and(tensile Clean b Mecnaniral 9 t j c In Place Slope end Handling at Clean Equipment and Utensils iT,:�q� � Chlorine b0-200 25 Single Sai:nce Ate,Ste,Dispensing,Used �^ppm Quaternary Ammonia 100-200 ppm Other Approved Sanitizes Z• No Re-thee d Single Smoke Ankle. I WATER - 3 ;: ' b Properly kWSd,Maintained 27 Water Source,Side;Hot and Cold under Pressure TAE ETAND HA aril SNEX4 Fif1 NkttleJ SEWAGE ejToilet Room I Fbtrrns HandvreM Sick 28 Approved Sewage and Wash Water Diapered / J. Clean d. Proper Went Re ceded*. PLUMBING I"�-'7 �P/ d. Toilet Room Enclosed,Do Doae Closed GAIIEAGEANDNoust 30 No Gross-Connection Batsmen Potable l Waste Water. - .. BackWow Devices Installed 33 Containers or Receptacles: Clean.Adequate Number, t Insect/Rodent Rod.Frsquency,Cowed TOILET AND HANOWASHING FACILITIES ' 31 FACILITIES COMPLY WITH CODE 34 grade oars",Area peon,Enclosures Prosody Cemrcld a, Handwaen sink -number/location c. Handwaek sink -accessible d 'f'=, 1 CrER.INQ b. Handwaeh sink - designed/Installed d. Toilet room and fixture SE Floors; Constructed,Drained,Clean,Good Repair,Gimping,Installation,Cored � ECT.AND RODENT-CONTROL 37 WaIs,CONN."elected Equipment,ConstruConstrucSurfacesCgnm ,Good Radek,Clean Surfaces a. Evidenced Rodents 0THEN OPERATIONS S. Evidence d made 30 Lighting Presided es Required; Flexes Shielded,Endcape 0 Outer Openings Protected Other 30 Roan end Equipment Vented es Required 40 Roans.Locke.: Podded.Located,Used OTHER OPERATIONS 42 Premises Mekteined: Fr of Liter,Unnecessary Article,,Cleaning I Maintenance, 41 TOXIC ITEMS Equipment Properly Stored,Authorized Personnel a Properly Shred Properly Labeled 43 Conde..Sepsstion From LMng I Seeping Dune,Laundry Propedy Used 44 Clesn endb Soiled Linen Properly Stoned INSPECTED BY: �/t, f� c/ C1 RECEIVED BY: CDH(Rev.12-94)CPD � l/j FOLLOW+xe YES....1 No...s , 3 �j DESCRIPTION Item Wt LOS? p '"-C�r� c..c,-P c�G>c/.. Source 1 5f . Z.e)-een ,, Container 2 1 _ Product temp. 3 5 k-s_c7/-- c17, --,(,p mac, c- circa-e_ Temp. facilities 4 4 / V6., c7:=:" Thermometers 5 1 Thawing 6 2 ` Cross- contamination 7 4 ,f�+ � — --«-- Food protect 8 2 ��"� W Unnec. handling 9 2 �- '"- Dispen. utensils 10 1 - (--6-C/7- a.- - -.r:, yPc. Personnel 11 5 Hygienic practices 12 5 -re6- O>-t_. � Clothes, hair 13 1 / A / r `� (7 FCS- construction 14 2 � �'/ NFCS- construction 15 1 (/ Dishwashing 16 2 3.S--- Thermo., kits 17 . 1 ��Pre- flushed 18 1 1�� c � 2 1it Dishwater 19 2 12-1.X.4 /7 -,--11 , Sanitization 20 4 --. Wiping cloth 21 1 Dx FCS - clean 22 2 `"CJ `�-`"�"-� NFCS- clean 23 1 ' £ --cam-. Storage 24 1 " - --d Single-service 25 1 Re - use of s-serv. 26 2 4-6?— --- - -- - - u. Water source 28 S % ezAt _ Sewage 28 4 Installed, maint. '29 1 —41e" AZ-- / czyt_fr Cross- connect 30 5 (1A-°-0j Installed 31 4 `jam Maintained 32 2 Covered, clean -33 2 /v- 2ccser ��., Ait_e_c_c_e__ 'K'',- —t-cx�1- Properly constr. 34 1 _`./> Pets, pests, screens 35 4 , �__ `�'� Construction 36 1 J�� _') �7�Ny'0 ---c-c, Clean, repair � 37 1 - be'-te: Lighting, shielded 38 1 , Ventilation 39 1 /2/. - _ - eZ....deDressing rooms 40 1 f ' '/i ' 't G-� � _ Toxic items 41 5 J�<' - r Premises 42 1 Living /slpg. quarters 43 1 -= ( 7c -- ($'2:5 Laundry 44 1 �. -40\r:e--A:a 4-4,4,,,,,, tt rirt DEPARTMENT OF HEALTH 1517 16TH AVENUE COURT GREELEY, CO 80631 C ADMINISTRATION (970) 353-0586 HEALTH PROTECTION (970) 353-0635 COLORADO COMMUNITY HEALTH (970) 353-0639 FAX (970) 356-4966 April 20, 1998 Certified Letter No.: Z 130 100 119 Legal Action No.: 98-014 K.W. Lin Number One China Buffet 1035 A South Boulevard Denver, Colorado 80219 NOTIFICATION OF NON-COMPLIANCE FOOD SERVICE ESTABLISHMENT Dear Mr. Lin: On April 15, 1998, Gary Hague of the Weld County Health Department conducted an inspection of Number One China Buffet, licensed by you, K.W. Lin at 2435 West 10th Street, Greeley, Colorado. The following items were found in violation of the Rules and Regulations Governing the Sanitation of Food Service Establishments in the State of Colorado : VIOLATIONS 03 Egg roles were being held at room temperature. Internal temperature was discovered to be 50°F. Egg roles must be held at 45°F or above 140° F. (Section 2-201) 12 An employee was observed picking up egg roles off the floor and placing them on a tray with uncontaminated egg roles. Effective sanitation procedures must be used at all times to prevent cross contamination. (Section 3-401)(d) 35 Properly secure screen door against door frame to prevent fly entry. All outside openings must be properly sealed against pest entry. (Section 6-701)(a) 09 Eliminate practice of using plastic cups for scoops to dispense ingredients such as rice and flour. Use only approved stainless steel scoops with a handle. (Section 2-506) 10 Stainless steel scoop handle was touching lettuce in lettuce bin. Handles of scoops must not touch food. (Section 2-506)(a) 9sat9 Certified Letter No.: Z 130 100 119 Legal Action No.: 98-014 K.W. Lin April 20, 1998 Page 2 21 Wiping cloths were found soaking in 0 parts per million sanitizer solution. Sanitizer solution should be 100-150 parts per million bleach solution. (Section 5-102)(b) 23 Thoroughly clean outside surfaces of all freezers, coolers, woks, and preparation tables to remove excessive grease and grime. (Section 5-101)(e) 32 Hand sink was without paper towels. Single use disposable paper towels must be supplied at hand sink at all times. (Section 6-503) Therefore, pursuant to sections 25-1-107, 25-1-109, 12-44-205(2), and 12-44-212 Colorado Revised Statutes 1973, you as the licensee are hereby ORDERED to correct the deficiencies set forth above as soon as possible but no later than April 25, 1998, so as to comply with the Rules and Regulations Governing the Sanitation of Food Service Establishments in the State of Colorado. Any written statement or data concerning the deficiencies set forth above will be considered by the Department. Failure to comply with the provisions of this NOTIFICATION OF NON-COMPLIANCE by continued or additional violations of rules and regulations within the category or categories of rules and regulations of which you are notified herein, will subject you, as licensee, to a civil penalty which may be assessed by the Department. The amount of the civil penalty would be no less than two hundred and fifty dollars and not more than five hundred dollars. If we may assist you in any way in complying with this NOTIFICATION OF NON-COMPLIANCE or should you have questions related to it, please do not hesitate to contact Gary Hague at (970) 353-0635 extension 2237. Sincerely, Gary Hague ✓ Charlotte Davis Environmental Health Specialist Consumer Protection Supervisor cc: John Pickle, R.S., M.S.E.H., Director, Weld County Health Department Lee Morrison, Assistant Weld County Attorney 98x190 rieHt t1 DEPARTMENT OF HEALTH 1517 16TH AVENUE COURT GREELEY, CO 80631 AC� TION (970) 353-0586 HEALTH DMPROTECTION (970) 353-0635 COLORADO COMMUNITY HEALTH (970) 353-0639 FAX (970) 356-4966 CERTIFICATE OF DELIVERY Undersigned, a person over the age of 18, hereby certifies that the following was hand delivered to: Documents Delivered: ? r 414, / I DATE/DELIVERED DELIVERED BY (Signature) Subscribed and Sworn to before me on '1 day of 199 l f NOTARY PUBLIC (Signs&zre) My Commission expires -� - �fl_; 9$.)90 Z 130 100 119 US Postal Service Receipt for Certified Mail No Insurance Coverage Provided. Do not use for International Mail(See reverse) Sent to KW LIN Street&Number 1035 A SOUTH BLVD Post Office,State,&ZIP Code DENVER CO 80219 Postage $ Certified Fee Spedal Delivery Fee Restricted Delivery Fee L m Return Receipt Showing to Whom&Date Delivered 123_ Return Receipt Showing to Whom, Q Date,&Addressee's Address O TOTAL Postage&Fees $ CO Postmark or Date E 0 LLn 04-21-98 a 9gai90 !G rA, L.-•- �OLORAbO DEPARTMENT OF Page of —"CI• ,/ .- F>uBLIC HEALTH AND ENVIRONMENT �1- ��.r 4800 CHERRY CREEK DRIVE SOUTH 1s,'"/ DENVER, COLORADO 80222.1530 LICENSE# C PHONE (303) 692-3620 . ESTABLISHMENT &Aden NAIL ' ADDRESS -/ jL_2 � /�/' f �7 )-17 .. •r ' 'iii> -1G'ci5, L. aP CODE mode.EST.NO. SAINT. CODE DAT1: TPII4EL INSPECT. ��SE TYPE YR I MO a TIME TAW V�. O T 3- CD"P"Int j)// d /yy I ,c /`�"/ } 2. Follow•up Revel Food- - L(- 2 1/ ! I g- �.I (l SQL '�}" - - - �'-/.1 IL,' 4. Investigation _ Food Sfrvlca al Mood Establishment kutpectlon Report Based on an inspection this day,the items circled below identify the violations in operation or f%0 ates which must be corrected by the next routine inspection or such shorter period d time as may be writing by the regulatory authority,Failure to comply with anytime limits for corrections specified in this notice reauk in cessaion dspeckled in may your Food Establishment operations. An opportunity ion appeal of the inspection findings and erne limitation will be presided if■w,itrn request for an adminadellve hearing le Ned with the department within eve(5)days following the date of the inspection. (CRITICAL ITEMS: These Rams rotate directly to factors wI,ch reed to foodbome knee. OTHER ITEMS: it test uncorrected,!trees items can becomes perdue problem. THESE THESE ITEMS MUST RECEIVE*MEDIATE ACTION. ITEMS SHALL BE CORRECTED BY THE NEXT INSPECTION OR AS OTHERWISE SPECIFIED. i F ,PROTECTION 0.000$ 1.0t4 71 FOOD 02 Original Cortditw, Properly labeled a Appyyi,ed Source. c Wholesome b Dewnted erolren,Damaged Corrtalrwrz Li Other 06 Thermometers Pri idea and Conspicuous; Accurate; Probe-type 03 FOOD T PEMPERATURE REQUIREMENTS DURING SERVING, a laird°r's Food Properly Thawed STORAGE TRANSPORTATION,DISPLAY,AND PREPARATION ' Food Protection During Sewing,Storage,Transportation,Display,and Preparation a Cooling Procedures c Hot Hording Temp.(140'F) OE Handling of Food Minimized,Proper Utensils Provided and Used b Potentially Hazardous Footle d. Required Cooling Temp. Rapidly Rendered to 185`f- e. Retngeiabon Temp(45"F) �� Food Dispensing Property 9sofnd In U.. ._ F1MCNNl1 U4 ADEQUATE EQUIPMENT TO MAINTAIN FOOD TEMPERATURE 12 Clew CbUws,Hair Restraints 07 PREVENTION OF CROSS-CONTAMINATION r � w.�. a Unwrapped S Potentially Hazardous Foods Not Ne-served 0 b No Cwh arnmahorr of Cooked with Raw 14 Food(Ice)Contact Surface; Designed,Constructed,Maintained,Metalled,Located c. Damaged/Detained Foods Separated 16 Non-Food Contact Surfacer Designed,Constructed,Meintekred,MsbNed,Located PERSONNEL 16 DhMrrrhkq Facilities, Designed,ConWucted.Maintained,Imbibed,Operatrd 11 PERSONNEL WITH INFECTIONS RESTRICTED h - 17 Accurate Thermometers,Chemical Test Kira Provided,Gauge Cock Cur IPS Veers) HYGIENIC PRACTICES a Harws'Nysheo es Needed Smoking,c o 18 Utensil,Equipment Pre-Flushed,Scraped,and Soaked s roc,Denking Resthct.d b. Hands Property Dried,No Common Towel Good Hygienic Practices 18 Wrh,Rinse Weise; Clean,Proper TempeMure FOOD EQUIPMENT AND UTENSILS j wiping Cloths; Clean,Stored,Proper uee 20 SANITIZATION temperature concentration exposure 22 Food Contact Surfaces of Equipment end ornats Clean,Fr..or Abrasives,Detergents it Mint 22 Non-Food Con �_�' .✓ WY. --V tact Surface.of Equipment li Macl,anhcei q hThsre and Utensils Careen t.Y!w,.s --Y - .-- 24 Storage and Handling d Clean Equipment and Utensils Chico hie iO .200 ppiri Quaternary Ammonia '.00.200 Single Servos Articles,Storage.Dispensing,Used > n 26 No Re-Use of Single Service Articles Other Approval Sanitiiers . IWATERt.uMSlt4c a Properly hurdled,Maintained r 27 worm Suuri;4,Safe;Not and Cold Under Pressure T jN0 HA61 $ 'PACILTTIEE SEWAGE •- ?--__— 32 Toilet Room/Frauds/Handymen Sink 28 Approved',ew.ge and Weals Water Disposal a. Cie.n c. Proper Waste Receptacles ::... b. Soap/Drying Denizen d. Toilet Room Enclosed,Doors Closed p30.,i�Cross tsnnscUoa Between Potabie S Waste Water.. � '' . se es... ......... ,. Bac kriow Devices Installed 2$ Cotrdkists at Recepte es; Clean,Adequate Number, Insect/Rodent Prod,Frequency,Covered • TOILET AND HANDWASHING FACILITIES c 31 F.AC%ILITiES•:OMPLY WITH CODE 34 Outer Garbage Area: Clean,Enclosures Properly Constructed FLOORS,WALLS Aria ON-Was : v a. Handwavh sink •number I looaticn . Handwaah sink -accessible .. - .. ' . u. rlsndwesh sink designed 11,,,de iwi d, railer iorarrt end nr4eR al Floors; Consbucdd,Drained,Clean,Good Repair,Covering,hstallabon,Cored ?INSECT AND RODENT CONTROL • 37 Wells,Ceiling,AMaoGood Repair, hed Equipment,Conebucted. Crean Cr Surfaces 04,03 Evidence of Rodents IDTIMt OP ATION$ . s ees .. see b. 'N'il rd.)lennC11 Of Insects . Lighting Provided Required; Fixtures Shielded.Endceps., a. :)later Openings Protitcaad u. tlier 3st Rooms and Equipment; Vented es Required + M . — --4 -q 40 Rooms,Lockers, Provided,:.ocated,Used ",THEi•t OPERATIONS .. ' XIG t7cM3 . mes- 42 Preis Maintained; Free d Unnecessary Lifter,Unnessary Articles,Cleaningarite/Mnance, ii,'I1 Equipment Properly Sicced,Authorized Auorized Personnel .. c'r�.1enY gored o Property Labeled43 Complete sdpeletion From Living/Sleeping Quarters,Laundry „...e. .' o rang .is,eu 6 e 44 Clean and x Soiled Linen Properly Stored . ._ti INSPECTED BY: .' I r RECEIVED BY. 1 /k.•. ,r,t,"/ , rf j , / ,`• .4:_•,.../, —�� .---- .,( 1 - /� • CDH(Rev.12-S4)CPD FOLLOW-UP lees ...t NO .2 • cSaigo c i - 6?-fr,-E -.1 n2-2 iii ! -- ..- � c ice:-;; DESCRIPTION Item Wt c� Source 1 5 �' � U�5 Container 2 1 "� r``` -C21- Le-c-'nn`-ecd! "e-e!'- 4,C t z Product temp. 3 5 Temp. facilities 4 4 ��. ' z 4wcv�.r�7-# fr ilK_c✓C-t-4-,2 /. Thermometers 5 1 Thawing 6 2 2 ' c v- /f.C.Zc /Ltc-ef° --c.',-k ck_._ Cross- contamination 7 4 // Food protect 8 2 'e' '- /2'- C - r..rel-v�y .matt. , ti Unnec. handling 9 2 - - / Dispen. utensils 10 1 ecz-� � - 42m— eer/Jt _-t-'-e? Personnel 11 5 , / Hygienic practices 12 5 —66/-e ,---t-e- �-v7 1��tt�C� Clothes, hair 13 1 i FCS - construction 14 2 - �-c-c- NFCS- construction 15 1 Dishwashing 16 2 t " & Un.. -r'e f -4).-4--J...° co> p -...c..0-...c..0Thermo., kits 17 . 1 .,L(1, -v.u_,-a�(� ...0447 -+-c_.e' z c-r_-G^ - Pre- flushed 18 1 Dishwater 19 2 3S_ 0 ��?�� ---6 �� ; Sanitization 20 4 /� � / r�/ ---c--y.._ �� . ern . Wiping cloth 21 1 FCS - clean 22 2 d -ecin --cli.C4 G't^-A-'Rc -„GU -2_z_ ...cer NFCS- dean 23 1 ' and_ t-e-w? -, Storage 24 1 Single- service 25 1 oe ex e Re - use of s-serv. 26 2 y �� `chil � Cc 2 Water source 27 5 Sewage 28 4 --r-t ..t4C-'CQ/vz- Ce 67d 0 N Z44A . �q,r,�c Installed, maint. 29 1 // /� '��ie-e_J-ei'1 .67...c /ryo —r.S-o7G-t,9+1 , Cross - connect 30 5 Installed 31 4 CAS'- -'-6-1)14---- C yu cvle e A-/(,a.,t,. .�. 4-SIT-H Maintained 32 2 _ �'h_ iJ a 6-(eO Covered, dean 33 2 Properly constr. 34 1 Pets, pests, screens 35 4 -4- '71-4-1'1' C,Lea.4Ul 4--e- '�-ci-p-g-�-t Construction 36 1 /, Clean, repair 37 1 1- t^.�t,�ti'>� � L.A.."7?+�, L.A.." x � -✓t.d� t.C�Ct Lighting, shielded 38 1 Ventilation 39 1 G - Dressing rooms 40 1 1 O /, r 4 �� cf �. Toxic items 41 5p �FLe_tikL� � 2t r22 cti �- ` e. Premises 42 1 G �� ° a qze Living I slpg. quarters 43 1 / " Laundry 44 1 ,,. ,J /7 4,4: " zc..n, z Will .. LD c COUNTY HEALTH DEPARTMENT 4-7 1517 - 16TH AVENUE COURT �� " ' `''✓ 0 GREELEY,CO 80631 COLORADO. (970)353-0635 FAX(970) 356-4966 Page One of PASS FA1Lt ESTABLISHMENT , ER NAME(,4ADDRESS j 5----- IL/(o '- ) PHONE 'ZIP CODE 7� FREQUENCY' ESTAB NO. SANIT.CODE ATE TRAVEL TIME INSPECT TIMEE of INSP. - r ..0"" up 3.ComplainJlnvestigation ((-� /G ) 9 -fi O • 1.Walk itrougtdPre-Opening RETAIL F OD ESTABLISHMENT INSPECTION REPORT Items circled below identify violations to be corrected as indicated by the regulatory authority. Failure to comply may result in further action by the regulatory authority. Red--Critical Items:These items related directly to foodborne illness I Black--Other Items:Uncorrected,these, an become serious problems. ,432:::i 09 Food Labeling,Food Protection . Fooet a.Approved source ross-Contaminition .- a.Original container,properly labeled b.Wholesome,free of spoilagr .d.HACCP plan b.Food protected from contamination • •- -• Personnel. e.k r; '= en* Cons! action ployee Health Hygienic Practices a.Personnel w/infections restricted c.Hands washed as needed CDFood-contact surfaces b.Wounds properly covered ®Hygiene practices f b.Nonfood-contact surfaces e.Smoking,eating,drinking c.Dishwashing facilities Des nstr n of Knowledge in Neede "; , d Food Temperature COnt{ ®Refrigeration units provided with accurate,conspicuous thermometer Temperature Control Procedures lZ` Chinning— Of tqa‘in6E:and.`1:Itrisd6i15 � ::..,i.,: . i.....:4:,. a.Rapidly cool foods to 41°F or less d.Hot hold at 140°F or greater b.Rapidly reheat to 165°F or greater old hold at 41°Fps l ss .,, a.Food-contact surfaces c.Dishwashing operations c.Required cooking temperature /t i c e i--Y --IC" vet--: I b.Nonfood-contact surfaces d.Wiping cloths w `t' v , Temperature Control Equipment 7ef'� m Food thermometer(probe-typ irilMtr to±3°F) • .Y3 - UtensI1&S Igle-Service-Art icle6;;;`. .-: ;. ,'.='.;.!r. s."r g.Adequate equipment to maintain ood temperatures I .. a.Utensils provided,used,stored 04 Sanidzadon Rinse h.Single service articles stored,dispensed.used c.No re-use of single-service articles Temperature concentration Exposure a.Manual --___ _ _ 14' . : . Phi Facilities b.Mechanical — v - 4 - a.Plumbing:installed,maintained e.Ventilation c.In-Place _ _ b.Garbage and refuse f.Locker rooms c.Floors,walls,ceilings g.Premises maintained Sanitizes- Chlorine Quaternary Ammonium Other 1 d.Lighting h.Separation of living,laundry •05:. Water,Sewage,Plumbing Systems a.Safe water source c.Backtlow,back siphonage i a.Personnel:clean clothes.hair restraints,authorized b.Hot&cold water under pressure d.Sewage disposal 1 b.Linen properly stored 06 Handwashing Fa iliities• ..:. a.Adequate number,location c.Soap&drying devices /) ,�/ b.Accessible /Xj 117,61..r(-€41d ,_.€ leg Pest Control ( �.Evidence of or rodents c.Animals prohibited J K O f/11 2 1(1/4512 yf� b.Pesticide app!cation /l �/1 's ` i Poisonous or Toxic Items -- a.Properly stored c.Properly used J : Properly labeled ��r�� / G — r � ENVIRONMENTAL HEALTH SPECIALIST: 73---RECEIVE Y: Q-r ji. 4 ,' /1.407/(4./€...„„, C 1 PAGE OF DATE: %G' - 27- r , ESTABLISHMENT: '22._ C . ..cz WS . LW-eV-ADDRESS: } y J Ai//M �e DEFICIENCIES FOUND: C3L _ (-tfc ) e L2A_,2. • --C c �- l' �Y+ �-ry - r Gam'h /`' '... e�.. , - -t 77- e, Gh ��.e 7 cetir 2 "Lei-VAU , .c,r r -ems p11-P-f ,-.e4h_.7'r----. _e*.u1.4- rr,,irt -m r.. - CO - _ .. - `--c"t�x-„G of . :At u6 ,.. .'z, c'i_lJn- A....?..--vi....e�...�..r rt *W>vl _ . al -i- f-z -c.. o-6 ‹---v. e?.-• ,t -�CZ "--' ea---r-112 cl• e-e_ --ta,&___/4-e-,-,, t- fill-°/WV/ . - 4- C71 - .e, - C �/z--> 1 .. ,,;)_..--,....„ ----- 6,,,,,...? r 'CJ`s ca eat-ice'_ 1 y'� �J -- - Y,.-7:/-----. QY p---Liz s-�e- ---7‘z4_,..)--- ' 4.-‘6.4,-�rrc wi % i v.��. _. --f" _,t,-v2-G- -- , _ _e - —e4 6, --"Z-e/7-.4-741-7 Lys/7 0?--- ems.:. / / Q I- C.4...- '4..-1Z-._.: _ /2-'2..e./2 e4t,-G e_ ez �� PLC r --e--?'l '-r---,- 'tel.-61i - -(l--e t .iLe1' _!.. ef)- ...___.z... _.,,- ...,.__— yee°-C-`.r," -��NL G e?/t . 1^7y�r^c f �+- cam• THE UNDERSIGNED HEREBY ACKNOWLEDGES THE FOLLOWING: Based on an inspection this day. the items circled identify the violation in operation or facilities which must he corrected by the next routine inspection or such shorter period of time as may be specified in writing by the regulatory authority. Failure to comply with any time limits for corrections specified in the notice may result in cessation of your food service operations. An opportunity for appeal of the inspection findings and time limitation will he provided if a written reque t for an administrative hearing is tiled with the department within(5)days following the date of inspection. A —---;224..fge."Enviro / ental Healt Specialist Received By 9'n l% PAGE 3 OF 3 DATE: )1-- .-2.7r'Cg r �/ /f ESTABLISHMENT: A)O .. r DDRESS: 2 . 4,)/Q �( T��W1, DEFICIENCIES FOUND: 6).5? - 5.3,...c.,_,„„...e ,,,c),-- ---ef./.)_-. ,—c,_."--;?--‹, ?Lf/. r ,,eoraz,t.. i _ « /0 1.'v --6,---6-4,--6,7) "€. �. 1/11-0'6",I-64e-- C.:9-6 (1.. ))1 ----71/<-1 C-,-p..-Q.1... ✓nv /rt • Ie.." Gc " -tsYvt.c�'N, +G-4,--- �e-c:, _ _ > iv."2.,rc)2-7., _' P -� "f .7 -4 n--- 4 e ��Y �� ______. I( ''` ,2c ��✓`�'utic/jynj"--e't --��'M/� .-_ems; 2�e.GJ NA, �cV,-,l1 72 THE UNDERSIGNED HEREBY ACKNOWLEDGES THE FOLLOWING: . Based on an inspection this day.the items circled identify the violation in operation or facilities which must be corrected by the next routine inspection or such shorter period of time as may be specified in writing by the regulatory authority. Failure to comply with any time limits for corrections specified in the notice may result in cessation of your food service operations. An opportunity for appeal of the inspection findings and time limitation will be provided if a written reque t for an administrative hearing is tiled with the department within(5)days following the date of inspection. . Environ enta Health pecialist Received By 9 CD f DLD COUNTY HEALTH DEPARTMENT Jr 1517- 16TH AVENUE COURT GREELEY,CO 80631 • (970) 353-0635 FAX(970) 356-4966 Page One of COLORADO PASS;',. FAIL ESTABLISHMENT OWNER NAME L eitr.er ADDRESS ]PHONE ZIP CODE leeeft FREQUENCY ESTAB.NO. SANIT.CODE ATE TRAVEL TIME INSPECT TIME PURPOSE of INSP. r ?. u�ITow u `f y/ ia8lnvestiga6on 2 1? C- t�` 9.Walk T roughiPre-Opening RETAIL FOOD ESTABLISHMENT INSPECTION REPORT Items circled below identify violations to be corrected as indicated by the regulatory authority. Failure to comply may result in further action by the regulatory authority. Red--Critical Items:These items related directly to foodborne illness 1 Black--Other Items:Uncorrected,these,pan become serious problems. Food Source 't1iPt: • .. • a.Approved source /Cross-Contamination a.Original container,properly labeled b.Wholesome,free of spoilage d.HACCP plan b.Food protected from contamination 0Z Personnel Employee Health Hygienic Practices a.Personnel w/infections restricted c.Hands washed as needed a.Food-contact surfaces b Wounds properly covered d.Hygiene practices b.Nonfood-contact surfaces e.Smoking,eating,drinking c.Dishwashing facilities Demonstration of Knowledge f.Training Needed Ii Testittg:I> foes 03 Food Temperature Control a.Refrigeration units provided with accurate,conspicuous thermometer Temperature Control Procedures : :.` of a.Rapidly cool foods to 41°F or less d.Hot hold at 140°F or greater - b.Rapidly reheat to 165°F or greater e.cold hold at 41°F or less a. ood-contact surfaces c.Dishwashing operations c.Required cooking temperature .Nonfood-contact surfaces d.Wiping cloths Temperature Control Equipment , f.Food thermometer(probe-type,accurate to±3°F) 13 Utensils,Single-Service Articles' t g.Adequate equipment to maintain food temperatures a.Utensils provided,used,stored 04 Sanitizadon Rinse • •. b.Single service articles stored,dispensed,used c.No re-use of single-service articles Temperature Soncentration Fltposure ! r a.Manual b.Mechanical _ a.Plumbing:installed,maintained e.Ventilation c.In-Place b.Garbage and refuse f.Locker rooms t I c.Floors,walls,ceilings g.Premises maintained Sanitizer: Chlorine Quaternary Ammonium Other d.Lighting h.Separation of living,laundry 05 Water,Sewage,Plumbing Systems c Oiber Operations a.Safe water source c.Backflow,back siphonage a.Personnel:clean clothes,hair restraints,authorized b.Hot&cold water under pressure d.Sewage disposal b.Linen properly stored • 06 Handwashing Faeillltie t . a.Adequate number,location c.Soap&drying devices . b.Accessible l Pest Control • DEvidence of insects or rodents ,,_If c.Animals prohibited • b.Pesticide application 1.04.4 ► 11 Poisonous or Toxic Items ► a.Properly stored . 'roperly used -I ,e Properly labeled i v ENVIRONMENTAL HEALTH SPECIALIST: RECEIVED BY: • r 5 J � PAGE .?- OF 2-- DATE: . 9- .).-2 - ' ESTABLISH SENT: Al O • C4,r c& 4PDRESS: 2 9 y5— /2/0 •fh .- ✓ DEFICIENCIES FOUND: (� / .y t-tix.ci✓L-d�G-e..• �'1e2�. C . ter, '., ./�,.7 ,----rte /;( -„,_t ,.,`' C1't�-�. .Z vt ��i .-E'er C'.4.Z�� F sl/ ,�t �� ( . :� Gr,e��t / ,-,,,,CJ2. _-E /I, t--c-t..,..„ .,t.2'.., (-{r7 4r--1,---x_ Cie .4-..� ...�4-\-, -<...:--e c ..c . _47 - .4&---7-' . Q n��1 P C ,/LL '3 2-C ACC) l --eli.:-C.••-•?;4-4....-vt,--e,e...77g1:— /-)___/-1._.e...t._.•:z.1“--E-- evec) ---?.?-.1-J..7C-4-t.:Z--;:i O .er 1.1 (e4-7-1 ,t,,,,' . tee,-/ c ..E(* �� - � �/�-- - e'--- /�► /L rCL ,---$1...-2_4 _,e(7i ....._ Gi4,6 . agirl 1'7-44,- .•_; O.A., 0✓3-17.G='t_ h_-, (.ic /r.(i'" �Z'r r �i f.l. d. !�.{..:fc�! iC.eft �,.4.4_;'�.�,�- .r,Z....f.•.. --C, :.e-e.1.i'1 .... c.J/•• 11 •.�A.A .. /00- (,s-C--st-mot . /1 - •Zrr-(_.{9 - C�er-ti 1 C'cc�1.. c,/2-4'y e, . __.�.e-, �-e�K.R-"tK,.,-- J2.-/Y--.1:�ni2.t-cr-�-• Ai".'-C .�-�4-t_E1'c--.5 4 THE UNDERSIGNED HEREBY ACKNOWLEDGES THE FOLLOWING: Based on an inspection this day. the items circled identify the violation in operation or facilities which must be corrected by the next routine inspection or such shorter period of time as may be specified in writing by the regulatory authority. Failure to comply with any time limits for corrections specified in the notice may result in cessation of your food service operations. An opportunity for appeal of the inspection findings and time limitation will be provided if a written request or an administrative hearing is tiled with the department within(5)days following the date of inspection. Envirory enttal He,enh Specialist �" Received By 9S190 'ART I RETAIL FOOD I .FABLISHMENT RISK ASSESSME - SURVEY ESTABLISHMENT NAME: i, 'HA:I III '") •-•C- :a � ; ,4 e •COUNTY r —.- .ADDRESS: '‘ "� -d SEATING CAPACITY: TYPE OF CUISINE OR SERVICE FACTOR I: <500 501 - 1000 WEEKLY MEAL VOLUME: 001 - 4000 . .. . \sab00 40015 8000 4 TOTAL: 3 FACTOR II: FOODS PREPARED AND/OR SERVED TOTAL: /c 4 gravies sauces, incl.hollandaise &beamaise raw shellfish _meat stews& soups ./sushi or raw/undercooked fihfish 3 , �_chili, including green chili •• raw meat,such as carpaccio or steak tartar , - beans, including refried _ ham(not precooked sandwich slices) cooked rice,pasta.tofu/sov products a"chicken or turkey, received whole and raw _cooked dressings&stuffings _fr.toast,omelettes, cook-to-order eggs.custard,quiche /Chicken or turkey,received cut-up vegetable stews&soups sicken or turkey,pre-cooked :^ _potatoes, served baked,boiled,as hashbrowns 3 ✓pork. such as roasts,chops, sausage 2 l deli and/or sandwich cheese,sliced or shredded /fresh shellfish,served cooked _ - cold salads, such as potato,macaroni, tuna fresh finfish,served cooked fresh green salads ,/ground beef,as patties.meatloaf or meatballs cream pies& pastries prime rib,beef roasts or steaks fresh pizza ice cream & frozen yogurt, soft serve ground beef, as taco meat or in a casserole - /cooked vegetables, deep fried potatoes& onion rings Iamb& gyros /'.- microwave sandwiches, or frozen burritos, dinners. pizza 2 _game meat; such as buffalo, elk.alligator cheese sauce, canned e _frozen or canned finfish, served cooked ` •_pre-cooked hotdogs • frozen shellfish,served cooked • .-t ice cream. hard-packed • deli and/or sandwich meats /non-dairy beverages FACTOR III: OPERATIONS TOTAL: r J . Have a presumptive or confirmed foodbome illness in the 2/ Contact food with their hands? past year?(See definitions) (-`' Use their hands to contact foods that do not require cooking? - . 4 . Use raw eggs in uncooked or lightly cooked items? 2. Have a salad bar or hot buffet? • -Vacuum package:foods,or smoke(not BBQ)or cure meats? - Do off-premise catering of dinners,parties,etc...? Serve in high volume during seasonal times? • 3 f. Cool hot foods which are prepared in advance or are leftovers? 2 Serve primarily to the young,elderly,or immune Serve leftovers or incorporate leftovers into other menu items? compromised? Prepare any food,listed above, 12 or more hours in advance? Reheat foods? . . • 2. Have recipes with multiple preparation steps/critical control -2 Have management with formal food safen/sanitation points? . training, with emphasis on factors that cause foodborne illness? Please specify. • • • - BASE RISK: Factors I + II + III = -_-:.--) • ,._., Person Ca pleung the s t ' {``:. " /`Assessment Title Date g8ano PART II: INSPECT:. .V HISTORY& RISK CATEGORY SSIGNMENT Table 1. Inspection History Factor (circle each violation) SUBFACTOR A SUBFACTOR B SUBFACTOR C SUBFACTOR D CRITICAL ITEM a h c d e f gab c' d' e f a b c dc f a b c d c f —0I Food Lc i a. b, d' 02 Personnel a; b; c e (% 03 Temperature a h c e d. e, 12 z _ 04 Sanitization i a b c 03 Plumbing a d, b c 06Handkxash ' a' b c• 07 Pests ! • b' c 08 To\ic i c a C Subfactor Number of Items Violated Under Each Subfactor Risk Index Subfactor 7 .1 • Results of Routine Inspection(s) Total First Secoildl. ' Third Fourth Average it, , A ` , r x �f B ii - 2 x3 C 11 1 (.7- x2 . D \ , '7) x ) 1 INSPECTION HISTORY FACTOR (TOTAL): i Table 2. Risk Category Assignment Matrix >rr INSPECTION HISTORY-FACTOR IV •_ 16 and over 12- 15 8- 11 0-7 .ate-« •Ca p 35-40 47.4. , is3:s 2 < 2S-34 +� #ter 3 ` r ., ..' • 2 2 f,• r I _ - 7-24 " . �M, '04,a �.`r3t�,8F'-4'?�T'$ 2 0-6 2 2ril .: Y; r` t1'' -, t{: , ,,'. to c Intervention Frequency and Contact Type RISK CATEGORY.ASSIGNMENT NEXT CONTACT TYPE • (Check one) (Check one) Contact required: ❑ Routine Inspection i ❑4 within 3 months ❑2 within 6 months O HACCP study within 4 months ❑l within one year `: E Documented Consultation & phone contact O Training within 6 months ❑ Announced Inspection t(J )4.e ...„,„„L.e.a,t-- /0 ._.et r...:LD COUNTY HEALTH DEPARTMENT ;�� ti 151 7 - 16TH AVENUE COURT v� Willie GREELEY,CO 30631 ` G r(970)353-0635 FAX(970) 356-4966 Page One of COLORADO I PASS CI FA1 . ESTABLISHMENT /0 n �ER NAME A169 v / i ADDRESS �� M PHONE ZIP CODE 2 9(6.3,3,- w/ G'�[hA,-- FREQUENCY TAB.NO. SANIT.CODE DATE TRAVEL TIME INSPECT TIME PURPOSE of INSP. L Re ular r/ �j • w `-f ✓ / n` �� /f� ' LIS� 3. omp maV[nvestigation / 6 3.Walk Itrough/Pre-Opening RETAIL FOOD ESTABLISHMENT INSPECTION REPORT Items circled below identify violations to be corrected as indicated by the regulatory authority. Failure to comply may result in further action by the regulatory authority. Red--Critical Items:These items related directly to foodborne illness Black--Other Items:Uncorrected,these an become serious problems. Food Source • . •-•- •09 :;::'.Foo•d•Labillii:hood Protection `:::.'.'.-:. a.Approved source c.Cross-Contamination a Original container,properly labeled •Wholesome.free of spoilage d.HACCP plan • t b.Food protected from contamination • Personnel " Employee Health Hygienic Practices Ia.Personnel w/infections restricted c.Hands washed as neesled od-contact surface Go r Z�Wounds properly covered )Hygiene practices t is c r�l b.Nonfood-contact surfaces I e.Smoking,eating.dunking c.Dishwashing facilities Demonstration of Knowledge I Training Needed -,. Devices• =; '.. —1 Fnod'Trtmprrattere Control ��. --- :... a.Refrigeration units provided with accurate,conspicuous thermometer I Temperature Control Procedures /2-3 3 /—� t ..• Gleaning.Of Equipment_and:Utensils a.Rapidly cool foods to 41°F or less ac,Ilot hold at I40°F or greater b.Rapidly reheat to 165°F or greater e.cold hold at 41"F or less 69Food•contact surfaces c.Dishwashing operations ' c.Required cooking temperature b Nonfood-contact surfaces d.Wiping cloths Temperature Control Equipment f.Food thermometer(probe-type,accurate to±3°F) 13 Utensils,SingienSetvice Articles : - g.Adequate equipment to maintain food temperatures I— _....___ a.Utensils provided,used,stored i 04 Sanidiration Este b.Single service articles stored,dispensed.used _•_ e.No re-use of single—service articles Temperature ConcentratioQ Exposure a Manual —— — ----- 114. r"J".w.l tIC1111S b.Mechanical —_— a.Plumbing:installed,maintained e.Ventilation c.In-Place _ -, b.Garbage and refuse f.Locker rooms c.Floors walls,ceilings g.Premises maintained Sanitizer: Chlorine Quaternary Ammonium Other d.Lighting h.Separation of living,laundry ^0S Water.Sewage. Plumbing Systems: jam!} .f�fher:Opefilkiae:'. .. . . . :i , ',_i.~.get a.Safe water source c.Backflow,back siphonage OPersonnel:clean clothes,hair restraints,authorized,le •I b.Hot&cold water under pressure d.Sewage disposal b.Linen properly stored #landwashiog Facilities t a.Adequate number,location c.Soap&drying devices • •a ccessible • ,r Pest Control i' Evidence of insects opens • c.Animals prohibited b.Pesticide application 38 ''Oiss nssus,ir Toxic items a.Properly stored c.Properly used b.Properly labeled ENVIRONMENTAL HEALTH SPECIALIST: RECErV El)BY -7 / �—, PAGE 2 OF DATE: '?-K - ft ESTABLISHMENT: A'O C• £ . trADDRESS: l/ 11.4O DEFICIE -CIES FOUND: �, v • l , • f ill: �Ct�1G1z7zLy�/ e � �L t ( Jnc71_, 3 - J. -6624_4>K 7A ._e !=.r .t-l.e s,r;r— (/).Lt--e-.;-$.-._ ?I:Ay/yr\ _Zzl-tip--1 • r.. - .h /Ike-7,0,67 /14 . e iL v / e�-Z L 'wGC S J,t *SX /S_.c .! - /-e-f • 10 C7-7/ THE UNDERSIGNED HEREBY ACKNOWLEDGES THE FOLLOWING: Based on an inspection this day,the items circled identify the violation in operation or facilities which must be corrected by the next routine inspection or such shorter period of time as may be specified in writing by the regulatory authority. Failure to comply with any time limits for corrections specified in the notice may result in cessation cif your food service operations. An opportunity for appeal of the inspection findings and time limitation will be provided if a written request for an administrative hearing is tiled with the department within 15)days following the date of inspection. r Enyironmpfital Healthot pecialist Received ny R_,L____ - ___-,-__„„ry,y77-- 0-- ..,e‘ee--( 4) PAGE 3 OF DATE: _ ?5? 2 al:' . ESTABLISHMENT: it/C2 • ( C'/ l ( -��/ DDRESS: .2 ((. (,i1/c f ik -/,r✓� DEFICI ENCIES FOUND: lit -- %C,�l-t.(.c. J.cs � �./Lj�-iZ/!L/1 Y '-'''(---/1"\_ L�Lz D�• /2.---E7.--,-8-,a7L-(,A,2-e-1%), ;:_f /3-, ,-(1 IL-cr? --2---)-\ c.-,._ ..---y\._ 6"-- -/-t,--4,,-.c-f.- 4.,"-'',e'---( ' -- ...4e),-41-' ' / S--47----- -t,4r-4,7)--- ---"j.---e-eflf;' j ---17-..._ --?ty /-- --c'' . :9__ __/2_,.1 ' p1'=•,--fgAe... .. '''_--1.r .,/ C , C2 71 X----. fel!'_fr 1,\._ fr-e_,,LIP ,,A.ge.e.„-'2_. Cc-44V • THE UNDERSIGNED HEREBY ACKNOWLEDGES THE FOLLOWING: . Based on an inspection this day,the items circled identify the violation in operation or facilities which must be corrected by the next routine inspection or such shorter period of time as may be specified in writing by the regulatory authority. Failure to comply with any time limits for corrections specified in the notice may result in cessation of your food service operations. An opportunity for appeal of the inspection findings and time limitation will be provided if a written request for an administrative hearing_is tiled with the department within(5)days following the date of inspection. Edvironm al HealthMpecialist .,..Received By - 9S' a 190 ` JOLORADO DEPARTMENT OF Page I of -� - -4'J / PudLIC HEALTH AND ENVIRONMENT /,• �,� 4300 CHERRY CREEK DRIVE SOUTH /e) .ij DENVER, COLORADO 80222.1630 LICENSE PHONE (303) 692-3620 ESTABLISHMENT OWNER mute/11/0 - 62.-k-12. • -(ill: iLele7e?----ADDRFA5 �/ � /_ s t O /_ t `- ,1 /� / - DP COOS il'/l`i 1/ �faJ' 1 (-a - COUNTY EaT.MO. MITT. COOS OATS TRAVEL CT. ` TYPE YR IIO DAY TIME TIME El' Retail Food l 2 `f 3 V.. f'o / Y 4Pefr a Investigadon Food Service Food Ratabllshmant Inspection Report Based on an inspection this day,the items coded below identify the vloleeona h operation or fealties which must be oonsctad by the nerd routine inspection or such shorter period d time as may be epscif'ed in writing by the regulatory authority. Failure to comply with any time Ilrnite for oorre bons specified in this notice may result in oessedon d your Food Establishment operations. An opportunity for appeal of the inspection findings and time limitation'MM be provided N■written request for so administrate heerwig is filed with the deportment within five(5)days following the dW d the Inspection. ICRITICAL ITEMS: these items relate dnectly to factors winch lead in loodbome Mine's OTHER ITEMS: N left uruoorrected,thew Marne can beeory a serious problem. THESE II'.ESE ITEMS MUST RECEIVE IMviEDIATE ACTION. l'EAMS SHALL BE CORRECTED BY THE NEXT INSPECTION OR AS OTHERWISE SPECIFIED, FOOD PROTECTION 01 FOOD 02 Original Container, Property IabeNd a. Approved Source. c. Wholesome b Dented,Swollen,Damaged Container, d Other 06 Thermometers Provided and Conspicuous; Accurate; Probe-type FOOD TEMPERATURE REQUIREMENTS DURING SERVING, OS Potently Hazardous Food Properly Thawed ,• e,•- ;1_ STORAGE,TRANSPORTATION,DISPLAY.AND PREPARATION(, I,L. --'r` Food Protection During Serving,Storage,Tranaporuton,Display,and Preparation t Cooling Procedures --4) liar Holding Temp(140•9 Oti Handling of Food Minimized,Proper Utensils Provided end Used b. Potentially Hazardous Foods Required Cooking Temp Rapidly Reheated r4 155'F RehgerationjP 4 'f) 10 Food Dispensing Utensils Properly Stored When In Use -,._ PERSONNEL 04 ADEQUATE EQUIPMENT TO MAINTAIN FOOD TEMPERATURE 13 Clean Clothes,Hun Raetrokb L. 07 PREVENTION 0f CROSS-CONTAMINATION a Unwrapped ... _ . app ed s Potentially Hazardous Froths Not Re-served .:.;..•;...,;..; . . L. No Contamination d Cooked with Raw 1 Food Qw)Ceded SJdsce. c. Damaged I Detained Foods Separated •Maintained.elatWd.Located PERSONNEL, W 1 I Non Food Contact Surlsooa Designed,; Constructed,Maintained,Installed,Crossed 1$ Dishwashing Facilities; Designed,Constructed,Maintained,Installed,Operated 11 PERSONNEL WITH INFECTIONS RESTRICTED 17 Accurate Th.,n..,..,etars,Chemical Tad Kits Provided,Gauge Cock(1/4-PS Vane) !TACTIC a /yrrF,asehea err Noeoed c Smoking,Gating,Drinking Restricted 18 Motile,Equipment Pre-Flushed,Scraped,and Basked u 1r,.ne Properly Dried,No Common Towel d Good Hygienic Practice, 10 Wash,Rinse Water; Clean.Proper Temperature FOOD EQUIPMENT AND UTENSILS 21 Wiping Cloths; Clean,Slotsd,Proper the , 20 SAKI CC'ATION temperature concentration exposure Food Contact Surfaces.or Equipment and Utensils Clean,Free of Abrasives,Detergents retar,ir.l - 23 Nan-Food Contact Suraae,d Eq uipment E ipment and Utensils Goan b. b+r•.J,aifecal —„,.•," ,•� �f')t iu 1,44.„,,1,44.„,, .w .-�'�_ s Storage and Handling d Clean Equipment and Utensils rit ii0-200 a Skgie Service Articles,Storage,Dispensing.Lied Chlunl ppm Quaternary Ammonia 100-200 ppm 0lhb Approved sanmtzera 21 No Re-Use d Singe Service Arbclee•WATER : ..: 2S Properly entailed,Maintained 17 Water Source,Salo;Hot and Cold Under Pressure ' HANDwAtio is t _ SEWAGE' Toilet Room I Peewee/Flrtduseh Sink 28 Approved Sewage and Waste Water Nepal* t Clean c. Proper Waste Receptacles v�_— - - 7'1 /Drety Dodoes d. Toilet Room Enclosed,Doors Closed PLJMBUgG . ': OVOIAOE.:040 fly: • 30 No Crory-Gennsction Between gratis A Waste Water .....:. eackfiow Devices Instilled 33 Containers or Rsceplacloa, Clean,Adequate Number, . - Insect/Rodent Prod,Frequency,Covered TOILET AND HAMGWASHINO..FACIt ES . .... _..:ti 34 Outside Garbage Areas Clean,Enclosures Properly Constructed FACILITIES COMPLY YVITH CODE /+ } FLOORS,WALLS A110 CEILINGS. • a. Hsndwa th slink -number/location �/ Handwash ens •accessible .. . b. Handwash oink - designed/installed `cif. Toilet room and fixture 30 Floes; Constructed,Drained,Clean,Good Repair,Cowering,Instillation.Cored )NSECT AND RODENT CONTROL 37 Walla,Ceiling,Attached Equipment.Constructad,Good Repair,Clean Surfaces .'3E i. Evidmca d Rodents —. . w000tCP AT10Ns. t✓ b. Evidence of Insects 3S Lighting Provided so Required; Fixtures Shielded.Endcaps 2a :Suuur Openings Protected / Other 31I Rooms and Equipment; Vented to Required .. Rooms,Lockers; Provided,Located,Used TITER OPERATION;:: 42 Premises Maintained; Free d Litter,Unnecessary Articles,Cleaning/Maintenance, ) DTOXIC ITEMS 4 Equipment Property Stored,Authorized Personnel h •dueny:Amato 43 Complete Separation From Living/Sleeping Quarters,Laundry . Properly Labeled :7rcperl Used 44 Clean and/or Saved Linen Properly Stored INSPECTED • s •• •• •• RECEIVED BY: l . C. 7 CDH(Rev.12-so) / 1 FOLLOW 41P: YES....1 N0.1„2 190 C...? - _,-.7)4,,-.., 14,,a,,,,,,,/, ---f-T.L.---,,,,,,, _.-c„..,..€ , .. 4 DESCRIPTION item Wt `7+-c)-6 - A CG)i .n.lv Source 1 5 , , C� / .� Container 2 1 �, r'y'e --C-v"e1" (;:-.-.),...,,,,,k .-�-c; Product temp. 3 5 Temp. facilities 4 4 -6-. e'' if �' r, dot-,-- --7 z cr�'Y►t_ Thermometers 5 1 �� ,,- tt ,c - Thawing 6 2 - Cross- contamination 7 4 >ta- �� ,-��) ` ` r'`" Food protect 8 2 /2„,6,e/c.,,e ...-r--v✓z--c..e. Unnec. handling 9 2 '�e� �`�'"�'`�/ Dispen. utensils 10 1 --c-crc -cam Syr...,,, -cz"4' :: ractices nnel 11 5 12 5 , J C ci-l� --,�rr,� - ;4 0 ai,' Clothes, hair 13 1 r e D / 4A .,�v �1 � c�-` F' FCS- construction 15 1 . v l•�i+le-60 n/- 0 c / Y� c�,'o'�✓ NFCS- construction 15 1 �eP Dishwashing 16 2 Therrno., kits 17. 1 � !� p Pre - flushed 18 1e /tire Dishwater 19 2 i �--c,,e, c'�- Sanitization 20 4 -e`' JJ -i--e uci- (Kr c%- Wiping cloth 21 1 j� / /1 FCS - clean -22 2 3/, , .�2c 4., -urciig E J�,e�-' --t,c f- NFCS - clean 23 1 /) /1_,.(.-1,- � A- Storage 24 1 - Ir- t.-t•''c4'/.L -r"-`,v ue�s-•, 4 '`ct Single - service 25 1 -6-e_ Gael: (_.1-- cc,C-7-T-1,-..-e.,, Re - use ofs- serv. 26 2 Water source 27 5 , 3S 4a1.7 474 /J f,✓ 14 Sewage 28 4 -�Crc / , ; // Installed, maint. 29 1 ✓c /lr '�` /y Cross- connect 30 5 - - " _Installed , 31 4 �`"�'�i'`�� - Maintained 32 2 f// .gia.4 <.- _ —� Covered, clean 33 2 7 1. /c'r _�.c,,--C(t Properly constr. 34 1 Pets, pests, screens 35 4 _.(..,.v\ ,.e_./ ��01 aG Construction 36 1 r.2. �_ Clean, repair 37 1 ' " t eel -e7 ._::-to-e-6›_ -'cc)4^-e Lighting, shielded 38 1 v2 -c -, p —.(--y-‘. jt„p�, ce Ventilation 39 1 Xe. ` _ Dressing rooms 40 1 . ' f`� 746c7 �� &_ � “ Toxic items 41 5 `� -4-"4- - Premises 42 1 ,/y,v2e/) Living /slpg. quarters 43 1 _ Laundry 44 1 0g• A1/477csr�,-'1 --c.4..,4 ./.-.%.._ iLe.e ..e -cam:-._ c c„--a.4„.,), i--- ---A.e. ,...stP (7-drr-r C/n'(/ /241,t&e,c4..-e' 2 1"c-O Re' IOLORADO DEPARTMENT OF Page 62, Of 2 PLaLIC HEALTH AND ENVIRONMENT 4300 CHERRY CREEK DRIVE SOUTH .--e DENVERR, 3 CO R O 8020 1530 LICENSE* PHONEESTAIUJSHMENT OWNER NAME ADDRESS ZW CODE COUNTY IpT.Na Eno. cope r DATE TRAUMA/ INSPECT. PURPOSE TYPE (, jYR p MO DAY / TIME TIMERetail Peed Ej �7 L1Q r l/ : Crompletnt Feed Service E. Foos EMaOR Inspection Report Based on an Inspection this day,the Mina circled taloa Natty the k4abo a In operation ex fae1MIes which must Seconded by 5..next roues*Stapesah er such shorter prod ce time-may be twined in editing by the regulatory authority. Failure to obmply with any ohm lads for arsolible specified In this rake may rears n conaton of your Food E bliehment epwtlbna. M opportunity for appal et the osp.c on findings sod Ent.Wnellen will be provided lie written r.quat far an adminiotlM horde Is Mad with the daparbmrd wMW,fie(5)days following the date of Ito hmptlbn. CRITICAL ITEMS: neee items relate dinaty to factors which lead to bdbome illness. OTHER ITEMS: If NR uncorrected,Mee*lame an berate a serious problem. THESE THESE ITEMS MUST RECEIVE IMMEDIATE ACTION. ITEMS SHALL BE CORRECTED BY T11E NEXT INSPECTION OR AS OTHERWISE SPECIFIED. FOOD PROTECTION _ FOODPROTECT1tN1 .. .. ... 01 FOOD 02 Origim6Consiner, Properly labeled a Approved Source. a. Whdeaane 06 Twmarewa Morbid and Conspicuous Accurate; Probe-hype b. Dented,Swollen,Damaged Coauthors d. Other ® FOOD TEMPERATURE REQUIREMENTS DURING SERVING, 06 Potentially tealare Food Properly Timed STORAGE,TRANSPORTATION,DISPLAY,AND PREPARATION (RI) Food Protection During Sewing,Storage.Transportation,Display,and Prepeaton ,C Cooing Procedures. a Hot Holding Temp.(140°F) 00 Handling d Fod Minimized, b. Potentially Hazardous Foods d. R Proper Utensils Provided end lied Required Cooking Temp Rapidly Reheated to lt5°F Refrigeration Temp.(45°F) 70 Feed DeperWng llOsrWe Reath'SkeadWhen MlM 04 ADEQUATE EQUIPMENT TO MAINTAIN FOOD TEMPERATURE V�EUIY16 ' 13 Con Gotha Her Reahekds 07 PREVENTION OF CROSS-CONTAMINATION a Unwrapped&Potentially Hazardous Foods Not Re-served toortmonAN0 'S • '" • b No Contamination of Cooked with Rae Food lice)Conted Surfaces; Designed,Constructed.klekhWned,In.telld,Located c Damaged/Detained Foods Separated NcesEcod Cadet Surface; Designed,Constructed,MWhteihwd,Installed,Lgeaed PERSONNEL • 10 DWnwsehkg Facilities; Deigned,Constructed,Meintelned ImWled,Opneted 11 PERSONNEL WITH INFECTIONS RESTRICTED 17 Accurate Thermometers,Chemical Toot Kite Provided,Gauge Cock(1/4•PS Val.) "(!� kiYGIENIC PRACTICES 10 Utensils.Equipment H Soaked .-Flushed,Scraped,e Soaked-� a Kends W ached as Needed C. Smoking,Eating,Drinking Restricted b. Hands Properly Dried,No Common Towel d. Good Hygienic Practices 10 Wart,Rinse Water, Cl.....Proper Temperature FOOD EQUIPMENT AND<UTENSIt°S 21� Wiping Cloths Clean,Stored,Proper Us. IZ 20 SANITATION temperature concentration exposure c--22„)) Food Contact Surfaces of Equipment and Utensils Oman,Free of Abrasives,Detergents a. Manual 23 Non-Food Contact Surfaces of Equipment and Utensils Chan b Mechanical �—� ` v i..✓'a,;r �. gymap.and Handling of Clean Equipment and Utensils 26 Single Salo Articles,Storage,Dispensing.Used Chlorine 50-200 ppm Quaternary Ammonia. 100-200 ppm Other Approved Sanitizes alNo Re•Use d Single Snwce Articles HATER PLQMeNVG _ • presses •mesons.27 Water Source.Sale;Hot and Cold Under Pressure SEWAGE.. TOR-F.TAlia,K NDWA3kpHO FAralitiO 28 roved Toilet Room I Fbdure./NandwaN Sink App Sewage and Waste Water Disposal Clan a. Parer Waste Receptacle rLUMBING. .., b. Sep/Drying Denbo. d Toil Doors Room Enclosed.D Closed GARBAGEAND REUSE 30 No Cross-Conneceon Bsbesen Potable&Waste Water. Sedition Devices Instilled 33 Carbine.,or Receptacles Clean,Adequate Number, Insect/Rodent Roof,Frequency,Covered TOILET AND HANDWASHING FACILme4 34 t7Wtoe serene Area: aeon.Enclosure.Popeey Caiabuaed '1i FACILITIES COMPLY WITH CODE FLOORS,WALLS AN CEILINGS a. Handymen ink -number I location HendW.ab sink .accessible +; <'. a. Handwseh Sink - designed I Installed d. Toilet roan ad flutes 3$ Fl on; Cahebuced,Deed,Clan God Repro Curerkq,Inabdbbn,coos NSECT AND RODENT CONTROL 37 wens,Citing.Attached Equipment Cameras,Good Repro,Olsen Sudans gJB a. Evidence of Rodents OTHER OPF,RATICNI A Evidence of Insects 30 Lighting Prded.d a Required; Fbdures Shielded,Endeps C Outer Openings Protected d. aNhar 30 Rooms and Equipment Vented a Required 40 Room.,Lockers; Provided,Lined,Used )THER OPERATIONS 42 Premise Maintained; Fred Litter,Unneceeery Articles,Cleaning/Maintenance, .OXIC ITEMS Equipment Propely Stored,Authonleed Personnel Pmfwdy Stored arooadv Labeled 43 Complete Separation From LMng/Sleeping Climbers,Laundry �oPedY Ueeq 44 Ce.n end Soiled Linen Properly Shred NSPECTED BY:�. �� RECEIVED BY: f-' �l 2 /94)C1R // y CDH(Rev.12-94)CRp/ FOLLOW air YES....I ra....x gsa►9D l'/ F DESCRIPTION Item Wt PLeiter p j:47T-t-e � Source 1 5 K�v. o% " am e"..) . 0 �� Product temp. 3 1 ` ' ✓y� ---C/-- --err- Product 3 5 Temp. facilities 4 4 Thermometers 5 1 ®utif-Ct-tt Thawing 6 2 /S` C I Ze-c-ac-2, c3$ -e-CA-c7 Cross- contamination 7 4 Food protect 8 2 € e // � _j _ �✓ai-L, Unnec.Dispen handling 9 2 �� -��`"h`-vjC-^ti''l" Q ' .th .J Dispen. utensils 10 1 /Len/ Personnel 11 5 R e, Hygienic practices 12 5 �' vrv(./y Clothes, hair 13 1 A---77;01 /2-e---O-ell"'t FCS- construction 14 2 NFCS-construction 15 1 .7) ` , _4 �j Dishwashing 16 2 F � i .-�� `� Thermo., kits 17 . 1 %2-�y-eA,ed ,g C-te, v& �-- Pre- flushed 18 1 --[U QAp.. .4-4712212 �X[ ,/*2trC„/C,Q�,. i2 Dishwater 19 2 � Sanitization 20 4 � _ ^ -C.c-p .01-Cm� Wiping cloth 21 1 �� -�h, c. .-- -u lLu c c4 roe, Gt ez� FCS - clean 22 2 1 c t' eon .�C .t-2.. a. O NFCS- clean 23 1 Storage 24 1 ;j [ Fr � - Single-service 25 1 7 v er Re - use of s-sent26 2 -4---e.eAS (—Gracie. - Go—e-C Water source 27 5 ° ec'ea c.2 � �.c-r Sewage 28 4 Installed, maint. 29 1 a P-ce. .V. .� -�9�C�t? v � Cross- connect 30 5 �_ _�i3/ ( y-kcc,,,cJ ,� Installed 31 4 � 71,0--(5,-L-14, Maintained 32 2 ' "eo ? �" CCrT Ju it r Covered, clean 33 2 Properly constr. 34 1 3?4 Q /> plug Jai �� Pets, pests,o screens 35 4 y �/art �_ Construction 36 1 CPn `�—O Clean, repair 37 1 Lighting, shielded 38 1 Ventilation 39 1 Dressing rooms 40 1 Toxic items 41 5 Premises 42 1 Living /sipg. quarters 43 1 Laundry 44 1 STATE OF COLORADO DR 0010(10/94) DEPARTMENT OF HEAL rH LICENSE TO OPERATE A FOOD SERVICE ESTABLISHMENT USE ACCOUNT NUMBER LIABILITY INFORMATION ISSUE DATE LICENSE VALID for all references TO COUNTY CITY INDUST TYPE LIABILITY DATE mo day year DECEMBER 31 03723840000 62 3 031296 01 01 98 1998 THIS LICENSE MUST BE POSTED AT THE FOLLOWING LOCATION: NO 1 CHINA BUFFET This certifies that licenses shown he, 2435 W 10TH ST is authorized and licensed to engage. " GREELEY CO 80631 business in accordance with the provisions of the law and regulations OWNER: K. W.LIN,INC. the Colorado Department of Health. LICENSING AGENCY: Any alterations made on this license w automatically make it null and void WE CO TY HEALTH DEPARTMENT � POST IN A JE . ST L, .P.H b ;ECTOR CONSPICUOUS ENVIRONMENTAL PROTECTION SERVICES PLACE ♦ DETACH HERE CO 1465(07/90) COLORADO Computation Worksheet for Sales Tax Deduction for Gas DEPARTMENT OF REVENUE P DEPARTMENT BUSINESS TAX SECTION -SALES and/or Electricity Use in Food Service Establishments 1375 SHERMAN ST DENVER,CO 80261 Either method I or 2 may be used if sales of processed food exceed 25%of your total business sales. Sales Tax Account No. Method 2 must be used if sales of processed food does not exceed 25%of your total business sales. Year 19! METHOD 1 METHOD 2 I.Monthly cost of gas and electricity used for restaurant operation minus sales tax: I.Total sales for year(do not include room sales for January May September hotels,motels,etc.) February June October 2.Processed food sales for immediate consumption March _ July November made during the calendar year minus liquor sales: April August December 3.Amount on line 2 x.005= Deduction from taxable sales to be entered on reverse side of Sales Tax 2 Total cost of gas&electricity used for year: Retum(DR. 100),line7. 3.Amount on line 2 x.55= TYPE OF RETURN DUE ATTACH THIS COPY TO Monthly February SALES TAX RETURN Deduction from taxable sales to be entered on reverse side of Sales Tax Return Quanerly April (DR 100) (DR 100),line7. Seasonal Submit with season's last return 9g Dicta Hello