Ii Ii: Food Safety Inspection Report

Florida Department of Agriculture and Consumer Services
Division of Food Safety

IIII
Visit # 3908-0000-20
FOOD SAFETY INSPECTION REPORT Bureau of Food Inspection
Attention: Business Center
NICOLE "NIKKI" FRIED
Chapter 500, Florida Statutes 3125 Conner Boulevard, C-26
COMMISSIONER
(850) 245-5520 Tallahassee, FL 32399-1650
Print Date: May 18, 2020
Food Entity Number: 299248

Food Entity Name: ADOLPHE TAKE OUT MARKET
Date of Visit: May 18, 2020
Food Entity Address: 64 NE 73rd ST Miami, FL33138-5350
Food Entity Mailing Address: 64 NE 73rd ST Miami, FL 33138-5350
Food Entity Type/Description: 111/ Supermarket

Food Entity Owner: ADOLPHE TAKE OUT RESTAURANT INC Owner Code:
INSPECTION SUMMARY - Re-Inspection Required

On May 18, 2020, ADOLPHE TAKE OUT MARKET was inspected by SEAN CULVER, a representative of the Florida Department
of Agriculture and Consumer Services. The following violations observed during the inspection must be corrected to be in
compliance with Chapter 500, Florida Statutes, and Rule 5K-4, Florida Administrative Code. A Department inspector will return for
a reinspection on or about June 01, 2020. The failure to correct the violations by this date may result in the imposition of the
maximum penalties provide in Chapter 500 Florida Statutes, including an administrative fine and the suspension or revocation of
your food permit. The reinspection visit is due to documented citations that pose a risk of foodborne illness.
PERMIT APPLICATION INFORMATION

The permit application information was verified with management or a qualified representative.
COMPLIANCE KEY
IN = In Compliance OUT = Not In Compliance N/O = Not Observed N/A = Not Applicable
FOODBORNE ILLNESS RISK FACTORS AND PUBLIC HEALTH INTERVENTIONS
Violation Compliance
Number Status Violation Description
1 IN SUPERVISION: Person in charge present, demonstrates knowledge, and performs duties
2 OUT EMPLOYEE HEALTH: Management, food employee and conditional employee; knowledge,
responsibilities and reporting
3 IN EMPLOYEE HEALTH: Proper use of restriction and exclusion
4 IN GOOD HYGIENIC PRACTICES: Proper eating, tasting, drinking, or tobacco use
5 IN GOOD HYGIENIC PRACTICES: No discharge from eyes, nose, and mouth
6 N/O PREVENTING CONTAMINATION BY HANDS: Hands clean and properly washed
7 N/A PREVENTING CONTAMINATION BY HANDS: No bare hand contact with ready-to-eat foods or
approved alternative method properly followed
8 OUT PREVENTING CONTAMINATION BY HANDS: Handwashing sinks properly supplied and
accessible
9 IN APPROVED SOURCE: Food obtained from approved source
10 N/O APPROVED SOURCE: Food received at proper temperature
11 OUT APPROVED SOURCE: Food in good condition, safe and unadulterated
12 N/A APPROVED SOURCE: Required records available: shellstock tags, parasite destruction
13 IN PROTECTION FROM CONTAMINATION: Food separated and protected
FDACS 14205 Rev. 07/13
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111111'11', 11 1111
Visit # 3908-0000 20
COMMISSIONER
(850) 245-5520 Tallahassee, FL 32399-1650

FOODBORNE ILLNESS RISK FACTORS AND PUBLIC HEALTH INTERVENTIONS
14 OUT PROTECTION FROM CONTAMINATION: Food-contact surfaces: cleaned and sanitized
15 OUT PROTECTION FROM CONTAMINATION: Proper disposition of returned, previously served,
reconditioned, and unsafe food
16 N/A TIME/TEMPERATURE CONTROL FOR SAFETY FOOD: Proper cooking time and temperatures
17 N/A TIME/TEMPERATURE CONTROL FOR SAFETY FOOD: Proper reheating procedures for hot
holding
18 N/O TIME/TEMPERATURE CONTROL FOR SAFETY FOOD: Proper cooling time and temperatures
19 N/A TIME/TEMPERATURE CONTROL FOR SAFETY FOOD: Proper hot holding temperatures
20 IN TIME/TEMPERATURE CONTROL FOR SAFETY FOOD: Proper cold holding temperatures
21 N/O TIME/TEMPERATURE CONTROL FOR SAFETY FOOD: Proper date marking and disposition
22 N/A TIME/TEMPERATURE CONTROL FOR SAFETY FOOD: Time as a public health control:
procedures and records
23 N/A CONSUMER ADVISORY: Consumer advisory provided for raw or undercooked foods
24 OUT EMPLOYEE HEALTH: Procedures for responding to vomiting and diarrheal events
25 N/A CHEMICAL: Food additives: approved and properly used
26 OUT CHEMICAL: Toxic substances properly identified, stored, and used
27 N/A CONFORMANCE WITH APPROVED PROCEDURES: Conformance with approved procedures
95 OUT SUPERVISION: Certified food protection manager
GOOD RETAIL PRACTICES
34 OUT FOOD TEMPERATURE CONTROL: Thermometers provided and accurate
36 OUT PREVENTION OF FOOD CONTAMINATION: Insects, rodents, and animals not present
37 OUT PREVENTION OF FOOD CONTAMINATION: Contamination prevented during food preparation,
storage and display
46 OUT UTENSILS, EQUIPMENT AND VENDING: Warewashing facilities: installed, maintained, and used;
test strips
49 OUT PHYSICAL FACILITIES: Plumbing installed; proper backflow devices
53 OUT PHYSICAL FACILITIES: Physical facilities installed, maintained, and clean
FDACS 14205 Rev. 07/13
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II II II
Visit # 3908-0000 20
(850) 245-5520 Tallahassee, FL 32399-1650
COMMISSIONER

OBSERVATIONS AND CORRECTIVE ACTIONS
COS = Corrected on Site P = Priority Citation Pf = Priority Foundation Citation
(Directly Associated with Foodborne Illnesses) (Supports or Leads to a Priority Citation)
INSPECTION: RISK BASED
Violation
Number Citation Description COS Observation
2 Person in charge does not ensure food employees o FOOD ESTABLISHMENT DOES
and conditional employees are informed in a verifiable NOT HAVE AN EMPLOYEE
manner of their responsibility to report to the person in HEALTH POLICY.
charge information about their health and activities as
they relate to diseases that are transmissible through
food. 2-103.11(0)
8 Handwashing sink or group of 2 adjacent O MEAT PROCESSING AREA:
handwashing sinks not provided with hand cleaning PAPER TOWELS AND SOAP NOT
liquid, powder, or bar soap. Handwashing sink or PROVIDED AT HAND WASHING
group of adjacent handwashing sinks not provided SINK ADJACENT 3-BAY SINK.
with: individual, disposable towels; continuous towel
system that supplies the user with a clean towel; a
heated-air hand drying device; or a device that
employs an air-knife system that delivers high
velocity, pressurized air at ambient temperatures.
6-301.11 and 6-301.12 Pf
11 Food not safe, or is adulterated. 3-101.11 P RETAIL AREA: OBSERVED
DENTED AND BULGED AT THE
RIM CANNED TUNA FISH. COS-
VOLUNTARILY DISCARDED AND
WITNESSED BY INSPECTOR
DURING VISIT.RETAIL AREA:
OBSERVED GRAIN INSECTS
INSIDE BAGS OF ON-SITE
PACKAGED CORN MEAL AND
FLOUR. COS- VOLUNTARILY
DISCARDED AND WITNESSED BY
INSPECTOR DURING VISIT.
14 Equipment food-contact surface or utensil used with O MEAT PROCESSING AREA:
time/temperature control for safety food not cleaned OBSERVED SOIL BUILD-UP ON
throughout the day at least every 4 hours. Exception BOTH MEAT BAND SAWS.
criteria for an alternative cleaning frequency not met.
4-602.11(C) P
FDACS 14205 Rev. 07/13
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Visit # 3908-0000-20
(850) 245-5520 Tallahassee, FL 32399-1650
COMMISSIONER


Violation
15 Food that is unsafe, adulterated, or not honestly O RETAIL AREA: OBSERVED
presented not discarded or reconditioned according to MULTIPLE ADULTERATED FOOD
an approved procedure. 3-701.11(A) P PRODUCTS, SPECIFICALLY BAGS
OF RICE AND FLOUR WITH
RODENT EXCRETA INSIDE AND
ON PACKAGING STORED ON
PALLET ADJACENT STORE
ENTRANCE IDENTIFIED AND
OBSERVED AT PREVIOUS RATED
INSPECTION ON 05/04/2020 NOT
DISCARDED.
24 Establishment does not have written procedures for O FOOD ESTABLISHMENT DOES
employees to follow when responding to an event that NOT HAVE WRITTEN
involves the discharge of vomitus or diarrhea onto PROCEDURES FOR EMPLOYEES
surfaces at the food establishment, or procedures do TO FOLLOW WHEN RESPONDING
not address specific actions employees must take to TO A VOMIT AND/OR DIARRHEAL
minimize the spread of contamination and the EVENT.
exposure of employees, consumers, food, and
surfaces to vomitus or fecal matter. 2-501.11 Pf
26 Poisonous or toxic materials not stored to prevent O OUTSIDE RECEIVING AREA:
contamination of food, equipment, utensils, linens, OBSERVED AUTOMOBILE
and single-service and single-use articles by MOTOR OIL STORED DIRECTLY
separating the poisonous or toxic material by spacing ABOVE SINGLE-USE ITEMS,
or partitioning, or locating the poisonous or toxic STYROFOAM CUPS, ON PALLET
material in an area that is not above food, equipment, ADJACENT NEIGHBORING
utensils, linens, and single-service and single-use RESTAURANT ENTRANCE.
articles. 7-201.11 P
FDACS 14205 Rev. 07/13
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IIII II
Visit # 3908-0000 20
COMMISSIONER
(850) 245-5520 Tallahassee, FL 32399-1650

Violation
95 Establishment does not have a certified food O FOOD ESTABLISHMENT DOES
protection manager who has passed a test through a NOT HAVE A CERTIFIED FOOD
recognized accredited program. Recognized PROTECTION MANAGER.
accredited certification programs include: National
Registry of Food Safety Professionals (Food Safety
Manager Certification Program) (800) 446-0257,
Website: www.nrfsp.com; Prometric, Inc. (Food
Safety - Certified Professional Food Manager) (800)
624-2736 Website: www.prometric.com; National
Restaurant Association (SERVESAFE Manager)
(800) 765-2122, Website: www.servesafe.com;
360Training (Food Protection Manager Certification)
(877) 881-2235, Website: www.learn2serve.com, and
AboveTraining/StateFoodSafety.com (Food Manager
Certification) (801) 494-1416 Website:
www.statefoodsafety.com. 5K-4.021(1), F.A.C.
INSPECTION: GRP
Violation
34 Temperature measuring device sensor not located to O MEAT PROCESSING AREA: MEAT
measure the air temperature or a simulated product AND PRODUCE COOLER NOT
temperature in the warmest part of a mechanically EQUIPPED WITH
refrigerated unit or in the coolest part of a hot food THERMOMETER. MEAT DISPLAY
storage unit; cold or hot holding equipment used for CASE NOT EQUIPPED WITH
time/temperature control for safety food not equipped THERMOMETER.PRODUCE
with at least one integral or permanently affixed AREA: 2 COOLERS CONTAINING
temperature measuring device that is located to allow TCS-FOODS NOT EQUIPPED
easy viewing of the temperature display; or WITH THERMOMETER.
temperature measuring device not designed to be
easily readable. 4-204.112(A), (B) and (D)
36 Dead or trapped birds, insects, rodents, or other pests O MEAT BACKROOM AREA:
not removed from control devices and the premises at OBSERVED TRAPPED LIVE
a frequency that prevents their accumulation, NUISANCE KITTEN INSIDE
decomposition, or the attraction of pests. 6-501.112 TRAPPING CONTROL DEVICE.
FDACS 14205 Rev. 07/13
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II
Visit # 3908-0000 20
COMMISSIONER
(850) 245-5520 Tallahassee, FL 32399-1650


INSPECTION: GRP
Violation
36 The presence of insects, rodents, and other pests not o OBSERVED ALL AREAS AND
controlled to eliminate their presence on the premises DEPARTMENTS OF FOOD
by eliminating harborage conditions. 6-501.111(D) ESTABLISHMENT CONTAINING
SOILED BOXES, DEBRIS, AND
LITTER PROVIDING AND
CREATING HARBORAGE
CONDITIONS FOR INSECTS,
RODENTS, AND OTHER PESTS.
36 Premises not maintained free of insects and other 0 OBSERVED CAT EXCRETA IN
pests; or not controlled to eliminate their presence on THE FOLLOWING DEPARTMENTS
the premise by routinely inspecting incoming AND/OR AREA'S: RECEIVING
shipments of food and supplies; routinely inspecting AREA, RETAIL AISLE AND
the premises for evidence of pests; and using SHELVING, DRY STORAGE AREA,
methods, if pests are found, such as trapping devices MEAT AND PRODUCE COOLER,
or other means of pest control. 6-501.111 (A)-(C) Pf MEAT BACKROOM AREA, MEAT
PROCESSING AREA, PRODUCE
AREA, PRODUCT REPACKAGING
AREA, BACKROOM AREA, AND
OUTSIDE RECEIVING AND
DISTRIBUTION AREA.OBSERVED
EXCESSIVE NUMBER OF FLIES,
FRUIT FLIES AND HOUSE FLIES,
IN ALL DEPARTMENTS/AREAS OF
THE FOOD ESTABLISHMENT;
INCLUDING THE FOLLOWING:
RETAIL AREA, RECEIVING AREA,
RETAIL AISLES AND SHELVING,
DRY STORAGE AREA, MEAT AND
PRODUCE COOLER, MEAT
AREA, BACKROOM AREA, AND
OUTSIDE GROUNDS.
FDACS 14205 Rev. 07/13
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II ii
Visit # 3908-0000 20
COMMISSIONER
(850) 245-5520 Tallahassee, FL 32399-1650

INSPECTION: GRP
Violation
36 Premises not maintained free of roaches and rodents; 0 OBSERVED RODENT EXCRETA
or not controlled to eliminate their presence on the AND LIVE ROACHES IN THE
premise by routinely inspecting incoming shipments of FOLLOWING DEPARTMENTS
food and supplies; routinely inspecting the premises AND/OR AREA'S: RECEIVING
for evidence of pests; and using methods, if pests are AREA, FRONT RECEIVING AND
found, such as trapping devices or other means of DISTRIBUTION AREA, ALL
pest control. 6-501.111 (A)-(C) P RETAIL AISLE AND SHELVING,
DRY STORAGE AREA, MEAT AND
PRODUCE COOLER, MEAT
AREA, BEVERAGE STORAGE
AREA, AND BACKROOM AREA.
36 Outer opening not protected against the entry of 0 RETAIL AREA: ENTRY ROLL-UP
insects and rodents by filling or closing holes and DOOR OPEN DURING ALL TIMES
other gaps along floors, walls, and ceilings; closed, OF OPERATION.RECEIVING
tight-fitting windows; and solid, self-closing, tight-fitting AREA: ENTRY ROLL-UP DOOR
doors. Windows or doors kept open for ventilation or OPEN DURING ALL TIMES OF
other purposes not protected against the entry of OPERATION.PRODUCE AREA:
insects and rodents by 16 mesh to 1 inch screens; OBSERVED GAP ALONG BOTTOM
properly designed and installed air curtains to control OF ROLL-UP DOOR.PRODUCT
flying insects; or other effective means. 6-202.15 REPACKAGING AREA:
OBSERVED GAP ALONG BOTTOM
OF ROLL-UP DOOR.RECEIVING
AREA: OBSERVED GAP ALONG
BOTTOM OF ROLL-UP DOOR.
FDACS 14205 Rev. 07/13
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IIII II
Visit # 3908-0000-20
NICOLE "NIKKI" FRIED Chapter 500, Florida Statutes 3125 Conner Boulevard, C-26
(850) 245-5520 Tallahassee, FL 32399-1650
COMMISSIONER

INSPECTION: GRP
Violation
37 Product held for credit, redemption, or return to the O MEAT PROCESSING AREA:
distributor not segregated and held in designated area OBSERVED FOOD PRODUCTS
that is separated from food, equipment, utensils, HELD FOR CREDIT NOT
linens, and single-service and single-use articles. SEGREGATED FROM
6-404.11 Pf WHOLESOME FOOD.DRY
STORAGE AREA: OBSERVED
FOOD PRODUCTS HELD FOR
CREDIT NOT SEGREGATED
FROM WHOLESOME
FOOD.OUTSIDE GROUNDS:
OBSERVED FOOD PRODUCTS
HELD FOR CREDIT NOT
SEGREGATED FROM
WHOLESOME FOOD.
46 Concentration of sanitizing solution not accurately O FOOD ESTABLISHMENT UTILIZES
determined by using a test kit or other device. BLEACH AS SANITIZER BUT
4-501.116 Pf DOES NOT HAVE CHLORINE
TEST KITS ON-SITE DURING
VISIT.
49 Plumbing system not installed to preclude backflow of O MEAT PROCESSING AREA: HOSE
a solid, liquid, or gas contaminant into the water SPIGOT NOT EQUIPPED WITH
supply system at each point of use, including on a BACK-FLOW PREVENTION
hose bibb, by providing an air gap or installation of an DEVICE.MOP SINK ROOM
approved backflow prevention device. 5-203.14 Pf LOCATED IN MEAT PROCESSING
ROOM, HOSE SPIGOT NOT
EQUIPPED WITH BACK-FLOW
PREVENTION DEVICE.
49 Plumbing system not maintained in good repair. O MEAT PROCESSING AREA: 3-BAY
5-205.15(B) SINK AND HAND WASHING SINK
DISCHARGE PLUMBING
SUPPORTED BY AN INVERTED
PLASTIC BASKET.
53 Physical facilities not cleaned as often as necessary O SOIL BUILD-UP, DEAD INSECTS,
to keep them clean, or cleaning not done during AND DEBRIS/REFUSE FOUND IN
periods when the least amount of food is exposed ALL AREAS OF THE FOOD
such as after closing. 6-501.12 ESTABLISHMENT.
FDACS 14205 Rev. 07/13
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II II II
Visit # 3908-0000 20
COMMISSIONER
(850) 245-5520 Tallahassee, FL 32399-1650


A Supplemental Report was also issued during the visit which includes important information for management.
COMMENTS
Re-inspection required due to pests. A re-inspection will be conducted on or about 14 days.
Re-inspection visit required due to pests. Food establishment can call 850-245-5520 to request food safety inspector visit for
written release when all affected areas have been adequately cleaned and sanitized. In addition, food establishment must develop
and implement a pest management control program.
Re-inspection visit required issued for food establishment. A re-inspection will be conducted on or about 14 days.
Stop Use Order issued. Food establishment can call 850-245-5520 when corrections have been made and/or when required
documents have been obtained to request food safety inspector visit for written release of equipment.
The original Stop-Use Order/Stop-Sale Order remains in effect.
Original stop-use and hold order for the following area's due to rodent infestation observed on 05/04/2020, Produce area, Retail
aisle and shelving, Product repackaging area, Dry storage area, Meat and produce cooler, Receiving area, Meat band saw, Meat
processing area, and the Backroom area.
Pest Control Checklist provided.
If evidence of pest infestation is observed on the next scheduled inspection, a Stop-sale of All Food Items will be issued.
ACKNOWLEDGMENT
I acknowledge receipt of a copy of this document, and I further acknowledge that I have verified the location and mailing addresses
on the first page of this document are correct, or I have written the correct information on the first page of this document.
4i 4a
(Signature of FDACS Representative) (Signature of Representative)
SEAN CULVER, SANITATION AND SAFETY SUPERVISOR - SES ADOLPHE ADRAS, PERSON IN CHARGE
Print Name and Title
FDACS 14205 Rev. 07/13
Page 9 of 9
Florida Department of Agriculture and Consumer Services Bureau of Food Inspection
Division of Food Safety 3125 Conner Boulevard, C-26
Tallahassee, FL 32399-1650
FOOD SAFETY INSPECTION SUPPLEMENTAL REPORT

Florida Statues. Chapter 500.172, 500.174

COMMISSIONER
(850) 245-5520
II II II II
11
Print Date: May 18, 2020 Visit #:3908000020
Food Entity #: 299248

Date Of Visit: May 18, 2020
Food Entity Location Address: 64 NE 73rd ST Miami, FL 33138-5350
Food Entity Type/Description: 111/Supermarket
STOP USE ORDER
You are hereby ordered to withhold from movement, sale or use subject to further instructions from an authorized agent of the
Florida Department of Agriculture and Consumer Services, the goods or equipment listed below.
Article: All processing equipment

Brand Name: Adolphe Take Out Market
Lot #: # Of Pkgs: Size Of Pkg: Total Weight:
Invoice #:
Invoice Date:
Manufacturer: Adolphe Take Out Market
Distributor: Adolphe Take Out Market
The primary reason and condition that caused the product or equipment stop sale or stop use and determined dangerous,
unwholesome, fraudulent, or insanitary was: FS 500.04; FS 500.10 ADULTERATED" PREVENTION OF FOOD
CONTAMINATION: Insects, rodents, and animals not present
Comments: CALL 850-245-5520 TO REQUEST FOOD SAFETY INSPECTOR VISIT FOR WRITTEN RELEASE WHEN ALL
EFFECTED AREAS HAVE BEEN ADEQUATELY CLEANED AND SANITIZED. IN ADDITION, FOOD ESTABLISHMENT MUST
DEVELOP AND IMPLEMENT A PEST MANAGEMENT CONTROL PROGRAM.
STOP USE ORDER
You are hereby ordered to withhold from movement, sale or use subject to further instructions from an authorized agent of the
Florida Department of Agriculture and Consumer Services, the goods or equipment listed below.
Article: Outside Recieving and Distribution Area

Brand Name: Adolphe Take Out Market
Lot #: # Of Pkgs: Size Of Pkg: Total Weight:
Invoice #:
Invoice Date:
Manufacturer: Adolphe Take Out Market
Distributor: Adolphe Take Out Market
The primary reason and condition that caused the product or equipment stop sale or stop use and determined dangerous,
unwholesome, fraudulent, or insanitary was: FS 500.04; FS 500.10 ADULTERATED* PREVENTION OF FOOD
CONTAMINATION: Insects, rodents, and animals not present
Comments: CALL 850-245-5520 TO REQUEST FOOD SAFETY INSPECTOR VISIT FOR WRITTEN RELEASE WHEN ALL
EFFECTED AREAS HAVE BEEN ADEQUATELY CLEANED AND SANITIZED. IN ADDITION, FOOD ESTABLISHMENT MUST
DEVELOP AND IMPLEMENT A PEST MANAGEMENT CONTROL PROGRAM.
When the department or its duly authorized agent finds, or has probable cause to believe, that any food or food-processing
FDACS 14205 Rev. 07/13
Page 1 of 2
equipment is in violation of this chapter or any rule adopted under this chapter so as to be dangerous, unwholesome, fraudulent, or
insanitary within the meaning of this chapter, an agent of the department may issue and enforce a stop-sale, stop-use, removal, or
hold order, which order gives notice that such article or processing equipment is, or is suspected of being, in violation and has
been detained or embargoed and which order warns all persons not to remove, use, or dispose of such article or processing
equipment by sale or otherwise until permission for removal, use, or disposal is given by the department or the court. It is unlawful
for any person to remove, use, or dispose of such detained or embargoed article or processing equipment by sale or otherwise
without such permission in accordance with 500.172 (1) Florida Statutes.
AN ADMINISTRATIVE HEARING IS AVAILABLE FOR ALL ORDERS, NOTICES, AND REPORTS IN THIS
SUPPLEMENTAL REPORT
If you wish to contest the Department's action, you have the right to request an administrative hearing to be conducted in
accordance with Sections 120.569 and 120.57, Florida Statutes and to be represented by counsel or other qualified representative.
Your request for hearing must contain:
1.Your name, address, and telephone number, and facsimile number (if any).
2. The name, address, and telephone number, and facsimile number of your attorney or qualified representative (if any) upon
whom service of pleadings and other papers shall be made.
3. A statement that you are requesting an administrative hearing and dispute the material facts alleged by the department, in which
case you must identify the material facts that are in dispute (formal hearing), or that you request an administrative hearing and that
you do not dispute the facts alleged by the department (informal hearing).
4. A statement of when (date) you received the Notice and the file number of this Notice.
Your request for a hearing must be received at the address shown on this Notice within twenty-one (21) days of receipt of this
Notice. If you fail to obtain a Release from this Notice or fail to request an administrative hearing within the twenty-one (21) day
deadline you waive your right to a hearing and the Department may enter a Final Order imposing up to the maximum penalties as
authorized by Florida Law.
HEARING WAIVER AND WAIVER OF RIGHTS
, ADOLPHE ADRAS
I the person in charge of ADOLPHE TAKE OUT MARKET
hereby waive a notice and a hearing as provided in Chapter 120, Florida Statutes and waive all rights as provided on the last
page of this report.
44 4d/La-d-
(Signature)
ACKNOWLEDGEMENT
I acknowledge receipt of a copy of this document.
c.550../j4f--
4
(Signature of FDACS Representative) (Signature of Representative)
SEAN CULVER, SANITATION AND SAFETY SUPERVISOR - SES ADOLPHE ADRAS, PERSON IN CHARGE
Print Name and Title
a-e-tt-y'Venzd-a,
FDACS 14205 Rev. 07/13
Page 2 of 2

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Florida Department of Agriculture and Consumer Services

Division of Food Safety

Print Date: May 18, 2020

Food Entity Number: 299248

Food Entity Type/Description: 111/ Supermarket

INSPECTION SUMMARY - Re-Inspection Required

PERMIT APPLICATION INFORMATION

FOODBORNE ILLNESS RISK FACTORS AND PUBLIC HEALTH INTERVENTIONS

Print Date: May 18, 2020

Food Entity Number: 299248

FOODBORNE ILLNESS RISK FACTORS AND PUBLIC HEALTH INTERVENTIONS

GOOD RETAIL PRACTICES

FDACS 14205 Rev. 07/13

Print Date: May 18, 2020

Food Entity Number: 299248

Print Date: May 18, 2020

Food Entity Number: 299248

Food Entity Type/Description: 111/ Supermarket

FDACS 14205 Rev. 07/13

Print Date: May 18, 2020

Food Entity Number: 299248

Print Date: May 18, 2020

Food Entity Number: 299248

Food Entity Type/Description: 111/ Supermarket

FDACS 14205 Rev. 07/13

Print Date: May 18, 2020

Food Entity Number: 299248

FDACS 14205 Rev. 07/13

Print Date: May 18, 2020

Food Entity Number: 299248

FDACS 14205 Rev. 07/13

Print Date: May 18, 2020

Food Entity Number: 299248

Food Entity Type/Description: 111/ Supermarket

The original Stop-Use Order/Stop-Sale Order remains in effect.

Pest Control Checklist provided.

Print Name and Title

FDACS 14205 Rev. 07/13

FOOD SAFETY INSPECTION SUPPLEMENTAL REPORT

NICOLE "NIKKI" FRIED

Print Date: May 18, 2020 Visit #:3908000020

Food Entity #: 299248

STOP USE ORDER

Article: All processing equipment

STOP USE ORDER

Article: Outside Recieving and Distribution Area

FDACS 14205 Rev. 07/13

HEARING WAIVER AND WAIVER OF RIGHTS

Print Name and Title

FDACS 14205 Rev. 07/13

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