Starbucks # in Casselberry

Comments: A copy of this report has been provided to the person in charge of the food establishment and will be available online at Ks Phare Cook. GydheCee+ ROBERT GAIT, GENIOITEANITATION AND GAPETY GPECIALIBT Nene and Tite of Viner Tha Hajar! aaa lead Manger. Pret Ome 612074 Page | fA Florida Department of Agriculture and Consumer Services Division of Food Safety Visit #: 9999-7182-2416-57 Bureau of Food Inspection Attention: Business Center FOOD SAFETY SAMPLE COLLECTION REPORT WILTON SIMPSON Chapter 500, Florida Statutes 3125 Conner Boulevard, C-26 COMMISSIONER (850) 245-5520 Tallahassee, FL 32399-1650 Name: Starbucks #9516 Establishment #: 305602 Owner: Starbucks Corporation Date of Visit: January 16, 2024 Type: Specialty Food Shops Inspected By: ROBERT SMITH Address: 168 State Road 436 Casselberry, FL 32707 - 4203 SAMPLE INFORMATION Sample Number: 99963883210087 Product: Ice sample Brand: Starbucks Variety: Ice Lot: N/A Origin Country: USA COLLECTION INFORMATION Date of Collection: 01/16/2024 12:15 PM Laboratory: Food Laboratory Reason for Collection: Resample Additional Comments: Re sample 99963883209436 SAMPLE DETAILS Type of Container at Time of Collection’ Whirl bag Type of Storage at Time of Collection: Chilled Size of Container. 100 ml # of Container In Sample: 2 Collected From: Food service Size of Lot 25 Pounds Stop Sale Issued? N SHIPPING INFORMATION Date of Shipment: 01/16/2024 Shipped By: Fedex Tracking Number; 774825535336 Wwhee ROBERT SMITH, SENIOR GANITATION AND BAPETY GPLECIALIOT Pant Name and Tithe print Date. 1/16/2024 Pago 2 04 Florida Department of Agriculture and Consumer Services Division of Food Safety Visit # 9999-7 182-24 16-57 FOOD SAFETY SAMPLE COLLECTION REPORT Biveaa’ dr Food franector Attention: Business Center Chapter 500, Flonda Statutes 3125 Conner Boulevard, C-26 COMMISSIONER (850) 245-5520 Tallahassee, FL 32399-1650 Name ‘Starbucks #9516 Establishment #: 305602 Owner: Starbucks Corporation Date of Visit January 16, 2024 Type Specialty Food Shops Inspected By © ROBERT SMITH Address’ 168 State Road 436 Casselberry, FL 32707 - 4203 SAMPLE INFORMATION Sample Number, 99963883210080 Product Ice sample Brand: Starbucks: Variety: Ice Lot N/A Ongin Country: USA COLLECTION INFORMATION Date of Collection: 01/16/2024 12:15 PM Laboratory: Food Laboratory Reason for Collection: Resample Additional Comments: Re sample 99963883209434 SAMPLE DETAILS Type of Container at Time of Collection Whirl bag Type of Storage at Time of Collection: Chilled Size of Container: 100 mi # of Container In Sample: 2 Collected From, Food service Size of Lot 25 Pounds Stop Sale Issued? N SHIPPING INFORMATION Date of Shipment 01/16/2024 Shipped By Fedex Tracking Number 774825535336 ‘Pont Name and Nie Print Dane 1/00r2U94 Page a4 Florida Department of Agriculture and Consumer Services Division of Food Safety FOOD SAFETY SAMPLE COLLECTION REPORT Vish #: 9999-7 182-2416-67 Bureau of Food Inspection Attention: Business Center WILTON SIMPSON Chapter 500, Florida Statules 3125 Conner Boulevard, C-26 COMMISSIONER (850) 245-5520 Tallahassee, FL 32399-1650 JOA 00000 0 0 A Name: Starbucks #9516 Establishment #: 305602 Owner: Starbucks Corporation Date of Visit: January 16, 2024 Type: Specialty Food Shops Inspected By: ROBERT SMITH Address: 168 State Road 436 Casselberry, FL 32707 - 4203 SAMPLE INFORMATION Sample Number: 99963883210092 Product: Ice sample Brand: Starbucksice Variety: Ice Lot NIA Origin Country: | USA COLLECTION INFORMATION Date of Collection’ 01/16/2024 12:00 PM Laboratory: Food Laboratory Reason for Collection; Resample Additional Comments: Re sample 99963883209428 SAMPLE DETAILS Type of Container at Time of Collection: Whirl bag Type of Storage at Time of Collection: Chilled Size of Container. 100 mi # of Container In Sample: a Collected From: Backroom Size of Lot: 250 Pounds Stop Sale !ssued? N SHIPPING INFORMATION Date of Shipment: 01/16/2024 Shipped By: Fedex Tracking Number. 774825535336 P< Nw tae ROBERT SIMTH, SENIOR SANITATION AND SAFETY SPECIALIST Print Name and Title Pont ate 111612074 Pages hs

Comments: A copy of this report has been provided to the person in charge of the food establishment and will be available online at https://foodpermit.fdacs.gov/Reports/SearchFoodEntity.aspx . SHANE COOK, MANAGER ROBERT SMITH, SENIOR SANITATION AND SAFETY SPECIALIST