Reason: FS 500.04; FS 500.10 Adulterated.* Distribution and Retail Sale

Disposition: Product was voluntarily destroyed by food entity management and witnessed by inspector.

Reason: FS 500.04; FS 500.172 Unsanitary Equipment.* Utensils, Equipment and Vending: Food and nonfood-contact surfaces cleanable, properly designed, constructed, and used.

Disposition: Equipment was obtained, repaired or replaced, checked, and released.

Reason: FS 500.04; FS 500.10 Adulterated.* Prevention of Food Contamination: Insects, rodents, and animals not present. Comments: All affected areas must be adequately cleaned and sanitized. In addition, the food establishment must develop and implement a pest management control program. Contact the Business Center at (850) 245-5620 or [email protected] to request a Food Safety Inspector visit for written release. FDACS-14325 Rev. 05/22 Print Date: 12/5/2023, Page 15 of 16 Scanned by CamScanner When the department or its duly authorized agent finds, or has probable cause to believe, that any food or food-processing 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 Ifyou wish to contest the Department's action, you have the right to request an administrative hearing to be conducted in accordance with Sections 120.589 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 ON DESTROYED PRODUCTS 1 Pe G A bdohwoar the person in charge of ST GEORGES SHELL 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, ae 2 (Signa ACKNOWLEDGEMENT A copy of this report has been provided to the person in charge of the food establishment. | acknowledge receipt of a copy of this documen Ltl ee Signature of FDACS Representative ‘Signature of Representative ISAAC ABRAHAM, OWNER: Print Name and Title AMBER RUCKDESCHEL, ENVIRONMENTAL SPECIALIST I FDACS-14325 Rev. 05/22 Print Date: 12/5/2023, Page 16 of 16 Scanned by CamScanner

Reason: FS 581.217 Distribution and Retail Sale of Hemp Extract. * Attractive to Children. Comments: When corrections have been made, request a Food Safety Inspector visit for written release of product by contacting the Business Center at (850) 245-5520 or [email protected]. FDACS-14325 Rev. 05/22 Print Date: 11/21/2023 Page 6 of 11 Florida Department of Agriculture and Consumer Services Bureau of Food Inspection sanacion Attention: Business Center 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 (850) 245-5520 WILTON SIMPSON COMMISSIONER Visit #: 99997182236354 Food Entity # 343821 Food Entity Name’ ST GEORGES SHELL Date Of Visit: November 21, 2023 Inspected By: AMBER RUCKDESCHEL Food Entity Location Address: 1698 Clearwater Largo RD Clearwater, FL 33756-1107 Food Entity Mailing Address: 1698 Clearwater Largo RD Clearwater, FL 33756-1107 Food Entity Type/Description: 124/Convenience Store Significant FS AND/OR Packaged Ice Food Entity Owner: KAB GROUP LLC SUPPLEMENTAL KEY #:

Reason: FS 500.04; FS 500.10 Adulterated.* Distribution and Retail Sale Comments: No certificate of analysis that meets requirements. FDACS-14325 Rev. 05/22 Print Date: 11/21/2023 Page 7 of 11 Florida Department of Agriculture and Consumer Services Bureau of Food Inspection Attention: Business Center Division of Food Safety 3125 Conner Boulevard, C-28 Tallahassee, FL 32399-1850 FOOD SAFETY INSPECTION SUPPLEMENTAL REPORT Florida Statues. Chapter 500.172, 500.174 : (850) 245-5520 WILTON SIMPSON ONE! COMMISSIONER Visit #: 99997182236354 Food Entity #: 343821 Food Entity Name: ST GEORGES SHELL Date Of Visit: November 21, 2023 Inspected By: AMBER RUCKDESCHEL Food Entity Location Address: 1698 Clearwater Largo RD Clearwater, FL 33756-1107 Food Entity Mailing Address: 1698 Clearwater Largo RD Clearwater, FL 33756-1107 Food Entity Type/Description: 124/Convenience Store Significant FS AND/OR Packaged Ice Food Entity Owner: KAB GROUP LLC SUPPLEMENTAL KEY #:

Reason: FS 500.04; FS 500.11 Misbranded.* Approved Source: Food obtained from approved source. Comments: When corrections have been made, request a Food Safety Inspector visit for written release of product by contacting the Business Center at (850) 245-5520 or FoodSafety@FDACS gov. FDACS-14325 Rev. 05/22 Print Date: 11/21/2023, Page 8 of 11 Florida Department of Agriculture and Consumer Services Bureau: of Food Inspection ee Attention: Business Center 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 (850) 245-5520 WILTON SIMPSON ;OMMISSIONER “ ‘one Visit #: 99997182236354 Food Entity #: 343821 Food Entity Name: ST GEORGES SHELL Date Of Visit: November 21, 2023 Inspected By: AMBER RUCKDESCHEL Food Entity Location Address: 4698 Clearwater Largo RD Clearwater, FL 33756-1107 Food Entity Mailing Address: 1698 Clearwater Largo RD Clearwater, FL 33756-1107 Food Entity Type/Description: 124/Convenience Store Significant FS AND/OR Packaged Ice Food Entity Owner: KAB GROUP LLC SUPPLEMENTAL KEY #:

Reason: FS 500.04; FS 500.11 Misbranded.* Approved Source: Food obtained from approved source. Comments: When corrections have been made, request a Food Safety Inspector visit for written release of product by contacting the Business Center at (850) 245-5520 or FoodSafety@FDACS. gov. FDACS-14325 Rev. 05/22 Print Date: 11/21/2023 Page 9 of 11 Florida Department of Agriculture and Consumer Services Bureau of Food Inspection Attention: Business Center 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 (850) 245-5520 WILTON SIMPSON COMMISSIONER Visit #: 99997182236354 Food Entity #: 343821 Food Entity Name: ST GEORGES SHELL Date Of Visit: November 21, 2023 Inspected By: AMBER RUCKDESCHEL Food Entity Location Address: 1698 Clearwater Largo RD Clearwater, FL 33756-1107 Food Entity Mailing Address: 41698 Clearwater Largo RD Clearwater, FL 33756-1107 Food Entity Type/Description: 424/Convenience Store Significant FS AND/OR Packaged Ice Food Entity Owner: KAB GROUP LLC SUPPLEMENTAL KEY #: