Cefco Convenience Store # 0408 Establishment #: in Crestview

Comments: This Focused Inspection is being conducted offsite to ensure required and/or requested documentation has been received from the food establishment. This check-back inspection conducted to verify compliance of food safety citations observed during previous inspection. The compliance issues that required a Check-Back have been resolved and this food establishment has Met Inspection Requirements. Received acceptable microbiological ice test results from establishment. See Attached.

Comments: A Supplemental Report was also issued during the visit which includes important information for management. COMMENTS When citations have been corrected and initialed, an electronic copy of the completed report may be emailed to [email protected]. Please note each observation that has been corrected. Trainee present during inspection. All violations verified by primary inspector. cos Stop Sale Order issued. Food establishment can visit https://foodpermit.fdacs.gov or contact the Business Center at (850) 245-5520 when corrections have been made and/or when required documents have been obtained to request food safety nspector visit for written release of product. Failure to comply with the request for written release may or will result in Administrative Action. ‘stablishment has 30 days to provide acceptable microbiological ice analysis for both total and fecal coliforms. Test results can be mailed to the inspector at: [email protected] Failure to fulfill this requirement will result in a “Stop Use" on all ice agging operations and ice bagging equipment. A “Stop Sale” will be issued for all bagged ice for retail sale. opy of this report has been provided to the person in charge of the food establishment and will be available online at /foodpermit.fdacs.qov/Reports/SearchFoodEntity.aspx. Ss: TRACY MATUZEK, STORE sowcen Ny ulllatiy Name and Title of Whom This Report was Issued _U v =RT KENISTON, ITATIDN TY SPECIALIST date: 1/29/202 2 of 4 CamScanner Bureau of Food Inspection Florida Department of Agriculture and Consumer Services Division of Food Safety Sie baivar Roukears 6-28 Tallahaaaee, FL 32399-1650 FOOD SAFETY INSPECTION SUPPLEMENTAL REPORT Florida Statues. Chapter 800.172, 800.174 (850) 245-5820 WILTON SIMPSON COMMISSIONER Visit #. 99997 182243077 Food Entity #: 368551 Food Entity Name: CEFCO CONVENIENCE STORE # 0408 Date Of Visit: January 29, 2024 Inspected By: ROBERT KENISTON Food Entity Location Address: 813 N Ferdon Blvd Crestview, FL 32536-2115 Food Entity Mailing Address: PO Box 1287 Temple, TX 76503-1287 Food Entity Type/Description: 124/Convenience Store Significant FS AND/OR Packaged Ice Food Entity Owner: CEFCO Attn Licensing Dept SUPPLEMENTAL KEY # STOP SALE ORDER AND RELEASE 335203 You are hereby notified that the following item on which a STOP SALE ORDER AND RELEASE was issued on 01/29/2024 by ROBERT KENISTON is hereby released. Chorizo, Sausage Crumbles, Steak Pieces Article: Brand Name: CEFCO Lot #: N/A # Of Pkgs: 3 Size Of Pkg: 2lbs Total Weight: Approx. Sibs containers Chorizo, 2lbs Sausage Invoice #: N/A Crumbles. 1 Ib Steak Invoice Date: Manufacturer: Distributor: 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.* Time/Temperature Control for Safety Food: Proper cold holding temperatures. Disposition: Product was voluntarily destroyed by food entity management and witnessed by inspector. Comments: ACS-14325 Rev. 05/22 it Date: 1/29/2024 je 30f4 (8 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 wams all persons not to remove, use, of 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 auch 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 of 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 |, Tracy Matuzek the person in charge of CEFCO CONVENIENCE STORE # hereby waive a notice and a hearing as provided in Chapter 120, Florida Statutes and waive all rights as provided on the last pag f this repart. ACKNOWLEDGEMENT A copy of this rt hasbeen provided to the person in charge of the food establishment. va 4 | acknowledge receipt of 4 co ON ae 4 ’ uv Signature of FDACS Representative Signature of Bepresentative ROBERT KENISTON, SANITATION AND SAFETY SPECIALIST TRACY MATUZEK, STORE MANAGER . Print Name and Title FDACS-14325 Rev. 05/22