Inspector: DAVID CANO, ENVIRONMENTAL SPECIALIST II
Risk-Based Violations
There was no proof of a certified food protection manager available. At least one Priority
violation was observed during the inspection. The person in charge was not able to correctly respond to
questions relevant to the operation.
o
Retail area - Raw shell eggs, raw chorizo sausage, and raw bacon were stored over ready to
eat foods and beverages inside of display cooler. Cos - All raw product was relocated to the bottom display
shelf.
Employees are not informed in a verifiable manner of their responsibility to report symptoms
and illnesses to the person in charge as they relate to diseases that are transmissible through food.
Inspector reviewed with the person in charge and provided guidance document.
The person in charge was not able to correctly respond to questions related to the food
establishment's employee health policy. Inspector reviewed with the person in charge and provided
guidance documents.
o
Print Date: 12/20/2024
Page 2 of 6
8
Pf
Citation Description: Handwashing sink not located to allow convenient use by employees in food
preparation, food dispensing or warewashing areas; or not located in, or immediately adjacent to, toilet
rooms. 5-204.11 Pf
Observation: Warewashing area - No adequate handwashing sink was installed in warewashing room. A
copy of the Minimum Construction Standards document was provided by the inspector. Please see
supplemental report and comments.
Backroom area - Internal temperature taken with accurate thermocouple of hot dogs were 43
degrees f. and 44 degrees f. inside of walk in cooler. All other product was 41 degrees f. or below. Please
see supplemental report.
x
Establishment does not have written procedures for employees to follow when responding to
an event that involves the discharge of vomitus or diarrhea onto surfaces at the food establishment.
Inspector reviewed requirement with the person in charge and provided guidance document.
Retail area - Chemical cleaners and insecticide were stored over and directly next to single
use food storage bags on isle adjacent to wall display coolers on display shelving. Chemical body care
products were stored over single use food storage trays and utensils on display shelving. Lighters were
stored over multi-use food utensils on hook display. Cos - All chemical products were relocated for
adequate segregation from single-use and multi use food articles.
Print Date: 12/20/2024
Page 3 of 6
Y
Y
x
x
95
o
Citation Description: Establishment does not have a certified food protection manager who has passed a
test through a recognized accredited program. 5K-4.021(1), F.A.C.
Observation: No proof of a certified food protection manager available. Inspector provided list of
course/test providers.
Retail area - No age placard was posted which states: "THE SALE OF HEMP EXTRACT
INTENDED FOR INHALATION TO PERSONS UNDER THE AGE OF 21 IS PROHIBITED, PROOF OF
AGE IS REQUIRED FOR PURCHASE". 5K-4.034(8)(a), F.A.C. Cos - Age placard was provided by the
inspector and posted by the person in charge.
Retail Area - Hemp extract products including vape cartridges, flower, or pre rolls found
without the statement "Not Intended For Ingestion - Do Not Eat" on product packaging. Please see
supplemental report and comments.
o
Retail Area - Hemp extract products including vape cartridges, flower, pre rolls, gummies, or
food products found without manufacturer's information and/or net weight identified on product packaging.
See supplemental report and comments.
o
Print Date: 12/20/2024
Page 1 of 6
75
Citation Description: Hemp extract intended for human consumption distributed or sold in the state
without being in a container that includes: a. A scannable barcode or quick response code linked to the
certificate of analysis of the hemp extract batch by an independent testing laboratory; b. The batch number;
c. The internet address of a website where batch information may be obtained; d. The expiration date; and
e. The number of milligrams of each marketed cannabinoid per serving. s. 581.217(7)(a)(2) F.S.
Observation: Retail Area - Hemp extract products including vape cartridges, flower, pre rolls, gummies, or
food products found without a scannable barcode/quick response code, a batch number, an expiration date,
an internet address, and/or the number of milligrams of each marketed cannabinoid on product packaging.
Please see supplemental report and comments.
o
Retail Area - Hemp extract products including vape cartridges, flower, and gummies do not
have a corresponding certificate of analysis by an independent testing laboratory. See supplemental report
and comments.
Retail Area - Hemp Extract products observed to be Attractive to Children - Product labels
contained the shape of an animal, human, or cartoon. See supplemental report and comments.
o
Warewashing area - Handwashing sign was posted over two compartment sink.
Retail area - Psyched Turkey Tail Gummies were missing manufacturer/distributor and
address and invoices or bill of lading were not provided. See supplemental report.
x
Retail area - Capri-Sun and Kool-Aid juice pouches missing ingredients,
manufacturer/distributor, and address, were offered for retail grab and go inside of retail display cooler. Cos
- All juice pouches were removed from retail sale and taken home by the person in charge. Retail area Psyched Turkey Tail Gummies were missing manufacturer/distributor and address. See supplemental
report.
Good Retail Practice Violations
Retail area - There is no ambient air thermometer for the Fruitissia ice cream freezer nor for
the De Conna ice cream freezer.
No suitable probe style thermometer provided for taking the internal temperature of
time/temperature control for safety (TCS) foods. Inspector discussed requirement with the person in
charge.
Retail area - There is a gap exposing daylight at the bottom of the front entry door.
Retail area - One set of tongs was provided for five different varieties of pickled foods offered
for consumer self-service at dispensing counter. Inspector discussed requirement for a dispensing utensil
for each variety of foods with the person in charge.
Warewashing area - Adequate warewashing sink is not installed. Please see supplemental
report and comments.
Backroom area - Toilet is in disrepair in the restroom.
Backroom area - Toilet is not conveying waste water into the sewerage system in a sanitary
manner. Specifically, leaked waste water was observed on the floor around the floor base of the toilet inside
of the restroom. Please see supplemental report and comments.
o
Print Date: 12/20/2024
Page 4 of 6
97
x
Citation Description: Food bears or contains a poisonous or deleterious substance which may render it
injurious to health. 500.10(1)(a), F.S.
Observation: Retail area - Two varieties of Psyched products were labeled containing Muscimol. Please
see supplemental report and comments. Retail area - Your Diamond Shruumz Infused Cones, Chocolate
Bars, or Gummies (Micro- and Mega/Extreme-Dose) contain poisonous or deleterious substances. A copy
of the Recall Notice regarding this product was provided by the inspector. See supplemental report.
INSPECTION: CONTROLLED SUBSTANCE
Violation No.
Retail area - Hemp Extract products observed to be over the 0.3% total delta 9 THC
concentration according to product package labeling or Certificate of Analysis. See 581.217(3)(e), F.S., and
Rule 5K-4.034(2)(m). See supplemental report and comments.
A Supplemental Report was also issued during the visit which includes important information for management.
Stop-Sale Orders & Supplemental Actions
STOP SALE ORDER
Reason: 500.10(1)(a), 581.217(3)(e), F.S., 893.03(1)(c)190.a., F.S.* Controlled Substance
Comments: The product contains a control substance prohibited pursuant to Chapter 893, Florida Statutes, and may not be sold or distributed. To
request a Food Safety Inspector visit to obtain a written release of the Stop-Sale Order for purposes of removing and destroying the product,
contact the Business Center at (850) 245-5520 or
[email protected]. Release of the product for destruction may require a court order.
Print Date: 12/20/2024
Page 1 of 21
Lot: Number of Packages:
Quantity: Size of Packages: · Total Weight:
STOP SALE ORDER
Reason: 500.10(1)(a), 581.217(3)(e), F.S., 893.03(1)(c)190.a., F.S.* Controlled Substance
Comments: The product contains a control substance prohibited pursuant to Chapter 893, Florida Statutes, and may not be sold or distributed. To
request a Food Safety Inspector visit to obtain a written release of the Stop-Sale Order for purposes of removing and destroying the product,
contact the Business Center at (850) 245-5520 or
[email protected]. Release of the product for destruction may require a court order.
Lot: Number of Packages:
Quantity: Size of Packages: · Total Weight:
STOP SALE ORDER
Reason: 500.10(1)(a), 581.217(3)(e), F.S., 893.03(1)(c)190.a., F.S.* Controlled Substance
Comments: The product contains a control substance prohibited pursuant to Chapter 893, Florida Statutes, and may not be sold or distributed. To
request a Food Safety Inspector visit to obtain a written release of the Stop-Sale Order for purposes of removing and destroying the product,
contact the Business Center at (850) 245-5520 or
[email protected]. Release of the product for destruction may require a court order.
Print Date: 12/20/2024
Page 2 of 21
Lot: Number of Packages:
Quantity: Size of Packages: · Total Weight:
STOP SALE ORDER
Reason: 500.10(1)(a), 581.217(3)(e), F.S., 893.03(1)(c)190.a., F.S.* Controlled Substance
Comments: The product contains a control substance prohibited pursuant to Chapter 893, Florida Statutes, and may not be sold or distributed. To
request a Food Safety Inspector visit to obtain a written release of the Stop-Sale Order for purposes of removing and destroying the product,
contact the Business Center at (850) 245-5520 or
[email protected]. Release of the product for destruction may require a court order.
Lot: Number of Packages:
Quantity: Size of Packages: · Total Weight:
STOP SALE ORDER
Reason: 500.10(1)(a), 581.217(3)(e), F.S., 893.03(1)(c)190.a., F.S.* Controlled Substance
Comments: The product contains a control substance prohibited pursuant to Chapter 893, Florida Statutes, and may not be sold or distributed. To
request a Food Safety Inspector visit to obtain a written release of the Stop-Sale Order for purposes of removing and destroying the product,
contact the Business Center at (850) 245-5520 or
[email protected]. Release of the product for destruction may require a court order.
Print Date: 12/20/2024
Page 3 of 21
Lot: Number of Packages:
Quantity: Size of Packages: · Total Weight:
STOP SALE ORDER
Reason: 500.10(1)(a), 581.217(3)(e), F.S., 893.03(1)(c)190.a., F.S.* Controlled Substance
Comments: The product contains a control substance prohibited pursuant to Chapter 893, Florida Statutes, and may not be sold or distributed. To
request a Food Safety Inspector visit to obtain a written release of the Stop-Sale Order for purposes of removing and destroying the product,
contact the Business Center at (850) 245-5520 or
[email protected]. Release of the product for destruction may require a court order.
Lot: Number of Packages:
Quantity: Size of Packages: · Total Weight:
STOP SALE ORDER
Reason: 500.10(1)(a), 581.217(3)(e), F.S., 893.03(1)(c)190.a., F.S.* Controlled Substance
Comments: The product contains a control substance prohibited pursuant to Chapter 893, Florida Statutes, and may not be sold or distributed. To
request a Food Safety Inspector visit to obtain a written release of the Stop-Sale Order for purposes of removing and destroying the product,
contact the Business Center at (850) 245-5520 or
[email protected]. Release of the product for destruction may require a court order.
Print Date: 12/20/2024
Page 4 of 21
Lot: Number of Packages:
Quantity: Size of Packages: · Total Weight:
STOP SALE ORDER
Reason: FS
581.217 Distribution and Retail Sale of Hemp Extract. * Attractive to Children.
Comments: The product contains a control substance prohibited pursuant to Chapter 893, Florida Statutes, and may not be sold or distributed. To
request a Food Safety Inspector visit to obtain a written release of the Stop-Sale Order for purposes of removing and destroying the product,
contact the Business Center at (850) 245-5520 or
[email protected]. Release of the product for destruction may require a court order.
Lot: Number of Packages:
Quantity: Size of Packages: · Total Weight:
STOP SALE ORDER
Reason: FS
581.217 Distribution and Retail Sale of Hemp Extract. * Attractive to Children.
Comments: The product contains a control substance prohibited pursuant to Chapter 893, Florida Statutes, and may not be sold or distributed. To
request a Food Safety Inspector visit to obtain a written release of the Stop-Sale Order for purposes of removing and destroying the product,
contact the Business Center at (850) 245-5520 or
[email protected]. Release of the product for destruction may require a court order.
Print Date: 12/20/2024
Page 5 of 21
Lot: Number of Packages:
Quantity: Size of Packages: · Total Weight:
STOP SALE ORDER
Reason: FS 500.04; FS 500.11 Misbranded.* Distribution and Retail Sale
Comments: The product contains a control substance prohibited pursuant to Chapter 893, Florida Statutes, and may not be sold or distributed. To
request a Food Safety Inspector visit to obtain a written release of the Stop-Sale Order for purposes of removing and destroying the product,
contact the Business Center at (850) 245-5520 or
[email protected]. Release of the product for destruction may require a court order.
Lot: Number of Packages:
Quantity: Size of Packages: · Total Weight:
STOP SALE ORDER
Reason: FS 500.04; FS 500.11 Misbranded.* Labeling
Comments: The product contains a control substance prohibited pursuant to Chapter 893, Florida Statutes, and may not be sold or distributed. To
request a Food Safety Inspector visit to obtain a written release of the Stop-Sale Order for purposes of removing and destroying the product,
contact the Business Center at (850) 245-5520 or
[email protected]. Release of the product for destruction may require a court order.
Print Date: 12/20/2024
Page 6 of 21
Lot: Number of Packages:
Quantity: Size of Packages: · Total Weight:
STOP SALE ORDER
Reason: FS 500.04; FS 500.11 Misbranded.* Labeling
Comments: The product contains a control substance prohibited pursuant to Chapter 893, Florida Statutes, and may not be sold or distributed. To
request a Food Safety Inspector visit to obtain a written release of the Stop-Sale Order for purposes of removing and destroying the product,
contact the Business Center at (850) 245-5520 or
[email protected]. Release of the product for destruction may require a court order.
Lot: Number of Packages:
Quantity: Size of Packages: · Total Weight:
STOP SALE ORDER
Reason: FS 500.04; FS 500.11 Misbranded.* Labeling
Comments: The product contains a control substance prohibited pursuant to Chapter 893, Florida Statutes, and may not be sold or distributed. To
request a Food Safety Inspector visit to obtain a written release of the Stop-Sale Order for purposes of removing and destroying the product,
contact the Business Center at (850) 245-5520 or
[email protected]. Release of the product for destruction may require a court order.
Print Date: 12/20/2024
Page 7 of 21
Lot: Number of Packages:
Quantity: Size of Packages: · Total Weight:
STOP SALE ORDER
Reason: FS 500.04; FS 500.11 Misbranded.* Labeling
Comments: The product contains a control substance prohibited pursuant to Chapter 893, Florida Statutes, and may not be sold or distributed. To
request a Food Safety Inspector visit to obtain a written release of the Stop-Sale Order for purposes of removing and destroying the product,
contact the Business Center at (850) 245-5520 or
[email protected]. Release of the product for destruction may require a court order.
Lot: Number of Packages:
Quantity: Size of Packages: · Total Weight:
STOP SALE ORDER
Reason: FS 500.04; FS 500.11 Misbranded.* Labeling
Comments: The product contains a control substance prohibited pursuant to Chapter 893, Florida Statutes, and may not be sold or distributed. To
request a Food Safety Inspector visit to obtain a written release of the Stop-Sale Order for purposes of removing and destroying the product,
contact the Business Center at (850) 245-5520 or
[email protected]. Release of the product for destruction may require a court order.
Print Date: 12/20/2024
Page 8 of 21
Lot: Number of Packages:
Quantity: Size of Packages: · Total Weight:
STOP SALE ORDER
Reason: FS 500.04; FS 500.11 Misbranded.* Labeling
Comments: The product contains a control substance prohibited pursuant to Chapter 893, Florida Statutes, and may not be sold or distributed. To
request a Food Safety Inspector visit to obtain a written release of the Stop-Sale Order for purposes of removing and destroying the product,
contact the Business Center at (850) 245-5520 or
[email protected]. Release of the product for destruction may require a court order.
Lot: Number of Packages:
Quantity: Size of Packages: · Total Weight:
STOP SALE ORDER
Reason: FS 500.04; FS 500.11 Misbranded.* Labeling
Comments: The product contains a control substance prohibited pursuant to Chapter 893, Florida Statutes, and may not be sold or distributed. To
request a Food Safety Inspector visit to obtain a written release of the Stop-Sale Order for purposes of removing and destroying the product,
contact the Business Center at (850) 245-5520 or
[email protected]. Release of the product for destruction may require a court order.
Print Date: 12/20/2024
Page 9 of 21
Lot: Number of Packages:
Quantity: Size of Packages: · Total Weight:
STOP SALE ORDER
Reason: FS 500.04; FS 500.11 Misbranded.* Labeling
Comments: The product contains a control substance prohibited pursuant to Chapter 893, Florida Statutes, and may not be sold or distributed. To
request a Food Safety Inspector visit to obtain a written release of the Stop-Sale Order for purposes of removing and destroying the product,
contact the Business Center at (850) 245-5520 or
[email protected]. Release of the product for destruction may require a court order.
Lot: Number of Packages:
Quantity: Size of Packages: · Total Weight:
STOP SALE ORDER
Reason: FS 500.04; FS 500.11 Misbranded.* Labeling
Comments: The product contains a control substance prohibited pursuant to Chapter 893, Florida Statutes, and may not be sold or distributed. To
request a Food Safety Inspector visit to obtain a written release of the Stop-Sale Order for purposes of removing and destroying the product,
contact the Business Center at (850) 245-5520 or
[email protected]. Release of the product for destruction may require a court order.
Print Date: 12/20/2024
Page 10 of 21
Lot: Number of Packages:
Quantity: Size of Packages: · Total Weight:
STOP SALE ORDER
Reason: FS 500.04; FS 500.11 Misbranded.* Labeling
Comments: The product contains a control substance prohibited pursuant to Chapter 893, Florida Statutes, and may not be sold or distributed. To
request a Food Safety Inspector visit to obtain a written release of the Stop-Sale Order for purposes of removing and destroying the product,
contact the Business Center at (850) 245-5520 or
[email protected]. Release of the product for destruction may require a court order.
Lot: Number of Packages:
Quantity: Size of Packages: · Total Weight:
STOP SALE ORDER
Reason: FS 500.04; FS 500.11 Misbranded.* Labeling
Comments: The product contains a control substance prohibited pursuant to Chapter 893, Florida Statutes, and may not be sold or distributed. To
request a Food Safety Inspector visit to obtain a written release of the Stop-Sale Order for purposes of removing and destroying the product,
contact the Business Center at (850) 245-5520 or
[email protected]. Release of the product for destruction may require a court order.
Print Date: 12/20/2024
Page 11 of 21
Lot: Number of Packages:
Quantity: Size of Packages: · Total Weight:
STOP SALE ORDER
Reason: FS 500.04; FS 500.11 Misbranded.* Labeling
Comments: The product contains a control substance prohibited pursuant to Chapter 893, Florida Statutes, and may not be sold or distributed. To
request a Food Safety Inspector visit to obtain a written release of the Stop-Sale Order for purposes of removing and destroying the product,
contact the Business Center at (850) 245-5520 or
[email protected]. Release of the product for destruction may require a court order.
Lot: Number of Packages:
Quantity: Size of Packages: · Total Weight:
STOP SALE ORDER
Reason: FS 500.04; FS 500.11 Misbranded.* Labeling
Comments: The product contains a control substance prohibited pursuant to Chapter 893, Florida Statutes, and may not be sold or distributed. To
request a Food Safety Inspector visit to obtain a written release of the Stop-Sale Order for purposes of removing and destroying the product,
contact the Business Center at (850) 245-5520 or
[email protected]. Release of the product for destruction may require a court order.
Print Date: 12/20/2024
Page 12 of 21
Lot: Number of Packages:
Quantity: Size of Packages: · Total Weight:
STOP SALE ORDER
Reason: FS 500.04; FS 500.11 Misbranded.* Labeling
Comments: The product contains a control substance prohibited pursuant to Chapter 893, Florida Statutes, and may not be sold or distributed. To
request a Food Safety Inspector visit to obtain a written release of the Stop-Sale Order for purposes of removing and destroying the product,
contact the Business Center at (850) 245-5520 or
[email protected]. Release of the product for destruction may require a court order.
Lot: Number of Packages:
Quantity: Size of Packages: · Total Weight:
STOP SALE ORDER
Reason: FS 500.04; FS 500.11 Misbranded.* Labeling
Comments: The product contains a control substance prohibited pursuant to Chapter 893, Florida Statutes, and may not be sold or distributed. To
request a Food Safety Inspector visit to obtain a written release of the Stop-Sale Order for purposes of removing and destroying the product,
contact the Business Center at (850) 245-5520 or
[email protected]. Release of the product for destruction may require a court order.
Print Date: 12/20/2024
Page 13 of 21
Lot: Number of Packages:
Quantity: Size of Packages: · Total Weight:
STOP SALE ORDER
Reason: FS 500.04; FS 500.11 Misbranded.* Labeling
Comments: The product contains a control substance prohibited pursuant to Chapter 893, Florida Statutes, and may not be sold or distributed. To
request a Food Safety Inspector visit to obtain a written release of the Stop-Sale Order for purposes of removing and destroying the product,
contact the Business Center at (850) 245-5520 or
[email protected]. Release of the product for destruction may require a court order.
Lot: Number of Packages:
Quantity: Size of Packages: · Total Weight:
STOP SALE ORDER AND RELEASE
Reason: FS 500.04; FS 500.10 Adulterated.* Chapter 5K-4: Food deemed adulterated.
Lot: Number of Packages:
Quantity: Size of Packages: · Total Weight:
Disposition: Product was voluntarily destroyed by food establishment management and witnessed by inspector.
STOP SALE ORDER AND RELEASE
Reason: FS 500.04; FS 500.10 Adulterated.* Chapter 5K-4: Food deemed adulterated.
Lot: Number of Packages:
Quantity: Size of Packages: · Total Weight:
Disposition: Product was voluntarily destroyed by food establishment management and witnessed by inspector.
STOP SALE ORDER AND RELEASE
Reason: FS 500.04; FS 500.10 Adulterated.* Chapter 5K-4: Food deemed adulterated.
Lot: Number of Packages:
Quantity: Size of Packages: · Total Weight:
Disposition: Product was voluntarily destroyed by food establishment management and witnessed by inspector.
STOP SALE ORDER AND RELEASE
Reason: FS 500.04; FS 500.10 Adulterated.* Chapter 5K-4: Food deemed adulterated.
Lot: Number of Packages:
Quantity: Size of Packages: · Total Weight:
Disposition: Product was voluntarily destroyed by food establishment management and witnessed by inspector.
STOP SALE ORDER AND RELEASE
Reason: FS 500.04; FS 500.10 Adulterated.* Chapter 5K-4: Food deemed adulterated.
Lot: Number of Packages:
Quantity: Size of Packages: · Total Weight:
Disposition: Product was voluntarily destroyed by food establishment management and witnessed by inspector.
STOP SALE ORDER AND RELEASE
Reason: FS 500.04; FS 500.10 Adulterated.* Time/Temperature Control for Safety Food: Proper cold holding temperatures.
Lot: Number of Packages:
Quantity: Size of Packages: · Total Weight:
Disposition: Product was voluntarily destroyed by food establishment management and witnessed by inspector.
STOP SALE ORDER AND RELEASE
Reason: FS 500.04; FS 500.10 Adulterated.* Approved Source: Food obtained from approved source.
Lot: Number of Packages:
Quantity: Size of Packages: · Total Weight:
Disposition: Product was voluntarily destroyed by food establishment management and witnessed by inspector.
STOP SALE ORDER AND RELEASE
Reason: FS 500.04; FS 500.11 Misbranded.* Approved Source: Food obtained from approved source.
Lot: Number of Packages:
Quantity: Size of Packages: · Total Weight:
Disposition: Product was voluntarily destroyed by food establishment management and witnessed by inspector.
STOP SALE ORDER AND RELEASE
Reason: FS 500.04; FS 500.11 Misbranded.* Distribution and Retail Sale
Lot: Number of Packages:
Quantity: Size of Packages: · Total Weight:
Disposition: Product was voluntarily destroyed by food establishment management and witnessed by inspector.
STOP SALE ORDER AND RELEASE
Reason: FS 500.04; FS 500.11 Misbranded.* Labeling
Lot: Number of Packages:
Quantity: Size of Packages: · Total Weight:
Disposition: Product was voluntarily destroyed by food establishment management and witnessed by inspector.
STOP SALE ORDER AND RELEASE
Reason: FS 500.04; FS 500.11 Misbranded.* Labeling
Lot: Number of Packages:
Quantity: Size of Packages: · Total Weight:
Disposition: Product was voluntarily destroyed by food establishment management and witnessed by inspector.
STOP SALE ORDER AND RELEASE
Reason: FS 500; FAC 5K-4 Violation of Florida Food Law.* Utensils, Equipment and Vending: Warewashing facilities:
installed, maintained, and used; test strips.
Lot: Number of Packages:
Quantity: Size of Packages: · Total Weight:
Disposition: Product was voluntarily destroyed by food establishment management and witnessed by inspector.
STOP USE ORDER
Reason: FS 500; FAC 5K-4 Violation of Florida Food Law.* Utensils, Equipment and Vending: Warewashing facilities:
installed, maintained, and used; test strips.
Comments: To request a Food Safety Inspector visit for written release when corrections have been made for request release of equipment,
contact the Business Center at (850) 245-5520 or
[email protected].
Print Date: 12/20/2024
Page 20 of 21
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.
Release - Other
The Food Establishment voluntarily agrees to release the products listed in the stop-sale order(s) on page(s) 14, 15, 16, 17, 18, 19, 20 for
destruction. The Food Establishment will not hold the Department liable for any lost revenue or income as a result of the destruction.
___________________________________
Signature of Food Establishment Representative
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
Jen Silva
I, _____________________________________________________
the person in charge of KELLEY QUIK STOP 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.
Refused to Sign
____________________________________________
(Signature)
ACKNOWLEDGEMENT
I acknowledge receipt of a copy of this document.
(Signature of FDACS Representative)
(Signature of Representative)
DAVID CANO, ENVIRONMENTAL SPECIALIST II
JEN SILVA, PERSON IN CHARGE
Print Name and Title
FDACS-14325 Rev. 07/13
Print Date: 12/20/2024
Page 21 of 21
Lot: Number of Packages:
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