Florida Gateway Food Bank in Lake City

Reason: FS 500.04; FS 500.10 Adulterated.* Pest Control

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

Reason: FS 500.04; FS 500.10 Adulterated.* Pest Control 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 FoodSafety@FDACS. gov. Print Date: 1/30/2026 Page 1 of 3

Reason: FS 500.04; FS 500.10 Adulterated.* Pest Control 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 FoodSafety@FDACS. gov. Print Date: 1/30/2026 Page 2 0f 3 When the department oF its duly authorized agent finds, of has probable cause to believe, that any food oF food-procassing equipment is in Violation of this chapter oF any rule adopted under this chapter 80 a8 to be dangerous, unwholosome, fraudulent, oF iInsanitary within the meaning of this chapter, an agent of the department may issue and entoroe A Btop-salo, Btop-1180, femoval, oF hold order, which order gives Notice that Ssuoh article oF processing equipment is, OF Is sUapPEoted Of being, In violation and has been detained or embargoed and which order warns all Persons Not to TeMoVeE, 86, OF dispose Of SUCH Article OF Processing equipment by sale or otherwise until pennission for removal, usa, or disposal is given by the department or the court. It ls unlawful for any person to remove, 86, oF dispose of such detained or embargoed article or processing equipment by sale or othorwise without such permission in accordance with 600.172 (1) Florida Statutes Release - Other The Food Establishment voluntarily agrees to release the products listed in the stop-sale order(s) on page(s) 41 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 tf 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 mus 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 \, the person in charge of Florida Gateway Food Bank 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. (Signature) ACKNOWLEDGEMENT y ofthis document. AA NY é cA (Signature of FIPACS Representative) (Signature of Representative) DAVID BOOZER, FOOD BANK WAREHOUSE MANAGER TERRY TAYNTON, ENVIRONMENTAL SPECIALIST Ill Print Name and Title FDACS-14325 Rev. 07/13 Print Date: 1/30/2026 Page 3 of 3