Polets Grocery Store # 2 LLC in Port Charlotte

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. Payments can be made online at https://foodpermit.fdacs.gov or can be mailed to Florida Department of Agriculture and Consumer Services, P.O. Box 6720, Tallahassee FL 32314-6720. Checks and money orders are to be payable to Florida Department of Agriculture and Consumer Services. All payments must include the Food Establishment number and reason of payment type in the memo section of the check or money order. Thank you for submitting your food establishment permit application. To complete the application process, you must meet all permitting requirements as specified in Rule 5K-4.020(2)(a)-(e), F.A.C. To expedite the processing of your food permit application, electronic online payment is available at https://foodpermit.fdacs.gov. Payment by check or money order is also accepted and must be accompanied by an invoice. Please note that payment by check or money order may delay the processing of your food permit application. Failure to meet all permitting requirements will result in the denial of your permit and you may be subject to administrative penalties if you are found operating without a valid food permit, which is a violation of Section 500.12(1)(a), Florida Statutes. If you are found to be in violation of this provision, the Department may impose up to a $5,000.00 fine against you and/or seek administrative action to suspend food activities. The Minimum Construction Standards checklist has been used in accordance with 500.12(2)(a) Florida Statutes by the food safety inspector to determine compliance before obtaining a food permit. The food establishment is operating without a valid food permit. An application for a food permit has been submitted. The Food Establishment shall remit payment of the appropriate fee within 10 days. Electronic online payment by credit card or e-check is available at https://foodpermit.fdacs.gov. Payment by check or money order is also accepted but must be made payable to FDACS and remitted to Florida Department of Agriculture and Consumer Services, PO Box 6720, Tallahassee, FL 32314-6720. Please

Comments: Emergency Response Assessment – Hurricane Idalia

Comments: Payments can be made online at https://foodpermit.fdacs.gov or can be mailed to Florida Department of Agriculture and Consumer Services, P.O. Box 6720, Tallahassee FL 32314-6720. Checks and money orders are to be payable to Florida Department of Agriculture and Consumer Services. All payments must include the Food Establishment number and reason of payment type in the memo section of the check or money order. Thank you for submitting your food establishment permit application. To complete the application process, you must remit payment in full. To expedite the processing of your food permit application, electronic online payment is available at https://foodpermit.fdacs.gov. Follow the instructions on the portal page for payment processing. Payment by check or money order is also accepted, but must be made payable to FDACS and remitted to Florida Department of Agriculture and Consumer Services, FDACS 14205 Rev. 07/13 Page 4 of 5 Florida Department of Agriculture and Consumer Services Division of Food Safety FOOD SAFETY INSPECTION REPORT NICOLE "NIKKI" FRIED COMMISSIONER Chapter 500, Florida Statutes (850) 245-5520 *99997182184182* Visit # 9999-7182-1841-82 Bureau of Food Inspection Attention: Business Center 3125 Conner Boulevard, C-26 Tallahassee, FL 32399-1650

Comments: Visit made to discuss permitting requirements with management. Three-compartment sink and water bill still required. Proper labeling and proper chemical storage was also discussed with management. Owner will contact when minimum construction standards are met. ACKNOWLEDGMENT I acknowledge receipt of a copy of this document, and I further acknowledge that I have verified the location and mailing addresses on the first page of this document are correct, or I have written the correct information on the first page of this document. (Signature of FDACS Representative) SCOTT RAPRAGER, ENVIRONMENTAL SPECIALIST II (Signature of Representative) AMI BENOIT, MGR Print Name and Title FDACS 14205 Rev. 07/13 Page 1 of 1 FDACS 14205 Rev. 07/13 Page 1 of 1