Inspector: BONNIE KRONZ, ENVIRONMENTAL SPECIALIST II
Person in charge: MARIESEL SILVA
Risk-Based Violations
Pattern of non compliance throughout the establishment of multiple duties to include cold
holding, cooling, and sanitization of food contact surfaces.
o
Deli: Employee wearing gloves, touched face and apron, and began touching racks holding
packaged ready to eat foods in the deli prep cold room. COS: Employee washed hands and changed
gloves before continuing.
x
Cafe: Solution made to sanitize clean utensils did not measure the required 150 - 400 ppm
according to manufacturer's instructions in the 3 compartment sink. Inspector test strips read 0 ppm. COS:
New sanitizer concentration bag was attached to dispenser and read 200ppm when tested with inspector
test strips.
x
Meat: Large meat slicer that went in to use at 6:00AM not washed, rinsed, and sanitized by
12:00PM. COS: A discussion was had with management about sanitization times and an employee was
directed to wash, rinse, and sanitize meat slicer.
x
Retail: Deli meat and cheese pinwheel sandwiches prepared on site at 1:00PM were being
placed in the retail island cooler near the deli at 3:00PM with an internal temperature of 47 degrees F.
COS: Sandwiches were moved to back cooler to be rapidly cooled. Meat Cooler: Various prepared on site
packages of ready to eat foods prepared at 8:00AM had an internal temperature above 41 degrees F at
12:50PM inside the walk in meat cooler. (Ceviche 45 degrees F. Chicken salad sandwiches 44 degrees F.)
COS: Ceviche and chicken salad sandwiches were voluntarily discarded. See Stop Sale and Release.
Cafe: Marinara sauce that was cupped at 9:00AM had an internal temperature of 48 degrees F at 1:30PM
inside the small reach in cooler under the ice cream machine. COS: Marinara cups were voluntarily
discarded. See Stop Sale and Release.
x
Print Date: 8/15/2025
Page 2 of 6
Y
x
It could not be verified that employees are informed of their responsibility to report
information regarding foodborne disease and symptoms. Food Employee Reporting Agreement handout
was provided.
The person in charge did not correctly respond to all questions regarding foodborne
disease. Employee Health Guide handout was provided.
o
Print Date: 8/15/2025
Page 1 of 6
6
P
Citation Description: Food employee not cleaning hands or exposed portions of arms immediately
before engaging in food preparation including working with exposed food, clean equipment or utensils, or
unwrapped single service or single use articles; after touching bare human body parts; after using the
toilet room; after caring for or handling service animals or aquatic animals; after coughing, sneezing, using
a handkerchief or tissue, using tobacco, eating or drinking; after handling soiled equipment or utensils;
during food preparation as often as necessary to remove soil and prevent cross contamination; before
donning gloves to initiate a task that involves working with food; or after engaging in other activities that
contaminate the hands. 2-301.14 P
Observation: Deli: Employee entered through deli door from deli prep cold room to enter the cooking
area and touched clean equipment without first washing hands. COS: Employee was directed to wash
hands before continuing.
x
Retail: Various ready to eat time/temperature control for safety foods had an internal
temperature above 41 degrees F inside several retail island display coolers throughout the establishment.
(Chicken Burgers 51 degrees F. Smoked Sausages 45 degrees F. Roasted Turkey 45 degrees F.
Provolone Cheese 45 degrees F. Ravioli 54 degrees F. Baby Bell Cheese 51 degrees F. Cheddar Cheese
46 degrees F. Loaded Potato Salad 50 degrees F. Mozzarella Cheese 44 degrees F. Guacamole packs 43
degrees F. Jalapeno Popper Dip 45 degrees F.) COS: Foods were moved to be rapidly cooled down or
voluntarily discarded. See Stop Sale Order and Release.
Establishment could not provide written procedures in regards to clean up of vomitus or
diarrhea event in food establishment. Industry handout provided.
Meat: Bottle of chemical wet wipes stored on top of equipment used to wrap cut meats next
to handwashing sink in the meat prep room. COS: Wet wipes were relocated for proper separation.
x
Deli: Employee dumped cups of water in the handwashing sink near prep room door. COS:
Employee was directed to use proper sink for disposal of liquids. Spray bottle of sanitizer hanging from
hand sink near prep room door. COS: Bottle of sanitizer was relocated. Back Area: Employee rinsed ice
scoop in handwashing sink in back hallway near ice machine. COS: Employee was directed to use proper
sink. Cafe: Blue slushie mixture was poured down handwashing sink in the front area of cafe near the ice
cream machine. Meat: Single handwashing sink in meat department was blocked by rolling carts used to
store packaged raw meats.
Good Retail Practice Violations
Meat and Deli: Various ready to eat foods (Meat and Cheese Pinwheels, Shrimp Cheviche,
Chicken Salad Sandwiches) are packaged in plastic containers with lids and placed on carts stacked on
rolling trays and placed in the walk in cooler or left in the deli prep cold room to begin the cooling process.
COS: Lids were removed from food packages to help facilitate cooling and all carts were removed from
deli prep cold room.
Deli: Various prepared on site ready to eat foods (Meat and Cheese Pinwheels, Chicken
Salad Sandwiches, Shrimp Ceviche) are packaged in lidded plastic containers and left to cool in the deli
prep cold room. Inspector provided probe thermometer indicates ambient room temperature of 50 degrees
F. Manager states that ready to eat foods are prepared in deli prep cold room and not relocated to another
area of the food establishment, but taken directly from racks to the retail sales floor. Inspector observed
sign on outside of deli prep cold room door stating this room should be kept at 41 degrees F or below.
Deli: Thawing ready to eat frozen foods (Sliced chicken, cooked pasta) were placed on
trays on rolling carts and were left in the deli prep cold room. Per manager, food will stay in this room to
complete the thawing process. Inspector provided probe thermometer shows ambient air temperature of
room at 50 degrees F. Foods were still in a frozen state when assessed by inspector. COS: Rolling carts
with thawing food were moved to proper refrigeration to complete thawing process.
Bakery: Two boxes of ready to eat food products stored on the floor of the walk in freezer in
the back bakery area. COS: Employee relocated boxes onto shelf.
Cafe: Multiple employees wearing bracelets, watches, and rings while working with exposed
foods.
Cafe: Tongs stored in plastic container containing cooked brownies with the handle touching
the food in small reach in fridge under the ice cream machine. COS: Tongs were removed from container.
Deli: Oven mitts stored on top of ready to eat pork ribs on racks near the rotisserie ovens in
the deli cooking area. Meat: Knife wedged between prep table and wall above prep table where raw
chickens were being prepped.
Back Area: Ice scoop stored uncovered on top of ice machine in back area near prep sink.
Meat: Styrofoam tray used to package raw meats not stored inverted on metal shelving in
the meat department. COS: Employee properly inverted trays.
Bakery: Warewashing machine has a data plate that does not contain the model or serial
number, the wash and rinse temperatures, the wash and rinse times, or the wash pressure. See Stop Use
Order.
Meat: A build up of old food debris on the underside of the non food contact surface of the
automatic raw meat wrapping station.
Receiving: No covered trash receptacle in the ladies employee restroom in the back
receiving area.
Meat: No trash receptacle near handwashing sink in the meat prep room.
Deli: Deli cold prep room used for cooling and thawing does not maintain internal
temperature of time/temperature control for safety foods at 41 degrees F or below. Manager states that
after products are prepared in the room they are held there to be cooled/cold held until placed into
customer self service retail area. COS: Per Management, deli prep cold room will no longer be utilized for
cooling and thawing of time/temperature control for safety foods. See Stop Use and Release.
Meat: Pieces of raw cut meat on floor in back area of walk in meat cooler.
Establishment did not have a current food permit displayed. COS: A copy of the current
food permit was provided before the end of inspection.
Stop-Sale Orders & Supplemental Actions
STOP USE ORDER
Reason: FS 500.04; FS 500.172 Unsanitary Equipment.* Utensils, Equipment and Vending: Food and nonfood-contact
surfaces cleanable, properly designed, constructed, and used.
Lot: Number of Packages:
Quantity: Size of Packages: · Total Weight:
Disposition: Print Date: 8/15/2025
STOP USE ORDER
Reason: FS 500.04; FS 500.172 Unsanitary Equipment.* Utensils, Equipment and Vending: Food and nonfood-contact
surfaces cleanable, properly designed, constructed, and used.
Lot: Number of Packages:
Quantity: Size of Packages: · Total Weight:
Disposition: Print Date: 8/15/2025
STOP USE ORDER
Reason: FS 500.04; FS 500.172 Unsanitary Equipment.* Utensils, Equipment and Vending: Food and nonfood-contact
surfaces cleanable, properly designed, constructed, and used.
Lot: Number of Packages:
Quantity: Size of Packages: · Total Weight:
Disposition: Print Date: 8/15/2025
STOP USE ORDER
Reason: FS 500.04; FS 500.172 Unsanitary Equipment.* Utensils, Equipment and Vending: Food and nonfood-contact
surfaces cleanable, properly designed, constructed, and used.
Lot: Number of Packages:
Quantity: Size of Packages: · Total Weight:
Disposition: Print Date: 8/15/2025
STOP SALE ORDER AND RELEASE
Reason: FS 500.04; FS 500.10 Adulterated.* Time/Temperature Control for Safety Food: Proper cooling time and
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.* Time/Temperature Control for Safety Food: Proper cooling time and
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.* 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 USE ORDER
Reason: FS 500.04; FS 500.172 Unsanitary Equipment.* Utensils, Equipment and Vending: Food and nonfood-contact
surfaces cleanable, properly designed, constructed, and used.
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: 8/15/2025
Page 6 of 9
Lot: Number of Packages:
Quantity: Size of Packages: · Total Weight:
STOP USE ORDER
Reason: FS 500.04; FS 500.172 Unsanitary Equipment.* Utensils, Equipment and Vending: Food and nonfood-contact
surfaces cleanable, properly designed, constructed, and used.
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].
Lot: Number of Packages:
Quantity: Size of Packages: · Total Weight:
STOP USE ORDER
Reason: FS 500.04; FS 500.172 Unsanitary Equipment.* Utensils, Equipment and Vending: Food and nonfood-contact
surfaces cleanable, properly designed, constructed, and used.
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: 8/15/2025
Page 7 of 9
Lot: Number of Packages:
Quantity: Size of Packages: · Total Weight:
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].
Lot: Number of Packages:
Quantity: Size of Packages: · Total Weight:
STOP USE ORDER
Reason: FS 500.04; FS 500.172 Unsanitary Equipment.* Physical Facilities: Physical facilities installed, maintained, and
clean.
Conditions under which the articles were released from this order:
Comments: Per Management, deli prep cold room will no longer be utilized for cooling and thawing of time/temperature control for safety foods.
Print Date: 8/15/2025
Page 8 of 9
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) 5, 6 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
Mariesel Silva
I, _____________________________________________________
the person in charge of SAM'S CLUB # 4785 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
I acknowledge receipt of a copy of this document.
(Signature of FDACS Representative)
(Signature of Representative)
BONNIE KRONZ, ENVIRONMENTAL SPECIALIST II
MARIESEL SILVA, ASSISTANT FRESH MANAGER
Print Name and Title
FDACS-14325 Rev. 07/13
Allison Lauricella
Environmental Specialist II
Print Date: 8/15/2025
Page 9 of 9
Lot: Number of Packages:
Quantity: Size of Packages: · Total Weight: