Flowers Warehouse and Thrift Store # 0094 in Tallahassee

Reason: FS 500; FAC SK-4 Violation of Florida Food Law.° Plant Construction and Design Comments: FDACS-14325 Rev. 05/22 ACKNOWLEDGEMENT Print Date: 5/30/7074 Page 4 of 5 Scanned by CamScanner 2107 ebeg vzOz/6z/S -aVeC Wud AN ADMINISTRATIVE HEARING IS AVAILABLE FOR ALL ORDERS, NOTICES, AND REPORTS IN THIS SUPPLEMENTAL REPORT Ifyou wish to contest the Department's action, you have the ri with Sections 120.569 and 120.57, Florida Statutes and to b for hearing must contain: ight to request an administrative hearing to be conducted in accordance represented by counsel or other qualified representative. Your request 1. Your name, address, and telephone number, and facsimile number (if any). 2. The name, address, and telephone ‘umber, and facsimile number of your attorney or qualified representative (if any) upon whom service of pleadings and other Papers shall be made, 3. Astatement that you are fequesting an administrativ case you must identify the material facts that are in dis; do not dispute the facts alleged by the department (i © hearing and dispute the material facts alleged by the department, in which pute (formal hearing), or that you request an administrative hearing and that you 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 req luest an administrative hearing within the twenty-one (21) day deadline you waive your right toa 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 - 1, Jaadie ni ay the person in charge of FLOWERS WAREHOUSE AND THRIFT STORE # 0094 hereby waive a notice and a hearing as provided in Chapter 120, Florida Statutes and waive all fights as provi le last ‘of port. (Sjaffature) ACKNOWLEDGEMENT A copy of this feport has been provided to the Person in charge of the food establishment. \ | acknowledge teceipt of a copy of this document. 4 22 LT Signature of FORCA\Repr tive Ighafure of Representative ° TERRY TAYNTON, NMENTAL SPECIALIST IL cl KIE BOHANAN, MANAGER Print Name and Tile FOACS-14325 Re). g Page 3ot3 Print Date: S720/2004 Page 2 of 2 Scanned by CamScanner