Date: Time: eport: 08/10/17 10:00:00 8010171131 Minnesota Department of Health Food, Pools & Lodging Services Section PO Box 64975 St. Paul, MN 55164-0975 651-201-4500 Page 1 Location: 428 N Central Avenue Duluth, MN55801 St. Louis County, 69 Establishment Info: ID #: 0023606 isk: Medium Announced Inspection: No License Categories: HOSP, FBLB, FBME Operator: PDI Foods LLC dba McDonald's Phone #: 2186240460 Expires on: 12/31/17 ID #: 47896 The violations listed in this report include any previously issued orders and deficiencies identified during this inspection. Compliance dates are shown for each item. The following orders were issued during this inspection. 1-100 Food Manager Certification 1-101.01MN MN ule 4626.2010 Employ one full-time State certified food manager for the establishment. YAN ANDESON HAS TAKEN THE SEV SAFE CLASS. COMPLETE THE STATE CETIFIED FOOD MANAGE APPLICATION AND POST CETIFICATE WHEN ECEIVED. 4-300 Equipment Numbers and Capacities 4-302.14 MN ule 4626.0715 Provide an appropriate test kit to accurately measure sanitizer concentration. POVIDE QUATENAY AMMONIUM TEST STIPS TO TEST THE CONCENTATION OF THE 3 COMP SINK AND SPAY BOTTLE SANITIZES. CONCENTATION IS BETWEEN 200-400 PPM. 4-500 Equipment Maintenance and Operation 4-501.11AB MN ule 4626.0735 All equipment and components shall be in good repair and maintained and adjusted in accordance with manufacturer's specifications. THE INSIDE OF THE WALK-IN FEEZE HAS ICE BUILD UP AND WATE DIPPING FOM A PIPE IGHT OUTSIDE THE FEEZE DOO. EPAI.
Page 2 6-300 Physical Facility Numbers and Capacities 6-301.12AB MN ule 4626.1445 Provide and maintain at each handwashing sink in the food preparation and warewash areas a supply of individual disposable towels or a continuous towel system that supplies the user with a clean towel. THEE WEE NO PAPE TOWELS AT THE HANDSINK. PAPE TOWELS WEE POVIDED BY YAN. Corrected on Site 6-500 Physical Facility Maintenance/Operation and Pest Control 6-501.18 MN ule 4626.1550 Clean and maintain the handwashing sinks. THE HANDSINK NEEDED TO BE CLEANED. CLEAN ON A EGULA BASIS. Surface and Equipment Sanitizers Chlorine: = 100 PPM at Degrees Fahrenheit Location: WIPING CLOTH BUCKET Quaternary Ammonia: = 400 PPM at Degrees Fahrenheit Location: 3 COMP SINK Quaternary Ammonia: = 400 PPM at Degrees Fahrenheit Location: SPAY BOTTLE Food and Equipment Temperatures Temperature: 149 Degrees Fahrenheit - Location: FOLDED EGGS Temperature: 153 Degrees Fahrenheit - Location: OUND EGGS Temperature: 156 Degrees Fahrenheit - Location: SAUSAGE Process/Item: Cold Line Temperature: 40 Degrees Fahrenheit - Location: SLICED TOMATOES-CHILL ACK Process/Item: Cold Line Temperature: 38 Degrees Fahrenheit - Location: SOUTHWEST VEGETABLES-CHILL ACK
Page 3 Process/Item: Undercounter cooler Temperature: 38 Degrees Fahrenheit - Location: SALAD Temperature: 41 Degrees Fahrenheit - Location: PACKAGED SALAD DESSINGS Temperature: 38 Degrees Fahrenheit - Location: LIQUID EGGS Temperature: 38 Degrees Fahrenheit - Location: SLICED TOMATOES Temperature: 36 Degrees Fahrenheit - Location: MILK-DIVE UP Temperature: 38 Degrees Fahrenheit - Location: ICE CEAM AND SHAKE SOFT SEV Process/Item: Walk-In Cooler Temperature: 41 Degrees Fahrenheit - Location: WALK-IN Temperature: 38 Degrees Fahrenheit - Location: YOGUT Temperature: 164 Degrees Fahrenheit - Location: HASHBOWNS COMMENTS: Total Critical Orders This eport: Total Non-Critical Orders This eport: EVEIWED THE EMPLOYEE ILLNESS LOG SHEET AND THE ECLUSION OF EMPLOYEES ILL WITH VOMITING O DIAHEA FOM THE FOOD ESTABLISHMENT FO 24 HOUS AFTE SYMPTOMS AE GONE WITH YAN. OBSEVED STAFF WEAING GLOVES WHEN MAKING SANDWICHES. OBSEVED STAFF WASHING HANDS WHEN CHANGING A TASK. 0 5
Page 4 NOTE: All new food equipment must meet the applicable standards of NSF International. Plans and specifications must be submitted for review and approval prior to new construction, remodeling or alterations. I acknowledge receipt of the Minnesota Department of Health inspection report number 8010171131 of 08/10/17. Certified Food Manager: Certification Number: See eport Expires: / / Inspection report reviewed with person in charge and emailed. Signed: yan Anderson Signed: Deborah Kosiak Public Health Sanitarian Duluth District Office 218-302-6176 Deb.Kosiak@state.mn.us
eport #: 8010171131 Minnesota Department of Health Food, Pools & Lodging Services Section PO Box 64975 St. Paul, MN 55164-0975 Food Establishment No. of F/PHI Categories Out No. of epeat F/PHI Categories Out Legal Authority MN ules Chapter 4626 Address City/State Zip Code Telephone 428 N Central Avenue Duluth, MN 55801 2186240460 License/Permit # Permit Holder Purpose of Inspection Est Type 0023606 PDI Foods LLC dba McDonald's FOODBONE ILLNESS ISK FACTOS AND PUBLIC HEALTH INTEVENTIONS Circle designated compliance status (IN, OUT, N/O, N/A) for each numbered item Date Time In Mark "" in appropriate box for and/or Time Out isk Category M IN= in compliance OUT= not in compliance N/O= not observed N/A= not applicable = corrected on-site during inspection = repeat violation Compliance Status 1A N/A Demonstration of Knowledge Certified food manager, duties 1B PIC knowledgeable; duties & oversight Employee Health 2 Management awareness; policy present 3 4 5 6 7 8 9 10 11 12 13 14 15 Proper use of reporting, restriction & exclusion Good Hygenic Practices N/O Proper eating, tasting, drinking, or tobacco use N/O No discharge from eyes, nose, and mouth Preventing Contamination by Hands N/O Hands clean & properly washed N/A N/O Hand contact with TE foods restricted Adequate handwashing facilities supplied & accessible Approved Source Food obtained from approved source N/A N/O Food received at proper temperature N/A N/O N/A N/A Food in good condition, safe, & unadulterated equired records available; shellstock tags, parasite destruction Protection from Contamination Food separated/protected from cross contamination Food contact surfaces: cleaned & sanitized Proper disposition of returned, previously served, reconditioned, & unsafe food Compliance Status Potentially Hazardous Food Time/Temperature 16 N/A N/O Proper cooking time & temperature 17 N/A N/O Proper reheating procedures for hot holding 18 N/A N/O Proper cooling time & temperature 19 N/A N/O Proper hot holding temperatures 20 21 22 N/A Consumer Advisory 23 N/A in MN Consumer advisory for raw or undercooked foods 24 25 26 GOOD ETAIL PACTICES Proper cold holding temperatures N/A N/O Proper date marking & disposition N/A N/O Time as a public health control: procedures & record N/A in MN N/A Highly Susceptible Populations Pasteurized foods used; prohibited foods not offered Chemical Food additives: approved & properly used Toxic substances properly identified, stored, & used Conformance with Approved Procedures 27 N/A Compliance with HACCP plan and variance 2 0 08/10/17 10:00:00 isk factors (F) are improper practices or proceedures identified as the most prevalent contributing factors of foodborne illness or injury. Public Health Interventions (PHI) are control measures to prevent foodborne illness or injury. Good etail Practices are preventative measures to control the addition of pathogens, chemicals, and physical objects into foods. Mark "" in box if numbered item is not in compliance Mark "" in appropriate box for and/or =corrected on-site during inspection = repeat violation Safe Food and Water 28 Pasteurized eggs used where required 29 30 31 32 33 34 Water & ice from approved source Variance obtained for specialized processing methods, documentation on file Food Temperature Control Proper cooling methods used; adequate equipment for temperature control Plant food properly cooked for hot holding Approved thawing methods used Thermometers provided and accurate Food Protection 35 Food properly labled; original container 36 Insects, rodents, & animals not present; no unauthorized persons 37 38 39 40 N/A N/A Food ecalls: Contamination prevented during food prep, storage & display Personal cleanliness Wiping cloths: properly used & stored Washing fruits & vegetables 41 In-use utensils: properly stored 42 43 45 Proper Use of Utensils Utensils, equipment & linens: properly stored, dried, & handled Single-use & single service articles: properly stored & used 44 Gloves used properly 46 47 48 49 50 51 52 53 54 55 56 Utensil Equipment and Vending Food & non-food contact surfaces cleanable, properly designed, constructed, & used Warewashing facilities: installed, maintained, & used; test strips Non-food contact surfaces clean Physical Facilities Hot & cold water available; adequate pressure Plumbing installed; proper backflow devices Sewage & waste water properly disposed Toilet facilities: properly constructed, supplied, & cleaned Garbage & refuse properly disposed; facilities maintained Physical facilities installed, maintained, & clean Adequate ventilation & lighting; designated areas used Compliance with MCIAA & Choking Poster Compliance with licensing & plan review Person in Charge (Signature) Date: 08/11/17 Inspector (Signature) Follow-up Needed: YES NO (Circle one) Follow-up Date: / /