Page 1 of 3

X Food Service Establishment
    Retail Food Store
    Temporary
    Mobile
KANKAKEE COUNTY HEALTH DEPARTMENT
DIVISION OF ENVIRONMENTAL HEALTH
2390 W. STATION STREET
KANKAKEE, IL 60901
(815) 802-9410, (815) 802-9411 (FAX)

FOOD SERVICE SANITARY INSPECTION REPORT
 Establishment #   SA003  
    Pre-opening
X Original Inspection
    Reinspection
   Follow-Up
    Possible FBI
    Complaint
   Other
Name of Establishment  CASEY'S GENERAL STORE #2217 Address  110 S DIXIE HWY
Owner or Operator   CASEY'S RETAIL COMPANY City   ST. ANNE Zip Code   60964
 
ITEM
X
WT
DESCRIPTION
ITEM
X
WT
DESCRIPTION
ITEM
X
WT
DESCRIPTION
 
FOOD
18
 
1
 Pre-flushed, scraped, soaked
34
  
1
 Outside storage area, enclosures properly constructed, clean: controlled incineration
*1
  
5
 Source, Wholesome, No Spoilage
19
  
2
 Wash, rinse after: clean, proper temperature
2
  
1
 Original Container, Properly Labeled
*20
  
4
 Sanitization rinse: Clean, temperature, concentration   INSECT, RODENT ANIMAL CONTROL
 
FOOD PROTECTION
*35
  
4
 Presence of insects/rodents - outer openings protected; no birds, turtles, or other animals
*3
X
5
 Potentially hazardous food meets temperature requirements during storage, preparation, display, service and transportation
21
  
1
 Wiping cloths: clean, use restricted
22
  
2
 Food contact surfaces of equipment and utensils clean, free of abrasives and detergents  
FLOORS WALLS AND CEILINGS
36
  
1
 Floor: constructed, drained, clean, good repair, covering installation, dustless cleaning methods
*4
  
4
 Facilities to maintain product temperature
23
 
1
 Non-food contact surfaces of equipment and utensils clean
5
X
1
 Thermometers provided and conspicuous
37
  
1
 Walls, ceiling, attached equipment: constructed good repair, clean surfaces, dustless cleaning methods
6
 
2
 Potentially hazardous food properly thawed
24
  
1
 Storage, handling of clean equipment utensils
*7
  
4
 Unwrapped and potentially hazardous food not re-served, Cross Contamination
25
  
1
 Single-service articles, storage, dispensing  
LIGHTING
26
  
2
 No re-use of single-service articles
38
  
1
 Lighting provided as required - Fixtures shielded
8
X
2
 Food protection during storage, preparation, display, service and transportation  
WATER
  
VENTILATION
*27
 
5
 Water source, safe: Hot and cold under pressure
39
  
1
 Rooms and equipment - vented as required
9
X
2
 Handling of food(ice) minimized, methods  
SEWAGE
  
DRESSING ROOMS
10
  
1
 Food(ice) dispensing utensils properly stored
*28
  
4
 Sewage and waste water disposal
40
  
1
 Rooms clean, lockers provided, facilities clean
 
PERSONNEL
  
PLUMBING
  
OTHER OPERATIONS
*11
  
5
 Personnel with infections restricted
29
X
1
 Installed, maintained
*41
  
5
 Toxic items properly stored, labeled and used
*12
  
5
 Hands washed and clean, good hygienic practices
*30
 
5
 Cross-connection, back siphonage-backflow
42
  
1
 Premises: maintained, free of litter, unnecessary articles, cleaning/maintenance equipment properly stored, authorized personnel
13
  
1
Clean clothes, hair restraints
  
TOILET AND HAND-WASHING FACILITIES
 
FOOD EQUIPMENT AND UTENSILS
14
  
2
 Food (ice) contact surfaces: designed, constructed, maintained, installed, located
*31
  
4
 Number, convenient, accessible, designed, installed
43
  
1
 Complete separation from living/sleeping quarters, laundry
32
 
2
 Toilet rooms enclosed, self-closing doors, fixtures, good repair, clean: Hand cleanser, sanitary towels/hand drying devices provided. Proper waste receptacles, tissue
15
X
1
 Non-food (ice) contact surfaces: designed, constructed, maintained, installed, located.
44
  
1
 Clean, soiled linen properly stored
 
CERTIFIED PERSONNEL
16
  
2
 Dishwashing facilities: designed, constructed, maintained, installed, located, operated
*45
     Management personnel certified Yes X No     Registered for class    
 
GARBAGE AND REFUSE DIPSOSAL
17
  
1
 Accurate thermometers, chemical test kits provided, gauge cook
33
X
2
 Containers or receptacles covered: adequate number, insect/rodent proof, frequency, clean
 
      
Sanitizer Requirement:  Chemical   QUAT 100 ppm                   Dishwasher Temperature   NA °F or label
Food Temperatures:   SAUSAGE 22.5°, PEPPERONI 40, SAUSAGE 27, PEPPERONI PIZZA 142, PULLED PORK SAUSAGE 143, EGG SALAD SANDWICH 41, ICE CREAM 4.5, SMOKED TURKEY 47
 
General Comments
HACCP CONCEPT DISCUSSED: PROPER COLD HOLDING TEMPERATURES.

ALL FOOD HANDLERS ARE REQUIRED TO HAVE FOOD HANDLER TRAINING BY NEXT INSPECTION (750.570) 
Report and Instructions Received By   BEN PECK /  
 
(Please Print)
  
(Signature of Owner or Representative)
Date  06/25/2015 Time In  12:45 PM Time Out  3:50 PM Sanitation Score  86 (100 Minus Demerits)
By  Bryan Kennedy (Sanitarian) Adjusted Score  86  
 
Page 2 of 3

    Food Service Establishment
    Retail Food Store
    Temporary
    Mobile
KANKAKEE COUNTY HEALTH DEPARTMENT
DIVISION OF ENVIRONMENTAL HEALTH
2390 W. STATION STREET
KANKAKEE, IL 60901
(815) 802-9410, (815) 802-9411 (FAX)

FOOD SERVICE SANITARY INSPECTION REPORT
 Establishment #   SA003  
    Pre-opening
X Original Inspection
    Reinspection
    Follow-Up__________
    Possible FBI
    Complaint
    Other______________
Name of Establishment  CASEY'S GENERAL STORE #2217 Address  110 S DIXIE HWY
Owner or Operator   CASEY'S RETAIL COMPANY City   ST. ANNE Zip Code   60964
 

ITEM
Remarks and Recommendations for Corrections
Corrected By
*3  OBSERVED POTENTIALLY HAZARDOUS FOODS AT THE SOUTH END (NEAR THE DOOR) OF THE WALK-IN COOLER TO BE HELD AT IMPROPER TEMPERATURES DUE TO ONE OF THE FANS NOT WORKING (SEE VOLUNTARY DESTRUCTION AGREEMENT). PROVIDE FOR ALL COLD POTENTIALLY HAZARDOUS FOODS TO BE HELD AT 41F OR BELOW AT ALL TIMES EXCEPT DURING NECESSARY PERIODS OF PREPARATION. (750.120) 5 Days
5  OBSERVED NO THERMOMETER TO BE AVAILABLE IN THE PREP COOLER. PROVIDE FOR AN ACCURATE, CONSPICUOUS THERMOMETER THAT IS ACCURATE WITHIN +/-3F TO BE AVAILABLE IN ALL UNITS HOLDING POTENTIALLY HAZARDOUS FOODS. (750.140) Next Inspection
8  OBSERVED BOXES OF FOOD STORED ON THE FLOOR IN THE WALK-IN FREEZER. PROVIDE FOR ALL FOOD PRODUCTS TO BE STORED AT LEAST SIX INCHES OFF OF THE FLOOR. (750.130) Next Inspection
9  OBSERVED EMPLOYEES USING IMPROPER UTENSILS TO DISPENSE FOOD PRODUCTS: CUP USED TO DISPENSE PIZZA DOUGH MIX. PROVID A SUITABLE UTENSIL WITH A HANDLE STORED UP AND OUT OF THE FOOD FOR DISPENSING FOOD PRODUCTS. (750.160) Next Inspection
15  OBSERVED THE FOLLOWING IMPROPER NON-FOOD CONTACT SURFACES: 1) RAW PARTICLE BOARD FRONTS OF SHELVES IN CABINETS 2) TORN GASKETS ON TWO REACH-IN-COOLER DOORS (NEAR THE ICE AND BUD-LIGHT) PROVIDE FOR ALL FOOD CONTACT SURFACES TO BE SMOOTH, EASILY CLEANABLE, NON-ABSORBANT, CORROSIVE RESISTANT, AND LIGHT COLORED. (750.600) Next Inspection
29  OBSERVED THE FOLLOWING PLUMBING TO BE IMPROPERLY INSTALLED OR MAINTAINED: 1) LEAKING CONDENSATE LINE IN THE KITCHEN WALK-IN FREEZER. PROVIDE FOR ALL PLUMBING TO BE SIZED, INSTALLED, AND MAINTAINED IN ACCORDANCE WITH APPLICABLE PROVISIONS OF THE ILLINOIS STATE PLUMBING CODE. ALL PLUMBING MODIFICATIONS AND/OR UPGRADES WILL BE REQUIRED TO BE PERMITTED TO BE INSPECTED BY THE LOCAL PLUMBING INSPECTOR. Next Inspection
33  OBSERVED THE DUMPSTER LID OPEN. PROVIDE THAT THE DUMPSTER LID BE KEPT CLOSED, EXCEPT WHILE THROWING AWAY TRASH. (750.1130) Next Inspection
     
     
     
     
     
     
     
     
     
     
     
     
Report and Instructions Received By   BEN PECK /  
 
(Please Print)
  
(Signature of Owner or Representative)
Date  06/25/2015 Time In  12:45 PM Time Out  3:50 PM Sanitation Score  86 (100 Minus Demerits)
By  Bryan Kennedy (Sanitarian) Adjusted Score  86  
 
Page 3 of 3

    Food Service Establishment
    Retail Food Store
    Temporary
    Mobile
KANKAKEE COUNTY HEALTH DEPARTMENT
DIVISION OF ENVIRONMENTAL HEALTH
2390 W. STATION STREET
KANKAKEE, IL 60901
(815) 802-9410, (815) 802-9411 (FAX)

FOOD SERVICE SANITARY INSPECTION REPORT
 Establishment #   SA003  
    Pre-opening
X Original Inspection
    Reinspection
    Follow-Up__________
    Possible FBI
    Complaint
    Other______________
Name of Establishment  CASEY'S GENERAL STORE #2217 Address  110 S DIXIE HWY
Owner or Operator   CASEY'S RETAIL COMPANY City   ST. ANNE Zip Code   60964
 

ITEM
Remarks and Recommendations for Corrections
Corrected By
     
     
Report and Instructions Received By   BEN PECK /  
 
(Please Print)
  
(Signature of Owner or Representative)
Date  06/25/2015 Time In  12:45 PM Time Out  3:50 PM Sanitation Score  86 (100 Minus Demerits)
By  Bryan Kennedy (Sanitarian) Adjusted Score  86