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
X
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
X
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
  
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
  
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
  
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
X
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
  
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
  
2
 Containers or receptacles covered: adequate number, insect/rodent proof, frequency, clean
 
      
Sanitizer Requirement:  Chemical   QUAT NOT SET UP ppm                   Dishwasher Temperature   N/A °F or label
Food Temperatures:   PROVOLONE CHEESE 41, ROAST BEEF 41, HAM 41, TURKEY 43, VEGGIES 43, MILK 37, EGGS 37, GRAVY 128, PIZZA 140, HAMBURGER PATTY 174, BREAD DOUGH 39, NACHO CHEESE CUP 39
 
General Comments
HACCP CONCEPT DISCUSSED: HEATING AND HOLDING PROCEDURES FOR ALL TIME TEMPERATURE CONTROL ITEMS.

REGARDING SHED FOR DRY STORAGE. SINGLE SERVICE ARTICLES ARE APPROVED BY KCHD TO BE STORED IN THE WOODEN SHED AS LONG AS THEY ARE STORED IN SOME KIND OF CONTAINER( LIKE THE BOX THEY CAME IN, PLASTIC THEY CAME IN, OR A PLASTIC TOTE) AS AN EXTRA MEASURE TO PROTECT THEM FROM ANY TYPE OF POTENTIAL CONTAMINATION. 
Report and Instructions Received By   JAKE. /  
 
(Please Print)
  
(Signature of Owner or Representative)
Date  11/21/2016 Time In  10:15 AM Time Out  11:20 AM Sanitation Score  90 (100 Minus Demerits)
By  Angela Colon (Sanitarian) Adjusted Score  95  
 
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 the following potentially hazardous foods to be held at improper temperatures Small batch of gravy was found to be 129-130. The internal temperature of potentially hazardous foods shall be 135°F, or above except during necessary periods of preparation, including foods requiring transportation. 750.150. Turned up. Immediate/Onsite
2  Observed the following food products to have improper/no labeling information: Seasoning/toppings in clear containers by doughnuts and white seasoning container by dough mixer not labeled. Provide all bulk stored food items to be labeled. 750.130. Next Inspection
5  Observed no thermometer to be available in the following units: kitchen walk-in cooler. Provide for the thermometer to be conspicuously stored in all coolers and freezers. 750.140 Next Inspection
14  Observed the following improper food contact surfaces: Shelves in sandwich prep coolers had some chipped/rusty shelving. Repair. 750.650. Next Inspection
37  Observed the following wall/ceilings, and attached equipment to be unclean: Vent covers above the store walk-in cooler entrance by sub shop. Clean. 750.1220. Next Inspection
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
Report and Instructions Received By   JAKE. /  
 
(Please Print)
  
(Signature of Owner or Representative)
Date  11/21/2016 Time In  10:15 AM Time Out  11:20 AM Sanitation Score  90 (100 Minus Demerits)
By  Angela Colon (Sanitarian) Adjusted Score  95  
 
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   JAKE. /  
 
(Please Print)
  
(Signature of Owner or Representative)
Date  11/21/2016 Time In  10:15 AM Time Out  11:20 AM Sanitation Score  90 (100 Minus Demerits)
By  Angela Colon (Sanitarian) Adjusted Score  95