Food Establishment Inspection Report
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KANKAKEE COUNTY HEALTH DEPARTMENT
 2390 W. Station Street
Kankakee, IL 60901
Phone: (815) 802 - 9410
Establishment
 CASEY'S GENERAL STORE #2217 		License/Permit #
 SA003
Street Address
110 S DIXIE HWY
City/State
 ST. ANNE, IL 		ZIP Code
 60964
No. of Risk Factor/Intervention Violations 1
No. of Repeat Risk Factor/Intervention Violations 0
Date 05/07/2021
Time In 01:45 PM
Time Out 03:20 PM
Permit Holder
CASEY'S RETAIL COMPANY 		Risk Category
M
Purpose of Inspection
ORIGINAL INSPECTION

FOODBORNE ILLNESS RISK FACTORS AND PUBLIC HEALTH INTERVENTIONS
Circle designated compliance status (IN, OUT, N/O, N/A) for each numbered item
IN=in compliance    OUT=not in compliance    N/O=not observed    N/A=not applicable
Mark "X" in appropriate box for COS and/or R
COS=corrected on-site during inspection    R=repeat violation 		Risk factors are important practices or procedures identified as the most prevalent contributing factors of foodborne illness or injury. Public health interventions are control measures to prevent foodborne illness or injury.
Compliance Status
 COS R

SUPERVISION

 
1 IN OUT     Person in charge present, demonstrates knowledge, and performs duties    
2 IN OUT N/A   Certified Food Protection Manager    

EMPLOYEE HEALTH

 
3 IN OUT     Management, food employee and conditional employee; knowledge, responsibilities and reporting    
4 IN OUT     Proper use of restriction and exclusion    
5 IN OUT     Procedures for responding to vomiting and diarrheal events    

GOOD HYGIENIC PRACTICES

 
6 IN OUT   N/O Proper eating, tasting, drinking, or tobacco use    
7 IN OUT   N/O No discharge from eyes, nose, and mouth    

PREVENTING CONTAMINATION BY HANDS

 
8 IN OUT   N/O Hands clean & properly washed    
9 IN OUT N/A N/O No bare hand contact with RTE food or a pre-approved alternative procedure properly allowed    
10 IN OUT     Adequate handwashing sinks properly supplied and accessible X  

APPROVED SOURCE

 
11 IN OUT     Food obtained from approved source    
12 IN OUT N/A N/O Food received at proper temperature    
13 IN OUT     Food in good condition, safe, & unadulterated    
14 IN OUT N/A N/O Required records available: shellstock tags, parasite destruction    
Compliance Status
 COS R

PROTECTION FROM CONTAMINATION

 
15 IN OUT N/A N/O Food separated and protected    
16 IN OUT N/A   Food-contact surfaces: cleaned & sanitized    
17 IN OUT     Proper disposition of returned, previously served, reconditioned & unsafe food    

TIME/TEMPERATURE CONTROL FOR SAFETY

 
18 IN OUT N/A N/O Proper cooking time & temperatures    
19 IN OUT N/A N/O Proper reheating procedures for hot holding    
20 IN OUT N/A N/O Proper cooling time and temperature    
21 IN OUT N/A N/O Proper hot holding temperatures    
22 IN OUT N/A N/O Proper cold holding temperatures    
23 IN OUT N/A N/O Proper date marking and disposition    
24 IN OUT N/A N/O Time as a Public Health Control; procedures & records    

CONSUMER ADVISORY

 
25 IN OUT N/A   Consumer advisory provided for raw/undercooked food    

HIGHLY SUSCEPTIBLE POPULATIONS

 
26 IN OUT N/A   Pasteurized foods used; prohibited foods not offered    

FOOD/COLOR ADDITIVES AND TOXIC SUBSTANCES

 
27 IN OUT N/A   Food additives: approved and properly used    
28 IN OUT N/A   Toxic substances properly identified, stored, & used    

CONFORMANCE WITH APPROVED PROCEDURES

 
29 IN OUT N/A   Compliance with variance/specialized process/HACCP    

GOOD RETAIL PRACTICES
Good Retail Practices are preventative measures to control the addition of pathogens, chemicals, and physical objects into foods.
Mark "X" in appropriate box for COS and/or R      
COS
=corrected on site during inspection  
R
=repeat violation  
Compliance Status
 COS R

SAFE FOOD AND WATER

 
30   Pasteurized eggs used where required    
31   Water & ice from approved source    
32   Variance obtained for specialized processing methods    

FOOD TEMPERATURE CONTROL

 
33   Proper cooling methods used; adequate equipment for temperature control    
34   Plant food properly cooked for hot holding    
35   Approved thawing methods used    
36   Thermometers provided & accurate    

FOOD IDENTIFICATION

 
37 X Food properly labeled; original container    

PREVENTION OF FOOD CONTAMINATION

 
38   Insects, rodents, & animals not present    
39   Contamination prevented during food preparation, storage & display    
40   Personal cleanliness    
41   Wiping cloths: properly used & stored    
42   Washing fruits & vegetables    

PROPER USE OF UTENSILS

 
43   In-use utensils: properly stored    
Compliance Status
 COS R

PROPER USE OF UTENSILS

 
44   Utensils, equipment & linens: properly stored, dried, & handled    
45 X Single-use/single-service articles: properly stored & used    
46   Gloves used properly    

UTENSILS, EQUIPMENT, AND VENDING

 
47   Food & non-food contact surfaces cleanable, properly designed, constructed & used    
48   Warewashing facilities: installed, maintained & used; test strips    
49 X Non-food contact surfaces clean    

PHYSICAL FACILITIES

 
50   Hot & cold water available; adequate pressure    
51 X Plumbing installed; proper backflow devices    
52   Sewage & waste water properly disposed    
53   Toilet facilities: properly constructed, supplied, & cleaned    
54 X Garbage & refuse properly disposed; facilities maintained    
55 X Physical facilities installed, maintained & clean    
56   Adequate ventilation & lighting; designated areas used    

EMPLOYEE TRAINING

 
57   All food employees have food handler training    
58   Allergen training as required    
IOCI 17-356

Food Establishment Inspection Report
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Establishments: CASEY'S GENERAL STORE #2217 Establishment #: SA003
Water Supply:   Public Private   Waste Water System:   Public Private
Sanitizer Type: Chemical PPM: QUAT 200 Heat: N/A °F
CFPM Verification (name, ID#, expiration date):
JACOB WILLIAMS
17998131
06/13/2024 		ADELA GAYTAN
20258873
02/09/2026 		ASHLEY MONIAK
21732749
02/15/2027 		LYDIA HALL
19934275
10/27/2025

TEMPERATURE OBSERVATIONS
Item/Location
Temp
Item/Location
Temp
Item/Location
Temp
cheese pizza 159.00°F packaged popcorn chicken 137.00°F gravy 175.00°F
onions 38.00°F pepperoni 40.00°F cheese slices 36.00°F
walk-in freezer 0.00°F cucumbers 40.00°F green peppers 40.00°F
walk-in drink cooler 40.00°F soft serve ice cream 40.00°F open air cooler 40.00°F

OBSERVATIONS AND CORRECTIVE ACTIONS
Item
Number 		Severity Violations cited in this report must be corrected within the time frames below.
10 PF 5-205.11 (A): (A) A HANDWASHING SINK shall be maintained so that it is accessible at all times for EMPLOYEE use.
observed hand sink to be blocked by old shelving rack and partially obstructed by bread cabinet. - COS (Correct By: May 7, 2021)
37 C 3-302.12: Except for containers holding FOOD that can be readily and unmistakably recognized such as dry pasta, working containers holding FOOD or FOOD ingredients that are removed from their original packages for use in the FOOD ESTABLISHMENT, such as cooking oils, flour, herbs, potato flakes, salt, spices, and sugar shall be identified with the common name of the FOOD.
Observed a spray bottle of water not labeled. Correct and maintain by next routine inspection.
45 C 4-903.11( A)(1)(2)(3): (A) Except as specified in ¶ (D) of this section, cleaned EQUIPMENT and UTENSILS, laundered LINENS, and SINGLE-SERVICE and SINGLE-USE ARTICLES shall be stored: (1) In a clean, dry location; (2) Where they are not exposed to splash, dust, or other contamination; and (3) At least 15 cm (6 inches) above the floor.
Observed boxes of single use cups and containers stored on the floor throughout the establishment. Correct and maintain by next routine inspection.
49 C 4-601.11(C): (C) NonFOOD-CONTACT SURFACES of EQUIPMENT shall be kept free of an accumulation of dust, dirt, FOOD residue, and other debris.
Observed some debris in the bottom right side of the sandwich prep cooler. Clean and maintain by next routine inspection.
49 C 4-601.11(C): (C) NonFOOD-CONTACT SURFACES of EQUIPMENT shall be kept free of an accumulation of dust, dirt, FOOD residue, and other debris.
Observed shelves to the baking prep table to have some debris collecting. Clean and maintain by next routine inspection.
49 C 4-601.11(C): (C) NonFOOD-CONTACT SURFACES of EQUIPMENT shall be kept free of an accumulation of dust, dirt, FOOD residue, and other debris.
observed flour debris collecting in the cabinets behind the soda pop machine. clean and maintain by next routine inspection.
51 C 5-205.15 (B): A PLUMBING SYSTEM shall be(B) Maintained in good repair.
Observed the hand sink in the sandwich making area was clogged. Repair and maintain by next routine inspection.
54 C 5-501.115: A storage area and enclosure for REFUSE, recyclables, or returnables shall be maintained free of unnecessary items, as specified under § 6-501.114, and clean.
Observed dumpster area to be in need of cleaning. Clean and maintain by next routine inspection.
55 C 6-501.11: PHYSICAL FACILITIES shall be maintained in good repair.
Observed the seal around the mop sink to ben in poor repair. repair and maintain by next routine inspection.
HACCP Topic: PROPER HAND WASHING PRACTICES.
 

Person In Charge

  JACOB 		 

Date:

  05/07/2021
 

Inspector

  Angela Colon 		 

Follow-up:  Yes   No   Follow-up Date: