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
X
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
  
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
X
1
 Floor: constructed, drained, clean, good repair, covering installation, dustless cleaning methods
*4
  
4
 Facilities to maintain product temperature
23
X
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
  
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
  
2
 Containers or receptacles covered: adequate number, insect/rodent proof, frequency, clean
 
      
Sanitizer Requirement:  Chemical   Quat 100-200 ppm                   Dishwasher Temperature   120F °F or label
Food Temperatures:   pizza 150; cheeseburger 137; pepperoni 39; moz. cheese 40; sausage 17; roast beef 40; milk 40; ham and cheese 38; dove bar 12; pizza 8
 
General Comments
Haccp: discussed not blocking hand sinks.

No follow up required. 
Report and Instructions Received By   Shannon Schnell /  
 
(Please Print)
  
(Signature of Owner or Representative)
Date  02/26/2009 Time In  1:30 PM Time Out  2:30 PM Sanitation Score  94 (100 Minus Demerits)
By  Penny Suszycki (Sanitarian) Adjusted Score  94  
 
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
5  Observed no thermometer in table top cooler. Please provide. (750.140) Next Inspection
15  Observed the following non-food contact surfaces to be improper: 1. chipped wood on shelves in kitchen, 2. rust on racks inside prep cooler in kitchen, 3. cracked edging on garbage can flap door, 4. torn gasket on cooler door in front of Hydrive. Repair or replace. (750.690) Next Inspection
23  Observed the following non-food contact surfaces in need of cleaning: 1. box fan in kitchen, 2. gaskets of prep cooler in kitchen, 3. white buckets in kitchen, 4. small storage bin at end of counter, 5. inside chemical cabinet, 6. juice holder in walk in cooler, 7. inside ledges of wall cooler. Please clean. (750.800) Next Inspection
34  Observed lid off of outside dumpster. Please keep lids on at all times. (750.1170) Next Inspection
36  Observed floors in all walk ins in need of cleaning. Please clean. (750.1220) Next Inspection
37  Observed stained ceiling tile above beer display in store. Please replace. (750.1210) Next Inspection
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
Report and Instructions Received By   Shannon Schnell /  
 
(Please Print)
  
(Signature of Owner or Representative)
Date  02/26/2009 Time In  1:30 PM Time Out  2:30 PM Sanitation Score  94 (100 Minus Demerits)
By  Penny Suszycki (Sanitarian) Adjusted Score  94  
 
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   Shannon Schnell /  
 
(Please Print)
  
(Signature of Owner or Representative)
Date  02/26/2009 Time In  1:30 PM Time Out  2:30 PM Sanitation Score  94 (100 Minus Demerits)
By  Penny Suszycki (Sanitarian) Adjusted Score  94