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 #   BB019  
    Pre-opening
X Original Inspection
    Reinspection
   Follow-Up
    Possible FBI
    Complaint
   Other
Name of Establishment  DAIRY QUEEN OF BOURBONNAIS Address  121 S MAIN ST
Owner or Operator   NOBLE STORES, LLC City   BOURBONNAIS Zip Code   60914
 
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
  
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
 
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
  
2
 Handling of food(ice) minimized, methods  
SEWAGE
  
DRESSING ROOMS
10
X
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
X
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
X
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   Chlorine 200 ppm                   Dishwasher Temperature   °F or label
Food Temperatures:   ice cream cake 13, dilly bar 17.5, starkiss 2, milk 42.5, ice cream cake -6.5, ice cream mix33.5, buster bar 0
 
General Comments
 
Report and Instructions Received By   Tiffany A. Mosier /  
 
(Please Print)
  
(Signature of Owner or Representative)
Date  01/10/2012 Time In  2:45 PM Time Out  3:40 PM Sanitation Score  84 (100 Minus Demerits)
By  Steven Lamb (Sanitarian) Adjusted Score  89  
 
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 #   BB019  
    Pre-opening
X Original Inspection
    Reinspection
    Follow-Up__________
    Possible FBI
    Complaint
    Other______________
Name of Establishment  DAIRY QUEEN OF BOURBONNAIS Address  121 S MAIN ST
Owner or Operator   NOBLE STORES, LLC City   BOURBONNAIS Zip Code   60914
 

ITEM
Remarks and Recommendations for Corrections
Corrected By
*41  Observed the following toxic chemical container(s) to not be properly labeled: two spray bottles under 3 compartment sink. Provide for all chemical containers that no longer have the original label on them to be labeled with chemical content. Immediate/Onsite
8  Observed no covers on the ice cream syrups next to drive through window. Provide for all food products in storage to have proper covers or overhead protection. Next Inspection
10  Observed the ice scoop(s) to be improperly stored: ice scoop hand sink. Provide for all ice scoops to be stored either clean and dry, or in the ice with the handle up and out. Next Inspection
15  Observed the following improper non-food contact surfaces: seal gasket on front reach-in freezer and chipping paint on inside bottom of front glass top freezer. Provide for all food contact surfaces to be smooth, easily cleanable, non-absorbant, corrosive resistant, and light colored. Next Inspection
23  Observed the following non-food contact surfaces to be unclean: back shelf below prep table where sugar is located and seal gaskets on back Masterbelt freezer. Clean and maintain. Next Inspection
29  Observed the following plumbing to be improperly installed or maintained: back handsink not draining properly. 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 inspected by the local plumbing inspector. Next Inspection
32  Observed no paper towels at the following handsink(s): handsink with non functioning drain. Provide for all handsinks to have supply of soap and paper towels to assure that proper handwashing occurs. Next Inspection
33  Observed the following garbage containers to be full: near back table and employee restroom. Empty garbage containers as needed. Next Inspection
36  Observed the following floor areas to be unclean: walk-in freezer with food debris. Provide for all flooring areas to be in a clean condition. Next Inspection
     
     
     
     
     
     
     
     
     
     
     
Report and Instructions Received By   Tiffany A. Mosier /  
 
(Please Print)
  
(Signature of Owner or Representative)
Date  01/10/2012 Time In  2:45 PM Time Out  3:40 PM Sanitation Score  84 (100 Minus Demerits)
By  Steven Lamb (Sanitarian) Adjusted Score  89  
 
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 #   BB019  
    Pre-opening
X Original Inspection
    Reinspection
    Follow-Up__________
    Possible FBI
    Complaint
    Other______________
Name of Establishment  DAIRY QUEEN OF BOURBONNAIS Address  121 S MAIN ST
Owner or Operator   NOBLE STORES, LLC City   BOURBONNAIS Zip Code   60914
 

ITEM
Remarks and Recommendations for Corrections
Corrected By
     
Report and Instructions Received By   Tiffany A. Mosier /  
 
(Please Print)
  
(Signature of Owner or Representative)
Date  01/10/2012 Time In  2:45 PM Time Out  3:40 PM Sanitation Score  84 (100 Minus Demerits)
By  Steven Lamb (Sanitarian) Adjusted Score  89