HomeMy WebLinkAboutBlackburn Elementary Kid Connection 420097 04 05 11. LS.pdf14.C, Depwirneat of Environment and 1, at R murcts Denterit, 2 Health
Division ofEnvironaierital Health,
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Sanitation Standards Evaluation Date of hisp/clrg 0 4 ----- / 0 5 1 1 Current Facility ID 2018420097
or for Child are Centers
StiarA Old Facility I
trIS Code. D
classirivortical [ESuperior ElApprove d 0 P-r-o-v-i-si-o-n-aT-LTt�is-appro ved WAer sample, to Wdar, []Yes [E No
water S Opp ly: Rc 0 MM U My 11don-TransWnt Non -Commune lnSP'':1i10n Name Change
DTranslonl Non -Community [j],Non-Public Water SuppN Re-ffi P ytion Verification of Closure
Wastewater SystencE VrSlt Status Change
community [Eon-slte system
Licensing ID lulu. Maximum Capacdyll= Comment Sheet Affached ElYes [ENO
COMMUNITY SCHOOLS
Nwne of E;acrlii r.BLACK BURN ELEM KID CONNECTION Operator:
Street Address, 4377 W NC 10 HM
aty, NEWTON statt'NC zip.28658
HAND WASH #4 G:.2803,.2836
D ent erits
D em erits
I , Handwashing when required
05
30. Non,hazardoin products property stored
3
2 proper handy ashing procedure
05
31, ForulMes provided for proper storage, used and kept dean
82
FOOD: 2804,2006, 2807, 2008,183
BEDS, COTS, MATS AND LINENS: 2821,1836
*3- From approved scumers, no "hige, no adulleration
06
P2, Indimclual hinen provided adequate bed$, oois, or rinsats proyido,,
(D3
*4, Potentially hazardous foods meet storage and hohing
06
in giccol repat, prop-erlys toted, labeled, spaced airing use,
territyeratures'- Isclilles, lunches refrigerated at 450 F or Le�.Iovv
n� , Linen, booklint; wash doths, Istics, Wrlsing cloths launderea and
U3
5, F ocd prfWly stored, awed, epared, wed, Cod ect,
5
in good teprair
hang ect smed, kansporteo pack,9ged and identilrej, kvly
�jr
TOYS, EQUIPMENT, FURNITURE: .2822, 2t13fi
su pervised oinkiten in Morien
A. Clean and in glyscl repair,, water p4aycenters cleanest sanitized
(D 4
6, Not re-steved
03
and mainlained
7. Thertmonceterrs providact accurate
02
35, Mouth -coatad , surfaces deanerd and sanitized in rooms vidlere
04
FOOD SERMCE EQUIPMENT& UTENSIL&- 2M, 2810,2812,1814
chit en who are not h�Aet Iminedare cared 14
*8, Meets spooifications fof reffigetalion, sinks, lavatoiires and
6
PERSONNEL .2008,.28,23:
36,
dsherashing equipment
Approved hygienic pladices, dean dothes, hair train where
02
Meets spv�ficaficorrs for other equipTient and utensils,
required;: no ewidence of tobacco use where prohibited
approved rnaitonal and construction
04
FLOORS,;FALLS & CEIUNOS,R .2824,,28", 1832,2836
37 E osily dearnable, dean, and in 9ex)d repwair, carpels vacuumed
04
Food conlad, surfaces l;properlywadiod, rinsed, sanitized
05
and air dried; sin je-sm.crice article. not re -used
as required and ex1radion derinect date deraned__
LIGHTING AND THERMAL EW IRONMENT:.M6
11, Approved sandizer pert to kit arvailartile
02
38, Room temperature between 6550 F alvd�" Fr
C) 3
1Equipment, nonf ood contad sudarces, clon" in good, repair
04
39 Eqttipment clean and in good repair„ rnwntained as required
(_)2
13 Proper sora, and handing of dw e quipment, ul onsils
03
COMMUNICABLE DISEASE CONTROL M, 7,1834
and singe -service arts ley
*40, Porcons *tha wmirru"iolle deecisoor conditiori excluded in
06
WATER SUPPLY & DRINKING WATER FACILJTIE&.ni5,2836
acio-rotlancewilln 10,ANCAC,41A.0200
*14- Wtersopplyrneels 15ANCAC, 18A,1700 and lSANCAC,
06
41, Pei - sons caring fcf sickorty9dyill children excluded from
04
18C d applicable dowim"lation pirovirded
*15, Hot VAter suppfl�d and maintained in the, kitchen
06
situalions in vitich disease transmission likelyto +xcur
16, Hot water supplied and tempered water trainlained as
04
42 Designated area forsrok ollidreir, nroiritsdnM is required
WASTEWATE R: 2829
02
required in all other areas
*4d, Apprs)vedwastewaterdisposal inmordancewil;hISANCAC
06
IT Hot wat of, in ox eos of RIFF n d a tow ed in areas
06
18A , f XXI
accessible to children
SOLID WASTE:.2330, Mi
18 Back1low pervenfice pick4ded, no cross connextions
03
44, Solid waste riiclpe;t't handled, containers and deaning
02
119. Apprcktd drinking louplain s, pressuie relalecf dean
02
equipment kept clean can cleaning lacililies adequate
LEAD POISONING HAZARDS., .2816
ANIMAL & VERMIN CONTROL, OUTDOOR LEAR.N440 ENVRONMENT
*20, No idenfililed lead poisoning hazards in accordance with
NGGS 130AA31 7(7)
06
& PREMMES:.2831,1832
*45,
0 6
Pesticides prop-ery used,, no new CC.A pressure41eri led wood
TOILET AND LAVATORY FACILITIES. 2847, 23 18, 1834
46, CCA pressuirer4realed wcod sealed date sealed )2
21, Properlysize4 locarted, yiccesstthle, and in pood repair,
04
sort onvele'd or inaccossible
sinks, toilets and p* charrs c6aned and cliskifecred
47, No ant riats- in food prepairalion areas andno unrestrained
(:)3
22. Soap, approved hand ck�ing d"cers, toilet tissueavailable,
03
animals exceM as allmed; no prohibited antrials,' required
2,3, Appir%"J storage in toiet rwms, I ovatones froo 0 storager,
02
%*terinary reoNxds avadaUry and current
hand wash sigris posted,
48 Eff edwe control of rodents, inseds, and othei veirnin., prernim ft,
0 3
DIAPER CHANGING FACILITIES. 2811, 2818, 2819;.2820,.2M
Iree of vefirnin harborage and brewing areas
*24. Aprarovod f acildies as needed
06
49 Preffises doarr arid dmineA 60lornent in grood repair,
* 2 5, Dior_�erinq surfaces dooned and disittleded after oach rase
son rtv xos proWly oonstr u d ed a n d c loo n, acti eio in oo t o at
213 Approved cleaning and clisinfeofing solutions provkiekt test
-
2
quality foirecad ouldoor adivity restindions when appficalsle
kit a4lable when inquired
SWIMMING &WADING POOLS: 33
2T Free rit storage and in good ropir; dooning and,*sinfeding
0 4
*fX) Designed, Go cted, crated and maintwned in accorylance
06
coWpm,s labeled; approued diapering methods used,, dapef
w1h 15A NG $A
chancitng and handwash signs posted
STORACE:1820
hdkat 'Calram '-derrients)
*,n, Medications properly stored
r 6
EIHSID
S rr t7 d 1896
*29. Hazardous products property stored and looked
J6
ah Specas
Iro e 11I I ell ilit
Aapqwa TNS form is wed to aMrrlevett GS. 110-33 requirng 6M ewe mterc to, vAmit evidence of rmetwl- sanAakun
standardi m 0111 U-91 ° PirvparAiairc An of final and im cones d f6z1fWM AaAbe cornpletej kylual,
Thear4rolasedinihe
NCD DHHS, om mpy k qiwh to the di Id tare operakw; and the Mier opyia ke ra by 1:4. boa h4th
de{arnim
EUi 5,iffica*w Soptflor- 015 oenls, no 6 -point 4ermtil; AWowd -1 -30 *Merl,, no 6-P wit derrent Piroubliaial - 31-45 d mmritt, or any 6-p oint dom rlr UbiiWavvit - 46
classlicatm, im DispailifiThis form maybe destroyed 6 accordance Wth Stardvd-8.01., 62pedian pe"irds, of the Rmords Retettion aM fie' sr. NrC1
Aftonal fomis may be ordered fryar: Dimuon prierrinwrtal Hiraft,,1632, �Mad o C* r, "Rget� 7699 632, (cawierQ,4140),
gh, NC2 -1
DENR 1617 ONiftst 706), A
Services Sectim(Rmiew M)
N.C. Department of Environment and NaturM Peso
Division of Environmental Health
Name: BLACKBURN ELEMKID Time In: 0 4 0 01 E] a rn
[D: t1 Time Out: 4 0 1 E]am
Stre et' 4377 W NC 10 HWY Total Time- 1 minute R]pm
IMMEMEM
I I MIX SANITIZE TO 50-20OPPM AND DISINFECTANT TO 500-800PPM BLEACH.
General Comment? E]yes
EM
Department o f Environm ent and N atural P asourses
Division of Environmental Health
ID: 2018420097
M614031"' 004011
Street: 4377 W NIC 10 HWY
City,
IM
N.C. Department of Environment and Natural Resourses
Division of Environmental Heafth
Name BLACKBURN ELF M KID,
0: 2018420097
Street: 4377 W NC 10 HWY
ESSMINIMME
M
N.C, Department of Environment and Natural Resourses
Division of Environmental Health
Name: BLACKBURN ELEM KID
iD, 2018420097
Street 4377 W NC, 10 HWY
ESSME94MM