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CIASSWAtiolm E]Sulterior []Approved OProviSionil D_D7s a -PP, o V ed Water sample taken toW, 1:1 Ye s EE NO
Wa*'rSQPP1"ycommunity [ijIsJon-firawssent Nrrn° Comm, unity Inspection Name Change
OTransient Non-Communily [ilklon-Public Water SuppN 2Re-inspection Verification of Closure
Wastewater, Sys*nt. [I]Connnnunfly [Eon -site System Vrsft Status Ctiange
Licensing ID N a M aunnurn Capacity Comment Sheet Attached 11 Yee RINo
N am 0 of F 1611ty BLACKBURN ELEM KID CONNECTION COMMUNITY SCHOOLS,
Strtet Addixesi: 4377 W NC 10 HWY
C'n., NEWTON snorw NC Zip 28658
HANDWASHING: .21103,21336
D mi erits
Dent eri,ts
1,
Handwashing when required
0
Non-hazardous products propedy, stored
3
2,
Proper hand woshing procedure
05
31, Facilities provided for proper storage, used and kept deori
82
FOOD:
1804,2806,2807, 2808,1836
BEDS, COTS, MATS AND LINENS: .2821,1836
*3,
From approved sources, nospisdage no adullerrifion
4 )6
'6'2 1 Indivolual lei on provided,, adequate beds, cols, (x is provided
03
*4,
Pot entra Ity In aza rdisus 1'rvds meel stsca pe anti h oldin 9
01 6
in repair, pmperly stored, laix1od, siosood doing use
temper atures, sottles, lon (bes T Ori ger oted, at 45" F or bel ow
33, Linen, bedding, wash doths, bits, Wong oicillris laundere'd, and
(33
5,
Food properly strxed, thawe 0, prepared ocodred, coc4e1,
05
in gcw.A repair
handed, served, kansported,' packaigisd and *n1dred; only
TOYS, EQUIPMENT, FURNITUIRE: .2822,.2836
sop em'sed, ohddren in k1chen
'A Clean and in good repair; water' play centers deane4 sa nifiz ed
04
F.
Not re-swed
03
and maintained
7,
Thermcdrneters provided, acwraie
n2
%
3& Moulh-contrid surfaces cleaned and sandized in morns where
04
FOOD
SEMACE EQUIP UTENSIL& 2809, 2810, 2M,.28114
shildronwho are not toilet trainedere corodfor
*8,
Meets s. ifiorrtiixvs for reffigeration, sinks, lavoatiories and
06
PERSONNEL: .2808, m2823
dslivashing equipmeta
36. Approved hygienic practices, dean dothes, hair restraints where,
02
9,
Meets specifications fc; rither equipmrit and utensils,
required; no evidence of tobacco use where prohibited
approved tcniharW and oonlroolion
04
FLOOR%, WALLS &CEILINGS:.2824. Z25,4832,2836
10
kxd contad surfaces properly washe l, rinsed, sanitized
37, Easih, cleanable, dean, and in good repair,, carpels vacmurned
04
11,
and air dried; sing to-sweice articles not re -used
Appmwed testkit
05
(_)2
as required and ex1radon cleaned; date deaned
LIGHTING AND THERMAL ENVIRONMENT. 2826
sanifizer providect available
38, Room temperature between 65' F and &S'
03
1Z
EqOpmeni, non-foodl omtrid wads oknrt; inmATepaiir
04
39, Equipment dean and in good repair,, maintained as required
2
13,
Prq*r idoroge and handing of olsian e0tareant,grijenOls
i"D,
COMNICABLE DISEAOL SE CONTR.2327,,28N
MU3
and singe-se4vice artides
*40, Persons with a oismunicaLye dsease or condtion excluded in
WATER SUPPLY & DRINKINGWATER FACILITIE&.2945, 1134
accadancese4th IOANCAC41A.(M..
*14.
Water supply meets 15A NCAC 18A 1700 and 15A NIA G
06
4 1, Persians caring for sick or inildly III chit excluded horn
04
*15
18C 1 appticoib� okiounientation proviclo'd
Hotwater suWieoi and mraintairaod in thelkitchen
06
situalions in which disease Inansmission Likely to %4rif
42 Designated area lor sick chi4dren,', montained as required
02
16.
Hotoraterr suppled and tempered water rnaintained as
04
MAST ATE R,: 1829
required in oil other areas
(,--,)6
*43, Appftiveil wastewaller disposal inramorlani;evoth 15A NO -AG
6
IT
Hot, mter in exciers d 120'F not al" edIn areas
10 -19M
accessilble to childen
SOLID WASTE: 2830,.Mi
18
BaN, low prevention provided, no orsissoxnectims
03
44. Sold waste properly handed oontairrers and clearing
i 2
19.
Aperoved cunking lounlains, pressure reguNiled, clean
02
ecluitinned kept clean, can cleaning hicillies adequate
LEAD
POISONING HAZARDS: .2816
ANIMAL & VE RMIN CO NTR611., OUTDO OR LEA RN 14 G EN I NMENT
*20.
No idenfilred lead poi inning hazards in accordarimWilh
NO GS 130A- 131 7(7)
06
& PREMISE& 2831,1832
*45,
.
laedidics pfoperiti, used; no new 0,C.A loressure-ji , - ea 0 vsood
TOLETAN D LAVATORY FACILITIES* 2317, 2818, 1831
46, CCA pr e u re4 realed wood seaie,4date sealed
21.
Properly siz ed I ocate4 a coas dldo, and in good repair"
04
sail ered or inaccesspide
&nks, f(AMs and psotty, chairs cleanedrinddisnfeded
47, No aria Is in food preparalion areas andno unrestrained
(D 3
22-
Sopp, approved hand <Jirriq clo,6ioiss, todist tissue avafla,tIe
_)3
arjinnaIS ftoop it$$ ally W'ecl�'no prLohibitod ain imis, required
23,
Apprmd storage in toilet roms, la Bones tree d storage.,
02
veterinary records available and current
hand wash signs posted,
48, Eff elive conlrd of rodents, inseds, and othssrvefrnin"
03
DIAPER, CHANGING Fat CU-ITIES- 2811, 2818, 2818;.2,820,.28N
"-)6
'Premises
kee of vermin harborage and breeding areas
* 24 .
Appq-ovod facifilies as needed,
6n
4A Proms es dean and drainer ipnrrsint in gwd repair,
* %r,,
Diapering surfaces cleaned and disinfected after each, use
6
sandooxes, proW, ly coo *,trudeol and clean, adheronctlo air
26.
Appowed cleaning and disinfecting solutions prrovided tealquahlyforecast
02
ouldoor aclivityrestrictions oilhen applicable,
kit available Wien required
SWIMMING &WADING POOL 2833
27
Free of flora ge, and in gocol repair, reining anddsi Most in g,
04
.01
Des onedconstrod erated sintained in a anoe
06
sci0ons Ialpele(t approved dapeering methods used, daper
wth 15A NCAC 18
changing and handsash, sigis posted
STORAGE,,2820
*28
Medications properly stored
06 EHS Sionalure,
*29.
Hazardous pfoduds properly stored and Locked
06
EHS
Nivs*,Tian foom Opkaer0l, I* I in 0,$. 110C
d4wqoadi
hnspedw NC EMS, one,qq is giotm to tie r &Wthe
oewr c,4*y is te*pt b7 ft I sakies*tdied ubiat
ptc-01"tw'414 d4modis or' w 6-P*A *M;"t e"'Apon-od R* "'.9" dwt'io' WpPWnJNs " mov ht ft"Todootord,^q with pt"Ords
Relier6m and Nsposban Sthe4& kr Ca#*JUutr0HM*1 Die. P&ftef'b_ WNsh 0 p4*511eli by the NCL Dm wn d Anhweswul KA.ay. Mdtlfcms, mity keor&"A hem, Datsiond ErmimmeoW He 102 MidSerwe ceder, Rakb,311 W 2mg-%n (C%Aw
N,C. Department of Environment and Natural Resour NarnURN ELEM KID Time ln: 0, 0 0 1 [Jam
CONNEC110 L--L--i L --- L---J[E PM,
Di�,ision of Environmental Health ID: 2018420097 Time Out: a g a I F--jam
S [T PM
,treet 4377 W NC 10 HWY Total Time: I minute
SMEMERM,
General Comment? E]Yes
Department o f Environm ent and N atural P asourses
Division of Environmental Health
Name: BLACKBURN ELEM KID
QQN N LK, I TUN
1U 2,'018420097
M614031", 004011
Street 4377 W NC 10 HWY
city. -NEVYI-QN