Food Establishment Inspection Report
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Lake logo Lake County Health Department
and Community Health Center
500 West Winchester Road Suite 102
Libertyville, IL 60048
Establishment
 A JS 		License/Permit #
 000635
Street Address
114 E WASHINGTON ST
City/State
 ROUND LAKE PARK, IL 		ZIP Code
 60073
No. of Risk Factor/Intervention Violations 1
No. of Repeat Risk Factor/Intervention Violations 0
Date 06/05/2025
Time In 01:25 PM
Time Out 02:15 PM
Permit Holder/Person Interviewed/Person In Charge (PIC)
AMY WALTERS 		Risk Category
Medium
Purpose of Inspection   Routine/Educational

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

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 and 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    

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, and unadulterated    
14 IN OUT N/A N/O Required records available: molluscan shellfish identification, and 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 and sanitized    
17 IN OUT     Proper disposition of returned, previously served, reconditioned and unsafe food    

TIME/TEMPERATURE CONTROL FOR SAFETY

 
18 IN OUT N/A N/O Proper cooking time and 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 and 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, and 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 the box if the numbered item is not in compliance        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 and 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 and accurate    

FOOD IDENTIFICATION

 
37   Food properly labeled; original container    

PREVENTION OF FOOD CONTAMINATION

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

PROPER USE OF UTENSILS

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

PROPER USE OF UTENSILS

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

UTENSILS, EQUIPMENT, AND VENDING

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

PHYSICAL FACILITIES

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

FOOD HANDLER AND ALLERGEN AWARENESS

 
57   Food handler training 410 ILCS 625/3.06.    
58   Allergen awareness training for CFPM 410 ILCS 625/3.07 (rest. only)    
59   Allergen awareness notice 410 ILCS 625/3.08 (rest. only)    

Food Establishment Inspection Report
Page 2  of ?????? 
Establishment: A JS License/Permit #: 000635 Date: 06/05/2025
Water Supply:   Community Non-Community Licensed Non-Community  Waste Water System:   Community On-Site IEPA System
Sanitizer: Temperature Logs in Use:
Location Method Sanitizer Type Concentration (PPM) Heat(F)
3-Compartment Sink Chemical Sanitizer Not Setup 0 0.00
CFPM Verification (name, expiration date, ID#):
       
Presentation Type: VISUAL Number Attended: 1
HACCP Discussed HACCP Principle Plan Onsite
3. Establish the Critical Limit for the CCP Discussed the HACCP principle of identifying critical control points in your processes such as hot holding at 135 degrees F or above, cold holding at 41 degrees F or below and at freezing for frozen foods and 165 degrees F for reheating. Not Applicable
IL Requirements: Use of non-latex gloves for food handling and preparation 410 ILCS 180/10.
  Appropriate default beverage for children's meal 410 ILCS 620/21.5.

TEMPERATURE OBSERVATIONS
Item/Location
Temp
Item/Location
Temp
Item/Location
Temp
SOUR CREAM/COOK'S LINE COOLER 39.00°F MILK/WALK-IN COOLER 39.00°F CHICKEN/CHEST FREEZER 0.00°F
PIZZA/ONE-DOOR UPRIGHT FREEZER 0.00°F        

OBSERVATIONS AND CORRECTIVE ACTIONS
P=Priority      PF=Priority Foundation      C=Core      R=Repeat
Item
Number 		P/PF/C/R Code Reference Violations cited in this report must be corrected within the time frames below.
2 C 2-102.12 The person in charge shall be a certified food protection manager who has shown proficiency of required information through passing a test that is part of an accredited program (ANSI).
The PIC is not a certified food protection manager.
Register for an ANSI approved certified food protection manager course and successfully complete the course/examination within 60 days.
CORRECT BY: Aug 5, 2025
49 C 4-601.11 (C) Nonfood-CONTACT SURFACES of EQUIPMENT shall be kept free of an accumulation of dust, dirt, FOOD residue, and other debris.
The interior of the walk-in cooler is heavily soiled. Provide a thorough cleaning of the interior of the walk-in cooler by June 18th, 2025.
Clean all non-food contact surfaces frequently to prevent soil accumulation.
CORRECT BY: Jun 18, 2025
AMY WALTERS
Person In Charge (Signature)  		Michael Polzin
Inspector 
Follow-up:  Yes   No   Follow-up Date:  06/18/2025
 
Lake County Health Department
And Community Health Center
Facility I.D.#
0000000635
Date: Month: Day: Year:
0 6 0 5 2 5
Presentations Type: 
  Standard (S)    Demonstration (D)    Video (I)    Visual (V)DISCUSSED HOW TO SET UP A SANITIZING BUCKET FOR WASH CLOTHS. DISCUSSED HOW TO USE THE TEST STRIPS AND THE PROPER CONCENTRATION.
Indicate details about presentation for your records. (i.e. video title, demo/visual shown)
(Please write your name below------------------Por favor escriba su nombre abojo)
Attendance: Number of People Attending: 1
1. AMY
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