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HomeMy WebLinkAbout2026/08/04 - BOH Packet MASON COUNTY • COMMUNITY SERVICES Building,Planning,Environmental Health,Community Health MASON COUNTY BOARD OF HEALTH August 4, 2026 Commission Chambers 411 North 5th Street Shelton, WA 98584 DRAFT AGENDA 1. Welcome and Introductions Chair 2. Public Comments 3. Approval of Agenda—ACTION Board Members 4. WA Cares Presentation Emily Hearn 5. Administration Report Dave Windom 6. Health Officer Report Dr. Steve Krager 7. Environmental Health Report Ian Tracy a. Environmental Health Report b. On-site Sewage Advisory Committee Membership Applications c. Draft Revisions to MCC Title 6 Chapter 6.04 8. Community Health Report Melissa Casey 9. Other Business and Board Discussion Board Members 10. Public Hearing for Food Establishment Appeal Board Members 11. Adjourn Mason County Public Health 415 N 6th Street, Bldg.8,Shelton WA 98584, Phone: (360)427-9670 ext.869 ❖ Fax: (360)427-7787 If special accommodations are needed, please contact McKenzie Smith at(360)427-9670 ext.589 or at msmith@masoncountywa.gov. Benefits Navigator for LMTAAA Emily Hearn 08/04/2026 Presented by the Lewis-Mason-Thurston Area Agency on Aging (LMTAAA) WA Cares Basics Families need a better way to pay for care •WA Cares moves cost to years when your income is higher •Public insurance model covering all workers keeps contribution rate low Contribute at a low rate during working years Contributions end after retirement Access benefits when you need care 31 How it works Automatically contribute Contribute 0.58% of your paycheck during your working years Qualify for benefits Apply to access benefits if you’ve met contribution and care needs requirements. Benefits became available in July 2026. Use your benefits Choose how to use your $36,500 lifetime benefit amount (grows with inflation) on covered services 2 Affordable contributions across your career To earn benefits that start at $36,500 and grow over time $40,000 annual salary Per month $19 Over 30 years $6,960 TYPICAL WORKER WHO PARTICIPATES $59,000 annual salary* Per month $29 Over 30 years $10,260 $80,000 annual salary Per month $39 Over 30 years $13,920 *Washington State Employment Security Department data Most Washington workers contribute •People who don’t work in Washington •Federal employees •Temporary workers on non-immigrant visa •Self-employed workers Can opt in •Employees of tribal businesses Only included if tribe opts in •Approved private insurance exemption Can opt in from Jan. 2026 – July 2028 Not included Can apply for exemption Workers who live out of state Must continue to meet condition Spouses and domestic partners of active-duty U.S. armed forces Must continue to meet condition Active-duty service members with civilian job Must continue to meet condition Veterans with 70%+ service- connected disability Permanent Learn more: wacaresfund.wa.gov/exemptions •Get same affordable benefits available to other Washington workers •Contribute 0.58% of net earnings and gross wages •Must work 500+ hours per year to earn benefits •Must opt in: o Within 3 years of becoming self- employed for first time •Learn more: wacaresfund.wa.gov/opt-in Self-employed workers can opt in Permanent access to 10% of full benefit amount for each year contributed TransitionTemporary Permanent access if contributed for 10+ years at any point in career Permanent Contribution requirement Meet requirements for one of three pathways to qualify Temporary access if contributed at least 3 of last 6 years at time you apply for benefits For example: 2 years earns 20% of full benefit amount FULL BENEFIT AMOUNT PRO-RATED AMOUNT if born before 1968 •Need help with 3+ activities of daily living •Will continue to need help for at least 90 days Care needs requirement MobilityBathing Transferring Eating Bed mobilityMedication management Toileting •Create a benefits account at wacaresfund.wa.gov/apply •Submit your application online •Get your contribution history confirmed •Schedule an appointment to talk about your care needs •Get approval to use your benefits Apply for benefits Need support? Someone else can manage your account Your local Area Agency on Aging can help Call 844-CARE4WA to apply over the phone Use your benefits for any covered services To help you stay at home In-home care (individual provider or home care agency) Home safety evaluations Home modifications Home-delivered meals Transportation Adaptive equipment and technology Personal emergency response systems Housework and yardwork To support your family caregiver Paid care from a loved one Respite care in your home or a facility Education and consultation Dementia and behavioral supports Care transition coordination In a facility Assisted living Nursing home Memory care services In your community Adult family home Adult day services Up to $36,500 in services and supports from WA Cares providers How far your benefits will go These are estimates and do not guarantee the cost of any services, which may vary based on your area and other factors. Family caregiver Paying family caregiver 10 hours/week for 2 years $31,200 Care supplies 2 years of incontinence products $3,600 Total $34,800 Home accessibility Home safety renovations Build ramp & widen 3 doorways $8,000 Personal emergency response system Installation & 3 years of service $3,124 Weekly meal delivery 10 meals/week for 3 years $24,960 Total $36,084 Temporary support Part-time caregiver 20 hours/week for 6 months $23,400 Home modification Ramp $5,000 Safety equipment Bedside commode, bath bench $500 Total $28,900 •Standards created for supplemental private insurance •Public-private partnership like Medicare •Policies kick in seamlessly after WA Cares benefits •Likely more affordable than current private insurance •Additional consumer protections Get more coverage May 2026 Office of the Insurance Commissioner finalized rules Early 2027 Policies could become available •Can continue participating after leaving the state if you: o Have contributed for at least 3 years (500+ hours per year) o Opt in within 1 year of leaving •Keep contributing during your working years •July 2030: Benefits available for out of state participants Take your benefits out of state “If my family had WA Cares, I would’ve had a different reality. WA Cares and your ability to take it to another state is huge.” – Kendall, family caregiver in Seattle Benefits & provider registration •Process benefit applications •Determine care needs •Manage providers Cross-agency responsibilities DSHS HCA ESD State Actuary (lead agency) Employers & exemptions •Collect premiums and wage reports •Determine contribution status •Process exemptions •Process opt-in requests Provider payment •Manage payment system Actuarial analysis •Analyze and monitor solvency Questions & answers Call us LMTAAA 360-664-2168 and ask for WA Cares Contact us by email or live chat wacaresfund.wa.gov/ contact or for LMTAAA, emily.hearn@dshs.wa.gov Find webinar materials at wacaresfund.wa.gov/webinars Follow us on Facebook, Instagram, and LinkedIn Thank you! Call us DSHS (benefits and provider registration) 844-CARE4WA From the Director's Desk u1IIIIIIIIIJj After a grueling 2026 legislative session, the Legislature ultimately re-funded Foundational Public Health Services (FPHS) at roughly 7% below the previous biennium after making the tough decision to cut statewide funding across agencies. WSALPHO committed to ensure the reductions were spread equitably across jurisdictions, and the methodology funded the reductions at a higher percentage to jurisdictions that historically have under-spent their FPHS dollars, primarily due to our inability to recruit and retain a workforce. Although painful for every jurisdiction, this methodology resulted in significantly higher percentage reductions to smaller, rural U's when compared to some of the largest jurisdictions in the state. For Mason County, that ultimately meant a cut of$260,269, or approximately 15% of our FPHS funds. King County, by contrast, saw no reductions. Several of the smallest rural jurisdictions saw reductions of close to 30%. Reductions were effective July 1. Programs we were able to eliminate to prevent any loss of permanent staff include the FPHS-funded Hepatitis C program. We have also pulled FPHS funds from supporting Emergency Response Planning and dramatically scaled back our Life Course and chronic disease prevention efforts. Although painful, these steps will allow us to retain our current staff. The tradeoff is we have limited ability to expand or enhance services, including several planned initiatives we were hoping would improve outcomes for our community. Uncertainty also exists at the federal level with the passage of H. R.1. Although many of the implementation rules have yet to be clarified, we know this legislation will result in reduced federal support for Medicaid and other health programs in the years to come. Rural communities are likely to be hit hardest, as many rely on Medicaid-funded health services at a greater percentage than their urban counterparts. These changes have the potential to both increase demand for local public health programs while decreasing resources for providers who care for our communities. We will continue to monitor federal guidance on implementation of this new legislation and determine any direct fiscal or operational impact to Mason County programs as it becomes available. The largest near-term impact we expect to see as a result of H.R. 1 is barriers to accessing care. Many of our residents receive their health coverage through Medicaid, and any changes to eligibility requirements or federal reimbursement will likely result in more uninsured seeking care through emergency rooms and other safety-net providers. We also anticipate many of our local healthcare organizations will see increasing financial From the Director's Desk IuII!I!UJjj strain as a result of growing uncompensated care, particularly in our rural communities where the capacity to absorb these costs is already stretched thin. Although not all public health services are delivered through Medicaid, we expect to see increased demand for communicable disease control, maternity and child health programs, substance use prevention and treatment, behavioral health coordination, and community outreach if residents are unable to access and utilize primary and preventive care services. We will continue to work with healthcare providers, community partners, and our state public health agency to monitor these changes and identify ways to lessen the impact on Mason County residents. David Windom, MSHS Code Enforcement Data for Solid Waste and Onsite Sewage Systems 2024 2025 Jan- Feb- Mar- Apr- May- Jun- Jul- Aug- Sep- Oct- Nov- Dec- 2026 Total Total 26 26 26 26 26 26 26 26 26 26 26 26 Total Cases Received 318 270 27 17 20 31 22 12 16 145 Cases Closed 184 261 14 8 15 27 18 16 9 107 Infractions Issued 41 86 15 0 10 3 19 2 1 50 Mason County Board of Health STEVEN KRAGER, MD MPH HEALTH OFFICER 8/4/26 Topic •Cyclosporiasis Cyclosporiasis Outbreak •Microscopic parasite spread by water or fresh produce •Symptoms include frequent watery diarrhea, stomach cramps, bloating, nausea and fatigue •Symptoms can last for days to weeks if left untreated •Treatment is very effective – if you have concerning symptoms ask your doctor to test Cyclosporiasis Outbreak •No local cases tied to larger outbreak at this time •Iceberg lettuce recall on July 17, 2026, by Taylor Farms de Mexico •Other smaller outbreaks still occurring with unknown source •Continue practicing basic food safety practices, but no need to avoid specific foods in Washington currently Environmental Health (EH) Report - Mason County Board of Health August 4, 2026 From Ian Tracy, Environmental Health Manager Solid Waste We recently partnered with the Sheriff's Dept. to execute our first criminal search warrant for solid waste violations. Four (4) environmental health specialists worked nine (9) hours to gather evidence and document 70 hulk/inoperable vehicles. Four (4) sheriff's deputies served the warrant and remained on-site to provide security for the duration of the inspection. Water Quality Daniel Osborn joined our staff on July 1 st. Daniel will be conducting pollution identification and correction work and public outreach to fulfill grant deliverables in South Sound and Hood Canal. Attachments: EH Quarter 2 Report MASON COUNTY Public Health&Human Services 11Page Environmental Health 2026 Statistics Environmental Health 2026 Statistics 2026 1st 2026 2nd Quarter Quarter Funding source Data Data Water Recreation Permit fees Pools 5 5 Seasonal Pools 11 11 Spas 3 3 Seasonal Spas 1 1 Total Inspections 1 2 Drinking Water Fees. Contract with DOH & ECY. Group A Sanitary Survey 0 2 Special Purpose Investigation 0 0 Group B Approval 2 0 Well Construction Inspections 16 21 2 Party Well inspections 13 5 Well Decommission Inspections 1 1 Food Fees. FPHS Annual Food Establishment 237 235 Mobile Food Establishments 30 29 Street Vending Establishments 2 3 Temporary Event Establishments 15 65 Temporary Event Inspections 5 22 Number of routine inspections 87 60 conducted Number of Reinspections conducted 5 3 Pre-Operational inspections 8 5 Complaint Inspections Conducted 3 1 New Food Worker Cards 823 636 Replacement Food Worker Cards Issued 0 0 Vector All County contribution. Rabies calls 7 7 Rabies specimen tested 1 0 Rabies specimen tested positive 0 0 Solid Waste Ecology grant. Fees. FPHS. Complaints Received 22 34 Complaints Closed 14 16 Civil Infractions Issued 3 12 Current Enforcement Case Load 318 335 Facility Inspections 0 1 Facilities permitted 11 0 MASON COUNTY Public Health&Human Services 21Page Environmental Health 2026 Statistics Environmental Health 2026 Statistics 2026 1st 2026 2nd Quarter Quarter Funding source Data Data Professional Certification Fees. Pumpers Certified 30 4 Installers Certified 97 6 O&M Specialists Certified 48 3 Onsite Sewage Systems Fees. FPHS. DOH. New System Applications submitted 90 115 New System Permits issued 86 111 New System Permits closed 53 95 Tank Only Permits 18 27 Repair/Replace Permits 15 26 Finals Conducted 38 82 Preapplication Conferences 10 14 Environmental Health Reviews 5 1 Short Plats 0 4 Large Lot Subdivisions 2 3 Boundary Line Adjustments 5 8 Complaints Closed 23 43 Complaints Received 41 44 Current Enforcement Case Load 89 92 Number of Civil infractions 19 12 Homeowner workshops 0 0 Blitz Mailings 0 37,406 Deficient OSS 1243 1314 Overdue Maintenance 20,402 20,014 J OSS records on file 28,516 28,550 CWD parcel fees. Various Water Quality grants. Water Samples analyzed 194 219 _ Water Quality Surveys Closed 5 22 Water Quality Surveys 32 20 Mailings 0 22,857 Miles of shoreline sampled 1.78 4.7 _ Public Meeting/education 0 3 Shellfish Consolidated Contract: DOH. Bi-weekly Jarrell's Cove 7 6 _ Oysterfest Booth 0 0 Environmental Health Briefing TO: Mason County Board of Health FROM: Ian Tracy, Environmental Health Manager DATE: August 4th, 2026 ITEM: On-site Sewage Advisory Committee (OSAC) Membership Applications SUMMARY: We have received two applications for membership on OSAC. Paula Johnson is currently appointed to the committee and has applied to extend her service for an additional 3-year term. Paula has held one of the three designer positions since 2020, and she has contributed a great deal to the committee's work to develop and fine-tune department policies and processes. Dale Tahja has applied to join the committee to fill a vacant designer position. Dale is a licensed septic designer currently working in Mason County who previously served on the committee, holding a citizen/watershed representative position from March 2019 through August 2020. Dale is also a retired environmental health specialist formerly employed with Mason County Environmental Health. REQUESTED ACTION: Board discussion and call for a vote to approve appointments if appropriate. ATTACHMENTS: Applications Received 06.11.2026 Commissioners Randy Neatherlin, Sharon Trask and Pat Tarzwell, Travis Adams, McKenzie Smith, Ian Tracy Entry#: 77-On-Site Sewage Advisory Committee(OSAC) Status: Submitted Submitted: 6/9/2026 9:31 AM S, CooNTo Advisory Board Name: On-Site Sewage Advisory Committee (OSAC) 1854 Name: Today's Date: Paula Johnson 6/9/2026 Address Voting Precinct: Phone Email ( Community Service: Employment: Mason County OSAC Designer Rep 6 year term from July President/Owner of Arrow Septic Designs.Active full-time 2020-2026,WOSSA - Designer Rep 2 year term from January designer in Mason County for 21 years. 2022-2024, Shelton Presbyterian Church Member and former Deacon, North Mason Eagles FOE 4226 Member, What do you perceive is the role or purpose of this advisory board? To address concerns and issues facing our industry on a local and state level. Coordination and communication between the county, designers, installers, pumpers and o&m professionals to make our industry the best it can be.To promote education of our customers and protect public health. I believe our industry plays a critical role in micro-environmentalism, taking care of one land parcel at a time. I also want to help our other industry professionals like suppliers and installers keep up on education, standards, regulations and the most current technologies. What interest or skills do you wish to offer this advisory board? 21 years of onsite septic industry experience, plus 7 years of commercial construction business experience, bachelors degrees in Construction Management and Business from WSU. I am a full-time designer living and working in Mason County for 21 years. I have great working relationships with many industry professionals including suppliers, industry experts,WOSSA members and contractors which contributes diverse feedback to bring back to the committee. List any financial, professional, or voluntary affiliations that could create a potential conflict of interest: none Required Training: Yes or No: Participation is dependent on attending certain trainings such as the Open Public Meetings Act (OPMA) Yes and Public Records Act (PRA) trainings at no cost to you. Will you be able to attend such trainings? How much time can you commit to Are you a U.S. citizen and *For Civil Service applications ONLY, what this advisory board: Mason County resident? is your political party? Quarterly, Monthly Yes Republican *For Wake Board Advisory Committee applications ONLY: Entry#: 84-On-Site Sewage Advisory Committee(OSAC) Status: Submitted Submitted: 6/10/2026 3:46 PM S, CooNTo Advisory Board Name: On-Site Sewage Advisory Committee (OSAC) 1854 Name: Today's Date: Dale Tahja 6/10/2026 Address Voting Precinct: Phone Email ( Community Service: Employment: Septic system designer Dale Tahja Septic System Designs What do you perceive is the role or purpose of this advisory board? Representing the citizens of Mason County in developing recommendations for the operation of the Health Department's on-site sewage program. What interest or skills do you wish to offer this advisory board? I'm a professional in the industry and a retired Environmental Health Specialist. List any financial, professional, or voluntary affiliations that could create a potential conflict of interest: None Required Training: Yes or No: Participation is dependent on attending certain trainings such as the Open Public Meetings Act (OPMA) Yes and Public Records Act (PRA) trainings at no cost to you. Will you be able to attend such trainings? How much time can you commit to Are you a U.S. citizen and *For Civil Service applications ONLY,what this advisory board: Mason County resident? is your political party? Quarterly Yes *For Wake Board Advisory Committee applications ONLY: Environmental Health Briefing TO: Mason County Board of Health FROM: Ian Tracy, Environmental Health Manager DATE: August 4th, 2026 ITEM: Draft Revisions to Mason County Code Title 6 Chapter 6.04 SUMMARY: Mason County Code(MCC) 6.04 Definitions and General Provisions was established in 1970 and last updated in 1979. At that time, Mason County was part of the Thurston-Mason Health District, which combined or shared public health authority with Thurston County over both jurisdictions. Since that time, much has changed in Mason County. The focus of this code update is to remove language that conflicts with the Fourth Amendment, correct out-of-date code references, and reflect our current status as a local health department rather than a health district. This item was on the agenda for the Board's May 2026, however the Board passed a motion in May to move this item to the Boards next meeting in July. REQUESTED ACTION: Review changes to the regulation and discuss. If appropriate, vote to approve changes and make a recommendation to the Board of County Commissioners to adopt the proposed changes to MCC 6.04 Definitions and General Provisions. ATTACHMENTS: Draft Regulation Title 6-SANITARY CODE Chapter 6.04 DEFINITIONS AND GENERAL PROVISIONS Chapter 6.04 DEFINITIONS AND GENERAL PROVISIONS 6.04.010 Title. The rules and regulations contained in this title shall be known as the Sanitary Code of the Mason County District Board of Health. (Ord.963(part), 1979;Art. I § 1,of Res. dated July, 1970 and amended November 5, 1970). 6.04.020 Definitions. (a) "Board of health" means the Mason County Board of Health pursuant to the provisions of RCW Section 70.4605.020-030(Districts of two or morc Counties Hcalth Board). (b) "Health department," "department of health"or"department" means thethe Mason County Public H4ealth and Human Services department and includes all the territory embraced within Mason County and all cities and towns therein,as defined in RCW Section 70.4605.O0-030(Definitions). (c) "Health officer" means the district local health officer of the Mason County Public IiHealth and Human Services department as defined in RCW Section 70.4605.90-010(District calth Offi cr etc.` or his duly authorized representative. (d) "Person" means any individual,firm,corporation, partnership or association and the agents, employees, servants and legal successors thereof or agency of the federal government which is subject to the jurisdiction of the state. (e) "Sanitary code"or"code" means and comprises the rules and regulations now formulated, promulgated, adopted and subsequently amended by the Mason County District of Health pursuant to the provisions of RCW Section 70.4605.060_(District Health Board Duties and Powers). (Ord.963(part), 1979;Art. I § 2 of Res.dated July, 1970 and amended November 5, 1970). 6.04.030 Sanitary code—Jurisdiction and filing. (a) Jurisdiction.The provisions of the code shall be in force within the jurisdiction of the Mason County District Board of Health as defined in RCW Section 70.4&05.02 -030(Districts of two or more counties Health Board). (b) Filing.At least one copy with accompanying chapters of RCW and WAC as indicated in separate articles shall be on file in the office of each municipal clerk or auditor within the jurisdiction of the Mason County health department. (Ord.963(part), 1979;Art. I § 3 of Res.dated July, 1970 and amended November 5, 1970). 6.04.040 Enforcement. It shall be the duty of the Mason County District health oOfficer to enforce the provisions of this code,and, in the performance of this duty is hereby authorized to request entLyef,at any reasonable hour,to any premises as may be necessary in the enforcement of this code. If the request for entry is not granted by the owner or Mason County,Washington,Code of Ordinances Created: 2023-12-19 11:21:08 [EST] (Supp. No.65,11-23) Page 1 of 5 occupant currently in possession of the property,-the health officer may seek a warrant for entry as provided by state law. (Ord.963(part), 1979;Art. I §4 of Res.dated July, 1970 and amended November 5, 1970). 6.04.050 Penalties. Any person who violates or refuses or fails to comply with any of the provisions of this code is guilty and subject to punishment pursuant to the provisions of RCW Section 70.0€05.070-120 Violations—Penalties)as follows: "Any person violating any of the provisions of this act or violating or refusing or neglecting to obey any of the rules and regulations of this code shall be guilty of a misdemeanor,and upon conviction thereof shall be subject to a fine of not less than twenty five dollars nor more than one hundred dollars or to imprisonment in the county jail not to exceed ninety days or to both fine and imprisonment.!! (Art. I §5 of Res. dated July, 1970 and amended November 5, 1970). 6.04.060 Hearings for proposed articles. Pursuant to the provisions of RCW Sections 70.20.020(Notices of Regulations),70.46.060(District Health Board Powers and Duties), The health officer shall advertise a hearing for the adoption of proposed articles in this code in a newspaper of general circulation in ch of the two counties comprising the health department at least ten days prior to the date of a hearing for the adoption of articles.The advertisement of hearing shall include a summary of the articles proposed to be adopted.The health officer shall provide a sufficient number ofelectronic copies of the proposed articles to meet the reasonable demands of persons interested therein,and the same shall be available for distribution at least ten-fourteen days prior to a public hearing held for the adoption of articles.All hearings held under this code for the adoption of articles shall be open to the public and a record of the proceedings shall be kept by the health officerclerk of the board of Mason County Commissioners. (Art. I §6 of Res. dated July, 1970 and amended November 5, 1970). 6.04.070 Interference with notices. No person shall remove, mutilate or conceal any notice or placard of the health department posted in or on any premises or public place except by permission of the health officer. (Art. I §7 of Res. dated July, 1970 and amended November 5, 1970). 6.04.080 Regulations supplemental—Supersede prior rules. The regulations of this code shall be supplemental to the rules and regulations of the State Board of Health, Public Health Law, Penal Law and other Washington State Laws relating to public health and shall,as to matters to which it refers,and within the jurisdiction heretofore prescribed,supersede all prior rules, regulations and standards of the board of health and all local ordinances heretofore or hereafter enacted inconsistent herewith. (Art. I §8 of Res. dated July, 1970 and amended November 5, 1970). 6.04.090 Inspections. (a) All premises covered by this code shall be subject to the inspection of the health officer and if any violation of the sanitary code exists on the premises,any permit granted by the health officer may be suspended forthwith. Created: 2023-12-19 11:21:07 [EST] (Supp. No.65,11-23) Page 2 of 5 (b) No person shall rcfusc to 3110w the health officer to fully inspect any and 311 premises entered in the performance of his duty and no person shall molest harass or resist the health officer in the discharge of his duty. (Art. I §9 of Res. dated July, 1970 and amended November 5, 1970). 6.04.100 Permits. (a) All applications for a permit,certificate, inspection or written approval by the health officer as herein required shall be made upon forms prescribed and furnished by the health department and shall be signed by the applicant who shall be the person or authorized agent thereof responsible for conformance to the conditions of the permit,certificate, inspection or written approval by the health officer for which applied. Such application shall contain such data and information and be accompanied by such plans and specifications as may be required by the health officer. (b) A permit or certificate issued to a particular person or for a designated place, purpose or vehicle shall not be valid for use by any other person or for any other place, purpose or vehicle than that designated therein. Such permit,certificate, inspection or written approval by the health officer may contain general and specific conditions and every person who shall have obtained a permit,certificate, inspection or written approval by the health officer as herein required shall conform to the conditions prescribed in the permit,certificate, inspection or written approval by the health officer and to the provisions of this code. Every such permit or certificate shall expire as stated on the permit or certificate and may be renewed,suspended for cause or revoked by the health officer after due notice and hearing in accordance with Sections 6.04.120 and 6.04.130. (c) Notice in Writing by Health Officer of Violation. Whenever, upon inspection of any public establishment, sanitary facility or utility,the health officer finds that conditions or practices exist which are in violation of any provision of the sanitary code,the health officer shall give notice in writing in accordance with Section 6.04.4-30120(a)to the person to whom the permit or certificate was issued that unless such conditions or practices are corrected within a reasonable period of time specified in the notice by the health officer,the permit or certificate shall be suspended. At the end ..f such period,the health officer hall make other inspection and, if such conditions or practices arc corrected within a reasonable period of time specified in the notice by the health officer,the permit or certificate shall be .At the end of such period,the health officer shall make another inspection and,if such conditions or practices have not been corrected, he shall suspend the permit or certificate and give notice in writing of such suspension to the person to whom the permit or certificate is issued. Upon receipt of notice of such suspension, such person shall cease operation except as provided in Section 6.04.4-30-120(b). (Art. I § 10 of Res. dated July, 1970 and amended November 5, 1970). 6.04.110 Fees. All fees collected under the provisions of this code contained herein shall be payable to the Mason County health department and credited to the public health pooling fund to aid in carrying out the provisions of the sanitary code_pursuant to provisions of RCW Sections 70.46.050 and 70.46.060(Local Health Board Duties and Powers) (Local Health Officer Power and Duties). (Ord.963(part), 1979;Art. I § 11 of Res.dated July, 1970 and amended November, 1970). Created: 2023-12-19 11:21:08 [EST] (Supp. No.65,11-23) Page 3 of 5 &Q-44-2O- Right of appeal and hearing by petitioner rcgucst and shall bc grantcd a hearing on thc mattcr bcforc thc Mason County district board of hcalth pursuant to section 6.04.130. (Ord.963 (party 1979;Art. 1 § 12 of Res dated July, 1970 and amended November 5, 1970) 6.04. 120 Notices, hearing and orders. (a) Notice_of 'inn.Whenever the health officer determines that there are reasonable grounds to believe that there has been a violation of any provision of the sanitary code,the health officer shall give notice of such alleged violation to the person to whom the permit or certificate was issued,as hereinafter provided. Such notice shall: (1) Be in writing; (2) Include a statement of the reason for its issuance; (3) Allow a reasonable time for the performance of any act it requires; (4) Be served upon the owner or his agent as the case may require; provided,that such notice or order shall be deemed to have been properly served upon such owner or agent when a copy thereof has been sent by registered mail to his last known address,or when he has been served with such notice by any method authorized or required by the laws of this state; (5) Contain an outline of remedial action which,if taken,will effect compliance with the provisions of the sanitary code. (b) Hearing.Any person affected by any notice which has been issued in connection with the enforcement of any provision of the sanitary code, may request and shall be granted a hearing on the matter before the health officer; provided,that such person shall file in the office of the health officer a written petition requesting such hearing and setting forth a brief statement of the grounds therefor within ten days after the day the notice was served.The filing of the request for a hearing shall operate as a stay of the notice and of the suspension except in the case of an order issued under subsection (e)of this section. Upon receipt of such petition,the health officer shall set a time and place for such hearing and shall give the petitioner written notice thereof.At such hearing the petitioner shall be given an opportunity to be heard and to show why such notice should be modified or withdrawn.The hearing shall be commenced not later than ten days after the day on which the petition was filed; provided,that upon application of the petitioner the health officer may postpone the date of the hearing for a reasonable time beyond such ten-day period when in his judgment the petitioner has submitted good and sufficient reasons for such postponement. (c) Order in Writing.After such hearing the health officer shall make findings as to compliance with the provisions of this chapter and shall issue an order in writing sustaining, modifying or withdrawing the notice which shall be served as provided in subsection (a)(4)of this section. Upon failure to comply with any order sustaining or modifying a notice,the permit or certificate affected by the order shall be revoked. (d) Recording of Proceedings.The proceedings at such a hearing, including the findings and decision of the health officer,and together with a copy of every notice and order related thereto shall be entered as a matter of public record in the office of the health officer, but the transcript of the proceedings need not be transcribed unless judicial review of the decision is sought as provided by this section.Any person aggrieved by the decision of the health officer may seek relief therefrom in any court of competent jurisdiction,as provided by the laws of this state. Created: 2023-12-19 11:21:08 [EST] (Supp. No.65,11-23) Page 4 of 5 (e) Emergency Requiring Immediate Action.Whenever the health officer finds that an emergency exists which requires immediate action to protect the public health, he may without notice or hearing issue an order reciting the existence of such an emergency and requiring that such action be taken as he may deem necessary to meet the emergency including the suspension of the permit or certificate. Notwithstanding any other provisions of this chapter,such order shall be effective immediately.Any person to whom such an order is directed shall comply therewith immediately, but upon petition to the health officer shall be afforded a hearing as soon as possible.The provisions of subsections (c)and (d) of this section shall be applicable to such hearing and the order issued thereafter. (Art. I § 13 of Res. dated July, 1970 and amended November 5, 1970). 6.04.130 Right of appeal and hearing by petitioner. Any person whose permit or certificate has been denied,suspended or revoked by the health officer may request and shall be granted a hearing on the matter before the board of health pursuant to Section 6.04.130. Appeal must be received in writing by the department within 10 days of the decision rendered. The hearing before the board of health will be scheduled for their next regular meeting. (Ord.963(part), 1979;Art. I § 12 of Res.dated July, 1970 and amended November 5, 1970). Created: 2023-12-19 11:21:08 [EST] (Supp. No.65,11-23) Page 5 of 5 Community Health rT�¶ 1T Report MAY - JUNE 2026 LI WOMEN, INFANTS, AND CHILDREN (WIC) Monthly Caseload • May: 966 • June: 972 After School Snack Program • 967 snacks distributed, on a pause for the summer r Program Highlights • 44 WIC families received an additional $30 in fruit and vegetable benefits during the Bike Rodeo and Safety Days event • Conducted a WIC Customer Service Survey during the Farmers Market Nutrition Program (FMNP) Event. 91.7% of participants rated our service as excellent - 1 Community Health Re ort p MAY - JUNE 2026 HOMELESS RESPONSE SYSTEM Final PIT Count Results Location Sheltered Unsheltered Total Individuals WA State 14,063 18,657 32,720 Mason County 126 279 405 Emergency Shelter Transitional Sheltered Unsheltered TOTAL Housing Mason County Ind HH Ind HH Ind HH Ind HH Ind HH 2026 94 58 32 11 126 69 279 175 405 244 2025 94 59 30 9 124 68 311 210 435 278 Notice of Funding Opportunity (NOFO) On July 7, 2026, Mason County Public Health & Human Services is pleased to announce the release of two Requests for Proposals (RFPs): one for Homeless Crisis Response System Services and another for the Acquisition, Development, or Preservation of Affordable Housing. The application deadline is August 7, 2026. Southsde SchooL 'Ii, *4 : ('•H - . . . .:: .. : . . : . .1. 1FI'NIU.:It;t:.; . ' : -. .:.: . . --;-: \- 1 : r • It was amazing ■ Herb Butter If I had the chance ■ ■ • .. : I I : : . Hand-Pressed Tortillas with. Avocado to do it again I would • I ,J 1 : : • Tamalitos (little Tamales) - :: I Like cooking and now I ■ 'm more confident .n • Short Cakes With Strawberries ■ ; other types of cooking. ■ • Spring Rolls ■ ■ weeks. : ; It should be enjoyed { Emanc'pation Proclamation Breakfast. Cake • ": C,'■ . . •. -. .�. . ....M M.M ■ :.f•• •* ■ ■ ■ . ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ . . ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ . ■ ■ ■ . . . .•■ ■ . ■. �. ■ ■- ■.. II by a bunch of people 1h1t1 1111 UU ■ . . : . ■.■., ■ ., ,.. . . . . . . • • • • • • • • • •'• • ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ • ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ .* . everywhere_____ J • Just do it, it's a very • • iI' fun experience" ■ • -Anthony E .. - - ■ ■ ■ ■ ■ ■ 5._s., . • . `^mot ■ ■• - 5. _ 55 . - -: . .-. .5 •. .. .......... ' 5_, -S - -5• ■ ■ Our Charl'e Cart food education program visited Southside school to provide students with hands-on cooking ■ and nutrition lessons that made healthy eating fun and engaging. Students learned basic kitchen safety, ■ practiced using age-appropriate cooking tools, prepared healthy recipes, and explored new foods in a supportive environment. Through these interactive classes, students built confidence in the kitchen, developed ■ li f elong healthy eating habits, .and gamed practical sk;lls they can use at home with their f amities. •♦■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ s■ . ■ ■ ■ ■ � ■ ■ ■ ■ ■ ■ ■ ice ■ ■ ■.�-■ ■ ■ ■ ■ ■ ■ i ■ ■ ■ ■ . ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ �♦ 1 "It was really fun and -'we got to try new things:`'.I learned how : : _ to use a juicer and how to : ■ properly use a grater. We w S 01. learned about history, like the : • I : : / drt Emancipation Proclamat;on. : "k, 1 Anyone can join, no matter who you are or what you look Like."- Zara J 11 i J Ii'Y r I 'r, ;r I M Q So Y C o u v t y UKE RODEO & SAFETY DAY - . 0 0• •• ••0 •. • - 4. Community E ' - - • approximQteLy kids * Partners -, .. - 0 . . - . 1. ; : • -. -: -�,IUE1: - • ■ ■ pia fir• � , ■ ■ � �. � � � - ■ � _ '' `F••,w���,r/uco•v "'"fit ■ ■ ■I. . . . . . . U U U UUUUUUUU U U U U U U U U U •IU • UUUUU U U U UUUUUUUU U U U U U U U U * - -. , a . . . . . . • • UU U.0 U U U U U U U U U * 0*. . . . . . U U U U U U U U U U U U U U U U U U U U U 00 • - 0 - ; - , . -. . - - .. .. . . . .. 0 11% 1 ■ • • � r h n CONNECTING FAMILIES WITH -. 0 - • The Bike Rodeo & Safety Day brought together f am l es, commun. ty. .part ers, a d local organizations for a fun and educat;onal event focused on keeping children safe. . Helmets Participants had the opportunity to practice bike handling sk;lls, . receive helmet f fittings, • bikes : . ■ and learn about bicycle, scooter. , water, electrical, f hear and emergency safety . Life Jackets through interactive demonstrations. and. activities. The event .also connected families with : Boatin Whistles 9 valuable community resources while encoura in health , active l'f est ' les. Thanks to the : • Firearm story a/locks 9 9 Y Y 9 support of our volunteers, sponsors, .and community partners, the event provided children ; • Reflective Safety gear with im ortant sa et education ,in an en a in and memorable wa saf ey Education p f Y ' 9 g 9 Y � ••♦ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ 1 ■ ■ U ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ U ■ U U-�' U ■ ■ ■.'U 0 0 0 0 ■ ■ ■ ■ 0 0 0.0 ■ ■ ■ ■ ■ ■ ■ I I ■ ■ ■ ■ ■ ■ ■ ■ U• U 0 0 ♦ � ■ ■ ■ ■ , ounty.com ■ - - - '?â . : : : : / 0 E:Ø• ,;EU . . U: - - - - I ;,-:. - - -. . -: - - 0 -. - . . - - - - - - - . - . - :0 - - i. 4p tJorth_& 5:. A a 1TfL M ( o . • • U . U UU • U UU UU U U UU U U U U U U U UR • worth"� ­ ' Go • h South aso BeLfcr 8' :• SoMthSsde. Soiv4hiLL - . ELeme.nt rr ! . E •. . SC. O' O.L. . UUUU • UUUUUUUUUUUUUUUUUUUUI. • .* UUUUUUUUUUUUUUUUUUUUUUUUUU ,, r xim ti : : Q r xima eL a o atel o t kids kidsW • • U U U U U U U U U U U U U U U U U U • U U U U U U U U U U U • • • . • U U U U U • U U U U U U U U U U U U U U U . ..• . . . U • U U U U U U U U U U U U U U U U U U U U U U U U U U U U U U U our bike and scooter sa et education program visited' local schools to provide f Y p 9 ■ students:. with hands-on safety lessons that: helped build the knowledge and confidence needed to ride safely. During the program, students learned the im ortance of wearin a properly fitted helmet, following traffic and .: p 9 p p Y 9 edestr-fan sa f et rules, performing ormin basic: bike sa f et checks, and riding p Y p 9 Y responsibly. These interactive lessons reinforced l;f elong safety habits while ■• encouraging healthy, active transportation and help'ng reduce the risk of i. . •. S ■ preventable in juries. 555 •I U U U U U U U U • ••••U U U U U U5U U U U U U U U U U U U U U U U U U U U U U U U r U U U U U U U U U U U U U U U U U U U U U U U U U U U U U U U U U U U U • U U U U U U U U U • U U S • ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ k 1 ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ • .. * . ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ 1♦ w. - Or E'- v44 • ♦ �- • _ ■ ■ ■ - ■ ■ w ■ mm y ershp t1 KUCKB ' L \LUGH 1100 _ ■ i School.C A SELementry euuuuuuuuuuuuuuNuuuIuuuuuuuI. • • • u • • uuuIuuuuuuuuuuuuuuuuIa ___ • ____ theci.0 1.1t EHACY ' ' • 1 E U 1% L ti - ' jiiItt k ' E ." IJ • EASE . - • . . Community connection is at the heart of public health because it helps us : : . . . • • • • • : : understand the hopes and needs .of the people we serve. During a visit to: • _ •• - :.- - ::-, : local elementary school, we heard a student share in an AS election : : : : a.iid1 ' : : speech that they wanted more balls for the playground. While that may : : •" ppp : 1I1.iL " : : : seem like a small request, it ref lected a bigger need for opportunities to- ;• : : • ■ - _ •• play, connect, and be active. 6y Listening to our community ,and partnering ■ ■ • • ` ''•With the Shelton Centennial Lions Club and Prevention •Eduction Partners, : - ________ : r - • U • U : I - we were able to purchase 10 kickballs for all 10 public elementary :' ' -- _ ■ : schools in Mason County, supporting the mental, physical, and social well : : : - : being of local youth through active play, friendship, and healthy habits. : •• • U U • U • U U I U U U U U U U U U U U U U U U U U U • • • • . • . • • • • • • • • • • • • • • • • • • • • • • • . . . . . . . A• •. • • • • • • • • • • • • • • • • • • • • • • • • • • •; - .•. : �o p"rAPEVIE . HO • _�. :1 : may ® �� ■• ■ ♦ •♦ • • /b ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ►♦♦ ♦�■ ■ arri" �"r■ � �■•was-■ ■ M ■ ■ ■ ■ ■ ■ ■ ■ ■ ►♦ ♦♦■ . ■ ■..■ ■ i . ■'a ■ ■ s ■ arUr.■.i'■ i ■� i'.a ■►.•J • -• ø..1■ ■ ■ ■ ■ U ■ ■.■ 0 ■ ■ ■ s ■♦. O • ii , i1 IIldIM?h1 / I i.ii,i. • ♦ . ■ • • • ■ ♦ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ 1 ■ - ■ • ■ ■ L ■ ■ ■ ■: ■ r~~ _ ■ ■ / I _ ■ y• ■ kNd6 v ■-.. r / J r ♦ ♦ ■ ♦■ ■ ■ ■ ■ •■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■♦ ■ if. . ■ .mi. `r. ! ■ ■ U ■ ■ 1 ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ 1 • . . • • • • • • • • • • . • • • . • . . . . . . pp ♦� � • � RS Provided a roximately kids dental education at 6elfa"r, Sandh�ll ` and Souths'de elementary schools during Safety Days! ■ -- ' a : ♦ - --- 1TII1I! U- c, iç. lvi / 1FlI.ah11, _ 47' k ■ ■ - U• U Prov;ded ■ BelfQir `� N o 1 ■ Gra ev;ew : . -- ■ Elemehto►r ,♦.. . . . . . . . . . . . . ■ . . . . . . . . . . . . . . 0 0 0 0 ■ ■ ■ ■ ■ ■♦♦ ■ ' ABCD Dental is committed to improving access to • t+- : kiy%dergQrtey% p - y g ■ed�atr�c oral health• care b working to increase : CIASSeS with Medica'd acceptance among community dental providers ■ and connecting children and families with available . • dental kits • ;• dental services. While we cannot determine which • ♦♦1■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■♦♦ ■ ■ ; ■, insurance plans individual dentists choose to accept, we : ■ ■ can reduce barriers by providing education that : : _ ■ empowers families to take an active role in their ■ ■ • • - • ■ ■ • children's oral health. -Through hands-on education about ■ ; proper dental hygiene, healthy nutrition, and preventive ; , • O • care, we help children develop lifelong healthy habits, - , • BABY'S u� ' .- __ - - - reduce the risk of dental disease, and support healthier : TEETH MATTER outcomes for youth throughout our community. ; . =_. : p • • . • . . • . . . . . . . . . . a * . I I I I I • I I I 11111111 UI II UI UI 111111111111111111111111 .0 � r � Community Health Re ort p MAY - JUNE 2026 Childhood Lead Investigations There is no safe level of lead in the blood.Any detectable blood lead levels, even below 3.5 pg/dL, are associated with subclinical effects such as inattention, hyperactivity, and decreased cognitive function. Bones act as a reservoir for lead over an individual's lifetime and have potential consequences for later health. -------------------- �� COMMUNICABLE DISEASE AND NOTIFIABLE CONDITIONS Chlamydia - 30 cases Tuberculosis Cases One active case. Our office continues to "rule out" 2-3 possible TB cases per month. Animal Bites — Post-Exposure Prophylaxis (PEP) Approximately 10 dog bite calls. Our office works closely with Environmental Health if the animal needs to be tested for possible rabies. When a dog's vaccination history is unclear or unavailable, we work with the healthcare provider to decide whether to recommend Post-Exposure Prophylaxis (PEP). Bat calls are at their peak during the summer months. We receive 8-10 calls a month during the Spring. We put out educational material on social media about "What to do if I find a bat." Communicable Disease Cases We see many foodborne illnesses. Salmonella, Campylobacter, Shiga-toxin, and Giardia are the main bacteria and parasites found. As the weather improves, there are more cases of foodborne illnesses due to improper food storage and temperature control HEALTH EDUCATION AND OUTREACH In the months of March and April, there were a total of 42 social media posts, with an average engagement rate of 8.26% Environmental Health Briefing TO: Mason County Board of Health FROM: Ian Tracy, Environmental Health Manager DATE: August 4th, 2026 ITEM: Appeal Hearing - La Poblanita #1 Food Establishment Permit Revocation SUMMARY: La Poblanita #1 is a Mobile Food Establishment permitted to operate in Mason County beginning in January 2023. The facility has been found to be consistently non-compliant with food safety requirements. Between July 2025 and June 2026, eight inspections were conducted, and the establishment was shut down three times. The most recent closure was on March 26, 2026. In June, the department received documentation from the City of Shelton showing that the food establishment owner had constructed, without permits, a large commercial kitchen in a series of outbuildings at their home. The department issued a notice to the owner on June 26th that the food establishment permit would be revoked effective July 6th. The owner appealed this decision, and a hearing before the Health Officer was conducted on July 8th. The Health Officer issued a decision to uphold the permit revocation on July 14th. The owner has now appealed the Health Officer's decision. Per Mason County code, the permit revocation is suspended pending a final decision by the Mason County Board of Health. The facility is currently operating. A food establishment that has had its permit revoked is not eligible to apply for a new permit for a minimum of six months. At the end of the six-month period, the establishment may request a hearing before the Health Officer to determine if they will be allowed to reapply. REQUESTED ACTION: Hold an appeal hearing. The Board may choose to uphold, modify, or overturn the Health Officer's decision. ATTACHMENTS: Notice and Order, Health Officer's Appeal Decision, Department's Enforcement Summary • MASON COUNTY 415N6THSTREET, SHELT0NWA98584 SHELTON: 360-427-9670, EXT.400 Public Health & Human Services FAX:360-427-7798 Hand Delivered& Posted at Establishment NOTICE AND ORDER/NOTICE OF PERMIT REVOCATION June 26,2026 MASON COUNTY PUBLIC HEALTH AND HUMAN SERVICES 415 N 611 STREET SHELTON, WASHINGTON 98584 Claimant vs. La Poblanita's#1 LLC FEP2023-00006 Gloria Martinez-Ascencio 2126 Olympic HWY N SHELTON, WA 98584 To all concerned, NOTICE IS HEREBY GIVEN that Mason County Public Health and Human Services has determined that the lack of adequate food safety practices at the establishment listed above is a risk to public health and is in violation of WAC 246-215 and Mason County Code chapter 6.08. THEREFORE,THIS FOOD ESTABLISHMENT PERMIT IS REVOKED effective July 6, 2026. (ref. 6.08 and 06.08.090). On June 81,2026, Mason County Public Health was informed by the City of Shelton of an at-home kitchen being used to cook and prepare food for the above-named mobile food establishment. Further investigation found the approved commissary kitchen was not being used for all required processes.(ref. WAC246-215 Part 9, Subpart A Mobile Food Units 09100 (1.)) The above mobile food establishment has been serving food to the public that is not from an approved source, being stored,prepared, and cooked in a home kitchen. (ref WAC246-215 Part 3, Subpart B Sources 03200(1)&(2).) Repeat Red critical violations continued to be found during re-inspections, including the above violations, which were observed and addressed during previous inspections and closures. On July 16,2025, Mason County Public Health Food Safety Inspectors noted violations involving food cooked at home and placed on the mobile food unit for public service.On January 18,2026, inspectors found the Mobile food unit getting water from an unapproved source through non-food-grade hoses. During that same inspection, sewage was found to have been discharged directly onto the ground. On March 26,2026, it was observed that the mobile food unit was not using the approved commissary for waste disposal, sewage, and public water. Food waste was found dumped on the ground around the mobile food unit,and sewage was being discharged into an unapproved pipe. A non-food-grade hose was found supplying water from an unapproved outside water spigot. In response to the violations and closures,corrective action agreements were signed, education was provided,and the food code and regulations were reviewed at multiple meetings. Between July 16, 2025, and June 8,2026,eight(8)inspections have been conducted,during which high- risk violations have been observed and documented. The establishment was closed three(3)times during that period to allow corrections and bring the establishment into compliance. Closures occurred on July 16, 2025,January 16, 2026, and March 26,2026. 6.08.090 Permit—Revocation. (a) The health officer may revoke a permit for repeated violations of any of the requirements of this chapter or for repeated interference with the health officer in the performance of his duty. (b) Prior to revocation,the health director shall notify in writing the holder of the permit or the person in charge of the establishment,the specific reason for revocation. (c) The effective date of revocation shall be ten working days following service of notice as described in Section 6.08.100. If a written request for a hearing is filed with the health officer within this ten-day period,the revocation shall not take place until after the date of the hearing and after being sustained by the board. (d) Any person whose permit has been revoked may make a written application for the purpose of obtaining a new permit.A hearing will be provided before the health officer to determine if a new permit shall be reissued,however in no case shall a permit be revoked for less than six months. 6.08.170 Variance/appeal. (b) Actions and determinations of the health officer may be appealed to the board within ten days of notice of said action or determination.The health officer shall schedule a hearing with the board within thirty days of receipt of the appeal,and shall notify appellant of the date,time and location of the hearing. For any questions or to request a hearing, contact the Environmental Health Manager Ian Tracy at(360) 427-9670 x 544 or email at itracy(rdntasoncountywa.gov Ian Tracy, RS Mason County Environmental Health Manager 415 N 6TH STREET, SHELTON WA 98584 MASON COUNTY SHELTON:360-427-9670, EXT.400 • Public Health & Human Services Entregado Personalmente Publicado en el Establecimiento AVISO Y ORDEN I AVISO BE REVOCACION DE PERMISO 26 de Junio de 2026 MASON COUNTY PUBLIC HEALTH AND HUMAN SERVICES 415 N 61h STREET SHELTON, WASHINGTON 98584 Reclamante vs. La Poblanita's#1 LLC FEP2023-00006 Gloria Martinez-Ascencio 2126 Olympic HWY N SHELTON, WA 98584 A todos los interesados, Por la presente se notifica que la Salud Publica y Servicios Humanos del Condado de Mason ha determinado que Ia falta de practicas adecuadas de seguridad alimentaria en el establecimiento mencionado anteriormente representa an riesgo para la salud p6blica y constituye una infraccion de la WAC 246-215 y del capitulo 6.08 del COdigo del Condado de Mason. POR LO TANTO,SE REVOCA ESTE PERMISO DE ESTABLECIMIENTO DE ALIMENTACION CON EFECTO A PARTIR BE JULIO BE 2026. (ref. 6.08 y 06.08.090). El 8 de junio do 2026, Ia Salud Publica del Condado de Mason fue inforrnada por Ia ciudad de Shelton de que se estaba utilizando una cocina domestica para cocinar y preparar alimentos para el establecimiento de comida movil mencionado anteriormente. Una investigacion posterior descubrio que Ia cocina do comisaria aprobada no se estaba utilizando para todos los procesos requeridos. (ref. WAC246-215 Parte 9, Subparte A Unidades de Comida MOvil 09100(1).) El establecimiento de comida movil mencionado anteriormente ha estado sirviendo alimentos al pfiblico que no provienen de una fuente aprobada, siendo almacenados, preparados y cocinados en una cocina domestica.(Ref. WAC246-215 Parte 3, Subparte B, Fuentes 03200(1)y(2).) Las violaciones criticas de repeticion en las inspecciones continuaron detectandose, incluyendo las violaciones mencionadas anteriormente,que ya fueron observadas y abordadas en inspecciones y cierres previos. El 16 de Julio de 2025, los inspectores de Seguridad Almmentaria de Ia Salud Publica del Condado de Mason detectaron incumplimientos relacionados con alimentos cocinados en casa y colocados en la unidad movil de comida para su servicio pirblico. El 18 de enero de 2026, los inspectores encontraron que la unidad movil de comida obtenia agua de una fuente no aprobada mediante mangueras no aptas para uso alimentario. En esa misma inspeccion, se detecto que se habia vertido agua residual directamente sobre el suelo. El 26 de marzo de 2026, se observo que Ia unidad movil de comida no utilizaba Ia comisaria aprobada Para Ia eliminacion de residuos,aguas residuales y agua p6blica. Se encontro basura alimentaria arrojada al suelo alrededor de Ia unidad movil,y las aguas residuales se estaban vertiendo en una tuberia no aprobada. Tambien se detecto una manguera no apta para uso alimentario que suministra agua desde tin grifo exterior no aprobado. En respuesta a las violaciones y cierres, se firmaron acuerdos de acciones correctivas, se proporciono educacion y se revisaron el codigo alimentario y las regulaciones en varias reuniones. Entre el 16 de julio de 2025 y el 8 dejunio de 2026, se han realizado ocho(8) inspecciones, durante las cuales se han observado y documentado incumplimientos de alto riesgo. El establecimiento fue cerrado en tres(3)ocasiones durante ese periodo para realizar correcciones y garantizar su cumplirniento. Los cierres tuvieron lugar el 16 de julio de 2025,el 16 de enero de 2026 y el 26 de marzo de 2026. 6.08.090 Permiso—Revocacidn. (a)El funcionario sanitario podia revocar un permiso por incumplimientos reiterados de cualquiera de los requisitos de este capitulo o por interferencias reiteradas en el desemper o de sus funciones. (b)Antes de la revocaci6n,el/la director/a de salud debera notificar por escrito al titular del permiso o a la persona responsable del establecimiento la causa especifica de la revocacion. (c)La fecha efectiva de revocaci6n sera diez dias laborables despues de la notificacion,segun lo descrito en la Seccion 6.08.100.Si se presenta una solicitud por escrito para una audiencia ante el funcionario de salud dentro de este periodo de diez dias, la revocacion no tendra lugar hasta despu6s de la fecha de la audiencia y tras su ratificacidn por la junta. (d)Cualquier persona cuyo permiso haya sido revocado podra presentar una solicitud por escrito para obtener un nuevo permiso.Se realizara una audiencia ante el funcionario de salud para determinar si se reemitira un nuevo permiso;sin embargo,en ningun caso,un permiso sera revocado por un periodo inferior a seis meses. 6.08.170 Variation/recurso de apelacion. (b)Las acciones y determinaciones del funcionario de salud podran ser apeladas ante la junta en un plazo de diez dias contados desde la notificacion de dichas acciones o determinaciones.El funcionario de salud programara una audiencia con la junta en un plazo de treinta dias desde la recepcion de la apelacion,y notificara a la parte apelante la fecha,hora y lugar de la audiencia. Para cualquier consulta o para solicitar una audiencia,contacte con el Gerente de Salud Ambiental, Ian Tracy,en el telefono(360)427-9670, extension 544, o por correo electronico a itracy@masoncountywa.gov. Ian Tracy, Gerente de Salud Ambiental del Condado de Mason, RS !T " • MASON COUNTY Public Health & Human Services Julio 14, 2026 La Poblanita's#1 LLC/Gloria Martinez-Ascencio 2126 Olympic HWY N SHELTON,WA 98584 Recurso contra La revocacion del permiso de La Poblanita # 1 Numero de Permiso FEP2023-00006 Estimada Senora Martinez, Esta carta es la resolucion de La audiencia de apelacion del Funcionario de Salud que tuvo Lugar el 8 de Julio de 2026. El 26 de Junio de 2026, el departamento notifico a La Poblanita #1 la revocacion de su licencia de establecimiento de alimentos segun MCC 6.08.090. La carta detalla en su totalidad Las conclusiones del departamento, incluyendo Las infracciones insistentes y graves del Capitulo 6.08 de MCC y del WAC 246-215 documentadas en la inspeccion, asi como la confirmacion de que el establecimiento operaba sin utilizar su cocina aprobada. Las conclusiones de La carta del 26 de Junio de 2026 se incorporan aqui por referencia. La titular del permiso, Gloria Martinez, presento una solicitud de audiencia en tiempo y forma, y se realizo una audiencia el 8 de Julio de 2026. La titular del permiso no ofrecio una explicacion suficiente para Los haLLazgos en La carta del 26 de Junio de 2026, ni identifico medidas que impidieran futuras infracciones. Nada de to presentado en La audiencia refuto Los haLLazgos del departamento ni demostro que La continuacion de la actividad bajo el permiso vigente resultaria en cumplimiento. La apelacion es denegada y se mantiene la Notificacion de Revocacion. La revocacion del permiso toma efecto en un plazo de 10 dias desde La fecha de esta carta. Segun MCC 6.08.090(d), eL permiso sera revocado por un periodo minimo de seis meses. MASON COUNTY PUBLIC HEALTH, COMMUNITY&ENVIRONMENTAL HEALTH 415 6TH ST.,SHELTON,WA 98584 SHELTON:(360)427-9670 X400*BELFAIR:(360)275-4467 X400 Despues de ese tiempo, podra solicitar por escrito un nuevo permiso y se le conceders una audiencia ante el oficial de salud para determinar si se emitira un permiso nuevo. Esta decision podra ser apelada ante la junta de salud en un plazo de 10 dias desde la fecha de esta resolucion. Sincerely, Steven Krager, MD MPH Oficial del Departamento de Sauld Servicios de Salud y Bienestar del Condado de Mason 2 • • Public Health & Human Services July 14, 2026 La Poblanita's#1 LLC/Gloria Martinez-Ascencio 2126 Olympic HWY N SHELTON, WA 98584 Re: Appeal of Permit Revocation for La Poblanita's#1 Permit No. FEP2023-00006 Dear Ms. Martinez, This letter is the determination of the Health Officer appeal hearing that took place on July 8th, 2026. On June 26, 2026, the department served La Poblanita's #1 with a Notice of Revocation of Food Establishment Permit under MCC 6.08.090. That letter sets out the department's findings in full, including the repeated serious violations of MCC Chapter 6.08 and WAC 246-215 documented on inspection, and the finding that the establishment was operating without use of its approved commissary. The findings in the June 26, 2026 letter are incorporated here by reference. The permit holder, Gloria Martinez filed a timely request for a hearing, and a hearing was held on July 8th, 2026. The permit holder did not offer a sufficient explanation for the findings in the June 26, 2026 letter, and did not identify any measures that would prevent further violations. Nothing offered at the hearing rebutted the department's findings or showed that continued operation under the existing permit would result in compliance. The appeal is denied and the Notice of Revocation is sustained. The permit revocation will take effect within 10 days of the date of this letter. Under MCC 6.08.090(d), the permit shall be revoked for not less than six months, after which time you may apply in writing for a new permit and will be given a hearing before the health officer to determine whether a new permit will be issued. This determination may be appealed to the Board of Health within 10 days of the date of this decision under MCC 6.08.170(b). MASON COUNTY PUBLIC HEALTH, COMMUNITY& ENVIRONMENTAL HEALTH 415 6TH ST., SHELTON,WA 98584 SHELTON: (360)427-9670 X400*BELFAIR: (360)275-4467 X400 Sincerely, Steven Krager, MD MPH Health Officer Mason County Public Health and Human Services 2 MASON COUNTY 415 N 6T"STREET, SHELTON WA 98584 SHELTON: 360-427-9670, EXT. 279 or 361 Public Health&Human Services foodsafety@masoncountywa.gov Food Establishment: La Poblanita's#1 Permit#: FEP2023-00006 Inspection and Enforcement Summary July 16, 2025—June 8th, 2026 July 16, 2025, a routine inspection was conducted, and multiple red violations were observed and documented. Critical Red Violations—98, Blue Violations—8, Total—98. During the inspection, the food worker stated the refried beans were made at home and placed in the mobile unit. No commissary kitchen was used. The food establishment was closed. Education and training on how to correct the violations took place. We then set up a meeting for the following day to discuss it further. At the meeting, a training agreement and a corrective action agreement addressing all violations were implemented, and a new commissary kitchen agreement was required.A reinspection was scheduled for July 18, 2025 July 18, 2025, A reinspection was conducted, and the food establishment was approved to reopen. It was noted that Active Manager Control plans and training must still be completed by the listed corrective action agreement date. January 16, 2026, A complaint inspection was conducted for possible sewage on the ground. During the inspection, we observed sewage on the ground behind the mobile unit. We also observed signs of older areas where sewage may have been discharged multiple times. We also observed an unapproved water source being used and non-food-grade hoses. See the inspection report for full details. The mobile unit is only approved to obtain water and discard grey water/sewage at the approved commissary kitchen. Due to sewage on the ground and the non-use of the approved commissary, the Mobile unit was closed. Black sewage pipes were not approved, and City of Shelton was notified. A meeting was held, and a corrective action agreement was issued. The mobile unit remained closed. January 26, 2026, a site visit was conducted after being notified by city officials that the mobile unit was being used during closure status. Pictures were provided that showed the use of the mobile unit during closure. Notification was given that the mobile unit is not to be used in any capacity during closure until approved. March 6, 2026, Re-inspection was conducted, and all violations from the closure inspection had been corrected. Reminders were given about commissary use requirements and that commissary logs must be turned in every Monday. March 26, 2026, A complaint inspection was conducted due to food waste and grease being discarded on the ground. During the full inspection, multiple locations were found where food waste was discarded. Non-food-grade hoses were being used, and there were other red violations. Red Violations — 65, Blue Violations —8, Total —73. The establishment was closed. Other new plumbing and sewage piping were observed that were not approved. Due to the City Sewer being affected, they were advised of this site. The owner-manager of the mobile unit came to the office, and corrective actions for violations were explained. Reminded that the approved commissary is where food waste, sewage, and food preparation is to take place. A reinspection was scheduled for the next day. March 27, 20206, The owner-operator was on-site for a reinspection and stated she understood the risks to food safety and that corrective actions had been completed. All corrective actions had been completed, and they were approved for opening. June 8, 2026, I received a notification from the City of Shelton that they found a residential property listed under the owner of La Poblanita's with an unpermitted kitchen being used to support commercial cooking. Pictures were provided. June 15, 20206, I spoke with the mobile unit owner regarding the use of the approved commissary kitchen and the unapproved residential kitchen. She stated it was used for an event/organization (Anti-Drug-Anti Alcohol) in Tacoma/Pierce County. • MASON COUNTY 415 N 6TH STREET, SHELTON WA 98584 SHELTON: 360-427-9670, EXT. 279 or 361 Public Health& Human Services foodsafety@masoncountywa.gov June 16, 2026, I spoke with the approved commissary kitchens coordinator and representatives. At the commissary location. Al Tupper stated they can see on the cameras that they enter the location but are unsure of the activities they complete. Patty Tupper stated they have not used the kitchen much, but this last week they have moved in a lot more stuff than before and are using it a lot. I was offered the opportunity to view video footage from their cameras, but it only went back approximately 10 days. After reviewing all previous inspections requiring closures and the enforcement policy, I issued a revocation on June 26, 2026. We have a Spanish-speaking staff member who can accompany me on inspections and during meetings to provide interpretation and translation. All pertinent documents have been provided to the mobile food establishment in English and Spanish. I believe the red repeat violations, the consistent non-use of a commissary kitchen, and the lack of basic active manager control pose a risk to public health. My translator and I have spent many hours providing education to this mobile food establishment, verbally and physically demonstrating it onsite, and providing documents. Please see the attached files for the full inspection reports, pictures, and the violation correction agreement. Understanding A Food Establishment Inspection Report: Food establishments are routinely inspected a minimum of two times per year, depending on the complexity of their menu and operations.A Food Establishment Inspection report is a snapshot in time of the food safety practices and management system observed at a restaurant. This is the primary way for our local health jurisdiction to monitor and evaluate compliance with the Washington State Retail Food Code. During the inspection process,the inspector looks for critical violations (red) and non-critical violations (blue). Critical Violations (red), of the Food Code, if left uncorrected, are more likely than other violations to directly contribute to food contamination or foodborne illness. Examples of critical violations include poor temperature control of food, improper cooking, cooling, refrigeration, or reheating temperatures. These problems can create environments that cause bacteria to grow and thrive,which can put the customer at risk for foodborne illness. Non-critical Violations (blue), not directly related to the cause of foodborne illness, but if uncorrected, could hinder the operation of the restaurant. The likelihood of foodborne illness in these cases is very low. However, if non-critical violations are not corrected,they could lead to critical violations. Examples of non-critical violations include a lack of facility cleanliness and maintenance, or improper cleaning of equipment and utensils. Additional inspections take place as needed for the following reasons. • A routine inspection fails and falls into re-inspection (Over 35 critical red point violations) • Complaint inspection • Foodborne illness investigation inspection • Preoperational inspection (conducted prior to opening a new establishment or when a change of ownership occurs) • Emergency Inspections (following a fire, flood, sewer/septic backup, etc.) G lcctke- MASON COUNTY PUBLIC HEALTH & HUMAN SERVICES Food Establishment Inspection Report 415 N 6th St.,Shelton,WA 98584 1 Shelton:360-427-9670 ext 400 1 Belfair:360-275-4467 I�� ey rfiFv�=�If I�Health Name of FAa ashmenU LA Poblanna l LLC Cstabtahrre of Ti 1.labile Food Estabfsh Trent Risk CategaK High Perch Nunbe i FEP2023.00006 Estabashment Weet:2126 O1i'miic Hwy N Ernst:gtu'mN850yrralcons EstMhhment City'. Shehan Phone:000-000-0000 Date: Tine the Ebpsedi Purpose Of lnspe[tbn: pdRilC Meals Served: Meals Observed: Total Foists: 98 Red FOF6: 90 Repent Red:0 ]/16/2025 0150 pm 01:4090 L D L k F' •eP e' e' F High Risk Factorsare Improper practices or procedures identified as the most prevalent contributing factors of foodborne illness or injury. Checked Box indicates compliance statustiN,OUT,NO,NA)foreach Item IN=1n Compliance OUT=Not in Compliance NO=Not Observed NA=Not Applicable CDI=Corrected During Inspection R=Repeat Violation 4 64 OUT NA NO Item Oss[ription CDI R PTS a IN CUT NA NO tem Dacnption Cot R PIS r1 OUT PlC preset,daTmnstratn knensM6eaerd performs dudes to 5I 16 510 Properice.1he procedures 25 rrWntNn hllC;testified manages-on staff unlessenerpt 2 IN Food Workcr redsmrrea tort']foodxnrler;n[w foodsoM1¢s 17 OUT Proper hotho!dingtemperatarm ispts if 130-F to134'FI 25 trained Ig I'! Props-cook:ngt(meandtemperatuw;pmpxuseof 25 onEnuoux moFng 3 IN Priori l l xoricrand mndltionel unplo}ea prxcticx;no'iI xnkes 25 19 IN Ito mom ten to of Omer as a control 25 Present;Pro,errepnningof Ileess Pe+are storage:ProPrr use 20 NA Proper retreating procedures forhoc he'd'n8 15 4 IN Hands was bed asrequired 25 21 OUT Props'co'dbo!d;ngterpe'aural5ptsif42-Ft045'11 10 Proper barriers used to ene.'ml Ierr trend roraxl xitM1 ready-so- Accurate Namorre[r provd dand used to[vakia[elsn3aca[ure 5 RI eatfoods 25 22 IN of TCSfoods 6 it Adequate beodxesbing/xirrlix 10 23 NA Propxwnrvma Mvisorypos(M for ra.a or unde[ooiM foods 7 OUT Food obtained from appm:M so r 15 8 IN Wester supply,Ice from approved source 10 24 I!A Festooned foods used at requelf prohibited loads no[oRer[d J 30 9 14 Propermanbleg of fruits and vegdzbla 10 Food in good condition,sale,and enedulterats;zpWovrd 25 DI rescsubstar[a peopedyidentified,itoco,an S 10 10 OUT Address 10 ss Proper di,pashies of resume,unsafe,or camas's ated food; 25 OUT p -g an disk control p lass, 10 1] OUi 10 Com orbs ,It nprocedarrs raDn nroper date mar4ing pmceiures for lootl zl hipf risk fv Lis(vi and rcQulrcd xnllen proccdur 12 NA P mpess hAlstock ID;x:'d mu shore m l0;pzras He desWRion a 5 22 NA Come'air,eilh eanaa¢,5 ttsiaN procedures forfah p processes;HACCP plan SO Food cones(Uhrfi[leaned and s,nfusid;nouose 5 l mnlamination B 14 OUt R—nests be!o:voraxuyfrorinii o-wt food;sp«des 5 • � , � 90 separated 15 RO Proper preeaztlonofrawshgleggs IluI1flwp:l1:lyT.flh4=acar.].I1rn Low Risk Factorsare pteventltive measuresto control the addlalon of pathogens,chemicals,and physical objects Into foods.Checked Box Indicates compliance status. 4 N OUT ttern Described CDI R PTS 4 IN OUT hanOencnplisn Cq R PTs 28 Food recu':ed at pmpertenperatu re 5 40 Food and nonfood surfaces properly used and constmcted;cleanable 5 29 Adequate cquipmmt forlemperalureconirol 5 41 Wa'eanshingfaciitien propm'y inste'ed,mintaMed,used;sanduer 5 CO mteation;tat stops salable and used 30 OUT Pro perthaningmethods use 3 42 Food-contactsurzces man[aned,clean M,snidzed 5 43 Nonfood Contactsurfaamzntanedandclen 3 31 Food properhiabded;propa'dalenurking 5 44 Plumbing Propo-lysUM,inslaed,and mSn[YnM;proper bacNbwdedces, 5 32 OUT Insects,rodents,animals not present;sentence conboted 5 bd'utttdralns,0ocross-corrections 33 Posential foodcenlaminallon prnar[M during dd,:ery,preparation,storage, 5 45 Senag;xas[eaalrr praperydisposed 5 displhy 45 Toi'R facirTies prapenlycansiruded,suppled,cleansed 3 34 Wiping cloths property used,stored;s enitizu concentration 5 47 Garbage,reusepropeny deposed;fxprlks mantared 3 35 Fmploi-eedeanllnessandhygene 3 48 Phynifa i'itix property lnsta'1d•su'nta'n ed,cleaned;unnecessary peasons 2 36 Proper eaMg taMg deeming or tobacco use 3 Boded from atabl'ifment 49 Pd[y uate[entilation,Iglting designated areas used 2 3] In-use ulznsl6 property stood 3 50 Pasting of permit;mobiseestabrahrrent more eastycsible 2 38 Ulcnsils,"oip sent,lie so,properly stored,used,b mdled 3 39 5'ng:euse aesdsieeo-,enice articles propaflstcred,used 3 a a 8 Comments,Temperatures,and Photos on the to]l owing pages. Comments: No Record Temperature Observations Item Location Temperature Shredded cheese Outside make table 70 Pico de gallo Inside make table 65 Sliced tomatoes Inside make table 65 Lettuce Inside make table 43 Refried beans Stand up cooler 45 Raw meat Make table cooler 41 VOILATIONS, OBSERVATIONS AND CORRECTIVE ACTION Hltems Comments 1 Violation: 02100(PIC—Assigned, present) Violation: 02105(PIC—Demonstration of knowledge) Observations : AMC toolkit and CFPM not observed. Corrective Action: The arrival of a knowledgeable Person in Charge(PIC).Discussed with the Person in Charge(PIC)about their duties and how to achieve Active Managerial Control (AMC). Corrective Action: On-site education of risk factors.The Person In Charge(PIC) must train Food Workers on foodborne illness risk factors. Corrective Action: Food workers must obtain a food worker card within 14 days of hire and the Person in Charge(PIC) must train them on task food safety requirements. 7 Violation: 03200(Source—Compliance with law) 'Observations : Staff said that refried beans came from the owner's home.That they were made there and brought over,but directly into the hot hold Corrective Action: Food from an unapproved, unsafe,or unverifiable source,must be discarded or placed on hold. Described how suppliers are selected and how foods are properly received and stored. Corrective Action: The Person-in-Charge(PIC) must retrain Food Workers not to use'unapproved sources and how to evaluate food deliveries.The Person-in-Charge(PIC) must check that foods are properly labeled and invoiced from an approved source. 10 Violation: 03100(Food condition—Unadulterated,safe) Violation: 03255(Food condition—Package integrity) ; Food is observed outside,open to the environment. Meat observed In the back of the truck,,not In the cooler, Observations sitting at room temperature Corrective Action: Food Workers must be trained on how to receive and assess food conditions. Discussed how food should be received and conditions assessed. 11 Violation: 03527(1-2) (Date Marking—High risk foods,disposition) Food was observed with no date marks throughout the establishment. None of these items had date marks: Observations Refried beans were in a cooler,rice was in a cooler,and meats were in a make-table cooler. 14 Violation: 03306(la)(Raw animal food—Food,adequate separation) Observations : Raw eggs observed stored above lettuces and ready to eat foods in tall cooler in food truck. Corrective Action: Food without obvious contamination moved during the inspection. Discussed how raw animal food will be stored and separated in order of Cooking temperature to prevent cross-contamination. Food Workers must be trained on proper raw animal food storage and separation. 17 Violation: 03525(la) (Hot holding—Process) Refried beans were observed at 120°F in the hot hold. From what the staff said, beans came directly from the Observations : owner's house. Beans were discarded Corrective Action: Improperly hot held food must be reconditioned by reheating to 165°F. Food Workers must be trained on proper hot holding procedures and temperature monitoring.The Person in Charge(PIC) must verify Food Workers are monitoring hot holding temperatures and control measures are taken as needed. Corrective Action: Improperly hot held food that cannot be reconditioned must be discarded or placed on hold. Refer to the Food Destruction Guidelines for more info. Food Workers must be trained on proper hot holding procedures and temperature monitoring.The Person in Charge (PIC) must verify Food Workers are monitoring hot holding temperatures and control measures are taken as needed 21 In make table cooler outside,shredded cheese was observed at 70°F. In make table cooler in the truck,shredded Observations : cheese was observed at 46F,sliced tomato at 47F, pico de gallo at 59F,and refried beans in a stand-up cooler observed at 43F Corrective Action: Improperly cold held food cannot be moved/reconditioned must be discarded. Refer to the Food Destruction Guidelines for more info.Discussed proper cold holding procedures.The Person in Charge(PIC)must monitor Food Workers to ensure they are following proper procedures. Follow a maintenance schedule and repair equipment,as needed. 26 Violation: 08200(Required plans—Review and approval) Observations : Observed make table cooler and kitchen setup outside,prep is not allowed outside food truck. Please see application for approved set up. Corrective Action: Food Establishment is not doing the process correctly and does not have an approved plan,they must immediately cease and desist the process.Affected food products must be discarded or placed on hold. If Food Establishment wants to do the process,they must have an approved plan before resuming the process. 30 Violation: 03510(Thawing—Methods) It was observed that fish was stored on front seat of food truck. Parts of fish observed at 70F and parts of fish Observations : observed at 30F. Corrective Action: Frozen foods must be thawed under cool running water(70°F or under)for a period of time that does not allow food to get over 41°F or in cold holding unit under 41°F. 32 Violation: 06260(Pests—Outer openings protected) Violation: 06265(Pests—Exterior walls,roofs,barriers) Violation: 06550(Pests—Methods of control) Observations : Food stored outside was observed with bugs in it. Food stored outside was not protected from pests.Also,single- use items stored outside allow bugs to enter the packaging. Corrective Action: Food establishment needs to obtain pest control to eliminate pests. Corrective Action: Openings need to be properly screened or otherwise protected against the entry of insects and rodents. Corrective Action: Food Establishment must take appropriate action to eliminate pest harborage conditions.Clean and organize areas to eliminate harboraging. Clean pest evidence with disenfectants. Remove trapped/dead pests from control devices. Item:Food in good condition,safe,and unadulterated;approved Item:Proper cold holding temperatures(5 pts if 42°F to 45°F) additives o I, J ' 1� s 1�- y�y Item:Compliance with valid permit;operating and risk control plans,and required written procedures Item:Proper thawing methods used Q Item:Insects,rodents,animals not present;entrance controlled fhnonlnCharget3gi Wrt) Poson In Cage W.7/16207.5 Gloria RguialwyAulhwity(Signanv) RgWl .yAuthodty Followup:Na Raid 4mn y /re ft T a F i i i f 11' e S� i J $©'ii��lii ______ 4Y �� 4 -y • hf `su ? S r 1 s � i s i L _ f i rt Y I �t dlll(Ii ? !I' i t V t (.: V ;II74 . j� t�`�1"" �t T. s a a4q r 1M' ` d A.' kfVL ti i tIJ 9 1 4' i$ a `` ` �. - .'3f ` 7 1 � r , \ , a i1 ` rFtiV ,y.r:: ! ! a , � ' • / .��T C __ r n+t2KJ�f-:k .__. ±- ,�y ': fl1J I Sfl1L ,III " �`.at fls I S4 I.I X11 r I �II u• ti'q m r 3 , I `\ I( I I I \ r 4 ts H : Tk . .3 i t i �' is Mason County Public Health&Human Services MASON COUNTY 415N 6th Street,Shelton,WA98584 Public Health&Human Services (360)427-9670 ext.279&361 foodsafety@masoncountywa.gov Aviso de Cierre: Venta de comida suspendida Establecimiento PR# 2i Ue Olin, o. k\Wu N i/I S 2�3ô Direcci6n Fecha Horario ( I� C(RW Iw WA t Codigo Post I ❑ Se suspenders de inmediato toda operaci6n de alimentos y bebidas. Este establecimiento de comida opera sin un permiso vslido. Esto es un delito menor segun RCW 70.05.120 y el C6digo Administrativo de Washington (WAC)246- 215-08600. ❑ Todas las operaciones de alimentos y bebidas cesarsn inmediatamente. Ninguna persona podrs operar un establecimiento de servicio de alimentos si no tiene un permiso vslido emitido por un oficial de salud de acuerdo con el Kl0 6, Capltulo 8 de las Regulaciones de Servicios de Alimentos del C6digo Sanitario del Condado de Mason. Todas las operaciones de alimentos y bebidas cesarsn inmediatamente. El permiso del establecimiento de entos ha sido suspendido por las siguientes infracciones de la secci6n 246-215 del C6digo Administrativo de Was o ( ): (WAC): n p L vvW 1YL'J ' tA5 l ' 1�+ — Tres la emisi6n de este aviso, se podr6 presenter una solicitud por escrito para una reuni6n administrative, segun to dispuesto en WAC 246-215-08600. He leido y comprendido el procedimlento de cumplimiento indicado anteriormente. Persona encargada Autoridad re uladora Fi ma Firma Escribir Nombre cribir Nombre Telefono/Correo Electr6nico Cualquier persona cuyo permiso de establecimiento de servicios de alimentos haya sido suspendido padre, en cualquier momenta, solicitar por escrito una nueva inspecci6n pars su restituci6n. La solicitud debere incluir una declaraci6n firmada que explique como se han corregido las circunstancias que motivaron la suspensi6n. Dentro de los dos dlas hebiles siguientes a la recepci6n de una solicitud por escrito de nueva inspecci6n, la Autoridad Reguladora completare una inspecci6n de seguimiento obligatoria y restablecere el permiso si el establecimiento de alimentos cumple con el Capitulo 246-215(WAC). REINSTALACION DEL PERMISO Las infracciones mencionadas anteriormente se han corregido y se restablece el permiso de alimentos. Se padre realizar una inspection de seguimiento dentro de los 10 dlas posteriores a esta notificaci6n pars garantizar el cumplimiento continuo del capttulo 246-215 (WAC). Persona r " "� Autoridad Reguladora response le V �) Fecha �] QQZ Hare �k Fecha i D ( (Jw3 Hors ' r N\,V On o C MASON COUNTY Public Health&Human Services 15 N 6-STREET,SHELTON WA 98584 SHELTON: 360-427-9670, EXT 400 FAX:360-427-7798 ACUERDO PARA LA CORRECCION DE INFRACCIONES EL siguiente establecimiento debera corregir todas Las infracciones en una fecha acordada para reanudar sus operaciones a plena capacidad.A continuacidn,se detallan Las infracciones detectadas y to que debe corregirse. 7/17/2025 La Poblanitas LLC1 2126 N Olympic Hwy Shelton WA 98584 Correcciones: Infraccion: (1)WAC246-215 02107 Credenciates CFPM,02110 CFPM-Deberes, 02115(4-16)-Deberes del PIC Correccion: El curso y el examen de Gerente Certificado en Proteccitn de ALimentos deben completarse dentro de Los 30 dies. Fecha de Correccion: 7/17/2025 Iniciales Infraccion:(1)WAC246-2150 2110 CFPM-Deberes, 02115(4-16)-Deberes del PIC Correccion:EL kit de herramientas de controtgerencial activo debe completarse en una semana yet personal debe recibir capacitaci5n y contar con una hoja de aprobaciOn. Correccion Date: 7/17/2025_Iniciales 1. MA Infraccion:(7)WAC246-215 03200 Fuente:Cumplimiento de La Ley Correccion: Se explic6 que Los atimentos se etaboraban en el domicilio del propietario. No se permite preparar ni almacenar atimentos en el hogar ni en areas privadas. Los atimentos para estabtecimientos minoristas solo se pueden preparar y almacenar en areas autorizadas por la autoridad sanitaria Local. Fecha de Correccion:_?/17/2025_Iniciales Ms, Infraccion: (10)WAC246-215 03100 Estado de Los atimentos: no adulterados y seguros, 03255 Estado de Los alimentos: integridad del paquete. Correccion:Todos Los atimentos deben atmacenarse en un area Segura,Lejos de contaminaci6n, problemas de empaque y plagas. Fecha de correccion: 7/17/2025_Iniciales_C Mt MASON COUNT' Public Health&Human Set 415 N 6-STREET, SHELTON WA 98584 SHELTON:360-427-9670, EXT.400 FAX:360-427-7798 Violacidn: (11)WAC246-215 03526 Etiquetas de Los alimentos-Marcado de Fecha Correccidn: Se requiere capacitacion sobre marcado de fechas. La hoja de aprobacion, firmada por todo el personal, debe entregarse antes de la aperture y entregarse en et edificio de Satud Publica o enviarse por correo electronico at personal de Seguridad Alimentaria del Condado de Mason. Consulte la pagina 15 del folleto de la tarjeta del trabajador de alimentos.Fecha de correccion: 7/18/2025 lnicialesrC H4 Violacidn: (14) WAC246-215 03306 (1a and 1b) Alimentos crudos de origen animal- Alimentos, separacidn adecuada, separaci6n de especies. Correccidn: Se debe impartir capacitacion sobre el almacenamiento de alimentos crudos. La hoja de aprobacion, firmada por todo el personal, debe entregarse antes de la apertura en et edificio de Salud Publica o enviarse por correo electronico at personal de Seguridad Alimentaria del Condado de Mason. Consulte la pagina 11 del folleto de la tarjeta del trabajador de alimentos. Fecha de correccion7/18/2025_Iniciales Violacidn: (17)WAC246-215 03525(1 a)Proceso de re calentamiento Correccidn: Se requiere capacitacion sobre mantenimiento y recalentamiento de alimentos. La hoja de aprobacion, firmada por todo el personal, debe entregarse antes de la apertura en et edificio de Satud Publica o enviarse por correo electronico at personal de Seguridad Alimentaria del Condado de Mason. Consulte la pagina 13 del folleto de la tarjeta del trabajador de alimentos. Fecha de Correccidn: ON? i 2S Iniciales qA Violaciones:(21)WAC246-215 03525 1 b,2 Proceso de mantenimiento en Frio Correccidn: Se requiere capacitacion sobre el mantenimiento en frfo. La hoja de aprobacion, firmada por todo el personal, debe completarse antes de la apertura y entregarse en el edificio de Satud Publica o enviarse por correo electronico at personal de Seguridad Alimentaria del Condado de Mason. Consulte Las paginas 12 y 14 del folleto de la tarjeta del trabajador de alimentos. Los registros de cada refrigerador deben completarse diariamente. Fecha de Correccidn: /2-5 Iniciales MASON COON'."' Public Health&Human Servi. 415 N 6TM STREET,SHELTON WA 98584 SHELTON:360-427-9670, EXT 4L`0 FAX:360-427-7798 Las infracciones mencionadas anteriormente pueden provocar directamente enfermedades transmitidas por Los atimentos. Todas Las infracciones deben corregirse en la fecha acordada anteriormente. Entiendo que, si no se corrigen en Las fechas acordadas, el establecimiento permanecera cerrado haste que se solucionen. Debido a que estas infracciones se han repetido durante Los Gltimos 4 anos de inspecciones y multiples Re inspecciones, si se observan en futures inspecciones, el establecimiento cerrara inm amen sta que se solucionen. Print Name-Owner/Manager Sign riManager Date 0 71 7 Print Name-Environmental Health Signature-Environmental Health Date ( 4 MASON COUNTY Public Health&Human Services 415 N 6-STREET, SHELTON WA 98584 SHELTON:360-427-9670, EXT.400 FAX:360-427-7798 Violaciones:(26)WAC246-215 08200 Pianos requeridos- Revision y aprobacion Correccion: Se observo que se instataba un refrigerador pars mesas y la cocina en at exterior; no se permite La preparacion fuera del camion de comida.Consulte la solicitud pars la instalacion. El establecimiento de comida no esta realizando at proceso correctamente y no cuenta con un plan aprobado; debe suspenderLo de inmediato. Los productos alimenticios afectados deben desecharse o suspenderse. Si un establecimiento de comida desea continuar con at proceso,debe contar con un plan aprobado antes de reanudarlo. Fecha de correccion: /��y 2._5 Iniciales A Violacion: (30)WAC246-215 03510 Metodos de descongelacion Correccion: Los alimentos congelados deben descongelarse bajo ague corriente fria (a 21 °C o menos) durante un periodo que no permita que superen Los 5 °C ni en una camara frigorifica a menos de 5 °C. Capacite at personal y asegurese de que esto se haga correctamente. Fecha de correccion: Jniciales_ I-4 Violacion:(32)WAC246-215 06260 Plagas-Aberturas exteriores protegidas 06265 Plagas-Paredes exteriores,techos, barreras, 06550 Plagas-Metodos de control Correccion: Se observo que los alimentos atmacenados en at exterior contenian insectos. Los alimentos almacenados en at exterior no estaban protegidos contra plagas. Ademas, los articulos de un solo use almacenados en at exterior permiten la entrada de insectos en at empaque. Medida corrective: El establecimiento de alimentos debe contratar un servicio de control de plagas para eliminar Las plagas. Medida corrective: Las aberturas deben ester debidamente protegidas contra to entrada de insectos y roedores. Medida corrective: EL estabLecimiento de atimentos debe tomar Las medidas necesarias pars eliminar Las zones de anidamiento de plagas. Limpie y organice Las areas pars eliminar Las zones de anidamiento. Limpie Las zones con desinfectantes. Retire Las plagas atrapadas/muertas de los dispositivos de control. Fecha de correccion: 7/17/2025 Iniciales Eacf�d_e_ o[7ecaion: Tciales MASON COUNTY Public Health&Human Services '415 N 6-STREET,SHELTON WA 98584 SHELTON: 360-427-9670, EXT.400 FAX:360-427-7798 AGREEMENT FOR CORRECTIONS OF VIOLATIONS The following establishment will need to correct all violations on an agreed-upon date to resume full operation. Below are the violations noted and what needs to be corrected. 7/17/2025 La Poblanitas LLC1 2126 N Olympic Hwy Shelton WA 98584 \'Corrections: Violation: (1)WAC246-215 02107 CFPM Credentials, 02110 CFPM-Duties, 02115(4-16)-PIC Duties Correction:The Certified Food Protection Manager class and test must be done within 30 days. I Correction Date: 8/17/2025 Initial Violation:(1)WAC246-2150 2110 CFPM-Duties,02115(4-16)-PIC Duties Correction:The Active Managerial control toolkit must be done in one week and staff must be trained and have a sign-off sheet. Correction Date: 7/18/2025 Initial F Violation: (1)WAC246-2150 02120 Food worker card Correction: All staff must have food worker cards. Establishment must have everyone trained, and a food worker card must be presented to the Health Department before the location can open Correction Date:_7/18/2025 Initial Violation: (7) WAC246-215 03200 Source-Compliance with law Correction: It was explained that food was being made at the owner's home. Food may not be made, prepped, or stored in a personal home or personal area. Food for retail establishments may only be made, prepped, or sto< 84 in areas that are approved by the local health jurisdiction. c a QO&S tSo VtxI l -.Ut, Correction Date:_7/17/2025_Initial Y�Violation: (10)WAC246-215 03100 Food condition-unadulterated and safe, 03255 Food Condition package integrity €orrection:All food must be stored in a safe area away from contamination,package issues,and pests. Correction Date:_7/17/2025_Initial MASON COUNT Public Health&Human Servict 415 N 6'"STREET, SHELTON WA 98584 SHELTON:360-427-9670, EXT.400 FAX: 360-427-7798 j,violation: (11)WAC246-215 03526 Food Labels- Date marking Correction: Date marking training must occur Sign-off sheet signed by all staff must be done before opening and turned in at the Public Health building or emailed to the Food Safety staff at Mason County. See page 15 of the food worker card booklet. Correction Date: nitial iolation: (14)WAC246-215 03306(1a and 1 b)Raw animal foods- Food, adequate separation,species separation. Correction: Training on how raw foods are stored must occur. Sign-off sheet signed by all staff must be done before opening and turned in at the Public Health building or emailed to the Food Safety staff at Mason County. See page 11 of the food worker card booklet. Correction Date: 7( 12 I7c75 Initial TViolation: (17)WAC246-215 03525(1 a) Hot holding-Process Correction:Hot-holding and re-heating training must occur.Sign-off sheet signed by all staff must be done before opening and turned in at the Public Health building or emailed to the Food Safety staff at Mason County. See page 13 of the food worker card booklet. Correction Date:--Initial '/.Vidlation: (21)WAC246-215 03525 1 b,2 Cold holding-Process Correction: Cold-holding training must occur. Sign-off sheet signed by all staff must be done before opening and turned in at the Public Health building or emailed to the Food Safety staff at Mason County. See pages 12 and 14 of the food worker card booklet. Cooler logs must be done daily for each cooler. Correction Date: 7/( b Initial ,�lolation:(26)WAC246-215 08200 Required plans- Review and Approval Correction: Observed make table cooler and kitchen setup outside, prep is not allowed outside the food truck. Please see the application for the setup. The Food Establishment is not doing the process correctly and has no approved plan; they must immediately cease it. Affected food products must be discarded or placed on hold. If a food establishment wants to proceed with the process, it must have an approved plan before resuming it. Correction Date: Initial _ '&ock ce MASON COUNTY ) Public Health&Human Services 415 N 6TM STREET,SHELTON WA 98584 SHELTON:360-427-9670,EXT 400 FAX:360-427-7798 Violation:(30)WAC246-215 03510 Thawing methods Correction:Frozen foods must be thawed under cool running water(70°F or under)for a period that does not allow them to reach over4l°F or in a cold�holding unit below 41°F.Train staff ensure this is happening correctly. Date: '7/Date / 7 5Initial Violation: (32)WAC246-215 06260 Pests-Outer Openings Protected 06265 Pests-Exterior walls, roofs, barriers, 06550 Pests- Methods of control Correction:Food stored outside was observed to have bugs in it.Food stored outside was not protected from pests.Also, single-use items stored outside allow bugs to enter the packaging.A food establishment needs to obtain pest control to eliminate pests. Openings need to be adequately screened or otherwise protected against the entry of insects and rodents. Food establishments must take appropriate action to eliminate pest harborage conditions. Clean and organize areas to eliminate harboring—clean pest evidence with disinfectants.Remove trapped/dead pests from control devices. Correction Date: 7/17/2025 Initial The above violations can directly lead to foodborne illness. All violations must be corrected on the agreed-upon date listed above. I understand that if the violations are not corrected by the dates agreed upon, the establishment will stay closed until fixed. Due to these violations being repeated through the last 4 years of inspections and multiple re-inspections, if these violations are observed during future inspections,the establishment will be closed immediately until the violation is fixed. Print Name-Owner/Manager Signature-Owner/Manager Date Print Name-Environmental Health Signature-Environmental Health Date MASON COUNTY Public Health&Human Services 415 N 6TH STREET,SHELTON WA 98584 SHELTON:360-427-9670, EXT.279 or 361 ACUERDO DE FORMACION REQUERIDO V APROBACION Atencion: La Pobtanita LLC, Gloria Martinez El establecimiento mencionado anteriormente debera completer[a siguiente capacitacion y/o recapacitaci6n utilizando el Manual del trabajador de alimentos del estado de Washington Vol Codigo de alimentos minoristas del estado de Washington WAG 246-215 Todos los trabajadores de alimentos del establecimiento mencionado deben completer la siguiente capacitacion. Se Les ha proporcionado el Manual del Trabajador de Alimentos del Estado de Washington yet COdigo de Alimentos Minoristas del Estado de Washington en ingles y espanol. El gerente/propietario debe reviser y capacitarse sobre el COdigo de Alimentos Minoristas del Estado de Washington yet Control Activo del Gerente. El gerente/propietario debe supervisar y garantizar que todos los trabajadores de alimentos completen toda la capacitaci6n. Utilice el Manual del Trabajador de Alimentos del Estado de Washington pars capacitar a los trabajadores sobre cada tema de seguridad alimentaria y luego practique las medidas de seguridad alimentaria en la cocina. El trabajador de alimentos debe firmar cada tema al completarlo. El gerente debe registrar el tempo que cada trabajador dedico altema yfirmarlo. 1.CONTROL ACTIVO DEL GERENTE: CODIGO DE ALIMENTOS PARA LA VENTA MINORISTA DE WA PARTE 2-PAG. 17-25/MANUAL DEL TRABAJADOR DE ALIMEN O{S.PG1-3 Fecha:'YYI1)/25 Iniciales del trabajador: D 0 Tiempo entrenando: IL Inicial de gerente: G4A 2.FUENTE DE ALIMENTOS: CODIGO DE ALIMENTOS MINORISTAS DE WA PARTE 3 SUBPARTE B PAG. 27/MANUAL DEL TRABAJADOR DE ALIMENTOS 19 �Fecha : Iniciales del trabajador:3_>_1 Tiempo entrenando- e b nicialdegerente: c i' 3.MARCADO DE FECHA Y HORA, CONTROL DE TEMPERATURA: CODIGO DE ALIMENTOS PARA LA VENTA AL POR MENOR DE WA, PARTE 3, SUBPARTE E- PAG. 45-49/MANUAL DEL TRABAJADOR DE ALIMENTOS, PAG. 15 Fecha:.Q1 17/'5 Iniciales del trabajador::Lj 0 Tiempo entrenando:I Inicial de gerente: C MAA 4.CONDICION DE LOS ALIMENTOS Y PREVENCION DE LA CONTAMINACION: CODIGO DE ALIMENTOS PARA LA VENTAAL POR MENOR DE WA PARTE 3 SUBPARTE C PAGINAS 33-40/MANUAL DEL TRABAJADOR DE ALIMENTOS PAGINAS 5-6 Y 25. Fecha :07 7/l7/Z$ Iniciales del trabajador. 0 Tiempo entrenando: I. k Inicial de gerente: ( .Q 5.ALMACENAMIENTO Y SEPARACION DE ALIMENTOS CRUDOS: CODIGO DE ALIMENTOS PARA LA VENTA AL POR MENOR DE WA PARTE 3 SUBPARTE C PAGINAS 33-40/MANUAL DEL TRABAJADOR DE ALIMENTOS PAGINAS 5-�6V25. fecha� y� >i c 5 Iniciales del trabajador. .) >I/ Tiempo entrenando:'/yvn Inicial de gerente:.C 6.PROCEDIMIENTOS DE ENFRIAMIENTO: CODIGO DE ALIMENTOS PARA LA VENTAAL POR MENOR DE WA PARTE 3 SUBPARTE E PAG. 46/ MANUAL DEL TRABAJADOR DE ALIMENTOS PAG. 16 Fecha:0 7/2 5 Iniciales del trabajador. 115 P Tiempo entrenando: (5m Inicial de gerente: 7.REQUISITOS DE MANTENIMIENTO EN CALIENTE: CODIGO DE ALIMENTOS PARA LA VENTA AL POR MENOR DE WA PARTE 3 SUBPARTE D PAG. 43-44/ MANUAL DEL TRABAJADOR DE ALIMENTOS PAG. 11-13. Fecha:O7JiL2/25 Iniciales del trabajador: b P Tiempo entrenando: Qm Inicial de gerente:_(a_ A Ct MASON COUNT` Public Health&Human Service 415 N 6T"STREET, SHELTON WA 98584 SHELTON: 360-427-9670, EXT.279 or 361 B.REQUISITOS DE MANTENIMIENTO EN FRIO: CODIGO DE ALIMENTOS PARA LA VENTA AL POR MENOR DE WA PARTE 3 SUBPARTE E PAG. 47-49/MANUAL DEL TRABAJADOR DE ALIMENTOS PAG. 7, 12 Y 14. Fecha: 0)7/1/2 I/25 Iniciales del trabajador: Tiempo entrenando: t m Inicial do gerente: k_l/{ 9.REQUISITOS DE MARCADO DE FECHA: CODIGO DE ALIMENTOS PARA LA VENTA MINORISTA DE WA PARTE 3 SUBPARTE E PAG.47-48/MANUAL DEL TRABAJADOR DE ALIMENTOS PAG. 15 Fecha:07/Q/25 Iniciales del trabajador: )5 P Tiempo entrenando rn Inicial de gerente: , All 10.PROCEDIMIENTOS DE DESCONGELACION: CODIGO DE ALIMENTOS PARA LA VENTAAL POR MENOR DE WA PARTE 3 SUBPARTE E PAG. 45-46/ MANUAL DEL TRABAJADOR DE ALIMENTOS PAG. 14 Fecha:/)///7/25 Iniciales dot trabajador. 1 Tiempo entrenando: i8 Inicial dogerente: £L� I, 11.CONTROL DE PLAGAS: CODIGO DE ALIMENTOS PARA LA VENTA AL POR MENOR DE WA PARTE 6 SUBPARTE E PAG. 95/ MANUAL DEL TRABAJADOR DE ALIMENTOS PAG. 25 Fecha:07/17124 Iniciales del trabajador_S_i Tiempo entrenando )IJr>1 Inicial gerente: jtiA La capacitation anterior se relaciona directamente con Las infracciones observadas durante su inspection del 16 de Julio de 2025. Estas infracciones pueden provocar enfermedades transmitidas por Los alimentos. La capacitaci6n proporcionara a los trabajadores do alimentos los procesos y procedimientos orrectos para prevenirlas. 7'�nn'iy 5-wAO5 A� 03/17125 Imprimir el nombre del trabajador Firma del trabajador Fecha Todos los gerentes/personas a cargo (PIC) deben estar capacitados en el curso de Gerente Certificado en Protection de Alimentos (CFPM). Es responsabilidad del propietario, operador y gerente certificado en protection de alimentos asegurarse de quo todos los empleados esten capacitados y Sean capaces de mantener siempre la inocuidad atimentaria en el establecimiento. Todos los establecimientos de alimentos deben proteger la salud publica mediante el cumplimiento del Codigo de Alimentos Minoristas del Estado de Washington (WAC 24-215)y el Regtamento de Servicios de Alimentos del Condado de Mason, Capftulo 6.08. El abajo firmante certifica la exactitud de la inform roporcionada on Este documento. Imprimir Nombre- rma- Fecha Duena del establecimiento/Gerente Dueno del establecimiento/Gerente MASON COUNTY Public Health&Human Services 415 N 6'"STREET,SHELTON WA 98564 SHELTON: 360-427-9670, EXT.279 or 361 ACUERDO DE _FORMACION REQUERIDO YAPR0BACI0N Atencion: La Pobtanita LLC, Gloria Martinez El establecimiento mencionado anteriormente debera completar la siguiente capacitacion y/o recapacitacion utilizando at Manual del trabajador de alimentos del estado de Washington Y el Codigo de alimentos minoristas del estado de Washington WAG 246-215 Todos los trabajadores de alimentos del establecimiento mencionado deben completar la siguiente capacitacion. Se Les ha proporcionado el Manual del Trabajador de Alimentos del Estado de Washington y el COdigo de Alimentos Minoristas del Estado de Washington en ingles y espanol. El gerente/propietario debe revisar y capacitarse sobre el COdigo de Alimentos Minoristas del Estado de Washington y el Control Activo del Gerente. El gerente/propietario debe supervisar y garantizar que todos los trabajadores de alimentos completen toda la capacitacion. Utilice el Manual del Trabajador de Alimentos del Estado de Washington para capacitar a los trabajadores sobre cada terra de seguridad alimentaria y luego practique las medidas de seguridad alimentaria en la cocina. El trabajador de alimentos debe firmer cada terra al completarlo. El gerente debe registrar el tiempo que cada trabajador dedic6 altema y firmarlo. 1.CONTROL ACTIVO DEL GERENTE: CODIGO DE ALIMENTOS PARA LA VENTA MINORISTA DE WA PARTE 2-PAG. 17-25/MANUAL DEL TRABAJADOR DE ALIMENTOS. PG1-3 Fecha:;4 I iT?C Iniciales deltrabajador: Tiempo entrenando: I hyru Inicial de gerente:) 2.FUENTE DE ALIMENTOS: CODIGO DE ALIMENTOS MINORISTAS DE WA PARTE 3 SUBPARTE B PAG. 27/MANUAL DEL TRABAJADOR DE ALIMENTOS PAG. 19 Fecha : IBS Iniciales del trabajador Tiempo entrenando: Inicial de gerente: Q b lk 3.MARCADO DE FECHA Y HORA, CONTROL DE TEMPERATURA: CODIGO DE ALIMENTOS PARA LA VENTA AL POR MENOR DE WA, PARTE 3, SUBPARTE E-PAG.45-49/MANUAL DEL TRABAJADOR DE ALIMENTOS, PAG. 15 Fecha: j-/i 1112 5 Iniciales del trabajador: kA Tiempo entrenando: I kt rCi Inicial de gerente: 11 4.CONDICION DE LOS ALIMENTOS Y PREVENCION DE LA CONTAMINACION: CODIGO DE ALIMENTOS PARA LA VENTA AL POR MENOR DE WA PARTE 3 SUBPARTE C PAGINAS 33-40/MANUAL DEL TRABAJADOR DE ALIMENTOS PAGINAS 55=,6 Y &.., 11 Fecha : 25, Iniciales del trabajador: i t.4 b Tiempo entrenando: 4 „ 0tU Inicial de gerente:k(g 5.ALMACENAMIENTO V SEPARACION DE ALIMENTOS CRUDOS: CODIGO DE ALIMENTOS PARA LA VENTA AL POR MENOR DE WA PARTE 3 SUBPARTE C PAGINAS 33-40/ MANUAL DEL TRABAJADOR DE ALIMENTOS PAGINAS fecha3//7. /2$ Iniciales del trabajador: 6M(\ Tiempoentrenando: U mii QInicialdegerente: c�i-i4 6.PROCEDIMIENTOS DE ENFRIAMIENTO: CODIGO DE ALIMENTOS PARA LA VENTAAL POR MENOR DE WA PARTE 3 SUBPARTE E PAG. 46/MANUAL DEL TRABAJADOR DE ALIMENTOS PAG. 16 Fecha:__________ Iniciales del trabajador.GMA Tiempo entrenando: ( S MI Inicial de gerente: 7.REQUISITOS DE MANTENIMIENTO EN CALIENTE: CODIGO DE ALIMENTOS PARA LA VENTA AL POR MENOR DE WA PARTE 3 SUBPARTE D PAG. 43-44/ MANUAL DEL TRABAJADOR DE ALIMENTOS PAG. 11-13. Fecha: Iniciales del trabajador: _. MO Tiempo entrenando:3D s , it\Inicial de gerente: ,_4k MASON COUNTY Public Health&Human Services 415 N 6T"STREET,SHELTON WA 98584 SHELTON: 360-427-9670, EXT.279 or 361 B.REQUISITOS DE MANTENIMIENTO EN FRIO: CODIGO DE ALIMENTOS PARA LA VENTA AL POR MENOR DE WA PARTE 3 SUBPARTE E PAG. 47-49/ MANUAL DEL TRABAJADOR DE ALIMENTOS PAG. 7, 12 Y 14. Fecha:—__________ Iniciales del trabajador: GSM( Tiempo entrenando: , c ) m2Inicialdegerente:Qi p 9.REQUISITOS DE MARCADO DE FECHA: CODIGO DE ALIMENTOS PARA LA VENTA MINORISTA DE WA PARTE 3 SUBPARTE E PAG. 47-48/MANUAL DEL TRABAJADOR DE ALIMENTOS PAG. 15 Fecha:. L (_ Iniciales del trabajador: GM n Tiempo entrenando '5x Inicial de gerente: M li 10.PROCEDIMIENTOS DE DESCONGELACION: CODIGO DE ALIMENTOS PARA LA VENTA AL POR MENOR DE WA PARTE 3 SUBPARTE E PAG. 45-46/MANUAL DEL TRABAJADOR DE ALIMENTOS PAG. 14 Fecha: S Iniciales del trabajador: i'-M Tiempo entrenando: IR tl[ Inicial de gerente:6/L J 11.CONTROL DE PLAGAS: CODIGO DE ALIMENTOS PARA LA VENTA AL POR MENOR DE WA PARTE 6 SUBPARTE E PAG. 95/MANUAL DEL TRABAJADOR DE ALIMENTOS PAG.25 Fecha: Iniciales del trabajador 1Mfl Tiempo entrenandol _ vt Inicial de gerente: C;AU) La capacitacidn anterior se relaciona directamente con Las infracciones observadas durante su inspeccidn del 16 de jutio de 2025. Estas infracciones pueden provocar enfermedades transmitidas por Los alimentos. La capacitacion proporcionara a Los trabajadores de alimentos los procesos y procedimientos correctos para prevenirlas. S Imprimir el nombre del trabajador abajador Fec a Todos Los gerentes/personas a cargo (PIC) deben estar capacitados en el curso de Gerente Certificado en Proteccion de Alimentos (CFPM). Es responsabilidad del propietario, operador y gerente certificado en proteccidn de atimentos asegurarse de que todos los empleados esten capacitados y sean capaces de mantener siempre la inocuidad alimentaria en el establecimiento. Todos los establecimientos de atimentos deben proteger la salud publica mediante et cumptimiento del COdigo de Alimentos Minoristas del Estado de Washington (WAC 24-215) y el Reglamento de Servicios de Alimentos del Condado de Mason, Capitulo 6.08. El abajo firmante certifica la exactitud de la n proporcionada en este documento. I /C�Ifcl t1GII�(r'fl c is !tRLt 1 /(f�/� Imp rimir Nombre- Irma- Fecifa Duena del establecimiento/Gerente Dueno del establecimiento/Gerente MASON COUNTY Public Health&Human Services 415 N 6T"STREET,SHELTON WA 98584 SHELTON:360-427-9670, EXT.279 or 361 REQUIRED TRAINING AGREEMENT& SIGN OFF Attention: La Poblanita LLC, Gloria Martinez The above-named establishment will need to complete the following training and/or re-training using the Washington State Food Worker Manual AND Washington State Retail Food Code WAC 246-215 All food workers in the above-named establishment are required to complete the following training.AWashington State Food Worker Manual and Washington State Retail Food Code has been provided to you in English and Spanish.The Manager/Owner must review and educate themselves on the Washington State Retail food code and Active Manager Control.The Manager/Owner must oversee and ensure that all training is completed by all food workers. Use the Washington State Food Worker manual to educate workers on each food safety subject and then practice the food safety actions in the kitchen.The Food worker must initial each subject when completed. The manager must log how much time each food worker spent on the subject and initial. 1. ACTIVE MANAGER CONTROL:WA RETAIL FOOD CODE PART 2-PG 17-25/FOOD WORKER MANUAL PG1-3 Date completed: Food Worker Initials: Time Spent Training: Manger Initials: 2. FOOD SOURCE:WA RETAIL FOOD CODE PART 3 SUBPART B PG 27/FOODWORKER MANUAL PG 19 Date completed: Food Worker Initials: Time Spent Training: Manger Initials: 3. DATE MARKING&TIME TEMPERATURE CONTROL:WA RETAIL FOOD CODE PART 3 SUBPART E-PG 45-49 /FOODWORKER MANUAL PG 15 Date completed: Food Worker Initials: Time Spent Training: Manger Initials: 4. FOOD CONDITON & PREVENTING CONTAMINATION: WA RETAIL FOOD CODE PART 3 SUBPART C PG 33-40 /FOOD WORKER MANUAL PG 5-6, &25. Date completed: Food Worker Initials: Time Spent Training: Manger Initials: 5. RAW FOOD STORAGE&SEPERATION: WA RETAIL FOOD CODE PART 3 SUBPART C PG 33-40/FOOD WORKER MANUAL PG 5-6, &25. Date completed: Food Worker Initials: Time Spent Training: Manger Initials: 6. COOLING PROCEDURES: WA RETAIL FOOD CODE PART 3 SUBPART E PG 46/FOOD WORKER MANUAL PG 16 Date completed: Food Worker Initials: Time Spent Training: Manger Initials: 7. HOT-HOLDING REQUIRMENTS:WA RETAIL FOOD CODE PART 3 SUBPART D PG 43-44/FOOD WORKER MANUAL PG 11-13. Date completed: Food Worker Initials: Time Spent Training: Manger Initials: 8. COLD-HOLDING REQUIRMENTS:WA RETAIL FOOD CODE PART 3 SUBPART E PG 47-49/FOOD WORKER MANUAL PG 7, 12, &14. Date completed: Food Worker Initials: Time Spent Training: Manger Initials: MASON COUNTY Public Health&Human Services 415 N 6-STREET,SHELTON WA 98584 SHELTON:360-427-9670,EXT.279 or 361 9. DATE MARKING REQUIRMENTS:WA RETAIL FOOD CODE PART 3 SUBPART E PG 47-48/FOOD WORKER MANUAL PO15 Date completed: Food Worker Initials: Time Spent Training: Manger Initials: 10. THAWING PROCEDURES:WA RETAIL FOOD CODE PART 3 SUBPART E P045-46/ FOOD WORKER MANUAL PG14 Date completed: Food Worker Initials: Time Spent Training: Manger Initials: 11. PEST CONTROL:WA RETAIL FOOD CODE PART 6 SUBPART E PG 95/FOOD WORKER MANUAL PG 25 Date completed: Food Worker Initials: Time Spent Training: Manger Initials: The above training directly correlates to the violations observed during y our inspection Jul 16, 2025. p on July 16, violations can lead to food born illness. The training will provide the food workers with the correct processes and procedures to prevent food borne illness. Print Name Food Worker Signature Food Worker Date All Managers/Persons in Charge (PIC) must be trained in the Certified Food protection Manager course (CFPM). It Is the responsibility of the Owner, Operator, and Certified Food Protection Manger to make sure all employees are trained and able to always maintain food safety in the establishment.All food establishments must protect public health by following the Washington State Retail Food Code WAC 24- 215 and Mason County Food Service Regulations Chapter 6.08. The undersigned attests to the accuracy of the information provided in this document. Print Name- Signature- Date Food Establishment Owner!Manager Food Establishment Owner/Manager II MASON COUNTY PUBLIC HEALTH & HUMAN SERVICES Food Establishment Inspection Report 415 N 6th St.,Shelton,WA 98584Shelton:360-427-9670 ext 400 I Belfair:360-275-4467 lvetige°vnryel.nJr/ I I0Health Hanna of ESlabIhmenu LAPabWital LUC IEstabibhment1bp.,Mobanfood Fstabkshmenl Rkkcategery High Permit Number.FEP2023-00006 Fs tab&hmentWreet:2126 ONmpk R"N Erade:dtr$485@Prel.com EslabhhmentCeh, Sharon Phone:000-000-0000 Date: Isles.In: E2apsedTkne: IPurpose ofnspecten: Fracrr Meals served: Meals Observed: TOW Paints: 5 Red Ponts: 5 leepeut Red:0 7/18/2025 iodoam Iooa000 I ILD Ito F F' aa1F' F a High Risk Factors are Improper practices or prace dotecidentited astha most prevalent contributing factors of foodborne illness or injury. Checked Box Indicates compliance status(IN,OUT,NO,NA)for each Item IN=1n Compliance OUT=Not in Compliance NO=Not Observed NA Not Applicable CDI=Corrected During Inspection R=Repeat Violation a W OUT NA NO nemDmcripibn cot R PTS ® IN OUT NA NO henoesropton cut R PTS PlC present,tlemonstoates Lnowedge zntl pvlarms duties to procedures 2S l OUT ma'nla'n ANC;[ttlifkd mono or on stal(unless a,empl s 16 el Pro Per[co4n8Pro[ 2 01 Food VlorIer Cords current for o'l food oorlces;sacs food work as 5 17 NA Prop.'hothoWngtenperturo(5ptsg 130'Ftol34'n trSed 1R W Prapc[poBng omend[enpe'Murepropor use of 25 ontinuous cooking Prop.'R wuA.'and cord Oil sal emvlopm prx6<B;no i3 unrkers 3 L'J pramt;prpper�oNng of Y'n 25 19 W No room ternpeaturestora grope'YzeoftnCu a control 25 20 W Props reheatingprocdure far hot bedding 15 4 01 Handswashdazrtpubd 15 21 W Propb[ok hokingpmperaturm(5 pts H 4PFto 45'F) 5 dl Proper barriers used to present bare hand contact with reed to 25 accorateth bmometer prodded and used to enluatetempeaturr .foods 22 IN of TCS foods 6 W Adequatehvrdwashingfxlnies l0 23 IN Pespee mnsumrdvlso, post[d forraoorurderwok[d foods 7 01 food obtaind from approved source 15 8 W WatesuppN,lee from approved source 10 24 NA Pasteurii[d roods us[-0as rcgNr,d,prah,bit[d foods not offe'd to 9 NA PropervmhngoffruAs nd Metables to 10 W Food In good condition,safe,andunaduxerdd;approved 10 25 W Tm"e rvbstanres pmpedy ldr»OLrd,smad,used 10 ddNwe 11 W Pmaerdhpozilbn of rHumd,unsale,ortmbn5NNd food; 10 Complianawithva'id pvm a n;ope't,ng driskconirolpWs, propsrdaemalrgproceduresforfoadath%ts rekforLhi.'G 2fi IN and ryuid wntte:procedure 10 12 NA Propetihdhb[kl0;v'dmu5M1room ID;pxa5M1edesWCtbo 5 27 IN Campl','ce WthwrLnce;zpcia'rzdpro[ese;HACCPPIn l0 procedure for rub 13 IN Food contact surfaces droned and zantt0 ed;a ocelot is cootminalbn 14 W Raw arnsual blow or avow from rddy-to-eat food;species 5 separated 15 W Proper prepsallos ofradshaR eggs 11111 g e' FPF 'lays!I uthlstu INS Low Risk Factors are preventitive measures to control the addition ofpathogens,chemicals,and physical objects into foods.Checked Box Indicates compliance status. g IN OUT Inn Decrmeion CDI R PTS 0 W OUT rem Description ml R PT5 28 Food receiedat properteipnawre 5 40 Food and nonfood sedxes propel used and consWcted;cleanable 5 29 Pdequrteequpnmlfortnrperaturecontrol 5 d1 warenohingfxigdes property installed,nWntaned,used;saner 5 cntralkn;tat zidps wrlabknd used 30 Properhawngnethods usd 3 42 Food-contact sudxamrntnd,ckr,ed,znlad 5 43 Nonfood-contactsudara.snared and clean 3 31 Food propertf labded;proper data marking 5 44 Plumbingpropchsted,installed,and mantsnd;proper bxkbwdnAces, 5 32 Insects,rodents,animals not prnnbntrncecontroled 5 ndrect drins,nocross-connetions 33 Potential food contandratlon prevented durngda'e.'y,preparation,storage, 5 45 Sewage,u de esteseter properly posed 5 dbplaf 45 Toilet facCres properly constructed,suppled,cleared 3 34 Wspngcloehs propedf used,stored;snidtamn[mvatbn 5 47 Garbage,rduse property dispozdpao[ties.throned 3 35 fmpioeacleaniness nd Moms 3 4g Phwkalfxdtie pmor b"d, k,ns ,ma:ntand,Ofeend;uOaxnsar,Persons 2 36 Propenung.tasting,ddnkng or tobacco use 3 ncluded from eetablahrrent 49 Adequate vrd0ation,i'ghinwdngnated areas used 2 37 ln-tsemmzis propat stored 3 •50• • Posingof peniO rmbYetabBZM1maz[nmeanty ve ible 2 30 Utnsts,yulpmeit,son,propdyslored,used,hndled 3 39 Sineleusend znglesaticeankle pmpedystord,used 3 ' a 0 Comments,Temperatures,and Photos on the following pages. Comments: Once AMC toolkit is turned in then establishment can open. Temperature Observations Item Location Ilemperature Beef raw Make table 40 Chicken IMake table 40 Coconut Stand up cooler 40 VOILATIONS,OBSERVATIONS AND CORRECTIVE ACTION #Items Comments 1 Violation: 02105(PIC—Demonstration of knowledge) Violation: 02107(CFPM—Credential) Observations Pnontn Clntge(3�wM1ee) Pason In cbaBe Dwc 7/182025 ClothReBWaoryAuhodty( cSp ine) FeedsoryAu odty Followup:No Rmd Ooran - L ii MASON COUNTY PUBLIC HEALTH & HUMAN SERVICES Food Establishment Inspection Report 415 N 6th St.,Shelton,WA98584 I Shelton:360-427-9670 ext 400 1 Belfair:360-275-4467 /I y'•�Y-<s•�'Dyen.<I,T vHealth Name of Estab&hmanL LA Po blerire l LLC Fstairshment Type:Mobile Food Es tabls M1ment Risk Category,H'gh Perrrv[Number.FEP202300006 EstabtshrrcntWeet 21260!',mpie Hw/H Emal gloyuH85@gmat[om FstabPshmest City: Shelton Phone:000-000.0000 Dye: T t,: Elaysedi: Purpose of inspection: Routine Meats Served: Meals Observed: Total Points: 0 Red Points: 0 Repeat Red:O 7/28/2025 0200 pm 11:4500 0 0 a • ••s:•• •• • High Risk Factorsare improper practicesor procedures Identified asthe most prevalent contributing factors of foodborne Illness or Injury. Checked Be.Indlcatescompliance status IN,OUT,NO,NA)for each Item IN=In Compliance OUT=Not In Compliance NO=Not Observed NA o Not Applicable CDI=Corrected During Inspection R=Repeat Violation o 1Y OUT NA NO kern Description CDI R PTS k w OIIT NA NO lean 0xvlpton 1(01 15 IPTS rl PC present,demonstrates brovlNge end performs darks to 5 16 Proper cooing procedures 25 nantin AMC;cetifted mancier en staff unless enanpt 2 food Wohu Cxtls[urentl^ra'lfeodv.oNers;ne.r foodvnrkas 17 Propshotho!d'ngtesnpefaturml5 pis N130'F to134'H ain d IB Prepermob^g Gmea,d[emPe2[ure;Ploper useof 25 nontinu0us moking 3 PmperR ss'orer a hn k 'd condnal enplora p rx, iic cs;no1 het-krrc 25 J roo m tonp[refure star present;proper raporlingof'r^.naz aen propo useolterea acoettrol 25 :701'-ht 'ri_ per reheating procedures for hot holding 15 4 Hantli suosheed as required 25 Proper cold M1o!dingtanperyuresl5 pis if 42'Ffo 45'N Pro5 ( surd to prevent bare hind[on12[IN'�Ih ready to 25 22ratefhtlmomR9prOkded and used to P.'a'ua[etam PafOds CSfoods 6 Adequate M1 m dwasbing fx;9tlas SO - per consumee ad14o,y posted forra,m ru noumo4c4 foods 5 7 Food ohtarnS from approved s oarco 15 8 Water suppP/,ice from apPros¢E source 10 Pasteurized foods used as required;proMhoed roe di not attain 10 9 Proper wisb'mg offmits andeoyetables 10 10 Food in goodcondAjar,safe,and uradulraate ;approved 1p e substances peopely id entailed,stored,used 10 eid;fiyss _ Propsrdisposdion of osu med,uns ife,or mntam'naled food; pfancossit ya•d perm C operating 11 p roes-date marlin 10 gand risk[onGOl nuns, In g pro[[dures For al high risk for lis[[n2rcquTcd untten pro[edma 12 Propv uhdtslob ID;sq'd mushroom Is,rural rteden W[tion 5 pl'ancewNsariance;urecia'ized pm[rss[s;HACCP ptM ]n procedures for fish 13 Foadconta[Isurfacesctemcd andsanitiah nacres y5 onlanJnatbn ' , 14 Raun.cats be'owor anayfrom ready-to-eel food;spxles I •i ii separated 15 Properpreyxatin of ra„she11ffi5 5 Low Risk Factors are preventitive measuresto control the addition of pathogens,chemicals,and physical objects Into foods.Checked Box Indicates compliance status. IN OUT henoscription opt R P15 M IN nor tarn Oes[npi:on CDI R P15 28 Food receded at propertonperature 5 40 Food and nonfood surfxa propNY used and constmetcd;c@mabk 29 Ad[q uate eel uipiront for temperature control 5 41 War[dws king facittis property inita"ed,manta red,used;svlhuer S ¢ntratlon;test st;ps as lab!¢a,d used 30 Proper[buMngrrethods used 3 42 Food-metact surfaces ma'ntand,cleaned,s aridued 43 Nonfoud-cnntxtaudxes mentined andcleen 3 31 Food property labeled;plops-date marling 5 44 Plumb!og prop"sfzed,Instied,andmirtaned;properbxtlkwdeaics, 32 Insects,rods-is,animals not presort;mirm onuolkd 5 'odireeudrans,nocross-[onnecbons 33 Potential food contami^ation Fomented duriogdocrery,preparation,storage, 5 45 Seeagexast-ater propdydisposd 5 d Is pies/ 46 TeilHfxilfis property mnswtted.suppl'd,clean S 3 34 Wiping doih s property used,stored;waltzes coeceurafon 5 47 Garbage,r¢fuse pro palydzposed;fxi5tiemantaned 3 35 Employeecleanllnss and hyg'ale 3 4R Physical lan'uic5r openlylnsta"eel,mo'rta'red,0[wed;ennxssay persons 2 36 Proper euti^btastlnb tlrirl4in6 orlobx[a unr 3 ealudd from establshment 49 Adnquateven0'ation,ightir,dsignanda usd 2 37 re-sues toastspropel/scored 3 50 Ponung of permit;mob?eestabrahmmi nave k 2 eazP,yvaIb 38 Iltees Its,equipmenh I nen,propal/stord,usd,herdld 3 39 S'n r'use and sing'esenaeartids propdy stored,used 3 ' 4 0 Comments,Temperatures,and Photos on the following pages. Comments: Trailer has been approved for dry storage. If trailer is used for refrigeration storage please let us know. No prep or cooking can be done in Trailer. Temperature Observations Item Location Temperature No Record VOILATIONS,OBSERVATIONS AND CORRECTIVE ACTION Hltems Comments FWionInClmtge(9gmtun!) PesonLiChage Q[c 7/2%2025 Cloda Rcevlxory At hcdty(5 we) R u] oiyAuthodty. FoIIowup:No Rsnd Qaan MASON COUNTY PUBLIC HEALTH & HUMAN SERVICEc ' ' Food Establishment Inspection Report 415 N 6th St.,Shelton,WA 98584 I Shelton:360-427-9670 ext 400 1 Belfair:360-275-4467 tip Lwmgkesmkpre'fy IHealth Nmoffstabikhment,LAPoblania 1 LLC 4tab1shenentTpe:Mori,Food ntebtshmenl RkkUtego,n Htr), PernftNumber.P92023-00006 Fztabtzhmentsureetr 212sotmpk Hwyx Final:g♦0wd465@gr.tcoen Fstab6hmentCTy.shdton Phone:000-000-0000 Drtr line b: fbpsedIDne: lfstrpose Ot Nspectbn: Carplint IMeals seMd: Meals Observed: Total Petals: 27 med Points: 15 RepeatRed:O 1/16/2026 02Dopm o030130 I 0 a i J' I.I.PR' a' [.II High Rlsk factors are improper practices or procedures Identified as the most prevalent contributing factors of foodborne Illness or Injury. Checked Box indicatescompl lance statusQN,OUT,NO,NA)for each item IN=1n Compliance OUT=Not in Compliance NO=Not Observed NA=NotApplicable COI=Corrected During Inspection R=Repeat Violation Y W OUT NA NO g—Description coils PTS A W OUT NA NO g,pgrdpipn C01 R PTS lint-fAUuLC:i'.i9f(' rl OUT NC present,demonstrates Anov.!edge and pybrrrs duties to 5 16 Prapaccor'mgprocMurez 25 mm tab ADC;co-lA"dw,nagsonstaffunlesa serpt 2 food Works Cardscurrent for Al food vortrs;neu food worker 5 17 Prope-hot hoNMgtemponatureslS pts-d 130-F to 134°F) true d ,. - _ Ig Prnprconbngtmeand tenpaNurc Propauseof 25 onUnuouscooldng 3 PraPerkluorteroed m.1,11rnelemploueeprrt,tfs;noplunrucen 25 19 No r re trneratvre storag;Pmprusmftirreu ontrol 25 present;pro pet reponing of ness .j 20 Proper rehearing procedure for hot holm, 15 4 Hmdsvas hM asrellubed 2s 11 Propercotd lwMingterrpe'auures(S pet if42'Fto 4S'n 5 Properboerkes used to preanbre herd contact uith ready-to- 25 eatroodz 22 Accurate thermometer v'Aes pro and used to NdkJMete'nperMure 5 of TCSfoods 6 Meeustehandwashingfacetls 10 23 Proper on um r advlsorvposnd forravmr undcrmokcdfoods 7 Food obt*ned from app.wd mecca 35 8 OUT WMazpppN,kefrom approd souse 10 14 I 1Poedfoods used as tutored;pmF acted foods not offered ]o 9 Proprwazhrgorfm05andwgeables 10 ±'4111!{9 10 Food In goad condltbn,5af5 and unaduttratetl;approd 10 25 (mksubstancs properlylde4Tgd,stored,usedd 10 ddeAe 11 Prope-dhposilbn of resume,etnsafG errconirNna[esfood; 10 16 W CamplbnceoiUtva'd penrnr;I;oprur;rg and tutmntrol plans, to propadaterrating procedures rorfood at high dot foe Lklea and required vrittes procedures Proper sheflstecb ID,w'd mushroom SD;paeans:,deo Wctlon pm crd a ret for nob 5 27 Comp!'�ancevitF variaicespaWtrd process;HAC<P pier 10 b;rtli0)u4p'pp}(a,�--Bill !1 d1 - 13 fend contact surfaces cleaned end tan lied:no,toss is on[minalbn 14 Spa means bdpwor arayIron,ready-to-eat food;specks 5 _ • • 15 pv td IS Propaprroratbn ofrawzhet ag5n S cmii i •• Jgi ' Low Risk Factors are preventative measures to control the addition ofpathogens,chemicals,and physical objects into foods.Checked Box indicates compliance status. Y W OUT lens Description CDI R Pry J W OUT gee Decdptbn ON R P15 28 Food reseed atpropntpnperature 5 40 Food aid nonfood surfaces yroper}yusd and conswRe;cleanable 5 29 Mequateequiprenlforicryratureront,ol 5 11 wreaash"mefzci5Uepropdylnnteed,man[snd,uzd;sanidzr rrcentratan;testsdpza rabkrrd uses 30 ProprrhaMngrrethods use 3 42 Food-contrtstirfaces to ntind,cleand,sanidzd 5 43 elonfood-con[rtsu,faes rnaintind and dean 3 31 Food propeff labeled;proper datemrking 5 - — - 44 OUT Plumbinepropdryslzd,In errti stalled,andmaiterd;pro, bbwdMce, 32 Insects,rodents,aninak not peemt;rdrrcecontrol'd 5 Mirect dranv,no[toss-connections 33 Potential food CpntaMnatbn presented duringddrmy,prepaaon,s � Wrt titoreee, 5 45 OUT 5G uaster properNdkposes 5 dhpiay 45 Toilet frxue properly constructed,supprd,cleaned 3 34 wpbecbths propey osd,ntoresanlUzrconcentratbn 5 3S Fnp eeckanibrs»dhy®me 3 47 Grbag5 testis,propakytlappsd;fariSirs mant9nd 3 4 OUT PhyskNfraNe propaN3nstand,minisd n ,entered;unnrssaryprzons 2 36 Propreatbgtastingdrirkingortobacco 3 eecbded fromstablshmrat 49 MequatezwWlbn,TehdngdrpPresree use 2 37 N-uzeutorsJs propeM1ystord 3 •50 • Posdrrgpf parrvt;mobikeWPoM1ms[nmenayvkbk • 2 38 Utenslt,equlyn-t,tinor propetj stoned,use,handled 3 39 SInglauseand sbPdezeMceankls property stores,uses 3 11TTZMTI1R 12 Comments,Temperatures,and Photos on the following pages. Comments: Food Establishment is Posted Closed for Food Safety violations that are a risk to Public Health. This Establishment will remain closed until a reinspection can be conducted. Food establishments must notify the Food Safety Inspectors that all violations have been corrected and request a re-inspection. A re-inspection to open fee of$170 will be issued. Temperature Observations Item ILocation Temperature No Record VOILATIONS,OBSERVATIONS AND CORRECTIVE ACTION Nltems Comments 1 Violation: 02100(PIC—Assigned,present) Violation: 02105(PIC—Demonstration of knowledge) Violation: 02107(CFPM—Credential) Violation: 02110(CFPM—Duties) No food worker or manager currently has a Certified Food Protection Manager certificate. (CFPM) PIC on-site does : not have complete knowledge of how to handle situations.The owner/operator does not demonstrate Observations understanding of food safety requirements to protect public health. The owner/operator does not perform and regulate basic duties to protect food and or monitor basic sanitary requirements of a mobile food unit. Corrective Action: On-site education of risk factors.The Person In Charge(PIC)must train Food Workers on foodborne illness risk factors. Corrective Action: The Person in Charge(PIC) must obtain a Certified Food Protection Manager Certificate through training.The permit holder and/or Certified Food Protection Manager must verify that the Person in Charge(PIC)has appropriate food safety training. Corrective Action: Ihe establishment must post job aids. 8 Violation: 09135(1) (Water system—MFU approved source) Violation: 09135(3)(Water system—MFU food-grade hose) Observed Mobile Food Unit using a garden hose to fill a freshwater tank. Food-grade hoses must be used every time the truck is filled from the approved water source. Corrective Action:Obtain Food Grade Hoses. Empty Observations : freshwater tank,sanitize with bleach solution-filling tank completely and discharging into the approved location. Rinse the freshwater tank by filling it completely and discharging it again into the approved location. Then fill the tank with fresh water and use it normally. Food Establishment is currently closed. Corrective Action: If there is no water,or the water supply is contaminated,the Food Establishment must immediately cease food preparation.The Person In Charge(PIC) must ensure emergency plans are understood and followed when the water system is disrupted. Discussed the responsibility of the Person in Charge(PIC)to notify Public Health Food Safety of the situation. For more information see the Emergency Water Supply Guidelines for Food Establishments. Corrective Action: Food,including ice, prepared using non-potable water must be discarded and all plumbed food equipment such as ice machines and beverage dispensers must be cleaned and sanitized prior to reuse. For more information see the Restoring Service After Extended Water Interruption-Guidelines for Food establishments. Corrective Action: The Person in Charge(PIC) must retrain on response to water contamination events. Corrective Action: Describes that ice used in the Food Establishments must be from an approved source/potable water. 26 iolation: 09175(Complalnce with permit—MFU food and equipment storage) Violation: 08600(1) (Compliance with permit—Enforcement) The Food Establishment was operating outside of the approved mobile food unit.A meeting was held to Observations : implement corrective actions to remove all unapproved cooking equipment and to stop all food handling,cooking, serving, and storage that is not approved. At this inspection,we verified that the corrective actions for this item have been completed. 44 Violation: 05135(Plumbing system—Capacity) Violation: 05145(Plumbing system—System) Violation: 05200(Plumbing system—Approved materials) Violation: 09135(2)(Plumbing system—MFU approved construction) The sewage line is hard plumbed from the mobile unit to the nearby store,which is then discharged into the city sewer. Unknown if this is approved by the City Utilities &Waste Dept.At no time is it allowed to discharge any Observations : sewage or wastewater products from the food truck onto the ground.This is a risk to food safety and public health. Corrective Action: Plumbing and equipment need to be verified with the health department for any remodels, big equipment changes, or menu changes. 45 Violation: 05400(Wastewater—MFU capacity and drainage) Violation: 05425 (Wastewater—MFU disposal) Observed sewage on the ground In the back of the mobile food unit. Fluid with soap bubbles,debris,and odor.At the time of inspection, multiple areas showed sewage on the ground.Also,signs of older areas where sewage may have been possibly discharged multiple times in the area behind the mobile.The sewage line is hard plumbed from the mobile unit to the nearby store,which is then discharged into the city sewer. Unknown if this is approved Observations : by the City Utilities &Waste Dept.At no time is It allowed to discharge any sewage or wastewater products from the food truck onto the ground.This is a risk to food safety and public health.At this time, with sewage on the ground and the unknown of how the Mobile Food Unit discharges its grey tank to an approved location,they are ordered to close. TO DO:Apply Lyme to all sewage on the ground.Submit an approved location where grey sewage tank will be disposed off. Sewage must be disposed of In an approved location, or the unit must be pumped by an approved septic pumping company. Corrective Action: Mobile units must have proper retention,drainage,and delivery. 48 Violation: 06205(Physical facilities—Utility service lines and pipes) At the time of inspection, multiple areas showed sewage on the ground.Also,signs of older areas where sewage may have been possibly discharged multiple times in the area behind the mobile.The sewage line is hard plumbed Observations : from the mobile unit to the nearby store,which is then discharged into the city sewer. Unknown if this is approved by the City Utilities &Waste Dept.At no time is it allowed to discharge any sewage or wastewater products from the food truck onto the ground.This is a risk to food safety and public health.Corrective Action:Contact the City of Shelton to determine if sewage plumbing from a mobile unit to another location is allowed and approved. INSPECTION IMAGE z? ? a i� ,. 1 ij \f I\ } c ;SryS�p �';� I �.. � �> � CIS +S3S>•• n. 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J a a r >�, Yom." .. /' r1,. _f ... r• ,.W y i ey�.a 4 7i Sig r4 A U I1 Ld ur • S� s ` � F'4 s� � �_ 1' � 1 Mason County Public Health&Human Services MASON COUNTY 415 N 5th Street,Shelton,WA 98584 Public Health&Human Services (360)427-9670 ext.279&361 foodsafety@masoncountywa.gov Closure Notice: Food Service Operation Suspended La IPc Lgc A S I FEP ,aa3- 0000 6 Establishment PR# 0`21 ? (yroi? HGJy .st.J I / l(b/a10 ' IS' r2• ►+� Address Date Time she 4-on WA 98� 9y City State Zip Code ❑ All food and beverage operations shall immediately cease. This food establishment is operating without a valid permit. This is a misdemeanor pursuant to RCW 70.05.120 and Washington Administrative Code(WAC) 246-215-08600. ❑ All food and beverage operations shall immediately cease. No person shall operate a food-service establishment who does not have a valid permit issued by a health officer according to Mason County's Sanitary Code Title 6, Chapter 8 F od Service Regulations. All food and beverage operations shall immediately cease. The food establishment permit has been suspended for the below violation(s)of WAC 246-215: 3e J)P1 C4 (LChcJed to 4nc arouriA , C4abIMnrcwIit sw-i ollnjjs'A 3o sc a• is Cxrc7 ILI jyme_ on nce aVeas. n1t+ us avn 1tfe5c9an/f 1.aO'� �c,y� re - i)\S1��a�,or-T Upon issuance o' this notice, a written request for an administrative meeting may be submitted, as provided in WAC 246- 215-08600. I have read and understand the enforcement procedure as stated above. Person in Charge Regulatory Authority Si Signature ame Printed Name 14 c* Me IS UY1Y�t —Va� Tele one/Email 6 35B - £53y. Any person whose food service establishment permit has been suspended may at any time make written application for a re-inspection for the purpose of reinstatement of the permit. The application must include a signed statement explaining how the conditions causing the suspension of the permit have been corrected. Within two working days following receipt of a written request for re-inspection, the Regulatory Authority shall complete a mandatory follow-up inspection and reinstate the permit if the food establishment is in compliance with Chapter 246-215 (WAC). PERMIT REINSTATEMENT The violation(s) listed above have been corrected and the food permit is hereby reinstated. A foll p inspecti may be made within 10 days of is n ' nsure continued compliance with chapter 246-215 (WAC). Person in Care Regulatory Autho ity Date L I i°'- '- a yh Date Time 1O o: ', .c S° q /tn ) Mason County Public Health&Human Services MASON COUNTY 415N 6th Street,Shelton,WA98584 Public Health&Human Services (360)427-9670 ext.279&361 foodsafety@coutywa.gov Aviso de Cierre: Venta de comida suspendida Lc& Po ah ;1c,e ctt 1 Fe- P 3o2 -ctxn-� Establecimiento PR# 2 ' OI.( oy�f c Ws ( ) L /16 /Z 1, kQ• ►m Direccl n F— a Horano She,l+or WA 98� F�1 Ciudad Estado Codigo Postal ❑ Se suspenders de inmediato toda operation de alimentos y bebidas. Este establecimiento de comida opera sin un permiso valido. Esto es un delito menor segun RCW 70.05.120 y el Codigo Administrativo de Washington (WAC)246- 215-08600. ❑ Todas las operaciones de alimentos y bebidas cesaran inmediatamente. Ninguna persona podra operar un establecimiento de servicio de alimentos si no tiene un permiso valido emitido por un oficial de salud de acuerdo con el msilo 6, Capitulo 8 de las Regulaciones de Servicios de Alimentos del Codigo Sanitario del Condado de Mason. t( Todas las operaciones de alimentos y bebidas cesaran inmediatamente. El permiso del establecimiento de alihientos ha sido suspendido por las siguientes infracciones de la section 246-215 del Codigo Administrativo de Washington (WAC): 1 l e n S( YeStCLIiPJ , " O a ci*enos e, tAartes ao , Vag una re i sQecciQ�?• Tras la emision de este avlso, se podra presentar una solicitud por escrito para una reunion admlms ra iva, segun lo dispuesto en WAC 246-215-08600. He leido y comprendido el procedimlento de cumpllmiento Indicado anteriormente. Persona encargada Autoridad re uladora Firma Firma ? ombre Escribir Nombre tea .h a aez 3u nn n GU C4 Y Te16f o/Correo Electr6nico 73 & 35s 65 . Cualquier persona cuyo permiso de establecimiento de servicios de alimentos haya sido suspendido podra, en cualquier momento, solicitar por escrito una nueva inspeccion para su restitution. La solicitud debera incluir una declaration firmada que explique como se han corregido las circunstancias qua motivaron la suspension. Dentro de los dos dias habiles siguientes a la reception de una solicitud por escrito de nueva inspeccion, la Autoridad Reguladora completara una inspeccion de seguimiento obligatoria y restablecera el permiso si el establecimiento de alimentos cumple con el Capitulo 246-215(WAC). REINSTALACION DEL PERMISO Las infracciones mencionadas anteriormente se han corregido y se restablece el permiso de alimentos. Se podra realizar una inspeccion de seguimiento dentro de los 10 dias posteriores a esta notification pare rantizar el cumplimiento continuo del cap(tulo 246- C). Persona Autoridad Reguladora responsabl Fecha 3 6 2 4 Fecha 3 : 2 (o Hora D '1/1 oM gnvironmental Health-Food Safety MASON COUNTY 415 N 6th Street, Shelton,WA 98584 Public Health &Human Services Phone(360)427-9670 ext. 279 or 361 Email:foodsafety(c masoncountywa.gov Required Corrective Action Agreement This Required Correction Agreement is made between Mason County Public Health and Human Services and La Poblanita LLC Parties Involved Location of Violation La Poblanitas#1 (Mobile Food Establishment) La Poblanitas#1 (Mobile Food Establishment) Gloria Martinez Ascencion Gloria Martinez Ascencion 2126 Olympic HWY N 2126 Olympic HWY N SHELTON,WA 98584 SHELTON,WA 98584 Description of Violations: The Food Establishment is not operating as approved by Mason County Public Health & Human Services Environmental Health.The following information addresses the regulations and codes violated, including the use of unapproved cooking equipment,food handling,storage, and cooking outside of the approved mobile food unit, insufficient business license, and operating without a current commissary agreement. Establishment History: These violations have been observed,discussed, and a voluntary correction agreement was signed previously.This is the second notification of these violations and an attempt to work with the Food Establishment to come into compliance and continue to operate as approved. Regulations/Codes Violated: Washington State Retail Food Code WAC246-215 (Document provided in English &Spanish on 1/15/2026) Mason County Food Service Safety Regulations Chapter 6.08(Document provided in English on 1/15/2025) Corrective Actions Required for Compliance: 1) Immediately stop all food handling,cooking,serving, and storage outside of the approved mobile food unit. 2) Remove all unapproved equipment from the location of the Mobile Food Unit 3) Contact the City of Shelton regarding Business License requirements and submit the correct business license. r4) commissary agreement must be submitted and verified by the end of business today. 5) Submit written food flow processes for menu items Food Safety Processes Required for Compliance: 1) An inspection will be conducted to verify that all processes that have been ordered to immediately stop and equipment that is not approved have been removed. 2) Submit a variance for any unapproved food processes that you would like to have reviewed. (Where applicable.) Date and Time Required for Completion: • All food handling, cooking,serving, and storage outside of the approved mobile food unit must stop immediately. • Commissary agreement must be submitted by 1/15/2026 at 4:00 P.M. • All other documents, information, and processes not on file must be submitted to come into compliance by January 31, 2026, by 4:00 P.M. (See list attachment) Page 1 of 2 � f Failure to Comply: Failure to complete the above corrective actions will result in the suspension, revocation, and/or closure of the Mobile Food Establishment. The responsible party agrees to communicate all possible delays that may result in additional time needed due to unforeseen circumstances,so we can evaluate the risk to public health (Where applicable). I, the undersigned, acknowledge and understand that to operate a food establishment,the Washington State Retail Code (WAC246-215)and Mason County Public Health Food Safety Regulations(Chapter 6.08)must be followed and applied at all times to protect public health and prevent Foodborne illness. I understand and agree that I must complete the Corrective Actions listed above by the given deadlines. I understand the failure to comply with these requirements may result in the suspension, revocation, and/or closure of my Mobile Food Establishment. Responsible Party x x Q( 1 )Jalr4►t1e?. Ascertcta7 Owner Operator-La Poblanitas LLC Print Date: Oh Is,J2 6 The following documents have been provided to the food establishment listed above for reference: All Documents provided at the meeting on 1/15/2026 • Washington State Retail Food Code WAC246-215 • Mason County Food Service Safety Regulations Chapter 08.06 • Past inspections completed • Records of past Voluntary Correction agreements Page 2 of 2 (Environmental Health-Food Safety MASON COUNTY 415 N 6`1 Street, Shelton,WA 98584 Public Health & Human Services Phone(360)427-9670 ext. 279 or 361 Email:foodsafety8&masoncountywa.gov Acuerdo de Accitin Correctiva Requerida Este Acuerdo de Correcci6n Requerida se celebra entre la Salud Publica y Servicios Humanos del Condado de Mason y La Poblanita LLC. Partes involucradas Ubicacidn de la infraccion La Poblanita#1 (Establecimiento de comida movil) La Poblanita#1 (Establecimiento de comida movil) Gloria Martinez Ascencion Gloria Martinez Ascencion 2126 Olympic HWY N 2126 Olympic HWY N SHELTON,WA 98584 SHELTON,WA 98584 Descripci6n de infracciones: El establecimiento de alimentos no esta operando de acuerdo con la aprobaci6n de Salud Publica y Servicios Humanos del Condado de Mason, Salud Ambiental. La siguiente informacidn detalla las regulaciones y cbdigos violados, incluyendo el use de equipo de cocina no aprobado, manejo,almacenamiento y coccion de alimentos fuera de la unidad m6vil de alimentos aprobada, licencia comercial insuficiente y operaci6n sin un acuerdo de comisarla vigente. Historia del establecimiento: Estas violaciones han sido observadas, discutidas y previamente se firma un acuerdo de correccidn voluntaria. Esta es la segunda notificacion de estas violaciones y un intento de trabajar con el establecimiento de alimentos para que cumpla con las normas y continue operando como fue aprobado. Infracciones a Reglamentos/Codigos: Codigo de alimentos minoristas del estado de Washington WAC246-215 (Documento proporcionado en ingl6s y espan"olel15/01/2026) Reglamentos de seguridad en servicios de alimentos del condado de Mason Capitulo 6.08(Documento proporcionado en ingles el 15/01/2025) Acciones correctivas requeridas para el cumplimiento: 1) Detenga inmediatamente toda manipulacion,cocci6n,servicio y almacenamiento de alimentos fuera de la unidad mdvil de alimentos aprobada. 2) 2) Retire todo equipo no aprobado del lugar de la Unidad M6vil de Alimentos. 3) 3) Comuniquese con la Ciudad de Shelton respecto a los requisitos de licencia de negocio y presente la licencia correcta. 4) 4)Se debe presentar y verificar un acuerdo de comisaria antes de que termine el dia habil. 5) 5) Envie los procesos escritos de flujo de alimentos para los artfculos del menu. Procesos de Seguridad Alimentaria Requeridos para el Cumplimiento: 1) Se realizara una inspeccidn para verificar que todos los procesos que hayan sido ordenados detenerse de inmediato y los equipos no aprobados hayan sido retirados. 2) 2) Presente una variacion para cualquier proceso alimentario no aprobado que desee que sea revisado. (Cuando sea aplicable.) Page 1 of 2 H) Fecha y hora requeridas para la finalizacion: • Todo manejo,coccion,servicio y almacenamiento de alimentos fuera de la unidad movil de alimentos aprobada debe detenerse de inmediato. • El acuerdo de la tienda debe ser presentado antes del 15/01/2026 a las 16:00 horas. • Todos los demas documentos, informacion y procesos que no esten en archivo deben presentarse para cumplir con los requisitos antes del 31 de enero de 2026,a las 4:00 P.M. (Ver lista adjunta). Incumplimiento: El incumplimiento de las acciones correctivas mencionadas anteriormente resultara en la suspension,revocacion y/o cierre del Establecimiento Movil de Alimentos. La parte responsable acepta comunicar cualquier posible retraso que pueda requerir tiempo adicional debido a circunstancias imprevistas, para que podamos evaluar el riesgo a la salud publica (donde sea aplicable). Yo,el/la abaio firmante, reconozco v entiendo que para operar un establecimiento de alimentos,se deben seguir y aplicar en todo momento el Codigo de yenta Minorista del Estado de Washington (WAC246-215)y las Regulaciones de Seauridad Alimentaria de Salud Publica del Condado de Mason(Capitulo 6.08), con elfin de proteger la salud p6blica y prevenir enfermedades transmitidas nor alimentos. Entiendo y acepto que debo completar las acciones correctivas listadas arriba antes de las fechas limite establecidas. Comprendo que el incumplimiento de estos requisitos puede resultar en la suspension, revocacion v/o cierre de mi Establecimiento Movil de Alimentos. Parte responsable /� XT)— x �O �o r i a f'1 ak 1"I n fY s ce.rlcl a r] Pr o perador-La Poblanitas LLC Impr�im r(�Jombre Fecha: 0 O z , Los siguientes documentos han sido entregados al establecimiento de alimentos mencionado arriba para su referencia: Todos los documentos entregados en la reunion del 15/01/2026. • Codigo de Alimentos Minoristas del Estado de Washington WAC246-215 • Reglamento de Seguridad en el Servicio de Alimentos del Condado de Mason Capitulo 08.06 • Inspecciones pasadas completadas • Registros de acuerdos previos de correccion voluntaria Page 2 of 2 j Checklist for La Poblanita's Establishments The following checklist is designed to ensure that all necessary items are in place for the establishment to continue operating safely.It is hereto inform us when items are due and what specific items need to be done. Please get in touch with the Food Safety team if any of these items cannot be completed by the date indicated on the checklist. ❑ Commissary Agreement needs to be turned in by 4:00 pm 1/15/2026, or both la Poblanita's#1 and#2 will need to close until a commissary is available and used for water, grey water, prepping food, and cooling food. Sub } euo Mondhy Correction Date 1/15/2026 InitialA MA 'O Commissary check-in paperwork needs to be turned in once a week for the next 3 months, with a signature/initials from the owners of the commissary. Correction Date:1/15/2026 Initial G A d ❑ Immediately stop all food handling, cooking, serving, and storage outside of the approved mobile food unit. Correction Date: 1/15/2026 Initial , MA ❑ Remove all unapproved equipment from the location of the mobile food unit. Correction Date:_1/15/2026 Initial / M a ❑ Contact the City of Shelton regarding business license requirements and submit the correct business license. Correction Date: j I3i/2LInitial CH ll ❑ Alt Food processes and menus need to be updated. Please turn in the menu and food processes. Correction Date: I6 Initialnn d Q JS fi LI Cornplef Cev-h'f�,,A Co� QrD� cc��'of+ MOnaS-v CocJVc I1al/ zaa6 . i'A fiI 6 MA Print Name-Owner/Manager Si at Baal ier/Manager Date CIOylO ' cw4maea \5cenuon O, �I5 �'L626 Lista de Verification para La Poblanita La siguiente lista de verification esta disenada para asegurar que todos los elementos necesarios esten en su tugar para que et establecimiento continue operando de manera segura. Este aqul para informarnos cu'ando deben realizarse ciertos items y quo tareas especificas deben completarse.Por favor,comunicate con et equipo de Seguridad Alimentarla si alguno de estos elementos no puede ser comptetado on la fecha indicada en la lista. ❑ El acuerdo de comisaria debe entregarse antes de Las 4:00 p. m. del 15/01/2026, o ambos establecimientos de La Poblanita #1 y#2 deberan cerrar hasta que haya una comisaria disponible yen use pars agua, aguas grises, preparation de alimentos y enfriamiento de alimentos. ' Sub Yh 4 Guer'1j Mon dy Fecha de Correcci6n 1/15/2026 Iniciales 6 NQ M a tint�ee u r Gx9 a LW e , a cada e e.imano- ❑ La docu entacion para el registro en La comisaria debe entregarse una vez por semana durante Los proximos 3 meses, con firma o iniciales de Los propietarios de la comisaria. Fecha de Correcci6n 1/15/2026 Iniciales G MA { ❑ Detenga inmediatamente todo manejo, cocinado, servicio y almacenamiento de aLimentos fuera de la unidad movit de alimentos aprobada. Fecha de Correcci6n 1/15/2026 Iniciales G N-eE ❑ Retira todo el equipo no aprobado del Lugar dgnde se encuentra la unidad movil de alimentos.Fecha de Correcci6n¶#1€/2028 Iniciales G ',''�A /a1Jaoa(e ❑ Comunicate con el Ayuntamiento de Shelton respecto a Los requisitos para la ticencia de negocio y presenta La licencia correcta. Fecha de Correcci6n 1/15/2026 Iniciales 6 N A ❑ Todos Los procesos y menus de alimentos necesitan ser actualizados. Por favor, entrega el menu y Los procesos de alimentos. Fecha de Correcci6n'ft512026' Iniciales Cn MA IJ31/ Ooa6 CWpl�,tr el CaAiUco O 9�teciOn cue Corv�4CL gere.� to hk c\w y e�� n at ( 20 26 i M�- -- ImprlmirNombre-Dueno/Gerente F aF a Duego/Gerente Fecha C1) orCa /NavaMez Astenac;n p -tjI5/2626 , CC�El\y/ [ DE MASON COUNTY 152026 ® JAN Public Health&Human Services ACUERDO DEL AREA DE SERVICIO/COMISARIO DEL ESTABLECIMIE ALIMENTOS Establecimiento m6vil de alimentos: j V 6(3 LA N PrP.t- LLCC NGmero de licencia:FEP N O LZ-19) 29 53 B Nombre del propietario: C JOV I n IL4Z AS(e•n LiOn Horas y dfas de operacibn: Lines G Korntn3O • II �, 10O am — 2 ' OC ? *fl Horario y dfas en el comisario/area de servicio: 17 o to 1n G O M el y I-es — 1l 1PV PS q 60 o\en —10: N5 Este formulario debe completarse cuando el propietario de Ia comisarfa(es decir,el establecimiento de alimentos)o el area de servicio (es decir,el negocio aprobado)acepta brindar servicios especfficos para respaldar Ia operacibn de an Establecimiento m6vil de alimentos(MFE).Este acuerdo entre el comisario o propietario del area de servicio y el propietario de MFE significa que ambas partes acuerdan que se proporcionaran los siguientes servicios. Aprobacion de la fuente de agua pi Si ❑No Aprobacion de elimination de aguas residuales ig Si ❑No Elimination de basura m Si o No Espacio de almacenamiento en seco (se proporcionan estanterias adecuadas) 12 Si o No Refrigeration comercial (se proporcionan estanterias adecuadas) ia Si ❑No Disponibilidad de maquinas de hielo ❑ Si m No Disponibilidad del fregadero de preparation de alimentos (con espacio de aire) m Si ❑No Disponibilidad de lavaplatos o fregadero de tres compartimentos d Si o No Disponibilidad del fregadero para trapeador d Si o No Disponibilidad de bafios ctSi o No Disponibilidad de almacenamiento de unidades moviles de alimentos d Si ❑No Accesibilidad fuera del horario de atencion (have de entrada provista) a Si ❑No Los acuerdos de economato/area de servicio no son transferibles a otras partes y quedan anulados y sin efecto al cambiar Ia propiedad de cualquiera de las partes.Ambas partes entienden que Ia modification o cancelacibn de este acuerdo per cualquiera de las partes por cualquier motivo resultara en la suspensi6n del permiso de funcionamiento de MFE emitido per la Salud PGblica del condado de Mason.Esta suspensi6n es efectiva hasta que se proportion y apruebe an nuevo acuerdo per parte de Ia Salud PGblica del condado de Mason. Declaration inicial a continuation $/ NINGUN ALIMENTO SE DEBE ALMACENAR,PREPARAR,COCINAR, ENFRIAR Y/O RECALENTAR EN LA COCINA DE UNA CASA. COMIDA MOVIL AUTORIZACION DEL COMISARIO DEL ESTABLECIMIENTO/AREA DE SERVICIO: Comisario/Area de servicio nombre: `4 Comisario/Operacion del area de servicio horas y dfas: VUM%Agp d UY\e5, c3 eoS es, S:00 am_(0'.45 (0'.45 am Direccibn: 113 Westl Co\a sA Ciudad: S½\eU-Or\ Telefono: Q— — 1 K('5+cKa, N'ewkk I moo► ev 1 (NOMBRE EN IMPRENTA DEL CO RIO/DUENO OEL AREA DE SERVICIO) ( IRMA DEL COMISARIO/PROPIETARIO DEL AREA DE SERVICIO) GlnricA frxr4At? \ DCenCian Actuatizar(IMPRIMIR NOMBRE:DEL PROPIETARIO DE LA UNIDAD M VO IL DE ALIMENTOS)Este formulario se puede escanear y goner a disposition del publico en el sitio web del condado de Mason. (FIRMA DEL PROPIETARIO DE LA UNIDAD MOVIL DE ALIMENTOS) FECHA 0 2,6 (FECHA) oi,JieI6 Ti')• MASON COUNTY (Community Health/Environmental Health) Public Health & Human Services 415 N.6'"Street—Shelton,WA 98584 Shelton;360-427-9670,Ext.400 FOOD ESTABLISHMENT COMMISSARY/SERVICE AREA AGREEMENT Mobile Food Establishment: License#:FEP Owner Name: Hours and Days of Operation: Time and Days at Commissary/Servicing Area: This form is to be completed when the owner of the commissary(i.e.,food establishment)or servicing area(i.e.,approved business)agrees to provide specific services to support a Food Establishment(FE)operation. This agreement between the commissary or servicing area owner and the FE owner signifies that both parties agree that the following services shall be provided. Approved Water Source: Public Water System Name WFI# Approved Wastewater Disposal: o Municipal Sewer ❑ On-Site Septic System Cl Holding tank Garbage/Trash Disposal ❑ Yes o No Dry Storage Space (adequate shelving provided) ❑ Yes ❑ No Commercial Refrigeration (adequate shelving provided) o Yes ❑ No Ice Machine Availability ❑ Yes o No Food Preparation Sink Availability (with air gap) ❑ Yes ❑ No Three Compartment Sink or Dishwasher Availability ❑ Yes o No Mop Sink Availability o Yes ❑ No Restroom Availability ❑ Yes ❑ No Mobile Food Unit Storage Availability o Yes ❑ No After-hours accessibility (entrance key provided) ❑ Yes ❑ No Commissary/servicing area agreements are not transferable to other parties and become null and void upon change of ownership of either party. Both parties understand that modification or cancellation of this agreement by either party for any reason will result in the suspension of the Food Establishment operating permit issued by Mason County Public Health. This suspension is effective until a new agreement is provided and approved by Mason County Public Health. Initial Statement Below: NO FOOD IS TO BE STORED, PEPARED, COOKED, COOLED,AND/OR RE-HEATED IN A HOME KITCHEN. WAC26-215-06290 MOBILE FOOD ESTABLISHMENT COMMISSARY/SERVICING AREA AUTHORIZATION: Commissary/Servicing Area Name: Commissary/Servicing Area Operation Hours and Days: Address: City: Phone: (PRINT NAME OF COMMISSARY/SERVICING AREA OWNER) (SIGNATURE OF COMIvIISSARY/SERVICNG AREA OWNER) (PRINT NAME OF FOOD ESTABLISHMENT OWNER) (SIGNATURE OF FOOD ESTABLISHMENT OWNER) (DATE) (DATE) MASON COUNTY PUBLIC HEALTH & HUMAN SERVICES Food Establishment Inspection Report 415 N 6th St.,Shelton,WA 98584 1 Shelton:360-427-9670 ext 400 1 Belfair:360-275-4467 / ''�esrsmrnr,rr.,,ni IDHealth Flame of E5Ublnhmenl:LA Poblania I LLC tslabISM1mentType:hlobi!e Food Estabishmeeet Rhk Category:High Perot Nunben F1P2023.00006 Eslaashment Street;2126 Orr'mpic Hw/N Feet:y'opr:!85[3gmalgom rstabbhmentCily. 5heton Phone:0000000000 Date: Imo h: Fbpsedume: Purpose 0fbspecibn: Reiespes0o-c Meakgened: Meals Obsersed: Total Pobts: 10 Red Pobts: 10 Repeat Red:O 1/26/1026 1090 an 001000 L 0 0 1 i' ••1:•' •' High Risk Factors are Improper practices or procedures identified as the most prevalent contributing factors of foodborne Illness or Injury. Checked Boxindicates compliance statustlN,OUT,NO,NA)for each Item IN=in compliance OUT=Not in Compliance NO=Not Observed NA=NotApplicable CDI=Corrected During Inspection R=Repeat Violation p IN OUT NA NO Rem Description I CDI R PTS p 6N OUT NA NO Ito,Description CDI R vTs rl PlC pen cut,dear onsIfaIes 1noxledge 2nd IF zdoems duties to 5 16 Proper cool Tg procedures 25 amain AV,G cenired manage-on sluff unless eremp[ 2 Food W.reer Cads current for l rood workers;newrooat ssorkas ll Proper hot boding tempeeutures(5 lots if 130-F to 134-F) trained 18 Propercoosing Ome aid temperature,proper use of 25 ontnuousmonng 3 Properil aaheradcanditionalarybM prectkes;no I lo.mFas 25 19 t,a room temperate re storage;proper use of time as a m moot 25 praml;properreporlMboFSness 20 Propa.rehen;ng Praaelures for hotho!din8 15 4 Hands uesned as requSel �5 21 Pmpneo'd ho'dnnote-nperatunesfS pis lf42-Fto45'n Properbarrins madroprnarl beer hand roms,"shreadµto- 25 Acemate Nerenometee provded.1tl usedmeean;etemperture eatfood: 72 orTcsrpods s fTlAdmNtahadd�shmZfa,o5Unt 10 tpn1 23 Propueonsumer adesnry meted lot rauorundercoolcd feeds 1 7 Food obtained from app rosed so 15 I watvsupplg ke fmmzpprmnndsoer,a 10 24 PashvnzcA foods used as rc,o ood;prohibited foods not natural 10 9 Properwasb Ing offru its andvgstabks 10 10 Food in good condition,safe,and undulteratd;apprased 10 25 Tosrsubstan aspropedvldenO4cd,sto+ed,used c0 ddlti.e 11 P roper disposition oRHumd,etnefe,mmntom'nald load; 10 26 OUi CarnpRaece sehvYE perrnt;operating and r3k mnnol plans, 10 proper date making procedures for food at high risk for listeria and reputed weitten procedures 12 PeapershdbtocklD,void mushroom ID;puaslte desWctiore 5 22 Compliancewth uafarce;specia'ad processes;ll ACCa el so 10 Procdures forfsh 13 Food contact sudxescleend and saniToed;no cross 15 ontammatme 1d R.meats beow or axa/from redµto ear Idea;s pities 5 ii, 10 sryarzte 15 properprepaalbn of rawnbdl sets • 5 Low Risk Factors are preventitive measures to control the addition of pathogens,chemicals,and physical objecteinto foods.Checked Box indicates compliance status. 6 IN OUT ftemoescnptlon [DI R Prs N IN OUT Item Description CDI R Prs 28 Food rtttied at proper targvature 5 40 Food and nonfood surfaces propely usd and mnztrvctd;cleanable 5 29 Adequate equipn,eet tortom cratureronVol 5 q1 waeverhingfaci sties propefy iestaied,manta'nd,used;sanNZC eibatian;test stops ara1able and cud 30 Proper th adng methods used 3 42 Food-contatsudaes mantooed,c!ebre,sairaed 5 43 Nonfood-contact s udxnna maned and dear 3 31 Food pzopa4y labeled;proper dale morning 5 44 Plu mbingprope'y slad,instarcd,ardmantane;Praperbxtlbwdem'es, 5 32 Insect;rodents,animalseot p rnest;nha,cecentool'd 5 indirect drains,no cross-can nations 33 Potential food contamination preentd duringdN.ey,preparation,s forage, 5 45 Saas>sgxasle.wly prapeiy disposed 5 displa/ 46 Toi'm lttaities props-!yconsWtled,s upp"d,clean ad 3 34 Piping cloths prop xl/use,stored;saitiaer concenValbn 5 42 Garbage,refers a propene/daposed;fau'Rin mantain ad 3 35 Fmployeecleaeteess and M1l$ene 3 48 Physical fan'it:n ProPeriYinsta'ed,mant eed,darted;unnnnsany parse no 2 36 Proper ezibgtasting ddnbng or tobacco tate 3 eaNded from establsb moot 49 4dcyuateeentpaton,Fghlng,dnlgnetd areas used 2 TS Iordainmetupropetrslord 3 50 Paztingotpermit;mobaeatdYahrno'st enik/v'sbk 2 Ulensis,eulpndre rimes prope'/stord,used,handled 3 j5dogicureaid,res-,en me arlidx pmpenli stored,used 3 •TflTfl o Comments,Temperatures,and Photos on the following pages. Comments: No one was on-site at the time of the visit.An inspection report was completed for documentation of the site visit. Temperature Observations Item ILocation ITemperature No Record VOILATIONS,OBSERVATIONS AND CORRECTIVE ACTION Interns Comments 26 Violation: 08300(Compliance with permit—Valid permit) Violation: 08600(1) (Compliance with permit—Enforcement) Violation: 09100(5)(Compliance with permit—MFU permit suspension) Received a complaint that the mobile food truck was being used after a closure was issued.Photos of the truck in use were received. Posted additional closure notices on Mobile Food Truck and set up a meeting with owner Observations : operators. This Mobile food unit is not be used for any food service,cooking,cleaning or occupied at any time during closure. Mobile Food Truck must remain closed until all violations from previous inspections are brought into compliance and a re-opening inspection is passed. PenanlnCMIge(&gmwn) PasonlnCtvge 41c 1/262026 Nooneonsile RegWatay AWFsaity(Signfurt) Rc ory•Autho`iry- Follow uP:N / . RaA Ot®n Fo -t I Ltd 01123 3:59: P Food being prepared and person working in mobile food truck after being shut down by the health department. • is w a "� — r — ,y ti+' '4 1 j : 1F • , .. S a , ,r#' _ I I : # 1i ' ' { ;Y j Sys - r. a �. ,1 tiyf • 1 ?I$3 ' I , . ., . '� �rf1J�f 1� iii'♦ '�t fli / It < & SI a, / * a 1 - 1 .. 1 Y+' r i R - • W'frl • ti ; Y r :; \ I p - • i ,n v , $ : cc t1� U- j JAsLFE4/ ? ! T �~ a I: / _tn ! S f I I � � I AJrjii - -- 1 + � 4 N G ' I- ' I__ ii I 1 N J7 ]! \ _ f1 U— �N 6TM STREET, SHELTON WA 98584 {ln, MASON CuUNTY SHELTON:360-427-9670, EXT.400 Public Health & Human Services FAX:360-427-7798 Mailed Certified&Regular NOTICE AND ORDER January 28,2026 MASON COUNTY PUBLIC HEALTH AND HUMAN SERVICES 415 N 6a' STREET SHELTON, WASHINGTON 98584 Claimant �s. L?iJCpp La Poblanitas#1 Gloria Martinez Ascencion 2126 Olympic HWY N SHELTON, WA 98584 To all concerned, NOTICE IS HEREBY GIVEN that Mason County Public Health and Human Services has determined that the lack of adequate food safety practices at the establishment listed above is a risk to public health and is in violation of WAC 246-215 and Mason County Code chapter 6.08. AN ORDER IS HEREBY GIVEN TO REMAIN CLOSED. A closure was issued and posted on January 16, 2026. On January 23, 2026, La Poblanitas#1 was observed operating this Mobile Food Unit after a closure was issued. THEREFORE,THIS FOOD ESTABLISHMENT MUST REMAIN CLOSED All operations at this location and inside this Mobile Food Unit must stop.At no time is the mobile food unit to be serving, cooking,cleaning, or using the unit. Failure to remain closed and failure to follow all approved Washington State Retail Food Code (WAC215-246)and Mason County Food Safety Regulations(Chapter 6.08)will result in the suspension or revocation of your Mobile Food Unit. Failure to obtain the required permits and approval from other government agencies will delay any re-opening. Other agencies may include the City of Shelton,WA State Labor&Industries,and Mason County. 6.08.080 Permit—Suspension. (a) Food-service establishments shall immediately cease all food-service operations and close to the public upon permit suspension. (b) The health officer after proper service of notice as described in Section 6.08.100 of this chapter,may suspend the food-service establishment permit when the health officer determines one of the following occurs: (1) The total demerit score of the establishment is more than seventy,using form DOH 334-001(Rev.6/92)or its successor forms as hereafter modified,revised or amended; (2) The critical-item demerit score of the establishment is more than sixty,using form DOH 334-001(Rev.6/92) or its successor forms as hereafter modified, revised or amended; (3) The same violation occurs during three consecutive inspections,using form DOH 334-001(Rev.6/92)or its successor forms as hereafter modified,revised or amended; (4) The operation of the food-service establishment otherwise constitutes an imminent health hazard such as, but not limited to,a lack of potable running water;a lack of facilities to maintain potentially hazardous foods at required temperatures;a sewage system malfunction;fire or flood; 1 ) Page (5) The holder of the permit fails to comply with the time limits set by the health officer for correction of violations; (6) The holder of the permit refuses to sign or fails to comply with an order to destroy a potentially hazardous food item determined by the health officer to be unfit for consumption; (7) The holder of the permit interferes with the health officer in the performance of his duty. (c) An opportunity for hearing with the health officer shall be provided if a written request for hearing is filed by the holder of the permit within five working days of the service of notice described in Section 6.08.100.If no written request for hearing is filed within five working days,the suspension is sustained.Prior to the hearing,the permit for the establishment shall remain in suspension,and the establishment shall remain closed to the public. (d) Any person whose permit has been suspended,may at any time,make application for a reinspection for the purpose of reinstatement of the permit.Upon receipt of a request for reinspection,which must include a statement signed by the applicant that in his/her opinion the conditions causing suspension of the permit have been corrected,the health officer shall make a reinspection.If the applicant is complying with the requirements of this chapter,the permit shall be reinstated;however,in no case shall an establishment be closed for a period less than twenty-four hours. (Res.68-96(part),1996:§8 of Ord.dated 3/22/93). 6.08.090 Permit—Revocation. (a) The health officer may revoke a permit for repeated violations of any of the requirements of this chapter or for repeated interference with the health officer in the performance of his duty. (b) Prior to revocation,the health director shall notify in writing the holder of the permit or the person in charge of the establishment,the specific reason for revocation. (c) The effective date of revocation shall be ten working days following service of notice as described in Section 6.08.100.If a written request for a hearing is filed with the health officer within this ten-day period,the revocation shall not take place until after the date of the hearing and after being sustained by the board. (d) Any person whose permit has been revoked may make a written application for the purpose of obtaining a new permit.A hearing will be provided before the health officer to determine if a new permit shall be reissued, however in no case shall a permit be revoked for less than six months. 6.08.130 Closure. Any business or other food service establishment found to be in violation of this chapter as determined by the health officer is declared to be a public nuisance and subject to immediate abatement,including closure of such establishment,by the health officer.Where practical,at least twenty-four hours'notice of the closure of an establishment shall be served in the manner provided for in Section 6.08.100 of this chapter;provided,however,that when in the judgement of the health officer an immediate hazard to public health exists,no advance notice shall be necessary. (Res.68-96(part),1996:§13 of Ord.dated 3/22/93). 6.08.170 Variance/appeal. (a) A variance may be granted by the health officer from any section or sections of this chapter covering physical facilities and equipment standards when no health hazard would exist as a result of this action and the variance is consistent with the intent of this chapter and Chapter 246-215 WAC.The health officer shall schedule a hearing board within fourteen days of receipt of the appeal,and shall notify appellant of the date,time and location of the hearing. (b) Actions and determinations of the health officer may be appealed to the board within ten days of notice of said action or determination.The health officer shall schedule a hearing with the board within thirty days of receipt of the appeal,and shall notify appellant of the date,time and location of the hearing. For any questions,contact the Environmental Health Food Safety Environmental Health Specialist at (360)427-9670 x 279 or email at sevans a masoncountywa.gov Sunni Evans,Mason County Environmental Health Specialist, Food Safety Inspector 21Page MASON COUNTY PUBLIC HEALTH & HUMAN SERVICES Food Establishment Inspection Report 415 N 6th St.,Shelton,WA 98584 1 Shelton:360-427-9670 ext 400 1 Belfair:360-275-4467 (/ Iva eSabOlr=*'h-I[ *Heat None of EsirihhmenU lA Poblenital LLC Establishment Type:l.lobile Food @Iab!'zhrrznl Risk CNegoM Nigh Perot No mba t FEP2023-00006 EstabFM1mentstreet:2126 O3,nnpic Hw,r II Renal:y'o,mH85agm£I<am 6W&hme«Cily. Shelton Phone:000000-0000 Data trop it: Fhpsedi Purpose dmspenbn: Preuperatioed Meals Seised: Meals observed: Total Paints: 5 Red pawls: 0 Repeat Red:O 3/6/2026 10:11 AM 002390 0 0 High Risk Factorsare Improper practices or procedures Identified as the most prevalent contributing factors offoodborne illness or injury. Checked Box indicates compliance status(IN,OUT,NO,NA)for each item IN=In Compliance OUT=Not In Compliance NO=Not Observed NA=Not Applicable CDI=Corrected During Inspection R°Repeat Violation U IN OUi NA NO f,oscnption Cot R PT$ s es OUT NA NO eemtcmptlon C01 R PTS jliil-/MILnI:I IP.PU(tf.i11I:in, Z1tTl7l -; rl I:I PIC resent,demonsual as lnoafrdge and performs duties I. 5 16 NO Proper cooing procedures d5 me'Ita'n AMC;certifiedmanadu n staffunlessexunpt I IN PoodwoAer Lrdsrurreeo renal food neu food--revs 5 17 I11 Proper hot ho!dinglepcNurslS pts if 13Pf to 1349 5 :eanad 18 1!O Proper I.Iirg time and temperature,proper us a of 25 ontinuousroobng 3 01 Propen 9xurke and condnbnalempbyeepracuces;no 0 vantso 25 19 IN lo room tan tn lure Pr eat;trope reporting of Onaz pea storage;pro peruse of lure as amntrol 25 Z➢ No Properraheaengproredurxforhotbolding 15 4 19 H sods soothed asrryWr f 25 21 I!1 Prepam'dho!dingt.npeatural5ptsif42-F1o45'F 55 5 11 Proper borers used to Dre.vnt bare hind conitttxilh ready-to 25 ¢—I,mumomrer prov not foods 22 IN ;A dcdand ascd to narJate lcmerrature 5 pf ice foods 6 el Adequate M1andwas M1inglttull3es to 23 NA Praper<onsumer advisory postal far ra:r arundemo led foods 5 7 IN rood obtand from approved eo 15 t;-:: ,i ilk 1'A1.:ill'•lpld) 8 IN watersupply,i¢Gomappmsedoourcr 10 24 IN Pas[eufiic-0(oods usNd asryu red;proh60n3 loads notolkfcd J 10 9 IIO Prop.washingofrnrilu andsegetablee 10 10 I'! Food In good condio,safe,and unadulterated;approved 10 25 PI im2zubxtaxes 0roprnk/idei(fied,stored,used t0 ddiLves I Propadis poseion orTNurned,an safe,erconlam'n used food; co f edit veal permit On d riot control pi=ns, 11 NO proper datemarne 10 26 IN mp a«e t psi Pero g„ 10 g pmcMurs forrootl at Filth dace for Listeria and required mitten procedures 12 I!A Proper.hellstocklo,aP-d mush no,m 10;parasite destruction 5 27 NA Comp[pith vobnce,peWrzM NACCP Ian 10 pracedu res fprfieh pr«¢ees; p :1nH;5iFalionkFfrs:leas__?'dIL;H?Jo 13 IN Fo adconlaclsurfaresdean ed andsemit.ad;no.oss 15 Co nlam;oalirn 04 I10 Pax rtaali batoworway from ready-to-eat rood;speck • • 11 Iii separated 15 NO Propeprepaallon of rmeshmeggs 5 Low Risk Factors are preventitive measures to control the addition of pathogens,chemicals,and physical objects Into foods.Checked Box Indicates compliance status. a 01 OUT ftsnDescrpgmn COX R Pf5 g IN OUT dam Descrpdon 021 R P15 ! Eit nun 28 Food receded at Propalanpaatu re 5 40 Food and nonfood surfaces property used and constructed;cle able 5 29 Adcqu ale equ ipmen(for tmnp.atarn control 5 41 OUT y/arenazhingfac,iiies pmpa'ry instated,rnantdne,used;sanNae 5 cen0atbn;test strips a:a iab!e and used 30 Fmpsih eNngmehods used 3 42 Pond,.etactsurfacs mintaned,cleaned,saritiaed 5 43 Nonfood-contact s urfacs masta'mat and clear 3 31 Faod pmps+ylaboe;pmperdatereariing S - 44 Plumbmgproperlshed,instated,and rvs,maind;proper buclibwdences, 5. 32 .erqiipnryll rts,rod[nts,an imals not present;erbznmmniroPd 5 -rdrectdra'ns,nocrosz-connectors 33 ential food c0nton motion Dre•ented dunng derrveey,preparation,storage 5 45 Sesoge,wastewater properly deposed 5 lat 34 laths .I ed,stored;nanitherwnoenuralion 5 46 ioi'H1tti12tes propMymnstructM,zupp!d,dewed 3 ingc prop yus35 loya deanl'ness and hyyene 3 47 Garrage,rafusepropxydlsPosel;fad,Des—one_ 3 40 Phs!ealfae"tirmprap.lyinsta'el,mantanast,dFand;unnotessary persons36 per siting tooling,drinking or tobacco use 3 ciudd from stabl'sbwent 49 Mostuatesenti'ation,Igsfnedsig,atedaeas used 2 37 Ia-useutensis p ropefl stored 3 50 Posting of Tarrit;reablkatabkhmmt nmeeasdysssUie 2 38 Utepit its,ego 1pment,rates p ropedy stored,used,hag died 3 39 5'ngfe-use and singRzaNce Mkles propd'i stated,used 3 :IlTT1SflTTIfl S Comments,Temperatures,and Photos on the following pages. Comments: All violations from closure inspection have been corrected. Permit is reinstated.All codes and regulations must be followed. Commissary must be used minimum every 48hrs. Commissary use log must be turned in every Monday to the front desk at public health office. Mobile food establishment is on a modified inspection schedule to monitor all food safety is being followed. If a violation is found during any inspections an immediate closure will be issued and a revocation of the permit will be issued. See notice of violation- modified inspection schedule notice in file. Pay permit and inspection fees and then you are approved to open. Temperature Observations Item Location Temperature water cup produce cooler 39 water cup make table 36 water cup one door cooler 40 water hot hold 155 VOILATIONS,OBSERVATIONS AND CORRECTIVE ACTION #Items Comments 41 Violation: 04345(Sanitizers—Test kit) Observations : No test strips for chlorine was observed. Please get some on the truck before opening. Please use before each use of ware washing and sanitizer bucket. Corrective Action: The chlorine sanitizer for ware washing machine or three-bay sink must provide a concentration of 50 to 100 ppm of chlorine.Chlorine test strips must be on hand and frequently used to test for accurate concentraion. L nonInClmige(S1gnhn) Pawnlnoage t c 3/67026 Gloria lhal. Rcpol.yY l.dty(&g mv) Pi&toiyAuduity: Follow up:No th MASON COUNTY PUBLIC HEALTH & HUMAN SERVICES Food Establishment Inspection Report / _ 415 N 6th St.,Shelton,WA 98584 I Shelton:360-427-9670 ext 400 I Belfair:360-275-4467 He7 Nm of FstabRshmenn tAPoblanla 1 LW kbb6hment Two:MobSefood Utablshmmt RhkCatego.Y High Pen*Nun*en FFP2023-00006 Esta56hment6tree;2126 OMpk H* N Food:gbsn44g5@gnalcom FstabtshmentCM Shelton Phone:000-000-0000 Dale: Irs,.in: 6lapsedlbx: Purpose Ofbspecton: Corplant IMesis tenet IMeals observed, ToulPobU: )3 lArd Ppbts: 65 Repeal Redo 3/26/2026 0130 pr I 02 0000 ii e g' ggk:k' k' g High Risk Factors are Improper practices or procedures identified as the most prevalent contributing(actors offoodborne illness or injury. Checked Box Indicates compliance status(IN,OUT,NO,NA)for each Item IN=In Compliance OUT=Not In Compliance NO=Not observed NA=NotAppllcable COI=Corrected During Inspection R=Repeat Violation A W OUT NA NO kbn Descriptbn CDI R PTS B ed OUT NA NO non Dez[dpCron C01 R PTS PK Arent,demonssrae Lnoxldgeand prAoms duties to pe'coorng procedures l OUT mlntan AvG[stifred mane;xon,self urtas plapt 5 16 NO Pra *-elutes 25 2 W Feed Wonborords currntfora8 rood vohers;newfood warkas 5 17 OUT Prop*-hothokNgtepe'aures(5 Aso H330•Fto 134•F) 25 seabed _ ]6 NO Proper cooking Time and terpeaNre;proper use of 25 onsmunus mok:ng 3 I`I Proper 0l¢odwand rondiHonalrnptotiez przcticsz,no l!hmrkas 1 25a present;proparmonMgoTrrn 19 IN Na coons 5*-npefa(urestomge,propauseofWreaz con Vol 25 20 NO Proper reheaungpradure for hot holding 15 4 NO Handsvashecl rtymred 2s 21 W Propecold holdigtempaamren(5 pts if 42•Fro 4511 5 W Propobarkrs used to presw't bare hard<nntxtaath redl`to 25 K N[rpods 22 W curatethnmpmecer pros:ded andused toesauatetamparature 5 of TC5 foods 6 OUT ldMoodalanduaubingfxAties 10 23 NA Prope C onnosrerolvisory potted form"or undor[oobcd foods 5 7 IN Food obtanrl from approzd 5 sorce 15 8 OUT hate supphtkefroesappradzource 10 24 LY Paoteri,rdfoods used asrca uirai;prohlbited foods not oHerod 10 9 NO Propavnshkrg of fruits ardwgnabie 10 Food b good condrtlon,sate,and unodufterstd;mprusd 25 IN forksubsla'Iceu prop*-:y idea Ofied,stored,used 10 W 10 t0 dditiw Propedbpozition of returned,unlafe,orconlanbNd food; 11 W 10 26 OUT Cdum,uicexit n d noed.o. Ming and risk control plaits, 10 propedate makbg procedures forreod at rain risk forlhtuda and required 5,,355*-,procedure 12 NA PropashdktockIt;aid mushroom II);puas;sedenWctlun 5 procedure For fish D IIA Comp•ancexiUlvaias¢;spdpraaza;HACCP plan 10 13 IN Food contact surface cleaned and sanwzed;nsums IS mntarNatbn la OUT Rawsreatb bdoworaaayfrom ready-to-eatfood;:pecles 5 • • 65 paaLd 15 NA Proper preparatan ofrawshdlgg 5 ilujIOiljI:lI1lt• ggg • Low Risk Factors are preventitNe measures to control the addition ofpathogen s,cheminis,and physical objects Into foods.Checked Box Indicates compliance status. g IN OUT floss Decriplbn (DI R PT$ I W OUT oars Decriptbn CDI R PTS 2g Food recehd at propatepeature 5 40 Food and nonfood surface property used and constructd;cleanable 5 29 4dequaleequipment roriempeaoure conbol 5 41 Waeaashinefacn4tes proPabinslalld,ma'ntaned,used;sanitise 5 ores Vaf on;tat stops mLbleard usd 30 Propalhayingnallods used 3 42 Food-contactsurfacei mantand,[kssnd,znR¢d 5 43 Nonfood-contactsurfacesmantaned ardckrr 3 31 Food propefl'/Autd;prope'daterwHpg 5 • 44 Plumbing properlb fooilostasetnd mantand;proFabactlbwdeKes, 5 32 bsrcls,mdesn,nirrWz not preenl;entncecortrotted 5 indirtt[drdns,no cmii<onne[4ons 33 Potntialrood co�ta dnalbn presenteddurkgdek5ry,prgaalbn,slorage, 5 45 OUT Sage,vain tes p.,.+,dsposed 5 dspia,a 46 TOPdfacanks prep"consWcted,supp'ed,c4ned 3 34 Wipbg cloths grope,used,stored;sankbamnemtakn 5 47 OUT Ga-bagq refuleproperlydiposd;faditle maMSnd 3 35 EmpbyeecknYneu and hyping 3 45 PAyskafa rn ePropeh'bila'd,mantand,rleand;unnttezay persons 2 36 Proper satin&satingd,i'Ung,ortobacco use 3 eacWdd from eldsshment 49 Adequaeswnbtauon,rghun&designated areas used 2 37 In-useutessgs property stored 3 5o Posting ofpining;mobikesabtshmstnmeauiyKsible 2 38 Usnsls,equbrrwr,lees properly stored,used,handled 3 39 SSingkusendskngle-serriceafks pno,aystored,used 3 j Jl1TSIflIfl8 Comments,Temperatures,and Photos on the following pages Comments: Inspection done due to complaint:The complaint was for food waste and grease being discarded on the ground. The mobile food establishment is CLOSED due to inspection results exceeding 70 points in violations. All violations must be corrected. Once corrections are complete,you can contact the inspectors to schedule a re-opening inspection.The mobile unit is not authorized I.. to operate in any capacity until a re-opening inspection has been conducted and passed. Fees will be issued for the inspections. Inspection realizada a rafz de una queja:La queja se referfa al desecho de residuos de comida grasa directamente en el suelo. El establecimiento m6vil de alimentos se encuentra CERRADO debido a que los resultados de la inspection llegaron a un total de infracciones superior a los 70 puntos.Todas las infracciones deben ser corregidas. Una vez completadas las correcciones, podra Temperature Observations Item Location Temperature Re fried beans hot hold 109 re fried beans hot hold 131 came asada hot hold 154 shredded cheese Top make table 40 Pork Bottom Make Table 39 Beef tall cold-hold 36 VOILATIONS,OBSERVATIONS AND CORRECTIVE ACTION Hitems Comments 1 Violation: 02105 (PIC—Demonstration of knowledge) The Commissary is not being used for dumping sewage or food waste. Grease and food waste is being poured on the ground outside of Managers and food workers have been educated on the proper use of the commissary,the dumping of sewage,and the disposal of food waste on the ground La Comisaria no esta siendo usada para tirar o Observations descargar las aguas reciduales y los desechos de comida. La grassy desechos de comida esta siendo tirada en el suelo afuera de la traila. Los gerentes y trabajadores an sido educados en como usar apropiadamente la comisaria para descargar las aguas reciduales y los desperdisios de la comida. Corrective Action: On-site education of risk factors.The Person In Charge(PIC) must train Food Workers on foodborne illness risk factors. 6 Violation: 05270(HW sink—Accessibility and use) The handwashing sink was full when we arrived for inspection. I had to remove items to wash hands.Train all Observations : employees on handwashing sink usage. El lava manos estaba Ileno cuando se Ilego ala inspecion.Tube que remover las cosas que abia para lavar las manos. Entrenartodos los empleados en como usar el lavamanos. Corrective Action: Unblock or remove items from the hand-washing sink. Discussed who will ensure the hand washing sinks are properly stocked and maintained for handwashing only. 8 Violation: 09135(3) (Water system—MFU food-grade hose) Food-grade hoses were found lying on the ground next to the building in the dirt,with no protection from contamination.Food worker stated it is only used for the mop bucket.The food worker could not provide a sanitization process for using the hose before filling the mop bucket.The food unit must secure the hose from contamination and provide steps that will be taken for sanitizing the hose before use. Even if only used for Observations : cleaning purposes. Mangeras de grado alimenticias usadas se encontraron tiradas en el suelo alado de el edificio /tienda en la tierra,sin protecion pra evitar contaminasion. El trabajador contesto que solo se usaba para la cubeta de el trapiador.El trabajador no pudo explicar el proceso de desinfectacion antes de usar la mangera para Ilenar la cubeta con el trapiador. La unidad de comida tiene que asegurar la mangera para evitar contaminacion y prover los pasos que se utilisaran para desinfectar la mangera antes de usarse.Si solo se usa para servicios de limpiesa. Corrective Action: Food,including ice, prepared using non-potable water must be discarded and all plumbed food equipment such as ice machines and beverage dispensers must be cleaned and sanitized prior to reuse.For more information see the Restoring Service After Extended Water Interruption-Guidelines for Food establishments. 14 Violation: 03306(lb) (Raw animal food—Species separation) Eggs were found above open containers of diced onions and lettuce. Ready to eat food.Trai n all food workers on Observations : proper storage of foods. Lo huevos se encontraron en la parte de ariva de contenedores que tenian sebolla y lechuga cortada.Comida lista para comer. Entrenar toos los trabajadores en como guardar/almacenartodas las comidas. Corrective Action: Food without obvious contamination moved during the inspection. Discussed how raw animal food will be stored and separated in order of Cooking temperature to prevent cross-contamination. Food Workers must be trained on proper raw animal food storage and separation. 17 Refried beans in hot hold had a range of temperatures between 105F& 131. Reheated approximately 1.5 hours prior. Beans were moved back to the stove and reheated to 165F. Train all food workers on hot-holding temperature requirements.Train all employees to verify that proper re-heating temperatures are met. Frijoles Observations : fritos tenian temperatura de 105f y 131f. Re calentar aprocimadamente 1.5 horas antes.Los frijoles se removieron y se pusieron a recalentacion a 165F. Entrenar todos los trabajadores en como y a que temperatura se requiere mantenimineto en caliente. Entrenar todos los empleados para verificar que se estan re calentando a la temperatura necesaria. Corrective Action: Improperly hot held food must be reconditioned by reheating to 165°F. Food Workers must be trained on proper hot holding procedures and temperature monitoring.The Person in Charge(PIC) must verify Food Workers are monitoring hot holding temperatures and control measures are taken as needed. 26 Violation: 09126 (Compliance with permit—MFU commissary use) The mobile unit is not using the approved commissary for waste disposal/refuse,sewage disposal,or a public water source. The mobile unit is using a public water source, but this was neither communicated to nor approved by Public Health Inspectors. Mobile Unit is discarding food waste and grease directly on the ground outside the mobile unit at the vending location. The mobile unit has been repeatedly informed that nothing,including sewage,food waste,or liquid waste,is to be discarded on the ground. La unidad m6vil no esta utilizando el Ob comisariato aprobado para la eliminaci6n de residuos/basura, la eliminacion de aguas residuales ni para el servations : suministro de agua p6blica. La unidad m6vil esta utilizando una fuente de agua publica,pero esto no fue comunicado a los inspectores de salud publica ni aprobado por ellos. La unidad m6vil esta desechando residuos de alimentos y grasa directamente en et suelo,en el exterior de la unidad,en of lugar de yenta.Se ha informado repetidamente a la unidad m6vil que nose debe desechar nada en el suelo, incluyendo aguas residuales,residuos de alimentos o residuos I(quidos. 45 Violation: 05425(Wastewater—MFU disposal) The mobile food unit is discarding sewage into an unapproved pipe located at the building on the vending site location. The mobile unit is approved only to dispose of sewage at the commissary. City of Shelton and the building department must be contacted to get authorization to use that pipe at that location. La unidad movil de Observations : g ag uas esta descar ando a uas residuales en una tuber(a no autorizada, ubicada en el edificio del sitio de yenta.La unidad m6vil esta autorizada unicamente para desechar las aguas residuales en la comisaria.Se debe contactar a la Ciudad de Shelton y al Departamento de Edificaci6n para obtener la autorizacion para utilizar dicha tuber(a en esa ubicaci6n. 47 Violation: 05550(Garbage and refuse—Inaccessible to pests) iolation: 05560(Garbage and refuse—Outdoor storage prohibitions) Violation: 05590(Garbage and refuse—Removal methods) Violation: 05595(Garbage and refuse—Approved disposal) Observed food waste and grease dumped on the ground around the mobile unit vending area. All ground surfaces with grease and food waste must be scraped,and all material must be removed in garbage bags to the approved dumpster. The commissary garbage dumpster/refuse area is to be used for discarding food waste.All food waste/food garbage must be disposed of in the garbage. You must properly dispose of all garbage and waste to prevent pests. Filled grease jugs were found outside the mobile unit;1 lacked a lid to secure it.The location/storage of this grease is not approved.The mobile unit must provide the location or the company for discarding grease by Monday, March 30,2026.We will review for approval. Mobile Unit must remove all garbage, food waste,and liquid waste to the approved commissary dumpster or provide a dumpster/refuse area at the vending location. All employees must be trained on the approved way to discard any and all waste/garbage from the Mobile Food Establishment. Se observaron restos de comida y grasa tirados en el suelo alrededor del area de la unidad m6vil.Todas las superfic(es del suelo que presenten grasa y restos de comida deben ser raspadas,y Observations : toda la grasa y comida debe ser retirado en bolsas de basura y trasladado al contenedor de basura aprobado. El contenedor de basura o area de residuos de la comisaria debe utilizarse para desechar los restos de comida. Todos los restos y desperdicios de comida deben ser depositados en la basura. listed debe desechar adecuadamente toda la basura y los residuos para prevenir plagas. Se encontraron recipientes de grasa Ilenos en el exterior de la unidad movil;a uno de ellos le faltaba la tapa de cierre. La ubicaci6n o el almacenamiento de esta grasa no estan aprobados.La unidad m6vil debe indicar el lugar o la empresa encargada del desecho de Ia grasa a mas tardar el lunes 30 de marzo de 2026. Esto sera revisado para su aprobacidn. La unidad m6vil debe trasladar toda la basura, los restos de comida y los residuos I(quidos al contenedor de basura aprobado en la comisaria,o un contenedor o area de residuos en el propio lugar de yenta. Todos los empleados deben recibir entrenamiento sobre el procedimiento aprobado para desechar los residuos,desperdisios de comida y la basura generados en el establecimiento m6vil. INSPECTION IMAGE j , s Item:PIC present,demonstrates knowledge and performs duties to maintain AMC;certified manager on staff unless exempt Item:Adequate handwashing facilities a wt - jjn. tTL % ins Item:Water supply, ice from approved source Item:Raw meats below or away from ready-to-eat food;species separated rkyr e 11 { a '7��Y X56 �. C.�• �i ,i i nFf '5T.- r 1 r ' l Vie. _. Ti1 Item:Compliance with valid permit;operating and risk control Item:Sewage, wastewater properly disposed plans,and required written procedures L { �J4,i a Item:Garbage, refuse properly disposed;facilities maintained Ihnonln Clnsge(6igmSne) Fawn In avage Data 3262026 Josel5az RegoilaryA RegWyay Au@airy: Tdlownp:It 9vdEsem 1. r • - t: ic 4. / 1 a k1 ( ) jb ' a MI _ c ome r 4 � y ,�y(�:,. •!�I ,��� �,�� '.X28 Sri 1. A. 1 � i r„ 3 •�. !� �� b �rPi C ®�' `�13M� ' -V �f� 1..f � }4r' % •� y'A�T�l .� a. t'l, 6A .>. i tai�� a,JI� ➢ ,.� '�•.=.i1 l di! II�,_ , 4 . dv ;�G:� N' r 4 T r, . /�. .. MASON COUNTY PUBLIC HEALTH & HUMAN SERVICES Food Establishment Inspection Report 415 N 6th St.,Shelton,WA 98584 I Shelton:360-427-9670 ext 400 I Belfair:3G0-275-4467 j6 Health Her,,of Eztabtshment,LA Po Manila l LLC Estzbi bment Type:ltobra Food Es tab Is n moot Riot Categor H!gn Permit Number:FEP2023-00006 Fs betterment Sweet:2126 O!,mp!c Hw/!1 Emuk gdom485gdrontrom Fztablshmenl City. 5hdson Phone:000-000.0000 Date: i N: napted{: Purpose OfNspe[tbnt Peinspocfon Me9[Serzed: Mea40bserved: Total paNb:0 Red petits: 0 Repent Red:0 3/27/1026 0150 pm 0111090 L D L ;14.El[cl1 111:1' 1' 1 High Risk Factors are improper practices or procedures Identified as the most prevalent contributing factors offoodborne illness or injury. Checked Box indicates compliance sl atus(IN,OUT,NO,NA)(or each item IN=In Compliance OUT=Not In Compliance NO=Not Observed NA=Not Applicable COI=Corrected During Inspection Re Repeat Violation p IN ONT NA NO Item oesmpt!on C01 R PTS p W OUT NA NO itesnoescrip4an CD1 R PTS nJili it ua.,[if�h01'ifpit-'. 1 111 PC presret,derror stralc-nlnox/Nge and perform,deters to 5 16 Proper coo'ng procedo res 25 arta'n AUC realiflai manzgn on stall unless evanp[ 2 Food Worker Cards for a'I food corkers rev parkas 5 1] R! Proper hot torpvaturrol5 pat ifl30-F to 1341) ba'e `--- ---'- IB Proper cookingl;meentl tampaa[ur2ProPv use of 25 i antlr003e making 3 Pmpal'Iv.orler antlmWitionzl anp!o,x Practices.noi hvv Aers 25 to no room[anpora[urezloraga;propv useof time at a Control 25 present Popv repanin6 of I!'nes 20 Prope-rahealrgpmceiures for hotholtling 15 4 Hands unshed asrryu!rN 25 21 Proper cod M1otling lanpefaNresl5 plz J42'Fto4S1) 5 mars usedNpraent bare hood mntxt xHM1 ready-to- 25 22 Accurate lnermometer provided eat foods id ed and usal to Weluatetelpeaure aftC5foods 6 IN m na • AduatehandsF!ng fxpRies l0 ✓.•t,.c9 lnTl,y.l.1r. - " ]3 Proper umerr,advlzory posted forrau ru edercoetarl foods 7 Food obta'ned from apposed so 15 11502 eJ5'+7;1711- 'lil-o 8 IN Water s apply,ice from approved source 10 24 Pazlewiz[dfoods used as required;pro hlblted food,not oNaaJ 10 9 Propauash'mgoffmits and veydab!es 10 0di Fhillt'I to Food In good mndaron,s afe,and unzduttaate,-approved 10 25 Tos substanzsprop,C,nzralifeJ,zlored,used to dd41ses Prop[rdlsper aloe of relumed,unto/e,ormnizm`nxted food; M7t rImp tM1va'd palit;apva0n11 pro pv date main 10 va g and risk control Plsns, 18 pm[edur[z forfood at M1ig,risk for lisleria wntoo pro[edumPmpvshelltnck ID,rrTd mushrooml0;perasitedestmctiont2 pmcc-0ur,mrIah5 wth variance;ipe<ia'rzaJ processes;ll ACCP pion 10 :if ii z4ihli/f(Nl,yrtt}'LI,f0 iIt-:iN)n 13 Food mnlaztsudxez cleaned andsan!titcd;nocross 15 ontarn!nation 14 IN Ra.vneats belowor eras/(mmredy-to-tvt(ootl;settles 5 • • Q sp anted 15 Pmperpraparatior ofra'nsk/leggs • 5 1 (!)&11'I'] ' Low Risk Factors are preventitive measures to control the addition of pathogens,chemicals,and physical objects Intofoode.Checked Box Indicates compliance status. 9 IN OUT Ion Description I wit I R P15 a IN OUT ,ern Description COI R PS's 28 Food rec6'sed at proper temperature 5 40 Food and nonfood surfaces properly used andwns erected;[kaenbfo 5 29 Adequate equipment for tenparalure con0ol 5 41 hvareuash'ngtrade as proper)onta"ed,ma ntalncQ used;sanulzv 5 concentration;test strips aa'able and used 30 Proper to Wfog realhods used 3 42 Food-contact surfaces Crantaned,cleaned,sanitized 5 43 Ilonfood contact s urf,ces mantaned and dean 3 31 Food proped/labeled;proper date mating 5 44 Plumbingprepelysieed,resta"ed,asdrru:ntane;propebucl-0awdedcm, 5 32 Insets,rodonls,anlmak not poet cot;entrance cantro!lal 5 edlrcet dra 1)s,in o cross Conn setions 33 Potential foodcortarrinalion pra.'eted during delivery,prepareliory to rage. 5 45 IN tease..ceste.vater propa'ry dlspot eel 5 display ;471N robe:fa[Plres properly constraned,St pence,clear eel 3 34 Wiping cloths propel/used,stn reds anniz err con Centration 5 Garbage refus ep mealy die posed;feli'al;�,tan� 3 35 Empbee clean)secs and hkgene 3 Pnye[al fcilrx propa;ymzla'el,ma ntnnttes:ary eraser 2 36t�rout�'� aztMg EMtlng ortobemu 3 eluded from establhM1mant AdNualevellIation,lghang delyratetl 2 3JpropMystored 3 Post;ngof parrvt;rtmbaeestabeshnm[nk 2 38339lreie-sen.ceutictezpropalyslmed,used 3 1ITTSflThIfl 0 Comments,Temperatures,and Photos on the following pages. Comments: Gloria stated she understands the risks to food safety and has made the corrections and trained employees. The mobile unit is not allowed at any time to use the unpermitted water access or the sewage pipe on the building at the mobile units vendor location. All corrections have been made.Approved to re-open. Re inspection fee has been provided. Pay fee. Temperature Observations Item Location Temperature Water Hot hold 145 VOILATIONS,OBSERVATIONS AND CORRECTIVE ACTION #items Comments 1 Violation: 02105(PIC—Demonstration of knowledge) The manager described how she corrected the violations and showed the job aids used to retrain the food Observations : workers. Discussed that as the manager and certified food protection manager, it is her responsibility to monitor all food workers are practicing food safety processes correctly at all times. 6 Observations : Handwashing sink has been cleaned and all items removed from area. 8 Violation: 09135(3)(Water system—MFU food-grade hose) : Manager has educated employees that the hose to be used for all water supply for mobile truck is located in the Observations trailer. Hose is the approved hose. 14 Violation: 03306(la)(Raw animal food—Food,adequate separation) Observations : Cold holding storage is in proper order,recommended to post the job aids on the unit. 17 Violation: 03525(la)(Hot holding—Process) Observations : Hot holding has temperature of 14SF. Manger used the job aids to retrain food workers on reheating to proper temperatures then-lacing in hot hold and never allowing it to drop below 135. Recommended posting job aids. 26 Violation: 09126(Compliance with permit—MFU commissary use) Observations : Commissary will be used for all water supply of mobile unit.All waste and sewage will be discarded appropriately at the commissary. Manager state all employee have been trained of this requirement. 45 Violation: 05425 (Wastewater—MFU disposal) : All food waste that was on the ground has been removed and put into the trash. Pictures were provided during Observations inspection of cleanup and disposal. 47 Violation: 05505(Garbage and refuse—Outdoor storage surface) Violation: 05560(Garbage and refuse—Outdoor storage prohibitions) Violation: 05590(Garbage and refuse—Removal methods) Violation: 05595(Garbage and refuse—Approved disposal) All garbage and food waste will be disposed of at commissary. Grease has been removed to local landfill where Observations : they excepted the containers and will now discard there regularly. FmonlnOmgeftmj; ) Persanlnchage I]tc3O7/2026 Gloria MuthwAsmdo RegulaloryAu0nuty(SigMu ) RegutyoryAutlrority. Followup:No Sin i E\215 3 N 6TH STREET, SHELTON WA 98584 MASON CuUNTY SHELTON:360-427-9670, EXT.400 FAX'360-427-7798 Public Health&Human Services Hand Delivered March 2,2026 NOTICE OF VIOLATION MASON COUNTY PUBLIC HEALTH AND HUMAN SERVICES 415 N 6's STREET SHELTON, WASHINGTON 98584 Claimant vs. La Poblanita's#1 (FEP2023-00006)/Gloria Martinez 2126 Olympic Hwy N Shelton,WA 98584 To all concerned, NOTICE IS HEREBY GIVEN that Mason County Public Health and Human Services has determined the history of inadequate food safety practices at the establishment listed above is a risk to public health and in violation of WAC 246-215 and Mason County Code chapter 6.08. THEREFORE,THIS FOOD ESTABLISHMENT PERMIT IS ON A MODIFIED INSPECTION SCHEDULE effective March 5,2026. (ref. 6.08 and 06.08.090). Between September 25, 2024, and January 16,2026,all routine inspections have resulted in reinspection. Multiple violations are repeats of observations from previous inspections. Closures of the establishment were issued during that time to allow corrections and bring the establishment into compliance. Closures occurred on January 16, 2026. Your mobile food establishment is now placed on a modified inspection schedule. Inspections can occur at any time. If violations are found during any inspection,the mobile food establishment will be immediately closed, and a Permit Revocation will be issued. 6.08.090 Permit—Revocation. (a) The health officer may revoke a permit for repeated violations of any of the requirements of this chapter or for repeated interference with the health officer in the performance of his duty. (b) Prior to revocation,the health director shall notify in writing the holder of the permit or the person in charge of the establishment,the specific reason for revocation. (c) The effective date of revocation shall be ten working days following service of notice as described in Section 6.08.100. If a written request for a hearing is filed with the health officer within this ten-day period,the revocation shall not take place until after the date of the hearing and after being sustained by the board. (d) Any person whose permit has been revoked may make a written application for the purpose of obtaining a new permit.A hearing will be provided before the health officer to determine if a new permit shall be reissued,however in no case shall a permit be revoked for less than six months. For any questions, please contact Sunni Evans at Mason County Public Health&Human Services at (360)427-9670 ext. 279 or sevans n@masoncountywa.gov Sunni Evans, Environmental Health Specialist, Food Safety 415 N 6TH STREET, SHELTON WA 98584 MASON CG�NTY SHELT0N: 360-427-9670, EXT.400 FAX:360-427-7798 Public Health &Human Services Entregada Marzo 2,2026 AVISO DE INFRACCION MASON COUNTY PUBLIC HEALTH AND HUMAN SERVICES 415 N 6" STREET SHELTON,WASHINGTON 98584 Reclamante vs. La Poblanitas#1 (FEP2023-00006)/Gloria Martinez 2126 Olympic Hwy N Shelton, WA 98584 A todos los interesados, Por medio de Ia presente, se notifica que Ia Salud Publica y Servicios Humanos del Condado de Mason han determinado que la historia de practicas de seguridad alimentaria inadecuadas en el establecimiento mencionado arriba represents un riesgo para la salud publica y viola el WAC 246-215 y el capftulo 6.08 del C6digo del Condado de Mason. Por In tanto,este permiso para el establecimiento de alimentos esta sujeto a un programa de inspecci6n modificado,efectivo a partir del 5 de Marzo de 2026. (ref.6.08 y 06.08.090). Entre el 25 de Septiembre de 2024 y el 16 de Enero de 2026,todas las inspecciones de rutina han resultado en preinspecciones. Las multiples infracciones son repeticiones de observaciones de inspecciones anteriores. Durante ese periodo, se emitieron cierres del establecimiento para permitir correcciones y asegurar que este cumpliera con las normativas.Los cierres ocurrieron el 16 de Enero de 2026. Su establecimiento de alimentos movil ahora estd sujeto a un programa de inspeccion modificado. Las inspecciones pueden realizarse en cualquier memento. Si se detectan violaciones durante una inspeccion, el establecimiento sera cerrado de inmediato y se emitira la revocacion del permiso. 6.08.090 Permiso—Revocacit n (a)La autoridad sanitaria podra revocar un permiso per violaciones re(teradas de cualquiera de los requisites de este capftulo o per interferir de manera reiterada en el desempefio de su funcidn. (b)Antes de la revocacion,el director de salud debera notificar per escrito al titular del permiso o a la persona a cargo del establecimiento, la causa especffica de la revocacion. (c)La fecha efectiva de revocacion sera diez d(as habiles despuas de la notificacidn,segun lo establecido en la Seccidn 6.08.100.Si se presenta una solicitud por escrito para una audiencia ante el oficial de salud dentro de este periodo de diez dfas,la revocacion no se Ilevara a cabo hasta despues de la fecha de la audiencia y tras ser ratificada por la junta. (d)Cualquier persona cuyo permiso haya side revocado podra presentar una solicitud por escrito para obtener un nuevo permiso.Se realizara una audiencia previa ante la autoridad sanitaria para determinar si se debe emitir un nuevo permiso;sin embargo,en ningun case se revocara un permiso por menos de seis meses. Para cualquier duda,por favor contacte a Sunni Evans en Salud Publica y Servicios Humanos de Mason al (360)427-9670 ext. 279 o seans( masoncountvva.goy Sunni Evans, Especialista en Salud Ambiental, Seguridad Alimentaria Sunni Evans From: Dan Woodard <dan.woodard@sheltonwa.gov> Sent: Monday,June 8, 2026 12:04 PM To: Sunni Evans Cc: 'Keith Reitz';Jill Patnode;Jason Dose;Will Gano Subject: 728 W Cota ST Illegal Commissary Kitchen Attachments: LA POBLANITA1 LLC3.PDF Greetings Sunni, Please know that the city was made aware of the subject residential property developed into a commentary kitchen. Noteworthy, the said property is the mailing address for La Pobtanita Mobile Food Unit with email of gloymi485Co)gmait.com and contact Ramon Cortez (360)819-9342. Know that the cite will be employing active compliance and likely condemn this site immediately. Below are some photos of my spot visit and I will cc you on the official correspondence when I get the go ahead for compliance. i ,'. : i , eM 9'• 2 S a - . i _ - : , T •i p , _ t JJ{II � S ! . 1 -is 1 •C LW a i I I i i i I i i I 6 ' a � ♦ w = Ct a F H ' _ I of SHEET Dan Woodard �y Building Official T(360)432-5120 /z 2 M (360)968-0942 E dan.woodard@sheltonwa.gov 525 West Cola St. f V 0 Shelton Washington 98584 The City of Shelton is subject to the Washington Public Records Act, Chapter 42.56 RCW. This message and any attachments may constitute records subject to public disclosure pursuant to the Act. 8 Sunni Evans From: Dan Woodard <dan.woodard@sheltonwa.gov> Sent: Monday,June 8, 2026 5:27 PM To: gloymi485@gmail.com Cc: Sunni Evans;Will Gano; Patrick Hoffman;Aaron Nix;Jason Dose;Jill Patnode; duem235 @Ini.wa.gov Subject: RE: 728 W Cota ST NOTICE OF CODE VIOLATION AND ORDER TO CEASE UNPERMITTED USE Attachments: 728 Cota Commercial Kitchen Violation and construction without permit Demolition Site Plan.pdf;Guia Rapida de Permisos de Construcci6n Para Trabajos Exentos (Work Exempt form Building Permit Quick Guide 20260514).pdf Estimado Solicitante: La presente correspondencia tiene como proposito resumir nuestra reunion y establecer la posicion de La Ciudad con respecto a esta propiedad. Se ha determinado que el antiguo garaje que contiene instalaciones para la preparacion comercial de alimentos, la estructura tipo cochera metalica utilizada para at almacenamiento y servicio de alimentos, y el pasillo cerrado que conecta dichas estructuras con (a residencia unifamiliar existente fueron construidos y utilizados sin Los permisos correspondientes. En consecuencia, estas estructuras han sido dec(aradas condenadas y deberan permanecer desocupadas y fuera de uso. Asimismo, sera necesario obtener un permiso de demolicion aprobado antes de proceder con su remocion. Nose permitira La ocupacion, almacenamiento, preparacion de alimentos, coccion, procesamiento, limpieza ni ninguna otra actividad dentro de Las estructuras condenadas. Las Unicas actividades autorizadas en estas areas seran aquellas directamente relacionadas con Los trabajos de demolicion aprobados por la Ciudad mediante la emision dot permiso correspondiente. Una vez completada la demolicion, el uso de La propiedad debera Limitarse exclusivamente a fines residenciales, de conformidad con Los codigos residenciales y Las regulaciones de zonificacion aplicables. El uso residencia)se limita a Las actividades com6nmente asociadas con una vivienda unifamiliar. Se prohiben Las actividades comerciales, inctuyendo, entre otras, el almacenamiento, preparacion, coccion, procesamiento, empaque o distribucion de productos aLimenticios para yenta o fines comerciales. Dichas actividades generalmente deben LLevarse a cabo on una instalacion comercial de tipo cocina comisaria (commissary kitchen) (egalmente establecida y autorizada. Como cortesfa, he preparado y adjuntado un piano conceptual de demolicion para su referenda. Favor de incluir un plan de demolicion junto con su solicitud de permiso. La Ciudad mantiene actualmente un caso activo de cumplimiento de codigos relacionado con esta propiedad y continuara monitoreando at sitio para verificar el cumplimiento de todos Los codigos, reglamentos y ordenes aplicables. Tonga en cuenta que el cumplimiento de Los requisitos de la Ciudad no exime at propietario ni al operador de la obligacion de cumplir con Los requisitos impuestos por otras agencias o jurisdicciones. Es posible que se requieran aprobaciones, permisos, inspecciones o medidas de cumplimiento adicionales por parte de autoridades estatales, del condado o federates. 1 • Se espera y agradece su pronta cooperacidn pars corregir estas infracciones y lograr el cumplimiento de Los requisitos aplicables. Greetings Applicant, This correspondence serves as a summary of our meeting and the City's position regarding the property. The former garage containing commercial cooking facilities, the metal carport utilized for food storage and service activities, and the enclosed corridor connecting these structures to the existing single-family residence have been determined to be unpermitted and are hereby condemned.These structures shalt remain vacant and unused and will require an approved demolition permit prior to removal. No occupancy, storage, food preparation, cooking, processing, cleaning, or other activities shall occur within the condemned structures. The only activities permitted within these areas shall be those directly associated with an approved demolition permit once issued by the City. Following demolition, the property shall be limited to residential use in accordance with the applicable residential codes and zoning regulations. Residential use is limited to activities customarily associated with a single-family dwelling. Commercial activities, including but not limited to the storage, preparation, cooking, processing, packaging, or distribution of food products for sale or business purposes, are prohibited. Such activities are typically required to occur within a legally established and approved commercial commissary facility. As a courtesy, I have prepared and attached a conceptual demolition plan for your reference. Please include a demolition plan with your permit application.The City currently maintains an active code enforcement case associated with this property and will continue to monitor the site for compliance with all applicable codes, regulations, and orders. Please be advised that compliance with City requirements does not relieve the property owner or operator from complying with requirements imposed by other agencies or jurisdictions. Additional approvals, permits, inspections, or enforcement actions may be required by state, county, or federal authorities. Your prompt cooperation in resolving these violations is expected and appreciated. Dan Woodard I Building Official City of Shelton T: (360)432-5120 M: (360) 968-0942 E: dan.woodard@sheltonwa.gov The City of Shelton is subject to the Washington Public Records Act, Chapter 42.56 RCW. This message and any attachments may constitute records subject to public disclosure pursuant to the Act. 2 From: Dan Woodard Sent: Monday,June 8, 2026 12:31 PM To:gloymi485@gmail.com Cc: sevans@masoncountywa.gov; Will Gano<will.gano@sheltonwa.gov>; Patrick Hoffman <patrick.hoffman@sheltonwa.gov>;Aaron Nix<Aaron.Nix@sheltonwa.gov>;Jason Dose<jason.dose@sheltonwa.gov>; Jill Patnode<jill.patnode@sheltonwa.gov>;duem235@lni.wa.gov Subject: 728 W Cota ST NOTICE OF CODE VIOLATION AND ORDER TO CEASE UNPERMITTED USE Property Owner and/or Resident, Please review the attached Notice of Violation. In addition, a Code Enforcement Officer has been dispatched to the property to post a notice of noncompliance. Your prompt attention to this matter is requested. *IN Dan Woodard Building Official T(360)432-5120 M (360)968-0942 E dan.woodard@sheltonwa.gov 525 West Cota St. f !I C Shelton Washington 98584 The City of Shelton is subject to the Washington Public Records Act, Chapter 42.56 RCW. This message and any attachments may constitute records subject to public disclosure pursuant to the Act. 3 t 728 W Cota y O SN ► NG'( NOTICE OF CODE VIOLATION AND ORDER TO CEASE UNPERMITTED USE To: Ramon Cortaz Property Address: 728 W Cota Street, Shelton, WA Associated Business: La Poblanta LLC UBI Number: 604698957-001-0006 Dear Mr. Cortaz, The City of Shelton recently conducted an inspection of the above-referenced property. During that inspection, it was observed that the existing single-family residential structure has been altered and is being utilized to support commercial food preparation activities through the installation and operation of a commercial kitchen. City records indicate that no building, mechanical, plumbing, fuel gas, fire, or change-of-use permits have been issued or approved for the development, installation, or operation of a commercial kitchen at this location. The current use appears inconsistent with the approved occupancy and use of the structure as a single-family residence. Accordingly, you are hereby ordered to comply with the following directives immediately: 1. Cease and desist all commercial food preparation, food service, and other commercial business activities occurring at this location. 2. Do not alter, remove, relocate, conceal, modify, or demolish any equipment, appliances, electrical systems, fuel gas systems, plumbing systems, ventilation equipment, fixtures, structural components, or any portion of the building or property without first obtaining the appropriate permits and approvals from the City of Shelton. 3. Maintain the property in its current condition pending further review and direction from the City. 4. Obtain all required permits and approvals before performing any work intended to restore, modify, remove, or legalize the existing improvements and use. Please be advised that additional permits, inspections, approvals, and enforcement actions may be required by other regulatory agencies, including but not limited to: • The Washington State Department of Labor& Industries • Mason County Public Health • The City of Shelton Fire Marshal Failure to comply with this notice may result in further enforcement action, including civil penalties, citations, legal action, abatement proceedings, permit restrictions, and any other remedies available under applicable federal, state, and local laws and regulations. Should you have questions regarding this matter or wish to discuss compliance options, please contact the City of Shelton Development Services Department immediately. 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