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BROTHERS DELI - ESTABLISHMENTS BROTHERS DELI 283 Derby Street V V I�i 9 I 0 a 11 I d (V 'I 9 III 1� y I V o u Q.. _77nr r r 9 I � I t i ry}jY T l} k N 7 ! t I. S x I I+ F i N ' I w I f �� a �� 1 1�/ � � I !U/ �CtiCCi 'GC. iI � � � � i Massachusetts Department of Public Health Salem Board of Health 120 Washington Street,4"'Floor Division of Food and Drugs Salem, MA 01970-3523 Tel. (978) 741-1800 Fax(978) 745-0343 City/Town of-- � Address: FOOD ESTABLISHME T INSPECTION REPORT Tel. Name 1 r Operadon(s) Type of Inspection V Food Service ❑Roo-ne Address Risk ❑ Retaila inspection Telephone ry / Level [I Residential Kitchen Previous In pe ion (a r ❑ Mobile Date: 1��2 1y, Owner ��pyyy�;(� HACCP YIN ❑ Temporary ❑Pre-operation n 1 ❑ Caterer ❑Suspect Illness Person-in-C arge PIC) Tim , ryi ❑ Bed 8 Br a ❑ General Complaint In: W ❑ HACCP Inspector Y - Out - ,r Permit No. ❑ Other Each violation e#fecked requir s an explanation on the narrative pages and a citation of specific provision(s)violated. Non-compliance with: Violations Related to Foodborne Illness Interventions and Risk Factors_(Red antiChokg in 590.009(E) ❑ (Violations marked may pose an imminent health hazard and require immediate Tobacco 590.009(F) E]Allerrgen Awareness 590.009(G) ❑ corrective action as determined by the Board of Health. FOOD PR07ECTION MANAGEMENT _ - - ❑ 12. Prevention of Contamination from Hands ❑ 1. PIC Assigned/Knowledgeable/Duties EMPLOYEE HEALTH "" - - ❑ 13. Handwash Facilities ' -' ,PROTECTION FROM CHEMICALS ' '-� ❑ 2. Reporting of Diseases by Food Employee and PIC - _ .. _.. __ El3. Personnel with Infections Restricted/Excluded El 14.Approved Food or Color Additives _ ❑ 15. Toxic Chemicals FOOD.FROM APPROVED SOURCE_- � -Y _ _ _ F1 4. Food and Water from Approved Source TwEIrEMPERATURE CONTROLS(P.otentialty Hazard_ous Foods) ❑ 5. Receiving/Condition [116. Cooking Temperatures ❑ 6. Tags/Records/Accuracy of Ingredient Statements ❑ 17. Reheating ❑ 7. Conformance with Approved Procedures/HACCP Plans [118.Cooling PROTECTION FROM CONTAMINATION _ _` ❑ 19. Hot and Cold Holding ❑ 8. Separation/Segregation/Protection ❑ 20.Time as a Public Health Control ❑ 9. Food Contact Surfaces Cleaning and Sanitizing REQUIREMENTS-FORHIGHLYSUSCEPTI6LEEPOPULATIONS(HSP)` I ❑ 10. Proper Adequate Handwashing El21. Food and Food Preparation for HSP ❑ 11. Good Hygienic Practices ONSUMERADVISORY _ ❑22. Posting of Consumer Advisories Violations Related to Good Retail Practices_(Blue Number of Violated Provisions Related Items) Critical(C)violations marked must be corrected To Foodborne Illnesses Interventions immediately or within 10 days as determined by the Board and Risk Factors (Red Items 1-22): of Health. Non-critical (N)violations must be corrected Official Order for Correction: Based on anpecton immediately or within 90 days as determined by the Board today, the items checked indicate violations of 105 CMR of Health. 590.000/federal Food Code.This report,when signed below C N by a Board of Health member or its agent constitutes an 23. Management and Personnel (FC-2X590.003)) order of the Board of Health. Failure to correct violations 24. Food and Food Protection (FC-3X5990.00cited in this report may result in suspension or revocation of 25. Equipment and Utensils (Fc-aX59o.o05) the food establishment permit and cessation of food 26. Water, Plumbing and Waste (FCsX590.006) establishment operations. If aggrieved by this order,you 27. Physical Facilit (Fc-6X590.007) have a right to a hearing. Your request must be in writing 28. Poisonous a_terials (FC-7X59o.o08) and submitted to the Board of Health at the above address 29. S a quire ent (590.009) within 10 days of receiptAthis order. 3 . Other DA TE OF RE-INSPECTIQN: I Inspector's Signature: '' I Print: PICa Signature: /J i Print: Pagel ofZages V V � � i � w Violations Related to Foodborne Illness x Interventions and Risk Factors(Nems 1-22) PROTECTION FROM CONTAMINATION FOOD PROTECTION MANAGEMENT I S Crass-contamination j 3-302.11(A)(]) Raw Animal Foods Separated from I 1 590.003(A) Assignment of Responsibility* I Cooked and RTE Foods* 590.003(B) Demonstration of Knowledge" I I I Contamination from Raw Ingredients I 2-103.11 Person in charge-duties I 3-302.11(A)(2) Raw Animal Foods Separated from Each EMPLOYEE HEALTHI I Other* 2 590.003(C) Responsibility of the person in charge to 1 9 I Contamination from the Environment ) I . 302.11{A) I Food Protection require reporting by foot emptoyees and applicants* � 3-.,, 0_ 15 _ I Washing Fruits and Vegetables J 590.003(F) Responsibility Of A Food Employee Or An ( 3-3i 4.71 I Food Contact with Equipment and Utensils Applicant To Report To The Person In I I Contamination from the Consumer I Charge 590.003(G) Reporting by Person in Charge* I i 3-306.14(A)(B) Returned Food and iof Fund* J Disposition of Adulteratedaced oror Contaminated 13 590.003(D) Exclusions and Restrictions* Food 590.003(E) I Removal of Exclusions and Restrictions I 13-701.;t Discarding or Reconditioning Unsafe FOOD FROM APPROVED SOURCE Food* 4 Food and Water From,Regulated Sources ( ( 9 Food Contact Surfaces } 590.004{A-B) Complianee with Ford Law* I 4-501.I I I Manual Warewashing-Hot Water 3-201.12 Food in a Hermetically Sealed Container* I Sanitization Temperatures* 3-201.13 Fluid Milk and Milk Products* I 4-501.1 l2 Mechanical Warewashing-Hot Water 3-202.13 Shell Esgs* I Sanitization Temperatures* J 13-202.14 Eggs and Milk Products.Pasteurized* 4-501.114 I Chemical Sanitization-temp.,pH, 3-202.111 I Ice Made From Potable Drinking Water* I concentration and hardness. 5-107.1 l I Drinking Water from an Approved System" I 14-601.11(A) 113quipment Food Contact Surfaces and Utensils Clean* 590.006(A) I Bolded Drinking Water' 4-602.1 t I Cleaning Frequency ofEquipment Food- 59t1.006(E) I Water Meets Standards m 370 CMR 22.0* I I g q y to Shatmsh and Fish From an Approved Source I Contact Surfaces and Utensils* 3-201.14 I Fish and Recreationsll Caught Molluscan I 4-702.1 I Frequency c Sanitization of Utensils and Shellfish* y I Pond Contact Surfaces of Equipment* J 3-201.15 Molluscan Shellfish from NSSF Listed Chemical*14-703.11 I a of Sanitization-Hot Water and Chemical* Sources* I t0 I I Proper,Adequate Handwashing Game and Wild Mushrooms Approved by Regulatory Authority 2-3(11.11 I Clean Condition-Hands and Arms* 13-202.15 Shellstc,ck identification Present" 12-301.12 I Cleaning Procedure* 590.004(C) Wild Mushrooms* I i 2-301.14 When to Wash* 3-201.17 Game Animals* I I it I I Good Hygienic Practices g I Receiving1Condition I 12401.11 I Eating,Drinking or Using Tobacco* 13-202.11 PHFs Received at Proper Temperatures* I 401.12 Discharges From the Eyes, Nose and 3-202.15 I Package Integrity I I Mouth* 3-10;.1 1 Foil Safe and Unadulterated* I 3-301.12 I Preventing Contamination When Tasting* I 161 ( Tags/Records:Shellstock I 112 Prevention of Contamination from Hands 3-'-)02.t8 Shellstock Identification* I 590.004(E) Preventing Contamination from 13-203.12 Shellstock Identification Maintained" I Employees* Tags/Records:Fish Products i 113 I Handwash Facilities 1 Conveniently Located and Accessible 3-4()1..11 Parasite 1h.µtTUl't(On' I 3-402.12 Records.Creation and Retention* I 5-203.t 1 Numbers and Capacities* 590.004(1) Labeling of ingredients' -I 15-204.11 I Location and Placement* 71 Conformance with Approved Procedures I 15-205.11 I Accessibility,Operation and Maintenance I /HACCP Plans I I Supplied with Soap and Hand Drying 3-502.11 Specialized Processing Methods* I Devices 13-502.12 Reduced oxygen packaging,criteria* I 16-301.11 I Handwashing Cieanser,.Availabiliry 8-103.12 Conformance with Anproved Procedures* I 16-301.12 I Hand Drying Provision -Denotes critical item in[tie federal 1999 Food Cede or 105 CMR 590 O(N). CITY OF SALEM BOARD OF HEALTH {� Establishment Name:--6 fY15 `.jO�r Date: INV �_� Page: L/ Of ILI Item Code C-CnticdF:Wrn DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date No. Relerence R-Red Item VerNled I I _ I� � PLEASE PRINT CLEARLY �� 5 ` ' r -;Z) I rte' (.r gi PAA ala-4 Cf- 14MI e2, 101 , 1h ftH I I I I I 1 1 j 1 I 1 I 1 i i Discussion With Person in Charge: Corrective Action Required: I tYNo Yes I have read this report, have had the opportunity to ask questions and agree to correct all E7,,.3/6untary Compliance ❑ Employee Restriction/ Exclusion violations before the next inspection, to observe all condi 'ons as described, and to El Re-inspection Scheduled El Emergency Suspension comply with all mandates of the Mass/Federal Food c d . I understand that noncompliance may result in daily fines of t e or suspension/revocation of ❑ Embargo ❑ Emergency Closure t your food permit. ❑ Voluntary Disposal ❑ Other: 3-50I.14(C) PHFs Received at Temperatures } Violations Related to Foodborne Illness Interventions and Risk According to Law Cooled to Factors(hems 1-22) (Cont.) 41'F145*F Within 4 Hours. I ( 3-501.15 Cooling Methods for PHFs PROTECTION FROM CHEMICALS ( 14 ( Food or Color Additives ( ( 19 PHF Hot and Cold Holding 3-50L16(B) Cold PHFs Maintained at or below 13-202.12 Additives* 590.004(F) 410145'F* 3-302.14 Protection from Unapproved Additives* ( 3-SO1,1fi(A) Hot PHFs Maintained at or above 15 Poisonous or Toxic Substances I4Q 7-101.11 Identifying Information-Original Roasts 3-501.16(A) Roasts Held at or above 130'F. Containers 20 Time as a Public Health Control { ( 7-102.11 Common Name-Working Containers* ( 3-501.19 Tillie as a Public Health Contra* 1 r-01.1 I Separation-Storage* 7-202.11 .Restriction-Presence and Use* ( 590.004(H) Variance Requirement ( 7-02.12 Conditions of Use* ( REQUIREMENTS FOR HIGHLY SUSCEPTIBLE ( 7-203.11 Toxic Containers-Prohibitions* I POPULATIONS(HSP) 7-204.11 Sanitizers.Criteria-Chemicals* 7-204.12 Chemicals for Washing Produce,Criteria* ( 21 3-801.£](A) Unpasteurized Pre-packaged Juices and 7-204.14 Drying,Agents.Criteria* ( Beverages with Warning Labels* ( 7-205.11 Incidental Food Contacx.Lubricants* 1 3-801.1](8) Use of Pasteurized Eggs* I ( 7-206.11 Restricted Use Pesticides,Criteria$ I 13-801.11(D) Raw or Partially Cooked Animal Food and I Raw Seed Sprouts Not Served. 7-206.12 [rodent Bait Stations* 7-206.13 Tracking Powders,Pest Control and 13-801.11(C) Unopened Food Package Not Re-served. Monitoring* CONSUMER ADVISORY ' TIMEMEMPERATURE CONTROLS 22 3-603.11 Consumer Advisory Posted for Consumption of 16 Proper Cooking Temperatures for Animal Funds That are Raw.Undercooked or 4 j PRFs Not Otherwise Processed to Eliminate 3-40£.]IA(I)(2) Eggs- 155°F 15 Sec. Pathogens.*Eft' n "I Eggs-Immediate Service 145'Fl5sec* 3-301.13 Pasteurized Eggs Substitute for Raw Shell 3401.11(A)(2) Comminuted Fish.Meats&Game { Ewe Animals-155'F 15 sec. ' ( SPECIAL REQUIREMENTS 3-401.11(8)(1)(2) Pork and Beef Roast-130'F 121 mm* I i b90.009(A)-(D) Violations of Section 590.009(A)-(D)in 3.401.11(A)(2) Ratites,Injected Meats- 155°F 15 sec.* catering, mobile fwd,temporary and 3-401.1 I(A)(3) Poultry,Wild Game,Stuffed PHFs, residential kitchen operations should be f Stuffing Containing Fish,Meat, debited under the appropriate sections t Poultry or Ratites-165'F 15 sec. * above if related to foodborne illness ! 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks interventions and risk factors. Other h 145*F* 590.009 violations relating to gow retail `t 3-401.12 Raw Animal Faints Cooked in a practices should be debited under#29- 3 Microwave 165'F* Special Requirements. ( 3401.11(A)(1)(b) All Other PHFs- 145'F 15 sec.* r ( 17 Reheating for Not Holding i VIOLATIONS R.LATE®TO GOOD RETAIL PRAC77CES 3-403.11(A)&(D) PHFs 165'F 15 sec. * I (Item,23-30) ti3-403.11(B) Microwave- 165`F 2 Minute Standing Critical and non-critical violations,which do not relate to the Time* foodborne illness inierventions and risk factors listed above, can be 3-403.11(C) Commercially Processed RTE Foal- found in the fbitowing sections of the Food Code and 105 CMR 140*F* 590.000. f 3-403.11(E) Remaining Unstic:ed Pordarts of Beef 1 Item I Good Retail Practices I FC 1690.000 j Roasts* ( 23. i Management and Personnel 1 FC-2 1 .003 i 118 j i 1 24. i Foal and Food Protection I FC-3 ! .044 Proper Cooling of PHFs 125. I Equpment and Utensils _ I FG-4 j .005 i 3-50IA4(A) Cooling Cooked PHFs from 14TF to 2g, f Water.Plumbino and waste ( FC-5 I .906 i 70'F Within 2 Hours and From 70'F 127. 1 Physical Facility FG-6 .007 to 41`F/45'F Within 4 Hours.* 1 28. ' Poisonous or Toxic Materials FC=7 .008 ' 3-501.14(B) Cooling'PHR Made From Ambient ! 1 29. Special Requirements .009 30, Other Temperature Ingredients to 41 017/450F It( Within 4 Hours* Denote.,crincat item in the federal 1999 Food Caie or 105 CMR X90.000. Massachusetts Department of Public Health Salem Board of Health 120 Washington Street,40'Floor Division of Food and Drugs Salem, MA 01970-3523 Tel. (978)741-1800 Fax(978) 745-0343 City/Town of n Address: FOOD ESTA LIS T (/INSPECT14N REPORT Tel. Name 1_ ( ' DfDI1I(� Typ fOpere6on(s) TT a Inspection Food Service LTJ-Routine Address � �^ /�X Risk ❑ Retail ❑Re-inspection i/ •) r l l.i i ion Level ❑ Residential Kitchen Previous Inspection Telephone El Mobile Date: HACCP YIN [I Temporary ElPre-operationOwner I ❑ Caterer ❑Suspect Illness Person-in-Charge(PIC) TI [I[IBed&Br akfast ❑❑General HACCP Complaint In Inspector `{ > r OutIl11 ' ermk No.li -),A3fD 0,Other Each violation aJee�Ced requires an xplanation on the narrative liage(q add a citation o specific provision(s)violated. Non-compliance with: Violations Related to Foodborne Illness Interventions and Risk Factors_(Red Items) Anti-Choking 590.009(E) ❑ Violations marked may pose an imminent health hazard and require immediate Tobacco 590.999(F) ❑ Allergen Awareness 580.009(G) ❑ corrective action as determined by the Board of Health. LFOOp.PRDTECTION MANAGEMENT' ( ❑12. Prevention of Contamination from Hands ❑ 1. PIC Assigned/Knowledgeable/Duties ---EMPLOYEE HEALTH r' -� ❑ 13. Handwash Facilities - «_ - tPROTECTION FROM"CNEMI_CALS ❑ 2. Reporting of Diseases by Food Employee and PIC El 14.Approved Food or Color Additives ❑ 3. Personnel with Infections Restricted/Excluded _ ❑ 15. Toxic Chemicals FOOD'FROMAPPROVEDSOURCF. _ 1ECO -_ .�._- ❑ 4. Food and Water from Approved Source [tIMEREMPERATURNTROLS(Potentlalty HZ-rd_ous Foo_d_s) ❑ 5. Receiving/Condition ❑ 16. Cooking Temperatures ❑ 6. Tags/Records/Accuracy of Ingredient Statements [117.Reheating ❑ 7. Conformance with Approved Procedures/HACCP Plans ❑18.C oling PROTECTION FROM CO_NT_AMINATIO_N �t and Cold Holding V❑ 8/Separation/Segregation/Protection C320.Time as a Public Health Control 9. Food Contact Surfaces Cleaning and Sanitizing (REQUIREMENTS FORHIGNLYSUSCEPTBLE-POPULAY(ONS_(HSP)_ ❑21. Food and Food Preparation for HSP El 10. Proper Adequate Handwashing ❑ 11.Good Hygienic Practices I CONSUMER ADVISORY ❑22. Posting of Consumer Advisories Violations Related to Good Retail Practices_(Blue Number of Violated Provisions Related Items) Critical (C)violations marked must be corrected To Foodborne Illnesses Interventions immediately or within 10 days as determined by the Board and Risk Factors (Red Items 1-22): of Health. Noncritical(N)violations must be corrected Official Order for Correction: Based on an inspection immediately or within 90 days as determined by the Board today, the items checked indicate violations of 105 CMR of Health. 590.000/federal Food Code.This report,when signed below C N 004)) by a Board of Health member or its agent constitutes an 23. Management and Personnel (FC-2X590order of the Board of Health. Failure to correct violations Food and Food Protection (Fc-3X550 oa) cited in this report may result in suspension or revocation of 5. Equipment and Utensils (Fc-aXs9o.006) —� the food establishment permit and cessation of food Water, Plumbing and Waste (Fc-5X590.006) establishment operations. If aggrieved by this order,you 7. Physical Facility (Fc-6X590 007) have a right to a hearing.Your request must be in writing 28. Poisonous or Toxic Materials (FC-7X590.008) and submitted to the Board of Health at the above address 29. Spec (590.009) within 10 days of receipt of this order. //�? 3��+ DATE OF RE-INSPECT/ N: I � l/&,Inspector's SignatuPrint: /ODPICS Signature: Print: �� N� ,17,�Uv Page./ offllsa-ges II / Violations Related to Foodborne Illness Interventions and Risk Factors(items 1-22) PROTECTION FROM CONTAMINATION FOOD PROTECTION MANAGEMENT 8 ( Cross-contamination 3-302.11(A)(1) Raw Animal Foods Separated from I 590.003(A) Assignment of Responsibility Cooked and RTE Foods* 590.003(B) Demonstration of Knowledge* Contamination from Raw Ingredients 2-103.11 Person in charge-duties 3-302A I(A)(2) Raw Animal Fonds Separated from Each EMPLO"EE HEALTH Other* ( 2 590.003(0) Responsibility of the person in charge to Contamination from the Environment3-302,tl(A) Food Protection- require reporting by foal eniptoyees and applicants* � 02.15 I Washing Fruits and Vegetables 590.003(F) Responsibility Of A Food Employee Or An ( '"304'11 I Food Contact with Equipment and Utensils* Applicant To Report To The Person to I Contamination from the Consumer Charge* 3-306.14(A)(B) Returned Food and Reservice of Food* 590.003(0) Reporting by Person in Charge 31 590.003(D) Exclusions and Restrictions* Food tionotAdufterafedorContaminated Food , 590.003(E) Removal of Exclusions and Restrictions 1 3-701,11 Discarding or Reconditioning Unsafe FOOD FROM APPROVED SOURCE I Food{ I ' 4 Food and Water From Regulated Sources ( 9 Food Contact Surfaces 590.004(A-B) Compliance with Fold Law* 4-501.111 Manual Warewashing-Hot Water 3-201.12 Fool in it Hermetically Scared Container" Sanitization Temperatures* 3-201.13 Fluid Milk and Milk Products* 14-501.112 Mechanical Warewashing-Hot Water 3-202.13 Shell Eggs* - Sanitization Temperatures* 3-202.14 Eggs mid Milk Products.Pasteurized* ! 14-501.114I Chemical Sanitization-temp.,pH, 1 .1 3-202.16 +; Ice Made From Potable Drinking Water" concentration and hardness. I 5-101.11 I Drinking Water from an Approved System' 4-601'i I(A) Equipment Food Contact Surfaces and I 590.006(A) I Bottled Dunkin,Water* Utensils Clean* J 4-602.11 I CleaningFrequency ofEquipment Food- 590.006(B) Water Meets Standards in 310 CMR.220 q y ShelRish and Fish Front on Approved Sourve Contact Surfaces and Utensils* 4-702.11 Frequency of Sanitization of Utensils and 3-201.14 Fish and Recreationatiy Caught Molluscan I I I Food Contact Surfaces of Equipment* Shellfish* ( 4-703.11 Methods of Sattitization-Hot Water and 3-201.15 MoOse uan Shellfish from NSSF Listed Chemical* Sources* Game and Wild AAushrooms Approved by 110 Proper,Adequate Handwashing Regulatory Authority 2-301.11 I Clean Condition-Hands and Arms* 3-202.18 Sheilstock Identification t resew" 2-301.12 Cleaning Procedure* 590.004(C) Wild Mushrooms* 2-301.14 When to Wash* 3-201.I7 Game Animals' 11 Good Hygienic Practices S Rece!vingiCondition 2-401.11 I Eating,Drinking or Using Tobacco* 1 3-202.11 PHFs Received at Proper Temperatures* 2401.12 Discharges From the Eyes,Nose and 3-202.15 Package huegrity* I I Mouth* 61 3-!C,L l l Food Safe and Unadulterated* 3-301.12 Prevention Contamination When Tasting* I TagsiRecords:Sheiistoek 12 Prevention of Contamination from Hands 3-202.18 Sheflstock Identification* 1590.004(E) Preventing Contamination from 3-203.12 ShetIstock Identification Maintained* I Employees* ' Tags/Records:Fish Products f 13 Handwash Facilities 3-402.11 Parasite Destruction* Conveniently Located and Accessible 3-402.12 Retxrrds.Creation and Retention* 5-203.11 Numbers and Capacities* 590.004(1) Labeling of Ingredients' 5-204.11 Location and Placement* 5-205.11 Accessibili .Operation and Maintenance 7 Conformance with Approved Procedures ry. � iHACCP Plans ( I Suppled with Soap and Hand Drying 3-502.11 Specialized Processing Methods* Devices 3-502.12 Reduced oxygen packaging;criteria* 6-301.11 Handwashing Cleanser,Availability 8-101!2 Conformance with Approved Procedures* 6-301.12 Hand Drying Provision *Denotes critical item in the federal 1999 Pad Clode or 105 CMR 590.0(6) CITY OF SALEM / ✓� , LTH Establishment Name: ,�' � BOARD OF HE Date: I e: Ol ��_� Page:�� of // . Item Code C—Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date. No. Reference R—Red Item I I Verified PLEASE PINT C ARIV njJ _4A I,h -1( _ pff A i�r �-r� h,1 I , rn o 1nV1� 11) 0"a LI I 0 ° a v �,t�NPaJ- nl�� lnl�t�C. llrl' _ UR ��-c ° I Jfa,vf(l) [) . trnt�l Isar I nw.1 I oVYA ill✓ Discussion With Person in Charge: ` C rective Action Required: ❑ No I ] Yes I have read this report, have had the opportunity to ask questions and agree to correct all Ib,-Toluntary Compliance ❑ Employee Restriction/ inspection, to observe all conditions as described, and to Exclusion violations before the next ins P �-inspection Scheduled ❑ Emergency Suspension comply with all mandates of the Mass/Federal Food Code. I understand that noncompliance may result in daily fines of twenty-fiv dollars or suspension/revocation of ❑ Embargo ❑ Emergency Closure your food permit. ❑ Voluntary Disposal ❑ Other: y { + 3.501.14(C) PHFs Received at Temperatures Z Violations Related to Fwafborno illness Interventions and Risk According to law Cooled to Factors(items 1-22) (Cont.) 41'Ft45'F within 4 Hours. iPROTECTION FROM CHEMICALS 3-501.15 Cooling Methods for PHFs 1 { } 19 PHF Hot and Cold Holding 14 Food or Color Additives `¢ 3-50L16(13) Cold PHFs Maintained at or below ( 3-202.12 Additives*' 590.004(F) 410/450 P* 3-302.14 Protection from Unaenroved Additives'% { 3-501.16(A) Hot PRFs Maintained at or above { 15 Poisonous or Toxic Substances 140,E * 7-101,11 Identirying Information-Original _-501.16(A) Roasts Held at or above 130'F. * } Containers* { 20 Time as a Public Health Control { 7-102.11 Common Name-working Conminet>;* { 7-101.11 Separation-Storage* 3-501.19 Time as a Public Health Control* { 590,004(H) Variance Requirement 7-202.11 Restriction-Presence and Use* y { 7-202.12 Conditions of Use* REQUIREMENTS FOR HIGHLY SUSCEPTIBLE t ( 7-203.11 Toxic Containers-Prohibitions* POPULATIONS(HSP) , { 7-204.)1 Sanitizers.Criteria-Chemicals' { { 7-204.12 Chemicals for washing Produce,Criteria* { 121 3-801.11(A) Unpasteurized Pre-packaged Juices and .Beverages with warning Labels* { 7-204.14 Drying Agents.Criteria* { 3-801.11(B) Use of Pasteurized Eggs* 4 { 7-205.11 incidental Food Contact.Lubricants* { 3-801.11(D) Raw or Partially Cooked Animal Food and { 7-206.11 Restricted Use Pesticides,Criteria* { Raw Seed Sprouts Not Served. { 7-206.12 Rodent Bait Stations* 7-206.13 Tracking Powders,Pest Control and 3-801.11(C) Unopened Food Package Not Re-served. 1 1 i } Monitoring- CONSUMER ADVISORY i 22 3603.11 Consumer Advisory Posted for Consumption of TIMEMEMPERATURE CONTROLS Animal Funds That are Raw, 16 I Proper Cooldng Temperatures for Not Otherwise-Prcx•essed to Eliminate or r PHFs Pathogens.*�"ln,�'1 3401.1lA(1)(2) Eg_es- 155`F 15 Sec. '} Eggs-Immediate Service 145-Fl5,wzl 3-302.13 Pasteurized Eggs Substitute for Raw Shell 3-401.11(A)(2) Comminuted Fish.Meats&Game Ems* Animals-155'F 15 sec. 3-401.11(B)(I)(2) Port,and Beef Roast-130'F 121 min* { SPECIAL REQUIREMENTS 3-401.11(A)(2) Ratites,Injected Meats- 155°F 15 590.009(A)-(D) Violations of Section 590.009(A)-(D)in see.* catering, mobile food,temporary and 3-401.11(A)(3) Poultry,wild Game,Stuffed PHFs, residential kitchen operations should be Stuffing Containing Fish.Meat. debited under the appropriate sections Paul"or Ratites-165'1715 sec, * above if related to foodborne illness f 3401.11(C)(3) Whole-muscle,Intact Beef Steals interventions and risk factors. Other 1 1450F* 590.009 violations relating to good retail t 3-401.12 Raw Animal Foods Cooked in a practices should be debited under#29- r Microwave 165'F* Special Requirements. 3401.11(A)(1)(b) { All Other PHFs- 145'F 15 sec. { 17 { Reheating for Not Holding VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 1 3-403AI(A)&(D) PHFs 165T 15 sec.* (Itetits 23-30) 3-403.11($) Microwave- 165'F 2 Minute Standing ! Critical and non-critical violations, which do not relate to the i Time* I foodborne illness interventions and risk factors luted above, can be 3-403.11(C) Commercially Processed RTE Foots- i found in the following sections of the Food Code arid JOS CMR { 140°F* ! 590.000. 'I 34113.11(E) Remaining Unsliced Portions of Beef 1 item I Good Retail Practices I FC 1 690.000 Roasts* S 23. 1 Manaaament and Personnel i FC-2 .003 ! { 7g { Proper Cooling of PHFs i 24. Foal and Food Protection FC-3 .004 125. Equipment and Utensils I FC-4 .005 3-501.14(A) Cooling Cooked PHFs from 140`F to 26. i Water.Plumbinq and Waste ! FC-5 .006 70`F Within 2 Hours and From 70*F 27. ( Physical Facility i FC-6 .007 to 4 VF/45'F Within 4 Hours.°` i 26. 1 Poisonous or Tadc Materials ! FC=7 .008 3-501.14(B) Cooling PHFs Made From Ambient ! 129. ( Special Requirements .009 Temperature Ingredients to 41'F/45'F I 30 1 Other Within 4 Hours* "Deno e critical tom in rhe L&rul 1999 Food Caie ur 105 C.MR 594.000. Commonwealth of Massachusetts -, City of Salem u ro Board of Health s 4 Kimberley Driscoll '- j Ma ori 120 Washington Street,4th Floor' Y .y ¢SALEM,MA 01970 Ir q � `_� Food/Retail Establishindit Perlitit. .:' - `DATE PRINTED: 01/03/2013 ,. i`P - r ESTABLISHMENT NAME" Brother's Deh _ >z- - File Number:BHF-2004-000018 -- - 283 Derby Street Salem '' . MA ., 01970 °x✓ s ip x =., LOCATED AT:, 0283;DERBY STREET. ;" SALEM,.MA '01970 AI ,; , Permit Type Permit No. Permit Issued i'Permit Expires - -o --Fee Restrictions/Notes - FOOD SERVICE i BHP-2013-0300 Jan.l,2013 Dec 31,2013 $420.60- -ESTABLISHMENT' 420:00-ESTABLISHMENT h } '. r` '', Total Fees: $420 00 . < - e y� `a s 7 _ PERMIT EXPIRES Oecember 31;2013 ' Board of Health ,=° ;_ n ` This Permit is- not transferable and must be reissued upon change of ownership or location.,The permit must be posted" i in a prominent location in the Establishment. ` - - -; .3t.-,. 4 In'accordance with the State Sanitary Code,-beofre any revaluations,improvementsrte-:,or equipment changes are made, all plans for,such must be submitted to and approved by the Salem Board of Health: 9 pa e t 1 CITY OF SALEM, • '" � MASSACHUSETTS Publicxeatth BOARD or HeAI:1I 120 WASHINGTON S'Iltlurr,411'FLOUR it KINfBF_RLEY DRISCOLL Ti;I..(978)741-1800 FAX(978)745-0343 LARRI'RADiDIN,RS/RB-IS,CHO,CP-FS MAYOR kamdinl7salem.com Hi;31;1'!-1 A(;EN'I' Food Establishment Permit Application (Application must be submitted at least 30 days before the planned opening date) i 1) Establishment Name: D /J//n 2) Establishment Address: 2-S3 50e,-k(-1 S d am? l ` q � 0 /coo n ^ 1 3) Establishment Mailing Address(if different): d, ,l / 0 4) Establishment Telephone No: q79 — Nl— 7 (�/ YX 5) Applicant Name&Title: !t' 9,Ze,17 A2rti `W4' 8) Applicant Address: 9w FZ21-41 9'/7- 3/9 3#- b,oYA-3 7) Applicant Telephone No: 24 H��ouppr��Emergency/N�o�: /?RQ Email: <W1 '-; 8) Owner Name&Title(if different from applicant): Ztk Wn ` r ��aye 9) Owner Address(if different from applicant): 10) Establishment Owned by: 11) If a corporation or partnership,give name,title and home address of officers or partner. An association Name p Title Home Address / A corporation An individual J,_(�,�/'-��f/G��J `�/tX! N/ r�cYl(Gill[7 A partnership 1� lil, I I �/n P-46u`197„YOE" Other legal entity Nf� �`�w1 �`"►l0 o co—ate 1 12) Person Directly Responsible For Daily Operations(Owner, Person in Charge, Supervisor, Manager,etc.) l Name&Title: /Ml� (a"?'Z / J1U'Qq'k4LL6W)-7 Address: Telephone No: 31,3 z � Fax: ( Email: Emergency Telephone No: /�",Q &'�, 9 al,)-¢/ V4 / 13) District or Regional Supervisor(if applicable) p1 Name&Title: II Address: Telephone No: Fax: Email: Check#: I ✓ V Date: Amount: /UD Food Establishment Information 1 � 14) Water Source: 15) Sewage Disposal: DEP Public Water Supply No: (if applicable) 16) Days and Hours of Operation: * �e,(�(�y� 17) No. of Food Employees: 18) Name of Person in Charge Certified in ood rotea- nManagement: ^ n� Required as of 101112001 in accordance with 105 CMR 590.003(A) !A,0, U/ F % f7(,(4� 19) Person Trained in Anti-Choking Procedures(if 25 seats or more): k Yes No 1 20) Location: 22) Establishment Type(check all that apply) (check one) ❑ etail( Sq. Ft) ❑ Caterer Permanent Structure AlFood Service—( W Seats) ❑ Frozen Dessert Manufacturer Mobile ❑ Food Service—Takeout ❑ Residential Kitchen for Retail Sale ❑ Food Service—Institution ❑ Residential Kitchen for Bed and ( Meals/Day) Breakfast Home ❑ Food Delivery ❑ Residential Kitchen for Bed and 21) Length Of Permit: reakfast_Establishments__________.............. ----------------------------------------------------------------------------- --- (check one) RETAIL STORE RESTAURANT An ❑ Less than I000sq.ft. _ $ 70 ❑ Less than 25 seats $140 nal/Dates: ❑1000-10,000sq.ft. $280 ❑ Residential Kitchens $140 ❑ More than 10,000sq.ft. $420 ❑25-99 seats $280 4 Vlore than 99 seats $420 ---------------------------------------------- --------------------------------------------------------- TemporarylDateslTime: ❑ Bed&Breakfast/Childcare Services/Nursing Home $100 - - ----------- ---_...--------------------------------------------------------------------------------------------------------------- � ADDITIONAL PERMITS ❑ MAKE ICE CREAM, YOGURT/SOFT SERVE $25 ❑ PASTURIZATION $25 ❑TOBACCO VENDOR $135 ❑ALL NON-PROFIT $25 (Including, church kitchens,state funded childcare&private clubs) 23) Food Operations: Definitions: PHF-potentially hazardous food(timMemperature controls required) 1 Non-PRFs-non-potentially hazardous food(no timeltemperature controls required) (check all that apply): RTE-ready-to-eat foods(Ex.sandwiches,salads,muffins which need no further processing Sale of Commercially PHF Cooked to Order / Hot PHF Cooked and Cooled or Hot Held l Pre-packaged Non-PHFs tl for More Than a Single Meal Service Sale of Commercially Preparation of PHFs For Hot And // PHF and RTE Foods Prepared For Highly Pre-packaged PHFs Cold Holding for Single Meal Service F Susceptible Population Facility Delivery of Packaged PHFs Sale of Raw Animal Foods Intended to be Vacuum Packaging/Cook Chill Prepared by Consumer Reheating of Commercially Customer Self-Service Use of Process Requiring A Variance Processed Foods for and/or HACCP Plan(including bare hand Service Within 4 hours contact alternative,time as public health control. Customer Self-Service of Ice Manufactured and Packaged for Offers Raw or Undercooked Food of 1 Non-PHF and Non- Retail Salo- - Animal Origin Perishable Foods Only Preparation of Non-PHFsI/ Juice Manufactured and Packaged for Prepares Food/Single Meals for Catered Retail Sale Events or Institutional Food Service r Offers RTE PHF in Bulk Quantities To be comnleted by the Board of Health Retail Sale of Salvage,Out of Date or Reconditioned Food Total Permit Fee: Payment is due with application I,the undersigned,attest to the accuracy of the information provided in this application and I affirm that the food establishment operation will comply with 105 CMR 590.000 and all other applicable law. I have been instructed by the Board of Health on how to obtain copies of 105 CMR 590.000 and the Federal Food Code.C-== V 24) Signature of Applicant: v Pursuant to MGL Ch.62C, sec.49A, I certify under the penalties of perjury that I,to my best knowledge and belief, Have filed all state tax returns and paid state taxes required under law. 7 25) Social Security Number or Federal ID: n _ _ 0 —d 79_ IN 26) Signature of Individual or Corporate Name: ) HVAC Mechanical Services, Inc. SERVICE ORDER HVAC Specialiste Phone:(857)829-0055 V' INVOICE P.O.Box 390562 a Cambridge,MA 02139 0411 BILL TO .��„(�Z'.'�"!.� �I�_/N/7,/ N(—C'._... :/�E•........ .... .._. �. TwsvNRK ISTD BE C.O.D. Z CHARGE - � MAKE NO CHARGE 1 3.... .�.na_ .. S�._.. ....... . V,. ii /� /_J Pi?N �//t�. •'L •I _�• 0 I MW RI4 NUMBER ML NUMBER f I\ J NME A .� 1 SRIEET �/zU�� ENVIRONMENTAL CHECK LIST WORK PERFORMED , �CITV FROMI�ED WORK PERFORMED CITY. TYPEOISPOSmON CONDENSING UNIT COMSKM DRAMS PHONE CALL BEFORE // _ KODUERED LE'SLED MOYNDRRAIN _ A.M. _ _ REM P _ P.M. RECTCLEp LLE.Wm DDIL MEM RED TECHNICIAN AUTHORREDBV = RECLAIMED CHECKED CHECKED CLEANED CHARGE P410MIN RETURNm REMIR:P REPAIRm WORK TO BE PERFORMED Y _ LEAK IN COIL Mx DRBN L DIsP . EAK INC FURN.OR FAN COLL REPAIRED PER _DIGMAMLED AREF REP ED BELT _CHANGED OUTOTAL $rMEPIACED 'SHECNED ADJUSTm BELT ]MOTOR OTY. MATERIALS 8 SERVICES UNIT PRICE - AMOUNT DESCRIPTION OF WORK PERFORMED CHANGED REPLACED MOTOR NW �f STED REFRIGERANT R- 'LBS7/� / y/ //q TREPPUPLLEY // D CLEANED ^. B'wELTUBtE N.OwER REPLACED REPLACED COMPACTOR I BEARINGS RREPLTsmRr I OILED MDroR clic . Ccl�Cr��' -.D�STAR ' I Oltm BEARINGS MR %/�l/d.,.p �rs-I., / n�/%. C�'S •fG 1l'I.SU I�rr l/' usl�-G+'Y-fl AAMD uPPnC�NOFRUN I HEAT EACH L Y�C v./J7 �� S�I �,,�f v. AN CIZAODNTAcmR HEAREPLACED REPAIRED CLEANED OR PUDT 1 wi 18411 �I rti s ` . . .. .... .T / WIRING AN (�/l. � /YI'/��r REPLACED NEE THERMOCOUPLE REPLACED i RENAR REPLACED D VERVE .. .. I .I .. .... ... /. .�. I G I ,.✓-Ge�CT C r� /✓��//.�Ihf IEVAPO TOR COUL S! /C e�xv vuv°E Duey .. . ..., f .1 ..... .. . . ... ............ .. . ... .. ._ .IREPLACED REPAIRED FILTERSz x CLEARED CLEARED Ayx6lED REMISED THERMOSTAT > FILTERS % % COIREP USAN I REPAIRED OONN REPLACED BELTS �' -� �_I RECOMMENDATIONS r (CLEANED COIL Awus I TOTAL MATERIALS /j/yj/I;ral �pr2ir}lµ f ) T�A.ra �' /P�t:.eo�' °/m LEVELED COIL ELECT.HTR. CLGTOWER HRS. LABOR RATE AMOUNT { REPucmunK CLEANED I lJJ � J� I �� PEP'J,CE0 KLI% I :v t /� �. ]REMIPm W WE PUMP(S) I i 5- I O // _ / ifo" REPLACED CCM GREASED I ✓' I d/ REPRRED TOTAL LABOR J I ^II I MRERP,L..IApR M.6E joy >�L LIMITED WARRANTY: All materials, party FlLm TERS I ZCLEANREPLACED car.WumavomEKsIDE AI and equipment are warranted by the TOTAL SUMMARY TERMS _ manufacturers' or suppliers' written warranty Net 30 only.All labor performed by the above named TOTAL company is warranted for 30 days or as MATERIALS [„ Y�� L•�d otherwise indicated in writing.The above named TOTAL Company makes no other wartanties, express LABOR I I eemnmy W ogee,ft Work DlwRed AKN.B wMcn nu Deep.Pwwl rry mKIINMN. apes mer. or implied, and its agents or technicians are nn _ 41 SADer xwrM axe m eaupmenUm.bRM.tvDatMd Wlel DNA,LaYmeR M DMde.x PMDMN G Rm DMdp not authorized to make any such warranties r/JSCVA'^` 07J� Bs ay xd.WWP DSII mM)PIl Md.DDmWeRvlKmluM Al SAMWA ezNwBr Aly Or-F,MWftn NWR on behalf of above named company. sem RM a,owl net M LAW MAacrszBoy a seller. TRAVEL I = REGULAR =WARRANTY ! CHARGE /DI r I - SERVICE CONTRACT TAX CVB,D .SPPRUNE DME I LJ M1 j U1w I TOTAL w Air Cleaning Services, LLC. �19 Rawson Road Hanover, MA 02339 781 826,9444 888.260-4314 611170 BROTHERS DELI SALEM Acct# 607046 ShipTo BROTHERS DELI SALEM Ticket# 7190 283 DERBY STREET SeniceDate 5/5/2012 Contact MAZ MOUHIDIN SALEM, MA 01970 Phone 978-741.4648 Week: 17 ADVANTAGE HOOD CLE UP AI BELT CELL 617-319-3156 n E LT �� r ' FAX 976498-0002IMAiCE UP AIR BELT SIZE IS A-67 ( II',�� I c 8111 :RE$CS.- >:>:<:?;:::>.e<;...... ::::rr;>;»>rt>?:r::> z:::t_::<:>:>::<<:;;>>;.. :.....a<..:. ...:..:.:::r..;::::. 13064 HOOD DEGREASE 2HOODS(24iMi I HOOD&16'IN BACK) $ 700 I $650.00 CLEANING SE PJ L P.ELATED STRAIGHT VERTICA.I DUCT, Last Service 11/6/Z011 13064 HOOD 3-FANS,ALL RELATED ACCESSIBLE BACKSPLASH 8 700 C:LEANINCi SE '"1'' OLISHHOODS INSIDE&OUT W/STAINLESS POLISH Last Service 111612011 130¢4 DATE OF LAST BELT CHANGE 8 700 \� Last Service Service Performed By: �I Z� Y ' , �u� Total: $650.00 E Date Completed : 5_1611(i Time: 7-,5Q 1 I hereby accept the above performed service and charges as being satisfactory and acknowledge that equipment has been left in aod-co it' l Customer Signature Printed Name Cash Check Acot Payment Method COD S031 Small Business Services Program/MA Questions?Call us at 1-800-332-3333 Energy 4.1 166 Savingt i Savings Plan SUMMARY C1liQ� 1� lpag id Application Number: 1723977 Date: 4/12/2012 Customer Name: HAZEL DELI LLC App# 1723977 Account# 13097-77018 Save money on your electric & gas bill by using energy more efficiently. And, through the power of action, you reduce greenhouse gases (CO2) annually by 12,980 pounds. _ Estimated Annual$aymgt(Energy) .I Estimated Annual Savings'(Dollair 'I Electric(kWh) 11,799.98 I Electric $1,312.16 Gas $0.00 Gas(Therms) 0.00 Total $1,312.16 You pay only 30% of the installation cost- National Grid pays the rest. Estimated Job Estimated National Grid Estimated Customer, Prevailing Wage Lift Charge.' o u - ' Cost iContribution@70% Contrlhution@30%„ Electric $5,134.36 I $1,540.31 $3,594.05 Gas $0.00 I $0.00 Payback Period in Months 14 No upfront cost to you - finance your contribution on your monthly electric bill. Choose from 3 convenient payment options. L_ Sum Payment 12 Monthly Payments 24 Monthly Payments- (Additioaa1.15%^Discount) (Interest Free) I, (Interest Frie) J Electric $1,309.26 I $128.36 $64.18 Gas I $0.00 I $0.00 $0.00 Page 1 S031 Small Business Services Program/MA 7 Questions?Call us at 1-800-332-3333 Energy Savings .Plan r�'f''/''�p^� I �*o DETAIL natio I a l 6 id Date: 4/12/2012 Application Number. 1723977 Customer Name: HAZEL DELI LLC % - . Application Number: 1723977 DBA Name: BROTHERS DELI - Account Number: 13097-77018 Address: 283 DERBY STREET - - Telephone: 978-741-4648 City: _ SALEM Contact Name: MAZ MOUHIDIN State and Zip MA 01970 Auditor Name: BRIAN FENOCHIETTI Facility Square 5000 Audit Date: 03/23/2012 Footage: - ECM 'SifeLocation- "EGM' _-_ 'ECMDe§cripNon - Kit Type Quantrty iC}1' KWHSavings' Id _ Code _ Savings , 103009 Entry&Open Area 127 LED Exit-0.93 W-Dbl Compact Fluorescent New 2 0.06 508.08 4 Face/Red Fixture Hardwired Interior Kit 103009 Open Sitting Area 498 Fluor-3L4 T8/LP 28W Fluorescent Fixture Installation 21 0.95 5,500.72 5 Kit 103009 Open Sitting Area 248 Fluor-3L2 T8/LP Fluorescent Fixture Installation 1 0.03 184,70 6 Kit 103009 Fluorescent Fixture Installation 7 Behind Counter Area 248 Fluor-3L2 T8/LP Kit 7 0.22 1,292.93 103009 Fluorescent Fixture Installation 8 Hall To Restrooms 248 Fluor-3L2 T8/LP Kit 2 0.06 369.41 103009 Fluorescent Fixture Installation 9 Restrooms 248 Fluor-3L2 T8lLP Kit 2 0.06 320.00 103010 Fluorescent Relamp/Reballast Ladies Room 496 Fluor- 1 L4 T8/LP 28W1 0.02 90.00 0 Kit (1-2;3lamps) 103010 Fluorescent Fixture Installation 1 Hall To Restrooms 498 Fluor-3L4 T8/LP 28W Kit 1 0.05 271.28 103010 Fluorescent Eight Foot Fixture 2 Kitchen 451 Fluor=41-4 8FT TS/LP Kit -" :•- 8 0.48 2,770.56 103010 Fluorescent Ei ht Foot Fixture 3 Storage Room 499 Fluor-4L4 T8/LP 28W Kit 1 0.07 370.00 Page 1 S031 Small Business Services Program/MA Questions?Call us at 1-800-332-3333 Energy Savings Plan na .ic�na �, DETAIL r id Date: 4/12/2012 Application Number: 1723977 %_EGM - - - Type 'Quanhty KWHSa - - ' ECM .. 1P - - Stte Location-., - ECM Descr tion Krt: KW .Id. .. Code - - --: . - - .gs _ vings" ' Savior . . :...__ 103010 Office 497 Fluor-2L4 T8/LP 28W Fluorescent Fixture Installation I 0.03 122.30 4 Kit 2.04 11 799.98 Page 2 View Customer Usage Page 1 of 2 nat►Onalgrld D *r'nat * Slee 1 maget on`t • Home • DSM Delivery • Program Management • Evaluation • Tools • Search View Customer Usage Premise No:.130977700 -HAZEL DELI LLC Account Header I History I Usage I Applications I Customer Notes Electric Usage Data _ Average monthly kW(last 12 active months) 79.1 Average monthly kWh(last 12 active months) 18715 Bill Month and Latest Meter Read No Of Billing Actual kWh Actual kW Conservation Charge Year Date Days Contribution Feb 2012 Jan 30,2012 31 15840 70.1 $123.55 Jan 2012 Dec 30,2011 30 13361 7B.0 $104.21 Dec 2011 Nov 30,2011 33 17428 75.3 $135.94 Nov 2011 Oct 28,2011 30 20284 86.3 $158.22 Oct 2011 Sep 28,2011 27 19848 79.7 $154.81 Sep 2011 Sep 01,2011 34 24925 88.6 $19441 Aug 2011 Jul 29,2011 30 25282 89.3 $197.20 Jul 2011 Jun 29,2011 33 24048 89.0 $187.57 Jun 2011 May 27,2011 28 16567 75.2 $127.17 May 2011 Apr 29,2011 29 - 16810 70.8 $72.79 Apr 2011 Mar 31,2011 31 16487 71.5 $71.39 Mar 2011 Feb 28,2011 30 17475 75.0 $75.67 httos://naapps.nationalgridus.com/dsmprod/DsmWeb/do/billingaccount/sbs/usage/View?isCdiSource=true&... 3/23/2012 60 -W 3 - � 06 S031 Small Business Services Program/MA Terms & Conditions national ril Date: 4/12/2012 Customer Name: HAZEL DELI LLC Vendor: AECOM USA INC Address: 283 Derby Street Audit Date: 03/23/2012 Town,State,and Zip Code: Salem,MA 01970 Auditor BRIAN FENOCHIETTI Account Number: 13097.77018 Application No: 1723977 )N01697 National Grid("Company")is offering an energy efficiency program("Program')to certain commercial and industrial customers ("Customer")that have an average monthly demand less than or equal to 300 kW. Under the Program,the Company is arranging the installation of certain energy efficiency electric and natural gas measures("Measures")at the facilities of eligible customers.Customer agrees to have a contractor hired by the Company for the Program install the Measures and pay a portion of the installation cost as described in Section Six listed below.The following are terms and conditions that govern the Program and the installation of the Measures. 1. Measures to be Installed An Independent contractor("Installation Contractor")hired by the Company will install at Customer's property,the;conservation ; Measures described in Section Six below.The InstallationContractor shall permanently disable all lamps replaced p666ntt0 th_is" Agreement(make them unfit for reuse).The disposal of any lighting equipment which is removed(with exception of fluorescent ballasts and lamps)will be the responsibility of the participating Customer.The disposal of any fluorescent ballasts and lamps will be the responsibility of'an'outside contractor hired by the Company. ' 2. Installation Date, - The Installation Contractor will attempt to install the Measures within thirty(30)days of Customer signing this Agreement. 3. Warranty and Disclaimers (aj The Company will provide a one-time equipment replacement free of charge for any equipment that fails to operate'a'ccordiri'g to manufacturers specifications for a period of two years after the date of the original ' installation.Lamps will be warranted for one year. (b)Customer may have other warranty rights that may have been provided by the manufacturer of the devicas ' Installed-under this Agreement:Customer,however,may exercise such rights only againstthe manufacturer:and '' •' '° 'not against the Company or its'affiliates: ' (o)OTHER THAN THE REPLACEMENT WARRANTY STATED IN SUBPARAGRAPH 3(a);ABOVE,,NEITHER "'' ' ':: "' THE COMPANY NOR ITS AFFILIATES MAKE ANY WARRANTIES OF ANY kiND,INCLUDING WARRANTIE`S'; OF'MERCH' - , ANTABILITY ANDFITNESS FOR A PARTICULAR PURPOSE' (d)The Company does not guarantee that the Measures will,in fact,save any level of energy or result in lowering of the customer's utility bill: _ e)Neither'the Company nor its'affiliates shall be liable to Customer for consequential or incidental damages arising out of the Program,whetherin contract,tort(including negligence)or any other theory of'racovery." 4. Access to,Property, (a)Customer will provide reasonable access to Customer's property during normal business hours for Installation Contractor to perform the Installation work. (b)In addition,the Customer will allow the Company to make a reasonable number of follow-up visits during the twenty-four month's following'installation,with advance notice and at a time convenient to the customer.'The purpose of the follow-up visits is to provide the Company with an opportunity to review the operation of the Measures.rDuring the follow-up visits,the Company may make suggestions to the Customer regarding operation. , of the Measures, but the Customer is under no obligation to follow any such suggestions. If the Customer does follow any instructions,the Company will not be liable to the Customer in tort(including negligence)for the Customer's reliance on the suggestions. 5. Discretion of Installation Contractor. - When undertaking the installation,the Installation Contractor or the Company(at their sole discretion)may choose not to make the, installations specified below for reasons related to safety or discovery of unforeseen conditions. '- Initial Here: Page 1 5031 Small Business Services Program/MA Terms & Conditions nationalri Date: 4/12/2012 Customer Name: HAZEL DELI LLC Application No: 1723977 Address: 283 Derby Street Town,State,and Zip Code: Salem, MA 01970 6. Equipment and Customer Contribution (a)The Installation Contractor will install the equipment listed on the attached Small Business Energy Savings Plan, incorporated herein by reference.The estimated cost of the installation including the estimated cost of the Customer's contribution is also Itemized on this report.The Customer may choose to pay its cost contribution over twelve or twenty-four months or may choose to pay it In one lump sum.If the Customer chooses to pay it in one lump sum,the Company shall discount the Customer's contribution by 15%. The Customer opts to pay Its cost contribution by(check one): _ Lump sum payment of $ 1,309.26(Elect) $ 0(Gas) includes Customer discount of 15% 12 monthly payments of $ 128.36(Elect) $ 0(Gas) per month JV24 monthly payments of $64.18(Elect) $ 0(Gas) per month (b) The Customer shall pay no more than the estimated cost shown on the report. If the actual cost of the installation is less than the estimated cost or if the Installation Contractor chooses not to make an installation in accordance with Section 5,the Installation Contractor shall adjust the customer's contribution and advise the Customer. 7. Authorized Signature of Customer By signing below,the Customer agrees to the applicability of the terms and conditions described above. CUSTOMER ADDRESS WHERE MEASURES WILL BE INSTALLED: HAZEL DELI LLC Signature: 283 Derby Street Salem,MA 01970 Name(Print): Title: Date: 1 / Incorporated Not Incorporated ❑ If Not Incorporated, Federal ID# Page 2 i Commonwealth off Massachusetts r o City of Salem; Board of Ilealfh Y IGmbefl®y.pnscoll 120 Washm&0' Street,.4th Floor IVI2}/Of, 4 t SALEM,MA 01970 - Y h } F®Dd/Rdidl Establishirteaa>t Per1n1B s DATE PRINTED .6f/63/2013 TT- t Y 'x-ESTABI.IS_ HMENT NAME , I$Y®t}teY�S IDelt - ~ ` _ FiteNw bd:BHF-2004-000018 - X283,Derby'Street 1s ` Salem MA 01970- I ®C kTED AT -,028S-DERBY-STREET SALEM, MA 01970 3 x --` Permit Type Pernut AIo.,_, Permit Issued Permit-Fres, Fee Restrictions/Notes yFOOD SERVICE BHP 2ot3 0300 Jan-1 2013 -200 31;2013 $920 00 1 ,--ESTABLISHMENT _ Total Fees $42040 3 4 - IT �7 IT IT - s x - b y h 4 „y ka--» - _ - - ST P9-kMIT EXPIRES �ecetinbep 31,.2013 ,, ' Board dbf Heattb A 9 - �tr 71 This Perunt isnot transferable and.must be eeissued up"on change'of owners_lrip or,locat�on:The permit must be posted in a prominent location in the Establishment In accordance"with the State4.Sanitary Code,beofre any_revonabons;=improvements,or equipment;changes are made, alt plans for such must be submitted to and`approved by.the Salem Board of:Healt6 page t Massachusetts Department of Public Health Salem Board of Health 120 Washington Street,40' Floor Division of Food and Drugs Salem, MA 01970-3523 ITel. (978) 741-1800 Fax (978) 745-0343 City/Town ofI//yVt Address: FOOD ESTA�MENT INSPECTION REPORT Tel. Name Y Dater Type of Operation(s) Type of Inspection �t i I I ❑ Food Service ❑ Routine Address Risk ❑ Retail ❑Previous InceRe-inspection I Telephone / �/ ' Level ❑ Residential Kitchen Previous Inspection I I / El Mobile Date: Owner HACCP YIN ❑ Temporary ❑Pre-operation ❑ Caterer ❑Suspect Illness Person-in-Charge(PIC) Tim ❑ Bed&Bre kfast 0 General HACCP Complaint ^ In: to Inspector \� !��r� /� Out:l/,7j� Permit No. E]Other Each violation ecked requires an explanation on the narrative page(s)and a citation off specific provision(s)violated. Noncompliance with: Violations Related to Foodborne Illness Interventions and Risk Factors_(Red Anti-Choking 590.009(E) ❑ Items) Tobacco 590.009(F) ❑ Violations marked may pose an imminent health hazard and require immediate Allergen awareness 590.009(G) ❑ corrective action as determined by the Board of Health. r FOORPROTECTION-- MOR GEMENT-_ - __ [112. Prevention of Contamination from Hands ❑ 1. PIC Assigned/Knowledgeable/Duties EMPLOYEE HEALTH _ -_ -- E] 13. Handwash Facilities -- gPROTECTION FROM CHEMICALS, . ❑ 2. Reporting of Diseases by Food Employee and PIC ❑ El 3. Personnel with Infections Restricted/Excluded 14.Approved Food or Color Additives - W_ -- _..- e ❑ 15. Toxic Chemicals r FOOD FROM APPROVED SOURCE, __ ___ _ _ ___t ,-_ ,_ ❑ 4. Food and Water from Approved Source W TIM_EREMPERATURECONTROL_S(Potantlalty titizaidous Foods) _J ❑ 5. Receiving/Condition ❑ 16 Cooking Temperatures ❑ 6. Tags/Records/Accuracy of Ingredient Statements ❑ 17.Reheating ❑ 7. Conformance with Approved Procedures/HACCP Plans ❑18. Cooling .PROTECTION FROM CONTAMINATION -- e®� a_ ❑ 19. Hot and Cold Holding ❑ 8.Separation/Segregation/Protection ❑20. Time as a Public Health Control ❑ 9. Food Contact Surfaces Cleaning and Sanitizing REQUIREMENTS FOR NIGHLYSIJ$CEPTI-BLE=POPULATION$'LHBP). El 10. Proper Adequate Handwashing ; [121. Food and Food Preparation far HSP _ ❑ 11. Good Hygienic Practices rCONSUMERADMSORY ❑22. Posting of Consumer Advisories Violations Related to Good Retail Practices-(Blue Number of Violated Provisions Related Items) Critical(C)violations marked must be corrected To Foodborne Illnesses Interventions immediately or within 10 days as determined by the Board and Risk Factors (Red Items 1-22): of Health. Noncritical(N)violations must be corrected Official Order for Correction: Based on an inspection immediately or within 90 days as determined by the Board today, the items checked indicate violations of 105 CMR rf Health. C T N 590.000/federal Food Code.This report,when signed below _ 23. Management and Personnel (FC-2X590.003) by a Board of Health member or its agent constitutes an 24. Food and Food Protection (FC-3X590.004) order of the Board of Health. Failure to correct violations 25. E ui ment and Utensils cited in this report may result in suspension or revocation of q p (FC-4X590 005) the food establishment permit and cessation of food 26. Water, Plumbing and Waste (FC5X590.006) establishment operations. If aggrieved by this order,you 27. Physical Facility (FC-6X590.007) have a right to a hearing. Your request must be in writing 28. Poisonous or Toxic Materials (Fc-7X590.008) and submitted to the Board of Health at the above address 29. Special R quirem ntsl (590.009) within 10 days of receipt of this order. 30. Other l/7 I DI I �E DF RE INSPE TIQN: 11/ 11 Inspector's Signatu Print: ' fj�f'fV ILI, I PICS Signature: U`/i V I Print: "1 p rt/ Paget of / Pages III / I ry Violations Related to Foodborne Illness Interventions and Risk Factors(items 1-22) PROTECTION FROM CONTAMINATION 1 FOOD PROTECTION MANAGEMENT 1 8 I Crass-contamination 1 3-302.11(.0)(1) I Raw Animal Foals Separated from If 590.003(.0) Assignment of Responsibility" I Conked and RTE Foods* J 590.003(B) Demonstration of Knowledge` I Contamination from Raw Ingredrents 2-103.11 Person in charge-duties I 13-302.1 I(A)(2) Raw Animal Foods Separated from Each Other* ` EMPLOYEE HEALTH I i Contamination from the Environment 2 590.003(C) Responsibility of the person in charge to 13-302.11(A) Foal Protection* 1 require reporting by food employees and , applicants* 13-..02.15 ' Washing Fruits and Vegetables 590.003(F) Responsibility Of A Faid Employee Or An1 3-30411 ' 1 Food Contact with Equipment and I Utensils* Charsan[To Report To The Person In , Charge* y I Contamination from the Consumer 590.003(G) I Reporting by Person in Char e* I 3-306.14(A)(B) I Returned Food and Resenice of Food* 13 590.003(0) I Exclusions and Restrictions* I DisposNon of Adulterated or Contaminated Food 590.003(E) I Removal of Exclusions and Restrictions I 3-7111.11, Discarding or Reconditioning Unsafe FOOD FROM APPROVED SOURCE \ I I Food* 4 Food and Water From,Regulated Sources 19 - FcContact Surfaces 590.004(A-B) Compliance with Food Law't -� 4-501.11 l Manual Warewashing-Hot Water" 3-201.12 I Food in a Hermetically Seated Container`* I Sanitization Temperatures* 13-201.13 I Fluid Milk and Milk Products* I 14-501.112I Mechanical Warewashing-Hot Water 13-202.13 Shell Eggs* I Sanitization Temperatures* 13-202 14 ( Eggs and Milk Products. Pasteurized` I I ti-501.114 I Chemical Sanitization-temp.,pH, 13-202.16 Ice Made From Potable Drinking Nater* concentration and hardness. 5-101.11 I Drinking Water frtnn an ApnroVed System* 4-60 1 A I(A) Equipment Food Contact Surfaces and I 590.006(A) I Bottled Drinking Water- I I I I Utensils Clean* 4-60_2.11 Cleaning Frequency of Equipment Food- I 590.006(1.') I Water Meets Standards is ppr c:dSMR 22ce Contact Surfaces and Utensils* I Shelpish and Ftsh From an Approved Source I 4-702.11 Frequency of Sanitization of Utensils and 3-201.11 Fish and Recreatitmal}y Caught tviolitoer.n I Food Contact Surfaces of Equitur Sliel Molluscan ( 4.703.11 I Methods of Sanitization-Hot Water and 3-201.15 Sources* She(Jtish from vSSF lasted Chemical* Game an 110 i + Proper,Adequate Handwashing Game and Wild Mushrooms Approved by Regulatory Authority I I 2-301.11 I Clean Condition-Hands and Arms- 3-20119 Shellstock identification Prescnv' I 12-301.12 Cleaning Procedure* 1590.004(C) I Wild Mushrooms* 12-301.14 I When to Wash* 3-201.17 I Came Animals* I 111 I I Good Hygienic Practices I S ReceivingrCondition I 12-401.11 I Eating,Drinking or Using Tobacco* 3-202.11 PHFs Received at Proper Temperatures* I 2401,12 Discharges From the Eyes,Nose and 13-202.15 Package integrity' I Mouth* 3-I0i.II Pool Safe and Unadulterated* I 3-301.12 I Preventing Contamination When Tasting* 6 I I Tags/Records;Shellstock I 112 Prevention of Contamination from Hands 3-202.18 I Shellstock Identification* I 590.004(F) Preventing Contamination from 13-203.12 Shellstock identification Maintained'* i Employees* I I Tags/Records: Fish Products I 13 I Handwash Facilities � f 3-402.11 I Parasite Destruction, I I Conveniently Located and Accessible 3-40^_.12 I Rcoords. Creation and Retenkun* I 15-203.11 I Numbers and Capacities* 590.004(1) I Labeling of ingredients* I 15-204.11 I Location and Placement* 7 Conformance with Approved Procedures 15-205.11 I Accessibility.Operation and Maintenance I /HACCP Plans I I Supplied with Soap and Hand Drying 13-502.11 Specialized Processing Methods* I Devices J 13-502.12 Reduced oxygen packaging,criteria* 16-301.11 I Handwashing Cleanser,Availability f 8-103.!2 Conformance with Approved Procedures* 16-301.12 I Hand Drying Provision Denotes critical item in the Werai 1999 f a)d Code of 10 CMR 590.000. e CITY OF SALEM 1 BOARD OF HEALTH Establishment Name: ('nVf if 1 moi'Vl Date: I Page: t'{� � of Item Code C-Critical Item r DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date' No. Reference R-Red Item Verified PLEASE PRI T f`..EARLY val P IL/4f, � I � �-� ' ' L � I r >J ��, hk `�- Cid-(,��re� r✓�n�Yr�1r vr,i'�^rte - �� I I I � "r r�-i4r i x rA I � I 1 Discussion With Person in Charge: Corrective Action Required: I ❑ No I [mss I have read this report, have had the opportunity to ask questions and agree to correct all ❑ Voluntary Compliance ❑ Employee Restriction/ violations before the next inspection, to observe all co itions as described, and to � Exclusion P GYRe-inspection Scheduled ❑ Emergency Suspension comply with all mandates of the Mass/Feder nderstand that noncompliance may result in daily fines of twe y-fip%or suspension/revocation of ❑ Embargo ❑ Emergency Closure your food permit. ❑ Voluntary Disposal ❑ Other: — J — . - - • / 3-501,14(C) PRFs Received at Temperatures Vfofatfons Relatad to Foodborne Illness Interventions ane Risk According to taw Copied to Factors(Items 1-22) (Cont.) _ 41T/45°F Within 4 Haus. PROTECTION FROM CHEMICALS 3-501.15 Cooling Methods for PHFs 1 14 ( i Food or Color Additives 19 CHF tilt and Cott Holding i 3-901,16(B) Cold PHPs Maintained at or below 13-202,12 Additives' - 590.004(F) 41°f450 F* 3-302.14 Protection from Unapproved Additives" 3-501,16(A) Hot PHFs Maintained at or above 115 Poisonous or Toxic Substances I 140°F ' 7-101-11 ldentifyingInformation-Original I �; I Containers* 3-501.16(A) Roasts Held at or above 1300F. 7-102.11 Common Nam-Working Containers* I 120 Time as a Public Health Control 7_201.11 Separation-Storage* ( 3-50I A9 Time as a Public Health Control* I 7-202.11 Restriction-Presence and Use* ( - 1590.004(H) Variance Requirement { 7-202.12 Conditions of Use* ( REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 17-203.11 Toxic Containers-Prohibitions* I ' POPULATIONS(HSP) 7-204.11 Samtizers.Criteria-Chemicals* 17-204,12 I Chemicals for Washing Produce,Criteria* J 21 3-801.11(A) Unpasteurized Pre-packaged luices and 17-204.14 Irving Agents,Criteria' 4 - I Beverages with Warning Labels* 17-205.11 incidental Food Contact Lubricants* I t t 3 801.11(B) Use of Pasteurized Eggs* t { v _ 3-80L 11(D) Raw or Partially Cooked Animal Food and 7-206.11 Restricted Use Pesticides;Criteria* I Rau,Seed Sprouts Not Served 17-206.12 Rodent Bait Stations* - { t- 7-206.13 Tracking Pawders;Pest Control and ( 13-$01.11(C) Unopened Food Package Not Re-ser,'ed;" Monitoring* _ CONSUMER ADVISORY � TIME/I EMPERITURE CONTROLS �) 22 3-603.11 Consumer Advisory Pasted for Consumption of Animal Foods That are Raw-Undercooked or 16 1 Proper Cooking Temperatures for PHFs = Na Otherwise Processed to Eliminate 3-401.11A(I)(2) Eggs- 155°F,15 Sec. , P3{(t°gens'* - 3-302.13 Pasteuri2ed Eggs Substitute for Raw Shell Eggs-Immediate Service 145°FlSse:.* "� Ems* 3401.i 1(A)(2) Comminuted Fish.Meats&Game ' Animals-155°F 15 see.* Z. SPECIAL REQUIREMENTS 3401.11(B)(1)(2) Park and Beef Roast-130°F 121 min• I - { 3_411.11 Ratites,Injected Meats- 155`F 15 590-009(A)-(D) Violations of Section 590.009(A)-(D)in sec.* catering,mobile fold,temporaryand 3-401.11(A)(3) Poultry,Wild Game.Staffed PHFs, residential kitchen operations should be Stuffing Containing Fish,Meat, debited under the appropriate sections Poultry or Ratites-165°F 15 sec. * < above if related to foodborne illness 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks � _ interventions and risk factors. Other 145°F* 590.009 violations relating to good retail 31401.12 Raw Animal Foods Cooked in a practices should be debited under#29- Microwave 165°F* Special Requirements. 3401,11(A)(1)(b) All Other PHFs- 145°F 15 sec. 17 Reheating for Hot Holding I VIOLA77ONS R SLATED TO GOOD RETAIL PRAC77CES 3-W3.1 l(A)&(D) PHFs 165"F 15 sec."" (Items 23-30) 4 3-403.11(B) Microwave- 16.5`F 2 Minute Standing � Crirical,and non-critical violations, which do not relate to the Time foodborne illness interventions and risk factors listed above.,can be 3-403AI(C)1(C) Commercially Processed RTE Food- Lound in the following sections of the Food Code and 105 CMR 'y 140'F* r 590.000. 7 3-403.11(E) - Remaining Unsliced Portions of Beef item i Good Retail Practices 11 FC 59d.Wo Roasts* ( •; 1 23, i Management and Personnel FC-2 .003 18 I Proper Cooling of PHFs 24, Food and Food Protection I FC-3 .004 ' 1 25. t Equipment and Utensils I FC-4 005 3-501.14(A) Cooling Cooked PRFs from 140°F to_ 1 261 Water,Piumbinq and Waste I FC-5 .006 r 700F Within 2 Hours acid Frorii 70`F ( 27' Physical Facikty FC--6 .007 to 4I°F145'F Within 4 Hours. * 128. Poisonous or Toyjc Materials FC-7 ma i 3-501.14(8) Cooling PHR Made From Ambient 129. ( Special Requirements .009 Temperature,tngredientsto41'Fl45',F 30. 1 Other ! Within 4 Hopes* I ,sem,;=n,+�.:..,•m< ]]] i 1 'Denoms critical is m in the federai 1999 Fw:J Ca L w 105 CM k 905000. i I Massachusetts Department of Public Health Salem Board of Health 120 Washington Street,44'Floor -Division of Food and Drugs Salem, MA 01970-3523 Tel. (978) 741-1800 Fax(978) 745-0343 City/Town of Address: FOOD ESTABLISH ME NSP CTION REPORT Tel. Name th4AC ( Dat LLr fOpevice s) Typ Routine ecfion r Rood Service Routine Address Ris ❑ Retail ❑ Re-inspection Telephone Level ❑ Residential Kitchen Previous Inspection ❑ Mobile Date: Owner HACCP YIN ❑ Temporary ElPre-operation F j(l ❑ Caterer ❑Suspect Illness Person-in-Charge(PIC) / A A Time ❑ Bed&Breakf st ❑General Complaint 1 A In: qX billP ❑ HACCP Inspector f 7 Out. )Permit No-7,)l o ❑Other Each violation 1CFiecke requires an explanation on the narrative ages and a citation o provision(s)violated. Noncompliance with: Violations Related to Foodborne Illness Interventions and Risk Factors_(Red AnUCtrokin9 590.009(E) ❑ IViolations marked may pose an imminent health hazard and require immediate Tobacco 590.009(F) ❑ ❑ corrective action as determined by the Board of Health. Allergen Awareness 590.009(G) FOOD PROTECTION MANAGEMENT __ ¢_- e ❑12. Prevention of Contamination from Hands [1 1. PIC Assigned/Knowedgeable/Duties ._, , ,r_ _ _ ��_ .___ pyf3. Handwash Facilities EMPLOYEE HEALTH _ __ e _m u ❑ 2. Reporting of Diseases by Food Employee and PIC iPROTECTION FROM'CHEMICAL$ E] 3. Personnel with Infections Restricted/Excluded El 14.Approved Food or Color Additives FOOD FROM APPROVED SOURCE ` ❑ 15. Toxic Chemicals 4. Food and Water from Approved Source TIMEfrEMPERATURE CONTROLS_(POtenUaltyHazardous Foods) ❑ 5. Receiving/Condition ❑ 16 Cooking Temperatures ❑ 6. Tags/Records/Accuracy of Ingredient Statements ❑ 17.Reheating ❑ 7. Conformance with Approved Procedures/HACCP Plans ❑_,18. Cooling PROTECTION FROM CONTAMINATION _' - &,)8.Hot and Cold Holding ❑ 8.Separation/Segregation/Protection ❑20.Time as a Public Health Control ❑ 9. Food Contact Surfaces Cleaning and Sanitizing REQUIREMENTS FOR HIGNLYSUSCEPTIBLE=POPULATIONS'(HSP)', El 10. Proper Adequate Handwashing El21. Food and Food Preparation for HSP _ ElR A 11. Good Hygienic Practices ,CONSUMEDVISORY, ❑22. Posting of ConsumerAdvisories Violations Related to Good Retail Practices_(Blue Number of Violated Provisions Related Items) Critical (C)violations marked must be corrected To Foodborne Illnesses Interventions immediately or within 10 days as determined by the Board and Risk Factors(Red Items 1-22): of Health. Noncritical(N)violations must be corrected Official Order for Correction: Based on an inspection immediately or within 90 days as determined by the Board today, the items checked indicate violations of 105 CMR of Health. 590.000/federal Food Code.This report,when signed below C N by a Board of Health member or its agent constitutes an 23. Management and Personnel (FC-2X order of the Board of Health. Failure to correct violations 24 Food and Food Protection (FC-3)(5990.000.003)4) cited in this report may result in suspension or revocation of 5. Equipment and Utensils (FC-4)(590.005) the food establishment permit and cessation of food 26.Water, Plumbing and Waste (FC-5)(590.006) establishment operations. If aggrieved by this order,you 27. Physical Facility (FC-6X590.007) have a right to a hearing. Your request must be in writing 28. Poisonous or is Materials (FC-7X590.008) and submitted to the Board of Health at the above address 29. Special Req re is (sso.009) within 10 days of receipt of this or .er. ' 30.Other DATEOFRE-INSPECTION: 1 �� s ae� Inspector's Signa 'f Print: I )p PICS Signature: I Print: `Z7 �n".�: ) Page of Pages 1 V V . 111 • � -,-I�.r a-•s .ti.rJ .. .� .••"Rl.� �-..._,,..- .y.�.. . . i -ti .r' r. - -a r.. �^ �� . T4 '� h Violations Related to Foodborne Illness Interventions and Risk Factors(items 1-22) PROTECTION FROM CONTAMINATION FOOD PROTECTION MANAGEMENT S 1Cross-contamination I 13-302.11(A)(1) Raw Animal Foods Separated from 1 590.003(A) Assignment of Responsibility* Cooked and RTE Foods* 590.003(6) Demonstration of Knowledge* I Contamination from Raw Ingred,-nts 2-103.11 Person in charge--duties I 3-302.11(A)(2) I Raw Animal Foods Separated from Each - t Other* i EMPLOYEE HEALTH I Contamination from the Environment 2 590.003(C) Responsibility of the person in charge to I +-302.11(A) I Fiord Protection* require reporting by food employees and 3-302.15 -1 Washing Fruits and Vegetables applicants* 3-304.11 Food Contact with Equipment and 590.003(F) Responsibility Of Furl Employee Or An ( 'I Utensils*' Applicant To Report To The Person In _ I Contamination from the Consumer 590.003(G) Report ng by Person in Charge* t Charge* � .S~'. 1 3-306.14(A)(B) I Returned Food and Reservice of Food* Disposition of Adulterated or Contaminated i 3 590.003(D) Ezelusions and Restrictions* '" Food 590.003(E) Removal of Exclusions and Restrictions I 3-701J! Discarding or Reconditioning Unsafe I J FOOD FROM APPROVED SOURCE Food* ( 4 Food and Water From Regulated Sources I ( 9 Food Contact Surfaces 590.004(A-8) Compliance with Food law* I 4-501.111 Manual Warewasbing-Hot Water 3-201.12 Food in a Hermetically Scaled Container* I Sanitization Temperatures* 13-201.13 Fluid Milk and Milk Products* I 14-50 1.1 t2 Mechanical W'arewashing-Hot Water f 13-202.13 Shell Eggs* I Sanitization Temperatures* J ( 3-202.14 Eggs and iNlilk Products,Pasteurized' I 14-501.114 I Chemical Sanitization-temp.,pH, 3-202.16 i ice Made From Potable Drinking Water* I concentration and hardness. * 5-101.11 Drinking Water from an Approved System* I 14-601.11(A) I Equipment Food Contact Surfaces and 590.006(A) I Bolded Drinking Water* Utensils Clean* 590.006(13) Water Meets Standards in 310 CMR 220* ( 4-602.11I Cleaning Frequency of Equipment Food Shellfish and Fish Fran an Approved Source Contact Surfaces and Utensils* 4-702.11 Frequency of Sanitization of Utensils and 3-201.14 Fish and Reaeationaliy Caught Mellascan I Food Contact Surfaces of Equipment* 3-207.15 MolluscaJ Shellfish, Food Shcllfi 4-703.11 Methods of Sanitization-Hot Water and b from vSSF f stall Chemical* Sources* I to I ProperAdequate Handwashin Game and Wild AAashrooms Approved by� , g ( Reoulatory Authority v ( 2-301.11 I Clean Condition-Hands and Arms* ( 3-202.18 I Sheilsicvk Identification P resew* I I 2-301.12 ( Cleaning Procedure* 590,004(C) I Wild Mushrooms* I 12-301.14 ( When to Wash* 3-201.17 I Game Animals" ( I it I I Good Hygienic Practices S ( ReceivingrCondition 12-401.11 I Eating,Drinking or Using Tobacco* 3-202.11 PHFs Received at Proper Temperatures* ( 2-401.12 I 1Discharges From the Eyes,Nose and 3-202.15 Package futepsity" Mouth* J 3-!'%i.11 Food Safe and Unadulterated* I 13-30(.12 I Preventing Contamination When Tasting* I 16 I I a agslllecords:Shelfstock I 112 Prevention of Contamination from Hands 13-202.18 I Shellstock Identification* I 590.U04(F) Preventing Contamination from 13-203.12 I Shellstoek Identification Maintained* Employees* Tags/Records: Fish Products 113 Handwash Facilities ( 3-402.1 i Parasite Destruction* Conveniently Located and Accessible ( 3-402.1^_ ( Records.Creation and Retention* I 5-203.11 Numbers and Capacities* ( 590.004(1) I Labeling of Ingredients, -_I 15-204.11 Location and Placement* 7 Conformance with Approved Procedures 15-205.11 Accessibility. Operation and Maintenance /HACCP Plans I I I Supplied with Soap and Hand Drying 13-502.11 Specialized Processing Methods* ( Devices 13-502.12 I Reduced oxygen packaging,criteria* I 16-301.11 Handwashing Cleanser,Availability_ I 18-103.!ZI Conformance with Approved Procedures" I 16-301.12 Hand Drying Provision '. llenotz.':critia0 item in the federal 1999 Pgxl Comic or 105 CMR 590.000. t Si Commonwealth of Massachusetts c City of Salem Board of Health Kimberley Driscoll 120 Washington Street,4th Floor Mayor SALEM,MA 01970 Food/Retail Establishment Permit DATE PRINTED: 01/06/2011 ESTABLISHMENT NAME: Brother's Deli File Number.BHF-2004-000018 283 Derby Street Salem MA 01970 LOCATED AT: 0283 DERBY STREET SALEM, MA 01970 Permit Type Permit No. Permit Issued Permit Expires Fee Restrictions/Notes FOOD SERVICE BHP-2011-0217 Jan 1,2011 Dec 31,2011 $420.00 ESTABLISHMENT Total Fees: $420.00 PERMIT EXPIRES IDecember3l, 2011 Board of Health 7 �Q ��l,L2f./r�U✓y' I This Permit is not transferable and must be reissued upon change of ownership or location.The permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code,beofre any revonations,improvements,or equipment changes are made, all plans for such must be submitted to and approved by the Salem Board of Health. Page 1 CITY OF SALEM, MASSACHUSETTS a BOARD or HEALTH 120 WASHINGTON STREET,4"1 FLOOR TEL. (978) 741-1800 KLNIBERLEY DRISCOLL FAx(978) 745-0343 MAYOR DcafEENBAUMOSALEM.COSI DAVID GREENBAUM,RS ACTING HEALTH AGENT 2011 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT ` (/ �® NAME OF ESTABLISHMENT ,%'i7//f"/�l S 6o✓-�I I f TEL# ��2 —7 ` / r/ �1' ff ADDRESS OF ESTABLISHMENT GAX# MAILING ADDRESS {�(if different) /�� / � /n4,�^ EMAIL- Business':hlaa 'KJt)e!,/4l44WQ?Va u4,OQ9^Neebsite: /J/H� `L ��2/.`� OWNER'S NAME /Y�,.1� TEL# t��y7�—/S/ J/��V7 ADDRESS /t/(� /�iO�%'�/ j7�/t(/tf,_ SQ1W5?. IYA ell (�r STREET ��,,QQ�� /�CITY / -rSTATE ZIP CERTIFIED FOOD MANAGER'S NAME(S) 2 9jcz/ X CERTIFICATE#(S) (Required in an establishment where potentially gh�,rdous food is prepared) /* / EMERGENCY RESPONSE PERSON ✓LU/L 9 U/fd�ll��I HOME TEL# F� / —.�/9 3/�,' `.DAYS.OFOPERATION '..3i'; -Monday-':',i Tuesday;,, :.'I"`Wednesday;;=l?`�.:Thursdayi.", i `:.l-`Fdday�-_: -*..i''i�= Saturday;°: 'i n. ''Sunday ';-`] HOURS OF OPERATION 6r r^ Please write in time of day I�4 ray o2'� (For example I1am-11Pm) B• ✓y!7/�f �91/ U- !�//! O �/� p . ./f/�/�ji 7_, TYPE OF ESTABLISHMENT ' E (check onlvl RETAIL STORE YESNO less than 1000scift =$70 1000-10,000sq.ft. =$280 more than 10,000sq.ft. =$420 -------------------------------------------------- --- ------------------------------------------------------------------------------------------------------- RESTAURANT YES NO less than 25 seats =$140 (Outdoor Stationary Food Cart$210 25-99 seats more thar199 Seats20 " -- --------------------------- -------- ---------------------------------------------------------------------- ------------------- BE /BR DEAKFAST/ YES NO $100 CHILDCARESERVICES/NURSING HOME.----------------------------------------------------------------------------------------------------------------------------- ADDITIONAL PERMITS MAKE (notjust serve) ICE CREAM, YOGURT/SOFT SERVE YES $25 TOBACCO VENDOR YES $135 ALL NON-PROFIT(such as church kitchens) YES O $25 'Please pay total with one check payable to the City of Salem. This Permit is not transferable and must be reissued upon change of ownership.The Permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code,before any renovations, improvements,or equipment changes are made,all plans for such must be submitted to and approved by the Salem Board of Health. Pursuant to MGL Chapter 62C,Section 49A,1 certify under the pains and penalties of perjury that I,to my best knowledge and belief,have filed all state tax ret all state taxes required under the law. Signature Dat Social Security or Federal Identification Number Revised ionli 1 FOODAP201 Ladm Check#&Date 7 $ 4 ,I� 0283 DERBY STREET Brother's Deli City of Salem FOOD SERVICE ESTABLISHMENT - FOOD SERVICE Inspection HACCP: ❑ Item Status Violation Critical Urgency ,Telephone: PROTECTION FROM CONTAMINATION 1741-4648 Food Contact Surfaces Cleaning and Sanitizing FAIL CntcalJ❑ RED !Owner: Comment:The dish machine only reached a temperature of 170'F in the final rinse. Repair dish machine to reach a minimum I Nidal Rajah temperature of 180°F. Dish machine can be used to wash dishes all dishes must be sanitized in the 3 bay sink. PIC. TIME/TEMPERATURE CONTROLS(Potentially Hazardous Foods) 1 Mazen Muhieddin Hot and Cold Holding FAIL Criticald❑ RED Inspector: Comment:Owner must submit a procedure to the Board of Health indicating how roasts and corned beef are cooked. This must David Greenbaum show minimum internal temperature requirements and a temperature log must be used to show that these temperatures are Date Inspected:ICorrect By: achieved. 5/10/2012 1 Violations Related to Good Retail Practices (Blue Items) Risk Level: Physical Facility FAIL Non-Critical BLUE Permit Number: Comment:The light at the dishwasher and in the dry ingredient room are not working. Repair to good working order. BHP-2012-0334 The employee restroom needs a self closing mechanism. Status: PARTIAL COMPLY �#of Critical Violations: 2 1ITime IN: Time OUT: Urgency Description(s): BLUE: All other violations cited in the 5/3/12 inspection report have been corrected. Violations Related to Good Retail Practices(Critical owner to notify the Board of Health upon completion of all outstanding violations. violations must be corrected immediately or within 10 days)(Non-critical violations must be corrected immediately or within 90 days) City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741-1800 GeoTMS®2012 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. May 11,2012 ) Page 1 oft ' Item Status Violation Critical Urgency RED: j Violations Related to Foodborne Illness Interventions' and Risk Factors (Require immediate corrective action) I City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741-1800 GeoTMS®2012 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. May 11,2012 ) Page 2 of 0283 DERBY STREET Brothers Deli City of Salem FOOD SERVICE ESTABLISHMENT - FOOD SERVICE Inspection HACCP: ❑ Item Status Violation Critical Urgency Telephone: PROTECTION FROM CONTAMINATION 741-4648 Separat on/S ation1 Protection FAIL Critical 0 RED Owner: c ment:The walk in freezer has potentially hazardous food stored above and on ready to eat food. Separate PHF from RTE to Nidal Rajah ``.prevent cross contamination. PIC: , y71e walk in refrigerator has PHF stored above RTE food. Store PHF below RTE food to prevent cross contamination. Mazen Muhieddin V 11 i Inspector: T3o.Pepsi unit at the end of the service line has PHF stored above RTE food. Store PHF below RTE food to prevent cross ontami "on. David Greenbaum Date Inspected:Correct By: 3 door unit under the desert reach ins has PHF stored with and above RTE food. Store PHF separate and below RTE food to prevent oss contamination. 5/3/2012 Food Contact rfaces Cleaning and Sanitizing FAIL Critical RED Risk Level: c ment:Sanitizing solution throughout the establishment found too weak. Sanitizing solution of proper concentration must be adily liable at all work stations at all times. Permit Number: BHP-2012-0334 a cutting boards in the kitchen are stained and scored. Resurface or replace all cutting boards. Status: The dish machine only reached a temperature of 170"F in the final rinse. Repair dish machine to reach a minimum temperature of VIOLATION 180"F. Dish machine can be used to wash dishes all dishes must be sanitized in the 3 bay sink. #of Critical Violations: ins' a panel of the ice machine has an accumulation of grime. Thoroughly clean and sanitize the ice machine. sme IN: Time OUT: T ice scoop stored on a dirty tray. Clean and sanitize the ice scoop and store in the ice handle side up or in a clean,sanitized ontainer tabled"Ice Scoop Only" Urgency Description(s): PROTECTION FROM CHEMICALS BLUE: Towc Chemira FAIL Critical ❑ RED Violations Related to Good C ment:Cleaning chemicals found hanging on a rack above produce items. Store chemicals in an appropriate storage area Retail Practices(Critical way from food to prevent cross contamination. violations must be corrected immediately or within 10 days)(Non-critical violations must be corrected immediately or within 90 days) I City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741-1800 GeoTMS®2012 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. May 03,2012 ) Page I of 4 t Item Status Violation Critical Urgency RED: TIMElrEMPERATURE CONTROLS(Potentially Hazardous Foods) Violations Related to Cooling FAIL Critical ❑ RED Foodborne Illness Interventions omment:Cooked chicken and chicken dishes found cooling at room temperature. Cool PHF in a refrigeration unit to allow proper and Risk Factors(Require cooling. immediate Corrective action) Hot and Cold Holding FAIL Critical d❑ RED Comment:The corned beef had a temperature of 1177 Nd roast beef had a temperature of 125°F. Hot PHF must be held at a temperature of 140°F or higher. Owner must submit a procedure to the Board of Health indicating how roasts and corned beef are cooked. This must show " minimum internal temperature requirements and a temperature log must be used to show that these temperatures are achieved. Lrne small omellet reach in had a temperature of 48°F. Repair unit to maintain a temperature of 41°F or below. t ThQ�Pepsi reach in with the Jello had a temperature of 47°F. Repair the unit to maintain a temperature of 41°F or below. City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741-1800 GeoTMS®2012 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. May 03,2012 ) Page 2 of i Item Status Violation Critical Urgency Violations Related to Good Retail Practices (Blue Items) Food and Food Protection FAIL Critical BLUE ment:Carrots found stored on the floor under the dish washing area. Store and prepare carrots in an appropriate area to reve cross contamination. Carrots discarded at the time of inspection. re i ood stored directly on the floor of the walk in freezer. Store all food at least 6"off the floor. Vere is uficovered food in the walk in freezer. all food in storage must be covered. Lere.is uncovered food in the walk in. All food in storage must be covered. ere Wdry ingredients in cardboard barrels. Store dry ingredients in containers that are non-porous and easily cleanable. el all dry ingredient bins. er is uncovered food in the fish reach in. All food in storage must be covered. afood items stored in contact with ice.Store seafood so that ice is not touching them to prevent cross contamination. Equipment and Utensils FAIL Non-Critical BLUE �ent:The Continental reach in in the kitchen needs a thorough cleaning. as unit has a broken door gasket. Repair or replace the door gasket. e BI01 tt oven needs a thorough cleaning. ,T shelf at the prep table has an accumulation of food debris. Thoroughly clean this area. walk in freezer has an accumulation of frost. Repair the freezer to be free of frost build up. T . T walk in freezer needs a thorough cleaning and organizing. T"walk in Flooring needs a thorough cleaning,including under all racks and shelves. T an in the employee restroom has an accumulation of dust. Thoroughly clean the fan. Mops laying in the mop sink. Clean mops and store hung upside down to air dry. ere' a refrigerator unit in the service line that is not working. Repair to good working order or remove. for salad reach in needs a thorough cleaning. e 3 door reach in under the deserts has an accumulation of water in the bottom. Repair unit to be free of leaks. Physical Facility FAIL Non-Critical BLUE Comment:The light at the dish washer and in the dry ingredient room are not working. Repair to good working order. Theemployee restroom needs a self closing mechanism. L"T"Tp€wall near the mop sink is damaged and missing some tiles. Repair the wall and replace all missing tiles. City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741-1800 GeoTMS@ 2012 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. May 03,2012 ) Page 3 of 4 1 Item Status Violation Critical Urgency Re-inspection in one week, all violations to be corrected. City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741-1800 GeoTMS®2012 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. May 03,2012 ) Page 4 of HVAC Mechanical Services, Inc. SERVICE ORDER HVAC Specialists Phone:(857)829-M5 P.O. Box 390562-Cambridge,MA 02139 INVOICE BILLTO P, ?N3S MAK ISM BE C.O.D. ; CHARGE 0 NO CHARGE .......... E IMu( uPKE t+rr161 V�' (MODEL MODEL ................ � 194,kl.NUMBER SEIM.NUMBER NAME STREET DOE Ir, ENVIRONMENTAL CHECK LIST WORK PERFORMED CITY Pr-IWD WORK PERFORMED Ory. TYPEDISPOSMON CONDENSIFIG UNIT COND'SATE DISMISS :: RECOVEREDUNELED CUMNED PHONE C�BEFORE A.M. MANDAMN P.M. Z AS=LED CUAMEM WIL REPATED . MON GIRD TECHNICIAN AUTRORCEED BY RE�IMED CHECKED CLEARED CHARGE ANN ORLON RETLANEED REM NCOIL WORK TO BE PERFORMED =NCOIL RMIN OMAN DISPpSAL REPAIRED LEAK IN COPPER FURN.OR PAN COIL CHANGED OUTMENWED CHECKED ITOMAL $ aREP' REPLACED BUT MOTOR ADJUSTED IGUT QTY. MATERIALS&SERVICES UNIT PRICE AMOUNT DESCRIPTION OF WORK PERFORMED INGED REPLACED MOTOR PULLEY REPLICED �USTED REFRIGERANT R. Las: "',9 BELT PULLEY CLISMED ADUUMD ELT SUCA'SA I Q REPLAC�ED WWIAINGSCED CONTR S RRMPLSTMRT OILED M(n0R ELAY ....... REPI-SOAr MPRCrIOA OILED SWINGS REPLACED RUN HW"CH. CLSONED OR REPLACED =LGOWN70K NEXT EXON A�MRED CLSONLEIDOR 7�1 WIRING Au'I REPLACED NSE REPLA ED THEM, R SPLICED REPAIRED 5�1 COMPRESSOR VXJV EVAPORATOR COIL REPLACED VAL" PDRILACED CLEANED WVALVE BURNERS MMUSTED DUCT MP VAVVE 4 WTUSE REFORED FILTERS X X I CLEARED 4 UPTUBE ADJUSTED REMIRED > FILTERS X X I COILLEAK THERMOSTAT REFORM BELTS COPPER DORN. REPLACED RECOMMENDATIONS CILWBO COIL ADJUsrrc, TOTAL MATERIALS ELECT.HTR. CLGTOWER HRS. LABOR I RATE AMOUNT REPLACED UNK CLEANED ��l42EPI-ACED KLIX — RIERAIREDWIRE PUMP($) Y! REPLACED CONT GREASED REFORM BE FILTERS CLISNED ::AUH-ADED MMONOrIGIRSIDE TOTAL LABOR LIMITED WARRANTY: All materials, parts and equipment are warranted by the ( TOTAL SUMMARY TERMS manufacturers or suppliers written warranty Net 30 I only.All labor Performed by the above named I TOTAL company is warranted for 30 days or as MATERIALS Otherwise indicated in wrifing.The above namedI TOTAL _ company makes no other warranties, express LABOR 11-22- or implied and its agents or technicians are implied, to make any such warranth �W�W BtFriem Is matte �t is mage aUtho as agNNK.wwr Dan m,,KMG ISH,e4uo��at sellersF,S,M,A, M,,V mwDog f� on behalf of above named company. "'a Stott W ww. TRAVEL REGULAR = WARRANTY CHARGE SERVICE CONTRACT TAX WaIDMERSIGeWPE n i DIME '14W TOTAL 9 Rawson Road Hanover, MA0233-0 686.46c"31 I �.,, z. $;uFv Vin;%iric;v Ucii $+.:f:.a .�s4G'L L"' ovIG°+L• �!N.O tinCrraciZ:d uc!_) aiL=iei Talke'3' 7/I J/>; 283 DERBY 5rREET Genwr[;6v� J,MEM, MA 11 S:I Phone e7444446Q Mew 17 „'..,A' YAGE�iOC. t.-v ,•..nf:i�:+�.,a '� - .°§VV)t1'Iltla]i<-�llfJt3 l•_LFV d!1dVefkl�'u'_'yS�GVL Ut:-.11SSILf rKr,a' o1r94a-UIla3"�ieiF'InE.i:i'.i�ti SE T :ii:'_E_ SA-£ii a , :AE+` 16064 HOOD 8 700 S650.00 I ' ns�r n�•:En STR:'v '---Il'�1'f-.,i.:'i'�'''�.?.:?.iC.'T� i I i 11'00 ?-t'DOD 3-FA'iS.fL,L RELATED C.CESSMLE k 7Q!} 1 I! I I Last SeTvice 11 r!`(••- ^y - t '�i r'1 i � 7. � �; /,/%j� ! n -• - � (: , :_ JI j � 'jai• ,. -- - '�yi � 1 �� _{ ! i,'/1 Lr' � lr .l y' !/:• fl I � ¢��1 li� r.�-I:I /� { i r � ,/` ` l+ C: I ,>`k '. G'.. . •, l_d, ,{ v L, 7 J ( � x=-11 _/ ..,� /�:l� �i ;.;;�11,.': '.y.�, l•1' f IGS � - {' - l,' � � li t I I t f I � 1 ' 1 I ictal $6b,*l,CG # ihe,euy Gf:`=:i.3'inn imbovt Pei,un-fled se viot2 and C:sicia"t",'•us a3 bong satl6iaotu aild a:;k.nowtecjgge slat "i(.!(:Ip{Iaent has Ilett' haft in S�G6x7 E�tl��ii{C:f� �.�iiSic:aS?ter S,Grlaiur, .---.._!.✓.'•.'L�� "] ___ Pilded Name v�$i1 rv;Gi 'i'GyalerA Miiili JSt VOL S031 Small Business Services Program/MA Questions?Call us at 1-800-332-3333 Energy Savings Plan nati onal E SUMMARY Application Number. 1723977 Date: 4/12/2012 Customer Name: HAZEL DELI LLC App# 1723977 Account# 13097-77018 Save money on your electric & gas bill by using energy more efficiently. And, through the power of action, you reduce greenhouse gases (CO2) annually by 12,980 pounds. Eshmated Annual`Savmgs(Energy) --,'I Estimated Annual S'-aving$(Apllaks}'+ ,.) Electric(kWh) 11,799.98 Electric $1,312.16 Gas I $0.00 Gas(Therms) 0.00 Total $1,312.16 You pay only 30% of the installation cost - National Grid pays the rest. Estimated Tob' prevailin Wr a Estimated Nohooal Gnd Estimated tustoiner - Cost g g PL bu Lift Char`e g , Contrition @ 70°Io ConntnbutiQn a 4W Electric I $5,134.36 $1,540.31 $3,594.05 Gas $0.00 I $0.00 Paylzaa, ertodlm Mouths 14 No upfront cost to you - finance your contribution on your monthly electric bill. Choose from 3 convenient payment options. Luhtp$um Jleyment I 12 Monthly Payments 24 Moitbly Payments- 1 : ( ldHitlofal]5%°Distbunt) (Interest Free) (IriterestFree) Electric $1,309.26 $128.36 $64.18 Gas $0.00 $0.00 $0.00 Page 1 S031 Small Business Services Program/MA _ Questions?Call us at 1-800-332-3333 Energy Savings,Plan � , DETAIL Date: 4/12/2012 Application Number: 1723977 Customer Name: HAZEL DELI LLC - Application Number: 1723977 DBA Name: BROTHERS DELI - - Account Number: 13097-77018 Address: 283 DERBY STREET - Telephone: 978-741-4648 City: SALEM Contact Name: MAZ MOUHIDIN State and Zip : MA 01970 - Auditor Name: BRIAN FENOCHIETTI Facility Square 5000 Audit Date: 03/23/2012 Footage: ECMSiter cation- - EGM e ECMDescrgifron. - I4tTyp -Quan{ity- '' V4HSavin Id L Cude _ Sayings,- g .. 103009 LED Exit-0.93 W-Dbl Compact Fluorescent New 4 Entry&Open Area 127 Face/Red Fixture Hardwired Interior Kit 2 0.06 508.08 103009 Open Sitting Area 498 Fluor-3L4 T8/LP 28W Fluorescent Fixture Installation 21 0.95 5,500.72 5 Kit 103009 Fluorescent Fixture Installation 6 Open Sitting Area 248 Fluor-3L2 T8/LP Kit 1 0.03 184.70 10 Behind Counter Area 248 Fluor-3LKit 2 T8/LP Fluorescent Fixture Installation 7 7 0.22 1,292.93 7 103009 Fluorescent Fixture Installation 8 Hall To Restrooms 248 Fluor-3L2 T8/LP Kit 2 0.06 369.41 103009 Fluorescent Fixture Installation 9 Restrooms 248 Fluor-3L2 T8/LP 'Kit - 2 0.06 320.00 103010 Fluorescent Relamp/Reballast Ladies Room 496 Fluor- 1L4 T8/LP 28W Kit (1-2-3lamp"s)' 1 0.02 90.00 0 103010 Fluorescent Fixture Installation 1 Hall To Restrooms 498 Fluor-3L4 T8/LP 28W Kit I 0.05 271.28 103010 Fluorescent Eight Foot Fixture 2 Kitchen 451 Fluor=414 8FT T8/LP Kit 8 0.48 - 2,770.56 103010Fluorescent Eight Foot Fixture 3 Storage Room 499 Fluor-414 T8/LP 28W Kit 1 0.07 370.00 Page 1 S031 Small Business Services Progmm/MA Questions?Call us at 1-800-332-3333 Energy Savings Plan DETAIL n a o n a r* 1 Cl Date: 4/12/2012 Application Number: 1723977 ECM 'SfteLq-afl ECM ECMDescr 9-n C�, 0- � KatTy KW ''Code; 103010 Office 497 Fluor-214 T8/LP 28W Fluorescent Fixture Installation 4 Kit 1 0.03 122.30 Total 2.049.98 11 Page 2 View Customer Usage Page 1 of 2 natianaigr d Demand Side Management • Home • DSM Delivery • Program Management • Evaluation • Tools • Search View Customer Usage Premise No:.130977700 -HAZEL DELI LLC Account Header I History I Usage I Applications I Customer Notes Electric Usage Data Average monthly kW(last 12 active months) 79.1 Average monthly kWh(last 12 active months) 18715 Bill Month and Latest Meter Read No Of Billing I( Conservation Charge Year Date Days Actual kWh Actual kW Contribution - Feb 2012 Jan 30,2012 31 15840 70.1 $123.55 Jan 2012 Dec 30,2011 30 13361 78.0 $104.21 Dec 2011 Nov 30,2011 33 17428 75.3 $135.94 i Nov 2011 Oct 28,2011 30 20284 86.3 $158.22 Oct 2011 Sep 28,2011 27 19848 79.7 $154.81 Sep 2011 Sep 01,2011 34 24925 88.6 $194.41 Aug 2011 Jul 29,2011 30 25282 89.3 $197.20 Jul 2011 Jun 29,2011 33 24048 89.0 $187.57 i Jun 2011 May 27,2011 28 16567 75.2 $127.17 i May 2011 Apr 29,2011 29 - 16810 70.8 $72.79 i Apr 2011 Mar 31,2011 31 16487 71.5 $71.39 Mar 2011 Feb 28,2011 30 17475 75.0 $75.67 httros://ngapps.nationalgridus.com/dsmprod/DsmWeb/do/billingaccount/sbs/usage/View?isCdiSource=true&... 3/23/2012 6(� W 3 5031 Small Business Services Program/MA Terms & Conditions f 1ational ri Date: 4/12/2012 Customer Name: HAZEL DELI LLC Vendor: AECOM USA INC Address: 283 Derby Street Audit Date: 03/23/2012 Town,State,and Zip Code: Salem,MA 01970 Auditor BRIAN FENOCHIETTI Account Number: 13097-77018 Application No: 1723977 )Nlbllo$7 National Grid("Company')is offering an energy efficiency program("Program")to certain commercial and industrial customers ("Customer")that have an average monthly demand less than or equal to 300 kW. Under the Program,the Company is arranging the installation of certain energy efficiency electric and natural gas measures("Measures")at the facilities of eligible customers.Customer agrees to have a contractor hired by the Company for the Program install the Measures and pay a portion of the installation cost as described in Section Six listed below.The following are terms and conditions that govern the Program and the installation of the Measures. 1. Measures to be Installed An independent contractor("Installation Contractor")hired by the Company will install at Customer's property.the!conservation' Measures described in Section Six below.The InstallationContractor shall permanehtly disable all lamps replaced pursuant to this Agreement(make them unfit for reuse).The disposal of any lighting equipment which is removed(with exception of fluorescent ballasts and lamps)will be the responsibility of the participating Customer.The disposal of any fluorescent ballasts and lamps will be the responsibility of'ah outside contractor hired by the Company.' 2. Installation,Date - The Installation Contractor will attempt to install the Measures within thirty(30)days of Customer signing this Agreement. 3. Warranty and Disclaimers (a)The Company will provide a one-time equipment replacement free of charge for any equipment that fails to operate eccordirl'g to manufacturer's specifications for a period of two years after the date of the original installation.Lamps will be warranted for one year. (b)Customer may have other warranty rights that may have been provided by the manufacturer of the devices installed under this Agreement.Customer,however,may exercise such rights only against•the rhanufactutor,and not against the Company or its affiliates. (c)OTHER THAN THE REPLACEMENT WARRANTY STATED IN SUBPARAGRAPH 3(a)ABOVE, NEITHER THE COMPANY NOR ITS AFFILIATES MAKE ANY WARRANTIES OF ANY KIND, INCLUDING WARRANTIES' - OF MERCHANTABILITY AND FITNESS FOR A PARTICULAR PURPOSE (d)The Company does not guarantee that the Measures will, in fact,save any level of energy or result in lowering of the customer's utility bill. e)Neither'the Company nor its affiliates shall be liable to Customer for consequential or incidental damages ' arising out of the Program,whether in contract,tort(including negligence)or any other theory of'recovery. 4. Access to Property ; .. . ., .. (a)Customer will provide reasonable access to Customer's property during normal business hours for Installation Contractor to perform the installation work. (b)In addition,the Customer will allow the Company to make a reasonable number of follow-up visits during the twenty-four months following installation,with advance notice and at a time convenient to the customer:The; purpose of the follow-up visits is to provide the Company with an opportunity to review the operation of the Measures. During the follow-up visits,the Company may make suggestions to the Customer regarding operation of the Measures, but the Customer is under no obligation to follow any such suggestions. If the Customer does follow any instructions,the Company will not be liable to the Customer in tort(including negligence)for the Customer's reliance on the suggestions. 5. Discretion of Installation Contractor When undertaking the installation,the Installation Contractor or the Company(at their sole discretion)may choose not to make the installations specified below for reasons related to safety or discovery of unforeseen conditions. Initial Here: Page 1 S031 Small Business Services Program/MA Terms & Conditions national n Date: 4/12/2012 Customer Name: HAZEL DELI LLC Application No: 1723977 Address: 283 Derby Street Town, State,and Zip Code: Salem, MA 01970 6. Equipment and Customer Contribution (a)The Installation Contractor will install the equipment listed on the attached Small Business Energy Savings Plan, incorporated herein by reference.The estimated cost of the installation including the estimated cost of the Customer's contribution is also itemized on this report.The Customer may choose to pay its cost contribution over twelve or twenty-four months or may choose to pay it In one lump sum. If the Customer chooses to pay it in one lump sum,the Company shall discount the Customer's contribution by 15%. The Customer opts to pay Its cost contribution by(check one): Lump sum payment of $ 1,309.26(Elect) $ 0(Gas) includes Customer discount of 15% �t 12 monthly payments of $ 128.36(Elect) $ 0(Gas) per month // Iv 24 monthly payments of $64.18(Elect) $ 0(Gas) per month (b) The Customer shall pay no more than the estimated cost shown on the report. If the actual cost of the installation is less than the estimated cost or if the Installation Contractor chooses not to make an installation in accordance with Section 5,the Installation Contractor shall adjust the customer's contribution and advise the Customer. 7. Authorized Signature of Customer By signing below,the Customer agrees to the applicability of the terms and conditions described above. CUSTOMER ADDRESS WHERE MEASURES WILL BE INSTALLED: HAZEL DELI LLC Signature: 283 Derby Street Salem,MA 01970 Name(Print):�� Title: DatL. Incorporated Not IncorporatedLl If Not Incorporated,Federal ID# Page 2 Commonwealth of Massachusetts City of Salem Board of Health 120 Washington Street,4th Floor Kimberley Driscoll SALEM,MA 01970 Mayor Food/Retail Establishment Permit DATE PRINTED: 01/25/2012 ESTABLISHMENT NAME: Brother's Deli File Number:BHF-2004-000018 283 Derby Street Salem MA 01970 LOCATED AT: 0283 DERBY STREET ' SALEM, MA 01970 Permit Type Permit No. Permit Issued Permit Expires Fee Restrictions!Notes FOOD SERVICE BHP-2012-0334 Jan 9,2012 Dec 31,2012 $420.00 ESTABLISHMENT Total Fees: $420.00 PERMIT EXPIRES December 31, 2012 Board of Health This Permit is not transferable and must be reissued upon change of ownership or location.The permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code,beofre any revonations,improvements,or equipment changes are made, all plans for such must be submitted to and approved by the Salem Board of Health. Page 1 » CITY OF SALEM, MASSACI IUSE'I"I'S 4 ) �`. BOARD OF FIF\LTH �'"-' 120 WASHINGTON)\;iTREi'-T,-}..`F(.t tt 1lZ 'D?'1- (978) 741-1800 KIIvffiEJUI.Y DRISC011, FAX (978) 745-0343 MAYOR iramdrn tusalcrn.com LARKYRAMIAN,16,/10A IS,CI It),(;P-FS Fl F,.11ali A(] wr 201— APPLICATiO,,q FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT NAME OF ESTABLISHMENT_jr=�r�b��r" `� 1. _TEL" V a -7 1 —y6'Y�' ADDRESS OF ESTABLISHMENT oCO ! �� FAX# I 7� 71 ( E l0 MAILING ADDRESS(if different) Q e EMAIL-Business':k� y�W ebsite:�J t �r�xY! l • can OWNER'S NAME V/ TEL# v/+n — J r q-,3166 66 ADDRESS-aO(q <1;6�'L UW STREET /CITY J STATE ZIP CERTIFIED FOOD MANAGER'S NAME(S) �41 � CERTIFiCATE#(S) (Required in an establishment where potentially hazardous food food is prepared)f Cl } /° EMERGENCY RESPONSE PERSON G: aI— I"L&4AAki HOME TEL# (7 / / —3l 07 31.60 I DAYS OF OPERATION;= I. Monday Tuesday* Wednesday -Thursday 1, °-Friday: Saturday Sunday I HOURS OF OPERATION t(j Please torte in time of day. (For example 11 am-11 pm) 7. i' TYPE OF ESTABLISHMENT ( FEE (check oniv) RETAIL STORE YESNO less than 1000sq.ft. =$70 1000-10,000sq.ft. =$280 more than 10,000sq.ft. =$420 - - - ---------- - - - - - - - - ---- ------ ------ RESTAURANT YES NO Iess than 25 seats =$140 (Outdoor Stationary Food Cart$21 25-99 seats more than 99 seats 66420 - - - - - --------- ------- BED/BREAKFAST/ YES O $100 HI CLDCARE SERVICES(NURSING H4ME.-•-------- ADDITIONAL PERMITS MAKE(not just serve) ICE CREAM, YOGURT/SOFT SERVE YES $25 TOBACCO VENDOR YES $135 ALL NON-PROFIT(such as church kitchens) YES *NO $25 `Please pay total with one check payable to the City of Salem. This Permit is not transferable and must be reissued upon change of ownership.The Permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code,before any renovations,improvements,or equipment changes are made,all plans for such must be submitted to and approved by the Salem Board of Health. Pursuant to MGL Chapter 62C,Section 49A,I certify an71-411 the pains and penalties of periury that 1,to my best knowledge and belief,have filed all state ta� return late taxes required under the law. Signature dibft�a-f te,%r1 1 7— Social Security or Federal identification Number Updated 523/11 FOODAP201 Ladm Check#&Date_�/ D rt W/ $ r CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH • KIMBERLEY DRISCOLL 120 WASHINGTON STREET,4T"FLOOR MAYOR TEL.(978)741-1800 FAx(978)745-0343 LARRY RAMDM,RSIREHS,CHO,CP-FS LRAMDM(@SALEM.COM HEALTH AGENT COMPLAINT INTAKE FORM Date: SS Z-I 2 Time: 2 , a" Pm Received By: 7 C, Complaint Number: 0230 Complainant �vctlt,�) W1Lt�NiLowS�l Address: Phone: i'7 Q 3» • y 1Z0 A-1V- d31' ►� O ��StAn\v— )Z. S1�L 14-r+ to fL.sI 0 pi' F — rhA (W� ratio t�TAVN)_ Faa" VbAS rj Investigated By: 7j Date: 5- 3 -I.1 Property Owner/Occupant Name Telephone#: ,—o nd �o-�Tri:�rr��•�-��rts� �r I �b�r S��s. Ir'+ �vN`t�, ��`rP�� Do+�;'e.� 5-3- �1 • Massachusetts Department of Public Health Salem Board of Health 120 Washington Street,4 1 Floor Division of Food and Drugs Salem, MA 01970-3523 FOOD ESTABLISHMENT INSPECTION REPORT Tel. (978) 741-1800 IFax(978) 745-0343 r Name Date Ty e of OosrationTyke of Insoection /1 ��c 1J PYA (-A- U VZ I Food Service 07ROutine Addresscy� C� Risk Retail 40 Re-inspection nn� �L�yLr r+ ' r /fix Level El Residential Kitchen Previous Inspection Telephone ❑ � _ � Mobile Date: Owner HACCP YM ❑ Temporary ❑ Pre-operation ( p ❑ Caterer ❑Suspect Illness Person In Charge(PIC) CIM Time El Bed& Breakfast El General Complaint Ol / Ir�`Q ❑ HACCP Inspector � / � A /� D �-� ' Permit No. I�AA&. r o-rf/r lf� Out: ❑Other Each violation checked requires an exp ahation on the narrative page(s) and a citation of specific provision(s)violated. Non-compliance with: Violations Related to Foodborne Illness Interventions and Risk Factors Antl-Chokin Tobacco Violations marked may pose an imminent health hazard and require immediate corrective 590.009(E) � 590.009(F)� action as determined by the Board of Health. 11�T�I" 1r��Ivf`�1 L FOOD PROTECTION MANAGEMENT " 41 ( /;L�J 12. Prevention of Contamm�tion Hands G�C I� 1. PIC Assigned/Knowledgeable/Duties V!` _ ❑ 13. Handwash Facilities EMPLOYEE HEALTH , ' '- "'""------ � MPROTECTION FROM CHEMICALS " ❑ 2. Reporting of Diseases by Food Employee and PIC ❑ 14.Approved Food or Color Additives ❑ 3. Personnel with Infections Restricted/Excluded ❑ 15.Toxic Chemicals [El 4. FROM APPROVED-SOURCE . ,..- I TIMEITEMPERATURE CONTROLS(Potentially Hazardous Food' ❑ 4. Food and Water from Approved Source ❑ 5. Receiving/Condition ❑ 16. Cooking Temperatures ❑ 6. Tags/Records/Accuracy of Ingredient Statements ❑ 17. Reheating ❑ 7. Conformance with Approved Procedures/HACCP Plans ❑ 18.Cooling PROTECTION FROM CONTAMINATION ., ) ❑ 19. Hot and Cold Holding [1 8.Separation/Segregation/Protection ❑20.Time As a Public Health Control ❑ 9. Food Contact Surfaces Cleaning and Sanitizing [REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS-(HSP)I E]21. Food and Food Preparation for HSP ❑ 10. Proper Adequate Handwashing ❑ 11. Good Hygienic Practices t CONSUMER ADVISORY [122. Posting of Consumer Advisories Violations Related to Good Retail Practices Number of Violated Provisions Related Critical (C) violations marked must be corrected To Foodborne Illnesses Interventions immediately or within 10 days as determined by the Board and Risk Factors(Items 1-22): of Health. Non-critical (N)violations must be corrected Official Order for Correction: Based on an inspection immediately or within 90 days as determined by the Board today, the items checked indicate violations of 105 CMR of Health. 590.000/federal Food Code. This report, when signed below Z_ x 003)Management and Personnel (FC-2)(590 23. . by a Board of Health member or its agent constitutes an IC order of the Board of Health. Failure to correct violations 24. Food and Food Protection (Fc-3)(sso.00a) cited in this report may result in suspension or revocation of �L 25. Equipment and Utensils (Fc-4)(590.005) the food establishment permit and cessation of food 26. Water, Plumbing and Waste (FC-5)(590.006) establishment operations. If aggrieved by this order, you �`- 27. Physical Facility (FC-6)(590.007) have a right to a hearing. Your request must be in writing 28. Poisonous or Toxic Materials (FC-7)(590.008) and submitted to the Board of Health at the above address 29. Special Requirements (590.009) within 10 days of receipt of this order. 30. Other p /// p /J }(�I/ � t[D/A[)TE//O��F RE-INSPECTION: 5 sso��omb-ia � Ce,,h �{ I r IZ l - Y '� �J l/ 1 1 U (� l I_ �(1� C)3 l Inspector's Sigfa ermt: YJ PIC's Signatu e: Print: ( �'� Page of-Pages n i U gal o- res er,Q -` z �--- Violations Related to Foodborne Illness Interventions and Risk Factors(Hems 1-22) PROTECTION FROM CONTAMINATION FOOD PROTECTION MANAGEMENT 18 Cross-contamination 3-302.1](A)(]) I Raw Animal Foods Separated from I 1 590.003(A) Assignment of Responsibility* I Cooked and RTE Fads* 590.003(B) Demonstration of Knowledge* Contamination from Raw Ingredients 2-103.1 I Person in charge-duties I 13-302.11(A)(2) Raw Animal Foods Separated fromEach EMPLO"EE HEALTH Other* I Contamination from the Environment 2 590.003(C) Responsibility of the person to charge to require reporting by food employees and 13-30' 1.5 Food Protection* ) � 3-30.. 15 Washing Fruits and Vegetablesapplicants* I 590.003(F) Responsibility OCA Fool Employee Or An 13-304.1 l Food Contact with Equipment and Utensils Applicant To Report To The Person In I Contamination from the Consumer Charge* 590.003(6) Reporting by Person in Charge* 3-306.14(A)(B) Returned Food and Reservice of Food* Disposition of Adulterated or Contaminated 3 590.003(D) Exclusions and Restrictions* I Food 590.003(E) Removal of Exclusions and Restrictions 3-701.1 I Discarding or Reconditioning Unsafe I FOOD FROM APPROVED SOURCE Food* l 4 Food and Water From Regulated Sources 19 I Food Contact Surfaces 590.004(A-B) Compliance with Food Law* ( ( 4-501.111 Manual Warewashing-Hot Water 13-201.12 Food in a Hermetically Sealed Container* ( Sanitization Temperatures* ( 3-201.13 Fluid Milk and Milk Products* 4-501.112 I Mechanical Warewashing-Hot Water I3-202.j3 Shell Eggs* I Sanitization Temperatures* 3-2(12.14 I Eggs and Milk Products.Pasteurized* I ( 4-501.114 Chemical Sanitization-temp.,pH, 13-202.16 Ice Made From Potable Drinking Water" concentration and hardness.1k J 5-101.11 Drinking Water from an Approved System* I 14-601.1 I(A) Equipment Food Contact Surfaces and I 590.006(A) Bottled Drinking Water* I Utensils Clean* 590.006(B) Water Meets Standards in 310 CMR 22.0* I 14-602'11 Cleaning Frequency of Equipment Food- SheiNrsh and Fish From an Approved Source I Contact cy of fes and Utensils" . 1 4-702.1 I I Frequency of Sanitization of Utensils and 3-201.14 Fish and Recreationally Caught Molluscan Fad Contact Surfaces of Equipment* Shellfish" 3-201.15 Molluscan Shellfish from NSSP Issted 14-703.11 Methods of Sanitization-Hot Water and I Chemical* Sources* I to I Proper,Adequate Handwashing Came and Wild Mushrooms Approved by Regulatory Authorty 12-301.11 Clean Condition-Hands and Arms* 3-202.18 Shellstock Identification Present* I 2-301.12 Cleaning Procedure* 590.004(C) I Wild Mushrooms* I ( 2-301.13 When to Wash* 3-201.17 I Game Animals* I 11 t I I Good Hygienic Practices 5 I Receiving(Conditlon I ( 2401.11 I Eating,Drinking or Using Tobacco* 1 ' -202.1 t I PHFs Received at Proper Temperatures`" I -401.12 Discharges From the Eyes,Nose and ' ) 3-202.15 I Package integrity* I I Mouth* 3-101.11 I Food We and Unadulterated * 13-301.12 ( Preventing Contamination When Tasting* I 16 I Tags/Records:Shellstock ( 112 I Prevention of Contamination from Hands 3-202.18 Shellstock Identification* 1590.004(F) Preventing Contamination from 13-203.12 I Shellstock Identification Maintained* I Employees* TagstRecords:'Fish Products I 113 I Handwash Facilities 13402.11 I Parasite Destruction* I I Conveniently Located and Accessible 3-402.12 Records,Creation and Retention* I 15-203.11 I Numbers and Capacities* 590.004(7) Labeling of Ingredients' 15-204.11 I Location and Placement* I 15-205.11 I Accessibility.Operation and Maintenance ? Conformance with Approved Procedures I Y /HACCP Plans I Supplied with Soap and Hand Drying 3-502.11 Specialized Processing Methods* Devices 3-502.12 Reduced oxygen packaging,criteria* I 16-301.11 Handwashing Cleanser,Availability 8-103.12 Conformance with Approved Procedures* I 16-301.12 Hand Drying Provision *Denotes critical nem in the federal 19991'(M Cate or I(h CMR 590.000. W W Q). S e-r v ice a v lir. G Ci YN,-\ , �c�� zS/ c�2 r�v� v-boc ce �£ to •r� CITY OF SALEM ^\ BOARD OF HEALTH Establishment Name: ` G OAy/�` S✓_ _ Date: - 3-- i L Page: of a Item Code C-Critical Item ��i DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date No. Reference R-Red Item - --r�M� Verified e, PIEASE PRINT CLEARLY � _ �QS�P.Q �f�Yl 1Ubygo- kopU-11. v ) I01 _1AA _ I Cil.' Lrto ��o° - L.or�m� ot ( orw, . — /n i A.-61 �� 2rilllt 0[� t�rc�ueeQ 9L- . l t,l,_ mr - rc�6p -1 Aa/YYl Awi 4wr Yyr 6 aviA - SIAr�JA� _ �P a -,��Jr �� CYC FLAP ad �_ Discussion With Person in Charge: Corrective Act"equired1�2( IY Yes I have read this report, have had the opportunity to ask questions and agree to correct all 1K Voluntary Compliance ❑ Employee Restriction/ violations before the next inspection, to obse all condition as described, and to Exclusion P e-inspection Scheduled ❑ Emergency Suspension comply with all mandates of the Mass/Feder, 1 ood ode. I derst d that noncompliance may result in daily fines of a ty-fi a doll or su ens' revoc 'on of Embargo ❑ Emergency Closure your food permit. ❑ Voluntary Disposal ❑ Other: { 3-501,144C) PHFs Received at Temperatures Violaflons Related fo Foodborne Illness Interventions and Risk According to Law Cooled to Factors(Hems 1-22) (Cont.) 41017145017 Within 4 Hours. PROTECTION FROM CHEMICALS 3-501.15 Cooling Methods for PHFs 14 Food or Color Additives 19 PHF Hot and Cold Holding 3-501.16(B) Cold PUFs Maintained at or belay i 3-202.12 Additives* 590.004(F) 410f45'F* 3-302.14 Protection from UnapprovedAdditives" 3-501.16{A} Hot PHFs Maintained at or above Poisonous or Toxic Substances � 140T. * 7-101,11 Identifying Information-Original 3-501.16(A) Roasts Held at or above 130'F. Containers* 7-102.11 Common Name-Working Containers* 1 0 20 Time as a Public Health Control 7-201.11 Separation-Storage* � 3-501. Tante as a Public Health Control* , 7-202.11 .Restriction-Presence and Use* ` 590•C04(H} VarianceRequireme j 7-:02.12 Conditions of Use* REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-203.11 'Toxic Containers-Prohibitions* 4 POPULATIONS(HSP) 7-204.11 Sanitize".Criteria-Chemicals* r 21 3-801.1)(A) Unpasteurized Pre-packaged Juices and 7-204.1., Chemicals .Cashing Produce,Criteria* Beverages with Warning Labels* ?-204.14 Drying Agents.Criteria* 3-$0L I I(B) Use of Pasteurized E-_-s* 7-205.11 Incidental Food Contact.Lubricants* ( 3-801.11(0) Raw or Partially Cooked Animal Food and i 7-206.11 Restricted Use Pesticides,Criteria* ( Raw geed Sprouts Nor Served ' 7-206.12 Rodent Bait Stations* ( 3-801A I(C) i Unopened Food Package Not Re-served. _1 7-206.13 Tracking Powders,Pest Control and Monitoring* CONSUMER ADVISORY TIMEtFEMPER'1TURE CONTROLS 22 3-603'11 Con'cunter Advisor'Pasted for Consumption of 16 Proper Cooking Temperatures for Animal Foods,That are Raw,Undercooked or PHFs Not Otherwise Processed to Eliminate { Pathogens.*Eft''nnav j 3-40LIIA(t)(2) Eggs- 155'F 15 Sec. II Eggs-Immediate Service 145'F15sec* 3-302.13 Pasteurized Eggs Substitute for Raw SiteB 3-401.11(A)(2) Comminuted Fish.Meats&Game Eggs* Animals-155F 15 sec. 4 `f 3.401.11(B)(1)(2) Pork and Beef Roast- 130'Ft2lmin* SPECIAL REQUIREMENTS 3-40IA I(A)(2) Ratites,Injected Meats-15.5'F 15 590.009(A)-(D) Violations of Section 590.009(A)-(D)in sec.* catering, mobile fcK4 temporary and 3-401.1 I(A)(3) Poultry,Wild Game.Stuffed PHFs, residential kitchen operations should be Stuffing Containing Fish,Meat. debited under the appropriate sections Poultry or Ratites-165°F 15 sec, * above if related to foodborne ilhness 3-401.11(C)(3) Whole-muscle,intact Beef Steaks l interventions and risk factors. Other 145°F 4' 590,009 violations relating to goal retail 3-401.12 Raw Animal Fouls Cooked in a ( practices should be debited under#219- Microwave 165F* Special Requirements. + 31301.1 1(A)(1)(b) All Other PHFs- 145°F 15 sec.* C f 17 Reheating for Hot Holding VIOLA77ONS R SLATED TO GOOD RETAIL PRACTICES r 3--403.11(A)&(D) PHFs 165T 15 sce. * (Items 23-34) + 3-403.11(B) Microwave- 165'F 2 Minute Standing Critical and non-critical violations,which do not relate to the Time* foodborne illness interventions and tisk factors listed above, can be 3-403.11(C) Conunercially Processed RTE Food- found in the following sections of the Food Code and 105 CMR 140T* 590.000. 3-403.1I(E) Remaining Unsliced Portions of Beef lfsm Good Retail Practices IFC 590.0m I 1 23. 1 Management and Personnel ' FC-2 .003 Roasts 1 24. 1 Foul and Food Protection I FC-3 .004 Ig Proper Cooling of PHFs k 125. ( EouiomeM and Utensils i FC-4 .005 3-501.14(A) Cooling Cooked PHFs from 140'F to a6, 1 Water.Piumbino and Waste i FC-5 .006 I ? 700F Within 2 Hou"and From 70 F ; 27. 1 Physical Facility. 1 FC-6 .007 t to,I10F/45'FWithin 4 Hours. * 1 28. ' Poisonous 6r Ymdr Materials ! FC-7 008 i t ! 3-501.14(6) Cooling PHFs Made From Ambient 129. I Special Requirements .009 30)I Temperature Ingredients to 4l°F/45'F i 1 1 i Within 4Hours* s', •""�"``r-'`�` 'Dancuca uinca:imm in tiro L-doral 1999 Pond Cale or 105 C.'YtR 590.000. 1.'�: I L(% w, ,. N *' ,YY.s�.,y.d l�`hi•-."t � )i+i w k{ bix,r... errFa`P-'. {,M.{t#[(' V�i'asd k^"AI'ry„ ;'w' �r-. s r'..�e'' .,A _ "Masisachusetts Department of PublicMealth , ) , Salem Board of Health Division'of Food and Drugs S 4 11 120 Washington Street,4'"Floor Salem, MA 01970-3523 FOOD ESTABLISHMENT INSPECTION REPORT Tel. (978) 741-1800 Fax(978) 745-0343 Name Date / �v1 TY a of Ooeration(s) Tyge of Inspection (1" t I Ty Service Routine Address FJ Risk Retail I ❑ Re-inspection 1S< a, `\ '0 A p A-.0 1 \ 11 D Level ❑ Residential Kitchen Previous Inspection Telephone ' ((JJ ,,ff ❑ Mobile Date: Owner HACCP YMEl I ❑ Caterer ElPre-operation El Suspect Illness / Bed&Breakfast I Person in Charge(PIC) ( �r� ' /(.,n Time El General Complaint El HACCP inspector n/n� n In �U Permit No. ❑Other P (�ua �. �1 I Out: Each violation checked requires an explanation on the narrative page(s) and a citation of specific provision(s)violated. Non-compliance with: Violations Related to Foodborne Illness Interventions and Risk Factors Anti-Choking-_`1Tobacco Violations marked may pose an imminent health hazard and require immediate corrective 590.009(E) Lj 590.009(F),0 action as determined by the Board of Health. FOOD PROTECTION MANAGEMENT,'. ❑ 12. Prevention of Contamination from Hands ❑ 1. PIC Assigned/Knowledgeable/Duties El• - -- - 13. Handwash Facilities EMPLOYEE HEALTH . . PROTECTION FROM CHEMICALS ' ❑ 2. Reporting of Diseases by Food Employee and PIC - El 3. 14.Approved Food or Color Additives 3. Personnel with Infections Restricted/Excluded . ❑ 15.Toxic Chemicals ,FOOD FROM APPROVEDSOURCE., -®.„.,. , ;"__ r " E3 4. Food and Water from Approved Source 'TIMErTEMPERATURE CONTROLS(Potentially HaiaMous Foods) �'` ❑ 5. Receiving/Condition El16. Cooking Temperatures As ❑ 17. Reheatin ❑ 6. Tags/Records/Accuracy of Ingredient Statements 9 X, ❑ 7. Conformance with Approved Procedures/HACCP Plans ❑ 18. Cooling > r PROTECTION FROM CONTAMINATION El 19. Hot and Cold Holding O�nF.8. Separation/Segregation/Protection ❑20.Time As a Public Health Control ❑ 9. Food Contact Surfaces Cleaning and Sanitizing -REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP)' ❑21. Food and Food Preparation for HSP ❑ 10. Proper Adequate Handwashing ❑ 11. Good Hygienic Practices CONSUMER ADVISORY ❑22. Posting of Consumer Advisories Violations Related to Good Retail Practices Number of Violated Provisions Related Critical (C)violations marked must be corrected To Foodborne Illnesses Interventions immediately or within 10 days as determined by the Board and Risk Factors(Items 1-22): of Health. Non-critical (N)violations must be corrected Official Order for Correction: Based on an inspection immediately or within 90 days as determined by the Board today, the items checked indicate violations of 105 CMR of Health. 590.000/federal Food Code. This report, when signed below e N � P 9 23. Management and Personnel (FC-2)(590.003) by a Board of Health member or its agent constitutes an 24. Food and Food Protection (FC-3)(590.004) order of the Board of Health. Failure to correct violations n 25. Equipment and Utensils (FC-4)(590.005) cited in this report may result in suspension or revocation of the food establishment permit and cessation of food / 26. Water, Plumbing and Waste (FC-5)(590.006) establishment operations. If aggrieved by this order, you .u; 27. Physical Facility (FC-6)(590.007) have a right to a hearing. Your request must be in writing 28. Poisonous or Toxic Materials (FC-7)(590.006) and submitted to the Board of Health at the above address 29. Special Requirements (590.009) within 10 days of receipt of this order. 30. Other DATE OF RE-INSPECTION: S 5901nsp tFom 14 Cw ID Inspector's Signature:, U Print: I PIC's Signature: / ,// Print: ( r)A n,Print: I�� I Page 1 of Pages F Violations Related to Foodborne Illness Interventions and Risk Factors(items 1-22) PROTECTION FROM CONTAMINATION FOOD PROTECTION MANAGEMENT 8 Cross-contamination I 590.003(A) ( Assignment of Responsibility* ( 3-302.11(A)(]) Raw Animal Foods Separated from 590.003UH Demonstration of Knowledge* I Coked and RTE Foods* 2-103.11 ( Person in charge --duties Contamination from Raw ingredients 3-302.11(A)(2) Raw Animal Fools Separated from Each EMPLOvEE HEALTH i Other 2 590.003(C) Responsibility of the person to charge to Contamination from the Environment require reporting by food employees and 13-302.11(A) Food Protection- applicants* 3-302.15 Washing Fruits and Ve;etables 590.003(F) Responsibility Of A Foxod Employee Or Art 3-304.1 t Food Contact with Equipment and Applicant To Report To The Person In Utensils* Charge* Contamination from the Consumer 590.003(G) Reporting by Person in Charge* I 3-306.14(A)(B) I Returned Food and Rescrvice of Food" 3 590.003(D) Exclusions and Restrictions* I I Disposition of Adulterated or Contaminated 590.003(E) Removal of Exclusions and Restrictions Food 3-701.11 Discarding or Reconditioning Unsafe FOOD FROM APPROVED SOURCE Food* J 4 Food and Water From Regulated Sources ( 9 Food Contact Surfaces 590.004(A B) Compliance with Food Law* I 4-501.111 Manual Warewashuig-Hut Water 3-201.12 Food in a Hermetically Sealed Container* ( Sanitization'rennperatures* - 3-201.13 Fluid Milk and Milk Products* I 4-501.112 Mechanical Warewashing-I-foi Water 1 3-202.13 Shell rggs* ( Sanitization Temperatures* 3-202.14 Eggs and Milk Products,Pasteurized* I 4-501.114 I Chenucal Sanitisation-temp.,pH, 3-202.16 Ice Made From Potable Drinking Water" concentration mid hat dress. 15-101.11 Drinking Water from an Approved Svstem" 4-601.1 1(A) Equipment Food Contact Surfaces and 590.006(A) Bottled Drinking Water* 4-602':1 Clearing Clean" J 59f}006tB) Water Meets Standards on 310 CMR 22.0" 1g Frequzncy of Equipment Food- I Contact Surfaces and Utensils r l Shellfish and Fish From an Approved Source I 14-702.11 Frequency of Sanitization of Utensils and 3-201.14 Fish and Recreationally Caught Molluscan I Food Contac[Surfaces of Equipment* Shellfish* 703.;1 ( Methods of Sanitization-HotWaterand 3-201.15 Molluscan Shellfish from NSSP Listed I Chemical'* Sources* Game and Wild Mushrooms Approved by 10 I Proper,Adequate Handwashing Regulatory Authority ( 24-301.11 Clean Condition-Hands and Anus* 3-202.18 Shellstock Identification Present* I 2-301.12 Cleaning Pr ccdurc= 590.004(0) Wild Mushrooms* ( 2-';(if,! When to Wash* 3-201.17 Game Animals* ( it I Good Hygienic Practices 5 Receiving/Condition I ( 2-401.11 Eating,Drinking or Using Tobacco* 3-202.11 PHFs Received at Proper Temperatures* 2401 13 Discharges From the Eyes, Nose and 3-20115 Package Integrity* Mouth* 3-101.11 Food Safe and Unadulterated* I 13-301.12 Preventing Contamination When Tasting1` 16 Tags/Records:Shelistock 12 ( Prevention of Contamination from Hands 3-202.18 Shellstock Idenuticauon* ( ( 590.004(E) Preventing Contamination from 3-203.12 Shellstock Identification Maintained, Employees* Tags/Records:Fish Products 113 Handwash Facilities Gonvenlentti Located and Accessible :i-402.11 Parasite Destruction* 3-402.12 Records,Creation and Retention* 5-203.11 I Numbers and Capacities* 590.004(J) Labeling of Ingredients' 5204.11 ( Location and Placement* 7 Conformance with Approved Procedures 5205.11 I Accessibility.Operation and Maintenance /HACCP Plans I Supplied with Soap and Nand Drying 3-502.11 Specialized Processing Methods* Devices 3-502.12 Reduced oxygen packaging.criteria* b-301.11 Handwashing Cleanser,Availability 8-103.12 Conformance with Approved Procedures* 6-301.12 Hand Diving Provision *Diacxes critical item in the federal 1999 Fwxl Cale of 105 C&IR 500.000. I , CITY OF- SALEM (0 f( pD- {{�� BOARD OF HEALTH (( Establishment Name: 1� 'AA o a Date:L,,)- Page: 3�\ of Item Code C-Critical Item _ DESCRIPTION OF VIOLATION/ PLAN OF CORRECTION Date No: Reference R-Red Item -2 - - '. Verified f� "p- / PLEASE PRINT, LCLEARLY � 1 V1 K_ � ' —��n�.,r�n.n1 Ylen 01_) � ! { � I.P >:ACPn nnn/ A/)(I rA �lr� U ,--tom 4()�a �k ��d r I Com/ a E .. (' ,, t - „p „.I -,a , isC, I -_ (ILS (�_ .2 �, ,n7 )nn RO N/) Sinn o .a,A1/1 1 Ihfn - `- �} I t t9JtM�, i Yt�rIYJ(o'.KCf . 1 it�.�n I ; ,ar��n � V'.�r��-,Y� ( �(n � V� 1.1"1�•,�9 � C��.-� ` IrYj ��'() 7 �S CAnn �� I ll ^ >9rra_ \ a SAA c,)_ ;_/t/AIrrAVA (n P .1', p? l�,/r/�A '011COn h_/ (n•. �n'3 !4, Pn_A'DIIn, A t M0%0 a,\ (k 1 r P (nom (� 0 � J G/X AoXcL (7n ,i� 1 ,fir' Sly IO n 0_ iaLC � ✓v U� v _ _ 1 C_ x )(11 l VI (!.,j F (, ,,., — l�(, rrJo 4,)A (,;-0- 'tiTo + tun r\"'c „�,.(�i 0 p)/1A 0,l� ht A'. k�— --Y\ n n V"a) - ` Discussion With Person in Charge: Corrective Action Required: I ❑ No I O• 'Yes I have read this report, have had the opportunity to ask questions and agree to correct all d--Voluntary Compliance ❑ Employee Restriction Exclusion violations before the next inspection, to observe all conditions as described, and to ❑ Re-inspection Scheduled ❑ Emergency Suspension comply with all mandates of the Mass/Federal Food Code. I understand that noncompliance may result in daily fines of twenty-five dollars or suspension/revocation of ❑ Embargo ❑ Emergency Closure your food permit. w/ l L L3 Voluntary Disposal ❑ Other: Vierations,Related to Foodborne fitness Interventions and Risk Ccc:rdirlg to Coo!ed Ile Factors(Items 1-22) (Cont) It Wilh;n fiiouls Cixllia'e kl.tllkxi: PHFI, PROTECTION FROM CHEMICALS 19 PHF Hot and Cold Holding 14 Food or Color Additives T`HF�NlAnr,JrvW arm 6,4,�w 3-,t02 14 V(owliov) Front L':milpnaml VlefinvQ, 3-�OiJ(,tA) li"t Is i Poisonous or Toxic SubsIrmces 7 101.11 i k1'!kufyllIg Cityinal Hdd ai ti! abol,Q 13:' F. Time;ls a Puturc"va'Ih Control 10-1 11 morwIn Name- %Aiorking S�ramiil'n--Sltnai:�' T'im,aS'l =;Iytth Cotrt,"Il 7 2o 1.1) 7-20--"11 kosvitlloo - pr"S'�IwQwld :,,c" —------ I 7-7(}2.1_ 7 (13 11 RECIUMEMENIS FOR HIGHLY SUSCEPTIBLE POPULATIONS (HSP) (hemic:00 Chejownk for lAwhvig,Fnxlaec.Cfitezia' Qvdroill'- 7 NA 14 Omioz AirclW,C "I'liefto Iltitl I 7 205 11 hm&aws Fax!I kmmct.bib)icapis' I 3-W!�I W)l or Cwf�d Anitelld 1:(xd irld 1--'06-11 ko�n Ow P" rwleie"'Critel o' I i'lil, St:^d Sprole. N.-t Strlv L 7-2106.12 P"kilt.ro Bell sllmol,' 3,1.271.1 F�,,d Pa,-k:icQ N,.t Re-wed 7 N)6 13 i Tr.!,:Jk!tig h»Qcri, otord and Morotori ng- CONSUMER ADVISORY P;ntrdQw,'ouektuipdlm of TIME/TEMPERATURE CONTROLS 16 Proper Cooking Tomporatutes for PHFs 3 401 1 I'A'itl)(2, Fggz- 153'}: 15 S�c. P5 iv! Rag. ShOl vl"h Nlcar.,& 61me !."5T 1� SPECIAL REQUIREMENTS i 40IJ!(13)4],;121 1,I'll, and S...1 Rov.t PO'l, 121 Gill' —, 41 Vioi,vi,,n,ol Sc,tielo �1)00)9f,N)4rl) In 11 JII(Ali:'� tejlilQ� filie"��d Ntc�it'- 15's I" J.� II.W. te:mporwl,liod 4411,1 I(Att 1) floultr), W!1d how. Siderd VNF, itotild he Sloffills, Fi�ml.M;UL' 16llud Wid;n flIQ ajl"Pruprl;kte qk:Q1 loll's Pollilt,I'll UIC0, 'Xhol.� qoi�.'IQ. laut o BI:JNwaks ivwl vemi0f".. and _-ill: ?:!croft. 00)+T 14 5 1 ;z �90.009' viol'ol(lb:'realm' if)"()(j retail : 3-4f) 12 RXIVArliffto Fl)lrd, III It !Ivl.t �,ccild he dcbi!rd undQr #29 -- Sp:!vml =,40 1,1 f All Otrze,.i 1111,,; - 145'F 15 ctc 1 17 i Scherating for Hot Holding i VIOLATIONS RELATED TO GOOD RETAIL PRACTICES pill,, 165,p I", Iel,. 1) (Jtenn4 21.31[P 3-1W.I I(B) F,Mirilve Yarldivi, cllw.-il alw!j?"'i I"III,al I:o; :-clare v,Ille risk to,tors L'Qu.4 aboi,e can for 3- (fi3.i 1:C`) Commeiciall v flroei;aJ ItTEhod- fi,wFul fo dir !q "ee,imll of ell, rIkeff Cezde'ald 10("WR 3-10 1 ItEl R,:wajjon1, civ hc�d or litt"I I-on, i Good Retail--- -me- T 23 T03'Ia(ren!knnI and Per F orl 1-e-1 i Ffi -2 II tg Proper Coaling of PHFs 24, '-C z!'- ind I lla�iliti PC -4 1)0�) 501,141A) CtIofiiqc PIIFc irmi 14W Fu, Wal"I,Ph.mpinIj and FC-5m 7€1°F Within 2 fflw-1 and From PiT FC-6 '007 41 J`/4'i FWitbin 4 fimw, 1 '�8 I P0,3�nou�I,! Tmc Matar4c 1 FC -7 00t, 501.14(8) C"Olvie HIR IllellIQ Frolo, -\IIII[ Tcntpr,aoov ltiI.reoitw;1,,41'1 "lo 1 Omer I Within J !iota," Don 10MII-nI lam ill th< !'!')9 loo'l('%'! " WS CMk I JTY, 0F SALE.M., , pp nn BOARD OF HEALTH 4 ` r��Establishment Name: ��>1rlNl? -� ��DYP , Date: �O'�Y,/ Page: of Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF/CORRECTION Date , No. Reference R-Red Item - , , Verified PLEASE PRINT CLEARLY { �-n c.�-�.0, ��1 �i �1-fn o n ,ti1n i;•��`�YI� ' X101,\i.1AA $,Ie1/) "ri 10112 fAA / )!)Ac,9_4l i,;nQD: � . t : ,.lam /1Ail.t7J� (40AnA '^ 1�oorn . /1I1t1? 4't/��1� ��i.�YAnAn Y J.1 ? n I�n) ()A0- CJUC /cx9 ( ]t l� , l (�7�4 Inn Q- . Alr 1 _3A r, A,,e ,1� j � ' / / r/ 1 C 1t�4i:- '1 P<4 `roMS— �YO.sm Qn .Q � //�_i�`e � I /�1=(�rnr. InP i- ,/\ v-e la�.-,��D k1 ,'+•`-WA OA 0_ 0r/1 � I I l 'JAt.r A�+ 0;� 0,0_1T1-VM b � ��P Q �l i�� V P F�c-h moi,�r1a. �'.D�'ct, w o r ( _ F — — - — Discussion With Person in Charge: Corrective Action Required: ❑ No I ❑ Yes 4 k I have read this report, have had the opportunity to ask questions and agree to correct all ❑ Voluntary Compliance ❑ Employee Restriction / If P Pp Y q � Exclusion violations before the next inspection, to observe all conditions as described, and to ❑ Re-inspection Scheduled ❑ Emergency Suspension l comply with all mandates of the Mass/Federal Food Code.I understand that noncompliance may result in daily fineA of/twenty-five dollars or suspension/revocation of ❑ Embargo ❑ Emergency closure your food permit. ❑ voluntary Disposal ❑ Other: + 4 ' i 1 low! 34g 1 PiNs R:Gi nod''I'lcopminrn Violations Related to Forndbornt 11trsess tntwventrona and R15A i I �t.xt.r:ii{; £.�?ar:t',udt•`{f 1,s Factors,(ftertfs I-V) (Cont.} ! ;{ 1-1=5`1' Wit ;n,1 F1.ims , �I. .r;ad, ii>r PIiFi. PROTECTION FROM CHEMICALS RICALS ! tv ! PHF HO:mc€C,n:d Holding � tq hood or Color Additives 15wlwl"} C'old d'HVF Mointamed'atvrbalrw ( !1.202A2 ( :.;1d:tive•,' t 1 t 3-3^214 E'.o1xhm From Undp-,rp=1 Additi•,c.' t t E 1 :-I'rk'i{l� ?.tain5.17{srct.,Lurak�.n, j Po;sonaus or Toxic Substances ; I � 7 E{i 1.11 1 Waiting lnlormation -Ur!"i t�rHSta3ACtA' t �?U_mL.. 1 ins as a i'uh#€c Health CantsoJ 11 Cularantt cute- �t'ork;rr t'tuuainrn" }-'#};.1i S.f%a,:u,=n- 5ttrzf~s. ! t -5}! i ! €';n, nE`unfi':'t#raifhC.uaraJ' r;?^'4r 1tCN21ti":I'.iirt ' ;?t}7.11 EtCottLCL'Op- 1'i�6c nCG.11itJ lc�" _ _) . 7-'€tt I J Env f"t,t• me`r -PreltAr:i WA REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POP3L ATIO 3S{HSP) '_t}J.VI ;.tns'iaec+.fr;{;:&11mg,Chi rixhws^ � 11 i.T,rt•i 1;A} ( • t + icu'rW lkyjac!acted Joitea and j "-'Od,i 2 t.'fr:nticaL,for�h as.€attf;Yr;aluec.Cuicda-' j t `9 ve �' 7-.'64.14 DnnnAveay.Lru.,:r;a'. t I l :3c5rr.ace;s:rs.,;iarnrnal,t:€,;is' i itli' L"'o td i?ttG 1; Jax'id wal F,,xl Cl:n:act. I.ctl3rlcanrs' I 10h Rai,:ko t'-,tuzith C.x,,h,,d Aniittsl RI,d and i 't ion! LN; omd Uw 1:::**n&n Criteria' RdUNwdt*w NO ( 7- it(s.!2 Rt'<ian{ Bait 3.€;1;i 111 C: F,l.t{,rr.:,!TAK C•sck,'::'.r No Re wMe.l , ^_4}n f? '1�r a,-F tris;P,,.�rlero. E'rat C',mir.,i ant? 4 unitorin CONSUMER ADVISiDRY ' :7 ,2j>Q i 1 ' Cocw•:,et •1.:.:te,v e'n%~ J for Corr,impti„n o TIMEFFEMPERA'1 URE CONTROLS i i11,in,1I f :r„j< lllal:Q;'Ru'r' tJ7a€C[CJ4Jlied Ot ' 116 Proper Cooking Temperatums Por PHFS 30M I i:•U,l Kq Begs- 15+'F 13 Sun ! I t 40 ~iaRm3! rp?i..:,Diixt't§{e o aei Fags hroxd::{tc 'ier'i,;r 1 {.i't=l5set' � � f tl loRaw Shell I W'3(.7NANO CrnulnnatedlT:n 'aic,.': ,t. tian3t ! Anit mk I i5'T A'5 w.. { SPECIAL FtlwfJtllFdEets NTSr 401.1 i(E3 Yi E ii j} � PolkPolkand li�ei ie,kt5i - ;17 P 121 uun' l3 •i:11.i1#A3(.�;' 3H:,tne+. hna:x3A4cnts i'ih-I-.I�.v I ! j cta:rmn , nK)t)tie €cx;,i, totlporat l and 4Li€A AW9 I'.;u'.try.Wild Ciarne, Sitttiett t�llri,,; rr.;.ia�rril.*t? 1,:t,I',,.'n vp,.alitrii li lidd he t WntlrOintsrrum, Fish, hiew, I 1':til€rt'r,t ItNnf.S if>5 t :5 ri,.'C. Ulxv< If i'1ai.'d :(”f�'kAJ)orfle 3-901.1 1f1U(31 Wc,ie-a:U;::IV. lilt'itI Si'. :itcxns j st,tet t',?nidian�and it±s. !:ti€t3TC Other I 145 1, t,3;p-d retail f 30MAI i?'ox .1wct:a; f,'x;(".mIC(l Ea a }�} �<.i;tit+:t ,i:trul„i-K,'JI itLd L,t}der li29 .- 1'IiidJl,,ale 163"I'.• Jt73,11t,i 11{}tht j rll:i}Lhet 11100-- 14"I l5+cc j Reheating for Hot Holding i VIOLATIOAfS RFd_ATED Tfl GOOD PFT41L PRACTICES 3013.111A)Ntli P1 INi09'E- 15w - 2XII) - .1 .J 1(i€) S11a:se me 165.'0 2 Mh,ave Standing com•,n'«qd r fw '-we:( Iimato=a,. "loch dc,nn; ttklre:r.tpc 1! Inm.' j ;'tt'd7,nrrtc'?:St,'s.lurr.,r.l,,;'+rr.nt;,ar:<r::d}itt:,:;> T�'rd cti„c�c•. <ctrt ur i I-WI3 IJ:(`.) Girnmerciaifv l9no': d WFE a,::td i i ran.,r it,:ki!m:/: I,:r[ci s:•.'rinr:; .'f rh 7:»,,r x'nur ru•rt lfii C'd;k (� _., N 1 4L I Rrl;t miriv L'ntl nd l'ta tE'`ns of€ eel j lolas i R"a b, i i 73 __: hhan.tyn=r::a,P T.;3 j'?.1._ ' Fo,_:: nd Fasci`Pros xc ,:in C; .._�a' I Ila j Proper Costing of Pt1F>r j -- I '' ?5 i Erinu:r:er�!and Uta.,s,:s {}# E tih) C,tt'dn)j!0x i,td PHPr Amt iMY 14 u, 6 -•— _ - r. R r i-e _.�.. t _ r'F `l.'.i:�.i.Pfi:,ilu,i :l',r1�,.aya , .-�5 . 006 ._ 7:r E'N'itlu{+ 7 I iovr+„lid frr,rt 7r}'•[ i �'7 Ph,,ry._as Fat ads : t;A f Illy c'LS!t1,Lis a Htxn:. ° s t 'L%J or Tw tar<e:,.,:n rC � 3S'iF i ( ,.err! 1tF ftJ t.:tm?tag I'kik•: ?vJ1:r€e Fc„ao Aahieu: F Torilwrarare hsirzedi:nf',{<,-it"ri45' 1 t3:: i rJ;hF, - _ __ - --- ' Pct3,.;,cnncal,Deal,n ihz G ar,.+: i"'I't P.,;.i t:,dr cr 10i C14Jc 58+7 tu§ i calzzl0 CNA ms�imt- c � pl Aa a � 4 \ IMPORTANTMESSAGE FOR .( ltle-'. -� A.M. DATE TIME M ✓SM:/ OF PHONE AREA COOE NUMBER EXTENSION O FAX O MOEIII F AREA CDOE NUMBER TIME TO CALL TELEPHONED I �,I PLEASE CALL CAME TO SEE YOU �f WILL CALL AGAIN WANTS TO SEE YOU I RUSH RETURNED YOURCALL i I WILL FAX-TOO YOU MESSAGE Jam',' S I .aJ Lae W- Gt✓ t, l r te- 6zt 1 V,7 3 n SIGNED/1r,�'40H `` J �1 -wp& RoMA ( NOTES n Massachusetts Department of Public Health Salem Board of Health Division of Food and Drugs 120 Washington Street,4'"Floor 9 Salem, MA 01970-3523 FOOD ESTABLISHMENT INSPECTION REPORT Tel. (978) 741-1800 Fax (978) 745-0343 Name\qmt WS �2I I Dae 410,? Tyoe of Ooerationfsl Tyge of Insoection /❑ Food Service ❑ Routine Address C'�$'2 Risk LJ Retail pte-inspection Level ❑ Residential Kitchen Previous Inspection Telephone ❑ Mobile Date: 6Y17/3!9 q7� 14I"-�t6�t8 )'1/ !9 Owner t 1^ HACCP YIN ❑ Temporary ElPre-operation CIA 4 PiV 1 ❑ Caterer ❑ Suspect Illness Person in Charge(PIC) �"afh 2 Time El Bed&Breakfast El General Complaint In: ElHACCP Inspector rI I CA,jA(4rRa Out: Permit No. ❑ Other Each violation checked requires an explanation on the narrative page(s) and a citation of specific provision(s)violated. Non-compliance with: Violations Related to Foodborne Illness Interventions and Risk Factors Anti-Choking Tobacco Violations marked may pose an imminent health hazard and require immediate corrective 590.009(E) ❑ 590.009(F) ❑ action as determined by the Board of Health. FOOD PROTECTION MANAGEMENT-_ _W. : . ... ❑ 12. Prevention of Contamination from Hands ❑ 1. PIC Assigned/Knowledgeable/Duties ❑ 13. Handwash Facilities EMPLOYEE HEALTH .i PROTECTION FROM CHEMICALS ❑ 2. Reporting of Diseases by Food Employee and PIC ❑ 14.Approved Food or Color Additives ❑ 3. Personnel with Infections Restricted/Excluded El 15.Toxic Chemicals FOOD FROM APPROVED SOURCE ❑ 4. Food and Water from Approved Source TIMEITEMPERATURE CONTROLS(Potentially Hazardous Foods) ❑ 5. Receiving/Condition [116. Cooking Temperatures ❑ 6. Tags/Records/Accuracy of Ingredient Statements ❑ 17. Reheating ❑ 7. Conformance with Approved Procedures/HACCP Plans ❑ 1 B. Cooling PROTECTION FROM CONTAMINATION ❑ 19. Hot and Cold Holding . 20.Time As a Public Health Control E:18. Separation/Segregation/Protection � El ❑ 9. Food Contact Surfaces Cleaning and Sanitizing ;REOUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) ❑21. Food and Food Preparation for HSP ❑ 10. Proper Adequate Handwashing ❑ 11. Good Hygienic Practices CONSUMER ADVISORY ❑22. Posting of Consumer Advisories Violations Related to Good Retail Practices Number of Violated Provisions Related Critical (C) violations marked must be corrected To Foodborne Illnesses Interventions immediately or within 10 days as determined by the Board and Risk Factors(Items 1-22): of Health. Non-critical (N)violations must be corrected Official Order for Correction: Based on an inspection immediately or within 90 days as determined by the Board today, the items checked indicate violations of 105 CMR of Health. 590.000/federal Food Code. This report, when signed below C N by a Board of Health member or its agent constitutes an 23. Management and Personnel (FC-2)(590.0 order of the Board of Health. Failure to correct violations 24. Food and Food Protection (FC-3)(590.0044)) cited in this report may result in suspension or revocation of 25. Equipment and Utensils (FC-4)(590.005) the food establishment permit and cessation of food 26. Water, Plumbing and Waste (FC-5)(590.006) establishment operations. If aggrieved by this order, you 27. Physical Facility (FC-6)(590.007) have a right to a hearing. Your request must be in writing 28. Poisonous or Toxic Materials (FC-7)(590.006) and submitted to the Board of Health at the above address 29. Special Requirements (590.009) within 10 days of receipt of this order. 30. Other DATE OF RE-INSPECTION: S 5901nW Fol 14 da Inspector's Signature Print: l I (.t, O ,�kQA, r1 PIC's Signature: A V/i/ Lrrfj�y-�-� Print: AI W AL i(`/A T f7 h Pagel of-,Pages / � % I J t'' V! I Violations Related to Foodborne Illness Interventions and Risk Factors(items 1-22) PROTECTION FROM CONTAMINATION FOOD PROTECTION MANAGEMENT 18 Gross-contamination I 1 590,003(A) Assignment of Responsibility* I 3-302.11(A)(1) Raw Animal Foods Separated from 590.003(B) Demonstration of Knowledge" Cooked and RTE Foods* 2-103.11 Person in charge-duties I Contamination from Raw Ingredients 3-302 11(A)(2) Raw Animal Foods Separated from Each EMPLO"EE HEALTH Other- 2 590.003(C) Responsibility of the person in charge to I Contamination from the Environment I require reporting by fail employees and 3-302.1)(A) Food Protection" applicants* 3-302.15 Washing Fruits and Vegetables I 590.003(F) Responsibility Of A food Employee Or An 3-3t.4.1: Food Contact with Equipment and Applicant To Refo n To Hie Person In Utensils* Charge' Contamination from the Consumer 590 003(G) Reporting by Person in Charges I 3-306.14(A)(B) Returned Food and Reserme of Fad'* 131 590.003kD) Exclusionsand Restrictions" I Disposition of Adulterated or Contaminated 1590.003(Fl Removal of Exclusions and Restrictions Food i-70111 Discarding or Reconditioning Unsafe FOOD FROM APPROVED SOURCE Fess 4 Food and Water From Regulated Sources 19 Food Contact Surfaces 590.004(A-B) Compliance with Food Law'1 I 4-501 111 Manual Warewashing-Hot Water 13-201.12 Food in a Hermetically Scaled Container" I Sanitization Temperatures* 13-201.13 Fluid Milk and Milk Products* I 1-,S01.1 12 Mechanical Warewashing-Hot Water 3-202.13 Shell Eegs * Sanitization Temperatures* 4-5{)1.114 Chemical Sanitization-tem H, 13'20214 Eggs and Milk Products,Pasteurized* I I concentration and hardnessp" P 3- 202.16 Ice Made From Potable Drinking,Water' ( 14-ti01.1 1(A) Equipment Mood Contact Surfaces and 5-101.11 Drinking Water from an Approved System' 590.01J6(A) Bottled Drinking Water* I Utensils Clean` 590.006(B) Water Meets Standards in 310 CMR 22.04' I 4-602.11 Cleaning Frequency of Equipment Food- Sheitlish and Fish From an Approved Source Contact Surfaces and Utensils* 4-702.11 Frequency of Sanitization of Utensils and 3-2()1.14 Fish and Recreationally Caught Molluscan Food Contact Surfaces of Equipment+' Shellfish' 4-703,11 ( Methods of Sanitization-Hot Water and 3-201.15 Molluscan Shellfish from NSSP listed ChemicaP' Sources* I IO ! I Proper,Adequate Handwanhing Game and Wild Mushrooms Approved by 11 301 x_ . Clean Condition-Hands and Aims" Regulatory Authority I 3-202.18 Shellstock Identification Present* 12-301.12 Cleaning Procedure* - 590.004(C) Wild Mushrooms° ( i 2-301.14 When to Wash* 13-201.17 Game Animals" I 11I Good Hygienic Practices ISI Receiving/Condition I 12-401.1 I Eating.Drinking or Using Tobacco* 13-202.11 PHFs Received at Proper Temperatures* I 2-401.12 I Discharges From the Eyes, Nose and 13-202.15 Package Integrity, I Mouth* 3-101.11 Food Safe and Unadulterated* I ( 3-301.i2 I Preventing Contamination When Tasting* � i 6 TagsiRecords:Shellstock ( 12 Prevention of Contamination from Hands I 3-202.18 I Shellstock Identification* 590.004(E) Preventing Contamination from 3-203.12 Shellstock Identification Maintained` I I Employees* Tags/Records: Fish Products ( 113 I Handwash Facilities - - - I ! Conveniently Located and Accessible 3402.11 Parasite Destruction* - --- 13-402.12 I Records,Creation and Retention* 15-203.11 ( Numbers and Capacities* 590.0040) I Labeling of Ingredients* I 15-204.11 I location and Placement* I 7 Conformance with Approved Procedures I 15-205.11 I Aceessibility_Operation and Maintenance /HACCP Plans I Supplied with Soap and Hand Drying 3-502.11 Specialized Processing Methods* I Devices 3-502.12 Reduced oxygen packaging.criteria'" I ( 6-301.11 ( Handwashing Cleanser,Availability 6-=01.12 Hand Drying Provision 8-103.12 Conformance with Approved Procedures* ( ( 'Denotes critical item in the Wend 1999 Food Cale or 101 CNIR 590.000. CITY OF SALEM ��-�{-t + BOARD OF HEALTH n Establishment Name: �CV I 1 t �'� S11 Date: Page: of Item Code C-Critical Item DESCRIPTION OF VIOLATION/ PLAN OF CORRECTION - Date No. Reference R—Red Item- Verified 1 ,. _ _ PLEASE PRINT CLEARLY f�\I v'iolcvfions Y`eMakn1no1 -{-torn ttu- 619 / LV In-)Pit iz.�hor) 1 1w'�?'In c_,--)erre �4 ry n X,;u ! 1 1 .j��CeYI��re f fcr n I u: I .. I 1 1 I 1 I 1 I 1 Discussion With Person in Charge: Corrective Action Required: I ❑ No I ❑ fes I have read this report, have had the opportunity to ask questions and agree to correct all ❑ Voluntary Compliance ❑ Employee Restriction / Exclusion violations before the next inspection, to observe all conditions as descriged, and to ❑ Re-inspection Scheduled ❑ Emergency Suspension comply with all mandates of the Mass/Federal Food Code l understand that noncompliance may result in daily fines of twenty-five dollars or suspension/revocation of ❑ Embargo ❑ Emergency Closure your food permit. /f' r ❑ Voluntary Disposal ❑ other: - I J Violations Ralabid to Foodborne fitness tnter rmliofas and Risk to Factors(Itivas 1-22 (Cont.] KolafI f 11 - PROTECTION FROM CHEMICALSPlif's 14 Food or Color Additives 19 PHF Welt and Cold Holding kMail3lijiled ator L-Iorf, Prowl,11,xt Ifoar J-11rapi,n):ed AWiL%t�' t -i 5t)I.It,!.3: I iot NiF��Ataimaiecci,aorakw Poisonous or Toxic Substances 101.11 0111-ma! Hoid iAt'l , 1 26 Time as a Politic Hilafth Control 'r-'s C12,1 I Common'Natile - working "atanicr." 11 rw,a,a Putilic I fe-a4h Control, i'2o"ll I I If H, V;,i-otme Rk�qlao:mcnf lic"victi('n -prestfloe<utd 7-102.12 Cwidili(xi,of Use, Toxic Container; - POPULATIONS(HGP) lo", �,I REOUIREMENTS FOR HIGHLY SUSCEPTIBLE 1 204.11 Sdnilr..eL�,Cr:Wrilt It i Sol 1 IfA) Pre niwi,n4f�d 1�fnot,,;wid 1 I '04,!2 Chtnuicak for WaIlone hnd�lcc,Ciitc,ial ivilb -204.14 Drving Aeoutt�Criteria- 7.205.11 ljlcid"(l,i hod Corqw,t,Lula icanit-, I I I(ill 1?ow of ilwu til';C,r tkkn 3jtiwfil Food wd t'tj 7 '06.12 Rodtoll BIlit sl:ailInt," -1 otdong po�k&-r� pcm Control and -�CL Ftxxi pft;k:wv Not 11�,-serwzl 206,13 Mollitorinl- CONSUMER ADVISORY 31 P-q,:j k1ri"al'umptiOn ot, TWEITEMPERATURE CONTROLS Tempeolthaes for Anio�I:l l, R w. Unhrl,wked v! PHFs 11oFlimlyive P "a'Cooking .....�ag ro' 40 1.11 A(,I Pathou"ot,; Egg,- I Sj,F 15 L5"i"1 1 : �-to".!3 1,; 1C,,!i f ,�d I gf�;� 1 ori,� ol Raw sjl�lf quo'Idiate Ser- I i, E 1-0 1.11(A)(2) ("'jmaint,It I jT-I I_h1lictots—r (-i—)I I T �Y Awrfmi,i 13:l"I SPECIAL REOWRIEMENTS 401.t I(B li f;€2) ;(.2) rot I, and lit-cl Rkxkst 1,301- 1 7 I n);f) to -St,c000 0J)0');Al-trA Its 1-46 f.I I(Aft R,alte,, ll,jeod Mc.lt, - 05 F 15 oi inuffilf. to,,tl, teolpomry and re"Itle-al I ki'l,heo opcla(ifails 'llovid be 40LI1tA),-3) rqulrr�,Wild Came $rWted 111-IF's Sluffool Cnitowns)`vel-Steal. ul(!e4 iJte;ipffft, _4 c:Jtgxj, P,,Uitjy K:ao" o55 F 15 Sn. if'klait-d ilincs� 3 40 1,1 i(CY 3 f Whole iou!,IAC. Imact fl,J StcakI; veotiol';alid risf: Factors, ltd)ff "40 0r)9 vi�,I:lIt r-turn, i.)noA retail W51, I 1 )-40;J-' RIA NoilW F"Ild,CiA,,:d of 8 pra'.6ccN 'ho;l1d IX,&Ntcd told"T i29 - Mic")t"aw lo^ I 4t0,111A)(1)ih? All Other Pill� - 14-5'F 15 se,: 17 Reheating lot got Holding VIOLA TIONS RFLA TED TO GOOD RETAIL PRACTICES ;40,111(A')&,{D I pql, 165'F 15 sec, ^ I (Itew.,23.3t1) fI irlo ',Lee S1411aing C;ii:I'll"'sel r:,.,,-, Iilwjwbi"i,do,urf ic;ate;o file ritire ;l1wrVolpi'ay ol',KIA-j"',tf,rT Jii I'll elhole ("a be Coqtfm:f(1aA RTF FofA- fw!rvlo,tht of z!iI. Food(odeajtd Ito C'.VIR 314fl3 1107) Rf:lralltln,1'"Alced Item Coed Retail Prartaces FC 5.90.000 and P�nI,orinel F(' N3 24 F11,00 Ird K- 3 C4)4 Proper Coating of PHF5 -- ----- f cooki"d N114 from WWI:to ^,F, vjo . Wc-f,, -,k- ------ Tjq;Within 2 Hour.,: .; nd Froni'Pi-l' t,,tFa,,:,h, PC (K7 to 4 1^Y145 F%V;thm 4 Hour:-. ?b, j_Pwf>olt,s:Ir T,Inr Moleffa!s i FC- 71 008 -'0 1 i 4f 111) CoolifiL, PHFt Made Frwi,AmIllcot r'ravtrt, InClthE� ,grcdi(,Lt%o,4l'F,4S,F I Withot 4 Holu, i,ell,in If,i"to,,! 10)ll t1raR oda"! Ills CMM 39,p'lle;, CITY OF SALEM BOARD OF HEALTH Date: December 1, 2009 Name of Establishment: Brother's Deli Address: 283 Derby Street Owner(s): Mazen Mouhidin G�,II 6k't 31a Nf3e Phone: 978-741-4646 The proposed owner Mazen Mouhidin and the Certified Food Manager, Wagoner Santos presented a Floor Plan and Menu for review in accordance with the State Food Code. A more comprehensive floor plan must be submitted. The menu is approved as presented. CERTIFICATION Wagoner Santos is the Certified Food Manager at this time. There must be at least one full time CFM at this location. Please provide a copy of Mr. Santos's certificate. A"Person in Charge" or"PIC" must be available at this location when the CFM is not present. The PIC must have knowledge of sanitation techniques, holding temperatures, operations, etc. CHOKE-SAVING There must be someone trained in choke-saving techniques at the establishment during all hours of operation. FLOOR PLAN Hand wash sinks must be well located in all food preparation areas. The hand sinks must have a wall hung soap and paper towel dispenser. These must be stocked at all times. The hand sink must be used for hand washing only. All floors, walls, and ceilings where food, utensils, paper products, etc, are stored, prepared or served must be intact, impervious, and easily cleanable. A three bay sink is available for washing, rinsing and sanitizing all utensils equipment, dishes and a dishwasher with a chemically fed sanitizer will also be used. The dishwasher must be equipped with an audible alarm to indicate when the sanitizer is empty. MENU/FOOD PREP All food must be held at 41°F or lower, or 140°F or higher, at all times. Therefore, soup and other hot items should be brought to the appropriate internal temperature before being held hot. Food may not be added to containers in holding unit. Instead, a sanitized container with new product may replace the existing container and the old product may be placed on top of the new product. Food must be cooled and heated quickly. There may be no bare hand contact of ready-to-eat foods. Gloves, tongs, or tissues must be used when handling such food. All refrigerator/freezer units must have internal thermometers maintained at proper temperatures as stated above. r UNDERCOOKED FOODS The consumer advisory is posted on the menu. EXTERMINATION Monthly services of a Licensed Pest Control Operator are required. Please keep receipts for inspections. SANITIZING SOLUTION Sanitizing Solution must be accessible at each prep station and for the patrons' tables. Test strips corresponding to the kind of sanitizer, must be on hand to check concentration of solution. Solution must be made daily, tested, and the results recorded on a log sheet for examination by Board of Health inspectors. Spray bottles with clean paper towels may be used, as well as wiping pails with wiping clothes always held in the solution in the pail. Outside area of premises, including the dumpster area must be kept clean and sanitary. A change of ownership inspection will be conducted by December 4, 2009. An plicat�' ` check was not submitted. David Greor�ba `m Date Acting 0eaP, gent N iz 11011 :2010 Made o h in. Date �1 Q� f �I-- WaUMer §m-Os�- Date Commonwealth of Massachusetts City of Salem Board of Health Kimberley Driscoll 120 Washington Street,4th Floor Mayor SALEM,MA 01970 Food/Retail Establishment Permit DATE PRINTED: 12/16/2009 ESTABLISHMENT NAME: Brother's Deli File Number:BHF-2004-000018 283 Derby Street Salem MA 01970 LOCATED AT: 0283 DERBY STREET SALEM, MA 01970 Permit Type Permit No. Permit Issued Permit Expires Fee Restrictions/Notes FOOD SERVICE BHP-2010-0002 Dec 16,2009 Dec 31,2010 $420.00 ESTABLISHMENT Total Fees: $420.00 PERMIT EXPIRES IDecember 31, 2010 Board of Health 7 This Permit is not transferable and must be reissued upon change of ownership or location.The permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code,beofre any revonations,improvements,or equipment changes are made,all plans for such must be submitted to and approved by the Salem Board of Health. Page 1 ' CITY OF SALEM, MASSACHUSETTS o BOARD OF HEALTH 120 WASHINGTON STREET,4°4 FLOOR TEL. (978) 741-1800 KIMBERLEY DRISCOLL FAX(978) 745-0343 MAYOR DGREENBALIM RSALEM.CONI DAVID GREENBAUM, ACTING HEALTH AGENT 2009 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT NAME OF ESTABLISHMENT--A1a/'lP�� bail/r TEL# q7� ��/ - 7//6V 2r ADDRESS OF ESTABLISHMENT /1019/( >21e/t/ FAX# �� "7 - r&1242-22 MAILING ADDRESS(if different) may'/h O.-1 r /r// EMAIL- Business': /a h lt7 /�� yN, 00, COM Website: b �O• �/ OWNER'S NAME L��%2 i�� TEL# �T- 3A? J�1V� ADDRESS °/DW lye STREET CITY i STATE ZIP CERTIFIED FOOD MANAGER'S NAME(S) CERTIFICATE#(S) (Required in an establishment where potentially h§zardous food is prepared) �l EMERGENCY RESPONSE PERSON �'/ /,,�` '/ HOME TEL# e'DAY$.' ION "� Mbnd �i husdaykVFfl*;„ yrQA HOURS OF OPERATION _ I 6* /` _ ;6"Cyt ! 6 Please write in time of day. ( c/ �/� (OQQ Q / ,F� (For example Ilam-11pm) i 9 �J/J� J�l'2[/�N ! � " -/ ! p��'�'/ 34,b TYPE OF ESTABLISHMENT FEE (check only) RETAIL STORE YES . NO less than 1000sq.ft. =$ 70 1000-10,000sq.ft. =$280 more than 10,000sq.ft. =$420 -..... - ---•........ . .... ...........i... ...----------------- ........................ YE NO less than 25 seats =$140 (Outdoor Stationary Food Cart$210 25-99 seats =$280 more than 99 seats =$420 ------------------------------------------------------------- ------- ------------------------------------------------------------------------------------------ BED/BREAKFAST/ YES NO $100 CHILDCARESERVICES/NURSING HOMF---------------------------------------------------------------------------------------------------------------------------•-- ADDITIONAL PERMITS MAKE (not just serve) ICE CREAM, YOGURT/SOFT SERVE YES $25 TOBACCO VENDOR YES NO $135 ALL NON-PROFIT(such as church kitchens) YES $25 'Please pay total with one check payable to the City of Salem. This Permit is not transferable and must be reissued upon change of ownership.The Permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code, before any renovations,improvements,or equipment changes are made,all plans for such must be submitted to and approved by the Salem Board of Health. --- Pursuant to MGL Chapter 62C,Section 49A,r I certify under the pai sand penalties of perjury that I,to my best knowledge and belief,have filed all state tax returns nd paid a 1 state taxes required undehe aw. /I 0�3 0% 6%$ -x" 71 131 tl Signature ) Dat Social Security or Federal Identification Number returns Wnd paid a_>1state taxes required unde Revised 424/07 FOODAP2008.adm Check#&Date_)n )q, ,10 1610 $ CITY OF SALEM ` 't (� I BOARD OF HEALTH Establishment Name: Pvc�-t Vl-V f)P�6 Date: I'lJ-aI ✓/;_1L1 Page: / of / Item Code C-Critical Item DESCRIPTION OF VIOLATION/ PLAN OF CORRECTION Date fI No. Reference R—Red Item Verified PLEASE PRINT CLEARLY �J )� i"C ' )-Y" 'T ( � r A D(T Ce`l n F t C"�P('d q u r I��JQ_C�5 '1Vl � I r � � �� t C Al!VI Dir 4_V a- --Pn UI a_41nC__ v(A )v/\P v) 1Tv d- ' U`( s � r��i + Q, 0 ,11Y)CI VCcc,r.e f /1 �Ir (�F.s '{'n �nC' r �e .i) (aeoC r)e. .�2Cr /ee� i IVtyOX' r Writ k�flln0 Il�<rltrc--�1nYl v [ "' " ' �� C��nP,r vi�� rc'E'i C1a'1< [/k`l�'Pe� tin f rx r�- ,/n �/7C�t--I;-�✓1 (�e.nnrl" �� 18,/q X09 Itaj ^te3G tn ( rt'Vl-ls ky-y P 'V d . I , 000a, (�7 r s�tiJ-WKJ lY.. C Suvl,&D.Ii � V) s — ° 'Discussion With Person in Cha— rge: Corrective Action Required: I ❑ No I ❑ Yesi I have read this report, have had the opportunity to ask questions and agree to correct all ❑ Voluntary Compliance ❑ Employee Restriction/ violations before the next inspection, to observe all conditions as described, and to Exclusion P p ❑ Re-inspection Scheduled ❑ Emergency Suspension comply with all mandates of the Mass/Federal Food Code. I understand that noncompliance may result in daily fines of twenty_f_ive-d.o.11ars-o.r-su�ension/revocation of ❑ Embargo ❑ Emergency Closure your food permit. rU� A t4 A i ❑ Voluntary Disposal ❑ Other: ?-50I.14fC) PHFs Re"wed at Temperatures Violations Related to Foodborne fitness Interventions and Risk Aa ording to Lau Cooled to Factors(Itetm 1-22) (Cont.) 41`Fl45"F Within 4 Hours. { __ PROTECTION FROM CHEMICALS 3-5{11.15 C K)I1ng Method for PHFs 14 I Food or Calor Additives 19 PHF Hot and Cold Holding 3-501.16(B) I Cold PHFs Maintained at or below -202.12 Additives" 590004(f) 41"145"F" 3-302.14 Protection front Unapproved Additives" ( 3-50 L lb;at IInt PHF<M1laintained at or above 15 ' i Poisonous or Toxic Substances ! } I 40'F tol.lI identifying information -Onginai C -SUt I Containers' h(A) Ro { ams Hcid at or.1bw'e 13(1'1,.' ! ' C ownion Name- Wnrki +„,,,f i_.�1t ! Time as a Public Health Control i f � 'r '0_.it _ w.utr�r>” Pim." .;�d Public lietdrh Central' -j Ii -01.11 —.__, }{} ,._- : V::daf,;c keyu)mmeut i li x , ..12-t1 lf{L�tnct:on -Rose ncc.t,.at t,::'- '--- 1 7--202.12 Co!tdmun:of IIyo" --- � 7 2o'l I1 Tunic Cuniameta -Pcohlbl!iun,' REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 17-204.11 ( S:mitizer,.Crnrrur-Chauic:'c" POPULATIONS(HSP) (_.',}4.12 (-hrmicah t„r'+'a,hing 1'rodure.Olte.6.11 21 :_501 1 itA; Uttpa,ic,wired Re-oatlagcd Jme'e,c and -i-- .__ �_-- -' I Hr,eut^ee wi!h Rarnin Lab._I:, ! ! 7 A04,14 ( Dnuw Ai',=,e._Criteria_`__-�---� -- - ---------- ._ _ ,-8111 I'.fi1) 1:::of Yalemi2,M �_ '051l___ Imid:'ntal I;.Xl Contact, I,uhfrapH, _.t.-.____ —__--._.--. _.� a-SOLE ij)) R.,w'or Pathali'. C:K,i.rd Animal Ftx,d and ".>0(..!i R,e,;naae<l I'Rr Pe"icui;, C,itn :n' ' :ref NO; Serves. ! p p;x 1.we an:,,a;:d. v: ;tL}:aa'r Nu: Re-<cr•.s_d i CONSUME!' ADVI SOPY TiiiElYE14SPER`TUHECQNTROLS et :rrfz, ,'. tlnci.',r,.+•.,ked i ! 16 Proper Cooking Tempnat,re=fn; 1 11rf-.._ 155'F ,S S.'; ft?r Rw5 ,Sly.: r. t 3 , ;?t:,, a . tiles' u Ci. PE :AL REOulREM[#a t S -------------- f :,.; .i, ., ^, . *t :- ':,. � a`.:. .. - :i, I l'iciat;,yt. .• `:e�;1,r ^.'41.£X;;:�i-Brite , , �.,.:r; '?it1!'ft' i;Y,ct. tClrl(�:,l::r• ,i:ld i 1J'.i. ri :ai a } 1 f'.•,n:,a:t1lY a r:,l:, (1 -' .;,ti; 't LF,!"':) , i 17 _ PLh_2a_m,3foFief i ". = `f ... � i7?.t 1FL �- 77 f;:tr;2TOI."Ft�.A .'r.:C� Es- ` I Iit ;b:+ i l;: Kv,- - - - -- tkfrai5 23.36; .103.11113 \tt.tu:';n':'- V:z' f' `- 4Artaa S',nding ' .`';<•"m +,,,:- .. ,at : '?L . u+ !',$r•r:r; 'c(sa'.:-;,. ( 111Ur _ ____.__ '.,u:a, rri,.:il•. cat. -r„"tr.,,^t� ..n(r'1JhVtr:rc(,arC<?ftr,., , rrt/;, i--i`t?.i lit.') Coni:nzi:'ially f'rtx: i iYi l 1""k: - •i`rr<:i'::;:: i.' ; ,;':c; sr, o,.` . i:ha P,,,,ri C`do wid i:', .',tlll 4u Ft -10, ! I(E) i R,rmaww':t.•nsh(cc P:,Conti.y Bc.; f Yom i Good Neta'Pracs,ces FC 530.000 oo- iZ ;a,L^` � � 23 i•I,f_iacsm„rt one Perzamr`i -_ 1 18 1 Proper Cootinq of PHPo ( _'*_ _ _t-_>'xi.:P;l raA Pmie-t.n., _ ___i FB -t &I. 2b. :.ntpzgn:rgt ana Ule(:Fde-- -_ __ _'- ? F' .4 _ 000 _. 1 501 1 I(A) ( Ccadunt Ca,k'd Y1-I1 s Pon• 14WI i„ �-.. -- - ' - - -- -- --+ I o W ilor,ptl,mbiga-s rj vV�.E i? FC-5 7.),l 1wohm 2 iitwr Hort From -L7_- -. own Fa:'lit} - --- - FC.-S _ •_u6"_ - FW'itnm4H,,ur^ "20- -;'ua.•r'-'o:a cr-nxtc_t,iztr-'af; '- C_ �- _00+_ __-- �. - > r.,,. OC'a attl.i ?161 C oolirw i iMt Macs: , ra 'mbcnt .= 1--- ----`------ -- ----- -------'-- _ --- - _-- _ - -- Tem:irai,:Tc in_'re.lii la;b. •10i �_ r„+v; � j 'i r na'_...local„vy,:,': ^!,.:.'..' ��,;'.,0. CITY OF SALEM BOARD OF HEALTH nn Establishment Name: ;RrcthPeA S .I )R \l Date: Page: C of c�( Item Code C-Critical Item DESCRIPTION OF VIOLATION/ PLAN OF CORRECTION Date No. Reference R-Red Item .Verified �-} PLEASE PRINT CLEARLY ' �,�CA nc ? I� �.S�t !7 i 5?aP r TI-»n l� I a //On G. Ot{( (iI n--. F I ieel c ct-- � ��vvu h-;,vie' hek vl r<,r c-fP d An : P.vntr,� (�0< c- --P�c 1, 0, , , r Gli tLC t ill( "Wivic`'j uJV\P V1�ri�r � ? i I ✓ r� �lti t r�.2r�rr� 'rFe(�IS air e 1.4r� ;� t � c� b�t, e � IIv fi� rcpt I �nll kA S-eMl2( C6 UV6i-, ; tNally tixlQAdZ�t-1 ifY,t7 Ill 1Us k-)e I I y;v\ s 6-nIaLe. OM rust-,✓ + c`v(, r �hC (�iv� 1rcrcf s lf) �irl�� al�� a lis« i r, I 1 � I ✓;fitly I:r � �tnili�Qr c�t�c�VC�yc(fi'!lt�t � uSt be lv�rl-I-, I J` ✓JI Sb}c� ca5l r h��tl ri /ls� I�vti nt.rce lc� e 7�� r�n4�� -fp Y\eac k a —hc�4e (ltsdl�, nka � )( ud -t'o ILS ) r" h i0n , 1 1)1 be b (,,/ S�il� t �r11� I I `r A�oli4- �s F cussion With Person in Charge: Corrective Action Required: ❑ No ❑ yes ave read this report, have had the opportunity to ask questions and agree to correct all ❑ Voluntary Compliance ❑ Employee Restrictionlations before the next ins ection, to observe all conditid`ns as described, and to Exclusion 'F P ❑ Re-inspection Scheduled ❑ Emergency Suspension r' comply with all mandates of the Mass/Federal Food Code��l understand that noncompliance may result in daily fines of twenty five4dollars:o r suspension/revocation of ❑ Embargo ❑ Emergency Closure your food permit. ��r// //�/v�(// ❑ Voluntary Disposal ❑ Other: � 4 3-501,14(0 PHFi,Recervad at Temperatures Violations Related to Foodborne illness Interventions and Risk According to Law Cooled to Factors(Iters 1-22) (Cont) 41'F/45'F Within d How's- I 3-501,15 Cooling Methods for PHFs PROTECTION FROM CHEMICALS ( 19 PHF HM and Cold Holding 14 ( Food or Color Additives 3 50?.1(F) Cold PHFs Maintuinul at or teinw ?-2(12.12 Addtti>.•csr 590(Hk{1-1 1 f ?-302.14 Protection front l:na>prw ed Adddri,cs' 1 i-501,l6iA I lot t'HFs Maintained at or above I IS I i Poisonous or Toxic Substances : I � 1 IOIAI I Identifyin ,nfoioration - Of +n.d 40F. ` 1 I Cnutainera' Roast,tidd at orabove 1?U•'F `ZO Time as a Public Health Control 7 iQ211 Cutnnnat Namt - W',n•k n,e,Cum.nnarr` -- — - —_ 1n --- II'i ntn5t'uirila111 ti• aruogn-Situahc" r}t r'onl_of--� -- Cond j 7-103 11 Tom(ttit-n:-if of c- REOUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-_'03 tl Toai� fontamc_c -Prnhl b_r.•t,t,.' 7 2(A4 I I I ti.tnitrrr .C'ritr'rtn -C'hrtniea!e - POPULATIONS(HSFj— 7-'_0112 —_— I zi7 '-s'i' :t,�t 1.'r{`:fcteunredPre-pac,:.teedJuretc:,tld {'hrnticaL frn W'a�h{n�Proul¢•e;c ,Hari a' . ')---..-------� 1 i lialertes a-id: learning iabzlti' �7-2ti=! IQ (h�nte .'ltxnr..Cmarnr' —� . SU1J i(fii I L,:of Pa,iswi^_ed 7 205 11 _ haid:'n{al :.S„IJ iii-t= 1<.mr„r 1'arvaih.(_)K,wd Animal 11X,J and Rau S d -21N).12 i :itxlrn: i>,:; $lauu;c.' I--: 'l:1 1 1 -. is ' �::: :;,{. ' C:,,=p,.ard ,cxi Pac+:.{�. tioi -.'Gti ii Ifdtkfng^♦:�tdrr:. Pca:Con::.i .,tfa i __-_-.__. .�_{.__._...._ _ I 4taanonp.. -- - — ` - — CONSUMER ADY)S0RY r'2 3L0: i 1 C on,i)I1wI Ad,•u,rr i'tnt„1 I,{r Continopt.ivn of� TIME/TEMPERATURE CONTROLS :uiu:,:i }•vgJ i'1:.^ .:rc Rw Cn3ar...+:dc:1+: lri _ � Proper Cooking Temperate es for � ,• f i I PHFn I �:,t '"?i:{:a,:far ?•n..c';<rd:,J i:':ivan:,re i-till .:all:( i? 15 5,•.: S44 I I t SPECIAL RF.OWREMENT'S i vy It ns' f•. 1 y" { -,ai}:.- :-.+::a t: ty?'' ` h:,a�:. L:� - ,..r n::dt;nu; c;f`scar...: - SAtJt:\•-t t gl ut —_ .;I rAv I h-tnrr t3',id CPi'! <:,.;:e.1 t'•t:l-. _-_�� ':n;ci:ii' 't; .;Idtl , :{.t:urs !fund be i •' C,vi h-t♦ .`.rfiPn O:m t i,.7, +t::�. I � !�.'.ia1(,:.' ,...Vit, r t7,; :.1 ..R:;tt':df c' ;r:!,q3.. , I t r Pel,t for Hot c:.,::.:ny ._;r;of r i .J;u`::ri A7'•"_ O :x-100 ri .f , rJ..Ct_ "f'' I it i I i 'C', , t l,,aii5 i.Zti3 -IW't l;hi r.I(ii ' Jr .. ; .: gut I Ilan. ;'i', nt. :'.'.:'et t.r gig,.•::, <I n•tr g"•+... , /r,g.rt i"lei,:. nfl br i i{r> Arta t.,,z,i P't 1 1•.♦,1 - ;o:,nt, ig:ti•: t%•.. •a.::q,_ ;�) rit: i rcri i',',it:u..g I„` r'<1;1. r 11():, Ren:awil” L•n,llrcd ('+:;wn,:f;is;.ri lIlan? cr-nnri Fierarl Practrce_s Ft: 5JP.O00 -P�rr - _-_- ' FC.- ? 1 f 2+3 _ �F_Yi:ind'wo F'n.rr tion _._F -.+1g Proper Cooling of PNFs f w _ ._-- - __. � 1X''4 r . •i)niGnF dnd iltengs P -,. }py- `+o: L;4A7 (`t>t,lme IIIIn 2 d Pl-Wow, I ro'(J'f to ( [P Wa'ar t'4:qb,� .v r"No 'e ' PC-5 CN;6 Whthm ? ilour.::'u:lnnn ..! t' ( >: G5 PC I 501,i 1)131 (`i, P14F:.M14adc F{ant .0:Ntiw --_i "-- -" ---' "---- -- - 'Panprraurrehuse+iaan<;' -1:'b, :SF30 . Otac: i- 't'tinVtt".(it iC':t,.t.,'. .. . .i:f.-,: i .i•Iiu♦ uic.. :..-. .fv - ritn _ CITY OF SALEM < � BOARD OF HEALTH / Establishment Name: `V'1 v ��C < <_ �\ Date: Q\ fG /�i Page: of �c I Item code c-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION DOW No. Reference R—Red Item = .Verified { PLEASE PRINT CLEARLY ' PrP 5+_)r\eJ i)V)n-A r lu �n � etP,iilefl ,t rt �v Irt r (a ntn < n111f1� P, / rIrri�rtkfi� V'oorl (` 1'PN01r)0 _ t..!\-�`��n N -c-ziV� ltA]n9Y �_ h6rit0(� —{ � I10 U n.,� 3� }lkf � ^��rGS� ek+-erVI/II Ic lVl f-i1� 7 rlylVCxr�� CIOCUWL�vi �ct�l"�e1 �+ eH1 l >>,E' PS' ch��4 Cct✓e 44/� `_�- I pa I IYI �K (-Akw,'viSD PC {, l? ) n I/ Mkcf �+ itis 4-b b c0 rf, c kpc(. ' -0 " 1 6_01) ifcr fr�>7' Co-�� C cl(ec E d at -kAn 15 t wut I ` I r x7 s I I ' I I k Discussion With Person in Charge: Corrective Action Required: I ❑ No ❑ Yes I have read this report, have had the opportunity to ask questions and agree to correct all ❑ Voluntary Compliance ❑ Employee Restriction/ violations before the next inspection, to observe all conditions as described, and to Exclusion p � / ❑ Re-inspection Scheduled ❑ Emergency Suspension comply with all mandates of the Mass/Federal FoodLq�gle jl-understand that noncompliance may result in daily fines of twenty=five/d,ollars-or" spension/revocation of ❑ Embargo ❑ Emergency Closure your food permit. /f✓(J P"/I, / ❑ Voluntary Disposal ❑ Other: Y v 4-501.14!(') PHFs Received at Temperatures Violations Retatild to Foodborne Illness interventions and Risk According to Law Cooled to Factors(/tefns l-22) (Cont) I _41'F/45"F Within 4 Hours. } PROTECTION FROM CHEMICALS 13-501.15 I Conlin!;Methods fix PHFl, 14 I Food or Color Additives 19 PHF Hot and Gold Holding I # 501.16(B) Cold PHFS Maintained at or below 3-262.12 1 Additinc0 54110440-i 41"/4j°F• 3-302.14 I Piotectloufront Unapproved Addinvec^ j --- - i 3 A5 LIt)(A) HotPHFgor above t5 i Poisonous or Toxic Substances ; (01.11 Mcnttl'ymr infounatnm -Chtginat 140 F. - I Cunt,tinete' _;_5ta.1`'"'-ii I Rtx?at.�Wd at or.tbot'e 130'1: a ------ ---- 20 I f Time as a Public Heatth Control 7102.11 Ck%imnnn SnnrW.)rkmr s_1nx.lral - { t9 i _ rice,a.a Puhiit Health Control'-20L11 ^Jdpm soon-Star aCc" ---'--- rga'�k 67�� I , , . :.,,:c Ficantreefant '--.5.02.i i Y,e>tnct:on-Pwg Tice and i....^ ___-.._- — �.__- _._ _— 7-202.i2 To,%i of I)f i!st` REQUIREMENTS FOR HIGHLY SUSCEPTIBLE ? '_0? 11 "Co;.ic Cunntin..1: --Prolr,ht•n,n.' POPULATIONS 7-1.04.11 Sanitiiecl. 12 ('h:ntica3n$n 44,t'htrp.l'r<nD,:c (ntc±ia' E 21'"+-I,01,11(AT Unpoacurvcd Pm-paa led laieec and tilt(: 4i'aruinE lahrls` 7 204 14 [dine Aecna.Cntaia'� _ _I:xxl i',•ora t tuh; a,n!.;`—_� ' 3;;! 1103t Ull u! Pa>tc•urr. '.t.C'i 1 !1!}t Rn'. nr P.m:ai!v G,>k,d.4nitnai Foes}end ?.206.tI — ! Re,iriued t',,v Pe,riude, ! 1 ), L------- i 7-200.12 1 ,ix lcrt t3aa S:anom , ,—:--- ._—_ .____- -_ _ jSt:! ;ilf.! `l.;c•+'ti 1¢=d1-'.nvi k'ack.tet L<v R•:-gent:!. : 73ti 13 � }5'.l,kil;g P,,:ule^:. )':��t:'onstc;l ,nul ._.- CONSUMER ADY1rn7-71 _ TIM 'TEMPERATURE CONTROLS == ? .' ar, utun :4.r ,eJ !'tr i int;tnvptiun of :i;:i1tiA ! .3� lhet'i, ku:=. Cndeoa>,kvd n: 1 1 F f Proper Cooking Temperatures for j ! PHF -. _— J j � ,,- . i r- - - ;;t.,,; ,-rtb:::;.,: t'n,rssr^d•n iaitntn.t:.e ",,..i- 'rin,t• 1nuul d,.ae 4rr:n... 1r; 1-U:-e, !', ,".c:.. . ' t[r:' :,:},aL:utr 6t• €2 mi, S!,'li , Altironl._ lSi i� 1` _: P,,, .^ri l:'.:.I ? u:..t -i -r.}in' SPECIAL RE(3Gt'r3lNIENTS —e cv ._..__, ._{ 1 .r.14,`'); i'. .;}) i i,ti 131: •i` i ,i1t.:i! "St){R�ti:.?i-{i•r7 j :ai•'rlii t'. RF,,';.': hgtti 1. (ril,�.�„Tari' 3:1(1 ! � - - ( , - 1•I_T:`.._._� (, . ..,.,.� , ; t.fi:..,e9 C'}>¢LSt:U;±S t;;.l is,: , . , r•h:iiL m:•lion, cW1 '<ci:. 4 S';'i”?:Cp it4,i,': Vl,' a(1nr+gL'i Ati' "C:gH}N t?, t.. i;,. itGi i-!'Jlt.:r±a 1:_T J ,-tlwt )t{ T 2/t. , �. Ilii t("`i- '• ;c, ------ - '-- t)iertsP v;_,;tit 40-.I I(F•t \furor N+a i 24icn::•S'an'!:rr: G:r:r z,,.` •> : ,p• 'r�. rR =z u':'rcl:d:- a,r, ::'Fs:<': :1•d,sari Te; - --- - -- - ---- �443 ! IQ:, Rilinaning u'nshr:,; Pwiwfl,1,15, Hdnt Good Rera:(Practices FC- - 530.006 _.._ _Aanag,mc_'t and 'K -? !4D_ L8 i Proper Cooling of PHFS — _.?_ _.;.Foca%;r:d Furxi Pmt<t'•5a', ._- -__. °C -I CK)"_. __.r <';i Enur:ntr-.Tit,and UIPr,Si Y f�' -4 005 ' )hl i it iii a>Idntc C.#,L,d l'Hpc unn. 1-u?'i'tr � �c � YJ Ater,P:,:^Gn„ ,nr 'tla,re, _ -__ _,. FC-5 f _5 ,. 00;= J' 14'uhm 2 flou :a!;d From r,'r'i' pp, a.F:- r'; FC—ti GC7 i 1 t H-15; F WitDm 4 Howl --i - - r �F rei'S',:;c;,.a > -- - -- --`-0" -- -F PI N,L dr Fr.,ni "<d 41t_fa I ' Ti-mpclaarre Gtercnlc(it,n,;1`'1 t` \born rt 41itrcIf, ; :)Cr, -..,f:iia I:1}:'lt II••!, :•.,:: !� i I, r ,..I.- ., �.5:, _. :,'t, CITY OF SALEM BOARD OF HEALTH Establishment Name: P)Kkk e t S V.t, Date: Ia,IU 10:4- Page: of Item Code c-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date No. Reference R—Red Item cc PLEASE PRINT CLEARLY Verified GVIrv�.,1P `I� V1Q n IVISn�� {i ,n 1!l)( c ( IrYI ( � V1fY f I I t c\I�l em c A IP(P Yv7 ;d' �'tC's\YI 9rl C-'Q ('l 6T �i�C3 (`x �'la•P �.VQ Rl� (Z V�Q G Ill -�-t r LI'r �'� �YJ V�V ,n�r,r 17 (Y , I V '_,(CIc PG C-0 � v,-)V-4 V1 -flrnr �i( PG ih 8 Sh r. ,G-$�i✓1G C7r\O(> �zj �,P ; t.//WonC4I C!5� <_IY1 ril l[IP -P vi I A .")P-P kc-1�fn-,M I< \0(-I 6l✓1a —I,U f-)('f I✓- h .11 ' I�-)-5,'P -i-Y'n_ n IMD(-_ 1VLYL Girt - !--,IA rte( V1�Pr IC�f(� lYlr 10 -HnZ)r deCtii_ I/Q fV11Jc, Gli[� t7151�5 D {Vim {127(7)JC� . �(1uf�571r-,GfP QI�P(YIZIIbP -ba J r 1'o cct I i it<( 11�'cc t , '� a rc -I �, �nec t�y� a��c1 Ctn on•�Ilif�,- 1i1s�Pr-Ei�n � GSI ab:�,� �li,�la'i�o�� -{�� hel'c�rrNc�c✓. I I f r lan--- — Discussion With Person in Charge: Corrective Action Required: I ❑ No I ❑ Yes d I have read this report, have had the opportunity to ask questions and agree to correct all ❑ voluntary Compliance ❑ Employee Restriction/ Exclusion violations before the next inspection, to observe all conditions ds described, and to P r V ❑ Re-inspection Scheduled ❑ Emergency Suspension comply with all mandates of the Mass/Federal Food Code. I understand that noncompliance may result in daily fines of twenty-five dollars or suspension/revocation of ❑ Embargo ❑ Emergency Closure your food permit. / ❑ Voluntary Disposal ❑ Other: � ✓ V 3-507.14fC) PHFs Reuived at Temperatures Violations Rulated to Foodborne fitness Interventions and RiskAccording to Lau Couled to Factors(Itehits 1-22) (Cont.) , I ( 41`F/45"F Within 4 Hums { PROTECTION FROM CHEMICALS ( 3-5(11.75 Qutin0 Methods for PHFs 14 Food or Color Additives 19 PHP Hot and hold Holding ?-2(72.12 Addnite.^ _ -- f I -(-5(71.16($) Cold PHFs Maintained at or below 590 004(F) 41"!45"F" 3-302.14 Protection from UnapprIwed Additives' f i ( plot P}1}'s Maintained at ur ab we 1.5i Poisonous or Toxic Substances -501 INA)I 1340'F i(1Ltl idcnut mttnfr',t maunn Uu�inai -+ Y t• +-541.I'it,.\t ! Roasts Hcld ai tx abo:'e 13W1% i'uIt,uner>- ----------- ,Q I Time as a Public Health Control Common Nana, - D«,trk r, l owam,.r;,� _.__�-- .__ ._.____...{��_�s SdPa au+:n .-----'-f s.:i U ( Tim,a5 a Puhlir I feaith Coml III, ! ' __ _____, )iLr7:Ut41i t°•:,GCC l:euti3RillC37t 2.1 i { l:c�tdctinn T'r,•seruc and h,c.' j 7-'02.12 Condition of tT%e- f 7.:103 tl Toxic Contain REQUIREMENTS FOR HIGHLY SUSCEPTIBLE ( i-204.11 lannizet ,`C'nterPn -C�t\:,nic:icPOPULATIONS(HSS ' —t-------,---- '-- - ----" --�— 'fl ; �Q'.I lt,3'r t:,tpaacurt.cd Pr;:paci'atIe9 tunic atti3 ?-'(A.1? C'h,,nucah k104.14 ( Drsinfl Avents.Crucrui i Raf ela2v?pith li,Ir:nne 1.31,ac' "05.7 t hn'id�rtal t-,:xl t_un,.tct tf;of Pa.n.,tri;,-d G:�' ?.t„,1.i l u'rt P w'or 7'zinai) C•„O0d Animal Ftxril .ind ai6.(1 Rr,,it it It:d I',r Pe,tl'tde, GII-teri r ka,: St••J ",n:•tt. \.., S•:rvc ?-_206.1? k<xt, a; 13:tr 5t:u;orl'. . _-_--- .—.— .-------- , I ' fti., It.C. 1 C;!,+p;nea F+.ki Paceaer \,it R•'-scr:et) J ;0673 hr.trk:rI o•,tdtf 7'c,;! o;nn ,t;1 _.___. _ _ ._ CO_NSUMEP..ADVISORY -r-- 7„ t,(t,. it TIME/TEMPERATURE COCONTROLS (...,a,,t F�[ Ai! !?oi'v ;Y-t,d t)r i twun,-'li:tn Ct...... !-,xxh 'i h,a air: ):,:v f';Idci.,r+kr:i r: 16 �---'--'---' � ;=rcper Conking Tempze aUues for � i •,< ,-.t07 77 tri;('; � '� ,•.: r: .: 4., i I S"01 — t Ftnh. Me ii,•�, _ - . _..�.-_ -_ _-__._ ------ I:f ._...__...______.._.__ ... Aa i Anind!i, SPECIAL REQUIREMENT -tel '!o3vI,0) 1 c,ed y,.'i li;bt K,+:,i LI, � ---" -- --- - itt! ` 4',i I it-I ',lf'b - - , ,tb'•.,.\lit}: i[iv:a'..`L, J SiPcii<r,t . ... i0) ;n S ,li,t.l t'iU"1`.,'h'lj cif.mJ •a u'I ,',i,f.,_ ... .-.-' ... '.t"si :.'t:'r:. - .:c:.:;.:'I:. .ik't'itl i:f+ � � Sti.ih. , . -':11:ti Ia1U;i-Ish ,*•`,. .. � .,!! !'{>'. !^ ,.., 'tt.' '6"Fi , .. .. ,.'a,?CJ ft i to,F:;;t}t^lu,r:.�`.. zr r' -"WS - fru'., _ ...n.' ...: '.. Fr»: Jt2rk.Rr»� tE. 1;,. r:L'ars%lt: HiA; tit lilt • :CG."I' .., • .tii't.l Stli; 'fl 1,a:n•fit,- 1�+ 1 � Rl t III aamain,: , ;if r .1'. +,..,,-, ,u.,., 11•:"J: :r1:,:;, •n. , ',etre:,•. I.,tT. — _ --- i..it%t,r,F .J... q\ Rl•?„J:(.!lis 2f :}.i IIt/II-fi" ,.�ti'PnY. "in ,., 1I tr'i i C,,n.n,r3:ia:fro )4c,....;' :"Ck' F• „ .n.(<'a1 II'; 1.• a ... a:•.< rro:d C'n,:'.,,:,' hl° t11:R., ISU (- :"tuiir t, .-4(Uilii: I7cm.mm,, L,,,QtrdPI,mitvsolliar : IM17 Good Retail practices -- `FC _-- -(_$90.000 Sf: .1to9 C!nCt2 n: Pett_Jm•r,i.. i-i, 2 001 _ r'-- r,d.�.; . 'r eat n:xi Pt0i l' tikI -. I jg I Proper Cooling of PHFs ( _ -.._ _ t__ ` _ - .- _._.-_.__, :- _ __.__ - Fo ungm nt norl i iia.,_,5 f_' -- 4 Oct ! . tj,l 141;11 ( ue:,tna Gw �d Hpom L 6PPc ar Fit' � - - ---- --.-` . - - - -- -'-- . „ P , � ;rP 1t'uhm 7 1!our<;:nd (•nan ,.. I _ .. � , 2, c„t<��Fa;'tip' uc. ;18 -.',,.. F,.; Pr 3!8 I r,. - 7 ti6c i 501 1471111 0o,Ju:v HIF 'a'1:4 dc Fo:ui -- f F.int':ia;arr 111erzme3,;<i„ =7'i .ti F '. - -7G_Fr- - -- - - - - ---- ----- �- -- - CITY OF SALEM, MASSACHUSETTS • • BOARD OF HEALTH 120 WASHINGTON STREET,4"FLOOR TEL. (978) 741-1800 KINBERLEY DRISCOLL FAX(978) 745-0343 MAYOR IXBEENBAUMOSAuiM.COM DAVID GRFENBAUM ACTING HEAL:PII AGENT Facsimile 1 (� I Transmittal To\k��5 ! 1�bk - mcez Fax # T�) 4qs ++- 000a , RE: Q Vl I"f1'Lzr 1 C), Date : (6 (-)"o kc J Page(s): including this cover# (O Message: L S a , Cop � �I P San I�-4-xl l ac� Sh-ee'-Q'f euCP fvSZ�Or� enc -HA0 Sahi�( zIer Loh(QN►' t'Dyl U Board of Health News -----------------------------------------------------------For Your Information OFFICE HOURS: Monday, Tuesday, Wednesday 8:00 AM to 4:00 PM Thursday 8:00 AM to 7:00 PM Friday 8:00 AM to 12:00 NOON Sanrt¢er Concentration Log-Sheet 19_ Date:Time Conc Init-Date Time Conc Init,-..Date Time Concanit , Date Time Conc Init i i xI .1 r f 1 Date = The day and month Time= The time of day Conc= The concentration of the sanitizer according to the test kit. Init. = The initial of the person making up and testing the sanitizer r HP Fax Series 900 Fax History Report for Plain Paper Fax/Copier Joanne ScottSalemBOH 978 745 0343 - Jan 06 2010 4t08pm Last Fax Date Time Type Identification DuradAM- Bagel esult Jan 6 4:07pm Sent 919784980002 0:49 2 OK Result: OK - black and white fax Pest Control Service Agreement NORTH SHORE PEST CONTROL 7 Macarthur Road PEABODY, MASSACHUSETTS 0:960 (508) 532.3330 1165 (617) 596.2710 -- --- - dilS[ }� SERVICE LD4ptIhN - ^ITY,S'A`T/g')e�M�Zb f� PER504'fi pf CC''a];c6 5£Plvfd PNJnE . ' ' PVONt__.___. _.__- .._.. ..__.- _____ _-tVpl 4J�FNSPEHT•TO(iE SE�wCEi: - ___. _ .._. .__ __.... _ _ .. C"t.�817LA Ltn,- _ i 5ER' TO Pi�CHu(tFNFO MONTHLY UUARTERILY QTHEH--__ _ 1`115T5 t0 C1E:ONYNtlLikU p T-0 !N -SP42.Gl" '4' .+('`ft T- 4"1- j NS e-crS r t {� vT'S ✓h N k . f9t e ``ce--. -+ .c�t4+c7 t.e ce�atgvm ; SNECIAL INSTtlUGnGNS: -" - '-" ' T BRMS ANDCO//N''Ol�iyfON1S , SERVICE GUARANTEE:We agree to apply chemicals to control above-named pests in accordance with terms and conditions of this Service Agreement. All labor and materials will be furnished to provide the most efficfe17, pest cr.ntrol and rnaximurn safety requireo by i federal, state and city regulations. SERVICE RENEWAL:This agreement shall be for an initial period of one year and will �e�-ew' it!erf annually unless "iiher i;arty cer.Gels this agreement by giving thirty days written notice before any expiration date ANNUAL AGREEMENT CHARGE $ ._ ..- _ .. BY .... GQMPANv _ DA- E INITIAL SERVICE CHARGE $ a . .- .rfiLi;:nti,IdiinruREi" ,yc MONTHLY.'t2UARTERLY PAYMENTS $ -- - ._ _ FOR L'UETOMER_ nJ:�6Hixe'S'sionnfiusci.. DA-E DAILY SPECIALS ` S4 -MON6y4Y- + r--T1J SDArY- + Y ` S * p� 1 CHICKEN NOODLE SOUP WGETABLESOUP 1 CHICKEN LEMON SOUP 1 1 CHICKEN LEMON SOUP SALEM BEEF STEW I 1 BEEF SIEW BEEF STEW I 1 BEEF STE 1 STUFFED PEPPERS 1 ROAST LAMB 1 BAKED LAMB CABBAGE 1 1 STUFFED W AGE ROAST PORK ! 1 MACARONI&CHEESE I 1 YAAMERICAN CNKEE POTHOP ROASUEYST j j ROAST PORK ' 1 SHEPARD'S PIE ! 1 SPINACH PIE CHLCKENPARMESAN 1 BOILED DINNER BRO 1 MEAT LOAF 1 1 SALISBURYSIFAK 1 1 MEATLOAF 1 1 AMERICAN CHOP SUEY� ••� DELI RESTAURANT r--F—R10A.l(---+ rSAeT-UfZDA*--? r--SUNDAY--T I FISH CHOWDER I I 1 1 LENTIL SOUP j j CHICKEN LEMON SOUP 1 CHICKEN LEMON SOUP] NNER j MEAT LOAF 1 1 BEEF STEW 1 1 BEEF STEW yr - { j ROAST LAMB j j BAKED LAMB j 1 1 P li I 1 F 1 SHEPARD'S PIE j ROAST PORK j ry I 4 1 1 YANKEE POT ROAST j MACARONI&CHEESE 1 I AMERKAN CHOP SUEY 1 I BBQ CHICKEN j � SPINACH PIE + FRESH SOUP DAILY 1 SIDE ORDERS DESSERTS NMI= w ONION RINGS .......... .... . .....2.95 CHEESECAKES ... ......... .... ... .2.95 } :. CAKES .... ......... ... .... ....... .2.95 7 1" ,I FRENCH FRIES ... ....... .... .... ..2.50 BR�RKF"I oI,UNC o '�_OMEM',' ��OINNIRS�SAIRDS ? CANADIAN POUTINE Mozzarella 6 Gravy.3.95 FRUIT PIES ..... ... ... .... ....... .2.75 - COLESLAW... .... ....... .... . .....2.25 PUDDING ....... .. ... .... .... ... .1.95 POTATO SALAD..R. ...... ...... .....2.25 HOMEMADE COOKIES COOKIES . ....... .... .2.75 !'0- CHICKEN18$)� _ >� PICKLES Z 3 d Cda ahead SPECIALS Cooked Daily.1.00 REMAIN •••••••'$MALE 1.25... .L�wGs 1.55 .2.9 FOUNT 0 r - � BEVERAGES and to place your Take-Out orders C HOT CHOCOLATE SM LL 1.75 LARGE 1.95 0 We Specialize in serving COFFEE .... ..... ..SMALL 1.55 LARGE 1.75 C bus loads ofbungry travelers 1 20Z SODA J ..1.75 � e i y4vvvlvw fw in approximately 20 minutes CANS ... •..• .•..1.25 2 r n N T ti Z � � 4 11t;., 111 m OPEN DAILY a ¢ { Monday- Saturday:6am - 830pm •Sunday.' Gam - 7.'30pm s § '' a �li'Al. .w-is1•��:��1:��•��1A�7_�A�IuR•i•Ju� CONSUMER ADVISORY WARNING FOR RAW FOODS: y ADD MASS MEAL IM to ALL PRICES IN COMPUMCEW ME DERNUMENr OF mom onion �(s �--- WFRDVISfIIWtEVINGMWORUNOERCOONE)Mar POMMY. Q° " 29,1 DEARBY ST(�R�EIE ,99� S.ALEAM MA.01970 PRICES,ITEMS,&OFFERS ARE SURIECT TO CHANGE WNNOUT NONCE ORsooF a POSESARIMPOYOURNEAON o !A�� ,J BREAKFAST OMELETTES SANDWICHES SEAFOOD .. Served w/Ho er�'Toast '� LOCANICO 3.95 - ...... .. ... .... ........ FRIED CLAMS ..... .....15.95 '. Served All Day PLAIN. . . . . .. . , ROAST BEEF 5.75 _ .4.50 ....... ... .... .... .... • • • ••• • •••• •• • FRIED SHRIMP ... . .....11.95 We Also Have E eaten CORNED BEEF ..... ........... ....5.75 & CHEESE . . . .. . . .. . ... . .... .. . . . . .4.75 FRIED SCALLOPS. . . .....11.95 GREEK . . .. . .. . .. . . .. . . . .. . . . .. . .6.25 PASTRAMI ..... .................. .5.75 �•g 1 EGG... ...... ... ...... . . .2.50 FRIED HADDOCK . ......11.95 SPANISH .......... 5.75 SLICED TURKEY .................. .5.75 r � 2 EGGS ........ ... ...... . ..3.50 """��' FISH &CHIPS .... ......10.95 WESTERN ...........................5.75 SOUVLAKI ........... ... .... .6.95 1 EGG W/BACON, HAM CHICKEN KABOB .. ... ... .... . ... ..6.95 FISH&FRIED RI . ......10.95 EASTERN ...........................5.75 FRIED FISH& OR SAUSAGE ......... ....4.25 ONION .............................4.75 VEGGIE BURGER ........ .... ......4.50 2 EGGS W/BACON,HAM PEPPER .............................4.75 HAM ...... ............. .... .... ..4.75 CHIPS&SHRIMP ......11.95 FISHERMAN'S PLATTER .15.95 OR SAUSAGE ...............4.95 B.L.T. ..... .......... ... .... . .... .. 3.75 BACON .............................5.75 2 EGGS W/KIELBASA CORNED BEEF ...5.75 HAMBURGER .......... ..... .... ..3.75 BROILED SHRIMP .......11.95 OR LOCANICO ... ........5.75 MUSHROOM ........................5.25 CHEESEBURGER ........ ...........3.95 BROILED SCALLOPS .....11.95 ! BROCCOLI ..........................5.25 ii HAM&EGG 3.25 BAKED HADDOCK ......10.95 \►++ 3 EGGS W/7oz. STEAK ......9.95 SPINACH&FETA 5.75 BACON&EGG .. .... ..............3.25 " 2 EGGS W/HASH ...........5.75 ,,,,,,,,,,,,,,,,,,,, VEAL CUTLET ... ... . ........... ...4.50 Fried Dinner Served w/French Fries,° GREEK FETA ...5.25 � Onion Rings e$Coleslaw ` EGGS BENEDICT ......... . .5.95 VEGGIE OMELETTE ..................6.95 „ WESTERN ...3.95 AQAbove Served wl Honsefsies&Toast EASTERN ............. ......... ...3.95 DINNERS „ FRENCH TOAST CLUB SANDWICHES PEPPER&EGG ........ ............3.25 OR PANCAKES ... ...... . ..4.50 GRILLED CHEESE...... ............2.75 SIRLOIN STEAK ... ......11.95 Served w/French Fries GENOA SALAMI 4.50 "' SHISH KABOB .... ..... .11.95 5.75 TURKEY EF .. ............ ... . . ...8.25 KNOCKWURST ....................2.75 CHICKEN KABOB ...... ..9.95 FRENCH TOAST ROAST BEEF 8.25 REUBEN ... ............... ........6.95 LIVER&ONIONS . .......8.95 .. .... ...... .. ..... ... + n .. ... ... ... ... ..... CHICKEN BREAST ........ .........5.95 v , , CHOCOLATE CHIP OR HAMBURGER 8.25 FRIED HADDOCK . ....6.95 HAMBURGER PLATE .....8.95 4 With Baron,Hamar Sown e HAM &CHEESE .. ......... ... . . ...8.25 I' 1 CHEESEBURGER.. ......... . 8.25 HOT DOG . .... .......... .... . ....2.75 CHOPPED SIRLOIN .... ..9.95 BGS,ONO PANCAKES ....5.75 p BB STEAK TIPS .. ..... .10.95 EGGS,ONIONS &LOX.. ....7.95 B.L.T. . ... .... .... ...... ... ....... .7.25 ,; GRILLED VEGGIE POCKET ..... ....4.95 Q TUNA SALAD .... 8.25 CHEESE STEAK ........... .... . ....G.50 q VEAL CUTLET 8.95 CHICKEN SALAD ...8.25 �I W/Onion,PepperorMushroom(0.40each) ROAST BEEF ... ... .. ... ..9.95 _ BAGEL OR ROLL Mw w W/CREAM CHEESE&LOX .7.95 MONTE CRISTO Sneed w/Fria .. . . ....7.25 CORNED BEEF .... . ......9.95 ? BAGEL OR ROLL SALAD SANDWICHES STEAK TIP SUB Snwdm/Fria . .... . ....7.25 SLICED TURKEY .. . . .....9.95 W/CREAM CHEESE .. ... ..1.75CHICKEN THAI WRAP Srrvedulfries .. .7.25 LOCANICO .... ... . . .....7.95 GREEK SALAD IN SYRIAN + ..... .... ..4.95 BAGEL OR ROLL TUNA SALAD....... ... ........ . GYRO Srrval sv/Cse` -"""" "" " ""T 25 CHICKEN FINGERS. . .... .8.951 . ..4.95 W/BUTTER . .1.50 CHICKEN SALAD ... . ...4.95 1' SALADS ROAST OR BB CHICKEN(ONE HALF) 9.95 ; FCHEESE NGLISH MUFFIN.. ... ... . .1.50 CRABMEAT SALAD .......... ... . . ..5.75 Q TOSSED SALAD . .... .....3.75 4.95 CHICKEN BREAST(GRILLED) 9.95 HAM SALAD .... ............ ... . ...4.50 x UFFIN OR TOAST ..... . . .1.50 GREEK SALAD .. .........4.95 5.95 EGG SALAD ... .... ... ...... ... . ...4.50 SPAGHETTI MARINARA.. .5.75 OLD CEREAL .......... . . .2.50CHEF SALAD ............5.95 7.25SPAGHETTI SALAD PLATES „ CAESAR SALAD ....... .... . ... . ....4.95 OT OATMEAL: CHICKEN CAESAR SALAD . . ... . . ...7.50 &MEATBALLS .... . .... .7.95Lbr1.75 Bovet 2.50 Sevedw/PotaroSalade Cale4worTo edSdal LASAGNA 8.95 �' 'CHICKEN KABOB SALAD .. .... . ....7.25 ......... . .... .DE OF HAM,BACON, TUNA SALAD .. ... . ...... ..... .....7.95 CHICKEN THAI SALAD ..............7.25 MOUSSAKA. ....... . .... .8.95 OR SAUSAGE .... ... ... ...2.50 CHICKEN SALAD . ...... . ......... .7.95 MEDITERRANEAN SALADS: PASTICHIO . .... ... . .... .8.95 GG BEATERS ExTRA PER EGG ...0.40 CRABMEAT SALAD . .. ... ...... .... .8.95 COLD PLATE WITH POTATO +,HAM SALAD.. .... ... ... ...........7.95 FISH OR SHRIMP ....... ......... . .9.95 ON ANY ITEM .....0.40 CHICKEN OR TURKEY .. ... ...... ..7.95 SALAD&COLESLAW . .. .8.95 EGG SALAD . ..... ... ... ...... ... ..7.95 I , Page 1 of 1 ; t l Janet Dionne From: Jason Silva Sent: Friday,July 11, 2008 10:46 PM To: Joanne Scott; Janet Dionne Subject: FW: Reporting Graffiti fyi Best Regards, Jason Silva Chief Administrative Aide Office of Mayor Kimberley Driscoll 93 Washington Street Salem, MA 01970 (978)745-9595 ext. 5603 (978)744-9327 fax isilva0salem.com From: Scott Hall [mailto:scotthaII1000@hotmail.com] Sent: Friday,July 11, 2008 6:45 AM To: Jason Silva Subject: Reporting Graffiti ACV Request From:Scott Hall Email:scotthallI000(ahotmad com Address: 35 school st City: Wellsley State. Ma Zip 02481 Phone: N/A Organization: customer hello My name is Scott,I was at brothers deli yesterday and i had fish and chips.at the time i thought i smelled something bad,but i gave them the benfit of doubt,when they told me that they get their fish on friday's. I really could't sleep all night from vomiting and other matters. please be advied to this issue and see if any other reports to brother's deli for the same matter. 7/29/2008 T Page 2 of 2 Thanks for listening, Peter Crowley 400 Essex St. 978-828-7886 7/29/2008 Commonwealth of Massachusetts s 8 City of Salem Board of Health lGmberiey Driscoll 120 Washington Street,4th Floor Mayor SALEM,MA 01970 Food/Retail Establishment Permit DATE PRINTED: 12/23/2008 ESTABLISHMENT NAME: Brother's Deli File Number:BHF-2004-000018 283 Derby Street Salem MA 01970 LOCATED AT: 0283 DERBY STREET SALEM, MA 01970 Permit Type Permit No. Permit Issued Permit Expires Fee Restrictions/Notes FOOD SERVICE BHP-2009-0218 Dec 23,2008 Dec 31,2009 $420.00 ESTABLISHMENT Total Fees: $420.00 PERMIT EXPIRES IDecember3l, 2009 Board of Health f v This Permit is not transferable and must be reissued upon change of ownership or location.The permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code,beofre any revonations,improvements,or equipment changes are made,all plans for such must be submitted to and approved by the Salem Board of Health. Page 1 CITY OF SALEM, MASSACHUSETTS • BOARD OF HEALTH 120 WASHINGTON STREET,4"FLOOR TEL. (978)741-1800 KINIBERLEY DRISCOLL FAA(978) 745-0343 MAYOR IDIONNHOSALEN1.COAI JANET DIONNE, ACTING HEALTH AGENT 2009 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT \ NA%',,E OF ESTABL!SHPAEN!T�YJ V hW(, 0 d, �e," I I-v.V_Crn f TEL# q 7V 7W I 'W ilk � ADDRESS OF ESTABLISHMENT �— FAX# 4q u ✓u 2- MAILING MAILING ADDRESS(if different) < M, 1C-yt n r� ( cl7-� EMAIL- Business': n Website: / OWNER'S NAME /1/ IY)AL V' 1 6 h TEL#�� 7 ADDRESS f t,,4 P) & vdl C rv' r0-q..)iqury /Y1,C1 "Z72s STREET - CITY STATE ZIP CERTIFIED FOOD MANAGER'S NAME(S) (3�1�k �d0 ,S ,,n r� CERTIFICATE#(S) (Required in an establishment where potentially hazardous food is prepared) EMERGENCY RESPONSE PERSON N IYIY�L P I b HOME TEL# /( 7 IDAYS OF OPERATION,- (. , Monday !.:°`+Tuesday Wednesday ir:, 'Thursday,, I, _: 'Friday.'- .! .'Saturday- 1.,° "Sunday I HOURS OF OPERATION 6 M G (n G O Y) : A m 6 P lr1 6 P rvl 6 A'r Please write in time d day. ' � !!e"� � n n (For example Ilam-11pm) ,�IM ! 1 ( M q Pal 1 TYPE OF ESTABLISHMENT FEE (check onlv). RETAIL STORE YES OJT less than 1000sq.ft. =$70 1000-10,000sq.ft. =$280 more than I0,000sq.ft. =$420 --------------------------- ----------------------------------------------------e.s-s-'h----------- ---------------------------- RESTAURANT ES NO less than 25 seats =$140 (Outdoor Stationary Food Cart$210) 25-99 seats =$280 more than 99 seats --------------- kl- ------------------- ------------- ---------------------------------------------------------------------------------------------- BED/BREAKFAST/ YES NO $100 CHILDCARE SERVICES ------------------------------------------------------------------------------------------------------------------------------------------------------------------ ADDITIONAL PERMITS � MAKE (not just serve) ICE CREAM, YOGURT/SOFT SERVE YES NO $25 TOBACCO VENDOR YES NO $135 ALL NON-PROFIT(such as church kitchens) YES NO $25 'Please pay total with one check payable to the City of Salem. This Permit is not transferable and must be reissued upon change of ownership. The Permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code,before any renovations, improvements, or equipment changes are made,all plans for such must be submitted to and approved by the Salem Board of Health. Pursuant to MGL Chapter 62C,Section 49A, I certify under the pains and penalties of perjury that I,to my best knowledge and belief,have fled all state tax returns and pa i all ate es requ fed under the law. .15ig4ure Date Social Security or Federal Identification Number Revised 424/07 FOODAP20�dm Check#&Date ,QQ 41 �a/X�DSJ $ x. - r 7:S.y My File Edit Tools Help C,astomer acc,unr mformion History ; i f j 2009 PP-R m r', ; 603�:i . :'. . .-'� �". - � � �. �` - s NIHAZ INC 283 DERBY STREET:, Orig Bill I _ SALEM,MA 01970 Eftective D .. - ... Display original billing information for the current bill. - - ---- - - ' Lien/Sale '. _ ,---„-Y- :' -, . '-• .•` _Parcel lD I�Special P ial Conditions/Notes , =: � Quick Scan Prop ID -= 500655' - Prop Loc 283 DERBY STREET - ,_ Utdly Accl - ' Parcel °` Int Dl - : • Billed A6l/Adl PmUCid Interest• , ” Unpaid bal '. � ` 08/04/08 29.29 ? 00i Name Ill/04/OB , 29291 i" .001 .57{ `29.86 102/03/09 33.66 00; .00l .00;; " 3366 - Bilking Dares t__."f.�.__. - ...� . � .—_._�:.... . .. , X05/04/09 33651 ` ., 00' _00!1 3365 . ... . ......_..� -1111_ -._.......... - - -1111. _ ._. .. ..-1111___. _ �JBillAudit Fees/fen . 00) �.00 > �.00� .,3 .00;{� , •, Re rint Totals 125.691 ��— - DO' "29.29; - ' 5711 -. 9717 p Preferences� Notes,.Ner, Due 12/24/2008 � T 29 86":.. �...._:.�._. DBG BILL HDR Per Die ;07 'JAN 1 Owner' NIHAZINC. m ... --. . . id t Paid .00'. : : ..� �'..: : _ DBA.BROTHERS DELI&RESATURANT - „} VON pnnc,.inPard bill, lIt 3 o f 10 _______. �1 f •. . 4 206 ' - tG , G17Y ci= ill' PER. Display transaction history for the current bill.' tcaasuasv -- 1111"._ 0283 DERBY STREET Brother's Deli City of Salem FOOD SERVICE ESTABLISHMENT - FOOD SERVICE Inspection HACCP: ❑ Item Status Violation Critical Urgency jelephone: Violations Related to Good Retail Practices (Blue Items) 741-4648 Physical Facility FAIL Non-Critical BLUE '-OWner: Comment:There are several areas of chipped/broken floor tiles in the kitchen,including at door to walk-in freezer.Repair or I Nidal Rajeh replace tiles to ensure good condition of the floor.This to be completed by next routine inspection. 4PIC: 3 Nidal Rajah Inspector: I Elizabeth Salandrea Date Inspected:Correct By: 112/18/2008 Risk Level: s I Permit Number: f BHP-2008-0210 'Status: 4 SIGNED OFF #of Critical Violations: 0 (Time IN: Time OUT: Urgency Description(s): BLUE: All other violations noted in the 12/11/08 inspection report have been corrected. Violations Related to Good Retail Practices (Critical violations must be corrected .immediately or within 10 i iiays)(Non-critical violations 'must be corrected immediately or within 90 days) 1 1 City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741.1800 GeoTMSO 2008 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Dec 19,2008 ) Page I oj2 Item Status Violation Critical Urgency RED: A Violations Related to Foodborne Illness Interventions and Risk Factors (Require immediate corrective action) City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741-1800 GeoTMS®2008 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Dec 19,2008 ) Page 2 oft s w z 0283 DERBY STREET Brother's Deli City of Salem FOO® SERVICE ESTABLISHMENT - FOO® SERVICE Inspection HACCP: ❑ Item Status Violation Critical Urgency Telephone: '5- PROTECTION FROM CONTAMINATION -741 Z4648b -- ` Separation/ gregation/Protection FAIL Critical 0 RED OwneC ' '`- om ent Walk-in freezer had PHFs stored above RTE items.Organize freezer to properly separate PRFs from RTE items. Nidal Rajeh c ° ' _ _ _ ontinental fridge next to stove had PHFs stored above and next to RTE items.Organize freezer to properly separate PHFs from PIC. - RTE items. 1 Nidal Rajeh a Food Conta Surfaces Cleaning and Sanitizing FAIL Critical ❑d RED Inspector: r 7f'�ment: Slicer in kitchen had food debris build up in blade guard and on bottom of blade.Thoroughly clean and sanitize slicer. Elizabeth Salandrea Date Inspected_:Correct By: yW ' e cutting board in kitchen is stained and scored.Resurface or replace cutting board. 12/11/2008 'v "' ` anitizer log not being kept daily.Maintain daily log of sanitizer concentration. Risk Level: Permit Number: „ BHP-2008-0210 - VIOLATION - ry #of Critical Violations: { 3 , Time IN: ' .Il Time OUT: 'Urgency Description(s): BLUE: . Violations Related to Good Retail Practices(Critical violations must be corrected immediately or within 10 days)(Non-critical violations .must be corrected immediately. or within 90 days) I . - . City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741-1800 GeOTMS®2008 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Dec 12,2008 ) Page 1 of ' Item Status Violation Critical Urgency RED: Violations Related to Good Retail Practices (Blue Items) Violations Related to Food and Fo Protection FAIL Critical BLUE :Foodborne Illness Interventions, �n o ent:Walk-in freezer had some uncovered food in it.Cover all food in storage to prevent contamination. and Risk Factors (Require fir/ immediate corrective action) �/]90mental fridge had some uncovered food.Cover all food in storage to prevent contamination. Zo a produce on shelving in kitchen uncovered.Cover all food in storage to prevent contamination. food in 3door fridge across from fryolators was covered with cloths directly on food.Do not use cloths to cover food. 06ome dry ingredients in barrels had their scoops stored incorrectly.Store scoops either in a clean sanitized dedicated container or in the product with handle extending out. Equipm�e,nntt�nd Utensils FAIL Non-Critical BLUE : ant:Walk-in freezer had significant frost and ice buildup.Thoroughly defrost and de-ice the freezer. helf with spices above the large prep table in kitchen needs general cleaning. ett oven needs general cleaning;replace tin foil at bottom. 7o in kitchen was in bucket.Store mop hanging to air dry. loor of the dry storage room needs general cleaning/sweeping. er nit at end of front service area was leaking water on the bottom.Investigate for leaks and repair,and remove water. read drawers need general cleaning. Physical Facility FAIL Non-Critical BLUE —Comment:There are several areas of chipped/broken Floor tiles in ythr�e.kitchen,including at door to walk-in freezer.Repair or replace tiles to ensure good condition of the floor. 710 J(,fi r-C1 K_Q_ L/ere is a stained ceiling tile in the kitchen.Investigate for leaks and replace tile. Reinspection in one week, all violations to be corrected. J�"w f. 4 City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741-1800 GeoTMS®2008 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Dec 12,2008 ) Page 2 of2 0283 DERBY STREET Brother's Deli City of Salem FOOD SERVICE ESTABLISHMENT - FOOD SERVICE Inspection HACCP: ❑ Item Status Violation Critical Urgency ',Telephone: PROTECTZomment: OM CONTAMINATION 741-4648 Food Curfaces Cleaning and Sanitizing FAIL Critical Q RED Owner: Container of sanitizer in front was too strong.Provide sanitizer of proper concentration at all workstations at all times. 9 Nidal Rajeh TIME(TEMPERATURE CONTROLS(Potentially Hazardous Foods) PIC: HotandHolding FAIL Critical ❑d RED Nidal Rajah 1 omment:Walk-in fridge found to be 46°F at time of reinspection.Turn down fridge to ensure temperature of 41°F or lower is met; Inspector: monitor fridge closely to make sure temperature is correct.Owner stated fridge to have new compressor installed on 6/21. Elizabeth Salandrea Violations Related to Good Retail Practices (Blue Items) Date Inspected:IVCorrect By: Equipmtensils FAIL Non-Critical BLUE �Yf1eS �/17��. v4m : nt:Slicer needs general cleaning including undersides of all components. Risk Level: small fridge under the handsink in front is in disrepair and has grime accumulation in corners where flooring has failed. Re it floor to ensure good condition and impervious&easily cleanable. Permit Number: an opener needs thorough cleaning/scouring. BHP-2008-0210 . Status: PARTIAL COMPLY I#of Critical Violations: (2 Time IN: I Time OUT: Urgency Description(s): BLUE: Fin reinspection will take place in one week, all outstanding items must be corrected. Violations Related to Good Retail Practices (Critical , here are water stained ceiling tiles above dishwashing area and one tile is partially missing. Replace all water violations must be corrected stained and damaged ceiling tiles. immediately or within 10 days)(Non-critical violations must be corrected immediately or within 90 days) City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741-1800 GeoTMS®2008 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Jun 24,2008 ) Page 1 of 4 tl Item Status Violation Critical Urgency RED:`__–r_— _ —.- 7 Violations Related to I s Foodborne Illness Interventions and Risk Factors (Require immediate corrective action) City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741.1800 GeoTMS®2008 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Jun 24,2008 ) Page 2 oft (617)625-0386 ' (617)625-0386 - S exiax c4le & ex , 9nc. $upexaox og/G�&' da0exation, 9AW 1 atioxCOMMERCIAL&INDUSTRIAL SERVICE COMMERCIAL&INDUSTRIAL SERVICE GAS FURNACES + HEAT PUMPS+A/C INSTALLATIONS GAS FURNACES • HEAT PUMPS•A/C INSTALLATIONS DAVID SIDOTI 11 PINE RIDGE RD. DAVID SIDOTI 11 PINE RIDGE RD. Proprietor N ANDOVER,MA 01845 Proprietor r NANDOVER, MA 02845 r=, (617)625.0386 Sage 4 e c4le&W4iu.Vezataan, Pne, COMMERCIAL&INDUSTRIAL SERVICE GAS FURNACES•HEAT PUMPS•AJC INSTALLATIONS DAVID SiDOTi 11 PINE RIDGE RD. Proprietor N ANDOVER, MA 01845 < CITY OF SALEM ,� BOARD OF HEALTH / Establishment Name: Date: 61 ( 0�� Page: of te Item Code , C-CNtical item " DESCRIPTION OF VIOLATION/PLAN OF CORRECTION veritied I, No. Reference R—Red Item 7 .. PLEASE PRINT CLEARLY ' I D fr-reA union t-A N-insloe_�,+ion cyP ecifakh",-, t moyit CLU 1 s I rekcl cecrt� i on omits Oc:z4 -R1 o 0_en,�i unir ate holdi J I?ronPr- i �PiWvl1�CI�UY`e S � r c - C�-�,rrFi h o vrl- .1 r\e_ach-i n-- Ute.Li°-F t""� tl✓-rv, Ifild 4 I. ' - I e.D' i onk- may hot- lop- used onfu f,�o.an(eA -kD mulrrl-cj�n arn,ner- F�wl.�arc� h � 'op 9 f�� C)c icJue'r. 1 F}otu ly f eyt��era��>� toq O-p cd( G�ec{�ed uni1, rx a Pr11 rf�.r�ts IV! callcx IK-in �eQ�_�,r more Abe nt�t' ivrt-o -fttQ c>.� IY-/�, 1 _ I i d I�r tw_ c�.l( "tfitaw-ed eehd mr,,,i in. 6& li'Le4rzpeli(Y I F 1 l lsl, .AA&V-is ream t?kt'_d +n o0" UmQ( Ove(CrIP av oitf). �h� ner`t�r ( vi(I vN { I ,rn toP morni,r)G -(n chpc k a II `I�v>r, .rYx Fu(i�c. t J Y anifarIan u:-60 rit, 1 Discussion With Person in Charge: Corrective Action Required: ❑ No ❑ Yes j I ❑ Voluntary Compliance ❑ Employee Restriction / I have read this report, have had the opportunity to ask questions and agree to correct all Exclusion violations before the next inspection, to observe ail conditions as described, and to ❑ Re-inspection Scheduled ❑ Emergency Suspension comply with all,mandates of the Mass/Federal Food Code. I understand that noncompliance may result in daily fines of twenty-five dollars or suspension/revocation of ❑ Embargo ❑ Emergency Closure your food permit. J; r ❑ Voluntary Disposal ❑ Other: sot 0.1 4Q I PF[Ft: Re,6ved-it*1 crnpevcarc� Violations Related to Foodborne Illness Interventions and Risk Act^.i di ag i o I-aa, CIvind to factors(items 1-22) (Cont.) -:F[-t 45-F Witlein', ibike PROTECTION FROM CHEMICALS mal 15 CooliaL Nldhrdt fi)r FlfiF, I Food or Color Additives i 19 i OW Hot and Coll Holding 14 i 1 1 3 son 1610) Wi FOR Nividmned Pair below 59ii bi4ii-i 4 1"/4,;',1- 3-30114 pr"bectioll front Unalmny're'd Atielintnew Mn MV Madistied at 15 Poisonow or 7oxic Substances AUT 17101.11 W!Enttfy111t; Original RatFe,I kid,a a 3hoor 13U"P M) irin,as a PubaiL fleafth Control i 7-102,11 Common Name - Vy Aing Arfeaenors' 7-2()1.1! Se Parluoin-sin:aje�- 3.5'A 19 a praah�)Italth Corau""! 7 .^.02.11 Rcetsicoori-poeaetcravd U'C* 7-202 12 Coadilicern4of f�Sv' 7-203 ll Tunic OallfimrtI4 -itauhifntical�* REOUIREMENTS FOR HIGHLY SUSCEPTIBLE 1 7-204.11 sallill"el,,.Ctilrij -CbemictJO POPULATIONS(HSP) 7-204.!2 ("honicab,for',�aIlavyx llr(ahwe,Ci bci a), 1551 i k t:nra;e,',jn,,ad PrQ pa-Ir ailed 3vitts wid 7 204 14 Dr,:ing Agnvik.Cowria" &vecm-'e'i V'i"l,Walnnl�e lat ------ 1 W",15 R; UA 0 palvivived Eye,- 7 ao 11 lividdumvid Fad(Imma, "hircares" ?AW I hit R,w or Paroatly Call td Anivid Foodand 7011G.H Rc'al icti,ri Ctte reeticide",0lena, 206.112 Rak'n! B41t Stalim1b't AV Sot Ammy So su"d. 706 151 lilt %*,.ned Foxi Piaci ag: Noe R,--ecnEd e0cuitoring* to NSUMER A06SCRY TIMErf EMPERATURE CONTROLS 1 22 t ON? I! tt k1angunwr A0J.,.,)tv Poste.d 1t)r i'cavomption of 1wWol H-4, thatam Qw. Un&r Wd to Proper Cooking Tempooilures lot 3 i �tol t'is� p PHr',cb"Ird w s''.:minae K i'monns i-101 11 Ar1;(.n Eslf-'- 15YF 155:x. 1 !no flf1511A 3 Ryknez&11q; hcha%v fret Wov Shell comminjite(1I 1A, meuu,'k tiamr Winds 1= 15stc. ' 3401.i I(B)H)(2) Poll, ared Iwof Rost 121 mert, SPI REOUIREMENTS ledeend 15 'Viclulion,,oi Sc�lloei �IaW09(AHD� in ban 04OA14Amb Pwhry,WHd Quite. Studied PHAV ciichen %hotild be What Owmang lAh, Mem. tichitud tinter the rqIpalprlatc 'a^cti oils P,ailuro or liitdr, ,165'1' 15 bcc. A -,ve it fai-d tIt fcxxJ1vtrailhcta, 3-401.I I t(N(3, Whole-mit,,le miatA DcO Sleak. Aitd o," facton, Oibor W51:* 591i,(Xit vtolalioi,,oclakuai. to ,otrd rctO 3-4WJ2 Raw Arairetl F(,rel,C'melied tit a pactio.'s ;huellill� lebival under #29 %licrowder 1651 * 101 lHAWm10 .111 UK I'llf s-.. 144 1„e: 17 Reheating for Hot Holding VIOLADON"S REIATED TO GOOD RETAIL PRACTICES 3.4011 101W) l"K 1659, 15 sec. t1tems 23-39) 403-1"H) Nkinwavc- 165”(Z 2 Wave Slandhig (ITIM mal,,del,rin�vl lit'Z,ato,tt, aitff.h do It,)! ehlre, :.'llu:. I we' fordbvr'zbt'1i:'ftvf inl"'k I"�Pjor eore 11 ved'ait"I": "'"be —r)3.1 I W! (Antowwialy Pt me avd RIF FYA Ammd I rh,- Z4"he Food Code and 105 CUR 14U'F` 111).000, �r. 3403 1 I(E) Remaining UnFliccel Porokais(If licer Isar T!"Al '3 Manaeiorp,,trif and Pw�tpnrtc�_ .2 W3 l"Umf - - -- _ _ _,�FG 124 i Fwd and Ewa Mwerfor '00e, Proper Cooling of PHFr. 25, 1: - -+----txrs 3 W WA) CwJwg CyAwd PFWs hvw IMPF to W11 I PC. a ! va 7WF MINn 2 Hmm,wed From'ITF -Gr w rlql5'F WhIrm 4 himun 2P roi, )m c r xic mtacttao� i PC L'ooa 3-501 Wit) ci-sairtte PHF,mit(le Front -$anblelit 29 bpexo! T +np^Iar,trelnl:rcriicn+st„dt`Fr.i4'I; 3G otho-- Whin 4 lisirs' 10�( t,11,510i"t CITY OF SALEM _ {�� BOARD OF HEALTH �r / Establishment Name: ' �� 1 J efs l Date: 6�I�/ �� Page: of Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date No.'^ Reference R—Red item - - - - Verified ; - PLEASE PRINT CLEARLY i`cuSed, upon ta. mk7hvlo and di-,cnvQy 'of r>-Yb,1Y � I YY rirerr� YI�h onrK ftr,.4 &5I" h,--t hNcl,vt` r>z_+ C;-)rrPC 1 c� ">C -hAIs P� 'c� hl,5�rna.hT iS *r pr '.4 dcr� P_d I� t t�I rp. rt�t-�I )t I�( rt �' 1=fR-. rl-- Q 0,0 rc, c-P I cknc-�- �1�r�:v r -.-�n.�.n t.c� �( - k )hiII n�Ir rcrTtiCetcr'�1,1� (-x P1 bal.� �i-a1 r�� nrc ,r�t !4'<P 1`11 nPr(a� fu ^�_�. fill rl -�rnm rxA�`` rc-,nrfr tMt m4 t-,p NlScr-Arddrz t 1 ()(_c )LQ Qr COL n (-,-O 1`f c ct )r i I c nyr-frf c-f' k30*1 �-�iie rr lLrA 'in rn hc((,r r+ 1 I f: YAP—iYl'S ,9Pr-�I?�Vl (alytQvt r`Yl"tr�Pr0.'froY] t )nr� rx�t� v, fie ,-�Gn^cr/. l4veyfi�, l In ra.t:e ( t'-(n 4-ikeo_-7ey IM (.A+ co l�� r i JPAr��I�� C)nco , 1 w i / IC f pT OY)p Vl -�i�PC-37 Pcts �CthrfGrian �_pi[4Fm . 1 I Discussion With Person in Charge: I Corrective Action Required: I ❑ No ❑ yes Emloyee �1U:1 I have read this report, have had the opportunity to ask questions and agree to correct all ° Voluntary Compliance ° Elusion Restriction/ violations before the next inspection, to observe all conditions as described, and to ❑ Re-inspection Scheduled ❑ Emergency Suspension comply with all mandates of the Mass/Federal Food Code. I understand tat noncompliance may result in daily fines of twenty-five dolla/rs or suspension/revocation of ❑ Embargo L3 Emergency Closure your food permit. �; �� ,,' ,� 1 rJ ❑ Voluntary Disposal ❑ Other: r Violations Related!to Foodborne Illness Interventions and Risk Auc,,IrJiog to I,zl+. C',x4utI: Fortiliv(items 1-22) (Cant) fi-i,J,:Vilbin- K"o F PROTECTION FROM CHEMICALS :)L!5 C1)0010'04W),Al t-a PHFN 1.1 1 Food or Color Additives 19 i P41F Hot and Goid Holding -262,12 A(Wi,�O�* Cott VHUI�Mairv,me1 at or iielvw 19ki 0!}4(F; 41't-45°f,. -302,14 P[otec6on front I:tl H-0 :%Iaimonedat.n abow Poftno' us or Toxic iialbstancer i,IWF i I(il.I I ld(ow lying Infuunation -Ctol:ina3 ".501 !W t} '2 t I imc as a public Hbafth Control 102,11 Umoron N:ane PubfiL Ooiarol ll,,viuion 7-201.12 Conditions of Usa� REOUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-*03 11 Toxic 0311lawl"probibitiolW! POPULATIONS IHS') 204,11 Naniti/tr;,Cr1wri"-cfieiuic,ls^ zeuI.L(d Pr,� wid '-_TT1__1`I1p�t, Chemic�ik for Wu:hing Po�Jom:(Atekial iI 1' 7 _')04.1.4 Dr)ing Avcnt.Crivvia" 'o� 11 lacid'.11W foixj(Aq1ja,I.ilibi)car::'.' Au I I I(;;) I_ P�,trwik�d E�w�, 1.1;;1)) kav, of '1t,,jK,d Auiinal Food an.3 -."0(, I I Re,Iricled Uw pvqjcides,C rvel!" 0,m 5:-,d •."t'i,1 Not Ro served.7 206 1 1 C�Ickmx,po�%Jvr,. Control and CONSUMER ADVISORY 2« 3 upmim,I a"k Y P(nw.j 1,sr k nvoolp6nn of TIMEITEMPERATURE CONTROLS fb Propw Cooking Temperatuies lor j 1 Ai,ioml r"ol"IbX aw Rw" 01,0,,mkvd ,I Flimmare PHFs 5uhaI'1111 Iu Raw sli'll Inswdulte 4elvcc I"s, � :):e" Comminalcd Foh_Meats& Gamr Aoirpqls 1511: 15 w,. ; SPECIAL REOWREMENTS 3 101.11(8}t r1ocl, and 6 v. Rovl !'_11 1-11-1d Vit !atmits of Scelton In 1111tIlritig- mk1bj1I:,tkXIO. tel)lporwy and 7 401A I(A)'3) P(aj I t r I o I I I(I I U 11eki pljj'�, rcm&m A 1,ilcfo:ti opur_ljons�Jiotdd heiklebil'-d un&l iliQ auprkrpriaw w,:Joji,, Siofbog Ovznmag Fish. Mew PcultrykI kwies-ii abut: IiCt'3, ',Nlwleqlar�Ac 101,10 Rr0,f 31eat.s inte;V.mtion,jild -I.k -40 1.12 Ra% •tmlrwl Fods Coolk,d III a I-raoic,�< Jwiiij Iv&NtLti unki,t//29 - 1651. � 3.461A J(Al(lt(to All kthei PUFs. 14i"l: 15 etc 17 Reheating let Hot Holding 1 VIOLATIONS FR L4TED TO GOOD RETAII PRACTA7ES 1101.IVA),C,;D) Pll[-, 10"F IJ e,% 1 (Items 2?-Xl) 3 40''..11{M} MlcrowavC 10,F 2 NItawc swrt'liq 01ahul:z,&oop.,rzio:w wh;,h dr,ow r,.lwe;o dir I Time, oew"+,V;aod nAjac lor, loied ko"be 34')3.111)3.111 Q (7namelmuly Pave."'d R1 F (oo"d io ot,.'p,liou;,ri; "w-;',!, 4 Ott t f"O Codeal"i)05 CAIR 140 F� ,;-40;,11(1:) RCITI,olliTol L.:tslwed Ptjttions of IfOrn practices FC 690.01110 'I rC 0o 1 IK Proper Cooling of PHF-, 26 1 iE 'q)1 1 4(A) coolum Cook,:d PRFc t'ro 14Y V gi r, o 26, Watel, I FC -5, W, 7(Yf' Within ?flour, :td Fron.1,R)l 9 At F.1_,�, F( -G_?, ----- OOY lk,41,}/A5,F Witlan 1, Houl'. po:soir,us�,r....Tnxc Malef,,[,_ . . .... iol.l•libi Oxiliiw 1111F,Made Flom Arobjent IS�P ,14 T�;mpciaollc �O Cather Within 4 ll�mvO Dop.ke, slIkeol m o' 1. k:,:l I':94 t"(d I 10 t'MR sot, �� ,. !,_ , _ �- - - -- j --- _ _ _ _ _-rs,�.-.r�—- - _ ,_� - - - _ _x.. _._... ,� ''� c __.___ _ , � p � A _ a r r 1 f s L 0283 DERBY STREET Brother's Deli City of Salem FOOD SERVICE ESTABLISHMENT - FOOD SERVICE Inspection HACCP: ❑ Item Status Violation Critical Urgency 'Telephone: PROTECTION FROM CONTAMINATION 1741-4648 Food Contact Surfaces Cleaning and Sanitizing FAIL Critical Vj RED Owner: Comment: Bottle of sanitizer in the front at cookline found to be water,and container of sanitizer in kitchen was too strong.Provide Nidal Rajeh 9I sanitizer of proper concentration at all workstations at all times. PIC: anitizer log not being kept.Daily log of sanitizer concentration must be maintained. v' �dwv — j t7f9�"`kJz 'Nidal Rajeh 'Inspector: Elizabeth Salandrea Date Inspected:Correct By: 6/10/2008 gRisk Level: 8 Permit Number: f BHP-2008-0210 1 Status: d VIOLATION I#of Critical Violations: ,4 ;Time IN: Time OUT: a I d Urgency Description(s): BLUE: Violations Related to Good Retail Practices (Critical violations must be corrected immediately or within 10 days)(Non-critical violations must be corrected immediately l or within 90 days) City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741-1800 GeoTMS®2008 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Jun 12,2008 ) Page! of Item Status Violation Critical Urgency RED: TIMEITEMPERATURE CONTROLS(Potentially Hazardous Foods) Violations Related to n Cooling FAIL Critical ❑d RED Foodborne Illness Interventions Comment: Soup found cooling on the stove in deep pots.Cool soup in shallow containers no more than 4"deep in refrigeration. and Risk Factors (Require Hot and Cold Holding FAIL Critical ❑d RED immediate corrective action) Comment: Many refrigeration units throughout establishment were not holding proper temperatures at time of inspection- temperatures as follows: walk-in fridge-59.7°F walk-in freezer-approximately 25°F _ continental fridge-59.5°F Pepsi fridge-approximately 54°F deli unit-approximately 46°F Temperatures of some foods in the walk-in fridge were measured,and none were below 500f. Establishment was ordered to close at approximately 3:30pm and was not permitted to re-open until refrigeration units were working properly again.All items from affected units were discarded. Inspector returned to establishment at 9:20pm after units had been serviced and recorded the following temperatures: walk-in fridge-41.5°F walk-in freezer-20°F continental fridge-40.4°F deli unit-41°F Pepsi fridge could not be repaired immediately-this unit may not be used until repaired to maintain proper temperature of 41°F or below. All items from the walk-in freezer were moved to the walk-in fridge once it was repaired-items had thawed and were not to be re- freezed.Freezer may not be used for frozen foods until it has returned to a temperature of 0°F or lower. Establishment was permitted to operate again at inspector's return visit.Owner was instructed to keep hourly temperature log of all affected units to ensure proper temperatures are being held. City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741-1800 GeoTMS®2008 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Jun 12,2008 ) Page 2 of Item Status Violation Critical Urgency Violations Related to Good Retail Practices (Blue Items) Food and F d Protection FAIL Critical BLUE ;Fm Some uncovered foods found in the continental fridge and the walk-in fridge.Cover all food in storage to prevent cross contamination. Equipm;e/nt,illd Utensils FAIL Non-Crifical BLUE 7Co ant:Walk-in freezer had accumulation of ice and water on bottom.Remove ice&water and investigate for leaks. ontmental fridge had water accumulation on bottom.Remove water and investigate for leaks. 7Sli r needs general cleaning. loor in dry storage area needs sweeping. :31P Floor of small fridge under the handsink in front is in disrepair and has grime accumulation in corners where flooring has failed. Repair floor to ensure good condition and impervious&easily cleanable�.„C,,�t71e� 6,� L p�J2 — Can opener needs thorough cleaning/scouring. t� , Reinspection in one week, all violations to be corrected. H� `tc �� City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741-1800 GeoTMS®2008 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Jun 12,2008 ) Page 3 of S MOV-21-2007 09: 16 AM WHEN SECONDS COUNT P.02 4' Choke Saving Course Registration #,origt�; Each attendee must complete a Registration Form P g I ; : I j . To reserve a space in the Choke Saving Course Registration Form,please complete and i'ctum� t.:��1I_' Registration fonn to the Salem Board of Health. Course provided by When Seconds Co i nt, ZMO"�+ `F ` •Class size is limited and will be on a first come first serve basis. *Registration Fee is Non-Refundable Si ` S:: i ti I•: • Registration Deadline is Friday,December 28,2007 at 4:00 p.m. 5 341 Date of Registration: // / 017 7 /01 Form Completed by: Name: �/1G1 Restaurant: � : Business Address: � k , City/Town Business Phone: '7 p ? �l Y State&Zip �1y�4 (5 'V) Email: s li i understand that the information provided to the City of Salem&cWhen Seconds Count.In :wt Hbb:1<In confidential and I hereby attest that the information supplied on this Course Application is accurate. Cast: Choke Saving Class S5•00 per person 4. Course Date: Wednesday,January 16,2008 Q i.•, Time: 2 p.m.to 4 p.m. Location: City Hall, 120 Washington Street,Floor 3, Salem,MA q I I have read and understand the above registration form,its requirements. P 0 Student Signature: Date: Return the completed application and payment to: Salem Board of 126 Washin on 4 "� Salem,MA 01970° o , •'Y� I I ' v U NOV-21-2007 09: 16 AM WHEN SECONDS COUNT P.02 ,. . . .t,i i • Y�..$ApyS' µ 111 ('i Choke Saving Course Registration Vbr�999 :�; Each attendee must complete a Registration Form To reserve a span:in the Choke Saving Course Registration Form,please complete and ielurt, P. Registration form to the Salem Board of Health.Course provided by When Seconds Cot nt, 11tE:o", al t �1t *Class size is limited and will be on a first come first serve basis. "Registration Fee is Non-Refundable * Registration Deadline is Friday, December 28,2007 at 4:00 p.m. -� ; ,1 , Date of Registration:_+J! ( ?IY1A 5 Form Completed by: t Name: AJ l d_Ci_ 1 Restaurant: Business Address: " --ay��✓'�y 1 _ City/Town Business Phone: 7-2 L State&Zip Email: I understand that the information provided to the City of Salem&When Seconds Count,in ll,be.lt tpt confidential and I hereby attest that the information supplied on this Course Application is idle 8ig3:. accurate. Cost: Chokc Saving Class $5.00 per person ' Course Date: Wednesday,January 16,2008 [� G Time: 2 p.m.to 4 p,m. Location: City Hall, 120 Washington Street, Floor 3, Salem,MA i I have read and understand the above registration fort,its requirements. f, Student Signature: Date: 77 Return the completed application and payment to: Salem Board of e�1ttl '' 120 Washin ono Salem,MA 01970' P Il I N04-21-2007 09: 16 AM "HEN SECONDS COUNT pfiP 02 'r Choke Saving Course Registration Por" Each attendee must complete a Registration Form ` ? ` �• i To reserve a space in the Choke Saving Course Registration Form,please complete and iretturi' ! Rcgistratinn form to the Salem Board of Health. Course provided by When Seconds Cont, tr o' 'Class size is limited and will be on a first carne first serve basis. 1� ! ,�! it 17. 'Registration Fee is Non-Refundable Registration Deadline is Friday,December 28,200'1 at 4:00 p.m. j' , Date of Registration: Form Completed by: 6!e. D i Name: UI)Q me,r Restaurant: C" is tq Businesss Address:_gP�C3__ �C4.7CityjTownBusiness Phane: 'T to`1State&Zip Email: j I' I understand that the information provided to the City of Salem&When Seconds Count,InIlvw_ be,Vt confidential and 1 hereby attest that the information supplied on this Course Application is � . accurate. f, ' Y. Cost: Choke Saving Class $5.00 per person I' Course Date: Wednesday, January 16, 2008 [� YITime: 2 p.rn. to 4 p.m. !I. i Location: City Hall, 120 Washington Street, Floor 3, Salem,MA "` I I have read and understand the above registration form,its requirements. } Student Signature: Date: Return the completed application and payment to: Salem Board of � ( ' 120 Washin�,ton :I Salem,MA 190: t i' i Commonwealth of Massachusetts City of Salem Board of Health 120 Washington Street,4th Floor IGmbedey DriscollMByOf SALEM,MA 01970 Food/Retail Establishment Permit DATE PRINTED: 01/07/2008 ESTABLISHMENT NAME: Brother's Deli File Number:BHF-2004-000018 283 Derby Street Salem MA 01970 LOCATED AT: 0283 DERBY STREET SALEM, MA 01970 Permit Type Permit No. Permit Issued Permit Expires Fee Restrictions/Notes FOOD SERVICE BHP-2008-0210 Jan 4,2008 Dec 31,2008 $420.00 ESTABLISHMENT Total Fees: $420.00 PERMIT EXPIRES December 31,2008 Board of Health This Permit is not transferable and must be reissued upon change of ownership or location.-The permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code,beofre any revonations,improvements,or equipment changes are made,an plans for such must be submitted to and approved by the Salem Board of Health. Page 3 of 24 / I CITY OF SALEM, MASSAC HUSEM <'3�f BOARD OF HEALTH 120 WASHINGTON STREET,4" FLOOR TEL.(978) 741-1800 KIMBERLEYDRISCOLL FAX(978) 745-0343 RECEIVED MAYOR ISC MOSALEM.COM NOV 2 71001 JOANNE SCOTT, CYIY OF SALEM HEALTH AGENT BOARD OF HEALTH 2008 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT � NAME OF ESTABLISHMENT 'RPO( f- Vit( ofIlli d�Jti�� TEL# q 7f' X7411 u4y� ADDRESS OF ESTABLISHMENT s2 r)L54 1/ S'K. FAX# 979/ 7 191 C1002- MAILING 1002- MAILING ADDRESS(if different) EMAIL-Business': Website: / OWNER'S NAME 11VI N !, A,P TOA TEL# 6i 7 6 53 � 7 ADDRESS 17 U'Cl1 Ad2,0 0Z FQ,�6090 /Y1 A 0'9 03 5 STREET ''/nCITY STATE ZIP CERTIFIED FOOD MANAGER'S NAME(S) C q Lr r7 170( S f%N1w S CERTIFICATE#(S)�72.7 (Required in an establishment where potentially)hazardous food is preparetl) V� EMERGENCY RESPONSE PERSON A LyAIC � HOME TEL# q 7 2-10 q Zff'd DAYS OF OPERATION Monday Tuesday Wednesday Thursday Friday Saturday Sunday HOURS OF OPERATION / l Please write in time of day. C G a� - cl G - q G R 6 (Forexample I1am-11pm) TYPE OF ESTABLISHMENT FEE (check onlvl RETAIL STORE YES NO less than 1000sq.ft. =$70 1000-10,000sq.ft. =$280 more than 10,000sq.ft. =$420 ------------------------- .........- - " ------------------------------- '--' ""-"-"- .... RESTAURANT YES NO less than'- 25 seats.. =$140 (Outdoor Stationary Food Cart$210) 25-99 seats =$280 more than 99 seats =$4 .."-'-'---"-----'-'.....-'------------*----- ....*--. ----- ---------------------------------------------'--....'1'0"0..... BED/BREAKFAST/ YES NO $100 CHILDCARE SERVICES --- ---------------. ADDITIONAL PERMITS ------- MAKE (not just serve) ICE CREAM, YOGURT/SOFT SERVE YES NO $25 TOBACCO VENDOR YES NO $135 ALL NON-PROFIT(such as church kitchens) YES NO $25 'Please pay total with one check payable to the City of Salem. This Permit is not transferable and must be reissued upon change of ownership.The Permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code,before any renovations, improvements, or equipment changes are made, all plans for such must be submitted to and approved by the Salem Board of Health. Pursuant to MGL Cha ter 2C,1/49A, I certify under the pains and penalties of perjury that I,to my best knowledge and belief,have filed all state tax returns and aid all sty�e xe nder the law. f�✓G' Sign re / Date Social Security or Federal Identification Number Revised 4/24/07 FOODAP2008 2dm Check#&Date NOV-11-2007 01 ;44 AM P. 01 r II o Irl►'�� I.�r r � � ` �,rjr �Q �agc1 C� N NOV-11-2007 01 :44 AM P. 02 ^THE PEPSI BOTTLING GROUP --- Equipment Work Order NUMDER I u C".�j 4' Technk:hranta). Custamer Numbs Worn Date Customer Name' IKR Status: Truck: '�)i o+il ea I; 1 ?90 T IAtltlieaarx'-? � _ rb (service Cantrarx rt �� {Cdy. Stats. Zap Code. `may, Ii Parent Name i Phon�e.3Nomber M Ropah II —<CK� C.wt 1-1 PM Icontact Name, Phone { PM Sticker added Yes or No(circle) Water Filter changed Yes or No(circlj tf No Reason ) IAs;iet N' �q/ro Location In Bldg f7 4 L•tr 16e��e+N Make/Model 1,- 7-07 r Dle. Drive Start Time Work Stan Time, Rafrigo ant type: Beg.Met r Re.iciny, 1,- }-$ 7 1t- o5 // / C 1 s -�' /� Order Time Drive Stop Time, Work Stop Time. End Mater Readmg' l, Survey Correct D (No} `l , I 0 f, 7`T Product on site (No) Key IS Condjon Graphics APperanca - Door Stine cord SYSTEM SUBSYSTEM PROCEDURE DETAIL 1 Keolct(c Tc WP C0^44^0 1 / I -- ( TRUCK PART# CITY I DESCRIPTION UNIT PRICE EXTENDED PRICE I 1 I I j _ I S tYJ COMPLETED ❑ INCOMPLETE SITE NOT READY TOTAL PARTS C T A A ❑ INCOMPLETE NEED PARTS ❑ INCOMPLETE CUST CLOSING INSTALL ANGR L T PIR A lad M PER Hal LU ,,,,.�---'---......-. ---- 9 ❑ INCOMPLETE NEED MEL F-1INCOMPLETEOTHER(EXPLAIN) EQUIPMENT SELLING PRICE I comments Cor>)Cf CI-it- 31}0 IRADFIN CHARGE FOR LOST TIME<PEOPLE 5E Qz rk� TE.—jp Cc1 n(t+ i PATMPNT ON ACCOUNT _- f! �Y 1 Li ASt'ju N1'AL PAYMENT ' TechMeian'a S19rr Payment Type TAX ON LABOR �I '"!/1 CHARGE TAX ON MATERIAL �Cunmmer Sugnatura ICASH 0 CHECK F,7 ( �¢ NOV-11-2007 01 :45 AM P. 03 leaning Proposal ---------- _!RH ]p< .......... .. ..... P412L*4j2j'`�6jVK c D: -ale! Yrj warm lfrpvftv-dsa am saw q vomLptmcr-.fxru 27 .yumdk:rcwkbSrma! 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Yri'VV Sl,aia6'a+sgas.�ila 7 �kmys£'�C32;Yraa,;r cr..:-_rs„it TJC�P'AA C111 •MatAITILTS a Sr Aftcrsw�-cssful completion of Phil Ackirand's Authorized ExIinust Cleaner Coll 1-se. t�is Certification lies been granted to: G� Q V1 r t. OF ; M&G CLEANING tr4 + 40 + S7 h8 K C'� C , 9 V l,we r:kxnlnc-fry E.IG:`v1A CM. , CD a E AlUSr SRRV�C S �+j �. �Yi �f/. W► + �ffid �� V `J ,V %t gid-97.1;3x135 7X1.24941203 Spr.�ialxj lr.;ul:Sru:t. ^a:wnr.o cb Aera �A� f At ` d f� �� .�flC! 'iC:Ci`,1.}51;1 (.plj'If l::lel):! t"� .1 `u•t ilL•.'.'t.�{i1t } 1yt:{:�i:17 ,1�'[�!f :::.'xF!.:1 f.1.': t.. 7 <!i1L'1 1.('iJ:_.. . � 1ij � ♦ .1i1� ?. C! I;i'7.iaiD E:i',9 iieflfi40 cli - 040 ) �0It "gg' �� • .,I',!: !lr°' 't ' ._.! `: .`.Sri! t^: n.;,'i.' �. ,.A!'1(11'.'. :•l;A.`.j �:. ,�1, `'na<. ��+� � Pl�'I �nr, lo�lktd� 0 0283 DERBY STREET Brother's Deli City of Salem FOOD SERVICE ESTABLISHMENT - FOOD SERVICE Inspection HACCP: ❑ Item Status Violation Critical Urgency Telephone: TIMEITEMPERATURE CONTROLS(Potentially Hazardous Foods) 741-4648 Hot and Cold Holding FAIL Critical RED Owner: Comment:The True Pepsi reach in in the service line has a temperature of 58°F. Repair unit to maintain a temperature of 41°F or Nidal Rajeh I below. PIC: Nidal Rajeh Violations Related to Good Retail Practices (Blue Items) Inspector: Equipment and Utensils FAIL Non-Critical BLUE David Greenbaum Comment:The hood filters have an accumulation of grease. Thoroughly clean the hood filters. Date Inspected:Correct By: 11/1/2007 The front hood filters have an accumulation of grease. Thoroughly clean the hood filters. Risk Level: the Ansuls systems are scheduled for cleaning in November. Owner to forward a copy of the invoice to the Board of Health. GENERAL COMMENTS: Permit Number: All other violations cited in the 10/25/07 inspection report have been corrected. BHP-2007-0226 Status: SIGNED OFF #of Critical Violations: ! 1 Time IN. Time OUT. Urgency Description(s): BLUE: Violations Related to Good Retail Practices (Critical violations must be corrected immediately or within 10 days)(Non-critical violations must be corrected immediately or within 90 days) City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741-1800 GeoTMS®2007 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Nov 01,2007 ) Page I oft Item Status Violation Critical Urgency RED: Violations Related to Foodborne Illness Interventions and Risk Factors (Require immediate corrective action) /b/LX1 City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741.1800 GeoTMS®2007 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Nov 01,2007 ) Page 2 oft 0283 DERBY STREET Brother's Deli City of Salem FOOD SERVICE ESTABLISHMENT - FOOD SERVICE Inspection HACCP: ❑ Item Status Violation Critical Urgency Telephone: PROTECTION FROM CONTAMINATION 741-4648 Separation/Segregation/Protection FAIL Critical RED Owner: Co ent:The True Pepsi reach in in the service line has PHF stored on and above RTE food.Organize unit so PHF is below RTE Nidal Rajeh �.f od to prevent cross contamination. PIC: Food Contact Surfaces Cleaning and Sanitizing FAIL Critical ❑.01 RED Jose Domiuez Co e�ere is no sanitizing solution in the kitchen. Sanitizing solution of proper concentration must be readily available at all Inspector: rk station at all times. David Greenbaum T mte for panel on the ice machine has an accumulation of grime. Thoroughly clean and sanitize the ice machine. Date Inspected:Correct By: 10/25/2007 �, T wood cutting board in the kitchen needs to be resurfaced or replaced. Risk Level: TIME/TEf7(PERATURE CONTROLS(Potentially Hazardous Foods) Coo/Cold FAIL Critical ❑o RED Permit Number: t:There is soup and food cooling in large deep containers. Cool hot food in containers that are no more than 4"deep to BHP-2007-0226 en cooling. Status: Hoting FAIL Critical ❑d RED VIOLATION mm t:The walk in freezer has a temperature of 27°F. Repair unit to maintain a temperature of 0°F or below. #of Critical Violations: 5 V walk in has a temperature of 48°F. Repair unit to maintain a temperature of 41°F or below. Time IN: I Time OUT: 9 The True Pepsi reach in in the service line has a temperature o49°F. Repair unit to maintain a temperature of 41'F or below. I Urgency Description(s): 7 three Pepsi dessert reach ins have temperatures of 50°F. Repair these units to maintain a temperature of 41'F or below. BLUE: Violations Related to Good Retail Practices (Critical violations must be corrected immediately or within 10 days)(Non-critical violations must be corrected immediately or within 90 days) City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741-1800 GeoTMS®2007 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Oct 25,2007 ) Page 1 of i Item Status Violation Critical Urgency RED: Violations Related l9400d Retail Practices (Blue Items) Violations Related to Food and FoodOrotection FAIL Critical BLUE Foodborne Illness Interventions and Risk Factors (Require FAimr nt:The Continental reach in in the kitchen has uncovered food. All food in storage must be covered. immediate corrective action) T e walk in has food uncovered food. All food in storage must be covered. tiealk in freezer has food stored directly on the floor. Store all food at least 6-8 inches off the floor. ere i read stored directly on the kitchen floor. Store bread at least 6.8 inches off the floor. T container of spices on top of the microwave need to be covered and labeled. `l Label all desserts with a common name, ingredients in descending order and an expiration date. Equip nent and tensils FAIL Non-Critical BLUE C ment:The ice scoop container needs a thorough cleaning and sanitizing. -� Theod filters have an accumulation of grease. Thoroughly clean the hood filters. he canopener and holder have an accumulation of grime. Thoroughly scour the canopener and holder. T meat slicer needs a thorough cleaning. T w Ilk in freezer flooring needs a thorough cleaning. T we in freezer needs a visible,accurate thermometer. e end hand wash sink in front needs to be labeled"Hand wash sink only" to Beverage air seafood unit needs a visible,accurate thermometer. The front hood filters have an accumulation of grease. Thoroughly clean the hood filters. T Beverage air reach near the grill needs a thorough cleaning, including the racks. Th ck of the griddles has an accumulation of grease and grime. Thoroughly clean the back of the griddles. helves of the reach in under the toasters need thorough cleaning. Whe/s/helves of the salad reach in need a thorough cleaning. Tho elves of the end reach in need a thorough cleaning. TW e same unit needs a visible,accurate thermometer. City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741-1800 GeoTMS®2007 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Oct 25,2007 ) Page 2 of Item Status Violation Critical Urgency GENERAL COMMENTS: Reinspection in one week, all violations to be corrected. Owner to provide 6 consecutive months of extermination invoices for inpsector to review. J City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741-1800 GeoTMS®2007 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Oct 25,2007 ) Page 3 of i' 0283 DERBY STREET Brother's Deli City of Salem FOOD SERVICE ESTABLISHMENT - FOOD SERVICE Inspection HACCP: ❑ Item Status Violation Critical Urgency Telephone: TIMEITEMPERATURE CONTROLS(Potentially Hazardous Foods) 741-4648 Hot and Cold Holding FAIL Critical [ RED Owner: Comment:The roast beef and corned beef had temperatures of 115'F and 110'F respectively. All hot potentially hazardous foods Nidal Rajeh must be held at a temperature of 140'F or higher. PIC: Unable to check the temperatures of the roast beef and corned beef. I spoke to the CFM regarding the importance of checking the Wagner Dos Santos temperatures of these items frequently and reheating as needed. Inspector: GENERAL COMMENTS: David Greenbaum All other violations cited in the 4/12/07 inspection report have been corrected. Date Inspected:Correct By: 4/20/2007 Risk Level: Permit Number: BHP-2007-0226 Status: SIGNED OFF #of Critical Violations: 1 Time IN: Time OUT. Urgency Description(s): BLUE: Violations Related to Good Retail Practices (Critical violations must be corrected immediately or within 10 days)(Non-critical violations must be corrected immediately or within 90 days) City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741-1800 GeoTMS®2007 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Apr 20,2007 ) Page 1 oft Item Status Violation Critical Urgency RED: Violations Related to Foodborne Illness Interventions and Risk Factors (Require immediate corrective action) City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741-1800 GeoTMS®2007 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Apr 20,2007 ) Page 2 oft 1 ( IMPORTANT MESSAGE ) FOR . •� A.M. DATF .a T TIME P.M. M. An ham) OF PHONE AREA CODE NUMBER EXTENSION ❑ FAX ❑ MOBII F AREA CODE NUMBER TIME TO CALL I TELEPHONED IA I PLEASE CALL CAME TO SEI5 YOU I I WILL CALL AGAIN WANTS TO SEE YOU I RUSH RETURNED YOUR CALL WILL FAX TO YOU MESSAGE Z7Z/• Lam f , T I` I rSIGNEO FORM 4009 MADE IN U.S.A. NOTES I 0283 DERBY STREET Brother's Deli City of Salem FOOD SERVICE ESTABLISHMENT - FOOD SERVICE Inspection HACCP: ❑ Item Status Violation Critical Urgency Telephone: FOOD PROTECTION MANAGEMENT 741-4648 PIC Assigned/Knowledgeable/Duties FAIL Critical RED Owner: C ment:There was no Certified Food Manager or Person in Charge. A full time CFM must be employed at this establishment,in Nidal Rajeh he absence of the CFM a knowledgeable PIC must be designated. PIC: I PRO'T'ECTION FROM CONTAMINATION Separation/Se�,,'r�'"gation/Protection FAIL Critical ❑d RED Inspector: C9lnment: The walk in freezer has potentially hazardous food stored above other food. Store all PHF below other food to prevent David Greenbaum cross conta 'nation. Date Inspected:Correct By: 4/12/2007 The k in needs to be organized to insure all PHF is below other food to prevent cross contamination. Food o ct Surfaces Cleaning and Sanitizing FAIL Critical ❑J RED Risk Level: C ment:The final rinse temperature of the dishwasher was 175°F. Repair dishwasher to reach a minimum final rinse Permit Number: temperature-of 180^F BHP-2007-0226 Jislicer in the back has an accumulation of food debris. Thoroughly clean and sanitizee the meat slicer after each use. Status: i _/ e salad rxmg bowls in the prep line must be changed or cleaned and sanitized frequently. VIOLATION #of Critical Violations: Theitizing solution in the front prep line found too weak. Sanitizing solution of proper concentration must be readily available 6 I work stations at all times. Time IN: Time OUT: j Tfront meat slicer had an accumulation of food debris and grime. Thoroughly clean and sanitize the meat slicer after each use. Good Hygienic actices FAIL Critical RED Urgency Description(s): BLUE: C mment: Employee drinks observed in the front prep line area. Employees must eat and drink in a designated employee area or Violations Related to Good n the dining room to prevent cross contamination. Retail Practices (Critical TIMEITEMPERATURE CONTROLS(Potentially Hazardous Foods) violations must be corrected Hot and Cold Holding FAIL Critical RED immediately or within 10 days)(Non-critical violations Comment:The roast beef and corned beef had temperatures of 115°F and 110°F respectively. All hot potentially hazardous foods must be corrected immediately must be held at a temperature of 140°F or higher. or within 90 days) City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741-1800 GeoTMS&2007 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Apr 13,2007 ) Page l of Item Status Violation Critical Urgency RED: Violations Related to Good Retail Practices (Blue Items) Violations Related to Food and Food Protection FAIL Critical BLUE Foodborne Illness Interventions and Risk Factors (Require L_,� m ent:The Continental reach in in the kitchen has uncovered food. All food in storage must be covered. immediate corrective action) The small Beverage air reach in by the grill had uncovered food. All food in storage must be covered. The small reach in below the toasters had uncovered food. All food in storage must be covered. The end reach in under the desert coolers had uncovered food. All food in storage must be covered. Equipment and ensils FAIL Non-Critical BLUE C ment: The South Bend ovens have an accumulation of food spills and debris. Thoroughly clean all ovens. TI gett oven needs a thorough cleaning. /� 1fewalk in freezer floor has an accumulation of ice. Repair unit to prevent ice build up and remove all ice. 1, hawalk in freezer flooring needs a thorough cleaning including under all racks and crates. L/ abet the produce sink"Produce Only' Th mployyee restroom needs a sign stating"Employees Must Wash Hands Befroe Returning to Work" i�op and container need a thorough cleaning. Mo stored in the mop sink. Clean all mops and store hanging upside down not touching any surface to air dry. T e Beverage air seafood unit missing a thermometer. Provide a visible,accurate thermometer in this unit. T sm Beverage air unit near the grill needs a thorough cleaning, including all racks. T small reach in under the toasters missing a thermometer. Provide a visible,accurate thermometer in this unit. .. a same unit needs a thorough cleaning including all racks. Th si Trus reach in at the front of the line needs a thorough cleaning. T long deli unit at the front of the prep line needs a thorough cleaning. he end reach in under the desert units needs a thorough cleaning. Physical Facility FAIL Non-Critical BLUE mment:There are missing ceiling tiles above the dishwasher. Replace all missing ceiling tiles. GENE AL COMMENTS: Reinspection in week, all violations to be corrected. City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741-1800 GeoTMS®2007 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Apr 13,2007 ) Page 2 of Item Status Violation Critical Urgency City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741.1800 GeoTMS®2007 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Apr 13,2007 ) Page 3 of r "•:�- "_'�,,'TMi, `'" i`� »' .`r:'4"' ' Y ° ' �'i' ., a �'.". SFS 'z:."4,'^: ..'s "' f .^. '^'V!:*k�-.+"p i'.�t '. y,�.. .. .3: � 'NR"' a• ,..;�+... �'e�,_;-y w y. s i F'Y•a,,e1'= aw^''' s+�}'f e Y �,�iY, .`�'' i'.. .✓,....' .� ' el" �,iw mmonwealth of Massachusetts's "3f .'w ", titan m �;j� Y % �, • • y.#Y^rx,.a�2i.u ' ai-"'. rf^s, -:.• 's&t� '� ' T��, ..^..: 5^. { .,"`,y- , . . :t_-. , .. _.;Board ofFIealth. m.-g,''�;�-; ,µ, 1 �#•,'�:',:>"z�: k�;:a , �a%&,��: �'� :»'. Fie ,'Ty,3� _- ..: z,:."i".ry ...'�n`a'<-..,: aR�`:`'-...- •.'3"' xe .-*• ,�s.'<��,i IGmberley riscol -s� Dl ,.-,- a,.. ' - 120 Washin ton Stree 4th Floor; �` � ` �.-�a•• >. , =. SALEM,MA 01970 T '' "' Food/Retail Establishment Permit DATE PRINTED: 01/02/2007 ESTABLISHMENT NAME: Brother's Deli File Number:BHF-2004-000018 283 Derby Street Salem MA 01970 LOCATED AT: 0283 DERBY STREET SALEM, MA 01970 Permit Type Permit No. Permit Issued Permit Expires Fee Restrictions/Notes FOOD SERVICE BHP-2007-0226 Jan 2,2007 Dec 31,2007 $200.00 ESTABLISHMENT Total Fees: $200.00 PERMIT EXPIRES !December 31, 2007 Board of Health This Permit is not transferable and must be reissued upon change of ownership or location.The permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code,beofre any revonations,improvements,or equipment changes are made,all plans for such must be submitted to and approved by the Salem Board of Health. Page 2 of 20 CITY OF SALEM, MASSACHUSETTS • • BOARD OF HEALTH 120 WASHINGTON STREET, 4TH FLOOR SALEM, MA 01970 TEL, 978-741.1800 FAx 978-745-0343 Kimberley Driscoll WWW.SALEM.COM Mayor JOANNE SCOTT, MPH, RS, CHO HEALTH AGENT 2007 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT NAME OF ESTABLISHMENT 142 rtgY�C rte I ( 4&EJV r-i r1- TEL# /r Ll� 41{S" ADDRESS OF ESTABLISHMENT X4(2 acv Icy C�Y FAX# I A� L09/ ox-2- MAILING ADDRESS(if different) rr,�iMK EMAIL--Business': / +i Owner's: /ViI)AL kAfgt1, ! OWNER'S NAME /V 1 17� L- Jq A j t% (� TEL# 17 i4 -v 3V 7 ADDRESS 263 OWb a QT-Y- is", (ulq /Y1/'(- (f2! Z v STREET () CITY STATE ZIP CERTIFIED FOOD MANAGER'S NAME(SV A1119P I P-r6 it CERTIFICATE#(S) (Required in an establishment where potentially hazardous toad is prepared) EMERGENCY RESPONSE PERSON HOME TEL# ( OAYSOFOPERATION Monday Tuesday Wednesday Thursday Friday Saturday Sunday ) HOURS OF OPERATION Please write in time of eat. (for example 11am-110m] TYPE OF ESTABLISHMENT FEE (check only) RETAIL STORE YES NO less than 1000sq.ft. =$ 50 1000-10,000sq.ft. =$100 more than 10,000sq.ft. =$250 -._. .- - -- - - - - - - ---- ----- -...... RESTAURANT YES NO less. - -than. - 25 seats $100 25-99 seats 150 more than 99 seats =$200 -- - - - ... - ----N6- " _ --- --- ---- -- - - - - - - ---- --- ................. BED/BREAKFAST YES $100 ----------- --------------- ----- --- ----- ----.-..... ..... ..... ..._ ... ... .. .... - - -_. ...... .....-. ..... ----- .... ADDITIONAL PERMITS MAKE (not just serve) ICE CREAM, YOGURT, SOFT SERVE YES NO $5 TOBACCO VENDOR YES NO $50 ALL NON-PROFIT(such as church kitchens) YES NO $25 `Please pay total with one check payable to the City of Salem This Permit is not transferable and must be reissued upon change of ownership. The Permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code, before any renovations, improvements, or equipment changes are made, an plans for such must be submitted to and approved by the Salem Board of Health. Pursuant to MGI- Chapt r 62C, ection 49A, I certify under the pains and penalties of perjury that I, to my best knowledge arid belief, have fired all sate ax urns a d paid all state taxes requir it under the law. 'Signature Date Social Security or Federal Identification Number Re,ised 11113/06 FOODA 2007 adm Checklt& Wle j4;1441l $ IMP®RTAPJT? MESSAGE + FOR Q DATE (^G1b��dl-r` TIME �6 .,DR'/ M \ A l lIlUn.la� OF PHONE AREA CODE NUMBER EXTENSION U FAX U MOBII F AREA CODE NUMBER TIME TO CALL f TELEPHONED PLEASE CALL CAME TO SEE YOU WILL CALL AGAIN WANTS TO SEE YOU 747 RUSH RETURNED YOUR CALL�.f •,, WILL FAX TO YOU MESSAGE ` ' "-{ 6n AJ e j�jc�t/Ps, ot�, Y SIGNEGNED N F M 400A MAGE IN U S A VVVVVV f - - - -- -- � _ i � - V CITY OF SALEM BOARD OF HEALTH { Establishment Name: Date: /o/Z310 4 Page: of - r Rem Code C-Critical nem DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date No. Reference R—Red Item Verified PLEASE PRINT CLEARLY I 44, cv /auk '/�irJrc�s rn�l r I%r,� I &&e-� o7l llvJIng JMA 12� 'No eff'(-710-0.ee W06 oleo o . ,4/1 Pm�lv�I�ls rnu6� km_ W�frin� loV2s- vsrra,,OJJ�. � ee� or AM y�a %�e/ riJh� //� I YI .4,0 01 it, v�d 'M f/ Y�7lDt s Yid/or- l�� 4Ml s . I J , er�r�lr,�c�Qc IIT � 9,l'ib, _ .4,r, 7I- Y, t; 4Z) be- l n I 1 Ii✓ -Sodkx W,4 YD ilwmfr Nd4 rl ordw, ttu(d< 1 ISsS � ��i I net ka iA I IV r S,Pa4 Ge�IGs �w�II ' Ize I ' frr,,�l,n �t-cQ , n�,vuv It SoLt�c -6 W0yUkIV_ 4 YPrsinv�vh oM a�z v�6d V091,h' 61101&)iP_ff /n _ ICY '- `x l� i-�✓luw�� I Discussion With Person in Charge: Corrective`Action Required: I EINo ( O Yes t I have read this report, have had the opportunity to ask questions and agree to correct all L3 Voluntary Compliance ❑ Employee Restriction/ y inspection, to observe all conditions as described, and to Exclusion violations before the next ins P ❑ Re-inspection Scheduled ❑ Emergency Suspension comply with all mandates of the Mass/Federal Food Code. I understand that noncompliance may result in daily fines of twenty-five dollars or suspension/revocation of ❑ Embargo ❑ Emergency Closure your food permit. „�. ❑ Voluntary Disposal 0 Other: 3-501 i-!C, PHFs Received at Tuinoentures Violations Related to Foodborne illness Interventions and Risk 4ccoldtng to L 1,x Copied to Factors(items 1-22) (Cont.) 141'Ft-'S'(r SGnhin d Hours. I PROTECTION FROM CHEMICALS i-50!.15 I (Aaalim_ivlethodslurFHFs 1; Food or Color Additives I i9 PHF Fat and Cro Holding Cold 3-501.16(8; C PHFs Maintained at or hek,w 5'iU1)0'ifF) 1i`lt F' 3-302,14 Protcc ion from unapt, ofed Addilr.cs* 3:101.i6(?,) Hui PHFsMaintained at or above i 1S Poisonous or Toxic Substances 7-101.11 Ide"ntif}ane Intormahon-Orig nal j 3-501.t6(A) Roust:, u;st:,Held at r;enve I30'F ContmnerO 6. 7-102.1 I t"nrnmon]Name - Workin;Containers°" ( 20 Time as a Public Health Control 7-''_01.11 Separation-Storage' ( 13-=101.19 Ti me as a Public Health Control 590 'if i4(H) Variance Reumm uirce 7-202.11 Restriction-Presence and Use" 7.202.12 Condition;of llsc" 7-203.11 Toxic Containers -Prohil•itions*' REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 2 POPULATIONS(HSP) Od.11 Sanitizers.Criteria-C'hemicals'� 7-204.11 ( Chemicals for W4shnte,Produce,Cril,rift' 21 3SOI.11(A) IW:hasieunzedPr.-pacl.aged)titianand Bever::ces w!Ih W'arraille I ab.lcF 7204.14 Dryin-Aecnts.Criteria' I3-80J.II(B) I ,eof>asteurizd ^ .. I 7-%05.11 � Incidental Foal Contact.Lubricants,` : 7-206.11 Restricted Use Peaiciclss.Criteria" I s 501.11:15) 1 Raw or Partially Cooked.Ionil Frxsl find n i Raw Se•cd Sprouts Not Ser veal. " 7-'06.12 Rrx{ant Boil S+auuns^ j 3-80 I.I!(C) Unopened Pond Packr:,c Not Rc served. 7-_06 I3 'Pracking Powders. Pest Control and Monitot ing:- CONSUMER ADVISORY TIME/TEMPERATURE CONTROLS 22 3-603.11 Consumer Athisary Posted for Consumption o! Animal Foods That are Raw, Undetconked or lh Proper Cooking Temperatures for PHFs yl yNot Ce -rnise Processed to Eliminate ' '-_ r• 3-401.IIA(1)(2) F);g.;- 155`F' 15Sec. Eves-Immediate Service 145"Fi5secr 3-3(1'-13 Yasieurv> d Eggs Substitute for Raw Shelf -401.11(A)(2) Comminuted Fish,Meats&Gavle ! Ani reals- 155�F 1 i sec 3-401.11( )( ,l ) Pork and Bucf Roast i 30-F t I_, nonff - SPECIAL REQUIREMENTS 3_ 090.0091A)-(D) inolatron:,of Section 590009(A)4D) in _ 40L1 l(A)f,.,) Ratites,Injected Meats- 15:i'F' 15 sec. ' catering. mobile food, tenipotary and -401.1 I(A)t 3) Poultry,Wild Game Stuffed PHFs, re,sidentnal kltcben operations should be Stuffing Containing Fish. Meat, debited under il,:appropr::+t, sections Poultry o,Ratite,-165"F 15 ;ec. ^ above If I etated to facxtborne illness 3401.1 it C)(3) Whole-muscle,Intact Beet Steaks interventions ant risk factors. Other 145'F,- ( :ui).009 violation; eta relating i:,good ril J-401.12 Raba- Animal Foods Cooked in a pracncc� should be debiieci under H29-- Miciimave 1(5`1= 5pe6a0 Becuirentcnts. 3-401 11(Ai(1)0h) All Othe: PHF. - 145'F IS sec. * _ 17 Reheating for Hot Holding ( VIOLATIONS R.=LA-a'E't7 TO GOOD RETAIL PRACT.tCES 3-403.11(A)&(1.7) PHFs 165'F l5.sec. " ( (Iteurts 13_3(3) 3 4M.11(8) Microwave- 165" F 2 Minute Slandina Crruccd and,ion,-c wical viudaia/na, uvrrch do not rciare to the Timc" j'ondborne ilhtesr N;:o vodwa,and risk Incite:y listed above, can be 3-403.11(C) Commercially Processed RTE Frod- jotmd hl; J."%otiomin,e vectinnr u%;ha F"Dort Cole ar,d 1115 CMR 140" 590.Oriu. 3-403.1 t(E) Remaining Ltisliced Portions of Beef item Good Retail Fractices FC s80.000 Rossts* 23. Manaoornent and Pei sorrel FC,-% .GC3 ---- 24 Faad and Food Protection FC - 3 .004 18 Proper Coaling of PHFs ( ?5. Guuiomrni..^rd Ulensas FC -4 ,_005 _ 3-501.14(Al Cooling Cooked PHFs from 1409-lo 2C. VJater,Plumbingand WaFe FC-5 OOC 70°F(Within 2 flours and From 70"F 27. Phv=icai Faclity FC-6 .007 to 411 F14 jr Within 4 Haus. " ( 22. Poisonous or Towc Materialsf•C 7 . .006 3-501 14)R: Coolimg PHFs Made Hoot Ambient ( 29. Special Reaoaements -__( CO C, j `('empeiaturehigredientsto4l`F/45`.p 130. Ogler Within 4 Hours= 1`1,rt,ro.,,,i.- e 1,1V Iles Cnucel item u:IIV fMCral I()'."9 Foo-,1 C•ode or 101 CMI'5+4)r)(A). 0283 DERBY STREET Brother's Deli City of Salem FOOD SERVICE ESTABLISHMENT - FOOD SERVICE Inspection HACCP: ❑ Item Status Violation Critical Urgency Telephone: PROTECTION FROM CONTAMINATION 741-4648 Handwash Facilities FAIL ❑d RED Owner: Comment: Kitchen handwash sink obstructed at time of inspection. Sink to be clear and easily accesible at all times. Nidal Rajeh PIC: Wagner Dos Santos Inspector: John Gehan Date Inspected:Correct By: 10/11/2006 Risk Level: Permit Number: BHP-2006-0487 Status: Open #of Critical Violations: 2 Time IN: Time OUT: Urgency Description(s): BLUE: Violations Related to Good Retail Practices (Critical violations must be corrected immediately or within 10 days)(Non-critical violations must be corrected immediately or within 90 days) City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741-1800 GeoTMS®2006 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Oct 11,2006 ) Page 1 of f Item Status Violation Critical Urgency RED: Violations Related to Good Retail Practices (Blue Items) Violations Related to Food and Food Protection FAIL Critical BLUE Foodborne Illness Interventions and Risk Factors (Require Comment:Walk in freezer has uncovered foods. All foods in storage must be covered. immediate corrective action) Walk in freezer has food stored directly on floor. Foods to be stored 6.8 inches off of the floor. Walk in refrigerator has potentially hazardous foods stored directly overe ready to eat foods. All PHF to be stored correctly. walk in refrigerator has uncovered foods. All foods must be covered. dry strorage has uncovered foods. All foods in storage must be covered. Beverage Aire unit by front hand wash sink has uncovered foods. All foods must be covered. True unit at end of food line holding at 50°F. Unit to be holding at 41°F or below as mandated. Orange Juice container being stored directly on ice for beverages. Discard ice. OJ to be stored in proper designated areas. Sauces being stored directly on floor. All foods to be stored 6-8 inches off of the floor. Same sauces being covered by improper fitting utensils. Find proper covers. Equipment and Utensils FAIL BLUE Comment: Ice machine inside panel has accumulation of grime. Thoroughly clean and sanitize ice machine panel. Continental unit next to stove requires general cleaning. Blodgett Oven requires thorough cleaning. Walk in freezer requires thorough cleaning. Sanitizing log not being kept properly. Log to be maintained daily. Utensils being stored incorrectly next to Pepsi refrigerator and milk machine. Store utensils in proper areas. Shelves beneath plates requires general cleaning. Three Pepsi refrigerators on front line missing thermometers. Provide visible and accurate thermometers. Shelf holding spices above prep area requires general cleaning. Physical Facility FAIL BLUE Comment: Kitchen missing ceiling tile. Provide tile. City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741-1800 GeoTMS®2006 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Oct 11,2006 ) Page 2 of Item Status Violation Critical Urgency GENERAL COMMENTS: 890:Owner to fax over last three months of extermination reports to BOH. l� City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741-1800 GeoTMS®2006 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Oct 11,2006 ) Page 3 of 0283 DERBY STREET Brother's Deli City of Salem FOOD SERVICE ESTABLISHMENT - FOOD SERVICE Inspection HACCP: ❑ Item Status Violation Critical Urgency Telephone: PROTECTION FROM CONTAMINATION 741-4648 Handwash Facilities PASS ❑d RED Owner: Comments: Kitchen handwash sink obstructed at time of inspection. Sink to be clear and easily accesible at all times. Nidal Rajeh PIC: Nidal Rajeh Inspector: John Gehan Date Inspected:Correct By: 1011112006 Risk Level: j Permit Number: BHP-2006-0487 j Status: SIGNED OFF j #of Critical Violations: 0 Time IN: Time OUT: Urgency Description(s): BLUE: Violations Related to Good Retail Practices (Critical violations must be corrected immediately or within 10 days)(Non-critical violations must be corrected immediately or within 90 days) City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741-1800 GeOTMS@ 2006 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Oct 18,2006 ) Page I of r Item Status Violation Critical Urgency RED: Violations Related to Good Retail Practices (Blue Items) Violations Related to Food and Food Protection PASS Critical BLUE Foodborne Illness Interventions and Risk Factors (Require Comments:Walk in freezer has uncovered foods. All foods in storage must be covered. immediate corrective action) Walk in freezer has food stored directly on floor. Foods to be stored 6-8 inches off of the floor. Walk in refrigerator has potentially hazardous foods stored directly overe ready to eat foods. All PHF to be stored correctly. walk in refrigerator has uncovered foods. All foods must be covered. dry strorage has uncovered foods. All foods in storage must be covered. Beverage Aire unit by front hand wash sink has uncovered foods. All foods must be covered. True unit at end of food line holding at 50°F. Unit to be holding at 41"F or below as mandated. Orange Juice container being stored directly on ice for beverages. Discard ice. OJ to be stored in proper designated areas. Sauces being stored directly on floor. All foods to be stored 6.8 inches off of the floor. Same sauces being covered by improper fitting utensils. Find proper covers. Equipment and Utensils PASS BLUE Comments: Ice machine inside panel has accumulation of grime. Thoroughly clean and sanitize ice machine panel. Continental unit next to stove requires general cleaning. Blodgett Oven requires thorough cleaning. Walk in freezer requires thorough cleaning. Sanitizing log not being kept properly. Log to be maintained daily. Utensils being stored incorrectly next to Pepsi refrigerator and milk machine. Store utensils in proper areas. Shelves beneath plates requires general cleaning. Three Pepsi refrigerators on front line missing thermometers. Provide visible and accurate thermometers. Shelf holding spices above prep area requires general cleaning. Physical Facility PASS BLUE Comments: Kitchen missing ceiling tile. Provide tile. City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741.1800 GeoTMS®2006 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Oct 18,2006 ) Page 2 of Item Status Violation Critical Urgency GENERAL COMMENTS: 909:All violations have been corrected from 1011112006. v City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741.1800 GeoTMS®2006 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Oct 18,2006 ) Page 3 of Commonwealth of Massachusetts City of Salem Board of Health 120 Washington Street,4th Floor SALEM,MA 01970 Food/Retail Establishment Permit DATE PRINTED: 05/22/2006 WHO'S PLACE OF BUSINESS IS: Brother's Deli File Number.Brie-2004-0018 283 Derby Street Salem MA 01970 LOCATED AT: 0283 DERBY STREET SALEM,MA 01970 Permit Type Permit No. Permit Issued Permit Expires Fee Restrictions/Notes FOOD SERVICE BHP-2006-0487 May 22,2006 Dec 31,2006 $200.00 ESTABLISHMENT Total Fees: $200.00 PERMIT EXPIRES (December 31, 2006 I A Board of Health V This Permit is not transferable and must be reissued upon change of ownership or location.The permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code,beofre any revonations,improvements,or equipment changes are made,all plans for such must be submitted to and approved by the Salem Board of Health. Page 1 of 1 ti CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH j s 120 WASHINGTON STREET, 4TH FLOOR SALEM, MA 01970 TEL. 978-741-1800 FAx 978-745-0343 Kimberley Driscoll WWWSALEM.COM Mayor JOANNE SCOTT, MPH, RS, CHO HEALTH AGENT 2006 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT NAME OF ESTABLISHMENT f f /. TEL# l 7!�F 0 ADDRESS OF ESTABLISHMENT I MAILING ADDRESS (if different) Keo / / OWNER'S NAME // 119 L P/ 16� h TEL# 6( 7 �0 ADDRESS 9�0dor.J S (-{- CITY PA '(7-0 ✓O STATE MGI ZIP CJ f O Z <- CERTIFIEDFOOD MANAGER'S NAME(S) //(2WL __/ 66/j 'foc �rlcvCERTIFICATE#(s) ` £IK 3ddS4 a �3 (required in an establishment where potentlally'hazardousfnod is prepared.) �a 5 720Z EMERGENCY RESPONSE PERSON A AL RA�0 HOME TEL# (7 53 6 HOURS OF OPERATION: Mon.ff-l--Tue. Wed.��Thu.-&-��Fri. ( Sat.-kL S TYPE OF ESTABLISHMENT FEE (check only) RETAIL STORE YES NO less than 1000sq.ft. =$ 50 1000-10,000sq.ft. =$100 more than 10,000sq.ft. =$250 -... ............................... ......-----................................................ RESTAURANT YE NO less than 25 seats =$100 25-99-seats-------E- 150 /more than 99 seats =$200 -� ------------------------------------- =` ---- - _ :-.................--------------- BED/BREAKFAST YES NO $100 - ------------------------------------------------------------------------------- ....................... ADDITIONAL PERMITS MAKE (not just serve) ICE CREAM, YOGURT, SOFT SERVE YES NO $5 TOBACCO VENDOR YES NO $50 ALL NON-PROFIT(such as church kitchens) YES NO $25 'Please pay total with one check payable to the City of Salem . This Permit is not transferable and must be reissued upon change of ownership. The Permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code, before any renovations, improvements, or equipment changes are made, all plans for such must be submitted to and approved by the Salem Board of Health. Pursuant to MGL Chapter 62G, Section 49A, I certify under the pains and penalties of perjury that I, to my best knowledge and ef, ave f ed all state tax returns and paid all state taxes required under the law. 24 1 Signature V iJ Date Social Security or Federal Identification Number ---------------------------= ------------------------------------------------------------------------------------------------------- Revised 11/03/05 1`00q/-P2.adm Check#&Date-,,Sf4R"—n/DDJ(3Xe-(- A6 e-(- n6 lir q /�, /� ///�, // // _i //i �/ -� �/ ,+ �l�l � ��"� ��' i 0283 DERBY STREET Brother's Deli City of Salem FOOD SERVICE ESTABLISHMENT - FOOD SERVICE Inspection HACCP: ❑ Item Status Violation Critical Urgency Telephone: PROTECTION FROM CONTAMINATION 741-4648 I Handwash Facilities FAIL RED Owner: mment: Kitchen handwash sink obstructed at time of inspection. Sink to be clear and easily accesible at all times. Nidal Rajeh PIC: Wagner Dos Santos Inspector: John Gehan Date Inspected:Correct By: 10/11/2006 Risk Level: Permit Number: BHP-2006-0487 Status: Open #of Critical Violations: 2 Time IN Time OUT, i Urgency Description(s): BLUE: Violations Related to Good Retail Practices (Critical violations must be corrected immediately or within 10 days)(Non-critical violations must be corrected immediately or within 90 days) City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741-1800 GeoTMS®2006 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Oct 13,2006 ) Page I of Item Status Violation Critical Urgency RED: Violations Related to Good Retail Practices (Blue Items) Violations Related to Food and Fo Protection FAIL Critical BLUE Foodborne Illness Interventions and Risk Factors (Require Comment:Walk in freezer has uncovered foods. All foods in storage must be covered. immediate corrective action) Walk m freezer has food stored directly on floor. Foods to be stored 6-8 inches off of the Floor. ,,.Walk in refrigerator has potentially hazardous foods stored directly overe ready to eat foods. All PHF to be stored correctly. �k in refrigerator has uncovered foods. All foods must be covered. .' strorage has uncovered foods. All foods in storage must be covered. rage Aire unit by front hand wash sink has uncovered foods. All foods must be covered. ,jkl` unit at end of food line holding at 50°F. Unit to be holding at 41°F or below as mandated. Ono t rarae Juice container being stored directly on ice for beverages. Discard ice. OJ to be stored in proper designated areas. aces being stored directly on floor. All foods to be stored 6-8 inches off of the floor. �me sauces being covered by improper fitting utensils. Find proper covers. Equipment and Utensils FAIL BLUE /comment: Ice machine inside panel has accumulation of grime. Thoroughly clean and sanitize ice machine panel. vnntinental unit next to stove requires general cleaning. vy8lodg van requires thorough cleaning. alk m freezer requires thorough cleaning. nitizing log not being kept properly. Log to be maintained daily. �ensils being stored incorrectly next to papal refrigerator and milk machine. Store utensils in proper areas. !Shelves beneath plates requires general cleaning. ,jIlree Pepsi refrigerators on front line missing thermometers. Provide visible and accurate thermometers. elf holding spices above prep area requires general cleaning. Physical Facili FAIL BLUE omment: Kitchen missing ceiling tile. Provide tile. City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741-1800 GeoTMS®2006 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Oct 13,2006 ) Page 2 of Item Status Violation Critical Urgency GE RAL COMMENTS: "11(90:Owner to fax over last three months of extermination reports to BOH. City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741-1800 GeoTMS®2006 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Oct 13,2006 ) Page 3 of 0283 DERBY STREET Brother's Deli City of Salem FOOD SERVICE ESTABLISHMENT - FOOD SERVICE Inspection HACCP: ❑ Item Status Violation Critical Urgency Telephone: PROTECTION FROM CONTAMINATION 741-4648 Prevention of Contamination from Hands PASS RED Owner: Handwash Facilities PASS RED Penny Christopher PICViolations Related to Good Retail Practices (Blue Items) Hazem Muhieddin Food and Food Protection PASS BLUE Inspector: John Gehan _ Equipment and Utensils PASS BLUE Date Inspected: Correct By:. Physical Facility FAIL BLUE 5/5/2006 Comments: Light in kitchen above hand wash sink missing cover. Any cracked covers must be replaced.Owner states new lights Risk Level: are on order. Lights to be replaced and in working order by May 15,2006 per order of Health Agent. Permit Number: Owner has provided door sweep on back exterior door.screen door still has gaps.Owner to keep exterior closed until screen door is repaired or replaced.Seal all gaps to prevent entrance of insects/rodents.Owner has been told that if exterior door is observed BHP-2006-0023 to be in open position, based on establishments meeting on 5-4-06 with Health Agent Joanne Scott,establishments permit may be Status: revoked until further notice.Screen door to be repaired/replaced by 5-15-06. PARTIAL COMPLY Worriers rest room door handle in disrepair. Handle to be fixed at time of next routine inspection. #of Critical Violations: GENERAL COMMENTS: 0 Time IN: Time OUT 608: Urgency Description(s)' BLUE: Violations Related to Good Retail Practices (Critical violations must be corrected immediately or within 10 days)(Non-critical violations must be corrected immediately or within 90 days) City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741-1800 GeOTMS®2006 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. May 08,2006 ) Page I oft r r Item Status Violation Critical Urgency RED: Violations Related to Foodborne Illness Interventions and Risk Factors (Require immediate corrective action) NZ City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741-1800 GeoTMS®2006 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. May 08,2006 ) Page 2 oft , 00 y _ DfE L.NI OUT M1. rn '. •t. PEO. TME RES. OMd N000 U DOOR jf ... 'Ai CIlY.3I'PlE,E1Pl.+1m -.•• YXONE 'S511YICE5'VERF gAIEC :TARGET P5tIi91i'l-'I'AROLICATIGN METHOD.` ❑ INSPECTION '''•'; __ __ _____ 6 ❑ :� ❑ TREATMENT ^I s❑c o, I ❑ D3� D :A 1 Y CNEWCAIS USED {I' AMOUNT X I_yEPA NNMSEq DESCRRIPTION/REMAIikS AMOUNT Z, �. 'II• �_�_–._.4, .� _• -._ _:..'ale-�-. m � A Z g i 'f—–• + � ' B s[irvGiiiAv ! N.__.._..-_,.. TOTAL n: � B rty p 31, 'N rro " ;a SERVICE REPORT "' "i t;' 3 ��' ❑ V, ;..- qi,;, m` '+!:'i,:?;,-'r::,•av,„'.^:sn.AUY_arr.?ulekr+,t•Avk:°':p=„I, I N. I/ COURT DOCKET NOCITATION NO . 00 JW CITY OF SALEM PD ©-- VIOLATION NOTICE 0 NAME(LAST,FIRST,INITIAL) atz�ft�rs �; STREET ADDRESS CITY/TOWN STATE ZIP 2� > Dt120Y s- 5i�ieyr, rrA 0 P,70 LICENSE NO LIC,EXP.DATE DATE OF BIRTH OWNER'S NAME(LAST,FIRST,INITIAL) VAT& It N ITpA/ STREETADDRESS CITY/TOWN STATE ZIP REGISTRATION NO. STATE EXP.DATE I MAKETYPE YEAR(COLOR DATE OF VIOLATION TIME DATE CITATION WRITTEN I PERSONAL (( / INNRY P ?�I_IfVYJ /a-ry QM 3/ZH �O� ❑VES ❑ND LOCATION OF VIOLATIONENFORCING DEPT. OFFENSE .. CHAP SECT FINES A kL-?C1iaNTIOIS —1c> I�ttcoJ . �t 'z i 4 - S-zAr7E- fcxa,) r,cter ar-rzle�r+ - x—'fol' iI R-5ade C OFFICER I D NO.I TOTAL($ 6b DUE OFFICER CERTIFIES COPY GIVEN TO VIOLATOR -:)4 [-] IN HAND X _ © BV MAIL DOTIOT MAIL CASH-PAY ONLY BY POSTAL NOTE,MONEY ORDER OR BY CHECK MADE PAYABLE TO: CITY CLERK CITY HALL 93 WASHINGTON STREET SALEM,MA 01970 TEL.(508)745-9595 X 251 1 HEREBY ELECT TO EXERCISE THE FIRST OPTION AS STATED ON REVERSE, CONFESS TO THE OFFENSE CHARGED,AND ENCLOSE PAYMENT IN THE AMOUNT OF $ CASE# SIGNATURE SEE OTHER SIDE FOR FURTHER INFORMATION ENCLOSE PAYMENT INTHIS ENVELOPE,PEEL AND SEAL 4 i � ( IMPORTANT MESSAGE FOR (�. DATE /J/� TIME 2 `POI I. M 11"r.�n v �ticAU.s OF PHONG AREA CODE NUMBER EXTENSION ❑ FAX O MOBII F AREA CODE NUMBER TIME TO CALL TELEPHONED I X PLEASE CALL JF CAME TO SEE YOU , WILL CALL AGAIN l WANTS TO SEE YOU I RUSH Ik I RETURNED YOUR CALL I W_ILL FAX TO YOU MESSAGE /�/if/�,✓o 1.c1'i,'S o�s'�."'h*j u� ,�i7.�.A.dS D� La 71 SIGNED ,�Z .e �� FORM U A MAGE IN U 5. NOTES ` I CITY OF SALEM ` /�,�, BOARD OF HEALTH Establishment Name:&zr/%� Date: �j�/ 7� (a Page: of Item Code C-Critical Item DESCRIPTION OF VIOLATION/PIAN/OF CORRECTION Date No. Reference R—Red Item Verified ' PLEASE PRINT CLEARLY r /- i ��r=i<<s .e�Cr� v A �or�r •1s r %/�� 7 -71*46F w/s A i 7#,c5- -211 �7 A--r JS 1 1}i3G�5/fJ77,?-a 1-r WAIZ/�-'�= O/U 1,A-s /nNF0rz/rre1r--> _ m vi A,„rr /2e-l_/e7/1'--D toN2-3) /NSi2,112571&9 h�7 :�nnye� s /vim P2/5 ,—mac ri CeE 2&s—. i>+r'S- E I -7n fir/�� r T--`-��srvr � 2 ate- l o/✓i A-v�-� i�/.t�7/�! 'Irr Tf}� Sm/�zG D!— l// A�Z� ,-d S. T lOD/Gt� OV!>YL i}7✓/� df7�r'J2 � Ate✓ M7io,A- r/ WJ7-ft Srn n 7,7. 2 iiU,.-, G/CSA Dvi, h�✓7 vL X-5 A1z 7/;e-_1&7"__) YVI `Z Re /va—/Fi,1_6'/D AIV P i AA-T l�/s /E� S /iRTP_'4T fl /!7e/1/�i AQ✓ I _ � I 216!�/iL-r /oV 1270Nr9-72,/ X::-/Ne5 O,=- 4 ZS b° 4dGL 2e;-b-;r124`/s1J7- 11-rv'D 4 /071 . Fio.n 1P�<>g1-n 9-1V Discussion With Person in Charge: Corrective Action Regyired- ( ❑ No I ❑ Yes t 1 have read this report, have had the opportunity to ask questions and agree to correct all ❑ Voluntary Compliance ❑ Employee Restriction/ Exclusion violations before the next inspection, to observe all conditions as described, and to ❑ Re-inspection Scheduled ❑ Emergency Suspension comply with all mandates of the Mass/Federal Food Code. I understand that noncompliance may result in daily fines of t dollarsor)suspension/revocation of ❑ Embargo C] Emergency Closure N. your food permit. // ❑ Voluntary Disposal ❑ Other: l 0 ;'144 l` --;art 3.110: PHFs R,:ca ved it Temporal urea Violations Related to Foodborne Illness Interventions and Risk Ac;rrd:ng to L ov Cooled to Factors(items 1.22) (Cont.) .11`F/iSiFWithin 4Hours. ` PROTECTION FROM CHEMICALS 3-50:.!S Cn,9;ga biedxxls for Pills � I1 Food or Color Additives ! 19 PHr-Hot and Cold Holding 3-20112 Additives` 13-50I.1(,(k) Cold PHFa Maintaiue;t at or beton: 3302.14 Protection from Unapproved Additives' j 590)004("F) JA 1'145° F" 15 Poisonous or Toxic Substances j 3-50(.IG(:1t HotPHFsMaintained -itorabove 14fi'F. 7-101.11 Identifying Informal ion-Original Containers^ 1 3-501 16(3) Roast:, Held at or above 1300n 7-102. ( 2p , T'me as a Public Health Control II CnmmonName-\S'otking,Cnnrtincrs* 1 1 7'01-Ii Separation-ShmsKe" i 3-501-(9 Tim"a::aPahiiCHealthConnor) 7-202.! 1 Re>trichon-- Presence and Use" 1590.ODv(H) Vi,iance Requirement j 7-202.12 03Conditions of Use* REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-204.11 Toxic C'is.Critesers a Clwnrofi'bi tions" j POPULATIONS(HSP) '1-..04.11 Sm»tizer>.Criteria-Chemicds� j 7-204.12 Chemicals for Washing Produce,Criteria* j 2E 3301 II(A) Unp:steurizcd Heverazes with Waran.p IPre-packaged Juices and u:[ °. 7-2Ud.b1 Diving.Agents.Cnteria)* ( 3-301.1t1a 1!se"f E 7-205.11 incidental Food Contact.Lubricants` ( ! ) Pastemizea_.qga' o r I 13-81)1.1 i(D) Rau 9r P.^.Spit CCN q s Anunal Food and ( 7-_GG.I i Restricted Use Pesticides,Criteria* - Kaw'Seed Spit Is I�;,t Sci ved. 7206.12 Rodent Bait Stations" 3$01.11;(.) Unoocred Food"Packativ \'ot Re-served ! 1 '06.13 Tracking Powder:,Pest Control and - - LlontaingT CONSUMER ADVISORY TiMEITEMPERATURE CONTROLS 22 --603.11 Consumer Ach,,ory Posted for Consumption of 16 Proper Cooking Temperatures for ! Anint:d Foods;hat kite Raw,Undcrcunked or PHFs Not Cghcew isr Processed to Liitmnate 3-301.11 A(i)r•') Eggs- 155'F 15 Sec. Pntho:;en:. �'� ' rr.:.:•e tv:^wr E;,gs-Immediate Ser icc 145`Fl.isec 3 302.13 Patiteurized I?gg=Subztitnte for Rae'Shell 3-401.11(3)(2) Comminuted Fish.Meals&,O;une Epee" Awrittils- 155`17 15 sec. 'f 3-401.11(B)(1)(2) Pork and Beef Roast- 130`F 131 min* . SPECIAL REQUIREMENTS 3-401.17(A)(2) Ratites, Injected Meats--155"F 15 j 590.909(1)-(D) Violations of Section 590.0091A)-fD) in sec. '" c.eU-rine4 mobile food, temporary and 3-•101.11(.1)(:1; Poultry, Wild Game,Stuffed PH17S. residential kitchen operations tilIQUId be Stuffing Containing Fish,Meat, d6ited under the app)opriate Sections Poultry or Ratite,.-165T 15 sec. " above if related to f(Kidbom,, illness 3-401 1ItC)(3) Whole n usc',e,Intact Beef Steaks. ( Interventions and risk factors. Otlier 145`F* 590.;009 violations rclatin- to good retail 3-401 12 Raw Animal Foods Cooked in a pracucec should he debited under #29- Mt_towave 165`F* Special Requirements. 3=101.1 I(A)(10) All(hher PHFs- 145'F 15 sec 17 Reheating for Hot Holding ! VIOLATIONS RJLAI-ED TO GOOV RETAIL PRACTICES 3..1x,3.11(,A)&(DI PHFs 165'F 15 sec. * ! (Items 23-30) 3-4U3.1 I(B) MICrOWaVC- 165'F 2 Minute Slanding ! Critical and non-critical viulaoonv. which do nor relate to the Time" k,udhorns d',e:as iwei venrions and risk far torr listed above. can he 3-40311(C) Commercially Pnxecsed RTE Food- Rnina' n rhe faliuwing ser;inns of the Fnrvl Code and 107 CAI.R 140°F* `9QOt7U. 3-403.11(6) Remaining Unsl'ced Portions of Beef I r Item Gond Rerail Practices FC j 590.000 Roasts" j 1 23. Management and Personnel FC -2 003 18 Proper Cooling of PHFs ! 24 Food and r cod Protection FC-3 : .004 ! ! 25. Equipment and Utensils FC--4 .0105 ! 3-501 14(.'1) Cooling Cooked PHFt, from 140`F to 26 Water Plumbing and`Noste FC-5 ( 306 --- j "0:F Witton 2 Flours end From 70'F 27. PhV°real Faaidy FC--6 ! 007 to 41`F745°F Within'Hours. * 1 28 Poisonous or Toxic Matedalc FC-'1 ! .008 I 3-5U1.14(H) Cooling PHFs Glade Front Ambient29 Special"lecueements Temperature In!,,;redieni s to 11'F/45`'P 30. Gtner , Within 4 Hour.1, ;-n,. 1 Denote%enucal ilem In Iho G:d.a.,! i 999 Food C wle or 105 Clin;190 i r01). i ` is f 1 _,,� �; +. ,: ^`�a:- _ n _ vti- .✓- ,:gW: '; . ? v' "3,';L,^w•:: ?ri:.;ir,.::'. -T"'A ??2;.,"4?^..'y:y.. .Va� �1i• i 6 :rtTIT'p�', v5>.,y-.:r�,...,-:S a':%%ry':` ::P�,=-i5?<�t,,•,'-'' ^' ;v3;r. ^..;.as '� } ✓uStrv.. +A + ! ,q +� ,+'. �I u I r,�s 1 t t '.ted j " �'v '.'' -Nom' yy1ssf v1IT. J ✓. (LASI;'fIRST,!I,NITIAy fi�'�'.^'^'.;:w., - r - ,,.,- -n'wdc pWzw II.' II l aSIlIIII//I/l✓ S�REETAooREss - - CfTY/fONM;_,,STATETzA;: xEr�� rrl IIIrIII✓ , 7$3 'Ar7Z6V 57 � S(� ►n"� aSa \: \\\\\\\ti- SII moi'/!II/IIIIf✓ % LICENSE No. �uC EX O ER'S NAME(LAST,FIRST,INITIAL) - ! .^ p ;� III `r�I✓rII� IIIIII✓II✓=� ��;� ,�� II II✓' II II✓IIIIIIf�I. !STREETADDRESS clTVrtowN STATE LP ✓;/II,7rIIIIII ;rlr�/II�^-/I�r � &41W 401 /�q- 6oZa 3S \ ,„�\ ,, �\. \, \, �\,,� REGISTRATION NO. STATE EXP DATE MAKET/PE YEAR 111ICOLOfl ..�' /Q✓ 7 l.�.f.�.�./f✓i.l/.� .�1.�IJ flnf�/fl 9l J: f//f'• ✓. : . .. ' ' /✓/-�a JJ L DA EOF VOCATION TIME DATE TATI NWRITTEN PERWNN. }, ter`\ \�\\\\'.\� .�-,\\\.\�.\oWl.Z•\'� -`� 1 1r}� �t( ES /C/� /9 iwu r r�f ./.�./�f.///J✓ %:f/.�f.��r.`�'�J�✓.i i �1 0�//V W ❑PM �/ �/ O NO M F LOCATION OF VIOLATION ENFORCING DEPT. \ - - OFFENSE CHAP. SECT. FINES ::s:: / /%/ i",-/✓i /i✓'.'ii i%j/' / A 4/2f)J'7I�/OC fi%SONS 7V %';%✓%i//�'/✓.i:/i ://, ii:%i✓%/,,///r`� % � SHF '� ip%%!.!/%`/_!/;' �//,`!,;//i%`//,'✓;rte; , iB eCIIA7 16SC to .Q7//,-J: /' ,//• •'/'�- `i.' ./J .,% OqFFFFIICERR LD NO TOTAL FINE Is �.V. � DUE '1 I, ti ' l ";.0 CER CERTIFIESCOPY GIVEN TO VIOLATOR IN HAND v W •'ham , . _ X 1 ❑ BY MAIL ! 2(0/NOT MAIL CASH-PAY ONLY BY POSTAL NOTE,MONEYi� ORDER OR BY CHECK MADE PAYABLE TO: CITY CLERK b -- ,•� .�. �.,,'. '' .� ." S -3 CITY HALL 93 WASHINGTON STREET j SALEM,MA 01970 TEL.(508)745-9595 X 251 I HEREBY ELECT TO EXERCISE THE FIRST OPTION AS STATED ON _ REVERSE, CONFESS TO THE OFFENSE CHARGED,AND ENCLOSE PAYMENT IN THEAMOUNT OF \ , - ' . . ;� �•- I S CASE# � SIGNATURE � R9 r I D C' k SEE OTHER SIDE FOR FURTHER INFORMATION ENCLOSE PAYMENT INTHIS ENVELOPE,PEEL AND SEAL W I � 1 p5u 6 $ s - 03 (�f n L 0283 DERBY STREET Brother's Deli City of Salem FOOD SERVICE ESTABLISHMENT - FOOD SERVICE REINSPECTION Inspection HACCP: ❑ Telephone. Item Status Violation Critical Urgency Nature of problem or correction 741-4648 Non-compliance with: Done Owner: Anti-Choking PASS ❑ Penny Christopher Tobacco PASS ❑ PIC: Hazem Muhieddin - FOOD PROTECTION MANAGEMENT Done PIC Assigned/Knowledgeable/Duties PASS RED Inspector: David Greenbaum EMPLOYEE HEALTH Done Date Inspected: Correct By: Reporting of Diseases by Food Employee and PIC PASS RED 3/28/2005 _ Personnel with Infections Restricted/Excluded PASS RED Risk Level: _ FOOD FROM APPROVED SOURCE Done Permit Number: Food and Water from Approved Source PASS RED BHP-2005-0080 Receiving/Condition PASS �/❑ RED Status: Tags/Records/Accuracy of Ingredient Statements PASS /1 RED FULL COMPLY #of Critical Violations: Conformance with Approved Procedures/HACCP PASS RED Plans PROTECTION FROM CONTAMINATION Done Time IN Time OUT: Separation/Segregation/Protection PASS d❑ RED Notes: Food Contact Surfaces Cleaning and Sanitizing PASS RED 46: Proper Adequate Handwashing PASS RED Urgency Description(s): Good Hygienic Practices PASS ❑d RED BLUE: Prevention of Contamination from Hands PASS ❑Q RED Violations Related to Good Retail Practices (Critical Handwash Facilities PASS ❑/ RED violations must be corrected immediately or within 10 days)(Non-critical violations GeOTMS®2005 Des Lauriers Municipal Solutions, Inc. ( Rev. Mar 29,2005 ) Page 1 oft 0283 DERBY STREET Brother's Deli must be corrected immediately PROTECTION FROM CHEMICALS Done or within 90 days) Approved Food or Color Additives PASS RED RED: Violations Related to Toxic Chemicals PASS ❑d RED Foodborne Illness Interventions TIME/TEMPERATURE CONTROLS(Potentially Haz Done and Risk Factors (Require Cooking Temperatures PASS RED immediate corrective action) Reheating PASS RED Cooling PASS RED Hot and Cold Holding PASS ❑d RED Time As a Public Health Control PASS ❑d RED REQUIREMENTS FOR HIGHLY SUSCEPTIBLE PO Done Food and Food Preparation for HSP PASS ❑d RED CONSUMER ADVISORY Done Posting of Consumer Advisories PASS ❑d RED Violations Related to Good Retail Practices (Blue Done Management and Personnel PASS ❑ BLUE Food and Food Protection PASS ❑ BLUE Equipment and Utensils PASS ❑ BLUE Water, Plumbing and Waste PASS ❑ BLUE Physical Facility PASS ❑ BLUE Poisonous or Toxic Materials PASS ❑ BLUE Special Requirements PASS ❑ BLUE Other-See Notes PASS ❑ BLUE All violations cited in 3/17/05 inspection report have been corrected GeOTMS®2005 Des Lauriers Municipal Solutions, Inc. ( Rev. Mar 29,2005 ) Page 2 oft CITY OF SALEM BOARD OF HEALTH Name of Establishment: Brother's Deli Address: 283 Derby Street Owner(s): Hazem Muhieddi, Nidal Rajeh Phone: 978-741-4648 Date: May 4, 2006 The owners of this establishment were requested to appear for a hearing regarding multiple repeat critical violations observed at their establishment during a routine inspection on April 27, 2006 by Senior Sanitarian Janet Dionne and Sanitarian John Gehan. There were multiple repeat, and some critical, violations observed since the last inspection in December 2005. The owners were asked to appear for a hearing in December for the same violations. Mr. Rajeh claims that he will be taking over sole ownership of the establishment within the next two weeks. An application for a new food permit was given to him so that he will apply for a permit under his name only. Mr. Rajeh claims that the repeat violations will not occur again when he is the sole owner because he will have more control. He says that he will not be working at this location full time. He understands that the manager of the establishment must be a Certified Food Manager and responsible for complying with the State Food Code. Repeat violations of the Food Code during any future inspection will result in suspension of the food permit. In addition,ikthe following violations noted on the April inspection and the May inspection, with some repeated from the December inspection, must be corrected by 8 AM on May 5, 2006, or the establishment's food permit will be suspended until noearlierthan Monday, May 8, 2006: �, Personal items next to take-out containers �idence of cigarette smoking within the establishment ,.. Ice on walk-in floor Water stained ceiling tiles Air gap next to office door --�56ffvfj_ ,.--Air gap beneath and on the sides of door next to public bathroom The following cases may not be used unless electrical cooling (ice not allowed) cools foods to 41 degrees C or cooler: ✓. Pie case yl Salad case l /S In addition the following is required by May 1-2, 2006 • All light covers replaced • Source of leak determined by professional. Invoice must be available for inspection The Board of Health is issuing a $300 ticket for repeat critical violations. S - L/-0 6 Joanne Scott Date Health Agen Nidal Rajeh Date i CITY OF SALEM t BOARD OF HEALTH Establishment Name: &00TNE iCS DEC ( Date: V, Page: of Item Code C-Critical nem DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date , No. Reference R-Red Item Verified //��, I PLEASE PRINT CLEARLY } (JWnO vS /O�i till •` ��ii ria ( /'C a i-eh . /Q�/rci A" ✓P✓/C_ �.[J !/ 7 n/( �J yr1 s ,, G /i � /r /A 7Z(O. �3f�2,Fn. �1wi �IiH [ Otte F/c>. 72le-A A.pPi",o,4 Os PI,03-e 4-t-W- /.l wl ✓FHd�a �iv>,s 19� t-k?dce. -f-i 7%,5 -Ps-EA 4//s 514K l/) 44a._ l« Le� rra/d c Q-4, % -fa a rNare' Iva/ )eel u- �^^ IIDJ/�wf.�. �P�QrQ'FIM [fit i'K?LPA �G/�S I/A'� ltx+l�j I ` c4�,u rCK Cowl, �� h Pa,�r Tio 110,: 1 i F/w, Lvg's �s C��fr-�rcu�«->•r � /V/cam.-/ /PsfQh is 2 C'Pi->!r�r?d -�� /ii�r��„r. SI-7,r /Yv54 iia ue Lt_& /! hL” Ci Soli P aand FjP.e.-U 064 a(( �% s �n.eian� /QP,Zr //Ltn-rr-g ' / 1"...2i `zr0�/- /✓I - (7 V-tom./A 1 _ H Pr 'r-i 1.-j. ci /`&f do,(A t oz a- �cr 0 4-Az4 e, - rows f bc, a rS' 5-14e a4 _1 Discussion With Person in Charge: U Corrective Action Required: I ❑ No I ❑ Yes i+have read this report, have had the opportunity to ask questions and agree to correct all ❑ Voluntary Compliance LI Employee Restriction/ Exclusion c violations before the next inspection, to observe all conditions as described, and to ❑ Re-inspection Scheduled ❑ Emergency Suspension comply with all mandates of the Mass/Federal Food Code. I understand that rioncompliance may result in daily fines of twenty-five dollars or suspension/revocation of ❑ Embargo ❑ Emergency Closure k your food permit. .r I ❑ Voluntary Disposal ❑ Other: r ' 3-501 1:;C! P1f Fs Reeeived at-temperatures Violations Related to Foodborne Illness Interventions and Risk Accrann,to I.aw Cooled to Factors(items 1.22) (Cont.) 4FFr45'F Within 1 Hut PROTECTION FROM CHEMICALS 3-5 1.15 Coaling Methods for I'HFF j j 14 Food or Color Additives I 19 PHF Hot and Cold Holding 3-501.16(6) Cold PIIFs Maintained at ur tie-low3 202.12 Additive:' I 500.004(,F) -4:"/45°17.: 3-302.14 Protection hroot Uuapprrned AdditivesT ( 13-,101 16(A) Kit P I-IFs Ivtaintained at or abme j 15 1 Poisonous or Toxic Substances 7-I01.11 Identifying Intirnmaion-Original I ;-501.16(:1) Rusts Held at or above I t)"F Containers" 7-102.1 1 Common Name-Working Containers" ( ( 20 1 Time as a Public Heal' Control j 7-201.11 Separation-Storage.•, 1 3-501.19 Time as a Public Health Conhvl' j 7-202.11 Re aricti nn-Prcacnce and Lke" I 1590.0!)It H) Veriance Rt'(hlirt'lMIn 7 '_0'_.12 Conditions of Use' 7-203 11 Toxic Container.-Prohibitions" REQUIREMENTS FOR HIGHLY SUSCEPTIBLE Criteria-Chemicals-' POPLLATIONS(HSP) 7-21)4,11 Satntizets. ( l "21 3-x01.1;(,1) Un}' tzvnzed Pro- ack.a4ed jukes and 7-161.12 Chemicals for Y1'ashm}*Pnxinee,Criteria"' l I ! 6evr!aees wnh R'arninp 1 sheis' 1 7-204.14 Dying Agrnts.Criteria' I ' 7-205.11 Incidental Food Contact. Lubncants^ ( 1 3-861.i I(k) Use of Pasteurized Eggs" 7-206.11 Restricted Ue * ( 1 3-80 i.11(D) Raw or Pa.tially Conked Awned F(KQ anal e Pesticides Criteria Rale Seed Sprouts Not Sc std. 7-206.12 Rodent Hatt Stations' j 13-g01.11(C') !Inupercd Food Package Not Re:env^d. ' 7-206.S3 Tnwking Powders,Pes; Control and ASonrtasing" CONSUMER ADVISORY 22 3-03 11 Consurucr Adtismy Posted ,")I-Consumption of TIME(TEMPER4TURE CONTROLS Animal Foods Mat are Raw.Undercooked or 1fi Proper Cocking Temperatures for I PHFs Not Otnery:)sm e Processed to Elunate w,•na.,-+,ale 3-401.1 1 A(i)('2) E.<>g>:- 155 F 15 Sec. Pathu,:.ens." s Egger hnntediate Servos 145'F15sec* 3-302.13 Pa;tenriled Fgl ,c SnhStinut'for Raw Shell 13-401.11(A)12) Comminuted Fish,Meats&Game Eg4,sr Animals- 155'F 15 sec. ,r SPECIAL REQUIREMENTS3-401.11(6)(2)(2) Park and Beef Roes(- 13{1`5 131 min' 590 009(A)-(D) Violations of Section 590.009(A)-(D) in 3-101.11(A)(2} Ratites,Tnjected Mats-155"F 15 sec. :e catering. mobile food,temporary and 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs, residential kitchen operations should be Si offing Contain1112 Fish,Meat, debited under the appropriate seetmons Poultry or Ratite;-165`5 15 sec above it telowd to faatbornc illness ( 3-40L11(C(3) Whole-muscle,butadBvefS+caks ( interrentians.:ndrisE. factors. Other 115°P'' 590.009 violations reiating to good retail 3-401.12 Raw Animal Foods Cooked in a practices should be debited under#29- M!crowaoe 165`P ° Special Requirements. 3-101,11(A)(]c(b) All Other PT-IFs - 115'F 15 ser. ' 17 Reheating for Hot Holding VIOLATIONS R.FLATED To Go00 RETAIL PRACTICES 3-403.11(A)&,(I)) PHFs 165'F 15 sec. "` (items 1..3-30) 3-403.11(6) Microwave- 165'F2 Minute Standing Critiad and,mm critical ciul(aumv, winch du not relate to the Time" (oodi;orrre dihess intrrverLc-to and risk factors listed above. (an be 3-103.11(C) Comm-r,!ally N(xessed RTE Food- h,e:rrd in the follnning secd,.ns of the Fon,1 C'ude mid 105 041? 140'F" 590.000, 3-403.11(E) ReniainmgUnshecdPoriunsofBeef Item GoodRetaAPractices FC 590.000---� Roasts23. 04anacament and Personnel FC-2 .003 j 1g Proper Coming of PHFs 24 =ori and FoW Protection FC-3 0,04 25. Emauinrnent and W rsD3 F,'-C 065 j 3-501.14(:) Conlon;Cooked PHFs from 140'F to 26 Wa:a:,Plu;ncino and Waste F.^-5 _006 70'F Within 2 Hours and From 70'N1 27. Physical Faciily t-C-6 007 -----I to 41`F145'F Within 4 Hnu;s. ' l 1 28, Poisonous u:Toxic flaterial, FC - 7 .008 _ ?-561.11(6) Cool III,,,PHFs Made From Ambientj 29. Sc-ec it Readiements _00.9__- - Temperature htgredient s to 41'x/45,F ( 30. Other Within 4liour ' """""1,11, Denoes'Tical ne:p,III III,,Wend )ri`)v Fou(]Cod:or 105 CNIk 590 000. CITY OF SALEM \ BOARD OF HEALTH Establishment Name: �'°�� 11 Date: DSl Page: -2 of 2 Rem Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date No. Reference R—Red Item Verified PLEASE PRINT CLEARLY P.S-IWS//s ,:r�� ., 1-7 V tea.,,i��I� /•af�w. 1 ce.. ✓P GP i�Q d. I � Tk�Q r sf he. �JrlHy '9P_C f"- Cv /S (Ylaa, :5 - tr-i tul'A (4, 4zLU Lu ook5 1 . I � I I I I Discussion With Person in Charge: Corrective Action Required: I ❑ No ( ❑ Yes (-have read this report, have had the opportunity to ask questions and agree to correct all ❑ Voluntary Compliance ❑ Employee Restriction/ Exclusion Violations before the next inspection, to observe all conditions as described, and to ❑ Re-inspection Scheduled ❑ Emergency Suspension comply with all mandates of the Mass/Federal Foo Cod I understand that noncompliance may result in daily fines of twenty-fi dollars-or suspension/revocation of ❑ Embargo ❑ Emergency Closure your food permit. �� Jv��r/ ` ❑ Voluntary Disposal P osal ❑ Other: _ l i=iiC) PHF,l.ecrrvedatTcng.eruures Violations Related to Foodborne Illness Interventions and Risk Accerdin,to law CeK9cd to Factors(Items 1.22) (Cont.) ?1F745'F Within•] Hnur.;. ' PROTECTION FROM CHEMICALS3-50i.t5 C',w!mg\-leiluus for PRFs l4 IFood or Color Additives f 14 I PHF Hot and Celd Holding n ,„l2 Additicc<' 3-501.16"") Coid P1 IFs Maintained at of below 3 11- 5vf 004('F) 9l145' t" 3-302.14 Protection front Unair nrved .1Wditrvec« j l 3-501.INA) !-lot P1IFs Maintained nt or abole 1$ Poisonous or Toxic Substances i 140'F } i 7-101.11 Identifying hdl>nnaluat-Original `;-101.16(A) Roasts Held at or above 130'F. ` Containers' 7-102.11 Comn)on Name-Worhm„,Containers'' 2(i Time as a Public Health Control 3-501._i1 Tit^e as a Pubii�,Health Control* 7-201.11 Separation-Stor age` ( q, 7-202A 1 Restriction-Presence and Use" 5 )OUdt H) Variance ftequtren)ent 7-202.12 Conditions ofI-FseI 7-203.1 t Tunic Containers-Prohibitions'' REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-204.11 Sanitizers,Criteria-Ciie nicAs' POPULATIONS(HSP) 7-204.12Chemicals for Wushme Produce,Criteriar, r � 21 3-501.1 It 4) Ui:pasteurized Pre-packaged Juices and I 7=204.1.1i Bevcrnpes mnh Warning I,abels' Dr�ine.4gefvs.Cnteria' �- ,.,. ( 3-501.1 I(B) Use of Pasteurized F,rrls> ICz. .l i Incidental Food Contact.Lnbucan 7-206.1 i 3-301.E 11 D) Rae or Parially s Couke,]animal f'<;nd and Keniricted L!se Peaicides.C'ritena=- 7-206.12 Rodent Bait Stations" Unopened ened Sprouts Not e Not . " '7-206.!.3 "racking powders,Pest Control and ?-801.1 UC) Unopened lnhvd Package Not Ru-srrveW. i 4.<ntt nn'" CONSUMER ADVISORY 22 3<q3.1 1 Consumer Adtifsory Posted for Con,nrnptiun of TIMEtTEMPERATURE CONTROLS Aruwwl Foods Phat arc Raw. Undercooked of PHFs 16 Proper Cooking Temperatures for Not Odrerwtsc Processed to Eliminate 3-401IlA(i)(2) Eggs- I55°P 15 Sec. Elzgs-hnmediate Service 145'Fl5sec• ' 3-301.13 Paw ste -fzed E^ t Substuar for Raw Shell 3-40Li1(r1)(2) Comminuted Fish,Meats,kGnnc L's Animals Animals - 155'F 15 sec. 3-401.i l(B)(1)(2) York and Beef Roost- 130"F 121 min` SPECIAL REQUIREMENTS 3-401.11(A)(2) Karnes: injected A1rats-155'F IS 590J)0e)(A)4D) Violations of Section 590.009(A)-(D) in sec. I catering- mobile food,temporary and 3-401.11(A)(3) Poultry, Wild Game, Stuffed PHFs, residential kitchen operations should be Smfting Conta.:iiu;Fish, Meat, defined under life appropriate sections Poultry of Ratites-165'F 15 sec. ^ above if related to foodborne illness '.-401.I I(C)(3t Whole-muscle, Intact Beef Steal.; interventions and risk factors. Oilier 145-F :z ! 590.004 Violations relatinv to rood retail 3401.12 Raw Animal Foods Cooked in a p;actices should be debited under#29-- Microwave 165'"* Special Regoireraents 3-401.1 1(AI(I H b) All Other PHFs - 1.15'F 15 sec. " 17 Reheating for Hot Holding VIOLATIONS RvLATEO TO GOOD RETAIL PRACTICES _3-103.!1(A)&(D) PHFs 165'F 15 sec. * I (Items 23-30) 3-403.11(6) Microwave- 165'F 2:fronto Standing I Crilirni aid non-r•ritital violations, uhich all,not relate to the Timer .Joodhnrne itlnesi inre'rvafnone'ma.:riA tartars lived above. can be 3-403.11(C) Commercially Pr ocessed KT'E F1-�ld- ,Joued;rt tilt.j8llowing sections of rite Food Cod,,and 105 C'KI? 140"F" `;y(t00u. --- ----------- ----- 3-403.11(E) P.rg L' naininmsliced Voniunc of Reef Item Good Retail Practices FC 590.WO Roasts" i 23. Ivlanaoert:ent and Persoltne1 FC -2 .003 l8 Proper Coaling of PHFs 24. Foo:and Feed Prota.tion FC--3 004 f 3--501 14(A) Coolirn,Cooked Pt1Fs rrom WO'F h, 1 25. Equipment and Utensils FC--a .005 1 _ ! 26. Water, F'lunobinq an;Waste FC-5 :DCS 70'F Within 2 flours and From 70`F 1 27 7hvsical Fail' FC-n GO?_- to 41-Ft451 F Within 4 Hum s. '" ! 20 Posoncus or"I oxo NIl erias FC - 7 .008 ,-50114(B) Coohm;PHFsMadeFrow,gmbfent 29. Spod9lPeauir-men, 009 Temperature Ingredient;to-1'17145'1 30 Other __- ---------1 `Dcnot,:cnucal item in flhr frde'al 19()9 Food Cod;or IM CMR 590 000. r' } - CITY OF SALEM BOARD OF HEALTH Establishment Name: )#,46t, -bVIl Date: 11 -/7"�y Page: / of Item Code C-Critical nem DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date 1 No. Reference R—Red Item Verified PLEASE PRINT CLEARLY - in cAYld u( i Pte' 9 n / A t° r rr c! .z. CG �,Q V lei` \ (�!,• 1 n rPF'i 1� Pva �w $Qr, Prso� v t✓ /s S"v°F. P,,,I°avalrrr --- �� ma n.>I- P�CCP_ d us°F ?Ills YPFl9��a1n✓ nrr,sh L� vF r)I i./,l f vr, nu A 1 A e e 4IV f"07 ��eP ee, �GJ !r!P �f !d �)P, /o-ry fn AlSreAdw /tfu5< 6e PWjvv-I- R 11 /qe�s 1,v;1/ <+PIIInuS ,n..sl �v_ rn /-aejl C/.v�, I m pOr //e US AlO AoPPllnp l S-�C1l"5f c�1e4ett4S/ _SAva4ejbS 1 - �a y[ v/bwl - all .9010-4e1•rs Mvs f br-- P0117 ani Mao f m { � ►vQ 1 .�vls us. c -la ko%' iFo�v-ln,-s } 6� ,s 1 holds nrrsJ 6v G[Pa� i 1 /u /6 cP A1e,,w -PJf 0,1 n I•rde 1�r lei �i�us //-I I zliiei '5olv4i,-o ryws! be- wi•/G, -ks/ C I t F Discussion With Person in Charge: I Corrective Action Required: I ❑ No ❑ Yes ❑ Voluntary Compliance ❑ Employee Restriction/ `s I'have read this report, have had the opportunity to ask questions and agree to correct all Exclusion violations before the next inspection, to observe all conditions as described, and to ❑ Re-inspection Scheduled ❑ Emergency Suspension comply with all mandates of the Mass/Federal Food Code. I understand that noncompliance may result in daily fines of twenty-five dollars or suspension/revocation of ❑ Embargo ❑ Emergency Closure r your food permit. ❑ Voluntary Disposal ❑ Other: t i l 'f i '[w) PRFs Recen•ed at Tenipervures Violation Related to Foodborne lllress 01e,ventions and Rask ( According to Law(tooled to Factors(items 1-22) (Cont) 41'F/45'17 Witt.-in,lHours. ' PROTECTION FROM CHEMICALS 15 CooLn¢Alcehcais Irr l'HFs j 14 Food or Color Additives ( 19 Col Her and Califn(Maintained Holding 35tii.16(Yi Cehi Pt[P, 1laintaincct a[or below 3-202.12 Additives* � 590.UUii1') 3-302.14 Protection {Font ljnapproved Additives' 3-501 16,,1 A) lint PHFs 'Inint ain-d at(r above 1.5 Poisonous or Toxic Substances 140'F 7-101.11 Identifying lntorur;non-Original t-SU 1.161A) Roasts}field at or above LiW Containers' 7-102,11 Common Narne - Working Containers' i 20 ' Time as a Public Health Control ! 7-20 LI t Separaeion-Stot age' 13-501.!9 Time a:.a Public Health Cont c4i` 7-202 it Restriction-Prc:.ence and U,e' i 590.004t H) Re holo, a t 7-202.12 Conditions of I-!se' 7-203.11 Toxic Containers:-Proh,bitions REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-204.11 : Sanitizers.Criteria-Chemicals POPULATIONS(HSP) r I 121 i 3-KO1.1'.(A) t:npas�eu rzcdVic-packagedhaice-,and 7-204.12 Chemicals for W"ashu(c t roduce,Criteria' r 7-201.14 Drying Agents,Criteria, Bever,,,-,es with \outing Labels 3-80'.SI(BI Ute cj Pasteurir-ed Ego," 7-205.11 ( Incidental Food Contact.Lnbncants^ {)i.l l?Di Ria or i'atiialty Corked Animal Food and 7-206.11 ( Rech[etrd(iso Pesticide+.t'riterrr' kav, Seed Sprouts Not Seri-ed, 7 206.12 ( Rodent Bait Stations' i '7-206.13 Iluckm'Mg Powders,Pcst Control and '-801 I l(C; Unopened Pia{Ym:kage Not Re-served. '.onitoring^ CONSUMER ADVISORY TIMENEMPERATURE CONTROLS 22 3-603.I 1 Consumer advisory Posted for Consumption of 16 Proper Cooking Temperatures to: AniviA F.,ickis'1'hat Raw Underurokedoi PHFs N+4 Ctiter,nsc Processed to Eliminate t tFJt� 3-401.1]A([1(2) Eggs- 155'1" 15 Set. Egos-Immediate Service 1450P15stO 3-302.13 P::steunzcn Eag�Substitute for Raw Shell 3 40L 1 l(A)(2) comminuted Fish, Mears&Gain, I E^gs* AnitnalS- 155'F 15 sec. " 3-•101.11(1-1)(1)(2) Pork and Beef Roust- 130°P121 min SPECIAL".90.009(A)-ii))".90.009(A)-ii))) Viola[icns REpOiREVTS 3-401.11(AN21 Rattles. Injected Mcats- 155'F15 GnS o;Section `,90.0;0}I,Aj_1D) in Set,. W catering, mobile foga, temporary and 3-401.1 I(A)i 3) POUltry, Wild Game,Slotted PHPs, residervial kitchen operations should be Stullitig Containing Fish,Nleat, debited uodcr the appr,n'riatc sections Poultryor Ra ites-165'`F 15 see. '' abov,it related to foodborne illness 3401.11(C')('1) Whole-muscle,Intact Beef Steaks interventions and risk fat,tors. Other 145`17* 540).009 Violations rolating to good retail 3--01.12 Rail-Animal Foods Cooked in a )!ac ticec should be debit:,d under if29- Microwave 165^F" tipeciai Regt:hrments. 3-401A1(A)(1)(b) All Other PHFs- 145"F15sec, '- 17 Reheating for Hot Holding VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 3-403.11(A ['HF. 165 017 15 sec. * (items 23-311) 3-4(13.11(6) 'lic ouave- 165° F 2 Minute Slaoding Cririral and nun-rril;cni rnrtatums. r.{uch do not relate to the Time" fot"Iburne illness uurrrennorc,unci risk ja(tors listrr7 obnre, ran be 3-40.1.11((') Commercially Processed RTh Food- ( found in rhe folhm-ine urtlons of rhe Fond C de and 105 G1412 Ido`F" 590.0011. 3-403.11(H)- Remaining Unsl[eed Purtionsof Beef ( Item Good Retail Practices FC ' 590.000 - 1 Ruas;s•: I 23. Manacement and Personnel FC-2 ' .003 j 7 g Proper Cooling of PRFs I 24. Foos and Food Pro,ecticn Ft;--3 Ms 'F Equ pmerif and Utensils FC-G -_005 Coming Cooked PHFs from 140"P to V6 Nlater Plumoinq and Waste FC-5 .JOc 70`1=Within 2 flours and Fmm 701' 27. Physical FaclilV t-C--6 .007 1 to 41`F/45'1=Within-1 Hours. ` ( 23. Pasonous or Toxe klaierials FC -7 1 .00A z 501.14(B) Carling PliFs Made Froin Ambient j 29 Special Hequlr mems ! ,009 j TempOF/45'F Ingredients to 41°F/45` 30 uthei Within 4llours°' °0^" "-'°.•" Dcoioltt cntsdl dem nr:tic lederal 19()l Food C,do or 105 CNIR 590f,00 CITY OF SALEM BOARD OF HEALTH Establishment Name: &D44 5 Deli el Date: // /7—o5/ Page: ofd Item code C-Critical item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date 1 No. Reference R-Red Item \ Verified - PLEASE PRINT CLEARLY b ,4v, elk 7-1 neo.., 0-16�)Ce . I-C"54 k�-e— YLL7T!I 1�vin„ S ,... vP!✓I�-CvA-�nf� // -Yv-111 zt�v> vkvs-� J�.e G'oa...�`•�� \�lai 1 YP�ir�{ .L'i�f2ly s /-w�S! /�.rr.�{ !list 6/,r f acre+ ✓r<dL �y,.�,/ers IV�w r�r�na. wt ► I ✓ -s a„ d -1-Ih,._ aA Nips lh.ra. #i.° I �o�� Pii„-� wle..+ hn•!- V? r�r�-(�'l url�,I i q -� p(us�i� lS /SSI/P,-.( I I G I ii Discussion With Person in Charge: Corrective Action Required: ❑ No I ❑ Yes have read this report, have had the opportunity to ask questions and agree to correct all Ll Voluntary Compliance El Employee Restriction/ Exclusion 'violations before the next inspection, to observe all conditions as described, and to ❑ Re-inspection Scheduled ❑ Emergency Suspension l comply with all mandates of the Mass/Federal Food Code`I understand that 'i i1oncompliance may result in daily fines of twenty-fivedollrs or suspension/revocation of ❑ Embargo LlEmergency closure your food permit. ❑ Voluntary Disposal 0 Other: r 56'."t(C) VHF:.Rccelved.+t'1'-,tparature Violations Related to Foodborne Inness interventions and Rsk According to Lau,Corded to Factors(items 1.22) (Cont.) 'll PROTECTION FROM CHEMICALS 501 15 ^.coling McvIt xls for i'11Fs pHF Hot and Gold Holding 14 Food or Color Additives 1 14 - 2_;0!.;6(B) CnidPiFs Mti ntained at or below3-202.12 Add o es" 590.00a(F) 3-302.14 Protection from UnapPrrned Additives ( ( 3-501.16!A) iiia PiIFs Maintained ai or abm,e In Poisonous or Toxic Substances j 110"F '-101.11 Identifviucfiformmtinn-Origins( 3-50 .!6(.`,) Roasts Field a:orabu,ei30'i'. * Ccntainerc` 20 Time as it Public Health Control 7-102,11 Compton Narne-Workim.*,Containers" ) ( 7-201.11 Separation -S!oraee°` I 13-501 I9 Time as a Public Health ControP; 7-202.11 Restriction--Presence and ti se° 590.004(4) Variance Rcquirentean 17-202.12 Conditions o tjs -I'rohihitions" REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-203.t l 1-oris C'nmain,-r;er.: � I POPULATION$!HSP) 7-104.1 j Chemicrs,als fori Wt.,- Chemicals' ,1 :-80L 1 NA Uapnmenrized Pic packaged Jui.es and i j z°04.12 Chemicals fur\\%ashmi Produce,Glu+ria>; i ,: � «_- Bevau;yes with droning labels 7-204.11 Dryden;Agents.Criteria" I 3-50!.t 1 To r s-of Pasteurized Eccs` ( 7-205.11 Incidental Food Contact,Lubricants Stxd sprouts 7-206 11 Restricted Use Pesticides.Criteria" I I 13-301.!1 D) Raw or ParConked Animal Ftxxl and 12:rr: \ot Sersed. ' 7-20Ci.12 • 1Rodent Ban Stations- 7-20o tation 7 3Un I+ Tracking Powders,Post st Control utd 13-8o 1.11(C) I Uaopencd Foal Package Not Re-served. ' A4unitnrin�^ I CONSUMER ADVISORY TIMElTEMPERAT)!RE CONTROLS 22 3-603.11 Consumer Adhi,ory Posicd Gs Consumption of .4nintal Funis 77tat are Raw. Undercooked or 16 Proper Cooking Temperatures for PHFsho:{}ti;crwise P-oces?ed to Ficnin«ic -0IJ1A(I)(2) F'-s- 155F15SeL,. Padn�2etrv.;.r,�rw..c:,ennr LFes-Immediate Son-tee 145'Fi5sec' =-302.15 P�steurized FO�'a Substinnc for Raw Shell 3-401.11(A)i2) Comminuted 11.:h,McaLS Bt Gaine CE,,,s' Animals- I WF 15 sec. ` 3-401.;`(Is I(I)12) Pork and Beef Roast- 130"F 121 minx I SPECIAL REQUIREMENTS 3-401.11(A)(2) Ratites,Injected Meats- 155'F 15 590.U(19f.\)-(D) Violations of F.^etion 590.009(A)-(D)in Set. ,: I catering. mobile food, temporaryand 3-401,11(A)(+) Poultry,Wild Game,Stuffed PHFs, residt•ntta': kitchen operations should be Studios Containing Fish, Meat, i dchited unuer the appropriate sections Poultry or Ratites-Iti 15 sec. -above if rei,ded to foodborne illness 3401.111 C)(3) Rrhole-nutscle, Intact Feef steaks inteiveNlons and risk factors. Other 145°F 5901109 violation:;relating to good retail 3-401.12 Rae. Anunol Fails Conked in it I prtcuccs shonlu be debited under X29- &Hcrmmave IOYF* Special Requirements. 3-4011f(A)(1)(b) All 01hcrPlil7s- 145°F 15 see 17 Reheating for Hot Holding VIOLATIONS RvLATED TO GOOD RETAIL PRAC77CES 3-403.11(A)&(D) PHFN I65"F 13 sec. * (tteuts 23-30) 3-403.11(B) Mictosave- 165°F 2 Minute Standmg Crztinri and non-rrilica(Viokifuars, Mach do not relate to th•, Time, y.ndborne illness rote,wmiuns and ri:;b/alto y lbi,.d obov., can be 3-403.11 it Commercially Piocessed RTE Food- ,/nand it,the f d6,+.ory feerions gr`the Feud C,de wal 105 CA4R 140"F* 590.000. 3-403A 1(F) P,em:ining Uushc•ed Portions of Becf I - item Good,Retail Practices j FC 590.000 Roosts4 i 23. Management -2 and Pat sonnet FC .003 1g I Proper Cooling of PHFs 24 Food and Forxi Protection FC- .(,04 25. Equipment and Utensils FC-4 .005 I 3-50LI-ItA) CobGugCorkedPHFsfromi40Fto ( pg_ ?ydater,Plurnbin!tacctih'aste FC-5 :�06 707 Within 2 tours and From 70"F 27. FhyRicRl Facility FC-6 1 007 to=tl`F/-i5'F Within-}Hours.' j 26. Poisonous or Toxic Klaieria:; FC-7 .OU8 -501 14tB) Coolie;,PF1Fs Made From Ambient _"U Special Recuirements 009 I I entperature Ingredients to 41'F/41'F t 30. Clher ---------- Within.11 lour�* Dtn,,!rs ud,cal hem u,11:Gd;rat i9y')Fon.'Code.,r 195 CHIP 590 000 CITY OF SALEM BOARD OF HEALTH Establishment Name:jl LA4 / K y 4,_r" Date: �'tf/8�aly Page: of Item 'Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTIONI Verified Date No. Reference R—Red Item PLEASE PRINT CLEARLY re AK 40"tT.rtE 11 rUrA .4A 40&r- ,r.�. iO4.1 I I m rti,.0 Q.uct� Dnw.c ra dir. cA.a�#-iii rfc&o. S-o �f !M'A -041�,' I ArrfSvY SN-/T/11w1 !it4**J#Xn ofr tde4lev its r� ,su &I-f x I � .�rws� v f e�a.,.><.r r c.�ncn i.r o r/�-r/e� ,...rA� cr><o�✓ rt.�-�s.�r- i I -A IcI AlIll I I I I I I I . Discussion With Person in Charge: Corrective Action Required: I ❑ No ( ❑ Yes J have read this report, have had the opportunity to aslc-c} ti ns and agree to correct all ❑ Voluntary Compliance ❑ Employee Restriction/ violations before the next inspection, to observe all c>\onditions s described, and to Exclusion P ❑ Re-inspection Scheduled ❑ Emergency Suspension comply with all mandates of the Mass/Federal Food Code. I u erstand that noncompliance may result in daily fines of twenty-,ive dolla. r su pension/revocation of ❑ Embargo Ll Emergency Closure your food permit. - i., ❑ Voluntary Disposal ❑ Other: C 3-�0!.'dt�":} Pi-LFs Eiec;ireci at'Pcarnersaures. Violations Related to Foodborne)llrass lNerventions and Risk Aa:orcling to I Aw Cooled W Factors(items 1-22) (Cort.) ;I-7745'1=-Within 4 fiuwn. PROTECTION FROM CHEMICALS 3-501 15 Coolinc,Meinnds for PH^s 14 Food or Color Additives 39 PHF Hot and(;old Holding 3-202.11 s 1 7 501.16(") Cold P11Ps Maintamea at or helot% Addimes' I 59D 0(12(F; ,l i`i 7 i"F" 3-302.14 Protection from l?nappruszd Addtuaev'' ( 3-501..16(A) I-f�,t PE Fs Maintatuetf ar r.r abrr:e 1.5 ( Poisonous or toxic Substances 7-101.11 Identifying information-Original ;->itl.i(-dA) Roucc;Held at ortbnre lit}"F. " Coll"llerx" ! 30 Time as a Pu6!ic Health Control 7-102.11 01mmon Name-Working Containers x.501.1n Ti 7-'_01.11 Separation-Storage me w a ,o ublic He,ilth Control 7-2U2 11 Restriction-Pi-"cncr will Use' 5`>(!it{4 iH) l'+ri:ince Rryuirente:n e 7-203.12 Conditions of era ( REOUIPEMENTS FOR HIGHLY SUSCEPTIBLE 7-20311 Toxic C'rs.Crit r a Cli ndcals" POPULATIONS(HSP) 7-204.11 Sanitizers.Criteria-ChemicaL;"' 7-204.12 Cheinicais for Washmc Produce,Criteria'' ( 121 � 3-801.11!,) Lnpasteunxcd Pte-packaged]U;LPS mid j bcvuges;with Warning I abet,;' 7-204.14 Drying Agents.Criteria'' 3-80:.11'1?) Ilse of Pasteurized 7-205.11 incidental Food Contact, Lubnrtnrs^ 13_gp?.I 1(DI Raw or Putu:U Cooked Animal Food and 7-20(t,11 ( Restricted Use Pesticides.Criteria" kaw Seed Sprouts %of Served. :` 7-206 12 Rodcut Bait Stations" 7-'_06.13 ( Tracking Powders, Pest Control will 3-1;(11 I I(C; UnuRened Food Pack. e Not Re-;er�,etl. i Monitorin;* CONSUMER ADVISORY TIME,TEMPERATURE CONTROLS 22 1603.' 1 Consamer Advisory Posted for C'oi;umption of Antmat Foods rh.n are R:«,. Undern,oked(it 16 I Proper Cooking Temperatures for ( tiot Otherw:ee Processed t„Eliminate PHFs 3-401-I1A0)(2) Egg<- 155`F15Sec. l i'athcrg:un. Eggs-imroedi:¢t Service 14571 5scc' 3-702.13 Pasteurized F.g€tc Substitute for Raw Shell 3-401.?1(A)(2) ( Comm inti ci Fish, Meats R,Game Eggs .Animals- 155'17 15 sec. " SPECIAL REOU€REMENTS 3-401.11(,")11)(2) Pia;and Bret Roast- 130"T121 n:in+ 5(r1009(A)-tD) Violations of Sect on 590.009(A)-1D) in 1 40 1.1I(A)i2) Ratites, Injected Meats- 155'F 15 set:. v. catcrir . mobile food,temporary and 3-401.11(An3) Poultry, Wild Game,Stuffed PHFs. rettdential kitchen operations nhouid be Stuffing Cuntaimil Fish,Meat, debited undet the appropriate sections Poultry or Rallies-165`7 15 scc ^ above if related to foodhurne illness 3.101.1 hC;(3r Whole mriwle,Intact B cf Steaks interventions and risk factors. Other 5'F° 590,009 violations relating to good retail ! 3-401.12 Raw Animal Fotrds Coked in a i otactit'es should lie debited under #$9- j Muzowave 1650F* Spedal Rcquhemeats. 3-10i.i1(A)(I)ib) All Other PHFs-- 145'F15see. " 17 Reheating for Hot Holding VIOLATIONS R2LATED TO GOOD RETAIL PRACTICES "403.11(A)&(D) I'1113 165'F 1.5 sec. Ilteizsc 23-301 3-403 t 1(B) ,Microwave- 1650 F 2 Minute Standing Cihral and ncrt-rri6r al violations, :.filch do aul,'!arts to the Time* foodborne'R s.c n¢ei twwiorn and risk Pastors tis!ed above, .eut be, 3-403.11(C) Commercially Peo.esstd RTF Food- ( found in the f)llowitie sections of file Triod Cole and 105(2191? 14W IFI sail(Uuu. 3-303 1 U,lil Remaining C'nsliced Portions of Reefitem Grind Retail Practices FC 590.000 koasls i 123. Ma)age,T.ent:and Personnel FC-2 .003 1 1S Proper Cooling of PHFs ' 1 24. Food and Food Protection FG--3 .004 1 1 25. Equipmern and Utensil PC-4005, 3-51)114(.A) CoofingCookedPHFs front 140"Fto 26. Wat2'. Pmmod:gand Wash, -C-5 '6 70:F Within 2 flours and From 70"F 27 Phvsical F:_ct4v FC- 6 007 to a 1`F/45'F Within 4 Hours. ` 1 28. Po'sonous or Tnxtc Materials FC - 7 .008 1 3-501.14(6) Cooling PHFs Made From Ambient _29 Sr)eciai RepWrrments ! 009 --- - Ternpetatate htgredients to 41'F/45'13 1 30, Other Within 4 Hours ••.roe.,,m i,.z a„ *Denotes eriucai item oi the federal 1999 Fo:xl Cody or 105 Cb;k 590 OOG ' Henri S . Bellows - � Carpenter , Contractor , Builder : Tel . 9 ?8 - 852 - 4182 P . O.B . ##445 Danvers , Ma . 01923 Licensed & Insured : Sold To: Qf^CJ�'h �t- � ��.11 tR �s7-ercq.u,vr j' Job Site. r✓ l^ J�CLJ�om? na- 0! 770 Jlt�l7la� ro ht. r .e,yrW r- "? o-v&ole r z» a VC 2hors PE'X � x ;1 " ee. a- m CdoorrI, hdwa-vtij Pw.`hex Sw� T�1�s � �-off `7�.Q4 y, yl y 1 -. cit; i I HVAC : <._; ._v:.,�. -`aSUREFtTOR ll: cW W'RIGE.; NC. SERVICE ORDER 63 EndRVILAvenue INVOICE SGMERVIILE, MA 02144 (617) 625-0386 13579 BILL TO iwswDRe ISTD NE -•i,� t C,O.D '_ CHARGE E NO CHARGE } .�". .. .. ... ... ... . ,uAACE "AIS .... V t L `,Y�! •,..�'Y'/ V�t )yi 1 .. � MODEL M,JDE'. I NAME �SCRIAL NUMBER SERIAL NUMBER � /f {\ STREET DATE f + { ENVIRONMENTAL CHECK LIST WORK PERFORMED CITY I PHOwiSEP' ' WORK eCRFERl OIY, TYPE DISPORTiON G^NOENISiN(;UNIT CGNO'SAIE DRAINS tCA ❑ RECOVERED LEVELED MAIN DFA D PHONE GAIL BEFORE r __ MERAKREIN A.M. MAIN ❑ PM. ❑ RECYCLED CLEANED COIL MAIN DRaw TECHNICIAN AUTHORIZED BY r. gECtA:MCO DHECKED cpFANeD LRAPGE :URAL. r REPAIRED REPAIRED WORK rO BEPERFOMMED I - RrTURNEe LEAK IN COIL PAN CHAIN _ DISPOSAL cECAiIN FUR.OR FAY COIL LEAK IN COPPER r DISMANILED TOTAL s #qEc REPT ACED 9f or ,1:AiANGE IXI'(REP.Af,£6 MOTOR MOTOR iJ ADJUSTED RI IT CITY. MATERIALS&SERVICES . UNIT PRICE AMOUNT DESCRIPTION OF WORK PERFORMED ICHAEll REPLACED ti- I / REPLACED A J LISTED ,REFRIGERANT q- LBS I 1 /% � /-{' :,t ./'�s _ AEms'ED c_EANEo / 1 ✓ % I _ i ... �,...- t ( ji . : - (BELT REPLACED JIfIflPHILIP PLACED Y J I `{ (P/ �. 1 LE11.STARILACC T DI DINGS f: .. - „` i ! ( `; �l ✓g:.t.. - .. IRELAY oRUN CLEANER 1iELAV DIILD MOTOR Ael OI'.rD BEAR'NGS ,EAC OAPAOIIOR HEAT EACH < ,T C'_E R CORIARE¢IACE: _ ADJ DNiACTOR MEAT ESCn fV�/Y , REAAIFCD CLEANED OR •• ••• •• •• v:<y'� a •• WIPING AO.I PILOT I f'' PC ITCED REPLACED FUSE THERMOCOUPLE REPLACED REUAIREO e* ccvoefSSOR YA.VE ., j.'''- J/. �J ,a.- .. EVAPORATOR COIL REILAUCR VAIVE I f�• i 1'-" �'ff/ £%P YAI YE BVRM1ERS .. ✓ . f.,L.-. ADJUSTED DUCT ' REP VALVE TUDE .. .FILTERS x .. '._ i•,'.r Y `•I`f�' / I Cax CCK ,PU REO _ , J � STEU KCD > FILTFRS x x THERMOSIAT ... . .. -- _ I BEPoIRE'JPUP ACED ' CAPPER CGNN { BELTS RECOMMENDATIONS �CLEAMU COIL ADJUSTED 'r' t 1111 LEVELlD COIL TOTAL MATERIALS I LECT HTR CLC(OWER HRS. LABOR RATE AMOUNT IREPIACED LINK CLEANED I 'PP,-A:k.n_I% • ��J,1• �'. i.. , ,f IREPAIRr.DwIRF PI11.1Ps) �PEPLAI f D CDNI, GALASED REPNRED t I FILTERS I [OI AHED _PCP'ACED 1 IIAICAAI:,LeDR.1A.BL- - I <- LIMITED WARRANTY: All matenals. parts vxruauEDa:DTHB�cue TOTAL LABOR arra equipment a:e warranted b: i �; 1•. y the TOTAL SUMMARY TERMS manufacturers' or suppliers' written warranty only. All labor performed by the above nanted 1 TOTAL _ company i:; warranted for 30 days or as I MATERIALS otherwise indicated In Wiling.The above named TOTAL - company makes no other warranties express LABOR 1 rav aznnom.c m maxi me wal omYeeO ahou•vrb�cb nay heti:satsh¢Ianly c naplerea I agree Inat Or Implied, and Its agents 01 technicians are Sete.Ieams IL"a aq,dpaeNImaenas Il.,inn 11.1 Aa—L I,ay. 'd yry nlen not auth �; nave oihed l0 make any S.:Ch Wat'al)f ES 1 aDleed muel an remove Sala eDumalemnlmfeaal:Ra 50,111.1-'�v Any doh,,aa PlUbr,Boar on behalf of above named company I _TRAVEL .hAl�nnia,al Nhall IlR b¢Ine 11110alhily Of$CI¢t L' REGULAR - WARRANTY -ARG' I SLRVICCF CONTRACT TAX I�,,.IIRSK,I:AILIRC ,.IE ./ �iti,rtW� 'Ir I TOTAL J I CITY OF SALEM n BOARD OF HEALTH Establishment Name: Date: 1 / /7- V Page: / Of Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date No. Reference R-Red Item Verified PLEAS//E PRINT CLEARLY // �{t/.✓l �v S �A__ Q � N Qom. GAG._ /h U/[.1�Pu �N/ � �/�✓✓ ....�-- n/.vi+..i/ iS /�t7../✓A �-iy�+ LCA i,�N�.s,.G is YJT)� P�✓wl fd �� -✓,� t o ��;,,., /�,r �,. 5�--� L, r—;,�/.� Cdr 4 !1 n+�i e� iors ✓i,.vc.l l ohu_ /�n �/1 a �sr�d�1 Pfvs,rl� -F- v 1 1 i 1 1 Discussion With Person in Charge: Corrective Action Required: I ❑ No I ❑ Yes I have read this report, have had the opportunity to ask questions and agree to correct all ❑ Voluntary Compliance ❑ Employee Restriction/ Exclusion violations before the next inspection, to observe all conditions as described, and to ❑ Re-inspection Scheduled ❑ Emergency Suspension comply with all mandates of the Mass/Federal Food Code. I understand that noncompliance may result in daily fines of twenty-fry or suspension/revocation of L, Embargo ❑ Emergency Closure your food permit. ❑ Voluntary Disposal ❑ Other: L � 3-50!.3;:'{t PHFs Rere!ved at Temperatures Violations Related to Foodborne Illness Interventions and Risk Accor:i,n toy Fav Cooled to Factors(items 1-221 (Cont) ! 41'F/45'F AtirYhin 4I{o+,rs. PROTECTION FROM CHEMICALS 3-. CQ!.! i Coni:nz M,eEhods lar F'HF's j 14 i Food or Color Additives I j 19 ( PHF Hai ane Cold Holding 3 .501 16:B) Codd P1-iF,. :Ylaintaio,cd at or below 3-202.12 Additives" i 590,(,',0-4(F) 41''!-15' F' 3-302.14 Protection from Unapproved .Additives* I ? 501.1(;[A` Flat PI-IF, i. a 15 Poisonous or Toxic Substances t 7-101.11 Identifying, infermat ion-Otiginal I ( 3-50!.!6(.4) Roasts He!d at oraboee 130`F. " C.nntaincr�^ 20 Time as a Public Health Control j j 7102.11 Common Name-Working Container." j 3-501.1 9 Time as a Pu{,iic Health Control 7-201.11 Szparation-Sto!acc" r '7-2(.12.11 Restriction-Presi.nee and U6eF j 59:1(?041'>i; Vadsnc�Rrymremznt j 7-202.1'1 Conditions of UscT I 7-203.11 'folic Contain,r.-Prohibitions' REAU!REMENTS FOR HIGHLY SUSCEPTIBLE 7-204.11 Sanitizers,Criteria-Chemicals* POPULATiONS(HSP) j 7-20d.I','. j Chemicals for Washing Produce,Craoria" i 21 3-80!A I IA) Unpzsteunzrd Pre-packazcd Juices and 7-204,14 ( Dr)in.g Agents.Criteria' I B--Wragg,,with W'arning!,ibelss. 3-R01.111B) U•,e of Pasteurized E,n-;;s" j 7-205.11 Incidental Fut xi Cvntaet. Lubncnnts'^ ( 3,W1! I I(D) Raw or Partially Cooked A-nnnal Fart and j 7-206.11 Re�,trided Use Pesticides.Criteria* Raw Seed Sprouts Noi Served. % 1 j 7-206.1-2 Rodent Ban Sun ons" ! j A 801.'.I(C) Unopened Food Packag. Not Re-served. 7-206A 3 'Tracking Powder:. Pest Cnntrni and h9nnitorng* CONSUMER ADVISORY Time-TEMPERATURE CONTROLS 2.'. 3-60_.11 Consumer Advisory Posted for Cou,umptoon of .4nim[d Foods I hat are Raw,Uadeicooked of ;d Proper Cooking Temperatures for Not O;herwisc Pro:.essed to Eli:mnate PHFs ? 401.I1A(3)(2) Eggs- I55"F IS Sec. i Yathgccuz.* ""''::aoer Eggs-fu nediate Service 145°1715scc' -3-302.13 Pasteuoied Rags Subs;iat:to.,Raw Shell 3-401.11(A)(2) Comminuted HAI, Meats&Gants I Eees'• Animals- 155"F 15 sec. " 3-401.11(B',I 21 n„ , j SPECIAL REQUIREMENTS J� ){ rk,and Beef Roast � 4311'F 11 rani* 5(xlU r q 3-401.1 I(A)i2) ihitites, Injected Meats-155*F 15 1 09 A)-(D) Violations o.'Section 590.00.(A)-(D)in sea > catering, mobile food, temporary and 3-401.11(A)(3) Poultry, Wild Game,Stuffed PHFs, residential kiic';en operations should be Sniffing Cont:anm;,Fish,Meat, debited under the opprcpriate sections Poultry or Ratites-i05`F 15 sec. * abov;if related to foodborne ilitics.s u0t.d I(Cl(?) W'hnle-aliVele,huact Led Steaks i ntervrntions and risk factors. Other i45'F^' 590.009 1 tOltilltinS rei:nmg to-cod retail j 3.401.12 Raw Animal Foos Coked in a practices should be debited under/,129 - Miclowave 165"F" Special Regmrements. 3401.11(A)(i)(b) All Other PHFs- 145'f' 15see. 17 Reheating for Hot Holding ( VIOLATIONS R.XATEV TO GOOD RETAIL PRACTICES 3-403.11(A)&(D) PHFs 165'F 15 sec. ' j (Itenns 23-30) 3-4U.I1(B) Mic!owave- 165"F 2 R9uute Standing ( Crikral curd nt,+,-c*in,,al violationv, which,do not relate!n The Time" 1 fauelborne tllnesr bttel::e:tivns and ri.rF:t i(lois lived above, cars be i-403.11(C) Coinmcrciallt Priicessed 12Th'Food- I jortnd in dteJntlm,d,r; sol.thou of the Fend('ude and 105 CAIR 140 F" 5e6.000 3-403.11(P.) Rzntainine tinshced Portions of Beef • Item. Good Retail Practices FC 530.009 Roasts" V 23. Maras-nerd and Per,cnnel FC--2 .003 JS Proper Cooling of PHFs 24 Food and Food P:otec[wn FC-3 004 25. EnUipnrnt anc!Utenst:s FC--4 005 j 3-5o1 14(A) Cooling Cooked Pf lFs from 140°F io 1 26, seater,Rumbato and Waste � FC -5 .GG6 j 70'P Within 2 Hours.aid From 70`F 27 Phvsical Faci!ily ! PC-6 007 -- - to 41"F/45"F Within 4 Hours. * 1 2s Poisonous cr Tows Maleriais FC - 7 .0G8 I l 3-501.140:;) Cooling PI-11s Made From Ambieto 1 29, Soecid Reau:remenis i .G09 j T emperanue higredienL;to 41'F/45"F j 30, ether tbithin 41-lours" • 'O'`"."`:".'.` Denotes ent:cnl Asn:m inn 4•Serd 799v bund Gude or 105 CNIR 59! 030. 0283 DERBY STREET Brother's Deli City of Salem FOOD SERVICE ESTABLISHMENT - FOOD SERVICE Inspection HACCP: ❑ Item Status Violation Critical Urgency Telephone: FOOD PROTECTION MANAGEMENT 741-4648 PIC Assigned/Knowledgeable/Duties PASS ❑d RED Owner: _ PROTECTION FROM CONTAMINATION Penny Christopher Prevent*pn of Contamination from Hands FAIL Critical 0 RED PIC: Hazem Muhieddin 5% Comments: Personal items stored next to take-out containers. All personal items to be stored in designated employee areas to prevent contamination. John Gehan Inspector: Handwash Facilities FAIL Critical ❑d RED John Date Inspected: Correct By: Comments:Ashes from cigarette found beneath handwash sink in rear prep area at reinspection. Smoking is prohibited in any 4/27/2006G establishment according to Massachusetts General Law. Health Agent will be notified. Owner could fined accordingly starting at a minimum of$100.00. Risk Level: Permit Number: BHP-2006-0023 Status. PARTIAL COMPLY #of Critical Violations: 4 Time IN Time OUT: Urgency Description(s): BLUE' Violations Related to Good Retail Practices (Critical violations must be corrected immediately or within 10 days)(Non-critical violations must be corrected immediately or within 90 days) City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741-1800 GeOTMS®2006 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. May 04,2006 ) Page I oft r Item Status Violation Critical Urgency RED: Violations Related to Good Retail Practices (Blue Items) Violations Related to Food and Food Protection FAIL Critical BLUE Foodborne Illness Interventions and Risk Factors (Require _J�QG . Comments:Walk in Freezer has accumulation of ice on floor. Remove ice and repair leak.send copy of work invoice to the board immediate corrective action) of health for our records. -� wK S Equipment and Utensils FAIL Critical BLUE A10r ✓Comments:Pie display case temperature holding at 50'F. All refrigerated foods must be held at 41'F or below as mandated. /4-I`h I Salad bar temps holding at 45'F. Foods to be held at 41'F or below as mandated.As of todays inspection all PHF are being held on ice. make sure containers are surrounded by ice to ensure proper temperature is maintained. Physical Facility FAIL BLUE Comments: Light in kitchen above hand wash sink missing cover. Any cracked covers must be replaced.Owner states new lights are on order. Lights to bereplacedand in working order by next routine inspection. !n a� /'t" IN, Water stained ceiling above stove lirl rear prep area. Replace ceiling tile and find source of leak and repairr<?Wl✓^rl^�o l� lir gap beneath door next to office area. Provide door sweep and/or seal gap. ,>rgap beneath and on sides of door next to public bathrooms. Repair gaps around door. Seal all openings to exterior to prevent entrance of insects and or rodents. Mµ.1 S% Womens rest room door handle in disrepair. Handle to be fixed at time of next routine inspection. GENERAL COMMENTS: 602:All violations from 4127106, unless noted in this report have been corrected. Thank You City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741-1800 GeoTMS®2006 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. May 04,2006 ) Page 2 oj2 CITY OF SALEM BOARD OF HEALTH Name of Establishment: Brother's Deli Address: 283 Derby Street Owner(s): Hazem Muhieddi, Nidal Rajeh Phone: 978-741-4648 Date: December 16, 2005 The owners of this establishment were requested to appear for a hearing regarding multiple repeat critical violations observed at their establishment during a routine inspection on December 14, 2005 by Sanitarian David Greenbaum, a-ld 50xA-10y Mr. Muhieddin and Mr. Rajeh understand the seriousness of the violations and that such violations increase the change of foodborne illness. The owners further understand that if the critical violations are observed again, their food permit may be subject to suspension or revocation. Mr. Rajeh is a Certified Food Manager. The owners agree to have at least one other full time employee become a Certified Food Manager. The owners agree to hire a professional cleaning company to steam clean the establishment. Receipts for such cleaning must be shown to Mr. Greenbaum at the scheduled reinspection. The owner agrees to develop a written cleaning schedule showing: • tasks • when they are to be done • by whom - This schedule must be presented to Mr. Greenbaum during the scheduled re- inspection. The Board of Health is issuing a $250 ticket for repeat critical violations. Joanne Scott Date Health Agen Hazem� hied/din, Ovyt�er Dat1.2— Nidal z / 6 S 4rAA�cor/. /� r Nidal Rajeh � "'� Date 0283 DERBY STREET Brother's Deli City of Salem FOOD SERVICE ESTABLISHMENT - FOOD SERVICE Inspection HACCP: ❑ Item Status Violation Critical Urgency Telephone: - Violations Related to Good Retail Practices (Blue Items) 741-4648 Equipment and Utensils FAIL Non-Critical BLUE Owner. Comment: The racks in the walkin refrigerator have an accumulation of food debris,grime and rust. Owner will purchase new Penny Christopher racks for the walkin by the next routine inspection. PIC: The meat slicer at the counter has an accumulation of food debris. Thoroughly clean and sanitize the meat slicer. Maitain a spray Hazem Muhieddin bottle of sanitizing solution at the counter to clean the meat slicer. Inspector: . David Greenbaum Date Inspected: Correct By: 12/22/2005 Risk Level: Physical Facility FAIL Non-Critical BLUE Permit Number: Comment: Dirty mops stored in the mop bucket and mop sink. Mops to be cleaned and hung upside down not touching any BHP-2005-0080 surface. Status: PARTIAL COMPLY The floor in dry storage is unfinished. The floor needs to be cleaned and made impervious and easily cleanable. Owner will correct this violation by the next routine inspection. #of Critical Violations: - 0 There is a gap on the side of the door near the restrooms. Seal all gaps around all doors. Time IN Time OUT GENERAL COMMENTS: Urgency Description(s): 407:All outstanding violations will be corrected by the next routine inspection. BLUE Violations Related to Good All other violations cited in the 12/14/05 inspection report have been corrected. Retail Practices (Critical violations must be corrected immediately or within 10 . days)(Non-critical violations must be corrected immediately or within 90 days) City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741-1800 GeoTMS®2005 Des Laurlers Municipal Solutions, Inc Commonwealth of Massachusetts ( Rev. Dec 28,2005 ) Page 1 ort 1 c= � Item Status Violation Critical Urgency RED: Violations Related to Foodborne Illness Interventions and Risk Factors (Require immediate corrective action) �V v Ll City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741-1800 GeoTMS®2005 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Dec 28,2005 ) Page 2 of 0283 DERBY STREET Brother's Deli City of Salem FOOD SERVICE ESTABLISHMENT - FOOD SERVICE Inspection HACCP: ❑ Item Status Violation Critical Urgency Telephone: FOOD PROTECTION MANAGEMENT 741-4648 PIC Assigned/Knowledgeable/Duties FAIL Critical ❑d RED Owner: mment:There was no designated person in charge at the time of the inspection. In the absence of the Certified Food Manager a Penny Christopher nowledgeable Person in Charge must be designated at all times. PIC: PROTECTION FROM CONTAMINATION Separation/Segregation/Protection FAIL Critical ❑d RED Inspector: Co nt: There is potentially hazardous food stored with and on top of ready to eat food in the walkin freezer. Potentially David Greenbaum zardo ood and ready to eat food must be stored separately to prevent cross contamination. Date Inspected: Correct By:. 12/14/2005 Pe onal items stored on top of food items in dry storage. Personal items to be stored in a designated employee area to prevent oss co tion. Risk Level: The T cooling unit had potentially hazardous food stored above ready to eat food. Store potentially hazardous food under ready to t food to vent cross contamination. Permit Number. BHP-2005-0080 The sae unit had a dirty bowl stored directly on lettuce. Do no store dirty utensils on top of food products to prevent cross con mat'on. Status: VIOLATION Food act Surfaces Cleaning and Sanitizing FAIL Critical RED #of Critical Violations: SC07et:There are dirty,scored and stained cutting boards. Replace all cutting boards. 8 es observed at counter for customer use. All dishes are to be cleaned and sanitized prior to being used for customer use. Time IN Time OUT: The flo scoop has an accumulation of food debris. Thoroughly clean and sanitize the flour scoop and store in the flour handle Urgency Description(s): sid p. BLUE. Violations Related to Good Handwash Facilitie FAIL Critical ❑� RED Recall Practices (Critical C ment:The kitchen hand wash sink has water and soda stored around it. Keep hand wash sink clear and accessible at all violations must be corrected Imes. DO NOT store anything around sink. immediately or within 10 days)(Non-critical violations Dish96found-in the counter hand wash sink. Hand wash sinks MUST me kept clear and accessible at all times and used for must be corrected immediately 1 M9wuWASHING ONLY or within 90 days) V City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741-1800 GeoTMSO 2005 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Dec 21,2005 ) Page 1 of Item Status Violation Critical Urgency RED: TIME/TEMPERATURE CONTROLS(Potentially Hazardous Foods) Violations Related to Cooling / FAIL Critical ❑d RED Foodborne Illness Interventions // and Risk Factors (Require Comment:Soup and food found cooling in large pans and buckets. Food must be cooled in containers no deeper than 4 inches to immediate corrective action) ill ow proper cooling. Hot and Cold Holding FAIL Critical ❑d RED Comm : Meat and fish found out thawing at room temperature. Food MUST be thawed in a refrigeration unit,under cold running wate or.n a microwave. Randall cooling unit had a temperature of 56°F. This unit must repaired to maintain a temperature of 41°F or below. This unit an not b sed until the unit is repaired. Th end sit 060oling unit had a temperature of 50°F. Repair unit to maintain a temperature of 41°F or below. 4—Eg�tored at room temperature. All potentially hazardous foods must be held at a temperature of 41`F or below or 140°F or above. CONSUMER ADVISORY Posting of Consumer Advisories FAIL ❑Q RED City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741-1800 GeoTMS®2005 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Dec 21,2005 ) Page 2 of Item Status Violation Critical Urgency Violations Related to GoogAetail Practices (Blue Items) Food and Food Prot ion FAIL Critical BLUE Com nt: Di room and dust pan stored on top of bags of potatoes. Store brooms and dust pans in appropriate utility closet on f products. T e online cooling unit in back has uncovered food. All food in storage must be be covered. ac of ead found stored on top of trash barrels. Do not store food products on top of barrels to prevent cross contamination. Th pices d dry ingredients under the back prep table have no covers. Keep all spices and dry ingredients covered. Th alki ezer has food stored directly on the floor. All food MUST be stored at least 6-8 inches off the floor. T w fre r has uncovered food stored in it. All food in storage must be covered. T Ra ell cooling unit in the prep line has uncovered food stored in it. All food in storage must be covered. • T end silver cooling unit in the service line has uncovered food. All food in storage must be covered. -Th alkin refrigerator has uncovered food. All food in storage must be covered. The Ikin refrigerator has food stored directly on the floor. All food must be stored at least 6-8 inches off the floor. dry ingredients in dry storage are not covered. Keep all dry ingredient containers covered. Rel el all dry ingredient containers. JT ae paper ducts stored above the office need to organized and stored away from all piping. T e are sa ce containers under the back prep table with food spills and splatter. Clean all sauce containers. The' tea container was found uncovered. Keep ice tea container covered to prevent cross comtami nation. Eqwpment and Ute ils FAIL Non-Critical BLUE Cc ant: The Continental cooling unit missing a thermometer. Provide a visible,accurate thermometer in this unit. The nopener needs a thorough scouring. LThwave has an accumulation of food spills and splatter. Thoroughly clean the entire microwave. T shelf ove the back prep table needs a thorough cleaning. • Th to gett oven has an accumulation of food debris and grime. Thoroughly clean oven. ' T e A ul systems in front and back need professional cleaning including the filters. T ere i an ice build up in the walkin freezer. Repair any leaks and clean ice build up. e Norlake freezer has an accumulation of mold and grime around the door and gasket. Thoroughly clean unit inside and out. City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741-1800 GeoTMS®2005 Des Lauriers Municipal Solutions, Inc Commonwealth of Massachusetts ( Rev Dec 21,2005 ) Page 3 of Item Status Violation Critical Urgency r !" The produce buckets in the walkin refrigerator need to be thoroughly cleaned. The floor and racks in the walkin refrigerator have an accumulation of food debris,grime and rust. Thoroughly clean the floor and racks and repaint all racks. The mea.s{er at the counter has an accumulation of food debris. Thoroughly clean and sanitize the meat slicer. Th everage air cooling unit in the cookline needs a thorough cleaning. Ther an accumulation of grease and grime along side of and behind the frylator. Thoroughly clean around the fryolator. T Silver king milk dispenser at the counter has an accumulation of grime and mold inside. Thoroughly clean and sanitize the ntire unit. There is an accumulation of food debris,grease and grime in the cookline. Thoroughly clean entire cookline.Professional steam ®cleaning is in-order. el the ice scoop container"Ice Scoop Only" - Physical Facility FAIL Non-Critical BLUE Comment: Dirty mops stored in the mop bucket and mop sink. Mops to be cleaned and hung upside down not touching any S'surface. ter., The floor in.dry storage is unfinished. The floor needs to be cleaned and made impervious and easily cleanable. T ight ' tures in dry storage are not covered. Provide protective covers on all light fixtures. walls in dry storage have food spills and s er. Clean all walls and repaint. There is a gap at the bottom of th kit n door and a gap on the side of the door near the restrooms. Seal all gaps around all doors. Th are some missing/broken ceiling tiles. Replace all missing/broken ceiling tiles. GENERAL COMMENTS: 404:There are 10 repeat violations from the last inspection. Monetary fines for each repeat violation will be issued. /v City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741-1800 GeoTMSO 2005 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Dec 21,2005 ) Page 4 of 0283 DERBY STREET Brother's Deli City of Salem FOOD SERVICE ESTABLISHMENT - FOOD SERVICE Inspection HACCP: ❑ Item Status Violation Critical Urgency Telephone: FOOD PROTECTION MANAGEMENT 741-4648 PIC Assigned/Knowledgeable/Duties FAIL Critical ❑d RED Owner: /Comments: No certified food manager on hand at time of inspection. Store manager stated CFM went to pick up plumber. MOD Penny Christopher stated he tried calling CFM 5 times with no answer. PIC: Non-compliance with: Ghassan Esdwani Anti-Choking PASS Inspector: Tobacco PASS John Gehan Date Inspected: Corr ct By: EMPLOYEE HEALTH 4/27/2006 tj�I/t(td0 Reporting of Diseases by Food Employee and PIC PASS _ ❑d RED Risk Level: r 7 Personnel with Infections Restricted/Excluded PASS 0 RED Permit Number: FOOD FROM APPROVED SOURCE BHP-2006-0023 Food and Water from Approved Source PASS RED Status: Open Receiving/Condition PASS 0 RED *of Critical Violations: Tags/Records/Accuracy of Ingredient Statements PASS RED 5 Time IN: (Time OUT, Conformance with Approved Procedures/HACCP Plans PASS 0 RED Urgency Description(s): BLUE: Violations Related to Good Retail Practices (Critical violations must be corrected immediately or within 10 days)(Non-critical violations must be corrected immediately or within 90 days) City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741-1800 GeoTMS®2006 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Apr 27,2006 ) Page 1 of Item Status Violation Critical Urgency RED: PROTECTION FROM CONTAMINATION Violations Related to Separation/Segregation/Protection PASS ❑d RED Foodborne Illness Interventions and Risk Factors (Require Food Contact Surfaces Cleaning and Sanitizing PASS RED immediate corrective action) Proper Adequate Handwashing PASS ❑J RED Good Hygienic Practices PASSd❑ RED Prevention of Contamination from Hands FAIL Critical RED Comments: Improper use of hand gloves. Washing hands and proper use of changing gloves between tasks to prevent cross contamination. Ready to Eat foods stored next to Potentially hazardous foods in Continenal Unit. Foods to be separated to prevent cross contamination. Meats stored above breads in walkin freezer. All raw meats shall be stored below all potentially hazarous foods to prevent cross contamination. Handwash Facilities FAIL Critical ❑d RED —�Comments:Ashes from cigarette found on and in handwash sink in rear prep area. Smoking is prohibited in any establishment ccording to Massachusetts General Law. Health Agent will be notified. PROTECTION FROM CHEMICALS Approved Food or Color Additives PASSd❑ RED Toxic Chemicals PASS ❑Q RED TIMEITEMPERATURE CONTROLS(Potentially Hazardous Foods) Cooking Temperatures PASS 0 RED Reheating PASS ❑d RED Cooling PASS RED Hot and Cold Holding PASS ❑J RED Time As a Public Health Control PASS RED REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) Food and Food Preparation for HSP PASS 0 RED City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741-1800 GeOTMS®2006 Des Laurlers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Apr 27,2006 ) Page 2 of Item Status Violation Critical Urgency CONSUMER ADVISORY Posting of Consumer Advisories PASSd❑ RED City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741-1800 GeoTMS@ 2006 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Apr 27,2006 ) Page 3 of Item Status Violation Critical Urgency Violations Related to Good Retail Practices (Blue Items) Food and Food Protection FAIL Critical BLUE Comments:Walk in Freezer has accumulation of ice on shelves and floor. Remove ice and repair leak. eve ar gar ge Air unit beneath front hand wash sink had uncovered foods. All foods in storage to be covered. �eovered foods in small refrigerator beneath toasters in front line. All foods in storage must be covered. l PO'p i refrigerator has uncovered foods. All foods must be covered in storage. "Lettuce in holding container uncovered and has a lid from dressing cups in it. All foods in storage must be covered. . Uncovered foods beneath salad bar area. All foods in storage must be covered. �Q Equipment and Utensils FAIL Critical BLUE omments: Grime found on inside panel of ice machine. Thoroughly clean and sanitize inside panel of ice machine. ceesscoop holder found with accumulation of debris and other utensils. Ice scoop holder to be labeled and used only for ice scoop. ✓beverage Air Unit beneath front hand wash sink needs thorough cleaning. Pie display case temperature holding at 50°F. All refrigerated foods must be held at 41°F or below as mandated. eat slicer in front requires thorough cleaning. dk dispens)ker requires general cleaning. Vice scoop in front at soda fountain stored in ice. Ice scoop to be stored correctly to prevent cross contamination. psi refrigerator in front holding at 50°f. Refrigeration units must be at 41°F or below as mandated. �< Salad bar temps holding at 48°-58°F. Foods to be held at 41'F or below as mandated. L.a 'strips noyon hand at time of inspection. provide test strips to ensure proper ppm of snaitizer is maintained and test and recorded daily. L sanitizing bay of three bay sink water was being kept in bay by papertowels in drain. provide appropriate drain cover. Pieces of pertowel were floating in water at time of inspection. anitizing log not being maintained.sanitizing log to be maintained daily. Water, Plumbing and Waste PASS BLUE Physical Facility FAIL BLUE _C66mmments: Dry storage floor needs to be cleaned and made impervious. Owner to correct within one week. ./Furnace in dry storage missing front protective shield. Owner to replace shield. City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741-1800 GeoTMS®2006 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Apr 27,2006 ) Page 4 of Item Status Violation Critical Urgency —� Light in kitchen above hand wash sink missing cover. Provide cover. /- Any cracked covers must be replaced. Water stained ceiling above stove in rear prep area. Replace ceiling tile and find source of leak and repair. -Bay sink has leak beneath it. Repair sink by licensed plumber. Womens restroom had back up of sewage at time of inspection. Manager stated plumber in route to fix problem. L'lRepair issues immediately and notify BOH by 7 pm on 4127106 on status. Air gap beneath door next to office area. Provide door sweep. Air gap beneath and on sides of door next to public bathrooms. Repair gaps around door. Seal all openings to exterior to prevent entrance of insects and or rodents. Management and Personnel PASS BLUE Poisonous or Toxic Materials PASS BLUE Special Requirements PASS BLUE Other-See Notes PASS BLUE GENERAL COMMENTS: 589: City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741-1800 GeOTMS®2006 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Apr 27,2006 ) Page 5 of I _ 0 SOD COURT DOCKET NO:.' .' CITATION NO. . s n�f CITY OF SALEM p 0�' 3m VIOLATION NOTICE PD NAME PAST.FIRST,WTRAU'�... .. � I STREETADDRESS CITVRgWN STATE ZIP � ' � i 283 ��egay 57 Sk-eM m 01c170 LICENSE NO. UC.rDATEDATE GF BIRTH ERS NAME(LAST,FIRST,INITIAL) C� p m� 3 tb t� Dm� STREETADDRESS CITYROWN STATE ZIP l ry Z I ! �LA'NG �i2 S i FCY l3 C m G 3c�6� C� REGISTRATION N0. STATE I EXP DATE MAKERYPE I YEAR ICOtORj O S DATE OF VIOLATION TIME DATE CITATIO WRI TEN aEEi y 4 OEM I J��C7 �Q to I ONO O f LOCATION OF VIOLATION ENFORCING DEPT. r jIOFFENSE CHAP. SECT,'FINE$ Lu t . B Coif(:= .$iltOYl�-,ire IN r i I IX1 I C O - OFFICER IA NO, TOTAL Q6 I S Cwt HN'rV DUE OFFICER CERTIFIES COPY GIVEN TO VIOLATOR ❑ IN HAND WX BY MAIL WNOT MAIL CASH-PAY ONLY BY POSTAL NOTE,MONEY ORDER OR BY CHECK MADE PAYABLE TO: I m CITY CLERK CITY HALL 98 WASHINGTON STREET \ ` SALEM,MA 01970 tN TEL.(508)745.9595 X 251 I HEREBY ELECT TO EXEHCISE THE FIRST OPTION AS STATED ON REVERSE,CONFESS TO THE OFFENSE CHARGED,AND ENCLOSE PAYMENT IN THE AMOUNT OC _ N - $ CASEk SIGNATURE SEE OTHER SIDE FOR FURTHER INFORMATION ENCLOSE PAYMENT INTHIS ENVELOPE,PEEL AND SEAL I C. Fy CD N , ; ppppp o CO ySt IMPORTANT_MESSAGE ) ` FOR f �y OATF S�"�� TIME4 A.M. M �� OF nyiv'r-+iilwr' PHONIP AREA CODE NUMBER EXTENSION ❑ FAX ❑ MOBII F AREA CODE NUMBER TIME TO CALL - TELEPHONED C---rPLEASE CALL CAME TO SEE YOU ' WILL CALL AGAIN ' WANTS TO SEE YOU RUSH ' RETURNED YOUR CALL ' WILL FAX TO YOU MESSAGE c� � SIGNED wftFORM 400 MADE IN U 3 NOTES ( IMPORTANT MESSAGE ) FOR DATF TIME -Pa71w:- OF PHONE 17- G, 7 AREA CODE NUMBER EXTENSION ❑ FAX O MOBN F AREA CODE NL VBER TIME TO CALL TELEPHONED r "'P�LEASE CALL CAME TO SEE YOU t + WILL CALL AGAIN WANTS TO SEE YOU RUSH RETURNED YOUR CA,LI ' WILL FAX TO YOU ---I{ MESSAGE /�GLYa-�1f�.fr /Yl SIGNED � n1,(,f� m5ps FORM 4 09 ��■��III MARE IN U 5 A. NOTES IMPORTANT MESSAGE ) FOR ��'�'P� GIB Y1 DATE �-� TIME 'i M OF PHONE .._/ AREA CODE NUMBER EXTENSION U FAX U MDBII F AREA CODE NUMBER TIME TO CALL TELEPHONED PLEASE CALL CAME TO SEE YOU WILL CALL AMN WANTS TO SEE YOU 11 RUSH RETURNED YOUR CALL l� WILL FAX TO YOU MESSAGE - SIGNED OC FORM 4 MADE IN S A A NOTES C IMPORTANT MESSAGE FOR_______ �'v�/n� DATE" �7-/1YLTIME to7 P.M. M OF OL!/ PHONE /z,/-)f 6-34 `/ AREA CODE NUMBER EXTENSION El FAX ❑ MOBII F i AREA CODE DGUMBER TIME TO CALL TELEPHONED ��f PLEASE CALL / CAME TO SEE YOU J WILL CALL AGAIN I WANTS TD SEE YOU I RUSH I RETURNED YOUR CCA/LL I WILL FAX TO YOU MESSAGE / _ rA'��/-/(d�-.e� SIGNED Q FORM 400 A f/ v MADE IN U S P, NOTES __ . ( IMPORTANT MESSAGE ) FOR A.M. GATE � -yo� � Q TIME P.M. M "�I /.(A.RJ azlw, " yy OF PHONE AREA CODE NUMBER EXTENSION ❑ FAX ❑ MOBII F AREA CODE NUMBER TIME TO CALL , TELEPHONED ' j/fPLEASE CALL (/ CAME TO SEE YOU ' II WILL CALL AGAIN WANTS TO SEE YOU ' �fI RUSH RETURNED YOUR CALL iI WILL FAX TO YOU MESSAGE !I![ i1l6/.d. .J✓ /z,-/ ,��// SG D I WbpsFORM 4009 MADE IN J S A DOTES COURT DOCKET�O. CITATION NO CITY SALEM PD 1522 • � VIOLATION N NOTICE NAME(LAST,FIRST INITIAL) STREETADDRESS CITY?OWN STATE ZIP &3 /7t-gg,/ S;szc:I�71 5feH,1 wq 0l1;7o LICENSE NO. LIC.EXP.DATE DATE OF BIRTH OWNER'S NAME(LAST,FIRST,INITIAL) Mjetl, N/D/Y I-- STREETADDRESS CITY/TOWN STATE ZIP / &4-Aolkzc25 i- r&,bo'o /nq 6d6 3,5- REGISTRATION NO. I STATE EXP.DATE I MAKETPE I YEAR COLOR DATE OF VIOLATION TIME DATE CITATION WRITTEN PERSONAL WUflY 4la7/V1/0 El Pm bb oNO LOCATION OF VIOLATION ENFORCING DEPT. 383 �exzr3y S; /!�f�C F� OFFENSE CHAP SECT. FINES - A if1E"• 5�Ps�c $}}N/Tgft�f B �cJl-• /aS<miz 5 lG , asp c OFFICER I D NO TOTAL C FINE DUE OF_EICER CERTIFIES COPY GIVEN TO VIOLATOR j �T4� �+ IN HAND X ��++++.•••.••• ❑ BY MAIL DG NOT MAIL CASH-PAY ONLY BY POSTAL NOTE,MONEY ORDER OR BY CHECK MADE PAYABLE TO: CITY CLERK CITY HALL 93 WASHINGTON STREET SALEM,MA 01970 TEL.(508)745-9595 X 251 1 HEREBY ELECT TO EXERCISE THE FIRST OPTION AS STATED ON REVERSE, CONFESS TO THE OFFENSE CHARGED,AND ENCLOSE PAYMENT IN THE AMOUNT OF $ CASE k SIGNATURE SEE OTHER SIDE FOR FURTHER INFORMATION ENCLOSE PAYMENT IN THIS ENVELOPE,PEEL AND SEAL Brothers Deli 283 Derbi Street Salem, MA 01970 Not complete from 12/22/05 Re-inspection: Equipment: 1) Racks in walk in refrigerator had accumulation of food and grime. Owner will purchase new racks by next routine inspection. Physical Facilities 1) Dry storage floor is unfinished. Floor needs to be cleaned and made impervious and easily cleanable. a� 2) Gap on the side of the door near restrooms. Seal all gaps. $ Repeats from 12/14/06 1)No CFM at time of inspection. 2) PHF next to or above RTE foods. 3) Uncovered foods in units. a2 $ 4) Ice build up in walk-in freezer ;(5 Concerns: 1) Cited previously for smoking on 3/17/06. At time of inspection inspectors observed ashes in and on hand wash sink. J b v 2) Complaint on 1/31/06 about lack of glove usage. Inspectors observed at the inspection done on 4/27/06 improper usage of gloves and lack of glove use. 1 q � ( IMPORTANT MESSAGE ) FOR M. __ DATE �- TIME P.M. Ni OF PHONE AREA CODE NUMBER EXTENSION ❑ FAX O MOBII F AREA CODE NUMBER TIME TO CALL TELEPHONED C,YPLEASE CALL CAME TO SEE YOU WILL CALL AGAIN WANTS TO SEE YOU RUSH RETURNED YOUR �CALL � WILL FAX TO YOU MESSAGE FORM 4009 MARE IN U.S.A. NOTES ' i L CITY OF SALEM BOARD OF HEALTH Establishment Name S' �eCG Date: /- 3/"0 Ze Page: / of Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date No. Reference R—Red Item Verified PLEASE PRINT CLEARLY i1>//'ce 1��rl,�G✓ l�m,o/aur f �h a� %iA& 110,0 r/al-s r,z)el� 1 )1 A,!41 /5 _ es /,t',k;;'7Ped �,L d glw�,s 1�hr/�, br�pa�r� an lnQ�r c1/ice v��` 24y �> � I ✓C�.e,/i.�.ed �r3'vn� �1a�2 -_Ioc-� ✓�S�mp�� , GUQs I r �vd �' ��rnD)ar�✓¢ r�/'vr/.Soon/ arty Udf�75er1 .o sl✓�e y � �� s Grre�c� rU -�i�e �✓v� rn I I I Discussion With Person in Charge: Corrective Action Required: ❑ No ( ❑ Yes I have read this report, have had the opportunity to ask questions and agree to correct all ❑ Voluntary Compliance ❑ Employee (Restriction/ Exclusion violations before the next inspection, to observe all conditions as described, and to ❑ Re-inspection Scheduled ❑ Emergency Suspension comply with all mandates of the Mass/Federal Food Code. I understand that noncompliance may result in daily fines of twenty-five dollars or suspension/revocation of ❑ Embargo ❑ Emergency Closure your food permit. ❑ Voluntary Disposal ❑ Other: A.. ., ..... �....- � ..-•,rv.-,.,.raw. ,,,,--r.a; r ---�,,.. ,. .- _... +w...s <'Sl�"•., .. ,-.-...-.r'.+-- , ,.... ... ... ....- - .•� 3-501.khr") PHI'S Recened of Temperatures Violations Related to Foodborne Illness Interventions and Risk i According te-to laCool:d I Factors(Items 1-22) (Cont.) 4PF/45'F Within 4 Homs. PROTECTION FROM CHEMICALS 3-507.15 Cooling!Methods fir PHFS I Food or Color Additives ( 19 PHF Hof and Cold Holdinglou' 3-501.16(B) Cold PHF;Maintained at or be-lou 3-202.12 Additives* 590.001(F) 41'/41" F" 3-302.14 Protection from Unapproved Additives* I 3-501.16(A) Ilot PHFin S Maintained at or above 15 Poisonous or Toxic Substances I 140'F. 7-101.11 Identifying Information-Original ;-501.16(:\i Roasts Held at or above 130"17.Containers" 7-102,11 Common Name-Workin-Containei.,"' ( 20 rime as a Public Health Control 3-501.19 Time a,a Public Health Connol* 7-201.11 Separation-Siciage" I 7-202.11 Reatrictiou-Presence and Ilse* 590.003(H) Variance keu,mremzm. 7-202.12 Conditions of Use" 17-203.11 Toxic Containers-Prohibitions" I REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-204.11 Satitizers.Criteria-Chemicals^ I POPULATIONS(HSP) 7-7(14.12 Chemicals for Washing Produce,Criteria" I d1 3-501.i IiA) steu t'npari7ed Pre-packaged Juices and 7-204.14 Di ging Agents.Criteria.. I I Bevcfages want Warning,Libels. 7205.11 ( Incidental Food Contact Lubricants` 1 ,iQ1.'j(B) Ilse of Pasteurized Bets^` a . I 3-80:.i 1(D} Rau cr P,utia0y Cooked.4nint.tl Food.:nil 7-206.11 Restricted Use 1 esticules. Cri,eru' Ray.Seed Sprouts Not Seri ed. 7-206.12 Rodent Bait Stations* I 3-501.11-CI Unopened Pool' Packa€;e Not Re-serwd 7-206.13 Praeking Powders,Pest Control and - MonitoT, CONSUMER ADVISORY TIMEtfEMPERATURE CONTROLS 22 1-002 11 Consumer A,6isory Posted for CotuumPrion of Arwna] Rr As f1tal .,re Raw. Cudricooked of 14 Proper Cooking Temperatures for I PHFS Not Othennse Pro_essed to Eliminate Paihogens.^ 3-4ULIIA(I)(2) Eggs- ISS"F 15 Sec. ( evran. .cu.n, Egts-Immediate Service 145'F15sec" 3-302.13 P.tsfeun7ett Eggs Substinne t%+r Raw Shell 3-4013-401.111A)(2) ComminutzdFF;h, Islcats&Game Esgs< Animals 155`F 17 sec. n SPECIAL REQUIREMENTS 13-401.11(B)(1)(21 Pork and Beet Roast- 130+ 121 min" ( 3 401.11(A)2) Ratites, Injected Meats- 155'F 15 590.009(A)-(D) Violations of Section 590.004(A)-(D) in' sec.' I catering, mobile food, temporary and 3-401.11(A)0'i Poultry,Wild Game Stufted THl"s, residential kitchen operatiuns dopuld be Stuffing Containing Fish. Meat, debited under the appropriate sections Poultry or Ratites-165'P 75 sec. ' above if Riatcd to loodhorne illness 3-401A 1(C)(3) Who1r-muscle,Intact Beef Steaks interventions and risk faclors. Other 145"F a I 592000) violations telating to good retail 3401.12 Raw.Animal F„ods Cooked in a ( practlecs should be debited uncler X29-- Miciuwave 165`F* Special !ceyuircnicuts. 3-401.1 IiA)tI)tb) All Other PHF,- 14S'F I5 sec, s 117 Reheating for Hot Holding VIOLATIONS R.1LATED TO GOOD RETAIL PRACTICES 3-403.11(.A)&(0) PHFS 165'F 15 sec. ,_ j (Items 23-30) 3-403.11(B) MiuowaW- 165` 1-2 Mmmt`Standinc Critical owl ntui-critical cioiiai,ws, t,ih,h do not relate w the I Tune" foodborne illness inteiventmn.c'urr!ris,c)crucrr(isn'rl nGorr, inn be 3-403.11(C i Com nerc,alN Processed RTE Food- found in the follnu'utg sections of the 1•bud Crele acrd 105 CMR 140"F" 590-000 3-103.11(E) RemainingUnshcedPortions(if Beef I Item I Good Retail Practices - FC- -i 590.000 Roasts' _2_3. 1 Mane ement ano Personnel _ FC-Z 003 ! Proper Cooling of PHFS I ( 24 Ford and Food Protection FC-3 OUA 4444---4444---- l8 I, it 3-507 14(A) C'oolmc Conked PHFS from 140`P to - -4444 -25. Equipment and Uter�ils FC-4 .00 ------_ 26 Water,Plumbing and Waste FC-5 ( .Utt5 6 i0"F Within 2 Yours and Fron-,70'F 1 27. Phyucai Facility . C 6 .007 to 41'F/45'1,Within.4 Hours. " 1 28. Poisonous or Toxic Materials FC-7 .008 30or,„,:,O -- 3-50114(Bi Coolin:;PtIFs Maria Fmm..mbtent Special Requirements oog n � ^9 'pempziatureingredientsto47"F/451^ cher Within 4 hours* 'Denotea craical item,n the]' lIea l 1999 Fund Cad.or 105 CNW 5af)Wit. 4 COURT DOCKET NO CITATION NO. CITY OF SALEM VIOLATION NOTICE PD 03$'1 NAME(LAST,FIRST,INITIAL) 16?'oT)-:C25 DSL) STREETADDRESS CITY/TOWN STATE ZIP 783 T),;-R3) 5, SAL_ m rnr� ol9'b LICENSE NO LIC.EXP.DATE DATE OF BIRTH OWNER'S NAME(LAST,FIRST,INITIAL) 1Z.p%5C,14 0 l 7 i)'k- STREETADDRESSCITY/TOWN STATE ZIP 1 Qil..r;N4..trta7, ST Vci+!',Au rnt) 02a3R REGISTRATION NO. STATE EXP DATE MAKE)YPE I YEAR(COLOR DATE OF VIOLATION TIME I DATE CITATION WRITTEN eeasoNu _ [-IAM INJUflY 12'lu 'Q� Z.�''o4PM 12.' 2-7-4 S ❑YES FIND LOCATION OF VIOLA�TIIO�.N\ ENFORCING DEPT. 70 7D� OFFENSE CHAP. SECT FINES A {O -lb T iS`;N n-�I-i B c OFFICER I D.NO TOTAL FINE $ DUE OFFICER CERTIFIES COPY GIVEN TO VIOLATOR e04T ® IN HAND X ❑ BY MAIL CASH-PAV ONLY BV POSTAL NOTE,MONEY ORDER OR BY CHECK MADE PAYABLE TO: CITY CLERK CITY HALL 93 WASHINGTON STREET SALEM,MA 01970 TEL.(508)745-9595 X 251 1 HEREBY ELECT TO EXERCISE THE FIRST OPTION AS STATED ON REVERSE, CONFESS TO THE OFFENSE CHARGED,AND ENCLOSE PAYMENT IN THE AMOUNT OF $ CASE# SIGNATURE SEE OTHER SIDE FOR FURTHER INFORMATION ENCLOSE PAYMENT IN THIS ENVELOPE,PEEL AND SEAL .. ,..� .g.., CGURrtXxr�TNo.� � � .aranorvrdo. .. ..., ..�.. CITY'OF SALEM w }+finn +Q3Q�p VIOLATION NOTICE PD 4., N g NAME(LAST;FIRST.INITIAL)to r . T'I Lei 0 jSTREET ADDRESS C1TY(TOWN STATE 21P t (n a\\ 12,53 T%,aal 5r SAt_,_m Mo, ,"k3 (LICENSE NO -ILIC.EX . . , 4A• G � lifer fOWNER'S NAME(LAST,FIRST,INITIAL) , STREETADDRESS CITYITOWN STATE ZIP f I Suv-J s Sr Fok2ARo mt� o2o3s li i I REGISTRATION NO. STATE I EXIRDATE I MAKETYPE IYEARrORI DATE OF VIOLATION "7TIME DATE CITATION WRITTEN Io�ut �Sg bYES M I1', -z.Z'U'.1 I jNO O , LOCATION OF VIOLATION ENFORCING DEPT ril 1 OFFENSE CHAP. SECT. FINES IA 1diZ Pti W vlo� (a- c;v4 X10co )1 Tc ' IB 1 Ccs 1� lv6C(h2 S90.aac, I m s - Er IG 1 =� 3 1 OFFICER I'D NO I TOTAL �^ FINE 42S vO W I - DUE $Z$O' rm OFFICER CERTIFIES COPY GIVEN TO VIOLATOR \, ❑ IN HAND O X / U ❑ BY MAIL ❑ DO NOT WAIL CASH-PAY ONLY BY POSTAL NOTE,MONEY ORDER OR BY CHECK MADE PAYABLE TO: CITY CLERK �}- 1:''^- ❑ CITY HALL �._. 93 WASHINGTON STREET - SALEM,MA 01970 TEL.(508)745-9595 X 251 z rn o �� ry I I HEREBY ELECT TO EXERCISE THE FIRST OPTION AS STATED ON > EE r� REVERSE, CONFESS TO THE OFFENSE CHARGED,AND ENCLOSE PAYMENT IN THE AMOUNT OF _ �•.,,5 I,L $ CASE# z � ❑ SIGNATURE SEE OTHER SIDE FOR FURTHER INFORMATION ENCLOSE PAYMENT IN THIS ENVELOPE,PEEL AND SEAL O w0 W � Y O O IL 0 LL �,.. a4-...:,1"�is<a, -'tdSR.$s�.,t.:w.&•A?::.: ,.„¢ xF . Y -„Y”"�..'` ,,.,,xs, .-w..;�v-as.. ,,.._,.. .. _ - -._'ar+ns.�m �.yli' ..-o.P+,Mi,.'S<Mt'k^Mhl_Al tvu^>a.xp'+'F!"..¢r::,v�yscyt+a;yw-.cx ary.:.aw wmlCwMt!89x+T'^'ft'v.-. . _•,•.R�'m.A^-»-..,i......v.f:..5..m...+ f -w—.o-.. . - v...s. „.fit:,n„ Commonwealth of Massachusetts i City of Salem Board of Health 120 Washington Street,4th Floor 0 IF) SALEM,MA 01970 Food/Retail Establishment Permit DATE PRINTED: 01/05/2006 WHO'S PLACE OF BUSINESS IS: Brother's Deli File Number:BHF-2004-0018 283 Derby Street Salem MA 01970 LOCATED AT: 0283 DERBY STREET SALEM,MA 01970 Permit Type Permit No. Permit Issued Permit Expires Fee Restrictions/Notes FOOD SERVICE BHP-2006-0023 Jan 1,2006 Dec 31,2006 $200.00 ESTABLISHMENT Total Fees: $200.00 PERMIT EXPIRES December 31, 2006 Board of Health This Permit is not transferable and must be reissued upon change of ownership or location.The permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code,beofre any revonations, improvements,or equipment changes are made,all plans for such must be submitted to and approved by the Salem Board of Health. Page 17 of 18 CITY OF SALEM, MASSACHUSETTS ,6 BOARD OF HEALTH s 120 WASHINGTON STREET, 4TH FLOOR SALEM, MA 01970 TEL. 978-741-1800 STANLEY J. USOVICZ, JR. FAX 978-745-0343 MAYOR W W W.SALEM.COM JOANNE SCOTT, MPH, RS, CHO HEALTH AGENT 2006 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT NAME OF ESTABLISHMENT ,G V(7 rb W S I0151I/t' TEL# CI7K 1W W� l9' ADDRESS OF ESTABLISHMENT V.Z2 L� YI rr'4 C7 (�I� MAILING ADDRESS (if different) A /VV// OWNER'SNAME 11/1001,11/1001, JRATi;il�,/ 1 /✓I�Pz ING�TEL# 071S-v 53�� ADDRESS I a 14n64C4 G1 �- CITY I%o.ch pVt2 STATE /d1 Gr ZIP 02- 0-SS CERTIFIED FOOD MANAGER'S NAME(S) e6z(Ogl, 12F4 y CERTIFICATE#(s) 5 Lk,,,3 (required in an establishment where potentially hazardous food is prepared.) y EMERGENCY RESPONSE PERSON Ia li �-Lf7 /"UI1 it6111 r✓ ,< HOME TEL# iQ7D0V (0 -70 HOURS OF OPERATION: Mon.-Tue.-Wed.-Thu.-Fri.-Sat.-Sun.- TYPE on. Tue. Wed. Thu. Fri. Sat. Sun.TYPE OF ESTABLISHMENT FEE (check only) RETAIL STORENO less than 1000sq.ft. =$ 50 1000-10,000sq.ft. =$100 more than 10,000sq.ft. =$250 ------------------------------------------------------------------ --------------------- RESTAURANT YE NO /� 2 _ seats 5-99 seats =$150 more than 99 seats =$200 .........YES NO......... - BED/BREAKFAST $100 --- ---.... C'ii3...... ---------------------------------------------------------------------- ------. ------------------ ADDITIONAL PERMITS MAKE (not just serve) ICE CREAM, YOGURT, SOFT SERVE YES itvC $5 TOBACCO VENDOR YES NO $50 ALL NON-PROFIT(such as church kitchens) YES N $25 'Please pay total with one check payable to the City of Salem . This Permit is not transferable and must be reissued upon change of ownership. The Permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code, before any renovations, improvements, or equipment changes are made, all plans for such must be submitted to and approved by the Salem Board of Health. Pursuant to MGL Chapter 62C, Section 49A, I certify under the pains and penalties of perjury that I, to my best knowledge and b lief,. ve filed/all state tax returns and paid all state taxes required under the law. � nature ;% Date Social Securityor Federal Identification Number --- ------------------------ �1LT I------ -- �--------------------------------------- Revised 11/03/05 FOODAP2.adm Check#&Date a-��`> % 'CITY OF SALEM9 MASSACHUSETTS BOARD OF HEALTH 120 WASHINGTON STREET, 4TH FLOOR SALEM, MA 01970 TEL. 978-741-1800 FAX 978-745-0343 STANLEY J. USOVICZ, JR. JOANNE SCOTT, MPH, RS, CHO MAYOR HEALTH AGENT COMMONWEALTH OF MASSACHUSETTS PERMIT TO OPERATE A FOOD ESTABLISHMENT In accordance with regulations promulgated under authority of Chapter 94, Section 305A and Chapter III, Section 5 of the General Laws, to operate a Food Establishment in the City of Salem is hereby granted to: Type of Establishment: FOOD SERVICE Name of Establishment: Brothers Deli Address of Establishment: 283 Derby Street Owner's Name: Hazern Muhieddin & Nidal Rajeh Restrictions: Application Date: 11/18/2004 Permit for Food Establishment 15-05 Frozen Desserts/Ice Cream Permit for the Sale of Tobacco Products These Permits Expire December 31, 2005 This permit is not transferable and must be reissued upon change of ownership or location. The permit must be posted in a prominent location in the Establishment, In accordance with the State Sanitary Code, before any renovations, improvements, or equipment changes are made, all plans for such must be submitted to and approved by the Salem Board of Health. HEALTH AGENT CITY OF SALEM, MASSACHUSETTS /-� 0-5 c BOARD OF HEALTH 120 WASHINGTON STREET, 4TH FLOOR f SALEM, MA 01970 TEL. 978-741-1800 FAX 978-745-0343 STANLEY J. USOVICZ, JR. JOANNE SCOTT, MPH, RS, CHO MAYOR HEALTH AGENT 2005 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT NAME OF ESTABLISHMENT ro l h e�r e li I TEL# 9�8- `!l- `�6l/8 ADDRESS OF ESTABLISHMENT Z 93 7i er by r MAILING ADDRESS (if different) ,S /JtdAL 6ia- -3a8 -104o OWNER'S NAME VkpZfv'A W1lJ�; �a'/� �F �(�TEL# E0tl - CIR17 -S3 G-+ ADDRESS Soo CITY STATE tmp ZIP O/ &86 CERTIFIED FOOD MANAGER'S NAME(S) at IAlJF_ CERTIFICATE#(s) 3 (95054 (required in an establishment where potentially hazardous food is prepared.) EMERGENCY RESPONSE PERSON 0 PZew1 1MJIAi ecLI.IN HOME TEL# Vepi-216-9119r HOURS OF OPERATION: Mon.k-4Tue.kWed.6Thu.6-9 Fri. �-) Sat.6_9 Sun. G-9 TYPE OF ESTABLISHMENT FEE check only RETAIL STORE YES NO less than 1000sq.ft. =$ 50 1000-10,000sq.ft. =$100 more than 10,000sq.ft. =$250 RESTAURANT YES NO less than 25 seats =$100 25-99 seats -$150 more than 99 seat =$200 BED/BREAKFAST YES NO ADDITIONAL PERMITS MAKE (not just serve) ICE CREAM, YOGURT, SOFT SERVE YES NO $5 TOBACCO VENDOR YES NO $50 ALL NON-PROFIT(such as church kitchens) YES NO $25 Please pay total with one check payable to the City of Salem This Permit is not transferable and must be reissued upon change of ownership. The Permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code, before any renovations, improvements, or equipment changes are made, all plans for such must be submitted to and approved by the Salem Board of Health. Pursuant to MGL Chapter 62C, Section 49A, I certify under the pains and penalties of perjury that 1, to my best knowledge andli , have filed all state tax returns and paid all state taxes required under the law. Signature g Date II /I�/o Social Security or Federal Identification Number Si Revised 11/ 3/03 ..DA �2:d !_ _ t _____ y S1 ------------------------- m Check#&Date 0283 DERBY STREET Brother's Deii City of Salem FOOD SERVICE ESTABLISHMENT - FOOD SERVICE Inspection HACCP: ❑ Telephone: Item Status Violation Critical Urgency Nature of problem or correction 741-4648 Non-compliance with: Not Done Anti-Cho PAS Owner: P Tobacco FAILS Penn Christophe El ash tray in kitchen. Smoking in the PIC' dchen is prohibited Rami Mohammed FOOD PROTECTION MANAGEMENT Not Done Inspector: PIC Assigned/Knowledgeable/Duties PASS ❑d RED David Greenbaum EMPLOYEE HEALTH Not Done Date Inspected: Correct By: Reporting of Diseases by Food Employee and PIC PASS RED 3/17/2005 Risk Level: Personnel with Infections Restricted/Excluded PASS RED FOOD FROM APPROVED SOURCE Not Done Permit Number: Food and Water from Approved Source PASS ❑J RED BHP-2005-0080 Receiving/Condition PASS ❑Q RED Status: - - Tags/Records/Accuracy of Ingredient Statements PASSd❑ RED VIOLATION #of Critical Violations: -- Conformance with Approved Procedures/HACCP PASS RED Plans 3 Time IN: I Time OUT: Notes: 34: Urgency Description(s): BLUE: Violations Related to Good Retail Practices (Critical violations must be corrected immediately or within 10 days)(Non-critical violations GeoTMS®2005 Des Lauriers Municipal Solutions, Inc. ( Rev. Mar 17,2005 ) Page 1 of 0283 DERBY STREET Brother's Deli must be corrected immediately PROTECTION FROM CONTAMINATION Not Done or within 90 days) Separation/Segregation/Protection PASS ❑d RED RED: Violations Related to Food Contact Surfaces Cleaning and Sanitizing PASS RED Foodborne Illness Interventions Proper Adequate Handwashing PASS ❑d RED and Risk Factors (Require immediate corrective action) Good Hygienic Practices PASS ❑J RED Prevention of Contamination from Hands PASS ❑d RED Handwash Facilities FAIL Critical ❑d RED Kitc/handwash sink obstructed. s must be clear and acces5i,bre at all times Pr ' e"Employees must wash hands" L-sfgns in the men's and employee restroom. PROTECTION FROM CHEMICALS Not Done Approved Food or Color Additives PASS RED Toxic Chemicals PASSd❑ RED TIMErTEMPERATURE CONTROLS(Potentially Haz Not Done Cooking Temperatures PASS RED Reheating PASS RED Cooling FAIL Critical RED --w FF cooling in 1 gallon containers. Food VF be cooled in containers no deeper than 4". Hot and Cold Holding FAIL Critical RED Tur s thawing at room temperature rkeys must"awed in refrigeration or under cold r ing water. +e Eggs sto out at room temperature Pote ally hazardous foods must be stored a temperature of 41°F or below Time As a Public Health Control PASS ❑d RED REQUIREMENTS FOR HIGHLY SUSCEPTIBLE PO Not Done Food and Food Preparation for HSP PASS RED CONSUMER ADVISORY Not Done Posting of Consumer Advisories PASS ❑d RED GeoTMS®2005 Des Lauriers Municipal Solutions, Inc. ( Rev. Mar 17,2005 ) Page 2 of 0283 DERBY STREET Brother's Deli Violations Related to Good Retail Practices (Blue Not Done Management and Personnel PASS ❑ BLUE Food and Food Protection FAIL Critical ❑ BLUE Man refrigerators and freezers have u overed food. All food in storage must e covered s Thart is food stored directly on the floor in e walkins and in dry storage. All food M red at least 6-8 inches off the floor. K all dry ingredients in dry storage overe Equipment and Utensils FAIL Non-Critical ❑ BLUE v Bo al ns have an accumulation of food bn ho roughly clean both walkins. W in refrigerator has a broken ermometer. Provide a new visible, accura ermometer. 1"Th anopener has an accumulation of nme. T4aroughly clean canopener. Bever40 air and Pepsi cooling units need visi ccurate thermometers. wave needs a thorough cleaning. rov sanitizing solution of proper c centration at all work stations at all mes. Water, Plumbing and Waste PASS ❑ BLUE Physical Facility PASS ❑ BLUE Poisonous or Toxic Materials PASS ❑ BLUE Special Requirements PASS ❑ BLUE Other-See Notes FAIL Non-Critical ❑ BLUE Bot strooms need a thorough cleaning. �vr/V L'V GeoTMS®2005 Des Lauriers Municipal Solutions, Inc. ( Rev Mar 17,2005 ) Page 3 of ( IMPORTANT MESSAGE ) a FOR DATE M <� OF AREA CODE NUMBER EXTENSION ❑ FAX ❑ MOE311 F AREA CODE Nt}Do1BER TIME TO CALL TELEPHONED �G,/ PLEASE CALL / CAME TO SEE YOU WILL CALL AGAIN WANTS TO SEE YOU RUSH RETURNED YOUR CALL I WILL FAX TO YOU ' MESSAGE SIGNED smrOPs FORM 4009 MARE IN U 5 9 4 � ( IMPORTANT MESSAGE ) FOR ` ///��/�� 8 / los A DATE M Oji C/J.P�L� on 9�� 7 / SLIofL� AREA CODE ME EXTENSION AR AHtX-CDOE NUMBER TIME TO CALL TELEPHONED PLEASE CALL 1� CAME TO SEE YOU ' WILL CALL AGAIN WANTS TO SEE YOU I RUSH , RETURNEC YOUR CALL WILL FAX F,AAX TO YOU MESSAGG-e- L --- SIGNED OP� FORM 4009 MADE IN U.S.A. - ( IMPORTANT MESSAGE ) FOR OATF TIME OF PHOr\ G AREA CODE NUMBER EXTENSION 0 FAX 0 MOBI1 F AREA CODE NUfy1BER TIME TO CALL TELEPHONEDPLEASE CALL CAME M SEE YOU WILL CALL AGAIN WANTS TO SEE YOU I RUSH RETURNED YOUR CALL 'I WILL FAX TO YOU � IG D � FORM 40D9 MAGE IN t1.5.A. ( IMPORTANT MESSAGE ) FOR OATF /S/J.s TIMEP.M. M L OF E ✓J /' Li PHON /y�lS. REA COBE NUMBER EXTENSION ❑ FAX ❑ MOBN F AREA CODE NUMBER TIME TO CALL TELEPHONED I PLEASE CALL I I CAME TO SEE YOU I WILL CALL AOAIN I WANTS TO SEE YOU I I RUSH I RETURNED YOUR ]CIALL I WILL FAX TO YOU MESSAGE I��.C` »B.v SIGNED FORM 4009 w MARE IN IJ S.A. YrxU)l Ar�tIZlS 1�/t II I I i n J t� .t t 1, i i t: I 11 �t -4 _ _ 1 I; II � I CITY OF SALEM, MASSACHUSETTS � BOARD OF HEALTH 120 WASHINGTON STREET, 4TH FLOOR SALEM, MA 01970 TEL. 978-741-1800 _ FAx 978-745-0343 STANLEY J. USOVICZ, JR. JOANNE SCOTT, MPH, RS, CHO MAYOR HEALTH AGENT COMMONWEALTH OF MASSACHUSETTS PERMIT TO OPERATE A FOOD ESTABLISHMENT In accordance with regulations promulgated under authority of Chapter 94, Section 305A and Chapter III, Section 5 of the General Laws, to operate a Food Establishment in the City of Salem is hereby granted to: Type of Establishment: FOOD SERVICE Name of Establishment: Brothers Deli Address of Establishment: 283 Derby Street Owner's Name: Hazem Muhieddin & Nidal Rajeh Restrictions: Application Date: 11/18/2004 Permit for Food Establishment 15-05 Frozen Desserts/Ice Cream Permit for the Sale of Tobacco Products These Permits Expire December 31, 2005 This permit is not transferable and must be reissued upon change of ownership or location. The permit must be posted in a prominent location in the Establishment, In accordance with the State Sanitary Code, before any renovations, improvements, or equipment changes are made, all plans for such must be submitted to and approved by the Salem Board of Health. HEALTH AGENT L Massachusetts Department of Public Health Salem Board of Health 120 Washington Street,0 Floor Divisitin of Food and Drugs Salem, MA 01970-3523 FOOD ESTABLISHMENT INSPECTION REPOT Tel. (978)741-1800 Fax (978) 745-0343 Nam �(p) (} Date / Type of Operation(s) TM of Inspection �nJA0AP) �L )DX? �i �� -(! I Food Service Routine Address k 1'�Dn `fit T Risk Retail ❑ Re-inspection J_) n t w P P Level ❑ Residential Kitchen Previous Inspection Telephone G �Cn� i , V, OAvQ )� ILH 4&4 ❑ Mobile Date: Owner //)� HACCP YM ❑ Temporary [3 Pre-operation _k1A�r, �1PA 4, I ❑ Caterer ❑ Suspect Illness Person in Charge(PIC) _ Time El Bed 8 Breakfast El General Complaint w_ El HACCP inspector K p ^� 10 Permit No. ElO herr Each violation checked requires t explanation on the narrative page(s)and a citation of specific provision(s)violated. Non-compliance with: Violations Related to Foodborne Illness Interventions and Risk Factors Anti-Choking Tobacco Violations marked may pose an imminent health hazard and require immediate corrective 590.009(E) 0� 590.009(F),JZ] action as determined by the Board of Health. f)k I � Cej ` LFOOD PROTECTION MANAGEMENT _ y E] 12. Prevention of Contamination from Hands ❑ 1. PIC Assigned/Knowledgeable/Duties ° 14[EMPLOYEE-- _ ❑ 13. Handwash Facilities ❑ 2Re Reporting FoodEmp W r PROTECTION FROM CHEMICALS, ' P 9 Y Employee and PIC , d ��' -_'_ a _ _ .. r ,, t ❑ 14.Approved Food or Color Additives ❑ 3. Personnel with Infections Restricted/Excluded [ y' � _ El 15.Toxic Chemicals FOOD FROM APPROVED SOURCE_, TIMEITEMPERATURE CONTROLS(Potentially Hazardous Foods I L] 4. Food and Water from Approved Source ^` j; ) I )_j 0`5.__Receiving/Condition .. ! El16.Cooking Temperatures w \ ❑ 17. Reheating El 6. Tags/Records/Accuracy of Ingredient Statements � 9 ❑ 7. Conformance with Approved Procedures/HACCP Plans ❑ 18.Cooling PROTECTION FROM CONTAMINATION a 1 El 19. Hot and Cold Holding El 8. Separation/Segregation/Protection t ❑20.Time As a Public Health Control ❑ 9. Food Contact Surfaces Cleaning and Sanitizing (,REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP)I t5 h ❑21. Food and Food Preparation for HSP ❑ 10. Proper Adequate Handwashing V i f CONSUMER ADVISORY -' -"'�� "' ❑ 11. Good Hygienic Practices I _ Posting of Consumer Advisories Violations Related to Good Retail Practices '}��' Number of Violated Provisions Related Critical (C)violations marked must be corrected Cr�, To Foodborne Illnesses Interventions immediately or within 10 days as determined by the Board ` and Risk Factors(Items 1-22): of Health. Non-critical (N)violations must beicorrected Official Order for Correction: Based on an inspection immediately or within 90 days as determinpd by the Board of Health. 1`I today,the items checked indicate violations of 105 CMR c x tit 590.000/federal Food Code. This report, when signed below 23. Management and Personnel (FC-2)(590.003) by a Board of Health member or its agent constitutes an 24. Food and Food Protection .(FC-3)(590.004) order of the Board of Health. Failure to correct violations 0L_.,><_ 25. Equipment and Utensils 6 TFc-a)(ss0005) cited in this report may result in suspension or revocation of . the food establishment permit and cessation of food 26. Water, Plumbing and Wastel (FC-5)(590.006) establishment operations. If aggrieved by this order,you Q� 27. Physical Facilityr3 T(FC;6)(590.007) have a right to a hearing. Your request must be in writing 28. Poisonous or Toxic Material s�(F-7)(590.008) and submitted to the Board of Health at the above address 29. Special Requirements (590.009) within 10 days of receipt of this order. 30. Other DATE^OF RE(INS{PE`C/TIIOIN� 'I{(,/ ��/ S Mn 'Farm/-14.obc FI/ Inspector's Si \re: Print: &)D C)I A n PIC'sSignature: U Print: 1[ng2rkj gyp, J ,1, t`I, 1 ' I Page�off Pages Violations Related to Foodborne Illness w Interventions and Risk Factors(items 1-22) PROTECTION FROM CONTAMINATION FOOD PROTECTION MANAGEMENT 8 1Cross-contamination 3-302.11(0.)(1) I Rav, Animal Foods Separated from I 590.003tA) Assignment of Responsibility* ( 1 Cooked and RTE Fads* 590.003(B) Demonstration of Knowledge* I Contamination from Raw ingredients 2-103.11 Person in charge-duties i 3-302,11(.4,)(2) Raw Alunctl Foals Separated from Each I Other' EMPLOYEE HEALTH Contamination from the Environment 2 590.003(C) Responsibility of the person to charge to 3-302.1[(A) Food Protection* require repotting by food employees and 3-302.15 I Washing Fruits and Vegetables � applicants* 3-304.11 Food Contact with Equipment and 590.003(F) Responsibility Ol A Food Employee Or An Utensils* Applicant To Report To The Person In ` Contamination from the Consumer Charge* ( 3-306.14(A)(B) Returned Food and Reservice of Food* 590.003(6) Reporting by Person in Charge* i -- -- Disposition of Adulterated or Contaminated 3 590.003(D) Exclusions and Restrictions* ( Food 590.003(E) Removal of Exclusions and Restrictions I 13-701,1 1 Discarding or Reconditioning Unsafe FOOD FROM APPROVED SOURCE Fad* 4 Foodand Water From Regulated Sources 9 Food Contact Surfaces 590.004(.0.-B) Compliance with Food Law* 4-501.111 Manual Warewashing-Hot Water 3-201.12 Food in a Hermetically Scaled Contamer* Sanitization Temperatures* 3-201.13 * 4-501.112 Mechanical Warewashin Hot Water I � Fluid Milk and Milk Products � g- J 3-202.13 ( Shell Eggs* Sanitization Temperatures* 3-202.14 Eggs and Milk Products.Pasteurized` 4-501.114 I Chemical Sanitization-temp.,pH, 1 3-202.16 I Ice Made From Potable Drinking Water' concentration and hardness ' 5-101.1 1 Drinking Water from an Approved System' 4-601.1 I(A) Equipment Food Contact Surfaces and Utensils Clean* 590.006(A) Bottled Drinking Water* 590.006(B) Water Meets Standards in 3I G CMR 22.0* 4-602.1 t Clearing Frequency of Equipment Fad- Shellfish and Fish From an Approved Source Contact Surfaces and Utensils`" J 4-702.1 1 Frequency of Sanitization of Utensils and I i-201.11 Fish and Recreationally Caught Molluscan4-702.1 Contact Surfaces of Equipment* l Shellfish" I ( 4-703.11 ( Methods of Sanifization-Hot Water and 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* Sources* 10 Proper,Adequate Handwashing I Game and Wiid Mushrooms Approved by I -- -- i Regulatory Authorftv 2-301.11 Clean Condition-Hands and Arms* f 3-202.18 Shellstock Identification Present* 2-301-12 Cleaning Procedure* 590.004(0) I Wild Mushroouts* j 2-301.14 When to Wash* 3-201.17 Game Animals* 11 +�+ Good Hygienic Practices $ Receiving/Condition 2401.11 Eating.Drinking or Using Tobacco* 3-202.11 PHFs Received at Proper Temperatures* I 2401.12 Discharges From the Eyes,Nose and 3-202.15 Package Integrity* Mouth* J 3-101.11 Fond Safe and Unadulterated* 3-301.12 Preventing Contamination When Tasting* 6 Togs/Records:Shellstock I 12 Prevention of Contamination from Hands 3-202.18 Shellstock Identification * i 590.004(E) ( Preventing Contamination from 3-203 12 Shellstock Identification Maintained* Employees* Tags/Records:Fish Products ' ( 13 I Handwash Facilities 3-402.11 Parasite Destruction* Conveniently Located and Accessible. 3-402.12 Records,Creation and Retention* � 5-203.11 ( Numbers and Capacities* 590.004(1) Labeling of ingredients' 5-204.11 ( Location and Placement* 7 I Conformance with Approved Procedures I 5-205.11 Accessibility.Operation and Maintenance IHACCP Plans I Supplied with Soap and Hand Drying 3-502.11 Specialized Processing Methods* Devices 3-502.1 Z Reduced oxygen nackang,criteria* 6-301.11 Handwashing Cleanser,Availability 8-103.12 Conformance with Approved Procedures* ( 6-301.1.2 Hand Drying Provision •Denotes conical item in the federal 1999 Frnid Code or 105 CMR 590.000 CITY OF SALEM �i _ BOARD OF HEALTH Establishment Name:Y )fr)4A nA iv 1�v Q Date:, 2-,— W�-1 \ Page: of Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date No. Reference R-Red hem T� !k7,l VerifiedJJ PLEASE PRINT CLEARLY v f pr) n.Q f -/,�Ot rPA/ ", A�.�.r D "1 �y .�C DAAIAJ.v I � {i/—��F7`,a �, 'n` ,n � �� l\am ' �, � �r >� (o{; I .�Prvc-r7 /., Yn -KN: v �OMnoC /�.n �l'-T_X P10A 01-A k, Yl ev!X L' A^ ( - J I .. n A V _��._1,.�n_• i n.� 1!�/vl /1�-,/iA \r.,A.p?p , /�y� 01x'7/ _(A;nr_ � ) j -I ��t7 O rY- /� i -Al�I'4)J (/,. U� 4)X�P ,c 0j0 ,L�tl rj �V1 A'Off l7/ nr< 1Gan A/ tnn 6P/L�4f l/OAAA /Jv/ /10)171 / /� �1 P/Yl rn.`r/./1. nN Un,r�NAlali/ /�/nTG'1 I��OA-nJ .t,l-I'1 fon r - z" I / I Vn\(ent G. Yi/R VLO Y- \�^/ (� '/,�� II/ n t V' l /"�•'�,r'� altf 0A r^, r j�`,�/I/OD , , k/. v.t/Ani ,'l/ V IJ r1y(Jn nn/t�rY VCIW p,Wnt,l)0� JOAA Discussion With Person in—Charge: U Corrective Action Required: I ❑ No Yes I have read this report, have had the opportunity to ask ques 'ons and agree to correct all Voluntary Compliance ❑ Employee Restriction/ violations before the next inspection, to observe all condf` )d Re-inspection Scheduled Ll Emergency Suspension o s/as described, and to Exclusion comply with all mandates of the Mass/Federal Foo�C cJ,e. understand that I wed noncompliance may result in daily fines of twent five 611 o suspension/revocation of ❑ Embargo ❑ Emergency Closure your,food permit. , ❑ Voluntary Disposal ❑ Other: , 3-501.14(C) PHFs Received at Temperatures Violations Related to Foodborne Illness,interventions and Risk According to Law Cooled to Fedora(items 1-22) (Cont.) _ 41'F/45"F Within 4 Hours. PROTECTION FROM CHEMICALS I 13-501.15 Cooling Methods for PHFs ( 14 1 . Food or Color Additives ( 119 PHF Hot and Cold Holding 13-202.12 Additives* 3-50L16(B) Cold PHFs Maintained at or below 3-302.14 Protection from Unapproved Additives* ( 590.004(F) 410145°F* 115 Poisonous or Toxic Substances 3-501.16(A) Hot PHFs Maintained at or above 7-101.11 Identifying Information-Original I 140°F. * 3-50 .16(A) Roasts Held at or above 130'F. Containers* * I 17-102.11 Common Name-Working Containers* I ( 20 ( Time as a Public Health Control 01.11 Separation 3-501.19 ( Time as a Public Health Control* 7 ( 7-202.11 Restriction-Presence and Use* I 15r>U.004(11) I Variance Requirement ( 7-202.12 I Conditions of Use* ( REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-203.11 Toxic Conrainers-Prohibitions* ( 17-204.11 Sanitizers.Criteria-Chemicals* ( POPULATIONS(HSP) 17-204.12 Chemicals for Washing Produce.Criteria* 121 3-801.11(A) Unpasteurized Pre-packaged Iuices and 17-204.14 ( Drying Agents.Criteria* Beverages with Warning labels* 17-205.11 ( Incidental Food Contact,Lubricants* 3-801.11(B) Use of Pasteurized Eggs* 17-206.11 + Restricted Use Pesticides,Criteria' 13-801.I I(D) Raw or Partially Cooked Animal Foal and Raw Seed Sprouts Not Served. 7-206.12 ( Rodent Bait Stations* ( ( 3-801.11(C) I Unopened Food Package Not Re-served, 7-206.13 ( Tracking Powders,Pest Control and Monitoring* CONSUMER ADVISORY TIMEITEMPERATURE CONTROLS 22 3-603.11 Consumer Advisory Posted for Consumption of 16 I Proper Cooking Temperatures for Animal Foods That are Raw.Undercooked or PHFs Not Otherwise Processed to Eliminate ') 3-401.11A(1)(2) Eggs- 155°F 15 Sec. Patbogens'*e"°` 11" Eggs-Immediate! 145°F15sec* 3-302.11 Pasteurized Eggs Substitute for Raw Shell 3-401.11(A)(2) Comminuted Fish.Meats&Game Ems* Animals-155'F 15 sec. * SPECIAL REQUIREMENTS ( 3.401118)(1)(2) Pork and Beef Roast-130'F 121 min* 3-401.11(A)(2) Ratites,Injected Meats-1550F 15 590.009(A)-(D) Violations of Section 590.009(A)-(D)in i sec.* catering, mobile food,temporary and 3-40111(A)(3) I Poultry,Wild Game,Stuffed PHFs, residential kitchen operations should be Staffing Containing Fish,Meat, debited under the appropriate sections Poultry or Ratites-165°F 15 sec. * above if related to foodborne illness 3401.11('C)(3) Whole-muscle,Intact Beef Steaks I interventions and risk factors. Other 145 OF 4` 590.009 violations relating to good retail 3-401.12I Raw Animal Foods Cooked in a practices should be debited under#29- Microwave 165°F* Special Requirements. 3.401.11(A)(1)(b) I All Otber PHPs-1450F 15 sec. ' I 117 ( Reheating for Hot Holding I VIOLATIONS R_LATED TO GOOD RETAIL PRACTICES ( 3.403Al(A)&(D) PHFs 165'F 15 sec.* I (Items 23-30) 3-403.11(B) Microwave- 165'F 2 Minute StandingI Critical and non-critical violations,which do not relate to the Time* foodborne illness interventions and risk factors listed above, can be 3-403.11(C) Commercially Processed RTE Food- I found in the follon-ing sections of the Food Code and 105 CMR 140°F* 590.000, 1 3-403.11(E) Remaining Unsliced Portions of Beef 1 Item I Good Retail Practices FC 1 590.000 1 I Roasts* 1 23. Management and Personnel I FC-2 1 .003 I 118 Proper Cooling of PHFs ( 1 24. Food and Food Protection I FC-3 1 .004 1 25. Eguitxment and Utensils I FC-4 I .005 I 3-501.14(A) Cooling Cooked PHFs from 1400F to ( 12g Water.Plumbinq and Waste FC-5 1 .006 700F Within 2 Hours and From 70°F 1 27. Physical Facli ty ! FC-6 1 .007 ! to 41°F/45'F Within 4 Hours. * ! 28. Pdsanous or Toxic Materials 1 FC-7 1 .008 3-501.14(B) ( Cooling PHFs Made From Ambient ! 129. I Special Requirements 009 Temperature Ingredients to 410171450F I 130. 1 Other ! I Within 4 Hours* s.we:�„mncznx 'Lhnotes critical item in the federal 1999 Food Code or 105 CMR 590.000. v ' CITY OF SALEM C� BOARD OF HEALTH 2 Establishment Name: EXO J o/AA �1eX t _ Date:2D-,)K-I Page: J of Item F CORRECTION em Code C-Critical nem DESCRIPTION OF VIOLATION/PLAN ODate No. Reference R-Red Rem Verified it t PLEASE PRINT CLEARLY UJAz A,i o A /'ice YY_ X P�• /�r) - _ . Jhv�/;O •GHQ A O..nJ.0 L y r''(i�A-�` a I71.e 0,J X X o J I �t I �/��u^,-%,/�,�0�,-.��-_��/) Jr �1�I a/D /// 0� lII\'\l/IF�/Y.( OA, Xl� ._nn 4�O�T-rrS/• n '\� D eO e n 1�/� r)n P (�ry_Ah 7AAX v 1 q S P V) SP V't/ p4 A P7J04) \ �l I I I I Discussion With Person in Charge: Corrective Action Required: I ❑ No 16d/ Yes o {{N I have read this report, have had the opportunity to ask questions and agree to correct all Voluntary Compliance ❑ Employee Restriction/ violations before the next inspection, to observe all conditions as described, and to Exclusion comply with all mandates of the Mass/Federal Food Co1/e. I nderstand that �Z Re-inspection Scheduled ❑ Emergency Suspension noncompliance may result in daily fines of weliar` o suspension/revocation of ❑ Embargo ❑ Emergency Closure your,food permit. Tlvveo ❑ Voluntary Disposal 0 Other: r � t � ' 3-501.14(C) PHFs Received at Temperatures Violations Related to Foodborne Illness Interventions and Risk According to law Cooled to Factors(Nems 1-22) (Cant.) 41'F/45`F Within 4 Hours. PROTECTION FROM CHEMICALS ( 3-501.15 Cooling Methods for PHFs 14 I Food or Color Additives i ( 19 ( PHF Not and Cold Holding 3-202.12 Additives* ( 3-501.16(B) Cold PBFs Maintained at or below 590.004(F) 410/45'F* 3-302-14 I Protection from Unapproved Additives" 3-501.16(A) Hot PHFs Maintained at or above ( 15 + Poisonous or Toxic substances I 140°F. * 7-101.11 Identifying Information-Onginal I 3-501.16(A) Roasts Held at or above 130°F. Containers* 1 7-102.11 ( Common Name-Working Containers* ( 20 Tirm as a Public Health Control ( 7-201.11 ( Separation-Storage* ( 3-501.19 Time as a Public Health Control* ( 7-202.11 ( Restriction-Presence and Use* 590.004(H) Variance Requirement ( 7-202.12 Conditions of Lise* ( 7-203.11 Toxic Containers-Prohibitions* REQUIREMENTS ( 7-204.11 Sanitizers.Criteria-Chemicals* POPULATTIONNS(HSP} IOFOR HIGHLY SUSCEPTIBLE (HSP) ( 7-204.12 Chemicals for Washing Produce.Criteria* I 121 3-801.11(A) Unpasteurized Pre-packaged Iuices and ( 7-204.14 Drying Agents.Criteria* + Beverages with Warning Labels* 7-205.11 ( Incidental Food Contam Lubricants* 3-801.11(8) ( Use of Pasteurized C oked ( 7-206.11 + Restricted Use Pesticides,Criteria* 3-801.11,D) Raw or Partially Cooked Animal Food and ( 7-206.12 ( Rodent Bait Stations* Raw Seed Sprouts P Not Served. 7-206.13 I Tracking Powders,Pest Control and 3-801,11(C) Unopened Food Package Not Re-served. Monitoring* CONSUMER ADVISORY TIMEITEMPERATURE CONTROLS 22 3-603.11 Consumer.Advisory Posted for Consumption of 16 Proper Cooking Temperatures for Animal Foods That are Raw.Undercooked or PHFs Not Otherwise Processed to Eliminate 3.401.1IA(i)(2) Eggs- i55°F 15 Sec. pathogens,*6d"uczoor Eggs-Immediate Service 145'Fl5sec* 3-302.13 Pasteurized Eggs Substitute for Raw Shell 3401.11(A)(2) Comminuted Fish.Meats&Game Eggs* Animals-155'F 15 sec. * ( 3401.11(B)(1)(2) Pork and Beef Roast- 130°F 121 min* SPECIAL REQUIREMENTS 340LI I(A)(2) I Ratites,Injected Meats-155°F 15 590.009(A)-(D) Violations of Section 590.009(A)-(D)in f sec. * catering, mobile food, temporary and 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs, residential kitchen operations should be Stuffing Containing Fish,Meat, debited under the appropriate sections Poultry or Ratites-165'F 15 sec. * above if related to foodborne illness 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks interventions and risk factors. Other 145°F* 590.009 violations relating to good retail 3-401.12 Raw Animal Foods Cooked in a ( practices should be debited under#29- Microwave 165'F* Special Requirements. ( 3401.11(A)(1)(b) All Other PHFs-145'F 15 sec.* ( ( 17 Reheating for Hot Holding VIOLATIONS R LATER TO GOOD RETAIL PRACTICES ( 3-403A I(A)&(D) PHFs 1657 15 sec. * ( (Items 23-30) 3-403.11(B) Microwave- 165°F 2 Minute Standing 1 Critical and non-critical violations,which do not relate to the Time* ( foodborne illness interventions and risk factors listed above, can be 3-403.11(C) Commercially Processed RTE Food- ( found in the following sections of the Food Code and 105 CMR 140°F* 590.000, 3-403.11(E) Remaining Unsliced Portions of Beef Hem i Good Retail Practices I FC 590.000 1 Roasts* I i 23. 1 Management and Personnel FC-2 .003 1 ( 18 Proper Cooling of PHFs i 24. I Food and Food Protection I FC-3 .004 I 1 25. 1 Equipment and Utensils 1 FC-4 .005 i 3-501.14(A) Cooling Cooked PHFs from 140'F to1 �, W ater.Plumbinq and waste I FC-5 .006 ' 70°F Within 2 Hours and From 70"F 1 27. I Phys ca!Facility FC-6 .007 to 41`F/45'F Within 4 Hours, * 128. Poisonous or Toxic Materials FC=7 .008 I 3-501.14(6) Cooling PHFs Made From Ambient 129. I Special Requirements .009 1 Temperature Ingredients to 41°F/45°F 1 30. I Other ! I Within 4 Hours* 'Denotes critical item in the federal 19991"Code or 105 CMR 590.000. -R'^+F'4 ,• M -a•+"vR`.�"' ....n4:.; Y� -} 'y.v"✓1M'*.Mtr�',R+v-*nrm.,{�J,. .�,q,,L . Massachusetts Department of Public Health Salem Board of Health Division of Food and Drugs r" 120 Washington Street,4'" Floor 9 Salem, MA 01970-3523 FOOD ESTABLISHMENT INSPECTION REPORT Tel. (978) 741-1800 Fax (978) 745-0343 Name (� p (� Date Type of Operation(s). Type of Insoection 1"�n' lv,�) . I J P.l'_P . -f rl-j (] Food Service NEI Routine Address-- Risk R Retail ❑ Re-inspection _� / Level ❑ Residential Kitchen Previous Inspection Telephone ❑ Mobile Date: Owner V / L �/ HACCP Y/N ❑ Temporary ❑ Pre-operation 1 11 r o AA P)A / 7�_ y ��0 l X ❑ Caterer ❑ Suspect Illness ❑ Bed&Breakfast Person in Charge(PIC) r 1, L Time El General Complaint I /r AI\(UA-,-CA Y\u km In:11:0,� ❑ HACCP Inspector l Ar� A I Out: Permit No. ❑Other Each violation checked requires an explahation on the narrative page(s) and a citation of specific provision(s) violated. Non-compliance with: Violations Related to Foodborne Illness Interventions and Risk Factors Anti-choking / Tobacco Violations marked may pose an imminent health hazard and require immediate corrective 590.009(E)�p 590.009(Fl/ action as determined by the Board of Health. Go _ �tswj -ei,r.� FOOD PROTECTION MANAGEMENT `S ❑ 12. Prevention of Contamination from Hands S ❑ 1. PIC Assigned/Knowledgeable/Duties R13. Handwash Facilities EMPLOYEE'HEA" EALTH . . . ,. _.. .., PROTECTION FROM CHEMICALS. . .. ::_ .. . _.. .. . .... ..... El 2. Reporting of Diseases by Food Employee and PIC [114.Approved Food or Color Additives ❑ 3. Personnel with Infections Restricted/Excluded ° - - 7 -- • El 15.Toxic Chemicals FOOD FROM APPROVED SOURCE TI El 4. Food and Water from Approved Source „ ME/TEMPERATURE CONTROLS(Potentially Haiardous Foods) ❑ 5. Receiving/Condition ❑ 16. Cooking Temperatures ❑ 6. Tags/Records/Accuracy of Ingredient Statements ❑ 17. Reheating ❑ 7. Conformance with Approved Procedures/HACCP Plans ❑ 18. Cooling PROTECTION FROM CONTAMINATION -' ❑ 19. Hot and Cold Holding ❑ 8. Separation/Segregation/Protection ❑20.Time As a Public Health Control ❑ 9. Food Contact Surfaces Cleaning and Sanitizing REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) El21. Food and Food Preparation for HSP El 10. Proper Adequate Handwashing SUMER ADVISORY ' � � El 11. Good Hygienic Practices 00•�I ' " ' -'' "-_ ', ' TQC 22. Posting of Consumer Advisories Violations Related to Good Retail Practices Number of Violated Provisions Related Critical (C)violations marked must be corrected To Foodborne Illnesses Interventions 1 immediately or within 10 days as determined by the Board and Risk Factors(Items 1-22): O of Health. Non-critical (N)violations must be porrected Official Order for Correction: Based on an inspection immediately or within 90 days as determined by the Board today, the items checked indicate violations of 105 CMR of Health. 590.000/federal Food Code. This report, when signed below C N by a Board of Health member or its agent constitutes an 23. Management and Personnel (FC-2)590O0 4)) order of the Board of Health. Failure to correct violations 24. Food and Food Protection (FC-3)(sso.00a) U cited in this report may result in suspension or revocation of 25. Equipment and Utensils (1 C-a)(sso.00s) the food establishment permit and cessation of food 26. Water, Plumbing and Waste (FC-5)(590.006) establishment operations. If aggrieved by this order, you (J V 27. Physical Facility (FC-6)(590.007) have a right to a hearing. Your request must be in writing F� 28. Poisonous or Toxic Materials (FC-7)(590.008) and submitted to the Board of Health at the above address 29. Special Requirements (590.009) within 10 days of receipt of this order. 30. Other DATE OF RE-INSPECTION: 6- 3-0 r s 59JM,.Fmm 14d. f '�Cl1 Inspector's Signature:" 0 Print: n PIC's Signature: -y;�� v Print: \ M ' Page ofages r Violations Related to Foodborne Illness Interventions and Risk Factors(items 1-22) PROTECTION FROM CONTAMINATION FOOD PROTECTION MANAGEMENT 18 I Gross-contamination I 1 590.003(A) ( Assignment of Responsibility* I 3-302.11(A)(I) Raw Animal Foods Separated from 590.003(B) Demonstration of hnowledget` I Cooked and RTE Foods* 2-103.11 I Person in charge -duties I Contamination from Raw ingredients 3 302 11(A){2) Raw Anhrsn Foods Separated from Each EMPLOYEE HEALTH Other* 2 590.(H)3(C) Responsibility of the person in charge to I Contamination from the Environment require reporting by flood employees and 3-302.1 t(A) Food Protection` applicants* 3-302.15 Washing Fruits and Vegetables 590.003(17) Responsibility Of A Food Employee Or An 3-104.11 Food Contact with Equipment and Applicant To Report To The Person In Utensils* Charge* Contamination from the Consumer 590.003(6) Reporting by Person in Charge* I 1-306.t4(A)(B) Returned Food and Reservice of Food* 3 590.003(D) Exclusions and Restrictions* Disposition of Adulterated or Contaminated 5c O.003(F) Removal of Exclusions and Restrictions I Food 13-701.11 Discarding or Reconditioning Unsafe FOOD FROM APPROVED SOURCE Food" 4 Food and Water From Regulated Sources s 9 : Food Contact Surfaces 590.0W(A-B) Compliance with Food Law' I 4-501.1 11 Manual Warewashing-Hot Rater 3-201.12 I Fo,nl ma Hermetically Scaled Container* I Sanitization Temperatures` 3-201.13 Fluid Milk and Milk Products* I ( 4-501.1 12 Mechanical Warewashino Hot Water 3-202.13 Shell Eggs* I Sanitization Temperatures* 3-202.14 Eggs and Milk Products.Pasteurized* 14-501.1 L4 Chemical Sanitization-temp.,pH, 3-202.16 ace Made From Potable Drinking Water" I concentration and hardness. 't 15-101 11 Drinking Water from an Approved System" 4(r01 I I(A) Equipment Food Contac Surfacesand i90.006(A) Bottled Drinking Water* I Cleaning Clean" 590.006(,B) Water Meets Standards in 310 CMR 22.0* I I -1-602.11 Cleaning Surfaces Frequency of Equipment nt Food- Shellfish and Fish From an Approved Source I FrequContaency Surfaces and Utensils* 4-702.1 I Frequency of Sanitization of Utensils and 3201.14 Fish and Recreadonally Caught Molluscan I Food Contact Surfaces of Equipment* Shellfish* 14-703.11 Methods of Sanitization-HotWaterand 3-201.15 Molluscan Shellfish from NSSP Listed ( Chemical* _- Sources' 110 Proper,Adequate Handwashing Game and Wild Mushrooms Approved by ( 2-301.1 1 Clean Condition-Hands and Anes* _ Regulatory Authority - 3-202.18 Shellstock Identification Present" I 12-301.12 Cleaning Procedure* 590.004(0) Wild Mushrooms" 12-301.14 When to Wash* 3-201.17 Game Animals* I I 1 i I Good Hygienic Practices 5 Receiving/Condition 1 2-401.1 I I Eating.Drinking or Using Tobacco* 3-202.11 PHFs Receives!at Proper Temperatures" I 1Mouth*I Discharges From the Eyes,Nose and 3-2(}2.15 Package Integrity" � 3-101.11 Food Safe and Unadulterated* j 3-301.12 Preventing Contamination When Tasting"_ I 6 I Togs/Records:Shellstock I 12 Prevention of Contamination from Hands 3-202.18 Shellstock Identification* 590.004(E) Preventing Contamination from 13-203.12 Shellstock.Identification Maintained" I Eupleyces* Tags/Records: Fish Products I I '.3 Handwash Facilities 3-402.11 Parasite Destruction` Conveniently Located and Accessible ( I 13-402.12 Records,Creation and Retention* 5-203.11 ( Numbers and Capacities* 590.004(1) Labeling of Ingredients" I 5-204.11 I Location and Placement* 7 I Conformance with Approved Procedures 15-205 11 I Accessibility,Operation and Maintenance /HACCP Plans Supplied with Soap and Hand Drying 3-502.11 Specialized Processing Methods-* Devices 13-502.12 Reduced oxygen packaging.criteria* 6-301.11 Handwashing Cleanser,Availability I 18-103.12 Conformance with Approved Procedures* I 16-301.12 ( Hand Drying Provision Denoles critical nem in the federal 1999 FNA Code or 105 CMR 590.000. ,F CITY OF SALEM 1 r, BOARD OF HEALTH Establishment Name: tACi'�'?I�,t?.I.d J� Date: S-1;).-/ 0 Page: 1�_ of Item Corte C-Critical Item DESCRIPTION OF VIOLATION/ PLAN OF CORRECTION No. Reference R-Red Item - 'Verified �('`� (` ) / r l PLEASE PRINT CLEARLY \ F�n�1. \ "- - � V,�roD.t "�c �f YO��cG��Gw1u��/ tiA �11�� tf-/ Qi ' V�CGZP� ✓(? A S-t to b �' I F - 45' :1/A-kt,_ c M Ll f I c 1.4— 4 , j o Uz of&4 N yn (,1)0,z 0n Q AC �YiA;t_ a J _ l 6!4 ,A, ,11,, nor, J V)Oo{1 �O��ISZ° ,.� �y� llnnn tam Ib AOtJ ,.�- . n.l:n ren" 4.tn,si y 1 ak� �Ar ��rnX - IDJftP7h k!tn s��n nii/�An� F !J� v u fjes� '/ ! < (� /' _ \ �1 I �) I I dx_ ..�+'"'L r � !}�-{ �G�..I inn in..,'{''I Q_-1/itol �-Vnnn�' / 7 Yi nn n-,in -17) 40X ,� do . .� �f)-" �rinI , NY0 - (/ . - .( /& , n1 SY/rKT�� )�T,Ir..Nctnu..rN in/,V�-Pl !/Y .n/L !_)t.,n. K `0I /t/,/�(Y�AP< \�� '�I \1_,YA�i �1/t1 _� IYI G � QA PitAA.-�Lt� VcQ�.C?� OD/a. /,1� _ rtae _ q(.1 A,, 0lA Mtl �,/Y1it.l 'frJO A/1..J I lY � I AI *XS/i+!`r —/ iWf1DAX AD OA A n 1CJS t? /7 t tY)(?_ N/.n Discussion With Person irf Charge: J Corrective)Action Required: I ❑ No ytl4 les I have read this report, have had the opportunity to ask question and agree to correct all Voluntary Compliance ❑ Employee Restriction/ violations before the next inspection, to observe all conditiof)s as described, and to V Exclusion k P LI Re-inspection Scheduled ❑ Emergency Suspension I comply with all mandates of the Mass/Federal Food Codel ur)derstand that noncompl!ance may result in daily fines ofrtw nerve dollars or suspension/revocation of ❑ Embargo ❑ Emergency Closure our foo _ y dermit.p ❑ Voluntary Disposal ❑ Other: 5 �ttl )"I/() PRFs Rtu ived at Ternlieratures' Violations Related to Foodborne illness Interventions and R/sk Aci:ording to Lal\ Cowled to Factors(Items 1-22) (Cont.) _ _ _ I I'F145'P Within d Huw's. ' PROTECTION FROM CHEMICALS t i 501 i, Galin,Methods or i'HFs � j 19 PHP Hof and Cold Holding 14 I Food or Calor Additivesowes" ( Cold PRFs A9ainteined at or below 3-2(1'_.12 Adi 540tN14±F1 41 /45'F' 3-302.14 Protection front Unapproved Addiows' j t 3-591,16iAj lint PHI<hfaintaiuedatorat+cn'a i5 I Poisonous or Toxic Substances 1 i WIAI hlenUtywglni2amavnn - on;jna! 1 I E4017. ' 1 i`nntattners' _ E _t-St !.1G(:\) j R,n!st,Hdd.a or .ibo%e i3ir 1, " ! 7 112 t I i t otnm,m;van+r }- Time as a Public Hearth Control __._ .__.ti - Vi I't ( t'inir e.,t!'nbfic lieahh r7mh'o(' r-_0t.11 1 5rpz.'tur:n-Si,napc ' j-:—_-- T-202Pw'u.1; K:::.t kt:nn- IIcc,wd 1, i¢itH'._-_.__ 7 202.12 (',ntduion.ttf Usc" - '- REQUIREMENTS FOR HIGHLY SUSCEPTIBLE ? 103 I t I Tonic Comatneu --Prnhtbt•,ira+." 1104.I I Sarno It .Crocrtn-C'hrrtic:,ir � 7 PQPLst ATEQNS(HSP) _ ^ n _i? 1 2f I +.gt!1 li(.-1} i tittp,-tam tx:d t're-pac}: cd lei ec aul� 4 ('htnticals ten ty'ashir.>?.k'rodu;:c;Criieno t M-----._• L--J- 1 Rtt'cfa2.es w idN;Vt!trl:>!Rl,,titi" d_7 104 14 tarev e Aw:,_na.('maria'' `_S+): l i'Rt l c„1 }'a,t:vo,o d'r:at '"'05 11 I Imif!Vntai 1:>,rl Contact, iatbiwarn s, -,.St i,t 1j), i sa�lr.,1-:"t4 Ct.r at:'i, :�Ai(t1Ni ir.r+1 .+nti ;___ kt.:�l•,rd: sr Pr"irnlee.('rtte!:v ------ S01, 7. 1l6.15 1 R,r;n; Bout S;etn+ns. I.?-]:'L: - �c; h'e::!'t:, "m\,fr, . Pc.,.Canit;•i ,.ort .11.11____ ._ .... __ ..- ..___ __ _ r, IUMU:�All h1,t+t ,,it COT 1,1-I.')ti,m o TIME/1 EIVIPERF T TIRE CONTROLS - ' - -- a.::: t. .i' k'..+:.::c :.;,:r t_•:,±erc ,i..i a.: 14 i I Pea r Cookie Toam ntnPutet,in* i ` ILS!4Cttr:p' 4ei:Ise t �1 !,5 e� . , :.":.i` t "kJt,bilb'ti{q,,}t, tQt t II•S _ ._.._. ,__ -.. .-...,._.__.- __ - ___ _. .1....1.11_ .__. -_. .. i -_- — s":, - o- . _ - __ _ - ,P�, CA'' .tw:to -:..:.Il.� �ir=..::.� Pt.Pit. , ,- .. .. .. ... ,.. C',E;". •'.r.�°i e'.:i. .. .b i i • ,` :'; • . `, I r..,, -r \A. ,.: _._._ __. -.> tr:,,�-- +::vu.•rraj tsirr.ctt oj,•t'..cn;;, .,t. �fC !\: I S:eP;... , ^nt'n11sn,Fssit. ;drat. .._ ,!:r'; t;a<t;t i?\.. 3nn', •..ia'<' ,a., .du•. �� i r1.2tY. e :Pe for r1:.4 n , ry t;l s.i;<t.. +it.r:n-al�.- Sr- }1?:tin:-•S�andin;; C�i�. ,, a:.i„.;,:-r-. ct '. ,.. . . ::�:r,.h f. . , ... .. . jlq�,' _ _ _ ... . 'r:< . .,� .. 4r::t,� .. . , :d '.'.n-i-:r! , r,'d.,.. c•r:1, .1 i.:i,t', i.•)mq.,J Ldi.�Pu'., d "'I 1,0 r: ,..rJ ;.r[ c . „_r . .. .. . , . .• S)..i s}'.;- .,rat 1'r , : -. - �r. Pr,fCtice=s . .,t'� ii• CY.ii qlr• L't,?':,cG i�4itrn. ,•i ?SCp: ftP'h- {;r.G.• ;i��.tat:, __ +93y±::x•1,3:.6='?o:"nt" _ __ -_- _...;_- ;'.. of PHFs...s �Fr7.Ki P'V,.^f,.i t(. -3 _ 1:-- ,K , Pru}ter Cooling _. r ` r `'rj I ".1\ _. 1 Ct,I44w G,?,,(I bnn'. 71;'1 iVuhtn ' l:o;+r:.,:ci 7-rrrrr /'}'i' - - - t.:.1 ^P;:S Pti:;t61_n.tt-i„a!, � 7s �c..; .,:a<.r_:,:'_,,; !_t:_nc[._;:; �r i- r. .. ?S Pitt• ade .r:,.ion.• , i'.nt}'rt an:re tt!:-r�:hrxn�u';"i'�d5 t� � '��_ - 1-•'if1II, . _--_ -_ _ -_ ._ _ - _ }�:,.ar.. .vt. ,...... ,,.�. .,... ;I':n R' a h'. ,lo-- •�,. I CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH 120 WASHINGTON STREET,4"FLOOR 11 �1CH t1'1 rrwve.r.omm .r.om TEL. (978) 741-1800 Fax(978) 745-0343 HIMBERLEY DRISCOLL kamdinasalemxom LARRY RnMAN,R�/Rrrrs,cr 10,(IP-PS MAYOR FbArn I A(; N'1' This Form will be collected during your next Board of Health inspection. QUESTIONAIRE — GREASE TRAPS 2012 1. NAME OF ESTABLISHMENT: "14-"C2 Ad 2. ADDRESS OF ESTABLISHMENT: 2 3 70 V947* 1 3. DOES YOUR ESTABLISHMENT HAVE A GREASE TRAP? '1 Poi 4. WHAT SIZE GREASE TRAP DOES YOUR ESTABLISHMENT HAVE? CAPACITY IN GALLONS % O 5. HOW IS THE GREASE TRAP MAINTAINED? ON A DAILY BASIS? BY AN IN-HOUSE PERSON OR BY AN OUTSIDE CLEANING SERVICE? 6. WHAT IS THE FREQUENCY THAT THE GREASE IS REMOVED FROM THE TRAP? 7. WHAT IS THE NAME OF THE FIRM WHO REMOVES AND/OR PICKS UP THE GREASE FROM YOUR ESTABLISHMENT? 8. WHAT IS THE DATE OF YOUR LAST INVOICE FROM THE REMOVAL FIRM? S4A4 )-0lZ V