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CAFE KUSHCO - ESTABLISHMENTS t4�e tc�lhco 126� war,4�ryt�n i}��tl- _ __ _ ___ ___.__�__._.,�.__. ___.____ ___ __ ____ __ _ __ ___ __ __- _ _ � �niversai one� www.myuniversalop.com phone: l-800-756-4676 UNV16162 � � � � � � MADE IN U&1 . . . . . � - -----..._ � _� G� 0 _ _ _ _ _ _ _ __ _ __ _ I� \��.n4m` Massachusetts Department of Public Health Salem Board of Health 120 Washington Street,4'" Floor Division of Food and Drugs Salem, MA ,01970-3523 FOOD ESTABLISHMENT INSPECTION REPORT Tel. (978) 741-1800 Fax (978) 745-0343 Name Date T of O eration s T f Ins ection G - - ,� Food Service outine Address Risk ❑ Retail ❑ Re-inspection Level ❑ Residential Kitchen Previous Inspection Telephone , � ❑ Mobile Date: Owner HACCP YM � Temporary ❑ Pre-operation ❑ Caterer ❑ Suspect Illness Person in Charge(PI Ti ❑ Bed&Breakfast ❑General Complaint Inspector In�l•,� rmit No. ❑O her�P Out: Each violation checked requires an e lanation on the narrative page(s) and a citation of specific provision(s)violated. � . Non-compllance with: ". Violations Related to Foodborne Illness Interventions and Risk Factors nnn-Cnokin9 ronaeco. Violations marked may pose an imminent health hazard and require immediate corrective 590.009(E) �590.009(�� action as determined by the Board of Health. ,h � � - . - � 0�OOD_PROTECTION MANAGEMENT ��. _ .: __ � � � ❑ 12, prevention of Contamination from Hand �,1 PIC Assigned/Knowledgeable/Duties / ��3. Handwash Facilities EMPLOYEE HEALTH - y��""�� --- - ---� `--- �PROTECTION FROM CHEMICALS �`�� ' ' "'�'f�� ` ❑ 2. Reporting of Diseases by Food Employee and PIC ❑ 14.Approved Food or Color Additives ❑ 3. Personnel with Infections Restricted/Excluded ' QV �15.Toxic Chemicals FOOD PROM AP_PROVED SOURCE� �• h� ❑ 4. FOOd and WatBf from ApprOvBd SOufCe � 77MElfEMPERATURE CONTROLS(PoteMlally Hazardoua Fooda) ❑ 5. Receiving/Condition ❑ 16.Cooking Temperatures ❑ 6. Tags/Records/Accuracy of Ingredient Stetements ❑ 17. Reheating ❑ 7. Conformance with Approved Procedures/HACCP Plans ❑ 18.Cooling PROTECTION FROM CONTAMINATION , •�;.a , ,., O�19. Hot and Cold Holding � _ . . _. . , �. ,, : ��-8. Separationl SegregatioN Protection ❑ 20.Time As a Public Health Control I ❑ 9. FOOd COfIt2Ct SUrf8C6S CI88ni�g 8�d Seflitizifl9 . - CREOUIREMENTS POR HIGHLY$USCEP7IBLE POPULATIONS(HSP_).' ❑21. Food and Food Preparation for HSP ❑ 10. Proper Adequate Handwashing ❑ i l.GOOd HygiO�iC Pf2CtICeS� . � �ONSUMER ADVISORY. _� *. � �� /l�[_�22. Posting of Consumer Advisories v' ' 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 Rlsk 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 705 CMR of Health. 590.00Offederai Food Code. This report, when signed below C x by a Board of Health member or its agent constitutes a� 23. Management and Pe�sonnel (FC-2)(590.003) order of the Board of Health. Failure to correct violations 24. Food and Food Protection (FC-a)(5so.00a) cited in this report may result in suspension or revocation of 25. Equipment and Utensils (Fc-a)(59o.00s) the food estabiishment permit and cessation of food 26. Water,Plumbing and Waste �Fc•s��eso.00s� establishment operations. If aggrieved by this order, you 27. Physical Facility (Fc-s)(sso.om) have a right to a hearing. Your request must be in writing 28. Poisonous or Toxic Materials (FCa)(5so.00a) and submitted to the Board of Health at the above address 29. Special Requirements (eso.00s) within 10 days of receipt of this order. 30. Other DATE OF RE-INSPECTION: ��_� $-` I s�,�Fa�,4 a= - ` �c�l �.�cwv�@-� a�.�'`l'�-e �2�-�n � � ° ' Inspector's Signature: � Print: PIC's Signature: Print Page�of�ages ,, _ __ ..,. -. . � ,� r^ „y� . .- • t .. , . a ..._ .n . '� .• • N, ��.R �}n9. . '�.e _ . r .. �rd•,.J:...-.-a , . � ,� r..,�_. . .. • i _.. -. Violations Related to Foodborne Illness � lntervenfions and Risk Factors(ltems i-22) pppTECTION FROM CONTAMINATION FOOD PROTECTION MANAGEMENT x Crass-contamination 1 590.003(A) Assia mentofRes neiBilit * 3-3Q2.L1(A}(I) RawMimalFoodsSep�ratedham Cooked and RT'E Faxls* 5')0.003(B) Dem�nsvation of Knowled e� Contamination irom Raw ingredients 2-103.11 Pe[son in ehar e-duties 3302.11(A)(2) Raw Animat Foocis Separated hom Each Other* EMPLOYEE HEALTH Confamination lrom the Emrronment 2 590.003(C) Responsibility Qf.thc petson in chuge to 3302.11(A) � Foai Vrorection* require reporting by fiwd employees and 3_302.I5 Washin Fruits and Ve etables a licants* � 3-3(M.i l. - F�od Contaa�witl�Eqoipment and 590.�03(F� Responsibility Of A Fc�cl Employee Or An � rtpplicant To Report To The Person In , Utensils . . � Contamination lrom the Consume� Chai e* . 590.003 Bj Re Nn b Pecson in Char e* 3-306.1�(A)(B) Returned Food aud Reservice of Fuod* 3 590.003(D) - EzclusionsandRcstrictions* p�sposdionofAdulteratedorContaminateo' Food 590.OQ3{P.) Removal of Exclnsione ancl Restrictions 3-?Ol.l l Disuudiag�or Rew�ditioning Unsafe FOOD FROM APPROVED SOURGE r�� q Food and Water From Regutated Somces 9 Food Contact Surfaces � - 590.Q04(A-B} Compliance with Food Iaw�` 4-501_11 t. Manual Wazewashi.ng-Hot Water � � 3-2Di.12 Fcmd in a Hennetically Scaled Container* Sanitization Te rafures'� _ mre 3-201.13 Ftuid Milk and Milk Re�ducts* 4-SU i.]12 � Mechanical Warewashing-Hot Water , 3-202.73 Shell E� s*� � S9nirization Tem eratures*- � � 450 . llt4 , Chemical Sanitization-te 3-202.14 E s and ivfilk Produc[s,Pasteurized* � mP•�PH� � 3-202.16 ice Made From Potablc Urinkind Water' concentration and hazdness. * � 5-lUl..l.l �Drinkin� Water Ymm an A roved S [ent* 41i01.,l 1(A) _ . Equipment Food Contact Surtiac�es and� �- 59U.006 A) Botded Drinkin Water'" � Utensi(s Clean" � Sy0.006(B) Water Meets Standards in 310 CMR 22.Q"` �-602.11 Cleanin�Frequency of Equipment Feiod-' Contact Sudaces and U[ensils`� � Shel/fish and F'rsh From an Approved Source 4-7Q2.11. Frequency of Sanicizztion of Utensils and . 3-201.14 Fish and Recreauonally Caught Molluscan � - Fouii Co�tact Surfaces oPE i�ment" � � Shclltish" 4-703.11 Methals of Sanitization-Hot Water and� � 3-201.15 Molluscan Shellfish from NSSP I,isted Chemical* Sources* ip proper,Adequate Handwashing � . - � . Game a�d Wild Mushrooms Approved by p-301.71 � � - � Clean Condition-Hands and Arms"'.- Re ulato AuthorR . � ' 3-202.18 Shellstock IdenNfieation Present"` 2-301..12 Cleanin Procedure* 590.OQG(C) Wild Mushrooms* 2-30114 When to Waeh* , 3-201.17 Game Animals* � ll Good Hygienic Practices� � � " � g � ReceivingtConditlon . 2-�101.11. Eatin ,Drinkin or Usin Tobacco* 3-202.11. PHFs Received at Pro er Tem eraNres* 2-401.L2 Discharges.Fromthe Epes,Nose and 3-2U2.15 Packa e Inte it'" Mouth* - 3-I Ol.i l. Fooci Safe and Unadulterafed* 3-301.12 Preventin CoutaminaCion When Tastina� ( Tags/Records:Shellstock �Z Prevention of Contamination from Hands- � 3-202.18 �Shellstuck Identification * 590.(HW(F,) Pieventing Cuntaminaaon from .� 3-203.12 Sheltstock Identification Maintaineci* Em lo ecs* � � � � � TagslRecords:�Fisb Products la Handwash Pacilities � � � Conveniently Located and Access�ble � � 3-402.11 �Pazasite Destmction" 3-4O2:12 Recrords.Cceation and Retencion* 5-203.1 t . Numbers and Ca acities* 540.U04(77 Latieling of Ingredients' �-2(W.11 Location and Placemen[* . q �- Conformaace with Approved Procedures 5-205.I1 �Accessibili .0�eratian and Maintenance /HACCP Plans Supplied with Soap and Hand Drying 3-502.11 S eciuliud Processin Methcxls* Devrces 3-5Q2.12 Reduced ox en acka 'n�.criteria* � � 6-301.1�1 � Handwashin Cleanser,�.Avxilabilit 6-3Q1.12 Pland D ' �Pro�ision 8-103.12 Confoimance with k. rovael Procedures" . *Uenotes ciibcal ieem in ehe Fe�eral 1999 P�f Caie ur!OS CMR 59QIX)0. CITY OF SALEM BOARD OF HEALTH Establishment Name:C6D9_f-�)_<'- krA Date:jQ_:'a_o--)/ Page: cq�_ of Item Code C-Critical lt�n DESCRIPTION VIOLATION/PLAN OF CORRECTION d/ Date No. Reference R-Red Item Verified eA 0 PLEASE PRINT CLEARLY + 11VUX A I L 0 AJ L�4' I 9MO� 2 k)o 0 rn f4 Q 0g1J_'A (1-ZA11 A 0_j- aim "&Lmd Odp\ C �S-eN i\ A vo, a A'-1_S)F'_h '/y V t -sq- 0 5-: 4 (I f�_f�SA oAJ— Pic, d A/\ I-A'A APA10 91 modiz)-k AIIA _64 -4. L ?I(_ /_AA —It U 6� I - Discussion With Person in Charge' C®rre IS Act- equired: o No Id fog I have read this report, have had the opportunity to ask questions and agree to correct all voluntary Compliance 13 Employee Restriction Exclusion violations before the next inspection, to observe all conditions as described, and to Ll Re-inspection Scheduled El Emergency Suspension comply with all mandates of the Mass/Federal Food Code. I understand that noncompliance may result in daily fines of twe y-fly doll r suspension/revocation of 0 Embargo Lj Emergency Closure your food permit. Voluntary Disposal LI Other: � �I �. _ -- �� . � � 3-SOl.ld(C� PHFsReceivedatTempermures . Viodaifpns Reiated ta Footibunre lliness inter✓enFtons and Risk � , Acccxrding to Law C�o[ed to - c Faetors{ttems�!-?2} (Coat.I dt'LY45°F Within4 Hoiiss.* 3-501..15 Cuo3ine TvSethocis for PHFs PRf?'CEEGTIOtd PftQM GHEMICALS 29 �taF ktot and Ca4a t3olding 19 Foatl or Co{or Additives t6 S-Spi.36(B) CddPF3Fs4iainminedatorbeFow 3202_Y�ditives* - 594.00d{FI �I'/45°F# . 3-342.24 Protection from Un ;rmed rldclirioes� 3_SOi.lfi{A} � FIot PHFs MtiataiTaed ai�or a}wve pg PWsonousorToxicSubstences _ . r�� 7-10t,i1 Identify9nglnfozmuion-Original 3-501.f6(A) RoascsAeldazorabuvei30'F. * Cont¢iaen° � 7-30211. Caxnouuat�Arazne-48orkin Concainerc* . . Time es a PubBic 6ieatth Con4roi x 7-201.!1 Se aration-Strna e' . 3-SDl,i9 Time a�a Publac I�IeattU Cnntrcil" 7-202.11 .Restcicifan-Presenceand�Use° � - �gQ•�� VarianceRe uirement �� 7-?02.32 Conditians oCliSe� - � - 7-2D3.11 'Tozic Cattainers-Pmhibidons" ��'�tUIREAdENfS F�R HtGHi.Y SUSCEH�T181.E � 7-20�t.1 t Sanitiztrs.Criceria-ChemicaEs' i�aPULA770N5 ti�P 7-2{kf.12 Chemicals fru 63*ashin Yralmx,Ctiteria• 21 3-801.17(A) Unpasteurirxd Pre-pack�nged Iuices aud 7-20�1.14 �n nts.Criteria° . . .Bevos�aires with R%ncmna Labeis* � � 7_a45.11 ficidental Food Cwrtaix.Lubsioants�' s-sai.i its -u�o��8ste,�;��fiffas" . � 7-2U6.11 Restricted Use Pesticides;Criteria� 3-801.11(i)} Rew or Partially Cooked Anima7 Food and � 7-306.I2 � . ftadenf Bait Stations* RaR Seed S . tts Not Sesved.' f 3-8(31.1 f C Un ned Fani Pack �Not Iie-servec4. " 7-2i}G.33 Treckiag Yowdcrs,Yer,t Canuol and �� Monitcrrin " . � CONSi3MEi$ADVi.�'sOfiY ' TtME!'FEMPERA7IJRE CONTRQLS 22 3-ti0:§.S 1 Consumer Acivis+m Pasted frrr C.onsumprian eif I�i' 16 � PropEa'Cooking Tampereiures for Animal Foods'11iia(xre Raw.I3ndetrooked or PHFs Noz Qtherwise-PmceSsed w Elitnixuau 3-40i.11A(i}f2} Eggs- 155`F IS Sec. p�7O'�'*�� E �s-Immeciiatz Serr7e;e i45°F15sec• 3302.13. Pasteurizec3 E�,s Subs[itute f�Raw SheIl III� � > I, 3-0�I.I l{.Pi)(2) ' � Cunmtinuted Fish.Meats&.C.ame . � P.nimals-155°F IS sec." r,apEC1AL REQtlIRE[NEN75 3-R61.11(B)(1)t2) Porl:and$eef Roast-130°P 127 min* i`r 59D.004{A}-{D) Vioiations of Section 59C?.4(19iA)-(D)in 3-401.11{1l)(2) Ftatite:�3njected A4eats-lS:i°F 15 sec • cateting,mobile[cmd,tcmparary and I� 3-4()1.1 kA)(3) Poultry,Wild Game,Stuffeai PHFs, residenhal kitchen operations shouid be Stuffing Cornaining F'uh,A4eut; de6sted vnder the appcapriate sections ; Ponl or Ratites-7G5'F t5 sec * above if related to fc�odtwrne illne:s I � 3-�DI_ii(C)(3) Whole-muscle,lutact Beef Steaks interventions and risk factors. 4tlier � 145°F* 5411.049 violations retaling to ga�d retail °` 3-401.12 Raw Animei Fa�s Cooked'm a praerices should be debited under#39- Microwave t65°F* Special Reguirements. � '��r, 3-401:11(A){i){b) Al3 Ot6ec PHFs- i45°�1�5 sec.'� 't 17 R�heating 6or Hat Molding YdOLA�ONS RELkTEES TU GDOD RETNL dTR4CTlCES � 3-363.i 1(A)&{D) PHF� 165°F 15 sec. ' {Itet�23-30) � 3-4�3.11(B} . Microwave-�Ib�`P 2 Minnie Standing �Gruical,ar�d non-critical veqlations, which do nat relnte to the - �� Ti�* � � � f<wdb�rne illrseas intarventiarss wul resk,fiutors liste�3 abai•e, ccvr�be 3�D3,f l{C) Con�meerciatly Yrocessed RTE Faoti- - jaund in ihe fo7towtxg seczions�aF fhe Food Code m+d 105 CMR z4qn� s�o.aao. 'E � fterrl ! Good Aetatl Ptactices .FC 59D.DD7I-j �, 3�U3_II{E} RemaininglinslicedPortitmso£Peef - � � �� Rrnasts" �. ! _Manaqement an0 Persairrel �-FC-2. .0�3 - ��i l8 Prope�CoWing of PHFs 24.. I Food 2nd��i RraYection I FC-3 .044 � ( 25. E ui ment and Utensiis i FG-4 .COS I ' 3-�41.i4{A) CnotingCookedPHPsfrom3A(3`Fto I�, Water.PicimbinaaMWaste i FC-5 006 --; ..,` � 70°F 4S'it4�in 2 Ha�rs and From 70`F 27. - � Phvsicai FaciVity � FC-8 � � .6D7 � .� to 41°P/45'P��ithin 4 Haurs. * 1 28, �Poisonaus a Taxic Materiai� ! FG-7 .068 . ; :� 3-SOI.l4fB) Ca�iing PF[f's hlade Ftam Ambieni �� Special Requiremems • � ,009 '± Temperatnre Sngru}ienta ro 41°F/45°F ' � I 4thet ' -� i H%ithin 4 Htwt:s'� s::vofo�t-zc: *Dern�rr.s critica:ivm.in the G,-d��ral 1999 Fcm.�Cale w�Sp5 GNf::9(1.090. � :f r � CITY OF SALEM BOARD OF HEALTH Establishment Namej'A Date:10 —2(()—( 1 Page: Of INtem Code C-Critical[to DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Onto Relerence R-Red Item PLEASE PRINT CLEARLY Verified r (D Y-virV f)rAlm =6 61 - - L 4*_b� IPIEI_k��t 0 I A KP A VQ0A _+n f)0 A OAM_.n",,0 A A-,IJA a (3 Q I 044.3-7 (d- �7,40 —4,10 11 �Y_lk - C c,':A AJ InA A n��) &P PA"9 ;Kp' V%0 V�A u-,�\ K-m+ — vvotir- ��A PL-)adA- Rac4,vp [—D—iscussion With Person in Charge: 7orreocuve Action Required: (3 No Q'�-Ies V I have read this report, have had the opportunity to ask questions and agree to COIRICA 8111 Voluntary Compliance Q Employee Restriction Exclusion violations before the next inspection, to observe all conditions as described, and to 0 Re-inspection Scheduled Q Emergency Suspension comply with all mandates of the Mass/Federal Food Code. I understand that noncompliance may result in daily fines of twen W-five ollarsorsuspension/revocationof o Embargo U Emergency Closure your food permit. ZZ U Voluntary Disposal Ll Other: ,. - 3-SQI,i4(G� PHFs Receiued af Tempe�ature.c . Violsi6ons Retated io Faotlbarne llJness fnterventions ana RlsJc Accouiin�co Law C:oq[ed to - ! factors{ltems�t-?2) (Cont.1 d£aFY45°F Wittriu4 Hoius.* - P1iOTEC7'!ON FRQhI C}iEG41CALS 3-501..15 Coolin Methods for PHFs 14 . . . Pootl or Color AddKives � . Ig .� S'HF Siof and CatC HWding 3-50t.i6($) Cold PI�Fs hiaintnined at a below 3202.12 _�Additives' _ � 59Q.00d{Fl 4i°t�5°F� 3-302.1d Frotection fratn Un rovcd tldiliti�es'} gg Poiisonous oc Taxie Sube4enees . 3-50 t.ifi(A} Hot PHFs Maintasned at�ur aEwve 7-l Ot,i l Idemif}ing Info=mation-Ori�inal r�� * 3-S�i.f6tA7 RoasrsAeidatorabav�t3�'F. ' Containers* 7-102.1 i. Crnnttron n`ame�-Workin Coniaiuere* . �o Time ss a Pubiie Heai4t�Control 7-'_Ol.i I Se azatiou-Strna * . 3-501:19 Time aa a Pubtic Healtti Cnncral* �� 7-202.11 ,Restciction-Ptesenc�eand�Use° � 596.{164{Aj Varianc�eRe nirement -� - �,, 7-202.12 Conditions of tiseff REQt71REMEdFT'3 FOR HtGk6LY SUSCEf'TIB�E �'�f 7-203.t l T�ic Cattainers-Pruhibitions* . - 7-204.I I Sanitiurs.Criuria-Chemica(s' �QpULA77QNS N�P 7-2fM.12 C7temicals frir�Vashin Producx,Ctitexiai 21 3-301.1I(A} � Unpasteuiv.e<I Pre-packaged Iuices atu! 7-20d.1� 'n ents.Criteria° :Severasec+xithA%arvinatabels*` . 7_�g.i l ficidental Food Ccmta�,Luhricants* �-8a1.i l(9 Use of Pasteurized B * - 7-206.11 �Restricted Use Pestieides;Criterin� � 3-�t77..11{D} ftaw or Partially Cook.ed Aaintal Faod and a � Raw Seed S � rts Not Served.# � '-206.I2 Etadene Sait Stations* 3-801.12 C Un ned Fcwd Pac �e Nnt Re-sen-ed. ' i�� 7-?Afi.l3 ?racetdng Powders, Pesr Cpntrol and . � Ivtonitcxin M CONSUMER AQVISOflY TlMEJTEMPERATURE CQNTROtS 22 3-503.11 Consumer:Advisory PoStel for Consnmption of � 3� proper CooBdng Temperaturea for Aoimal Eu'acls Tttat are Raw.Undetcaoked or i PNFs Noz 4therwise-E'rvc�esseQ w Eliminate ' 3-401:SPA(t}f2} Eggs- tS5`F t5 Sec. �a�O��.#��"�� ? �E -.immediatz Senice 145°FtSsec* 3-3Q2.13. Pasteurized E+�s Substitute f�Raw Sheil 8 ' � 3+4QLFk{A)(2) � � Conuninuted Fish.Meaats&C'rame � y' Animals-155°F 15 sec. * 3-001.118){1}(21 Pori:and Bce£Roast- 130°F t21 mio* ^sPECdAL REflU1REMENTS 3-4Ql.l I(A){2) Ratites,tnjecied n4eats-155`F 15 590.004fA}(D) ViolaYions of Section 59Q.009(A}-tD)in ' sec." es[ering, mobile[cmd,temparary and 3-40111(A)(3) Pau[try,SVild Game,Stuffed PftFs, residentiat kitchen ogerations shauid be S Stuffm�Coutaining Fcsh,Atieac, deblted vnder the appropriate sections p Poul or Ratices-165°F 15 sec. * above if retated to faodt�rne il tness � 3-901.11(C}{3} Whdfe-mascle,intaet Beef Steaks interventious and zisk factors. 4ther f 145°F a` 59t3.009 violations retating to gaxl retail � .� 3-401.12 Raw Aaimal Fa�s Caczker!in a . practices shotild be debited under#29- F Micruwave 165"F k Speciai Requiremenis. 3.d4Y:ll(A}(1}@} �p pf6er PHFs-345°F 15 sec.f ; i� Reh�tlng frn Hat Hotding V10LA77ONS RELATED TO GOOD RETi4IL PRAC7tCES ` 3-4t73.11(,1)&{l3? PHFs 165"F lS sec. * (Items 23-30} , 3-4E13.11(B) . RRicrawave-�I65`F 2 Minute Staneking �CriTicai,arrd non-crrticat violarions, which do not retnte to tlu - � - Time* � � � fiwd6orne iJlness intervenrians and ris&.factors trstert aboce, azn�be 3-4(13.11(C} Cnmmercially Prtxessed R'F'E Fcacl- founrt in ihe fotlnn•ing sections.of the Food Cade urrd 105 CMR 140°F'% 590.OI10. 3-aU3.11(E) Remainiag linsticed Pmvaus af Beef i Nem I Gnad Rerait Practtcas ; .FC 530.000 � - �Roasts<` 1 23. '� tutana.qemenfandPars��el 3-FC-2 .o�3 - i . ,g � Proper Cooting of PHFs 24.� i Foa!and Food Prctection I FG�-3 A�i 1 25. E ui ment and Utensiis I FG-4 005 I � - 3-i41.14{A) Cooting C:�oked FFTFs from 140`F to I 28, W ater.PStimbinq and W asfe � FC-5 .006 � 7D`F`Nithici 2 tioucs and From 70`F 27. i �wsical Facietv i FC-6 007 . i i to 41`F/4S'F Within d Raurs. * i 28. ' Poisw�mus a Toxic Materials ! FC-7 .008 j 3-501.14fS) C�wling PRFs Made Ftum Mil�fent �� .�Spe.cia!R �iremems ! � .009 ' Temperamre Ingredients to 41°F(45°F � �� `� � , -- .,��I Within?Hrnrrs` s:.sye:,nx,.:�.;.m< 'Dem�tes critical i�m in tUe tederal i�7Y9 Ftx,��I Cain or lU5 C4IR:90D00. i CITY OF SALEM BOARD OF HEALTH Establishment Name:P'A�V'P_ L),Sh C?"�) Date: qr)— Page: of Item Code C-Critical Item DESCRIPTION OF VIOLATION PLAN OF CORRECTION Date NO. Reference R-Red Item ';Z�' Verified PLEASE PRINT CLEARLY 1NA4_,,k_A� _-2) ' �) ( 617� "',;g",I�A — Y\CJ QAA,01~ -YV" 'i 10 __i� 9 AA CL47) r, 0 P-1,r'Pl"a-4 9,4 ". 01-N L/V\ a4 /,_N T2 iV 4) (0 - JP 1?Djj OP "�Z� -I%� /. I ' -') --ro a t— 6r ('_� 1.4 A A 17V 01,1/v\ )rl'�' ry C;� 0 0 Discussion With Person in Charge: c7ec Ve "es orre.11' Action Required: 0 No Vol, I have read this report, have had the opportunity to ask questions and agree to C011EICL clil Voluntary Compliance E3 Employee Restriction Exclusion violations before the next inspection, to observe all conditions as described, and to 0 Re-inspection Scheduled Ll Emergency Suspension comply with all mandates of the Mass/Federal Food Code. I understand that noncompliance may result in daily fine f t t .�fi�ed_�ars or suspension/revocation of u Embargo El Emergency Closure ypur food permit. EI Voluntary Disposal LI Other: � . . 1 � ) � � 3-�pl,t4{C� PfiFs Receivzd at Temperatwes � Viodatians AeFated to Foatlborne ittness.l»ter�entlons arrd Posk . rlccotciiug co Law C�o[ed ta � � ` Faao�s(Items!-22} (Cant.) dt'F145°FBKitisi¢4Haixs.* PROi'EGTiON FFtOM CtiEMICALS 3`�1.15 Cc�olin Methods far PHFs g¢ , � - Footl or Go{or AddiGves � . lg �� PP1F Hot snd CWtl HWding 3 202.12 Additives*' 3-Sat.16(B) Cold PHPs biainYained at or below 54Q.00�1(F1 4i 145'F# 3-342.24 PrMectiou from IIna roved�lddi�ires� ' lg poisanous or Toxic 5u6stences 3-SOl.lfi(A} _ � Ho[PHFs Maintained at�or abos+e I SO`F. � 7-t0t,li 7cientify�nglnfocmation-Chigna! 3.SOk.t6tA) RoascaHeldatorabuvet30'ft' , �Cantainers'" - � Tim��s a Pubtic heaith Cantru! � 7-102.11. Cmnmon R'ame-Workin Containers* . .� 7?OI.I l S aration-Strna e* . - 3-50Y:19 - Time as a PublSc Healt4e Cnntrv!' ' 7-202.11 .Restcictian-Presenc�and-Use° - � �g�•�`��> VarianceR uirement � 7-202.12 Conditions of tise* REQtD9RE�AEPftS POR FBIGNLY SUSCEPTI�I.E 7-2D3.13 Tozic Caicaineas-Prohibirions* FOPUtATlONS MSP 7-204.11. Sssnitiurs.Criuria-Chemicssis° - 7-2tk.12 Chemirals f�r ti*ashin Pradu�,Crite�ia* � 21 3-8Q1.l l(A) I3ap:t,ttc�uized Pre-pnckagetl Iuices at�d ' 7-20A.14 . �n ents.Critecia'D .Hevenees with R'arnino-tabels'6 - Sr 2� 3-80'1.11E9 Use of Pnsiem-izeci Ea " � 7-205.11 Irtcidentai F�d Cunkact Lubricant5* 3-801.1 I{D} Raw or Parfially Ca�.ed Anin�al Fcad and 7-206.i 1 Restricted Use Pesticides;Criteriafi Raa Seed S �ts Nar Served* 7-?06.I2 Rnden[Bait Statirnas�' 3-R01.1 f C) Unn ned Fa�d *e Not Re-served. '� � 7-206.73 Ttaceiciag Powdeis,Pest Cotttrol and . � y Monitcnin '� CONSUMER ADViSORY 7iMEffE4dIPERATURE CONTflOLS �2 3-6t)3.74 Consumez:Advuoty PosteR3 fra Cansumption of gb Proper Caoldng Temperatures tar Micnal Fc�ods 1Yiiai are Raa-.Undercaoked or P�F$ Not Otherwise f'�xacesxd eo Eliminace � � �PaC�1V*ens.�`�m«>vc,�r;zm!r � 3-401.11A(1}(2) Eg„es- 155°F IS Sec. E as-Immediatz Sentix 145°FtSsec^ 3'302_13 Pasteurized��Substitute f�Raw SheII s- � ,� � 3-401.11{A)(2} � � C�mminuted Fish.Meats&Cram.e _ Animals-155°F 15 se�;.* gp��qg_REQUIREhiEN1'S 3-4Q1.11(B)(i}(2} poai:and Beef R�ast-130°F t21 mia� ��Ay_tD� yiolatians af Section .590.OQ9(A)-(D)i.n 3-4(}l.l l(A){2) Ratites,lnjeded A4eats-155°F 15 sec.'� catering,mobile[ood,temparuc�and � 3�-0{)l.l.t(A)(3) Paultry,Wild Grme,SNffecl PHFs, residenrial kitchen operations shauid be t Stuffmg Contsining Fish,htieat, dei�itetl und�t the appmpriate sectians � Paul or Rarizes-765'F t5 sec, * above if related ta fcmdborne iltness � 3-403.11(C)(3) Whole-maccle,lntiact Beef Steat;s interventions and zisk factors. Other 145°F� 59�.049 violataons re3ating to�axl retail , 3-401.12 Raw Aaimal Fau)s Ccaked in a practiees shottid l�debited under#29- Microware 165"F k Sgecial Reqlli[emeRtS. 3-d4'l:i i(A)(I)tb} A11(Sthcr PHFs-145"F TS sec.� � g� Rahesting for Hoi Hatding VlpL AT/t3NS RELA7ED'TO Ca0019 RETAJL PRACPlCES " , � 3�ll3:11(A)&{D) PHFs 165"F 1S sec. � {Items 23-36) � 3-4ti3.11($) . Microwave-�1b5"F 2 Minide Suwding �Criiicat,krrd non-crittcat viotations,which dn not relnte fo ihe � , Z'�� faodb�irne iltness intervenrians and risk facaors tisre�3 ab�ve, cars be � 3-A03.11(C) Consmercially Processed RTE Food- fourul ier ihe folluwing sections�of ihe P�od Code uird IUS CMR ��a� s90.tHN1. 3-AD�.I 1(E} ftemainiag linsLic�ed Pvraons of Seef . i ftem ! Goad Ratatt PracNces .FC 59iJ.00b �; R�sts„ 23. i Mana ement and Persw:nel 1�FC-2 .Q03 � � �---- gg Proper Conling of PNFs i 24.. TFood and Foai Pr4t�iion . FC-3 .004 i � ! 25. � EqvipmeMandUtertsils i FG-4 .005 I � 3501.14(A) Coating Cooked PHPs from 140`F[o ! p6. W ater.Piumbin erxl W aste 1 PC-5 .006 ; 70`P�`ithin 2 Hours and Front 70°F 27. ica�FaciN i FC-& .tE67 . t to 41`F145°F R'ishin 4 Haurs. ° i 28. � Poisonous w T+�ic Materiald ' FC�=7 008 j 3-561.14fE} Couling PHFs Made From Mtbient I 29 �[�i�Raqu'rremer�fs � 0�9 1 � , Temperamre Tngrulienir,Yo 41°F/45°F ' � i Other � � Wikhin 4 Htwrs" s:.aes�„so.;.c. i . 'Dern,cea uiiicai i�.nx in the federi 19°9 Fti�l Caie a'10�G41R:90.4p0. � 7 � i � , - ^.. , , . . . .. . . ,. . ,, _ . , � ,.,. - ,.. .,.� . ;+.. -.. . .. , ; , ; '. — -a e � M1SS8ChUSettS D@p81'tm@Ilt Of PubliC He81th sa�em eoard ot Hea�tn 120 Washington Street,4'" Floor Division of Food and Drugs Salem, MA 01970-3523 FOOD ESTABLISHMENT INSPECTION REPORT Tel. (978) 741-1800 Fax(978) 745-0343 Name(0 � �, Date T of O eration s �e of Insoection �,K.Q� Ci �.-o�l - ( Food Service [�'Routine Address I l,�' � r„ _ p_ , - C��.., p� Risk , ❑ Retail ❑ Re•inspection �s .wv��.e�-tr", iititl �.tJ� Level ❑ Residential Kitchen Previous Inspection Telephone ��(, � � ❑ Mobile Date: LS Owner HACCP Y/N � Temporary ❑ Pre-operation �-'�;1�� ,(� �-^,� p,��,�, ❑ Caterer ❑ Suspect Illness Person in Charge(PIC) �� U Q�. _ p /� . 0 Time ❑ Bed&Breakfast ❑General Complaint ��-t�Ct��'.J�4-Ctrl,Ii�.-• In:'a;�/ ❑ HACCP Inspector � Out: � Permit Na. ❑Other Each violation checked requires an expl n' tion on the narrative page(s) and a citation of specific provision(s) violated. 9• � Non-compliance with: Violations Related to Foodborne Illness Interventions and Risk Factors nnti-Cnoking Tobacco ,�,� Violations marked may pose an imminent health hazard and require immediate corrective sso.00s(e) ❑ s9o:oos(F) U action as determined by the Board of Health M'�' ^� � 0�� -�� FOQD PROiECFION MkNA6EMENT""�'� k „�.,�;�„m ,.�<a.�,�.,��.�.,,� ❑ 12. Prevention of Contamination from Hands ��7t�..1. PIC Assigned/Knowledgeable/Du6es �/ ry fi a /� �J 13. Handwash Facilities � EMPLOYEE HEALTH - ` U�'y . . ❑ 2. Reporting of Diseases by Food Employee u �� IX�_" "' j pR07eCT�ON FROM CH�MiCA�S'�"° �' ` 'm ' ,,_�_. . a � andPlC "' vw..,s,: � i�ea ,� � �,.��. �' a>. ==,��a�_�,!.. T:�e�,� �,�. �❑ 14.Approved Food�or Color Additives ❑� 3. Personnel with Infections Restricted/Excluded � ,� ��15.Toxic Chemicals :,FOOD FROM APPROVEO 50URCEg` ��,n,,,. „� „s.n„�,.,„,,,,,,,�. ,,.y •� °'�TIME/TEMPERATURE CONTROLS{Potentially`Hazardous Foods) m� ❑ 4. Food and Water from Approved Source W = � �: s,o�_. . .s ,wa„ �_ ,..,_ »�. �_�,,m �u.�� ❑s 5. Receiving/Condition ❑ 16.Cooking Temperatures '"❑*6. Tags/Rewrds/Accuracy of Ingredient Statements ❑ 17. Reheating +.❑ 7. Conformance with Approved Procedures/HACCP Plans ❑ 18�Cooling ' PROTECTION-FROM CONTAM(NA710N""� m"`,'�'��"��a �:�'s �"'x� ❑ 19. Hot and Cold Holding � � - � � ._..�,�__ - . .:w.,;,aY�.�,.:�:� ❑ 8 Separation/Segregation/Protection ❑20.Time As a Public Health Control , ❑ 9. Food Contact Surfaces Cleaning and Sanitizing � l:��REQUIREMENTS FOR HIGHLYSUSCEPTIBLE PdPQLATION${HSP)� ❑21. Food and Food Preparation for HSP ❑ 10. Proper Adequate Handwashing _ ❑ 11. Good Hygienic Practices � -��._C�OySUME�i ADVISORY„� _, �4,e„,' a ,�,�,,.,,,,,m„a �„ �`�`"`� �"E ti.a..s m�-�.�,..�,�.,_ ` O�/�,22. Posting of Consumer Advisories Violations Related to Good Retail Practices Number of Violated Provisions Related ❑ Critical (C)vioiations marked must be corrected � To Foodborne Illnesses Interventions y- immediately or within 10 days as determined by the Board and Risk Factors(Items 1-22): ( of Heaith. 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,tlie•items checked indicate violations of 105 CMR of Health. � 590.00Offederal Food Code. This report, when signed below � ` � by a Board of Health member or its agent constitutes an 0 23. Management and Personnel �Fc-2��eso.00s� order of the Board of Health. Failure to correct violations 24. Food and Food Protection �Fc-s)(sso.00a) cited in this report may result in suspension or revocation of 25. Equipment and Utensils (Fc-a)(sso.00s) the food es[ablishment permit and cessation of food J�. 26. Water, Plumbing and Waste (Fas)(eso.00s) establishment operations. If aggrieved by this order, you 27. Physical Facility (FC-s)(sso.00�) have a right to a hearing. Your request must be in writing �� ' 28. Poisonous or Toxic Materials (Fc-�)(5so.00&) and submitted to the Board of Health at the above address � 29. Special Requirements �sso.00s� within 10 days of receipt of this order. 30. Otlier DATE OF RE-INSPECTION: � J��// sssa��aeciFormsiaax ( `� p I� I � , r^ 1�' � -E-�'I� Y� -Q1�QXt,"�.Q2(� � ��1'V�� i-r..G n Ins ector's Si natii�e: , (� Print: P g .��D .��rX6,l .�0� '�.1� � � PIC'sSignature: �! fl� Prinh �1� � Q'�„ . / Page��of�i-Pages \ l v /� � � d ' !► - � 4 Violations Re(ated to Fopdborne lliness � lnierventions and Risk Factors(Items 1-22) PRpTECTION FROM CONTAMINATION FOOD PROTECTION MANAGEMENT 8 Cross-contamination 1 590.003(A} Assip,nment of ResponaibiGty* 3-302.11(A){1.) Raw Animul Foods Separateci from � 590.003(B) Dem<mstration of Knowledge�� - Cooked and RTE Fcwds* � 2-]03.1 t Person in c(taz e-ciudes Contamination from Raw(ngredients � � � 3-302.11(A)('2) Raw Anirz�al Pocxls SeparaYed from.Sach EMPLOYEE HEALTH Other'" 2 590.(Hl3(C) Responsibility a[tk�e person in c�hatge to Confarolnation from the Envlrortment �requirc ceporting by faxt employees and 3302.11(A) - Pc�od Yrotection" � x �l�icants" 3-302.15 tiYashin Fruits and Ve �erables 590.003(,F) ResponsibiliTy Of A F<x�ci Employee Or An 3-30A.11 Ruad Contact with��qoipment and , . � A�7plicant Tii Report To 71ie Person In UEensils* � Char * � Contamination 1rom the Consumer 5'10d)03 G) Re�oxtin b Pecson in Char�e* . 3-306.14(A} B Retm�ned Pood and Re�exvice of Fnod'* 3 590.0(�3(D) ExclusionsandRestrictions* � DlsposkionofAdulterafedorConiaminated � 590.003{E) Removal of'Bxclusions and Restrictions � Food � . 3-701.11 Discxrding or Rewndi,6oning L,•usafa FOOD FROM APPROVED SOURCE H��* 4 Food and Water From Regulated Sources 9 Food Contact Surtaces � � 590A04(A-B) Com xliance with Food L.nw* A-541_I11 Manual Wazew;is6ing-Hot Water � 3-20112 Pcxxi in a HenneCicaily SealcKi Container" Sanitization Tem eratures* �- 3-201.13 Fiuid Milk and Milk&odoeCS* 4-50'1.]'t2 Mechssnical FYarewashing-Hot Watu 3-202.13 Shell E� s* � Sanifrzation Tem eratures* � � 3-20214 E«>s and Milk Prodncts.Pasteurized* 4-501114 Chetnical Saniti7ation-temp.,pH, � 3-202.16 Tc�e Made FrQm Putable Drinkin �WaterM � concentraCion xnd hardness. * 5-101.1] Drinkin Water from an A roved S stem" d�p�-�1{Aj Eqni�ment Naxt Contact Sorfaces'and� i9UA06(A) Bottled Drinkin Watcr'� � Utensils Clean* � 590.0(Ki(B) W'ater Meets Standards in 3 LO CMR 22.Q"` 4-602.1 l Cleaning Frequeney of L'quipment F�d- - C'untact�Sod'eocs and Utensilsk ShelilAsh and Fish From an Approv¢d Source � 47021 t Frequency of Sanitization of Utensils and � 3-201.14 Fish and Recreati<anally Caught Mollvscan Food Contact Surfaces oE E ui� mentm Shell4ish* 4-70311 Methc�sof$anitization-HotWaterand- 3-201.15 Molluscan Shellfish from NSSP I.isted Chemical* Sources� 1p Proper,Atlequate Handwashing Game and Wi(d Mushrooms Approved by y_3p1.1.1 � Clean Cunditi<rn-Hands and Artns* � Re uJafo Aathodt 3-20218 ShellstockIdentifieationPresent�* 2-3QL12 Cieanin Prexedure* 590.004(C) Wild Mushrooms' 2-301.14 When ta Wash� 3-201_17 Game Animals� � ��i Good Hygienic Practices �ti Receiving/Candition 2-401.11 Eatin ,Drinldn or Usin TQhaca>* � 3-20211 � PHFs Received at Pro c Ten� ecatuxes* 2^�01.12 D3sch�rge�From the Eyes,Nose and . 3-202,l5 Packa e Inte it '^ Movth* 3-101.11 i'ood Safe and Unadult�erated* � 3-30'L.'12 Pieveutin Contaminacion When Tastin " (� . TsgslRecords:Shellstock 12 - Prevention of Contaminatian from Hands 3-20218 Shellstock Identificarion M 590.004(E) Pleventing Contaminadon from � 3-203.12 ShelLstwk ldentifieation Maintainecl* Em lo ces* - Tags/Records:Fish Products 13 Handwash Facilities 3-402.11 PacasitcBe„stmcdon* . ConveNentfylocatedandAccesslble � 3-403.12 � Records,Creation and Retention* 5-203.11 Numbers and Ca acifies* � 540.004(J) Labeling of Ingredlents' _ 5-2tk1.11 I.oca6on and Placement* q � Conformance with Approved Procedures 5-205.11 � AceessibiGt ,O�cration and ivlaintenance � /HACCP Plans � - Supplied wfth Soap and Hand Drying �3-502.1 l. S ecialized Processin Methads* Devices 3-502.12 Reduoed ax en acka'n�.ceiteria* � 6-301.11. Handwashin Cic�ansec,Availabilit� 8-IU3.12 Confarmance wit6 A. roved Procedures* 6-301..12 Hand�D 'n� Provision - *Denoies rriticnl item in the tede�al 1999�onci Cate a'105 C�iR 590.000. � � � CITY OF SALEM BOARD OF HEALTH Establishment Narne:(?� �p 0 Date:a 9-- i I % P;'ilge: of --a Item Code C-,Critical fter-h DESCRIPTION OF VIOLATION PLAN OF CORRECTION -We NO. Reference R-Red Item Vefffied rl Pi.rASF.PRINT MIFAMY Y' C�A �Ak' "MI, o 1�"'�a".o'Rbj. �014 X op L"Alix �b J_ 0"§1 pA/A D- A, k/ 609 J;__� J A A.n 4�,)\ 1/1 ro.d �R-) 4-0) 1 I_J4 R Q I AY� C _h ),o J" I Ll--6 4 � i t�Al j 9),LZ_4')'P� \_1'1-3 1 000A �el,f 0) � 'j �J' 0A J 4- k&t ',' AVA�IA, A P"q 0, __A-1-/"1 A A 1_11PA RA N ,-,Lx� -iL4)A1Y OAA �—MoeC_ - ��,%AA t, V�, 0,4('A A) At\ VVI11k) �aAA 4 NO 0C _Ii,% O'A& 0 _AP A00 Aa..e )P—A 4�,& d eA_,j,'v\6-�M dPA'-' 6_1�lu N&elk C'tt f A A fi qv A-I T&Y A� _t t;Jj, YAL +AJAI� A 16117S_C� Corr ctive Action Requirdcf- Li No With Person in Charge: U 0 I have read this report, have had the opportunity to ask questions and agree to correct all (3 oluntary Compliance 0 Employee Restriction Exclusion violations before the next inspection, to observe all conditions as described, and to iCl Re-inspection Scheduled Ll Emergency Suspension comply with all mandates of the Mass/Federal Food Code. I understand that - noncompliance may result in daily fines of twenty-fiV�e dollars or suspension/revocation of Ej Embargo EI Emergency Closure your food permit. 0 Vol.untary Disposal Ll Other: 'f,--:;... P �i-�irl_14f(It Pt{FsRecefvedat'CemperaWces � Viofafions Relaterl to Faodborne 7/fness lnterven[lons and Alsk Ac:ct>rding to t,uH�Coqied to � ' Factors(tteMs t-2Z) �Cont) .,I'}745`F VWitl�in 4 Hom�s. * - PROTECTYON FROM CHEMiCALS �3-SOt.75 Cool,ioa+MethodstixF�H['s � —�-- 19 RHF Hol and Eoid Holding 14 Food or Colar Additives 4-Spr t6f�} Cotd PHh}Mninwineci at or belc+w 3-2f72_12 Ad��ii� +'' S90-{}S7,{F'7 41 �l�AS`t-.. 3��3Q?.14 PnRcclioi3f'ramUnappio�°zdAd�lifiYes^` - , -- � "�-5t31 I fi(:1j I i�t E Hf��4faintained at nr above ( (� P� oisonnusorToxicSubstances _�� aG T" x ----�,� � 7-(U111 t Luenufymg:atininanon-On�mai � -j�)i i6 A �' � � I C:c�iu,u r . � � . f ) ki ,�,N�cld a�er sbo�e Ii{}f; � �— -� �i I,tF � �T3me as a Pub3ic Fieafth Cont�ol �__ F � � �.�r -i.�2 (t ` Conm�rr 4amn Ro�k �ou i�zi r.�� I i - ---{-- .--� t 7 ?OL1I Se s n�ri �Sr„ a c �� - � . j_� ni as�[�ubfa�� h�atchCvnte.�t' -i �-P . --�.-.. � --� � )U'1�.YN� � V s�.�eRwuir�ncut � 2�O2.11 � Rs t-t� cn 1'r uncc v�� C c - � -.. _-.. _ -..__ ._._�:_�, _.__ . . _......� '� 7 ?0��_1� ( a,itiit an uFt.�� _ � ?�3.[i koxic C untaxne{ P oti'hi.��n � REQUfREMENTB Ft}R IitGMLY SUSCEPTI$LE � "Qd.l t Satutitei�, Ctixe i+ C1�cinic �t ,POPULA7fQNS{NS�_ � �� .� - �t 's-SO': 11t�.) linp ieura.edPc {, �' .ged3tnce,c�d 7�1 } Ch�nu�al.t<ir i� xchit� t oJi�t ( n�.raa�' i � �7�30:.id Di�u� # cntF Cni iis � — ' ��-�--�-_ Re� s e. iv[dt 4��tE�tni�Lab Is � � - ��--� �,U; {t�i3) L'ti � F e tc.ini � 3 t i �- � , � 05 1 t L�cid nt ai } xx1(�nt�ct L �b�i e i - �I- � -- � � - --� � 4ut i it 3� 1<.�ne ur Y2�(ai! C,K i, �7 Aniiaa} [ixn a iti � � J6.(i Ren�ii � a ;� t'r �i «Ic .C< [ i�r� i �- - �—� _ S }j i 5 d )t�R� `tia S�.rvc I i �� U6.iZ � T��,xl�t B i S�rinm i � E _� �. _ �� tiii I ( �(E � .1 �� t!�i �c t2 d E CeM i �� t�. [tia r: �,cnt:_ . ..� ��._C3K_7 �1 4� �,�id� F �.f turtr � i u�� ` ` . -.. '- _ _� _ _:____ � J ltiinRui„ .. .i ��._.__.. .,..____. ..___.,._. ....__._.--- CQN5t3hf�R �hC?ViSC}RY f'iFiA�lT�lU1PERA7URE CONTFtQLS �1 i 3 t>03 �� ' ,��u x t 1s� :sor� ��st-�l u�r t otz a��apiirx�ot ! �'— '� "'� .'—'t —•..._•.. ..'—. . --"""'--� � i Iii �. � tw� �tYdl !K ��x0. �41�Pt8"H'.cu�E . � � �6 y � Ptapdr Cook�ng iempe�aPures t�r � � ,. 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I . __^ .� _: , If7'.l} Y,; � 57�.� x .��i i�' ( _ �inrt,.: S[dn�t z,� _ .".�,� „ _.�:ta„ u,';i,�,zl ,<.=t==;+t�_ :u,r,h un r.,;t �..a.< . r.. I � � � �� l � ��r s . � S r1 I '�tt �� 1�` � l7 tr c ?,��c�� 5 .::ui C�!' . _.�...�._._�_. .� _. _""_ � ,��i'-�3.i�{{'t � ( �CI IiAln�\ l�ild.w.�tiri��f ��Ft- �?< J,.�_.t.�t[,� i >R��h'tC .. :2Rc'r <,tjS >d�t3i.E3 . � f oi.i � � �(��f�� U n<<� �� ,. ' ,... . .__ ._._.._.. .___. _ . , _ ' 4:;3.1 A.; � i< iarrt„L v.,eJ Pcxb� +.�t 13sx., � i }fenz ,�,n4cf Reta tPrxottc S _. _ KC 5 d-Lst7fi i �._.._ ��—.- . . � -�. �� ` 1 i�tnd4 T't t a�q f t » �- r C � C.,. , a �_ — 1 2" F��d d�azi Pr�ta <ee GC, v�� i f� � � . Prsspar£oa�ing ot pNF� � `2, .�i�n�Fei ar�Utea s � � �5 - , x 581.E1(tS) -�CtKEhn� C M�3. (dP}Il c(.-vm i +C7 f tc. �`�r ti - -- �� - � i _ � �. v^��.�.� RIi i-c,��s V_ a _ _ 7C.? _ � 7� E 1itYi;2liou r<<llr�r*� �i�r � "�l rh� �,Ea '�'�._ �C � �4,/ : ' 7 ; _ _._ , 9 F !,- U fii» Hai �3 '< sa �a r �x� r t �s G , t}�+-. � T..� ._...__--� — — ..�.. .. .- - � ,,:61.i�7 B7 ( C�c liu PiTf '�i ic 'c ;t ir �cient _ " or a i P<s r,.u�Y 6C• j . � � I j ` S' �n�.t.tartt li r�c.eie15� {i :�4$.F i �� <)<viF _ �r , _ .... __ ' ____ �' t.i�, indtl�nv.� ,.' .� - -----'--'---L._..�._'-----"----'-----� ` I)- � . r-s�u.9i� .�� ..�i,.hc IYJyP<xxlt tY,�• y(,•r +� �r�.��:i:.. 0128 WASHINGTON STREET Caffi Kushco City of Salem FOOD SERVICE ESTABLISHMENT - FOOD SERVICE Inspection HACCP: El Item Status Violation Critical Urgency 'Telephone: PROTECTION FROM CONTAMINATION 978-745-6996 Food Contact Surfaces Cleaning and Sanitizing FAIL Critical RED Owner: Comment:Sanitizer available was too strong.Provide sanitizer of proper concentration(50-100ppm)at all times. ' Mark M. Stafford Violations Related to Good Retail Practices (Blue Items) 'PIC: Equipment and Utensils FAIL Non-Critical BLUE Darya Stafford Comment: Right freezer in back has broken lid. Repair freezer so lid closes and seals properly. Inspector: Other-See Notes FAIL BLUE Elizabeth Salandrea Comment: Owner's ser"afe certification has expired.Inspector will give PIC information on upcoming classes; PIC must register Date Inspected:Correct By: to re-certify.Owner registered to take course June 16th 2009; please bring copy of certificate to Board of Health when obtained. t 4/2112009 'Risk Level: 'Permit Number: BHP-2009-0347 'Status: SIGNED OFF #of Critical Violations: Time IN: Time OUT: Urgency Description(s): I BLUE: All other violations noted in the 4/6/09 inspection report have been corrected. 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 Ge,oTMS@ 2009 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts Rev. Apr 22,2009 Page I of 2 > - - �Y ' Item Status Violation C�itical Urgency RED: _� - -- _'1 Violations Related to � Foodbome Iliness Interventions�. and Risk Factors (Require 1 immediate corrective action) City of Salem Board of Health 720 Washington Street,4th Floor SALEM MA 01970(978)741-1800 GeoTMSOO 2009 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Apr 22,2009 ) Page 2 of2 � Commonwealth of Massachusetts �; , i�►s � City of Salem Board of Health Kimberley Driscoll � 120 Washington Street,4th Floor Mayor SALEM,MA 01970 Food/Retail Establishment Permit DATE PRINTED: 02/07/2011 ESTABLISHMENT NAME: Cafe Kushco FileNumber:BHF-2004-000090 128 Washington Street � Salem MA 01970 LOCATED AT: 0128 WASHINGTON STREET SALEM, MA 01970 Permit Type Permit No. Permit Issued Permit Eicpires Fee Restrictions/Notes FOOD SERVICE BHP-201t-0354 Jan 1,2011 Dec 31,2011 $140.00 ESTABLISHMENT FROZEN DESSERTS BHP-2o11-0355 Jan 1,2011 Dec 31,2011 $25.00 Total Fees: $165.00 PERMIT EXPIRES December 31, 2011 Board of Health 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 acwrdance with the State Sanitary Code,beofre any revonations,improvements,or equipment changes are made, all plans tor such must be submi[ted to and approved by the Salem Board of Healt6. Page 1 _ _ � CITY OF SALEM, MASSACHUSETTS 1 M ♦ �� Bo��oF Ha�r TH 120 W�ISHINGTON STREET,4`"FLOOR T�L. (978) 741-1800 KIMBERLEY DRISCOLL F,��(978) 745-0343 I��1YOR ncaei�Nt+nu�tCc�sni_rsn�.COM D:1�'1D GREENB�U:�4,RS ACTiNG HFar.TT3 AGEtv[' 2011 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT NAME OF ESTABLISHMENT �r P�_cYrrp IA.L TEL# R7& -��-69�� ADDRESS OG ESTARI !SHPAFP!T_L��fiJr'5�.� S�=,�aJo.,. ./Yb4�04�'o FAX tt _ MAILING ADDRESS(if different) EMAIL-Business': Website: OWNER'S NAME �inc �v l�,so�, l�r TEL#�7�7)�4l�9£rSb ADDRESS �7 Nawc�ds�t ��f, Sole� m� fl�47o � STREET CITY STATE ZIP CERTIFIED FOOD MANAGER'S NAME(S) �!i1 G ��B 125 0� 1 � CERTIFICATE#(S)_(�7C�Z C�Is 7_ (Required in an establishment where potentially hazardous food is prepared) EMERGENCY RESPONSE PERSON �l"fn L ��L!29 oR I�i HOME TEL# CZ��IJ�y ( '-�'I��6 D¢YS`OF^OPERAiION - ',`Monday "� "i;� ;,Tuesday;'_.. .�!Wednesday�, ,,�¢Thursda > `_:: �a,�Friday� „ �� ..,:Sat,urday �?: � .•:Sunday;;< -: HOURS OF OPERATION i i , � ; � PleasewriteintimeMday i��4m -ll�n i lOc.� •fIY�- � (Ocv� �!lo.•- �fOI.m—Ilp.n i /Jc..- -llp.,.-� 10c,� fIP � 10�-(�p.-- � Forezamplellam-it TYPE OF ESTABLISHMENT FEE (check onlv) RETAIL STORE YES � less than 1000sq.ft. _$70 1000-10,OOOsq.ft. =$280 more than 10,OOOsq.ft. =$420 ------------------------------------------------- --------------------------------------------------------------------------------------- -- RESTAURANT YES NO less than 25 seats = 14 - (Outdoor Stationary Food Cart$ 25-99 seats =$280 � 111C1'B llidll`�J�J aGal3 =.V4i�i '""""""""""'"'""""""""""""""""""""""""""""""""""""""""""'" "'"""" """"_""_"___________'"_'"_""""""""""'""""""""""""'""'""'""'.'_""""""""""""""""""""""" BED/BREAKFAST/ YES� $100 CHILDCARE SERVICES/NURSING HOME--------------•----•---•----------------------------------------------------------------------------------------------- ADDITIONAL PERMITS MAKE (notjust serve) ICE CREAM, YOGURT/SOFT SERVE ES NO 25 TOBACCO VENDOR YES � $135 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 belief,have filed all state tax retums and p 'd all state taxes required under the law. - 02/'0 3/�r y� - 12! �'� 3�l Signat e Date Social Security or Federal ldentifi ion Number --------------r '�—y—� --- ------------- — - - - - Revised 10/7/11 FOODAP2011.adm Checkli&Date �—lJ $ � Y � IMP013TANT MESSAGE FOR A.M. DAT (AD TIME P.M. M 4)c (�fo, OF U4'P ( PHONE Q FAX EXTENSION 1:1 MOBIl r AREA CODE NUMBER TIME TO CALL TELEPHONED x PLEASE CALL CAME TO SEE YOU WILL CALL AGAIN WANTS TO SEE YOU RUSH RETURNED YOUR CALL. WILL FAX TD YOU MESSAGE .I\ SIGNED FORM 4009 MADE IN U.S.A. r i� - r �� j � ; . `.i � . --- - r _ -- • ---- � - - - - - - --- - - I --- - - �- - - -- - - --- I - - -- - - � - -. - - - - - -- - I ---- - -- - - . . � I ...,,��, EXAM FORM NO. 4502 ServSafe � E R T I F I C A T E N O. 6767482 � Servsafe° Certification � � �.� ��.� �� rz�� ;. � �, � � '�`'�^�,e w.� �� k�s�-A�;�� Fs..�. _�,�.��; .�E� v #,r ,��To-�D:I �I�C�KEL�E,SO�G°L.U��Yi��.�° � � .��.��---- for successfully completing the standards set forth for the ServSafe�Food Protection Manager Certificati which is accredited by the American National Standards Institute(ANSp-Conference for Food Protectic 11/11 /2009 DATE OF EXAMINATION 11/11/2014 DATE OF EXPIRATION Local laws appiy.Check with your local re9ulatory agency for racertification requirements. � s� NATIC ' . , , .., . REcpST ' � � � �David Gil6ert A�7pQ Chief Operating Otficer,National Restaurant Association ' q0655 ' Executive Director,Na[ional Rastaurant Association Solutions 02fq9 Nafianal flesteuraMAssocienan EAucarional Poundanon.NI nghta reserveG.ServSefe and Me ServSafe logo are regisrered tredemarks of Me Nafional Nertaurant Associavon Educatlonal Founderion, antluseEunEerlic¢nsabyNa4onalNastaureMAssociafionSolutions,LLC,ewhollyovmadsubsidiaryMNeNauonalBeneuraMAssociafion � ThistlocumeMcennatberspmducado�ekeretl. ' � ' . � � � ' '- . -- -. 0812tl02 v.0911 . . " . . . . • - . .. . . . __ . _ . . _ . . . . . , ..' r u` n . " 'xt:� � ' -. Date: . , SE�iVICE�;RECEI�T� � , i/�o/La� ' __ :._ . . Oneway Services Pest, Securiry and Cleaning Solutions P.O. Box 393• East Boston, MA 02128 617-516-7486 � Name: �A9F.c �`�-UCi1G() //L� -� . _ � Address: �Z& ��{f'e7'Zj/V. ST � I Ciry . �`��yJ State/yj/1 zip C��U ._ t� � Typeof Initial Maintenance Jnside � Oulside Extra � Arrival Service - Time AM PM � �{ � tsq�' <�uiBR� ti'L #, �"'�' �' � �n.*: � ;*,F ��t' �r° �."� w's . �g�-.• 4.. � ��s)�.' �„ r fi��'0�� G z�4 � ,.�'rs WI'e'°"`��y - �� .� f Ter9et'�'i+.� � �,.utea." r ka •�$� .pJ �o y ��{.�`3 xA 1� .APW�ed� .i'' L ^�` �y;�q� ,Pest - �. �.. 2�# �'F. Y'� ��Y '��,4�� F��t'"k s.3� .w� .� :��4�"v<"i� t{*W. i � �`d�f,�� . a 9 aarnw . a i . � �D�� . . . . . . � � .. . �)..� . . � . � � . *G= General Treatment; S= Spot Treatment; C= Crack & Crevice Treatment�. � , � TECHNICIAN'SREMARKS: /N�/A/- i .N�G�C�/I/ A%UC� O.LE- � . - 1iFA.�L dG,e..,Gr��G/!/T" .�D.0 r�IYJ/YJE.�C//lG �. � .. �r T . . . k.�� . G - . O ri�-/(dA � . � : �/L. Z O/O ,tP7?�J - � . `'��-� �Y produaNeme�� CommonNeme` past Due Balance $ ' � 7. Ant-F�x BoncAcid �°�� =' . . �. �`� .s* • � ��.� Totlays Service..�'� . �` ��, �.� t'-+ ��' . 2. ContrecBlox Bromadiolone .��,,,,,,,.,,;,�,y,r,,,�,_,,,�',�„„�,'�, _� „�.,Q, $� � �' `* � 3. �EcoPCOACU Hexa-Hydro�ryl Total-0ue -- -- -�- � ��.� 4. Eco Exempt D Hexa-Hydro�ryl p.D date � $. „ �� 5. ExcitaR Pyrathrins �AmOUnt Pald�^,�.�� ' � � �;. � q.l'�4 '�g, t:i k� � �6. NylarlGR . ethozylpyridine (cash)�(cneck)°�.,,-�,_,__ � / -�$ - � '� . �.:, � �. onhene Pco il Acephata Remaining Balance &beeoere eigto9 fee $ � � � , , � e. Siege Hydromethylon �� .� � . 9. Suspend SC . Deltathnn � - � '� � �. �'�-� � 10. Tengertl Pertnethnn stametsSignat �. � " 11. Viper25G Pertnethrin - ��8 - �. �,.�� . Techniclan'sSigneture: � _ PEOfl�Efl%100VCTflG[�F�M•CPOWXM/.%�IdOD15PJ011 -� �.. . ,. , , ,Q.a,:�<7 CITY OF SALEM BOARD OFHEALTH Establishment Name: �� VS�cc'� Date:�_n Page: � of / �tem Code C-Cr�tica��tem DESCRIPTION OF VIOLATION/ PLAN OF CORRECTION Date No. Reterence R—Red item - ' ,Verlflecl PLEASE PRMT CLEARLV V`e-i Y1`L� c`t� ,� �c-.t 5 c o V1 � r-te.c-� �,c --�f �u,�nG Lv� e�e,c� • ' ' � � -� �k.�'JC � � „V .51 4�'I (( � A�i v'Xi; . (n,t -f; �P �O ri ��f`P � ;�" -�� i �Q�� ✓1•�.t7�Q "'f" 51 `-� 1 - - _ � — — � ( �tor( r �1. � c k-47 �li�' c-/( �'�l�l n ,�;� n� ) C �,'�( �U� h`Pr�✓1 3 �l - Q i�t'. y , l t' �.� r: Y �n Vl0�� c l! .c n nM_ ' > ; ? / �/ �/ } L-f Y ; � � r U � � .� ; _ _ > , � � � Discussion With Person in Charge: Corrective Action Required: ❑ No ❑ Yes 1 ❑ 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 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 o Embar90 ❑ Emergency Closure your food permit. �� /� ❑ Voluntary Disposal ❑ Other: i � r +-�i!l.IA(Cl � PHFs Reu.ived at't'emperaWres Vtolations Related to Foodborne!llness lnterventions end H/sk Accx>rding to Lxw Cooled tu �. ' � > � Factors(1teMs f•2?) (ConG) - -A I`P/45`F Witliin d How's. ' � � ' PROTECTION FROM CHEMICALS 3-50t.1 S Carlin�Methpds f'or PF{Fs � ----- �9 PHF Hot and Qoid Hoidim,� 14 Food or Oolor Additives, - 9 SU1.1bBy C'old PHFs Maintainui at or beinw 3-20?.12 Ad�tn�,x 590.QS}1(E�=7 -#(°l4S`r" 3-302.14 ProtccU<yn Prom tfuappn?ved 1ddi�ves° -- — >�;9i_i 6(Aj I lnt PHF c itiaintnn�ed .t or above 15 � Poisonaus or Taxic Substances �� j,f_ � '-(Ol.11 o ldenUtving lnYounahnn �-Oii,_oa� C ; 3f`1 16( - I (.ontau�c,r,� � ai _�[2v.c,tc Hc.ld at or above 1+p°t= * . — --- �Zp � �Time as a Pubi�c Heatth Cantro# -�-� �t IEll.l( ' Cctnmo��Aam.� R �rk� i�f<riini��r,_* �f �. _� . _ }- - — '— - -1 z '+ill !) �a��.,�s a [�nbhc 7�leatth Lont�rui^' � � _,� _ 7-'pt.l t I S��in anc n �5tn5a <� _ ,_ _t �r�t�t}?.!}�r � 4 r st�,Re�nir�i3aeit�. �' 2D2 1 l �} F:� t�tt �n -Pr +t��u-'tt� ' t,.. . � -... . — -. 1 __. _'i__..__.. ._.� ' _' ZfJ2.l� 1 Co_idmon.of Itti�" � - -----'� t-. -- RE4UfREMENTS FOR HlGHLY SUSCEPTI86.E �.'f}J.tl � turt f o x itncr Pcoli bi.i�rz ` _ppPUL�tTiONS{HSF�_ 2O�4.11 'inmu eAti �titeii Ct�mic �� --- 7 'f�1.7' �nv jl,irtti� «hii. t nn�e. tn.�ia.. -i, �t � 8011'�A+ l��np reu +�edi'api�� gedkncex�r.[i�� i '0�-4.td Uwa,, ltu�e.tnt ii - � � �- t3e�e� ecx�it(t1�atm�3 t.ab3s'. � �� - -{ �t $OI PiB} !-. ui Paturvned t i � p5,lt �In,:m n a� t«xltsrtu L ihri�an I - t — ..�---. 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I r }� (,, iti � . h s;�� .`�. � ..I L� v.._" .�...___ ��I � r,r�.,11.1 { � T.o ilv. �. .,, , � _. ._ _ _ . _ . .__� i � ,� ,, � ; , ti � � � - _ � :it^Et�is�L nEe�:f��'h4EN�S � �',)'.3 Rus, � ' � ird 't e R�, �.. i i — .-_ ., i : ..._. _L . . _ � ._ � r.) t `?(rt).it) i.iJ.0 17�r,iJCt£if.i ,'�C?.{�31}lt t. t),.' ;`�� i � � }c71.1i <�h. � rt, n� 6:ic�t.aAi, z4=.. t � i� , � � i � ____� � j � A �� -n�hti: tsxz rc ap is�� utd � � __� s- _ �. 1 a r r=1C�LL�Ai ;, ' 1' i -� Nil �' ,n Stu � <'( !�7. � 3 +..,r-. a . �t tc,tc,hc� o� r�=�o. t # rn`��e � , . i ; i �;') a,�:bn �it�tn_��i.;i.,h�.,,a.. � I � c.L37 (� l.,d4ta�t�ls. I��f�.:,7eSAtc �t.;i..i1S 7 i"•;,�•. k„ `:tC ' � .�li:l'� � .�.�.�.� t� kni i:F.t� ..1CS;� ._.__ _ � . '._:. _ _.__. _. �_f�.,. t"'i z I ii ._ .__ _ t.i � ti��.t > ,s> � ic;t,�r ., ,. z�=: .. :. ?.a.;.y,� �_-.i�_ � f i i , � : �ti:.r . .,:�tt= 2 i � i .,��_��3 � -- ._._-'-t --- -- .. _--- _ �� - i .�:.��..;: '. , ...��.. ,�.. :�- � :. z � ' �:-: �- � � � ' '� , ..,& . .._� � , ,��-��,u x. a.__:�._ . �.'.+�- , � � � . r.r . �Nvc 1( . :�t�tue:?9[>. . _ ._. .. _ __ . _ ... . __"i : . � ' - �, - , ! . ` ' i F zt i ) . Y � .�.._ ._ _.__.__ _ „'__ -{-- _ _.... .."" "". ___... .� ." . " '_"__ _ _.._"" '_"___ __.... .�._:'. ` 7? i ; FteneaYhtci?u� Hot�.�;::�r.r ; b'lGL,4 i`lilluS NrCat7�L TC3 GtJ:7..n,r°PE7.�?i �'t>4C7iG`t:'� ,.__ _�_. ._ _ . lb.11� ti� ,3- � i �f� l�i=i � < = j ilt�tns�3-3i}) � __� ._____ -- -_ _._, S �#03.11Bi � 41w �,w��c- ir� i' �P:ti iu. :�t..,dia�a � C�� . ?r� ri i �,-al � rt �rs. nt r � 7 �ut � r r< r:.� � ,� 7 p ____� � rrrrturlJ� t n rr�<� �tni a�r b7utr 2r��c � r . .cdrteu �.�..._�..` __ . __ _ � 4-{r�3.UtCj ; (orsri�rrial} i'�a.�;,etif�[t.}�,,w,' - � <=ie«i.uh�ix ,3� ry<sc . i , ,rz�ln�,e�in,:_ra-.. �S, t';S4R ., i i l�, } � �/f��ir ' � _ ___1- -� r -. _ -', �_ 1?-3.i !(El � R�.u�n��i-�L�,c,it:er,l Poraoun! h_�.; - tte�n C,007f?ata�lAraotices ._ _ `�FC a 53A.f3fSu ( _ -. : { �<<,a�x, � i L , t�;�hag,,mE E aad P r u r�i FG i ^�:!. I _. __. ._ _.. .._. .(,_._._.�. _..____ � _-.�_.._ _'____� �. t�cxi dFa.�di' oteci�,n cC , ,X'„ ' g ' � Pruper Conftng oi PNFs ! '�'� -- . - -- a �-- 1. �.� -}- .- -- —.' � F r _qu� n nt and Vte� �is f� r i�5 ; I � 5G1.!d!A! � 'sx I i�e Ca�h��d flNl=t fr,ri t-�t,=f�tn j 1_�,, wVa ri PF. n�n�'+rt + e ' '"C 00:;� ` . � � +g<iur'<a��d F<<nn :i3'�t� f �� - • �- -'�- - -- � - j i 7�F 44 ithi,� ; � >7 Pny a�Fa I�t�. . F(1 E , .407 ? � ._.. ____ --- - � � � ' _ _s� n s�r Tnx U r .�s i; 7 00� i _�_. ._L —� I. — — — • -. � .,aal.hfCBi ' f��lu RIiL 11�d, :Eoi�i��u 6 eit� � f_ 3 S�,e� ��n ai i�r-c� 009 [ -1i i7a5 \ i ir �hot� Ic� n � j i ._... ..�_ a ' ,,.. .. _. .._._ . .__... ._-. ._� � � l -nErrac,rc�ln r.�.;.x[s �.#; ri-FS`} . i. �� I Os€,r� .. ` , -- . . ...__, _. _-- - `-- _...-- ' . P tiflitl a {liuitc� � .�`�'` L��___.__ ! __."_- _-.________._._: `1 11�.2}TIOC911tGY UVf�:l.i' I•, �•�• •:. .,..: lV` � l � �G(�f�li. � CITY OF SALEM BOARD OF HEALTH Establishment Name:��l.�C'C� Date: 1�, �1C7 Page: � of a �tem 6ode C-Critical�tem DESCRIPTION OF VIOLATION/PLAN OF CORRECTION `= Date- ".-;° No. RMerence . R—Red ltem � �_:�r VerMled �� PLEASE PRINT CLEARLY ��1 15 C i n IC ,�CA �5 0 �)JQ� ('. 1 {Ra r i �� 1��s - �k-�r o � �� n� �i � I'�-5 10Y1 (I l�, �� U�� C�� , . � \\ � � O . 1��'1 CO f�2C�@. 2J(c , � - ra� � - , � . �v ��n�,. CYp� �r � be I�t,k �� , � < '� ` �, Y15m� �10 .vcts �ti .c � Ctiv �19 ��!lo�-c)it'1 — � � r e IE',� . I ��7�� . �a �.� �� d_ �� i - h� � ��L��.� � ,� ��s��. � � �4 �<<�� -r�s+ �- , � s�� r2�. �� -� ,� -4r'�� °cJs er I CF �cri� v `/ v , � i P 1 S --� �� C. P�H�Uc �" sc(VI �' �, c ' 1c� �� vci5�t � cn k 4sz,��1S wa I I -l� � � G ( �,�< < i e �'�'. � c,� '� c�- c? 1 �u i� 4 :� � i'�4 C7w �S C��f V S� C� C a�� i�Pu,' '{� b �we 'C, i � ' n 'rCA�� , Gi.�1 , �. �" Y�cDv �� I ��'�� e �-� �y 1�61�0 � 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 Resiriction/ Exclusion vioiations 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 d611ars�or suspension/revocation of ❑ Embar90 ❑ Emer9ency Ciosure yourfoodpermit. ��f�«�i:/�`�`i //I�� ❑ Voluntary Disposal ❑ Other: - i� v " =-��II.i4[C� � VHFsReccivedat'Pemperatures:. Vtolatrona Aelated to Foodborne I/fness Mtervendons end Rlsk AaY>rding to Luu�Cooled W - Factors(ltems 1-ZZ) (Cont) � -�i'P/45`!=W iCt�in 4 Hnw�s. * � � PROTECTION FROM CHEMICALS 3-SOt.I 5 Cc�lirr>;+7ethods for PHFs 14 Food or Coior Additives �y . �F�and 6ald Hoiding 3-202.12 �.dciztive�'z �50?.16($1 Cotd P}IFs Mai�it.�inul at c7 bel<�w �40.01}+(E1 al i45`i„' ?-3�2.1� Proucli<rnfronxtina4�P�u�etiAd�fitives"` i ; '�j�,�{�i:aj IIrSPPiP� lTainlameditorabotie 15 P� oisonous o�Saxic Substances � 7-fOt.lt �l�s;ntt�m ,(otei»af,r,�n -0n�!oa� � ��F.� � � - 3 Sf3i it{:1) Rv �ts H41tE u.Fx;tbove i3p�1=, * � Cnnt.ui er�� „ _� ;�� - �T�me sx a Pub(ic Heatth ControF � -- 7�i�J2.0 ' (:omn�>utixme W �r(�i � (.nuun r,- � �- - -�— - '- -�-j ��1 Ir -�r ati zPnbh�HealthControl` '� 7 3�(.I 1 S�ta t tn �Strna . � E- " ' -' - . ...-- 90'�tta f-E� � t � rc�e 2< nu�.>>i�r��. 7-20M 1 I lte t «i on -Yr �cnu w} 1� � �� t�_- .L .� �' .._ _._..�. �J 7 ?02.i2 � C+_idi wn of!is� _ _ _ Fi�t3t1lREiNEN75 FOR HIGNLY SUSC�PTIBLE � �-7--?03 tl �1�c�xicC��na�nei Profuhi:or ppPULAT(ONS{HS� 1 7?.�4.71 Sani i e�ti Grnriia Cr�ciuc I� - ---- >r � t - � �t� 3 lt,)1 I �� V! th�j�a�sceri�cd t a ��c��i?ad k�i�nud � � 7 .}g i (h�,�u +i,t n � � hii. � <�d�4 t �ir� n z" (� . �FleEeia e. �[di 44a�nng iab�ls" ( �� ?ud.11 D �%Aic�te.irftii� � -�- -� . �� . S�RQ! I�uSa l�?c�Pitc�nindt�. �:� i 1 7p5 !1 Li.id n al f wxl�unr�c� E 1? �+ - - - -� � � � ' SC�t i{lla s � i 1"u�lail G�>i. d laEi�at �-cK��zmd � . � 1.op(.t 1 i2c. n u 1 c�.Pe � �t� C; [u�i ' ., -4-- - - � ' R i 5c a �rr�at,'�ut S i vt '7� �' z�6.1_ � KtA n 23 f 1'q�OF, _ �.� - � i i - ..-� hf:i 1�'C ��_ �>� ei�l�a� 'ac }'�tiui R 4reed ' _ . . _._ _. __ � � ! i =B6_f � Ir.� k, � � H�dec } y �.am I e,id �-.. _2-��..�__,_ ?I � : t�� iias�7y-_.__ ..__..__....e._...__.._,-J C�NSUM�E` i.G�V;SfiflY __..._..._._._�_ ... _ __..._ ..._. __, FiWiE/TEA�lREk��7U�'iu CG^dTF�OLS j Z< s-6i�_ t j t,��, c lA s ;ort i'rnt f � � � c^ r�t,,,nxrn o; �! �-__r�..�.r_..�� . _._. . ._.._._..f i � i i f„�. } a+d hx� �rc R� '� � ��,,.c-;z� I IG { P oir'�r �cErri�nq Temaer�ture�,tor ; � � i i ��:��)t� r _. #'rc�z�.v �iui,Sn_�.i�c. ; I 4 NI- � --�--f I � � r :.= n � �_._ . .' __ .. _�. _ i �43.L, �tt (�� } � t ,� �, � � -t---� ' �'.; ' _� � _ I � . ! ..� i l�r� t d 1 �4 1t (iot. ,*c�k�a SY��`1.. .� . .� rr inti it�tltt r ��; I "�i � �5?C� � t i S �' I ��i.�s�:i�� .._ .��«�s,. �. �t�.,r;,:� . :�,,t E � � ___ _��.x__.__ , � ' : 9f � .. fl1 G .. � 1Q} sf��4s1� 1��1� i � b l � 7 � Fli C23ti� � r—' wcfP�.��1�L �.��r��L�1E�F�J " _' ' . -I..� !((14� F' J, i:�.� .,. 1Er .t: � � � 1 i c ...._i � n.i�, .>{:S}7)) � tkt �s�E a{I ��C�.L'�7) v. t :2}': 1 _ � � f ; � ,�t�_: e. ,��i,ii,:t��A. t. :,iu.�,a�t a.^,d j r �..,_'— _.w ._._. .. .. . ..�___7 ? i .4tiF_I��r3'�+1 i i � +�1P�3 i�4 r. e i'lir�; � ; ; �u si��cGnci o� ��t;cn r<e.`dl;e ; � i . =:>.,�+ r� . i�;.. .h,�:.,. � ' e._??ir� ' t� .�3.� �tz at.s�r-;'t�ief�c � ous t t Ci. (.ti2...(6 V 7�1i'R � t_ 2,ji ]��y+�4J,_n �� . Cti: ..__._ � ._�,. _ . _. . _._._ � . ii.! ! �.n, ..,, . t.. c� ...Y� a,+, � � .,_. ,u.:. .�_ .,_ .�,.::4. ..... � � ; •� � ' : i ��{I'� i .citU !lE 'iiiiC O `ifC��t.� �; ___. .. . ... .. . .... . .. _____'— � - y,� • . . 1� � ��2 -.r . � . , � . �. ..�.`tia . . ��. 2�{G't i . . ../ � i , :c4�� . � ` I _.. . __f. � .__ ...__.. ._ ._. . . . . . . z y_,:.. , .. ..,s.� .. __ � . _ _. .._ , .,. ,.., _. Rt .J' �t r+, ..r, 't: "_. . ..._.'_. _...__.:_ � � ` . , ''�. '....."'__....' _'._""" ' ' _ '- ......__ _._._.�: _.._... .""''..__..... � �f ,,,5.i i� l)b i�)} _� R�tac r g tor rka4 t.�tdit q _ » t/tC3LA7tiJhiS RELR7�U' r c: t'rOt327 FfiE�'A!i #yHtt� iiG*F_S - -r _.._ . .__. � .. _._.... .._ _...__ � � a� , , � ({l - !h` 7 1 P: . i , 0 2 . � {�LEiT1C � „d}t _i ��.#03.11lA; -- I 4t3w,u�. �-,� itz�t`2 A�I�a�. - Stan<+iag C�t, i.�l < ..z: rr t ?.re •�it ct ac�1 etc �`ur � �1 t�" � � �� nc `dJ s tt t , . [ � uu+.t.' }nt � e hst i c r�. ean f�r --- -.�...._ ..._ _._ �__-.' � ril3.il�t_j � E a> ,cr;i:tivf'ux. :asia�t }�.;,xi-� ; nuni .�;.�:_ �a.u�F _,c �n �.'��Irs.dc..�:.a+ JJu, 1..,:�/{ ��t� E - � 4tr ._ . ___ _. ._. _.. - � -�4{li.i 4{!��I �2c i i ii�. ( nt� �t.d Po; u, s�xt l3eei 1 : tternv ' t,oad RaLa�i Prarfrces _ fC 596.60fi � � � i�,n�t `. � � o � l�nar� �[ic 4 a o P r �n r� i � �_ � flC � -( '- "�`- 1" �x! ad axiPro9ertc �-C.- i CK�d � �lg ; ; Proper Cooling ot PNFs � - �-- - -. -, .. -t .__. < --�- -- - - -- ° c.yit� r� azidUte+ s � f -a 10? � � +�561.(=!G 7,xft�i�Ct�k cr PHl s ir.�G f.(�F'ic� � ?�r YJaStr PI �.ik,��v^� S e rC--� .6G„ . � � r uhlntlwa � u�3LFur� PFt � �� r,�;, dCa it� .. FC-€� �07 I I t, � 41?S"F R ti in " P3„tt� � 2� a � �� zr � ix� F f.a�� C- 06& �. F .,-..-�_-- - ��--1 p.. a. . ._ . .J , � ;. a _s�. F s.. .rngi - ��- '` ��l.la.{Bi----.._.T f�2r�ruu FLqlr�.,c,u�`:i� 1 t�i�It`F ; �'`' ' ._ --� - > ( t � .---.,,. , ___ ____ -- � �n iz ��. 8.n� � ., `,i.ai -..cr;UCSI� i ':;z�.<; •+i�t�a i . :r !4�C irix 59g(�r)ff. CITY OF SALEM I _ BOARD OF HEALTH r Establis3ement Name: �CP'�Q�I�Y)CC� Date: I�6( (� Page:� of c� _ Item Code C-Critical Item DESCRIPTION OF VIOLATION/ PLAN OF CORRECTION Dete No. Relerence R-Red Item � ��: �,Verified . PIEASE PRINT CLEARLY � � :�� O -� v G.k � s IC� Ce�t . �Y1S o e � r�.c� ' � ,. . _. _. i � i — - ; . , }� n � � � ; c� � /. � S_aP1L .L' � / lr: fl _2I1 . � '� � / ; ! � t' t t 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/ violations before the next inspection, to observe all conditions as described, and to Exciusion ❑ 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'dollays,or suspension/revocation of o Embargo ❑ Emergency Closure your food permit. ^ /%� /, �%n �i�/� �j j/�/ (/�� ❑ Voluntary Disposal ❑ Other: i� � 6 i ✓ � 3-�f1L IA(Cl PHFs Received�t Temperatures � ��--� �. Violatrons Related[o Foadboroe Ilfrress Inferven[ions and Hisk Flat�rding to Laµ�Cooled tu � factors(BeMs f•12) (Cont.} -. � �11'F/45`'F WZ6in-0 How's, ' � - 3-501.15 Ccalin��A4eUxds for PHFs PROTECTION FROM CHEMICALS _ �g — RHF Hot and Cald HWding 14 Food or Cobr Additives 3-S�t.l'6B) Cotd PHFs Mamt�inecl at or betnw 3-2{)2.12 Additn�<m _ 590iN1�lC) 4d`/45`F" 3-302.14� PrutccGon from llnapproeed Additi4es* �� 3;�aj ��{,�j ]:I�n� PN}��tainra[uecl at br above 1S Poisonous or Toxic Substances 1d0'F. �' '�-IOt.l I ldentafying Infonrrdion�-ilrl;;ioal — . � i , . i ��: 51t116� a)_�o:�3,tsH.clda[a:�bo�et3D°(=. '� � _ t��mvu r�� _ .�� r?� � Tsme as a Rubl�c Heafth Controt i �J� li C�.o�am�n\aae H ,�k .i� r�tu��m�x�;. � �- — . ..-- -- � — -I'- - -- �-- - — � � ��i i � 'tm� as e Pot�lu Fie7i1[h Contr�l' +� Ol it � S_p� iucn �Su, � " � � �- - � —�—. -- -- .— dG:`H�-'«i7 � G ri. n_t_ `icym ��neit��-- ' 2f)�.l I P.:;+t xt on �T�r �,n e v;E l. � -- -..� ..—__ . - 7 '02.i� (.o�iditi�>n uf IR� — . .�_� ? �43.t 1 toxzc( u it u.nei P o�nbi�,ii t REOUIREMENTS �OR HIGHi..Y SClSCEPTI�LE / ^_Od.l 7 � Sam veir t rite. �+ C'��m�+�� POPUtATIONS{HSP) �. . � � '?l�"+-Sgt 1 3�,�1�L��F Seur�z d Pr �.a�}.��cci Jvic�s auad� I .04J (_n..,�u ilti c�t rh.��hi ,. t ��c u,�. <nSe, a�--� � i 13�4ri a ca tctt! k mm�� laheis' 1 �?Od.IJ �Dr•:m�A�cotc_Crit it _ -�} �� ..RO; 11(N}+:� i1An.tciizir�dk �� ('S.i i ln st' nt 3� t tixJ t� tact �I. �b�i� t � - --�'_-- r _ .�,_._ — . ...--1 � 't Sili i 1{�)� � r.: �rYufa6 C�Kh�d Aaanal E=aa! and � � `'JC.;( it^, a � �t 1 sc I'r b i�le: C:urei t � . ^ ..F- -- — -_— __..._..�_ � t.v� S .a S,sruiaC ��i 7crsc i =:: � ' 96 Y ��xie�v b t l:atiom. . ; L __ t .. ------- .._-I � '- t .'._ _ . __ ._I � v`.•i � I = k. c� i.vr�v � 3c ��tiaa R s�n�ecl.___� � � .Jy.;_ � � a�i,ni> >rlee i . .�.7tr i �� i}NSliil9EPr�i3YES0_ ._ _..._ . ..........� ._._ � 11:;1 r��rr nc�_.__�N.._.�� __._.....___....._._t �`f ._ ... r __-. ----_.... .��_.___...� H�l��71F:�SP�l3ATtIRE CQNTRt}L�a > � ' �i�,_ l i � on3it � t { ';a.� r'�c=_�,ibr{rnt�.amptioa of � L.._ _ � � , � 16 'FrcrperCooicingTeroaa�atweaiar__ .f � } � " " '�` ��a� t `�n� l.nuer.,a;keil�.• I 1 PNFe � � � 1c t Q��as i u 7�.;x� ti �t+>>_ui. inuu. -" -- � � �� i�l..l.l ltt �. .�f �, Inu dR�t<�4�i�.iu t � i.e<_.. i �� `,. � f k'ti��„ -r-`'�h ni. f�,:kau Sh�fl ( --� " -i jjj( 3 �f �"t � C, r i nti:u f � A i�t � i ,t., � _ _.. __ ...�_ �. . ._ ._ _ . _.._..�.�--- . � ' tn li. � i1'3 ( vE� . � __.. . .. ; . � _ ...--- -'� °ark.`"3r :_.rY!= ,r ttsL.t'ri€;!V `a '3 r� � P 3i1� tr'� li:. Ka n� - I"'i t i i�ia-. 1 . .. x . .� .�._. � _ � * _ __ -___.� � �.,st �k.�i�- �� t��; 7 ,�e��it 1 � 3(�.i7t.��'��-(iYiir ' _ )i:'iriJ "cii 3.,tc abict{s- 1 � t� i., r � � � � E � I ��.t�rrtit� x�a�iiit ftxr 1 t� �i��ra�� an� j ��.� _.�, _ _-- � - ` � r=�41.li,Fsi '� ! S 7iarr, 1n=E1dC ,i�� 4;c' Yf}C', f I r :ee � 1 �'ch 5 � t:.,a� s .i�otzic! !�e ( � °��,ttm, .'oa.e�r,u�. [�sh,t,�.,,__ � � � .:'`[�r! � r,,.3.�r tli., hp� i..t�riatc 5et';�.tt�uu5 � . ( r :'iE., _i ' v".. " � � .E�x:.;i ,....._ i i zfiCtit��`R ...�� I _"' __'... , __'_ _. ____ ., . . _ _... : , e , _ .��„_. v t„�.. = s..,i , .. i � .r.'i . . . �„�_�t .... (t_�n. . rFi,.<< , , � i i �`=+4i.+� a;��;E� tti �,; _ �< o..�i _,tt : � }_. ._� - -."-' ---- -_' ._.__..- j ` .. . h�}_l- 11'ra,. } t .� .ajh. _ y ._,�. � i.'�r �k I 45.i�i fFci i;�s � f r- � ,' . ..:,�i .... .. � .i � ,. .�: . . . �t.as- ..�'7f�_ _. _ `' _ . .._ ._ . � . , ._ . � .. .. . t . ,. �.(� �k . i1 i t J �'1 1 : ' 1 � ..� i., . ._� . _.. ___ • � .... '"__ ". . _.. _._ ..._._ __-__ _�_.�... _. __- ! i7 I- 1 flefitaP�rtq�tnr tiot Ftc�ifn4 i ...�1tC7L�Piu'tVfs'R��L,27+�r. � ,__, _ _ T67 C'.+C�C7t'7 S?ETf}!E. PR�BG�'T#!'f=.S �s �3 tli�) tU� � } EIl tc��f t c� Wi�n� S�,.ad:��, � Eifttu423-3fi) �..._ __.�._ _ � � _.1 109.1NH, � �iz�,ut ..ta- i( ( ,� � C.+itr .r�:xud r r ,��;,;sai �t� _t. �.�i. xi� �,:1�:.'o.�r7t r,�at< . .�;:e � I t,�' i fr 3rthcnee ilI i s ue�ve�r� u >z�zi rz ' �n tc�s h,trd �f�rr. w.n(�c _._ _.� ...— �'_-- � i -i�?3.11�C) f ( ��vn�i�ria.l} VScs�,5-at9.tts }'�xhi- � It1+rGa�ihe/�t�n<<,,,,.:et. r ;�iuFr�,tft.o,tetu.�1U) C9tt{ � dU F ` � �b PUJ � _�._..,_ -- --- -- :.. . -- . .._ _.. ; � � , � i ; ttem G'na f Refa�t Prarf,c<s FC 580.OtXr ; � �j-�1�f33.i t([, < ��a�iing L�, }:«i t�rtx ��.! �3,:ci . ..- .- . - -- -. . � i � � ,��6 4J��'C�Pl.c 1 3 tC Par.t�,., : � FC l ' 'S(�6 : , ha�� ` �j� I Proper Coolint�ot PWFs �_� ; 4 o^C i7 �x4 f i t� . EG + � t�4_ �.� ` 7a �-Cgil��x nt and Ute� 3 f d Sn5 1 4=56Lld;A) I . �x LnzCa�l.,d PFII':frntu t ,1;`F ta i i`� _ _ _ � OG5 '. __ :.9. _ ._ __ � j � F=Viti:in t I�4wrc,!�d f r�� 1'<)"t� ; ,� ' �-�y �ai'" �.}�... ... = FC � _�. .GO% 1 � ! ��'�T l;5 ;�i4zti3in:H n �.. ` : ; 2N ?os> » ��?�zir F . �:>, rC 7 00� _} __'__....""_"_.-L _._._._. _._ _�._._.. .. f.. � _�. . _ . _.- __. � .5�Ul.l�k;Sj 1 r i��tEe,!PHE�:'�I.��Yc E�r��ai An',bient ; �_'4 : S�� G.v �r�are� � _� ._._ .609_. � � � . "- -- : -. -: � � :i�, , c ; t, ' nthPr ..._ , ...._i � m�, ru[un la.ce< cr r�,u + f Id(�7� ' _ _ __ .---' .___ � _.,_._.. _ __..... ��.�.� }t i1t ❑ + !`IL�I( ' . ,1' :t- . .scriuc.ilrG_��.�ri„i� 1�;�4Pu��t -.. . . � ,<��.�:. � • �r CITY OF SALEM �--� t� BOARD OF HEALTH Establishment Name: �,c.f�tE �u,�'1� O Date: � ( Page: � of o� Item Code C-CrR�cal Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION `= Deta .' No. RMerence R-Hed Item ,'� Vedfied � PLEASE PRINT CLEARLV I� :�, c, c�� . .� r �b . �,, c,�i�� r,-,. , _ a ��f � � nQ, ��r � � � �e�� n� � • -- - � ' J � Lic;;4��' in cK o.(ocv� Co� c�oler y�2e,c�� ,,�rw. . � v � ' O'�C '�"1 2. `(�C�C� C G Vl'C�caP f01 �. �7�)� h'�-P �n/1D- � � k�-t-c �+'� ��-t- e p I cr �r/. `' u� y � � hc �o/,�i � �Irr,c, �-i(.�, i� k�"� c � (�,(.-�r> >v � _ � tY� !'F� � tT�r c� n G �ci �� C'.t V ('P A . V�P tP,�- ,t ' i � Ltc. I t'�f"�1 oaYYl 0 ( 1 V PD 0 C C c � t i — 3 G I: ' I a s n c� _Y.n .. .;. -�'o I c�o/c' � I� ,, J . _�_ , � • 'I� —�ce( fC �-�'c � �� .`�X'.c �-f� � t Y'U1.� I�c-d,r s o� � �,,-� �r��- � r - I; _ � F n ;n�>,n h2. � Ck.e 4' � 2A S eYrTc �-'��P. Iv1 f'�Q,1 l i� r , � v � C S �tnfl � _ .�:� _ � e � � Discussion With Person in Charge: Corrective Action Requfred: ❑ No ❑ Yes ` � ❑ Voluntary Compliance ❑ Employee Restriction/ I have read this report, have had the opportunity to ask questions and agr' e to correct all Exclusion � violations before the next inspection, to observe all conditions as described�, nd to ❑ Re-inspection Scheduled ❑ Emergency Suspension � compiy with all mandates of the Mass/Federal Food Code. I unde`t�nd t�t � noncompliance may result in daily fines of wenty-five dollars or susp2llsioil/revocation of o Embarqo ❑ Emergency Closure � your food permit. �\�� ❑ Voluntary Disposal ❑ Other: • tiv�, � —t�' � � � r - - �3-Sf}L 1.4(C'.) PHFs Received Hr Temperatuces �� Vioiatione Related to Foodboroe Illness lnterventions end Risk Acxrording to Luw Cooiul to _ ' � Fectvrs(lfeMs f-?2) (ConG) �. • � . .. -�I'W45"1=Wetliin 4 How's. x � r � PROTECTION FROM CHEMICALS 3-5t11.15 Cc�lin��Iethod�for PHFs -- 19 � PNF Hol and Cold Holdfm� 14 Food or Coior Additives � 3-SOLlb(B) Cotd PHFs Wiaint.�inecl at or btk,w 3-203.12 Additne.� 540.0�}��FJ -11`/�5°F' � 3-302.14 Prut�ct�onfromLiwppivvedAdddSves�' 'ij��Llb(Aj ItntPHFo- bfadntai��edstoraboce (c Poisonous or Tox�c Substances _ � , � f_ '-L01.11 Ident��}m� tntiv metion- On +o i � -- I C'ont�u n � �. xtt 1 �A} ( Ru3,t�Hc-tt�nt oc ;bove i4Ei �a * �1p � � T�me as a Pubi�c Neafth Controi � . � � 102.1 I ' C:aiffm�in ti ime !t �[tu C un[tm�n�_ ' - .— -- — s`=- - -. -� ;I ! ('i�3cd1'o613vHealchCu�tral' '1 Of.11 �Se�uAtCt�n Stini � - � --1 �� 1 2U2.1� 1 S�t i�t nn �I r u n«-wJ l, � �� ap,�`�a,y).- - 1 S a m_e Reqtareniea[ 7-�02.12 C'r,ud�i»n erf?;4� _� , �r}.3 t 1 ` Tox�c f�r,uainrz Prohil _uu� RE4ll[REA�EN7S�OR NI�HL.Y SC38CEPTIBLE ---i-- - POPULATIONS{HS�_ , ?0�l.11 � Samtueir L�tne�i+ Chcmic �ti � -�r-- �� '- � �t � 35qt tiSi �iJ��vteurizcdPr� j,a� iocd7uices�r�d ( 7 J�1.t� �Ch..�i +IS or N � hi t�*uii ct f iruia'� � . i � _ _L ... � � �e�era e.aith ti��ii me lat, s* S t � �i �U-t.i4 Dr,i� �t� uic.t rn< �i ; � -�- --� � -`. .- -� -- --� --bi�f il�t3i lis u Pd�tt i�ir�dre :.�_� i �.415_li 6ic�id �i�ltw�� in+i � �.ai= �n �, ' : 3d' ��i))�da� nr3'�.7i�G1 !�e>F. .�fAnim<ilPa�dund � �7 �I�6.(i t�e;�i f it �,c. i'e n e f.utcti} . �� - - ..--� � Std tie a 5 a�t�at, �ctSeavc i � � � �Ofi.i� 1lZix� nlii + lasi �n � � �- ----- --_ ' , _66 7� � L:� � is,"anccic P Si�:uitr I �.x. _. �� hi�i 1��< � t�r� r�aE l�cxxi P.�� i�r ti<i R .crced. `� � _._.�_ .� .. ._ --- -- �_.._. , lvzni�rn�--'- � CQtdSUMEfi&6YlSOFQY � Yt6iAElfE[6RPERAT(1Ft� �OM17TROlS � 2� 1:;� 1 i , t'onwm�c �i�� sn.�ti >� trd I:�r<<�t:u�rautina of�� —3 � a,;ii7i:3i t ed.-� tia* ire t�w i+uaer�x>kcd i� ____ __.. _ �.�_ ' � � 16 t PtopriCook�ngTemae��6urEstar ( � j j �, j�O� is,, et<xc 4ti n.:Ciiinn's � ' � PN�s . . i � ' � t__ __.'_ ,.._ . .� _. ._____� i s I' th:��n ` , i � ti 90L3J � 1 f f � � �3.�� S �- -.E -�. . - � .. � f�. < iiiu�ttd st Ss ici [ 's i rs �,� j � �� `�` z� z .t ��'- '� 'nt. ftisr tt,tu °t ��tl ( ��I.1F(11�. �_.._�( 7v,n ,u.e�zrG h } t £ 3.,:�---� � 1�M1if t �� i l � �eC. �GI I� Rrt! >r I r�� ' �� l3 �(itu , !. i r r'� I � SP�CIAL F#Ef3dTtREfl+f�PitS � --- , _. _ � ; i�1t' 4 2 i ;�� a 1n - } s � `; 91�i��€�z.1- 3J7 � 1t�;latt it c u � ML�trl, � ��r3 I � �' j j j <zer, t� n h�l, +�x� tc �p ra rt3 � _. � i � ��Ff1�.�t��xS � ..�.� P tlry V'it3�tii .:c ��t �',. � . ;t� S i� � i �__+ t 7 'ttCV74 HO��j�ti i L j S t<�� .) S» � e: 4�r,,, . ( ; �'l: � ti-S�tc �li _ .i4< ti i1ttS � ' t 'I'd, { Iria't f (� _.,.' a '.tk� . �� . ....__ . ._.-. . , . , _..._ . � .0. li, . .��ic ,,.�, [ L 'r i_ i � � � � ..v . . , . . , � ! i � ; � )i;.�rt � 4 ... i1 C at..( O ..� .. _._._. ._ _ _ t _ _.. _.. .._.__._, y .. .. , .i' _ 1 .. . _ . .. �� . ' . . . . ...St . _ .. ._ _�. .., .�f. � . , i � ! � .tr. ��F ! � ,� . .. . � __ .i .. . .. __... . , , . . � �� } t �i tl t.i �. t .. . i : . . ,...._ .J , ....:...___. ___� .._ _.__ � .»._..... .� ...T._.. ._ ... .. _. . . - , �.__ ......� _,. _ ' 77 � � Refiea� g t�e ro�t�i��1 rq __ € VlCSC�2TtG}N.`1 f?�xAF�L� 7t1 Gt7Gt7 l��s"t!1. P�,�E Ttt>ES .__ } . ._ ... , . . _.. . . .?,� iti1?`*tlh � ti(1 �6e��: t < _} (Cttn�i�4�Tr3) �i dC��.11EFi3��'tt> >uu iti•- it ti � ��Ry tk S�i7�itati ( Cii u .n.t� n rrul ta �t � r. rrt �.p ar' fat< I.e � 7� tt � F dUzriG �i2 s r r�cn< n r� xf rt re �,.trdr r ant€,�r �� _�. .__... � � �. 40?.i1tC) . (�5mn�cri2h �'3u . ' tt}�t��kti- � ,�� t�< rrr.i.:i t r � �� <<rr � :• 'hc " x�� o�t�<:it ' , �'k,X � � it) F . � t r� t�U _ _ .._ . _, � �.�..._..---- — - ----- _. �-0Si3.1 iil.i � ir�i i r�.ic�t o.�,�e.;,3 P+.�r r<� „I 13ci^t i �tfee� Goo�Reta�Prac�ces FE 57P.Ofh1 � � 1�ia�� . _�� r 13na�r�rt i . d E`er �r r=� I t� l c'0'. � '(�� Pr�per Caoiing oi PNFS � i Lt Fc�i �d'��i„Proi< tEc _. �°C' � i�'� � � 26 gui m<r, and Utenoi�s f . n nn � 5iil.E••'-{�lj � {tw;d�tt.,C:+��l..t1 P}I7=c(,-ixu ! lt}��7=t�� 3 ;`"c+- . . `rJa`er P�.mC��n Utd �1 0 +e .+_�C' S GG> ! � _ � _ �_ . . -� - �-- - � � Zt�'F WiGnin '�-[ou-c sr�i F�n� 7=FE' } � o . PhJs r�.Ea i�Ep�- -..- ; FC C : .('i07 , 7 � � ; F�.'"1 14 tk ro 4}tn�� ? 1c ' �s �� or � an ._.. ..� _ .. ---..--�_`1 .-- _ . �� r z s i t, � CJOS ��-.,l;1.id(hj � C i�shi h Pi(� �i �3 !c-nz-1mb[ent � � 'a 5�a. f F �,�rnmcv, -. .- - ,'. � I��nH�tu�i�rc (i rec..e7�,su {i Cld<`t � I_ao " t�+hc . . _ _ . '- i ._ _- ' -- '_._ ' � !.itt,in 4 tl�x¢ i . _t ., �_�_.___."_...._'.__._.-____�...�.___._.._..__.' '! � t ;vie:!'nl`e ;in�hr(.�4 1 ��vicou( ... tgiC ..,p:'.+: �4 C � CITY OF SALEM � � � ` BOARD OF HEALTH � Establishment Name: ��7:C�N �lt_.�YlC.O Date: II I� IO� Page: a of o� �tem Code C-Cr�t�cal�tem DESCRIPTION OF VIOLATION/ PLAN OF CORRECTION Date:.. F No. Re4erence R—Red Item � .Verifieil�. � . PLEASE PRINT CLEARLV i �l,U .�� Cca� � --, et -�'� .5c .�i oc�� p ol. , i —�1�5 �� i r1 I�C�� n; in � C�`�r PC�'�P�l . ; — � , a � �n� � , in .5 e cfi on � �_.. k,P c . c��_.a c� �c�r, —{-� n �� , '>� ,,r�o,� . � �k� ' <� �. � ' _ � � i t - ; � � � ; � � � F � � .� , �- i 3 i � — � t � > � Discussion With Person in Charge: Corrective Action Required: ❑ No O Yes I � ❑ Voluntary Compliance ❑ Employee Restriction/ I have read this report, have had the opportunity to ask questions and agr�o correct all Excwsion violations before the next inspection, to observe all conditions as described�an t � ❑ Re-inspection Scheduled ❑ Emergency suspension � comply with all mandates of the Mass/Federal Food Code. I understa d�that � �'��.� noncompliance may result in daily fines of twenty-five do lars or� uspension/r�vocation of o Embargo ❑ Emergency Closure your food permit. 4 ❑ Voluntary Disposal ❑ Other: P 1 i � � . , ( � � t i �� V \ v . )�!1.14(C� PtiFs Received at Tempr;raWres V7olationa Related to foadborne If/ness(ntervenirons antl Hisk Accrording m Ixu�Coolecl w � � Facto�s(ltetns f-22) (ConL) �. - . ____}_� -9l'P/45"P W ithin 4 Hom's. z � . I 3-Si)1.]5 Cailin�Meff�ods for PFIFs PROTECTION FROM CHEMICALS ` � 14 RHF Not and Cold Holding 14 Food or Color Addieves 3-2U�.I2 .4dciFtives* �SOt.T6[g} Cotd PHF s Nlaintuinut at or be3c+w 590.x�(F=; -ii`(A�`F,• 3-302.1�k Protection frpmUnappre�•ed AdJitives^; I 15 Poisonous or Toxic Substances — —� � 3-597.1 G{Aj H�T PHF�i4tainta[uect at or above � � � --{ I 14(1'F,a . ( �� Ideruf m tni'��nnti�n-Od<�inal I t)I.11 i _ t i . o I � .. �L�lN.15(A! ��ft(�a5ts Held aC or above 13Q°F� �' i C�.i�atainers�" ^� -- ---- - --- !- , - -- �j j 2f�� _ � Time as a Pubtic H�afth Cantra# . . . .. ,��,�. _��_._....__..- '; .' _,�i . �� ,x - ' 7 10Z.I1 � Ci>rotnnn 4tivie �1_rki�„C .�.inr_r, t------- ,; � �_----}-.._ _ .. __- -� - 70Lt�; l unc ng a F'obli�;Healt6 C'oetral`� ') 7 'l0 t.l� t S_(7a �ticrt-SPora�.: _..._____- � t ��r u.-�.. r '-� ?-2U2.17 Petit,zcnon-Pr.�,enceeu�dt,zc* °U_tE�.,H) .,�ar-mxR�t�iren2�at _ ._i � �--- 7 ?C' 1��.12 Condip�m of l�,v �� 7 �US.fl Tox�c Eux.ime� "roinSx�.,on RE4t71REMENTS FOR HIGHLY SUSCEPTI�LE ��— — .— — - - - P4PUlATtONS(F3SP�_ ---.� t-2t)d.t) Suniu eiti t.riaria Chzi�uctiv �- -�-,- � -�-- � - -- - ' 2F �-ri�.i. lilj ihip� seuiircdPrc �a� ��;cd1t�3�zc�uicl � � ° '4AA�.t"' C-h�ntt �i�t i�\§ ��hu r l s�dn c t i t.��z r,— - - -� . ... -..� I �3eFez a e. ��th k n�in lat Is` �--_.{ �7 °O=V.i�t �Dinn�, 4i � e.Cnt �ii ' � �- b0; liiB� � ll> i' i�nte.uii�dEn�" I , , �{15_7 1 in<td ��t al t xx](ui+�u l.nb �i� 5� �� ` _g�,3 I tU}�ka� ur i'u��ai; uK-�i.��aurxl Err�;�and 1 � 7.`'06.1! i{�>t�ri � 1 l i�.Pc q uae�. 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I �-4�C)� i!(7 � � ��c»�umn�tr�q c<,d Vor ic 55 + �?:el` � ` ttam 1 GoodReiarlAr�rtrces FC_ 59DOfh� _ h�act.* i �2 4a�aynmc t a C P r �r _ , r(,� � ^�__ � ��.��_�Proper Cooiing ot PHFS� _ C�`� F '� r-i a�Vro rrS o� _ FC� + v04_ x �� 2� ��u rrenf anQ Uke 3 q F�.�-� �6`: I �-.Sbl.t"-(A) {zK�lin�C.xik,tiPNtcF=xtnt ,i �t�`tn�. i� vJaferP� �bt.rg:tt .+.se PC- > _ Of�:�_. - ---,. I i �r f Wi�hin � lic�ur. and(n�� .��c . � �r F�}�s r � ��ty �- . FC-f 067 � i � ( Al I'-4�'�r t4�tf in t?inu E 2d � r c�s> >>a�� x � ct i�� r� - 7 Q0�' . r __._. __ _ _ _ _ - , �91.i4iBI t �r qnL b'i{6 11 +!c €�ro i4 �ar risut � i ° �5��.i s R�t e x�c� 4D. . _..... _.--... . __ i � � 1i1�,iCa�t`TLiltlCCtie:lii5,� a� t/=4$'F j � � ntfiPr ' .. _ ._ _."_ ' _ ._.__. ..._. . I l�IL�II(t$(-[tq.it+ ` . •�t �, l��__._.__..�i :..__.._____...�_ _`"'__"_—f `Uci�i.4i cYiucal�u �n'�?ir.lt r I I��)�r,v� -_�.. ;,.5 C u `Jiri:.. ; � � Commonwealth of 1VI�ssachusetts - �' � City of Salem Board af Aealth Kimberiey Driscoll 120 Washington Street,4th Floor Mayor SALEM,MA 01970 I Food/Retail Establishment Permit �i DATE PRINT'ED: 11/OS/2009 � _ I ESTABLISHMENT NAME: Cafe Kushco FileNumber:BHF-2004-000090 12$W251liIlgtOIl SV¢0t � �� Salem MA 01970 LOCATED AT: 0128 WASHINGTON STREET SALEM, MA 01970 Permit Type Permit No. Permit Issued Permit Expires Fee Restrictions/Notes FOOD SERVICE eHP-2009-0596 Nov 5,2009 Dec 31,2010 $140.00 ESTABLISHMENT FROZEN DESSERTS BHP-2009-0597 Nov 5,2009 Dec 31,2010 $25.00 Total Fees: $165.00 PERMIT EXPIRES December 31, 2010 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 Saititary Code,beofre any revonations,improvements,or equipment changes are made,all plans for such must be submitted to and approved by the Salem Board ot Health. Page i � � CITY OF SALEM, MASSACHUSETTS , ' • B0�1RD OF HE�I.TH 12O WdSHINGTON STREET,4°i FLOOR TEL. (978) 741-1800 KIMBERI.EY DRISCOLL FAx(978)745-0343 MAYOR UGREL:NI�AUM([7�SALEM.COi�T D��RD G1tEstvsauvs, ACI'R�rG HF.�1I,T7I AGENT 2009 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT NAME OF ESTABLISHMENT -Cey�e—fL�cIG!/o �n/L. TEL# 9�b� - 7�/S- 69yb ADDRESS OF ESTABLISHMENT /2�' i.vul�ihe •�� S��J/9�AX# MAILING ADDRESS(if different) EMAIL-Business': Website: OWNER'SNAME �,�LAy/-� TEL# �l��f - ZS)-S`�P� ADDRESS_Z/U 2 ua. ,ri Ce.�� !� fu�le Zl� I/'�/�e r� y Z�l Z— STREET CITY T STATE ZIP CERTIFIED FOOD MANAGER'S NAME(S) �in//' iLr=LL'SO6L�I CERTIFICATE#(S) (Required in an establishment where potentially hazaMous food is prepared) , . EMERGENCY RESPONSE PERSON t)�� G jCeCeSo9�ZN HOME TEL# Zo 7� D��- %��b DAY,S,%OFtOP,ERATIONs,��Monda ,n,. ;,`�-y�;Tuesdayi` ;�.�,"�W.ednesday�;'i �'"Thursday��,��;,�Pridayx , ;�°I,, ,: Saturdayr,r�;s'', {�SunCay�§�<> HOURS OF OPERATION � � Please write in time of day. i lUey�-///i'�! i /UaN-/(/�/'� i /dw+I-/(Fi ' !�eis�-//ii' I(Oasnl-// /N ! �(�ir„�,// I`7 � /Qw�if-C�� Forexam 1e11am-11 m I � � � � � � ; TYPE OF ESTABLISHMENT FEE (check onlv) RETAIL STORE YES NO less than�OOOsq.ft. _$70 1000-10,OOOsq.ft. =$280 more than 10,OOOsq.ft. =$420 --------------------------------------------- -- -------'--------------------------------------------------------------------------------- -- --•-- RESTAURANT YES NO less than 25 seats =$140- (Outdoor Stationary Food Cart$21 25-99 seats =$280 more than 99 seats =$420 -•---•--------------------------------------------------------------------------------------------------•------------------------------------------------------ BED/BREAKFAST/ YES NO $100 CHILDCARE SERVICES/NURSING HOME..-------------------------------------------------------------------------------------------------------------------------- ADDITIONAL PERMITS MAKE (not just serve) ICE CREAM, YOGURT/SOFT SERVE � N $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 under the pains and penalties of perjury that I,to my best knowledge and belief,have flled all state tax returns a i II state taxes required under the law. - — // 7� D% 27— /2/ l�T3c� Signat Date " Social Secwity or Federal Iden[ification Number ------------------------------��----- ------------------ Revised 424/07 FOODAP2008.adm Check#&Date �O-0 7i/,� �{ $ 5' I i FROZEN YOGURT � � SANDWICHES A!o Su � 23 — Ham and cheese ....................................................................................................... $635 PIAIN .....S3J6 � � 24 — Smoked turkey ...................................... ..................................... . ................ .......... $635 ,� � SUGAR FREE .....$3J6 , 25 — Turkey and Avocado . .. ................................ ............................................... ............ $7.29 �r� � .,'�-� � � � .--^"'� , f � A yi 1� � � _ � 26 Roast beef ..................................................................................................... TOFU .....$3J6 (� N S/f) ...........$635 y ` / 27 — Egg salad ......................... ................................................................................ .......$5.88 �' �� J��;' � FJ � � -� ��'rY �, ` f� - ,;% � F�VO� 28 — White tuna salad ................................... ....... . .. ................. . . . $7.29 � � : '; % V., . �. ..: _ m.= f'�;,. ^' i ........... ............... <,�'�,' t_' : 29 — Chicken salad ............................................................................................................$7.29 .� , : . y�,�- Oreo, Kit Kat, Coconut, MM, Banana, f, y, Butterscotch, Fat free elfin, Scor, 30 — Prosautto and provolone ...........................................................................................$6.35 �, _: 31 — BLT ............................................................................................................................$5.88 Cradin'oat bran, vanilla, Ginger, Milky 32 — Corned beef ..............................................................................................................$7.29 Way, Peanut butter, Wa/nut, Raspberry, 33 — Pastrami .......................... . .. ......................................................... ..........................$7.29 � Reese's, Granola, B�ownie, Cookie dough,. �. ; q 'Y�"', y , 34 — Grilled chicken .......................... ........ . ............ . .......... . . . .................. .. ..........$7.29 Mint choc Peanut MM, Peach, Snickers, 35 — Fresh mozzarella, tomatoes and tresh basil ................................................................$635 - � - �� ' CHOC. chip, Heath bar, eutterfinger, 36 — Goat cheese, roasted peppers, eggplant and pesto ....................... $7.29 � . ' Nest/e's crunch, Choco/ate, Twix, Coffee, �� _ " �w �� ' � 37 — Smoked mozzarella, tomatoes, roasted peppers, oil and vinegar .. ................. ..........$7.29 ' y�f /1�[, �(� , Pistachio, Marshmallow, Decaf coffee, 38 — Prosciutto, tomatoes, fresh mozzarella, roasted peppers and basil ............. .. ......... $7J6 ; . �� ' �� r ' l • r•. , Grapenuts, Mocha, Cherry, Cinnamon, 39 — Grilled portabella mushroom, roasted peppers and goat cheese ....... . .. . ........ .........$7.z9 , � *",�-.�F,{ : �'� �v � � � . A � M1 Uanilla wafer, Caramello, Cheese cake, 4 0 — Smoke d sa lmon, goa t cheese an d capers on a Frenc h ro l l ... ..... .. ................... ......... $7.Z9 ' � a; j�� ;� � ��f�� = �� .. Pineapple, Strawberry, Malted 41 — Grilled chicken, bacon, avocado, lettuce, tomato and ranch dressin � �' �'"`�� "r fi.�"y „ � � � g .......... .. .........$7.76 e P e p p e r m i n t, B l u e b e r ry, H o n e y g r a h a m, ` 1� � Y „"�' ��.' • .r,',u r-- Peppermint patty, Choc. chip cookie 42 — Gril led chicken, portabella mushroom, smoked mozzarella and pesto ..... ..... ............ $7.76 ; 'a,,, A��,�,�.,r,��,� +�,' t ;��.4 � �i 43 — Gnlled chicken, portabella mushroom, artichoke hearts, capers and prosciutto .... ..... $7.76 ��,;�"� �'.�, � z��*�°;. ; - FROZEN YOGURT MILK SHAKES ...$5.41 44 — Meatballs on a French roll with melted provolone and marinara sauce ........ ..... ........$7.Z9 �.,�„�" ''-^ SMOOTHIES .....$5.41 DOUBLE STIIFFED SANDWICHES ..... $7J6 each BOSTON COLLEGE- Chicken salad, bacon, lettuce, tomato p D ESSERTS RED SOX-Smoked turkey, ham, Swiss, coleslaw and Russian dressing ��p. 7 4 5. 6 9 9 6 PATRIOTS - Pastrami, corned beef Swiss, coleslaw and Russian d�essing BANANASPLIT.....$6.82 REVOLUTION -Smokedturkey, bacon, lettuce, tomato, co/eslawandRussiandressing � 128 Washington St. • Salem, MA 01970 Whole banana with your choice of frozen CELTICS -Smoked turkey, roast beef corned beef co/eslaw and Russian dressing � yogurt, topped with strawberries, BRUINS -Smoked turkey, pastrami, roast beef, Swiss, coles/aw and Russian dressing � I pineapple, hot fudge and whipped cream gREADS BROWNIE SUNDAE.....$6.35 Foccacia, white, wheat, rye, multigrain, French roll, pita Warmed brownie slices with your choice CONDIMENTS of frozen yogurt, whipped cream, Cafe H ou rs: 7 days chocolate chips, walnuts, hot fudge Mayo, Dijon, yellow mustard, ketchup, pesto, sun-dried tomato spread, black olive pesto 10:00 a m to 1 1 :00 pm. , c►nssic surv�AE.....S6.3s ACCOMPANIMENTS Your choice of frozen yogurt, hot fudge, strawberry, pineapple, whipped cream, Lettuce, tomato, wcumbers, green peppers, walnuts onions, alfalfa sprouts, carrots, pickles si�E o�ERs Free Delivery Ask about our Pies Jasmine rice ...$2.82 • Coleslaw ...$2.82 • Potato Salad ...$3.76 • Hummus ...$3.76 . . $10.00 mm�mum HOT GRILLED SANDWICHES COMBOS .......................$9.41 each COFFEE H51 - Grilled chicken, provolone, caramelized onions, tomatoes, sun-dried ........................ $7.76 Soup and half a sandwich • Soup and garden salad • Garden salad and half a sandwich tomato paste and mesclun mix SOUPS ...........................$5.65 i 6oz. Bow� C.O.D./Decaf coffee ......... $1.43 H52 - Smoked turkey, caramelized onio�s, Swiss cheese, tomatoes, pesto, mesclun mix ..... $7.76 Lemon Chicken Rice • Minestrone • French Onion • Clam Chowder • Corn Chowder • Chicken Noodle Tea .................................. $7.43 H53 - Eggplant, fresh mozzarella, tomatoes, roasted peppers, sun-dried tomato paste ...... $7,75 Mediterranean Veggies • Beef Chile • Three Bean Chile • Tomato Florentine • Beef Barley wNeggies ��ed Tea ........................... $1.90 and mesclun mix HS4 - Portabella mushrooms, caramelized onions, Swiss cheese, Dijon mustard. ................ $7.76 PITA ROLL UPS Specialty Drinks and mesclun mix 09 - Veggie................... ...... . ....... .. . . . . . . . . $635 . . . . . . ... . ....... . . . ........................................................ HSS - Prosciutto, tomatoes, fresh mozzarella fresh basil leaves and olive oil ....................... $7.76 Lettuce, tomato, cucumber, carrot, green pepper, onion, pickles, sprouts MOCHA CAF� .................. $2.62 HS6 - Grilled cheese with tomatoes ..................................................................................... $4.24 Coffee, whipped cream, 10 - Greek.........................................................................................................................$6.59 MELTS Ve ie roll u with feta cheese, black olives and Greek dressin add chicken.. 7.7g choc. syrup, hot cocoa 99 P 4........ $ 11 - Humus.......................................................................................................................$6.35 CAF�AU TAIT ................. $1.90 H57 - Tuna melt with tomatoes ............................................................................................ $7.29 Coffee, steamed milk H58 - Ham and Brie melt with Dijon mustard .......................................................................$7.29 12 - Tabbouleh..................................................................................................................$6.35 CAF� COCOA.................... $1.90 H59 - Smoked turkey and Swiss melt with coleslaw and Russian dressing .................:'..........$7.29 13 - Avocado and Brie.......................................................................................................$7,29 Coffee, hotcocoa H510 - Artichoke and provolone melt with tomatoes and black olive paste ........................... $7.29 14 - Falafel and Humus.....................................................................................................$7,29 OREGON CHAI............. $2.86 . .... PIZZAS AND CALZONES 15 - Garden Burger............................................................................................................$7.29 HOT COCOA ................... $238 16 - Chicken Kebab...........................................................................................................$7.76 PIZZAS SMALL uacE CALZONES 17 - Grilled Chicken...........................................................................................................$7.76 Espresso Drinks Cheese ............... $6.35 $70.99 Cheese.............. $7.29 =` One topping....... $7.35 $11.99 18 - Grilled Chicken Caesar................................................................................................$7.76 One topping...... $8.29 ESPRESSO ........................ $1.65 Two topping....... 58.19 $12.99 Two topping...... 59.29 18a-California...................................................................................................................$7.29 ESPRE550 CON PANNA ... $1.65 Three topping..... $9.79 $13.99 Three to m $70.29 Avocado, olives, provolone, tomato, mesdun mix, sprouts, cucumber, PP� 8••• . Espresso, whipped cream Four topping.......$10.19 $14.99 Four to in $11.29 olive oil and balsamic v�negar PP 8�• •• MOCHA CON PANNA...... $LFS 18b-Mediterranean Tuna............. ..... ••••••••••••••$�•76 Es resso, wh� ed cream, .................................................................. T IN White tuna, marinated artichoke hearts, black olive paste and mesdun mix choc. S ru PP Chicken, pepperoni, ham, meat loaf, sausage, turkey, mushroom, broccoli, artichoke hearts, Y P s inach, tomato, e lant, arlic, 'ala enos, roasted e ers, sun-dried tomatoes, onions, 18c- Roasted Vegetables....................................................................................................$7.29 ESPRESSO MACCHIATO .. P 99P 9 � p P PP Hummus and mesdun mix $7.65 green peppers, black olives, feta cheese, goat cheese Espresso, foamed milk 18d -Beef Teriyaki...............................................................................................................$7.76 AMERICANO ................... $1.65 SALADS lasmine rice with orzo, roasted peppers and teriyaki sauce CAPPUCCINO ................. $z.g6 01 - Garden Salad - crisp iceburg lettuce, tomatoes, carrots, green peppers, cucumbers .... $5.41 18e-Chicken Teriyaki..........................................................................................................$7,76 Espresso, steamed milk, 02 - Mesclun Mix Salad - mesclun mix, tomatoes, cucumbers, carrots, green pepper ..........$5.65 Jasmine rice with orzo, roasted peppers and teriyaki sauce plenty of froth 03 - Fresh mozzarella and roasted peppers - mesclun mix, fresh mozzarella. ...................... $7.29 18f- Crab Meat..................................................................................................................g7.76 CAF� IATTE .................... $2.38 roasted peppers, croutons and black olives Mesdun mix, avocado and carrots Espresso, steamed milk 04 - Goat cheese and sun-dried tomato - mesclun mix, goat cheese. .................................. $7.29 �gy -Meat Loaf..................................................................................................................$7.76 MOCHACCINO ................ $3.10 sun-dried tomatoes, croutons and black olives Lettuce, tomatoes, onions and marinara sauce Espresso, whipped cream, OS - Greek Salad - garden salad topped with feta cheese and black olives .......................... g635 , , $7,76 choc. s ru steamed milk 06 - Grilled Chicken Salad - mesclun mix salad topped with grilled chicken breast ..............$7.29 18h -Pork Back Ribs...................................................... Y p, 07 - Ceaser Salad - romaine lettuce, croutons, parmesan cheese .........................................g5.65 Lettuce, tomatoes, onions and barbeque sauce CAF� MOCHA ................. $3.10 add grilled chicken............$7.24 18i- E99plant Parmesan ................................................................................................... $7.29 Espresso, choc. syrup, 08 - Chef Salad - garden salad topped with smoked turkey, ham and Swiss cheese ............ g�,24 18j- Chicken Parmesan .....................................................................................................$7,76 whipped cream, hot cocoa 8A - Spinach Salad - spinach, sun-dried tomatoes, capers, pine nuts. ..................... $ IATTE MACCHIATO ........ 52.86 .•••..••.••• 635 SPECIAL ROLL UPS . $7J6 each Steamedmilk, ....... ack olives, parmesan cheese ........................................... a gri e c ic en ...........$7.29 stained with espresso 19 - Eggplant, sun-dried tomatoes, fresh mozzarella and roasted peppers SALAD DRESSING 20 - Grilled chicken, avocado, and sun-dried tomatoes EXTRASHOT ....................55¢ Greek, Russian, light Italian, honey Dijon, blue cheese, creamy caesar, 21 - Smoked turkey, fresh mozzarella, and roasted peppers fat free ranch, fat free honey Dijon, Balsamic Vinaigrette, olive oil ZZ - Grilled chicken, eggplant, fresh mozzarella and roasted peppers CITY OF SALEM BOARD OF HEALTH Date: November 2, 2009 Name of Establishment: Cafe' Kushco Inc. Address: 128 Washington Street Street Owner(s): Dinc Kelesoglu Phone: 207-841-9856 Mr. Kelesoglu presented a Floor Plan and Menu for review in accordance with the State Food Code. Both are approved as presented. Owner to h�d write No Sugar Added for frozen yogurt. This must be added on the next menu printing. CERTIFICATION Mr. Kelesoglu is not a Certified Food Manager at this time. Information on classes was given to Mr. Kelesoglu at time of this review. Current owner Derya Stefford is a Certified Food Managers (CFM) and has agreed to stay at this establishment for one month. Ms. Stefford will be the Certified Food Manager. There must be at least one full time CFM at this location. The proposed owner must provide a copy of his certification upon receipt. If certification is not obtained an CFM must be hired at this location. 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 if new owner is to have 25 seats or more. If additional seats are added you must notify the Board of Health and must have someone that is Choke Save Certified on hand any time it is open for business. ' FLOOR PLAN A Hand Sink will be located in the front prep area. The hand sink 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. This includes any such areas in the basement if these products are to be stored in the basement. A three bay sink for washing, rinsing and sanitizing all utensils equipment, dishes will be used. This three bay sink must be NSF certified and large enough to provide an adequate number of service ware and to hold all equipment. MENU/FOOD PREP At time of review I spoke with Derya who will be the Certified Food Manager until Mr. Kelesoglu becomes certified. 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 boiling 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. EXTERMINATION Monthly services of a Licensed Pest Control Operator are required. Please keep receipts for inspections. Before the new owner can open this establishment for business they must provide a signed contract with a Licensed Pest Control Operator and an initial inspection must be conducted prior to opening. 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. Please call for a change of ownership inspection. An ppli�Cati nd check was not submitted. I � � David Gr enbaum Date Acting H alth,Agent /� � � � � 3 �vq Dinc Kelesoglu Date r 2-�� 0 M � Z� R.� � ��yzzs� I �`'o/�,�n S �--! ( �1 �� a�H� � � �j t�l I�"( . , (:.,._zJ �a n � �J � �: ,�o�� mas � � j ` l I �-�) �_ � 1 �1�{�� O�S 7Y�1� �x' y` � � 3 � � f Z '�� ' / � � ' " � �� l I�, COI�E ��i� �� d I C- w o g'�> c �� C a U N`�/�R z . � � c�`KE . � � � . � " i �h � �} / . � � � � � ., [�� / � - � __�-�� Blend-Ins NSA VANILIA -Z W4 fle�4 qff'a r Y� nd�'U�gum, oilat quaasparame,and M�Ulfafn,0 p0t=ium COri(Milk) OF',809 #2533 IMPORTANT MESSAGE FOR A.M. DATF= 6- )Jo- TIME -P.M. rvi pl� OF PHONF= �,R�C:QOE� NUMBER EXTENSION U FAX Ll MOBJI F= AREA CODE NUMBER TIME TO CALi- TELEPHONED PLEASE CALL CAME TO SEE YOU WILL CALL A(3AIN WANTS TO SEE YOU RUSH RETURNED YOUR CALL WILL FAX TO YOU MESSAGE SIGNEO FORM 4009 MADE IN U S A NOTES ( IMPORTANT MESSAGE FOR 4[EAM D DATE &212,51C)q TIME M m4i4k - OF PHONE191 - �Mfi 0 6 - -- T -T ARa C011ff NUMBER EXTENSION D FAX U MOBII F: AREA CODE NUMBER TIME TO CALL TELEPHONED PLEASE CALL CAME TO SEE YOU WILL CALL AGAIN WANTS TO SEE YOU RUSH RETURNED YOUR CALL WILL FAX TO YOU NAF-��'-ArZr- VqQ hr - 'U&7�&— ? c�ttCaL�- - j IGNED AMU lqv FORM 4009 MADE IN U S A. u NOTES ..: . : • ,,, ; +� Commonwealth of Mas"sachusetts ` f City of Salem Board of Health �(It11(�f�gY Df1SC011 � 120 Washington Street,4th Floor Mayor SALEM,MA 01970 Food/Retail Establishment Permit DATE PRINTED: Ol/02/2009 ESTABLISHMENT NAME: Cafe Kushco FileNumber:BFIF-2004-000090 128 Washington Street Salem MA 01970 LOCATED AT: 0128 WASHINGTON STREET SALEM, MA 01970 Permit Type Permit No. Permit Issued Permit Expires Fee Restrictions/Notes FOOD SERVICE BHP-2oo9-034� Jan 2,2009 . Dec 31,2009 $140.00 ESTABLISHMENT Total Fees: $140.00 i PERMIT EXPIRES December 31, 2009 Board of Heaith . � . . . . . . . r This Permit is not transterable 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 ti :�,1 � CIT'Y OF SALEM, MASSACHUSETTS + �' � B0�1RD OF H&aLTH 120 Wf1SHINGTON STREET,4"{FLOOR TEL. (978) 741-1800 KIIvIBERLEY DRISCOLL F.17;(978)745-0343 �'�YOR � NIONNE'([�SALI3M.COM Jf1NET DIONNE, ACTING HE�ILTH AGE:�TT 2009 APPLICAT ON FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT % r / NAME OF ESTABLISHMENT CQ TEL# .� ]�� r 1 V�� ADDRESS OF ESTABLISHMENT V FAX# MAILING ADDRESS(ifdifferent) \QJ� � EMAIL- Business': I Website: OWNER'S NAME�� Q TEL# ? 2S 1 � oC�`� �I.-� � ADDRESS�1r7 M� l� �� - c�.UV1i1 ��- �I`�'1� STREET � STATE ZIP CERTIFIED FOOD MANAGER'S NAME(S) � CERTIFICATE#(S) . (Required in an establishment where potentially hazardous f is prepared) � EMERGENCY RESPONSE PERSON��l p HOME TEL# DAYS;OF OPERATION =-Montl - .-Tuesda � :Wedne'sda ' �. ±.-Thursd ' .` •Fritla � Saturd ',i Sanda . '; HOURS OF OPERATION ^ / � i i � ; � � Please write in t'one of day. � X I �/ � 1l (Forezamplellam-11pm) f� i /� /� TYPE OF ESTABIISHMENT FEE (check onlv) RETAIL STORE YES NO less than 1000sq.ft. _$70 1000-10,OOOsq.ft. =$280 morethant0,000sq.ft. =$420 ------------------------------------------------- -- ---------------------------------------------------------------------------------------------------- RESTAURANT YES NO less than 25 seats =$140 (Outdoor Stationary Food Cart$21 25-99 seats =$280 more than 99 seats =$420 ---------------------...---------------------------------- -- --------------------------------------------------------------•------------------------ BED/BREAKFAST/ YES NO $100 ' CHILDCARESERVICE$------•-------------------------------•------------------------------------------------ ADDITIONAL PERMITS --------------------------------- MAKE (notjust serve) ICE CREAM, YOGURT/SOFT SERVE YES NO $25 TOBACCO VENDOR YES NO $135 ALL NON-PROFIT(such as church kitchens) YES $25 'Please pay total with one check payable to the City of Salem. This Pertnit is not transferable and must be reissued upon change of ownership.The Permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Cade, before any renovations,improvements,or equipment changes are made,all plans for such must be submitted to and approved by the Salem Board of Health. Pursuant to MGL Chapter 62C,Sectio 49A,I cert'rfy under the pains and penalties of perjury that I,to my best knowledge and belief,have filed all state tax retums d paid all stffie taxes r quir der t law. - � � 2 � � "� Signature te Social Security or Federal Identification Number Revised 424 8. m C eck#&Date ��()� l��fj( a � ` ._� ' � k � t' 1 t My Fle ��-Edit;Tools�-Help ' - - ��, �,�;„ :� X'� �, R� �M �3+#� :.�, �� ,�'. � , � �"� �`' � � �., � �; *'� � } 3'. . � �.. .:.. ��..,.�, .. .v. .� ! � ¢ > �tl Detail = �T p�operty Code SD349 _ 'n ,'� � y ` Notes/SC � � - � -.ElfecUveDate: il2/31i200� _�_ ,_ � .-, ._�.. __ `= — — I CustomerFile � '�'Year �Cat � �,Bdl NSC �OngBdled '' �Acliviry r (��UnpaidBal �� DueNows , � �D`, EffecliveDate E �;- 2007PP-R 162 � 179.59 -178.59 .00 .00 � ; 2008 PP�R 159 � 166.05 �123.79 45.75 45.75 � , 2009 PRR 153 � 16025 .00 163.65 126.08 � ,� ' , . � .' ,� .! �. � '. t . � �. ,k'�: C : �. � � ; z � � € I. ' i �F l: ¢ : . ( fi I � ��I� '. � � � DEC �k 20Go � t .� CITY Gr ��,L�M� � ' . � CITY COLLk R �. � ,� PER �_..---�— ° _ � :: _ � , .,. ; ; • � �_ s: . � � � , � � �: �(,Z� � � i � � �- - — - - - . � � , ' � � r u., ;. ' { _ � : . � } n =-Tatalduenova � z 17L93 , . "^.� h . 3. �_ h � �-`Totalunpaid ': � . � �-�"; ..: _ � t... ° e: � , , �'0128 WASHINGTON STREET Cafe Kushco City of Salem FOOD SERVICE ESTABLISHMENT - FOOD SERVICE Inspection HACCP: ❑ Item Status Violation Critical Urgency , . . _ . .. .......... . ... �TeIBphOf12: '� PROTECTION FROM CONTAMINATION � Q7$-745-6996 Food C� o�ntact Surfaces Cleaning and Sanitizing FAIL Critical ❑� RED ��Wf12f: � jOComment:Sanitizer was only available at 3bay sink,not in front or back prep areas. Provide sanitizer of proper concentration(50- e Ma1'k M. StaffOffl - � . 100ppm)in all work areas at all times. �P�C� � � —Sanitizer available was too strong.Provide sanitizer of proper concentretion(50-100ppm)at all times. ;Derya Stafford. �( `If1SP2ClOC . . � � (/�+t time of inspection,there was food in the sanitize bay of the 3bay sink.Sink to be thoroughly cleaned 8 sanitized prior to use for sanitizing-do not put food in sanitize bay. . + Elizabeth Salandrea Date Inspected:Correct By: �anitizer log not being maintained-maintain daily log of sanitizer concentration.Blank log sheets given to PIC. �:4/6/2009� � �/y�licer had accumulation of food debris on it;thoroughly clean&sanitize slicer. iRiSk L2V81: Handwash Facilities FAIL Critical ❑d RED e �omment: Front handwash sink had rags in it. Handsinks must be free from obstructions at all times and may only be used for 'Permit Number. ha�dwasning. � BHP-2009-0347 ygack handwash sink missing paper towels.Paper towels must be available at all handsinks at all times. SietUS � TIMEITEMPERATURE CONTROLS(Potentially Haurdous Foods) VIOLATION Cooling FAIL Critical ❑d RED #of Critical Violations �ommenk Soups cooling in refrigeretion were not in shallow containers. Place soups in shallow containers of 4"or less to cool to � �.5 faciliWte proper cooling. . , Time IN: �Time OUT:� � � � Hot and Cold Holding FAIL Critical ❑d RED � y�omment:Soup fridge recorded at 48°F at time of inspection;soups were testad at 51°F and 44°F. Repair or turn down fridge to Urgency Description(s): � maintain temperatu�e of 41°F or lower.Soups were removed and put in a fridge at correct temperature.do not store anything BLUE: potentially hazardous in soup fridg until holding at 47°F or below. Violations Related to Good ^O{' �n �%� �� -ftX� Retail Practices (Critical ' �oke fridge at 46°F at time of inspection.Repair or turn down to maintain temperature of 41°F or lower. violations must be corrected � immediately or within 10 days)(Non-critical violations i 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 GeoTMSOO 2009 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Apr 07,2009 ) Page 1 of3 .f Item Status Violation Critical Urgency �RED:�- � � �- @� ? Violations Related to Good Retail Prectices (Blue Items) Violations Related to ' � Food and F od Protection FAIL Critical BLUE Foodborne Illness Interventions d �mment. Flour scoop was laying in flour container.Store scoop in flour with handle extending out. and Risk Factors (Require immediate corrective action) � �hildren's benadryl found in the back of a drink fridge.All personal items must be stored separately from customer items to prevent cross contamination. �time of inspection,chicken was being cooked on a small stove that sits on the floor and the pot was not covered.Cover food being cooked on this stove to prevent contamination. . Equipme/nt and Utensils FAIL Non-Cri6cal BLUE (�omment:Shelving above soup fridge needs general cleaning. � �eft freezer in back needs generel cleaning. �. ".I ,�," —Right freezer in back has broken lid.Repair freezer so lid closes and seals properly.��6 �� re �7cW�r� �)u� o�� I no �,d �. esc�..� ��,5 c�s �an opener needs general cleaning/scouring. �ke fridge needs generel cleaning in the door trecks. . �bel flour container. � �/Sfhelving above right freezer in back needs general cleaning. �rozen yogurt freezer needs general cleaningldefrosting. Physic�a`l Facility FAIL Non-Critical BLUE �Comment:There is a tile missing on the floor in the prep room.Replace tile. �an in restroom did not appear to be functioning.Repair fan to working order. Other-See Notes FAIL BLUE ✓Comment:Owner's servsafe certiflcation has expired.Inspector will give PIC information on upcoming classes; PIC must register tore-certify. ��y,L �� 14`'At time of inspection,owner's baby was in a pack&play behind the counter,and owner stated that her other child also frequently spends time in the back of the establishment.A sleeping bag was set up on top of a freezer,and a portable dvd player was set up on the hot water heater next to the freezer.Owner may not keep the children in the establishment in any prep,service,or food storage areas,and may not have any personal items, including toys&bottles, in said areas. Reinspection in two weeks, all violations to be corrected. �ease have last 3 months' eutermination receipts available at reinspection. City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741-1800 GeoTMSO 2009 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Apr 07,2009 ) Page 2 of3 ;� , �) Item Status Violation Critical Urgency � City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)747-1800 GeoTMSO 2009 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Apr 07,2009 ) Page 3 of3 r; ,-,.�.,. y, ��} y , �/�{n N�jy �• � �{�� f �} yJjyl�+ � A_P� �-'Vf '_'MV�.a` ��""f.}Vl'h...'4R:,' ..�F\T�V1�nM...i�T�'�'R ,fa'+r..a+�:{Y"yY.u��Y}`.�FR 'TI��'aE��"rE�aYV�^T��MII4.��A� •� �. � i Salem Board of Health � Ma�sacl�usetts Department of Public Health ,2o wash��9to� st�eet,4`" Floor Division of Food and Drugs Salem, MA o1970-3523 FOOD ESTABLISHMENT INSPECTION REPORT Tel. (978) 741-1800 Fax(978) 745-0343 Name�J (� Date � voe of Ooeration(sl Tvoe of Insoection � / A ./�.�tl Food Service ❑ Routine Address � � 1 C ' r^ isk ❑ Retail ❑ Re-inspection � Level ❑ Residential Kitchen Previous Inspection Telephone _ _ � ❑ Mobile Date: ,/� � n HACCP YM � Temporary ❑ Pre-operation ❑ Caterer ❑ Sus ect Illness Owner n_n A6l � n LUn/1 P Person in Charge(PIC) �1 U Time � ❑ Bed&Breakfast ❑ General Complaint � X �,R � � � ��.I_ �� ❑ HACCP Inspector �� D �� Out: _ �'Permit No.� ❑Other Each violation checked requires an ex la ation 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-Cnoking rotaeeo Violations marked may pose an imminent health hazard and require immediate corrective s9o.009(e) ❑ 5so.00s(F� ❑ action as determined by the Board of Health. � r ��. �; , �'� FOOD PRO7EC7(ON MANA6EMENj;,"�'�„ ,�,mmsw.�.�ex .,z,` . ❑ 12. Prevention of Contamination from Hands � 1. PIC Assigned/Knowledgeable/Duties ❑ 13. Handwash Facilities „ e EMPLOYEE HEALTH � � 3 , t r ,� ...�u�� . .m.,�re�,s ,�x,� . i . �. :. ,.. � i:, �.�'i.,,�,�7 rc.3wa; �� ;.PROFECIION FRQM CHEMICAk- ,s�'m.....,t r � i i2y�Q.,�ts"s.w..u��:€�.�'�?a��.° .:..,._�,r.m,�,�.,�.-��_ .�.�.,�_�a.� ❑ 2. Reporting of Diseases by Food Employee and PIC � ❑ 14.Approved Food or Color Additives ❑ 3. Personnel with Infections Restricted/Excluded ❑ 15.Toxic Chemicals i''FOODFROMAPPROVEDSOURCE�;�„� „�„„`.,�,u�,'�`"�.:��," j'"�' �;3„��,a� , .. ��TIMfJTEMPERATURE CONTROLS(Potentlafly Haxardoas Fooda)'�`�'"', ❑ 4. Food and Water from Approved Source �_ � .n�� _:� ,,� „ � s�m tlL�_ �,_,�, � ❑ 5. Receiving/Condition ❑ 16. Cooking Temperatures ❑ 6. Tags/Records/Accuracy of Ingredient Statements ❑ »� Reheating ❑ 7. Conformance with Approved Procedures/HACCP Plans ❑ 18� Cooling 1 RROTECTION�qOM CONTAMINATION = r�' � 1�,fi �� ❑ 19. Hot and Cold Holding ' � � ,....�.E,,.aai .� .Pr,.-. . ._ ,..,x �❑�8. Separation/Segregation/Protection � ❑�0.Time As a Public Health Control ' ❑ 9. Food Contact Surfaces Cleaning and Sanitizing � I`Q�REQUIRENl�N7S FOR HIGHiY SUSCEP779LE POpUIp'fIONS(HSP)g,� ❑21. Food and Food Preparation for HSP ❑ 10. Proper Adequate Handwashing ❑ 11. Good Hygienic Practices �.�G6tJSUM1AERADVISQRY" �-�23.��e�"��,.,�� wna�s.�_,�.,'a.>:.-„? ��...M.=� ❑22. Posting of Copsumer Adwsories Violations Related to Good Retail Practices Number of Violated Provisions Related � Critical (C)violations marked must be corrected To Foodborne Ilinesses 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 � �� by a Board of Health member or its agent constitutes an 23. Management and Personnel (FC-2)(590.003) order of the Board of Health. Failure to oorrect violations 24. Food and Food Protection (Fc-a)(sso.00a� cited in this report may result in suspension or revocation of 25. Equipment and Utensils (FC-a)(5so.00s) the food esfablishment permit and cessation of food 26. Water, Plumbing and Waste (Fc-s��sso.00s) establishment operations. If aggrieved by this order, you 27. Physical Facility (Fc-s>�eso.00�> have a righf 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 (sso.00s) within 10 days of receipt of this order. 30. Other �('(^V.�DATE OF RE-INSPECTION: -�� ' t � ] a�� / �/I�'(/ ///�� / �i ri� 5�5901nspeclFomb-14cbc ��'(�/. '/ �// � / � l �it> ^ �N U r V f _ �--< < � Inspector's Signature: . /� ' . Print: (,�G 4J 1 e �G� �� n 1 X PIC'sSignature: � � Print: � � . ,�. Page��of�Pages �� u �.,.- r.' '� Violatfans Related to Foodborne 1ilrsess �� Inferventions and Risk Factors(ttems 1-22) PROTECTION FROM CONTAMINATION FOOD PROTECTIdN MANAGEMENT S C�oss-contaminatron 1 590.003(A) :1ss(gnment uf Res�msibility�` 3-342.11(A}(7) Raw Animul Foods Sep�rated frrnn �590.OQ3�B)_ Demonstcation of Knowtedge"` � � -� Cooked antl RI'E Foais* � 2 103.1]. Person in cliarge--duties . Contamination f�om Raw fngredienis - 3-3021 I(A)(2j Raw Animal Foals Separated frczw Each EMPLOYEE HEALTH Other' 2 590.003(C) Kesponsibility of t6e}�ccson in charee ro Contamina6on from tha Envlronment require re�orting by fuocl emplpyecs and 3302.11(A ['oal Protecrion'" a licants* 3-3Q2.15 Washin Fruit�s and Vemetabies 9y(}_pp3(F) Respwisibiliry OYR Fcx�P,mpLoyee(?r E1n 3-304.]i Food Contau�with EqnipmenY ancl . Applicxnt Ti�ReporC"Po The Person In Utensi1s* Char*e* Contaminatron irom the Consumer 594003(G) Re oreina b�Person in Chaz¢e* 3-306.14(A)(;B) Rehuned Food and Rescivice of Pund* 3 590.003(D) Exclusions and Rest�ictionsM , D(spositlon oiAdultarafed or Cantamfneted � 590.043(F..) Renlova(of Exulosions:u�d Restrictions Food � :�-70712 Discardino or Ruond[tioning Unsafe FOOD FROM APPROVED SOURCE N'��" ,y Food and Water From Aegatated Sources 9 Food Contact Surfaces � 590.004(A-B) Cum��lianee with Food Law" 4-501.13 t Mana�l Wazewashing-Hot Wat�r � 3-201.12 Pa�in�Hermetically Seuled Gontainer� Sanidzation Tem eratures* � 3-201.13 FiuidMilkand�btilkProducts* �-�Q�•112 MechanicalWarewashing-HotWater �-202.13 Shell F;n s* SanitizalionTem eratures* � 3-20214 E��s xnd Milk Rndncls,Pas'-teuriud* 4-SOI.I l.d Chemieal Sanitirarion-temp.,pH,- 3-202.16 Iee Made From Potxble Drinkinn Water* concent�ati�n:md tuvdness. 'k 5-lOS.l.I Drinkin Water frt>m an A roved S stem� 4-601.11(A) Equipment Fcwci CQntaM Surf�accs and� 59D.006(A) Bottled Drinkin Watex* - Tttensils Clean" 4-602.11 Cteanin Fre uency oY'F ui ment Fcrod- 590.006(Bj Water Meets St�ndards in 310 CMR 22.Q* S 4 � -9 P Shel7fisR and Fish From an Approved Souroe Contaet Surfaces and Utensils'" 4702.1 L Frequency of Sxnitization of Utensils xnd 3-201.14 Fish ancl Recxeadanally Caught Mollusc�n Fow�l Coutact Surfaees of E ui.ment* Shellf sh* 4-703.11 Methods of Satuuzation-Hot Warec and � 3-20].15 Mnlluscan She71fis6 from NSSP I.istui Chemical* Sources" 10 Proper,Adequate Handwashing Game and Wild Mushrooms Approved try 2_�pj �� Clean Condirion-Hands and Anns" Re utato Aufhor'rt 3-2Q2.18 She1lsY�xk Identification Present�* 2-301.12 Cleanin Pra:edure* �590.OQ4(C} Wild Mushrocoms* 2-301.14 When ta Wash* � 3-201.17 6ame Animals� 11 Goetl Hygienic Practiaes g Heeeiving/Conditton 2-401.1 t Eatiu .Drinkina or Usin Tobacco* 3-202.11 � PFIFs Reeaivetl at Pro er Tem etaNres* 2-441.12 D3scharges F[om the Eyes,Nose and 3-202.15 Packaae liue it * Mouth* 3-101.11 Paod Safe and Unadutterated* 3-3Q'112 fYeventin Contasnination When Tastina" ( � Tsgs/Records:Sheilstock 12 Prevention of Contaminatian from Hands 3-202.18 ShelIstuck Ident�ificaCion* 54QOtF1{B) Pcecenting Contamination from 3-203.12 Shellstock IdenfificaGon Maintait�ed'" Em�to ees" 7ags/Records:Fish Products 13 Handwash Facilities 3-002.11 Pacasitc Destroctirnt�" ConvenlenBy Located and Accessrbte � 3-402.12 Rewcds,Creation and Reten[ion* 5-203.11 Nmnbers and Ca acities� 596.00�(� �abelVng of Ingredients° 5-204.11 I�cation and Piacement* 7 Conformance with Approved Proeedures 5-205.11 Accessibilit �.O eraYion and Ntaintenance tHACCP Plans � Supplied wdh Soap and Hattd Drying �3-502.L 1. S eciaPized&oeessin Methc�s* Deviees 3-502.1.2 Reduced ox en aaka �nR,critecia* 5-30111 Handwashin C(eanser,Avxilabilit� A-103.12 Conformance with A. roved Pcocedures^� �'"�Q1��1-2 Hand D �n��Pro�ision *Ue�iotec cri[icai item in the fe�'lerai l94)9 Pwd Code or 105 CMR 590.00Q. - � t � 1 � 15 ��l� � � ,�Tp� CITY OF SALEM ' C�)'/✓� l/�� /� I � BOARD OF HEALTH r� ' li timent Name:�02 . o .l1 �� Date: I!)�_� I �D?S Pa e: � of�_ i Estab s N 0 .P YI 9 � ��tem� Code � �C-CNt�ca�itein�� `��" ,w�� ^DESCRIPTIONOF,VIOL`ATION7PCANOF.CORRECTION�` ��'��xu�",,��/r` �"'� �ate �r?,� � 'No � Reterence R-RedRem� � `A "�' '. " �" '�` � wc` Verified` � . r v " , 'sx:�n,. a c .,.�v„ .e �r,i �, a,�,.b _�i� .,€�S, .�. r.a/`% . < �,'..< s,�� 'o'x � .� a k: n. �a." > � �+ PIEASE PRMT CLEUAR Y � � l�l ir � P�Aa n , .+ .,Q i�e, —`�_ � ) nn, ��,�P, I� nn��n�nMn�nn, — /le n ��/�(�V�� ne ,A,r . � ' . )/n �n/1l�.� ��1 di�.Y�/1� (�Q /�0 /\^ li 1 �i/J/�� Di A � �� /1 t /1 �1. LT/.'.' .. V y v i _ _ ,J_ � � � _ � � � � ' �._�.� _ � -- ��Pn�,n�� .+�� ,� �i�,�a, I�� I �XO /71n � n�n� ln� (.U1�4�ir1 (�Slo�.,n s�� .. , .�✓n rN�+V.-, , � , .__ _ _ � _ . � _ - � . �_ �`l �� _ y � I) � q- (� �y� !1 /� �' / ��(� I{ � � I�k1A�x ,.X-n„ � �_ie/�) (��/ r_, en�Ann — I - i /1�n,fn1V ,.,..n.lU 'i� i \lXAn. n . ��/ �_�( _I' �� n � rnn (Vl�l� .�'7� �1.�„ , D/t iv V�Y�v' .�.r(.� �' kn /�,�, �n. .,�\. �-��n�n � r-� , ��(1`b(Oito y / (TF �dl1 I erlen) 1/ b�'V�) in �� - _ ., � �� /J - , � i u - � , _ '. ,r��,r� r� ,A�i . �n� A,.�, ,�> ( �,�.�i.�n , ��--� o� nn��nnn �<n,/ . ' n ��r ,�f„-}�. t ni _n--- ��.t,�,. l�l',i n. ;vt'1�/)nn�/�, I� .n., .e �iQ� -� /� _�� I ' � � , __ . - - � _ � Vr�an:�„✓VnnO nA/ (P-lnnLY/1,�n�K/�.. � , v "� � �'� " �5� - - /1 - 1J�-lit;��a. (' a.�x�� — �ila, nor�,nrnnnn O,,�i ' � ,. _ � ,�,( -y . _ x I p ��ry�- � r''„n`K�''��-a !),/i,�s1f4!A1 A.�AI `--�!',�9 /ai `- 1'1 sl � �t�I � A 0 n/Inn(Mn n,QO� �( p � C :� - - �j � � (� � /j ,n1' n � ' %)r/—� -/an� ,: (� O.�OABf�. 11M/�nll /�nA.l� �A r�i�.v �l-YO il/I� 1 I� Y .. `} lY�(_�1�n/9..�\ � v �P.BI'� _ ' � .� _ _ � � V" ,t — l�,/) h,l,!/).f_�.�.�P� A r�i7�f.�� Xi �n '�--��f� t ,�,f11�/P ,_( l ".� P�,�G '� . � S �,t �'i. � ` 1 (1�/wir -� J nn� 1,1� Iv ��/ARD N-�• � (� '1 /1� ! � ! 1-� ��z Pn . ,� J (`�XF 1h ..�,0_:N � I ° /dt ,�� ,� /( / A O,Y��.r,r,t�l.(,-rf J � s _ _ . — � _ J� _ �— � _ � � — r � Discussion With Person in Charge: Corre ive Action'Requfred: ❑ No Yes I have read this report, have had the opportunity to ask questions and agree to correct all voiumary Compliance ❑ Employee Restriccion/ � Exclusion violations before the next inspection, to observe all conditions as described/and to ,� .� ❑ Re-inspection Scheduled ❑ Emergency Suspension �omply with all mandates of the Mass/Federal Food Code. I under.startd�tha�t noncompliance may result in daily fines ot�twe ty- �ue d Ilars or'sus ertsion/revocation of ❑ Embargo ❑ Emergency Ciosure your food permit. �� Ce�;`�� ❑ Voluntary Disposal ❑ otner. \\\ v n } v �- . ' �,-S�tl_}.dlL�._ TFHI�aRecsic�edaP"I"ecnperaiurx�s � Vtotattorrs Ralatad to Fandborne 1lfioss lnterventions and fifsk � � 1 hccbrdimg ic�ia�.a Coq}ed qa Fsctars(Items i-22) (Caa�J � * � r(�Ff45 f kYiiiie�z�#H xurs- .. 5'tH 1��_ _—.. Cixif,ins�ieth9ds f�3r PHFs PF�C3TEGTlON FROM CHEMlCALS — _ �1A E ��aod or Cnlar Addit{yes (�.4_�___,_ PHF HM and F,oFd F#oldmg _ _._ i ;SOrt 1fi{A} � C o3d PflFs 4Rnrnt�sinc<!at or taIciw ? 262 I� �Addime.* ____�_.�� .9il.iN}d{�; t ._..� 3-�t}214 Vrou.ci�fn froznt3�e��ir�3� .d Au�diuiz5___� �2 45"t � � � -fEYl.li �Ident3f in� nfointatinn - -� � ��k IG(:�,} HniF'H2�Sir�tztaineda¢rnabirve � e Potsar�aus ar Tax9¢Subs�anc€a 13C'I. ' � Y b 1 t1t7 a.0 7fi t 16{A} Riu2it�Hetd aC ez�bave 13fl'F.* � 1 f;z>ntun r,*� ; 2{1 3�me as a Putotic He�ftt+Controi —j (._ � J.f7�17 ��zior��ima W,3rk}��t xntnxr�rs�` . ---- ..�.�.__{.___�.� I � 7 °�l.I I Sr ni at�c,n St�,�ag �� 3 SCit 13 'rt�r�as a t'3rt3fxU Hcalth Cani3•at�` � ''2i}2.27 RGsir�u an� Pc�uK�u ar�l t i 596_t}OtS(H) Y3i�aneeReqetfr�tzx.a7f �..._..� �7 �0�.12 Condzti�n�otT�sc �--� Rt�QUtF��AA�N7SPOR(°iIGPiLY5US�EPTIBL� 7'0>11 7°oatuCrsx�tainet Proliib"ttiotrs' PCPPU[.A7fON5{F3�F} � , 2t34 3'I Sunnireiti Cnierta C6c.mic ls � � 7 ?,�.1' Ch..nticrl�fnc t4,��ht�1�roc!Ree <sztena r� � � 21 �-SE?( 1 i(13� t,n� vte.ur��.,d F4e pa�P,��cd 7utccs�.cl� . . � �#ctiekaze�iWitf� 1��zs�F.au.�li�. 7 20d�id Urti7r� As-entc.(rf[eria'� .�. � ,�BF � (;�t t�#Pa�teu��x�d 1�? ,r° _ "{35.41 Ltcad,ntalh<�ad(un�act.:t�zitr�ic�nrs'�� r---�-�--------{�---�-�----- � . .--- ` � 3-$t;l S t{Et) Rrw ar Paliialla C�x�kc.�Aaima!Fa,�i a��d "06.t t RU+n�i�d l`te Pe tri iAes.Crz€eii�'� 4 � �` - --- R t;v Sc td S�r�sntw Uot 4e�rtsS � , !�7 206.22 Ral�ai �3��s S�t�ar,n�� d-8QS t i fC, t;n,} �ned Fa�i E�ac(�a��ot Re�erre�i. *� 7?06.t3 T'raektrrg f',x4vctc,rv,k't�Cuniri:I ssnd — " - --- ��P�(oaiturinia=�_._.. � � CC3t�SUMEF?ADVSSCIKiY j 2�tit};.!I t"i�nsuea�r Acis�itiery Posred tzar{'rnts�it�t L€on o£ TiPa9�tFEMRERATUFt�GC?PITROt.S --�- _. _ ___.� � �� Prope�Cooking Temperstsres inr � [ � �Fciusti F std<Tt�at ic�Raw.t'adex'u�l;ed cr: PNFa "�or f)tl�cru ts4 F'ra�titied to 131imenau� .�.�. _.._ _.. I'.tf�o c,n� x_uw, ze�r 3�-4fll,lk9t17(2; Ex� .. I�5 x iSSL� - -.-� . Y <. Lnm d��ts.S�r��tr€ 1 5 F`.l ise,c,� �{ ��- 3i)° 1'� P ete�ratt i P�.��: Si�E�.�itute E<?!�Ftt+v.•Shet1 .�_ � ...._ _._._ ...,1.�.� � « c" � 3-�it}1.21.tA}(2) CUnvnmuted F e�h.A�[eat�h t;.ma —�=- ---- — � h�i��tJs- l�z I 15 set: SPE�IAt�Ft�QBJIE3EN6�AiTS ;-4f;[.13(S}tl}t2}�('vrkandtic�tRi#i,t-i�Dt t�t �nin° i _ — 540 i}O9C��i tF7}�Violut�,rst uf Sc�L�tsn ,40.t1f)�tA}-Ct�}in� ?-4�'1.71(R)(y R suiev 1r»cct �5 Mcni� 3 9 F IS � s a � � 'scr'ii�a in��bil frx�d te�npi��aryand � k�€.ItiArt3�� Foulttv t�'NSd C,ar�e,Shiftcci PHrs, 1 � s�,�id�nt�at 3;i�chcn aperztion�, �Eitxild be � i Stt,ifin�Cc�nit�i Mf��Pish �t st_ � <iehs3ed un<Ier t3fe appra>prsatc vectlas�s � � � 3'uuit�ryactt�n��, 1fiS°t i�ste. " � � abc�tic if're(atadtoinotSl.sorr�� ttl=,css � � � i-.d��.11r�� Whcde:mi��7e [�irac�.B��fyte�ks int�a�entzor�sxnclers�:£ac#'�rs. Chl�e�c ��(45�T+' 54i)�104 vioiatzoz��reka�ing ta g��re[�I � � ��0 t.(2 R iw :�rr9ma'T`ecxis Coaked i�M a� � qFaidces 3hoald t�e del�zteci ur+tie=/129- � . � � Lticrowavc 1b5°F� � � S��e,ciaEk.e itire�trt;aTs. �.� � � 3-Avi_17{<'�t(I){h) Aii Chitez Y[iE o F�S°F�[5 sec. * j � ' �I�_ Rehea4�ng for liot Nold�n9 ,_`_~yµ� t/ta'1LAT1C3�S REL,dT�7J TO GOOD�E7'sldL PRACTfCES �-x05,liCr1)K{L7} THf 165°} F7sc� "' {Stetf�v23�s3E1} � 3_<}{p,li(Bj 14ics•oicavc-1b5•'�'2;vTf3mteStandinb Griizrota3+dreurt-crsu•;atvtuealion,s. x4rrchu��rv��cdctte:ni&a � `£ime" ,�ofxlUr.;rn�artru is%rirrr-ventt�ns«n<L rdti�ZJe�cto,s Fi.sted eGnr�-. r��n be 3-�2�3.21(C} � C-:�nrrner:iat(v Pecxacscd R`I'E F�nc+d- fi�unei€�f the•1oElo�ar�sg,eecei�srzr o;:fte Fnud "i"ade cuid 1t�i CMR '�kf) t'x .��flOCH1 3-44i3.31{f:} � I2Ganauzin;;Lnfi[icedVcx�iocsai'AecF �..-tt�m�GoodRelartPracGces , � .�.,_FC 5�l10Q -� �_��_��,�� 12oast:* �2� ' Manay�mtrF an@ P�r nnrei �FC ? � 603 � I i Zg ( �(�Pr''oper Cotrti�vg Qt PHFs � �( Eauf ineni an P�otect,o� � �FC 9 i .Wd � 27 Fh�,,al Fa�� —�---��-}--� — �25 � p d Utensne � �(, n �JO6 � 35UE.1-1(A) i CcKrline Cook�d PHI's from 24t)`Y ta � 2S ! �h�atat P�t�iFs�n�and`N�ste .. . ' FG a � .OGb --i � � ?u f' �Vithrn 2 Tlour: �tad Fr��m?J'}' � � � � � � � �FC 6 � 667 �� _____��_.__ . � t�,41 'T�135 P 44itt fn d Nnar, � 2S Faso�n.�s or o�c tv�er _ �FG 7 ,�008 ' " e ' r T +als 4-S' O1,1ktB} ��t1mlt�iP}j£ h7ideFrunt.�srtL�ient� � 'S fSpaaa3Ft�,ausesnent� . .. �' .OU9 �; t . _' ._...� _'— _`i ( T rrN�ratarelii�!re<lie3ititr>�17"P/4S`F � 30 �fh�r _..^._.__ �.__ _.__ :._ . ._� _......... .. �'___'___ «itltin�i3utirs'� ..�..._.� ti w.. �.r.i� ...�_...____.. �`71er�u;es�ritkcal Siem irs thr i2 kein?1994 i'oEut Gxle or�1tlS t'�€.2 SE3ti 0�. � CITY OF SALEM � /�� n /� BOARD OF HEALTH , .-- � Establishment Name:t G2' t�D �� o n lA_�� Date:4(1—�\—C�l� Page: � of � ' �tem,� ;Code *� � ;C�Critica��#em , �; �� r•s �� ,,�;�� ;�DESCRIPTION OF VIOLATION/ PLAN OF CORRECTION ' ' ; � '`� � � oate �'° Reterence ER-Red ltem,"fS" � � � � a� � � . ..�, x 5 ,..� „ �. �. �.�_� m�,.�, .�,. .,� 3�,,,�.a�m �. w�a-e.�y.� �3n�^,��sk��` � �S" t� .� Venfied��_ �� %'� �*:�� vS'f v^.�,.�i-Ah,.�+`a's z 96��''2a� u�t s'./ ",a-PLEASE PRINT CLEARLV f' • '� ° � �r, � � � � �� ` �n.n,,,�n�� o o n n — ��n .�, ,�:� ,-r� n nn ,� ,t �,_ ��.e i _ � � -- _ �S • - - . • U � ,\ ( I t� n -,. �At 'ln . -,Q-iin.. 'Yn� ` l Q �O-Q � � �-� ' n n c� � � � _ On (�A/JL(.t b.tw a nil n.7 /A .l n9.� . \\ O.t �l C.00,P � n7/1 01t � i �7A n �) �;70 � D(1 � n n�/ � r�D/�On.- . �-1/1 Oc s � An r ��! � �1� f�1 ,1n ��, ��1n�/9 /lnA� .� � � �` 1 �1^ ` � � �)11) 0 V . �� D,J/n t �, c� ,.�`�i,n� � ��n� lJ i�^C'P i�'� on (�n n �� 4'� �?n o l )1 S� ll� P � � f"� a d,�� (��i�.. g� a , '�-k--r,t �n ,� ,i r,�n��s"�n n .a> � 2 / \ ^ _ _ _ � n �,.J . _ ___ r 'l n,, - ? I �J UI� f tit 0�Jt � AOnM/An c _ -��n/1n rc� 1 X1 �_v.�C'Dn.t.�. — .lfl � ; ..�- . . _ /� -(. _ _ . _ . � . . ! '•.(1.�� A B.f/n a n,0 A n Y i,�h.�] �ne. �.t n n ' � P,� 4. �� ,A �,� �. �i�a�� (� ,ra �nlI�, .a�� ;--T,n I - ; , � �4 �` 0 a-.1�( n /�l�n n .i Q n� 1 t� . i��il o v�� n�,t - 0 l( I � v, /� � — /� � ( a x �Y . C��n Mn r•� � c �.t�0 ( � .t � .Q ��+ n.YA a n.r � (�M . ._.Y.!,�� a A n /1 � ��. ��(')/' 0/i v y _ - - -. �. ! �i� ...�D nliA . l� � `A A NC10 v� X D A�� `�n n M 1_AA�s � ,l� .. .� � - a _� - - - ,} � --- �:� — � , �� -- v � - � �` ��),� �-C a /I o . D� ;� E��X/�� ' o l — .� �_ Gl - l � _ — ,� — � � �1 � - , i� Discussion With Person in Charge: Corrective Action Required: ❑ ' No S�' Yes . ` i ! Voluntary Compliance ❑ Employee Restriction / ; I have read this report, have had the opportunity to ask questions and agree to correct all �ry°� Exclusion � violations before the next inspection, to observe all conditions as describe�,�d to ❑ Re-inspection Scheduled O Emergency Suspension � �omply with all mandates of the Mass/Federal Food Code. I:un�d�tand th t.-� noncompliance may result in daily fines�of twenty-five dollars or susp�en;r-s�it�i�d�evocation of ❑ Embar90 ❑ Emergency Closure � your food permit. ��\\\�� \��p �� ❑ Voluntary Disposal ❑ Other: � �� n � �U� � �. i ) � . .-. �?-5t!f.i<t(C:i �--FiF�sRe,u:�i��edat"i'eta��peraGsres Viotation�Re&Rfed to FaodBarne tttnass fnterven2ians antl Rtsk Acc�rciinb to C,,iw C:a31ed Yo �'acfnrs(Itehzs f-ZZj (ConG} � 4I"E�745`'€�LR�eTlun=1 Hctu�s. �x Q��4r��F�{}� Q�i��.r��.rJ (�.�. J�Ell �` w_ �W�t15°�Pf�39dS FCX Q��`S .._.._ ,.._._..._.�.._ �.__.____...._.� �bg R .—.._._.. � PF£f Hat ans�old Holding ��4 ( Pood or Colav A@dits`vesr..._. 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Path� cn�� .� `^"" F�t�S:nrncAi atu Sen�iu 1�5�3�l 4s'ec�. �-`-.30° 1 !' a[efsi��.� 3 F��.s 5txhsC tute fe� Raa+Shetl �-�k@I.1�l.i�.)t�) Cvm�mm�trd T ish Me¢ts F U�azn� � �- ��'-`-- —____ ___.___... _�liii[ilt�3- z)``�� 1�_CC '�'� .sP�C.�F4l. 'R�f�UIFiE149E('iT.si II T � ;-QOl.I l(H)�}}�2} ��rk zr d 3� t Ru?st- I C} # i 21 nun* � --- - � _— "' S96.±i69tAi t7� Vioi.�t s�r�s �t Sc £�t,n 59f.(�ti`�tA)-(53}in •-�lf�},I7(A�C�} � Rauttti,Irict� n �lents I 5 E 2S � ' � �� ,�c � 'aterzE��. mo!�ii #�crc2 c�rnp�raty �z�d � �-40LSlf'A)3) � Pnultr�.l�AdC,�ate. StuEtu(Y4-�s, � F rt�si�l�tii al e:ifcH�n operaiior��ltt>atd be � S3afit S�C�niumint Fish hfeat, � { deG�t�d uac�cr d�e ipnFopfi �t 4� tto�ss � � P�r�itcvcv k�irss lb5`3 �9 s��;. ^` � � � ��bo�c ff�e3nied t�iuedharr�c�IL�c�s i � 19�l,IlfC}!3) �hG,2e-mu•c)� tn�ac�i3cuf`,aca�s � � inteiiant�o�sancfr�il�facf�rc (hi2er 145'F�" � � � 5F3C7 t3fl9 i,s�lat'tasati c.tatin�to�o�r� r�tai7 � � 3=i0l.32 R�w �n9ia�al F��sxl;t�'a�kc.cl 9fe a � � � � ;az�ti�ce� �.;(teziEd be debited urttier#{29-- v[ruoa-ave 35°'F * Spetaat 12��iremenTs_ -401 S7(A}(1)(h� kltt)dSea�Yt�f� IKS�� t5.ec.�" �� . � ; �___._ .�_._.._____�._____� �7 Retreafmg toe Moc HokdFng __ � YttTl�7/CSNS da"�LATED TD Gt30[P t?ET�3Jt Pi?,4CTPCES �-v�03.11{4)i�t'D} AtLt�, ,1bSt nsc. � {ifeES'ts23 �{b � i d�3.i 1C$j � Yluiowav� IA5 ['z't13nu� SEa¢ditt� C'r� c�i�a�srl n�n �niieat m ntt<,rta. skich do na ec6at�.:�r the Tinv,� � Fi ranGt rrze dfn st+at��rvrntzona anct rr t jm�Xars liued trbnve, cmt bz � i dp3,I1tC') t s�n�muriai(� Pio�essed R71"F+.u�i- (uefn<,irr tF�e f�dt>at�rg s tt nm ui�ake Fo«d f'trcfe ctrid L75 CNtK , id{)'F=" SrG.fi�J. ._._......_.._....__.._._...__.._....�..�... ..._. ._._.._�,_-- -- -- 3-h03.t?(E7 Sic 3x2ainir�s Unskice�i Pa>rtivns af3iee., i_tMm_�'�Gc+od Rstar't Pract�ces __._. I F(' `-�90.fttHI .1 � . � 8 T p4an emE €and Per onnzi_ . . �'�C � i 043 _; I�uast� � � ` xg Prapsr Gooling at pHFs � � 24 -�Fmd 3rd Faxi 6'raternms FC 3 f f�i . � � �,._. -----.( �25 �Ectu�pmentanUUae�3sii� �FG h OQ5 � :�-SOf.1�4(A) [3 4,�F/=1.. F luz 1 m 4�Hnur��}��j� e6. t'aso�i u�s ob��v�d Wa fe �FG b ' .£K16 ! ( < � i 27 � F h�r,�C�f F�c�f� � .. � 6 ��l _..� .� � • s f � ...i_ s � rf 7 i ;008 '. ____._.�._....._...__... ..�.� _.........._.�. ...-- --- -- -�-'7 3-�(�i.i�#iC3j ("�a}zngP34F�'tiF.iAeNroatAsnbceo� � � 2'' i Spaa�IR�t,c�reer,ent ._...__ ._.� i__ �,��'.° __.t � y"` -- T�inp^c�t[nn.tf�gradier�tstn�tl`F1d5.-p: E ; 3u C�U�e� _. . --- i--- , ----� �...._____ , WithEa�i-ku�:,`x � ti +�,.s. - *lleoates Griacal stetn nt ih;f�:izrn' t984 Piuxt C�e or l05{_'.v112 59i)EM70. „ - . 128 WASHINGTON STREET Cafe Kushco City of Salem FOOD SERVICE ESTABLISHMENT - FOOD SERVICE Inspection HACCP: ❑ Item Status Violation Critical Urgency TBI0ph0112: �, PROTECTION FROM CONTAMINATION 978-745-6996 . Handwash Facilities PASS Critical ❑d RED �W�e�: Comments: Back hand wash sink has no soap. Provide soap. Mark M. Stafford i PIC: I Back hand wash sink missing sign. Provide sign. � DeryB Staffo�d Front hand wash sink has no paper towels. Provide paper towels. If1SPBCYOf: � Violations Related to Good Retail Practices (Blue Items) John Gehan � Food and Food Protection PASS Critical BLUE Date Inspected:Correct By: j 8/�$�2�07 � Comments: Personal drinks stored in unit for food. All personal items to be stored in designatetl employee areas. RiSk L8V01: - Equipment and Utensils PASS BLUE � Comments: Back Coke refrigerator requires thorough cleaning. P@fmit NumbeC � White freezers in back require general deaning. BHP-2007-0261 StatUs � True unit for soups require generel deaning. SIGNED OFF �� Piva oven top requires general cleaning. #of Critical Violations: � � � White Frigidaire freezer requires thorough cleaning. ��, Time IN: Time OUT: �, Pro Max sandwich press requires thorough cleaning. ��,, Urgency Description(S): True unit for sandwiches requires generel cleaning. BLUE: ViolatiOns Related to Good Front white freezer requires generel cleaning. Retail Practices (Critical Front refrigerators require general cleaning. violations must be corrected immediately or within 10 GENERAL COMMENTS: days)(Non-critical violations All violations from August 6 have been corrected. must be corrected immediately o:within 90 days) City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)74�-1800 GepTMSO 2007 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Aug 13,2007 ) Page 1 of2 � . Item Status Violation Critical Urgency RED: Violations Related to Foodborne Illness Interventions and Risk Factors (Require immediate corrective action) � - c City of Salem Board of Health 720 Washington Street,4th Floor SALEM MA 01970(978)741-1800 G�oTMSO 2007 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Aug 13,2007 ) Page 2 of2 ?28 I�ASHINGTON STREET Cafe Kushco City of Salem FOOD SERVICE ESTABLISHMENT - FOOD SERVICE Inspection HACCP: ❑ Item Status Violation Critical Urgency TBIePIlOq2: �. � � � PROTECTION FROM CONTAMINATION ��978-745-6996� - � � Food Contact Surfaces Cleaning and Sanitizing 1 1 � PASS ❑J RED - `1 -OWf18C � � � . � � ' , ' Comments:third bay of three bay sink not holdiS�g w t r properly.repair third bay of sink. Ma►kM. Staffo�d Handwash Facilities PASS ❑J RED :P�C: � � � � . Violations Related to Good Retail Prectices (Blue Items) i ;D@ry0 SfdffO�fl � � - Food and Food Protection I PASS BLUE =1�Sp2CfOC" . , �'�. EquipmentandUtensils, . �10� FAIL Critical BLUE � , i � Janet Dionne. comment r mu t provide sanitizing solution that is made and tested daily and is readily available at each work station and - D8t2 I(1Sp8Ct@d:COf�@Cl By: , also used to sanitize patrons tables. . �4/14/2008: �� - � • White standup freezer at 30°F.freezer to be maintained at 0°F or below as mandated.Owner to remove all potentially hazardous �RISk L8V0C foods that are being held in freezer and that shall be frozen and relocated to another freezea This unit must be serviced and ' maintain a tempereture of 0°F or below as mandated. Permit Number. 1�°F BHP-2008-0230 � Status Open #of Critical Violations: L �Time IN: Time OUT.� � Urgency Desc�iption(s): BLUE: Reinspection. Violations Related to Good All other violations noted in the 4/14/08 inspection repoR have been corrected. Thank you. 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 720 Washington Street,4th Floor SALEM MA 01970(978)741-�800 GeoTMS�2008 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Apr 28,2008 ) Page 1 oJ2 � ,� � Item Status Violation Critical Urgency �� RED: '. - ViolationsRelated ro ` " Foodborne Illness Interventions ', and Risli Factors (Ftequire immediate corrective.actionj i � City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 07970(978)741-1800 GeoTMSO 2008 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Apr 28,2008 ) Page 2 of2 1,28�WASHINGTON STREET Cafe Kushco City of Salem FOOD SERVICE ESTABLISHMENT - FOOD SERVICE Inspection HACCP: ❑ Item Status Violation Critical Urgency TBIOPhOf16: FOOD PROTECTION MANAGEMENT 978-745-6996 PIC Assigned/Knowledgeable/Dufies PASS N❑ RED ��Wf1Ef: Non-compliance with: Mark M. Stafford Anti-Choking PASS kPIC: Tobacco PASS �erya$taffO�d EMPLOYEE HEALTH - If1Sp8CI0�: Reporting of Diseases by Food Employee and PIC PASS � RED Janet Dionne personnel with Infections Restricted/ExGuded PASS 0 RED �Date Inspected:Correct By: 4/14/2008 FOOD FROM APPROVED SOURCE �RISk L2V01: Food and Waterfrom Approved Source PASS Q RED Receiving/Condition PASS � RED .P@�fl'li1NU0'IbeC Tags/Records/AccuracyofingredientStatements PASS � RED BHP-2008-0230 Confortnance with Approved Procedures/HACCP Plans PASS d❑ RED Status: Open �#of Critical Violations: 4 �Time IN: Time OUT: Urgency Description(s): BLUE: Violations Related to Good Retail Practices (Critical vioiations 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 RO 2008 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Apr 22,2008 ) Page 1 oJ4 f Item Status Violation Critical Urgency " Violations Related to Good Retail Practices (Blue Items) Management and Personnel PASS BLUE Food and Food Protection FAIL Critical BLUE �mments: lettuce stored on washboard at 3 bay sink.concerns of food not being covered while in storage.Food to be covered. . TXare was an employees water bottle stored with deli meats.Owner to provide designated area for employees to store personal ��ems.employees and cusomers food shall not be stored in same area. � Equipmenta Utensils FAIL Critical BLUE mments:white ice cream freezer missing thermometer.Provide visibke accurate thermometer maintained at 0°F or below as . mandated � - �me freezer needs general cleaning of food debris and buildup. �, No sanitizing solution available at time of inspection.Owner must provide sanitizing solution that is made and tested daily and is readily available at each work station and also used to sanitize patrons tables. �o sanitizing log on hand.Sanitizing log to be maintained daily. crowave needs general cleaning. -�White standup freezer at 10°F.freezer to be maintained at 0°F or below as mandated. ��,, �all white freezer chest missing thermometer. Provide visible accurate thermometer maintained at 0°F or below as mandated. �me unit needs general cleaning of food debris. P vide visible accurate thermometer in coca cola unit in back area maintained at 41°F or below as mandated. I ig Frigidaire freezer in back area need visible accurate thermometer maintained at 0°F or below as mandated. �e unit needs general cleaning. � an opener had accumulation of food debris on blade.thoroughly clean and sanitize daily to prevent buildup of dried food debris. � �ved visible accurate thermometer in desert display case mainWined at 41°F or below as mandated. Physical Faciliry PASS BLUE �mments: light fixture in back area missing cover. Provide light fixture cover. There were some holes in ceiling tiles observed. seal all holes and gaps to halp prevent entrance of insects and rodents. Water, Plumbing and Waste PASS BLUE Poisonous or Toxic Matenals PASS BLUE Special Requirements PASS BLUE Other-See tes PASS BLUE omments: Baby high chair stored in restroom.wash and sanitize chair and relocate as to not be stored in restroom. , City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741-1800 GeoTMS RO 2008 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Apr 22,2008 ) Page 3 oj4 :r Item Status Violation Critical Urgency RED: PROTECTION FROM CONTAMINATION Violations Related to Separation/Segregation/Protection PASS � RED Foodborne Illness Interventions Food Contact Surfaces Cleaning and Sanitizing FAIL Critical � RED and Risk Factors (Require / immediate corrective action) �Omments: Cutting boards stained and scored.Resurface or replace. �per ware washing of equipment and utensils was not being done correctly.Employee was using sponge and soap to wash plates and utensils and rinsing them and putting them in a container to dry and were not being sanitized.All utensils and equipment to be wash rinsed and sanitized in proper manner.and shall be dried on drain board provided with 3 bay sink.drain board to be washed and sanitized before items are placed to dry. � . . Proper Adequate Handwashing PASS . 0 RED � Good Hygienic Practices PASS ❑d RED Prevention of Contamination from Hands PASS ❑d RED Handwash Facilities FAIL Critical RED . �ents: There were knives stored in hand sink. Handsink shall be used for hand washing only.Do not store knives in hand sink. `�oap at restroom sink. Provide soap at all hand sinks at all times. PROTECTION FROM CHEMICALS Approved Food or Color Additives PASS d❑ RED Toxic Chemicals PASS �❑ RED TIMEREMPERATURE CONTROLS(Potentially Hazardous Foods) Cooking Temperatures PASS � RED Reheating PASS � RED Cooling PASS O RED � Hot and Cold Holding - PASS 0 RED Time As a Public Health Control PASS . 0 RED � REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) Food and Food Preparation for HSP PASS � RED CONSUMER ADVISORY �,. Posting of Consumer Advisories PASS � RED , City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)747-1800 GeoTMS�2008 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Apr 22,2008 ) Page 2 oJ4 � Item Status Violation Critical Urgency � op stored incorrectly.Mop to be stored mop head up to air dry. yly trap paper observed in back area indicating�flylinsect issues.exterminator to be made aware of issue and shall be treated until \/problem is resolved. I �� 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. Apr 22,2008 ) Page 4 oJ4 __� COURT DOCKET NO.SCITY OF SALEM CITATION NO VIOLATION NOTICEPD6219 NAME(LAST FIRST,INITIAL) CAI;=�- )6jslic-'I�j STREETAIDDRESS CITY/FOWN STATE ZIP 12,9 vAq)<-v-i t-i to it, S- I i � f� �, 'zz�l 0,4, LICENSE NO LIC EXP DATE' DATEOFBIRTH OWNER NAM( ;( ST,,PIR51r,I S STREE 1) CITY/TOWN STATE ZIP REGISTMTIONNO STATE mAKE�TYPE YEAR ICOLORI 7-1;��) I TTZ�� I DATE OF ViOLATIO0 DATL CITATION WRITrEN 1,PERU�,y3yL ..0 TIME AM ES EINO LOCATION 01 FORCING DEPT 17-3 -1�4z,", OFFENSE fT;HAP SECT FINES I A B �w -;i�: C OFFICER 10 NQjZbTE- A v T, FIN Is 106z--,� DUE OFFICER dEbTIFrES COPY GIVEN TO VIOLATOR X IN HAND x BY MAIL DO NOtIMA3 ASH-PAY ONLY BY POSTAL NOTE,MONEY - , ' S� ORDER�OR BY HECK MADE PAYABLE TO CITY CLERK CITY H LL 93 WASHINGTON STREET 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 THE AMOUNT OF $ CASE# SIGNATURE SEE OTHER SIDE FOR FURTHER INFORMATION ENCLOSE PAYMENT INTHIS ENVELOPE,PEEL AND SEAL � .a � � 4.`.. ' ... '�'_Pxf iSk '..A,. � �uMT, i . . .- . . . ...{ :a-. .y ' '�. . . .: �.. Commonwealth of Massachusetts ' • � City of Salem s • Board of Health K'imbertey Driscoll 120 Washington Street,4th Floor Mayor SALEM,MA 01970 Food/Retail Establishment Permit DATE PRINTED: Ol/07/2008 ESTABLISHMENT NAME: Cafe Kushco FileNumber:BHF-2004-000090 128 Washington Street Salem MA 01970 LOCATED AT: 128 WASHINGTON STREET SALEM, MA 01970 Permit Type Permit No. Permit Issued Permit Expires Fee RestricHons/Notes FOOD SERVICE BHP-200&0230 Tan 4,2008 Dec 31,Z008 $140.00 ESTABLISHMENT Total Fees: $140.00 PERMIT EXPIRES December 31,2008 � Board of Health ('x,C, f► This Permit is not transferable and must be reissued upon change of ownership or loca[ion.The permit must be posted in a prominent locadon in the Establishment... . In acwrdance with the Sta[e 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 6 of 25 i. .� 0 3 `� ��, CITY OF SAL,EM, MASSACFILJSETTS �� BOARD OF HEALTH �s�:..�t%� 'rti 120 WASHINGTON STREET,4 FLoox TEL. (978) 741-1800 KIMBERLEY DRISCOLL Frix(978) 745-0343 MAYOR JSCOTTC�SALEM.COM Jon�soorr, HF..�u.Tx AGErrr 2008 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT NAMEOFESTABLISHMENT� i'�LS�C� �' TEL# � T2S� ��-I��o ' ADDRESS OF ESTABLISHMENT I'2Y, L��liYl(1'� S1� ' FAX# �— MAILING ADDRESS(if different) �7✓y� EMAIL-Business': Website: OWNER'SNAME �G1,C��L C'`-G1+-4t') TEL# �`�iI -' :,CI.��_ ADDRESS �L��'1 r��` C-�'X cS�- ��AC`�JY� �� IG�� STREET � CITY STATE ZIP CERTIFIED FOOD MANAGER'S NAME(S) �l �-'��l �T '�C-4�C�� CERTIFICATE#(S) `ST"..C� aLU �, (Required in an establishment where potentially hazardous d is prepared) - , EMERGENCY RESPONSE PERSON Ql. S't � HOME TEL# �"�� I�� U�I �"I DAYS OF OPER4TION Monda Tuesda Wednesda Thursda Frida Saturda Sunda HOURS OF OPER4TION 1 1 Please vrtite in time otdaY ' \\� �\ �\��\ � `�r' \� ; �� \\ `�.� �� ,-�`� � i�1- `, � Forexam 1e77am-11 m TYPE OF ESTABLISHMENT FEE (check onlv) RETAIL STORE YES NO less than 1000sq.ft. _$70 1000-10,OOOsq.ft. =$280 more than 10,OOOsq.ft. =$420 � --�-�-�--- - --�--�--�- - -�---�-��- - -----.. .....-�- - -- --��--- - - - --�--�-- - - -----�--�--�-�-�--�-�- -- - -- RESTAURANT YES NO less than 25 seats =$140 . (Uuidoor Staiionary Food Cart�2 i 26-99 seais =$28C more than 99 seats =$420 ._.. -- ---�--�--�-- - -----... --- - -.... ...... - - -- �-� --� - --�--� �-�--�-�-� -- BED/BREAKFAST/ YES NO $�oa CHILDCARE SERVICES ---..--�--- - -- -� -_. .......- - -�--�-- - - --� -�----- -- - -- -- ................. ADDITIONAL PEf2MITS 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. �n 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 retums and paid all state laxe uired nder the law. . - : Signature Dace I. � � _Social Sewrity or Federal Identification Number � ------ - --- -- ------ -------------------------� -- -�-�- ��J--- --------------------------- Revised 4/24 7 F00 AP2008.adm Chcck#&Date�/n�� /1 /� $ � 1 =. 128 WASHINGTON STREET Cafe Kushco City of Salem FOOD SERVICE ESTABLISHMENT - FOOD SERVICE Inspection HACCP: ❑ Item Status Violation Critical Urgency T21BPhOf12: i PROTECTION FROM CONTAMINATION 978-745-6996 i Handwash Facilities PASS d❑ RED OWf1Bf: � Comments: Front handwash sink missing sign. Provide sign. . Mark M. Stafford PIC: Same sink soap dispenser has come off of the wall. Repair unit. Derya Stafford I Inspector: � John Gehan Date Inspected:Correct By: 2/14/2007 � Risk Level: � i Permit Number: BHP-2007-0261 � Status: SIGNED OFF i #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 GeoTMSO 2007 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Feb 14,2007 ) Page 1 of2 ,:. � Item Status Violation Critical Urgency RED: Violations Related to Good Retail Practices (Blue Items) Violations Related to Food and Food Protection PASS BLUE Foodborne Illness Interventions and Risk Factors (Require Comments: Can opener has accumulation of food. Thoroughly clean and sanitize opener. immediate corrective action) plastic ware must all be inone direction to prevent cross contamination. Equipment and Utensils PASS BLUE Comments: Back coke refrigerator requires general cleaning. Backk freezer has no visible thermometer. Provide visible and acwrete thermometer. Bread freezer requires general cleaning. Ice cream cooler requires general cleaning. Cake display case requires general cleaning. Sanitizing log not up to date. Log to be maintained daily. Pro-max sandwich unit requires general cleaning. Physical Facility PASS BLUE Comments: Floor has tiles that are missing. Replace tiles so floor is easily cleanable and impervious. There are a few water stained ceiling tiles. Find source of leak and repair. Replace tiles. � The ceiling grates require general cleaning. GENERAL COMMENTS: All violations from 2/7/07 have been corrected. � C�� "'�`� C% City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741-1800 GeoTMSOO 2007 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Feb 14,2007 ) Page 2 of2 128 WASHINGTON STREET Cafe Kushco I City of Salem FOOD SERVICE ESTABLISHMENT - FOOD SERVICE Inspection HACCP: ❑ Item Status Violation Critical Urgency Telephone: � PROTECTION FROM CONTAMINATION 978-745-6996 � Handwash Facilities FAIL Critical ❑d RED �W�ef: ' �G6`nment: Back hand wash sink has no soap. Provide soap. Mark M. Stafford j P�C: � ck hand wash sink missing sign.Provide sign. Derya Stafford I ro� nt hand wash sink has no paper towels. Provide pape�towels. If1SPBCfOC II Violations Related to Good Retail Prectices (Blue Items) John Gehan Food and Food Pro ection' FAIL Critical BLUE Date Inspected:Correct By: 8/6�2007 omment: Personal drinks stored in unit for food. All personal items to be stored in designated employee areas. Rlsk Level: —�, Equipment and Utensils FAIL BLUE immenY.Back Coke refrigerator requires thorough cleaning. POffTlit NUfilb2f: I ite freezers in back require generel cleaning. BHP-2007-0261 � SYBtUS: ue unit for soups require general cleaning. Open I P' a oven top requires general deaning. #of Critical Violations: �� Z ./P/hite Frigidaire freezer requires thorough cleaning. Time IN: Time OUT: —� ax sandwich press requires thorough deaning. 1 �� UrgenCy DeSCription(S): - -�T6��t for sa dwiches requires generel cleaning. BLUE: F white freezer requires generel cleaning. Violations Related to Good �--�'�'� Retail PraCtiCes (CritiCal ro�— nt re{�ig¢rators require generel cleaning. 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-�800 GeoTMS02007 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Aug 06,2007 ) Page 1 of2 Item Status Violation Critical Urgency RED: Violations Related to Foodborne Iliness Interventions and Risk Factors (Require immediate corrective action) �� d City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741-1800 I, GeoTMSOO 2007 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Aug 06,2007 ) Page 2 of2 f _ � 128 WASHINGTON STREET Cafe Kushco � City of Salem FOOD SERVICE ESTABLISHMENT - FOOD SERVICE Inspection HACCP: ❑ Item Status Violation Critical Urgency � TQI@PhOf1B: PROTECTION FROM CONTAMINATION 97$-74$-fi996 ' Handwash F/acilities FAIL �❑ RED �W�ef: �� rCommenk Front handwash sink missing sign. Provide sign. Mark M. Stafford I PIC: � �Ae'sink soap dispenser has come off of the wall. Repair unit. � Derya Stafford _�� , Inspector: I John Gehan Date Inspected:ICorrect By: � 2/7/2007 � Risk Level: � —� Permit Number. I BHP-2007-0261 J Status: I Open #of Critical Violations: 1 � Time I�e 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 GeoTMSR02007 Des Lauriers Municipal Solutions, Inc. Commonweaith of Massachusetts ( Rev. Feb 07,2007 ) Page 1 of2 . � Item Status Violation Critical Urgency "��RED: Violations Related to Good Retail Practices (Blue Items) Violations Related to Food and Food Protection FAIL BLUE Foodborne Illness Interventions and Risk Factors (Require mment: Can opener has accumulation of food. Thoroughly clean and sanitize opener. immediate corrective action) �a5#ic ware must all be inone direction to prevent cross contamination. Equipment and Utensils FAIL BLUE omment: Back coke refrigerator requires general cleaning. ckk freezer has no visible thermometer. Provide visible and accurate thermometer. �r requires general cleaning. ce cr�r requires general cleaning. isplay case requires general cleaning. Sanitizing log not up to date. Log to be maintained daily. /Pro-max sandwich unit requires general cleaning. Physical Facility FAIL BLUE �Eomment:,Floor has tiles that are missing. Replace tiles so floor is easily cleanable and impervious. �There are a few water stained ceiling tiles. Find source of leak and repair. Replace tiles. /The ceiling grates require general cleaning. r � City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)747-1800 GeoTMSO 2007 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Feb 07,2007 ) Page 2 of� q�s� � '' r • �+ra� g�r�#�tf :f. �A � +T ,..,,,Y v� ic` +" :rx'"i+ ,� � .. �, 'e �k�y'^�" � _�� G� ".4p� . ,�+ k.� � +s.� 3s. 'n a i ��A U��.w�de ;r, �s �� A Ts ;,n�� .�Y 9+'.m� t "`YiK +x'�3.�� y h. J . w�� . 3Af`'�� .. `}�. �-?� � � k'Cve�"4WnN4' �7GFe£y�`�.m+..�,�g*x¢ ��e�.C'i'�2� .�� '+� .s4} , � .}� �� fd ;: Ci. s.. 4 �� V` +'� M *�it � �,�°+',*� Cca�,tmmonyw,ealth of Massachusetts, ;�' „„� r �� . „�. �h�'l'`�'br} Gf.s� �`� ��w,�,i��.'. s h�R�'a�x'{'d'srwK'"M$ Y'��"�.��`�'"�"�t,'„�n ,K� '��i�sY''�r �� 3�jb' *'��t' �[fi �n r�"� �' ` r ,t�`�s„ �'�" 1`i��£� �' " C�ty Of Salem � �` ysr ro� �'�,'��Zs"� ,�" d y £ ` ++"}e� ✓ "'S 2� s m.�"�Tz a [�` r Y t _.,,svv -as � Mt r { —i. �5.- t 5# �" K,t'�t ac fi� Y° .,. a�"��F{,�;"' �7 M z+s.s^ .' r,+. �t$�3 •.Board of Health x�y� v� ir��1 �}i��J .±a�r��k ,�i,dwr��4i�£, ap�s.,��v.�j e'�!�s . a z ^� ' °;� .IGmbe�iey OnscoO + ,.,;� > , f,�t^ •'� +�w 120 Washmgton Street,4t6 Floor , �= 9; '�� %. -��,� :, �: - . - :..y,,,,.�, ,- . ,�,� „� . 5.,�: � �k„.��-- :Mayor �- , SALEM,�MA 01970 Food/Retail Establishment Permit DATE PRINTED: Ol/02/2007 ESTABLISHMENT NAME: Cafe Kushco File Number:BHF-2004-000090 128 Washing[on Street Salem MA 01970 LOCATED AT: 128 WASHINGTON STREET SALEM,MA 01970 Permit Type Permit No. Permit Issued Permit Expires Fee Restrictions/Notes FOOD SERVICE BHP-20m-o261 Jan 2,2007 Dec 31,2007 $100.00 / WATER SOURCE:CITY ESTABLISHMENT WATER SEWER DISP: CITY W ATER Total Fees: $100.00 PERMIT EXPIRES IDecember 31, 2007 � Board of Health This Permi[is not transferable and must be reissued upon change of ownership or locatioa The permit must be posted in a prominent location in the Establishment. In accardance with the State Sanitary Code,beofre any revonations, improvements,ar equipment changes are made,all , plans for such must be submitted to and approved by the Salem Board of Health. Page t of 7 �--- t :� ,. � CITY OF SALEM, MASSACHUSETTS o � BOARD OF HEALTH s 1ZO WASHINGTON STREET, 4TH FLOOR � SALEM, MA 01970 TEL. 97S-741-1800 Fnx 978-745-0343 . WWW.SALEM.COM Kimberley Driscoll JOANNE SCOTT, MPH, RS, CHO Mayor HEALTH AGENT 2007 APPLICATION FPR PERMIT TO OPERATE A FOOD ESTABLISHMENT NAME OF ESTABLISHMENT_ � TEL# ��p�� Y 1 VJ�Fj ADDRESS OF ESTABLISHMENT '''///�� S • FAX# MAILING ADDRESS(if differenl) �n�1,.��1� � EPJ�AIL--Business': Owner's: OWNER'S NAME �.�a3�� . ��# �� ADDRESS s��i �C��-/' �� / ` STREET CITY STATE I� ' CERTIFIED FOOD MANAGER'S NAME(S) S CERTIFICATE#(S) � (Required in an establishment where potentiall hazardous food is prepared) I (� (� / n EMERGENCY RESPONSE PERSON HOME TEL#� l oC —�;'1 I k9 %� OAYSOFOPERGTION Mondav Tuesday Wednestlay I Thursdav Fridav Saturday SundaY HOURSOFOPERATION ' , P,IeasewriteinUmeofOay. '�. ' �, , � [Pof¢xemple118m-110m1 � ' TYPE OF ESTABLISHMENT FEE (check onlv► RETAIL STORE YES NO less than 1000sq.ft. _$ 50 1000-10,OOOsq.ft. =$100 more than 10,OOOsp.ft. =$250 - - --- - - - -- - - - -- - - - - - - ---- - -- -- -- - - � RESTAURANT YES NO less !han 25 seats = 25-99 seats =$150 more than 99 seats =$200 - - - - -- --- - -- --- - -- -- -- - - - - -- -- - -- - - - -- $100 BED/BREAKFAST YES NO - - - -- -- --- -- -- -- -..__...._ - ._..._ _- ADDITIONAL PERMITS MAKE (notjust 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 Chap�er 62C, Sec-0 9A, t rtify under the pains and penalties of perjury that I, to my best knowledge and belief, ha iled all state lax reWms nd p �d II state xes required under the law. Sign tur Date S cial Security or Federal Identification Number �- - -- - - - ----- -12�2_I-�C��-�a/a-�--��-�---------------------------- ---- --------- �, ----- , - ---- -------- -- - - - Revised 1 6 F ODAP20 .atlm Check#&Date��',��_� , --' 128 WASHINGTON STREET Cafe Kushco � City of Salem FOOD SERVICE ESTABLISHMENT - FOOD SERVICE Inspection HACCP: ❑ Item Status Violation Critical Urgency TBI2PhOfle: I PROTECTION FROM CONTAMINATION 978-745-6996 Handwash Facilities PASS � RED OW�ef: �I Violations Related to Good Retail Practices (Blue Items) Mark M. Stafford Food and Food Protection PASS BLUE PIC: Derya Stafford Equipment and Utensils PASS BLUE Inspector: JOFIfI G@h2I1 Physical Facility PASS BLUE Date Inspected:Correct By: � GENERAL COMMENTS: 9/20/2006 � 853:A11 violations from 9/20/2006 have been corrected. Risk Level: I i Permit Number: BHP-2006-0036 Status: SIGNED OFF #of Critical Violations: 0 Time IN: Time OUT: Urgency Description(s): BLUE: Violations Related to Good Retail Practices (Critical ' violations must be corrected immediatelyorwithin 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 GeoTMSO 2006 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Sep 28,2006 ) Page I of2 � _� 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 GeoTMSOO 2006 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Sep 28,2006 ) Page 2 of2 �� 128 WASHINGTON STREET Cafe Kushco City of Salem FOOD SERVICE ESTABLISHMENT - FOOD SERVICE Inspection HACCP: ❑ Item Sfatus Violation Critical Urgency T81EphOhB: � �" ' PROTECTION FROM CONTAMINATION � �,97$-745-6996 � HandwashFacilities FAIL Critical Q RED OWner: v�omment:Back handwash sink had raw poulVy in it Sink to be used for handwashing only. Mark M. Stafford PIC: . . . �` �e sink obstructed. Hand wash sink to be clear and accessible at all times. ��.a D@ry3 StaffOfd � ack handwash sink missing papertowels. New paper towel to be installed by next reinspectlon. Inspector: ° `�, ront hand wash sink requires new soap dispenser or proper soap container. yJohn Gehan � >�., < Date Correct By: �e sink had cloth towels in sink. Sink to be used for hand washing only. I� �e sink had piaa cutter on sink. Utensils to be stored in proper designated area. Risk LeveC Pe�mit Number: BHP-2006-0036 Status: Open #of Critical Violations 2 Time IN: Time OUT ��' �� Urgency Description(s): BLUE: Violations Related to Good Retail Practices (Critical violations must tie ao�rected immediately or withirt 10 days)(Non-critical violations= must be corrected immediately or within 90 days) City of Salem Board of Health 720 Washington Street,4th Floor SALEM MA 01970(978)747-7800 GeoTMS�2006 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Sep 20,2006 ) Page I of3 �'i � . Item Status Violation Critical Urgency RED: '�" ' � ' �' "�' �� ' �� Violations Related to Good Retail Practiees (Blue Items) Violations Relatetl to�g��t ;,,. Food and Food Protection FAIL CrRical BLUE Foodbome illness Interventions' �afld RISk F2Ct0lS�(R2QUIf2 ,„,:;� � omment: Raw poultry thawing In back hand wash sink at time of inspection. All potentially hazardous foods to be thawed immedi8t8 COffeCtiv@ BCtlOf1)... . beneath c Id running water or at 41"F or below as mandated. zen yogurt freezer has opened and uncovered foods. All foods in storage must be covered. Equipment and Utensils FAIL BLUE Cu(ment:Coke refrigerator in back requires general cleaning. V �me unit has broken handle. Repair handle to working order. i8oth back white freezers missing thermometers. Provide visible and accurate thermometers. i6ack white freezers require thorough cleaning. Mop stored incorrectly. Mop to be stored so it is hung up and air drys. �k shelves require general cleaning. ue refrigerator beneath soups missing thermometer. Provide thertnometer. v�pite Frigidaire refrigerator requires generel cleaning. me unit missing thertnometer. Provide thermometer. �. - nitizing log available at Gme of inspection. Log to be mainted daily with proper ppm. _ �azen yogurt freezer requires thorough cleaning. � � S�ne unit missing thertnometer. Provide visible and accurete thermometer. V �es observed at time of inspection. Sponges carry bacteria and are not a good source of cleaning material. Seek altenate source. Physical Facili FAIL BLUE omment:Walls throughout back area require general cleaning. GENERAL COMMENTS: 844: � City of Salem Board of Health 720 Washington Street,4th Floor SALEM MA 07970(978)74�-7800 GeoTMS�2006 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Sep 20,2006 ) Page 2 oJ3 __!- c � Item Status Violation Critical Urgency \ 4 City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)747-�800 GeoTMS�2006 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Sep 20,2006 ) Page 3 oJ 3 � - - ,�''; ;1 lcouRrooc�rr�m. ��'----_—�— ��.` .: crtanoNNo:.� I� • CITY OF SALEM ' � } viownoNNonce PD 05.29 .:. � d J . � .i- ruMe��usr,Flasr,�winay... .. . . . �. � .:. .. ...,__... ..._ ..... . # Q �� g � ' , �FfG�Okv YY1� w1 � � �� S7AEETADDRESS cmrtowri STA7E 21P � p 2B5 FSsey S� S��n n14 oiS7o 0 � � i � ' LJCENSE NO. UC.� TM ' � �^, � 6 `8 D�v a - �,`( � . OWNER'SNAME(LAST,FIRST,INITIAL) ' bq � St�Fi'0/1 J IYi4/2 J� STREETADDRESS CITV/TOWN STATE Z�p ; tb'S �iSE�c S� S/3t em rV�! G/> 76 � "m j . REGISTRATION NO. STATE EXP.DATE - MAKET'PE VEAR COLOfl - � � � �� I ' S DATEOFVIO TION TIME �pT(E�CRATqiON RITTEN PEAsorvu. �� F i O �M1 � O � �'/�b db J..w�FM J '�p � �J iwuA❑YES I .a ❑ NO LOCATI OF VIOLATION ' ENPORCMG DEPT. � Q� ; . '�'� i;,��/iivC�:GI� S"" ;9ct�r, n'✓� �i'p�.;�if i � OFFENSE/�jAjL ;p t-Tj�!{ [��i+f�I, CHAP. SECL FINES � IA '%� a!%el'� /'��/iii�N s�c:. 75. o- E,� m o m � B Lll -'� o I° � . 'OFFICER I.D.NO. � m -{' / /�,, TOTAL _��c �;: 5 � � � .J . (_�{.�%f7��•� pI�E ,��LJ , (� Q � g` � OFFICER C�ERTIFIES COPY GIVEN TO VIOLATOR � �' �" a � i . . .:f ' "/� ' / � � OO LF.� � ' ��. '. i ��f; i'` ,'/�� ❑ INHAND / j Lii w'�� i X :�� '.: - �{ ' i✓JBVMAIL fF �"' g � �+ � DO NOT MAIL CASH-PAY ONLY BY POSTAL NOTE,MONEY � � � ,a `: OROER OR BY CHECK MADE PAYABLE TO: � F;o � i p7V CLERK r �" Q N¢ o M � CITY HALL I p � 93WASHMGTONSTREET � � �� o i° � SALEM,MA 01970 ! -�"-� ¢z �o � O '� r TEL.(508)745-9595 X 257 ' ¢ W �Z r� y � • I HEREBV ELECT TO EXERpSE THE FIRST OPTION AS STATED ON ! � Q �� F g .. � REVERSE, CONFESS TO THE OFFENSE CHARGED,AND ENCLOSE — PAYMENT IN THE AMOUNT OF { ! 3,...,,��,3,,..3M,bo I $ CASE N . SIGNATURE , SEE OTHER SIDE FOR FURTHER INFORMATION � � ENCLOSE PAYMENT INTHIS ENVELOPE,PEEL AND SEAL COURT DOCKET NO. Q CITY OF SALEM CITATION NO VIOLATION NOTICE PDO529 NAME(LAST,FIRST,INITIAL) 57#,'F-0A,f) 0-4,C4 STREETAIDDRESS CITYITOWN STATE ZIP -�j t-sse-1 5—, 541�--Ar fM 0/9 76 LICENSE NO. LIC EXP.DATE DATE OF BIRTH OWNERPS NAME(LAST FIRST,INITIAL) tl)41211- , 10 STREETADDRESS CITYfTOWN STATE ZIP zO &s5ex 5�/ 51t4 e-m pvy4 o�� 76 REGISTRATION NO. STATE � EXP DATE � MAKErryPE �YEAR JCOLOR� DATE OF VIOLATION TIME DATE CITATION BITTEN r1l �,PEZSON& M `yLJYES Apm 7c EINO LOCATION OF VIOLAT16N f �ENFORCING DEPT 175 �v1,511114ZIj 5—, Sqo-lp'A� & Az7j-� OFFENSEJ&A- CHAP. SECT, FINES A IoV ZtCi- I�'-. B C OFFICER 10 NO�TOTAL F IN E [$ 2EA!�:7�60 DUE OFFICER,CERTIFIES COPY GIVEN TO VIOLATOR El IN HAND x El BY MAIL DO NOT MAIL CKSH-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# MNATURE SEE OTHER SlDE FOR FURTHER INFORMATION ENCLOSE PAYMENT IN THIS ENVELOPE,PEEL AND SEAL : . . ._ . . ` .. / : - .4 . . . .. �� ^ �.I � � � �. �k � � .� . " ``4 � Salem Board of Health Massachusetts Departr�ent of Public Health ? 120 Washington Street,4`" Floor Division of Food and Drugs Salem, MA 01s70-3523 FOOD ESTABLISHMENT INSPECTION REPORT Tel. (978) 741-1800 Fax(978) 745-0343 Name (� Date Tvpe of Ooeration(sl Tvoe of Insuection ��$ C /} ZZ-�JL �O�Food Service ,[��Routine Address � Risk ❑ Retail ❑ Re-inspection _ Level ❑ Residential Kitchen Previous Inspection Telephone S� G ❑ Mobile Date:3�/c �.,� Owner �j HACCP YM � Temporary ❑ Pre-operation I'iUf � ❑ Caterer ❑ Suspect Iliness Person in Charge(PIC) ^ � Time ❑ Bed&Breakfast 0 HACCP Complaint In:(a,�1J Inspectar � � p Out:� ,q�- Permit No, ❑Other Each violation checked requires an explanation on the narrative page(s)and a citation of specific provision(s) violated. . Noe-compliance with: Violations Related to Foodborne Illness Interventions and Risk Factors Anti-Choking robacco Violations marked may pose an imminent health hazard and require immediate corrective sso.00s(E) ❑ sso.00s(F) ❑ • action as determined by the Board of Health. h FOQD PROTEC'f10N M/1NAGEMENT'""�`"" , ��m,s.�..,,�„'� ❑ 12. Prevention of Contamination from Hands ❑ 1. PIC Assigned/Knowledgeable/Duties� � ❑ 13 Handwash Facdi4es `�EMPLOYEE HEdLTH s :..,.,.._»�.,..�%,�....��'w�,u.v„a '«:.P;i:x.,� � �,�.�w�;i.,�aa.� �PROTECTION FROM CHEMI�AIS F e`�°�"" , x�r "`","�.:# T' '�"'"r�a ❑ 2. Reporting of Diseases by Food Employee and PIC � -"=�<��=�w�F�� _�-�. _�....� »..�-.�-,��=s� ❑ 14.Approved Food or Color Additives ❑ 3. Personnel with Infections Restricted/Excluded ❑ 15 Toxic Chemicals a w�;�._u"'e W��°�s�� kii ��t"`^�'J �„FOdDFR.OMAPPROVEDSQURCE��,m,�,„,,,„.,��,,:�,,�,..,,,,�.„,�„�„�,..,�„, . , ❑ 4. Food and Water from Approved Source �71MEffEMPERA7URE CONTROLS{Patent7aNyHatardous Foods) � ;,n, „tii«. .'76i. ,,,:s,��,u+�a,�,..� u�lrawm� �a �( � �i�a.�.- ❑ 5. Receiving/Condition �0�16. Cooking Temperatures ❑ 6. Tags/Records/Accuracy of Ingredient Statements ❑ 17• Reheating ❑ 7. Conformance with Approved Procedures/HACCP Plans ❑ �a•Cooling 4 , ;�PROTECTION FROM GONTAMINATION -�' '�` �`° �� '�� ❑ 19. Hot and Cold Holding �t . . :. �W�.� , ��u��9� ❑�8. SeparatioN 8egregation/Protection ❑20.Time As a Public Health Control ❑ 9. Food Contact Surfaces Cleaning and Sanitizing � ?`REi�UIREMENTSFORHIGHLY$USCEPTIBLEPOPU4:AT16NS(HSP)� � ❑21. Food and Food Preparation for HSP Ly'10. Proper Adequate Handwashing ❑ 11.GOOd HyglenlC PfdCTICeS � ,.�COySUMERADVI80RY�E r,,,�,.m ' ±��"��"� ' +„�o�.?""',�`��,u .,,.�,�y.,,,�� ❑22. Pos4ng of Copsumer Advisories 1 1 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. 590.00Offederal Food Code. This report, when signed below � ` �` by a Board of Health member or its agent constitutes an 23. Management and Personnel (FC-2)(sso.00a) order of the Board of Health. Failure to correct violations � �'4"Food and Food Protection (FC-3)(sso.00a� cited in this report may result in suspension or revocation of 25. Equipment and Utensils (Fc-a)(sso.00s) the food establishment permit and cessation of food 26. Water, Plumbing and Waste �Fc-s)(sso.00s) establishment operations. If aggrieved by this order, you 27. Physical Facility (FC-s)(sso.00�) have a right to a hearing. Your request must be in writing e 28. Poisonous or Toxic Materials (Fc-�)(5so.00e) and submitted to the Board of Health at the above address 29. Special Requirements (eso.00s) within 10 days of receipt of this order. 30. Other DATE OF RE-INSPECTION: /\\'_�(� � 5:59JInspeclFom1614.Eoc �� "� � n � w Inspector's Sign ture: � Print:� � 'P I PIC'sSignature: \\ ��,, � \�1 � Prinh . �__� �I � � � r. Page.�of�ges. r � � � � - , . ` l. � N Violations Related to Foadborne!ltness Jnferventions and Risk Factors(items Y 22) PROTECTION FROM CONTpMINATION FOOD PROTECTION MANAGEMENT S Cross-contamination �1 59(I 003(A) Assi�ment of Responsibility* � 3-3Q2.11(A}(1) Raw Animal Foais Separated frrnn � 590.003(B) Demansteation of Knowledge* � �� Coaked and R1'E Fa�ds" 2-103.11. Peison in diar e--duties , Contamirtatbn from Raw ingredients - - � 3-302.1.1(A)(2) 'Raw Aniai�l Foats Separated from Each EMPLdYEE HEA�TH Other* 2 540:003(C) ResponsiUitity of tiie pcasan in charge to ConfaminaUon Irom the Envapnment cequlre reporting by foal employees and 3302.11(A) � FOad Protectipn* a flicants* 3-302.15 Washin Fruics and Ve,�etables 590D03(F) Responsibilit}Of A Fa�Bmployee Or An 3-30411 Foi Contacs wi2h EquipmenY and . . Applicant To RepoiY To The Persc,m Tn Utensils* � Char e* � Cotttaminatlon trom the Consumer ' S90.OQ3(G) Ke ort'rn b �Person in Ch�u�e` 3-306.14(A)(B Retumed�F,a�d xnd R�.yereice of Foad* �. 3 590.003(D) ExclusinnsandRestdctioa4* . � DlsposhionofAdutte�atedorGontamirrated � 590.003(F) Removal of 8xelusions and Restr3c.�tions . � Pood � � 3-701.11 Discarding oc Rewnditicmin�Linsafe FOOD FPiOM APPROVED SOURCE H��* 4 Food and Water From Regulated Sources 9 Food Contact SuAaces 590.0(kt(A-B) Compliance with Food Law" 4-SOl.I l t Manual Wacewashing-Hot Water 3-20112 Fc�ci in a HernieticalL�Scaled Container� Sa�ieization Tam eratures" -� 3-20113 Fluid Mitk and Milk Prodacte* d-5011 t2 Mechanical Warewashing-HoY Water 3-20213 Shell�n a* SanitrzaaonTem cratures* � 3-202.14 E_=s and Milk Procinets.Yasteurized* 4501.114 Chemical SaniGzation-temp.,p'H, � c�ncentration and hatdness. '" 3-202.16 Zce M�de Bmrn Pnta6lc I3rinkin��Water* 4-[i01.11{A) &juipmcnt Food Contact Sud'uces and 5-1.61..1.1 Driukin Water f�um an A roved S stem" � � 590.006(A) Bottled Dri�lcin Water* � Ute.nsils Clean` - 590.0(16(B} Water Meets SCaudards in 3 LO CMR 22.0* �"6f72��1 Cleaning Freqoency aP Fquipment Fo�xl- She)lBsh and Fish From an Approved Source � ContacE Surfnces and Urensils� 4702.11 Fcequeney of SanitizaGon of IRensils and 3-2OI.i4 Fish anct Recreational'ty Caught Molluscan Food Contact Surfaces of ui ment" Shellfisii* 4-743.11 Methods of Sanitization-IIot Water antl 3-201.15 Molluscan Shellfish from NSSP tasted Chemical* Sources* jp Proper,Adequate Handwashing Game and Wiid Mushrooms Approved By � Re utalo Authorit 2-301 J I � Clean Cundition-Hands and Arms* 3-202.18 Shellstack Identification Present'� 2-301.12 Cleanina Preciure* 590.004(C} Wild Mushcooms' 2301.14 LVhen to l�'ash* 3-201.17 Game Animals" 11 Gootl Hygienic Practices � - Reoeiving/Condition 2-4�1.1�. Eatin ,Drinkin or Usin Tobaa:o* 3-202.11. � PHFs Reezivett at Prn ex Tcm ert�tures* 2-4fl1.]2 Disohnrges Frqm the Eyes,Nose and . 3-202.15 Packaae Inte it ` Mouth* � � 3-101.11. Food Safe and Lnadulterated* 3-30112 Preventin Contazninacion Wi�en Tastin�" ( � . TagslRecords:Shellstock 12 � Prevention of Contamination from Hands 3-2tJ2.1 S Shellstuck Identification ` 590.(H14(F.) Pcecenring Contamination hom � 3-20312 ShelLstockIdenti6cation Maintained* Em la ees* � Tags/Records: Fish Products 13 Handwash Facilities 3-402.11 PazasiteDestruction" ConvenientiyLoeatedandAccesslble � - 3-40212 Ruords.Creation and Retenut�n* 5-203.11 Nmnbers and Ca acifies* 540.004(J) � I.abelfng ot Ingredfents' . 5-2ik4.11 Lucation anct Placement* ry Conformance with Approved Procedures 5-205.11 �Awessibilit ,O�eration and Mai�tenance /HACCP Plans Suppi'red w'rth Soap and Hand Dryrng -3-502.1]. S ectialized Processin Meth�xis* DeNces 3-502.12 Redueed bx en acka �n�.criteria'� 6-301.]1 � Handwashin Cieansei,Avuilabilit� K-103.12 Conformance with A. roved Ihoc:edures*� b-301.t2 Hand D ht�Provision �DenoPts c'titiud item in the federd 1999 I�ood Code or l OJ CivIR.590.000. � � � F - - . `�y - � .,,F � � CITY OF SALEM '` � , BOARD OF HEALTH ! � Establishment Name: �,�� v�"tn Date: / Page:�_ of � c Item Code C-Critfcai�tem DESCRIPTION OF VIOLATlON/PLAN OF CQ�RRECTION � Date I No. �Reference R-Retl Item � � � � � �� ' �� Venfied '� _, � ("ti� PIEA E PHINT CLEAflLY �. �'�, : � 1 r n �T' /. �.� � l0 , � � � .� � � / W�(��14 i5 f i o I � . , � i r r � _ I1,�1 P o ri l`QD �U.I n �S o ,u, �, _ �% _ . J '�u� v /�"� /' i � �l u C �Jv (1� �l�r G N i - �, � � � ��1 � l n ' , _ , ; - i � � - �� `.r � � u , I�� , i - � � � , � � �. , _ ��, I�/ A u =�- ; , . � ` ` ,i ; � - , , � � � �� , . Discussion With Person in Charge: Corrective Action Requiredc ❑ No Yes �i I have read this report, have had the opportunity to ask questions and agre�t0 COI'r2Ct 811 Voluntary Compliance ❑ Empioyee Restriction/ i Exclusion violations before the next inspection'�e observe all cond��ons s �escribed, nd to ❑ Re-inspection Scheduled ❑ Emergency Suspension ! ♦comply with all mandates of the Mass/Fe�deraf Food C dc�`I\n��and t�ia�� 'noncompliance may result in daily fines oftwenty�fiv ollal�s or suspensibn ation of o Embar90 ❑ emer9ency ciosure I '� � your food permit: . - �,�� ❑ Voluntary Disposal ❑ otner: �� .�� •r - �� y � � y . _ _ _ , �, r . r �� A � 3-503.Sd{C) ,VHFs Re,ceive�3 ae'1'em}�eratures Vlofatlons Retated to Foadbarne illness Mterv�ntfons end Risk According to Iaw Cooled to Factors(tfems T-22} {Cont.) 1...A_I.°F('+S°F�yitliin 4 Hours. " PflOT�CTIbN FROM CHEM6CA�S 3 �O1.I5 I Coo(ing Methods for PHFs j4 u� Pootl or Color Additives 14 PHF Hof antl Cold Hoiding -.�..-�-- 3-50'L(6{H) Cold PHPs Maintained at or belaw 3-262.12 Addm�c.�" 590.003(1^� 41'145`F` 3-302.14 Proce.cu�>n�from Una� roved F�<iditives* �i_�p7,Lh(;1} I-[ot PFIFs Maintained ac or abova YS Pol�onous ar TQxlc SubsCances l��o� 7-101.11 1deMifyiiig Iniormation-C)iigSnal g_jpx �6�a� Etoasts Held at or�t�ove 130'F. " Con[aiuers" 7-10211 Common Nam�-Workln�*Containers* � Time as a Puhiic Heatih CoMrol 7-20L L 1 Se.�ration-SPoa�a*e�` � 3-�0719 Time as a Pubi4c Healtl�Conhr.t* 590.00d(H) Variance Re uiremenC 7-202.1( Restt'iction-Presenc�uud Iige'k � 7-202.12 Conditions af Use* 7-203.11 Toxic Conteinem-Pxol�lbitions�' REQUIREMENTS POR HIGHI.Y SUSCEPTIBLE 7-20d.11 Sanitiuis,Criteria-Chemicals* ROPULATIONS{H5P} 7-20a�12 Chemieals for 4Vtiahin�Pmdnce,�'riteria* 21 3-861,i 1(,�.j Liapasteucized Pte-packaged Jt�iees and Hevei�aees wirh Yva�nink,(,abels* 7-204.14 Dr�iri . encsCri[eria* --� � 7-2�5.11 IncidentalFoodG3ntact. Cubrfcants* 3-k30Lt1(B) UseofPaeteiicizedEQes* 7-206.11 ftestdcted lise Pesticides. Criteda* 3-801.11(B) Raw a Paitiallv Coukect Anlmal FoOd and Raw Sce:d S xa�its Not Se�ved.'� 1-20G12 Rbdurtf f3art Starions* 3-801.11(C) � Uno ened Fcwci P i�ka=e!voE Re-served. * Z206.13 "i"cac.kmg Puwders,Pest Control and Monrtorin�� CONSUIVIER.QDVISQRY TIMEfTEMP6RATURE CpNTROLS 2� 3-h03.11 Consumer Advisozy Posfad far Wnsmnpdon uf . ib Proper Coaking Temparatures Por Animal Fuads'1'hat are Kaw,Undereooked oc PHFs Iv'<n'Otheraisz Proc:esseci to Eliminste � S'stho�cns."E"�"'d vr��oor � 3-d0111A(t)(2) f 4yi- �155 I 7.5 Sec. � � s-Lumedtatt Sarvicc 145".PlSsec* 3-3Q2.I3 Pasteurized G�s Snbstitute for Raw Shell 3-461.,1 t(A)(2) Commiunted Fisl�,Meats Fz Garne E �� Animxis-li3°F 15 sec. `A � 3-0.0Lll(B)(I)(2) PorkandBee�fRoast-130°P121inin* �PECIALREQUIREMEP7T$ 3 40111(A)(2) Rutires,Injccted Me�ifs-155°E i5 590.Op9{A)-(D) Violalious of Section �90.009(A)-(B}in sec. * cate.ring, mobile food, temporz�ry and 3-461..1.1{A}(3) Poultry,Wild Game, Sivtied PHFs, residential kitchett operations shotdd be Stuffing Containing Fish, Meat, clebiCed mider die apptopriate sectians Poultr>or It�ci[es-165°F 15 sea � al�ove if relnted tc�food(>orne illness 3-401.11(C)(31 \�hole-muscle,li��act Beef Steaks interveutions and risk factozs. Other 145°F* 590.009 viotarions reln[ina to good r�tail 3-40L12 ltaw Anim:.�E Poods Cwke�in a practices should be debited uxider-/(29- Mlcmwave 165'F* Speeial Reqnn�emenes. 3-=t01.11(A)(1)(b} ,'�t(C}ther PHFs- 145°F'15 sec. * �7 Reheating sor Hot Ho�ding VlOLATIONS RELATE�TO GOOd REYAtL PRACTlCES 3-�03.11(A}&tl>) PHI^s 165°P JS sec. * {Ste�ns 23-30} � 3-d03.11(B) M'reruw'uvc- 165°t�2 Minnte SCandiug Cnticr�t arrd nun-criticnt vrotattor�s, w7rich do tto€relate to fhe Time� ' ,foodbnrne.tltness intn�venrion.s atrd risl�j'rrctors li.ste�l above, cnn be 3-d03.I 1(C) Cammcidally R�peessed RTE F�wd- ,fnured in the fod7oH�irig seccions qj�the Foo�l Code nr�d 10�CMR 140°F'k S)0.0�0. �. � > ttem Good Retait Practices � �'C 590.000 � 403.11(F.) Retnai�ning Unsliced 1 oxtion$oEBeeP -- --- Rriasis* 23. Mana ement and Personnel_,__ _ FC-2 .OD3 jg Froper Cooling of PHFs 24. Footl and Fofld Protection�� _ FC-3 .004 --. 25, guipmentandUtensiis FC-4 �� .005 3-501.1d(.q) Cunl:ng Cook�ed PHI's fram 140°P to 26. W atec Pimnbin and W aste FG-S .006 7Q`P Within 2I•Ionrs and From 7Q°F 27, Ph sical Pacility___...__ FG-6 .p07 Co�t°F/45°F Within 4 Honis. * 28. Poisonous o�Tobc Materials FC-7 .008 _ _-- --_____...---- 3-�QL14(B) Coaling PFIFs Made From An�bie��t 29� S ecial Re uirements __ _ ` .009 . 'I'emperatareingredientsio4,l°�/d�`F 30__ ,Other _ 1ViYhin 4 E�tours''` �r �r.:,:e�z:w� "Uenotes critical item in tl�e Federa) 19y9 Pood Code or 105 fiMR 590A00. � qv'�+.. ."�"��*0}�."1.'ri"xY4'�.+.`°" r ..;a '��'"' .: *�� 4 �:`,�ii a�"^ ' e��. �'s ar� �„. �,.'�r,��''�v'evr *�+.w. . . � � yd � �^#ik.' A�'✓�5�:��*}N4��"�'�w4�'"��k.,'�'c�F�'+'�,�'i'�' �» "�� r�e'�. � v ,��,��ay Hµ��' �'h6"R- a `' � sa �;�'rrFx�r'�f�°�'+�T*�el�ie'. h, r rro�^"�'�e�u�enJF�'P+ts'�qk?A�'�'t�' s:� , " n - ..�'�" :'-s_ . _ w;x.' .. � �4"� .,� �� ?` . �--1;,,• a. • i .F.� ..�.' wjN„& \a tha'.v4i r4pCw�..'. � . . . .. , . . . , , : . Commonwealth ot Massachusetts. <. ._. ^�M:�� .--: ; ' � �. , .: . . , � m: . � �S � . , . �::City of Salem � x � Board ot Healt6 � 120 Washington Street,4th Floor c � SALEM,MA 01970 ,y�� Food/Retail Establishment Permit DATE PRINTED: Ol/02/2006 WHO'S PLACE OF BUSINESS IS: Cafe Kushco File Number:BHF-2004-0090 128 Washington Street Salem MA 01970 LOCATED AT: 128 WASHINGTON STREET SALEM,MA 01970 Permit Type Permit No. Permit Issued Permit Eapires Fee Restric[ions/Notes FOOD SERVICE BHP-2oo6-0036 Jan 2,2006 Dec 31,2006 $100.00 ESTABLISHMENT Total Fees: $100.00 PERMIT EXPIRES December 31, 2006 � Board of Health t.r�� c-a�t�+ This Permit is not transferable and must be reissued upon change af ownership or locatioa The permit must be posted in a prominent location in the Establishment. In accordance with[he State Sanitary Code, beofre any revonations,improvements,or equipment changes are made,all plans for such must be submitted to and approved by the Salem Board of Aealth. Page 7 of 26 � - `o� CITY OF SALEM, MASSACHUSETTS R� �� R� „ ;, BOARD OF HEALTH �II 11 � e iZO WASHINGTON STREET, 4TH FLOOR � o �,�� SALEM, MA 01970 NOV 2;� �Q05 TEL. 978-741-1$OO Fnx 978-745-0343 CI�I�'QF STANLEY^Jn.AU�SR VICZ, .IR. yyyyyy,SALEM.COM B�AR� OF HEq MH . JOANNE SCOTf, MPH, RS, CHO ' HEALTH AGENT 2006 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT NAMEOFESTABLISHMENT r �GY�QC'� TEL# ��R -- ��O��Fj ADDRESS OF ESTABLISHMENT�2�_(��S�1fl(11� - � Ci' • ��Y� M� MAILING ADDRESS (if different)_� I ��-� OWNER'S NAME ��r"�(� M . C��L�� TEL# �� I — �Li� s.�I.� �j� ADDRESS ,2�� ^C 'x S 4- - CITY STATE ZIP ['j 1��- CERTIFIED FOOD MANAGER'S NAME(S) CERTIFICATE#(s)t��,�L-I � (required in an establishment where potentially hazardous food is prepared.) ' EMERGENCY RESPONSE PERSON �E�`UC� HOME TEL# ��1 "� .lLf� �S �� HOURS OF OPERATION: Mon.�Tue.__�__ ed. 'X' Thu.__ �C Fri. C Sat.�Sun.�� TYPE OF ESTABLISHMENT FEE (check onlv) RETAIL STORE YES NO less than 1000sq.ft. _$ 50 1000-10,OOOsq.ft. =$100 more than 10,OOOsq.ft. =$250 - -- . . . .-- .......--..... . .... .................... � ��---.... - ----------------..... --------�- --- ..... - --------�� RESTAURANT YES NO ��0� less than 25 seats =$100 25-99 seats =$150 more than 99 seats =$200 , --------------�------------��... ........ ..... ....... ---�---- ......._- ........ - -... ..--- - -.... BED/BREAKFAST YES NO $�a� ..... ............. . ------�-- ---.... .....- - - .....---------....... - - - ---... - --��-�- - ------ ... ....... 4DDITIONAL. PERMITS MAKE (notjust 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 trensferabie and must be reissued upon change of ownership. The Permit must be posted in a prominent location in fhe 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 filed all state tax returns and paid all state taxes required under the law. i natur Social S rit or de a Iden ' i tion Number ��---{- - -- --- --------��2�_l� ---------�►�_��--��---��--------- Revised 11/03I05 FOODA adm Check#&DateZ�y //��v� � �� l � � .. i� 128 WASH/NGTON STREET Cafe Kushco City of Salem FOOD SERVICE ESTABLISHMENT - FOOD SERVICE Inspection HACCP: ❑ 'Telephone' � nem Status Violation Critical Urgency Na[ure of problem or correction ��978-745-6996�� Non-compliancewith: NotDone �,�W�ef: :y , ... , . . Anti-Choking PASS ❑ Mark M. Stafford = 7obacco PASS ❑ PIC: � :.� _ . . �'DBn/a StBffOfCJ , FOOD PROTECTION MANAGEMENT Not Done �I�Sp@CfOC ' ` �� ,�� PIC Assigned/Knowledgeable/Duties PASS � RED Janet Dionne EMPLOYEE HEALTH Not Done D8f8 If1SP@CfBd: COff2Ct By: �� Reporting of Diseases by Food Employee and PIC PASS d❑ RED 3/9/2005� � Personnel with Infections Restricted/Excluded PASS ❑d RED Risk LeveC -�� FOOD FROM APPROVED SOURCE Not Done :P2frTlit NUfnb@f: � Food and Water from Approved Source � PASS ❑d RED � BHP-2005-0237 .. � Receiving/Condition PASS ❑d RED _ �StBYUS: ..: Tags/Records/Accuracy of Ingredient Statements PASS ❑J RED PARTIAL COMPLY #Of CfitIC81 V1018tiOn5:, �. . Conformance with Approved Procedures/HACCP PASS 0 RED Plans 4 'Time IN: �� ..Time OUT: - � Notes: 12:- , Urgency Description(s): BLUE: Violations Related to Good Retail Practices (Critical violations must be corrected immediately or within 10 ° iiays)(Non-critical violations GeoTMS�2005 Des Lauriers Municipal Solutions, Ina ( Rev. Mar 11,2005 ) Page J ot4 I �j y 128 WASHINGTON STREET Cafe Kushco must be corrected immediately PROTECTION FROM CONTAMINATION Not Done Of,Wlthlfl 90 dByS) � SeparatioN Segregation/Protection FAIL Critical �/❑ RED ite freezer-store raw meat products R�E�: � � separately from all ready to eat foods to Uiolations Related to / prevent cross contamination. Foodbome Illness Interventions , „a5me freezer missing thermometer. and Risk Facto�s (Require ' �� provide visible accurete thermometer ifilfil2di8t@ COff@CfIVe BCYlOf1) = maintained at temperature of 0'f or below . as mandated. Food Contact Surfaces Cleaning and Sanitizing FAIL d❑ RED ., , �ir,g board stained&scored-resurface or �replace. ProperAdequateHandwashing PASS ❑d RED � Good Hygienic Praclices FAIL d❑ RED �ersonal eyedrops stored near bread products. store all personal items separately from all food to prevent cross contamination. Prevention of Contamination from Hands PASS ❑J RED Handwash Facilities FAIL Critical ❑d RED �k handsink no papertowels. owner to provide papertowels at all times. nt handsink missing sign, provide sign labeled"handwashing only" f nt and restroom sinks had no hot water at time of inspection. restore/repair sinks immediately. PROTECTION FROM CHEMICALS Not Done Approved Food or Color Additives PASS J❑ RED Toxic Chemicals PASS �/❑ RED TIMEITEMPERATURE CONTROLS(Potentially Haz Not Done Cooking Temperatures PASS � RED Reheating PASS � RED ��,, Cooling PASS � RED Hot and Cold Holding PASS � RED � coca cola fridge had temp of 46°f. maintain at temp of 41"f or below as mandated. Time As a Public Health Control PASS � RED � REQUIREMENTS FOR HIGHLY SUSCEPTIBLE PO Not Done Food and Food Preparetion for HSP PASS 0 RED GeoTMS�2005 Des Lauriers Municipal Solutions, Inc. ( Rev. Mar 11,2005 ) PaQe 2 0!4 (^, '128 WASHINGTON STREET Cafe Kushco CONSUMER ADVISORY Not Done Posting of Consumer Advisories PASS d❑ RED Violations Related to Good ReWil Practices (Blue Not Done Managementand Personnel PASS ❑ BLUE Food and Food Protection - FAIL Critical ❑ BLUE ood stored on floor. all food must be kept at least 6-8 inches off floor. coc cola,tru�dge�,ic�e.sream freezer, � ndwiche unit and ��ert unit had some � uncovered food. all food in storage must be covered. , a1l�ry ingredients not in original container �'(o be labeled. Equipment and Utensils FAIL Critiral �❑ BLUE ice cr m"freeze�r-�+'hiCe lo�ng� fr zer,sand6vlcfi unit, true�ffftlge all issmg thermometers. Provide visible accurate thermometers maintained at proper temperature.freezers 0°f or below. refrigerators 41°f or below as mandated. �vide sanitizer in spray type bottles at . each work station. • nitizing log not being maintained . sani ing log to be maintained daily. re silverware handleside up to prevent contamination from hands. za cutter stored incorrectly.sanitize behveen uses and store in proper manner. Water, Plumbing and Waste PASS ❑ BLUE Physical Facility PASS ❑ BLUE Poisonous or Toxic Materials PASS ❑ BLUE Special Requirements PASS ❑ BLUE Othery See Notes PASS ❑ BLUE nges being used.sponges can bread bacteria.single-use towels or towel that is able to be washed and sanitized. GeoTMS�2005 Des Lauriers Municipal Solutions, Inc. ( Rev. Mar 11,2005 ) Paee 3 0l4 � ' 128 WASHINGTON STREET Cafe Kushco C�d �JIJ u ` GeoTMS�2005 Des Lauriers Municipal Solutions, Inc. ( Rev. Mar 11,2005 ) Paze 4 ot4 1�8"WASHINGTON STREET Cafe Kushco City of Salem FOOD SERVICE ESTABLISHMENT - FOOD SERVICE REINSPECTION Inspection HACCP: ❑ Telephone: icem Status Violation Critical Urgency Nature of problem or correction 978-745-6996 ' ` Non•compliancewith: Done OWf1@C � Anti-Choking PASS ❑ Mark M. Stafford robacco PASS ❑ PIC ° �_ � DOn/a StBffO�d � FOOD PROTECTION MANAGEMENT Done , InSpeCtof: - ' �� - ��, PIC Assigned/Knowledgeable/Duties PASS ❑d RED Janet Dionne ;� � EMPLOYEE HEALTH Done D8Y2 If1Sp0CtEd: COffeCY BY: �� Reporting of Diseases by Food Employee and PIC PASS ❑� RED 3/16/2005 - � Personnel with Infections Restricted/Excluded PASS ❑d RED Risk LeveC ��- � " �� '` � �� FOOD FROM APPROVED SOURCE Done PEffT11Y NUf11b2f: Food and WaterfromApproved Source PASS ❑� RED BHP-2005-0237 Receiving/Condition PASS 0 RED SfBYUS: �� Tags/Records/Accuracy of Ingredient Statements PASS 0 RED FULL COMPLY .-. " Conformance with Approved Procedures/HACCP PASS ❑d RED #of Critical Violations: Pians �1� �� PROTECTION FROM CONTAMINATION Done Time IN: ��Time OUT: Separation/Segregation/Protection PASS ❑J RED NOtOS:�� Food Contact Surfaces Cleaning and Sanitizing PASS ❑d RED � -� 29� � ProperAdequateHandwashing PASS d❑ RED UfgBflCy DeSCfI(JtlOfl(S):��5i� �� Good Hygienic Practices PASS d❑ RED BLUE � - , VI018YIOf1S RBIBt2d t0 GOOd � Prevention of Contamination from Hands PASS d❑ RED RBY811 P('eCfICBS (CfIYICeI- 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 17,2005 ) PaQe 1 0l2 1,2� WASHINGTON STREET Cafe Kushco must be corrected immediately L PROTECTION FROM CHEMICALS Done Of Wltlllfl JO(JByS� �� 3 Approved Foad or Color Additives PASS � RED RED: ' : �� Violations Related to Toxic cnemicais PASS O RED FOOdbOfflO IIIII@SS IIlt2NB�f1tIOf1S TIMEITEMPERATURE CONTROLS(Potentially Haz Done - and Risk Factors (Require Cooking Temperatures PASS ❑d RED immediate corrective action) Reheating PASS ❑d RED Cooling PASS � RED Hot and Cold Holding FAIL Critical ❑d RED coca-cola fridge had temp of 48°f. Service unit to maintain temp of 41°f or below as mandated. Time As a Public Health Control PASS Non-Critical ❑J 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 Prectices (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 � � GeoTMS�2005 Des Lauriers Municipal Solutions, Inc. ( Rev. Mar 17,2005 ) Paxe 2 of2 r ,y��Y'7`� t .'.+�tze r .r a�.. Y n.�' ^m 6...++=:?a4#^ ,ri 'te";'.��+S�a+i`55w�u��a�u��k+""'�.n91`4"��- '�"'.�.. r1v x i.�. 'ys 'v� �! �''i"�C'�`i -i , . r �s n� �, F* � : � �� ." �7'c� � ..t `" ., r�" � „� >r, i .,��,S p '' *e� . �, wx. �°i'-�. »d..,.��.-y�+.n �. ,.« .�.. u,.:�. .t�«,�e,.p . .r-�.- r „r�..a:,L7 �,� -=,.'+...�.- .,y,... _ . x.. ... _ ..._.._ b ,+�.. .. .w.�».w.. fa}p.'Fiw.- � ,`��y�.+,t�-.-,� � ,n- ' , �b.'�...'N..r � „E � � � .. .. � . ,�-e - : . ' � CITY OF SALEM� MASSACHUSETTS ' ��C�.'...-f•' . � , � � ' . , . n 'r . . - . � .. t - � . , � � � ,� � - .BOARD OF HEALTH - . ' ' . � � , - � 1 20 WASHINGTON STREET, 4TH FLOOR � � � � � SALEM, MA 01970 � � TEL. 978-741•1800 Fnx 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: Cafe Kushco Address of Establishment: 128 Washington Street Owner's Name: Mark M. Stafford Restrictions: Application Date: 12/3/2004 Permit for Food Establishment 162-05 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. �J�D�s�x.�, ��i�— HEALTH AGENT r � CITY OF SALEM, MASSACHUS �� I��` 1�� - . "�`Y � '� BOARD OF HEALTH �� .6 120 WASHINGTON STREET, 4TH FLOOR � �� a SALEM, MA 01970 DEC - 1 2004 �,�� TEL 978-747-1800 Fnx 978-745-0343 CITY OF SALEM STANLEY J. USOVICZ, JR. .10ANNE SCOTT, MPH, RS, CHO BOARD OF HEALTH MAYOR HEALTH AGENT 2005 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT NAME OF ESTABLISHMENT� �.[-� 11 �Cr 1 CC� TEL# ��IO' 7i"✓��G'//�/ ADDRESS OF ESTABLISHMENT 1 dL 11 WO.c�r}IRC�1�n �S�`- �d1�lYl Ml� 0�� --� MAILING ADDRESS (if different) �ry1C� OWNER'S NAME M(��"� M • �'FQ+1-O( CY TEL# 9�p �-I..�,�C�� ADDRESS �_ M�QI� St• CITY ST:,4TE_�_ Zii CERTIFIED FOOD MA AGER'S NAME(S) �� CERTIFICATE#(s) (required in an establishment where potentially hazardous food is prepared.) EMERGENCY RESPONSE PERSON �c��iC7+C7+ �_HOME TEL# T I �G �S �J HOURS OF OPERATION: Mon.�Tue. �Wed.�Thu.�Fri.�Sat.�Sun. �'/ l��/� l/ �� TYPE OF ESTABLISHMENT ecK onry RETAIL STORE YES NO less than 1000sq.ft. _$ 50 1000-10,OOOsq.ft. =$100 more than 10,OOOsq.ft. =$250 RESTAURANT YES NO �� less than 25 seats = 100 1 ��-- 25-99 seats =$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 dL� 11��N-P�20FIT/gprh ae {�hUrch k�trhn�e� VEC NQ ��S 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 bes �ow�edge and e ve filed all sta e t returns and paid all state taxes required under the law. C��1L) � � �/�O� Signature Ja�� Social ecurdy or eder I Iden i tion Number ----------------------------------------------- ---6- -----� - --- -��-----��-�`�------- ' Revised 11/03/03 FOODAP2.adm Check#& Dale � 1oa • , , IMPORTAIVT MESSAGE ) FOR DATr �5- TIME M OF PHONF ITT �JREA CODE NUMBER T N6'ON U FAX Q MOBILEC��A?d REACOOE NWBER, TI TO CAEL TELEPHONED &rpUEASE CALL CAME TO SEE YOU WILLCALLAGAIN WANTS TO SEE YOU RUSH RETURNED YOUR CALL WILLFAXTOYOU + MESSAGE ,41 1,' jSMVI;NE� pFORM 4009 MADE IN U�S.A �II, • E; ' ' . CITY OF SALEM � :�.:.:.:�' tf , � � :. �� / BOARD OF HEALTH ' Establishment Name: US Ci� �- Date: I -/D - OS Page: / of�/ r Date neni Code C-Cr�tica��tem DESCRIPTION OF VIOLATION/PLAN OF CORRECTION � i-��No;4� � Reference ��R—Redltem � Verified PIEASE PRINT CLEAfiLY f` +, 6) !Jml, - ,�' ✓ !7 ;1 . , � _ � � , i � .�e "� - !,�� ''She �u � h � Sou�.�1 r L �� r :: � v o f �2 �, � � � � �. � � �ti�� : .K � 1 Y1/ /� /�' { ^ / {� .Y� . . � � '� Y !(.� � ��Y_ � �� QY� ('� /C-P(.� � ( , 71 . �11� d cCed l' � ��'r ' � � � , .s� n� , � �,�� ls fr�� n�z-iec{ -�rum �C . � / � -�' s ' se u rP �n C1vtGi` ,Uh �� f , irG , lf I ; f � , � i� i� Ct7'7�IY)S t� � r � � � � �-� • ( `_'�� - 1 / l � / L1 a� /l/! P _ 7�7 k � � r: � �� :- k Discussion With Person in Charge: Corrective Action Required: ❑ No ❑ Yes � .� SG(,di��C�1,( C�lL � �,, I have read this report, have had the opportunity to ask questions and agree�to corre��all � Voluntary Compliance � E cPusion Restriction/ z violations before the next inspection, to observe all conditions as de�rib�d, and��✓ ,/ ❑ Re-inspection Scheduled ❑ Emergency Suspension ' eomply with all mandates of the Mass/Re�eral FooB Code. I un�decstar�d th�at � � noncompliance may result in daily fines of t enty-fiv doltars or sus�en ion�re�cation of ❑ Embargo . ' ❑: Emergency aosure - your food permit. . ��\ '�� •- ❑ Voluntary Dispo a ❑ otner: �� 'a . t > � \ � .... � „�, . � ;. . % - - -- � 3-SG L 14{C} PHFs Receivecl at Tempexatures Violations Relefed io Foodborne 18ness tnterventfons aod Risk Accardinq to Law Cooled to i Factors(tfems t-22) (Conk) 4)°F1�5`F'Within 4 kfours. * PFIOTEGTION FROM CHEMICALS 3-501.15 Coo(ina R4ethods forPFiFs . 14 Food or Coior Additives �� PHF Fdot and Cold Ho7tling - 3-50'1162t) Cald PFII��s MHlntaineci at or belaw i 3-20212 Addrtiu.e` 540.0�4(F) �l`/45°}^�` . 3-30214 t'rotc,cnnn froinlina>>�oved Actditives� 3-501.16(A} t�tot PHFs Marntained at or above l5 Poisonous or Toxic Substances 1d0'F.* 7-101.11 I�tendfying fitorinxYion-Origival 3-SQ116(�) R�asts Reld at or abo��e 130°P. �" Co�itainers* 7-102.3 7 Common Nsme-Workin��Containers* Z� Time as a Pubiia Naalth Conteol 7-201.1 I S�.araciou-SZorc�e�` 3-SU1 19 Tim�as a Pubfic Realth Contml-� 5�0.004(H) Variance Re�ul�cmetaC 7-2i12.1 I Restridion-presenc�and lise" - 7-20212 Conditions of Use" 7-30=i.11 'Ioxic C:o��tainera-Prohibitions* REQUlREM�NTS FOR HIfiaH�Y 3US�EPTIBLE 7-204.11. Sanirizei:s,Criteria-Chemicals� POPULATIONS(HSP} 7-204.12 C6enaic�ls for Washine!'toducc,Criteria"` �l 3-SOL11(Aj U��pastem�ized Pte-packaged 7uices and 7-20d.74 Dr�in A ents,Criceriax Bevei�aees with 4VarningL.ttbels' 3-H01_1 i{B} U�e ot�PasietiiizeU F,�+�s�' 7-2(L5.11 7ncidentnl Food Contact.Lnbricants* � 7-206.'I l Rcstricted Use Pescicides.Criteria* 3-&�11.11(I)) Raw�r Partially Cc�ked.9nima7 Fa�d�nd Raw 5cxd S�mnts No[Served.'� 7-20Ci.12 Rod�nt Bait 5tati��ns* 7-20fi.'l3 'I'ra�kmg Powders,Pest Control uad ��L ll(G} Unu�ened I�ooc(Packa re Noe Re-servecL � Ytonitorin��* „� CONSUMER ADVISQRY TIME/TEMPERATUR�CQNTROLS �2 3-60�9_i t Consumer Advisory Posfed for C:onsumptioo of 16 �� PmAer Cooking Temperetur�s for Aninaal Foods l'hat are Kaw,Undermaked or{1� PHFs Not OtJ�ezwise Pr<�ssed to Eii�ninate 3-40't.i1A(1)(2) F�gs I.55 F'lSSec. P13khO cnS ��`�:""r-r,-2�oi 6>�e �i�m�eAiste Sen�ice 145°FlSsee* 3-303.13 Pasteuncea L�+gc Snbs(iniTe for Rxw Shell gr>Sr 3-401.11.(A)(2) Cbmminuted Fish,Mests e�Gamc Anitn�tls- 15�°F 15 sea * � 3-401.17.(B}(1)(2) Park:and Beef Roast - 130`F 121 m'rn* SPEClAI.R6QUIREMEN7S 3-401.i1(A)(2) Ratites, [njectedMeats- 1�5°FLS 59Q009(A)-(D) Violauot�sofSection �90.�09(A)-(D)in sec. * c�tering,mobile foa9, temporary aud 3-4Ql.11{A)(3) Poultry�,Witd Game,StufFed P,HPs, retiidcutiai kitehen operations shoedd be Stutfii�g Cantaining Fish,Ment, de6it�d under the appcopriate sections Poultcy or xa�itea-165°F 15 sec.�` abovz if related to foodborne�llness 3-A011 t<C)(3) 4Vhote-muscle,Tntact I3eef Steaks interro�enttons nnd risk f�.ct�rs. Ofhee 145'B* 590.009 violarions relatin�to good r�tail 3-at71.12 Raw Animal Foa1s(`ooked in a pratctices should be debited under 1129-- Microwave I GS°F* Spec�ai Reqi�irements. 3-401.U(A)(I)(b) A(1 Other PHFs-1�5'F 15 sea * �7 Reheating fer Not Nolding V10LATlONS RELATED TO GOpp RETEIlL PRACTPC�S 3-d03.11(9}&(ti)) PH.Ps 1 fi5'P 15 sec. ' {(teuts 23-30) , 3-4Q3.11(B) Microwave- 1G5°F 2 MinuYt Standine Critica]and nnn-r.rrticat vfotntions, iahrch do not re6ate tn tFae Time* fa�dborne iltness irftetventions and�ixk fticun-r.listcd�t�ove, can be. 3-403.11(C) Commercihily Pxoceesed R'CE Foud- found irti ihe follnwitEg secRons of�the Food Code nnd IGJ CMR 140°F" 590.t�/�U. 3-d03.t 1(�) Remaininh Unsliced Porcions o[AeeP ' � GoaB Retail PractCcea _� FC 590A00 � Rc�asts" 23. Mana cment anti Personnei _ �'�� C--2 .003 (g Proper Cooling of PHPs 24. Footl and Food Protection� .._ � PC-3 .004 :�-5Ol..l.df1; 25 E�cu�mentandUtensiis FC 4 q05 � ( CoaHng Cooked PE3Fs fram 140°F tt� p6 W zter,Plumbinq and W aste PC 5 �006 70°F Wit'hin 2 Iiaur�and From 70°1' 27. Ph sical Facili FC-6 ` .007 to A1°F(AS°F Within 4 Hours.* 28. Poisonous o�Tox!c Makerials FC-7 .008 3-501.1�(B� Coo{ing PHFs A4ade Fram.4mbieiu �9. S ecial R uirements .00.9 Temperatnce ingredients to 41°FldS°P �30, pther I I[ ! 4: -- . .__ .�.._.. �I�illl�1'�OU($` '2.�nc �Uenot4e critical item in 4h�E�virnl 7999 Food Cade or 105 CMR 590,000. � ;/' ` CITY OF SALEM� MASSACHUSETTS , � � BOARD OF HEALTH - �� e e �20 WASHINGTON STREET, 4TH FLOOR I �� , 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: Cafe Kushco Address of Establishment: 128 Washington Street Owner's Name: Mark M. Stafford Restrictions Application Date: 2/6/2004 Permit for Food Establishment 274-04 � Frozen Desserts/Ice Cream � Permit for the Sale of Tobacco Products These Permits Expire December 31, 2004 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. J�� HEALTH AGENT i � o . CITY OF SALEM, MASSACHUSETTS �" v � BOARD OF HEALTH � � � 12O WASHINGTON STREET, 4TH FLOOR � � SALEM, MA 01970 � T E L. 978-74 1-1 800 Fnx 978-745-0343 STANLEY USOVICZ� JR. ,JpqNNE SCOTT, MPH, R5� CHO MAYOR HEALTH AGENT 2004 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT � NAME OF ESTABLISHMENT C� n��i `�� QC� TEL# 9�g �- �.I�h b9 �J6 ADDRESSOFESTABLISHMENT �I�SC (�, �t��(1f� �l � �.t�M ��? OI�� MAILING ADDRESS (if different) OWNER'S NAME l�� '..� ��Cl{71� TEL# �� — ')`t�� ADDRESS e 5"�' - CITY STATE ZIP ��l '�� CERTIFIED FOOD ' NAGER'S NAME(S)�et- CERTIFICATE#(s) (required in an establishment where potentially hazardous food is prepared.) EMERGENCY RESPONSE PERSON IlP(`�1(��rrClf� HOME TEL#_��:1�Q '.L � HOURS OF OPERATION: Mon._Tue._Wed._Thu. Fri._Sat. Sun. TYPE OF ESTABLISHMENT FEE check only RETAIL STORE YES NO � less than 1000sq.ft. _$ 50 ,j,�l� 1000-10,OOOsq.ft. =$100 �7 'f' more than 10,OOOsq.ft. =$250 RESTAURANT YES NO less than 25 seats - 1A0� 25-99 seats =$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 kitchensJ 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 be��,knoyXledgg��d b ie , h file II state t r ur�and paid all state taxes required under the law. '�'l/,� 1 / �// Z � Z �f U �i / .-(� �f-�� . ignature D e Social Security or Federal Identification Number ----------------------------------------------------- --------------------------�-/--�------------------------------------------------- Revised 11/03/03 FOODAP2.adm Check#8 Date �G�r2" �Zo 6� ` — — _ ORTANT MESSAGE FOR C4 M DATE-12�a C) TIME LL-Oa PV M OF C D PHONE- AREA CODE NUMBER EXTENSION 0 FAX Q MOBIl F- AREA CODE NUMBER TIME TO CALL TELEPHONED PLEASE CALL CAME TO SEE YOU WILL CALL AGAIN WANTS TO SEE YOU RUSH RETURNED YOUR CALL WILL FAX TO YOU MESSAGE (EVAe, bV IQA�40V- SIGNED FORM 4009 MADE IN U S A NOTES 4J7 �,\ V�� - �,Cu�lr-�rt9 �b�Cavt. D/C � .3Zecc�-G�— �- G�c�� i� ��-�c�. - <S'�u,c�i�i� ��q l�rn� 1��` _ �Qc� �v(�rn�1.��`� �-es s�nps ,�v�-- ��v �ow olz. � �,.� c� , - c�-�n� b��s � he �es � IMPORTAW MESSAGE FOR DATF '02-toi TIME -��p M KA A-M)'Al IZ,b J& OF PHONF AREA CODE NUMBER E�ENSION • FAX • MOBII P AREA CODE NUMBER TIME TO CALL TELEPHONED PLEASE CALL CAME TO SEE YOU WILL CALL AGAIN WANTS TO SEE YOU RUSH RETURNED YOUR CALL WILL FAX TO YOU MESSAGE w 13L C,ok A the D'A I VP;Ppk% wNf4aA afka -No mckd� �t( Q* ccv WeAm �a�11 - cl %)%4Lc.tu �eczvxtwv to CAr 31L�141- 10, & A�A ka mA RA q�OL -"=—ur%q �( SIX&m4 ck&4411%,%Iag �epe uu!tf�V- IS, kklo� SIGNEff U-�\N-b AVIL L FORM 4009 0 CAR �,;NOPS- MADE IN J S A NOTES _ � CITY OF SALEM , ' n U BOARD OF HEALTH , Establishment Name:�/�I-f-�. /l U S� �� Date: � /3 O Page:� of � ' � Item Code C-Critical Item � DESCRIPTION OF VIOLATION/PLAN OF CORRECTION ver fied II � No. � Reference R—Retl Item � �� ; � . � � PLEASE PRINT CLEARLV - -. � ... .se cz � f c _i abvuf Cu ev C / � 1� a � h i ,u a.d � s rc _s ', . �' �ver2 c� � - � �i ` s oi-+ - �� I , � at�r �- U�P ,e . a.�u � a e�e rP Cl P4P-3(n�ch �- Gua,(�r ;vhe _n /a be � SQIu- - - 2�ri fa� �-vLicfa�/ ' , o n �u t b' b �r�c.� /awn� -CQ " %�d E �taaa Pi,. � -1 v -c �ce �� f e.s'Ur�ce . , i ' �y . / � — � � � i . , . ; a ; ~� Discussion With Person in Charge: Corrective Ac[ion Required: ❑ No ❑ Yes i f � I have read this report, have had the opportunity to ask questions and agree�to correct all � Voluntary Compliance ❑ Employee Restriction/ � , � �,Exclusion viol&tions before the ne� inspection, to observe all condit�onsy described,; nd to ❑ Re-inspection Scheduled ❑ Emer9ency Suspension i �''� ;corr�Qly with all mandates of the Mass/Federal Food Code. I un�i��,stand that ,� 'nontompliance may result in daily fi�es twenty-five doll .rs o�sl�spens' re ocation of ❑ embargo ❑ Emergency ciosure i � yourfood permit � ' � �, ❑ Voluntary Disposal ❑ Other: i v I V I 3-JG1.14(C) PHFs Received at'I'emperatures� VioJations Reta}ed to Foodborne fRness Iniervenf(ons and Rlsk Ac:eording Yo I.vw Cooied to Factors(ttems 142} (CQnt) �1"PI�S"F��itl�'rn w'Hotus. * PftOTECTIQN FROM CHEMICALS 3�U1.15 Coolin��t�tetivxis for YHPs 14 Food or Color Additives ly PHF Hot and Goid Hoiding 3-501.16tB) Co(d PHFs eY�intainecl at�r below 3-202.]2 Additiveg'� 590.UQ4(F) -11'145°Y* 3-302.14 Protc,cuon frou�Ilna� roved Aciditives` 3-501.16(A} F�lot PHFs Maintainecl at or above 15 Poisonous or Toxic Substancee 1d0`F.* 7-101..11 Identifyi��g Infonnation-Chi�inal 3_�(j7,16(A) Roasts Reld�it oc aboae 130"F. �' Gincainers* 7-7 02.11 Cornmon Name-Workino�Cantainers* � Time as a PUBiic Health Contral 7-201.11 S�.aralion-Stora e" 3-7U1.7 y Time as a Pub(ie Health Controlfi 7-2�2.1t Rest�ricYiqn-Ytese.��ceu�dUse'" 596.004(H) Variance Re�uirement � 7-202.12 Conditions oP Use" 7-2Q3.11 Toxic ConYniners-Prol�ibitionsM' REQUIE?EMEPlTS FOFi HIGHI.Y 5U8CEPTIBLB 7-2tk}.it Sanitizers,C`�i[eria-Chemic.�ls* PQF�ULATIONS{HSP} 7-2(14.12 C6emlcals for Washuie Produue,Criteria" 21 3-RGY_l I(A) Lnpastem�Szed Pra-packa�ed Juices and 7-204.14 Drvin i ents.C`.riteria�` Bevei�ages witt� R%arnint;Labels` ?-Z0511 Inciden4al Foal Cuntaet.Lubricants* �-��L l l(Et} Use of Pxsceuiized'En��s* 7-206.11 Restncted L'se Pesdcides.Criteria* 3-SQ1.11(D) ftau°or Parfially Cooked Animal Foud and . Raw Seed S routs 1A'oC Served. '" 7-206.12 Rodcnf Bait Stati�rts" 3-801.11(C} Una ened 1=ood Packa�c Not Re-served. " 7-2Q6.13 Truc.king Powdzr�,,Pest Conteol tmd Mon'rtorfn�* CQMSUMER ADVISORY 71ME1TEMP�RATUR6 CONTRbLS 22 3-(03.]I Consumer Adl�isory.Postet7lor Consnmppon of AnuTzal Foncts`1'hat are Raw,i7ndera�oked or 16 Proper Coakiog Temperatures tor Nog Otherwise Procaesed toL'liminate PHFs 3-40L L lA{7)(2) Fggs- SS:i'F I S Seo. Pathoaen5.* Enav�,e v�,.zaoi � B>qs-L�unediau:SrrvicclAS°F75sec" 3-302.13 Pasteuri�F.ggs5�bstiCuteforR�twShell 3-461.1((A)(2) Comminnted 1'�ish,MeaLS &Came � Kg" Animsls- I5�°F 1S sec.'� � 3-0.0I.11(B)(I)(2) PorkandBeefRoast-130`F12linin" SPECiALREQUIR�(uIENTS 3-401.11(A){Z) RatiY�s,Injected Meafs-155°F 15 590.009[A}-{Dj Violadous o[Sectinn S9Q.009(A)-(D}in sec. * catering, mobile fard, te�mporary uid 3-40LJ.1{A}(3) Poahry,Wiid Game, Stuffed PHFs, resiclentlal kitchen oper�tions should be Smffing C,�nt�aining Fish, Meat, debi[ed mtdcr the�tppropriate seccious �'oultr�or Racites-165°F 15 su�,. "` above if relaCed to f�od(>orne lllness 3-401.11(CJ(3) 4Vhole-musele,Incact 13ecf Steaks lntecvenrions and risk Cactors. Othee 1�5°R* 590.009 violations relaun�eo�ood retail 3-=Wi 12 Raw Anirr�:�I Foods Coaked in a �sacrices should be debited undec J129- Microwave ((i5°F'� Speeial Requirements. 3-40(.11(A)(1)fh} A(1 Othec PFIFs-7.4>°F 15 see '= 77 Reheating far Hot Nolding VIpLAP10NS REiATED TO GO00 RETAIL PRACTtCES 3 403.11(A}&(I)) PH1��,165°F 15 sec. * {Iteins 23-30} 3-403.11(B) Mra'owave- 165"R 2 Minute Staudin� Crztica7 nud non-criFicai cidatrorrs, ichrch do trot re7ate to tfte Time* ,f�ndhnrne.t(Iness interveruiansa�+d riskfnctors tisted aGn»e.can be �3-a03.1 l(C) Commercially Pivicessed R'CE Fax!- ,fi�amd in the fo/lowing sereirms t�Y the Fnod C'r�de and 105 CMR 1 AO°F'" 590_OOQ 3-�D3.t l(13) Remainina*Unsliced Po�cdoas oF Recf item Good Retail Praciices FC 590 000 � �I - -_____. Roasts* 23. Mana ement and Personnel____ FC-2 .003 ------.-_ - lA Proper Cooling of PHFs 24. _ Food and Food Proiection ____ FC_3 .004 25 Egui�ment a�id Utensils FC 4 :005 3-SOL1d(.A) Cuoling Ca�ked PHFs from 1�k0°F to zg �� VJater, Plumbin and W este FC 5 i .006� 70°f'Wit�hin 2 Hours and From 70°N' 27. Ph sical Facilit PC-6 .007 eo 41.°F/45°F WiYhin 4 Ftoncs. * 28. Polsonous or Toxic Materials FC_�7 �008 3-901.14(S3) Cooling PEIPs Mad�From Ambieiac ?9. S cicial Re uirements _ I .0p9 � "Cemperuture 7ngredients to 41`f�/45°F 30. Other - --- .. _- --- ... .---------..._._. Within�Hours'� ,r d��zAoe "'Denotr.s cri«cul ite�n in ih��.Cederal 1999 7'aoil C,ude or I fl5 C61R 590.000. IMI?O ATANT MESSAGE FOR ;L41"A+ D TF TIME P M M OF PHONIF AREA CODE NUMBER EXTENSION Q FAX U MOBIl P AREA CODE UMBER TIME TO CALL TELEPHONED PLEASE CALL CAME TO SEE YOU WILL CALL AGAIN WANTS TO SEE YOU RUSH RETURNED YOUR CALL WILL FAX TO YOU M SA Clyina )�E ole, u) chn(Y)AU\0 dl[) P\- SIGNED FORM 4009 Vrm- MADE IN U.S.A ------------ NOTES ,v ,' �;J r � �e� CITY OF SALEM 'y � BOARD OF HEALTH ' Establishment Name: Date: o�- oZ/c�� Page: � of_ � ''. nem Code C-Critica��tem DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date - No. � fieference R—Red Item � � " � Verified 'r PIEASE PRINT CLEARLV a . '''c �o f ,�ii �s �z� �� c7s _— o ,' n i — r �r ' Li Ps a tii r i��.e.r .� � � „ � �cf�.�� r . , � �S , � r� ,vc ,.v4 a .� � i�i i.v ,v a/ da ,/'J�ii ft` � `s /ir« 1�r� , ;� � o I-P�i�liavd.u�yl � • 7vYfuG�1!cr��c,�,, �` � , , t ;4 :':> . ,t i ,ry 1 1 �, Discussion With Person in Charge: Corrective Action Required: ❑ No � o 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 ins ection, to observe all conditions as described, and to Exciusion 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 ciosure your food permit. ❑ Voluntary Disposal ❑ Other: ; t > : - ' _ 3-SDi.t�1(C} PHFsReceh�edafTeu��eramres� Viataltons Related ta Food6crne RMess Inferventfons anc/RisK � Accordi»;;to t..�iu�Casle<i ca Factors(ttemsT-22) (Cant.j dl°F145^FWithin4Houcs. "� PROTECTION FROM CHEMICALS x-501.15 � Ca�l'v�e bteYhocls for PHFs 14 Food or Colar Additiaes�--��---� 19 PHF Hot and Coid Noiding 3-20Z12 Add�tie�ec�� 3-501.16(B) Culd PHFS �Saintainrd at�7r below 3-3(YZJ<4 Protectionfroml�nappraF•ed .ldditil�es:". 59U.00d(F�1 dl°/4�°7�* . (g Poisonous or Tox�c Substances� 3-501.16t,A) Hot P?[Fti Maintained at o��ab�ve 740`F: * 7-101.i] IdenNt}+inglnfoe�riatSon-Origiottl - 3-SQl.lfif�} Rousts Held at ac above 130`f'+. * Containers' 7-10211 Co�mno��Name-Warkina Conta9ners` Z� 7ime as a Pu61ic Hsaith Controi 7-?01.11 S�.aralion-Stora e�' 3-507.19 Tima as a PublicHealth ConEm(* 7-202.11 Restriction-Presenceandllae'� �9Q�004(H) VazianceRccuh�ement 7-302.P2 Conditions af IJse" 7-203.11 ToxicConta'rnexs-Prohibitio�ti'* REt�UIRFM�NT9PORHiGH�YSUSCHPTIBIE �-20�.11 Sanitizecs.Criteria-Cheinicats� ROPULATI4N5(HSP} 7-20�L.L Chemicals for W'ashSn�Produce_Cr'rteris"` 2�1 ' 3-801.ll(P� Un�eSteuriz�e'1 Fc�paekaget3 Juict-�and . . 6evei�e,es with Warninnl<abels"�. 7 204.IA Dcyim� A�ents,C rite�i�"` 3-bp1.11(A) Use of Pasteuriaed B^ris* 7-205.11 Inctdentat Food Contict,Lub�Scants* 7-206.11 Restncte� Uee Pestmides,Criter(a* 3'8�t.11(D) Raw rn Pa��flally(.x�akeci Aninia(Pa�d m�d Raa Seed S�touts Not Secvad. � 7-20612 RudentBxi[S(alions�` 3-gp�.11(C) C7ni�.encdFoodPacka>eN�tRe-eerved. "' 7-206.13 Trn�}.mg Powders, Pest Cuntrot m�d Monitarine"` CONSUMER ADVlSQRY TIME(fEMPERATURE GQNTROLS 22 3-G03.11 Consumct 1�visory Posted Por Consumptio�ti of Anun�l Fauls`That are Raw. L7ndermoked qr �.(� Proper Cooking Temperatu•rea for � Not Otl�ecv.�sa Processed to Elimina[e PHFs r o,,, -.aooi 9-dO1.11A(1}(2) Fkt�s li5=F15Scc. Paffiac,nti' L s immedi ite S�cvice 145"Fl.$sec* 3-302.13 Pastaur�rcd E�oS�ibstiuite'For Raw Shell 3�01.1I(A)(2) Comminuted 4�ish.Meats&Game �'�Q'� Anim�Is- 155°F 1�sec. Y' 3-461.17(B)(1)(2) Pork and Bcef Roast- 130°F 121 mui" SP6CIAL RBQUIREMENTS 3-0t�l.l l(A)(2) Rati[es,Injccted Meats- 155°F 15 590.009(.4j-(D) Viotations of Sec6on 590.0C)�3(A)-(D)in 5e� ;. catecing, mobile fa>d, temparazy Rnd 3-401.1 I(A)(3) Ponitry,Wilcl�ame.Stut�fed PHF,, resldential kiCchen operations shoutd be Stu�nn Containing Fish,Mear, debited under tfie appcopri�Te sections I'onttry or Ratites-165°F 15 sec * above if related to foodboi'ne ilLiess 3-�t1711(C)(3) tiVhole-n�uscl�,Intact Seef Stent:� intervenLiaas and risk factoi:s. 4fhcr 145°F* 5)O.QQ9 vio,latfons relxtiug to good retail 3-d4L 12 Rxw Anunal Foucis Cooked in a piactice5 Should be debited uudat ti?�- Mia�owuve 165°F�^ Specia] R�quireiuents. 3-�F6111ta1(i�(b) AI( t)ther PFTI�s- 145"F 15 sec. * 19 Reheating for Hot Noiding YtOLATlONS RELATED TO GDOQ RETAIL PRACTICES 3-403.21(.A)c�.(D) PHFs 165°F I�sec. '" (Items 23-30) 3-403.11(B) Mic�owave- 165°F 2 Minote Stant'ling Critrcai a3rd rmn�-crrfieat violutions, whicli do no�rc�late to the Time` �oc7Fiorrce illness inten�er�£ions nnct ri�kfactars listed abot�� caz�fie 3-=403.11(C) Commerc9ullyPracessed RTE Faod- found in the fol7�inzng sections of theT"ovcE Code and 105 G41X 140°F� 590.(T00. 3=I03.11(E) Remaining UiisticedPortiaos ofBeef = ifem � Good Retail Praefices { FC 590=000 Roasts�` ,.,23 Mana,gemsni and Personnel I FC-2 .003 Ig .Proper Cooling of PHFs � 24 ��Food and Food Proter,tion � FC_�3 .004 i '-- ---- --- 25 E m ment and Utensils FC 4 ,005 3-SU1.74(A) Co�lin�CaikeclPHF.sCmm740'Pt'o .p -�- -�--- ��---- --... ..-----� � 26 WatecPlumbin andWaste FC 5 006 __J ip�F FWithi�i 2 Hourc and Frc�m 70"F^ 27 I Ph sicai Fao�lit ` FC-6 .007 I tu 41'l�l4a°F Within�Hours. * 28 � Poisonous orToxic(vtaterials FC-7 .008 ' '__-�.-. - - _, � 3-SOI.I0.tB} U�olingPHbs Macie From Amhient _29 � 9peclal Requirements ,_ .009 , 1'emperatnr�Tog��edients[o41°F145'F �30 � Othar _- -- .. __._. . ..___. ...___-_. _�'��. � WiEhin 4 Hours* ' . ° '"`".'."°' *prn��ley Cdficat item in t6e[adrral'f949 Food C`odc or l0i CMR 590.600. . , CITY OF SALEM BOARD OFHEALTH Establishment Name: �i� �__�i i1 Date: Page: � of / nem code C-Critica�uem DESCRIPTION OF VIOLATION/RLAN OF CORRECTION oate ��No. Reference R—Red Item � � � �� - Verified ; PLEASE PRWT CLEARLV �. t / !s ./' J � P i l / � , � �f . / ^ � \ ,� 1 t ll � .,L ' 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/ .�fExclusion , 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/Fe�al Food Code. I urrderst��hat noncompliance may result in daily fines of t enty-f� � doliar o sus�e � ion/revocat�o of ❑ Embargo ❑ Emergency Closure your food permit. (�i � �/ I ❑ Voluntary Disposal ❑ omer: vv r� - i J � 3-7P1.7�}(C) PHEs Receivad at Temperatur�,v, Viotatiotts Refatetl to faodborne lilness tnterversilons and R1sk Accordine to Law Cwled ro � Factors(lPems 7-22) (Cont.) 4'1°Fl4�°F Wittdn�H�xu�s." PROTECTIONFRCIMCHEMIGALS 3-501.I3 � Coo]ingA4eU7odsfirPHFs Food or Color Additives r� PHF Hot and Coid Holding 1� 3-50116(B) Co1dPNFs Mai,ntained at or belotiv 3 202.�t2 �arlchti�es�x i90.Q4d(b� 41'l4�`F�' 3 )(72Jd Protu.hon Prom Lh�appraved .ldditities'4 9-501.16{t1) Hot PHFs Maintained at or above a,s Poisonous or Toxic Substanaes 14p�� ; 7-I�Jl.11 Iclr,ntifyi��g Information-Oii�viniil 3_501.16(r17 I2oast�s Held at oc above 130'F. * Centainers' 7-102.11 Cotmnon Namc-Warkina Contxiners" �Q Time as a PubOc H�alth Contwi 3-501.19 Time xs a Yublic HealYtr ControPk " 7?01.11 S�.eimlion-Stora e"` - 7-202.11 Reshiction-Piesenceand [Jsc'k �90.00d{H) Vmiance,Recu'v�emcnY 7-202.12 Conditi�,�ns qf Use" � � 7-203.11 'CoxicCuntainers-Prohibikions" aEZ1U1FtEMENTS FOR HIGHLY SUSCEPTIBLE �-204.I7 Sanicizers.Criteria-Chemicals* P�pULATIONS(HSP) 7-20�t.33 Che�uictilsforWashin>f'ratn�eCi-itaiia* 21 3-801J.1(,4� (Inpaste�ntizadPrepaekng�d.luicesnnd 7 20�1.14 Dcvin�� A4euts,Ciitena* He�ei�-eF ivich W arnm�I,abels* 7 3(1511 Licidentut Foo�l C.ont�ct,Lubi iwnts* 3-b01.17(Sj '0'seofPtsteurize�lL *s* 7 20611 Restricted Use P�sncicies,Cntcu�t* � 3-f3U7 11(D) fta�c ni Partially Ccre�ked Anim�l Food and Baw Saed S�rontti Not Secvel � 7-206.12 RodtnCBt�iCStahons� 3_gOLll(C) Unu.enedFoodPacka�c;Notftc,-srrved. "` 7-206.13 `Truckm,;Powdecs, Pest Controt and M�nitari�7e* �p(�SUMER A�VISQRY TIME(f6MPERATURE GONTROLS �Z �-60311 Consumer Adtiisory Posted foi Consumpt'ion of Lh Proper Cooking Temperatures for � Anima7 Fc�uds'1'hz#are Kaw,Undercoal:ed or PHFs N�>t Ot6erx�se Processed to Eliminate 3-4011tA(1)t21 Eees- 155�F 1� Sec. Patho�t,ns � ri .n,-.;+ ;nnr H Rs-immediateService 1&5°FiSsec"� 3-302 L� PisYcwucd F„�s 6obsLiCuf�for Raw Shelt 3-AOI.'i t{A)(2} Co�mninuted l�ish.Meats&Cia�ne r�_.� .inimals- 155""F l�sec. �: 3 401.118)(1)(3} Pa�kancl'BeetI2oast- 130°F 127 mSn� �PECIAL REQUIREMENTS 3-001.11(Ai{2� Ratiu,,L�jected Meaus- 155`F 15 �`�0.009tA){Dt Vic�lations of Secaon .S�JO.OQ9{A)-(D)in � sec. ' catering,mob�Ile f'ood, tempornry and 3-401.11(A}(;� Pouihy,Wil�t Game.Scnffcd VHFa, re�side�nual ki2chen operations should be Stuffin�*Conta(ning Ftsl�,Meat. delziTed und2r the appcop[iate seetions Youttry or Rautes-1(5'F 15 scc. '� above if related Co foa�borne illness 3-4�111(C)(3) Whnie-muscle,Intack Beef Stexks intcrvenuons and risk F�ctors C)Cher 145"P�' S)(}.009 ciolatfans relating to gcwtl tetai( 3-401.12 Raw Animat Fo��s Ca�ked in a � practzces shoulc(be debited w�der 4�29- D4icrowzive 165°F* . S�aeeial Re,quixemenes. 3-401.11(A)(,l)(b) All Other FAFs--7d5°F IS sec. * j7 Reheating for liot Holding VlOLATlpN$RELATED TO GOOD fiETAtL PAAC7/CES 3-1D3.t1(A)&(D) PEIF�165°F IS sec. * (Items 23-30} 3-d03.11(Bj Microwat�e- 165`I'2 Minufc SCtmding Critir.al ar�d r�on-criticat violaPeons, wkich do not relnte to ihe `Sime* fooel&orrae i7tness irrt¢rver�tioru anet nskfaetora lrsted aF�oee, euei be 3-403.11((.� Cotuwercially Pra;eseed tt'I'E Nood- fitund i�r the foltoia�irig secticros of the Food C.ode and IOS CMR 1�Q'F* 590.t�b0. 3��3.1 I{E} Re�naining U�1sliced Yortions of}3cef I ttem Cood Refail Aracfices � fC 590.000� ftoxsts" '�,� 23. _;�._Management aotl Persannai ( FC-2 .003 t jg Proper Cooling of PHFs ��. 24 I Food and Poc�Proter,tiqn _ FC--3 .004 ; � � ..___._. - �_g� �_ C 4 .005 � 3-�O1.14(Aj o a3t Fld7°f�1�ithin 4 Hr�urs . .. 2S. � P asono s o IT�cnAqat a ais I F ..� . � 25. E m rrent and Utensifs _ F__ Ca�k�d i FiPs from 1d0'F to C-5 .006 _� '7O F 1Vithi�i 2 Hiwrs�nd From 70't' I, C-6 .007 3-g011�B Coo7�n,PHb� �adeFrom Ambient ��30 � Ot�her� �e uirernents � � ,009 ? K -�-�-- � 7eroxramx� lniu9ientsti��('�Fld�'F' � .. . I W ithm 4 Hours � �Drnofes criticat ium in t6o federal 1949 Fnaf Caie or 7 Uj C�9R 590.000. � CITY OF SALEM BOARD OF HEALTH i Establishment Name: �a -�e l��s h � n Date: �'/o�� Page: � of � � Item Code C-Critica��tem DESCRIPTION OF VIOLATION/PLAN OF CORRECTION oate No. Reference ' R-Red Item � �� Verified -' PLEASE PRINT CIEARLV .'. ..A__✓C�� D+ / r �HI ... c� q/l7U / �O � (_Ca7��c� 7 ... (y� �i / 4 .-1-�lJ�cl ��f ' ' ✓ S� ar '� ; � � o! ,r/ co-nc¢� �'�� P c� f c� J'11�i/l/ '� a✓c� ' rlf.U.S�/ Q,U � �Q 5� �G .�/� .� G� � SG` J , s ern / �c�,ssP� ��l � �t '� �t a-� -{�v-� /� Sery i ce.> ; � l,� � �/ n��f o�� a�� ,� � °i f3 .� � ° O-F �/s Q,< �D° � lza. Sa-n r - u.. : r.� .od v� 5 � of�� u� /N % ' { � �?.�i �3``� o� �'/ �• v �v.t /� a � a ��r9-� � S�ii � �i z� ' -� �-e6 � i Q-�/c✓ /b / � .� ,0��/-�s, �f a� .v�� / s � � � �� u�� a Ea �f � d s � _ � �vssc -he-��- � '� �1 Q r�f Qa P�� ' �l.S � .�.. s�-� - �� G� �s fx a d� �s�/�L� . 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/ ` violations before the next ins ection, to observe all conditions as described, and to Exciusion 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 ❑ Embar90 ❑ Emergency Closure ` , yourfoodpermit. A ❑ Voluntary Disposal ❑ Other: r < 3-50114(C) PNFsReceiva�l�atTemperatures - Viatations Re/ated to Foodborne lttness interverttlons and Alsk Accordim*ta L.�w Cooled to Faciors(Items 7-22J (ConG} 41°PIdS'F l§'itl�9n 4 Houcs.* PR0T6GTION PRQM CHEtutICAl3 3-501.1� Cot�lin^MethaLG for PHFs jq Food or Color Additives 1y PHF Hot and Cold Hoiding 3-�Ol.l6($} Co7d PI{Fs ivlaintained af Gr b�low �-202�t2 tlddirives� 59C1.604(F} 41°l4s°F, 3-303.Ld Pro[ection fi�om[Jna� nwed Attditive,i'" ,3-501.16(r1) EIot PHFs MainYnined at or abuve �.5 Poisonous or Toxic Substanc¢s lA0°r. * 7-101.I 1 IilentitySng Iaf'armation-Oxiginal 3-501.16lA1 Roastc Held�t or above 'L30'F." C�neaiuers* - 7-,102.17 Common Ntime-Woxkim*Cuntainer8'"� �� Time as a Public Heaith Controi 7-20L L1 Se aratiUn-Stoi��iae* 3-501.19 Tinte as a Public FIealYh Controt* 7-202.7 I Restriction-Presence aiid Uea'� �90.0(�4(H) VaiixrceR� ir6�ezn�nY ?-202.12 Condi[ions of Use" 7-2C13.t I loxic Cont�iners-Prohibikions* REQUIREMSNTS POR HICaHLY SUSCEPTIBLB 7-?0�.11 Sauitizzrs.Criteria-Cheinicats� P�PULATtON5(HSP} 9-2D4.12 Cheinic�ls foz�Washin�Pcodui,e. Criteria* 21 3-8Ql.11(.4) IInpanicurized Pre paek�grd 7uices;and 7-20�.14 Dtvim�A�ent.-._Critetiu'� Se4etageswithWarmnat.abels� 7-2{}5.11 Inc.idental Fooci Contact,L�iCrica�ts* 3-80L,i1.fB) I,iseotPasreuiizedb��rrs" 7-206.17 Restricted Uee Pesticicles,Criteeia� 3'`��11(D) Raw ar Psu'tially Coakec(Aninta(Food:md RaH�4eed S�muis Not Ses4�d �` 7-?.66,t2 R�ident 13ait Stanans�"' 3-801.11(C} Un��ened Foa!Yacka>e Not Ro-sarved." 7-206.13 Tracl.3n�Powden,Pest Control and Monitorine" CONSUMER ADVISpRV TIMEITEMPERATURE CONTROLS =z 3-(i0311 Caosutner Advisory Posted tor Cansumption a[ '16 Proper Cooking 7emperatures for Animal Pood�That are Kaw.Undercoolied or PHFs Not 08�erwise Processed to'Elimivate Pat6o��ns ' "Oe11aooi 3-401.11.��(1)(2) E�gs- 1�5^F I�Sec. 4_3Q2.1.3 Pnsteuurc,i F �Substimte for R:aw Shell H Rs-,immedi�te Servicc l�i°E15sec* �� 3-40t.1 t(A)(2} Com�uinuted Fish.Idcats&Game �'�:'� � rinimals-755`F 15 sec.� ' 3=401.11(E){1)(2) Pork and Br��:1`Roast- 't30'F 121 min* �PECIAL REQUIREMENTS 3-401.11{A�(2) Ratites,Injcete<I Meats- L55°P 15 590.OQ9{A)-(D) Violations of Section 590.009(A)-(I?)ir� se�. * cateiing, mobile fcwd, temporary and 3-401.11(A)(3) Poiiltry,�Wild Game.Sn�iPed VHP's, residential kitehan operations shoutct be StuR3n�Conluinin�Fi9h,Meat. debited under the appropria(e sectiqns f'outtry or Ratites-165"F 15 sec " aboee if related eo foodborne illsicss 3-AQi.'11(C)G) Whole-musde.Incict T3e�fSteaks inCetvenCio��s and risk facYors. Qther 14S°F^` 59(�.Q09 violtiuons relaring to good retuil 3-�101.12 Raw Animal Foods Cooked in a Pr2CTiceS should be de-hi[ed utldes 113)- � M;crowave 165°F* Special Requireme.nt,s. 3-0OLlt(A)(7)(b) AllOtherPH}^'s�- 145°F15,yec. * I7 Reheating for Hot Hoiding VIOLATlDA:S RELATED TD GOOD RETAtL PRACT/CES 3-403.i((A)&(D) PFIFs 165'P IS sec. '0 (Items 23-30) 3-a03.I1(13) Microwave-]65°F 2 ivtinute Standino� Criticat mrd nnn-crrrieat ciolations, whick da not relate zo the 9'iiiie" � fondbnrne itlness intee��entioru and riskfacta�s tisted ufioce, carr be 3-4t)3.l.l-(C) Cotu,mezcially Praxssed R'PE Fuod- focrnd in the fo8oia•ing sectioris oJ'the Food Code and lO.S C;MR 14fl°T�* 5>Ci.000. 3-4t73.1 I(E) Remaining Linsliced Portions of BeeP Ilem I Gond Retail Practices ! FC 590.000 I Roi�stsx< 23. I Management and Persannel i FC-2 .003 Ig Proper Cooling of PHFs ��- Food and Poad Protection __ I FC-3 .004 i _�___ . . ....._ _- . � 3-501.14(A) Cooting Cooked PtiPs from 140'F to z6 ; W ater,nP utmb'��n�and�W aste FC 5 .00& i . 70`F Within 2 Hours an�l From 70°A 27. I Ph sicai Facilit : FC-6 007 to�11'F/di'F �i'uhin 4 Honrs * . 29 �� S ecai i�Reouirementsater�ais-_ --...F�-7 .009- --- 3-SO1.IA(B) C ooltng Pl-[Fc M14,acdi itts�u��mbiz1�,yF 40 i Other..�- � [emperaYurc Tog'^ biithin 4 Hours� s.,•:�:no�;�n�:r.ad.,� .*DenoCes critical i[em in the tula�al 1999 Fo��C<�de or t05 C39R 59090U. CITY OF SALEM BOARD OF HEALTH � Establishment Name:�n �� l�r��%J Date: � �/02 ' �`� Page: oZ of� nem Code C-Critiea��tem DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date No. �Reference R-Red Item � �� VeNtfed � ` PLEASEPFlINT CLEARLY. / i 9 .� � � Q .� .,4 �/ ( B ` Q.ii � ✓aLL /,�f � „ ( � � � , 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/ violations before the next ins ection, to observe all conditions s describe and to Exciusion P � n �� ❑ Re-inspection Scheduled ❑ Emergency Suspension comply with all mandates of the Mass/Fe2ieral Food Code. I un�erstand th��t noncompliance may result in daily fines df Ywenty-fiv dolla`�\\s or`s�,spensionY�revocation of ❑ Embar90 ❑ Emer9ency ciosure your food permit. �\� �� 1\ � 1 1� ,�`�� , N i�v V•�- ❑ Voluntary Disposal ❑ Other: �w- i �> > a � r � v 3-501.L4(C} � FHFs Ftecei ced at Teu�peratures VFolatfons Helated to Fopdbpme lNness lnferventions and Rrsk AccorJin*tta L.au�Cooied[o Faciors(Items t•22) {Cant} � d]'F1d5'F Within 4 Hoiire. * �RdTECTIONFROMCHEMICAIS 3-501.1� � CimHngMethodeforPHFs 1') PHF Hoi and Coid Hoiding ]q Food or Color Additives 7-501.Ib{i3} Cold PHFs�Saint�ined at or betow 320Z.(2 Addttltcct�. iy0.Q04(F) 4L"145`F* 3 302.!<4 Prot�chon trom Una ruv�d.ldditives'k 3-501.15(Al Ftot PHFs Maintained at or abqve 75 Poisonaus or Toxic Substances� ]46'H. � 7-107.71 kientif}nn�Intoririation-Original �_501.16(A} Ro2sts Hetd ut ar above 130'E. ' Contalners"� 1-]02.11 Common Natne-Workinv Cantainers'r �� Time as a Public Heatth Contrai � 7-�Ol.t I Se eiracion-Sto�Qec.3: 3-507.1.9 Time as a Public Health ControP� ' 7-202.1t ftestnction-Pres�nceandlise` 596.064(H� VananceRecuirement '?0'_.12 Cnnditions af Use` --- 7-2U3.i 1 9 oxic Containexs-Pcohib9tionsm ��QUI REM HNTS FOR HIGNLY SUSCEPTIBLE �. 7-204.71 Sanirizeis.Cnterla-Chemicais" POPIDIATION5 NSP 7-204'L2 Chenucsils foa`Washin>Prodnce.CriteriaN ZI �-��l.11(A) UnPasteurized Pre-packaged.luices and 7-204.7=4 Dr�nn A�ents.Citteiia* 6etieiaRes with V.inunnl.,abels* 7-30�.11 IncidentalFoodCont�et,Labii�ants'� '-b��l�� seofPisteurize�lL �s* 7-266.7 t v Reetricfad Use Pesticide�s,Criten�* 3-801.11(D) R:�w oL Pcu�tially Cnoked A�nimal F�wct and � Raw Seed S xonts Not Served ^ 7-206.12 Rodcnt Bait Stauons" 3-80 Lll(C} Un��3ened 3'oai Packave NoC Re-s�rved. * 7-206.13 Trac.6ing Powdcrs,Pesf Contta(2nd Monitorin** CpN5UMER ADVISt7RY TIMEITEMPERATURE CONTROLS ZZ 3-(iO3.,t t Cons'utnec Advisrn'y Posted for Consumptio�i of ___.._. .W ,_.._.._,._,_. .,...�,.,.,. _.,._...,_.. Anim�l FoocL�'I7iat are Raw, iJndexcooi:ed or 16 9 Proper Gookmg Temperatures for Not Otherwise Frocessed to E,timina[e PHFs 3-d(71.11��(1)(2? E��s- 155'F 15 Sec. PaO�oe, ns F� .�,,.�„�zoo� L�as lmmediatc Seevice 14�°FI.Ssec* 3-3(YL.13 Pasteuuic.d Fg„s Subs[imte for ftaw Shell 3��01.11(A)(2) Cumminut�d Fish.Metits&Game �' �� 4nnnals-1�5 F 25 sec. "' SPECIAL REQUIREMENTS 3-4Q1.11(B)(1)(3) Prnk andBceERoist- 130°F 121 min'k 590.Q09(.4}-(D) Violittions ofSec[ion 590.Q09(A)-(ll)in 3-0Ol.l 1(Aj(2) RaCites, Inje�t�.d Meais-15S°F IS s�� M catei9n�, mobile foai; eempnrar_y aind 3-401.11(A)(3) Poaltcy,Wilct Game.Stuffcd PH�,, resldential kitchen oparations should be StufBn;Cot�taining Fisl�,iNeat, deb�ted under the appropriate sec[ions PoutYry or Rantes-165°F 15 sec " abc�ve if reLateci eo foodborna ill��ess 3-401.11(C)(3) Whote-nauseie,InYack Se�f Skeaks inteivenTionS and i,isk f3etor,s. Other 745"F�` 590.009 violauons relaring to g��od retail 3-4Q1.12 Raw Animal Foods Ccx,keA in a practicas should be dehi[e�l uiidzr#29- M'rcrowave 165°E'* Spccial Reqniremen[s. 3-�401.1 L(A}ft)(b) A(I Otl�er PHFs-145°F 15 sec. * ,q Reheating tor Hot Holding VtOLAi70t�JS RELA7EA TQ GOOD R�TAIL PftAG7/CES 3-4p3.t1(A)&CD) pHl,s 765'F li sec. "� (Items 23-30) 3-403.11(B) Miu'owave-165°F'2 MinuYe CCttuding Critrcat arrd xon-critical ciolatiora�, whicl��lo not rctnte to the `I'itt�e" fondborne illr¢ess iritervca[ions nnd risk facronti(isted aborP, cnn be 3-403.7J(C) Conanere3af Iy Prcwessed RTE Eaod- ,f'vund in the jo(lomirrg sectioe�s of the l�"oocf Code and IQS CA9R 140°F"` 590.OFJ(1. 3-403.11(E) Remainin€Un,(ieed 1'orriaos ofBecP �em I GoodRetai/Pracfiees I FC 590.DD0 Roasts` �?3._ _M emeni and Personnei _ FC-2 .003 �� '�24 food and Focd Protection j FC-3 .004 '� tg ProperCoelingofPHFs i- --�----. ..- -----. .---- '. � j FC 5 00 I 25 �E qm mPnt snd_Utenall� FC 4 9-5011��A) Cooling C:ookrxi PHFs li<ym 1�40°F t�o �26 � Water Plumafnc�and Wasie �e 90`F WiGhiri 2 How's and Fro�70°F , 27. Ph slcai Faci(Ii i FC-6 .007 � ro A1°F745°F Within 4 ftonrs. * 2S. , Poisonous or Towc Materiels i FC-7 .008 3-501.1�(B1 CoulinePHE+s Made H'rom Ambient t 30 � S��ial.Reguirements � ,� 009 � 'Pemt�erature inorediems t<,i�1l'F/4>'F � - . . .. �-.- wit}tllt 4 HOUTS`k s�.s.x;�a;ne.m.xa:n,� �� `DenoCcr eritical item in tho fidemi 7999 Food Code or 10�C�9R�9Q000. �....�:.,.1...,,� � �e�.• (978� 745-6996 �28 `Was�i�ngtary st�. s�,e,�, �2�., o � 90� � �'� ��,: � ��, �o:oo � � � �:oo � �� s� � � �.oo ,�� ( ) HOT GRILLED SANDWICHES HS 1-Grilled chicken,provolone,caramelized onions,tomatoes,sun-dried tomato paste and mesclun mix HS2- Smoked turkey,carametized onions,swiss cheese,tomatoes,pesto,mesclun mix HS3-Eggplant,fresh mozzazella,tomatoes,roasted peppers,sun-dried tomato paste and mesclun mix AS4-Portabella mushrooms,caramelized onions,swiss cheese,dijon mustard and mesclun mix HSS-Prosciutto,tomatoes,fresh mozzarella,fresh basil leaves and olive oil HS6-Grilled cheese with tomatoes MELTS HS7-Tuna melt with tomatoes HS8-Ham and Brie melt with dijon mustard HS9-Smoked turkey and swiss melt with cole slaw and cussian dressing HS10-Artichoke and provolone melt with tomatoes and black olive paste PIZZAS AND CALZONES SMALL LARGE CALZONE Cheese One topping Two topping Three topping Fourtopping TOPPINGS Chicken,pepperoni,ham,meat loaf,sausage,turkey,mushroom,broccoli,artichoke hearts,spinach,tomato,eggplant,gazlic,jalapenos,roasted peppers,sun-dried tomatoes,onions,green peppers,black olives,feta cheese,goat cheese SALADS O]- Garden Salad ---crisp iceburg lettuce,tomatoes,carrots,green peppers,cucumbers 02- Mesclun mix Salad---mesclun mix,tomatoes,cucumbers,carrots,green peppers 03- Fresh mozzarella and roasted peppers---mesclu�mix,fresh mozzarella,roasted peppers,croutons and black olives 04- Goat cheese and sun-dried tomato---mesclun mix,goat cheese,sun-dried tomatoes,croutons and black olives OS- Greek Salad---garden salad topped with feta cheese and black olives 06- Grilled Chicken Salad---mesclun mix salad topped with grilled chicken breast 07- Ceaser Salad---romaine lettuce,croutons,pazmesan cheese with grilled chicken 08- Chef Salad---garden salad topped with smoked turkey,ham and swiss cheese 8A- Spinach Salad---spinach,sun-drieA tomatoes,capers,pine-nuts,black olives,parmesan cheese SALAD DRESSING Greek,russian,light italian,honey dijoqblue cheese,creamy caesar,fat free ranch,fat free honey dijoqbalsamic vinegratte,olive oiI COMBOS Soup and half a sandwich Soup and garden salad Garden salad and half a sandwich , SOUPS.......................... . ...�6oZ.Bo�. Vegetariaqlemon chicken rice,Ask for daily special PITA ROLL UPS 09- Veggie.... Lettuce,tomato,cucumber,carcot,geen pepper,onioqpickles,sprouts 10- Greek ..... Veggie roll up with feta cheese,black olives and greek dressing ll- Humus.... 12- Tabbouleh.... 13- Avocado and Brie _.... 14- Falafel and Humus .... 15- Garden Burger 16- Chicken Kebab .... 17- Grilled chicken ... 18- Grilled Chicken Caesar... 18a-California..... avocado,olives,provotone,tomato,mesclun mix,sprouts,cucumber,olive oil and balsamic vinegaz 18b-Mediterranean Tuna white tuna,marinated artichoke hearts,black olive paste and mesclun mix 18c-Roasted Vege[ables hummus and mesclun mix 18d-Beef Teriyaki jasmine rice with orzo,roasted peppers and teriyaki sauce 18e- Chicken Teriyaki jasmine rice with orzo,roasted peppers and teriyaki sauce 18f- Crab Meat mesclun mix,avocado and canots 18g-Meat L.oaf lettuce,tomatoes,onions and marinaza sauce 18h-Pork Back Ribs lettuce,tomatoes,onions and barbeque sauce 18I-Eggplant Parmesan 18j-Chicken Pazmesan SPECIAL ROLL UPS 19-Eggplant,sun-dried tomatoes,fresh mozzarella and roasted peppers 20-Grilled chicken,avocado and sun-dried tomatoes 21-Smoked turkey,fresh mozzarella and roasted peppers 22-Grilled chickeqeggplant,fresh mozzarella and roasted peppers SANDWICHES 23-Ham and cheese 24-Smoked turkey 25-Turkey and Avocado 26-Roast beef 27-Egg salad 28-White tuna salad 29-Chicken salad 30-Prosciutto and provolone 31-B.L.T. 32-Comed beef 33-Pastrami 34-Grilled chicken 35-Fresh mozzarella,tomatoes and fresh basil 36-Goat cheese,roasted peppers,eggplant and pesto 37-Smoked mozzarella,tomatoes,roasted peppers,oil and vinegaz 38-Prosciutto,tomatoes,fresh mozzarella,roasted peppers and basil 39-Grilled portabe(la mushroom,roasted peppers and goat cheese 40-Smoked saimoqgoat cheese and capers on a French rolt 41-Grilled chicken,bacoqavocado,lettuce,tomato and ranch dressing 42-Grilled chicken,portabella mushroom,smoked mozzazella and pesto 43-Grilled chickeqportabella mushroom,artichoke hearts,capers and prosciutto 44-Meatballs on a French roll with melted provolone and marinaza sauce DOUBLE STUFFED SANDWICHES BOSTON COLLEGE-Chicken salad,bacon,lettuce,tomato RED SOX-Smoked turkey,ham,swiss,cole slaw and russian dressing PATRIOTS-Pastrami,comed beef,swiss,cole slaw and tussian dressing REVOLUTION-Smoked turkey,bacoqlettuce,tomato,wle slaw and russian dressing CELTICS-Smoked turkey,roast beef,comed beef,cole slaw and russian dressing BRiJINS-Smoked turkey,pastrami,roast beef,swiss,cole slaw and mssian dressing BREADS;Foccacia,white,wheat,rye,multi-graiqfrench roll,pita CONDIMENTS;Mayo,dijon,yellow mustard,ketchup,pes[o,sun-dried tomato spread,black olive pesto ACCCOMPANIMENTS;Lettuce,tomato,cucumbers,geen peppers,onions,alfalfa sprouts,carrots,pickles SIDE ORDERS Jasmine rice cole slaw potato salad hummus FROZEN YOGURT P� SUGARFREE TOFU FLAVORS Oreo,Kit kat,Coconat,MM,Banana,Butterswtch,Fat free elfiqScor,Craclin'oat bran,vanilla,Ginger,Milky way,Peanut butter,Walrmt,Raspberry,Reese's,Gronola,Brownie,Cookie dough,Mint choc.Peanut MM,Peach,Snickers,CHOC.chip,Heath bar,Butterfinger,Nestle's crunch,Choocolate,Twix,Coffee,Pistachio,Marshmallow,Decaf coffee,Cttapenuis,Mocha,Cherry,CinnamoqVanilla wafer,Caramello,Cheese cake,Pineapple,Strawberry,Malted,Peppermint$luebetry,Honey graham,Peeppermint patty,Choachip cookie FROZEN YOGURT MILK SHAKES SMOOTHIES DESSERTS BANANA PLIT S Whole banana with your choice of frozen yogurt,topped with strawberries,pineapple,hot fudge and whipped cream BROWN�SUNDAE Wazmed brownie slices with your choice of frozen yogurt,whipped cream,chocolate chips,walnuts,hot fudge CLASSIC SUNDAE Your choice of frozen yogurt,hot fudge,strawberry,pineapple,whipped cream,walnuts 1 COFFEE MEDNM LARGE C.O.D.Necaf coffee Tea Iced Tea Specialty Drinks MEDIUM LARGE Mocha cafb Coffee,whipped cream, choa Syrup, hot wco Cafe Au Lait Coffee,steamed milk Cafe Cocoa Coffee,hot cocoa Oregon Chai Hot cocoa . Es resso Drinks P SINGLE DOUBLE Espresso Espresso Con Panna Espresso whipped cream, Mocha Con Panna Espresso,whipped cream, choc. syrup Espresso Macchiato Espresso,foamed milk Americano Cappuccino Espresso, steamed milk, plenty of froth Cafe Latte Espresso, steamed milk Mochaccino Espresso,whipped cream,choc. syrup, steamed milk Caff6 Mocha Espresso, chco. Syrup,whipped cream, hot cocoa Latte Macchiaro Steamed milk, stained with espresso Eatra Shot Massachusetts Department of Public Health Salem Board of Health 120 Washington Street,4"' Floor Division of Food and Drugs Salem, MA o1970-3523 Tel. (978)741-1800 Fax (978) 745-0343 Clty/TOwn Of ndaress: FOOD ESTABLISHMENT INSPECTION REPORT Tel. Name D Type of Operetion(sj Type of lnspection ,�-�ood Service ❑ Routine ' -Address � - Ris ❑ Retail [�Re-inspection 7ele hone Level ❑ Residential Kitchen Previous ns ction p ,.., � ❑ Mobile �ate: �/ Owner �� HACCP Y)N � Temporary ❑Pr�p kl�n e ❑ Caterer ❑Susped Illness Person-in-Charge(PIC)�� , Time ❑ Bed 8 Breakfast ❑General Complaint �n, ❑ HACCP ' Inspector 0u Permit No. �.Other Each violation checked requires an explanation on the narrative page(s)and a citation of speci£c provision(s)violated. � � Non-compliance wlth: Violations Related to Foodborne lllness Interventions and Risk Factors_(Red It0111S) � � , � Mti-Choking 590.009�E) ❑ Violations marked ma ose an imminent health hazard and re uire immediate robaeeo 590.009(F) ❑ y p 4 Allergen Awareness 590.009(G) ❑ corrective action as determined by the Board of Health. ��FOO��PROTECTION MANAGEMENT�� . . ❑12�_Prevention of Contamination from Hands ❑ 1. PIC Assigned/KnowledgeablelDuties � 'EMPCOYEEHEALTH � � ❑ �3. Handwash Facilities � � � " � �PROTECTION��FROM'CHEMiCAI$` ❑ 2. Reporting of Diseases by Food Employee and PIC ❑ 14.Approved Food or Color Additives ❑ 3. Personnel with Infections Restricted/Excluded ❑ 15.Toxic Chemicals FQOD'FROM�%1F!PROVED�SOURCE � TIMEITEMPERAT.URE�CONTROLS(Po[eirtlallyliazardous�F.00dsj- � ❑ 4. Food and Water from Approved Source ❑ 5. Receiving/Condition ❑ 16. Cooking Temperaiures ❑ 6. Tags/Records/Accuracy.of Ingredient Statements ❑ 17. Reheating ❑ 7. Conformance with Approved Procedures/HACCP Plans ❑18. Cooling PROTEC710N FROM CONTAMINATION � ❑19. Hol and Cold Holding ❑ 8. Separaiion/Segregation/Protection ❑20.Time as a PublidHealth Control ❑ 9. Food CoMact Surfaces Cleaning and Sanilizing_ � REQUIREMEN7'$�FOR HIGHLY:SUSCEPTI6CE+POPULA710NS"(H8P).' ❑21. Food and Food Preparation for HSP ❑10. Proper Adequate Handwashing ❑ 11. Good Hygienic Practices CONSUMERADVISORY � ❑22. Posting of Consumer Advisories Violations Related to Good Retaif Practices (Blue Number of Violated Provisions Related Items) Critical(C)violations marked must be wrrected To Foodborne Ilinesses 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 • � Otficre Order for ConecSon: 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. 590.00O/federal Food Code.This re ort wh n i n d b I w C N p , e sg e eo by a Board of Health member or its agent constitutes an 23. Management and Personnel (Fc-zxss0.003) order of the Board of Health. Failure to correct violations � 24. Food and Food Protection �pc-s)(sso.00a) cited in this report may result in suspension or revocaGon of 25. Equipment and Utensils (FC-4X590.005) the food establishment permit and cessatlon of food 26.Water, Plumbing and Waste (FCS)(59D.006) establishment operations. If aggrieved by this order,yo� 27. Physical Facility (FC-6X590.007) have a right to a hearing. Your request must be in writing 28. Poisonous or Toxic Materials (Fc-�Xsso.o0a) and submitted to the Board of Health at the above address 29. Special Requirements �5eo.00s) within 10 days of receipt of this orde1, 30. Other DATEOFRE-INSPECT(ON: I�� l I /_�� s: aw.d« y�-�aw lospector's Siguature: Print: PICs Signature: Print ""�� Page�o Pages , ; _ _., �:,. - , _ ,, -y _...,-..,�.... --�.. ,. . �..,� : . .__ , Violations Relafed to Foodborne lllness Pnferventtons and Risk Factors(lterns 7-22) PROTECTION PROM CONTAPAINATION �S Crass•contamination FOOD PROTEC710N MANAGEMENT 3_3D2.41{A)it) Raw Animai Foocls SeparateA f�um 1 590.6p3(A} Asti�nment of Responsit�iliry* . Cc�ked and R'Th Poods* � 590.003(B) Demc!nslrntinn of Knouled�e_' Cantamrnatron from Rawingredients 2-103.I1. Pc.i�son in�harga�-<tufies . 3-302.11{A)(2) ltaw Aniceinl Foocls Separ�ted from Each Qther' EMPlOYEE HEALTH Confamination�rom rhe Em�ironment 2 590.0{13(C) Respunsib'r1ity af.t6e person in churee to 3-302.11(A � Fad Protection"` � require repoeti�g by frxui empioyees und 3-3(}2,LS ��r`aslvn Fmit�s and Ve�etables a ��lic�uits�' 3-.gp�},1 t . Foal�Contact with Fquipment and 590.003{F� Responsibil�ty�P A T'cxxt Lmployee Or M � � • � . ApplicanCToReport'fo`ChePers��,mH� Ctcnails , - . � Contaminallon from the Consamer Chat x'" i-3p6.14(�a)(H Returned Foal and Reseavice uf Food* :iJ0.bU3(Cj fte or'tin �b�Person in Char>e� 3 590.003(ll} � Exclnsionsxndkestrictions* Qoodsklono/AdulleFatedorConfaminafed 590.003 E) Reanoval i�f P.xelusious anit Res¢dcti�ns � 3-7Q1.,11 � Ilisc•arding eu Recoitelitiouing linsafe F'aod* FOOD FROM APPRONED SOURCE a Food and Wate�From Regoiated Sources 9 Food Contuct Surtaces 590.00�(A-Bl C�oro slirnce with Fex�d Ia.w'k - A-SQ L 1 f 1 Mannai V4%azewashing-Hot Water 3-2D1.12 Food in a Heisnetically Sealed Container'� Senitiu[ion Teniperatures* 3-2U1_13 Fluixl Milk nnd Milk PrctducGs�" � �-SOI.I l2 � M�chanical Warewashing-Flat Water SanitizationTem eratures* � 3-202.73 Shcll E��s* - � 4-SOl.11A �C.hemical:Sanitivation-tem H, � 3-262.1d F s and MilkPsoctnet�s,Pasteurized'k p'�U 3-2021b lcc Made From Potable�ncinkin*Water* comen�acion und hF¢dness.'" � 5-IOI.FS � Drinkin wVatei�f�vm�an A roved S etem" 4-fipi.l l{A) CqaipmentEoocl Contace Surfaces and � 590.006 A) Bottli Drinkin �Water'' Utensils C(ean" 590.Otlfi(B) Watar Meets Standards in 3 t0 CMR 2?.t7^` �-��Z.a 1 Cleaning Ereguency of Fquipment Food- ConEace Su.rf�aces and Ucensils* 5hellfish and Fish Fror.i an Approved Souree q_7Q2 7 I Fre.quency o[Saniu�afion of Utensils and � . 3-201.14 Eish and R�^,ceeati<7na1ly Caunl�t Molluscan � Fo�xi Contaci Surfaces aP E ui ment* Shell6sh* 4-7p3,�� Methods of Sanitizatiou-F[ot Watet and� '� 3-20t.i5 htoLlnscanShellfishfromNSSPTdsted Chemical* Soutt:es" 10 Proper,Adequate Handwashing � -Game and Wild Mushrooms Appraved by �,-3p I.I l. � C'lean Conditi on-Ha»ds and Arms" � Ae vlato AutMor'rt . 2- ^ Cleanim�Prc�:edurc* . � 3-2Q2.13 ShellstockIdentiBcaYionPresent�* 3ql.i� 59D.004(C) Wild Mushravms* 23(�1.1� When lo Wtash" 3-201.77 C,nme�Animals* Il Good Hygienie Practices - g AeceivinglConditfon 2-0Ol.l I Eatin ,Drinkina or Usin To6acco* I 3-202.71 PF�F�s Rec;eived at Pro er Teur ratnres'" 2-00,1.12 Discharges From[he Eyes,Nose and 3-2U2,l5 Packa elute�mit � Iv[outh* 3-10'1.1 I. f'^oofl Safe ans1,L'nmdulteruted "` 3-301.12 Preventin>Cuntamination When Tast'ru � (� TegsiRewrds:Shelistock 12 Prevention of Contaminatian from Hands� 3-2(YL.1& Shellstock Identificaricm* � � Sy0.0(kl(E) Preventing Contxmination from � . 3-2�3.12 � Shellstock Tdentilzr,ati�m Maintained'� Em�lo ees'k � TagsiRecords:�Eish Products � 1� Handwash Fecilities 3-402.7 f � Parasite pcat�ucrion�" Conve�ientty Locafed and Accesslble 3=Ap2.12 Re�urds.Creation cand Reteni�ion'" 5-203.11 Nmnbers and t:a aciries* 590.!}04(J? Labefing o}lagredients' � 5-204.71 I.a:ation and Plac�ment* ' � Conformance with Approved Procedures �'ZO�.11. �Accessibilit ,O xration and iYlaintenance MACCP PIen3 Supplied wrth Soap and Hand Dryrng � Devrces 3-50211 S euia4ized Prceessin Metho�s* fi301.i 1 Handwashin Cleanser,Availabilit 3-5p2.7.2 AeduceA ox er�i xetc�a"n4,criteria* 6-301.12 H B ,�8-103.12 Conformancewitl�A. rc�vedPmeedures* �d . ❑�Pro�isian '*Denoiac ciitica!icem in the f�leral 1999 Aa��l C�ale ur l0i CMIt i90.(H)0. . CITY OF SALEM �� BOARD OF HEALTH Establishment Name: A �S � Date: � ^ / Page:� of_ f�._ nem Code c-cr�t�ca��tem DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Dete No. Reference R-Red Item � �VerHled PLEASE PRINT C ARLY ��, � W ' ! �/ W 3 Q Discussion With Person in Charge: Corrective Action Requfred: ❑ No Xes 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 ins ection, to observe al� conditions as described, and to Exciusion P ❑ Re-inspection Scheduled ❑ Emergency Suspension compiy with all mandates of the Mass/Federat Food Code. I understand that noncompliance may result in daily fines of twenty-five Ilars or suspension/revocation of ❑ Embargo ❑ Emergency Closure your food permit. ❑ Voluntary Disposal ❑ Other: > � 3-5U3.1�t(� PHFs ftec�ived at Temperaturzc . ' YtvlafPons Relatt:d to Foadhanre llJness IntervenHons and Risk rlccutdinb t�Law Cooted to � ' Factvrs(Iteins�Y-22} (Cont.) � dt'F145°F Wit3rin4 Hcmrs.* . � PR04ECTiON FFtQM C}iEMICALS 3-501..15 Coolin Methods for PHFs I 14 . . . Faotl or CaSor AddRives � �g . ��t and Cattl Holding A 3-202.12 Additives* � 3-541.ib{I3) Cold PtiPs hiainzained at or betow 3-302.14 Fzotection from C7n roved.4dclizivest 590.00d{F) 4i°Id5'F* � gy Pasonous or Toxie Sumstences 3-541.16(A} � Hot PHFs Maintained at�ur above 7-107,11 7clenti'in Infocmation-Ori at �� # Contaiaers"` � � 3-50t.i6(A1 RoasrsHeidaYarabuve7.30'F. * , 7-102.11. Coinenon 11Tazne-Workin Concainern* . zD Tima as a PubBic Hea14h CoMro! � - 7-2U1.11 S -'on-Stnra e* . 3-SO1:I9 Trttre as a Publ'se Aealt6 CantroiA 7-202.11 .Restcictian-Presenceand�Use' � ��.�tx? VarianceR uirement .. � 7-202.12 Conditi.ans oCUse° . . . . '� 7-203.11 'Toxic Cattainers-Prohibirivns* AEQUIREMEt+Fi'S FOR HBGH�Y SUSCEPTIBLE � 7-204.7I Sanitiun,Criteria-Chemicats�` P4PUi.A770NS HSF �� 7-2{M.t2 Chemirals fir Washin Prcxluce,GYiteria• 2� 3-801.1I(A} Un�steucized Yre-packaged Iuiees and �� 7-2fW.14 �n ents.Criteria' .Beveraees wvith 41'armna l,abels'" � i 3-80'1.i 1tB) �Use of Pasfeurized�S * .� 7-2D5.11 fncidental Food Contact,Luhiicsats* 3-801.11{D} Raw or Partia2l Ccaked Anin�al Fa�and � 7-206.31 Restricted Use Pesticides;Cziteria* y � `4 - 7-306.12 - . Radent Bait Stuions' . � Raa'Seed S .ixrts Not ServecL * 1 7-2t}6.73 7racking Powders,Pest Canuai and . 3-801.If C Uno ned Fcwd Pac Not Re-sened. " ; Monitorin � CpN$UMER JIDVtSORY TtMEIFEMPERATlIRE CONTfl�1.S 22 3-6ffi.i 2 Cmunmer Advuvru Posted for Consnmptian of p{ Pro�t Caokfng Tem�aerrrtures tor ��'Fchds 1Yiiat are Rua;,Undetwoked or � P�F$ - . Not Qtherwisz-ProceSseQ W Eliutinate 3-�t01.ItA(Ij(2} Eggs- 155°F 15 Sec. - Pat�o*ens.°�BC>"�'nrroe� � �E -Immediatr Setvic:e 145°FiSset:° 3-302.13. Pasteurized Eg�s Substitute for Raw St�ell 3-401.11{A)(2) Comminuted Fish.Meats&Ciame E " ; P.aivmLs-155°F 15 se+;. * �p�CBAL REflU1REMENTS t 3-401.11(I3){1x21 Por(:and Beef Roast-130°F t21 min'� � 3-4(}i.l ttA)t2) Ratites,Injected h4eats-155°F 15 540.Q04(A}-{D) yioiatians of Sectian 59D.009{A)-{D)in } sec.* catering,.mohile food,temparary and t 3 40i.1 L(A){3) Pou[try,SVild Gxme,Snrffeci PIIFs, residential kitchen opecations shouid be ' StufCing Containing Pish,A�eat, debited vnder the appropriate sections � Paui or Raates-165°F t5 sec. * above if related w foodborne illness � 3-40L 1t(C}(3} Whole-mascle,lutact Beef Seeals interventions and risk factors. Other � 145°F fi 59t1.t}0�violations rclating to goocl retail � .� 3-461.12 Raw Animat Faxi.s Cr,oked in a . practices shouid be debated-under�t29- Microwave t65"F x Speciai Rer�uiremenis: � 3-d61:111A)(1}{b) rUl Otlior PHFs- S45'F 15 sec.' iq Reh�Bng fm kot Hotding V10LAT[�NS ftELA7EdY TO GOOQ RFTA1t PRAC77CES 3-1Q3:11(A)&{D) pHFs Ib5°F IS sec.* {Ite►ns 23-30) � 3-4f)3.11(B} . Micraivave--165`F 2 Minnte Stwdiug � Criziatl,arrd non-crrtirat vtotafions, whicTz da not retnte to the - Tinre* � � - foodborne rllness intarrentians anJ risk factors tister3 aboi�e, ain'be � 3-�03.t 1(C} Coasmerciaily Processed R'CE Footi- fou+uf in the fa7lor�ing sections�qf the Food Ca�le and 105 CMR }4p°�* 590.400. , 3-4G3.11(E) � Rcma�ining lir.�(iced Po�rkons of Beef i Ptem � Good Aelatl Practices ; .FC b30.QD0 � � Raasts'� �3. 1 �+lanaqement 2nd Persannel 4�FC-2 .003 � ; � ig Proper Coaiing of PNFs ! 2�.� � foai and Food Pratectiw� ( FC-3 .004 ! . 1 25. E ul merrt and Utensits 1 FG-4 .OL5' t � � 3-5d1.14{A) Coo{�ngCcmkedPHFsfrom740`Fto � �, Water.Pttimbi andWaste � FC-5 .006 � 4 70`F tiVi[hin 2 Haurs and From 70`P p7. ' ph ,i��i Faci' i FC-8 .OD7 i to 41`F/45'F 1�ithin d Haurs.* f 28. ' Pasonovs w Tawc Materiais ! FG-7 .OQS . '� 3-SQ1.74(Bj� Couting FHFs Hlade Ftom Ambient � 2g. �S ecia7 fi uiremerns i .609 1 �� Temgerature Tngre(iienfa co 41'F/45°F ' �' � �{ ---i- _ i(, Within�Hours* ss�,�,.,,�--..:�.,'•.c; . e f ^Drncxes czitica,ivnx in the L.-deral 1949 Fuc�i Ccx�e a�1p5 G17R 590.DOp. � f i Massachusetts Department of Public Health Salem Boa�d of Health 120 Washington Street,4"' Floor Division of Food and Drugs Salem, MA 01970-3523 Tel. (978)741-1800 Fax (978) 745-0343 C►It�/�OWII Of Address: FOOD ESTA LISHMEN SPECTION REPORT Tel. Name a Ty eofOperation(s) Typeof►nspecSon C� ( / �ood Service � Routine �Address Risk Retail ❑ Re�inspection Tele hone ., Level ❑ Residential Kitchen Previous nsppection P 4 ❑ Mobile Date:��/�� Owner � HACCP Y1N � Temporary ❑Pre-dpefa on , � ❑ Caterer ❑Suspect Iliness Person-in-Charge{PIC) Time ❑ Bed&Breakfast ❑General Complaint Inspector r ��J� permit No. O ah CP Each violation c ecked requires an explanation on the nanative page(s)and a citation of specific provision(s)violated. NOMt»mpliance wifh: Violations Relafed to Foodborne lllness Interventions and Risk Factors_(Red k0ro5� � � MtiChoking 590.009(E) ❑ Violations marked ma ose an imminent health hazard and re uire immediate Tobaceo sso.00s(F) ❑ y P 4 Allergen Awareness 580.009(G) � corrective action as determined by the Board of Health. .�.. �..,. . � _ _ .._,_ - _ __ _ _ _ - - ; FOOQPROTECTION MANAGEMENT__ _ _, _ _ __� _ _ __�� ❑12. Prevention of Contamination from Hands ❑ 1. PIC Assigned/Knowledgeable/Duties . _ . ,„.. _ _. .. _ __ ❑ 13. Handwash Facilities ..EMPLOYEE IiEALTH .. ._ ._� .._•, ,_. - --��- � - �-... ._ _ .- , - . w...._ ��_. . , . . _. . . . .s_ _.- . .. -- . - -- �-- • yPROTECTIONPROM"CHEMICACS'. .._.,.__ .._ ..._.___. . _. � . ! ❑ 2. Reporting of Diseases by Food Empioyee and PIC ` � ❑ 14.Approved Food or Color Additives ❑ 3. Personnel with Infections Restricted/Exciuded _ _ __ _ ,. .. . - _ .. __ . . ...,__. �, ❑ 15. Toxic Chemicals �,FOOD'FROM APPROVED SOURC6 _ __,.T_.__. __ � - � _ ._ .._.__. TIMEITEMBERATUBE-.CONTROLS�RotaMlail�Ha¢erdous Fo'als �.. . , ❑ 4. Food and Water from Approved Source • . . . . . �� y . . .. .1� ❑ 5. Receiving/Condition ❑ 16. Cooking Temperatures ❑ 6. Tags/Records/Accuracy�of Ingredient Statements ❑ �7.Reheating ❑ 7. Conformance with Approved ProcedureslHACCP Plans �'18 Cooling ,PROTECTION FROM CONTAMINATION ._ � � `; �-19.Hot and Cold Holding ❑ 8. SeparationlSegregationlProtection ❑20.Time as a Public Health Control � ❑ 9. Food Contact Surfaces Geaning and Sanitizing ��,REDUIREMENTS FOR,HIGHLYSUS.CEPTIBLE=POPULATION3"(FiBP)` � ❑27. FooC and Food Preparation for HSP ❑ 10. Proper Adequate Handwashing ❑ 11. Good Hygienic Practices �CONSUMERADVISORY_�� ___� . _ _ ._____ _ A ❑22. Poshng 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 Healfh. Noncritical (N)violations must be cortected pfrycial Order for Conection: Based on an inspection immediately or within 90 days as detertnined by the Board today, the items checked indicate violations of 105 CMR of Healih. 590.00O/federal Food Code.This report,when signed below C N 23. Management and Personnel (Fc-zKsso.003) by a Board of Health member or its agent constitutes an 24. Food and Food Protection (FC3X590.004) order of the Board of Health. Failure to correct violations 25. Equipment and Utensils (Fc-aXeso.005) cited in this report may result in suspension or revocation of the food establishment permit and cessation of food 6. Water, Plumbing and Waste (FCSKsso.00s) establishment operations. If aggrieved by this order,you 27. Physical Facility {FC-sxsso.00�� have a right to a hearing.Your request must be in writing 28. Poisonous or Toxic Materials (Fc-�Msso.00a> and submitted to the Board of Health at the above address 29. Special Requirements (5so.009) within 10 days of receipt of this order. 30. Other DATE OF RE-INSPECTION: s s„� ��,/Sa�i�� . 1 Iuspector's Signature: � Print: PICs Signature: Priut: '�,�C �_ , � Page�of�ages T .✓'., �..-� J..•`/'„r+rL�.,m �.�.- ---••�y.�..�.�`.,;.,,,-...-`�.��-�++.++-^"__.,�:��:--.� :�:,.:,s-�yt�y,y�,;„^^r�11�. � .....+^'^'• � -'"�• �.,. . *�^ti�A+ Violafions Related to Foodborne 1llness Interventions and Risk Factors pfems t-22) pROTECTION FROM CONTAMINATION FOOD PROTECTION MANAGEMENT � Crasscontaminatron , 3-302.t i(Alf I,j Raw Ani mal Foods Separated hom 1 590.003(A) Assia ment nf Res nsibilit " C«�ked and RTE Fwds* 540.003(B) Demonstration of Knowled e* � Contaminatiort from Raw Ingredients 2-103.11. Person in chu a-duUes 3-302.11(A}{2) Raw Anim�il Foods Separa[ed from Each - • � Other' � � EMPLOYEE HEALTH Cantamination�rom the EnNronment 2 59Q.t�3(C) Responsib'r)ity ef the person ia charge to 3302.11(A) � Food Protection* � require reporting by fuod employees.md 3?02.1 i Washin Fruiks and Ve etables � a licants* � � 3-3{W.,11 Food�Contact with Equipment and 59U.003(� Responsibility Of A Food&mployea Or An -litensils" � � . rlpplican[Tu R.eport'To'['he Pnrson in � � � � - Coniaminatbn lrom the Consumer ChaT * � 3-30E.14(A)(.B ReturnedFoodandReserviceofPa�d* � 590.003 G) � Re ortin b Person in Chu�ee" - Dis rt�on of Adulte�aied or Contaminated � 3 590.003(D) Ezclusions and Restrictions* Food� � Si)0.003{E) Removal of Exctusions and Restn'ctions 3�-?01.i'! Discazding or Reeouditiaoing Unsafe FOOD FROM APPR4VED SOUPiC£ �0°d� � food anU Water From Reyufatetl Source; 9 Pood Contact Surteces � � � �i 59Q.004(A-B) Con� liwce a�itiz Youd.i,aw* 4-�01.111 Manual Wazewashing-Hot Water � 3-2U1.12 Ferai in a Hermeticail -Seaied CunYainer" Sauitization Temperatures* 3-201.13 Pluid Milk and�titk Pralucts� d-501.712 Meehanieai Warewashing-Hot Wate� r, 3-202.13 Shell E��s* - � � Sanitization Tem tatures*� � � � i 3-20?.t4 E�Us und iYiilk FnMucis.Pxsteiirizzd* a-S01.t I4 � Chemical Sanitizatioo-temp.,pR; 3-2t?2.16 Ice Made From Potahie I3riakin�N'a,er* concentration and 6azdness. '" 5-10111 Drinkin R'ater tcom:m A r��ved S ,tem` 4-G01.1!(A} . &juipment Food Contad-Surfaces and� . 590.006(A) Botded Drinidn Water� � Utensits Clean'` . � 59p.pp6(B} Water Mezts Standar:i,in 310 CMR ZZ.Q�' �-60211 Cleaning Frequeucy af Equipment Food� ShelMsh And F'uh Fror•,�an Apprcved Soure Contact Sud�aces and Utensils"� , 4-702.1 L Freq�en�y of Sanidzalion of Utensils and � 3-20114 i�ish ancl Fec��eat,ionaliy Caug'ut MaEiueea�e � Focd Coutact Surfaces of E ai ment" ShciL`"ish" 4-703.11 Me[hcds of Sani[izalion-Hot Water and� � 3-207.15 Mnlluncan Shepfish fror�'dS5^r I..r,tert Chemicat* � Sources" � Gar,�e anAWi�d Mushrooms Approvetl by 10 Proper,-Atlequate Handwashing Re ulato Authodr � 23i1L.11 � � � Clean Cundition-Hands aud Arms* � 3-202.18 Shel(stock idenafiaatian.Preseat^` 2-30L l2 Cleanin Proe:edure* 590AOh(C) Wild Mus(uooms" 2-30L l4 When to Vb'ash* 3-207.t7 Game.An'vnals�: . Il - Gootl Hygienie Praotices . . . 5 � RecelvinglCondRion 2-40I.71 ETrin ,Drinkin or Usin Tobacco* 3-202.11 PHFs Received at P[o ei Ter,� ataxe,* '-'4��,t2, Ihscharges.From ihe Eyes,Nose and 3-202.15 Fuckane Iute,i[ '* Mouth* . 3�-!C�'t.:t F�od Safe and Una�ulterated M � 3-301.12 Freventin Contamination When Tastin�* 6 'r ayslfieco�:ds:ahellstock 12 � Prevantion of Contamination from Hands � 3-202.18 �Shellstuck identification" 590.004(E) Preventing Contamination from � � - � 3-203.12 SheUstock identificaiion A2a;ntaiaed% Em�lo ees* � � - � - 7agslAecords:�Fish Predaci5 � 13 Handwash Facilities � - - � Convenien8y Lxated and Accessible - - �' 3-402.11 � z�nrasite Deytrua;on' ', 3-402.12 P.ecurds,CreaGon and Reizntivn` 5-203.11 . Numbers and Ca acities* � ' 590A04(:� � Labeling olingredients' � � . �-204.I1 Locufion and Placement* � 7 Conformance with Approved Procedures 5-205.11 �Accessibilit ,p ration and Maintenance i . /HACCP Plans � Suppl'�ed w'rth Soap and Hand Drying �- 3-502.11. S� ecialized Prexessir. �tethals* � Davices� _ 3-502:12 Redaced6xven acka��n�,�criteria'� � ��-301.1�1 � � Handwashin Cleanset,�Availabilit R-103.!2 Confoimance wiit!A ;oved ptocedures* � � 630t12 Hand-D 'n Provision 'Denotcs eFitical item iir.the federal(999 Paid Code ur 1�5 CMR 596.000. • ' : . • - . . : . . � . . : - . . - . - .r�� . . . � . . . • - . � �. 1�1�� .o � � .��e .i •� L u�i��.�i �� - •^� ��! 1� .. ��_ �. G... . �'111�._ � .. i �iG��d.��.�'st�I..�.t�►�� ;, �-�� .�. .I . �.�/�.� � r� � i; �. � ..� . � �. It .�I I ,�" L� � I • � I ��.��L�1.4' -- �ry �r r��1!\.�1�I/ 3� � �J . �I/ —�.�S�1�.71ir'��!c.,'��Sii�_.r � ��_� .�, • �i . '. ��s - !;.!�/1��!! �fiu ii� • � :!I:ST•S_�_- r. ..I � � ._ s � f :!_s._� r� �i L ��L■it�l.7fr� �■■ � � �� ;/ / 1 � ! :�i J�L. I � � � . �/ � Gi-�" �. .�� . • i:�7�1�iYa7��/�(� /I / ♦.r ,� �. � �� •�� r%fi�► .. / i �ii • � /�CII + � � ��r� -,1��% ��' .�r. .. 'I �i.�I'I _ I / �,1 ._ 1 I �i �.. . / _ . . ��5 -`�!��- �� _�.l��'� c�, , i , :}�� r. .,. _ �, �..7l,1,�.�� =� - . — --�.�. - -- - - - . -�,'�* � !'!��.-`;��1�'� ._�',.�"i�i��- _•_� _�'..,��l,.'.:��. ,��, _�,'! w�!IIt�t1��Lr�.�• �,�w�.�� •�n L ��c!��. •.�i�!^�L�f!.TiYi��7�tC�"ariL�L��L!1��:7t9�i.� �� ..�li"'I�ir.'��_.� •!�__� � ,.R�/..��1��i . ./��_ -�+�� ,•�,�iT►�/�I.i,.4�� rC . � - �., �. .,. � , i . - . .'- , .�.!�i - t�1,� ��- = •.� .. �s ... . - r� � �z �� / �t�- ��.l��'/.��_. - �. --.. .�l: . � . . - .,.T � ��_� - , ��—,_ —�.'�,151�/'i��s 3i�!I/�fI/ L L _�—�a�`c' � �-----�—� . — - -- -- - — � �� „ i . . - .. . . - •� . . . . . . • . • - • • ■ . . . ■ . . . . . . . . • . - •- . . •. . . . . - • -. . . ■ �- . -. �. ■ - .- - . . . . . - . -. - ••• .. - • - . - . . . . . . . r - . . . . �.- .� . . . . .. .. . : .. . . ... . - � � � �/ , � . . . .. . . . - -- - - - — - _ . ,.._ . � , .. . _,� _ _, _.. _��_ .W.�..�� _ _, __ -.._....�._ , w,.._�.r-_; . 3-�01.1�A(C} FHFs Received at Temperaturzs Y1a/atioas RetataJ to Fnndbome JDnaS&tnterver+tlons snd Risk . According to L.aw Cooled to Factars{ttems�l-22} (CnnrJ � - � � dl."F145`F Within 4 Hours.* � PR(3TEG7'OOtd FRQGd CHENIICAIS 3-501.15 Ccmlin Meth<xis for PFJFs 14 - Footl or Galor Add@Ives . , �q P'HF Hot and Colo Noiding . 3-501.9b(B) Coid PtiFs 4lazntxined at ur beluw 3-2U2.72 Additives* 590.00d(F) di°/45°F* 3-3Q2.1d ProtertionfromUn raved,�dciiuves* 3_90LF6(Al HotPFiFsM:sinntainedaYorabove . g5 � Paisanats nr Toxic Sub�anc� . . - 15U°F. * . 7-141.1 i Idemifying Infonnation-OLiginal 3-501.16(A) Roas[s:Held at or above t30'F. " CanGainers'" - � Time as a Pubiic Health Contral 7-7 02.1 I. Common Name-Warkia Containers*- . 7-�01.1 I Se aration-St '° 3-541.t9 I"ime as a Publie Healtli Controi* 7-202.11 ,Restiiciion-Paesence and L'se' - ' S90.t7(ki H) Variance R nirement 7-.',d2.12 C+mditions bf Use* , REQUIREMEMS FOR HtGHLY SUSCEPTIBLE � 7-2Q3.11 ToxicCon[ainers-Prohibitions* POPULAilONB HSP � 7-2.64.11 Sanitizers.Criteria-Chemii�ts° .. Z1 "3-&QL 1 I(.4) Unpasteuri.zx.d Pre-packnged luice,e and 7-2M.13 Chemicals for�Vashin¢A•oduce,Criteria° :Bevera e�a•izh Wumin�La6els' 7-20d.S4 D a ents.Csitenx° 3-Kpi.11B} Use of Pasteurizecl E g" � �Ag--- 7-205.21 htcidental Foal Cc�tact,Iubricants* 3-801.11(0) Raw or Partiaily Cailced Aninial Food and 7-205.11 Restricted Use Pesticides;Criteria' Raw Seed S rts[Qot Served.* ?-206.12 Rodent:Bait Sta[ioas� 3-R01.17(C) Un enrd Food Packa>e Not Re-�erved. '" � 7-2D6.13 Trac�Powders,Pest Cpntrol and . , . . - Monitorin * COtdSUMER ADVISORY TIMEJTEMPERATURE CONTROI.S ZZ 3-663.11 C�sumer Advisory Posfe+t fot Consumption of Animai Foods'I9taz are Raw.i3ndercnoked ar 16 Proper Cootang Temparatur�far Not Qtherwise Prqcessed to Eliminate PHFs � Patho x an�o.�rnieooi 3-d01.21A(t)(2) figgs- t55"F 15 Sec: ' - 'E �s-Immediate Servic�e 145°FiSsec" 3-302.t3. Pastei�rized Eggs Substitute fcrc Raw Sheil . E * 3-461.11{A){Z) � -Camminuted Fish.Meats�2 Game , . � Animais-155°F 15 sec.'� gpEClAI REQUIREMENTS 3-40t.11{$)(I)(2) P�r}:and Bee#Roast-130°P 121 min� ��A)-(D) Yiolarioas of Sec[ion 590.�9(t�,)-(,D)in 3-40LI l(A)(2) Ratites,Injected Meats-155°F 15 sec.• cateting,,mobile food,temporary and 3<401.I itAD(3) Poultry,W ild Game,Swffed PHFs, residenaal kitchen operations shoutd be Stuffing Contsining Fish,Meat, � debited urider the appropriate sections Ponl or Rstius-165°F 1.5 sec. " ' abcrve if related to f�dborne illness 3-4q1.11(C)(3} SV6olamoscle,Intact BeeC Steaks ' . intervenaons and iisk factors. (7ttier 145°P� - 590.i109 violations relating to gaid retail . 3-401.12 � Raw Animat Foods Cooked in a � . ' ptactices should be debited under#?4- Microwave 165°F' Special Requirements. 3-401il 1(A7(ixb) All Other PFIFs-145°F 15 sec.* 17 Fieheatiag for Hat Hulding YIptAT/ONS RELATED TO GOOD RETA2 PRAGT/CES 3-41}3.i t(A)&{D) : ptiFs 165°F IS�.° (Items 23•30) � 3�03.7.1(B) Microwave-�165`F 2 Minute Standing� �.Criiical,arid non-eritical violqfions,which dn not relate so rhe - � , Ti�> foodbome illness interventi�ns mid risk factors listed abut�e,can be 3-{(t3.1!{C� . Commerciaily Pmcessed RTE Foud- � founrl in the follnxzng sectio.es�o(the Food Code mrd 105 CMR 740°F'x 590 Q(t0. . 31tp3.I 1(E,} . Remaining Un.sliced P�rtii'ms of Beef � �_�, �d RetaJ1 Prsetlees _ FC 590.000 . .:Rnasts�` � 23. Manaaemen[and Persannel � �FC-2 .003 � gg . . Proper C�6ng ot PHFs� . � 24.. Food and Fo�Protection FC-3 A04 25.� E ui merrt and Uteruiis " FC-4 .005 3-501.14(A) Cooling Cooked PHFs from 140°F to pg. W ater,PlUmbi and waste i. FC-5 008 �0°FWithin�2fioars�andFraiu'70`F � 27. � PhsicaiFaclHt � FG-6 .W7 � ' � to 41°F/45°F Within 4 Houis. * 28. Pdsonous wToxic Matsrials ' FC�=7 .008 3-SD1.14{B) - Cooling PHFs Made From Ambieat �• �S ecial R irements : .OD9 � Temperutureinb�redientsto�l°F/45oE �. I �� i____. . � �thin$Hows* s=�:.>,,.�.az� : . *1):?no4x criticai itrm inlhe fedtral t`J'19 Ftad Code or 105 CSNR 590.IXm. � !' ` • ' :. . . . . : . ► ,.� � : - . � • . . - . �� . �� • • • � • • � • • ' � � �� i�y ` ` , r;�� .1.L1'I./ e L:' '�/ l.J 'lrl��6��l�1�ZJ/I�a1��/L�l■_ �� Aw. �. , � _ ��i.�J� ��.��i.�.� � �/�i/ :', � , i_. _ F�� i'�. _�_ �,._ ��: . ��- �-_ - � �i��r�� .�.,�, � •.��_ - • . .. � . -� _./�� .. ,7..��,►.��u�� _ �.�:ts..�.L�.u�� .�-�� !-_►„ � . � �. ,: - 1, , , � ��r"':�.�,� . ,,.. .'� ��11�'.._ . . � --�ic 'r�l>�}/�r11�11��'��!I��.f'�l. . . .: : .,,�!'r,T► , _,. ..:. �'�T-!�!1-!!'.�'�',�_!�!J • ,..' ��i{ 1 �/ i • f�/ /l� l� /� ��i / ��L�. � It��►! �F.7� _-�, � � �.'!�!�il��!. .� _ r_ . _. .-�'�.�!!� _ . ',�...�1J! �_��a,�� .' �I/ I � , 1 (/�� I � -�I..�1a�-�L I'L A� —�� . ��.�7:rd'�SA�.u�7�C..�: � : �I�G• /: . '!33 �. ..��lTii��iTi.��/�� =��-�1i,...�! .. . �.. .� ��i� .., .,-� . _!_. !� .� ,.�l1�.�� e � ��/_ = �� ir.�._. ![ , ,; s.�� '= �I�C;� ' i. � � --� �l/�TYL!JJ.I, t/ �-� --� ��w.�... � ,.� �1 �.0 �.�� / .��,� �� . �.�":�� `'� ., � - � _ --- V - - �� . . - . . . . - .. .. . . . . . . . - . . . . . . . . . . . . . . - . - . - . . .. . � . . - . -. . . . .• . -. •. . - .- .- � . . . . - . -. - ... .. - . - . . . . . . . . . ,.. .. . : . .� . - ... . . . �. �. . : .- . . ... . - - �. � �� /_ • . � .. . ■ • - r � � � � — -- „' "_ .. . .._ _ . . .._.},F _'m`•_-.�-..--.... �-r�..._,-.�+ .. . . __.,.�-.n „ --.. .,,�,�_a„��,� � .�.�. . ,r- ._. ..� . . ..-.-� ..r.P .-- .... ...+- . ... _.`. .^� y ..' � . 3a01.1d(C} PHFs Received at Temperaturzs �' Yiotations Relafed fo Foadborne R/nes&fntervenEiorts and Ris& .- P,ccording ta Law Cooled to � Fsctors{ttems7-22) (Corti.) � � dl.°FfdS°FWithiu4Hours,' , 3-501.15 Ccrolin Methals for PHEs PROTECTlQN FRQM CHEI�AICAIS �q p►}F Hpt antl CoIA Hoiding 14 -� F�°A'�6�'��9� 3-�01.16(B) Culd PHFs blaintained at cx bel�v ' 3 2U2.I2 Additives* 590.00d(Pl 41°/45°F* 3-3Q2.14 ProteMion from Un roved itddiuv�ea'� 3.5�L.16(A) �Hot PHFs M:lintau�ed at�or abos�z . 15 � Foisonous or Toxie Substences . . . � 190°F. * � 7-14I.1 t Idemifying Infonnation-Originat 3-501.16(A) Roasts Held stt or above 130°F. " �Cont.ainers* � � � Time as a Pubiic Health Corrtrol 7-102.71 Common Name-Workin Concainecs* 7-'_Ol.l i S 'on-Stora * 3-501.t9 Tirtre as a Public Healttt ContralTM 7-202.I1 .Restiictian-Presence and�Use" � . . S9U.00W(H7 Variance R airement 7-202.12 Cnnditi�ns af Use* • " REt�UiflEMENTS POR HIGH4Y SUSCEPTIBLE 7-203.I I Tox'sc Containcrs-Pr�hibiti+ms' pOPULAT1flNS NS 7-204.11 Sanitizers.Criteria-Chemirats' 7-2P9.t2 G7cenucais for Washu &*roduce,CYiteria' 21 3-801.21(.4) Ungast�xi�.ed Pre-packaged Iuicea:tnd -�--- Bevera s with Warninrt La6ds* 7-2Q�3.14 D�ia�Agents.Criteria' 3-801.118) Use of Pasteurized E * 7-205.1 l fncidentai Fcwd Conta{x,Lz+bricants* 3-801.11(D} Raw ar Partially Coc�ked Aninurt Fuod and 7-2fXi.11 Restricted Use Pesticides:Criteria* Raw Seed S rts Not Served.* ',-206.t? Rodent:BaitStations° 3-gpi.(1(C} Un enedFoodPackaeNatRc-�erved. * � � 7-206.13 Tcecking Powders,Pest Control and . . . . . . � �OtpLO1"� � CONSUMER ADVISORY 71MEIf'EMPERATIlRE CQN7ROLS ZZ 3-603:71 f'ansiuner ridvisary Poste3 for Co-nsumptian of 26 Proper Coqking Temperaturea for Animal Foods'fiat are Raw.Undercoai:ed or �� , Not OtLenvise Prqcessed to Eliminate 3-d01.IlA(t)(2} Eggs- t55"F 15 Sec. � . Patho ens.°`Emxw<vnrza� � �E .-Imwediate Servire 145°FlSsec" 3-3Q2.t3. Pasteucized Eggs Substitute Cor:Raw Shell , ' g s . 34Q3.11{A){Z) � -Cumminuted Fish.Meats�Game , � AnimaLs-155°F 15 sec.x SFECiAI.REQUIREMENTS 3-4Q111(B)(tX2) Pork andBeef Roast-130°F t21 min# 590.009(A)-{Q� Vioiations of Section 590.009{A)-fD}in 3-401.11(A){2) Ratites,Snjectecl Meats- 155°F IS �� W catering,mobile food,�orary and 3-0Ql.l l{Ax3} Poulhy,W ild Ga�,Stuffed PHFs, residentixl kitchen operations should be Stu�ng Coataining Fssl�,A4eat, deb'rted under the appropriate sections Poul or Racires-165°F 1 S sec.* above if related[o f�dborne illness 3-907..11(C)(3} BJtxole-muscle,intact Beef Sceaks interventaoas and risk fadors. Other 145°P^ � 590.(Hl9 violations retating to good retail 3-401.12 Raw Animal Foals Ccs�ked in a �ac�tices should be debited under#24- Microwme 165°F; ' 5pecial Requireatents. 3-401;11(A)<ixb) ALl Other PHFs-145'F]5 sec. ° y� . - Reheatt�g 4pr Noi Nolding YlpLATK?NS RELATED TO GOOD RETA(L l�RAGTIGES � 3-443.i 1{A)&(D) PF1Fs]fi5°F'IS sec.* (Items 23-30) 31403.17(B) Micmwave--165`F 2 Minate Stauciiug � �.Gritrcal,mrd non-criticaT viotaJions,which do not retale to ihe � � , 'i'ime* faodbr.+me illness interventi�ns and risk factors listed a6uti�,can be 3-iO3.11{C} . CommexciaEly Processed RT'E Food- faunrl i+�she faltoxdng sectiens�of the Fnod Code and 105 CMR 740ay� 590.OG'0. � 3-403.t 1{E} Remaining Unslia�ct Portic>as of Beef - 1��c°Od R�n P�� FC 59D.UA0 R�sts� � � � 23. AAan. emenl ami Psrs�rref � � FC-2 .00:3 � � � 1$ Praper Cooting ot AHFa � 24.. �ood and F�d Pro[ection FC-3 .064 � ! 25.- E ui ment and Utensi� FG-4 .�5 i 3-Sd1.24(A) Cooting Cookeci PHFs from 140°F ro �, I W ater,Plumbi and W aste � FC-5 008 ; 70'F WitLin 2 Hotirs and Fram 70`F 27, pii ical Facl6 � FC-6 007 . � " to 4i°FJ45'F�i�iUil.n A Hours. * 28. Pdsonrous wTazic Metsriafs '; FC��=7 .OoB � 3-501.14(B) _ � Cooliug PHFs;Ylade From Ambient �• �S ecia)R ulremants .009 � Temperature Inf,2edients to 41°F(45°F . �' ( �� . � -�---- . .VrSthin 4 Ht�urs` s:=atr.��,:«-zax � � : . *Drnoies ccitical itzai in the federel t`�9 Fcwd Cate w lUS CR4R 590.OW. � • ' : • � - . . � � I � I �_ � " ' /.ii. / - . - . �� • � • � • • � • • • � ,.�� I� l� _ ._ ��.'�'�,I�, �.��. -- _ �;,. _��l,�I��'. .I� , ��I �� 1J /Y/I � I l� �� /� �// , I /��I��_ -- ��I��l��.�/ �5�� ► . � , � ��1/��t�►.�. .�!J�> . ��9.�l1.T.�1l�.l��l.L��1�.�.1�� A��O!. ' : ,- . .-'��`'.�'�-- � � •i��i�l'I�.�I� �v_� r 1 .� �I+: �.. il i �� r � r , .��t. � �� 7.%�l ��I_ I�=��.��i,�* / _. . ! . :�!� , .._,__ _ _�!�. .�'r.��ii�I��iP�L� r.�}.�l. � �:.;1�'i.'�!��lIR1L - � ' ��r . •_ �i �.. � � __. ,. . r . ., ,,� - •_ � ��.�.►�:. . _, _ . ►Jl��-�.� ��_ , .-_• _.. ,,_ � .= T��I�-•1��9�'��. .��.�, .. J _ _l�1+��!� �,7��//�� . . .� s .�...c. . '/ _ . ��»� ■!�'iiilal:[IL'� . ' '� A. � .s ' � ��tC . � -- _ r � � .i�� ./1t4b1 i = - '- . ._ -� �.:C�.. ��L�Ti'�!!4� c � � 11� ♦ ..� .� ulT//%Siiil� ��:� ° � _•. ._. �. . ./. _ �,�..�t�� a. .r'��.��€.��.�� i�� .� a. . ti�)1�� .�� I_ .� � l / I I/ _ �� I�'i-IIr. � - � _ -- � , --- . I — — ---- � ,—� r� i i . • • � � . � - •� � � � . � • � . • - • • ■ . . . ■ . . . � • . • • - • - �- • • � • - � � • • - • -• � • � _ �• . -. •. ■ • .- .- . . � � . ' • - � ' ��• •� - � - � . � � . � . • - ,• . • •- • ' . . • � . .. �. ■ : .- . _ • •�� • - � � . . � .. . ■ • /fL/ i� .� � �i � - � lLa��< - � — -- .. . �_ . �,., .. _. .. .� ,...�.. � � , , ..: �_ _ . .. : _ , . �: . � 3-501.1d(C'� , PHFs Received at TemQeraturas I Yiotationa ReJated fa Fondbanre ttlnesa M#erver+Elorts antl Risls According to Law Cooted to Factors{[tems l-22) (Cotti.) dl°F(d5°F Within 4 Houxs.' 3_gpL15 Ccmlin MethaLs for PFSFs PROTECTION FRQM CHEiNiCALS ,_ iq pHP Hot and Cnitl Holding �¢ �Food or Cosw Addittves 3-�Ol.l6(B) Guld PIiFs 4laintained at crc bel�nv 3-2U2.12 Additives° 590.00d(F) dl°(45°F* 3-302.ld ProteMion from(Jn rerved rldditives* 3-SOL 16(A) Hot PHFs Maiataimed at�or above _ � � Poisonous or Toxic 3obstencag . � �� 7-107.1 i Identifying Infonnation-Original 3-501.16(A) Roas[a Hetd at or above 130'F. " • ��¢e�� Zp Tim�as a Public Health CartMot , 7-102.11. Common Name-Wozkiu Coatainers# 3-501.t9 Time as a Public Heslth Contnsl* 7?OI.Il S amiion-Sto eu . � . - .590.004H) VnrianceRe airement � 7-302.11 .Restrictirnn-Presenceend-lise° . " . . 7-242.12 Condetions oC Use�' . REflU1REMEFfT3 FOR HIGNLY SUSCEPT181.E 7-2Q3.1 d Toxic Conwineis-Proriibitions* pppULA710N5 HS 7-20a4.11 Sunitizets.Criteiia-Chemirats" Zl 3-801.11(A) Ungacteur"u.eti Pre-packaged Juices and 7-2(A4.t2 Chemicals for Washin i'roduce,Ctiteria• � _$e� e with Vrarnina Labels* i-20d.14 . encs.Criteriu" 3-801.I1fB Use of Pastemized E as� _ 7-205.11 � Incidental Foocl Conta�^t,Iubiicnnts* 3-g01.11(D) Raw ot Partiully Cocik.ed Anima]Food and . 7-20G.11 Restricted Use Pesdeides;Cciteria° Ruw S�ci S rts Not Served * ',-3D5.12 Rodent Sait Stariuns° 3-gpi.i l(C} lin ened Foai Pack e Not Re-served. '" 7-2lJfi.i3 Traeking Powders,Pest Controi vnd Monitorin * CONSUMER ADVISORY 77ME7TEMf�ER/ITURE CONTROIS 22 3-603.11 C�sumer tldvfsory Posfed for Consumpcion of Aniroat Foods'Ihaz aze Raw,tfndercaaked or 16 Proper Cooi6ng Temparatnresfar �yp�qjherwise Prqcessed to Elimivate PHFs � P� y k.m�,„o�nrzw� ' 3-dOi.FIA(1)(2) 'Hggs- t55°F 15 Sec. ' - � �E �s-Fmmediata Secvi.ce 145°F15se:.+ 3-302.13. fasteurized Eggs Substimte for Raw Shell E �` � 3-407.21(A)(2) � �Comminuted Fis6.Meats&Game . . . � , Aoimals-155°F IS sec.* SPEClAL REGPUIREfNENTS 3-441.11(B)(1}t2) Pod:and Beef Roast-13P°F t21 min'� SyQ 009�A}-{D) Yio2arions of Section 590.009{A)-fD)in 3-401.1 lft\x2) Ratites,Injeded Meats-155°F 15 sea� cate:ing,mobile food,�orary and 3-4tl1.11tA1(3) Poultry,Wiid Genee.Stuffecl PHPs, residential kitchen operations shauld be Stuffing Containing Fis6,Meae, dehited under the appropriate Sectians P�i or Ratices-Ib5°F 75 sec.* above if related tn f�dborne illness 3�01.1t(Cj{3} eJhoIe-muscle,Intact Beef Stesks � � interventions and risk factors. C3ctter 145"F" 59Q.009 violations relating to goad retail 3-401.12 Raw Animat Foods Co�ked in a ptactices should be debited under�f29- Micmwave 165°F• Speciai RequiremenCs. 3-401;11(A)(1)(b} ;yll Ot6et PHFs-145'P 15 sec.* 1? Reh�Hag f¢r HoE Hotding � VlOLA7TONS RELATED TO GOOD RETAPL PflACTMCES 3-t63.t 1(A)&(D) , PHFs 165°F IS sec." (Items 23-30) .- 31t03.7.i(B} Mi¢owave-�155`F 2 Minute Stancling �.Critreat,mrd non-crrtical violations,which dn not rttate to the � � _ , � 'pip�s . . � foatborrte i!lness interventi�ns arsd risk faetors tisted a6ore,ean�6e 3-'!{!3.t 1(C} . Commerciaily Pri�ce.gsed RTE Faal- found in rhe folloxdng sectiares�of the Food Code mrd 105 ChfR 140°F* ��590.Q(t0-. 3-4113.ti{E) RemainingUnsti�.�ctPorticm.cofB�f j �•_�� r°°dReta!lPrectices FC 590.�j �Ras.sts* � 23. ManavementartdPstsontml - �FC-�2 .Oa3_� 1g . Ptoper Coding of PHPs � 24. Food and Food Protec[ion FC-3 .�4 � 25.- Equipment and Utensiis , FC-4 .005 3-5d1.14{A) Cqoting Cookeci PEiFs fmm 140°F to f �;I W ater,PlUmbi�and W aste FC-5 0-� � 70°FWitltin�2ftodrs�and�Frrnu70`F - 27. � phitsicalFacfary ,_ . FC-6 � .007 . [0 41°Fl45°F��ithin 4 Hours. ° 28. Pasonaus w Trntic Materiafs ; FC=7 008 i 3-50 L.14(i3) - Cooling PHPs Made From:4mbient �� -S ecial R uiremenis .009 � Temperatuce Ingcedient�to 41°F/45°F � ( �� ---+---- - Within 4 Haurs* c.ui:,,,.�.o-zm: . . . ' ;Denotrs critical i�em in the fedzta!t�9 Fc�ai i:Ude w lU5 CMR�90.000. . • l