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CAFFE GRAZIANI - ESTABLISHMENTS CQ�fe 642Waj 1$ f W,4 universal one www.myuniversalop.com phone: 1-800-756-4676 UNV16162 MADE IN USA mom _. _%' �., b�� 0 Commonwealth of Massachusetts City of Salem Board of Health Kimberley Driscoll 120 Washington Street,4th Floor Mayor SALEM,MA 01970 Food/Retail Establishment Permit DATE PRINTED: 01/06/2011 ESTABLISHMENT NAME: Caffe Graziani File Number:BHF-2004-000270 133 Washington Street Salem MA 01970 LOCATED AT: 0133 WASHINGTON STREET SALEM, MA 01970 Permit Type Permit No. Permit Issued Permit Expires Fee Restrictions/Notes FOOD SERVICE BHP-2011-0239 Jan 1, 2011 Dec 31,2011 $280.00 ESTABLISHMENT Total Fees: $280.00 PERMIT EXPIRES IDecember3l, 2011 Board of Health ✓ This Permit is not transferable and must be reissued upon change of ownership or location.The permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code,beofre any revonations,improvements,or equipment changes are made, all plans for such must be submitted to and approved by the Salem Board of Health. Page 1 C x 3 � CITY OF SALEM, MASSACHUSETTS °� BOARD OF HEALTH 120 WASHINGTON STREET,4"'FLOOR TEL•. (978) 741-1800 K110BERLEY DRISCOLL FAZ(978) 745-0343 MAYOR DgREENBAUMnae tiALEM.COM DAVID GREENBAUM,RS ACTING HEALTH AGENT 2011 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT NAME OF ESTASLISHRAENT 4- (Srm'ZIGt V) � TEL# gj'7r:7 q Ic�go .)- ADDRESS OF ESTABLISHMENT I�3 j/Ua S /1Q4zJ1 .S 4- FAX# ��F6&e c 7 71.Sr MAILING ADDRESS(if different) r( rr EMAIL- Business' f C t Website: %f/(441, C&-FP?C& -aZtae" I , (IJ 1 OWNER'SNAMEerij /,2 v7v?i CW ? ((f//I y TEL# &el:Z .S(o 7 5�Z7 ADDRESS 1�f Th -s-r 6LGST CSS' STREET CITY STATE ZIP CERTIFIED FOOD MANAGER'S NAME(S) �Cl f t I� /I/I Gf-e4 ✓Cc I�,,K CERTIFICATE#(S) (Required in an establishment where potentially hazardous food is prepared) EMERGENCY RESPONSE PERSON�2G(LCt 0"Y C4 4 dYac/7/ r HOME TEL# ZO17 J'� 7 DAYS'OF OPERATION . " : Monda f Tuesda ;, _ Wednesday,�,,; = y 3 Saturday,., c;:: , , Sunday,,,--.',---', y, � . y� � �<. ,Thursda �� , , Fdd �; .. HOURS OF OPERATION Please write in time of day. L�5 QG! fi 3 ! �/� 3 ��3 �� �i �,— �/ ?3 J� / Forexample l lam-llpm I J TYPE OF ESTABLISHMENT FEE (check only) RETAIL STORE YES NO less than 1000sq.ft. =$70 1000-10,000sq.ft. =$280 more than 10,000sq.ft. =$420 - --- --- -- - RESTAURANT YE NO less than 25 seats ,--$ (Outdoor Stationary Food C-ar $2 0 2G^9 sects =$280 more than 99 seats =$420 ---------------------------------------------------------------- ---- -------------------------------------------------------------------------------------------- BED/BREAKFAST/ YES O $100 CHILDCARE SERVICES/NURSING HOME ---- ---------------------------------------------------•------------------------------------------------------------------------------------------------------------------ ADDITIONAL PERMITS MAKE (not just serve) ICE CREAM, YOGURT/SOFT SERVE YES $25 TOBACCO VENDOR YES $135 ALL NON-PROFIT(such as church kitchens) YES $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 an approved by the Salem Board of Health. Pursuant to MGL Chapter 62C, tion 49A, I certify under the pains and penalties of perjury that I,to my best knowledge and belief,have filed all state lax return paid II stat tax ired under the law. "('�A a s-i e� S Signatureate Social Security or Federal Identification Number --- ------- - ----------- Revised Ionli 1 FOODAP201 Ladm Checkft&Date $ J II 4 > A•1 Exterminators PLEASE REMIT PAYMENT TO: 183 SHEPARD STREET,LYNN,MA 01902.4597 INVOICE P.O.Box 310, Lynn,MA 01903.0310 © 781-592.2731 1-800.5254825 FAX 781.592.7641 606677 CURRENT 1 30 DAYS l 60 DAYS ( 90 DAYS Pest and Termite Control Professionals RT DATE DAY TYPE DATE • r ACCT.NO.T,�1VJJ7'VJ I r CIII�:-k7QJc1"i'-' 1007 Thu 101 10,,0'7/10 CAFE GRAZANT CONTR FOR REGULAR T=EST CONTROL SERVICECHARGE 4 t'3 WIFISH 1PJ(:i FON ST NUMBER UNITPRICE AMC SALEM Mfg �i197� / MOUSE GL BD 9!8-741-4282 741-4282 08iO`i110 700AM MULTI-CTTRAP DATE-----1 �_ !1`�__, PROTECTA SW _ biz-`j47-3i' Kt's -. cell CHECK NT�' rr— PROTECTA SK RTU BAIT STA COMMENTS ❑MG }d�VISA MOUSE SNAP S ATCNG ARES+/PIT: HEN/1,L?Rlwti!AL.f. RAT SNAP STORAGE AREA ❑DISCOVER ❑AMEX (DOES 1',101T INCLUDE BStrtT i SALES TAX O.Oy.D.❑ CHG❑ wC❑ J TOTAL DUE ff� , TOTAL AMOUNT PD i `t— ADDITIONAL COMMENTS COMMERCIAL SANITATION REPORT YES NO Floors-Clean _.....................................__........__....... 2` ❑ Counter Surfaces-Clean ...............................-........... X ❑ Drain Areas-Clean ....................................................... ❑ Rest Rooms-Clean ...........__....-.......... ............. -.... - d ❑ Dining Areas-Clean ...............................................-.... Et, ❑ Employee Areas-Clean .._........................__.............. ❑- ❑ RESIDENTIAL WARRANTY INFORMATION Locker Areas-Clean.........-.........................-1........... 2� ❑ .DWELLING TYPE WARRANTY YES❑ NO O Storage Areas-Organized .•..•---............................- ❑" ❑ 1 Family` ❑ 3 Family ❑ 30 Days ❑ 60 Days ❑ ,omments 2 Family ❑ 66 Fa—mily— ❑ 90 Days CI 6 Mos. ❑ _ -- REASON FORO WN ARAANTY i —.—.__ -Partial service requested ..................-....................._............-........................❑ -Poor sanitation ...................................................................................................❑ POST APPLICATION REOUIREMENTS -Kitchen/bathroom Cabinets not prepared .................................._.....__....__.❑ CCUPIED AREAS MUST BE VACATED FOR HOURS. •Closets/furniture not prepared...................................................__...__._.........❑ AOROUGHLY VENTILATE TREATED AREA$ BEFORE THEY ARE •Rodent proofing needed...................................................................._............❑ =OCCUPIED. DO NOT ALLOW ADULTS, CHILDREN,OR PETS ON .Other SEATED SURFACES UNTIL DRY. -------------- --- INTRACTING ENTITIES HAVER IVED ALL MASSACHUSETTS DEPARTMENT OF FOOD 8 AGRICULTURE'S PES7IGIDE TIME iN REAU CONSUMER ASH S,WR EN STATEMENTS POSTING NOTICES AND HAVE AGREED TO NOTIFY TENANTS 2-7 tS PRIOR TO ON TIME. ABOVE SER E HAS BEEN SATISFACTORILY COMPLETED. INS s, STONIER�I E 1",J' LtC.If "TEPH SIGNATURE ECH NO. ?E RlY`t%ERSE SIDE FOR PERTINENT INFORMATION s White-Office Copy Canary --Customer Copy TRAPPERS '%�' 0 Professional Grease Trap&Barrel Service y' PO Box 2422 foodgreasetrappers.com Lowell, MA 01851 (978)373-3058 (800)34 -4454 CLIENT DATE(?[/ L� GREASE TRAP SERVIC BAN ENHA ENT TABLETS GREASE BARRELS SERVICED DRAIN LINE CLEANING 1 CHARGE , SIGNATURE: THANK YOU FOR YOUR BUSINESS! I ,. s.Fl.�'�_«��.kaal.:-..�+'y.1.eP.:....,.ert•.rr ._...... , ,...,.....fy c.�i',+Y-t nfr7gti,4....kyr.+r••-+`�.y«t....�.....,,,r,�:„..dRY'11s.loy.r°f^ ��d^Ssa;n. Mas'sachusetts Department of Public Health Salem Board of Health Division of Food and Drugs 120 Washington Street,4'"Floor 9 Salem, MA 01970-3523 FOOD ESTABLISHMENT INSPECTION REPORT Tel. (978) 741-1800 Fax(978) 745-0343 Name/ n y Date Tvoe of 0 eration(s) Tvoe of Insoection 1 - A P Yn A Y_ , A a 9,Food Service NJ Routine Address_ -9 1" /� CSRisk ❑ Retail 'E2 Re-inspection \ Q_ )r, .n A o Y ate. A n Level ❑ Residential Kitchen Previous Inspection Telephone p (,�,. /. El Mobile Date: Owner (( u ? �I I (Ju HACCP Y/N El Temporary E] Pre-operation xK M r n AA AA o IA a /`i i ❑ Caterer ❑ Suspect Illness Person in Charge(PIC) /l r ^ Time ❑ Bed&Breakfast ❑ HACCP Complaint Inspector \^ p✓(Ju 9�, /- Out: Permit No. ❑Other Each violation checked requires an explanation on the narrative page(s) and a citation of specific provision(s)violated. Non-compliance with: Violations Related to Foodborne Illness Interventions and Risk Factors Anti-Choking Tobacco Violations marked may pose an imminent health hazard and require immediate corrective 590.009(E),0' 590.009(F)Z action as determined by the Board of Health. "FOOD PROTECTION MANAGEMENT ❑ 12. Prevention of Contamination from Hands ❑ 1 PIC Assigned/Knowledgeable/Duties ❑ 13 Handwash Facilities EMPLOYEE HEALTH'"" 4PROTECTION FROM CHEMICALS 1. a q10" „❑ 2. Reporting of Diseases by Food Employee and PIC r= „ �. »• « ,--m. _ �_ � m�� � m� m1 Y [114. Approved Food or Color Additives a❑ 3. Personnel with Infections Restricted/Excluded ❑ 15.Toxic Chemicals ]FOOD FROM APPROVED SOURCE`�'vk;;�;,���re� ,�r',w„?„���P"��,.�.as f' }❑ 4. Food and Water from Approved Source TIMErrEMPERATURE CONTROLS(Patamfally Hazardous Foods)"�"�'I 1 k amStl&ti'e. ❑ 5. Receiving/Condition El 16. Cooking Temperatures ❑ 6. Tags/Records/Accuracy of Ingredient Statements ❑ 17. Reheating i '? ;;❑ 7. Conformance with Approved Procedures/HACCP Plans El 18. Cooling "PROTECTION FROM CONTAMINATION'iT11� ,� �.1�X a '1 -119. Hot and Cold Holding ❑ 8. Separation/Segregation/Protection ❑20.Time As a Public Health Control ❑ 9. Food Contact Surfaces Cleaning and Sanitizing ,REQUIREMENTS POR FfIGHLY$USCEPTi6LE POPULATIONS(H$P)-; ❑21. Food and Food Preparation for HSP ❑ 10. Proper Adequate Handwashing ; DVY,r` E] CONSUMER AISOR 'e 11.Good Hygienic Practices ❑22. Posting of Consumer Advisories Violations Related to Good Retail Practices Number of Violated Provisions Related ❑,/ Critical (C) violations marked must be corrected To Foodborne Illnesses Interventions immediately or within 10 days as determined by the Board and Risk Factors(Items 1-22): of Health. Non-critical (N)violations must be corrected Official Order for Correction: Based on an i�ispection immediately or within 90 days as determined by the Board . of Health. today, the items checked indicate violations of 105 CMR C , iN ,l 590.000/federal Food Code. This report, when signed below 23. Management and Personnel (FC-2)(590.003) by a Board of Health member or its agent constitutes an order of the Board of Health. Failure to correct violations �I24. Food and Food Protection (Fc-3)(ssb.00a) cited in this report may result in suspension or revocation of IL 25. Equipment and Utensils (FC-4)(590.005) the food establishment permit and cessation of food 26. Water, Plumbing and Waste (FC-5)(590.006) establishment operations. If aggrieved by this order, you v27. Physical Facility (FC-6)(590.007) have a right to a hearing. Your request must be in writing 28. Poisonous or Toxic Materials (FC-7)(590.008) and`submitted to the Board of Health at the above address 29. Special Requirements (590.009) within 10 days of receipt of this order. 30. Other � DATE OF RE-INSPECTION: (� 9:501n tFom -14.Jw ( V V _�V'C..1.fi.�t'f'L l Y 0 Q U /)`(k�.l.i,l.:. l�(.C/VI.P�,�IJ�-• ti� ���}IX�X�t�" '"h'�1�Y r�X�PJLWLtNti C�YY1� Inspector's Signature: rnrn AA Print: ( I PIC's Sig'natuie• (( Print:``� t / ' n Page of�)'ages 7/7/, I lne A h� rA In ( �f�h / Violations Related to Foodborne illness Interventions and Risk Factors(items 1-22) PROTECTION FROM CONTAMINATION FOOD PROTECTION MANAGEMENT S Cross-contamination 1 I 596.003(A) I Assignment of Responsibility* 4-302.11(A)(]) Raw Animal Foods Separated frrnn 590.003(B) Demonstration of Knowledge* Cooked and RTE Foods* 2-103.11 Person in charge-duties Contamination from Raw Ingredients 3-302.11(A)(2) Raw Animal Foods Separated from Each EMPLOYEE HEALTH Other* 2 590.003(C) Responsibility of the person in charge to Contamination from the Environment require reporting by food employees and 3-302.1.1(A) Food Protection* a ilicants* 3-302.15 WashipE Fruits and Vegetables 590.003(F) Responsibility Of A Food Employee Or An 3-304.11 Food Contact with Equipment and Applicant To Report To The Person In Utensils* Charge* Contamination from the Consumer 590,903(G) Re orting by Person in Charge* 3-306A4(A)(B) Returned Food and Reservice of Fwd* 3 590.003(D) Exclusions and Restrictions* - Disposition of Adulterated or Contaminated - 590.003(E) Removal of Exclusions and Restrictions Food 3-701.1.1 Discarding or Reconditioning Unsafe FOOD FROM APPROVED SOURCEFes* 4 1 Food and Water From Regulated Sources F 9 Food Contact Surfaces 590.004(A-B) Compliance with Food Law* 4-50u I 1 Manual Warewashing-Hot Water 3-201.12 Food in a Hermetically Sealed Container* Sanitization Temperatures* - 3-201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Warewashing-that Water 3-202.1.3 :91teLi Eggs* Sanitization Temperatures* 3-202.14 E<=gs and Milk Products.Pasteurized* 4-501..11.4 Chemical Sanitization-temp.,pH, 3-202.16 Ice Made From Potable Drinking Water* concentration and hardness. * 5-101..1.1 Drinking Water from an Approved System* 4-601.11(A) Equipment Food Contact Surfaces and Utensils Clean* 590.006(A) Bottled Drinking Water* 4-602.11 Cleaning Frequency of Equipment Food- 590.006(B) Water Meets Standards in 310 CMR 22.0" Contact Surfaces and U'tensils'" Sheltfrsh and Fish From an Approved Source 4-702.11 Frequency of Sanitization of Utensils and 3-201.14 Fish and Reerearionally Caught Molluscan Foot]Contact Surfaces of Equipment* Shellfish* 4-703.11 Methods of Sanitization-Hot Water and 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* Sources* 10 Proper,Adequate Handwashing Regulatory Authord Game and Mushrooms Approved by 2-301.1.1 Clean Condition-Hands and Arms* Aut 3-202.18 Shellstock Identification Present* 2-301..1.2 Cleaning Procedure* 590.004(C) Wild Mushrooms* 2-301.14 When to Wash* 3-201.17 Game Animals* 11 Good Hygienic Practices g Receiving/Condition 2-401.11 Eating,Drinking or Using Tobacco* 3-202.11 PI-IFs Received at Proper Temperatures* 2.401.12 Discharges.From the Eyes, Nose and 3-202.1.5 Package Integrity, Mouth* 3-101.11 Food Safe and Unadulterated* 3-301..12 Preventing Contamination When Tasting* 6 Tags/Records:Shellstock 1.2 Prevention of Contamination from Hands 3-202.18 Shellstock Identification* 590.004(E) Preventing Contamination from 3-203.12 Shellstock Identification Maintained* Entloyees* Tags/Records:Fish Products 13 Handwash Facilities 3-402.11 Parasite Destruction* Conveniently Located and Accessible - 3-402.12 Records,Creation and Retention* 5-203.11 Numbers and Capacities* 590.0040) Labeling of ingredients' 5-204.11 Location and Placement* 1 Conformance with Approved Procedures 5-205.H Accessibility,Operationand Maintenance -/HACCP Pians Supplied with Soap and Hand Drying 3-502.11 S eciahzed Processing Methods* - ' Devices 3-502.12 Reduced Ox gen acka 'ng.critecia* 6-301.11 Handwashing Cleanser,Availability 8-103.12 Conformance with A. roved Procedures'" 6-301.12 Hand Drying Provision Denotes critical item in the federal 1999 Foal Cotte or 105 Calif 590.000. - - L CITY OF SALEM BOARD OF HEALTH � EstablishmIent Name: A ,_P.P_ ;`IA zi-a A,1�A c � Dat _ 1� �(� Page:_ of j Item Code C7 Critical Rem iU DESCRIPTION OF VIOLATION/PLAN OF CORRECTION ; DaTe .`,•, No. Reference R-Red Item VeriRed;.q �/ PLEASE PFUNT CLEARLY ) VaAje,_'„v u/r rd I ad"f i\ eA Y,_ •-P .Z ,r_w , n A A-.R ���1•.,� Az' 6,-- (9_A n IV�.Q� �lU , X7(3AA a �U< .vJ ((DP 1 P ) �) ,n _! [�,i•x / 6 G M ,r. I rPk ��r„ :,,� p 4 t .). A ±-P P, &1P C,_y12 0 _Y1M fM1A`1 / 'Y:n _A .4 ,L.I,n [Yi n_\w(117 n�n_n 1 1-L,4 �In 1•.04 1Itn nV_ tan �r;n.� 111 Gn �' L( _ 1 � '"lI" / /J.07,.P/i1 IAn On_ r IpWI//i� Al� �. ,(p1tiv(��n 6 q /} 'lam n.,. _ n WfOY �,�4ew% -��n P,r, nn' in n )(`A➢ I V/ �n-.Gl . _ r D r/1,, IIII v v - D �TAI)11 IIt ills r7 fi/r1 p�tin r (�,l�.rl,t/InA a.X A.u. 011A k- 01'U 47,-"� { 10 _ /"' F� �>`rt XA rI /1 IrP\'? A _ q_Y A -S. ,_n , ( '(� /��l Gi cr o,' �P,ory 1 1)/�\ �l la,,n 0-19 ��I,DAO �A.�,i,' ,�'/1 ! 0 n ,f/1 '/� //_!� fR P/y IOA 1 n/� nra., -1A � .lin nem. r V - ��n,,..0 In h`>•>,2 0- ( l c�1 P t��`z �.r �.)J.o) /- -=� CI; A oma_ Po r7 .,. ,-4-,_% 1_ f ,�,1 C U'� '^ 1'1lnn N (_F A o .Ye.v ,'n1AI, IPA C__A71 0 ,9 P, \ �� I/ Y n Nl,Gun, �Gn �/( (ln �l I )x t D Nvrnn P t e irN crY i;e n Y Y l r^itza' ry ' l � �.CU11��P Discussion With Person in Charge: Corrective Action Required: ❑ No O Yes t, '-w I have read this report, have had the opportunity to ask questions and agree to correct all Voluntary Compliance ❑ Employee Restriction violations before the next inspection, to observe all conditions as described, and to Exclusion P � ❑ Re-inspection Scheduled ❑ Emergency Suspension comply with all mandates of the Mass/Federal Food Code I understand that noncompliance may result in daily fines of-twerity_five dollars or suspension/revocation of Cl Embargo ❑ Emergency Closure your food permit. -4 � J jf/j ��( /J� ! / ❑ Voluntary Disposal ❑ Other: , 3-501.F4(C) PHFs Received at Temperatures Violations Related to Foodborne illness interventions and Risk ,According to Law Cooled to - - Factors(Iterns 1.22) (Cont) 41=Ff45"P Within d Hours- PROTECTION - PROTECTION FROM CHEMICALS 3-501.15_ Cooling Metbo&for PHFs 14 Food or Color Additives 14 PHP Hot end Hddi 4 5(J1 1'fi(S) Cold PHF+Maintaintained at at or below 1 3Fdd + 590.0(144) 4i I45°F 3302.14 Protection front Unappro:edAdditivcs*�_� z5r,l,lfii:1) I:Irtk'FFF+ 4ftintaitmdatorab:.tve c Poisonous or Toxic Substances 14U F." IUI.F 1 l� c'ehttiymg 1ntc.m t,rn Ouarn.z! Cklnawe.r , _ St t 15t k) �Raaus Held at or abod e t 30 F� — j_20 _ 1 Time as a Public Health Control —� 7-101,11 CotumetrNdm. !i ik c�"n urr -- P--1 " --"[[�� _. ..._ - -. .—..— —` in ,, publich altOC ontcol' . MIJI iSrm hien Stn t �i .�. _ E 7202.1t 1<3'.i su on -Pr +,nu nritic 7--'02-12 ("Ondmoir.of Ike REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7 '03.11 lirxdc Contiroer 2( 11 Smnn et, cxitrn+ Clic nuc t+ _ POPULATIONS{HSS_ 7704.12 Cheep ti+f t bl s hi a t i_3C c C lio u,.''-j � '1 � Z4lf llt li nt• ieos edPrn wkaacd Jwcec wtd� -- — 1 i Bete ewe dtttld O„i in I,aidals 7 ?04.14 Di;ut '`Brett-Cntc tt — / -05A i Lttad ntal l wxl r u ta1 uh tui+ ..___; 531 i !,i)) ( t<_aa or P ti+11 L,+,>k d Aattnal Fix:d an9 7 .06.41 , F�<„ i t to Pr r u1< C.r i i i '„---. F d ' ltoct B 0 S,as < rti 3 14i I t rC : C i e d Fcxx }'ae' e cii Rd u..eu. 06.1^ I t7F>l I tuf,cn3, ' wjr t + t'oin I d i... L CONSUMER ADVISORY t 'I 6113 s, F t-onsvon r tt s;w! Po l_d't<,r C rnt un trtel,n o,-' _ TIMETEMPERATURECONTROLS ---d— — -- — , t { Liu it} od hat iic j F6 Proper Cooking Tenipecatuee�s for t ' ; Clot ?the Scra e + t�u F.rr nt z r tHss :10i.1Jlti t cthy:. t -1 t c + in�u rcd uc Sc lu I t5 i I >,3 2I1 Yc rti[ ' 1 1-S,h lute lc;Raw Sh°t -, � L tr.mlw'dF h W;e 4.t '.3c. __ _. SPECIAL REQUIREMENTS401.1 B 1, tt 'n,d ' He Ro t 13W”' i t mii,. .__..^ _ I ..._ ..___ iWt 3Z+ll, c'.j(a tit 44c rtE5- del G I` + � &tbtdt t(Jt Kse i ss 1 3-401.11,A) 3,, } ' u r lh.ld(;jw stu'h Pfif;5, 3 t rcp,d tt dkllcnx�l cq'L'Iat,OiiS h lddiV , -- _ e- i i f it ?ehr l,.gto l>atI,oldir9 VIOLA TIOASREL 4TED TOGOOCRErAH RRAC7WZ3 --.,. i s e0-.11 131 Sri ! 1 t,1 'C 1e {ttatls52,3_3£}} _;-1C111 i(h I lh„vaaw r 2 k1 ul"Stnudin„ � C„ r:h„ a d r=te=._a! wwch do wr; ( We to*r'w UC r ";')d$Yltt 'll e R, t "wi, 1 ct d f if r(isle l LW!(.Y' Jtf'j ! L s �rr_i.,.tti 1§th.+_c0,t IF.Fel !'o'-d"- :dea_,,f, CWR _ '10T, 4f)3 i 1 ti 1 1 R i i » ,;t n , c c-. Pof u a c, 1. s i t_ttsrn Good Retry i Prinfrces _ FE_ 59QX"Z 1 r^Syr muni d Pta ,tr r G `tc , . �(g ' Proper Cooling of PRFs— _74 t ood wi card Prolcrtu _,_ y FC- i (',4 1 r-St71.i.4tA) C rn i ne C<wk.tt PH[s from 1 i} r'ic• r-- ^-_ _ _ -.._L watt P ibi FC 1 ' ' ' .;,n 1 ,*c � FG ( , ' \Vltnird ' +lou :and From a i'.l`"F ` r - -- -- t ` 'T,-!5 F lr tt ht 4T3ott _ r4 sr r„ Tont a d s'y FC F 006 ,. 501.14(W j t z e'tup f'IlFk 'N.dc.Front Ambit t JC9 , � j '1 ml,craturc In=reSsenrs r -, F r�15'F �3d r�tirr 1� t i❑�211es.,r. i i ss , av'al"or:,I 111,k dl[ i 1 aad( r W<;,%it, ril:i;)0(J .. . �,P"K,•. y/.�r,r:yia�n(..�i ;Ad'Z.�,^„YA"`T.PIU.T«�'4*�.'d'xS-'�.j'��F aSfi '' ...„vn ...y�,. .y�..+,.v� �rt" R3�. e ' �� � �ft'3 4.�y� ..r^ 1 i ¢ l Salem Board of Health Massachusetts Department Of-;Public Health ; ; 120 Washington Street,41h Floor Division of Food and Drugs Salem, MA 01970-3523 FOOD ESTABLISHMENT INSPECTION REPORT Tel. (978) 741-1800 Fax (978) 745-0343 Names Date T e of O eration s Type of Inspection ( P Y'r ' -G Food ServiceRoutine • Address 1 Risk Retail � Re-inspection r^ Level ❑ Residential Kitchen Previous Inspection Telephone _ !1 G ElMobile Date: Owner / ' / `dv� HACCP YM El ElPre-operation f ❑ Caterer ❑ Suspect Illness Person in Charge(PIC) Time `� ElBed&Breakfast El General Complaint a i O In:`< �`/yW ❑ HACCP Inspector p Out:\', Permit No. ElOther Each violation checked requires an expla�ation on the narrative pagd(s)and a citation of specific provision(s) violated. Non-compliance with: Violations Related to Foodborne Illness Interventions and Risk Factors Anti-Choking Tobacco Violations marked may pose an imminent health hazard and require immediate corrective 590.009(E) 2-' 590.009(15)-n action as determined by the Board of Health. 1 wFOUD PROTECTION MARACEME'TIT;�„�,-`„ ,� :mob , s�i=�,•;;,I ❑ 12. Prevention of Contamination from Hands ❑ 1. PIC Assigned/Knowledgeable/Duties ❑ 13. Handwash Facilities aEMPLOYEE HEALTH + = „...,s, r`t,p�a ii'PROTECTION FROM CHEMICALS r: , ❑ 2. Reporting of Diseases by Food Employee and PIC �s' ��- yka�« _�- .4. - 9 E] 14.Approved Food or Color Additives E] '3. Personnel with Infections Restricted/Excluded -- - ❑ 15.Toxic Chemicals ��, ;FOODFROMAPPROVEDSOURCE"�;u`. " � ;i�;q�,, ��, k??u" F f v71ME(TEMPERATURE CONTROLS Poternial Hazardous Foods 3 4gp>r ❑ 4. Food and Water from Approved Source t IY ) r i .m.,,; .�,is_��­-P �H. :.i„& fv g o..va�.'...�ii,rFw.,....-s.� ❑';5. Receiving/Condition ❑ 16. Cooking Temperatures ❑ 6y Tags/Records/Accuracy of Ingredient Statements ❑ 17. Reheating ❑ 7 Conformance with Approved Procedures/HACCP Plans \❑ 18. Cooling rPBOTECTION FROM CONTAMINATION" 1, 19. Hot and Cold Holding ❑ 8ASeparation/Segregation/Protection 20.Time As a Public Health Control 1 9. Food Contact Surfaces Cleaning and Sanitizing E,REQUIREMENTS FOR HIGHLY SUSCEPTIBLE P0PULATI0N5(HSW.J [121. Food and Food Preparation for HSP ❑ 10. Proper Adequate Handwashing ❑ 11. Good Hygienic Practices :;CONSUMERADVISORY ❑ 22. Posting of Consumer Advisories Violations Related to Good Retail Practices Number of Violated Provisions Related Critical (C) violations marked must be corrected To Foodborne Illnesses Interventions immediately or within 10 days as determined by the Board and Risk Factors(Items 1-22): of Health. Non-critical (N) violations must be corrected Official Order for Correction: Based on an inspection immediately or within 90 days as determined by the Board today, the items checked indicate violations of 105 CMR of Health. 590.000/federal Food Code. This report, when signed below. C by a Board of Health member or its agent constitutes an 23. Management and Personnel (FC-2)(990.003) order of the Board of Health. Failure to correct violations 24. Food and Food Protection (FC-3)(590.004) cited in this report may result in suspension or revocation of 25. Equipment and Utensils (FC-4)(590.005) the food establishment permit and cessation of food 26. Water, Plumbing and Waste (FC-5)(590.006) establishment operations. If aggrieved by this order, you 27. Physical Facility (FC-6)(590.007) 'have a right to a hearing. Your request must be in writing 28. Poisonous or Toxic Materials (FC-7)(59o.o08) and submitted to the Board of Health at the above address 29. Special Requirements (590.009) within 10 days of receipt of this order. 30. Other DATE O///FRE-INSPECTION: ,(nn`-� ( 4I XQO S59JInspeMFamSl4 tla �Y Inspector's Signature: ( C-_ _ Print: ( f C PIC's Signature Print: Page Of ages 1 . Violations Related to Foodborne Illness Interventions and Risk Factors(items 1-22) PROTECTION FROM CONTAMINATION FOOD PROTECTION MANAGEMENT 8 Cross-contamination 1 590 003(A) Assignment of Respunsib pity_ 3-302.11(A)(1) Raw Animal Foods Separated from 590 003(B)_] Demonstration of Knowledge's - Cooked and RTE Faxls* 2-103.11 Person in charge -duties Contamination from Raw ingredients 3-302.1.1(A)(2) Raw Annual Foods Separated from Each EMPLOYEE HEALTH Other* 2 590.003(0) Responsibility of the person in charge to Contamination from the Environment require reporting by food employees and 3-302.1 I(A) Food Protection'" a >licants1` 3-302.15 W35hin Fruits and Vegetables 590.003(F) Responsibility Of A Food Employee Or An 3-304.11 Food Contact with Equipment and Applicant To Report To The Person In Utensils* Charge' Contamination from the Consumer 590.003(0) Reporting by Person in Charge* 1-306.14(A)(B) Returned Food and Resctvice of Food* 3 590.003(1)) Exclusions and Restrictions* Disposition of Adulterated or Contaminated - 590.003(E) Removal of Exclusions and Restrictions Food 3-701.11 Discarding or Reconditioning Unsafe FOOD FROM APPROVED SOURCE Food* 4 Food and Water From Regulated Sources 9 Food Contact Surfaces 590.004(A B) Compliance with Food Law* 4-501.111 Manual Warewashing-Hot Water 3-201.12 Food in a Hermetical)•Sealed Container* Sanitization Tem eratuaes* 3-201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Warewashine Hot Water 3-202.13 Shell Ees* on SanitizatiTem eratures* 3-202.14 E �s and Milk Products.Pasteurized* 4-501.114 Chemical Sanihization-temp.,pH,- concentration and hardness. * 3-202.16 Ice Made From Potable Drinking Water* 4-601.1 5-101.11 DrinkingWater frnm an A Utensils Croved System* . 1{A) Equipment Clean* Food Contact Surfaces and 590.006(A) Bottled Drinki ng Water* 590.(X)6(13) Water Meets Standards in 310 CMR 22.0"' 4-602.11 Cleaning Frequency of Equipment Food- SheJNfsh and Fish From an Approved Source Contact Surfaces and Utensils' 4-702.11 Frequency of Sanitization of Utensils and 3-201.14 Fish and Recreationally Caught Molluscan Food Contact Surfaces of E ui menu* Shellfish* 4-703.11 Methods of Sanitization-Hot Water and 3-201.15 Molluscan Shellfish from NSSP Iisted Chemical* Sources* ip Proper,Adequate Handwashing Game and Wild Mushrooms Approved by Regulatory Authority 2-301.11 Clean Condition-Hands and Arens* 3-202.18 Shellstock Identification Present* 2-301.1.2 Cleaning Pnx:ednrc* 590.004(C) Wild Mushrooms* 2-301.14 When to Wash* 3-201.17 Game Animals* I.1 Good Hygienic Practices 5 Receiving/Condition 2401.11 Eating,Drinking or Using Tobacco* 3-202.11 PHFs Received at Proper Temperatures* 2-401.1.2 Discharges From the Eyes, Nose and 3-202.1.5 Package Integrity' Mouth* 3-101.11. Food Safe and Unadulterated* 3-30112 Preventing Contamination When Tasting" 6 Tags/Records:Shelistock 12 Prevention of Contamination from Hands 3-202.18 Shellstock Identification* 590.004(E) Preventing Contamination from 3-203.12 Shellsfock Identification Maintained* Em to ees* Tags/Records:Fish Products 13 Handwash Facilities 3-40211 Parasite Destruction* Conveniently Located and Accessible 3-402.12 Records.Creation and Retention` 5-203.11 Numbers and Capacities* 590.004(J) Labeling of Ingredients' 5-204.1.1 Location and Placement* 7 Conformance with Approved Procedures 5-205.11 Accessibility,Operation and Maintenance /HACCP Plans Supplied with Soap and Hand Drying 3-502.11 S ecialized Processin Methods* Devices 3-502.12 Reduced oxygen packaging.criteria* 6 301.1 t HaLdwashing Cleanser,Availability 8-103.12 Conformance with Approved Procedures' al Drying Provision '°Denotes critical Item in the federal 1999 Poixl Code or 105 CMR 590.000. i CITY OF SALEM s n� � BOARD OF HEALTH Establishment Name: �b_Uo, _"&0 7.l a/)1 s Date: 1+-r7-(-)qI Page: - of T Item Code,p C,-Cnticallteiril � � , , '^ F �DESCRIPTIONOFVIOLATIONIPLANOFr✓ORRECTION• ;�_ � verfleif Date No. r"�' Reference R-Red Item .� - "" _" * PLEASE PRINT CLEARLY k 9 A n .A,, � 1 # VI l \ IIP_ nZa� Lv, I pp �I 0 i lAl9t�1)IY.t�' ,1 r.n 1...dl�' � — � � \ I P>✓X�. : X o. 1 9 a'^�A! ,n A+ 7 dqA 12 AM + OA \ tet nk 17 1, nnl /bAA. ,� ��2n. n) ..� rx (:.n Inn ., !1 N ,A/..A1.1 \/1 n ..V i ( -D s) .�/�/ rA, .fit.( F7fAOS — ��'l Ja ,().. S.'i/r n..• 1 n, l.� 7nn 7Yln n_/_I (4.Pi C PP, �I),Pn - 111 014 V�-�'1) _ !�P o1z� l/ " ��t .1.t r.,-I:.r.rk�a f7F1.1 f-A 1A ATA T_(,o c 1 n w.YW 0 �� �Mn 1_,l' _.�Pi ! �.rYY ._�d - 410_ a�i 1 ? Discussion With Person in Charge: /� Correcti z'Action`Required: ❑ No Lq0 es IX I have read this report, have had the opportunity to ask questions and agree to correct all ❑/Voluntary Compliance ❑ Employee Restriction/ inspection, to observe all conditions as described, and to v Exclusion violations before the next ins p ❑ Re-inspection Scheduled ❑ Emergency Suspension comply with all mandates of the Mass/Federal Food Code. I understand that noncompliance may result in daily fines of_twenty five dollar or suspension/revocation of ❑ Embargo ❑ Emergency Closure 's your food permit. G� ❑ Voluntary Disposal ❑ Other: r li, I x F75- PHFs Received,it Temperahiras Violations Related to Foodborne illness Interventions and Risk Accurclue,to La,c Cordell to Factors i7hims 1-22) lCocit) 41-,F!45'F Within J,H4 iw s. 3- Ji.ls Cooliu,,Methods for RIFsPROTECTION FROM CHEMICALS r- 19 PHF Hot and Cast Holding L14 -7— ----� -i 50 1 1�(B) old PHFNlouitairled at or beltirr, 13-202 I2 1 Addirlives* 590,0041", 410/45`F' +30214 Pruiection ;-50£,16(A) I flit PHF� Maintained at of il IL is onous or Toxic Substances 140'Y. 50 "um - Basis Heid at or ,b,,, 13CY-I ii ing In or manna- 3- 1,16(A) 1 Idert conudllers,* I Time as a Public Health Control wainm,*'Sc3-501,19 Tifficr as a Public f lealth Control, 2araLrin- Sri R0risenseuon -I's .. .. 7-t I ,1 Wart L4�! 7-202.£2 _ Condidons of Use* REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 30311 POPULATIONS HS 77 Unpaileurized Pro-paeligy.d Joices and 21 -[)1—�,j��) 7-204.12 h�ruicrds for BeVI-trices with Waroil!L abis 7 204.14 tri [!� -- --P 1 3-801JI(B) F T- i(f5 11 bradental F�rod Corrtiicr,LuNicaros" ,2-fq)1.11(1)) R,rv,or Partirdiv Cix)ked Animal Frnwd and l-206.11 kestricled UsePe thider,.Criteria IrnM5rcdS, iruiNr,tS�iyvtL1 i 7-206.12 Rodent Bait Suttiom" th�8("1-11(c) 1�10,ld P "'06.13 Flacking Prnvdcli,P,l[Control and RIonit2rirn�r- CONSUMER ADVISORY -22 03AF TIMElTEMPERATURE CONTROLS Animal Rwr&Threare Raw, Undcruclokild vi 16 Proper Cooking Temperatures for PHFs Not Othem his e Prvss'ed to Eliflreuna 3-401 11 A(l)(2' Fggc- 155 c 15 Sc.Service l5sec, 3 lo° I I Paiteurix��d F-�gg"Stthstioue i, Rn",%,11 --i-40 Comminuted Fi,hMears G.(ruric -- Animals- 1-55F 15 sec. " SPECIAL REQUIREMENTS 3-40 1.11(-R)(1)(2) Pork and Roast - i 3W F 121 fni0 401.'I(A)(2) k1crill, 155 T 15 590.009(,%)-(D) Violation,of Section -,-)9{),I'X)9,At-(D)in sec calurine.mobile "al,temporary and 3.401.11(A1 -i) Poultry, Wild('arno.$ruffed l)f4Fs,, tresit,u ual kitchen operations Aiould he Stuffu'ig C(ailairding Fish,Ideal, debited t'iliter the appropriate sections Plruhry or Rawer-165"T 15 sec. above if related to foKAborric illness 3-4f)I.1JiC);3) 'WhAe-ii lutact Ref Strews interventions and risk factom. Other 1459; 590.009 Violations relating to"aid rctaii. 3- tit actices�ihould Iv debited under#29- x01.1 2 1 Amoral Fords Cooked wit liclowave 16"'1 Special Rlojuircmonti,. 3-40i,I1(A)(3nb) All Other 111-11-s 145'1 1 s sec. I --------------------L— VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 7 Reheating for Hot Hoicking —(D) -f 11—IF l 16 51� 15 Sec (Items 23-30,I 401 11 i4i) movrti 22 Minw, lairdia, critiral and rem-f riucal uldch Co nol felare is the foorhorne illness wic,visition-vand zlA factors Iiiied abore, (rin be, 7 ( 0 e 3-403.1.'1(C) Commercially Ptocess�td RTF Foir�- found`red in the,joVou ing ser of;he Food d and Jb5 CArlil! 5 90.Orel, r 3-403.1 t(F) Rcaurinin,Unshced Portions f Hml test Good Retail Practices QFC 590,000 R rants* 23Management magement and-Per ean.nel1 FC 2 643 Proper Cooling at PHFs -24 Food rd Food Piersciron FC 3 004 i ena 3-501.14(A) FC- 4 005 26� Watio,Pkaribi and Waste FC-5 w1i 70'F Within 2 Hour,and From 79'1' 27 P la _�Lsr _Fa 1y C 6 007 ir)4l'T145FWithur 4 Hours. 20 1 Poisonous or Toxic Materials FC-7 008 ----F,4PIHFc Made Fitriustinbrent-­ 29 3 --------- T�nymirrrrc Ingredients or 4161,/45°17 Within 4 11(itas Dcpvies critical mm ill the fskleull 19'44 FoW lz I its(AR 590 flon I/ CITY OF, SALEM (�t C 1 BOARD OF HEALTH o� Establishment Name: QU 2 4 ,(ate l (-I,-\A rl� Date: �1 -d'] Page: of Item CodeC-Critical item {;t DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Uate ,.a d e. i No. Reference R-Red Item Verified s - - , , PLEASE PRINT CLEARLY - - ' i�n ,��towe_c6 ( III do 4,.r7jA_Q+ oj. . �AOP� ' k[��i /1/\A_ttAIA —` (-Aon , 1A_0P�2 U)A4,elL ��/V\n k� �1 L f' S �\ -� A_,^S"1�1,7.r.� )j 01D 4-t C_/V(n� f � v _ � .Co � . S/s.�v ` nI P 0�. `r lA/ r n OIL' �� n 1 i Discussion With Person in Charge: Corrective Action Required: ❑ No ❑ Yes I have read this report, have had the opportunity to ask questions and agree to correct all ❑ voluntary Compliance ❑ Employee Restriction/ Exclusion violations before the next inspection, to observe all conditions as described, and to ❑ Re-inspection Scheduled ❑ Emergency Suspension comply with all mandates of the Mass/Federal Food Code. I understand that noncompliance may result in daily fines of twenty-five dollars or suspension/revocation of ❑ Embargo ❑ Emergency Closure ryour food permit. C3Di Voluntary sposal 0 Other: it 1.1*C) PHFs Roceivedat Tewmertunrc�; Violations Related to Foodborne Illness Interventions and Risk at to Law Cooled to Factors(item 1-22) {Cont) 4 1 Ti45'F Within 4 Hours. —350TT� —Coolj n,,Methods for PHFs PROTECTION FROM CHEMICALS 19 PHF Hot and Cold Holding 114 i Food or Color Additives —PHnooeme,meu at or bclow 0-202,12 A(RJhives* 590 004(F) 4 1`/45`F* 3-30114 Proiection firon 21-1 3-501,16(.k) Not PHI's 1\buttamed at or abrve L Z or Toxic Substances------- ' 7-101.11 1 3140F, -501,16(A) Rtiasas Held at orabove 1301 L20 Time as a Public Health Control /7102,1 I Common Name Worlun=lenwamer,* r�OLII Se ma on—Storage- -3-101 !9-- Time as a Pubfiw licaal,C"It'll, 1)90 0014H) Variance Ra")E�Llncnt 7-20111 Rcsv ict nm-Prestoiw an', I.I,- 7-202.12 Condition REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-20111 Toxo.:Comhrmca� --Prohibition- , POPULA IONS(HS 2 17-57ST)1-11(=k) F—,,-20411 Samitzen,Criteria-Chemicals 7-204-12 Chemicals for — VN IL 1.'s, -7204114 Drjnc ALentk.Criteria- Reverwes with W'aniimr Labof;,` s�(itpa�tetuized I, Incidental Fwd Contact, Lubocants,4 3-801 Of1to—-L 3-801 I I(D) Raw or Prali aih, 2-206.11 R-esincled Cw Ciitenn* rla� st�d Sprmio�Not Served, Pt;lein _ no2c nSd I ktiai fracking poadom Pest F11-11trol and ADVISORY Tl -0,0 (10111,anuet-Aaisory of TIMErrEMPERATURE CONTROLS Ankoalf',rids 1had'arc Raw, Llridera )IaNl of 16 Proper Cooking Temperatures Gr—1 "ot Other iso Processed no 1"'limmate PHFS -3 f7gg., �'F 15 S, patho"ons , 4 - 01.11A(l)(') - 157 3-302:AJ31",stet rm,d Fq-,Stibstituic lot Bow—Shell 4-40LIH= 7(27 Contoonuted Fish, Meats&(13ule Atntuah- i5,�,,F I�Sec. � I'll 11—1- 1 1 —6-- SPECIAL REQUIREMENTS ;-401.1 I(B)(I p`2) �P(wk and 11"'Or Roart - 1^)01:, 121 nain Ratites,Irviecteii Mata - 155'F 15 Violations ofSection 0.009(A)- 3-401.4)(A)t2} I catering soc. mk)bil,,,.food, temporaiv and 3 40 1 11(A)(3) Poulvrp,Wild Siu iial 1,iTN, tosideul4al kitchen opeiations�boklld be Solfflng Comauling FishMeat, dohiled under the ippropritue wcfion Poultry or RatAcs-165'F 15 sec. above if r�Iaicd to foodborne jiloos's Whole-muscle.Intact Beef Sicaks interventions and risk factors (hl)cr 145"T e 590.009 violations relating to good retail Raw Atoural Fads Caikcd in a j practiceg dinsuld be debited finder 1F29 - 165'F Speeial Requirements. 3-401,1 HAKIM)) Ali Onhea 1`111's-- 145'T 15 sec- ,I10 timg for Hot Holding VIOLA TIONS RE—LA'TEDTO G—OOD RE—TAIL PRA CTICES R i7 —3-103,1iAF)&F15) P Reheating 165`F 15 ser. (Items23-30) 7453.161(B) Microwaw- 165°F2 Minute Standing Ci iiiral ace non-t rifical vio,'oliott i, which do not relate to dw Time' foodborne d ,,.�5 lns imervention a and riskjw sors h TreJ above can Ce1:-4()-3TFt C-}— Cornutercialiv kwind in:he,011,oi-ing sections otlhe Food Corte orad 105 CXIR 14()'P' 7 401 11(F i Remainiro,Unslised Nations of Beef Item Good Retail Practices T FC 590Ow 23, M 1 24, Food and Food Protection PC--3 004 1 tIi Proper Cooling of PHFs 12n Equq, rr� nsn d, C-4 '005 4(j%) Cooling Cool,,,d PAPS from 140'f F -- ----I 26 Water M HILind'Nase, FG-5 701, Wiilan 2 Hours and From 70"F oysir�Facidi 6' 7 to 411-145 F Whhju 4 Hours. 28. Poisonous or T,,)xtc Materials 1 FC-7 I 008 -1 r5o I I 11W Cooling PiMs Made From Ambient 29 w �pcl Pcqunoattoat000 1 Temperature perate Ingredients to 41`}145`} X30 .other 1 Within,l llkkirrs iiem in the 1,deetl 1994 Food Cede<,r 105 CMR 5W,0006 %y 0133 WASHINGTON STREET Caffe Graziani City of Salem FOOD SERVICE ESTABLISHMENT - FOOD SERVICE Inspection HACCP: ❑ Item Status Violation Critical Urgency Telephone: 741-4282 Owner. Cafe Graziani Inc. ^PIC: Giovanni Graziani. Inspector: Elizabeth Salandrea Date Inspected:Correct By: ,5/28/200 tRisk Level Permit Number: °BHP-2008-0296 Status: SIGNED OFF `#of Critical Violations: 0 'Time IN: Time OUT: Urgency Description(s): BLUE: i All violations noted in the 5/20/08 inspection report have been corrected. Violations Related to Good s Retail Practices (Critical Violations must be corrected immediately or within 10 days)(Non-critical violations must be corrected immediately or within 90 days) City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741-1800 GeoTMS®2008 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. May 28,2008 ) Page I oft Item Status Violation Critical Urgency r _ ,Violations Related to. Foodborne Illness Interventions and Risk Factors (Require 'immediate corrective action) City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741-1800 GeoTMS®2008 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. May 28,2008 ) Page 2 oft s 0133 WASHINGTON STREET Caffe Graziani City of Salem FOOD SERVICE ESTABLISHMENT - FOOD SERVICE Inspection HACCP: ❑ Item Status Violation Critical Urgency Telephone: - PROTECTION FROM CONTAMINATION 741-4282 - Separatio egregation/Protection FAIL Critical RED Owner: omment: Reach-in freezer in storage room had bags of shrimp mixed in with bags of ready to eat items such as fruit and Caf@ Graziani Inc. vege les.Freezer must be organized so that potentially hazardous items are separated from other items. PIC: freezer in kitchen had shrimp above breads and vegetables-freezer must be organized so that potentially hazardous items are Giovanni Graziani separated from other nems. "Inspector: Food Contact Surfaces Cleaning and Sanitizing FAIL Critical ❑d RED i Elizabeth Salandrea - �ganeomment:Sanitizer too weak at approx.10ppm-provide sanitizer of proper concentration(50-100ppm)at all times. Date Inspected:Correct By: yitizer log to be maintained daily. 5/20/2008 "Risk Level: - uttmg boards throughout establishment are stained and scored-resurface or replace cutting boards. Prevention of ontamination from Hands FAIL Critical ❑J RED Permit Number: mment: Raw chicken being prepared without use of gloves upon inspector's arrival. No bare hand contact with any food BHP-2008-0296 permitted-employees must wear disposable gloves when handling and preparing all foods. Status: VIOLATION t#of Critical Violations: 4 Time IN: Time OUT: Urgency Description(s): BLUE: Violations Related to Good Retail Practices (Critical violations must be corrected immediately or within 10 days)(Non-critical violations must be corrected immediately or within 90 days) City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741-1800 GeoTMS®2008 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. May 28,2008 ) Page I oft ), Item Status Violation Critical Urgency RED:- x �. ! Violations Related to Good Retail Practices (Blue Items) Violations Related to Food an�d/F/A od Protection FAIL Critical BLUE Foodborne Illness Interventions I (18omment:Some uncovered food in GE freezer in kitchen-all food in storage must be covered. and Risk Factors (Require ; � � immediate corrective action) I t�95 out at room temperature at grill-potentially hazardous items must be held in refrigeration at 41°F or lower.Eggs were put away in fridge at time of inspection. Ob/od being held hot in steam table not covered properly-covers were not the right sizes for each compartment.Ensure covers are rights size so that items in the steam table are covered completely. EquipmEfflt,Qnd Utensils FAIL Non-Critical BLUE r/omment: Fridge in dining area needs general cleaning in door tracks. jiiWea,er in storage room needs general cleaning and de-icing. or on fridge needs general cleaning along bottom. E freezer needs general cleaning and de-icing. 04119 In maker and pizza dough machine have dust build-up from dough;both need general cleaning. yolator has large build-up of grease.Thoroughly clean and de-grease the entire machine,including the baskets and the sides. tlCrea of counter to left of deli unit where microwaves are needs general cleaning. ream freezer needs general cleaning. Reinspection in one week, all violations to be corrected. i%10l ase have March and April extermination invoices available at reinspection. City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741-1800 GeoTMS®2008 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. May 28,2008 ) Page 2 oft r• r, -.\'Y.f..\nr..r.r�.,;>"i'ir. •.'Iu:.9n.�A+,i'r+'C .,?'n+- a ...nrr•'. .�.y.�ya,(en�.i){r'^i-Hti'y'vSK-,i ..It'wl�9t?.S�`"S sMIM. r..: ,.. .. y. ..�.-\ Mass6chusetts Department of Public Health Salem Board of Health Division of Food and Drugs 120 Washington Street,4'"Floor g Salem, MA 01970-3523 FOOD ESTABLISHMENT INSPECTION REPORT Tel. (978) 741-1800 Fax (978) 745-0343 Name/y Date�y (y Type of Ooeration(s) Tvee of Inspection 1 C' �� f r� c� 1. 7 TDC b Food Service ❑ Routine Address _ " a- Risk Retail ❑ Re-inspection ( �(�� 1 1410 Level ❑ Residential Kitchen Previous inspection Telephone _ ❑ Mobile Date: a Owner � HACCP YM El Temporary El Pre-operation O (0 (-AV) n 1 y d 21 1/) ❑ Caterer ❑ Suspect Illness Person in Charge(PIC) /l1 ( Tiirle y ❑ Bed&Breakfast E] General Complaint El HACCP Inspector ^ 1 / In r' ' Permit No. ❑Other��J�n ,� ( L- d u Out: U Each violation checked requires an explanation on the narrative page(s) and a citation of specific provisions)violated. Non-compliance with: Violations Related to Foodborne Illness Interventions and Risk Factors Anti-Choking Tobacco [9-'190,009(F)\ Violations marked may pose an imminent health hazard and require immediate corrective 5190.009(E) action as determined by the Board of Health. "FOOD PROTECTION MANA¢EMENT" "', ,� „„p,�.�, ,t.„;.., ��"„.,"` ❑ 12. Prevention of Contamination from Hands ❑ 1. PIC Assigned/Knowledgeable/Duties El 13. 13 Handwash Facilities u3a q1 �, t t�PRO7ECTI0N FgOM CHEMrCAI$� '�-'f"'-"�` "p" 1 - �.� i.as ...3,.. ., ,x, a.., !„ . �Y.9+?:,a,v.d�: �'fUa U Ta ,-��d.,.cx .,�+ . " ❑ 2. Reporting of Diseases by Food Employee and PICA/ �. i� ❑ 14.Approved Food or Color Adddwes ❑ 3. Personnel with Infections Restricted/Excluded ❑ 15 Toxic Chemicals OL i„FOODFROMARPPROVERSOURCil ,p ," oly;";,,�' ❑ 4. Food and Water from Approved Source +TIMEREMPEAATURE C?NTROLS(PbterttieflyH aMous Fus ds)�i pp a,a u.u.G,M. ww,an„ s am,� . .w�,.�.0 v✓amexs a:@, � ...:-� i. ❑ 5. Receiving/Condition ❑ 16.Cooking Temperatures ❑ 6. Tags/Records/Accuracy of Ingredient Statements N/ ❑ 17. Reheating OP El7. Conformance with Approved Procedures/HACCP Plans ❑ 18. Cooling PROTECTIONFROM CONTAMINATION 1" El 19. Hot and Cold HoldiOL i Baa ❑ 8 Separation/Segregation/Protection / ❑20.Time As a Public Health Control ❑ 9. Food Contact Surfaces Cleaning and Sanitizing HIL YSUSCEPTIBLtPOPULAt16NI§_tk$Oj„ l!JiJI� _ EI21. Food and Food Preparation for HSP El 10. Proper Adequate Handwashing C©NSUMER/10VISORYgcgi��n,..�S-� A��.. ..V 90, "-m."-+ .�7',>. ....:. El 11. Good Hygienic Practices J ❑22. Posting of Consumer Advisories Violations Related to Good Retail Practices Number of Violated Provisions Related Critical (C)violations marked must be corrected To Foodborne Illnesses Interventions immediately or within 10 days as determined by the Board and Risk Factors(Items 1-22): of Health. Non-critical (N) violations must be corrected Official Order for Correction: Based on an inspection immediately or within 90 days as determined by the Board today, the items checked indicate violations of 105 CMR of Health. 590.000/federal Food Code. This report, when signed below Ca. N by a Board of Health member or its agent constitutes an 23. Management and Personnel (FC-2)(s90.0 order of the Board of Health. Failure to correct violations 24. Food and Food Protection (FC-3)(590.0044))) cited in this report may result in suspension or revocation of 25. Equipment and Utensils (FC-4)(590.005) the food establishment permit and cessation of food 26. Water,Plumbing and Waste (FC-5)(590.006) establishment operations. If aggrieved by this order, you 27. Physical Facility (FC-6)(590.007) have a right to a hearing. Your request must be in writing 28. Poisonous or Toxic Materials (FC-7)(590.008) and submitted to the Board of Health at the above address 29. Special Requirements (590.009) within 10 days of receipt of this order. 30. Other DATE OF RE-INSPECTION:0 S 501nsps For -14.em Inspector's Signature* ��,, ,,l�/ / �! Print: {, 1..(Ot / P g .r V/auAU it1eAl. (!/Nil / /1 1 / f PIC's Signature: ,fA/,l / l! 1 .1,1&,l�,pPrint. r f, 11 ( 4 r j1 r^I I c,„ Page of Pages Violations Related to Foodborne Illness Interventions and Risk Factors(items 1-22) PROTECTION FROM CONTAMINATION FOOD PROTECTION MANAGEMENT 8 Cross-contamination 1 I 590.003(A) I Assignment of Respontiibiht_ � 3-302.1.](A)(]) Raw Animal Foods Separated from 590.003(B) Demonstration of Knowledge* Cooked and RTE Foods* 2-103.11. Person in charge-duties Contamination from Raw ingredients 3-30211(A)(2) Raw Animal Foals Separated from Each EMPLOYEE HEALTH Other* 2 590.003(C) Responsibility of the person in charge to Contamination from the Environment require reporting,by fund employees and 3-302.11(A) Food Protection* applicants* 3-302.15 Washing Fruits and Vegetables 590.003(F) Responsibility Of A Foul Employee Or An 3-304.11 Food Contact with Equipment and Applicant To Report To The Person In Utensils* Charg,0 Contamination from the Consumer 590.003(G) Re orcin b'Person in Charge* 3-306.14(A)(B) Returned Food and Reservice of Faid* 31 590.003(D) Exclusions and Rest Potions* Disposition of Adulterated or Contaminated 590.003(F..1 Removal of Exclusions and Re-strictions Food 3-701.1 1 Discarding or Reconditioning Unsafe FOOD FROM APPROVED SOURCE Food." 4 Food and Water From Regulated Sources 9 Food Contact Surfaces 590.004(A-B) Compliance with Food Law' 4-501.11 I. Manual Warewashine-Hot Water 3-201.12 Foul in il Hermetically Sealed Container* Sanitization Temperatures* 3-201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical WarewashingHot Water 3-202.13 Shell Eras' Sanitization Temperatures* 3-202.t4 Eggs and Milk Products.Pasteurized* 4-501.114 Chemical Sanitization-temp.,pH, 3-202.16 Ice Made From Potable Drinking Water* concentration and hardness. * 5-101.11 .Drtnkin Water from an Approved System* 4-601..11(A) Equipment Food Contact Surfaces and Utensils Clean* 590.006(A) Bottled Drinki nE Water'" 590.006(B) Water Meets Standards in 310 CMR 22.0* 4-602.11 Cleaning Frequency of Equipment Food- Contact Surfaces and Utensils'" Shellfish and fish Froman Approved Source 4-702.11 Frequency of Sanitization of Utensils and 3-201.14 Fish and Reereationally Caught Molluscan Food Contact Surfaces of Equipment* Shellfish* 4-703.11 Methods of Sanitization-Hot Water and 3-201_;15 Molluscan Shellfish from NSSP Listed Chemical* Sources* 10 Proper,Adequate Handwashing Game and Wild Mushrooms Approved by Re utato Authorit 2-301.11 Clean Condition-Hands and Arms* 3-202.18 Shellstock Identification Present* 2-301..12 Cleaning Procedure* 590.004(C) Wild Mushrooms* 2-301.14 When to Wash" 3-201.I7 Game Animals* 11 Good Hygienic Practices 5 Receiving/Condition 2-401.11 Eating,Drinking or Using Tobacco* 3-202.11 PHFs Received at Proper Temperatures* 2-401.1.2 Discharges From the Eyes, Nose and 3-202.15 Package integrity* Mouth* 3-101.11 Foul Safe and Unadulterated* 3-301.12 Preventing Contamination When Tasting* 6 Tags/Records:Sheilstock L12 Prevention of Contamination from Hands 3-202.18 Shellstock Identification* 590.004(E) Preventing Contamination from 3-203.1.2 Sheilstock Identification Maintained* Em loyecs* Tags/Records:Fish Products 13 Handwash Facilities 3402.11 Parasite Destruction* Convenlentiy Located and Accessible 3-402.12 Records,Creation and Retention* 5-203.11 Numbers and Capacities* 590,004(1) Labeling of Ingredients' 5-204.11 ,Location and Placement* Conformance with Approved Procedures 5-205.11 Accessibility,O oration and Maintenance /HACCP Plans Supplied with Soap and Hand Drying 3302.11 sing Methods* Devices 3-502.12 Reduced ox an acka 'nom,criteria* ti-301.11 Hindwashing Cleanser,Availability 8-103.12 Conformance with A. roved Procedures* 6-301.12 Hand Don"Provision Denotegcritical item in the federal 1999 Food Code or 105 CMR 590.000. _ 4 s` CITY OF SALEM BOARD OF HEALTH 1 r/ 't Establishment Name: �\ ��r� l �, r( � 71 1�� Date:i; — —0 JS Page: of 1 item Code C-Critical item DESCRIPTION OF VIOLATION/ PLAN OF CORRECTION Date No. Reference R–Red Item II Verified PLEASE PRINT CLEARLY 1 J 1 y 1n� i YI �� X I ?4 , his 1 ,f i n(ry Po �,,.. -- ✓✓ iii .— ��,._ ii- ._.�.� --'f' r1� /_,,i�.�A�l� n"�Y Y) h A/ ► -CFO `N . .'I'm,/t./ ft/l I _l ..� _ / - �- �� V_ ,1 n Ai AA,Q�e �} r nAAFI� — n o - 1 �(ZY\ 0?,/O, 0Aa m/ , ,r 9/v,nP1Wn Ll \ / (A e— 1'�1 rio . - � 11—a o_,/n_of/J-)P� ' nVl,n oV i _ J�In _�,� / , �S �rn✓_Ji., � .iu� o�K/ / U/ n 1/fin fv-i-r'h / I A .T.� V/`n14A �nA C'�is /t/ r ��� V0 n, i14 T//l lean „ 0 , ._ 0 V J!/J/ 1K �0 )14_n4 /v f Discussion With Person in Charge: Correct!ye Action Required: ❑ No ❑�Y,es » r Voluntary Compliance ❑ Employee Restriction/ S I have read this report, have had the opportunity to ask questions and agree to correct all Exclusion violations before the next inspection, to observe all conditions as described, and to ❑ Re-inspection Scheduled' ❑ Emergency Suspension } comply with all mandates of the Mass/Federal Food Coderl understand that f ? ' i ( noncompliance may result in daily fines o�wenty-five dollars or suspension/revocation of ❑ Embargo, ❑ Emergency Closure your food permit. /l A t I PI l�ld���" ❑ Voluntary Disposal ❑ Other: /Ili l/I /I / 1;1A Rlv � 1-501�14((') PHFs Receive io Temperalurcs Violations Related to Foodborne fitness Innirventibirs and Risk Ac�,rdiri,to Lm% Coolitri lo Factors fiteft 1-22) (Cont) I I I T745 Witbin 4 Hvus� 73,S:lC 15 CooliD,X4e,.thW,l for PHFX PROTECTION FROM CHEMICALS 19 3 PHF Hot and Cold Holding L14 Food or Colar Additives—-- 3 56 .I6(R) Cold PHFs Maintained at -w 3-20,12 590 00411 4 i"1115l,F" 3-,102,14 From "lap2rlSid p� -W(Jiovcs� —-- --jL— — L�-- — 3-50 1,16(A) Hot PHI '+t untamed at oj-ab,,rve Poisonous or Toxic Substances 140'F'. 3-501,16(,)�) Re Held at or,)bove 130"T, 1,7111 Ic mtitsivg imfinmoon Ori,,m ------ Time�as a Public Heafth Control W2 11 LR---- iii _3 i671 ,, Timt,,aia Public llcillffi Control' cion 7 20LI -Sn I P-1 0.0 q ___: '19k '0401) Variam,R atsrentent ___7 ­20111 1 Re"triction -Fr,,,si:nc0�Ulo Ule- 7-202.1 -"OnditlorC,of 11 0, - ---- --------�-iv—i REOUIR'EMENTS FOR HIGHLY SUSCEPTIBLE 7-203,11 Toxic(Amitnrjlxt� - POPULATIONS HSP 7 1-201�4.11 ——Sano�Zerq,crillcriii -- IT 2 1 1-801,11 A) Pre-palAaged Joicts and 7-204.12 (Torliclis for WashqT, ± dilce,clito(T- fieverrImex, with Warflin 7,104,14 rireria: pa'!tul i7ed 1 7-205,11 Incidental Fisxl Comm, lAtim imils, 3-801.I I(D) Raw or fiartiiill,,Cix)k-d ADimal iiild Re !ricled t' e Pe�trcides,critel[Ill S 11 1 au;Sc.d 7-406.12 Raton 13�4 Stlmoni,' �1-1 3 Inollel Not Sery A BOLI�tj�C 't,'�.. raid R, c—ka 1 7"306 1 Frocking llnwljers�Pe-SL Control and CONSUMER ADVISORY TIMEITEMPERATURE CONTROLS 221 1 Dented fir(Immumption of, 16 Proper Cooking Temperatures Anhmil Foods That art Raw, Underoixiked ill —lo�-- PHFS -Not Oth-,rwise Prol'exse.d to 1%1CIT011"Ite 3-30n.13 Postelin&,�d E P�:1nlbwiuIv fol,Raw Shell T(I 1�2) ig,- T-401AI(A)(1, i Comjmnu,ej Fish,latent &Gaim ARiulak- 55T t5 lleC. ' SPECIAL REQUIREMENTS 401.1'(Ilij))e IIJit) Pork and Belif RAmsl 110"1' 121 aliril' -S90 w9le—Im 7D)l 'folaticios of Sutton 90.009W-(D) in I 3-4101.11(A)U'l j Ratae,,lliwcled l4em�- 1�5 F 15 ing, mobdo food, wiriporary and cater �kjld Gi'CIIIC, SlOffed PHFS, roCidenlild kitchcri op" tic, �-441.II0AJt3) mutons,i on s, � t I dd k, �'wffmg Conounin, Fish,Meat, Licbned under the appropriate sections Poultry or Ramcli-j65115 sec, :dove if related it)fyx1horm: ithicss i 340*1 IIfC)Qi Slakr iutctfsuntionsanclrickfacfor5 Other 145'T 590.009 violations relatim, to goolf! retto! 1 1-401.12 Raw Aniarat Foodi Cooked ma pno'.6ces .hoktld I-v debited under#29 - 16S fspecial iter juirenwlits. 3-401,11(Ar(1)(b) 1.11 Ott mi:Pffl-v- -iiefteianiq iOTHot Holiciing VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 3-403,11(,A)mm 21-11-s-IWF {Rents 23-30) 'Microwave- 165F 2 Mlimae,Standint, Criiweil and thln-o ron.al viloliPliiij, which do noeiare w the !`Clodborne illness imi_mentions and r )jocrors lived abore, uo?be 3-403,1 ICC:) j C nrCourcialiv Processed RIF K"I- jounu ol the.joilmopig seciion,of the Food Cods aid 105(,,AIR �190JW& 7-FC-----7-59--Ox m- 3-401,11(F I Realailling Unsbcr,d Portiong of ril�,ef I H3_j t)larojPTql2!A,j d onnot 1 FC -2 1 003 _ 24, 1 Fend and Food Prolection FC 1 13 WA 18 ! Proper Cooling or PHFS -t—1 74 3 501.1461r) Cooling Cook PFIF's from 140T to 26 vi,ate',Pal To -4 1 ----------------- -Wl- Within 2 Hours and From 701, 9-, P Cot t hpi ...... F(,-6 1 ,007 w 11 T/45�F Wiflan 4 fimrr,� PoCiorIOUS Or TOXIC Mjter,jg FC -7 008 PHFb Made From Arobrion 'j)Kid Rcqwrein 00 Tenip,orwre lngrrdilmis ill 431'545°17 Withm4 llourti* CM.19II000, Commonwealth of Massachusetts City of Salem Board of Health Kimberley Drisooll 120 Washington Street,4th Floor Mayor SALEM,MA 01970 Food/Retail Establishment Permit DATE PRINTED: . 01/04/2010 ESTABLISHMENT NAME: Caffe Graziani File Number:BHF-2004.000270 133 Washington Street Salem MA 01970 LOCATED AT: 0133 WASHINGTON STREET SALEM, MA 01970 Permit Type Permit No. Permit Issued Permit Expires Fee Restrictions/Notes FOOD SERVICE BHP-2010-0055 ,Ian 4,2010 Dec 31,2010. $280.00 ESTABLISHMENT Total Fees: $280.00 PERMIT EXPIRES December 31,2010 Board of Health i 7ww I(Y1 This Permit is not transferable and must be reissued upon change of ownership or location.The permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code,beofre any revonations,improvements,or equipment changes are made,all plans for such must be submitted to and approved by the Salem Board of Health. Page I CITY OF SALEM, MASSACHUSETTS • BOARD OF HEALTH 120 WASHINGTON STREET,4n'FLOOR TEL. (978) 741-1800 KIMBERLEY DRISCOLL FAX(978) 745-0343 MAYOR DGREENBAUMOSALEM.COM DAVID GREENBALTAi, ACTING HEALTH AGENT 2010 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT NAME OF ESTABLISHMENT (_ EC t Gt TEL# q7 t(l 4/ 0 ADDRF_S8 OF ESTABL!SHMENTJnJI,, i �j�- FAX# _ MAILING ADDRESS(if different) �� EMAI L- Business'12 0,(A�� 0 q�e a i-a z, c li (t c-041 Website: ttl 1w. G e5? Jqe a r-G Z f all l , CO/7, OWNER'S NAME L�ioyLu/nnI /(rMzi arl t �a�C�a �Va //e-Se TEL# �7 JI; 4 2x0-7 ADDRESS T 7-4 rt{-Sf-e n. St �� 5f -Z S� J Zt _Z'_ �- STREET /� CITY STATE ZIP CERTIFIED FOOD MANAGER'S NAME(S) Ci1ti� (9 rccVc�I�PS �- CERTIFICATE#(S) (Required in an establishment where potentially hazardous food is prepared) EMERGENCY RESPONSE PERSON e t l of or- Cwt dV C 7 n HOME TEL# (n/ 5(a 7 7 DAYSgQF QFERATION Monday„ ' T,uesday Wed'nnesday, ; Thursday j'� Fnday; ',Satgrda Sunday;` HOURS OF OPERATION i Please write in One of day. i Ci(V0 1 C !! C/ j30 For example 11 am-11 m ! 1 ! o­ k ! o TYPE OF ESTABLISHMENT FEE (check only) RETAIL STORE YES NO less than 1000sq.ft. =$ 70 1000-10,000sq.ft. =$280 more than 10,000sq.ft. =$420 ----- ----- - - - - - RESTAURANT ES NO Tess than 25 seats = 140 (Outdoor Stationary Food Cart$210 25-99 seats more than 99 seats =$420 . BED/BREAKFAST/ YES $100 CHILDCARE SERVICES/NURSING HOME---- ----------------------_----------;- -- ADDITIONAL PERMITS MAKE (not just serve) ICE CREAM, YOGURT/SOFT SERVE YES O $25 TOBACCO VENDOR YES O $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 certify under the pains and penalties of perjury that I,to my best knowledge and belief,have filed all state tax 62C,. returns and paid- tate to quired u e he law. or l 3 Signator Date Social Security or Federal Identification Number. Revised 424/07 FOODAM08.adm Check#&Date 9 A0 S '-;b3d 4 CITY OF SALEM BOARD OF HEALTH Establishment Name l_fro r4 nJq n r Date: 1<�'aLI/rCt Page:_ of Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date No. Reference R-Red Item -V " ,Verified PLEASE PRINT CLEARLY l / -„'�V4ctt f Sr I�.h �nrCC! !_� �'� !li o n ! 2i f � C•w i� I(�' I� �'P l J �/ + (�Y „I ?/Y L .., `�ln f�`d` ,rr71 :07 { Discussion With Person in Charge: Corrective Action Required: ❑ No ❑ Yes I I have read this report, have had the opportunity to ask questions and agree to correct all ❑ Voluntary Compliance ❑ Employee Restriction/ F 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 I understand that Food�Code. i l A noncompliance may result in daily fines of t�w�enty'ftve dollars or suspension/revocation of ❑ Embargo ❑ Emergency Closure your food permit. ❑ Voluntary Disposal ❑ Other: F r F7, 5 P1IFs Received at TemtSeratures Violations Related to Foodborne Illness Interventions and Risk According to Law Cooled to Factors((tears 1-22) (Cont) _ 41`F/45`F Within a Homs. * PROTECTION FROM CHEMICALS 3-501.1 s_ Colum,D4ethods for PHFs _ 14 Food or or Color Additives 19 t PHF Hot and Cold Holding 3-202A2 F its 3-501 I6(F3) Cold PHF,Maintained at or below 590.004(F) 41°l45°I 3-302.14 Protection from Unapproved Additives* ----4 3-591.U>iAj Ilot PHIS 4lavmrmned at or above i 15 Poisonous or Toxic Substances '-101.11 Ids nt lying-Inti Matic n -On to tt 140 P. 501,16IA) Rwo3 Htid at or abot-e 130°F * (-antau u�" [0 Time as a Public Health Conti of 1 t 102nin 11 � t'.o on'lm R t, - rl.ir�t tax �"an r ' - �-j--�— �--- -t- -' ---{ :;_50i l� _ i ui as 3 Pubftt hl alth Coniroi'_ r �d 1.1t t sep urn sham1- `--�st )(10,0+'11 i 5 rrt 2ucnu'went ' "'02.11 rReto to Yr un 1.e mud _.. .-- L __------- 7- —7 '02.11 Toxic t�»i. i.nm _ REOUIREMENTS FOR HIGHLY SUSCEPTIBLE 7 '9311 Coxa f o,Crile -Ow,1i on ' POPULATIONS 3 °04.11 S«mnveti Cntru (Omni -ti — — -- 1-1� ;-101 11(A) i+np teurtc,d Pt past cged Juices and °01.I2 (11k ill orA� t�hu. 1-ndu ( n.t-`a" 1t ( t _ '3c et a c.with N tumrti,;tt, lti 7 -,o4.14 U-'v Aititc tau ti --t- 40! 11031 Uc 1fpa,wulile 7 205.11 hirtn nt tl t xxl t tat xt tathtt a t, --'� t _'—_ -}---- L=-- v. r7 '�a It i.c~.! klr rntt (itt rPttt,i.i 1, Ri 'r4rlctt'+iTn tart it.scrvvd.. ty ux3 Jtd � oniturir,r` CONSUMER ADVISORY _ t vt 22 ._.. -___.:... 1 3 4) 3 t 1 ossa in t 1d :sort P recd i%,r t onutmlAwn of I TIMZTEMPERATURE CONTROLS vo ti,1 i `r'r.t a E x 1'nt n L.n?l:.od r i !6 t P open Cookngrempet mur es for i —�HF � t i n}tit r nc Tr x r i v n t ' r an ars i� 1(31.. 11 11 - . 1 A,i — _ tntmt h att,SPf".t-r I,5 I t iser''� r�� i i c. t o 5 + t , f _ iLai Snr_st_. .,t,c •.. _. _—____.�.__. _.... ._.__ . _ . ._.___.__�.___ ..—_a „_...— Ili - ;ll Y ! bi".. �.___.. d M, .th� i sot { } 3 t ate nn nt hi' food. temp,rat y aA t 101 11 „'?j I Po r: Ort ftli'L��'tn t t .i Fish �1L'-ii. i : tl .}',Ytt 7P,(i<r tilo r.rlrUPi;arc' SE.".'7 if}nS _ i i . r i )(y,lu;r tit ilr t i 'U 12. r 2;Edk.k .s.. Vwt" r ti .,oh V ._� ,. w _. •ii3� tA. Ic} A LI.Z la 4` 1, j ii4 i 9 q I u �?bk7- s 4t ItcGr t� £.C� r". 7;>"ciL f?fif ilt7£' t 03.1111}r t,�l. ttl (6 t l _ (Items 23 36l 1 ,103,11(13 ^a, un. .tr Ir ti F 2, u.. t,_<i r to not 's „r rt tr. :a:• rut _ etc idkt t ,,tattmR ra n,,a r, ,ttc,r>rc ii=cdrt ,.Cern be -4'?3,11(C) ( ananeraiah i'ux used it Ftaxl uta- nzttei t r,u Gitt ci,`ir• rr;ti Cou::ari1't.F`;4;i; 3-403.1 1(F) { lir n i ting 1 t,.wvd Po-ti is 'i meet 1 71sm Gaod Raiarf Fracbces _ FC 590,000 _ h,dlt>' - a 4ait9g me t m la P In r i, a 1 24 r ,)a nd roar P,owttrc GC s 00' LIS _ Proper Cooling of PHFs i_j — --t - - .- -_ 5011.LdfA —�- °: cqut meet and_uten lis - ) I s ts�1 n..C_w6 od PifF's kom i ltt'i'tn 1 l` i t 2C Water Pi nc hg u e J tz. _ PC_`a OoZ3 = I Within;rt 7lrour til[nin t"l f a7 P �; a,F3 ire fC 6 007_ thin H u 2d ops n is nMr N zh rt, l O(3H �. — _ _ . 5 eUL(a{f3i t<lu HIR 4I t Ic Rom Ambient i 155pq. I 1 ,nl. canrce h rcd�ent;to-!! riA5 ,,tt ❑t.1 t-hn,. __ _ .f cn,te,mural amt .a tn:G-:kry 1 i>rt,ta'r ,: !r;( 1c z 700. Commonwealth of Massachusetts s i City of Salem Board of Health lUmberiey Driscoll 120 Washington Street,4th Floor Mayor SALEM,MA 01970 Foo"etail Establishment Permit DATE PRINTED: 12/30/2008 ESTABLISHMENT NAME: Caffe Graziani File Number:BHF-2004-000270 133 Washington Street - Salem MA 01970 LOCATED AT: 0133 WASHINGTON STREET SALEM, MA 01970 Permit Type Permit No. Permit Issued Permit Expires Fee Restrictions/Notes FOOD SERVICE BHP-2009-0300 Dec 30,2008 Dec 31,2009 $280.00 ESTABLISHMENT Total Fees: $280.00 PERMIT EXPIRES December 31,2009 Board of Health This Permit is not transferable and must be reissued upon change of ownership or location.The permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code,beofre any revonations,improvements,or equipment changes are made,all plans for such must be submitted to and approved by the Salem Board of Health. Page 1 r CITY OF SALEM, MASSACHUSETTS + • BOARD OF HEALTH 120 WASHINGTON STREET,4"�FLOOR TEL. (978) 741-1800 KIMBERLEY DRISCOLL FAX(978) 745-0343 MAYOR IDIONNE SALEM.COM JANET DIONNE, ACTING HEALTH AGENT 2009 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT p 1 NAME OF ESTABLISHMENT TEL# ADDRESS OF ESTABLISHMENT_ 133 W T/0,5f L 1 )n(1-ftYn 5f FAX# MAILING ADDRESS(if different) EMAIL-BusinessQk t b-q p CG G f-Ce a razl an i . C-O M Website: WWW G Q__q 0 lL nq2 I Qn l . LC7�Y1 OWNER'S NAME�Q ,,iI/I�(� �S(T����I�iL lTtdy�'�l/�GiayR(ll TEL# l%J20-7 ADDRESS 14 T`1 t)�S+f,n Si 5f lj0s�a) ( .�1f1 oalc r-F STREET r (CITY STATE ZIP� a CERTIFIED FOOD MANAGER'S NAME(S) Pa-U,l� V0. L '� CERTIFICATE#(S) gaq�I(7�/L 3& (Required in an establishment where potentially hazardous food isprepared) EMERGENCY RESPONSE PERSON(a-LA L0., o,('- G1 0 VQn n ( HOME TEL# DAY.SOF-9PERATION . =Monday : T _uestla WeGoesda r.,+: tThursBa :, -Frida Saturday. 1 Sunday HOURS OF OPERATION o j G / Please write in time d � day. 0 5 l .3 j 0 '"3 9% .— d e . 1 3 0 � 1 (For example 11 am-11 pm) TYPE OF ESTABLISHMENT FEE (check only) RETAIL STORE YES NO less than 1000sq.ft. =$ 70 1000-10,000sq.ft. =$280 more than 10,000sq.ft. =$420 ------------------------------------------------- ----- RESTAURANT YES NO less than 25 sea ts140 (Outdoor Stationary Food Cart$210 25-99 seats 80 more than 99 seats =$42:17� -------------------------------------------------------------- ----- ------------------------------------------------------------------------------------------ BED/BREAKFAST/ YES NO $100 CHILDCARE SERVICES ADDITIONAL PERMITS MAKE (not just serve) ICE CREAM, YOGURT/SOFT SERVE YES NO $25 TOBACCO VENDOR YES NO $135 ALL NON-PROFIT(such as church kitchens) YES NO $25 *Please pay total with one check payable to the City of Salem. This Permit is not transferable and must be reissued upon change of ownership.The Permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code, before any renovations, improvements,or equipment changes are made,all plans for such must be submitted to and approved by the Salem Board of Health. Pursuant to MGL Chapter 62C,Section 49A,I certify under the pains and penalties of perjury that I,to my best knowledge and belief,have filed all state tax retu a d p�aid'�l tate t es required under the la . Signature Date Social Security or Federal Identification Number Revised 424/07 FOODAP2008.adm Check#&Date* Ya 96 )/-)6-00 s CITY OF SALEM MASSACHUSETTS HEALTH AGENT R 120 WASHINGTON STREET, 4TH FLOOR SALEM, MA 01970 TEL. 978-741-1800 FAX 978-745-0343 KIMBERLEY DRISCOLL JSCOTT@SALEM.COM MAYOR JOANNE SCOTT HEALTH AGENT October 18, 2007 Caffe Graziani 133 Washington Street Salem, MA 01970 Dear Owner: This department has received numerous complaints regarding trash being placed on Washington Street over the weekend for collection on Tuesday. Trash has been observed uncontained. This attracts animals and rodents creating a public health nuisance for the neighborhood. This letter is a reminder that in accordance with Board of Health regulation 7, Section 3:10 and CMR 410.600 (A) trash cannot be placed curbside prior to 6:0013M the night before collection, therefore, you cannot put trash out for collection before 6:0013M on Monday, trash placed out the night before collection must be contained in weather tight, rodent proof trash receptacles. If you have any questions, please do not hesitate to call the Board of Health office at 978-741-1800. Thank you for your anticipated cooperation in this matter. For the Board of Health: Reply to: if �-f-�-/�ne Scott- David Greenbaum Health Agent Sanitarian HOV-2.I_720?7 09: 16 AM WHEN SECONDS COUNT P.02 • 1, I 1 Y " p I Choke Saving Course Registration #orlgt1 I Each attendee must complete a Registration Form To reserve a span;in the Choke Saving Course Registration Form,please complete and fretum Registration form to the Salem Board of Health. Course provided by When Seconds Co i nt,Itat 'c *Class size is limited and will be on a first come first serve basis. (' *Registration Fee is Non-Refundable • Registration Deadline is Friday,December 28,2007 at 4:00 p.m. I 11! a Date of Registration:_j f r 2! 1 C, 7 Form Completed by: I r ; , i Name: -�t,,c t ct z� ,, Restaurant: c Business Address: City/Town Business Phone: 7 /_4 State&Zip MA c) I W : MI �t Pier ' I I!i Email: 1 understand that the information provided to the City of Salem&When Seconds Comfit,In U60'lC t. confidential and t hereby attest that the information supplied on this Course Applicatiob is e `` accurate. Cost: Choke Saving Class $5.00 per person + Course Date: Wednesday, January 16, 2008 Y Time: 2 p.m.to 4 p.m. Location: City Hall, 120 Washington Street, Floor 3, Salem, MA 1 ! I have read and understand the above registration form, its requirements. Student Signature: Date: / ! ' � i j Return the completed application and payment to: Salem Board of i ' 120 Washin; on ighedt °I Salem;MA 01970 P a NOV-21-2007 09: 16 AM WHEN SECONDS COUNT ,.._.....__.,.. P-02 �I , Choke Saving Course.Registration l+or it I � Each attendee must complete a Registration Form To reserve a space in the Choke Saving Course Registration Form,please complete andzetuta Registration form to the Salem Board of Health. Course provided by When Seconds Count, *Class size is limited and will be on a first come first serve basis. ' I� s 'Registration Fee is Non-Refundable i Registration Deadline is Friday,December 28,2007 at 4:00 p.m. ? r 1 , a , Date of"Registration: i 1„•�]_l� Farm Completed by: Name: eo.,( Gt- , N ,o Restaurant: _tel Csc• I _ Business Address: City/Town Business Phone: t�3a. State&Zip "-A © i a?_„ iP Email: I understand that the information provided to the City of Salem&When Seconds Coatit.fit , l,lie t. confidential and I hereby attest that the information supplied on this Course Applicatioe is accurate, r r Cost: Choke Saving Class $3.00 per person Course Date: Wednesday, January 16, 2008 Q I lo f Time: 2 p.m.to 4 p.m. Location: City Hall, 120 Washington Street,Floor 3, Salem,MA I have read and understand the above registration forst,its requirements. 1 Student Signature: Date: Return the completed application and payment to: Salem Boaxtii of 1.20 Washin�, toa Seiem,MA 41970, P i Commonwealth of Massachusetts .� City of Salem • a Board of Health Kimberley Driscoll 120 Washington Street,4th Floor Mayor SALEM,MA 01970 Food/Retail Establishment Permit DATE PRINTED: 01/08/2008 ESTABLISHMENT NAME: Caffe Graziani File Number:BHF-2004-000270 133 Washington Street Salem MA 01970 LOCATED AT: 0133 WASHINGTON STREET SALEM, MA 01970 Permit Type Permit No. Permit Issued Permit Expires Fee Restrictions/Notes FOOD SERVICE BHP-2008-0296 Jan 7,2008 Dec 31,2008 $280.00 ESTABLISHMENT Total Fees: $280.00 PERMIT EXPIRES December 31, 2008 Board of Health This Permit is not transferable and must be reissued upon change of ownership or location.The permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code,beofre any revonations,improvements,or equipment changes are made,all plans for such must be submitted to and approved by the Salem Board of Health. Page 5 of 11 o CITY OF SALEM, MASSACHUSEM BOARD OF HEALTH r 120 WASHINGTON STREET,4" FLOOR TEL.(978) 741-1800 KIMBERLEY DRISCOLL FAX(978)745-0343 MAYOR iscoTrasALEM.COM JOANNE SCOTT, HEALTH AGENT 2008 APPLICATION FOR PERNNT TO OPERATE A FOOD ESTABLISHMENT fpZ NAME OF ESTABLISHMENT %f K l�' (a /) � ��� TEL# L� 7f7✓7L11 L/�j� /�� ADDRESS OF ESTABLISHMENT/ FAX# MAILING ADDRESS (if different) EMAIL-Business': ' (Wr Website: OWNER'S NAME _ C'10CA/1111 ( U f TEL# j,z /7 ADDRESS I q _T�1 _ SGL STREET /J / /'CATTY,{ STATE M ZIP CERTIFIED FOOD MANAGER'S NAMES) Aii/4 L- f71Va �[�/a CERTIFICATE#(S) ko 7 /773(0 (Required in an establishment where potentiialPR ly ha ardous oo(d is prepared) EMERGENCY RESPONSE PERSON I RRA (A 17' l7 l(!V AA✓1 1 HOME TEL# � ( 7 J� 7 7 DAYS OF OPERATION MondayTuesday Wednesday Thursday Friday Saturday Sunda HOURS OF OPERATION Please write in lime of da (Forexample 11am-11pmj TYPE OF ESTABLISHMENT FEE (check only) RETAIL STORE YES NO less than 1000sq.ft. =$70 1000-10,000sq.ft. =$280 more than 10,000sq.ft. =$420 - - -- - ------------------------------.....-------------- , RESTAURANT YES NO less than 25 seats - Q (Outdoor Stationary Food Cart$21 25-99 seats 280 more than 99 seats - =$420 '-'-'--'-'- -------'--'-'-- ---------------------Y- ES------N-----O---........... .....----------------.:..---........---"----------- ---- BEDIBREAKFASTI ES $100 CHILDCARE SERVICES.--------...___-..--._-. ADDITIONAL PERMITS MAKE (not just serve) ICE CREAM, YOGURT/SOFT SERVE YES NO $25 TOBACCO VENDOR YES NO $135 ALL NON-PROFIT(such as church kitchens) YES NO $25 'Please pay total with one check payable to the City of Salem. This Permit is not transferable and must be reissued upon change of ownership.The Permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code, before any renovations, improvements,or equipment changes are made, all plans for such must be submitted to and approved by the Salem Board of Health. Pursuant to MGL Chapter 62C,Section 49A,I certify under the pains and penalties of perjury that I,to my best knowledge and belief,have filed all state tax returns and paid all state taxes,r uired under the law. Si are Date Social Security or Federal Identification Number Revised 4/24/07 FOODAP2008.adm Chccktl&Datc 7 0133 WASHINGTON STREET Caffie Graziani City ofSa/em FOOD SERVICE ESTABLISHMENT - FOOD SERVICE Item Status Violation Type Urgency Non-compliance with: Address: 0133 WASHINGTON STREE r AntChoking FAIL COMMENTS: There must be someone on staff on every shift that is chokesave certified. Telephone: 741-4282 Owner to have employees certified and send copy of certification to board of health office Owner: Cafe Graziani Inc. for our records.Owner to have employees certified within 1 month or proof that they are enrolled in course. PROECTION FROM CONTAMINATION Haidwash Facilities PASS RED PIC: Paula Gravailese and Giovanni Gi azianiViolalons Related to Good Retail Practices Inspector: Janet Dionne (Blue Items) Date: 10/25/07 Fod and Food Protection PASS BLUE Risk Level: Eqdpment and Utensils PASS BLUE GE4ERAL COMMENTS: Water stained ceiling tiles observed throughout establishment indicating HACCP: No possible water leak. replace all stained ceiling tiles within one month. Please call salem board of health Correct By: forreinspection. Permit Number: BHP-2007-0236 Status: Open Allather violations noted in the 10/25/07 inspection report have been corrected. *of Critical Violations: 0 Time IN: OUT. Urgency Description(s): BLUE: Violations Related to Good Retail i City of Salon Board of NaBh 120 Washington Sheet,4th Floor SALEM MA 01970 Phone:(978)741-1800 Fax:(978)745-0343 reorMs®zo9semtau reMunhipelsaononslnc. COMMONWEALTHOFMASSACHUSETTS Page 0133 WASHINGTON STREET Caffe Graziani City of Salem FOOD SERVICE ESTABLISHMENT - FOOD SERVICE Item Status Violation Type Urgency Practices (Critical violations must be corrected immediately or within 10 days)(Non-critical violations must be corrected immediately or within 90 days) RED: Violations Related to Foodbome Illness Interventions and Risk Factors (Require immediate corrective action) I Signature PIC 518 C of Salem Board of 120 Wallin ton S 4th Floor SALEM MA 01970 Phone:(978)741-1800 Fez(978)745-0 BeoTMS®2005 Des Leaden Munklpal Saunenk Inc. COMMONWEALTH OF MASSACHUSETTS Page 2 0133 WASHINGTON STREET Caffe Graziani City of Salem FOOD SERVICE ESTABLISHMENT - FOOD SERVICE Inspection HACCP: ❑ Item Status Violation Critical Urgency Telephone: § FOOD PROTECTION MANAGEMENT 741 4282 p': I PIC Assigned/Knowledgeable/Duties PASS 0 RED Owner ,.-,. �.. m Non-compliance with: Cafe Graziani Inc < 5Anti-Choking FAIL PIC a M. Gravallese 4 Comments: There must be someone on staff on every shift that is chokesave certified.Owner to have employees certified and send Paula a! �, copy of certification to board of health office for our records. Owner to have employees certified within 1 month or proof that they Inspector �,�! are enrolled in course. David Greenbaum e ' 59,1 Tobacco PASS Date Inspected Correct By 61-0/25/2007:,11,5 �r�if EMPLOYEE HEALTH 1 !, , Risk Level �, �, Reporting of Diseases by Food Employee and PIC PASS ❑� RED l!f�i C4r Personnel with Infections Restricted/Excluded PASS 0 RED Permit Number �1�-, BHP-2007-0236 ,," FOOD FROM APPROVED SOURCE Status Food and Water from Approved Source PASS RED Open ' ., of Critical Violations- Receiving/Condition PASS ❑� RED Q113 %,xh- _� ax i?e,t Tags/Records/Accuracy of Ingredient Statements - PASS ❑d RED Time 4 Conformance with Approved Procedures/HACCP Plans PASS ❑J RED Urgency Description(s):if BLUE `011r1j Violations Related to Good,, ! ;' Retail Practices(Critical , violations must be corrected Yt immedlatelyorwithin 10 P ; days)(Non-critical violations, must oe corrected immediately y , or,within 90 City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741-1800 GeoTMS®2007 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Nov 01,2007 ) Page I of Item Status Violation Critical Urgency RED Q-31F PROTECTION FROM CONTAMINATION Violations Related to all Separation/Segregation/Protection PASS kRED Foodborne'Illness Interventions and Risk Factors Food Contact Surfaces Cleaning and Sanitizing PASS ❑d RED immediate corrective action) Proper Adequate Handwashing PASS 0 RED Good Hygienic Practices PASS 0 RED Prevention of Contamination from Hands PASS ❑d RED omments: disposable gloves not being worn when handling ready-to-eat foods. No bare hand contact with all ready to eat foods. employees to wear gloves or use single use tissue paper or tongs to prevent barehand contact. Handwash Facilities FAIL Critical ❑/ RED omments: handwash sink no soap. Provide soap a all handwash sinks at all times. PROTECTION FROM CHEMICALS Approved Food or Color Additives PASS ❑J RED Toxic Chemicals PASS ❑/ RED TIMEITEMPERATURE CONTROLS(Potentially Hazardous Foods) Cooking Temperatures PASS ❑J RED Reheating PASS RED Cooling PASS 0 RED Hot and Cold Holding PASS RED Time As a Public Health Control PASS 0 RED REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) Food and Food Preparation for HSP PASS ❑10 RED CONSUMER ADVISORY Posting of Consumer Advisories PASS 0 RED City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741-1800 GeoTMS®2007 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Nov 01,2007 ) Page 2 of y Item Status Violation Critical Urgency Violations Related to Good Retail Practices (Blue Items) Management and Personnel PASS BLUE Food and Food Protection FAIL BLUE 11Z'VM ments:there were uncovered food items in GE freezer.All food in storage must be covered at all times. Equipment and Utensils FAIL Critical BLUE Comments: Jordan reach in unit at temperature of 50 degrees F.Owner stated he had put large amount of soup in unit that was "-/causing internal temperature to rise.Inspector to recheck temperature of this unit o ensure maintaining a temperature of 41 degrees F or below as mandated. If at this time temperature requirements have not been met food must be relocated to cooling unit that is mainaining proper temperature. ite frigidaire freezer at temperature of 15 degrees F. Unit to be maintained at 0 degrees F or below as mandated. Physical Facility PASS BLUE Comments:water stained ceiling tiles observed throughout esablishment indicating possible water leak. Find source of leak and repair.replace all stained ceiling tiles. Water, Plumbing and Waste PASS BLUE Poisonous or Toxic Materials PASS BLUE Special Requirements PASS BLUE Other-See Notes PASS BLUE City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741-1800 GeOTMS@ 2007 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Nov 01,2007 ) Page 3 of 01.33 WASHINGTON STREET Caffe Graziani City of Salem FOOD SERVICE ESTABLISHMENT - FOOD SERVICE Inspection HACCP: ❑ Item Status Violation Critical Urgency Telephone: Non-compliance with: 1741-4282 Anti-Choking FAIL Ow 1 ner. Comments:There must be someone on staff on every shift that is chokesave certified.Owner to have employees certified and send ; I Caf@ Graziani Inc. copy of certification to board of health office for our records.Owner to have employees certified within 1 month or proof that they PIC: are enrolled in course. Paula Gravallese and GIOva PROTECTION FROM CONTAMINATION Inspector: Handwash Facilities PASS 0 RED ,,Janet Dionne - Violations Related to Good Retail Practices (Blue Items) Date Inspected: Correct By:. Food and Food Protection PASS BLUE 10/25/2007 Risk Level Equipment and Utensils PASS BLUE Permit Number. GENERAL COMMENTS: BHP-2007-0236 Water stained ceiling tiles observed throughout establishment indicating possible water leak. replace all stained Status: ceiling tiles within one month. Please call Salem board of health for reinspection. Open #of Critical Violations: All other violations noted in the 10/25/07 inspection report have been corrected. 0 Time IN: Time OUT: Urgency Description(s): BLUE: Violations Related to Good Retail Practices (Critical violations must be corrected immediately or within 10 days)(Non-critical violations must be corrected immediately or within 90 days) City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741-1800 GeoTMS®2007 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Nov 26,2007 ) Page 1 oft Item Status Violation Critical Urgency RED: Violations Related to Foodborne Illness Interventions ' and Risk Factors (Require immediate corrective action) City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741-1800 GeoTMS®2007 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Nov 26,2007 ) Page 2 oft r � 5 � t=� rsntor`s " �MS41EPAODSTREEf,tYNN,7dAOta0 -�i697 t' .- '� 7a1S92-Ml t1-800.625.4825"FAX781.02,764 " + } P�stand;ferm44"' antnrp"OfoSSfaYialS .' RSl1CIT"aTh .. ax F All Q. Ala 1IS jx TV *fir� EXPAA't�' � � s � � � `�a "` "�°", "• :r , u . 3bT',#� ws'z_4y. n —M.Mn�S�,rw,�h-fie 2 - � '�,�,,... rte. —"' y i' ,F �S z�r ',:-r�x .,.-Gv-r�'�,�i• ��;�.'-`�,",i�•-y�. .t SI '<�;r,•Tt.. ,. . . �` , mp 3 Ilk _u24r _. _ 4k , s�za Ac.�xss'�^resmau '�vnxmwr ai `» ° _. y � - "G+�ku ..*m.--�.d - 1. c cAr Service Slip / Invoice A-1 Exterminators INV . 0 T2T P.O. Box 310 ,u�TE`;, ' 11123y - Lynn,MA 01903-0310 RD, R'"' 72.: 781-592-2731 _ But-To: [1305700) Work (1305700] 978-741-4282. CAFE GRAZANI - Location: CAFE GRAZANI 133 WASHINGTON STREET - 133 WASHINGTON ST SALEM, MA 01970 - SALEM,MA 01970 x�Y � '� • ,x V b r r,.� - . a. 101.;.1.: REGULAR PEST CONTROL SERVICE _ $45.00 SEATING AREAIKITCHEN2RR/SMALL STORAGE AREA -.__......_._ - � SUBTOTAL----'"' "$45:00 (DOES NOT INCLUDE BSMT) - TAX - $0.00: TOTAL ._$45.00 ) AMT.PAID -$0.00 BALANCE $45.00 r Ll Qharges outstantling over 30 days from the date of service are subject toe 1 12% I hereby acknowledge the satisfactory completiohof all semws rendered end agree to pay the FINANCE CHARGE PER MONTH or annual pe"Mage rate of 18%.Customer agrees to cost of servicesas specified above.--- - - pay accrued expenses in the event of collection. `. X CUSTOMER SIGNATURE - PLEASE PAY FROM THIS INVOICE l 0133 WASHINGTON STREET Caffe Graziani City of Salem FOOD SERVICE ESTABLISHMENT - FOOD SERVICE Inspection HACCP: ❑ Item Status Violation Critical Urgency Telephone: Violations Related to Good Retail Practices (Blue Items) 741-4282 Food and Food Protection PASS Critical BLUE Owner: Comments:Jordon unit has uncovered foods. All foods must be covered. Cafe Graziani Inc. PIC: Ice scoop in front stored incorrectly. Scoop to be stored with handle exposed from ice or in a designatrd labled container. Paula M. Gravallese Equipment and Utensils PASS BLUE Inspector: John Gehan Comments: Microwaves require general cleaning on the outside. Date Inspected:Correct By: Refrigerator beneath cookline requires thorough cleaning of shelves and inside. 3/30/2007 Risk Level: GE refrigerator requires general cleaning on outside by handle area. Frigidaire unit requires general cleaning around handle area. Permit Number. Front true unit requires general cleaning on bottom. BHP-2007-0236 Status: Physical Facility PASS BLUE SIGNED OFF #of Critical Violations: ' Comments:There are water stained ceiling tiles in kitchen. Find source of leak and repair. Replace any water damaged tiles. 0 GENERAL COMMENTS: Time IN: Time OUT: Owner to fax pest control invoice to BOH. Urgency Description(s): BLUE: Tiles to be replaced by next inspection. Violations Related to Good Retail Practices (Critical violations must be corrected immediately or within 10 days)(Non-critical violations must be corrected immediately or within 90 days) City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741-1800 GeoTMS®2007 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Apr 03,2007 ) Page 1 oft Item Status Violation Critical Urgency RED: Violations Related to Foodborne Illness Interventions and Risk Factors (Require immediate corrective action) City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741-1800 GeoTMS®2007 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Apr 03,2007 ) Page 2 oft 0133 WASHINGTON STREET Caffe Graziani City of Salem FOOD SERVICE ESTABLISHMENT - FOOD SERVICE Inspection HACCP: ❑ Item Status Violation Critical Urgency Telephone: Violations Related to Good Retail Practices (Blue Items) 741-4282 Food and Food Protection FAIL Critical BLUE Owner: omment:Jordon unit has uncovered foods. All foods must be covered. Cafe Graziani Inc. PIC: a scoop in front stored incorrectly. Scoop to be stored with handle exposed from ice or in a designatrd tabled container. Paula M. Gravallese Equipment and Utensils FAIL BLUE Inspector: John Gehan �menta Microwaves require general cleaning on the outside. Date Inspected:Correct By: rRefngerator beneath cooktine requires thorough cleaning of shelves and inside. 31231200 7 Risk Level: refrigerator requires general cleaning on outside by handle area. _-F�igfdaire unit requires general cleaning around handle area. Permit Number: ton BHP-2007-0236 —Front—true unit requires general cleaning on bottom. Status: Physical Facility FAIL BLUE Open #of Critical Violations: Comment:There are water stained ceiling tiles in kitchen. Find source of leak and repair. Replace any water damaged tiles. 1 -OUT GENERAL COMMENTS: Time IN: Time OUT: �— Owner to fax pest control invoice to BOH. Urgency Description(s): BLUE: Violations Related to Good Retail Practices (Critical violations must be corrected immediately or within 10 days)(Non-critical violations must be corrected immediately or within 90 days) City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741-1800 GeoTMS®2007 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Mar 23,2007 ) Page I oft Item Status Violation Critical Urgency RED: Violations Related to Foodborne Illness Interventions and Risk Factors (Require immediate corrective action) Lj 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. Mar 23,2007 ) Page 2 oft { "'r- b✓9vA a.rrtµt ' m 4kz � �#{n a rt' ��Commonweatnwi lth of wr4. s K"fi7'1^wc,F' rr-' s �r,, k a aq. f aw-a �*.a"IETn•s,: f 'r ^C .4 "! w a-„ 'da t^ r�� 7-'4' ,� *!w' ,tW '.�w��'' S�>��"f+4""� ' ♦: Ity Of Kalem rt,na'i� `r F x{�� �n N • � { 4 � "�. 4;A 41A h xj?f{aa�"la"�R. Bnardof Healthy rte %d w ;r 120 Washington Street,'4th Floor rn.IGmberley Driscoll :- a u x: Mayor SALEM,MA 01970 Food/Retail Establishment Permit DATE PRINTED: 01/02/2007 ESTABLISHMENT NAME: Caffe Graziani File Number:BHF-2004-000270 133 Washington Street Salem MA 01970 LOCATED AT: 0133 WASHINGTON STREET SALEM, MA 01970 Permit Type Permit No. Permit Issued Permit Expires Fee Restrictions/Notes FOOD SERVICE BHP-2007-0236 Jan 2,2007 Dec 31,2007 $150.00 ESTABLISHMENT Total Fees: $150.00 PERMIT EXPIRES !December 31, 2007 Board of Health This Permit is not transferable and must be reissued upon change of ownership or location.The permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code,beofre any revonations,improvements,or equipment changes are made,all plans for such must be submitted to and approved by the Salem Board of Health. Page 3 of 20 CITY OF SALEM, MASSACHUSETTS $CARO OF hMTH 120 WASwtteroN STREET,4TH FLoCR .SALEµ, MA 01970 TEL 978.741.1800 Fax 978.745.0343. Kimberley Driscoll WwW.SAu=M.c&i Mayor JOANNE Scor, MPH,RS, CHO HEALTH AGENT 2007 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT NAME OF ESTAEi! S.SHMENT (( •y 'zt 7 e Lt.r ! � _TEL#a7i:_74/ 4d�LZ ADDRESS Or ESTABL IS4MENT /33 ,(AAs At ` FAX 9_ �7f- MAILING AGOHt SJ iir olffnrnnt)_, EMAIi:'-_S'bell;" 'i -' ,' -`'`-L �.,=t�+s ikr a_? L6L✓'�'�asa'.:<. z r do%t'cztl�a �s'1"g t/ar��P.F OWNrzRlS NAME. ADDRESS I ' aC5fit S-j Co tads a o tL 3TRECT. __ CI?Y STATE ZIP CERTIFIEeFOOD MANAGER'S t4AME(S)rt4AI1Q: 0��``rr ✓cx' I f f?l�_ CERTIFICATE#(S)� Z *gW"Kall elatlsPmgn!.WhereWtenbaityhuardalsfood is7epatedi EMERGENCY RESPONSE PERSON HOME l'E.rt �BpvEiJdBP�ffllfHi ; _ fdEedpg TeOaYaY WtsdnesdaY Thttrs�9 ;. ., fRday ,.. S9fut8� __sgnUat! ( Rog ASOiIiEtpPttJp tserrdgtot&taemmp. ,�'�( '.t �.,_ 3U l i � TYPE OF ESTAi3 isNM£ � FEE (check onlyl RETAi! STORE Y } Iota than 1000sq.ft =g 50 tx Y n 4 . 1000-10,000sq.ft, =5100 L'0 i .�r, more than 10 000sq ft a25C ( REST7 X11 + €i'r r, Iesa th,t za...............• ¢ 1110 � lhena Sp m �F $100 14 lixpv T �rtSt iF _ ar ai E us rAW"d upon change of ownership. l'rie ermit„a;ea a postast Sn a '�:rvexer wl iiF2 E&'.dhlC4hftfont. In accureFanaa Wfih rho Stato Sanitary Code,before any renovatfoat,, :rnpxove€renis,or equipment changes are made, aii piens for such must be submitted-to and approaed_tay the Salem board of He41th. aaesuart to M` ':r+ap4r,* G.S 2; 1149A,I cwtifv.unOCr the 1);J1114,1110 prnali;c�=,of po.riurti tP a! t,,r. It t� . ..,t>.� u^w�a Lk^stet. have F1W' ".1- - 1,1A n t U' (I ail St',' f7 t yd,_�ri undo Uip 1• _ .. 67 q S�gn,yl P u. OVW1 'o6`Sati'tf}t7t I'nrjBr3t ldenti!xaltun %%ober ........... ..._..,.,. ...._....... ........................._... ....:... ......., ..._... ....... � ' .. --- R,.v.tigd `171 a+DG i`(7,lUAP2tx} tlfrt Gh,;f AY,8 U3t3 � ! �"`- J��,., t �✓(',f - _ 0133 WASHINGTON STREET Caffe Graziani City of Salem FOOD SERVICE ESTABLISHMENT - FOOD SERVICE Inspection HACCP: ❑ Item Status Violation Critical Urgency Telephone: PROTECTION FROM CONTAMINATION 741-4282 Food Contact Surfaces Cleaning and Sanitizing FAIL I] RED Owner: mment: Sanitizer running too high. Provide sanitizer with proper ppm. Caf@ GraZlanl Inc. Handwash Facilities FAIL RED PIC: Paula M. Gravallese mment: Hand wash sink obstructed at time of inspection. Hand wash sink to be clear and easily accessible at all times. Inspector: John Gehan Date Inspected:Correct By: 10/19/2006 Risk Level: Permit Number: BHP-2006-0035 Status: NEW #of Critical Violations: 3 Time IN: Time OUT: Urgency Description(s): BLUE: Violations Related to Good Retail Practices (Critical violations must be corrected immediately or within 10 days)(Non-critical violations must be corrected immediately or within 90 days) City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741.1800 GeoTMS®2006 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Oct 19,2006 ) Page I of Item Status Violation Critical Urgency RED: Violations Related to Good Retail Practices (Blue Items) Violations Related to Food and Food Protection FAIL Critical BLUE Foodborne Illness Interventions and Risk Factors (Require omment:Jordon refrigerator has uncovered foods. All foods in storage must be covered. immediate corrective action) UN1dfe Frigidaire freezer temperature at 20°F at time of inspection. Freezer to be holding at 0'F or below as mandated. S unit refrigerator holding at 48°F. Refrigeration unit to be holding at 41°F or below as mandated. K m knife rack found with accumulation of food debris. Thoroughly clean and sanitize knife. Equipment and Utensils FAIL BLUE om"menu: General Electric freezer in back requires thorough cleaning inside and out. �or✓.f don refrigerator requires general cleaning inside and out. V White frigidaire unit requires thorough cleaning on outside. ttmg boards stained and scored. Resurface or replace boards. Sanitizing log not being kept daily.Log to be maintained daily. olator requires thorough cleaning. LA e cream unit missing thermometer. Provide visible and accurate thermometer. icrowaves require general cleaning. e cooler in front requires general cleaning. ere is large amounts of built up grime on many of the kitchen equipment and utensils. Thoroughly clean and sanitize any necessary units. Physical Facility FAIL BLUE ment:Water stained ceiling tiles over the sink in kitchen. Find source of leak and repair. Replace any water damaged tiles. Other-See Notes FAIL BLUE ✓Comment: Inspector to be back later in the day to check temperature of warewash machine. Machine should be reaching 180°F on final rinse. GENERAL COMMENTS: 912: Ci of Salem Board of Health 120 Washington Street 4th Floor SALEM MA 01970 978 741-1800 City 9 ( ) GeoTMSO 2006 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Oct 19,2006 ) Page 2 of Item Status Violation Critical Urgency U City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741-1800 GeoTMS®2006 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Oct 19,2006 ) Page 3 of 0133 WASHINGTON STREET Caffe Graziani City of Salem FOOD SERVICE ESTABLISHMENT - FOOD SERVICE Inspection HACCP: D Item Status Violation Critical Urgency Telephone: Violations Related to Good Retail Practices (Blue Items) 741-4282 Equipment and Utensils FAIL BLUE Owner: Comment: Establishment dishwasher in disrepair. Owner states repair man to be on premises this week. Dishwasher not to be Cafe Graziani Inc. used until machine reaches 180°F on final rinse. Owner to contact BOH within one week regarding matter. PIC: GENERAL COMMENTS: Paula M. Gravallese 912: All violations have been corrected unless noted from 10/19/2006. Inspector: John Gehan Date Inspected:Correct By: 10/19/2006 Risk Level: I Permit Number: BHP-2006-0035 Status: SIGNED OFF #of Critical Violations: 0 Time IN: Time OUT: 1 I Urgency Description(s): BLUE: Violations Related to Good Retail Practices (Critical violations must be corrected immediately or within 10 days)(Non-critical violations must be corrected immediately or within 90 days) City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741.1800 GeoTMS®2006 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Nov 07,2006 ) Page I oft Item Status Violation Critical Urgency RED: Violations Related to Foodborne Illness Interventions and Risk Factors (Require immediate corrective action) City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741-1800 GeoTMS®2006 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Nov 07,2006 ) Page 2 oft IMPORTANT MESSAGE FOR( Dbn DATE.t.�12-01, 0� TIME SS�/• AM M p/ u( PHONE ()AREA OODE NUMBER EXTENSION 0 FAX 0 MOBILE AREA CODE NUMBER TIME TO CAL TELEPHONED PLEASE ALL CAME TO SEE YOU WILL CALL AGAIN WANTS TO SEE YOU RUSH RETURNED YOUR CALL WILL FAX TO YOU MESSAGE Jt&j HV. Ili SIGNED INJ;ej CA FORM 4009 MARE IN U.S.A. NOTES i rrr w'✓✓r9r r'!U'+'.'.err.-.w.rvr...rv...r.,..�.n..•w•v n.�n+rwvwr..v.. .....���...�..... �-------------��. UNITED SERVICE COMPANY SERVICE INVOICE REFRIGERATION • AIR CONDITIONING • HEATING FOOD SERVICE EQUIPMENT N4 251497 i OARDYN STReiT.DANVCRer MA 01923 - i.800.761.0900 14 HOUR SERVICE -- —_— 'HNL N:M9Er' MZ.1 UMBEP- voil9 V\ TO: --- Madl - - -LIJaC_ 6ER'AL,WUM6EF I NAME DAE —� _— U _... WµtlLN FU r VUTS --� PNASL I -HFfeleFiUVI T EL. y �S F� tlY�x MT - DESCRIPTION OF WORK PERFORMED TROUBLE REPORTED • � i _ � b tj ZMA%TERIAL IT FW S 8 EQUIPMENT PRCAMOU _kill e.J --- a� ALq 1 I_ 1�e- ls� -tom sur__ -_— --- - LAJUM F _-� PIT! _Wttliniva- FILTERS X % ai VOA-11- "iad�' I FILTERS X X _ r TOTAL MATERIALS PARTS A EQUIP. Ig - — ' �- -- -----^--------- OTHER SERVICER _ ____--_..-------__._.-__ iT I I TOTAL OTHER SERVICES ❑ HEATING _ [IREFRIGERATION ❑ VENTILATING_ _ I ❑ ICE MACHINE Limited Warranty:Ail materiel,pans aid OgUDment are warranted by me manufacturers ar suppliers writlen warranty only All labor performed by the above named company is warranted G AIR CONDITIONING for 30 days or as Otherwise incmaled In writing.The above named cnnpsny,makes no other war _—__... rarities,expreesed or implied,arra its agents,mechanics,or serNieemen,are not authorized to r�-JJ -� make any such warranties on behalf of above named company. DISPATCH �VLY ----- ---" I HAVE AUTHORITY TO ORDER THE WORK,WHICH HAS BEEN SATISFA�ORd_Y D COMPLETE ❑INCOMPLETE SERVICE SALES PERFORMED, AS OUTLINED ABOVE. IT IS AGREED THAT THE SELLER WILL -. ITEM AMOUNT RETAIN TITLE TO ANY EQUIPMENT OR MATERIAL THAT MAY BE FURNISHED � .ULAR D WARRANTY - UNTIL.FINAL PAYMENT IS MADE.AND IF SETTLEMENT IS NOT MADE AS AGREED, MATERIAL THE SELLER SHALL HAVE THE RIGHT TO REMOVE SAME AND THE SELLER WILL BE HELD HARMLESS FOR ANY DAMAGES RESULTING FROM THE REMOVAL Hcun THEREOF.THIS SERVICE INVOICE COVERS TRAVELING TO AND FROM THE JOB, ❑ SERVICE CONTRACT L_ TIME TIME ACTUALLY WORKED,ALL TRAVELING EXPENSES AND MATERIAL USED, - —_____... ._ --- OTHER SERVICES TERMS'NET 18 DAYS ❑ EMERGENCY SERVICE ---VE ;TRAVEL M Met )d0 ALES TAX �M.'C 1 _— 0 CHARG< B TONER'S SIG ATU ❑ CHECK# ❑ CASH TOTAL i,, a�lS'�—I G6 ""7 '8£ 'L£ '9£ 'S£ ,FROM kAFFEGRAZIANI FAX NO. :9767446665 May. 30 2006 11:33AM P1 A MAY 30 2006 o CITY OF SALEM BOARD OF HEAhTH UNIT I ir SERVICE COMPANY E Iii�� SERVI REFRIGERATION a AIR CONDITIONING • HEATING C INVOICE, C FOOD 52viQE EQUIPMENT 6 GARDEN STREET,DANVERS,NA 01028 1-800.761.0900 24 HOUR SERVICE T \j W 'a Aw n 1 4c _t IV r,F V Q 'y UNIT NWO . Von FMAL; R FN6FBAHT FU1 - -- 4aNE '�- XFFfiI(iEWiS -•_ FVFL OESERN>TION"OFWORK DERFORh1E0- it e. C .e_pc tr- . `• UNIT. A CITY MATERIAL PARTS&EQUIPMENT PRICE- AMOUNT - .-. , � )-tTK. -ee 7M 170? .GA.c =11 ,4 ka �Q �GJ�. I✓,IaBq - _ ✓i J��i � ^C c.J F'>' Tit 5 c � �C. FILTERS X. X Eli FILTERS X TOTAL MATERIALS PARTS&EQUIP, OTHER SERVICES LQ T ot orr[+- Q TOTAL OTHER SERVICES ❑ HEATING ❑ REFFInERATION. ❑ VENTILATING ❑ ICE MACHINELPillted Warranty:All materiel.paps and eouipmem are warrenmd by the monvF30hireea eVppli@�s'_;_ yreeany limy,All lab-pedo,mod by IN above named company is wmramea ❑ AIR CONDITIONING1a.30daya'oas blherwiaC miMaled In willing,The aCon nomeo company,makes no other war• rentioa,expmosed ar Implied,and'its ageMS,mochanka,lir aervieomtn,art.0sulMdzed to make any such warranfes on Debar of above named company. DISPATCH a I HAVE AUTHORITY TO ORDER THE WORK.WHICH HAS BEEN SATISFACTORILY f COMPLETE ❑INCOMPLETE SERVICE SALES PERFORMED,AS OUTUNED ABOVE. IT IS ADREEO.THAT THE SELLER.WILL ITEM AMOUNT RETAIN Tfra TO ANY EOUPMENT OR MATERIAL'THAT-MAY RE-NRNISNED ❑ REGULAR C WARRANTY UNTL FINAL PAYMENT is WOE AND IF SETTLEMENT 16 NOT MADE AS EEO. MATERIAL THE SELLER SHALL HAVE THE RIGID TO REMOVE SAME AND THE SELL BE HELD HARMLESS'EOR A Y DAMAGES RESULTING FROM TME REMOVAL - THEREOF TRIGSERVICEINV CE COVERS TRAVELING'TO AND'FROMTHE JOa: ❑-SERVICE CONTRACT LABOR TIME ACTUALLY WORKED.A}L TRAVEUNG EXPENSES AND MATERIAL USED. OTHER SERVICES y TF NE'T 10 OS �' Q EMERGENCY SERVICE TRAVEL G S f ,^�" - Method of Payment SALES TAX Q O VISA e P ' .wC ❑ CHARGE A XQ CASH, - TOTAL /ya R S CUSTOMEy°IB r(RE' ❑ GMECK k - .p a « _. �." ` +J*,g v1+- ' ~r- +*^sk{�S:ph •rr by -!d u. �i�'£`.:arvNe .gF% +� ..+-..s usr-nx. Ma«iH- "�i7irYa �wMs;t#v� -r;�"k'.'"' a,`�PWTrv*.m*4i§l�i� nFW'Ca'Fn`w��Asbi'"Mr k'a,e� rt*✓ '' 2�u•:..T'r-eR-�?pT!'td*X•^7ni?-TP'��"'T+a+yd'S'+�w*'CA�rR�•- �'' � � ' �Commonwealth of Massachuse � t� .._ 'City of Salem' .. Board of Health 120 Washington Street,4th Floor • " SALEM,MA 01970 Food/Retail Establishment Permit DATE PRINTED: 01/02/2006 WHO'S PLACE OF BUSINESS IS: Caffe Graziani File Number:BHF-2004-0270 133 Washington Street Salem MA 01970 LOCATED AT: 0133 WASHINGTON STREET SALEM, MA 01970 Permit Type Permit No. Permit Issued Permit Expires Fee Restrictions/Notes FOOD SERVICE BHP-2006-0035 Jan 2,2006 Dec 31,2006 $150.00 ESTABLISHMENT Total Fees: $150.00 PERMIT EXPIRES December 31, 2006 Board of Health This Permit is not transferable and must be reissued upon change of ownership or location.The permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code, beofre any revonations,improvements,or equipment changes are made,all plans for such must be submitted to and approved by the Salem Board of Health. Page 8 of 26 ' CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH j 120 WASHINGTON STREET, 4TH FLOOR b� • SALEM, MA 01970 TEL. 978-741-1800 STANLEY J. USOVICZ, JR. - Fax 978-745-0343 0 1(l� MAYOR WWW.SALEM.COM FC O t,yv // // JOANNE SCOTT, MPH, RS, CHO C/ ,ZOOS //v// HEALTH AGENT 8Q,1 OP 00"81`'✓/ 'l '7 `t�c' 2006 APPLICATION F R PERMIT TO OPERATE A FOOD ESTABLISHMENT 7�1 NAME OF ESTABLISHMENT- -a/l Zi CG✓J i /1 i')C-TEL# L ADDRESS OF ESTABLISHMENT kld.ShlaakaS / MAILING ADDRESS (if different)/ l OWNER'S NAMEr'T/�.�vt (e)Yrz? I/!at iDIA1� (-rrAVu1I10S2 TEL# G(7 S(o7 Saa--7 ADDRESS 14 _rkVCn S CITY aa!' - (7; � STATE Mk ZIP 021 CERTIFIED FOOD MANAGER'S NAME(S) n.>I( VaIjgsrCERTIFICATE#(s) 3 (required in an establishment where potentially hazardous food is prepared.) ff EMERGENCY RESPONSE PERSON HOME TEL## HOURS OFOPERATION: M n G Tud" ef ,�Wed. hu Fri.��Sat. Sun. 73u_/ TYPE OF ESTABLISHMENT FEE (check only) RETAIL STORE YES NO less than 1000sq.ft. =$ 50 1000-10,000sq.ft. =$100 more than I0,000sq.ft. =$250 -------------------------------..............----------------------------..........------ RESTAURANT lthan 25 seats =$150 more than 99 seats = 200 -----------------------------------------------------------------------------------------0--------------- BED/BREAKFAST YES NO $10 - ------------------------------------------------------------------------ ---------------..-----------.....------- ADDITIONAL PERMITS MAKE (not just serve) ICE CREAM, YOGURT, SOFT SERVE YES NO $5 TOBACCO VENDOR YES NO $50 ALL NON-PROFIT(such as church kitchens) YES NO $25 *Please pay total with one check payable to the City of Salem . This Permit is not transferable and must be reissued upon change of ownership.The Permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code, before any renovations, improvements, or equipment changes are made, all plans for such must be submitted to and approved by the Salem Board of Health. Pursuant to MGL Chapter 62C, Section 49A, I certify under the pains and penalties of perjury that I, to my best Wneand belief, haV 'ed all s to tax return and pai state taxes required under the law. Date Social Security or Federal Iden fication Number ---------- -- -----------------------------------------r-f-------------r --------------------- - Revised 11/03/05 FO AP2.adm Check#&Date I �����J °e 0133 WASHINGTON STREET Caffe Graziani City of Salem FOOD SERVICE ESTABLISHMENT - FOOD SERVICE Inspection HACCP: ❑ Item Status Violation Critical Urgency Telephone , ., PROTECTION FROM CONTAMINATION 741-4282 M Food Contact Surfaces Cleaning and Sanitizing FAIL Critical RED Owner: vx Comment:The final rinse temperature on the dishwasher was 170°F. Owner must have dishwasher serviced maintain a final Cafe Graziani Inc. minimum rinse temperature of 180°F. Provide repair invoice to the Board of Health within onr week. PIC. GENERAL COMMENTS: 634:623:Reinspection in one week, all violations to be corrected. Inspector: David Greenbaum Date '- ct By`. IW6 Risk Level: Permit Number BHP-2006-0035 Status: . . VIOLATION #of Critical Violations: 1 Time IN: Time OUT: � x Urgency Description(s): BLUE: Violations Related to Good` Retail Practices (Critical violations must be corrected immediately or within 10 days)(Non-critical violations must be corrected immediately or within 90 days) City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741-1800 GeoTMS®2006 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. May 30,2006 ) Page I oft FL • ' Item Status Violation Critical Urgency RED: Violations Related to Foodborne Illness Interventions and Risk Factors (Require immediate corrective action) City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741-1800 GeoTMS®2006 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. May 30,2006 ) Page 2 oft 0133 WASHINGTON STREET Caffe Graziani City of Salem FOOD SERVICE ESTABLISHMENT - FOOD SERVICE Inspection HACCP: ❑ Item Status Violation Critical Urgency Telephone: _ -' PROTECTION FROM CON INATION 741-4282 Food Contact Sudac Cleaning and Sanitizing FAIL Critical ❑� RED Owner: .Com nt: The sanitizing solution in the kitchen found too weak. Sanitizing solution of proper concentration must be readily Cafe Graziani Inc. dable at all work stations at all times. PIC: - The final rinse temperature on the dishwasher was 170°F. Repair dishwasher to maintain a final minimum rinse temperature of Paula Gravallese and Giova 180'F. Inspector: Handwash Facilities FAIL Critical ❑J RED David Greenbaum - Date C ant: kitchen hand wash sink found obstructed. Keep all hand wash sinks clear and accessible at all times. Correct By: 1 6 t T men's restroom soap needs t be refilled. Risk Level. - - Violations Related to Good Retail Practices (Blue Items) Food and Food Prot n FAIL Critical BLUE Permit Number: Co ant:The Jordon refrigerator has some uncovered food. All food in storage must be covered. BHP-2006-0035 Equip nt and Ut FAIL Non-Critical BLUE Status: VIOLATION ment:The GE freezer has an accumulation of frost. Defrost this unit. #of Critical Violations: T deli cooling needs a thorough cleaning. 3 _ Physical Facility FAIL Non-Critical BLUE Time IN: Time OUT L ' Com :There are some water stained ceiling tiles. Investigate the source of the leak and repair. Replace all stained ceiling tiles. Urgency Description(s): A BLUE: ral cleaning of the wall above the sink is needed. Violations Related to Good GENERAL COMMENTS: Retail Practices (Critical 623:Reinspection in one week, all violations to be corrected. violations must be corrected immediately or within 10, a k days)(Non-critical violations 4 must be corrected immediately or within 90 days) k City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741-1800 GeOTMS®2006 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. May 19,2006 ) Page I oft Item Status Violation Critical Urgency RED: Violations Related to Foodborne Illness Interventions and Risk Factors (Require immediate corrective action) City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741-1800 GeoTMS®2006 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. May 19,2006 ) Page 2 oft Massachusetts Department Of Public Health Salem Board S Health M 120 Washington treat,41''.Floor Division of Food and Drugs Salem, MA 01970-3523 FOOD ESTABLISHMENT INSPECTION REPORT Tel. (978)741-1800 Fax(978) 745-0343 Name Da T e of O arationts) Type of Inspection, CO1311_;t/ ( Food Service ® Routine Address IRIS [IRetail Q Re-inspection rn Level ❑ Residential Kitchen Previous Inspection Telephone Q Mobile Date:-4/+4 J Owner ~ HACCP YIN F-1Temporary ElPre-operation G ZZ (0 ❑ Caterer ❑Suspect Illness Person in Charge{PIC} Time El Bed& Breakfast El General Complaint In: CI; ( ❑HACCP InspectorOut: t Permit No. ❑Other _ Each violation checked requires an explanation on the narrative page(s)and a citation of specific provision(s) violated. / Non-compliance with: Violations Related to Foodborne Illness Interventions and Risk Factors Anti-Choking Tobacco Violations marked may pose an imminent health hazard and require immediate corrective 590.009(E) ❑ 590.009(F) ❑ action as determined by the Board of Health. FOOD PROTECTION MANAGEMENT E] 12. Prevention of Contamination from Hands ❑ 1. PIC Assigned/Knowledgeable/Duties ❑ 13.Handwash Facilities EMPLOYEE HEALTH - - . - � _. PROTECTION FROM CHEMICALS �F ❑ 2. Reporting of Dis ases by Food Employee and PIG , w Q 14.Approved Food or Color Additives ❑ 3. Personnel with Infections Restricted/Excluded ❑ 15.Toxic Chemicals FOOD FROM APPROVEb-SOURCE -. . .� -- TIMEITEMPERATURE CONTROLS(Potentially Hazardous Foods) ❑ 4. Food and Water from Approved Source Q El 16.Cooking Temperatures 5. Receiving/Condition ❑ 6. Tags/Records/Accuracy of Ingredient Statements ❑ 17. Reheating ❑ 7. Conformance with Approved Procedures/HACCP Plans [118, Cooling ' PROTECTION FROM CONTAMINATION ` ❑ 19. Hot and Cold Holding ❑ 8. Separation/Segregation/Protection ❑20.Time As a Public Health Control Q 9. Food Contact Surfaces Cleaning and Sanitizing REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP), _ ❑21. Food and Food Preparation for HSP ❑ 10. Proper Adequate Handwashing CONSUMER ADVISORY E311. Good Hygienic Practices ❑22. Posting of Consumer Advisories Violations Related to Good RetWil-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. Nan-critical (N)violations must be corrected Official Order for Correction: Based on an inspection immediately or within 90 days as determined by the Board today, the items checked indicate violations of 105 CMR of Health. 590.000/federal Food Code.This report, when signed below C N i by a Board of Health member or its agent constitutes an 23. Management and Personnel (Fc-2)(990.003) order of the Board of Health. Failure to correct violations ,24. Food and Food Protection (FC-3)(590.004) cited in this report may result in suspension or revocation of 25. Equipment and Utensils (Fc-4)(590.005) the food establishment permit and cessation of food PB. Water, Plumbing and Waste (Fc-5)(590.006) establishment operations. if aggrieved by-this order, you 27 . Physical Facility (Fc-6)(590.007) have a right to a hearing. Your request must be in writing 28. Poisonous or Toxic Materials (Fc-7)(590.008) and submitted to the Board of Health at the above address 29. Special Requirements (590.009) within 10 days of receipt of this order. 30. Other DATE OF RE-INSPECTION: S 50ffi p W.1m6 14da Inspector's Signature: I V I Print: j d PIC's Signature: Print: r v /�� Page of ravages Violations Related to Foodborne Illness Interventions and Risk Factors(items 1-22) PROTECTION FROM CONTAMINATION FOOD PROTECTION MANAGEMENT K Cross-contamination 3 59{).003{A) Assignment of Res onsibilit * 3-302.1 I(A)(]) Raw Animal Foals Separated from 590.003(B) Demanstcation of Knowledge" Ctx)ked and RTE F(mis* 2-703.11 Person in char e-duties Contamination from Raw ingredients 3-30211(.4)(2) Raw Animal Foods Separated from.Each EMPLOYEE HEALTH Other" 2 590.003(0) Responsibility of the person in charge to Contamination from the Environment require reporting by food employees and 3-302.1](A) Food Protection'" i ilictmts* 3-302.15 Washine Fruits and Veeetables 590.003(F) Responsibility Of A Food Employee Or An 3-304.11 Food Contact with Equipment and Applicant To ReportTo The Person In Utensils* Char e' Contamination from the Consumer 590.003(G) Re ortin b I Person in Cha"n- 3-306.14(A}(B) Returned Food and Reservice of Food" 3 590.003(D) Exclusions and Restrictions* Disposition of Adulterated or Contaminated 590.003{E} Removal of Pxelusions and Restrictions Food 3-701.11 Discarding or Reconditioning Unsafe FOOD FROM APPROVED SOURCEFood" a Food and Water From Regulated Sources 9 Food Contact Surfaces 590.004(A-B) Com iliance with Food Law" 4-5(11.111 Manual Warewashing-Hot Wa[er 3-201.12 Food in a Herniehcaliv Sealed Container" Sanitization Temperatures, 3-201.13 Fluid Milk and Milk Products* <I-501.112 Mechanical Warewashine Iiot Water 3-202.13 Shell Eggs* Sanitization Temperatures* 3-202.1.4 Eu Is and Milk Products.Pasteurized* 4-501.114 Chemical Sanitization-tcom., pH, 3-202.16 Ice Made From Potable Drinking Water` concentration and hardness. * 5-101.1.1 Drinkil Water from an Approved S •slam" 4-601.11(() Equipment Food Contact Surfaces and Utensils Clean* 590.006(A) Bottled Drink n Water* 4-602.11 Cleaning Frequency of Equipment Food- 590,006(B) Water Meets Standards in 310 CMR 22.0"' Contact Surfaces and Utensils SheiNish and Fish From an Approved Source 4-702.11 Frequency of Sanitization of Utensils and 3-201.14 Fish and Recreationally Caught Molluscan Food Contact Surfaces of Equipment* Shellfish* 4-703.11 Methods of Sanitization-Hot Water and 7201.15 Molluscan Shellfish from NSSP Listed Chemical* Sources* 10 Proper,Adequate Handwashing Game and Wild Mushrooms Approved by2-301.11 Clean Condition-Hands and Arms"` Re ulato Authorit 3-202.1.8 Shellstock Identifi cation Present'* 230112 Cleaning Procedure* 590.004(C) WildMushiaoms* 2'30114 When to Wash 3-201.17 Game Animals* (F, 1" t T Good hygienic Practices g Receiving/Condition 2-401.11 �4 Eating,Drinking or Using Tobacco* 3-202.11 PHPs Received at Proper Tem eratures* 1301`12 Discharges From the Eyes, ':Vose and 3-202.15 Package Irate i0i- Month* 3-101.11 Food Safe and Unadulterated* 3-301.12 Preventing Contamination When Tasting" h Tags/Records:Sheiistock 12 Prevention of Contamination from Hands 3-202.18 Shellstock Identification * 590.004(B) Preventing Contamination from 3-203.12 Shellstock Identification Maintained'" Employees* TagsiRecords:Fish Products 13 Handwash Facilities Conveniently Located and Accessible 3--402.11 Parasite Destruction* 3-40112 Records, Creation and Retention* 5-203.11 Numbers and Capacities* 590,004(1) Labeling of Ingredients' 5-204.11 Location and Placement* � Conformance with Approved Procedures 5-205.11 Accessibility,Operation and Maintenance fHACCP Plans Supplied with Soap and Hand Drying 3-502.11 Specialized Processin Methods* Devices 3-502.1.2 Reduced oxygen packaging,criteria* 6-301.11 HandwashSneCleanser, Availability 6-103.12 Confotmance with Ap roved Procedures* 6-301.12 Hand Drying Provision 'Denotes orifi gal item in the tedeal 1999 Fapd Code or 1115 ChiR 590.000. CITY OF SALEM BOARD OF HEALTH Establishment Name: Cc Gn-,f 7, 1 Date: Pager of Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date No. Reference R-Red Item 9� Verified PLEAS PRINT CLrfARLV f m . Ef oo n oaccJ 'f 2 .frau 1 Q ( � I r (. 9446 -zx, j(6Dqa)7 Ot 511&P a 082 67 7. f Discussion With Person in Charge: j Corrective Action Required: ❑ No Yes have read this report, have had the opportunity to ask questions and agree to correct all ❑ Voluntary Compliance ❑ Employee Restriction/ inspection, to observe all conditions as described, and to Exclusion violations before the next ins P La Re-inspection Scheduled ❑ Emergency Suspension comply with all mandates of the Mass/Federal Food Code. I understand that noncompliance may result in daily fin s of4w my-five d II or suspension/revocation of ❑ Embargo ❑ Emergency Closure your food permit. �� �O,. � ❑ Voluntary Disposal ❑ Other: . v 3-501.14(C) PHFs Received at'lemperatures Violations Related to Foodborne Illness lnterventfons and Risk According to I-iw Cooled to Factors(Items 1-22) (Coni.) 41F/45'F Within 4 Hours. PROTECTION FROM CHEMICALS 3-501.15 Coolm, Methods for PHFs 14 Food or Color Additives 19 PHF Hot and Cold Holding 3-202.12 Additives" 3-50(16(13) Cold PHFs Maintained at or below 590.0(W(F) 41°1451 F* .r 3-302.14 Protection frorn Una) roved Additives" 1_-501.16(A) Hot PHFs'Maintained at or abotie. 's15 Poisonous or Toxic Substances 140°F. * 7-10L1l Itlentrfying Information-(h'iginal 3-501,M A) Roasts Held at or above 130'F. Containers' 7-102.11 Commies Name-Workin-Containers" 20 Time as a Public Health Control 7-201.11 Se raraiiom-Storage( 3-501.(9 Time as a Public Health Control* 7-202.11 Restriction-Presence and_Use" 590.004(H) Variance Requirement 7-202.12 Conditions of Usa 7-2031.1 Toxic Containers-Prohibitions* REQUIREMENTS FORWIGHLYSUSCEPTIRLE 7-204.11. Sanrtu rrs,Critera-ChemiclW POPULATIONS(HSP) 7-204.12 01cmicals for Washing Paith e.e, Criteria" 21 3-801.11(A) Unpasteurized Pre-packaged Juices and Beverages with Watmmg Labels- 7-204.74 Dr inn Agents.Criteria* - 7-2(15.11 Incidental Food Contact,Lubricants* 3-801.11(13) Use of Pasteurized Eggs* 7-206.1 1 Restricted Use Pesticides. Criteria* 3-80111(D) Raw or Partially Conked Animal Food and Raw Seed S trout's Not Served. 's 7-206.12 Rodent Bait Stations* 3-g01.11(C) Uno.enact Fond Package hot Re-served. 7.206.13 Tracking Powders,Pest Control and MonitminL* CONSUMER ADVISORY TIMEfTEMPERATURE CONTROLS 22 3-603.11 Consumer Advisory Posted for Consumption of Animal Foods"That are Raw.Undercooked or 16 Proper Cooking Temperatures for PHFs Not Otherwise Processed to Eliminate 3401.11A(ll(2) Eggs- 155'F is Sec. Pathosens.^`enacuv�arozooi b yas-Lmnedmte Service 145'Fi Ssec* 3-302.13 Pasteurized Eggs Substitute for Raw Shell .11(A)(2) Cottumnuted Fish,Meats&Game - plies- 3-101 Animals- 155'F 15 sec. 3-401.1 l(B)(1)(2) Pork and Beef Roast- 130°F 121 min* SPECIAL REQUIREMENTS 3-401.11(A)(2) Ratites, Injected Meats-155'F '15 590.009(A)-(D) Violations of Section 590.009(A)-(D)in Sec. t catering, mobile food,temporary acid 3-401.11(A)(,3) Poultry,Wild Game,Stuffed PHFs, residential kitchen operations should be Stuffing Containing Fish,Meat, debited under the appropriate sections Poultry or Ratites-165'F 15 sec. 1° above if related to foodborne illness 3--10111(C)(3) Whole-muscle,Intact Beef Steaks interventions and risk factors. Other 145"17t _ 5.9,0.009 violations relating to good retail 3-401.12 Raw Animal Foods Cooked in a practices should be debited under#29 Microwave 165'F* Special Requirements. 3461-11(A)(1)(h) All Other PHFs- 145715sec. 17 Reheating for Hot Holding VIOLATIONS RELATED TO G000 RETA/L PRACT/CES 3-403.11(A)&(D) PUFs 165�F 15 sec. * (Items 23-30) 3-403.11(13) Microwave-165'F 2 Minute Standing Critical and non-critical violations,which do not relate to the Tune' foodborne illness Into ventions and risk factors listed above, eon be 3-403.I.1(C) Commercially Processed RTE Food- ,found 4t the fnllowfng sections of the Food Code and 105 CMR 140'Ft 590.000. _ 3-403.11(E) RemainingUnslicedPortions of,Bcef Item Good Retail Practices FC 590.000 Roasts` 23. Mona anent and Personnel.... _ FC-2 .003 18 Proper Cooling of PHFs 24. Food and Food Protection FC-3 .004 25. Egupment and Utonsils FC 4 .005 3-501.14(A) Cooling Cooked PHFs from 140°F to 26Water.Plurnbinq and Waste FC 5 .006 70'F Within 2 Hours and From 70'F 27. Ph sicai Facility FC-6 .007 _ Y__. to 41'F/45°F Within 4 Hours. * 23. Poisonous or Toxic Materials FC-7 .00& 3-501.14(13) Cooling PHFs Made From Ambient _29. S racial Re uirements .009 Temperature Ingredients to 41°F/45°F 30._ ..Other _. . . Within 4 Hours'r led6-2 J'° "Denotes critical item in the federal 1994 Food Code or 105('h-IR 590.000. rCITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH _ 120 WASHINGTON STREET, 4TH FLOOR o 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: Caffe Graziani Address of Establishment: 133 Washington Street Owner's Name: Paula Gravallese and Giovanni Graziani Restrictions: Application Date: 12/01/2004 Permit for Food Establishment 93-05 Frozen Desserts/Ice Cream Permit for the Sale of Tobacco Products These Permits Expire December 31, 2005 This permit is not transferable and must be reissued upon change of ownership or location. The permit must be posted in a prominent location in the Establishment, In accordance with the State Sanitary Code, before any renovations, improvements, or equipment changes are made, all plans for such must be submitted to and approved by the Salem Board of Health. HEALTH AGENT CITY OF SALEM, MASSACHUSE /C UIV o ' BOARD OF HEALTH `s^ til D e s, 120 WASHINGTON STREET, 4TH FLOOR SALEM, MA 01970 71 NOV 3 0 2004 TEL. 978-741-1800 FAX 978-745-0343 CITY OF SALEM STANLEY J. LISOVICZ, JR. JOANNE SCOTT, MPH, RS, CHO BOARD OF HEALTH MAYOR HEALTH AGENT 2005 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT"/ NAME OF ESTABLISHMENT (?JJCi�P Gr6cZ( al( TEL# — ADDRESS OF ESTABLISHMENT 133 MAILING ADDRESS (if different) ��Yr OWNER'S NAME�ctd�a 9aw,211ese TEL# Z 7.,r-7 1�4/ ADDRESS 14 7%ar5fvr ST CITY_F STATE zip O-a-f a-� 'P CERTIFIED FOOD MANAGER'S NAME(S) J`gpt(, C, CERTIFICATE#(sL_775d� (required in an establishment where potentially hazardous food is prepared.) EMERGENCY RESPONSE PERSON–"/?,,,(, of HOME TEL# �2 HOURS OF OPERATION: Mon. Tue. ✓Wed. cThu. V Fri.vSat. v Sun. TYPE OF ESTABLISHMENT FEE check only RETAIL STORE YES NO less than 1000sq.ft. =$ 50 1000-10,000sq.ft. =$100 more than 10,000sq.ft. =$250 RESTAURANT YES NO ! � 'd� less than 25 seats =$100 25-99 seats more than 99 seats =$200 BED/BREAKFAST YES NO $100 ADDITIONAL PERMITS MAKE (not just serve) ICE CREAM, YOGURT, SOFT SERVE YES O $5 TOBACCO VENDOR YES O $50 ALL NON-PROFIT(such as church kitchens) VFq O $25 Please pay total with one check payable to the City of Salem This Permit is not transferable and must be reissued upon change of ownership. The Permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code, before any renovations, improvements, or equipment changes are made, all plans for such must be submitted to and approved by the Salem Board of Health. Pursuant to MGL Chapter 62C, Section 49A, I certify under the pains and penalties of perjury that I, to my best knowledge and be have filed all state tax return anO paid all state taxes required under the law. O S �� V - Sig at Date Social Security or Federal Identification Number -- ---- ---- lI Revised 11/03/03 FOOD P2. dm Check#& Date3),3% �Jsd 0133-WASHINGTON STREET Caffe Graziani �- City of Salem FOOD SERVICE ESTABLISHMENT - FOOD SERVICE Inspection HACCP: ❑ Telephone`. Item Status Violation Critical Urgency Nature of problem or correction 741-4282 - - Non-compliance with: Not Done Owner: Anti-Choking PASS ❑ Cafe Graziani Inc. `r Tobacco PASS ❑ PIC: eUIa GraValleSe and GiOva FOOD PROTECTION MANAGEMENT Not Done P ❑d `PPIC Assigned/Knowledgeable/Duties PASS RED Inspector: Gr Janet Dionne EMPLOYEE HEALTH Not Done Date Inspected: Correct By: Reporting of Diseases by Food Employee and PIC PASS Q RED y J4/14/2005 Personnel with Infections Restricted/Excluded PASSd❑ RED Risk Level: FOOD FROM APPROVED SOURCE Not Done Permit Number Food and Water from Approved Source PASSd❑ RED 6HP-2005-0183 Receiving/Condition PASS Q RED Status: Tags/Records/Accuracy of Ingredient Statements PASS ❑d RED Open #of Critical Violations: Conformance with Approved Procedures/HACCP PASS ❑d RED ,. ,^ ,. Plans PROTECTION FROM CONTAMINATION Not Done Time IN: ...Time OUT: Separation/Segregation/Protection PASS ❑d RED Notes Food Contact Surfaces Cleaning and Sanitizing PASS ❑d RED 92:no extermination report on Proper Adequate Handwashing PASS ❑d RED hand. Owner to fax copy of most recent report to board of Good Hygienic Practices PASS ❑d RED health office. Prevention of Contamination from Hands PASS ❑d RED Urgency Description(s): Handwash Facilities PASSd❑ RED BLUE: Violations Related to Good Retail Practices (Critical GeOTMS®2005 Des Lauriers Municipal Solutions, Inc. ( Rev. Apr 14,2005 ) Page / of 0133 ASHINGTON STREET Caffe Graziani violations Illuf';i be corrected PROTECTION FROM CHEMICALS Not Done Immediately or within 10 _ Approved Food or Color Additives PASS ❑d RED days)(Non-critical violations must be corrected immediately Toxic chemicals PASS ❑D RED or within 90 days) TIMEITEMPERATURE CONTROLS(Potentially Haz Not Done RED: Cooking Temperatures PASS RED Violations Related to IT Foodborne Illness Interventions Reheating PASS ❑O RED and Risk Factors(Require Cooling PASS ❑d RED timmediate corrective action) Hot and Cold Holding PASS 0 RED Time As a Public Health Control PASS RED REQUIREMENTS FOR HIGHLY SUSCEPTIBLE PO Not Done Food and Food Preparation for HSP PASS ❑d RED CONSUMER ADVISORY Not Done Posting of Consumer Advisories PASS ❑J RED Violations Related to Good Retail Practices (Blue Not Done Management and Personnel PASS ❑ BLUE Food and Food Protection FAIL Critical ❑ BLUE F d stored on Floor. all food to be stored at least 6-8 inches off floor. rdan and hordorves unit had some uncovered food. all food in storage must be covered at all times. same unit had accumulation of debris on shelves.thoroughly clean shelves. 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. Apr 14,2005 ) Page 2 of 0133.WASHINGTON STREET Caffe Graziani GeoTMS®2005 Des Lauriers Municipal Solutions, Inc. ( Rev. Apr 14,2005 ) Page 3 ora 0133 WASHINGTON STREET Caffe Graziani City of Salem FOOD SERVICE ESTABLISHMENT - FOOD SERVICE REINSPECTION Inspection HACCP: ❑ Telephone: Item Status Violation Critical Urgency Nature of problem or correction 741-4282 - -_ Non-compliance with: Done Owner: Anti-Choking - PASS ❑ Cafe Graziani Inc. Tobacco PASS ❑ PIC: Paula Gravallese and Giova FOOD PROTECTION MANAGEMENT Done Inspector: - PIC Assigned/Knowledgeable/Duties PASS RED Janet Dionne EMPLOYEE HEALTH Done Date Inspected: Correct By: Reporting of Diseases by Food Employee and PIC PASS ❑d RED 4/28/2005 - - Personnel with Infections Restricted/Excluded PASS RED Risk Level: FOOD FROM APPROVED SOURCE Done Permit Number: = Food and Water from Approved Source PASS RED BHP-2005-0183 : Receiving/Condition PASS ❑d RED Status: Tags/Records/Accuracy of Ingredient Statements PASS RED Closed #of Critical Violations: -. Conformance with Approved Procedures/HACCP PASS d❑ RED Plans PROTECTION FROM CONTAMINATION Done Time IN: Time OUT: Separation/Segregation/Protection PASS ❑ RED Notes: Food Contact Surfaces Cleaning and Sanitizing PASSd❑ RED 117:offlce received ComplaintProper Adequate Handwashing PASSd❑ RED of bathrooms being dirty and . rusty. No sanitary violations Good Hygienic Practices PASSd❑ RED were seen at time of Prevention of Contamination from Hands PASS Q RED inspection. accumulation of rust in both toilets owner to Handwash Facilities PASS ❑/ RED remove rust accumulation. 11 Urgency Description(s): GeoTMSO 2005 Des Lauriers Municipal Solutions, Inc. ( Rev. Apr 28,2005 ) Page ! of2 Ir 0133 WASHINGTON STREET Caffe Graziani BLUE: - PROTECTION FROM CHEMICALS Done Violations Related to Good Approved Food or Color Additives PASS ❑d RED Retail Practices (Critical - _ violations must be corrected Toxic chemicals PASS RED Immediately Or within 10 TIMEITEMPERATURE CONTROLS(Potentially Haz Done days)(Non-critical violations Cooking Temperatures PASS ❑d RED must be corrected immediately or within 90 days) , Reheating PASSd❑ RED RED: Cooling PASS ❑Q RED Violations Related to _ Foodborne Illness Interventions Hot and cold Holding PASS ❑D RED and Risk Factors (Require immediate corrective action) _ ', Time As a Public Health control PASS ❑Q RED REQUIREMENTS FOR HIGHLY SUSCEPTIBLE PO Done Food and Food Preparation for HSP PASS RED CONSUMER ADVISORY Done Posting of Consumer Advisories PASS RED Violations Related to Good Retail Practices (Blue Done Management and Personnel PASS ❑ BLUE Food and Food Protection PASS ❑ BLUE Equipment and Utensils PASS ❑ BLUE Water, Plumbing and Waste PASS ❑ BLUE Physical Facility PASS ❑ BLUE Poisonous or Toxic Materials PASS ❑ BLUE Special Requirements PASS ❑ BLUE Other-See Notes PASS ❑ BLUE all other violations cited in 4/14/05 report have been corrected. than you. (;av GeoTMS®2005 Des Lauriers Municipal Solutions, Inc. ( Rev. Apr 28,2005 ) Page 2 of 0131 WASHINGTON STREET Cafife Graziani City of Salem FOOD SERVICE ESTABLISHMENT - FOOD SERVICE REINSPECTION Inspection HACCP: ❑ Telephone: r, hem Status Violation Critical Urgency Nature of problem or correction 4 741-4282 Non-compliance with: Done Owner: Anti-Choking-590.009(E) PASS ❑ Cafe Graziani Inc. Tobacco-590.009(F) PASS ❑ PIC: FOOD PROTECTION MANAGEMENT Done Inspector: PIC Assigned/Knowledgeable/Duties- PASS ❑� RED p r _ 590.003(A),590.003(B), 2-103.11 Janet Dionne A EMPLOYEE HEALTH Done Date Inspected: Correct By: "" Reporting of Diseases by Food Employee and PASSd❑ RED 5/12/2005 PIC-590.003(C),590.003(F),590.003(G) ` Personnel with Infections Restricted/Excluded- PASS ❑d RED Risk Level: _ 590.003(D),590.003(E) x FOOD FROM APPROVED SOURCE Done Permit Number _ Food and Water from Approved Source- PASS ❑d RED BHP-2005-0183 .. 590.004(A-B),3-201.12,3-201.13,3-202.13,3- 202.14,3-202.16,5- `$tatUS: 101.11,590.006(A),590.006(B),3-201.14,3- [Closed s; 201.15,3-202.18,590.004(C),3-201.17 #of Critical Violations' Receiving/Condition-3-202.11,3-202.15,3-101.11 PASS RED - Tags/Records/Accuracy of Ingredient PASS RED Time IN: Time OUT: _ Statements-3-202.18,3-203.12,3-402.11,3- 402.12,590.004(J) Notes: - Conformance with Approved Procedures/HACCP PASS ❑d RED Plans-3-502.11,3-502.12,8-103.12 RE-inspections was conducted_ based on a complaint of the cleanliness of the restrooms. Upon inspection the main complaint of rust in the toilet bowls had been corrected. No other violations seen at time of inspection. All other violations have been corrected.. Thank GeOTMS®2005 Des Lauriers Municipal Solutions, Inc. ( Rev. May 12,2005 ) Page 1 of 3 0133 WASHINGTON STREET Caffe Graziani you PROTECTION FROM CONTAMINATION Done .z Separation/Segregation/Protection-3- PASSd❑ RED Urgency Description(s): ` 302.11(A)(1),3-302.11(A)(2),3-302.11(A),3- BLUE: 302.15,3-304.11,3-306.14(A)(B),3-701.11 Violations Related to Good Food Contact Surfaces Cleaning and Sanitizing- PASS RED Retail Practices Critical 4-501.111,4-501.112,4-501.114,4-601.11(A),4- ( f 602.11,4-702.11,4-703.11 violations must be corrected Proper Adequate Handwashing-2-301.11,2- PASSd❑ RED immediately or within.10 L 301.12,2-301.14 days)(NOn-critical violations Good Hygienic Practices-2-401.11,2-401.12,3- PASS Q RED must be corrected immediately-' 301.12 or within 90 days) Prevention of Contamination from Hands- PASSd❑ RED RED: r 590.004(E) Violations Related to- Handwash Facilities-5-203.11,5-204.11,5- PASSd❑ RED Foodborne Illness Interventions205.11,6-301.11,6-301.12 and Risk Factors (Require PROTECTION FROM CHEMICALS Done immediate corrective action) Approved Food or Color Additives-3-202.12,3- PASS ❑Q RED 302.14 Toxic Chemicals-7-101.11,7-102.11,7-201.11,7- PASS ❑Q RED 202.11,7-202.12,7-203.11,7-204.11,7-2 04.12,7- 204.14,7-205.11,7-206.11,7-206.12,7-206.13 TIME/TEMPERATURE CONTROLS(Potentially Haz Done Cooking Temperatures-3-401.11A(1)(2),3- PASS Q RED 401.11(A)(2),3-401.11(6)(1)(2),3-401.11(A)(2),3- 401.11(A)(3),3-401.11(C)(3),3-401.12,3- 401.11(A)(1)(b) Reheating-3-403.11(A)&(D),3-403.11(B),3- PASS ❑d RED 403.11(C),3-403.11(E) Cooling-3-501.14(A),3-501.14(B),3-501.14(C),3- PASS RED 501.15 Hot and Cold Holding-3-501.16(B)590.004(F),3- PASS ❑Q RED 501.16(A),3-501.16(A) Time As a Public Health Control-3- PASS ❑./ RED 501.19,590.004(H) REQUIREMENTS FOR HIGHLY SUSCEPTIBLE PO Done Food and Food Preparation for HSP-3- PASS ❑d RED 801.11(A),3-801.11(B),3-801.11(D),3-801.11(C) CONSUMER ADVISORY Done Posting of Consumer Advisories-3-603.11,3- PASS ❑d RED 302.13 GeoTMS®2005 Des Lauriers Municipal Solutions, Inc. ( Rev. May 12,2005 ) Page 2 of 01."'3-'WASHINGTON STREET Caffe Graziani Violations Related to Good Retail Practices (Blue Done Management and Personnel-(FC-2)(590.003) PASS ❑ BLUE Food and Food Protection-(FC-3)(590.004) PASS ❑ BLUE Equipment and Utensils-(FC-4)(590.005) PASS ❑ BLUE Water, Plumbing and Waste-(FC-5)(590.006) PASS ❑ BLUE Physical Facility-(FC-6)(590.007) PASS ❑ BLUE Poisonous or Toxic Materials-(FC-7)(590.008) PASS ❑ BLUE Special Requirements-(590.009),590.009(A)-(D) PASS ❑ BLUE Other-See Notes- PASS ❑ BLUE GeoTMS®2005 Des Lauriers Municipal Solutions, Inc. ( Rev. May 12,2005 ) Page 3 of FROM :CAFFEGRAZiANi FAX NO. :9767448665 Apr. 20 2005 08:00AM PS 10 U s rl -e--r-7 Ues 01.1 Ext Turin t�7T5 PLEA5EAEMITPAYMENTT4: 183 SNEPARO EBTT L ,MA 01802 4607 10 E. ... ¢QURRENTta Ly,MA 190 *0«t.4 A�® 78tr682-29ar 1-e00-626.4e25 FAX]81.692.7en Pest an8 Termite GTnUOI Prafess+ana� 177514 ". z.. ." DAYS 0,0009-: w DAT4 DAY Yve 6a E C01) AccT rvo. 1305700 TEC14 050f 7 ' 0419 Trte ,109 44/19/05 NTCtV$I CAFE GRRZANI CONTROL FOR j VE' CQNTRCL F'RVRYICE'CHAROE 175. 20 WASHINGTON ST N/M6ER UNIT r AMOUNT" SALEM 'Mfa. 01972 tOUSEOLaD .. 978-7x1! -'4288? 05/07/01 0Zc•0--70 `��'' MULTI-CTTRAPt j . DRTE "'i 7 �'� Pt{OTE6TA- __ y CHECK NO COMMENTS - •-f'cw- - 0VISA. fkDISCOVER -AaTGLUEtffi TCP MICE $17: PLUS PRCID SERTING .....,,,.. :.';. ARTA/KITCHEN/i;RRt ACGr SMALL STQRAU[ .RM %DOES NOT EXP DATE ESttX (`\ Ir�tCLUDE sSMT) I)POPPINI� FOUND IN }2R d STORAGE cHop wcp IOTA DUE_ `� " a fe :1 .,,45, _ -iOTALAMU.NrrD jp ! jili 111 ADDITIONAL G,D�AM�NT$ 1 ' ; «r r COMMERCIAL SANITATION REPORT •YES Nb i. . .. . ' Floors Glean CJ - p -. .,... Counter Suncces.-Glean = 1 G . .. .. .... RestReotris—.Ctn....,.- ..::..i....... Dining Areas-Cle9n...'.,,... .. Employee Area6 ..... 0 � d Locker Areas:-Clean .. p _ d - RESIDENTIAL wARRANTY tNFORN{AT1ON Storage Areas—Organized .. 0 0 DWELLING TYPE `WARRANTY' YES13 NOLf comments t Family "d 3 Family ❑ 30 Days d 60 Days d :....:.2-Eamlly.'.C1 BFamily 0 80 Days .d SMos. . ❑ -. REASON FOEINaWARRANTY :Partial soroice reCuested.. ......................... .. ..❑ . .-. ..-POW APPLIGATION-REQUIREMENTS .. .,inet.. - Ia -Kitchen/bathroomc0binets not prepares .......... ... ...... ..--❑ ane HOURS, i' :nknMathmnitura not 0rapared._.................._........,,.............,..,._._......:...❑' " OCCUatEDA `RI, Mua1 ec .,..,,,.w..v.. .THOROUGHLY.VENTILATE TREATED AREAS BEFORE THEY ARE 'REOCCUPIED.DO NOT ALLOW ADULTS.CHILDREN;OW PETS;ON; •Rodent ptODfing nReded .:::..:.. . ... ....... .......... ....... .........u LTREATEP$URFACE&UNTILDf;Y. .... ., ....... ... .... _.... :•Other.... .. .. .....,.. .: .....,... c, ,. ,......_.' CC=GN_T+RACTING ENTITIES" A ECEVEDAtUmAS$AOHUSETTs OEPAWTMENT.&FODDS AGR1CULTUAE6PE$k4m TlO4flIlL BTIREAUCONSUMEA WfiRTENSTATEPAENT5;PO6TNdGNOTICESANDHAVEAGREED TONOTIFVTENNVTSt7 DAYS PROP TO TIME MEMW SERVICE RAS BEEN SATISFACTORILY COMPLMM.,,,m s'i C TOMER , LIC p CH TEOH NO. 312 -�- _..._••�....'.n•,tATlnu, wtide—Otlke.CopK CwAN—Customer Coat Fmk—Rmksence CgpY i I I - CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH _ 120 WASHINGTON STREET, 4TH FLOOR SALEM, MA 01970 •�,QAIlB 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 111, 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: Caffe Graziani Address of Establishment: 133 Washington Street Owner's Name: Paula Gravallese and Giovanni Graziani Restrictions: Application Date: 12/2/2003 Permit for Food Establishment 79-04 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. HEALTH AGENT e CITY OF SALEM, MASSACHUSETTS o ; •- " BOARD OF HEALTH '`✓" �� • + 120 WASHINGTON STREET, 4TH FLOOR . SALEM, MA 01970 NOV 19 2003 TEL. 978-741-1800 FAX 978-745-0343 _ STANLEY USOVICZ, JR. CITY OF SALEM JOANNE SCOTT, MPH, RS, CHO BOARD OF HEALTH MAYOR HEALTH AGENT 2004 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT NAME OF ESTABLISHMENT� 6raztarn ! / TEL# �7�7/y�/ l�Za°Z ADDRESS OF ESTABLISHMENT /3 3 l(/RS,4 fZ7 MAILING ADDRESS (if different) GUT-ea',';NAME 9ro✓a. 171 GUT—rvnr 44r/4, (;;vya&41e TEL# Gl7SG 7 se - 7 ADDRESS /-/ 74 oo-5 7,1w,7 5r CITY E STATE 4 zip o 2- CERTIFIED FOOD MANAGER'S NAME(S) ✓ CERTIFICATE#(s) 3 (required in an establishment where potentially hazardous food is prepared.) GrO�/annr Gr7�,21an% EMERGENCY RESPONSE PERSON Cpm yra HOME TEL HOURS OF OPERATION: Mono �Tue. 9,'3 Wed.�Thu.F-3 Fri.fLJVSat. Orr F Sun. 730— ' TYPE OF ESTABLISHMENT FEE check only RETAIL STORE YES NO less than 1000sq.ft. =$ 50 1000-10,000sq.ft. =$100 more than 10,000sq.ft. =$250 RESTAURANTES NO �A � less than 25 seats =$100 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 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. �kno L Chapter 62C Section 49A, I certify under the pains and penalties of perjury that I, to my belie , e fled all to tax retur s and paid all state taxes required under the law. ature Date Social Security or Federal Identification Number ----------------------- -------------------------------------------------------------------------------------------------- Revised 11/03/03 FOODAP2.adm Check#&Date o7�/87�`//'�&'� / �J `� Massichusetts Department of Public Health Salem Board of Health Division of Food and Drugs 120 Washington Street,4th Floor Salem, MA 01970-3523 FOOD ESTABLISHMENT INSPECTION REPORT Tel. (978) 741-1800 Fax(978) 745-0343 Name Date Tvoe of 0n (s) Type of Inspection O/x-10 ❑ Food Service Ll Routine Address / Risk i ❑ Retail 01Re-inspection 1 Level ElResidential Kitchen Previous Inspection Telephone _ ❑ Mobile Date:/®�g/��f El Temporary Temporary Pre-operation Owner, / //p C /� n 1 ' !Z/i/ai) HACCP YM ❑ Caterer ❑Suspect Illness Person iri Charge(PIC) Time ❑ Bed&Breakfast ❑ General Complaint ��}7f In: ElHACCP Inspector I r Out: Permit No. ❑ Other Each violation checked requires an explanation on the narrative page(s) and a citation of specific provision(s)violated. Non-compliance with: Violations Related to Foodborne Illness Interventions and Risk Factors Anti-Choking Tobacco Violations marked may pose an imminent health hazard and require immediate corrective 590.009(E) ❑ 590.009(F) ❑ action as determined by the Board of Health. FOOD PROTECTION MANAGEMENT F-112. Prevention Of Contamination from Hands El 1. PIC Assigned/Knowledgeable/Duties EMPLOYEE HEALTH _ - ❑ 13. Handwash Facilities PIC PROTECTION FROM CHEMICALS El 2. Reporting of Diseases by Food Employee and PIC �- ❑ 3. Personnel with Infections Restricted/Excluded ❑ 14.Approved Food or Color Additives FOOD FROM APPROVED SOURCE - - - " ❑ 15.Toxic Chemicals c - TIMEITEMPERATURE CONTROLS ❑ 4. Food and Water from Approved Source (Potentially Hazardous Foods) ❑ 5. Receiving/Condition ❑ 16.Cooking Temperatures ❑ 6. Tags/Records/Accuracy of Ingredient Statements ❑ 17. Reheating ❑ 7. Conformance with Approved Procedures/HACCP Plans ❑ 18. Cooling - PROTECTION FROM CONTAMINATION " - ® 19. Hot and Cold Holding ❑ 8. Separation/Segregation/Protection ❑20.Time As a Public Health Control ❑ 9. Food Contact Surfaces Cleaning and Sanitizing REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) ❑ 21. Food and Food Preparation for HSP ❑ 10. Proper Adequate Handwashing ❑ 11. Good Hygienic Practices k CONSUMER ADVISORY ❑22. Posting of Consumer Advisories i 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 of Health. today, the items checked indicate violations of 105 CMR Ca N 590.000/federal Food Code. This report, when signed below 23. Management and Personnel (FC-2)(590.003) by a Board of Health member or its agent constitutes an 24. Food and Food Protection (FC-3)(590.004) order of the Board of Health. Failure to correct violations 25. Equipment and Utensils (FC-4)(590.005) cited in this report may result in suspension or revocation of the food establishment permit and cessation of food 26. Water, Plumbing and Waste (FC-5)(590.006) establishment operations. If aggrieved by this order, you 27. Physical Facility (FC-6)(590.007) have a right to a hearing. Your request must be in writing 28. Poisonous or Toxic Materials (FC-7)(590.008) and submitted to the Board of Health at the above address 29. Special Requirements (590.009) within 10 days of receipt of this order. 30. Other DATE OF RE-INSPECTION: S.501nsp ctFo m 114 de I / 1 Iuspe�tliT atar : �� Print: PIC;Jwgrgnatore- 1= Print: Page of Pages Violations Related to Foodborne Illness Interventions and Risk Factors(Items 1-22) PROTECTION FROM CONTAMINATION FOOD PROTECTION MANAGEMENT I Cross-contamination 1 590-003(A) Assignment of Responsibility` 3-302.1 t(A)(I) Raw Animal Foods Separated from 590.003(B) Demonstration ofKnoutedge* _ Cooked and RTE Foods* 2-103.11 Person in charge-dudes Contamination from Rawfngredients 3-302.11(A(2) Raw Animal Foods Separated from Each EMPLOYEE HEALTH Other' 2 590.003(C) Responsibility of the person in charge to Contamination from the Environment require reporting by foot employees and 3-302.11{A) Foal Protection* applicants* 3-302.15 Washing Fruits and Vegetables 590.003(F) Responsibility Of A Food Employee Or An 3304.11 Food Contact with Equipment and Applicant To Report To The Person In Utensils* Char-e* Contamination trom the Consumer 590.003(6) Repo tinby Person in Charge* 3-306.14(A)(B) Returned Food and Reset vice of Food- 3 590.003(DI Exclusions and Restrictions* Disposition of Adulterated or Contaminated 590.003(11,) Removal of Exclusions and Restrictions Food 3-701..11 Discarding or Reconditioning unsafe FOOD FROM APPROVED SOURCE Food` 4 Food and Water From Regulated Sources 9 Food Contact Surfaces 590.004(A-B) Compliance with Food Law* 4-501.111 Manual Warewasinng-[lot Witer 3-201.12 Food in a Hermetically Sealed Container" Sanitization Tem eratures* : 201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Warewashing-Hot Water 3-202.13Shell E�> s* Sanitization Temperatures* 3-202.14 Eggs and Milk Products,Pasteurized" concentration Chemical Sanitization-temp..pH, :oncentration and hat'dness 4` 3-202.16 Ice Made From Potable Drinking atter* ` 5-101.11 4-601.11(A) Equipment Food Contact Surfaces and Drinking Water from an Approved Srstcm'" 590.006(A) Bottled Drinking Water* LRensiIs Clean- 4-602.11 Cleaning Frequency of Equipment Food- 590.006(B) Water Meets Standards in 310 CMR 22.0* Contact Surfaces and Utensils* Shellfish and Fish From an Approved Source 4-702.1 1 Frequency of Sanitization of Utensils and 3 01.14 Fish and Recreationally Caught Molluscan Food Contact Surfaces of Equipment* Shellfish* 4-703.11 Methais of Sanitization-Hot Water and 3-201.15 Molluscan Shellfish from NSSP listed Chemical* Sources'" 10 Proper,Adequate Handweshing Game and Wild Mushrooms Approved by Re mato ry AutOorit 2r301.11 Clean Condition-Hands and Arens* 3-202.1.8 Shellstoek Identification Present' 2-301-12 Cleaning Procedure` 590.004(C) Wild Mushrooms* 2-301.14 When to Wash* 3-201.17 Game Animals* 11 Good Hygienic Practices g ReceivingfCondition2-401.11 Eat in ,Drinking or UsingTobacco* 3-202.11 P11Fs Received at P o cr Tetn)eramres" 2-401.12 Discharges From the Eyes.Nose enol 3-202-15 packagelnicerit,* Mouth' 3-101.1.1 Food Safe and Unadulterated'' 3-301.12 Preventing Contamination W * hen Tasting* 6 Tags/Records:Shellstack 12 Prevention of Contamination from Hands 3-202-18 Shellstoek Identification* 590.004(E) Preventing Contamination from 3-203.12 Shellstoek Identification Maintained* Em lovees* Tags/Records:Fish Products 13 Handwash Facilities 3=102.11 Parasite Destmction^' Conveniently Located and Accessible 3-402.12 Records,Creation and Retention* 5-203.11 Numbers and Ca ochres* 590.004(7) Labeling of Ingredients' r6-301.11 04.11 Location and Placement* 7 Conformance with Approved Procedures 05-11 Accessibilit eeration and Maintenarme /HACCP Plans SuppGod with Soap and Hand Drying 3-502.11 S ecialized Proeessin r Methods* Devices 3-502.12 Reduced oxygen packaging,criteria" I3andwashine Cleanser.Availabilit y8-103.12 Conformance with A roved Ptoceitnresy 01.12 Hand Drvin Provision '"Denoiec cratoal item in the federal 1999 Food Code or 105 CNIR 590.000. CITY OF SALEM BOARD OF HEALTH Or Establishment Name: ( Ci Y ( ),V7, 7I/Z t. Date: A)AS /D Page: oZ of Item Code C—critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date No. Reference R-Red Item Verified F PLEASE PRINT CLEARLY a� CC rrea 1 /J✓ C j 6tA)PU R AVXO 1 r j(JZu2 1 t r.9. YV7 f 1. ar/ r /,?. l 0- �/tcA � D'6 ail _// t) W fdt . Discussion With Person in Charge: Corrective Action Required: ❑ No ❑ Yes I have read this report, have had the opportunity to ask questions and agree to correct all ❑ Voluntary Compliance ❑ Employee Restriction/ Exclusion violations before the next inspection, to observe all conditions as described, and to ❑ Re-inspection Scheduled ❑ Emergency Suspension comply with all mandates of the Mass/Federal Food CodeXl)-understand that noncompliance may result in daily fines of twent v B Fars or suspension/revocation of Ll Embargo LI Emergency Closure your food permit. ���� ❑ Voluntary Disposal ❑ Other. v E 3-501-14(C) PHFs Received at Ten?(ieratures Violations Related to Foodborne Illness Interventions and Risk Ac:ording to Law Cooled to Factors(items 1-22) (Cont.) 41'F/45'F Within 4 Hours. PROTECTION FROM CHEMICALS 3-501.15 Coolinv Methods for PHFs 14 Food or Color Additives 19 PHF Hot and Cold Holding 3-202.12 Addnnc,S,x _ 3-501.16(?) Cold PfffWs Maintained at or below --59t).001(F) 4i"145°F* 3-302.14 Pois ousion om Toxic rP oven Additives* 3-501,16(A) Hot PHFs Maintained at or above 15 Poisonous or Toxic Substances 140'R * 7-101.11 Identifying Information-Original 3-50116(A) Roasts Held at or above 130'P. Containers"` 7-102.11 Common Name-Workim*Containers* 20 Time as a Public Health Control 7-201.11 Separation-Storage 3-501-19 Time as a Public Health Control* 7-202.17 Restriction-Presence and Ilse'" 590-004(1-1) Variance Re uircment 7-202.12 Conditions of Use, 7-203.11 Toxic Containers-Prohibitions"^ REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-204.11 Sanitizers,Criteria-Chemicals* POPULATIONS(HSP) 7-2@1.12 Chemicals for W ashin>Produce,Criteria* " 21 3-801.11(A) Unp steunzed Pre-packaged Juices and _2-204 14 Beverages with Warning Labels* Dr'in A*cuts,Criteria` _ - 7-205.11 incidental Fail Contact.Lubricants* 3-801.11(B) Use of Pasteurized Eaesl r 206.11 - Restricted Use Pesticides.Criteria* 3-801.1I(D) Raw or Partially CookedAnimal Fail and Raw Seed Sprouts Not Served.206.12 Rodent Bait Sders,Pe 3-g01.11(C) Uno cued Food Pa;ka re Not Re-served. X`206.13 Tracking Powders,pest Control and Monitoring* CONSUMER ADVISORY TIME)TEMPERATURE CONTROLS 22 3-603.11 Consumer Advisory Posted for Consumption of Animal Foods Fhat are Raw.Undercooked or 16 Proper Cooking Temperatures for PHFs Not Otherwise Processed to Eliminate 3-401.1.1A(1)(2) Fggs- 1.55 F 15 Sec. Palhoarens.*ECe`e""`^i0nr E ygs-hmmedtate Service 145'1715sec* 3-302.13 Pasteurized Eggs Substitute for Raw Shell 3-401.11(A)(2) Comminuted Fish,Meats Game Animals- 155°F 15 sec. 'x 3-401.11(B)(1)(2) Pork and Beef Roast- 13WF 121 min* SPECIAL REQUIREMENTS 3-401.11(A)(2) Ratites,Injected Meats-155'F 15 590.009(A) (D) Violations of Section 590.009(A)-(D)in sec, r catering, mobile food, temporary and 3-401.1 f(A)(3) Poultry, Wild Game,Stuffed PHFs, residential kitchen operations should be Staffing Containing Fish,Meat, debited under tate appropriate sections Poultr or Ratites-165°F 15 sec. xabove if related to foodborne illness 340111(C)(3) Whole-muscle,Intact Beef Steaks interventions and risk factors. Other 145"'* 590.009 violations relating to good retail 3-401.12 Raw Animal Foods Cooked in a practices should be debited under#29-- Microwave 165'F` Special Requirements. 3401,11(A)(1)(b) All Other PHFs- 145'F'15 see. * 17 Reheating for Hot Holding VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 3-403A I(A)&()) PHFs 1650F+ 15 sec. * (Itents 23-30) 3-403.11(B) Microwave-165' F2 Minute Standing Critical and non-critical violations, which do+rot relate to tyre Tine` ,foodborne diness interventions and risk factors listed above, can be 3-403.11(C) Commercially Processed RTF Food- found in the following,sections of the Food Code and 105 CMR 140°F" 590.000- -----....-. 3-103.1 1(P^^.) Remaining Unsliced Porrions of F1cef Item Goad Reiail Practices FC SBQAOo Roasts" 23. k anagsment and Personnel FC-2 .003 lg Proper Cooling of PHFs 24. Food and Food Protection __ FC_-3 .004 25.___E�t uipment and Utensils _ FC 4__.005 3-501.14(A) Cooling Cooked PHFs from 140`P to p6 Water,P_iu_mbin and W aste FC 5 .006 70°F Within 2 Hours and From 70°F 27. Physical FacilityFC-o" 1 .007 to 41''F145'F Within 4 Hours. * 28. Poisonous or Tors;Materials 3-501.14(8) Cooling PHFs Made From Ambient 29. S e;ial Re utrements .009 Temperature In to 41'F/45'F 30 Other Within 4 Hours* ssoorm,:cxw-z.m,� 'r Denote.,critical item in the Federal 1999 Foul Code or 105 CMR 590000. . . . -. .. . :e..'„•�'kr'+•.*«..•xGq}�,,.yy�,n_M1'Oo-fl,.�...v:...•.e-. ,w..v• ._C�,... ' " w:."�f.'11v/.,1;.- •,A„�q,i:, �'` ,..... . . _.. . 1 Massachlisetts 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 DateTvpe of Operation(s) Tvpe of Inspection A U 0 B FOOd Service ® Routine Address Rik ❑ Retail ❑ Re-inspection Telephone I Level ❑ Residential Kitchen Previous Inspection ❑ Mobile Date: OwnerHACCP Y/N El Temporary ElPre-operation 7 / / 3 7 ❑ Caterer ❑ Suspect Illness Person in Charge(PIC) Time ❑ Bed&Breakfast ❑ General Complaint Inspector In: El HACCP Out: Permit No. ElO herr O Each violation checked requires an explanation on the narrative page(s) and a citation of specific provision(s) violated. Non-compliance with: Violations Related to Foodborne Illness Interventions and Risk Factors Anti-Choking Tobacco Violations marked may pose an imminent health hazard and require immediate corrective 590.009(E) ❑ 590.009(F) ❑ action as determined by the Board of Health. FOOD PROTECTION MANAGEMENT - ❑ 12. Prevention of Contamination from Hands ❑ 1. PIC Assigned/Knowledgeable/Duties ] 13. Handwash Facilities EMPLOYEE HEALTH - . PROTECTION FROM CHEMICALS ❑ 2. Reporting of Diseases by Food Employee and PIC El 14 Approved Food or Color Additives ❑ 3. Personnel with Infections Restricted/Excluded a FOOD FROM APPROVED SOURCE El 15.Toxic Chemicals_. _„ : ❑ 4. Food and Water from Approved Source TIMENEMPERATURE CONTROLS(Potentially Haiardous Foods) ❑ 5. Receiving/Condition ❑ 16. Cooking Temperatures ❑ 6. Tags/Records/Accuracy of Ingredient Statements [:117. Reheating ❑ 7. Conformance with Approved Procedures/HACCP Plans ❑ 18. Cooling PROTECTIONS FROM CONTAMINATION - s ❑ 19. Hot and Cold Holding ❑ 8. Separation/Segregation/Protection ❑ 20.Time As a Public Health Control ICI 9. Food Contact Surfaces Cleaning and Sanitizing - REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) j- ❑21. Food and Food Preparation for HSP ❑ 10. Proper Adequate Handwashing ❑ 11. Good Hygienic Practices CONSUMER ADVISORY t. ❑ 22. Posting of Consumer Advisories Violations Related to Good Retail Practices Number of Violated Provisions Related Critical (C)violations marked must be corrected To Foodborne Illnesses Interventions immediately or within 10 days as determined by the Board and Risk Factors(items 1-22): �C 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 23. Management and Personnel (FC-2)(590.003) by a Board of Health member or its agent constitutes an 7 24. Food and Food Protection (FC-3)(590.004) order of the Board of Health. Failure to correct violations 25. Equipment and Utensils cited in this report may result in suspension or revocation of (FC-4)(590.005) the food establishment permit and cessation of food 26. Water, Plumbing and Waste (FC-5)(590.006) establishment operations. If aggrieved by this order, you 27. Physical Facility (FC-6,)(590.007) have a right to a hearing. Your request must be in writing 28. Poisonous or Toxic Materials (FC-7)(590.008) and submitted to the Board of Health at the above address 29. Special Requirements (590.009) within 10 days of receipt of this order. 30. Other DATE OF RE-INSPECTION: S:5901nsppCffom,6/-1�4.Cx / s\ 1 . Inspe ! rl/,f" 1 _t%!l� Print: PI 's Si nature -"�~ Prink y t Page_of Pages Violations Related to Foodborne Illness Interventions and Risk Factors(items 1-22) PROTECTION FROM CONTAMINATION FOOD PROTECTION MANAGEMENT 8 Gross-contamination 1 590.003(A) Assignment of Responsibility` 3-302.11(A)(1) Raw Animal Funk Separated from 590.003(B)_ Demonstration of Knowledge" Cooked and RTE F-oodi,* 2-103.11 Person in charge--duties Contamination from Raw Ingredients 3-30111(A)(2) Raw Animal Foots Separated from Each EMPLOYEE HEALTH Other 2 590.003(C) Responsibility of the person in charge to Contamination from the Environment require reporting by food employees and 3-302.11(A) Food Protection* applicants` 3-30215 WashineFruitaanciVegetables 590.003(F) Responsibility Of A Foci Employee Or An 3-304.1.1 Food Contact with Equipment and Applicant To Report To The Person In Utensils* Charge" Contamination from the Consumer 590.003(G) Re brim by Person in Charge^ 3-306.14(A)(1i) Returned Fond and Reset vice of Food^` 3 590.003(D) Exclusions and Restrictions" Disposition of Adulterated or Contaminated 590.003(h) Removal of Exclusions and Restrictions Food 3-701.11 Discarding or Reconditioning Unsafe FOOD FROM APPROVED SOURCE Foe* 4 ^'i Food and Water From Regulated Sources 9 Food Contact Surfaces 590.004(A-B) Cam Bance with Food Law" 4-501.111 Manual Warewashing-1Iot Water 3-201.12 Food in a Hermetically Sealed Container* Sanitization Tem.cloture** 3-201.1.3 Fluid Milk and Milk Products` 4-501.112 Mechanical Warewashing-Hot Water 3-202.13 Shell Eggs Sanitization Temperatures' 3-202.14 E gs and Milk Products.Pasteurized'" 4-501.114 Chemical Sanitization-leap.,pH, concentration and hardness. 3-20216 fee Made From Potable Drinking,Water" 4-601..11(A) Equipment Food Contact Surfaces and 5-101.11 Diinkin«Water from an Approved Svsttm* Utensils Clean* 590.006(A) Bottled Drinking Water* 4-602.11 Cleaning Frequency of Equipment Food- 590,006(13) Water Meots Standards in 3I0 CIOR 22.0` Contact Surfaces and Utensils" Shellfish and Fish From an Approved Source ¢702.11 Frequency of Sanitization of Utensils and 3-201.14 Fish and Recreationally Caught Molluscan Food Contact Surfaces of Equipment* Shellfish* 4-703.11 Methods of Sanitization-Hot Water and 3-201.15 Molluscan Shellfish from S1SSP Listed Chemical* Sources* 10 Proper,Adequate Handwashing Game and Wild Mushrooms Approved by Re Mato Authofi 2301.1 1 Clean Condition-Hands and Rams* 3-20118 Sheilsiock Identification Present* 2-301.12 Clea rim*Procedure* 590.004(0) Wild Mushronns* 2-301.14 When to Wash* 3-201.17 Came Animals* 11 Good Hygienic Practices ReceivingfCondition 2-401.11 Eatina. Dnitking or Using sink Tobacco* 3-202.1 t Mips Received at Proper Tem>eratures* 2401.12 Discharges From the Eyes.!Vose and 3-20?15 Package lnnoadt,x; Mouth` 3-102.1.1 Food Safe and Unadulterated* 3-301.12 Preventing Contamination When Tastirl�* 6 Tags/Records:Shellstock 12 Prevention of Contamination from Hands 3-202.18 Shellstock Identification* 590.009(E) Preventing Contamination from 3-203.12 Shellstock Identification Maintained* Em lovees* Tags/Records:Fish Products 13 Handwash Facilities Conveniently Located and Accessible 3--902.1'1 Parasite Destruction* 3-402.12 Records.Creation and Retention* 5-203.11 Numbers and'Ca otitic** 590.004(}) Labeling of Ingredients' 5-20}4.11. Location and'Placeracut` 7 Conformance with Approved Procedures 5-205.11 Accessibility,t7 eration and Maintenance lHACCP Plans Supplied with Soap and Hand Drying 3-502.11 1 Specialized Processing Methods* Devices 3-502.12 Reduced oxy en packagin ,criteria* 6-301.11 Handwashing Cleanser.Availability rocdure6 30L12 8-103.12 ComptitxedPHand Drvin*Pro glen ^'Denote,critical item in the federal 1999 Food Codeor 105 Ck1R 590.000- CITY OF SALEM BOARD OF HEALTH Establishment Name: 7_-70 / 1 ( Date: d S LO Page: �3 of Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date No. Reference R–Red Item Verified it. PLEASE PRINT CLEARLY G IvesJZQ l l> a JC601_Y7UI D . .PCFO dhd n !D ;l C M a ISO h �' (Q d — ev m " - C 6_Y) vs rl T, / Y � . S - 2 L _ l�/k o aL O� Q IF J hn +V ]6- mr r' ro Lo Nop sh)Y-P6 uOrmyeM( 1 - M-o +v kp S±)rP6 11 r 'ti I� , o ,l YO a nr } Cl -U _ ) r Y U 1 v It12 ! rI 1-.)OAfeS hl- M _JZ-106 r lAj nA on 4 + b c r F -fn Ili' I—Oak,( to l- � -h a 14 ayiAlw S1061 i O 's !PV!P nn :{ Discussion With Person in Charge: } Corrective Action Required: ❑ No ❑ Yes I (lave read this report, have had the opportunity to ask questions and agree to correct all C] Voluntary Compliance ❑ Employee Restriction/ violations before the next inspection, to observe all conditions as described, and to Exclusion P ❑ Re-inspection Scheduled ❑ Emergency Suspension comply with all mandates of the Mass/Federal Food Code. I understand that 'noncompliance may result in daily fines of-t_eeit five.doll r suspension/revocation of ❑ Embargo ❑ Emergency Closure your food permit. 0 ❑ Voluntary Disposal ' ❑ Other: 3-501.14(C) PHFs Received at Temperatures Violations Related to Foodborne Illness Interventions and Risk According to Law Cooled to Factors(items 1-22) (Cont.) 41"'F745°F Within 4 Hours. PROTECTION FROM CHEMICALS 3-507.15 Conlin"Methods for PHFs 19 14 Food or Color Additives PHF Hot and Cold Holding 3-501.16(B) Cold Pill's Maintained at or below 3-202.12 Ad teclio* 590.004(:7 41°J45° F` 3-302.14 Poison a from Unapproved Additives* 71 M 1.16(A) Hof PHFs Maintained at or above 15 Poisonous or Toxic Substances 40T. * 7-101.11 Identifying Containers' Information-Original 3-SOLl6(A) Roasts Held at or above 130°1Z Container" 7-102.11 Common Name-Woilento Containcrs"` 2fi Time as a Public Health Control 7-201.11 So aration-Storaze"` 3-501.19 Time as a Public Health Control* 7-202.11 Restriction-Presence and Use* 590.004(H) VarianceRequirement 7-202.12 Conditions of Ilse* 7-203 11 Toxic Containers-Prohibitions" REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-204.11 Sanitizers,Criteria-Chemicals* POPULATIONS 'HSP) 7-204.1.2 Chemicals for Washine Produce,Croatia* 21 3-80'1.11(A) Unpasteurized Pre-packaged Juices and Beverages with Warnine Fabels* 7-204.14 Dain tui Foo.Criteria" 3-801.11(B) Use of Pastennzed Eoes* 7-205.11 Sncidental Food Contact Lubricants' 3-801.11 7-206.1 t Restricted Use Pesticides.Criteria* (D) Raw or Partially Cooked Animal Food and 7-206.12 Rodent Bait Stations* Raw Seed S routs Not Served-'s 801.1 1(C) Uno encd Food Packa�e Not Re-served. * 7-206.13 'Cracking Powders,Pest Control and 3- Monitoring* CONSUMER ADVISORY TIMEITEMPERATURE CONTROLS 22 3-60111 Consumer Advisory Posted for Consumption of Animal Fawds 7fiat are Raw.Undercooked or 16 Proper Cooking Temperatures for PHFs Not Otherwise Processed to Eliminate _ 3-40'I.1.1A(1)(2) Fps- 155'F15Sec. Pathogens.*Ensco, E>>s-limnedtatc Service 145°F15scc* 3-302.19 Pasteunu a Eggs Substitute for Raw Shell 3-401.11(A)(2) Comminuted Fish,Meats Ss Game Eggs' Animals- 155°F 15 sec.* 3-401.11(B)(1)(2) Pork and Beef Roast-130°F 121 min* SPECIAL REQUIREMENTS 3-401.11(A)(2) Ratites, Injected Meats-155°F 1.5 590.009(A)-(D) Violations of Section 590.009(A)-(D)in sea * catering, mobile food,temporary and 3-401.1.1(A)(3) Poultry,Wild Game, Stuffed PHFs, residential kitchen operations should be Stuffing Containing Fish, Meat, debited under the appropriate sections Ponitr,or Barites-165°F 15 sec. r* above if related to foodborne illness 3-401.11(C)(3) Whole-numscle,intact Beef Steaks interventions and tisk factors. Other 1.45°F* 590.009 violations relating to good retail 3-41)1.12 Raw Animal Foods Cooked in a practices should be debited under#/29- Microwave 16,5°F* Special Requirements. 3-40 1,11(A)(1)(b) All Other PHFs-145°F'l5see. 177 Reheating for Hot Holding VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 3-403.11(.4)&(D) PHF,, 165°F 15 sae. a* (Items 23-30) 3-403.11(B) Microwave- 165°F 2 Minute Standing Critical and non-critical violations, which do not relate,to file Time* foodborne illness interventions and rick joctors lister!above, can be. 3-403.11(C) Commercially Processed RTE Food- .found or tree fallowing sections of the Food('ode and 165 CMtt _t40"F* 590.660. 3-403.11(F.) Remaining Unshced Portions of Reef Item Good Retail Practices FC 590.000 Roasts*. 23. Mara ement an_d Personnel _ FC-2 .003 18 Proper Cooling of PHFs 24. Food and Food Protection FC-3 .004 25_____ _Equipment and Utensils _ FC 4 .005 3-501.14(A) Cooling Cooked PHFs from 140°F to 26. Water, Plumbing and Waste FC 5 006 70"F Within 2 Flours and From 70".F 27. Ph*s1cal FaclliiyFC-6 .0D7 to 41°Ff45°F Within 4 Hours.,* 28. Poisonous or Toxic_Materials FG-7 ' .068 3-501.14(13) Cooling PHFs Made:From Ambient 29. S ectal Re uiremonts .009 Temperature ingredientsto4l°17145°F -30_ ,Other_ Within Hours* Denotes critical irem in the Weral 1999 Food Code or 105 CN1R 590-000. CITY OF SALEM BOARD OF HEALTH 4 Establishment Name: (�4+ i C=I rC( � I/l h L Date: U U Page: c�;2- of 3 1 Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date TNo. Reference .R—Red Item Verified /� PL�E/ASE PRINT-CLEARLY 7 lZ T( "IIIc .e 'h0d /7 P l I l( /) E 7 ) 3 d(' 7 IPAl c G - c / . ti / 1v -!� - ) i s 7 s. 110 Sri 0 ( n jia gh ,- ,A 4 ¢� n J �y 1 -i t / 1 J i '11 A-o�a d 14W ollxl U t . "1019 /`t7 i, r. - 7vignprAila, rteaia rte { , Discussion With Person in Charge: iral(A SUty ICl scv�p is e U0 n } Rn f Al trd a vtd Strbw& Corrective Action Requlled: El No LI Yes V'Ctndl� C�2 i SI Ur L hquestions E2 Voluntary Compliance ❑ Employee Restriction/ 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 LI 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 werrty= ive dollars or u ension�ation of ❑ Embargo El Emergency Closure your food permit. - ❑ Voluntary Disposal ❑ Other: f 3-50114(C) PHFs Received at Temperatures Violations Related to Foodborne illness Interventions and Risk According to Iaw Cooled to Factors(items 1-22) (Cont.] 41".FI45"F Within 4Hours.' PROTECTION FROM M CHEMICALS 3-501.15 Cooling Methods for PHFs 14 Foad or Color Additives 19 PHF Hot and Cold Holding - 3-501.16(B) Cold PHFs Maintained at or below 3-202.12 Additives* 3-501.16(B) 410/45° P 3-302.'14 Protection from Unapproved Additives* 3-501,16(A) Ilot PHFs Maintained at or above 15 Poisonous or Toxic Substances 140"K 7-,U)1..11 IdentifyingInfonnatian-Original 3-501A6(A) Roasts Held at or above 130°F. Containers* 7-102.11 Common Nat ne-Workin*Containers` 20 Time as a Public Health Control 7-201.11 Se oration-Storage" 3-501.19 Time as a Public Health Conttnl* 7-202.11 Restriction-Presence and Use* 590.004(H) Variance Re uiretnent 7-202.12 Conditions of(iso* 7-203.11 Toxic Containers-Pmhihitions" REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) 7-20d.11. Sadr6zers,Criteria-Cfiemicals'� --- 7-204.1.2 Chemicals for Washine Produce,Criteria"` 21 3-&01.1 I(A) Unpasteurzed Pre-packaged Juices and 7-204.14 Beverages with Warnine IAbets* Drvt � enrs,Criteria* -- 7-205.11 Iucidental Food Contact. Lubricants* 3-80 L.11(B) Use of Pasteurized Fees* 7-206.11 Restricted Use Pesticides.Criteria` 3-801A 1(D) Raw or Partially Cooked Animal food and Raw Seed Sprouts Not Served..' 7-206.12 1 Rodent Bait Stations* 3-801.11(C) Unopened Food Package Not Re-served.7-206.13 Tracking Powders,Pest Control and Monitorim,* CONSUMER ADVISORY_ TIMETTEMPERATURE CONTROLS 22 3-603.11 Consumer Advisory Posted for Consumption of Animal Foals`Pkat are Raw.Undercooked sit 16 Proper Cooking Temperatures for Not Otherwise Processed to Eliminate PHFs Pathogens.*EII r,Av ""00! 3-401.tIA(1)(2) Eggs- 158 F IS Sec. E s-hnmedro¢.Services 145°Eliseo* 3-302.13 1 Pasteurized Eggs Substitute for Raw Shell 3-401.,11(A)(2) Coauninuted Fish,Meats&Gaune B ss Aninads-155°F 15 see. 3-401.11(8)(1)(2) Pork and Beef Roast- 130°F 121 rI SPECIAL REQUIREMENTS 3-401.11(A)(2) Ratites, Injected Meats-155`F 15 596.009(A)_(D) Violations of Section 590.009(A)-(D)in sec. r catering, mobile food,temporary and 3-401.11(4(3) Poultry, Wild Game,Stuffed PHFs, residential kitchen operations should 6e Stuffing Containing Fish,Meat, debited wider the appropriate sections Ponhr,or Raptes-165°1-15 sec. a= above if related to foodborne illness 3-401.11(,C)(3) Whole-muscle,Intact Beef Steaks interventions and risk factors. Other 145°F 590.009 violations relating to good retail 3-401.12 Raw Anim l Fcxxls Cooked in a practices should be debited under#29- Microwave 165^F* Special Requirements. 3-401.11(A)(1)(b) All Other PHFs- 145°F 15 sec. 17 Reheating for Hot Holding VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 3-403.11(A)&CD) PHFs 16YT 15 sec. * (Items 23-30) 3-403.1 I(B) Microwave- 165°F 2 Mintne Standing Critical and non-critical siolalions, which do not relate to the Time*' foodborne illness interventions and risk fnctorc listed above, can be 3-403.11(C) Commercially Processed RTE Food- found in the following sections of the Food Code and 105 CMR 140°Ft 590.000. 3-403.11(F) Remaining Unsliced Portions of Beef Item Good Retail Practices_ FC 580000 Roasts ____ eI FC-2 .003 ,v 2 . Mena ement arid Persons 1g Proper Cooling of PHFs _24. Food and Food Protection __ FC-3 .004 25. Equipment and Utensils _FC 4 _.005 3-50114(A) Cooling Cooked PHFs from 140°P to 2& Water.Pl mbin and W este FC-5 .006 70°F Within 2 Hours and From 7WF 27. -Physical Facility_ FC-6 1 007 to 41.°F/45`F Within 4 Hours.* 28. Poisonous or Toxic Materials FC-7 .008 3-501.'14(}3) Coaling PHPs Made From Ambient 29-, __S eeial Re viremenfs .009 Temperature Ingredients to 41°'145°F 30 Other Within 4 Hours* ss�om,mnheaz.m,� Denotes uriucal iters in the federal 19991•ood Cod,,or 105 CNIR 590.064 r IMPORTANT MESSAGE FOR A.M. DATE .3 O, O �CQ TIME �P.M. M Sw2M f_ H e GJ OF PHONE AREA CODE NUMBER EXTENSION ❑ FAX ❑ MOBILE AREA CODE NUMBER TIME TO CAl TELEPHONED.. PLEASE CALL CAME TO SEE YOU WILL CALL AGAIN WANTS TO SEE YOU RUSH. RETURNED YOUR CALL WILL FAX TO YOU MESSAGE r SIGNED MCPS FORM 4009 LL 09 MARE IN NOTES -JMPORTANT MESSAGE •FOR i Jit,,,.Z-,(:- M. DATE % 0 1 0 Tqq TIME /% P.M. M i OF a 7 V �y�v PHONE�A EI�UM ER EXTENSION ❑ FAX ❑ MOBILE 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 SIGNED oPsFORM 4009 MARE IN U.S.A. NOTES -rte ' - a:�h_r S Gee_ I It CITY OF SALEM BOARD OF HEALTH Establishment Name: ( GI t �P ( �/�G L�/Qn Date: g 6 Page: of T Item Code C-Critical Rem DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date No. Reference R—Red Item PLEASE PRINT CLEARLY Verified aSe /a it 74 Qboil 2s be-117Q111-171 y houlh a a Aj o ho Iva le1 roir qin a, 6 raVa III' " nlu ekaLLp �>` f loin zjF o4-- /S L (Ana, 00 '4 3 IL I 'ITT /'0^ 1r tI ycc[[ A I/ // I l 1IJIlf _ L ' — 1 ti f i qr { Discussion With Person in Charge: Corrective Action Required: ❑ No ❑ Yes t ❑ Voluntary Compliance ❑ Employee Restriction/ I have read this report, have had the opportunity to ask questions and agree to correct all Exclusion vi4ations before the next inspection, to observe all conditions as described, and to ❑ Re-inspection Scheduled ❑ Emergency Suspension f 'comply with all mandates of the Mass/Federal Food Code. I undertand that r . no compliance may result in daily fines two t •five-dollars orskraensionftevocati6n of ❑ Embargo ❑ Emergency Closure your food permit. { ❑ Voluntary Disposal ❑ Other. 3-501.14(C) YHFs Received at'Ceinperrures Violations Related to Foodborne Illness Interventions and Risk According to Iaw Cooled to Factors(items 1.22) (Cont.) 41°F145°F Within 4 Hours. PROTECTION FROM CHEMICALS 3-507.15 Cools e,Methods for PHFs 14 Food or Color Additives 19 PHF Hot and Cold Holding 3-501.16(B) Cold PRFs Maintained at or below 3-292.12 ProtectionAdditives590.004(F) 41°145°F� 3-302.14 Protection from trnap roved AddStives* 3-501.16(A) Rot PHFs Maintained at or above S5 Poisonous or Toxic Substances 40°F. * 7-101.11 ntaine g lnfonnation-Orig nal Co3-50d.16(A) Roasts Held at or above 130°F. Containers' 7-102.11 Commits Name-Workim*Containers" L 20 Time as a Public Health Control 7-201.11 Sc oration-Slot aze* 3-501.19 Time as a Public Health Contra!* 7-202.1.1 Restriction-Presence and Use* 590.0 Ell Variance Re uirement 7-2(12.12 Conditions of Use's 7-203.1.1 Toxic Containers-Prohibitions" REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-204.11. Sannizers.Criteria-Chemicals* POPULATIONS(HSP) _ 7-204.12 Chemicals for Washine Produce,Criteria" 21 3-801.11(A) Unpasteurized Pre-packaged Juices and 7-204.14 Drvina, cuts.Criteria* Bevetaees with Warnine Labels^ 7-205.11 Incidental Food Contact.Lubricants* 3-801.11(B) Il se of FastendzedFg>s* 7-206.1t Restricted Use Pesticides.Criteria* 3-801.11(D) Raw or Partially Cooked Animal Food and Raw Seed S xotits Not Served.' 7-206.12 Rodent Bait Stauotts'� 3-801.11(Cj Uno erred Faxxi Pucka=e Not Re-served. *- 7-206.13 'Praekmg Powders,Pest Control and Monitoring-` CONSUMER ADVISORY TIMEITEMPERATURE CONTROLS 22 3-603-i i Consumer.Advisory Posted for Consumption of Animal Foods That are Raw,Undercooked or S6 Proper Cooking Temperatures for PHFs Not Otherwise Processed to Eliminate _ Er°�nb �,7xr 3-401.1 lA(1)(2) Eggs- 151°F 1.5 Sec. Path° ns' E ts-humedtatc Sesvicc 1=t5°Fl)sec* 3-302.13 Pasteurized Eggs Substitute fin Raw Shell 3-40L l I(A)(2) Comminuted Fish,Meats&Game R gsm Animals-155°F 15 sec. * 3-401.11(B)(1)(2) Pork and Beef Roast-130°F 1.21 min* SPECIAL REQUIREMENTS 3-401.11(A)(2) Ratites, Injected Meats-155°F 15 590.t)09(A)-(D) Violations of Section 590,009(A)-(D)in sec. * catering, mobile food, temporary and 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs, residential kitchen operations should be Stuffing Containing Fish,Meat, debited under the appropriate sections Poultry or Ratites-16.5°F 15,sec. s above if related to foodborne illness 3-401A 1(C)(3) Whole-muscle, Intact Beef Steaks interventions and risk factors. Other 145°F* 590.0}9 violations relating to goad retail 34011.12 flaw Animal Foods Cooked in a practices should be debited under#29- Microwave 165'F* Special Requirements. 3-401.11(A)(1)(b) All Other PHFs- 145°F15see. 17 Reheating for Hot Holding VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 3-403.11(A)&(I)) PHFs 165°F 15 sec. '^ (Sterns 23-30) 3-403.11(B) Microwave-165°F 2 Minato Standing Crin,al and non-critical violations,ithich do not relate to the Time* foodborne illness interventions and risk far tors listed above, can be 3-403.11(,C) Commercially Processed RTE Food- found in the follondng sections of the Food Code and 105 CMR 140°F* 590.000. 3-403.11(13) Remaining Unsliced Portions of Beef Item Good Retail_Prac6ces FC 590.000 Roasts* 23. Maria ement and PersonnelFO-2 .003 Ll 8- Proper Cooling of PHFs24. Food and Food Protection _ FC-3 .004 25 Equi_ _ _ ,005 tmint and Utensils FC 4 4_�_.._ 3-501.14(A) Cooling Cooked PflFs from 140°F to 26 _ Water Plumbing and Waste FC 7 5 006 70°P Within 2 Hours and From 70°F 27. Ph deal FacilitesFC-6 I .007 to 41°Fl451F Within 4 Hours. ' 28. Poisonous or Toxic MaterialsFC-7 .008 -----___-_.--------- 3-501-14(73) Cooling P17Fs Made Froin Ambient 29. S ©cial Re utremanis .009 Temperature Ingredients to 41'F/45°F 30.......1. Other Within 4 flours* *.Denotes critical item in the federal 1999 Food Code or 105 CN1R 590.000' COURT DOCKET NO. Q CITATION NO. CITY OF SALEM A ON VIOLATION NOTICE A 291? NAME(LAST,FIRST,INITIAL) STREETADDRESS CITY/TOWN STATE ZIP 13 ) I JY) )TCi{ LICENSE NO. f LIC.EXP.DATE DATE OF BIRTH OWNER'S NAME(LAST,FIRST,INITIAL) w-)/ ra aJles� � �Vdt)nl0r41ia& STREETADDRESS CITY/TOWN STATE ZIP C. ttJ��h,ru n s. "salerr,im" aq-A) REGISTRATION NO. STATE EXP.DATE MAKE/TYPE i YEAR COLOR DATE OF VIOLATION TIME DATES CIITAT`ION WRI(T��TJEE1 wRgORAL El Pm El No LOCA ION'OF VIOLATION ENFORCING DEPT. rel r taa M OFFENSE ( �e CHHAAPP. SECT. FINES A B C OFFICER \ LD.NO. TOTALFINE -CY DUE $d5 OFF, ICER CERTIFIES COPY.GIVEN TO VIOLATOR DO NOT MAIL CASH-PA ONLY BY POSTAL NOTE,MONEY OROER OR BY CHECK MADE PAYABLE TO: CITY CLERK CITY HALL 93 WASHINGTON STREET SALEM,MA 01970 TEL.(508)745-9595 X 251 1 HEREBY ELECT TO EXERCISE THE FIRST OPTION AS STATED ON REVERSE, CONFESS TO THE OFFENSE CHARGED,AND ENCLOSE PAYMENT IN THE AMOUNT OF $ CASE# SIGNATURE ' SEE OTHER SIDE FOR FURTHER INFORMATION ENCLOSE PAYMENT IN THIS ENVELOPE,PEEL AND SEAL _ . -- - •----�� COURT DOCKET NO. - - CITATION NO . . • CITY OF SALEM A 2917 ,. IT 9 y k - VIOLATION NOTICE G y o< f O y 00 --- - NAME(LAST,FIRST,INITIAL 0-q S darre 10 (7 < m STREET ADDRESS CITYROWN STATE ZIP .moi, 6 LICENSE NO. LIC.EXP.DATE DATE OF BIRTH Rr % W O D V N 3 T OWNER'S NAME(LAST,FIRST,INITIAL) Ow m r1 / yin O R A 0 r 3 N STREET ADDRESS CITY/TOWN STATE ZIP w p j �zn - r F O-1 N REGISTRATION NO. ST E EXP DATE MAKET'PE YEAR COLOR O 2 ru : _ e ONI? DATE OF VIOLATION TIME DATE CITATION WRITTEN P'EERSSOyNAL x z ,� '�.p I o rj j5 Del ❑YES ` n NO Qx LOCA 10 OF VIOLATION ENFORCING QEPT. r OFFENSE CHAP, SECT. FINES W x x r R ` a e � x - y x R G x O * OFFICER' - -`� LD.NO. TOTAL Qp * (/ FINE $ �`• .D « _`'V-'�A<_y DUE �V r * OTgER CERTIFIES COPY GIVEN TO VIOLATOR x ❑ IN HAND IL IT!fu « N n . y DO D NOT MAIL CASH-PAV-ONLY BY POSTAI NOTE,MONEY >m ORDER OR BY CHECK MADE PAYABLE TO: * 370 CITY CLERK Z _ CITY HALL • * fD D n 93 WASHINGTON STREET x SALEM,MA 01970'. Z x x w o 7c TEL.(508)745-9595 X 251 * om I HEREBY ELECT TO EXERCISE THE FIRST OPTION AS STATED ON c REVERSE, CONFESS TO THE OFFENSE CHARGED,AND ENCLOSE 'o PAYMENT IN THE AMOUNT OF $ CASE# * x x x t SIGNATURE w 6 * SEE OTHER SIDE FOR FURTHER INFORMATION U ENCLOSE PAYMENT IN THIS ENVELOPE,PEEL AND SEAL r*i p N O � O A O W O N D (D m Scc my F,a.uins Indo,,(,' Dc,..I o10a 1 r"} Massachusetts Department of Public Health Salem Board S Health Department 124 Washington Health 4'" Floor Division of Food and Drugs Salem, MA 01970-3523 FOOD ESTABLISHMENT INSPECTION REPORT Tel. (978)741-1804 Fax(978) 745-0343 Name ions Woof Inspection auting p FooOsrve Risk ❑ Retail Re-inspection Addressn �T Level ❑ Residential Kitchen Previous Inspection Telephone u �' Wll ❑ Mobile Date:3-�/'�V HACCP YIN E] Temporary ❑ Pre-operation Owner n n P„ 171 Caterer ❑Suspect Illness Person in Charge(PIC) Time 171Bed& Breakfast ❑General Complaint In: ❑HACCP Inspector Off. Permit No. ❑Other _ - t V � 1 Each violation checked requires an explanation on the narrative page(s) and a citation of specific provision(s) violated. Non-compliance with: Violations Related to Foodborne Illness Interventions and Risk Factors Anti-Choking Tobacco Violations marked may pose an imminent health hazard and require immediate corrective 590.009(E) Q 590.009(F) ❑ action as determined by the Board of Health. ;,.FOOD PROTECTION MANAGEMENT �" '., . ❑ 12. Prevention of Contamination from Hands ❑ 1. PIC Assigned/Knowledgeable/Duties Q 13, Handwash Facilities EMPLOYEE HEALTH PROTECTION FROM CHEMICALS Q 2. Reporting of Diseases by Food Employee and PIC a,. ❑ 14.Approved Food or Color Additives ❑ 3. Personnel with Infections Restricte d/E xclud ad Q 15.Toxic Chemicals FOOD FROM APPROVED SOURCE ;TIMErrEMPERATURE CONTROLS(Potentially Hazardous Foods) ❑ 4. Food and Water from Approved Source E] 5. Receiving/Condition ❑ 16.Cooking Temperatures Q 6. Tags/Records/Accuracy of Ingredient Statements ❑ 17. Reheating ❑ 7. Conformance with Approved Procedures/HACCP Plans ❑ 18. Cooling PROTECTION FROM CONTAMINATION [119. Hot and Cold Holding ❑ 6. Separation/Segregation/Protection [120.Time As a Public Health Control ❑ 9. Food Contact Surfaces Cleaning and Sanitizing . REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) ". ❑21. Food and Food Preparation for HSP ❑ 14. Proper Adequate Handwashing El1 t. Good Hygienic Practices ,CONSUMER ADVISORY.v o ❑22. Posting of Consumer Advisories Violations Related to Good Retail Practices Number of Violated Provisions Related Critical (C)violations marked must be corrected To Foodborne Illnesses Interventions G immediately or within 10 days as determined by the Board and Risk Factors(Items 1-22): of Health. Non-critical (N)violations must be corrected Official Order for Correction: Based on an inspection immediately or within 90 days as determined by the Board today,the items checked indicate violations of 105 CMR of Health. 590.000/federal Food Code.This report,when signed below C 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 correct violations 24. Food and Food Protection (FC-3)(590A04) cited in this report may result in suspension or revocation of 25. Equipment and Utensils (Fc-4)(590.005) the food establishment permit and cessation of food 26. Water, Plumbing and Waste (FC-5)(590.008) establishment operations. if aggrieved by this order, you 27, Physical Facility (FC-5)(590.007) have a right to a hearing. Your request must be in writing 28. Poisonous or Toxic Materials (FC-7)(590.008) and submitted to the Board of Health at the above address 29. Special Requirements (590.009) within 10 days of receipt of this order. 30. Other DATE OF RE-INSPECTION: 5:5901nspeclForm6lP Doc �p ctor's 'igna e: 77 Print: / . Icotgn tune: Pr'It r Page-1 of�Pages f t Violations Related to Foodborne Illness Interventions and Risk Factors(items 1-22) PROTECTION FROM CONTAMINATION FOOD PROTECTION MANAGEMENT 8 Gross-contamination I 590.003(A) Aasignment of Responsibility* �� 3-302.11(.4}p) Raw Animal Foods Separated from 590.003($) Demonstration of'hnowledL' Cooked and RTE Foods* 2-103.1 1. Penon in cl arge duties 1 Contamination from Raw Ingredients 3-302.11(4)(2) Raw Annual Foods Separated frontEach EMPLOYEE HEALTH Other* 2 590.003(C) Responsibility of the person in charge to Contamination from the Environment require reporting by food employees tmd 3-302.11(A) Food Protection* applicants* _ 3-302.15 Washing Frulisand Ve*etables 590.003(F) Responsibility Of A Food Employee Or Art 3-304.11 Food Contact with Equipment and Applicant To Report To The Person In Utensils* Char e* Contamination from the Consumer 590.003(G) Re�erson in Charge* 3-306.14(A)(B) Returned Food and Resenice of Food* 3 590.003(0) Exclusions and Restrictions* Disposition of Adulterated or Contaminated 590.003(E) Removat of Exclusions and Restrictions Food 3-701.11 Discarding or Reconditioning Unsafe FOOD FROM APPROVED SOURCE Fow, 4 Food and Water From Regulated Sources 9 Food Contact Surfaces 590.004(A-B) Compliance with Food Law* 4--501.111 Manual Warewashm-Hot Water 3-201.12 _Food in a Hermetically Sealed Container* Sanirization'1'em eratures* 3-201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Warewashing-Hot Water 3-202.13 Shell Eg s* Sanitization Tem eratures* 3?02.14 Eggs and Milk Products,Pasteurized* 4-501.114 Chemical Sanitization-temp., pH, 3-202.16 Ice Made From Potable Drinking Water* concentration and hardness.'fi 5-101.11 Drink in=Water from an 4 roved S stem* 4-601.11(4) Equipment Food Contact Surfaces and 590.006(4) Bottled Drinking Water* Utensils Clean* 4-602.11 Claanin Frequency ofEquipment Food- 590.006(Ii) Water Meets Standards in 310 CMR 22.0* Contact Surfaces and Utensils* Shellfish and Fish From an Approved Source 4-702.11 Frequency of Sanitization of Utensils and 3-201.14 Fish and Recreationally Caught Molluscan Foal Contact.Surfaces of E ui menu Shellfish* 4-703.11 Methods of Sanitization-Hot Water and - 3-201.15 ;Molluscan Shellfish from NSSP Listed Chemical", Sources* 10 Regulatory AWilduthorit Proper,Adequate Handwashing Game and Authority Mushrooms Approved by 2-301.1 1 Clean Condition-Hands and AnO"n R 3-202.18 Shellstock Identification Present* 2-301.12 Cleaning Procc re* 590.004(C) Wild Mushrootns* 2-101.14 When to Wash* 3-201.17 Game Animals* 11 Good Hygienic Practices Receiving/Condition 2-40111 Eating,Drinking or Using Tobacc(7 3-202:11 PHFs Received at Pro rer Tcm eratures* 2401.12 Discharges From the Eyes, Nose and 3-202.15 Package lute rit'* Mouth* 3-101.11 Food Safe and Unadulterated* 3-301_12 Preventut>Contamination When fasting* 6 Tags/Records:Sheilstock 12 Prevention of Contamination from Hands 3-202.18 Sheilstock Identification* 590M04(E) Preventing Contamination from 3-203.12 SbellstockidenfificationMaintained' ees* Emmhw TagsiRecords:Fish Products 13 Handwash Facilities Conveniently Located and Accessible 3-402.11 Parasite Destruction* 3-402.12 Records.Creation and Retention* 5-203.11 Numbers and Capacities* 590.004(1) Labeling of Ingredients' S-20411 Lavation and Placement* 7 Conformance with Approved Procedures 5-205.11 Accessibilit O)oration and Maintenance 1HACCP Plans Supplied with Soap and Hand Drying 3-502.11 S ecialized Pra•essing Methods* Devices 3-502.12 Reduced oxygen tacka>in«.criteria* 6-301.11 Handwashin Cleanser,Availabllit 8-103.12 Conformance with A. roved Procedures," 6-3(11.1.2 Hand D ingProvision "Denotes critical item in the tede d 1999 Foal Code or 105 CMR 590.000. 1 - CITY OF SALEM BOARD OF HEALTH �r Establishment Name: /%I.r Date: Page: of Z L Item Code C-critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date No. Reference R—Red Item - Verified PLEASE PRINT CLEARLY '-' 2 L r ALL, E � S r f :S 4 ' 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 Exclusion " P L3 Re-inspection Scheduled ❑ Emergency Suspension comply with all mandates of the Mass/Fede'�a1_Foo l Cade. I understand that noncompliance may result in daily fines of'twent�� •dollars I"aspension/revocation of ❑ Embargo ❑ Emergency Closure your food permit. ❑ Voluntary Disposal ❑ Other: �_ t 3-501 II(C) PH Fs Received at'I Violations Related to Foodborne illness Interventions and Risk According to Law Cooled to Factors(items 1-22) (Cont) _ 41°17/45'F Within 4 Hours. PROTECTION FROM CHEMICALS 3-501.15 Cooling g Methods for PHFs 14 Food or Color Additives 19 PHF Hot and Cold Holding - 3-501.16(B) Cold Plil s Maintained of or below 3-02.12 Additives* 590.004(F) 41'145`F ' 3-302.14 Protection from thiapfitoved Addiuves* 15 Poisonous or Toxic Substances 3-501.16(A) Hot PHFs Maintained at or above 140 F. 7-101.I Tdentitcing Information-Original 3-501.16(A) Roasts Held at or above 130'F Containers* 7-102.11 Cornton Name-Working Containers' 20Time as a Public Health Control 7_201"1,1 Se..aration-Slur lac" 3-501.1.9 Tim'as a Public Health Control" 7-202_11 Restriction-Presence and Use" 590.Ofl4(H) Variance Recuirentenr 7-202.12 Conditions of Use* 7-20111 Toxic Containers-Prohibitions., REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-204.11 Sanitizeis. Criteria-Chemicals* POPULATIONS(HSP) _ 7-204-12 Chemicals for Washing Produce,Criteria* 3-801.11(A) Unpasteurized Pre-packaged Juices and 7-204.14 Drying A eats.Criteria'= Beverages with Warning Labels* E7-2 Incidental Food Contact,'Luricants* 3-901.11(B) Use of Pasteurized Fggs«Restricted Use Pesticides.Criteria* 3-801.11(D) Raw or Partially Cooked Animal Food and Raw Seed S routs Not Served.Rodem Ba.ie Stations"` 3-801.11(C) Uno ened Fond Packa e Not Rc-served.T'rackine,Powders, Pest Control and Mona Lorin¢'" CONSUMER ADVISORY TIME/TEMPERATURE CONTROLSCoumer Advisofy Posted for Consumption of Animal Foods That are Raw.Undercooked or PHFs L6 Proper Cooking Temperatures for Not Otherwise Processed to Eliminate 3-401.11A(1)(2) Eggs- 155`P IS Sec. 7rea Pathos, ns ft-s-Imredi ate Service 145'Fl.5sec* 3-302 13 Pastamire 1 Eggs Substitute for Raw Shell 3-401.1 i(A)(2) C.ommimned Fish. Meats&Game Animals- 155'F 15 see. * SPECIAL REQUIREMENTS _ 3-401.11(B)(1)(2) Prnk and Beet Roast- 130'F 12'1 min'" 97 p 009(A)-(D) Violations of Section 590,009(A)-(D)in 3-401.11(A)(2) Ratites, Injected Meats-157°F 1S see. * catering,mobile food, temporary and 3-401.11(A)(3) Poultry,Wild Game. Stuffed PHFs, residential kitchen operations should be Stuffing Containing Fish,Meat, debited tinder the appropriate sections Poulb y or Ratites-165'F 15 sec. * above if related to Foodborne illness 3-401A 1(C)(3) Whole-muscle, Intact Beef Steaks interventions and risk factors. Other 145`17'° 590.009 violations relating to good retail 3-401.12 Raw Animal Foods Cooked in a practices should be debited under,Y29-- Microwave 165'F* Special Requirements. 3-401.11(A)(1)(b) All Other PHFs-- 145'F 15 see. 17 Reheating for Hot Holding VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 3-403.11(A)&(D) PHF_165--F 15 sec. * (Items 23-30) 3-403.11(B) Microwave-165'F 2 Minute Standing Crilwal and non-critical violations, which do not relate to the Time' foodborne illness interventioru and risk factors listed above, can be 3-403.11(C) Commercially Processed RTF Fold- found in the follon ing sections of the Food Code and 105 CMR 140'Fy 590.000. _ 3403.1 I(L) Remaining Unsdiced Portions of Beef Item Good Retail Practices FC 500.000 Roasts* 23 Management and Personnel IFC-2 ,003 24 Food and Food Protection FC_3 .004 ig Proper Cooling of PHFs - -- - ta - 25 Equpment and Utens Is FC 4 005 3-501.14(A) Cooling Cooked PHFs from 140`F Cn - b � 26 Water.P,umbtn and Waste FC-5 006 7WIF Within 2 Hours and From 70'F 27. Ph sical Facility -� FG-6 .007 -501.14(B Cool into -7 5'1` Made 4 Hours_* 28.-- Poisonous or Toxic Materials FC-7 .008 • , -- g le From Arnbient 29 -Poisonous Re9uirercents ___ __ ^ 5, . C 30- Other - ----- -l- ......---- --- T'emperamr' Ingredients to 41 gFf•4� [' ..I Within 4 Hours* *D noses critical+tem in the federal 1999 Food Code or Illi CZAR 590.000. 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 /i xe / Date T of 0 eration s T of Inspection C 4 C9Qa !Z c 3 '_ - SZ Food Service Routine Address /33 /GkS/r/NG�Or> Sf Risk`° ❑ Retail El Re-inspection Level ❑ Residential Kitchen Previous Inspection TelephoneElMobile Date: ?l 7y/- ya�a Owner HACCP YIN El Temporary E] Pre-operation G2Q LL 2, C Y 0//atiNl�Pa ❑ Caterer ❑ Suspect Illness Person in Charge(PIC) /J, Time ❑ Bed&Breakfast 0 General HACCP Complaint Inspector _D G�Pe4)lntw V, A'47 05{ze k/ S Out: Permit No. ❑ Other Each violation checked requires an explanation on the narrative page(s)and a citation of specific provision(s)violated. t1 Non-compliance with: Violations Related to Foodborne Illness Interventions and Risk Factors Anti-Choking Tobacco Violations marked may pose an imminent health hazard and require immediate corrective 590.009(E) ❑ 590.009(F) ❑ action as determined by the Board of Health. .FOOD PROTECTION MANAGEMENT _ w_. ❑ 12. Prevention of Contamination from Hands ❑ 1. PIC Assigned/Knowledgeable/Duties EMPLOYEE HEALTH / 0- Handwash Facilities .PROTECTION FROM CHEMICALS • '�' "` '" ❑ 2. Reporting of Diseases by Food Employee and PIC [114.Approved Food or Color Additives ❑ 3. Personnel with Infections Restricted/Excluded ❑ 15.Toxic Chemicals FOOD FROM APPROVED SOURCE. ❑ 4. Food and Water from Approved Source - TIME/TEMPERATURE CONTROLS(Potentially Hazardous foods) ❑ 5. Receiving/Condition ❑ 16. Cooking Temperatures ❑ 6. Tags/Records/Accuracy of Ingredient Statements ❑ 17. Reheating ❑ 7. Conformance with Approved Procedures/HACCP Plans ❑ 18. Cooling PROTECTION FROM CONTAMINATION .. ❑ 19. Hot and Cold Holding ❑ 8. Separation/Segregation/Protection ❑ 20.Time As a Public Health Control ❑ 9. Food Contact Surfaces Cleaning and Sanitizing REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) El21. Food and Food Preparation for HSP El 10. Proper Adequate Handwashing ❑ 11. Good Hygienic Practices CONSUMER ADVISORY{ [122. Posting of Consumer Advisories Violations Related to Good Retail Practices Number of Violated Provisions Related Critical (C) violations marked must be corrected To Foodborne Illnesses Interventions immediately or within 10 days as determined by the Board and Risk Factors(Items 1-22): of Health. Non-critical (N)violations must be corrected Official Order for Correction: Based on an inspection immediately or within 90 days as determined by the Board today, the items checked indicate violations of 105 CMR of Health. 590.000/federal Food Code. This report, when signed below C N ' by a Board of Health member or its agent constitutes an 23. Management and Personnel (FC-2)(590.0 order of the Board of Health. Failure to correct violations 4. Food and Food Protection (FC-3)(590.0044)) cited in this report may result in suspension or revocation of 25. Equipment and Utensils (FC-4)(590.005) the food establishment permit and cessation of food 26. Water, Plumbing and Waste (FC-5)(990.009) establishment operations. If aggrieved by this order, you 27. Physical Facility (FC-6)(590.007) have a right to a hearing. Your request must be in writing 28. Poisonous or Toxic Materials (FC-7)(590.008) and submitted to the Board of Health at the above address 29. Special Requirements (590.009) within 10 days of receipt of this order. 30. Other DATE OF RE-INSPECTION: 3/I r/oL/ 5:5901nspeclFo,m614.tloc (6 n e to " e: Print: Pic"S' � Print: Page/ of3 Pages ;r Violations Related to Foodborne Illness Interventions and Risk Factors(items 1-22) PROTECTION FROM CONTAMINATION FOOD PROTECTION MANAGEMENT 8 Crass-contamination 1 590.003(A) I Assignmetrt ol'Responsibiltty* 3-302.110)(1) Raw Animal Foods Separated from 590.003(B) Dcmonstr,itionofHnov,ledtre" Cooked and RTE Foals* 2103.11 Person in charge--duties Contamination from Raw Ingredients 3-302.1.1(A)(2) Raw Animal Foods Separated from Each EMPLOYEE HEALTH Other- 2 590.003(71 Responsibility of the person in charge to Contamination from the Environment require repotting by food employees and 3-302.11(A) Food Protection- applicants': rotection*a 9iamts* 3-302.15 Washing Fruits and Vegetables 590.003(,-) Responsibility Of A Food Employee Or An 3-304.11 Food Contact with Equipment and Applicant To Report To The Person In Utensils* Thar*e* Contamination from the Consumer 590.003(G) Re ortia b Person in Charge* 3-306.14(A)(B) Returned Food and Rescrvico of Fund* 3 590.003(D) Exclusions and Restrictions* Disposition of Adulterated or Contaminated 59p,p03(E) Ramos..of Ex htsions and Restrictions Food 3-701.1 1 Discarding or Reconditioning Unsafe FOOD FROM APPROVED SOURCEFood* 4 Food and Water From Regulated Sources 9 Food Contact Surfaces 590.004(A-B) Com Aiance with Food La"* 4-501..1.11. Manual Warewashing-Hot\later 3-20112 Food in a HermeticalLv Sealed Container* Sanitization Tem eratures* 3-201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Warewashina Hot Water 3-202.13 Shell E-as* - San9tiza6on Tera eratures* 3-202.14 E>>s and Milk Prodacts.Pastenrrzed" 4-501.114 Chemical Sanitization-temp.,pH, concentration and hardness. 3-202.76 Ice Made From Potable Drinkin-Nater* 'w 5-7.01.1.1 Drinkutg Water from an A raved S°stem* Uten4-601.11(A) Equipment Food Contact Surfaces and 590.006(A) Bottled Drinking C Water* leamis Clean' 590.006(B) Water Meets Standards in 310 CMR 22.01` 4-602.11 Cleaning Frequency of Equipment Food- Shellfish and Fish From an Approved Source Contact Surfaces and Utensils* 4702.1 L Frequency of Sanitization of Utensils and 3-201.14 Fish and Recreaur aally Caug t Molluscan Food Contact Surfaces of E ui ment* Shellfish* 4-703.1.1 Methods of Sanitization-Hot Water and 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* Sources* 10 Proper,Adequate Handwashing Game and Wild Mushrooms Approved by Re Mato Aut2-301.11 Clean Condition-Hands and Arms°` hors 3-202.18 Shellstock Identification Present* 2-301.12 Cleaninry Procedure* 590.004(0) Wild Mushrooms* 2-301.14 When to Wash* 3-20117 Game Animals* 11 Good Hygienic Practices L-5 Receiving/Condition 2-401.11 Eating,Drinking or Using Tobacco* 3-202.11 PHFs Received at Pro er Tem eratures* 2-401.12 Discharges,From the Eyes, Nose and 3-202.15 Package tette lily* Mouth- 3-101.11 Food Safe and Unadulterated* 3-30112 Preventing Contamination When'rastin * 6 Tags/Records:Shelistock 12 prevention of Contamination from Hands 3-202.18 Shellstock Identification* 590k04(E) Preventing Contamination from 3-203.12 Shellstock Identification Maintained* Ent tlo gees* Tags/Records: Fish Products 13 Handwash Facilities 3-402.11 Parasite Destruction* Conveniently Located and Accessible 3-402.12 Records,Creation and Retention* 5-203.11 Numbers and Capacities* 590.0040) Labeling of Ingredients' 5-204.11 Location and Placement* 9 Conformance with Approved Procedures 5-205.11 Accessibility,Operation and Maintenance /HACCP Plans Supplied with Soap and Nand Drying 3-502.11 Serialized Processing Methods* Devices .2 educed axv*en tacka�in�.criteria` 6-301.11 Handwashia 3-502.1RCleanser,.4varlabHlt 6-103.12 Conformance with Approved Procedures* 6-301.12 Hand D in Provision *Denotes critical item is the levlerat 1999 Food Code m 105 CMR 590.000. if CITY OF SALEM BOARD OF HEALTH Establishment Name: Date: Page: 2 of 'i Item Code C-critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date It No. Reference R-Red Item - "" -- - Verified .PLEASE PRINT CLEARLY t 'Q X64e-hf rN ffk!_�(:nr A 7W avrla a&m Ce- 4,rteG —nrs10e;-� ans C- ! r- rca'�?vSrftri i5eDS tKJvG )0 F A_rV1rIr6- I J lDZE ,Aev '.j L OV k .t aS G�8✓�,4f L Cc. .fir r✓irr 41E 1-) S s 4A A21 S)a K- Vv-v4 tom-- tnS /✓ v ` ro U 'r ha 5r�-R-s'+�lL-. T-/•3 t1,tJ ��F�� Ct.�Idr✓ e� r as /LI dJL- (etf ) a& "r-opc s 44vO ' F"Zct: v Y -vacs 1= rtr 'r r� �5 r7vt l M F fN OZ00(111 v y ` / As .ln/ C�✓,U LSF 'rJ O F OL, olt3v&-aL r ILeLf rzv4 - ,j 1 M1 as C ou �yvL���,C. n5 A G � ,vfr✓G- Discussion With Person in Charge: Corrective Action Required: ❑ No ❑ Yes fl have read this report, have had the opportunity to ask questions and agree to correct all ❑ Voluntary Compliance ❑ Employee Restriction/ inspection, to observe all conditions as described, and to Exclusion violations before the next ins P ❑ Re-inspectiori 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 doll s or suspension/revocation of ❑ Embargo ❑ Emergency Closure yb your food permit. /oa ❑ Voluntary Disposal ❑ Other: >S Ile 3-501,14(0) PHFs Received al Temperatures Violations Related to Foodborne Illness interventions and Risk Accordin,,,to Law Coaled to Factors(items 1-22) (Cont) 41"17/45�FtVahin4tlouis PROTECTION FROM CHEMICALS _3-501.15 _LCoolina MetIvyls for PHFs 1=4 Food or Color Additives 19 - PHF Hot and Cold Holding 3-50L16(B) Cold PHFs Maintained at nr beFC11-1 3-202.12 AdditiWO 590.004(F) 41'/45'Ft 3-302.14 Protection locin Unapproved.Additives`j.Additives` - Poisonous or Toxic Substances 3-501,10(A) Hot PHF�Maintained at tri above - 14WE 7-101.14 Identifying Information-Original 3-501A6(A7 Roasts Held at oi above l30°F. - Containers' 24 Time as a Public Health Control 7-102.11 Common Name-Working,Containers! 1 -501 19 Time as a Public Health 1-101.11 Separation 590.004(11) C1C:(:)nntr:0�P 7-202.11 Restriction-Presence and Use t ls000l f)j%9(I;E]E 7-202.12 LLDKA 2 Conditions of Use- 7-203.11 Toxic Containers-Prohibitions* REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-204.11 Sanitizers,Criteria-Chenricals* POPULATIONS(HSP) 7-204.12 Chemicals for Washing Produce,Critedai* 1 21 1 3-801-ii(A) Unpasteurized Pre-packaged Juicas and 7-1204.14 [hying Ag-ents.Criteria* L I I Beier cies with NVarnin, Labels* 7-205,11 Incidental Food Contact, Lubricants* 3-801.11(B) Use of Pasteurized �* J F00�-V1- 7-206.11 Restricted Use Pesticides,Criteria* 3-801.11(D) Raw or Partially Cooked Animal Furst and RawSeedS)rou1sNotScrved 7-206,12 Rodent Bait Stationsg' 801�I I(C) Unopened Food Package N 7-206.13 Tracking Powders,Pest Control and a3zlEaaot Re-served. I CONSUMER ADVISORY TIMEfTEMPERATURE CONTROLS 22 3-603.11 Consumer Advisory v Posted for Consumption of 16 Proper Cooking Temperatures for Animal Funds That are Raw. Undercooked or Not Otherwise Processed to Eliminate PHFs 3-401.11A(1)(2) Eggs- 155'F 15 See Pathogcris.* La Ts-Immediate Service 145'Fl�scO Pasteur tied F�,,gs Substitute for Raw Shell 3-401-'11(A)(2) Comminuted Fish. Meals&Game Lags* Animals- 155'F I5 sec. * 3-401.11(B)(1)(2) Pork and Beef Roast- 130'F 121 anti SPECIAL REQUIREMENTS 3-401.11iA)(2) Ratttes,Injected Nicatq- 155'F 15 590-009(A)-(Dii Violations of Section 590.009(A)-(I))in sec. * catering, mobile food, temporary and 3-401.11(A)(3) Ponta y,Wild Game. Stuffed PHFs, residential kitchen operations should be Stuffing Containing Fish,Meat, debited under the appropriate sections Poultry or Ratites-165'F 15 sec, above ifrelated to foodborne illness 3-401.11(C)(3) Whole-muscle, Intact Beef Steaks interventions and risk factors. Other 145'F', 590.009 violations relating to prod retail 3-401.12 Raw Animal Foods Cooked in a practices should he debited under #29 Microwave 165'P * Special Requirements. 3-401.11(A)(1)(b) A11Other PHFs 145°Fl5sec, * 17 Reheating for Hot Holding VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 3-403.11(A)&(D) PHFs 165"F 15 sec. I - (Items 23-30) 3-403.11(B) Microwave- 165-F 2 Minute Standing Critical and non-crilicul violations, which do not relate to the Time* foodhorne diness interventions and n5kfiacro).s listed abate, can be 3-403.'11(0) Commercially Processed RTE Food found in the followbig se(tions of the I ood Code and 105 01)? 140T' 590.000. 3403-11(E) Remainin Item Good Retail Practices FC 590 000 g Unsliced Portions of Bee gement and Personae! ----tl-C2 .003 Roasts'! 23.----- --tAanaq----- roorool Li 8- Proper Cooling of PHFS 24. Food and Food Protection FC--3 M4 25- - �and Utestis-­--i FC --4 -,005 3-iOlAzl(A) Cooling Cooked PHFs front 140'F to -- ---- 26. Water Plurnbm�Wast-ee-- 006 ------ - 70-'F Within 21-lours and Fron170+ 27 1 Ph I F IN FC-6-----007 to 41'17/45017 Within 4 Hours. Poisonous or Toxic Materials PC-7 008 3-501.14(B) Cooling PHFs Made From Ambient 29. S ectal ReciLdmerrients_ . ....L_ '009 Ternparaurac Ingredients to 41'F/45F ��l Other--- Within 4 Hours* Denotes critical acn)in rlrt taleral 1999 Food Cc&a 10i CNIR ,t CITY OF SALEM [+ BOARD OF HEALTH ai Establishment Name: ,rc ef.Pcn-Z/rxin/ Date: 3/y�o �4 Pager of Item Code C-Critical item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Rate No. Reference R—Red Item Verified : PLEASE PRINT CLEARLY 2 L- C `Lvcf K if A— Jv iv 2�' rtLe t /rIZ_ w 1' rU J r C S F k r` 4 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/ y violations before the next inspection, to observe all conditions as described, and to Emersion P 13 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 d Has or suspension/revocation of ❑ Embargo ❑ Emergency Closure your food permit. L3Voluntary Disposal ❑ Other: F t -75(TI 14(C) PHFs Received at.Temperatures Violations Related to Foodborne Illness Interventions and Risk Acciading to Law Cooled to Factors(items 1-22) (Cont.) 41'T 4 'F Within 4 Hours. PROTECTION FROM CHEMICALS Coldhil,Methods for PHFs Food or Color Additives 1:19 PHF Hot and Cold Holding -- 3-501.16(B) Cold PHFs Maintained at or below 3-202.12 Additives i' 590.004(F) 4 1'/45^FI: 3-30114 Protection front thiappiowd Pulditivcs*15 3-501.16(A)I 6(A) Hot PRFs Maintained in oj abovePoisonous or Toxic Substances 140°P. * 7-101.11 Identifying Information-Original 1-501.16(A) Roasts Held at or above 130°F. Containers -Time as a Public Health Control 7-102.11 Coalition Name-WorkinL Containers* 20 --_ ---7 7-201 11 Separation-Storaite� i -ml�19 � Time as a Public Health Control 7-202.11 Restriction-Presence and Use* 590,004(H) Vanialce Requij et tent 7-202.12 Conditions of Use' REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-203.11 Toxic Containers-Prohibitions' 7-204.11 Slantizers.Criteria-Chemicals* POPULATIONS(HSP 7-204.12 Chemicals lot Washing Produce. 21 3-8 1.11(A 13 Unpasteurized Pre-packaged Juices and "ciasall' with 7-204A4 Drying Agents.Criteria* Beverages with Warnin�Labels* 7-205.11 Incidental Food Contact,Lubricants* 3-801.11(B) Use of Pasterlmzd 7-206A1 Restricted Use Pesticides,Criteria'? 3-801,11(L) Raw or Partially Cooked Animal Food and Raw Seed Sprouts Not Served. � 7-206,12 Rodent Balt S anonOT 3-801.1 I(C) Unt(!ecried Food Package Not Re-served. 7-206A3 TrackiiiL,Powders,Pest Control and I Monitoring*ng* CONSUMER ADVISORY TIME/TEMPERATURE CONTROLS3-603.1 I 22 Consumer Advisory Posted for Consumption of Proper Cooking Temperatures for Animal Foods'ghat are Raw, Undercooked or 16 PHFs Not Otherwise Processed to Eliminate 3-401.11A(1)(2) Eggs- 155`1' 15 Sitc, Pattlogens., E-s-Immediate Service 14-SF 15iec- 3-30113 Pasteur iz.cd Eggs Substitutc for Rev,,She]] 3401.11(A)(2) Comminuted Fisfi, Moals,&Game Aninitak- 155'F 15 sec. 401.11 SPECIAL REQUIREMENTS 3- (14)(1)(2) Pork and Beef Roast- 130'F 121 nriji* 3-401.11(A)(2) Ratires,Injected Mears- 155°F 15 590,009(A)-(I)) Violations of Section 590.009(A)-(D) in sec. catering, mobile food, temporary and 3-401 II(A(3) Poultry,Wild Came.Stuffed PHFs, residential kitchen operations should be Stuffimi Contanuric Fish,Meat, debited under the appropriate sections Poultry or Ratites-1651- 15 see above if related to foodborne illness 3-401.t I(C)(3) Whole-muscle, Intact Beet Steaks interventions and risk factors. Other - I±LF retail 590rOO9 violations relating to good reta 3-401.12 Raw Annual Foods Conked ma practices should be debited under#29 - Microwave 165'F* Special Requirements. 3-401.11(A)(1)(b) All Other PHFs'- 1451F 15 sec. 17 Reheating for Hot Holding VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 3-40".11(A)&(D) PfiFs 165-F 15 sec. * (Items 23-30) 3-403.11(B) Microwave- 165'F 2 itlintile Standing Critical and non-critical violations, which da not reline to the, 'I'llael: .160(lborns,d1ness inicn,enrions and risk,factol's listed above, can be 3-403.11(C) Commercially Processed RTE Food found ill thefidlarvis)",sections of the Food Code and 105 CIIIR 1400F* 590.000. 3-403A I(E) Remaining Unsliced Portions of Beef Item j Good Retail Practices rc 59alloo Roasts* 1..23. -tlranagement and Personnel FC -2 '003 Proper Cooling of PHFs 24 Food and-Fra�P-rotWlion FC-3 - 004 LI_8 25. Equipment and Utensils _ 4 .005 3 501,14(A) Cooling Cooked]'PIFs from 1401`F to - -------- ----------------- 126. Water.Plumbing and Waste FC-5 006 70"F Within 2 Hours and From 70'F 27. Physical Facility FC-6 .007 to 41'F/45°F Within 4 Hours. 28 Poisonous or Toxic Materials FG-7 .008 29. SEe�291s; 3-501.14(B) Cooling PHFs Made From Ambient '009 Temperature ingredients to 41'f-,/45'F 30. Other Within 4 Hours* Darvae,crificat item in the federal 1999 Filed Code or 1W 0IR 590.000. a CITY OF SALEM, MASSACHUSETTSBOARD OF HEALTH 120 WASHINGTON STREET, 4TH FLOOR SALEM, MA 01970 TEL. 978-741-1800 FAX 978-745-0343 STANLEY 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 : Owner' s Name : Paula Gravallese & Giovanni Graziani Name of Establishment : Caffe Graziani Address of Establishment : 133 Washington Street Type of Establishment : FOOD SERVICE Application Date : 12/20/2002 Restrictions : Permit for Food Establishment 123-03 Frozen Desserts/Ice Cream Permit for the Sale of Tobacco Products These Permits Expire December 31, 2003 This permit is not transferable and must be reissued upon change of ownership or location. The permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code, before any renovations, improvements, or equipment changes are made, all plans for such must be submitted to and approved by the Salem Board of Health. HEALTH AGENT /coHmx� CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH n 120 WASHINGTON STREET. 4TH FI-0011 SALEM, MA 01970 TEL. 978-74 1-1 800 �C/M1me-W FAX 378-745-0343 STANLEY USQViCZ. JR. JOANNE SCOTT- MPHI, RS CHO M 31'bR HEALTH AGENT 2003 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT NAME OF ESTABLISHMENT .it ��^aTEL ADDRESS OF ESTABLISHMENT 135 11t1, S,4I` MAILING ADDRESS (if different) OWNER'S NAME (91dY0e71-JJI Z/ TEL# 1-7 ADDRESS CITY ZLc _ STATEZIP a CERTIFIED FOOD MANAGER'S NAMES) 1'u.ct CERTIFICATE#(s) (required in an establishment where potentially hazardous food is prepared.) EMERGENCY RESPONSE PERSON ?A" l>rOLW41(eS 2 'r �HOME TEL HOURS OF OPERATION: Mod Tut e,Y 3 Wedl�3_Thu." Fri --e Sat.�Sun. �`-J TYPE OF ESTABLISHMENT FEE check only RETAIL STORE YES less than 1000sq.ft. _$ 50 1000-10,000sq.ft. =$100 more than 10,000sq.ft. =$250 RESTAURANT YES NO f less than 25 seats 25-99 seats 1 more than 99 seats =$200 BED/BREAKFAST YES NO $100 ADDITIONAL PERMITS MAKE ICE CREAM, YOGURT, SOFT SERVE YES $5 TOBACCO VENDOR YES $50 ALL NON-PROFIT(such as church kitchens) YES O $25 Please pay total with one check payable to the City of Salem This Permit is not transferable and must be reissued upon change of ownership. The Permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code, before any renovations, improvements, or equipment changes are made, all plans for such must be submitted to and approved by the Salem Board of Health. Pursuant to MGL Chapter 62C, Section 49A, I certify under the pains and penalties of perjury that I, to my be ledg d have ' d all state t r rns and paid aII tate taxes required under the law. ra �r Da Social Security or Federal Ide ification Number }//�� / - - ------------------- Revised 11/25/02 DAP2.adm Che ck#&Date Massachusetts Department of Public Health Salem Board of Health120 Washington Street,0 Floor Division of Food and Drugs Salem, MA 01970-3523 Tel (978)741-1800 Fax(978) 745-0343 City/Town of �y„yy-1 Address: FOOD ESTABLISHMENT INSPECTION REPORT Tel. n� Name D to ype of Operadon(s) Type of Inspection - I 01\A11- 1� Food Service rr1Wtoutine Addres i Risk Retail I(J Re4nspection Telephone14 Level ❑ Residential Kitchen Previous Inspection P ❑ Mobile Date: Owner• -e HACCP YIN ❑ Temporary ❑Pre-operation ❑ Caterer ❑Suspect Illness Person-in-Charge(PIC) oum ^im� ❑ Bed&Breakfast [j HACCP Complaint Inspector Out: Permit No. ❑.Other Each violatiotA checked requires an explaa 'on on he narrative page(s)and a citation of specific provision(s)violated. Non-compliance with: Violations Related to Foodborne Illness Interventions and Risk Factors_(Red Anil-Choking 590.009(E) ❑ Items) Tobacco 590.009(F) ❑ Violations marked may pose an imminent health hazard and require immediate Allergen awareness 590.0091 ❑ corrective action as determined by the Board of Health. [FOOOPROTECTION MANAGEMENT_____ __ ❑ 12. Prevention of Contamination.from Hands ❑ 1. PIC Assigned/Knowledgeable/Duties _ _ .._� ❑13. Handwash Facilities EMPLOYEE HEALTH ��- .- _PROTE_C_TIO_N FR_OM`CHEMICAC_5'.� ❑ 2. Reporting of Diseases by Food Employee and PIC ❑ 14.Approved Food or Color Additives ❑ 3. Personnel with Infections Restricted/Excluded ..�-.y�_._ --= � ❑ 15 Toxic Chemicals CF.00DfROMAPPROVEDSOURCE.,__� :� -- _ ❑ 4. Food and Water from Approved Source ITIMEREMPERATURE.CONTROLS:(P.otentlalty'Haaerdous Foods) ❑ 5. Receiving/Condition ❑ 16. Cooking Temperatures ❑ 6. Tags/Records/Accuracy of Ingredient Statements ❑ 17.Reheating ❑ 7. Conformance with Approved Procedures/HACCP Plans [118.Cooling PROTECTION FROM CONTAMINATION- __ ❑ 19. Hot and Cold Holding ❑ 8. Separation/Segregation/Protection ❑20.Time as a Public Health Control ❑ 9. Food Contact Surfaces Cleaning and Sanitizing REGUI-REMENTE-FORHIGHLY-SUSCEPTIBLE=POPULATIONSI(HSP) ❑21. Food and Food Preparation for HSP ❑10. Proper Adequate Handwashing _ ❑ 11. Good Hygienic Practices ;CONSUMER`ADVISORY ❑22. Posting of Consumer Advisories Violations Related to Good Retail Practices_(Blue Number of Violated Provisions Related Items) Critical(C)violations marked must be corrected To Foodborne Illnesses Interventions immediately or within 10 days as determined by the Board and Risk Factors (Red Items 1-22): of Health. Noncritical(N)violations must be corrected Official Order for Conecdon:Based on an inspection immediately or within 90 days as determined by the Board today, the items checked indicate violations of 105 CMR of Health. 590.000/federal Food Code.This report,when signed below C N 23. Management and Personnel (Fc-2X550.003) by a Board of Health member or its agent constitutes an 24. Food and Food Protection (FC•3X590.004) order of the Board of Health. Failure to correct violations 25. Equipment and Utensils (FC-4X590.005) cited in this report may result in suspension or revocation of the food establishment permit and cessation of food 26. Water, Plumbing and Waste (FC-5X590.006) establishment operations. If aggrieved by this order,you 27. Physical Facility (FC-6X590.007) have a right to a hearing. Your request must be in writing 28. Poisonous or Toxic Materials (FC-7X590.006) and submitted to the Board of Health at the above address 29. Special Requirements (590.009) within 10 days of receipt of thig.prder. -LI30. Other DATEOFRE-INSPECTION: I )-3o-13 t� Inspector's Signature: Print: 1 PICS Signature: Print: �� `, Page 1. of ag ♦� '�.�ar•.v ��.r.. ��h-. '�. .l�y/T rr� _ 4 A .1../ N�!'�rr".:��. ..'a..>."r..-.. �`'r y. . r .T �� .,/ \..�. - 1-�.�.•1-rr ..,rte..� ... i r Violations Related to Foodborne Illness Interventions and Risk Factors(Hems 1-22) PROTECTION FROM CONTAMINATION FOOD PROTECTION MANAGEMENT 8 Cross-contamination 3-302.1.1(A)(1.) Raw Animal Foods Separated from 1 590.003(A) Assig ment of Responsibility* Cooked and RTE Foods* 590.003(6) I Demonstration of Knowledge* � Contamination from Raw Ingredients 2-103.11. Person in charge-duties 3-302.11(A)(2) Raw Animrl Fonds Separated from Each EMPLOYEE HEALTH Other* Contamination from the Environment 2 590.003(C) Responsibility of the person in charge to 3-302.11(A) Fiord Protection* require reporting by food employees and 3-302.15 WashingFruits and Vegetables a licants* 590.003(F) Responsibility Of A Food Employee Or An 3-304.11 Food Contact with Equipment and Utensils* Applicant To Report To The Person In Contamination from the Consumer Charge* 590.003 G Reporting b Person in Charge* 3-306.14(A)(B) Returned Food and Resenice of Food* - Disposition of Adulterated or Contaminated 3 590.003(D) Ezelusions and Restrictions* Food 590.003(E) Removal of Exclusions and Restrictions 3-701.11 Discarding or Reconditioning Unsafe FOOD FROM APPROVED SOURCE Focd* y 1 Food and Water From.Regulated Sources 9 Food Contact Surfaces 590.004(A-B) Compliance with Food Law* - 4-501.111 Manual Warewashing-Hot Water - 3-201.12 Food Ina Hermetically•Sealed Container* Sanitization Te eratures* 3-201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Ware-washing-Hot Water 3-202.13 Shell Eggs* Sanitization Tem eratures* 3-202.14 Eggs and Milk Products,Pasteurized* 4-501.114 Chemical Sanitization-temp.,pH, 3-20216 Ice Made From Potable Drinking Water* concentration and hardness. 5-101..11 Drinkin Water from an Approved System* 4-60 Ll I(A) Equipment Food Contact Surfaces and 590.006(A) Bottled Drinking Water* Utensils Clean* - 4-602.11 Cleaning Frequency of Equipment Food 590.006(6) Water Meets Standards in CMR 22.1)* Contact Surfaces and Utensils* Shalltish and Fish From in Approved oved Sourcee - - 4-702.11 Frequency of Sanitization of Utensils and 3-201.14 Fish and Recreatianalfy Caught 2vfoliuscan Foot Contact Surfaces of Equipment* Shellfish* 4-703.11 Methods of Sanitization-Hot Water and 3-20115 Molluscan Shellfish from NSSF L.istcd Chemical* Sources* 10 Proper,Adequate Handwashing A Re ulatouthcr)t Game and uAAushroans Approved by 2-301,11 Clean Condition-Hands and Alms* 3-20118 Shellstock Identification present* 2-301.12 Cleaning Procedure* 590.004(C) Wild Mushrooms* 2-301.14 When to Wash* 3-201.1.7 Game Animals* 1.1 Good Hygienic Practices 5 ReceivingrCondition 2-401.11 Eating,Drinkin or Using Tobacco* 3-202.1.1 PHFs Received at Proper Tem erasures* 2-401.12 Discharges.From the Eyes,Nose and 3-202.1.5 Package hue,it * _ Mouth* 3.10i.1l Food Safe and Unadulterated* 3-301.12 Preventing Contamination When Tasting* E6 TagslRerords:Shellstock 12 Prevention of Contamination from Hands _ 3-202.18 Shellstock Identification* 590.004(E) Preventing.Contamination.from 3-203.1.2 Shellstock Identification Maintained", -- Employees* Tags/Records:Fish Products 13 Handwash Facilities 3402.11 Parasite Destruction' --i Conveniently Located and Accessible 3-402.12 Records.Creation and Retention* 5-203.11 Numbers and Capacities* 590.004(l) Labeling of Ingredients* 5-204.11 Location and Placement* 7 Conformance with Approved Procedures 5-205.11 Accessibility,Operation and Maintenance ±1ACCP Plans Supplied with Soap and Hand Drying 3-502.11 Sessin Methods*' eciatiMd Processing Devices 3-502:12 Redueed oxwen acka'ng.criteria* 6-301.11 Handwashing Cleanser,Availabilit 5-103.!2 ConformancewihA roved Procedures* 6-30].t2 Hand Drying Provision *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.0x). WIFE 10,111"ll -M wtirmi 1091M.C 0 an m as / I_ �,����.PI I�\�I , -11 rum WIN ON �� � .eat.., �%!�a �� tl_.aul� ' � .. I��_ � iS- � �• / � CA III , iie."%M I /ice! ',�•W. !t ��--- - ����� ♦� =11 1 MI ORA.o . . . . . . . . i i - 3-501A4(C) PHFs Received at Temperatures 1 Violations Related to Foodborne Illness interventions and Risk According to Saw Cooled to Factors(Hems 1-22) (Cont.) 41'F/45`F Within 4 Houm PROTECTION FROM CHEMICALS 3-501.15 Cooling Methods for PHFs 1' 14 Food or Color Additives - 19 - PHF Not and Cold Holding 3-501.16(6) Cold P13Fs Maintained at or below 3-202.12 Additives*' 3-302.14 Protection from Unimproved Additives'} 590'004(F) 410145'F* I5 Poisonous or Toxic Substances 1400F. Hot PRFs Maintained at or above 140`F. + 7-101,11 identifying Information-Original 3-501.16(A) Roasts Held at or above, 130'F. Containers* * 7-102.11. Common Name-Working Containers* 20 -3-501- as a Public Health Cartrol 3-501 £9 Time as a Public Health Central* 7-201.t 1 Separation-Storage* i - 004(H) Variance Requirement ? 7-202.11 ,Restriction-Presence and Use* 590, - 7-202.12 Conditions of Use* l 7-203.11 Toxic Containers-Prohibitions* REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-204.11 Sanitize".Criteria-Chemicals* POPULATIONS HSP l 7-204.12 Chemicals fur FVasIn Produce,Criteria* 21 3-841.11(A) Unpasteurized Pre-packaged Juices and ,i 7-204.14n . encs,Criteria* .Beverages with Warms labels* j 3-801A I Use of Pasteurized Eggs* 4 7-205,11 Incidental Food Contact,lubricants* 3-801..11(D) Raw or Partially Cooked Animal Food and 7-206.11 Restricted Use Pesticides,Criteria* Rau Seed Sprouts Not Served. 7-206.12 Rodent Bait Stations* 3-801.11(C) Unopened Food Package Not Re-served. 7-20(1.13 Tracking Powders,Pest Control and Monitoring* CONSUMER ADVISORY TIMEITEMPERATURE CONTROLS 22 3-603.11 1 Consumer Advisory Posted for Consumption of 16 Proper Cooking Temperatures for Animal Foods Mat are Raw.Undercooked or PHFs - Not Otherwise,Pin 'ootssed to Elimate *ERecdva t/flFCI 3-401.IIA(1)(2) Eggs- 155°F 15 Sec. Pathogens. 1 Eggs-Immediate Service 145°Fl5sec+ 3-302.13. 1 Pasteurized Eggs Substitute for Raw Shell EggO } 3-401.11(A)(2) Comminuted Fish.Meats&fame Animals-155'F 15 sec. * 3 401.11(B)(I)(21 Pork and Beef Roast-130°F 121 min* SPECIAL REQUIREMENTS 3-401.11(A)(2) Ratites,Injected Meats 155`F 15 590.004(A)-(D) Violations of Section .590.009(A)-1J)in sec.* catering, foo ,mobile d,temporaryand 340LI UA)(3) Poultry,Wild fame,Stuffed PHFs, residential kitchen operations should be Stuffing Containing Fish,Meat, debited under the appropriate sections ;i Poultry or Ratites-1650F 15 sec.* aboveif related to foodborne illness 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks interventions and risk factors. Other } 145°F* 590.009 violations relating to good retail 3-401.12 Raw Animal Foals Cooked in a practices should be debited under#29- Microwave 165 F* Special Requirements. 3401:11(A)(I)(b) All Other PHFs- 145'F 15 sec. 17 Reheating for Hot Holding VIOLA77ONS RELATES TO GOOD RETAIL PRACTICES 3403.1I(A)&(D) PHFs 165'F 15 we. * (Items 23-30) ,l 3-403.11(B) Microwave 16S F 2 Minute Standing Critical,and non-critical violations,which do not relate to the Tithe" foodborne illness interventions and ris&,factors listed above, carr be 3-403.11(C) Contnrerciatty Processed RTE Food- found in the following sections of the Food Code and 105 CNIZ 140°F* 590,000. 3-403.11(E) Remaining Unsliced Porticos of Beef Hem 1 Good Retail Practices FC 650.001© Roasts* L23_ _Ma mentandPersonnel -FC--2 .003 1 i IS Proper Cooling of PHFs 1 24. Food and Foci Protection I FC-3 .004 t 1 25. Equipment and Utensils i FC-4 .W5 3-541.14(A) Cooling Cooked PHFs from 140`F to 25, ~Water.Plumbing and Waste i FC-5 .006 1 j 70°F Within 2 Hours and From 70'F 277.Physical Facility 1 FC-8 .GD7 to 41`F/45°F Within 4 Hours. * 1 28. ' Poisonous or Toric Materials ' FC-7 .008 (l 3-501.14(B) Cooling PHFs Made From Ambient ~29. S eclat R uirements .009 ,1 Temperature Ingredients to 41°F/45°F Oma - - d Within 4 Hours* 1 Drnotac critical iwnx in the L•:derat 1999 Foci Cale ur IUS G112 590.000. I ► PIIL r CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH 120 WASHINGTON STREET,4'FLOOR PtiblicHe81t11 ero.cnc.rromac:r.oio. TEL. (978) 741-1800 FAX(978) 745-0343 KIMBERLEYDRISCOLL -- Itamdin@saleln.com _ LARIt)'RAMI)IN,RS/RIsHS,C1-10;CP-PS M 1YOR HF ALCH AGENT This Form will be collected during your next Board of Health inspection. QUESTIONAIRE - GREASE TRAPS 2012 1. NAME OF ESTABLISHMENT: Ca Tf P l �"(_CtZl. GLS l 1 2. ADDRESS OF ESTABLISHMENT: w ms a :h 5f '3Y�- 3. DOES YOUR ESTABLISHMENT HAVE A GREASE TRAP?-- 4. WHAT SIZE GREASE TRAP DOES YOUR ESTABLISHMENT HAVE? CAPACITY IN GALLONSd 5. HOW IS THE GREASE TRAP MAINTAINED? ON A DAILY BASIS? BY AN IN-HOUSE PERSON OR BY AN OUTSIDE CLEANING SERVICE? dv+-;;' Icfe Sek0z'IC.e fZaa { ✓r moon 6. WHAT IS THE FREQUENCY THAT THE GREASE IS REMOVED FROM THE TRAP? 7. WHAT IS THE NAME OF THE FIRM WHO REMOVES AND/OR PICKS UP THE GREASE FROM YOUR ESTABLISHMENT? ff noTQ/1' yy1C1h 8. WHAT IS THE DATE OF YOUR LAST INVOICE FROM THE REMOVAL FIRM?