The URL can be used to link to this page

CAPTS WATERFRONT BAR & GRILL - ESTABLISHMENTS CAPT'S WATERFRONT BAR & GRILL 94 WHARF STREET n A. MMMmMj o � s 4 it :t 4 O 4 h } / ( CAPT.'S ; I� IGGRILL RILL & �'C�,L�-U/n/B JIM ,LEE C General Manager, 94 WHARF STREET • PICKERING WHARF SALEM, MASSACHUSETTS 01970 TELEPHONE: 978-741-0555 • FAX. 978-741-8722 -� EMAIL:JIMLEE@CAPTS.COM CAd'. PT.'S GRILL & CLUB -WILLIAM PARK Executive SOUS Chef. 94 WHARF�STREET• PICKERING.WHARF' SALEM, MASSACHUSETTS 07970 ' TELEPHONE:978-741-0555 • FAX:978-741-872Z EMAIL: SOUSCHEF@CAPTS.COM i ISI CILL & CLU PTI GRsI i lu:'LL UB & BI 6�aD�94 WHARF STREET• ICKERING WHARF SALEM, MASSACHUSETTS 01970 -7q ( -�1�z Massachusetts Department of Public Health Salem Board of Health 120 Washington Street,0 Floor Division of Food and Drugs Salem, MA 01970-3523 Tel. (978) 741-1800 Fax(978) 745-0343 City/Town of aQ,p,,j/) Address: FOOD ESTABLISHMENT INSPECTION REPORT Tel. G(.QR" -144 (.�-oa Namatg� Type of perafion(s) Type of Inspection 7 1 od Serviceoutme Add ss Risk Retail ❑Re-inspection Telephonev I Level ❑ Residential Kitchen Previous Inspection ❑ Mobile Date: Owner HACCP YIN ❑ Temporary ❑ Pre-operation ❑ Caterer ❑Suspect Illness Person-in-Charge(PIC) ` Time I ❑ Bed&Breakfast ❑ General Complaint Y l01 I' �//MtcL In � J ❑ HACCP Inspector ��I� �1 J O aVl/I 41 Permit No. L] Other Each violation checked requires an exp nation 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_(Red Items) Anti-Choking 590.009(E) ❑ Violations marked may pose an imminent health hazard and require immediate Tobacco 590.009(F) ❑ q Allergen Awareness 590.009<G) ❑ corrective action as determined by the Board Of-H h. FFOOD,PROTEC_TIQN MANAGEMENT _ __ _] ❑ 12. Prevention of Contamination from Hands ❑ 1. PIC Assigned/Knowledgeable/Dut es n'(/ t0/ryI [EMPLOYEEHEALTH,___ _ ^v_I •q 13. Handwash Facilities - - - --_ IPROTECTION FROM CHEMICALS -73 ❑ 2. Reporting of Diseases by Food Employee and PIC [114.Approved Food or Color Additives El3. Personnel with Infections Restricted/Excluded _ -� ❑ 15.Toxic Chemicals ('<F..000:F.ROMAPPROVED SOURCE �� __ - - T ...,., ❑ 4. Food and Water from Approved Source iTIM_EREMPERAT_URECONTROLs_(P.oteMla_ItyHa_r_ard_ou_sF_oods),.,j ❑ 5. Receiving/Condition ❑ 16. Cooking Temperatures ❑ 6. Tags/Records/Accuracy of Ingredient Statements ❑ 17.Reheating ❑ 7. Conformance with Approved Procedures/HACCP Plans ❑18. Cooling [MROTECTtON FROM CONTAMINATION - � ❑19. Hot and Cold Holding ❑ 8.Separation/Segregation/Protection ❑20.Time as a Public Health Control '049. Food Contact Surfaces Cleaning and Sanitizing IREQUIREMENTS FOR HIGHLYSUSCEPTIBLE-POPULATIONS_(HSP) �' ,0. Proper Adequate Handwashing El21. Food and Food Preparation for HSP ❑ 11. Good Hygienic Practices ( ONSUMER ADVISORY <1171 P2. Posting of Consumer Advisories 10--620 Violations Related to Good Retail Practices-(Blue Number of Violated Provisions Related i.�..J 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 forConection: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-zxs90.0 order of the Board of Health. Failure to correct violations 24. Food and Food Protection (Fc-3xsso.004) cited in this report may result in suspension or revocation of 25. Equipment and Utensils (FC-4x590.005) the food establishment permit and cessation of food 26. Water, Plumbing and Waste (FCsx590.006) establishment operations. If aggrieved by this order,you 27. Physical Facility (FC-6x590.007) have a right to a hearing.Your request must be in writing 28. Poisonous or Toxic Materials (FC-7x590.008) and submitted to the Board of Health at the above address 29. Special Requirements (590.009) within 10 days of receipt of this order. 30. Other �t�/> /» k.- DATE OF RE-INSPECTION. S &,O.ba o In/Atvt��JNG1- .Y�I. Isspator's Signature:I� ptA .9 v Print: � !!__ rr->�� `� P[CsSignature/� -� ,., - Print: G�� '(��(- , Page_[, f ages I Violations Related to Foodborne Illness , Interventions and Risk Factors(Items 1-22) PROTECTION FROM CONTAMINATION Cross-contamination I FOOD PROTECTION MANAGEMENT 8 I I * 3-302.11(AN I) Raw Animal Foods Separated from I 1 590.003(A) Assignment of Responsibility I I Cooked and RTE Foods* 590.003(B) 1 Demonstration of Knowledge" 1 I Contamination from Raw Ingredients 12-103.11 Person in charge-duties, I 3-302.1 I(A)(2) I Raw Animal Foods Separated from Each EMPLOYEE HEALTH Other* 2 590.003(C) Responsibility of the person in charge toI I Contamination from the Environment 3-302.1 1(A) Food Protection I require reporting by food employees and applicants* 3-302.15 Washing Fruits and Vegetables � 590.003(F) Responsibility Of A Food Employee Or An 13-304.11 I Food Contact with Equipment and I Utensils* Applicant To Report To The Person In I Charge* Contamination from the Consumer I , 590.003(G) Reporting by Person in Charge* I 306.1»(A)(B) I Returned Food and Rof Food* Disposition of Adulteratedted or or Contaminated i 3 590.003(D) Exclusions and Restrictions* I Food 590.003(E) Removal of Exclusions and Restrictions I 3-701.1 1 Discarding or Reconditioning Unsafe FOOD FROM APPROVED SOURCE Food* d Food and Water From,Regulated Sources I 19 Food Contact Surfaces j 590.004tA-B) Compliance with Food Law'' I 4-501.111 Manual Warewashing-Hot Water 3-201.12 Food in a Hermetically Scaled Container* I Sanitization Temperatures* .� 3-201.13 Fluid Milk and Milk Products* I I 4-501.112 I Mechanical Warewashing-Hot Water 13-202.13 Shell Eggs* I Sanitization Temperatures* 13-202.14 Eggs and Milk Products.Pasteuazed* I 14-501.114 ( Chemical Sanitization-temp.,pH, 13-202.16 I Ice Made From Potable Drinking Water* I concentration and hardness. 5-101.11 I Drinking Water from an Approved System* I 14-601.11(A) I Equipment Food Contact Surfaces and 590.006(A) I Bottled Drinking Water, I Utensils Clean- 590.006(B) 4-602.11 Cleaning Frequency of Equipment Food- 590.006(B) Water hlzzts Standards in 310 CMR 22.G I P Shellfish and Fksh From an Approved Source I Contact Surfaces and Utensils* 3-201.14 Fish and Recreationally Caught Molluscan 14-702-11 Frequency of Sanitization of Utensils and Sltelhisb* Food Contact Surfaces of Equipment* 4-703.11 Methods of Sanitization-Hot Water and 3-201.15 Molluscan Shellfish from NSSF Listed Sources* Chemical* Game and Wdd Mushrooms Approved by - 110 Proper,Adequate Handwashing Requlatory Authority I 12-301.11 I Clean Condition-Hands and Arms* 1 3-202.13 SheilstockIdentification Present" 2-301.12 Cleaning Procedure* 1590.004(C) ( Wild Mushrooms* I 12-301.14 When to Wash* 3-201.17 I Game Animals* I 111 I Good Hygienic Practices 5 I I Receiving/Condition 1 2401.11 Eating,Drinking or Using Tobacco* 1 3-202.11 1 PHFs Received at Proper Temperances* I 12-401.12 I Discharges From the Eyes,Nose and I 13-202.15 Package Integrity* I Mouth* 1 1-10 i.i 1 Food Safe and Unadulterated* I 13-301.12 I Preventing Contamination When Tasting* J 16 Tags/Rerords:Shellstock I 1 12 1 I Prevention of Contamination from Hands 3-202.18 i Shellstock Identification° 1 590.004(E) Preventing Contamination from 3-203.12 Shellstock Identification Maintained* I Employees' Tags/Records:Fish Products I 113 Handwash Facilities 3402.11 Parasite Dcstrnl,ign" I Conveniently Located and Accessible 1 3402.12 I Records,Creation and Retention* I 15-203.11 ' Numbers and Capacities* 1590.004(.1) 1 labeling o1 Ingredients* 15-204.11 1 Location and Placement* 7 ( I Conformance with Approved Procedures II 5-205.11 1 Accessibility, Operation and Maintenance /HACCP Plans i I Supplied with Soap and Hand Drying 13-502.11 Specialized Processing Methods* I Devices 316-301.11 Handwashing Cleanser,Availability -502.12 Reduced oxygen packaging,cnteria* 18-103.!2 I Conformance with Approved Procedures* 16-301.12 Hand Drying Provision *Denotes critical item in the federal 1999 I'a)d Code oa 105 CMR 590.M). 4tN CITY OF SALEM ,1BQARD OF HEALTH — Establish : 1-4I h t9A �in �r�1�PQ Date: .'— � (� Page: /� of Item Code C-Crnlcso Item V DESCRIPTION OF VIOLATION/PLAN OF CORRECTION ^ Date. No. Reference R—Red Item f, Verified PLEASE PRINT CLEARLY V tie 301+U`9 tce ' I CAI 1141 �et.lD?) A� Imo a� _ � . I 4 44 1 �.s� iia ��`��"� �� -' �,,,� — �� ,� pgV CD4( � _ 1 Discussion With Person in Charge: I Corrective Action Required: I LiNo ❑ Yea . ! 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 oft y-five dolla o suspenslonlre ocation of ❑ Embargo ❑ Emergency Closure your food permit. / / /� G/L ❑ Voluntary Disposal ❑ Other: v I r;1 ( 3-501.14(C) PHFs Received at Temperatures t( Violations Related to Foodborne Illness,interventions and Risk According to Law Cooled to Factors(Items 1-22) (Cant.) 41'F/45 F Within Hairs. PROTECTION FROM CHEMICALS I 3-501.15 Cooling Methods for PRFs 14 Food or Color Additives I 119 PHF Hat and Cold Holding I 3-202.12 Additives*' I 3-501.16(B) Cold PHFs Maintruned at or below I 590.004(F) 4101450 F* t 3-302.14 Protection from Unapproved Additives* 501.16(A) Hot PHFs Maintained at or above j 15 Poisonous or Toxic Substances I 140 7-10111 JdemifyingInformation-Original Roasts 3-501.16(0) Roasts Held at or above 230'F. Containers* ' 7-102.11 Comment Name-Working Containers* 1 120 Time as a Public Health Control 7-201.11 Separation-Storage* ' 3-501.19 Time as a Public Health Control* 17-202.11 Restriction-Presence and Use* 590.0N(Hl Variance Requirement I 17-202.12 Conditions of Use"` 17-203.11 Toxic Containers-Prohibitions* REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-204.11 Sanitizers.Criteria-Chemicals* ! POPULATIONS{HSP} 7-204.12 Chemicals for Washing Produce,Criteria* 21 3-801.11(A) Unpasteurized Pre-packaged Juices and t 17-204.14 Drying Agents.Criteria* ' Beverages with Warning Labels* 7-205.11 Incidental Food Contact Lubricants* ( 3-801.11(B) Use of Pasteurized Fggs* I ! 17-206.11 Restricted Use Pesticides;Criteria* ( 3-801.11(D) Raw or Partially Cooked Animal Food and 17-206.12 [rodent Bait Stations* I Raw Seed Sprouts Not Served 7-206.13 Tracking Powders,Pest Control and 13-801.11(C) Unopened Foal Package Na Re-served. ' I Monitoring* CONSUMER ADVISORY 71MElFEMPER4TURE CONTROLS Animal 3-603.11 Consumer Advisory Posted for Consumption of 36 Proper Cooking Temperatures for � Animal Foods That are Raw,Undercooked or PHFs Not Otherwise Processed to Eliminate pathogens., l�W� 3-40L1IA(t)(Z) Eggs- 155 15 Sec. I Substitute f 3-30213 Pasteurized E Eggs-immediate Service 145°F15sec* . ggs a Raw SheIl 3-401.11(A)(2) Comminuted Fish.Meats&Game 1 Ems* Animals-155"F 15 see. * ( SPECIAL REQUIREMENTS 3401.11(B)(1)(2) Pork and Beef Roast- 130"F 121 min* I 3-401.11(A)(2) Ratites, Injected Meats- 155`F 15 59lX009(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 1 Poultry or Ratites-165°F 15 sec, " above if related to foodborne illness i 3-401.11(C)(3) Whole-muscle,intact Beef Steaks interventions and risk factors. Other 145°F" 590.009 violations relating to good retail it 3-401.12 Raw Animal Foods Cooked in a practices should be debited under#29- Microwave 165°F* Special Requiremenrs. " 3401.11(A)(1)(b) All Other PHFs-145°F 15 sec. 117 Reheating for Hot Holding I VIOLA770NS RAA7ED TO GOOD RETAIL PRACTICES 3403.14A)&(D) PHFs I65"F 15 sec. * I (Items 23-30) 3-103.11(B) Microwave- 165`F 2 Minute Standing Critical and non-critical violations, which do not relate to the Time* foodborne illness interventions and risk factors listed above, can be 3403.11(C) Commercially Processed RTE Food- found in the fallowing sections of the Food Code and 705 CAM 140'F* 590.000. 3-403.11(E) Remaining Unslieed Portions of Beef item i Good Retail Practices ! FC $90.000 Roasts* i 23. c Management and Personnel i FC-2 .003 f tg Proper Cooling of PHFs I 1 24. 1 Food and Food Protection 1 FC-3 .004 II 11 25. Equipment and utensils 1 FC-4 .005 i 3-501.14(A) Cooling Cooked PRFs from 140`F to ( Water.Piumbino and waste e FC-5 .006 70°F Within 2 Hours and From 70'F 1 27. I Physical Facility FC-6 .007 to 41`F/45'F Within 4 Hours.* 1 28. ' Poisonous or Toric Materials FC-7 .008 3-501.14(B) Cooling PHR Made From Ambient ' 29. 1 Special Requiremerds .009 1 Temperature Ingredients to 41°F/45°F 30. 1 Other Within 4 Hours* Denotes critical item in the federal 1999 Fuad Cale a,105 CMR 390.000. CITY OF SALEM 1 ,� BOARD OF HEALTH l Establishment Name: /S ILh6n�i t' � 1-Pn�ltJ Q , Date:,_�—�—f Page: �i ot nem Code C-Critical IteDESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date No. Reference R-Red Item verified PLEASE PRINT CLEARLY , I �q 1QZ11 � . 1 .14__ I ✓ n'Vi th 2-,.PA r.ri I - _ - ,(0 f Q 1 � ✓Plc I ,•P 11 55. _ t(1 P _ Pi1n o.v r .r�c�4 Qd Q.�• , Pr�S��/� axil o�M Q� C) I Discussion With Person in Charge: Corrective Action Required: I C3 No Yes i I have read this report, have had the opportunity to ask questions and agree to correct all q oluntCompliance ❑ Employee Restriction/ violations before the next inspection, to observe all conditions as described, and to �I �jy1 Exclusion P ❑ e-inspe i c eduled ❑ Emergency Suspension comply with all mandates of the Mass/Federal Food Code. I understand that noncompliance may result in daily fines oftw ty-five dollar f suspension/ evocation of El Embargo C2 Emergency Closure your food permit. / _ I�(il�f ❑ Voluntary Disposal ❑ Other: 3-501.14(0 PHFs Reccived at Temperatures Violations Related to Foodborne fitness Interventions and Risk According to Law Cooled to Factors(Items 1-22) (Cont.) 4t"F/45°F Within 4 Hours. r PROTECTION FROM CHEMICALS +i 3-501.15 Coding Methods for PHFs ( ` 19 PHF Not and Cold Holding t 1 14 Food or Color Additives 3-501.16(B) Cold PURR Maintained at or below r + 3-202,12 Additives*' ; 590.004(F) 41'145'F* 3-302.14 Protection from Unapproved Additives't ( j 3-501.16(A) Hot PHFs Maintained at or above 15 Poisonous or Toxic Substances 140 • * 7-101.11 ldentifyingInformation-Original � 3-501.16(A) Roasts Held at or above 130'F, Containers* j 7-102.11 Common Name-Working Containers* 20 Time as a Public Health Control [ 7-201.11 Separation-Storage* j 3-5.1.14 Tante as a Public Health Control* j 7-202.11 ,Restriction-Presence and Use* j 590.004(H) Variance Requirement j j 7-202.12 Conditions of Use* j REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-20111 'Toxic Containers-Prohibitions* j POPULA11ON3(HSP) 7-204,11 Sanitizers.Criteria-Chemicals* 7-201.12 Chemicals fru Washing Produce,Criteria* j 21 3-801.11(A) Unpasteurized Pre-packaged dukes and f { 7-204.14 Drying Agents.Criteria* { .Beverages with Warning labels* 3-801.11(6) Use of Pastemizecl Eggs* 1 1-205.11 incidental Food Contact.Lubricants* 3-801.11(D) Raw or Partially Cooked Animal Food and i 7-206.11 Restricted Use Pesticides,Criteria* Raw Seed Sprouts Not Served j 7-206.12 )talent Bait Stations* I 7-206.13 Tracking Powders,Pest Control and ( 3-801.11(C) Unopened Food Package Net Re-served. Monitoring* CONSUMER ADVISORY 22 3-6.3.11 Consumer:advisory Posted fur Consumption of TIMEIFEMPERATURE CONTROLS 16 Proper Cooldng Temperatures for Animal Otherwise Foods That are Raw, limina Undercooked or PHPs Naogens,I ProcessedwEliminate r ( 3-401.11A(t)(2) Eggs- 155°F 15 Sec. Pathogens, fggs Sn�r Eggs-Immediate Senicc 145°FtSsec* 3-3.2.13 Pasteurized Eggs Substitute for Raw Shell ". 31401.11(A)(2) Comminuted Fish.Meats 8 Game i Ems* Animals-155'F 15 se:.* l j 3-401,11(B)(1)(2) Pori and$eef Roast-d30°F d21 min* j SPECIAL REQUIREMENTS s 590 009(A)-(D) Violations of Section 590. 13-401.1 t(A)(2) Ratites,Injected Meats-155°F 15 590.009(A)-(D)in sec.* I catering, mobile food,temporary and ' 13401.11(A)(3) Poultry,Wild Game,Stuffed PHFs, residential kitchen operations should be Stuffing Containing Fish,Meat. debited under the appropriate sections Poultry or Ratites-165'F 15 sec, * above if related to foodborne illness 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks interventions and risk factors. Other 145°F* 590.009 violations relating to good retail 3-401.12 Raw Animal Funds 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 IS sec,* i { ( 17 Reheating for Hot Holding VIOLATWNS RELATED TO 0000 RETAIL PRACTICES 3403:11(.A)&(D) PHFs 165°F 15 sec. * (Itefns 23-30) 3-40.3.11(B) Microwave- 165'F 2 Minute Standing Crkical mrd non-critical violations,which do not relate to the Time* foodborne illness interrenttona and risk factors listed above, can be 3-403.11(C) Commercially Processed RTE Food- found in the,toltowing sections of the Food Code and 105 CMR 1400F* 59(X000. 34033I(E) Retraining Unsliced Portions of Beef 1 item Good Retail Pmct9ces FC 590.000 Roasts* i 23, : Manaqament and Personnel i FC-2 •003 t r f 18 ( Proper Cooling of PHFs 1 24. Foal and Food Protection FC-3 .004 I it 1 25. 1 Equipment and Utensils ( FC-4 ,005 7 3-501.14(A) Cooling Cooked PHF%from 140'F to 126, ( Water.Plumbinq and Waste ; FC-5 1 .0o6 70°F Within 2 Hours and From 70`F 1 27. 1 Physical Facility FC-6 .007 to 41'F/45'F Within 4 Hours. * i 28. ' Poisonous or Toxic Materiais ; FC=7 .008 1 } 3-501.14(6) Cooling PHFs Made From Ambient 29. I Special Requirements 1 .009 i Temperature ingredients to 41'F/45'F 30. I Other I i Within 4 Haus* 'Denotes critical is rn in the fedecH 1999 Fwd Cale w 105 CMR 590.000, ss�_m%'�.—'•r.Tm, "�.w � � eF'�� i„ �� pa .��, � J a.++xe.9,*ms�p,. � .s i-- -, - � -��a x N . � - ,�•` 'rte �.�'� - r i ft p ` CommonwealthofMassachusetts r d 3_ City ofSalemH s. �, JAR Board of Health --- � { " 4 a' � - SOI.E_M,MA01970a�z � c ` Food/Retail Establishment Permit _ 7 r DATE PRINTED 12/17/2013 - _ ON xU d y ESTABLISHMENTNAME: Y- F Capt's Waterfront Grill& Club = FileNumba BHF-2U04-000093 Wharf Street '" '- -- , - -� ',' - -. .i - .•ay' we `#'-s.:3' s-" .. _r.._ - - 'yJyaa"s' '? LOCATED AT �C094 WHARF STREET �,� �T- 4 ' - SALEM,MA 01970 . s PermiCTyy'y{fie :Permit No.:-W-_..1- <Permit IssuedPermit Expires - Fee Restnctoms/Notes - - ` 'FOOD SERVICE BHP 2014-0111 �Aio -Jan i,2014 ' i�Dec31,2014 $420 00 ESTABLISHMENT e' r a Ivi Total Fees° x" s420'00 ;y a-v.4- �- OiN g - '45�, s - �{g- •'b- 'c l- t S -�` F - '..'�5 ii E �` Ste" SN A" $' 5' t _ c +4 _"'§. ..f °s 3az{ fi - ��, r? �A i^.� r..�;, a> t`# .Y c ' .s✓ 5 d 'h - '`app+ i- t I "K ' PERMTI:EXPIRES �Deeember f w S .. J Board of Health AiK � .J- k "§n �"_—h'r a ^3' Y' En�, This Permit ii not transferable and must b issued upon change,of ownership or location The,permit must be posted 7- ` k .$ r Ina prominent location.in the Establishment_ In accordance with the State Sawtary Code,beofre any revonatonsjmprovements;or equipment changes aremade 'r ti `*=1 ' all plans for such must be subnutted toFand approved by the 8alem`Board of Health , page 1 h t * s '£xa _ ii" Jj d -•� -`` - P �i• � 1 fir' .{ 2ya $ Y+ j2"i- y:S le „ � , • CITY OF SALEM, MASSACHUSETTS t�r . BOARD of Hi:ju:Cli P”` `. �ult�xeettt",." 120 WAs11INGTON S'1RF,IE'1',4'FI,0012 KIMBERLEY DRISCOLL Tal..(978)741-1800 Fill(978)745-0343 Rec, DIN,RS/RF,1-IS,CHO,(T-PS MAYOR ImundinGsalem Tem mss' ft-11I AG ENT �F� t 3 Food Establishment Permit A�PjicgtGA13 (Application must be submitted at least 30 days before `i�n`i� Nt` opening date) 1) Establishment Name: JhQ �(Ja nro�t / (�?. �.��• /[g�f� l�aPr'r X)Ar--RF1eo1jF r-A/i L 2) Establishment Address: l wf��I F Jf 54kfA1 Mfg (2/976 3) Establishment Mailing Address(if different): 4) Establishment Telephone No: 9 N-J1//-06:j` 5) Applicant Name&Title: DIRK L',>RR.41JDTSFd . :72ESi✓)EiIIT 6) Applicant Address: 7) Applicant Telephone No: 29-1 5/-7(3if 24 Hour Emergency No: 7490707 Email: av-&-.p I 6) Owner Name&Title(if different from applicant): 9) Owner Address(if different from applicant): 10) Establishment Owned by: 11) If a corporation or partnership,give name,title and home address of officers or partner. An association Name Title Home Address A corporad--BM7 / 1 An individual DAI< HRRr�PT�` P��R�SiDL-n1r (�IS�BDi/ / A partnership Other legal entity 12) Person Directly Responsible For Daily Operations(Owner, Person in Charge,Supervisor,Manager,etc.) Name&Title: -&R/< ZSRR�II1DT,lF/J Address: Telephone No: Fax: Email: Emergency Telephone No: 13) District or Regional Supervisor(if applicable) Name&Title: Address: Telephone No: Fax: Email: Check#: —L�D� Date:—�� Amount: IFood Establishment Information 54) Water Source: 15) Sewage Disposal: DEP Public Water Supply No: (if applicable) FOAM - 1 PM 16) Days and Hours of Operation: 7DA"IS A UrP--K 17) No.of Food Employees: 18) Name of Person in Charge Certified 16 Food Protection Management: ea`)�rr; 1 6L(eC7�$ JceS0/J�A�AMSY Required as of 10111201 0ayin accordance with 105 CMR 590.003(A) C- ;r 17r �e A , 19) Person Trained in Anti-Choking Procedures(if 25 seats or more): ❑ Yes No 20) Location: 22) Establishment Type(check all that apply) (check one) / ❑ Retail( Sq. Ft) ❑Caterer Permanent Structure ✓ RKFood Service-( Seats) ❑ Frozen Dessert Manufacturer Mobile ❑ Food Service-Takeout ❑ Residential Kitchen for Retail Sale ❑ Food Service-Institution ❑ Residential Kitchen for Bed and ( Meals/Day) Breakfast Home ❑ Food Delivery ❑ Residential Kitchen for Bed and 21) Length Of Permit: ... ..........................................................Breakfast Establishments...................... (Chyck one) RETAIL STORE RESTAURANT Annual !, ❑Less than 1000sq.ft. $70 ❑Less than 25 seats $140 Seasonal/Dates: ❑ 1000-10,OOOsq.ft. $280 ❑Residential Kitchens $140 ❑More than 10,OOOsq.ft. $420 ❑25.99 seats $280 21Nlore than 99 seats $420 Temporary/Dates/Time: ----------------- --------- --------------- e__r_v------- ----------------------------------------------------------------_..-..------- ❑ Bed 8 BreakfasUChildcare Services(Nursing Home $100 ADDITIONAL PERMITS ❑MAKE ICE CREAM,YOGURTISOFT SERVE $25 ❑ PASTURIZATION $25 ❑ALL NON-PROFIT* $25 *Including, church kitchens,state funded childcare&private club 23) Food Operations: Definitions: PHF-potentially hazardous food(time/temperature controls required) Non-PHFs—non-potentially hazardous food(no timeRemperature controls required) (check all that apply): RTE—ready-to-est foods(Ex.sandwich=s,salads,mu/fins which need no further processing Sale of Commercially PHF Cooked to Order ✓ Hot PHF Cooked and Cooled or Hot Held✓ Pre-packaged Non-PHFs for More Than a Single Meal Service Sale of Commercially Preparation of PHFs For Hot And PHF and RTE Foods Prepared For Highly Pre-packaged PHFs Cold Holding for Single Meal Service Susceptible Population Facility Delivery of Packaged PHFs Sale of Raw Animal Foods Intended to be Vacuum Packaging/Cook Chill ✓ Prepared by Consumer Reheating of Commercially Customer Self-Service Use of Process Requiring A Variance Processed Foods for / and/or HACCP Plan(including bare hand Service Within 4 hours contact alternative,time as public health control. Customer Self-Service of lee Manufactured and Packaged for Offers Raw or Undercooked Food of Non-PHF and Non- Retail Sale Animal Origin Perishable Foods Only Preparation of Non-PHFs ✓ Juice Manufactured and Packaged for Prepares Food/Single Meals for Catered Retail Sale Events or Institutional Food Service Offers RTE PHF in Bulk Quantities To be completed by the Board of Health Retail Sale of Salvage,Out of Date or Reconditioned Food Total Permit Fee: Payment is due with application 1,the undersigned,attest to the accuracy of the Information provided in this application and I airm that the food establishment operation will comply with 105 CMR 590.000 and all other applicable law. I have been instructed by the Board of Health on howto obtain copies of 105 CMR 590.000 and the Federal Food Code. 24) Signature of Applicant: �////�S�J, Pursuant to MGL Ch.62C,sec.49A,I certify under the penalties of perjury that I,to my best knowledge and belief, Have filed all state tax returns and paid state taxes required under law. 25) Social Security Number or Federal ID: 01_61?0711t / _{) 26) Signature of Individual or Corporate Name: (t/� Y� ^�Ii1^ i /�Jif/,�CDG^✓'..!' Massachusetts Department of Public Health Salem Board of Health 120 Washington Street,0 Floor Division of Food and Drugs Salem, MA 01970-3523 Tel. (978) 741-1800 Fax (978) 745-0343 City/Town of Address: FOOD ESTABLISHME N P3ECT N REPORT Tel. Name J ( f ¢ l Da �`m T�ypr�"Perotion(s) Type of Inspection APF"..Food ServiceR tine Addres Risk [I ❑Retail e-inspection Telephone r r, I r Level ❑ Residential Kitchen Previous Ispction drL ❑ Mobile Date: -717(J Owner HACCP YIN Temporary ❑ Pre-operati ❑ Caterer ❑Suspect Illness Person-in-Marge(131c) I Tim@@ ❑ Bed&�t ❑ HACCP General Complaint {� In:ll�ry� Inspector I Out: i Permit No. I❑ Other Each violation mocked requires an exp anation 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_(Red Items) Anti-Choking 590.009(E) ❑ Violations marked may pose an imminent health hazard and require immediate Tobacco 590.009(F) ❑ corrective action as determined by the Board of Health. Allergen Awareness 590.009(G) El IFOOO,PROTECTION MANAGEMENT' _ - _ El 12. Prevention of Contamination from Hands ❑ 1. PIC Assigned/Knowledgeable/Duties wkoYEEHEALTH ' _ "-`�T_ ❑ 13. Handwash Facilities � -- PROTECTION FROWCHEMICALS_ ❑ 2. Reporting of Diseases by Food Employee and PIC El 14.Approved Food or Color Additives El3. Personnel with Infections Restricted/Excluded ❑ 15.Toxic Chemicals FOOD'FROM APPROVED SOURCE - ❑ 4. Food and Water from Approved Source -TNIEREMPERATURE CONTROLS(PotentlaityHazardous_ F_.o__oda).m ❑ 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 N CONTAMINATIO _ _ ❑19. Hot and Cold Holding Y❑ 8.Separation/Segregation/Protection _ ❑20.Time as a Public Health Control ❑ 9. Food Contact Surfaces Cleaning and Sanitizing REQUIREMENTS FOR HIGHLYSUSCEP-BLEEPOPULATIONS_(HSP),j ❑ El 10. Proper Adequate Handwashing 21. Food and Food Preparation for HSP _ ❑ 11. Good Hygienic Practices CONSUMERADVISORY a ❑22. Posting of Consumer Advisories Violations Related to Good Retail Practices_(Blue Number of Violated Provisions Related Items) Critical(C)violations marked must be corrected To Foodborne Illnesses Interventions immediately or within 10 days as determined by the Board and Risk Factors (Red Items 1-22): of Health. Noncritical(N)violations must be corrected Official Order for Correction:Based on an inspection immediately or within 90 days as determined by the Board today, the items checked indicate violations of 105 CMR of Health. 590.000/federal Food Code.This report,when signed below C N by a Board of Health member or its agent constitutes an 23. Management and Personnel (FC-2X590.003)a) order of the Board of Health. Failure to correct violations 24. Food and Food Protection (Fc-sXs9o.00a) cited in this report may result in suspension or revocation of 25. Equipment and Utensils (FC-4X590.005) 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-7X590.008) and submitted to the Board of Health at the above address 29. Special Require (590.009) within 10 days of receipt of this order. 30. Other DATE OF RE-INSPECTION. S 6f4uo Inspector's Signature: Print: 1::W, �j �/�Y[//,1,( /�//J PICS Signature: ,jig Print: /l � / .�ril+ry � Page � of CiPages III H I Violations Related to Foodborne Illness Interventions and Risk Factors(Items 1-22) PROTECTION FROM CONTAMINATION 1 ( FOOD PROTECTION MANAGEMENT 8 Cross-contamination a 1 3-302.11(A)(1) Raw Animal Foods Separated from 1 590.003(A) Assignment of Responsibility* i Cooked and RTE Foods* 590.003(B) Demonstration of Knowledge,_ 1 Contamination from Raw Ingredients 1 2-103.11 Person in charge-duties I 3-302.1 I(A)(2) Raw Animal Foods Separated from Each I EMPLOYEE HEALTH Other* J 1 Contamination from the Environment 2 59U.(X)3(C) Responsibility of the food e in charge to I 13-302.1I(A) Food Protection- applicants* requreporting by food employees and 3-302.15 Washing Fruiis and Vegetables applicants* 590.003(F) Responsibility Of A Fund Employee Or An 3-304.11 Food Contact with Equipment and Applicant To Report'Io The Person In G[ensils* Charge* I Contamination from the Consumer I 1 3-306.14(Aj(B) I Returned Food and Reservice of Food* ( 590.003(G) 1 Reporting by Person in Charez* I I 131 590.003(D) I Exclusions and Restrictions* I Disposition of Adulterated or Contaminated Food J 1590.003(E) I Removal of Exclusions and Restrictions I 3-701 .1: Discarding or Reconditioning Unsafe FOOD FROM APPROVED SOURCE I Food* d IFood and Water From Regulated Sources ( 1 9 Food Contact Surfaces 590,004(A-B) Compliance with Food Law* ( 4-501.11 I Manual Warewashing-Hot Water 13-201.12 Food in a Hermetically Sealed Container* I Sanitization Temperatures* 13-201.13 Fluid Milk and Milk Products* -501.112 MechanicalWarewashing-Hot Water 13-202.13 Shell Eggs* I _ Sanitization Temperatures* 1 3-202.14 1 Eggs and rMilk Pmcluct<5,Pasteurized' 1 4-501.114 Chemical Sanitization-temp.,pH, I 13-202.16 Fee Made From Potable Drinking Water* I I concentration and hardness. 5-101.11 Drinking Water from an Approved System" 1 14-601,11(A) I Equipment Food Contact Surfaces and 1 590.006(A) Bottled Drinking Wrateff 1 Utensils Clean* l 4-602.11 I Cleaning Frequency of Equipment Food- 1590.006(B) 1 Water Meets Standards in?10 C;VFF,_ZA)* I Contact Surfaces and Utensils* 1 Shol�sh and Fish From an Approved Source 1 4-702.11 Frequency of Sanitization of Utensils and 3-201.14 Fish and Recreadunaily Caught Molluscan Food Contac[Surfaces of Equipment* Shellfish* I 14-703.11 Methods of Sanitization-Hot Water and 3-201.15 Molluscan Shellfish from NSSP Le,tad Sources* Chemical* Game and Wild Mushrooms Approved by I 1 10 1 I Proper,Adequate Handwashing Regulatory Authority 1 2-301.11 1 Clean Condition-Hands and Arms* I 1 3-202.18 Shellsnxk identification Present' 1 1 2-301.12 Cleaning Procedure* 1 590.004(C) Wild Mushrooms* 1 12-301.14 When to Wash* 1 3-201.17 Game Animals* I 1 1t 1 Good Hygienic Practices I 1 51 Receiving/Condition 1 2401.11 Eating,Drinking or Using Tobacco* 1 3-202.11 PHFs Received at Proper Temperatures* 1 2-401.12 Discharges From the Eyes,Nose and 3-202.15 Package Integrity° 1 Mouth* 1 3-10;.'1 I Fond Safe and Unadulterated* I 1 3-301.12 I Preventing Contamination When Tasting* 1 6 1 Says/Rerotds:Shelistock 1 112 1 1 Prevention of Contamination from Hands 1 3-202.18 Shellstock idenGficatina* 1 1590.004(E) Preventing Contamination from 3-203.12 Shellstock Identification Maintained* I Employees* TagslRecords:Fish Products 1 13 ( Handwash Facilities I 1302.71 I Parasite Destruction* Conveniently Located and Accessible 1 3 15-203.11 Numbers and Capacities* 1 -402.12 Records,Creation and Re enti�n* 1 15-204.11 Location and Placement* 1590.004(n I Labeling of Ingredients' 1 1 7 Conformance with Approved Procedures I 15-205.11 Accessibility.Operation and Maintenance IHACCP Plans I I Supplied with Soap and Hand Drying 3-502.11 I Specialized Processing Methods* 1 Devices 1 13-502.12 1 Reduced oxygen packaging,criteria* 1 1 6-301.11 1 Handwashing Cleanser,Availability 1 8-103.12 Conformance with Approved procedures* 1 16-301.12 Hand Drying Provision 1 *Denotes critical item in the(edetal 1999 Pax(Code or 105 CMR 590 OW, CITY OF SALEM Establishment Name: 7G7 W(�+�w __C �7l�VtYA Date: Pager W L/ Item Code C-Critical Item I DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date No. Reference R—Red Item EAS(k- _ 1PA .IXCrr.L7-EA!RLV�! Verified v �n 14y, 0q � L +I I Discussion With Person in Charge: Corrective Action Required❑ No 111.—V� 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 twenty y--fIV ollars o suspension/revocation of ❑ Embargo ❑ Emergency Closure your food permit. %Ld�7/ i 0 Voluntary Disposal ❑ Other: t i 3-501A4(C) PHFs Received at Temperatures Violations Related to Foodborne tiiness.Interventions and Risk According to law Cooled to ,1 Factors Monte 1-22) (Cont.) I 4t'F/454 Within 4 Hoare. r J ?-501.15 Cooling Methods for PHFs PROTECTION FRO A CHEMICALS J 14 J Food or Color Additives ( J 19 CHF Hof and aintCold Holding J 3-501.16(B) Cold PRMaintainedaintFs ained at or below J 3-20212 Additives*' 590.004(M 410145'F* 3-302.14 Protection from Unapproved Addirives* 3-50116(A) Hot PIFs Maintained at or above J 15 Poisonous or Toxic Substances } � 7-101,11 identifying Intormation-Original � 3-501.16(A) Roasts Held at or above t300F. Containers* ' S J 20 Time as a Public Health Control J 7-102.11 Common Name-Working Containers* I 3-501.19 Time as a Public Health Control* J i 7-201.11 Separation-Storage* � 590.004(H) J Variance Requirement � 7-202.11 ,Restriction-Presence and Use* I J 7-202.12 Conditions ot'Use* J REQUIREMENTS FOR HIGHLY SUSCEPTIBLE J 7-203.11 Toxic Containers-Prohibitions* POPULATIONS(HSP) J 7-204.11 Sanitize".Criteria-Chemicals* 7-204.12 Chemicals for Washing Produce,Criteria* 1 21 3-801.11(A) Unpasteurized Pre-packaged Juices and J Beverages with Warning labels* J 7-204.14 Drying Agents.Criteria* ( 3-80L I UB) Use of Pasteurized E es* J J 7-205.11 htcidenml Food Contact.Lubricants* 3-801.11 $h 7-206.11 Restricted Use Pesticides;Criteria* J ` (D) Raw or Partially Cooked Animal Food and I Raw Seed Sprouts Not Serv,d. 7-206"12 Rodent Bait Stations* J t ( 3-$01.11(C) Unopened Food Package Not Re-served. " I 1 i 7-206.13 Tracking Powders, Pest Control and ' 1 Monitoring* CONSUMER ADVISORY TIMErrEMPERATURE CONTROLS 22 3-603.11 1 Consumer Advisory Posted for Consumption of ( 16 Proper CooMng Temperatures for Animal Foods That are Raw.Undercooked or 6 PHFs Not OtherwiseProcessssed to Eliminate i-40L11A(1)(2} Eggs- 155`F 15 Sec. P�OI� ( Eggs-Immediate Service 1450F15sees 3-302.13 1 Pasteurized Eggs Substitute for Raw Shell 3401.11(A)(2) Comminuted Fish.Meats .1 &Game Ewe i ,r Animals-155'F 15 sec.* J 401.I1(B)(1)(2) Ptak 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 l sec.* catering,mobile food,temporary and 3-401.1 I(A)(3) Poultry,Wild Game,Stuffed PHFs, i residential kitchen operations should be Stuffing Containing Fish,Meat. C debited under the appropriate sections Poultry or Ratites-165'1715 sec,* above if related to foodborne illness 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks 1 interventions and risk factors. Other 145'F r' i 590.009 violations relating to good retail fff 3-401.12 Raw Animal Foods Cooked in a I practices should be debited under#29- } Microwave 165F* Special Requirements. 340111(A)(1)(b) All Other PHFs-145'F 15 sec.* J J 17 Reheating for Hot Holding VIOLATIONS R-RATED TO GOOD RETAIL PRAC77CES ' 3403.11(A)&(D) PHFs 165'F 15 sec. * _ (Items 23-30) i 3-403.11(B) Microwave- 165'F 2 Minute Standing Critical and non-critical violations, which do not relate to the Tire* foodborne illness interventions and risk factors lisled above, can be + 3-40311(C") Commercially Processed RTE Food- found in the following sections of the Food Code and 105 CUR i 140017* 590.000. titem Good Retail Practices FC 1 590.000 3-403.11(E) Remaining tinsiic;ed Portions of Beef � I ' i Roasts* j 23. Management and Personnel FC-2 .003 i ` J 18 Proper Cooling of PHFs J 24. I Food and Food Protection FC-3 .004 1 25 J Equipment and utensils I FC-4 .W5 3-501.14(A) Cooling Cooked PHFs from 140'F to 1 26, ( W star.Plumbinq and Waste 1 FC-5 "006 1 70°F Within 2 Hours and From 70' ` 27. Physical Facifty FG-6 .007 I to 41`F/45'F Within 4 Hours.* 1 1 28. ' Poisonous or Toxic Materials ' FC=7 ,008 3-501.14(B) Cooling PHFs blade FromAmbient + 129. 1 Special Requirements .009 Temperature Ingredients to4l'F/45'F til ' I Other ! ' Within 4 Hours* s.mt,m:,*:.„:c_ 0.notes critical it`rn in the federal 1999 Food Cale or 105 CMR 590.000, Massachusetts Department of Public Health Salem Board of Health 120 Washingtpn Street,4a' Floor Division of Food and Drugs Salem, MA 01970-3523 Tel. (978)741-1800 Fax (978) 745-0343 City/Town ofI Address: FOOD E Y/,STA�BL SHMENT INSP TION REPORT Tel. Name T O peration(s) DD fInspectiona Service ff Routine Address Rlsit ❑ Retail ❑Re-inspection Telephone � / Level ❑ Residential Kitchen Previous Inspection U r t ❑ Mobile Date: Owner \ HACCP YIN ❑ Temporary ❑Pre-operation 111 t ❑ Caterer ❑Suspect Illness Person-in arge tPhC)" Tim ❑ Bed&Pfpt ❑ General Complaint In: 7Jti ❑ HACCPInspector / � Out Permit No. - ❑ Other Each violation efie a re re n explanation on the narrative e )and a citation of specific provision(s)violated. Non-compliance with: Violations Related to Foodborne Illness Interventions and Risk Factors_(Red Items) Anti-Choking 590.009(E) ❑ Violations marked may pose an imminent health hazard and require immediate Tobacco 590.009(F) ❑ Allergen Awareness 590.009(G) ❑ corrective action as determined by the Board of Health. FOOOPROTECTION MANAGEMENT 12. Prevention of Contamination from Hands ❑ 1. PIC Assigned/Knowledgeable/Duties �I v�Handwash Facilites ,:EMPLOYEE HEALTH _ 1 'r/_ 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 1 El 15.Toxic Chemicals FOOD:FROM APPROVED SOURCE_ - _ . —• TIMFITEMPERATURE CONTRO (P.otei tlalty HAA1iii97..00de) 171 4. Food and Water from Approved Source _ - - - _LS - - - ❑ 5. Receiving/Condition ❑ 16. Cooking Temperatures ❑ 6. Tags/Records/Accuracy of Ingredient Statements ❑ 17.Reheating ❑ 7. Conformance with Approved Procedures/HACCP Plans ❑ 18 Cooling PROTE_C19-_TION FROM CONTAMINATION _ _ Hot and Cold Holding (❑ eparation/Segregation/Protection E]20.Time as a Public Health Control Food Contact Surfaces Cleaning and Sanitizing REQUIREMENTS FOR HIGHLYSU$CEPTIBLE=POPULATI.ONS(NSP)',_ i El 10. Proper Adequate Handwashing ❑21.Food and Food Preparation for HSP _ ❑ 11.Good Hygienic Practices .CONSUMERADVRY�ISO ❑22. Posting of Consumer Advisories Violations Related to Good Retail Practices_(Blue Number of Violated Provisions Related Items) Critical (C)violations marked must be corrected To Foodborne Illnesses Interventions immediately or within 10 days as determined by the Board and Risk Factors (Red Items 1-22): of Health. Noncritical (N)violations must be corrected Official Order for Correction:Based on an inspection immediately or within 90 days as determined by the Board today, the items checked indicate violations of 105 CMR cf Health. 590.000/federal Food Code.This report,when signed below MT by a Board of Health member or its agent constitutes an Management and Personnel (Fc-2x990.003) order of the Board of Health. Failure to correct violations 24. Food and Food Protection (FC-3X590 004) cited in this report may result in suspension or revocation of Equipment and Utensils (FC-4X590.005) the food establishment permit and cessation of food 26. Water, Plumbing and Waste (FC-5)(590.006) establishment operations. If aggrieved by this order,you 27. Physical Facility (FC-6X590.007) have a right to a hearing. Your request must be in writing 28. Poisonous or Toxic Materials (FC-7X590.008) and submitted to the Board of Health at the above address 29. Special Re ents (590.009) within 10 days of receipt of this order. 30. Other DATE OF RE-INSPECTION: �J Ir , s Sudoc _ � G I! Inspector's Signature: Print: I PICS Signature: jj / w j I Print // r�M�IAOn/'��SX/'_v v I Page of_ ages III � , ,,_� r Violations Related to Foodborne Illness Interventions and Risk Factors(items 1-22) PROTECTION FROM CONTAMINATION 8 Cross-contamination FOOD PROTECTION MANAGEMENT 1 3-302.11(A)(]) Raw Animal Foods Separated from I 1 590,003(A) Assignment of Responsibility* I Cooked and RTE Foods* 540.003(6) Demonstration ofKrtowledgex" I , contamination from Raw Ingredients 2-103.11 Person in charge-duties I 3-302.1 I(A)(2) I Raw Animal Foods Separated from Each EMPLOYEE HEALTH Other* Contamination from the Environment 2 590.003(C) Responsibility of the person in charge to 13-302.11(A) Food Protection* require reporting by food employees and J 3-302 15 J Washing Fruits and Vegetables J applicants 3304.11 Food Contact with Equipment and 590.003(F) Responsibility Of A Food Employee Or An I I Utensils* Applicant To Report To The Person In ( I I Contamination from the Consumer Charge* 13-306.14(A)(B) I Returned Food and Reservice of Food* 590.003(G) Reporting by Person in Charge* J Disposition of Adulterated or Contaminated 13 590.003(U) I Exclusions and Restrictions* Food 590.003(E) I Removal of Exclusions and Restrictions 3-701,11 Discarding or Reconditioning Unsafe FOOD FROM APPROVED SOURCE Fad* 4 Food and Water From Regulated Sources ( i 9 Food Contact Surfaces 590.004(A-B) Compliance with Fad Law* J 4-501.111 Manual Warewashing-Hot Water 13-201.12 F+xd in a Hermetically Scaled Container, I Sanitization Temperatures* J 13-201.13 Fluid Milk and Milk Products* I 14-501.1 12J Mechanical Warewashing-Hot Water I 13-202.13 Shell Eegs* J I Sanitization Temperatures* 1 I13-202 14 Eggs and NSrlk Pnxucts.Pasteurized* 14-501.114 Chemical Sanitization-temp.,FH , 3-202.16 IceMade From Potable Drinking Nater* ( concentration and hardness. * 5-101.11 Drinking Water firom an Approved System* J 14-601.11(A) ( Equipment Food Contact Surfaces and 590.006(A) ( Bortled Drinking Water' I Utensils Clean* 590.006(6) I Water Meets Standards in 310 CNIR 22.01' I 4-602.11 Cleaning Frequency of Equipment Food- J J Shefsh and Fish From an Approved Seurre J I Contact Surfaces and Utensils* 4-702.11 Frequency of Sanitization of Utensils and 3-201.11 Fish and Recreationally C:mcJrt Molluscan I Shellfish* Food Contact Surfaces of Equipment* I 14-703"11 Methods of Sanitization-Hot Water and 3^01.15 Molluscan Shellfish from SSF L steel I Chemical* Sources* 110 1 Proper,Adequate Handwashing Game and Wi,dnRushroon, Approved by R.equ/atory Authority I 2-301.1 I I Clean Condition-Hands and Arms* J 3-202.14 Shellstock identification Present" I 2-501"12 Cleaning Procedure* 1590A04(C) Wild Mushrooms* I 2-301.14 When to Wash* 3-201.17 Game Arlmals* I ( It I I Good Hygienic Practices S ReceivingfCondition 12-401.11 Eating,Drinking or Using Tobacco* 3-202.11 I PHFs Received at Proper Temperatures* I 2401.12 Discharges From the Eyes,Nose and 13-202.15 I Package integrity" I ! I Mouth* J 3-10 L I I Food Safe and Unadulterated* 13-301.12 I Preventing Contamination When Tasting* J 16 Tags/Records:>Shelistock I L I J Prevention of Contamination from Hands 3-202.18 I Shellstock Identification* 590.004(F,) Preventing Contamination from 13-203.12 Shellstock Identification Maintained* Employees* Tags/Records:Fish Prc-ducts I 113 Handwash Facilities 1 3-402.11 Parasite Destruction` Conveniently Located and Accessible J I 15-203.11 Numbers and Capacities* 13-402.12 Records,Creation and Retention` I I 1590.0040) Labeling of Ingredients' ' 15-204.11 Location and Placement* I 71 Conformance with Approved Procedures 15-205.11 Accessibility, Operation and Maintenance /HACCP Plans I I I Supplied with Soap and Hand Drying 13-502.11 Specialized Processing Methods* J Devices 13-502.12 Reduced oxygen packaging,criteria* J 16-301,111 I Handwashing Cleanser,.Availability 8-103.!2 Conformance with Approved Procedures" i 6-301.12 Hand Drying Provision 'Denotes critical iu"rn in the federal 1999 Faxi Cale or 105 CMR 590-00(). CITY OF SALEM Cr HEALTH // Establishment Nae: �,1 t , Date: �I f(� �� Page: 7 i of m Item Code C-Critical Ite DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date No. Reference R-Red Item Verified - PLEASE PRINT CLEARLY e ZT i r3✓ �er,� .Y arm f1,�L t •Wa 5 F I Moi— r dl �Jl, f (fir A W f Discussion With Person in Charge: ICbriective Action Required: I ❑ No ��fes 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 e-inspection Scheduled ❑ Emergency Suspension comply with all mandates of the Mass/Federal od Code. I understand that noncompliance may result in daily fines of77VK- doll or suspension/revocatio ❑ Embargo El Emergency Closure J your food permit. ❑ Vo luntary Disposal LiOther: i v } 3-501,14(C) PHFs Received at Temperatures 1 Violations Related to Foodearne!tunes&Interventions and Risk According to law Cooled to { Factors((terns 1-22) (Cont.) 41"F/45'17 Within 4 Hours. PROTECTION FROM CHEMICALS 3-501.15 Cooling Methods for PHFs g¢ i Food or Color Additives { { 19 PHF Hot and Cold Holding { J-501,16(B) Cold PHFs Maintained at or below { 3-202.12 Additives* 590.004(F) 430/45"F* 3-302.14 Protection from Unapproved Additives" { { 3-501.16(.0) Hot PHFs Maintained of or above 15 Poisonous or Toxic Substances 140 7-101.11 Identifying yr Information-On 3501.al . f i6(A) Roasts Held at or above 130'F, Containers* * E M 20 S 'nine as a Public Health Control I 7-102.11 Common Name -Working Containers* I li 3-501.19 Time as a Public Health Coutrol' � 7-101.11 Separation-Storage* F ! ( 7-202.11 .Restriction-Presence and Use* { 590.004(H) Variance Requirement I 1 { 7-2202.12 Conditions of Use* E REQUIREMENTS FOR HIGHLY SUSCEPTIBLE h 7-203.11 Toxic Containers-Prohibitions* I r 17-204.11 Sanitizers.Criteria-Chemicals* POPULATIONS(HSP) 7-204.12 Chemicals for Washing Produce,Criteria* ) 21 3-841.11{A} Unpasteurized Pre-packaged Tutees and { .Beverages with Warning labels* 7-204.14 Drying Agents.Criteria* { Use of Pasteurized 7-205,11 incidental Food Contact,Lubricants* ! { 3-801.11(9) Eggs* 3-801.11(l)) Raw or Partiallyy C Cooked Animal Food and 7-206.11 RenUse Pesticides,Criteria* Raw Seed Sprouts Not Served. ' 7-206.12 Rodent Bait Stations* i 7-206.13 Tracking Powders,Pest Control and ( 3401.11(C) Unopened Food Package Not Re-served. " I r Mon tering CONSUMER ADVISORY } 22 3-643.11 Consumer Advisory Pasted fca Consumption of TIMEti EMPERATURE CONTROLS p ( Animal 16 Proper Cooidng Temperatures for ! Not Otherwise wiss That are Raw,Undercooked or I Not Processed to Eliminate s PHFs Pathogens.* ! 3 441.I1A(1)(2) Egg- 155°F IS Sec. 3302.13 Pasteurized Eggs Substitute for Raw Shell r; Eggs-immediate Service 145°Fl5sec* 3.401.11(A)(2) Comminuted Fish.Meats&Game Eggs j Animals-155°F 15 see. / 3-441.11(B)(1)(2) I Pork and Beef Roast- 130°F 121 min* { SPECIAL REQUIREMENTS 3-401.11(A)(2) Ratites,Injected Meats-155`F 15 y 590.009(A)-(D) Violations of Section 590.009(A)-(D)in sec.* I catering, mobile food,temporary and 3-401.1 t(A)(3) Poultry,Wild Game,Staffed PHFs, i residential kitchen operations should be Stuffing Containing Fish,Meat. f1( debited under the appropriate sections Poul F t try or Ratites-165 F 15 sec, above if related to foodborne iciness { 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks interventions and risk factors. Other i 145°F* 590.009 violations relating to good retail 3-401.12 Raw Animal Foods Cooked in a practices should be debited under#29- Microwave 165F Special Requirements. 3-401.11(A)(1)(b) All Other PHFs-145°F 15 sec. 17 I Reheating for Hot Holding I VIOLA77ONS R:LATED TO GOOD RETAIL PRACTICES 3-403.1 l(A)&(D) { PHFs 165`F 15 scc.* I (Items 23-30) 3403.11(B) Microwave- 165-`F 2 Minute Standing Critical mrd non-critical violations,which do not relate to the Time* Joridborne diness interventions and risk,faerors listed above, can be 34.¢3.11(C) Commercially Processed RTE Fowl- found in the following sections of the Food Code and 105 CMR 140°F* 590.000. 3403.11(E) Remaining Unslic:ed Porrions of Beef Iitem Good Retail Practices 1 FC 590.000 j Roasts" 1 23. i Management and Personnel I FC-2 4 .003 tg { Proper Cooling of PRFs { 1 24. Food and Real Protection I FC-3 .004 1 25. I EquiDmaru and Utensils 1 FC-4 ( .005 i 1 3-501.14(A) Cooling Cooked PRFs from 140`F to 2fi. Water.Plumbing and Waste_ � FC-5 i .006 70°F Within 2 Hours and From 70'1 127. i Physical Facility FG-6 1 .007 i to 41`F/45°F Within 4 Hours.* i 26. Poisonous or 4'orac Materiais ! FC-7 .008 3-501.14(B) Cooling PHFs Made From Ambient ( 29. Special Reguiremetts ! ,009 r Temperature Ingredients to 41'F/45°F i 30. I Other ! M Within 4 Hours* 'Dmvre uineal ivm in the L•-doral 1999 Food Cale w 105 CMR 590.000. S t CITY OF SALEM ARDEALTH Establishment Name: 64c� � 44M"'� Al �i; D te:ul. I �� Page: of Item Code C—Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date No. Reference R-Red Item verified PLE SE PRINT C EAR Y- �� " VrAYL [. i�4 v V Uc 1 - � (� 1.• �,i , �' � ✓ �� t 1 I I � I I Discussion With Person in Charge: Corrective Action Required: I ❑ No Yes i 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 o' Re-inspection Scheduled ❑ Emergency Suspension comply with all mandates of the Mass/Federal Food Code. I understand that noncompliance may result in daily finesWtwnte d liarsor suspension/revocation of ❑ Embargo ElEmergency Closure your food permit. ❑ Voluntary Disposal ❑ Other: " 3-501.14(C) PHFs Received at Temperatures ! Violations Related to Foodborne illness Interventions and Risk According to Law Cooled to Factors(items 1-22) (Cont) 41T-/45F Within 4 Hours. j PROTECTION FROM CHEMICALS 3-501,15 Cooling.Methods for PHFs ! 14 Food or Color Additives j 19 PHF Hot and Cold Holding ! 3-50L16(B) Cold Pl1Fs Mainta'uned at or below 3-202.22 Additives*' j 590.004(M 4101450 F* 3-302.14 Protection from I)napnroved Additives'' 9 ( 3-SOt.1fi(A) Hoc PHFs Maintained at or above is Poisonous or Toxic Substances 7-101,11 Identifying Information-Original I I40sts 3-501.16(Ai Roasts Held at or above 230'F. Containers* � { 20 Time as a Public Health Control 7-102.11 Common Name-Working Containers* ! n 3-501.19 Time as a Public Health Control' 7-20111 Separation-Storage* j 7-202.11 ,Restriction-Presence and Use° i ( 590.004(11} Variance Requirement ! y 7-202.12 Conditions of Use* 7-203.11 Toxic Containers-Prohibitions* REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-204.11 Sanitizers.Criteria-Chemicals* ! POPULATIONS(HSP) ! 7-204.12 Chemicals for Washing Produce,CTitetia* 21 3-801.11(A) Unpasteurized Pre-packaged iuices and ! 7-204.14 Drying Agents.Criteria* ! Beverages with Warning Labels" 7-205.11 Incidental Foal Contact,Lubricants* + 3-801-11(9) Use of Pasteurized Eggs* ! 7-206.11 Restricted Use Pesticides,Criteria* i 13-801.11(6) Raw or Partially Cooked Animal Food and Raw Seed Sprouts Not Served. 7-206.12 Relent Bait Stations" 3-$01 7-206.13 I Tracking Powders,Pest Control and I ! .11(C) Unopened Fated Package Not Re-sensed. Monitor ng* ` CONSUMER ADVISORY ( TIMEtFEMPERATURE CONTROLS 22 3-603.11 Consumer Advisory Posted for Consumption of i 16 Proper Cooking Temperatures for Animal Foods That azo Raw,Undercooked or ! PHFs Not Otherwise Pocessed to Eliminate 3-401.I IA(1)(2) Eggs-, 155°F 15 Sec. 1 Pesos(=" Eggs-Immediate Service 145`F15sec* { 3-30113 Pasteurized Eggs Substitute for Raw Shell x 3-401 A I(A)(2) Comminuted Fish.Meats&Game gYs Animals-155°F 15 see. ° a 3-401.21(8)(1}(2) Por};and Beef Roast- 230°F 121 mia* SPECIAL REQUIREMENTS! 'y 3-401.11(A)(2) Ratites,Injected Meats-155`F 15 590.009(A)-(D) Violations of Section 590.609(A)-(D)in sec. * catering,mobile food,temporary and 3-501.11(A)(3) Poultry-,Wild Game,Stuffed PHFs, residential kitchen operations should be Staffing Containing Fish,Meat, debited under the appropriate sections Poultry or Ratites-165°F 15 sec,* above if related to foodborne illness 3-401,11(C)(3) Whole-muscle,Intact Beef Steaks interventions and risk factors. Other 145°F* 1 590,009 violations relating to good retail { 3-401.12 Raw Animal Foods Cooked in a I practices should be debited under#29- i Microwave 165°F* Special Requirements. t 3401.11(A)(1)(b) All Other PHFs-145°F 15 sec. ! 17 Reheating for Hot Holding VIOLATIONS R:LATED TO GOOD RETAIL PRACTICES 3-403:11(A)&(D) PHFs 165-F 15 sec,* I (Items 23-30) F 3-403.11(B) Microwave- 165"F 2 Minute Standing Critical mrd non-critical violations, which do not relate to the Time* foodbonue illness interventions and risk,factors listed above, can be 3-403.t 1(C) Commercially Processed RTE Fad- found in the following sections of the Food Cade and 105 CMR 140°F* 590.000. 3403.11(E) Remaining Unsliced Portions of Beef item ; Goad Retail Practices I FC 590.060 j li Roasts* i 23. i Management and Personnel 1 FG-2 .003 1 ! SS ! Proper Cooing of PHFs 1 24. 1 Food and Food Protection ' FC-3 .004 ! 2S. Equipment and utensils I FC-4 '005 I, 3501.14(A) Coaling Caked PHFs from 140`F to I26, Water.Plumbinq and Waste ! FC-5 .406 i 70°F Within 2 Hours and From 70`F j 27. ! Physical FaciNty FC-6 .707 j t to 41`F/45TF Within 4 Hours.* 1 28. Poisonous or Toxo Materials FC-7 .008 3-501.14(8) Cooling PHFs Made From Ambient 29. , Special Requirements .009 Temperature Ingredients to 41°F/45°F 30, 1 Other Within 4 Hours* "Dmov%critical tum in the federal 1999 Fuad Cmie or 105 CMR 590.000. Massachusetts Department of Public Health Salem Board of Health 120 Washington Street,0 Floor Division of Food and Drugs Salem, MA 01970-3523 Tel. (978)741-1800 Fax (978) 745-0343 City/Town of Address: FOOD ESTABLISHMENT INSPECTION REPORT Tel. Name / Datcr If Type of Operation(s) Type of Inspection ( ftow / �fs�+ � ood Service El Routine Address rk Ris c IJ Retail (JtRe-inspection Telephone / Level ❑ Residential Kitchen Previous nspectio P I 9 � E] Mobile Date: Owner ❑ Temporary ElPre-operation (e i) r,/ I �� e HACCP YIN I ❑ Caterer ❑Suspect Illness Person-in-Charge(PI(5) E] Bed&Breakfast ElGeneral Complaint T i7 ❑ HACCP Inspector �rrss i�Or�f Permit No. E],Other Each violation checked requites an explanation on the narrative pedals)and a citation of specific provision(s)violated. Non-compliance with: Violations Related to Foodborne Illness Interventions and Risk Factors_(Red Anti-Choking 590.009(E) ❑ Items) Tobacco 590.009(F) ❑ Violations marked may pose an imminent health hazard and require immediate Allergen Awareness 590.009(G) ❑ corrective action as determined by the Board of Health. FOOD PROTECTION MANAGEMENT _ _ u ❑ 12. Prevention of Contamination from Hands ❑ 1. PIC Assigned/Knowledgeable/Duties .. - ❑ 13. Handwash Facilities EMPLOYEE HEALTH PROTECTION FR&CHEMICALS ❑ 2. Reporting of Diseases by Food Employee and PIC ❑ 14.Approved Food or Color Additives El3. Personnel with Infections Restricted/Excluded .. _ _ ❑ FOOD FROM APPROVED SOURCE 15.Toxic Chemicals _ _ _ _-_ ..� ._ TIME/TEMpERg7URECONTROLs(PotantiaityHazardous Foods) -] 11 4. Food and Water from Approved Source ❑ 5. Receiving/Condition [116. 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,HIGNLYSUSCEPTIBLE=POPULATIONS'(HAP)._ ❑21. Food and Food Preparation for HSP ❑ 10. Proper Adequate Handwashing _ _ _ ❑ 11. Good Hygienic Practices CONSUMERADVISORY Z ❑ 22. Posting of Consumer Advisories Violations Related to Good Retail Practices_(Blue Number of Violated Provisions Related Items) Critical (C)violations marked must be corrected To Foodborne Illnesses Interventions immediately or within 10 days as determined by the Board and Risk Factors (Red Items 1-22): of Health. Noncritical (N)violations must be corrected Official Order for Correction: Based on an inspection / immediately or within 90 days as determined by the Board today, the items checked indicate violations of 105 CMR of Health. 590.000/federal Food Code.This report,when signed below C N by a Board of Health member or its agent constitutes an 23. Management and Personnel (FC-2X590,003) by of the Board of Health. Failure to correct violations 24. Food and Food Protection (Fc-0xsso.00a) cited in this report may result in suspension or revocation of 25. Equipment and Utensils (FC-4X590 005) the food establishment permit and cessation of food 26.Water, Plumbing and Waste (FCSX590.006) establishment operations. If aggrieved by this order,you 27. Physical Facility (FC-6X590.007) have a right to a hearing. Your request must be in writing 28. Poisonous or Toxic Materials (FC-7X590.008) and submitted to the Board of Health at the above address 29. Special Requirements (590.009) within 10 days of receipt of this order. v 30. Other DATE OF RE-INSPECTION: Inspector's Signature: ! int: PLCs Signature- IPriat: ��K�� Page/ g(�Pages Violations Related to Foodborne Illness Interventions and Risk Factors(items 1-22) PROTECTION FROM CONTAMINATION FOOD PROTECTION MANAGEMENT I 8 I Cross-contamination I 1 590.003(A) Assignment of Responsibility* I 13-302.11(,A)(1) Raw Animal Foods Separated from Cooked and RTE Foods* 590.003(B) Demonstration of Knowledge* I J Contamination from Raw Ingredients 12-103.11 Person in charge-duties I ( 3-302 11(A)(2) I Raw Animal Foods Separated from Each EMPLOYEE HEALTH Other, I J( 2 590.003(C) Responsibility of the person to charge to Contamination from the Environment13-302.11(A) I Food Protection* applicants require reporting by food employees and 3-302 15 J Washing 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* I Contamination from the Consumer 590 003(G) Reporting by Person in Charge'" I 3-306.14(AK13) J Returned Food and Reservice of Food* J Disposition of Adulterated or Contaminated J 3 590.003(D) Exclusions and Restrictions* Food 590.003(E) Removal of Exclusions and Restrictions I 3-701,i I Discarding or Reconditioning Unsafe FOOD FROM APPROVED SOURCE 1 Food* Food and Water From Regulated Sources I ( 9 Food Contact Surfaces j 590.004(A-B) Compliance with Food Law* J 4-501.111 Manual Warewashing-Hot Water 3-201.12 ( Fooil in a Hermetically Sealed Container* J Sanitization Temperatures* J 3-201.13 Fluid Milk and Milk Product;* I 1 4-501.112 Mechanical Warewashing-Hot Water 1 13-202.13 Shell Eggs* J Sanitization Temperatures* 1 3-202.14 Eggs and Milk Products,Pasteurized* ( ( 4-501.114 ( Chemical Sanitization-temp.,PH, J 3-202.16 Ice Made From Potable Drinking Water* J concentration and hardness.* 5-101"11 Drinking Water from an Approved System* J 1 4-601.1 I(A) 1 Equipment Food Contact Surfaces and 1590.006(A) Bottled Drinking Water' ( Utensils Clean" c r t 22 * 4-602.11 Cleaning Frequency of Equipment Focd- 1590.006(B) I Water Meets ing a.t. n 310 CMR22.0* I J Shotffish and Fish From, an Approved Source I Contact Surfaces and Utensilsr 1 1 3-201.14 Fish and Reereatienaliy Caught ivlollusct,n 4-702.11 Frequency of Sanitization of Utensils and Food Contact Surfaces of Equipment* Sloli "ish" 1 1 4-703.11 1 Methods of Sanitization-Hot Water and 3-201.15 MAtlluscan Shellfish from NSS^r L gtod Chemical* Sources* ___1 J to I Proper,Adequate Handwashing I Game and Wild lvhshrooms.4pproved by I Regulatory Authority 2-301.11 J Clean Condition-Hands and Arms* j J 3-202.13 Shellstock identification Presetn* J 12-301.12 J Cleaning Procedure* 1590.004(C) I Wild Mushrooms* 12-301.14 When to Wash* 13-201.17 I Game Animals* I I if J Good Hygienic Practices 5 Receiving/Condition I 12401.11 Eating,Drinking or Using Tobacco* 3-202.11 1 PHFs Received at Proper Temperatures* I 1 2-WL 12 Discharges From the Eyes,Nose and 1 3-202.15 Package hitep-rity' J Mouth* 3-!`i i.11 Food Safe and Unadulterated" ( 13-301.12 Preventini;Contamination When Tasting* J 1 61 i Tags/Records:Shelistock I 112 1 1 Prevention of Contamination from Hands 13-202.18 Shellstock Identification* 1 ( 590.004(F,) 1 Preventing Contamination from 1 3-203.12 Shellstock Identification hlaintaineTl 1 Employees* f J Tags/Records:Fish Products I 113 I J Handwash Facilities 13402.11 ( Parasite Destruction' I J 1 Conveniently Located and Accessible 1 3-402.12 I ('records.Creation and Retention* 15-203.11 I Numbers and Capacities* 590.004(.f) ( Labeling of Ingredients' -I 15-204.11 I Location and Placement* f- 7 I I Conformance with Approved Procedures J 5-205.11 I Accessibility,Operation and Maintenance I li IHACCP Plans ( I Supp%red with Soap and Hand Drying 1 13-502.11 Specialized Processing Methods* Devices 13-502.12 J Reduced oxygen packaging,criteria* 16-301.11 I Handwashing Cleanser,.Availability J 8-103.12 I Conformance with Approved Procedures` J 6-301.12 J Hand Drying Provision 1 *Denotes critical item in The f.^deml 1999 Faxt Code of 105 CMR 590.000. CITY OF SALEM ,^ ( BOARD OF HEALTH Establishment Name: 1=Ct Lets JCIL 6;z-,q Date:,�i T Page: of I Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date No. Reference R—Red Item Verified J j / PLEASE PAiNT CLEARLY) / / �,t')- i, (1 And 6,1L ,f � rfOcar: °r 2)(7A /Lo�7e�. SCaNUd f�-�_ XG i4I?6 �J a4ej4S 4- /rU A ) O 0� n, V-d -<Ur, z-_/ re- 6 ,c- hc,,0 -S-A P/ /JavvA-_Jo C-Dc� C01i_ rnce � 1 I V 0 f I r f LJ KC 1A b-LAJ 0-14 1 Y I I I I I I Discussion With Person in Charge: Corrective Action Required: I ❑ No ��e]'le8 I I have read this report, have had the opportunity to ask questions and agree to correct all Voluntary Compliance E] Employee firsstriction/ Exclusion violations before the next inspection, to observe ail conditions as described, and to ❑ Re-inspection Scheduled ❑ Emergency Suspension comply with all mandates of the Mass/Federal Food Codo undersand that , noncompliance may result in daily fines of twe y-five rs or pension/revocation of ❑ Embargo ❑ Emergency Closure your food permit. ❑ Voluntary Disposal 0 Other: 3-501.14(0 PHFs Received at Temperatures Woleflons Related to Foodborne Illnesstnterventtons ams Risk According to Law Caoted to Factors(Items 1-22) (Cont.) 41'F145°F Withm 4 Hmits. PROTECTION FROM CHEMICALS I 3-501.15 Cooling Methods for PHFs I ( 14 { Food or Color Additives { 119 PHF Hot and Cold Holding 4 3-202.12 Additives* I .3-501.16(B) Cold PHFs Maintained at or below 590.004(F) 410145'F* 3-302.14 Protection from Unaporoved Additivzs* 3-50 L I6(A) Hot PHFs Maintained at or above ( 15 Poisonous or Toxic Substances 1400P. 7-101.11 Identifying Information-Original Containers* 3-501.16(A) Roasststs Held at or above 130'F. " 1 ( 7-102.11 Comuaon Name-Working Containers* 1 12® Time as a Public Health Control r101.iI Separation-Storage* I 3-501.4( Tiaraasa Requirement ement Control* j 7-202.11 Restriction-Presence and Use* 1 590.06=1(H) Variance Requiremeffi { 17-202.12 Conditions of Use* { REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-203.11 Toxic Containers-Prohibitions* I POPULATIONS(HSP) 7-204.11 Sanitizes.Criteria-Chemicals' 1 { 7-20412 { Chemicals for Washing Produce,Criteria* 1 21 3-801.11(A) Unpasteurized Pre-packaged Juices and 7-204.14 Drying Agents.Criteria• 4 Beverages with Warning Labels* 7-265.11 Incidental Food Cwatact Lubricants* { 3-801.11(B) Use of Pasteurized Eggs* { 3-301.11(l)) Raw or Partially Cooked Animal Fail and 7-206.11 Restricted Use Pesticides,Criteriaz 206.22 Rodent bait Stations* Raw Seed Sprouts Not Served 7- Package 3-801-II(C) Unopened Food 7-206.13 Tracking Powder,Pest Control and Package Not Re-served * { 'Monit x nq* CONSUMER ADVISORY TIME71 EMPERATURE CONTROLS 22 3-603.11 Consumer Advisory Posted for Consumption of 16 Proper Cooking Temperatures for Animal Foods That are Raw.Undercooked or PHFs Not Otherwise Processed to Eliminate 3-401.11A(1)(2) Eggs- 155`F 15 Sec. Pad veers* Eggs-Immediate Service 145'F15sec* 3-362.13 Pasteurized Eggs Substitute for Raw Shell { 3-401.11(A)(2) Comminuted Fish.Meats&Game Ems* Animals-155'F 15 ser,. * 1 3401.11(B){1)(2) Pork and Beef Roast- 130'F 121 mm* f SPECIAL REQUIREMENTS 3-461.11(Ax2) Ratites,Injected Meals-155`F 15 590.009(A)-(D) Violations of Section 590.009(A)-(D)in sec.* catering, mobile food,temporary and 3-401-1 t(A)(3) Poultry,Wild Came,Stuffed PHFs, residential kitchen operations should be Stuffing;Containing Fish,Meat, debited under the appropriate sections Paul"or Ratites-165°F t5 sec. * above if related to foodborne illness 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks interventions and risk factors. Other 145'F* 590.009 violations relating to good retail 3-401.12 Raw Animal Fails Cooked in a practices should be debited under#29- Microwave 165F* Special Requirements. 3-401.1l(A)(1)(b) All Other PHFs-145'F 15 sec.* I { 17 Reheating for Hot Holding I VIOLA77ONS RELATED TO GOOD RETAIL PR4C77CES 3403.11(&)&(D) PHFs 165"F 15 sec. * {Itstrts 23-30) 3-403.11(B) Microwave- 16F F 2 Minute Standing Crulcal and non-critical violations, which do not relate to the Time" foodbonte illness intren entions and ris&,factors listed above, can be j 3-403.11(C) Conmercially Processed RTE Foci- found in the following sections of the Food Crule and 105 CMR I 140°F* 590.000. 3403.1)(E) Remaining Unsliced Portions of Beef ( item : Goad Retail Practices i FC i 690.0w Roasts* i 23. I Management and Personnel I FC-2 .003 1 { 18 { Proper Cooling of PHFs ! ( 24 Food and Food Protection ! FC-a .004 1 1 25. Eguipmem and Utensils i FC-4 .005 i 3-501.14(A) Cooling Cooked PHFs from 140`F to 1 26. ' Water.Plumbing aria Waste ( FC-5 1 .006 70'F Within 2 Hours and From 70'F 27. 1 Physical Facit>1iv FC-6 007 to 410F/45'F Within 4 Hours. * 28. Poisonous or Toxic Materials FC=7 .Ma 3-501.14(B) Cooling PHFs Made From Ambient 29, Special Requirements 009 1 Temperature Ingrodient-s to 41'F/45'F 30. 1 Other Within 4 Hours* „Denotes crificai ncal in the L-dent 1999 Foal Cale or 105 C..MR 590.000. Massachusetts Department of Public Health Salem Board of Health 120 Washington Street,4m Floor Division of Food and Drugs Salem, MA 01970-3523 Tel. (978) 741-1800 Fax (978) 745-0343 City/Town of Address: FOOD ESTABLISHMENT INSP CTION REPORT Tel. Name l Date I Type of Operation(s) Type of Inspection / t/1u/, 2-PoodService QRoutine Address Risk ❑ Retaile-inspection Telephone Level ❑ Residential Kitchen Previous Ipe,Mion (� I_ ElMobile Date: j IW13 Owner HACCP YIN ❑ Temporary ❑Pre-operation �NIG."t t -V J ❑ Caterer ❑Suspect Illness Person-in-Charge(PIC) v Time ❑ Bed&Breakfast ❑General Complaint Y� �Af, In:0Z, �� El HACCP Inspector �9 V1�Dr uot. Out: 177J Permit No. El Other Each violation checked requites 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_(Red ItemsAntiChoking 590.909(E) ❑ ViTobacco 590.009(F) El marked may pose an imminent health hazard and require immediate AOergen Awareness 590.009(G) ❑ corrective action as determined by the Board of Health. FOOOPROTECTION MANAGEMENT' T _ - _ ❑ 12. Prevention of Contamination from Hands ❑ 1. PIC Assigned/Knowledgeable/Duties - __ ❑ 13 Handwash Facilities -'EMPLOYEE HEALTH - ,PROTECTIONPROM"CHEMICALS _ ❑ 2. Reporting of Diseases by Food Employee and PIC El 14.Approved Food or Color Additives ti El 3. Personnel with Infections Restricted/Excluded _, _ _ ❑ 15.Toxic Chemicals FOOD FROM APPROVED SOURCE _ j _ F14. Food and Water from Approved Source_ _ ttmEREMPERATuRiCONTROLSiO6etftfiltyFaaardiusFgods) ; ❑ 5. Receiving/Condition ❑ 16. Cooking Temperatures ❑ 6. Tags/Records/Accuracy of Ingredient Statements [117. Reheating ❑ 7. Conformance with Approved Procedures/HACCP Plans ❑ 18. Cooling PROTECTION FROM CONTAMINATION - _ 19. Hot and old olding ❑ 8.Separation/Segregation/Protection ❑20.Time as a Public Health Control ❑ 9. Food Contact Surfaces Cleaning and Sanitizing R HI GHLYSUSCEPTIBLE-POPULATIONS(HSP);_2 El 10. Proper Adequate Handwashing El21. Food and Food Preparation for HSP ❑ 11. Good Hygienic Practices CONSUMERADVISORY, __ El 22. Posting of Consumer Advisories Violations Related to Good Retail Practices-(Blue Number of Violated Provisions Related Items) Critical(C)violations marked must be corrected To Foodborne Illnesses Interventions immediately or within 10 days as determined by the Board and Risk Factors (Red Items 1.22): of Health. Noncritical(N)violations must be corrected Official Order for Correction:Based on an insp ction immediately or within 90 days as determined by the Board today, the items checked indicate violations of 105 CMR of ce Nth' 590.000/federal Food Code.This report,when signed below 23. Management and Personnel (Fc-2X590.003) by a Board of Health member or its agent constitutes an 24. Food and Food Protection (FC-3X590.004) order of the Board of Health. Failure to correct violations 25. Equipment and Utensils cited in this report may result in suspension or revocation of (FC-4X590 005) the food establishment permit and cessation of food 6.Water, Plumbing and Waste (Fc-5)(990.009) establishment operations. If aggrieved by this order,you 27. Physical Facility (FC-6X590.007) have a right to a hearing. Your request must be in writing 28. Poisonous or Toxic Materials (FC-7X590.008) and submitted to the Board of Health at the above address 29. Special Requirements (590.009) within 10 days of receipt of this order. 30.Other DATE OF RE-INSPECTION: e Inspector's Signature: Print: '�( � � PICS Signature: �� I Print: Page�of�Pages Violations Related to Foodborne Illness Interventions and Risk Factors(items 1-22) PROTECTION FROM CONTAMINATION 8 Cross-contamination FOOD PROTECTION MANAGEMENT 1I 3-301.11(A)(]) Raw Animal Foods Separated from I 1 590.003(A) Assignment of Responsibility* I P Conked and RTE Fads* 590.003(B) ( Demonstration of Knowledge* I I I Contamination from Raw Ingredients 2-103.11 Person in charge-duties 3-302 11(A)(2) I Raw Animal Foals Separated from Each EMPLOYEE HEALTH Other* 2 590.003(C) Responsibility of the person to charge to I I Contamination from the Environment I 3-302.1 RA) I Fad Protection require reporting by foal employees and 13-302.15a I Washing Fruits and Vegetables applicants* I304,i t Food Contact with Equipment and 590.003(F) Responsibility Of Arad Employee Or An Applicant To Report To The Person In I utensils* Charge* I I Contamination from the Consumer 13-306.14(A)(B) I Returned Food and Reservice of Food* 590.003(G) Reporting by Person n Charge* I I 13 1590.003(D) Exclusions and Restrictions* I Disposition of Adulterated or Contaminated Food 590.003(E) Removal of Exclusions and Restrictions I 3-701.1 I Discarding or Reconditioning Unsafe I J FOOD FROM APPROVED SOURCE 4 Food and Water From Regulated Sources ( 9 ol Food Contact Surfaces 590.004(A-B) Compliance-,vdth Food Law* I 4-501.I i l Manual Warewashing-Hot Water I 3-201.12 I Fad in it Henuetically Scaled Container'' ( Sanitization Temperatures* J 3-201.13 I Fluid Milk and Milk Products* I 14-501.112 Mechanical Warewashing-Hot Water 13-202.13 Shell Eggs* I Sanitization Temperatures* 13-202.14 Eggs and iAilk Pr xiucts. Pasteurazd" I 4-501.114 Chemical Sanitization-temp.,pH, 202.16 i ice Made From Potable Drinkine I I concentration and hardness. I -„,Nate.r* I 5-101.11 Drinking Water from an Approved System"' I 14-601.11(A) I Equipment Food Contact Surfaces and 590.006(,4) Bottled Drinking Water- I Utensils Clean* 590.006(B) Water Meets SLndards in 370 t_'.'v1R 22.01* I ( 4-602.11 I Cleaning Frequency of Equipment Food- Shellfish and Fish From an Approved Source I Contact Surfaces and Utensils* 4-702-11 Frequency of Sanitization of Utensils and 3-201.14 Fish and Recreationally C'aapJtt htolius-can Food Contact Surfaces of Equipment* 301.15 M Sheijusca ( 4- 703.11 I Methods of Sanitization-Hot Water and Chemical* Souurces"rces* Shellfish frim`jSSP C stcd - - 130 ( I Proper,Adequate Handwashing I Game and Wild Mushrooms Approved by f Regulatory Authority I 12-301.11 - I Clean Condition-Hands and Arms* J I3-202.18 I Shellstock identification Pre�cm° i ( -301-12 Cleaning Procedure* 1590,004(C) I Wild Mushrooms* I 12-301.14 When to Wash* 3-201.1 7 I Game Animals* I 11t I Good Hygienic Practices 5 Receiving/Condition I 12401.11 Eating,Drinking or Using Tobacco* f 3-202.11 PRFs Received at Proper Temperatures* I ( 2-401.12 Discharges From the Eyes,Nose and 3-202.15 Package Intepstry` I Mouth* 3-10i.l I foal Safe and Unadulterated* I 3-301.12 Preventing Contamination When Tasting* 16 I Taus/Records:Shellstock I 112 1 Prevention of Contamination from Hands 13-202.18 I Shellstock Identification* I 590.004(E) I Preventing Contamination from 13-203.12 Shellstock Identification Maintained* Employees* ' Tags/Records:Fish Products 113 I Handwash Facilities 1 Conveniently Located and Accessible 3-402.11 � Parasite I)r•struction* I � . 3-402.12 I Records.Creation and Retention w I 15-203.11 I Numbers and Capacities* f 590.0040 Labeling of Ingredients' I 15-204.11 I Location and Placement* 7 Conformance with Approved ProceduresI 15-205.11 I Accessibility,Operation and Maintenance /HACCP Plans I I Supplied with Soap and Hand Drying 3-502.11 Specialized Processing Methods* I Devices l j 13-502.12 Reduced oxygen packaging,criteria* I 16-301.11 ( Handwashing Cleanser, Availability 8-103.!2 Conformance with Approved Procedures* I 16-301.12 I Hand Drying Provision I *Denotea critical item in the federal 1999 r^ jd Code or 105 CMR 59 OM, CITY OF SALEM �,, � (� BOARD OF HEALTH �! Establishment Name: V1arl�nlr ; �i Date: 1�Lr�;� Page: of Rem Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date, No. Relemoce R-Red Item VedRed l PL E PRINT CLEARLY Oc f1 CDMrvJ >1 n/ �� -Sur AJ Red o7 r/min c I I T 1 h ILS f nn.V. -,, K L,,G A.� L fJx g4 - c-66 cz C o /t_ rec,C-A —ail / I Al q � t Pc r6J �$ fi�l]ol � pp A a n re- � 0 AJ a-r �svt, ra 6 �rx �,�J,�b,,rh�h (/�n� lu�, , , ��D.j _ Discussion With Person in Charge: Corrective Action Required: I ❑ No I �/7es 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 descri ed, and to Exclusion violations before the next ins P inspection Scheduled ❑ Emergency Suspension comply with all mandates of the Mass/Federal Food Code. I n erst that noncompliance may result in daily fines of twen -f ve d r s ension/revocation of ❑ Embargo ❑ Emergency Closure your food permit. 0 Voluntary Disposal ❑ Other: i C t t s 3-501.14(C) PHFs Received at Temperatures Violations Related to Foodborne Illness Interventions and Risk According to Law Cooled to Factors films 1-22) (Cont.) 4t'F145°F Within 4 Hours. 1 PROTECTION FROM CHEMICALS 3-50L 15 Cooling Methods for PHFs Q ( 19 P14F Hot and Cold Holding 14 ( Food or Gabor Additives 501.16(B) Cold PHFs Maintained at or below { ( 3-202.12 Additives" t, 3-302.24 Protection from Un proved Additives* � ! 590004{F Hot P 'F* i-SUt.i6(A) HoxPHFsMaintained atorabove ( 15 Poisonous or Toxic Substances o * ` 7-101.11 Identifying Information-Original 140 F. 44 3-501.I6(A) Roasts Held at or above 1300FContainers* ( i ( 20 ! Time as a Public Health Control ( 7-102.11 Common Name-Working Containers* ( It 3-501,1.9 Time as a Public Health Control* ( 7-201.11 Separation-Storage* ( ( 590.004(H) Varia=Requirement ' ( 7-202.11 Restriction-Presence and Use* ( ( 7-202.12 I Conditions of Use* REQUIREMEty,"` FOR HIGHLY SUSCEPTIBLE 7-203.11 Ionic Containers-Prohibitions* POPULAMON- ="-SP) ( 7-204.11 Chemicals Criteria-Chemicals, 21 3-801.11(A) Unpasteurized Pre-packaged Juices and ( 7-203.12 ( Drying Ag fru.Criteria* Produce,Criteria' Beverages with Warning Labels* ( 7-204.14 Drying Agents.Criteria. � 3-2t01.11(B) Use of Pasteurized Eggs* { ( 7-205.11 Incidental Food estnaix, ,Criteants* 13-801.11(D) Raw or Partially Cooked Animal Food and ( 7-206.71 Restricted Use Pesticides,Criteria' Raw Seed Sprouts Not Served- ' ( ,-206.12 Rodent Bait Stations" � 3-801.11(C) Unopened Food Package Not Re-served. * ! i 7-206.13 Tracking Powders,Pest Control and - e ` Monitoring' CONSUMER ADVISORY TIMEtTEMPERATURE CONTROLS 22 3-603.11 Consumer Advisory Posted for Consumption of ( Proper Cooling Temperatures for Animal Foods That are Raw.Undercooked or 16 S Not Otherwise.Processed to Eliminate PHFs Padtogens.* 3-401.I1A(i)(2) Eggs- I55'F 15 Sec. f Eggs-Immediate Service 1450F15sec4 3-30113 Pasteudzed Eggs Substitute for Raw Shell 3-401.11(A)(2) Comminuted Fish.Meats&Game Eggsa Animals-155°F 15 sec. " } SPECIAL REQUIREMENTS 4-461.11(F3)(I)(2) Port:and Beef Roast-130°F 121 min* 3-401.11(A)(2) Ratites,Injected Meats-155°F 15 590.009(A)-(D) Violations of Section 590.009(A)-(D)in W, a. s entering, mobile food,temporary and 3-401.11(A)(3) Poultry,Wild Game.Stuffed PHFs, residential kitchen operations should be r Stuffing Containing Fish,A4eat. debited under the appropriate sections Poultry or Ratites-165°F 15 sec." above if related to foodborne illness r I3-401.11(C)(3) Whole-mascle,Intact Beef Steaks interventions and risk factors. Other 145°F" 590.009 violations relating to goxi retail ,t 4-401,12 Raw Animal Foods Cooked in a practices should be debited under#29- 1 Microwave 165°F* Special Requirements. 3-40k.11(A)(1)(b) All Other PIFs- 1-45°F 15 sec. ( 17 Retreating for Hot Holding ( VIOLATIONS R :LATER TO GOOD RETAIL PRACTICES 3-4030 I(AWD) PHFs 165°F 15 sec,* ( (Items 23-30) 'i 3-403.11(B) Microwave- 16.5°F 2 Minute Standing Critical and non-critical violations, which do not relate to the Time* foodborne illness interventions and ristc factors listed above,can-be t 3-403A I(C) Commercially Processed RTE Foal- found in the following sections of the flood Code and 105 CMR 240°F* 590.000. 34031I(E) Remaining UnstiLed Portions of Beef flan ! Good Retail Practices FG 590.000 t I Roasts" 123. 1 Management and Personnel FC-2 .003 i ! ( 18 ( Proper Cooling of PHFs } i 24. 1 Food and Food Protection i FC-3 .004 1 25. ! Equipment and Utensils I FC-4 .005 I y 3-501.14(A) Cooling Cooked PHFs from 140`F to 26. 1 Water.Ptumbino and waste ! FC-5 .066 i ` 70`F Within 2 Hours and From 70F 27. 1 Physical Faciity FC--6 .007 17 to41`F/450F Within 4 Hours.* i 28. ' Poisonous or Toxic Materials FC=7 .008 i i 3-501.14(B) Cooling PHFs Made From Ambient 29. I Special Requirements ,009 I y Temperature Ingredients to 41°F/45°F : 30. i Other ! i :i Within 4 Hours* &` Denote,critical ham in the federal 1999 Focd Caie w'105 CNG 390.000. i a Massachusetts Department of Public Health Salem Board of Health 120 Washington Street,0 Floor Division of Food and Drugs Salem, MA 01970-3523 Tel. (978) 741-1800 Fax(978) 745-0343 City/Town of Address: FOOD ESTABLISHMENT IN PECTION REPORT Tel. Name Dae I Type of Operation(s) Type of Inspection 7 ood Service �outine Address Q � R k lu UJ Retail ❑ Re-inspection Telephone Level ❑ Residential Kitchen Previous Inspection U ( OS� ❑ Mobile Date :r/� �� Owner /BVI^ Y HACCP YM ❑ Temporary ❑Pre-6pe aeon h/,(Y, /rAt-„A�-114/ ❑ Caterer ❑Suspect Illness Person-in-Charge(PiCr Time ❑ Bed&Breakfast ❑General Complaint Inc ?� ElHACCP Inspector / 1`15QDt, On� Outrt Permit No. L],Other Each violation checked requires an explanation on the narrative liage(s)and a citation of specific provision(s)violated. Noncompliance with: Violations Related to Foodborne Illness Interventions and Risk Factors_(Red Anti-Choking 590.009(E) El I9 Violations require marked may pose an imminent health hazard and re uire immediate Tobacco 590.009(F) ❑corrective action as determined by the Board of Health. Allergen Awareness 590.009(G) El 2,�,0 PROTECTION MANAGEMENT'„ _ m _ _ _ El 12. Prevention of Contamination from Hands 1.. PIC Assigned/Knowledgeable/Duties ❑ 13. Handwash Facilities 'EMPLOYEE HEALTH -- - , F12. Reporting of Diseases by Food Employee and PIC PROTECTIONFROM'CHEMICALS El3. Personnel with Infections Restricted/Excluded ❑ 14.Approved Food or Color Additives El 15.Toxic Chemicals F000'FROM APPROVED SOURCE - _ -- - - - tIMEITEMPERATURE CONTROLS(Potentially Hazardous Foods) F14. Food and Water from Approved Source . . . ❑ 5. Receiving/Condition ❑ 16. Cooking Temperatures ❑ 6. Tags/Records/Accuracy of Ingredient Statements ❑ 17. Reheating ❑ 7. Conformance with Approved Procedures/HACCP Plans ❑ 18 Cooling PROTECTION FROM CONTAMINATION Hot and Cold Holding ppEl 8. Separation/Segregation/Protection 20. Time as a Public Health Control Y�7 9. Food Contact Surfaces Cleaning and Sanitizing REQUIREMENTS FOR HIGHLYSUS,CEPTIBLE=_POPULATIONS(HSP)', U" ❑21.Food and Food Preparation for HSP ❑ 10. Proper Adequate Handwashing _ME_ ❑ 11. Good Hygienic Practices CONSURADVISORY ❑22. Posting of Consumer Advisories Violations Related to Good Retail Practices_(Blue Number of Violated Provisions Related Items) Critical(C)violations marked must be corrected To Foodborne Illnesses Interventions immediately or within 10 days as determined by the Board and Risk Factors (Red Items 1-22): of Health. Noncritical(N)violations must be corrected Official Order for Correction: Based on an inspection immediately or within 90 days as determined by the Board today, the items checked indicate violations of 105 CMR of Health. 590.000/federal Food Code.This report,when signed below C N 23. Management and Personnel (FC-2X660.003) by a Board of Health member or its agent constitutes an order of the Board of Health. Failure to correct violations 24. Food and Food Protection (FC-3X590.004) cited in this report may result in suspension or revocation of 5. Equipment and Utensils (FC-4X590.005) 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-7X590.008) 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: Inspector's Signature: Print:` ' P[Cs Signature: �J �,� Print: Page_jofjPages III Violations Related to Foodborne Illness Interventions and Risk Factors(items 1-22) PROTECTION FROM CONTAMINATION 8 Cross-contamination FOOD PROTECTION MANAGEMENT ( I 3-302.1 t(A)(1) Raw Animal Foods Separated from I 590.003(A) Assignment of Responsibility* I Cooked and RTE Foods* 590.003(B) Demonstration of Knowledge* I , Contamination from Raw ingredients 2-103.11 Person in charge-duties I 3-302.11(A)(2) I Raw Animal Foods Separated from Each EMPLOYEE HEALTH Other* Responsibility of the person in charge to I Contamination from the Environment 2 590.003(C) Res P y p g 13-302.11(A) I Food Protection* require reporting by food employeeand nd I 3-302.15 I Washing Fruits and Vegetables I applicants* 13-304.11 I Food Contact with Equipment and 590.003(F) Responsibility Of A Food Employee Or An Utensils* Applicant To ReportTo The Person in 11 Charge* I Contamination from the Consumer 3-306.14(A)(B) I Returned Food and Reservice of Food* 590.003(G) Reporting by Person in Charge* 131 590.003(D) Exclusions and Restrictions* I Disposition of Adulterated orContamnated Food 590.003(E) I Removal of Exclusions and Restrictions ( 3-701.11 Discarding or Reconditioning Unsafe FOOD FROM APPROVED SOURCE Ford* 1 4 Food and Water From Regulated Sources I 19 I Food Contact Surfaces 590.0041 A-B) Compliance with Food law* ( 14-501.111I Manual Warewashing-Hot Water 13-201.12 Food in a Hermetically Seated Container* I Sanitization Temperatures* 13-201.13 Fluid Milk and Milk Products' 14-501.112I Mechanical Warewashing-Hot Water I3-202.13 ShellEegs* Sanitization Temperatures* 13-202.14 Eggs and Milk Products.Pasteurized* 14-501.114 I Chemical Sanitization-temp.,pH, 13-202.16 I Ice Made From Potable Drinking U'a:er* I concentration and hardness. 5-101.11 I Drinking Water from an Approved System* I 14-60 L 11(A) I Equipment Food Contact Surfaces and 590.006(A) I Bottled Drinking Water* ( Utensils Clean* l 590.006(B) Water Meets Standards in 310 CMR 22.ff I 4-602.11 Cleaning Frequency of Equipment Food- Shol7rsh and Fish From an Approved Source I I Contact Surfaces and Utensils* 3-201.14 Fish and Roc eatit relay Caaght Molluscan I 4-702.11 Frequency of Sanitization of Utensils and I Food Contact Surfaces of Equipment* 3 201.15 Mollusca Shellfish*can Shellfish from NSSP Listed 14-703.11 Methods of Sanitization-Hot Water and Chemical* SgdLCe$* I Game and Wild Mushrooms Approved by 110 I Proper,Adequate Handwashing Reoulatm AUthonty I ( 2-301.11 I Clean Condition-Hands and Arms* j 13-202.18 She)lsto k identification Preen ` I I -301.12 I Cleaning Procedure* 1590,004(C) ( Wild Mushrooms* I 12-301.14 I When to Wash* 13-201.17 I Game Animals* I 111 I Good Hygienic Practices 3 ( ReceivingrCondition I + 2401.11 1 Eating,Drinking or Using Tobacco* i 3-202.11 PHFs Received at Proper Temperrtues* I ( 2-401,12I Discharges From the Eyes,Nose and 13-202.15 Package hueFrity" I Mouth* J 3.10L]I Food Safe and Unadulterated* 13-30L 12 I Preventing Contamination When Tasting* I 16 I Tags/Records:ahellstock 112 I I Prevention of Contamination from Hands i 3-202.18 I Shellstock identification* 590.004(F) Preventing Contamination from 1 3-203.12 I Shollstock identification Maintained'" Employees* Tags/Records:Rsh Products 1 113 Handwash Facilities 13-402.11 Parasite Destruction" ( Conveniently Located and Accessible 3-40^_.12 Records,Creation and Retention* 15-203.11 Numbers and Capacities* 1590.004(J) + Labeling of Ingredients* 15-204.11 Loudon and Placement* 15-205.11 Accessibility,Operation and Maintenance 7 Conformance with Approved Procedures I Y _ I /HACCP Plansi Supplied with Soap and Hand Drying 3-502.11 I Specialized Processing Methods* I I Devices 13-502.12 I Reduced oxygen packaging'criteria* I 16-301.1 l Handwashing Cleanser,.Availability I 18-103.12 Conformance with Approved Procedures* I 16-301.12 Hand Drying Provision •Denotes cridul item in the federal 1999 reed Cale ot 105 CMR 590.000. CITY OF SALEM BOARD OF HEALTH Establishment Name: n'i ! 01441 (tact _r,� rKt . > Date: /!4/-2 Page: of Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Data No. Reference R-Red Item Verified PLEASE PRINT CLEARLY /��Zj- J.t x4--b C 0a 6—� KA err fy�� .l2, r f�� ),)IF- iN A)aed e)- ('1n'-nnS � II_ V _ II G Q o! �✓, �, _ L r (^ of O >� / -+ -- A W ni �� N Ian rJ,lh 5^eLv.A5 jr� /7Ncp.Jcv Cdi� " <- V/ ��f Anf+, Discussion With Person in dharge: I Corrective Action Required: I ❑ No 1.4Y fes 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 inspection Scheduled ❑ Emergency Suspension comply with all mandates of the Mass/Federal Food Code. I un r land t noncompliance may result in daily fines of twenty dollars r uspe on/revocation of ❑ Embargo ❑ Emergency Closure your food permit. ❑ Voluntary Disposal ❑ Other: r� i i 7 li 3-501.14(0 PHFs Received at Temperatures f Violations Related to Foodborne,Illness Interventions and Risk According to Law Cooled to Factors f!lerns 1-22) (Cont) - 41'F/454 Within 4 Hous. CHEMICALS ( 3-501.15 Cooling Methods for PHFs PROTECTION FROM t ( 14 I Food or Gator Additives ! ( 19 PHF Hot and Cold Holding 3-50L16(B) Cold PHFsMaintained atorbelow ' 3-202.12 Additives* } 540.004(F) 41'!45"F* 3-302.14 Protection from Un proved Additives'% I ( gy Poisonous or Toxic Substances ( 3-501.16(A) Hot PRFs Maintained at or above 140 7-101,11 Identifying Information-Original es Containers* 3-501.16(A) Rouses Held at or above 130'F. ( ( 20 Time as a Public Health Control 7-102.11 Compton Name-Working Containers* ( 3-501.19 Time ae a equie Health Control* 7-201.11 Separation-Storage* ( 59Q•004(H) Variance Requirement t 7-202.11 .Restriction-Presence and Use* rement ( 7-202.12 Conditions oft se* ( REQUIREMENTS FOR HIGHLY SUSCEPTIBLE ( 7-203.11 Toxic Containers-Prohibitions* POPULATIONS(HSP) ( 7-204.11 ( Sanitizers.Criteria-Chemicals* ` ( 7-204.12 ( Chemicals for Washing Produce,Criteria* 1 21 3-801.11(A) Unpasteurized Pre-packaged Juices and ( 7-204.14 Drying Agents.Criteria* { Beverages with Warning Labels* ! 7-205.11 Incidental Food Contact,Lubricants* 3-801.11(B) Use of Pasteurized Eggs* { " 3-801.11(D) Raw or Partially Cooked Animal Food and ( 7-206.11 Restricted Use Pesticides,Criteria* Ras Seed Stations Not Served. 1 ( 7-206.12 Rodent Bait Stations{ 3-801.11(0 Unopened Food Package Not Re-served. " 7-206.13 Tracking Powders,Pest Control and Monitoring* CONSUMER ADVISORY TIMEMEMPERNTURE CONTROLS 22 3-603.11 Consumer Advisory Posted for Consumption of lb Draper Cooking Temperatures las Animal Foods That are Raw,Undercooked or PHFs Pathogens." Not Otherwise Processed to Eliminate 1 3401.IIA(1)(2) Eggs- 155`715 Sec. s"D*rn sxr Eggs-Immediate Service 145°F15see* 3-302.13 Pasteurized Eggs Substitute for Raw Shell 3.401.11(A)(2) Comminuted Fish.Meats&Game Epasr Animals-155°F 15 sec.* SPECIAL REQUIREMENTS 1, ( 3.401.11(B)(1)(2) Pork and Beef Roast-13TF 121 min- ! 3-401.11(A)(2) Ratites,Injected Meats- 155`F 15 590.009(A)-(D) Violations of Section 590.009(A)-(D) in: sec.* catering,mobile food,temporary,and 3-403.11(A)(3) Poultry,Wild Game,Sniffed PHFs, residential kitchen operations should be Stuffing Containing Fish,Meat, debited udder the appropriate sections Poultry or Ratites-165OF 15 sec.* above if related to Foodborne illness 3401.11(C)(3) Whole-muscle,Intact Beef Steaks interventions and risk factors. Other 145*F* 590.009 violations relating to good retail 3401.12 Raw Animal Foods Cooked in a { practices should be debited under#29- Microwave 165F* f Special Requiretnenrs. 3401.11(A)(1)(b) All Other PRFs- 145°F 15 sec. ( 17 Reheating for Hot Holding ( WOLA77ONS R LATED TO GOOD RETAIL PRACTICES 3-403AI(A)&(D) PHFs 165T 15 sec. * ( (Items 23-30) 13-403.11(B) Microwave- 165-F 2 Minute Standing Critical and non-critical violations,which do not relate to the j Time" foodborne illness interventions and risk.factors listed above,can be 3403.11(C) Commercially Processed RTE Fool- found in the following sections of the Food Code and 105 CMR 140°F* 590.060. o 3-403.11(E) Remaining Unsliced Portions of Beef 1 Item Good Retail Practices FC 540.000 i ( Roasts* - 1 23. i Management and Personnel . FC-2 .003 f ( 18 Proper Coating of PHFs { ! 24. Food and Fact Protection FC-3 .004 j 1 25. Equiument and Utensils I FC-4 .005 I 3-501.14(A) Cooling Cooked PHFs from 140°F to ! 26, Vyaier,Plumbing and Waste FC-5 .006 + 70*F Within 2 Hours and From 70°F ! 27. Physical Facility FC-6 .007 I to 41`F145OF Within 4 Hours.* 1 28. ; Poisonous or iacc hAatenals :, FC=7 .008 i 1 3-501.14(8) Cooling PHFs Made From Ambient 129. ( Special Requirements .609 1 Temperature Ingredients to 41°F/45°F 30. 1 Other ! I Within 4 Hours* Denotes critical trim in the federal 1999 Food Code o 105 C-MR 590.000. , CITY OF SALEM BOARD OF HEALTH Establishment Name: C4 , 1 Date: Pagei7 of Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date No. Reference R-Red Item Verified PLEASE PRINT CLEARLY 1 v � mix, 4G S.✓r� • Iz� � G'.I v I � 11 k _itIA-� Lf -3� • rs mit_ 1/ 0 f� rd . \ of c� V .� JJ�£ /G✓i �� —tom a A . �� s(u 4 D � _ V C t r &M A CL A\ C3 .n - 1 li SCS v/A,//., -7 , V Ao - �itP�= OJ d IL J � 1p u _ _f_kfC.-r Al M. 6 IID Discussion With Person in Charge: ! Corrective Action Required: I ❑ No ❑ Yes I have read this report, have had the opportunity to ask questions and agree to correct all ❑ Voluntary Compliance ❑ Employee Restriction/ violations before the next inspection, to observe all conditions as described, and to Exclusion P ❑ Re-inspection Scheduled ❑ Emergency Suspension comply with all mandates of the Mass/Federal Food ode. I u ersta that noncompliance may result in daily fines of twenty- v dolla su nsion/revocation of ❑ Embargo ❑ Emergency Closure your food permit. ❑ Voluntary Disposal ❑ Other: � I l k 3-i01,t hC) PHFs Received at Temperatures 1 Violations Related to Faodborrre Illness.Interventions and Risk According to Law Grated to (! Factors fftems 1-22) (Cont.) 4FF145°F Within 4 Hours. PROTECTION FROM CHEMICALS 1 3-501.15 Cooling Methods far PHFs } 1 14 1 I Fond or Color Additives ( 119 PHF`tot and cold Holding I I 501.16(13) Cold PRFs Maintained at or below 1 3-202.12 Additives* 10 590.004(F) 41'145°F* P 3-302.14 ] Protection from UnaEcroved Addinves* E 3-50IA6(A) Hot PHFs Maintained at or above { 15 4 Poisonous or Toxic Substances + 140°F. * t 7-101.11 Identifying Information-Original „ 13-501.16(A) Roasts Held at or above 130'F. Containers* { { { {7-302.11 Common Name-Working Containers* 20 Time as a Public Health Control ` { { 3-501,t9 Time as a equie Health Cnntrat' 7-201.l l Separation-Storage* { ' { 7-202.11 .Restriction-PresenceandUse* ( 1 590- (H} Variance Requirement 1 7-202.12 Conditions of Use+ i 1 REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-203.11 Toxic Containers-Prohibitions* { POPULATIONS(HSP) 4 { 7-204.11 Sanitizers.Criteria-Chemicals* { 21 3-$01.11(A} Unpasteurized Pre-packngud)urges and { 7-204.12 Chemicals for Washing Produce,Criteria* 1 Beverages with Warring Labels { 7-204.14 Drying Agents.Criteria* 1 3-801.11(B) Use of Pasteurized Erase 7-205.21 Incidental Food Confect lubricants* { 1 i 7-206.11 Restricted Use Pesticides;Criteria* { ( 3-$01.11(D) Raw or Partially CookedServed. 7-206.12 Rodent Bait StAnimal Food and Stations* RSR'Seed Sprouts Not Serrved. I 7-206.13 Tracking Powders,Pest Control and 13-801.11(C) Unopened Food Package Not Re-served *' I A Monrtonna* CONSUMER ADVISORY TIMElI'EMPER iTURE CONTROLS 22 3-603.11 Consumer Advisory Pasted for Consumption of 16 - Proper Cocking Temperatures for Animal Foods That are Raw.Undercooked or PHFs Not Otherwise Processed to Eliminate 3-401.IIA(1)(2) Eggs- 155 F 15 Sec. Pathogens.* " Ewes-Immediate Service 145'F15see. 3-302.13 Pasteurized Egg's Substitute for Raw Shell 3-401.11(A)(2) Comminuted Fish.Meats&Game Ems* j Animals-155'F 15 sec. * SPECIAL REQUIREMENTS { 3-401.11(11)(1)(2) Pork:and Beef Roast- 130'F 121 mitt* 1 3-401.11(A)(2) Ratites,Injected Meats-155`F 15 590.009(A)-(D) Violations of Section 590.009(A)-(D)in see.* catering, mobile foul,temporary and 31101.1 I(A)(3) Poultry,Wild Game,Stuffed PHFs, residential kitchen operations should be G Stuffing Containing Fish,Meat, debited under the appropriate sections Poultry or Ratites-165'F 15 sec, * above if related to foodborne illness _ 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks interventions and risk factors. Other 143'F°` 590.409 violations relating to good retail 3101.12 Raw Animal Foods Cooked in a I practices should be debited under#29- Microwave 165F* Special Requirements. E 31101.11(A)(1)(b) All Other PHFs-145'F 15 sec. 119 Reheating for Hot Holding I WOLAT7ONS RAATED TO GOOD RETAIL PRACTICES 3403.11(A)&(D) PHFs 165°F 15 sce.* {hearts 23-301 " ! 3-403.11(B) Microwave- 165`F 2 Minute Standing CrEilcat asd non-critical violations,which do not relate to the Tits* foodborne illness interventions and risk factors listed above, can be 3403.t 1(C) Commercially Processed RTE Food- found in the following sections of the Food Code and 105 CMR 1 1400F* 590.060. 3-403.I1(E) Remaining Unsticed Portions of Beef I Item I Goad Retail Practices i FC 59D.O00 i - i Manawmem and Personnel ! FC-2 03 .0 Roasts" 1 23. 1 { 18 Proper Coaling of PHFs 1 24. 1 Food and Foci Protection I FC-3 .004 1 25. Equipment and Utensils I FC-4 .005 3-501.14(A) Cooling Cooked PHFs from 140'Ftoi 26, Water.Ptumtingand Waste FC-5 006 70'F Within 2 Hours and From 70'F 1 27. j Physical Facility FC-6 .007 I to 4I`F/45'F Within 4 Hours.* 1 28. Poisonous or Toxic Materials ! FC-7 .008 i 3-501.14(B) Cooling PHFs Made From Ambient + 129. Special Raquiremams R09 1 yTemperature Ingredients to 41017145"T lil ' 30, 1 Other I F Within 4 Hours* Denotes crificat s.m in the federal 1999 Foal Cale a 105 C.MR 590.000. r- f k t CITY OF SALEM BOARD OF HEALTH / Establishment Name: �' r�,,,tc � y� �i;?�1� Date: — L_� Page:Zi' of Item Code C—Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date No. Reference R—Red Item n PLEASE PRINT CLEARLY Verified ✓�5 �°� k i Y ✓1 t r.� 1 e �� aJi— — �iL �.t e— q. n i RVFir Tl I n , Discussion With Person in Charge: Corrective Action Required: I ❑ No I � , s 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 undepfand that noncompliance may result in daily fines oftw ntt,five d rs o n/revocation of ❑ Embargo ❑ Emergency Closure your food permit. r/// Voluntary Disposal LlOther: A ( 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'F/45`F Within 4 Hom ( 3-501.15 Cooling Methods for PRFs I PROTECTION FROM CHEMICALS 11g PHF Not and Cold Hotdv g ( 14 I ( Food or Color Additives ( 3-501,16(B) Cold PRFs h'laintained at or below 3-202.12 Additives* ( 590.004(F)' 41'1+15'F* f 3-302.14 Protection from Unapproved Additives" ( 13-501.16(A) Hot PHFs Maintained at or above I ( 15 Poisonous or Toxic Substances 1400F. * 4 7-101,11 identifying Information-Original 3-501.16(A) Roasts Held at or above 130'F." I i Containers* ( 20 Time as a Public Health Control } 7-102.11 Common Name-Working Containers* } 3-501.19 Time as a Public Health Control* r 201.11 Separation-Storage' } i 17-202.11 .Restriction-Presence and Use* } 1 590.004{H3 Variance Requirement i ( 7-202.12 Conditions ot'Use* REQUIREMENTS FOR HIGHLY SUSCEPTIBLE ( 7-203.11 I Toxic Containers-Prohibitions* ( POPULA71ONS(HSP) 17-204.11 I Sanitizers.Criteria-Chemicals* ( I 1 ( 7-204.12 ( Chemicals for Washing Produce,Criteria* ( 121 3-801.i I{A} Unpasteurized ev r ages wit Pre-packaged Labels* and Beverages with Warning Labels* ( 7-204.14 Drying Agents.Criteria' 7-205.11 incidental Food Contact,Lubricants* 3-901.11(B) Use of Pasteurized C Eggs* a ( 3-801.11(0} Raw or Partially Cooked Animal Food and I ( 7-206.11 Restricted Use Pesticides,Criteria* I Raw Seed Sprouts Not Served- 7_206.12 erved7-206.12 Rodent Bair Stations* 3-801.11(0) Unopened Food Package Not Re-served. " l 7-206.13 I Tracking Powders,Pest Control and Monitoring* CONSUMER ADVISORY a ! 22 3-603.11 Consumer Advisory Posted for Consumption of TiMEII EMPERATURE CONTROLS fl Animal Foods That are Raw,Undercooked or T f 16 Proper Cooidng Temperatures for { Not Otherwise Processed to Eliminate i I PHFs I Pathogens.* 3401.1IA(1)(2) Eggs- 155°F 15 Sec. I r Eggs-Immediate Service 145'Fl5seca 3-302.13 Pasteurized Eggs Substitute for Raw Shell 3.401.11(A)(2) Comminuted Fish.Meats&Game i Ems. Animals-155'F 15 sec. * SPECIAL REQUIREMENTS ( 3-401.I1(B)(1)(2) Port:and Beef Roast- 130'F 121 min* 'h 13-401.11(A)(2) Ratites,Injected Meats-155'F 15 590.009(0.)-{D) Violations of i Section temporary and in sec.* catering,mobile food,temporan'and 3-401A I(A)(3) Poultry,Wild Game,Stuffed PHFs, residential kitchen operations should be Stuffing Containing Fish,Meat, debited under the appropriate sections Poultry or Ratites-165'F 15 sec. * above if related to foodborne illness 13-401.11(C)(3) Whole-muscle,Intact Beef Steaks interventions and risk factors. Other Ct 1450F" 590.009 violations relating to good retail 3 JOLI2 Raw Animal Foods Cooked in a practices should be debited under#29- Microwave 165°F* Special Requirements. P 3-401.11(A)(1)(b) All Other PHFs- 145'F 15 sec. * ( 17 Reheating for Hot Holding 1 WOLA77ONS RELATED TO GOOD RETAIL PRAC77CES 3403:11(.0&(D) PHFs 165'T 15 sm. * (Items 23-30) 3-403A I(B) Microwave- I65`F 2 Monde Standing Critical and non-crideal violations,which do not relate to the Time* foodborne illness interventions and risk factors listed above, can be � 3403.11(C) Commercially Processed RTE Food- found in the following sections of the Food Code and JOS CMR i I 1400F* S90.000. 3-403.11(E) Remaining Unsliced Portions of Beef land j Good Retail Pracdcos 1. FC 590.000 I Roasts* l 23. 1 Management and Personnel '. FC-2 .003 i ( 1S Proper Cooling of PRFs { 1 24. i Food and Foci Protection FC-3 .004 'I r 1 25. I Equipmernand Utensils FC-4 .005 i - 3-501.14(0.) Cooling Cooked PHFs from 340`F to , 26. 1 Water.Piombino and Waste l FC-5 .006 A 70`F Within 2 Hours and From 70`F 1 27. i Physical Fact& FC-6 .007 to 41'F/450F Within 4 Hours. ° 1 1 28. 1 Poisonous or Toxic Materials FC-7 .008 f 3-501.14(B) Cooling PHFs Made From Ambient ' 29. 1 Special Requirements .009 ! Temperature Ingredients to 41'F/45'F l 30' 1 Other Within 4 Hours* • s,.rio. :o.a e�: 'D:nor+•s exitical rzLm in the frdersl 7 999 Fwxl Code�'lU3 CStR 390.000. - �t CITY OF SALEM BOARD OF HEALTH Establishment Name: aV42M,;jC �4) „� Date: Clc,/? Page: �- of. Item code c-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date. No. Reference R-Red nem 6 n Verified PLEASE PRINT CLEARLY S� 0r v r c? -t--- — �✓i n)_ �1e f-0I r�ro ti 1 r - r c F �1 �, � CST y�ccn r)L J-0 . i vw r'11�✓ 6L, �rt-, C4S / 1 A.1 I e 7Z f GP V; � 44-o - Discussion With Person in Charge: ` Corrective Action Required: ❑ No 0--yes I have read this report, have had the opportunity to ask questions and agree to correct all ❑ Voluntary Compliance ❑ Employee Restriction violations before the next inspection, to observe all conditions as described, and to Exclusion P Re-inspection Scheduled ❑ Emergency Suspension comply with all mandates of the Mass/Federal Fo d Code under d that noncompliance may result in daily fines of twenty-f sion/revocation of ❑ Embargo ❑ Emergency Closure your food permit. ❑ Voluntary Disposal ❑ Other: 3-501,14(C) PHFs Received at Temperatures i Violatlons Related to Foodborne Illness tnter✓entions and Risk According to Law Cooled to Factors fttatns 7-22} (Cont.) 41°F145°F Within 4 Homs.' ! PROTECTION FROM CHEMICALS jh 3-501.15 Cooling Methods for PHFs � j 14 ( Food or Calor Additives j 119 PKF Not and Cold Holding ` 3-202.12 Additives* 3-501.16(B) Cold PRFs Maintained at or below 590.004(F) 4101450 F* ( 3-302.14 Protection from Unapproved Additives'¢ 3-50 L I6(A) Hot PHFs Maintained at or above j 15 Poisonous or Toxic Substances •r u -Original � I' l40` 7-101 A 1 Idemi • t Information 3-SOI.I6(A7 Roasts Held at or above 130'F. * t Containers* 1 j 20 Time as a Public Health Control 7-102.11 Common Name-Working Containers* j 4 ' 3-501.19 Time as a Public Health Control* 7-201.11 Separation-Storage* 590.004(H7 Varian f 7-202.11 .Restriction-Presence and Use* M Variance Requirement j 1 j 7-202.12 Conditions of Use* j i 7-203.11 Ionic containers-Prohibitions* REQUIREMENTS FOR HIGHLY SUSCEPTIBLE j 7-204.11 j Sanitizers.Criteria-Chemicals* j POPULATIONS(HSP) 7-204.12 Chemicals for Washing Produce,Criteria* j 21 3-801.I1(A) Unpasteurized Pre-packaged Juices and .Beverages with Warning labels* E 7-204.14 Drying Agents,Criteria* 3801.€1(B) Use of Pastemiml E„,qs* 4 j 7-205.11 Incidental Food Contam Lubricants* 3-801-II(D) Raw or Partially Cooked Animal Food and 3 j 7-206.11 Restricted Use Pesticides,Criteria* Rau Seed Sprouts Not Served. t j 7-206.12 [rodent Bait Statlans* 7-206.13 Tracking Powders,Pest Control and ( 3-$01.11(0) Unopened Food Package Not Re-served. * j MonitorinG* CONSUMER ADVISORY TIMEfIEMPER4TURE CONTROLS 22 3-603.11 Consumer Advisarg Posted for Consumption of ' 16 Proper Cooking Temperatures for t Animal Foods That are Raw,Undt;rcaoked or PHPa I Not Otherwise Processed to Eliminate { tePathogens.*sxecm"t J 3-401.I1A(1)(2) Eggs- 955`F IS S . I ' Eggs-immediate Service 145°Fl5see* 3-302.13 Pasteurized Eggs Substitute for Raw Shell f 3-401.11(A)(2) Comminuted Fish.Meats&Came Ems* l Animals 155°F 15 sec. 3.401.11(B)(1)(2) Port;and Beef Roast- 130°F 121 min* � SPECIAL REQUIREMENTS 3-401.11(A)(2) Ratites,Injected Meats- 155`F 15 5��(A)@) Violations of Section 590.009(A)-(D)in sec.* catering, mobile ford,temporM,and = 3-001.11(A)(3) Poultry,Wild Game,Stuffed PHFs, residential kitchen operations should be Stuffing Containing Fish,Meat, debited under the appropriate sections Poultry or Ratites-165'F 15 sec. * above if related to foodborne illness t I3-401.11(C)(3) Whole-muscle,Intact Beef Steaks interventions and risk factors. Other 145°F* 590.009 violations relating to good retail 3401.12 Raw Animal Foots Cooked in a practices should be debited tinder#29- r Microwave 165°F* Special Requirements. 3-401:11(A)(1)(b) All Other PHFs- 1, 15 sec. S j 17 Reheating for Hot Holding VIOLATIONS R RATED TO GOOD RETAIL PRACTICES S 3403.11(.A)&(D) PHFs 165°F 15 sce. * (Items 23-30) 3403.11(B) Microwave- 165`F 2 Minute Standing Critical mrd non-critical violations, which do not relate to the Tits* foodborne illness interventions and risk factors listed above, can be 3 3403-II(C) Commercially Processed RTE Food- found in the following sections of the Food Code and 105 CMR 140°F* 590.000. I ` Item ! Goad Retail Practices FC 690.600 j 3-403.11(E) Remaining Unstic�ed Portions of Beef 11 I ( Roasts* 23. 1 Mana9ament and Personnel 1, FG-2 .003 i j 1g j Proper Cooling of PRFs 1 24. 1 Food and Food Protection { FC-3 .004 1 25. I Equipment and Utensils 1 FC-4 1 .005 1 3-501.14(A) Cooling Cooked PHFs from 140°F to 1 2g, { Water.Plumbino and Waste FC-5 ( .006 T 70°F Within 2 Hours and From 70°F - 27. Physical Faol6ty FC-6 007 to 41°F/45'F WithiniTiMt 4 Hours.* 128. Poisonous or oxc aerials FC-7 .008 { '} 1 3-501.14(B) Cooling PHFs Made From Ambient 129. Special Requirements i .009 f I Temperature Ingredients to 41'Fl45°F ' Other j 1 Within 4 Hours* It lkmtrs critical mein in the£-deral 1 Y99 Foal CW a or 105 CMR X90.000. 1 t M1 CITY OF SALEM BOARD OF HEALTH r� Establishment Name: C-A*4& //, Date: 5 «/� Page: .0 , of Item Code C-Critical nem DESCRIPTION OF VIOLATION/PLAN C(F CORRECTION Date No. Reference R-Red Item Verified . � PLEASE PRINT LEARLY ! lien S� ILL. Ir%-Q'- a^j .l/Ccr U i O.Jc.7 re r I I I I I I I 1 I 1 I � I I I - - Discussion With Person in Charge: Corrective Action Required: I ❑ No ❑ Yes I have read this report, have had the opportunity to ask questions and agree to correct all ❑ Voluntary Compliance ❑ Employee Restriction/ violations before the next inspection, to observe all conditions as described, and to Exclusion P ❑ Re-inspection Scheduled ❑ Emergency Suspension comply with all mandates of the Mass/Federal Food Code. I ders d that noncompliance may result in daily fines of twenty- ' e doll r s ension/revocation of ❑ Embargo ❑ Emergency Closure your food permit. ❑ Voluntary Disposal ❑ Other: fr I� '• 3-i07.144C) PHFs Received at Temperatures Violations Related to Foodborne Illness lnter�enftons and Risk According to Law Cooled to Factors(items 1-22) (Cont.) 4t'I745°F Within 4 Hours. CHEMICALS I 3-501.15 Cooling Methods for PHFs PROTECTION FROM { 19 PHF Hot and Cold Holding 14 { Food or Color Additives y 3-501,16(B) Cold PIIFs Maintained at or below { 3-202.12 Additives* 590.004(F) 41°145"F* 3-302.14 Protection from Unapproved Additives* { 3-501.16(A) Hot PHFs Maintained at or above ( Ig Poisonous or Toxic Subsnces { 7-101,11 Identifying Information-Original 140 F. ta , 3-501.16(A) Roasts Held at or above 130°F. Containers* r 7-102.11 Common Name-Working Containers* 1 ` 20 Time as a Public Health Control { 3-501.19 Time as a Public Health Control' 7-201.11 Separation-Storage* 590.004(11l Variance Requirement 7-202.11 .Restriction-Presence and Use* { { 7-202.12 Conditions of Use* ! t 1 7-203.11 Toxic Containers-Prohibitions* REQUIREMENTS HIGHLY SUSCEPTIBLE 7-204.11 Sanitize".Criteria-Chemicals* POOPPUULLATIOATIO N NS(HSP) 7-204.12 Chemicals frit Washing Produce,Criteria* 21 3-801.11(A) Unpasteurized Pre-packaged Juices and { Beverages with Wartung Labels* 7-204.14 Drying Agents.Criteria* 3-801.11(B} Use of Pasteurized Eggs* 1 7-205.11 ResInctricts FoodCwicide ,Crt. iteria* , 13-801.11(D) Raw or Partially Cooked Animal Food and 7-206.71 Restricted Use Pesticides,Criteria* Raw Seed Spiritus Not Served.* 7-206.12 [rodent Bait Stations* f 3-801.11(C) Unopened Food Package Not Re-served. 7-206.13 Tracking Powders, Pest Control and * { f Monitoring* CONSUMER ADVISORY TIMEMEMPERATURE CONTROLS 22 3-603.11 Consumer Advisory Posted Jilt Consumption of 16 Proper Cooking Temperatures for Animal Funds That are Raw.Undercooked or PHFa Not Otherwise.Processed to Eliminate 31101.I1A(1)(2) Eggs- 155`F 15 Sec. 1 Pathogens.''N ",n2a 1 Eggs-Immediate Semen 145'Fl5see* 3-302.13 Pasteurized Eggs Substitute for Raw Shell 3.401.11(A)(2) Comminuted Fish.Meats&Came Ems* Animals-155'F 15 sec.* l 3 401.21(B)(1)(2) Port and Beef Roast- 130°F 121 mit* 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. * catering,mobile food,temporary and 3-401.13(A)(3) Poultry,Wild Game,Stuffed PHFs, residential kitchen operations should be Stuffing Containing Fish,Meat, debited under the appropriate sections Poultry or Ratites-165'F 15 sec.* above if related to foodborne illness 3-401.11(C)(3) Whdle-muscle,Intact Beef Steaks interventions and risk factors. Other 145'F*'�� 590,009 violations relating to good retail 3-401.12 Raw Animal Foods Cooked ilia practices should be debited under#29- h Microwave 165'F* Special Requirements. 3401.11(A)(1)(b) All Other PHFs- 145'F 15 sec. ` f 17 Retreating for Hot Holding 1 VIOLATIONS R_CAPED TO GOOD RETAIL PRACTICES 6 3-403.11(A)&(D) PHFs 165'F 15 sec. * { (Itefm 23-30) } 3-403.11(B) Microwave- 165°F 2 Minute Standing Critical acrd non-critical violations,which do not relate to the Time* foodborne illness interventions and risk factors listed above, can be L 3403.l i(C) Commercially Processed RTE Food- found in the following sections of the flood Code and 105 CMR 140°F* 590.000. 3-403.11(E) Remaining Unsticed Portions of Beef item Good Retail Practices FC 590.00o 1 {! Roast&* ! 23. i Management and Personnel ; FC-2 .003 � q 18 Proper Cooling of PHFs { 1 24, 1 Food and Food Protection FC-3 .004 4L4 1 25, 1 Equipment and Utensils I FC-4 .005 I 3-501.14(A) Cooling Cooked PHFs from 140'F to 1 28. _ _ Water.Plumbing and Waste_ ! FC-5 006 ! y 70'F Within 2 Hot"and From 70°F 27. 1 Physical Facility FC-6 .007 to 4I'FI45'F Within 4 Hours.* i 28. ' Poisonous or Tpwc Materials j FC-7 .008 i 3-501.14(13) Cooling PHFs Made From Ambient ! 29. I Special Requirements .009 Temperature Ingredients to 41*Fl45°F 30, 1 Oram i I Within 4 Hours* i "Denotes critical tvm in the L^deal 1999 Food Cate o'105 CMIi>90.000. - ^ 4-- Commonwealth -Commonwealth of Massachusetts ` " City of Salem Board of Health" -Kimberley Dnseo11F; e hc s 120 Washington Street,;4th Floor '�; -`° ' `'3 `;1.M8yOf a R SALEM,MA`-01970 a ? J M. ° Y _ T Food/Retail EstaUshnient Permit aSam s DATE PRINTED: 12/18/2012 "z' 0- a Z. Al ESTABLISHMENT NAME: " - Capt.'s Waterfront Grill& Club„ rV U 2004000093FileNumb _6NE94 Wharf Street - . Al W ery x ,� - 5 �- F Ai.• 4 � - � Salem a SMA 01970 - . . r , LOCATED AT 0094 WHARF STREET SALEMAMA 01970$ Permit Type Permit No. ° Permit Issued, Permit Expires ¢_-Fee'Restrictions/Notes ."=. ° s ,m fj J _ - - - R- .i V - aF• sK - 9 FOOD SERVICE 'BHP•-2013-0228_ Jan 1,2013 Dec 31,2013 $42U0 _ ESTABLISHMENT ^ g ' A. x. Total Fees `'$420.00 A [- 41 w E " a � _ 2 _. @z - - PERMIT EXPIRES Peceniber 31,`2013 Board`of Health �F§ n , - This Permitis not transferable and must be reissued upon change of ownership or location.The pernut must be posted in a prominent location in therEstablishment. > a'. .-In accordance with the State Sanitary Code,beofre any revonations,improvements,or equipment changes aremade, all plans for such must be submitted to and approved by the Salem Board of Health; Page " ;s" r t i •' s ;sc C CITY OF SALEM, _--''7- IV SSACHUSETTS p„blicHeakh w.,.., Ar1Y40WAsnlNcroNSlTa?I1,4 Pl.00li KIMBERLEY DRISCOLL '� SPFLevi..(978)741-1800 FAX(978)745-0343 LARRY RAMUIN,R5/RFI-IS,CHO,CP-FS MAYOR co 7 �''OF 1-{EAtIVA Icamdinna.saletn.com Ht',AI a'I I AGENT BOARS Food Establishment Permit Application (Application must be submitted at least 30 days before the planned opening date) 1) Establishment Name: r% !�� / /ted , !�C• �B� �a8 * . (/luf�/ �,p / 0 2) Establishment Address: 9Lereynt : am• /f jr� //� 0IF70 3) Establishment Mailing Address(if d 4) Establishment Telephone No: �'7-P7[/1-Qfjf 5) Applicant Name&Title: /�/Q/l 1!SB/lAil/DTC6/J 6) Applicant Address:// Eb�/16/r �4J.tlf_ ��Ul'• �� ©/9q5 7) Applicant Telephone No: ]k/-�3/� �/ 24 Hour EmergencyNo:&117-010-707 Email: 8) Owner Name&Title(if different from applicant): 9) Owner Address(if different from applicant): 10) Establishment Owned by: 11) If a corporation or partnership,give name,title and home address of officers or partner. An association Name Title Home Address cor oration An individual 14/30617�7 A partnership Other legal entity 12) Person Directly Responsible For Daily Operations(Owner, Person in Charge, Supervisor,Manager, etc.) I j name&Title: /�QfC ZfBRANDTI�!✓—SNS/J /4Adl��jiy6/iT/96l2 / : A Address: �esif/hPi� - /73 �'� Z-Y IV 0///4/�7/�0 Telephone No: 50,7V I Fax: AIIA Email: 4Ps.P79 Emergency Telephone No: -fq 7� 13) District or Regional Supervisor(if applicable) i Name&Title: Address: Telephone No: Fax: Email: Check#:/ I - 49 Date:J/��7t///y Amount: / W Food Establishment Information 14) Water Source: 15) Sewage Disposal: DEP Public Water Supply No: ( if applicable) 19x&1 C 7yA�5 AWEG(C -dXAMA 4y (/ARRI>=3 St:l.IDNAbtiN-APP�DN 16) Days and Hours of Operation: 71.30 -I1:go 17) No. of Food Employees: 9)v-.%,o —�,rAti� SO 18) Name of Person in Charge Certified in Food Protection Management: Required as of 101112001 in accordance with 105 CMR 590.003(A) Q7cATMER $ORA7AS_) HATr EL/NE 19) Person Trained in Anti-Choking Procedures(if 25 seats or more): L9/Yes No 11CAT&A 1050PMAJ 20) Location: 22) Establishment Type(check all that apply) (check one) / ❑ Retail( Sq. Ft) ❑ Caterer Permanent Structure✓ P1'food Service-(d-mo Seats) ❑ Frozen Dessert Manufacturer Mobile ❑ Food Service-Takeout ❑ Residential Kitchen for Retail Sale ❑ Food Service-Institution ❑ Residential Kitchen for Bed and ( Meals/Day) Breakfast Home ❑ Food Delivery ❑ Residential Kitchen for Bed and 21) Length Of Permit: Breakfast Establishments------------------------ ------------------------------------------------------------------------------------ (check one) RETAIL STORE RESTAURANT Annual ❑Less than 1000sq.ft. $ 70 ❑ Less than 25 seats $140 Seasonal/Dates: ❑ 1000-10,000sq.ft. $280 ❑ Residential Kitchens $140 ❑ More than I0,OOOsq.ft. $420 ❑ 5-99 seats $280 f ore than 99 seats $420 Temporary/Dates/Time: ------------------------------ ---- ----------------------------. ❑ Bed&BreakfasUChildcare Services/Nursing Home $100 - ------------------------------------------------------------------------------------------------------------------------------------- ADDITIONAL PERMITS ❑ MAKE ICE CREAM, YOGURT/SOFT SERVE $25 ❑ PASTURIZATION $25 ❑TOBACCO VENDOR $135 ❑ALL NON-PROFIT $25 (Including, church kitchens, state funded childcare&private clubs) 23) Food Operations: Definitions: PHF-potentially hazardous food(timeRemperature controls required) 1 Non-PHFs-non-potentially hazardous food(no timeltemperature controls required) (check all that apply): RTE-ready-to-eat foods(Ex.sandwiches,salads, muffins which need no further processing Sale of Commercially PHF Cooked to OrderHot PHF Cooked and Cooled or Hot Held 1 Pre-packaged Non-PHFs 'el� for More Than a Single Meal Service p Sale of Commercially Preparation of PHFs For Hot And PHF and RTE Foods Prepared For Highly Pre-packaged PHFs Cold Holding for Single Meal Service Susceptible Population Facility Delivery of Packaged PHFs Sale of Raw Animal Foods Intended to be Vacuum Packaging/Cook Chill Prepared by Consumer Reheating of Commercially Customer Self-Service Use of Process Requiring A Variance Processed Foods for and/or HACCP Plan(including bare hand Service Within 4 hours contact alternative,time as public health control. Customer Self-Service of Ice Manufactured and Packaged for Offers Raw or Under cooke Food of l Non-PHF and Non- Retail Sale Animal Origin Perishable Foods Only Preparation of Non-PHFs Juice Manufactured and Packaged for Prepares Food/Single Meals for Catered l Retail Sale Events or Institutional Food Service Offers RTE PHF in Bulk Quantities To be completed by the Board of Health Retail Sale of Salvage,Out of Date or Reconditioned Food Total Permit Fee: Payment is due with application I,the undersigned,attest to the accuracy of the information provided in this application and I affirm that the food establishment operation will comply with 105 CMR 590.000 and all other applicable law. 1 Pave been in tructed by the Board of Health on howto obtain copies of 105 CMR 590.000 and the Federal Food Code. 24) Signature of Applicant: Pursuant to MGL Ch.62C, sec. 49A, I certify under the penalties of perjury that I,to my best knowledge and belief, Have filed all state tax returns and paid state taxes required under law. 25) Social Security Number or Federal ID: 01�///_ 0 S 9e�l� 0 / - 26) Signature of Individual or Corporate Name: �Gti/c i� f -�/ti IVXX ? Y /i 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 Na 01 to T e o erasions Type of-lnsoection ood Service O'Routine Ac ess ©� Risk ❑ Retail ❑ Re-inspection n1 l�lJ FiI Level ❑ Residential Kitchen Previous Inspection Telephone vl ' 1 ke %� D C./ ❑ Mobile .Date: Owner v,,tp 2a� HACCP YIN ❑ Temporary ❑ Pre-operation /� �s � (( q�p^� I ❑ Caterer ❑Suspect Illness Per n in C ge( ) Time ❑ Bed&Breakfast ElGeneral Complaint Ins actor iA ( out:outlYVO Permit No. El Other Each violation checked require4jan xplanation on the narrative ages)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) U/490.009(F action as determined by the Board of Health. �n, LFOOD PROTECTION-MANAGEMENT_ t El 12. Prevention of Contaminatio'Qll� PIC As n from�HlanUdL�' W _ Handwash Facilities ❑ 2. ReportingLTH I of Diseases bg Foold Emtiosee a -y p y nd PIC ❑ 14.Approved Food or Color Additives ❑ 3. Personnel with Infections Restricted/Excluded ❑ 15.Toxic Chemicals L FOOD FROM APPROVED SOURCE ❑ 4. Food and Water from Approved Source I 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 [118.Cooling PROTECTION FROM CONTAMINATION - . ❑ 19. Hot and Cold Holding [1 8.Separation/Segregation/Protection El20.Time As a Public Health Control d1Id 9. Food Contact Surfaces Cleaning and Sanitizing (.REQUIREMENTS FOR-HIGHLY SUSCEPTIBLE_POPULATIONS(HSP)' -1 ❑21. Food and Food Preparation for HSP ��...��❑/////10. Proper Adequate Handwashing -1. Good Hygienic Practices �tONSUMER_ADVISORY,' , l0 /LRu2. 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-z)590.0 4)) order of the Board of Health. Failure to correct violations 24. Food and Food Protection (Fc-8)(990.000) 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 ©IL 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�/� 1 1 a DATE OF RE-INSPE TION:1 S 5 / Fomi9 4a �/ 1 I�l,`� V L c A � I I v` 14 Inspector's ignat Priv C n 1„l� �n ( �., PIC's Signature: J �' l 1 Prink j/ /��Ci,7r7 ` 1 IT'Paget- of Pages l ,y Violations Related to Foodborne Illness Interventions and Risk Factors(items 1-22) PROTECTION FROM CONTAMINATION S Cross-contamination FOOD PROTECTION MANAGEMENT ( ( I I 3-302.1](A)(1) Raw Animal Foods Separated from 1 590.003(A) Assignment of Responsibility* I Cooked and RTE Foods* 590.003(B) Demonstration of Knowledge* Contamination from Raw Ingredients 2-103.11 Person in charge-duties I 13-302.11(A)(2) Raw Animal Foods Separated from Each Other* J EMPLOYEE HEALTH I - I Contamination from the Environment 2 590.003(C) Responsibility of the person to charge to 13-302.11(A) I Food Protection* require reporting by food employees and3-302.15 Washing Fruits and Vegetables applicants* 590.003(F) Responsibility Of A Food Employee Or An 3-3(A.1 I Food Contact with Equipment and Utensils Applicant To Report To The Person In Contamination from the Consumer Chafge* 13-306.14(A)(B) Returned Food and Reservice of Food* 590.003(G) I Reporting by Person in Charge Disposrtron of Adulterated or Contaminated 13 590.003(D) Exclusions and Restrictions* Food 590A03(E) Removal of Exclusions and Restrictions 3-701,11I Discarding or Reconditioning Unsafe FOOD FROM APPROVED SOURCE Fwd* J 4 Food and Water From Regulated Sources 19 Food Contact Surfaces 590.004(A-B) Compliance with Food Law* 4-501.111 Manual Warewashing-Hot Water 3-201.12 Food in a Hermetically Sealed Container* I Sanitization Temperatures* I3-201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Warewashing-HotWater 3-202.13 Shell Eggs* Sanitization Temperatures* 3-202.14 Eggs and Milk Products.Pasteurized* 14-501.1 14 Chemical Sanitization-temp.,pH,. 13-202.16 I Ice Made From Potable Drinking Water" concentration and hardy ess. 15-101.11 I Drinking Water from an Approved System* 4-601.11(AI Equipment Food Contact Surfaces and I 590.006(A) I Bottled Drinking Water* ( Utensils Clean* 1 590.006(B) I Water Meets Standards in 310 CMR 22.0* I 4-602.11 Cleaning Frequency of Equipment Food- Shellfish and Fish From an Approved Source I Contact Surfaces and Utensils* 3-201.14 Fish and Recreationally Caught Molluscan 4-702.11 Frequency of Sanitization of Utensils and ( I Food Contact Surfaces of Equipment* Shellfish* 14-703.11 Methods of Sanitization,-Hot Water and 3-201.15 Molluscan Shellfish from NSSP Listed I Chemical* Sources* I to I I Proper,Adequate Handwashing Game and Wild Mushrooms Approved by I Regulatory Authority 2-301.11 Clean I Clean Condition-Hands and Arms* I I 3_202.18 Shellstock Identification cation Present* 2-301.12 Cleaning Procedure* 590.004(C) Wild Mushrooms` 12-301.14 When to Wash* ' 3-201.17 I Game Animals* I 111 I Good Hygienic Practices �. 5 Receiving/Condition I 12401.11 Eating,Drinking or Using Tobacco* I 3-202.11 PHFs Received at Proper Temperatures* I 2401.12 Discharges From the Eyes,Nose and 13-202.15 Package Integrity* I I I Mouth* 3-101.11 Food Safe and Unadulterated* I 13-301.12 I Preventing Contamination When Tasting* I I 112 I Prevention of Contamination from Hands b Togs/Records:Sheiistock I I 3-202.18 Shellstcek Identification' 590.004(F) I Preventing Contamination from 13-203.12 Shellstock Identification Maintained* I Employees* Tags/Records:Fish Products I 113 +I+ Handwash Facilities 3402.11 Parasite Destruction* I I I Conveniently Located and Accessible 13-402.12 ( Records.Creation and Retention* I 15-1-03.11 I Numbers and Capacities* 5)0 i .004(1) Ingredients* 15-204.11 I Location and Placement* ( Labeling of 15-205.11 I Accessibility,Operation and Maintenance T Conformance with Approved Procedures I S)' I fHACCP Plans I Supplied with Soap and Hand Drying 3-502.11 Specialized Processing Methods* Devices , 3-502.12 I Reduced oxygen packaging,criteria* I 16-301.11 I Handwashing Cleanser,Availability 8-103.12 I Conformance with Approved Procedures* I 6-301.12 Hand Drying Provision *Denotes critical item in the feJeral 1999 Food Cate or 105 CMR 590.000. uJ w tar . -�� Se v-v ll ce cl v t sa cwlq C-01 - tJ -bGd<s - CITY OF SALEM CarL_ / ) BO D OF HEALTH Establishment Name ` IWrn Q �0 CO PV,jj� Date. i�l� Page: of v7 It code c-critical Ito DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Dem 7 No. Reference R-Red Item ;✓,y,AKyt- 1 �, verified PLEASE PRINT CLEARLY i ( AJ TV A&.&t P I C� IC ¢!U _S� a /UG N�S nn l f.)IIP_ C © Irl vlr� i��i� ail — �ocro ( Q Jh-Pchi , U� t J' 11 \ t �, a2. fAA ll1 Discussion With Person in Charge: Corrective Action Required: I ❑ No 1Y,Fes I have read this report, have had the opportunity to ask questions and agree to correct all U-' Voluntary Compliance ❑ Employee Restriction Exclusion _violations before the next inspection, to observe all conditions as described, and to P #4e)-inspection Scheduled ❑ Emergency Suspension comply with all mandates of the Mass/Federal Food Code. I understa that ar171 noncompliance may result in daily fines of twenty-fi olla su sion/revocation of b' `em`b'argo ❑ Emergency Closure youi food permit. ❑ Voluntary Disposal ❑ Other: t t f 3-501.t4(C) PHFs Received at Temperatures 4 Violations Related to Foodborne Illness Interventions ane Risk According to taw Caused w Factors totems 1-22) (Cont) 417145°F Within 4 Htxtrs. i f 501.15 Cooling Methods far PHFs PROTECTION FROM CHEMICALS { 19 PHF flat and Cold Holding { f 1¢ Food Gator Additives { 3_501- i6(B) Cold PRFs Maintained at or below 3-202.12 Additiviv es' { 590.004(F) 41'145°F* P 3-302.14 Protection from Unapproved Additives" � I 3-501A6(A) Hot PHFs Maintained at or above ( ( 15 Poisonous or Toxic Substances f ' 7-101A I identifying Intormation-On;final (Ilk 3-501.16(A) Roasts Held at of above 130'F. " s Containers* r { 7-102.11 +Common Name-Working Containers* J f 20 Time as a Public Health Control f 1-201.11 Sepaention-Storage'" f 13-501.19 Time as a Public Health Control* 7-202.11 .Restriction-Presence and Use* j { 590.004(H) Variance Requirement f M 7-202.12 Conditions oUse"` REOUIREMF_MS FOR HIGHLY SUSCEPTIBLE 7-203.11 Toxic Containers-Prohibitions* { 7-204.11 Sanitizers.Criteria-Chemicals° { POPULATIONS(HSP) f 7-204.12 Chemicals for Washing Produce.Criteria* 1 21 3-801.11(A) Unpasteurized Pre-packaged Juices and { 7-204.14 Drying Agents.Criteria° { .Beverages with Warning Labels* 7-205-11 Incidental Food Contact,Lubricants* f 3-801.11(6) Use of Pasteurized Eggs* f { 7-206.11 Restricted Use Pesticides,Criteria* 3-801.11(D) Raw or Partially Cooked Animal Food and f { Raw Seed Sprouts Not Served.*7-205.12 Rodent Bait Stations" ( 3-801.11(C) Unopened Food Package Not Re-served. 7-206.13 Tracking Powders,Pest Control and Monitoring* CONSUMER ADVISORY i 22 3-603.I1 Consumer Advisory Pouted for Consumption of TIMEt(EMPERATURE CONTROLS Anneal Foods That are Raw.Undercooked or C ( 16 Proper Cooking Temperatures for f PHFs I Not Otherwise Processed to Eliminate ,nam Pathogens.*trxsve ( 3-401.11A(t)(2) Eg_es- 155°F 15 Sec. Eggs-Immediate Service 145°Fi5sec* 3-302.13 Pasteurized Eggs Substitute for Raw Shell 3.401.11(A)(2) Comminuted Fish.Meats&Game i Eggs. Animals-155'F 15 sec. " I SPECIAL REQUIREMENTS { 3401.21(6)(1)(2} Pork and Beef Roast- t30°F 121 min* f 590.009(A)-(D) Violations of Section 590.009(A)-(D)in 3401.11(A)(2) Rallies,Injected Meats-155°F 15 i sec. * catering,mobile food,temporary and 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs, residential kitchen operations should be 1 Staffing Containing Fish,Meat, debited under the appropriate sections j Poultry or Ratites-165'F 15 sec, * above if related to foodborne illness 3401.11(C)(3) Whole-muscle,Intact Beef Steals interventions and risk factors. Other 145°F 4' 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. 3-401.1l(A)(1)(b) All Other PIFs-145°F 15 sec.' { 1 j pry Reheating for Not Holding f VIOLA77ONS RAATED TO GOOD RETAIL PRACTICES 3-403:11(A)&(D) PHFs 165-F 15 sec. * i (Items 23-36) - 3-403.11(B) Microwave- 165'F 2 Minute Standing Critical and non-critical violations,which do not relate to the 2 Time* foodbome illness interventions and risk factors listed above, can be ( 3-403.11(C) Commercially Processed RTE Food- ( found in the following sections of the Food Code and 105 CMA 140°F* 590.000. 3403.1I(E) - Remaining Unsliced Portions of Beef j Item j Good Retail Practices FC 590.000 I Roasts" j 23, Management and Personnel i FC-2 .003 { f Proper Cooling of PHFs j 24, Food and Food Protection I FC-3 .004 38 I 1 25. I Equipment and Utensils 1 FG-4 '005 j 3-501.14(A) Cooling Cooked PHFs from 140"F to 1 26, I Water.Plumbinq and waste ! FC-5 .006 i 70°F Within 2 Hours and Front 70°F { 27. 1 Phvstcal Facility . FC-6 .007 1 { to 4I`F/45°F Within 4 Hours. 29. Poisonous or Tabic Materials ! FC=7 .008 3-501.14(6) Cooling PHFs Made From Ambient ! i 29. { Special Requirements A09 v 'Temperature Ingredients to 41°F/45°F Iii 30' ! Other 'r Within 4 Homs* 1 Deak u%ceincal twin in the£^.doral 1999 Fuad Cate w 105 CMR 590.900. - I 1 l f r Commonwealth of Massachusetts City of Salem Board of Health Kimberiey Driscoll 120 Washington Street,4th Floor Mayor SALEM,MA 01970 Food/Retail Establishment Permit DATE PRINTED: 12/19/2011 ESTABLISHMENT NAME: Capt.'s Waterfront Grill& Club File Number:BHF-2004-000093 94 Wharf Street Salem MA 01970 LOCATED AT: 0094 WHARF STREET SALEM, MA 01970 Permit Type Permit No. Permit Issued Permit Expires Fee Restrictions/Notes FOOD SERVICE BHP-2012-0056 Jan 1,2012 Dec 31,2012 $420.00 ESTABLISHMENT Total Fees: $420.00 L PERMIT EXPIRES IDecember 31, 2012 Board of Health n This Permit is not transferable and must be reissued upon change of ownership or location.The permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code,beofre any revonations, improvements,or equipment changes are made, all plans for such must be submitted to and approved by the Salem Board of Health. Page 1 CITY OF SALEM, MASSACHUSETTS BoAR17 OF HE.0 r1-1 120 WASHINGTON SI-REL.T 4... FI,(x iR \ TFL. (978) 741-1800 KIhfBIuRLI:Y DRISCOL1 F.\x(978)745-0343 NIAYOR IraindinO.salem.com Lr\I2121'lir\\it)liti,tiff Sl Hi;Aixi1 (;Fh6P 201_APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT NAME OF ESTABLISHMENT � 5 /UATF.Rf�nNr �12%l_i_ TEL# ADDRESS OF ESTABLISHMENT �?`/ A)Xan -j�tzc� FAX# 5F7f 7///'rP7.7-2- MAILING ADDRESS(if different) ) EMAIL-Business': Gyrr/ Q 6, co Website: 1 "11 2 /�TJ, Cdr1 f OWNER'S NAME PIA K LSYRPX A)P11,-4/k) TELL# ADDRESS STREET CITY STATE ZIP CERTIFIED FOOD MANAGER'S NAME(S) Gf4 `/ Gf PZ' r04425 GER7IFIGATE#(S) (Required in an establishment where potentially hazardous food is prepared) 17 71—Y7 EMERGENCY RESPONSE PERSON 01R K HOME TEL# 7r'f 6 7/-7r?V I DAYS OF OPERATION' I Monday ! =;Tuesday j , Wednesday j=" :.Thursday:: .j '` Friday ; • Saturday Sunday ! HOURS OF OPERATION //30/q Please write in tune of day. j /�, /1/0�/!G!7 (Forexamplellam-itpm) /a ,ti1/Dl✓16Nj" TYPE OF ESTABLISHMENT FEE (check onivl RETAIL STORE YES NO less than 1000sq.ft. =$70 1000-10,000sq.ft. =$280 more than 10,000sq.ft. =$420 -... - -•---- - - --_-----------------------------, --- --------------- ---------------- RESTAURANT YES NO less than 25 seats =$140 (Outdoor Stationary Food Cart$21 25-99 seats 80 more than 99 seats $420. ---- - - ------------ --------------- -----------------------------------------•------------------------$--10------- ' BED/BREAKFAST! YES NO 0 GHIZQCARE SERVICESlNURStNG HdME.... --------------- ------------------------------------------------------------- ------ ----------------------------.-- ADDITIONAL PERMITS MAKE(not just serve)ICE CREAM, YOGURTISOFT SERVE YES NO $25 TOBACCO VENDOR YES NO $135 ALL NON-PROFR(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 required under the law. Signature Date /�- Social Security or Federal Identification Number Updated 523/11 FOODAP2011.adm Check#&Date 1! S i Massacil3usetts Department of Public Health Salem Board of Health Division of Food and Drugs 120 Sa eWaMA Oton Street, " Floor 0-3523 FOOD ESTABLISHMENT INSPECTION REPORT Tel. (978) 741-1800 Fax (978) 745-0343 Name / n n Date Tyoe of ODeration(sl Type of Insoection U �„ 7n ),-�}en . inn . ln0 T �9j,0, -1n Food Service ;S Routine Addre"ss (� I n A D , Risk []' Retail Re-inspection I 1 N q .wt Level ❑ Residential Kitchen Previous Inspection TelephoneCA�u o )Vu �� El Mobile Date: Owner HACCP YM ❑ Temporary ❑ Pre-operation ❑ Caterer ❑Suspect Illness Person in Charge(PIC) 11 S Time ElBed&Breakfast ElGeneral Complaint - 1 ),OM Ina ❑ HACCP Inspector Out:evo Permit No. ❑ Other Each violation checked requires-atLeiplanation on the narrative page(s) and a citation of specific provision(s)violated. Non-compliance with: Violations Related to Foodborne Illness Interventions and Risk Factors Anti-Choking Tobacco Violations marked may pose an imminent health hazard and require immediate corrective 590.009(E) P 590.009(F)� action as determined by the Board of Health. . FOOD PROTECTION MANAGEMENT ❑ 12. Prevention of Contamination from Hands ❑ 1. PIC Assigned/Knowledgeable/Duties El-, •, 13. Handwash Facilities EMPLOYEE HEALTH -.. ..�. ... , � : PROTECTION FROM CHEMICALS' ❑ 2. Reporting of Diseases by Food Employee and PIC [:114. Approved Food or Color Additives ❑ 3. Personnel with Infections Restricted/Excluded FOOD FROM APPROVED SOURCE El 15.Toxic Chemicals i ❑ 4..Food•and Water from Approved Source TIMEITEMPERATURE CONTROLS(Potentially Hazardous Foods) 5. Receiving/Condition [116.Cooking Temperatures ❑ 6. Tags/Records/Accuracy of Ingredient Statements ❑ 17. Reheating ` ❑ 7. Conformance with Approved Procedures/HACCP Plans ❑ 18.Cooling _ Q�� ` PROTECTION FROM CONTAMINATION 19. Hot and Cold Holding .. ` ❑ 8. Separation/Segregation/Protection ❑20.Time As a Public Health Control J( 9. Food Contact Surfaces Cleaning and Sanitizing REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) ❑21. Food and Food Preparation for HSP ❑ 10. Proper Adequate Handwashing El11. Good Hygienic Practices "CONSUMER ADVISORY ❑ 22. Posting of Consumer Advisories Violations Related to Good Retail Practices Number of Violated Provisions Related Critical (C)violations marked must be corrected To Foodborne Illnesses Interventions immediately or within 10 days as determined by the Board and Risk Factors(Items 1-22): of Health. Non-critical (N) violations must be corrected Official Order for Correction: Based on an inspection immediately or within 90 days as determined by the Board today, the items checked indicate violations of 105 CMR of Health. 590.000/federal Food Code. This report, when signed below C N by a Board of Health member or its agent constitutes an 24. Food and Food Protection (FC-3)(sso.004) 23. Management and Personnel (FC-2)(590.0 order of the Board of Health. Failure to correct violations V� 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 G�� 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: Inspector's Signature:i p �� Print: P I C,d' PIC's P i P Signature: Print: a e�of- -a es g Dia� .2rDRR�lls/i/ � g ZP g r 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 Responsibilitv' 3-302.11,(A)(1) Raw Annul Foods Separated from 590.003(B) Demonsb aeon of Knowledge* ( Cooked and RTE Foods* j 2-103.11 Person in charge--duties ( Contamination from Raw ingredients 3.302 11(A)(2) Raw Animal Foods Separated from Each EMPLO"EE HEALTH I Other` 2 590.003(C) Responsibility of the person in charge to Contamination from the Environment require reporting by food employees and 3-302.111 A) Food Protection, applicants" 3-302.15 Washing Fruits and Vegetables 590.003(F) Responsibility Of A F.xd Employee Or An 3-304.11 Food Contact with Equipment and Applicant To Report To Tice Person In I Uten,ils* Charge' Contamination from the Consumer 590.003(G) Reporting by Peron in Charge 3-306.14(A)(B) Returned Food and Rescnv ce of Food` 3 590.003(D) Exclusions and R" icbnns* i I Disposition ofAduiteratedorCantaminared 590.003(F.) Removal of Exclusions and Restrictions I Food 3-701.1 I Discarding or Reconditioning Unsafe FOOD FROM APPROVED SOURCE Ftp* 4 Food and Water From Regulated Souices ( ( 9 Food Contact Surfaces 590.0(4(A-B) Compliance with Food laws 4-501.111 Manual Warewashme-Hot Water 3-201.12 Fond in a Hermetically Sealed Container* Sanitization Teluperatures* a-501.112 Mechanical Warewashin�n Hoc Water 3-201.13 Fluid Milk and Milk Ynducts�` ( 3-202.13 Shell Eggs* Sanitization Tertmeratores* 3-202 14 Fggs and Milk Products.Pasteurized* 4-50 Ll 14 Chemical Sanitization-temp.,pH, 3-202.16 Ice Made From Potable Drinking Water" concentration and hardness. * 1 5-101.11 Drinking Water From le an Approved System- 14-601,I t(A) Fquipment Ford Contact Surfaces and I 590.006(A) Bottled Drinking W 4-602.11 602.11 Cleaniater* Cails Clean^ Clean' J 590.0064B) Water Meets Standards in 310 CMR 22.09' ( ng Frequency of Equipment Food- Contact Surfaces and Utensils* Shetpish and Fish From an Approved Source i ( 4_702 11 ( Frequency of Sanitization of Utensils and 3-201.14 Fish and Recreationally Caught Molluscan j I Fad Contact Surfaces of Equipment Shellfish` 14-703.11 Methods of Sanitization-Hot Water and 3- ^_01.15 Molluscan Shellfish from NSSY Listed ( i I ChetutcaPx - - Sources* I I to ( Proper,Adequate Handwashing Game and Wild Mushrooms Approved by 2-2p1.1 1 Clean Condition-Hands and Arms* Reautatory Authority ! 3-202.18 I Shellstock identification Present" 12-301.12 Cleaning ProccrILIre* 590.004(0) Wild Mushrooms' 2-301.14 When to Wasb* � 3-201.17 Game Animals* I it I Good Hygienic Practices g Receiving/Condition 12-401.11 Eating,Drinking or Using Tobacco* 3-202.11 PHFs Received at Proper Temperatures* 2=401.12 Discharges From the Eyes.Nose and 3-202.15 Package tmegritya Mouth* 3-101.11 Food Safe and Unadulterated* 3-301.12 Preventing Contamination When'1'_astinq* I 16 Tags/Records:Shellstock 12 Prevention of Contamination from Hands 3-202.18 Shellstock Identification" I 590.0()4(F) Preventing Contamination from .3-203.12 Shellstock identification Maintained" Employees* Tags(Records:Fish Products f 113 Handwash Facilities 3-402.11 Parasite Destruction" I Conveniently Located and Accessible 3-402.12 Records,Creation and Retention* I 5-2203.11 Numbers and Capacities* Labeling of Ingredients' 5-204.11 Location and Placement* 590.Ut4(J) 9 9 ( 11 Accessibility,Operation and Maintenance 7 I Conformance with Approved Procedures 5-205 ( Y lHACCP Pians Supplied with Soap and Hand Drying Devices 13-502.11 Specialized Processing Methods* I 3-502.12 Reduced oxygen packaging.criteria` 6-301.11 Hio dwashine Clcatser, Availability ( � -- -- - 18-103.12 I Conformance with Approved Procedures- I 16-301.12 Hand Drving Provision ''Denotes critical nem in the Cedes] 1999 Food Code of 105 CbiR 590.000. it 4. BOA,ry.,RnnD OF HEALTH I tV n� .. -/,I� C lJC d C �A� 0 ^ Date: p ��l n Page: of Establishment Namea! >n 1� k��. -c� II - 1 v Rem Code C-Criti*Item l Rem DESCRIPTION OF VIOLATION / PLAN OF CORRECTION Date ft No. Reference R-RL _... Verified (�XEASE PRINT CLEARLY 1 -�/"f�`yl<J^)nnO.Il I> --X f l 1'AAW AA /YA 3,,iA P q'A40 <! -n Ir?�/�i 1 '1�.f/W✓ iT�/ -r�\ tF Ih-'VWl1 n�,1pU�/��FA�I X-�-P�nnvM/r'�ZZF�-11 I-t� ��" ��'� 17� I✓��en�� IQ�r`tP �_'�Ti� ( '.j�U/ j �-� C\OA-,l , W 1 O.N214A,0-1 1 11 Vj.-4 ,-e I I A— C (:::) ,� l Pm k.'2+ ( P.PD,(o + A4 �tZ z, Q 'Nnn ej P, ^ fI tJNn7 n17'�1 / �/ P17,v,VIU V--lM�C� I "-1(I/ufi �Ann.Klan aAF' J(A of U\ �`J .�i_... • 1 \!'%�.a /� /li na ,�.a. 17. �I - s' v V U` v 1s 1 vk o N fP�_(n 0 � �Y(�O,Rn,0-X � n U tj - 1 ) .II,- .. 0A ��A.INI 4`Pn�riac - tYa�.,A'_'Y" 0,) -OA- )t4 094 SII, by 47/ 6C- 0P,�(��_DI) U012.0l�.l4_ n. �),(IIAA �_PP� ��Pn� Ing 1 �P � t�1. �� I ('r I Ca/>,r4•o�� ' v � ,0r`PRR.oU P�0tv.P PYAr .t _,�r/,4 �nnN . Q/f:t�//A/ /czn'nn((AtOA n —4��n�nIIl � \ � D'L (An U)rd.P� , '14-✓��B,l<-�I t`l1 2 - �t �]P _ a , I-IP (1 < 1 *� A7i1. C� ' Qll) -))l) T Y)i- X�(/ihv)' no� `V Cv-vio k lf;'n l �lnP">..firI 1))�P 1Q.liQiCL. )(1- A/tlC/�_}/ 1 I i/FJYi9C 1 r-1754 LY� U !�{.�/ S lin - lAw J(�Un� —NYI r�/Y -fie AA rAl P- na"IA l� n1�V0110 , -= Discussion With Person in Charses v Corrective Action Required: ❑ No ` U.Ves V ` W,""Voluntary Compliance ❑ Employee (Restriction/ M _itDA�.00.vv1, { ' �/� , l/_I ilA'nn 0/�iI��c7 {l0 X.t.�O nn -` Exclusion � � '' nn )) X � Tn_!_1Y/ 'a nAPfova i (1 /1 ❑�. Inspectio cheduled ❑ Emergency Suspension �Xna2Pn � I t/i19A0W(7/� ADAA/x_ X l/Oe.sP (� ❑ Embargo ❑ Emergency Closure t U'q,.'1 - f 1/_M �f//_X ❑ Voluntary Disposal ❑ Other P FORM 7348 (REV. 7/2000) HOBBS & WARREN, :.BJfSSTON This Form APPrOVCd by the DCP1RmCRI OP public Health Violations Related to Foodborne Illness Interventions and Risk 3-501.14(C) PHFs Received at Temperatures Factors(Red Items 1-22) (ContAccording to Law Cooled to 41°F/45°F Within 4 Hours.* PROTECTION FROM CHEMICALS 3-501.15 Cooling Methods for PHFs 14 I Food or Color Additives 19 PHF Hot and Cold Holding 3-202.12 Additives* 3-501.16(B) Cold PHFs Maintained at or below 3-202.14 Protection from Unapproved Additives* 590.004(F) 41'F/45'F* 15 Poisonous or Toxic Substances 3-501.16(A) Hot PHFs Maintained at or above 7-101.11 Identifying Information-Original 140'F.* Containers* 3-501.16(A) Roasts Held at or above 130'E* 7-102.11 Common Name-Working Containers* ( 20 Time as a Public Health Control 7-201.11 Separation-Storage* 3-501.19 Time as a Public Health Control* 7-202.11 Restriction-Presence and Use* 590.004(H) Variance Requirement 7-202.12 Conditions of Use* REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-203.11 Toxic Containers-Prohibitions* POPULATIONS(HSP) 7-204.11 Sanitizers,Criteria-Chemicals* ( 21 13-801.11(A) Unpasteurized Pre-packaged Juices and 7-204.12 Chemicals for Washing Produce,Criteria* 11 Beverages with Warning Labels* 7-204.14 Drying Agents,Criteria* 7-205.11 Incidental Food Contact,Lubricants* 3-801.11(B) Use of Pasteurized Eggs* 3-801.11(D) Raw or Partially Cooked Animal Food and 7-206.11 Restricted Use Pesticides,Criteria* Raw Seed Sprouts Not Served.* 7-206.12 Rodent Bait Stations* 3-801.1I(C) Unopened Food Package Not Re-served.* 7-206.13 Tracking Powders,Pest Control and Monitoring* _ CONSUMER ADVISORY 22 3-603.11 Consumer Advisory Posted for Consumption of TIMEITEMPERATURE CONTROLS Animal Foods that are Raw,Undercooked or 16 Proper Cooking Temperatures for not Otherwise Processed to Eliminate PHFs Pathogens.* Elecl-111/2101 3-401.11A(1)(2) Eggs- 155'F 15 Sec. 3-302.13 Pasteurized Eggs Substitute for Raw Shell Eggs* Eggs-Immediate Service 145'F 15 Sec.* _ 3-401.I1(A)(2) Comminuted Fish,Meats&Game SPECIAL REQUIREMENTS Animals- 155'F Sec.* 590.009(A)-(D) Violations of Section 590.009(A)-(D)in 3-401.11(B)(1)(2) Pork and Beef Roast- 130'F 121 Min.*I catering,mobile food,temporary and 3-401.11(A)(2) Ratites,Injected Meats- 155'17 15 Sec.*1 residential kitchen operations should be 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs, debited under the appropriate sections Stuffing Containing Fish,Meat, above if related to foodborne illness Poultry or Ratites- 165'F 15 Sec.* interventions and risk factors. Other 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks 590.009 violations relating to good retail 145'F* practices should be debited under#29- 3-401.12 Raw Animal Foods Cooked in a Special Requirements. Microwave 165'F* 3-401.11(A)(1)(b) All Other PHFs- 145'F 15 Sec.* VIOLATIONS RELATED TO GOOD RETAIL PRACTICES t 17 Reheating for Hot Holding (Blue Items 23-30) 3-403.11(A)&(D) PHFs 165'F 15 Sec.* Critical and non-critical violations, which do not relate to the 3-403.11(B) Microwave- 165'F 2 Minute Standing foodborne illness interventions and risk factors listed above, can be Time* found in rhe following sections of the Food Code and/05 CMR 3-403.11(C) Commercially Processed RTE Food- 590.00. 140'F* Item Good Retail Practices FC 590.00 3-403.11(E) Remaining Unsliced Portions of Beef 23. Management and Personnel FC-2 .003 Roasts* 24. Food and Food Protection FC-3 .004 18 Proper Cooling of PHFs 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 Hours and from 70'F 27. Physical Facility FC-6 .007 to 41'F/45'F Within 4 Hours.* 28, Poisonous or Toxic Materials FC-7 .008 3-501.14(B) Cooling PHFs Made From Ambient 29. Special Requirements .009 Temperature Ingredients to 41'F/45'F 30. Other Within 4 Hours* *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. ... vtv wt,.,a �a.«d ^4,;k�+•t5.1• 1• y a r wr..•..»' Y.a i, Maszachtusetts Department of Public Health Salem Board of Health Division of Food and Drugs 120 Washington Street, 4t" Floor 9 Salem, MA 01970-3523 FOOD ESTABLISHMENT INSPECTION REPORT Tel. (978) 741-1800 Fax(978) 745-0343 Name" Rate Type of Ooeration(s) Tyge of Inspection J, -�, t/�,(Ah.CRYA In I X10 � Food Service 55,Routine Address `Ya (p ) (( „ , Ij) �I - Risk El Retail El Re-inspection ~' 1✓ r�c�t r 2 t Level ❑ Residential Kitchen Previous Inspection Telephone ) ❑ Mobile Date: 6- qlg hi I 05. 5 - dti Owner �n \ HACCP Y/N El Temporary ❑ Pre-operation _��m ,a-,�A u/w _' , ❑ Caterer El Suspect Illness Person in Charge(PIC;-• l� C #� ,it 4 t I Tinier. ❑ Bed&Breakfast ElGeneral Complaint n- El HACCP WIti(aQX'' Inspector 1�G�J�7 I c>v 1�0�n Out: Permit No. ❑ Other Each violation checked requires an eiplanation 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. rZOD PROTECTION MANAGEMENT ❑ 12. Prevention of Contamination from Hands . 1. PIC Assigned/Knowledgeable/Duties }}��": ' ' "�� •� .. ._., , _,,,,, ,,, 00 13. Handwash Facilities EMPLOYEE HEALTH' „ „ ., PROTECTION FROM CHEMICALS " F-12. Reporting of Diseases by Food Employee and PIC ❑ 14.Approved Food or Color Additives ❑ 3. Personnel with Infections Restricted/Excluded ❑ 15.Toxic Chemicals FOOD FROM APPROVED SOURCE 7. ,; . . , TIMEJTEMPERATURE CONTROLS(Potentially Hazardous Foods F1 4. Food and Water from Approved Source ( y ) ❑ 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 rl' di Separation/Segregation/Protection [120.Time As a Public Health Control Ul ❑ 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 PracticesCONSUMER ADVISORY. ; r1Q 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 C N 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)(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)(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. �y30. Other DATE OF RE-INSPECTION: LUX U 1 G ms 14 e Y 0 Inspector's Signature: I 11 Print:,) 1 U PIC'sSignature:� SCJ /_�� GY/ J Print: J/1/'(�S Sit`lrli�N�� Page L Pages Violations Related to Foodborne Illness ' Interventions and Risk Factors(items 1-22) PROTECTION FROM CONTAMINATION FOOD PROTECTION MANAGEMENT I s Cross-contamination I 590.003(A) Assignment of Responsibility* 3-302.11(A)(1) Raw Animal Foods Separated from 590.003(B) Demonstration of Knowledge* I Cooked and RTE Foexls* 2-103.11 Person in charge-duties ( Contamination from Raw ingredients 3-302.11(A)(2) Raw Anunal Foals Separated from Each EMPLOYEE HEALTH Otherx J 2 590.003(C) Responsibility of the person in charge to Contamination from the Environment require reporting by fond employees and 3-302.11(A) Food Protection" applicants* 3-302.15 Washing 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(G) Reporting by Person in Charge* I 13-306.14(A)(B) I Returned Food and Rescrvice of Food* 131 590.003(D) Exclusions and Restrictions* ( Disposition of Adulterated or Contaminated 590.003(F) Removal of Exclusions and Restrictions Food 3-701.11 Discarding or Reconditioning Unsafe FOOD FROM APPROVED SOURCE fund* 4 1 I Food and Water From Regulated Sources ( 19 Food Contact Surfaces 4-501.1 t I Manual Warewashin Hot Water 590.004(A-B) ( Compl t i:mce with Food leu' I 6- 13 01.12 Food in a Hermetically Sealed Container* ( Sannizrtion'reiriveratures* 3=201 13 I Fluid Milk and Milk Products` f 14-501.11-7 Mechanical W'arewashing-Hot Water 13 202.13 Shell Eggs* Svtitizatioa Temperatures* 13-202.14 F,<;ys and Milk Products.Pasteurized* 4-501,114 I Chemirti Sani fation-temp.,pH, 3-202.I6 ( lee Made From Potable Drinking Water" cone.eutration and hardness. " 5-101.111 Dnnkmg Water from an Approved System" 4-601.11(A) Equipment F=1 Contact Surfaces and 590.006(A) Bottled Drinking Water" Utensils Clean" f 590.006(B) Water Meets Standards in 310 CMR 22.0=` { 4-602.11 Cleaning Frequency of Equipment Food- Shellfish and Fish From an Approved Source I Contact Surfaces and Utensils* 4-702.1 1 Frequencv of Sanitization of Utensils and 3-201.11 Fish and Recrea[ionally Caught MolluscanI food Contact Surfaces of Equipment* _ Shellfish" ( 4-703.11 Methods of Samtization-I-IotWaterand 3-201.15 Molluscan Shellfish from NSSP lasted I Chemical* Sources* t0 Proper,Adequate Handwashing Game and Wild Mushrooms Approved by Requiatory Authority 12-301.1,1 Crean Condition-Hands and Arms* 3-202.18 Shellstock Identification Present* ( 12-301-12 Cleanin;t Procedure* 590.004(C} Wild Mushrooms* I ( 2-301.14 when to Wesli* 3-201.17 Game.Animals* I I tI Good Hygienic Practices 5 1 Receiving/Condition I 2401.11 Eatine.Drinking or Using Tobacco* 1 3-202.11 ( PHFs Received at Proper Temperatures* ( 2401.12 I Discharges From the Eyes,Now and 13-20215 I Package Integrity* ( Mouth* 3-101.11 I Food Safe and Unadulterated * I 3-301.12 I Preventine.Contamination When Tasting* I 6 Tags/Records:Shellstock I 112 Prevention of Contamination from Hands 3-202.18 Shellstock Identification` 590.004(F) Preventing Contamination from 3-203.12 SheillstnekIdentification Maintained" I Employees* _ Tags/Records:Fish Products I I I3 Handwash Facilities 3-402.11 Parasite Destruction* I Conveniently Located and Accessible 3-402.12 Records,Creation and Retention* I 15-203.11 I Numbers and Capacifies* 590.004(J) Labeling of Ingredients' 15-204.11 I Location and Placement* 5-20-5.11 I Accessibility,Overatron and Maintenance 7 Conformance with Approved Procedures i Y 1HACCP Plans ( Supplied with Soap and Hand Drying 3-502.11 Specialized Processing Methods* Devices I 3-502.12 Reduced oxygen packaging,criteria` 16-301.11 Handwashing Cleanser, Availability 18-103.12 Conformance with Approved Procedures* I ( 6-301.12 Hand Drying Provision 'Denotes critical item in the Federal 1999 Fund Code on 105 CNIR 590.000. CITY OF SALEM BOARD OF HEALTH # Establishment Name:�s stn. b �Y �_r �nn,� �n 0 0 cd (DQ Qr Date: ,4 — Gl —1 r_) Page: of } nem Code C—Critical Item v DESCRIPTION OF VIOLATION/PLAN OF CORRECTION ; 'Date - No. Reference R-Red item *:-;i:"Verified PLEASE PRINT CLEARLY n r� n_(J 0 P-11 ��p�� V_V1_ri.LI' - 0,a n 1 . of n O /Yl�_ C\FO n/, /y % n A,rt l .�,1 OAA .1V.[ .Q A ' n A{ 00111— A I .. r /An /C n n 4_44t tit Ii / � P_- �`1 11-0 n, A0 /V1/7t /] Dp �1 A - ;l FYY JL rA/AI.Pp, /I C,(�- rtiJ/ A 1 1/) /l/l/ 6 1.i11OW � � a1 PI - $ --PD 1_� �Qn. �10A 1 I I ` Discussion With Person in Charge: Corrective Action Required: I ❑ No 1 I have read this report, have had the opportunity to ask questions and agree to correct all Z�Q voluntary Compliance ❑ Employee Restriction i iolations before the next inspection, to observe all conditions as described, and to Exclusion }r P LI Re-inspection Scheduled ❑ Emergency Suspension comply with all mandates of the Mass/Federal Food Code. I understand that noncompliance may result in daily finesof�twent�a dollars.or-suspensiGA/r vocation of ❑ Embargo ❑ Emergency Closure ybuf food permit. �—>— ❑ Voluntary Disposal ❑ Other: yjf A • t. 1-501 )4(C'} PHFs Reu ived at Temperatures •. Violations Related to Foodborne Illness Interventions and Risk According to Law Cooled to Factors(!tents 1-22) (Cont) 41'FW5'F Within 4 Hours. > )I PROTECTION FROM CHEMICALS ( 3-501.15 Cooling Methods for PHFtt 14 I Food or Color Additives 19 PHF Hot and Cold Holding 3-501.16{13} Hold PHFs Maintained at or Mow I 202.12 I Addttn'cs" 590J441-) 41"145`F` 3-302.14 , Protectinn from UnaEtprtned Addatvei' - 15 ( i Poisonous or Toxic Substances t 501,16'A; i-Int PHF�Maintained at or above (01.11 ( identifying Infos mation - Du�in•d !:1(1'F. �.itit,l h;<lt 1 Ft^.+,t,Hrld a:or above 130°F * I r t"ontainer,' -- - 7 107..11 ; (ommon Nam, - R,r6 +:e irme as n Public Hearth Conte of .t Ii'i!n,'.as;: Puhh du, e€ie alth Control r _� 't)(Ji S<pzr: on- Stac^' _�. 7-'02-12 ` _ ttCoc" ------ - _ ='�---^-^udmom,of UsRE0116REMENTS FOR HIGHLY SUSCEPTIBLE ! 7-?i)3 tl Taxi: ctj nam_en -_Piniibca l,:'. � POPULATIONS'_'04.1 I Saniu:�erv.i�ntct'i:+ --C!tc rtic:dc' I - -�----------- 7-_104.12 Chtntiral>fcn A'a,hmg t^chino° (Atezia' 1.1 1 it,\) Unpsacoria,d Pre-pac,aecd)taco•.and with 1t'aroinL I�b.;ls., ii 7-?0=1.L7 Ur}ina A[:enc•.Cnta is _ ---- ., &}! 1411) C,:t,' Pa:te!oized Eee,' C" t 105.11 htcidrnlal f-•><xi r'unla;t_Lnbmra lain• iw Po t,alP. C,w>i.-d Amon) RmJ and I??06.t 1 Kean rn•;i 1'Sr Pe,!ictde= t.:a tc'U 7-:.06.1' Rkxlew 13si Sr!non, .—..�'-�^- i S:.r: S::d `;irr„nt, �nl Sr!v,:.l. i i4nt R•:,":nea �La; (',,na,.t az,l Atn t - CONSUMER ADVISORY _ ZI TIME(TEMPERATURw CONTROLS .I+ur: 11 i '.on,nme, A+'�a:»F P„n,:,l b!r Cowinit lti„n o{ A_ ,ntta:i i ,d."ata' arcR:r.�. L'nduc:xkcd, ' 16 ——( Groper Cooking Tempe(Moroi;for_ I 4 i PHFe ! .',rt'atlter:',iac t'n"r,avi:.tt:iirun.ue i .___�..__..__ __ .__ _ __ � ! Pitt}V,_�,Il� c:.,c•...� ,:r , Pzer-hruaedi:ar Set,=t�, Is4'1'i5:ec 'will J Fr;' Sub"ntFnr ii: R;a>.'Shif( t ” , Cunt, .-;21;1.7',)1 I(I .r>1 r:1,Ef :ii`:� li•li Kt,:�i i'.�;,.t' l:; 1,1117' �P�.vi�L RE(�7CiQR3:v�l�{ENTS Ii—Ait IK:+.itt,, lo;ty .i \1;.si•=---f. i` -- i'';ti:;`ata) ;}; ! L"r.l.rt,,lil: of tic:ttt';:�:N};Nih: 1Cillp;Urat i ind i :hl.liLQN:+t au't'. 41aid Gat 5tuR2,i '1iFs rt,::!ew AI.iicrc11 oilal.:licw `.hould ! ti::al,a�a,a(:at,:,•, !t:h. Ne,:. .Sl,d Ct' tt;N€rr f}K<?l..?irpn.tt a. ,'t Y,i11,� nt t'" ! 17 Fleit.`atir:;ro,€;.?tt::a•,r.: u7c??..Q?;(3jiYf:'._:t-$rF•`i77u :i+i£:t: ' ;'411. :-'�iNt:;'t:;l:.` 1P. !6r"h I_ acc iiteu!s2.i,301 103.1 Ifh) Yhcs',,a,rlv:- It,` _ 4ivu:.•a4!nQt! ;J,;,. ^n .u:'r:,.n.. .:! .'.<•:ur. . �i. cl.y„ , r �elcr _ 'E';:nC' _ _ t"r,%:. :. :i.'. .. ^t:* ,,:,r, ,. . ...: � 1. !afin'. i .,. .,...,�r. ,,.•:Lr• i 13.! It(') Commki 1d;h'Pa.,— ..., :'ti 1"�a[ __. r. }!:. : �:.: , ^ :r<:'. •�± r" - - - -- - n i--$113 i HGr Rrm::,via:t i.ni:±"c•: Pa N-r:.,>i 7:C;y item gnatN Rz,ta:l PlSCftca_s ._ F_C _ _: 5_9L'Pth't :_ 74 epYt ^nd`•cT:xt F=J:('itu,n _ _ PC .W4_ l8 ! Proper Cooling of PRFs ;__� i- _ -- _ 't-_, ' , 2n Equ^nnu-n'.,nG li—.- tr rw}ktd €'ffi-r i�Jn: t.pi ( Lf ? ;- ---- - — - -- . : , .�F :ts-n`,,�r,P,;.tr.G�:y V[;'Na '._. ; {C -" - ', b1i'omn . t,.t:aa:;dFrora'i' I 1-27 l - -- -- - [,:.¢; 28 � 0^5 .:a7 of 7-:xt�. �:r Ien:s-- -C - ' 'JC3 ' i �U1.idt fit Coolin"MIR.Nhid: I'tont.wrd-tctft : 29 •Dim h.,r±Uc.d del'. x.!e,.,! l"%'1' alilx'c lit,t ,..nnf. r CITY OF SALEM BOARD OF HEALTH Establishment Name:(t1q' - \.l.h anl,�i .,�1� .t D Q. a��.._ flr— Date: r�- lq— l 7 Page: of E Item Code C.-Critical Item •L `1 DESCRIPTION OF VIOLATION/PLAN OF CORRECTION No. Reference R'-Red Item /� _Date'•',•.; PI F4RF PRINT CLEARLY �-�-r PP / 4n. 'c/jyc ,.1/ — _"I ""'fI C !-�O i rJ l 0 P i ' T AGnr {{�^- S �.,.. . /'\' i_a •\ Y_ 1C \ I'',i '�;`.r , ib P,Sr i :n —Y0O K%•� Ann n\n:.�.h, w:� ' _I.) 1--5'—• r� �i�ir. ��.�1 I, Ic A. - ZJ _. lV 1/�I¢_ �/rr —ro _� nnyr, _1l I-1-!) �l` o 6 g tl ` � „� ' I IV 1 tl �Yn n �� O 1 -O,i XiV ' ,.� -� n.✓-1- U.n h I )p� .44.��In n�,P pJ( �1/(� } I")`11' 1 / �/Yn n/n` �Kfa i/. P/i l 1 o(�AQ l-e/ 1( A k ri <� I 't Discussion With Person in Charge: Corrective Action Required: I ❑ No I (f res 4 I have read this report, have had the opportunity to ask questions and agree to correct allIN Voluntary Compliance ❑ Employee Restriction/ fiolations before the next inspection, to observe all conditions as described, and to Exclusion t � P � ❑\Re-inspection Scheduled ❑ Emergency Suspension comply with all mandates of the Mass/Federal Food Code. I understand that r noncompliance may result in daily fines of twen y-five dollar or_ausp_erzsion/revocation of ❑ Embargo ❑ Emergency Closure ( yOur food permit. / - _� I ❑ Voluntary Disposal ❑ Other: { A ' s Jul.i411C) PHFs Received:a Temperatures .I Violations Related to Foodborne Illness Interventions and Risk I According to Lav Cooled to Factors(llenrs 1-22) (Conk) .11-F/45"F Within J Hums. PROTECTION FROM CHEMICALS ( 13-Sul 15 C,xling Myt- ....for 1'HFs 14 ! Food or Color Additives 19 PHF Hot and Cold Holding- - - 1-202.12 Additiles* ?-501.10( ) Cold PHFs Maintained at or below 3-302.14 Protection (rontilnanvnr+ed ,lddlttsec' 5900011}-, .:1`145"F' j Poisonous or Toxic Substances I v!i 14,:1) Hot PHI=v 1laintaim:d at or 8bove }c ! lol.li idt•ntrfvutglnfionwtion -0!lgina:' i 14(i'F. ` tL,,io; Wd atoi above i!WF a rtl #? Time as a Public Health Control 7 . tl Ct�.:nu1Cn5;anr; ! _,.::. !. t,;Tr•as 11-ubLc lt,,alfh C olwr tl' }il-t Y :rinr,c Re n 9tttlit . � '%-'_U2.Il itir>t:i,.eun--Pn•scncc and i.,:.. ._ _.. -- -- --.-... 1- -__-----5l-------------�-- ---� 1-_'0'_12C',nui!Fit•n:ofi`t¢° ,'v; f'untatncu -Prolfibt ::a;,; REQUIREMENTS FOR HIGHLY SUSCEPTIBLE -- i( POPULATIONS HSPL C'riterin-C'hrmic:Jo' - - —_- ---- --. 1)•1.12 Ch.nevals l,e Wwhwp,Fhndnct'.C1it,;.ua'. j21 T ;-�o IItA' � UtmI'teunrod Ym-lrn t:.,a`d Juicrs ana --� �_ Brtt'rages 1ab<ls' j i 20-1 14 ( ilrtirt;;At•wntn.Cntcria' tvith tldruin, —_ — !-'— --- ( _.-------- ;-S•J; 11iR: L <.o; Pa�truized't C�.,•_ , 1 1(1,511 6tcid: F;x41 ntal Contact l tfhnrnn!,• !--------.. h I r) 1<du or Y,aV:ili: 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: Capt.'s Waterfront Grill& Club File Number:BHF-2004-000093 94 Wharf Street Salem MA 01970 LOCATED AT: 0094 WHARF STREET SALEM, MA 01970 Permit Type Permit No. Permit Issued Permit Expires Fee Restrictions/Notes FOOD SERVICE BHP-2011-0218 Jan 1,2011 Dec 31,2011 $420.00 ESTABLISHMENT Total Fees: $420.00 PERMIT EXPIRES IDecember3l, 2011 w Board of Health Ifs Abu 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 t CITY OF SALEM, MASSACHUSETTS 1 .( a BOARD OF HEALTH \ 120 WASHINGTON STREET,4n'FLOOR TEL. (978) 741-1800 KINIBERLBY DRISCOLL PAS(978) 745-0343 �1AYOR DGREEN4AUNIO[ ALENI.CONI DAVID GREENBAUM,RS ACTING HEALTH AGENT 2011 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT NAME OF ESTABLISHMENT r-4PTs 1A)A725n F2DNr Ga)r l- TEL# 978-2V1-0J--,T ADDRESS OF ESTABLISHMENT �FAX# 979-7W-_qy 40 871 � MAILING ADDRESS(if different) LL EMAIL-Business': �Lrk(�C"ir-C6M Website: WWW• ro-0/ .coM OWNER'S NAME D/Rk H r-X9RAA)97-(6N TEL# 7?146 173y ADDRESS--// L-'U6RGT7 PAIAF 81,UP, MRRDaNEAD M A STREET CITY STATE ZIP 9AU/d S/�.bExtgfl GyyyAab CERTIFIED FOOD MANAGER'S NAME(S) PAT/AICI< DOft/U CERTIFICATE#(S) L4Yc/99 (Required in an establishment where potentially hazardous food is prepared) EMERGENCY RESPONSE PERSON RAI< T0/LA/UOTS611) HOME TEL# 7V4-T1-7LrY 1 :DAYS`OFOPERATION'= I _'.Monday' <..:Tuesday' ii, Wednesday Er i; zThursdayi, .jr ;;`?Friday:.:.;-_; % S,atulday ;,= �:i;_ ; $uoday,' HOURS OF OPERATION f f 3o AM - i /ygo All Please write in time of day. (For example 11 am-11 pm) 42 AM fR:00�iM TYPE OF ESTABLISHMENT FEE (check only) RETAIL STORE YES NO less than 1000sq.ft. =$ 70 1000-10,000sq.ft. =$280 more than 10,000sq.ft. =$420 ---------------------------------------------- ES- --------- - --N--O------------------------------------------------le-s-s-t,h-a-n...2-5---s-ea--t-----------------=-$14---------- RESTAURANT Y -- s 0 (Outdoor Stationary Food Cart$2 25-99 seats =$280 more than 99 seats =$420 ---------------------------------- ------------------------------------------------------------------------------------------------- BED/BREAKFAST/ YES NO $100 CHILDCARE SERVICES/NURSING HOME ADDITIONAL PERMITS MAKE (not just serve) ICE CREAM, YOGURT/SOFT SERVE 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 submitt9d to and approved by the Salem Board of Health. Pursuant to MGL Cha )?2C,SecF n 49A, I certify under the pains and penalties of perjury that I,to my best knowledge and belief,have filed all state tax returns pa' all st R&es re d under the law. 0/ -08'DRz4o Signature / Dafe Social Security or Federal Identification Number Revised 10/7/11 FOODAP201 Ladm Check#&Date 1276a/ 'i SWWM Harry Noyes Chemical Asount Representative 4 978.7444880 Phone 140 South Street 978.815.0745 Cell Hopkmton, MA 01748 508.497-9600 Fax www.svAsfierhygiene.cam .Moyes@r«ishenervice.mm ' v k. 6 �► GNZYME CH DAMA L19UID :`. . Drain and Grease Trap Treatment Clean out and clear up organic odor-causing waste in drains, down pipes, grease traps and septic fields with this semi-viscous enzyme treatment. Keeps drains open safely and effectively. Naturally occurring, non-pathogenic aerobic and anaerobic bacteria and enzymes work continuously to solubilize and digest waste without the use of harmful acids,caustics or solvents. This natural decomposition of soils and waste helps eliminate drain and sewer line problems when used as directed in a regular program. Liquid Enzyme is safe, easy to use and requires no special equipment. Semi- viscous formula clings and promotes "dwell time" on vertical surfaces for im- proved retention and performance. Eliminates odor.Keeps drains open.Liquifies waste. BENEFITS • Natural, 100%Biodegradable • Safe—No Harsh Chemicals • Controls Odors TECHNICAL SPECIFICATIONS • Digests Waste—Liquifies Solids • Non-corrosive—Will Not Harm Plumbing Appearance Red Liquid / Odor Sweet Cherry r %Volatile by Weight 85.3% RECOMMENDED USES Health Hazard Slight • Drains/Down pipes Detergency NA • Grease traps Wetting Ability NA • Septic tanks • Drain fields Foaming Very Low to None • Portable holding tanks Flash Point <212°F Solubility in Water 100% + Specific Gravity 1.00 SPECIAL INSTRUCTIONS pH 7.00 • Protect from freezing Free Acid None • Store product between 3rF—100T. • Contains live bacteria which may cause allergenic skin Density 4.4 lbs./gal. or respiratory reaction. Freeze Thaw Stability Passes 3 cycles KEEP OUT OF REACH OF CHILDREN Rinsing Properties Excellent APRODUCTOF C,Ai D ■ ech, � J.FnD Chmagalo 1800-621-3888FAX(314138 4398 Et Company ■■■■PROW03 COMPRHv '� F DALEY International, Ltd. St Lours,MO 1800-325-8891 FAX{ Y4)78S-OJba HAZARD RATING FlRE MATERIAL SAFETY DATA SHEET = ME 1 2 0 REA�ym. (Prepared According to 29 CFR 1910.1200) 2-MOCE"TE HEALTH 00IMNIFICUn-SUGHT0 sPEC1AL Date Prepared 12-30-96 SECTION 1-PRODUCT 1001THTCATiON i Distributor Name Candy&CoJPeck's Products Emergency Telephone No. 1-80p.535-SM i Address 2515 W.35th Street,Chicago, IL 60632 Information Telephone No. 773523-8320 i Trade Name Liquid Enzyme(154) Product Type Drain Treatment i i Chemical Family NA Formula NA i SECTION 2-HAZARDOUS INGREDIENTS CHEMICAL NAMEICOMMON NAME CAS NO. PERCENT(optional) TLV(Source) i No hazardous ingredients i I i I I i i i SECTION 3-PHYSICAL DATA i 8ot11ipzt 210°F ( __N`,orief"`r 1.00 :o.lxlos i pH 7.0 x Dal I J F.Y, 1 i =16)ra - 20i tyA!°POtnsY�t11y 98 ab1M� g Ii Solubles ® comolets 13 Insoluble ❑ (a ei°apmeanlEb) ❑I In («gPamlaa E"eprr,,,%-M ® Faster ❑ Slower ❑About the Some i Appearance and odor Red color,cherry odor. i SECTION 4.FIRE AND EXPLOSION HAZARD DATA Rash Polati .) <212°F IfD e u no u ROVaRb1e upper 1 ower i Extinguishing Media Alcohol foam,foam,CO2,dry chemical,water spray. i Special Fire Fighting Procedures Weer NIOSH/MSHA respirator to orevent exposure to acrid smoke&hazardous decomposition orodu i Usysuai Fire and Explosion Hazards None known i SECTION S-REACTIVE DATA Stability Stable Incompatibimy Strong oxidizers,bleach,disinfectants,other harsh drain chemicals. Hamrdous Decomposition Products Oxides of carbon,acrid smoke j i SECTION a-HEALTH HAZARDS Tixeehols Uma VSIW-Prea,wY tions Source Sas Esctbn 2 for Maroelmb TLV EsrsblleMd ❑ ApplkebN Eye Skin oral W Inhalation ❑ other signs and Symptoms of Own-exposure{Act") Direct eye contact may cause Irritation.May cause allergic skin or respiratory reaction.May Irritate sensitive skin after prolonged and repeated contact. Signs and symptoms of Over-expesurs(Chronk) May cause mild incitation to eyes.May cause skin reddening with irritation leading to dermatitis. iMedical Conditions Aggravated by Ovff-"P sure Unknown cc:=« ❑ NIP ❑ IARC ❑ OSHA lc Nos i SECTION 7-EMERGENCY AND FIRST AID PROCEDURES i Eyes Flush with plenty of water for at least 15 minutes.Get medical attention immediately. i Skin Wash with plenty of water.Seek medical attention H Irritation persists. i Ingestion If large quantities Ingested,give 2 glasses of water and Induce vomitinq.Get medical attention. i Inhalation Get fresh air and treat symptomatically. i SECTION 9-SPECIAL PROTECTION MFORMATWH PR." tlm Avoid breathing spray mist If product is misted,a NIOSH/MSHA mask Is recommended y� i neouVentilation p in Eduu z ❑ Mechanical ❑ Other i Gwve1°`atV° Optional Eye Protection Optional Otho protective Clothing NA SECTION 9-SPILL OR LEAK PROCEDURES Ste"to be Taken N Released Or spilled Flush dawn drain with large volume of water. i waste Disposal Methods Flush down drain with large volume of water. i SECTION 10-STORAGE AND HANDLING INFORMATION i Precautions to be Taken in bandiIng and Storage Store at moderate temperatures.Keep out of reach of children. FORM It 34-0311 M117.91 i Commonwealth of Massachusetts s r- City of Salem Board of Health IGmberiey Driscoll 120 Washington Street,4th Floor Mayor SALEM,MA 01970 Food/Retail Establishment Permit DATE PRINTED:. 02/01/2010 ESTABLISHMENT NAME: Capt.'s Waterfront Grill & Club File Number:BHF-2004-000093 94 Wharf Street Salem MA 01970 LOCATED AT: 0094 WHARF STREET SALEM, MA 01970 Permit Type Permit No. Permit Issued Permit Expires Fee Restrictions/Notes FOOD SERVICE BHP-2010-0338 Jan 4,2010 Dec 31,2010 $420.00 ESTABLISHMENT Total Fees: $420.00 PERMIT EXPIRES December 31, 2010 Board of Health /�b �W'✓' This Permit is not transferable and must be reissued upon change of ownership or location.The permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code,beofre any revonations,improvements,or equipment changes are made,all plans for such must be submitted to and approved by the Salem Board of Health. Page 1 • CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH 120 WASHINGTON STREET,4n'FLOOR TEL. (978)741-1800 KIMBERLEY DMSCOLL FAX(978)745-0343 M.-�YOR LK;R61 N4AUMI SAWN1.CONI DAt11D GREE.NBAUM, ACTING HEALTHIAGENT Y010 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT NAME OF ESTABLISHMENT_ _ &rS Lfti4� #Al-r 6AIJ.z TEL# ADDRESS OF ESTABLISHMENT -57L FAX# 97 -7J1 —Si� � MAILING ADDRESS(q different) EMAIL-Business': e�&t*aCa/013' COM Webstte: rvWW'Cr/06 Cd-_4.4! OWNER'SNAME___rJjAK Z3Q TJ t ? TEL# nO'f�3i`7*y ADDRESS//ro 'AJK &0 0 >P Mit �• "�- STREET CITY STATE ZIP CERTIFIED FOOD GERSNAME(S) /PAONAc4,�/�J�Fr4Tt� CERTIFICATE#($) (Required in an esteb8sh ent where potentially hazardous food is prepared) EMERGENCY RESPO E PERSON--J�—.rHOME TEL#��471 e7y T{CINr;..i , lbkidaN,,.., desdW, .A'd r fff!" 'd' .,tri:,:Q HDQRS dFERATIdtd i Pkese wrAe in thne d day, i (Forsxam Jlan•ttpm} i TYPT9FE§TABLI�}IMENT FEE (checkonlvl RETAIL STORE YES NO less than 1000sq.fL --$70 1000-10,000sq.ft. =$280 more than 10,000sq.11. =$420 .............. ..... ..............._........ RESTAURANT �. J NO less than 25 seats $140 (Outdoor Stationary Food Cart$210) 25-99 seats more than 99 seats =$420 BEDIBREAKFASI'%•- - LL- - --- YES NO ------• $1� CHILQC�/lRE_,SERVIGF f)RJR$INC,HQh�) ................................................................................................•....... ........ ...... APDITIPNAL PERM TSS MAKE (not just serve i ICE CREAM, YOGURTISOFT SERVE YES NO $25 TOBACCO VENDOR YES NO $135 ALL NON-PROFIT(soh as church kitchens) YES NO $25 *Please pay total with bne check payable to the City of Salem. This Permit Is not tramisferable and must be reissued upon change of ownership.The Permit must be posted In a prominent location In the Establishment In accordance wRh t a State Sanitary Code,before any renovations,Improvements,or equipment changes are made,all plans for such must be submitt d to and approved by the Salem Board of Health. Pursuant to MGL Chapt 82C,Section 49A,I ceNfy under the pains and penalties of pariury that i,to my best knowledge and bafief,have filed all state tax returns paid all state r it der the taw. / ,,�� t�lw• VYV l ��© Sigttature Date 7 Social Security or Federal Identification Number Revised 424/07 F00DAP20d8.adm Checks&Date S _ I RESTAURANT• GRILL & PV6 DIRK H. ISBRANDTSEN 94 WHARF STREET • PICKERING WHARF SALEM,MASSACHUSETTS 01970 TELEPHONE: 978-741-0555 FAX: 978-741-8722 Email:dirk@capts.com W .capts.com 12/23/2009 City of Salem(Licenses&Permits) **460.00 Four Hundred Sixty and 00/100ssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssssss City of Salem(Licenses&Permits) 120 Washington Street ^ (f Salem, MA 01970 ` City of Salem(Licenses&Permits) 12/23/2009 Date Type Reference Original Amt. Balance Due Discount Payment 12/08/2009 Bill BoardofHealth Permit 420.00 420.00 420.00 12/23/2009 Bill Building Dep/Inspect 40.00 40.00 40.00 Check Amount 460.00 Operating Account 460.00 City of Salem(Licenses&Permits) 12/23/2009 Date Type Reference Original Amt. Balance Due Discount Payment 12/08/2009 Bill BoardofHealth Permit 420.00 420.00 420.00 12/23/2009 Bill Building Dep/Inspect 40.00 40.00 40.00 Check Amount 460.00 Operating Account 460.00 ...- � a r.. l" -,- `""+'.n..N*r90r^v'sMir^.,Lty2!'r -an-...e.\ .r+^^�.+T" J+ r '��, S +xy�y_�. �p✓�'+'Yi�e'Y't*`• f-N'.h:IT'+"�}l� �1..s..-{R Massachusetts Department of Public Health Salem Board of Health Division of Food and Drugs 120 Washington Street,4'"Floor 9 Salem, MA 01970-3523 FOOD ESTABLISHMENT INSPECTION REPORT Tel. (978) 741-1800 Fax (978) 745-0343 NamDale e (A <<_ on(s) Type of Insoection M�} +Lp IUXr , Qr Food Service ❑ Routine Address �) A 11_ ( p�$ Risk- J ❑Retail ElRe-inspectionI^ �Y� Level ❑ Residential Kitchen Previous Inspection Telephone qAC<' 0'1 4-0 O �y� ❑ Mobile Date:t� _ �G� Owner 1 nt✓ __,_{�� HACCP YIN ❑ Temporary ❑ Pre-operation / �,Ah �XIt o�7rA _<;� I ❑ Caterer ❑Suspect Illness Person in Charge(PIC) i_ Time ❑ Bed&Breakfast El General Complaint f In: ❑ HACCP Inspector , jIv) r- � v \, I Out: Permit No. ❑ Other Each violation checked requires an exlavation 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) i/-�,590.009(F)ALO 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 1_ .. ', PROTECTION FROM CHEMICALS ' ❑ 2: Reporting of Diseases by Food Employee and PIC ❑ 14. Approved Food or Color Additives ❑ 3. Personnel with Infections Restricted/Excluded ❑ 15.Toxic Chemicals F000 FROM APPROVED SOURCE " TIME/TEMPERATURE CONTROLS(Potentially Hazardous Foods ❑ 4. Food and Water from Approved Source ( Y ) ❑ 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 - •- El 19. Hot and Cold Holding O8. 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 (1�Vq.,❑ 10: Proper Adequate Handwashing lJ I ®111. Good Hygienic Practices ,( , CONSUMER ADVISORY /VVVIr�/� 22. Posting of Consumer Advisories Violations Related to Good Retail Practices Number of Violated Provisions Related Critical (C)violations marked must be corrected To Foodborne Illnesses Interventions immediately or within 10 days as determined by the Board and Risk Factors(Items 1-22): of Health. Non-critical (N)violations must be corrected Official Order for Correction: Based on an inspection immediately or within 90 days as determined by the Board today, the items checked indicate violations of 105 CMR of Health. 590.000/federal Food Code. This report, when signed below C N by a Board of Health member or its agent constitutes an 23. Management and Personnel (FC-2)(590A03) order of the Board of Health. Failure to correct violations 24. Food and Food Protection (FC-3)(550.000) 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.00s1 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 r> DATE OF RE-INSPECTION: jV ky)-6q S 5Mn$WtFOFm 1C dM Qk( ill n ( Inspector's Signature: )P -j o v)(p <�,�A P h Print: PIC's Signature: rig 0�� `� h �J Print: �� ' �,n u�\ S. e (-�u I Page of Pages Violations Related to Foodborne Illness Interventions and Risk Factors(items 1-22) PROTECTION FROM CONTAMINATION FOOD PROTECTION MANAGEMENT 8 Cross-contamination I 590.003(A) Assignment of Responsibility"` 3-301.11(A)(1) Raw Animal Foods Separated from 590.003(B) I Demonstration of Knowledge* Caked and RTE Foods* 2-103.11 Person in charge--duties ( Contamination from Raw Ingredients 3-302.11(A)(2) Raw Anurad Fonds Separated from Each EMPLOYEE HEALTH Other* 1 2 590.003(C) Responsibility of the person in charge to I Contamination from the Environment require reporting by foal employees and 3-302.11(A) Food Protection applicants* 3-302.15 Washing Fruits and Vegetables 590.003(F) Responsibility Of A Favi Fit ployee Or An 3 304.11 ( Food Contact with Equipment and Applicant To Report To The Person In Utensils* Charger ( Contamination from the Consumer 590.003(G) Reporting by Person in Charge" 3 306.140V)(B) ( Returned Food and Reservice of rood- 3 590.003(D) Exclusions and Restrictions* Disposition otAdulterated or Contaminated 590.003(E) Removal of Exclusions and Restrictions I I Food f 701.11 Discarding or Reconditioning Unsafe FOOD FROM APPROVED SOURCE Food* 14i I Food and Water From Regulated Sources ( 9 Food Contact Surfaces i 590.004(A-B) I Compliance with Food Laws ( 4-501.111 Manual Warewashing-Hot Water 3-201.12 ( Food in a Hertnetically Sealed Contamer* Sanitization Temperatures* 3-201.13 Fluid Milk and Milk Product;* 14-501.112 Mechanical Warewashing-I-lot Water 3-1.02.13 I Shell Eggs* ` Sanitization Temperatures* 3-202.14 Eggs and Milk Products.Pasteurized* 14-501.114 I Chemical Sanitization-temp.,pH, l 32 Ice Made From Potable Drinking Water- ( concentration and hairiness. " 5-101.11 Drinking Water from an Approved System^` 4-601.11(A) Equipment Food Contact Surfaces and _ Utensils Clean- 590.006(A) Bottled Drinking Water* --- -� 3 * 4-602.11 Cleaning Frequency of Equipment Food- 590.006(B) Water Meets Standards m CMR 22Contact Surfaces and Utensils s SheJtlish and Fish Roman Approved oved Sourcc e 4-702.11 Frequency of Sanibzatton of Utensils and 3-201J4 Fish and Recreationally Caught Molluscan Food Contact Surfaces of Equipment"' _ Shellfish' 4-703,11 Methods of Sanitization-Hot Water and 3-201-15 Molluscan Shellfish from NSSP Listed Chemical* Sources* ( to Proper,Adequate Handwashing Game and Wild Mushrooms Approved by Regulatory Authority I 2-301.11 Clean Condition-Hands and Arms* f { * I ( 2-301.12 Cleaning Procedure - _-_ 3-20..2.18 I Sh_ilsHxk Identification Present* 's � 590.004(C) Wild Mushrooms* ( 2-301.14 When to Wash* 3-201.17 Game Animals* if Good Hygienic Practices 5 Receiving/Condition 2401.11 Eating,Drinking or Using Tobacco* 3-202.11 PHFs Received at Proper Temperatures* i 2-401.12 ( Discharges From the Eyes, Nose and 3-202,15 Package Integrity" Mouth* _- 3-101.11 Food Safe and Unadulterated* 3-301.12 Preventing Contamination When Tasting* 6 Tags/Records:Shellstock 12 Prevention of Contamination from Hands 3-202.18 Shellstock Identification * 590.004(E) Preventing Contamination from 3-203.12 Shellstock Identification Maintained" Employees* Tags/Records:Fish Products I ( 13 Handwash Facilities 3-402.11 Parasite Destruction' I Conveniently Located and Accessible 3-402.12 Records.Creation and Retention* 5-203.11 ( Numbers and Capacities* 590.0040) Labelingotingredients' 5-2{k1.i 1 Location and Placement* 7 I Conformance with Approved Procedures 5-205.11 Accessibility, Operation and Maintenance /HACCP Plans I ( Supplied with Soap and Hand Drying 3-502.11 Specialized Processing Methods* ( Devices _ 3-502.12 Reduced oxygen packaging,criteria* ( 6-301.11 Handwashing Cleanser,Availability 8-103.12 Conformance with Approved Procedures* 6-301.12 ( Hand Drying Provision - *Denotes critical item in the federal 1099 Fond Cate ui 105 CtiIR 500.000 r .i CITY OF SALEM BOARD OF HEALTH Establishment Name:f"i. ,:-,f 9�� )/��A P A rnrq' ;I 1 ,0 0 m (JX.Lt�ate: In-- Page: a of Item Code C-Critical Item) v DESCRIPTION OF VIOLATION/ PLAN OF/CORRECTION Dote_ No. Reference R-Red Item �}- ,Verified y _ O PLEASE PRINT rt EARLv �r" P/_Ale, T \/I . 'V' fV' -k,t"t rt } I f`;�(�".:?/;!'`,��r,a n a f-a ,�b'.�-�-"U� -�% "1' 1 .h �/ �_ 7,�r,✓ U I ��✓,� . , �I �i `� So rn �_ x��V �-/t/V �t �/nr rt,,Gn/lN` �I ✓� I I I 1f1 A )0,7 S 11,170 1 1 O kP l r m w 1Pi,.` ��(f �'V"/•nn OXY f rn:t I 11L \�U,, 1 1 f,1 1 '1/I - �'._-t r A.� r.., ,�/t ? .l�'VrfAnn_--- I ,tA R,r_n v�_o..V G' 0 -,*I v U " � 1( r r�? Svc i / /nni� n{A ( u,� !.-r, (.M /Y na r. Q_ O'n/n'U An _� /Al At AwS✓� ,r J \�.O.t_A 1Q.�n �I,l ./i .P iX. �� \(X.1,1,1,UX /M � rV A,;-f J4 -`�1cceM'00ng klnn,D �— I� �t�� r a9 �i,,. ,P� 6:1 ne..r .V A, ,.,,� J� )� In ,,f nnA1 .Ar e - T I OV-1 PX FiO, r, i ;fl,r f an.' I I t p tt I 1 n :,).1 \, )n -)N r,, (,n n >� J 1.1 X nO'tLN -q"" A jj0i // r nA', '-) C ,/ .4 • ,_1-,a NrJI.,-i/ A,())-�r'4�'l1 A IAl/nt/ Discussion With Person in Charge �I Y� CorrectiJe Actionvquired: I ❑ No ' Yes I have read this report, have had the opportunity to ask questions and agree to correct all `Voluntary Compliance ❑ Employee Restriction/ violations before the next inspection, to observe all conditions as described, and to Exclusion ❑ Re-inspection Scheduled ❑ Emergency Suspension comply with all mandates of the Mass/Fede 1 Food Code. understand that noncompliance may result in daily fines of enty-five h, �ollar or suspe sion/revocation of ❑ Embargo ❑ Emergency Closure i your food permit. \\ ' �` 0 Voluntary Disposal ❑ Other: 3501.14((..') PHFs Redxrved at Temperatures Violations Related to Foodborne Illness Interventions and Risk According to Lau Cooled to Factors(!tarns l-22) (Cont) 4I'F/45'F Within 4 Hotns. PROTECTION FROM CHEMICALS 3-501.15 Cooling Methods for PHFs 19 j j PHF Hot and Cold Holding 14 Food or Color Additives ;-501.16(B)0 16(B) I Cold PHFs Maintained at or below 3-202.12 j Additive," 590.0(1♦(f-) 41`/45°F" 3-302.14 Protection from llnapproied Additives' 3-501.16(A) l int PHFs Maintained at or above 1.5 Poisonous or Toxic Substances r ',-101.11 klc:ntifin Inforinallnn - Onginal I �, 14(1-1. Container(., " I :->Gi 75(A) I K+s±,t,Held at or abode I30°E•. 1 7 102.I t ' Common;tiantr - Po',,;•l;ina t l,ut.un::r�` 1 �= _ _ _ 1 Time as a Pubic Health Control i r--� Pin;c as a Public I leatth Control' r-_0 1.11 j 7-2U?1 I 1 °'rte�>{t.ir}tl-_"-_` j \`;nar;e tteyture n,ent j I{CA(rli(p At -1't PS(PiC:LLlli !.."' 7-_'0'2.12 C,•ntiititai.<tf t ,�" j 7 203 11 Toxk Comainet: -Prnhibinon" I REQUIREMENTS FOR HIGHLY SUSCEPTIBLE IUILe4 ad7^0.4.11 Saniuets,Cnnsin --Clicrlic:, sPOPULATIONS(HSP) 7-203.12 ! 2t i _----- ----- - Recets.es•with WarnurK Labels` i 7-104.14 Dnintt Apent'.C'nse!iaJa°Pa>iru;ized l:Vta` I '05.1 7 _ h)d:id::nta? 1:>'xi Cuniact, t nhucal,'s -- i-``Pi.I lain ! i .,:vor^a:f rdl'. G+tv,i afsur,<:1 Ftxd inn I q-206 i R,:.tn,:;',iCS�I'e rude: C:r.tett;—.�. I I-- ' I ----- ltay.Sr:`d ysraat.. ssvt:icrved. i 7-206.12 R«Iart 13.:11 S:etu'Te.` E-, ----�---- ---- _ . „c; nceed I','.Ki pa0:aec tint 14, sC rid,, , 'Ictt6!rg Bra d.r:. N•`ai Cuntr,:'.tnd ttmi+, rut•" CONSUMER A13VISORY TiMkErrE:MPERATURE CONTROLS '{": l; ! ,.n tnv., .3r,:so.'• P±..t.::i 1,=r i'cnt;itn',:,f:, ; i aLid;'I 1'lr�� I11.1t.la' Raw, 16 ; Prope+Cookir.S Tei,ipot afures f;s , I - I - � `:,:.,':.d•;;.for t . .rss.:L', , MHP ____...___... , --'•::"- r.,:e'_•__7•,n,r:_thateSe__;u t „'i-l :: l H'' rii, .' 1l, ::,;tiq:vll;>}i. :,t.' {:. '�'r}R',:.. ut"npEtii<• ;. tt.'P;'S: 1 f .. + I � c ---. ----- -_ SPECIAL REfSUtRE(t§ NTS »Oi.f 1'RV:I ---- (--+,,; �J . . -. ':.1 ii 1, .., . 11,'.: u,,-.. $r;)'.,,i2 .'I- r. ,..:..:s1 . .•.. ,. :r: ....C:', . .:b.: s< j � .e:l'd.. .•,+n'aR eq^ i,iS hl:,., � I + : ,. . . . .. ,.. :a': .. . ,e r i7 RchC:3tir4 t,» ho: :!00r ;;t'>i_Ai::t;L. ,,'L.A`:!:f: . ?GC+:7'7,c7ET`ti. i"'.`?:C'r"`%�• +.teusbdt`: .,-1113.11CH) Mwov at` (f,I,'(-2 1 ww.,:i'andi+i;` t'':✓ , ,. . "Z' :., Jt:..:, h(1t'{ do twir ;Ti p!, < __ �.__._-.—___.__— ,.,.�.:!: 'rr:I,i!q;,,,•. d,trr.'i.1 tdt G,n ! 'q)t leu,.,.' id/t i^. � .-;:'r3.ii1C•) (�.)mtnrt;,±il1 l's ta:,:c,i �1'il�F >ci jmr:<:•!. a: : ,t.: , .•d:•rr. , . da fi:<,rl f:rJe a,.,'1' ) t?„ ! _-3:�2IEQi; R::ma;niil Ln.gred Po,:,oi,of l'_r; : tier., _.I_Goc<f f7era„rracP(ces _ ___ -' FC__ f53Q_U_Cnr . . `211 'id't8�eroE•nt u;q Per:^nn„i_ i F C; �_ . 09. (g . nd FcatProper Cooling of PHFs _2_.. _ ri,o: , 2e. E� o-i,rrer,t ±nd Ute;:'es ' f_”.-,1 ')!+:• : vpi !'(A) t'„14me G ot,,d PHPc t::'n, 141'F l+. l ___ -_:._ ,. __. - _>_-__.._ .�.,..� t ibu.tm< 1!vur.�+nlFrom..,i.. pf-r on I f/-t:': r l7Riwi.!Kn:r, Daso, 'k)xu. M,ateaais - - . `<.(. - - 11)01#-- - 501.i4;1{r CooliuL n;IF.M1S:1dc FI I)1)1 Ambient � T,,,q.ru!e[_ h:eredicut. i,11'k/.t< F ; Lao Ike--_ J .R•d,+',J'ILs:,.cal:')th-,,.!-:P 1')14 loodt ,C, • '„„ '.,., ,Utiu I I ,M1I Massachusetts Department of :Public Health Salem Board of Health Floor Division of Food and Drugs 120 Washington Street, 4a" 9 Salem, MA 01970-3523 FOOD ESTABLISHMENT INSPECTION REPORT Tel. (978) 741-1800 Fax (978) 745-0343 Name }�^ /� /� nn n Date Tvpp of'Ooeration(s), Type of Insoection � (l-C4 Y!1 A PCIM�l�1X X X ( X L( V f �� I ❑�F'ood Service ❑ Routine Address�� ' n + ]�(1 Cl p Risk . Retail ❑ Re-inspection X�v `I vv \ Level ❑ Residential Kitchen Previous Inspection Telephone ❑ Mobile Date: q�u 11C- o ti.�. s Owner !),- HACCP Y/N ❑ Temporary El Pre-operation A).tA p i/1Q)1:1/X�S Pte. I ❑ Caterer ❑ Suspect Illness Person in Charge(PIC) /> Time ❑ Bed&Breakfast ❑ General Complaint 1 r1C no r Ot Ps 1 In. I ❑ HACCP Inspector (}a Qu p , �i u it /C I Out: Permit No. El Other, Each violation checked requires a 1 explanation on the narrative page(s) and a citation of specificiprovision(s) violated. U 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 MANAGEMENTw,��+ "�"" " w • � ❑ 12 Prevention of Contamination from Hands ❑ 1. PIC Assigned/Knowledgeable/Duties ❑ 13. Handwash Facilities 7EMPLOYEE HEALTH ' PROTECTION FROM CHEMICALS El 2.2. Reporting of Diseases by Food Employee and PIC - ❑ 14.Approved Food or Color Additives ❑ 3. Personnel with Infections Restricted/Excluded ❑ 15.Toxic Chemicals ` FOOD FROM APPROVED SOURCE'S 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 Proce' dures/HACCP Plans J-] 18.Cooling I ' - : PROTECTION FROM CONTAMINATION " El 19. Hot and Cold Holding ❑ 8. Separation/Segregation/Protection El 20.Time As a Public Health Control El 9. Food Contact Surfaces Cleaning and Sanitizing ' REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) , El 211. Food and Food Preparation for HSP ❑ 10. Proper Adequate Handwashing ❑ 11. Good Hygienic Practices nj CONSUMER ADVISORY' __ " ''_ _. .. "" 11 ❑ 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 x by a Board of Health member or its agent constitutes an 23. Management and Personnel (FC-2) order of the Board of Health. Failure to correct violations 24. Food and Food Protection (FC-3)(5590.90.0 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: i C�fi 1 a 5 SXOS,,WFCr 14 me Inspector's Signature: Print: PIC's Signature:��s"�!r,G/ '"� Print: "q v 5 I�U f,r j��' Page of ,3ages U Violations Related to Foodborne Illness Interventions and Risk Factors(items 1-22) PROTECTION FROM CONTAMINATION FOOD PROTECTION MANAGEMENT ( 8 Cross-contamination I i 590.003(A) Assignment of Responsibility' I 3-302.!1(A)O) Raw Annual Foods Separated from 590.003(B) Demonstration of Knowledge* I Cooked and RTE Foods* 2-103.11 Person in charge-duties I I Contamination from Raw Ingredients I 3-102.11(A)(2) Raw Animal Foods Separated from Each EMPLOYEE HEALTH Othcr" 2 590.003(C) Responsibility of the person in charge to I Contamination from the Environment require reporting by food employees and 3-302.L1(A) Font Protection' I applicants* ( 3;302.15 Washing Fruity:and Vegetables .590.003(F) Responsibility Of A Fein?Employee Or An 13-30-tA I Food Contact with Equipment and Applicant To Report To The Person In Utensils* ChargO' I I Contamination from the Consumer 590.003(6) Reporting by Person in Charge* I 13-306.14(A)(B) I Returned Food and Rt-service of Food* 3I 590.003(D) Exclusions and Restriction,* Disposibon of Adulterated or Contaminated 1590.003(E) Removal of Exclusions and Restrictions ( I Food 3-701.11 Discarding or Reconditioning unsafe FOOD F9OM APPROVED SOURCE Funic` J f 4 Food and Water From Regulated Sources I 9 Food Contact Surfaces _ 590.0041A-B) Compliance with Fait Law* 4-501.1 I 1 Manual Warewashing-Hot Water 3-201.12 Food in a Hermetically Sealed Container* ( Sanitization Temperatures* 3-201.13 Fluid Milk and Milk ProductsM i 4-501.112 Mechanical Warewaslunr Hot Water 3-202.13 Shell Eggs* i Svtitization Temperatures* 4-50L114 ChemicalSanitiztmon-tem H, 3-202.14 Eggs and Milk Products.Pasteunzed* I P�,P l concentration and hardness. " 13-201 11 Ice Made From Potable Drinking Water* 14-r01 i l(A) Equipment Food Contact Surfaces and I ( 5-101 11 Drinking Water frau an Approved System" ( � J 590.0061 A) Bottled Drinking Water' I Utensils Clean* 590A06(B) Water Meets Standards in 310 CMR 22.0 4-602.11 Cleaning Frequency of Equipment Food- ( Shellfish and Fish.From an Approved Source I Contact Surfaces and Utensils* 3=101.I4 Fish and Recreationally Caught Molluscan 14-702'11 Frequency of Sanitization of Utensils and Shellfish- Food Count Surfaces of Equipment" l 4-703.11 M-tho h,of Sanitization-I fat Water and 3-201.15 MoOnsvan Shellfish from NSSP Listed ( Chemical* Sources* ( III I Proper.Adequate Handwashing ry Regulafo Game and Authority Wild Mushrooms Approved by I 2-301.11 Clean Condition-Hands and Arms* 3-202.18 Shelistock Identification Present* I I --301.12 Cleaning Procedure* 590.004(C) Wild Mushrooms* j 12-50 1.:4 When to Wdsh* 3-201,17 Game Animals* ( 11 I 1 Good Hygienic Practices 5 Receiving/Condition i ( '=:01 11 Eatin¢,Drinking or Using Tobacco* _ I 3-202.11 PIIFs Received at Proper Temperatures" ='-401.12 I Dintharges From the Eyes, Nose and 13-202.15 Package Integrity" ( Mouth^ 3-101.11 Food Safe and Unadulterated* I 3-301.12 I Preventim,Contamination When Tasting*_ 16 Tags/Records:Shelistock j 112 Prevention of Contamination from Hands 3-202.18 Shellstock Identification* I 590.004(E) Preventing Contamination from 3-203.12 Shellsiock Identification Maintained, ( Emploeecs* l Tags/Records:Fish Products I 113 ( Handwash Facilities 3402.11 Parasite Dcstruction` I i ConvenienV Located and Accessible 3-402.12 Records.Creation and Retention" I I 5-1203.11 I Numbers and Capacities* 590.004(J) Labeling of Ingredients` ( 5-2104.11 I Location and Placement* ( 5-_05.11 I Accessibility,Operation and Maintenance 9 Conformance with Approved Procedures I Y /HACCP PlansI Supplied with Soap and Hand Drying 3-502.11 Specialized Processing Methods* I Devices 13-502.12 Reduced oxygen packaging,criteria' ( ( 6-30L11 Handwashing Cleanser,Availability 8-103.12 Conformance with Approved Procedures* I 16-301.12 1 Hand Drying Provision I Denotes aitiail Ilam in the federal 19991-ood Code of 105 CDA12 590.000. C OF SALEM r l BOARD)OFdHEALTH Establishment Name''a ��S �(X Q_n ;"t Page: of Item Code ' C-Ciltical RemN" ~DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date No. Reference (, R—Red Item " - - ; " - Verified PLEASE PRINT CLEARLY i lU� ✓ � I C�� (\�(�7�{�4)�".O��J; /�l -1A itA U J .PIP A,' — .k'AAA- .1,4,t V-\ f�D /-I nA .7"f Cin�l'7/I/'.�,r n/ �'I rt nom,. (1n AA '� 114k 11\ " J '1 .1, '.O`/1-Y ��1V"/ ,.l� .I nnnJlPlri1_1\ , ��m 1Aj-EbA ��.Pii _hA rr�" /_1\Ji .:C.t�Y`)�!J -to /\/Vt,LI y Discussion With Person in Charge: // Corrective Action Required: I o No I ❑ Yes I have read this report, have had the opportunity-to a' sk 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 twenty-five dollars or suspension/revocation of ❑ Embargo ❑ Emergency Closure your food permit. ❑ Voluntary Disposal ❑ Other: Vioboorns Related to Foodborne Illness Intc-rlventions and Risk Aoc rdian to[,:i" C xil=A- I,) Factors(item 1-22) (Cont) 1 '1�! �N1'hkxh for PHF� PROTECTION FROM CHEMICALS cix)jn 19 PHF Hat and Cold Holding 14 Food or Color Additives 'Fq N '.e. 16.rpl Cold Ph a 1 i" 3-302A4 I Povo nin frona I itinppro,ed Adkiinv�.s' 3 i,10,A; i lot PHF,Mainowedat or Alow Poisonous of Toxic Substanes 14", F. WI Infonnintil'r, orlilinw � �t�! H'IAI kAiii;ls fidd at or iloove 24) Time as a Pubim Hoohiti Control CovatlyniN,nme rim,as,Pubti�I Icalib C,earq1' V(,tt-iction -t reser,u.drid L:+;^ 7 202.12 Cwifhdksli�of Uwll REOUfREMENTS FOR HIGHLY SUSCEPTIBLE 7 ?03'11 Toxic Conuumc,- P(olviNtion,1 POPULATIONS(HSP) 7-204.11 samtizer;,Crilerin-ChcuiiAs' 21 1 IA" JwLes and llnulttcc,Ciiti�.,IcIl I I :`:its; Wdrili w, 7 104,14 Dv�lng 'Xincn(�.Criteria!' ;-2( bici&nw! NWKI Cill`1110 [Athl'I"inti" ,z 4SC! lliRl 1'�'_.(X Piv,t'nlr;�.ed EsIll! 7-"06.11 Rein,(ed U,�v Cniewil R'iw sc'ti�po tul t Not Sin ved. 7-206.}2 R,Aorn Bio P"XXI R" 7,206 1 1 i;icling Cost;c4 and Mon(tot i n;'4 CONSUMER ADVISORY TIMMEMPERATURE CONTROLS 22 k 14")-l.11 Parledior Coll':ilvlptiun 0 16 Proper Cooking Tempe,atures for xti: fhai, irc R,w, Undercili,ked or PHFS N'q;)flwrwi"' I 11iialwee Pafb'tl�m' - Eggs- Innwoi;kte Scrlc. I 45'F'15.trc� tin IIaw 5101 Corriviiintli'd vish. K (Alut Animah- i i5"F I i se.:. ' SPECIAL REQUIREMENTS 7401.1 J(lTyljn2; ftildk alal 1301___-__123 win, �-4u 1.11(A),2'� Raire� %I'A�i, 155 V 15 (llRertag 3-401 ll(Ai(5l Pmftr}.Vi'M G;aac, Stafted 1111F�% A iiti.hCti he suding Fish, Meet, and" The approp'nate ie�.!ions Poilitr v or knows-l I,,5�1" 15 ,.c. zlvve if 1'�iafcjd"')tt'XxJ'bl,rn'�. ilhlcs� Intact BeotStzaks Inl0i N ftfllloll.W)d Liclor", {hb(.r 3-401 1 ,.}5'F rdatin" to qo(d retail l-'_i% Aranial F,ld-,Cixl1,i,d to a pr"licesAwlild he dubiteil under #29 - Nlictowaw Ifi-''I- * Sp,11.6:0 Requircownt,. 340 JA HAKI l(b i Afl Chhei 11 il_-�.- 14s,F 15 sec 17 Reheating for Hot Holding VTOLATIONS RELATED TO GOOD RETAIL PRACTICES 3-,4)3.1 I(A')&iD) pill., lWF 1'i ser. (Itersis 23-30) 3-4W.)IiB) Nficrowa% l65'F2Nclinin,•Staijdin,, Cnip ,I Iraa!non-'.iaf at viofal;�nq, whirli dil'un IVIW':10 IIW • Time" 'r;q3'oy'r:M;Zcs', "'i'!venn'l'b�gnar";Aja'la"?Awed ai")w' fan 1'r .3-{03.11,C) CtllffilllltrNAII� PIWIN,.d RTV hKW1 h,q,,d;n rliurn Fo,ud t ade and JI)J CSIR Ciuo 4o IF, '11, :1.103 590,00 1 FC 2 OW 1 1R Proper Coculylg of PHFs 004 4 00S Cisfing C,K)kt it PHFI, lrow 1441'1:1 10'F Within 2 f fow,',and FfomIfY F '17 P!,-,cal Fh,,,Iitv �C__6_ il, 41 T/44 F W'iti,ji,4 Hlluv,. I __1111------ i (Y07 .2� Pour �,r T,�l,;,Matef:a!s I rc 7 1 m; ------------ 50 1 14f b) G'ailliat I'l-Irl;Nlilde Sp_-,a+ I _3 61-0 uner Tcmperawrc lllgrtdions to 4 1'1-05`F `;%ithm-I (lkxifs' - lion,ill ar i.V;'lf Iv")VolldW"Ior 105 C%ii:51 ;t (; r CITY OF 'SALEM } �i BOARD OF HEALTH 3 Establishment Namesa� x�� ( Orth ' Q—A^"� . �i l ff P Q (t 0_9j rk- Date: ! li7= Page: of Item Code C-Cr'iticai Item DESCRIPTION OF VIOLATION/ PLAN OF CORRECTION Date } No. Reference R-Red Item „ Verified s PLEASE PRINT CLEARLY ,�1� r��.��,,.�� I . n V�A/!� C>'r/.iA,t.P'L I "I 1) o � P�(`LCJW i._ )550 r ..i 1 I GAI fN`C;l n�li, A fl n 1 ..n 0 A 0A I C`A�'%A ;� .C.t o,.� �S -f�'v!V nA ?" " �/ k—)A t.1.'�' lV_Z)"Ad n A, XI- -'Y\1\ i Pe- C; Aj?2A YeC.4�tiP_� Discussion With Person in Charge: ( \ Corrective Action Required: No I ❑ Yes I have read this report, have had the opportunity to ask questions and agree to correct all ❑ voluntary Compliance ❑ Employee Restriction/ Exclusion l 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 `t your food permit. ❑ Voluntary Disposal ❑ Other: : s violarlons Ranted to Foaci)arne fitness interventions and Risk Uytl,:d to ravro's(Iter"s I-Z) (Cont.) 5W.i VHr-1, PROTECTION FROM CHEMICALS 14 1 Food or Color Additives 19 PHF lil-land Wit Holding 61"1") COW PhFs,Nls<i!V,wwl at^z f•:qlw Ad,btiw 3-.34:2 14 from l;,iapj)rwed 15 j Poisonous or Toxic Substanner, 7 101AI i lkill,11"mw Infolow! (ell - 0r;inuld mm� Wd-,t or I�04-, Con t�inm, i it 7 1 11 C k�nimm Nam, - W,rki•,., :„>U 14joe _q a PiJhj�C Health Control 7 20L)1 S<pUmt-k'a--511-(Age' V C,wrlll, 7-201.11 # R•:,vicilon Fr- n.7c wid L,e+ !,er4uiNffleW 7-toy'?.t2 Co3tditi,,w,of 1l:,,' I REGUIREMENTs FOR HIGHLY SUSCEPTIBLE _(>,;.I I j T MV; I POPULATIONS(HSP) 21 f I! agcd j1k%eS;,J1d fo; �N wnia, 7 N)4 1-1 Dl iii1l; Nt=cw,,,Cm-!w "e-sol,I !fill L^w ker P"mA!, C:;+71-d Avilml I"Ked.110 1206, !(��Irio.�d L:w Pe,rk,nies,Critemi" I iNo: S--i. 7 20(J,12, RW��W 13"il 461h I e i j i , I I(C, llr,��pcncd Not P� 'i f06 ;3 '1 t:Oral:port i CONSUMER ADVISORY TIME(TEMPERATURE CONTROLS 22 3 4,0-, o i Con,mi '1ttt i,nrt PlNi,d :(it Com,iwiption o'16 i Prcper Cooking Tempilatutes lot Un PHFs o!Otiirzliw to Flwwmw ry t. !h)-F1 5,:C. 401 1 1 At I lt.�l 'T Mcw: 401.1 lfll)i 1 21 (( P,.t k lqjB l .;l RwM - 121 Jilin SPECIAL REWREMCNTS 0� Section i"(!009(Al-i DI iA ioo!lth t;mporarp and 4D 1.1 t(Ay3) Pollim,VN 6d sniffro pffs, hoidd W lIoefp:c Cont mop„ Pqh. Meal, c;nefil'r 01C "Ippr"rmlic CtUk7llll, 0 we. It'I�,iwvij 1%�jltr, or 1 34"1 WhAe mu>,Jt. ;jvvct Bej m, s lumvvilocn,and �isk factuiOib,-r :��10J)00 viuielti-sl;rehqin,: ((, -7ty;xl retail 3 411:,i I i6w Anna [t),X�k Ica praL Litr:t 11culd )-c deiitcul ,nde-t #?9 - '40!,H(Aimlb) I'M Otimi JIHFc 145 T I ec 17 I Rchnating tot Ht Holding WOLATION-14 RFLATED TO GOOD RETAIL PRACTICES -;-WOJI,At4�D) Plik 11651. !` leu i (Items 23-30) 3 10:1AUU) Mikmv,,iw- 16YF Z Moroi-Standing I f.w,!b,qpe i3r"." 1w. ell?",'i�410110rt im'd obo"r, ('ln be, C) ht.ee.",'d'PIF I-IRRI- j fijeln-';j: lg ti;, 1,0,j J,? 11)i I IF.; Remajoin. 1.qSh<td pozkwn�elf ri.,.o stuff Flat:.t-;Cps 15-90 1�00- L�Wd F-1 2 1 00-� 18 Propur Cooling of PHFS rF�,)a r)nd Fond Pic;,�Iflo 001: �uMe )(11 i A7 i ljz�-3zls e T..-1,nd 'd 2si 'Nevar,P4.mUnp Ij 71)"1 Within 2 lfAir,wid From 70` J7, 1 Phvsicat Fa-;it, FC 6 00; io 4 1'F/45 F 41 How, or 7 (1,02 5w.i4b CoolimPllFa Mwdc From nmht nf 009 n,4l'F;45 �N Itbin 4 1 Lows" e t TOWN OF MARBLEHEAD— FOOD ESTABLISHMENT INSPECTION REPORT C E�tablishmena 7,LL l)C/(x j1 Am-,t A " 0 b FOOD Yti(TI'ECTION Violations Related To Foodborne Illness Interventions NIANAGEMENT AndRiskFactors IC ITIC is not qualified-PIC is not certified or certification has C-Diexpired. Assigned/Knowledgeable/Duties 2.Each establishment shall employ 1 FTE/PIC over 18 yrs, rtified as an on site manager. i , 3 Certification not posted. (� `.J�.--,^„ ._ �� 4. quire rsuo r r food safety. in foocsafet / Vim°` ff�x��-- _ not required but they must be knowledgeable in food safety k,.�l a 5.Non employees in non restricted areas of the kitchen, prep azea or ware-washing area. EMPLOYEE HEALTH 2. Reporting of diseases by Food l.Lmployer is not checking on the health of the employees or 0 �-2.The employees are not telling the PIC of their health Employee and PIC problems. 3. Personnel with Infections 1.PIC is not excluding or restricting an employee who has r�yp�- alth symptoms. Restricted/Excluded v 2.PIC is not following procedure for exclusion and restriction of employees. 3.PIC is not following procedure for the removal of exclusions and restrictions of an employee. FOOD FROM APPROVED SOURCE. 4. Food and Water from Approv d 1.Food or bottled water not frau an approved source. lee not from an approved source. Source 2.Food not sealed property 43. Milk and Shell Eggs note A standards X6 4.Fish not approved for salee or or recreationally caught shellfish.Shellfish not tagged or from an approved source 5.Game animals on the endangered species list. Wild mushrooms that are not inspected. 5. Receiving/Condition PHF not received at 41�or below. t.' V 2.Raw eggs not received in refrigerated equipment at 45-or HACCP—RECEIVE less. 3.PHF cooked to a temperature not received hot or at a temperature of 135,or above. 4.Frozen foods not received frozen 5.Foods received that have evidence of previous temperature abuse. 6.Foods that are not received in good condition,dented-cans or torn packages. 6. Tags/Records/Accuracy ofV 1.Sfietlstock not obtained in containers with legible tags or <_© labels affixed by the harvester or dealer. Ingredient Statements 2.A tag that does not have the harvester's identification# HACCP-RECEIVE and the date of harvesting.3.Tags that do not have dealer's information and certification number-tag stating to keep tag days.90 4.Labe 4.Label tops from shucked shellfish missing. 5.Fish received damaged. Raw or raw-marinated ready to eat fish-fish that is not frozen at-4�or below for a minnmmm of 168 hours. 6. Fish that does not have records of temperatures,sale and records kept for 40 days. 7.Any fish that does not have labeling or ingredients f.., S �' 0 7. Conformance With Approved 1. Establishments that have not received a variance for smoking food, curing food or preparing foods that require a i Procedures/HACCP Plans variance• 2. Establishment that packages PHF using a reduced oxygen packaging method without an approved HACCP Plan. 1 Does not comply with the HACCP plans and procedures that have been approved. 4. Does not provide records to demonstrate procedure for Critical Control Points. PROTECTION FROM 8,�., CONTAMINATION Deparatton - Segregation - R f separating raw foods from each other,cooked and //�� RTEE foods during storage,preparation,holding and display. {1teCtion of arranging each type of food in separate equipment. HACCP—STORE 3 ackages are received opened or cut. HACCP—PREPARE -Storing damaged,spoiled or expired foods. 4.Not washing fruits and vegs before they are cooked or NY served. 5. Food in contact with unsanitized utensils or surfaces. 6.Re-serving food that has been returned or not eaten except for condiments in jars or containers with lids. 7.Serving food that is not from an approved source-RTE foods that have been contaminated by an employee-foods that have been contaminated by employees or consumers 8.Food not covered 9. Food Contact Surfaces Cleaning 1.Manual ware washing-temperature is not 171-or highet. 2.Mechimical ware washing-temperatures for rinse are not and Sanitizing 165.for stationary rack or 180-144- for other machines. UJ� ,5 3.A chemical sanitizer used in a solution for manual or � S C�`-'win mechanical operation does not meet the criteria determined by the test kit, 4.Food contact and utensils not clean to sight or touch.Food contact surfaces of cooking equipment not free of grease or soil accumulation.Non food contact surfaces not free of dust, dirt,food residue and debris. S.PHF equipment and utensils not cleaned euery 4 hours. 6.RTE,salads bars not cleaned every 24 hours. 7.Ice tea dispensers,ice dispensing nozzles,ice makers.and any dispensing lines not cleaned on a regular basis. 8.Utensils and food contact surfaces not sanitized before us after cleaning. C)0/L_� 4.Cutting boards dirty,deep cuts or chipped. 10. Proper Adequa e Hand' 1.Employees are not keeping their arms and hands clean. .2.Employees washing their hands in sinks not designated for Washing Hand wash. I-L4CCP—PREPARE 3.Employees not following a hand wash procedure or not using paper towels to dry their hands and arms. 4.Employees not washing their hands before they engage in any type of food preparation,set up or serving. 5.Employees not washing their hand after touching bode parts,animals,soiled equipment or using the rest rooms 6.Not washing hands when switching from raw foods to RTE Foods. 11, Good Hygienic Practices 1.Eating,drinking or smoking in a non-designated area. 2.Not drinking from a closed container. HACCP—PREPARE 3.Employee working with a persistent discharge from eyes, nose or mouth. 4.An employee that uses a utensil more than once when tasting food. f r 12. Prevention of Contaminatio1.Except when washing fruits or vegetables or handling RTF. -hinds an employee not using utensils such as deli tissue, from Hands spatulas,tongs,single use gloves or dispensing equipment. 2.No gloves,tissues or utensils readily available. 13. and -Wash Facilities 1.Establishment does not have a Hand-Washing Sink available. 2.Establishnient does not have a utility sink with a floor drain � 3.Hand-washing sink not located in prep area and/or in or adjacent to rest rooms. AtA hand-washing sink being used for multiple purpose. { A hand-washing sink that does not have hot water,soap a heated drying system or paper towels 6. Hand Wash Sink not labeled for Use. PROTECTION FROM CHEMICALS 14. Approved Food or Color f 1.Foods that have added chemicals or pesticide residue. 2.Eggs,milk,cheese or ice cream that is not pasteurized. Additives 15, Toxic Chemicals Y 1.Cleaning bottles,sanitizers or poisonous materials not Y labeled.Or smaller containers from bulk products not HACCP-STORE properly labeled 2.Poisonous or toxic materials are above food,equipments utensils or linens. 3.Poisonous or toxic materials that are not used in the establishment are on the premises. 4.Containers originally used for toxic materials are now used to store or transport food. 5.Facility not using a sanitizer to clean food contact surfaces. 6.Lubricants used on equipment conning into contact with food 7.Rodents bait is not covered or in a tamper resistant hatt station or a tracking powder pesticide is being used in the food establishment. TIMEITEMPERATURE CONTROLS (Potentially Hazardous Foods) ` 16. Cooking Temperatures / ly 1.One or more of the following foods have not been cooked up to temperature HA CCP-COOK Eggs-1.55-for 15 secs.Or 145-for immediate use Pork or beef roast 130- ^ Igjected meats 155,,Poultry,wild game or stuffed meats 165-,Comminuted fish,meats&Crime 150= 2.Micror 17. Reheating 1.Foods taoteheated6 o l5 sec. 2.Microwave food not reheated at 1 5-a d a 2 minute HACCP- EAT �� _�p_.1p� standing time. T�"aD 1,QA\ AeX,�ll IV " 3.Commercially R'I'E not reheated at 140n 18. Cooling � 6�t'tt 1 1.Not cooling cooked PHF from 140-to 70-within 2 hours. 2.Not cooling cooked PHF from 70-to 41-within 4 hours. ACCP COOL-FREET,E- TH ,W .p 3.Food that is thawed not using a cooling method such as, ur � .A ice baths,running cold water,or cooling in the refriecrator. 19. Hot "old Holding 1,Cold PHFs not maintained it or below 41-. 2.Hot PHFs not maintained at or above 140- IIA CCP-HOLD 3.Roasts not maintained at 130-. {1d0 4.No thermometers visible or accurate readings. , 5.Frozen food not kept at 0- 20, Time as a Public Health rIlk I.Food that has exceeded 4 hours and was not removed from ' v' "service or discarded. Control �t HACCP-SER VE PQA_(A )�,OIckQY)P)V REOUIREMENTS FOR HIGHLY j SUSCEPTIBLE POPULATIONS (lisp) 21. Food and Food Preparation for 1.Unpasteurized pre-packaged juices and beverages being served to children 9 years and under. HSP 2.Raw or partially cooked animal foods and raw seed sprouts are being serviced to HSP 3.Unopened food packages being re-served to HSP. CONSUMER ADVISORY I 1 osting of Consumer 1.Foods are not properly labeled to include 2 or more ingredients listed by descending order by weight,quantity of dvlsorles contents or an artificial color,flavor or chemical preservative -Y'-OGQren Y,J 1/ 2.Foods are not honestly presented by using colored (3 ^ """ __ "`"'�� vq..aaa overwraps or lights that misrepresent the true appearance of 1 �g c the food ICM c5t�VVl�t�tCt ��Z!�� VIOLATIONS RELATED TO GOOD Violations Which Do Not relate To Foodborne Illness RETAIL PRACTICES (C or N) Interventions and Risk Factors 23. Management and Personnel/^� 11.Employees hair restraint is not worn or excess jewelry V' ` 2.Fingernails are not short,clean or unpolished 3.Personal items in restricted areas 24. Food and Fo Protection 1.Food prepared in private home being sold retail. rp _ � .RTE foods being handled with bare hands. 3.Food not covered in fridge,freezer or room temp. Frozen foods not kept at Oo or below _5 Jtenstls are not handles up for distribution. 6.Food is not stored at least 6 inches off the floor. 7.Refrigerator or Freezer units are not clean. 8.FIFO is not being conducted. 9.Reusable towels used for dryinghands,pans and utensils. rEquipment and Utensils 1.Refrigerators or freezers do not have visible or correct thermometers or are not working S �"�"e-- 2.Food slicer or prep areas are not clean _I Cabinets,shelves, ovens,fryer or ranges are not clean. (4,lExhaust hood and filters are not clean. 26. Water, Plumbing and Waste 1.Bottled or drinking water not coming from an approved source. 2.Chlorine test kits or chemical sanitizers not being used to check on cleaning and sanitizing. 27. Physical Facility /�� 1.Screens not installed or doors not installed properly. I\:XC� 2.Three bay sink not labeled. C rMS 3.Flies in any part of the establishment. 4.Garbage cans are'not clean or emptied. �1 .Boxes and containers are not removed from the site. 6.Loading docks and dumps[ers are full or not cleaned. 7.Open doors or windows without screens. _ 8.Unfinished construction. 9.Lights that are not shatter-proof or do not have shields 10.Floors and walls are not clean 11.Restrooms do not have hot water, soap,toilet paper or I ' paper towels. 28. Poisonous or Toxic Material� 1.Chemicals are not stored properly. 29. Special requirements L Caterers-Not informing the BOH of events where they / are catering. 130. Other / HACCP Plans Commonwealth of Massachusetts s City of Salem Board of Health Kimberley Driscoll 120 Washington Street,4th Floor Mayor SALEM,MA 01970 Food/Retail Establishment Permit DATE PRINTED: 12/29/2008 ESTABLISHMENT NAME: Capt.'s Waterfront Grill & Club File Number.BHF-2004-000093 94 Wharf Street Salem MA 01970 LOCATED AT: 0094 WHARF STREET SALEM, MA 01970 Permit Type Permit No. Permit Issued Permit Expires Fee Restrictions/Notes FOOD SERVICE BHP-2009-0271 Dec 29,2008 Dec 31,2009 $420.00 ESTABLISHMENT Total Fees: $420.00 PERMIT EXPIRES IDecember3l,2009 I Board of Health This Permit is not transferable and must be reissued upon change of ownership or location.The permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code,beofre any revonations,improvements,or equipment changes are made,all plans for such must be submitted to and approved by the Salem Board of Health. Page 1 CITY OF SALEM, MASSACHUSETTS • • BOARD OF HEALTH 120 WASHINGTON STREET,4T°FLOOR TEL. (978)741-1800 -. KIMBERLEY DRISCOLL FAx(978) 745-0343 . �� NtwOR IDIONNEOSAI.EM.COM JANET DIONNE, DEC - 4 7008 ACTING HEALTH AGENT BOARD OF HEALTH 2009 APPLICATION FOR PE MIT TO 'O,{PEERnA/T/EA FOOD ESTABLISHMENT NAME OF ESTABLISHMENT C�Off !�U J} L"—"¢"'/ v' -TT EL# ADDRESS OF ESTABLISHMENT JJ /�G(/�tY U�PQY. -570Z'1 . FAX# MAILING ADDRESS(if different) // EMAIL- Business': '5&4Ce GQ-pts- COm Website: CQ-'Otf,,r 0M OWNER'S NAME Plgl< TEL# 7,P/-63/-7`?�1 ADDRESS AhR/ z5W,�A1I rw qvf` STREET /; _}� / ITY STATE - ZIP CERTIFIED FOOD MANAGER'S NAME(S) 1<o- frf o- ,l--t/l CERTIFICATE#(S) sj—1 l o:r (Required in an establishment where potentially haiard96s food is prepared) J Sj 512P e sQrii= EMERGENCY RESPONSE PERSON J7/Rl< :rJNX JP/'fF/'J HOME TEL# /X/,� 17f17" I DAYS OF.OP,ERATION.- : :. Mdnday 1 '`-r7uesday '.Wednesday- ' Jhursday_ I Friday- 1 Saturday- I Sunday, 1 HOURS OF OPERATION1 jj:30AM Please write in time of day. (Forexamplellam-11pm) IF00 AM TYPE OF ESTABLISHMENT FEE (check onlvj RETAIL STORE YES NO less than 1000sq.ft. =$70 1000-10,000sq.ft. =$280 more than 10,000sq.ft. =$420 ------------------------------------------------ ------ ------------------------------------------------------------------------------ ------------------------- RESTAURANT YES NO less than 25 seats =$140 (Outdoor Stationary Food Cart$21 25-99 seats =$280 more than 99 seats =$420 B---E--D--/-B---R--E--A---K--F--A---S--T--/---------------------YE-S---- NO ------------------------------ ------------------------------------------------$100-- ------ CHILDCARE SERVICES ---------------------- MAKE --------------------MAKE (notjust 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 pajd pa' all tate'.axe a red un the law. 01-00460 Signature Date..." y� Social Security or Federal Identification Number Revised 424/07 FOODAP2008 adm Check#&Date /p /c v. Fire &Water- Cleanup & Restoration' Marc LeBlanc 1-800-504-8131 SERVPRO of BurfingtonM/obum X781-939-9960 Fax 781-935-8222 q� 38 High Street,Suite#4 SERVPRO of Stoneham!Wakefield Woburn,MA 01801 781-245-0011 mleblanc@sempm9427.com rd,p,,rdmd,owa,dOpmW i ' CITY OF SALEM` �Y . BOARD OF HEALTH Establishment Name: C_r_ aAAM ws' ( r, ) -o''P/_- v .rL Date: liq -)q Page: / of Item Code C-Critical Item ti DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date No. Reference R-Red Item Verified I PLEASE PRINT CLEARLY l 1 vY ro 0 r i I 1 I ciPr 11 � .,nf i�tvlll� nsPc�x a� 1�nt� t`s—f �It 1 < C1 P c->-c-eX 7X r- k1 t•11)11054rcrC_+11Y-1 c-0A (71QZAVA , ,(l do.hrIc D11 I it's Np,%vVN titP,4\ 4-) o (l em. - I I i I I -��^f-f'C¢n I I I I I � ` I - I I " Discussion With Person in Charge: Corrective Action Required: I ❑ No I ❑ Yes I have read this report, have had the opportunity to ask questions and agree to correct all ❑ Voluntary Compliance ❑ Employee Restriction/ 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 twenty-,ive dollars or<suspenssionlrevocation of ❑ Embargo ❑ Emergency Closure your food permit ��n� � ❑ Voluntary Disposal ❑ Other: i a _ i1i Fo', R, :,t Tmrkr,!wrc, Violariaos;Rotated to Frodborne Ifinsaff Intervernions and Risk A", ding Lay. Cl,-J to Factors(item 1-4) Kort) ti-Fr-«5`F Wqb;if How�� ''1 1 3 jill,!5 C.Ax'Im"Nl('Lhm'�ffir pliFf, V' Fa' PROTECTION FROM CHEMICALS PHF Hot and Coil Holding 14 Food or Colo,Additives E ".(tW pll'vs Mdillf'oil"d ai,•yr b6ow 12 33-302,114 Prrytec.tian Iftifirl I Addilws' It iii�, I i I! Nfami.)oieil rt-it! abovv Poisonous or Toxic Substances R,,isi-.He11 at or iti,,ve 000K 2ij i Time no a Pulufle Hoalth Control 01 .20 i, I svpa"- Olt!Ijj� Reqruo:m:ot 7 2011: lfeni,-to�n- 71-20N.12 cowiltiom,of!)w' RFOUIREMENTS FOR HIGHLY SUSCEPTIBLE Crov"i", POPULATIONS(HSP) 7 �-204,1 Chooif.i&s fw Vk`u,hjU, Pw-j?i'Jiglcd Juices Laki 7-104.14 Drin- i CITY OF SALEM BOARD OF HEALTH Establishment Name: Date: Page: of r Item', Code ,, C-Critical Item DESCRIPTION OF VIOLATION/ PLAN OF CORRECTION Date No. Reference R—Red ItemI Verified PLEASE PRINT CLEARLY 1 nn ^��dT3 n FLa®1 { V�--- C^ `lam V l e-1 , S Com\ Mr`0 V;`J ` I � r I Nit\1 r VC, \ I _ %girl I 1 j Discussion With Person in Charge: Corrective Action Required: ❑ No I ❑ Yes I have read this report, have had the opportunity to ask questions and agree to correct all ❑ Voluntary Compliance ❑ Employee Restriction/ violations before the next inspection, to observe all conditions as described, and to Exclusion P ❑ Re-inspection Scheduled ❑ Emergency Suspension comply with all mandates of the Mass/Federal Food Code. I understand that noncompliance may result in daily fines of twenty=fi/ve dollars/or/Suuspension/revocation of ❑ Embargo ❑ Emergency Closure your food permit. �Jl/7/1L /l ❑ Voluntary Disposal ❑ Other: iia . v. o 'rs% Viciations Rotated to Foodborm.,Illness Intemontions;and Risk widin",tc C,4,i,-A;to Factors(11chns I-V) Irot4.) PROTECTION FROM CHEMICALS PHFs 14 l j Food or Color Additives PHF Hoo and Cold Holding 5w t!if) M PFIF"Mawielfi'd at o: hAvvv 2 :ft V 1-v12.14 Pfowoion frgm Polsonow,or Substances3 I'll-cp 'WF wimInfol Immko - Ot J,miL' 3-50IANA) R,nn,lkid at v! %bvve I APE conla;new 'oT ime as 0 Public liaatit,Control q :ij' IQ I I ubilt '1-0th Cowml' 701,11 t Stpal:won-sl,rape" 701 11 7-202A !rIl I if Al,of PEOUIREPA,ENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) 1.204.!2 ('11,11-icals fol Vywhing Ctiteflal Unp:,meurizt 0.Pre-pak,:izc Uvwcs.ard 7 ':74,14 Cclm'ia locid" If I-;oj ctmm'O,LkIbricallis, .v 10)l " C, "-kj jZkXA 7-206.!1 R�,trif:tckl U;x llv,.rwldes t llteIM' 7,W6.12 R,xk-m I lrc: FXni packjiI4- Not "'Illilorinl! j CONSLIMLS ADVISORY sa T' "I"T IWYI�ory f'wl�j z4 TIMEITEMPERATURE CONTROLS " a*I'ol);(Illlption of Avlk,1�1 Tha[me R l�, 16 3 fill )I A(] Proper CookingTervilmaturss for for Raw ShOl Illam'di'lw S�-E-v, 15�ee I .'•-401.1 t A)k 2) (lalm SPECIAL REOUIREMENTS 40 1.11(Ily I; 2; PwN and li.0 Ro;,m 121 ntii,` i'lieviud NIVA�, 153 F 15 4J Iljon�: o+ S"-,tloll 3'40,00'�ItIV-(D), In sm and I e�woat d Imflen uperi:t;ow; fhould lie ;-1(ii-H(Ayl) Poultr, ,h id 6am-, SiWfed dcFlico� undcr Iiia apprk pri.tt, ;(Alt0lis PoWlty(,I kaiilI,s-'65T 15 arc. ' n lo fffllblfrqt I hnc« L'I"o 13c-f slowk, Ir 'jfjj risk. factor',. Oth^r 1.4;'1• 5QUII(Y) c iet3u,ica::zrla[i :'•:d r"'Iall PIAOK C'< "iloAd 1� 'k-hil0i uncll-r �'19- ka%v Awmal}=,.",l,Cl� -d III I MILtOAa,V 105 f 40! 1 IIA)(l 0) Ah Otho Plff:. - 1-45'F 15 se,: 17 Rehearing for Hit Holding VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 1111 13 f1tenis 23-301 qi'wifm)n-, wi?mh'k.wn e�,vrp;1h, ,403,11 W) (unb,: i-401 i 1!C) G)flcllaWiitil.'Pttnecsed RT`- l`!KXi 140T Rcamijliw�Ln>llccd Pfviom of FC .59O.Wo 2:1 ,t fIno Per,irrn,s! FC -2 003 Proper Cooling of PHF6 # 24 FNd Pmlmion 2, 1 WXW�W no ljlaosjda FC-4 005 i0l 14(A) Cw1m{t 1,14}'Flo FC-5 1 00", lu1, I'virlml 1 1 four;fal(I Frf^a 701, 1 I '2 Fc,-6 W? Eo 4 Hom., 1 i -- pot,mws at �*m-fAltef.acI FC -7 008 -i- -,-501 i4(B) FHE,Nl;,de Fifalk Air, bwllt Tempmourc Ic WT-05, WilmrI4 11,fin0' 1%, r: CITY OF SALEM 11 �(r� BOARD OF HEALTH Establishment Name: C��1(T IAS �lrt��l V 7r1 C-)( 1 it Date: I �6 I��r Page: of j item Code C-Critical Item DESCRIPTION OF.VIOLATION/ PLAN OF CORRECTION Date No. Reference R-Red Item 11 " - Verified n ' PLEASE PRINT CLEARLY n-Drtr) le.( 1 U_(),-v) IrA"�\ner'Ito4 . 1 I �Fc'� c �1vtN1'\G 1 'Z-A t t rxtel GCCc jstiI )I r��t�a ' 1 \ hUt7� cI. I-tswc 'h( 4 r� r CvtQGr and t-,() L,fc Uuh 1)( � Ct/�QCuSd I 1,l)c ��"rte 1rt� �t� Q�Ih Cf.�rh cc? i �tY1a I v (t,rt� I11 or (�,ak� QyrC'� L(A ce.t,h��' th �ktc ks - i I q I I \ hxp aw-Cter �cfi� tta�l�f1 IVtr �1 c1 . . �. cIt\ 3n -1 C1Af-fz_- iKca 1� !`��rrYtC CLv\cl f >if �f C� �tr :3 � 1 h�rliti!!"tP�lt, 1 I YryQ" ° ,� 11t rc1 F 11tet1fk _t r1\i1e .< . L� P� ` CvWIthn-(LV1t t5 kn K e iA7k'v, c\3�,P c� �c \��f l ca I t rP.0 -CRA ��.rig a \�"d c-I P-� vtQ cl a cj-� k�'t �I�tir1 �n�\vc1�rI ice cec�eu� c`xt.lc� -r,� 1 � (crc n 1 9__ t`-it ti cA IA it 0 Q ilz-A i—d _ ', F,+ } i ��.5c c rlcrl e iC11 rUC r1\cx�LQ C-ck (I --�O -e r c-t i \f L. t , fiat - kl Q\ n.no }kC _ ei Pc c c cu l -y�"t eryt (S ��t 4 0 ti Discussion With Person in Charge: 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 violations before the next inspection, to observe all conditions as described, and to Exclusion P Ll Re-inspection Scheduled ❑ Emergency Suspension comply with all mandates of the Mass/Federal Food Code. I understand that% noncompliance may result in daily fines of twenty`five dollars or suspension/revocation of ❑ Embargo ❑ Emergency closure { your food permit. ❑ Voluntary Disposal ❑ Other: '. l Violations RciaW to Pondborni-riftiotfs InWrVentiOrw end Risk to Factors iffterris 1-2k.i (Cont'.} kvidim 1 Roul,, PROTECTION FROM CHEMICALS f7,x,Iin:i�M,7ihod:, f,r 011F Fund or Color Auldnives 19 PHF Hot and Cold Holding (7vid brb'w 4 1-i4t-' f 14 Prowcuon iwialk rkddilivcs' INA) llat PHI f,%Iawl'iee'i�q or aboNe Pulsations or Toxic Submances 140 1-, I0 i A 1 ldf:allf)ing intovm':wni thi"';nw pf'ist:' or"b',vr' 130'F Containers- Time as a Public Hearth Control 7-W2 It f Comktoi,Narrw -N%'„rhi. i „atm..ern"' ic-'alth Coyarrit S�palzifpm "'lolagc- t'Ondiiion''d Uw� REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7 YVAI Toxi,; z::n 7_20J.i I C POPIULATIONS(HSP) '.."jt".?I(,,-I I I 4)pt,,ic,fmt.d Pro-;..c}.Pro-;..c}.Pro-;..c}.aged lfiwe.and 7-204 14 DrNing Avmt�.Cnwrij 1 Bc"Vera'Iet; witf, 7-205.?I Incidental NffX1 JAth11CaW,f' 2t'("1 1 kc-[rick:d 1*s,K�'fit id�" II R,-w or fluvad,,Omi;id -1fmitiril hxj and R;;:' i'tiggiti=. X"t Srrvt-'L 7 206.12 RWmv 8,111 SU[AklaI SUI I ifC) U:wi;iotcd Fkxxi c`aci:ao No Re- f:ncfl 20f� 13 T%Ickmg ilowdvti' f"I'st Ctmt!-1 ar'l Monitol3w, CONSUMCR ADVISORY TIMErrEMPERATURE CONTROLS 1 16 Proper Cooking Tarnpaiatures tor PHx: 't,-fdy?V,Ist. lo 1'limln4fe Slkhs.Iwu- K)3 R:tay Shell ht"gt-linit"Qmu.Sc r•,1"t, I 15T-I Ll cwnwijaw,d FiQl' A"im,tls 155 1"1 PECIAL REOUIREMENTS S. pk'11, 1tod littcl Rtxixt I-)i cit.: k-i S�::Iirfif at)t I in niolql" fotifi, temml'a fl t andv 3-401.1 t(AV-3', Wild(;,vne' Sit)fteri III fPs' Tt'mdt'w,J ',ktlTn "Itould be SI'4filw k [h, o RIows 16�1` I° ii'. iiir'!Itq.d Iti fi,ftd *'n'; iih)cs� HA, 1�30ffrq ("obor I lfut'ct lf"4 ui"f 10'1, 5%J,09 vit"Iza:',11"r6ladn' To':ftod ft�tad ma hnfilkl f,,!dt:NULI :.it #29 Si 10,�fqivir;�mc!lt' 17 j Rehearing ter Hal Holding VIOL A T1 ONS RELATED TO G 0 OD RETAIL PRACTICES 3-If)1,11 f AWf 0`1 Pill- 1(,5"F 15 set', 23,30) 3-41W,f lits,) mif:.owav:- 1()ti'F Nl,vt'-swflin, '.1,0Z-11,tio; 'ftidr'tIo J" 1,wv""fl, :.!h,s.+ imotcw".11;Witt rlltjfct."Irs I;W'Jabol:' c'Jn be fo;mt,4t!ii;' 11 RIT,fiRXi- �o�!;ttw. '1!�hf I'tud C de ci'd He, ("WR 140T go,Of;o' .140 1 10z i I Remljfawg U1111'ej Portion,:"f llevi from 1 Goodiiiira;TPraicGc%eW 7Fj- ii0,060 '�2h_+m''!. mu-1 nol" ton18 Proper Cooling ot PHFS I N, J- 0 --- - andUlo��gl� 1 FC-4 u0n501 WAi 1441�Ft,, 1I,------ -- — ... --- --- -4 I I tl'" Wahm 2 Iftfif'I uvj From 7TV ------ +f- FC-.t= -: hy�'Ctl -3�!itky t - Within 4 Hacme. cgmioi��j�^r Trfx!r kls;tcer:f' 008 it)1.i !4(b) t-ooliifg,NTF,, Madt From 'anhieut Iciriperanne i,,410[7WF i:l th" dm:': 1)'19; "'1, 'r 105(-W 5,11)g('(1 ,t CITY OF SALEM [� / 1 BOARD OF HEALTH I Establishment Name: F�t4 , � k�r ccvlt l)( \ t 1 I Date: Page: of Item Code ' C-Critical nem" DESCRIPTION OF VIOLATION! PLAN OF CORRECTION Date No. Reference R—Red Item - - ' " I i Verified PLEASE PRINT CLEARLY ' i hl svin ft �o fro 1bc&ic6 3-F i 1cx RI'I 4� Ye, -I ri7,ppIrV- i (.k)k P r)� � \� �p��c�, C� ip�rc CTr'� �,�1,•1lF�I �V c�fiP[l �IPc�-rtl�l� rtlr� .cCPhifl�.Pl7. I I Q,'Q,C'�flCy\CkVI [. �lY�� Yk-' c'r-�V1.1IhC C1t11 �'J Ii1�.1nPC 1- �fCf ��l�'Y71�(O,ii� y�r r, P C2 tri t c x�ce T E 4 ( "{`I Vo D-I17+, CY�ld @ f e ( 'h-I c r f 1 b,r { Cr-)^k /V,&- Oce call / ��lr�� -P< i+ c1�( 1�4� vl.tr_.t,�t—L{��P-)p —o4ie�l . JC.{j Y r ) (S C� �St� 5i 1 .Srn /IQ� Ct l�l c� I V C`�)P C ,V? `t i✓7 (`t t,a 1, I -d JI CA Ll 5hS1L2I ft yna,, ' -6ko - ��'Soc�td t I e, Mk wr !) f AYr I �n ,ate ct (lam t�n /�- ��1�2�t r"I- t 1 I I � Ii Discussion With Person in Charge: Corrective Action Required: I ❑ No ❑ Yes I have read this report, have had the opportunity to ask questions and agree to correct all ❑ Voluntary Compliance ❑ Employee Restriction / i 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 thdtl ii air noncompliance may result in daily fines of twenty^/-five cJolla/res/,ornsuspension/revocation of ❑ Embargo ❑ Emergency Closure your food permit. / / ///� ! ❑ Voluntary Disposal ❑ Other: , ;i."i P111-4 Violations Rotated to Foodborne illness Interventions and Risk C oliletlj"i Factors(Ifiems 1-22) (Conti 4 r ritF kVittim '+ Hour>. PROTECTION FROM CHEMICALS -i"Ij5 CAKIIIII-11 M,Lh(xl�for PHF, Food or Calor Additives PHF Hed and Card Hotding T1 j 1I1 4 iW.16tB; Colo Phil':,Mel at or b"'I"kv Addiu%��t�2, 41 3-30114 Prvtection Ittan i Inapprtp,,id Addinws fl;q PH!_� Poisonous,or Toxic Substances 140'F P 1 1 1 Time as a Nblic Health Control Common Name Akorkinp aliz';Ilrlers" I I Cifrll as 4 Pubik He8dlh 1 3 iul tl� _ 7 X)LI1 S�raljtwll- Storage" `°U liwf it) V-'tiftn�e 202 11 Prrt-P4:,, aud U,el 7-2i)2 12 Coadiliol".at 1 TREQUIREMENTS FOR HIGHLY SUSCEPTIBLE wik Cenlaiflcft C P 4.11 Saniuvct,.('riem, -ChelnicttW I I I I , I 7.2( POPULATIONS(HSP) Ch'-'Illu6 fill W:1,hin:i 12 1 iR,',(r,ta�;swith \karnin� 7 ?04 14 Dryllitt Crm-vill" -80 I!Ibl I tl I?4,wwt2,cd Ev" (.%ok;,dAAaTvI1 Vxd atid 06.)2 R'Xit-ill fs:'il Si:IIIoTII,* I mo 1 1 r'Ckmlg P'I1v'1Cz,t Pest Ckintrol Iwo '%lonitlifirl"', CONSUMER ADVISORY TIMElTEMPERATURE CONTROLS 2 11 CkvumtT Poiij Ckjo-liniptilin ot 1 16 Proper Cooking TllIrpavattires fm vlw� Irc )taw- Urkderctx'k�d<:aPHFs Not'Rlitirwe to I liminaLe i-40t I IAtl Al',) Egg- !i„'F 15 `+••cC i'� )�Ieml, kil !-Il� St,h.I,ane for Raw Sliji Z-401A Trulwd Fi>h. & Oung SPECIAL PEQUIRFMENTS Vi,hw,ii of (D) is _J�_.'k end Ilt-J koe.�l I' I twin lileMIIil !'ll0isik. and 3.401.11(A 1!31 'A ijrt Gaio,, Piff:, I:;ic;Icn lipeiati0n �Jwtdd ho Nlem rchlt,d io flilyd'honic 1-401 I i i(7)131 WhO�-mlnVIV, lilract 11t•vf Sical,", arld riqk tiwtke&�' Oft"T rclalin• to w(i,j r0rd! 145"1- 40 1,12 Raw AnITIVII Fut O,('(XACd III I ,ljk)okj)'e dcblind widur #29 N1I0"_,wlIvC 10'F 401A 1 t.At(I)i1t) All Wier PUV: 111i"F 15 17 Reheating for Hrif Holding j VIOLATIONS RELATEO TO GOOD RETAIL PRACTICES Pin,, 15 23-3o) 1f-.5' F Sullefirig rill,(.,I wpt0z'du lial lure, ,,fill 'im bl, 03. J X) Pioe.�,,,d RTY 1,tx d- !h, !")I'd i'orte'00 P0 t"N'R Wmandw, Ut0ivil Pvrtior,+'Il Ni iton, I roic:f wetal:t practices I FC 590,OW . .......... , '__ — i %jan'Itia 71(ill at�d P'Rlsw r ol! FC - om 18 Proper Coning of PHFs 24' 1 F'Y"1'IndFcWvrlx(c!ton K- 3 W4-,- It. I - 3-S01 I I(A) Ctolitig cix'k'A PHF,-. from 141'F lit 2R, "�Iii3q-a 1 FC,-5 i 00b 701, Within "}four::,rill From'it)- 2 F1 FP(Aitj FC-A '007 to.31'k11+'F\Viffnu 4 Hnw.. 1 i i._2H. Pos,no,ill,,r 7tx;4 tAi!&Ie!si FC -11 008 4-- -5';1.1 4i 8) Cooiiun PRF-,k1odc Fi,)m Amrielli 3pe"."!R.s.Ijlfelnfu'l Tvin[viawic It,41'T'145' - ----- - i`vithm 4 Htw CAPT.'S WATERFRONT GRIM. &c CLUK 94 Wharf Street, Salem, Mtn 0070 Tel.-978-741-0555. . Fax-.978-741-8722 t} / FAX COVER SHEET TO: h�J/< '"y`' � DATE: f'ROM: /f !< _%l/�r!OT✓E/ NUMBER OF PAGJ,'S: .` . ,r'( 1 Sw.J/Jl/IfriP/C/��/�Q-UTA'._ ,�4' �✓�///,J�y:�..'��G .(�irRro^' VV'c.^\/J /"///1/�'J�' C6�i/6Cc L.�(//<VI ..S^/�'IL .U��//v'� /.-?',•L/H/'�/�.F�{/�;�...�yt�rl�yn�././�...s ] �//A..�%q r�Ai':f�,l� �,.4a.4K l/ 7- FAX FAX TO,91-SENT-TCL.- tt. 0094 Wharf Street Capt.'s Waterfront Grill & Club i City of Salem FOOD SERVICE ESTABLISHMENT - FOOD SERVICE Inspection HACCP: ❑ Item Status Violation Critical Urgency ;Telephone: PROTECTION FROM CONTAMINATION 978-741-0555 Food Contact Surfaces Cleaning and Sanitizing FAIL Critical RED 40wner: Comment:The sanitizing solution throughout the kitchen found too weak. Sanitizing solution of proper concentration must be The Waterfront Asset Co., In readily available at all work stations at all times. PIC: Owner to notify the Board of Health once sanitizer dispenser has been repaired. I Dirk Isbrandtsen Violations Related to Good Retail Practices (Blue Items) Inspector: Equipment and Utensils FAIL Non-Critical BLUE David Greenbaum Date Inspected:Correct By: Comment:The black bar reach in needs a visible,accurate thermometer. 4/3/2008 Other-See Notes FAIL BLUE !Risk Level: Comment:The upstairs kitchen is not being used at this time. Prior to using this kitchen all equipment must be cleaned and A sanitized,all refrigerators/freezer must have visible,accurate thermometers in them. All hand washing stations must be stocked Permit Number: with soap and disposable paper towels in wall hung dispensers. r BHP-2008-0201 GENERAL COMMENTS: ,Status: All other violations cited in the 3/28/08 inspection report have been corrected. SIGNED OFF 1#of Critical Violations: 1 ;Time IN: Time OUT: i Urgency Description(s): I BLUE: Violations Related to Good i Retail Practices (Critical 'violations must be corrected immediately or within 10 days)(Non-critical violations 6 must be corrected immediately or within 90 days) I City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741-1800 GeOTMS®2008 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Apr 04,2008 ) Page 1 oft riP 4. 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®2008 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Apr 04,2008 ) Page 2 oft r 0094 Wharf Street Capt.'s Waterfront Grill & Club City of Salem FOOD SERVICE ESTABLISHMENT - FOOD SERVICE Inspection HACCP: ❑ Item Status Violation Critical Urgency Telephone; PROTECTION FROM CONTAMINATION 978-741-0555 Food Contact Surfaces Cleaning and Sanitizing FAIL Critical ❑ RED Owner: ,,,, Comment:The sanitizing solution throughout the kitchen found too weak. Sanitizing solution of proper concentration must be The Waterfront Asset Co., In readily available at all work stations at all times. PIC' cutting boards throughout the kithcen are stained and scored. Resurface or replace the cutting boards. Rafael Liberty - ---- --- HandwFacili'es FAIL Critical Inspector. ash WRED David Greenbaum mment:The habd wash sink at the dish machine found obstructed. Keep hand wash sinks clean and accessible at all times. Date Inspected:'Correct By: TIMEITEMPERATURE CONTROLS(Potentially Hazardous Foods) $/25/2008 Hot and Cold H01 g FAIL Critical ❑� RED Risk Level: c merit:The small Beverage air unit had a temperature of 50°F. Repair unit to maintain a temperature of 41'F or below. Permit Number: -BH-P--2-008-0201- Status: HP-2008-0201Status: VIOLATION #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. Apr 02,2008 ) Page I of 4� Item Status Violation Critical Urgency RED: Violations Related to Good Retail Practices (Blue Items) Violations Related to Food and Fo Protection FAIL Critical BLUE Foodborne Illness Interventions and Risk Factors (Require Comment: Relable the flour bin"Flour" immediate Corrective action) Equipment asils FAIL Non-Critical BLUE m t:The Beverage air unit needs a thorough cleaning. e fr True reach in needs a general cleaing. e sm Beverage air rach in needs a thorough cleaning. �T�hehtes Conti tal freezer has an accumulation of food debris. Thoroughly clean this freezer. behind the service line need general cleaning. T can ner needs a thorough scouring. Z�Tles, each in needs a general cleaning. reach in needs a general cleaning. ice earn freezer needs a thorough cleaning and defrosting. T microwave in the dessert station has an accumulation of food spills and splatter. Thoroughly clean the microwave. T griddle in the dessert station needs a thorough cleaning. able he rinse bay of the 3 bay sink. T wire racks in the walk in have an accumulation of food debris and grime. Thoroughly clean all wire racks. T fan gaurds in the walk in have an accumulation of dust. Thoroughly clean the fan gaurds. walk in needs a visible,accurate thermometer. L, a black bar reach in needs a general cleaning. The a unit needs a visible,accurate thermometer. e mens room needs a sign stating"Employees Must Wash Hands Prior to Returning to Work" Physical Facility FAIL Non-Critical BLUE Co menta There is a gap at the bottom of the back door. Provide a sweep on this door. Other- e Notes FAIL BLUE Comment:The upstairs kitchen is not being used at this time. Prior to using this kitchen all equipment must be cleaned and sanitized,all refrigeratorsifreezer must have visible,accurate thermometers in them. All hand washing stations must be stocked with soap and disposable paper towels in wall hung dispensers. 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. Apr 02,2008 ) Page 2 of J Item Status Violation Critical Urgency GENERAL COMMENTS: Reinspection in one week, all violations to be corrected. City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741-1800 GeoTMS®2008 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Apr 02,2008 ) Page 3 of Commonwealth of Massachusetts 4 s � City of Salem Board of Health 120 Washington Street,4th Floor IGmberiey Driscoll Mayor SALEM,MA 01970 Foo"etail Establishment Permit DATE PRINTED: 01/07/2008 ESTABLISHMENT NAME: Capt.'s Waterfront Grill& Club File Number:BHF-2004-000093 94 Wharf Street Salem MA 01970 LOCATED AT: 0094 WHARF STREET SALEM, MA 01970 Permit Type Permit No. Permit Issued Permit Expires Fee Restrictions/Notes FOOD SERVICE BHP-2008-0201 Jan 4,2008 Dec 31,2008 $420.00 ESTABLISHMENT Total Fees: $420.00 PERMIT EXPIRES (December 31, 2008 Board of Health Xv �1 V This Permit is not transferable and must be reissued upon change of ownership or location.The permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code,beofre any revonations,improvements,or equipment changes are made,all plans for such must be submitted to and approved by the Salem Board of Health. Page 5 of 24 a� Vit, CITY OF SALEM, MASSACFIUSEM 3�I� y � BOARD OF HEALTH q Btiu+ 120 WASHINGTON STREET,4h'FLOOR TEL.(978) 741-1800 RECEIVE® KIMBERLEY DRISCOLL FAx 978 745-0343 MAYOR ISCOTWO SALEM.COM DEC 7— 2007 JOANNE SOOTT, HEALTH AGENT CITY OF SALEM BOARD OF HEALTH 2008 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT NAME OF ESTABLISHMENT C17,0T.✓t 1(IA-reeFR01\rI 6AIkL 4-CLUB TEL# 97r?L7V o,a_-' ADDRESS OF ESTABLISHMENT 7�1 1,,W ,*r 5)- SAIA11•P!A 01970 FAX# MAILING ADDRESS (if different) EMAIL-Business': aP�<(V ca&-Com Website: W vjw• Cf)r�-T.CO/%J OWNER'S NAME -P/AK 1✓"BR4PID7Sr-W TEL# 7V-Ev'(7.5-✓V ADDRESS // 6VEA67_1 PAIar P!-UD el &P 1,41) OM, — STREET CITY STATE ZIP ?.`/{lcNlfr_"LSld4ClupM` - i(C3ocxt3(7592 CERTIFIED FOOD MANAGER'S NAME(S) AAANAFi 1./027U CERTIFICATE#(S) SSZXios- (Required in an establishment where potentially hazardous food is prepared) %, MtcNAEi- Suti/IrAN C -591-o;,yy _ EMERGENCY RESPONSE PERSON _Vml< �arAI07 t N HOME TEL# C-E/7-680-7SS/N F ��s3* DAYS OF OPERATION Monday Tuesday Wednesday Thursday Friday Saturday Sunday HOURS OF OPERATION Please write in bme of day (For example 11 am-t tom) TYPE OF ESTABLISHMENT FEE (check onlvJ RETAIL STORE YES NO less than 1000sq.ft. =$70 1000-10,000sq.ft. =$280 more than 10,000sq.ft. =$420 '-----'-'-------'- -------- '-'- RESTAURANTES NO less than 25 seats =$140 (Outdoor Stationary Food Cart$210) 25-99 seats =$280 more than 99 seats =$420 - ------------------------------------------------ ----------------------------- BED/BREAKFAST/ YES NO $100 CHILDCARESERVICES -------- ------------------- .....-------------------------....----------------------------------------. 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 al�p paid all state taxes required nder the law. Ah I - /07 Signature Date Social Security or Federal Identification Number Revised 4/24/07 FOODAP2008.adm Check#&Date V la./([ 1, $ Massachusetts Department of Public Health Salem Board of Health Division of Food and Drugs 120 Washington Street,4'h Floor 9 Salem, MA 01970-3523 FOOD ESTABLISHMENT INSPECTION REPORT Tel. (978) 741-1800 Fax (978) 745-0343 Name /� / / / / Date, Type of Operations s) Tvpe of Insoection Lc s�/t �t/Gf G✓P/rJ �T 167 E 1. &od Service ❑ Routine Addressq � )/7�✓� �� Risk El Retail E]-RB=inspection Level ❑ Residential Kitchen Previous Inspection Telephone 'Nl_ OSS ❑ Mobile Date: Owner � r�{ /5 HACCP YM El Temporary ElPre-operation I rGn vL ❑ Caterer ❑ Suspect Illness Person in Charge(PIC) o +� d I S P� Time El Bed&Breakfast E] General Complaint In: ❑ HACCP Inspector T mr �» 1 qr�J 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' ❑ 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 ❑ 14.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 - E] 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 CONSUMER ADVISORY , ❑22. Posting of Consumer Advisories Violations Related to Good Retail Practices Number of Violated Provisions Related Critical (C) violations marked must be corrected To Foodborne Illnesses Interventions immediately or within 10 days as determined by the Board and Risk Factors(Items 1-22): of Health. Non-critical (N) violations must be corrected Official Order for Correction: Based on an inspection immediately or within 90 days as determined by the Board today, the items checked indicate violations of 105 CMR of Health. 590.000/federal Food Code. This report, when signed below C N by a Board of Health member or its agent constitutes an 23. Management and Personnel (Fc-2) order of the Board of Health. Failure to correct violations 24. Food and Food Protection (FC-3)(5550.090.0 054))) cited in this report may result in suspension or revocation of 25. Equipment and Utensils (Fc-5)(550.005) 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,00e) 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 5901nspecYPorm6-14 tlx Inspector's Signature:�,i}/ // Print: PIC'sSignature: ` Print: ny,e.il ,(� O, Page_of �ges Violations Related to Foodborne Illness Interventions and Risk Factors(items 1-22) PROTECTION FROM CONTAMINATION FOOD PROTECTION MANAGEMENT ( 8 ( Cross-contamination { 1 596.003(A) Assignment of Responsibility' I 3-302.11(A)(1) Raw Animal Foods Separated from 590.003(B) Demonstration of Knowledge" I I Cooked and RTE Foods* 2-103.11 Person in charge --duties { ( Contamination from Raw ingredients 3-302.11(A)(2) Raw Aniunil 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 food employees and 3-302.11(A) Food PmtectionA applicants* { 3-302.15 Washint Fruits and Vegetables 590.003(F) Responsibility Of A Food Employee Or An 13-304.1 1 Food Contact with Equipment and Applicant To Report To The Person In Utensils* Charge* I Contamination from the Consumer { { 590.003(C) Reporting by Person in Charge* I 3-306.I A(A)(B) Returned Food and Rcservice of Food* 3I590.003(D) Exclusions andRcstrictions* { I Disposition of Adulterated or Contaminated 590.003(E) Removal of Exclusions and Restrictions Food J 13-701.11 Discarding or Reconditioning Unsafe f FOOD FROM APPROVED SOURCE Fax!* J 4 Foodand Water From Regulated Sources { i 9 Food Contact Surfaces f 590.004(A-B) Compliance with Food Law* ( 1-501.111 Manual�tiuewashing-Hot Water 13-201.12 Foal in a Hermetically Scaled Container* ( Sanitization Temperatures* 3-201.13 Fluid Milk and Milk Products-* ( 4-501.112 Mechanical Warewashing-Hot Water { 3-202.13 ( Shell Eggs* { i Sanitization Temperatures* { 3-2(}2.14 { Eggs and Milk Products.Pasteurized* I 14-501.11} Chemical Sanitization-temp.,PH, concentration and hardness. * J 13-202.16 ( Ire Made From Potable Drinking Water- ( 14-601.11(A) Equipment Food Contact Surfaces and 5-101.I 1 Drinking Water from an Approved Svstern` J Utensils Clean* 590.006(A) I Bottled Drinking Water* 1590.006(B) ( Water Meets Standards in 310 C,MR 22.0* 14-601..11 Cleaning Frequency of Equipment Fond- { Shellfish and Fish Froman Approved Source Contact Surfaces and Utensils* 4-702.i I Frequency of Sanitization of Utensils and 3-201.14 Fish and Recreationally Caught Molluscan food Contact Surfaces of Equipment* Shellfish" 4-703 11 I Methods of Sanitization-Hot Water and 3-201.15 I Molluscan Shellfish from NSSP Listed Chemical" Sources* 10 { Proper,Adequate Handwashing Game and Wild Mushrooms Approved by 1 l Cl 301 12- . ean Condition-Hands and Arens* Regulatory Authority I _ { 13-202.18 Sheltstock Identification Present" { 2-301.12 Cleaning Procedure* 590.004(0) Wild Mushrooms* ( 2-301.4 When to Wash* 3-201.17 Came Animals* I I it ( Good Hygienic Practices { 5 Receiving/Condition ( 2401-11 Eating,Drinking or Using Tobsu co* 13-202.11 PIfFs Received at Proper Tentperaiures* � '401 12 Discharges From the Eyes,Nose and y 3-202.15 Package Integrity* Mouth' 3-101.11 Food Safe and Unadulterated* I 3-301.12 Preventing Contamination When Tasting" { 6 Tags/Records:Shelistock { { 12 Prevention of Contamination from Hands 3-202.18 Shellstock Identification* I 590.004(E) Preventing Contamination from I 3-203.12 Shellstock Identification Maintained" Employees* l Iii { Tags/Records:Fish Products { 13 Handwash Facilities 4-402.11 _ Parasite Destruction''` I Conveniently Located and Accessible � 3-402.12 Records,Creation and Retention" { 5-203.11 { Numbers and Capacities* { 590.0040) Labeling of Ingredients' I 5-204.11 I Location and Placement* _ { 7 Conformance with Approved Procedures ( 15-205.11 ( Accessibility, Operation and Maintenance { /HACCP Plans I Supplied with Soap and Hand Drying 3-502.11 Specialized Processing Methods* ( Devices 3-502.12 Reduced oxygen packaging.criteria* { 16-31)1.11 Handwashing Cleanser,Availability { 8-103.t26-301,with Approved Procedures' { ( 6-301.1.2 Hund Drying Provision { 'Denotes critical item in the federal 1999 Food Cate of 105 CMR 590,000. I i CITY OF SALEM � BOARD OF HEALTH Establishment Name: / Q�� n�e � v�✓ori� Date: -717_3 ln--7 Page: of � nem „ Code . C-Critical Item, - DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date k No.,, Reference R-Red Item Verified i I PLEASE PRINT CLEARLY 1 s `t, I I I k I I 1 Discussion With Person in Charge: Corrective Action Required: I ❑ No ❑ Yes have read this report, have had the opportunity to ask questions and agree to correct all ❑ Voluntary Compliance ❑ Employee Restriction Exclusion y 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 twe �-fivedollars or suspension/revocation of ❑ Embargo ❑ Emergency Closure your food permit. �`L� �C,O _ ❑ Voluntary Disposal ❑ Other: V -- - WC) PIN, Tanpetatures WoWions Related to Foodborne Illness InterventIons and Risk E A(xo)lding to Lza ClX4,'d to Factors f1forns 1-22) {Cont) 41 F;45`F bit�thin 15 M-Lhed,Tor PF(Fs PROTEC'nON FROM CHEMICALS PHF Hot and Wd Holding 14 d or Color Addit;vas 19 PI!Fl,,v1vmr:irwd at or heJVW 4-2,02,12 3-102,14 Prk;irctmn from Unapproacd AjJdme<* Poisonous or Toxic Substances lol PHI-',,,, kfaintpined;q u,. above 14WF or,.Nwc 13it'1, i 20 1 ime as i Public Heafth Control 7-;102,11 ommon Nartt, - Vvork;ng Coioa,n�r, 1 5010 a�a Public Health Control, I sopw-,uon 5iflljag��` uld U>w cojkdiflkxn,ot tjw° REOUIREMENTS FOR HIGHLY SUSCEPT18LE !0,',,11 Toxic Colltairl.fz.-Prollibillon, POPULATIONS(HSP) 1 7 104.11 sAnit;/trs,Cnwrili, ---I 2 Ownucitt,foi nd Ulkmmeu /� wit lf)4 w Drying Crimia- \VarllinK I 209,i t I'v"idt-mol Fax!Cvvla�'I, I I rii) U�of P,l,je,,jtj 7ej j�,el-,j 206,11 Roc :rvjrj Cl,e Critem" I 10), Cia)#ed Avimal FAKid and R,kv. sv-,�,j:;irrout, N�t stryed. 17-20(4.12 Rlxhew Boo Skaton", 7 *206 1 T;ackmg 11,,�E Corltrd awt -l4l I )#r("' 1,,xxi Not tic-s:ne,j CONSUMER ADVISORY I Covuwer Ae�iwry it TIMErrEMPERATURE CONTROLS ."oliwil I tN+'Plat.lm IZ;;",, Ulldeluxlkcdl 16 Proper Cooking Temperallui ts for PHFs \',,llinowat. 3 VA I lAf i ;5'F 15 S,:_% wil Rllw She',( 4(�1.11(A)i,2 1 Gmllljlklted F„h, Meaz';e-ciallic Put Is and jl,^oi klm'.t i 30'F i 21 min SPEC!AL REOUIREMENTS .4f)1.11(A)Q,� Ratite,, liar ocd Nlvai�� 155, F I" 0; soction In ttyod- lentporavv laid 3 4411,11(A)0) POUIM,Wiid STO(ted IIHF�, be st'llbi'la Coa!-.tltlmt;Fish. klmr widei tit. appruprjate sc.twws P�ultry or kootcs-i t,5`P I5,;ec. it 4(')I.1 11 C)i I Wh-le-n),wdc. Inifici P,,f Sieji.S 1111c]vvimojl�wot risk factors. Olthff 1451; 5Q(l 00r, A 401.12 R:iw ;maul I o k1%C,*.,hod its i pracflcrs ,(mold Iv dubitLd wider 929 - Microwave 165P` .401 0(Al(!0)j A1100xi NIFS- ) slz 15 se,. 17 Fleftafing for Hot Holding VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 3-K13.114 A)&ti)) rl-lh: I(,.,s"r I•�e0(, - (Items 23-30) 3-1G3.11(t3) "Microv,4tc, 16i+, ,,2 Millow"ilandillg flo l;ft;rebate rn the 3-403.i I t(7) in (j ih bood f(ldc and 105 CmR .; f , . � t IE, l K:,a�0 23 1 -2 i 00° 24 18 Proper Cooling of PHFs , F:�Jarn Fow Pmlect,,,n FC J Ctt'4 24D alld Ule!:09 FC 3-5'01,1-,(A l Cixilialz C(xk�,d PHI-s frow I ?b" "d altar.Pit-mbmil arld Wa,;% FC-5 00E, withm 2 IP,llr<nJld Froin 7 FC-6 00/ "mc l3('; t FC -7 00P. ,i-50L 00i) illuig,PFIR Nlid, Fwm Ambient i t 2' 1 �Po�,o- Ternperawr� hij,,redimt,t(•,:1.1`745 p Within 4 11,mir, Massachusetts Department of Public Health Salem Board of Health Division of Food and Drugs 120 Washington Street,4'"Floor 9 Salem, MA 01970-3523 FOOD ESTABLISHMENT INSPECTION REPORT Tel. (978) 741-1800 Fax (978) 745-0343 Name ^ Date Type of ODeration(s), Type of Insoection %-i o�S GI�Q K!/ J✓�T 7�/S 107 E Food Service 3-Routine Address '/c� �� 5�, Risk t El Retail [:] Re-inspection Level ❑ Residential Kitchen Previous Inspection Telephone7/-// _ �� [IMobile Date: Owner J HACCP YM ❑ Temporary ElPre-operation �JI_11"7 lI Yl ❑ Caterer ❑ Suspect Illness Person in Charge(PIC) Time El Bed&Breakfast El General Complaint a ( Q ISS v In: ❑ HACCP Inspector 1 tyJ C--7 ff-77t,4,.J I 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, El12. 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 ❑ 14.Approved Food or Color Additives ❑ 3. Personnel with Infections Restricted/Excluded : . _ , , ❑ 15.Toxic Chemicals FOOD FROM APPROVED SOURCE = TIMEREMPERATURE CONTROLS(Potentially Hazardous Foods ❑ 4. Food and Water from Approved Source ( y ) ❑ 5. Receiving/Condition ❑ 16. Cooking Temperatures ❑ 6. Tags/Records/Accuracy of Ingredient Statements ❑ 17. Reheating ❑ 7. Conformance with Approved Procedures/HACCP Plans ❑ 18. Cooling PROT-,ECTION FROM CONTAMINATION � ❑ 19. Hot and Cold Holding D 8. Separation/Segregation/Protection ❑ 20.Time As a Public Health Control K 9. Food Contact Surfaces Cleaning and Sanitizing REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) / 0 21. Food and Food Preparation for HSP 0 10. Proper Adequate Handwashing ❑ 11. Good Hygienic Practices CONSUMER ADVISORY ❑22. Posting of Consumer Advisories Violations Related to Good Retail Practices Number of Violated Provisions Related Critical (C) violations marked must be corrected To Foodborne Illnesses Interventions immediately or within 10 days as determined by the Board and Risk Factors(Items 1-22): of Health. Non-critical (N) violations must be corrected Official Order for Correction: Based on an inspection immediately or within 90 days as determined by the Board today, the items checked indicate violations of 105 CMR of Health. 590.000/federal Food Code. This report, when signed below C N by a Board of Health member or its agent constitutes an 23. Management and Personnel (FC-2)(590,003) by 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)(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 590Me IFOm 14 Uw �1 /t/� Inspector's Signature(�� X Print: J e,a?3 C� �/ PIC's Signature: / .1(! Print: �t�� =w ` Page of TPages ,j J Violations Related to Foodborne Illness Interventions and Risk Factors(Hems 1-22) PROTECTION FROM CONTAMINATION FOOD PROTECTION MANAGEMENT ( 8 I Cross-contamination . i I 590.003(A) ( Assignment of Responsibility* I 3-302.11(,A)(]) Raw Animal Foods Separated from 590.003(B) I Demonstration of Knowledge* ( Cooked and RTE Foods* 2-103.11 Person in charge --duties I ( Contamination from Raw Ingredients 3-302.11(A)(2) Raw Animal Foods Separated from Each EMPLOYEE HEALTH I I Other* 2 59(f003(C) Responsibility of the person in charge to I Contamination from the Environment -- - --- . . ....,..---J require reporting by to employees and 13-302.11(A) Food Protection* applicants* 13-302.15 Washing Fruits and Vegetables J 590.003(1`) Responsibility Of A Food Employee Or An ( 3-304.11 Food Contact with Equipment and Applicant To Report To The Person In Utensils* Charge" I I Contamination from the Consumer 590.003(133) Reporting by Person in Charge* ( 13-306.14(A)(B) I Returned Food and Reservice of Food' J 3 590.003(D) Exclusions and Restrictions* I Disposition of Adulterated or Contaminated 590.003(E) I Removal of Exclusions and Restrictions ( I Food - 3-701 11 Discarding or Reconditioning Unsafe FOOD FROM APPROVED SOURCE Food' J 1 4 1 Food and Water From Regulated Sources I 19 Food Contact Surfaces J 590.004(A-B) Compliance with Food Law* ( 4-501.111 Manual Warewashing-Hot Water 13-201.12 Food in a Hermetically Scaled Contained* Sanitization Temperatures* 1 4-501.112 Mechanical Warewashin Hot Water 3-20 L 13 Fluid Milk and Milk Products* I g- J 3-202.13 Shell Eggs* Sanitization Temperatures* 3-202.14 Eggs and Milk Products.Pasteurized* I 14-501.114 I Chemical Sanitization-temp.,pH, 13-202.16 Ice Made From Potable Drinking Water* I concentration and hardness. * __ 5-101.11 Drinking Water from an Approved System- I 14-601.1 I(A) Equipment Food Contact Surfaces and 590.006(A) Bottled Drinking Water* I Utensils Clean* l 590.(H)6(B) Water Meets Standards in 310 CMR 22.0* I 4-602.11 Cleaning Frequency of Equipment Food- Contact Surfaces and Utensils* J Shellfish and Fish From an Approved Source ( 4-702.11 Frequency of Sanitization of Utensils and Shellfish* 3-201.14 Fish and Recreationally Caught Molluscan I Fail Contact Surfaces of Equipment*3-201.15 Molluscan Shellfish from NSSY Listed 14-703.11 Methods of Sanitization-Hot Water and I Chemicals` Sources* I lg Proper,Adequate Handwashing Game and Wild Mushrooms Approved by 2-30111 ( Clean Condition-Hands and Arms* Regulatory Authority I -_ 3-202.13 Shellstock Identification Present* ( 2-301.12 Cleaning Procedure* J J 590.004(0) Wild Mushrooms, I 2-301.14 When to Wash* J 3-201.17 I Game Animals* I 111 Good Hygienic Practices - 5 ( Receiving/Condition I 2-401.11 Eating,Drinking or Using Tobacco* 3-202.11 I PITFs Received at Proper Temperatures* I 2-401.12 Discharges From the Eyes, Nose and 3-202.15 ( Package Integrity- I Mouth* 3-101.11 ( Food Safe and Unadulterated* 13-301.12 Preventing Contamination When Tasting* 6 Togs/Records:Shellstock I 112 Prevention of Contamination from Hands J 3-202.18 Shellstock Identification* I 590.004(E) Preventing Contamination from 13-203.12 Shellstock Identification Maintained* I Employees* Tags/Records: Fish Products ( 113 I Handwash Facilities J 3402.11 Parasite Destruction* I I Conveniently Located and Accessible 1 13-402.12 Records.Creation and Retention* I 15-203.11 Numbers and Capacities* 590.004(J) ( Labeling of Ingredients* I 15-204.11 Location and Placement* 7 I Conformance with Approved Procedures 15-205.11 Accessibility. Operation and Maintenance /HACCP Plans I I Supplied with Soap and Hand Drying Devices 3-502.11 Specialized Processing Methods* 3-502.12 Reduced oxygen packaging,criteria* 16-301.11 Handwashing Cleanser, Availability 18-103.12 I Conformance with Approved Procedures" 16-3(17.12 Hand Drying Provision 'Denotes critical item in the federal 1999 Fond Code of 105 CMR 590,000. CITY OF SALEM / // BOARD OF HEALTH ,l ' Establishment Name: �Gj015' �h f CY�Vav>f Date: -7116 16 -7 Page: of S Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date ! No. Reference R–Red Item Verified C PLEASE PRINT CLEARLY 1 z� l��ve/2 . � - Ir✓/i� V"aVrre'C OrPr/GYa / � �,A'L�.r a �ln�,,vc�C <�eine/.� %n!�/ .S�/�Y1D.�. �DCr✓rF/Ge O� V�P�aP,� -'r / -- r rjl r cr,-, / 1AAgV'11f?v YCG1r/ireS GJ /t�/tliG� CIOI r�inC �� Z� � �N� l�,-tDv< tiiDrave i�t�Yav� Z� ��UdiinR v ZS� ! /,C l�/✓+O /�� Yl lJr/, l/,C S� �C')1F0„C L� C !/. N/� ZS" OVp.v. Irf (3( )kV� C) ✓Ov�� l �cG ✓tI ✓� . 2� /t CV'\A vnri _l4\.,e rOnrJtVeS cjPhO_Ir� e-Lenoth�- d -2 " _5n <t�.0 t)✓1 I� Vl(f,U i V'9 S 4� P_r- of_vra ( !'-f 1 G G v) I ✓� - *: I Z � v �AN'tD I_I✓It`1" l/V1fSSIr1S `%ISl��1— ilv✓,PJ✓Yl0– f. ` I�rv� C�e s I _vI s_) ii of a r L-u u u� ,v c GVV 5�.,') le c' -t'Yc I �a�lvnj I G vI Oaf dC lu c_e_ b oche( . 1 �zeV- we C.6 04 des�rr� S �oY` . S� �1-i Z,*-, r j �e ftae�tn� a� 2cX� ? lis vl�Grtic�G • 9 C a SII ce v Vitas, ctcr.ovk,,lol o-,-. o-V� �,j catbr,s . 1 --'( In norm Ixl, ,�f / ( .9 n,v Ctln d Z-e G c-C. tJ I _ Discussion With Person in Charge: Corrective Action Required: I ❑ No I ❑ Yes t 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 toExclusion ❑ Re-inspection Scheduled C] Emergency Suspension comply with all mandates of the Mass/Federal Food Code. I understand that 4 noncompliance may result in daily fines of twe ty ive dollars or suspension/revocationof ❑ Embargo ❑ Emergency Closure your food permit. (��A[Otli' ❑ Voluntary Disposal ❑ Other: J 3-5.%'.'4(L') PHFs R�cen•eri nt'1't mperaturas Violations Related to Foodborne Illness Intervention and Risk %ccordi ng in Law Cunled ki Factors(items 1-22) (Cont.) 4,'F14}'F\vrti:in 4 Hours. PROTECTION FROM CHEMICALS C:oLns:vT.0:ada for['HFs i 14 Food or Calor Additives ' j 14 PHF Hot and Cold Heading j Cold PHF: Rlaintaino7 at of below 3-202.12 Additive.' 590.004(F') r, ;;02.14 Protection from xic Substances A(tdinvesF j ;-S01.16f A) Hie PHF: Mamia:ned at or above 15 Poisonous or Toxic Substances ! i,ft ,F A 7-101.11 klentlfying !.ntum:.mon-Original I Containers` 7.501.10(1] Ru::,ts Held at of above l;)°F. ' 1 ( 2P Time as a Pabuc Health Control 7-103.7 i Counnna Nsme-tt'orkin;;Containers' ?-20!.;1 Separation-Sto:ztg•e" 3-S0I.Irt Tme as-'.PebLc Hea.lih Carmol* 7-^_U2 11 Rc.;trictiun-Presence mid lase` 1 ti90004�,1-,) VnrianceReuniremew. 7-202,12 Conditions o! [ see j 7 2w? I1 Toxic Contain:r.-Pr.:bihili:misx, REQUIREMENTS FOR HIGHLY SUSCEPTIBLE j POPULATIONS 'HSP) 7-21)4.11 Samtirer;,Criteria-Chemicals" t. _ ! mc t> I ''I 3 ':01 l ItAi 1-"np<tste•unzed Pre-packaged Juices and 7-2(1t.12 Chemicals for W4shrudoce,Criteria"' ; iBove:aces wd th Rare.:ne Tabels": i 7-'104. -} Dryinn A^eats.Criteria, I ) ! j 1 3-90'..!t(T51 Ute:)t Pasteurized F,^ �'• 1 05.1 t ncident:ii Fu�r1 t:'ontacL,Lubricant s- - :;-SOI 11(D) Raw or Pmtiall"Cooked Aa:mrd! F;Kul and 7-206 I I ke;arictcd lire Pesmaths,Criteria' I !few Seed Sprouts Nvt Served, 72)6.1% Rodent Ban St.a:ons" 13_g:,)L11(C; l)mdpened Pcxxi Fa;.l:agr Not Re-served. " f 1 7-"06.13 Tracking Pomlors.P-st Control and Moniutring^ CONSUMER ADVISORY TIMEITEMPERATURE CONTROLS 22 3-603.1 •. Consumer Adlsory Postal fur Consu:np6or,010 16 Proper Cooking Temperatures for ( Animal Fads That an: Raw,Fln:icrcawked or PHFs Noi Othcrrr.ise Processed to E-!nnimue 3401.11A(1)(2) Eggs- 155`F 15 Sec. Eges-!mmediatc Sertice 145'1715secv j t-3U..li P::steunzed Reg,;Substitute fol Raw Shell 3-401.1l1AU(2) Comtmnuied Fish, Nlilat:&G,.n:e Aitinct(s- 15Jir'F 15 sec. j 3-4UI.I I(B)l1)(2) Pork and Beef Roa<t -- i!0'F 121 uen* SPECIAL REQUIREMENTS 3-401.11(A)(21 Ratites, Injected Mcats- 155'615 590.009(.1)-(D) Violations of Section 590.009(A)-(F)) io sec. catering. mobile foci,),teniporary and 3-401.11(A)r3) Poultry, RildGnnta,Smt?cd PI-IFs, residential kiteh.n operations should be Stuffing Containing Fish,Meat, debited under the appropriate Sections Poultry or Rat:tcs-165 F 15 sec. * nbove :t related to foodborne iilnese 1 .3 W1.11(C)(3) Whore muscle,Loa-a BedS!eaks interventions and risk fae?ors. 01,her f45-F 590.009 violations relating b;good retail 3401.12 Raw Animal Foods Casket)in a pracuccs should be debited under tt 29- Mi<aowavelb.5'F" i Special Requirements 3-401 11(A)(1)(h) A11 0thcr Pt-IFz-- 145"F l5 sec ' 17 Reheating for Hot Holding VIOLATIONS RELArEO TO GOOD RETAIL PRACTICES 3-=n3.1I(AWD) PHFs 165'17 15 sec. ' ftietrts 23-30) 3-4113.1 I(B) Microwave- 165°F2 Minute Stnridin, Gitint7 and non-r,ritivid vi"?''1:otm trbich do nor�elaw to the I Tann:^' luodbnrne diners internen tonand iisk!n(tors tisted above, can be j 3-40111(C) Commercially Proccssed RTE Food- I (rund ir+thc,rellm,lag sections o0he F,„d Godc and 1,05 C AIR ` 140"F" 500.0110. 3-403.11(F) Remaining lhrshaed Purtiunc of Beef ' l Item Good Retail Practices 1 FC 590.690"--] Rua sir': 23. Ivlana0ement ar:d Persom-el j FC--_ :JO.= J8 ( Proper Cooling of PHFs 24 Fotra and r ocd Protection ! FC-3 OC4 J j ( 5(11.14(A) _uuiatg Cooked i HFs from 140'F b+ 25, Eruipmcnt and utensils FC-4 W5 -; 2(i. ( 4N ater,PL:n:binq and Waste PC- 5 .U06 70`6\4iihm 21Iuurs and From %0'17 ?, P_hy_a)cal Faal_!ty FG--6 007 to 4!'F/45°F Wido n 4 Hour. * ; 28 Poisonous of Toxic 141a!etia!s FC-7 .00.3 _J 3_501f4(B) C+wling PlIFs Made Nrnm Ain[»eat 29. apecia!Feouirements IpUg l Temperi otre Ingredients to 41"Ffl i'F j 30. I Other j Within Hours� *Denotes cnucdl item m the lidera) I^UV!ood Code or 105 C"LE 3'A0 000 CITY OF SALEM / f BOARD OF HEALTH ! i Establishment Name: �` �L C ��/ Date: -7 / /F f//a -7 Page: 3 of 7 Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLXN OF'CORRECTION Date No. Reference R-Red Item Verified PLEASE PRINT CLEARLY Z >" �' Sctiotvcc vJev\ea((� rv�eG s1,cz ✓ fCCx%j Zv-2Lr"s 1 G V, t 6-% -I 1 z \� TOC�lJrO ! /Jof(lk-Ivy IDdJj walls Cttr,U CP-rllhS �cr�ltre �--Ina VC_� (' l2 CA 01 nC- f , z to(� s (a✓P�� vt(C>✓ vJfr - VV/ o(D 6 Lw �tJnr 50 tf f �V\ (3 i r �`'✓ ?e V<e Yl 4/✓'t✓lL 0-17 (Oc_ C1117)v e.Fj 1 ✓1 k[-e a� L'_)aA - t4'ki0 � G- 7-r ✓_< - a.l U✓-' `� F I 2- r / 2` (Jnr�C r s K I� enc ' Cir �,\aS n � Sao "J �Fo❑ ,c� soe- ? vii lc/ I/� n l� �rrr �/_ 1_(P-1^( r�LVG�-1'7(CZ� � i✓I I (S �P(JU1 v2 t 1/t0`(oJ U(^ ' I I ,.�\ n 1II '�[ I Z�'� �C(�✓rS �S.I' �. M�l�i'irs�Q.�F7l1 i_ �r= 12 1 cam- ci f /V' 6'Y2A c L L.�-�)N6 I V cs/ rte- L Ls �✓�,a2r�n ovh L 7�n . � 5za✓It7� ulsif3�c— ,�� Acs-c>�21r�� /-tr,�<uorur��drZ_ 1 F Discussion With Person in Charge: I Corrective Action Required: I ❑ No I ❑ fes # 1 have read this report, have had the opportunity to ask questions and agree to correct all ❑ Voluntary Compliance ❑ Employee Restriction/ F violations before the next inspection, to observe all conditions as described, and to Exclusion F 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 twent -five dollar orsus vocation of LIEmbargo ❑ Emergency Closure your food permit. ❑ Voluntary Disposal ❑ Other: PHl s Receive,!et Te::per•nures Violations Related to Foodborne Illness Interventions and R;.S;( accordius :L1 U w Q,,,led to Factors(items 1.22) (Cont.) =I`Fi?5"F 1,4'ithin 4 Hours. " j PROTECTION FROM CHEMICALS ?-`u I.IJ Cooling Methods :or PI-IFs j 1: PHF Hot and Cold Holding x202.12 Additives x j 13 Food Color Additives i ;.5(;1.16(1x) Cold Pt 1F, Mai ntaino:.! at tit below Additive,* 590.00a! ' CITY OF SALEM BOARD OF HEALTH / I Establishment Name: C g P �� W, Date: 7 Page: L of J ` Item Code C-Critical Item ' Date DESCRIPTION OF VIOLATION/PLAN OF CORRECTION No. Reference R-Red Item Verified IPLEASE PRINT CLEARLY � `7 /'�z Ftz lJ✓ �cJ pe Ov 11-2 2x-- oLI— /J/Nc, 2� C r1jr) 2csOcj17_X/a72orC, // LLC ,JC, z /� IZ�/ o z A a ri s IV_eco u 1 R r �(- o)2o1J�-, 4 G[ Efts cam. tzcs-, 5-6-v 072.0,-Z- e-, �F I'V��tiTH a1 .. l . I 21 � U j D;�.�'' S-j-0Yl e-7 1r-_�c d CTO? 0 3� 21 C C,t/g-rU,/\J(' I /-1-nJA � MIr2en J.A1J�t5 F' A'S � l'�o LL_ SIS�i�6, �✓J I �. 'A' CG"L4 k I C�\� 1��4>•1�� i �(� ' \I..J r - + Discussion"With Person in Charge: Corrective Action Required: I ❑ No I ❑ Yes a 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, anis 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 twentyFfive dollarWor suspension/revocation of ❑ Embargo ❑ Emergency Closure your food permit. ❑ Voluntary Disposal ❑ Other: nil 14ri') PFrs ReceteeJ ,t T_mperatm es Violations Related to Foodborne Illness Interventions and Risk I AcoAYiin_to L-1* Cncled to Factors(Items 1-22) (Cont.) 41'P/-15'F With: d Hours. PROTECTION FROM CHEMICALS i 1 3-`W, 5 i Cuoltn�,,`deiL�n?s tisr:'fff s 1 14 Food or Color Additives 119 PHF Hot and Cold Ho!dirg I 3-207 12 Additiv,-" 3-501,16,B) Coid PHFs XlainlaDied at or below S90.0040-") 1 4.1:M• " F- 3-302.14 Prcted on 1 0m Unaoprtn-eel Additives" i ! i 501,16(A• Hot PHFs hfaiatained at or abnve 15 j Poisonous or Toxic Substances i ' `114)'h j "7-101,11 kientli'ymg]nformatum-0;iginai ( , 3-501 WA) Roasts Held at or above I30'F. Cuutumer.," -i 02 11 COr INat N me-NGo 6 ing Con tai net j 20 Time as a Public Health Control 7-201 11 Sopa ro to+e ecn ace', 3-_:ill 19 Tilde ac a Public Health Comr01=, j -.c,. j i 202 11 Restriction-Preneuce and Use � 590.004(11) Requirement j j i '20'.12 Conditions to Use, j REQUIREMENTS FOR HIGHLY SUSCEPTIBLE j 'I moi 1! 'roxlc Contaiaet,- Prohibitions' POPULATIONS(14SP) 7-204.it Sanitizets.,Crirer;a-Chanicais° 7-204.12 Chcinicals G+r Washing Produce,Criteria" � ' nl 3$Ui.;i(,`,) t;ttpas:eur;zed Pic packageo Suites and 7?U# 1'- Ut ving Acents.Crtteua' � y Beteraces with Watling labels` i-205 11 hrcidenial Food Contaci I obr;ctmts* .11(H! Use 0 Pasteurized F;cas^ (� 3-86 1.11(D) Row of Pattialiy Coked Animal Fard and I?OG 11 Reslricn•d Use Pestic:;les.Cr;terin' � , j 7 206•.12 R<xient Bait Stations" 1<-: Seed Sprouts \ht Scrr-ca. " 7-206.13 Tracking Powd;rs,Pest Control and 3-801.1 RC) Unwoened Fo-w Packa=;c Not Re-served. * j Monitoring* CONSUMER ADVISORY TIMEITEMPERATURE CONTROLS 22 3-603.11 Consumer A(hiw.) Posted li»'Consumption of Pi Proper Cooking Temperatures fn. Animal Foods Th,t aic Raw.Ut:dercooked or PHFs Not Other,+ate Pr�cessrl to Eliminate ,,-,fitJIA(U(2) Eggs- 155--F15Sec. i P.Ces-InnualiatcScrvicc145�F15ser 3-30`'.13 Fes:eur;zed Eggs Stthntitrte for Raw Shell 3-401.11(A)(2-) Comminuted Fisli, Meats k GameI Lgcs* I Animals- 155'F 15 sec. * SPECIAL REQUIREMENTS 3-40i.i i(By;I(2) Pork ano Beef Roast- 13(1"F 121 min` I 3-401.1 IWQ) Raines. injected Mats- 155'F 15 59000cit A) (D) Vio;a•tions of Section i90.009(A)-(D) in . sec. 's catering, mobile fire!, temporary and 3-101 11(;,.,(3) Poultry, Wild Game,Shifted PHP-, r,-mdeni;nl Litcbca operations shou'd be SiuR'ing Conta;nirw,Fish,Meat, dehited under the ipptooria:e N ctichs Poultry or Rai;ies-165°7 13 s,c. ' above if related to io idborne illness i 3-401.1!(CI(3) Whole-muscle,Intact beef Steaks interventions and risk factors. Other 145-F ^ :190.009 violation3 relating to good retail 3-401.12 Raw Animal Fonds Cooked in a pra.aces should be clebiier.; under /729- j _ Miciowa e 16i'F" Soecial Recluiremen;s, 3-401JIfA)(1)1b1 M! ()therPI-IFs-- 145`F15sec. * j 17 Reheating for Hot Holding VIOLATIONS RELATED TO GOOD RETAIL PRACTICEor 3-403.11(A)0)) PH(,s 165'F 15 see. * j (Items 23-30) 3-403.1 l(R) Mit rowave- 165'F? Bunte Standing Cridr:d wad am-r;tricot woladow. which do,a:! whae to the Timesfoodborne illness intei:,e+:'inns and ri.sh/actors tLiwd above' call he I 3-4U;.11(C) Commercially Pi oeessnd RTE Food- fo udu in rJw inllm,,,rg see inns of the load C'ode emd 105 CNIR 140°F* 3-403.11(P) Remaining Lnsllced Portions of Beef Item Good Retail Practices Fc 006 1 Roasts,. 23 _) mat art-¢ment antl Personnel �_FC_-2 .003 1g Proper Cooling of PHFs j 24. Food ac r cud Pro+action FC--3 1 .004 j i 25 ;'EWpmenl and Uter3ilr FC-4 : .005 -501.14(A) CooligCoukedPP.Psfrom l4WFio 126, Water, Plumb,ngand'Wasto FC-5 .006 70'F Within 2 Hours ami Frotu 70'F 27 Ph sisal Fzr•d,ty FC-6 007 I to4i°F1 5"F Within.1 Hours. r 28 Posonous or TTaac materals FC-7 ,008 _+-5111 14(61 Cunhn-PHFs Made Fnmt Ambient ! 29. Sneci^l Psowremcnts Oyu -- - Temperature Inar_dients 1,,41"F/4i 30, I Other ! - Within 4 Hours ' Dcrntr:<cnn.a!itcro u,ilia f:dcr:d le)ll Fond C nd2 ur 105(7A11<590 OnO. n 0094 Wharf Street Capt.'s Waterfront Grill & Club City of Salem FOOD SERVICE ESTABLISHMENT - FOOD SERVICE Inspection HACCP: ❑ Item Status Violation Critical Urgency Telephone: PROTECTION FROM CONTAMINATION 978-741-0555 Food Contact Surfaces Cleaning and Sanitizing FAIL Critical ❑J RED Owner: Comment: Seafood unit cutting board is stained and scored. Resurface or replace board. The Waterfront Asset Co., PIC: Cutting boards on main food prep line badly stained and scored. Resurface or replace boards. Dirk Isbrandtsen Salad unit cutting board stained and scored. Resurface or replace board. Inspector: There is no sanitizer on the main food prep line. Sanitizer to be readily available at all working stations in tabled containers with John Gehan proper concentration. Date Inspected:Correct By: 1/10/2007 There is no sanitizer at the salad station. Sanitizer to be readily available with proper concentration as mandated. Risk Level: Bar sanitizer reading below mandated concentration. Sanitizer to be reading at 200 ppm. Front wait station sanitizer reading below mandated concentration. Sanitizer to be reading at 200 ppm. Permit Number: BHP-2007-0176 Handwash Facilities FAIL Critical ❑d RED Status: Open Comment: Hand wash sink next to coke refrigerator requires thorough cleaning. Hand was sink for hand washing only. #Of Critical Violations: Same sink obstructed at time of inspection. Sink to be clear and accessible at all times. 4 Handwash sink next to salad station has a spoon in it. Sink to be used for hand washing only. Time IN: Time OUT. Handwash sinks in kitchen have fading or are missing signs. Provide new signs. Urgency Description(s): BLUE: Handwash sink next to upstairs ice ceam unit has no soap. Provide soap. Violations Related to Good NOTE:many of the soap dispensers are running near empty. Refill dispensers. Retail Practices (Critical violations must be corrected Upstairs hand wash sink next to produce sink has no paper towel. Provide towels. immediately or within 10 days)(Non-critical violations Same sink has food at drain. Sink to be used for hand washing only. 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. Jan 10,2007 ) Page 1 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 Comment:Seafood unit has uncovered foods. All foods in storage must be covered. immediate corrective action) There are spoons being stored in the container with what appears to be swiss cheese. Utensils to be cleaned,sanitized and stored in an appropriate container. Discard cheese. There are three white uncovered containers by entrance to kitchen. All food must be covered. Same containers require labels or relabeling. All foods not in their original containers must be labled. Food scale has accumulation of food and grime on it. Thoroughly clean and sanitize scale. Meat slicer has accumulation of food debris on it. Thoroughly clean and sanitize slicer after each use. Walk in freezer has food stored on floor. All foods must be stored 6.8 inches off of the floor. Ice scoop at wait station next to bar stored incorrectly. Ice scoop to be stored in designated labled container or with handle outside ice. Upstairs True refrigerator on food prep line reading at 70°F. Unit to be holding at 41°F or below as mandated. Have unit serviced. Beverage-air unit upstairs on food prep line has broken thermometer. Provide new and accurate thermometer. Utensils being stored between units on main kitchen food prep line. Utensils found with accumulation of food debris on them. Thoroughly clean and sanitize utensils. Utensils to be stored in proper designated area. Utensils being stored above 3-bay sink found with accumulation of food debris. Wash, rinse and sanitize utensils. Relocate utensils or provide splash guard to prevent cross contamination. Employees observed eating and drinking in kitchen at food prep areas. Employees must eat and drink at designated employee areas. Equipment and Utensils FAIL BLUE Comment: Beverageair refrigerator unit on main food prep line requires thorough cleaning. Vulcan unit requires thorough cleaning. Stove on food prep line requires thorough cleaning. Fryolator on food prep line requires thorough cleaning. Both reach in refrigerators facing front require general cleaning. Coke refrigerator requires thorough cleaning. Same refrigerator has broken handle. Repair handle. 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. Jan 10,2007 ) Page 2 of S Item Status Violation Critical Urgency Salad station refrigerator requires thorough cleaning. Same unit has no visible thermometer, Provide visible and accurate thermometer. Microwave requires general cleaning. Bar refrigeration units require general cleaning. Bar has broken refrigeration unit. Owner states unit being replaced in spring. Remove or repair unit to good working order. Ice scoop holder requires general cleaning. Walk in freezer has accumulation of ice build up. Find source of leak and repair. Remove ice. Produce walk in has accumulatuon of grime on shelving units. Thoroughly clean slelves. Toastmaster at wait station by bar requires general cleaning. Produce walk in Floor requires thorough cleaning. Ice cream unit upstairs has large amounts of mold growing inside unit. Remove and discard old ice ceam. Thoroughly clean and sanitize unit. Upstairs coke machine requires thorough cleaning. Upstairs Imperial oven requires thorough cleaning. Amana microwave found with plate of food in it. Remove and discard food. Thoroughly clean and sanitize microwave. Upstairs Vulcan unit has accumulation of water build up at door. Remove standing water. Thoroughly clean and sanitize unit. True unit next to produce sink upstairs has accumulation of mold inside. Thoroughly clean and sanitize unit. Mop stored incorrectly. Mop to be stored so that it can air dry and not touching any surfaces. Upstairs stove/oven requires thorough cleaning. Upstairs fryolator requires thorough cleaning. Sandwich grill downstairs requires thorough cleaning. Sandwich grill upstairs requires thorough cleaning. Physical Facility FAIL BLUE Comment:All shelving in the kitchen require general cleaning. Entire kitchen requires thorough cleaning beneath all units and on floors,walls and ceiling. 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. Jan 10,2007 ) Page 3 of Item Status Violation Critical Urgency Upstairs floors beneath all units,walls and ceiling requires thorough cleaning. All shelving upstairs requires general cleaning. Drain cover missing from floor next to beer walk in. Replace or repair drain. There is grease being stored in uncovered trash cans outside next to trash dumpster. Grease is to be stored in appropriate designated covered containers. Clean any spilt grease. There are 55 gallon barrels of grease stored outside that must be up off of the ground. Provide proper equipment. Outside area around the trash dumpster requires general cleaning. There are ceiling tiles missing in hallway next to ice machine. Replace tiles. Wall in hallway next to ice machine require thorough cleaning. Other-See Notes FAIL Critical BLUE Comment:There are cigarette butts on the floor in the hallway going from kitchen to outside. No smoking is permitted within any food establishment. Health Agent has requested owner to come in regarding critical violations as well as multiple repeat violations. Owner is subject to a monetary fine per repeat violation. GENERAL COMMENTS: Owner to present last three months of extermination reports to inspector at reinspection. A reinspection will be conducted in one week. All violations to be corrected at that time. (1/17/07). YM � �� 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. Jan 10,2007 ) Page 4 of {{'fF ' qj• - _ _- _ _ •.. _ -� ..•T '.4 i':� F''i.i'a'jC•.v J}��\ r.} R ' ., z Z•: t "\-`. _ h £ip',K,-NAGS Y � 9f - _ — nroL - 5'•.:.v:1'i.�':•.i T {'..r �^fi'k'i:�'n".^'.'t�. �-0 +tet ti.rw _ OOI�RT,DOFKETN0.1 X:t�?.-WYe°'^'�,1�iGe �,y�, CRAYON NG. ' -.e - VIOLATION.NOTi EryFlR3�.WAL±:^.<y. ��TSADDRESS_. �- ,�., CRY/fOWN ,ATEa'i'4 ZIP.: :i»� ^. - _ � A• a .I e.? "1i1f7A%J� $% ` !Y.�iit - `>0�9.70_ LICENSE NO. UC.EXP.DATE DATE OF BIRTH ' � Y•+� ' R•! 1 �-7 FI IO�^9'�ER'S NAME(LAST,pIRST.INITIAL) f Vi`Ak; t: u:t �i;_I.:.i ; /S�irlfil�/1S'il l�lr 607 STREETADDRESS CITYROWN „JTATE ZIP `sn d elsY ' iY' •- �''-�,+, .alFl1f-,+ ,I=:� L I I �. •R+2- _z x 1 .'�� 9 / chart S{ S6l�m r'll tr o/9 7r_) ;. ".il: m:•ny¢ - L'�: ;w r�u�L_.T'% i�":<;f;' T. REGISTRATION NO. STATE EXP.DATE MAR{dTYPE I YEAR COLORI .Gtic"<v ,'�.,r'(e^•'{• •,a .R�,1 ;}Ir-�; r_ 'ri _ DATE FVI LATION TIME DATE CITA NWRITTEN PEAL ' 'k ;r d a' ':x"F: t=",i:Y'!i}'.�"IA, ,v_--'L__ • - 1�Q�� 7 0 AM ❑PM //// ,!}`� INIU ONO Cin' "1 Un LQFATIONOFVIOLATIOV ' ENFORCING DEPT Ci Un o ti OFFENSE AL6 IJr A: Pj,', 14 nN+ OI. CHAP SECT FINEST q rn LoI 'p::...,'r•'(.. is �: ,. G OFFICER 1 D.NO TOTAL @ ma�yy'� fjp _r �' LTE fid. /� DIUE s/VI/. OFFICER CERTIFIES COPY GIVEN TO VIOLATOR µ. i �/ _ •__ _ 2 L� 1 _J IN HAND " J• H'. a Z I'll X � ❑ BY MAIL V i ti 'Z .a 150 NOT MAIL CASH-PAY ONLY BY POSTAL NOTE,MONEY ORDER OR BY CHECK MADE PAYABLE TO.: ca CITY CLERK CITY HALL J ; \ ` 93 WASHINGTON STREET SALEM,MA 01970 2 _ TEL.(508)745-9595 X 251 0 o^ `« Q U M 1 HEREBY ELECT TO EXERCISE THE FIRST OPTION AS STATED ON REVERSE,CONFESS TO THE OFFENSE CHARGED,AND ENCLOSE PAYMENT IN THE AMOUNT OL 0 <2 a¢a b IT Z 2� $ CASEp aJ E 0. li ga m y hSIGNATURE O o °cI SEE OTHER SIDE FOR FURTHER INFORMATION (n U c o ENCLOSE PAYMENT IN THIS ENVELOPE,PEEL AND SEAL U rn o IL > U 0 �w O >c w a0 0094 Wharf Street Capt.'s Waterfront Grill & Club City of Salem FOOD SERVICE ESTABLISHMENT - FOOD SERVICE Inspection HACCP: ❑ Item Status Violation Critical Urgency Telephone: PROTECTION FROM CONTAMINATION 978-741-0555 Food Contact Surfaces Cleaning and Sanitizing PASS Critical ❑d RED Owner: Comments: Seafood unit cutting board is stained and scored. Resurface or replace board. The Waterfront Asset Co., I PIC: Cutting boards on main food prep line badly stained and scored. Resurface or replace boards. Scott Olsen Salad unit cutting board stained and scored. Resurface or replace board. Inspector: There is no sanitizer on the main food prep line. Sanitizer to be readily available at all working stations in tabled containers with John Gehan proper concentration. Date Inspected:Correct By: 1/17/2007 There is no sanitizer at the salad station. Sanitizer to be readily available with proper concentration as mandated. Risk Level: Bar sanitizer reading below mandated concentration. Sanitizer to be reading at 200 ppm. Permit Number: Front wait station sanitizer reading below mandated concentration. Sanitizer to be reading at 200 ppm. BHP-2007-0176 Handwash Facilities PASS Critical RED Status: SIGNED OFF Comments: Hand wash sink next to coke refrigerator requires thorough cleaning. Hand was sink for hand washing only. #of Critical Violations: Same sink obstructed at time of inspection. Sink to be clear and accessible at all times. 0 Handwash sink next to salad station has a spoon in it. Sink to be used for hand washing only. Time IN Time OUT. Handwash sinks in kitchen have fading or are missing signs. Provide new signs. Urgency Description(s): BLUE: Handwash sink next to upstairs ice ceam unit has no soap. Provide soap. Violations Related to Good NOTE:many of the soap dispensers are running near empty. Refill dispensers. Retail Practices (Critical violations must be corrected Upstairs hand wash sink next to produce sink has no paper towel. Provide towels. immediately or within 10 days)(Non-critical violations Same sink has food at drain. Sink to be used for hand washing only. 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. Jan 17,2007 ) Page 1 of Item Status Violation Critical Urgency RED: Violations Related to Good Retail Practices (Blue Items) Violations Related to Food and Food Protection PASS Critical BLUE Foodborne Illness Interventions and Risk Factors (Require Comments: Seafood unit has uncovered foods. All foods in storage must be covered. immediate corrective action) There ares spoons being stored in the container with what p g appears to be swiss cheese. Utensils to be cleaned,sanitized and stored in an appropriate container. Discard cheese. There are three white uncovered containers by entrance to kitchen. All food must be covered. Same containers require labels or relabeling. All foods not in their original containers must be tabled. Food scale has accumulation of food and grime on it. Thoroughly clean and sanitize scale. Meat slicer has accumulation of food debris on it. Thoroughly clean and sanitize slicer after each use. Walk in freezer has food stored on floor. All foods must be stored 6-8 inches off of the floor. Ice scoop at wait station next to bar stored incorrectly. Ice scoop to be stored in designated labled container or with handle outside ice. Upstairs True refrigerator on food prep line reading at 70°F. Unit to be holding at 41'F or below as mandated. Have unit serviced. Beverage-air unit upstairs on food prep line has broken thermometer. Provide new and accurate thermometer. Utensils being stored between units on main kitchen food prep line. Utensils found with accumulation of food debris on them. Thoroughly clean and sanitize utensils. Utensils to be stored in proper designated area. Utensils being stored above 3-bay sink found with accumulation of food debris. Wash,rinse and sanitize utensils. Relocate utensils or provide splash guard to prevent cross contamination. Employees observed eating and drinking in kitchen at food prep areas. Employees must eat and drink at designated employee areas. Equipment and Utensils PASS BLUE Comments: Beverage-air refrigerator unit on main food prep line requires thorough cleaning. Vulcan unit requires thorough cleaning. Stove on food prep line requires thorough cleaning. Fryolator on food prep line requires thorough cleaning. Both reach in refrigerators facing front require general cleaning. Coke refrigerator requires thorough cleaning. Same refrigerator has broken handle. Repair handle. 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. Jan 17,2007 ) Page 2 of Item Status Violation Critical Urgency Salad station refrigerator requires thorough cleaning. Same unit has no visible thermometer, Provide visible and accurate thermometer. Microwave requires general cleaning. Bar refrigeration units require general cleaning. Bar has broken refrigeration unit. Owner states unit being replaced in spring. Remove or repair unit to good working order. Ice scoop holder requires general cleaning. Walk in freezer has accumulation of ice build up. Find source of leak and repair. Remove ice. Produce walk in has accumulatuon of grime on shelving units. Thoroughly clean slelves. Toastmaster at wait station by bar requires general cleaning. Produce walk in floor requires thorough cleaning. Ice cream unit upstairs has large amounts of mold growing inside unit. Remove and discard old ice ceam. Thoroughly clean and sanitize unit. Upstairs coke machine requires thorough cleaning. Upstairs Imperial oven requires thorough cleaning. Amana microwave found with plate of food in it. Remove and discard food. Thoroughly clean and sanitize microwave. Upstairs Vulcan unit has accumulation of water build up at door. Remove standing water. Thoroughly clean and sanitize unit. True unit next to produce sink upstairs has accumulation of mold inside. Thoroughly clean and sanitize unit. Mop stored incorrectly. Mop to be stored so that it can air dry and not touching any surfaces. Upstairs stove/oven requires thorough cleaning. Upstairs fryolator requires thorough cleaning. Sandwich grill downstairs requires thorough cleaning. Sandwich grill upstairs requires thorough cleaning. Physical Facility PASS BLUE Comments:All shelving in the kitchen require general cleaning. Entire kitchen requires thorough cleaning beneath all units and on floors,walls and ceiling. 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. Jan 17,2007 ) Page 3 of Item Status Violation Critical Urgency Upstairs floors beneath all units,walls and ceiling requires thorough cleaning. All shelving upstairs requires general cleaning. Drain cover missing from floor next to beer walk in. Replace or repair drain. There is grease being stored in uncovered trash cans outside next to trash dumpster. Grease is to be stored in appropriate designated covered containers. Clean any spilt grease. There are 55 gallon barrels of grease stored outside that must be up off of the ground. Provide proper equipment. Outside area around the trash dumpster requires general cleaning. - There are ceiling tiles missing in hallway next to ice machine. Replace tiles. Wall in hallway next to ice machine require thorough cleaning. Other-See Notes PASS Critical BLUE Comments:There are cigarette butts on the floor in the hallway going from kitchen to outside. No smoking is permitted within any food establishment. Health Agent has requested owner to come in regarding critical violations as well as multiple repeat violations. Owner is subject to a monetary fine per repeat violation. GENERAL COMMENTS: All violations corrected unless noted. Establihment to have sanitizing dispensing unit serviced to produce proper ppm. Bar refrigerator requires general cleaning. Owner or PIC to monitor hallway to outside to ensure no smoking is present. jc"-t� P Mr. 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. Jan 17,2007 ) Page 4 of 0094 Wharf Street Capt.'s Waterfront Grill & Club City of Salem FOOD SERVICE ESTABLISHMENT - FOOD SERVICE Inspection HACCP: ❑ Item Status Violation Critical Urgency Telephone: PROTECTION FROM CONTAMINATION 978-741-0555 Food Contac Surfaces Cleaning and Sanitizing FAIL Critical RED Owner: Comment: Seafood unit cutting board is stained and scored. Resurface or replace board. The Waterfront Asset Co., I PIC: - utting boards on main food prep line badly stained and scored. Resurface or replace boards. I �� Dirk Isbrancitsen Salad unit cutting board stained and scored. Resurface or replace board. Inspector: jhefe is no sanitizer on the main food prep line. Sanitizer to be readily available at all working stations in labled containers with John Gehan proper concentration. Date Inspected:Correct By: 1/10/2007 i /1"J/Q7 ^care is no sanitizer at the salad station. Sanitizer to be readily available with proper concentration as mandated. Risk Level: J Bar sanitizer reading below mandated concentration. Sanitizer to be reading at 200 ppm. Permit Number: Front wait station sanitizer reading below mandated concentration. Sanitizer to be reading at 200 ppm. BHP-2007-0176 Handwash Facilities FAIL Critical 0 RED Status: Open ,045fiment: Hand wash sink next to coke refrigerator requires thorough cleaning. Hand was sink for hand washing only. #of Critical Violations: isame sink obstructed at time of inspection. Sink to be clear and accessible at all times. 4 Time IN: I Time OUT: wash sink next to salad station has a spoon in it. Sink to be used for hand washing only. � Ai- andwash sinks in kitchen have fading or are missing signs. Provide new signs. Urgency Description(s): _�� BLUE: ale dttwash sink next to upstairs ice team unit has no soap. Provide soap. Violations Related to Good Retail Practices (Critical -.NOTE:many of the soap dispensers are running near empty. Refill dispensers. violations must be corrected airs hard-wash sink next to produce sink has no paper towel. Provide towels. immediately or within 10 days)(Non-critical violations Same sink has food at drain. Sink to be used for hand washing only. 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. Jan 11,2007 ) 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 .,Comment: Seafood unit has uncovered foods. All foods in storage must be covered. immediate corrective action) —.Tfi 11 are spoons being stored in the container with what appears to be swiss cheese. Utensils to be cleaned,sanitized and stored in an appropriate container. Discard cheese. /Ttiere are three white uncovered containers by entrance to kitchen. All food must be covered. 1.8ame containers require labels or relabeling. All foods not in their original containers must be tabled. ,lKood scale has accumulation of food and grime on it. Thoroughly clean and sanitize scale. .Meat slicer has accumulation of food debris on it. Thoroughly clean and sanitize slicer after each use. alk in.freezer has food stored on floor. All foods must be stored 6.8 inches off of the floor. Ici;�scoop at wait station next to bar stored incorrectly. Ice scoop to be stored in designated tabled container or with handle outside ice. .'Upstairs True refrigerator on food prep line reading at 70°F. Unit to be holding at 41'F or below as mandated. Have unit serviced. verage-air unit upstairs on food prep line has broken thermometer. Provide new and accurate thermometer. Utensils being stored between units on main kitchen food prep line. Utensils found with accumulation of food debris on them. Thoroughly clean and sanitize utensils. Utensils to be stored in proper designated area. ,,AJrnsils being stored above 3-bay sink found with accumulation of food debris. Wash, rinse and sanitize utensils. Relocate utensils or provide splash guard to prevent cross contamination. iEmptoyees observed eating and drinking in kitchen at food prep areas. Employees must eat and drink at designated employee areas. Equipment and Utensils FAIL BLUE _-C�Omment: Beverage-air refrigerator unit on main food prep line requires thorough cleaning. can unit requires thorough cleaning. f' .Stove on food prep line requires thorough cleaning. olator on food prep line requires thorough cleaning. ,-Bot rrrreach in refrigerators facing front require general cleaning. e refrigerator requires thorough cleaning. --Same refrigerator has broken handle. Repair handle. Cify,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. Jan 11,2007 ) Page 2 of Item Status Violation Critical Urgency ,851ad station refrigerator requires thorough cleaning. ,8-ame unit has no visible thermometer, Provide visible and accurate thermometer. icrowave requires general cleaning. s Bar refrigeration units require general cleaning. Bar has broken refrigeration unit. Owner states unit being replaced in spring. Remove or repair unit to good working order. ce scoop holder requires general cleaning. alk in freezer has accumulation of ice build up. Find source of leak and repair. Remove ice. iProduce walk in has accumulatuon of grime on shelving units. Thoroughly clean slelves. ,/Toastmaster at wait station by bar requires general cleaning. i ,/Produce walk in floor requires thorough cleaning. Dream unit upstairs has large amounts of mold growing inside unit. Remove and discard old ice ceam. Thoroughly clean and sanitize nit: pstairs coke machine requires thorough cleaning. �kJ stairs Imperial oven requires thorough cleaning. ,A aiFi na microwave found with plate of food in it. Remove and discard food. Thoroughly clean and sanitize microwave. pstairs Vulcan unit has accumulation of water build up at door. Remove standing water. Thoroughly clean and sanitize unit. e unit next to produce sink upstairs has accumulation of mold inside. Thoroughly clean and sanitize unit. ford incorrectly. Mop to be stored so that it can air dry and not touching any surfaces. ,Ups stove/oven requires thorough cleaning. ,—Up air�ator, requires thorough cleaning. (sandwich grill.downstairs requires thorough cleaning. ✓Sandwicchh grill upstairs requires thorough cleaning. Physical Facility FAIL BLUE ' Comment:All shelving in the kitchen require general cleaning. iEntire kitchen requires thorough cleaning beneath all units and on floors,walls and ceiling. 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. Jan 11,2007 ) Page 3 of Item Status Violation Critical Urgency 'Afpstairs floors beneath all units,walls and ceiling requires thorough cleaning. UAI shelving upstairs requires general cleaning. ,Brain cover missing from floor next to beer walk in. Replace or repair drain. VI-here is grease being stored in uncovered trash cans outside next to trash dumpster. Grease is to be stored in appropriate designated covered containers. Clean any spilt grease. WThe re are 55 gallon barrels of grease stored outside that must be up off of the ground. Provide proper equipment. ✓•Out/sid'e area around the trash dumpster requires general cleaning. 4,-There are ceiling tiles missing in hallway next to ice machine. Replace tiles. LWall in hallway next to ice machine require thorough cleaning. Other-See Notes FAIL Critical BLUE f Comment:There are cigarette butts on the floor in the hallway going from kitchen to outside. No smoking is permitted within any food establishment. 'alth Agent has requested owner to come in regarding critical violations as well as multiple repeat violations. Owner is subject to a monetary fine per repeat violation. GEN'RAL COMMENTS: wner to present last three months of extermination reports to inspector at reinspection. A reinspection will be conducted in one week. All violations to be corrected at that time. (1/17/07). 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. Jan 11,2007 ) Page 4 of CITY OF SALEM BOARD OF HEALTH Name of Establishment: Capt.'s Waterfront Grill & Club Address: 94 Wharf Street Owner(s): Dirk Isbrandtsen Phone: 978-741-0555 Date: January 11, 2007 The owner of this establishment was requested to appear for a hearing regarding multiple repeat critical violations observed at his establishment during a routine inspection on January 9, 2007, discussed on January 10, 2007, by Sanitarian John Gehan. The owner, Mr. Isbrandtsen and the Certified Food Manger, Scott Olsen, appeared. Mr. Isbrandtsen understands the seriousness of the violations and that such violations increase the change of foodborne illness. The owner further understands that if the critical violations are observed again, his food permit may be subject to suspension or revocation. Mr. Olsen agrees to develop a written cleaning schedule showing: • tasks • when they are to be done • by whom This schedule must be presented to Mr. Gehan during the scheduled re- inspection. The Board of Health is issuing a $100 ticket for repeat critical violations. -x�-mac.=_ •�-n•tt- I- �c -�. 7 Joanne Scott Date Health Agent Dirk fsbrandtsen;`6wner Date L� 0094 Wharf Stneet Capt.'S Waterfront Gri//& C/ub City of Salem FOOD SERVICE ESTABLISHMENT - FOOD SERVICE Item Status Violation Type Urgency PROTECTION FROM CONTAMINATION Address: 0094 Wharf Street Food Contact Surfaces Cleaning and Sanitizing FAIL Critical RED COMMENTS: Seafood unit cutting board is stained and scored. Resurface or replace Telephone: 978-741-0555 board. Owner: The Waterfront Asset Co., Inc. Cutting boards on main food prep line badly stained and scored. Resurface or replace boards. PIC: Dirk Lsbrandtsen Salad unit cutting board stained and scored. Resurface or replace board. [Inspector: John Gehan Date: 1/10/07 There is no sanitizer on the main food prep line. Sanitizer to be readily available at all Risk Level: working stations in labled containers with proper concentration. IHACCP: No There is no sanitizer at the salad station. Sanitizer to be readily available with proper Correct By: 1/17/07 concentration as mandated. Permit Number: BHP-2007-0176 Status: Open Bar sanitizer reading below mandated concentration. Sanitizer to be reading at 200 ppm. # of Critical Violations: 4 Front wart station sanitizer reading below maniated concentration. Sanitizer to be reading at 200 ppm. Time IN: OUT: Urgency Description(s): BLUE: Violations Related to Good Retail City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970 Phone:(978)741-1800 Fax:(978)745-0343 OeoTMs®2005 Des Leaders Municipal solutions,Inc. COMMONWEALTH OF MASSACHUSETTS Page 1 00944 Wha fCity of Salem street Is Waterfront Grill& Clch � FOOD SERVICE ESTABLISHMENT - FOOD SERVICE Item Status Violation Type Urgency Handwash Facilities FAIL Critical RED Practices(Critical violations must be 7 COMMENTS: Hand ws sink next to coke refrigerator requires thorough cleaning. Hand corrected immediately or within 10 sink for hand washing only. days)(Non-critical violations must be corrected immediately or within 90 Some sink obstructed at time of inspection. Sink to be clear and accessible at all times. days) RED; Handwash sink next to salad station has a spoon in it. Sink to be used for hand washing Violations Related to Foodborne Illness only. Interventions and Risk Factors (Require immediate corrective action) Handwash sinks in kitchen have fading or are missing signs. Provide new signs. Handwash sink next to upstairs ice cea n unit has no soap. Provide soap. NOTE: many of the soap dispensers are running near empty. Refill dispensers. Upstairs hand wash sink next to produce sink has no paper towel. Provide towels. Same sink has food at draln. Sink to be used for hand washing only. Violations Related to Good Retail Practices (Blue Items) Food and Food Protection FAIL Critical BLUE COMMENTS: Seafood unit has uncovered foods. All foods in storage must be covered. City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970 Phone:(978)741-1800 Fax:(978)745.0343 GeeTMS®2005 Des taurfers Monkipal solations,Ins. COMMONWEALTH OF MASSACHUSETTS Page 2 0094 WharfStreet / 's Waterfront arat City of Salem FOOD SERVICE ESTABLISHMENT - FOOD SERVICE Item Status Violation Type Urgency There are spoons being stored in the container with what appears to be swiss cheese. Utensils to be cleaned, sanitized and stored in an appropriate container. Discard cheese. There are three white uncovered containers by entrance to kitchen. All food must be covered. Same containers require labels or relabeling. All foods not in there original containers must be fabled. Food scale has accumulation of food and grime on it. Thoroughly clean and sanitize scale. Meat slicer has accumulation of food debris on it. Thoroughly clean and sanitize slicer after each use. Walk in freezer has food stored on floor. All foods must be stored 6-8 inches off of the floor. Ice scoop at wart station next to bar stored incorrectly. Ice scoop to be stored in 7 designated'kabfed container or with handle outside ice. I Upstairs True refrigerator on food prep line reading at 70°F. Unit to be holding at 41OF or below as mandated. Have unit serviced. Beverage-air unit upstairs on food prep line has broken thermometer. Provide new and accurate thermometer. City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970 Phone:4978)741-1800 Fax:(978)745-0343 GeOTMS®2005 Des hurlers Municipal solutions,Inc. COMMONWEALTH OF MASSACHUSETTS Page 3 r--- 0094 Wharf Street Capt.'s Kraterfront gill&- C/"b City of Salem FOOD SERVICE ESTABLISHMENT - FOOD SERVICE Item Status Violation Type Urgency rg cY Utensils being stored between units on main kitchen food prep line. Utensils found with accumulation of food debris on them. Thoroughly clean and sanitize utensils. Utensils to be stored in proper designated area. Utensils being stored above 3-bay sink found with accumulation of food debris. Wash, a rinse and sanitize utensils. Relocate utensils or provide splas guard to prevent cross contamination. h Employees observed eating and drinking in kitchen at food prep areas. Employees must ear and drink at designated employee areas. Equipment and Utensils FAIL BLUE COMMENTS: Beverage-air refrigerator unit on main food prep line requires thorough cleaning. Vulcan unit requires thorough cleaning. Stove on food prep line requires thorough cleaning. Fryolator on food prep line requires thorough cleaning. Both reach in refrigerators facing front require general cleaning. City of Salem Board W Health 120 Washington Street,4th Floor SA1BM MA 01970 Phone:(978)741-1800 Fax:(978)745.0343 GwTMs(!D 2005 Des iaurfers Municipal solutions,Inc. COMMONWEALTH OF MASSACHUSETTS Page 4 0094 Wharf Street C"'S Waterfront Grill& C/ub City of Salem FOOD SERVICE ESTABLISHMENT - FOOD SERVICE Item Status Violation Type Urgency Coke refrigerator requires thorough cleaning. Same refrigerator has broken handle. Repair handle. Salad station refrigerator requires thorough cleaning. Same unit has no visible thermometer, Provide visible and accurate thermometer. Microwave requires general cleaning. Bar refrigeration units require general cleaning. Bar has broken refrigeration unit. Owner stag unit being replaced in spring. Remove or repair unit to good working order. Ice scoop holder requires general cleaning. Walk in freezer has accumulation of ice build up. Find source of leak and repair. Remove ice. Produce walk in has accumulatuon of grime on shelving units. Thoroughly clean slelves. Toastmaster at wait station by bar requires general cleaning. Produce walk in floor requires thorough cleaning. City of Salem Board of Health 120 Washington Street,4th Fluor SALEM MA 01970 Phone:(978)741-1800 Fax:(978)745-0343 , GeoTMS®2005 Des Lauriers Municipal Solutions,Inc. COMMONWEALTH OF MASSACHUSETTS Page 5 0094 Wharf Street apt,rF Waterfront Gr///& C/ub City of Salem FOOD SERVICE ESTABLISHMENT - FOOD SERVICE Item Status Violation Type Urgency Ice cream unit upstairs has large amounts of mold growing inside unit. Remove and discard old ice ceam. Thoroughly clean and sanitize unit. Upstairs coke machine requires thodugh cleaning. Upstairs 9mperial oven requires thorough cleaning. Amana microwave found with plate of food in it. Remove and discard food. Thoroughly clean and sanitize microwave. Upstairs Vulcan unit has accumulation of water build up at door. Remove standing water. Thoroughly clean and sanitize unit. True unit next to produce sink upstairs has accymulation of mold inside. Thoroughly clean and sanitize unit. Mop stored incorrectly. Mop to be stored so that it can air dry and not touching any surfaces. 7 Upstairs stove/oven requir3s thorough cleaning. Upstairs fryolator requires thorough cleaning. Sandwich grill downstairs requires thorough cleaning. City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970 Phone:(978)741-1800 Fax:(978)745.0343 GeoTMS®2005 Des Leaders Municipal solution,Inc. COMMONWEALTH OF MASSACHUSETTS Page 6 0094 WharfCWL's Waterfront Gri//& C/ub City of Salem FOOD SERVICE ESTABLISHMENT - FOOD SERVICE Item Status Violation Type Urgency Sandwich grill upstairs requires thorough cleaning. Physical Facility FAIL BLUE COMMENTS: All shelving in the kitchen require general cleaning. Entire kitchen requires thorough cleaning beneath all units and on floors, walls and ceiling. Upstairs floors beneath all units,walls and ceiling requires thorough cleaning. All shelving upstairs requires general cleaning. Drain cover missing from floor next to berr walk in. Replace or repair drain. There is grease being stored in uncovered trash cans outside next to trash dumpster. Grease is to be stored in appropriate designated covered containers. Clean any spilt grease. There are 55 gallon barrels of grease stored outside that must be up off of the ground. Provide proper equipment. Outside area around the trash dumpster requires general cleaning. City of Salem Board of Health 120 Washington Streeq 4th Floor SALEM MA 01970 Phone:(978)741-1800 Fax:(978)745-0343 'I GeoTMS®2005 Des Laurlers Municipal Solutions,Inc. COMMONWEALTH OF MASSACHUSETTS Page 7 _ ',, 0094 Wharf Street Capt.'s Waterfmnt Grill& C/ub City of5a/em FOOD SERVICE ESTABLISHMENT - FOOD SERVICE Item Status Violation Type Urgency There are ceiling tiles missing in hallway next to ice machine. Replace tiles. Wall in hallway,next to ice machine require thorough cleaning. Other- See Notes FAIL Critical BLUE COMMENTS: There are cigarette butts on the floor in the hallway going from kitchen to outside. No smoking is permitted within any establishment. Health Agent has requested owner to come in regarding critical violations as well as multiple repeat violations. Owner is subject to a monetary fine per repeat violation. GENERAL COMMENTS: Owner to present last three months of extermination reports to inspector at reinspection. A reinspection will be conducted in one week. All violations to be corrected at that time. (1/17/07). Inspector Signature PIC Signature City of Salem Board of Health 120 Washington Street.4th Floor SALEM MA 01970 Phone:(978)741-1800 Fax:(978)7450343 GeoTMS®2005 Bea Landers Municipal Solutions,Inc. COMMONWEALTH OF MASSACHUSETTS Page 8 CITY OF SALEM, MASSACHUSETTS BOARD of HEALTH ®E C E��NC L D 120 WASHINGTON STREET,4TH FLOOR ((''�� SALEM, MA 01970 TEL. 978-741-1800 DEC - 4 2006 FAX 978-745.0343 CITY OF c,,LEMI Kimberley Driscoll WWW.SALEM.COM BOARD OF rIEALTH Mayor JOANNE SCOTT, MPH, RS, CHO HEALTH AGENT 2007 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT NAME OF ESTABLISHMENT CAPT S A1A7X1Z)C 6N7-Skllt 4 C4UB TEL# 979-'71//-0y3j-5 ADDRESS OF ESTABLISHMENT 9V 1,61W IRF' _S FAX# `l 9-79'147aa- MAILING ADDRESS(if different) e114 Mr- / ,c EMAIL--Business': FiU6yzA� /�lf/11fACr6/�(dCG1J vr:CdMCvm�'s: rJ//-l�4?C OWNER'S NAME -ZS'BA4AJD 7SEl I TEL# 79/43/-25- LI ADDRESS /� I—�UG/l 7 7 AlAb,- S /IV lLl�/(c'Blt`fIEAD l=7 C�/tI�/S� STREET CITY STATE ZIP SCO-7-7- o[s Jj 3 j gy53,, CERTIFIED FOOD MANAGER'S NAME{S} /t.& CERTIFICATE#{S} /-1 CoRYLnN / 3 (Required in an establishment where potentially hazardous food is prepared) EMERGENCY RESPONSE PERSON 01R1< IS9A,4tJJTSElj HOME TEL# 7,?-1-6J1-7j-311 I DAYS OF OPERATION Monday Tuesday Wednesday Thursday Friday Saturday Sunday HOURS Of OPERATION //:3u //r3OAH Please write in time of day. �— (For exantdlellam-tinm) /,AM01GNC �/�� >A //PM TYPE OF ESTABLISHMENT FEE (check onlvl RETAIL STORE YES NO less than 1000sq.ft. =$ 50 1000-10,004sq.ft. =$100 more than 10,001 ft. =$250 - - --------- . - - --- ------- - - - -- ----- --- - _ RESTAURANT YES NO less than 25 seats $100 25-99 seats $4• more than 99 seats 0 BED/BREAKFAST .. ..YES--- -O ---- .. ---- --- - --$.1-00------------- _------- ----- -- ------ ---- --- .... ----- ----- ------ --- -- — .... ..._-...... ......... ..............__...... .. . ....... -.... ADDITIONAL PERMITS MAKE (not just serve) ICE CREAM, YOGURT, SOFT SERVE YES NO $5 TOBACCO VENDOR YES NO $50 iALL NON-PROFIT(such as church kitchens) YES NO S25 *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. Pwsuant to MGL Chapter 62C, Sechon 49A, I certify under the pains and penalties of perjury that I, to my best knowledge and belief, have fled all stale tax returns and paid •I.state taxes required under the 'aw. / Signature Date Social Security or Federal Identification Number — ------- Revised 11113/06 FOODAP2007.adm Checkq&Hate-ff-D 2-4 $ L "'�",. l► � '. '� '-3�-,9p::t ''r' iN+F"`f i. ,yro4.V i+ ^ y f='e x'.pa^y-[i::-.'y yraN'-J jt�yJ....AX`z-".•``j R-c n* .- •..^ q,tf!3k p $Y? +,nr .r'1:§`.�x.,_lF~+:"+:.a,'9t.�'•�+P�`��.q•..',`{7+r"'-.4"'.+..Cfs.1�g.Pi.F'tyt-�":.o.4"'fr._.dS.§.aeW•<le�4m�-•E-.',C;.F,- N?�n.CCYt,:`.'�t,:L��.rr 5ys.��.d'�n�''.Y.��',n:+,i,`�..^i�tf.�fa'4's.Mro..%.�:t*.�..,r. yM,a.a,m'r'{NL'gyVµ]ppL`".SF:.�-i..it»fLvl:.+"£e.-�:j'+.„�'u t:v{jy .wj,k .yamN� V vicommonweatm ofMassachusetst`^ , su4 fr :t ,'- ''^• IQmbt#riey Driscoll-° - ¢: _ , t,120 Washington Street.4th Floor ' .: ,' _. ^; s�;°,a.° r Mayor..,; , ... .fi`'''le-. �r^:y_. .i. ..g.`:yT•� :Z*':�asG` .:4'ti...d,...rv:S.:i. .. -. ..t}'::, - SALEM,MA 01970 Food/Retail Establishment Permit DATE PRINTED: 12/20/2006 ESTABLISHMENT NAME: Capt.'s Waterfront Grill & Club File Number:BHF-2004-000093 94 Wharf Street Salem MA 01970 LOCATED AT: 0094 WHARF STREET SALEM,MA 01970 Permit Type Permit No. Permit Issued Permit Expires Fee Restrictions/Notes FOOD SERVICE BHP-2007-0176 Dec 20,2006 Dec 31,2007 $200.00 ESTABLISHMENT Total Fees: $200.00 PERMIT EXPIRES December 31, 2007 Board of Health This Permit is not transferable and must be reissued upon change of ownership or location.The permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code, beofre any revonations,improvements,or equipment changes are made,all plans for such must be submitted to and approved by the Salem Board of Health. Page 1 of 8 0094 Wharf Street Capt.'s Waterfront Grill & Club City of Salem FOOD SERVICE ESTABLISHMENT - FOOD SERVICE Inspection HACCP: Item Status Violation Critical Urgency Telephone: ! FOOD PROTECTION MANAGEMENT 978-741-0555, j PIC Assigned/Knowledgeable/Duties PASS ❑J RED Owner: Non-compliance with: The Waterfront Asset Co., I Anti-Choking PASS PIC: Dirk Isbrandtsen Tobacco PASS Inspector: John Gehan EMPLOYEE HEALTH Date Correct By: Reporting of Diseases by Food Employee and PIC PASS �] RED I Personnel with Infections Restricted/Excluded PASS RED Risk Level: FOOD FROM APPROVED SOURCE Permit Number: Food and Water from Approved Source PASS RED BHP-2006=0039 Receiving/Condition PASS RED Status: l Open j Tags/Records/Accuracy of Ingredient Statements PASS '/ RED #Of Critical Violations, Conformance with Approved Procedures/HACCP Plans PASS L] RED 14 Time IN: Time OUT: (Urgency Description(s): BLUE: Violations Related to Good Retail Practices(Critical violations must be corrected immediately or within 10 Idays)(Non-critical violations must be corrected immediately orwlthin 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. Sep 06,2006 ) Page 1 of Item Status Violation Critical Urgency RED: PROTECTION FROM CONTAMINATION Violations Related to Separation/Segregation/Protection PASSd❑ RED Foodborne Illness Interventions and Risk Factors (Require, Food Contact urfaces Cleaning and Sanitizing FAIL Critical ❑d RED immediate corrective action) 4 Comments: No sanitizer available at time of inspection. Sanitizer to be readily available at each work station with proper ppm. o sanitizing log available at time of inspection. Log to be maintained daily. —test strips.available at time of inspection. Test strips to be provided. o t_Banitizer reading below required ppm. Sanitizer to be reading between 100-200ppm. Proper Adequate Handwashing PASS OV RED Good Hygienic Practices PASS W RED Prevention of Contamination from Hands PASS 0 RED Handwash Facilities FAIL [J RED mments: Hand wash sink in kitchen has utensil in it at time of inspection. HWS to be used for hand washing only. a awash sink at bar obstructed. Hand wash sink to be free and accessible at all times. pstaus hand wash sink by produce sink missing paper towels. Provide paper towels. PROTECTION FROM CHEMICALS Approved Food or Color Additives PASS ❑d RED Toxic Chemicals PASS [I, RED TIME/TEMPERATURE CONTROLS(Potentially Hazardous Foods) Cooking Temperatures PASS RED Reheating PASSJ❑ RED Cooling PASSJ❑ RED Hot and Cold Holding PASS ❑d RED Time As a Public Health Control PASS RED REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) Food and Food Preparation for HSP PASS ❑J RED City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741-1800 GeoTMS®2006 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Sep 06,2006 ) Page 2 of 6 Item Status Violation Critical Urgency CONSUMER ADVISORY Posting of Consumer Advisories PASS RED City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741-1800 GeoTMS®2006 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Sep 06,2006 ) Page 3 of Item Status Violation Critical Urgency Violations Related to Good Retail Practices (Blue Items) Food and Food Protection FAIL Critical BLUE ,,Gd�mments: Frying station has uncovered foods. All foods in storage must be covered. Sala[hre'frigerator has uncovered foods. All foods in storage must be covered. e L Personal items and drinks observed throughout establishment All personal items to be stored in proper employee designated ,_.area. Equipment and Utensils FAIL Critical BLUE o Comments:meat slicer requires thorough cleaning. o e refrigerator has broken handle. Repair handle. �m a unit requires thorough cleaning. c - eves throughout kitchen require thorough cleaning. T ontmental freezer requires general cleaning. Ftation requires general cleaning. 0 1/ ing boards stained and scored. Resurface or replace boards. ove vent vires general cleaning. Due 5/06. • ood refrigerator requires general cleaning. .- t line refrigerators require general cleaning. m Fro igerator public sees requires general cleaning. rtfrigerator requires general cleaning. Q .S91—ad refrigerator requires general cleaning. Knif salad refrigerator stored incorrectly. Utensils to be stored in proper designated areas. Mi ave requires general cleaning. cream freezer requires general cleaning. jce cre�coop holder requires general cleaning. lac machine,has grime on inside panel. Clean and sanitize ice machine. 6 e machine scoop holder requores general cleaning. 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. Sep 06,2006 ) Page 4 of Item Status Violation Critical Urgency Walk in refrigerator walls and ceiling require thorough cleaning. kin meat refrigerator requires thorough cleaning. ® alk in freezer has build up of ice. Remove ice,repair leak. i Same_unit ' sing visible thermometer. Provide visible and accurate thermometer. r e/scoops at service stations stored incorrectly. Ice scoops to be stored with handle exposed or in designated tabled container. Oze1rcoop in bar area incorrect. Store with handle exposed or in designated container. oops upstairs stored incorrectly at service stations. scoops to be stored with handle directly outside ice or in a designated scoop container. Iloo-scoop container at machine requires general cleaning. w ce cream freezer upstairs requires general cleaning. LJam scoop container requires general cleaning. m pstairs microwave requires general cleaning. ® L Co refrigerator upstairs requires thorough cleaning. �+rrr i n pperal oven requires thorough cleaning. _ t_4tefrigerator across from upstairs stove area requires cleaning. --same unit missing thermometer. Provide visible and accurate thermometer. irs service bar cutting board stained and scored. Resurface or replace board. Water, Plumbing and Waste PASS BLUE Physical Facili - FAIL Non-Critical BLUE omments:General cleaning of both kitchens upstairs and down required. Management and Personnel PASS BLUE Poisonous or Toxic Materials PASS BLUE Special Requirements PASS BLUE Other-See Notes FAIL BLUE —Comments. Many flying insects observed near each service station. Have exterminator check into problem. 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. Sep 06,2006 ) Page 5 of Item Status Violation Critical Urgency GENERAL COMMENTS: 735: i s� 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. Sep 06,2006) Page 6 of COURT DOCKET NO. CITATION NO SCITY O SALEM PD A b 0 81 VIOLATION NOTICE NAME(LAST,FIRST,INITIAL) 151/Y//1C�f�PfJ, G4✓ /�- STREETADDRESS CITYROWN STATE ZIP /�l f/Jif!/ f y l✓n, 1A O/G 70 LICENSE NO. LIC EXP DATE DATE OF BIRTH OWNER'S NAME(LAST,FIRST,INITIAL) /5 /r; {/ /Sf/1 1)11 k STREET ADDRESS CITY/TOWN STATE ZIP i/1l lu, 51 5r, r + litA circ. REGISTRATION NO STATE EXP DATE MAKE/TYPE I YEAR(COLOR DATE OF VIOLATION TIME DATE CITATION WRITTEN PERSONAL IWIIPY I/` 6 / ❑PM Ii��I //� El E]YENO LOCATION OF VIOLATIO J ENFORCING DEPT r`P,S Fjnpfi�on� �)�,�i 1 1'k1 t+e, II I, OFFENSE te{ 1-#r It viol R"/PNS of CHAP SECT FINES B C OFFICER / I D NO TOTAL /,y, J' 6t.1mt.) FINE DUE jiy)-� OFFICER CERTIFIES COPY GIVEN TO VIOLATOR i ❑`W HAND X j��l/ e— ❑ OV MAIL BO NOT MAIL CASH-PAY ONLY BY POSTAL NOTE,MONEY ORDER OR BY CHECK MADE PAYABLE TO CITY CLERK CITY HALL 93 WASHINGTON STREET SALEM,MA 01970 TEL.(508)745-9595 X 251 1 HEREBY ELECT TO EXERCISE THE FIRST OPTION AS STATED ON REVERSE, CONFESS TO THE OFFENSE CHARGED,AND ENCLOSE PAYMENT IN THE AMOUNT OF $ CASE# SIGNATURE SEE OTHER SIDE FOR FURTHER INFORMATION ENCLOSE PAYMENT IN THIS ENVELOPE,PEEL AND SEAL ��- �� • '�=� M CHAMBER OF COMMERCE &SALEM MAIN STREET INITIATIVE r Iry SALE y , . PRESENTa Y Salem's So Sweet Wine & Chocolate Tasting PartioiDation Information it -1 Ihri CnUCCIC:Te and Wine Tasting is part of The- "Saiern s SC -'wee, festival deslCCr;'✓'C'J increase cosiness ;r The Salem Community. This evert is continuing to evolve ,arch yetz, it ana is an excellent opportunity to showcase your cu!Inary talents of food ITe(Tis vaur t v , c h r ,^th ! `Jusl�rr=ss may s2il, This vear it will rake t.,ac� !r. thy,e�en.ng c;' Friday, i ,:..�rlsa.y 1 � at I 1I H0FrilTC -all, There is no Set-Up Cost, Ilov;ever, we WOuia ac;k that you bring G ChOC:il 7te. Cd dessert specialty to., at least 100 people, create an imaglnclki&di:play for an 3 tobie --no i wino fortais 0 Event Details: Date: Friday, February 10, 2006 / Time: 6:30-9:30pm Place: Hamilton Hall, Salem, MA I I Restaurateur's Resoonsibilities: • Food must be prepated ur`-site. a F^.Crr restaurant Will want an of poriuni-tv to give peGDle o taste se, please con Cler tNs 'vviien oetermlrvng yUur portion/taste. offering. I� rlccsE;provide your own n:_tpkins, paper plates and utensils. Prorno!ionn! materials tar your establishment, mentis, catering. etc- i Set-Up Iiii Is peiweeri 5:00-6:00prn • 2 Cries of went; (preferred) i• Oraaniaer's Will Provide: • Ar. 8-toot long fable and table coverings. + Wine Glossas l a ;tilted numoer of volunteeis to rnan tables. Please lel is kni It yGu need he p. i • Tickets wil! be so;d to event ifendees Ct $20 Ger t_eYst in \,,,I"n t-oceeds t0 oer=fit j the Solem Charnber of Corntnerce avid Salei n Main ,tree+ initiative Dawr.Tcwi i Program. a Kitchen facilities are avail--nie of Hamilton frcli for deaf, jp/,aet j0. , rf-sl Ude�NOula ilkC 10 pa,tI CIICiiTel PeaSe retU r"I ttlls fCifl' to t?'ie Ji.1em '..il':::'ii�E'.:",�' i Business: _— %fcfr_ i/��-- C��/L� y, n�1k� !i ' Contact: Phone: Item to be sampled: C_'/fiC <E�-' HCHr._fO��p1Nc ¢ -,;Frtnt � K� CNLFCr,4__u/r,rc:s,. rrr j '.l --'—'----- UPORTANT1 --- , !n ori=.r tc F':rnc:ipa to,r tris eve-it 5-ie 600rd o%Health t5qu�iras ;jr ,4APfioafion Icr A Temporary Food l,sr✓ice . Pefmft,'Ab,-;h 6 cilC!OS6t7, :16-C5e'ill.�ui htif Ti.n:i serrd i*-.. :he Pc,J'O Of heath, i-0'Nci,l �F .� IL cem, Mn_C,',n7c_no loler than February lst.,-_-_-__-_--_.-___-_-'-_'_-__--_-_---_-� ti T',uu rrouasficr-L cif c o ncerns plecae centacT Rossi ria",ar;;, %7E-7�4 000 .f Salem Chamber oT ComMerce 63 Wharf Street, SJerr, I`rIA rr,cne. 978-744-01J0-,! r'CX: >-7--7 r5-3FCC { `7 jail, Sok 9-1 c:T't OF r � � mm- IA iv..: _ — 3t on- APP i''^--O -c` .j, i._ul 1lrl-Qrr; %F?S !-`i t�`41 SCf�'v ICL PERMIT !=F_ '•-'_` DF"_ =," > X .- N,11elE if EVFit'. — �- �--- �,. � , �,.C:FiiiJDJ- `'�;•�' :l l�:..� �•z:;l '�_ \• •1 _`,>NAm r> 'PvUC'NT Choi li��IE"(CfRb'�> f FI1G1tLfal'i en _�7 1' I 'fid„ T MASE w Kse.,��. ,4vldFir� CfY6fx'. . K� �ririi CHnn�' a,t ar.CP�A��.- tom x4 facz .. --- --- ------- - ----------- 04 -------- ...._ - - ,lSery EXAMINATION FORM NO : 4001 _ CERTIFICATION NO : 4110005 AN IN ServSafe( Cermt-Iriceffboll1111111111111h moft r° FREDDIE G GRACE for suc::essfully completinq the standar,L- ,el forth by the National Restaurant Asse-,Iation Etlucatlolral F�•:rldafion for the ServSafeFood f l�otechon Mt,nager C.e,tification Examination, win lch Is acc reds ted by the Al nencan Naar nal Standards Institute (ANSli--Confemnre for Food Protection (f.Ff'! Presented by the National Restaurant Association Educational Foundation 11/i 1{'2004 UAIF OF ExAV It I A 11WIt 11/11/2009 DAI f GF r :, o.iq, I ,r);,i "'th voo. lace / tS - Mary M adoli Piea(I�or emr Cmc.: o!)m-ening orim t:anon�l R....en a, [,.,,, ,iAl,pn Fdx'm,^aI Fourtlar m: National Rest au l ant AtisoJal ion III.AIR! gffl EDUCATIONAL FOUNDATION :OW Naooual Fes+wma Aswaalmo F.,tucauona17oun:i.mm ��'.: �:�.r•,I , n i CITY OF SALEM BOARD OF HEALTH i Establishment Name:.5466-�71 lvi// Date: Page: of Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date l No. Reference R—Red Item Verified PLEASE PRINT CLEARLY I-) 6 �o (-�Z_Ovv' evu 5' =iti�Z I 1 /10--7691 A-- 5-7/�ia� I L) 2WAIA4 A I I I ,QLD I 1 1 I Discussion With Person in Charge: Corrective Action Required: I ❑ No I ❑ Yes I have read this report, have had the opportunity to ask questions and agree to correct all ❑ Voluntary Compliance ❑ Employee Restriction/ Exclusion violations before the next inspection, to observe all conditions as described, and to ❑ Re-inspection Scheduled ❑ Emergency Suspension comply with all mandates of the Mass/Federal Food Code. I understand that noncompliance may result in daily fines f-tw e d la or suspenslo /revocation of ❑ Embargo ❑ Emergency Closure your food permit. �� j }� rte_ ❑ Voluntary Disposal ❑ Other: Ile -- . +`.r' w ��-� ` ti � •� -.. e-1. ' .. - y.. � - - ,.� 5-501.1,'C) PHFs Received at Temperatures Violations Related to Foodborne Illness Interventions and Rtsh Aauording to law Cooled to Factors(items 1.22) (Cont.) 31�FAS-'F Within 4 Hours. PROTECTION FROM CHEMICALS 3-501"15 Cooling Methods for PHFi; 19 PHF hot and Cold Holding 14 Food iColor Additives 3-501.16(6) Cold PHF, Maintained at or below 3 202.12 AddiuvAdditive,;* ( 3-302.14 Protection from Unapproved Additives* 590A04(F) 41"I45°F= ( 3-501 INA) I lot PHF, Maintained at or above 1g Poisonous or Toxic Substances 140 F 7-101.11 Identityurg Information-Onginal I 3-SO1.16(A) Roasts Feld at or above 130°F. Container," 7-1011! Common Name--lb'rrking Containers' j 20 Time as a Public Health Control 7-201.11 Separation-Storage", 3-50L19 Time as a Public Health Control* 7-202,11 Rezlriction -PresenceandIise590.00-lfH) ariance Requirement 7-202.1 Conditions of Use' 7-^_03.11 Toxic Containers-Prohibitions" REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-204.11 Sanitizers,Criteria--Chemicals* POPULATIONS(HSP) 7-'_04.12 Chemicals for Washtno Produce,Craeria" 121 3-x501 IPA) Unitmieurized Pre-packaged Juicer and 7-204 14 Drvhtg Agents, Criteria,' J Be%ciages with Warning labels- 3-80 1.11(B) abels-3-801.11(6) Use,of Pasteurized)'vias" 7 205.11 Incidental Fond Contact. Lubncams-` i 3-801.11(D) Raw ta-Partiali) Cooked Animal Food and 1 '7-206.11 Restricted Use Pesticides.Criteria* � Raw Seed Sorkans Not Served. " 7206.12 _Rodent Bait Stanunil" -i-801.1](C) Unopened Fend Packa��e,Not Rc-served. " J 7-106.13 Trackine Powders,Pest Cnutr'.,l and Monitorin;,` CONSUMER ADVISORY TIMEITEMPERATURE CONTROLS 22 3 603 11 Conatmer Advisory Posted for Con<nmptiun of Animal Food,,"rha are Raw. fhi&rcouked of 14 Proper Cooking Temperatures far I Not Otherwise Processed to EliminatePHFs Pathos. enz.:o:.,.r.re- 3-401.11.4(0(2) Eggs- I55`F IS Sec. �n''* 3302.1< Pa�ieur:aed E>,c Substitute For Raw Shell Eu s- Sen'iee las"FlSseca kt•' 3-101.11P(A)(2) Comminuted Fish, Meat,k Game ( Eggs" Anima!n- 155'F IS sec.. a SPECIAL REQUIREMENTS 3-401.11(B)(1)(2) Polk and Beef Roast - IYJ'F12lnvn" 3-401.11tAl(2) Ranges, Injected bleats-- ]55'4 IS I 540.000(-4i (D) Violations of Section 590.009(A)-(D) in Sec, x cowrirg, mobile food, temporary and ?-401.1 i(A)(3) Poultry,wild Game. Stuffed PHFs, remdcnl:al kitchen operations should be Stuffing Containing Fish, Meat, debited under the appropriate.sections Poultry or Ratites-165"F 15 ser. '° above if related to foodborne illness 3-401A ItC)(=) Whole-muscle, Intact Beef Steaks interventions and risk factors. Other 14594* 590.009 violations retarir.g to good retail 3=401.12 Ray, Annual Foods Cooked in a praaicc�should he debited under ,X29- Micruwave 165`F* Special Requiternents. 3-401.11(A)f l)(b) j All Other PF F's- 145"F 15 sec. 17 Reheating for Hot Holding VIOLATIONS R ILA TED TO GOOD RETAIL PRACTICES 3-403.11(A)&(1)) PI IFs 165'F 15sec. " (Items 25-30) 3-403.1 IfB) Mictowave- 165' F2 Minute Standing Critical and non-,rilical vwlohom, which do not relate to dee Time" foodborne ilfnres inrovention,s anti risk Juniors 1f.,tad abom, cane be 3-403.11(C) Connucrcctlk Processed RTE Focal- found in the jollmriny sec lion.,-of the Feud Code and 105 Ch;R I40'F" 5e0.000. 3-403.1 l(Ii) Rentain!rr_L'nsliced Portions of Beef I Item Good Retail Practices FC 590.000 Roasts' 23. Management and Personnel, FC-2 .003___ 18 Proper Cooling of PHFs 24. Fiecd arid Food Protection FC-3 .004 25. Equipment and Utens!,s FG-4 005 3-501.14(A) Cooling Cooked PHFs from 140`F to ( 26. Water,Final and Waste Ft'--5 .006_ 7 kr'l�'Kithi n 2 Flours and From 70"'F I ( 27 Physical Farihhv FC-6 007 to-4117/45'1`Within 4 Houc;. "" 29 Poisonous or i oxic Materials -C-7 .003 3-501.141Bi CoolingPFIFsMadeFromAmbient 29 SpecialReawremeils 005 j "temperature Ingredients to 41'F745`F 30 . Other Within 4 Hours°t *Denotre cnncal ifrm in the(a{eral I9'o9 Font f'ndt or ;05 t.'FiR 591?Ot10. CITY OF SALEM BOARD OF HEALTH Establishment Name: Date: Page: of Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date 1 No. Reference R—Red Item Verified PLEASE PRINT CLEARLY ?r/(-7 v Uo F�GTI�I 1, /df ✓.� /31 CS lUa 2 dv Hfiv17S rr/V 7 �110-1nn/ A j �WOF�-i r A 'c /_7 51 � s ') asr'ftir �r� ��- ; s (�7njj2jnt-i FA-2( ALL /��al %s 6/1re-iv 1 I � 1 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 ❑ 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 Ll Embargo ❑ Emergency Closure your ��'food permit. �� (' ,, –'tel � �_ ❑ Voluntary Disposal ❑ Other: r 1-50:.!4(C., =HFr,I:ece:ced at Temperature;; Violat;ons Related to Foodborne Illness Interventions end Risk Ateord;ng to I aw Cooled it, Factors(items 1.22) (Cont-) -11'F,45'F Within 4 Hours ;: PROTECTION FROM CHEMICALS j ("nntiug Roe hods for PHFs j j 10 PHF Hot and Cold Holding 3-702.12 Additives j 14 FoodColor Additives ;-501.16(3) Cold PHF,Maintaine^ ;.t or below, �" � 590.004(F) 41''I45 `r" 3-302.14 Protection tion l5tappuned Additives" I ;_SOI.16(Al I-lot P1IFs Maintainedat or a6ore j 45 Poisonous or Toxic Substances j of;40 P 7-101.11 Identifying Information-O:igina! }l vU Roasts;leW s. or?6oce 130'F 1, Containers' j 7-102.I I Cnnu'uun blame ->,l'nrkine,Containers* ( 2.0 Time as a Public Heaith Control j ! 3-501 !o Time a,a Public Health Contro:" 7-211.11 Separation-S:oraec" ! 004(11) Variance Reuireutrr.: j 7-212.I I Restriction-Presence will t:sr." 590. Q ! i 7-202.12 Conditions of Use j REOU€REMENTS FOR HIGHLY SUSCEPTIBLE j 7-203.11 ':oxicContainen--Fmhihir::ns' j POPULATIONS 7-204.!t SanHSPitizers,Criteria-Chemicals- j ( ) 7-204.12 Chemicals for W,shm2 Pro--luce,C'riteria'" i 12i 3-801.1 I,Ai 1 Jnpacrcun,ud Pre-packaged Juices ad j t ( j B-.,�iages wno Warning Labels j i-204.1.1 Dcidex;1 Fro.Contact. 3-SO1,111B: i Use of pasteurized EA_I.,:. j j 7-205.11 lncidemui Food Contact.Lubncunts' ( 1 t 11 tD: R,.v or Parl,a!ly Coo}:ea Am:nai "ti�ad and 7-206.11 Recto cted Use Pesticides.C'riterm; j j Raw Seed Sprouts Not Sei ecd.7-206.12 Rodent Ban Stations` )3-801.11(0 Umo lined F(KKI Package Not Re-served " 7-206.1; Tracking Powders,Post Control :ad I p A --- - Monitornp' CONSUMER ADVISORY TIMETfEMPERATURE CONTROLS 22 3-603.11 Ccnsurmrr Adsimev Posted for Consumption of Atinnal Foods'That are Raw. Uudercnoked of 16 I Proper Cooking Temperatures for Not Otherwise Processed to Elmmnutc PHFs ;•i..,;re vaom 3401.11 A(1)(2) Eggs- 455"F 15 Ccs. Pathogens." Fggs ltnmedia,.e Service I45_FlSsec� 3-102.13 Pasreunt;e(1 E.^rs Substitute for Raw Shell * ?-401.1 I(A)(2) Conuninutcd Fish,Meat,t&Game E"'e Animals- 155'F 15 sec. " ' )t SPECIAL REQUIREMENTS3-4tiLl 1(R l)(2)r2) Pork and Beef Roast- I -F 121 min'' ' 3-401.11(.;)(2) Fames,Injected&Teats- 155'F 15 590009(Al-(D) Violalians of Section 590,009(A)-(D) in sea ( catering, inobile food,temporary and 340LI i;A)(3) Poultry,) i;d Game, Stufft•d PM's, rcl ideul,al kitchen operations shunld be Stuffing Containing Fish, Meat. debi led under ti,c-app(op nateSreitons Pouhry rn,Barites-165'F 15 sec. ^ above .1 related to foodborne illness 3-401.11(C)(3) \;9tole-muscle; intact lice£Steaks j tnterveniions.md risk iuc•,ors. Other 145°F a i 590.009 ilolations relating to good retail 3-401.12 Rmv An Cooked in a pa,,uc'c, should be debited under#29- i M,ctowave 10'F* I Special Rey(liren:ents. 3-401.11(.4)(1)(6) All Otter PHFs-- la5'F 15 sec ' j 17 ( Reheating for Hot Holding VIOLATIONS R.:LA TED TO GOOD RETAIL PRACTICES 3-403.11(A)&(])) j PHFs 165"F 15 scc. j (l tents 23-30) 3403.11(b) ( Microwave- 165'F 2 Uinutd Standing Critic(?and ran-(ritical eio!airuns. i-Inch do not iciate tr)d;., Time' f tudborn,r illness title,venrions and risk fat turn UNted above, ,an he 3-403.11(Ci Commercially Pr(xessed RTE Food- ,found in they talfti"Hrg,setlirns of the Fund("'dc and 105 CVR 140"FT j 500.000. 3-403.1 It E) Remaining Unsliced Portion;of Beef j item Gaod Retail Practices 1 FC Sgoxco 1 Kuast>" j 1 23. t,tanacement and rer:,enne! FC -2 ,003 18 Proper Cooling of PHFs ! 24 Food and Fox P,otect:on FC -3_ _ jO4 ! 25. Egaipm2nt and Utor its FC-4 CVM51 3-5!)1.14(,1) Choline Conked PHhs fron: Ido"F to ( 26 Water.Pimnbin4 and W asie FC -5 ! .006 70' F Within 2 f lours ane!From 70'1- i 127 Physical FaoRv FC--6 .007 in 417(45^F Vv rth;n 4 Hours, . ( 28, Fotsoi-ous or Trx,c tvlaletia!s FC -7 L-008 1-501.14(0 C,*Iing PHFe, Made Front Ambien 29, Spec-al Requirements 009 I Temperature lu2redients to 41"F7s5'F 30. Other Within( (lours ,•.""'"^::"-",. Denot�n enoc.d iban:n ire f.•aetal 1970 Fond Code to i 05 C%+IR 500 000 Commonwealth of Massachusetts City of Salem Board of Health 120 Washington Street,4th Floor SALEM,MA 01970 DATE PRINTED: 02/10/2006 WHO'S PLACE OF BUSINESS IS: Capt.'s Waterfront Grill & Club File Number BHF-2004-0093 94 Wharf Street Salem MA 01970 LOCATED AT: 0094 WHARF STREET SALEM,MA 01970 Permit Type Permit No. Permit Issued Permit Expires Fee Restrictions/Notes TEMPORARY FOOD BHP-2006-0405 Feb 10,2006 Feb 11,2006 $0.00 /TO BE SERVED: Strawberry chees cake with chocolate sour cream glaze. Total Fees: $0.00 PERMIT EXPIRES IFebruary 11, 2006 Board of Health Page t of 9 FROM .. FAX NO. :19787453855 Jan. 30 2096 12:31PM P1 3u1 1 95 i1 :.:9e 30ennc SV"C,LC 54Acm BON 9?e 745 0043 p. l w1iY OF SALEM, NIASSACHUSE7TS 1c S it c6t _ BOARD a= HEA67HHG{(}8 .P} y (?:>v ',- ` `:G7 `WA3r1NG.70N STR_ET, CTM FLoaR A. C.LC , MA nl97G rE'_, 1470-74,.1600 . FAX 4178.745-0343 JOANN? SC077, MON, R$ "HG MAYOfI {<F/1Lrn As:.xur APPLICATION FOR A TEMPORARY FOOD SERVICE PERMIT CjtL��71'1G4 iQrtnl Y {`� &'nr%�r(e FEE: 1-3 DAYS= *0 N(_,1—e e &,r SC,I-e r" _ . ate m so - tw-ee+ MORE THAm 7 DAYS$400 �t5i�c?SSi S ... -.. - - (,(.,�t(sP (1`Sf1tX ._0accu.u,�raets .a ,Nocokw NAMEar EvEM CS�it e_6Ie ;.`cAnoN i-3f`ig ltt5�1 ( ° �t �7i... _OATeis}-OF EYENT' i-r�Cid ,Fyl^ltG 4 ,C7: '2C;C:i�� SDiRk TSBRAA?AjS6A7 CRF''! ,s ,�,�r�,e�anNr_�9k//��FCLuPiiTE �-�,NAneEar AaaccpANT--� ADDRES:: /G/"GdN//P/,�C ' - -A4 F/y -----�NAME oreusmEss / - TELEFftOPtE'0 ADDRESS CGRT1Ftt0 PbOD MANAGERS NAICE DVJrtT'� .....t CERTfKtCATitNT.l.LL b, �i,C� A FLAN OF-HE ESTASLISriMENT,S: _' ENCLU5ED DRAWN ON TIIE SACU TYPE OF RErRIGERA-noN -,,,__GA9 _IC,S -„,—_DRY ICL _077 GR METHOD FOR C:OONINGtHOT HOUNNG" -GAS OTHEA A4E7NOfO,FOR SAwriZtNG. CHtMtGAI O`HER Y- V SG>tm&OF FOOD: Nme. AODRESS �,> fUaDS r,6E Sc"PIVEi INJ'wDIKG:NGrtcOIC�:TS ANC NE;i�„D OF'FPEPARATIUN ___ '__"- _ S'7`R.4tJ86A_,_„�,-CiN6 2AK� u�(rri..CHatuATf SaiR L'REari <AaE -__ ' I HAVE:READ THE e0AFJ)Or i'cnt_7'11, ••RSCU1Rt M2Nr7 FOP rEMPOr,AAy n)op E37ACLISHMEN TS I HAVE HAD SHE.001+0+R'I)NITY TO ASK CUCdTON?REt7AADING 140SE FEOINRFAAEN%;. IUNCERSTA.NOTHEM ALiIt,-* ,C)A811?E'OYtt1F;KIANGUNL'ER`>7,M1dii ''i1A7 �AIL,Pc 1C CO 30 WILL St SULT W REVOCATION Of eOY'�9,MFORARY F000 CSTASUSHMFNT oEHM17 .'AEFSVANi-Ta M,(y E'Lfj�C. S+S LSA. I{ERTIt�Y UNG%�Tri FLNAttif..<T° QGi:JUh` :t4h, I, TJ Hnt 3�-r tCNOWt 1Gc-tNt;.4=,.L'F. hAVE:d,=U ALL� TrvY :1RN$ei�410A'J/ATE 1.AXE�l Ar iR4a o'? SIGNATURE DATE SOCIAL SECURITt OR PoW£RAL ID L� RESTAURANT 02/10/06 BATCH/BULK RECIPE FORM ITEM COST $0.00 Strawberry cheesecake UNIT QUANTITY 1COST/UNIT #DIV/0! INGREDIENT QUANT UNIT UNIT COST INGRED.COST QUANTITIESIUNITS OF MEASURE cream cheese 2.00 Ibs $0.00 whole eggs 2.00 ea $0.00 egg yolks 2.00 ea $0.00 vanilla extract 2.00 tsp $0.00 sugar 1.00 cup $0.00 strawberries 1.00 pint $0.00 Isour cream 1.00 pinr $0.00 cocoa powder 1.00 cup $0.00 $0.00 $0.00 PREPARATION PROCEDURES $0.00 blend strawberries. Pass through sieve to $0.00 remove seeds. In mixer mix eggs, extract, si SUBTOTAL-PART#1 $0.00 and cream cheese until smooth. Separate I $0.00 equally in two separate bowls. Add strawbei $0.00 puree to one bowl and mix. $0.00 Pour vanilla mixture into springform pan thei $0.00 pour strawberry mixture on top of that. I SUBTOTAL-PART#2 $0.00 Bake at 325 degrees for approx. 45 minutes. Let cool for 4 hours. Mix 1/4 cup of sugar ai TOTAL COST $0.00 cocoa to sour cream and place on cake. HANDLING/STORING PROCEDURES SPECIAL INSTR 1CTIONS: 0094 Wharf Street Capt.'s Waterfront Grill & Club City of Salem FOOD SERVICE ESTABLISHMENT - FOOD SERVICE Inspection HACCP: ❑ Item Status Violation Critical Urgency Telephone: Violations Related to Good Retail Practices (Blue Items) 978-741-0555 Equipment and Utensils FAIL BLUE Owner: _ Comment:Walk in refrigerator walls and ceiling require thorough cleaning.To be cleaned by next routine inspection. The Waterfront Asset Co., 1 PIC: GENERAL COMMENTS: Dirk Isbrandtsen 817:AII violations unless noted have been corrected. thank you. Inspector: John Gehan Date Correct By: I lg : Risk Level: Permit Number: BHP-2006-0039 Status: Open #of Critical Violations: 0 Time IN: Time OUT: Urgency Description(s): BLUE: Violations Related to Good Retail Practices (Critical violations must be corrected immediately or within 10 days)(Non-critical violations must be corrected immediately or within 90 days) City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741-1800 GeoTMS®2006 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Sep 14,2006 ) Page I oft Y w Item Status Violation Critical Urgency RED: Violations Related to r 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. Sep 14,2006) Page 2 oft 'rtAMt^ 4^'1';YPie'xI�M:'""uF+?:� 'F' "',NRErl�P. ..x�T. wm.T� .+Y�t:i�i+W •'�tvel:$�+y "+ty^ �3A+.m^^w .vr 4yw. `�cF"L ��[�, .,bs Ss N` .,C ?is^q!Y.. .'ac°gN�b` � P"I��' z"�'�1t'�� •'•Stn -$�+��.pdc" R: _ •jN',,c . .»�r'o';�: ,, '..i-. .. .-g•"', t.� *i;�.r�, "ey 5t .ye3`n��w ryw t,. ��v�.Y,,' y,¢" —� -� ' ,`• Commonwealth of Massachusetts _ ;. 3 �. : s City of Salem .i.. �. Board of Health nalik" 120 Washington Street,4th Floor SALEM,MA 01970 lkwwFood/Retail Establishment Permit ;-gvw�r/ DATE PRINTED: 01/02/2006 WHO'S PLACE OF BUSINESS IS: Capt.'s Waterfront Grill & Club File Number:BHF-2004-0093 94 Wharf Street Salem MA 01970 LOCATED AT: 0094 WHARF STREET SALEM,MA 01970 Permit Type Permit No. Permit Issued Permit Expires Fee Restrictions/Notes FOOD SERVICE BHP-2006-0039 Jan 2,2006 Dec 31,2006 $200.00 ESTABLISHMENT Total Fees: $200.00 PERMIT EXPIRES December 31, 2006 Board of Health �w 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. Lf 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 10 of 26 CITY OF SALEM, MASSACHUSETTS BOARD OFHEALTH S � 120 WASHINGTON STREET, 4TH FLOOR SALEM, MA 01970 TEL. 978-741-1800 STANLEY J. USOVICZ, JR. FAx 978-745-0343 MAYOR W W W.SALEM.COM JOANNE SCOTT, MPH, RS, CHO HEALTH AGENT 2006 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT NAME OF ESTABLISHMENT CAPT )f Ar)&'RFleoaT 6k1 t TE # 97k'7y1—OJ-JT ADDRESS OF ESTABLISHMENT 9Y MMP— Sf- SAIV/ M 0/970 MAILING ADDRESS (if different) �/— , J �,y OWNER'S NAME L /DZK A99.410PJ—Y�/" TEL# 7� 11J7 � ADDRESS CITY l 6 STATE zip all CERTIFIED FOOD MANAGER'S NAME(S) S• r !� CERTIFICATE#(s) O (required in an establishment where potentially hazardous food is prepared.) cE�L. 6/7-6flo-7S"97 EMERGENCY RESPONSE PERSON 1>/2k =,8M t)UrSFA) HOME TEL# �7XV-671-7S-3Y HOURS OF OPERATION: Mon. 31/ !/ Tue. all °I Wed. !0 ! Thu. l/tel Fri. 2!/ Sat. &!—! Sun. //"-/ TYPE OF ESTABLISHMENT FEE (check onlvt RETAIL STORE YES NO less than 1000sq.ft. =$ 50 1000-10,000sq.ft. =$100 more than 10,000sq.ft. =$250 --------------------------------------------- ----------------- -------------------- --- - .--n---2- -.. --- -.......---_- --- -------------..- RESTAURANT YES NO less than 25 seats $100 /� /-6/„ more seats =$� ( �f/ more than 99 seats $200 ..............................................--------------------------------------$100- - ---------------- BED/BREAKFAST YES NO ADDITIONAL PERMITS ------------------------------------------------------------------------------......--------------------------------------- MAKE (notjust serve) ICE CREAM, YOGURT, SOFT SERVE YES NO $5 TOBACCO VENDOR YES . NO $50 ALL NON-PROFIT(such as church kitchens) YES NO $25 *Please pay total with one check payable to the City of Salem . This Permit is not transferable and must be reissued upon change of ownership. The Permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code, before any renovations, improvements, or equipment changes are made, all plans for such must be submitted to and approved by the Salem Board of Health. Pursuant to MGL Chapter 62C, Section 49A, I certify under the pains and penalties of perjury that I, to my best knowledge nd be ave d all state tax returns an paid all state taxes required under the law. r�v1� Signature Date / / Social Security or Federal Identification Number ------------------------------------------------------------------ ------------------------------------------------------- Revised --------- -------------- -- Revised 11/03/05 FOODAP2.adm Check#&Date `'G �e 0094 Wharf Street Capt.'s Waterfront Grill & Club City of Salem FOOD SERVICE ESTABLISHMENT - FOOD SERVICE Inspection HACCP: ❑ Item Status Violation Critical Urgency Telephone: FOOD PROTECTION MANAGEMENT 978-741-0555 PIC Assigned/Knowledgeable/Duties PASS 0 RED Owner: PROTECTION FROM CONTAMINATION The Waterfront Asset Co., I Handwash Facilities PASS ❑J RED PIC: Dirk Ist randtsen Violations Related to Good Retail Practices (Blue Items) Inspector: Food and Food Protection FAIL BLUE John Gehan Comments: Container of lemons stored directly on ice for customer consumption. Container to be relocated. Date Inspected: Correct By: Equipment and Utensils FAIL BLUE 2/9/2006 Risk Level: . Comments: Ice machine had accumulation of mold growth. Unit requires thorough cleaning. Permit Number: Physical Facility FAIL BLUE \ BHP-2006-0039 J Comments: Chipping paint in the walkin freezer. scrape and repair any loose paint to make walls and ceiling of unit smooth, Status: impervious and easily cleanable. Paintchips observed at time of reinspection. Open , Freezer needs to be completed within two weeks. Owner to notify Board of Health upon completion. #of Critical Violations: 0 GENERAL COMMENTS: Time IN: Time OUT 507: Urgency Description(s): l 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. Mar 02,2006 ) Page I oft r- 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. Mar 02,2006 ) Page 2 oft 0094 Wharf Street Capt.'s Waterfront Grill & Club City of Salem FOOD SERVICE ESTABLISHMENT - FOOD SERVICE Inspection HACCP: ❑ Item Status Violation Critical Urgency Telephone: FOOD PROTECTION MANAGEMENT 978-741-0555 PIC Assigned/Knowledgeable/Duties FAIL Q RED Owner: ✓Comments: no certified food manager on hand at time of inspection. certified food manager on hand had expired certificate. The Waterfront Asset Co., I Certified food manager to be on hand at all times. PIC: Non-compliance with: _ Dirk Isbrandtsen Anti-Choking PASS Inspector Comments: establishment to have person on staff at all times certified in choke save. John Gehan Tobacco PASS Date Inspected: Correct By: 2/9/2006 3/f EMPLOYEE HEALTH Risk Level: r Reporting of Diseases by Food Employee and PIC PASS ] RED Personnel with Infections Restricted/Excluded PASS 0 RED Permit Number, BHP-2006-0039 FOOD FROM APPROVED SOURCE StatusFood and Water from Approved Source PASS ❑d RED Open #of Critical Violations: Receiving/Condition PASS RED 4 Tags/Records/Accuracy of Ingredient Statements PASS 0 RED Time IN, Time OUT. Conformance with Approved Procedures/HACCP Plans PASS RED Urgency Description(s). BLUE: Violations Related to Good Retail Practices (Critical violations must be corrected immediately or within 10 days)(Non-critical violations must be corrected immediately or within 90 days) City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741-1800 GeOTMS®2006 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Feb 13,2006 ) Page I of Item Status Violation Critical Urgency RED: PROTECTION FROM CONTAMINATION Violations Related to Separation/Segregation/Protection PASS ❑0 RED Foodborne Illness Interventions and Risk Factors (Require Food Contact Surfaces Cleaning and Sanitizing PASS RED immediate corrective action) " Proper Adequate Handwashing PASS ❑d RED Good Hygienic Practices PASS RED Prevention of Contamination from Hands PASS RED Handwash Facilities FAIL Critical 0 RED VComments: Paper towel dispenser up stairs missing paper towels. Provide paper towels. lmd wash sinks upstairs obstructed. All hand wash sinks must be easily accesible. ✓Ha9nd wash sink requires thorough cleaning. ✓Handwash sink downstairs near ice cream freezer has accumulation of food debris. Hand wash sinks must be used for hand washing only. VHand wash sink near dish wash station has no soap. Peovide soap for employees. `Hand wash sinks must be used for hand washing only. PROTECTION FROM CHEMICALS Approved Food or Color Additives PASS RED Toxic Chemicals PASS 0 RED TIMEITEMPERATURE CONTROLS(Potentially Hazardous Foods) Cooking Temperatures PASS 0 RED Reheating PASS RED Cooling PASS RED Hot and Cold Holding PASS 0 RED Time As a Public Health Control PASS 0 RED REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) Food and Food Preparation for HSP PASS RED 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. Feb 13,2006 ) Page 2 of Item Status Violation Critical Urgency CONSUMER ADVISORY Posting of Consumer Advisories PASS RED City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741-1800 GeoTMS®2006 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev Feb 13,2006 ) Page 3 of Item Status Violation Critical Urgency Violations Related to Good Retail Practices (Blue Items) Food and Food Protection FAIL Critical BLUE Comments:True unit had uncovered food in it. All food in storage must be covered. LIKSt and rice found stored on floor. All food must be stored 6-8 inches off of the ground. L", toes stored on floor. All foods must be stored 6-8 inches off of the ground. VWalk in refrigerator had uncovered foods. All foods in storage must be covered. 0 tfood stored on floor in walk in freezer. All food must be 6-8 inches off of the ground. I Watk in freezer had uncovered food. All food must be covered in storage. Equipment and Utensils FAIL Critical BLUE GComments: Units upstairs require thorough cleaning and sanitizing. Units should be cleand after each use. _.,,Knives upstairs found with accumulation of food debris. Clean and sanitize knives correctly. • Ice cream unit upstairs requires general cleaning. . fiicrowave upstairs requires general cleaning. yShelf above 3-bay sink downstairs requirs general cleaning. o. 6,True unit in kitchen requires general cleaning. 0 ' eat slicer found with accumulation of food debris. Slicer must be clean and sanitized thoroughly. •. I Bev-air unit requires general cleaning. 1' l�CGttmg boards stained and scored throughout establishment. Replace or resurface boards. n LWarmer requires general cleaning in and beneath it. a, Vdoor refrigerator next to the grill requires general cleaning. q LAOicrowave requires general cleaning. ce Cream scoops found with accumulation of food debris. Thoroughly clean and sanitize ice scoops. Ice scoops must also be stored in running water when in use. e. 61'c�e cream freezer requires general cleaning. d LPro iv de sanitizer that is readily available with correct ppm's at each work station. 'VWalk in requires thorough cleaning. 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. Feb 13,2006 ) Page 4 of Item Status Violation Critical Urgency ` n„Walk in missing thermometer. Provide visible and accurate thermometer. -- Ice machine needs thorough cleaning of inner pannel. p cee scoop container requires thorough cleaning. K",ife on top of washing machine in bar area had accumulation of food debris. Clean and sanitize thoroughly. arref''rigeration(black)missing thermometer. Provide visible and accurate thermometer. %,K/elabel the sanitizer bottle in bar area stating"sanitizes". 10, (ice ✓Walk in freezer missing thermometer. Provide visible and accurate thermometer. Water, Plumbing and Waste PASS BLUE Physical Facility FAIL BLUE -Comments: Upstairs ceiling has opening to attic. Provide proper door or hatch. Chipping paint in the walkin freezer. scrape and repair any loose paintto make walls and ceiling of unit smooth, impervious and Veasily cleanable.. Management and Personnel PASS BLUE Poisonous or Toxic Materials PASS BLUE Special Requirements PASS BLUE Other-See Notes PASS BLUE GENERAL COMMENTS: 467: 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. Feb 13,2006 ) Page 5 of HP Fax Series 900 Fax History Report for Plain Paper Fax/Copier Joanne Scott Salem BOH 978 745 0343 F&27-20@6-121 pm_ Last Fax Date Time Twe Identification Duration Paees I Feb 27 11:59am Sent 919787418722 1:59 6 OK I Result: OK - black and white fax an� t er► a/a�o� CITY OF SALEM, MASSACHUSETTS • ; BOARD OF HEALTH s 120 WASHINGTON STREET, 4TH FLOOR SALEM, MA 01970 TEL. 978-741-1800 FAk 978-745-0343 Kimberley Driscoll WWW.SALEM.COM Mayor JOANNE SCOTT, MPH, RS, CHO HEALTH AGENT Facsimile Transmittal To: Fax# gem.-01 RE: -AwlL� W � Date : al oZ�/D�o 6 Page(s): including this cover# Message7D,rt 'k is o Board of Health News ----------------------------------------------------------------For Your Information OFFICE HOURS: Monday, Tuesday, & Wednesday 8:00 AM to 4:00 PM Thursday 8:00 AM to 7:00 PM Friday 8:00 AM to 12:00 Noon Do Salem Residents Know ? — Applications for a permit to remove exterior paint are required by the Salem Board of Health. No fee for permit and electric sandinq is not permitted. Regulations for home owners and painting contractors are available. 0094 Wharf Street Capt.'s Waterfront Grill & Club City of Salem FOOD SERVICE ESTABLISHMENT - FOOD SERVICE REINSPECTION Inspection HACCP: ❑ Item Status Violation Critical Urgency Telephone: Non-compliance with: 978-741-0555 Anti-Choking PASS Owner. Tobacco PASS The Waterfront Asset Co., I PIC: FOOD PROTECTION MANAGEMENT Brian Kilroy PIC Assigned/Knowledgeable/Duties PASS I] RED Inspector: David Greenbaum Date InspectedEMPLOYEE HEALTH ' Correct By: Reporting of Diseases by Food Employee and PIC PASS ❑J RED 11/9/2005 Personnel with Infections Restricted/Excluded PASS RED Risk Level: .. FOOD FROM APPROVED SOURCE Permit Number: Food and Water from Approved Source PASS RED BHP-200540313 Receiving/Condition PASS RED Status: SIGNED OFF Tags/Records/Accuracy of Ingredient Statements PASS RED #Of Critical Violations: Conformance with Approved Procedures/HACCP Plans PASSd❑ RED 1 Time IN. Time OUT Urgency Description(s): BLUE: Violations Related to Good Retail Practices (Critical violations must be corrected immediately or within 10 days)(Non-critical violations must be corrected immediately or within 90 days) City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741-1800 GeOTMS®2005 Des Lauriers Municipal Solutions, Inc Commonwealth of Massachusetts ( Rev. Nov 09,2005 ) Page I of Item Status Violation Critical Urgency RED: PROTECTION FROM CONTAMINATION Violations Related to Separation/Segregation/Protection PASS ] RED Foodborne Illness Interventions and Risk Factors (Require Food Contact Surfaces Cleaning and Sanitizing FAIL Critical 0 RED immediate corrective action) Comments:The long cutting board in the cookline must be replaced. Proper Adequate Handwashing PASS ❑ RED Good Hygienic Practices PASS 0 RED Prevention of Contamination from Hands PASS ❑d RED Handwash Facilities PASS ❑d RED PROTECTION FROM CHEMICALS Approved Food or Color Additives PASS RED Toxic Chemicals PASS RED TIMEITEMPERATURE CONTROLS(Potentially Hazardous Foods) Cooking Temperatures PASS ❑ RED Reheating PASS RED Cooling PASS RED Hot and Cold Holding PASS [vfl RED Time As a Public Health Control PASS RED REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) Food and Food Preparation for HSP PASS 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®2005 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Nov 09,2005 ) Page 2 of N—+ Item Status Violation Critical Urgency Violations Related to Good Retail Practices (Blue Items) 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 Comments:All other violations cited in the 10/26/05 inspection report have been corrected. GENERAL COMMENTS: 366:AII refrigeration/freezer units in the second floor kitchen should be up and running at all times. City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741-1800 GeOTMS®2005 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Nov 09,2005 ) Page 3 of 0094 Wharf Street Capt.'s Waterfront Grill & Club City of Salem FOOD SERVICE ESTABLISHMENT - FOOD SERVICE Inspection HACCP: ❑ Item Status Violation Critical Urgency Telephone: Non-compliance with: 978-741-0555 Anti-Choking PASS Owner. Tobacco PASS The Waterfront Asset Co., I PIC: FOOD PROTECTION MANAGEMENT Brian Kilroy PIC Assigned/Knowledgeable/Duties PASS RED Inspector: David Greenbaum EMPLOYEE HEALTH Date Inspected:)Correct By: ;. Reporting of Diseases by Food Employee and PIC PASS RED 10/26/2005 Personnel with Infections Restricted/Excluded PASS RED Risk Level: FOOD FROM APPROVED SOURCE Permit Number: Food and Water from Approved Source PASS ❑ RED BHP-2005-0313 Receiving/Condition PASS ❑ RED Status: VIOLATION Tags/Records/Accuracy of Ingredient Statements PASS RED #of CfItiC81 Violations: Conformance with Approved Procedures/HACCP Plans PASS RED i 5 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®2005 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Oct 27,2005 ) Page I of Item Status Violation Critical Urgency RED: PROTECTION FROM CONTAMINATION Violations Related to Separation/Segregation/Protection PASS Q RED Foodborne Illness Interventions and Risk Factors (Require Food Contact Surfaces Cleaning and Sanitizing FAIL Critical Q RED immediate corrective action) c ` Comments:All cutting boards are badly stained and scored. Resurface or replace all cutting boards. e ySanitizing solution found too weak. Provide sanitizing solution of proper concentration at all work stations at all times. 'av Sanitizing log not being maintained. Provide a daily sanitizing log. Proper Adequate Handwashing PASS RED Good Hygienic Practices PASS ❑d RED Prevention of Contamination from Hands PASSd❑ RED ndwash Facilities FAIL Critical d❑ RED Comments: The handwash sink by the salad prep area is missing soap. Provide a stocked wall hung soap dispenser in this prep area. 'The handwash sink near the dishwash station found obstructed. Keep handwash sinks clear and accessible at all times. The handwash sink at the downstairs bar missing soap. Provide soap at this handwash sink at all times. PROTECTION FROM CHEMICALS Approved Food or Color Additives PASS RED Toxic Chemicals PASS RED TIME/TEMPERATURE CONTROLS(Potentially Hazardous Foods) Cooking Temperatures PASSd❑ RED Reheating PASSd❑ RED Cooling FAIL Critical RED Comments:Soup and chowder cooling in large containers. Cool soup and chowder in small containers no deeper than 4". Hot and Cold Holding PASS RED Time As a Public Health Control PASS RED REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) Food and Food Preparation for HSP PASS RED CONSUMER ADVISORY Posting of Consumer Advisories FAILd❑ RED City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741-1800 GeOTMS®2005 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Oct 27,2005 ) Page 2 of ' Item Status Violation Critical Urgency Violations Related to Good Retail Practices (Blue Items) Management and Personnel PASS BLUE F od and Food Protection FAIL Critical BLUE Comments: Label all dry ingredient containers. Container of lemons in the ice for customers drinks in the second floor wait station. Do not store any containers in ice for cutomer rinks to prevent cross contamination. Equipment and Utensils FAIL Non-Critical BLUE `Comments: The shelves with canned goods have an accumulation of food spills and splatter. Thoroughly clean all shelves. .t The Coke unit needs a a protective cover for the light. Label all handwash sinks"Handwash Sink Only' The microwave needs a thorough cleaning. s he ice cream freezer has an accumulation of food spills and splatter. Thoroughly clean the ice cream freezer. The ADT reach in missing a thermometer. Provide a visible accurate thermometer in this unit. rovide a non flammable screening for open area on the lobster tank. The mechanical vent fans in the restrooms not working. Repair fans to good working order. The bar reachin containing dairy products needs a clean mat and a visible,accurate thermometer. o The ice cream unit in the second floor kitchen has an accumulation of food spills and splatter. Thoroughly clean ice cream freezer. The microwave in the second floor kitchen needs a thorough cleaning. \ The Coke reachin in the second floor kitchen missing a thermometer. Provide a visible,accurate thermometer in this unit. Same unit needs a thorough cleaning. e The stove has an accumulation of food debris. Thoroughly clean stove. + \ Charcoal grill needs a thorough cleaning. abel produce sink"Produce Sink Only' N.jTrue freezer in second floor kitchen missing thermometer. Provide a visible,accurate thermometer in this freezer. The Beverage air unit upstairs needs a thorough cleaning. \ The knife racks need thorough cleaning. The reachin in the second floor bar area needs a visible,accurate thermometer. Water, Plumbing and Waste PASS BLUE hysical Facility FAIL Non-Critical BLUE � Comments:All walls,floors and surfaces have an accumulation of food debris,spills and splatter. Thoroughly clean all walls, ��/// floors and surfaces including under and around all equipment. Poisonous or Toxic Materials PASS BLUE Special Requirements PASS BLUE they-See Notes FAIL Non-Critical BLUE Comments: Rodent droppings observed in charcoal area. Monthly extermination being conducted. Owner will have A-1 Exterminators check area and treat as needed. City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741-1800 GeoTMS®2005 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Oct 27,2005 ) Page 3 of Item Status Violation Critical Urgency GENERAL COMMENTS: 361:Reinspection will be Monday, November 7, 2005. All items to be corrected. City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741-1800 GeoTMS®2005 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Oct 27,2005 ) Page 4 of 1 NOS%-21-2907 09:16 AN NNE" SECONDS COUNT 92 e _ I , ff .a�,, Choke Saving Course Registration #orl p' Each attendee must complete a Registration Form To reserve a span:in the Choke Saving Course Registration Form,please complete and iretLj ttf n Registration form to the Salem Board of Health. Course provided by When Seconds Count, InC;oal � : r. 'Class size is limited and will be on a first come first serve basis. " [:! F Mc istration Fee is Non-Refundable I • Registration Deadline is Friday,Deccrnber 28,2007 at 4:00 p.m Date of Registration: Form Completed by: 0 ) Name: b _ Restaurant: 0 '�44 Business Address:_ 9tc - L� City/Town l. . Business Phone: 7 1�+ _. State&Zip ILIA ,;!9 . ? 1,i Email: 1 undcrstand that the information provided to the City of Salem&When Seconds Count, in` I,be:k tilt confidential and i hereby attest that the information supplied on this Course Application is cote accurate. Cost: Choke Saving Class $5,00 per person 4 Course Date: Wednesday, January 1b, 2008 Time: 2 p.m. to 4 p.m. ; { iI Location: City Hall, 120 Washington Street, Floor 3, Salem, MA I I have read and understand the above registration form,its requirements. Student Signature: Date: i t l i,a Return the completed application and payment to: Salem Board of ! . 120 Washington ghstt; Salem,MA 01970; f r NOY•"21-2007 09:16 AM WHEN SECONDS COUNT P.02 Ari\ j A 1 �t Choke Saving Course Registration 'orli> : ; Each attendee must complete a Registration Form To reserve a span:in the Choke Saving Course Registration Fors,please complete and return 1 rt; J:J Registration forth to the Salem Board of Health. Course provided by When Seconds Co nt In o'; *Class size is limited and will be on a first come first serve basis_ r *Rc istration Fee is Non-Refundable cl g * Registration Deadline is Friday, December 28,2007 at 4:00 p.m. '� t Date of Registration: Form Completed by: Name: 7 f 1 n Cn ��r !A aP/�� Restaurant: /",a € 1 �i Business Address: _ _ City/Town �C p Business Phone: _ ` ZJ / �i r) l _ State&Zip 0/ �J �� ;aI :f ii F ` Emelt: t!k_ t i l understand that the information provided to the City of Salem&When Seconds Count, In l;tte: Capt confidential and i hereby attest that the information supplied on this Course Appiicatioa is lite tha accurate. Cast: Choke Saving Class $5.00 per person 4 Course Date: Wednesday, January 16, 2008 Time: 2 p.m. to 4 p.m. Location: City Nall, 120 Washington Street, Floor 3, Salem,MA , I have read and understand the above registration form,its requirements. fl Student Signature: Date: IT 1 J Return the completed application and payment to: Salem Board of i 120 washinel an tlilett. . Salem,MA 01970:�` P i ' L r NOV-21-2007 09:16 AN "NEN SECONDS COUNT A.02 i I , Choke Saving Course Registration Each attendee must complete a Registration Farm [t 1•. q. jy f Y .. Ili gY To reserve a span:in the Choke Saving Course Registration Form,please complete and Fretum c .i ti Registration form to the Salem Board of Health. Course provided by When Seconds Cont, Ir o:, 4 o ry;:: yg • ii} 'Class size is limited and will be on a first come first serve basis. 6• ; Mc istration Fee is Non-Refundable • Registration Deadline is Friday,Deccmbcr 28,2007 at 4:00 p.m. ;; .: Date of Registration: Farm Completed by: . 'j' Name:--� � V IU(} _ Restaurant:--1��j —V)A" Business Address: �L11 t{t CityfFown Business Phone:�'lx � Q C State&Zip Email: lip I understand that the information provided to the City of Salem&When Seconds Couit, 11110:V41 b4 apt confidential and I hereby attest that the information supplied on this Course Application is C40iiiiti6Q , accurate. Cost: Choke Saving Class S5.00 per person CI, Course Date: Wednesday, January 16, 2008 I t.. Time: 2 p.m. to 4 p.m. I, Location: City Hall, 120 Washington Street, Floor 3, Salem,MA I' I have read and understand the above registration form,its requirements. ' Student Signature: Date: 1 J• 1 �t Return the completed application and payment to: Salem Board of 120 Washington I I° Salem,MA 01970;'' L J, CITY OF'SALEM, MASSACHUSETTS BOARD OF HEALTH 120 WASHINGTON STREET, 4TH FLOOR SALEM, MA 01970 TEL. 978-741-1800 FAX 978-745-0343 STANLEY J. USOVICZ, JR. JOANNE SCOTT, MPH, RS, CHO MAYOR HEALTH AGENT COMMONWEALTH OF MASSACHUSETTS PERMIT TO OPERATE A FOOD ESTABLISHMENT In accordance with regulations promulgated under authority of Chapter 94, Section 305A and Chapter 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: Capt.'s Waterfront Grill & Club Address of Establishment: 94 Wharf Street Owner's Name: The Waterfront Asset Co., Inc. Restrictions: Application Date: 12/7/2004 Permit for Food Establishment 208-05 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 r CITY OF SALEM, MASSACH o IPTG° !J y BOARD OF HEALTH DEC � $ 120 WASHINGTON STREET, 4TH FLOOR L�EC - 3 2004 go r?p SALEM, MA 01970 .� TEL. 978-741-1800 CITY O� FAX 978-745-0343 STANLEY J. USOVICZ, JR. JOANNE SCOTT, MPH, RS, CHOCARD OFHEAMH MAYOR HEALTH AGENT 2005 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTA LI. HMENT NAME OF ESTABLISHMENT T!!We/TEL# I/rFr�I/�� ADDRESS OF ESTABLISHMENT MAILING ADDRESS (if different) (� c�d p/kk ZSS/lkti/�l7T1�/t/ OWNER'S NAME 7X /�A'� eW. 1Ak_. TEL# ADDRESS X/ e "'Pe5�"Tj PX/N6 Pl- U-19, CITY 110 ,616-h'- // STATE ZIP 4�Y `z�- �br p CERTIFIED FOOD MANAGER'S NAME(S) 14114i.4M Aldi CERTIFICATE#(s) r4')It 9+1'?- f, tI nit�r05P:roe,,#fb Fain cv� i�AP� Rnflk16G1� _ /<E-lord aOALey ArnCH601r •: (required in an establishment where potentially hazardous food is prepared.) 2 �Q EMERGENCY RESPONSE PERSON- ,4aL /t � rx' t��'!�/J HOME TEL# 7,el-�3f !!32 a -p 6 HOURS OF OPERATION: Mon. /)Tue�n Wed./ 3OLThu. Fri.%/-12'5at. //3/2 Sun. � TYPE OF ESTABLISHMENT FEE check only RETAIL STORE YES NO less than 1000sq.ft. =$ 50 iGGG-iG,Gu"usq.fi. =$iiG more than 10,000sq.ft. =$250 RESTAURANT YES NO �� less than 25 seats =$100 l% 25-99 seats more than 99 seats =$200 BED/BREAKFAST YES NO $100 ADDITIONAL PERMITS MAKE (not lust 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 penury that I, to my best knowledge and belief, have filed all state tax returns and paid all state taxes required under the law. Signature;------ ---- --- Date-- —Social Security or Federal Identification Number �r 71 Revised 11/03/03 FOODAP2.adm Check#8 Dated � h-7 ae) t4 �x r .�1 r tkilm IT .�► 7 g n i N x !J2- < � i 00 ( IMPORTANT MESSAGE ) FOR `p DATE TIME -d P. M OF �'(ir/�%ifi ilY PHONE AREA CODE NUMBER EXTENSION 0 FAX 0 MOBII F AREA CCOE MEER 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 �- f, SIGNED SOPS. M°OE IN w NOTES JOB WORK ORDER 7482 REFRIGERATION HEATING .V�j.{rlgd road-8✓,444M4O,V21 DATE OFORDER CUSTOMER'S ORDER NO PHONE GH'NI HELPER STARTING DATE TrORDER/KEN By ADDRESS ❑ DAV WORK ❑ CONTRACT Gln G /� � �� '+w. ❑ EXTRA `�l�\ �uH/ �L•d 1 JOB NAME ANTJ LOCATION JOB PHONE PHONE -lrlr tAhriYllVUr'��i�, r_ DESCRIPTION OF WORK: LA jk'�k�v UAf mk As <,uv gc� - l) TOTAL MATERIALS TOTAL LABOR TAX DATE COMPLETED f WORK ORDERED BY ` TOTAL AMOUNT $ ❑ No one home ❑ Total amount due ❑ Total billing to r7 �r above work or be mailed after SI i .completion I hereby acknowledge the satisfactory completion of Work of the above described work I., IMPORTANT MESSAGE FOR ti vip,4- I 1- 0 DATE TIME M OF-CqW in 4n PHONE �Qm ggb Q FAX Ll NAOBII P AREA CODE NUMBER TIME TO CALL TELEPHONED 11 PLEASE CALL CAME TO SEE YOU WILL CALL AGAIN WANTS TO SEE YOU RUSH RETURNED YOUR CALL f WILL FAX TO YOU MESSAGE RP- CftA"j b cm6yro ttincroi-Nm SIGNED FORM 4(,)09 w7ops %IAUF IN U r A 1 NOTES IMPORTANT MESSAGE ) FOR 11 P-+ DATE D 12--1 0¢ TIME M �►nA Lf, OF—La. ±' l I PHONF AREACODE '1., N/U�MHEER EXTENSION iFAX MOBIl F (01-f 2-b b J2-Q AREA CORE PNMHER TIME TO CALL TELEPHONED ► PLEASE CALL CAME TO SEE YOU i WILL CALL AGAIN WANTS TO SEE YOU RUSH RETURNED YOUR CALL }}� WILL FAX TO YOU � MESSAGE ITQ, UVUlM1/ �11� TU 1/l/P� K , �mrhtravv I f ` SIGNED ps W J FORM 4 MMM MARE 1 5 S A A NOTES 4 a r ( IMPORTANT MESSAGE M ) FOR v 64N- DATE g k 10 4- AA i 1 u TIME 19 . �� PDP pt' M �1�YVL /� ..1- OF PHONE (O AREA CICII NUMBER EXTENSION ❑ FAX Or MORI, F= y AREA CORE NUMBER TIME TO CAL f -� EPHONEO I PLEASE CALL V ' CAME TO SEE YOU I WILL CALL ACAIN WANTS TO SEE YOU RUSH RETURNED YOUR CALL I WILL FAX TO YOU MESSAGE SIGNED r +4M FORM 4009 MADE IN J S A NOTES i rJ -tvS, cv-e on to Li 45 ; �i Y } 1 i ( IMPORTANT MESSAGE ) FOR / DATE P M PHONE_. .. AREA CODE NUMBER EXTENSION ❑ FAX ❑ MOBI1 F AREA CODE NUMBER TIME TO CALL TELEPHONED PLEASE CALL CAME TO SEE YOU WILL CALL AGAIN WANTS TO SEE YOU RUSH RETURNED YOUR CALL WILL PAX TO YOU MESSAGE SIGNED Y INO� FORM 4009 UU MAGE IN U SA. NOTES + 4 / �e II _ __ _ i I -_ it -_ II _ II _ II -_ II - II - - I - _ I _ II - � - - I - - - - I , ( IMPORTANT MESSAGE ) FOR DATETIME M M d' C OF PHONE 6< n j AREA CODE NUMBER EXTENSION a FAx ❑ MOBII F AREA CODE NUMBER TIME TO CALL TELEPHONED 1 PLEASE CALL CAME TO SEE YOU WILL CALL AGAIN WANTS TO SEE YOU I RUSH RETURNED YOUR CALL WILL FAX TO YOU SSAGE ,� �'' r.✓L ��L'yl eA.� 4 SIGNED NOTES I i I I i Lk vu pear -rv.+aro;`w.' �$,`±d�w'�"�*�a'.%u. �,.. .a'ri.. .�m;w+.}., .y.ns:,,,. .•Ne.�.s«.:, - �. -x'u :^..' CITY OF SALEM, MASSACHUSETTS " BOARD OF HEALTH • w 120 WASHINGTON STREET, 4TH FLOOR � SALEM, MA 01970 TEL. 978.741-1800 FAX 978-745-0343 STANLEY J. USOVICZ, JR. JOANNE SCOTT, MPH, RS, CHO MAYOR . HEALTH AGENT COMMONWEALTH OF MASSACHUSETTS PERMIT TO OPERATE A FOOD ESTABLISHMENT In accordance with regulations promulgated under authority of Chapter 94, Section 305A and Chapter III, Section 5 of the General Laws, to operate a Food Establishment in the City of Salem is hereby granted to: Type of Establishment: FOOD SERVICE Name of Establishment: Capt.'s Waterfront Grill & Club Address of Establishment: 94 Wharf Street Owner's Name: The Waterfront Asset Co., Inc. Restrictions: Application Date: 11/5/2004 Permit for Food Establishment 317-04 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 or De- �5 - P � �- JOD CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH 3 i 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: Type of Establishment: FOOD SERVICE Name of Establishment: Capt.'s Waterfront Grill & Club Address of Establishment: 94 Wharf Street Owner's Name: The Waterfront Asset Co., Inc. Restrictions: Just 2nd floor only. Application Date: 7/21/2004 Permit for Food Establishment 317-04 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 ,,o,,fAHealth. HEALTH AGENT CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH 120 WASHINGTON STREET, 4TH FLOOR SALEM, MA 01970 NAYN1ny 2 7 2004 TEL. 978-741-1800 FAX 978-745-034.3 CITY OF SALEM STANLEY USOVICZ, JR JOANNE SCOTT, MPH, RS, CHO BOARD OF HEALTH MAYOR HEALTH AGENT 2004 APPLICATION FOR OPERATE A FOOD ESTABLISHMENT / PE NAME OF ESTABLISHMENT 1 �(f /� S /`ITE/1FRdA �k&TEL ADDRESS OF ESTABLISHMENT 97 W11-4tt MAILING ADDRESS (if different) (!a YA < A e MOAa r /11Z 11 T Co' SnJC. c _ OWNER'S NAME �/�IC SjRRAAJT�lfe� TEL# 97,P-7SI-afY Y ADDRESS 9V AJ/ Iglu CITY-( fAL.E'M STATE IL4f1 ZIP CERTIFIED FOOD MANAGER'S NAME(S) CERTIFICATE#(s) �tTfR�l� (required in an establishment where potentially hazardous food is prepared.) EMERGENCY RESPONSE PERSON HOME TEL# //AH- 11411- AAAN-' ARAM- , 11'gW M11,414"" 11,41,111,41,1HOURS OF OPERATION: Man.lATue. _MWed.AAMThu._Aj1�Fn.AAMSat. LAM Sun. rAM TYPE OF ESTABLISHMENT FEE check only RETAIL STORE YES NOt Q less than 1000sq.ft. =$ 50 �_0 7 1000-10,000sq.ft. =$100 3) more than 10,000sq.ft. =$250 RESTAURANT YES NO less than 25 seats =$100 25-99 seats 150 more than 99 seats BED/BREAKFAST YES NO $100 ADDITIONAL PERMITS MAKE (not just serve) ICE CREAM, YOGURT, SOFT SERVE YES NO $5 TOBACCO VENDOR YES NO $50 ALL NON-PROFIT(such as church kitchens) YES NO $25 Please pay total with one check payable to the City of Salem This Permit is not transferable and must be reissued upon change of ownership. The Permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code, before any renovations, improvements, or equipment changes are made,all plans for such must be submitted to and approved by the Salem Board of Health. Pursuant to MGL Chapter 62C, Section 49A, I certify under the pains and penalties of perjury that I, to my best knowledge and belief, have filed all state tax returns and paid all state taxes required under the law. Signature -Date Social Security or Federal Identification Number A ---_---____ _ _ _ _________ ____________________________ _____________________________„_ Revised 1 v03/03 FOOOAP2.adm Check#&Date OZ27 .S>�Z fJ/ haw'` CITY OF SALEM BOARD OF HEALTH Establishment Name:C fer.� M41-ax-eKeerr (r'/E/LL_ Date: ��s�� Page: of Item Code c-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date No. Reference R—Red Item Verified PLEASE PRINT CLEARLY + �v�t S�an� J,ar�fw, Ce 4,E t: "r [=mode- rraar,�eNr 11-4,r ,cars— I u (1 rf 4.011 t a r.+«r N f f t-A 0 WA .r.a'.ir- .f edN.O a..rr W d6 �fj4leLKrr 11j 1j&trrir6 �G / r? /��_ lCl a,141 n/ ,.r �i.ss nd�r, fe1- J' wv, Nw d. gc e ('75 ry is ro-ex Ps Gi4F.Yrt3i a 6 arm- eau_ evAk?wr, en/ ari of pm AC r 0Wc 7 on/r 416- odor- Vm& 1 I 1 1 l Discussion With Person in Charge: Corrective Action Required: I ❑ No I ❑ Yes have read this report, have had the opportunity to ask questions and agree to correct all ❑ Voluntary Compliance ❑ Employee Restriction/ Exclusion violations before the next inspection, to observe all conditions as described, and to ❑ Re-inspection Scheduled ❑ Emergency Suspension comply with all mandates of the Mass/Federal Food Code. I and tand that/J noncompliance may result in daily fines of twenty i�ve dollars ods pensrt'r/evocation of ❑ Embargo ❑ Emergency Closure your food permit. ' �/ � ❑ Voluntary Disposal ❑ Other: ";C) PHFe Recetwd at'Pemperaty:es Violations Related io Foodborne lilness Interventions and Risk A<rordina'u t.::w G;oled to Factors(items 1.22) (Cont.) 41`F/45`FV,it4in4Hutu;- PROTECTION FROM CHEMICALS 'O(i1 15' Coling Methods for PILNs j 14 Food or Color Additives i � 79 PHF Hut and Cold Holding 3202.12 Addibt`:.'" 3-5')1.16(B! Cold III IF:. Matntainri[at or below j 550,004(c) =1'74:1' F° 3-302.14 ote<lion Brum i?nappnned .ci�iihszs* ;-501-16(A) TIM FHFs Miint.imecl at or above 1.5 Poisonous or Toxic Substances - 7-10!.11 identif}vie lnfounation-Original ! 14C'F. " -- Cunminers" 13-501.16(A) Roasts Held ai or above I;'011P. " 7-102,11 Common Name,-Woilong Containers" � 20 Time as a Public Health Control j l 1 ? 7-20211 Separation-:%tonere" -5G1 li Time a6 c a Public Health i:tail* j 590.004[11) Vallance RPULIIR-111CA 7-J(}2 11 Re<srictiun - Presence and i.'se' 7-20 .'2 Conditions ut erse" � REOUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-203.0411 Toxic Cts,Cr4rcrri;--[inhibitions* POPULATIONS(HSP; ?..^04.'! Santiiizets,Ori r.cr•a-Chci.ncals-�. 7-204 !11 Clliewicals for W'ashinL Pruduce, Criteni � � 21 3-ROI I)t,4) t.n7;actew'�reti Pre-pac}:aged Juices and 8eceriges vntn eL'aming Lxn wW 7-205.1.1 hciDryikQ ,,l Foo.Cvutai del I a" I 3-301.11 B! t'r.e 4 Piste:nri::ed Eges� 7-205.11 huitrictalPadCanac:.Lubneuni* 3S0 I1(D) Raan PainallyCooledAmmo 7-?06.11 Re;aicted Use Pccticides.Cnrena* ! I r 1 fuod mxi Raw Seed Sprouts Not Saved, ' 7-206.12 Rodent Ban Staauns" ! ! 3 Sill.11(C; Line�zued Ptxd P;:<I:a)(: :\tit Re-served. " 7-206 13 Tr-.cking Powders.Pest Controland Monitoring` CONSUMER ADVISORY TIMFJTEMPERATURE CONTROLS 22 3-6( 3.: ! Consumer Advisory Posted for Consumption of 1fi Proper CooKr.4 Temperatures for ! Ai-woA Foods Thai xrc T'aw, Undercooked a ! PHFs j N�'�t Otherwise F-oeessed to Elimin.ue oa it"' „ 3-401.;IA(l)(2) Eggs- 1.55'F I Sec. ^"e°`'" Eggs-hnniediate Service 145'1715se:. = 30213 Pasteurized Eggs Substitute rot Raw Shclt 3-401.1I(A)(2) Comminuted Fish,A1eat:,C G:utie Animals- 155"F IS SPECIAL P.EOUIREPdENTS 3-1OL11(B)(t)(2'r PnrY and Beet Roasl - i�p"'F' 121 nrin� :-401.11(A)(2) Rattles, fnjeeted Meat,- 155"F 1.5 590.009(Ae(D) Violations of Section 590.009(A)-(D) in SeL.- catering, mobile fad,temporu:y and 3-401.1 !(A)0: Poultry,1k'ild Came, Stinted PHFs, residential kitchen operation:: should be Stuffing Containing Fish Meat. delated under the appropr ate sections Poultry ur Ratites-165`F 15 see. - above if related to loodborne i llness 3-401.11IC)(3) Whole-nitride, Imict Beef Steaks j interventions and risk factors. Other 1=15'17 " 590.009 violations relating to goad retail 3-401.12 Raw Animal Feuds Cooked Inn i ptact;.es should h; debited under!129 Microwave 1')5` ; Special k:�quiretnents. 3_401.11(A)(!)(h) All OtheiPHF.-- 145°N 15 sec. ' 17 Reheating for Hot Holding VIOLATIONS RtiLATED TO GOOD RETAIL PRACTICES 3-403.11iA)f.(D) PHFs 165'F 15 sec. ° (items 23-30) 3-403.11(B) Microwave-165'F 7 Minute Stand iL Cain cal and nun-cririoil violollop s, tvli.ch do not rcla?e!o the fa '171111:" ndhnrne iiiness nrterventior,v ural risk%a;ba;:tiered above, can be 3-403.1 1(C) Comtuereially Pi xe;:sed RTE F<cod- found in the tclbm ing,"'croon of tine Fm ml Code and/05 LAIR 140'Fi 590.1900 3-i 03.11([1) Remaining C'mslired Purions of Beef ficin Goad Rotail.Prac?ices FC 590.00p Ro.'Is ': 23. Managemer:i and Personnel FC -2 .003 18 Proper Cooling of PHFs 24 Food and Food Protection FC-3 .ono j 25. :'auipr+ent and U,rnsas FC - 4 .005 70"F'Within 2[Inurs tt,ttnm 14017 ul 25 Watei.Plumbinq and Wase FC-v 5n7.1a(,1 C01 g Cooked I'HFs frt 005 j i From 70'F 27. Pnvslcal 7acdty FC-6 067 j to 41'Fb15'F IN ithm 4 Heins. I ( 28. Poisonous or Toxic Maierisls FC-7 I .008 j = 501 14(H) Cnaing Pt-[Fs A9 ale From Ambient29 special Requirements ', .00c J Tempertnure ingt'edients io 41'Fl45`P 1 Within 4 Hour(= lien.n;v cnucal item in the fzdeod 1991)Food Cotten IV)C'hIR 590 tdi0. f CITY OF SALEM / ? / / BOARD HEALTH Establishment Name: C _/, t4, 2ajh �� ( I Sr�/dZ)P- Date: 1612BIOLI Page: of Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date No. Reference R—Red Item Verified PLEASE PRINT CLEARLY 7 Qr�rur��i cis ecfi/m fare / 57- Hoot no g' fv'/10w/1_ 7a G2t/�r yCshrovt 1 / can tfo Calif f3�a/'we, - I No lh MP shat/ 7L,749 zo/ocC dawnc, Jai lug I I � 1 1 Discussion With Person in Charge: Corrective Action Required: I ❑ No I ❑ Yes I have read this report, have had the opportunity to ask questions and agree to correct all ❑ Voluntary Compliance ❑ Employee Restriction/ / inspection, to observe all conditions as described, and to Exclusion violations before the next ins P ❑ Re-inspection Scheduled ❑ Emergency Suspension comply with all mandates of the Mass/Federal Food Code. I under and tpa� noncompliance may result in daily fines of twe?tjrfive dollars/or S spensioFI/revocation of ❑ Embargo ❑ Emergency Closure your food permit. /(/ `,1fj /�� C-.%`�`''�� O ❑ Voluntary Disposal ❑ Other: 3 s0 i^.((1) PHFs Peceived at'Fempet:zmres Violations Related to Feadborne Illness Intereeniicns and Risk :,;,cording to Liv, C.;vled lu Factors(items 1-22.) tGort.) =t!"FI+S`FWuhin4Hours- ' PROTECTION FROM CHEMICALS 3-50i 15 C+.•olint MethWs for PHF___ 14 Food or Color Additives ' 19 PHF Hot and Cold Holding 3-203.12 Addiures'" ' ( z 5()1.16(}3', Cold PHF:.:vlaintainrd at or below 159pQ(4(F) 4l'/15` F• 3-3011: i'rotccUcm from !?naPpro ed Additives* 3-50 t.I6(.4) 1-Iot PHFs Nliintained at or ahov.- 15 Poisonous or Toxic Substances 7-101.11 identifying Informati (h on - -:,^_irml _ r 140': � Containers' 3-501 I o:,A) Roar's He!d at or oho+:c !.i0"F. j 7-102.I i Container Sante - !t'orkinq Container,,* 2t` Time as a Public Heath Control 7-20;.11 C pamon --ue. - c" 1 3-501 to Tint-as a Public Health Coutes]* 7-202.1 1 I Restriction-Presi.rec and Use i'J0.{)0�(H) Variance Rczmremrnt 7-20:.'.11 Toudttions of l;sc` REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-20311 � ToxicConhninrrs-Prate:hitiurs* ;, POPULA i IONS(HSP) 7204.11 Sanitizeis,Criteria-Chemic;iW- I ^ `- V Y- 7"'±04.12 Chemicals for W'ishrnc Produce,Criteria"' I ! I _ 5 I I If A) Cntustc•u.uc Ver-packaged tenses and Eevemees with Wartvne lahels^ 7-204.14 DcyurgAkenis.Criteria' 3-SC.1.1t(B) Use of Pasteur izedE!_�s^ 7-205.11 Incidental Food Contact.Lubricants'- ( 3-Sf:L: :(B) Raw or Partially Coked Aminal Fexx1 and - - 7-206.11 Restricted Use. Pecticidee,Criteria" Rate Seed SGrnrts Not Sen-ed. '^ 7-206J2 Rodent Ba:, Stations" , - 3-90I.11;C) Unoper:ed Pxxl Package Not Fe-served2Oh.l7 1ra:hin„Pant .rs, Yrtt Control and � MonitorinrX CONSUMER ADVISORY TIMEtTEMPERAWRE CONTROLS 22 13-or,)' I I Consumer Advisory Posted for Consumption of 16 ( Proper Cooking Temperatures for Iour ia1 Fonds"haat are R.,w. Undercuoked or : PHFs I ! No! Ciiberwise Processed to Eliminate 3-401.11A(1)(2) Egg,- 1.55'F 15 Sce. ( - - - Pathogem,_;. .zr,.•,.e,.,:ovr Eggs-hontediate Service 145'Fi5z,e,, j 13-302.13 P.!A(211n7m Eggs Substitute for Rats Shell S s' 3-401 it(A)(2) Cummmutcd Fisln, Meats<�Game Animals- I55'F 15 sec. 3-401.11(8 I I SPECIAL REQUIREMENTS )C ){2) Park end Beet Roast t 1 15 121 mite* 59O.009(Af([)) 'violations of Section 540.009(5)-(D) in 3-tULll(Ai12) Rantes,lnjettedMeats- 155°FIS I sad catering, mobile food,temporary and 3-401.11(1)(3) Poultry,Wild Game, Stuffed PHPs, Test.tct tial kitchen operations shn;dd he Stulling 0,ntaimng Fish, Meat, debited under the appropriate seoions Poultry or Ratites-165°F 15 sec. ' above if related to foodborne illness 3-4U1.11(C)(3) Whole-mascle. intact Beef Steals interventions and risk factors. Other 145°F+ 590.0)9 Violations teiating to good retail 3-401.12 Raw .Anintal Fonds Cooked in a ptactice;sLould be debited trader iff29 -- Microwave 165'F* Special Requirements. 3 401 11(,A?(i)(b) All Other PHFs-- 145"F 15 sec. 17 Reheating for Hot Holding VIOLAT.'ONS RELATED 7'0 G00D RE7AIL PRACTICES 3-40111(A)&(D) PHP, 165`Fljsec. 4` (1tetns23-30) 3-403.11(R) Miaowme- 165'F 2 Monde Standing Ci k<<'umd non-critical vtolrrnnn;, w!:;(.h do not rehire to tL< i Time" (rndborize dlneea intcn,cwivns mut risk fuu.,rs liv:,d uhtme, an be 1 3-403.11(C) Commercialh Processed RTE Rx)d- ,found in rhe,+n!loii big.ser-tions of the Food Code,i,id 105 CMR 14('Ft I 590.001). 3-403.11(E) R emainin2 Unsi teed Portions of Bcc f 1 item Good Re'sil Practices 1 FC ,5,go.000 Ronsis" - 123. Manaoem-ra and+Personnel FC - 2 .00 24 Food and Food Protection FC-3 004 I t8 Pripet Cooling of PHFs 25. Equipment and Uiens is FC -4 .005 3-501.14(11 Cooline Cookai PHI,., from 140`F to 26 'NaleC Fiurnbinp and\^lard: FC-3 005 70 F Within 2 }fours and From 7(ff ( 27 Pnyc:,ml raccaty FC- 6 .Dol ----� to 41 F/45"17 Within 4 Homs. ' 28. Poisonous or Toxic NiateriJs ., - , .003 3-501.i4(B) Coolin, cl PHRs Mule Froin Ambient 29 Special Rturements -^ ung -- -� Iemperauneingredientsto I11/45"F 130. Uthei - -- Within,tFlours:z s •mai,,,,:,.>.:a. ' [?an:tz;causal item m the LSA a.,; 1094 Food Code or 1,)S CMR 5yo pUO. .-r l CITY OF SALEM BOARD O/F�HEALTH Establishment Name: i�fi�� -� �nr)�r� �.,� /fir l�r.��Date: ,Y �1c/ Page: of l f Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date No. Reference R—Red Item Verified PLEASE PRINT CLEARLY p .— I I I X I Discussion With Person in Charge: Corrective Action Required: I ❑ No I ❑ Yes I have read this report, have had the opportunity to ask questions and agree to correct all ❑ Voluntary Compliance ❑ Employee Restriction/ inspection, to observe all conditions as described, and to Exclusion violations before the next ins p El Scheduled ❑ Emergency Suspension comply with all mandates of the Mass/Federal Food Code. I understand that noncompliance may result in daily fines of twenty-five dollars or suspension/revocation of ❑ Embargo ❑ Emergency Closure your food permit. ❑ Voluntary Disposal ❑ Other: f ?'UI 14(C) PHFS kc�eived at'Ceniper:aures Violations Related to Foodborne Illness Interventions and Risk According to Law Cooled to Factors(items 1-22) (Cont.) i -!1"F145"F`A;thin 4 Hours PROTECTION FROM CHEMICALS ( ' 50 1,15 Cowling Method,lin PHFS 14 Food or Color Additives ( 19 PHF Hot and Cold Holding 1i -501.Ib(H) Cold PHFn Maintaineu at or below I i 3-203.12 Additives* s9Q004(F? 41'/d5` F": 3-302.14 Protc�tion from Unapproved Addimcs ( 3-50L16(A) Hot PHFS tvfainlainrd nt u, above i5 Poisonous or Toxic Substances I4i)''E. 7-101.11 ldenil'vogInformation-Ongninil ( I k } Containers" 1 3 501.16(:0 Roasts Held at or above 130'F '^ ( ?(} Time as a Public Health Control ( 7-102.11 Common Name - Working Containers 3-501.19 Time as a Public He�ihh Conhol' 7=101.11 Sep:uation-SUx age` ( 7-203.11 Restriction-Presence and l.Tie* ( 590.004(H) Variance Requirement . 7-202.12 Conditions of Oce" ( 7-203 11 Toxic Containers-Prohibitions- REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-204.11 Sanitizers.Cnteua--Chemicals`, ( POPULATIONS(HSP) !(j 7-20= 13 Chemicals fpm Washing Prednce;Criteria21 3-801.!1(A) Un azteunrA-d Pre-P a,kavedJuices and 7-204.14 Drying Agents.Cnlerin* Beverages with Warniu-Lahrk* 3-0 .1 (B U&e of Pasteurized Ergo- ( 7-20i I I Incidental Food Contact.Lubricants'- ( ( 3-301 1 t(D) Raw of Partially Cooked Aniraal Food and ( 7-206.11 Rr.trictied Use Pesticide.,Criteria' ( Rain Send Sprouts Not Served. 7-300.12 Rodent Ban Stations" 3-801.11(C) Um)pencd Rood Package Not Re-ser,.cd 7-206.13 Tricking Powdcrs,Pest Control and Monitoring, CONSUMER ADVISORY TIME/TEMPERATURE CONTROLS 22 3-603.11 C onsumer Aehisory Posted for Consumption of Antucd Foods, That are Raw, i tndercaoked of f( Proper Cooking Temperatures for I PHFS Not Otherwise Processed to Eliminate PadlU rnprm:.rrPaar 3-40 i.l i A(1)(2) Eggs- 1.55'F 15 Sec. -ens." Eggs-Immediate ScrviLe 145"F ISsec, =-302.73 Padrw;zed Egg,Substitute fu.Raw Shell 3--107.11(A)1,21 Comminuted Ptah. Meats t..Game Eggs" Arinals- 155'F 15 sec. * SPECIAL REQUIREMENTS � 3-401.17(B)(1)i2) Pork and BectedMRoast- 1- 1551F1rmn' 1 5O(W09(A)-(D) Violations of Section 590.009(A)-(I)) in 3-401.i7(A)(2) Ratites, Injected Meat.-- I55"F 15 sec. ^ 1 catering, mobile food, temporary anal ( 3-401.1 I(A)(3) Poultry,Wild Game, Stuffed PHFS, residential kitchen operations should be Stuntng t.oniain itt;Fish. Meat. .,.,.ta.., ..oder the :,.;. Poultry or Ratites-105"F 15 sec * above if related to foodborne illness 3-401.11(C)(3) Whole-muscle, Intact Beef Steaks interventions and risk factors. Other 145'F* 590.009 violations relating to good retail 3-401.12 Raw Animal Foods Cooked in a I practices should be debited under#29- Microwave 105`F * Special Requncments. t 401.11(A)(1)(b) A11 tither PHFS-- 145'F 15 sec. 17 Reheating for Hot Holding VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 3-403.1 HAW D) PHFS 165"F 15 sec. (Items 23-30) 3-40111(B) Microwave- 165'F 2 Minnie Sumdin•t Crim al and iwn-critiral viutarions, kehirh do not relate to rhe Time* ,roodborne dbae s inian,entions and risk jaclon Irsrecl above, can be 3-403.11(C) Commercially Pioeessed RTE Food- jaunt(in the Jolh,wing sections Qf tire Food Cod( and /0.5 CAIR 140°F'' 590.000. 3-403.11(E) Remaining,Unsliced Portions of Beef 1 Nem Good Retail Practices FC 590.000 Roasts' 23 NlartaeIement and Peinonnel FC 2 .003 ( Cooling of PHFS 24. Food and Food Protection FIC-3 .004 18 Proper 1 3-5(71.1 l A' P 25. ', Eampment anti Utensils FC-4 .005 ( ) Coot g Coked PHFS front 140'F to 26 Water, Plumbinq and lNaste 1 FC--5 006 70'F Within 2 Hours and From 70'F ; 27 ! Physical Facility j PG-b 007 !, to 41'F/45'F Within 4 Hoors. * 28 Poisonous or Toxic Materials FC-"7 008 I 1 3-501.14(B) Cooling PHFS Made From Ambient 28 Special Requirements t Tenipermrc Ingredients to 41'F/45 30 Other Within 4 Hours- Menotti,rrili,.al item in the ledcral 19`+5'Fund Cods of 105 C:NiR fML000. AA•1 Exterminators PLEASE REMIT PAYMENT TO: 183 SHEPARD STREET,LYNN,MA 01902-4597 INVOICE P.O.BOX 310 Lynn,MA 01903-0310 781-592-2731.1-800-525-4825 FAX 781-592-7641 CURRENT 30 DAYS 6 O DA S 90 DAY Pest and Termite Control Professionals 12:x590 fl R 93 T DATE DAY TYPE DATE COD ACCT NO 07E 0802 Non 109 08/02/04 CAPTAIN' S WATERFRONT GRILL CONTROLFOR INTENSIVE CONTROL F. LRVICE A6'180.RGE 00 94 WHARF STREET ; N�MEER UNITPRICE AMOUNT SALEM MA 01970 MOUSE GL BD 978--741--0555 9-12l/It/ MULTI-CTTRAP DATE l(J�Q�� PROTECTA CHECK NO. PROTECTA LP COMMENTS t RTU BAIT STAB ❑MC ❑VISA ❑DISCOVER RAT GLUE BD •„ """"""LLl ICP/8180+}=PROD/TARGe1y1ICE & ACCT# RATS/T2 KITCHENS. i. BAR. ISERVL BAR. 4RR. 3BUS STAT. //TREAT' ENTIRI. EXP DATE SALES TAX CLUB AS LADED/SCHED 08-0"r_'?I.9AM PE d co.©❑ CHG❑ wc❑ KEVIN/DC: TOTAL DUE v�-�✓J✓^2�I TOTAL AMOUNT PO } �,x v 40 ?>aA4, aADDITIONAL COMMENTS FI nroT- 70` o�iP�/ Tr LL COMMERCIAL SANITATION REPORT Floors—Clean YES NO , Counter Surfaces—Clean .. .. . .. . .. ... ... . ❑ ❑ Drain Areas—Clean ❑ ❑ Rest Rooms—Clean . .. . ... .. . .. . .. . .. ... ... ❑ ❑ ' Dining Areas—Clean ... ... ... .. . .. . .. . .. ... ❑ ❑ \ Employee Areas—Clean ... .. . ... .. . .. . .. ... ❑ ❑ `�, ' Locker Areas—Clean .. . ... .. . ... .. . .. ... ... t Storage Areas—Organized . .. . ... .. . .. ... ... E] L1 RESIDENTIAL WARRANTY INFORMATION ❑ ❑ DWELLING TYPE WARRANTY YES NO Comments 1 Family ❑• 3 Family ❑ 30 Days ❑ tO Days ❑ 2 Family ❑ 6 Family ❑ 90 Days ❑ 6 Mos. ❑ REASON FOR NO WARRANTY " -Partial service requested.............................................................................❑ POST APPLICATION REOUIREMENTS -Poor sanitation...................................................,.........................................❑ -Kitchen/bathroom cabinets not prepared............... ....... ............................. ❑ OCCUPIED AREAS MUST BE VACATED FOR HOURS -Closets/furniture not prepared...................... ............................................. THOROUGHLY VENTILATE TREATED AREAS BEFORE THEY ARE REOCCUPIED. DO NOT ALLOW ADULTS, CHILDREN, OR PETS ON -Rodent proofing needed..............................................................................❑ TREATED SURFACES UNTIL DRY. -Other CONTRACTING ENTITIES HAVE RECEIVED ALL MASSACHUSETTS DEPARTMENT OF FOOD&AGRICULTURE'S PESTICIDE TIME IN BUREAU CONSUMER SHEETS,WRITTEN STATEMENTS,POSTING NOTICES AND HAVE AGREED TO NOTIFY TENANTS2-7 DAYS PRIOR TO APPLICATION TIME THE ABOVE SERVICE HAS BEEN SATISFACTORILY COMPLETE INS"s-1 CUSTOMER SIGNATURE LIC.# JECH SIGNATU E TECH NO. Rn SEE REVERSE SIDE FOR PERTINENT INFORMATION - White—Offic Copy Canary—Customer Copy Pink—Remittance Copy CHECK THE CONCENTRATION OF EPA REG NO. I ] MATERIALS USED MATERIALS USED [ ] Advance Dual Choice 0500% 499-459 [ ] Avitrol Concentrate 25% 11649-10 [ ] Avil Whole Corn I 5% 11649.7 ( ] Baygon Bait 2% 3125-121 I ] BP-100 ( See Label 499-452 [ ] CB-80 Extra See Label 9444-175 [ ] CB Wasp&Hornet Jet Freeze See Label 9444-98 [ ] Conquer 027%or 05% 1021-1641-57076 [ ] Contrac Blox 005% 1245b-79 I ] Delta Dust 05% 482-772 [ ] Drax Sugar 1 9444-131 ( ] Drax PF. 5% 9444-135 i I ] Drione Dust See Label 4816-353AA ( ] Intruder HPX See Label 9444-183 ' [ 1 Max Force Ant Bait Gel .0010?0 64248-21 [ ] Max Force FC Bait Station .05% 64248-11 ' ( ] Max Force FC Gel Ot'% 64298-14 [ 1 Max Force Gel See Label 64248-5 I ] Maxforce Tick System 70% 432-1248 [ ] Nylar Carpet Spray See Label 4758-169-57076 I ] Phantom .25%„5%,.125% 241-392 [ ] Purge III See Label 0444-33 ( ] Precor 1.2% 2724-352-50809 ' [ ] Pro Control Fogger See Label 499-465 ( ] Recruit III AS ,5% 62719-454 ' [ ] Recruit It .5% 62719-453 [ ] Rozol Tracking Powder 02% 7173-113 [ ] Suspend SC 01%or.03% 432-763 I ] Talon Weather Block 005% 10182-339 [ ] Tempo 1%Dust 3125-569 ( ] -rounder SC 069%,or.125°/ 432-901 I ] Timber 98% 64405-8 [ ] Wasp Freeze See Label 499-362 I ] Whitmire[ j See Label [ ] ZP Tracking Powder 10% 12455-16 [ ] Other ( ] [ ] METHOD APPLICATION BAIT STATION TARGET PESTS APPLICATION CODE PLACEMENT CODE ( ] Ants [ J Millipedes [ j Squirrels Bait Station -BS Under Eck US [ ] Bees [ ) Mites [ ] Termites Broadcast -BC Behind Stove BS [ ] Birds [ ] Powder Post Beetles [ ] Ticks Brush -SR Behind Refrigerator BR ] Centipedes [ ] Raccoon [ ] Wasps Crack&Crevice -CC Closet C [ ] Crickets [ ] Rats [ ] Wood Boring Insp Duster -D Floor F [ ] Farw;gs [ ] Roaches ( ] Other Foam -FM Sill S Fog -F Cabinet CB [ J Fleas [ j Silverfish [ ] Inspection Only Micro Injector -MI [ J Flies [ ] Skunk [ ] Other Stab Injector -51 [ ] Hornets [ ] Sowbugs [ ] Otbar Ultra Low Volume -ULV ( ] Mice ( ] Spiders Rod -R A-1 EXTERMINATORS MISSION&GOOD PRACTICE STATEMENT A-1 Exterminators adheres to all Federal and State regulations pertaining to the use of pesticides Our mission is to provide our clients with satisfaction through reliable pest control services.Or occasions,we shall instruct you to vacate the area of treatment or to remain off of treated surfaces until they have dried.Your family,clients,employees,and pets are always our first priority.Labels and MSDS sneets are available upon request,Commercial property and public buildings shall be posted to notify you of the pest control services being provided at your location.On file in the contracting entity's office is a list of"Materials In Common Use—General Pest Control.”Please refer to this notice for information required should you have questions.Do not hesitate to contact our office for pest control questions or needs F a CITY OF SALEM � BOARD OF HEALTH Establishment Name: e &^ // Date: //ri/2��y Page: of / Item Code C-Critical Items DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date No. Reference R-Red Item Verified PLEASE PRINT CLEARLY 7/l �iii.r%sZiZ(Jl/.//j''�,/j �i, �4 ✓/iii/.C� �L� /�..1 fli��!Y. its Cl A.�i�� ✓�� C Dii JPi CZ1 le 4W I I � II _ .C/l/��fJ�ibl S i'fll/LZ-/ .G� sGifiL�il N O' �/ice � Ji�l/Xzs /11 Zli VAIN ��.,, /�J�, �ii c 7Z �J�r/ //./��i_it/ �.�/PiP -sY/oll/a/ //..f ��✓i.�� AI �rc/7�P�/ .�1�/�vA a� iii d .�iG/h.f��s-.lC' a -�✓� ./Jiit..J,� �2 � ,�i,�i//C�C� ' . Discussion With Person in Charge: Corrective Action Required: I ❑ No I ❑ Yes s 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 Exclusion violations before the next ins P C] 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 4 your food permit. J t � / ❑ Voluntary Disposal ❑ Other: w y i 3-5ti'.i•t(C') ?Hes R�ceiveci:t'temperatures Violations Related to Foodeorne Illness tntervant?ons and Risk 1cca d:ng to?aw Ce-,led h7 JII Factors(Iterus 1.22,) (Cont.) -}! F145`F W'Cl:ir:'Method, Huur; j ! 3-50:.!'+ Coolitiv fvr P14Fs PROTECTION FROM CHEMICALS ' � i 19 PHF Hat and Cold Bolding 14 Food or Color Additives ti01.16*1 Cold.PHF.Mtaintaii ed at of below 3-202.12 Additisec" 9y(tU0-1(F) 41'145'F" 3-302.14 Protection fruit: Unw,),oned Additives" I ( DS Poisonous or Toxic Substances ' 1,16(A) Hot PRF.Allai,itained u, orabore 140'F. It 101.11 1denLftnng lnfounahon-Ori ginai 3_j01 16(,1) Roasts field at or above 130'F. Containers^ - j 7-102.11 Common Name-14 orkmg C ninainers" 20 Time as a Public Health Control 7-101.11 j Se•r i ation-Stora c 1.5(11 19 Time as:i Public Health Control'"1 .. gc : j S111.004(I-P `>.niaeta-Requirement 7-202 11 Kesrriction-Presence and I1se't ' 7-202.12 Conditions of!Ise' 7-203.11 Toxic Contt:iners-Prohibitions"' REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-204.11 Smuuzets,Cnteria-Chemicals;, ' POPIt; ATIONS(HSP) 7-204.12 Chewicals foriProduce,Criteris2t ?nplHtA) Unpasteurized Pre-packaged Juices and 7-201.14 Drying aeents.Critenr' Eeveraees withWainwttabc _ ti0: i(S) Use 7-205.1 Incidenud Fuad Correct. Lubricants" 13-' ' . :' Us• f Pasteurized&-,,es* 3$01.!I(D) Raw o, Partiili Cunk'd Aninud Food and 7-200.11 Rogtrcted Ilse Pesticides.Criteria" ,i Paw iced Sptru:s icor Seised. " 7-206.12 Rodont Ilan Stnuoas" - - 7-206.11 TrY lcking Powders,Pcst Coatrnl and 3-SOLI 1(C; Unopened Pevxi Package Nei Re served. " ivIoni2x-inr;' ! CONSUMER ADVISORY TIME/TEMPERATURE CONTROLS 22 3-603.1 ! Consumer Ais,sor} Posted for Coa;a1»prion of A.nituai Ponca"Iliat are Raw. Lhidercooked of 16 j Proper Cooking Temperatures for PRFs T i:rt Otherwise Processed to Eliminate e:eca:,.r-ra:e 3-4U1,I1A(1)0) L:ggs- ISs'FISSec. I'nuro;tens.* Eggs-hmnediam Service 145"17ifisec* 3-30-' 1! Pastetiri ed Egg> Substitute for Raw,Shell I3-101.11(A)(2) Comnwurte(iFish,Meals e&Game Egg,. Animals- 1551` I5 sec j 3-401.!1(13)(1)(2) Pork and Beef Roost- 130'F 121 min=' SPECIAL REQUIREMENTS 3-40 1.11 A)(2) Ratites, in cute Meats --155°F i5 j 590.O(!9(A)-(L7) Violations of Section 590.009(A)-(D) in j. ,i catering, mobile food, temporary and sec. " � p } ' 3-401.1 1(A)(3) Poultry, Wild Cisme,Stuffed PHFs, residential kitchen operations should be Smftimt Containing Fish, Meat, debited under file anpropriare sections Poulirl'sir Ratitcs-1 65`F 15 See. above if rel5ted to foodbornc illness 401.11101(3) Whole muscle,hitact Beef Steaks ( :etervcnlions and risk factors. Other 145°r" 540.009 violations relatine to'good retail 340 1.12 Raw Animal Foods Cuoked in a I pr'a(uce v should be.debited under 1129- ! Microwave 165'F " Special Regwirements. 3-401.1 HA)(10)) ,111 Other PRFs - 145°F 15 sec. yry i Reheating for Hot Holding VIOLATIONS R.LATED TO GOOD RETAIL PRACTICES t-403.11(A)4(U) PHF, 165'F 15 sot. " (Iter<as 23-30) i-403.11(H) Alicrowave- itis`'P 2 Mmuie Standine j Critic d antl nun rritfcaf,tulntiunyt .dish dr,not rch,ac to tAe i TLne` j l aodbcrne abtt -a inter✓ennom rn,d r isk lot tors listed above, cmc be 3-303.1 t(C) Commercialiy Prrnecsed RTE Food- n1f"d i,!die futlmrilrg;ec:ions of doe Feud Code and 105 C'llt 4WFx 59101"0. ? -4(13.11(r;) Remaining Uns iced Portions of Bcef I Item Goad Retail Practices : FC5.07.000 Roasts' I 23. Manedarrcent ano Personnel PC-2 .003 i . Food and Protection 1 FC 3 004 18 Proper Cooling of PRFs 24Fdd F 1 j 25. Gquioment and Utens:Is FC-4 005 3-501,MIA) Cooling Gwkrd PRFs from I40`P to 26. Water, �Iuirbtrra and'Waste � FC-5 --006 ---� 70'1` Wither 2 Hours end From 70°F 27 Physical Facl itv FC-6 .007 ----� to 41"F/45'u Within 4 Hours. " l 28. Po!sonou;or Toxic Matenals FC-7 .008 _ 3-501 14(Q) Cooling PHFs,Made From Ambient j 29. Special Recuirements I 009 f 7nmpetature Ingredients to it"F/45"F j 30. Other Widiin4Hour,* *Deixavr:critical ile:n in the i:dera! 1999 Fi*I Cu„e nr n I5 CMR 590 00c. CITY OF SALEM BOARD OF HEALTH Establishment Name: S 'z ei rydc/4 vi/� Date: /n _ 8-D Page: of Item Code C—Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date 1 No. Reference R—Red Item Verified PLEASE PRINT CLEARLY p,rK �sh� d,Cse�� . o�vub✓ I ,4 re✓/.,.w o�' r/V/�,d .<i�� I�i�, a-�d �i ��v wds 1 - lleA Solo i 1Lv� ('G1f�isrn LSC 542� ered !?2f9�Y i2C e-,-, hov ✓ a 1 �1 41Kelt' ' — dish I /,@/QeA 2rfiL Ua/ .srn 1C Discussion With Person in Charge: Corrective Action Required: I ❑ No I ❑ Yes I have read this report, have had the opportunity to ask questions and agree to correct all ❑ Voluntary Compliance ❑ Employee Restriction/ Exclusion violations before the next inspection, to observe all conditions as described, and to ❑ Re-inspection Scheduled ❑ Emergency Suspension comply with all mandates of the Mass/Federal Food ode. I understand that noncompliance may result in daily fines oft w ty- dollars or suspension/revocation of ❑ Embargo ❑ Emergency Closure your food permit. ❑ Voluntary Disposal ❑ Other: J J-50 i.14c:'; PRFs Received at'1'entn,r,nuree Violations Related to Foodborne Illness Interventions and Risk According no Cooled to Factors(items 1-22) (Cont.) 4ff/45'F Wtthi„.J Horns. PROTECTION FROM CHEMICALS ( 3 501 15 Coulin♦Mcibuds lot PHFS 14 PHF Hot and Cold Holding 14 Food or Calor Additives 3-5t;1.l6f B) told MIPs Maintained at or below- 320_.12 Additive,, 3-302 14 Protection from t?nanprosed Addrtrves` 590.00CF) 41`/45` F, 1,5 � Poisonous or Toxic Substances i 3-501,16(A) I4ot WIF,[F> titaintained.uorabrne 7-101.11 Identifyinginformatun -Original I i-t6F, { 13-SUI I6(A) Roasts Heid ator above 130°F. Containers" 7-102 11 Common Naule-Workin;;Containers' 20 Time as a Public Health Contras - 7-301.11 Separation 3-501,10 Time as a Public Health Control* � ' i ' 7-202 11 Restriction-Presence and Use` 4i,�',� "74(11:) Variance:Requirement 7-202.12 Cmditxm;,of U':e' 7-203 11 'toxic Container,, - Protnhitions,. REQUIREMENTS FOR HMHLY SUSCEPTIBLE 7-204.11 Sanitizers,Criteria-C}temirds' POPULATIONS(HSP% 7-30-t.12 Chemicals for Washing Produce; Criteria, 121 j 3 SOL III a) Unpastem iiied Pa-packaged Juices and 7-204.14 Diy-inr Agents.Critemia- i Beverages with Warning I abels^ 7-205.11 Incidental Food Contact. Luhru:mtST 3-80;.1 :(B) Use of Pasten!izcd Ergs 3-80 LII(D) Raw tit PmtiallpCookedAuun,dFood and 7-206 11 R---,emoted Use Pesticides Char:' R'm Seed Sprouts N, t 7.206.12 Rodent Bail Stations:;: tit t .served. 7-206.13 ?racking Puaders, Pest Control and ( '-n(11.I I(C} Unopeue.<I;a,~<i Package Not Reserved. " Monitoring" CONSUMER ADVISORY TIMErrEMPER'1TURE CONTROLS 22 3.603.'! Consumer Advisory Pusted for Consumption of 16 Proper Conking Temperatures for Animal FiAnls That are Raw. Undprcooked(it PHFS � Fo±O;h„iw'ioe Procresed to glim:nrf[e 3-401 I1A(I)72) Ecgs- ISS"F 15 Roc. Path Orem-'. Eggs- !n'mnedia[e Sen"v:e 145"r'Usea* 1.302.13 Pasteurized Eggs Substitute For Raw Shell 3-101.1 J(A)(2) Comminuted Fish,]bleats Sc G:une Egvs` Anile and 155"17 15 sec. SPECIAL REQUIREMENTS :-d01.11(B)(I}(2) Pork and Beef Roast- 130"1 121 min" I 3-401At(A)(2) Ratites; Injected Meats-- 155°F 15 590.0I19(A)-(D) Violalnoosof Section 590.009+,A)-(D) in sec. ” catering. mobile food, temporary and 3-401.11(A)(3) Fi,ultry, Wild Gamc,Stunted PHFS, residential kitchen operations should lie � debitcd under the a�Fi ro nate sections,Stuffing Containing Fish, Meat, } Poultry or Rarites-165"'F 7 5 sec. ', above ii related to foodborr!c illness 3-401.11;7)(.3) Whole muscle,Intact Beef Steaks interventions and risk factors Other 145'F' 590.009 violations rel ding to good reiuil 1_' Ria Animal Foods Cooked iu a practices should be debited under 1129 - Microwave 105`F * SpeciLd Roquirernent5. �,.401,11(A)(1)(b) All Other PHF;. - 145"F i5 sec, 17 Reheating for Hot Holding ( VIOLATIORrS R.LATEO TO GOOD RETAIL PRACTICES 3-403,I I(A)R'(D) PHF's 165`F 15 soc. ^" ( (Items 23-30) j i-403.11(B) Microwave- 165')F 2 Minute Standinta Ci stir,,?cad rzor.-,,stoat ;iolalwn.I, whreh du not,elure to the Tints"' ,fundhorne dh<es.c mtoeentions and riskjac:nrs listed above, ran be 3-403.11(C) Commercially Procc ssed RTE Food- %wood in thr'foNrn:-iter saetimu o(d;c F-nod Cole mrd 105 0/X 140"F' I _590.000. 3-403.11(6) Remaining Unsheed Portions of Beef j Item Good Retail Practices FC 530.0(70 j R;,.asts* ' 129. tilanaaer-ent and Fersonnd FC -2 003 IS Proper Cooling of PHFS j j 24 Poxl and Fcetl Protection FC-3 .004 25, Fuuipment and Utens'is FC-4 .005 3-501 !d(;1) Cuulnng Cooked I'I IFs froth I d0`F to126. Water, PL—,binq and Was!-. FC-5 .006 70'F Within 2 1Ioun.mid Front 7W ( 27 PhyslGY;l Fts I4i!:V rC-6 .007 j to 41`P/4511 Within 4 Hours. " 2�.....n._--.-_-- Poisonous o: l oxic Materiais FC 7 i 0' apxiai Reaorements 009 3-SQLi4(B) C,n,hngPiIFsA4adeFrumAntbieet Temperature IneredienL.iu 41°F/4-) Other -) Within 4 Hours' .•.nci rt,e�ta,< Deno[-,cnrcal uor r)the i mesal 099 Food C."L or ICK C\tk 590 000, CITY OF SALEM BOARD OF HEALTH Establishment Name: _ i IC WYi ) Date: Page: of a Item Code C-Critical item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date l No. Reference R—Red Item Verified 11 PLEASE PRINT CLEARLY — C l J , D, d Yl2lil4� ✓6 9lJ/ C cw*C +3 e_?"Ze C7 ; I — �o ✓, DwiJ.O� n� �� /l� Se[>�/�1 /may lC S ce., I 10 I � I � I 1 1 1 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 un rstand that noncompliance may result in daily fines of twenty-fiv dolla or su pension/revocation of ❑ Embargo ❑ Emergency Closure your food permit. / ❑ Voluntary Disposal ❑ Other: Cow . ,- h .w ,k„i'n',`�y+.. ;r^ys err',.�, :s,...g'.Y -r'r�ls �Y?TY.�'7'.r.'�ta'.dY+'w` ..rr: ' . •• -t. � .. ,..n 3_101 14t C; i PHFs Received at Temperalures --- Violations Related to Foodborne Illness Interventions and Risk ACCOrdm2 10 Iaw Coo1eJ to Factors(Items 1.22) (Cont.) ` � 41'Fl45'F Within 4 Huws. PROTECTION FROM CHEMICALS 3 51)1.15 ( Cooling �Merhods for PHFs 14 Food or Color Additives ( 19 PHF Hot and Cold Holding 3-202.12 Additives', 3SU 1.lwlli I Co!d PRE Maintained at u! below 590.0"WF) 41`/45°E' 3.302.14 Protection from Unapproved Additives* ( 13-501 INA) Ifot PHF: hiamtained at or above 15 Poisonous or Toxic Substances i 14t"l- 7-101.1 1 Identifying Information-Original - Containers" 1 .3 501-16(A) Roasts Held at or above 130',. ' i 7-IU2 11 Common Maine-W'orkin,;Containers' 1 Zg ( Time as a Public Health Control 7=0 L I I Separation-St,nage" 3-50;.19 Time as a Public Health Conav't, 7-202 11 Restriction--Presence mid Use° ( ( 590.00.(H) Variance RQquirwnent 7-202.12 Conditions of Use" ( REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-203.11 Toric Containers-Prohibitions" � POPULATIONS(HSP) 7-204.11 SanitizetsCriteria-Chemicals 7-204.12 Chemicals for Washing Produce,C7its+ria" 121 3-501.1 I(A) Unpasteurized Pre-packaged Juices and Bcveittges with Warninit Iahcts' 7-204.Li Drying Agents.Criteria''' ( 3-bU!.'1(f) Us of Pasteurized l✓.egs" 7-205.11 Incidental Food C'onlact,Lubricants^ ( 13-801.i I!D) Raw or Partially Cool,ed Animal Frxal and 06. 7-211 R.drieted I.se Pesticides,Criteria" Raw Seai Sprouts Not Served. " 7 206.12 Rodent Berl Stations" ( 3-901.11(C) Unopened Food Package Not Re-served. 7-206.13 Tracking Powders,Pest Control and Monitoring" CONSUMER ADVISORY TIME)TEMPERATURE CONTROLS 22 3-603.i i Corsumor Advisory Posted for Consumption of Aninrl Foods'Ctvtt are Raw.Under,•ooked of 16 Proper Cooking Temperatures for PHFs Not Otherwise Processed to Eliminate -401.1 L4(I)(2) Eggs- 155", IS Cee. I Pathupens Eggs-htnnediate Service 145,1Zl5sec', 3-302.13 Pasteurized Eggs Substitute for Raw Shell I-401.11(A)(2) Comminuted Fish. Mean&.Game ` `cges" Animals- eI5 sec. '% f SPECIAL REQUIREMENTS 3-401.11(A)( Ratites; injected 155"F IS 3-401.11(13)(1)t2) Pork and Beeef f Roast- 136'5 121 min" SPECIAL Violations of Section 59Q009(A)-(D) in 2) sec. - catering, mobile food,temporary and 3-401.11(Att3) Poultry, Wild Game,Stuffed PHFs, residential kitchen operations should be Stuffing Containim'Fish,Meat, debited under the appropriate sections Poultry or Ratites-165°F 15 sec. "' above if related to foodborne illness 3-40L l I(C)(3) Whole muscle,Intact Becf Steaks ( interventions and tisk factors. Other 1-15`7, " 990.009 violations relating, lo good retail 3-401.12 Raw Animal Foods C<xiked in a I practices should be debited under #29-- Microwave 165`5 Speeiel Requirements. 3401.11(A)(1)(b) Ail Other PHFs - 145•'F l5 sec. 17 Reheating for Hot Holding VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 3403.11iA)&(D) PHFs l65`F I5 sec."` (l tents 23-310) -403.1 I(B) Microwave- 165'F 2 Minute Standen„ Critical oml mwt-crit,,al violations, %inch do nor retaw to tF,e Tinto' foodborne ithwsv into mentions„rid risk krr torr lived abov' can he 3 403.11(C) Commercially Processed RTE Fixed fand in tete follnwi,rg sections 0, the Food de and 105 C'-b1R 140'F' 590.000. __ -403.1 I(E) Reomuning Unsliced Portions of Beef I item Good Retail Practices FC 540.000 Ruastc"' 23. Manaaamen!and Personnel FC -2 1 003 1& Proper Cooling of PHFs ( 24 d and Food Protraction FC-3 : .004 Co F Within.. Floor,;and From 7U'F 26 Water d q and 's FC-4 A05 25 rrn,ipmerd and _ � 501 14(,4) Cooling Crn:ke.l 1 Hi->from 140,17 in r , :er Flumoinq and Waste FC-5- -��! .006--- i r ; 1 127. P. esu^al Facility FC-6 1 007 to 4i'F/45'17 Within 4 Hours. " ( 28. Po!sonous or Tomc Materials FC -7 1 .0081 3 fro 1,14(B) cowling PFIFs Made Froiri Ambient 29 Sp=cial Requirements 003 1 Temperature ingredients 1o4l`F/45`F 30. other W!thin 4 flours� ;••mn,nn,u...a., -Dena(••-,UPIc:1 itmn m file ledaai i'N9 Food('ode or I t i 0.1R 590 U(1O �?u-q -tz> `a lr-s�a I1e__d(Up--v_b±zb o-6pe_run � ,�►or� ct n&_�,e -0 -i +v-le o sk ►r 6l. UP v vcu�n�n.C� "9 nto ooQ �7) d z;-)n lvs -In_Ud �I '501u+o Cno► er- ) he n tsbP �� -pro-�sT� { _ ! �(L_.must 41as6 handsl _ 111)U "ilu4 _ � I��n - , �- - OJOLP E%4- e� tna� III i �i r � nRn MID DHI ASSOCIATES I�I/111u1 MAY 2 7 2004 Management Support&Consulting Profit From Great Hospitality CITY OF SALEM 11 EVERETT PAINE BOULEVARD BOARD OF HEALTH MARBLEHEAD,MA 01945 TE TEL.781/631-375555 ✓moi FAX 781/631-9515 CELL 617/680-7547 � , `"' ��✓/�4L 1, �� zl CITY OF SALEM �f BOARD OF HEALTH Establishment Name: (10'4 6 GUa/>i Cmr_� 23P ' (i�tl/ Date: ,3-.30 - 7) Y_ Page: 9 of � r Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date No. Reference R—Red Item Verified PLEASE POINT CLEARLY /S a anr2ox J A ii Q_ n� 'I ✓! 1 . /uss n/Y / l✓ s /ell,l , et, I 04 rr7 r-24,4.,. -lam /LJO S� / Y!!i/�_ //Al� �v4 r/t /'ZP /�'14�"v A4r w i / 17/v.?.a sl✓/� �cevJ- .L„ 55 (.v�� ah/r, !?iils-/ L). _ /��.ro.sS/ �/� 1 i -SMG / C/onK//Hcy 1 �. 1/( IN,A)//`�l�i YYIirJ�-1 /JO C 1��/ �/� I/T �A/4 /"'I N� /�/N J�ti✓/A/ I Iti,�.�� cam»// ti.�H y 5��p /�, .. .1�i r-// syve� CO_ �vwt�4l/e+. Pv ✓/`r�v<a;+-,..., 1,4f,4 )-14 `1a.Al- /r i) /,s' / U r Discussion With Person in Charge: Corrective Action Required: I ❑ No I ❑ :es I have read this report, have had the opportunity to ask questions and agree to correct all ❑ voluntary Compliance ❑ Employee Restriction/ f inspection, to observe all conditions as described, and to Exclusion violations before the next ins p Ll Re-inspection Scheduled ❑ Emergency Suspension -' corhply with all mandates of the Mass/Federal Food Code. I understand that noncompliance may result in daily fines of twenty-five dollars or suspension/revocation of ❑ Embargo ❑ Emergency Closure your food permit. ❑ Voluntary Disposal ❑ Other: 4 t 3-501.14((',) PHFn Received Pt Terrlier:.';ures Violations Related to Foodborne Illness interventions and Risk Accoi dir.,to Law C<»Icd it. Factors(Items 1-22) (Cont,) 41'1-14j'F W olnn 4 Homs. 3-501.15 Cooling Methods for PHFn PROTECTION FROM CHEMICALS j 14 Food or Calor Additives 119 Cold Hot and Cold Holding 3-70'..12 Additives* lt+(Br ColdPliFc \�Iantained:nnr6zl,.w 3 302 14 Protection froto Unapproted Adding-es" i 50LV A) 'F,Mannainrd at or abate I Poisonous or Toxic Substances I Hot 140'F. 7-101.11 7-101.11 Identitpir,c,!nfi>nn:nion-Original 3.501.1((A) Roast, Held at nr above 130"F. =_ I Containers" 110 Time as a Public Health Control 7-102.11 Common Vane-Working,Containers" ( 1 j 3-561.19 Time as a Public H,ahh Cbntro! 7-201.11 Separation-Storage^` " 7-202.11 Restriction-Presonec and L`se:. I I :i90004(H) Vm'ianca Rw!liramen[ 7-202.12 Cnnl:tions tit Use' 7-20111 look Containers-Prohibaions' REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-204.11 Sanitizets,Criteria--C'henticals; POPULATIONS(FISP) Chemicals for Washing 7-204.1'_ Produce,C'riteriaa I 21 3-ROI I UA) Unpa:stcurized Fre-packaged 7uicee and I7-11,04.1 1 Divinic.A�rnts Criteria' I Beverages with Warning Labelsr E, 7-105 11 htn¢leme(Food Contact.Lubceants^ I - 501.11(B) Use of Pa:aruriu<t ._gPia I 7-1106.11 Restricted Use Pesticides,C'rituia" 13 401 1 1(D) Raw or Partia!ly Cooked Anunal Ford and 7-'.06,1'_ Rodent Bait Stations* Raw Seed Sprouts Not Served. ' j 3-ROI.i 1(C:) Unc )enect Food Package Not Re-served ' 7-11106.13 Tracking•Powders, Pest Control and MonitorinyYr CONSUMER ADVISORY TIME/TEMPERATURE CONTROLS 22 3-603.11 Consumer Advisory Posted lin Consmnpuon of Animal Foods Th.it are Raw', ilndetcroked or 1F Proper Cooking Temperatures for I Not Cithemise processed in Eliminate PHFn 3-401.11A(1)(2) E;gs- 155°F 15 Sec, Pathggcns.'- Fsgs-Immediate Service 14i`F15sec' 3-302.!3 Pasteurised Eggs Substitute tar Raw Stell 3-4111.11(_4)(3) Comminuted Fish.Meads,A, Game Eggs' urinals- 155-F 15 SPECIAL REQUIREMENTS 3-40 L 1 I(B)(1)(2) Pork and Beef Roaat- 130'F 121 mite` 3-401.1 I(AI(2) Ratitcs, Injected Meals-- !55"F 15 300,009(A)-(D) Violations of Section 590 00t)(A)-(D) in sec. * catering, mobile food, b mporory and 3-401.i I(A)(3) Poultry,Wild Garne.Stuffed PHFn, residcnaal iutehen operations should 've Stuffing Cuntahtntg Fish, Meat, dchited under the appropriate sections Poulrry or Ratite.-165'F 15 sec " above if related to foodborne ilh)ess 3-401,11(0)(3) Whole-muscle. Intact Beef Steals interventions and risk factor~. Other 145"F 590 009 violations relatinv to good retail 3-401.12 Rant Animal Fonds Cooked in a practices should he debited tinder#29 - Microwave 16.5 FT Special Requirements. 3401.11(A)(!)(b) All Other PHFn - 145'F 15 sec. 17 I Reheating for Hot Holding I VIOLATIONS R_LATED TO GOOD RETAIL PRACTICES 3-403.11(A)&(D) PFIFs (65'F t5 sec. " I (Items 23-30) 3-403.11(B) Micuiwave- 165`F 2 Minute Standing Crine-ctl and nor,-craicaI vioiulions, int u'h do not relate to the Dime* fnvdhnrne illness interventions and ri,%l Tactors Ls!al above, ran be 3-403.11(C) Commercially Processed RTE Food- Iourd in the jniloming sec tions t f the Food Code and 105 CAIR 14017* 59().000. 3-403.11(E) Remainlne Unshccd Portions of Beef ( item Good Retail Practices FC 590.000 Roasts* ( 23 ! Management and Pcisonnel ( FC--2 .003 18 Proper Cooling of PHFn 24. Foal and Food Protection F'-3 .004 25 I Equipment and Utensils FC-4 ,005 3-501.11(A) Cooling Cooked PHFn from 140'F it 1 26. 1 Water, Plumb,nq and Waste I FC-5 .006 70-F Within 2 Hours and Front 70'F1 27 Phys:nal Faciliiv FC-6 OOi 0 41'F/45'F Within 4 Hour. ' _28.____ Poisonous or Toxic Materials FC-7 .008 3-501.14(6) Cooling PHFn Made From Ambient 29. Special Requirements A09 I Temperature ingredients to 41°F/45°p ' 30 Other Within 4 Hours" `lirnofe:crifical arm in the feral 1.199 Food Cotte nr Ufa CNIR:;') '0110. CITY OF SALEM �1 r BOARD OF HEALTH Establishment Name: Date: 3- 30 OL/ Page: 12 of -2 Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date No. Reference R—Red Item Verified ' PLEASE PRINT CLEARLY I — Q IZHf__j I T I �pr-�rlln. l /rr • I _ /l ('��/�.>'� �z-:l vu,s<-,i�c^�� /vi// vet%/r4-.��,./ �i�/ �ii._ I _ _ .l t�/fir �_ G/,/�r>_�- G� r✓.�drr,DS�i. �o� s.>fi/ t_�D_,J,vuJ L'..,./ G,/..� _ 21" J-/> nI-O id )1),40 � Discussion With Person in Charge: uCorrected Ad:(ction Require ❑ No I ❑ Yes I have read this report, have had the o ppoounity to askp((S q e ttonsCdfifagree fo correct all ❑ voluntary Compliance I ❑ Employee Restriction/ violations before the next inspection, to observe all conditions as described, and to Exclusion P El Re-inspection Scheduled E) Emergency Suspension comply with all mandates of the Mass/Federal Food Code. I understand that noncompliance may result in daily fines of twenty-five dpilars or suspension/revocation of ❑ Embargo ❑ Emergency Closure your food permit. !� ❑ Voluntary Disposal ❑ Other: i 3-501 14t(') PHFs Receivedat Temp.ratu'es Violations Related to Foodborne Illness Interventions and Risk Acott ding;to Law Cooled u; Factors(items 1-22) (Cont.) j 41'F145'F Within 4 Hours. PROTECTION FROM CHEMICALS 3-50:.l i Cooling Methods for PIIFS j j 19 CHF Hot and Cold Holding 14 Food or Color Additives ' 3-501.16(P.) Culd?HFs\;aima:ned at or below 3-2112-12 .Additives'! 590.004'P) d1=(aS=F': 3-302.14 Protection from (JnaPproved Addmtes:` ' I � c Poisonous or Toxic Substances Ux,=t) Hot PI Ts Maunainrd at w above ) i40`t' 7 1U1,11 ldennfy;n_ Information-Original Containers" 3-501.16(.-3) Roasts Held at of above I3U`F j I 7-IU2.l l Conunun Nam20 e-Working Contatuers" Time as a Public HealthControl 1 33-501.193-501.19Pune as a Polios Health Gnti roP` j 7-201,11 Separation-Storaec"' ( ' 7-202 11 Restriction-Presence and Use" 590 004(H) Variance Rcnou'en(ant j 7-702.12 Conditionslse' ( 1 7-203.11 'Toxic Containers e ncrs-T'rohibitions" REQUIREMENTS FOR H€GHLY SUSCEPTIBLE 7-204.11 Sanitizers.Criteria-Chemicals" POPULATIONS(HSP) 7-204 12 Chenucals for Washine Produce. Criteria` ( 21 3-901. 1(A) Unpasicmnved Fre packaged Juices and Beverages with Warning Labels! j 7 2(74.14 Drvmg,4gents,Criteria' ;-801.i i(B) Lse of PaNnalt17e"Eggs^ 7-205.11 Incidental Food Contact,Lubricants" j 3.80(.11(U) Raw or Partially G� iked Annual F<xkl omd 7-206.11 Restricted Use Pesticides,Criteria" Raw Sced Sprouts No! Ser'o'ed. r 7-206.12 Rodent Bait Stations" ( 3-901.11(C) j Unopened Food Package Not Re-served. 7-206.13 Tracking Powders,Pest Control and j Motntoring* CONSUMER ADVISORY TIMEITEMPERATURE CONTROLS 22 3-603.;1 COTISnmer Adosoty Posted 114 Consumption of Anemdl Frds'That are Raw. Undercooked of 16 Proper Cooking Temperatures for ( Not Olhery:ise Processed to Eliminate PHFs v:ero;..vvaap 3-401.11A(1)(2) Eggs- ln`F 15 See Pathogens.* ' Eggs-Immediate Service 145'1-15sec' 3-102.1 3 Paaeu'ized Eggs Substitute for Raw Shell i 3401 1 l(A)(2) Comminuted Fish. Meats R Came I Egt'ss Ani nals- 155`F l}sec. '` 3-401.1 l(B)(t)(2) Pork and Beef Roast- 130'F 121 min'' SPECIAL REQUIREMENTS 3-=401.1 i(A)(2) Rati[es,Injected Mea[:- I55`P 15 500.009(a)-(Dt Violations of Section 790.009(,1)-(D) in set'. ; catering, mobile trod, letnporary and 3-401.11(A)(3) Poultry,lVild Came. Stuffed PHFs, resrdeftual kuchen operations should be Stuffing Containing Fish,Meat, debited under the appropriate sections Pou(try or Ratites-I6i'F 15 sec, ' j above if related to foodborne illness 3-401.11(C)(3) Whole-muscle, Intact Beef Steaks nitervenuons and risk factors. Other 145'F" 590.009 violations relating to good retail 3-401.12 Raw Anunal Foods Corked inn I practices :diould be debited tinder 1129- Miurowave 1659F * Special Requirenleuts. 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 1ItA)&(D) PHFs 165'F 15 sec. t theins 23-30) 3-403.11(13) Microwave- 165'F 2 Minute Standme Critical and non-croicot vintation..c, which de not relate to the Tonle^' fnodbome ilbiess interventions and risk,factint listed above, can be 3-403.11(0) Commercially Puaessed RTE Food- found in rhe followhig sea ttotra of the Food Code and 105 GllR 14WF' 590.000. 3-403.11(E) Remaining Unsltced Portions of Beef I item 'I Good Retail Practices FC590.000 Roas1:." 't 23. Management and Personnel FC-2 003 IS Proper Cooling of PHFs 24. 1 Food and Fueti Prota:ciion FC-s .004 3-101.14(ri) Cooling Conked PHFs from 140'F to 1 25. Equipment and Utensils FC-4 ,005 { 1 26 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(4i'F Within 4 Flours. * 28. Poisonous or Toxic Materials FC-7 _008 _-al 3-5U1.t4(Bl CoolingPHFsModeFromAmbteut 29 SPecialRcquirements OG3 Temperature Tngretlien[s to 4i'Fl-:5'p I-3o----Other f Within 4 Hours' 'Dmo(es critical nem in the federal 1994 Food Code m 165 CZAR�90.00d. CONCEPT STATEMENT FOR: CAPT.'S WATERFRONT GRILL & CLUB (A Seriously Enjoyable Waterfront Grill) (DRAFT #5 01/26/2004) NOTE: The purpose of this concept statement is to drive design, construction, decor and operational decisions. The first draft is full of specific observations and recommendations. At the outset, these are intended to stimulate discussion and debate. Because time is short, however, this document should be refined quickly into a design narrative that can become a strongly suggestive statement to guide the development and execution of operational details. From menu development, to uniforming, to service style design, to selection of background music, once a draft is ratified, it is expected to be followed through on for a substantial period of time. - - - - - - - - - - - - - - - Imagine a modern version of a solidly built private club set above a more casual but still high quality popular bar/restaurant. Such will be the nature of CAPT.'S WATERFRONT GRILL & CLUB. Thematically, and with today's contemporary flair of modem yacht interior design, the decor of the upper level would evoke a sense of the privilege and power of the affluent clipper ship owners and wealthy merchants of the China trade era of historic Salem. The decor of the ground level, not quite as detailed as the space above, would none-the-less, bring historical reverences and contemporary maritime decor elements together in a comfortable and highly convivial atmosphere. Such a vision should drive the concept for CAPT.'S WATERFRONT GRILL & CLUB at 94 Wharf Street, Salem Massachusetts. The location is perfect. It is adjacent to the historic customs house and maritime wharf of Salem harbor. Views of the city's tall ship recreation, The Friendship square rigged sailing ship, docked diagonally in front of CAPT.'S enhances the strength of this vision. (For the purpose of this concept statement, we will say that the building faces south to the boat slips, east to the wharf and the customs house, west toward the hotel under construction and north toward Derby Street.) THE FACILITY & DECOR THE FEELING(In general) CAPT.'S WATERFRONT GRILL & CLUB would in fact not be a private club (at least initially) in any way. The atmosphere created by its decor would simply be thematic of such a businesspersons' club. A rich, warm and substantial feeling of mahogany, teak and holly paneling and trim so typical of yacht styled decor would set the tone. Rich upholsteries and carpeting would add to this feel. A strong nod to historic Salem would be added with appropriate artwork and a slight hint of the china trade would be introduced through wall mounted and furniture artifacts. There should be a distinctly upscale feeling throughout the facility. CAPT.'S is housed in a two-storey facility. The lower level will be the "hospitality center," a combination bar, lounge and casual dining area with predominantly,but not exclusively, stand- up level furniture. The upper level will have two facets. Near the entrance, there will be plush living room section. Further in will be the main dining room. A waterfront deck completes the upper level. The two levels must be tied together into one cohesive concept. This will be accomplished in at least two ways. First there will be an open atrium style grand entrance enabling a high degree of visibility into the upstairs as well as the ground floor space. Secondly, if possible, in a central location of the upstairs main dining room, and lower level bar/lounge, there will be a cutout section with view up and down. A railing may surround this cutout section and it may also be glass enclosed. Perhaps a high quality sailing ship model or other three- dimensional artifact will hang in the center of the cutout. GRAND ENTRANCE (in more detail) Replacing the existing comer"tower" and undistinguished side entrance and stairway, in the southwest comer of the building,will be a grand heavily glassed atrium style entry way. If possible, the fagade would be rounder and would have a slightly arched roofline. Entry double doors will be centrally located diagonally to the building's harbor facing front. (Because the entry way will be a large open space, careful thought should be given to seasonal climate control situations.) Upon entering, the guests' eyes should be drawn in two directions. A view of the richly decorated upper level should stimulate curiosity. A view of at least three to four dominant objects of interest bordering the entry to the lower level should clarify any questions as to what CAPT.'S WATERFRONT GRILL & CLUB is about. The objects of interest, not necessarily in order of geographical location, are as follows: an exposed section of the main kitchen behind which an attractive charcoal briauette burnine Brill has been installed, a glass enclosed wine rack housing a collection of fine red wines, a retail styled commercial walk-in cooler or smaller display case for large cuts and displays of meats and seafood (accessible directly from the kitchen). Finally as the initial part of a drinking bar that might curve around into the main hospitality area,would be located a working seafood raw bar. A (double wide?) hostess stand should be properly located in this entryway. Space for less secure and quite secure coat storage with easy access for the host/hostess should be a consideration. LOWER LEVEL (in more detail) The initial lower level items of interest have just been described. Placement of the main kitchen should remain as it is. The same applies for the restrooms. The existing bar on the adjacent waterfront side should be removed. The existing front wall containing the kitchen should remain with the previously described visual cutout for the grill being included. Continuing into the east—after the corner of the kitchen wall, there should be an access corridor for the restrooms. Following that, it seems at this writing, that the main bar should begin in an easterly direction for a short distance then should quickly curve north as far as possible and then east again parallel to the northern most interior wall. Should it be determined that such a long bar is not needed, consideration should be given to installing a fireplace on the northern most wall. The back bar could utilize mirrors to reflect the outside scene. Moving in a southeasterly direction away from the bar, furniture nearest the bar should consist of bar stool-level tables surrounded by standing level one-sided drink rails. Traditional 30' high dining tables and or booths should parallel the east and south windowed walls. This space should easily reflect"people noise,"perhaps spurred on by"stimulative"background music. With lightly stained or natural varnished mahogany and/or teak and holly for the facing and top of the bar and the back bar, a moderate amount of mahogany, teak and holly trim could tie the entire lower level together. Aside from that, the interior surfaces could be fairly light and warn tones. Interesting perhaps modernistic lighting fixtures could introduce a contemporary flair to an otherwise very traditional space. Currently the windows on the east and south walls do not open. As they are, these windows do not provide the feeling of connection to the sea and the outside that is desired. They also come close to permitting"below table level"visibility from the outside looking in. Some form of opening, should be considered for at least some windows. If necessary, to limit the lower level exposure, perhaps the lower sections of these windows could be covered on the outside with louvered shutters. As discussed after our initial walkthrough, the ceiling may call for some decorative treatment. Consider creating a late evening or night sky showing the primary stars of the major constellations. Alternatively or additionally, this ceiling treatment or a version of it might be applied to the upstairs as well. UPPER LEVEL (in more detail) How does one get upstairs? Is there a spiral staircase in a place that does not obscure the initial entry view? Is there an elevator or handicapped chair lift? Can we incorporate the existing staff stair well space in some way? We look forward to guidance from the design team. Once upstairs the guests should again arrive at a greeting station. It is on the second floor level that the most complete feeling of the well aged but updated private club atmosphere should be expressed. This space is much more plush and more serious than the lower level. But it should not be dark or so formal as to be intimidating. It must work in full daylight as well as at night. More mahogany and/or teak and holly may be called for here as in the living room and dining rooms of major estates. Similarly, historically relevant oil paintings and high quality nautical and far eastern artifacts could decorate the walls. There may also be a place for silver trophies as in yacht racing to add additional character. As of this writing we will assume that the entryway to the second floor is generally in the southwest section of the building. The greeting station would likely be immediately east or north east of the entryway. Passing in an easterly direction, guests could initially be introduced to a f sofa, easy chair lounge,perhaps around a small fireplace. Three to five seating groupings should be adequate. There may only be an exposed service bar in the upper level. "Club service"might be the style of serving all cocktails on this level. Passing the lounge and continuing easterly, one would enter the dining room. Furnishings in the dining room could be upscale colonial such as Chippendale style furniture. Dinner table will be padded and clothed in starched white table linen. Except for special occasions, the dining tables will be devoid of flowers. They may however have an interesting centerpiece candle. Dinner flatware will be substantial, heavy gage, high chrome stainless steel. Glassware, both for cocktails and wine will be somewhat oversized, in a contemporary rendition of a traditional shape and may also include more contemporary design. Similarly, the style of china should be upscale but could bridge, combine or juxtapose the traditional or colonial with the modern. These tabletop design considerations will necessitate larger than standard tabletops. Dining room chairs, however, should not be overly wide or large. Further, they should be capable of being lined up efficiently together when combining tables for larger parties. Rounded front comers are preferred. THE DECK(in more detail) As it stands now, the deck could best be described as rustic. This should change, both in terms of existing surfaces and furniture selection. There should be an as much of an upscale feeling to the deck as to the other spaces of CAPT.'S. It may be that resurfacing existing woodwork will accomplish part of the goal. It may also be the case that modern upscale patio furniture may be not only functional but be an attractive compliment to the interior decor. The deck must be enclosable; with an awning roof and clear side curtains or drop down windows. If a multi-peaked curving style of awning can be utilized, it would make a strong style statement that would be excellent for marketing CAPT.'S. MENU The Club restaurant will offer what people are looking for in a waterfront restaurant. That is to say, it will offer fresh, fresh seafood. The seafood will be prepared in distinctively traditional and in distinctively contemporary styles. Sometimes there will be a fusion of the two. There will also be a nod to the China(read that far eastern-oriental)trade. Seafood will not dominate the menu however. There will be a selection of red meat and poultry selections as well. Again some items will be prepared in traditional or classic style, some in a contemporary style and some combining the two extremes. The key to food offerings will be noticeably high quality. Prime steaks if possible, sushi grade tuna where appropriate. r A note about price ranges mentioned here. These are particularly loose guidelines, designed to emphasize large price range possibilities for the creative culinary team. The cost and anticipated desirability of specific menu items and the pricing of comparable successful direct competition will determine actual pricing points. The luncheon menu will offer appetizers, sandwiches—both grilled and chilled, entree sized salads and luncheon sized entrees. It will not be dissimilar to what is offered at many highly successful upscale waterfront restaurants. Appetizer/tasting plate prices will range from $5.00 to $15.00. Sandwiches from around $6.00 to $10.00. Luncheon entrees will range from $9.00 to $16.00 (excepting lobsters). It is the dinner menu that will drive and differentiate the food concept for CAPT.'S WATERFRONT GRILL & CLUB from the competition. It is expected that the dinner menu will offer at least twenty appetizers/tasting plates priced from $5.00 to $15.00. The number of core entree selections will be limited however to no more than 10 nongrilled items of which at least half should be totally unique to CAPT.'S. As mentioned above, a signature feature of The Club will be the Charcoal briquette-burning grill. In Addition to the nongrilled dinner entree items there will be up to 10 items from the Charcoal Grill. Noting a significant trend in more contemporary upscale Boston restaurants, a number of entrees and possibly all of the appetizers may be offered in two portion sizes with appropriate prices. Large entree portions will be priced from about $14.00 to $32.00 (excepting lobsters). Modest portioned entrees will range from $12.00 to $25.00 or approximately 2/3 to '/4 of the larger portioned prices. Menu Terminology for consideration Small Plates, Main Plates, Salad Plates, etc. For Grilled Meats &Fish,plain no sauce—"Naked". For Grilled Meats &Fish jazzed up with sauce or other accompaniments—"Dressed". UNIFORMING Carrying the upscale nautical theme through, the service staff will dress in well ironed crisp white officers shirts, will wear neckties. They will wear sharp black pants covered by long white bistro aprons and polished black shoes. Summer and non-summer versions of this uniform will be developed. DIRK HANS ISBRANDTSEN 11 Everett Paine Blvd., Marblehead, MA 01945 (781) 631-7534 EXPERTISE: Hospitality Management with focus on Hotels, Restaurants and Private Clubs, gained from over 25 years of experience in a variety of challenging environments with revenues from $1 million to $80 million. PROFESSIONAL EXPERIENCE: January 2, 2001 —October 18, 2002 HYANNIS YACHT CLUB Hyannis, MA General Manager Scone of resuonsibility: Hired by the Board of Trustees to direct the Club toward improved quality in all aspects of marine, hospitality operations and facility construction and maintenance. Also, to interface with capital project committee chairs, architects, engineers and contractors in the successful completion of clubhouse expansion and dock construction projects. The Hyannis Yacht Club is a unique club organization because in addition to 575 Active full members, there are over 5000 Associate (dining) members. The Club is a year round operation with Food and Beverage revenues of about $2,000,000. Profits from the F&B operation subsidize much of the other Club operations. The Club also owns 10 power boats, 16 sail boats, a maintenance facility and the Lewis Bay Yacht Club property. Fiscal 2002 was completed on or ahead of budget with a 17% increase in F&B revenue and substantially improved member satisfaction results. In September we hosted the International Laser Association's World Championships (150 Olympic caliber and 300 Masters competitors) and received commendations for the"best ever worlds." 1999 - 2000 INDIAN RIDGE COUNTRY CLUB Andover, MA General Manager Scone of responsibility: Selected by ownership of this large and highly active country club to improve the facility,member satisfaction, and profitability, while balancing continuity and the need for change. Developed a 3 year business plan, annual budget and capital plan. Completed a$500,000 first phase remodeling of the club house and significant upgrades to the golf course. Updated human resource policies to reward excellence and to encourage higher performance standards. r DIRK HANS ISBRANDTSEN 11 Everett Paine Blvd.,Marblehead, MA 01945 (781) 631-7534 1991 - 1999 DHI ASSOCIATES Marblehead, MA Principal ScoDc of resnonsibility: Established this management and consulting practice to improve business performance of independent hotels,restaurants, and food service related operations. Developed a network of professionals including chefs, advertising specialists, architects, interior designers, purchasing agents, builders and financing specialists. Led significant repositioning, design and development with several clients. Assisted clients in improving revenue, profits, employee and customer satisfaction. 1993 - 1996 THE BEECHWOOD HOTEL Worcester,MA General Manager Scone of responsibility: Initially retained as a consultant, then as General Manager of this beautiful, high quality property. Recruited and developed a top notch staff and strengthened and focused our sales effort. We increased revenue, customer satisfaction and profitability in the first two years. Sales growth provided us with funds to re-concept our restaurant and to add a wing of new rooms. We earned top market positioning amongst all hotels in Worcester and a five star rating for our restaurant from the Worcester Telegram newspaper. (Increase in occupancy of 16 points & ADR by 18°%). 1987 - 1991 BEACON HOTEL CORP. /GUEST QUARTERS SUITE HOTELS Boston, MA Corporate Director of Food and Beverage(4/90-6/91) Scope of responsibility: 30 Guest Quarters Suite Hotels - nation wide, directing all F &B operations generating approximately $80 million in revenue. Guest Quarters moved from limited or complimentary Food & Beverage to full service in all possible hotels. Our goal was to develop and implement a cohesive approach to profitable F&B management and to position our hotels as "First Class, Full Service" all suite hotels. Additionally, I had lead involvement in facility design and concept development opening two properties in 1990. Rewrote Policy& Procedure Operating Manuals for all Guest Quarters F&B operations and developed corporate beverage and marketing relationships and standards. Regional Director of Food and Beverage (10/87-4/90) Scope of responsibility: First region included 7 hotels. Second region included 11 hotels. Extensive management development, budgeting, food and beverage marketing, cost reduction. Improved revenue by 12% in 1989 versus 1988, bringing 95% of increased revenue down to G.O.P. 1990—Increased Food &Beverage revenue by $5.9 million, and departmental profit by$1.4 million by strengthening catering sales, re-concepting several restaurants and modifying staffing. DIRK HANS ISBRANDTSEN 11 Everett Paine Blvd., Marblehead, MA 01945 (781) 631-7534 1987 D. RICHEY MANAGEMENT CORPORATION Wilton, CT Senior Consultant- Hospitality Quality Assurance and Staffing Scone of responsibility: Concentrated on executive recruitment and placement while assisting in quality assurance and integrity evaluation for client properties. Consulted on design and acquisition of multipurpose restaurant, catering and private club facility. 1979 - 1987 THE SHERATON CORPORATION Boston, MA Director of Food and Beverage - Sheraton Meadowlands Hotel(1986-3/87) Scone of responsibility: Opening and operating $7 million food and beverage operation of this 430-room corporate-managed property with two restaurants, two lounges, banquet capacity to 2,000 and 24-hour room service. Overall responsibility for quality and financial performance. Developed all outlet concepts; established budgets, hired and trained management and hourly staff. Assistant Food & Beverage Director - Sheraton Boston Hotel and Towers (10/79- 4/86) Scope of responsibility: Progressive positions within this 1250-room hotel with a $15 million food and beverage department, four restaurants, five lounges, 24-hour room service and banquet capacity for 3,000. Positions included: Assistant Director of Food & Beverage, Director of Banquets, Banquet Manger, Assistant Banquet Manager, Restaurant Manager. 1969 - 1979 Chain Restaurant Management, Restaurant Owner, Management Trainee for International Sporting Goods Manufacturer. EDUCATION: SYRACUSE UNIVERSITY, B.A. - ECONOMICS, 1969 ADDITIONAL: Adjunct Instructor, Newbury College (1992— 1993)—Hotel Front Office Management, Facility Design, Food and Beverage Management Chair, Board of Directors—The Connections Program, Inc. (a Marblehead, MA based affordable housing nonprofit corporation) Seared filet mignon, rosti potato cake, East coast halibut, Asian greens, shitake sauteed Tuscan kale, crispy leeks& mushrooms, potato chive dumplings, cashew balsamic-wine drizzle &ponzu broth CHARCOAL GRILLED PLATES 10 to 12 entrees Classic Contemporary Marinated skewered shrimp, sea scallop & Atlantic salmon, sweet"n" sour cucumber, vegetable kebob with pine nut, scallion jicama& fresh dill salad, fingerling potatoes Dry aged New York strip steak, potato an Bourbon Dijon pork tenderloin, sweet potato gratin mash with sun dried cherries Capt's bone-in sirloin, golden Yukon potato puree 8 oz sterling silver ground burger, brioche bun, French fries, cabbage, fresh fennel coleslaw SWEET & SAVORY PLATES 4 to 6 desserts, 2 cheese plates Classic selection of cheeses, sun dried fruits, nuts & Flourless chocolate hazelnut cake, creme crusty bread anglaise, hazelnut gelato Contemporary Blueberry nectarine crisp ,vanilla bean ice _banana, chocolate—praline crunch, vanilla cream bean ice cream, banana, warm caramel sauce Fresh seasonal fruit , mixed berries& , sorbet strawberry coconut cheese cake ,graham Belcolade chocolate mousse, whipped cracker crust ,whip cream, strawberry coulis cream & chocolate shavings_ —chocolate-espresso-pecan torte, vanilla bean ice cream SALAD PLATES Classic (Large & Small) Contemporary 6 to 10 Selections (3 small,3 to 7 entree sized. Some could be modified with toppings Chilled poached seafood& shaved fennel, Sun ripened tomato salad, boccocino shrimp, scallops, calamari, mussels in a mozzarella, fresh herbs, bruschetta& lemon-parsley dressing balsamic reduction Grilled tomato, fennel & chipolte pepper Iceberg wedge , beefsteak tomato, smoked soup with sweet com salsa& goat cheese applewood bacon, red onion&blue cheese dressing_ Herb crusted warm goat cheese with mesclun greens, roasted leeks, sweet hearts of romaine, roasted peppers, capers, peppers, grilled sour dough&sherry wine parmesan cheese,tapanade croutons &our emulsion own version of Caesar dressing Swordfish& bay scallop ceviche with mango, coconut, mint& plantain chips CHEF' S SPECIAL PLATES 10 to 12 Entrees Classic Veal scaloppini, arugala, endive, radicchio, frisee & lemon thyme dressing Contemporary Long Island duck breast (med-rare) Steak an poivre, Courvoisier cognac cream cranberry-almond wild rice, dried fruit peppercorn sauce, mashed potatoes_ compote &port wine sauce_ Seared Maine diver sea scallops, sauteed butter beans, leeks, baby spinach& lemon infused oil Seasonal Vegetable selection sauteed tuscan kale, marinated artichoke hearts, grilled vegetable- quinoa succotash&ratatouli CAPT. ' S WATERFRONT GRILL & CLUB SMALL PLATES (Select one as an Appetizer or Several to make a Meal) 18 to 24 selections Classic Contemporary Local mussels, aromatic Pernod-basil broth, grilled sour dough Fried clam strips with lemon coriander aioli Smoked bacon, gouda cheese fritters & Marinated artichoke heart,parmesan, lemon sweet cornjalapano coulis &mint bruschetta_ Ratatouli, mussels and fresh basil Jumbo lump crab cakes with fresh herb bruschetta remoulade Crispy Fried squid, spicy cherry peppers, Grilled shrimp, butter beans, leeks & fresh fried parsley &marinara sauce thyme Chilled Jumbo shrimp with classic cocktail Tuna tartar, tobiko cavier, avocado,jicama sauce & cucumber on wonton crisps_ Blue cheese stuffed green olives, almonds, Grilled stuffed squid,white bean relish, & oregano & endive tomato coulis Fresh oysters on the half shell presented with mignonette & cocktail sauce New England baked stuffed clams CAP ' 1 ' " s • f GRILL & CLUB Opening Menu Week # 1 Welcome to Capt. 's! This is a limited menu for our opening period. We want Capt. 's to be your favorite restaurant. With that in mind, we encourage you to provide us with your comments and suggestions. Each week we will add refine, change or eliminate items on the menu—taking into account your ideas. We hope you enjoy your current visit with us and future ones as we evolve and grow. pgl 071604 l Srr).?// Plc?tes (Select one as an appetizer or sever,3l to make,3 meal) New England Style Fried Clams VegetWe Spring Roll With lemon coriander moll Mango sesame sauce, sweet soy drizzle. $9.95 $7.50 Pan Seared Crab Cake Medallion ofBeef With fesh herb remoubde. Parmesan herb crusted tenderloin morsels $7.95 cherry tomato salad sweet pepper coulis. Crispy Calamari X8.95 Spicy cherry peppers, Fier/parsley& marinara sauce. Lobster Risotto $5.95 Mixed with chive and citrus flavors. $70.95 Steamed Musse/s PeMOCI Accented with Pernod coconut& basil. Raw Bat-Selections 6.95 $ Additional Bruschetta Offreshly m7nnated artichoke hearts, 4 Chilled"iumbo Shrimp Jif 50 $2.50 shredded parmesan, lemon Br mint. 4 Oysters $8.50 $2.25 $5.95 Comments &Sugge5tion5 Comments & 5uaae5t1on5 Soups & ChowdeP5 New England Clam Chowder Cup Bowl $5.95 $4.95 Grilled Tomato &, Fennel Soup—With chipotle peppers, $325 $4.25 sweet corn salsa &-goat cheesegarmsh. Comments &Suoge5tion5 pg2 071604 r CC7551c k Cot)tem ot- ,tS I,?d5 (Dressings: Blue Cheese, Thousand/stand Lemon-Thyme & Balsamic Vnaigrette) Garden Sala% Mesclun greens, fesh herbs, grape tomatoes 15.25 Capt. ' Speci3154d A medley ofchopped salad greens, a vocado $6.25 chick peas, tomato, feta cheese and sunflower seeds. Hearts oflceberg—A large wedge oficeberg lettuce with 4.50 beefsteak tomatoes and smoked apple wood bacon. Hearts ofRomaine—Roasted peppers, capers, parmesan cheese $4.95 j tapenade croutons, egg-Fee Caesar style dressing. Charcoal Grilled AccornP-3nrmen& Breast ofChicken 5.95 5 Urge Shrimp $6.95 Grilled Steak Tips $5.25 Petite Grilled Swordfish Steak $6.95 Comments &Suaae5tion5 5, oodwiches (With Fennel Cabbage Slaw& French Fries) Turkey BL T—Freshly roasted turkey breast, choice ofbread - $8.50 New England Lobster Roll—Chunks oflobster and a dollop ofmayonna1 $94.95 and a little diced celery on a grilled hot dog roll. Charcoal Grilled Hamburger—Freshlygrouad top quality $ 7.95 beef. Add Bacon or choice ofCheese $ 75each. Panini5 (5pec1a1Grilled 5andwiches) Grilled Chicken—with brie, apples&Dilon honey mustard $ 8.95 Grilled Vegetable P.?nini—With basil pesto spread $ 6.95 Crab Melt—Brie, red onion and avocado. $90.50 Comments & Sugae5Son5 pg3 071604 I Chef's 5pecl,�l LUocheol) Pl,�tes Grilled Swordfish Steak—Tangy fuitsalsa $13.95 Pan Seared Salmon Filet—Sweet&sour cucumber, licama slaw. $10.95 Crab Cakes—With mesclun greens and Fesh herb remoulade. $15..95 Medallions ofBeef Parmesan herb crusted tenderloin morsels, cherry $14.95 tomato salad, sweet pepper coulis. Grilled Vcgetable Medley—With marinated artichokes, ratatouille, white $10.95 bean relish & Tuscan kale. Grilled Marinated Breast ofChicken—Lemon herb marinade. $ 9.95 Comments &5ugge5tion5 ._ . Chefs Spec c?1 Dit)net Plc7tes Veal Medallions—Creamy polenta, green beans, baby carrots& mushrooms. $2195 Pan Seared Salmon Filet—Sweet&,sour cucumber licama slaw. P595 North Atlantic Haddock—Served with lobster risotto, tomato 11795 caper beurre blanc. Center CutSwordf<5h Steak— Basm,?&scallion rice, tangy f itsalsa, X2195 Medallions ofTenderloin—Pan-seared, rosti potato cake, crispy $19.95 leeks, balsamic reduction sauce. Capt ' Pry Aged Bone-in Sirloin A very special Steak. $26.00 Lemon Herb Chicken—Cannellini beans and chef's vegetable. $12.95 Comments &5ugae5tion5 pg4 071604 f Sweet c�Z~ S� VOPY Warm Chocolate fake—Espresso ice cream and vanilla creme anglaise. $4.50 Banana Three Ways—Caramelized bananas, bananas wrapped Ma crepe $4.95 with custard, and banana ice cream; chocohte tum sauce.. .. . Sticky Tome Pudding A British Specialty, with figs and vanilla ice cream. $5.50 Seasonal Fresh Fruit CwA,3da Available with ice cream. $5.50 Freshly Blended Ice Creams &Sorbets 4.25 Special Coes & A her PlImer OntAs Freshly Bt-ewed Coffee of Te —Re9uar ordecafin tod It.50 Espresso—Regular or decaffeinated, 51ngle$5.5O Pouble$4.5O Cappuccino—Regular or deco&inated. $4.95 Spanish Coffee—Tia Maria, Grand Marnier, and Cognac. $5.95 lri5h Cream—lr15h Whi5keyand Baileys. 5.95 Caribbean Comae—Gosling Rum and Kahlua. $6.50 B &r B, Grand Marnier, Dtambuie, and other premiumcordiab $6.25 �i liqueurs, fom: Comments &Suaae5tion5 & Consuming raw or undercooked products could increase your chance ofcontracting A foodborne illness. lfyou have any questions please ask your server. pg5 071604 Fe ---- ---------------- --- !0'�tR At FA I I I CIE ,(> „ - I �" ~1 F/7 o d VOL]� I y 02 i �LiEl �n 1 I I Q-21G/I Li �(( J U SECOND FLOOR a r I V t I I ! O I i % I I L cl 0 —;. C - L Cl FL I r i n --- -------T r tn r 1 f ) n � n r `,O 6 Tip= Rev No Date Description PRDJECI rn C FOOD SERVICE EQUIPMENT e,-10-04 RENSED PER MIENi COMMENTS BOSTON SHOWCASE COMPANY 9� MEQ roMM,al,.v,n mon—rn— e4mP.nent s..,.e 1913 CART'S WATERFRONT BAR & GRILL LOCATION PLAN 66 Winchester Street KITCHEN DESIGN Q Phonee617/96g5-1h100 Fax R /sss-e 26 SALEM, MA Capt. ' S Waterfront Grill & Club P(MV5T Ms. Joanne Scott Health Agent, MAR 3 0 2004 Board of Health 120 Washington Street CITY OF SALEM Salem MA 01970 BOARD OF HEALTH Dear Ms. Scott, As mentioned in my email, here is a copy of my floor plans for Capt.'s Waterfront Grill & Club. Also included is a fairly final kitchen equipment layout and equipment list. Obviously changes will take place based on construction and budget constraints, but I believe the final layout will be very similar to what is presented here. I look forward to seeing you Tuesday at 10:30. Sincerely, Dirk Isbrandtsen ".l A F O O D S E R V I C E E Q U I P M E N T S C H E D U L E �11L STATUE OW OESCRWINON ELECRSCTL MATER WASTE ,GAS REMANIS 1 N - 1 REFmOF1M70R.REAW-IN 7A 1/5 171 i. •X' , 2 N 1 ENNMST NOW W tm 1 x - x J N 1 RANGE,MEOW DUTY GAS 1/4 171 1 ,x 82/r 152 -4_ N 1_RE lMMIM CHEF BASE 7A 1/5 IN 1� x - 5 --. N _ 1 BROIWOMINiEA OAS 1 X7/4 1m - 1 E -I OWN.CCNYFC /4' m II/N IAS ED , 1/t 1m ,1 ,x ;] , - , 7 - - - SPARE NLQN R- '/ E 2 FRYER.OEFP FAT ;i/r ,1m 1 E 1 3/5 SIU,ON" IN"1/r 1-1/r - `10 N S S/S MALL SHOF 11 N T,FIE SUPPRESSION SYSTEM 40 1m Ili '12 N-- 1, HAIR.SINN---- . - . ' _ - - 1/r;1K 1-1/t.1-1/t.ONT TOj 18 E 1 FRECUR.WONT u 1/,1 :Im- 1 .x.. s $4 E 1 REFmOERATOF,MCML TOP U :1/2 C/ '1. x , Is N / WKTREN POW SHELF . 4 N -1,sERVNG WINTER,MEOW U fA m t' x i 17 N ,.1•OM:RRICF,o011Ri CSx _ C, -, .E 1 ,SANOWOL UMT....... .... .. . .. 166_.... ,1/2 "Clo _. 1,„..x ' ._-.- SPARE. N N. 1-WAIiRERS a N 1 QVIDIVIOF.DCOUE DELT '72 N 1 SANDWICH CR 72 1/7 IN 1; x 29 N 1 OVAL TRAY RACK _ IN, - .. SPARE NYYffR- _ m . ..N.....1..OVERPHIM.,SI MX,TABLE MOINT` ...- m------.- -. -.-_- SPARE_NINIIER_ _. ._ . . .. .. .-. 27 - - - SpAwE-NGMDR- _ E .. . . .. j m - - - SPARE MUM=- _ 20 - - - SPARE MUM- - m - - - SPARE NUMBER- T E- 1 UNITY COMER- NICE 162. 1/! _IN 1 I r - - 22 m E. ..1'PRE-IM6E SPRAY,. 1/r x _. ,N 1 ONALMITNOOD,CONDENSATE m N 1 OSIIWASIER,DOOR-TYPE COMET 7A 1 m 7 X3/4r r IM20 .. 2L ED 1 m ] x 2/4r 3E 1 CLEAN OMMAMS A E 1 RACE SHEW.SOD m-_ N, 2 NAMD,.SML._.,,-._. 1/1', 1/r, 1-1/r . . . m ._, E 2.51ELYU0-tMT-_ 4 N ,.1-S,COPAIMW POT SWM _ . . _ -. 1/!' IN.rtr 41 N 1 S/S RAIL 91WIPOT RACK 42 N / S/S 9II1 TARS (f4OBIE) 1 ' 4 E 1 REFRIGERATOR,WHIT TOO Y 1/5 in 1 x 44 N 2 FSWW0 OWN, -Ml,7A m 2 _x f 45 N_., 1 $A MALLSTET._.. M.. N . 1 S/S WALL SW-.. .... .. - _ . . 47 N 2 PAM ORORE 120 M. m 1 x 4 N , 1 SYARIMkL MALL SIEIF SYSIEY ' 4 N 1 WAIIIE'm POW SHELF m N 1 OMMDW.00111.E OECR IS E 1 SNIDUCH UNIT 7A 1/2 IN 1 x I2 , E... I SkWVMVSAAO-UHT. .- _ _ 40,- 1/U 115 1 x - m._ E -1, MAl1EENP.YOMIP,SHFOF. - N N 1 01FRSHEIF.OOmLE D= BE E, 1 NOT FOOD TARE m N t NOT FOOD SELLS,DROP-N 17A L m 1 IT 1/r . By E 1 SANDWICH IMT 1.6 1/2 no 1 x IS N. 1 FIE SUPPRMM SYSTEM _ 40 IN 1 x m N 1 FROME74 REAL-K NARROW 7A 1/2 120 .1 x N, I NETTIS,.70-GALLON,ELEICOW 447 lu m 2 x t/r 1/r W N 1 FLOM DRAW CUTE r m N 1 REM AND SATTER STATCI m N 2 FRYER,DEEP FAT 1/r NI /4 E 1 OONVECININ OYD4 SIRE DDDR,GAS 7A 1/2 Im 1 It 7/4 m m N 1 RUIUMPA11M CHEFS M45E 7A 1p IN 1 I R N 1 RANK MOD”GAS RESTMRMT 714r 1m D NA , I IONAUST HOW,. ICI lm 1 x , ISO, lm 1 x m N 2 REMOMICI,1-SWOON GLASS P/T EO 1/7 im 1 x m N / EXKAW HOW I" IN 1 x A N i CRL COC11E'R UNIT 1/r 4 71 N i SIFAMM 00NWOTION 222 W m 2 x 1/4- r 72 E / RFAWEAATOR.REAL-K 2 SWIICI u Ip 120 1 x 75 E -.1 MOd!SHELVING" 74 E 1 NE MANOR M/BNI,._ W 2-1/2 m, 7 X. 1/r 2/47/4' 74-A N 1 WAIW-TREATMENT CIT 2/0' m N 2 U CEM CABIET U 1m I x A N 2 OWPER L 1/t, r 71 N 1 COLOM SEVO A0E 78 N 1 FOOD WARMER,COUNTERTOP, ROM L 0.7 0 1 x 7/ JJl�,,,,,,� 1 3/3 MALL REF. mNN, (EJ( 1 TAIWOT COFFEE MOM 258 ES 12vm 1 x 1/Y W CT 1 a OLIO 100 1m I x 1/r7/W4r M-A E 1 NX SICO/m m 7/r R N H W M TREATMENT IMT 2/S' 63 E 1 S/S MCU TAKE _ Massachusetts Department of Public Halth Salem Board of Health �= 120 Washington Street,0 Floor Division of Food and Drugs Salem, MA 01970-3523 FOOD ESTABLISHMENT INSPECTION REPORT Tel. (978) 741-1800 Fax (978) 745-0343 NameDate Type of Ooeration(sl Type of Inspection Ctfj�r,Ac 'NA anti! Fr(r1/( 4 ( luAi (0b,)1UU I WFood Service 013outine Address Y �,1 W I_ (' Risk `r Retail /❑ Re-inspection �. Level E] Residential Kitchen Previous Inspection Telephone �/ ,( _ r ❑ Mobile Date:el�lU Owner HACCP YM ❑ Temporary ❑ Pre-dperation 114, 5 7r�N)�,iM I ❑ Caterer ❑ Suspect Illness %Person in Charge(PI ) 'd J Time ❑ Bed&Breakfast ❑ General HACCP Complaint ❑ inspector /- Out:z---f) Permit No. ❑Other Each violation ceiecked ?equires 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 [113. Handwash Facilities EMPLOYEE HEALTH" ' ... .. ' PROTECTION FROM CHEMICALS ❑ 2. Reporting of Diseases by Food Employee and PIC ❑ 14.Approved Food or Color Additives ❑ 3. Personnel with Infections Restricted/Excluded ❑ 15.Toxic Chemicals FOOD FROM APPROVED SOURCE' - - ❑ 4. Food and Water from Approved Source . TIMEITEMPERATURE CONTROLS(Potentially Hazardous 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 PROTECTION FROM CONTAMINATION """ ' ` ry •[,L19. Hot and Cold Holding ❑ 8. Separation/Segregation/Protection [120.Time As a Public Health Control ❑ 9. Food Contact Surfaces Cleaning and Sanitizing REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS El21. Food and Food Preparation for HSP E] 10. Proper Adequate Handwashirig i El 11. Good Hygienic Practices ` CONSUMER ADVISORY - • � ❑22. Posting of Consumer Advisories r Violations Related to Good Retail Prac[lces_ Number of Violated Provisions Related Critical (C)violations marked must be correcteTo Foodborne Illnesses Interventions immediately or within 10 days as determined by the Board and Risk Factors(Items 1-22): V of Health. Non-critical (N) violations must be corrected Official Order for Correction: Based on an inspection ) immediately or within 90 days as determined by the Board today,the items checked indicate violations of 105 CMR of Health. 590.000/federal Food Code. This report, when signed below C "N. by a Board of Health member or its agent constitutes an 23. Management and Personnel (FC-2)(590.0 order of the Board of Health. Failure to correct violations 24. Food and Food Protection (FC-3)(590.0044)) cited in this report may result in suspension or revocation of Ile- 25. Equipment and Utensils (Fc-a)(sso.00s) the food establishment permit and cessation of food - 26. Water, Plumbing and Waste (FC-5)(590.006) establishment operations. If aggrieved by this order, you -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: 2 S s901nsOBGfFoim610 me ^ -- I �I t. ] Inspector's Signature: ' \\\ / l(// //� Print: 0 PIC's Signature: //g Print: Page_ f 6 Pages Violations Related to Foodborne illness Interventions and Risk Factors(items 1-22) PROTECTION FROM CONTAMINATION FOOD PROTECTION MANAGEMENT 18 Cross-contamination 1 590.003(.4) I Assignment of Responsibility" i 3-302.1I(A)(1) Raw Animal Foods Separated from 590.003(61 Demonstration of Knowledge* I Cooked and RTE Frxxls* 2-103.11 Person in charge-duties I 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 to charge to ( I Contamination from the Environment require reporting by food employees and 3-302.1 1(A) Food Protection- appticants* 3-302.15 Washing Fiutts and Vegetables 590.003(F) Responsibility Of Food Employee Or An 3-30411 Food Contact with Equipment and Applicant To Report To The Person In I Utensils* Charge* Contamination from the Consumer 590.003(G) Reporting by Person in Charge* 3-306.14(A)(B) Returned Food and Rexrvice of Food` 13I590.003(D) Exclusions and Restrictions* I Disposition of Adulterated or Contaminated 590.003(E) Removal of Exclusions and Restrictions Food 3-701.11 Discarding or Reconditioning Unsafe FOOD FROM APPROVED SOURCE Food* 4 Food and Water From Regulated Sources ( i 9 Food Contact Surfaces 590.004(A-6) Compliance with Food Law* ( 4-501.1 I I Manual Warewashing-Hot Water 3-201.12 Food in a Hermetically Scaled Contamer^" I Sanitization Temperatures* 3-201 13 Fluid Milk and Milk Product;" I 4-501.112 Mechanical W'arewashing-Hot Water 202.13 Shell Eggs* Sanitization Temperatures* 3-20 Eggs and Milk Products.Pasteurized* 4-501.114 I Chemical Sanitization-temp.,pH, 3-202.16 I Ice Made From Potable Drinking Water* I ' concentration and hatdness. 5-101.11 ( Drinking Water from an Approved System" 4-601.1 t(A) I Equipment Food Contact Surfaces and 1590.006(A) I Bottled Drinking Water* Utensils Clean` 1590.006(6) I Water Meets Standards in 310 CMR 22.0* 14-602'I I Cleaning Frequency of Equipment Food- Contact and Fish From an Approved Souroe Contact Surfaces and Utensils* 4-702.11 Frequency of Sanitization of Utensils and 3-201.14 Fish and Recreationally Caught Molluscan I Food Contact Surfaces of Equipment* _ Shellfish* 14-703.1( Methods of Sanitization-Hot Water and 3-201.i 5 Molluscan Shellfish from NS5P Listed I ( ( Chemical* Sources* ( t0 Proper,Adequate Handwashing Game and Wild Mushrooms Approved by 1!301 12- . Clean Condition-Hands and Arens* _ Regulatory Authority 3-202.18 Shellstock Identification Present" ( 2-301.12 Cleaning Procedure* 590.004(0) Wild Mushrooms` 12-101.14 When to Wash* 3-201.17 Game Animals* 111 Good Hygienic Practices I 5 I Receiving/Condition 2401.11 Eating,Drinking or Using Tobacco* _ 3-202.11 PHFs Received at Proper Tmnpu atures* '--401.12 Discharges From the Eyes, Nose and 13-202.15 Package integrity' Mouth* 3-101.11 Food Safe and Unadulterated* I 3-301.12 Preventing Contamination W9ien Tasting* b Tags/Records:Shellstock I 112 Prevention of Contamination from Hands 3-202.18 Shellstock Identification" I 590.00.4(E) Preventing Contamination from 13-203.12 Shellstock identification Maintained* I Employees* Tags/Records:Fish Products 113 Handwash Facilities 1 3-402.11 Parasite Destruction" Conveniently Located and Accessible - - 1 I 3-402.12 Records.Creation Numbers and Capacities* and Retention* I I of 590.004(.1) LabelingIngredients* 15-204.11 ( Location and Placement* 9 I 7 Conformance with Approved Procedures ( 15-205.11 I Accessibility.Operation and:Maintenance /HACCP Pians I Supplied with Soap and Hand Drying Devices 3-502.11 Specialized Processing Methods* ( 16-301.11 Handwashing Cleanser,Availability 3-502.12 Reduced oxygen packaging,criteria* 8-103.12 I Conformance with Approved Procedures* I 16-301.t2 Hand Diving Provision *Denotes critical item in the federal 1990 pond Code in 105 CMR 590.000. CITY OF SALEM BOARD OF HEALTHY a a } Establishment Name: f }. n r 1 r %4 C`t`rl I f r/",�7 Date: J D4r/,0, Page: of �F_f Item Code ` C-Critical Item, DESCRIPTION OF VIOLATION/PLAN OF CORRECTION , . ate No. Reference R—Red Item < - r�. µ; {�erified PLEASE PRINT CLEARLY U/)l� ��I .� v, Intij /�l � J m v 6 s k, ILIA f I ! _ I t ,I•�- �!_r.n, it � ChlUn AnI rl,r I7n)Wfrn r P. ',Ar 1 �� A)O r, r— COY 01'0 _ I (a-r- 1,�,1, I I � l t ,tT n� _�r_n�_ � ��.• � nc,r" i('n M y v �nM � l� r�- �Sr .1�0 r_! f. i �_ _ _ �� f �9 (F>/ / 4ilnnn} fo r0r`I7 fy� I �v, vQ/� 1' , n� P/D fir r 1 r! f A I 1 r� r _ I I Cel-k41. AJ,.;_ ✓ s�,, �-��; Discussion With Person in Charge: orrective Action Required: ❑ No kd res 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 ail conditions as described, and to fff El qQ Re-inspection Scheduled Emergency Suspension 'C comply with all mandates of the Mass/Federal Food Code. I understand that /t s lop 7 noncompliance may result in daily fines of twenty-f�oll��su�on/revocation of ❑ Embargo ❑ Emergency Closure I I your food permit. ❑ Voluntary Disposal ❑ Other: s _ -. • { i T! !*i-') Pffl-', Kru•,':cd<,I I-:nl(>::Y:in3rci 'Jrobfiorfs Rotated to Foodbome fftress Inferventiors and Rish A,;,•rdi'.r to 1..3." Uxded ic7 Factors(Item 1-22) (Cont) 4l,rzt4H.ot„ .. li,•thctd.:fvr VHF PROTECTION FROM CHEMICALS ly v PHF HrA and Gold Holding { 14 ! Food or Color Additives { ! E Kti.lhiEt; cladPEYi'sNirate..i:,4.iat,�rFt:ic,:v I 3.:3t1:.14 Pr„t:ctiot; t},;trt t:nat,Pr,„r-d A<fdtttrc.c" ;-•i`:i.1 f r`t IIsi €'111:< , 15 Poisonaus or Tuxic Substances i 9;.0 u.ineJ at,m above { -t €iil.I( ! fife;nUtytngininr,n.ttu,r.--Urit;ina; y tt,., HL. > I C�t'ntati3Ot�a •. {}t"1 •',l,im- tl Id Jt or aFx>v,^. i,40`F k Time as a Public Health Contral k Cotrim„n\:;rve- 4`^'.n•i<inr C.=rt,uncra'” I { X01 t;- ( i ia:c as a Public Health t'Cnttot' 7-201.11 Srpat a6on -Snnai:c 1 t I r rt},:tt Y Geatnctioe -Prrn.nie wid i..>c^ ( tp......- ._. ! j7 '02.12 Conditit,n,of tlwc j 7 20 11 REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 204.1 l 1 saniti ers,Crircrla-C-i,ctatc"k- POPULATIONS(FISP) 2€ k :<,S tt.'irrt3t=iccr,,.cd T s:Y aged Sakes and i 7-3rid.?2 ch'uwicais fct `.i*:tchi l rtkltt�e,t_t ttt„'1_.. { - § t• f. ! ; 204,14 Drving Atret.t-.Crveri+;" E i3�� c::>s evstt, bar ,utr ta€'ei„` l t -5Vi Iltis: ?.•-:.'IofPa<te,u7zed}.•.c;::;.. -,.)0,5 1 i Lacideri.,i E,>,xi f'xmiait,1.unrt”ant.' t :_Siti.l 1 t'tr It 7-206.11 l2eo-t:i..tcd i`:.r €'colt ides i;,ritw ta' { j f Fiau c•r F'a;ti,tilY{;:�7r,•,i Sroim?E Ft>ex3 ,nu3 Rao ,Saed SP-•snis 'Wl SerVL-1. ' 7.2+tfi.12 Rtxirut Ti:;ii Sialiwe" { 1 t (.n« ; , _ .2 - tz >., r_, ., •.xtt 37�C. t .Crlvd 37,,,x1 Patki gu No Fe-'crved ^ { ?- Jn 't rtrptny}-',n.,:l<rs, t st, i,xrt� out. , CONSUMER ADVISORY ! r.2 ''.i,,t:.I ! t',•ns,u„-e Arlmsory Pi6t'A ru <-'tn>unlPtion nr TIMFjTEMPERATURE CONTROLS 1 try Proper Cooking Temnetaturesfor � { ,tt:3,,t'lF��<nF;tiilVazare:(Zaw. Urtdar.:utl:edt,; ise i i4fji 11:A(I:{2, f:_N,. I51,?=' IS.SCc. I 4 , '-3U:.i3 t�:�ct�;,nn^.{F.' Sttl,etit:atz• fist R;t'1'.Sh.fl ! }?Pio-itnn,cdiatr Ser•:tt:t• 1+51-15,er z_40€.i1t:lit27 t.,nmtan€r;;dV,.h,Nfca:�r, Cianu• lntnetis- t; F I: Sp�:CIAL REQUIREMENTS IJ);.1i(t3 tt 4}iL r1,t! and t)ea1 f;a7a<t - €+i}'t lil urin• { __.._..� .__._..._ 54'3{N:'it,'.t i)}-.-�..t._it'l,bli�-`n ill ScL lion o(}.00)tAi-,D) in �F.ttilc, 6tierAA�ic,t, 15 - i� I . t.ct:,w jr.1�t.itC- ;:u13,Iii f<ax;, .Citt(s.,rsi t. acid 1 '-401 11iAr'"''r Poultry, Vw;{`3(iuute, Srnite,.Y 1'til�`,: � � ri�t;;:nt;.,l +,ilchva �Y'eratlun� ,hould be 1u:fluts*t:.ta':aruns Fisc, Me'n' j t:•�httcd und;:t'tw appratnweSc,:tn.ns ka;ttcr ih3'i <rlx-,t'r if t:::`.tfoj to f.><rifhnrrrt'i€tt,cs� 1 401,1j ^j, Inr;tct +Se,:E'�icas;; Intrrvcriticrlcand risi, inciore, t.hht'r 4 `I s„{t_fh'ttt t;,iatt:rn-relatinP ut'"otx#r:laii i .'=it'?•iZ R'ow tmilid tvnl:.Ccx,i,.(l 1;;a { }:t::.Uice:>Itpttld t;c dcf-;tc>,i,(nc!t'r 429 - tiicrouatr 105'F € ".-.1pl,IY+Alcii'hi All rhLetPill- 1'i4 € ISre•: 3 17 Reheating for Hot Not:#ng ( VIOLA PONS RELATED TO GOOD RETAIL PRACTICES 340,1.t1<'.A) i3)1 P1€F•, Iis•,F1:;.e, {4#enie2t_xdl) j ;.40111(4) ;1 wrowavc. }f,?`F: Mitiwc swildinr 1 C,'t ,7'�21,dt:,r:-,olf!4t: rr,.,';rtr�x€,,. xvi,i,h dfr,r:r: ,ebn,,:,, o,e I '3tm•s' E ;oo"i;oruc i4us'ii„r,"n•<n„ tr:a trtc',+:.0;,x,.:,:;t trt7c,i„L.nc can G•r 3--i0>.1 Nc? C•exatn:ici'iry t't c,.;seed R'FF F•tx-1- { 't,rn:,t o,thrt„t„>t,n11:;...ri,,•1,of the Io';t{`xd.:,tt'd lU` C411M -(q T14 -- ? 3.4{ix„€ti:' t2elnaaning I:rift-hcati Port=cn+:,f Itci.i j tte`rn Good Rotatt Practices _ FC 59FO wo r23_..y 'y11, -TA.mem a,vj Fer,cnnei - _.j FC 2 CO2 r-. — t----_-- -_-'---_--- 2„ , (tv:rj:nd=ood Yrott•cliat F-C 3 .00,t I i [1t Proper Cooling of PHFs }{ ! ?h t E, .. -------- -- I70:TWithin frorm rt�r}?(' F zs. atrntpi'lm ` .a na'Nrts<e k FC-1 '000 P 7 , P'ws,,.at Fari.ty F..--S .67, —.__ �r?�'<,:t<da:ar,.ds FC�-7 �. .0{Sri t-st}1.l'ti } Cmliun;PHF-,Nl.,dr.From Ambiet,t k !,_r.7 Sun"at Rcat:;remnn6s � _ _ - 'Crn,pnaRive iuureS±,:uf,it.,.'1,.t:135 F 1 l :.t0. Within 4 11inn 'a�.�,tar;:nnc.,t tte,9.u, s,;t.,Sr,.J iyly Pori C,x:e or 3uG t'liit 5';,tnt�0 CITY OF SALEM IBOARD OF HEALTH 1 / ' Establishment Name: Cr, fi. �� a ✓ 7 (�Fa // a rt, . / Date: LI I i� Page: 7� of r C� Item Code, C-Critical Item : DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Data I No. ' Reference R-Red Item - PLEASE PRINT CLEARLY Verified I An F- __l.�" /,!/.(,/i_✓Y_� I I �/�r rc �ar� l r , I / � ,- I .. , II . ,. ,^._ �• V- t ( r n nom."� . n _ vC__. �AA. 4 I O '—) 1A LvA G. V_• ,.nl r Vii? CIS / 11 'l / 1 IGhl / ln,/1 ✓e� \ �h 11.i / ,1 � Ini, nln i -3 /'•1. Icq y 'r.�J .L-IS-.n / G��inr _ /. v tv_ " --L77, . . _ vJ f V �rr �iiw•_/" �^1ln ` (�1n...! �r_il�r� II �J f( I // • ;"I yX7 n -� r-ivvl r� A ��n r,l -h, _7JOfr I 7' (/ -w .0 • ) 'C�k�� 7 ` r L �J V.1 ) � � � i"L ' v v..ti � , J, - L - I .- _ _. ,..�i. /. J � n VT,.�.,� - Ill/// - -,vv- v. - �✓. .�/ �. � - .- - ..11 •L l 3Q ei.. ,. c-4- I /_l .}- r ��' II ff-- I r i l�t� -2 !7 �� 11/r.. )C �r+ Ul,.r- �) n!1 t4 �/ k9 (,I r-,(10.0 f f ,II -/J r .l hL, r v,/ . .1� <5,, 1 . r Discussion With Person in Charge: / ( Corrective Action Required: ❑ To fifes t I have read this report, have had the opportunity to ask questions and agree to correct all ° voluntary Compliance ❑ Employee Restriction- Exclusion estrictionExclusion } violations before the next inspection, to observe all conditions as described, and to is rteinpection Scheduled ❑ Emergency Suspension comply with all mandates of the Mass/Federal Food Code. I understand that �XJ noncompliance may result in daily fines of twenty-fivVdollar or suspension/revocation of o Embargo LlEmergency Closure 4 your food permit. i ❑ Voluntary Disposal ❑ Other: t db Litt' Vioinlions Related to Foodborne tllness Interventions and Risk According to€.a':. C'<Aed t., Factors{items 1-41 {Conti j F 1 1V_1Yt7 Within . H,xtr, PROTECTION FROM CHEMICALS I i; 1 ,0115 Cu,t!4u Wt3u,d: for VHFl, f Food or Color Additives i 19 3 PHF HCH aad Cold Holding th ;, 5{)i,37;Lir ri,i;tPTII•.:r9xlnr,inettat<trt:�h:v 3.3tJ2.14 Yt„wttr,,nttautBrea,S rc,.edAddtttve.' j z.,tJ; ct. i i i .t.,..ltc,i£'}52�: ritsi;truu,ed wool aih,ve i f5 � Poisonous or Toxic ubsYanaes '•o(J,t-. > ` 11 7 BHA! Laem,"Ig isit,,;,un:irn - (tr wow � '110, 1,1) €. wa,Will at or:t twe i 100 � Cont.un w j 7 10_+ t l,tonl;m :rnlc W,trkinr ii,uutuu:r,” 2!? s Time as a Pnhiie Heatt3+Control i '-201.11 S,:t:a tel,n -5inrage" i '-`-" IQ i'irlte as a E;,hLiL i 2Hatih t'„Hirai' I j -t--olA! Reviicti„r,-pawrow arm L:a” { S :'ariftwe RNWan:eta 70MA2 nnotoan,ofUw- j i-dui [I REOUTREMENTS FOR HIGHL`!SUSCEPTIBLE c 7204.11 Sanitirer,,(vierria-chrulic:,is' { _,.._._POPULAT€ONS(HSPL (:i' Zt `t31 [ist;�, Ieur:�eriPre-nani:nprdJuiceswid I -7-2,}'.T.:' Chcndenfsonth::.hiyt'radnce.Cliwoia'. j f:, f ze,wtdt 14',nl,iar tal•:is.` j 7 104,14 T3rein„Alnorw.t"riieria' Ls:orYa*tnun.cd toe. i 7-205 11 6x:€d::ntal F;.xt i.t,ntact.Lim!i,mw,' 3 it#7t ti•,u-„r Parall; r; •R••L,?nitva} F,k 3 nd 'Y-206.11 iLc,t rirird trsr Pe'�tr.,de. C:ritercl` � I j t Kau .Si t'd p'o;n,'cvl .`71 wd. i 7.2t)fi.€2 T:t+ci..'tti Bast 4t:nn,n,' 4 :.Xm A KC': t;v,,< ro ,Nor Rc-s;:rverl. € "-'_Oft t'? ` Tracking Prn,dw, 1%Cbntr,4 and � j I Niorumrin„ CONSUMER lcOV15{7RY TIMEITEMPERATURE CONTROLS : 22 tt:. !, :'v u=ncl A,htaor. hood :.,r i'ut5>ca1tP dtsn+=f PHPS 3{i Proper Calking Tesrmperatorass for P-•+r.A '3l;Aa,rC;tau:. Undrrouol vd o: i Not f fdx rH ij,�flvxe5: ,,d vi l:iil;ltn..t+^ f 3401 €l.t+it(;:i parhows Ff;y- I55'F755..,. + A '. 13 i'.;aca,t^ed F.s: : S:,hat,:i,t•• t,,r 3illw Sltcfl r C i:�a^-t;t_nrr:,ii.cic.4er:ur W5lt_5;.e.� � _ 0"in:nuted 'tt<h.'<4cc,4 to Ca.tlnc� Animal ;' mtce... ' SPECIAL REQUIREMENTS j -,b0i.t3tB}tP,u21 P,nP,and 17c1:3'R,xts - 3i+)`}' 12intit`* E sv0ii,s'r.Ai:h} L';t'istti�t'.. ,,ISo:B ,n :?l(lW9(A)-iC3) it, j +Af:3 iliAW 1 h'MWN lija d Nadia 155 F iS i# ( so% • ,':luting. t7ortib,Rood, lcoxporaiL and -401.11(Ait-l) Boldtr5,WiId tame Stu?ie.i P({rs• '-. rc�,!ti.:ri,al 1.401n of,Crrtiuloo•daxdd be `i o fine i:oali l ,rnn Fu;ro. Me, 601:ed trndt?-t=1C 3T•pr,:pT:;ite:�i'i1i(t1t1 Vouhry+,r 3tahtce 105'1: i'o.:c. ' n k`:c.' if relal'od to lu'Aix,rlic 11:;wss ,401.1 NQ31 1L'it.,le-nttrs:•te, Gu tet BuJStub:•• 01bor 1451; 15910.001; vt,tlationc relatin, I')�ocyj roffi? 3-401.12 i Raw Ardr,l„1 Voiuk C:.,=i,,:d en a .houla Ile iletllted ur.&r #29 - I Micro"Vi:•e B13 T," Sp„tI'd Roquirrtndnt.. 4i1 ..3� !._ll rA If,t,(b) All(1hu PIV . ta5`€' :5 Qu i 1 17 Reheating lot Hot Holding I VIOLA TIONS VELA IWD TO GOOD RETAIL PRACTICES -403JAfA)&f}?t Pith: tossF €', ec. - ( (lies l;;23-Ni'l ? V)3.11(B.r M1ficrou':ti's- 165'r 2?, 'mde Si-tndirz;; rili,:.a} :wsB:.r,nhwh do nw raw V1 the Tt nte' t`•raJ?rr.nsc i+7n,s.: nn.r'v'Ilo;o e rmr!r,cn ja,.00 tirn'd al,r,ve c;rn Lr 34011 I{C} � C.:nnnowia23v Yrr>rand R•t't: Y,nun loxmi w?hc;;•i mnta;.sc^r.7i:,t:•..!':hs rood Codan'l/t45 Cuk 403 1 Bj? ttctnatntn,t(:r::h•:ad Polzitals of lu ei , Rem Gacd Retail Pr»Micas Y1; t 59+J.OJO-_ { w 23 r_ (i rfi2:,as'tem art n=sd Fer;,,nnrt- —- F .2 ,sCi2 Roayt> _ ._ iK i Proper Cooling of PHFs 24 f c^,c rind Foo Pill,�ctirr: 1 FC--3_! - ' t=5.? _ -i C"Qoipm,-.^,t ;nut ltens,w rp5 t FC q-50, 14A) Ofoling{';Kaci#PHP:; from 141"17 r„ --. . - .-- - _ .. , ... _! ' _2%+ VJa±er,Pii.mi>ir,�,ynfl-N:t;e IFC•-5 i Orri 7FC'- tr'F Wilhtn?Wry:,:;d Trr,;,r. 7W27. P,,,r:,>t Fac�i i fC-6 , .v"Ot I w4 TMY F Vathin a#iou,s 28 ....t.Prnacrnou>.ri'�n,;;Ma:e;,a�s FC-7 ! 1708 ----� 4- -----___ -- ---- - - i 5-501.14(E3) C;ro3'tug PrIF,?v0&From Antb}ant TentYrCatnre to reSietus 1,=4},0;144 F fit' , C)inat ' . ITAnniHms .%Ln'tlt^a uw;14ali i0 me10'i•:1 lv RI too("yvl 105 WK V.4•¢,1 AT i CITY OF SALEM 1 r BOARD OF HEALTH # Establishment Name: �/a ( ,.� S i J 1 , �,-{ �f l(-Fr r -L Date: (0 + � /u Q1 Page: 4 of Ll Item Code C-Critical item „ DESCRIPTION OF,VIOLATION/PLAN OF CORRECTION Date I No. Reference R-Red Item - - - - - Verified PLEASE PRINT CLEARLY � = f` I P-7 �i�-pl f 1'"�i1 r C 1 �i_ n_ n_(,/ N �n u i_)n n ._ _n4 ov-. tJv! C .�-.-� V In�� II //r- Y� �nr r }�.� (in c R-1— �._� . v�/ t lac_ n n, - t f � � 1 1 1 1 f Discussion With Person in Charge: Corrective Action Required: I ❑ No frL res } ❑ Voluntary Compliance ❑ Employee (Restriction / I have read this report, have had the opportunity to ask questions and agree to correct all Exclusion } violations before the next inspection, to observe all conditions as described, and to ✓R -inspection Scheduled ❑ Emergency Suspension t comply with all mandates of the Mass/Federal Food Code. I understand that noncompliance may result in daily fines of twenty-five dolla'fs or suspension/revocation of ❑ Embargo ❑ Emergency Closure '! ;� your food permit. j�� ❑ Voluntary Disposal - ❑ Other: PHFI Rtmwd it Violations Rotated to Foodborne litnt'ss trofIrveritions and RIA Io Lu%, Ckxk:d to Factors(items 74Z) (Cont) Hnuv, PROTECTION FROM CHEMICALS 15 PHR 19 PHF Hot art(,;Coid Holding 14 Food or Color Additives at or IS" 3-302 W Prui,,Cljon fn)uk Uoaj,fisr,ed -%ddinve';' I 'J iioi PHFc "Manvoillej:,t or ab.)ee Poisonous at Toxic substances Im.11 I(Inym fywg Infui imitiov 0Iwinal 3-41-m- it c(a)( I ime as a pv�AA.He;thh Control 7102.1! CtlumlouNanw 1 19 Tiw,. a,'i IIUML health Convol, Vnrilm�,c Recvircni�in 7 2()2,1 i ud L"e* '-202.12 Condition.,of Ust' REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-2{;;-* 11 --Prohibi:i,in,* �04,11 1V POPULA!IONS(HSP) 21 1 too, P10-paci-Itird junts duj 7-N4,12 Chenacids foi V,ashicg flroll,wz, 6wii,i' Av;IL Wan,ing.i'abck* 7-'04,14 Onini,,,Agent^,Criteria, j-s;) ti B! L,e 0I Pai-telk,4.:-j FIp i 16';) i<,1,k or P�uimlj, Amami FiNd 411(1 hwidmi,l F(��J Din)iw.isl 7-206.11 kerirmun�d U" Pr.ricldee:,cr:f-a", Ro&nt Poit S;auov Stvd"Ilr,aN No 3-rwd, 1-206.1 i'+,%: N' "! Rc * -'06 13 fw&ingP,r,dvt, CONSUMER ADVISORY 22 -6(1, !1 Cos;�u,twT i,ir Cowumption of TIMEITEMPERATURE CONTROLS 16 Propos Conking Temperatures for PHFs t:,Niminate 3 101.I iAtl)(2� I 55�r I lFgp :,u t6vsirdl Imawdaw I ,401.1 IiA);,; c(rinninultod Ft ,, (11111v Amimn, I S,7 1 SPECIAL REQUIREMENTS -;-'0I.1 Iiil)t 1)(2} Poll, and R,wl I"!) t" 1 2 1 [All, (,Ak)(2) Kontv�, tricel,ii N1(,)1' - U,5 F 15 Vwlaliiv, ,it in wv. mobihc ftvd, tl-)riporaiv and 401.11tAy3) Pounn-N,WiIii Gans. Sturfcd PHI-s, TL: litctwn ON1-ation,; %honid hu, qnIffine Ckv:onm, Fish, in,dln ilio:ai:-rupi,ate Poultry i,r Rath"-1n5'1' 15 if ehnd 1()ftX)dIX)rqC iiinm 3-5111.1!(C)(;; nitu beef hnun-veilliow,and 6s], rartor-, Other 14511, vityl;,11011"TO I&io1,, to-wd seta(! 3-01.12 Roc., Aninnal I'ut,,J,C,*t,cd to a pr-,,:w es ;hould be 10);% I under #29 - ltict•�n'avc Il r ;i(;;ci'l 1 •'.401 !11'A)(1)4,) AR(-)thiti Pill-, 14T I- €° ' 17 Acti for Hot Holding i WOLATIONS RELATED TO GOOD RETAIL PRACTICES ;403.1!1 4)&t 0) Vilp: 165T }5 qtr" (Rams,21-30) ;--iaj I(b) Mw"ovtw- 105,ro r Minute standinn., i Crat, rns;at wimh i,nor ewdA"me i!l.:,SS a,J IiAj J lor"";�&, abm;e, torr I,, 1, ClInIT111:V'Mih, RIF K,iwl a, ih,-Fo,0 awi (1); 4o'F' 'R €(t?) Rf,inaming t)iK1 we'd of licL NO Practices FC 59J.001! F2��," kla'ltic,,menl FC -? 1003 4 Fenn and-wd Pror�Ilori P C 0 0 Proper Coaling of PHFs -4 i 00b 501 1 I(A) Cthiiing C,ltktdfromI140' Fig, �21` S C. W al -@z'.pi,nlur)Q FC,-5 000 i ?0'T Within 2 ffoul�;ard From 1`.)`1- '17 i� �"c, it ra-thtv pcnsqll�us ot 1,,ic makenal", FC, _7_ W8 ,,-Sf)j 14(b) (,oth.g,PHFirladc From Ambient Tcnilhr,ak Massachusetts Department of Public Health Salem Board of Health Division of Food and Drugs 120 Washington Street,4'"Floor 9 Salem, MA 01970-3523 FOOD ESTABLISHMENT INSPECTION REPORT Tel. (978) 741-1800 Fax (978) 745-0343 Name Date / Tyne of Ooerationfsl. Tvpe of Insoection r( r(��f Il< <n It a�r�a 'Nv (_� (I + C I �1, 1 t)M4, g [fir Food Service ❑ Routine Address` 'V ' I' 4 1 _ { Risk ❑ Retail &J Re-inspection Level El Residential Kitchen Previous Inspection Telephone � � ❑ Mobile Date: faf�,i(vJ ElTemporary ElPre-operationOwner �" - S�fnn HACCP YM I El Caterer El Suspect Illness Person in Charge(PIC - Time ❑ Bed&Breakfast ❑ General Complaint In ❑ HACCP Ins Out ^ d / Permit No. El Other inspector �- �,/ P 'X9/)�n J� : �� Each violation checked re4uires an ex lanation on the narrative'page(s)and a citation of specific provision(s) violated. Non-compliance with: Violations Related to Foodborne Illness Interventions and Risk Factors Anti-Choking Tobacco Violations marked may pose an imminent health hazard and require immediate corrective 590.009(E) ❑ 590.009(F) ❑ action as determined by the Board of Health. FOOD PROTECTION MANAGEMENT w. --'� ❑ 12. Prevention of Contamination from Hands ❑ 1. PIC Assigned/Knowledgeable/Duties El,, y 13. Handwash Facilities EMPLOYEE HEALTH' . . _" -" PROTECTION FROM CHEMICALS" El 2. Reporting of Diseases by Food Employee and PIC ❑ 14.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 TIMEtTEMPERATURE CONTROLS{Potendelly 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 El20.Time As a Public Health Control ❑ 9. Food Contact Surfaces Cleaning and Sanitizing REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) ❑21. Food and Food Preparation for HSP ❑ 10. Proper Adequate Handwashing ❑ 11. Good Hygienic Practices CONSUMER ADVISORY ❑22. Posting of Consumer Advisories Violations Related to Good Retail Practices Number of Violated Provisions Related Critical (C) violations marked must be corrected To Foodborne Illnesses Interventions immediately or within 10 days as determined by the Board and Risk Factors(Items 1-22): of Health. Non-critical (N)violations must be corrected Official Order for Correction: Based on an inspection immediately or within 90 days as determined by the Board today, the items checked indicate violations of 105 CMR of Health. 590.000/federal Food Code. This report, when signed below C N 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)(590.004) cited in this report may result in suspension or revocation of 25. Equipment and Utensils (Fc-a)(sso.00s) the food establishment permit and cessation of food 26. Water, Plumbing and Waste (FC-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) within110 days of receipt oflthis order.- ) 30. Other DATE1OF RE-INSPECTION: C� S SWInsWtFom 14 dac nIn Inspector's Signature: \ I �.!I/ Qom/ Print: PIC's Signature: /iYYY��JxlCVVI (��\C\� Print: /1 , n\ rrn\r.�,� ,_^,` I Page ofZPages Violations Related to Foodborne Illness Interventions and Risk Factors(items 1-22) PROTECTION FROM CONTAMINATION FOOD PROTECTION MANAGEMENT I $ ( Cross-contamination I 1 59O.003(A) .Assignment of Responsibility* 3-302.11(1vi(I) Raw Animal Foods Separated from 590.003(B) Demonstralion of Knowledge" I Cooked and RTE Foals* 2-103.11 Person in charge-duties I Contamination from Raw Ingredients i 3-302.1 1(.4)('2) Raw Animal Foods Separated from Each EMPLOYEE HEALTH I Other` 2 590.003(C) Responsibility of the person in charge to I Contamination from the Environment require reporting by food employees and 3-302.11(A) Food Protection' applicants* 3-302.15 Washing Fruits and Vegetables 590.003(F) Responsibility Of A Food Employee Or An 3-304.1:1 Food Contact with Equipment and Applicant To Report To rhe Person In ( Utensils* Charge" Contamination from the Consumer 590.003(G) Reporting by Person in Charge" I 3-306.14(,A)(B) Returned Food and Rescrvice of Food* f 3I 590.(X)3(D) Exclusions andRcarictions* Disposition or Adulterated or Contaminated 590.003(E) Removal of Exclusions and Restrictions Food J 3-701.11 Discarding or Reconditioning unsafe FOOD FROM APPROVED SOURCE Food* J 4 Food and Water From Regulated Sources ( 19 I Food Contact Surfaces 590.0(k1(A-B) Compliance with Food Law" 14-501 111 Manual Warewashing-Hot Water 3-201.12 Food his Hermetically Sealed Container'° i Sanitization Temperatures' ( 3X01.13 Fluid Milk and Milk Products* 4-501.112 Mechanical W'arewashing-Hot Water 3-202.13 Shell Eggs* I Sanitization Temperatures* 13-202.14 Fags and Milk Products,Pasteurized* I 4-501.114 Chetn cal SaniGrihon-temp.. pH, conuntration and hardness. 3-202.16 Ice Made From Potable Drinking Water* I 14.60 i.I I(A) Equipment Fond Contact Surfaces and 5-101.11 Drinking Water from an Approved System' 590.006(A) Bottled Drinking Water* Utensils Clean` 4-602.11 Cleaning Frequency of Equipment Food - 590.006(13) Witter Meets Standards in 310 CMR 22.0" Contact Surfaces and Utensils ( Shellfish and Fish Froman Approved Source -702.11 Frequency of Sanitization of Utensils and Shellfish" 3-201.14 Fish and Rccrearionally Caught Molluscan 4Food Contact Surfaces of Equipment* 3-201.15 Molluscan Shell14-703,11 Methods of Sanitization-Hot Water and Shellfish from NESP Listed I Chemical* J Sources* Game and Wild Mushrooms Approven by 10 Proper,Adequate Handwashing( i Regulatory Authority 1 2-301.11 Clean Condition-Hands and Anes* � 3-202.18 Shellstock Identification Present* I --301.12 Cleaning Procedure* 590.004(0) Wild Mushrooms* I 2-301.14 When to Wash* 3-201.17 Came Animals* I ( 11 Good Hygienic Practices .5 Receiving/Condition I 12401.i I Eating,Drinking,or Using Tobacco* 3-202.11 PFIPs Received at Proper Temperatures* I 12--401.12 Discharges From the Eyes,Nose and 13-202.15 Package httegrity* ( Mouth* 3-101.11 I Food Safe and Unadulterated* 3-301.12 Preventing Contamination When Tasting* 6 I Tags/Records:Shellstock 112 Prevention of Contamination from Hands 3-202.18 Shellstock identification* 590.00eh F.) Preventing Contamination from 13-203.12 Shellstock Identification Maintained* ( Employees* Tags/Records: Fish Products I 113 Handwash Facilities 3402.11 Parasite Destruction' I Conveniently Located and Accessible acities11 Numbers and Capacities- 590.004(j) I Records,Creation and Retention* � 5.203. p 590.004(1) I 9 g 15-204.11 Location and Ptacernent* Lanolin of Ingredients* I 7 Conformance with Approved Procedures 15-205.11 Accessibilitv,Operation and Maintenance /HACCP Pians Supplied with Soap and Hand Drying 3-502.11 Specialized Processing Methods* I Devices - _ 13-502.12 Reduced oxygen packaging,criteria* ( 6-301.11 Handwashing Cleanser, Availability 8-103.12 Conformance with Approved Procedures' ( 16-301.12 Hand Drying Provision Denotes critical item in the federal 1999 rml Code a 105 CMR 590.000. CITY OF SALEM /� I BOARD OF HEALTH Establishment Name: l Ct(117,r//IS 'U�i�lr /I �( I �� Date: IU�� (t).3 Page: r- of - '! Item Code- c-Critical Iters DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date I 'No. Reference R-Red Item- - Verified i - � � I -' PLEASE PRINT CLEARLY ' „94-- r, �t_ ll C�nr ,r 11- (,A venI,��,k , h,,, ( n��„✓ )lfLnc rl«�. ,�r✓ �� « c.,Y, � I I � tv l' / l rf ,/1�, �z air-J —l.o ihovrn dca- sPel!l , J t. ). 6t-�Or n ((z r,1 " g0 � � - P — C� G- b /Iff�o,?nYl (5/} 2 � 1 ` n7x 2kIo VC.. --7 two! �r27�Q I r r 1 } t I . 1 I o 1 J Discussion With Person in Charge: _ I Corrective Action Required: I ❑ No IU:ra� l 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/Fed.e a Food Code.�nderstar d that i noncompliance may result in daily fines o twenty-five rs or sussion/revocation of ❑ Embargo ❑ Emergency Closure Wour food permit. —T,\) ❑ Voluntary Disposal _ ❑ Other: I t I .10 i 3 ViW 14tCtPffs Recrivej at i cuiNvature, Violations Related to Foodborne 111ne-ss frifervorrWris and Risk A,vo'dju,to Um to Factors(11citna 1-22) (COPQ -J I i-F r-lS-,f- %Olin.: Kqik ',01 � � 3� PROTECTION FROM CHEMICALS Nlrdi'xi�Its PHFS 14 rood or Color AtInitives ti} PHF Hot and Cold Mottling 1-5 �2 12 AdLb 11�c;�' 111-50:.18617 cold PHFS Mma•ified am Or b+,vk- 3 501 Si, .;} VHV� "13drilitted it Or rkb;A�' Poisnnous or Toxic Substances14Wl' I Om'mul ftkmms Hdd na t:,; above 1 AY I-, * Time as a Public Healn;Control 7.162 H j C" Iom;'IlNanw 3 5ill 1-201,11 S.'-Jta:aurn- swta)�&' iH) V"aiaricr'Kv.'jlmrcn%R( -r.2(a 1! P-rtiricliwt -Pre&11cc"liki Lm: 7-202-12 ("unditions ot Llw.' comaimn REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7.10 1 4.1 l Crwri:'-cu-m lic.li%- POPULATIONS(HSP) 1 7-204,12 Chenfir,tL�Ax Vi'u,hirc Priulticc,Ciitizia' 3-Sitl HkAt 1:opqmou�,i!Pre ::,d,tticd Jukes tnd 7-204,14 ZLjt�jijji, A I Dnin�A"m,.Criteria" 0(b) of`Pa,teuri2�di--'+;e: ' PavnniJ," F(xJ an,1 7-20(i-i I fl,,,tricierl Usc Pe,rwvlc.�,Criteria` ?"tv, &Z'd"�prouts Not 'Sr3 wd. 7 :.06.12 Rolcn, Bail sim'Ork:'^ 1 it ur 'rt"ned U,,od Pacica;:, N,,t N)6 13 1'rackmP,milvi,, Pr,t(',mtroi and CONSUMER ADVISORY TIMEITEMPERATURE CONTROLS 2 i -60"' 1: "aswqc'l •'t, tort flo,t'j kir Cou'umptem of 1 16 Proper Cooking temperatures for lZaW Etndei4u,ked of ",q rr'rehq&.d to Flivortate 3 It)I I I At 1?f );92, 1 i5)r 1.r''s'c. lfAi(') C'4�M111'rinted %Jejrt4� &61am -11'n'iuv0s- 1.�o"F t -40 1.'t(117() i Pull, and 13�0 ?.4isl I A)"I" 121 notr SPECIAL REQUIREMENTS ;9ft iii�41 A j-j J)Y vitAillon, of Section in k nw,nitr' mol'u'.fomr,lenOpocal'. and Gin,- SIuffed i.it'hefl s.Ixntld he tulk:el llic aproprlatc set 110fis wi% jcjji.(l 3.4n1 (C)!!r 'Niar'le mu'de. 6114 Ogl'.ff rclali 40:.1 2 )ow Ariiitul Foxi,Cci;ked to a placticvN 'hoidd it debited t-'tidv? #^9 - 1-401,11(An Di b) All Offitr I'M 1,1TI 11;o' 17 Reheating for ft,HnIding VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 3-103.1 i(Al&d)) PI 11,, tb5°F i',sec, - j {Items 23-30t 3.403.11(B) Micvn,aN,- 1(;5"P 2 M t Owe S'anriin�. nth.! P,tit, III Tnut., "u, 411.,r%:.,rtvvw,rnd K, Joe u)rc It,ft�dabore, w-,b,- (C commulcmily RTE hod foaold to the 1%11'f'wi"t:"vr.vtm) of At Food Codc!md 101i,'M R 3-463 i1(F) RC1n:J:nW1' UQSii(tLI P0160a'ef Beel teT, -T I Fr r- —I ---- - -I------- -- -- I 23 Marta6'pmer I lv,o piesOnriei FC, 2 rf�--Iyi 3�11. (w �IkTitw rC, I Orj4 18 Pmpsr Cooling W.PHFs 1, - Cr Kikct t PH 1,s t i+,v, 140'F it moo, V Arm, 'tnd Wust OW 70T Wttiml 2 1 four", ,it(!Frurn*Plf F rc- w.A I'F'Ai 1:Withiri'l Howt, -Petwnws or 1"wc FG i 003 rom •Ambi�-q 009 I Tcrrpe rat;i re lriltmfieui,to 4 I'l -------- I Within.1 11mu" I,cnv;v, tton m th ,w 1,'r,l I')•)It I"'o3 105 C If,j 54'.1 Massachusetts Department of [Public Health Salem Board of Health DIVISIOn Of Food and Drugs 120 Washington Street,41h Floor 9 Salem, MA 01970-3523 FOOD ESTABLISHMENT INSPECTION REPORT Tel. (978) 741-1800 Fax (978) 745-0343 Name / ' t/ ` L /� Date Tvoa of 0 eration(s) Tyge of Insoection l Cr AC W/�trr u.T ( (';'( � r 1.1� 11 <�n bi le® Food Service El Routine Address ii t t (1' ]f Ri k' ❑ Retail /0 Re-inspection r.r _Y Level ❑ Residential Kitchen Previous Inspection ( Telephone (� ��( ❑I Mobile Date: 1,J}i/0�, Owner HACCP Y/N [D Temporary ❑ Pre-operation I ❑ Caterer ❑ Suspect Illness Person in Charge(PIC) - Time ❑ Bed&Breakfast ❑ General Complaint n n In4l-, ElHACCP Inspector '�/FAV• Outl/. )� 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) ❑ s9o.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 ❑ 14.Approved Food or Color Additives ❑ 3. Personnel with Infections Restricted/Excluded ❑ 15.Toxic Chemicals m+ FOOD FROM APPROVED SOURCE TIME/TEMPERATUREOONTROLS(Potentially Haiardous Foods ❑ 4. Food and Water from Approved Source ( .. y ) ❑ 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(MSP) El 21. Food and Food Preparation for HSP ❑ 10. Proper Adequate Handwashing CONSUMER ADVISORY El11. Good Hygienic Practices � -E] - - - . 22. Posting of Consumer Advisories Violations Related to Good Retail Practices Number of Violated Provisions Related Critical (C) violations marked must be corrected To Foodborne Illnesses Interventions immediately or within 10 days as determined by the Board and Risk Factors(Items 1-22): of Health. Non-critical (N) violations must be corrected Official Order for Correction: Based on an inspection immediately or within 90 days as determined by the Board today, the items checked indicate violations of 105 CMR of Health. 590.000/federal Food Code. This report, when signed below C N by a Board of Health member or its agent constitutes an 23. Management and Personnel (FC-2)(590.0 order of the Board of Health. Failure to correct violations 24. Food and Food Protection (FC-4)(550.0054))) cited in this report may result in suspension or revocation of 25. Equipment and Utensils (Fc-5)(550.005) 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 (550.005) within 10 days of receipt of this order � � - �J 30. Other DATE OF RE-INSPECTION: n S 5901 Vs tFo m-14 dx Inspector's Signature:` / x/ 'n Print: -' ��^- G PIC's Signature: {+�� 1�,'l� Print: `�! ,�`A�1r��t` L 117 Q tr`,; Page /of�--Pages J = r Violations Related to Foodborne Illness Interventions and Risk Factors(items 1-22) PROTECTION FROM CONTAMINATION FOOD PROTECTION MANAGEMENT 18 Cross-contamination I 596.003i A) .Assignment of Responsibility* I 3-302.11(A)(1) Raw Animal Foods Separated from 590.003(B) Demonstration of Knowledge* I Cooked and RTE Foods* 2-103.11 Person in charge-duties I Contamination from Raw ingredients j 3-30111(A)(2) Raw Animal Foods Separated from Each EMPLOYEE HEALTH I Other' 2 590.003(C) Responsibility of the person in charge to I Contamination from the Environment require reporting by food employees and 13-302.11(A) Food Protection` applicants* 3-302.15 Washing 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* ( I Contamination from the Consumer I j 590,003(G) Reporting by Person in Charge* I 13-306.14(A)(B) I Returned Food and Resercice of Fund* j 3 590.003(D) Exclusions and Restrictions* I ( I Disposition of Adulterated or Contaminated 590.003(F) Renio%at of Exclusions and Restrictions Food 3--701 11 Discarding or Reconditioning Unsafe FOOD FROM APPROVED SOURCE Food* j 4 Food and Water From Regulated Sources j 19 Food Contact Surfaces 590.004tA-B) Compliance with Food Law* 4-501.111 Manual Warewashing-Hot Water 3-201.12 Food in a Hermetically Sealed Contatner* Sanitization"termaeratures* 4-501.1 f2 Mechanical WarewashingHot Water 3-201.13 Fluid Milk and Milk Product:* I Sanitization Temperatures 13-202.13 Shell Ergs* j n' 3-202.14 Eggs and Milk Products,Pasteurized* I 4-501 114 Chemical Sanitization-temp.,pH, l 13-202.16 Tec Made From Potable Drinking Water" I concentration and hardness. s 1 4-6011 1(A) Equipment Fond Contact Surfaces and 5-101.I 1 I Drinking Water from an Approved System* I . Utensils Clean- 1-602.11 Bottled Drinking Water* I 4-602.11 Cleaning Frequency of Equipment Food- 590.(X)6(B) Water Meets Standards in 310 CMR 22.0* I Contact Surfaces and Utensils* j SheiBish and Fish From an Approved Source ( 4702.11 Frequency of Sanitization of Utensils and 3-201.14 Shellfish*Fish and Recreationally Caught Molluscan ( ( ( Food Contact Surfaces of Equipment* 4-703.11 I Methods of Samtization-Hot Water and 3-201.1 S Molluscan Shellfish from NSSP listed Chemical Sources'* I to I Proper,Adequate Handwashing I Game and Wild Mushrooms Approved by Regulatory Authority 2-301.11 Clean Condition-Hands and Arms* 1 2 301.12 Cleaning Procedure'*3-202.15 Shellsttxk Identification Present" � 590.004(0) Wild Mushrooms* ( 2-301.14 When to Wash* j 3-201.17 Game Animals* it I Good Hygienic Practices I g Receiving/Condition ( 2-401 11 Eating.Drinking or Using Tobacco* 3-202.11 PHFs Received at Proper Temperatures* j 2-401,12 Discharges From the Eyes, Nose and 3-202.15 Package Integrity" Mouthy - 3-I01.11 Food Safe and Unadulterated'• ( 3-301.12 Preventing Contamination When Tasting* 16 Togs/Records:ShelMock j 112 Prevention of Contamination from Hands 3-202.15 Shelistock Identification* 590.004(E) Preventing Contamination from 13-203.12 Shellstock Identification Maintained* I I Employees* I I TagslRecords:Fish Products I 13 Handwash Facilities I 3402.11 ParasiteDcstruction* I I Conveniently Located and Accessible 3-402.12 Records,Creation and Retention' j 1 5-203.11 j Numbers and Capacities* j j I ' 590.0(40} Labeling of ingredients* i 5-204.11 Location and Placement* 7 Conformance with Approved Procedures I 15-205.11 I Accessibility.Operation and Maintenance I /HACCP Plans I Supplied with Soap and Nand Drying I 3-502.11 Specialized Processing Methutfs* I Devices 3-502.12 Reduced oxygen packaging;criteria* 6-301.11 Handwashing Cleanser,Availability 5-103.12 Conformance with Approved Procedures* ( 6-301.12 Hand Drying Provision j *Denotes critical item in the federal 1999 Faxl CWe ui 105 CMR 500-000. CITY OF SALEM _ I I r BOARD OF HEALTH / f Establishment Name: l /�fl ,nt (,J"_tmt�L r ,,f . �/ 0,A Date: If /nR Page:.)` of Rem Code C-Critical Itein ' DESCRIPTION OF VIOLATION/PLAN OF CORRECTION '. `- Date No. Reference R—Red Item Verified PLEASE PRINT CLEARLY / 11' •' � . _,I f� flnn � ii�,. l-- /.�— I /on,� I� .1.,.,, �-,-„J N '.r , t....,�: -I-�cc--r,._._ _ U1,IJ �o_„-_ 11 1 ¢ I j � I j I I I 1 1 I f Discussion With Person in Charge: Corrective Action Required: ❑ Nodes r I have read this report, have had the opportunity to ask questions and agree to correct all 'k--ve Glary Compliance ❑ Employee Restriction/ Exclusion i violations before the next inspection, to observe all conditions as described, and to ❑ Re-inspection Scheduled ❑ Emergency Suspension i comply with all mandates of the Mass/Fea re al Food Code. understan that noncompliance may result in daily fines ofof t�five dollars or s\usp' nslon/rIb ocation of CI Embargo LJ Emergency Closure I your food permit. , ( 1 �\``T� / ,4 ❑ Voluntary Disposal ❑ Other: r \1 PHI S Re, It TmNr:ajrrs VoulatiortsRoloted to Foodbarno,fitness InterverIfForte and Risk t, .5 rectors(Items 1-22) (Cont) "Nill)in,! Hotio, Wulixh�for VHF4� PROTECTION FROM CHEMICALS 14 i 1 Food or Color Additives i 19 PHF HtA and Cold Holding NA 12 dtum��* _51wi.f(,iJl Cold plFlip.;Md1ni,;qW ai of b4,w � A 3-30-'.14 Protemon from Oiappr llfflsMaintained atw above Poisonous or Toxic Sulastiolles 140 F, Containers' Time as a Putift.4cafth Control Cklumnov Nalte I I S.:Pai Jd(m -SIo;af;e, Reqailcilml! ?.?,latl 11,q.iljl,,D - pr""Cnoo and Ux0 7-202.12 Condition,of Else=' T06 C 011faill't, - REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7 ?O.t.I I POPULATIONS(HSP) "52.12 1 1 3-101 l!'Al Lim;zt,uof. d Pre I aci,agcd!nuts and 1 ch�mic:Il! for Wa�ho.�fli,wltT. dle,,6, 7wfvwtlA Dr)'ing AccraN.craeri;,_ 2v,I i Imidentai 1-kAi Cvmnet. IAlbricarN, 3-�Oi.11:DI tZae,,r Paliiall,, Ational I-kx/J and !-206.11 Rc"incl,td U&t Pc,�ociJe_, Gitelm" -,J 7-2,00.12 Rw,w linin lr,ickin,Tlo,,+Jeie. P:,l ontr,t wid PONSUMER ADVISORY TIMEfTEMPERATURE CONTROLS 2� 3 Ai:%irory hKe;d for Cun�utoptilm of 16 Pmper Cooking Tempa:azures for I hl,A, rhak art. U�dere�,lccd of PHFs 3,101 lilvl)(2; Ft:g- I F, 15 se.". fail,�tdiaae Sr,%l�., fog Ri,%, sild! (A)i C"molimlied 1,h,ife�tt: t 1,M)v Cgt�,, Anarlitli ',75'F 1 , <ec. Ii �ANA HIP,,1 lt%b Poll, ind ll�vi ko.ist - 1)0-t 121 taint SPECIAL REQUIREMENTS int W,'ilA) I;)) \d Nlt,& 1�5 1- 1 ion,ot S�cocm i9il.WtXA'l-(Dj IfAy2l Vi.Ja, tn iil:rillq_ Illoild'-fchzl,lmnp,wary and ITSUICTIlml kit,�hvii operwicin,;�boeld he 3 40 1..'1(Ap 3) Poultr,, V�ild Stutled PKFs N'll'ifil!lt Lout:mw llt! piml I letti;ca l,n l icI&")I Q appront salt' se,:I i oil I 11oul t r.:or Rail w" 10 1 "IX,vc I •I el it I of "C'1ix IJ IX)r Ill, ,tilt.i, I hQl_1j iNrl,,,,k I,1:1t.t intul'WIWOVaaTtli rjd,N Isrtnra other 145'1. 1 590_W9 vioiatjolle reltili-11, to ImA fetal! i-Z R.)% Aniolal i3,,.j,,("okl;d 11)a ic debii'Rd tol&r #29 -- 101,1 IiAl(!Ithi Al:()the, I'M:, 145,; i4 see 17 j Reheating for Hot Holding VIOLATIONS RELATED rO 6000 RETAIL PRACT)ICES D) 1h5 F 1`arc. , I (Ilew, 23-3(I) lilmi(Iii Mwmwaw- 10"T'I klwia,,Standim, i tw,, 71f,a; h ?I",- Time"' 1 "h:dbo 4-ge ilia,A', rfi f,1 I:,ln;oh V em'! pff lo,-! I ai,ove, run k 1-•103.€1(c) colomcl6a'fy RTV,kloci "I ih:, lec,iun, ai ti7, fo,id Codefuid 105 I'MR ctoe's 3-W3 I I tF? pwmaillia",I w1wed po.lkm�,lf ji(�ej Pre -W -590-mo 2"tt. and Per`annpi VC 2 i '003 18 proper coong of I'mrs Pioi,,,Ion t FC 3 -,fk4-- 501,WA) 4 kID5 (ollul�Coo�,,d pill-s I'lull 14Wr to ------ 70'F Within 2 1 iours it(] From';:l'T 4.0er,pit.nt,;m�Vcpll�,to I FC-5 ft� F( 00 I'l.41 T"'.0"im Wltbin 11 26 r 7 i1p6 3 501.14(ltj ColioL VIIF. Nl,,,dr From Ambient 009 Within,I r _ RESTAURANT i O[NtOPo9 . ._ i._ __._- ____._..._.._ ._ ._.._....r_.._._. _-.__.___..__., .... . ..... ...... ........ _. - SATCN/SULKRECIPE FORM � _. fTtMCosT WAD ._ Pucmp!nn 8bgix,._„— — UNIT aD ..._. ._ _,_.._.._..... __._.------ I.. GIURNTI 250 _ I- t COSTAKitT $000 ' I ,401E Pum6kaNAvm=6-a0ot 1 mmro i6 _ Onfons(MMALaOe) 200 wi 50.06 Be”Nwaw make 29W-256mi ICAMIS _ e,0) _f ea $000 �Ceaery 0.50 bWAW So.00 8r SuaoartPabked Twht l 135 »tw So.00 lv"ola 2.00 T , $0.00 ; Red Cum Peoto s.0o T = 50.00 Isaaa 200 T _ $000 � INeavvCreem 26o ae 1 $000 $Mt 300 T I $0.00' ' ,.,3.. P 200 T SO.00 Stmt St cuanoanDaaeamM aM OLLm M PWAmamkm lwatu o 00 in 50.00 as eaa eM owau+.Ret m conaenlon men 300OOH twmotin re cM carmkxed, ISUSTOTAL-PART;_t SO.00ceaand asaiwa1.6AtaaMod ite.InaIOM$00000AIn and b"M10ran 50.00 aae"VW veo ADO eau Id COOk ao a DA Takeaanoka aot "rM aw - I 90.00 aW iM ekma Off.S-I&A Cone ON W a miopi bP trot Wl,YOU tet OW d rwwod i 50.00Piao raanWcin m oa and"n MMvarsw Mom suww.and bane aw aura i F so oa beoba Cmrar woa arewatd Mt bo0 amp rammer br 24 n*axe l au lsueTOTAL`PvtTa i 50.00 mama eM.ADDoaaeam wD mat art tar 30 pan on sww TtftS aadte iGmala 11roNI tate ON aea aw Ovtte as the sow Teate'tw aavw end TOTAL COS! I NANOi WWSTOPWN PROCEDURES SPECIAL 1NSTRUClIONS' i - -- - �rcvou Sava Ofe sawana ttm6l may make 9ya6 I t � Mile Fi�oM - �iL CX1R 1fl ,� _ VMSTA FT., Pmllfi 1170! 7 KREC EFO cannon DATC3tAWi,K REGWE FORM ITEM 1 COST aet.al Van Ten fare ( UNIT v } IOUANTITY M LOS7+Ui71T it.•B 1 wax, U L pa k ��' I lye artr�>^iWalaesa�ae�a•�arraa�iiC•:. e;h•.'i Mt.81�' ` [16�C �r . � ilirCUJtf iiOiYYli� Y Pamxm, 300 be* it.e3 $7.25 (AaaPefaer 3.00 ms 13th lab 3 4CAwn Pto•a _ 3w be $1/9 alM 19ear saes. 300 be $2.70 feta .I �Fels Ca 2A0 006 S1.02 Si.ae 01 200 T 1010 f0.e0 y ' low 000 T $020 sago {Cast a 0NIM Pa•a A00 T so.20 W ao socol �Pua sown Sb On m s0d0 Slim Pal on"R mm aeM/aaame oaalaa omaaaarealM ewean• aenarti 8000•Ice lemur MtPtew m eM ald 0eaoet madmaa.mmaMali fmoetml I (SUSTOVAL PART IM p3AT m.ieRaa+masd.eto pe•aagablpePdo0rrvsm piMSC+sMt.l adaafA lee iO04rccagr.�Oiia.wamaNbesowleMMsetlOWan.ren+are Caeow f0.00 apMadt dalorngls YrseWOe><aeaeMMamoalapaoM Ada ,netaeab $000 aeric nddwfm s•• �atooa prem YlanO rioe ple a sasinet a j - 1 so maroman rer•dn ars.Pam I"mm agave a oto saw•"0* ~4 1p ISOTOTAL.PARTR I s0,O01mp1a1.PNw•enus amwNgnafa•aaAreauPeaMlW ypa matsm ax i 1I(ow rt ue•mvw o Ma mm. 170TAL COST j nt.n t+NBkINCat6TORIM PROCEDUREti SYECua O+STNUCTHHIB: 1 1 I 1 ; 1 A"- Commonwealth of Massachusetts City of Salem Board of Health Kimberley Driscoll 120 Washington Street,4th Floor Mayor SALEM,MA 01970 Temporary Food Permit DATE PRINTED: 07/19/2011 ESTABLISHMENT NAME: Capt.'s Waterfront Grill& Club File Number:BHF-2004-000093 94 Wharf Street Salem MA 01970 LOCATED AT: 0094 WHARF STREET SALEM, MA 01970 Permit Type Permit No. Permit Issued Permit Expires Fee Restrictions/Notes TEMPORARY FOOD BHP-2011-0537 Jul 24, 2011 Jul 24,2011 EVENT: HSI fundraiser LOCATION: Freindship Dockside FOOD TO BE SERVED: Assorted international cheeses and vegetables with dips Total Fees: PERMIT EXPIRES 4uly 24, 2011 Board of Health Page 1 Jul 181108:32a Executive Chef 978-741-8722 P.1 s (!4e CITY OF SALEM, NIA.SSACHUSE71'1"S ' BoARD or, HE\LTH 120 WA.SHINGT()N STRLF.T,4 PLOC)R KIMBERLI;Y DRISCOLL TEL.(978)741-1800 FAx(97 8)745-0343 1biwox 1tAmt inQnl=eom L,\RRY RANfDiN,ItS/RIII IS,Ci 10,(P-IS HEALTH AG!{N'r APPLICATION FOR ATE RARY FOOD SERVICE PERMIT FEE: 1-3 $3 ON-PROFIT $25 4-7 DAYS= 600 OVER 7D - 7 DIVIDED BY 7 X 600=THE AMOUNT DUE. ( E:14 DAYS DIMDED BY 7=2 X 600=51200) t / _ _.KPAYASIFTOTHE CITY OFSALEM. SH '4AMEOFEVENT (TS"�'" — �'IeA4Sh(O (�LoCATION_�'��pnc �u.i�� DATE(S)OF EVENT Slt A -1 I cNA/ I I I to{ 2)i)"-1- i- m �J ��}} VAME OF APPL.ICANTy!-(Y` ��ram dfi5C1/T TELEPHONE# 97b ' � �`-S- aDDRESS 9f 6017a( 77 ,<}}4J rJ'`r te-11" Ll } / NAME OF BUSINESS ,Lei -, 1,1 f6a rra✓J-t a l� _ TELEPHONE#,279'- l CH -tf,+ ,,j NDORESS '77�_ ��i' �t i .44 �P4," 4 CERTIFIED FOOD MANAGER'S NAME ..-.-5�I k03 yo CERTIFICATION# k PLAN OF THE ESTA ISHMENT IS: OSED DRAWN ON THE BACK _ em, ^ TYPE OF GERATIOId: ICE RY ICE OTHER i�✓,� A OD FOR COQwWqoT HOLDING: AS TO AETHOD FOR SANITIZING: CHEMICAL OTHER Ale ztnq Sfa ox ,ybaas� S�tr�;a(sv S/�� iOURCE OF FOOD: NAME: ✓,/C'."3 �'n,�,r!! `L, ADDRESS ODDS TO BE SERVED INCLUDING INGREDIENTS AND METHOD OF PREPARATION: r7✓�pk'� /ti',''2f l%•'' J HAVE READ THE BOARD OF HEALTH,`REQUIREMENTS FOR TEMPORARY FOOD ESTABLISHMENTS."I HAUS HAD THE OPPORTUNITY TO ASK QUESTIONS IEGARDING THOSE REQUIREMENTS, I UNDERSTAND THEM,AGREE TO ABIDE BY THEM AND UNDERSTAND THAT FAILURE TO DO SOW ILL RESULT IN REVOCATION IF MY TEMPORARY FOOD ESTABLISHMENT PERMIT. 'URSUANT TO MGL C62C,S49A,I CE T1 OER THE NALTIES OF PERJURYTHAT I,TO MY BEST KNOWLEDGE AND BELIEF,HAVE FILED ALL STATE TAX ETURNS AND PAID rl ALL S RF ./i!'i_C t �`�' / 6/ /1'� /� •tea ' ' sa�7"�RFr4a NDERLAW. 1 �6'� _ cf//Ir j /- I �.// 'rJ'�,1 /F>� !_/ SIGNATURE DATE / SOCIAL SECURITY OR FEDERAL ID# '-MPMPIttl+1 o�G UPDATED52a'11 PEVNit# l=+ECx#8'JmE