The URL can be used to link to this page

CASA BLANCA SPORTS BAR - ESTABLISHMENTS CASA BLANCA SPORTS BAR 1 109 Lafayette Street lr u v a 4 �d \�o�gi RY LFgp� 1 is fit "{ � �IIIII►illul� I �a /�fpp0 SAF ERR RQ � `"'�" �Lp��y• � � ��p[kF�F' 19 ��t If dr: �s+v �'� � r �) '�"�`gp��f-'v ��, � `��.� 3 t 1 .��k,y t" $*C,, . > t '� ,.. �" •�a sY "`�}`� � a'.� ,,,,K� � e 'F`�.. !§'"+.Li .iE,_:' i ~ .'S,[ �- ',�';i'",'^"�'a'k-'.�� recognized for - meetingtheprescribed req SERVSAFP Food Protection Manager Certification Come. Presented by The Educational Foundation of the National Restaurant Association Date ' 1 I 11 President _ Naliow Restaurant Association ;� THE EDUCATIONAL FOUNDATION — t:,�- ate Sandwich Cubano ..................................... 4.50 I Cuban Sandwich ........................................4.50 Sandwich de Bistec .................................... 5.25 " Steak Sandwich ..........................................5.25 ham✓ Sandwich de Pollo ..................................... 5.25 Chicken Sandwich ......................................5.25 Sandwich de Jamon y Queso ..................... 2.65 Ham & Cheese Sandwich ............................2.65 Mill Hamburger w/ French Fries ...............................3.95 bf M ti 544 Ibl Papas Fritas .............................................. iso Cheeseburger French Fries ................................................3.50 .-- Ensalada Pequena .................... ................ 2.00 w/ French Fries ...............................3.95 �, ■■■ E; I Small Salad ................................................2.00 Ensalada Grande ...................................... 3.50 ' ? m • Large Salad ................................................3.50 Chicken Fingers ■■ �' J . 'eH6'' Tostones ................................................... 3.50w/ French Fries ...............................4.95 e Fried Plantains ............................................3.50 ■ / ® , Chicken Wings W/ French Fries ...............................4.95 i o � I 109 Lafayette Street*Consuming raw or undercooked meats,poultry,seafood, � y� ♦ / Batida de Lechoza ..................................... 3.000 shell fish,or eggs may increase your risk of foodborne illness. Salem/ MA 01 970 Papaya Shake ............................................3.00 Batida de Mango ...................................... 3.00 EL Consumo de carnes, pollo,mariscos,almejas o huevos Mango Shake .............................................3.00 crudos o a media cocinar puede incrementor el riesgo de Morir Sonando .......................................... 3.00 adquirir enfermedades relocionadas con los alimentos. Free Delivery Ca Orange Juice with Milk ........... ...................3.00 Limonada ................................................. 3.00 1 -978-744-0270 Limonade ...................................................3.00 Jugo de China Natural .............................. 3.00 ! *Prices do not include sales tax Ef Fresh Squeezed Orange Juice......................3.00 I A ua Gaseosa 1.50 Sodas ........................................................1.50 j Todas las ordenes son servidas con una seleccion de Todas las ordenes son servidas con una seleccion de Arroz tostones, papas fritas, maduros. Arroz tostones, papas fritas, maduros. Arroz con Camarones 14.70 All orders are served with one selection of white rice, All orders are served with one selection of white rice, Rice with Shrimp ...................................... 14.70 fried plantain, French fries,fried sweet plantain. fried plantain, French fries,fried sweet plantain. Arroz con Langosta ................................. 26.25 Polio a la BBQ . . Camarones con Mofongo...................... 14.70 Rice with Lobster ...................................... 26.25 Chuleto Frita ........................................... . .9 Shrimp served with Fried Mashed Plantain .................... 14.70 Paella 26.25 Fried Pork Chops 8 90 Camarones al is Sa ...................................................13.65 p •��•••••••••••••••••• Shrimp in Garlic Sauce ................................................ 13.65 Yellow Rice with Seafood .......................... 26.25 Cerdo Frito ............................................... 8.90 Camarones en Salsa Rojo ..........................................13.65 Fried Pork Meat ........................ .................8.90 Shrimp in Red Sauce ................................................... 13.65 . Polio Frito 8.90 Camarones d Shrimp .... Fritos ..................................14.70 ................................................. fried Breaded Shrimp .................................................14.70 Fried Chicken .............................................8.90 Camarones Enchiladas ...............................................13.65 Chicharron de Polio .................................. 8,90 Shrimp in Spicy Sauce ................................................. 13.65 fta Breaded Fried Chicken 8.90 Camaronesn la rDres sing.........................................14.70 ............................... Shrimp in Vinegar Dressing..... 14.70 Polio al Homo ........................................... 8.90 Ensalada de Camarones ............................:...............14.70 Baked Chicken ...........................................8.90 Shrimp Salad .............................................................. 14.70 adoLobster i Ged Sau .....................................................26.25 Pernll al Homo .......................................... 8.90 Lobster in Red Sauce26.25 ................................................... Baked Pork Shoulder ..................................8.90 Longosta Enchilada ....................................................26.25 Pechugas a la Parrilla .............................. 11.55 Lobster in Spicy Sauce .................................................26.25 Grilled Chicken Breast 1 1.55 Longosto en Salsa de Coco.........................................26.25 .............................. Lobster in Coconut Sauce.............................................26.25 Pechuga al Sart6n ................................... 11.55 Ensalada de Longosta ................................................26.25 Baked Chicken Breast ...............................11.55 Lobster Salad ..............................................................26.25 Lambi Guisado..........................................................18.90 Mofongo .................................................. 5.50 Stew Conch ................................................................ 18.90 Fried Plantain Ensalada de Pulpo .....................................................18.90 Mashed with baked pork .............................5.50 Octopus Salad ............................................................18.90 Pollofongo 5.50 Pescado en Salsa Rojo ...............................(consultar precio) ................................................ Fish in Red Sauce ............................. . ....(ask for price) Fried Plantain Pescado en Salsa de Coco..........................(consultor precio) Mashed with baked chicken ........................5.50 Fish in Coconut Sauce ......................................(ask for price) Pechuga Frita .......................................... 11.55 Pescado of Homo ......................................(consultor precio) Chicken breast breaded ............................1 1.55 Baked Fish .............................................. (ask for price) Pescado al Ajiltjillo...........................................(consultor price) Fish and Garlic Sauce.......................................(ask for price) *Consuming raw or undercooked meats,poultry,seafood, Lan ostofon o 27.30 shell fish,or eggs may increase your risk of foodborne illness Lobsterfongo ...............................................................27.30 • EL Consumo de carnes,pollo,manscos,almejas o huevos crudos o a media cocinar puede incrementor el riesgo de adquirir enfermedodes relocionadas con los alimentos. *Prices do not include sales tax E � � I J H 1 1 vl N goo K yJ J I i--r F—LEC o 0 OVEN SmK I N p✓err I ELECTRIC STRIN L, o FRIG PREP E TABLE 6 v E R H EAD V N TI LPr1 l N ELt�,Tr, E3 S RAN G E- ►=1RE SINK E40 - CDoLc ExT jGG,: o� �NT�`� p Commonwealth of Massachusetts ` f City of Salem Board of Health IGmberley Dt1SColl 120 Washington Street,4th Floor Mayor SALEM,MA 01970 Food/Retail Establishment Permit DATE PRINTED: 01/12/2009 ESTABLISHMENT NAME: Casa Blanca Sports Bar File Number:BHF-2006-000076 109 Lafayette Street SALEM MA 01970 LOCATED AT: SALEM, MA 01970 Permit Type Permit No. Permit Issued Permit Expires Fee Restrictions/Notes FOOD SERVICE BHP-2009-0353 Jan 9,2009 . Dec 31,2009 $280.00 ESTABLISHMENT Total Fees: $280.00 PERMIT EXPIRES December 31, 2009 Board of Health This Permit is not transferable and must be reissued upon change of ownership or location.The permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code,beofre any revonations,improvements,or equipment changes are made,all plans for such must be submitted to and approved by the Salem Board of Health. Page 1 CITY OF SALEM, MASSACHUSETTS • BOARD OF HEALTH 120 WASHINGTON STREET,4`FLOOR TEL. (978) 741-1800 KRABERLEY DRISCOLL FAx(978)745-0343 MBYOR IDIONNE e SALEM.COM JANET DIONNE, ACTING HEALTH AGENT 2009 APPLICATION FOR PERf/N��FT/O OPERATE A FOOD ESTABLISHMENT/ �/� NAME OF ESTABLISHMENT 0t ,X,l j 11 /N & / TS LSkO TEL — r Q !/U ADDRESS OF ESTABLISHMENT R GV O P- S- J�/�'JI/;LRAX# MAILING ADDRESS(if different) EMAIL-Business': Website: p OWNER'S NAME) �/1/Aq Of 1 TEL# V7D _ LY41 -VU ADDRESSIO � S_�' SIN r U STREETCITY STATE ZIP ��rr CERTIFIED FOOD MANAGER'S NAME(S) ��<�9� U..Q mlx UP CERTIFICATE#(S) (Required in an establishment where potentially hazardous foodig prepared) - •- ,(�/ EMERGENCY RESPONSE PERSON__ Yon 111CIAe2- HOME TEL /' -DAYS OF OPERATION :Mond -:;,,J iesda Wednestie.Thursda tr:: Fdd ° Saturda Sunda HOURS OF OPERATION //' I / j Please write in tune d day. ! C V S�(/l / '(.(/ (� 0-/O 1 01 0- /Q For example 11 am-11 pm V I l./ TYPE OF ESTABLISHMENT FEE (check only) RETAIL STORE YES NO less than 1000sq.ft. =$ 70 1000-10,000sq.ft. =$280 more than 1 0,000sq.ft. =$420 ------ - - ----------------------- RESTAURANT YES NO less than 25 =$140 (Outdoor Stationary Food Cart$21 5-99 seats = more - --------- -----------------.... ------------------------------------------------------------------------------------------------- BED/BREAKFAST/ YES NO $100 CHILDCARE SERVICES - - - ADDffIONAL PERMITS MAKE(not just serve) ICE CREAM, YOGURT/SOFT SERVE YES $25 TOBACCO VENDOR YES $135 ALL NON-PROFIT(such as church kitchens) YES NO $25 `Please pay total with one check payable to the City of Salem. This Permit is not transferable and must be reissued upon change of ownership.The Permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code, before any renovations,improvements,or equipment changes are made,all plans for such must be submitted to and approved by the Salem Board of Health. Purs nt to MGL Chapter 62 ,Section 49A,I certify under the pains and penalties of perjury that 1,to my best knowledge and belief,have filed all state tax ret d paid all state to quired under the law. �m 1&(39 / 5— (�—Co Y-2-SZ' Signature ate Social Security or Federal Identification Number Revised 424/07 FOODAP2008.adm Check#&Date CreI —()L s 5� �`�' �pS\RY lEgq� ��, 111111111111011111IIlu�lll :,, 1 r A�I10�OIIIIp�P,�\� FgOq SAYEVVI is k �f� recognized for / the prescribedrequirements / y examination of the SERVSAFr Food Protection Manager CeptifIcation Course. Presented by The Educational Foundation of the National Restaurant Association Date December I 11 President �.' I National Res�auiant Ass Clalion �� -- THE EDUCATIONAL FOUNDATION i CITY OF SALEM BOARD OF HEALTH Name of Establishment: Casa Blanca Address: 109 Lafayette Street Owner(s): Domingo Dominguez Phone: 978-744-0270 Date: April 7, 2008 The Owner of this proposed establishment presented a Floor Plan and Menu for review in accordance with the State Food Code. Also present for review was Michele Balcacer, Bar Manager. At time of review there was not a Certified Food Manager present. Menu items were not reviewed at this time. I informed Mr. Dominguez that at the Change in Ownership inspection that a Certified Food Manager must be present to review menu items and review proper food storage and handling techniques. FLOOR PLAN A Hand Sink must be located in each food prep and service area. Therefore there must be a hand sink in the prep area, used exclusively for hand washing. Hand sinks must have wall hung soap and paper towel dispensers. These must be stocked at all times. All floors, walls, and ceilings where food, utensils, paper products, etc, are stored, prepared or served must be intact, impervious, and easily cleanable. This includes those areas of the basement used to store any food items, beverages, supplies for the establishment. EQUIPMENT All food service equipment must be NSF (National Sanitation Foundation) approved. A three bay sink is being used to wash all equipment and utensils. The three bay sink must be labeled: first bay- wash. Second bay- rinse and third bay- sanitize. All equipment to be wash, rinsed and sanitized. MENU/FOOD PREP Any pre-made items must be purchased from a wholesaler licensed by the State. All food must be held at 41°F or lower, or 140°F or higher, at all times. There may be no bare hand contact of ready-to-eat foods. Gloves, tongs, or tissues must be used when handling such food. Refrigerators and freezers must have internal thermometers that are easily visible. Freezers must be maintained at 0°F or below and refrigerators must be at 41°F or below as mandated. CERTIFICATION There must be a Certified Food Manager working at this establishment full time. When a CFM is not onsite there must be a Person-in-Charge (PIC) who is fully trained in sanitation techniques and has a thorough understanding of the operation. CHOKE-SAVING There must be an employee, on the premises at all times, who is trained in choke-saving methods. EXTERMINATION Monthly services of a Licensed Pest Control Operator are required. Please keep receipts for inspections. SANITIZING SOLUTION Sanitizing Solution must be accessible at each prep station and for the patrons' tables. Test strips corresponding to the kind of sanitizer, must be on hand to check concentration of solution. Solution must be made daily, tested, and the results recorded on a log sheet for examination by Board of Health inspectors. Solution may be prepared in the 3`d bay of the 3-bay sink and spray bottles may be filled there. Spray bottles with clean paper towels may be used, as well as wiping pails with wiping clothes always held in the solution in the pail. r Outside area of premises, including the dumpster area, must be kept clean and sanitary. TRASH Trash and garbage at this location will be stored in basement in rodent proof, watertight receptacles. Per Owner Mr. Dominguez, Grease barrel to also be stored in this location. Owner has applied for a liquor license. A Change-of-Ownership Inspection will be conducted within two weeks. The owner will call one week prior to the expected opening to schedule an Opening Inspection. ann a t Dionne Date alth gent/ Senior Sanitarian Doming8 Domingu Date 4 SIMF \ �v�1 S+p,NL G•Pprc � \tA4,cr1 , �� Mai ao R%� 44w, Sandwich Cubano ..................................... 4.50 } r \ Cuban Sandwich ........................................4.50 Sandwich de Bistec ....................................5.25 Steak Sandwich ..........................................5.25 Sandwich de Pollo .....................................5.25 _ Chicken Sandwich ......................................525 Sandwich de Jamon y Queso .................... 2.65 Ham & Cheese Sandwich .......................... .2.65 I I Hamburger jo w/ French Fries ...............................3.95 � dtidevl Papas Fritos .............................................. 3.50 Cheeseburger French Fries ................................................3,50 Ensaloda Pequena ..................................... 2.00 w/ French Fries ...............................3.95 16111 r "` Small Salad ..........., 2.00 Ensalodo Grande ......................................3.50 fi Large Salad ................................................3.50 Chicken Fingers s Tostones ........:..........................................3,50wl French Fries ................... ...........4.95 • a Fried Plantains ............................................3.50 . 9444" _/ 44 w/ French Wings �, w/ French Fries ...............................495 'Consuming raw or undercooked meats,poultry,seafood, ; - 109 Lafayette f�y�Street, shell fish,or eggs may increase your risk of foodborne illness. Salem 01970 0 Batido de Lechoza ........................ 3.00 r tY A 0 PapayaShake ............................................3.00 Batido de Mango ......................................3.00 EL Consume de tames,polio,mariscos,olmejas o huevos Mango Shake .............................................3.00 crudes o a media cocinar puede incrementor el riesgo de Morir Soriando ..........................................3.00 adquirir enfermedades relacionacias con los alimentos, Free elivery Call Orange Juice with Milk 3.00 Limonado ................................................. 3.00 1 -978-744-8270 Lmonade ,,........._......................,,............,,3.00 1;ugo de China Natural .............................. 3.00 *Prices do not include sales tax Fresh Squeezed Orange Juice......................3.00 Agua Goseosa .......................................... 1.50 Sodas ........................................................1.50 i 4 hh &oov� Mum Todas las ordenes son servidas con una seleccion de Todas las ordenes son servidas con una seleccion de Arroz tostones, papos fritos,maduros. Arroz tostones,papas fritas,maduros. Arroz con Catnorones ...... 14.70 All orders are served with one selection of white rice, All orders are served with one selection of white rice, Rice with Shrimp ...................................... 14.70 fried plantain, French fries,fried sweet plantain, fried plantain, French fries,fried sweet plontain. Arroz con Langosto ................................. 26.25 Polio a la BBQ Camarones con Mofongo...........................................14.70 Rice with Lobster ....................................., 26,25 ....................................... Shrimp served with Fried Mashed Plantain.................... 14.70 Paella ..................................................... 26.2$ CfluletqFnta ........................................... . .9 Camarones aI Ajillo ...................................................13.65 Fried Pork Chops ........................................8.90 Shrimp in Garlic Sauce...................................,........... 13.65 Yellow Rice with Seafood .......................... 26.25 marones en Cordo Frito ...............................................8.90 Camarones d Sauce zod .. .Fritos.. ,,......................,,......14.70 Fried Pork Meat .....:............ ..................8.90 Shrimp m Red Sauce ....... ...................................... 13.65 P0II6 Frito ................................................. 8.90 Fried Breaded Shrimp 14.70 FriedChicken .............................................8.90 Camarones Enchilados ..:....................,,.,...................13.65 - Chicharron de Polio ................ 8.90 Shrimp in Spicy Sauce .........................,.......................13.65 " .................. Camarones a to Vinogretta...............................,.,,......14.70 Breaded Fried Chicken ...............................8.90 Shrimp in Vinegar Dressing 14.70 Polioof Homo ...........................................8.90 Ensalada de Camarones .....,,,,,,..............................,,.14,70 Baked Chicken ...........................................8.90 Shrimp Salad ..............................................................14.70 Longosta Guisado .....................................................26.25 Pemil al Homo .......................................... 8.90 Lobster in Red Sauce ...................................................26.25 Baked Pork Shoulder ..................................8.90 Longosto Enchilada...................................................,26.25 Pechugas a la Parrilla .............................. 11.55 Lobster in Spicy Sauce .......................,........................26.25 Langosto an Salsa de Coco.........................................26.25 Grilled Chicken Breast .....:........................11.55 Lobster in Coconut Sauce...............,..........................,,,26.25 Pechugo al Sart6n .................................:. 11.55 Ensalada de Langosto ................................................26.25 Baked Chicken Breast ...............................11.55 Lobster Salad ,.............................................................26.25 LambiGuisado ..........................................................18.90 Mofongo ..................................................5.50 Stew Conch .......---...---.......................................... 18.90 Fried Plantain Ensalada de Putpo .....................................................18.90 Mashed with baked pork .............................5.50 Octopus Salad .........._...............,...............................18.90 Pollofongo 5.50 Pescado an Salsa Rojo (consultor precio) ••...••••..•••••••..•••...•••...••• Fish in Rad Sauce ............ . . .(ask for price) Fried Plantain Pescado en Salsa do Coco.........................(consultor precio) Mashed with baked chicken ........................5.50 Fish in Coconut Sauce ......................................(ask for price) Pechugo Frita .......................................... 11.55 Pescado of Homo ,,,...........,.......................(consuftar predo) Baked Fish .......................... ............................(ask for price) Chicken breast breaded ............................11.55 Pescodo al Ajillo.....................................,.....(consultor prim) Fish and Garlic Sauce.......................................(ask for price) 'Consuming raw or undercooked meats,poultry,seafood, Langostofongo ..........................................................27.30 shell fish,or eggs may increase your risk of foodborne illness Lobsterfongo...............................................................27.30 i • EL Consumo de carnes,polio,mariscos,olmejas o huevos crudos o a media cocinar puede incrementor el riesgo de adquirir enfermedodes relocionodas con los alimentos. " *Prices do not include sales tax ONW1 CITY OF SALEM, MASSACHUSETTS / yrs '4s„ LICENSING BOARD I 120 WASHINGTON STREET � SALEM. MA 01970 F DAVID J.SHEA.CHAIRMAN ` , TEL. 978-745-9595 EXT. 5648 _JOHN H.CASEY �CGy1N6 F.Ax 978-744-6775 RICHAP13 C LER_ BARB;,RA A.SIROIS KIMBERLEY DRISCOLL CLERK OF THF.FOARD MAYOR HEATH DEPARTMENT NOTIFICATION FORM IF YOUR APPLICATION INCLUDES THE SERVING OF FOOD YOU MUST HAVE THIS FORM SIGNED BY THE HEALTH DEPARTMENT PRIOR TO SUBMITTING YOUR APPLICATION TO THE LICENSING BOARD. (this form MUST be signed and returned with your application). NAME OF BUSINESS Matematika Sport Bar, Inc. Corporate name: d/b/a: Doc Ryan' s Pub LOCATION: 101 Lafayette Street, Salem, MA TELE. # TYPE OF LICENSE Full Liquor License APPLICANTS INFORMATION Name: Dominguez, Domingo Home address:l 8 Raymond Rd. City: Salem State: MA Zip:01 970 Home tele. # 978-745-5474 HEALTH AGENT/INSPECTOR'S COMMENTS: p��ix<,C� Gccc.E2° K C L G 7/ �9C1 ` ��r c2o J L� X cG R 2 lyd `/Yy`z C v DATE .3 . Health Agent callh dept.notil form Commonwealth of Massachusetts City of Salem a Board of Health 120 Washington IGmberley Driscoll tree 4th Street,4h FlMayor SALEM,MA 01970 Foo"dail Establishment Permit DATE PRINTED: 01/07/2008 ESTABLISHMENT NAME: Casa Blanca Sports Bar File Number:BHF-2006-000076 109 Lafayette Street SALEM MA 01970 LOCATED AT: SALEM, MA 01970 Permit Type Permit No. Permit Issued Permit Expires Fee Restrictions/Notes FOOD SERVICE BHP-2006-0199 Jan 4,2008 Dec 31,2008 $280.00 ESTABLISHMENT Total Fees: $280.00 PERMIT EXPIRES December 31, 2008 Board of Health This Permit is not transferable and must be reissued upon change of ownership or location.The permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code,beofre any revonations,improvements,or equipment changes are made,all plans for such must be submitted to and approved by the Salem Board of Health. - - Page 6 of 24 a CITY OF SALEM, MASSAC UUSEM 1f BOARD OF HEALTH 4 120 WASHINGTON STREET,4m FL Nft TEL. (978)741-1800 �� KIMBERLEY DRISCOLL FAX(978) 745-0343 0 MAYOR IscoTrra�sALEM.COM re 2 JOANNE SCOTT, ,y�EM HEALTH AGENT TN 2008 APPLICATION FOR PERMIT TO OPERATE A FOOD/EES'TTA�/BLISH/MENT NAME OF ESTABLISHMENT /C'l�/ . +k TEL# y ��L/ /�� e ADDRESS OF ESTABLISHMENT / 4 ( FAX#"IT y/ ( /q9 MAILING ADDRESS (if different) zj � ✓ I G J f;4'-!1d EMAIL-Business': Website: OWNER'S NAME (1��L/4J �/JL� // 6A/A (l -TEL## ADDRESS 1(/ l �C (�� J� / / 4 �7Za STREET CITY STATE ZIP s /_ CERTIFIED FOOD MANAGER'S NAME(S) �lL �ClS7al� CERTIFICATE#(S) L (Required in an establishment where potentially haz rdous o is pr red / -7 p �i Cc EMERGENCY RESPONSE PERSON Hf3M EITEL#-1 0- �2<D;a DAYS OF OPERATION 1 Monday Tuesda Wvednesda Thursda Frida Saturda Sunda. HOURS OF OPERATION 1 QO7 m �a' p��/rl : /�, W !7 lg,edl"r7 Please write in time of day. Forexamle I1am-11m TYPE OF ESTABLISHMENT FEE (check only) RETAIL STORE YES less than 1000sq.ft. =$70 1000-10,000sq.ft. =$280 more than 10,000sq.ft. =$420 --------------------- - RESTAURANT YES NO less than 25 seats =$140 (Outdoor Stationary Food Cart$210, 25-99 seats =$280 more than 99 seats =$420 - ---- BED/BRAKF EAST/ YES O $100 CHILDCARE SERVICES ----------------------------------------------------- - ADDITIONAL PERMITS MAKE (not just serve) ICE CREAM, YOGURT/SOFT SERVE YES $25 TOBACCO VENDOR YES $135 ALL NON-PROFIT(such as church kitchens) YES NO $25 'Please pay total with one check payable to the City of Salem. This Permit is not transferable and must be reissued upon change of ownership. The Permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code, before any renovations, improvements, or equipment changes are made,all plans for such must be submitted to and approved by the Salem Board of Health. Pursuant to MGL Chapter 62C,Section 49A,I certify 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' t Social Security or Federa Identific tion Number '---------------'--- '----�,-Jj�- -------�--y ---}- ----- ---'--------------"- Revised 4/24/07 FOODAP2008.adm CheckN&Date, /(J J..Z�/� $ yob-13J73j0� �- 1 ■ • J/ ■ lllilmisuimm,5=011 ' r r �. ° � �`, i�K"%/� � .i vJ �, ,- �� h l� 2Q�✓ a� cvhele GUu c��LQ j 7 d r ' 1 " `, ` 11` 1'` 111 1` 1 ` '��1` ' 1 `' , 1`, 11 „ �� _ � 11� 1' 1 `1� 1` 11 � � �, 1 � �`1 , '� '` `� 1, , � , 1 ` 11 ,'` ' 1 1 1` 1 `, 1 1� � i1�1��1\�� 1 , , CITY OF SALEM BOARD OF HEALTH Name of Establishment: Casa Blanca Sport Bar Address: 109 Lafayette Street Owner(s): Andres Moya Phone: 978-210-8279 d1. 1 S-07 The proposed new owner of this establishment, Andres Moya, and Edwin Martinez, presented updated floor plans for this establishment. The Salem Licensing Board has directed the new owner to expand the menu beyond the existing one of hot dogs and pizza. A new menu has not yet been developed. All equipment in this establishment will be NSF certified. The new floor plan will be installed prior to the opening under the new name and owner. The Health Agent must approve the paln to protect food while renovations are taking place. /4fi 461,55 fi ur {�• �1oy�� /b� s fz re'we°,•Nae a/n/f i5 C' !a 'd , A new menu will be submitted to the Board of Health and the certified Food Manager will meet with the Health Agent to review food preparation. The floor plan must be updated with measurements. ,-)/l Joanne Scott Date Health Agent re's Mo/a, Proposed Owner Date I CITY OF SALEM BOARD OF HEALTH l s Establishment Name: 70 L IZy1a NS Date: ) 1 143 11Z7 Page: / of Z Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date ! No. Reference R—Red Item Verified -- PLEASE PRINT CLEARLY Ii `a ►'Rav In c: Sa P + \s �d s 3t✓� P PGn W� I N ww�� N vN y t 17l S S�� Yfi� d� (h6S r C si m 2y c�eJ o\'_-1N\1'N mvs� PtZs�,l �� r �n �2AL. T`a . 1�RtGfL7� \IP —\ �4 VA\� �oB VA P? 20 cam • V is � PQd .1I \ gs0. mom_ CZ n� ori Discussion With Person in Charge: corrective Action Required: LINo O Yes I have read this report, have had the opportunity to ask questions and agree to correct all ❑ Voluntary Compliance Cl Employee Restriction/ Exclusion violations before the next inspection, to observe all conditions as described, and to ❑ Re-inspection Scheduled ❑ Emergency Suspension comply with all mandates of the Mass/Federal Food Code. I understand that noncompliance may result in daily fines of twenty-five dollars or suspension/revocation of ❑ Embargo ❑ Emergency Closure your food permit. /r ��J��/J / � 0 Voluntary Disposal ❑ Other: 3-501.14(C) PI-IFs Received at Temperatures Violations Related to Foodborne Illness Interventions and Risk According to Law Cooled to Factors(items 1.22) (Cont.) 4I'F/45°F Within 4 Howl. PROTECTION FROM CHEMICALS 3-501.15 Cooling Methods for PRFs 1A Food or Color Additives 19 PHF Hot and Cold Holding 3-202.12 Additives'r 3-541.16(13) Cold PIEFs Miallbo ted at or below - 590.004(F� 41°1&5° E' 3-302.14 Protection from Una rovedAddinves" - 3-501.16(A) I{ot PH,Fs'Maintained at or above 1.5 Poisonous or Toxic Substances 14W " 7-101.11 Identifying Information-Original 3-501.16(A) Roasts Held at or above 130'F. * Containers* 7-102.11 Common Name--Workini,Containers' Time as a Public Health Control 7-201.11 3-501.19 Time as a Public Health Control* Se aradon-StoraQc" 7-202.11 Restriction-Presence and Use 540.004(H) Variance Requirement 7-202.12 Conditions of Use* 7203.11 Toxic Containers-Prohibitions* REOUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-204.11 SaniCrzets,Criteria-Chemicals' POPULATIONS(HSP-- 7-204.12 Chemicals for W ashin Produce,Cnteria* 21 3-801.11(A) Unpasteurized Pre-packaged Juices and Bevetaees with Warnine Labels^ 7-204.14 Dr'in A eats,C.nreria" -- 7-205.11 .Incidental Food Contact.Lubricants, 3-801.11(B) Use of Pasteurized El,�,s* 7-206.11 Restricted Use Pesticides,Criteria* 3-801.11(D) Ram or Partially Cooked An licit Food and Raw Seed Sprouts Not Served. 7-206.12 1 Rodent Batt Stations* 80111(0) Uno erred hood P taka�e Not Re-served. 7-206.'13 Tracking Powders,Pest Control and Monitarina* CONSUMER ADVISORY TIME)TEMPERATURE CONTROLS 22 3-603.11 Consumer Advisory Posted for Consumption of 16 Proper Cooking Temperatures for Ananal Foods That are Raw,Undercooked or PHFs Not Otherwise Processed to Flirninate 3-4011.IA(1)(2) Eggs- L55`F15Sec. Pathogens.* Eff"h.w r anal Eggs-hmnedrate Servlec 145°hl5sec* 3-302.13 Pasteurized Eggs Substitute for Raw Shell 3-401.11(A)(2) Comminuted Fish,Meats&Game Ee s* Animals- 155°F 15 sec. 3-401.11(B)(1)(2) Pork,and Beef Roast- 130'F 121 min* SPECIAL REQUIREMENTS _ 3-401.1 t(A)(2) Ratites,Injected Meats-155'F 1.5 590.009(A}(D) Violations of Section 590.009(A)-(D)in see. * catering, mobile food,temporary and 3-401.11(A)(3) Poultry,Wild Game, Stuffed PHFs, residential kitchen operations should be Stuffing Containing Fish, Meat, debited older the appropriate sections Poultr or Ratites-165'P IS sec. * above if related to foodborne illness 340111(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 165'F` Special Requirements. 3-401_1 I(A)(1)(b) All Other PHFs -145'F 15 sec. 17 Reheating for Hot Holding VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 3-403.11(A)&(1)) PHFs 165'F 15 sec. * (Items 23-30) 3-403.11(B) Microwave- 165°F 2 Minute Standing Critical and non-critical violations, which do not relate to file Timerfoodborne coneys rater ventions and risk factors listed above., can be 3-403.11(C) Commercially Processed RTE Food- found in theJDliowirrg sections of the Food Code and 105 CMR '140°F* 590.000. 3-40311(6) Remaining Unsliced Portions of Beef I Item Good Retail Practices_ FC 590.000 Roaste* 23. Mang ement and Personnel _ _FC-2 .003 1g Proper Cooling of PHFs 24__ Food and Food Protection __ FC-3 .004 25 _ Equipment and Utensils FC 4 3-50t14(A) Cooling Cooked PRFs from 140'F to 26 Water.Piumbiu and Waste FG-5 .006_ 70°F Within 2 Hours and From 70°F 27 Ph slcal Facility_. _ FC 6 007 to 41'F/45'F Within 4 Hours.* 26. Poisonous or Toxic Materials FC-7 .008 3-501.14(B) Cooling PHFs Made From Ambient _25._ S ectal R uirements _ 009 'temperature Ingredients to 41'F145'F 90 Other Within 4 Hours* csvora.nma�a.a,� *Dmone3 crnicut item in the rederal 1999 Food C'bde or 105 CbiR 590.600, i <dq 2� 22� 1� CITY OF SALEM, MASSACHUSETTS 3 ; BOARD OF HEALTH . ( 120 WASHINGTON STREET, 4TH FLOOR, SALEM, MA 01970 TEL. 978-741-1800 FAx 978-745-0343 Kimberley Driscoll WWW.SALEM.COM Mayor JOANNE SCOTT, MPH, RS, CHO HEALTH AGENT 2001 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT NAME OF ESTABLISHMENT (i�X14'-14 510/GT A4-17- TEL k 9-??) ?/0 ADDRESS OF ESTABLISHMENT .5- /— MAILING SrMAILING ADDRESS (if different) OWNER'S NAME Zye)1tt5 /)11 01;2v TEL ADDRE S /D 7 Z'v✓,�- Jr CITY 15LWY STATE/ f/� ZIP 01160 CERTIFIED FAD MANAGER'S NAME(S) CERTIFICATE#(s) i932D (required in an establishment where potentially hazardous food is prepared.) EMERGENCY RESPONSE PERSON ZUW,',J f}2T wed HOME TEL# 9?eJ -700- S�6 HOURS OF OPERATION: MoO m ,Tue. '�Wed. - Thu.�ri.j;,� Sat.,'�p" .,` TYPE OF ESTABLISHMENTFEE (check only) RETAIL STORE YES NO less than 1000sq.ft. =$ 50 1000-10,000sq.ft. =$100 more than I0,000sq.ft. =$250 - - ------------------- RESTAURANT YES NO less than 25 seats =$100 25-99 seats =$150 more than 99 seats $ BED/BREAKFAST' ................... ................................................................$ YES N6 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. Pursua t to MGL Chapter 62C, Section 49A, I certify under the pains and penalties of perjury that I, to my best knowl g and belief, have filed all state tax returns and paid all state taxes required under the law. IA46 o// (- Py-Z--3 a ure ate Social Security or Federal Identification Number ---- -------------------------------------------------------------------------------------------------------------------------------- Revised 11/03/05 FOODAP2.adm Check#&Date CITY OF SALEM BOARD OF HEALTH Name of Establishment: Casa Blanca Address: 109 Lafayette Street Owner(s): Andres Moya Phone: 978-210-8279 November 14, 2006 The Owner of this proposed establishment presented a preliminary Floor Plan and Menu for review in accordance with the State Food Code. FLOOR PLAN A Hand Sink must be located in each food prep and service area. Therefore there must be a hand sink in the prep area, used exclusively for hand washing. Hand sinks must have wall hung soap and paper towel dispensers. These must be stocked at all times. All floors, walls, and ceilings where food, utensils, paper products, etc, are stored, prepared or served must be intact, impervious, and easily cleanable. This includes those areas of the basement used to store any food items, beverages, supplies for the establishment. EQUIPMENT All food service equipment must be NSF (National Sanitation Foundation) approved. The dishwasher must wash, rinse and sanitize all dishes, utensils and food equipment. Sanitizing in the dishwasher may be by 180 degree water in the final rinse or by an automatically fed chemical sanitizer in the final rinse. There must be an alarm with the chemical sanitizer to indicate when it is running low. A three bay sink may may used as a substitute for the dishwasher. MENU/FOOD PREP Any pre-made items must be purchased from a wholesaler licensed by the State. All food must be held at 41"F or lower, or 140°F or higher, at all times. There may be no bare hand contact of ready-to-eat foods. Gloves, tongs, or tissues must be used when handling such food. Pizza will come frozen and maintained in a reach-in refrigerator. Hot dogs will come cold and will be maintained in a refrigeration unit. Refrigerators and freezers must have internal thermometers that are easily visible. CERTIFICATION time. There must be a Certified Food Manager working at this establishment full When a CFM is not onsite there must be a Person-in-Charge (PIC) who is fully trained in sanitation techniques and has a thorough understanding of the operation. CHOKE-SAVING There must be an employee, on the premises at all times, who is trained in choke-saving methods. EXTERMINATION Monthly services of a Licensed Pest Control Operator are required. Please keep receipts for inspections. SANITIZING SOLUTION Sanitizing Solution must be accessible at each prep station and for the patrons' tables. Test strips corresponding to the kind of sanitizer, must be on hand to check concentration of solution. Solution must be made daily, tested, and the results recorded on a log sheet for examination by Board of Health inspectors. Solution may be prepared in the 3rd bay of the 3-bay sink and spray bottles may be filled there. Spray bottles with clean paper towels may be used, as well as wiping pails with wiping clothes always held in the solution in the pail. Outside area of premises, e umps er area, must be kept clean and sanitary. Owner has applied for a liquor license. A Change-of-Ownership Inspection will be conducted within two weeks. The owner will call one week prior to the expected opening to schedule an Opening Inspection. j Janne Scott Date Health/Agent - n res Moya Date IMPORTANT MESSAGE FOR DATE TIME M OF 1 PHONE --SYlTS,-- A19EA GODE NUMBER ERTEN ION 0 FAX D MOBILE AREA CODE NUMBER TIME TO CALL TELEPHONED A PLEASE CALL CAME TO SEE YOU WILL CALL.AGAIN WANTS TO SEE YOU RUSH RETURNED YOUR CALL :WILL FAX TO YOU MESSAGE JL c5 b� �hc 0 SIGNED M®PS. M°oMNU. NOTES ----- -- --- r JON-16-2007 04 :41 PM P. 01 GENERAL ENVIRONMENTAL SERVICES, INC. TEAM GES Diversified Exterminating/Northeast Environmental/American Pest 930 Eastern Avenue, Maiden, Massachusetts 02148 (781) 321-4633 •(800) 343-8278 • (781) 333-3054 - (781) 321-9528 Fax P€ST CONTROL SERVICE AGREEMENT 1. This agreement authorizes General Environmental Services to provide Pest Control Services at the foilowing location: Telephone: Customer. V33-010, Contact: SA l0tn r WA, Fax Number: 2. Type of work to be done and areas: I i��sd er;m-r&c, we 'Air- U\-,40t A�r 4;7 Eltvj•Ce C,#iffS7"G4 p4Sfmc4ill-1,4v mih, ty Jei41itL. Anr uasr" f ;. Pest Control Inspections and or treatments will be prou[dat.teast{3}times/per year tx asneed ed. 4. Inspections and treatments are for the following: Rats, Mice, Cockroaches, (German, American, Brown-Banded, Oriental), Ants. 5. It is understood that other pest are not covered by this agreement,all other pest will be quoted on a job basis. . 6. The charge for initial treatment is; 7. This charge is billed ED r : eoual payment of you will be invoiced for service at each service calL 8. This is a continuing agreement but may be canceled at any time by either party, By: 24MCACK 1M t fAccepted For: General Environmental services, Inc. Team GES Date: l ��10�4 Date: .� i i I CITY OF SALEM BOARD OF HEALTH Establishment Name: Date: Page: of Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date No. Reference R-Red Item Verified PLEASE PRINT CLEARLY Discussion With Person in Charge: Corrective Action Required: ❑ No ❑ Yes I have read this report, have had the opportunity to ask questions and agree to correct all ❑ Voluntary Compliance ❑ Employee Restriction/ Exclusion violations before the next inspection, to observe all conditions as described, and to ❑ Re-inspection Scheduled ❑ Emergency Suspension comply with all mandates of the Mass/Federal Food Code. I understand that noncompliance may result in daily fines of twenty-five dollars or suspension/revocation of ❑ Embargo ❑ Emergency Closure your food permit. ❑ Voluntary Disposal ❑ Other: 9 3-501.14(C) PHFs Received at Temperatures Violations Related to Foodborne Illness Interventions and Risk According to Lttw Cooled to Factors(@ems 1-22) (Cont) 41'FI45'F Within d Houce. PROTECTION FROM CHEMICALS 3-501.15 Cooling Methods for PHFs 14 Food or Color Additives 19 PHF Hot and Cold Holding 3-501,16(13) Cold PI-IFs Maintained at or below 3-202.12 Addthves* 590.004(F) 41`145°F* 3-302,W Protection from Unapproved Additives* 3-501.16(A) Hr>t PHFs Maintained at or above 15 Poisonous or Toxic Substances 4WE * 7-I01.I] Identifying Info]]nation-Original 3-501.16(A) Roasts Held at or above 130°F. Cantainers* 7-102.1'1 Common Name-Working Containers` 2o Time as a Public Health Castrol 7-201.11 Separation-Stora e"' 3-501.19 'rime as a Public Health Control* 7-202.11 Restriction-Presence and Use* 590.004(H) VarianceRe airemeat 7-202.12 Conditions of Use* 7-203.11 Toxic Contamcrs-Prohibitions* REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-204.11 Sanitizers,Criteria-Chemicals* POPULATIONS(HSP) 7-204-1.2 Chemicals for Washing Produce,Criteria' 3-801_11(A) Unpasteurized Pre-packaged Juices and 7-204.14 Drying A tints.Criteria- Beverages with Ramme Libels* 7-205J1 Incidental Food Contact.Lubricants* 3-801.11(B) Use of Pastetmzed L ps* 7-206.11 Restricted Use Pesticides.Criteria* 3-801.11(D) Raw or Partially Cooked Animal Food and - Raw Seed Sprouts Not Served.'r 7-206.12Ra{untBaitStauons* 3-80Li1(C} UnoenedFoodPicka�eNotRe-servecL * 7-206-'13 'Tracking Powders,Pest Control and Monitoring` CONSUMER ADVISORY TIMEITEMPERATURE CONTROLS 22 3-60311 Consumer Advisory Posted for Cnnsamption of Annual Foods'I'ttat are Raw.Undercooked w- 16 Proper Cooking Temperatures for PHFs Not Otherwise Processed to Eliminate 3-401.L1A(1)(2) Eggs- 155'F 15 Sec. Pathos-ens.* `"r`<.*v,;zuo, E gs-Immediate Service 145°Fl5sec* 3-302.13 Pasteurized Egg,Substitute for Raw,Shell 3-401,11(A)(2) Comminuted Fish,Meats&Game Eggs' Animals- 155°F 15 sec. 3-401.11(13)(1)(2) Pork and Beet Roast-130`F 121 rain* SPECIAL REQUIREMENTS 3-401.1 I(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 3-40'1-1.1(A)(3) Poultry,Wild Game,Stuffed PRFs, 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 W. dbortte 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 3401.12 Raw Animal Foods Cooked in a practices should be debited under 7#29 - Microwave 165°F* Special Requirements. 3-401.11(Ahl)(b) Ail Other PHFs-1,45°F 15 sec. * 17 Reheating for Hot Holding VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 3-403.11(A)W) PHFs 165'F 15 sec. * (Items 23-30) 3-403.11(B) Microwave- 165°F2 Minute Standing Crith at and non-critical violations, which do not relate to the Time"' foodborne ittness interventions and riskfactors luted above, can be. 3403.11(C) Commercially Processed RTE Foal- ,found in rhe following sections of the Food Code and 105 ChIR 1.40°F` 590.000. 3-403-11(E) Remaining Unsliced Portions of Bee Item Good Rata(t Pracfrces_ FC 580.000 -- Roasts*` naha emenY and Personnel FC- 2 .003 1g Proper Cooling of PHFs 24. Food and Food Protection FC--3 .004 25 _EAuipmeni and Utensils FC 4 .005 3-50'L14(A) Cooling Ctx>kedPHFs from 140°F to - p6 _ Water Plumbinq and Waste FC 5 .006_____ 70'F Within 2 Hours and From 70°F 27 Ph sical Facility _ FC 6 .007 to 41 F/45°F Within 4 Hours. * 28 Poisonous or Toxic Materials FC I .008 3-50L141B) Cooling PHFs Made From Ambient _29 S eoial R uirements .009 Temperature Ingredients to 41°F/45°F 30 Other _ Within 4 Hours'" *Denotas critical itearr in the ledexal 1999 Food Code or 105 CbIR 590,000. CITY OF SALEM r BOARD OF HEALTH Establishment Name: Date: Page: of e Item Code c-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date No. Reference R-Red Item Verified PLEASE PRINT CLEARLY } i i , x f r 4 I 4 d A i y ti i t ..y C i '4 t 1 I 4 Discussion With Person in Charge: Corrective Action Required: ❑ No ❑ Yes I have read this report, have had the opportunity to ask questions and agree to correct all ❑ Voluntary Compliance ❑ Employee Restriction/ Exclusion violations before the next inspection, to observe all conditions as described, and to ❑ Re-inspection Scheduled ❑ Emergency Suspension comply with all mandates of the Mass/Federal Food Code. I understand that noncompliance may result in daily fines of twenty-five dollars or suspension/revocation of ❑ Embargo ❑ Emergency Closure your food permit. s ❑ Voluntary Disposal ❑ Other: 9 -"(C) PFIFs Received at"I'emperatures Violations Related to Foodborne,Illness interventions and Risk According to Ltw Cooled to Factors(items 1-22) (Cont.) 4 I'F/4Y F Within 4 Hours. PROTECTION FROM CHEMICALS 3-501.15 Coohro, Methods for PHFs F- 14 Food or Color Additives 19 PHF Not and Cold Holding 3-262.12 Additives' 3-501.16(B) Cold KIFe Maintained at or below 3-30214 Protection from Una Sgot)(cl(F) 41-145�1 F- a mrov�d Additives* --L -- ';-501,16(A) For PHFs Maintained at or above Poisonous or TOKiC Substances 140"F. 7-101.11 Identifying Information-Original Containers, 3-501.16(A) Roasts Held at or above 130'F. --7--102 it Conninon Name- =20 Time as a Public Health Control 7-201.11 Se nration-Store t-":��0&110 Containers* 13-50,-19 -Time-a-.,a Public-Health Control 590.004(1-1) V,iriarlce RLquirement 7-202.11 Restriction-Prerenati and Use)t 7-202.12 Conditions of Lace� REOUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-203.11 Touc Containers-Mollibitionsl- POPULATIONS(HSP) 7-204.11 Sanitizels,Coterns -Chemicak4- clienticals for 21 3-801.1 I(A) Unpasteurized Pre-packaged Juices and Divinp,Agerim Criteria* 7-204 12 7-204A4 mth Aal nine I�abela- 7-20511 Incidental Food Contact, Lubricants* 3-801.11(B) Use of Pasteurized Eins* 7-200I1. Restricted Ise Ise Pesticides, Croatia* 3-&01-11(D} Raw or Partially Cooked Animal Food and 7-206.12 Rodent Bait Stations' 3-fiO t.I I(C) Unopened F"X)d Pacloole Not Re-serve. 7-206.13 Tracking Powders,Pest Control and � - Moniturin,,* CONSUMER ADVISORY TIMErrEMPERATURE CONTROLS -F2 3603,11 Consumer Advisor) Posted for Consumption of 36 Proper Cooking Temperatures for Annual Foods`That are Raw, I hider cooked is PHFs Not Otherwise Processed to Eliminate 3-401.11 A(l)(2) Eggs- 155')F IS Sec. Pathons; 3-30213 Plateunred Fggs Substitute for Raw Shell 3-401.1 1(A)(2) Comminuted Fish,Meats&Game Aninvals- 155'F 15 sec. * 3-401.11(B)(1)(2) Pork and f3citfRoast- 130'F 121 min* SPECIAL REQUIREMENTS 3-401.1 1(A)(2) ftnutcs, Injected Meats- 155°F 15 -T90 009(1'0419 Violations of Section 590.009(A)-(D)in sec.* catering, mobile food, ternporan, and 3-401.11(A)(3) Poultry,WildGame, Stuffed PHI-i, residential kitchen operations should be Stuffing Containing Fish, Meat, debited under the appropriate sections Poultry or Ratites-165°F 15 sec. 4 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 g-fasel retail 3-401.12 Rtox Animal Foods Cooked ill a- practices should be debited under #29- Microwave 165"F* - Special Requirements. 3-401.1 l(A)(1)(b) All Other PIIFs-145°F 15 sec. * I' t7 - -RIeheatmg for Hot Holding VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 3-403.1](A)&(D) PHFs 165'F15 sec. (items 23-30) 3-403.11(B) Microwave- 165°F 2 Nfirrile Standing Critical and non-critical violations, rolfich do nat gelate In the foontilorne illness mrervenlions and riskJbc on-s lived above, can be, ,-403.11(C) CornmorcialiN,Processed RTE Food- found in the fol"Ocitno sections qf the Food Code and 105 CUR 140`14" 590.000. 3-403.11(F) Remainine Untliced Portiors of ficef 1 Item Good Retail Practices FC 590.000 Rnasts" 23.- Mame qmtent and Personnd........ PC-2 1 Ts 1 .003 Ig 24, Food and Food Protectior 3 1 004 Proper Cooling of PHFs -- - 25. EqpprnenLand Utensils __Fc-4+005 4(A) Cooling C - --- 3-501'j Cooked PHFs from 14 O'F it) 26 Water, Plurribinq and Waste FC-5 1 .006 70"I'Within 2 Hours and From 70°F Phvsical Facifit/ --F-C-6 .007 to 41'1?45°F Within 4 Hours. 28, oisonotts ors Toxic FC-7 .008 3-50114(13) Cooling PHFs Made From Ambient 29, .009 TempeTemper attire hieredionts,t,oo 4 1 9F/141'F 30, Other --- elar e ll'oedleyna r 4 lli`ou'ris Dell0a;critical item in the fol'aal 1999 Food Code or 105 CNIR590000, CITY OF SALEM BOARD OF HEALTH Establishment Name: (7f/ Date: I A o:p� Page: s of Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION" 'Date No. Reference R—Red item Verified PLEASE PRINT CLEARLY /J71//Ti z/,tJ! Lot, Ta lie rh A ,.✓%9 i.+/f� !� o� 1Uf-7'e2 /r/A c ✓ S r/�o,« J/'c ic-�l1oiZ to✓�/2�)J /� i�PL-T f7✓lJ /�L rJSj�c - .I ti I - 111/G/LoI'v4ve3 /Ze'Qc�,2��5 F110,U7- )3 42 - 1:�er"Vr///7 13 2 AS P/<OA?C,/1.kk7ep L7e-7V,-12A AN c>12F7I"ZA •OAl 4S .2eav112-e'2O. G i✓C70- /lc PS -7-0 e/ AleA- &eeAj { I F F n/� t'j //Ir"' Al. / tf NEt'f"f! Fi i - { t rYi IY Iu' . Discussion With Person in Charge: Corrective Action Required: ❑ No ❑ Yes s 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 descried, and to ❑ Re-inspection Scheduled ❑ Emergency Suspension comply with all mandates of the Mass/Federal Food�Zode. I understand/that noncompliance may result in daily fines of twenty4ive d7k �/ suspension/revocation of ❑ Embargo ❑ Emergency closure your food permit. � i ❑ Voluntary Disposal ❑ Other: 3-50i.I4(C) PHFs Received at'I'enrperatures violations Related to Foodborne Illness interventions and Risk According to taw Cooled to Factors(items 1-22) (Cont.) 41TR`45+Within 4 Hours. ` PROTECTION FROM CHEMICALS 3-501.15 Cooling Methods for PHFs lg Food or Color Additives 19 PHF Hot and Cold Holding 3-501.16(B) Cold PAPS Mamtamed at or below 3-202.12 Additivee'k 590.004(F) 41%4511 1, 3-302.14 Protection from Unapproved Additives` 3-501.1(i(A) tibt PHF�Marntained at or above 15 Poisonous or Toxic Substances 7-101.11 Identifying Inform40yF. , Original Interrelation-Orig3-501.16(A) Roasts Heid at or above 130°F. Containers* 20 Time as a Public Health Control 7-102.71 Common N.ante-Working Containers* 7-201.11 Sc aradon-Stora e" 3-501.19 Time as a Public Health Control- 7-20111 ontrol-7-202.11 Restriction-Presence and User 90 004(1-1) Variance Re uiremene 7-202.12 Conditions of Ose* 7-20311 Toxic Containers-Prohibitions* REQUIREMENTS ION (HSP) HIGHLY SUSCEPTIBLE 7-204.11 Sannizers,Criteria-Chemicals` P1AI(A) IONS(HSP) _ 7-204.12 Chemicals for Washing Produce,Criteria* 21 3-801.11(.0} Unpasteurized Pre-packaged Paoces and Bever alas; Drvin". cuts.Criteria* _ zaszes with Warninelabel * s 3-801 11(B) Use of Pasteurized Ee£s* 7-205.11 Incidental Food Contact. Lubricants" 3-MIA 1(D) Raw or Partially Cooked Aminal Food and 7-206.11 Restricted Usc Pesticides,Criteria" Raw Seed Sprouts Not Served. 7-206.12 Rodent Bait Stations" 3-s01.11(C) Un itiened Food Package Not Re-served 7-206.13 Tracking Powders,Pest Control and Monitorinit* CONSUMER ADVISORY TIMEtTEMPERATURE CONTROLS 22 3-603.11 Consumer Advisory Posted for Consumption of 16 Proper Cooking Temperatures for Animal Foods That are Raw, Underarokad or PHFs Not Otherwise Processed to Eliminate 3-401.1IA(1)(2) Eggs- 155'F 15 Sec. I'ffibORensrecem r �aea� Evas-hmnediate Service 145"Fl5sec* 3-302.13 Pasteurized Eggs Substitute for Raw Shell 3-401.11(A)(2) Comminuted Fish,Meats&Game - F s" Animals- 155'F 15 sec SPECIAL REQUIREMENTS 3-401.11(B)(I)(2) Pork and Beef Roast-130 F 121 min* 3-401.11(A)(2) It)ntes,Injected Meats 155"F IS 540.009(.0)-(D) Violations of Section 590.009(A)-(t))in sec * catering. mobile food, temporary and 3-401.11(;x)(3) Poultry,Wild Game,Strafed 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 i thress 3-401.11(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 Foods Cooked in a practices should be debited under 1129- Microwave 165`F* Special Requirearents. 140 1.11(A)(1)(b) A,ll Other PHFs-145'F 15 sec. 17 Reheating far Hat Holding VIOLATIONS RELATED TO GOOD RETAIL PRACTICES' 3-403.11(A)&(D) PHFs 165'F 15 sec. * (Items 23-30) 3-403.11(B) Microwave-165'F 2 Minute Standing Critical acrd non-critical violations, which do not relate to the Time' foralborne illness cine;venlions and ri.ek factors listed above con be 3403.11(C) Commercially Processed RTE Fail- I ,found in the fWoeving sections o_f'the Read Code and JOS CMR 140'F* 590.000. 3-403.11(E) Remaining Unsliced Portions of Beef Item Gaod Re tan Practices FC b90.00o FoastO 23. Management and Personnel FC-2 .003 18 Proper Cooling of PHFs _24. Food and Food Protection _ FC___3 .004 25 _ Equipment and Utensils FC 4 .005 3-501.l4(A) Cooling Cooked PHFs from 140`F to 26 ______Water. Plumbing and Waste FC 6 006_ 70°F Within 2 Hours and From 70'F 27. Ph sical FacilityFC--6 .007 to 41"F/45'F Within 4 Hours. * 28. Poisonous or Toxic Materials FC-7 .008 3-501.14(3) Cooling PFIFs Made Frora Ambient 29. S eciai Re uiremsMs ____ _ ________ .009 Temperature Ingredients to 41'F/45F 30.------ Other Within 4 HOtrs'k s9onmreevrM.zdoc Ilenotes critical item in the llsdes:d 7999 food Cac or 105 CNIR 590.000. ti CITY OF SALEM . BOARD OF HEALTH Establishment Name: S Cc'.5tk Date: ) —9 -Ul Page: of Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date No. Reference R–Red Item Verified f PLEASE PRINT CLEARLY r zo (/ I,/SS/erg Gt/ - 7 �� 7 �i✓i� L G e sin/. 7 i o qrJ iS 2 /-I �2o07 -ice ' / G L/L-->//9N G/ —&7,-,) 71/ lOY1/0 G'G7c� Rer l C _ T�/ e 7 9,0 W 7 flit Ll One- S ual�' 7 eNu Gu/L'L r 6- /Z&-0v,e2e D O •%D /uek) Ov/�/� 1F5 Dk/if/e2Z-S W&IS 7- l4N�i�C/r D IONTO{c > - ,-1 4 � _7�T 2�d/Z To l �i✓C�[3 D� wtiCl2s/f P. S 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 f ❑ Re-inspection Scheduled ❑ Emergency Suspension comply with all mandates of the Mass/Federal Food Code. I understajid that noncompliance may result in daily fines of tt�ty-five dollars or su enson revocation i_ o_of ❑ Embargo ❑ Emergency Closure { your food permit. ❑ Voluntary Disposal ❑ Other: 3-501.14((-,) PHFs Received at Temperatures Violations Related to Foodborne fitness Interventions and Risk According to Law Cooled to Factors(items 1-22) (Cont.) 41'Fl45'F Widrin 4 Hans. PROTECTION FROM CHEMICALS3-501.i5 Cooling Methods for PHFs 14 Food or Color Additives 14 PHF Hot and Cold Holding 3-501.16(B) Ca(d PPIFs Maintained at or below 3=202.12 i1o"mcs), 590.004(F) 411745° F` 3-302.14 Protection from Lina roved Additives" 3-501,16(A) .Hot PFIFs Maintained at or above 15 Poisonous or Toxic Substances 4WE 7-101.11 Identifying Intonnation-Original 3-501.16(A) Roasts at or above 130°F. Containers" 7-102,11 Compton Name-_Workim>Containers` 20 Time as a Public Health Control 7-201.11 Sc oration-Stonu>'e* 3-501.19 Time as a Public Health Control* 7-20111 Restriction-Presence Lund Use* 590.004(5-1) Variance Requirement 7-202.12 Conditions of Use* 7-203.11 Toxic Containers-Prohibitions* REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-204.11. Sanrttzers,Criteria-Chemicilsa` POPULATIONS(HSP) _ 7-204.1.2 Chemicals for Rashun Prndnec,Criteria"' 21 3-801.1 I(A) Unpasteurized Pre-packaged Juices and Labels* 7-204.14 Drying Beverages with_V_ents,Criteria" -- 7-205.11 Incidental Food Contact.Lubricants* 3-801.11(B) Use of Pasteurized L os* 7-206.11 Restricted Use Pesticides,Criteria's 3-801.11(D) Raw or Partially Cooked Animal Food and Raw Seed S routs Not Served. 7-206.12 Rodent Baitcrt ns* 3-801.11(C) Uno enedFood Package Not Re-served. " 7-20(i.l3 'pracking Powdders,Pest Control and Monitorin"* CONSUMER ADVISORY TIME/TEMPERATURE CONTROLS 22 3-603.11 Consumer Advisory Posted for Consumption of 16 Proper Cooking Temperatures for Animal Faods'I'fuat are Raw.Undeurooked or PHFs Not Otherwise Processed to Eliminate 3-401.1 lA(1)(2) Eggs- 155`1 1.5 Sec. Patho ens L es-Inmedrute Service 145°F75sec* 3-302.13 Pasteurized Eggs Substitute for Raw Shell 3-401.11(A)(2) Comminuted Fish,Meats&Game Eggs* Animals- 155°F 15 sec. 3 401.11(B)I1)(2) Pork and Beef Roast - 130-F 121 min* SPECIAL REQUIREMENTS 3-401.11(A)(2) Ratites, Injected Meats-155°F 15 590.009(A)-(D) Violations of Section 590.009(A)-(D)in sec. * catering, mobile food,temporary and 3-401.11(A)(3) Poultry, Wild Game,Shifted 111117s, residential kitchen operations should be Stuffing Containing Fish,Meat, debited under the appropriate sections Poultry or Rau9tes-1659.,15 see. * above if related to foodborne illness 3-401.1I(C)(3) Whole-muscle,Intact Beef Steaks interventions and risk factors. Other 145°F* 590.009 violations relating to good retail 3-401.12 Raw Animal Foods Cooked in a practices should be debited under#29- Microwave 165°F* Special Requirements. 3-401.1 1(A)(1)(b) All Other PHFs--1.45°F 15 sec. p Reheating for Hot Holding VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 3-403.1 1(A)MD) PHFs 165°F I S sen- „ (Items 23-30) 3-403.11(B) Microwave- 165'F 2 Minute Standing Oriticat and non-critical violemoos, which Ifo Trot relate io the Time* foodborne illness interventions unci risk factors Iiated above. can be 3-403.1 I(C) Commercially Processed RTE Food- fotord in the following sections of the Food Code and 105 CMR 140°F* 590.000. ood i-403.11(E) Remaining Unslieed Portions of Bee Item Good Retail Practices FC-C .0 0000 Roasts* 23. Manu ement and Personnel __ -2 .003 Ig Proper Cooling of PRFs 24. Food and Food Pr25 Eqotection upment and Utensils FC FC .4-3 .004 .00_5__ 3-501.14(A) Cooling Cooked PHFs from 140`P to 26 Water, Plumbin and Wasie FC 5 006 70'F Within 2 Hours atul From 70".F `--- 27. Ph-sical Facility_....___. FC-6 I .007 to 41.°Fl45°F Within 4 Hours. * 28. Poisonous or Toxic Materials FC -7 .008 3-501.14(B) Cooling;PHFs Made From Ambient 29_ _ Special Requirements _ l .009 Temperature Ingredients to 41°F/45"17 30 _ Other Within 4 Hours' or„.s,ana.ro� '�Denoted critical item in Ilre federal 1999 Food Code or 105 CMR 590.000- CITY OF SALEM L'ASa ✓��crncc` BOARD OF HEALTH Date: /AA7 Page: of :f Establishment Name: r item Code C-Critical item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date .' No. Reference R-Red Item - Verified t --- PLEASE PRINT CLEARLY -TG, , S �c �,�/sh,-� � i s orr�,� (l ��n� rad. wi {ZI o✓ f- w VI� /a/ l ,QvcP -<;erl/lGe !Lm = irarn 1 /� S� �a� •�� Nr'li r� hnr/S� !-a✓/4'G0" OGfr OI -a (1�- 171 rCl/a .c -o: H, c nc 15;WC / // v F ! _ i y r1, r" �s / o S? G( /, fv !Ji r �c rG l C S tc4rec 1-17C Y 9 19 Z F Discussion With Person in Charge: Corrective Action Required: LI No ❑ Yes I have read this report, have had the opportunity to ask questions and agree to correct all ❑ voluntary compliance ❑ Employee Restriction i c inspection, to observe all conditions as described, and to Exclusion violations before the next ins P Ll Re-inspection Scheduled Ll Suspension comply with all mandates of the Mass/Federal Food Code. I understand that noncompliance may result in daily fines of twenty-five dollars •r suspension/revocation of ❑ Embargo ❑ Emergency Closure your food permit. ✓ ❑ Voluntary Disposal ❑ Other: Z 3-501.14(0) PHFs Received at Temperatures Violations Related to Foodborne Illness Interventions and Risk According to Law Cooled to Factors(Nems 1.22) (Cont.) 41°F145'F Within 4 Hours. PROTECTION FROM CHEMICALS 3-501.15 Cooluu,Methods for PHFs 19 14 Food or Color Additives PHF Hot and Cold Holding 3-501.16(B) Cold PHFs Maintained at or below 3-202.72 - ProteAddiction 590.004(F) 41V45°F* 3-30214 Protcchon fromlJnat roved Additives* 15 Poisonous or Toxic Substances --501.16(A) Ilot PFTFs Maintained at or above 7-101..11 Identifying Information-Original 140'F. * 3-50.7.16(X) Roast's Held at or above 130°F. Containers* 7-102.11 Common Name-Workim, Containers* Time as a Public Health Control 7-201.1 L Separation-Storamc* 3-Sol.'19 Tune as a Public Health Control* 7-202.11 Restriction-Presence and I)se`k - 590.004(H) Variance Requirement 7-202.12 Conditions of Use* 7-203.1.1 Toxic Containers-Prohibitions' REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(FISP) 7-204.71. Sanitizet's,Criteria-Chemicals' 7-20.4.1'2 Chemicals for Washing Produce,Criteria* 2:1 3-801.1](A). Unpasteurizxd Pre-packaged Juices and 7-204.14 Dr�in�A cuts,Criteria* Beverages with WatningLabels* 7-205.11 Incidental Food Contact_Lubricants* 3-801 I I(B) Use of Pasteurized Er.e,s' 7.206.11 Restricted Use Pesticides.Criteria* 3-80I A I(D) Raw or Patoally Cooked Animal Food and I Raw Seed S trouts Not Served. 7-206.12 TraRodci Bait Powders, 3-80'1.11(C) Unopened Food Packa re hot Re-served. 7-206.13 Tracking Powders,Pest Control and Monitorim,* CONSUMER ADVISORY TIMElTEMPERATURE CONTROLS 22 3-603.11 Consumer Advisory Posted for Consumption of 16 Proper Cooking Temperatures for Annual Foods That are Raw.Undercooked or PHFs Not Otherwise Processed to Eliminate 3-401.11X(1)(2) Eggs- 155°F 15 Sec. Pathogens.*e"0htl ooi fi vs hmnedrato Service 145"F15sec* 3-302.13 Pasteurized Eggs Substi gte for Raw Shell 3-401.11(X)(2) Comminuted Fish,Meats&Game ECS` Animals- 155'F 15 sec. '" 3-401.11(B)(1)(2) Pork and Beef Roast- 130'F 121 min* SPECIAL REQUIREMENTS 3-401.11(A)(2) Ratites,Injected Meats-155'F 15 590.009(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 Stuftung Containing Fish,Meat, debited under the appropriate sections ___ Poultry or Ratites-165'17 15 sec. rc above if related to foodborne illness 3-401.11(01(3) Whole-muscle,Intact'Beef Steaks interventions and risk factors. Other 145'F* 590.009 violations relating to good retail 3-401.12 Raw Animal Foods Cooked in a practices should be debited under//29- Microwave 165r'F* Special Requirements. 3401..11(A)(1)(b) All tither PHFs- 145'F 15 sec 17 Reheating for Hot Holding VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 3-403.11(A)&(D) PHFs 1650F 15 sec. * (Items 23-30) 3-003.11(B) Microwave-165'F 2 Minute St'andina Crillcal and non-critical violations, which do not relate to the Time' ,foodborne illness interventions and tisk factors lialed above, can be 3-403.11(C) Commercially Processed RTE Food- ,found in tke follourzng sections of the Food Code and JOS OUR 14WF* 590.000. _ 3-403.11(6) Remaining Unsliced Pordoas of Beef Item Good Retail Practices IFC bHA.000 - - - - Roasts"` 23. Management and Personnel.-. _ FC-2 .003 18 Proper Cooling of PHFs 24. Food and Food Protection _-- _- FC--3 .004 25. Equi ment and Utensils FC 4 ,005 3-501.14(A) Cooling Cooked PHFs from 140'F to 26. Water, Plumbing and Waste FC 5 .006 707 Within 2llours and From 70°F 27. Ph sisal Facility FC-6 I .007 to 4 'F/45'F Within 4 Hours. * 2& Poisonous or Toxic Materials FC-7 .008 3-501.14(B) Cooling PFIFs Made From Ambient 29. 5 eoial Re uirements 1 .009 Temperature ingredients in4l`F/45°F 30 Other Within 4llours* ssuor„oun taz.ao� .y Denotes critical item in tlra[Meral 1999 Food Code or 105 C Mft 590.600. CITY OF SALEM BOARD OF HEALTH Establishment Name: //A-W A_L1*k//�t Date: 11q16 7 Page: of Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date No. Reference R—Red Item - - - - - Verified " --PLEASE PRINT CLEARLY - Nom,/v rhe /s �U �l2 /,<,9i�/dGl/iK /iN6 Oir/L F S/firl� SANK ys; /!/D .SOS �,� /'�F177?�TD�/��.5 . f'/�O✓/O� 50 flJl/v 1—D4M5?s /N /1 z- /'UNG 17lSPC. �7Z a `t i/r�� SGoO/� 5,�01dG0 //`lCO/Z2G�CTGL/ /�'CS SlooP 'O USC :� S: /Lei7 .n/ !I D�,ri✓A-7�y G ��7� lU.t/�+'l�i,_,�2 QrL ,y A111-1 srr✓Dc 5 moor o ,r- Ce- EV�2 yz7a 7 G✓ol2rc S7,f-7.o-v iY7 vs; {/��' E s k � FGCJ S F /�7 L' JZGbrI't /7I/SS�N/r 1/6417l'0✓e7Z. 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 LI Re-inspection Scheduled ❑ Emergency Suspension comply with all mandates of the Mass/Federal Food Code. I understand that noncompliance may result in daily fines of twenty-five d011a,so sion/revocation of LlEmbargo ❑ Emergency closure your food permit. ��///�j//j ❑ Voluntary Disposal ❑ Other: 3-50 L 14(C) l 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 flours.* PROTECTION FROM CHEMICALS 3-501.15 Cooling Methods for PHFs 13 Food or Color Additives 19 PHF Hot and Cold Holding 3-501.16(B) Cold PEIFs Maintained at or below 3-202.12 Additives* 590.004(F) 41`/45° F' 3-302.14 Protection from Una t roved Additives* 3-501,16(A) I-iot PHFs Maintained at or above 15 Poisonous or Toxic Substances 140'1`. * 7-101.11 IdeCont inerg lnii>rmafion-Original 3-50L16(A) Roasts Held at or above 130'F. Containers' 7-10211 Common Name-Workin- Containers* 2{1 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* 7-203.11 Toxic Containers-Prohibitions" REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-204.11 Smitizen,Criteia-Chemicals' POPULATIONS (H5P) _ 7-204.1.2 Chemicals for Washing Prodrlce,Criteria" 21 3-801.11(.x) Unpasteurized Pre-packaged Juices and 7-204.14 Drying Agents,Criteria* Beverages will, W tmnle Labels 7-205.11 Incidental Food Contact.Lubricants- 3-801.11(B) Use of Pasteurized Lees* 7-206.1 l Restricted Use Pesticides.Criteria* 3-801. 11(D) Raw or Partially Cooked Animal Food and Raw Seed S srouts Not Served. * 7-206.12 Rodent Bait Stations" 3-801.11(C) Unopened Food Package Not Re-served. 7-206.13 Tracking Powders,Pest Control and Monitorinb* CONSUMER ADVISORY TIMEITEMPERATURE CONTROLS 22 3-603.11 Consumer Advisory Posted for Consumption of 16 Proper Cooking Temperatures for Animal Faids That are Raw.Undercooked or PHFs Not Otherwise Processed to Eliminate . . Pathogens.* "*•" 1/15,00 t 3-401.1.1A(1)(2) Eggs-Immediate Service 145'1715sec' 3-302.13 Pasteurized Fggs St&utute for Raw Shell 3-401.11.(All Comtninnted Fish,Meats Xc Game Animals- 155°1` Is sec, * - 3-401.1 l(B)(1)(2) Pork and Beef Roast- 130'F 121 rain* SPECIAL REQUIREMENTS 3-4101.11(A)(2) Ratites,Injected Meats- 155'F 1.5 590.009(A){D) Violations of Section 590.009(A)-(D)in sec.'e catering, mobile food,temporary and 3-401.1 I(A)(3) Poultry,Wild Game,StuffedPHFs, residential kitchen operations should be Stuffing ConsainingFish, Meat, debited under the.appropriate secciotrs Poultr y or Ratites-165'F 15 sec. * above if related to foodborne illness 3-401.11.(C)(3) Whole-muscle,haact Beef Steaks interventions and risk factors. Other 14501`* 590.009 violations relating to good retail 3-401.12 Raw Animal Foals Cooked in a practices should be debited under#29- Mierowave 165"F* Special Requirements. 3-401.11(A)(1)(b) All Other PHFs-145'F 15 sec. 17 Reheating for Hot Holding VIOLAT/ONS RELATEDTO G000 RETAIL PRACT/CES 3-40111(A)&(D) PHFs 165'F 15 sea " (Items 23-30) 3-403.L1(B) Microwave- 165'F 2 Minute Standine Glucal and non-critical violations, which do not relate to the Time* ,foodborne illness interventions and risk joctors listed above, can be 3-403.11(C) Commercially Processed RTE Food- found inthefollowing sections of the Food Code and 165 CMR 140'F" 590.600. 3-403.11(E) Remaining Unslieed Portions of BeefItem Good Retail Practices ooFC 690.000__ Rsts* 23. Mona ement an_d Pers_ain_el..._.._ FC-2 I .003 lg Proper Cooling of PHFs 24. _ Food and Food ProtectionFC -3 j .OM 25. E ui trier(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 FG-6 .007 _ to 41`F/4501`Within 4 Hours. * 28. Paisonou-so r Toxic Materials _ F_C_-7 .008 3-501.14(B) Cooling l Made From Ambient 20. S ecial R ulrements _ _f_.009 Temperature Ingredients to 41"F/45'F 30 _,,Other Within 4 Hours ssmmn�u*�zsa Denotes critical item in the federal 1999 Good Code or 105 CNIR 590-000. CITY OF SALEM BOARD OF HEALTH i Establishment Name: 9S A 13?,*VL�4j Date: / 9 6 7 Page: 2 of S ,c Item Code c-critical Item l DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date No. Reference R-Red Item - - ( Verified PLEASE PRINT CLEARLY 1 - DA7' 1674vise7z /S //U 5/Ze- -r6 - � ✓!✓�F��— ,,¢/30✓�-' //j2rNA� 2eavilzr✓3 Ta 8c'" �fti2 . tZ�P r6/Zt& cant w Srfr�n eellw riz-e5. rl�u s��nce a /�7� ��F�i2 . /2�7'��e •Tips miA/v mtssin/E, eele-1a2 G sic-mss. erc,c ' Y s —ices - f �OOrrt /ZeDvi(Zc35 �Y C�t/in/L� .�i✓� OAC-,/Y/ltiZ.�i/ai�- �fts�m�7 $ /f2oont 'Y Nd /� %orclez iiu /s/'c�LiSc ?2ourk-e euiz s . +�T,Qoo�t l2�Qt/i,Q�3 ilfd2ouG�if ��iNe� - f Discussion With Person in Charge: Corrective Action Required: LiNo ❑ 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 `f comply with all mandates of the Mass/Federal Food Code. I understand that noncompliance may result in daily fines ofwe?It '�e dollars orAus ension/revocation of ❑ Embargo ❑ Emergency Closure ' your food permit. LIVoluntary Disposal ❑ Other: 3--A -1 47(17,) PI-IFs Received at're-niperatures Violations Related to Foodborne Illness Interventions and Risk According to Law Cooled to Factors(items 1-22) (Cont.) 4 FF145'T Within 4 flout s. PROTECTION FROM CHEMICALS 3 '501,15 Coolon,Methods for PHFs 14 Food or Color Additives Eq Phle Hot and Cold Holding - -501,16(B) Cold 1`11FsVinintained at or below 3-202.12 3 — Additi�c,, 590.004(F) 41"f45°P' 102 ',4 Pcoleclual fromEEM!ioxed Add(tives` 3-501.16(A) Act PHF, Maintained at or above =5 Poisonous or Toxic Substances 140+, 7-101.11 Identifying Information-Original — 3-501.16(,A) Roasts Held at or above 130+. Contairre'sIt 2f} Timeas a Public Health Control 7-102,11 Common Name-Working Containers" —Til 3-501.19 ar', ra�as a Public Healtb Control* 1 20 1.11 I- Serallation-Storaue, 7 ------T- tance�Rai rcu�ient � -20111 Reqriction-Presence and U�el 7-202.12 Conditions of Use* 7-203.11 Toxic Containers-I—rohihnions* REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-204.11 Sanitizers.Criteria--clienlicaN* POPULATIONS(HSP) Chemicalsmr� a 21 3-80 Ll I(A) IUroT sTeurized Pre-packaged I..ce,and 7 Bevelaaes with Warminz Labels* -�--20�12 /-204.1.1 —------ 3-801 1(B) tjqe of Prv�teuiizevl ELin,* 7-205.11 Incidental Food Contact,Lubricants` 1—,"11 R— 3-801A I(D) Raw to Partially Cooked Arland Food and 7-206A T Restricted Use Pesticides.Criteria" Raw Seed Sprouts Not Served. 7-206.12 R'�i t Bart Stations, - 3-$01.11(0) Uno rafted Foal Package Not Re-served. " 13 1-0tJ Tricking Powders,Pest Control and Moniturinc* m � CONSUMER ADVISORY TIME/TEMPERATURE CONTROLS 22 3-603.11 Consumer Advisory Posted for—Consumption of Proper Cooking Temperatures for Ational Foods That are Raw.Undercooked or PHFs Not Odiemqse Processed to Eliminate — Pathogen 40 1.11 A(l)(2) Fgg�,- 1551-- 15 Sec. J-— Eggs-Immediate Service 145"PI 5scc* 1-302.13 Pasteurized Eggs Substitute for Raw Shell 3-401.11(A)(2) Comminuted Fish, Meats&Game Annuals- 155°F 15 sec. � SPECIAL REQUIREMENTS ;;-401.I I(B)(1)(2) Pork and Beef Roast - 130°F 121 win* 590.009(A)-(D) Violations of Section 590.009(A)-(D) in 3-401.110W2) Ratites,Injected Meats-155`1715 sec.* catering, mobile food,temporary and 3-401..1.1(A)(3) Poultry'Wild Game,StuffedPH 11, residential kitchen operations should be Stuffing Containing Fish,Meat, debited order the appropriate sections Poultry or Ratites-I65°17 15 sea above if related to foodborne Illness 3-401.11(0(3) Vihole-muscle,Intact Beef Smalls interventions and risk factors. Other 145°F .590.009 violations relating to good retail 3-401,12 Raw Punned Foods Cooked in 8 practices should be debited under#29— Microwave 165'1-"* I Special Requirements. 3-401 1[(A)M(b) All Other PHFs- 145°F 15 sec -Bebeatmg for Hot Holding VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 3-403.11(A)&(D) PHFs 165°F 15 sec. * (Items 23-30) 3-403.11(B) Microwave-165'F 2 Minute Standing,, Critical and non-critical tiolariolm 0iich do nor relate to the Timor foodborne Illness interventions and risk factors listed above, can be 3-403.11(C) Commercially Processed RTE Food- found in the following sections of The Food Code and 105 CAIR 140'F!' 590.000 3-403.11(F)(E) Rearamin Linsliced Portions of Beef Item Good Retail Practices--�FC 590�O00 Roa,ilrl 23—. —, Vonaccarent and Personnel FC-2 1 o03 1=8 — Proper Cooling of PHFs -24. Food and Food Prot-e-cf-o-n- 3-501A4(A) Cooling Cooked PHFs from 140`F to -25� Equipment and Utensils -FC-4 m5-- - 26 Water.Plumbin and Waste FC-5 .006 70-F Within 2 Hours and From /,ff Physical Facility 667 to4l'F145'FWithin 4Hours. * 2-8 Poisonous or Toxic Materials-- FC- 7 .008 3-501,1,!(B) Cooling,PHFI,Made From Ambient 29. j Specie!Requirements '009 Temperature frolrodilurlits to 41 OF/45^F 30, Other i I Within 4 Hours* Denotes claical feln in the a'deral 1999 Food Code or 105 CkIll 590 000. CITY OF SALEM BOARD OF HEALTH i F Establishment Name: �'�`yfG�tiJCff Date: 4 /a 7 Page: of i item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date FNo. Reference R—Red Item. - Verified a PLEASE PRINT CLEARLY 3 i Ner Zoe* pl;70127Z4-v , 12er7'ir,2 She U✓vi7 RifOUt/L63 (7 &-?'Je_ 6t-9 I //A) - iff�_ne /S NO /A) -j1✓k/ raod /3us/fiue�J�. Cf; E�:e f3f/ rs 10v.va oy i__7 f,q � ✓��%/!/tsH ��1 12 LaQv�f?�'S '/fd2auln// Gt-�/r�liNL7. '//�15ft �o /3g 57oYde7� /.,u P/Lo�eW coltl�j?iNE2s- 2 eQvi/LGS C Z elNmlei . — 2t- iz�C ram A) joe vc ce /�W07' IL o t S` 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 Ll Voluntary Compliance ❑ Employee Restriction/ „r Exclusion violations before the next inspection, to observe all conditions as described, and to ❑ Re-inspection Scheduled ❑ Emergency Suspension comply with all mandates of the Mass/Federal Food Code. I understand%that noncompliance may result in daily fines of tw�y a dollars nsiocation of ❑ Embargo Ll Emergency closure your food permit. ❑ Voluntary Disposal 0 Other: 3-Sfll 14(C:} PHFs Received atTemperature s Violations Related to Foodborne Illness Interventions and Risk Ac eordi n„to I-aw Cooled to 1 Factors(items 1-22) (Cont.) 4I'Ft45 F Within 4 Hours.* PROTECTION FROM CHEMICALS 3-501.I5 ------------- Coolim>Methods for PHFs 14 Food or Color Additives 19 PHF Hot and Cold Holding -T202 1-2 -- Addnnev* 3-501,16(B) Cold P1 IFs2t4nintaired atinbelow 590"004(F) 41°745° F^ 3-302.14 Protection from Unapproved Additives* 15 Poisonous or Toxic Substances 3-501.16(A) Mot PHFs Maintained at or above 40'F. * 7-101.11 Identifying Information-Original 3-501.16(A) Roasts Held at orabove 130°F. * Containers" 7-t 02.11 Common Name-Working*Crnttamers" . 20 Time as a Public Health Control 7-201.11 Separation-Storaac"` 3-501.'19 Time as a Public Health Control" 7-202.11 Restriction-Presence and Use* 590"O(Y3(I-I) Vaiiancc Re uirement 7-202.12 Conditions(if Use* 7-2011.1 Toxic Containers-Prohibitions* REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-204.11 Sanitizers.Criteria-Chemicals* POPULATIONS(HSP)_ 7-204.12 Chemicals for Washine Produce,Giteria'' 21 3-801.1 1(A) Unpasteurized Pre-packaged Juices and 7-204.14 Drvi rig Agents,Criteria'" _ Beverages with W,mine I..abels^- r801.11(B) Lye of PasteurizedEaas* 7-205_11 Incidental Food Contact.Lubricants* 3-801.1 I(D) Raw or Partially Cooked Animal Food and 7-206.11 Restricted Use Pesticides.Criteria* Raw Seed Sprouts,Not Served. 7-206.t2 Rodent Bait Stations* Tracking Powders,Pest Control and 3-801.11(0) Unopened Food Package Not Re-served, 7-206.13 Monitorrn CONSUMER ADVISORY TIME/TEMPERATURE CONTROLS - o:36Consumer Advisory Posted for Consumption of 1fi Proper Cooking Temperatures for Animal Foods That are Raw.Undercooked or PHFs Not Otherwise Processed to Eliminate -T40111 A(1)(2) Eggs- 155`F 15 Sec. P3Lt0 Ln5 Rrovo r ;nai fits-Immedt ate Service 1.45°FlSsec* '302.13 Pasteurized Eggs Substitute for Raw Shell 3-401.11(A)(2) Comminuted Fish,Meats&Game Animals- 155'F 15 sec. * 3-401.11(@)(1)(2) Pork:and Beef Roast -130°F 121 min* SPECIAL REQUIREMENTS 3-401.11(A)(2) Ratites,Injected Mcats- 155°F '15 590.009(A)-(D) Violations of Section 590.009(A)-(D)in sec.°r catering, mobile fond,temporary and 3401.11(A)(3) Poultry,Wild Game,Stuffed PHFs, residential kitchen operations should be Stuffing Containing Fish,Meat, debited ander die appropriate sections Poultry or Ratites-I65°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 rook Crooked in a practices should be debited under #29- Mlcrowave 165`F* Special.Requirements, 3-401.11(A)(1)(b) All Other PHFs-145'F 15 sec. 17 Reheating for Hot Holding 00LATIONS RELATED TO GOOD RETAIL PRACTICES 3-403.11(A)&(D) PHFs 165°F 15 sec. 4' (items 23-30) . 3-403.11.(B) Microwave- 165°F 2 Minute Standing Critical and non-critical violations, which do not relate to the Time* foodborne i17ners interventions and risk factors listed above, can be 3-403.11(C) Commarcially Processed RTE Food- fauna in the followiog sections of the Food Code and 105 CMR 140°F" 590.0100. 3-403"11(E) RemaSn9ng Unsliced Portions of Beef Item Good Retail Practices FC 582000 Roasts" 23. Mang ement and Personnel FC-2 ,003 1g Proper Cooling of PHFs 24. Food and Food Protection__ FC-3 .004 5. Equipment and Utensils FC 4 _005 3-50114(A) Cooling Cooked PF1Fs from 140°F to p'--" ""- - _- 6. Water,,Plumbin and Waste FC 5 .00_6 70`F Within 21-iours and From 70'F 27" Ph sical Facili FC-6 1 .007 to 41°F145°F Within 4 Hours. * 28. Poisonous or Toxic Materials _ FC-7 .008 3-501.14(13) Cooling PHFs Made From Ambient 2@. -SpeciRequirements __ 1 008 Temperature Ingredients lo41'17/45'F 34- t_Other _____----------_--. Wi011n 4 Hou[Ss 33"�r«n� �zm° *Denotes tsitical item tit Qte fMe[al 1999 Food Code or 105 CN02 590.000. CITY OF SALEM BOARD OF HEALTH Establishment Name: —7Date: / 9�0 Page: of 'r hem Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date No. Reference R—Red hem Verified PLEASE PRINT CLEARLY FeT; c oN-770oc O/�e, oiz lc�� D.t�H� %d l Hie k- f'�T 3Lr5/FIYI�>UT FO/L /tGi/U�%r9�3L/Sf/121CN� %d I�9fiCS /N✓016CS Q% //r5 t -n"e'i�r" /7�Or%zl/n f17/�i� ¢ cam y7 r/LdheG7/O/l/ F/lC_,7f Z_e�9 1 W OU12eS i/Y0121!�?u6N eZe9^J11tC7 . E ✓sfi/✓!e U %i ff/IS yd UrS/I3�2 9/f /Li�orrrCs; 132aVi/7t� v/s 1 Rt E i� it CCr 6//Zf rte T/ Ja�no�x� i e7z• k Gr-OS e 5 . /ZC P4-,2 t ,F INS/Oe nom&e 1'4"15 t S ! -/tee iivs .ve ?,t7✓ez . r .'"�= SIYN/7/ZE7z '%Q �L �e�l71� /a'11A/c-q�3G� �� <IL'� S✓3-7ro�ds. 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 Foodde. I understandhat ty-f noncompliance may result in daily fines of twenive dollarrss or�sus ension/revocation of ❑ Embargo ❑ Emergency Closure your food permit. z / ❑ Voluntary Disposal ❑ Other: 3-50L1d(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 Homs.'" PROTECTION FROM CHEMICALS 3-501.15 Coolim,Methods for PHFS --------- 19 PHF Hot and Cold Holding lA Food or Color Additives 3-50 L t6(B) Cold P1IFs Maintained at or below 3-262.12 Addiuws r .-..-.- _ 590.004(£) 41°/45° E" X302.14 Protection fromUnapproved Additives* 3-501"'I ti(A) Hot PHFs Maintained at or above 1j Poisonous or Toxic Substances 140°F. " 7-101.11 Identifying information-Original 3-501-1.6(A) Roasts Held at or above 13 0F. Containers* 7-10111 Common Nanre-Working Containers'" 20 Time as a Public Health Control 7-201.11 Separation-Stora e* 3-50L19 Time as a Public Health Control* 7-262.1.1 Restriction-Presence and Use'w 590.004(Ff) Variance Requirement 7-202.12 Conditions of Use* REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-2(1'3.11 Toxic Containers-Probibitionss` POPULATIONS(HSP) 7-204.11 Sat»tizers.Criteria-Chemicals* - 7-2(f4.12 Chemicals for Washing Produce,Criteria" 2;1 3-901.1ION) Unpasteurized Pre-packaged Juices and 7-204.14DrVITTt eats,Criteria* Beverages with Wmnin*I..tbels" 7-205.11 Incidental Food Contact.Lubricants* 3-80] 11(R) Use of PasteunzedHaus* 7-205.11 Restricted Use Pesticides.Criteria* 3-80I1w,1(D) Raw or Partially Cooked Animal Foul and R Seed S*rout's Not Served. " 7-2A6.12 Rodent Bxif Staeions* 3-801.11(0) Uno erred Food Packa re Not Re-served. 7 206.13 Tracking Powders.Pest Control and Monitorim*" CONSUMER ADVISORY TIME/TEMPERATURE CONTROLS 22 3-603.11 Consumer Advisory Posted for Consumption of 16 Proper Cooking Temperatures for Annual Foods That are Raw. Undercooked or PRFs Not Otherwise Processed to Eliminate 3-401.11A(L(2) Figs- 1.55-F 1.5 Sec. Pathogens,*e"°itl"o r rzoa� E s s-Lmnedrate Service 14501715sec* 3-302.13 Pi steunred Eggs Substitute for Raw Shell 3-401.11(A)(2) Comminuted Fish, Meats&Game E 2s* Animals- 155°F 15 sec. 'r 3-401.11(13)(1)(2) Pork.and Beef Roast- 130`-F 121 minx' ' SPECIAL REQUIREMENTS 3-401.1 t(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 3-401.1 I(A)(3) Poultry,Wild Game,Stuffed PHFs, residential kitchen operations should be Stuffing Containing Fish,Meat, debited under the appropriate sections Poultry or Ratites-165°.£15,sec. * above if related to foodborne illness 3-401A I(C)(3) Whole-muscle,Intact Beet Steak's interventions and risk factors. Other 145`74; 590.009 violations relating to good retail 3-461.12 Raw Animal Foods Cooked in a practices should be debited under f129- Mlcrowave.165°F* Special Requirements. 3-401.11(A)(1)(b) All Other PHFs- 1.45°F 15 sec. 17 Reheating for Hot Holding -VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 3-403,11(A)&(D) PHFs 165°F 15 sec. * (Itenns 23-30) 3-403.11(B) Microwave-165'F 2 Minute Standing Critical and non-crifical violations, which do not relare to the Time" foodborne illness interventions and risk factors listed above, can be 3-303.1 1(C) Commercially Processed RTE Food- found in the following set cions of the Food Code and 105 CMR 1.40°F* 590.000. 3-403.11(E) Remaining Unsliced Portions of Beef Item Good Retail Practices FC 590.(X10 Roasts" 23. Management arid_P_ersonnel_ __ FC--2 1 .003 lg Proper Cooling of PHFs 24. Food and Fend Protection fFC' -3 .004_ _ _ 4 .00_5 3-501.14(A) Coating Coked PHFs from 140°F to 2fi. Water,Plumbin and Waste 5____006 70°F Within 2 1tours and From 70°F 27. Physical Faci6 ___f C-6 00 to 41°F/45°F Within 4 Hours. * 28. Poisonous or Toxic Materials FC-7 t .008 3-501.14(13) Cooling PHFs Made From Ambient _29 Special Requirements .009 Temperature fit gredients to 41°F/45FF 30,_ _ _-Other_ _';, Within 4 Hours'r Denotes cri«cal iteni in ilia federal 1999 Food Code or 105 CNIR 590.000. a SPORTS ■ AR 109 Lafayette St. Salem, MA 01970 Tel 978 833 0910 HAMANDCHr-r-5r- s6-85 WITH CHIF5 . . . . . Ly . . : . . LEMONADE • �v d - 711 1 . _ ` I t � i 00 O r i i CITY OF SALEM BOARD OF HEALTH Establishment Name: -r)6 Date: I \ci Pager_ of Item Code C-Critical nem DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date No.. Reference R—Red Item. .. PLEASE PRINT CLEARLY Verified o �A\?c\, 1:7S >,rx L\ S\)k 11 . 7 j-1 CA Is cA 5YA`N\ 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 Ll Voluntary Compliance Li Employee Restriction/ Exclusion violations before the next inspection, to observe all conditions as described, and to ❑ Re-inspection Scheduled ❑ Emergency Suspension comply with all mandates of the Mass/Federal Food Code. I understand that noncompliance may result in daily fines of twenty-five dollars or suspension/revocation of ❑ Embargo ❑ Emergency Closure your food permit. / C fiWf �/>o ( v ❑ Voluntary Disposal ❑ Other: J7// /� 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 Hours. PROTECTION FROM CHEMICALS 3-501.i 5 Cooluig Methods For PHFs 19 14 Food or Color Additives PHF Hot and Cold Holding 3-2t)2.12 Additives* 3-50't.I6(B) Cold PHFs Maintained at or below 590.0(W(F) 41%45°F* 3-302.14 Protection Fa>mina> roved Additives* 3-501,16(A) Rut PHFs Maintained at or above 1c Poisonous or Toxic Substances 140°F. 7-101,11 Identifying ZnformaNmn-Original 3-501,16(A) Roasts Held at or above 130°F. Containers" 7-102.11 Common Name-Working Containers* 20 Time as a Public Health Control 7-201.11 Se oration-Storage 3-501.19 Time as a Public Health Control* 7-20111 Restriction-Presenceaod Use" 590.004{'H) Variance Rc uirement 7-202.12 Conditions of Use, 7-203 11 Toxic Containers-Prohibitions* REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-204.11 Sanitizers.Criteria-Chemicals* POPULATIONS(HSP) 7-304.12 Chemicals for Washing Produce,Criteria" 21 3-801 11(A) Unpasteurized Pre-packaged Juices and Beverages with Warning Labels" 7-204.14 Davina guts,Criteria, ` 7-265.11 Incidental Food Contact.Lubricants* 3-801.11(B) Use of Pasteurized 7-206.11 Restricted Use Pesticides.Criteria'' 3-801.11(D) Raw or Partially Cooked Annual Food and Raw Seed Sprouts Not Served. 'k 7-206.12 Rodent' Bait Stationse 3-801.11(C} Uno ened Food Packer NNot Re-served. , 7-206.13 '1'ra�ktng Powders,Pest Control and Monitoring* CONSUMER ADVISORY TIMErfEMPERATURE CONTROLS 22 3-603.11 Consumer Advisory Posted for Consumption of Animal Foods'['bar are Raw,Undercooked or 16 Proper Cooking Temperatures for Not Otherwise Processed to Eliminate PRFs ERecn�e vvanai 3-401.11A(1)(2) Fri 155°F 15 Sec. Path Eggs hnuncdtate Service 145".Fl 5sec`^ 3-302.13 Pasteurized Eggs Substitute for Raw Shell 3-401.1 RA)(2) Comminuted Fish, More;&Game E gs"' Animals- 155`F 15 sea * 3-401.11(B)(1)(2) Por,k'.and Beef Roast- 130'F 131 min* SPECIAL REQUIREMENTS 3-401.1l(A)(2) Ratites, Injected Meats- 1.550F 15 590.009(A)-(D) Violations of Section 590.009(A)-(D)in sec:. * catering. mobile faid,temporary and 3-401.1l(A)(3) Poultry, Wild Game,Stuffed PIIFFs,. residential kitchen operations should be Stuffing Containing Fish,Meat, debited under die appropriate sections Poultry or Ratites-165'J"15 sec. s= above if related to foodborne illness 3-101.11(C3(3) Whole-muscle,Intact BeeFSteaks interventions and tisk factors. Other 145°F* 590.009 violations relating to good retail 3-401.12 Raw Amarod Foods Crooked in a practices should be debited under#29-- Microwave 165°F* Special,Requirements. 3-401,11(A)(I)(b) All Other PHFs-145°F 15 see, 17 Reheating for Hot Holding VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 3-403.11(A)&(D) PHF& 165'F 15 sea. 4` (Items 23-30) 3-403.11(B) Microwave- 165°F 2 Minute Standing Critical,and non-critical vivlalionat, which do rat relate to the Tunes` foodborne illness inrei venriom and risk factors listed above, can be. 3-403.I I(C) Commercially,Processed RTE Food- found in the following sections of the Food(title and 105 CMR 140"F* .590.000. 3-403.1.1(E) Remaining Unsl iced Portions of Beef Item TGood Retail Practices FC 590.00 Roasts` 23. Management and Personne_IFC-2 .003 1g Proper Cooling of PHFs 24. Food and Food Protection FC-3 004 25. _ Equipment and Utensils _ FC 4 .005_ 3-501.W(A) Cooling Coked PHFs from 140'F to - 26 Water.Plumbin and Waste FC 5 .006 70°F Within 2 flours and From 70".F 27. Ph sinal Facili FC-6 -007 to 41`F/45°F Within 4 Hours. '" _T8_ or Toxic Materials FC-7 .008 3-501.14(B) Cooling PI.IFs Made From Ambient _29-. S ecial R uirements _ .009 Temperature Ingredients to 41°F/45-F 30 Other Within 4 Hours;' s ovnrr,�,naa-z.�o� Denotes critical item in lho luleral 1999 Food Code or 105 CMR 590.000.