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CASTILLO GROCERY - ESTABLISHMENTS CASTILLO GROCERY 24 PALMER STREET u In i P M /3� a V a�'l V j -9 nv O a /��ns��-.OR,TANT MESSAGE ) FO! R � l� 1 `r OA( M- ► TIME 1 P.M. M 1 a� OF \\ PHONE AREA C00 NU BE -EXTENSION O FAX O MOBII F AREA CODE UMBER TIME TO CALL TELEPHONED LEASE CALL CAME TO SEE YOU WILL CALL AGAIN WANTS TO SEE YOU RUSH ' RETURNED YOUR jjjCj)-L WILL FAX,T(O' OU ,AQESSAGE \� s, SIGNED /�^J)' `^� 0 FORM 4009 VW - MADE IN U.S A I NOTES - z:- Commonwealth of Massachusetts City of Salem Board of Health IGmberiey Orisooll 120 Washington Street,4th Floor Mayor SALEM,MA 01970 _ Food/Retail Establishment Permit DATE PRINTED: 01/03/2008 ESTABLISHMENT NAME: Castillo Grocery File Number:BHF-2004-000106 24 Palmer Street Salem MA 01970 LOCATED AT: SALEM, MA 01970 Permit Type Permit No. Permit Issued Permit Expires Fee Restrictions/Notes RETAIL,FOOD BHP-2008-0020 Jan 3,2008 Dec 31,2008 $70.00 TOBACCO VENDOR BHP-2008-0048 Jan 3,2008 Dec 31,2008 $135.00 Total Fees: $205.00 PERMIT EXPIRES IDecember3l, 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 11 of 28 � ' 0 CITY OF SALEM, MASSACHUSETTS c BOARD OF HEALTH 11 120 WASHINGTON STREET,4" FLOOR TEL.(978)741-1800 KIMBERLEY DRISCOLL FAx(978) 745-0343 MAYOR ISCOT110SALEM.COM JOANNE SCOTT, HEALTH AGENT 2008 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT NAME OF ESTABLISHMENT (iAS-6 `yL�0 W000� TEL# 9p��Y/ ADDRESS OF ESTABLISHMENT 2� �f/v/ele S{ FAX# /-78 7 D�9S MAILING ADDRESS(if different) EMAIL-Business': ' / Website: OWNER'S NAME V 1C%1 Dk UDq/�/vf,Pz� ANW 0,4� TEL# �7 --,Z3S ADDRESS .� s'�Ge�t �Q - �i g�r�• STREET // p / /( CITY c� STATE ZIP CERTIFIED FOOD MANAGER'S NAME(S) bllLAle Y. ��i/ Ue CERTIFICATE#(S) (Required in an establishment where potentially hazardous food is prepared) EMERGENCY RESPONSE PERSON 44�eC AXlC_Ct1 HOME TEL# DAYS OF OPERATION Monday Tuesday Wednesday Thursday Friday Saturday Sunday I HOURS OF OPERATION / ! 7/ Please write in 6me of day. �( C O / l (For example l lam-11p / CN m) / K TYPE OF ESTABLISHMENT FEE (check onlyl RETAIL STORE YES NO less than I000sq.ft. _$70 1000-10,000sq.ft. 280 more than 10,000sq.ft. =$420 -----��- ----------------- E ------ d---------------------- -------------- - ---- RESTAURANT YES NO less than 25 seats =$140 (Outdoor Stationary Food Cart$210) 25-99 seats =$280 more than 99 seats =$420 '--'-'-'-'--'-------'--'--"---------------------------ES------N- O--------------------- ----------------------------------------$11-00--"--'- BED/BREAKFAST/ YO CHILDCARESERVICES -------------------------------------------------------------- --------------------- ------ ADDITIONAL PERMITS MAKE (not just serve) ICE CREAM, YOGURT/SOFT SERVE YES NO 25 TOBACCO VENDOR ES NO $135 ALL NON-PROFIT(such as church kitchens) YES NO $25 'Please pay total with one check payable to the City of Salem. This Permit is not transferable and must be reissued upon change of ownership.The Permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code, before any renovations, improvements, or equipment changes are made,all plans for such must be submitted to and approved by the Salem Board of Health. Pursuant to MGL Chapter 62C,Section 49A,I certify under the pains and penalties of perjury that I,to my best knowledge and belief,have fled all state tax returns and paid all state taxes required under the law. lL4 � //29_�q 0 Signature �' z,.a_. gQo Date Social Security or Federal Identification Number -- Revised 4/24/07 FOODAP2008.adm CheckN&Date /D7 O`6 - �7 TfaH6307b 24 Palmer Street Castillo Grocery City of Salem RETAIL FOOD - Food Establishment Inspection HACCP: ❑ Item Status Violation Critical Urgency Telephone: PROTECTION FROM CONTAMINATION 978-741-0295 Food Contact Surfaces Cleaning and Samtizmg FAIL Critical ❑d RED '�Owner: �l/Coafmenent: a cutting board in the meat room is stained and scored. Resurface or replace the cutting board. Victor J. Rodriguez 4 DI nife found stored in the knife rack in the meat room. Properly clean and sanitize all knives prior to storage °PIC: TIMEITE t RATURE CONTROLS(Potentially Hazardous Foods) ! Rafael Abreu Hot and Cold Holding FAIL Critical RED I Inspector: I ( Comment:The walk in freezer in the meat room had a temperature of 20°F. Repair unit to maintain a temperature 0°F or below. David Greenbaum L/ Date Inspected:Correct By: , 11/18/2006 $Risk Level: I Permit Number: +BHP-2008-0020 jStatus: i SIGNED OFF t#of Critical Violations: I 14 .Time IN: Time OUT: Urgency Description(s): ! BLUE: I 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) 1 j 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. Nov 20,2008 ) Page 1 of r: Item Status Violation Critical Urgency RED: M Violations Related to Good Retail Practices (Blue Items) Violations Related to Food and Food Protection FAIL Critical BLUE Foodborne Illness Interventions mment:There are many price labels obscuring expiration/sell b dates. Do not obscure an expiration/sell b dates with price and Risk Factors (Require labels. 'immediate corrective action) i The following items removed outdated: 3-Strawberry Chug milk 12-Campbells tomatoe juice 12-Bee h nut baby food 37-St a top stuffing 5-T,pdlpicana grapefruit juice 1 French's mustard 3 Wishbone salad dressing 26-Campbells gravy 5-Quaker cream of wheat 4-Bacon Closely monitor all expiration dates to insure no expired product is out for sale. 3 amag baby food was also removed from the shelf. T re is food stored directly on the floor of the walk in freezer. Store all food at least 6-8 inches off the Floor. Equipment and Utensils FAIL Non-Critical BLUE Comnt:The shelves under the onions and bananas has an accumulation of food spills and splatter. Thoroughly clean this entire If area. i-The wall reach in/walk in back fan unit has an accumulation of dust and grim. Thoroughly clean this fan unit. T oodng of the reach in/walk in needs a thorough cleaning,including under all racks. �- All slide racks in the wall reach hav an accumulation of dust and grime. Thoroughly clean all slide racks. aZapping machine in the meat room needs a thorough cleaning. e tabl n the meat room needs a thorough cleaning. T shelves and flooring in the walk in freezer have an accumulation of food spills and splatter. Thoroughly clean the flooring and all shelves in the walk in freezer. „y The plastic trays in the front deli case need thorough cleaning. e fro scale needs a thorough cleaning. e to of the deli case needs a thorough cleaning. 'the front 3 bay sink has an accumulation of food spills and splatter. Thoroughly clean the wall. :e,wall floorin at the front counter area needs thorough cleaning. The ershey ice cream freezer needs a thorough cleaning and organizing. City alem 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. Nov 20,2008 ) Page 2 of r�. Item Status Violation Critical Urgency The same/unit needs a visible accurate thermometer. T1" he iywe machine at the counter needs a thorough cleaning and sanitizing. �--�Th/ere is asmall electric fryolator at the front of this store. Fire Prevention has been notified and will be looking into this matter. N_,j.he basement stairs need a thorough cleaning. Physical Facility FAIL Non-Critical BLUE Comment:There are water stained ceiling tiles in the bathroom. Investigate the source of the leak and repair. Replace all stained ceiling tiles. _S-- There are unfinished wood shelves in the basement. Finish all shelves to be impervious and easily cleanable. Special Requirements FAIL Critical BLUE Comment:There were many rodent droppings observed in the basement and a live mouse was seen in the meat room. Owner must contact the licensed pest contro operator and have the store exterminated as often as needed to abate the problem. Owner to forward copies of all extermination invoices to the Board of Health. Reinspection in two weeks, 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. Nov 20,2008 ) Page 3 of J 24 Palmer Street Castillo Grocery City of Salem RETAIL FOOD - Food Establishment Inspection HACCP: ❑ Item Status Violation Critical Urgency Telephone: PROTECTION FROM CONTAMINATION 978-741-02.95 Food Contact Surfaces Cleaning and Sanitizing FAIL Criticald❑ RED Owner: Comment:The cutting boards are stained and scored. Resurface or replace the cutting boards. Victor J. Rodriguez Violations Related to Good Retail Practices (Blue Items) PIC: Physical Facility FAIL Non-Critical BLUE Victor Rodriguez Comment:There are unfinished wood shelves in the basement. All shelves must be finished to make them impervious and easily Inspector: cleanable. David Greenbaum Date Inspected:Correct By: GENERAL COMMENTS: 3125/2008 All other violations cited in the 3/18/08 inspection report have been corrected. Risk Level: Permit Number: BHP-2008-0020 Status: SIGNED OFF #of Critical Violations: 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/ of ..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®2008 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Apr 02,2008 ) Page 2 oft 24 Palmer Street Castillo Grocery City of Salem RETAIL FOOD - Food Establishment Inspection HACCP: ❑ Item Status Violation Critical Urgency Telephone: PROTECTION FROM CONTAMINATION 978-741-0295 Food Contact Surfaces Cleaning and Sanitizing FAIL Critical ❑d RED :Owner: t c�ent: Dirty knives found in the knife rack. Properly clean and sanitize knives prior to storage. 'Victor J. Rodriguez i PIC: �- The cutting boards are stained and scored. Resurface or replace the cutting boards. I Rafael Abreu TIME/TEMPERATURE CONTROLS(Potentially Hazardous Foods) Inspector: Hot and Cold idlding FAIL Critical ❑d RED David Greenbaum l�mment:The walk in meat room had a temperature of 54°F. Repair unit to maintain a temperature of 41°F or below. Date Inspected:Correct By: 3/18/2008 r The walk in freezer had a temperature of 30°F. Repair unit to maintain a temperature of 0°F or below. 'Risk Level: l/ tPermit Number: BHP-2008-0020 I Status: VIOLATION 1#of Critical Violations: 4 Time IN: I Time OUT: Urgency Description(s): i 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. Mar 18,2008 ) 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:The following items removed outdated: 4-Duncan Hines frosting immediate corrective action) 1 11 •'risco 1 -,Dinty Moore 5-Ronzoni parmesan cheese 7-Kraft Parmesan cheese V3-Salad dressing 1 -Salami 1 -Hot dogs 2-Baby formula Owner must closely monitor all expirations dates to insure no expired product is out for sale. Equipment and I.Wensils FAIL Non-Critical BLUE .`Com�:e !The shelves with the onions has food spills and splatter. Thoroughly clean these shelves. The'front-produce refrigerator needs a thorough cleaning. 1. 3hefront ice cream freezer needs a thorough cleaning and defrosting. - T same freezer needs a visible,accurate thermometer. T Tont display case needs a thorough cleaning including all shelves and replace the foil. T� rn ps found stored in bucket of dirty water. Clean the mops and store upside down not touching any surface to air dry. s ,_�Tliie floor and shelves in the walk in freezer have an accumulation of food spills and splatter. Thoroughly clean the floor and shelves. T basement stairs need thorough cleaning. Physical Facility FAIL Non-Critical BLUE Comment:There are unfinished wood shelves in the basement. All shelves must be finished to make them impervious and easily cleanable. Special Requirements FAIL Critical BLUE Common16 Rodent droppings observed in the basement storage area. Owner to contact the licensed pest control operator and ext inate as often as needed to abate the problem. Other-See Notes FAIL BLUE C_ omrpen't:There is cat in the basement. Animals other than service animals are prohibited in food stores. 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. Mar 18,2008 ) Page 2 of a �r Item Status Violation Critical Urgency GENERAL COMMENTS: Reinspection in one week, all violations to be corrected. JA 9 40 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. Mar 18,2008 ) Page 3 of IMPORTANT MESSAGE FOR .,..o DATE 9-5-/9 ;L U TIME OF /JJ __ p PHONE &L-tZ -,l AREA CODE NUMBER EXTENSION O FAX O MOBII F AREA CODE NUMBER TIME TO CALL TELEPHONED (11✓0LEASE CALL CAME TO SEE YOU WILL CALL AGAIN f WANTS TO SEE YOU RUSH k RETURNED YOUR CALL WILL FAX TO YOU MESSAGE 7 .ri1 iQ�A �2�•w— iawi�..sn,C�/n SIGNED ol 5psFORM 4009 MARE IN U.S.A. NOTES CITY OF SALEM BOARD OF HEALTH Name of Establishment: Castillo's Grocery Address: 24 Palmer Street Owner(s): Victor Rodriguez Phone: 978-741-0295 Date: October 16, 2007 The owner of this establishment met with the Health Agent to discuss lifting the suspension of the meat cutting operation. In December 2006, Mr. Rodriquez' brother met with the Health Agent regarding this suspension. At that time the Board of Health agreed to conduct frequent inspections to be sure that the Food Code was being followed. There was an understanding that if there were no more repeat violations the Board of Health would allow meat cutting again. The issue would be re-considered after six months. Mr. Rodriquez and I reviewed the several inspections since that meeting. There still remain repeat violations. Therefore the suspension of meat cutting is not lifted. Mr. Rodriquez says that he is allowing only family to work at the store. He will have his brother and brother-in-law take the Certified Food Manager class. The Board of Health will conduct additional inspections over the next few months and will re-evaluate the situation in January at Mr. Rodriquez' request. Mr. Rodriquez was given the opportunity to ask questions and stated that he q 9 PP Y understood this discussion about the violations and the restrictions remaining on this establishment. �Aanne Scott Date Health Agent ( 1 /D Victor RodKquez , Own r Date 24 Palmer Street Castillo Grocery City of Salem RETAIL FOOD - Food Establishment Inspection HACCP: ❑ Item Status Violation Critical Urgency Telephone: PROTECTION FROM CONTAMINATION 978-741-0295 Food Contac urfaces Cleaning and Sanitizing FAIL Critical ❑/ RED Owner: comment: The cutting boards are stained and scored. Replace all cutting boards. Victor J. Rodriguez V PIC: T ront meat slicer has an accumulation of food debris. Properly clean and sanitize the meat slicer after each use. Rafael Abreu Inspector: David Greenbaum Date Inspected:Correct By: 1/11/2007 Risk Level: i Permit Number: BHP-2007-0064 Status: VIOLATION #of Critical Violations: 2 Time IN: Time OUT: Urgency Description(s): BLUE: Violations Related to Good Retail Practices (Critical violations must be corrected immediately or within 10 days)(Non-critical violations must be corrected immediately or within 90 days) City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741-1800 GeoTMS®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: The wall reach/walk in has food stored directly on the floor. Store all food at least 6-8 inches off the floor. immediate corrective action) /_1`1„ There are many price labels covering expiration/sell by dates. Do not cover any expiration/sell by dates with price labels. �. There are food products stored under waste lines in the basement. Do not store anything under the waste lines in the basement. T e is sliced cheese in the reach in with no labels or expiration dates. Labels with all ingredients and expiration must be rowded on this cheese. The following outdated items removed from the shelves at the time of inspection: 7-Flan 10-Nestle Milo 18-Parmesan ese 2-Relish 12-Fr h dressing 12- raft parmesan cheese -Campbell's Tomatoe soup 12-Campbell's Cream of Chicken soup 1 •Skippy peanut butter 44-Jiffy corn muffin mix 10-Juicy juice 2-Lunchables Owner must closely monitor all expiration dates. Equipment and ensils FAIL Non-Critical BLUE mmenl:All trays in the front display cases have an accumulation of food spills. Thoroughly clean all trays. .Tloor of the reach/walk in has an accumulation of grime. Thoroughly clean the floor. T wra ping machine in the meat room needs a thorough cleaning. YThabl in the meat room needs a thorough cleaning. loor,walls and shelves of the walk in freezer have an accumulation of food spills and splatters. Thoroughly clean the floor,an helves. fro ce cream freezer needs a thorough defrosting. e same unit needs a visible accurate thermometer. e basement stairs need a thorough cleaning. Physical Facility FAIL Non-Critical BLUE y Comment:There are unfinished shelves in the basement. Finish all shelves in the basement to be impervious and easily cleanable. P�rode rotective covers on the all basement light fixtures. 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 2 of y 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®2007 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Jan 11,2007 ) Page 3 of f 24 Palmer Street Castillo Grocery City of Salem RETAIL FOOD - Food Establishment Inspection HACCP: ❑ Item Status Violation Critical Urgency Telephone: Violations Related to Good Retail Practices (Blue Items) 978-741-0295 Food and Food Protection FAIL Critical BLUE Owner: Comment:The wall reach/walk in has food stored directly on the floor. Store all food at least 6-8 inches off the floor. Victor J. Rodriguez PIC: There are many price labels covering expiration/sell by dates. Do not cover any expiration/sell by dates with price labels. Rafael Abreu There are food products stored under waste lines in the basement. Do not store anything under the waste lines in the basement. Inspector: These violations must be corrected immediately. David Greenbaum Date Inspected:Correct By: 1/18/2007 Risk Level: Physical Facility FAIL Non-Critical BLUE Permit Number: Comment:There are unfinished shelves in the basement. Finish all shelves in the basement to be impervious and easily cleanable. BHP-2007-0064 This violation must be corrected within 6 months. Status: PARTIAL COMPLY #of Critical Violations: GENERAL COMMENTS: 1 All other violatio_n_s cited in.the_1/11/07-inspection-report have-been corrected Time IN Time OUT Urgency Description(s): BLUE: Violations Related to Good Retail Practices (Critical violations must be corrected immediately or within 10 days)(Non-critical violations must be corrected immediately or within 90 days) City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741-1800 GeoTMS®2007 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Jan 18,2007 ) Page 1 oft Item Status Violation Critical Urgency RED: Violations Related to Foodborne Illness Interventions and Risk Factors (Require immediate corrective action) City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741.1800 GeoTMS®2007 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Jan 18,2007 ) Page 2 oft 24 Palmer Street Castillo Grocery City of Salem RETAIL FOOD - Food Establishment Inspection HACCP: ❑ Item Status Violation Critical Urgency Telephone: PROTECTION FROM CONTAMINATION 978-741-0295 Food Contact Surfaces Cleaning and Sanitizing FAIL RED Owner: iComment:Cutting boards are stained and scored. Resurface or replace boards. Victor J. Rodriguez PIC: -Sanitizing log not being kept daily. Log to be maintained daily. Victor Rodriguez Violations Related to Good Retail Practices (Blue Items) Inspector: Food and Food Protection FAIL Critical BLUE John Gehan Date Inspected:Correct By: iComment:There is packaged chicken in the front display case that have no tags or labeling on them. All foods must be tabled 2112/2007 accordingly. Risk Level: _There is a knife on the knife rack in back,found-with'food-debris: Thoroughly clean and sanitize utensils after each use. �� pfalk in freezer has temperature of 22°F. Freezer to be at 0°F or below as mandated. Permit Number: -' BHP-2007-0064 Walk in freezer has food stored dirrectly on the floor. All foods must be 6-8 inchesvoff of the floor. Status: .Walk intreach in unit has foods stored directly on floor. All foods must be stored 6-8 inches off of the floor. Open #of Critical Violations: Meat slicer has accumulation of food debris. Slicer to be cleaned and sanitized after see use. 2 .�mployee food being stored with store foods. Personal items to be stored in designated employee areas. Time IN: i Time OUT: Equipment and Utensils FAIL BLUE Urgency Description(s): BLUE: —Comment: Ice cream freezer has no visible thermometer. Provide visible and accurate thermometer. Violations Related to Good Retail Practices (Critical violations must be corrected immediately or within 10 days)(Non-critical violations must be corrected immediately or within 90 days) City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741.1800 GeoTMS®2007 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Feb 12,2007 ) Page 1 oft Item Status Violation Critical Urgency RED: Violations Related to Foodborne Illness Interventions and Risk Factors (Require immediate corrective action) City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741-1800 GeoTMS®2007 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Feb 12,2007 ) Page?oft 24 Palmer Street Castillo Grocery City of Salem RETAIL FOOD - Food Establishment Inspection HACCP: ❑ Item Status Violation Critical Urgency Telephone: Violations Related to Good Retail Practices (Blue Items) 978-741-0295 Food and Food ---^-^--_----- _ FAIL Critical BLUE Owner: comment:Walk in freezer has temperature of 22°F. Freezer to be at 0°F or below as mandatedT� Victor J. Rodriguez PIC: Walk in freezer has food stored dirrectly on the floor. All foods must be 6-8 inchesvoff of the floor. Rafael Abreu Walk in/reach in unit has foods stored directly on floor. All foods must be stored 6-8 inches off of the floor. Inspector: Meat slicer has accumulation of food debris. Slicer to be cleaned and sanitized after eac use. John Gehan Date Inspected:Correct By: 2/20/2007 Equipment and Utensils FAIL BLUE Risk Level: Comment: Ice cream freezer has no visible thermometer. Provide visible and accurate thermometer. Permit Number: GENERAL COMMENTS: BHP-2007-0064 �AII remaining violations to be correctea=py rriday 2/23/07 Status: ] PARTIAL COMPLY #of Critical Violations: 1 Time IN: I Time OUT: Urgency Description(s): BLUE: Violations Related to Good Retail Practices (Critical violations must be corrected immediately or within 10 days)(Non-critical violations must be corrected immediately or within 90 days) City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741.1800 GeoTMS®2007 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Feb 20,2007 ) Page 1 oft Item Status Violation Critical Urgency RED: Violations Related to Foodborne Illness Interventions and Risk Factors (Require immediate corrective action) City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741-1800 GeoTMSO 2007 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Feb 20,2007 ) Page 2 oft 24 Palmer Street Castillo Grocery City of Salem RETAIL FOOD - Food Establishment Inspection HACCP: ❑ Item Status Violation Critical Urgency Telephone: 1 Violations Related to Good Retail Practices (Blue Items) 978-741-0295 Food and Food Protection PASS Critical BLUE Owner: ( Comments:Walk in freezer has temperature of 22°F. Freezer to be at 0°F or below as mandated. Victor J. Rodriguez PIC: Walk in freezer has food stored dirrectly on the floor. All foods must be 6-8 inchesvoff of the floor. Victor Rodriguez Walk in/reach in unit has foods stored directly on floor. All foods must be stored 6-8 inches off of the floor. Inspector: Meat slicer has accumulation of food debris. Slicer to be cleaned and sanitized after eac use. John Gehan Date Inspected:Correct By: 2/23/2007 Equipment and Utensils PASS BLUE Risk Level: Comments: Ice cream freezer has no visible thermometer. Provide visible and accurate thermometer. Permit Number: GENERAL COMMENTS: BHP-2007-0064 Allremaining violations_have been-corrected. Status: t SIGNED OFF #of Critical Violations: 0 Time IN: Time OUT Urgency Description(s): BLUE: Violations Related to Good Retail Practices (Critical violations must be corrected immediately or within 10 days)(Non-critical violations must be corrected immediately or within 90 days) City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741-1800 GeoTMS®2007 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Feb 23,2007 ) Page 1 oft Item Status Violation Critical Urgency RED: Violations Related to Foodborne Illness Interventions and Risk Factors (Require immediate corrective action) J � City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741-1800 GeoTMS®2007 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Feb 23,2007 ) Page 2 of r. 24 Palmer Street Castillo Grocery City of Salem RETAIL FOOD - Food Establishment Inspection \l' HACCP: ❑ a� C Item Status Violation Critical Urgency Telephone: i PROTECTION FROM CONTAMINATION 978-741-0295 Handwash Facilities FAIL Critical RED Owner: i —1cOmment:The front hand wash sink is obstructed. Hand wash sink to be clear and accessible at all times. Victor J. Rodriguez PIC: r� om stand wash sink has temperature of 99°F. Sink temperature to be maintained between 110°-130°F. Victor Rodriguez TIME/TEMPERATURE CONTROLS(Potentially Hazardous Foods) Inspector: Hot and Cold Holding.... z_ FAIL Critical ❑� RED John Gehan ""'" � -�- �.-� ,- " ,,^—.' . „ ' .... Date Inspected:Correct By: Comment:Walk in refrigerator unit has temperature of 50°F. Unit to be maintained at 41°F or belowas maned -ated. 4/2/2007 Walk in freezer has temperature of 10°F. Unit to be maintained at 0°or Below as mandated. Risk Level: .--- The front hot holding unit has food holding temperatures at 112°F. Foods to be held at a minimum of 140°F as mandated. Permit Number: BHP-2007-0064 Status: Open #of Critical Violations: 2 Time IN. Time OUT: Urgency Description(s): BLUE: Violations Related to Good Retail Practices (Critical violations must be corrected immediately or within 10 days)(Non-critical violations must be corrected immediately or within 90 days) City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741-1800 GeoTMS@ 2007 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Apr 04,2007 ) Page 1 of f Item Status Violation Critical Urgency RED: Violations Related to Good Retail Practices (Blue Items) Violations Related to Food and Food Protection FAIL BLUE Foodborne Illness Interventions and Risk Factors (Require Comment:The following items were found outdated: immediate corrective action) 12 Dutchland cooked salami 6 Goya Chorzos 3 Boxes Parkay Butter 3 bacon packages 6 Lunchables 3 Leche Con Coco 9 Garlick Farms chug milk 8 La Yogurt 8 Chug orange juice 3 Hellmans mayonaise 30 Frosted cheerios 3 Wheaties 3 Bran Flakes 2 Product K 3 Corn flakes 6 Total Whole grain 2 1 gallon mayonaise bottles 2 Enfamil A.R.Lipil There are many items with expiration dates being obstructed by price labels. ./Cheese in thevreach in unit require sell by dates when packaged. here are eggs being stored at room temperature. Eggs to be stored at 41°F or below as mandated. Equipment and Utensils FAIL BLUE ,.0 mment:Walk in freezer floor requires general cleaning. Walk.in freezer shelves require general cleaning. f Back reach in freezer floor requires general cleaning. —Walk in/reach in unit requires general cleaning of the floor. .,same unit beverage shelves requires thorough cleaning. .Mea at case requires general cleaning throughout. -Meat display case trays requires general cleaning. rFro�alami case has has a broken thermometer. Replace thermometer with visible and accurate one. _A,im6'case requires general cleaning throughout. _,Pfoduce refrigeration unit requires general cleaning. City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741.1800 GeoTMS®2007 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Apr 04,2007 ) Page 2 of Item Status Violation Critical Urgency i /ce cream case has missing thermometer. Provide visible and accurate thermometer. /Same unit requires general cleaning. JSdme unit has build of ice. Defrost unit. Physical Facility FAIL BLUE —Comment:There is a water stained ceiling tile above the register area. Find source if leak and repair. Replace tile. GENERAL COMMENTS: Re-inspection to be in one week. All violations to be corrected at that time. 1 City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741-1800 GeoTMS®2007 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Apr 04,2007 ) Page 3 of i a.6 24 Palmer Street Castillo Grocery City of Salem RETAIL FOOD - Food Establishment Inspection HACCP: ❑ Item Status Violation Critical Urgency Telephone: I PROTECTION FROM CONTAMINATION 978-741-0295 Handwash Facilities PASS Critical d❑ RED Owner: Comments:The front hand wash sink is obstructed. Hand wash sink to be clear and accessible at all times. Victor J. Rodriguez PIC: Front hand wash sink has temperature of 99°F. Sink temperature to be maintained between 110°-130°F. Rafael Abreu TIMEITEMPERATURE CONTROLS(Potentially Hazardous Foods) Inspector: Hot and Cold Holding _PASS Critical SeRED John Gehan — Date Inspected:)Correct By: Commen<alk in refrigerator unit has temperature of 50*F.:Unit to be maintained at 41°F or below as mandated. �1 4/X2007 (41(.1 :iur�e f - _i dated --� J Fl � 7 I Walk in freezer has temperaure of 10°F. Unit to be maintained at 0°or Below as maniiated. Risk Level: //////'' I m -� The front hot holding unit has food holding temperatures at 112°F. Foods to be held at a minimum of 141 as mandated. Permit Number: BHP-2007-0064 Status: SIGNED OFF #of Critical Violations: 0 Time IN: Time OUT: Urgency Description(s): BLUE: Violations Related to Good Retail Practices (Critical violations must be corrected immediately or within 10 days)(Non-critical violations must be corrected immediately or within 90 days) City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741-1800 GeoTMS®2007 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Apr 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 PASS BLUE Foodborne Illness Interventions and Risk Factors (Require Comments:The following items were found outdated: immediate corrective action) 12 Dutchland cooked salami 6 Goya Chorcos 3 Boxes Parkay Butter 3 bacon packages 6 Lunchables 3 Leche Con Coco 9 Garlick Farms chug milk 8 La Yogurt 8 Chug orange juice 3 Hellmans mayonaise 30 Frosted cheerios 3 Wheaties 3 Bran Flakes 2 Product K 3 Corn flakes 6 Total Whole grain 2 1 gallon mayonaise bottles 2 Enfamil A.R.Lipil There are many items with expiration dates being obstructed by price labels. Cheese in thevreach in unit require sell by dates when packaged. There are eggs being stored at room temperature. Eggs to be stored at 41°F or below as mandated. Equipment and Utensils PASS BLUE Comments:Walk in freezer floor requires general cleaning. Walk in freezer shelves require general cleaning. Back reach in freezer floor requires general cleaning. Walk in/reach in unit requires general cleaning of the floor. Same unit beverage shelves requires thorough cleaning. Meat display case requires general cleaning throughout. Meat display case trays requires general cleaning. Front salami case has has a broken thermometer. Replace thermometer with visible and accurate one. Same case requires general cleaning throughout. Produce refrigeration unit requires general cleaning. City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741.1800 GeoTMS®2007 Des Ladders Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Apr 11,2007 ) Page 2 of Item Status Violation Critical Urgency Ice cream case has missing thermometer. Provide visible and accurate thermometer. Same unit requires general cleaning. Same unit has build of ice. Defrost unit. Physical Facility PASS BLUE Comments:There is a water stained ceiling tile above the register area. Find source if leak and repair. Replace tile. GENERAL COMMENTS: �WVviolations frdm=4/2/07=Have-been-correct@d. Establishment to closely monitor temperatures in the hot holding cases. All foods must be a minimum of 140°F. City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741-1800 GeoTMS®2007 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Apr 11,2007 ) Page 3 of t- 24 Palmer Street Castillo Grocery City of Salem RETAIL FOOD - Food Establishment Inspection HACCP: O Item Status Violation Critical Urgency Telephone: PROTECTION FROM CONTAMINATION 978-741-0295 Handwash Facilities FAIL Critical RED Owner: ° Comment: Bathroom sink has temperature of 104°F. Sink temperature to be maintained at 110°-130°F as mandated. Victor J. Rodriguez � 10 PIC: I Front handwash sink temperature reading at 92.7°F. Sink to be maintained at 110°-130°F as mandated. Victor Rodriguez Inspector: John Gehan Date Inspected:Correct By: 5/30/2007 Risk Level: Permit Number: BHP-2007-0064 Status: Open #of Critical Violations: 2 Time IN Time OUT: i Urgency Description(s): BLUE: Violations Related to Good Retail Practices (Critical violations must be corrected immediately or within 10 days)(Non-critical violations must be corrected immediately or within 90 days) City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741-1800 GeoTMS®2007 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. May 31,2007 ) Page I of 3 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:The following items were taken off of shelves to to being outdated: immediate corrective action) 9 Starbucks ice coffees Helmanns Mayonaise wishbone Ranch Dressing 5 Rice Chex cereal boxes 3 Cream of wheat 4 12 pack boxes-of,Ritr Ritr (g - Walk m refrigerator has a temperature of 52°F. Refrigerator must be maintained at 41°F or below ass mandated. Walk in freezer has a temperature of 25°F. Freezer to be holding at 0°F or below as mandated. Hot holding unit has chicken holding at 121°F. Chicken to be held at 140°F or above as mandated. Same unit has beef with a temperature of 110°F. Beef to be maintained at 140°F or above as mandated. There are many items with price obscuring. All dates on food items are to be made visible. Equipment and Utensils FAIL BLUE Comment: Produce shelves require thorough cleaning. .,,,___Produce reach in refrigerator requires general cleaning. .Walk in freezer requires general cleaning of floor and shelves. Back storage shelf has bare wood. All shelves need to be made smooth and impervious. �11-ront display case beneath register requires thorough cleaning. Same unit has a visible leak. Find source of leak and repair. Remove any water. Physical Facility FAIL BLUE Comment:There is a visible water stained ceiling tile in the restroom. Find source of leak and repair. Replace tile. City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741.1800 GeoTMSO 2007 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. May 31,2007 ) Page 2 of Item Status Violation Critical Urgency City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741-1800 GeoTMS®2007 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. May 31,2007 ) Page 3 of s24 Palmer Street Castillo Grocery City of Salem RETAIL FOOD - Food Establishment Inspection HACCP: ❑ Item Status Violation Critical Urgency Telephone: PROTECTION FROM CONTAMINATION 978-741-0295 Handwash Facilities FAIL Critical ❑d RED Owner: Comment: Bathroom sink has temperature of 107°F. Sink temperature to be maintained at 110°-130°F as mandated. Victor J. Rodriguez PIC: Front handwash sink temperature reading at 105°F. Sink to be maintained at 110°•130°F as mandated. Victor Rodriguez Violations Related to Good Retail Practices (Blue Items) Inspector: Food and Food Protection _,.- _ ._._._ _ ----FAIL—Critical, BLUE John Gehan _..-_._- '_1 — " Date Inspected:Correct By: Comment:Walk in refrigerator has a temperature of 62°F. Refrigerator must be maintained at 41°F or below as mandatetl\. Date Inspected: Comment: ) Walk in freezer has a temperature of 28°F. Freezer to be holding at 0°F or below as mandated. Risk Level: Equipment and Utensils FAIL BLUE Permit Number: Comment: Produce shelves require thorough cleanigg. BHP-2007-0064 Status: Produce reach in refrigerator requires general cleaning. Open Back storage shelf has bare wood. All shelves need to be made smooth and impervious. #of Critical Violations: 2 Front unit has a visible leak. Find source of leak and repair. Remove any water. Time IN: Time OUT: GENERAL COMMENTS: Urgency Description(s): All remaining violations to be corrected by Friday June 8, 2007. BLUE: Violations Related to Good Retail Practices (Critical violations must be corrected immediately or within 10 days)(Non-critical violations must be corrected immediately or within 90 days) City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741-1800 GeoTMS®2007 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Jun 06,2007 ) Page 1 oft ' I Item -- - -- - --- Status- Violation — Critical Urgency- - -- RED: Violations Related to Foodborne Illness Interventions and Risk Factors (Require immediate corrective action) City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741.1800 GeoTMS®2007 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Jun 06,2007 ) Page 2 oft 24 Palmer Street — Castillo-Grocery City of Salem RETAIL FOOD - Food Establishment Inspection HACCP: ❑ Item Status Violation Critical Urgency Telephone: PROTECTION FROM CONTAMINATION 978-741-0295 Handwash Facilities FAIL Critical RED Owner: - Commept-Bathroom sink has temperature of 107°F. Sink temperature to be maintained at 110'-130oF as mandated. Victor J. Rodriguez PIC: Front handwash sink temperature reading at 1050F. Sink to be maintained at 1100-130'F as mandated. Victor Rodriguez Violations Related to Good Retail Practices (Blue Items) Inspector: Food and Food Protection FAIL Critical BLUE John Gehan Date Inspected:Correct By: _;G� Comment:Walk in refrigerator has a temperature of 62'F. Refrigerator must be maintained at 41'F or below as mandated. 6/6/2007 `walk m freezer has a temperature of 28oF. Freezer to be holding at OoF or below as mandated. Risk Level: i a Equipment /and_Utensils FAIL BLUE Permit Number: ✓Comrnent: Produce shelves require thorough cleaning. BHP-2007-0064 Status: duce reach in refrigerator requires general cleaning. Open I .�.Back storage shelf has bare wood. All shelves need to be made smooth and impervious. #of Critical Violations: v 2 ' int unit has a visible leak. Find source of leak and repair. Remove any water. � Time IN: Time OUT: GENERAL COMMENTS: Urgency Description(s): All remaining violations to be corrected by Friday June 8, 2007. BLUE: Violations Related to Good Retail Practices (Critical violations must be corrected immediately or within 10 days)(Non-critical violations must be corrected immediately or within 90 days) City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741-1800 GeoTMS®2007 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Jun 08,2007 ) Page 1 oft - -- - - Item - -- - - - Status Violation - —Critical -Urgency- --- RED: Violations Related to Foodborne Illness Interventions and Risk Factors (Require immediate corrective action) City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741-1800 GeoTMS®2007 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Jun 08,2007 ) Page 2 oft 24 Palmer Street —Castillo Grocery - - City of Salem RETAIL FOOD - Food Establishment Inspection HACCP: ❑ Item Status Violation Critical Urgency Telephone: Violations Related to Good Retail Practices (Blue Items) 978-741-0295 Food and Food Protection FAIL Critical BLUE Owner: Comment:Walk in refrigerator has a temperature of 50°F. Refrigerator must be maintained at 41°F or below as mandated.Unit not Victor J. Rodriguez I to be used for storing any potentially hazardous foods until door is fixed. PIC: Victor Rodriguez Equipment and Utensils FAIL BLUE Inspector: John Gehan Comment: Back storage shelf has bare wood. All shelves need to be made smooth and impervious.Shelves to be completed by Date Inspected:Correct By: next routine inspection. 6/6/2007 Risk Level: GENERAL COMMENTS: All remaining violations to be corrected by Friday June 8, 2007. Permit Number: BHP-2007-0064 Status: SIGNED OFF #of Critical Violations: I 1 Time IN: Time OUT: Urgency Description(s): BLUE: Violations Related to Good Retail Practices (Critical violations must be corrected immediately or within 10 days)(Non-critical violations must be corrected immediately or within 90 days) City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741-1800 GeoTMS®2007 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Jun 08,2007 ) Page 1 oft Item Status Violation Critical Urgency RED: Violations Related to Foodborne Illness Interventions and Risk Factors (Require immediate corrective action) City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741-1800 GeoTMS®2007 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Jun 08,2007 ) Page 2 oft 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 Tyree of Ooeration(s), Tyge of Insoaction 1%/(/7///) l 1-711 1 ice,w -7�2�� 7 I ❑ Food Service ❑"Routine Address ' ' 7 Risk` El-Re-tail ❑ Re-inspection 12LI Level ❑ Residential Kitchen Previous Inspection Telephone �� 7L//_ n� y(_ El Mobile Date: Owner HACCP Y/N I [I Temporary ❑ Pre-operation ),r t ,r 17 ari ,< , o ❑ Caterer ❑ Suspect Illness Person in Charge(PIC). _ Time ❑ Bed& Breakfast ❑ General Complaint In: ❑ HACCP Inspector ? �� i£ I Out: Permit No. El 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; [112. Prevention of Contamination from Hands ❑ 1. PIC Assigned/Knowledgeable/Duties Q453• 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 ,.„ , ,.Y_ ........ . ... .. . ❑ 15.Toxic Chemicals FOOD FROM APPROVED SOURCE,_--','. ❑ 4. Food and Water from Approved Source TIME/TEMPERATURE CONTROLS(Potentially Haiirdous 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 PROTECTION FROM CONTAMINATION ❑1'y hlot and Cold Holding ❑ 8. Separatio11 n/Segregation/Protection ❑20.Time As a Public Health Control Q 9 Food Contact Surfaces Cleaning and Sanitizing REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(NSP) ❑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 x 23. Management and Personnel (FC-2)(590.003) by a Board of Health member or its agent constitutes an order of the Board of Health. Failure to correct violations . Food and Food Protection (FC-3)(590.004) cited in this report may result in suspension or revocation of ,i 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 v 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 5901nspectForme-14 d. Inspector's Signature: y) Print:�r 7 PIC's Signature: U, -A'r-m Print: Page oflPages Violations Related to Foodborne Illness Interventions and Risk Factors(items 1-22) PROTECTION FROM CONTAMINATION FOOD PROTECTION MANAGEMENT 18 Cross-contamination I 1 590.003(A) Assignment of Responsibility* 3-302.1](A)(]) Raw Animal Foods Separated from 590.003(B) Demonstration of Knowledge* I Cookedand RTE Fords* 2-103.11 Person in charge-duties I I Contamination from Raw Ingredients 3-302.11(A)(2) Raw Animal Foods Separated from Each EMPLO"EE HEALTH Othcr" 2 590.003(C) Responsibility of the person in charge to I Contamination from the Environment I require reporting by food employees and 13-302.11(A) Food Protection` I applicants* 3-302.15 Washing Fruits and Vegetables _ 590.003(F) Responsibility Of A Food Employee Or An l 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(0) Repotting by Person in Charge* I 13-306.14(A)(B) I Returned Food and Reservice of Food* 13 590.003(D) Exclusions and Restrictions* I I Disposition of Adulterated or Contaminated 590.003(E) Removal of Exclusions and Restrictions 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 I 590.004(A-B) Compliance with Foal Law* I 14-501.111 Manual W'arewashine-Hot Water 13-201.12 Food ma Hermetically Scaled Container* Sanitization Temperatures* 13-201.13 Fluid Milk and Milk Product;* I .-501.112 Mechanical Warewashina Hot Water 13-202.13 Shell Eggs* Sanitization Temperatures* * 14-501.114 Chemical Sanitization-temp.,pH, 13-_02.14 Eggs and Milk Products.Pasteurized I concentration and hardness. ,t 13-202.16 Ice Made From Potable Drinking Water" I 5-101.11 Drinking Water from an Approved System- 4-601 t I(A) Equipment Food Contact Surfaces and Utensils Clean` 590.006(A) Bottled Drinng Walcr* ki 590.000(B) Water Meets Standards in.310 CMR 22.0* i 14 602.21 I Cleaning Frequency ofenEquipmentFood- 590.000(B) Surfacxs and Uttensills*s* Shellfish and Fish From an Approved Source I 4-702.1 1 Frequency of Sanitization of Utensils and 3-201.14 Fish and Recreationally Caught Molluscan I I Food Contact Surfaces of Equipment* _ Shellfish* 1-703.11 Methods of Sanitization-Hot Water and 3-201.15 Molluscan Shellfish from NSSP Listed I Chemical* Sources* Game and Wild hfushrooms Approved by 11® I Proper,Adequate Handwashing I Regulatory Authority ( 2-301.11 Clean Condition-Hands and Arms 3-202.18 I ShellstockIdentification Present" 2-301.12 Cleaning Procedure* ---� 590.004(C) Wild Mushrooms* I 2-301.14 When to Wash* I Ill Good Hygienic Practices i3-201.17 Game Animals* I I g ReceivinglCondition 2-401.11 Eating. Drinking or Using Tobacco* 3-202.11 I PHFs Received at Proper Temperatures* 2-401.12 ( Discharges From the Eyes, Nose and 1 Mouth*3-202 1 I Package ity" I . I Preventing Contamination WhenTasting,* 3-101.11 Fcwd Safee and and Unadulterated* ( � 3-30112 Pti °�CiiWhI 16 I I Tags/Records:Shellstock ( 12 Prevention of Contamination from Hands I 13-202.18 I Shellstock Identification * I 1590.004(E) 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 Conveniently Located and Accessible 13-402.12 I Records,Creation and Retention* I 15-203.11 Numbers and Capacities* Ingredients* 15-204.11 Location and Placement* I 590.004(J} Labeling g of In g - 17 Conformance with Approved Procedures 5-205.11 Accessibility.Operation and Maintenance____I i IHACCP Plans Supplied with Soap and Hand Drying 3-502.11 Specialized Processing Methods'* I Devices 13-502.12 Reduced oxygen packaging,criteria* 16-301.11 Handwashing Cleanser,Availability I 8-103.12 ( Conformance with Approved Procedures- I 16-301.12 Hand Drying Provision °Denotes critical item in the federal 1099 Fowl Code of 105 CI 12590.000. CITY OF SALEM / BOARD OF HEALTH Establishment Name: Date: -11-2167 Page: Z. of Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date No. Reference R—Red Item Verified PLEASE PRINT CLEARLY (�/n I I' ILZL wG c u Azi_IA /h avii I A41', /G!a Yo tZ t s'C of S `/`/-- t/n, pdZ �r or h-��orJ AS `YIOhI�b-fCGr I r I �� g !/Ji.7l7✓f�! �7��r�t inlh �/ ,SOe-ad i i ISP�(/✓� G/ .y✓ ✓CvInt— �oG V' , ((k Is/((J - tti "JaIIL lr, iii✓nd W,I GSCeCIVYI ✓ e dt L F I 1V" pdxbr-� S _ �nrr.�,tc �n r , G&L " nI,/X SAnGku VA-) eS ak+,er �a�. lA uz-e 1 a /� � � Shelves IG bae (i 1\dkoAI 'IC i2_.VV\ bjPr�ns rice 142 �.e 51&w / bAv? we�do�. 51�. (voS 4n %9-e 1m �1e✓JtIoJS_ l Discussion With Person in Charge: Corrective Action Required: I ❑ No I LI tea d I have read this report, have had the opportunity to ask questions and agree to correct all ❑ Voluntary Compliance ❑ Employee Restriction/ r 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 E noncompliance may result-in daily fines of twenty-five dollars or suspension/revocation of ElEmbargo ❑ Emergency Closure t your food permit: /jt�� ❑ Voluntary Disposal ❑ Other: n "Cl PHFs Rer,eived at'tempernures Violations Related to Foodborne illness Interventions and Risk According to I.am Cool,(I to Factors(items 1-22) (Cont.) 41`Ft45"F'Within 4 Hours- " PROTECTION FROM CHEMICALS I ?-`::!1 15 Cooling Methods for PHFs lA Food or Color Aad,tives 19 PHF Hot.and Cold Holding 3-50 6W) Cold PIlr,Mianodnedat(it be! w 3-20"2.12 Additives'i 1 c' 590.001+'F) 41`,'45'1" 3-302,14 Protection Bram Unapproved Additive}' 3-5(it.l b(A1 I'•+t Ph F.Aiaurtai[ied at or above j 15 Poisonous or Toxic Substances 7-1ULI1 Identifying lntnnnanion-original i 4-5:11161Roasts fic!d at un ab,w ," ! ( ) e )3:-F. Containers' 7-102.11 Compton Name - Working Container," `0 Time as a Public Health Control i 3-561.10 Time a,a Pubic Health Control* 7-201.11 Separation-Storaee` 7-202 i t Restriction-Presence and Ute ( 5<)6.p(t_:(I-1) Variance Rrciuircn,:ent 7-202.11 Conditions of Use' 1 7-203.11 'toxic Container,-F'r:dr,ionions* REOUIREMENTS FOR HIGHLY SUSCEPTIBLE „ POPULATIONS'HSP) 7-11,04.1 t ( Sanitizer,,Criteria--Chemicals^ 20 !, , I I21 3-80111(A) L§illi:4eurizedPre-packagedhnices and 7-204.1_ Chemicals for Woshmg Produce,Crit:ria` Beeeraees with Wa-t i m nE I.abcl; 7 204.11 Incidental Fos.Criteria' 3-nOl.l it B) Use of Pasteurized Lies* 7-205.11 Incidental Fomf Contact. Iubrican±s" ( 3.cG 1.1 i(U) Raw or Pantnally Cocked Animal Food 4nd 7-206.11 Restricted Use Pesticides.C'ritcrrn* Raw Seed SProu±s Not Served. 7-20612 Rodent Bait Stations` 13-901 I liC) Unopened Fioxl Package Not Re-served " 7-206.13 'I'r:cking Powder, Pest Control and ! Menitorin;t,' CONSUMER ADVISORY TIMEJTEMPERATURE CONTROLS 22 3-6')3.11 Consumer Adv,sory Pest,,d for Consumption of Aninnai Foous'llut are Rms,Undeteis-ked or (6 `•`• Proper.Cooking Temperatures for PHFs Not Odxrwoe Processed to Eliminate i 3-40!.I1A(1)(2) Eggs- 155`F15See. Pathe,,ens a Env-,,, ",Pan Eggs immediate Service 1,15"Fifisec* 3-302.13 Pa.,te sized Egg=Substitute for Raw Shell 101.11 W(2) Comminuted Fish,Meat.&Game i Eger" Animals- 155"F 15 sec. ` SPECIAL REQUIREMENTS?-401 Por 3-4o 1.1 1I(A)(?) Ratites,Injected Meats- 155°F 15 . 1(Bhl)(1) Rial and Beet Roast - 130"'F 727 min* 59f)_(109(A),'D) Violations of Section 590.009(A)-(D)in --- sec. catering mobile food, temporary and 3-4131.!1(A)(3 n 1'oultrv,Wild Game, Stuffed PHFs, residcntaal kitchen operations should be Slum ne Containing Fish. ;Meat, - debiied under the appropriate sections Poultrvor Ratites-1e5oF 15.sec. above if related to foodborne illness 3-401.1I,C`(3) Whale-muscle,intact Beef Steaks interventions and rtsk (actors. Other 145"F I 590.009 violations relating to good retail 1-=401.12 Raw Amm;il Foods Choked in a practices should be debited under#2.9- Microwave 165`1 " Special Requirements. 3 401.11(A)0 tib) All Other PHF,- 145"17 15 sec. 17 Reheating for Hat Holding ( VIOLATIONS R2"T€D TO GOOD RETAIL PRACTICES 3-403.1 1(A)&(U) PHFs 165°F 15 sec, :,- ( (items 23-30) 3-403.!I(B) Microwave- 165°F 2 Mum::Standing Criu,,d and non-critical violovv;is, which da not relate h)the Tnne* Jondhnrne illness irvcrvunnens uod risk ftit oOrs listed abort can be 3-403.11(C) Commercial k Processed RTE Food- jound iu ection.s u('he F a,d Cow a,zd 105 CMR 1.00. 3-403.i 1'E) Rennaming ( Item Good Retail Fractices FC 5,90 000� Unslsced Portions ni'Bcef Ron sts* 23. Management and Petsonriel FC-2 X03 I iS ( Proper Coaling of PHFs 24. Foot'and Food Protection FC--3 004 25. Equtcanerit and Utensils Fr-4 005 3-501 14(A) Cooling Cooked PHFs from 140`F to 26 tstater, Ph:rnbm4 and`Ness FC_5 .006__J 7017 Within 2 (lours and From 70'1 1 2l. Physical Facili;y F(-,--- 6 007 u,41"Fl45FW,ihin4Hours. '1 126. Poisonous or Tnxic Malenals FC -7 ', .008 j 3-50t,I4(H) Cooling PHF:,Masse From Ambient 1_29 Saecia;Requirements 009 Tempetature Ingredients to 441Fl4i'F 130. Other Within 4 Hours* i -Denote;apical item u)ihr Gkler.L 1999 Fond t-ude,n 1 i)5 CMR 50)O(100. ' 1 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 L �V\1 2ftn Io"1 � o � vs:2 `lro Lo c.3 �D �2 IMG I r1l(I l VV_et c(e. 1 -/5 G ✓�., � sc�. l� V\lnS ciccUl.,.��1� � r ,. ..atlas 0� s lw} er• Tlnc�aovc � " ( cLta n AmcP SrAvtl6?.e kC✓ Q( r,� SSP I / T5/oy-\k Ice CVIGvv\ freao1✓eS 'ISR hR✓a, Cl{Gnln� . (ter \ y� 1 / 2q �. .S DIIa7-r v, nP cNS S (/�.CV.e l7n 1Ut- of � T I�-t S''�L Iv�S Ave � 1 I 1 . / 3 �G•�v c7or.-. Y\G �11b(D c,(--2.@.i '1-() v'j s _ V4-0'.i 'C Le W-C � S /�� / 3 ( _ � � �ln ✓�r, rr1 �� S °v� o Soc� � . .7 {o� tcl.e Soa'� • 1 � I 1 ,/ L. �1n2 b� ✓vor� slhk wti lev ?t'essvice 1 Q �� vlw�elti 1otiv. r n lon'r 1 x I r Discussion With Person in Charge: Corrective Action Required: I LINo ❑ 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 L3 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. ,/) D I/°l 60 CJ ❑ Voluntary Disposal 0 Other: r ,h 3-5'f1 la:. PHF,Reserved at'Penmeratures Violations Relined to Foodborne fitness Interventions and Risk Accorclory to Law Coiled to Factors(Items 1-22) (Cont) i 41`F7-'45'F Within,l Hrnus. .3-501.i 5 i Coo'.an!Methods for PFL�s PROTECTION FROM CHEMICALS 1 19 PFIF Hot and Colic Holding 1.1 - Food or Color Additives ! 3-501.16(E) Cold PHFs M:nmtmned at of below I i-2J'.12 Additivcs'r 590.t,0.1i F) 41l i,I5°F" 3 '302 14 Protection from Gnapprov:d Atlditives" ?-501 16(Ai lir. z- 15 Poisonous or Toxic Substances Hint P.1Fi lvo:intained at or above 7-101.11 ldcntifying Inforuwt:on-Original 3 Roasts i ^• 140'F. ' Contame-rs` .7(i1.16t.=,; Hcid at or above I'03F. 7-102.11 Common Name -Workinf Containers` 120 Time ac a Public Hezlfh Control 3-501.19 Time as.I Pubic Health Contr,,I* l 7-201.11 separation-Stouter°, i t r 590 OD4iH) V,nance Requirement 7-2J2 11 Restriction-Presente and Use ! - 7-202.12 Condt6ons of I:sc" 7-203.11 Toxic Container,-Prohibitions"' REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-204.11 Senidzers,Criteria --Chemicals* POPULATIONS(HSP) 7-204.12 t - �... , 1 21 ! 3-`801.t 1(A) Unpasrenrized Prc-packaged Juices and Chemicals for hacnma 3„x ice,Criioric 7-204.1=4 DrYiugAkents.Crnerin:r I iBeverageswnhWarmineUibels* - > 7 :.OS 11 „tcidcnf ai Fond Contact.Lubricams* :-"X)J,1(B) tJseu:`PasteurizedEggs* 7-206 I I Restnete:t lice Pesticides.Criteria' I3-i;0!.II;D) Hate orPirtiillyC'cv. 'vdAnimalFood and 7-206 12 Rodent Ban Stations" Raw Decd SI1r6ttiS Not Sere ed. # ?-801.11(C) Unopered Foci Pac�age N•.,!Re_Se-,Ned. " 7-2(16 13 I'racl:ing Powders, Pest Control and j - -- ivkmitorinp CONSUMER ADVISORY TIME/TEMPERATURE CONTROLS 22 3-60', I I Consumer Advisory Posted for Conenmption of Animal Foods`(hat are Raw.Undercooked or 1F 1 Proper Cooking Temperatures for PHFs Not Omerwme Processed to Elitmnate i I den�c r-;;om 3401.11 A(I)(2) Egg<- 155"F 15 Sec. i Pathu_^ens.* -- Eggs- bamedin!c Service I••}5"F15,ec'r =-=02.1? ft steuved Eggs Substitute for Raw Shell 3-40 1.11(A)(2) ComminutedFish, Meat.&Game FQ48W Animals- I55'F 15 ;:ec. * SPECIAL REQUIREMENTS 3-401.11(B)t 1)(2) Park and Beef Roast - 130"F 121 min* 5g0009iA)- D': 7 < .. 3-401.1 I(A)(2) Rants . , Injctted Meats- 155'F IS ( Violations of Section 590 009(A)-(D) in sec. * catering. mobile"o-cid,terrfpiaiu i and -401 1 I(A)(3) Poultry,Wild Game,Stuffed PHFs, residential kitchen operations should be Ctuffing Containing Fish,Meat, debiled tinder the appropriate serf ions Poultry or Ratite.-16:5"F 15 sec. above if related to lbodborne :Ilness 3-401.11(0) 3) \Whole-muscle,Intact Beef Steaks interventions and risk factors. Other 145"F* 590.009 violations relating to good retail F-401.12 Raw Animal Foods Cooked in a practices should be debited under 4`29- Microwave 165'F* Special Requirements. 1 ?-d01 A I(A)0 0) All Other PHFs- 145,I- 15 sec 17 Repeating for Hot Holding VIOLATIONS R,"LA'f-ED To GOOD RETAIL PRACTICES I ;-4113.11(.-1Q&(D) PHI�s 165'F 15 sec. * Means 23-30) 3-403.11(8) Microwave- 165` F 2 iMinute Standin-, Criv<,d will non-rrirhwl viotu!ffnm w1n,n do wir felrte!o the Time' I foodborne illness wrervrxion•s and risk fit,torts ltaval ainm,e, (cite he: i3-463.11(C) C'nmmerciaily Proce.sed RTE Focal- (enmd it,the f llmi ing sertions er!ke Fond('gide ane?105 011? i40'F'r 590.00(. 3-403.11(k) Rzmaining Unslieed Portions of Becf I ! item Good Retail Praeti•-es FC - 15Sawo F oasis" ( 23. _ Managemr,t and Pe:sonne! FC-2 _.003 18 Proper Cooling of PHFs 24 Food and Food Protection FC-3 1 .00a I 25 cgmpment aur,'I tensia FC--4 ,005 3-'501.14(A) Cooling Cooked PHFs from 140`1-to n; Weser Fkfmbinq a::d Vlaste =C-r .008 '10'1'Within 21lours and From 70"F I 127 Pnvsical Facihty FC-6 007 f to 41°F/45"F W itttin 4 Hours. 1 ?8. Pcfsonous cx Toxic Ialaleria!s FC-7 !-_008 ? 501,14(B) Cooling PHFi,Made From Ambient i 29, Special R=owrernoras .p09 Tempetatcre ingredients to 41°17/45)`F 30, Other Within 4 flours^ •„tier, r:a•.z oa i ^D0UACS:nuc:tl i'em m fits titfa'al 19119 Ford Pude or 105 C\llt 59'1 OW, Massachusetts Department of Public Health Salem Board of Health Division of Food and Drugs 120 Washington Street,4th Floor 9 Salem, MA 01970-3523 FOOD ESTABLISHMENT INSPECTION REPORT Tel. (978) 741-1800 Fax(978) 745-0343 Name11 / Date Tyge of Ooerationfsl, Tyge of Insoection ��o C (o v o c+ 71Ib 67 0<Fo'od Service ❑ Routine Address �� 7 S�_ Risk El [ Retail ?Re-inspection i Level ❑ Residential Kitchen Previous Inspection Telephone !� ' ElMobile Date: Owner e_1 -7 a- _ -7 '41 - 92 i HACCP YM ElTemporary E] Pre-operationL/t �. Fv✓ 120 Ciln.�h.- ❑ Caterer El Suspect Illness Person in Charge(PIC) Time ❑ Bed&Breakfast ❑ General Complaint In: ❑ HACCP Inspector Je_7 Nrl C? e-1 fAII.� 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 ❑ 12. Prevention of Contamination from Hands ❑ 1. PIC Assigned/Knowledgeable/Duties r ❑ 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 El.. .. ...... . ... .. . .... ......... 15.Toxic Chemicals FOOD FROM APPROVED SOURCE. - " E] 4. Food and Water from Approved Source 11MElTEMPERATURE 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 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(ASP) ❑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 C� 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 rrf 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)(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. �J 30. Other DATE OF RE-INSPECTION: S 5WM,edFoi 14 Inspector's Signature: Print: -,7p *J (7 P f� y / PIC's Signature: ('JJ k!j A/ dl,llkylj-.ir--- Print: T Page( of?_ Violations Related to Foodborne illness Interventions and Risk Factors(items 1-22) PROTECTION FROM CONTAMINATION FOOD PROTECTION MANAGEMENT 18 Cross-contamination I 1 590.003(A) Assignment of Responsibility* 3-302.11(A)(1) Raw Animal Foods Separated from 590.003(3) Demonstration of Knowledge* C(x)ked and RTE Foods* 2-103.11 Person in charge-duties 1 Contamination from Raw Ingredients 3-302.11(A)t2) 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 repotting by food employees and 13-302.1 HA) Food Protection" f applicants* ( 3-302.15 Washing Fruits and Vegetables 5901003(F) Responsibility Of A Food Employee Or An 3-304.11 Food Contact with Equipment and Applicant To Report To The Person In UtensilSM Charge* Contamination from the Consumer 590.003(G) Reporting by Person in Charge* i 13-306.14(A)(B) Returned Food and Reservice of Food* I 590.003(D ExclusionsandRtstrictions* -- ._ 13 ) I I Disposition of Adulterated or Contaminated 590.003(E) ( Removal of Exclusions and Restrictions ( Food 3-701.11 Discarding or Reconditioning Unsafe FOOD FROM APPROVED SOURCE FOO& 4 Food and Water From Regulated Sources 19 Food Contact Surfaces 590.004(A-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* 14-501.112 Mechanical Warewashiva Hot Water 3-202.13 Shell Fggs* _ Sanitization Temperatures* 3-202.14 Eggs and Milk Products.Pasteurized* 4-50L 114 I Chemical Sanitisation-temp.,pH. 3-202.16 Ice Made From Potable Drinking Water* concentration and hardness. 4-601.1 I(.A) Equipment Food Contact Surfaces and 5-101.11 Drinking Water from an Approved System' Utensils Clean^ 590.006(A) Bottled Drinking Watar* I 4-602.1 l Cleaning Frequency of Equipment Food- 590.006(B) Water Meets Standards in 310 CMR 220" I Contact Surfaces and Utensils=` Shellfish and Fish From an Approved Source I 4-702.11 Frequency of Sanitization of Utensils and 3-201.14 Fish and Recreationally Caught Molluscan Food Contact Surfaces of Equipmen 3-201.15 Molluscan Shellfish from NSSP listed t* Shell ( 4-703-11 I Mcthods of Sanitization-Hot Water and scaChemical"' Sources* 10 I Proper,Adequate Handwashing Game and Wild Mushrooms Approved by Regulatory Authority 2-301.11 Clean Condition-Hands and Arms"` 13-20218 I Shelistock Identification Present* I 12-301.12 Cleaning Procedure* 590.004(0) Wild Mushrooms" 12-301.14 When to Wash" 3-201.17 Game Animals* I it ( Good Hygienic Practices g Receiving/Condition 2-401.11 Eating,Drinking or Using Tobacco* 3-202.1 t PHFs Received at Proper Temperatures' 12-401.12 Discharges From the Eyes,Nose and Mouth* 3.102.15 Package integrity* I 3-301.12 Preventing Contamination When Tasting* 3-101.11 I Food Safe and Unadulterated* I g g I 6 Tags/Records:Shelistock I 112 Prevention of Contamination from Hands 3-202.18 Shellstock Identification ' 590.004(13) Preventing Contamination from 3-203.12 Shellstock Identification Mamtained" Employees* 113 I Handwash Facilities Parasite esti Fish Products I I Conveniently Located and Accessible 1302.11 Parasite Destruction' � 3402.12 Records,Creation and Retention* I 15-203.11 Numbers and Capacities* 590.004(7) Labeling of Ingredients' I 5-204.11 Location and Placement* 7 I Conformance with Approved Procedures I I 5-205.11 Accessibility.Operation and Maintenance /HACCP Plans I I Supplied with Soap and Hand Drying 3-502.11 Specialized Processing Methods* I Devices 3-502.12 Reduced oxygen packaging,criteria* I 16-301.11 Handwashing Cleanser,Availability 8-103.12 Conformance with Approved Procedures* I I b-301.12 Hand Drying Provision � *Denotes critical item in the federal 1999 Pond Cale of 105 CMR 590.(100. CITY OF SALEM BOARD OF HEALTH r Establishment Name: ( mt c�i 116 t_ �-r v aa-4 y Date: 111'6 /6-7 Page: �_ of Z Item Code c-critical nem DESCRIPTION OF VIOLATION/PLAN'OF CORRECTION Date No. Reference R-Red Item Verified PLEASE PRINT CLEARLY _14(// (ec -7/2- A /I A VO UZtw— � I I 1 ' I 1 I � k d r I Discussion With Person in Charge: Corrective Action Required: I C] No ❑ Yes I have read this report, have had the opportunity to ask questions and agree to correct all ❑ Voluntary Compliance ❑ Employee Restriction s violations before the next inspection, to observe all conditions as described, and to Exclusion y 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. � 1G. ❑ Voluntary Disposal ❑ Other: -)Oi.7•r:f-; FHFs Received at-[emperatures Vialabons Related to Foodbotne fitness Interventions and Risk According to law Ceoled to Factors(items 1-22) (Cont) =11`R-15 F Within 4 Hnnr;. " PROTECTION FROM CHEMICALS 3-^W,;15 Cooling,Methods for PHF� j 1? PHF Hot and Cold Holding ood J-20'.12 A�iihti Jed` IA I ddi or Color Additives 3-50L W13) Cold PI-I Fs Mauitain.d at or below 591W,04tF) 4!`/'5.1'1:" 3-302.14 Pnflccaon hunt Cnappmi'Cd Additrvee'� 3-5A,INA) Gn' PHF;Maintainedatorabove 15 Poisonous or Toxic Substances 14it F ' l 7-10(.11 idemlf}ing.lricrm,n:un-tluginal loulatnere:: � 3-501.I6(:\; Roasts Hcld '.+t Vr above !_l0'P. " <`C i Time as a Public Heath Control 7-102.11 Cuinunm Nawc-Workin;;Container,'" ( ! 7=_'01.1] Se t+ a ton-`;torn�t': i j-507 Iq Thur as a Public H-alth CuateW t+t..0 ( i )90.00111HI Variance Regaremc:n 7-202.11 Restriction-Pmsencc and Uie' 7-202.12 CunditionsofUse 1 7-203.11 Tonic Conttuncrs-Pruinhit;ins"' REQUIREMENTS FOR HIGHLY SUSCEPTIBLE : 7-204.11 Sanitizers,Criteria -Chemicals° POPULATIONS(HSP) '7-104.12 Chemicals for Washmc Pt oduce,Cnt:aia"' I I ZI 1 3-6011 I I(A; Uapesn•urixed Pre-packaged Juices and ' Beve:a2es with Warnrne Iabeli* 7-20=1.t+ Di 0n, Vg nls.Cnteriar i 7-205.11 Incidemai F.,c•d Contact. Lubnr,m+:' 3-SL:i(B) Use ofPasteunzeaELgs^ - ; 3-801A I(D) Rau or Pat ballvCooked.\nimal Food and 7-'_05.11 Restricted Use Pesticides,Cnteria* Ra,o Ged Slxains Not Sc:ped. 7-2-91".12 Rodent Hart Staiiuns°' _i-KOLII;C.) Unglued Pax{Pack.us•N:v Re-served ' , 2u6.1% Trecking Puwdec:,Pest Contrul and ' 11rnitcrin;" j CONSUMER ADVISORY TIME/TEMPERATURE CONTROLS 22 3 603 11 Consumer A(h'+sor;Pasted for Cois;unifrtion of 16 Proper Cooking Temperatures for I Anhnal Fuods'I'llat ate R:w,Undcro,oked of PHFs Not Oth: rwise Processed to Elhmnate. 2noovc,:r,-nc. 3-401.!1A(U(2) Eggs_ I55`F 15 Sec. I Patha;;ens.` 3-302.1 j Paateutized F.g Substitute for Raw Shcll Eggs Jnr.cdiatc Sen-,ce Itis"F15sec" -'' 3-401.11-(A)(2) Comminuted Fish,Bleat< Ak Gine Egg'* .Animals- I i5'17 15 sec. ` 3-401.11(B)t1)(2) Park and Beef Roast - 130,F i21 nun* SPECIAL REQUIREMENTS 3 401.11(A)t2i Rautcs,Injected[vleats- 155°F 15 590.009(a40) Violations of'Section 591.009(A)-(I)) in sec W catering. mobile ftxxl,temporurr acid 3-461.1 ;(A)(3) Poultry,Wild Game,Stuffed PHFi, resider:tial !citchen operations should be Stuffing Cuntanung Fish, Meat. debitco ander?lie appropriate sections Poultr-or Ratites 165°F 15 sec. above if related to foodborne illness 3-401.1I10(3) 4Yhole-muscle, intact Beef Steaks inicrventiors and risk factors. Other 145°F* 590.17)0%) viclat:Ows relaLing h)good retail Rau Anonai Foods rooked in a itactices should be del-,;ted under 2129- blicruuaee 165`F* `.pedal Rcquirernents. 1=101.1 d(A)(10) ',It Other PEIFa- 1145'F 15 zec. '^ 17 Reheating for Hot Holding VIOLAVONS RELATED TO GOOD RE;/1L PRQCFICES 3-403.11W&(Dt PHFs 165'F 15 see. x, (11errtc 23-d®) i3-403.11(B) Microwave- 165' F 2 Mouse Standing C;hrcal and non-crit3ral vmlaror.i, n'Lich do,rot,elate to Nuc t Tine* hlodbnnu ilblesi 611rrruihnn.•:uad,is.k,,It ;,v 7Wed ahnve, eriR be, 1 ;-403.11(0) Canniercialk Peocesscd RTE Food- /rnnal rr tl:e j'otfowi»x sertions of the Fuad C'odc,oud 705 CAJR !40'Fr ' 190.00;0. 3-403-i I(L) Rentainin, linchced Portions of Reef ( Item Good Retard Practices FC 590.50G Roasts* i 23. tvlar:agement and Personnel ; rC-2 .003 18 Proper Coaling of PH'rs 24 Foort and Fax)Protection. PC-3 004 25. Equipa-,ent snd utensils j FC-4 005 3S01 14(,1) Ccwling Cooked PHPs front 140°P to : 26. )Mater, Pb.:rnbine and Waste FC- 5 .006---� 7o'F Within'2 Hous and From 70°F 27. PhVsical FacihlV FC - 6 C-07 to 41'F/45'F Within 4 Hours. ` % 28. Pusenous or To* Malerlalr• FG--r .008 3-50!.!4(B) Cooling PHFt,Made From Ambient 29. Special Requirements ( 00g I Temperamtedngredicntstodl`'F/di"F 30. Other _---- 1 Within 4 Hours r ::•.,,..,�,,,.,.,.u. Denman cnucal itun m the rale,.:; ;499 Fund Codo or HIS CNIX 591)000. CITY OF SALEM BOARD OF HEALTH Name of Establishment: Castillo's Grocery Address: 24 Palmer Street Owner(s): Victor Rodriguez Phone: 978-741-0295 Date: December 5, 2006 The brother of the owner of this establishment, Vincento Rodriquez, appeared to discuss the November 22,2006 hearing that required a cease of all meat-cutting operations at this establishment. Ward 1 City Councillor Lucy Corchado, Health Agent Joanne Scott, Inspector Pablo Valdez, and Senior Sanitarian Janet Dionne were also present. The Health Agent discussed the repeat critical violations observed by the Board of Health on several of the previous inspections. These include lack of access to the hand sinks, improper cleaning and sanitizing of the meat cutting instruments, lack of sanitizing of other utensils, improper temperatures in the refrigerator and freezer units, outdated food items, and lack of proper cleaning of the premises and equipment. Mr. Rodriquez has agreed to become a Certified Food Manager. Mr. Rodriquez also understands that the meat cutting process is not permitted . The meat cutting room must remain dismantled. All meat products must be purchased from a Wholesaler permitted by the State. Meat must be purchased pre-cut, prepackaged, with labels already placed stating the kind of meat, the weight, the sell by date, and the wholesaler's name and address. The Board of Health will re-evaluate this establishment for re-permitting the meat cutting process, if after six months all other critical violations are not observed during inspections and re-inspections and Mr. Vincento Rodriquez is Certified. Mr. Rodriquez was given the opportunity to ask questions and stated through the interpreters that he understood the discussion about the violations, their seriousness, and the restrictions placed on this establishment. tctt 5--e � de(a—nne Scott Date Health Agent 1 � Vincento Rodriquez , Owner's Representative Date "J Pablo Valdez, Translator Date tw 'a CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH 120 WASHINGTON STREET,4TH FLOOR SALEM, MA 01970 TEL, 978-741-1800 Fax 978-745.0343 Kimberley Driscoll www.SALEM,COM Mayor .JOANNE SCOTT, MPH, RS, CHO HEALTH AGENT 2007 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT NAME OF ESTABLISHMENT f0A S-Tp l-L b U I�OGG iZ TEL# ADDRESS OF ESTABLISHMENT a H ?AL m eA S T FAX# MAILING ADDRESS (if different) ,ft �b`t1, EMAIL--Business-': Owner's: V � Y1 966_f—_f 11 b V tai tcA U e-Z„ OWNER'S NAME diti-2OSS DCtR12'u-k z' TEL# ADDRESS 2 $ SALem ST SALe'yvl -M IQ-- o STREET e /1 �j �j CITY STATE ZIP CERTIFIED FOOD MANAGER'S NAME(S) V t tTe tC (7 'f�6 t &LOL 1- CERTIFICATE#(S) T e1 5 S 3 61 f q (Required in an establishment where potentially jhazardous food is prepared) !� EMERGENCY RESPONSE PERSON _ A V4 4—L A y -A u- HOME TEL# 't 7 t' 1 `114 -919 -3 LSA-rfoLINA CAS-riLLO C11%- -14114 1- DAYS OF OPERATION Monday Tuesday Wednesday Thursday Friday Saturday Sunday HOURS OF OPERATION T A I-A '"I A M -1 A M `-I A Y1'1 `Z A-M A YE'( "14 M _ Please write in time of day. (for exampleftam-11om1 ( I 11 �►� { { I� M I { I�'Yf 1 1 I ?-M I I Tim 11 ?m TYPE OF ESTABLISHWNT FEE (check only) RETAIL STORE YES NO less than 1000sq.ft. =$ 50 1000-10,000sq.ft. =$100 more than 10,000sq.ft. =$250 ...._........ .... .... ..._......_ ... - -... RESTAURANT YES NO _less than 25 seats $100 25-99 seats =$150 more than 99 seats =$200 - ---- YES NO--- .._. . ..... -._ ....__._. ...--. .. - - $1-60- ... ....---- -_..._. --- _ BED/BREAKFAST ----------------------- ----- ----- ...- ...... ...... ...— ....._............---. ... -... ----. ...- ADDITIONAL PERMITS . ' MAKE (not just serve) ICE CREAM, YOGURT, SOFT SERVE ES.." NO $5 TOBACCO VENDOR YE $50 ALL NON-PROFIT(such as church kitchens) YE?-' NO $25 x: 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. 1*4407 /b � 04*3 - Signature Date Social Security or Federal Identification Number - - -- ---- ----- ---- ---- - - ----- -- - - -- -- - - ---- -- - - - - ct Revised 1 1/1 3/06 FOODAP 2007 adm Check#8 Date I;l I)I O(� 1V w,[ . ?'yI�&t4fleti. oe- J55?e 565-68 EXAMINATION FORM NO : 4006 ttn CERTIFICATION NO : 4552648 e' s -- T O VICTOR-3 RODRIGUEZ for successfully completing the standards set forth by the National Restaurant Association Educational Foundation for the ServSafe® Food Protection Manager Certification Examination, which is accredited by the American National Standards Institute (ANS 0—Conference for Food Protection (CFP). Presented by the National Restaurant Association Educational Foundation 9/22/2005 DATE OF EXAMINATION 9/22/2010 DATE OF EXPIRATION Local laws apply. Check with your local regulatory agency for recertification requirements. Wait Mary M.Adolf President and at Operating Officer National Restaurant Association Educational Foundation National Restaurant Association EDUCATIONAL FOUNDATION < ®2004 National Restaurant Association Educational Foundation www.nraef.org 03102301 v.0508 i mr 4 /4 W.N t,,• _IY �'f 4yr-A ..��y g0.gyf .'�a st 1}a� MSY, .!'HY(^-' 1��`P �M R _ i 'j4'YVC 3:10. iPfyU}, 3 6 'Nyui X'' td�w" .^J"Mf.'vM Y� ,ei .1�iglf*Y �/dEy, ..J + Ajh +Y.+"",q`. yb :� ?�' r. sCi of Salem. ,�y ,i..�=s i;�t � '�".s� ;•s��• „� •'h.. t ,+tom=; -°ib6;"!.P+i�L<. #.. t'�. �"i�5: ''A^ ��~ '-]`. �lt:.w�•i/,fl' .�s ,�^ ..,SS,f^ a +arr'.t - n.i. .::.Pe.:. A?. m--;.:v'..fx �.w�':-. p.,e. f y�'.�_.i .' ;�'f.�=`af .�3: • • x1,^'x '•' '....,��,c .,i:Boai'dofHealth i�:'.1;� 'stat�,..t,#�,.,�x.j�, �,::z ,�,yy � x. �: - ,_ ;'•� .- 120 W.ashiagtou Street,4th Floor � . .. _;�:.:,�•„<-�; `Kimbefley,Dliscoll :�;"s,�: SALEM,MA 01970 Food/Retail Establishment Permit DATE PRINTED: 12/19/2006 ESTABLISHMENT NAME: Castillo Grocery File Number:BHF-2004-000106 24 Palmer Street Salem MA 01970 LOCATED AT: SALEM, MA 01970 Permit Type Permit No. Permit Issued Permit Expires Fee Restrictions/Notes RETAIL FOOD BHP-2007-0064 Dec 19,2006 Dec 31,2007 $50.00 TOBACCO VENDOR BHP-2007-0066 Dec 19,2006 Dec 31,2007 $50.00 Total Fees: $100.00 PERMIT EXPIRES December 31, 2007 Board of Health gym .' 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 7 of 24 I CITY OF SALEM BOARD OF HEALTH Name of Establishment: Castillo's Grocery Address: 24 Palmer Street Owner(s): Victor Rodriguez Phone: 978-741-0295 Date: December 5, 2006 The brother of the owner of this establishment, Vincento Rodriquez, appeared to discuss the November 22-2006 hearing that required a cease of all meat-cutting operations at this establishment. Ward 1 City Councillor Lucy Corchado, Health Agent Joanne Scott, Inspector Pablo Valdez, and Senior Sanitarian Janet Dionne were also present. The Health Agent discussed the repeat critical violations observed by the Board of Health on several of the previous inspections. These include lack of access to the hand sinks, improper cleaning and sanitizing of the meat cutting instruments, lack of sanitizing of other utensils, improper temperatures in the refrigerator and freezer units, outdated food items, and lack of proper cleaning of the premises and equipment. Mr. Rodriquez has agreed to become a Certified Food Manager. Mr. Rodriquez also understands that the meat cutting process is not permitted . The meat cutting room must remain dismantled. All meat products must be purchased from a Wholesaler permitted by the State. Meat must be purchased laced statin the kind of meat the pre-cut, prepackaged, with labels already p g , weight, the sell by date, and the wholesaler's name and address. The Board of Health will re-evaluate this establishment for re-permitting the meat cutting process, if after six months all other critical violations are not observed during inspections and re-inspections and Mr. Vincento Rodriquez is Certified. Mr. Rodriquez was given the opportunity to ask questions and stated through the interpreters that he understood the discussion about the violations, their seriousness, and the restrictions placed on this establishment. anne Scolt Date Health Agent Vincento Rodriquez , Owner's Representative Date Pablo Valdez, Translator Date Massachusetts Department of Public Health Salem Board of Health Division of Food and Drugs 120 Washington Street,4th Floor 9 Salem, MA 01970-3523 FOOD ESTABLISHMENT INSPECTION REPORT Tel. (978) 741-1800 Fax (978) 745-0343 Name��/ // / I Date Type of Ooeration(s) Tyge of Insoection b �n//9 (� O /Qf'// //-2/Uro I 1 Food Service ❑ Routine Address /J�/ � • /�� , f Risk VJ, Retail El Re-inspection ,5 4 ux Level ❑ Residential Kitchen Previous Inspection Telephone id ❑ Mobile Date: Owner / ) / HACCP YM ❑ Temporary ❑ Pre-operation. M V 1/: �P, 7 (J(/ /�/(/°LZ I ❑ Caterer ❑ Suspect Illness Person in PIC Charge Time El Bed&Breakfast El General Complaint 9 (PIC) Time ❑ HACCPeyy -yeas /dam Inspector Out:4.4�m Permit No. ,Q"Other cckrt „rli�y Each violation checked requires an explanation on the narrative page(s) and a citation of specific provision(s)�atte. • rj 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 �• " •ti rt ❑ 12. Prevention of Contamination from Hands ❑ 1. PIC Assigned/Knowledgeable/Duties (-tYjl3. Handwash Facilities EMPLOYEE HEALTH 1 1. v.. •� T . _'_'__,.. . , -.. . _.' _ ,_.'_ ... PROTECTION FROM CHEMICALS' F-12. Reporting of Diseases by Food Employee and PIC ? N% , ❑ 14.Approved Food or Color Additives ❑ 3. Personnel with Infections Restricted/Excluded ❑ 15.Toxic Chemicals FOOD FROM APPROVED SOURCE__ , F] 4. Food and Water from Approved Source TIME/TEMPERATURE CONTROLS(PoteiNially 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 a d Cold Holding ❑ 8. Separation/Segregation/Protection 20.Time As a Public Health Control �]h 9. Food Contact Surfaces Cleaning and Sanitizing REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP),. 1 El21. Food and Food Preparation for HSP u 10. Proper Adequate Handwashing , ❑ 11. Good Hygienic Practices M+ .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 x by a Board of Health member or its agent constitutes an 23. Management and Personnel (FC-2)(ss0.0 order of the Board of Health. Failure to correct violations y 24. Food and Food Protection (FC-3)(590.0044))) cited in this report may result in suspension or revocation of 25. Equipment and Utensils (FC-4)(590.005) the food establishment permit and cessation of food 1 26. Water, Plumbing and Waste (Fc-s)(sso.00s) 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 50M�IFOn 14 doo Inspecto'r's/Sign Wa re•. Prml�:J, iU�Yr( , Mini w n ti/Elul,. PIC's Signature: Page_/ of Pages Violations Related to Foodborne Illness Interventions and Risk Factors(items 1-22) PROTECTION FROM CONTAMINATION FOOD PROTECTION MANAGEMENT i 8 i Cross-contamination 1 590.003(A) Assignment of Respomibility" j 3-302.11(A)(]i Raw Animal Foods Separated from 590.003(B) Demonstration of Knowledge' I Cooked and RTE Fouds* 2-103.11 Person in charge--duties I I ( Contamination from Raw Ingredients 3302.1 I(A)(2) Raw Aninud Fools Separated from Each EMPLOYEE HEALTH Other' 2 590.003(C) Responsibility of the person in charge to I j Contamination from the Environment require repotting by food employees and j 3-302.1 I(A) Food Protection` _ applicants* 3-302.15 Washing Fruits and Vegetables 590 003(17) Responsibility Of A Food Employee Or An 3-304.11 Food Contact with Equipment and Applicant To Report To The Person In Utensils' Chuget I I Contamination from the Consumer 590.003(G) Reporting by Person in Charge* 3-306.i4(A)(B) ( Returned Food and Resciroice of Food* 3 590.003(D) Exclusions and Restrictions* I Disposition of Adulterated or Contaminated 590.003(E) Removal of Exclusions and Restrictions j ( I Food 3-701.11 Discarding or Reconditioning Unsafe FOOD FROM APPROVED SOURCE Fonda' 1 A Food and Water From Regulated Sources j 9 Food Contact Surfaces 590.004(A-B) Compliance with Ford Law* j 4-50!.]11 Manual Warewaahma-Hut Water 13-201.12 Food in a Hermetically-Scaled Container* j Sanitization Temperatures* 201.13 Fluid Milk and Milk Products' I ( 4-50!.112 Alechanical Warewashing-Hot Water 3-202.13 Shell Eggs* j Sanitization Temperatures* 4-501.114 ( Chemical Sanitization-tem H, 3-202 14 Eggs and Milk Products.Pasteurized* j p.'P concentration and hardness. 3-2(12.16 Ice Made From Potable Drinking Water- j 4-601 11(A) Equipment Fond Contact Surfaces and j 5-101.11 Drinking Water from an Approved System* 590.006(A) Bottled Drinking Water* I Utensils Clear- 590.006(A) Water Meets Standards in 310 CMR 22.0* ( j 4-602'11 Cleaning Frequency of Equipment Food- Shellfish and Fish From an Approved Source ( Contact Surfaces and Utensilsl 3-201.14 Fish and Recreationally Caught Molluscan ( 4-702.11 Frequency of Sanitization of Utensils and Shellfish* I Fool Contact Surfaces of Equipment* -1-703.1 1 Mcthods of Sauitization-Hot Water and 3 20L15 Molluscan Shellfish hour NSSP Listed I 1 Chemical* Sources* ( P9 Proper,Adequate Handwashing Game and Wild Mushrooms Approved by Regulatory Authority 112-301.1 1 Clean Condition-Hands and Arens"' j 3-202.115 Shellstock Identification Present" I 1 2-301.12 Cleaning Procedurc* j 590.004(C) Wild Mushrooms" 12-301.14 When to Wash* 3-201.1 7 (lame Animals* I 111 Good Hygienic Practices j 5 I Receiving/Condition i 2-401.11 Eating,Drinking or Using Tobacco* 3-202.11 ( PFIFs Received at Proper'Ientperatures* ( 2401.12 ( Discharges From the Eyes, Nose and 13-202.t5 I Package Integrity- I Mouth'' 3-101.11 I Food Safe and Unadulterated* 13-301 12 { Preventing Contamination When Tasting* 6 j Tags/Records:Shellstock 12 Prevention of Contamination from Hands 3-202.18 j Shellstock Identification * j 590.004(F) Presenting Contamination from 13303 12 I Shellstock fdentification Maintained* I Employees* ( Tags/Records:Fish Products I 13 Handwash Facilities ( 3-402.11 Parasite Destruction" Conveniently Locatedand Accessible 13-402.12 Records,Creation and Retention* 5-203.11 Numbers and Capacities* 590-004(J) j Labeling of Ingredients* 15-204.11 Location and Placement* 7 I Conformance with Approved Procedures ( 5-205.11 Accessibility,Operation and Liaintenance /HACCP Plans I Supplied with Soap and Nand Drying 3-502.11 Specialized Processing Methods* Devices J 3-502.12 Reduced Oxygen packaging;criteria* j ( 6-301.11 Handwashing Cleanser,Availability 5-103.12 I Conformance with Approved Procedures` I 16-301.t2 Hand Drying Provision *Deno;e:criticid item in the federal 1999 Pond Code oc 105 C:NIR 590.000. CITY OF SALEM //'� / BOARD OF HEALTH r Establishment Name'.L/5�7//D �/'7JcL Lq Date: ��-2� Page: Z of Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF-CbRRECTION Date No. Reference R—Red Item Verified �lY PLEASE PRINT CLEARLY I iu�c �onile�i � mise �v �n> a�nnol-jm Im % as<d&l NGS -�<7WJK mmol)/ hoc 4a/ bIA4 oPe0;_�Ma.0 . '%i �rt� ,PUI /Y.' tel, Ute» //�0_01-75an of hvre�% r�9Ghin uhc_� / Ala-5, IwXed ffirr f �-ho,�e G�a_�e ma�� u/d�f�l i�eryls. ole I / �u�niifo.� /erns �o 6� Shc/ael'p. ✓C /� .�r�u urt�f '/Z oan a� rrce Yz/�e dish fh � 1 7U &uAS 46<MZCed Na r 14,15 a- Avvd mins b�'_sfa�ea GU/f1 ��surn�2 pfvd�rc�`s, lock -el- 4r, 1 i,P hIV rp+ �/)d _bY/.c Discussion With Person in Charge: Corrective Action Required: I ❑ No I ❑ Yes I have read this report, have had the opportunity to ask questions and agree to correct all ❑ Voluntary Compliance ❑ Employee Restriction/ Exclusion violations before the next inspection, to observe all conditions as described, and to ❑ Re-inspection Scheduled ❑ Emergency Suspension comply with all mandates of the Mass/Federal Food Code. I understand that noncompliance may result in daily fines of twenty-five dollars or suspension/revocation of ❑ Embargo ❑ Emergency Closure your food permit. - - ❑ Voluntary Disposal ❑ Other: � _ _.)1 1 PIFs S::cetyl t .uuperrhves Violations Related to Foodborne Illness Interventions snd Risk A-_cording to rats C onled to Factors(items 1-22) (Cont.) 1''Fl45 Ft%*Lin 4 Homs. ` PROTECTION FROM CHEMICALS 3- 0!.15 Coonng Methods for 1'Hbs it ( Food or Color Additives 19 PHF Hot and Cold Holding 3-201.12 Addimes" 3-50; 1(,(11;) Coll 1 fll's Sl intauted at or below tUiJ.Ot?-?iF) -11'145' F` 3-302.14 Roteclion!torn Fhtapnun:d Addillvez" j IS Poisonous or Toxic Substances ' 591 I+t A) 11:,t PHF.;Ittait:w:peri at or above 7-101.11 klentitmng Inforrnxtion-O;i *inai 3-501.16(:1! Roast:. Held at or above I;U"F. ` Cu:nainers^ 20 Time as a Public Health Control 7 to-, 1 I Common Name-Workine Containers' 1 ' :?SU1.19 ii:n::a,a PublicHaa1.Lh Ccnnr,F` 7-201.11 Separad,m. -Slur age" i� 0• 7-2 1! Use* ; ih:�,t.41Hi Variance P.equuenunt U2. Rearriction-Presence aznl (,.c 7-202.12 Condition of,,- REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-2(13.11 Sat i izeu, !net:-P nhCIWL ls. POPILATIONS(HSP) 7-:.U4..I J.mit2et:,.{'ritena-C.helmcals�^ 7-204.12 Chccr,cals for Wesh:r.e Pro;ince,Criteria' 21 ;- 01.1':1"\; Cnp.sfeurized Pre-pa 1mgcu Juues and 7-204.1.1 DrvingA,,ents.Cracria' 1 Levea esw-tthW'arrmnefabols^: 7-205.11 lncidcotal Food Contact. Lubricaraa'. ( 34G0 i 1(13) Use of Pasteu[ized Eggs^ 1 7-206 I 1 Restricted Use Pesticides.Craenar 3-80!.1 l:D) Raw or Partially Cranked An:mdi mixt and i k.i,r:iced Stxcuu:Not Served :} 7-206.12 Rodent Rail Stations' z_grll 11tC") ' Unopened Frxxl Package Not Re-ser-ed. 7-206 13 Tracking Powder,,, Peet Control and Monitoting* CONSUMER ADVISORY TIMEtfEMPERATURE CONTROLS 22 1 3 603.1' Consumer Advisory Posted for Ccasumption of 16 Proper Cooking Temperatures for Arnm.:i Fo:-•ds That are Raw.Undercooked or PHFs N:rt C)therwtsz Pnues,cd to Ei:mina[e 3401.11 A(I 1(2) ( Ggg,- 155`F 15 Sea Pmhgcem..''""°'"'°i'J0t 3-3(12 11 Pdsteunzao E Substitute for Raw Shell Eggs-htunediate Srn'icc 145°F15src-' €[�c�' 3-v0I.11(Al(2) Cormnuma[ led Fish, Me5&Ciame Animals- 133i'F 15 se:. ` 3-401.11(13)(1)(21 Pork and Becf Roast- 130"F i'_'1 min* � SPECIAL REOUEREla1ENTS 3-101.1 I(A)(2) R:lue;,Injected Meals- 155-F 15 590.009(A)-(D) Violations of Sectio. 590.009(A)-(D) in sec. " catering, ;nobile food,temport:ry wid- 3-401.11(%)(3) Poult ,,..Wild Game,Stetted NIB residential kitchen operations should he Stuffing Containing Fish,Meat, debited under the approrn late sections Poultry or Ratites-1 tis"F 15:;cc. " above if related to food Lorne illness 3-401 11(()(3) Whole-muscle,Intact Beef Steaks interventions and risk factors. Other 144 F 590.00,1) violations relating to good retail 3 401 12 ( Raw Animal Foods Cooked in it ( p:acuses should be dcKtcd under {1'29-- 1 Microwave 165`F'' Spacial Rocluh rricuts. a 401.11(Afl ub) f All CYhcr PHF.s- 145'F !5 sec. s 17 j I Reheating for Hot Holding j VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 3-403.1!(A)K(D) PHF,, 16SLF l5 scc- ' j ([tetiis 23-30) 3-403.11(B) Microwave- 165'F 'Minnte Standing C;ittad aad inn-rNiica!viotah,nc: much do not r4ate to thv Time'' (le,10rnr.ill,Ws.s hat'l vendory and tis'Ja,torn listed above, r on he 3-103.1 1(C) Commercially Proccssed RTE Food- foand in the folouving se,:6(-!45 of the Food Code and 105 Crdlt 140'F 5-)0.100. 3-40111(E) RenuJinng Cnsliced Portions of Bcef I itrm Good Retail Practices FC 540.000 � Roasts" 23. Management and Pers^nnel FC -2 .0O3 24 Food and Food Protecticn � FC-3 ' .004 1g Proper Cooling of PRFs ( ! 25 Equipmern and Utensils FC-4 005 3-SOl.ld(A) CoolmgCooked PHF, (torold(1"Fir, 126 Water ftntbinta and W?ste FC--5 ! 006 70'F Wuhan 2 tfour,,and From 70'13 27 ahvsical Faetl)ty FC-6 007 n:4['F745'F Within 4 flours " ' 28. Poi6o::taus or Tnx;c Matenal.; Ff, 3-501.1.4(B) Conlin„PHFs Madc Froat Ambient29. Bpaaa:Rcouire hent, ''I .009 Temperature Ingredients to 41"17145"F -30. Other Within 4 Hours.z Denotes einem nem 111,110 tedcsal 19991vod('udc to 1051'NIR 590 DOG. CITY OF SALEM BOARD OF HEALTH (i Establishment Name:/_/��//�/o�YUIO P� Date: P-Z `oz2 Page: of 6 Item Code c-Critical nem DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date is No. Reference R-Red Item Verified ` l PLEASE PRINT CLEARLY �SS'Cod40 a_y- /C¢. It/CISh l�i��. 12 /7/f' Gr�i/ Ge�y.O n.,� Srt� ire v hiv/rifle _3 Aa y v/vc, 5are Pi'o li, eco ha d hal Gua�// 1 I �� Arno_ /�� fl>C��/�i�m /CO.G'�P�_ hd/ l��/./�.2 //n%ho/✓i�S�if -Ihlee bqa /7U0 to /jy/a/ /67j"rV/:1 V-0 > I - " .��' r �"✓S� i,�. �� ir�c� � low n o n� in .�ia�,e m��no� . 1 ,t 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 r 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: PHF,I2ecc:vcd it remperaturec Violations Related to Foodborne Illness Interventions and Risk j Acaxding tr.i..:w Cooled tip Factors(Items 1.22) {Cont„ ; 4I`'F/45"F txi;tain4 Hours. PROTECTION FROM CHEMICALS j 50;.,5 Con':ing 5iethod,rn-P14 j I (; Food or Color Additives j =9 i PHF Hot and Cold Holding j 3 501.16Bi Cold P-1Fh:v!,dr aired at or below 3-20?.i:' Additive,* 5(l'0.0 4(v) -1'/4 i" F- 3-3011-i Piotcetion from Unapprried Audtt;cerr i ! 3-501,INA", lint :'Hb', Piainrai!ted at or^hrne 1.5 Poisonous or Toxic Substances 7-101.11 identifying Information-O1:gmai i 140"F, :° Ctnnainers, 3-501.?5(.1} Rua:as Field at or atsnve L O"F. Z ' � j 7 R12 1 I Connunu Nnn!c -Wb7kinr Cirntainer, i it "rime as a Public Health Control ( j ., 3-501 19 Ttmc as,!Puhl:c health G'nnol*7-?01.11 Srparninn-Suxase^' ; j 7 2117.11 Re.trichon - P-esence and l7se' j .00A(H) Voriance Rcou!rement j 7-202.12 Condition,of Use, 7 203 ! ; Toxi: Cootainou;-Prohibitions REOUIREMENTS FOR HIGHLY SUSCEPTIBLE 17-204.' ! Swt ;zets,frit:ria-Chcni:,als'� j POPULATIONS HSP) 17-704 12 Cheaucals for W'as5u;_1'r:xtuce Cri,eria' 21 3801.'.l(A) 1-4tp%steurized Pre-packaged Ince,and j 7-204.i-1 Diving Ascots.Criteri::T ! Bet'elagcn with%v'arn:ng I abzls` i-80i.1i(P) UseofPan:enr;zedliees` j 7-205.11 R eideataf 'rood Csticid . Lnbr!eaat ( 3 SWL I 1 fD) Raw�.i;Paibafl Cooked Animal Food and j 7-206 11 Restricted Uer F'e:aicrlcs.Critcna" Raw Sad Snrn:os Not Served. " j 7-2116,12 Rodent Bait S+annns^ a:<.d Fac!...,e Not Re-sen'ed " 7=_'06.13 -tracking Powders.Pest Control and Urou,ut j - ) 0 e e e d �- Monitoring` CONSUMER ADVISORY TIME(TEMPER'1TURE CONTROLS 22 3 603 1; Consumer Advisory Posted for Cousu!nption of 16 j Proper Cooking Temperatures forI Animal F:xwis Tnat me,Raw'.Undercooked of I PHFs 'Not Odr-ce;se I'vicesse:'.to Eliminate ' 3-401.1 1A(I)(2) Eggs- 155"F 15 Sec. I Pathogens.*"`•:"�;;,:"cr. 3-303.1 3 Pasteur:aed F +e Substitute for Ravr Shell I Eyes- Ini nediaie Sen ice 145'P15sW gg- 3-40L11tA)(2; Comminuted Fi.h,Mea[} ,4 Gam, I Eyys' Animals- 155'1` IS.ec 3-401.II(13)(i)(2) Pork end Beef Roast- 130'1` 121 min* SPEC-IAL REQUIREMENTS -40L1 t(rU(2) Ratites, injcued Meats- 155'1` 19 I 590.009(A) D) Violations of.'Section 590.009(,x)-(D) in Se,_• * catcrir,c'. inobile food, teinporary and 3-4Q 1.11(Aif3) Poultry,Wild Game,Sniffed III 117s, recideutw! kitchca operations shoubi be Stniints Comaining Fish,Meat, dcbited under d:c zPprnpciatc section. Pouitty of Rutite:a-i65'F 15 sec. above :t iela.ed to i-ondborne illness -901.1!((,)(3? Rt:ole-oniselr„ buact goof Steaks I inter Mentions and risk factors. Other 1453F'' 590.00')'Jolaticnm relating to good retail 3-101.12 Raw Anunal Foods Cooked in a prac!tc'cs sheuid be debited antler iJ29- M;c!owav'e 165"F" Special Retltnremerits 340!.i !(A)(1 h b) All Othet F'HFS - 1.45"F i. 17 Reheating for riot Holding i € OLATIONS R.FLATED TO GOOD RETAi1. PRACTICES 3-403.!liA)ir(11) PliPsih5'F' 15scc' ^ I I {lterns 2?-30) 3-403.11 B) Microwave- 165'F 1 Mointe Standing G't-itical u,ri run-r,vticuf vi,datioto, which do,rel +elate to dr,, ')'ime* I foodborrw dinoes intvivent;.mr ana risk fai!or.+ ksted above, run be ti Cl Comrncrcially Pio�eneed RTE Focd- I ;orad is Jte fnllon rr;; .se,Iwns nfthe j,')I'd Code and 105 CIfR 140"F'' 51;0 Of1O. 3-10311(F) RemainingUnslicedPortions of Beet I .rens GoadRetaitPractices FC ! 590llm F.'mst'0 ! 23. PAanaovmem and Personnel FC-2 .003 J j Ig Prayer Cooling of PHFs 24 Fca d arc Few Ponent!on FC-3 004 i 25. Equipment and UlensBs FC--o .005 I 1.501 14(A) C'oulm„C'o,'.kcd PHFs front 140-F to ( ! 26. 'water.P!umbintl arra Waste =C-5 .00R 70"F Within 21-lows and From 70°F1 27__. -Physeal Facdibl rC.-S .007 to 4!`1`(4.^:"F W;thit 4 i-lot,r a. " 128. Poiso-:ous or Tox:c Maeriais FC-r :JOE -501 14(f3) Coohng PHFs Made From Ambient ( 29. Snccial Reaulr.^merts OUS TeniperatureIngredients if)41`F(4j'F I (_30 Othei --- ----� Within ? llouts'� *i?enut:o-.cranio!item m Ihr Calera; i 49q F.¢x.('ode or 1115 CMR 5`:(I if0ii CITY OFSALEM'/ y / BOARD OF HEALTH { Establishment Name:(/�fS ri /� �17J/1�.U_ a/ Date: Z/- U 6e Page: / of5 Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date iNo. Reference R-Red Item verified _ PLEASE PRINT CLEARLY v1i�C ire bc./ ciao �2Ap1Z _ A14 XC 1-2/ei✓. J o/r,( ayl ma k' 147 4W/Z!/iotJS' /n�il-)Cr I)r); Ir /lDon/ �`liar�u/h C��irrai/7Gl oP a��i�rn, /ar�i tr I mss— %6�� hoot fin/ , gid oYi �ioe,P. a[// {•gin/ be, n hold 79d t o�roS' �,411 1'1e& '7 f zm ale-- ham %.750i 47' /oma hUr /1,//-,0 1 �F' Fa 0CA- Discussion With Person in Charge: Corrective/fion 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 j' 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. �� GL` &e94_ 4.. ❑ Voluntary Disposal ❑ Other: 3-50 .'4(C) PHFs Rr.eiwd at Tcny)cramres Violations Related to Foodborne Iciness interventions and Risk -lccurdinr lo Uw Cooled to Factors(items 1-22) (Cont) =1`Ft45'F Within 4 Hours. PROTECTION FROM CHEMICALS ! C-oo!in:' Methods for PHF 14 PHF Hot and Cold Holding 14 Fuad or Color Atlditives 3-.SO!.16(B) Col; PITv M::mhtincd at nl helow 3-202.12 Additive.' 59{LOUatF -ti"!,i' F Poisonnu5 or Toxic Substsnces 3-302 I4 Piutection from ("Impp[uved Additive<A j t 3I-501"16'A) of PEP;M,nr.,eincd at or above j 7-101.11 - ldenutying inrorm.m,;n-Original i -...�l.l iN,1) Roasts Held at or above 110'17. Cuntaiuers" j 7-102,11 Common Name - W'orking Container,'* ( 20 Time as a public HaaBn Contras 7- i ? 5f r1 I9 'Pune as a Public Iieaidi Gmholx -01. 1 Separation-St [e590.004(H) Vuri:me Retivarcri-in Resejic.and 7-202 11 Restriction- ncL'se` j I 20.12 C'onditiuns of U;', j 7-..U? It io is Containus-Pcoh[hitir;ns' REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-204.1; sanii iters, Critena-Chranic[lsT POPC--o ONS(HSP) i - 7 , 21 ! 3-;!01.11(:1' I:ones(c:toted?'-*•-ta�kacde=.!i.ca;md i 7-:-(At 12 Chenrcals for W'ashnr.�F r:xiuee. Crrier;a"' J } € Bever:"r_es wnh Want;nw(abets^ 7-204.14 Drying Amus Crirerla ;_801.1 i(BI its,�ftastrmized Egs•F 7-205.1 1 IncRcstrintd F Use Contact.Lubrieanh;T I I 801.,1 I OU) Ram or Partially Cooked Aria a1 Food and 7--206.1 I Restricted Usr Pesticiilcs.Critena* - 7"200.1= k.xtont P.:ut S+' R;iw Sced Sti routs Not Served. " ativus` 7-306 I3 'hacking Pocaders,Yell Comm. and ?-lMLI1f C; Unooened Food Package I%)t Re-served " I 1;:11it,ri, CONSUMER ADVISORY TIME/TEMPERATURE CONTROLS 22 3 603.i! Consumer AA',,oty Posted for Consuniption of Anincd F,.n,ds That ate Raw,Undercooked or 16 Proper Cooking Temperatures far FHFs Nui Olher'aJis Processed to Eliminate r a:�,a:•c vxarn, 3-401.11 AQI(2) E.,,F, 135`1715 Sec. Ia;iaJpcns Eggs- hernedinte Jervu;e 145°Fl Ssec* 1 3-302.1, Ps ^teurim: rges Substitute for Raw Shell 3-401.11(A)(2) Conunmutcd Fish, Metus do Gaine Fp'' Animals- 155°F I i sec .` 3-_101.11(6)(1)(2) Pork and Beet Roast - 1301E E31 ntln* SPECIAL REQUIREMENTS 3.401.11(:'1)121 Rantzs,hycrn;c{Mrtts- 155°FIS 590.009(A)-0)) Violations or Section: 590.009(A)-(D) in sce•* catering, lrmbile faod,temporary and 3-40! I i(P,)(3) Poultry,Wild Game,StuKcd hHPs, ru.idential kitdu•n operations Should Le Sniffing Containim Fish,Meat, debited under the appropriate actions Pouhry or Ratites-165'17 15 sec. ' abov<if related to food Lorne illness )-401.11(c)(1) Whole-muscle.intact Beef Steaks intervcraimis and risk factors. Other 1451F* 1 590.009 violations relating to good retail ;-401.12 Ria'Amtnel Funds Cooked in a ( pracuces should be debited under//29- NC rrnwave ;(15'F specie! RcGuiretnrts. 3-401.1 :(A!(t);b) All Oftter PHFs- 1.1i'F i5 set. j 17 Reheating for Hot Holding VIOLATIONS R.1LATEO TO GOOD RETAIL PRACTICES 3-•10341 i(,%)&(D) PHF. 165`F 15 sec. ,. i (Itetxts.E3_3(3) 3-403.i 1(11) Mir-rota-ave- ItiS' F 2 i44inttte Si;mdin2 Critu a!and nun-schism viutatimts, i,inck du nor relate m th;: Time j fitu:!!xnvee r:'htc:..c hnoi-ennotm and riykJanors iisad above, can he 3-403.11(C) Cannncrc:zlly Prkressed RTE Food- I round:It ncc foflui,in; q/Inc Food C,rae and 105 C?V!R 3-4(}3.: ;{E) Remaining Unsilced Portions of Beef Item, Good Fefal Practices F1' 590,000 Roasta* 23. klanagvm-ent and Pe-n:ornel ! FU 2 003 18 Proper Cooing of PHFs 24. Foos and Fail Protection ( FC;--3 I .004 25 Eau,::ment and Utensils FC-4 005 3-501 14(A) ('ailing Cooked PHFs from 140`F to j 26 Water P:umbina and Waste FC-.5 ,00& 7{WF With:n 2 Hours and From 701E 21. PhN;ical Faoddy FC--6 007 to 4I'F/45'F Within a Hours. " 1 28 Posotims or Toxic Materials FC-7 .008 3-301.14(p Cooling PHI'a Made From Ambient 29 SUt tial'Rec.wremcnts oftq _- Te:::!,eum[re htgrai;:atts to 11'F 30. O:Ler - -- 19Y0;in•1Hoar r Ueuoiea crne.al item m 41e foknd !`199 Food Cod'.or 105(''NIR 59110(1(1, f CITY OF SALEM t BOARD OF HEALTH •� Establishment Name: (!:2Sr1711D U/OGe/ Date: Z�-016 Page: �of Item Code C-Critical nem DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date No. Reference R—Red Item Verified PLEASE PRINT CLEARLY t 30 sth� rQ1no9S bid /n el7ec�l . /)/W,3 �`v h� .SfT d i;.n -fval'fiIla liz- d12� I I Z)S_ t _W2zjrfe /dls a_ fJv2 IS / son/ -77) �� /U� P �m h/r7hr err Sl/7/� ci //-22-e Ze mope I I �4� a/gra r✓ �i%s ire hir i��nm� zo d/ems 75� haXhavyn__ 4f 1104Wli e/�h /'/ooh )� � r/�c� al- X1Va 7a-ir 4Y fc nil-ir, /n �� 'G Pou�ri4® rf . 71'1ra� {�sinp _ � / QEF ar h4�i�a� CSC' �'11I//��-/-�x✓. ��,�v��n .. 1/1�af �-�r1 ��r��'/`1 ��Di? �C��J _ 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 i 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. p �r sD ❑ Voluntary Disposal ❑ Other: PHws Rrtcvicr,,; Temperatures Vfolat,'ons Related to Foodborne 110tess Interventions ano Risk 4c,-oiding,to J2Cooled to Factors(Items 1-22) (Cont.) 41"P45"r Vidiin 4 Hour, PROTECTION FROM CHEMICALS3-50?.ISCi,.N;n,ti cthodk lo-P!IF,,, 14 PHF Hurt and Cold Holding 14 Food or Color Additives 3-50!.168) Cold PIJJF,,*V,intain,-,d at of below 3-202.12 Additives 590(JOe-,T) 4i'!4�'F� ; ?02 14 Protection front Unapproied Additjvv� 3-507.1!1 lla�) Rol PH"F, at or above is Poisonous or Toxic Substances 7-101.11 lchtntifymu Inforowimn-Ori.inal Container" 3 501 16(.A) Roasts 14eij at or above 10 7-102.11 Common Name-Wwkuw Coirta;nzrs* 24. Time as a Public Health Contra! 3-501.19 Tirtiv is, �� Puo;:: Health Civiitrol* 7-20 t.I I Sopradon-Stoj a've Varian:::R,quirewent 7-202,11 Reftriction-Present,, mid Use'' 7-201.12 Conditions of Uw` 7 ^ Toxic Contain.-, Probiliti'als, REOUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(H.SP) i 7-204.1 S.OiJ70,is. Cf;tt�'Jjj—CIjcjjvC;jls* 21 3 XQ I�I i(A) Unpas-curtz!�,! Pr,,-pa.Jkagt11.It1ice�,and 7-204,�2 Clwillicals 0-or wa�h;ac Prodlict,Cri�crial 7-204.1, Bove:u%_cs%k.tli Wim;ni:i.A Dr-ying Aecats.Crion a' I I I 7-205-11 Incidental Food Contact. Lubricants- 3-80�.i i(B) ij��,�(V pastern ized 7-206 11 Restricted fisc P-r�tiiades,Criteria* 3-801 A I(D) Rroa --r Paftirdlv C--�)ked Animal Food and Raw Seed Svicalls IN"! Screed 7 200,12 Rtdcut Bait Stations" 7-206 1-, Tracking Rnvdem PCst Control and ;-SOIAPCi Unopcned Food Package N:,t Re-served Monitorial-* CONSUMER ADVISORY TIME/TEMPERATURE CONTROLS 22 11 Consumer Adv!sort'Post,d for C-1--fisarription of 16 Proper Cooking temperatures for Aniowi Foods that are R�v.,, Undercooked or PHFs IV,)! 0iher,,,ise Processed to Eliminate 3-301.11 A(l)(2) 155'F 15 Sec. Patho;,ens.r 3-31)2.131 11,�Meurlzw Substitute for Paw Shtil Eggs- Inanedia:e Service 145"F!�Sse& 1 3-40 1.11(Al(2) Comminuted Vi�;fe Meat,&Gtoile Ezis` Aniniats 15.5"F I5 Se- t CIDECIAL REQUIREMENTS 3-401.1 I(B7(1)(2i Pork and Beef Roast- 130-F 121 ruin* I5Yf),()-(J()tA)-(D) Violait,yis of Section 590.009(A)-(ll) in 401.1 t(A)i2) Rattles. Injected Meats-155°F 15 sec. catering. Moh0e food. temporary and 3-•4f)1.11(A70)1Poultri,Wild 6anre. Stuttv(I PHF;, dnitial kitchen opzraliotis should be Stuffing Conminim,Fish.k1caL. deh'tcd under the appfopriate sections Poultr-, or'Rdtites-165°F 1.5 sec. adobe if ielaied to fi-"Ohorne illness 3-901.11(C,)(3) NVIhole-truw1c, Intact Beef Steaks interventions and risk factors. Other 145017* 590.009 violations toloLin.g to good retail 3401A2 Raw Animal Foods Choked it,a FractiL-,should!),-debited antler#29 - Special Requiierrients. 3-401 A I(A I()(h) fQi Other PHFs - 145°F 15 sec. 17 Reheating for Hot Holding VIOLATIONS Rr:LATjED TO GOOV RETAIL PRACTICES 3-403.11(A)&(D) PHi-s 169=F 15 iRetins 23-30) -i uvd non-frifical viol., whi( -do,:of relate to rile 3403.11(B) Mic;fmdve- 165°F 2 Minute Standoil- C,.tif al Timc4 can Ge; 3-303.11(C Cranrrrercaally Piocessed RTE Food- f(mlid in thefollomiri,serfrotc;of the Fqod Code and 105 CAM' 1400F, -59(00 3--403.11 M,) Remaining I ptdiv-d Port:cos of Beef item Good.-qetsif!Practices FC 1 59atfoo Roasts, t 13. Manacerrip,-t and Personnel FC-200', 18 Proper Cooling of PHFs 24. Food anti Foca Picroi flon Fl--3 004 3-501 t4(A) Coolov)Cooked PHFs from 140'f-to I 25. Ecuirimprit aid Utensils FC -4 .005 '70'F Within 2 1 lours and From 70,17 Wder,PILI:nLinq and*d�lz FC-3 M6 27, Physical Fac:My FC M7 to 41`F/45'17 Within 4 Poors. " 28 Poisonous 01 7 ji,,r JV:;jteTicjS .--Fc ? .008 Oxdin-PHFs;'-Aade Fitaw Ambient 501 141 R) i 19, Special Requirormnts 3C. Otner Tenipery ,are hi"redierits lo J if c FV45,F \N ithin 4 1 lours* E"P011S MUL.1 it-'M 111 IhO 11 fiMll 10,19 1',o6 Code of 105 CNIR Syn uo0. CITY OF SALEM BOARD OF HEALTH Establishment Name: l .CTI /Z6 ��"oG�-,�L/ Date: I� z�`� Page: of Item Code C-critical nem DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date r` No. Reference R—Red Item Verified u PLEASE PRINT CLEARLY -1ArvzI, �� ✓U �la�� ce Q� ry i ov"��W a/- a //7a 6n�)Je /L 1 h .,L'IQ=. ppo e rod%ago hzmWe 1 I ._��' ✓C�12� o. /1�i�` ln�J.✓_ /,U��Lv,2 GJ /'�'i,mi� /��S�x /n hD�Drr) o,� Uh f`f - /,o 1m)�P _C YYvli l //2�4PP G/?// r ��- G ✓�fn�� h��,� l��,�'in.� . S'fi�wa/ /d'j�iiYJP��// lt�/�.CY 1 '€ G C/JfiSno GSo�rNc {�irjJ�ha �/zii�a/ fScor�a' r��rf �o _S'�hi712ZEC/ 111)k //7 /cP n� ass r�if � /s fid_ Sr�h,;D i 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 violations before the next inspection, to observe all conditions as described, and to ❑ Re-inspection Scheduled ❑ Emergency Suspension r 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. � i LlEIVoluntary Disposal Other: I.:f(c) ?HFI Iteci-,Isd at Violations Related to Foodborne II lntorveI and Risk A(cording to I a,,. Cook,"to Factors(items 1.22) -CVFI;�'Il-Wijhin•-Fear, :,Ci.15fur II PROTECTION FROM CHEMICALS Till 1I Hot pndCo',d Holding 14 Food or Color Additives 3 702.12 ATI�II -1-50 1.1 fl(B) Cold rsll-,%Lnr,7aiiiodat or helo�, 41-14 3-302.14 Protection from(inatiorowd Addit uvc�i- F- 3-J01 INA) Hot TfkI, MainwriedutoI 15 Poisonous or Toxic Substances 14(,'1:. 7-101.11 Identif3mg lulormation-'Original 3-Suj' al 6(."J ,,�I bHeld,it or above 130`F.C0111911I I k 7-102,11 Common Name-Akorking Containers' i 20 Time as a Public Health Control 17-201,11 scnai.iva-r3tojjFc* 501 12 ince as Public Heahh Cornet 1 7-202 11 Restriction-Prrscuce and ljs"* s00.004(H? V,iriaDce Requiretie-ri 7-2t)2.12 Conchutions of Us,-* REOUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-203 11 Toxic Containers-Prohibition:.'' 7-204,11 SwI Uterui-ChcHIlLaIN., POPULATIONS(HSP) 21 3-SOL[!(A) Uun.1eAeLiwcd Pre-packagedJuices:aid 7-204.12 Chemicals for NNashini, Prkelucc,Criwra'' j i Beres--es with WarninI, �ibc IT Atients.Criteria' I 1 7 204.1-1, Di vin 3-30;.i 1(R) Use of Pasteurized Pi T 7-205-11 IncidoiI Fnrd Contact.Lubriomis, 7-1016 11 kc�niicted Use PciticidIts.Criteria" -,-00 1.i 11 D) Raw or Pa.-tially Cooked Anamil Food and 7-706.1 2 Rcifmt Ban Statitus' iced Sorwis INI SII 3 801.1 UCI Lino cued Fund Package 1,I pc-s"rv�J= 7-2-06.11 Tracking Pest Cnnirnj and CONSUMER ADVISORY rimEtTEMPERATURE CONTROLS 22 3-603.1! Consumer Advisoty Posted for Consumption of 16 Proper Cooking Temperatures far Aniacil FI That wc Raw.Iffidercnoked of 11 PHFs Not Oulevrvise Processed to E1:1, 1111t 3-401.1 LA([1(2) EgII 15:5"T I"Sec. 330'' 13 P,:steurry.rcEggs Substitute folPav, Shelf Eggs- Cuenediaic Servicc 145'171 5se, 3-40 1.11(Ai(I Comeautued Kitt, Meal,&G,-.me Animals- I i:i'F 15 qe,. I '-40 1.11(B li,1)(2; lsi-sk and Beef R,wt- 130T 121 min* I SPECIAL REDUIREMENTS 3-10-1.11(A'I(2) C�it i i,I;, Inj cIncd Meats- t 5 5�F 15 590M09(,%)-(D) Violations of Section 540009(A)-(D) in see., I catering, mobile food,ticrapoiary and 3-401.11(A)(3) Poultry' Wild Gam-, Sit,ftej PHFs, residential kitchen operations shoeld be Sluffin'l.Containing Fish- Men, debited Jurder:he appropriate secvicris I'vil:ry or Ratites-165017 IS sec above it related lo fondborne 01n,I 3-401 11tC)I,3) iNhole reuscle,Tnitact Beet Steaks Other 1-95°F 4- 590.009 violaoorts relating to-cod retail 1401.12 j Raw Annual Foods Crooked in a ptoclicci;should be debited under#29- -Microwave 16:i'F Special Requircrintents. 401 ll(`kifICf1:T' All Other PHF;- 14s"l` 15 see, 17 R-miating but Hot Holding VIOLATIONS RjLATE0 TO GOOD RETAIL PRACTICES ](A)IiII PHT, 165°F 15 sec. (items 23-30) 3 403.11(}3) fvl:ernwave- 165'F 2 N'tuniteStandirr, Ctio,al TvTI nun-critical ;toiI vvI do not,-rhate to itse foodI II intc'T vesuw;ts wu/1IS4 Jac I'J'-s UIIII'd above. can be i 4w.I I(C) Commercially Foccsstcd RTF,Food- found in rhe P,l 14(fFt 701)000. -4:03.11(P-) Remaining Umliced Pottioris of CI Item Good Retail Practices FC 590.00(1 Roasts" 23. Manaarinent and Pe;sonnel FC-2 .003 18 Proper Cooling of PHFs 24, FI and Food Protection FC--3 0()4 25 Eq�Iprnenl and U! F�-4 �005 3-501.14(A) P -- i COLI CUDked PHFs from 14C"F to P, 'Nalei.Plumlmia., _ -5 1101: I., 'no waste '70:1-1 Within 2 flows aad From 70'1 �2 7. "'hvisicai-acuity FC-o__ 007 to 41'F/45'FWi1lnn4 Hours. t Pcisunrm or T oI Material FC- 7 PC- 7 .008 3 501 14(B) Cooling PHFs Made Hoot Atn'lient 29 So:�cval Requienioni.,; 1009 TernpI Ingredicniq io 41'F/45'F 30, Other Within 4[four.,,, I Dennis cral:'I I it,e)1111 lir f-I a i 1999 FToc Code of I L!5 CNIR 5'n 1000. CITY OF SALEM BOARD OF HEALTH )_ Establishment Name: ( _ L7.�77//d O ///Jl�i3 Date: �I Z/ O rP Page: of Item Code C-Critical nem DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date t i No. Reference R—Red Item Verified t PLEASE PRINT CLEARLY , V I .��- ✓�.-��,� �� n% .�Zib>-�►� o_ a�a.. -� ho .Som // �' �.��! orC/ 4` I ,�Uv�a°�_ %ISS L� ��,�., fi__ ✓�e�nUryr��ie rn�® ��i�o� g - // c I .��' ✓ ,P'-Jwld2 ///S,bC¢ aCGI/raxle I _ Discussion With Person in Charge: Corrective Action Required: I ❑ No ( ❑ Yes ❑ Voluntary Compliance ❑ Employee Restriction/ I have read this report, have had the opportunity to ask questions and agree to correct all Exclusion violations before the next inspection, to observe all conditions as described, and to ❑ Re-inspection Scheduled ❑ Emergency Suspension comply with all mandates of the Mass/Federal Food Code. I understand that noncompliance may result in daily fines of twenty-five dollars or suspension/revocation of ❑ Embargo ❑ Emergency Closure your food permit. ❑ Voluntary Disposal ❑ Other: 3-7,l .4(C) ',]Fs Rec,ened at Tc+,+po;.aures Violations Related to Fondboine Illness intarvsntions and Rrsk ! ^rceordint to Lr,+Cooled to Factors(items 1-222) (Cont) I .ti`Fiz`'F'Within-4 Him;. ` 3-:i0I it 1 C.'oliwt%lethndsfor PHFe PROTECTION FROM CHEMICALS I ,y I PH>Hot and Cold Holding 14 Food or Color Additives ( ;-591 16iB! i'old Pf IFs Maintained at m: hdmvr 3 202.12 Addiu.es" X40.0041 F) $I i 75° F- 3 -302.14 PtmteLlnnn Sano: Urnarprmcd Addinves' j I I_.,,_.; _ t I.16U1; Hot PHFs Nlaintanned:.o-or above 15 Poisonous oi Toxic Substances I ! 140'F 7-101.11 Identifying Information --Original I I 3-501.16(A) Roast:,Held at or above 130'F, ('0nLa;ner;' 7-102 It Counnon Noon- W++rkini;Cwn.ainers' I i 20 I Time is a P otic Health Control I '-201.11 Separation-Srtuaiec- ' I ?-50!.10 Time a Public I-fea!th Conhi,P 1.202 H Restriction-Pretence and Use 15S'Q UO, (H? V.:riga:e R_gtrircmem f 7-20'_.12 CnnchToxictimns of rs-- I REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 1720311 Toric Container,--1'rnhibi d,+ns"' 7-?04.11 Stanrirene.Cnreria-ChemPOPULATIONS(HSP)icals^ I ?-S,) 7-^_03.12 Chetucale for Washing Produ,e,Cnteriax, I I it LIRA; i}tp�steunzed Pre-packaged Juices and Fe erases with W-mince I.)bcic 7-201.id DryingAgents.criteriaI I ;-:i+il.l , of Fast.uriaed Ryes"` (Ti Ue, 7-205.11 incidental Food Contact.Lubricants' I 3-SOI.+1(U! Raw o•'Pattnail,,C'oo,,ed Animal Fetal and 7-?06.1 i Rentncied lice Pedicules.Criteria" 7-206,121 Rodclit Ban Suaions" ( Raw Seed Snrnt;t Not Served. :` 205.13 Tracking Powders,Pest Coutrul and ! 13+-80).11+'C) unopened rood Packu;te Not Re-served. At:mit.,rine^ CONSUMER ADVISORY TIME/TEMPERATURE CONTROLS 27. 3-603.11 Cuntumcr Adc tuor4 Posted for C'oncuinptimn of .4nined Foods Tha are Raw, undercooked int' 16 Proper Cooking Temperatures for ;rot 0th rwise FroceSsen to Eliminate PHFs En.�o.. vou• 3-401IIA(!1(7) Egos- !Si"F 15 Sec. Parhogc E_es-hnnLdiate Srraiee 145°PlSsec 3-30'?13 1'asreur;zed Eggs St&6o to lo;Raw Shell 3-401.1 NAM) Comrunuted Fish, Meats&Ganie I Eyys* Annuals- t n[i"}•' 15 sec. :' 3-401.11(13)(1212) Pork and Bee!Roast- 130'F 121 min` I SPECIAL REQUIREMENTS i 'NO 01)9(A)-(D)Ratites, Injected Meats- 155'F IS Vio(atonsolSecton �90.0)91•n) (D)in sec- ` I c•atertr e, rnobile food,temporary and 3-401,11(A1(3) A-+altry, Wild Game,Stuftcd HIFs, residential kitchcv opera'.ions should be SRttffing Containing Fish, Meai, debited ur,d:,r the appropriate sections Poultry or isatites-1, 15 sec. " above 1f related to ksidborne Wuess 3-101.11((")(+) Whole-nms,le,Intact Beef Steaks interventions and risk !actors. Other 145 F 590.009 violations relating to good retail 3 401.11 Ra,i Animal Fends Cook ed in a )lractice5 should he deb',,-d under//29- Misowav-e 165'1- * Special Requit orients. 4401 1 I(A)(1)(b) All Other PHFs- 145''F 15 sec. 17 Reheating tot Hot Holding ( VIOLATIONS RvLATEO TO GOOD RETAIL PRACTICES 3-40111(A)&([)) PRFs 165'F 15 sec ( Ot ens 23-30) 3-aO?.1113) Microwave- Itis' F 2 Minute to Standing C'W isi and non-crineal duhur:ur ))d„Jh u'o not rr'aIc In the 'Pirie" /nodho'ne illness ouervcrvn,nns erre?)isk f..,�Ieis liv:•d above, can he 3-40.1 I(C) Consmerciu l}Proce.sed RTE Foal- tuund ',,the f oilnnmg;ser'tlnne. I Code and 105 CAIR !40 Tt I 5911 nut. 3-1G3.1I(E) RemainineUnslicedl'ortimncol'Rcel' i Item Good-fie 0ii-racoces FC 5.40.000 Roasts' 23. hranaciemerl and Personnel FC--2 .003 (g Proper Cooling of PHFs I ( 24 r cod and Forma Protection FC--3 .004 25 Equipment anti utensils F(',-4 .005 3-501.14(A) Cooling C'cx)ked PIIFs from 1-.0'F it) ( 26. Water.Plumtanq a,d Waste PC-5M6 1 7WF Within 2 flouts and From 70`F 1 21 Physical Faci:ity C-6 66T - to 41`P/450F Within 4 Hour;. " 1 26 Poisonous or Tmx¢ Mstenals FC -7 .008 ?-501,14(6) Cooling PIIF,Made From Ambient 29 Special Rcgtdremer;ts 009 ! Tempei attire ingredients tit,!l"F/45'F i ( 80. Other Denotes Crncal ion;;it Ihr laderal 1940 Fund Code or 1+15 Colli 599 000. { CITY OF SALEM BOARD OF HEALTH Establishment Name: ( /J.C�1 ///_1 ( �/�//_O�/1 Date: l�-Z�- Page: of F Item Code C-Critical Item OF VIOLATION/PLAN OF CORRECTION Date -, No. Reference R—Red Item Verified PLEASE PRINT CLEARLY IVALP-/ nC `/�i a �/ iii,� o n% ry, i f y e � I � I � I tl ' I k � I I 1 ` 1 I ` I � 1 r 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. ��Qytti w ❑ Voluntary Disposal ❑ Other: -iu�.:4(C) PHFs Rere;Yect nt'1'empc rdiures Violations Related to Fccdoorne Illness laterventions and Risk According to Lae C-.n:ie d to Factors(items 1.22) (Cont.) 41`F 145'17 Within+4 Hear,;. ' PROTECTION FROM CHEMICALS 3 5111 1 Conlin;,t ledtods for PHI-'s 14 kCHood or Color Additives ( 1% PHF Hat and Cold Holding 16(11) Cold PT-IFn Maintained at .v below 3-202.12 Additivc,` 41 ,4i.5" 4 1 591).00-(F) 3-302.14 Protection from t:napprovcd AddinYe,s 13-501.16(A) 7lot PHFs Maintained at nr above 15 Poisonous or Toxic Substances 40'^ ( 7-101.11 Identifyinf: Container, 501.Ib(A) Roart,Holdatorabote130'€--. Co ' � 7-102.1 i Commtm ;Name -Working Containers' ' 2P Time as a Public Health Cont,of ; 5r11 17 Time ac a Public H:alth Connol 7-201.11 Scpaiation-Sturaec 7-202.!1Re,trivhon- Presence told Use'" 590.004(34) Vai:ante RequireuteW. 7-202 i; Condition;tit Uce" "_'03.11 Co is Container.- Pruhil,:tions' { REQU€REPdERd'f5 FOR HIGHLY SUSCEPTIBLE 7-1104.11 Sanitizcr,.Criteria--Cunicaii" POPULAT ONS(HSP) 7-_04.12 Chemicals for 1Vasluge Produce.l rite.tia" i 2i 3-fSOi.!I(A) iinp;astetuvedl're-packagedJuicesand 7-204.14 Drying Agents.Cnteria` ( l be.ehages with Warnine,lahnl.c* 7-205.11 Incidental Food+".nn?:K.Luhrcantc^ '-301 17('3) Use of Pastcarired E^_es' 501.1 ll7) Raw or Patt�al!v Ca,:ec Aninud Ftxxl and '1-206.1 i Restrieied Use Pe,ticides.Criteria= Raw Seed Jurouts Not Set vet. " 7-206.12 Rodent Bait Statiot:s" ( � ;-;i0 i.11(c) tinopennd Food Package Not R�sersed. " 7-20(1.13 1rackmg Powder:,Pest Control and A2.rn:iurin,,* CONSUMER ADVISORY TIMEITEMPER IT URE CONTROLS 12 3-603.1 I Consumer.Adeisory Posted fee Constunivion of iii Proper Cooking Temperatures for :Cntn;al Foods"Ptah %ac Raw Undercookrd or PHFs i Not Otherwise Pr;x:essed to Eliminate 3 1() P.tiho;; r�,r.,:. :•:ane. 111A(li(2) Eggs- i55'F 155rc F.ccs-6mneciiateSrcvice -3,°.i3 Pasteur:oarcsd..: 6ggt.Sub.tit.dc for Raw Shelf145'FI5secnI EggcW 344 I1 1I(A)(2) Comminuted Fish,Meats&Game Ataimals- i 55-F 15 sec. '� ! 3-401.1](1')(1)(2) Pork and Beef Roast. I30`F 121 min'` SPECIAL REQUIREMENTS 590.0;r),A)-(D) Violations of Section 590.009(A)-i(D) in 3-40 I(AN_) Rallies. Injected Meats- 155'17 ]5 I { } Sec. catetnig, mobile fn:xl, temporary and 3-401.1I(A)i3) Poultry, Wild6ame,Smtied PI-TFs. recident;a! kitchca operations should be Stuffing Contannng Fish,Meat, ticbited und.:r the apinonriate aecornis Poultry or Ratitet;-i65'F 15 sec. " above it rckaed to I;x)dbor tic illness n-401.1 HCV) lgfir4e-nntsde,Intact Rczf>!caks :ntervaitions and risk fat-tors. Other 45=P* 590.004 tdolations relating to good retail ? ul.I'_> Raw-Ammal Foods Conked in a practice, should he debitct:under N24- Rlicrcwaae 105'IF* Special Requircrocits. 3-407.1 ](A(lrb) All Odheh PHFs- 145'F i5 we * j 17 j Reheating for Hot Holding VIOLATIONS RELATER TO GOOD RETAIL PRACTICES 3-403.11(A)&(D) PHFs165'r' 15sec. '' (Items 23-30) 3-403.;UB) Mictmk%tve- 165' F 2 Mmule Standing j C:ilcral and nn;t-cri6cai violanwt.v, o1 ich do not relate to the Time' fonJuont:(1!ncs.c olir-r:enti,ms and i ivd ja,tee+ listed above, can be 3-403.11(C) Commcrctally Pioce:osed RTE Food - ,$atnd m the follutring w,r i.+as qt the Food Code and 105 CbIR i 4n.'F„ `r/Qix10. 1 3-+103.1 1(E) Rcnm:i6av;Pnsh:ed Portions of Beef' ( Iter.; Good Retail Practices FC. 500000 j Roaats' l 23. Maragament avid Personnel FC-2 .093 13 I Proper Coaling of PHFs 24 Food and Food Protection FC -3 .064 25. Equipment and Utensils FC-4 005 3-501 1-(A) Cooline Cooked PHFs from 140°P to ? o and b\a-te FC-5 --666 ---- 70"F Vr;hi 2 Hours:vol From 70'F 27 Physical Fartldv FC-6 .607 to 11"7T45'F Within 4 Hours. " 26 _ Posonws o:I oxi; ivlata::als FC--7 '�i .170£: j l 3-501.14(ln) Cooling PHFs Made 'rrom .Ambient 1119, SQ?cia:Reouirements Opo _ _ _J Temperatute Ingredients to 4 t"17145'F 30. Other j -- Within 4 Hour,# Denotes cnauil;rem m the fedora] 1999 Fuod C,.da or 105 C\.tR 59:,U!n;. CITY OF SALEM BOARD OF HEALTH Name of Establishment: Castillo's Grocery Address: 24 Palmer Street Owner(s): Victor Rodriguez Phone: 978-741-0295 Date: December 5, 2006 The brother of the owner of this establishment, Vincento Rodriquez, appeared to discuss the November 22-2006 hearing that required a cease of all meat-cutting operations at this establishment. Ward 1 City Councillor Lucy Corchado, Health Agent Joanne Scott, Inspector Pablo Valdez, and Senior Sanitarian Janet Dionne were also present. The Health Agent discussed the repeat critical violations observed by the Board of Health on several of the previous inspections. These include lack of access to the hand sinks, improper cleaning and sanitizing of the meat cutting instruments, lack of sanitizing of other utensils, improper temperatures in the refrigerator and freezer units, outdated food items, and lack of proper cleaning of the premises and equipment. Mr. Rodriquez has agreed to become a Certified Food Manager. Mr. Rodriquez also understands that the meat cutting process is not permitted . The meat cutting room must remain dismantled. All meat products must be purchased from a Wholesaler permitted by the State. Meat must be purchased pre-cut, prepackaged, with labels already placed stating the kind of meat, the weight, the sell by date, and the wholesaler's name and address. The Board of Health will re-evaluate this establishment for re-permitting the meat cutting process, if after six months all other critical violations are not observed during inspections and re-inspections and Mr. Vincento Rodriquez is Certified. Mr. Rodriquez was given the opportunity to ask questions and stated through the interpreters that he understood the discussion about the violations, their seriousness, and the restrictions placed on this establishment. do'a—n Scott Date Health Agent � n Vincento Rodriquez , Owner's Representative Date Pablo Valdez, Transrator Date CITY OF SALEM BOARD OF HEALTH Name of Establishment: Castillo's Grocery Address: 24 Palmer Street Owner(s): Victor Rodriguez Phone: 978-741-0295 Date: December 5, 2006 The brother of the owner of this establishment, Vincento Rodriquez, appeared to discuss the November 22,2006 hearing that required a cease of all meat-cutting operations at this establishment. Ward 1 City Councillor Lucy Corchado, Health Agent Joanne Scott, Inspector Pablo Valdez, and Senior Sanitarian Janet Dionne were also present. The Health Agent discussed the repeat critical violations observed by the Board of Health on several of the previous inspections. These include lack of access to the hand sinks, improper cleaning and sanitizing of the meat cutting instruments, lack of sanitizing of other utensils, improper temperatures in the refrigerator and freezer units, outdated food items, and lack of proper cleaning of the premises and equipment. Mr. Rodriquez has agreed to become a Certified Food Manager. Mr. Rodriquez also understands that the meat cutting process is not permitted . The meat cutting room must remain dismantled. All meat products must be purchased from a Wholesaler permitted by the State. Meat must be purchased pre-cut, prepackaged, with labels already placed stating the kind of meat, the weight, the sell by date, and the wholesaler's name and address. The Board of Health will re-evaluate this establishment for re-permitting the meat cutting process, if after six months all other critical violations are not observed during inspections and re-inspections and Mr. Vincento Rodriquez is Certified. Mr. Rodriquez was given the opportunity to ask questions and stated through the interpreters that he understood the discussion about the violations, their seriousness, and the restrictions placed on this establishment. ch 5`6 6 dda-nne Scott Date Health Agent Vincento Rodriquez , Owner's Representative Date Pablo Valdez, Translator Date CITY OF SALEM BOARD OF HEALTH Name of Establishment: Castillo's Grocery Address: 12524 Palmer Street Owner(s): Victor Rodriguez Phone: 978-741-0295 Date: November 22, 2006 The owner of this establishment, Victor Rodriquez, was requested to appear for a hearing regarding multiple repeat critical violations observed at his establishment during a re-opening inspection (closed because of building condemnation by Fire and Building departments) on November 21, 2006 by Senior Sanitarian Janet Dionne. Mr. Rodriquez was not able-to attend the hearing because of personal family reasons. Manager Francisco Castillo attended in his place. The inspection for 11-21-06, as well as all discussion regarding the violations observed then and during the several past inspections in 2005 and 2006 were translated to Mr. Castillo by Code Enforcement Inspector Pablo Valdez. Mr. Castillo was given the opportunity to ask questions and stated through the interpreter that he understood the discussion about the violations, their seriousness and indication of an increased risk of foodborne illness because of them. Mr. Castillo understands that the establishment must remain closed until the Board of Health re-inspects it on Friday and verifies that all critical violations have been addressed. Mr. Castillo also understands that the meat cutting process is no longer permitted and that operation is revoked. The meat cutting room must be dismantled and the meat saw removed. Joanne Scott Date Health Agent OLP Francisco Castillo, Manager Date Pablo Valdez Translator` Date 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 Operationfs), T%e of Inspection / CO S T l ll tfd (7I D/G vv9 /!�>Y�06 I ❑'Food Service ❑ Routine Addresssly Risk ❑ Retail [D°Re-inspection Level ❑ Residential Kitchen Previous Inspection TelephoneElMobile Date: �� _ 7y - 2 �`� ❑ Temporary ❑ Pre-operation Owner V 1 I'r1 r _fV I S HACC l i P YM [I Caterer YD N1 ❑ Suspect Illness Person in Charge(PIC) J Time ❑ Bed&Breakfast ❑ General Complaint In: f' S ❑ HACCP Inspector \� � �� Out:,! .W 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 El,_ - .. ... . ......... 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 j TIMErrEMPERATURE CONTROLS(Potentially Hazardous Foods) ❑ 5. Receiving/Condition ❑ 16.Cooking Temperatures ❑ 6. Tags/Records/Accuracy of Ingredient Statements ❑ 17. Reheating ❑ 7. Conformance with Approved Procedures/HACCP Plans ❑ 18.Cooling PROTECTION FROM CONTAMINATION ❑ 19. Hot and Cold Holding ❑ 8. Separation/Segregation/Protection ❑20.Time As a Public Health Control ❑ 9. Food Contact Surfaces Cleaning and Sanitizing REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) ❑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 23. Management and Personnel (Fc-2)(590.003) by a Board of Health member or its agent constitutes an order of the Board of Health. Failure to correct violations X24. 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 590199 IFOr 14 - Inspector's Signature` Print: -y PIC's Signature: �.r�� Print: vv I Page of4 Pages 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 Responsibility` 3-302.111 A)(1) Raw Animal Foods Separated from 590.003(B) Demonstration of Knowledge" _ Cooked and RTE Ftxids"' J 2-103.11 Person in charge-duties Contamination from Raw ingredients 3-302.11(A)(2) Raw Animal Foods Separated from Each EMPLOYEE HEALTH Other-' l 2 590.003(C) Responsibility of the person in charge to ( Contamination from the Environment require reporting by food employees and ( 3-302.1 t(A) Fund Protection" applicants'' I '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 Utcusils* Charge' Contamination Gum the Consumer 590.003(G) I Reporting by Person in Charge* j 3-306.14(A)(B) Returned Food and Reservice of Food* 3 1590.003(D) Exclusions and Restrictions* I Disposition of Adulterated or Contaminated 590,003(E) Removal of Exclusions and Restrictions Food 3-701.11 01.11 Discarding or Reconditioning Unsafe FOOD FROM APPROVED SOURCE Food* 4 Food and Water From Regulated Sources 9 ( Food Contact Surfaces - 590.004(A-B) Compliance with Food Law* 4-501.1 t 1 Manual Warewashmg-Hot Water 3-201.1-1 Food in a Hermetically Scaled Container* Sanitization Temperatures* - - 3-201.13 Fluid Milk and Milk Products* I ( 4-501.112 Mechanical Warewashina Hot Water 3-202.13 Shell Eggs* Sanitization Temperatures* _ 3402.14 Eggs and Milk Products.Pasteurized" ( 4-501.1 i4 I Chemical Sanitization-temp., pH, concentration and hardness. 3-201 16 Ice Made From Potable Drinking Water* 14-601 11(A) Equipment Food Contact Surfaces and ( 5-101 11 Drinking Water from an Approved System' � 590.006(A) Bottled Drinking Water* ( Utensils Clean* - 4-602.1 t Cleaning Frequency o1 E ui ment Food- 590 006(8) Water Meets Standards in 310 CMR 22.0' Contact Surfaces and Utensils* J Shefflish and Fish From an Approved Source 4-702.11 Frequency of Sanitization of Utensils and 3-201.14 Fish and Recreationally Caught Molluscan Food Contact Surfaces of Equipment" _ Shcllusca T-703.11 Methods of Sanitization-Hot Water and 3-201.15 Molluscan Shellfish from NSSP Listed I Chemical* J Sources* Game and Wild Mushrooms Approved by 110 Proper,Adequate Handwashing Regulatory Authority 2-301.11 Clean Condition-Hands and Alms'' 3-203.18 Shellstrx:k Identification Present* 2301.12 Cleaning Procedure* 590.004(0) Wild Mushrooms` 2-301.14 ( When to Wash* 3-201.17 Game Animals* i 11 Good Hygienic Practices g Receiving/Condition 2-401.11 I Eating,Drinking or Using Tobacco* 3-202.11 ( PHFs Received at Proper Temperatures* ' 401.12 Discharges From the Eyes, Nose and 3-202.15 Package hnte¢rity" I y ( Mouth* 3-101.11 Food Safe and Unadulterated* 13-301 12 ! Preventing Contamination When Tasting* 6 Togs/Records:Sheiistock ( 12 1 I1 Prevention of Contamination from Hands 3-202.18 Shelistock Identification * 1590.0(A(E) Preventing Contamination from 3-203.12 ( Shetlstock Identification Maintained" Employees* ( Tags/Records:Fish Products � 13 Handwash Facilities- _- 3402.11 Parasite Destruction* Conveniently Located and Accessible 3-402.12 Record:,Creation and Retention* 5-203.11 Numbers and Capacities* 590.0040) Labeling of Ingredients' 5-204.11 location and Placement* 7 Conformance with Approved Procedures 5-205.11 Accessibility.Operation and Maintenance /HACCP Plans Supplied with Soap and Hand Drying 3-502.11 Specialized Processing Methods* 1 Devices 16-301.1 t Handwashing Cleanser, Availability 3-502.12 Reduced oxygen Packaging.criteria* ____� 8-103.12 Conformance with Approved Procedures" 6-301.12 Hand Drying Provision *Denoles critical item in the federal 1999 Rxxl Cale of 105 CMIZ 59(1.(100. a CITY OF SALEM BOARD OF HEALTH Establishment Name: Date: filg"I 6 Page: 7 of 3 Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date No. Reference R—Red Item Verified PLEASE PRINT CLEARLY �rJa17 I/7 r V,4 712P 25 '— r/I0 in 1Vo,0e « 4uOe �GGwrny�✓� ion /ce I I k lr7/ef vo /71�7n - �r� f2Pl�n an s/7t . llvolGe ><a - — V� n-1 in f�flroorh /gel y/ar/L/.�G rorr�o(f� K�y��r 1 rr� r�lfll�+ce ✓�hE . � 1 I r�-c'OGhL i/7 /odes 1?a1l7r4 /��rr/rx • /�// 1 r G7 rGt�(Yq rpa T6 be r'-"VV•Cd /V be L2Ae_ an ZL /Ift <� �`/� I �vn2e�al��p . l�hlfi Fo be 1 nJ o F or hr //>w 4s rh4rIlA1 � 1 I 2�� 6r0/4f-� 6 IR ;.5 /J�or �� b"✓.eila'i6 r�/�G/ti >n , lae Mir 1 1 �m!�Ovlr��s bpi I'1-cif r�v�ihr lrsoicf'ia�. � Discussion With Person in Charge: / Corrective Action Required: I ElNo I ❑ les 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 understand that noncompliance may result in daily fines of twenty-five dollars or suspension/revocation of ❑ Embargo ❑ Emergency Closure your food permit. `X/ 6G� 4,41- ❑ Voluntary Disposal ❑ Other: i 3-541.14(c) PHF' Rt'eived at TenipcxatnrVi Violations Related to Foodborne Ificess Interventions and Risk Accordnq to Law Cooled to Factors(litems 1-?2, (cont.; 41-F/45'F Within 4flovis. PROTECTION FROM CHEMiCALS ;-501,15 Cooling Metho.,Js for PilFs 14 Food or Co:,r Additives 19 PHF Hot and Cold Holding 350:.16(B) Cold PF-IFs,'VI,�intaijwd at or he](11V 3-202.12 Addithes' 500.001(17) lq^ 3-30114 Pr,.1wchon from t 7 DapoI Substances jovd Additives' 1 16 15 Poisonous or Toxic S 3-501 0) Hot PHF,Mainained at�r abose 14()_'17, . * I I I Identif-mw Infonnation-Orwiaal INA; Roasts Held at or bON'L 130"U, Cuinainers' -;-102.1 1 1 1 20 Time as a Public Health Control 7-201.!1 sep�waLion-sturave" 3-501.19 Time as a Public Health Control* 7-201. 11 Restriction-Pice--ilce and Us--r }1)0.004('H) Variance Requirement 7-102.12 1 - �Qrahtion!,of Lae 7-203 11 Toxic Centainerr Prohibitions' REOUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-204.11 Sanitizefs.(fiterin-ChL!!'iCaIN* POPULATIONS`(HSP) 7-104.1'2 Cheaji,,nk for Wwhijw,Piodi 21 l :3-801.11(A) thipwacurized Prepackaged Juices and 7-204.1.1 D1 011e Catena' I i 13cietages with 1N arning 7-205.11 -i-80 L I I i B Ike of Pasteut ized EeQs" Incidental Food C011Eat Lubric,pis:: 3-8111.11(l)'1 Rav,,jf Partially Cooked Animal F,od and 7-106,11 K,,-;an;jcd U.,c Pe,:mdes, COtcria* I Raw Seed Sprouts Not Served. 7206.12 Rodent B�0 Stations 1206J3I n!cking Powders,Pes, Control and 1 3-501.1 I(C) Unopened Food Package Not Re-ser%cd. Mcniterin- CONSUMER ADVISORY TIME/TEMPERATURE CONTROLS 22 3-603.11 Consumer Ad4isory Posted for Consumption of 16 Proper Cooking Temperatures for Annual Foods'lliat irc Raw. undercooked o:PHFs Not 0diermsc Processed to Eliminate 3-401A IA(l I(,.) Fgg�,- 155'F 15 Sec. Eags lnuncdjatcSer,icc 145'Ft5secr 3-302.13 Pasteurized Eggs Substitute"or Paw Shell 3-10 1.11(A),'2) ('0mumfuted Fish, ageels&Gare Eggs* Animals- I.-,5'F 15 sea. " 401.i 1(11)(1)(2) P.,r1l, and Bvul Roast- 130'F 121 min* SPECIAL REQUIREMENTS 3 401.1 1(A)(2) Ratj te;j t j,Cuj %f,1,3 ).4,1 y 5(40 009(A)-(f) �i 15 ) Violations of Section 590.009(A)-(D) in sec. catering, mobile food, tempornow and 3 401.1 I(A)(3) Poultry,Wild Came,Stuffcd 111-fFs, residential kitchen operations should be Coe:-;mn- Fish,Meat, debited under the appropriate qectinns Poultry(it Ratites-'i'0515 sec above if related to foodborne illness 3--101.i i Whole-naiwic, fntaLt reef S1rak's Interventions and risk factors. Other 115"F'' 590.009 violations relating to good retail 3-401.12 Rtox'Animal Rcds C,,oked in a practices.should be debited tinder 1129- M;-j owave 165"F Special Requirements. 3-MIA I:Af(i)(b) I All Otip.,, PHFs- 145'F 15 ;-c, 17 Reheating for Hot Holding VIOLATIONS RcLATED TO GOOD RETAIL PRACTICES 3-.103.1 l,A)&(D) PFFs I e,50F 15 sic * 'items 23-30) 3-403.11(B) Microwave- 165° F 2 Minute Standinl,, '-aitind and non-crifiCal ciolaftons wbich do not relate m rbc Time* foodborne illness harrrvennon,8 and iiskfi,t tursliWel o,'.ovc. ran be 3-403.11(C) Connwrcirilf-,Proce,sed RTF Frv-A- /ozind in the fid!(,v,ific secrions of the Fami Code and 105 CNIR 140'F' I 500.000. 3-403. (1-1) Remaiian-','rr,Nced Porrions,)f Beef Item Good Retail Practices Fr 590.000 Roastn. Management and Personnel FC ? .003 " 2j� Food and Food Po-doction FC -1 o04 18 Proper Cooling of PHFs 25. Equipmentand Utensils F"-A '005 '1-50 1,141 A) Cooling Co�-kect PHF,from 140'F to 26, Watet, Plumbing and Waste '006 70 1- Within 2 Tfours and From 70-F 27, Physical Facility FC-6 .(,67 ---] 'w 41`F'/45`F Within I Hours. 1 28. Poisonous or Tome VlaterWs FC 7 .008 3-501.14(8) Cooling PffNiade From Ambient 29, S rcial Requaernents 009 Temperinrre ttigredient�to 41`!!'(4_`17 30, Other Witliin-llloar..` Dcno:,•; Tat,al i)inr iederai 19-;"F-xl('-&or 105 CNIR 51)0(103. r CITY OF SALEM // BOARD OF HEALTH Establishment Name: /"�.5 b1110 AfDGfYq Date: 11 ZN/06 Page: 3 of 3 Item Code C-Critical Item / DESCRIPTION OF VIOLATION/PL'AN OF CORRECTION Date No. Reference R—Red Item Verified PLEASE PRINT CLEARLY % sem ter' lli�o17 /17sX2e1:9�o,13 M15 �sfu �lslarnevr` / < Dov 1� / InS Cfar '40 Y4ltif I ,�tl O�v V/0/�7crnS �]�i ✓.� /� CoY//G�� . � I �i Y�/�c�✓ t0 4G /1✓ y, %{1 ON Guq Ill z 7166 -t'O rAPn67/YI/rl` V(Jlk > 70n < . I � 1 i ` Discussion With Person in Charge: Corrective Action Required: I ❑ No I ❑ Yes t 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 C3 Re-inspection Scheduled Z) 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. � � Lo �� ❑ Voluntary Disposal ❑ Other: J-5u1.1-I(C) PHP:•Re,eived of Tcniperaturrs Violations Rciatod to FoodAarne Olness Interventions and Fisk ' According to Li,,,, Coded to Factors(Item, 1-22) tL'ori./ ( 41'F/45`F Within a H(urs. PROTECTION FRd?M CHEMICALS '501 15 C,a;ling Methods for PHF;a j l9 PHF Hot grid Cold Holding j j ]$ faotl or Color Ar.'ditives � II i -2(1-„1Audi r.ves' 3-501.16(B) Cold PIPs Maintained at or behru •:,13 590.00=;F) FI'/45" P:: , I4 ,roteclio i ;-501.16(A) Hot PHFs Maintained at or above 15 Paisaroaus n*Yox-sc Sab:.taact'e: 14WE 7-101.11 ]rknt:t,neg ini;vub::.iotn-Ononmal l 3-50i.I h(A) Roasts Held it or above 1:0"F. Container' 7-102.11 Comm,st'Nalnr. - tkra7tir;p?l'a::ia,net s' ( ! 20 Time as a Public Health Control ( 3-501.19 Time as a Public Health Control* "r-3U L 11 Szparaticn--St,•aaee" 7-202.11 Re>t;id zon --Presenia and Variance Requumnent j 7-202.12 Concutionc of Use' REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-203.11 Toxic Co,.:.ince>a--r ltcuh'ns" POPULATIONS(HSP) 7-264.17 Jani!izcrs.Cnteria--Cl;emin:F;' 7-'04.12 Che::aeals for Yi'a,hws.Produce,Criteria" n1 3-801.1I(A'; Unnasrcm'Ized Pte-packaged.11itt.es unit 7"204.14 Drying A&cats.Criteria' j Beeerases with Warnim, 7-205.11 Incident.1FknniContort.Lu:-1 suns ! 3-hOLIi(B) Use n(Pasteurized 7-206.!! Pestnh tcd Ute Pectieidec. Cn.erin'" 3-801.11(D) Rau or Partial l v Cooked Ant rlial Foist and i Raw Seed Sprouts Not Set ved. ri.;i: '^ 7-206.12 Rodent Station-,- 3-801.1 l(C) Unopened Food Packas Net Re-served. ' 7-206.13 Tr;cking Powcerc, Prat Contra and �,tonitnrrn�m CONSUMER ADVISORY TIMFITE9l!PERATURE CONTROLS 22 3-603 11 Consumer Advisor} Posted li,r Consumptiva of Aninm! Foods Ilia, are Raw'.Undcrcnoked tits 1fi I Proper Corking Temperatures#m PHFS Not Otherwise Processed to Eliminate a1u er:c200- 3-401.11 A(I;(2) Eggz- 1.5 i'F !5 Sec. Pathogens, ! 3-362.13 Pasteunzed H e Substitute for Raw Shell Eggs-Immediate Servicc 1=45°F15set- g '; 3-401.1 h A)(2) Comminuted Fich, A,leats 8:Game Egg`* P.niaixls - i55'F 15 sec. SPECIAL REQUIREMENTS 3-401.!1(1>)U)(21 Puck ard]ieet'dMe,lt1=055'F1211 nin* � 590.00WA)-(D) Violations of Section 590.009(A)-(D) in i--}OLtI(A)(2) 8.ltitrs; inectei Mean- 155`F IS ec '•` catering, mobile food, temporary and 3-401.1 I(A)(3) Poulin,Wild Ginnie,Stufled"HFs, I residential kitchen operations should be Stuft;ne Conr:ipma Fish, meat, debited under the appropriate seclions Pou!trt or Ratites-165`F 15 sec. above if related to foodhorae Illness + 401st i(C)t z) Whole-muscle,hitao Beef Steaks interventions and risk factors. Other 1=450F 590 009 violations relating to good reiad 3-401.12 Pace .Animal Foch Cooked in aI practices should be debited u.^.der #29 - Mic:otave 165'F' Special Requirements 17 '! 3-461.II(A)(lab) .SII Other PHF,- 145°FlSecc. * ! reheating for Hot Holding VIOLATIONS P-LATED TO GOOD RETAIL PRACTICES j 3 403.11(A)&(D) PHT, 165'T'15 sec. s` (lteutS 23-30) 3=ii) .11(BI Microwave- 165' F 2 Minute StauS:u; Ciincal and non-critical crolationv, whrch dei not is nee to rile Time* fnodborne d)ness imerventrnm and risk%n(tor:s 1611 l above ran be 3-403.!1(C) Commcrcially Processed RTL Ecru]- found in theJollmring leerions at the Fond Codc and Iii)01R i 140 TF I 590.000 3-403.1I(E) Remaining liushcedVortions;,jBuef it Item I Good Retail Practices FC 590.000 Mo.lAs", 23. Management and Personnel FC -2 .003 18 Proper Cooling of PFFs 24. Food and Food Pro!ection FC - 3 004 ?5. Equipment and Utensils FC-4 : .005 3-501 14(r1) Cooling Cooker{PHFc from 140"F to I 26 WWater, Plumhinq and Waste FC-5 00e 7WF Within 2 1(oars and From 70'F 27. Physlaal Farility FC-6 007 to-1`Fi45'F Pv IE h:n 4 Hours. 1 28. Poisonous or i owe Materials FC -7 .008 3-501.A(B) Cooling PHR Made From.ymbtent 29 Special requirements 009 Temperature htnredienr;t(�41'F145 F' 30 Othe! Within 4 I-blurs z ere.:re-x:m, 1:1 CD Itc,'o'mc!vein m ihr,hb 1el 11)01)Food C,xie o,105 f`p.IR 590 u00 CITY OF SALEM BOARD OF HEALTH Name of Establishment: Castillo's Grocery Address: 12524 Palmer Street Owner(s): Victor Rodriguez Phone: 978-741-0295 Date: November 22, 2006 The owner of this establishment, Victor Rodriquez, was requested to appear for a hearing regarding multiple repeat critical violations observed at his establishment during a re-opening inspection (closed because of building condemnation by Fire and Building departments) on November 21, 2006 by Senior Sanitarian Janet Dionne. Mr. Rodriquez was not able to attend the hearing because of personal family reasons. Manager Francisco Castillo attended in his place. The inspection for 11-21-06, as well as all discussion regarding the violations observed then and during the several past inspections in 2005 and 2006 were translated to Mr. Castillo by Code Enforcement Inspector Pablo Valdez. Mr. Castillo was given the opportunity to ask questions and stated through the interpreter that he understood the discussion about the violations, their seriousness and indication of an increased risk of foodborne illness because of them. Mr. Castillo understands that the establishment must remain closed until the Board of Health re-inspects it on Friday and verifies that all critical violations have been addressed. Mr. Castillo also understands that the meat cutting process is no longer permitted and that operation is revoked. The meat cutting room must be dismantled and the meat saw removed. Joanne Scott Date Health Agent 4 Francisco Castillo, Manager Date 2 2- Pablo Valdez, Translator° Date 24 Palmer Street Castillo Grocery City of Salem RETAIL FOOD - Food Establishment Inspection HACCP: ❑ Item Status Violation Critical Urgency Telephone: PROTECTION FROM CONTAMINATION 978-741-0295 Food Contact Surfaces Cleaning and Sanitizing FAIL Critical ❑d RED Owner: Comment:All cutting boards are badly stained and scored. Resurface or replace all cutting boards. Victor J. Rodriguez PIC: Violations Related to Good Retail Practices (Blue Items) Victor Rodriguez Food and Food Protection FAIL Critical BLUE Inspector: Comment:The walk in freezer has food stored directly on the floor. All food must be stored at least 6-8 inches off the floor. David Greenbaum Date Inspected: Correct By: 9/1512006 Equipment and Utensils FAIL Non-Critical BLUE Risk Level: Comment:The shelves with the potatoes and onions have an accumulation of grime and food debris. Thoroughly clean these shelves. Permit Number: The front ice cream freezer needs a thorough cleaning. BHP-2006-0040 Status: Physical Facility FAIL Non-Critical BLUE SIGNED OFF #of Critical Violations: Comment:There are unfinished shelves in the meat room. Finish shelves to impervious and easily cleanable. � 2 GENERAL COMMENTS: Time IN: Time OUT: 827:A11 other violations cited in the 9/7/06 inspection report have been corrected. 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 15,2006 ) Page I oft Item Status Violation Critical Urgency RED:. " Violations Related to Foodborne Illness Interventions and Risk Factors (Require., immediate corrective action) City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741-1800 GeoTMS®2006 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Sep 15,2006 ) Page 2 oft 24 Palmer Street Castillo Grocery City of Salem RETAIL FOOD - Food Establishment Inspection HACCP: ❑ Item Status Violation Critical Urgency Telephone: PROTECTION FROM CONTAMINATION 978-741-0296 Food Contact Surfaces Cleaning and Sanitizing FAIL Critical ❑J RED Owner: ! me mnt:There are dirty knives stored in the knife rack. All knives must be properly cleaned and sanitized prior to storage. Victor J. Rodriguez PIC: All cutting b rds are badly stained and scored. Resurface or replace all cutting boards. Victor Rodriguez Th bay sink is not being used properly. The 3 bay sink must be used in a three part system to wash,rinse and sanitize all dishes Inspector: d utensils. David Greenbaum Handwash Facilities FAIL Critical ❑d RED Date Inspected: Correct By: cme The nathroom hand wash sink found obstructed. Keep hand wash sink clear and accessible at all times. 9/7/2006 Risk Level: bathroom needs a wall hung soap dispenser. TIME/TEMPERATURE CONTROLS(Potentially Hazardous Foods) Permit Number: Hot and Cold Hol 'ng FAIL Critical [V� RED BHP-2006-0040 ment:The wall walk in/reach in had a temperature of 50°F. Repair unit to maintain a temperature of 41°F or below. Status: 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®2006 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Sep 12,2006 ) Page I of t 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:The walk in freezer has food stored directly on the floor. All food must be stored at least 6-8 inches off the floor. immediate corrective action) we[ a k in/reach in has food stored directly on the floor. All food must be stored at least 6-8 inches off the floor. T re are price labels obscuring expiration/sell by dates. Do not obscure expiration/sell by dates with price labels. The following items found outdated at the time of inspection: 10-bags cheese 14-Nutrament drinks 7-Boxe cocoa 3-pa ke mix 8- xes cereal 1 -Mayo 5-trema de maiz 4-Quaker instant oats 15-Quaker corn meal 29-Grape nuts 11 -salad dressing 24-mac&cheese 19-cans juicy juice Owner must closely monitor all expiration and sell by dates to insure no expired product is out for sale. Equipment and tensils FAIL Non-Critical BLUE C in t:The walk in freezer has an accumulation of food debris and spills and splatter. Thoroughly clean the entire walk in freezer. Th alk in freezer needs a visible,accurate thermometer. Th rapping machine has an accumulation of food debris. Thoroughly clean the wrapping machine. Th op stored incorrectly. Clean the mop and store upsidedown not touching surface to air dry. , II walk in/reach in needs a thorough cleanin including under all racks. The shelves with the potatoes and onions have an accumulation of grime and food debris. Thoroughly clean these shelves. e trays in the front meat case have an accumulation of food spills. Thoroughly clean the trays. T fron meat case needs a thorough cleaning. T fro deli case has a puddle in the bottom. Repair case to prevent leaks. e front eli case has an accumulation of food spills and splatter. Thoroughly clean this case. Th ins in front of the meat case have an accumulation of grime. Thoroughly clean the bins. 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 12,2006 ) Page 2 of ,t Item Status Violation Critical Urgency ZwwTho fron a cream freezer needs a thorough cleaning. same unit needs a visible,accurate thermometer. Physical Facility FAIL Non-Critical BLUE Comment:There are unfinished shelves in the meat room. Finish shelves to impervious and easily cleanable. The Is and floor in the meat have an accumulation of food spills,splatter and debris. Thoroughly clean all walls and floor 4i u ' g under and around all equipment. ere are water stained ceiling tiles in the restroom. Investigate the source of the leak and repair. Replace all stained ceiling tiles. T athr om needs a thorough cleaning and organizing including all fixtures. Remove all items from the restroom Th ails around the front hand wash sink and front prep area have an accumulation of food spills and splatter. Thoroughly clean walls. L. etire establishment os in need of a thorough cleaning. GENERAL COMMENTS: 794:Reinspection will be 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®2006 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Sep 12,2006 ) Page 3 of 3 24 Palmer Street Castillo Grocery City of Salem RETAIL FOOD - Food Establishment Inspection HACCP: ❑ Item Status Violation Critical Urgency Telephone' PROTECTION FROM CONTAMINATION 978-741-0295 Handwash Facilities FAIL Critical ❑J RED Owner: Comment: Remove all items from the bathroom and keep the handwash sink clear and accessible at all times. Including the video Victor J. Rodriguez game. Owner will remove items by the next routine inspection. PIC: GENERAL COMMENTS: Victor Rodriguez 596:AII other violations cited in the 4/11/06 reinspection report have been corrected. Inspector: David Greenbaum There is cardboard on the racks of the wall reachin. Remove cardboard to prevent the restriction of air flow. Date Inspected: Correct By: Owner will notify the Board of Health within 2 days. 5/2/2006 Risk Level: Permit Number: BHP-2006-0040 Status. SIGNED OFF #of Critical Violations: 1 Time IN: Time OUT Urgency Description(s): BLUE: Violations Related to Good Retail Practices (Critical violations must be corrected immediately or within 10 days)(Non-critical violations must be corrected immediately or within 90 days) City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741-1800 GeoTMS®2006 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. May 02,2006 ) Page I of Item Status Violation Critical Urgency [and : tions Related to borne Illness Interventions Risk Factors (Require ediate corrective action) Ci of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970 978 741-1800 City 9 ( ) GeoTMS®2006 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. May 02,2006 ) Page 2 oft 24 Palmer Street Castillo Grocery City of Salem RETAIL FOOD - Food Establishment Inspection HACCP: ❑ Item Status Violation Critical Urgency Telephone: PROTECTION FROM CONTAMINATION 978-741-0295 Handwash Facilities FAIL Critical R1 RED Owner: , +. Comment: Remove all items from the bathroom and keep the handwash sink clear and accessible at all times. Including the video Victor J. Rodriguez game. PIC: TIME/TEMPERATURE CONTROLS(Potentially Hazardous Foods) Victor Rodriguez Hot and Cold Holding FAIL Critical RED Inspector: III Comment:The freezer on the back wall of the store had a temperature of 20°F. Repair unit to maintain a temperature of 0°F or David Greenbaum below. Repair order has been made by Brito Refrigeration. Date Inspected:ICorrect By: 4/11/2006 Violations Related to Good Retail Practices (Blue Items) Risk LevelFood and Food Protection FAIL Critical BLUE 1,�Comment:There is food stored directly on the floor in the wall reach in/walkin and in the store. Store all food at least 6-8 inches off Permit Number: v the floor. BHP-2006-0040 Status. PARTIAL COMPLY Physical Facility FAIL Non-Critical BLUE 'i #of Critical Violations: g Comment:The side door has gaps at the bottom. Provide a sweep at the bottom of this door. Time IN Time OUT Urgency Description(s)' BLUE. Violations Related to Good GENERAL COMMENTS: Retail Practices (Critical 560:552:Reinspection will be 5/2/06. All outstanding violations to be corrected. violations must be corrected immediately or within 10 All other violations cited in the 4/4/06 reinspection report have been corrected. days)(Non-critical violations must be corrected immediately Any future repeat violations will result in monetary fines of$25.00 per violation be or within 90 days) City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741-1800 GeOTMS®2006 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Apr 12,2006 ) Page 1 oft Item Status Violation Critical Urgency RED: Violations Related to Foodborne Illness Interventions and Risk Factors (Require immediate corrective action) City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741-1800 GeoTMS®2006 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Apr 12,2006 ) Page 2 oft 24 Palmer Street Castillo Grocery City of Salem RETAIL FOOD - Food Establishment Inspection HACCP: ❑ Item Status Violation Critical Urgency Telephone: PROTECTION FROM CONTAMINATION 978-741-0295 Separation/Segregation/Protection FAIL Critical RED Owner: V Comment: Label 3 bay sink wash-rinse-sanitize. Victor J. Rodriguez Food Contact Surfaces Cleaning and Sanitizing FAIL Critical RED PIC: Victor Rodriguez V Comment:The cutting boards in the meat room and int a front of the store are badly stained and scored. Resurface or replace all cutting boards. Inspector: David Greenbaum Handwash Facilities FAIL Critical RED Date Inspected: Correct By' Comment: Remove all items from the bathroom and keep the handwash sink clear and accessible at all times. 00 Risk Level. TIMEITEMPERATURE CONTROLS(Potentially Hazardous Foods) Risk BVHot and Cold Holding FAIL Critical RED Permit Number: 311 Comment:The freezer on the back wall of the store had a temperature of 32`F. Repair unit to maintain a temperature of 0°F or BHP-2006-0040 below. Status: PARTIAL COMPLY #of Critical Violations: 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®2006 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Apr 05,2006 ) Page 1 oft =y 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 d'M and Risk Factors (Require Comment:There is food stored directly on the floor in the wall reach in/walkin and in the store. Store all food at least 6-8 inches off immediate corrective action) the floor. Equipment and Utensils FAIL Non-Critical BLUE A� Comment:The shelves in the meat cutting room are unfinshed. Finish shelves to be impervious and easily cleanable. V The freezer in the back of the store has an accumulation of food debris,spills and splatter. Thoroughly clean this freezer. '40 The shelving units in the back of the store are unfinished. Finish shelves to be impervious and easily cleanable. I/There are dirty mops stored directly on the floor and in the mop bucket. Store mops upside down not touching any surface. Physical Facility FAIL Non-Critical BLUE Comment:The walkin floor is in disrepair. Repair Floor to be completely impervious and easily cleanable. .,r. The side door has gaps at the bottom. Provide a sweep at the bottom of this door. Y There are water stained ceiling tiles in the bathroom. Investigate the source of the leak and repair. Repair all stained ceiling tiles. ? There are broken/damaged Floor tiles thoroughout the establishment. Replace all broken/damaged floor tiles. NEW: Make sure all fluorescent light fixtures have protective covers. Including all refrigeration units. GENERAL COMMENTS: 552:Reinspection will be in one week. All outstanding violations to be corrected. All other violations cited in the 3/27/06 inspection report have been corrected. Any future repeat violations will result in monetary fines of$25.00 per violation being issued. City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741-1800 GeoTMS®2006 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Apr 05,2006 ) Page 2 oft I 24 Palmer Street Castillo Grocery City of Salem RETAIL FOOD - Food Establishment Inspection HACCP: ❑ Item Status Violation Critical Urgency Telephone. PROTECTION FROM CONTAMINATION 978-741-0295 Separation/Segregation/Protection FAIL Critical RED Owner: bj�llcomment: Both 3 bay sinks are not being used properly. 3 bay sinks must be used in a 3 part system to wash, rinse and sanitize all Victor J. Rodriguez dishes and utensils. PIC: (,/There pans,dishes and utensils stored under and around the counter handwash sink. Store all pans,dishes and utensils in a Victor Rodriguez proper storage area to prevent cross contamination. Inspector: Food Contact Surfaces Cleaning and Sanitizing FAIL Critical ❑d RED David Greenbaum Y Comment:There is an accumulation of food debris on the entire meat saw and blade. The meat saw and blade MUST properly Date Inspected: Correct By: cleaned and sanitized after each use. 3/27/2006 The cutting boards in the meat room and int a front of the store are badly stained and scored. Resurface or replace all cutting Risk Level: boards. Permit Number: There are dirty knives stored in the meat room. All knives MUST be properly cleaned and sanitized after each use. BHP-2006-0040 VThe meat slicer in front has an accumulation of food debris. Thoroughly clean and sanitize the meat slicer after each use. Status: VIOLATION � There is no sanitizing solution available in the establishment. Sanitizing solution of proper concentration MUST be readily available at all work stations at all times. # of Critical Violations: Handwash Facilities FAIL Critical ❑d RED Time IN Time OUT :r Comment: The bathroom handwash sink found obstructed. Remove all items from the bathroom and keep the handwash sink clear and accessible at all times. Urgency Description(s): 14ne front hand wash sink found obstructed. Keep handwash sink clear and accessible at all times. BLUE. Violations Related to Good TIMEITEMPERATURE CONTROLS(Potentially Hazardous Foods) Retail Practices (Critical Hot and Cold Holding FAIL Criticald❑ RED violations must be corrected Comment:The meat cutting room had a temperature of 50°F. Repair cooling unit to maintain of 41°F below. Immediately or within 10 days)(Non-critical violations The freezer on the back wall of the store had a temperature of18°F. Repair unit to maintain a temperature of 0°F or below. must be corrected immediately or within 90 days) The wall produce cooling unit had a temperature of 50°F. Repair unit to maintain a temperature of 41°F or below. City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741-1800 GeOTMS®2006 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev Mar 28,2006 ) Page I of Item Status Violation Critical Urgency RED: Violations Related to Good Retail Practices (Blue Items) Violations Related to Food and Food Protection FAIL Critical BLUE Foodborne Illness Interventions and Risk Factors (Require Comment:There are price labels covering expiration/sell by dates. DO NOT cover any expiration/sell by dates with price labeles. immediate corrective action) There is food stored directly on the floor in the wall reach in/walkin and in the store. Store all food at least 6-8 inches off the floor. The following items were found outdated at the time of inspection: 7-Nutrament drinks 3-112 Gallons of strawberry milk 2-112 Gallons of chocolate milk 7-14oz milk 10-soy milk 9-quarts of milk 5-112 gallons of 2% milk 6-Pan Sobao(bread) 1 -complete wheat bran 19-8oz Parmesan Cheese 11 -3oz Parmesan Cheese 29-gravy 9-15oz Bread crumbs Owner must closely monitor all expiration dates to insure no expired product is out for sale. Equipment and Utensils FAIL Non-Critical BLUE I Comment:The meat cutting room walls have an accumulation of food debris,spills and splatter. Thoroughly clean the walls. The flooring in the walkin has an accumulation of food spills and splatter. Thoroughly clean the floor including under all shelving. All shelving in the walkin has an accumulation of food spills and splatter. Thoroughly clean all shelving. 4-The shelves in the meat cutting room are unfnshed. Finish shelves to be impervious and easily cleanable. The wrapping machine needs a thorough cleaning. V The wall cooling unit has an accumulation of food debris and grime. Thoroughly clean the wall cooling unit. The freezer in the back of the store has an accumulation of food debris,spills and splatter. Thoroughly clean this freezer. The shelving units in the back of the store are unfinished. Finish shelves to be impervious and easily cleanable. VThe wood shelves where the onions are has an accumulation of food spills and debris. Thoroughly clean these shelves. /The front side deli cooling unit has an accumulation of food spills and splatter. Thoroughly clean this unit and all trays in the unit. WThe front cooling unit needs a thorough cleaning. VThe wall cooling unit with the produce needs a thorough cleaning. VClean and defrost the front ice cream freezer. 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 28,2006 ) Page 2 of Item Status Violation Critical Urgency t " There are dirty mops stored directly on the floor and in the mop bucket. Store mops upside down not touching any surface. V The walls behind the front counter have an accumulation of food spills and splatter. Thoroughly clean the walls. Physical Facility FAIL Non-Critical BLUE Comment:The walkin floor is in disrepair. Repair or replace the walkin floor. The side door has gaps at the bottom. Provide a sweep at the bottom of this door. There are water stained ceiling tiles in the bathroom. Investigate the source of the leak and repair. Repair all stained ceiling tiles. There are broken/damaged floor tiles thoroughout the establishment. Replace all broken/damaged floor tiles. GENERAL COMMENTS: 541:Reinspection will be in one week. All violations to be corrected. Any future repeat violations will result in monetary fines of$25.00 per violation being issued. City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741-1800 GeoTMS®2006 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Mar 28,2006 ) Page 3 of �.e�x-. ,�:.,« ,1w��'+';w.'i' �Zis ur:✓r`.-y ai.- - a"�.. , .�1:Aiwee �"4•tm �r.twe.��-�:$:fy;.�.v*�c+d'r•-«w-'{:.-swo �mT... . .'.h,r"RF•'A��N s¢�*'e.F*' n:^t _ R�w+ns.�#•Yy1,,TG,�.'•v::u^'1� rC T�x'�"4±wr5t't'� '_ 1%�. .. .,v ., . 4 z. .,�Sy r .,r•, . $: �°,r'.+3+e:rvg� ° .w ";. < rI - we ,,?.. ., ., ix ` - - . • Commonwealth otMassachusetts,. �_ - ` n. :,: .. , , City ofSalem Board of Health 120 Washington Street,4th Floor s , SALEM,MA 01970 v Food/Retail Establishment Permit DATE PRINTED 01/02/2006 WHO'S PLACE OF BUSINESS IS: Castillo Grocery File Number:BHF-2004-0106 24 Palmer Street Salem MA 01970 LOCATED AT: SALEM, MA 01970 Permit Type Permit No. Permit Issued Permit Expires Fee Restrictions/Notes RETAIL FOOD BHP-2006-0040 Jan 2,2006 Dec 31,2006 $50.00 TOBACCO VENDOR BHP-2006-0041 Jan 2,2006 Dec 31,2006 $50.00 Total Fees: $100.00 PERMIT EXPIRES December 31, 2006 Board of Health ��-- This Permit is not transferable and must be reissued upon change of ownership or location.The permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code,beofre any revonations,improvements,or equipment changes are made,all plans for such must be submitted to and approved by the Salem Board of Health. Page 11 of 26 CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH a 120 WASHINGTON STREET, 4TH FLOOR SALEM, MA 01970 TEL. 978-741-1800 deo STANLEY J. USOVICZ, JR. FAX 978-745-0343 C0& MAYOR WWW.SALEM.COM "79OO�s <Oot JOANNE SCOTT, MPH, RS, CHO HEALTH AGENT �/x 2006 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT �� p NAME OF ESTABLISHMENT C,�,27140 �vr�0Ce KTEL# ADDRESS OF ESTABLISHMENT 2 451 PWMef Stt'ee� / 3*e"04- !til/ — MAILING ADDRESS (if different) /��Q OWNER'SNAMEJSCt g (l f�J��UB� TEL# ADDRESS , O S /i CITY,34teitA STATE t1A A ZIP — CERTIFIED FOOD MANAGER'S NAME(S) 0 Z 7 CERTIFICATE#(s)�8 (required in an establishment where potentially hazardous food is prepared.) EMERGENCY RESPONSE PERi-) eG ri �V HOME TEL# HOURS OF OPERATION: Mon.STue._5- Wed. LThu. ZFri. ' Sat. f qit�$Sun2.ZK�/- TYPE OF ESTABLISHMENT FEE (check only) 'RETAIL_STORR ES NO less than 1000sq.ft. =$ 50 0,000 =$100 more t more than 10,00000sq.ft. =$250 RESTAURANT YES NO less than 25 seats $100 25-99 seats =$150 more than 99 seats =$200 ------------ --------- ------------------------------------------------------------------------------------$- -10------------------ BED/BREAKFAST YES NO 0 - - ---------------------------------------------------------------------------------------------------------------------------- ADDITIONAL PERMITS tv1AKE (not just serve) ICE CREAM, YOGUP.T, SOFT SERVE YES NO $5 TOBACCO VENDOR (E 3a-6(P 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. i _ f c ► /2- o5-�S l D- f12-�v Signature Date Social Security or Federal Identification Number �1----------� -------------------------------------------- - ------------------------ -- Revised 11/03/05 FOODAP2.adm Check#&Dale ��o 0 CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH 120 WASHINGTON STREET, 4TH FLOOR SALEM, MA 01970 TEL. 978.741-1800 STANLEY J. USOVICZ, JR. FAX 978.745-0343 MAYOR WWW.SALEM.COM j„ c7j-f?J JOANNE SCOTT, MPH, RS, CHO October 17,2005 HEALTH AGENT Castillo Grocery 24 Palmer Street Salem,MA 01970 Dear Owner: On Monday October 3,2005 personnel from the Tobacco Control Program conducted a compliance check to determine if your permitted establishment would sell a tobacco product to a minor. A 17-year-old female purchased cigarettes from a clerk in your store. Documentation is now on file at the Board of Health regarding that sale. Castillo Grocery is in violation of Section lll(A)of the Salem Board of Health Regulation Affecting the Purchasing of Tobacco Products. According to this section,the sale of cigarettes, chewing tobacco,snuff, or any tobacco in any of its forms to any person under the age of eighteen shall be punished by a fine of jTwo Hundred Dollar fine)for the blmQ, ! FOLLOWING THE THIRD (3RD)OFFENSE, E BOARD MAY CONSIDER POSSIBLE REVOCATION OR SUSPENSION OF THE PERMIT. The North Shore Tobacco Control Program and the Salem Board of Health have worked with you and your employees to demonstrate methods to ensure compliance with this regulation. ' Therefore,you are ordered to pay a fine of$200.00 for the violation stated above. A check or money order payable to the City of Salem must be at the Board of Health office, 120 Washington Street,4th floor,within ten days of receipt of this notice. Should you be aggrieved by this Order, you have the right to request a hearing before the Board of Health. A request for such a hearing must be received in writing in this office of the Board of Health within seven (7) days of receipt of this Order. At said hearing,you will be given the opportunity to be heard and to present witness and documentary evidence as to why this Order should be modified or withdrawn. You may be represented by an attorney. Please also be informed that you have the right to inspect and obtain copies of all relevant inspection or investigation reports,orders,and other documentary information in the possession of this Board, and that any adverse party ties the right to be present at the hearing. If you have any questions regarding this notification please call me at 741-1800, ;cery your Jonne0:'Sottc Health Agent JStmfp CERTIFIED MAIL: 7003 3110 0005 1992 2131 cc: North Shore Tobacco Control Program Christina Harrington, Board of Health Chairman and Members ( YMPORTANT MESSAGE ) , DATFCfR EG9G STIME I�^ U M V/c,'td2 /�rbelf d e.2 OF ASI 11611_f PHONE Lq IF-- Ol0 Q= 9d 7� AREA CODER EXTENSION ❑ FAX ❑ MOBII F 1 i AR CO El I NUM R� /PWE TO CALL TELEPHONED ' A/'Z LL CAME TO SEE YOb d ILL CALL AGAIN WANTS TO EO� ERUSH URNEYE�CALL k (' WILL FAX TO YOU MESSAGE Ae, Aceined /whcc fe ' f-P&cca lllelaki - wlo As /s Ills ,Sano 8,ed aeF,,vse. Oawej6 /o ee Ivy 13 2,117M A — J)1D 7,^h21 e <S�o,Pe A/o�me. SIGN �L FORM 400 A ��1 MADE IN U.S A NOTES ,t. i (' IMPORTANT MESSAGE ) FO // r/-/'l 11-��D �/�.,�7A,M. DATE TIM � OF PHONF ASiEA CODE NUMBER EXTENSION ❑ FAX Q MOBII F AREA CODE NUMBER TIME TO CALL TELEPHONED ' -- LEASE CALL (� CAME TO SEE YOU I WILL CALL AGAIN WANTS TO SEE YOU I RUSH RETURNED YOUR CALL I� WILL FAX TO YOU MESSAGES - � < If Y SIGNED � t �/,/ �sFORM 4009 �(��y MAGE IN U S A. NOTES ry K �I I CASTILLO GROCERY 05-04 2153 VICTOR J. RODRIGUEZ CATALINA CASTILLO 24 PALMER STREET SUITE 1 5.701712110 i _= SALEM,MA 01970 //v1�16 //-r ' /'�+� 146 g ,. 7 <, F��y� �� (""�— Q `tel /r v✓�f y� O lotCitizens Bank Massachusetts �, 118002iS30I t: 21107017S,: 113SS3SI30611 CITY OF SALEIVhjMASSA,CHUSETTS '. t4 1 120 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: RETAIL FOOD Name of Establishment: Castillo Grocery Address of Establishment: 24 Palmer Street Owner's Name: Victor J. Rodriguez Restrictions: Application Date: 12/6/2004 Permit for Food Establishment 190-05 Frozen Desserts/ice Cream Permit for the Sale of Tobacco Products 44-05 These Permits Expire December 31, 2005 This permit is not transferable and must be reissued upon change of ownership or location. The permit must be posted in a prominent location in the Establishment, In accordance with the State Sanitary Code, before any renovations, improvements, or equipment changes are made, all plans for such must be submitted to and approved by the Salem Board of Health. HEALTH AGENT CITY OF SALEM, MASSACHUSETTS r BOARD OF HEALTH 120 WASHINGTON STREET, 4TH FLOOR ?a SALEM, MA 01970 ^' TEL. 978-741-1800 FAX 978-745-0343 STANLEY J. UISOVICZ, JR. JOANNE SCOTT, MPH, RS, CHO MAYOR HEALTH AGENT 2005 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT NAME OF ESTABLISHMENT�Q_ S�J�Cd ,F&09-t'�-I TEL# ADDRESS OF ESTABLISHMENT /j yi MAILING ADDRESS (if different) OWNER'S NAME —A IQ Il p D df l-cyme TEL# Z 9�''�/—/9/ ;LV1 ADDRESS b Si¢GeAl �7 v BAIZ CITY A4_ CTA.TF T 71P�.' -'Lcf 1?LV•. CERTIFIED FOODMANAGER'S NAME(SLWL4eR A- 2yt k*ERTIFICATE#(s) (required in an establishment where potentially hazardous food is prepared.) EMERGENCY RESPONSE PERSON D1ot.1— HOME TEL F4/ HOURS OF OPERATION: Mon. �1/19PTue. ,DAAed.' D©fhu. i ODFri. ,'resat. Mun. 01� TYPE OF ESTABLISHMENT FEE check only RETAIL STORE YES NO less than 1000sq.ft. P= 1 $ 50 1000-10,000sq.ft. 100 more than I0,000sq.ft. =$250 RESTAURANT YES NO �Q/�>�5 less than 25 seats =$100 ((VV 25-99 seats =$150 more than 99 seats =$200 BED/BREAKFAST YES NO $100 ADDITIONAL PERMITS MAKE (not just serve) ICE CREAM, YOGURT, SOFT SERVE XES NO $5 TOBACCO VENDOR d YES NO $50 ALLA1n,e�r-PRO IT(Such as church k:tchens) jsw YES NO $25 nv Please pay total with one check payable to the City of Salem This Permit is not transferable and must be reissued upon change of ownership. The Permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code, before any renovations, improvements, or equipment changes are made, all plans for such must be submitted to and approved by the Salem Board of Health. Pursuant to MGL Chapter 62C, Section 49A, 1 certify under the pains and penalties of perjury that I, to my best knowledge and belief, have filed all state tax returns and paid all state taxes required under the law. Signature Date /zzSocial Security or Federal Identification Number ........ ....J ---------- - Revised 11/03/03 FOODAP2.adm Check#8 Date�� ' _1,. -,.. r-•A�.,,,,,,, ... --F• '..yart." ,,. .fl.a,n w�r ,n+v�� .w. . "S .. r-sm.• •-L.,r.-....,,.,...,p ,. l^'u` ,. 4 i Massachusetts Department of Public Health Salem Board of Health 120 Washington Street,41h Floor Division of Food and Drugs Salem, MA 01970-3523 FOOD ESTABLISHMENT INSPECTION REPORT Tel. (978) 741-1800 Fax (978) 745-0343 Name _ I r / 4atg TYDe of Ooeration(s) TYDe of Insoection Cxh �I - 1 (' Y1YOrr IQIf,gf;)I- ❑ Food Service ❑ Routine Address n Risk i ❑ Retail ❑ Re-inspection Telephone ( - - ? I Level ElResidential Kitchen Previous Inspection _ ❑ Mobile Date: / Owner WINp �'�YG 1 / p HACCP E] Pre-operation '1� I ElEl Temporary Caterer ❑ Suspect Illness Person in Char�e(PIC) t Time ❑ Bed&Breakfast ❑ General Complaint 1 In: ❑ HACCP Inspector O<p1O1 t �� Out`' J� Permit No. E]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 El 2. FROM CHEMICALS 2. Reporting of Diseases by Food Employee and PIC ' El3. Personnel with Infections Restricted/Excluded El 14.Approved Food or Color Additives FOOD FROM APPROVED SOURCE [115.Toxic Chemicals ❑ 4. Food anis Water from Approved Source TIMEITEMPERATURE CONTROLS(Potentially Hazardous Foods) ❑ 5. Receiving/Condition ❑ 16.Cooking Temperatures ❑ 6. Tags/Records/Accuracy of Ingredient Statements ❑ 17. Reheating ❑ 7. Conformance with Approved Procedures/HACCP Plans ❑ 18. Cooling •PROTECTION FROM CONTAMINATION "` ❑ 19. Hot and Cold Holding '.� ❑ 8. Separation/Segregation/Protection ❑ 20.Time As a Public Health Control ' REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS ❑ 9. Food Contact Surfaces Cleaning and Sanitizing (HSP) ❑21. Food and Food Preparation for HSP ❑ 10. Proper Adequate Handwashing ❑ 11. Good Hygienic Practices CONSUMER ADVISORY _ ❑22. Posting 0f Consumer Advisories / 4 t 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 ol Health. today, the items checked indicate violations of 105 CMR C N 590.000/federal Food Code. This report, when signed below 23. Management and Personnel (FC-2)(590.003) by a Board of Health member or its agent constitutes an _ 24. Food and Food Protection (FC-3)(590.004) order of the Board of Health. Failure to correct violations 25. Equipment and Utensils (FC-4)(590.005) cited in this report may result in suspension or revocation of 26. Water, Plumbing and Waste (Fc-6)(660.006) the food establishment permit and cessation of food 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 5901 Vs 'Fom 14 do Inspector's Signature:) \ 1 lJ\ Print: PIC's Signature: //iA� �\�rf Print: I/��.� -�- : n T�) UP-� Pageof�Pages Violations Related to Foodborne Illness Interventions and Risk Factors(items 1-22) PROTECTION FROM CONTAMINATION FOOD PROTECTION MANAGEMENT { 8 Cross-comaminauon ( i 590 0(Y3tA) Assignment tit Responsibility" 3-302 I]iHt(1) I2sw Animal rcrxls Separated hom 59(1A03(B) Demonstration of Knowledge* I Cooked and R'IF Foods' { 2-1( l 1 Fermat in charge-duties { i Contamination from Haw Ingredients { 3-302 i l(A)(2) kaw Animal Foods Separned from Each EMPLO`'EE HEALTH I Other,` 2 500.003(C) Rcsponsibduy u1 the person in charge to ( Contamination from the Environment { require reporting by food employees and 1-30,111 A% RxAl Pruteetionr applicants^ 3-363-'.5 'Washing Fruits and Vegetables 54wtw(F) Respon;tbility Ora Bod Employee Ot An t ! 3-304.11 Fool Cunrut��,,dh Equipment and Applicant To Report To The Person In ( Utensils,. Charge* Contamination from the Consumer { 590.003(G) Reporting by Person in Charge` { 3-306.14tA)(B) Returned Fool and Reset rice of Food" j 3 590 003(l)) Exclusion;and Restrictions`" ( Disposition ofAdjlteratedor Contaminated 590.00311h) Removal of EnCILIAoris and Restrictions i Food 3-701.11 Discaiamg nt Reconditioning Unsafe FOOD F IOM APPROVED SOURCE Food" 4 Foodand Wa+er From Regulated Sources ( 9 Food Contact surfaces 590 00<t(A-B) C'ompbantc with F n d Law" { 1-501.111 Manual Warcvma hir.le_got Water "-20 1,1 rood:n a Hermetically Scaled Container" { Sanitization T-cmpertrtrrrzs* ' -,-701 1? Fluid Milk and Mill:Ponlncts; { +-501.112 mechanical Adrewashin 14o1 Water Sarlitizatinn Temperatures'" { 3 202..13 She! E(at_s' { 3-202.14 Eggs and Milk Products.Pasteurized" ! � (-501.114 Chemical Saniuzatiun-temp.,pH, { 2?J6 Ice blade f:om r''Potable 0rinkrne Wate { concenh ntinn kind hardness. ; 4-601.11;.A 1 Lacipment Foxl Contact Surfaces and 5-101.11 Drinking Water from an Approved Syst etri' ( ' Utensils Clean' 590.0061A) liutticd lltinking Water" &-602.11 Cleaning Frequence ot Egmpmant Food- ] 5`)(t.U06(B) Water Meets Standards 1n 310 CNIR 22.0" � Conhr.: Surface:and Ut'nsifl Sheliflsh and Fish From an Approved Source { 1-7152,11 Fie,ueney o. S u:tizativn u Utensils and ) of f i?01.14 Fish and Recreationally Caught Molluscan 1 Fnol Ga:uict Surfaces of Equipment* 4-703.11 ;Methods of Sanitization - Hot Watet and 1 13-201.15 Molluscm Shellfish from NSSI'Lasted I I Chemical- � Source:'` { 10 { Pieper,Adequate Handrvashing Game and Wild Mushrooms Approvad by I 1 Crean Condition- Haid;and Arma41 { Regulatory Authority i 23(11.12 Clea;r.n;=Pr<xedme" { { ;',03.15 Shellstock Identification heseot"` I - { { 590.004(C) Wild Mu:.Ftrooans'" I i 2- .' t R.h::; ;n Wa.h". 3-291.1? Game Animals" { if Good Hygienic Practices : Receiving/Condition ^_-=401.]1 Eahn,z,)lnn4mg arlkine Tobacco- 5 { 3-302.1 ; PF[Fs Rrceivzd at Prope. Tenyteraturrs;r 12 401.12 Discharges From the Eyes.\usr and 3-20'.15 Packal;e hlcgdty" { Month, 3-101.11 Foil Safe and Unidu!terated 3-301 12 Prevenhug Contamma:ion When Tasting° 6 Tags/Records:shellstock ( 12 Prevention of Contamination from Hands 3-202.15 ShellAock identification 'h I S90.004(L) Preventing Contauunatir;n tiom 3-203.1 2 Shellsto:k Identification Maintains-d, Employees Tags/Records:Fish Products I,{ Handwash Facilities { Conaanrerrly Located and Accessibie 13-402.11 Paiasle Deshuction' { { 3-402.12 Records,Creation and Retention'" � ( 5 203 11 Numbers and lacceienl* Labeiin_ of Ingredients' ( 5-204.1 I Lec.rtior and Plaa-n;enl SrrU 0041.1` 9 9 I ? Conformance with Approved Procedures ! 1t Aceccs;Mlitp,Over-rtio;;.mil 1^.sin:vnmlcr tHACCP Plans Sueaked wifn Soap and Hand Drying I 3=,02.11 Specialized Proczssmg Methods" { I Devices { { { ?-503 12 Reduced oxygen Packaging.cn6-301.! t Handu-hhing Cleanser.Aeailantity teria" � { :i-103.12 Conformance with Appiot-cd Procedures' 6-3O:..2 1Laid D:V:op Provi,wn f mnv(e:cnucai nmu;o the iede;.a 1449 hNd Cole or 105 011k 590 000 \ CITY OF SALEM �— ] BOARD OF HEALTH /� ¢ Establishment Name: I_ 6l:z l 't.V l Cf ii� Date: t o 'i ,�� n1" Page: of .� Item Code C-critical Item DESCRIPTION OF VIOLATION/PLAWOF CORRECTION Date No. Reference R-Red Item Verified 't - PLEA RINT CLEARLY Z I 1 �I . �a I�f C (C C 0 c� _Apr,�rlf Y'T 4n.� Ja _ l hCSJ c \A �.- / l.i no N re .1, AQ � 11 ' i �g fl``� ;- 37'� // r !P��.ti� nn.K_� s., Ngo Gc ✓ i l�.Mt, t' j Coil Scc . 1144er I 1 - I ,d I SI I 1 . I I , s 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 c3 Voluntary Compliance ❑ Employee Restriction Exclusion tviolations 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. ^,_ — DY1 ❑ Voluntary Disposal ❑ Other: _;- t}�.��±C) PHi's Sre.er.ed at'1'cmper:uurrs I Violations Related to Foodoorne Jrfness 7nterveniions and Risk According 31F, to Law Cooled to Ill Factors(Items 1.22) (Cont.) " +45`F Within 4 Hours. PROTECTION FROM CHEMICALS 01 IS Co,:ling`,irthodi for PHFS f 14 ( Food or Color Additives ( i9 PHF Hot and Cold Holding 3-i61.16(4) Cor,!±PHI s Mat ntamcd at or h,low 3-202.12 Additt,-e,* 19000-'Fi 41`,145` FM 3-302.14 Ptotection from (hinpproved Arditives� 13-501.16,(A) Hot PHFs Maintained at or abu"c 15 Poisonous or Toxic Substances I do F 7-101.11 Identitymc lnform.tu ',:i-Origmal 16(1) Roasts Held at or nbuwe !30`F. Containers - ..,.,.) 7-102.11 C'nminon Natue-Wotl;inrt Containers* 2!i I Time as 3 Public Health Control � 7--f;1.11 Scrniratian-Stoi xec", 1 3-501.i') Time as c Public Health Congo]* 7-202.11 Restriction-Presence and Use" ( 1590.004 H) Variance Rcquiremcnt 7-202.12 Conddion;of Uso l 7-303 1 I Tnxic Contained. - Pro!:,h,tions" REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-204.11 I POPULATIONS(HSP) t Sanitizers.Criteria--Cremir:(s' 7-204.12, ( Owtuicals for Washuu,Produce.,Criteria" 121 j 3-801.1 t(q) L^PAsiCuii ed Pre-packaged Juices and 17-204.11 Drying Attests.Cntcria' ( Heverases •srh 4varnine f abrls c ' ;-ti01.1 i(B) U,ce,,f Paateuized Egr 7-205 j .11 ( Incidental Food Contact.Luhncantc^ .;_g1,7.1 i{D} Raw or Ps::ially Cin}ked Ar.un:; r i-206.11 Resnicied (is,,Pesmides. Criteria:: ! iaxl and Raw Sced tiixouts Not Ser,•ed. 'F 7-206.12 Rodent Bat Stations' ' f-306.!3 Ft ask n;o Powders,Pect Control and -801.11(C) Unopened Fcxxt Packas!r Nut Re-served ' Monitorinri* CONSUMER ADVISORY 22 -6+1=.11 CoPiumer AA:soty Posted for Consumption Of TI M EIl EM PER 4TURE CONTROLS ndcrau ked of Anim¢d Foods'41tat ore knu,,L r 16 Proper Cooking Temperatures for PHFS Not Oi her'vise Processed to El imitate '.-401.11 A(1)(2) F-s- 155-F 15 Se, I Pathogen. a Ekes-Inmtediate Service 145'FIS::ec' 3-302.13 Pi'teunzed Hgcs Substitute for Rani S!r;l! 3-40L 11(A)(2i Comminuted Fish, ;!Meats&Game I EKgc„ Amours- 155'F 15 see „ 1 3-401.1 t(R)(1)(2) Pork and Reef Rust- 130-F 121 ntin* j SPECIAL REQUIREMENTS 3-401.!1(A)(2) Ratites. htiected Meats-155"F 15 { 59C'.V09(A)-(D) Yiolan„ns of Section 590.0091A)-(D) in sec. " I catering, mobile food.temporaryand 3-401.11(1)(3) Poultry, )Wild Game,Stuffed PHFS, residential kit:fwtt operations should be Stuffine Corr a:onl Fish,Mea., debited :order tac appropriaae sections jPoultry-or Ratite::165-F 15 ser. ^' above if related to foodhnrne illness 3-401.1!(C)(31 W'hAe-muscle,Intact Beef Steaks interventions and ricfi factors. Other 14.5'P 590.11119 t9olatiuns relutim= to good retail 3-101.12 Raw Animal Foods Cooked it,a pioctuces should be dehited under#29-- Micu,wace 165 ! Special Requirement;. 3 40i,11(A)(1)ib) All Other PHFS- 145'F 15 sec. j 17 Retreating for Hot Holding VIOLATIONS RELATER 7G GOOD RETAIL PRACTICES 3-403.11(A)lt(D) PHFS 165'F 15 sec. * 1 (!terns 23.30) 3-403.11(B 1 Micrmt'ave- 165'F 2 Minnie Standim* Clitrrat oad non-rri!icr:+ciekdwns, ivh,ch do eat;e!ate;c,he Timr." foodborne dlnrrs inter venlro;vs and iick fot torr!e:red,76oi,e, an be 3-1W.11(C) Commercially Pimessed RTE Food- I ,f<io d in tlwjJoflmn„�sections q!'!1w Fond Cod,,rmd 105 CbtR Ido"F' `90.000 3-403.1 U,E, Remaining Unsliced Portions of Reef ! /rem Good Retail Practices FC 540.000 � koasti'. 23. 1Ja uxlemen±and Personnel FC-2 .003 ! 1R Proper Cooling of PHFS 24. Ftd and Food Prcdect on FL'--3 001 25 Equiprneni and U±ensiis F%-a .005 3-501.!4(,'1) Cordon!Cooked PHFS from 140'F to -- 26 Water Plumbinq and Waste FC-S .o0 70`F Within 2 Huurs aid From 70'F 27. Physical Facility FC--6 ,007 10 41`17/450F Within 3 Hours. 28. Poisonous or Tone Materiels FC - 7 008 � 3-501 1401) ('Holing Pl-IFs A4nde FirnnAmbient j 29. Saecel Regwremerds 009 Temperature higredients to 41`F/45'F a0 Other -- _ - __---__- --- --_J Within 4llours` ' Dentis c meal item m tog!wised !999 F,md Code or 1415 CPIR 590 000. �-.y Vsw��d;`1-.+.•. m.'+r.,ryM+eR+e.rm,i^rv,r}.,�'}IO- +r.+.n�v'1�'t+l�,`n3nr•.N. r- .a4 •. .i. ..,fin�-v.....w- , , ... . mn�r-9 ^'�\: � Y ' Massachusetts Department of Public Health Salem Board of Health 120 Washington Street, 4'h Floor Division of Food and Drugs Salem, MA 01970-3523 FOOD ESTABLISHMENT INSPECTION REPORT Tel. (978) 741-1800 Fax (978) 745-0343 Name Dat Type of Operation(s). Type of Inspection rrrz �_k un « � I (ay( I I Address ,! -_P L1 El Food Service �] Routine � II Risk I _ Retail ❑ Re-inspection Level ❑ Residential Kitchen Previous Inspection Telephone / �� ❑ Mobile Date: 0' 0� Owner r_ ' HACCP Y/N El Temporary ❑ Pr ��e-operation I! .' r r h3' v�f tai ,07 I El Caterer El Suspect Illness Person in Eharge(PIC) �� ` P+ Time El Bed&Breakfast El General Complaint `1 In- E:1 5 E:1HACCP Itlnspector ,)�''J _ I,) 0� UO Out$7.n Permit No. E-1 Other , Each violation Check" ^h ed('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 4 ❑ 13. Handwash Facilities EMPLOYEE HEALTH. } PROTECTION FROM CHEMICALS ` ❑ 2. Reporting of Diseases by Food Employee and PIC ❑ 14.Approved Food or Color Additives El 3. Personnel with Infections Restricted/Excluded t FOOD FROM APPROVED SOURCE ❑ 15.Toxic Chemicals ❑ 4. Food.and Water from Approved Source TIME/rEMPERATURE CONTROLS(Potentially Hazardous Foods) , _1�/5. Receiving/Condition ❑ 16. Cooking Temperatures � r ❑ 6. Tags/Records/Accuracy of Ingredient Statements ❑ 17. Reheating ❑ 7. Conformance with Approved Procedures/HACCP Plans ❑ 18. Cooling a PROTECTION FROM CONTAMINATION 19.Hot and Cold Holding ❑ 8. Separation/Segregation/Protection ❑20.Time As a Public Health Control ❑ 9. Food Contact Surfaces Cleaning and Sanitizing REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) El 10. Proper Adequate Handwashing El21. Food and Food Preparation for HSP , ❑ 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 ofC eaNh. 590.000/federal Food Code. This report, when signed below 23. Management and Personnel (FC-2)(590.003) by a Board of Health member or its agent constitutes an �( 24. Food and Food Protection (FC-3)(590.004) order of the Board of Health. Failure to correct violations 25. Equipment and Utensils f (Fc-a)(5so.00s) cited in this report may result in suspension or revocation o the food establishment permit and cessation of food f 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 -H 29. Special Requirements (590.009) within 10 days of receipt of this order. 30. Other DATE OF RE-INSPECTION: O !� s 5901nspecfform644aoc Inspector's Signature: �I / Print: r /_ j ��• 9 X PIC's Signature /f /,' c - / - Print: %� Q �'�- J�,�.�Q� I Page of�Pages v U 'YD /U7 Violations Related to Foodborne illness interventions and Risk Factors(items 1-22) PROTECTION FROM CONTAMINATION FOOD PROTECTION MANAGEMENT 8 Cross-contamination i Soof)(YitAo) 1 302.1 If A)(!) Rai,Animal roods,�epanlwd florn 590.0031,111 Dorrionstvilion of Knowledge' Cranked and RTE Foods' 2-I04 11 Pcr:orf in charge --duti,s Contamination irom Raw ongrotijants 3-302 11(A)12) Raw Animal Foods Sip:rated from EaJi EMPLOYEE HEALTH Other:• 1 2 590.003(C) Rcstionsibilit-V(it the Pelson in charge to Col.',imfifavoohom the Eoonanmeni require reporting by Food employees as 3-302.11(A) Food Protecoon4 applicants- 3-302 15 Washirea FtUiLS 590 003(1,) Respmeability Of A Food Employee vec Or An 3 2.'4.11 Food Contact with Ptluipwcni and Applicant To Report To'l he Person fit Uten!41,* Cleu ge Confamiraiionilrom the Consumer 590.003(G) Reporting h} Person in Charge" 3-306.1 isA)(P) Returned Food find Resci,;cco"F�xd:: -iqo.00,.im) FXclusifons and Restrir.tifonsT D;'s�onsitocn of Adufaratod or Contofnilafed Food 500.001(l') Removal of Exclusions and Rcqriction,� I I D:scafdjjtg or Reconditioning Unsafe FOOD FIOM APPROVED SOURCE Foal' Food and 6113ter Ftotn Regulated Sour,-es j 9 Food Contact Sta'aces 590,004(A-B) CVfflPIiallLC e fill Food Law* 4-501J] 1 N'"lual Wa,�-,Vasinn,-Hot Water 3-20IJ2 Flood in a Ifermeticaily Sealed Container- SanitizationFeirnjejaturci^- 4-501,112 Nleclijoical NVal-ewahim, Hot Water ;-201,13 Flutdklilk and Milk Products* 3-202.13 Shell Eevs* Saniuzatkorf']-eMperatulcs* 3-202.14 hpps unit Mfll, Products.Pasteun7ed" 4-501,1 It Chemical Sanitization-temp.,piI, conccntr,&000 and hardness. 3-202.:6 ace Made From Potable Drinking Ware! 5-101,11 Drinking'A ager loan an,-%pproved So'sunn 4-601.11(A) Equipo,ent F(KxI G�ntactSurfftce,.;md 590 006f Al Walled Drinkinv Water"' 11ten"lls Clean, 4-602.i I Cl,-jining Fiequem:y of FqLdPnJCnI Food- 590J`�06(11) Water Meets Standards fit 310 CNIk 22 0- Gunter: Surfowo.q alld Ltellslko She,'Ifish and Fish From an Approved Source I. 4-702.I I Frequency of Swuti,,n,,n of Utensils and 3-20 1,14 Fish and Recreational I) Caught Molluscan Food Contact Sorl.,cesofFquipitwrit, Shellfish* 1-7111*11 Me11...ds of Sanoizootiun Hot'Walct and 3-201.15 Molluscan Shellfish f-ioni NSSP Lasted Choioical'' I Sources!' LO Proper,Adequate Handwashing Game and Wild Mushrooms Approved by l 301.11 Chan Condition - Hands arid Arms"Regul-torvAurnority 3?0.1 F Shelfisux.k Identification Present" 2-30'.12 Cleanin.,Proceduic* 5901f:04(Q Wild Mushrolan.i" 2-301.14 When to Wash" 3-1101.17 (nune Animals` if Good Hygienic Practices 5 Reseiving/Condftion 2-40 1.1 i Raling, Drinking of U,3mL I obacco- 3-'02.I! P1417s Recelyed at Proper Temperature.` 2-40!.12 Discharges From the Evcs.Now and 3-2u3.i5 Package hiu;grttyz-� Mouth'. 3-30IJ2 Preventing Contamination When TastingTasting"3-101.�I Food Safe field ()nicliflicrated � 6 Tags/Records:Shellstock 12 Prevention of Contamination from Heads 500.004(E) Pre.,,entin,,Contarranfitiort from 1-202.1 S Shellsicck Identilication 3-203.12 Shellblock identificaoolf Maintained" Tags/Records: Fish Products j 13 Handwash Facilities 1-402.11Convenoenthl LocatPda,-odAcces5,h1e 3-402.12 ReLOMS,Creation and Retention j 5-'2'05.11 Numbers and Cftpa(-ilie,5o' 590.U(340) Labeling of Ingredients* 5-204.11 Location and Placement" 5-20;�11 ikccessihilitv. Operation and Mairacnano, 7 Conformance with Approved Procedures /HACCP Plans Su000,'ted wan Soap.-,,nd Hand Drying I Devices ;-502,1 i Specialized Processing Nlethodsl* 6301.! 1 liartffo+aslurie Cleanser, AvcJ1,,ibl;ty 3-502.12 Reduced oxygen packagirwl �ricna* 6-301.12 Halel DrNing Fro,%ision 8-!oA.1 Get inance with Approvvd Prvce"Jui es* Uv:,ole. ,,wr,41 nofif I a the reseal ;Y)9 F(sol`,,&Cl: 105(2MR 5911 1'W GITY OF SALEM 1 ///� BOARD OF HEALTH Establishment Name: CO l� 11 rireM Date: ~�� /� Page: .-2 of t` Item Code c-Critical Item DESCRIPTION OF VIOLATION/PLA OF CORRECTION _ Date No. Reference R—Red Item Verified .i 1 PLEASE POINT CLEAji LV • hz _�; I i Tz L�P��, i� n � J �1 �n sl , -1P� cJ0- , _, OV Oj Tl f r r V _Nt of 4njie r)I ; /7/ ` I r W kJ N/l rl r0�1M M �n/G c� C1� K 6 GI S, // r��l f /} —T �, ;v 4TH / I _P til*V� iDiscussion With Person in Charge: r Corrective Action Required: I ❑ No L\Q"--tes I have read this report, have had the opportunity to ask questions and agree to correct all ❑ Vo untary Compliance ❑ Employee Restriction/ k t Exclusion violations before the next inspection, to observe all conditions as described, and to comply with all mandates of the Mass/Federal Food C68e. I understand that Re-inspection Scheduled ❑ Emergency Suspension } noncompliance may result in daily fines of twenty-five dollars or suspension/revocation of ❑ Embargo ❑ Emergency Closure your food permit. ❑ Voluntary Disposal ❑ Other: n - — A I 3-50; 1,TC, PRFs Rv rued at'I'en:peraturrc Violations Related fo Foodborne Illness Interventions and Risk According to I aw C'..led to Factors((isms 7-22) (Cont.) dl'FI45`F`rcithin 4 Hours. '' PROTECTION FROM CHEMICALS _ 5u1I5 'Calm,MP.ticdsfor PHP. j 14 Food or Color Addrfives ( 19 PHF Hat and Cold Holding 3-50!AutP) Cold Pt-1F:, 1�a:ncsin�.d.aor below 3-202.19 Additiecs" ( 5901):1-1(17) 3 302,14 Protection front ti:u4tpnrved Additive,., 3-501,16(A) Hot PI4F, 15;u^ained at erabove lb Poisonous or Toxic Substances - _ 40°F, i 7-101.11 hlenrfp,ng Idunu.unm-Or;gintd "s-[i01 16(;1; Roasts Held .:[ur abrve 301s, " (.Onlalit rc" 7-102.1 ! Comm on Name- Wtakin„Contain:rs` ( � 20 Time as a Public Health Control -- 7-201.1 ! Separation-Storaeo"' 3 .iii t.':1) Time as a Public Health Control j 7-:01 I Rc,tricton-Preence and L sr1 59(L(D031HVariance Requirclncn' 7-!02.12 C'ondioons of Usc* 7-_'03.11 'loxic Container. - ; u!: h1 noris'l REOUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-204.11 ( Sanitizcrs,Cri tend--('hemir.4s' i POPULATIONS(HSP) 7-'04.12 ( C'hentieals for Washme Produce,Criteria` j 21 i 3-8(11.111 A) Unpn,tetuind Pre-paci`aged Juices and 1'szcetatw-with Warnirt Lab�is 7204.14 ( Di One.lyenls.Criteria, j 3_c011 i(B) Ude of f aatcuriied);!acs' 7-205.11 ( Incidental Food Contact. Lubricants"- ( ; -Sp 1.1 i D) Ra,„ 7-200.1 11Rosuictcd 1:15e Pesticides. Criteria-' { i Pat(rally Cooked Anunal Pard and Raw Sc,.d Sprouts Not Served. 7-206.12 P.cxbmt Bait Stations" j -80i.t 1(C) Unotiencd Pard Fackace Not,Re- 7-206.13 ; 'Praeking Poweiera,Pest Control and served, R4onnoringT CONSUMER ADVISORY TIMEITEMPERATURE CONTROLS 22 3-6o; 11 Consumer Advisor} Pnstcd fol Consumption of 16 Proper Cooking Temperatures forI Animal Fav:;That arc Raw,Undercooked or _ PHFs Not,Gwi :ixrsr Processed it)Eliminate i.lfil.l lA(1)(2) E,,gs- 155'F 15 Svc. j Ecys-Immediate Service 145°1715secr --302.13 Paiteunied Eggs Substitute for Raw Shell 3-401.11(Att2i Comimnuted Fish,Meat,&Game � Egea''. I Animals - Ii5'F 15 sec. 3-401.1 1(B,i(!)(2) Pork and Bret`Riast- 130'F 121 min* j SPECIAL REOUiREMENTS-11011 UA)(2) Ratits,id A9155'F 15 S00.0W(A)-(D) Violauoue of Secbr,rt 590.009(A)-(DI in 3 . enjectecale. -. sec. .. I catcrin'2. mobile friod, temporary and 3=101 11{x)131 Pouht-3,Wild Game, Stuffed PHF,, I revd�ntial kitchen operalions should lie j Stuffing Coatauum;Fish, Meat, dehited under the appropriate sections Poultry or Ratites-165'17 15 sec. a above if ielaled to foeunurne illness 3-401.1 i(C)(3) Whole-muscle, Intact Beef Steaks iMr-ventions n:ol risk factori. Other 145`1' 500.009 violallons re?,ring :o good retail 3-401.12 ['sky Animal Fouls Ccokzd in a pfacaces should be dehited_rdei 1/29- Microwave 165'F* Special Requirenlenia. 3401 I1(Ai(1)i1i! Ali Other PHFs-- 1.15°F 15 sec " 17 Reheating for Hot Holding VIOLATIONS R,-i_ATEJ TD GOOD RE'AR. PRACTICES 3-403.11'A)&D) PHPs 165'17 15 see. e (Items 23-30) 340?.IPit) Microwave- 165'F 2 Minute Standin,; C;;tl(n and non-r'ririval viol itroae, which du no;,-elute to tier Timc" fro(Ihnrue ilb:err interventfon,r and risk j'actors lived alone, tan be: 3-403.11(C) Commercially Processed RTE Food- found ix the jc/lotring<artn)ns of the Foo, C ode and 105 1}1iR I40317" 5on.p,?i. 3103.11(P,) Remaining Unsliced Portiooa orticer Item Good Petal Practices FC ; 590.000 Roasts'° ( 23. MananemAnt and Personal . --2 ! .003 - 18 Proper Cooling of PHFs 24 Food and Fond Protection FC- 3 _ 00? ! 3-501 14(,1) Coining Cooked PHFs from 140'17 to -2-'-=-__--- Equipment and Utensils FC-4 __005 26. V'l,ter, Plumbini and Waste FC-5_ 1)0 _ 70'F Within 2 Flours and Front t 70'f 27. Physical Facdity, - '! Fl-1- 6 }(U7 to^I'F/45'F Within 4 Hour;. * 20. PolsonotS or"oxic lVate,t3h ( FC - 1 .005 3-50 11(b) Cooling PI-IFN Made From Ambient 29. Special Reg:.iremcnl, -005 J T;mretature hlgredients to al'F/45"F j 3C. ! Omer Within.1 Hoor'z :,•^,",".��o.:n. Denow,cnucol item r.1 the tedro,; !094 Food Cotte or toi CP9R 5,11)rn10. 1 ' t _ CITY OF SALEM ; r / BOARD OF HEALTH Establishment Name: rG S�. do 1 YI-r'ey Date: //)-/)�— Page: of € Item Code C—critical item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date No. Reference R—Red Item - .- Verified PLEASE PRINT CLEARLY KiW�,, ul� Cita �t,�/A/!r> nt- �1' T l.i c� cF ,l tf 4-v I&/ CG-si 3 _( _. _ I y `�3�, / �✓L�/ c y-A n �1 `S�d7� �� tel( D�#��✓5� �e `i,�l e, 8 l t< Y Wk W 1-rc�c.A F,)v_T_T/As VTC �7noS3 n Jtu / 13-X4 77 t S�e-4 �, � F.,1 `lc' J G) (1Pff� r✓ � Mr ICY O¢ c!D )vT' t�L`� U A _ Srf l'S sC�i / o ®r * Z ✓�,Udsic ,ATUr Q . l_r, r kA <c- ;_S?' ^(TrU l fCA l�J� d-t.�a!' A'1 J 111 p 1 '1��)X42 CI •3�t'hY'1 % �.� I i Discussion With Person in Charge: Corrective Action Required: I ❑ No ( Yes f ❑ Voluntary Compliance ❑ Employee Rest�itction/ t I have read this report, have had the opportunity to ask questions and agree to correct all Exclusion violations before the next inspection, to observe all conditions as described, and to Re-inspection Scheduled ❑ Emergency Suspension comply with all mandates of the Mass/Federal Food Code. I undersfand that c noncompliance may result in daily fines of twenty-five dollars or suspension/revocation of ❑ Embargo ❑ Emergency Closure your food permit. / / M ' ❑ Voluntary Disposal ❑ Other: llr� K' 'X4 -5(11 i-,('I PHFs I2tcewe�la 'I'eniperamres Violations Related to Foodborne Illness Interventions and Risn Asruramr ti I,aw Cooled to Factory(Items 4-22) (Cont.) 41 F/45"F WirEn�I Hoare e j 3-50!.15 Cooliu),btethws for PHF's PROTECTION FROM CHEMICALS j 1419 or Color Additives 119 PHF Hot and Cold itafdiny -501.15(8) Cold PftFs'Maintained a!of below 3idte -203.12 Addr" I `vilnb4tP1 _ 4i"145°F' 1 i-302.14 Proteciinr,'.;om linaporoeed Ad hove ( ;.5ft1.16(Ai F?ui PHP; Mainuuucd at or aboec 15 j Poisonous or*1 onic Substances j d0'F 7-101.1( 1:!ennf}vte Inti'a'sration-Ongina( ( 3-501 '6(A) Roasts fi0d at or aboae 1300F. Conra;ner.,,: j 7-102.1 i Coalition Name - Workine Gonia:net,' ' 20 "rime as a Public Health Control j j rc c 3bU1 19 Timc a::n Public Health Cowrol'� j 02 11 Separation- ase" ( j -'0O 11) verian.a Rcauireounir j 7.'.U2 I I Re,triction-PPresence and fisc790 i "` � j 7-202 12 (-:undnions:it Use REQUIPEMENTS FOR HIGHLY SUSCEPTIBLE 7-203.II 'fo;icCuntaireciS-'n;bil,i:rma" i POPULATIONS(HSP) 7-<)4.t 1 Sanitizers,Criteria --Chemic:ils'" , �, t L. , 121 ?-801.1 l(A) Cmp.ateunzed Pr.-packaged h.uccs and 7-'.'4. Cbemicais for V.-'ashore f ro:incc,Crrteri.:"' ! 7-20414 Drying Agents,CntedaT i Heves?es e•tth Rkarmne 7-205.1 i ncidrnta? pard Contact.Loht icao! = 8t)i.i „B) Use of Pa:teutized Fees^ ,. 1340,.1 i;D) Raw ur Partially Cooked Anunal Food and 7-206.11 Restricted Use Pesticides"Criternr+ 7-206.12 Rcxtrznl 13ah Sta:uatr;" Rae Sced Sprouts Not;cried. " 7-206.13 'I'mcking Pow(ler:;, Pest Cne;trol and j -`-80i.41iC-I ihcapencd Food Package Not Re-served " :Ytrmtorrn,�* CONSUMER ADVISORY TIMEIfEMPERATURE CONTROLS u2 t I t:'unsumer AI%isoiy Posted for Colisumptien of At ime.l Fo.nis T tat are Rhee,Undenooked or j 16 Proper Cooking Temperatures for Not OiliLrwisr Processed to Elitninate PHFs 3-401.1IA(1a Begs- 15i'F i5 Sec. Pathoe.-)]c:.T '"<'re:v:r.n:a: l_es-huinediate Servi,e t=i5,-Y(iseca i 3-302.13 Pl,geunze:l Egg,S:bstiune for Raw Shell 3-401.11(A)(2) Comminuted Fish,M9 aL & Game ` Egt cn Aniruals- 155'F 15 sec. 3 ?01.11(1)(1)(2) Pork and lcef Roast- i30`F 121 train' SPECIAL REQUIREMENTS 3-401.11(A)(2) Ratnes. Injected bleats-155'F 15 `40.00o(A}-t D) Viols ions of Jee1 ion 5?J.Ofi9'..A)-(D)in j sec. re c:cerin„ mohde fond. temporary uad 3-401 11(A)(-,) Pouhry, Wild Game, Stuffed PHFs, renidentia':kitchen operations should be I Sniffing Contowne Fish bleat- deF:ted under the appropriate sections Poultry or Ratites, i5 sec. " above i`re?aced to ioodbornz illuesr; ! 1I(c)(3) Whole-muscle,Intact B:ef Sicaks inte:venlions and risk factors. Other 145°1' 590.000 viol rtious ielatina to pood retail 3-401.12 Raw Animal Foods Cuokcd in a pi,,,,,ecce Should be debited under #29 - hlicicwmee 165'p* � ``pedal Requirements. 3-40111(A)(1)(b) All Other NIF:. - 1,15'F I` 17 j Reheating for Hot bolding VIOLATIONS R.A.ATED TO GOOD RETAIL PRACTICES 3-403.1?(A)K(1)) jIII-1 Fs !65`Fl5scc.' (Iteinc23-3(i) .i-403.11(8) ( Mic(owave- 165'F 2 IID rule Standint+ Grifica'arsrl;rcr,-r'rtitul violations, »high III,not relate,la the Time"' ,/00'iboee'!Il7eecv itltee�enlnons irn<!rind(utnrs ILSICl,obovc, ran be . :-303.11(C) Com itzr-i ally Paxcssed RTE Food (Hind ni ahe t(,llr wine Sections of the homl("deand 105 C;VH 140°FT 50(t00:). 5-403.111,L•) Renmming Unsliced Portions of Recr ! %tem Good Retai!Practices FC 530.000 Roo;;ta"' 23, _ tvaraaement and Personnel FC-3 ! .003 24 Food avid Fwd Proteacti FG-3 1 .004 Proper Cooling of PHFs I ," i 25 ouipmert and Utonsiis F C-4 .005 3-501 14(A) Coolvng Cranked MIN beat 14(1'"F to c12,. Walei FlumbincIand Waste f C-5 70'•F Wilhm 2 Rour;an"' i rom 70'F 127 P4ysical Faci!Oy :,---6 007 I w-1 'F,115'12`V'thin 4 Ho::ra. ( 28. F osoious of Toxic dtatedais FC--7 .002 3-501.1.4(13) Cuuim2 PHFs Made From Ambient i ( 29 uPeciai Requvcments -� Tempeiaturerredientsto�3t°F/45F 130 Oahe: lnJ ---- Withitt 4 Hnnrs' Denoes am<al rte+::In IIIc lvde(al 1909 Food('rad:or 705 CNR 59n 0W. CITY OF SALEM pFF ) BOARD OF HEALTH t Establishment Name: ( �: 3 y/ g �)Yi� P Date: 0/ /0 5 Page: of G� °s Item Code C-Critical Item % DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date No. Reference R–Red Item Verified PLEASE PRINT CLEARLY f 1 11 j no h z 4-- h,,�r 1. c45w ti a. 'Y'/a"�_-% C_ i� ✓� �C��!//� �O.�I�Vi d 1t I �f'7✓ /'X-/ ABY �'a J— ° �0Lt (o ' 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 di 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. � ¢y , ❑ Voluntary Disposal ❑ Other: / j 7TT! P]Wi Rec,,1-ved at Tempt ratuTes, Violations Related to Foodborne illness interventions and Risk to lain ct,,,Ied I() Factors(Items 1-22) (Cont.) 41"F/45`5'Wttbiti 4 Fowi;. PROTECTION FROM CHEMICALS1.15 cloolim2 Methocl, trr flffs 14 Food or Color Additives 19 FHF Hot and Cold Holding 3-202.12 Additiws3-5(11,16(e,) Cold PfWs Vlaicta:ncd at of below 590.004f,F: 41 V45'F- 3-302.14 Protection from Unppprmed Additives" Poisonous or Toxic Substances 3-501.;6{A) Nor J`Ht'�Maintained cr abov,15 7 101.11 Identil'vare !nlonwitton-Original 1401-, 3-501 UIAi, Roasi-,He!J at or above 120"F. Containers, I Time as a I Public Health Control 7 102,11 Common Name- Working Contin:-r< �;A 19 Time as,a Public Health Control* 7-201.11 S,paration-Stotave,� I "7-2(}2.1 1 Reqricflun-- Pre!:crice and Ue:l O(W H) Varianc- `,VQIs-,Cffl1 III 7202.12 Conditions of lisc` REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-20i I I Toxic' ontainvr: -- Prohit)i6.�ns" POPII 1ATIUNS(FISP) t-2(14,11 1 San;tizcf ,Criteria -ChendcalsT 7-2(9.12 Chemicals for Cr;te.tat 1 121 '13';I)1 It i�Iw'.'Stcw mcd Pre-packaged Juices and 7 Beverages with Warn,ri.�- [,,bds1 -204.14 Dr,,irig Avejw� Criteria' 1 3-901'413) l:seof Pasteur'zed Eggs* 7-205J] cidental Fo(d Contact,Lubricaril Par% or Partiall-v C-7)ked Amm.1 Food and 7-200.11 Rear:-.,ted Usr Pe,aicidcs.Criteria" waw'iced Sprouts'Not Sti 7-206.12 Rodent Baii Stations" 206 13 Tr��cking Powders,P-A Control andI�,C) Unopened F*txxi Pack. Re-served. CONSUMER ADVISORY TIME/TEMPERIATURE CONTROLS 22 3-603-11 Consumer Advisory Posted fOr Consumption of 16 l Proper Conking Temperatures for Arnow` Foods lbat are Raw. Lrn&cuoked or PHFS Not Oltu,rvisc Processed to lnJimiiiate ;-401.11A(1)G'--} Eggs- 155'F 15 Sec. i Pathogen:.., 3 302.1 S Pasteurized F gs Sut-tilute for Raw ',hcJ I Eggs-ininnediatc Service 1115'1415sec 9 3-401.11(A)(2) Comminuted Fish,?,Icata&Game Erg;' Animals- I�YT 15 sec. * 3 401 11(1 )(1)(2) P,wk and Beel'Roa,t- 130+ 121 11 SPECIAL REQUIREMENTS -3-4101.1 l(A)(2) Rolires.Injected Meats- 155�F I.i s90-(t09(A)-(D) Violations tit Section '190.009(A)-(D) in get;. catering, mobile fbill,temporary and 3-401.: 1(A)(3) Poultry,Wild Game, S,uftcd PHFs, IFL-Sidi-11tial hitcher operations should be Stuffing Containing Fish,Meat, debacdauder the appropriate woicins Pouitry or Ratites-165`F 15 we above if'related to fixx3horne illness 1-401.11(0(3) Whci intac', Bect Sle:tks intervention., and risk factcq>. Otber 1450F^ I -�90.009 violations relainig to good retail ,-401.12 Raw Anhwil Foods Cooked tit a Practice&dlould be(iehilcd under #29- INficrowav- 165'F* Special Requirements. 3-401,1 I(A)(l)(b) AI] Other Mir's- 145"F 15 see. 17 Reheating for Hot Holding VIOLATIONS RtiLATED TO GOOD RETAIL PRACTICES 4(13.111 A)c�t t31 PHFe 105)F 15 se.:. (Bents 23-30) 3-4u3.11(Li) Nl;ctuwave- 165' r2 Mime Standing cliwal and non-criti'al w"lich do nur -e!at( w flm- Ti:'He". ♦ foodborne illness oIreivenlions rind risk,10(tors!!sled above, ban 1'r 403.1 i(C) Commencialiv Pincccszd RTE Fund- fol(IIJ i7rtlefolloiiing sec!iom of,hc Eoua Cod,,oid 105 40`17'" 500.0iio. 3-41011 I(E) Remanfirr, Urgliced llofliomof*ttocf ltofn i Good Petah Practices rc590.000 Roasts* ! 2!. i Management aniPersa oel - .008 24, Food and Food Protection 1 18 Proper Cooling of PIKFs FC-3 11)(14 ?-501.14(:1) Cooling Cookcd PHI,s from 140'F to 25. Equcrtont and UlcnOs FC-4 .005 126 Watcr, 8ndWaste FG -5 - 606 7(ff Within 2 Hour,and From 70'F27. Phvsical Facility FC-6 007 to 41"F/457 Within I Hours. 1 28. Poiecnws or Toxic Materials FC-7 .003 3-501.I-(B) Cooling Pln Made From-Ambient 1 29, Special RiGuimrncnts Temperature lugred�ents to 41"F/451F 30, oftr Within 41 icnlrs: Dellow;enti,J]item III Ili,,roicral 1(IIN Food Cod,or I M CNIR 5901100. Massachusetts Department of Public Health Salem Board of Health 120 Washington Street,4r" Floor Division of Food and Drugs Salem, MA 01970-3523 FOOD ESTABLISHMENT INSPECTION REPORT Tel. (978) 741-1800 Fax (978) 745-0343 Name+ Date �/ Type of Ooerationlsl, Type of Insoection rA rr7ole A 1_/2 0 rl ❑ Fp�od Service ❑ Routine Address y /0i4 Ltif/kS/" Risk Kr Retail ®.fie inspection Telephone Level,u El Residential Kitchen Previous Inspection `>vl • 42 5P.1' I / ❑ Mobile Date: Owner HACCP Y/N ❑ Temporary ❑ Pre-operation tledrVOA Z xdO,<e& jA2 I ❑ Caterer ❑ Suspect Illness Person in Charge(PIC)1^ I Time El Bed& Breakfast El General Complaint In: El HACCP InspectorAa,#V1V 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 El2. Reporting of Diseases by Food Employee and PIC PROTECTION FROM CHEMICALS L13. Personnel with Infections Restricted/Excluded El 14. Approved Food or Color Additives ❑ 15.Toxic Chemicals FOOD FROM APPROVED SOURCE ❑ 4. Food and Water from Approved Source TIME/TEMPERATURE CONTROLS(Potentially Hazardous Foods) ❑ 5. Receiving/Condition ❑ 16. Cooking Temperatures ❑ 6. Tags/Records/Accuracy of Ingredient Statements ❑ 17. Reheating ❑ 7. Conformance with Approved Procedures/HACCP Plans ❑ 18. Cooling PROTECTION FROM CONTAMINATION ❑ 19. Hot and Cold Holding ❑ 8. Separation/Segregation/Protection ❑20.Time As a Public Health Control ❑ 9. Food Contact Surfaces Cleaning and Sanitizing REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) El 10. Proper Adequate Handwashing El21. Food and Food Preparation for HSP ❑ 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 ofC eaNh. 590.000/federal Food Code. This report, when signed below i 23. Management and Personnel (FC-2)(590 003) by a Board of Health member or its agent constitutes an ✓ 24. Food and Food Protection (FC-3)(590.004) order of the Board of Health. Failure to correct violations 25. Equipment and Utensils (FC-4)(590.005) cited in this report may result in suspension or revocation of the food establishment permit and cessation of food 26. Water, Plumbing and Waste (FC-5)(590.006) establishment operations. If aggrieved by this order, you 27. Physical Facility (FC-6)(590.007) have a right to a hearing. Your request must be in writing 28. Poisonous or Toxic Materials (FC-7)(590 008) and submitted to the Board of Health at the above address 29. Special Requirements (590.009) within 10 days of receipt of this order. 30. Other DATE OF RE-INSPECTION: S S90Mn IdFom 14 d. Inspector's Signatulrl,„ . C.�__ / �., Print: q PIC's Signature: : Print: ° ` I ,' . _ Page-of G Pages V f o Violations Related to Foodborne Illness interventions and Risk Factors(items 1-22) PROTECTION FROM CONTAMINATION FOOL' PROTECTION MANAGEMENT 8 Cross-conteminatror 1 190.0031 A) Assignment of Responsibility" I 3-302.11(A)1 U Raw Aniautl Fowls Separated fn7m 591,003(B) j Demonstration of Knowledge Conked and R'FF Foods" 2-10? 11 j Person in charge - duties I Conramoa+ion from Raw ingredients 3-302 11(A)(2) Rain Animal rook Separated from Each EMPLO"EE HEALTH ( Jlhcr" 2 190.003(0 Responsibility of the person to cha,-ge to Contaminamr from the E-ioronrnart require rcporting by fool employees and I 3-302.1 1(A) Food Pmtecdon* applicants' 3-307..15 Wr -shins Fruits and Vegrtibles 590 603(F•) Responsibility Of A Food Emploaee or An 13304.11 Food Contact with Equipment and Applicant To Report To The Pet s:m in Uteneitn'" charge* j Coaaminanon from the Consumer 590 003(0,) Reporting by Person in Charge" 1 3-306.19(A)Q3) Retur tied Fool and Resetvice of Food^ i 3 590.0030[1; Exclusions and Restrictions# I Cispdsit011 of Adulterated or Contaminated 590.003(P) Removal of Exdusions and Restrictions Food 3-701.11. Discarding lir Reconditioning Unsafe FOOD F"iOM APPROVED SOURCE Food' I 4 Food and Water From Regulated Sources ' i 9 Food Contact Surfaces 59CW04(A-8) Compliance with Ford Law* I 4-501 111 Maun2l W.uewashmg- Hot Water 3-20L 12 Food in a Hermetically Sealed Container" ! Sanoizatiun"G:mperatures' 4-501 112 Mechanical Warewashinv riot Water 3--01.13 FluidMiikandMifkProducts"' ,; 3-202.13 Shell Egos^ Sanih7•ttiun To. I 4-501.I I A Chemreal Sanitization- a.tion-tan ., iii, 1 3-20'_'.14 Exgs and Milk Produt r,:.Pasteurised'" cuncettna[ion and t" 1 3-202.16 tce Made Frorn Potable Drinking Water' � 4-60I.11i,A) Equipment Food Contact Surface;and 5.101 11 Drinking Wafer Orom.:.m Approved Siston' � 590.006(A) Bottled DrinkingWaler* j ClelsClean° j 590.(106(B) Water Meets Standards m 310 CMR 22 UT 14 G021 I Cleaning Pr-.uuencl'ui Equipment Food- 590.006(B) Sul facet and t'tvllsils* Shellfish and Fish From an An,7roved Soutre ( 4-702 11 Frequency of Saintizatiou of Utensils and 3-201.1+ Fish and Recreationally Caught Mollurcal Shellfish* Food Contact Surfaces of Guuinment" 4 703,11 Methods of Sanitization --Rot W ntcr and 13-20 1.15 Molluscan Sheilfish tion;NSSP Listed Chemical* Jvurcrs* 1Q Proper,Adequate Handwashing Game and Wild Mushrooms Apprrved by Re_gdlatory Authority 2-301.11 Ci I _-301.11 . eau Condition--Hlmd3 slid Arm," 1 I z.202.18, Shellstock Identification Present" 2-301.12 Cleaning Procedure* ! 590.004(C) Wild Mushnxxns- , 2.301.14 ti{.3t:n m Wash' ! 3-'01.17 Game Animals iJ Good Hygienic Practices 1 E g Receiving/Condition ( 2-401 11 Facing,Drinking or fls:n Tobal':'O"' I 3-?02.11 PRFs Reccn ed at Proper Tenipe!:itures; ! 12-301.1' 17,ch.:rstes Prom the byes,Noz�and 3 202.15 Pa_kage hnegnjfy* Mouthy 3-I01.1 I Food Safe and Unadulterated 3-301.12 Preventing Contamination When Tasting" � j 6 Tags/Recnrds:Sheiistock 12 Prevention of Contamination from Hands i 3-202.1 S Shrllstock Identitical!on 595.01M(E) Presenting"Initanuttction hum ;-2-03.12 Shellstuck Irlentitication A1aintaned" 1 Emplo}ecsT Tags/Records;Fish Products ( }3 ( Handwash Facilities Conveniently% tedand Accessolc 3-302.i; Parasite Destruction's i -,..rca 3-402.12 Records.Creation and Retention" ( >--'-0:.1 I Numbers Lind Capacities" j l 590 00.90) Labeling of ingredients• 5-204.11 Location and Placement': j ry Conformance with Approved Procedures 1 ( -5-205 11 :iecescibtii.y, ()pet,mnn alit! ";lainu-noncC MACCP Plans Supplied with Soup and hand Cryir�q 1 3-502.1.1 Specialized Processing Ivlethuds` I Dpvice., i-8,0212 Reduced oxvtmt paekxgmg,eriteuaM 6-301.11 Iiandwashing Cleanse!,Aeailabilitv 6-"'.01.12 Iland Drvino PrMd 8-103.12 Conldrmance with Approved Px,cedures"' ct:•n '17pne»,r eruc.0 ib:m m iho wdera! 19'10 Foou CoJe�u h'•5 CMR 5901;00 i CITY OF SALEM BOARD OF HEALTH ¢ Establishment Name:CA rP7L t- D Owe rR lv Date: L/2 S�S Page: 2 of Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date No. Reference R-Red Item Verified PLEASE PRINT CLEARLY 2 t/ C t•..n.r/3- L. Au d t£A-U 1 ,4.f/(,.a,ttrc ,N IdS 1 s F v er? S rlsotA947 cW "'000 0".4- t'6dn ".4-f6dn NtJJr' iS.0 .44' L44Tr L rA ."te#4f et-F fW%r 1140- .1 2 ! wfA MS S'rrj A..kq I _r fi 447f7tfieM sl tV4r AW 1CeZ"4LAk - - -2 At�n 7l4ftVC0 "&4&0 A n► 0A JU6-t+- 27` NrC � r r°,t��t'4fti I*4r oeew®' T//ter .A-4W 4V4A1 2LA 0#4 r04-ti r/ffUAer a- rflat�.,c.rt.N CAw gym. 0u2act4er//+a,r$ r3eger C.f44fcJt�tz F 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/ Exclusion violations before the next inspection, to observe all conditions as described, and to ❑ Re-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 dollars or suspension/revocation of ❑ Embargo ❑ Emergency Closure I/ your food permit. , P�^ �I ❑ Voluntary Disposal ❑ Other: �a _-501 14(i,} PIIF;,Received at Turaperaturec Violations Related to Foodborne Illness Interventions and Ri ak ,,,cording to Iaw"C il,dcd to Factors(Items 9-22) (Cont.) 4i "F,'4,`F Within 41lowl. ` PROTECTION FROM CHEMICALS ' 5J!.15 Corh=g Methods for PHFs 13 Food or Color Adddives 19 PHF Hot and Cold Holding 3-202,12 Additives' ' i 3 501.161 B) Cold Pf117. Maintained at or below 3-302.14 Frotection{'cora lfieppr.;vet Audurs?a+ 5901 004(F) -tl'/d5"F` - ' 3-501,16(A) 1lot PHFc Maiora:nod at or above 15 Poisonous or Toxic Substances 140'1' � 7-101.11 klenittyum lr.formatwn-Ougtnai 501Afi(A) Roasts Held td,:r abuse 1 ;0"1- Containers' 7-102.11 Common Naute . Workinh Crnttainers'" j 20 Time as a public Health Contra! "7-201.11 Sepaiation--Storaee` �. 5!1119 Time as a Public Health Control 7-202.11 Restriction-Prascnce and Use:1 1 90.004( 0 i4tnance Requirement -'.0'_.12 Conditions of Use''' 7-203.11 Toxic Containers-Prohibirions' � rPEOUe POP ILTOIeS(HSP) ATiO NTS FOR HIGHLY SUSSUSCEPTIBLEt-201.11 ( Saniti2ers.Criteria--C};emicais- I 7-204.12 Chemicals for Washing Producc,Criletia" ! ! 1; 3-80! J VA I Lnpasremn'ed Piz-packaged Juices and - i 4 1 Bever..tces wI1h Vvdrni,>.o t.abels-s ! 7 204.14 � 6reinB,:kgents.Criteria"' ; 7-205.1 1 incidental Focal Contact, Lubricants" .t-801 11(B! j Use of Pasteurized Ega�s' ! �,' ! , i j 3S0i I11D1 Fav, of Panislly Cooked Anhaal Rid and 7-200.1, Restricted lice Pesticides.Cieer:a ; ' ! Raw Secc! Sprouts Nul Serted. "" I 7-206.12 Rodual Bait Stations" j 3-SOL 1 I(C} Uuepened Faxi Package Not Re-served 7-206,13 Tracking Powders,Pest Control and Monitorin;t ! CONSUMER ADVISORY TIME/TEMPERATURE CONTROLS 22 1,103.1 I Consumer Advisory Posted for C laisuniptiun of Animal Funds litai u u Raw,Undercooked of lfi Proper Cocking Temperatures for Not Othcnv;ee Frocesscd to Eliminate 1 PHFs fil=l,-1,1-x, 3-401.11A(l)(2) Eggs- 155"F i5 Sec. ' tzgs-Immediate Servme !45-F15see' 3-302.13 Pastenr:zed Eggs Substitute !br Raw Shill 3-40L11(.1)(2) Comminuted Fish,Meats&sante EogsW Animals- 155`F I5 sec. „ 3-401.11(B)(1)(2) Pork and Beef Roast 130'F121min" SPECIAL REQUIREMENTS 3-401.11(A)(2) Ratner,ilieeteti Meats-155'1- 15 590.0(?9tA) D) Vioia;ions of Section s90.009,A)-(D)in sec.. "` cateting, mobile fond, terriporary and 3-401.1l(At3) Poultry, W'ildGame,Stinted PHFs, residew;al kitcneu operations should he ! Stuffing Contamine Fish,Meat, debited undeisppropn:de section. Poultrvot Ratiles-165'F 15 sec. * above ifre!nted to foodbornei8nes:; 3-401.11(C)(3) Whole-muscle,6ttaa Beel'Sieaks mtervenilons and risk facn,ts. Other 145`F^ 590.009 violations relatine to good retail 3401.12 Raw"Aninsd Fouls Cooked in a pra,Uces should be debited under #29- Mictowave ibiol,:: ! Soccial E2equircments. r-10i.11lA)(1Rb) All Other PHFs- WS'F i` ':cc 17 Reheating for Hot Holding ✓IOLATIOA'S RELAT EO TO GOOD RETAIL PRACTICES 3403.11(A,)&{I)) PHFs 165`r 15 sec. ' (Items 23-30) 3-403.11(B) Microwave- 165'F 2 Minnie Slandine Cutts<n,•',inn-rrieir:nt rhtlnnunc, which do nor re/are to the Time' fovdhorre iillu,-s.s iwerventiom and risk jot utrt iisted ttbov, , (at?be 3-403.11 W) Comrumrially Processed RTE Food- found in the following se.tions o)the Food Crude find 105 C',Ltp 3-403.11(E) Remaining tiunliced Pardons of Beef I I Item Good Retail Practices FC ' 580,(}00 Rog,sts+ ! 23. fAaraO went and Pers nne! FC-2 1 003 Ig Proper Cooling of PHFs I i 2-4. Foch and Feud Protection FC-3 I OOn j 25. Eqa;Omtsit and Uternils FC"-4 .005 _ 3-501 14(41) CooIHIS Couked PHFs from 140`F it, 1 26. 'Natar, P!umbirq and Waste FC-5 .006 70°F Within^_ Hours and From 7011- 2 Physical FaciiilV FC-fi .007 to 4 i"F/a5"F W rthm 4 Hours. * 1 25 ?o)sonous or l cxe fdatrriais PC-7 .00c 3-501.h1(B) Cauling PHFs Made Frow Ambient 29 special Peameouarts 009 - -i Tempera,Lire Ingredients:udl"F/dj`F 30, Other FSthin 4 How.,` �:. .m.,.n:ae-a a•„ taxdea enheal ilea,In,Ut federal 191w hm•d Code or 105 Cptlt 4190 00' Massachusetts Department of Public Health Salem Board of Health (� 120 Washington Strr eet,4t" Floor Division of Food and Drugs Salem, MA 01970-3523 FOOD ESTABLISHMENT INSPECTION REPORT Tel. (978)741-1800 Fax(978) 745-0343 Name i DatV J I Type of Operationisi TYoe of Insoection 1'1A rar-U {"rti)PA t r I w/lOr ❑ Food Service 9<outine Address - r= Risk 0"Retail ❑Re-inspection 2 N PA4_.A4AEK -rs" Leve E, Residential Kitchen Previous Inspection Telephone /� ❑ Mobile Date: 74 i�dZ� ❑ Temporary ❑ Pre-operation Owner HAGGP YIN , ❑ Caterer ❑Suspect illness l Person in Charge(PIC) Time ❑ Bed& Breakfast El General Complaint �✓� � I In: ❑HACCP Inspector + Out: Permit No. El Other Each violation checked requires an explanation on the narrative page(s) and a citation of specific provision(s) violated. Nan-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 T1MEn EMPERATURE CONTROLS(Potentially Hazardous Foods) ❑ 47. Food and Water from Approved Source ❑ 5. ReceivingtCondition [116.Cooking Temperatures ❑ 6. Tags/Records/Accuracy of Ingredient Statements [:117, Reheating ❑ 7. Conformance with Approved Procedures/HACCP Plans ❑ 18. ooling A PROTECTION FROM CONTAMINATION 19. Hot and Cold Holdingo) ❑ 8. eparation/Segregation/Protection p ❑20,Time As a Public Health Control and Contact Surfaces Cleaning and Sanitizing(*� REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) [:121. Food and Food Preparation for HSP ❑ 10. Proper Adequate Handwashing CONSUMER ADVISORY ❑ 11. Good Hygienic Practices ❑22, Posting of Consumer Advisories Violations Related to Good Retail Practices, Number of Violated Provisions Related Critical (C)violations marked must be corrected To Foodborne Illnesses Interventions immediately or within 10 days as determined by the Board and Risk Factors (Items 1-22): of Health. Non-critical (N)violations must be corrected Official Order for Correction: Based on an 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 N by a Board of Health member or its agent constitutes an 23. Management and Personnel tFc-2)(590.oa3> order of the Board of Health. Failure to correct violations 4. Food and Food Protection (FC-3)(590.004) cited in this report may result in suspension or revocation of 5. Equipment and Utensils (FC-4)(590.005) the food establishment permit and cessation of food 2f. 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 (sso.00s) within 10 days receipt this order 30. Other DATE OF RE-INSPECTION: S 5MnsXCIF0�6-14AW Inspector's Signature* l Print: J v rr Y,Afasr�✓ r�Y Print: , ,b� « ,� Low/��? 9 ,Page of-YPages PIC's Signature: / / � � „(� / Qd' l,i Violations Related to Foodborne Illness Interventions and Risk Factors(items 1-22) PROTECTION FROM CONTAMINATION FOOD PROTECTION MANAGEMENT 8 Cross-contamination 1 ( 59(}.0031 A) Aesicnment of Respnnsibitity" 3-302.11(A)i.1) Ras•,"Animal Fails Sepanitcd fi:nn 590.003(B) I Dernomtration of Knowled„e* Cooke+:and WIT Fi-oi s" 2-103.11 Person in charge-duties j Cootarotm*ion from Raw Ingredients 3-302.11(A)(2; K%;w Anincd Foods C,parated from Each EMPLOYEE HEALTH other- 2 590.003(C) Responsibility of the person in charge to Crntaminat!on f om the Eweonment requite reptntiug by Ibod employees and ( 13-%2.11(A) Food Protection" applicanns 13-302.15 W,Annz Fruit;and'✓e,tctiblcs 590.003(F; Rcsponsibihty Of A Food Emp!nyce Or An 13-304.11 Food Ccatact wits;hquipment and Applicant To Report To The Person In Utensils Chtu;;e' Gontamination tram the Consumer 590.003(G) Reportim;by Person in Charge" 3-306.1-lW(B r Returned Foci and Reset vice of Food^ 3 590 pU I(D) I Exclusions and Restrictions" Urspcsition o!AduHcrated er Conraminated 590,003(E) ! Removal of Exclusions and Reitnotions ( Food 3-701AI Du.carding or Reconditioning Unsafe FOOD F 10M APPROVED SOURCE Food' ! 4 ( Food and Water From Regulated Sources ( 9 Food Contact Surfaces 590.004(A-B) Compliance with Fond Law* 4-501,11 t vianual Wncv.ashiro_- Hot water i i 3-201.12 Fixid in a ltanteticall} Seated Container" Sanitizati.,r:"1'c:rrperatures" 3-201.13 Fluid Milk and Milk Product:,* ( 4-811.112 MechanicalW'urrva+ping-!lot water f J:minzitun'Cemperatwns 113-202.13 Eggsell Ergs* ( � 4-50'.€I-< ClteiniatlSanitization-tem �H, � 3'?02.i4 egsandMilkPr(xlrcis.Pasteurized" concentration and hardttes. 02.16 kc blade From Potabtc Drinking W':uer^ 5-101.11 Drinking WaterFrom an Approved System* 6i71.11t A) Equipment Fixxl Contact Surfaces and Utensils Clean' 590.006(A) Bottled Drinkink lv"ater* 4 602.1 I Cleaning Frequency of Equipment Final- i 59(%AOti(ft) Water Meets Fish From ds in Approved CMR 22 Source i Contact Surfaces and Utensils,: I Sheil{ish and Fish From an Approved Sour^e 1 1 4-702. 1 Frequ ncy of Sanitizal ion of Utenmiis and 3-2011.14 Fish and Recreationally Caught Molluscan 'rood Contact Surfaces of Equipment" Shellfish" 4 703A] Methods of Samtisa'aon Hot water and 3=201.i 5 Molluscan Shellfish iron NSSP Listed ! Chcmiad" Sources` ! to Proper,Adequate Handvaashing Game and V✓I!d Mushrooms Approved by ( i P,egUlatorp AWriorify 2-30611 Clean Condition-"Hands and Anus` 3-202.18 Shelivtori: identification Present'' 301.12 C'lmning Pnx•edute* j � 540.004{C) wild Mushrooms- 2-3t)L.14 When to V,asit" 3-20i.17 Gamc Annmds" I if Good Hygienic Practices 5 Receiving/Condiition j 2-40i.77 Feting. Drmiririg of(!ling Tcbacar` 3=202.11 PIIFs Received at Proper Temperatures* 2-40!.12 Disdiaiecs From the Eyes.Ruse and _i-202 15 Padkagc hvcgtitv`: M;Aith.' 3-101.11 Frttxi Safe and Iinad..i r,;ratod" 3-301 12 Preventing Contamination when T;isting. 6 Tags/Records:Shellstock 12 Prevention of Contamination from Hands 320215 Slalistais identification590.004(E) Preven-ing Contamination from 3-203.12 Shel!stock 4lentiticadan P9 auriained Emplupee¢^ ! 13 Hand(vaFacilities Tags/Records:Fish Products 3-402.1 1 Par cRe Dest otionT ! Convenrentiy Located and AccessiM? 3-,102.12 R4 cor(s.Creation and Retenlo,0 ! ! 5-203.11 Numbers end capacities" 8)0.004(1) Labeling of Ingredients' 5-^_04-1.1 L +eation wir, pla'clucni^ Conformance with Approved Procedures 5-205.11 Accessibility,Operation and Maintenance /HACCP Hans I Suppled with Soap and Hand Urymq I 3-502.11 Spectattzed Processm-1,1Vlelhods' Uei'icas 3-502.C2 Reduce(!oxygen packaging,alter.::* ( (1 3ul.I 1 Ii:ndwashmg Cl:anaer.Avrilabil;'ty (,301.12 Pimm!Drying Prmiwin S 103.12 Conformance with Approved Procedures`. Drnnirr nae. itrm m the fedaril 1090 Fxyl(ode of 105('617t`.90,006, CITY OF SALEM BOARD OF HEALTH V Establishment Name:CriS!'itCa �4s'A-`! Date: -2//0/041 Page: Z of f f Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date No. Reference R—Red Item Verified PLEASE PRINT CLEARLY 2 Y C \ t7 fsc�etitli�/6 rzs Nx rr c,..r rR�//� ou fV,*4* "V .h— nvra v7 re 6 4r d V* rAffj • /Il- �i rJe rw AWA1C OIC,rar IIs 2 4&(-" goo= I / ' C&C Awf 'W Imo, 40,PLAC ✓WcKT eaAdA-L I 2-7 • cww ,,, &sf.c. _ o/wr.nc.ALv - PfO:r- Ct,,r c *-4A .i r fnA u d tt a f 941-e F.- � �c�oc.�iiC.mnnf D�rrts 1 C Tt ol+d Ur"t A&.FGA' /N 4rh' .-r/f Nw sr I d6w 'UW r� f< DK � O . /?R t Ae"L I I wtJs'r pj c d-.0 Z"eo 5Ac sr Oe w P7fi.r �Ldd.L Q 1'' /✓fie oGr 4.+r r Mtf A" nfyA �.....w.�.�ss�,..✓ .ls ,�d,?a1 flQ.s.[.r. GzfdcevCs�/ Y s /Qaea.t._ A-r- .t'SAee_ /.."I .Am A-• vx#,t/ of SiJOF d.LlhAL uN rr v7� t, AFrA",tj.Z.04 .t//�rz3�.��P e/- /-f6'F oa- T'rl .4' & xok4 r /S C1.fXKX-;&0• /C.i£.V_/ /4bM04mrk' TIN K cz oc&+l �llnif0 rz Mo-r. rrW"Xr_ "A%~Av"a4 S. I _ � ilk rd1 il�+was•.�' �. s Discussion With Person in Charge: Corrective Action Required: I ❑ No ❑ Yes r LI Voluntary I have read this report, have had the opportunity to ask questions and agree to correct all Compliance Ll 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 I Vyour food permit. / j ❑ Voluntary Disposal ❑ Other: 3-50E la,C'S I PH'rsRoc6vedInTcmp�rrtures Violations Related to Foodborne Illness Interventions and Riasi Ac:oI le rdiag to Law Cook to Factors(hems 1-22) (Cont.) ; 41`F!45'1-'Within 4 He,urs. PROTECTION FROM CHEMICALS 3-50: ' 1 Co,!nr Methods tear PHra � Iy ( PHF Ha:and Cold Holding ' 14 Food Color Additives 3-501 l6(B; Cola N IFa.M.♦urtained at of below 3-203.12 AdditiNisec'^ ( . SrnC04(F) (-r4j' F* 3-302.•4 4 n 3-501.16(A) 110 PHFs Nlsimained at<.r;rbnve 15 Poisonous or Toxic Substances ( 40.,F Identifying Information-O:i ral --� l Cu:nainers^ 3-501.16(A) Roasts Held at or above 130`F. i ltJ2 11 (ummon Name--Wnrl.tn',Container" 20 Time as a Public Health Control � 7-201.11 Senaratiun-Storage- '-5',U 19 Ti:nc a:.a Public Hecdth Conhol r. I` �9U.I)04(Hi 7-202 11 Restriction-Presence and Use* Varian;CRs Uutrx•mcnt � 7.202.12 Conditions of Us.- 7-203.!1 TuxiL Container.-Prohibitions, POPUATSC 1S(. REQUIREMENTS(HSP) FOR HIGHLY SUSCEPTIBLE 1^04.11 Sauilicers.C'r,ter:.:--C'hcittiai}=^ ! 21 :;-SU i.li(?.) :Jnpast euri'red A:-packaged prices and ( 7_'04 12 Chemicals for Washing 1 induce, ('s itrda'4 , 7204.14 Urvine.ygens.Critcrnt.. j Beverages wnh Warning Labels* 1 7-205.1 ! ;Ol.l lll{; Use of Pxstcmir-d In�iu�ntal Food Contact.Luhru•unts� j i 7-206.1 I Redrictcd Cse Pescictdes. C'nler�a-" I )) Raw of Pattialip Cooked Animal hkul and j n o - - ( , ' Rau;Secd Sprouts Nut Scned..,7-206.12 Rodent Bait Stations" i 7-2 i ra king Powders,Feat Control and ( 3-`i!)!•!I(t') unopened 1 o-0a Par-kaev Not Re-served 06.13 I .. ,c � I Nlonitarin„* CONSUMER ADVISORY TIME/TEMPERATURE CONTROLS 22 ?-60'.11 Consumes Adviso:q Posted for Consumption of 16 Proper Cooking Temperatures for Aminal Foods'flnt.;re•Raw,Undercooked ar j Not Otheiwiw Pru�eswd to Eh:umate PHFs •rc. . ::uar 3-401.11A(1)(2) Eggs- 155`F Li Ser. 1"xdutgenS.""„ Eggs-hnntediate Svrvicc 145°Fl Ssecv 3-302.13 Pasteuri cd F_y_s Substitute for Rew Shell I 1-401.11(A)(2) Comminuted Fish, McstsR.Game I Egiest Animals- 155"F 15 sec. 3-401.1411)(1)(2) Pork and Be,-[Roast- 13WF 121 min* SPECIAL REQUIREMENTS 3-401.1 I(A)(2) Ratites, injected Mesta-19.5'F 15 590 0;?9t A. (L7) Violations 01 Se:.:ion 590.009iA)-(D) in seL. T i caterin;, mobile Food, temporary and 3-401.1 I(Pot 3) Poultry, Wild Game,Stuffed PHFs; r stdentiat kitchen operation-should be Smffina Contoinsne Fish,Meat cehned under the appropriate sections Poulhy of Rtuites-165-F 0 sec. " above is related to loodbotne illness 3401.11((:)(3) Whole-inuscle,IntaLtBeef'Steak, htrervention`tand risk factors Othcr 145�F 590.009 violations rclatini� to good retail 3-401.12 Raw Animal Foods Gylked in a prod ICCS should be debited under #29- Ivlictow•ave 1650F Y Special Pet{uirenients. 3-40i.11(A)(1 vlo Ali Othet F'HF, - 145`F 15 ser. 17 Reheating for Hot Holding j VIOLATIONS R.:LATEU TO GOOD RETAit PRACTICES 3-103A 1(,aWD) PHFs 1650E 15 sec. "` 1 (Items 23-30) 3-403.11 rB) Microwave- 165'F2 Montle Standing CoiPcol mrd non-, inra!rb;Lr;rune, nd„eh du na! relare to the 1'411ex; frndbome i/tnee:,interveni.ons and iW-fb.tans lived abort eon be 3-403.1 I(C) Commercially Processed R-1 E Fwd- fcmrd in the p)!/oo big serotina cf eh.F2xa1 C ode anad10?(',11R 140`F" 500.000. -103.1 1(E) Rc;naining L'nsliced Portions officer I Item Good Retail Practices FC 590.000 L3.toas ` Manacement and Peisonne =C-? .003 24 Food and Foots Protection FC--3 .004 ! 1R Proper Cooling o`PHFs ! Lo Equipment and Utensils FC-4 .OGS 3-5(?LId( l) Cooling CookedPHFafrooti`0'Ft° � e.B.---IVJa1er.FlumGinaand'tNas:a FC - S ( .CbE 7W Within 2 Hours and From TOME i7 PhysioFac lily FC- 6 CO' to 41'F/45'F Within 4 How s. '" 23. ! Poisonous or Toxi, Maternls FC -' .008 3-501.14(B) Cooling PFIFs Made Front Ambient i 29. Special Reouirements 009 1 empeminrehtc7'edicntsto41'Pi45`P I U0. Within 4 Hours,` x.- Demttry crn¢al;ten n,IIIc!cdeml 109"'Food 11'0d:or 105 CII Ik 590 0W. CITY OF SALEM BOARD OF HEALTH 2/ �� Page: 20 of y Establishment Name: ( fd S� t,I GI�dGa.u! Date: Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date No. Reference R-Red Item Verified PLEASE PRINT CLEARLY 27 kf/e S FaWwic o t r..f Z%W1,0 Gwvw I 4 I C - rvu,r4r- r.Iao� IM ^w A«&.�ofr nF fa.e oA61,e r_ FUXIy as.w 1 g I C c ,�G ,c rww /Ato .,r IU 044- eta 0? 'F - eA A4,eCA r ,O IX /G. ~rf- I .�t,b f./iB-r./tl:O :W- A MA e. z� 9-//644- . A_ ,Sow t_4ar . /.LJ Jr D,9 r7 rlydh tm�u£IULc I 2� Arle " AtA_ 645aa..cr_ 4/*etr Are jUke_ fe" /f-f X,&EAC Curt AGA ,c.rou /t,..,x Ae4 #4 ,s, a LaC-1 A, 14- -rlfl c A"a 0-00r- la'C d 4 s_ r I 3ck.LAels.r o�.w . - < I ` I 2 s AJ�[I ^/� �^ dJM.�re✓ <^s/e.ra2.L.� /tit T P-�Joo ,'Yh�t-!'' .dr�l� T/trt-r°ILefC �.-nr ..rfifi.� S't�%eass, I �` I«..y71�3 .t+�� an.►t�_C_ i�h►1_aJl3+dv4 !'".lea►.! �+R,�+i ,�+(.e�rc2.�-�t � I t f P S' `\ " S,•n Chute/&" d 6C*4,44 Of- "V9 , It V mt_*C. &OW'r v3 Att4.urM.rJ � Discussion With Person in Charge: Corrective 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 ❑ 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 ty-five do ars or suspension/revocation of ❑ Embargo ❑ Emergency Closure your food permit. r i �� r �'/ ❑ Voluntary Disposal ❑ Other: 3 541.:4((", PLiFs Received at T-niner,turcs Violations Related to Foodborne,Unless interventions and Risk According io Law 0i"Ied to Factors(items 1-22) {Cont.) '5'F W� urs. 4 V F!- ddn 4 Ho - PROTECTION FROM CHEMICALS I 3-S01.I S Coolinl,,TIethri&;;Ir Pf-LFs 14 ood or Color Additives 1,9 FHF Ho-and Coin Holding I G,Itt :'ill's�vlanitaineuator below -501.J61B 3-202.i2 x n�Nes 59,1004(17) 3-302,14 Protection front Unapproved Additives'" 3-501 Imp(A) l4oT PHF� Maintained at or above 15 Poisonous or Toxic Substances 7-tol.11 I(Itnintyin.gat-Original Containers' i Roasts Held,I',ur above 130T. 1 7-10111 Cominon Naine -Wotliing Crirrtainc�s* ; Time as a Public Health Control 7-201.11 S:paration-Sunalvel, 3-511:.'.9 Fimc as a Public Health Conno!* 590.004�fi) Variance Requn-CMC[a 7-201!1 Re,,trittwn- Pres.cacc and Use* 7-202.12 Conditions of I se` REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-'r)3.1 1 '1(,%;c Cnntainers-Prolobltiiiat4 POPULATiONS(HSP) -�-2.w.11 I Saiiitiz,os.Criteria--Chemicals' �-201 12 Chruricuk for WashingPi.sluce, Crilcria4 21 3-801 11;A) Unpaleirrinal rlrd-pacl:qtd Juices and 7-204,14 Di'sing Agents.Critciia'� l Beverages ivint Warturi-, 3-801.1 I(B) Use of Pisteulized 7-205.11 Incidental Foot] Cotaam Uri flbcants� 7"06.11 Rest�'ictt-'U,.e Pe,;twdes,Cnien0 13-0.01.1 PD) Pew or Partially Crx1ked.Atn;rad! Food and 7-2()(,.12 Rodent Hall SiafiCTIS' Raw S,--ed Splints Not Seved. :r 3-Y01.1 1(C, I Jnoocned Food PaOkage Not Re-ser,,cd. 7-?06 11 Track I ug Pov,dors, Pest Control and Monitoring* CONSUMER ADVISORY TIME/TEMPERATURE CONTROLS 22 3-60; 11 Consumer Advisory Posted for Consumption of 16 Proper Cooking Temperatures for Aninnai Ixt"is,riiat as Raw.Undercooked tia Not 0r6;-mi,,e finice,ged to Eliminate PHFs 3-4f!l IIA(i)(2I 155'F i 5 Sec. Padikn,�ens,� EgLs-Immediate Service !45'115sec* 3-_;02.13 Pl,leuii,ed Egg: Sulhslluute for Raw Shell 3-40 1.11(Ali 2) Comminuted Fish-Mcats&GameEggs* Anitruds- 155'17 15 sec. ' 3-401.1!(B l(1)(2) Pork and Beef Roast- 130'F 131 min* SPECIAL REQUIREMENTS 3-401.11(A)(2) Ranges. Iniceted Meals--ISS"IF 15 500 00"'1 A)-(D) Violoacins of Section 590.009(A)-(D) in set:. entering, mobile fixrd,ten inch ary and 3-401.11(A)(3; Poultry,Wild Game,St tutit,I PHI residential kitchen operations should be Stuffing Gartaining Fish. Meat, debited under the appropriate sections Poultry or Ratite-165°F 15 set above if related to foodhorric illness 3-401.1 I(C)(3) Whole-nnricic, Intact Beef Stoaks, j interventions and risk factors. Other 145°F' 590.009 violations ielatin.- to good retail 3-401.!3 Pit% Animal Foods Cooked in a inoclices should I),-debited under#29- Microwave 165'F* Special RecInirements. 3-401,11(A 401,11(A Kl)(b) till Other PHFs - 1457F 15 sec. 17 Reheating for Hot Holding VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 3-403.11 i A i&(D) PHFs 165-T '5 sec. * (Items 23-30) 3-403.11(B i Microwave- 165"F I Minute Otardino C-iticaland non--ritical venlatwim :vhich do not relate to the Tall-* Jregthor;-,e III...o:'i Intel ventilvss and risk fi7mws livolobove, ran be 3-403.111C) Commercially Processed RTE Foz-id- fiochd In the folhiiiiltg Sections of the Food("lie and 105 CAP? 140'FT 5()0.600. -1-40-1�I I(E) Remaining Unsliced Potticrvs, of Beer item Good Riib FlIeraclicce FO 590.006---j Rvas,t,t 1 2'3. r0anactenim,1 and Pe.sonne! FG -2 .0o3 Proper Cooling of PHFr; 24 Food and F ooct Piotfaot�on FC-3 .00-4 18 25, =-quipment and licens0s FG--4 .005 ,-901 WtAI Cooling,Ccoked PHI:- funn 140-F tu26 'Naiia Plorabinq ard VJai;te FC-3- W-3 70`1`Within 2 flaunt,and From 70"F 27. ProIsical Faci:av t-C - 6 007 to 41 F[115"F Within 4 Hour.,. 23 ^,Isonous or Tom MalerHs FC - a .008 3-501.14(B) Coaling PHFs Made FroniAmblent 29 316GIA Recanements 009 1 Temperance Ingredicias to 41 T/45IF 130. Other t --- kVith;a 4 1 lottr,* D,,nWsvrjocjl item Inflv folcrti CITY OF SALEM BOARD OF HEALTH Establishment Name:/'4 S'r"BI 1 (nGy�CNr Date: �C ,�/Q.� Page: / of y Item Code C-critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date No. Reference R—Red Item / ' PLEASE PRINT CLEARLY Verified 2r Ave .T.e,A.f nue '404-re 401W cr-sk . 1 r 67 Ale tjW..V ar .4 d.� n et- r &4-0 AZA_ ett_X ..r• I Cif s OW /Fe.~t,1444, f asts yr .r r C rants; rl�fr l�ur� r8r4n dr< q&°.6_ .here e- apt'r- re ~N7ww .F 17X,44. Ll; y/e F Am-t.6.f. i Z Ml — " AA60mdif C,#.Tw Awe _ref6tWr A n,.JL*A"uQS 1t cc<r,f.V1r rd - t � I C'f C �J6 fMdF A ci,n,to s A4AI1£ c-&,M&W A APP 5rW"1ZC-'l2 d rselx cer df� fe3l'f�er� CAmq'L eS Od_ ✓c r ftRr�,c,�sllgaxrcelf` , ` - !1r}r.raerar9Ntd�- .�k,Hs- ✓��)Y fD es,fr- format. i I t-�i�n Ao-e,.Gfn a d sAA^t t JP a Yt 2M06 1 Discussion With Person in Charge: Corrective Action Required: I ❑ No I ❑ Yes I have read this report, have had the opportunity to ask questions and agree to correct all ❑ Voluntary Compliance ❑ Employee Restriction/ Exclusion violations before the next inspection, to observe all conditions as described, and to ❑ Re-inspection Scheduled ❑ Emergency Suspension comply with all mandates of the Mass/Federal Food Code. I understand that noncompliance may result in daily fines of twenty-five dollars or suspension/revocation of ❑ Embargo ❑ Emergency Closure Ll food permit. {�„ /� Voluntary Disposal Other: i 3-561.I P9r'g Received n TeflnrlerdcLn`C� Violations Related to Foodborne Illness Interventions and Risk Ac,niditig to I.aw Coaled to Factors(items 1-22) (Com.) 4l"F/45"FWildn 4 Hours. PROTECTION FROM CHEMWALS 3_50: i5 Coohn.-Methods!or PFIFs 19 PHP Hot and Cold Holding 14 Food or Color Additives 3 20112 Athfin�os* -50LJ6i`Bjt old PHP:. Maintained at or below c, ).004(F) 4i"ia•5°F' 3-302.14 Protection horn Unapproved Add I live,; ;-.0 1,1 Hot P111 at or above 15 Poisonous or Toxic Substances 7-101.11 kicrin'rying Information—origini Containers' 3-J01 WA) 'Kwtsts Held raorabo,7e 13(j)" T. " 7-102.11 Common Name—Workiw�Cownirtcrs' 20 Time as a Pubilic Health Control 7-201.11 sen,wroitV,—st"J."ge- 10 Ti�mo w,:I Pnblic Health Cuntiol't 7-202 11 Restriction—Presence and I T,,e* Vn�Lnce RcqUie`nWlr 7-202.12 Conditions of 7-203 11 Toxic Container.--Prnhibitiorisl REOUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-204.11 Saimizers.Criteria--CherniQaW POPULATIONS(HSP) 7- C-4.12 Chewicals for Wt shave Produce, Cmenal 21 l (A) Unnnsieunz,J4 Pre-packaged puce:and Beverages with Warning 1_abels^ 7-204.14 j Dr)ln_o Agents.Criteria'" 3-'il)1,i (b) U�e of Prileirrized Le!s* 7-20-5.11 Incidental Food Coninct. hibricariti' ..11 1 1 34301A j(D) Rai, w Parially Cooi,ed Annual RK0 and 7-206.11 Resirictcd Uge Pei icides Critcriak Raw ScedI Spouts Not Sen ed. �, 1 7-206.12 Rod"m Bait Stations" L I I 1,C Unopened Food Package Net Re-scrvcd, 7-206.13 Fracking Powders,Pest Control and CONSUMER ADViSORY TIME/TEMPERATURE CONTROLS 22 3-c03.11 Cor-quimer Ajjvjeuf%, PO.Ned fIF Clonq1toption or 16 Proper Cooking Temperatures For Not Foods-fiat are Raw.Undercooked or PHFs Not Oflerwiso Processed to E!inanate 3--101,1 IV i)(2) Lg2S- 155--F 15 Sec. Pw'ho;zcns." hg s-hinnediate Scrvicc 145-1-15,._e 3-3021.1; rlsteiuized Egg,Sidisritute for Raw Shell 1-401.11(A)(2) Conationtried Fish,Vicat:&Game Animals- 155-1- 15 sec. 3-401.1 j(rf)(l)(2) Pork and Beef Roast- 130'T 121 IA0 j SPECIAL REQUiREMENTS 3-401.11(A)(2) Rattles, Injected Meats— 1551 15 I, 590(1,119(A) :;13) Violations of�eclinn 590.00()(A)-(D) it, sec. * catering, mobile told, temporary and 3-40 i.11(A)(3) Poultry,Wid Game,Staffed PHFs, i renal.aha; kitchen operations should be Stilling OnItaining Fish, Meat, Jeln'Z'..d uniler the appropriate sections Poultry nr Ratites-165'F 15 see, ' above it related to f(odborne. illness 3-401A 1!C)(3) Whole-muscle,Intact Beef Stcaks intcolentionsand risk factors. Other 145'F 590.,'09 viciatiom;retatin, to good retail 3-401.1.1 Raw Anim.,il Feuds Cwked in piacuccs should be debited Linder #29— Miciowave 165'F Sficcial Requirellicill. 3-401,1 I(A)(1)(h) All Other PRFs— 149'F 15 see. 17 Reheating for Hot Holding j VIOLAT101i TED TO GOOD RE7AIL PRACTICES 3 (Itenv3 23-30'! 3 403.11(A)&(D) PHI-N 16�'F 15 sec. 4: rhe Ctiorcal and nor rritn,al violations. ,retch do not while to -401.11(B) Nlicroviave- 1650, F 2 Minute Standing Mille, Jonelburnedivess anownlions,and risk to(zors listed above, Can be Cornmorcialb, Procescd RTE Food- Lound it;Elic fififolviog seli:ons of the Food Cdc and 10(,VR 140-'Fi j 590.0t)(". I I(E) Remainin.,Unsliced Pat tions 0'Bccf Item Good Retail Practices 1 1 590.000 Roast.* i2,Z5. Manarlernent and Personnel ___ FC- 2 1 0r03 is Proper Coating of PHFs 24 Foot and Protection FG—C 1 004 25, Et,,ticirront and Ulensils R, -4 005) 3-501 14fN) Coohtw Cooked PHFs from 140_F it) 26. Water,PLimbirro,and Wasio FC— ow 70,F Within 11 Hours and From 70°F i 27. PhvsIGo:Facility FC--6 007 1 1 i to 41'Fi45'f'Within 4 Hours. * 1 28. Poisonous or Toxin Materials FG -7 :1 .003 3-SOL 14(B) Cooling PHFs Made From Ambient 29. Special Be,oil ontents .009 Terripciature linaedients to 41 T-/,15'F j x_30, -- Caner Within 4 Hours r Denotes Critical Ist'n,II,III,-, 1,tvi)Ford Code ui 105 CNIR 5"(1600 CITY OF SALEM MASSACHUSETTS BOARD OF HEALTH 120 WASHINGTON STREET, 4TH FLOOR o SALEM, MA 01970 TEL. 978-741-1800 FAX 978-745-0343 STANLEY J. USOVICZ, JR. JOANNE SCOTT, MPH, RS, CHO MAYOR HEALTH AGENT COMMONWEALTH OF MASSACHUSETTS PERMIT TO OPERATE A FOOD ESTABLISHMENT In accordance with regulations promulgated under authority of Chapter 94, Section 305A and Chapter III, Section 5 of the General Laws, to operate a Food Establishment in the City of Salem is hereby granted to: Type of Establishment: RETAIL FOOD Name of Establishment: Castillo Grocery Address of Establishment: 24 Palmer Street Owner's Name: Victor J. Rodriguez Restrictions: Application Date: 4/6/2004 Permit for Food Establishment 290-04 Frozen Desserts/Ice Cream Permit for the Sale of Tobacco Products 63-04 These Permits Expire December 31, 2004 This permit is not transferable and must be reissued upon change of ownership or location. The permit must be posted in a prominent location in the Establishment, In accordance with the State Sanitary Code, before any renovations, improvements, or equipment changes are made, all plans for such must be submitted to and approved by the Salem Board of Health. HEALTH AGENT µ• CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH 3 ° 120 WASHINGTON STREET, 4TH FLOOR a SALEM, MA 01970 TEL. 978-741-1800 FAX 978-745-0343 STANLEY USOVICZ, JR. JOANNE SCOTT, MPH, RS, CHO MAYOR HEALTH AGENT 2004 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT JJ NAME OF ESTABLISHMENT t A511 9�t� TELL# 7–zr//_oe_9!r ADDRESS OF ESTABLISHMENT MAILING ADDRESS(if different) OWNER'S NAME C X '�Vez TEL# j 9 //" G g _ 9-QIJ CetG ADDRESS, ?U' 57a&.a 5' gee-1 10 —.– CITY '-aVg0Af TATEZIP ( 2!2Q CERTIFIED FOOD MANAGER'S NAME(S) G1 /'tet, C RTIFICATE#(s) _�o1 a (required in an establishment where potentially hazardous food is prepared.) EMERGENCY RESPONSE PERSON &/ eZ �ii/cz�Lz HOME TEL HOURS OF OPERATION: Mon.67�vue.fa!�tMed4_�//Thuk 7011Fri., T" at..74//Sun.71� ,<( TYPE OF ESTABLISHMENT FEE check only RETAIL STORE Ea) NO less than 1000sgft 1000-10,000sq.ft. =$100 more than 10,000sq.ft. =$250 RESTAURANT YES NO less than 25 seats =$100 25-99 seats =$150 more than 99 seats =$200 BED/BREAKFAST YES NO $100 ADDITIONAL PERMITS fU D MAKE (not just serve) ICE CREAM, YOGURT, SOFT SERVE YES NO $5 TOBACCO VENDOR 63_01'- YE NO (0 ALL NON-PROFIT(such as church kitchens) ES NO ' 2�5" 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 bet kn wled an bel' f, have filed all state tax returns and paid all state taxes required under the law. � _ Q�- -041D��f2 Signature v kq ate Social Security or Federal Identification Number --------------------------------- ----------------------------- I Revised 11/03!03 FOODAP2.adm Check#&Date 70--- -------- -5'—� "Cj y Massachusetts Department of Public Health Salem Board of Health 120 Washington Street, 4`" Floor Division of Food and Drugs 120 MA 01970-3523 FOOD ESTABLISHMENT INSPECTION REPORT Tel. (978) 741-1800 Fax (978) 745-0343 Name/r Date Type of Ooerationfsl, Tyge of Insoection C4ST-1 LC-c� 61/ e&lt4 DIV Type ❑ Food Service ElRoutine Address Risk R`Aetail ❑,6thinspection 2 y �4t�ud� XT-' Telephone Level El Residential Kitchen Previous Inspection 74/1.D 2 7r I I" ❑ Mobile Date: Owner HACCP Y/N ❑ Temporary ❑ Pre-operation ❑ Caterer ❑ Suspect Illness Person in Charge(PIC)S C Time ❑ Bed&Breakfast ❑ General Complaint In: El HACCP inspector /r�d.£.CnfoBtN tJ�t t 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 _ [112. Prevention of Contamination from Hands ❑ 1. PIC Assigned/Knowledgeable/Duties - 0'13. Handwash Facilities EMPLOYEE HEALTH PROTECTION FROM CHEMICALS E:12. Reporting of Diseases by Food Employee and PIC El3. Personnel with Infections Restricted/Excluded El 14.Approved Food or Color Additives FOOD FROM APPROVED SOURCE [:115.Toxic Chemicals ❑ 4. Food and Water from Approved Source TIME/TEMPERATURE CONTROLS(Potentially Hazardous Foods) ❑ 5. Receiving/Condition ❑ 16.Cooking Temperatures ❑ 6. Tags/Records/Accuracy of Ingredient Statements ❑ 17. Reheating ❑ 7. Conformance with Approved Procedures/HACCP Plans ❑ 18. Cooling PROTECTION FROM CONTAMINATION ❑ 19. Hot and Cold Holding ❑ 8. Separation/Segregation/Protection ❑20.Time As a Public Health Control ❑ 9. Food Contact Surfaces Cleaning and Sanitizing REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) El 10. Proper Adequate Handwashing ❑ 21. Food and Food Preparation for HSP ❑ 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 a 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 rF Health. today, the items checked indicate violations of 105 CMR C N 590.000/federal Food Code. This report, when signed below 23. Management and Personnel (FC-2)(590.003) by a Board of Health member or its agent constitutes an Food and Food Protection (FC-3)(590.004) order of the Board of Health. Failure to correct violations 25. Equipment and Utensils (FC-4)(590.005) cited in this report may result in suspension or revocation of 26. Water, Plumbing and Waste (FC-5)(590.005) the food establishment permit and cessation of food 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 s901nspeclFoime-14 nx Inspector's Signature• .- Print: I PIC's Signature: �� 'fL f/ n.. ./ I Print: JI Page ofPages Vlola4icns Related to Foodborne Illness Interventions and Risk Factors litems 1-22) PROTECTION FROM CONTAMINATION FOOD PROTECTION MANAGEMIENT 8 -t I ';90.0K036Aj Pks<_iarrincnt of Responsibility 1-102.i t(14)H i Raw Anir-,,d fluffs 'Sparated tram Soomw'B) Deknoner'anon of Kno,je-gC„okai a"! R7F 2-103.1 i Pelson III charge -duties Contamination front Raw ingrod.0rits K0 11(.a;;2) RkwAninO Fokkj:,Svpi,rio-d f-10111 Hitch EMPLOYEE HEALTH Oilier 58ao.00(c) ResponsibiFty of the pert,un In Ch:r2--to C,nramiadon the Fnvito,",Pnt require repoflm,-,by food employees and -302 1]:A) Fi,id Protection" applic'uns': 3-302 15 Washing Frirr,I andV,_etable,i 590 003(D Repottqibahty Ofr,Foal Employee G)r An -.0•;.11 Fad G,arrctwith EquIpmant and Apptic,mt'fu Repot To The Porkon]it 17unik;!0 Charge:1 Contamiri;;;rknfrom the Consumer 590 001(C) i Repordnt,hy Yeisoo in Charge"'I I 31-30b.I=v'A)(H) Retuned Foo::and Rc,ericc u+.-Food'" and flesri(kcw,-; Disposlion ca 1-YJI-rqter or,-nr:,,mi^afPd 500,0W111Fj Reluo'itl of Excluq�or;:"and Restnotions Fn'lr '-70 1 Disear--lin,nr Reconditioning Unkafte FOOD FROM APPROVED SOUNCE Food 4 1 Food and Klat,-r Frani RVgIAted SoUrCes Food Contact Surfaces 590.0040-13) Cujiqfltanc, with Food Law 4-50 Manual Warewa,In ng- Hot Water 3-201.12 F'oixf in It Herinetice.ih Scaled Coru,;tnej I Sanitization Tenaperauurc,- 3201.1; Fluid Milk arid,\Iilk Proiftur.- i i 51'if.] Rut Water 3-202.13 Shell h-es, Sanitization Terripr.rauircs* 3-202 :4 f""s and Milli 1`1(sducrs. +-5J1.114 Chemical Sanitisation-temp.,pH, concentratk-on and hadae,s. 3 202.10 Ilei 10n.de From portable Duinking, Water' I6'1,11 iA) E1,W11I'�I WILut MICOII�4-t SdJaLei,1.16 5 101,!i Drinkinw.Water from an Approved Sys:.=11- I I UT ton.i'.Clcxi- +90.00(,(A) Bottled Drinliinv Waivi I, 4-601,11 Cfeark;n_F-ccv-:cricy of Equipment Food- )C 000(ii) cootiv.1 Nuctaws-fit' Utensils r Shekifisii and Fist From an Approv--d Source i 4-y02-i! 201.14 Fish and Recreationally Caught I&Ihiscan FoLd Coni-et Surfaces I&Eounpruent, .1-703.:i Methods of Sanitization-Ilk),Water and 3-201 15, MAhiscair Shellfish form NSSP Listed Clieunva)* Sources' to Proper,A-fZequate Handviashing Game and Wild Allurlirooms Approved uk, Roou4n.lort,Authoity ?-3111 i I Clean cond1tv.'n-thuds and A ruis4 2-30! 1) I 3-202.18 Identification PrCSe"L* CleiminQ Proc,durk;' 2-201.i4 Vy fien to Wish' 590.004i Q Wild Mushrooms- Game AninialO it Good Hygienic Praz:dc- Fiume,Di inkin-,ei -jainjc T4+aLka) Recejvirkqitondiz�on 3 20-7.11 PH Fs Recervekl at Proper Toniperatur"k, Disdraiget, Faun the Eyes. Nuke trial 3-202 15 Pack,j.,,V lntegra,, 5'Iouth` 3-;0:.11 I Food Safe and Unadulterated 3-301 I,' When"astine'I 6 Tags/Records:Shellstock 12 prevention of Contam?naticn from Hands 1 590.00-1;F) Pivneiit'oz Corraininvoon from -'02.18 Shellstott,Identification Elnplo'-rs "03.12 Sfic-ilstock fdentifi,--atior Mainta,ne,V' Tags/Records: Fish Products 13 Hkuxlw3sh Facilities 3-402 11 Parasite Uic;inmion' C'urvemptifli,Locaieo an,'Accessibb 3-492 1 75 11 Nunib,f, and Capacities.- Records.Creation and Retention* 5 2iN 11 I-Kmtiun a:ij U�1 3cration and %lainterianc, 590,0040', Labeling of ingredients' Conformance with Approved Procedures 5='1)5.11 /HACCP Plarnt I Su11 4�ptted with Soap and =ro On trig 12;02, OLV;cec 11 Spicialized processing it'leti,ods� - I Hunch,as C'..,Imscr, Availability 11"t criteria, 1-502.12 Reduced oxygen pa(:ka:zi' 6-301.71 8-103.12 Coiffo!!:iance with Arlftr-,%oci Vokiedurc•" ! h-30':.:2 11,rad Drvin"P101"u,nn. I Dkaiules 'riti.al ituni ir.the 1ekhaiu 1119.)Pori!CId--,it 105 C,.'kll?5)014)0 CITY OF SALEM BOARD OF HEALTH Establishment Name: t _4SV-/L_L_f') Afc3C_,&i�- Date: ��1/�� Page: 2 of 2 Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date No. Reference R—Red Item Verified PLEASE PRINT CLEARLY I /3 IFIL - /00r9- r /"&_0VX9-"r mvro-- 6VAt* /N I ? _AtlL: - /CiC C_AmCs4A4 '.c .— n/[�c�!)f' fJrtF r.PnPA Ar/17 f-7?V- z= t I � I � /du- �P Atc�Fc� vi a C.," ,,3AAr C-�I iXO i LJ Rl2/ate/ i I✓rP2C04'7 Ls e.e AKrc«S(Z I I I I � 1 Discussion With Person in Charge: Corrective Action Required: I ❑ No I ❑ Yes I have read this report, have had the opportunity to ask questions and agree to correct all ❑ Voluntary Compliance ❑ Employee Restriction/ Exclusion violations before the next inspection, to observe all conditions as described, and to ❑ Re-inspection Scheduled ❑ Emergency Suspension comply with all mandates of the Mass/Federal Food Code. I understand that noncompliance may result in daily finesofz ve dollars r suspension/revocation of ❑ Embargo ❑ Emergency Closure ty-fi your food permit. f s t//i ❑ Voluntary Disposal ❑ Other: Y _ I 3-50' I,(C) PHFs Recetved at a'emm.ratures Violations Related to Foodborne Illness Interventions and Risk According to f atw Cooled to Factors(Items 1-22) (Cone.) 4I'Ft451F Within 4 Hours. r PROTECTION FROM CHEMICALS -501 15 Coolin„Methods for PI-[Ps j j { 19 PtiF Hao and Ga!d Holding I 14 I Food or Color Additives 3.501.16(1) Cold PFIFs Misintautcd at or below 3-2(12.12 Additives" 590.'004(F) 41'175"F:' 3-302.14 Pm-tection front UnatimovedAddihves* _3_SOLIb;A) HotPY:F; [f4s)ntainedaturabove { 15 Poisonous or Toxic Substances ! 140'F. i ((11.11 Cont iner?in{nem:(tn:n-Chtginui I �t__=.p1.16( t' R r 'F r { Containers" ( � oasts Heid a,or above I30 F. j 7-102.1 I Common Name-Working Containers" ( ( 20 ! Mime as a Public Health Control j j 7-2!11.11 Separation-Storake' { 3-501.19 Time as v Public Health ConhoV { -7-202.11 Re,tnclion-Presence and Use' { { ?')QOt)•V,N) Variance Rryuirentcm j 7-202.12 Conditions of Uw- ! { 7:.03.11 'Toxic Containers-l-toh hN!iuna'o { REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-204.11 Satlitizers,Criteria-Chemical 4' j POPULATIONS(HSP) 7-'_04.12 ( Chemicals for W'ashmg P-(Yfuse,Ci a-ia" 121 { 3-50 L I II-,) Lhipostetlrized Pre-packag-I)nice,and j Beverages with Warning ic:hels^' { 7-204.64 { DrInw Agems.Criteria' ( { { j 3-301.1 !(3) Use of Pasleurzed hggs* 721}9.11 hicidentai Food.Contact.Uthnettnls` I 'J-206.11 Re�tncted Use Pesticides.Critena" 3-80t.`:1{ll} Raw Sced Sirrons or Partial]y x:kedi,,ed.mal Ford and 7-206.12 Rodent Bari Stations' { Raty Seed Spruuu:Not Seared. " { "801.11(C) Unopened rood PaCkage Not Re-served. " 7-206.13 Trackmg Powders,Pest Control and - --- ivUmitaring* 1 CONSUMER ADVISORY TIMErrEMPER'%TURE CONTROLS 22 3-603.11 Consumer Adtlsory Posted for Consumption of 16 Proper Cooking Temperatures for animal Fonda 91tat are Raw,Undercooked at PHFs Not Od,eraise Proczssed to Eliminate i q_ n Pathueens.y enocvoc rosin 101.1 i Af 1)(..) Eggs- 15 SOF j5 Sec. Eggs-humediate Sere-ace 145'1775secr I 3-302.P. Pa,teuazed Egg,Substitute for Rats Sit,11 3-4011.11(A)(2) Comminuted Fish,Meats k Game I Egg' i P.r.intais- 155'F t5 sec. '" i { 3-461,1!(H)(1lt2) Pork end Bccf Roast - I',WF 121 ruin* I SPECIAL REQUIREMENTS 3 i 590m09(A)-(DI Violations of SeetIOn 590.009(A)-(DI in , dR g, sec. ` caterin , mobile.food, tcinpurary'and 3-401.11(Ap;) Poultry,Wiid Came, Stuffed PHFs, res,dentiai kitchen operations should he Stuffing Containing Fish, Meat. debited under the appropriate sections Poultry or Ratites-165 T'15 sec abose if'relatad to foodhorne illness 3-401.1 i(C)(3) Whole-nnrscle. Intact Beef Steaks interventions and risk factors. Other 14517 590,009 violations relating to good retail 3401.12 Eats Anirnii Foods Cooked in a practices should he debited under N29- Microwave 165'F* Special Requirements. 3-401A l(A)(1)(h) All Othcr PHFs-- 1-19'F t5 see. { 17 Reheating for Hot Holding VIOLATIONS RcLATED TO GOOD RETAIL PRACTICES 3-403A 1(A)K(D) P11Fs 165'F 15 scc. * ( (Items 23-30) 3-403 I l(B) 10i(r,-,wave- 165' F 7 Minute Standing Craicai raid not-rriti(al wolathiiis, which do non relate to the Time,, foodborne it4(ess intervcnnone'and vis(-J'aors fisted above, can he 3-403.11(C) Commercially Prxessed RTE Food- faun!in the fol?,�n-trig roetttms of the Food Cndc wnl 105 C1WR t40"F� j 590.(iUO. 3-463.11(E) Remaining_ unshced Portions of Beef I I Item Good Retail Practices FC 590.000 Roasts* 23. fManacemont and Pers:v^nel FC - 2 I .003 j 18 { 24. Food and Food Protection FC--3 .004 Proper Coaling of PHFs 25. c4uipment and Utersi's FC-4 .005 3-501 14(A) Cooling Cooked PHFs from 140`7 to 26 'Water,F'lumbir.0 ino Waste rC-5 .005 70"F Wiftn 2 Flours and Front 70'F 27 Physical Facility rC-6 .007 to 41"F/45'F Within 4 Hours. * 28, Pcisorous or Tox:c Wieriais F-C--7 AOR j 3-501 141E, Coulm,PHFs Made From Ambient 1 29, Special!Requirements OOg j Temperature Ingredients to 4'F,'45'F 30 Othas Within 4 flours', 'Deaotrr critical item is(]to tzder,: 999 Eorn!Code or I lis CNIR 590 000. 1 THE COMMONWEALTH OF MASSACHUSETTS i CITY OF SALEM Address: 120 Washington Street, 4th Floor BOARD OF HEALTH Salem, MA 01970-3523 FOOD ESTABLISHMENT INSPECTION REPORT Tel: (978) 741-1800 Fax: (978) 745-0343 Name Date Tvoe of Ooerattonf� T In CAS{-/cLe3 AleoccA4 B�l�go ❑ Fo dService outine Address n ' Risk etail ❑ Re-inspection 21/ A4 LMA-4- Sr' Level ❑ Residential Kitchen Previous Inspection Telephone 6293- M ❑ Mobile Date: Owner a - HACCP Y/N ❑ Temporary ❑ Pre-operation V I C-rax 07 ❑ Caterer ❑ Suspect Illness Person In Charge(PIC) Time ❑ Bed&Breakfast ❑ General Complaint I In: El HACCP Inspectorl). rrr4.EiKr A%1A /!T OfQ,.h, 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 (Red Items). 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. Local Law ❑ FOOD PROTECTION MANAGEMENT ❑ 12 Prevention of Contamination from Hands ❑ 1. PIC Assigned/Knowledgeable/ Duties 3. 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 TIMEJEMPERATURE CONTROLS(Potentially Hazardous Foods) El 4. Food and Water from Approved Source El16. Cooking Temperatures El 5. Receiving/Condition ❑ 17. Reheating E] 6. Tags/ Records/Accuracy of Ingredient Statements ❑ V❑ 1 Cooling 7. Conformance with Approved Procedures/HACCP Plans 19.. Hot and Cold Holding PROT CTION FROM CONTAMINATION El 20. Time as a Public Health Control 7.8. Separation/Segregation/ Protection REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) ❑ 9. Food Contact Surfaces Cleaning and Sanitizing ❑ 21. Food and Food Preparation for HSP ❑ 10. Proper Adequate Handwashing CONSUMER ADVISORY ❑ 11. Good Hygienic Practices ❑ 22. Posting of Consumer Advisories Violations Related to Good Retail Practices (Blue Number of Violated Provisions Related pe Items) Critical (C) violations marked must be corrected To Foodborne Illnesses Interventions CJ immediately or within 10 days as determined by the Board and Risk Factors (Red Items 1-22): of Health. Non-critical (N) violations must be corrected Official Order for Correction: Based on an inspection immediately or within 90 days as determined by the Board today, the items checked indicate violations of 105 CMR o 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 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: ' 5 atur Print: ec[ s PIC's Signature: � �� Print: �� /1 'A ��. Page-of-y-Pages FORM 734A HOBBS&WARREN - BOSTON IAF tJ w s Violations Related to Foodborne Illness Interventions and Risk Factors (Red Items 1-22) PROTECTION FROM CONTAMINATION 8 Cross-contamination FOOD PROTECTION MANAGEMENT 3-302.11(A)(1) Raw Animal Foods Separated from 1 590.003(A) _ Assignment of Responsibility* Cooked and RTE Foods* 590.003(B) Demonstration of Knowledge* Contamination from Raw Inqredients 2-103.11 Person in Charge-Duties 3-302.11(A)(2) Raw Animal Foods Separated from Each Other* EMPLOYEE HEALTH Contamination from the Environment 2 590.003(C) Responsibility of the Person in Charge to 3-302.1](A) Food Protection* require reporting by Food Employees and 3-302.15 Washing Fruits and Vegetables Applicants* 3.304.11 % Food Contact with Equipment and 590.003(F) Responsibility of a Food Employee or an Utensils* Applicant to Report to the Person in Charge* Contamination from the Consumer 3-306.14(A)(B) Returned Food and Reservice of Food* 590.003(G) Reporting by Person in Charge* Disposition of Adulterated or Contaminated 3 590.003(D) Exclusions and Restrictions* Food 590.003(E) Removal of Exclusions and Restrictions 3-701.11 I Discarding or Reconditioning Unsafe Food* FOOD FROM APPROVED SOURCE 9 Food Contact Surfaces 4 Food and Water From Regulated Sources 4-501.111 Manual Warewashing-Hot Water 590.004(A-B) Compliance with Food Law* Sanitization Temperatures* 3-201.12 Food in a Hermetically Sealed Container* 4-501.112 Mechanical Warewashing-Hot Water 3-201.13 Fluid Milk and Milk Products* Sanitization Temperatures* 11 3-202.13 Shell Eggs* 4-501.114 Chemical Sanitization-tem pH, I 3-202.14 Eggs and Milk Products,Pasteurized* 1 Concentration and Hardness* 1 3-202.16 Ice Made from Potable Drinking Water* 4-601.11(A) Equipment Food Contact Surfaces and 5-101.11 Drinking Water from an Approved System* Utensils Clean* 590.006(A) Bottled Drinking Water* 4-602.11 Cleaning Frequency of Equipment Food- 590.006(B) Water Meets Standards in 310 CMR 22.0* Contact Surfaces and Utensils* Shellfish and Fish From an Approved Source 4-702.11 Frequency of Sanitization of Utensils and 3.201.14 Fish and Recreationally caught Molluscan Shellfish* Food Contact Surfaces of Equipment* 4-703.11 Methods of Sanitization- Hot Water and 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* Sources* 4 10 Proper,Adequate Handwashing Game and Wild Mushrooms Approved by Regulatory Authority 2-301 11 Clean Condition-Hands and Arms* 2-301.12 Cleaning Procedure* 3.202.18 Shellstock Identification Present* 2-301.14 When to Wash* 590.004(C) Wild Mushrooms* 11 Good Hygienic Practices 3-201.17 Game Animals* 2-401.11 Eating.Drinking or Using Tobacco* 5 Receiving/Condition 2-401.12 Discharges From the Eyes,Nose and 3-202.11 PHFs Received at Proper Temperatures* Mouth* 3-202.15 Package Integrity* 3-301.12 Preventing Contamination When Tasting* 3-101.11 Food Safe and Unadulterated* 12 Prevention of Contamination from Hands 6 Tags/Records:Shellstock 590.004(E) Preventing Contamination from 3-202.18 Shellstock Identification* Employees* 3-203.12 Shellstock Identification Maintained* 13 Handwash Facilities Tags/Records: Fish Products - 3-402.11 Parasite Destruction* Conveniently Located and Accessible 3-402.12 Records,Creation and Retention* 5-203.11 Numbers and Capacities* 5-204.1] Location and Placement* 590.004(J) Labeling of Ingredients* 5-205.11 Accessibility,Operation and Maintenance 1 I Conformance with Approved Procedures /HACCP Plans Supplied with Soap and Hand Drying Devices 3-502.11 Specialized Processing Methods* 6-301.11 Handwashing Cleanser,Availability 3-502.12 Reduced Oxygen Packaging,Criteria* 6-301.12 Hand Drying Provision 8-103.12 Conformance with Approved Procedures* "Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. CITY OF SALEM BOARD OF HEALTH Establishment Name: S/�/LLDe�cif2�! Date:'q�2/'/ Page: eal of ZY Item Code C-Critical item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date No. Reference R-Red ItemVerified PLEASE PRINT CLEARLY 1 �C9LLDW/K(rr /VZCMX L-JAR'S 0601,A OUr � /Ihf G�ltftr G /rNt� I 3— K vNQ� r eef��S� s-s urA-,w_ Pis or P,4 eadL dt4oe r (Jo2ia—c�3. OW"t 2 Mulr �� 7rfOc.� ,Qkrr�e,2 c£XP1114117 9 QAf'tFr �Ta c�n/rcNcS I 2 C 7s1Ea2_ jjv `1 u.►4V 4 V QArSS h6s"k-e44efgo 6 y VP �14+ca 10/errzg- [.e61fLr rd :as I 2 ,rJSI- &C .as �,e [ s �� 'c - & , ,� � V /V AFtC I j Discussion With Person in Charge: Corrective Action Required: I ❑ No I ❑ Yes I have read this report, have had the opportunity to ask questions and agree to correct all ❑ Voluntary Compliance ❑ Employee Restriction/ Exclusion violations before the next inspection, to observe all conditions as described, and to ❑ Re-inspection Scheduled ❑ Emergency Suspension comply with all mandates of the Mass/Federal Food Code. I understand that noncompliance may result in daily fines of twenty-five dollars or suspension/revocation of ❑ Embargo ❑ Emergency Closure your food permit. n ❑ Voluntary Disposal 0 Other: ' ....- .r,. . :r �..fr•.*..^'f_ .. .'cafe"... �.+ge«wt�rf4{�9,:N:frr.rub a�•.Ten'r i'� •1i:.{r},+t.. r..,,.�.-:-..... ..� 501.14ot") PHFs Received at it'mperatures Violations Related to Foodborne illness Interventions and Risk .Ao_ordi ge to Iaw C,xr!ed to Factors(items 1.22) (Cont.) 41'F/45`F Within 4 Hewn. ' PROTECTION FROM CHEMICALS 3 `01.15 Cooling Methods li,r PRFs 19 PHF Hot and Cold Holding 14 Food or Color Additives 3-501.10(B) Cold PI IP, Maintainer)at or below 3-262.12 Addiuves" 590.004(0) 41"7,tY F* 3302.14 Protection from Unapproved Additives* 3-501.16(x) I hit PHFs Maintained at or above 1.5 Poisonous or Toxic Substances 140=0 l 7-101.11 fdentiiymg Informaaun-Original I 3-501.16(,1) Roasts Held at or above 130"F. " Containers" 7-102.11 Comn+on Name-Working Containers* 20 Time as a Public Health Con 3-SUl.lo Time a:a Public Health Control*rol* 7-201.11 Separation-Storage" ( - 590.00AiH) - Variance Requirement 7-202 11 'Restriction-Presence and Use' 7-202.12 Conditions of Cse REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7 203 1 1 Toxic Cis,Crites a-Chemicals,- POPULATIONS(HSP) � 7-2(b1.11 Sanitizers,Criteria-Chemirtls* � 7-204.12 Chemicals for Washmc.Produce,Criteria" ( 21 3-SOI I I(A) Unpa,teuri red Pre-packaged huees and 7-204.14 Drying Agents.Criteria' Betenaees with Nkarmn.e 1 abels� 7-205.11 incidental Food Contort. Lubricants• 3 800 l 1(B) 1 ke of Pasteurized Eggs* ?- 7-206.1 1 Restricted Use Pesticides:. Cruenn* � ( ;;Gl.I I(D) Raw or Pttially C<x7ked Animal Food and i Raw Seed Sprouts Not Served. " 7-206.12 Rodent Bait Stations" 3-s01.11 KC) Unopened Food Package Not Re-served. 7-206.13 Tracking Powders,Pest Control and MonitoongT CONSUMER ADVISORY TIMEITEMPERATURE CONTROLS 22 3 603 ll Consumer.Advisory Posted for Consumption of 15 Proper Cooking Temperatures for I Aminal Foods That circ Raw, tfndersuoked or PHFs Not Otherwise Processed ai Eliminate 3401 I tAtU(2) Eggs- 155`F 15 Sec. Pathogens.* Eggs-Immediate Service 145`171.5sec* 3-302.13 Pasteurized Eggs Sub,tiodc for Raw Shell 3-401.11(A)(2) Cotnmmtned Fish,Meats<X Game I Enlist., Annuals- 155"F 15 sec. " SPECIAL REQUIREMENTS 3-401.11(B)(1)(2) Park and Beef Roast- 130"F 121 min ).t 9(A)-(D) Voolanons of Section )- (D) in 590A09 A -- ?-401.1115)12) Rsinms,Injected Meats 50--155"F 15 ( )(} (• sec r catering, mobile food,temporary and 3-401.11(A)(3)_ Poultry,Wild Game, Stuffed PHFs, residential kitchen operations should he Smifmg Containing Fish, Ment, debited under the appropriate secitons Poultryoi Ratites-165'0 15 sec. " above if related to foodborne illness 3-401.11(0(3) Whole-muscle, Intact Beef Steaks intolvenlions and risk hactors. Other 1450P m 590.009 violations relining to good retail 3=401.12 Raw Animal FaKIs Cooked in a pracnecs should he debited under)/29- Microwave 165"F* Special Requirements. ',-401,11(Ai(l)(b) All Other PHFs- 145`F15 sec. j 17 Reheating for Hot Holding VIOLATIONS Rr LATED TO GOOD RETAIL PRACTICES 3-403.111A)&(1.)) PHF, 165'F 15 sec. x (Items 23-30) 3-403.11(B) Microwave- 165°F 2 Minute Standing I Critical and which do not relate In t&e Tints" ,foodborne lilies utterventions raid rirb-(.r(rorc listed above, can be 3403.11t,C) Commoici:dly Processed RTE Food- .iwmd in the followh:g sectio,�s ui the Fond Code muf 1Q5 CAIR 3-403.11(E) Rrmmning Unsliccd Portions of Beef I i ttom Good Retail Practices FC 590.000 1 Roasts', ': 23 FAanagement and Personnel FC -2 .003 I lg Proper Cooling of PHFs I ! 24. Food and Food Protection FC-3 004 25. Equipment and Utensils FC-4 005 3-501.14(5) Cooling Cooked PHFs from 140`1 it, 26. Water,Plumbing and Waste K'--S .006 70"F W41 in 2 flours and From 70T ! 27. Physical Facil tv FC-F 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 669 I Temperature Ingredients to 4VIV45`P 30. Other W ithin'l Hours* Denote,mood item m ihr f derel 1999 Food rode or l05('N1k 590 Opo, CITY OF SALEM BOARD OF HEALTH Establishment Name: 043,5-1Lt,/A 6W-O(!&"C-q Date: 87h2�oy Page: 3 of y Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date No. Reference R—Red Item Verified PLEASE POINT CLEARLY 27 ,✓%c. 4 4-W Ae-Nu,N r✓LA-t-,t J 57'PIL6 r A-f-"O 1 S L.�'C'e�Q n /du.� �/t�W/r✓/r /9 rA BC M.M� /MP�GvYouB ArJ'A I drn2n�t.ffitd-W C/�a�'11 I 2t( (', — S�� lrvv,�t /,�S t.WLrlhS/r-.fes_ Ir�r,�S). YJ� �6vD i!✓ s'r0 70 S/Legy" Alta/Juc.rc eaw,ftD "kn# ",6&6 orf ,V146:rJ, a'&TA'rJ;7 sd'-� krlrrr6- d� (Lt/�-,r R' ;r!. nAsry our rta�Ft�n rw twjv/� PO ae tS pallopcxtw 17^<-A-_mo0. 8r rltitoaM MisStrf- `~K£MP1_"gF69 iMvxr- Wrastt I"-rAS OfF00 14APt6 r, W_?1d- Srrrx R& 1— -1, ao-- OVS/6Cs AY-40 IIWJ'. f / .rOt40"+rw SirrK MU.7r- /3.: Fnr;K- Arte e.i.r.o- AND ,�er ,�rrrht� 1 2n J rtlCrst/r, tea- rr-rs�n�� t� s�-� .6�r ,a r� A cam. ria./ rr� �usr. 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 allI ❑ 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: w,n•rr:.a �n aa.m.wr T-.. �. Yc 'AVN , s+.« . �... -:R4N"'.SnA�Y.Y,a-T m z .. ..,r. f., x �. t. PHFN Received at Temperature; Violations Related to Foodborne Illness Interventions and Risk I According to Lw� Coo!ed to Factors(items 1.22) (Cont) 1 4!'F/'; S F Within 4 Hours. .. PROTECTION FROM CHEMICALS 3-501 15 I Cooling Metl;ods for PHFs 9 PHF Hot and Cold Holding 74 Food or Color Additives I ; I ! 3-501 I6(B) Cold PHFs Maintained at of below 3-202.12 Additives* 590.004(F) 41145° F- 3-302 14 Protection from Unapproved Additives, ( -. ,01,16(A) I-lot PHF:: Maintained at or above 15 •Poisonous or Toxic Substances I 140"F 7-101.11 Identihane Information-Original ( - - • 3-501.I Gl6(A) Roasts field at or oboes 130°F. 7-102,11 C]nnnum tiante-Wcrkin)n Containers* -0 Time as a Public Health Control 1 7-201.11 Srparation-Stprag:� 1 3-501 19 T+me a:.a PLINi:Heath Control"_ i _ 17-2021 t Restriction-Presence and INO � 1 -590.00401) Variance Requirement 7-202.12 Conditions of Use' I REOUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-203 11 Toxic Containers a Prohibitions;, - I POPULATIONS(HSP) 7-201.11 SattitizerN.CYirena-Chcmiads` � I - ni 3-8oL 1 NA) Unpasteurized P'e-packaged Juices and 7-204.1_ Chemicals for W'ashme}mdace, .tjter a` m Berza::;eo:with W'arninet later;^ 7-20-1.14 DrvinR Agents.Criterlar I 3-80!.I i{B) Use iA Pa<teutized E_qs' - - 7-205.1 1 Incidental Food Contact, Lubricants* 3-801A 1 d)) Rats-or Partially Corked Animal Fold and 7-206.11 Restricted CNe Pesticides.Criteria* ! 7-20G.12 Rodent Bait St'sunnt" Raw Seed Sprnuis Not Set ved. i 7-206A!3 Tracking PowcL rs,Pest Control and I x &(11.111 C t I Inonened Food Packa;ze Not Re-Nerved " Monitorin;;* CONSUMER ADVISORY TiMEiTEMPERATURE CONTROLS 22 3-603A 1 Consumer Advisory Posted for Caanumption of Annum Foods Ihar are Raw. Undercooked or 16 Proper Cooking Temperatures for Not Otherwise Processed to Elitmnate PHFs 3301 IIA(i)(2) Fees- 155-F 15 Sec Patlaarens.^eaacv., Eger-hmnedlateService t '=45`F75scc, 3-302.13 Pasteurized Eggs Substitute for Raw Shell 3-401.1 1(A)(2) Comminuted Fish, Mci ts,&Game Eees' Animals- 155-F 15 Nee. 3-•401.11(B)(1)(2) Pork and Beet Roast- 130"F 121 nrin` I SPECIAL REQUIREMENTS 3-401.11(A)(2) Karnes, injected Meats- 155`F IS I _190 001)(A14f)) Violalions of Section 590.0094A)-ff))in Sec. catering. mobile foal,temporaiv and 3-401.11(Aa i) Poultry, Wild Game,Sniffed PHFN. residential kitchen op.-rations should be Stuffnle Containing Fish,Meat, debited under the appropriate sections Poulin) or Ratitcs-165°F 15 sec nhove if related to foodhrrrne illness 3-401.11(C)(3) Whole-nnlscle, intact Beef Steaks interventions an i risk factors. Other 145`17 1: 590.009 violations relating to good retail 3=401.12 Raw Animal Foods Cooked in a i practice should he debited under #29- Microrcave 165"F Species': P.eyuitetaents. 1-401.1 FA)(!)(b) I All OtherPHF;- 145`F 15 ser j 17 I Reheating for Hot Holding j VIOLIST/ONS R.rLATED TO GOOD RETAIL PRACTICES 3-403.11(A)&(D) I PHFs 165`1% 15 sec, * (Iterns 23-30) .i-403 I IBJ Microwave- 165°F 2 Minute Standina Ci;tira!and nun-r"inrul vu,ktL,ms. rc/rich no our r�,iau t,.71rn Tinter' Jnndborne 16'ne.cr intei,,nuions,and,is,/,cars iiatrd nbov , <on he 3 403.11(C) Commercially Puxesscd RTI:Food- found in the initawing sec,inns of the Food Calc,md /05 CA4R 140°Fv 59Q000. 3-403.11(F.) RcmainingLnsliredPortions ofBeef . -Item GoadRetai/Practices FC 580.000 I RoastO 1 23. _ Management and Perscnnel FC -2 .003 18 Proper Cooling of PHFs I - 24 Foal and Food F'ro'ectirn FC-3 004 25. Equipment and Ulensis FC-4 .005 J 3-501.14(A) Cooling Cooked PHFs from !40'F to 126 Water,Plumbinct and W ante t'C-5 .006 70"F Within 21fours and Front 70°F 27. PIiys:e:il Facility FC- 6 007 to 41'FA5`F Within 4 Hourti. "" 28. POIS0110 LIS or Toxwc Maledais FC- 7 .008 3 501.14(B) Cuoling PHFs Made From Ambien[ 29, Syaaal Regwiements 009 Temperature hogredients tro 41`F/45`F 1 30. otnet W'nhin4Hours'x -Dcnotr>critical item m tho Iedund 1999 Fond('ode or 105 CMR 590 000, CITY OF SALEM BOARD OF HEALTH f / Establishment Name: CAPriu_ , OG6R 1a Date: �/ Z ley Page: of 1V Item Code C-Critical nem DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date No. Reference R-Red Item Verified P? PLEASE PRINT CLEARLY c� ` 1�26� /rr PSK SYr0/69 N7+0 A- Mm do. tea f r- /d"" M tICAV- s OXIC0 a+,r rW Or- G9_d E r Z0. �i4zA/�ooi0s �cvfls MV-.sr *E- rv-hz.e '7 s rr�c�T o,•t - �oe,or fa I . 27 N��- /� icy C�,�-.tet �raz.sfL ls�s »a,f kcc�,�f�c.ar,� �-` ��c+�c .ar✓D � r tA�, 4WD �►aT��c,i/�,vu, c�,a,� �r-�t I r v014U - Aec I t��R..ctfrrorcrf � �.k�aoK tea, �,si- FDADS Anvis��,�/ olds I Discussion With Person in Charge: Corrective Action Required: I ❑ No _ ( ❑ Yes have read this report, have had the opportunity to ask questions and agree to correct all ❑ Voluntary Compliance ❑ Employee Restriction/ Exclusion violations before the next inspection, to observe all conditions as described, and to ❑ Re-inspection Scheduled ❑ Emergency Suspension comply with all mandates of the Mass/Federal 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: ,-5t);.,4(0 PHFs i2ecriroect at Tr,ntperatures Violations Related to Foodborne illness Interventions and Risk Accordwg to law Cooled to Factors(items 1-22) (Cont.) 41`F/45'F Within 4 Hunts. PROTECTION FROM CHEMICALS 3.501 15 Coohrej:Methods for PHFs 19 PHF Hot and Cold Holding 14 Food or Color Additives 7-501.I6(B) Cold PHFs Mainiaincd at or below 3-202.12 Addiuvca-� 590.004(F) 41'/45'F- 3-3 Protc�tion from Unapproted Additives` 3-501,16(A) Hot PIIFs A9air,iained at or above IS Poisonous or Toxic Substances 1 ! 140'F * 7-101.11 Identifying Information-0:iginat 3-501.16(A) Roasts Held at or above 130'F. Containers` 7.102,11 Common Name-Work m;,Containers: 20 I Time as a Public Health Control 1 7-201.11 Separation=Sit,,,ape* ( z--`'(i1 19 T¢ne as.a Public Heath Control'" 7-202.11 Restriction-Presence and User ( - 590.004(H) Variance Requirement 7-202.12 Conditions of Usc`' I 7-203 11 Toxic Container,-Prohibitions' REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-204.11 Sattitizers,Criteria-ChemiLeds^ POPULATIONS(HSP)r 2t' ': 3rX01:11(A) l lnpastebnzed Pre-packaged Mire,and 7-204.12 Chemicals for Wa;thing Produce,Criteria' I Retrrages with NWarningLabe:s- 7-..7 04.14 hacidc;Agents.Criteria" - 3-301.11(B) Ilse of Pasteurized H',as' 7-205.11 lnciderial Food O ntact. Lubricarth� 13-801,11(D) Raw o,Pal.'twl;y Cooked Ani u:l Food and 7-206.11 Restricted Use Pesticides,Criteria - Raw-Set d Sp;oua Not Sewed. 'z 7-206.12 Rodent Bait Stations" 7-306.1 3 Tracking Powders.Pest Control and 3-80L11'.C) Unopened Food Packa,e Not Ro-served. " Monitorin * I CONSUMER ADViSCRY TIMElTEMPERATURE CONTROLS 22 3-603 11 Consurner.Adot.or) Ported fol Consumption of .animal Foods:Tt::e;trc Rate. Undercooked of 16 Proper Cooking Temperatures for I etut Otherwise Plocvssrd to Eliminate I PHFs 3-401.1 1 AN)(2) Egg, 155'F Is Sec. pathogen'-.': Eggs-Inm,ediate,Cervix 14.5-F151ec; 3-302.13 Pasteurized Egg,Subscu3e for Raw Shelf 3-401.11(A)(2) ( Conmunuted Fish.Meats. k Game Egp-,* Animals li'Fl>cea " - SPECIAL REQUIREMENTS 3-401.1](B)(1)(2i ( Pork and Beef Roast- 1J0`6 121 min*.i 5,)U. ) r 09(A)-.,D) `violations of Section 5t90.009t A)- 3-401.1 I(A)(2) Ratires,Injected Meats--155"E 15 D)in i sec. catering.. mobile fixed, temporaty and 3-401.11U'0(3) Poultry,Wild Game, Stuffed PHFs' residential kitchen opeta0uns should tie Stuff oe Containing Fish,Meat, debited under the appropriate sectrona Poultrp err Ratites-165'7 15 sec. abu-,e)f related to ktodhorne illness 3-401.111(-)(3) l§'hole-nnedt,Intact Beef Steaks interventions and risk factors. Other 145'F ' 590.009 violation:;relating to good retail 3=401.12 Raw Animal Foods Cooked in a ( prac.ices should be debited under x/29 -- Microwave 165^F" Special Requirements. 3=401.11(A)(t)t b) Al Other PHFs- 145'F IS sec. 17 - Reheating for Hot Holding VIOLATIONS RSLAT6D TO GOOD RETAIL PRACTICES 3-403.11(A4(D) PHFs !65-F 15 sec. * {Items 23-34)) 3-403.11(B) Microwave'165'P 2 Mottle Standing C,inial and run-(ritn'al violations, which du,un relate to the Time' fovdborrz iiheess mien ver ions urrd r-tci;J'n(tors listed abnre, (are he: 3-401,11(C) Contmern ally Processed I2TE Food - file rid rn the folhol ia'ser:kms Of the Food Code and 105 CAIR H F* 590.aoo. -+03.1 ItE} Krnuunmd L'nshccd Portions of Ree)' Hem Good Retail Practices _ PC 590.000 Ru.ish"" L 23 management and Persennei FC-2 .00.3 I 1 24. Food and Food Prote4 18 Proper Cooling of PHFs ct:on Fr-3 ( 00 -----I i 25 Equitiment and Utenstis FC'-4 005 4-501 14('1) Cooling Cooked PHFs front 140'F to ! 26. Water,Piumb4iq and Waste FG--5 .006 70`17 Within 2 Hour;and From 70'F 27 Physical Facility FC-6 007-__---j to 41`F145"F Within,l Hours. "' 28 Poisonous or ro;:,c Materia's FC, -7 .008 f 3-50L14(B) Cooling PHFI,Made F7omAmbientF29 SnecialRcitu'remenl, 009 � Temperature Ingredients to 4 t"F145`F, 30. Ocher Within Hours Demttea cnacal item in II�e fedmal 1994 Fond Code nr o 15 CMR 59(1600. CITY OF SALEM, MASSACHUSETTS Ir_ `� � !/ t g mal. BOARD OF HEALTH gj 120 WASHINGTON STREET, 4TH FLOOR \ y+ I 'A SALEM, MA 01970 TEL. 978-741-1800 FAX 978-745-0343 STANLEY J. USOVICZ, JR. .JOANNE SCOTT, MPH, RS, CHO MAYOR HEALTH AGENT April 12, 2004 Castillo Grocery 24 Palmer Street Salem,MA 01970 Dear Owner, On March 27,2004 personnel from the Tobacco Control Program conducted a compliance check to determine if your permitted establishment would sell a tobacco product to a minor. A 17-year-old male purchased cigarettes from a clerk in your store. Documentation is now on file at the Board of Health regarding that sale. Castillo Grocery is in violation of Section III(A)of the Salem Board of Health Regulation Affecting the Purchasing of Tobacco Products. According to this section,the sale of cigarettes,chewing tobacco, snuff, or any tobacco in any of its forms to any person under the age of eighteen shall be punished by a frie of THREE hundred dollars($300)for the THIRD offense. FOLLOWING THE THIRD(3)OFFENSE,THE BOARD MAY CONSIDER POSSIBLE REVOCATION OR SUSPENSION OF THE PERMIT. The North Shore Tobacco Control Program and the Salem Board of Health have worked with you and your employees to demonstrate methods to ensure compliance with this regulation. Therefore,you are ordered to pay a fine of$300.00 for the violation stated above. A check or money order payable to the City of Salem must be at the Board of Health office,120 Washington Street,4`h floor,within ten days of receipt of this notice. Should you be aggrieved by this Order,you have the right to request a hearing before the Board of Health. A request for such a hearing must be received in writing in this office of the Board of Health within seven (7)days of receipt of this Order. At said hearing,you will be given the opportunity to be heard and to present witness and documentary evidence as to why this Order should be modified or withdrawn. You may be represented by an attorney. Please also be informed that you have the right to inspect and obtain copies of all relevant inspection or investigation reports,orders, and other documentary information in the possession of this Board,and that any adverse party has the right to be present at the hearing. If you have any questions regarding this notification please call me at 741-1800. Sincerely yours, oanne Scott Health Agent JSfbas Cc: North Shore Tobacco Control Program Christina Harrington,Board of Health Chairman ,f ire N2 2182 e � s City of Salem - Board of Health Violation Notice- Tobacco Sale to Minors uy two A This notice is to inform you that during a tobacco sales compliance check,your establishment violated the Salem Board of Health regulation#24 prohibiting the sale of tobacco products to persons under 18 years of age. G SI / tf- (3 pr Name of establishment Z-,./ /n/YL,A'1Z_,F_)e- �-r Address -?/y-71&') /z ; S3n..t Ar" .� Date esale Time of sale 'Minor's age/gender Minor's ID# Adult supervisors Narrative report of incident and description of seller by adult supervisor who will testify at the Salem Board of Health meeting including a description of the seller: MAZE - Ll v T - 1,,3L4 cam- I affirm,under the pains and penalties of perjury,that the above report is true to the best of my knowledge and bbelief. Adult supervisor(Signature) 0 //tEEA76,41_/vc. Adult supervisor (Print name) VENDOR STATEMENT: I acknowledge I received this Violation Notice on A , " U at 12; SMo � AM/ nd 1 am being given a carbon copy of this notice. I also acknowledge that I have been fold that a letter regarding Board of Health follow-up to this violation will be mailed to me at the above address -� pp _� � Q4 is �-� Owner/Manager/Clerk(Signature) A i- A -�- 1_ WT"� R -Q Lk Owner/Manager/Clerk(Print name) If vendor refuses this Notice or if Adult Supervisor feels unsafe in delivering it, an explanation must be written on a note attached hereto. Mailing of this Notice is thus required. For further information,contact the North Shore Tobacco Control Program at 978/741-5646. Board of Health-white/NSTCP-yellow/Establishment-pink L p iw.-,o✓' tw+.trv�+.nr.T.ry..0 yc+„[ge �3T..niiC�� , '5". ?,.' k' OOURT DOCKET NO ' ORATION NO. ° CITY OF SALEM VIOLATION NOTICE PD 1145, ` lV •.. '� i NAME LAST,FI T,INITIAL) / I CAUO CA a, I, L. STREET�R S � CITY OWN STATE ZIP r e� LICENSE NO. l} LIC DATE DATE OF BIRTH Lu 7Co1-a>`-o w O OWNER'S IMED S `( " j a1WISTRATIONNO �� S CITY/TOWN STATE ZIP '7 Ila � STATE EXP.DATE I MAKEMPE YEAR ICOLOR r IIl I O T { N S D I ❑A DATE C A�T�ION WRITTEN 6 w, u 1Zy /O K1g — , ❑N O L ATIC VIyLATIC� jlla 1�OC RCING DEPT./ Ln •• • s y O O OOFFENSE //' �/7 /// CHAP. SE�CTj.I�Fl1NES II/ LuO.yjA r be—m . mem r w I NOS C r �'\ T OFFICER J //T)my I.D.NO TOTA41 r l 4. p !_) . � FIN Pci//JdL!//+L DUE I�v"� W + � _, 'u m OFFICER CERTIFIES COPY GIVEN TO VIOLATOR l IN HAND I X,-(7,T, "J'. �� BY MAIL ..""DD//O011 NOT MAIL,ICAS PAY ONLY BY POSTAL NOTE,MONEY - . -':' ORDER OR BN(C CK MADE PAYABLE TO: ) 'v I " • 1L``\ ""t"_` I C[l'f CLERK CITY HALL - (�\ 93 WASHINGTON STREET ' SALEM,MA 01970 1 TEL.(508)745-9595 X 251 I HEREBY ELECT TO EXERCISE THE FIRST OPTION AS STATED ON REVERSE, CONFESS TO THE OFFENSE CHARGED,AND ENCLOSE J PAYMENT IN THE AMOUNT OF - $�' e $ CASE# � ' I SIGNATURE { Zzz W SEE OTHER SIDE FOR FURTHER INFORMATION :T V t O ENCLOSE PAYMENT IN THIS ENVELOPE,PEEL AND SEAL is rwe r l Massachusetts Department of Public Health Salem Board of Health 120 Washington Street, 4'" Floor Division of Food and Drugs Salem, MA 01970-3523 FOOD ESTABLISHMENT INSPECTION REPORT Tel. (978) 741-1800 Fax (978) 745-0343 Name s�+ � Date Type of Operationfsl, Type of Inspection l/r.$�/LLJdC�X..IP 2 /LOIu� I ❑ Food Service ©-Routine AddressLy pw,,4,, G� Ste- Risk 8-Retail ❑ Re-inspection TelephoneLevel ElResidential Kitchen Previous Inspection el ❑ Mobile Date: Owne'VIC�f- 9,30j t G t)&7� I HACCP Y/N ❑❑ Caterer ary ElPre-operation El Suspect Illness Person in Charge(PIC) Time Time ❑ Bed& Breakfast El Complaint 7A c . r/ In. Permit No. E] HACCP Inspectors Gat.. OR�rvk ��_ n,A v � Out: ❑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 El13. Handwash Facilities EMPLOYEE HEALTH PROTECTION FROM CHEMICALS E] 2. Reporting of Diseases by Food Employee and PIC El 14 Approved Food or Color Additives El 3, Personnel with Infections Restricted/Excluded FOOD FROM APPROVED SOURCE ❑ 15.Toxic Chemicals ❑ 4. Food and Water from Approved Source TIME/TEMPERATURE CONTROLS(Potentially Hazardous Foods) ❑ 5. Receiving/Condition ❑ 16.Cooking Temperatures ❑ 6. Tags/Records/Accuracy of Ingredient Statements ❑ 17. Reheating ❑ 7. Conformance with Approved Procedures/HACCP Plans ❑ 18. Cooling PROTECTION FROM CONTAMINATION - ❑ 19. Hot and Cold Holding ❑ 8. Separation/Segregation/Protection ❑20.Time As a Public Health Control ❑ 9. Food Contact Surfaces Cleaning and Sanitizing REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) El 10. Proper Adequate Handwashing El21. Food and Food Preparation for HSP ❑ 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 cfC Health. 590.000/federal Food Code. This report, when signed below 23. Management and Personnel (FC-2)(550.003) by a Board of Health member or its agent constitutes an 24. Food and Food Protection (FC-3)(590 004) order of the Board of Health. Failure to correct violations rr'25. Equipment and Utensils (FC-a)(Sso.00s) cited in this report may result in suspension or revocation of 26. Water, Plumbing and Waste (FC-5)(590 006) the food establishment permit and cessation of food establishment operations. If aggrieved by this order, you 27. Physical Facility (Fc-6)(590.007) have a right to a hearing. Your request must be in writing 28. Poisonous or Toxic Materials (FC-7)(590.006) and submitted to the Board of Health at the above address 29. Special Requirements (590.009) within 10 days of receipt of this order. 30. Other DATE OF RE-INSPECTION: 5 5901nspecfFomSJq Dec ,.} tsps tor' - g�� IPrint: Y C'141'- PIC's Signature: / � �/ I Print: Page of Pages V Violations Related to Foodborne Illness Interventions and Risk Factors(items 1-22) PROTECT;ON FROM CONTAMINATION FOOD PROTECTION MANAGEMENT I 8 clous_rntaMoIv't;on 3-30:!-! Raw Anunal Food.,Separat,aI Ionic 590 003(5} Cookedand RTE F'iod,� Dnauastratiora of KnowIroJ-_,e* 2-103.I1 I 'Person in change- r_0ntvmio,.ion f-or-,Raki,L'gradients Kaci Annual Forks.SeparttrB front FIwh EMPLOYEE HEALTH Othcr` 2 590.003K ) Responsibility offlic purstm in chiti-e to Contprrciatocio from the Environment reofraro;oepiorluig t-y f,',ocl eil;plol"'Saird 1 3-302.1 1(A) Food Prniection" 3-302.15 Wa;hiiig Fru4and V:_-etablci 50.I,03(F;) Rusponsibility Of A Fuod Emplo,%ee sir An 3-304.! F.`,d CI!?ctith Equipment and Applicant"Po RopoilTuThe Forson In Ulens-N Charil"- cont.rninaton tom the Consumer 5()0.()03(G) Reporting by Person in 0,arge' z.106.14(A)13l Retart tred Fouu and Ruscc<,%e.of Foe!i Oisprsil;on o,'Adulteiancd o.,Oor,*aminatend I 3 590.00-i(D) Exciusionsand RestricvonO 590.003(E) Removal of Exclusions and Restrictions Food FOOD F IOM APPROVED SOURCE Fotd' 4 Food and water From Rog_,Iated Sources 9 Food Contact Surfaces 500.00 I(A-B) Cumpl iarwL with Food'lacy" 4-501 111 Mantic',!Wawwqthing Hoc Wawr 3.21}!,+,2 Food in Ii Herneticaliv Soaled Conlaintrl sari!Lrz.lttuil TencrIerature's, 1 ?01.13 iNuidMilk and Milk Pr(),IUL* 4-jo:.1 1 i Mecfiollieal Y,;uewa,hin1,.Hot M'Pier 3-207.1.1 Sajiitiz.oto-)co Tu:o)rejatnrus' 4 501.) :4 Chtjnical Sanitb-tocai- pH. 3-202,14 Eggs and Milk Piodurts.ParctCLIrize& 3-202.16 lcc Made Ftorn Potable Drinkir:,Wa!erl I "oI;I;V'uh;1tio1I ciro". hardness 1 601 1 !(A) Ecpopm-,roo Food Contact Surfaces and 5-101.11 Drinking Water frorn as Approved Sy�to.tn' Ijleu'i!s C!'-:11r, I :i90.00o`,( 1) Bottled Drinking Waa.:-' 11-b(I7 I i Cleciniw,Frequency(,,I T-.'oluipmen,Food- :i90.014'cH) WaresWets Standards 1-,310 0AR 22.0* Contact Stn,'W e- and Urefij' .3hollLsI,and Fish Fiorn an Approved Source ?02.1 I Ffe.-uellm,I. S ani tization ututvatsi 1 S and 3-20'1.i4 Fish tmd Rccrcaionally Caught Mol!usc:rn Fond Contact Surfac,S of Fctooinln'It* Shellfish' I Moiloiscan Shel&h I'rou,NSSP Liak-d %I�Ihod'�I)! Saaoltiz�1i'qc'-Hot Water an-I 3-20i,ls 0wi:w al' snljrcvs' I IIB I Proper,Adequate Handovasbirg Gama and W.0 Mushrarins Approved by Regula!or,Atithardy Condition-Hands,mJAims- bhellstock Idv.rorific,,..ti,n Present" 2-301.12 Clecuons P-(oc:vchorw 590.004(Q Wild N'lu-4iorcims- 1 j2-301 14 When to Wasl'.* 3 201.17 Game Animals'` if Good Hygienic Practices s Reo;efv�n,f/Condition 2-40iA I hating,D(inking o.,UsinoI Tubaccici 3'202.11 P1 IFs Rcceivtol at Proper Temperatures" I 2-10'1.!2 Dit;cbi,,gc,Fn.n,the Eyes, Nose and 3-202 15 Package lme�nrty' 3-10IJ 1 5 cod Safe and Llnadtdlerat�-d 301 12 Ptuventing C.,iitaiuijratron When Tasting' 6 I Tags/Records:Shellstock 12 Preverino n of Contamination from Hanog 1 102.18 Stiellswidentification 590.1- I10.1Q111) Pre,7coror, Contaminatinto from 12 Shcllstock identificati(r, M4,ounEmplow",ncd' 13 Tags!Records; Fish Products Conveniently LtocauodandAcceS3;ble it 3-402.':! PairasiL, D(;,IrIictirorv: 3-402.12 RVWids, Creation and Retevuow* '03.11 Nojnbt;r. and Capacities- 590 004U) Labeling of Ingredients' o-20,�I I Lo.miou and?IuconotIot, 5-205.11 X,c-ss:bilay. �")peiafion ac,d Nlaintenaj,.x 7 Conformance with Approved Procedures /HACCP Plans S,ppl.ed vIft-Soap Pnd 11arcd Drying IfD i ewcas 3-502.11 Specialized Proees!' w '\'IcthW oo Cloa;v;�,r, ANailctbila� 3-:102.1'_ Ruclueed oxygen pack,,Ang,;crite:ki* a-103.!2 COnfocrnarre e with Arprovoct ProiLedtircs" 6-31)112 Komi Ci-�raq Dmok",criti III ilk-III;oo III,-retie,..! 11;91)rood Code oi I01'(.N.IR5'i)Jo()()' M CITY OF SALEM BOARD OF HEALTH Establishment Name: C47rju o 6'AociEs" Date: 2 Jz ° leis/ Page: 2 of 3 Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date No. Reference R—Red Item SE PRINT CLEARLY Verified PLEA 27 N ! G.r,Ac ,� s N Ft_. , A4" .5 r 13S M/��J�r F,�`4lri:r�✓�udt . cdwJr� 1 M VS PA ker -,-it vt-. 1 r I Z� At / C f�.t�.hf )"4- .A44-6 N IA4C AAC If O'T .4 "r/-f0f_ W6-4 Ce-&*4,,tl . MLR r- .3✓4 W /-3�4r a,✓ .a CC Cf.44U .A r,,,.A/ rIF F-0. i) ,0C YIA'f. rr�..,covc raLLf C .� �.s,J A.vt1 9f rn rizr� Ir 14 za W. � I9 t. ( 214 c.T-i_y ten/ as47?fcf" of r-tic Aet-'5 vrti - AtLt_ PA0()t10r 8r£ 1 Jkre7 A f LkAfT_ 6 - 8 , Wel.,rAEs oFt �M� rGon►� 27 tj p4if—Ar Ovr1'7—ffvb- FLt,drCIMP so„Lr AHO /=w0 9.EAe)r rte/ T711z - I - I - I - I - 1 Discussion With Person in Charge: Corrective Action Required: ❑ NoI LIYes ❑ Voluntary Compliance ❑ Employee Restriction/ I have read this report, have had the opportunity to ask questions and agree to correct all Exclusion violations before the next inspection, to observe all conditions as described, and to ❑ Re-inspection Scheduled ❑ Emergency Suspension comply with all mandates of the Mass/Federal Food Code. I understand that noncompliance may result in daily fines of twenty-five dol rs or us ension/revocation of 13Embargo LlEmergency Closure your food permit. U cit t ❑ Voluntary Disposal ❑ Other: 4 i 3-;01 14, PHlrs Retr;ved at'1-entperaturet 'Wv!aUors Related to Foodborne ittness Interventions and Risk Accortlinc 1'�!;:w Cooled to Factors(items 1-22; (Cont.) 41-Fi45'P V,;ihio4 Homs. ^ PROTECTION FROM CHEMICALS ;'Doling Methodsi::r NHF Food or Calor Additives 19 PHF I'M an4 Cold Holding 14 ;-.`+01 16(H) Cold Mills Maiulahwd at or below 3-202.;2 ,4dditives'' i "^') 3:30.14 ProL:ction front l rnapprovc•d' Additn r: }j Poisonous or Toxic Suostances U,1 oov Hot PFIFs Maintained at sa obove I1 'F. 7-101.11 Identif'vinuI britrinL on-Orisdrial j -5i)L utUs; i?os[r. Held at rn abut: 13017. Container;" ZPe Time as a Pebi:c Health Control ;'-i i12J I C:u:nnum Name-tVutkinn C'ontainzr-" � 3-5 : �:: ;' , i '-'01 11 Sc t r r on-Siorave i _ (.L!9 T:nte as Pubic .leeidt Control* , _ t:: ai 7-202.11 Re:.trietion-Presrue.e wit Use* � � 500.001(H) Vonlmce Rruuuucuent 7-'_(13.12 Conditions of Use* ! 7-20:.11 toxic Contoiners-ProhihitiotW: REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(MSP) 7-1 t4.1 I Sa:atizers.Criteria_Cher,,icak+ ... . 21 3-801 11(A! Unpasicutizerl Pre-packaged Juices and -<04 12 e_ Chemicals for Washing Proince, ] LW.I-1 Uiyin_ Agztttn-Crttcsi:a' ( Beverages with WarningLabeN� - 3-8{il ll:B! Use of l'astawized 7-105 It Incidental Fo(d Coninet,Lubricant,- ;° :1 11:D) Ra+v of Ru'di ly Cooked-Anunal Food and 7-2(16,11 Resoicied Use Pesocides,Crdeua Raw Seed Sprouts Not 7 '_On 1_ Rodent Stations 7-206,1 3 ackin,Invders,Fest Control and ( I3-80111 t C)" Uno L x d Food Packa w Nct Rc-screed. Monitoung" CONSUMER ADVISORY 22 ?-oM%II Con,umcrAde:seiy Posted 'or Consuniptiun of TIMEffEMPERATURE CONTROLS 4nunal Foa1.s'll:.0 ate Ravi, Underco ked of 16 ' Proper Cooking Temperatures for I Not Othc-, n Mse Prees:d tr;Eliminate PHFs i 3-401.11 Atl)(2) Eggs- I55`17 I Sec. Pathogan,.^ E'-s- lm media;e Servlet 1.75"Fl;arc` j ;-302.13 Fastcm-tz:ed b�g>Suhstitntc tit;Ra,.v Shell 3-401.i I(A)(21 Canuninue(I i^.sh,Meats&Game ( F•i"','„ Animals - I55'F 15 sic * SPECIAL REQUIREMENTS 3-401.11(13)(1)(2) ( PurkandRcel'Roast- 130-F 121 ruin^ 3-401.11(A)(2) Ratiu�, hdNcats- I55`FIS gg0.0UTr?)-( }: � i. dation~of Section 590.009(A) (D) in se. * catering., nubile food, ternporory and 3-401.11(A)(3) R.ultty, Wild G nte.Stuffed Pl-il , residential kitchen operations should he stuffing eontatn;ng Fish,Mea., debited undid'the appropriate so'tions P<•athr4 or R;tor;-165 F 15 sec " above if related to tcodbornc illness 3-401.1110(3) Whole-muscle, Intact Ree(.Stzaks inter-enLcne,anti risk Factors. Other 145`F* 590.009 violations i latus to good retail 3-401.12 Raw Animal Foods Cooked in a � practices should be debited under#b29- Microwase 165'F'F Special Requiretnents. 3401.11(A)(I)lb) All Other PHFs-- 145'F15see. ` 17 Reheating for Hot Holding VIOLA7IONS R.:LATED TO GOOD RE 17AIL PRACT.'CES 3-403.1100&t D) PIFs 165"17 15 sec. * ( (lterns 23-301 3--103.1 I(13) Niicruwavc- 1650 F 2 Minute Standing I Critts al and nor--croicat >nilatiuns, which do not relate to tha Tuuce foofhorne:!Inesr ev mid risk facio.s hsted above, can hr 3403 11t Commercially Pio,.e;.sed RCE Fucd- /burr;io the fn(lowint;sec inns n(il e Food Code arni /G.5 ("MR 140''F' 540.(H)6. 3-403 11tH) Remaining Lasliced Purtiuos or Reet i Item 1 Good Retail Practices FC 590.000 Roar„ts'' 1 23. ;_Afanagement and Persennr l FC-<^ .003 i !4444 4444- 24, Fred and Fnoc Pmte ecn FC -3 .00= 1s ( Proper Cooling of PHFs : 25 Fq;;ipment ane Utensils FC--c ,005 3-101.;4:"A� riwl!ngCo,,kcdPl-iP;(rc-midOFw 128. I 'Alw-r,Plumoinga.-elWaste rC--5 .005 70'F Within 2I-lours,and From 70`F 1 27 Physical Facilty 1 F.-6 .007 ' tool"F/45F Within Hones. * 23 Poisonous or Toxo fAata:ials 1 FC-7 008 ! 3-501.13(13) Cooling PHFs Made From Ambient 2} Special Requireno nl5 009 Temperature htgmd:ents to-!I'Fr45:F 30 Cther Within 4 Hours' `I cw.te,critical ittnt m the letkrai 19'+9 Putt('ale ni I )i CMR X90.000. CITY OF SALEM BOARD OF HEALTH Establishment Name: �v$5`ilcyo GGt9c. rLY Date: 2 ��©I:'y`>r Page: 3 of 3 Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF'CORRECTION Date No. Reference R—Red Item Verified PLEASE PRINT CLEARLY A ZY G �t� F�cwu✓,NCr Fv�n .�-s"�ar v�rrR� �vvv�rJ �'�-�i 1 I 'ri+ .OI st.4 r, 0.kr&-s r I � 6s AXjf Lt GP_ M ► 2" r I II 31liRtr�REFA-/ w(rtrC� �/Z �rALt.Of✓ It V\114 3 LC IL41 LV— 47LJAA-r-_T S TyvE- T,nP Gff re-x4jul A6_&'Crf mk/IM 0"?,+eq FOOD /37_�2b `)'AA.3 ` �f g St9V�- �,*l,r. .-JNr�r✓ c,y, /'S /02_ /v • I x ►Jvre� c)war&,-- uA/f c.A-- U M .t— -ni el- r jor� PRIL Pirm clam rff W& 1 ,-rtIIV(D PAS-j-&_LITU S' /4&1 —1 L,- Mlltro 1 op ru�v,t M urrr CL P Fs r&x'L-7 rpt¢ rl r4�f E !t' vF.l✓� /°el,ot` RI C'rl./(i✓6�r FjLS >t✓Cr ,�N'f tom. I I . D,scussion With Person in Charge: Corrective Action Required: ❑ hlo I ❑ Yes I have read this report, have had the opportunity to ask questions and agree to correct all ElVoluntary 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 qr suspension/revocation of ❑ Embargo ❑ Emergency Closure ' ,. your food permit. �/ ❑ Voluntary Disposal ❑ Other: v 3-501.'aC) PHFs R,Lei ved:'t'eemperatures. i Violations Related to Foodborne Illness Interventions and Risk According to L:;w Cooled W Factors(items 1-22) (Cont.) 4 i R'45'1 er hui 4 Uoms ' PROTECTION FROM CHEMICALS ±-501.;i C,dirl)t h}ethrds fr,_'PHFs j 14 Food or Color Addifives j I ig PHF€-!ot and Cold Holding 3-7.02.1? iddlti�esF 3-501.1`.:B) Cr;ldpl-11's,Maintaine•datrribeiem, 5VO.004(17) -11'145"F" 3-30 1-1 Prosection front Urappimed 1Pill's" Nsintainea P.1 ar eboi-c Is Poisonous or Toxic Substances 14(,, 1 7-101.11 Ident,&,l o InfOrm:hr,n-Original !j 1 3-501.10(:U 7:oasts Held at at above 130`F Containers' ! 20 ` Time as a Public Health Control '-l0i.l l Common Name-Working Cnntainerc` I I i-501.i 9 ' :um as z P:;hilt I Ie:ath Coutrol" 7-2u1.11 Sepur:,tion-Storagc^' ( 5)090,:, ,,.. 7-203.11 Restriction-Presence and 1)sz* ( H) 7-207.17 Conditions of Use" 7?0;.11 Toxic Con:aineo; -.Prnhibaious ( REQUIREMENTS � 7-30-4.11 Samtizers.Cnrcris-Chem "icalPOPULATIONS(HSP) FOR HIGHLY SUSCEPTIBLE Pi 121 3-Y;11.1 U•A) ! ,lnpasieuiii.:d Pre-packaged Juice:,and i 7-20q 12 Chemicals for iVashmg}u Ktuce.Criteria^ 17-2114.14 Ilrsin Alznts.Criteria` I Bcveraee,v,iih ll'arning Labeisa 3-1t01.11iB) I Useof Pasteurized Eg:s" 17�"!ii 11 Incidental Food C'unlavt. Lubricants'" j I, r 13-&ill I Ii,1�) 1 Rsv;or Partially Cooked Animal Food mid 7-2fh.t: Pvwieled Use f estieides,Criteria' Raw Seed Sprouts Not Jets ed. 7-206 12 Rodent Runt r , e I I 1-801.1 K-) I Unopened Food Package Not Re-served ' 7-206.'3 'tracking Powders,Pest Com ml and I Muaaori°c" CONSUMER ADVISORY TIME(TEMPERATURE CONTROLS 22 .1-603.1 i COISLArn-o Ad,;aoty Pos:ad 1,,r Consa:nuuou of 16 Proper Cocking Temperctures for An`Inal F.juds that arc Ras,. Undercooked or PHFs I N(o: Othervvise Processed to Fiiminate Pz?u:rvens a: rrr �r..ar: 3-=401.11 A(I)(2) F.ttrs- nimuc 13 Sec 3-30_'.13 f`.otemricd Fags Substitute 1cr Raw Shell Egz s-hnmcrh:ne Service 145"F I Ss:e� �'C' 3 40L l I(A)(2) Comminuted Push. Mens ti tunic ( Pgvs* Amntals- 15YF 15 t.ec. " 3-401.1l(B)(1)i21 Pori,and Beef Raast IW F 121 ruin' SPECIAL REQUIREMENTS 590009(A)'D) �'iollions of Sc^,:lion 590.0091ts,)-(D)in 3-401.1 I(A)(21 Ratites, Injected Meals-- 155'F 15 ` [See. cotering, mobde load, temporal Wil i 3-401.11(Au", Poultry,Wild.G:nne.Sr„ifed MF:; residential kitchen operatons should be iStuflin;Containing Fish. Meat, dohited Linder U:t;appropriate sections Poultry or Ratites-105'17 IS sec. " j above if related to focxlhofue illness 3-401. 1(001) 14'hole-muscle. [;:tact Beet Steaks inlervcntion.s anct risk factors. Other j 145'F" 590.009 violations relating to good retail 3-101.12 Raw Animal RA&Cexrked in a practice;:.hntdd be debited under#29- ! ( A4icrow:rye IIiS`F`` S,mel,d Requirements. 3-401.11(,)(1 ub) All Other PHFs - I45�F 15 sec. " 17 Reheating for Hot Holding VIOLATIONS R--LATED TO GOOD)RETAIL PRACTICES 1 3-403.i I(A)&(D) ( PflPs 165'F 15 sec. (items 23-30) 3-303.!1(B) Microwave- 165'F 2 NUnute Standing Grip'ai wid 11011-0:tircl i;o! ri:,n s, wbich donot relate to the Time* flodb ime iltnes,;irrternemi:;ns and nskfiaciors bsleu:rF,err, r,c+be 3-403.1 I(C) Conunercially Processed RTL Fox}- found in die fallowing seettan.c of ilu Fond Code and 305(-WR 140„Fm Sint Ot i'1. 3-403 11(E) RetnninmG Unlined Portions of Beef Item I Good Retail Practices FC 590.000 Roasts,, I 23. Wna:,ement and Personne! 1 FC-2 .003 ! ! (g Proper Cooling of PHFs I 24 Foca and rood Prola:tiun FG -3 .004 : 25. - j Erywrment and Uten_ils PC-d 005 350 I.idlAi Cooling Cooked Pl-fI'sfrom l4tl°F:o j Writer,Plumbied -------. 26. and Wae.te FC--6 .006 70'F Within 2 Haus and Fran 70'F 27. Phy,icni Facility FG-6 007 I to 41'F(45'F Within 4 Homs * 2S. Poiscna_s or I uxis A,iat rals ! FC-7 C08 _ i3-501.14(R) Cooling PHF,blade FinalAmbient � 29. Special Requirements .009 [cmper.durc [ngrcdie:)t;ar 11"Fi45°F Within 4 Flours'' ' Den,de•:ritual ant,n the lederal 1999 Feoj Codu o: I(I.;C:,1R 590.000. /COURT DOCKET NO, CITY OF SALEM CITATION NO � VIOLATION NOTICE Pry U J.S. NAME(LAST,FIRST,INITIAL) /:s Cr r✓sf C f/c. r1 STREET ADDRESS' f CITYJOWN STATE�7 ZIP LICENSE NO. I LIC,EXP DATE DATE OF BIRTH OWNERS NAME(LAST.FIRST,INITIAL) Com'" JCS>fr/i/ 1� STREETA.�D}/D�RESSS /CITYITOWN STATE ZIP ' v 4 1 ^ 4-/e�i'I, REGISTRATION NO I STATE IEXPDATEI MAKEITYPE I YEAR ICOLO DATEON RISp (TIME l IPuo / uA � f / © 7/ 7?1ev ❑NoS I OCATION OF VIOLATION 1{Y//�>f /,o�M NPpgCING DEPT -741 OFFENSE CHAPISECT. FINES] Acif17 / IG OFFICER �( SLY I D.NO TO7AL IIA] I DUE ✓'�� OFFICER CERTIFIES COPY GIVEN TO VIOLATO�4Rj X .'/ A .r,/G.�.�i—�J(,/C.C�"` hBY MAIL DO NOT MAILCASH=PAY ONLY BY POSTAL NOTE,MONEY 'ORDER OR BY CHECK MADE PAYABLE TO V 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