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CINDYS PLANET - ESTABLISHMENTS cin�y's e��tt �X i fort QV�( universal one m www.myuniversalop.com phone: 1-800-756-4676 UNV16162 MADE M USA _ 1 dia ��I i � __ CITY OF SALEM l BOARD OF HEALTH Establishment Name: Fto 4 - z Date: I Page: of Hem Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION foate- No. Reference R-Red Item Verified PLEASE PRINT CLEARLY Q P cr \ 1`;r p'- t I l I "::�eu'P ct fD �i P 1 In r,.1 e CS rp'- r ._.k�LCvYbi 1r1 �'1� i I 0�•a_t � I 1 •t t _ Ittc ; I a L i rte:- l I � r ,r,.all 71.�rvr�,r�cc Y�2.¢JIr�n i :rf� b c,�Ct i S (n _ V 7 + C-1 J T s' 1 Ctdl 4r) Op P,r rr -tfo _ P 7 r J -r ,nlirt/, . �� _ IGS, _ tY OVIP. �i r.�_7 I , �.• , i Discussion With Person in Charge: Corrective Action Required: ❑ No ❑ Yes I have read this report, have had the opportunity to ask questions and agree to correct all ❑ Voluntary Compliance ❑ Employee Restriction/ violations before the next inspection, to obsery conditions as described, and to Exclusion II 13 Re-inspection Scheduled ❑ Emergency Suspension comply with all mandates of the Mass/Feder Food Code. I understand that noncompliance may result in daily fines of wenty-five doll rs ors pension/revocation of ❑ Embargo ❑ Emergency Closure your food permit. �j�( ❑ Voluntary Disposal ❑ Other: t .� 3-501.14(C) PHFs Received at Temperatures Violations Related to Foodborne/lines.Interventions and Risk According to law Cooled to Factors(Items 1-22) (Cont.) _ _ 41'F/45°F Within 4 Hours. PROTECTION FROM CHEMICALS3-50IA5 Cooling Methods for PHFs 14 Food or Color Additives 19 PHF Hot and Cold Holding 3-202.12 Additives* 3-501.16(B) Cold PHFs Maintained at or below 590M04(F) 410/45-F* 3-302.14 Protection from Unapproved Additives" 15 Poisonous or Toxic Substances 3-501.16(A) Hot PHFs Maintained at or above 140°F. * 7-101.11 Identifying Information-Original 3-501,16(A) Roasts Held at or above 130°F. Containers* 7-102.11, Common Name-Working Containers* Time as a Public Health Control 7-201.11 Se aration-Stora e* 3-501.19 Time as a Public Health Control' 7-202.11 .Restriction-Presence and Use* 590.004(H) Variance Requirement 7-202.12 Conditions of Use* 7-203.11 Toxic Containers-Prohibitions* REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-204.11 Sanitizers.Criteria-Chemicals* POPULATIONS HSP 7-204.12 Chemicals for Washing Produce,Criteria* 21 3-801AI(A) Unpasteurized Pre-packaged Juices and 7-204.14 Drying Agents.Criteria* - Beverages with Warning Labels* 7-205.11 Incidental Fowl Contact,Lubricants* 3-801.11(B) Use of Pasteurized S iis* 7-205.11 Restricted Use Pesticides,Criteria' 3-801,11(D) Raw or Partially Cooked Animal Food and 7-206.12 Rodent Bait Stations* Raw Seed Sprouts Not ServetL 3-801.11(C) Unopened Food Package Not Re-se 7-206.13 Tracking Powders,Pest Control and Re-served. " Monitoring* CONSUMER ADVISORY TIME/TEMPERATURE CONTROLS 22 3-603.11 Consumer Advisory Posted for Consumption of 16 Proper Cooking Temperatures for Animal Foods That are Raw,Undercooked or PHFs Not Otherwise Processed to Eliminate 3-401.)IA(1)(2) Eggs- B5°F15Sec. Pathogens.*e'°"`°lfl` ' Eggs-Immediate Service 145°F15sec* 3-302.13 Pasteurized Eggs Substitute for Raw Shell 3-401.11(A)(2) Comminuted Fish.Meats&Game E s* Animals-155'F 15 sec. SPECIAL REQUIREMENTS 3.401.11(B)(1)(2) Pork and.Beef Roast- 1.30°F 121 min* 3-401.I1(A)(2) Ratites,Injected Meats-155°F 15 590.009(A)-(D) Violations of Section 590.009(A)-(D)in sec.* catering, mobile food, temporary and 3-101.11(A)(3) Poultry,Wild Game,Stuffed PHFs, residential kitchen operations should be Staffing Containing Fish,Meat, debited under the appropriate sections Poultry or Ratites-i 65'F 15 sec. * above if related to foodborne illness 3-401.11(0)(3) Whole-muscle,Intact Beef Steaks interventions and risk factors. Other 145°F* 590.009 violations relating to good retail 3401.12 Raw Animal Foods Cooked in a practices should be debited under#29- Microwave 165'F* Special Requirements. 3401:11(A)(1)(6) Ali Other PHFs-145'F 15 sec. 17 Reheating for Hot Holding VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 3-403A1(A)&(D) PHFs 1657 15 sec. * (Items 23.30) 3-403.11(B) Microwave- 165'F 2 Minute Standing Critical and non-critical violations,which do not relate to the Time* foodborne illness interventions and riskfactors listed above,can be 3-303.11(C) Commercially Processed RTE Food- found in the following sections of the Food Code and 105 CMR 1400F* 590.000. - 3-403.11(E) - Remaining Unsliced Portions of Beef ItItem I Good Retail Practices I FC S Roasts* 2; 3. Management and Personnel __ F(3-2 .003 .I 18 Proper Cooling of PHFs 24. Food and Food Protection FC-3 .004 J 25. Equipment and Utensils FC-4 _005 3-501.14(A) Cooling Cooked PHFs from 140'F to 26. Water.Plumbinq and Waste FC-5 .006 ? 70'F Within 2 Hours and From 70'F 27. Physical Facility FC-6 .007 to 41'F/45'F Within 4 Hours.* 28. Poisonous or Toxic MaterialsFC 7 1 ,' 3-501.14(B) Cooling PHFs Made From Ambient 29" S ectal Requirements .009 I Temperature Ingredients to 41°F/45°F 30. Other ! t Within 4 Hours x: x zex 'Denotes critical item in the federal 1999 Food Code or 105 CMR 390.000. < +dt )P. > r � < I< pw v t -r✓l � r r ♦ t .r �, , v t .r � r , � , / ' m. - ...a � rCERTIFICATE AwARENEss TRAIN ING ��. Name of Recipient: Cindy Yen 0. . �_ to nDate of Completion: 7 - �F i.� <� H Issued Bv: a NATIONAL .�� . RESTAURANT <.� ONm in accordance i •i ii r , • 2 -fes 7V�E ESouthborough,MA 01772 r 508-303-9905 r t_v4�r11Y1 r tv'l�i>Yr,> r ty6 i>Yi'.p r. t -<l ilYrt r. tr'tt i)Yr� r trltf�%lY,t tett iYYr , U fS';e;r0vSgaf— EXAM FORM NO. 4440 CERTIFICATE NO. 6351406 ServSafe" Certification a Ta N N for successfully completing the standards set forth for the ServSafee Food Protection Manager Certification Exilmination, which is accredited by the American National Standards Institute(ANSI)—Conference for Food Protection (CFP). 3/12/2009 DATE OF EXAMINATION 3/12/2014 DATE OF EXPIRATION Local laws apply.Check with your local regulatory agency for recertification requirements. S NATIONAL RESTAURANT ® David Gilbert ASSOCIATION Chief Operating officer,National Restaurant Association f10665 Executive Director,National Restaurant Association Solutions - Q=National IiaamuremNwcletion Educational Foundation.Aa don reserved.SneSaM and the ServSafe logo are registered trademarks of the National Restaurant Association Educational roundadon, and used oder Hoene by National RaataunmAsewlodon Solutions,LM a whollyommd wbaldlaryof 00 National RaetaummAamc4don. This document cannot be reproduced or altered. 08121102 v0803 EXAM FORM NO. 4299 CERTIFICATE NO. 5213978 rserv.% fe Certification for successfully completing the standards set forth by the National Restaurant Association Educational Foundation for the ServSafea Food Protection Manager Certification Examination,which is accredited by the American National Standards Institute(ANSU-Conference for Food Protection(CFP). Presented by the National Restaurant Association Educational Foundation 2/6/2007 DATE OF EXAMINATION 2/6/2012 DATE .OF EXPIRATION - Loral laws apply.Check with your local regulatory agency for recarti0cation requirements. lot, National Restaurant Association Mary M.Adolf EDUCATIONAL FOUNDATION President and Chief Operating Of[car National Restaurant Association Educational Foundation www.nraef.org 02WOThe National Restaurant Association Educational Foundation 05051402 - 0.0911 CITY OF SALEM BOARD OF HEALTH Establishment Name: l ,(VNA4'S G Cf4l_Z �� C-reCAVVt Date: 3Isk) Page: / of Item Code C-critical item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date No. Reference R-Red Item 3e Verified PLEASE PRINT CLEARLY r) 1 th7)mecti Jr, -Hc 1kQ SSe asan c cc C n tic-1 u reed (--I o — clto clve.r2 Vl � U �ois c �lerS on v� It) 1ttQ cflr �ivxa rt +(0)1�� b i o n C-, c 1c vtC l�J r C S.. o n-,P I -tto -Jr nmVvl• a�7Hca 17-c, (A_ Cl Ia_f IY11 �`�5 (1-1 )(-jc, nn/Ii r f n- r I ,a a f cz + , ( u�C&C, I,, o i I- - r - EV�, _.f4 � Y it I�1 r7 In :! /roYl 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 Foof-Code. I understand that noncompliance may result in daily fines of twent --five dollars,or suspension/revocation of ❑ Embargo ❑ Emergency Closure your food permit. / �( � ❑ Voluntary Disposal ❑ Other: l r 3-501.14(0) PHFs Received at Temperatures Violations Related to Foodborne Illness Interventions and Risk According to Law Cooled to Factors(llehis 1-?2) (Cont) 41`F/45"F Within 4 Homs. PROTECTION Ff30M CHEMICALS 3-501.15 Cooling Methods for PHFs 13 PHF Hot and Gold Holding 14 Food or Color Additives 3-501.16(B) Cold PHFs Maintained at or below 3-20212 Addiivcs* 590.(tWF) 410145°F" 3-302.14 Protection from L'nappro„ed Additives` 3.501,16(A) Hot PHF s Maintained at or above I-5Poisonous or Toxic Substances 1101.11 ! Identifyinginforntation-Original )40'F. ” _ l Contau erg" _ 3-501,16(S) Roasts Heid at or above 130°F. -� 120 3 I Time as a Public Health Control �..t 11.02.11 " CCommoti Acme Flnitxr < oui trier"` -I _ ---- i 701.11 Se a lucn-Shnahc� G_ (i_- ro..asalubhaI-len(h 7 ('clfluvt" -1- -�----� "10.121}1(1-{) �4_rianccRc Requirement _-�j 7-20111 1 ke lriclon- Yr xnu.lnd 1 c --- 7 202.12 Cook lxi of Ilse 7REOWREMENTS FOR HIGHLY SUSCEPTIBLE '_0311 Toxic f ont linea Prohibititml�`� POPULATIONS(HSP) 7-204.11 it Sanivecti Cardin C11011ic Is - -- 7-204.11 C.h ntic&tor_41 a hu r i 1 iducc C lie,ria" �t 3 301 I !tA) llnfa tem izsci Pro pact agcd Juices cuui I 20�4 14 Bclee.with Rmf nnl,�iaWl," fu! I1(B) 1,,c o Paqw7rcdH . 05-11 Inci&rilil F nd Contact uNi a a1 '-531 ( HPiv r INl;a➢ o;:)kiAni 3ai Fix�d Awu06 !I Pr ,rk C! el! -- --! i Ral SL vj r,ua til i 1.rte 1 i ' .0(y.)0 �i�;,}ri l3 f�4Ulio}i ( h(ii 1 ({ : t i. (ic rr ak'I t' "k IW) it hCr t.i i J 1 i`a n t;, 'gwdi _ _. _..._ .2, ��,. _..___.. CONSUMEf7kIDWSORY TIkSF YEEU REf?ATURE CONTROLS 22 i 1 hCi: 1:' 1 C ons(! icr lci.iscnt l'Kicd!=rr r r ompt ce of i I 1 fta c ft 1.111 o4 xke:)o:. :-^roper Cooking Tempe ata e..for Pki-, i 1 j � I int t r( < v 1!.UcwK,ie t Sir S& An a u:- 1�i t SPECIAL REQUlREMZNTS t 011 1-)(i : t i andlSci Rimrai 1 , 1 4)1ni' _- --- -- i 4'11.1i3OV —r-� ( i.,� A r i . '_` I ) �.) }FtAi-:t}r I V%i,Loii Se bt1! r{1Cki�fAi iL� . C I : ordl v ntk'3 WIN C„1 .;r _ t Y 'ion, , i r � 1 '. c><i a it sAa'T � 1 � '11•,kr r 'di.prl { 'k:r'nt )iF-y= a � , !n 31,:. l iSF::"iL t. ;-.. i C , 17 i ! Rahc�ting for Hat Holding I VfOLAt ONS RELATED 70 000.01fiETAIC PR,Af`TWES 3-403,11(A)&W ( t tll ioi I 1 c _ j Otems 23-30) -44T.JIB) lluio%,avr I15 , � NI)n eSlaudingj C,F ,t_,-'._rt?tr,r. t.m.u.' <_:7ioirs. nrich do 1101 Ciat< .,p" �1 t c” l fa,torr li, tr6 i t . cern t:'r i)(C) 1 t :mnm6aillf`it:.,:.::;dPl#.Fvuxi- (nt r 'r;Frt/, ,,I1,[ se,..1r :hc 'audC`odz:awl l ). 1MR 4()'F ir}Ju - --- .---'-- '---- T'. 34113.1 I(F) P-mamin, hns!ic ed Yornc _s of Beef 1 r ItemGaod Retail Practices i fC 510AOC - ( tt r 7 >nanal,rmc t a.,d Pei er r; _ IPC dC? --- -""-- : 24 F ,xf +d 8ax1 FroFeri Gn FC i GG4 ($ , roper Cooling of PHFs ._ ��( — — —_ ;_'5 : rIu:omr nt 3nd Uleni s F , a ){i- i : ,sf I1Q twk d PHI s horn 110 F to ! 2 tlJ c! Pii 'rbi me e/ to °C 5 .OqS — hon 2 tfou,. d€Yom iO'l f j 27, Flmjslc�Facility _ - _FC 6 w I il, ^ 1 15"F Pr thm 4 Ht uFf" _28 1 Poi's J s: r t :3 S G 7 008 ri r Iu g PHF M adc From Ambient i m{,l iauin li rcFeuR to 47 1 } "+v Otter I P t3 i d H:nn - Commonwealth of Massachusetts s r: City of Salem Board of Health Kimberley dri3Coii 120 Washington Street,4th Floor Mayor SALEM,MA 01970 Foo"etail Establishment Permit DATE PRINTER: . 0310$!2010 ESTABLISHMENT NAME: Cindy Planet Fite Number:BHF.2003,000048 888 Washington Street#903 Boston MA 02111 .LOCATED AT: SALEM, MA 01970 Permit Type Permit No. Permit Issued Permit Expires Fee Restrictions I Notes FOOD SERVICE BHP-2010-0373 Mar 8,2010 Dec 31,2010 $140.00 ESTABLISHMENT FROZEN DESSERTS 13HP-2010-0374 Mar 8,2010 Dec 31,2010 $25.00 Total Fees: $165.00 PERMIT EXPIRES December 31, 2010 Board of Health 4WT//,7 �� This Permit is not transferable and must be reissued upon change of ownership or location.The permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code,beofre any revonations,improvements,or equipment changes are made,all plans for such must be submitted to and approved by the Salem Board of Health. Page I �� bili a ��`�`5 CITY OF SALEM, MASSACHUSETTS + BOARD OF HEALTH 120 WASHINGTON STREET,4:� FLOOR TEL. (978) 741-1800 KIMBERLEY DRISCOLL FAx(978) 745-0343 MAYOR DGREENBAUM&SALEM.COM DAVID GREENBAUM, ACTING HEALTH AGENT 2009 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT NAME OF ESTABLISHMENT ul IA(CI CYLWl ( TEL# ADDRESS OF ESTABLISHMENT �� tY✓ I— �/e - FAX# MAILING ADDRESS(if different) EMAIL-Business': Website: OWNER'S NAME TEL# Cb L_T — &-23 —R 19 P ADDRESS STREET /1 �) CITY STATE / ZIP CERTIFIED FOOD MANAGER'S NAME(S) ` 114 . l.O.Vl CERTIFICATE#(S) 10.3� 1 40(::� (Required in an establishment where potentially hazardousfood s prepared) ` —7 0. �i q(� EMERGENCY RESPONSE PERSON v HOME TEL# (D ['r1 .� 'n I ! 6 DAYS OF OPERATION I Monda Tuesday Wednesday Thursday i Friday Saturday Sunda HOURS OF OPERATION ( Pease write in time of day l�rlYr'l�t I at �IR YVr ' p ( �I , For example ttam-11 m ll at l 11 TYPE OF ESTABLISHMENT FEE (check only) RETAIL STORE YES less than 1000sq.ft. =$70 1000-10,000sq.ft. =$280 more than 10,000sq.ft. =$420 ........---- RESTAURANT YE NO less than 25 seats (Outdoor Stationary Food Cart$2 25-99 seats =$280 more than 99 seats =$420 BED/BREAKFAST/ YES $100 CHILDCARE SERVICES/NURSING HOME........--------------------- ----------------------- ----------------------------- ----------------------------------------- ADDITIONAL PERMITS MAKE (not just serve) ICE CREAM,YOGURT/SOFT SERVE YE $25 TOBACCO VENDOR YES $135 ALL NOAFPROFIT(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 mu be submitted to and approved by the Salem Board of Heafth. Pursuer MGL Chapter 62C, ection 49A, I certify under the pains and penalties of perjury that I,to my best knowledge and belief,have filed all state tax returns paid all tax 'r quired under the law. Z 3c� sigi6dee Date Social Security or Federal Identification Number �3a 31t�ly l �� My File Edit Tools Help - III Itl AR Category 160-Services-General Account 1011487 —� Customer F 33075 Parcel 450008 Name CHIN WAYNE Loc#1 177 Suff Str FORT AVENUE Apt I City SAL St ❑ Zip Balancel 1859.83 i I Date Bill# Type Check# Amount Interest Balance ^.� 591915 Charge 271.18 2.50 1859.83 12/16/2009 Adu -2248.36 158615 10/06/2009 577346 Charge 969.99 42.41 3834.51 07/07/2009 562713 Charge 531.93 41.82 2822.11 04/06/2009 548120 Charge 338.64 .00 2248.36 01/06/2009 533557 Charge 348.60 .00 1909.72 12/04/2008 Adu -1585.22 1561.12 10/06/2008 519085 Charge 1035.84 .00 3146.34 07/07/2008 504633 Charge 525.28 .00 2110.50 j 04/01/2008 490165 Charge 215.74 .00 1585.22 {OVRI .:E I CITY OF SALEM BOARD OF HEALTH Establishment Name: (",lrl !S t5 �CYK- t tc- C-X P_Z lm Date: 3�13 �C�1 Page: �_ of item Code CodeF C-Critical item s f DESCRIPTION OF VIOLATION/PLAN OF CORRECTION < Date `No.` Reference �R 7 Red Item ° .l „` t , , a c, H e . _. PLEASE PRINT CLEARLY �- � flv'e--o�etn��, - - , I { t R(t oth P,r rexxii .&nvvt-, 4-o gppicrfiP cp-P�I �rcy� e 4-t4;2V1 7 4 i i Discussion With Person in Charge: Corrective Action Required: ❑ No U Yes y ❑ Voluntary Compliance ❑ Employee Restriction / s I have read this report, have had the opportunity to ask questions and agree to correct all Exclusion s violations before the next inspection, to observe all conditions as described, and to P / , ❑ Re-inspection Scheduled ❑ Emergency Suspension comply with all mandates of the Mass/Federal Food Code. I understand that j noncompliance may result in daily fines of twenty-five dollars or'sdspension/revocation of ❑ Embargo ❑ Emergency Closure f your food permit. / l/, y �� // p S ❑ VoluntaryDisposal U Other: z PHF;Received atTemperatures Violations Related to Foodborne fitness Interventions and Risk Accordingto Lax Cooled to Factors(item 1-22) (Cont) 4 1�F/45-F Within 1 Hk ws� 3-501.15 PROTECTION FROM CHEMICALSHITi PHF Hot and Cold Holding Food or Color Additives —15011(a) 2(P- 12 Adduive� 590.004(F)-- 41 145`F" —TTOT14 Plotoolon from Lnappru;ed Oddi nL�— 1-501,1NA) flat Pffls�Maintained at or above Poisonous or Toxic Substances 40'F. Iderififyinglitfo;ination-Oti�gnad 501 lf�(Ikl�oas contaillers* L%11,ddat or aborti 130°F.. Time as a Public Health Control 7-102,11 0annionName- 19 T as a Public Health Conn'OV 7-201.11 S<pw�nion- —t�a 7.202.11 R(nvictnm-Pre��-ncovd Lse* riance" 7-202AT--Condit ions of Use REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7 203 it Toxic Contanrrcl� -PTOI'ibinom�l POPULATIONS(HSP} 7-204.11 Samli7trs' 7 —217 —Iso 1'�-,-1(7) UnIelteurizad prepallJuices and ,--204.12 Chenheafs for Washit Ciire6a* L--�I itevuloees w Llh-l�'arning labQ[S* 7204.14 ;F---Soi 11'B) Use of pa-trlloi '7-206.11 Roiiricled,,Nt Petik.ides.Criterm- Rae-Sned S 1`aokq Solved. —7TOO.I i iodcul Bait�Stauom' 7-206 13 flacking Pokvderi.Pest C.kaarol and CONSUMER ADVISORY TIMEITEMPERATURE CONTROLS 26:7 T —onulrlor—Advisoi Y—Powd for Consumption of Aninial I iKAs That are Raw, Undercooked to Proper Cooking Temperatures for Not Othem ise f'rocesseal to Fliptolove PHFs 3�O1.114(1t(z; Gigs I—iVF 155.e unalclItate Ser ice 145'115sccl 3-301 113 PB,stakoiz d FggSubstitute for Raw Shell I a—1 t Comininuted Fih, Pleats& Gana, v — l Pariards 154,rT E5 sec * -- SPECIAL REQUIREMENTS I 1(13)(i)(2) Pork and Beef loaxist - I A),f,121 coa0 -40 1.11"k)(2) Ralite,, h1jeLfed ML4h, 15-S'F 15 C5)—(T)t J-;Tlal 71or 5t?0,(W0 A)-(D)in sec. i'aleringraobilfood, temporary and remdent'al Utchen opLiaflons,�huuld be Iss, --i 40 1.11(A)(3) Pauh,),Wild dame; Sin f7 S 1 debited raider the appropriate sections niffing ConninuriL Fish folca�' abowe if rehued to b)(Alf o)).r ne ithicss Poul n(Lr I�a�iteLl 65"'T' 15 vel. 3-401.1](C)(3) WhOeao -pscle,Inattllcefsteaks inwi veortions and risk factors, Other 145 F 59(#.009 violations relating to p(xxl retail 3-401.12 Raw Annual Fo(ook Cooked in a piacticesshotold be debited Under#29 - Nlicoo.wnve 10"FS I Requirernehts. U1 --Reheat'ing for Hot Holding VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 3-4031 I(A)&(D} PHF> 165"F 15 sec. (items 23-39) 3-403.1)(F3) Microwave- 165"F 2 Milane Standin., Critical and nwi-critical viokawnj, aldch do net relate to the Time, 'forldhorne ollness nuervelloona and risk factors lisirdaheve (an be 3-103.11(C) Cominter(�Wly Poa'cssad RTEFtxid- fi'luld in!Jowfollon4lig se coons of rhe frn,d Code and)05 CXIR 140'F* 3-403.11(E) Remaillun, Unfired Portions of Beef item Fmcil�aei` FC 590 000 F"asr"t H22L f1l"nemtlat and Pereonn6 6 -2 1 003 tg Proper Looting at PHFsi 24, Food and Food Protection FC—3_ 004 t 25 Eno ment and Utensils FC-4 009 1.14—(A) Coolinq Ox)ke4i PFFs'from J4WF to -------------- 25 �YJatot Plumbtt;2 Nas+e FG-5 'WF Wifidit 2 lfour�and From 70`1' 1 27 1 PrW6id Facilliv FC-6 i-007 Within 4'Hours. Materials I FC-7 i 008 Cix)fuojg PHF a Made From Ambient R'quirentelaF, 009 50-- LO t lseTenperaorrchigredieragn,41'F/45 r------ ------- Within 4 Boon* Z.a' it noes ImUcal Atealm 1994 F')'A Oxlr or 105('NTK 540 000 1 Commonwealth of Massachusetts • F City of Salem Board of Health IGmberley Driscoll 120 Washington Street,4th Floor Mayor SALEM,MA 01970 Food/Retail Establishment Permit DATE PRINTED: 03/13/2009 ESTABLISHMENT NAME: Cindy Planet File Number:BHF-2003-000048 888 Washington Street#903 Boston MA 02111 LOCATED AT: SALEM, MA 01970 Permit Type Permit No. Permit Issued Permit Expires Fee Restrictions/Notes FOOD SERVICE BHP-2009-0395 Mar 13,2009 Dec 31,2009 $140.00 ESTABLISHMENT FROZEN DESSERTS BHP-2009-0396 Mar 13,2009 Dec 31,2009 $25.00 Total Fees: $165.00 PERMIT EXPIRES December 31,2009 Board of Health This Permit is not transferable and must be reissued upon change of ownership or location.The permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code,beofre any revonations,improvements,or equipment changes are made,all plans for such must be submitted to and approved by the Salem Board of Health. Page 1 CITY OF SALEM, MASSACHUSETTS �I BOARD OF HEALTH 120 WASHINGTON STREET,4°'FLOOR TEL. (978) 741-1800 KIMBERLEY DRISCOLL FAx(978)745-0343 MAYOR IDIONNo:2SALEM.COM JANET DIONNE, SENIOR SANITARIAN 2008 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT NAME OF ESTABLISHMENT �' ls►1�` TEL# �J'k ' Ifl - 6c 1 1 ADDRESS OF ESTABLISHMENT FAX# MAILING ADDRESS(if different) } EMAIL-Business': C1NA Kort Website: OWNER'S NAME r fYV` TEL# ADDRESS gASK �i��lni( s—�, �Iw &fo-- AiA 17 iiI STREET CITY STATE ZIP CERTIFIED FOOD MANAGER'S NAME(S) CERTIFICATE#(S) (Required in an establishment where potentiall hazardous food is prepared) EMERGENCY RESPONSE PERSON � HOME TEL# In T ff23 — 4 DAYS OF OPERATION Monday Tuesday' i Wednesday Thursday Friday Saturday Sunda HOURS OF OPERATION ^ j Please write in time of day. Ij jCM ?•t) r� i�QM - i(]PM. ' OQWr FIIP t(awl-!U f+^ ICh+— Ilm ?am - 11 fm j 114 - IDS, ) Forexam le llam-1t m I ! TYPE OF ESTABLISHMENT FEE (check only) RETAIL STORE YES j :O less than I000sq.ft. =$70 1000-10,000sq.ft. =$280 more than I0,000sq.ft. =$420 ----....-- RESTAURANT ES NO less than 25 seats (Outdoor Stationary Food Cart$210) 25-99 seats =$280 more than 99 seats =$420 ----_-----------_----- --------- ---------------- ----------------------- -------------------- BED/BREAKFAST/ YES-----NO—...... ..........I---------------- - — ........... ------- ........ $10..0. CHILDCARE SERVICES------------------- - ' ADDITIONAL PERMITS MAKE (not just serve) ICE CREAM, YOGURT/SOFT SERVE E N 25 TOBACCO VENDOR YES $135 ALL NON-PROFIT(such as church kitchens) YES y� $25 _ "Please pay total with one check payable to the City of Salem. 9 �✓�6 D This Permit is not transferable and must be reissued upon change of ownership.The Permit must be posted in a prominent locatio 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 1,to my best knowledge and belief,have filed all state tax returns and paid all state taxes required under the law. D433Z 301 Signature Date t Social Security or Federal Identification Number Revised 4/24/07 FOODAP2008.adm Check#&Date 3 t i Commonwealth of Massachusetts City of Salem e • Board of Health 120 Washington Street,4th Floor KimberleyMayo Driscoll Mayor SALEM,MA 01970 Foo&Retail Establishment Permit DATE PRINTED: 03/05/2008 ESTABLISHMENT NAME: Cindy Planet File Number.BHF-2003-000048 888 Washington Street#903 Boston MA 02111 LOCATED AT: SALEM, MA 01970 Permit Type Permit No. Permit Issued Permit Expires Fee Restrictions/Notes FOOD SERVICE BHP-2008-0418 Mar 5,2008 Dec 31,2008 $140.00 ESTABLISHMENT FROZEN DESSERTS BHP-200&0419 Mar 5,2008 Dec 31,2008 $25.00 Total Fees: $165.00 PERMIT EXPIRES December 31, 2008 Board of Health This Permit is not transferable and must be reissued upon change of ownership or location.The permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code,beofre any revonations,improvements,or equipment changes are made,all plans for such must be submitted to and approved by the Salem Board of Health. Page 1 of 1 1 r, r CITY OF SALEM, MASSA©:IUSE'TTS �. ✓° BOARD OF HEALTH �rayt vdc' 120 WASHINGTON STREET,4ro FLOOR 'ILL.(978)741-1800 KIMBERLEY DRISCOLL FAX(978) 745-0343 MAYOR ISCl�TTCCr)SALUM COM JOANNE SCOTT, HEALTfiAGENT 2008 Aff LICATION FOR PERMIT TO OPERATE AyyFOOD ESTABLISHMENT �/ NAME OF ESTABLISHMENT 1 II j 4L#� � �� j ADDRESS OF ESTABLISHMENT ! 1 IZ FAX# MAILING ADDRESS(if different) EMAIL-Business': f �� Ce bsite: — D �U NJ � OWNER'S NAME ( V1 TEL#.Co_– R-23 —S, ADDRESS ! 903 'klf A: 02/ STREET CITY STATE ZIP CERTIFIED FOOD MANAGER'S NAME(S) or,e trk t(�p. CERTIFICATE#(S) (Required in an establishment where potenti ly hazardous food is prepared) v EMERGENCY RESPONSE PERSON �� HOME TEL# L(:Z 4-237-0 DAYS OF OPERATIONMonday Tuesday Wednesday Thursda F day Saturday SundaL_ HOURS OF OPERATION �i Please Mte in Ime of da ' \ nrfi� (� ( �pM n' I r' 10 (Forexamplettam•11P) T (�y 4 ) �rt.; �- '• TYPE OF ESTABLISHMENT { FEE (check only? RETAIL STORE YES NO less than I000sgA. =$70 1000-10,000sq.ft, =$280 more than 10,000sq.ft. =$420 RESTAURANT YE NO ess than 25 seats $140 (Outdoor Stationary Food Cart$21 �avut C-0_ 25-99 seats more than 99 seats =$420 - ... - ---------- - - -- .......- -----------.......- ------- ------ --.------ BEDiBREAKFASTi YE5 NO CHILDCARE SERVICES $100 • ADDITIONAL PERMITS ---------------------------------------_ MAKE (not just serve) ICE CREAM, YOGURT/SOFT SERVE YES_ NO $2 TOBACCO VENDOR YES $135 ALL NON-PROFIT(such as church kitchens) YES NO $25 'Please pay total with one check payable to the City of Salem. This Permit is not transferable and must be reissued upon change of ownership,The Permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code, before any renovations, improvements,or equipment changes are made,all plans for such must ubmitted to and approved by the Salem Board of Health. Pursuant L 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 a id all state to s req 7e nder the law. - f-05 O Sig ature Date Social Security or Federal identification Number '-- ---------- _ -•_ --------•----- ----Hare r-- --------- --- ----•----'r-- -------- Revised 4/24/07 FOODA 008,a m Check#& , _ . 4 -'v 'r 888 Washington Street #903 Cindy Planet City of Salem FOOD SERVICE ESTABLISHMENT - FOOD SERVICE Inspection HACCP: ❑ Item Status Violation Critical Urgency Telephone: Violations Related to Good Retail Practices (Blue Items) 617-823-9198 Physical Facility FAIL Non-Critical BLUE OWner: I Comment:There are water stained ceiling tiles in the back room. Investigate the source of the leak and repair. Replace all stained Cindy Yen ceiling tiles. `PIC: GENERAL COMMENTS: Cindy Yen All other reuirements to open have been satisfied. Inspector: David Greenbaum Date Inspected:Correct By: 3/5/2008 Risk Level Permit Number: BHP-2008-0418 Status: SIGNED OFF ;#of Critical Violations: 10 ITime IN: Time OUT: 4 Urgency Description(s): BLUE: Violations Related to Good Retail Practices (Critical violations must be corrected immediately or within 10 I days)(Non-critical violations I must be corrected immediately or within 90 days) City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741-1800 GeoTMS®2008 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Mar 06,2008 ) 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®2008 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Mar 06,2008 ) Page 2 oft / I 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 Dat T of Operations) Tvoe of Inspection s ood Service 51-Routine Address RiskRetail ❑ Re-inspection Level ❑ Residential Kitchen Previous Insp ction TelephoneElMobile Date:..��// rr�� Y Owner HACCP YM [I Temporary El Pre ibrt ❑ Caterer ❑ Suspect Illness Person in Charge(PIC) Time ❑ Bed&Breakfast ❑ General Complaint In:I ❑ HACCP Inspector Out SC7 Permit No. ❑Other Each violation 6heckbd 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 MAHAGEMENT�---- . - "" 11 ❑ 12. Prevention of Contamination from Hands ❑ 1. PIC Assigned/Knowledgeable/Duties ❑ 13. Handwash Facilities EMPLOYEE HEALTH PROTECTION FROM CHEMIC ALS ❑ 2. Reporting of Diseases by Food Employee and PIC •� '� a =rF � r =tea ❑ 14. Approved Food or Color Additives ❑ 3. Personnel with Infections Restricted/Excluded ❑ 15.Toxic Chemicals ' FOOD FROM APPROVED SOURCE---"--," � TIMErrEMPERATURE CONTROLS(Potentially Ha ardour Foods)-7�" ❑ 4. Food and Water from Approvedd Source f ❑ 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 El9. Food Contact Surfaces Cleaning and Sanitizing ;REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) ❑21. Food and Food Preparation for HSP ❑ 10. Proper Adequate Handwashing o- CONSUMER.ADVISORY`,� 3'-+.. 'W 1�4_E El 11. Good Hygienic Practices ' �v. ❑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 i"Nr' by a Board of Health member or its agent constitutes an 23. Management and Personnel (Fa2)(990.0 order of the Board of Health. Failure to correct violations 24. Food and Food Protection (FC-3)(5cited in this report may result in suspension or revocation of 25. Equipment and Utensils (Fc-a)(s90.00x4)))o.00s) the food establishment permit and cessation of food 26. Water, Plumbing and Waste (FC-5)(590.006) establishment operations. If aggrieved by this order, you 27. Physical Facility (FC-6)(590.007) have a right to a hearing. Your request must be in writing 28. Poisonous or Toxic Materials (FC-7)(590.008) and submitted to the Board of Health at the above address 29. Special Requirements (590.009) within 10 days of receipt of this order. 30. Other DATE OF RE-INSPECTION: S,5901n,p For -14,d I ( Inspector's ig tures Print: PIC's Sig ate: Print: Page of�Pages I Violations Related to Foodborne Illness • interventions and Risk Factors(Items 1-22) PROTECTION FROM CONTAMINATION FOOD PROTECTION MANAGEMENT 8 Gross-contamination 596.003(A) AssignmenfofResponsibility* 3-302_1,1(A)(1) Raw Animal Foods Separated from 590.003(B) Demonstration of Knowledge* - Cooked and RTE Foods* 2-103.11. Person in charge--dutres Contamination from Raw ingredients - 3-302.1.1(A)(2) Raw Animal Foals Separated from Each EMPLOYEE HEALTH Other* 2 590.003(C) Responsibility of the person in charge to Contamination from the Environment require reporting by food employees and 3-302.11(A) Food Protection* applicants* 3-302.15 Washing Fruits and Vegetables 590.003(F) Responsibility Of A Food Employee Or An 3-304.11 Food Contact with Equipment and Applicant To Report To The Person In Utensils* Charge* Contamination from the Consumer 590,003(G) Reporting by Person in Charge* 3-306.14(A)(B) Returned Food and Reservice of Food* 3 590.003(D) Exclusions and Restrictions* Disposition of Adulterated or Contaminated 590.003(E) Removal of Exclusions and Restrictions Food 3-701.1.1 Discarding orReeond[tioningUnsafe FOOD FROM APPROVED SOURCE Food* 4 Food and Water From Regulated Sources F 9 Food Contact Surfaces 590.004(A-B) Compliance with Food Law* 4-501..1.11. Manual Warewashing-Hot Water 3-201.12 Food in a Hermeticall•Sealed Container* Sanitization Tem ratures* - 3-201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Warewashing-Hot Water 3-202.1.3 Shell Eggs* Sanitization Temperatures* l S i 114 Chemical Sanitization-tem 3-202.14 E sand Milk Products,Pasteurized* 4-501. p^pH, 3-202.16 Ice Made From Potable Drinking Water* concentration and hardness.'" 5-101..1.1 DrinlcinE Water from an Approved System' 4-601.11(A) Equipment Food Contact Surfaces and 590.006(A) Bottled Drudd ng Water* Utensils Clean* 590.006(B) Water Meets Standards in 310 CMR 22.0* 4-602.11 Cleaning Frequency of Equipment Food- Shellfish and Fish From an Approved Source Contact Surfaces and Utensils' 4-702.11. Frequency of Sanitization of Utensils and 3-201.14 Fish and Recreationally Caught Molluscan Food Contact Surfaces of Equipment* Shellfish* 4-703.11 Methods of Sanitization-Hot Water and 3-201.15 Molluscan Shellfish from NSSP Listed Chemical*. Sources* 10 Proper,Adequate Handwashing Game and Wild Mushrooms Approved by Regulatory Authority 2-301.1 t Clean Condition-Hands and Arms* 3-202.18 Shellstock Identification Present* 2-301.1.2 Cleaning Procedure* 590.004(C) Wild Mushrooms* r 2-301.14 When to Wash* 3-201.17 Game Animals* I it Good Hygienic Practices g Receiving/Condition 2401.11 Eating,Drinking or Using Tobacco* 3-202.11. PHFs'Received at Proper Temperatures* 2-401.12 Discharges From the Eyes, Nose and - 3-202.15Packa e Integrity* Mouth* 3-101.11. Food Safe and Unadulterated* 3-301,12 Preventing Contamination When Tasting* 6 Tags/Records:Shellstock 12 - Prevention of Contamination from Hands 3-202.18 Shellstock Identification* 590.004(E) Preventing Contamination from 3-203.12 Shellstock Identification Maintained* Employees* Tags/Records:Fish Products 13 Handwash Facilities 3402.11 Parasite Destruction* Convenienty Located and Accessible 5-203.11 Numbers and Capacifies* 3-402.12 Records,Labeling of Inge and Retention* 5-20411 Location and Placement* 590.004(J) � Labeling of Ingredients` Conformance with Approved Procedures 5-205.11 -Accessibility,Operation and Maintenance IHACCP Plans Supplied with Soap and Hand Drying 3-502.11 Specialized Processing Methods* Devices 3-502.12 Reduced oxygen packaging,criteria* 6-301.11 Handwashin Cleanser,Availability 8-103.12 Conformance with A roved.Procedures* 6-3(11.1:2 Hand D hg Provision 'Denotes critical item in the federal 1999 Food Cale or 105 CMR 590A00. CITY OF SALEM BOARD OF HEALTH Establishment Name: CCr Date: Page: of Item Code C-critical Item DESCRIPTION OF VIOLATION I PLAN OF CORRECTION Date a_n,ce 4W _1'1 ,, - 9 1 -j'�' iii Verified No.' Refer R-Red Item PLEASE PRINT CLEARLY _:C;70j_ cle bO heal Qk(� --k 1:x Ls6 �zd r Z:44- 10 fter it n Discussion With Person in Charge: Corr ctive Action Required: Li No Yes I have read this report, have had the opportunity to ask questions and agree to correct all Voluntary Compliance EJ Employee RestrictionExclusion violations before the next inspection, to observe all conditions as described, and to comply with all mandates of the Mass/Federal Code. I understand that Ll Re-inspection Scheduled U Emergency Suspension M / I I I noncompliance may result in daily fines of twe�nit fi dollars or suspension/revocation of Cj Embargo U Emergency Closure ive o ars your food permit. U Voluntary Disposal U Other: PIH,'_s_Re"_ived_at T_�nperaia_r_07S Violations Related to Foodborne Illness interventions and Risk According to Iaw Cooled in Factors((hose 1-22) (Conk) 41 F!45'F Within 4 H;rw 2- 01,15 Cooliw,,V�thay&for PHF PROTECTION!FROM CHEMICALS 2�10r rru,` __ 14 — Food.or Color Additives 191 PHF Hot and Gold Holding -501 A6(9) Cold PHFs,Nbiwained at or belvai 1-20112 A(Utivc,�`r F_ 3- 2.14 Protection(rout Una 590,004 }iI45°F, 5 Eirjoed�.MiFt .. 5 3 50 1,16(A) licit IIHF�, Maintained at or above pwf;��ous or Toxic IMS 140"K 1—dontiNi-11 - 161.11IIII9 Info]Ination-. Ori,anal 154;_1 16(A) Roioas Hold in or above 13WF. Containers* Time as a Public Health Control 7102.11 Courerrit Name, - Workin.Cnlrcuners 19 Time as a Public flealth CoraroV -—-—-— 590J)(ififl) Variance Rd 20111 1 ReAiction-Presence and L.,c* t-202.12 Conditions of tjw REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-103 11 Toxic Contairia,-Pronihwony, POPULATIONS(HSP 204.11 Sann;rer, cin'ria-chcloicrW I(Ar Uninisteurizcd Pre-pad"agcd Juicts and 7-204A2 Cheyaicajs for Wa5hiriv,IlittrInce,clirelia' i '04.14 Mend ural Fooj ctnrac! d 7-206.11 Peticirlcs,Criterin, Raw Scd,E+uis Not Served. 7-206.12 kod(ail B�ot Statnnjs' r-, --—, , -T-,-------- h-&(, --- -- `)06 11 Tracking Powde-ri. Control and -_,crvctl.- MoninirirQ CONSUMER ADVISORY TIMErrEMPERATURE CONTROLS 23b0: 11 (liaisuarter Aoyisory Posted lor Conounlrafla(It Anin'il F�Kxls Triatarc Raw, Undercix)kcd oII - 16 Proper Cooking Temperaturesfor PHFs Not(Xiierwise Prxogs'ed it)I'llurinair Pathoren, A(2)(2) Egg- 15i'F 15 Sx. 3-302.13 1 flawurizitcl I ggs Sinl#stittRe for Raw SlteFl 31401.I1(A)t2, Curruninwed Fith,Mews&Ganit , 401 1 I(H)(J)iT NJ d bed Roast 1301, 121lrtal° SPECIAL REQUIREMENTS -10�11 1 15511-' 15 A3 t1)) 1rieJatn xis 2ec,t:�,D,o 'I�in rb, ,�ibixi,ternporary and spa catering, mobil, d a, _37461.11(A)C5 Porthr), 'Wild Ginne, Staffed PEN, resident al kitchen operations,should be sln(fiiu�Coniaining Fish, Meal, 7 debited under the apprupriatt.sections Pouhn,or Ratner-165'F 15 scc, above if related to foodborne Illness 3401.IHC)f3) Wholit-niusele, Intact Beof Steaks interventions and risk factors Other 590.009 violationv relating to ,orid retail 3-4f7)1 12 Raw Animal Fooil,Conked Ina viactjces Should be debited under#29 - Micio,aave lri`,F special Requirernows, 11(A)(1)(b) N!(Xhei Kif,",, Reheating for Hot Holding VIOLATIONS RELATEC7 TO Gt7L1D RETAIL PRACTICES 3-d03.11(A)&Q7}_ F, 16�F 15 e, - (Sterns 23-30) 3-40111(8) Microwave- 165'F 2 Minnie,Standing Coo(w air(]nori-criliwl' violations, which do norrelate m the I filiedborcre lllnesr aa�lrvennorrsand risk jae tors lishelithow, (an be 1746 11(C) I Commercially Pim essed RTE'Rxid- found in rhe jird sc,firiny jq the Food Cadc and 1(i5("bill? 14WFP 3-463-1l'F) I Rewainin- Unslired Portiom of Beef II- 23 managrenent and PeFsRnne! 003 oodprolection 24 d Ind r FC--3 004 I Proper Cooling of PHFs — i _4 25 E quipv_ent r1_1 005 50 1,14(A) _ar ii_l�_ rC(;,_ju19Cooked PHFs f ow 14)'F to 1 70"F Within 2 1]ours an FC-6--1 007 to 4 I'T'145'F 1,N)thin 4 Knits, I Pwonousor Toxic mlatefiws Fc-7 t 008 3-501.14173) C(XrIuty PH[Fs W&Front Ambient 4r,_29 tat Regc ren aenr� 009 Tcropinature hcocdiiait,�,to4l'B45'F 1_3 Other I Within 4 Hours r I Den,ees critical herr,in Oic i,.deral 1991)Foml Cale of 105 CMR cii 0400 888 Washington Street #903 Cindy Planet City of Salem FOOD SERVICE ESTABLISHMENT - FOOD SERVICE Inspection HACCP: ❑ Item Status Violation Critical Urgency Telephone: Violations Related to Good Retail Practices (Blue Items) 617-823-9198 Physical Facility FAIL BLUE Owner: Comment:There are many water stained ceiling tiles throughout the establishment. Investigate the source of the leak and repair. Cindy Yen Replace all stained ceiling tiles. PIC: The flooring needs a general cleaning. Cindy Yen GENERAL COMMENTS: Inspector: David Greenbaum All other requirements to open have been satisfied. Date Inspected:Correct By: 4/13/2007 Risk Level: Permit Number: BHP-2007-0448 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 13,2007 ) Page 1 oft Item Status Violation Critical Urgency RED: Violations Related to Foodborne Illness Interventions and Risk Factors (Require immediate corrective action) City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741-1800 GeoTMS®2007 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Apr 13,2007 ) Page 2 oft 7 rro m. w.. r "Av"�nat wv.,... pa.«. ,�.+. M...w�Awa s.+s„v•..-.,+waR"'"�'"f�'�i' >a �" "rd+ �^,'Fw+ ae. '!re°°`i:`..Yr .x � , �' ' "F�^cAWM'- �eww +h&.eFeysk'✓nnsnyres+ F3. ayy �..r > 3 Lr, s `.yvs }tE 6 ♦ r •�- q'sc 'F"A'.hr:� �., ?^ • - • + r s �+ ras.. y. .. t$�^" tt r xa r �R � � Board of Health IGmberiey Dri 11 ,,� _; ,,. " .. 120 Washington Street,4th Floor z :� v �Mayor SALEM,MA 01970 - Food/Retail Establishment Permit DATE PRINTED: 04/04/2007 ESTABLISHMENT NAME: Cindy Planet File Number:BHF-2003-000048 888 Washington Street#903 Boston MA 02111 LOCATED AT: SALEM,MA 01970 Permit Type Permit No. Permit Issued Permit Expires Fee Restrictions/Notes FOOD SERVICE BHP-2007-0448 Apr 4,2007 Dec 31,2007 $100.00 ESTABLISHMENT FROZEN DESSERTS BHP-2007-0449 Apr 4,2007 Dec 31,2007 $5.00 Total Fees: $105.00 PERMIT EXPIRES December 31, 2007 Board of Health L This Permit is not transferable and must be reissued upon change of ownership or location.The permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code,beofre any revonations,improvements,or equipment changes are made,all plans for such must be submitted to and approved by the Salem Board of Health. Page 1 of 1 CITY OF SALEM, MASSACHUSETTS • « BOARD OF HEALTH 120 WASHINGTON STREET, 4TH FLOOR SALEM, MA 01970' TEL. 978-741-1800 FAX 978-745-0343 Kimberley Driscoll www.SALEM.COM Mayor JOANNE SCOTT, MPH, HIS, CHO HEALTH AGENT 2007 APPLIC TION FOR PERMLT TO OPERATE A FOOD ESTABLISHMENT NAME OF ESTABLISHMENT— ^ _ _TEL# ADDRESS OF ESTABLISHMENT FAX## MAILING ADDRESS (if different) EMAIL--Business': Owner's:_ iVt-G � , P(d e� -QlVICKIS� �V�}fZ� OWNER'S NAME TEL _#1_ 6:9t J — 23 ADDRESS STREET CITY STAT ZIP CERTIFIED FOOD MANAGER'S NAME{S} Ali 6i V YJe " t CERTIFICATE#{S} (Required in an establishment where potentially hazardous food is prepared) EMERGENCY RESPONSE PERSON HOME TEL# OAYSOFOPERATION Monday Tuesday Wednesday__ Thursday Friday SatuNay Sunday ROOKS Of OPERATIONPlease i I { 7 I 1 t l } 1 t 0 (forexmplepdmeaiday. _.IIQWt — l{�✓YI1 �� .'l��i�l,6lihM—( lOm, l h—!(pyry 0/pl, // — [Farexamplettam-t1pm1 � I � l TYPE OF ESTABLISHMENT FEE (check only) RETAIL STORE YES -(R0--'-1 less than I000sq.ft. =$ 50 1000-10,000sq.ft- =$100 more than 10,000sq.ft. =$250 - -- - - --- -- _-- - -- ...- - _.... .... RESTAURANT YE NO less than 25 seats $100 25-99 seats =$150 more than 99 seats =$200 -- .... ...... . --- -- ---- --------- ._..-.._._------------------------ ----... .... .I.._._._. BED/BREAKFAST YES $100 ------------- ----- ----------- -------------- ---- ----..._...__....--- -... .............._ ..... ADDITIONAL PERMITS MAKE(not just serve) ICE CREAM, YOGURT, SOFT SERVEYES $5 TOBACCO VENDOR YES $50 ALL NON-PROFIT(such as church kitchens) YES $25 Please pay total with one check payable to the City of Salem. This Permit is not transferable and must be reissued upon change of ownership. The Permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code, before any renovations, improvements, or equipment changes are made, all plans for such must be submitted to and approved by the Salem Board of Health. Pursu t t GL Chapte 62C, Section 49A, I certify under the pains and penalties of perjury that I,to my best knowledge and belief, hav rte all state Ian' rns an 2Bi alt state taxes req sired under the law- z� o 0 - 32301 —_ ture D to Social Security or Federal Identification Number ---------------------- ------ ----------------------------------- -- ------ ------ ----- ------ ---- Revised 11/13/061`0 AP2007.adm Check#&Da �� s/a5 FROM (WED)RUG 2 2006 14 :11/ST. 14: 11/No. 6818626307 P 1 Foods Research (817)442-9322 LABORATORIES, INC. (617)427-3322 FAX-(617)-442.2013 - •� 130 NEWMARKET SQUARE --BOSTON MA 02118 DATE: August 2, 2006 BOARDW HEALTH: Salem TO: Board of Health Dept. FROM: Andrea POR! July 2006 MANUFACTURER LAB-CODE Cindy's Planet 6208-50 Facsimile confirmation signature: Date: Please sign on line above and jaz back to(617)441-1013 jor confirmation. Please call(617) 442-3-1221jany of thew-reporh are nutssing._ Thank you. Over 40 years--Dedicated to.Quality arrdService FROM (WED)AUG 2 2006 14 : 11/ST. 14 : 11/No. 6818626307 P 2 Foods Research (617)442-3322 (617)427-3322 LABORATORIES INC, FAX(617)442-2013 57w•m 130 NEWMARKET SOWARE-BOSTON,MA 02118, Report Date: July 31, 2006 Date Collected: 7/27/2006 Lab Code: 6208-50 -Date Analyzed: 7/28/2006 CLIENT Cindy's Planet 181 Fort Street Salem,MA 01970 SAMPLE-DESCRIPTION- SPC/-g Coliform L g Chocolate and Vanilla Soft Serve 5,100 < 1 NOTE: <=less than COMMENTS: These results are.in.compliance with the bacterial standards asestablishedby the. Massachusetts Department of Public Health Division of Food and Drugs. METHODS: Vtmrdard Methods for the F.raminalion of Ibiry Prorhrctc, American Public Hcaltll_Association-16th-edition-199 Respectfify ubmitted, Andrea Fontaine Laboratory Director Over 40 years--Dellrcatedto Quality andSentice .. - +-'::i-YnTw'•�RY'raai'Lr..r.... .i .Y£n _.. ._. _: _ _ 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 DatType of Operation(s) Type of Inspection C I V" u of c n o r� 1( , 4-Food Service ❑ Routine Address I..- I Risk ❑ Retail p Re-inspection 12, 1 .4r Level ❑ Residential Kitchen Previous Inspection Telephone ❑ Mobile Date: v lCfV � VS `Ei3G Owner HACCP Y/N Temporary ❑ Pre-op Yatton ❑ Caterer ❑ Suspect Illness Person in Charge(PIC) Time ❑ Bed&Breakfast ❑ General Complaint In: Ello. HACCP Inspector 1 Out: Z Permit No. El Other Each violation c hecked Vicibirbs 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. n FOOD PROTECTION MANAGEMENT;, _ ,;w m :��.,, ;�; ❑ 12. Prevention of Contamination from Hands ❑ 1. PIC Assigned/Knowledgeable/Duties ElY 3 13. Handwash Facilities r EMPLOYEE HEALTH i '""i e t=v- += „ ` s_,.'._,1 Ir PROTECTION FROM CHEMICALS 1:12. Reporting of Diseases by Food Employee PIC e Z& 1_, _ <<-§Q : •« . �. �_.a'r - ❑ 14.Approved Food or Color Additives ❑ 3. Personnel with Infections Restricted/Excluded ❑ 15.Toxic Chemicals "' °=mwSA"wv.wa'§ ,� 'r x:ercif.Fa 7i rvf t FOOD FROM APPROVED SOURCE „,m„„„ ,,, 4S a„>,.,�„W,„s �..»m -. '71ME/TEMPERATURE CONTROLS(P;1lerttta0y Haiardous Foods) " "� ❑ 4. Food and Water from Approved Source ❑ 5. Receiving/Condition ❑ 16.Cooking Temperatures ❑ 6. Tags/Records/Accuracy of Ingredient Statements ❑ 17. Reheating ❑ 7. Conformance with Approved Procedures/HACCP Plans ❑ 18. Cooling PROTECTION FROM CONTAMINATION'' � '°' l" �'" ' '_ 'f '` i= El 19. Hot and Cold Holding ❑ 8 Separation/Segregation/Protection ❑20.Time As a Public Health Control El 9. Food Contact Surfaces Cleaning and Sanitizing FOR HIGHLYSUSCyEPTIBLE PpUTATIONS(WSP)ea ❑21. Food and Food Preparation for HSP ❑ 10. Proper Adequate Handwashing P.coNSUMEF ADvisOR'X ri t' '"� ` '$ '- �'MN El 11. Good Hygienic Practices I ❑ v ..m 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` ' a by a Board of Health member or its agent constitutes an 23. Management and Personnel (FC-2)(590.0 order of the Board of Health. Failure to correct violations 24. Food and Food Protection (FC-3)(590.0044)) cited in this report may result in suspension or revocation of 25. Equipment and Utensils (FC-4)(590.005) the food establishment permit and cessation of food 26. Water, Plumbing and Waste (Fc-5>(5so.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 F 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.5901rtspecfFamB-14A. n Inspector's Signature: / Print: i PIC's Signature: Z Print: Page?of -Pages Violations Related to Foodborne Illness Interventions and Risk Factors(items 1-22) PROTECTION FROM CONTAMINATION FOOD PROTECTION MANAGEMENT F g Cross-contamination 1 590.003(A) Assignment of Responsibility* 3-302.11(A)(1) Raw Animal Foods Separated from 590.003(B) Demonstration of Knowledge* Cooked and RTE Foods* 2-103.11 Person in charge-duties Contamination from Raw Ingredients 3-302.1 I(A)(2) Raw Anirrial Foods Separated from Each EMPLOYEE HEALTH Other- 2 590.003(C) Responsibility of the person in charge to Contamination from the Environment require reporting by food employees and 3-302.1.1(A) - Food Protection* applicants* 3-302.15 Washing Fruits and Ve*embles 590.003(F) Responsibility Of A Fail Employee Or An 3-304.11 Food Contact with Equipment and Applicant To Report To The Person In Utensils* Charge* Contamination from the Consumer 590.003(G) Reporting by Person in C'haree* 3-306.14(A)(B) Returned Food and Reservice of Food- 3 590.003(D) Exclusions and Restrictions* Disposition of Adulterated or Contaminated 590.003(E) Removal of Exclusions and Restrictions Food 3-701.11 Discarding or Reconditioning Unsafe FOOD FROM APPROVED SOURCE Food* d Food and Water From Regulated Sources 9 Food Contact Surfaces 590.004(A-B) Compliance with Food Law* 4-501.11 I Manual Warewashing-Hot Water 3-201.12 Food in a Herineticali Seated Container* Sanitization Tem eramres* - 3-20'1.13 Fluid Milk and Milk Products* 4-501.1 t2 Mechanical Warewashinb Hot Water 3-202.13 Shell En s* Sanitization Tem eramres* 3-202.14 E s and Milk Products.Pasteurized* 4-501.114 Chemical.Sanitization-temp.,pH, 3-202.16 Ice Made From Potable Drinking Water* concentration and hardness. * 5-101.11 DrinkingWater from an Approved System* 4-601,11(A) Equipment Food Contact Surfaces and 590.006(A) Bottled DrinkingWater* Utensils Clean" 590.006(B) Water Meets Standards in 310 CMR 22.0* 4-602.11 Cleaning Frequency of Equipment Food- Contact Surfaces and Utensils* Shellfish and Fish From an Approved Source 4-702.11 Frequency of Sanitization of Utensils and 3-201.14 Fish and Recreationally Caught Molluscan Food Contact Surfaces of Equipment* Shellfish* 4-703.11 Methods of Sanitization-Hot Water and 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* Sources* Ip Proper,Adequate Handwashing Game and uMushrooms Approved by - Re Mato Authorit 2-301.11 Clean Condition-Hands and Arens" 3-202.18 _ Shellstock Identification Present* 2-301.12 Cleaning Procedure* -590.004(C) Wild Mushrooms* 2-301.14 When to Wash* 3-201.17 Game Animals* l.i Good Hygienic Practices 5 - Receiving/Condition 2-401.11 Eating,Drinking or Using Tobacco* 3-202.1.1 PHFs Received at Proper Temperatures* 2-401.1.2 Discharges From the Eyes, Nose and - 3-202.15 Package hite it y* Mouth* 3-101.11, Food Safe and Unadulterated* 3-301.12 Preventing Contamination When Tastin 6 Togs/Records:Sheiistock 12 Prevention of Contamination from Hands 3-202.18 Shellstock Identification* 590.004(E) Preventing Contamination from 3-203.12 Shellstock Identification Maintained* -.Employees* Tags/Records:Fish Products 13 Handwash Facilities 3-402.11 Parasite Destruction* Conveniently Located and Accessible 3-402.12 Records.Creation and Retention* 5-203.11 Numbers and Capacities* 590.004(J) Labeling of Ingredients' 5-204.11 Location and Placement* 7 Conformance with Approved Procedures 5-205.11 Accessibility,O)eration and Maintenance IHACCP Plans Supplied with Soap and Hand Drying 3-502.11 Specialized Processin Methods* Devices 3-502.1.2 Reduced ox en acka 'ng.criteria* 6-301.11 1 Handwashing Cleanser,Availability 8-103.12 Conformance with Approved Procedures' 6-301..1.2 Hand Dn Provision Denotes critical item in the federal 1999 Foal Cate of 105 CMR 990.000. i f CITY OF SALEM S BOARD OF HEALTH i Establishment Name: D Date: &10 G ' Pager_ of c Rem Code C=critical item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Vete Verified NO. Reference R=Red HET. PLEASE PRINT CLEARLY. p W9 i t� 4• n� .a r� 9 -.A _J r x t F %' Discussion With Person in Charge: Corrective Action Required: Ll No t untary Compliance ❑ Employee Restriction/ 's I have read this report, have had the opportunity to ask questions and agree to correct all Exclusion violations before the next inspection, to observe all �Pnditions as described, and to Re-inspection Scheduled ❑ Emergency Suspension comply with all mandates of the Mass/Federal Fo(A Code. I understand that noncompliance may result in daily fines of {y ffve dollars or sus a on/revocation of ❑ Embargo LI Closure your food permit. / LI Voluntary Disposal ❑ Other: twe Wk �_ k 3-501.14(0) PHFs Received at'Temperatures Violations Related to Foodborne Illness Interventions and Risk According to Iaw Cooled to Factors(Items 1-22) (Cont) 41'F145°F Within 4 Hours. PROTECTION FROM CHEMICALS3-501.15 Coolins Methods for PHFs 14 Food or Color Additives 19 PHF Hot and Cold Holding 3-50'1.16fB) Cold Pf1F5 Maintained at or below 3-202.12 Addiuws* 3-50t,16(B590.004(F) 41`/45° F* 3-302.14 Protection from Toxic Su sta Additives* 3-501.16(A) Hot Nips Maintained at or above I,5 Poisonous or Toxic Substances 40°F.* 7-101.11 Identifying Information-Ori nul 3-5011I6(A) Roasts Held at or above 130°F. Containers"` 7-10211 Common Name-Workin-Containers* 20 Time as a Public Health Control 7-201.11 Separation-Storage* 3-501.19 Time as a Public Health Control* 7-202,11 Restriction-Presence_ mid Use* 590.004(H) Variance Re uirenient 7-202.12 Conditions of Use* 7-203.11 Toxic Containers-Prohibitions"' REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS{HSP) 7-204.11. Sanitizers,Criteria-Chemicals* 7-204 12 Chemicals for Washine Produce,Criteria"' 21 3-801.11(A) Unpasteurized Pre-packaged Juices and 7-204.14 Dr'in A*encs.Criteria* Beverages with Wamin r Labels* 7-205.11 Incidental Food Contact, Lnbriaants* 3-801.11(B) Use of Pasteurized Egps* 7-206.]I Restricted Use Pesticides, Criteria* 3-801,11(D) Raw or Partially Cooked Animal Forxl and Raw Seed S Trouts NoC Served. n7-206.12 Rodent Bait Stations* 3-801.11(C) Uno erred Food Paeka*e Not Re-served. "` 7-.,06.13 Tracking Powders,Pest Control and Mond rind* - CONSUMER ADVISORY TIMEITEMPERATURE CONTROLS 22 3-603.11 Consumer Advisory Posted for Consumption of Aniutal Foods,chat are Raw.Undercooked or t6 Proper Cooking Temperatures for PHFs Not Otherwise Processed to Eliminate .�. Pathogens,* `nncsva 1111,P),1111111,P),1113-40'LL1A(1)(2) Fogs- 155°'F 15 Sec. K=es-Lnmedtatc�45°Fl5sec* 3-303.13 Pasteurized Eggs Substitute for Raw Shell 3-407.11.(A)(2) Comminuted Fish,Meats&--Game E es" Animals- 155"17 15 sec. 3-401.11(B)(1)(2) Pork and Beef Roast_- 130`F 121 min* SPECIAL REQUIREMENTS '3-401.11(A)(2) 'Ratites,Injected Mexts-155°F 15 590.009(A)-( Violations of Section 590-g09(A)-(D) in sec, _ r. catering,mobile food, temporary and 3-401.11(A)(3) Poultry, Wild Game,Stuffed PFIN, residential kitchen operations should he Stuffing Containing Fish,Meat, debited under the appropriate sections 22u1n or Barites-IG5'.F 15 sec. * above if related to foodborne illness 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks interventions and risk factors. Other 145°F _ 590.009 violations relating to goad retail 3-401.12 Raw Animal Foods Cooked in a practices should be debited under#29- Microwave 165'F* Special Requirements. 3401.11(A)(1)(b) All Other PHFs-145°F 15 see. * - 17 Reheating for Hot Holding VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 3-303.11(A)&(D) PHFs Itis°F 15 sect. "` (erns 23-301 3-403.11(B) Microwave-165°F 2 Minute Standine Critical and non-critical violations, which do not relate,to the Time* foodborne illness interventions and ii.skfactors listed above., can be 3-403.11(C) Commercially Processed RTE Food- found in the following sections of the Food Code and 105 C'MR '140°F* 590.000. 3-40311(P.) Remaining Unsliced Portions of Beef Item Good Retail Practices FC 530.AAD --------- - Roasts* 23. Manaement and Personnel FC-2 .003 1g Proper Cooling of FHFs24. Food and Food Protection FC-3 004 25 Egui rnent_no Utensils 3501.1.4(A) Cooling Cooked PHFs from 140`P hi 26 Water Plumbin0 and Waste FC 5 _� .006 70'F Within 2 Hours and From 70°F -27--Physical F_acri FG-6 007 to 41°'Fl45aF Within 4 Hours. * 28. Poisonous or Toxic Materials FC-7 .008 3-501.14(73) Cooling PHFs Made From Ambient 29_ S eeiel Re uiremenis .009 Temperature Ingredients to 41'F/45°F 30 Other Within 4 Hours:x i svoa,nm,arz,aoc `Denotes critical item in Ifie fa aral 1999 Food Code or 105 Cp1R 590.000. Massachusetts Department of Public Health Salem Board of Health 120 Washinon Division of Food and Drugs Salem, MA 019 035234 h Floor FOOD ESTABLISHMENT INSPECTION REPORT Tel. (978) 741-1800 Fax (978) 745-0343 Name !-� t _ Date Tvpe of Ooeration(s) Type of Inspection c lJ G K c ( oU �' Food Service Routine Address i Risk ❑ Retail ❑ Re-inspection I Level ❑ Residential Kitchen Previous Inspection Telephone `G �� ❑ Mobile Date: 3'3r /JG OwnerHACCP YM El Temporary ❑ Pre-operation C(ncw ❑ Caterer ❑ Suspect Illness Person in Charge(PIC) ' - Time ❑ Bed&Breakfast ❑ HGeneral ACCP Complaint In: I�'4� ❑ Inspector Out: Permit No. El Other Each violation checked req ires 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 :7 .'M7® "„ , , ❑ 12. Prevention of Contamination from Hands ❑ 1 PIC Assigned/Knowledgeable/Duties ❑ 13. Handwash Facilities .'EMPLOYEE HEALTH 'm ` z_ "�,,* ,s' r ,,6gk:PROTECTION FROM CHEMICALS 'i,"".; ❑ 2. Reporting of Diseases by Food Employee and PIC - r«» •�� .m ❑ 14.Approved Food or Color Additives ❑ 3. Personnel with Infections Restricted/Excluded ❑ 15.Toxic Chemicals 9 FOOD FROM APPROVED SOURCE TIMEIiEMPERATURE CONTROLS Hazardous Foods `' '"t ❑ 4. Food and Water from Approved Source _ ,, qe `ribs..uw_w.: .�rfu„farTR ..,.a6t Z j Hide L '��.,® ❑ 5. Receiving/Condition ❑ 16. Cooking Temperatures ❑ 6. Tags/Records/Accuracy of Ingredient Statements [:117. Reheating ❑ 7. Conformance with Approved Procedures/HACCP Plans [118. Cooling 3`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 `I:REDUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) ❑21. Food and Food Preparation for HSP ❑ 10. Proper Adequate Handwashing ❑ 11. Good Hygienic Practices -..CONSUMERADVISORY? ❑22. Posting of Consumer Advisories Violations Related to Good 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 by a Board of Health member or its agent constitutes an 23. Management and Personnel (Fc-2) order of the Board of Health. Failure to correct violations 24. Food and Food Protection (FC-3)(5590.090.0 054))) cited in this report may result in suspension or revocation of 25. Equipment and Utensils (Fc-5)(550.005) the food establishment permit and cessation of food 26. Water, Plumbing and Waste (FC-5)(590.006) establishment operations. If aggrieved by this order, you 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.501nV�tFon 14,eoo Inspector's Signature;//\ Print: r PIC's Signature: Print: Page or-2 Pages Violations Related to Foodborne illness Interventions and Risk Factors(items 1-22) PROTECTION FROM CONTAMINATION FOOD PROTECTION MANAGEMENT $ Cross-contamination 1 590.003(A} AssignmentofResponsibility* 3-302.11(A)(1) Raw Animal Foods Separated from 590.003(B) Demonstration of Knowledge* Cooked and RTE Fatds* 2 103.11 Person in charge-duties Contamination from Raw ingredients - 3-302.11(A)(2) Raw Animal Foocls Separated from Each EMPLOYEE HEALTH Other* 2 590.003(C) Responsibility of the person in charge to Contamination from the Environment require reporting by food employees and 3-302.11(A) Food Protection* a phcants* 3-302.15 Washing Fruits and Vegetables 590.003(F) Responsibility Of A Food Employee Or An 3-304.11. Food Contact with Equipment and - Applicant To Report To The Person In Utensils* Charge* Contamination from the Consumer 590 003(G) Reporting by Person in Charge* 3-306.14(A)(B) Returned Food and Reservice of Food` 3 590.003(D) Exclusions and Restrictions* Disposition of Adulterated or Contaminated 590.003(E) Removal of Exclusions and Restrictions Food 3-701.11 Discarding or Reconditioning Unsafe FOOD FROM APPROVED SOURCE Food* 4 Food and Water From Regulated Sources 9 Food Contact Surfaces 590.004(A-B) Compliance with Food Law* 4-501..111 Manual Warewasbing-Hot Water 3-201.12 Foal in a Hermetically Seated Container* Sanitization Temperatures- 3-201.13 Fluid Milk and Milk Products* 4-501.11.2 Mechanical Warewashina Hot Water 3-202.13 Shell Ea s* Sanitization Temperatures* 3-20214 Eggs and Milk Products.Pasteurized* 4-501.114 Chemical Sanitization-temp.,pH, 3-202.16 Ice Made From Potable Drinking Wafer* concentration and hardness. * 4-601.11(A) Equipment Food Contact Surfaces and 5-101.11 DrinkingWater from an Approved System* Utensils Clean" 590.006(A) Bottled Drinking Water* 4-6f)2.11 UnslFrequency ofE ui mentFood 590.006(B) Water Meets Standards in 310 CMR 22.0* Cleaning 4 y q P Contac;Surfaces and Utensils* Food- Shellfish and Fish From an Approved Source 4-702.11 Frequency of Sanitization of Utensils and 3-201.14 Fish and Reerearionally Caught Molluscan Food Contact Surfaces of Equipment Shellfish* 4-703.11 Methods of Sanitization-Hot Water and 3-201-15 Molluscan Shellfish from NSSP Listed Chemical* Sources* 10 Proper,Adequate Handwashing Game and Wild Mushrooms Approved by Rpaulatow Authority 2-301.11 Clean Condition-Hands and Arens* 3-20118 Shellstock Identification Present* 2-301..12 Cleanin Procedure* 590.004(C) Wild Mushrooms* 2-301.14 When to Wash` 3-201..17 Game Animals* 1.1 Good Hygienic Practices 5 Receiving/Condition 2-401.11 ..Eating,Drinking or Using Tobacco* 3-202.11 PHFs Received at Proper Temperatures* 2401.12 Discharges From the Eyes, Nose and 3-202.15 Package Irate it * - Mouth` 3-101.11. Food Safe and Unadulterated* 3-301.12 Preventin Contamination When Tastin * 6 Togs/Records;Shellstock l2 Prevention of Contamination from Hands 3-202.18 Shellstock Identification * 590.004(E) Preventing Contamination from 3-203.1.2 Shellstock Identification Maintained* Em to gees* Tags/Records:Fish Products 13 Handwash Facilities 3-402.11 Parasite Destruction* Conveniently Located and Accessible 3-402. Capacities* 4( Records,Creation and Retention*on" 5-203.11 Numbers and 5-204.11 Location and Placement* 590.004(1) Labeling of Ingredients" q Conformance with Approved Procedures 5-20.5.11 Accessibility,O reration and Maintenance /HACCP Plans Supplied with Soap and Hand Drying _ 3-502.11 Specialized Processing MethWs* Devices 3-502.1.2 Reduced oxygen packaging,criteria* 6-301.11 Handwashi ng Cleanser,Availabilit 8-103.12 Conformance with Approved Procedures* 6-301.12 Hand Dryin. Provisian *Denotes critical item in the federal 1999 Pool Code or 105 CMR 590.000. CITY OF SALEM, BOARD OF HEALTI-6, ' Establishment Name: r n )1 r.Ae �- (ce C/Po+,-. Date: Co Page:_ ` of . Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date ' No. Reference R—Red Item ;E' I Verified g LEASE PRINT CLEARLY Y ' t i J43 04(zl�A rv� O o r i U t r ' ,• G r i U leo r �1 t Discussion With Person in Charge: Corrective Action Required: ❑ No s f 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 nditions as described, and to ❑ Re-inspection Scheduled ❑ Emergency Suspension comply with all mandates of the Mass/Federal d Code. I understand that noncompliance may result in daily fines of tw ty lve dollars or suspe ion/revocation of a Embargo ❑ Emergency Closure your food permit. ❑ Voluntary Disposal ❑ Other: I 3-501.14((,-l) PRFs Received at Temperatures Violations Related to Foodborne Illness Interventions and Risk Accordiao>to Law Cooled to Factors(items 1-22) (Cont.) -41'F/45°F Within 4 Hours. PROTECTION FROM CHEMICALS 3-50,15 Coolim� 19 Methods for PHFs 14 Food or Color Additives PHF Hot and Cold Holding 3 3-50116(11) Cold PFiFs Maintained at or below 3-30-302.12 Additives'" 590.004(F) 41%45° F*2.14 Protection from Unapproved Additives` 3-501.I6(A) Itot PI-IFs Maintained at or above 1.5 Poisonous or Toxic Substances 7-101..11 Identifying Information-01`(ginal 3-501.16(A) Roasts Held at or above 130`F. " Containers* 7-102.11 Common Name-Working Containers* 20 Time as a Public Health Control 7-201.11 1 Separation-Slolage* 3-501.19 Sime as a Public Health Control* 7-202.11 Restriction-Presence and Use* 590.004(H) variance Requirement 7-202.12 Conditions of Use" 7-203.11 Toxic Containers-Prohibitions' REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-204.,11 Satnnzers,Criteria-Chenucals* POPULATIONS(HSP) 7-204.12 Chemicals forWashumProduce,Criteria* 21 3-301.11(;v) Gnpastewi ctPrepackagedJuices and 7-204.74 Frying Agents.Criteria* Beverage,will, Warninn I.;abels* 7-205.11 Incidental Food Q>ntaM, Lubricants' 3-501 ll(B) Use of Pasteurized Y, gs* 7-206.11 Restricted Use Pesticides. Criteria* 3-801,11(1)) Raw or Partially Cooked Animal Fcwd and Raw Seed S Trout's Not Served. 7-20G.12 Rodent Bait Stations"` 3-801.11(C) Uno erred Food Package Noe Re-served � 7-206.13 Tracking Powders,Pest Control and Monitoring` CONSUMER ADVISORY TIMEITEMPERATURE CONTROLS 22 3-603.11 Consumer Advisory Posted for Consumption of 16 Proper Cooking Temperatures for Animal Foods 9'hat are Raw.Undercooked or PRFs Not Otherwise Processed to Eliminate Pathogens* B gs-7hu„edlaterre,k�"vnaal� 3-40'LL1A(1)(2) Eggs- lune ateService 145°FlSsec*15 Sec. 3-302,13 Pasteurized Eggs Substitute for Raw Shell 3-401.11(A)(2) Comminuted Fish, Meats&Game Eggs* Animals- 155`F 15 sec. * 3-401.11(B)(1)(2) Porkand Reef Roast -130"F 121 min* SPECIAL REQUIREMENTS 3-401.11(A)(2) Ratites,Injected Meats-155°F IS 590.009(A)-(D) Violations of Section 590.009(A)-(D)in sec. ,r catering.mobile food,temporary and 3-401..1.,1(A)(3) Poultry,Wild Game,Stuffed PHFs, residential kitchen operations should be Stuffing Containing Fish,Meat, debited alder the appropriate sections Poultry or Ratites-165"F 15 sec. * above if related to foodborne illness 3-401.11(C)(1) Whole-nmsele,Intact Beef Steaks interventions and tisk factors. Other 145rF* 590.009 violations relating to good retail 3-401.12 Raw Animal Foods Cooked in a practices should be debited under#29- Microwave 165'F* Special Requirements. 3-401.11(A)(I)(b) All Other PFIFs-145'F 15 sec. * - 17 Reheating for Hot Holding VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 3-403.11(A)&(D) PHF, 165'F 15 sec. : (Items 23-30) 3-40111(B) Microwave- 165°F 2 Minute Standing Critical and non-critical aolations, which do not relate to the Tonc* .fandborne illness interventions and riskfactors listed above, can he -403.11(C) Commercially Processed RTE Food- laund in the fallowing sections of the Food Code and 105 CMR 140"F' 590.000. 3-403.1I(E) Remaining Unsliced Portionsof,Beef item Good Retail Practices FC 590000 Roastso 23. Mena einem and Personnel FC-2 .003 113 Proper Cooling of PRFs 24. Food and Food Protection FC-- 3 1 .004 25 Equipment and Utensils FC 4 .005 3-501.14(A) Cooling Cooked PHFs from 140"F to -- _-__ 26 Water Plumbin and Waste FC S 1 006 7 "F Within 2 FIours and From 70°F 27. Physical Facility _ FC-6 ! .007 to 41"F/45'F Within 4 Hours. * 28. Poisonous or Toxic Materials PC 7 I .00II r 3-501_14(1?) Cooling PHFs Made From Ambient 29. S ecial Re uiremonts _ .009 _ Temperature Ingredients to 41"F/45'F 30 -_ Other _ -.J Within 4 Ilours'A Denixes'l local item in 1110 t cod 1999 Food Code or 105 CMR 590.000. FROM (FRO JUN 2 2006 11 :31/ST. 11 :36/No. 6818626810 P 1 < ` Foods Research (617)442'3322 (617)427-3322 LABORATORIES,INC. FAX(617)442-2013 130 NEWMARKET SQUARE-BOSTON,MA 02118', DATE. June 2, 2006 BOARD OFHEALTH. Salem TO: Board of Health Dept,, FROM. Andrea FOR May 2016 MA1VUFAC7VRER LAB CODE-, Cindy's Planet 6139-60, Faerimiic coxibmadon signa&re. + Dale_ -- +Piease sign on fine above and fax back-to(617,fQ-2013 Pie+asa salt(bl n IIT-3332 iJony ojlkeva-mare miwfng " Thank yon- Over Io Wail-vr&watadfb Qlw&y 4ndsevive- FROM (FRI)JUN 2 2006 11 :37/ST. 11 :36/No. 6818526810 P 2 Foods Research (817)442-3322 LABORATOME-9 INC. (81-7)427.3= FAX(61-1)442-2013 130-NEWKVWErSclt)AAE-BOSTON.MA 02118 Report Date: May 22, 2006 Date Collected: 5/19/2006 Lab Code: 6139-60 Date Analyzed: 5/19/2006 CLIENT Cindy's Planet 181 Fort Street Salem,MA 01990 SAMPLE DESCRIPTION SPC/g Coliform/g Chocolate and Vanilla Soft Serve Ice Cream 1,100 --c I NOTE: <=less than COMMEN'T'S:These results are in compliance with the bacterial standards as established by the Massachusetts Department of Public Health Division of Food and Drugs. METHODS: Stoed3rd Melhods fin the Pramination of Dairy Products, American Public Health Association, 16tlredition,.1992. Respectfully submitted, 04,,f , Ff Andrea J. Fontaine Laboratory Director Over qn-gears—ver$tatedto emaCrymidservkw. Commonwealth of Massachusetts 3 City of Salem Kimberley Driscoll ;Z s Board of Health Mayor 120 Washington Street,4th Floor SALEM,MA 01970 Food/Retail Establishment Permit DATE PRINTED: 03/30/2006 WHO'S PLACE OF BUSINESS IS: Cindy Planet File Number:BHF-2003-0048 888 Washington Street#903 Boston MA 02111 LOCATED AT: SALEM, MA 01970 Permit Type Permit No. Permit Issued Permit Expires Fee Restrictions/Notes FOOD SERVICE BHP-2006-0443 Mar 29,2006 Dec 31,2006 $100.00 ESTABLISHMENT FROZEN DESSERTS BHP-2006-0444 Mar 29,2006 Dec 31,2006 $5.00 Total Fees: $105.00 PERMIT EXPIRES December 31, 2006 Board of Health b+E� This Permit is not transferable and must be reissued upon change of ownership or location.The permit must be posted in xki'.a prominent location'in.the Estabhsbment t + �"° ,-" � �n +'a?•.a "�;In accordance with the State Sanitary Code,beofre any revonation ,improveme1.nts,or;equ�pment changes aree made,all lans for such must be submitted to and approved by the Salem Boazd of 13ealthz Page i*ot t Yee+!� k , i , ";14� rv'4 � 'a4 "xz �-''°,r-Fa � " s: ,�� w;�,. �x �r 3 l�Mr�ggl�Yi' CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH 120 WASHINGTON STREET, 4TH FLOOR ) . SALEM, MA 01970 "0N8 TEL. 978-741-1800 FAx 978-745-0343 Kimberley Driscoll www.SALEM.COM Mayor JOANNE SCOTT, MPH, RS, CHO HEALTH AGENT 2006 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT n NAME OF ESTABLISHMENT C i ILt :r4oCEL# ADDRESS OF ESTABLISHMENT "O l �`11 7r� 1 �P ry� MAILING ADDRESS (if different) aSY\h r tv� SI X103 tQwo(^ f d44p O�II f OWNER'S NAME TEL# �O U —O Z3 4-H- - ADDRESS &5� ?CJ 2, CITYp�TnyJ STATE_,,� ZIP_ rXLLL CERTIFIED FOO' MA AGER'S NAME(S) ERTIFICATE#(s) � 7 (required in an establishment where potentially hazardous food is prepared.) EMERGENCY RESPONSE PERSON C. rV� ��^ HOME TEL# &17- �z3 -9j9 HOURS OF OPERATION: Mon.9 1d Tue.lz iu We'd. fz luThu. l2-w Fri. IZ-/o Sat./t- /c) Sun. //-/ L, TYPE OF ESTABLISHMENT FEE (check only) RETAIL STORE YES NO less than 1000sq.ft. =$ 50 1000-10,000sq.ft. =$100 more than 10,000sq.ft. =$250 - ............ .... _.... RESTAURANT YES NO less than 25 seats $100 25-99 seats =$150 more than 99 seats =$200 - - ........... -------------------------------------------------------------------------------------$,`10-0- - ---------------- BED/BREAKFAST YES � - ..... ----------------------------------------------------------------------------------------------------------------------------- ADDITIONAL PERMITS MAKE (.^,ot just serve)ICE CREAM, YOGURT, SOFT SERVE vF NO $5 TOBACCO VENDOR YES 6D $50 ALL NON-PROFIT(such as church kitchens) YES (2 $25 *Please pay total with one check payable to the City of Salem . This Permit is not transferable and must be reissued upon change of ownership.The Permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code, before any renovations, improvements, or equipment changes are made, all plans for such must be submitted to and approved by the Salem Board of Health. Purs n to MGL Chapter 62C, Section 49A, I certify under the pains and penalties of perjury that I, to my best kn le ge and b ief, h v filed allstate tax returns and paid all state taxes required under the law. 3 - 5-C 0 - 3 3Z.3O � lQignat-Lfre Date SocialSecurity or Federal Identification Number ------------------------ •-------------------- ------------------------------------------ -------------------- ------- ------ Revised 11/03/05 FOODAP2.adm Check#&Date .� b . 6j 1 Massachusetts Department of Public Health Salem Board of Health Floor Division of Food and Drugs 120 Washington Street,4th 9 Salem, MA 01970-3523 FOOD ESTABLISHMENT INSPECTION REPORT Tel. (978) 741-1800 Fax(978) 745-0343 Name f ) p Date Tvoe of Ooeration(s) Tvoe of Inspection Ili 1 ( , LG M {y Q Food Service Routine Address ' �2 /� N RiskI ❑ Retail ❑ Re-inspection Level ❑ Residential Kitchen Previous Inspection Telephone 1 t� ❑ Mobile Date: Owner t� HACCP YIN ❑ Temporary ❑ Pre-operation f uf Nip kq ❑ Caterer ❑ Suspect Illness Person in Charget(PIC) *V\ In: El Bed&Breakfast ❑❑General HACCP Complaint AlInn In: Inspector _ P n 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 MANAGEMENTm` ,:_. _ 1 - 1 " -.,_, ❑ 12. Prevention of Contamination from Hands ❑ 1. PIC Assigned/Knowledgeable/Duties / 13 Handwash Facilities = EMPLOYEE HEALTH �. 'w' "� _�� a �� ! a PROTECTION FROM CHEMICALS tE`-Milr "q p�,�...�:u14�m _vsaa>d"o-m . r,�.,c,it L3 =� 1:12. Reporting of Diseases by Food Employee and PIC ❑ 14. Approved Food or Color Additives ❑ 3. Personnel with Infections Restricted/Excluded 4-FOOD FROM APPROVED SOURCE- s �"�'I".; c + �. ❑ 15 Toxic Chemicals ` '"""� ""'" �� `"` 'fIMEREMPERATl3RE CONTROLS(Potedt(ally Hazardous Foogs) 6 ❑ 4. Food and Water from Approved Source ... r""° "�- ,aid ,"_ a"a r a- " ❑ 5. Receiving/Condition ❑ 16. Cooking Temperatures ❑ 6. Tags/Records/Accuracy of Ingredient Statements ❑ 17. Reheating ❑ 7. Conformance with Approved Procedures/HACCP Plans [118.Cooling PROTECTION FROM CONTAMINATION x, """I"®.� --.' It El 19. Hot and Cold Holding k - swimdt 4 F a'-i-o"«. .' ❑ 8 Separation/Segregation/Protection ❑20.Time As a Public Health Control ❑ 9. Food Contact Surfaces Cleaning and Sanitizing [.REQUIREMENTS FOR HIGHLY SUSCEPTI6LE POPULATIONS(HSP) ❑21. Food and Food Preparation for HSP ❑ 10. Proper Adequate Handwashing [CONSUMER ADVISORY "" s" "" t ' -'�'m`" El11. Good Hygienic Practices .u" ... - y" El 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 by a Board of Health member or its agent constitutes an 23. Management and Personnel (FC-2)(990.003) order of the Board of Health. Failure to correct violations 24. Food and Food Protection (FC-3)(590.004) cited in this report may result in suspension or revocation of 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 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)(5so.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. r:H 30. Other DATE OF RE-INSPECTION: S:5901 Ss IFOm 14 d Inspector's Signa7tG i ' J Print: < PIC's Signatur� / Print: ' Page J of Pages f n Violations Related to Foodborne Illness Interventions and Risk Factors(items 1-22) PROTECTION FROM CONTAMINATION FOOD PROTECTION MANAGEMENT 8 Cross-contamination 1 I 596.003(A) Assig went of Responsibility* _ 3-302.11(A)(D Raw Animal Foods Separated from t 590.003(B) Demonst ation of 1 Howled e* Cooked and RTE Foods* 2-103.1 i. Person in char e--duties Contamination from Raw Ingredients 3-302AI(A)(2) Raw Animal Foods Separated from Each EMPLOYEE HEALTH Other* 2 590.003(C) Responsibility of the person in charge to Contamination from the Environment require reporting by food employees and '3-302.1.1(A) Food Protection* applicants* 3-302.15 Washin Fruits and Ve etnbles 590.003(F) Responsibility Of A Food Employee Or An 3-304.11 Food Contact with Equipment and Applicant To Report To The Person In Utensils* Charge* Contamination from the Consumer 590.(H)3(C,) Reporting by Person in Char=e* 3-306.14(A)(B) Retuned Food and Reservicc of Food* 3 590.003(13) Exclusions and Restrictions* Disposition of Adulterated or Contaminated 590.003(E) Removal of Exclusions and Restrictions Food 3-701.11 Discarding or Reconditioning Unsafe FOOD FROM APPROVED SOURCE Food* 4 Food and Water From Regulated Sources 9 Food Contact Surfaces 590.004(A-B) Compliance with Food Law* 4-501.111 Manual Warewashing-Hot Water 3-201.12 Fcwd in a Hermetically Sealed Container* Sanitization Temperatures* 3-201.13 Fluid Milk and Milk Products' 4-50t.1t2 Mechanical Warewashing-Hot Water 3-202.13 Shell Eggs* Sanitization Tem eratures* 3-202.14 F.'==s and Milk Pmduets.Pasteurized* 4-501.114 Chemical Sanitization-temp.,pH, 3-202.16 Ice Made From Potable Drinking Water* concentration and hardness. 5401.1.1 Drinking Water from an Approved System' 4-601.11(A) Equipment Food Contact Surfaces and 590.006 A) Utensils Clean* Bottled Drinkin Water* 590.006(B) Water Meets Standards in 310 CMR 22.0* 4-602.11 Cleaning Frequency at Equipment Forxt- Shellfish and Fish From an Approved Source Contact Surfaces and Utensils* 4-702.71 Frequency of Sanitization of Utensils and 3-201.14 Fish and Recreationally Caught Molluscan Food Contact Surfaces of Equipment* Shellfish"` 4-703.11 Methods of Sanitization-Hot Water and 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* Sources* 10 Proper,Adequate Handwashing Game and Wild Mushrooms Approved by Regulatory Authority 2-301.11 Clean Condition-Hands and Arms* 3-202.18 Shellstock Identification Present* 2-301.12 Cleaning Procedure* 590.004(C) Wild Mushrooms* 2-301.14 When to Wash* 3-201.17 Game Animals* 12 Good Hygienic Practices 3 Receiving/Condition 2-401.11 Eating,Drinking or Using Tobacco* 3-202.11 PHFs Received at Proper Temperatures* 2401.12 Discharges From the Eyes,Nose and - 3-202.15 Package Integrity* Mouth* 3101.11. Food Safe and Unadulterated* 3-301.12 Preve iting Contamination Wien Tasting* 6 TagstRecords:Shellstock 12 Prevention of Contamination from Hands 3-202.18 Shellstock Identification * 590.004(F) Preventing Contamination from 3-203.12 Shellstock Identification Maintained° Em to gees* Tags/Records:Fish Products 13 Handwash Facilities 3-402.11 Parasite Destruction* Conveniently Located and Accessible 3-402.12 Records.Creation and Retention* 5-203.11 Numbers and Capacities* 590,004(j) Labeling of Ingredients" 5-204.11 Location and Placement* 7 Conformance with Approved Procedures 5-205.11 Accessibility.Operation and Maintenance 1HACCP Plans Supplied with Soap and Hand Drying _ 3-502.11 Specialized Processing Methods* Devices 3-502.1 g.2 Reduced oxygen packaging,criteria* 6-301..11. Handwashin Cleanser,Availability 8-103.12 Conformance with Approved Procedures* 6-301.12 Hand Drying Provision °Denotes critical item in the federal 1999 Foal Cade or 105 CNI R 590.000. CITY OF SALEM BOARD OF HEALTH / p Establishment Name: <f�/X Date: 2 Page: of Item Code C-Critical item DESCRIPTIONOF VIOLATION/PLAN OF CORRECTION Date No. Reference R—Red Item - Verified PLEASE PRINT CLEARLY V / L3Y C LL / 3 � J 5 I . r � �71 vvet5 01,)OV 0. SIll . l t s , (l Ac CC . a 0 0 0 r l c 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 o Voluntary Compliance ❑ Employee Restriction/ Exclusion violations before the next inspection, to observea coyi'ditions as described, and to ❑ Re-inspection Scheduled ❑ Emergency Suspension comply with all mandates of the Mass/Federal F�dPode. I understand that noncompliance may result in daily fines of twe y/rfive dollars or suspension/revocation of ❑ Embargo LI Emergency Closure your food permit. / ,/ 4 . �/I^ ��• llllll /\ �vV' ❑ Voluntary Disposal ❑ Other: I t 3-50 L Id(C) PHFs Received at Temperatures Violations Related to Foodborne Illness interventions and Risk According to IAw Cooled to Factors(items 1-22) (Cont.) 41',(45°.F Within 4 Routs. PROTECTION FROM CHEMICALS3-501.15 i Cooling Methods for PHRs 1=414 u1 Food or Color Additives 19 AHF Hot and Cold Holding 3-501.16(B) Cold PRFs Maintained at or below 3-202.12 Additives 540.00417 41°/45°F* 3-30114 Protection treat Unapproved Additives* 4_gpf I6(A) Hot PRFs Maintained at or above 15 Poisonous or Toxic Substances - " 7-101.11 Identifying Information-Original 140°F 3-50116(A) Roasts Held at or above 130'F. Containers"` 7-102.11 Common Name-Working Containers* Time as a Public Health Control 7-201.11 Sc natation-Storage" 3-501.'19 1 Time as a Public Health Control* 7-20211 Restriction-Presence andilse'r 590.004(H) VarianeeRe ulrement 7-202.12 Conditions of Use= 7-203.1.1 Toxic Containers-Prohibitions, REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-204.11 Satntizers,Criteria-Chemicals* POPULATIONS(HSP) 7-204.12 Chcmieals for Washing Produce,Criteria"` 21 3-801.11(A) Unpasteurized Pre-packaged Juices and 7-204.14 Dttiina A eats,Criteria` Beveraues with V. nnmg labels* 7-205.11 Incidental Food Contact.Ltdtricants* 3-801_11(B) Use Of Pastermzed E" S* 7-206.11Restricted Use Pesticides.Criteria* 3-SOI,I J(D) flaw or Partially Cooked Animal Food and Raw Seed S xonCs Not Served. 'z 7-206.12 Rodent Bait Stations" 3-801.11(C) Unn tined Fcxtd Packa=e iVot Re-served. 7-206.13 Tracking Powders,Pest Control and Monitoring* CONSUMER ADVISORY TIME/TEMPERATURE CONTROLS 22 3 X03.11 Consumer Advisory Posted for Consumption of "16 Proper Cooking Temperatures for Animal Frnids That are Raw, Undercooked or PRFs Not OtherwiseProcessed to Eliminate 3-401.1 Eggs- 155"F1a.SSe Pathogens LIWe .., ^rm !s-hnnredtate Service 145'Flisec* E 302.13 Posteurimd Eggs Substitute for Raw Shell 3-401.11(A)(2) Comminuted Fish,Meats &Game G.�s* Animals- 155'F 15 sec.s 3-401.1 l(B)(1)(2) Pork and Beef Roast-130°F 121 min* SPECIAL REQUIREMENTS 3-401.11(A)(2) Ratites,Injected Meats-155°F 15 590.009(A)-(D) Violations of Section 590.009(A)-(D)in see.x catering, mobile food, temporary and 3-401.1.1(A)(3) Poultry,Wild Game, StuffedPHF" residential kitchen operations should be Stuffing Containing Fish, Meat, debited under the appropriate sections Poultry or Ratites-165`F 15 sec, * above if related to foodborne illness 3-401.11(C)(3) Whole-muscle,hitact Beet Steaks interventions and risk factors. Other 145°F* 590.009 violations relating to good retail 3-401.12 Raw Animal Foods Cooked in a practices should be debited under//29- Microwave 165'F* Special Requirements. 3401.11(A)(1)(b) All Other PHFs- 145°F'15 sec. 17 Reheating for Hot Holding VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 3-403.1 1(A)&(D) PH.Fs 165'F 15 sec. * (Items 23-30) 3-403.1 I(B) Microwave- 165°F2 Minute Standing Critical and non-critical violations, which do not relate to the Time* ,foodborne illness interventions and risk jactors listed above, can be 3-403.11(C) Commercially Processed RTE Food- foraid in the follon=ing sections of the Food Cade and 105 CHIP 140"F* 590.000. ------------- ------- 3-403.11(E) Remaining Unsliced Portions of Beef Item Good Retail Practices IFC 590.000 Roasts* 23. Mana ement and Personnel FC-2 .003 - j tionFC-----__-- 1g Proper Cooling o4 PRFs 24. Food and Food"od Prote-ctioFC--3 .004 25..___, Equi�ent and Utensils FC-4 .005 3-501.14(A) Cooling Cooked PHFs from 140'F to 26 Water,Plumbing and Waste FC 5 006 -,01:Within 2 linins and From 70°F 2I Physical Facility _ FC 6 007 _ to 41'F/45'F Within 4 Hours. * 26. Poisonous or Toxic Materials FC-7 .008 3-501.14(B) Cooling PRFs Made From Ambient -29. S genal Re uiremsnts .009 Temperature Ingredients to 41'F/4517 30 Other Within 4 Hours° *Denote,enGcat item(n the federal 1999 Ford Code or 105 COIR 596,060. IMPORTANT MESSAGE FORZJ DATE `tea -,�,,�, TIME, .M. M OF PHONE AREA CODE NUMBER EXTENSION ❑ FAX ❑ MOBILE AREA CO lwMBER TIME TO CALL TELEPHONED PLEASE CALL CAME TO SEE YOU WILL CALL AGAIN WANTS TO SEE YOU RUSH RETURNED YOUR CALL WILL FAX TO YOU MESSAGE SIGNED P FORM 4V9 MADE IN U.S.A. NOTES ROM (VON)OCT 3 2005 14:30/ST. 14:29/No. 6818626735 P 2 ..;.� Foods research (617)442-3322 LABORATORIES.INC. (617)427.3$22 FAX(617)442-2013 •� 130 NEWMARKET SQUARE-BOSTON.MA 02118 Report Date: October 3, 2005 Date Collected: 913012045 Lab Code: 5273-54 Date Analyzed: 9/30/2005 CLIENT Cindy's Planet 181 Fort Street Salem,MA 01970 SAMPLE DESCRIPTION SPC/g Coliform J g Vanilla and Chocolate Soft Serve Ice Cream 750 9 NOTE: <=less than CO1MiMENTS:11we results are in compliance with the bacterial standuds as established by the Massachu$M$Department of Public Health Division of Food and Drugs. METHODS: SrandivdMethods for rhe Ermninatlon of Iaairy Products, American Public Health Association, 16th edition, 1992. Respectfully submitted, 1* Andrea J. Fontaine Laboratory Director Over 40 j/ears De4cated to euaCky mad'Service FROM (MON)OCT 3 2005 14 :30/ST. 14 :29/No. 6818526135 P 1 i` Foods Research- (617)442-3322. (617)427-3322 LABORATORIES,INC. FAX(617)442.2013 t�•srr 130 NEWMARKET SQUARE-BOSTON,MA 02TIS DATE: October 3, 2005 BOARDOFREALTIP Salem TO: Board of Health Dept. FROM: Andres FOR: September 2005 MANUFACTURER LAB CODE Cindy's Planet 5273-54 FaoinrHe cmaflrma&n signature: + Date: Please sign on line above and fax back to(617)442-2013 for co afirma&x Please call(617)442-3322 if any of these mpotm are mbsing. Tkank you. Over 4o years-0eewatedto qty mrdSe"iee FROM (FR I)SEP 2 2005 10:08/ST. 10:04/No. 6818626451 P 2 Foods Research (617)442-3322 (617)427.3322 LA90RATORIES,INC. FAX(617)442-2013. � 130 NEWMARKET SQUARE-t3OSTON:Mh02118, Report Date: August 3, 2005 Date Coffeeted: 8/1/2005 Lab Code: 5213-63 Date Analyzed: 8/1/2005 CLIENT Cindy's Planet 181 Fort Street Salem,MA 01970 SAMPLE DESCRIPTION SPC./g ColitormLg Chocolate and Vanilla Soft Serve Ice Cream 5,000 < 1 l NOTE: <=less than COMMENTS:These results are incompliance.with the bacterial-stendards as-established by the Massachusetts Department of Public Health Division of Food and Drugs. METHODS: Stm dard Methods for the Examination of Dairy Products, AmericanPublic:.Health.Association,-166edition,_1992: Respecdally submitted, a � Andrea J. Fontaine Laboratory Director -()ver 40 years-IeAmtedro emrity_andSwY ce FROM (FR I)SEP 2 2005 10:08/ST. 10:04/No. 6818626457 P 1 F7!&30 esearch (617)442-3322 (817)427-3322 BORATORIES. INC. FAX(817)442-2011 NEWMARKETSQUARE-BOSTON.MA02-tJ8 DATE: September2, 2005 BOARDOFHEALTH: Salem TO: Board of Health Dept. FROM: Andrea POR: August 2005 MANUFACTURER LAB CODE Cindy's Plana 5213-63 Fambaik confirmation signatarc " Date: "Pkese sign on Ane above and jar back to(617)412-1013 for conjbmadom Please caii(617)4123311 Jany of these reports are missing. Thank yac over ao years-77eduatedYo QuaCity mul'Serviee FROM (TUE)JUL 5 2005 11 :18/ST. 11. : 18/No. 6818626860 R 2 ~ FoodsResearch (8»)442-3322 LABORATORIES, INC. (617)427-3322 FAX(817)442-2013 do 130 NEWMARKET SQUARE-BOSTON,MA 02118 Report Date: June 22, 2005 Date Collected: 6/20/2005 Lab Code: 5171-53 Date Analyzed- 6/20/2005 CLIENT Cindy's Planet 181 Fort Street Salem,MA 01970 Frio,, SAMPLE DESCRIPTION SPC/g Coliform!g Chocolate and Vanilla Soft Serve Iee Cream 3,100 < 1 NOTE: <=less than COMMENTS: These reWllts are in compliance with the bacterial standards as established by the Massachusetts Department of Public I3eakh Division of Food and Dru�s. METHODS: Standard Me*xtr Jo►the Fxmnination of Dairy Products, American Public Health Association, 16th edition, 199 . Respectfully submitted, !AM J. Fontaine boratory Director Over 40 years-Deauitedto QuaCt y andse"ke FROM (MON)AUG 1 2005 10:10/ST. 10 09/No. 6818626121 P 2 - r Foods Research (617)442m3322, LABORATORIES.INC._ (617)"2-20*2 FAX-(617)M2-2043. • 130 NEWMARKET SQUARE-BOSTON,MA 021-18 Report Date. July 8, 2005 Date Collected: 7/6/2005 Lab Code: 5187-50 Date Analyzed- ?/612005 CLIENT Cindy's Planet 181 Fort Street Salem MA 01970 SAMPLE DESCRIPTION SPC/g Coliform!g Chocolate and Vanilla Soft Serve Too Cream 5,400 1 NOTE: <= less than COMMENTS:These results are in compliance_with the bacterial standards as established by-the; Massachusetts Department of Public Health Division of Food and Drugs. METHODS: Standard.Methods for the.E armtnation of I ry Produces,., American Public Health Association, 16th edition, 1992. Respectfully submitted; Andrea 1.Fontaine Laboratory Director Over 40 years-occ&Atedtoowfity,andsen4ce FROM (WED)JUN 1 2005 21 :52/ST, 21 :51/No. 6818626560 P 2 ma=y — Foods Research (817)442`'322 (817)427-3322, LABORATORIES,INC. FAX'(6 71442-2013 �� 130 NEWMARKET SQUARE-80STON;iNA92118. Report Date: May 13, 2005 Date Coeected: 5/11/2005 Lab Code: 5131-79 Date Analyzed- 5/1112005 CLIENT Cindyfs Planet 181 Fort Street Salem,MA 01970 SAMPLE DESCRIPTION SPC/g Coliform/g Chocolate and Vanilla Soft Seroe-Ice Cream 8,200 7 NOTE: <=leas than COMMENTS: These results are in compliance with the bacterial standards as established by the Massachusetts Department of Public Health Division of Food and Drugs. METHODS: Slandnrd Methods for the Fiamonatton of Dwry Products, American Public Health Association, loth edition, 1992.. Respectfully submitted, a uA^-1 Andrea J. Fontaine Laboratory Director over 4o years—vedeatrdto euatfty.andservice FROM (WED)JUN 1 2005 21 :5211ST. 21 :51/No. 6818626560 P 1 C Foods Research (617)442.3322 (617)427.3322 LABORATORIES, INC FAX(617)442-2013 • 130 NEWMARKET SQUARE-BOSTON.MA 021.18 DATE: June 2, 2005 BOARD OF HEALTH: Salem TO: Board of Health Dept. FROM: Andrea FOR: May 2005 MANUFACTURER LAB CODE Cutdy's Planet 5131-79 FaoimHe conJ)rmatlon signature.- Dare., ignature:Date: •Please sign on line above and fax back to(617)442-2013 for eonlTrmat0m Pleose call(6)7)442-3322 if any of these reports we missing. Thankrn Over 40 years-De&cated'to Quualiit y andSevvfce 888 Washington Street #903 Cindy Planet City of Salem FOOD SERVICE ESTABLISHMENT - FOOD SERVICE Inspection HACCP: ❑ Telephone: Item Status Violation Critical Urgency Nature of problem or correction 617-823-9198 . Non-compliance with: Done 'Owner " Anti-Choking PASS ❑ Cindy.Yen - Tobacco PASS ❑ PIC: Cindy. Yen FOOD PROTECTION MANAGEMENT Done Inspector:` , PIC Assigned/Knowledgeable/Duties PASS ❑d RED ,David Greenbaum EMPLOYEE HEALTH Done Date Inspected: Correct By: Reporting of Diseases by Food Employee and PIC PASS ❑� RED 4/7/2005:r Personnel with Infections Restricted/Excluded PASS RED Risk Level: FOOD FROM APPROVED SOURCE Done wY Permit Number: Food and Water from Approved Source PASS RED BHP-2004-0016 Receiving/Condition PASS ❑J RED Status Tags/Records/Accuracy of Ingredient Statements PASS ❑J RED SIGNED OFF Conformance with Approved Procedures/HACCP PASS RED #of Critical Violations: Plans PROTECTION FROM CONTAMINATION Done Time IN: Time OUT: Separation/Segregation/Protection PASS d❑ RED Notes: Food Contact Surfaces Cleaning and Sanitizing PASS RED 75 Proper Adequate Handwashing PASS ❑d RED Urgency Description(s): Good Hygienic Practices PASS RED BLUE' Violations Related to Good Prevention of Contamination from Hands PASS Q RED Retail Practices (Critical Handwash Facilities PASS ❑J RED violations must be corrected immediately or within 10 days)(Non-critical violations GeoTMSO 2005 Des Lauriers Municipal Solutions, Inc. ( Rev. Apr 07,2005 ) Paze I oft 888 Washington Street #903 Cindy Planet must be corrected immediately PROTECTION FROM CHEMICALS Done or within 90 days) - ' Approved Food or Color Additives PASS ❑d RED RED: Violations Related to Toxic chemicals PASS ❑ RED Foodborne Illness InterventionsTIME/TEMPERATURE CONTROLS(Potentially Haz Done and Risk Factors (Require_, Cooking Temperatures PASS ./❑ RED immediate corrective action) Reheating PASS ❑d RED Cooling PASS ❑d RED Hot and Cold Holding PASS ❑d RED Time As a Public Health Control PASSd❑ RED REQUIREMENTS FOR HIGHLY SUSCEPTIBLE PO Done Food and Food Preparation for HSP PASS ❑d RED CONSUMER ADVISORY Done Posting of Consumer Advisories PASS ❑d RED Violations Related to Good Retail Practices (Blue Done Management and Personnel PASS ❑ BLUE Food and Food Protection PASS ❑ BLUE Equipment and Utensils PASS ❑ BLUE Water, Plumbing and Waste PASS ❑ BLUE Physical Facility PASS ❑ BLUE Scrape and repaint left wall. Poisonous or Toxic Materials PASS ❑ BLUE Special Requirements PASS ❑ BLUE Other-See Notes PASS ❑ BLUE Establishment has met all requirements to open. Expected opening date is 4/9/05 GeOTMS®2005 Des Lauriers Municipal Solutions, Inc. ( Rev. Apr 07,2005 ) Page 2 oft IMPORTANT MESSAGE FOR DATE TIME P.M OF PHONE A A i a 9y O FAX ❑ MOBILE C REA COO NUMBER TIME TO CALL TELEPHONED PLEASE CALL CAME TO SEE YOU WILL CALL AGAIN WANTS TO SEE YOU RUSH RETURNED YOUR CALL WILL FAX TO YOU M /S;SA E � Vl O/-�V n Q J SIGNED FORM 4009 MAGE IN _--= ----- U.S.A. NOTES 'i IMPORTANT MESSAGE FOR r� DATE - 5' TIME A.M. M OF PHONE AREA CODE NUMBER EXTENSION ❑ FAX D MOBILE AREA CODE N ER TIME TO CALL TELEPHONED PLEASE CALL CAME TO SEE YOU ,F WILL CALL AGAIN WANTS TO SEE YOU RUSH RETURNED YOUR CALL i WILL FAX TO YDU MESSAGE .G+ SIGNED FORM 40 ��■��777 MACE IN U. A. NOTES CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH 120 WASHINGTON STREET, 4TH FLOOR SALEM, MA 01970 .� TEL. 978-741-1800 FAX 978-745-0343 STANLEY J. USOVICZ, JR. JOANNE SCOTT, MPH, RS, CHO MAYOR HEALTH AGENT COMMONWEALTH OF MASSACHUSETTS PERMIT TO OPERATE A FOOD ESTABLISHMENT In accordance with regulations promulgated under authority of Chapter 94, Section 305A and Chapter III, Section 5 of the General Laws, to operate a Food Establishment in the City of Salem is hereby granted to: Type of Establishment: FOOD SERVICE Name of Establishment: Cindy Planet Address of Establishment: 181 Fort Avenue Owner's Name: Cindy Yen Restrictions: Application Date: 4/5/2005 Permit for Food Establishment 291-05 Frozen Desserts/Ice Cream 15-05 Permit for the Sale of Tobacco Products These Permits Expire December 31, 2005 This permit is not transferable and must be reissued upon change of ownership or location. The permit must be posted in a prominent location in the Establishment, In accordance with the State Sanitary Code, before any renovations, improvements, or equipment changes are made, all plans for such must be submitted to and approved by the Salem Board of Health. HEALTH AGENT CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH 12-0 WASHINGTON STREET, 4TH FLOOR - SALEM, MA 01970 ,mom TEL. 978-741-1800 FAx-978-745-0343 STANLEY J. LISOVICZ, JR. JOANNE SCOTT, MPH, RS, CHO MAYOR HEALTH AGENT 2005 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT q NAME OF ESTABLISHMENT l �(��S �� /�7/�J> TEL# ([��7 � � ( r) ADDRESS OF ESTABLISHMENT (ZT t4V I� MAILING ADDRESS (if different) OWNERS NAME__t'`G yl �p�n T�� TEL#10 7443419,0 ADDRESS 0-5 0 1 CI l' Si ^TE SIR DZII CERTIFIED FOOD MANAGER'S NAMES) CERTIFICATE#(s) (required in an establishment where potentially hazardous food is prepared.) EMERGENCY RESPONSE PERSON HOME TEL HOURS OF OPERATION: Mon. C•lOTue.IA t0 Wed. o•r Thu. !6"!/ Fri./o-1( Sat. to—/! Sun./o-/U TYPE OF ESTABLISHMENT FEE check only RETAIL STORE YES QqT less than 1000sq.ft. =$ 50 1000-10,000sq.ft. =$100 q yJ more than 10,000sq.ft. =$250 RESTAURANT ES NO less than 25 seats =$100 25-99 seats =$150 more than 99 seats =$200 BED/BREAKFAST YES $100 ADDITIONAL PERMITS MAKE (not just serve) ICE CREAM, YOGURT, SOFT SERVE ( EB) NO $5 TOBACCO VENDOR YES � $50 ALL NON-FROFfT(such as church kitchens) b YES $25 Please pay total with one check payable to the City of Salem This Permit is not transferable and must be reissued upon change of ownership. The Permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code, before any renovations, improvements, or equipment changes are made, all plans for such must be submitted to and approved by the Salem Board of Health. Purs to MGL hapter 62C, Section 49A, I certify under the pains and penalties of perjury that I, to my Za- Owledg nd be f ave filed all state tax returns and paid all state taxesre ulred under the law. g-. 3 3 qL 0ture Date Social Security or Federal Identification umber -------------- --- ---------------------------------- Revised 11/03/03 FOODAP2.adm Check#&Dale i�L IK, �, / / - CITY OF SALEMy MASSACHUSETTS BOARD OF HEALTH 120 WASHINGTON STREET, 4TH FLOOR SALEM, MA 01970 TEL. 978-741.1800 FAX 978-745-0343 STANLEY J. USOVICZ, JR. JOANNE SCOTT, MPH, RS, CHO MAYOR HEALTH AGENT COMMONWEALTH OF MASSACHUSETTS PERMIT TO OPERATE A FOOD ESTABLISHMENT In accordance with regulations promulgated under authority of Chapter 94, Section 305A and Chapter 111, Section 5 of the General Laws, to operate a Food Establishment in the City of Salem is hereby granted to: Type of Establishment: FOOD SERVICE Name of Establishment: Cindy Planet Address of Establishment: 181 Fort Avenue Owner's Name: Cindy Yen Restrictions: Application Date: 12/11/2003 Permit for Food Establishment 174-04 Frozen Desserts/Ice Cream 008-04 Permit for the Sale of Tobacco Products These Permits Expire December 31, 2004 This permit is not transferable and must be reissued upon change of ownership or location. The permit must be posted in a prominent location in the Establishment, In accordance with the State Sanitary Code, before any renovations, improvements, or equipment changes are made, all plans for such must be submitted to and approved by the Salem Board of Health. ^ l��►�xx.e. HEALTH AGENT ,! a CITY OF SALEM, MASSACHUSETTS ` S ` •/' BOARD OF HEALTH 3t 120 WASHINGTON STREET, 4TH FLOOR �Yy C a SALEM, MA 01970 DECU5 _2003 TEL.. 978-741-1800 �4 FAx 978-745-0343 CITY OF SALEIM O ' STANLEY USOVICZ, JR. JOANNE SCOTT, MPH, RS, CHO ��p"-,D "'r t"'r Tl MAYOR HEALTH AGENT 2004 APPLICATION ,FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT �d (� NAME OF ESTABLISHMENT j ! VlLnni 6C EL# i� �0 ADDRESS OF ESTABLISHMENT � 1 -Ear/`� /QVC_ e wx 0 4 a i ej MAILING ADDRESS (if different) OWNER'S NAME} h c TEL# ADDRESS CITY Ur\1 TATE 11.4 zip CERTIFIED FOOD MANAGER'S NAME(S) — CERTIFICATE#(s) (required in an establishment where potentially hazardous food is prepared.) LEMERGENCY RESPONSE PERSONE,rN Aye UA HOMETEL# 07- L p-OMI' HOURS OPERATION: on.jZ"IITue.11'16 Wed.lz 10 Thu:Lt Fri!12 Sat. IL-I Sun. I Z TYPEryry e . � OF ESTABLISHMENT( FEE check only RETAIL STORE YES NO less than 1000sq.ft. =$ 50 1000-10,000sq.ft. =$100 more than 10,000sq.ft. =$250 RESTAURANT YES NO / less than 25 seats $100, 25-99 seats =$150 more than 99 seats =$200 BED/BREAKFAST YES NO $100 ADDITIONAL PERMITS -0� MAKE (not just serve) ICE CREAM, YOGURT, SERVE NO 5 TOBACCO VENDOR YES NO $50 ALL NON-PROFIT(such as church kitchens) YES NO $25 Please pay total with one check payable to the City of Salem This Permit is not transferable and must be reissued upon change of ownership. The Permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code, before any renovations, improvements, or equipment changes are made, all plans for such must be submitted to and approved by the Salem Board of Health. Pursuant to,A GL Chapter 62C, Section 491A, I certify under the pains and penalties of perjury that I, to my best knowledge and belief, h ve'filed all state tax returns and paid all state taxes required under.the law. Signa�re Date �] Social Security or Federal Identification Number ---- - - ------------------------------------------------------- Revise ]-1/03/03 FOOD 2. m Check#&Date �l�a�-7 �� ` Massachusetts Department of Public Health Salem Board of Health 120 Washington Street,4th Floor Division of Food and Drugs Salem, MA 01970-3523 FOOD ESTABLISHMENT INSPECTION REPORT Tel. (978) 741-1800 Fax (978) 745-0343 Name Date T of Operations) Tvpe of Inspection v d VI Tood Service ❑ Routine Address Ftis El Retail ElRe-inspection Telephone Levee E] Residential Kitchen Previous Inspection El Mobile Date: Owner �- HACCP Y/N ❑ Temporary J P -operation 11 ❑ Caterer (.'Suspect Illness Person in Charge(P /) Time ❑ Bed&Breakfast ❑ General Complaint ( 41 In: [_1HACCP Inspector 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 El 13. Handwash Facilities EMPLOYEE HEALTH "" PROTECTION'S FROM CHEMICALS f ❑ 2. Reporting of Diseases by Food Employee and PIC ❑ 14.Approved Food or Color Additives ❑ 3. Personnel with Infections Restricted/Excluded [115.Toxic Chemicals FOOD FROM APPROVED SOURCE ❑ 4. Food and Water from Approved Source TIMErrEMPERATURE CONTROLS(Potentially Hazardous Foods) ❑ 5. Receiving/Condition ❑ 16.Cooking Temperatures ❑ 6. Tags/Records/Accuracy of Ingredient Statements [117. Reheating ❑ 7. Conformance with Approved Procedures/HACCP Plans ❑ 18. Cooling PROTECTION FROM CONTAMINATION " ` ❑ 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 [:121. 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 of Health. 590.000/federal Food Code. This report, when signed below 23. Management and Personnel (FC-2)(590.003) by a Board of Health member or its agent constitutes an 24. Food and Food Protection (FC-3)(590.004) order of the Board of Health. Failure to correct violations 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)(590.000) 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:501nsp CtFom 14 dX .Inspector's Signature: Print: PIC's Signature: Panto hc%ra la qUrlhl1A-7. Pagel of,2Pages Violations Related to Foodborne Illness q Interventions and Risk Factors(items 1-22) PROTECTION FROM CONTAMINATION FOOD PROTECTION MANAGEMENT S Cross-contamination 1 590.003('A) Assignment of Responsibility* 3-302.1](A)(1) Raw Animal Foods Separated from 590.003(B) I Demonstrationof%nowledge* Cooked and RTE Foods* 2-103.17 Person in charge--duties Contamination from Raw Ingredients 3-30111(A)(2) Raw Animal Foods Separated from Each EMPLOYEE HEALTH Other* t 590.003(0) Responsibility(if the person in charge to Contamination from the Environment require reporting by food employees and 3-302.1 NA) Food Protection* o plicants* 3-302,t5 Washin Fruitland Vegetables 590.003(F) Respiambility 01'A Food Employee Or An 3-304.11 Food Contact with Equipment and Applicant ro Report To The Person In (Acmils' Charge* Contamination from the Consumer 590.003(0) Recorthre b v Person in Charge` 3-306.14(A)(B) Returned Food and Reservice of*Food* 3 590.003(D) Exchteions and Rest fictions* Disposition ofAduiteratedorContaminated 590-003(13 Removal of Exclusions and Restrictions Food 3-701.11 Discarding or Reconditioning Unsafe FOOD FROM APPROVED SOURCE Food* 4 Food and Water From Regulated Sources 9 Food Contact Surfaces 590.004(A-B) Com tliance with Food Law* 4-501.tl 1 Manual Warewashing-Hot Water 3-201.12 Food ma Hermetically Sealed Container* Sanitization Tem erasures' 3-201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Warewashing-Hot Water 3-202.13 ShellEg's* SmtitizadonTem eratures* 3-202.14 Eggs and Mill,Products.Pasteuri-red- 4-501.114 Chemical Sanitization-temp.,pH, 3-202.16 lee Made From Potable Drinking Water* concentration and hardness.,F 5-1.01.11 Drinkin Water from an A r roved S stemx 4-601.11(A) Equipment Food Contact Surfaces and Utensils Clean 590.006(A) Bottled Drinkin Watcr* 4.60111 Cleaning Frequency of Equipment Food- 590.006(B) Water Meets Standards in 310 CMR 22k* Contact Surfaces and Utensils ShePtlsh and Fish From an Approved Source ------ --- 4-702-11 Frequency ot:Sanitization of Utensils and Recreationall 3-201.14 Fish ant( y Caught Molluscan Foci Contact Surfaces of E ui meat* Shellfish* 4-703.11 Methods of Sanitization-Hot Water and 3-201.15 Molluscan Shellfish from NSSP Listed Chemical" Sources' 10 Proper,Adequate Handwashing Game and Wild Mushrooms Approved by Fe elate Authorit2-301.21 Clean Condition-Elands and Arms" 3-202-18 Shcllstock identification present* 2-301.12 Cleating Procedure* 590.004(C) Wild Mushrooms* 2-301.14 When to Wash* 3-201.17 Game Animals* ll Good Hygienic Practices $ Receiving/Condition 2-401.11 Eating,Drinking or Using Tobacco* 3-207.11 PHFs Received at I toper Temperatures, 2-401,12 Discharges,From the Eyes. Nose and 3-202.15 Pac&i ge Integrity* Mouth* 3-101.11 Food Safe and Unadulterated * 3301.12 Preventing Contamination When Tasting* 6 Tags/Records:Shellstock 12 Prevention of Contamination from Hands 3-202.18 Shellstock Identification* 590.004(E) Preventing Contamination from 3-203.12 Shellstock Identification Maintained" Ent tlo gees* Tags/Records:Fish Products 13 Nandwash Facilities 3-402,11 Parasite Destruction* Conveniently Located and Accessible 3-402.12 Records.Creation and Retentions` 5-20311 Numbers and Capacities* 590.004(7) Labeling of Ingredients' 5-204.11 Location and Placemcnt* 7 Conformance with Approved Procedures 5-205.1.1 Accessibility.0)oration and:Maintenance 1HACCP Plans Supplied with Soap and Hand Drying 3-502.11 S ecialized Processin Methods* Devices 3-502.12 Reduced ns 'gen ,acka>ing.criteria* 5-301.11 Handwashing Cleanser, Availability 8-103.1'2 Conformance with Approved Procedures* b-301.12 Hand Dn tg Provision *Dcnow.,critical item in the iedend 1999 Food Code 01 105 Cb9R 590.000. aP CITY OF SALEM BOARD OF HEALTH Establishment Name: Date: e�Z&6 ��/ Page: Z of Z Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date No. Reference R—Red Item Verified PLEASE/POINT CLEARLY 4 Ve ^/ l 7� �L (J G / / G o v L f � i s Discussion With Person in Charge: Corrective Action Required: ❑ No ❑ Yes I have read this report, have had the opportunity to ask questions and agree to correct all ❑ Voluntary Compliance ❑ Employee Restriction/ 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: 3-501.14(C) PHFs Received at Tereperatures Violations Related to Foodborne Illness Interventions and Risk According to Law Cooled to Factors(items 1-22) (Cord.) 4'1°F(45°F Within 4 Hours. PROTECTION FROM CHEMICALS3-501_15 Cooling Methods forPHFs 14 Food or Color Additives 19 PHF Hot and Cold Holding 3 202.72 Adchtiscs'F 3-501.16(B) Cold PRFs Maintained at or below 590.004(F) 41°1450 FI 3 302.14 Protection from(Ina roved Addi ives'r 3-SOl.l6(A) Hot PHFs Maintained at or above 15 Poisonous or Toxic Substances 140"F. * 7-101.11 Identifying information-Original 3-501.16(A) Roasts Held at or above 1.30'F. Containers* 7-102.11. Common Name-Working Containers* 20 Time as a Public Health Control 7-201..1.1 Se aration-Storaee„ 3-501,19 Time as a Public Health Control* 'i-2021 I Restriction-Presence and t sw* 590.004(H) Variance Rec uh'etitent 7,-202.12 Conditions of Use* 7-203.11 ToxicContainers-Prohibitions" REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-204.11 Sannizers.Criteria-Chemicals* POPULATIONS(NSP) 7-204.12 Chemicals for Washing Produce,Criteria'. 21 3-$01.11(A) Unpasteurized Pre-packaged.Juices and Beverages with Warning Labels* 7-204.14 Drying Agent,.Caireciae 3-801.11(13) Use of Pasteurized Eggs* 7-205.1.l_ Incidental Food Contact,Lubrtcants�` Restricted Use Pesticides,Criteria" 3-801.11(D) Raw or Partially Cooked AnimalFotxl and 7-206.11 Rau Seed Sprouts Not Served. 7.20612 Rodent Bait Stations* 3-801.11(0 Uno.ened Food Packa>e Nat Re-served. " 7-206.13 Tracking,Powders, Pest Contral and Monitoring* CONSUMER ADVISORY TIMEITEMPERATURE CONTROLS 22 3-603.11 Consumer Advisory Posted for Consumption of 16 Proper Cooking Temperatures for Animal Foods That are Raw, Undercooked or PHFs Not Otherwise Processed to Eliminate 3-4Q1.11All (2) Eggs- 155=F IS Sec. Pathogens r.ry"fl,-„anon Eggs-Immediate Service 14501715sec* 3-302 1.3 Pasteurized Egg,Substitute for Raw Shell 3-40L 11(A)(2) Connninuted Fish.Meats&Game Fgg=s* Animals- 155'F 15 sec. * 3-401.11(11)(1)(2) Pot kand Beef Roast- 130-F121mill- SPECIAL REQUIREMENTS 3-401.1'I(A)(2) Ratites,Injected Mears- 155°F 15 590.009(A)-(D) Violations of Section 590.009(A)-(D)in sec.* catering, mobile food, temporary and 3-401.11(A)(3) Poultry,Wild Game.Stuffed PHFs, residential kitchen operations should be Stuffing Containing Fish,Meat, debited under the appropriate sections Poultry or Ratites-165'P 15 sec. * above if related to foodborne illness 3-401.1 I(C)(3) Whole-muscle,Intact Beet Steaks interventions and risk factors. Other 145"17" 590.009 violations relating to good retail 3-4( 1.12 Raw Anunat Foods Cooked ked in a practices should be debited under #29- Micanwave 165°F* Special Regturernents. 3-401.11(A)(1)(b) A(( OtherPHFs- 145°F 15 sec. * 17 Reheating for Hot Holding VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 3-40311(A)&(D) PIIFs 165`F 15 sec. * (Items 23-30) 3-403.11(B) Microwave- 165°F 2 Minin'e Standing Critical and non-c.rifical violations, which do not relate to the Time" foodborne illness interventions and risk factors Listed above, can be 3-403.1.1(C) Commercially Processed RTE Food- found in the following sections t f the Food Code and 105 GbIR 140+* 590.000. 3-403,11(E) Remaining Unslieed Portions of Beef i Item Good Retail Practices FC _ 599.990 Roasts" ! 23 Management and Personnel FC-2 .003 24 Food and Food Protection FC 3 .004 lR Proper Cooling of PHFs i d(ne - 25. Egwpment and Uiens�ls _ _FC 4 .005_ 3-501.14(A) Cooling Cooked PHFs from 140°F to ! 26 Water,Plumbing and Waste FC 5 006 7WF Within 2 Hours and From 7WF 27. Physical Facility FC-6 .007 to 41'Fi45°F Within 4 Hours, Poisonous or Toxic Materials FC-7 .003 - 3-501.14(B) Cooling PHFs Made Frotn Ambient [ 20. S t�eclai Re uirements_ _ .009 Temperature ingredients to 4l'F145"F 30. Other _( -.,_-....___._1 Within 4 Hours' " *Denotes eriticaI item in the federal 1999 Food Code or 105 CMI't 590.000. CCT-04-2004 MON 11:23 AM FR(. INC, FAX NO, 16174422013 P. 01 Foods Research (617)442'3322 (617)427.3322 LABORATORIES, INC. FAX(617)442-2013 •ae 130 NEWMARKET SOUARE-BOSTON,MA-02116 RATE: October4,2404 BOARD OF HEALTH: Salelts TO: Board of Health Dept. _ ...Tz FROM. Andrea {t��'{ '—'3 r FOR: September 2004 OCT 4 , 20(14 LAB Planet ��.t�URFR "—� CITY OF SALEM f Cindys 4267-50 BOARD OF HEALTH Facsimile confirmation signature: _ Date: •Please sign on tine above and fax back to(617)442-2013 for confrrmatiop. Please call(617)442-3322 if any of these reports are missing. Thankyou. Over 40 years--Dedicated to owfity andservice OCT-04-2004 MON 11,23 AM FRL INC, FAX NO, 16174422013 P. 02 FoodL'o Research (617442-3322 (617)427.3322 LABORATORIES,INC. FAX 5617)442-2013 130 NEWMARKET SQUARE-BOSTON,MA 02118 Report Date: September 2,7, 2004 Date Collected: 9/23/2004 Lab Code: 4267-60 Date Analyzed: 9/23/2004 CLIENT o TP �l�/ F� n Cindy's Planet 9 181.Fort Street Salem MA 01970 OCT 4 ,. 2004 CITY OF SALEM BOARD OF HEALTH SAMPLE DESCRIP77ON SPC/g Coliform!g Chocolate and Vanilla Soft Serve Ice Cream 7,600 9 NOTE: <=less than COMMENTS:These results are incompliance with the bacterial standards as established by the Massachusetts Department of Public Health Division of Food and Drugs. METHODS: Standard Afelbodtfor the examination of)airyProduces, American Public Health Association, 16th edition, 1992. ReFea submitted,AnFontaine Laboratory Director Over 4o years-Vediicated to,ew&xty andService SEP-08-2004 WED 09:61 AM FRL INC, FAX N0, 16174422013 P. Oi �. s: Foods Research (617)442-3322 LABORATORIES,INC. (617)44 FAX(617}442-2412-2012 3 • 130 NEWMARKET SQUARE-BOSTON,MA 4211 S DATE: September 8, 2004 BOA"OFHEALTHS Salem TO: Board of Health Dept, FROM: Andrea FOR: August 2004 LAB CODE Cindys Planet 4229-52 Facsimile confirmation Signature.- Date, ignature:Date: "Please sign on fine above and fax hack to(617)442-2013 for eonfumatio(+. Please call(617)442-3322 if any of these reporn are misting. Thank you. Over 4o Years--De&caredto Qwfity andservrfe SEP-08-2004 WED 0951 AM FRL INC, FAX N0, 16174422013 P. 02 Foods Research (617)442-3322 LABORATORIES, INC. (817)427.3322 FAX(617)442.2013 ��► 130 NEWMARKET SQUARE-BOSTON,MA 02118 Report Date: August 19, 2004 Date Collected: 8!16/2004 Lab Code: 4229-52 -Date Aaalyzed: $11612004 CLIENT Cindy's Planet I a I Fort Street Salem,MA 01970 SAMPLE DESCRIPTION SPC t g Coliform/g Chocolate and Vanilla Soft Serve Ice Cream 1,500 7 NOTE: <=less than COMMENTS: These results are in compliance with the bacterial standards as established by the Massachusetts Department of Public Health Division of Food and Drugs. METHODS: Standard Alethods for the Examination of Dairy Products, American Public Health Association, 16th edition, 1992. Respectfully submitted, And I. Fontaine Labs ory Director Over 40 years—Dedicated to QuaCty and Service AUG-02-2004 i10N 0111 PM FRL INC. FAX N0, 16174422013 P. 02 Foods Research (6171442.3322 (617)427-3322 LABORATORIES,INC, FAX(6M 442-2013 130 NEWMARKET SQUARE-BOSTON,MA 0211$ Report Date: July 14,2004 Date Collected: 7/12/2004 Lab Code: 4194-53 Date Analyzed: 7/12/2004 CLIENT Cindy's Planet 181 Fort Street Salem,MA 01970 SAMPLE DESCRIPTION SPC/g Coliform!g Chocolate and Vanilla Soft Serve Ice Cream 1,100 5 NOTE: <=less than COMMENTS: These results are in compliance with the bacterial standards as established by the Massachusetts Department of Public Health Division of Food and Drugs. METHODS: Standard Methods fnr the Exmnination of Dairy Pro&cts, American Public Health Association, 16th edition, 1992. Respectfulllly..submitted, ea J. Fontaine L ratory Director Over 40 years—Dedicated to gµafity AlndServire JUL-02-2004 FR1 10:30 AM FRL INC. FAX N0, 16174422013 P. 01 i 4 Foods Research lesearch (617)442`9322 (617)427-3322 LABORATORIES, INC. FAX(617)442-2013 '�•� 130 NEWMARKET SQUARE-BOSTON,MA 02118 DATE: July 2, 2004 BOARD OFHEALTH: Salem TO. Board of Health Dept. FROM: Andrea FOR: June 2004 MANUFACTURER LAB CODE Cindy's Planet 4170-54 n n _ LU0 CITY Cr SALEM BOARD OF HEALTH Facsimile confirmation signature: Date: _.. ... *Please sign on line above and fax back to (617)442-2013 jor confirmation. Please call(617)442-3322 if any of these reports are missing. Thank you. Over 40 Years-Dedicatedto Qttarty andService JUL-02-2004 FRI 10;30 AM FRL INC. FAX N0, 16174422013 P, 02 r F®®ds Researc 1 (617)442-3322 (617)427-3322 LABORATORIES, INC. FAX(617)442-2013 130 NEWMARKET SQUARE- BOSTON,MA 02118 Report Date: June 21, 2004 Date Collected: 6/18/2004 Lab Code: 4170-54 Date Analyzed: 6/18/2004 CLIENT Cindy's Planet 181 Fort Street Salem, MA 01970 SAMPLE DESCRIPTION SPC/g Coliform!g Chocolate and Vanilla Soft.Serve Ice Cream. 2,000 5 NOTE: <=less than COMMENTS: These results are in with the bacterial standards as established by the Massachusetts Department of Public Health Division of Food and Drugs. METHODS: Standard Methods for the Examination of Products,. American Public Health Association, 16th edition, 1992. Respectfully submitted, �� IN Andrea J. Fontaine Laboratory Director 2z U � BOA RD OF yFq�n� Ty Over 40 Years-Dedwatedto 0tafity andServiq Massachusetts Department of Public Health Salem Board of Health 120 Washington Street, 4'" Floor Division of Food and Drugs Salem, MA 01970-3523 FOOD ESTABLISHMENT INSPECTION REPORT Tel. (978) 741-1800 Fax (978) 745-0343 Name Date Tvpe of Ooeration(s) T e of Inspection //l. Ji/� 41of i-�-04/ C1 Food Service Routine Address Risk ❑ Retail Re-inspection Level ❑ Residential Kitchen Previous Inspection Telephone/ � 9/9r El Mobile Date:G- 3' Owner HACCP Y/N ❑ Temporary ❑ Pre-operation ❑ Caterer ❑ Sus „ y,, L/pn^ Suspect Illness Person in Charge(PIC) Time ❑ Bed& Breakfast ❑ General Complaint In: ❑ HACCP Inspector,s , M 41,15 /k/S Out: Permit No. ❑ Other Each violation checked requires an explanation on the narrative page(s)and a citation of specific,provision(s) violated. Non,compliance with: Violations Related to Foodborne Illness Interventions and Risk Factors Anti-Choking Tobacco Violations marked may pose an imminent health hazard and require immediate corrective 590.009(E) ❑ 590.009(F) ❑ action as determined by the Board of Health. - FOOD PROTECTION MANAGEMENT ❑ 12. Prevention of Contamination from.Hands ❑ 1. PIC Assigned/Knowledgeable/Duties ❑ 13. Handwash Facilities EMPLOYEE HEALTH - - PROTECTION.FROM CHEMICALS ❑ 2. Reporting of Diseases by Food Employee and PIC - ❑ 14. Approved Food or Color Additives ❑ 3. Personnel with Infections Restricted/Excluded ❑ 15.Toxic Chemicals FOOD FROM APPROVED SOURCE ❑ 4. Food and Water from Approved Source TIME/TEMPERATURE CONTROLS(Potentially Hazardous Foods) " ❑ 5. Receiving/Condition ❑ 16. Cooking Temperatures ❑ 6. Tags/Records/Accuracy of Ingredient Statements ❑ 17. Reheating ❑ 7. Conformance with Approved Procedures/HACCP Plans [118. Cooling PROTECTION FROM CONTAMINATION- " " ❑ 19. Hot and Cold Holding ❑ 8. Separation/Segregation/Protection ❑ 20.Time As a Public Health Control ❑ 9. Food Contact Surfaces Cleaning and Sanitizing REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) El21. Food and Food Preparation for HSP E] 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. c; NP 9 590.000/federal Food Code. This re ort;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 Ay 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:5901ns clFcrm 10dm fn °e t c'sS'gnata e: i Print: KA PICignature: , Print: w Page oft.Pages ' S _/ 1 Violations Related to Foodborne illness interventions and Risk Factors(items 1-22) PROTECTION FROM CONTAMINATION FOOD PROTECTION MANAGEMENT R Cross-contamination 1 n90.003(A) L Assignment of Res�onsibility* 3-302.1IfA}(1) Rasp Animal Foods Separated from X90.003{B) Demons anon of Knowled e* Cooked and RTF Foods" 2 103 I t Person in charge--duties Contamination from Raw Ingredients -- 3-30211(A)(2) Raw Animal Foods Separated from Each EMPLOYEE HEALTH Other` 2 590.003(C) Responsibility of the person in charge to Contamination from the Environment require reporting by food employees and 3-30211(A) Food Protection* at licants* 3-302.15 Washing Fruits and Vegetables 590.003(F) Responsibility Of A Food Employee Or An 3-304.11 Faxl Contact with Equipment and Applicant To Report To The Person In Utensils* Chw-e* Contamination from the Consumer 590.003(G) Rs orting b Person in Chac e"` 3-306.14(A)('F) Returned Food and Reservice of Food* 3 590.0030) Exclusions and Restrictions* Disposition ofAduiterated or Contaminated 590.003(E) Removal of Exclusions and Restrictions Food 3-701.11 Discarding orReconditioningUnsafe FOOD FROM APPROVED SOURCE Food* 4 Food and Water From Regulated Sources F9 Food Contact Surfaces 590.004(A-B) Compliance with Food Law" 4-501.111 Manual Way ewashing -Hot Water 3-201.12 Food in a Hermetically Sealed Container* Sanitization Tem.eratures* 3-201.13 Fluid Milk and Milk Products* 4-501..1.12 Mechanical Warewashing-Hot Water Sanitization Tem aramres* 3-202.13 Shell Eggs* 3-202.i4 E* s and Milk Products,Pasteurized* 4-507.114 Chemical Sanitization-temp.,pH, concentration and hardness. 3-202.16 Ice Made Froin Potable.Drinkint Water* 4-601.11(A) Equipment Fcxid Contact Surfaces and 5-101.11 1?sinking Water from art A roved Svstem* Utensils Clean" 590.006(A) BottledDdni:in*Water* 4-60211. Cleaning F7equemyofEquipment Food- 590.006(13) Water Meets Standards in 310 CMR 22.0* Contact Surfaces and Utensils* Sheilfish and Fish From an Approved Source 4-702.11 Frequency of Sanitization of Utensils and .i-201.14 Fish and RecreatLoually Caught Molluscan Food Contact Surfaces of Equi'meat* Shellfish" 4-703.11. Methods of Sanitization-Hot Water and 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* Sources' 11) Proper,Adequate Handwashing Game and Wild Mushrooms Approved by 2-3011 1. Clean Condition--Hands and Arms"` Re Mato Author' 3-202.18 Shellstock Identification Present" 2-30112 CteauinI I§ocednre* 590.004(0 Wild Mushaxims* 2-301.14 Velien to Wash* 3-201.17 (oune Animals" I i Good Hygienic Practices ,5 Receiving/Condition 2-401.11 F..arin , Drinkin or Using`robacao* 3-202.11 PF[Fs Received at Pro ser Tem reratures't 2-401.12 Discharges Fi om the Eyes.Nose and 3-20215 Package Integrity* Mouth* 3-101.11 Ftxid Safe and Unadulterated* 3-301.12 Preventing Contamination When TastPu<>* 6 Tags/Records:Sheilstock 12 Prevention of Contamination from Hands * 590.004(E) Preventing Contamination from 3-202.18 Shelktock Identification 3-203.12 Shelistock Identification Maintained* Em iovees* Tags/Records:Fish Products 13 Handwash Facilities Destruction* Located and Accessibfs 3-402.11 Parasite 3102.12 Records. Creation:ted Retention"` 5-?0311 Numbers and Capacities* 590.0040) Labeling of Ingredients* 5-204.11 Location and Placement"' 7 Conformance with Approved Procedures 5-205-11 Accessibilit}, Operation and Maintenance /HACCP Plans Supplied with Soap and Hand Drying 1-502,11 1 Specialized Procestin,Methods* Devices 3-502.12 Reduced oxygen ackaintut criteria' 6-3011.1 liandwashing Cleanser.Availahilit 8-103.12 C :onformance with A t)roved Procedures" 6-301.12 Hand Erving Provision "Denote,critical item in the federal 1999 Food Code or 105 CMR 5e0,0W CITY OF SALEM BOARD OF HEALTH c Establishment Name: �St4or 1-911iyte7" Date: /o-dF`o '/ Page: of _ Item Code C-critical Rem DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date No. Reference R—Red Item Verified PLEASE PRINT CLEARLY - ti. / F } YS �7 f ie e—e9iy r Co OF eev c Y /NLfe old vW_ Or— LT 4 f Discussion With Person in Charge: Corrective Action Required: ❑ No ❑ Yes I have read this report, have had the opportunity to ask questions and agree to correct all ❑ Voluntary Compliance ❑ Employee Restriction/ Exclusion violations before the next inspection, to observe I conditions as described, and to ❑ Re-inspection Scheduled ❑ Emergency Suspension comply with all mandates of the Mass/Federal oodfCode. I understand that noncompliance may result in daily fines of en 4ive dbila or s e cion/revocation of ❑ Embargo ❑ Emergency Closure your food permit. ❑ Voluntary Disposal 0 Other: 3-50i.14(C) PHFsReceived atTemperatures Violations Related to Foodborne Illness Interventions and Risk According to Iaw Cooled to Factors(items 1.22) (Cont.) 41'F145°F Within4Hours. PROTECTION FROM CHEMICALS 3-501.15 Coolies Methods for PHFs 13 Food or Color Additives 19 PHF Hot and Cold Holding 3-501.16(B) Cold PHFs Maintained at or below 3-202.12 Additives'" 590.004(F) 41%45°F^ 3-302.14 Protection from Unapproved Additives* IS Poisonous or Toxic Substances 3-501.16(A) Hot PHFs Manicured at or above 7-101.11. Identifying Information-Or 140°F. Containers* 3-501.16(A) Roasts Held at or above 130°F. 7-102.11 Common Name-Workine Ctmtainers* 20 Time as a Public Health Control 7-201.11 1 Se aration-Storage'= 3-501_19 Time as a Public Health Control* 7-202.1.1 Restriction-Presence and Ilse" 5}0.004(H) Variance Requirement 7-202.12 Conditions of Use" 7-203.11 Toxic Containers-Prohibitionsr REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-204.11 Satntizefs,Criteria-ChemictW POPULATIONS(HSP) 7-2(1-1.1.2 Chemicals for Vvashine Produce.Criteria* 21 3-801.11(A) Unp tsteurized Pre-packaged Juices and 7-204.14 Drying Agents.Criteria"` Beverages with Warning I-the As, 7-205.11 Incidental Food Contact.Lubricants* 3-801.11(B) Use of Pasteuiized Fees* 7.206.]I Restricted Use Pesticides.Criteria* 3-801.11(1)) Raw or Partially Cooked Animal Foal and 7-206.12 1 Railcar Bait Stations, Raw Seed Sprouts Not Served, 3-801.11(C)JJ Unct erred Food Packatne Not Re-served. 7-206.13 'Cracking Powders,Pest Control and Monitarin^* CONSUMER ADVISORY TIMEITEMPERATURE CONTROLS 22 3 603.11 Consumer Advisory Posted for Consumption of 16 Proper r Cooking Temperatures for Aminal Foods That are Raw.Undercooked or PHFs Not Otherwise Processed to Eliminate 3-401.11A(1)(2) Fags 155°F 15 Sec. Patha res aa�eizver Eggs-learnediate Service 145°Fl5sec* -102.13 Pasteurized Eggs Substitute for Raw Shell 3-401.11(A)(2) Comminuted Fish,Meats&Game g•s=r Animals- 155°F 15 sec. )( )( SPECIAL REQUIREMENTS 3-401.11(B I. 2) Pork and Beef Roast-130'F 121 titin* - 3-401.11(A)(2) Ratites, Injected Meats 155°F 1.5 590.009(A)-(D) Violations of Section 590.009(A)-(D)in sea * catering. mobile food,temporary and 3-401.11(A)(3) Poultry,Wild Game, Stuffed PHFs, residential kitchen operations should be Stuffing Containing Fish,Meat, debited under the appropriate sections Poultry or Ratites-165".F 15 sec. ^" above if related to foodborne illness 3-401.11(C)(3) Whole-muscle,huact'Beef Steaks interventions and risk factors. Other 145°F* 590.009 violations relating to good retail 3-401.12 Raw Animal Foods Cooked in a practices should be debited under#29- Microwave 165°F* Special Requirements. 3-401.11(A)(1)(b) All Other PHFs- 1.45°F 15 sec. 17 Reheating for Hot Holding VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 3-403.11(A)&(D) PHFs 165°F 15 sea * (Items 23-30) 3-403.11(13) Microwave-165°F 2 Minute Standing Critical air(]non-criltcal cidation.s, which do not relate to the Time* foodborne illness interventions and risk f roars listed above, can be 3-403.11(C) Commercially Processed RTE Food- found inrhe follou big sections of the Food Cade anti 105 CAl'R '140'F* 590.000. 3-403.11(E) Retraining Uusliced Portions of Reef Mem Good Retail Practices_ FC 690.000 Roasts* 23. Manu ement and Personnel....__.. FC--2 .003 Ig Proper Cooling of PHFs 24. Food and Food Protection _ _ FC-3_ .004 25 Eguipmem and Utensils _ FC 4 1005__ 3-501.14(A) Cooling(looked PHFs from 140`F to 26 Water, Plumbin and Waste FC 5 �_006___ 70'F Within 21fours and From 70+ 27. Physical Facility FC-6 1 .007 to 41°F/45°F Within 4 Hours. * 28. Poisonous or Toxic Materials FC-7 I .008 3-501.14(13) Cooling PRFs Made From Ambient 29. S eciel R uirements -__________4_T9__ Temperature Ingredients to 41cF/45°F 30. ___ Other_ Within 4 Hours`" ssvnm„Paas-zm< *Denotes critical item in the radend 1999 Pool Code or 105 CNIR 590.000. IMPORTANT MESSAGE FOR DATE "6yf TIME�� A.M M C/ OF PHONE AREA CODE NUMBER EXTENSION O FAX ❑ MOBILE AREA CODE NU ER TIME TO CALL TELEPHONED " - ` PLEASE'CALL - CAME TO SEE YOU WILL CALL AGAIN WANTS TO SEE YOU RUSH RETURNED YOUR CALL WILL FAX TOYOU MESSAG `.4 SIGNED wOPsFORM 40 MADE IN U. .A. NOTES Massac'husetts-De artment of Public Health Salem Board Health M 120 Washington S Street, 0 Floor Division of Food and Drugs Salem, MA 01970-3523 FOOD ESTABLISHMENT INSPECTION REPORT Tel. (978) 741-1800 Fax (978) 745-0343 Name, gate T dof O eration s Te of Inspection Food Service " Routine Address Risk ❑ Retail E] Re=inspection I. 64 t ✓e' Level ❑ Residential Kitchen Previous Inspection Telephone El Mobile Date: 91/ Sf A/ 9S1 NOS HCl n � El Temporary ElPre-operation Owner HACCP YM ❑ Caterer El Suspect Illness P7 Du O� El General Person in Charge(PIC)' Time ❑ Bed&Breakfast In: HACCP Complaint Inspector -/ ,tw /S Out: Permit No. I ❑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 ❑ 1 . Prevention of Contamination from Hands ❑ 1. PIC Assigned/Knowledgeable/Duties V/2 !moi 13. Handwash Facilities (9.) , EMPLOYEE HEALTH - - - --` - , PROTECTION FROM CHEMICALS ,,..1 ,❑ 2. Reporting of Diseases by Food Employee and PIC ❑ 14.Approved Food or Color Additives ❑ 3. Personnel with Infections Restricted/Excluded ❑ 15.Toxic Chemicals FOOD FROM APPROVED SOURCE - -- ❑ 4. Food and Water from Approved Source TIME/TEMPERATURECQNTROLS(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(HSP) ; ❑ 21. Food and Food Preparation for HSP ❑ 10. Proper Adequate Handwashing IF11. Good Hygienic Practices CONSUMER ADVISORY El 22. Posting of Consumer Advisories Violations Related to Good Retail Practices Number of Violated Provisions Related G Critical (C)violations marked must be corrected I To Foodborne Illnesses Interventions immediately or within 10 days as determined by the Board land 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 l G 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)(990.009) 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 r 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: 5:501nsIdFc, 6 14.do - Inspector's Signature: -21 Print: A _PIC's Signature: 1 /h -- - / Print: - / Pagel of-\I 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) 1,Assignmort ofResponsibdtty* 3-302.1l(A)(1) Raw Animal Foods Separated from �590.003(B} 'Demonstration ofKnoaledaO Cooked and RTEFoods* 2-103.11 Person in charge-duties Contamination from Raw Ingredients - 3-302.i.1(A)(2) Raw Animal Fonds Separated from Each EMPLOYEE HEALTH Other- 2 590.003(C) Responsibility of the person in charge to _ _ Contamination from the Environment require reporting by food employees and 3-302.1](A) Food Protection* a flicanesx` 3-302.15 Washing Fruits and Vegetables 590.003(F) Responsibility Of A Food Employee Or An 3-304.11 Food Contact with Equipment and Applicant To Report To The Person In Utensils* Char*e* Contamination from the Consumer 590,003(6) Re cortin b Person in Char+,?e* '3-306.14(A)(I3) Returned Food and Rescrvice of Foal* 3 590.003(D) Exclusions and Restrictions* - Disposition of Adulterated or Contaminated 590.003(E) Removal of Exclusions and Restrlclions Food 3-701.1.1 Discarding or Reconditioning Unsafe FOOD FROM APPROVED SOURCE Food* L4 Food and Water From Regulated Sources F9 Food Contact Surfaces 590.004(A-B) Com ali:mce with Food Law* 4-501.111. Manual Warewashing-Hot Water Sanitization Tem eratures* 3-201.12 Food in a Hermetically Sealed Container* 4-501.112 Mechuiical Warewashin� Hot Water 3-20L13 Fluid Milk and Milk Products* g- 3-202.1.3 Shell Eoas* Sanitization Temperatures* 3-2t12.14 Ea�s and Milk Products,Pasteurized* 4-501.114 Chemical.Sanitization-temp., pH; concentration and hardness,* 3-202.16 Ice Made From Potable Drinking Water` 5-101.7.1 Drinkin Water from an A a roved S stem* 4-601.11(A) Equipment Food Contact Surfaces and Utensils Clean* 590.006(A) Bottled Drink n Water* 590.006(13) Water Meets Standards in 310 CMR 22.0* 4-602.1 i Cleaning Frequency of tenEcli Food- Contacx Surfaces and Utensils* Shellfish and Fish From an Approved Source- 4-70111. Frequency of Sanitization of Utensils and 3-201.14 Fish and Recreationally Caught Molluscan Food Contact Surfaces of ui ment* Shellfish* 4-703.11 Methods of Sanitization-Hot Water and 3-201.15 Molluscan Shellfish from NSSP Listed ChenucaF: Sources* 10 Proper,Adequate Handwashing Came and Wild Mushrooms Approved by Regulatory Autharit 2.301.11 Clean Condition-Hands and Aruis* 3-202.18 Shellstock.Identification Present* 2-301-12 Cleaning Procedure'* 590.004(C) Wild Mushrooms- 2-401.14 When to Wash* 3-201.17 Game Animals* I 1.1 Good Hygienic Practices g Receiving/Condition 2-401.11 Eating,Drinking or Using Tobacco* 3-202.11 PHFs Received at Proper Temperatures* 2-401.12 Discharges From the Byes,Nose and 3-202.15 package hrte>rity* Mouth'' 3-101.11 Food Safe and Unadulterated* 3-301,12 preventing Contamination When Tasting* (, Tags/Records:Shellstock 12 Prevention of Contamination from Hands 3-202.18 Shellstock Identification * 590.004(E) Preventing Contamination from 3-203.12 Shellstock Identification Maintained° _ Em 1p oyees_ Tags/Records:Fish Products 13 Handwash Facilities 3-402.11 Parasite Destruction* Conveniently Located and Accessible 3-402.12 Records.Creation and Retention* 5-203.11 Numbers and Ca acities* 590.004(7) Labeling of Ingredients` 5-204.1.1 Location and Placement* 7 Conformance with Approved Procedures 5-205.11 Accessibility.Operation and:Maintenance /HACCP Plans - Supplied with Soap and Rand Drying Devices 3-502.11 S ecialize 1 Processing Methals* 6.301.11 Handwashin Cleanser,Ava ability 3-502.1.2 Reduced ox en parka 'ng,criteria* 8-103.12 Conformance with Approved Procedures* 6-301.12 Hand Drying Provision Denons critical item in the federd 1999 Foal Cotte or 105 CMIZ 590.000. CITY OF SALEM BOARD OF HEALTH Establishment Name: tie Du s P/a �¢f Date: 6•d-o q Page: `a� of Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION - Date No. Reference R-Red Item Verified ., PLEASE PRINT CLEARLY Ale, 1,US G Q A0 NA r \ /Al 3- o, ° iot 1�Tr uhf o niot /:4 4edLf or 7 e Pte/ -ie,e / ,nY ;-/2P T Ae, /�� 1' ew S /TS d /aia/aL / dc" cvo/ ✓a 2 _\ / X -1 e2 7 11,411Z Coit' r //// //717 &4,9, / 2- Discussion With Person in Charge: \ Corrective Action Required: ❑ No ❑ Yes I have read this report, have had the opportunity,to ask questions and agree to correct all ❑ Voluntary Compliance ❑ Employee Restriction/ Y#ations 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 dollar or suspension/revocation of ❑ Embargo ❑ Emergency Closure your food permit. n f l� L3Voluntary Disposal El Other: U 3-SOi.14(C) PHFs Receitied at'2mperatures Violations Related to Foodborne fitness Interventions and Risk According to law Cooled to Factors(items 1.22) (Cont.) 41`F145 F Within 4 Homs. r PROTECTION FROM CHEMICALS 3-501.15 Cooling,Methods for PHFs 14 Food or Color Additives 14 PHF Hot and Cold Holding 3-202.12 Additives"' 3-%A6(B) Cold PffI s Maintained at or below "° n 590.004(F) 41°145°F* 3-302.14 Protection from Una o xoved Additives" 3-501.16(%) Hot PHFs Maintained at or above F- 1-5 Poisonous Irmat Substances 0°F * 7-101.11 Identifyingttormatipn-(h'iginal 14 3-501 1.6(A) Roasts Held at or above 130'F. Containers" 7-102.11 Common Name-Workine Containers"" 20 Time as a Public Health Control 7-201.11 Separation-Storage" 3-501.19 Time as a Public Health Control* 7-202.'11 Restriction-Presence and Use" 590.004(H) Variance Re ulremcnt 7-202.12 Conditions of Use* 7-203.1.1 'toxic Containers-Prohibitions* REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-2tk4.11 Saoitizers,Criteria-Chemicals* POPULATIONS(HSP) --- 7-204.12 Chemicals for Washing Produce,Criteria, 21 3-SO] INA) Unpasteurized Pre-packaged Juices olid 7-204.14 Di 'in =eats.Criteria" Beverages with Warning Iabels* 7-205.11 Incidental Food Contact.Lubricants* 3-50] ll(B� Use of Pasteuuzed'E�igsM 7-206.11 Restricted Use Pesticides,Criteria* 3-801 1 I(D) Raw or'Partially Cooked Animal Food and Raw Seed 5 fronts Not Served. ,F 7-206.12 Rcxienf Bait Stations" 3_80 L 11(C) Uno oened Foort Packa re Not Re-served. 7-206.13 Tracking Powders,Pest Control and Monito ring v* CONSUMER ADVISORY TIMEITEMPERATURE CONTROLS 22 3-603.11 Consumer Advisory Posted for Consumption of l6 Proper Cooking Temperatures for Animad F As That are Raw.Undercooked or PHFs Not Otherwise Processed to Eliminate 3-40'11.1%(]}(2) Eggs- 155`LiSSec. Pathogens.'" Fsecns rrozoo� Eggs-hinniediaw Service 145°Fl5sec* 3-302.11 Pasteurized Eggs Substitute hit Raw Shell 3-401.11(A)(2) Comminuted Fish, Meats&Game Eggs* Animals-155`F 15 sec. * 3-401.11(B)(1)(2) Pork and Beef Roast- 130`F 121 nun* SPECIAL REQUIREMENTS 3-401.11(A)(2) Ratites, Injected Meats-155"F 15 590.009(A)-(D) Violations of Section 590.009(A)-(ll)in sea * catering,mobile food,temporary and 3-401.11(A)(3) Poultry, Wild Game,Stuffed PHEs, residential kitchen operations should be Stuffing Containing Fish,Meat, debited under the appropriate sections Poultry or Ratites-165°F 15 sec. " above Ifrelated to foodborne illness 3-401.11(C)(3) 1Vhole-muscle,Intact Beef Steaks interventions and risk factors. Other I45°.F* 590.009 violations relating to good retail 3-401.12 Raw Animal Foods Cooked in a practices should be debited under/P29- Microwave 165°F" Special Requirements. -340 1A I(A)(1)(b) All Other PHFs-145°F 15 sec. 17 Reheating for Hot Holding VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 3-403.11(A)&(1)) PHFs 165'F 15 sec. * (Items 23-30) 3-403.11(B) Microwave-165=F2 Minute Standing Critical and non-critical violations, which do not relate to the Timesfoodborne illness onto venrions and risk jactnrs listed above, can be 3-40111(C) Commercially Processed ITE Food- ,found in rhe following sections of the Food Code and 105 CMR 140°Ft 590.000. 3-403.11(F) Remaining Unsliced Portions of Beef its Good Retail Practices FC b80.000 --- Roasts" __ I . 23. Mona ement and FC-2 003 ,_....... 18 Proper Cooling of PHFs 24. _ Food and Food Protection_ FC_3 .004 25__. Equipment and Utensils __ FC 4 �.005 3-501.14(%) Coaling Cooked PHFs from 140`F to 26. Water, Plumbing and Waste FC 5 .00ti 70°F Within 2I{ours and From 70°F 27 Physical Facility _ FC-6 .007 to 4I'F145°F Within 4 Hours. " 28. Poisonous or Toxic Materials_ _ FG-1 .008 3-50L14(B) Cooling PHFs Made Front Ambien[ 29. S ectal R uirements 009 Temperature ingredients to4l`F/d5'F __K _ ,Other Within 4 Hours•" or .n=Ve-2,4,� Denotrs critical item in the redend 1999 FoodCode or 105 CMR 590.000. r; CITY, OF SALEM BOARD OF HEALTH Establishment Name: v Jas S `a-, p Date: G 3-/i 4�/ Page: of 3 Item Code C-Critical Item DESCMPTION OF VIOLATION/PLAN OF CORRECTION Date �-# No. Reference R—Red Item Verified / PLEASE PRINT�CLEAAR�RLLY ' r --- _-27 /3 s c-ehOhrc-leer a N X 7 i191elee d-n G Z-S } t :g T��m�rvP/ �lus� B� '&1irlee1rotio yew-/-* Y.�Cc/ S. �� — Sff/V JLl7i w 9 A m's P AOO,PS4n ir kl'e?e '+ Discussion With Person in Charge: Corrective Action Required: ❑ No ❑ Yes i } I have read this report, have had the opportunity to ask questions and agree to correct all ❑ Voluntary Compliance ❑ Employee Restriction/ 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. t / ❑ Voluntary Disposal ❑ Other: i 3-So1.14(C) PHFs Received at Temperatures Violations Related to Foodborne Illness Interventions and Risk According to Law Cooled to Factors(items 1-22) (Cont) _ 41'F145'F Within 4 Hours- PROTECTION FROM CHEMICALS 3-501.15 Coolies:Methods for PHFs 14 Food or Color Additives i9 frcrtn IIna PHF Hot and Cold Holding -- ------------ - 3-501.16(8) Cold PHFs Maintained of or below 3-30214 Protection 3-202.12 Additives* 590,004(1) 41'(45'F* o n'rved Additives* 3-501.16(A) Hot PHFs Maintained at or above 15 Poisonous or Toxic Substances I40"F.M 7-10L I 1 Identifying Information-Original 3-501.16(A) Roasts Held at or above '130'F. Containers" 7-102.11 Common Name-Working Containers* 20 Time as a Public Health Control 7-201.11 Separation-Storage* 3-501.19 Titre as a Public Health Control'" 7-202.11 Restriction-Presence and Use" 590.004(H) lVariance Recuirernent' 7-20112 Conditions of Usc* 7-203.1.1 Toxic Containers-Prohibitions'* REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-204.11 Smitizers.Criteria-Chemicals* POPULATIONS(HSP) 7-204.12 Chemicals for W ,ashin Produce. Criteria* 21 3-801.11(A) Unpasteurized Pre-packaged Juices and 7-204.14 Drvin. Agents.Criteria* es Beveragwith Warning Labels* 7-205.1.1 Incidental Food Contact.Lubricants* 3-801.11(B) Use of Pasteurized E"3s* 7-206.11 Restricted Use Pesticides,Criteria* 3-801.11(D) Raw or Partially Cooked Animal Food and Po Raw Seed Sprouts Not Served. 7-206.1.2 Rodent Stations°` 3-80 LI I(C) Uno erred Food Package Not Re-served. " 7-206.13 Tracking Powders,Pest Control and Monitorn>>M CONSUMER ADVISORY _ TIMEITEMPERATURE CONTROLS 22 3-603.11 Consumer Advisory Posted for Consumption of 1( Proper Cooking Temperatures for Animal Foods`fiat are Raw. Undercooked or PRFs Not Otherwise Processed to Eliminate 3-401.11.A(1)(2) Eggs- 155'F 15 See. Pathos, ns r vsr,�zooi Eggs-Immediate Service 145'1715seO 3-302.13 Pasteurized Eggs Substitute for Raw Shell Fang" 3-401.1 t(A)C) Comminuted Fish Meat's&Game Animals-155'F 15 sec. " 3-401.11(R)(1)(2) Pork and Beef Roast- 1.30'F 121.uun* SPECIAL REQUIREMENTS 3-401.11(A)(2) Ratites, Injected Meats- 155°F 15 590.009(A)-(D) Violations of Section 590.009(A)-('I))in sec * catering, mobile food, temporary and 3-401.11(A)(3) Poultry,Wild Game, Stuffed PRFs, residential kitchen operations should be Stuffing Containing Fish,Meat, debited under the appropriate sections Poultry or Ratites_I(,"F 15 sec. * above if related to foodborne.illness 3401.11(C)(3) Whole-muscle, intact Beef Steaks interventions and risk factors. Other 145°F oc 590.009 violations relating to good retail 3-401.12 Raw Animal Foods Cooked in a practices should be debited under#29- Microwave 165"F* Special Requirements. 3-401.11(A)(1)(b) All Other PHFs-- 145'F 15 sec. 17 Reheating for Hot Holding VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 3-403.1.1(A)&(D) P1IFs 165'F 15 sec. * (Mems 23-30) 3-403,11(B) Microwave- 165'F 2 Minute Standing Critical acrd non-critical violations, which do not relate-to the Times foodborne illness iniernentions and risk factors listed above, can be 3-403,11(C) Commercially Processed RTE Food- _found in the following se(nano of the Food Code and 105 CMR 140017* 590.000, 3-403.11(E) Retraining Unsliced Portions of Beef Item 1 Good Retail Practices 1 FC 590.000 Roasts" `•`,,.23 Management and Personnel FC 2 .003 18 Proper Cooling of PHFs 24 I Food and Food Protection_ 1 FC-3_ .004 Utens'ls FC-4 005 i 3-501.14(A) Cooling Cooked PHFsfront 14WFto - . 26. �Wa�mPlumbient andngMAWaste-- FC o _.006 - 70'F Within 2 Hours and From 70'F 1 27. I Physical Facility I FC-6 .007 to 41'F145'F Within 4 Hours. * 28. Poisonous or Toxic Materials FC-7 .008 3-501.14(B) Cooling PHFs biadeFrom Ambient 29 SPeaal Requires; _meats 009 Temperature Ingredients to 41°Ft45'F 30 Other Within 4 Hours* "@motes cdiiliil item in the federal 1999 Food Code o, 105 CNIR 590.000. r CITY OF SALEM9 MASSACHUSETTS BOARD OF HEALTH 120 WASHINGTON STREET, 4TH FLOOR SALEM, MA 01970 S CO) 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: Owner' s Name : Cindy Yen Name of Establishment : Cindy' s Planet Address of Establishment : 181 Fort Avenue Type of Establishment : FOOD SERVICE Application Date : 06/06/2003 Restrictions: Permit for Food Establishment 302-03 Frozen Desserts/Ice Cream 22-03 Permit for the Sale of Tobacco Products These Permits Expire December 31, 2003 This permit is not transferable and must be reissued upon change of ownership or location. The permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code, before any renovations, improvements, or equipment changes are made, all plans for such must be submitted to and approved by the Salem Board of Health. HEALTH AGENT orml CITY OF SALEM, MASSACHUSETTS �. BOARD OF HEALTH n 120 WASHINGTON STREET, 4TH FLOOR SALEM, MA 01970 TEL. 978-741-1800 FAx 978-745-0343 STANLEY USOVICZ, JR. JOANNE_ SCOTT, MPH, RS, CHO MAYOR HEALTH AGENT 2003 APPLICATION FOA PERMIT TO OPERATE A FOOD ESTABLISHMENT NAME OF ESTABLISHMENT � -A N5 P Ci K04 —TEL# ADDRESS OF ESTABLISHMENTtCf ! VAP MAILING ADDRESS (if different) t OWNER'SNAME aIIrjL, e-A pTEL# ADDRESS R Yom- l� CITY STATE AA ZIP C>Zi 1 CERTIFIED FOOD MANAGER'S NAMES) IrA o,tA 4 le vi CERTIFICATE#(s) (required in an establishment where potentially hazardous food is prepared.) EMERGENCY RESPONSE PERSON�eyj HOME TEL# 12[3423 -&-196 HOURS OF OPERATION: Mon.lo-a Tue,to—S Wed. (0 Thu. to Fri. to at. - Sun. rd- TYPE OF ESTABLISHMENT FEE check only RETAIL STORE YES NO less than 1000sq.ft. =$50 1000-10,000sq.ft. =$100 more than 10,000sq.ft. =$250 RESTAURANT YES NO �b less than 25 seats 100 25-99 seats =$150 more than 99 seats =$200 BED/BREAKFAST YES NO $100 ADDITIONAL PERMITS MAKE ICE CREAM, YOGURT, SOFT SERVEE NO �� $5 TOBACCO VENDOR YES NO $50 ALL NON-PROFIT(such as church kitchens) YES NO $25 Please pay total with one check payable to the City of Salem This Permit is not transferable and must be reissued upon change of ownership. The Permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code, before any renovations, improvements,or equipment changesWmade, I plans for such must be submitted to and approved by the Salem Board of Health. Pursuantter 62 , S49A, I certify under the pains and penalties of perjury that I, to my bestkno 'Iief �v fitaI state tax returns and paid all state taxes required under the law. Signatu pate 2,' d� Social Security or Federal Identification Number Revised 11/25/02 FOODAP2. m Check#&Date CITY OF SALEM BOARD OF HEALTH n Establishment Name: ( .ItICL S P/&,u Fh^f AAe. Date: s— ;k 7 0 3 Page: ( of Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date No. Reference R-Red Item - - Verified q ' ff PLEASE PRINT CLEARLY n NO9 U Ot )A Je I (�-Prj0e S¢of J P u( i vel /a.r Oyf L/ -� /!u� ALO al Aaf2 Ar r ( ✓sc� doom ze S 0� 'j-7 real o-( �a -!i (fix a'r I /D r V GLX_( vru/ Cr#7LC f • a 2 /•Q Bi.t O �f�[ 4 W d�ry/ /S cls , �XP ILW / P ds. / b-� Discussion With Person in Charge: Corrective Action Required: ❑ No ❑ Yes have read this report, have had the opportunity to ask questions and agree to correct all ❑ Voluntary Compliance ❑ Employee Restriction/ 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. 0 Voluntary Disposal ❑ Other: 3-501,14(0) PHFs Received at Temperatures Violations Related to Foodborne Illness Interventions and Risk According to Law Cooled to Factors(Items 1-22) (Cont.) 41.'F145'F Within 4 Hours, PROTECTION FROM M CHEMICALS 3-501.15 C x9inq Methods frs PHFs Food or Color Additives 19 PHF Hot and Cold Holding 14 3-501.16(B) Cold PI.1Fs Maintained at or below 3-202.12 Additives* 590.004(F) 41°745°F* 3-302.14 Protection from Unal.rnved Additives" 3-501.16(A) Hot PHFs Maintained at or above 15 Poisonous or Toxic Substances 140Ea 7-101.11 Identifying Information-Original 3-501.16(A) Roasts Held at or above 't30'F Containers* 7-102.11 Common Nante-Workin. Containers* 20 Time as a Public Health Control araucla-Stomp'" 3-501.19 Time as a Public Health Control 7.201.11 Se '^ 7-202.11 Restriction-Presence and Use* 590.004(14) Variance Requirement 7-202.12 Conditions of Usc* 7-203-11 '1-oxicContainers-Prohibffions* REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-204.11 Sanitizem Criteria-C'hetnicais* POPULATIONS(HSP) 7-204.12 Chemicals for Washin>Pnxluee Criteria* 21 3-801.11(A) Unpasteurized Pre-packaged Juices and 7-204.14 Drying Agents,Criteria* Beverams with Warnin�Lnbels* 3-801.11(13) Use of Pasteur(rsd E��s* 7-205.11 Incidental Food Contact,Lubricants* 3-301..1 i(D) Raw or Partially Cooked Animal Food and 7-206.11 Restricted Use Pesticides,Criteria* Raw Seed S routs Not Served 1-206.12 1 Rodent.Bait Stations* 3-801.1.1(C) Unopened Food Package Not Re-served. 7-206.13 Tracking Powders, Pest Control and MonitorinK* CONSUMER ADVISORY TIME[TEMPERATURE CONTROLS 22 3-603.11 Consucuer Advisory Posted for Consumption of Animal Foods That are Raw,Undercooked or 1G Proper Cooking Temperatures for PHFs Not Otherwise Processed to Eliminate Pathogens 4 `� �"°�, "'0t L��s-ln 3-d(11.11A(1)(2) Eggs- ela Sec 3-302.13 Pastern ed F Substitute for Raw Shell unmanedtateServic�e 145°F15scc�" vEggs Fm ts* 3-401.11(A)(2) Comminuted Fish.Meats&Game Animals- 155'F 15 sec. "` SPECIAL REQUIREMENTS 3-401. (A(B)(l)(?) Pork and I Inef jected Me -13O F 1215 5gO009(A)-(D) Violations of Section 590.009(A)-(D)in 3-401.11(A)(2) Ranter,injected Meats- 15'+°F 15 sec ' catering,mobile food, ternpot uy and 3-401.11(A)(3) Poultrv,Wild Game. Stuffed PHFs, residential kitchen operations should be ' .,Ji i.-.� :andel`the, ^ - • •i4�o.......,;� Smtirng COntahiing Fish,Meat, -r,"^r- Po day or Ratites-165'F 15,sec * above if related to foodborne illness 3401.']l(C)(3) Whole-muscle,Intact Beef Steaks interventions and risk factors. Other 145"F* 590.009 violations relating to good retail 3-401.12 Raw Animal Foods Cooked in a practices should be debited under#29- Microwave 165'F Special Requirements. 3-401.11(A)(1)(b) All Other PHFs-145'F 15 sec. * 17 Reheating for Hot Holding VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 3-403.11(A)&(D) PRFs 165'F 15 sec. * (Items 23-30) 3-403.11(13) Microwave- 165'F 2 Minute Standins Critical and non-crificai violations, whichdo not relate to the Time* foodborne illness inien,entions and risk factors listed above, cat be 3-403.11(C) Commercially Processed RTE Food- found in the follou•ieg sections of the Food Code and 105 LAIR 140°F* 590.000. _ 3403.11(E) Remaining linsliced Portions of Beef ]tern Good Retail Practices FC 590,000 i SS Roasts* 1 Food Personnel Proper Cooling of PHFs 25. 9Pmnal U nsils 3-501.14(A) Coolim,Cooked PHFs from 140'F W6 i +- F .006_ _I 70°F Within 2 Hours and Front 70°F 27. Physical Facility I FC-6 .007 to 41.°F145°F Within 4 Hours. * 28. Poisonous or Toxic Materiels l FC- 7 .008 3-501.14(8) Cooling PHFs Made From Ambient 29. Special Re_guirements .009 -� Temperature Ingredients to41`F145`F 30 Other Within 4 Hours` *Denotes critical item in the federal 1999 F2rod Code or I OS Ck9R 590.000. CITY OF SALEM BOARD OF HEALTH Establishment Name: O Irkj&4-S P10-Xt 4- Date: 5- ; 7 -0 -3 Page: of 1z Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date No. Reference R-Red Item Verified ' - PLEASE PRINT CLEARLY It ✓t� ✓/ Y/ -Ps'S /�Yt/V`7t 6tCJ K�—Xf z/ 16-en-5 50 3' kay D< aSlc� 5 • r/ws� da C d Qy s YOdo-,-dP .I /o k"-6 Ca / a t ror� /ry 3 ar to Sha/orr ye H U Discussion With Person in Charge: Corrective Action Required: ❑ No L3Yes 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 nditions as described, and to Exclusion violations before the next ins P El Re-inspection Scheduled L3Emergency Suspension comply with all mandates of the Mass/Federal F d ode. I un erstand that noncompliance may result in daily fines of tw ty ve dollar or sus ns. /revocation of ❑ Embargo ❑ Emergency Closure your food permit. ❑ Voluntary Disposal ❑ Other: 3-501,14(C) PHFs Received at Temperatures Violations Related to Foodborne Illness Interventions and Risk According to Ulm,Cowled to Factors(items 1-22) (Cont) _ 41'F/45'F Within 4 Hows. PROTECTION FROM CHEMICALS 3-501,15 Cooling Methods for PHFs 14 Food or Color Additives 19 PHF Hot and Cold Holding 3-541-16(B) Cold PHFs Maintained alor below 3-20112 Additives" 590.004(F) 41°/45'F'` 3-302.14 Protection frourUnapproved Additives" 3-501 16(A) Hot PHFs Maintained at or above 15 Poisonous or Toxic Substances =s 7-101.11 Identifying Information-Original 140'F3-541.16(A) Roasts Held at or above 1.30"F, Containers" 7-102.11 Common Name-Working Containers" 20 Time as a Public Health Control 3-501.1.9 Time as a Public Health Control" 7-201.11 Separation-Storage" 7-242-11 Restriction-Presence and User 590,004(H) Variance Recuirement 7-202.12 Conditions of Use* 7-203.'11 Toxic Containers-Prohibitions* REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-204.11 Sznitizers.Crlteria-Chemicals* POPULATIONS(HSP) 7-204.12 Chemicals for Washing Produce. Criteria* 21 3-801.11(.A) Unpasteurized Pre-packaged Juices and 7-2174.14 Dr ging Agents,Criteria' Beverages with Warnin-hibeks 3-WL 11(B) Use of Pasteurized Eggs* 7-205,1.1 fact Restricted talU ori esti Contact,',Criubt teants* 3-801.1.1(D) Raw or Partially Cooked Annual Food and 7-206.11 Restricted Use Pesticides,Criteela* Raw Seed Sprouts Not Served T 1-106 11 Rodent Bait Stations* 3-801-1.I(C) Unopened Food Package Not Re-served, 7 24ti.13 Tracking Powders, Pest Control and Monitoring" CONSUMER ADVISORY TIME/TEMPERATURE CONTROLS 22 3-603.11 Consumer Advisory Posted for Consumption of 6 Proper Cooking Temperatures for Animal Foods That are Raw, Undercooked or PHFs Not Otherwise Processed to Eliminate 3-401.,nA(1)(2) Eggs- 155°r 15 see. Padlogen$* Eggs-Immediate Service 1450Fi5sec* 3-302.13 Pasteurized Eggs Substitute for Raw Shell E. 3401.11(A)(2) Comminuted Fish,Meats&Grannie =s* Animals- 155'F 15 sec. SPECIAL REQUIREMENTS 3-401.11(B)(1)(2) Pork and Beef Roast-130'5 121 into 3-401.11(A)(2) Ratites,Injected Meats- 155F 15 590-009(A)-(D) Violations of Section 590.009(A)-(I)))in - sec catering mobile food, tetnporary and 3-401.1I(A)(3) Poultry,Wild Game Stalled PHFs, residential kitchen operations should be sluing containing Fish,Meat, . ,aw. Vader the -It Vr-1..(1 Poultry or Ratites-)65'F 15 sec " above if related to foodborne illness 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks interventions and risk factors. Other 145°F* 590.009 violations relating to gaol retail 3-401.12 Raw Animal Foods Cooked in a practices should be debited tinder#29- Microwave 165'F* Special Requirements. 3-401.11(A)(1)(b) All Other PHFs--145'F 15 sea * 17 Reheating for Hot Holding VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 340111(A)&(D) PHFs 165'F 15 sec. * (Items 23-30) 3-403.11(,6) Microwave-165'F 2 Minute Standing Critical and non-critical violations, which do not reline to the Time* foodborne illness interventions and risk factors listed abaci, can be 3-403.11(C) Commercially Processed R'CE Foad- ,found in the following sections of the Food Code and 105 CYIR 1400F* 590.000. 3443.11(E) Remaining Unsliced Portions of Beef Item Good Retail Practices FC 590-000 Roasts" i..23 _ Management and Personnel FC-2 .003 ! IS Proper Cooling of PHFs 24 Food and Food Protection FC-3 .004 -- ---- .- 25. E m ment and Utensils 1_FC 4 .005 _i 3-501.14(A) Cooling Cooked PRFs from 140°F to - - --- ------ ... 0 26. Water.Plumbin and Waste FC 5 ,006 70'F Within 2 Hours and From 70°F 27. Ph sical Facilit FC-6 007 to 41.'F/45"F\Vithin 4 Hours, * 28. I Poisonous or Toxic Material-s, FC-7 .008 1 3-501 14(B) Cooling PHFs Made From Ambient 29 iS enol Requirements Temperature ingredients to 41'F145°F �30. ! Other ! Within 4 Hours* `Denotea critical item in the tederal 1999 Food Code of I(F CMR 590.000. OCT-07-2003 TUE 09:51 An FRL INC. FAX N0, 16174422013 P. 02102 Foods Research (617)47-3372 (617)4227$372 LABORATORIES,INC. FAX(617)442-2013 • 130 NEWMARKET SQUARE-BOSTON,MA 02118 Report Date: September 15,2003 Date Collected: 9/11/2003 Lab Code: 3254-51 Date Analyzed: 9/11./2+ ��n M CLIENT M0l:( Cindy's Planet OCT 7 —Z003 181 Fort Street Salem,MA 01970 O1T"y OF Sr\LF BOARD OF HEALTH SAMPLE DESCRIPTION SPC/g Coliform i g Chocolate 1 Vanilla Soft Serve Ice Cream 5,800 2 NOTE: <=less than COMMENTS:These results are in compliance with the bacterial standards as established by the Massachusetts Department of Pub&c Health Division of Food and Drugs. METgODS: Stw zdvd i1Mhods for the Axanumhon of Dairy Products, American Public Health Association, 16th edition, 1992. Respec y sbmitted, Andrea J.Fontaine Laboratory Director Over 40 years-Dedicated to qty amdSe"ice AUG-06-2003 WED 03: 13 PM FRL INC. FAX N0, 16174422013 P. 02 Foods Research (617)`142-9322 (617)427.3322 LABORATORIES, INC. FAX(617)442-2013 �"•� 130 NEWMARKET SQUARE•BOSTON,MA 02118 Report Fate: August 4, 2003 Date Collected: 7/31/2003 Lab Code: 3212-52 Date Analyzed: 7/3 U2003 CLIENT Cindy's Planet 181 Fon Street Salem, MA 01970 AUG 0 6 2003 U11-Y L r i�,+'l--LEI l BOARD OF HlEkTh SAMPLE DESCRIPTION _ SPC/g Coliform!g Vanilla/Chocolate Soft Serve ice Cream 24,000 3 NOTE: <=less than COMMENTS: These results are in compliance with the bacterial standards as established by the Massachusetts Department of Public Health Division of Food and Drugs. METHODS: Standard Methods for the Examination of DairyProducts, American Public Health Association, 16th edition, 1991 Respectfully submitted, And 7. Fontaine Laboratory Director Over 40 ifears Tiedwated to Quality andService � G . . c�' �� S r� ��" ��"�� —.._ -- _ JUL-31-2003 TNtt O1a20 PM FRL INC, FAX NO, 16174422013 _._._.. P, Ol a Foods Research (617)442.3322 LABORATORIES. INC. (617)427.3322FAX(617)442-2013 •� 130 NEWMARKET SQUARE-BOSTON,MA 02118 Report Date: July 31, 2003 Date Collected: 6/27/2003 Lab Code: 3178-60 Date Analyzed: 6/27/2003 CLIENT Cindy's Planet r 7 7,7 184 Fart Street 'I 1 Salem,MA 02118 JUL 3 120o3 80A8p OF NEAL7H SAMPLE DESCRIPTION SPC/g Coliform/g Vanilla/Chocolate Soft Serve Ice Cream 10,000 5 NOTE: <—less than COMMENTS: These results are in compliance with the bacterial standards as established by the Massachusetts Department of Public Health Division of Food and Drugs. METHODS: Standard Methods for the Examination of Dairy Products, American Public Health Association, 16th edition, 1992. Respectfully submitted, Andrea J. Fontaine Laboratory Director Over 40 years-2reXwated to euaCtty andservice I CITY OF SALEM ��,,// BOARD OF HEALTH Establishment Name: C / 12d- S Date: O3 Page: of / Item Code C-Critical Rem DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date No. Reference R—Red Item Verified .:.PLEASE PRINT CLEARLY CO 9r,, C LJ 12% 17qLjL �� /✓I T. Ole, -M-) a t Discussion With Person in Charge: Corrective Action Required: ❑ No ❑ Yes I have read this report, have had the opportunity to ask questions and agree to correct all ❑ Voluntary Compliance ❑ Employee Restriction/ 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. 0 Voluntary Disposal 0 Other: 3-501.14(C) PRFs Received at'Pemperahrres Violations Related to Foodborne Illness Interventions and Risk According to Law Cooled to Factors(Items 1-22) (Cont) 41'F145-F Within 4 flours. PROTECTION FROM CHEMICALS 3-501-15 Coolant Methods for PHFs 14 Food or Color Additives 19 PHF Hot and Cold Holding 3-50116(B) Cold KIP%Maintained at or below 3-202.12 Additives* 590.004(F) 41'(45`F* 3-302.14 Protection horn Unan roved Additives" IS Poisonous or Toxic Substances 3-501.16(.3) Hot PHFs Maintained at or above 7-101.11 Identifying Information-Original 740°F. 3-501.16(A) Roasts Held at err above 7.30'F. Containers" 7-102.11 Common Name- or it)�C;ontainers* 20 Time as a Public Health Control 3-501.14 Tune as a Public Health Control:,7-201.1.1 Searanion-Storage- 7-202.11 tora c*7-202.1I Restriction-Presence and Uge"'` 59o.004(Hl Var9ance Ree uaement 7-202.12 Conditions of 1Jso' 7-20311 1 oxic Containers-Prohibitions' REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-204.11 Sanitizers.Criteria-Chemicals' POPULATIONS(HSP) 7-204.12 Chemicals for Washing Produce,Criteria* 21 3-80111(A) Unpasteurized Pre packaged luiees and 7-204.14 Drying, ARenns.Criteria* Beneiages with Warning Labels* 3-801.11(B) Use ofPasteurized Eg�s* 7-205.11 Inci ental no Contact,Lubtrcants* 3-801.11(D) Rau or Partially Cooked Annual Food and 7-206.11 Restricted Use Pesticides,Criteria* Rev.Seed S nrotns Not Served. 7-206.12 Tacks g,Po Station e 3-801.11(C) Uno.ened Foal Package Not Re-served. * 7-20Ei.13 Tracking Powders, Pest Control and Monitorint* CONSUMER ADVISORY TIME/TEMPERATURE CONTROLS 22 3-603.11 Consumer Advisory Posted for Consumption of 16 Proper Cooking Temperatures for Animal Foods Thak are Raw.Undercooked or PHFs Not Otherwise Processed to Eliminate 3Patho4gens.":eP Y�rvzoai F Rs-Immediate Service 145'F15sec* 3-302.13 1 Pasteurized Eggs Substitute for Raw Shell 3-401.I I(A)(2) Catnuninutcd Fish.Meats At("Tame Animals-155''F 15 sec. 3-401.11(B)(' r 1)(2) PokandBeefRoast- 130'Ft2loull, SPECIAL REQUIREMENTS 3-40111(A)(2) Ratites,Injected Meats- 155'F 15 590.009(A)-(D) Violations of Section 590.009(A)-(D)in ee . catering,mobile food, temporary and 3-4( L11.(A)(3) Poulhy,Wild Caine.Stuffed PHF's, residential kitchen operations should be stutnng containing Fish,Meat, ....allc� '.ader the -:ri of_iwt, Poultry or Ratites-165'F 15 sec * above if related to foodborne illness 3-401.1.1(C)(3) Whole-muscle,Intact Beef Steaks interventions and risk factors. Other 145'F* 590.009 violations relating to gaxl retail 3-401.12 Raw Animal Foods Cooked in a practices should he debited under#29- Microwave 165'F* Special Requirements. 3-401.l l(A)(1)(b) All Other PHFs-145'F 15 sec. * 17 Reheating for Hot Holding VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 3-403.11(A)&(D) PHFs 165°F 15 sec. * (Items 23-30) 3-40311(13) Microwave- 165'.F 2 Minute Standing Ciilical and non-critical violations, which do not relate to the Time* foodborne illness inlerventions and risk factors listed above, can be 3-403.'11(C) Commercially Processed RTF Food- found in the followine sections of the Foot Code and 105 CMR _ 1400F* 590.000. 3-403.11(B) Remaining Unsliced Portions of,Beef Item I Good Retail Practices FC 590.000 I Roasts` _23._Managemenl and Personnel FC-2 .003 I 1g Proper Cooling of PHFs 24. Food and Food Protection FC-3 .004 I 0 6. ug rpment and Utensils I FC 4 005 1 3-501.14(3) Cooling Cooked PHFs from 140'F to ! 26. Water.Plumbing and Waste I FC 5 .006 �t 70'F Within 2 Homs and Fron170'F 27. I Ph sical Faoilit FC-6 .007 to 41'F145'1 Wthnn 4 Hours. * _28 Poisonous or Toxic Materials 1 FC 7 .008 3-501.,14(B) Cooling PHFs Made From Ambient 1 29 Special Requirements Temperature ingredients to 41'F/45°F 30 I Other Within 4 Hours* S", Denotes critical iter in the federal 1999 Fead Code or 105 Ck1R 590.000. i' INI IAL S61%C' sgnJ tGe Day ° RE LA SERVIC \, EXTR%ISVICE TERM/N/X rel ajM4 - 'BRANCH ACCOUNT T4T. TELEPHONE-- -GRID f S.DAV: T T. PRODUCTION TIME IN - TIM GOUT Zqa- I j�5 _SERVICE PROPERTY AT .Ir-i U,j P1C3Y CIL/ -7— ( 81 C" OPERATOR NAME&CE1g1�TIFICATION NUMBER SUPfE�RVISOR NAME&CERTIFICATION NUMBER 1'�Vv1 v� 6,;L 1�1\"T T ysl,�...^ Target1Geman c«kma�c�nas7� .�Pavemem Ants" ..- ❑ Para ❑ a'C�brel 1K Mate as" ^' 1 rutised e a Pests ❑ ar.encan cacwo sLGi mine Uf` ^r4ioa l...-'� I ❑ Bmred w'.P¢ts Insider s 620 WIND-UP TRAPS ❑ OrientalC«kroaches U Fve Mts ❑ Silverl'rsn ❑ finer L400 sect Monitors 610 TIN CATS ❑ qn«cacxrpaches ❑ Omer Ants ❑ Ram ❑ fire,_Alp-PheromaneT s Rat Bait Stations lue Tra s Ouse Bait Stations c Pest Control Materials Used EPA Reg.Y T/C FJC Amount 830 Snap Tharts 855 Liquid Bail Btdb00a tt)Advance Granular Ant Batt(Abamectin 81)0.011% 499-370 Areas Inspected and/or Treated Advance Dual Chobe Ant Soit(Sufluramid)0.5% 499459 )) n Pesrcoatmtmatwoura.eoindkatodbycoeesfwn#star" 315 Ascend FireAnt Bak(Abahn c nBl)0.011% 499-370 _ 309 Aved Roach Bait Stations A,eaz (7 O (Abame 15.4%05% 499467 ❑Ginirg Peas 365 Ativance 388B Ant Gel Balt(Baaxl S.d% 499492 ❑�,� 15 Demand CS Mnnbda-cyhaiothnn) 00.015% ❑0.03% ❑0.06% 10182-361 EJ pudic Areas 210 DettaGard G(Dehamethrio)0.05% 432-836 158 TnDlo Bulk Dull Silim Ge 40% ❑Resutacker Downs ( � (Pytellmre)1.0% 499-029 r�,, Gemml EC(Hydmprene)0.06% 2724-351 &SPlay Arat Generatbn Mini Blocks Bad(Dif rthialone)0.1025% 7173-218 ❑LauMry/Boil«Boom 43 Kicker EC(PyraNnre) 0005% 30.1% ❑0.2% 48161145 �oa9eNmiry �� (D .h 550 UquiTox II Bak(Disodium Salt of Diphadtwne)0.106% 12455£1 O Warehouse Aced 352 Maxfmce FC Roach Bak Stations(Fipmnl)0.05% 64248-11/432-1257 ❑P.in,Areas 351 Maxform FC Ant Bail Statiom(Fpmnip 0.01% 64248-10/432-1256 ❑Patient Rooms _357.Maxforca FC Ant Gel Bad(Fiproni90.001% 64248-21/432-1264 ❑Guest Roans i� 364 axfo=FCRoach Bail GeI(Fiptonfl)0.01% 64248-14/432-1259 / f. ❑taesemem 355 Maxlonce FG Insect Bai1(H "non)1.0% - 64248-19/432-1262 360 Niban Bak/Niban FG Bail(OMobpnd acid)5% 64405-2 ❑Poof 147 Ni-Bor D(Disodium Ontaborate Ttelrahydrate)98% 64405-8 ❑F+tenor Porrowter - - 46 NylarEC(Pynproxylen) 00.015% 00.02% 11715307-57079 ❑Laararaped aeaa — 49 Orthene Turf,Tree,&Shrub WP(Acephate)75% 59639-26-ZA ❑loading D IkDumpster 380 Pre-Empt Roach Gel Bail(Imbadopnd)2.15% 3125-525/432-1365 ❑Omer 65 PT Orthene Aerosol(Acephate)1.0% 499-373 - 151 PT Cy-Kick Atut(CyAulhnn)0.1% 499470 Precautions out I0of 70 PT Cy-Kick CS(Cyeuthnn)0.025% 0.05% 0.1% 499304 May cause xeep out of reach pl children and pets. 312 PT Avert Bait Gel Babamectin Bl)0.05% - 499-010 Avoca breath nose throat'orakininitetion. ng ors vapmats.« st ous.Harmful 4w swallowed, 69 PT 563 Plus XLO Aerosol Fhothris)0.5% """ 499-290 Dampen granules to activate. 159 PT TnDie Aerosol Silica Ae 4.8% Donor tamper with roden5olde placomems. ( raged (P30.03 s DO 499-385 Do rot return bat. until after ventilatbn. 121 Suspentl SC(Dellamethnn) ❑0.01% ❑0.03% ❑0.06% 432-7fi3 Do rot touts treatea areas until J, 81 - 81 Tempo Ukra WP(Cylluthrin) 00.025% ❑0.05% 00.1% 3125-482/432-1357 Fwflea tments.remainoffrete areaforaminimumof(our Wummuntll Ep 83 Tempo SCUttra(Cylluthnn)0.025% 125-498/432-13fi3 91 ULBBP 100 ULV(Pynethnns)10% I' —' 9-452/11540-9 Teehnent Cotle(</Ly: C=G1�ck&Ctevice r �� G=Geneal 92 ULD SP 300 ULV(Pyre45 thrins)3.0% 4990/115461 IN Spot BT=Bait OC=Directed�Ixad "B= SP=Space Sh,Bantl N=lnapetign 591 W¢atherblok XT Bait(Brotlifacoum)0.005% 10182-339 69ulpmem Gose l Gp GSys Comp.NrSpreyers-0 =Tap 520 Contrac Blox Bah(Bromatliolorte)O.WS% 1245.5-79 - Bs=Bait Station NG=Nana Duster` =Aemwl So;=Ban Gun PT=Power Treatment F=ULV 0 Pasting Service Sticker? ❑Yea ❑No Supervisor's Comments: JUN 141004 - 7 .SPECIAL SERNCE INSTRUCTIONS CITY BOARD OF HEA TH / �.2% 8�513 l CU To S IGNATUR Z' u NT SE HNIC 'S RE ;- D/P. UNRESOLVED PROBLEMS? C0�1t}'�(�l�. CALL 1-800-TERMINIX(1-800-837-6464) - rt IeTnnnro'c nnov Ott ) C, 5fl IWIER INF ATION �. P� ,TERM/N/X Service Areas-Activity and Conditions Observed This IPM report details where pests were found in and around the facility.The report also lists those steps you can take to help limit or minimize pest invasions.For each of the areas listed below,numbers represent the type of pests found in the area,and letters represent any conditions present that may be contributing to a current,or possibly a future,pest infestation. Interior Areas =. Pests Conditions Food Areas Pests Conditions ❑ Offices �❑ Dining Area ❑ Lobby/Public Areas .❑ Stove/Oven Line r ❑ Entryways Food Storeroom 9 r1V't Cl'Rest/Locker Rooms ❑\Dishwashing Area ❑ Janitor Closets ❑ Deli/Bakery ❑ Laundry ❑ Processing Area ❑ Boiler/Furnace Room r� ❑ Packaging Area Ef Storage Utility ❑ Produce Area ❑ Warehouse ❑ MeaVSeafood Shop ❑ Basement Exterior Areas ❑ Patient Rooms ❑ Exterior Walls-North ❑ ICU ❑ Exterior Walls-South ❑ Linen Storage Rooms ❑ Exterior Walls-East L) Kitchenettes ;y. 7- - — - '❑ Exterior Walls-West- —� Cl NursesStations L dirt Dock ❑ Guest Rooms t1�L ❑ Banquet/Meeting Rooms O DempsterLlExterior Storage Rooms ❑ Display Aisles# ❑ Roof ❑ Other 14 Other L) Other '^ Otheh'`' 1. German Cockroaches 6.Pharaoh Ants 11. Occasional Invaders 16. 2. American Cockroaches 7.Pavement Ants 12. Hunting Spiders 17. Mice 3. Oriental Cockroaches 8.Fire Ants 13. Web-Building Spiders 18. Stored Product Pests 4. Outdoor Cockroaches 9.Argentine Ants 14. Brown Recluse Spiders 19. Other- 5.-Silverfish ther5. Silverfish 10. Ants. 15. Black Widow Spiders ,1 ! 24 Otherir A`.`Drain Clogged/Dirty I. Paper/Litter O. Poor Storage Practices Y. Move Dumpster Away From Bldg. B. Food Debris Under Table J. Water leak R. Repair Water Damaged Wood Z. Dumpster Area Needs Cleaned C. Food Debris On Shelf K. Mops Improperly Stored S. Seal Exterior CrantfcSMgles A7�. M�rcurr��((apor Lights Outside- D. Food Debris Under Appliance L Trash Containers Need Cleaning T. Trim Back Tree/ShrLy Branches BB.Keemrs Closed E. Wet Organic Matter in Cracks . 7. M.Heavy Dust/Dirt Deposits - U. Remove Piles of Debris CkC.Repair Door/Screen F. Grease Deposits on Floorl { )-._ N,'Numerbua Cpa�Oebs Presknn[ V Cut Tall Grass/Weeds , DD.Replace DoorWeatherstripping G ,Grease Deposits on Equipment .c;0. Repair FloorR esM/all/Ceilin j' W-ImpfovlAOOutside Drainage - Ef- Poor Out dgor Sto jT%Practices H`Soiled Dishes Left-Qver ight� P. Seat Holes/Cracks in Walls 4 . Install GraverFounoation Bamer - 'FF. tither I ' Comments i X C u"stoma "Signature Service Professional's Signatu CUSTOMER'S COPY PERSONAL + MONEY ORDER 6975 Fleet ^ N{Bmo �(�' {'' j x {�/'� }— -sued 4Y mfayrmei Por>afl r,sWlJa i En9fowo Ca A,G Ju2lon C o [ , •j�./�\ (_ OrV l i"+V L `X (.�t� PaYa�%µ'of Writs far9n YJa�+k Gram I�fef�nrt oownb .N.A.,Grnntl Juncilo CWorntla:' �=m - t olo"tT't N07 VALID OVER$tppp y JUN 14. 04 —i Date SYI+ICSC. .... . I i 82720 NOTE:THE PURCHASER OF THIS MONEY ORDER AGREES TO INSERT IN INK,THE 't - z PAYEE'S NAME AND ADDRESS, AND ASSUMES ALL RESPONSIBILITY FOR A L - [u PAY EVENTS MADE POSSIBLE BY FAILURE TO DO SO. 4-4****'$49.90- TOTHE ORDEAW-X' a�49 q* 00UI_IAIE28-XRhE[13rt9C? ** �� 4�-_.gp&IABLE NIP IGNAT R`F,l-- OPY �y( ,p $ REE ADDR - v t7 1G1>� f t Y a-- M ! TATDRZIP RETAIN THIS COPY FOR YOUR RECORDS Examination Form No. 780 ' m � Cafti(ica-fe No. —' 3247119 w L� a o. a T4 ANGELA CHEUNG U- for successfully completing the standards set forth by the National Restaurant Association Educational Foundation for the ServSafe Food Protection Manager Certification Examination, which is recognized by the Conference for Food Protection(CFP). Afrseuted tip the National XertauyunrAssaciatlou Educaltonal Foundation. M 11/13/02 N - DATE OF EXAMINATION r M This saros Yom c fwal hea h epa vol 5 years. _ tm, Chadk avfhh yow beat health daparYnera for their SyeciAc requiremems. .y '+ NARY M. ADOLF v PRESIDENT AND CHIEF OPERATING OFFICER NATIONAL RESTAURANT ASSOCIATION National Restaurant Association A r`+ EDUCATIONAL FOUNDATION M EDUCATIONAL FOUNDATION '+ mBamllAWuml�n�6n rdsliyd kaMriX h baro:Atli:tlfetlaUVlsStthimfau9liNlFovtlUul WWW.nraefort r1 03/13/2004 10:18 6173572835 FIKFADV PAGE 01 J To- OS-e— —I aZ Se,le vv% 12v�e iS cvvr- CP k,- = cav e Uo e-9, V VU �Vlt � �taw, Tell -Cve i U�