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CLASSY CHASSIS MOBILES CLASSY CHASSIS MOBILES (5) fr,dough/slush � I UPC 12543 o- No. 53LOFF HASTINGS.NN i i i cd V o � �,.� ��/,� 't �� l r 7 t y.�.� !r/ d i\��/�� ,)t �� d�Q�� ,�. ,�{, .r.r ��, ��p,��l� cy Fq a Tn r ,�'—� . c k* A-- I Date Time 4� 6 W E YOU ERE OUT of v Phone Area Code Numbe, Extension TELEPHONED •IV' PLEASE CALL CALLED TO SEE YOU I I WILL CALLAGAIN I+ WANTS TO SEE YOU URGENT RETURNED YOUR CALL I Opera�f��i' , AMPAD 23-021-200 SETS !/�.[-i �� EFFICIENCY® 23-421-4DOSETS CAH LESS (IMPORTANT MESSAGE ) ` FOR A.M. OATF TIME=-P.M. 1 OF PHONE L✓`_`.r /,4 AREA CODE NUMBER EXTENSION U FAX U MOBII F AREA CODE NUMBER TIME TO CALL TELEPHONED PLEASE CALL CAME TO SEE YDU• WILL CALL AGAIN WANTS TD SEE YOU RUSH _ RETURNED.YO t1R CALL WILL FAX TO YOU MESSAf=F + SIGNE ) - TOPS 1LiF7 FORM 7-4600 '100%RECYCLED `� LITHO IN U.S.A. ( IMPORTANT MESSAGE ) ` FOR OA-VE 3�3 ( -Y c� TIME P.M. SOF / PHONF AREA CODE NUMBER EXTENSION ❑ FAX O MOBN F AREA COUE NUMBER TIME TO CALL TELEPHONED PLEASE CALL f/r CAME TO SEE YOU WILL CALL AGAIN WANTS TO SEE YOU RUSH RETURNED YOUR CALL I WILL FAX TO YOU MESSAGE . /iC/CY-l-t1d Or-t! SIGNED MFORM 4009 O. MACE IN U S A NOTES I 1 - t Date nt Tim-6 WHI YOU WERE OUT M � ��,/�/J D� of Phoneme Area Code mer Extension TELEPHONED LEASE CALL CALLED TO SEE YOU � WI LL CALL AGAIN WANTSTOSEEYOU URGENT RETURNEDYOURCALL Messagg Dc lye, f 6 & f Operato��fj� AMPAD 23-021-200 SETS ��Y EFFICIENCY® 23-421-400 SETS CAR50fkESS v� la.c r 4 t t� 1 To ,(IVt�Yt.�4 Date Time Q �j WHILE YOU U W RE OUT M of Rhone (—] Area Code Nu €xt nsion TELEPHONED PLEASECALC - CALLED TO SEE YOU WILL CALL AGAIN WANTS TO SEE YOU I- I URGENT iRETURNED YOUR CALL I M Message— n reorder 23-700 Operator �• L3 Green Cycle" nranno RECYCLEO PAPER c� IC TO DATE TIME AM jP.` ✓m `r19�7 3,/l5' PM u FROM D AREA CODE NO. OF EXT. E; M <,7,i7 FAX# E qa>c ,, M. S /07 E . " I ISIGNEDvV PHONED I CA ML I SEEVOUO ❑IWAS IN ❑IAGAIN ALL ❑ UP6ENT 1 TO D{{k�TE TIM �++ I,7; FROM AREA CODENO � H 7 O OF EX EXT. E M FAX# S S E n - 0 SIGIW/'I PHONED / I BACK 11I CALLRNED I SEEYOUO Ell WAS IN El I AGAIN ALL UNGENTIII IZ T, l // Oat— -1117h7 Time .3�5 WHILE YOU WERE OUT M 19,qvc.i9 kEFgcA S of t/�NDilj& C'liRr Phone Area Code Number Extension I` TELEPHONED1TURGENT PLEASECALL CALLED TO SEE YOU WILLCALLAGAIN WANTSTOSEEYOU I RETURNED YOUR CALL Messag— -qle 7- �iUS,occ-- >A j- 4:;:1i1JNY' 5)?Ok6- TO s' _' T Dopy TU NES Operator AMPADRB23 1-zoo SETS EFFICIENCY®,5,Vk 23-421-400 SETS CARBONLESS .5!�- i Commonwealth of Massachusetts / e City of Salem Board of Health Kimberley Driscoll t 120 Washington Street,4th Floor Mayor SALEM,MA 01970 MOBILE FOOD PERMIT DATE PRINTED: 01/06/2011 ESTABLISHMENT NAME: Classy Chassis Mobile Food Truck File Number:BHF-2000-000001 5 Maim Street SALEM MA 01970 LOCATED AT: SALEM, MA 01970 Permit Type Permit No. Permit Issued Permit Expires Fee Restrictions/Notes MOBILE FOOD BHP-2011-0313 Jan 6,2011 Dec 31,2011 $210.00 Total Fees: $210.00 PERMIT EXPIRES IDecember3l, 2011 Board of Health Page 1 CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH 120 WASHINGTON STREET,4`FLOOR TEL. (978) 741-1800 KIMBERLEY DRISCOLL FAX(978) 745-0343 MAYOR IDIONNEQ.S.M J-At.COM JANET DIONNE, ACTING HEALTH AGENT APPLICATION FOR A MOBILE FOOD SERVICE PERMIT eF/ee $210,,ppayable to The City of Salem, No Cash Name of Applicant ) /�f9 /QS Tele phone#�`-J'2, M6-, 03 Address 5 v�� .v_ 59�� N�55 vi Certified Food Manager �(Cvv.v Ade ,gloS Certificate # t+ Name of Business �cs5y Cf/gss/S ra� 4oNG Telephone# 1-7��-S/ D� Address Manufacture Frozen Desserts? Yes No v Type of Vehicle Registration# Location of Operation Name & Address 1of Licensed Food Service Establishment Serving as Base of Operation l'o7co — e�T-5 Telephone# 72S-W0 -IWO Location of Toilet & Handwashing Facilities --?ti Menu �a7' Type of refrigeration: Ice Dry Ice G s Other Method for Cooking and/or Hot Holding: Gas Other Method for Sanitizing: Chemical V Hot Water (170 F) I have read and agree to abide by The Salem Board of Health Regulations regarding "Mobile Food Units & Pushcarts" and will notify the Salem Board of Health of any changes in this application. Pursuant to MGL C62C, S49A, I certify under the penalties of perjury that I, to my best knowledge and belief, have filed all State tax returns and paid all State taxes required nder CO3 Z- 4,�'1�7-3 Signature Social Security#or Federal ID# Date ---------------------------------------------------------------------//-- --------------------------------------------- Revised: 8/14/07 Permit# Check#&Date tio / lO ' �aaa�4135�� F +� Commonwealth of:Wassachusetts • + City of Salem Board of health Kimberley Driscoll 120 Washington Street,4th Floor Mayor SALEM,MA 01970 Food/Retail Establishment Permit DATE PRINTED: 08/29/2011 ESTABLISHMENT NAME: Classy Chassis Cart#1 File Number:BHF-2004400100 Kevia Kafalas 5 Malm Avenue SAL—HM ivlA 01970 LOCATED AT: SALEM, MA 01970 Permit Type Permit No. Permit Issued Permit Expires Fee Restrictions/Notes MOBILE FOOD BHP-2011-0590 Aug 29,2011 Dec 31, 2011 $210.00 Outdoor stationary food cart located at The Crows Haven Total Fees: $210.00 U PERMIT EXPIRES [December 31, 2011 Board of Health r 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 Y BOARD OF HEALTH § 120 WASHINGTON STREET,4O.FLOOR TEL. (978) 741-1800 KINIBERLEY DRISCOLL FAx(978) 745-0343 MAYOR lratndinasalem com LARRY RANIDIN,RS/RI31IS,CI10,CP-FS Hi1.u:111 AGISNI' LC�C—,6t 2011 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT >_\ NAME OF ESTABLISHMENT C�CIsCN ( G9,6SFWt t `0CICT'1ns.C-# Q-1FS-qu(o—,S103 ADDRESS OF ESTABLISHMENT 5 Iy\Cl,I N'\ f) v-t-3, FAX# MAILING ADDRESS(if different) C�CLlt m m (:n 0 1 Ci.7 0 04choo,co rvN EMAIL- Business': CI 0. %S c6SSif R'A Cor)CPSSIon Website: OWNER'S NAME I-< -e , I A K c�a.1 a s TEL# ADDRESS 5 `,\e.1 m () VC- sc,,1 r ✓^ B� STREET CITY STATE ZIP CERTIFIED FOOD MANAGER'S NAME(S) IPI (/1 I v C i CERTIFICATE#(S) f�-(4 I J�o U Lt (Required in an establishment where potentially hazardous food is prepared) EMERGENCY RESPONSE PERSON HOME TEL# P DAYS OF OPERATION Monday Tuesday Wednesday Thursday , 1 Friday Saturday i Sunday- HOURS OF OPERATION / / /i ✓ ✓ �� / Please write in time of day. ✓ (/ l/ i �/ (For example l lam-11 pm) TYPE OF ESTABLISHMENT FEE (check onlvl RETAIL STORE YES NO� less than 1000sq.ft. =$70 1000-10,000sq.ft. =$280 more than 10,000sq.ft. =$420 - -------------------- ---------------------------------------------- --- RESTAURANT YES NO less than 25 seats =$140 (Outdoor Stationary Foodart$21 \ 25-99 seats =$280 _J more than 99 seats =$420 - --... - - - - ------------------------------------------------------------------------------------- BED/BREAKFAST/ YES NO $100 CHILDCARESERVICES/NURSING HOME--------- ----------------------------------------------------------------------------- ---------- ADDITIONAL PERMITS MAKE (not just serve) ICE CREAM, YOGURT/SOFT SERVE YES $25 TOBACCO VENDOR YES $135 ALL NON-PROFIT(such as church kitchens) YES $25 *Please pay total with one check payable to the City of Salem. This Permit is not transferable and must be reissued upon change of ownership. The Permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code, before any renovations, improvements,or equipment changes are made,all plans for such must be submitted to and approved by the Salem Board of Health. Pursu to MGL Chapter 52C,Section 49A, I certify under the pains and penalties of perjury that I,to my best knowledge and belief,have filed all state tax recur an aid all state taxes required under the law. P7 ! O ) t7' .I 77 97 Signa ure Date Social Security or Feder Identification Number Updated 523/11 FOODAP201 I adm Check#&Date S 43 Gt t/ r --------------- I Or°�� . .I• �IVBP't�l�'f�'LIVIT 1�\-(1{��„a�'SAC FOR DATE TIMEP.N PHONF 12"1 5 1 LI 0 '017 AREA CODE NUMBER n'EXTENSION AREA CODE NUMBER TIME TO CALL TELEPHONED PLEASE CALL CAME TO SEE YOU j� WILL CALL AGAIN WANTS TO SEE YOU RUSH ' RETURNED YOUR CALL WILL FAX TO YOU ' MESSAGE ^i r SIGNED / 1 ONBVERSAL_ 48005 ADE IN U S.A * NOTFS so Commonwealth of Massachusetts City of Salem Kimberley Driscoll Board of Health Mayor 120 Washington Street,4th Floor SALEM,MA 01970 MOBILE FOOD PERMIT DATE PRINTED: 07/20/2010 ESTABLISHMENT NAME: Classy Chassis Cart#3 File Number:BHF-2004-000102 Kevin Kefalas 5 Mahn Avenue SALEM MA 01970 LOCATED AT: SALEM, MA 01970 Permit Type Permit No. Permit Issued Permit Expires Fee Restrictions/Notes MOBILE FOOD BHP-2010-0477 Jul 20,2010 Dec 31,2010 $210.00 sausage,kielbasa,hotdogs,chips drinks and fresh squeezed lemonade Total Fees: $210.00 PERMIT EXPIRES December 31, 2010 Board of Health Page 1 CITY OF SALEM, MASSACHUSETTS # • BOARD OF HEALTH 120 WASHINGTON STREET,4".FLOOR TEL. (978)741-1800 KIMBERLEY DRISCOLL FAx(978) 745-0343 MAYOR IDIDNNE(MS.ALEN.COM JANET DIONNE, ACTING HEALTH AGENT APPLICATION FOR A MOBILE FOOD SERVICE PERMIT f F e $210 payable to The City of Salem, No Cash Name of Applicant vin) ,� O�Q < Telephone# 97,E- 0(0 - 5Y673 Address --5 ins/m a vG- - �9_�v m yas , 7lt� ,Qv:z- Certified Food Manager Ae vr,v 14C F-f /c s Certificate # y Name of Business G14sSY oSS/s 6on-/& ✓e • Telephone# 9�" 1 s9�3 Address IS? Manufacture Frozen Desserts? Yes No Type of Vehicle 01,,41ee W4 f- Registration# Location of Operation' Name & Addresspf Licensed Food Service Establishment Serving as Base of Operation CeT1c,7,5 Telephone# 979--75-o-/000 Location of Toilet & Handwashing Facilities /�A•��r �_ /�o�e�. / Menu 54 Type of refrigeration: Ice Dry Ice G s Other Method for Cooking and/or Hot Holding: _ Gas Other Method for Sanitizing: Chemical/ Hot Water(170 F) 1 have read and agree to abide by The Salem Board of Health Regulations regarding "Mobile Food Units & Pushcarts" and will notify the Salem Board of Health of any changes in this application. Pursuant to MGL C62C, S49A, I certify under the penalties of perjury that I, to my best knowledge and belief, have filed all State tax returns and paid all State taxes required under law. Signature Social Security#or�edera ID# 2 Date [/,/S_ --------------Z - - LL�-- - ---- ----- - Revised: 8/14/07 Pemut# ✓ Check#&Date / ��l oa-e7eo1 iE�� CITY OF SALEM BOARD OF HEALTH / Establishment Name: C� US�y C�C��SI S C'otr'F � Date: ~/�� b �0 Page: of Nem Cade C-Critical Rem DESCRIPTION OF VIOLATION/PLAN OCORRECTION Date No. Reference R—Red Item Verified PLEASE PRINT CLEARLY r` in� r�.r-lroh ,,- -ttilf n)-okIP -Food e s-fQ_bh4m eAf bw( 1 ( nl n�U J+e a - - - _ 'n<_�r 10 �C a �e rw�VY!� ('c �Y'P Unl cc i l Cr bi ,�_ to k� I f K �7'(A i rfowi fc Ott s -{v 3t)P r ctNo her oe .l Je_ _r) 'n 1 �F,% 3-501.14(C) PHFs Received at Temperatures Violations Related to Foodborne Illness.Interventions and Risk According to Law Cooled to Factors(Items 1-22) (Cont.) 41°F/45°F Within 4 Hours. PROTECTION FROM CHEMICALS 3-501.15 Cooling Methods for PHFs 14 Food or Color Additives 19 PHF Hot and Cold Holding 1 3-501.16(B) Cold PHFs Maintained at or below 3-202.12 Additives* 590.004(F)590.004(F) 4101450 Ft 3-302.14 Protection from Unapproved Additives* ( i-501.16(A) Ho[PHFs Maintained at or above 15 Poisonous or Toxic Substances 7-101.11 Identifying Information-Original ( 1403-501.16(A) � Roasts stc Held at or above 130°F. Containers* 7-102.11 Common Name-Working Containers* 20 I Time as a Public Health Control 1 7-201.11 Separation-Storage* I 3-501.19 Time as a Public Health Control* 1 7-202.11 Restriction-Presence and Use* 1590.004(H) Variance Requirement 7-202.12 Conditions of Use* 7-203.11 Toxic Containers-Prohibitions* I REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-204.11 Sanitizers.Criteria-Chemicals* POPULATIONS(HSP) 7-204.12 Chemicals for Washing Produce,Criteria* 21 3-801.11(A) ( Unpasteurized Pre-packaged Juices and 7-204.14 Diving Agents.Criteria* Beverages with Warning Labels* 7-205.11 Incidental Food Contact,Lubricants* 3-801.11(B) Use of Pasteurized Eels* 1 7-206.11 Restricted Use Pesticides,Criteria* 3-801.11(D) I Raw or Partially Cooked Amoral Food and Raw Seed Sprouts Not Served.* 7-206.12 Rodent Bait Stations* 7-206.13 Tracking Powders,Fest Control and 1 3-801.11(C) Unopened Food Package Not Re-served. " 1 i f Monitoring* CONSUMER ADVISORY TIMEMEMPERATURE 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 3-40i.11A(1)(2) Eggs- 1557 15 Ser. Perogens'*Ems"r . Eggs-Immediate Service 145°Fl5sec* 3-302.13 Pasteurized Eggs Substitute for Raw Shell 3-401.11(A)(2) Comminuted Fish.Meats&Game Eggs* Animals- 155F 15 sec. * 1 3401.11(3)(1)(2) Pork and Beef Roast-130°F 121 min* SPECIAL REQUIREMENTS 3.401.11(A)(2) Ratites,Injected Meats-155°F 15f 590.009(A)-(D) Violations of Section 590.009(A)-(D)in sec.* ! catering, mobile food, temporary and 3-401.1 t(A)(3) Poultry,Wild Game,Stuffed PHFs, residential kitchen operations should be Stuffing Containing Fish,Meat, debited under the appropriate sections Poultry or Ratites-165°F 15 sec.* above if related to foodborne illness 3-401.11(C)(3) Whole-muscle,intact Beef Steaks interventions and risk factors. Other 145°F* 590.009 violations relating to good retail 3-401.12 Raw Animal Foods Cooked in a practices should be debited under#29- Microwave 165`F* I Special Requirements. 3401.11(A)(1)(6) All Other PHFs-145°F 15 sec.* I 1 17 Reheating for Not Holding 1 VIOLATIONS R_LATED TO GOOD RETAIL PRACTICES 3403.11(A)&(D) PHFs 165°F 15 sec.* (Items 2_'1-30) 3.403.11(B) Microwave- 165°F 2 Minute Standing Critical aid non-critical violations,which do not relate to the Time* foodborne illness interventions and risk factors listed above, can be 3-403.11(C) Commercially Processed RTE Food- found in the following sections of the Food Cade and 105 CMR 140°F* 590.000. 3-403.11(E) Remaining Unsliced Portions of Beef 1 Nem Good Retail Practices FC 1 59now i Roactsa. ( 1 23. Management and Personnel FC-2 1 .003 I 1 18 Proper Cooling of PHFs 1 1 24. Food and Food Protection FC-3 .004 1 1 25. Eauitxriem and UterWls FC-4 .005 3-501.14(A) Cooling Cooked PHFs from 140°F to I 1 26. 1 yymer.Plumbino and Waste ' FC-5 .006 70'F Within 2 Hours and From 70'F 1 27. Physical Facility FC-6 .007 1 to 41'F/45'F Within 4 Hours. * 1 28. Poisonous or Toxic Materials FC-7 .008 1 3-501.14B) Cooling PHFs Made From Ambient 1 29. Special Requirements ' 009 1 1 Temperature Ingredients to 41°F/45'F ( 1 30. 1 Other I I Within 4 Hours* 55�(:lamhetS26x *Denies critical item in the federal 1999 Food Code a'105 CMR 590oW. Commonwealth of Massachusetts f City of Salem IGmberley Driscoll Board of Health Mayor 120 Washington Street,4th Floor SALEM,MA 01970 MOBILE FOOD PERMIT DATE PRINTED: 06/10/2010 ESTABLISHMENT NAME: Classy Chassis Cart#2 File Number:BHF-2004-000101 Kevin Kefalas 5 Malm Street SALEM MA 01970 LOCATED AT: SALEM, MA 01970 Permit Type Permit No. Permit Issued Permit Expires Fee Restrictions/Notes FOOD SERVICE BHP-2010-0448 Jun 10,2010 Dec 31,2010 $210.00 Fried dough-french fries-chicken ESTABLISHMENT fingers-fresh squeezed lemonaide- hot apple cider-drinks Total Fees: $210.00 PERMIT EXPIRES December 31, 2010 Board of Health Page 1 I` CITY OF SALEM, MASSACHUSETTS r Y BOARD OF HEALTH 120 WASHINGTON STREET,4"I FLOOR TEL. (978) 741-1800 KIMBERLEY DRISCOLL FAX(978) 745-0343 MAYOR IDIDNNEaMLLM.COM JANET DIONNE, ACTING HEALTH AGENT APPLICATION FOR A MOBILE FOOD SERVICE PERMIT // Fee $210 payable to The City of Salem, No Cash Name of Applicant if�viv� Telephone# 47?- 7-3 Address ;' OhuI," ve brr. 19-71"5-5 YQ�eLa.�w� Certified Food Manager Kevr 5914 s Certificate # Name of Business C/4s5Y cf/455/15 . Telephone# 97y- Address 1 S4 A�..e� Manufacture Frozen Desserts? Yes No Type of Vehiclewa /4e UN w/�fe- Registration# Location of Operation OAl /91460 Name &Address of Licensed Food Service Establishment Serving as Base of _ 978 77fl- ',300 Operation G-57`ca'S - Q7 s Telephone# 97S 0- /aoo Location of Toilet & Handwashing Facilities -Z-1V 11,7,? z�V6/1c til,6��:�s - G//,,cxev/15 -¢ios4i-�eaaa01Ze. .vao% Menu !-lad-',4- �O� Type of refrigeration: Ice !/ Dry Ices Other Method for Cooking and/or Hot Holding:/Gas t Other Method for Sanitizing: Chemical (/ Hot Water(170 F) I have read and agree to abide by The Salem Board of Health Regulations regarding "Mobile Food Units & Pushcarts" and will notify the Salem Board of Health of any changes in this application. Pursuant to MGL C62C, S49A, I certify under the penalties of perjury that I, to my best knowledge and belief, have filed all State tax returns gnd paid all State taxes required under law. Signature Social Security#or ederal ID# Date -� -- --7. 22 j l- c/J5- -`c- - - Revised: 8/14/07 Permit# Check#&Da[e '�-- -/-�- �O w CITY OF SALEM, MASSACHUSETTS a BOARD OF HEALTH 120 WASHINGTON STREET, 4TH FLOOR SALEM, MA 01970 TEL. 978-741-1800 FAX 978-745-0343 JOANNE SCOTT, MPH, RS, CHO Kimberley Driscoll HEALTH AGENT Mayor MOBILE FOOD UNITS & PUSHCARTS REQUIREMENTS These regulations are in accordance with The State Sanitary Code of the Massachusetts Department of Public Health, 105 CMR 590.029. The Board of Health may impose additional requirements to protect against health hazards related to the conduct of the mobile food unit of pushcart and may prohibit the sale of some or all potentially hazardous foods. Therefore the Board of Health reserves the right to make individual determinations on each application. Such determinations will be based on good judgement and sound public health information. FOOD MANAGER CERTIFICATION IS REQUIRED OF ANY UNIT WHICH PREPARES POTENTIALLY HAZARDOUS FOODS. Requirements of All Units All units must comply with the following: • Mobile food units and pushcarts shall operate from a fixed, licensed food establishment and shall report at least daily to such location for all food, supplies and all cleaning, sanitizing and servicing operations. The name and address of that licensed establishment will be required on the application form and will be subject to verification. • All units are required to have and use a food thermometer to check heating and holding temperatures. • All units shall obtain the use of toilet facilities where hand washing is available. All operators shall wash their hands after using toilet facilities and before returning to work. • All operators shall be clean in dress and appearance. • The Mobile Food Service permit shall be prominently displayed on the cart or unit. • All units must have refrigeration available which will maintain all potentially hazardous foods at a temperature of 40 F or lower. • All units must have wiping cloths in sanitizing solution at the concentration recommended by the manufacturer for that purpose. This solution shall be commercially prepared or made fresh daily. A log of the verification of the concentration by test strips shall be maintained and available to inspectors. The name of the owner and/or business and the address shall be displayed, in letters not smaller than three inches in height, on the left and right panels or doors. REQUIREMENTS OF BASIC UNITS: Basic units are limited to the service of hot dogs and/or to the service of wrapped food prepared at a licensed food processing, food service or retail food establishment. REQUIREMENTS OF MODIFIED UNITS: Modified Units may serve pre-cooked sausages, in addition to the items listed under "basic units" if the following additional requirements are met: Modified units shall work from a base of operation which also includes a "unit servicing area" with overhead protection, a location for flushing and drainage of waste liquids, a separate location for water servicing and the loading and unloading of food and supplies. Modified units must have equipment which allows the rapid heating and hot holding of potentially hazardous foods. Modified units shall have a water system supplying hot and cold potable water under pressure in sufficient quantities to allow for washing and sanitizing of all equipment and utensils. • Modified units shall have a three compartment sink large enough to immerse most equipment and utensils. All washing shall be done in detergent water at a temperature of 110 F. Modified units shall sanitize all equipment and utensils by immersion in a sanitizing solution or in water at a temperature of 170 F, or by swabbing with a sanitizing solution twice the strength of that used in immersion. Test strips shall be used to verify the strength of chemical sanitizers- Modified units shall store waste water in a permanently installed retention tank having a capacity of at least 15% larger than the water supply tank. Modified units shall have the waste connection located lower than the water inlet connection. The Board of Health may consider the preparation of raw sausage, chicken or hamburg foods, if the Health Agent determines that such preparation would not jeopardize the Public Health and if there is strict adherence to the preceding and following requirements: Only one such food item may be cooked on a cooking surface, such as a barbecue or grill. No other food, including hot dogs, may be heated or served from that cooking surface. Separate utensils for each item must be used. These foods may not be held longer than one hour before being served. Food thermometers shall be used to be certain that the food is thoroughly cooked to an internal temperature of 940 F throughout. These thermometers must be sanitized after each temperature reading. ReNs 1020M j CITY OF SALEM r f BOARD OF HEALTH / Establishment Name: 0 G S'J C +CA <_ tt c � C'r Date: t; I1 (� I I Page: / of 9 Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date ' No. Reference R—Red Item Verified 2 PLEASE PRINT CLEARLY An I —1?P C4 YI O-P n-\3V,I IP C('ir I 1 r L 0? civ, 1-Ocv_ 3T �",'lc &-)i3 -)I � I /All 1 � � 5 �7 V\ 'I .� � �rJ1 V i+- 'XI1PrYCC I - r � I I � I 1 I C/ ,(U)i Or1n✓t I 1 I `° I Discussion With Person in Charge: Corrective Action Required: I ❑ No I ❑ fes I r 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 it 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. LJ Voluntary Disposal U Other: PHFs Rceivcd at Ternperaoircs Violations Refp,ed to Foudborric ia',-ess!ntorventops and Risk 1 According io I Aw Cooled to factors(-Ifea,s 1-22) (ront.) I 4l'Fl4J"F Within 4 Holtr;. PROTECTION FROM CHEMICALS oolin'.medicyls for PHFs ]4 Food at Color Additives 19 PHF Pat and Cold Holding 3-202.12 Addit'a.s* 3-50 1.l6lB i Cold PH Fa'N''aintainelat or below 3-302.14 Pnlu��lloll from(.�iappr(—Af ndditjve;` i 15 5o()u(),I(F) 11 V45"F- 3-?G2, 'Ant PHFs Maintained at ur:ibove Pc-e�c.ious or Tov'r Substances i I 7-101.11 Identify nit, Ifilctmation,-Ori2inal 140'F Comtahlcn;' 3 01.16(t) Roasts I Icid it or above 130"F 20 Time as a Public Health Control 7-i 02.1 Commou N::-'a. - wort in,- Cxaitaai hers". I 7-2,01.11 sel'alafi,,a- ' ( 3-50: 9 Time a9 a Public Health Contioll " 7-202.11 Rt-trictiort--Piesonc- and I-al: 590. )(14 11) 'vatioucc ReciLitement 7 2iP,12 (701d)tions of t F;e- 7-203.11 Talc Cojltair-�'r- —Il-ohd"'l:Ons" REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-2(g. Sairi'flzev,Criteria-t lielylicals, POPULATIONS(HSP) 7-2(4-! Cfical:cah. for XV4show C,C ritcriO 1-s'01 I I(A) Urpastcui ized Pre-packaggcd Juice;.and 7�2011.1 DryingAseum(:r):e*i,,v Beverages with'Waenirle, I zbels� I lil'.1"imal Fned contict,1-11hrican's' 3 '401.11(B) lige of Pasteurized 1-"Lc� 3-801.11(D) or PatrillYCool:ed Alo-,ial Food and 7-206 11 Rwcoictcd Us, P,,ticidcs.Criteria" k--,x Seed Sprouts Not Served. 7-206.12 f',od,cn! Bait St,wons' 7-20o,13 Tracking P,wdvo,. Pcst Coolroi sod I 1-80L I I('-') Unopened Food Package Not Re-served Mowiorin'.1 CONSUMER ADVISORY TIJAALITEM PER ATURE CONTROLS 22 3-603.11 Consumer Advisory Posted for Consumption of Animal Foods That are Paw.Underoaked or 16 Proper Cooking Temperatures for PH=$ Not Odiermse Processed to Elinuriate 3-40 i.! i A(I ft Eggs- 1'"-F 15 Sr: Pathogens.* 145`FI;t;e'. 3 302.13 Pacteuriztd. FgIgS Sutlstioae Ira Rav, Shell 3-401.11(A)(2) Ccamrnauuted Fi:'h'Aicats.Gauze Eggs: Animals - I�. T 2 5 nec. :: 1.I It B): 1)(11 Fork and Beet R•�ast - 130'F 121 u»,t SPECIAL REQUIREMENTS 3-401A !(A)0) Raines, hijeQted Meals- 155'F 15 t S0 0,09111) f P) Violations of'Soction 590.0n9(A)-(JN)in sec. I catering, mobile food,temporary and 3-401 Pno-,ftrv, il,:1d Game. `:mfiod PHFs, residential kitchen operations should he Sniffing Containing Fish mc:r7 debited under the appropriate sections Poultry 01 Ratite,-165T 15 <ec. a4 above if reaj!ed to foodhorne illness 3-401 11 X);3) haact Beef Steak interventions and risk factors. Other 145,F 590.009 violations relating to good retail 3-40L12 Rios Anh..ial Pool.15 Ccjked in a llracticcs should be debited under #29- Mwwwave 165'F* Special PequireTrients. 3.401,1 bA,,'1)ff)' All Other PHFs- 145T 15 -;ec, 17 Reheating tor Hot Holding VIOLATIONS RrLATEO TO GOOD RETAIL PRACTICES 3403.11(4)&(D) PHT, 165017 jf)set- j (Items 23-30) (E-) Nliciowae- 165° F 2, Minale Standing Critical and viol000nv, .vh!ch do nor relate to the Time" 1'oodborne diness biterientiom and riskpctors listedallm,c, an be 3-403.1 I(C) ("Omni,rciallY Pi(sessed RTE Food found in tile e seri of the fia,d Cod,and 105 CUR 140=F 500.00o. 3403.1 I(I E) Perradnim,L;ialiced Porion;of Beef i Item Good netaff Practices FC 590.000 Roams, I 23. Maraciement and Pprsonnol FC—2 00" 18 Proper Cooling of Ftws I 24 Food and Food Protection FC—3 .004 1 25, �quipment and Utensils FC -4 005 (Asihn2 Cooked FHFs ftom 1-10�17 it, 261 Watta,Flumbinclarld Waste FC—5 .006 3-501 14(A; '7()'FWith!:i) Hours aid Frnn70'F 27 Physical Facifi;y FC—6 -00-7 to—';I'F/45'F W411:n 4 Hours. 2 r3. Poisonous or Toxic Materials F A008 3-S01.14 1 ii) Cooling PHFs Made Front Ambien £9. Special Requirements I .009 Temperature hittredietits in 41'F!4.5 F Within 4 l'0JLJrS* 'edc I ej i Commonwealth of Massachusetts City of Salem Board of Health 120 Washington Street,4th Floor Kimberley Driscoll Mayor SALEM,MA 01970 MOBILE FOOD PERMIT DATE PRINTED: 04/15/2010 ESTABLISHMENT NAME: Classy Chassis Cart#1 File Number:BHF-2004-000100 Kevin Kafalas 5 Mahn Avenue SALEM MA 01970 LOCATED AT: SALEM, MA 01970 Permit Type Permit No. Permit Issued Permit Expires Fee Restrictions/Notes MOBILE FOOD BHP-2010-0402 Apr 15,2010 Dec 31,2010 $210.00 Total Fees: $210.00 PERMIT EXPIRES December 31, 2010 Board of Health / ✓rf) Page 1 CITY OF SALEM, MASSACHUSETTS + r BOARD OF HEALTH 120 WASHINGTON STREET,4:"FLOOR TEL. (978) 741-1800 KIMBERLEY DRISCOLL FAX(978) 745-0343 MAYOR IDIONNE[(�SALF.M.COM JANET DIONNE, ACTING HEALTH AGENT APPLICATION FOR A MOBILE FOOD SERVICE PERMIT / F e $210 payable to The City of Salem, No Cash Name of Applicant I AJ 11c fra �G S Telephone# ? - d '�� 3 Address � ,yrs;1 e-kn 17ve— 44/e m h96S5 Certified Food Manager " Certificate # 5-yy/w/�V rA' l�-Ya lqs Name of Business z lk SsY clas3F15- Ce.4'!Telephone# 97f`Y&4w1' -,5-/c,,1'-3 Address Car rn e-- Manufacture Frozen Desserts? Yes No Type of Vehicle de A;e I/A V_ Registration# Location of Operation moll I.J fro•v7` ot�- Name &Address of Licensed Food Service Establishment Serving as Base of 73W Operation eo5 e. ,-5 — 6J s Telephone# 577S - 7So — /000 y` Location of Toilet & Handwashing Facilities --,,Al /",rd i� Menu 4 v5o-p- -11071Y//f, - e:41- Type of refrigeration: Ice 1- Dry Ice Gas Other Method for Cooking and/or Hot Holding: p�/ asOther Method for Sanitizing: Chemical L,1 Hot Water(170 F) I have read and agree to abide by The Salem Board of Health Regulations regarding "Mobile Food Units & Pushcarts" and will notify the Salem Board of Health of any changes in this application. Pursuant to MGL C62C, S49A, I certify under the penalties of perjury that I, to my best knowledge and belief, have filed all State to/x returns and paid all State taxes required under law. �'�'A" G Signature Social Security#or Federal ID# Dale ------------------------------------03Z---�' =/6 z3.................. ---- ----------------------------- Revised: 8/14/07 Permit# Check#&Date CITY OF SALEM BOARD OF HEALTH / Establishment Name: CaQS�; C�1G�51 t -c��co«t m {rr,llp,r Date: ( +I+ �1 II Page: I of Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN' OF CORRECTION Date No. Reference R-Red Rem verified PLEASE PRINT CLEARLY Tlh 1175�P.r fi.lY� �ql� �Mnh IP ( )vii-f ro Lr 1Ly �clr . n� - C )in"t jq�I ,,IVs cp �n�)foti�� r(,erknoc-- t �GVIrI;"� ,; 1 f�lc)r V , I ! I I v Discussion With Person in Charge: Corrective Action Required: I ❑ No ❑ Yes j I have read this report, have had the opportunity to ask questions and agree to correct all ❑ Voluntary Compliance ❑ Employee Restriction/ I violations before the next inspection, to observe all conditions as described, and to Exclusion ❑ Re-inspection Scheduled ❑ Emergency Suspension comply with all mandates of the Mass/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 Temperatures ` Violations Related to Foodborne Illness interventions and Risk According to Law Cooled to Factors(items 1-22) (Cont.) 41'F)45°F Within 4 Hours. PROTECTION FROM CHEMICALS j j 3-501.15 Cooling Methods for PHFs 14 I Food or Color Additives ( j 19 j PHF Hot and Cold Holding 3-202.12 Additives j 3-501,16(B) Cold PHFs Maintained at or below S90.004(F) 3-302.14 Protection from Unapproved Additives* ' 3-5011 t(A) Hot PHFs Maintained at or above °145°F+ j 15 Poisonous or Toxic Substances . 7-101.11 Identifying Information-Original I 140T. , 3-501.16(A) Roasts Held at or above 130°F, Containers* j 7-102.11 j Cornmon Name-Working Containers* j j 20 j Time as a Public Health Control j 7-201.11 Separation-Storage* j 3-501.19 1 Time as a Public Health Control* j 7-20111 Restriction-Presence and Use* j j 590.004(H) j Variance Requirement � j 7-202.12 Conditions of Use* j 7-203.11 Toxic Containers-Prohibitions* j REQUIREMENTS FOR HIGHLY SUSCEPTIBLE j 7-204.11 j Sanirizers.Criteria-Chemicals* POPULATIONS(HSP) j 7-204.12 + Chemicals for Washing Produce,Criteria* j 21 3-801.1)(A) ( Unpasteurized Pre-packaged Juices and j 7-204.14 j Drying Agents.Criteria* j Bevemees with Warning Labels* j 3-801.I 1(B) Use of Pasteurized Eg£s* j 7-205.11 j Incidental Food Contact, ,Criteria* 13-80L I I('D) I Raw or Partially Cooked Animal Food and j 7-206.11 j Restricted Use Pesticides,Criteria j Raw Seed Sprouts Not Served j 7-206.12 j Rodent Bait Stations* j ( 3-801,11(C) j Unopened Food Package Not Re-served. ' 7-206.13I Tracking Powders,Pest Control and Monitarine CONSUMER ADVISORY TIMEMEMPERATURE CONTROLS 22 3-603.11 Consumer Advisory Posted for Consumption of 16Proper Cooking Temperatures for Animal Foals That are Raw,Undercooked or PRFs i Not Otherwise Processed to Eliminate Paibogens.*Exx.1/11 °1 Eggs-immediate Service 145°Fl5sec* � 3 401.]lA(1}(2) Eggs- F I S Sec. I 3-302.13 Pasteurized Eggs Substitute for Raw Shell 3.401.11(A)(2) Comminuted Fish.Meats&Game Eggs* Animals-155°F 15 sec.* j 3401.11(B)(1)(2) Pork and Beef Roast- 130°F 121 min* SPECIAL REQUIREMENTS 3401.11(A)(2) Ratites,Injected Meats-155°F 15 590.009(A)-(D) Violations of Section 590.009(A)-(D)in sec.* catering, mobile food,temporary and ! 3-40EI I(A)(3) I Poultry,Wild Game,Stuffed PHFs, residential kitchen operations should be Stuffing Containing Fish,A4eat, debited under the appropriate sections Poultry or Ratites-165°F 15 sec.* above if related to foodborne illness 3401.11(C)(3) I 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. j 17 Reheating for Hot Holding j VIOLATIONS R PLATED TO GOOD RETAIL PRACTICES j 340311(A)&(D) PFIR 165OF 15 sec.* j (Items 23-30) 3.403.11(8) Microwave- 165°F 2 Minute Standing ` Critical mrd non-critical violations,which do not relate to the Time* I foodborne illness interventions and risk factors listed above, can be 340311(C) Commercially Processed RTE Food- f found in the following sections of the Food Cade and 105 CMR 140°F* I 590.000. 3-403.11(E) Remaining Unsliced Portions of Beef I i Nem I Good Retail Practices 1 FC590.000 1 Roasts* i 23. 1 Management and Personnel FC-2 --�-003 --- 1 j 18 Proper Cooling of PRFs 124. 1 Foal and Food Protection I FC-3 I .004 j 1 25. 1 Eauinmem and Utensils FC-4 .W5 I 3-501.14(A) Cowling Cooked PHFs front 140°F to 126. Water.Plumbing and W ante FC-5 .008 I 70°F Within 2 Hours and From 70°F i 27. Phvsical Facility FC-6 I .007 to 41°F/45'F Within 4 Hours. * 28. Poisonous or Toxic Materials FC-7 1 .008 1 3-501.14(B) Cooling PHFs Made From Ambient 129. I Special Reouirements I .009 1 Temperature Ingredients to 41017/45°17 ( 1 30. 1 Other I I Within 4 He=* *Denotes critical hent in the federal 1999 Foal Code or 105 CMR 590.000. CITY OF SALEM BOARD OF HEALTH b Establishment Name: CLs SSS) C t� VNS I S Date: Page: -of Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION fie` No. Reference R-Red Item Verified PLEGSE PRINT CLEARLY n - ' N S 4 r_ u t of O }d L � +r %rr3 Tn o � � � � 0v5� 3vtv-' SRIISI'I I i � I Discussion With Person in Charge: Corrective Action Required: I ❑ No ❑ Yes I have read this report, have had the opportunity to ask questions and agree to correct all ❑ Voluntary Compliance ❑ Employee Restriction/ 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 onsuspe sion/revocation of ❑ Embargo ❑ Emergency Closure your food permit. ❑ Voluntary Disposal ❑ Other: s r 51 J4W) PHFs Received an Temperatures Violations Relater!to Foodborne Illness Interventions and Risk � Aaording to iauCooled to Factors(items 1.22) (Cont) 41'F/45`F Within 4 Hums. § PROTECTION FROM CHEMICALS 3-501 15 Cooling 1'tethodi,for PRFs t ' 19 ( PHF Hot and Coid Holding j 14 i Food or Color Additives 3-501.16rtt} Cold PHFs Maintained at or below -20?.12 J Adclitivc0 -- 540 O{k(F t 3-302.14_ I Prixect;on IT0131 7napprmod Addilivec• ( Ilot 75`Y" t I ( - ;gl,ihirl;' 11nti'HP<llaintawedatura�ove 1 15 I poisonous or Toxic Substances 1 140"1: 101.11 khmi ;j'ing Information -Otigma' I6(:',) Roa,t,Held at or at,use 1"i0°F + - - _ ! ZO Time as a Public Health Control � 102,11 Comru„n \amc - N+,r6:^v'+. nutai:,<`n.' i � -- _-- --.- --'{ " I` _ Ting:as a Fubiit' Health Control'__ t 1-2011 1 S<pa:tUon-SA u'aC'' 1.n . 1.a.... _ ._ —!-'-- , . ”— 1 ''rt0"tyt'111 �',.rtin;C 12L'4titit'!IL'ttt '-2i;2.1 ! � l:xstnct:on-Rs:n.c au.: t.,r` 7-20112 I f',,;1d;ii„n:_of se — REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7 'i)033 11 ' T,.xir Contairie,: - Pn+h;h:r+x„'' ! POPULATIONS(HSP) ! 7-204,11 I laniiicert.Ctiic,ia"-lhcriit'plt^ ------ -- F-21 S'1, i i(.''.)tel ttp:"iculic..d Pte-pa.:.a'gcd Anct,mid j all+t,+t Rv,hiYioout_(":i'rii '__' Has,rares with V%arning_I,ah-W ! 7 X04.14 { Dr;ma.As:cotr Cnavts' _ _--- t_—'-�--- --.-__._ ��_.,_ i ' titi: {itis` t" t+i F'a`Ira:izrd im ill-r,:ai l:+x1 1 ,th;,al,a ------- 1 �, -,------ t b,'li i Iii it i,.+t� of i'.',n:ail C14ld Animal F,+t:d'11)(ICtv ! �— - --- --------- !13,LRa: b::d :i;r+nxh 1;. Srrvr,i. ! 7-i:6 � i< , thl2 f,i 't 4:,ti^rP, _. 'I kt i;u'f:BCP Ii;•n :Z, . fCP.ca r 06 L is ,ik:rg Pru,irr• I'`a:'..unt;r# ,,,.,1 .. _.____._._. . "---- — CONSUMER ADVISORY `_;td-' iI ! ^o.^,,:,r.i,•r 't.:":sots i'tnn.'f hyr t'ott tin, i,xi o:-� TIWE/TEMPERATURE CONTROLS i Pn•pei Caokr.,g 7enipei aPurps toe -y � :;' a:. Iti i e65+'i:'o 1itl61nid't' ' 310111 At I r(j, ls'e`. !55'F 1,: j.� - __ �. �_i.. :ii:\fi: } )t;r:,",_i. :'! r�.,= r:t=`kARFMENTS "+.;t •;tit_,,+,t r.dr: --- - - ------ F - .._- .__._.,._._--____.- - ---"_ - =--- - is F" !.ti:"H o: }iiltt.rl )i . 1 -:;4 :i�s;t ., ; R:'n.. i a'ro., !"I”.:U �k” .. .'Rt9,.�'," 1i. I ; 401.11(A) it t r;f 14 t1�':.,r.. 5`ue,i PII!., t :,n' d til:ciun oi:.`t.ainn::`imt'r.1 Si; •+t;d?i•i:i i',m, ii'in_ F4•` J1ec: }'Y;• ORri,'i iliC 1P?tt•!T[l.r,:,' ., , +IJs , . . _ .. ..�_ _ .. . . . . a ... .... . i. 17 iCnNii;.if„_FkJ< +::: "'! Qtefit, 2'1.30) X403.1 i(h) 11t......r... !r.+ 1'? t1:an:•S�aa:lin;c j ✓t,a 'It ?+,, , :u:,:t, '.< ai, rn. ,yra,.L,ir rd: nl{' !..,,,l;r+'n• .1;,. I t N...t 1 lilt n,> .,n,I+t:!.;,v ion:j..q,t in' ., •iltil'..q!•, i'i l^,,,,•.. ., 1`t\�1 ulw' !.t a, %(•• :•(•at, .. 'Iia FOtlfl C L,i<" k!? ,+:n •'iu� i : tram : Good Rcra✓Practices FC _ 5_7t1.6(h^l (g Proper Cooling of PHFS 1 24 F(,'q;r.J;`,o t'rpitrtion c(- '' ._: '104 _ 25 r.nu ,,ini and i)te^SdS� < 4011-':A: S't,dme 6>„kd PH Fr Pn+r, l4'rFi„ ! !-. _ 4_e ".PitIny_ -_ : 70'1' Within , k y3 ,I. 4oda_':.' ':t.a:� .1_,�------- FC, ni_ 13ot=::,+•ir n:,n.% i ! ?; cnR � F;�:'1:1, '�. . t.==!'F;-'SP lc$iva?lire.'. j 28 .1 r'^„ is ni FC, 7 OOr: ._ 701.11,1i, C,n,4n 2 PHF: M9;dc Ff-m Ambient _'i_-_:_�1% F; t,�f f;+•en!c-- - - --- -- - - "`--0118 ! "PcmF+rnll ere ,a�_r.d:eut+ III j _ 3f _ - _- It li�_ . - - -- -- __ dm1 1;':v fora t .a4' City o faSaler, Massachusetts (Fire Department 48 Gaffayette Street oavid'W. cody Tire Prevention Bureau chief Salem, Massachusetts 01970-3695 „ 29 Tort Avenue 978-744-6990 Te1978-744-1235 7e(978-745-7777 de°dy°Satem.com Tax 978-745-4646 Ta.�978-745-9402 VIOLATION NOTICE Kevin Kefalas Monday October 19, 2009 005 Malm Avenue Salem, MA 01970 An inspection of your facility on Saturday October 10, 2009 revealed the violations listed below. ORDER TO COMPLY: Since these conditions are contrary to law, you must correct them upon receipt of this notice.; An inspection to determine compliance with this Notice will be conducted on TO BE DETERMINED at / / If you fail to comply with this notice before the reinspection date listed, you may be liable for the penalties provided for by law for such violations. Violation Code Article Division Page Count 1.04.3 Conditions of Permit 1.04 3 0 0 Violation of Permit Condition. Permit # 090588 (Salem Common Location) Improper Fire Extinguisher on site during inspection. Conditions of Permit. A permit ' shall constitute permission to maintain, store or handle materials, or to conduct processes which produce conditions hazardous to life or property, or to install equipment used in connection with such activities in accordance with the provisions of 527 CMR. Such permission shall not be construed as authority to violate, cancel or set aside any of the provisions of 527 CMR. Said permit shall remain in effect until revoked, or for such period of time specified on the permit. Permits are not transferable and any change in use, operation or tenancy shall require a new permit. RECEIVED OCT 22 2009 10/19/2009 17:35 c . —.- oaLEiJM BOAHU OF HEAUTH Page 1 City ®fSafem, ,Vassachu.sett s Fire Department (Da"dW. Cod 48 Laffayette Street 1' Fire 2'revetttion Bureau Chief Salem, Massachusetts 01970-3695 29 TortAvenue 978-744-6990 Te[978-744-1235 Tet 978-745-7777 dcody@safem.com EaX978-745-4646 'Fax,978-745-9402 VIOLATION NOTICE X r Jr. , Chars R occupant/Owner CC: Chief David Cody Salem Building Inspector Licensing Board Salem Board of Health File 10/19/2009 17:35 Page 2 City, of Safem, JVlassachusetts Fire department 48 Gaffayette Street David W. Cody Eire(Prevention Bureau Chief Safem, W assackusetts 01970-3695 29 Fort Avenue 978-744-6990 7eC978-744-1235 7eC978-745-7777 `Ccody@safemcoin Ear,978-745-4646 `Fax978-745-9402 VIOLATION NOTICE Kevin Kefalas Monday October 19, 2009 005 Malm Avenue Salem, MA 01970 An inspection of your facility on Saturday October 10,- 2009 revealed the violations listed below. ORDER TO COMPLY: Since these conditions are contrary to law, you must correct them upon receipt of this notice. An inspection to determine compliance with this Notice will be conducted on TO BE DETERMINED at If you fail to comply with this notice before the reinspection date listed, you may be liable for the penalties provided for by law for such violations. Violation Code Article Division Page Count 1.04.3 Conditions of Permit 1 .04 3 0 0 Violation of Permit Condition. Permit # 90381 (Fountain Location) Propane storage in excess of permit limit. Conditions of Permit. A permit shall constitute permission to maintain, store or handle materials, or to conduct processes which produce conditions hazardous to life or property, or to install equipment used in connection with such activities in accordance with the provisions of 527 CMR. Such permission shall not be construed as authority to violate, cancel or set aside any of the provisions of 527 CMR. Said permit shall remain in effect until revoked, or for such period of time specified on the permit. Permits are not transferable and any change in use, operation or tenancy shall require a new permit. RECEIVED OCT 2 2 2009 t ,_.:'r! 10/19/2009 17:36 Page 1 City o Safem Massachusetts Fire Department 48 Laffayette Street David W. Cody Fire(Prevention Bureau Chief Salem, Massachusetts 01970-3695 29''ort lvenue 978-744-6990 Te1978-744-1235 7e[978-745-7777 dcody@sakm.com Exc978-745-9402 �'ax 978-745-4646 VIOLATION NOTICE � � x lloran, Jr. , Charles R Inspector Occupant/Owner CC: Chief David Cody Salem Building Inspector Licensing Board Salem Board of Health File 10/19/2009 17:36 Page 2 ( IMPORTANT MESSAGE , FOR DATE7/`TIME P� M � OF PHONE AREA CODE NUMBER EXTENSION U FAX ❑ MOBN F AREA CODE NUMBER TIME TO CALL TELEPHONED PLEASE CALL X CAME TO SEE YOU WILL CALL AGAIN WANTS M SEE YOU RUSH RETURNED YOUR CALL WILL FAX TO YOU p MESSAGE 6 4 LIS C/19 6h.� /I 1 s eaf-�,< , 7 " x rt A',.j j CA ZZliudc. g J U a LT SIGNED YYYYWFORM 4009 MARE IN IJ S.A I NOTES i Commonwealth of Massachusetts City of Salem Board of Health Kimberley Driscoll 120 Washington Street,4th Floor Mayor SALEM,MA 01970 MOBILE FOOD PERMIT DATE PRINTED: 07/27/2009 ESTABLISHMENT NAME: Classy Chassis Cart#3 File Number:BHF-2004-000102 Kevin Kefalas 5 Malm Avenue SALEM MA 01970 LOCATED AT: SALEM, MA 01970 Permit Type Permit No. Permit Issued Permit Expires Fee Restrictions/Notes MOBILE FOOD BHP-2009-0520 Jul 27,2009 Dec 31,2009 $210.00 Hot dog sausage kielbasa chips and drinks Total Fees: $210.00 PERMIT EXPIRES (December 31, 2009 1 Board of Health Page t CITY OF SALEM, MASSACHUSETTS + BOARD OF HEALTH 120 WASHINGTON STREET,4°1 FLOOR TEL. (978) 741-1800 KIIABERLEY DRISCOLL FAX(978) 745-0343 MAYOR IDIONNE(alSAT VM.COD4 JANET DIONNE, ACTING HEALTH AGENT I(� APPLICATION FOR A MOBILE FOOD SERVICE PERMIT �� Fee $210 payable to The City of Salem, No Cash Name of Applicant f c 1//A.) /Ce F9 Xi3 S Telephone# 971-,07YIS71 Address .aaa/ry! �� Sc/srr, �icr s y'grnr/a" Quiz 5-y5//& 041 Certified Food Manager Ta.✓ earp- Certificate # Name of Business <f ssy cf/GsSis te,-,jc.,.�,eTelephone# /fZP- Address < eaaw/, o vE Manufacture Frozen Desserts? Yes No Type of Vehicle /`?5V � Registration# Location of Operation Sa/e.>s, Name & Address of Licensed Food Service Establishment Serving as Base of Operation /'�sfC� "r Telephone# /97F 7S-0- /00 o Location of Toilet & Handwashing Facilities Menu �5 � //,/0/, Type of refrigeration: Ice ZDry Ice Gas Other Method for Cooking and/or Hot Holding:/Gas Other Method for Sanitizing: Chemical ✓ Hot Water(170 F) I have read and agree to abide by The Salem Board of Health Regulations regarding "Mobile Food Units & Pushcarts" and will notify the Salem Board of Health of any changes in this application. Pursuant to MGL C62C, S49A, I certify under the penalties of perjury that I, to my best knowledge and belief, have filed all State tax returns and paid all State taxes required under law. -7- 7- 2047 9 Signature Social Security#or FedeIaltD# Date ----------------- Z - - - - -- - Revised: 8/14/07 Permit# Check#&Date CITY OF SALEM, MASSACHUSETTS r e BOARD OF HEALTH 120 WASHINGTON STREET,4"'FLOOR TEL. (978)741-1800 KINIBERLEY DRISCOLL FAX(978) 745-0343 MAYOR ID10NN1;(@.SALLM.COSI (�( G, �v JANET DIONNE, �Q ACTING HEALTH AGENT XV APPLICATION FOR A MOBILE FOOD SERVICE PERMIT I�// Fee $210 payable to The City of Salem, No Cash Name of Applicant r e v I n/ bf F4 /c S Telephone# 97P-S931-/.1 V Address Certified Food Manager yQReL- c�,, A-xi or.Ai Certificate # Name of Business �/asst' cl%% s/s f�elLo��• Telephone#/-moi -�Sg/ Address Manufacture Frozen Desserts? Yes No� Type of Vehicle /9?? Do as'e t-?Al Registration# Location of Operation CA/e Gem'07 7 i✓ Name & Address of Licensed Food Service Establishment Serving as Base of Operation efosfco' z Telephone#/-9 F- 7S0— /deo Location of Toilet & Handwashing Facilities H4tl,<re- 14-4 Menu Frrs4 i fio.� e 770 l�'/i —� .>�i f%✓PS `�'GC/ic�in/�'i�P S Type of refrigeration: Ice Dry Ice Gas Other Method for Cooking and/or Hot Holding: Gas l/ Other Method for Sanitizing: Chemical � Hot Water(170 F) I have read and agree to abide by The Salem Board of Health Regulations regarding "Mobile Food Units & Pushcarts" and will notify the Salem Board of Health of any changes in this application. Pursuant to MGL C62C, S49A, I certify under the penalties of perjury that I, to my best knowledge and belief, have !filed all State tax returns and paid all State taxes required under law. �Keo, "" �—G� 7--? - `2-10f Signature Social Security#or Federal ID# Date --------------------- Z-3------------------------------------------------------------------ Revised: 8/14/07 Pemut# Check#&Date CITY OF SALEM s r � �I BOARD OF HEALTH t Establishment Name: a��t1 ( Y I(�h�f S W/�] Date: I� IU q Page: I of ) Item Code C-Critical Item DESCRIPTION OF VIOLATION/ PLAN OF CORRECTION " Date No. Reference R-Red Item Ver lflad r PLEASE PRINT CLEARLY/ _�,_/___ - f4ii � )-,�)��r.47i�7 ,R l 4 IS �P� //l 1/�L� -17J�10M ` 1� (WP te /� 7 (i0A J P. !IlJr(Y �YUPS �C`/e C a J 1 -A-rorV_ al A-iime (1P f V1 �F�<�, r r�rh(nn/nl IlncQvr--�,rn� 1 . r• ._, - - s r ' I I K,17 v I � I /� nl�-o(�vv�)1-�� li�c�norfiivt �'>7u�� !� rim._✓/,��n/ Or>vo �v �)/��i�J 1 ' W o.nc /a_A fz' 1t2T -�i nl �a��7o i� - �lo�s ! /�, 7 _/. J r V I Discussion With Person in Charge: Corrective Action Required: ❑ No I ❑ Yes I have read this report, have had the opportunity to ask questions and agree to correct all ❑ voluntary Compliance ❑ Employee Restriction/ y Exclusion r violations before the next inspection, to observe all conditions as described, and to ❑ Re-inspection Scheduled ❑ Emergency Suspension 1t 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: r. 3-501 )4(C') PHFs Reu•rved at Temperatures i !' Violations Related to Foodborne Illness Interventions and Risk ( , Ammoding to law Cowled to 1 Factors(lterns 1.71) (Cont) I -t I'P/45_`F within 4 Haws } F PROTECTION FROM CHEMICALS ( 13-501.15 Conlin M hods for PHFs ' 14 I Food or Color Additives I 119 PHF Hot and 6011 Hofding 3-501 16B) Cold PHFs Maintained at or below 2-262.12_ _Adcbticcst I 5130.00'(Fi 41`/45"P' 3-362.14 Protection from Unapproved Additives` j 3-501.10,A) ilot t'H}-cAfaimainectatnrabove 15 I Poisonous or Toxic Substances I 146'F ' ({)L]1 id<'nu lying lniiamanrn - Pn�Jn't' r.5tAJI)(A) I Rvnsts Held at or ahove 136°F " 1 tl attainer>` ii} ! Time as a Public Health Control r j 162.11 j C,enmon VamC lt,.rki+,„t I , ' cl;: I' ! fim:'a.a 1'ublit;f t;;ahh Cantroh i-_.,(.3.11 Jepa,ataan-SturaE,e' ( '? Yr„rncc u:a Re uirclucnt 0_.11 .'.Nncuon_ �`� j 7-202.12 Cwldni+sr.of 7-209 H 1a;i,.Conrlioael: - 4'roOiM'mn, REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP i 7-204.11 II tianit:zets.Criteria-ch,tnic::,3 c' I — - ----. -t-- -)---- 7-?rJ'1J° 1 Ch.3.ucais f<,r W'a'hie 1':awt:e,L:ntCn1' ( a -'-�iti !i(A1 I u;tp:t:lCuri�::d E'r::-},ni Y.nr',ed Jott-ec:md ' frith li a rniug 3abal5' 7-204 14 6r;inz Ai:enta.C'rw_-i ?05.11 _ ! hn'id'ntai ; 'u r 4;n: or i, v.ill:'G'c)1.zd Anitnst! Fixx3 and 7'2o6 l i� w Pe.ut.,de:.Ctlq•u:' a; Sad?enom e: Sci'aed. i 7-2o6.i2 1 1%.eta:: f>a:i S:aone.' u'd Eexei F,cd;aar tie; Ito- enol. Cotta! ,mit -----tmi` -- - '— --- -- CONSUMER ADVISORY 3 Qil' I Y l'+�L-+tn nGt :\f:`:�S+rt i't3�:rU ('pR.".tltn}'ilUti 0i ilhlElfElrPERATURE CONTROLS 2 k r i :ltez ert Rea. C'nderw t c•d n: 36 I Proper Cooking Tempetatures for t I _ YHFs j i "+1 '�il'vr:;iu r,n,..e;s,'d l:timmn.1te E ! t i ,=tran•..d Ee,c. 5t:ha+a:nv f,.: Raw 5101 ! inuitadatc Sc,:'rr IjS ?-d;11.1LA1', _-. C,:a::, ;nu:",:};:h. 11C. , ci:ntt EQU1RERtENTS i�1_"i ;�titt' -- ---- _. - , ,:.,rY; , i..!Jt;-�t?> .`iC,'liral ;')i i ^_d;11.i1(A)i_•' , k.,':f"\ ItgCa':c ?l:-tir, t i, . ui ; 1 :x`,, m"blk:i<x,d, trtapiaat and Qt!1.1i:"Ai' `> PJ.!ir, 11!!d(i3F q, StnVs;,i!,tI(5 }tui-n!°al i:i(C!l2n O}:'73:1:on,•.hut;id i?c j lan, <.:n tit)ne j 'il�it.. :l. ) , '.)ti .� 7i •t4 .... ,� I:t�i � tiv1 ... .'t. ": .. ::S �.:ri :7^, i.. t.l'G l�i'ine I b417 ', t w .. .._.. _.._._.__. R .n,n er.c .,7 tot 1s„t; ri•.t,z ? c',`t:t.4;%v.. 1y: TO t`:L"'Cq::?FtC T.4tE. Px.1a.Tfi`ES” t"II ',6`'"i !' :c• 1 ?3R'n",d_;-31"1 i dC',ll:Ft3 ".L,:<m at:- it�?" {'.'- :`.]:atcr Biondi s;:. � (%,. . . , .. .i; : .. a. •),. a,.rrn do ,:;r; , ruri r•:, . IiIPC' •.'It<. q., ,•fn.; , , <yj...:i. RV 'i`r, tvli lv`:,' � ,rt'f (a. rtn f+ I .4'1'3 l�i'j i."m•�tas ta!1 1'1 oa.,.aft1'sb ,k+ ... .. .'' .r..:r,) , , ... .� r,,.: , u a:.r t' •I,, .111 irj4U F- 3403 !ill:: _43 `'9::^age7n,.'!a:o rC 1 P�;r•.n'vr:_ _ .. � J •'•� _ 18 Proper Cooling of PHFs ! _"r__ Fo_'n m,r c_xt P_an':uoa _. FC _,<_—OC- �:Fni 311a IJ to'i FC --r ')06 I t 5U1 r'i417 C.x'iaP,Qet}:st PN Pc Pont SO I Fto '-- -- '- -- --`--= - --- -- --- --- -' - -- = "- ! _ 4- .,f, I Prem 1 ) t o S'aa '-FC _ X7_ ( t,:.7;'};'li F1t'!si:in-1 H,n..• ., _ ::f,n-,3<t;: '.,k:,. tsaa:,i;; - --- e`C, 7 r^ 4ol ai:li7 C,a'aw MIR M9;dc Flow,,mfna:i i �-•�`-----4 01:,>, F,__:,.n ,.: t:�----- --- - ---• i Anion 4If-iw LIC#01-09 CITY OF SALEM VENDOR LICENSE NAME : PAULA KEFALAS LOCATION: ESSEX STREET MALL/MUSEUM DATES: APRIL 1, 2009 - MARCH 31, 2010 ITEMS: SAUSAGES, HOT DOGS, KILEBASA, FRIED DOUGH, FRIES, CHICKEN FINGERS, LEMONADE, DRINKS VENDING HOURS ARE FROM 10:00 A.M. - 10:00 P.M. "CONDITIONS ON THIS LICESNE ARE LISTED ON THE BACK" CONDITIONS ON LICESNES: ➢ Vehicles cannot be on Essex Street pedestrian mall near your carts or parked in unauthorized and illegal locations. Any violation of these rules could result in your vehicle being towed and a suspension of your license for as many days deemed appropriate by the Board. Vehicles can only be on mall during setup and breakdown no longer than 45 minutes and no longer than 15 minutes if additional deliveries are made during the day. ➢ Must follow setup and break down times and rules and regulations set forth by Vendor Management/Licensing Board Area/Cart can be no larger than Vendor ordinance for size of cart(4x8) and size of vending area(10xi0)) ➢ No equipment/cart etc. can protrude into flat surface brick walkway at the Fountain location by the side of the plant bed.(or as determined by Building Inspector) Based on Police Department/Vendor Management cannot vend on pedestrian mall on October 31 - Alternative location will be determined by Police Dept./Vendor Management/Licensing Bd. ➢ Cart at the Salem Common is not allowed to be on the Cobblestone. Cart must be moved closer to the fence. All workers must submit a Board of Probation Form and proper ID before being issued a badge to work. VIOLATIONS OF ANY OF THE ABOVE CONDITIONS MAY RESULT IN SUSPENISON OR REVOACTION OF ONE OR ALL OF THE LICENSES. I -LIQ#02-09 s CITY OF SALEM VENDOR LICENSE NAME : PAULA KEFALAS LOCATION: ESSEX STREET MALL/FOUNTAIN DATES: APRIL 1, 2009 - MARCH 31, 2010 ITEMS: SAUSAGES, HOT DOGS, KILEBASA, FRIED DOUGH, FRIES, CHICKEN FINGERS, LEMONADE, DRINKS VENDING HOURS ARE FROM 10:00 A.M. - 10:00 P.M. "CONDITIONS ON THIS LICESNE ARE LISTED ON THE BACK" CONDITIONS ON LICESNES: ➢ Vehicles cannot be on Essex Street pedestrian mall near your carts or parked in unauthorized and illegal locations. Any violation of these rules could result in your vehicle being towed and a suspension of your license for as many days deemed appropriate by the Board. Vehicles can only be on mall during setup and breakdown no longer than 45 minutes and no longer than 15 minutes if additional deliveries are made during the day. ➢ Must follow setup and break down times and rules and regulations set forth by Vendor Management/Licensing Board ➢ Area/Cart can be no larger than Vendor ordinance for size of cart(4x8) and size of vending area (10x10)) ➢ No equipment/cart etc. can protrude into flat surface brick walkway at the Fountain location by the side of the plant bed.(or as determined by Building Inspector) ➢ Based on Police DepartmentfVendor Management cannot vend on pedestrian mall on October 31 - Alternative location will be determined by Police Dept./Vendor Management/Licensing Bd. Cart at the Salem Common is not allowed to be on the Cobblestone. Cart must be moved closer to the fence. ➢ All workers must submit a Board of Probation Form and proper ID before being issued a badge to work. VIOLATIONS OF ANY OF THE ABOVE CONDITIONS MAY RESULT IN SUSPENISON OR REVOACTION OF ONE OR ALL OF THE LICENSES. CITY OF SALEM VENDOR LICENSE NAME : PAULA KEFALAS LOCATION: SALEM COMMON DATES: APRIL 1, 2009 - MARCH 31, 2010 ITEMS: SAUSAGES, HOT DOGS, KILEBASA, FRIED DOUGH, FRIES, CHICKEN FINGERS, LEMONADE, DRINKS VENDING HOURS ARE FROM 10:00 A.M. - 10:00 P.M. "CONDITIONS ON THIS LICESNE ARE LISTED ON THE BACK" CONDITIONS ON LICESNES: ➢ Vehicles cannot be on Essex Street pedestrian mall near your carts or parked in unauthorized and illegal locations. Any violation of these rules could result in your vehicle being towed and a suspension of your license for as many days deemed appropriate by the Board. Vehicles can only be on mall during setup and breakdown no longer than 45 minutes and no longer than 15 minutes if additional deliveries are made during the day. ➢ Must follow setup and break down times and rules and regulations set forth by Vendor Management/Licensing Board Area/Cart can be no larger than Vendor ordinance for size of cart(4x8) and size of vending area (10x 10)) ➢ No equipment/cart etc. can protrude into flat surface brick walkway at the Fountain location by the side of the plant bed.(or as determined by Building Inspector) ➢ Based on Police Department/Vendor Management cannot vend on pedestrian mall on October 31 - Alternative location will be determined by Police Dept./Vendor Management/Licensing Bd. ➢ Cart at the Salem Common is not allowed to be on the Cobblestone. Cart must be moved closer to the fence. ➢ All workers must submit a Board of Probation Foran and proper ID before being issued a badge to work. VIOLATIONS OF ANY OF THE ABOVE CONDITIONS MAY RESULT IN SUSPENISON OR REVOACTION OF ONE OR ALL OF THE LICENSES. I Commonwealth of Massachusetts City of Salem Board of Health Kimberley Driscoll 120 Washington Street,4th Floor Mayor SALEM,MA 01970 MOBILE FOOD PERMIT DATE PRINTED: 06/10/2009 ESTABLISHMENT NAME: Classy Chassis Cart#2 File Number:BHF-2004-000101 Kevin Kefalas 5 Mahn Street SALEM MA 01970 LOCATED AT: SALEM, MA 01970 Permit Type Permit No. Permit Issued Permit Expires Fee Restrictions/Notes MOBILE FOOD BHP-2009-0471 Jun 10,2009 Dec 30,2009 $210.00 Lemonaide Cart Total Fees: $210.00 PERMIT EXPIRES IDecember3O, 2009 Board of Health �Acrloi � Page 1 J CITY OF SALEM, MASSACHUSETTS + BOARD OF HEALTH 120 WASHINGTON STREET,4°1 FLOOR TEL. (978) 741-1800 KIMBERLEY DRISCOLL FAX(978) 745-0343 MAYOR IMANCINI(a7SALEM.COM JANET MANCINI, ACTING HEALTH AGENT 2009 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT NAME OF ESTABLISHMENT G/QSSy G#,XrS1r /�ooQ' Coni TEL# ADDRESS OF ESTABLISHMENT FAX# MAILING ADDRESS(if different) EMAIL-Business': / Website: OWNER'S NAME �i�i�jC v��(� S TEL# ADDRESS STREET / CITY STATE ZIP CERTIFIED FOOD MANAGER'S NAME(S) (7 PJ 2Y O/a Ji4�tW oNP� CERTIFICATE#(S) �ra�1Ya�/�7'7iJ (Required in an establishment where potentially hazardous food is orebared) EMERGENCY RESPONSE PERSON keV1 N /� /�S HOME TEL# J' r/26p "- S7 '- ( DAYS OF OPERATION "'i =.Monday:: :i Tuesday:.::-'I` .Wednesday�'i :',ThuisdaV'='."I'- -Fdday"',- _ i Saturday-. 1 Sunday HOURS OF OPERATION Please write in time of day. (For example 11 am-11 pm) ! TYPE OF ESTABLISHMENT FEE (check only) RETAIL STORE YES NO less than 1000sq.ft. =$70 1000-10,000sq.ft. =$280 more than I0,000sq.ft. =$420 ------------------------------------------------------------------------------------------------------------------------------------------------------------------ RESTAURANT YES NO less than 25 seats =$140 (Outdoor Stationary Food Cart10) 25-99 seats =$280 more than 99 seats =$420 ------------------------------------------------------------------------------------------------------------------------------------------------------------------ BED/BREAKFAST/ YES NO $100 CHILDCARE SERVICES/NURSING HOM-- ----------------------------------------------------------------------------------------------------------------------------- ADDITIONAL. PERMITS MAKE (not just serve) ICE CREAM, YOGURT/SOFT SERVE YES NO $25 TOBACCO VENDOR YES NO $135 ALL NON-PROFIT(such as church kitchens) YES NO $25 *Please pay total with one check payable to the City of Salem. This Permit is not transferable and must be reissued upon change of ownership.The Permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code, before any renovations, improvements,or equipment changes are made,all plans for such must be submitted to and approved by the Salem Board of Health. Pursuant to MGL Chapter 62C,Section 49A, I certify under the pains and penalties of perjury that I,to my best knowledge and belief,have filed all state tax returns and paid all state taxes required under the law. Signature Ian,, , Date ap�i Zoa9 Social Security or Federal Identification Number Revised 424/07 FOODAP2008.adm Check#R.Date ��C) S C32 - Z/-,/, — 7K 73 r}' f CITY OF SALEM � f -0a BOARD OF HEALTH Establishment Name: 0055-, C v cs s5/s --I emoncxdo cc-4,4 Date: df()/C R Page: of t Item Code C-Critical Item DESCRIPTION OF VIOLATION/ PLAN OF CORRECTION Date ty No. Reference R-Red Item Verified tG /n� 11 PLEASE PRINT CLEARLY / i1 I i7 f7(C� —O�P_ VltVlctlYSMA( rla�l1 �T *i'r Ippmo ced-> rcL4f WG_5' I t I -- i ov I dQ vi r t i Le r 44 cc.&,+ ra + aft +me s , I VIt,)Cl,td ,n-� C--) 0lie1 (_Tic)( C" I - k I frit Y`e�t,u,trz✓t�.el,1"� 5 �'� o ��vcr.� c� w.ohr(o �-vac1 e51�/, �hvu�_u�� - I .I '` I �" �c�n�fa a✓f I � I I Discussion With Person in Charge: Corrective Action Required: I ❑ No ❑ Yes I have read this report, have had the opportunity to ask questions and agree to correct all ❑ Voluntary Compliance ❑ Employee Restriction/ violations before the next inspection, to observe all conditions as described, and to Exclusion P ❑ Re-inspection Scheduled ❑ Emergency Suspension comply with all mandates of the Mass/Federal Food Code.:l understand that noncompliance may result in daily fines of twenty-five dollars or suspension/revocation of CD Embargo ❑ Emergency Closure your food permit. � � ❑ Voluntary Disposal ❑ Other: i _- )4((') PIIFs Rec rwd at'Pemperatures Violations Related to Foodborne Illness Interventions and Risk According to Lim Cooled to Factors(Iterile 1-22) {Cont) 4I fi/45'E Within d How's. -501 15 Ctaling A4ethods for PHFS PROTECTION FROM CHEMICALS 19 PHF Hot and Cold Holding 14 Food or Color Additives ' � ?-202 12 Additives 3 5f}' lb(B) ColdPHPs Maintained at or below 590 004(F) 41°/45"F^ ?-302.1) Pn>tecl:nn Iron linappm'%ed Additives' j - - Poisonous or Toxic Substances t 't-5')1.161:1j I Int PFIF"g tifaintamed at or above 7 101.11 i Identifying Intoinannn -Orifi nal140 F t"nnrairier 16},1i Roasts Hcld at or ebot'e 130°F." 7"102.11 : Common anf - 44.,rklr,i; ,aua:nss` _2?} { Time as a Public Health Control --- !� 7 'ULiI ! % P-i—ma+a'—P-u�blic f?;alfh Control, _ 7-202.1! Y.c�tritt:on ,001+Fit ---' V.:can,c Rraelrcfnent ! 7-102.12 C •r,duion.of I T,•* -- 7 203 11 1,-,ic C'umamet: -Prch:hi:ira,.' REOUIREMENTS FOR HIGHLY SUSCEPTIBLE 17-?0.1.11 l.,nitiirls.i'rne :,--clicuti,.*Ic' E POPULATIONS {HSP) 12 ('lwnlicak f;, A't, -._ ( ?1 � '"Sni.i!tA7 � 111p:fcicurfrcd F'r:;-pucF�a_,cd Amts;md I r t bice t'•o;uec. Crifu:a" , + i -- - - ---- 1 kevetaees,l"ith U'aruiap labcic• i 4.7-_Ui 14 Di NinK Arrnec.C'ni.'ria" SUI i IIB; t...of Pa.trunc'd k,el-n" 20511 ' bxid,�rual F:xti Cunta, I,dr.r'anis'—. --- �. Srl,11l ', M h.::,: „r l4utf ulv Gv?1:d Aninrd Fix-.lard ! Cs+tes-,i ..__.__ ! :,r, ._. 8l``tit d ,U'•.`Y:'7 SCI Yt'(1. t t: ^_0613 � 1 �,�6usf r-,, .,.Ir"' 1' . . ..,�,:,. .,n:i r. _. ._i__{ : r�.: rr+tr,I1_a.__ ::;u�ai'_S'_-I-'-`__..+ .�__.- ny---- -- -- -- - — CONSUMER ADVISORY :'anttFt±ry,fi„❑'a -, TIME/1 E MPERATURE CONTROLS r— -- ---'_'---_..._--" --�_- ------ .'v:uF�n Rtrd. t'.a � 16 ! Proper Cookmq Tar:�prramres for _ FHFs :u: O hhrr.;it:'Protens•'t:::,i=Htatnare i " kcs,.rc ,-. i ininwth;Cit p 1 ,5')=1 :e: 'i;? i z i'r..,mt•c•t t c�. ?•:+i»,.;ar :. , Kdw Ssro.11 fit'; N.ii,•'.: .4: :b ij} F1, : -di+Lli, q,. ;t;id• Clu!!C, U1, '- f:aalt'ff!i;li >9tra+. ,y;c. , i6n: kLLw. Lo: ;4+I3.1 i,A),W i 11111- �1-30C .t07.lI:H; +.?iu,s.:+,'.:- ir.. i'; vruns, S .:n•i:nr C,f „ ,,:r;ou cli,Ut .,r. aI .. :i':r=:)t,:.• ar.,.,... . . .. ....r,r. ::'). r5� .!,•<"1:.9( .'it, f'a! :'}.%4$., , (i,f �' f+yn' I•.I l„' _ ;ti].i 1!{} ('in.w,a:t,, iv:'c:. .:il 'CI'}•,.><t , .. , ts:: p, ,t'rr4 . :hr 1ln.tt <.'r.: "d?'L• i}ih: 400 1% ', 4Q 1I(Ei Rr,n.umu_t!-,i,.,.rd Po•uom ofti-r1 Flem Gaol Retail Practices �FC 5317 000 "_ _ _ ._. _ _r 1 3nngrinrrt a_:r: 1H + Proper Coolmnj of PHFs '`f -_ til_t_ and"rrh,sd t'rgi<rna' __-- i,c _- G^-7__ —. t - E ' 5'11 ! I(A) f C n,bnr C:wk=d Ptii"r n.,ui t itrr r ! 25 lsworro.i and Uteosrii _ -_-- -- f -- I , ( f f FC_y -00 P 1'di:m Z +?(,11.l.:ad Froin 71)"I , L:' FC- t'ay5::_a!Fa'�.firy-- r, � CA7 -- --! - - — - - ! a '11-15 ,"#: . r P.:a fn-1 Nnns . :ry .:.,'c!,:n "„r&or T•�xr;:Mz'cr..,'s CT .o0a -_x ? SUI 6?Ilii (-,-i lir,,PHFs.M:,:Ic l:om Amhmnt "Ikra?;-rat,Uel:t,rrd;CW- !< al"ii.x; F ;{: LJihr+ - - -- _ Commonwealth'of Massachusetts e City of Salem Board of Health Kimberley Driscoll 120 Washington Street,4th Floor Mayor SALEM,MA 01970 MOBILE FOOD PERMIT DATE PRINTED: 04/09/2009 ESTABLISHMENT NAME: Classy Chassis Cart#1 File Number:BHF-2004-000100 Kevin Kafalas 5 Mahn Avenue SALEM MA 01970 LOCATED AT: SALEM, MA 01970 Permit Type Permit No. Permit Issued Permit Expires Fee Restrictions/Notes MOBILE FOOD BHP-2009-0436 Apr 9,2009 Dec 31,2009 $210.00 Total Fees: $210.00 PERMIT EXPIRES IDecember3l, 2009 , Board of Health Page t i CITY OF SALEM, MASSACHUSETTS + • BOARD OF HEALTH 120 WASHINGTON STREET,4°'FLOOR TEL. (978) 741-1800 KIMBERLEY DRISCOLL Fax(978) 745-0343 MAYOR IMANCINI a)ISAL EM.CONI JANET MANCINI, ACTING HEALTH AGENT 2009 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT NAME OF ESTABLISHMENT �;/4ssy Gf�Ofs/S f a�d Co✓L TEL# ADDRESS OF ESTABLISHMENT d ve� FAX# MAILING ADDRESS(if different) EMAIL- Business': Website: OWNER'S NAME fCwLr/, ¢ KLcO_ TEL# 703 ADDRESS S JYIc� yJ'7 ave- L19/ � STREET Rel,? CITY STATE ,ZIP CERTIFIED FOOD MANAGER'S NAME(S) -,?AW0A4� CERTIFICATE#(S) (Required in an establishment where potentially haz a rdous food is prepared) EMERGENCY RESPONSE PERSON ( E vt l`efa /,Is HOME TEL# I-DAYS,.OFOPERATIOK `'i . Monday, - Tuesday -i'`[:-Wednesdayl rThuisdav"I:;;I 'Friday Saturday Sunday HOURS OF OPERATION Please write in time of day. (For example 11 am-11 pm) TYPE OF ESTABLISHMENT FEE (check only) RETAIL STORE YES NO less than 1000sq.ft. =$70 1000-10,000sq.ft. =$280 more than 10,000sq.ft. =$420 -------------------------------------------------------------------------------------------------------------------------------------------------------14-,---- RESTAURANT ES NO Tess than 25 seats =$ 0 (Outdoor Stationary Food Ca210) 25-99 seats =$280 more than 99 seats =$420 --------------------Y--ES------NO----------------...----------------------------------------------------------------$---10-------- BED/BREAKFAST/ ES 0 CHILDCARESERVICES/NURSING HOM------------------------------------------------------------------------------------------------------------------------------- ADDITIONAL PERMITS MAKE (not just serve) ICE CREAM, YOGURT/SOFT SERVE YES NO $25 TOBACCO VENDOR YES NO $135 ALL NON-PROFIT(such as church kitchens) YES NO $25 *Please pay total with one check payable to the City of Salem. This Permit is not transferable and must be reissued upon change of ownership.The Permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code, before any renovations, improvements,or equipment changes are made,all plans for such must be submitted to and approved by the Salem Board of Health. Pursuant to MGL Chapter 62C,Section 49A,I certify under the pains and penalties of perjury that I,to my best knowledge and belief,have filed all state tax returns and paid all state taxes required under the law. Signature &Iol L'4� Date .7-C701LJ Social Security or Federal Identification Number Revised 424/07 FOODAP20�adm Check#&Date $ b32 .�/6� '7/�� 4'* Senal Number ''-Year,Month,Nay Past Cut. _,'US Dollars and Cents 1 16080114775 , 5 ; rf`°;`2009-o4-01 019602 5210- 29 -A � � fall to a// - C!" leric} All fid~"//i.45l _peeress U D - From Weress r< Memo e20.tl urvmO a..Ill.' All ell.FM.,reJ ..___ .- ,1,: .'a r.:,�- v'i SEE REVERSE WARNING•NEGOTIABLE ONLY IN,THE U.S.AND POSSESSIONS; coboo0l 160804 7 7 5 3 SIL' - l:::fL:.:J::f........ ::;;:5,:::::::G.._.L-.:..6,�7ii�.-s'^ ce ..........y�^�r ,. Serial Mumber '.Yea!ManN Nay Post O(fise U 5 Oallars anE Cells -.. - 16 0 8 0 4 7 1524 ion=o4-01 019602AX zl5210- 20 v.y AmWtD -11q-NA�RfD /WNUM arvY�,: Clerk Address FromU AOGress;� �' ezooe wme smo.rmxs..r�.uaarm P«..m s_m$EE REVERSE WARNING•NEI ONLY.IN THE U.S:AND POSSESSIONS 's 1:00000800 be Y.6-0804775241I' I I IMP_ ORTANT MESSAGE FO DATE I. v TI E P.M. M � i h OFf - `` PHONk 1 R CODE1 NUMBER EXTENSION ❑ FAX ❑ MOE311 F AREA COOE NUMBER TIME TO CALL TELEPHONED PLEASE CALL V//I CAME TO SEE YOU WILL CALL AGAIN WANTS TO SEE YOU RUSH RETURNED YOUR CALL WILL PAX TO YOU MESSAGE an fk u�amt� 7 n1 Mo y-P of + SIGNED FORM 4009 M%y_sw` MADE IN U.S.A II` III I i i - S3IO I, Examination Form No. 693 Certificate No. 3044548 t• s i I -,•4 a Alk t t 1 TO GERARDO YANNONE for successfully completing the requirements set by the National Restaurant Association Educational Foundation for the ServSafe® Food Protection Manager Certification Examination, which is recognized by the International Food Safety Council. Presented by the National RestaurantAssoclatton Educational Foundation 1 5/22/02 DATE OF EXAMINATION This ServSafe certification Is valid for 5 years. Check with your local health department for their specific requirements. r ELLEN MOORE, FMP SENIOR VICE PRESIDENT LEARNING AND CERTIFICATION DIVISION National Restaurant Association ®ueua�fl„eu�mam �aara� EDUCATIONAL FOUNDATION a 2000 final l eslaMA9s Man Humlional F000140 00031501 10107 www nraef,Org , -� scare Vit Y � Rutkowski, of Ziggy's Donuts, took on Manager Certification Exam on ' ;ate has been added to our file, and the 'the establishment with their food 4o°I sa�F L V—r P.O.Box t B0446 Botilen,MA 02118 1617)44S-1647 Fox 427.7890 n C9 O1'S u>."t�2 Gerardo lannone 32 Francis St.#2 -Revere, MA 02151 I r April 8,2009 APR 09?009 9?0009 Ij Dear Gerardo: j This is to confirm that you have attended the ServSafe Manager-Certification Food protection class and taken the certification exam on April 1,2009. Results from the exams will be available in approximately 2-3 weeks. 1f you have any questions,please feet free to contact me at(617)445-1647. Sincerely, Af� C: 44 . L #�d✓at f+� Cynthia L.Parentenu,CFSP Student Detail Page 1 of 2 SEARCH � Il Goll HOME CHECK EXAM RESULTS ACCESS ONLINE COURSE/EXAM PURCHASE MATERIALS Ii_Q ACCESS MY ACCOUNT CUSTOMER CARE/HELP I Certification Support I Find a class or Instructor/Proctor I Regulatory Requirements Hello G.Iannone Examinee Score Analysis Report - Detail Disclaimer: This Exam Score Report may not be considered appropriate documentation to meet regulatory requirements. Certificate Information by Exam If you passed the ServSafe Food Protection Manager Certification Examination,the ServSafe Alcohol Primary(Print only)or ServSafe Alcohol Advanced Exam,you will receive a Certificate from your Proctor or the person designated to distribute exam results. If you passed the ServSafe Alcohol Primary(Online Exam),you will receive a Certificate at the address you indicated on your Exam Registration Form. For these Exams,you can order a duplicate copy of your original Certificate. If you passed the ServSafe Starters Employee Online Course Assessment,you can print and re-print your Certificate of Completion from this Website. Course erv5afe o otection Manager Certification Examination tudent:GERARDO A IANNONE I s Tracking Report Class Informa Ion Class Organization Instructor Exam Exam Type of Hold Cert. Pass Number Name Location Date Training Code Number /Fail 739965 Berger Food Safety CYNTHIA 4/7/2009 Classroom 6396423 Passed Consulting PARENTEAU Form Information Test Pass Your Form Percent Percent Score Score 4436 75% 76% Domain Summary Domain %Score I. Foods 74% II. Clean/Sanitize/Maint. 67% III. Facilities 71% IV. Monitoring Food Personnel 92% V.Temp. Measuring Devices 50% VI. Allergens 100% VII. High-Risk Populations 100% VIII. Legal/Regulatory Issues 50% IX. Facility Layout/Design 100% http://www.servsafe.com/irc/classes/Student_Detail.aspx 4/17/2009 CITY OF SALEM i ,.,�(( •• BOARD OF HEALTH ) Establishment Name: CAQ5i I.VIC(5C1 5 Date: L4 I /O�f Page: of Item Code C–Critical Item DESCRIPTION OF VIOLATION/ PLAN OF CORRECTION Date No.'� Reference R–Red Item 'Verified PLEASE PRINT CLEARLY I 11 t_fPc( (4H rj n vt+ - C,D T A' Y)-)C',u h, l <,' ,��Q - nCc- t � pd. . I cell h-,i ha 15su � ot, 1 I I „ �f�n��Ler cllQPitc�C VYYYY ��Yl Csv� C3nt4C- '+G( i5 C of CtYW I �01ftA_ -rAAC4 o�11P c1a f1 1 7 I U ' crn(i�iAl cc/1 1 z I y I I 1 ' f Discussion With Person in Charge: Corrective Action Required: I ❑ No I ❑ Yes — — / I have read this report, have had the opportunity to ask quest ❑ Voluntary Compliance ❑ Employee Restrictions-and agree to correct all Exclusion violations before the next inspection, to observe all conpions(as'described, and to ❑ Re-inspection Scheduled ❑ Emergency Suspension comply with all mandates of the Mass/Federal Food Code..kunde jand that noncompliance may result in daily fines of twenty-fiv"'e�ollars or/suspension revocation of ❑ Embargo ❑ Emergency Closure your food permit. ❑ Voluntary Disposal ❑ other: Violations Related to Foodborne 111ross Interventions end RiSk Factors{Items 142) (Cont.) 4 l,1,-k5'i- Wtihir, Hours PSOTFC'nON FROM CHEMICALS 1 19 FkHF('tot and Cold Holding 14 Food or Color Additives r:o3;I FHY,;Moiou,u;ii at or Nftv froni linar-pm-ml Additiv-,!" I 1 3, f0l j64,,,�! I not 111Wt Mams awtj t or ailove Polsotmus or Toxic Suostonces, -nil "li,A, flkstst.,Haiti aiw a4ove l3W1,, 7-102A I 20 Time as a Puocc Health Control FkIhfic H�altl,C-nioul 7-201.11 Srrkar_tuon- ? Ilw.t i - n,uld 1 0 7-2€);.k? Cundmork,of Usc� 7 ?0 I I 5;xic Container; - Vrohihi,,wo„" REQUIREMENTS FOR HIGHLY SUSCEPTIBLE I I POPULATfONS(HSP) 21 -N)1 i tN) of%::ii.uri.,ed T1r-_-p,wj u,_,cd and 0woucaft,foo 11 oduce 7 104 14 Di:inttA4uiu,Criserial - _ Pate,In 4�d F�,, 091 In4,-j&'8jjj J'.�aj Gunnar.'. I k;tIril'ant" tB, - I it 1) Ka,b ,r P,,aiinfl; C("k.o nto �Nvkmal Ii did 7 oa.(I Rt,irktt,>d Pt,[ictde�, G imna, 7 vFi.1I. 3 Roilew fs,61 stall,qr., i-901.1 I(Q pkk�k.wc N,,t Rc-st ned, 7 M6 1 1 r.wk I ng flou dv P:r t(lktotrd and CONSUMER ADVISORY 2, r p0slj 1?nr Voilikinifition of IIME/TEMPERATURE CONTROLS 1jb Proper Cooking Temperatures tot I PHFs i t Not 0d-t:rvA,,-Pruvosed to Eltrn;nwr 3 401.1 IA{h(__,. E hl,D- 155°c 15 S,,<, I Fe( -Inllwamlc sr:,:tk,v i 14^F 15te,:, ft;l R)tWSL,fl 74Tl I!A)(2 1 &irana Po.I l SPECIAL REQUIREMENTS fiteL,01 oiiicV1013i '0,or Section 1 ',90.;)09(A)-(Din401,11iA) 2) I R � luicoiA 1�5 FIS ) cdwrim*, ni.4,th, lun,,-,porwi :wd Iroultr" snoitt'!PHF,�, 00:Qn shoidd tic soffi,w0vallim" hhl Mew— kindcr Ilw appropirlate Cekttk)iks It alwvt; i" lkaiiws-165"T' �Cfxod I)io"."iborm: dbw!ac �i Sn I I I roa.,Ae. fniact tievf slcakF iww!vention¢ vol r;,!" fijctnrs Otbccr t iYT, 5,}i 00V vlofafikal<rclitiirlr to ilooj rctull ;.401.1'-' k"A'Atnfllti COOKcd 11'a praoici,a 'hoold he under #29 - I tigicro.='air 10 F SpI:iaJ '4WA J(A)f Yb! All OThin Pfff' 1-15'r I 17 1 Reheating lot Not Holding VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 3.403.1!(A)&tIo N tl t65'F 1''C', ', (item:,23,,,10) 4;73,1 t(6) Micov.ik 2 Nimule Suindim, 4 Cr r",+ 16e vio!"poln. 'tbuh do Isol reive v,ow o)K.,A jdi fimC li,%wd ahtn;(, ton(.a, 1 1-z)3.! 1(c) Ctaronm mlfv prvri,,,,:J PIE ixki- 3 f,ma'n, o-coop'. qI dw Fowl foc,,zpd Yd C.WR (Mar -16oaa dl too ta it- -om�_ T F& -0-0-0 3-41;3 i I(F) Reprajoov^ Ln�;I.uj oi if,x! �--- -y- —- 1 23 Kfilnatiainerl and pef„onro! PC 003 2.} �A lv!�!'Ood PrIlention j-C -:3 V)4 18 PrWam Cooling of PHFs I -I, OleI, -mls FC I A-"(!( 14(A) 14017tv Walw,14,fnbinq PC,- �----�- 0-` -4 - - ) . We 7JI;wilbin 2 Hour;, :p'l Froln 701 P, Fx,:,Iiv FC-s 007 to 4 1'F,1&15', Within J Hono, I il"isonjus o! 1xv:Mate"als PC 008 I'oclivj['11F,Mad, (--I, ink P.�qti Iernw, -'t0_. Other lowS, M Ckl% �A CITY OF SALEM BOARD OF HEALTH Establishment Name: ( lcts�y Gkcr�515 Date: Page: Of Item„ Code C-critical nem DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date I No. Reference R-Red Item - _ Verified .y. i"'. PLEASE PRINT CLEARLY " / 1 An r�)� inm ►h�n�_c�i�n �' ilc vr� b IP Uvi 7 ( Sctvxe�C I C,rsf�✓II 1 . x-a s rriv%� U C'fE� - rtf.rR . -F-to(f owl)J I1 4;=4 I vrVe'( P] Cf l ov„��7tefet5 0 io (P _F( C Cc.r+ 1 I F)C>e,, U44 5 1 `�e.r�l5a-fie cf�P1 • ':;-e_r.1r4nfc�1r� nn( lCtl_ ( r/t I"�Y5 ht ��F �,� xy�CI to IAct I F)( li!(W � - IAtiJ -)-PLLC f)QnA 1 IPQ M) VnV,,) N3'\ Y 1 h7 01 I ,a ,7 to G1ocd C[h pvv✓t+ 5 y 44C( 0 A-PrirC;1 --por :: tj vlr�o �u,rl V�Ei _0 r)r,r rf" '�f I O� nvv IS�YAP�. I >>` Y u( vPVVLQYI�S �'o C)OeYt Vnv--e bf, ri 5atf -),-( e(4 - PO-erpU[ 1 O. - 1 i i �� Crvt��ari nfl 1 ! r Discussion With Person in Charge: Corrective Action Required: I ❑ No I ❑ Yes I have read this report, have had the opportunity to ask questions and agree to correct all ❑ Voluntary Compliance ❑ Employee Restriction/ Exclusion violations before the next inspection, to observe all conditions as.described, and to Ll Re-inspection Scheduled ❑ Emergency Suspension comply with all mandates of the Mass/Federal Food Code. l,understand that noncompliance may result in daily fines of twenty-five dollars or susp�ension/revocation of C1Embargo ❑ Emergency Closure your food permit. i y ❑ Voluntary Disposal ❑ Other: Vlobtions Rollatiecif to Foodbarno liftless tniervantrons and Risk F,actars(Ifem 1-22) (Cont) i I Flp5 F Willi ill J H i tul S, PROTECTION FROM CHEMICALS 14 I Fcicrd or Color Additives 19 PHIF Hot and Cold Holding -1-202,12 Prole"t'llf) froal Umlpprtivu Addizk,i,.' ji,tj 531 "t'jintji;,ed;jt Ilf is J Poisonous or Toxic Subtlutrunril !40 l'ifollm,q)p Onlfi,,l I l0l.V,1,1 .11heve 'Time as a pubDC Health Control If): I I C,>miwn N'nme - 1`,Ilrilttw,I',,w.im,,r,' at 7.202. of PEOWREMENTS FOR HIGHLY SUSCEPTIBLE P t I(Al 2 1 Chl:lllic.11s iot"Na'-flung Prod,tcc,if,jilel� -04 BcV,1ees'kill, %ii3rililig ? '04 14 Drain:: liccliw.Urjwri;t` -nl9,l I "I;kll iid)l RaV,or Nuu.til,Cl ol<Vd A;iiml [Alid ild ('11temn ilu I.0:'Q CONSUMER ADVISORY TIMFiTEMPERATURE CONTROLS 2 3 i: 11 1 klr I"Insmillition of 16 Proper Cooking Teroperaturos lot 4 t Ilai'm k:ndt.ra,)ked(11 aoi tritli're:i^'l. 1.1,110flare PHFs '10 1 1 t 5:,F 15 `ill0l I rg�s- Imai,tliaw Set,!,v 145'1'15tt l-orrimmili'd Fish '%teltt�& (,.1141 rlotl, bV0 0�l, 12i SPECIAL REQUIREMENTS Villi of Sucilcil (DI ill racljms, mobil'. lito'l. IcOlPiXaVY and 111"altr", 'A lilt(,aw�, VIU11'ed PHF�i, 34M.1 I(Avlli op,,Y.;tiov,,Aiould be k twl�,ilcd vn'iei late P'llItl v,lr lr, t5l,:Ialvd tiololAborlik. ittliost, lilmo ll,'.11f SIL,;IkS V E ;vIt"i vo:jtolls awl o7 fact VES. Win I �,QlujicN vlltja�ikrns relatkno to„(lixl retail Ili Pit% Animal Fkgui,C%W.Led .11,1 hhlkild he Ql.NtCd W-IdN #29 j 1Q ii:1+lavit5 t' 16i'f- I "AOLWA)(1)(bi All Otho PHF( - Illi'll 15 17 Reheating for Hot Holding i VIOLATIONS RELATED TO GOOD RETAX PRACTICES 1-103.1 I(A)&ffl) fllfft: 10517 1 i tc, I (Itenis 23-300 j 4o l.i I(B) MiocotvaLi- it,51`2 Suml;lig •v,d llhirIl dowi, �,414re,;Il 01" Tirri'l !ilodh!'riw Pbz�'S, illfz i rrkiii(te, (an br L402.1 ttCi comw, r :22h ri ozz�,,j RT� FiI Ki f,-:4rd�'lz!ht I, C,-ri t� P ol"',CoJ4"l,ld JlV�, C-Ilp '-40 1!:F) Reonawint"U!�,Iii:ed Potl� -_1___T--- _ ---- Ii— -- ,Igo --- tons Of(tut,f nem Good Pitraii pftrcth�ls I C 5 vw koj�[:t 23 and i F1, -,2 002 ig Proper Cooling at PHFs i tilt Fo,)d,zi,ld�cxx.l Prolv,:tlor FC 'I _094 110ji".1111m ilrld Uat!.;i!s t=.^ - 4 OU, Coohlig(:�Xtk_d PHFS trilti, I W-1 ilvatilt,�fi,muiriq anrj'Nti�',e FC-5 00b YO'J'willhin ' H(ivr�;:ld '1+11 1 0"7 _4 w 4 CY145 P Within, How 2e T,)xjc l;jzl!ej3ij I PC- 1, 00b + Wiiiiii PHF> Nlade Fi•),m Ambioilt I rt;qvfal, a,,it 41 T'•t.i 'm higfedict lj�l,4f'-5(11)11110, City of Salem,Wassachusetts Tire Department 48 Laffayette Street David'W. Cody 'Fire(Prevention Bureau Chi Safem, 94assachusetts 01970-3695 29 PortAvenue 978-744-6990 Te[978-744-1235 'Tet978-745-7777 dcodyosalem.com Ta.X978-745-4646 'F4,.978-745-9402 VIOLATION NOTICE Classy Chasis Monday October 20, 2008 8asex Street Salem, MA 01970 An inspection of your facility on Saturday October 18, 2008 revealed the violations listed below. ORDER TO COMPLY: Since these conditions are contrary to law, you must correct them upon receipt of this notice. An inspection to determine compliance with this Notice will be conducted on ( TO BE DETERMINED ) at / / If you fail to comply with this notice before the reinspection date listed, you may be liable for the penalties provided for by law for such violations. Violation Code Article Division Page Count 1.04.3 Conditions of Permit 1.04 3 0 0 Essex Street @ PEM Location VIOLATIONS OF CONDITIONS OF PERMIT OVER THE LIMIT OF APPROVED PROPANE ON SCENE IMPROPER TYPE OF FIRE EXTINGUISHERS * EXPIRED PERMIT DISPLAYED ON 1 OF 2 CARTS WAS NOT ISSUED TO THE OPERATING COMPANY Essex Street @ Fountain Location VIOLATION OF CONDITIONS OF PERMIT OVER THE LIMIT OF APPROVED PROPANE ON SCENE IMPROPER TYPE OF FIRE EXTINGUISHERS Salem Common Location VIOLATION OF CONDITION OF PERMIT NO PERMIT PRESENT ON SCENE Conditions of Permit. A permit shall constitute permission to maintain, store 10/20/2008 12:00 Page 1 n �. city of`,Safem, 9Yassachusetts Fire Department Wismi 48 Laffayette Street �navrd 4N. Cody Salem, Massachusetts 01970-3695 Fire� ort Non Bureau Chef 299 T�'ortAvenue 978-744-6990 Te1978-744-1235 2e[978-745-7777 dcody®safem.com T'ax978-745-4646 Tax.978-745-9402 VIOLATION NOTICE Classy Chasis Muday October 20, 2008 Eases Street Salem, MR 01970 or handle materials, or to conduct processes which produce conditions hazardous to life or property, or to install equipment used in connection with such activities in accordance with the provisions of 527 CMR. Such permission shall not be construed as authority to violate, cancel or set aside any of the provisions of 527 CMR. Said permit shall remain in effect until revoked, or for such period of time specified on the permit. Permits are not transferable and any change in use, operation or tenancy shall require a new permit. lz� x Rolloren, Jr. , Charles R Inspector occupant/owner CC: David Cody, Fire Chief Licensing Board Board of health Special Events Coordinator File 10/20/2008 12:00 Page 2 f t CITY OF SALEM r BOARD OF HEALTH Establishment Name: 0 VA S+ 6 Date: "1 la-(n S Page: of � - I! nem Code C-Critical Item DESCRIPTION OF VIOLATION!PLAN OF CORRECTION oate No. Reference R-Red Item Verified __ __ _ - - - -_ - _ - PI EASE PRrNT CI EARLY -_ - . -- _ - _- �Sr'A\1-44\ tn\ C.ANn:1 — - — � I j i I 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 I ED Voluntary Compliance ❑ Employee Restriction/ 's violations before the next inspection, to observe all conditions as described, and to Exclusion ❑ Re-inspection Scheduled ❑ Emergency Suspension comply with all mandates of the Mass/Federal Food Code. I understand that } noncompliance may result in daily fines of twenty-five dollars or suspension/revocation of ❑ Embargo ❑ Emergency closure your food permit. y?r� t J ❑ voluntary Disposal ❑ other: i 1"(,,i PI IFS R,cxiNt:-d it'I"Inf.xlvalure-, Violations Related to Foodborne 111i"irs Intfmventrons and Risk Ctr*!dio Factors{hems I-V) (Cont; i S I T'/45°F Witbn<i Homs t Cooliwa Ni'Lhod"for PHFN PROTECTION FROM CHEMICALS 19 PHF Hat and Gotd Holding 14 Food or Cola:Additives, x_5+1' ot(til Cold PHFS Man't,olied at(w")cIc, 5Wj 00' f- 4CW' F^ fr(all tlnoppr,,,ed Atfm',C,,' 15 Poisonous or Toxic Substances It)I.I 1 1,!c,)a i m Ii L Ird"'I trial;"ri -C at"';it a I 4tu'F, '>-5o Huldat orlbokc I:lll 1 20 Time as a Public Hoafth Control Nanw Cowarae.Z,' I as a Pubiti;Itcath":"tarol varlme Ri�quo�lmslt lf�,,tiicoon -F,t',�.PX la;d condto,)r,of tl�:kt, 7.20,1 11 I'mic Contaimi,-Probibi waw" REOUlREMENTS FOR HIGHLY SUSCEPTIBLE -204.11 crocria- POPULAT!ONS(HSP) ",,No' lItAl i:op:,,ivnr/vd Prc-pad-ited Juice,,,.u:<1 7-21P,12 Ctwlnn,ai�� u',,:hlnl; 61tia- 7 �04.14 Dvinal ilotcrv,.Cr!m ntl xi�tams whk Warnow 1,abals, -8(jj.11 jB L ka pi,tela j,fj FtQ, 7 20'A 1 In,i&nofl I wlj I Oil awils' 3.hCl.1 i(P) R,ov,•r Faxd inal ?-206�11 Ro'n,icl�,!Uw pc�ticviei; C I lan in' 7-2()6.I'l Tlojiolz Lett Jiw'� Sited Sjtrllkn�Nt 7 206 13 ita,puwdt�r,� Pt -tar"',;in", 1-ili�1.1 f IQ i!Illop,rred FXd PaLk:lge N'11 Rc-in,ne.+ Nlon i I ori nCONSUMER ADVISORY TIMEITEMPERATURE CONTROLS 22 3 0)� I I Cofisviiplf Ao,rSory p4md 1")r Collininotion(if Ii 16 Proper Cooking Tempetatures!or Anvil'a .ia: Raw, Undef,�oLdt;; Not llr��csiicit to Flinall'a. PHFs V� 1 3-4011 i Nk I if i.iaz, I 51-'1,F S�, Pathogens.` F 13 flvwka iz;:d 1:�.Substolav tui Rav, Sh�![T -lilflwd��ue i 45 T'5,e� commiliwee,Fi�h� *",Ieuts r 11 * UIRW ;-40(A 1,B)i I tr,�; SPECIAL REGUIREMENTS pqt� "val flee, Ruag ,"WP 121 rain, 90,i)(lofAI-ll)) Vio�aijow� ;I-Secbon �1)0 )9f }-(D)it, 3-40 1.11 Raqoec, biwr!cd'Wat, i�%S F I C 1 , *aafri-ig. mobir. It.41c,lemporas ajid ?.401,11!A ifi Poultr}4;,ild fiaoic, i PHRq, orl'vrt;nns shonld he r u ,tinlatrw pi, N %li, kbacd under Thc appropriate se-,Liao YOuhtYot J(Uotr� 4_j 6'4"� i ifmated it)ftriidNwric ilil^� 3-401.1'tCn nalkC1 jnaei tcnfloos aaid risk f.iclors. Oih,-r 5", )OC) viokit;um trtialin" it, tcrnl reti6! 3-401.12 Ra"v Aranial Fo4,CiKjk�d al c jrractices Awilld lie d0)iwN1 under 629 - sp"'ecd ?401 INA)(11th) ml Ctll,ei PHF�- 3-15=F !,i Lc 17 Retreating lot Hat Holding VIOLATIONS RELATED TO GOOD RETAIL PRACTICES I i A)&{I)) T P[&, I(IS1 (Metric 23-,3(S) lW3.1 Kit) ',Imaw SLqndvi,,, Giiftalaild no.1,fin"id vwkawns. -htth,1f,no; relax, I't III It 1 I'm inn'?t,Id"'wandI riA jin,Parc t,iq be 3-403.1 J iC) RIIAoird- lining at 11a, "I nin, f ovil CozL, rnd 105 Crtf 140,F 3-403 1 I'f) Raldolllk" Ll�z LiW and Peronrifl FG -2 18 Proper Cooling'of PHFS 1 24 Foodand Ftxsl Prolkflion RC_,i �004. 25 Eq 3 501 J4fA} PHF- 146-1: oqjrnant and tnc-rl3;1a FC-4 wk, 701-Wi:h*" Horn,.o,! Frear IT'' 1 27, Phvs,,Ii; FC-6 M? t-41 i=ss F)iVition 1 26pmIonous or Tow tittztwialss F . ..... .-� -- . -.-- --7— ,--I- ----: 3-501 "B) Ciofiutz 'HF, Mode Romkrithcni 1 2n +—r 00 ooft it,41-F1"I3 1, L Cather Within-1 i Commonwealth of Massachusetts s e City of Salem Board of Health Kmberiey Driscoll 120 Washington Street,4th Floor Mayor SALEM,MA 01970 MOBILE FOOD PERMIT DATE PRINTED: 07/10/2008 ESTABLISHMENT NAME: Classy Chassis Cart#2 File Number BHF-2004-000101 Kevin Kefalas 4 Azalea Lane W Peabody MA 01960 LOCATED AT: SALEM, MA 01970 Permit Type Permit No. Permit Issued Permit Expires Fee Restrictions/Notes MOBILE FOOD BHP-2008-0502 Jul 10,2008 Dec 30,2008 $210.00 Total Fees: $210.00 PERMIT EXPIRES IDecember3O, 2008 Board of Health Page 1 QTY OF SALEM, MASSACHUSETTS BOARD OF HEALTH �Qnnvs�" 120 WASHINGTON STREET,4" FLOOR TEL.(978)741-1800 KIMBERLEY DRISCOLL FAx(978) 745-0343 MAYOR TSCOTTOSALEM.COM JOANNE SCOTT, HEALTH AGENT t APPLICATION FOR A MOBILE FOOD SERVICE PERMIT Fee $210 payable to The City of Salem, No Cash Name of Applicant ee vi N k�j a /qg' Telephone#/-978-S��f-lS�� Address A ✓e— 0/970 Certified Food Manager Certificate # Name of Business G/Gssli cNgss/s lo0c7e,�*,��Telephone# %7�' �0� -5-1,7aj Address S� Manufacture Frozen Desserts? Yes No Type of Vehicle /9 9 y Do�� 6-'1A.19w Registration# Location of Operation /_,y ��,,� ry, ,n/ Name & Address of Licensed Food Service Establishment Serving as Base of Operation casfo-P11WbLZas1cf Telephone# 97F- 7,570 -1,06'0 Location of Toilet & Handwashing Facilities Menu D o vq,4 - 1)11-1A1-1-,r Type of refrigeration: Ice !-,' DryIce G - Other Method for Cooking and/or Hot Holding: as 4,,*' Other Method for Sanitizing: Chemical V Hot Water (170 F) I have read and agree to abide by The Salem Board of Health Regulations regarding "Mobile Food Units & Pushcarts" and will notify the Salem Board of Health of any changes in this application. Pursuant to MGL C62C,S49A, I certify under the penalties of perjury that I, to my best knowledge and belief, have filed all State tax returns and paid all State taxes required under law. 032-- Y6 -76Z3 7 -/o SG / /<` Signature Social Security# or Federal ID# Date / -------------------- - ------------ /� U----------- ------------------------------------------ -------- Revised: 8/14/07 Permit oC-I 0CheckN R Date ' `� �l(�'U D 4 Commonwealth of Massachusetts e City of Salem Board of Health Kimberley Driscoll QTY OF SALEM, MASSACHUSETB BOARD OF HEALTH 120 WASHINGTON STREET,4`1 FLOOR TEL.(978) 741-1800 KIMBERLEY DRISCOLL FAX(978)745-0343 MAYOR LETT ALLM.COM JOANNE SCOTT, HEALTH AGENT APPLICATION FOR A MOBILE FOOD SERVICE PERMIT � J // Fee $210 payable to The City of Salem, No Cash Name of Applicant fr 2i/1 �6 flys Telephone#l-5179-S-751- 1511 Address S mqlpy-) Q vu`` Sak.;7-7 ,a?os5 07/970 Certified Food Manager r7 ynder,gj Certificate # C/ k cH4;7 S F&-,1c6Ne-Telephone# 1 y7k- 5' Name of Business ass OG- Address �- Manufacture Frozen Desserts? Yes No 0— Type of Vehicle 199�f Dade tlGAl vRegistration# Location of Operation S r/� .r O m ,r, a ,1l Name & Address of Licensed Food Service Establishment Serving as Base of Operation Telephone# 9-2S- 7SO - l000 Location of Toilet & Handwashing Facilities MenuavS� Type of refrigeration: Ice DryIce Gas Other Method for Cooking and/or Hot Hong: Gas__�� Other Method for Sanitizing: Chemical z>! Hot Water (170 F) I have read and agree to abide by The Salem Board of Health Regulations regarding "Mobile Food Units & Pushcarts" and will notify the Salem Board of Health of any changes in this application. Pursuant to MGL C62C,S49A, I certify under the penalties of perjury that I, to my best knowledge and belief, have filed all State tax returns and paid all State taxes required under law. 03 Z - V6 -7-/0'S(o 1�� Signature Social Security#or Federal ID# Date --------------------------- ----------------------------------------- -�- ------------------------------------------ Revised: 8/14/07 Per N _ Check#&Date I� (//�� `:u/ of G f Commonwealtli of`ll; S—'6tiehusetts • City of Salem Board of Health tCilftbefl@y Ddst:oll 120 Washington Street,4th Floor Wyor SALEM,MA 01970 FOo&Retail Establishment Permit DATE PRINTED: 04/17/2008 ESTABLISHMENT NAME: , Classy Chassis Food Cart#4 Fite Number:BHF-2003-000047 Kevin Kefalas 4 Azalea Lane Ply MA 01460 LOCATED AT: SALEM,MA 01970 Permit Type Permit No. Permit Issued Permit Expires Fee Restrictions!Notes MOBILE FOOD BHP-2008.0441 Apr 17,2008 Dec 30,2008 $210.00 Total Fees: $210.00 PERMIT EXPIRES 16m-ember'-30,4008- Board December30,2008Board of Health . This Permit is not tranaferable and mast 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,beefre any revonatl=4 improvements,or equipment changes are made,all plans for such must be submitted to and approved by the Salem Board of Health. Pegs 1 z Ctr i:7ik iN'['(lri9!'4hl Antos to 112" .itik•A!y 2s, 4at.t§:t;r l:�z t�.";�.��::'��7d�:�� OM AA ESTAW-3 pul WIT folvd:to 04 a, veRWA SAO i� "';"o:.. bw..�.,;;.."w°°"..•ww.w.«an..�..,.':o-xw..r.w..ri" ..:ap.."N»w"'.". e"°"" ., vx„..«"..�wR"`�'�::.",..e�mw,.,..-.w,*,.rn.>,�.-.,..,....,m.,..,M..,n.�,>.,....,....«,...,n..®,.v.>....eo. �•F'tY3:.A i3{iJ� "3"2'Sf`E�% 'JcS":[ ,*, z'G';fi',�'_.,F 'Y�.�n+'�'FTf'.? �E�A.F t". 2il;z:�"�F,z:tit�;t+yit �']'F i":,w�ari£`i.iN. r't::'l9.� tl'sis•,-r ,inE7` i .x")v"})S`.:;3'a '�¢'.;T.'rt77x'!'1`S (.`'-"'ti[L� $(F4:.iw::.=if .ii>:k' ,c' 'sy.i.. 'A"'S-%;^-.;:i.:-t.::S vCai✓ 'F..;SY`:f,7':f LiEs:' „3��, •s^Rif;r.r�a°«2i e"�bi��:l.:�` f z"r:ai�8 ...s.+.-.a.-..+..«.'.-.µ. �%'sa'Lw•S.b�a.w... ._f`q.y�.e:.a 'f_.�i -f-...e. ;tI :�t7^=t} rf§ t'rat i.x 's-aEit'JEi 93t'i. aaUitd,'l:li T:r t(i;i+T't;ty+a+isr +{�i:51;7 Y3:ity:< (;••=,afx�5 S,i 1r;54. f.£+.:`A5^.fC" ;:lta:'€. ;rx{a wi S}faa'f a`i . 3['E' {{u .:bwa 10f:C,rjfk::t'." ii!$jia°;Fl['?`.i'it7 ttt'i:U3evli;f {r'f.{i0;'[>:S:?`V.'r'T PE!! _'.'a�;:eJ,7;;.5",) �'.:`Ilstit'`i;;:lt?..e[ At is 4'#:?,'i!"iSz nW c� .Srtz;".7t a:i'§;.'fk t+:`3•r9:F:fk'yfe)?'we`i'r'tgq, hat,of {':it7tt£Cik'.e ad i?fk'<i: F{in , -,.nL;ri CITY OF SALEM, MASSACHUSETTS • BOARD OF HEALTH 120 WASHINGTON STREET,4O'FLOOR TEL.(978)741-1800 KIMBERLEY DRISCOLL Fax(978)745-0343 MAYOR Isco t-1-QS,tl.r:M.COM f Z JOANNE SCOTT, �X - HEALTH AGENT IUrl6N�5 2008 APPLICATION FOR PERMIT TOO OPERATE A FOOD ESTABL —yam NAME OF ESTABLISHMENT �QS S % 1-7-11e15--5-15 /oaa t'alve TEL# '??P- ��G'S / 6�y ADDRESS OF ESTABLISHMENTS Mq Ivr» / vc FAX# MAILING ADDRESS(if differentli EMAIL-Business': //�� Website: , OWNER'S NAME rQ UI4- 4-- !/ e UI'`- /lam` ai A S TEL# X17?' - ,5 97/' IS I ADDRESS STREET / CITY STATE ZIP CERTIFIED FOOD MANAGER'S NAME(S) � -YU CERTIFICATE#(S) (Required in an establishment where potentially hazardous food is prepared) EMERGENCY RESPONSE PERSON HOME TEL# I DAYS OF OPERATION 1 Monday Tuesday i Wednesday I Thursday Friday I Saturday Sunday I HOURS OF OPERATION /0 ♦O Please write in time of day. (For example 1 lam-11 pm) /dry Z2M TYPE OF ESTABLISHMENT FEE (check only) RETAIL STORE YES NO less than 1000sq.ft. =$ 70 1000-10,000sq.ft. =$280 more than 10,000sq.ft. =$420 C(Outdoo:rG:S:::j ------- less than 25 seats =$140 d Cart$210) 25-99 seats =$280 more than 99 seats =$420 ---------------------------------------------------------------------------------- ---------------------- BED/BREAKFAST/ YES NO $100 CHILDCARE SERVICES---------------------------------------------- ADDITIONAL PERMITS MAKE (not just serve) ICE CREAM, YOGURT/SOFT SERVE YES NO $25 TOBACCO VENDOR YES NO $135 ALL NON-PROFIT(such as church kitchens) YES NO $25 'Please pay total with one check payable to the City of Salem. This Permit is not transferable and must be reissued upon change of ownership.The Permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code,before any renovations, improvements,or equipment changes are made,all plans for such must be submitted to and approved by the Salem Board of Health. Pursuant to MGL Chapter 62C,Section 49A, I certify under the pains and penalties of perjury that I,to my best knowledge and belief,have filed all state tax returns and pad all state taxes required under a la /I�i1l�"`- 7� -AI-1 y- s- z o,�,F 032-- I&ILI? -7451�2-.3 Signature Date Social Security or Federal Identification Number Commonwesith 4liti,esachuwtts • City of Salem Board of Health Virley Driscoll 120 Washington Street,4th Floor Yo SALEM,MA 01470 Food/Retail Establishment Permit DATE PRINTED: 04/17/2008 ESTABLISHMENT NAME: Classy Chassis Food Cart#4 File Number.BHF-2003400047 Kevin Kefalas 4 Azalea Lane Peabody MA 01460 LOCATED AT: SALEM,MA 01970 Permit Type Permit No. Permit issued Permit Expires Fee Restrictions/Notes MOBILE FOOD BHP-200 WW Apr 17,2008 Dec 30,2008 $210.00 Total Fees: $210.00 PERMIT EXPIRES December 30,200$ Board of Health This Permit Is not transferable and must be reissued upon change of ownership or location.The permit mast be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code,beefre any revonstious,improvements,or equipment changes are made,all plans for such must be submitted to and approved by the Salem Board of Health. p t .w= a t';�:`?d#;'BfiE,�=<<.sx", a..:•!f:z:vf:::5;4t<fi�� /f= ��`�',,.,: °;4Y ,.,NGr:S.1� %y�{i..�if i.�f 1 7 �tiM71 e�a✓ S)ty^ � cw�+ .}iii �tUC^.''1 EV7�Yi977:N t:n t:y,%:nfS?I:'+7"Lf.(mi •''.;`''�""^' . ^ ;''i' 2 0,4AM'.I C'S.`.;.h # `.A�:i:i�i:ts;::iiit):13(F:tfiJ i'•,Itu P !t:9PM i M QGif 1 AM AAAA,� .:-.m «. .,w..F.,.w,.hw..,......,....:.r.,w..,..a-h,...,-4�„remm....r.......,».,.,....,�r.n��,m....w,..�...,:...,,o.«�...w««.w°.,«.,,«,.,.....�.,m:.m.< .,�,�«,,.o..,=,.....�..m.,.<, c.ir:✓t '. ax'.`.iai:92 i`--."fig 3t#S :...t"tY�Y.,`� ti#r± °' ( 'i;rz9 F2F.li5`i .C;?':i t ';°{ ru+swwn.swur.r.u+ar.:.n�s•u„«,aw«°_..n...ww.r„w.++e.«wi:.v�wrrw,� «w(z�:rawm.+inr..ac•rv:a:..,wtw`. smma.n'wn-cu..em+-,,,znm.�.::w,m w:isa+�:+�+: ..�wu« C Boot "M ..^n51k'.«S'.��'.`.i R<%6.:'Y'M+K;H%SLtlbirai:YG5:k1VdVltia:.lL9k:.:fi+ZSSBMScvbSbAWS.NSh{H:�:6:,4M12E'�rCR W)HIC inane'! 'C:'{„Coq'adf.:1',dlieei�FT'4(7 '✓!!'d�.i1F:F.'?G.".•fit�`:f! (V/7i:'iJd4%(vi „'fididn;_ qu s!' vRi I A Iola htD::':S VI1�r.tiPW ion e9 A v,.i`94 Rai F ' iii)iV Cti):'F;i74`i;ill{dti't(#K h S"8..`.>u4,StF 351; 9 7 i1dFi Yi;'mift:x3_b'i in ,(S:•)m'.F,f upal..`ttR,'•ffe•YMm sv ioS3m.:S:Y. ^..^=F12Y`:P riCil, "0 ,,Iv,F 9,r v a)'sv) 'i€a€'( OPRA 'sdl huoU £i`.`•FKe ad!yd j;kr'rtnq,L too i?7 .`OPAd m sd tow Ame'id AmAj r CITY OF SALEM, MASSACHUSETTS • : BOARD OF HEALTH 6/ 120 WASHINGTON STREET,4O'FLOOR rya TEL. (978)741-1800 01 KIMBERLEY DRISCOLL FAX(978)745-0343 d MAYORr Isco*rr(iil ,11,ISM.CONf JOANNE SCOTT, ��5 �L5 HEALTH AGENT �7�t r/ 2008 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT NAME OF ESTABLISHMENT Gh+ s S t C11051S TEL# jlaI " 570—? ADDRESS OF ESTABLISHMENT ,S- /1'l9�rh Cs //E / FAX#11 / MAILING ADDRESS(if different) �/U �Sk� 5-/. /zf EMAIL-Business': / /� Website: OWNER'S NAME Pa �I Q 4 k�i10 /�/' ?la _S TEL# ADDRESS //7-7 GJvt -5gle�"77 1✓Ir9 Olg7d STREET CITY STATE ZIP CERTIFIED FOOD MANAGER'S NAME(S)a44,41P0'�UrZ-01,44440 ZOVONd CERTIFICATE#(S) (Required in an establishment where potentially hazardous food is prepared) EMERGENCY RESPONSE PERSON a"da— /�CFg1aS HOMETEL# Y 1 I DAYS OF OPERATION 1 Monday I Tuesday I. Wednesday Thursday i Friday ! Saturday I Sunday I HOURS OF OPERATION Please write in time of day (For example 11 am-11 pm) /yq, AYH TYPE OF ESTABLISHMENT FEE (check only). RETAIL STORE YES NO less than 1000sq.ft. =$ 70 1000-10,000sq.ft. =$280 more than 10,000sq.ft. =$420 RESTAURANT S NO less than 25 seats $140 (Outdoor Stationary Food Cart$210) 25-99 seats =$280 more than 99 seats =$420 ------------------------STI---------------- -------------------------- BED/BREAKFAST/ YES NO $100 CHILDCARE SERVICE ---- S- ---------- - ---- -------------------------------------------------------------------------------- ........................ ADDITIONAL PERMITS MAKE (not just serve) ICE CREAM, YOGURT/SOFT SERVE YES NO $25 TOBACCO VENDOR YES NO $135 ALL NON-PROFIT(such as church kitchens) YES NO $25 'Please pay total with one check payable to the City of Salem. This Permit is not transferable and must be reissued upon change of ownership.The Permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code,before any renovations, improvements, or equipment changes are made,all plans for such must be submitted to and approved by the Salem Board of Health. Pursuant to MGL Chapter 62C,Section 49A,I certify under the pains and penalties of perjury that I,to my best knowledge and belief,have filed all state tax returns and paid all state taxes requirecl under the law /L_ —ZO o ,t� 7 X 032 -yG - -26-22 Signature Date Social Security or Federal Identification Number Commonwealth of Massachusetts City of Salem Board of Health Kimberley Driscoll 120 Washington Street,4th Floor Mayor SALEM,MA 01970 MOBILE FOOD PERMIT DATE PRINTED: 07/27/2007 ESTABLISHMENT NAME: Classy Chassis Food Cart#6 File Number:BHF-2000-000001 4 Azalea Lane Peabody MA 01970 LOCATED AT: SALEM, MA 01970 Permit Type Permit No. Permit Issued Permit Expires Fee Restrictions/Notes MOBILE FOOD BHP-2007-0561 Ju127,2007 Dec 31,2007 $150.00 Total Fees: $150.00 PERMIT EXPIRES December 3l, 2007 Board of Health V Page 1 of 1 r CIN OF SALEMI MASSACHUSETTS a d BOARD OF HEALTH 120 WASHINGTON STREET, 4TH FLOOR SALEM, MA 01970 TEL. 978-741-1800 FAx 978-745-0343 Kimberley Driscoll www.SALEM.COM Mayor .JOANNE SGOTT, MPH, FIS, CHO HEALTH AGENT 2007 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT NAME OF ESTABLISHMENT --I q ss v en/-/asSlS Yooa CvA/C• TEL# ya6 - S9 03 i ADDRESS OF ESTABLISHMENT ow :7�rNN//- r'ernm n n/ r FA/X#/ MAILING ADDRESS(if different) hza ke, L Ax,+-,— 014260 EMAIL--Business': Owner's: OWNER'S NAME 0g_v e_ Iee_VeAI I/ ��4 /4S TEL# ADDRESS A /�Q-.- 1LJ2csd�ad(r �yyre7SS pj{J( O STREETs' CITY STATE ZIP LAO- ('ek gQi7 CERTIFIED FOOD MANAGER'S NAME(S)) \Jc//m� :t n tz ,. -> CERTIFICATE#(S) N14r-k&skei GaSteo — [jgdY (Required in an establishment where potentially hazardous food is prepared) // EMERGENCY RESPONSE PERSON I(arr�f/I1V �rql S HOME TEL# 97F- T�� — 67a3 1 DAYS OF OPERATION Monday Tuesday Wednesday Thursday Friday Saturday Sunday I HOURS DF OPERATION Please write in time of day. IQr0,0 ? lferentrutellam-Item) 401 TYPE OF ESTABLISHMENT FEE (check oniv) RETAIL STORE YES NO -- less than 1000sq.ft. =$ 50 1000-10,000sq.ft. =$100 more than 10,000sq.ft. =$250 ..._t.-------- - - --- ..0... RESTST AURANT YES NO less than 25 se-ats =$1-0 �lr uv�5 25-99 seats =$150 p� 1s more than 99 seats =$200 1` ---S-T - - -- ----------- BEDIBREAKFAST YES NO $100 ------------------------ _ ... - .. ....... ..... ....... ....... .... ....... .... ..... ...... ADDITIONAL PERMITS MAKE (not just serve) ICE CREAM, YOGURT, SOFT SERVE YES NO $5 TOBACCO VENDOR YES NO $50 ALL NON-PROFIT(such as church kitchens) YES NO $25 'Please pay total with one check payable to the City of Salem. This Permit is not transferable and must be reissued upon change of ownership. The Permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code, before any renovations, improvements, or equipment changes are made, all plans for such must be submitted to and approved by the Salem Board of Health. Pursuant to MGL Chapter 62C, Section 49A, I certify under the pains and penalties of perjury that I, to my best knowledge and belief, have filed all state tax returns and paid a! state taxes required under the laws I..L�.trc.n.�., e� 6-2(- 2cra7 C7 76 -7 Z3 Signature Date Social Security or Federal Identification Number --------- - ---- -----I------- - -- - - --- // - ---------------------- HcviSed 11/13/06 FOOOAP2007 adm Check#8 Date i Commonwealth of Massachusetts City of Salem Board of Health 120 Washington Street,4th Floor Kimberley DriscollMayor SALEM,MA 01970 MOBILE FOOD PERMIT DATE PRINTED: 07/27/2007 ESTABLISHMENT NAME: Classy Chassis Food Cart#5 File Number.BHF-2000-000002 4 Azalea Lane Peabody MA 01960 LOCATED AT: SALEM, MA 01970 Permit Type Permit No. Permit Issued Permit Expires Fee Restrictions/Notes MOBILE FOOD BHP-2007-0526 Jun 21,2007 Dec 31,2007 $150.00 Total Fees: $150.00 PERMIT EXPIRES December 31, 2007 Board of Health Page 1 of 1 CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH 120 WASHINGTON STREET, 4TH FLOOR SALEM, MA 01970 TEL. 978-741-1800 FAx 978-745-0343 Kimberley Driscoll www.SALEM.COM Mayor JOANNE SCOTT, MPH, RS, CHO HEALTH AGENT 2007 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT NAME OF ESTABLISHMENT Glass/ tqaal &Ale• TEL# ?7P- !Pd�- S9a3 ADDRESS OF ESTABLISHMENT P'7ow1v /aw v - e-0*i,97o1vs FAX/# / MAILING ADDRESS (if different) Y' 47-ale e, L.-4sv� -Jv��ba St"Y, /N?9S� ' 'Oil; aa / r EMAIL--Business': Owner's: OWNER'S NAME `L ruin/ ��r�}�R S TEL# �✓��` S 3S' �� j ADDRESS f 19Z-414- (4ti•r— STREETr/ CIT/Y STATE ZIP CERTIFIED FOOD MANAGER'S NAME(S) P. - CERTIFICATE#(S) [.osfGo' - ba/(Y (Required in an establishment where potentially hazardous food is prepared) EMERGENCY RESPONSE PERSON I1.9el'✓✓ /eft t�/G S HOME TEL# �2?- 706 sp�� DAYS Of OPERATION Monday Tuesday Wednesday Thursday Friday Saturday Sunday I HOURS OFeIntim Please writelndmeof oltlay. tporexample ilam-Tlpm) Awl - TYPE OF ESTABLISHMENTFEE (check only) ' RETAIL STORE YES IN less than I000sq.ft. =$ 50 L 1000-10,000sq ft. $100 more than 10,000sq.ft. =$250 as !?Jo h .. oo Gt l ----- ---- ---- - - .. .._-.... ... -.... ------- ----------... .. - ' b a 5 RESTAURANT YES . NO less than 25 seats $100 p"l 2.5-99 seats =$150 more than 99 seats =$200 'hl l VS - - ...._............ ---VES ......... -- --. -- --- ...- - ---.------- .. ... rl BEDISREAKFAST YES / Nth $100 (� - ...-------- - - --------1..............-....-- -- -- - .....-..... ..... . - ----------- --- --- ---- - --- -- ADDITIONAL PERMITS MAKE (not just serve) ICE CREAM, YOGURT, SOFT SERVE YES NO $5 TOBACCO VENDOR YES NO $50 ALL NON-PROFIT(such as church kitchens) YES NO $25 "Please pay total with one check payable to the City of Salem. This Permit is not transferable and must be reissued upon change of ownership. The Permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code, before any renovations, improvements, or equipment changes are made, all plans for such must be submitted to and approved by the Salem Board of Health. Pursuant to MGL Chapter 62C, Section 49A, I certify under the pains and penalties of perjury that 1, to my best knowledge and belief, have filed all state tax returns and paid all tate taxes required under the law Signature Date Social Security or Federal Identdlcation Number ----------------------- ---- ----- ---- -------------- - - J 7 �,.�')----------- - - - - Revised 11113/05 FOODAP2007 udm Check#8 Dnte - ? ((SL S -''" CITY OF SALEM BOARD OF HEALTH Establishment Name: » Date: Page: ? of Item Code C-Critical item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date No. Reference R—Red Item - Verified t PLEASE PRINT CLEARLY F � YaMTS r �t _ f 1 I F � 1 {� Sy O w {1 M y` I Discussion With Person in Charge: Corrective Action Required: I ❑ No ❑ Yes I have read this report, have had the opportunity to ask questions and agree to correct all L3 Voluntary Compliance L3 Employee Restriction/ violations before the next inspection, to observe all conditions as described, and to Exclusion ❑ Re-inspection Scheduled o 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: E S01.141C) PIiF,,Rrcnneti at"1'entpertrares Violations Related tc Fecdoorne it'ness Inlervamirns and disk According to Lxa CoOcd to Factors(items 1-22) Xonr.) 41`Ff45=F Within 4 Hour,. '- 3-50: 15 Cooling Methods for PHFs PROTEC'TSON FROM CHEMICALS 119 PHF Hot and Cold Holding 14 Food or Color Additives 3-501.16(5; Cold Pf 1Fs Maintained at or below! 3-'02.12 Additfte;' 590.004(F) 11'/25°F` 3-302.14 Protections from Oaappro-ed Additt vee* I ;-501,1(it.4) ?tot PI-MFs Alaimamed at or hove ;$ Poisonous or Tox:e Substances i4O:f, ; 7-101.1 1 Identifying Information-Otiginal ?-501.16(A) Roasts Hcid at or above 130"F I Cr nta net::" ( p Time as a Public Health Control 7-V)2 1 I Cunnnou Nnmc-tit aline Coniaincts, 7 '_( 1.1 I Srparae:.ten-Sto;ai-e'. ? SO1.19 Time as a Public Health ControV 590.0(N(H) Variance Regttlrenicltl 7-202 t i Rest;ictusn-Resencd and Use# � � 7-20'.12 Conditions; 7=?U3.11 "foe:;Contain::- Piot:,fitiun'* REOUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-204.11 Sanitizets,Criteria--C'heniicals* POPULATIONS(HSP) 21 3-SOI I I I A' Unpssteun red Pre-packaged Juice::and ! 7.204.12 ChctnicalsforWtshuseYrtducv. Grier,n, J ' 7-204.i4 ilr.:ing Agents.Criteria Eet�eraees will. Warning Labels 7-205.11 Incidental Food Contact,Lubticants'' 3-501.11(5) Use of Pasteurized ok'd ',-20ti.;! kearirn;d Use Pea:icicis. Criteria" I 3-80L L tt21 Rate of Partially Qxsb:ed Anime! FwxM and i 200.12Rodent B�a St:ttiva4" Raw Seed Sprouts Not Setved. 'a 7 206.13 Tracking Powdrrc,Fest Control and I � ;-nil L 11(C) � Unopened Pcxxs Package No:.Re-ser+ed. " 'vh:nitnrind^ CONSUMER ADVISORY TIMEITFMPERATURE CONTROLS 22 3-603 11 Consumer Adstscey Posted for Coasungnron,f 16 Proper Cooking Temperatures for ( Anim:d Foods That::re Raw.UndonoDked or PHF s Not Ou:ermi e Processed to Elirmnate 2-40:.1 !A1!j0) fSggs lii`F ;S sigh. Patho,ens.% Egg uwnediute Sen�icc 1.75`F15sc.•- 3-362.13 Pasteurized Eggs Substitute for Rats Shell 3-401.11(A)(2) Comtmnuted Fkh,Mats lC Game Eggs, Anitss:ds- 155'F 15 sec. " SPECIAL REOUIREMENTS 3-401.11(111(';(2) Fors and Beef Roa0"st- 13 F LI rtin* 3-401.11(A)(2) Ran?cs, Injeor d Mcats- 155"F 15 590,009(A) tD) Violations of Section 590.009(A)-(D) in set.. : catering, mobile trod, temporary and '01 1!(A)(i P:ru'.trv,WI!u Game, Stuffed PHFs, i rc.idcatial kitehcn operations should be Stuffing Contaiuin;l Fish, Meat, debited under the appropriate sections Poultry cr Ratitet-165-F 15 sec. above if related to foodborne illness 3-au1.1l:Ct(3+ tYholr-muadc, fiYuJ Reef Si:aks interventions and risk factors. (also 115°F* j 590.009 violations relating to good tetail 3-101.12 Rata Animal Fuuds Cooled in a ! practice* should be debited under #29- klicirwaee i65 * Speciel Requirements. j 3-401,11(A)(1)ib) All OthcrPHPs- 1-ic;F 15 see. 17 ' Reheating for Hot Holding VIOLATIONS Rr LATED TO GOOD RETAIL PRACTICES 1 3-1103.11(?,)S:(D'r :'yps !65'F 15 sec, (Items 23-30) 3-103.11(5) Mi:rowave- 165`'F 2 A'imu+e Stioiding Critical and non-critical vialations, which no not relate to the Tinto' ,rin0borne Ulnes.s wtel venrion,s and rash-1wrors listed above inn hr 3-403.11(Cl Commercially Processed RTE Fccd- lotmd ill the.following serti,ms of the Food Code and 105 CMR i40`F* 590.000. 3-40?,1l(Er Remaining Cnsliced Yurtiuns of Bcef Item Good Retail Practices FC580.000 Roasts" ( 23. Manaqement and Personnel FC-2 .003 18 ( Proper Coaiirg pt PRFs I 24 Food and Food Protilction FO-3 004 25 Equipment and Utensils Fr-4 .005 3-501.14(,1) CouiinyCook,dPHFsfrom 140`Ft+ 126 Vv'ater,PlumbingandWaste FC-5 70"F tMi;?an 2 FIoura.md From 7U°(' 27 Physical Facility FC-6 .007 to 4!''i;l l5'F Within 4 Hcnr;. poisonous nr Tox,c klatetiais FC-7 .003 1 i-5til.Ill Br Cooling PHFs-Made Frdw Ambient 129. Spe diel Raouiremenis ---- 1109 Ten,peramrcingredients !o41°F/45'F 30. Other Withia.1 Hoors^ I Dowl,,anucal vera m the kdetal 1999 Food Code,e 165 CMR 59(,Wl' ). syaX r � MITI ,ssachusetts #sou Yrx rw. C F .iPT. �vt 4 1 3 � °.y(, ±,.tlt..F.t f - 19 r • 3 !=x 4s • yQ'""�y 'j ��a+^-��a .,jg }"4°%fi y w4f SiilemV..' Ott Sl f`�_` .ci 5t*�'iTY' ani Ps`<✓�rYj .1* r � ��'�., -4TX $ x '1 • �4 t _ grg ''Board of Health 12U.1,Was =+� .«r ,..r• 1 n^.' .w.� w ";N � tr} � �IR1hCI�y�rlS�l ��" �3i hingtonbtr_eeee4t t,, hFloor}+.. i-. ,a :SP'xf �ar+*+s�r .dX:��-�4`.a�.�^ - �Y ` 01970 . o ..;4. , .;(a' `,•:aF:y'a'nxu .,z *!r,:. s=r.`*?"": ... Food/Retail Establishment Permit DATE PRINTED: 06/21/2007 ESTABLISHMENT NAME: Classy Chassis Cart#1 #597-095 Mass File Number:BHF-2004000100 Kevin Kafalas 4 Azalea Lane W Peabody MA 01960 LOCATED AT: SALEM, MA 01970 Permit Type Permit No. Permit Issued Permit Expires Fee Restrictions/Notes FOOD SERVICE BHP-2007-0522 Jun 21,2007 Dec 31,2007 $100.00 ESTABLISHMENT Total Fees: $100.00 PERMIT EXPIRES December 31, 2007 Board of Health This Permit is not transferable and must be reissued upon change of ownership or location.The permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code,beofre any revonations,improvements,or equipment changes are made,all plans for such must be submitted to and approved by the Salem Board of Health. Page 1 of 3 CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH 120 WASHINGTON,STREET,4TH FLOOR SALEM, MA 01970 TEL. 978.741-1800 FAX 978-745-0343 Kimberley Driscoll WWW.SALEM.COM Mayor JOA SCOTT, MPH, RS, CHO HEALTH AGENT 2007 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT NAME OF ESTABLISHMENT G/as5,,. ag15i 5' Fool Co,,C• TEL# /- }7F- Wv1 — -f a,? ADDRESS OF ESTABLISHMENT DoWM %owA) — l"rnr » oN FAX# MAILING ADDRESS (if different) r(42.Q //e,,t- Z1i.v2 1pez,0/1 /'a sir 019. a EMAIL--Business': l/ Owner's: OWNER'S NAME Dcxrllc� 4 I�v i Al ikeF4Iei. S TEL# 9 " :-?S- 1 ADDRESS JJ?a[{ ZA-_ t 4 AJe— /1 a.Llo gjy /1,1e.?S,f 0/9 �v STREET fJav/rtv �ei 4 faj C91-Y STATE ZIP CERTIFIED FOOD MANAGER'S NAME(S) Y/ yv%;J o. Yl i,. > CERTIFICATE#(S) (31a/+ BaS,�'Gf- Ga5'tC0 - q/�v (Required in an establishment where potentially hazardous food is prepared) EMERGENCY RESPONSE PERSON I�f�r/J 1Ce)!;;a/a S HOME TEL# ��` 70to 'Sl I DAYS Of OPERATION Monday Tuesday Wednesday Thursday Friday Saturday Sunday HOURS OF OPERATION Please write In time of gay, l f�' (for examplellam-ltpm) / A01 j TYPE OF ESTABLISHMENT FEE (check only) RETAIL STORE YESNO less than 1000sq.ft. =$ 50 1000-10,000sq.ft. =$100 more than 10,000sq.ft =$250 L l �SOS� �_f RESTAURANT YES NO less than 25 seats =$100 25-99 seats =$150 more than 99 seats =$200 -- .. __... - ... - -- - --.-._. I---- -------------_ .... ... BED/BREAKFAST YES $100 - trJj -------------- ------- ------------------- ..-._..------- --- --- --- - - -------- ------ ........... ...... .... Vr ADDITIONAL PERMITS MAKE (not just serve) ICE CREAM. YOGURT, SOFT SERVE YES NO $5 TOBACCO VENDOR YES NO $50 ALL NON-PROFIT(such as church kitchens) YES NO $25 *Please pay total with one check payable to the City of Salem. This Permit is not transferable and must be reissued upon change of ownership The Permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code, before any renovations, improvements, or equipment changes are made, all plans for such must be submitted to and approved by the Salem Board of Health. Pursuant to MGL Chapter 626, Section 49A, I certify under the pains and penalties of perjury that I, to try best knowledge and belief, have filed all state tax returns and pard all sta,19 taxes required under the law 11,-2I-_70o7 �/ C."�3G� 7�io - -74623 Signature Date Sacral Security or Federal Identification Number -- - -- -------------- ------ ------------ ----- ----- ---- ------- ----- -------------- ---- ---------------------------- ------ ---- ------ ------ ----- - Revised 11/13/06 FOODAP2007 adm Check#8 Date $ All ' sachnsetts " ."... i , "^' a *• a� ° F � ��-� � - ° � fi, � ��{ L..��'.. IQmbefleVDns_o_oll ^� 4)t As 6n• TX : .;j "� ; �w.u...Ya=.JI.�. ,4�, �r`r, ` 4_ �.12UWslungton',StYeet,�4`ttiFloor rwvf*�%£.rF�'�. -i.. tt'."�.2Ery'., , ..-_.Sk'�'«x'�'�d r%'a,'� ai°dr.+"',�wsP,2,G'Y."..2f', r5;r ',^,-Y,^'^a. 1 ^`. 'fw;.'•';7:',..- .r+,-.F,:^H. a-#n.'�• Mr ? Food/Retail Establishment Permit DATE PRINTED: 06/21/2007 ESTABLISHMENT NAME: Classy Chassis Cart#2 File Number BHF-2004-000101 Kevin Kefalas 4 Azalea Lane W Peabody MA 01960 LOCATED AT: SALEM,MA 01970 Permit Type Permit No. Permit Issued Permit Expires Fee Restrictions/Notes FOOD SERVICE BHP-2007-0523 Jun 21,2007 Dec 31,2007 $100.00 ESTABLISHMENT Total Fees: $100.00 PERMIT EXPIRES IDecember3l, 2007 Board of Health V This Permit is not transferable and must be reissued upon change of ownership or location.The permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code,beofre any revonations,improvements,or equipment changes are made,all plans for such must be submitted to and approved by the Salem Board of Health. Page 2 of 3 CITY OF SALEM, MASSACHUSETTS • s BOARD OF HEALTH 120 WASHINGTON STREET, 4TH FLOOR SALEM, MA 01970 TEL. 978-741-1800 FAx 978-745-0343 Kimberley Driscoll WWW.SALEM.COM Mayor JOANNE ScOTT, MPH, RS, CHO HEALTH AGENT 2007 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT NAME OF ESTABLISHMENT l/er 55y e,#4551S Faroj ra vc+. TEL# f��o' rya 3 ADDRESS OF ESTABLISHMENT AowAl/�w.J -'/- eo..,. o W FAX# MAILING ADDRESS (if different) 41 /7Ztt/P!--• L,.4 h.•E '� /'�er..FJ-ale EMAIL-Business': J/ // Owner's: ! OWNER'SNAME—P.I-L///a 4 ��` r"/e3S TEL# ADDRESS q 4ZL2le-Al- I ar✓E. Pea-Z�WJi ry1QSs 01 yb� STREET O �/ /CITY / STATE ZIP CERTIFIED FOOD MANAGER'S NAME(S) t ld f eR (R S CERTIFICATE#(S) (Required in an establishment where potentially hazardous food iiss/prepar/ed) 'J s EMERGENCY RESPONSE PERSON KI/l , e/o/ate r}{9tof@-ftp #'T �T 7�' 7�{� O DAYS Of OPERATION Monday Tuesday Wednesday Thursday Friday Saturday Sunday 1 HOURS OFOPERAIION60 /0",- Please write in timeotday. � tferexamalettam-110m1 Am j TYPE OF ESTABLISHMEN(D FEE (check only) RETAIL STORE YES NO less than 1000sq.ft. =$ 50 1000-10,000scIt. =$100 t more than 10,000sq.ft. =$250 All lC..--...--�oo..das I RESTAURANT YES' NO less than 25 seats $100 25-99 seats =$150 (' 1I r more than 99 seats =5200 4J _.-_.... _.-.....-ST.. ... ...... .--.. ----- ---. .. .. .. .. kj SEDI6REAKFAST YES NO $100 ADDITIONAL PERMITS . --...--- - -. k 5f8'1 9- MAKE (not just serve) ICE CREAM, YOGURT, SOFT SERVE YES NO $5 TOBACCO VENDOR YES NO $50 ALL NON-PROFIT(such as church kitchens) YES NO $25 `Please pay total with one check payable to the City of Salem. This Permit is not transferable and must be reissued upon change of ownership The Permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code, before any renovations, improvements, or equipment changes are made, all plans for such must be submitted to and approved by the Salem Board of Health. Pursuant to MGL Chapter 62C, Section 49A, I certify under the pains and penalties of perjury that I, to my best knowledge and belief, have filed all state tax returns a id paid all stajf taxes required under the taw ^. y 6-7-1- 2007 03 Z- - Yv' -76 23 Signature Dale Social Security or Federal Identification Number ---------------------- ------------ --- - ----------- ---------- ------ ---------------- ----------- ------ ----- ----------------- - Revised 11113/06 FOODAP2007 adm Checkf#8 Date $ $ er y.�, "�r '+s{ „r ' thT- r - _ 4 _ ¢ -,.� s a Z, lri}r.,,,ae i3�rk+y*y �iSYtr M a , •{r yt�1y, .="F,i'{�' " ` -M tm' �Q�` "°,f2 9y, aF•^°r7 r -h�ae LNC r k 's' tP 1i4% n't�.�> s✓#'^' }✓� +&s 3'y r.':� q•p -� r�� .+w a�> H� � Al - a.+.}. `6+- "}t+`+r _Mi StE s ..a.�+ J ,N F ;Commonwealth of Massachusetts, 5 v�� v q4 a _ a°`gm.,¢" r -k w•#'u%^ r �4'rtF+»ro3 'lZnom; .,y p w City of Salem { I s� <- _ _ �' .'xe zP ° s 4 ' - { • '` ' t6 �} • ik'�. is x",ro e.�.�.. a •r'S � �� s i -f•' fi, z: � � � a� eJ1s t 1<4.�t X�p Fq:,r€ 21Gmbeney,Dnsooil a ro 120WashmgtonStreet,,4thAFloor � SALEM MA U19 ° 7U - .. ,. Food/Retail Establishment Permit DATE PRINTED: 06/21/2007 ESTABLISHMENT NAME: Classy Chassis Cart#3 File Number BHF-2004-000102 Kevin Kefalas 4 Azalea Lane W Peabody MA 01960 LOCATED AT: SALEM,MA 01970 Permit Type Permit No. Permit Issued Permit Expires Fee Restrictions/Notes FOOD SERVICE BHP-2007-0524 Jun 21,2007 Dec 31,2007 $100.00 ESTABLISHMENT Total Fees: $100.00 PERMIT EXPIRES ,December 31, 2007 Board of Health ( e.aj�- V This Permit is not transferable and must be reissued upon change of ownership or location.The permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code,beofre any revonations,improvements,or equipment changes are made,all plans for such must be submitted to and approved by the Salem Board of Health. Page 3 of 3 1 CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH 120 WASHINGTON STREET, 4TH FLOOR SALEM, MA 01970 TEL. 978.741-1800 FAx 978-745-0343 Kimberley Driscoll WWW.SALEM.COM Mayor JOANNE SCOTT, MPH, RS, CHO HEALTH AGENT 2007 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT NAME OF ESTABLISHMENT G:1GSSfr ^f�t7SS�5 /oeq �qA, �/ . TEL# '72F- f1/ - Jam/ ADDRESS OF ESTABLISHMENT now AJ -7o FAX//# MAILING ADDRESS(if different) /7Z aleLt_ LaJt'� ��dbe ( //1�5 p/g/,;,p EMAIL--Business': Owner's: r �/ OWNER'SNAME �xU(cL d- //LSI i c/ f� ItLG_t TEL# 97f - ADDRESS 2414 ADDRESS 7 -o.. L4�� Co �o o/V !1?4�S at?6d STREETfL ' CITY STATE ZIP CERTIFIED FOOD MANAGER'S NAME(Sl pa.v�a- h-e // P4 ( 4s CERTIFICATE#(S) Cas/eG - Dar/li' (Required in an establishment where potentially hazardous N dous food is prepared) EMERGENCY RESPONSE PERSON Aelli 1-PI 6 S HOME TEL# ! g' J �(� — �✓ OAYSOFOPERATION Monday Tuesday_ Wednesday Thursday Friday Saturday Sunday HOURS Of OPERATION A 2 C Please write In time of day. l }A (far example[tam-Ilam[ TYPE OF ESTABLISHMENT, FEE (check only( RETAIL STORE YES NO less than 1000sq.ft, =$ 50 1000-10,000sq.ft. =$100 mare than 10,000sq.ft. =$250 ¢,e * - ----- -------------- ---- RESTAURA T YES NO less than 25 seats =$100 de 0 25-99 seats =$150 �n ti/P/� more than 99 seats =$200 Y// If $ BED/BREAKFAST YES NO $100 �/ *JS - ---- ----- ------ ---- ----------- ----. ..._....-.........- - ... -.... .... . ..... ......-- .....-..... ....... _. ..... ......... (Jr ADDITIONAL PERMITS MAKE(not just serve) ICE CREAM, YOGURT, SOFT SERVE YES NO $5 TOBACCO VENDOR YES NO $50 ALL NON-PROFIT(such as church kitchens) YES NO $25 Please pay total with one check payable to the City of Salem. This Permit is not transferable and must be reissued upon change of ownership. The Permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code, before any renovations, improvements, or equipment changes are made, all plans for such must be submitted to and approved by the Salem Board of Health. Pursuant to MGL Chapter 62C, Section 49A, I certify under the pains and penalties of perjury that I, to my best knowledge and belief, have fled all state returns , d paid all ate taxes required under the law Signature Date Social Security or Federal Identification Number ---- ------------------ ---- ------------ - ----- ----- ------------ - ----- ---------------- ----- ------ --------- ------- ---- --- Revised 11113/06 F0ODAP9007 r)dm Check#&Date $ ( IMPORTANT MESSAGE ) FOR DATE ^'A-e) / TIME //, ,3 M OF -- P ONF �7� �3C�a_ c3.S S�oZ AREA CODE NUMBER EXTENSION U FAX ❑ MOE31l F AREA CODE NL,�R TIME TO CALL TELEPHONED I G<PLEASE CALL CAME TO SEE YOU I I WILL CALL AGAIN WANTS TO SEE YOU I RUSH RETURNED YOUR CALL WILL FAX TO YOU MESSAGED ,i�.l�.G�%i/ti/O✓_ i/�A� SIGNS SOPSMAGE IN4 5 A -- S31ON r' CITY OF SALEM BOARD OF HEALTH Establishment Name: tLASS'y r"+10"<') S Date: ko- 2-o Page: of Item Code C-Critical item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date No. Reference R-Red Item Verified PLEASE PRINT CLEARLY r — TNt:, GR\nom. ON TNS lior �o(s� Sr>vS�bt' Cc>li.0 wIc<,��w R� 6 L TNoRov f.\a�,v C t,�,ric1� taav� St�d�1��12e'?c�. '-• T\�� o\�. ? i� oU T1i>n FR\e� �\ �N �0.� N�-�nt la g� • T1�Rc��6!\��\ C` �.i,rom�<JO Yje14 SIaNI�t'L�in.. FI '" pQpV l �;, r� '4'i��.4.f+•+or*^t�-2 c�.l 't^N a-. �� C�OI�, S fiV<AV� C.'�\i�� a lel Sv0. e R Rw�`a� ova' fotL SP tc,�xa` G—roc•+�s �'i�. . )a a•,v�'rao N a�'arN\c�\�L� l,.tll.� 3e? S�tlT6vt � T�r•�4aR'o,�`ft PcY�> P�%Q-'�`�� r�erS. Y�L�. oTH �'L 2�.Qv\ CLac,Yr,trNS`c T'Zi oP.?N l�ra�•� "3�bN. S'ca"c� s�\�':�_ _ S Aat ti*�1 Pp•J. Discussion With Person in Charge: Corrective Action Required: ❑ No I ❑ Yes { I I have read this report, have had the opportunity to ask questions and agree to correct all ❑ Voluntary Compliance ❑ Employee Restriction/ Exclusion violations before the next inspection, to observe all conditions as described, and to ❑ 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 of ❑ Embargo ❑ Emergency Closure your food permit. i// ❑ Voluntary Disposal ❑ _Other: 11(C.: PH Fe Received at Temperttures Violations Related to Foodborne Illness intervPritions and Riser According:a taw Co,,led in Factors(items i-22) (Cont 1 411'F/4.i'F t`.'id:'a 4 Hour;. (P.'5 (rooting Methods for PH'rs PROTECTION FROM CHEMICALS Food or Calor Additives 1' PHF Boland Cold Holdinght 3-501.i 6(B) Cold PHF. M cn;,Jced at or below ) 20.12 A(U6,,cs* 590 004"F) 4P!15°F` 3-302 Id I Protecdon frorn Unaprorrved Additivei* i 3-7O1.'6(A) Hot PHFs Maintained at or abo%e Tg Poisonous or Toxic Substances 7-i(iLI l Idenut'inc infr'ravnnm --iingrnat !4WF 5 I 13-S0l.J b(A) Roasts Held at or above 1300F, Containers` ' 7-102.!1 Com:men N,une-Workm,,C'on::6netc.` ( 21) Time as a Pao!ie Health Control i 3-50;.;9 Tine fie a Public.Health Con'r'ol* 7-201.!1 Separation-Storage^� j 7-2(12.1 1 Restriction --Presence aid Lice" 590.004:H) Valiance Requirement 17-20:'..12 Condnicns of Us,_' REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-20311 Toxic Containers -.Prohibitions' 7-204.11 Sanitizets,Critenr. - C'hcmci :is' POPULATIONS(HSP} 7-2041 2 Clnatiical.;for Wae:hmC Pr .,ducc,Criteria" 21 3-801 11(A, LOtpasirunzed P-t-p:.ikag::J Mice.and Beverazes With Warnine I2bels' 7204.14 Di ging Agents.Criterra* ( i-HO! IliR) Use of Yasieutved F^_gs" 7205.11 RciIrOe IT4Pcod oncart. t-nbrtcriat 3-801,1 If Do k.:wniPartal'vCookeaAnintalFund and i'2:;6.1! Reiinotcd lise Pesticides•f'rnrna'" Kew Seed Sprouts Not Jet vett.'^ 7-2(16.12 RcxlenrBanStations^ j 3-WLIPC Unop_' 7-206 13 Tracking Powders, Pest Conhol and ) sed Food Pzcl:agz !Set Reserved ,Ltuni to:ing` CONSUMER ADVISORY TIMEITEMPERATURE CONTROLS 22 3-603.11 'Onsmnor Advr�ory Posted or Consumption of Propet Cookie Temperatures for Annual Foxls'(hat are Raw-,Undcrcw,,ed of 16 Prop g r Not Odherwue Processed ro Eliminate 3-401.11A(1)(2) Gggo-- 155°F 15 Sec. P'thogens. Eggshnnreca ate Sereice 145"I=iS,ec; 3-302.13 PrstC::n cd Lg'tr Substiu^c ftu Raw Shell 3-401.1 I(A'K2) Comminuted Fish, lteata&Gave Animals 155"F 15 sec. '' SPECIAL REQUIREMENTS 3-401.11 40L1I(A)(2,t Ratites. injected 3 01.11(B)(I),2) Potk and ijectcted Mealts- 155'F 15 eRoar+ 130`5 1-2) nriu* 590.00Y(A)-tD) Violations of Section 590.rO09(A)-(D) in sec. * I caterinw. tuolwle food,tcmpcnary and 3-401.1 It 4)0) Poultry, Wild name, Stuffed Y!-TFs,, residentia! kitchen cincrations 6hould be Stuffing Containing Fish. Meat, debited under the appropriate section, Poultry or Ratites-165=F 15 sec. * =Bove it elated to foodborne illness i 3-401 1I(C)(=) Whole-muscle,Intact Bcef Steaks interventions and glut. Pdctors. Other 145`F' 590,0'f19 violations relating to p,c cxl retail 3 401 12 Raw-Animal Foods Caaked in a ]n act.ices should be de!.ited under /f29- M)ciovou,ie 165"F* Special Kequirentents. 3=401.1 l(Aa i)(b) All Other PHFs- 145°F 15 we * j 17 Reheating for Hot Holding VIOLATIONS R.=LATER FO GOOD RETAIL PRACTICES 3403 11(A)4(I?) 3=HFs t(;5`P 15 sec. * ;items 23-30) :,403.11(B) I54icruwace- 165'F 2 Minute StandinuI Critical aivi rton-rri tical cioiattuns, nisch do not aloin to the Time' foo,olhfirrr i;7nec.c interirentivns and raskJalu:rt '1;ved nhnne, an be 3-403.11(C) Coatrnercia!'}Processed RTE Food I fount:L;thefolinuarg seg tion::ur!hc J7u:d Coale Enid 7r)5 CNK 140'F* 59r000. 3403.11(1,1 Remaining Cnsliced Portions of BeefI iti em i Good Retail Practices Fr, 580.000 j Roast,* j 23. Van:iviownt and Persorne! FC-2 .003 ty Proper Cooling of PHFs ! 24. Fcod and Food Protection FC-3 004 ;-5()].!,I(A) Cooling rooked PHFs from 14G`F to I ' _ EgUipment and Utensils FC -4 ( ,005____ - ! 26 Nature Plum:,:nq and Waste FC- 5 ( 006 70"F Within 2 Tlourn:met From 70"F j 37. Ph4'sieal PaciLty FC-ti .007 j to 41'57455 Within 4 Hours. " I 28. Poisonous nr Tox:c MPt9tla:s FG-7 .008 j 3 ?)1 I,I(B) Coling PHFs Matic From Ambient 24. ! Special Requirements 005 'fernperstate Ingredients tc�4 i`ir/45`5 i Within 4 Hours Deno!ea CTAILII i:em m chi 6der;il 1994 Paoli Cody of 1❑i Cb1R`All n(1(r ( IMPORTANT MESSAGE ) FOR J DATE TIME�f M OF PHONE AREA CODE NUMBER EXTENSION O FAX O MOBII F AREA CODE NUMBER TIME TO CALL TELEPHONED PLEASE CALL CAME TO SEE YOU WILL CALL AGAIN WANTS TO SEE YOU I RUSH REfURN,,,�..._. _....... ,_ EO YOUR CALL I WILL FAX TO YOU � MESSAGE r SIGNEDVO/RM ' �� 40 MADE IN U.S.A 4 � DOTES IN PORTANT MESSAGE ) FOR' �/ h DATF C as 1 d`s TIME z4-4t M OF PHONE AREA CODE NUMBER EXTENSION O FAX Q MOBII F AREA CODE NUMBER TIME TO CALL TELEPHONED PLEASE CALL AME TO SEE YOU WILL CALL AGAIN WANTS TO SEE YOU RUSH RETURNED YOUR CALL WILL FAX TO YOU MESSAGE J ` SIGNED S/ � OpsFORM 4009 L MADE IN U S A NOTES �' ro Xf - - r _ I _ 1 _ _ II I _ - ! I ,� �� - _ II , � i __-: . - _ __...� ( IMPORTANT MESSAGE ) FOR LA DATF �a'� TIME��P.101- M z;;o OF PHONE AREA MOE NUMBER EXTENSION O FAX O MOBII F AREA LADE NUMBER TIME TO CALL TELEPHONED LJ- PLEASE CALL CAME M SEE YOU WILL CALL AGAIN WANTS TO SEE YOU RUSH RETURNED YOUR CALL WILL FAX TO YOU MESSAGE ri Y at--7 C3."o ell, SIGNED G r SOPSFORM 40 MARE IN 0 A i NOTES I I ( IMPORTANT .MESSAGE ) FOR %D/ a' 3 0 A.M. OATF Il TIME- 3 3o P.M. M �L-�Gv/ 5 OF cja .5S(� c�U SS JJ PHONE ` AREA CODE NUMBER EXTENSION ❑ FAX n ^ AREA CODE NUMBER TIME TO CALL TELEPHONED PLEASE CALL CAME TO SEE YOU WILL CALL AGAIN WANTS TO SEE YOU RUSH RETURNED YOUR CALL ,�L// I WILL FAX TO YOU/ MESSAGE A )0A" ]-_.2 �(9d 5 lei ('�2n'-�S W"" ozkivq' , A SIGNED �� !I ��/Y` FORM V9 -I � MAGE IN Y5 A I 4 � NOTES i Commonwealth of Massachusetts t City of Salem Kimberley Driscoll Board of Health Mayor 120 Washington Street,4th Floor SALEM,MA 01970 MOBILE FOOD PERMIT DATE PRINTED: 06/27/2006 WHO'S PLACE OF BUSINESS IS: Classy Chassis Cart#3 File Number:BHF-2004-0102 4 Azalea Lane W Peabody MA 01960 LOCATED AT: SALEM,MA 01970 Permit Type Permit Issued Permit Expires Fee Restrictions/Notes MOBILE FOOD Jun 27,2006 Dec 31,2006 $150.00 Total Fees: $150.00 PERMIT EXPIRES December 31, 2006 Board of Health v CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH 120 WASHINGTON STREET, 4TH FLOOR SALEM, MA 01970 TEL. 978-741-1800 FAX 978-745-0343 JOANNE SCOTT, MPH, RS, CHO Kimberley Driscoll HEALTH AGENT Mayor APPLICATION FOR A MOBILE FOOD SERVICE PERMIT )t- Fe $150 payable to The City of Salem, No Cash Name of Applicant v/n/ �� %4G sTelephone# 63S--62F6 Address Gf 4salt Q /— [-rr r Certified Food Manager �it v/� lei C cr j Certificate # i Name of Business tears/ �tYcrsS is ��6u� - Telephone# Address Manufacture Frozen Desserts?1 Yes No ' x Type of Vehicle /'l mil f°r[y Tvc% Registration# Location of Operation OAi Name & Address of Lie nsed Food Service Establishment Serving as Base of Operation Gd.-ZG o Telephone# Location of Toilet & Handwashing�(Facilities Menu Type of refrigeration: (lee Dry Ice Gas Other Method for Cooking and/or Hot Holding: Gas c-," Other Method for Sanitizing: Chemical Hot Water (170 F) I have read and agree to abide by The Salem Board of Health Regulations regarding "Mobile Food Units & Pushcarts" and will notify the Salem Board of Health of any changes in this application. Pursuant to MGL C62C,S49A, I certify under the penalties of perjury that I, to my best knowledge and belief, have filed all State tax returns and paid all State taxes required under law. Signature Social Securit # or Federal ID# Dat Zo a --- ---- --- - ------- Q -? _ �2 6 Z ----------- _�'" Revised 2/7/03 Penna 9 Check#&Date -;li_ . .w, _ ...._. . Commonwealth of Massachusetts City of Salem Board of Health Kimberley Driscoll '�gMn�at 120 Washington Street,4th Floor Mayor SALEM,MA 01970 MOBILE FOOD PERMIT DATE PRINTED: 06/27/2006 WHO'S PLACE OF BUSINESS IS: Classy Chassis Cart#2 File Number:BHF-2004-0101 4 Azalea Lane W Peabody MA 01960 LOCATED AT: SALEM, MA 01970 Permit Type Permit Issued Permit Expires Fee Restrictions/Notes MOBILE FOOD Jun 27,2006 Dec 31,2006 $150.00 Total Fees: $150.00 PERMIT EXPIRES December 31, 2006 Board of Health — ►-�- v I , CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH 120 WASHINGTON STREET, 4TH FLOOR ,fin SALEM, MA 01970 / TEL. 978-741-1800 C/ t/ 6p (/r' FAX 978-745-0343 JOANNE SCOTT, MPH, RS, CHO Kimberley Driscoll HEALTH AGENT Mayor APPLICATION FOR A MOBILE FOOD SERVICE PERMIT - �� Fges$150 payable to The City of Salem, No Cash a//� Name of Applicant v N Telephone#.-4 93 Address V 19z 4 /zA�p /��n ��, rh�s 5 Certified Food Manager 42 .vla- Certificate # Name of Business G/asS� cY44sr115 �ov� �af—�' Telephone# Vic, A �— Address Manufacture Frozen Desserts? Yes No (/ Type of Vehicle 111 / rorW -7,-rte le- Registration# Location of Operation a Ai , /h /"A/ Name & Address of Licensed Food Service Establishment Serving as Base of Operation l�,,c7LGrr Telephone# '7e, a P / 600 Location of Toilet & Handwashing Facilities Menu �ti'y — D 0`i.,� , — Type of refrigeration: Ice v Dry Ice Gas Other Method for Cooking and/or Hot Holding: Gas Other Method for Sanitizing: Chemical Hot Water (170 F) I have read and agree to abide by The Salem Board of Health Regulations regarding "Mobile Food Units & Pushcarts" and will notify the Salem Board of Health of any changes in this application. Pursuant to MGL C62C,S49A, I certify under the penalties of perjury that 1, to my best knowledge and belief, have filed all State tax returns and paid all State taxes required under law. Signature �/ Social Security#,qr Federal ID# Date v. Q�z-Y�— ,6-�Z-2-------------- Revised 2/7/03 Permit# Check#&Date Commonwealth of Massachusetts City of Salem Board of Health Kimberley Driscoll 120 Washington Street,4th Floor Mayor SALEM,MA 01970 MOBILE FOOD PERMIT DATE PRINTED: 06/27/2006 WHO'S PLACE OF BUSINESS IS: Classy Chassis Cart#1 #597-095 Mass File Number:BHF-2004-0100 4 Azalea Lane W Peabody MA 01960 LOCATED AT: SALEM, MA 01970 Permit Type Permit Issued Permit Expires Fee Restrictions/Notes MOBILE FOOD Jun 27,2006 Dec 31,2006 $150.00 Total Fees: $150.00 PERMIT EXPIRES December 31, 2006 Board of Health �� // G%iJ�� , I CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH 120 WASHINGTON STREET, 4TH FLOOR SALEM, MA 01970 TEL. 978-741-1800O(P FAX 978-745-0343 JOANNE SCOTT, MPH, RS, CHO Kimberley Driscoll HEALTH AGENT Mayor APPLICATION FOR A MOBILE FOOD SERVICE PERMIT �,� Fee 150 payable to The City of Salem, No Cash Name of Applicant �v,N � Is Telephone# Address tf 19921 zle 'of- r_ r Ve--- Certified Food Manager g , ,?- Certificcate# Name of Business 6/0 � efAr.rs%S' Telephone#,<02; r71 e— Address l Manufacture Frozen Desserts? Yes No_zY Type of Vehicle 11V Registration# Location of Operation s',_ /r �, t'7-6n7 d,,., r A,, Name & Address oft,icensed Food Service Establishment Serving as Base of Operation of o,z t-a 's Telephone# 73-0 /P0 O Location of Toilet & Handwashing Facilities s� Menu ' 1" � �' -��X41 S - DA,1^11e- 5 i Type of refrigeration: Ice, Dry IceCas Other Method for Cooking and/or Hot Holding: Gas Other Method for Sanitizing: Chemical Hot Water (170 F) I have read and agree to abide by The Salem Board of Health Regulations regarding "Mobile Food Units & Pushcarts" and will notify the Salem Board of Health of any changes in this application. Pursuant to MGL C62C,S49A, I certify under the penalties of perjury that 1, to my best knowledge and belief, have filed all State tax returns and paid all State taxes required under law. Signature Social Securit # r Fed ra ID# Date ---------�- � -------- -- Q - - `��--JA?-3-------&- Revised, 2/7/03 Permit 9 Check#&Date CITY OF SALEM9 MASSACHUSETTS BOARD OF HEALTH 120 WASHINGTON STREET, 4TH FLOOR SALEM, MA 01970 TEL. 978-741-1 800 FAX 978-745-0343 STANLEY J. USOVICZ, JR. JOANNE SCOTT, MPH, RS, CHO MAYOR HEALTH AGENT COMMONWEALTH OF MASSACHUSETTS PERMIT TO OPERATE A MOBILE FOOD SERVER In accordance with Regulations promulgated under authority of Chapter 94, Section 305A and Chapter 111, Section 5 of the General Laws a Permit is hereby granted to: Applicants Name: Kevin Kefalas Name of Establishment: Classy Chassis Cart#1 Whose Place of Business is: 4 Azalea Lane, W. Peabody, MA Date: 6/7/05 To Operate a Mobile Food Server in Salem Restrictions: Permit #: 009-05M Frozen Desserts/Ice Cream: PERMIT EXPIRES: December 3l, 2005 HEALTH AGENT I CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH 120 WASHINGTON STREET, 4TH FLOOR SALEM, MA 01970 TEL. 978-741-1800 0 FAX 978-745-0343 STANLEY USOVICZ, JR. JOANNE SCOTT. MPH. RS. CHO MAYOR HEALTH AGENT APPLICATION FOR A MOBILE FOOD SERVICE PERMIT r //// ,�F+ee 150 payable to The City of Salem, No Cash Name of Applicant ,�viN /�C /" Ci 1� S Telephone# 92g -Y33= & k9-c/ Address im / �. ✓ � ��0�6Jv' /vrlSS Certified Food Manager d i{u L, 14- 1(!�P-r4 fns Certificate #.�_ q Name of Business C�/q SSy C/�GSS/S #� Telephone# Address Sc /✓7 e Manufacture Frozen Desserts? Yes No L� Type of Vehicle 3j-'7 65--C`14z Registration# Location of Operation ow Name & Address of Licensed Food Service Establishment Serving as Base of Operation �' o<-7,e-- o , s Telephone# / oaO Location of Toilet & Handwashing Facilities Menu' Type of refrigeration: Ice Dry Ice Gas Other Method for Cooking and/or Hot Holding. ' Gas-- Other Method for Sanitizing: Chemical T/ Hot Water (170 F) I have read and agree to abide by The Salem Board of Health Regulations regarding "Mobile Food Units & Pushcarts" and will notify the Salem Board of Health of any changes in this application. Pursuant to MGL C62C,S49A, I certify under the penalties of perjury that I, to my best knowledge and belief, have filed all State tax returns and paid all State taxes required under law Signature �— Social secuiitt),4,oi Fedc/ral71)1/ Datc Kwiud 2/7/01 Puma, _7 I A`-'Wl4. IN? il� WIN CITY OF SALEM9 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 MOBILE FOOD SERVER hi accordance with Regulations promulgated under authority of Chapter 94, Section 305A and Chapter 111, Section 5 of the General Laws a Permit is hereby granted to: Applicants Name: Kevin Kefalas Name of Establishment: Classy Chassis Cart#2 Whose Place of Business is: 4 Azalea Lane, W. Peabody, MA Date: 6/7/05 To Operate a Mobile Food Server in Salem Restrictions: Permit #: 010-05M Frozen Desserts/Ice Cream: PERMIT EXPIRES: December 31, 2005 HEALTH AGENT CITY OF SALEM, MASSACHUSETTS '� BOARD OF HEALTH • • 120 WASHINGTON STREET, 4TH FLOOR SALEM, MA 01 970 TEL 978-741-1800 FAX 978-745-0343 STANLEY LISOVICZ, JR. JOANNE SCOTT. MPH. RS, CHO MAYOR HEALTH AGENT APPLICATION FOR A MOBILE FOOD SERVICE PERMIT �1/ /, Fee $150 payable to The City of Salem, No Cash Name of Applicant lke(/JN ///�z/- Cz/o S Telephone# 92g�--533= (n 9F1� Address er J,/), SS Certified Food Manager �it U (4- I�// r4 /17S Certificate # Name of Business ��i SSJ/ C/7liSS/S � Telephone# 9 3Gd 3�'�� Address 5 n -� �-- Manufacture Frozen Desserts? Yes No L� TypeofVehicle 35-0 EGo�o� /�P'KRegistration# Location of Operation ow ✓hc // f�'�tit4,ti- Name & Address of Licensed Food Service Establishment Serving as Base of Operation (- o<:�Le-- o " s Telephone#;r7F- 25-e' -/ dov Location of Toilet & Handwashing Facilities Menu5alvs�gP I-a-�s� SQJ�rZZcC� Type of refrigeration: Ice V Dry Ice Gas Other o Method for Cooking and/or Hot Holding: Gas _ Other Method for Sanitizing Chemical Li Hot Water (170 F) I have read and agree to abide by The Salem Board of Health Regulations regarding "Mobile Food Units & Pushcarts" and will notify the Salem Board of Health of any changes in this application Pursuant to MGL C62C,S49A, I certify under the penalties of perjury that I, to my best knowledge and belief, have filed all State tax returns and paid all State taxes required under law Signature Social Security# or federal I Dll Date G /� � ---------------u-- -- / Reri.nl '_/7/111 I'u nul r /V Je hCC1,,1& Hale '7(�y ��✓J_. ` 7 CITY OF SALEM9 MASSACHUSETTS BOARD OF HEALTH 120 WASHINGTON STREET, 4TH FLOOR SALEM, MA 01970 TEL. 978-741-1800 ,,pp,, FAX 978-745-0343 STANLEY J. USOVICZ, JR. JOANNE SCOTT, MPH, RS, CHO MAYOR HEALTH AGENT COMMONWEALTH OF MASSACHUSETTS PERMIT TO OPERATE A MOBILE FOOD SERVER In accordance with Regulations promulgated under authority of Chapter 94, Section 305A and Chapter 111, Section 5 of the General Laws a Permit is hereby granted to: Applicants Name: Kevin Kefalas Name of Establishment: Classy Chassis Cart #3 Whose Place of Business is: 4 Azalea Lane, W. Peabody, MA Date: 6/7/05 To Operate a Mobile Food Server in Salem Restrictions: Permit #: 011-05M Frozen Desserts/lee Cream: PERMIT EXPIRES: December 31, 2005 HEALTH AGENT u CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH 120 WASHINGTON STREET, 4TH FLOOR SALEM, MA 01970 TEL. 978-741-1800 FAX 978-745-0343 STANLEY LISOVICZ, JR. JOANNE SCOTT. MPH, RS, CHO MAYOR HEALTH AGENT APPLICATION FOR A MOBILE FOOD SERVICE PERMIT �F+ee150 payable to The City of Salem, No Cash Name of Applicant �l/�N /" /!�A 5 Telephone# 91-%--13-17- Address 3-1=Address q pz_ 4 /v0[__ / �, A✓le�., �po>6 a� SS Certified Food Manager �q.v / �,e- I 6z-r—q �AS Certificate # Name of Business e—, l4 SS CITAiSS/S3 Telephone# 9 3�d 3699 Address Sa Manufacture Frozen Desserts? Yes No 1� Type of Vehicle 35-6' e6'^ J Apz Registration# Location of Operation o.✓ i'hQ // 'v4,-o%v Name & Address of Licensed Food Service Establishment Serving as Base of Operation (�_7o<lLGo 'S Telephone#19`7F- 7S 'd -/ a00 Location of Toilet & Handwashing Facilities Menu Sit v sOL-ytf -(l c�� sG.-Na��5 - 1�rrn - 5�� ,e a Vyf/ Type of refrigeration: Ice I/ Dry Ice Gas Other `,.m,e-4d2 Method for Cooking and/or Hot Holding:/ Gas Other Method for Sanitizing: Chemical 1/ Hot Water (170 F) I have read and agree to abide by The Salem Board of Health Regulations regarding "Mobile Food Units & Pushcarts" and will notify the Salem Board of Health of any changes in this application. Pursuant to MGL C62C,S49A, I certify under the penalties of perjury that I, to my best knowledge and belief, have file//d all State tax returns and paid all State taxes required under law. 1� 702.3 032 - �/l0 Signature Social Security# or Federal ID# Date -------------------------------------------------------------^----------------------------------------------------------- Revlscd 2/7/07 rermnd 611-'On ChcckN&Date 4/56 CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH s 120 WASHINGTON STREET, 4TH FLOOR SALEM, MA 01970 "r o TEL. 978-741-1 BOO FAX 978-745-0343 STANLEY J. USOVICZ, JR. JOANNE SCOTT, MPH, RS, CHO MAYOR HEALTH AGENT COMMONWEALTH OF MASSACHUSETTS PERMIT TO OPERATE A MOBILE FOOD SERVER In accordance with Regulations promulgated under authority of Chapter 94, Section 305A and Chapter 111, Section 5 of the General Laws a Permit is hereby granted to: Applicants Name: Kevin Kefalas Name of Establishment: Classy Chassis Cart#1 #597-095 Mass Whose Place of Business is: 4 Azalea Lane, W. Peabody, MA Date: 4/14/2004 To Operate a Mobile Food Server in Salem Restrictions: Sausage, Kielbasa, Hot Dogs, Drinks, Chips. Permit#: 004-04M Frozen Desserts/Ice Cream: PERMIT EXPIRES: December 31, 2004 C' HEALTH AGENT CITY OF SALEM, MASSACHUSETTS ( d!•} �vQ' BOARD OF HEALTH ll� 2 ig e 120 WASHINGTON STREET, 4TH FLOOR SALEM, MA 01970 TEL. 978-741-1800 FAX 978-745-0343 n� STANLEY LISOVICZ, JR. JOANNE SCOTT, MPH, RS, CHO /i G•` MAYOR HEALTH AGENT APPLICATION FOR A MOBILE FOOD SERVICE PERMIT e $150 payable to The City of Salem, No Cash Name of Applicant K 2 it nJ ��G /9 S Telephone# 97)�- 36o -36079/ Address A2AGe ►�/ Certified Food Manager P2 v ! _roq l/A S Certificate # ac 5; GOAVC- _369 Name of Business G� ss y Ha r � Telephone# Spy-36a Address S y Manufacture Frozen Desserts? Yes No Type of Vehicle Z,40 � &1 < 1' Reg1istration# Location of Operation �SS�X 5' � wig i l Name &Address of Licensed Food Service Establishment Serving as Base of Operation /eo�co 'S - S^,4 Telephone# 97F- 7S—o — Location of Toilet & Handwashing Facilities , ,411////0 Menu 75� v �s Type of refrigeration: Ice 6-f- Dry Ice Gas Other Method for Cooking and/or Hot Holding: Gas Other Method for Sanitizing: Chemicalj�Hot Water (170 F) I have read and agree to abide by The Salem Board of Health Regulations regarding "Mobile Food Units & Pushcarts" and will notify the Salem Board of Health of any changes in this application. Pursuant to MGL C62C,S49A, I certify under the penalties of perjury that I, to my best knowledge and belief, have filed all State tax returns and paid all State taxes required under law. 032-/�— 7� 23 Signature Social Security#or Federal ID# Date ---------------------------------------------------------------------------�- -- /----------------- ----------------------- Revised: 2/7/03 Permit# Check#&Date-*is-oc? CITY OF SALEM ' /� / BOARD OF HEALTH Establishment Name:- -S / ( "ham. S�iS Date: 5�� i/t</ Page: of f Item Code C-Critical Item ! DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date No. Reference R—Red Item Verified PLEASE PRINT CLEARLY / 1_�G Z, i1J7JlJ L_l. /P Lias I I ✓ rl 1�IP/il,!/1//J4P 7 754. J(Jv f 5f.��.S I 1 Discussion With Person in Charge: Corrective Action Required: I ❑ No I ❑ Yes I have read this report, have had the opportunity to ask questions and agree to correct all ❑ Voluntary Compliance ❑ Employee Restriction/ Exclusion violations before the next inspection, to observe all conditions as described, and to ❑ Re-inspection Scheduled ❑ Emergency Suspension comply with all mandates of the Mass/Federal Food Code. I understand that noncompliance may result in daily fines of twenty-five dollars or suspension/revocation of ❑ Embargo ❑ Emergency Closure your food permit. 0 Voluntary Disposal ❑ Other: ( '.-``�[.i <:'{.: PFiFS t2ecen^d.n Temperatures Violations Related to Foodborne Illness Interventions and Ris,4 Accord;ng to 1s w Cooled to Factors(items 1.22) (Cont) »I'Pt45'F iVrtbin 4 Hours, PROTECTION FROM CHEMICALS 1 3-50L!ti (?c,olin- 1.1e:t.ds Wr Pf31'e 14 19 i F'HF Hot kind Cold Holdi;:g Food or Calor Additives .9-20'.12 At(ditive:r` 3-50 i.166) CJd Pill's Maintained at or below 59000.3(F) 4)-j'-U'F" 3-,02.14 Protection front l:nultpnned Additives* t-SDI Ifi:A) lint PHFs 5^,sintamed xt,:r above j 15 Poisonous or Toric Substance& ! - 7-101.11 Identifym Ltforio,mon-Original I i410 F. Coutainers" 13-501 MIA Roasts Heb;at or above 130'F. 7-102 if Common Nsnd-`+'r'�n4;int, Coiawners' � ' 20 M T!me as a a��;p;,c Health Control ?-2o I.I I Separotio*.-Stcn.are': 3-:101.10 Time an a Ftthl;c'0CI!tlt Conttot" 7-202.t I Restriction-Presence and Use* � ( Syrl 41.R) V`H iance Requirement 7-20112 Conditions of U3c' 7-203 11 Toxic Conta;net,--PoIniniti,ms" REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS i14:SP) 7-204.1 i 5,:::itizeo,.Criteria-Chemicals* - 7-2(4 12Cheuncals for Washing F`rtxlnec.Ctueria" 121 3-$01.! I(A) Unpasteurized Pre-packa€ted juices and 7-204.1.1 DivinlAMents.Cnrenr•" � I Beve;a;teswith N•iu-ntn%lnbels� -- cd Contac:. I ubrwtlnr" 13-80!.11(B) ('!.:o[Pasteurized ',-205.1 I !rcidcnta1 ��.;-� 7-206,11 Restricted Use Pesticides.Criteria* 3-801.1 III)) Paw or Pa tially Cooked An:olal Fcwd.Md 7-206.12 Rodent Beit St A)URS'" Ret+'Seed Stxouts N.,t Served. 7-204 13 Tracking POWders,Pest Contro'; and ;-8t)L I1(CI I Unopened Food PaAage Net Re-served. " :donitorrng'^ CONSUMER ADVISORY TIMEITEMPERATURE CONTROLS 22 3-603-11 Consumer Advisory Posted for Consumption of (b i Prooer Cooking Temperatures for Anima Foods'Fhat arc Raw. Undo;cuoked or I � PHFs Not, therwi::e Processed to Fbrrunatc Patho?em.^ ererv.:;.sur, 3-40L 11 AH)(2) Eggs- 155°F 15 Sic. 3.102.13 {'asteurizcd Eggs Subsriurtc•for Raw Shell Eggs-hmnedime Service 145°F15sec' 3-40LII(A)(2) Comminuted Fish, Meat:8aGame Eggs Aninatils- 155"F 4 c sec. " #01.11(,6 i I) t) P„ * SPECIAL REQUIREMENTS 3- ) (_ rk a,td 13ec1 Roast- i30`F 1_l min .590.009(A)-CD) Vi c 3101.1 I(Al(2) Ratites, Injected Meats- L55"F 15 olattons of Section 5)0.409(A)-(ll) in t1. catering mobile ftxul,temporary and 3-401.11 NON Poultf Wild name Stuffed ,'HFs, resWeeiial kitchen operations should be Stuifln1 Cumaming Fish,t,4cm, debited under the appropriate sections Pouitry or Ratites-165°F 15 sec '^ above if related to foodhorne illness 3-}01.11(C)(3) Whole-nurselc, intact Beet Steak; inlervettioCS and trci, faciors. Other 145°17"' , 594.0)09 violations relining to good retail 3-401.12 Raw Animal Fouds(coke,]in a I practices should be dehited under#29- Miciowave 165`0 x Special Rs7uiremettts. 3-a0I.1l(A)(1)(h) AllOthe,PHF's- 145'F 15 see. '' r Reheating for Hot Holding VIOLATIONS Ficl-ATED TO GOOD RETAIL PRACTICES 3403 if(A)&(D) PHFs 165'F 15 sec. * (!te=ns 23-30) -403.11 r B) Mi,aowave- 165` F 2 Minute Standing I %;riG,,ei and non-crithal .ar(nrr,;c;, nir,ua do nut a,file Ti mc" ,foodborne Hlnnvs iron veatr,.n:,uncirisA-Jirc tura listen amore. Inn he 3-403.11(C) Cimtmetcudly Processed RTE Fuad- I ,found in the Jei!nt,ing gtr timaa of'he Food Code nu.-,,•105 CMI? 140'14T 590 0110. 3-101.11(1:) Remaininf;Unsliced Portions of Beof ':, Item Good Reta)I Practices FC 590.000 Roasts' 23. Manacement and Peracnn?I FC-2 .003 18 Proper Cooling of PHFs ( 24. Food and Fond Prctect,on FC-3 .004 25. EcdornArt anti Utensils FC -t .005 3-SOLI4C A) Cooling Cooked PHFs from 140'F to 25. Watr-r.F'luma:nq a ad Waste FC--S ,OOc--_---- 70°F Within 2 th:nr:anti From 70'1 ' 27 Prys.cal FaciaA, FC-6 .007 to 41 F/4,3'F Within 4 Flours. " ( 26. Poisonous or'roxc M r'.eritO FC -7 .008 _J 3-501.141 B) Cooling PHFs Marie From Ambient ( 29 Special Reowrome:is .009 Temperature ingredients to 4)`F'/45°F 30 Omer til';titin 4 i lours:, r, 'Deaoir:email ih:m In Ole('&decal IgOq Food Codeor 105 CMR 590 000, 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 MOBILE FOOD SERVER In accordance with Regulations promulgated under authority of Chapter 94, Section 305A and Chapter 111, Section 5 of the General Laws a Permit is hereby granted to: Applicants Name: Kevin Kefalas Name of Establishment: Classy Chassis Cart#2 Whose Place of Business is: 4 Azalea Lane, W. Peabody,MA Date: 6/24/2004 To Operate a Mobile Food Server in Salem Restrictions: Sausage, hot dog, kielbasa, chips, drinks. Permit#: 010-04M Frozen Desserts/Ice Cream: PERMIT EXPIRES: December 31, 2004 HEALTH AGENT o CITY OF SALEM, MASSACHUSETTS A YX BOARD OF HEALTH 016 A V 120 WASHINGTON STREET, 4TH FLOOR s SALEM, MA 01970 yep TEL. 978-741-1800 FAX 978-745-0343 STANLEY USOVICZ, JR JOANNE SCOTT, MPH, RS, CHO MAYOR HEALTH AGENT APPLICATION FOR A MOBILE FOOD SERVICE PERMIT Fee $150 payable to The City of Salem, No Cash Name of Applicant Ice/ wN ��efc%s S Telephone# 979- -5 GF / Address + 2 ,rZ.e A__ /_.,,, tie- ll�eo, �O, A",-4-s-s Certified Food Manager /a1.1Q 4�9 .95-5- � Certificate # Name of Business C41,05.-%y � gSS1S r' o W GO,vC • Telephone# Address A- e� Manufacture Frozen Desserts? Yes No Type of Vehicle &m e T�v c K Registration# Location of Operation r lk?all 0r G- N Name & Address ofLicensed Food Service Establishment Serving as Base of G Operation os c c 's Telephone# 57,9- Location of Toilet & Handwashing Facilities wvSQ _' /7d7J7 J (��o�dlTG —G'7l�S ..// �'� ✓`l5 Menu Type of refrigeration: Ice DryIce Gas Other Method for Cooking and/or Hot Holding: as P� Other Method for Sanitizing: ChemicalGHot Water (170 F) I have read and agree to abide by The Salem Board of Health Regulations regarding "Mobile Food Units & Pushcarts" and will notify the Salem Board of Health of any changes in this application. Pursuant to MGL C62C,S49A, I certify under the penalties of perjury that 1, to my best knowledge and belief, have filed all State tax returns and paid all State taxes required under law. lJ Q Z 5/ Zo° Signature Social Security#or Federal ID# ,Date -------------------------------------------------------------- ------------------------------------------------------ Revised. 217103 Permit# Check#&Date a TL Y, CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH $ 120 WASHINGTON STREET, 4TH FLOOR SALEM, MA 01970 TEL. 978-741-1800 Qiyp� FAX 978-745-0343 STANLEY USOVICZ, JR JOANNE SCOTT, MPH, RS, CHO MAYOR HEALTH AGENT MOBILE FOOD UNITS & PUSHCARTS REQUIREMENTS These regulations are in accordance with The State Sanitary Code of the Massachusetts Department of Public Health, 105 CMR 590.029. The Board of Health may impose additional requirements to protect against health hazards related to the conduct of the mobile food unit of pushcart and may prohibit the sale of some or all potentially hazardous foods. Therefore the Board of Health reserves the right to make individual determinations on each application. Such determinations will be based on good judgement and sound public health information. FOOD MANAGER CERTIFICATION IS REQUIRED OF ANY UNIT WHICH PREPARES POTENTIALLY HAZARDOUS FOODS. Requirements of All Units All units must comply with the following: • Mobile food units and pushcarts shall operate from a fixed, licensed food establishment and shall report at least daily to such location for all food, supplies and all cleaning, sanitizing and servicing operations. The name and address of that licensed establishment will be required on thea application form and will be subject to PP J verification. • All units are required to have and use a food thermometer to check heating and holding temperatures. • All units shall obtain the use of toilet facilities where hand washing is available. All operators shall wash their hands after using toilet facilities and before returning to work. • All operators shall be clean in dress and appearance. • The Mobile Food Service permit shall be prominently displayed on the cart or unit. • All units must have refrigeration available which will maintain all potentially hazardous foods at a temperature of 40 F or lower. All units must have wiping cloths in sanitizing solution at the concentration recommended by the manufacturer for that purpose. This solution shall be commercially prepared or made fresh daily. A log of the verification of the concentration by test strips shall be maintained and available to inspectors. • The name of the owner and/or business and the address shall be displayed, in letters not smaller than three inches in height, on the left,and right panels or doors. REQUIREMENTS OF BASIC UNITS: Basic units are limited to the service of hot dogs and/or to the service of wrapped food prepared at a licensed food processing, food service or retail food establishment. REQUIREMENTS OF MODIFIED UNITS: Modified Units may serve pre-cooked sausages, in addition to the items listed under "basic units" if the following additional requirements are met: • Modified units shall work from a base of operation which also includes a "unit servicing area" with overhead protection, a location for flushing and drainage of waste liquids, a separate location for water servicing and the loading and unloading of food and supplies. • Modified units must have equipment which allows the rapid heating and hot holding of potentially hazardous foods. • Modified units shall have a water system supplying hot and cold potable water under pressure-in sufficient quantities to allow for washing and sanitizing of all equipment and utensils. • Modified units shall have a three compartment sink large enough to immerse most equipment and utensils. All washing shall be done in detergent water at a temperature of 110 F. • Modified units shall sanitize all equipment and utensils by immersion in a sanitizing solution or in water at a temperature of 170 F, or by swabbing with a sanitizing solution twice the strength of that used in immersion. Test strips shall be used to verify the strength of chemical sanitizers. • Modified units shall store waste water in a permanently installed retention tank having a capacity of at least 15% larger than the water supply tank. Modified units shall have the waste connection located lower than the water inlet connection. The Board of Health may consider the preparation of raw sausage, chicken or hamburg foods, if the Health Agent determines that such preparation would not jeopardize the Public Health and if there is strict adherence to the preceding and following requirements: • Only one such food item may be cooked on a cooking surface, such as a barbecue or grill. • No other food, including hot dogs, may be heated or served from that cooking surface. • Separate utensils for each item must be used. • These foods may not be held longer than one hour before being served. • Food thermometers shall be used to be certain that the food is thoroughly cooked to an internal temperature of 140 F throughout. These thermometers must be sanitized after each temperature reading. Revtsea 1012 s CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH gF 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 MOBILE FOOD SERVER In accordance with Regulations promulgated under authority of Chapter 94, Section 305A and Chapter 111, Section 5 of the General Laws a Permit is hereby granted to: Applicants Name: Kevin Kefalas Name of Establishment: Classy Chassis Cart#3 Whose Place of Business is: 4 Azalea Lane, W. Peabody, MA Date: 6/24/2004 To Operate a Mobile Food Server in Salem Restrictions: Fried Dough, Fresh sqezzed lemonade — drihks (Richie's Slush) Permit#: 011-04M Frozen Desserts/Ice Cream: PERMIT EXPIRES: December 31, 2004 HEALTH AGENT r CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH ° a 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 APPLICATION FOR A MOBILE FOOD SERVICE PERMIT able to The Cit of Salem No Cash Fee $150 pay y Name of Applicant i(-/R1V/N 4-rq Iq S Telephone# 97F-S2 -6 Fe y Address DeI, A. ,//- rn �s3 Certified Food Manager 1<�,•Fcr to S Certificate # Name of Business G/R S 5� CA,ssi s 01V 2°'—Telephone# 97�- 3(0 0 -36 Address S r4 m Manufacture Frozen Desserts? Yes No Type of Vehicle 6—Y" c t-e- !L Registration# Location of Operation r,ti /97a// Name & Address of Licensed Food Service Establishment Serving as Base of Operation 's Telephone# 97- - Location of Toilet &/Handwashing Facilities ry la l/ Menu �i^i�D 7� o vet� C�ic�Ip S S/�S�J Type of refrigeration: Ice ///Dry Ice Gam_ Other Method for Cooking and/or Hot Holding: - Gas // Other Method for Sanitizing: Chemical 4�' Hot Water (170 F) I have read and agree to abide by The Salem Board of Health Regulations regarding "Mobile Food Units & Pushcarts" and will notify the Salem Board of Health of any changes in this application. Pursuant to MGL C62C,S49A, I certify under the penalties of perjury that I, to my best knowledge and belief, have filed all State tax returns and paid all State taxes required under law. /S ILU�!-� 4 Z/1 2a o / Signature (l Social Security# or Federal ID# Date ----------------------------------------------------------g--�--�5---�---------- - --�p---------------------------------- Revised. 2/7103 Permit q Check4&Date �594P6 —6 o7S-O / Ape13a • � n l CITY OF SALEM, MASSACHUSETTS v BOARD OF HEALTH • • 120 WASHINGTON STREET, 4TH FLOOR SALEM, MA 01970 ,p�, TEL. 978-741-1800 4'� FAX 978-745-0343 STANLEY USOVICZ, JR. JOANNE SCOTT, MPH, RS, CHO MAYOR HEALTH AGENT MOBILE FOOD UNITS & PUSHCARTS REQUIREMENTS These regulations are in accordance with The State Sanitary Code of the Massachusetts Department of Public Health, 105 CMR 590.029. The Board of Health may impose additional requirements to protect against health hazards related to the conduct of the mobile food unit of pushcart and may prohibit the sale of some or all potentially hazardous foods. Therefore the Board of Health reserves the right to make individual determinations on each application. Such determinations will be based on good judgement and sound public health information. FOOD MANAGER CERTIFICATION IS REQUIRED OF ANY UNIT WHICH PREPARES POTENTIALLY HAZARDOUS FOODS. Requirements of All Units All units must comply with the following: • Mobile food units and pushcarts shall operate from a fixed, licensed food establishment and shall report at least daily to such location for all food, supplies and all cleaning, sanitizing and servicing operations. The name and address of that licensed establishment will be required on the application form and will be subject to verification. All units are required to have and use a food thermometer to check heating and holding temperatures. All units shall obtain the use of toilet facilities where hand washing is available. All operators shall wash their hands after using toilet facilities and before returning to work. All operators shall be clean in dress and appearance. • The Mobile Food Service permit shall be prominently displayed on the cart or unit. • All units must have refrigeration available which will maintain all potentially hazardous foods at a temperature of 40 F or lower. All units must have wiping cloths in sanitizing solution at the concentration recommended by the manufacturer for that purpose. This solution shall be commercially prepared or made fresh daily. A log of the verification of the concentration by test strips shall be maintained and available to inspectors. • The name of the owner and/or business and the address shall be displayed, in letters not smaller than three inches in height, on the left and right panels or doors. REQUIREMENTS OF BASIC UNITS: Basic units are limited to the service of hot dogs and/or to the service of wrapped food prepared at a licensed food processing, food service or retail food establishment. REQUIREMENTS OF MODIFIED UNITS: Modified Units may serve pre-cooked sausages, in addition to the items listed under "basic units" if the following additional requirements are met: • Modified units shall work from a base of operation which also includes a "unit servicing area" with overhead protection, a location for flushing and drainage of waste liquids, a separate location for water servicing and the loading and unloading of food and supplies. • Modified units must have equipment which allows the rapid heating and hot holding of potentially hazardous foods. • Modified units shall have a water system supplying hot and cold potable water under pressure in sufficient quantities to allow for washing and sanitizing of all equipment and utensils. • Modified units shall have a three compartment sink large enough to immerse most equipment and utensils. All washing shall be done in detergent water at a temperature of 110 F. • Modified units shall sanitize all equipment and utensils by immersion in a sanitizing solution or in water at a temperature of 170 F, or by swabbing with a sanitizing solution twice the strength of that used in immersion. Test strips shall be used to verify the strength of chemical sanitizers. • Modified units shall store waste water in a permanently installed retention tank having a capacity of at least 15% larger than the water supply tank. • Modified units shall have the waste connection located lower than the water inlet connection. The Board of Health may consider the preparation of raw sausage, chicken or hamburg foods, if the Health Agent determines that such preparation would not jeopardize the Public Health and if there is strict adherence to the preceding and following requirements: • Only one such food item may be cooked on a cooking surface, such as a barbecue or grill. No other food, including hot dogs, may be heated or served from that cooking surface. • Separate utensils for each item must be used. • These foods may not be held longer than one hour before being served. • Food thermometers shall be used to be certain that the food is thoroughly cooked to an internal temperature of 140 F throughout. These thermometers must be sanitized after each temperature reading. Reused IWOM8 ( IMPORTANT MESSAGE ) ` FOR /p�f`_ A.M. DATE TIME OF PHONE= AREA CODE NUMBER EXTENSION ❑ FAX ❑ MOBII F AREA CODE %ll IRER TIME TO CALL TELEPHONED I PLEASE CALL 4 CAME TO SEE YOU I WILL CALL AGAIN WANTS TO SEE YOU I RUSH RETURNED YOUR CALL WILL FAX TO YOU f MESSAGE A/!✓1 ��C/J'� V SIGNED �� FORM 400 MARE IN 00 NOTES CITY OF SALEM // BOARD OF HEALTH Establishment Name: e,4-?_c&,1Okr<SVs ( ,3 ) Date: — 7-OS Page: / of / Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date No. Reference R—Red Item Verified PLEASE PRINT CLEARLY U Axe-0A n//vA Aoc 'r re of 7 v_ 7��Pe �LQS�y CAS.('iC 1r 7-Z7L i,>l x .l/iV4 U/P,0,e AeY70- ' 1 /Pplr.rJ✓ r /Al C19y,/411 I mirIly 07,p7' 771 /�P s��u.pv�� Y ,�irta�7'i2�Gl 1 6,eS7'a/D SU Z24LIPS &144- f Z ��WWIIW oZW- o� o.� 'I/77/a us�a ~-4. S'.t,.rn.nKi rAar' SILn r`f¢kIQ N 1 1 1 I 1 Discussion With Person in Charge: Corrective Action Required: I ❑ No ( ❑ Yes I have read this report, have had the opportunity to ask questions and agree to correct all ❑ Voluntary Compliance ❑ Employee Restriction/ Exclusion violations before the next inspection, to observe all conditions as described, and to ❑ Re-inspection Scheduled ❑ Emergency Suspension comply with all mandates of the Mass/Federal Food Code. I understand that noncompliance may result in daily fines of twenty-fiv dollars or suspension/revocation of ❑ Embargo ❑ Emergency Closure your food permit. /C/ ❑ Voluntary Disposal ❑ Other: -50; :4(0 PIFs Retermri ,n Tumo,,ratures Violations Relatea to Foodhorne Illness Interventions and RhA According to i.aw Cooled [u Factors(Items 1.22) (Cont.) 41`17145`F lk idurt 4 Homs. 3-500.15 Cooliniz,Medinlc for Prff;s PROTECTION FROM CHEMICALS t9 PHF Hot and Cold Holding 14 Food or Color Additives 3-501.161B) Cold PHP,Vuintainedatoiblow 3-202.12 Addimes" G9U.U0-1(F) .};'(.9s' 3-302.14 Protection uOul unapproved Additives' 1 13.5p1 Ifi(.4) Hut PH Fc Ivlaint.nnetl at or above pj Poisonous or Toxic Substances ( 141, ,F ., 7=1{)1.11 Containing lnfbruutinn-Ortg;nai ( 3-g01.16(A 1,C 1 Container.,'" � ) l koasis Heid at or abrr-; 3,` +, j 7"102.11 Common Narne-%ax ink C'rraminers'" ; j 20 ( � Time as a Public Health Control 1 7-201.11 Separation-Sica nee, ( 3-501 11) 'Time a:.a i',1bh,.T-iealih Connell' 7-202.11 Restriction- Preserver:utd Use 59U.004(H) VaranceRequirement 7-20-1.12 Conditions of 1-kc, REQUIREMENTS FOR HIGHLY SUSCEPTIBLE r-^_(1303.1 11 '(oxicContainerr'-!'ruiun,bons" ! POPULATIONS(HSP) ' 7-2U4.I I Sanitizers.Criteria-C'hetnic ds^- ??04.12 Chemicals for b'shm�•Prndoce.Cr!te:is"' 'i --SA I t,A) LhifnAounzed Pre-pxclaged Juices are! 7-204.14 Dr'ing Aeents��.Cruena' Bevertees with W.,jming I.tbc!c' 7-205.11 IncidentalEoodConatr•;,Lubricants* ;-801.11(B) Csr.ofPasteuiisedE_gs' � 7-20ti.11 Rzstrietedl.'sePecticides.Criteria" 3-80:.1!(0) RavorPatt;allpCcokedAajimalFocx7and i 7-206.12 Rocient Ban Slmions- Raw Seed .S'urolns Not Served. 7=206 13 'I7.;cking Pow<irrs,Pr,t Coni':d and j 3-801.11((-') Unopened Ford Package Not Re-served. Monitorin;,^ i CONSUMER ADVISORY TIMEITEMPERATURE CONTROLS 22 3-603.11 ('"sumer Adv1 a)ry Posk-d for Consumption of ' Anim:d Foods That are Raw.Undercooked or 16 I I Proper Cookiog'femperahuas for Not Ou:erwise Processed to Eliminate PHFs � 3401.11A(1)(2) ( Gggv- 155°F 15 Sec. ladioe-,ns." '- Eggs-framediarc Service 145'F15sec* i 3-30?.t5 Pasteurized Eggs Substitute for Raw Shell 3-401.11(Al(2) ( Comnumo;d Fish, Mew,&Citntte Animak- 155-F 15 sec. 3-401.1 )l )( SPECIAL REQUIREMENTS 4J1.11(B 1 2) � Pork and Beef Roast � 130'F 121 tn:n 3-401.11(A)(2) It,Niy:;; injeted ideats-- 155°F 15 )')O.00Q(A)-(D) Violatio>, of Section 590.009(A)-(L)) in sec. , catering. mobtle food,temporary and 3-401.11(A)(3) Poultry. Wild Game. Stui led PHFs, resii.cutud Latchett Orcratians should be Stuffing Containine,Fish,Meal, debited under the appropriate stc6ons PouhrS nr Ratites-165'F 15 see. ' above if related to foodborne alness 3-401.11(("j(;) '`'hole "oasc:e,Intact Ht'ci %cak: lntervCRtioris an,I risk factor3. Other 145'F 590.009 violations relating to good retail 3-401.1:'. Raw Animal Poexls Cooked in a practices should be debited under#.^_9 -- tvhuowavc i65`1• * j snec;a; Acquirements. 3-401.11(A)(1 ab) All Other PEIF;.- 145'F 15 sec. * j 17 Reheating for Hot Holding VIOLATIONS Rt LA TED TO GOOD RETAIL PRACTICES 3-403.11(.A)&(D) ( PHFs 165"I' 15 sce. i (Items 2.3-30) 3403.11(B) A4icrost ave- 165"F 2 M1hnure Standing Cr itrc rd and nor ritual violation-v. uduch do not relate to the Time' ;ie dUorr:^ilLacss inoliventioas curd risk furors listed above, ton be ,403.11 f C) Commercially Pi o,,e!.sed RTC Foo- lurrnd nr the Ii)llon-irrg sertinn.t of the Fond Code and 105 C'A9R 1.10°F" Sr,O 000. i:insoTcn'- 03Ulttem Good Retail Prarelres ! FC 1380.000 M1". Roasts"' I __2I anagm eert and?ersonne' FC-2 .003 __I 18 Proper Cooling of PHFs 12a_1 Fail spa Food Protection FC-3 .ow, 1 3-501 14(:1) Cooling G:oked PHFs from 1400P tr, 6 -E-dprnert an-.j Ulensis FC-4 .0052 . 'hater,Fiumbinq Pod Waste FG-5 006 701 F Within 2 hours and From 70`F I , _ FC- i 27. Fhv_ica.I-acility c, 6 .007 to 41'F1450r Within 4 Hours. ` (, 28. Poisunoas or 70,1c Valem is FC .003 3-501.14(B) ) Cooling PHP:,Made Flom Ambrerl 29. Sot tial Req.aerrlenis ung Temperature fit-edients to 41"Fa45'F 1 30. Other Within 4 T!uurs Denate+enucal itch m Ihr feder,:l ;99u:oral C,xie or 105 f'P+IK 5ui10(u,. ( IMPORTANT MESSAGE ) FOP .>ylI DATE -2-lv�� TIME M OF PHONE AREA CODE NUMBER EXTENSION D FAX D MOBII F AREA CODE Ny1 MBER TIME TO CALL TELEPHONED PLEASE CALL CAME TO SEE YOU WILL CALL AGAIN WANTS TO SEE YOU I RUSH RETURNED YOUR CALL ( WILL FAX TO YOU MESSAGE � SIGNED �p•��,.[� � FORM 4009 Mops®C MADE IN U S A 4 � NOTES _ CITY OF SALEM BOARD OF HEALTH Establishment Name: �)a S5 y ��1 a�5 is Date: 3' Page: of Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date No. Reference R—Red Item Verified PLEASE PRINT CLEARLY ern rEa�a /is . ,�rv�ce. o•l' C10t>5v Ck& d j 4V f-hQ&_ /moi 4c. 4 VOfCe I A) I e�w /21a-rye-,e5 Ic I I I ► //� %. 1 Discussion With Person in Charge: Corrective Action Required: I ❑ No ❑ res I have read this report, have had the opportunity to ask questions and agree to correct all ❑ Voluntary Compliance ❑ Employee Restriction/ Exclusion violations before the next inspection, to observe 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: PMI's Received,it Tcuperatores Violations Related to Foodborne Illness Interventions and Risk ; According to fa•r,Cooled to Factors(items 1.22) (Cont.) ; 4I"F/45°F v'v i±his 4 Hours. I 3-50! 15 Coming Methods for H^s PROTECTION FROM CHEMICALS i9 PlIF Hot and Cold Holding 14 I j Food i es"Color Additives 2 501.16(6) Cold PHP:. Maintained a; or below 3-202.12 Add � itivj 590.00-4(I') tl'/45`' 8 3-302.14 Protection froth UD,jopr+-t-ed Additives,* ( 3.501.ifi(s,i lint PI-IF:. Mainteiaed at orabove t5 Poisonous or Toxic Substances j 7-101.11 Identifying lnfornwt)o!,-Or vnnal 14WF" i Containers' -501.16(,0 Rumis Held at or above 130°F. � j 20 Time as a Public Health Control j 7-IO2.11 Common Nam:: - Wotkin;;Crntntinc'rs* 3.-- 1'7 Time as a Public Health Control* j j 7-201.11i .Ceparation-Storaea' j ; 7-202.11 ( Restrictmir-Presrnee and Use* j ! '`J0.004(H) Valiance Requirement j j 7-202.12 j Conditions of Usu* j 7=_'03.11r,xic Containers-Prohibitions* j REQUIREMENTS FOR H?GHLY SUSCEPTIBLE ( 7-101,11 Sanitirers.Criterta-Chamads^ j POPULATIONS(HSP) 7-'_04.12 j Chemicals for Washing Produce, Criteria 21 3-30!.11(A) Lnpasleun;ed Pre-packaged Juices and 7..20.1.14 j Drving Agents,CriteinO ( Bevetaacs with Warning I abel.s#s - 72(15,11 ( ht6denudFood Cnutact. Lubn:ants^ ?-3O1 11(0) Use of Pastea:'ized Eons' 3-S01 i 1t t3) Raw or Part;a;1 Ccxrked Anocal Food and 7-206.! I Restricted tine Pesuc:des Cnrerta' i Raw Seed Sprouts Not Served. # j 7-206.12 , Rodent Bait Stations 3-80!.;l(C) Unopened Pool Package Not Rc served. 206.13 ; 'tYackutg Powders,Pest Control uric ( - A4ottitnrin:,'^ CONSUMER ADVISORY 2' 3-603.11 Consumer Advisory Posted for Consumption of TIME/TEMPERATURE CONTROLS Animal Food."That are Ravc.Undctcooled or t6 Proper Cooking Temperatures for PHFs Not Oihe-wise Pro.,ssed,o Eitunnrttc 3-401.11 A(I)(2) Eggs- 155''F 15 Sr.. Eggs-bnmediate Service 145715scc; 3-302.i3 Pa:;teunzed Eggs Substitute for Raw Site]] 3-401.1 I(AI(2t Comminuted Fish. Mcata 4 Game I F,gvs" ebtirnals- 155°P !5 sec, " SPECIAL REQUIREMENTS j 3401.11(N)(!)(2) Pork and Beef Roast- 130"'F 121 min" j 59f).Pi09(Ai-(D) Violations of Section 590.009(A)-(Dl in 3-40L11(A)(2) Ratites. injected b'fcals-155"F 15 Sec, v catering. mobile food, temporary and -10111(A)(3) Poultry,Wild Game, Stuffed PHFs, atdd.ntia) kitchen operations ehould he Stu(S'ins Coataining Fish, Meat, debits@ under the appropriate sections Poultry or Ratites-1 0515 sec. * above if related to foodborne Illness 2401.1:(0(31 Whale-muscle, In-met Beef Steaks interveottons and risk factors. Other 145°P" i 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* I Special Rccluirements. 3-401.1 I(A)01(b) 'dl Other PHFs-- !45^F 15 sec. ' j 17 Reheating for Hat Holding ( VIOLATIONS RcLATED TO GOOD RETAIL PRACTICES 141)3.11(A)&(D) PHFs 165''P 15 sec. ( ((tents 23.30) ?-403.11(6) Micsawave- 165` F 2 Minute Standing 1 Ct;ii:a/and no^-rritir:nl��irtia6rms, niri,h do not rrtatc to thn Time' fiwdborne ii/rest interventions end ristJ<«trrrc:ist«d nbnve, can be 3-403.11(C) C)mmen•iaily Prtxecsed RTF Food- rom:d it,the felom inc ceetial.c nJ the,Paid Code and 105 GVR 14W Ft 590.000. 3-dO.l W-) Renutining Uneliced Portions of Neer (teat Gooa Retail Practices FC 590.000 Noes,.;* I ! 23. Idanagemern and Persnnnel Fe-2 .003 j fg Proper Cooling of PHFs 24. Foos and Food Proract cn FC- 3 004 25 Equicment and Utensils FC-4 .005 501 14(;0 Cooling Cooked FHP, from 140'F to 26_ Water, Plumbing anC Waste FC-5 .008 n0-1--Within 2 i lours and From 70°F ?7, PhvsL;31-a'VT tv - F^-6 .OW-- to 007 -to 41'-P/45"F Within 1 Hours. * I 28 Po!soricus or Tcx:c Ltaisdais FC -7 .008 3-50L 14(B) Cooling PHFs Made Front Ambient 29, Soecia!RequvementS _- 009 Tempetatme Ingredients to 41°F/45-F ( 30 Other Within 4llowak i Denote:cnocat ihal m tLr redral 1999 rood rode or 105 0412 590 000. •ce 4 CITY OF SALEM BOARD OF HEALTH Establishment Name: 01a 55q 0 Date: � O S Page: 1 of 1 6 Item Code C-Critical Item DESCRIPTION OF VIOLATION/ PLAN OF CORRECTION Date No. Reference R—Red Item PLEASE PRINT CLEARLY Verified anrASS _4k"'7 PSH � .� �rtln /'lnc/in �2M�+ 1lnq MO"X!� a1�SPr�- /44 .. I/V�14II�✓ ! f?,t�� //00�Ov � r3 r I eNA: a �`✓ as l �i6'04� 's; Alv�e vse - oK v e � ! iPtH l n �tr ok Mum� {u �i.-r I�► 1� ',Sa�,lfi �-,t�.=c.."`n% � ' 11 41 if; 16 A ! Discussion With Person in Charge: Corrective Action Required: I ❑ No I ❑ Yes I have read this report, have had the opportunity to ask questions and agree to correct all ❑ Voluntary Compliance ❑ Employee Restriction/ violations before the next inspection, to observe all conditions as described, and to Exclusion ' p ❑ Re-inspection Scheduled ❑ Emergency Suspension comply with all mandates of the Mass/Federal Food Code. I understand that yourfood noncompliance may result in daily fines of twenty-five s qr pens tion of ❑ Embargo ❑ Emergency Closure our food permit. '�C/ i •,� Ll Voluntary Disposal LlOther: v HF:; Rr;cetveu n Temperatures Violations Related to Foodborne Illness Interventions and Risk - ! Accoa Sang to(a,w Cooled to Factors(items -22) (Cont.) {3^Ft15'F tiild;in4Flouc: ` PROTECTION FROM CHEMICALS 3 :i0;.15 C,oiiae iMethod,for PPFs t9 I PHF H.at slid Cold Holding 114 ! I Food or Color Additives 116,B' Cold Pi(Fs .1 .n Lun_r 3202.12 Additives° '-5rt . , at of below 590.004(1-; 41745` '-, 3-302.14 Protection from iJnauprooed Adddnev"' ;-50!.16(A) Hot PldFs Maint.uned at or above IS Poisonous or Toxic Substances ( 7-101,11 Identifyinelnttsnuaton-Original 3--0 Ibi•A) Rrxtsts_Tellutorabovel3U S !, r, x Containers' . 7-102,11 Co x. ( 20 Time as a Public Heai.n Control Common Name -t oil:rte;Containers" .5:)1.19 Tina as a Public Health CounoP" 7-2u L 11 Sep.r.,doa-SLaaec' 7-262 11 Rectiictton-Prrsrnce and Usc'" 540 004GE, Variam:e Requiteniern 7-2(12.12 Conditions of Use I 7-203.11 Toric Container.-Prohibitions* REOIAREMENTS FOR HIGHLY SUSCEPTIBLE 17-201.11 Saritizets,Criteria-Chemicals' I POPULATIONS(HSP) 1-204.12 i Chemical,for Nashme Produce,Criteria' ! ( 21 3-801 11:,A1 I Unparsteur,zed Pre-packaged,htices and 7-god 1.1 i ! Be�rrages with Warning Label;:,- ( Drrinz Agems.Cnteri:'" ; 3-S'1l Hid, I I ice of Pi:.teurixed Fees` 7 305.11 I intin!ental Food Contact, Lurri-ants' j 3-sl)l 11(D) Raw or Fal t:alis:Cooked.Annual Food and 7-206.11 I Restricted Ilse Pesticides.Criteria" Raw Se,_d S I 7-206.12 ( Rodent Bait Stations' I omnis Not Served. j 7-206.13 9'r ueking Powder;,Pest Couuol and 3-SIP.I!(C) Unopened Food Package Not Re-served. " ( :VTonizoringT CONSUMER ADVISORY TIMF11-EMPERATURE CONTROLS 22 3-603.11 Consul-net Ads ivory Posted for Consumption of Animal FoodL That are Raw,Li'ndercookcd at 16 Proper Cooking Temperatures for ! Not Otherµ,se Processed to Eliminate PHFs Prue;-.ce ;, '--IULI1.4(il(2) Eggs- 15i'F15Sec. Patha; ns.- h Fees- wuediate Sena.;- 145`'1-;5sec+ 3-31>2.13 Pasleurved Eggs Substitute for Raw Shell 3-401.11(AI(2) Comminuted Fish,Mau &Ginn I Eggs,. Ani u:alr.- 155'1- 15 sec. r SPECIAL REOUiRE61EiST5 1-40:.!I(B)11)(2 i Pvrk and Reel Roast- 130"1- 121 min'` I 51 / . -4DL1IGt)(2) Ratites, Injeciedh'leatt.- 155°F T5 0009(A ,D) Violations(it Section 54u.009(A) (1))in sec. catering, mobile food,tempoiaty and 401.11(Ait3) Poultry,Wild Game. Stuffed PHPs, residential kitchen operations should be Stulf og Containing Fish. Meat, debited under the appropriate sccwrns I'oulay or Ratites 165`P 15 sec. * above if related to foudhornc illness 3-401.1.:(6)(3) Wholernusrle Intact Beef Steak; interventions aril risk factors. Outer 145°F,. 590.009 violat!ons relalmg to g rxl retail 3-401.12 Raw Annual Fo;.ds Cooked ina pt'acbces should be debited wider f{29- Mictowave 165`F* Spe:ialRcquiie-'rents. 3-40111(A)(1)(b) All Other PHFs- 1-&F 15 see. '` 17 Reheating for Hct Ho!dmg ViOLATIONS RzILATED TO GOOD RETAIL PRACTICES 't -03.11(A)&(D) PHF;, lhS'F15sec. ' I (items 23-3e;) ."JI(B) Mi.io•wave- 165` F2 Minute Stsading i Ct;tr,.d"Ild non-r•rir6'a! rnrlahTals. which tin not r'i,.te Jr, the TimrJ j,odhnrue ilbu'u iw,-rvoinons :rod risk jdetorn ii.swel abore, can br. 3-403.11(C) Counnercial ly Pr(xecsed RTE Food- round ix!}re lol!ol,ing.tecti:m;,c of die Ford Code and 105 CMR 14WF* j syn,000. !At,0,I I(Ci) Remaining Unsliced Portions of Beef ( Item Gond Retad Practices FC E9Q.000 Ro;Ws' 23. hfannGa sent and Personnel FC 2 .003 1g Proper Cooling of FHFs I i ?4. Foal and Focal Pro?�r;trcn FG- 3 .C(ki GJ. Equipme i and Utensils FG - 005 3-501 i4(,\) Ci`oling Ccokcd I`flbr. Crour 610"F to 2ti. Water, !Iw;7hir:u and Waste Fl --n : ,065-_� 70-F Within 2 llours and From 70°F1 27 Ph1'siaal Facd:ry Ff,-G 100. 1 to 41`F/457 Within 4 Hout s. " ! 28. Pgaonous or Toxic Ivtalerial., FC-- j .008 _ 3-501.14(31,) Cooling PIIFs Made Flow Ambient 29, SoEwia:Rpwremeras .0C9 Temperature htgredients to 41'1-/45-F 1 30. Other Within 41lour,` 11-i TI ' Deno4 cnuca:item IT,1110 i?;"rid :979 Fond('w{e Of til){Cbl(?59;1(106, ( .aMPORTANT MESSAGE ) ICOR i A.M. DATE 71 "'T TIME P.M. M OF PHONE AREA CODE NUMBER EXTENSION ❑ FAX ❑ MOBII F AREA CODE MBER TIME TO CALL TELEPHONED _ �PLFASE CALL CAME TO SEE YOU WILL CALL AGAIN WANTS TO SEE YOU RUSH RETURNED YOUR CALL ' WILL FAX TO YOU MESSAGE �u o r� a SIGNED PQ FORM 4009 `- �I MADE IN U S A 4 NOTES �� E - a �a_ff�draq t-as p�Kr _Zrte spot -Y a "Did n'4 S�atru�cr��e &71-- htr _ t�lv_Q�o u Ota 1a tf2 L. d e --en Spode WDA 3,,2Apm - ,Said fa OJOV1 S I -fu.� �zt,� o P �ctruy�lAtu.1" 1 i Massachusetts Department of Public Health Salem Board of Health 120 Washington Street,4'" Floor Division of Food and Drugs Salem, MA 01970-3523 FOOD ESTABLISHMENT INSPECTION REPORT Tel. (978) 741-1800 Fax (978) 745-0343 Name(' Date Tyne of Ooeration(sl. Type of Insoection /,, .a 9-6 t ❑ Food Service ❑ Routine Address Risk ❑ Retail ❑ Re-inspection G«U_ -� o '/mi/ /�.I Level ❑ Residential Kitchen Previous Inspection Telephone _ Mobile Date:9�R - 535 - lo8'�y M [ OwnerHACCP YM ElTemporary ElPre-operation Ap(/Yt Xe 1(; /a S I ❑ Caterer ❑ Suspect Illness Person in Charge(PIC) {M P Time ❑ Bed&Breakfast El General Complaint In: ❑ HACCP Inspector >�eo n J /). 114as nX1)/1/1 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 Q 13 . Handwash Facilities EMPLOYEE HEALTH PROTECTION FROM CHEMICALS [12. Reporting of Diseases by Food Employee and PIC E] 3. Personnel with Infections Restricted/Excluded E] 14.Approved Food or Color Additives ❑ 15.Toxic Chemicals FOOD FROM APPROVED SOURCE ❑ 4. Food and Water from Approved Source TIMENEMPERATURE CONTROLS(Potentially Hazardous Foods) ❑ 5. Receiving/Condition ❑ 16. Cooking Temperatures ❑ 6. Tags/Records/Accuracy of Ingredient Statements ❑ 17. Reheating ❑ 7. Conformance with Approved Procedures/HACCP Plans �❑� 18. Cooling PROTECTION FROM CONTAMINATION X1'19. 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 E]21. Food and Food Preparation for HSP ❑ 11. Good Hygienic Practices CONSUMER ADVISORY ❑22. Posting of Consumer Advisories Violations Related to Good Retail Practices Number of Violated Provisions Related Critical (C) violations marked must be corrected To Foodborne Illnesses Interventions G immediately or within 10 days as determined by the Board and Risk Factors(Items 1-22): of Health. Non-critical (N) violations must be corrected Official Order for Correction: Based on an inspection immediately or within 90 days as determined by the Board today, the items checked indicate violations of 105 CMR of Health. 590.000/federal Food Code. This report, when signed below C N P 9 23. Management and Personnel (FC-2)(590.003) by a Board of Health member or its agent constitutes an 24. Food and Food Protection (FC-3)(590.004) order of the Board of Health. Failure to correct violations 25. Equipment and Utensils (FC-4)(590.005) cited in this report may result in suspension or revocation of the food establishment permit and cessation of food 26. Water, Plumbing and Waste (FC-5)(590.006) establishment operations. If aggrieved by this order, you 27. Physical Facility (FC-6)(590.007) have a right to a hearing. Your request must be in writing 28. Poisonous or Toxic Materials (FC-7)(590.006) and submitted to the Board of Health at the above address 29. Special Requirements (590.009) within 10 days of receipt of this order. 30. Other DATE OF RE-INSPECTION: S 50MSWIFOi -ir dX Insp CCto[['�s SiCnature• / Print: I Anfl/l 1111 ,i7 V / rv.�sttt'.-0/_h�� 9 PYC's Signature: / Print: ,S Page ofy�Pages Violations Related to Foodborne Illness Interventions and Risk Foctors(Items 1•22) PROTECTION FROM CONTAMINATION FOOD P90TECTION MANAGEMENT j s C; s:;:.rrt.lm:'ra6on j I 590.003(,A) <i t:rentol'fic,:pon>ibilitc 302.: :(.-,}tl) Raw Animal Foa:;Separatediiorn 54U.UO3(fil I Der:n,nr.Gahou u. Ktxswlod ez" Cat}:ed and RTF.FoMs'�` 1 '?- 03 t! Feu.ua In charge-- duties Crnt_e^;insaon,-om.Rav tnyraaiants 0 3-302.1](A)(--) Rim Animal Fund,Separatea from Each EMPLO"EE HEALTH i Other- ' 2 590.003(0} Responsibility at the person in _hknge ) I Conta.mirza'ron from the Eraironmeot i tequae repuritne h) food emplmocs and j 3-302.11!1) F,.,od Protection' j appiicantO 3-302 15 Wastdnr F ruin:oral \,,e tables 59U o0i,F) Respunsibility Of A Forrl E, rloyee t r An 3-304. 7 Food Contact wish F jlw,,ment anti Appiiaant To Fepot,•Co The Person ht Utcnsils Charge' ---- __ _- _ Crntaminatirn from+ha Consumei 59,0,5t 13(G) Reporrin^by Person in t hars:e, 3-306.rNA'(F4; Rehu',:ed Foodaril Rzacn;ee of Food, 3 .590.003(D) Exclusions aad Rzstr;aions' I Dsousrtrert otAdu!ierafed ar Can:am%nates ' 5906003(E) ke rvlal of Exclusions and Restrictiom Food ?-701.11 Di,carding or Reconditioning Unsafe FOOD c 10M APPROVED SOURCE Food' .1 Fo.V. and'Water From.Reaulated Source;; Food Contact Surfaces 50,0.0041A-13) Cotnplian:e with Food law'- -4-c"AJ 11 Manual Ware+.,nst,ny-fiot Water 3207.12 Food's:a Hcrlmlirall„Scabal Coutaii rr Sanitiratior. Tent rra ores" -=07.13 Fluid l:9iik and Milk Products* ; 1"51,111? DL:ch::n:_al`v4'ci ev.as}un:-fdor Water j :210.13 Shell Fggsx I Sauitiza tion TCnipc nature, ,,,,� i a_50LIld C'henmcalSauitizatutn-temp.,pH, 3-2,1_.14 F;=es anti[vh,k Prtxlurt:. i':r.,[e::riietP' j 3 202.16. Ice Made From Potable Drinkine W:xer" cur:cvnhanon and hWdr.�ss, t j 5-101.71 Drinking Water from an Approved Ss;cn-'" j I a-501.11(Ai Fqu:hment Food 0-gitact Surfaces aad 1'Ie:nil;C''ean'. 59:.cu6(.�t} Isoried Drinking Water' I Sb2.l! C9eaning Frequenc) ci Equipment Food- 59U.Uu6t H; Water Meets Standards!n 310 C",SR 220" ( ' " l„riact Snti:u:cs and Uten,do° Sheflfisit and Fish r=rarn an Approved Source _ 1 I Ft equine., of Sanitization of tlteusik and ", t01.1•? Fish and Rcereationally Caught Molluscan ,, Food Gorton,:Suditces ol'Equipntcnt` Shclliish" 1 1 7UKI II Dlethode of Sanwzation-- Hot Water anti 3-201 IS R ofli scan Shellfish front Ne;SP Listed ' 1"oeillwal" Sollfcet, Prooer,Adequate Han ilvashing Came and Wild Mushrorr, is Appravad by i Regulatory AuthentY 1 2"=01 11 Uean 6:,r:diboo- Hands,and Amts" j 3-202.E ns Shells:,xk ldennficahon Preszyw, 1 2.301.12 Cleaning Pviced.la ' ( - I590.004:C, Wild Mushroom.* 2- .ifl.14 V4..en to Cvm;h° 3-201.17 Game Anitmils* `t I Good Hygienic Practices 1 l ; 2-4'�I.I I Eatin¢.Drinking or Usiva Tobam) Receiving.Condition � i 13-7R?.1 PlIFS Reeetved at Proper Temperatures` j '41f11 12 Diseharltes From the Eycs, No,e,and 3-2132 15 Packaee Integrity- ( b'•trth` IR I.i i Stile,,rd L nadulta.dcd E;t t , j 3-101 19 rrcaenting Cunt:mtinaticn Whe,-:T�.stin,l' j ,oil I agslPecords:Sheilstoc!c j 32 Frovamlea e'Contamination from Hands .d.,ntificatu,n ( 5u:;t(rt;alE) ".,t%entir;7 Contatninatton from ; j 3-203.12 Sheilstock Identification 4falntained* I CmaivyccsX j 1:} Handwash Fa^;;ft;es TagstReeords:Fish Products j j 1 I Pa;:!:titc Dcstniction'F j !;anvnn+t•rily'1Cated a,;d Accesable j j 3-402 12 Records.Creation anu P.eiznuon„ j 5-203.i! j Vuntbers Lad Capacities* S9:r.004(1) Labeling of Ingredients, ( j 5-20=1.;I t },;,ration and Placenmat* j i-'205.i 1 j Ae:essibii;t Opetawm and Maintenance Conformance with Apptoaed Procedures ( ? j MACCP Plans I Supp/inti n^th Soap aria fia,od orying 3-50'_.11 Spe:ialized Pretcesmill• ` vdacds" ( ( levmces i 3-502,12 Rzdueed exvgen pac}:agi n;;.crneria` 1 ( 0-301.11 flandwashme Cleanser, availability j t�'Rli 7"e band Dryurv, Provo wn ti-103.12 (_'oofo;ntance with Appro•.u! Pro,edures" j � "Dmo%e,crtical:wn,in the ledeal 1999 RaIC,,&,n i0S i7\-IR`OOG(10 CITY OF SALEM n BOARD OF HEALTH Establishment Name: [ _ 14 S-_ l/ C S 1 S C. e"IV y-1Date: Page: of a Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date 1 No. Reference R-Red Item - Verified PLEASE PRINT CLEARLY I k)ou �/nn /vtcnan�/lv� nn�ar( v 1/mu�1�/ -,-0 rt/-r7/,n �I/ - C1'7)r l /-,'/V ✓ - ,P 1 Cl C - Pt-0111d4 i10 r/gym uo�Lo � hila .ti fii a �isit� h��ZP { I --. 'fit-rt.c_`l7 � ✓�cr �.rr/r,�-i<rn /� ,ir c />>i�ri/o l� 12_ 1 l,va��,e _'2_0( d f->-Ip t I I I I I I I I 1 I 1 1 1 Discussion With Person in Charge: Corrective Action Required: I ❑ No ( ❑ Yes I have read this report, have had the opportunity to ask questions and agree to correct all ❑ Voluntary Compliance ❑ Employee Restriction/ Exclusion violations before the next inspection, to observe all conditions as described, and to ❑ Re-inspection Scheduled ❑ Emergency Suspension 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 our food y permit.p �� ❑ Voluntary Disposal ❑ Other: I - Sia 1.4(C) PH Ps Peso✓ed at Te;::po ntur.s i Violations Related to Foodborne:aness LtYerventions and Risk Accord: to I s.v ticwled a, Factors((tears 1.22) (Cont.) 41'F/45'=Within 4 Hours. j PROTECTION FROM CHEMICALS � 501.1:i cooing;INI:lv)(h; forPHF= � Food or Color Additives ( 19 ! " PHF Hot and Cold Holding 3->01.i b(3) co1d PRFs Nla:niatncd at or below 13-_0'_.12 Addihse ig0.O0�(F't �.=?i i2,h1 Protection from Unapproved A,Jditiles` l5 Poisonous or Toxic Substances j 3-5(11.1NA:� Hot PRFs Maintained ai ca�abo,,o 140`F. 7-101.11 Identrtpog Ir+iurm.ttirm-Iln,riuni `0 L I 3 16LA, RoEmit Held at c•r above I z0 F. Conluuner,' o ' j 7-!02.11 Crnmon Nsme-Working Connurwrc' 20 Time as a Public Health Control 7-201.11 Se lr fit sioraee"' ( �-SU 1.19 Time as a Public Health Control' ( 7-20111 Restriction--Presence and Use ( � 590.(itJd(Ht t%ananrs Ruleu-entcm j 7-202.12 I Conditions of U;e' REQUIREMENTS FOR HIGHLY SUSCEPTIBLE j 7-203.11 fueic Containers-- PmhibitiotlI POPULATIONS(NSP) 7-204Ai Cuniti7ers,Criteria-Chemicals* j 7-204 12 C'hemtcals fol Waahing Produce;Crircri.:'^ ( 121 13.8ol I l(A) unpasteurized Pre-peckavcd juices and 7 20-1.14 Di tin;;?,gnat:..C'rituia ( Beveraees with War::in_ Labels* 7-101.1 t Incidental F:,:d Contact.Lubricants^ j 'Wl I ItB) Use of Pasteutaecl Fggs" ?°O1 11(D) Raw or Patueill'C'on'sed Aminal Foix!cud 7-?06.1 l Restricted Use Pt-giudes,Cri2tis" 7--.^.06 12 Rodent Brut Stations" 3-801 Seed Sproul-, Not Set ted.:. 3-801 1l(C) Unoo_ned Food Package Not Ro-served, ' 7-206.13 Trucking Powders,Pest Control and Mrmwnne" CONSUMER ADVISORY TIMEfTEMPERATURE CONTROLS 22 3-60'1 11 C nsumer Advisory Posted for Consumption of 16 ' Proper Cooking Temperatures for Anm:al Uood, 11tin are Raw, Undercool ed or j PHFs N;,r Othervise Pruccsu.ed to Eli ri mate �..,.. .zx+ Pafho_,ens.* -:;nl.11P,�!}(Z) Eggs I55''F 15 Sec j 1-302.1 3 Pasteurized Eggs Subsuune for Raw Slidl L-g;s-lmmedt.ite Servic. 1.45`1.15s:c4 3-401.1 I(A)l2) Comminuted Fish.Mears 8:Game Annnnals- 155''P i5 sec. * SPECIAL REQUIREMENTS3-401.11(6)(1)(2) Pori:and Heel Roast- i30`P 121 mi;r" So0Ota"A)-(U) Violations of Sectioti 590.009(A).(Di in 3-401.11+,-1)(2) Ratites, Injected Meats- I55'F 15 sec. ca:erin;r, mal>;1e food, temporary and 3-401.1 I A)(3) Pouttty,Wild Oamc.Stuffed PHFs residvirloil kitchen operations should be Stuffing Con;abting Fish Meat debited under the appropriate section,; Poultry or Ratites-1 65-F IS;ec, ' above if related to foodborne iltue,�s 3-401.!It(')(3) Whole-muscle, Intact Beef Steak. interventions and risk factors. Other 145"F 1, ! 590.009 Violations r:laiing to good retail 3-401.12 Raw:Animal Fouls Coiled ins o:actice� should be debited under #29 - lictrnvuve 1!5`F T Special 1?cqunrernentr,. 3 401.11(A)(1)(b) Pd ('they PHFs - 145`F' 15 sec. " J7 Reheating for Hot Holding ( VIOLATIONS R-LATED TO GOOD RETAIL PRACTICES 3-011 liA)&tEl) PIIFs 165`F 15 sec .� litems 23-30) 13-403.11(13) 4licrowave- t65' F 2 Minute Standirn, Cril;cai and non-rnricrl violations, which do not reiale to the i Tulle' .ovdborue ilh,os iwvrv,awious cwt ris$j,-a:tor,listed above, eun be 13-403.11(C) Comrnercially Pio.essed RTE Food- foand a++ahe follnxzug.m3 tiona of tl+e F. +oar Code�,,d 10.Cd IR 14001' SPO.UuO. 3-403.11(E) Remamine tinslicea Portions of Beef I Item I Good Retail Practices I FC 590,000 I, Roasts: 23 Ivlanaclement a-d Perso-�nel FC-2 003 1K Proper Cooing of PHFs j 29. Food and FoA Ptoledion FC - 3 004 2, ; Equipment and Utensils FC-4 005 3501.14(.A) Cool ing Cooked P1IFs from 14WF to 26. j Water, Piumumq and W ante FC 70'F Within 2 Hours and Frnn 7U`F %? i Physical Facil'dy FC-6 .007 2t3. Po'sonous or Toxic tdatena's FC-7 DOS 1 3-501.14(6) Cooking PHFs Made From Annbient 29 Special Reeuirements W9 Temperature Intradieuts ro 4I-'F/.15^F W 0!her i Within 4 Hour:' ' Dema(,:cnncaI item in the Iedrr:d !'149 RKA Code o: )Ili CM J90.0:)0. 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 NameDate Tyoe of Ooerationtsl, Type of Inspection G1i.4,�// /* f•fi.t 1pys/1,1/10?Food Service 2Routine Address ix 7Risk E] Retail ❑ Re-inspection Telephone Leve ❑ Residential Kitchen Previous Inspection (�y;K/ -7,41 d - 3 t, qO Mobile Date: t ❑ Temporary ❑ Pre-operation Owner HACCP YM /a/)/L., �e�s+f'/1�i� I E] Caterer ❑ Suspect Illness Person in Charge(PIC) // // Time ❑ Bed& Breakfast ❑ General Complaint In: ❑ HACCP Inspector J /� /�-l�le� l�iianirP 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 [114. Approved Food or Color Additives ❑ 3. Personnel with Infections Restricted/Excluded ❑ 15.Toxic Chemicals FOOD FROM APPROVED SOURCE ❑ 4. Food and Water from Approved Source TIME/TEMPERATURE CONTROLS(Potentially Hazardous Foods) ❑ 5. Receiving/Condition ❑ 16. Cooking Temperatures ❑ 6. Tags/Records/Accuracy of Ingredient Statements ❑ 17. Reheating ❑ 7. Conformance with Approved Procedures/HACCP Plans ❑ 18. Cooling PROTECTION FROM CONTAMINATION ❑ 19. Hot and Cold Holding ❑ 8. Separation/Segregation/Protection ❑ 20.Time As a Public Health Control ❑ 9. Food Contact Surfaces Cleaning and Sanitizing REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) E]21. Food and Food Preparation for HSP El 10. Proper Adequate Handwashing ❑ 11. Good Hygienic Practices CONSUMER ADVISORY ❑ 22. Posting of Consumer Advisories Violations Related to Good Retail Practices Number of Violated Provisions Related Critical (C) violations marked must be corrected To Foodborne Illnesses Interventions immediately or within 10 days as determined by the Board and Risk Factors(Items 1-22): of Health. Non-critical (N) violations must be corrected Official Order for Correction: Based on an inspection immediately or within 90 days as determined by the Board today, the items checked indicate violations of 105 CMR of Health. 590.000/federal Food Code. This report, signed below, when c N P 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 cited in this report may result in suspension or revocation of (FC-4)(590.005) the food establishment permit and cessation of food 26. Water, Plumbing and Waste (FC-5)(590.006) establishment operations. If aggrieved by this order, you 27. Physical Facility (FC-6)(590.007) have a right to a hearing. Your request must be in writing 28. Poisonous or Toxic Materials (FC-7)(590.008) and submitted to the Board of Health at the above address 29. Special Requirements (590.009) within 10 days of receipt of this order. 30. Other DATE OF RE-INSPECTION: S 5XIIn OF.r 14 Joc /^I Inspector's Signature: Print: IPIC'sSignature: ��/ `�i1/.%l`/at�%/ _ Print: I'Pagel of�21`ages .c I �/l-ctUSG..fJ�1/�S j Violations Related to Foodborne Illness Interventions and disk Factors(Ilents 1-22) PROTECTION FROM CONTAMINATION FOOD PROTECTION MAN A-.GtEMENT I s ! Cru>s-cur tami:"atian T 5"0.0031.4} A+signraenf of kc;puatbilityrc ;-;ii" i (A):'` R..;v .lnitm; Faxl:;Scparaxt9 frrna 590.003(13) Dt mmnsn:mon of Knowledte" Cook,d and RTI;F(rms' 2-10'3.11 Person in dairge -duties ( Cartami^aiior.Gwr:r Raw ingredients i s-302.1 Ii A)(2) i:aw Animal Fi,k&,Separated from each EMPLOYEE HEALTH Other 7 59(:.003(0) Respone:b:3:tp of the pc:=on :n dnt:ge to I ! CJontr::rinairun ku,^r ibe Erniranmenr tequirc repts'nm by foul employe.::;and i 3-302.1 l iA) Food Protection' apphcantsT 3-302'.35 Wasiii:Sm F-lints and 1 e,atjes 590.003:F! kesponsibility Oi A FtKxl Eutpii.yee Or,V: i Foa!Corntid •with Pyugnua:t::mf Applicant To Rcport'rn'llie Person lit Change* ( Ccntarruhation front the Consumer 140 0()3(Gr : Repotting by f'ersun vt Cn,:rge" � ( '�-sub.t avl': R: I Rehuned Pood a::d?.csen i_e of Food" i I 590.003(D) Exclusi:'ns and Res.riU:ons* I .I I D:spos6)n of Adulrera'ec or(:o-ramrnarec I 59).00311.1 Relo"'al of Exclusionsnod Restrictions Food 3 701,1 1 Dist;riding of Re�enditionis:g Linsafe FOOD FROM APPROVED SOURCE �d' I 4j Fond and 4"✓ater:=rcm Reyulared.Seutcea- ( 1 `f Food Contact Surfaces Contphancc wrth Food Law' ( -SOI 1 t 1 Manua! Rl;urwashing-Not b4'atet Sanitizat .,n Te,f.�oerlfti es" 13-201.1 Food in a Heron-ica0y Seated Container" 4-50:.1!7. M-Clsi;ncal Vt roasnx: Ho: War,r 3-201.i 3 Fluid M lk and Milk Products* : 13 Shcllgs." I SanitizationTcnip:ra*arcs" ?-20214 Fg€ts and Milk Pralncts. Pasteurized" 1.53)1.114 Chemical Saniti.ation-tens ,pH, 3-202.16 Ice Made From f't,hible Dunking Water" ! .encontr.;!aw and htarthte�r.. 4-6t}1 111 A: Equipment Fund Costa;t Sa:hues and 5-!01.11 Drinking Water front an Approved S,,geu,' 500.006(A) iluttiod Drinking Wats• I Uiensiis Clem" 590 O(16(T3I ater e.ts Standards :n 31;)CNIR 2211' '2.11 Cleaning Frequency of Biu:prnemt Food- 590 I Comw Surfaces turd I;gem;il,r' i SbeltAsh and Fish From an Aporovcd Source _ :t I; P.c,;:.,ncp of Canir.zatinn of Ut<atc;is and 7�_. I ?2fit.L1 Fish and Reeration.dly Caught Mo(hasatu Fowl Contact Surfaces of Equipment" Sheilhth" ( 1.703.11 Methods of Sanitization–11,11: Waterand 3-2b1 L h!olhiscan Shellfch frim IN it aced ( !* Chemise;: Soliwes" Game and Wada'hfmi looms A,opoweo by ( t0 • Proper.Adaqur,'2 Handvaashing Requiatory AuthardY : 1-3t.1.: Clean Condition-Hands and AtniO 3-102.1$ Shellstx)ck Identification Presen: 12:;)I C1 ! Cleanit:g Procedure` 590.004(0) Wild Mushroutir,' I 2--i;ll 1 7 When to P'ash' ! 3 ?01.17 Ga:nie :animals+, I 1 Good Hygienic Practices ' ' Receivirigl4ondAien I 2-10;.1 i D:•sting. DrinItim,or Uemg 1•ubecco* y 3 202.11 PUS Rrcerved at Proper Tempemtines:' i X1,12 Discharges From the Eyes, ts.ose and 3202 i5 Packa elntegrity' Mouth' ! 3-10t.: : Ftx,d Safe turd Unatiuib;cdct * ( 3-30!.1' Prev-nony Couto:iiiii-ttvn -When't-train:-* h Tags/Records:S!+e!intoc4 I +2 Prevention of Contam:,, Hon from Hands .305.13 Shel(sitxk Ide:r'ticatiam* 1540 004(1,) Prccentinyz Comaminatien fiurT: 3-203.i2 Shellstodk Identification Maintained" Einpluvices" ragclR,ecords:Fish Products F3 Handwash Facilities 11 ! Pautsitc DeRnu4i0,1"' I Conveniently LOcared and Access'blie 3-40'_.1:' R,'cords.Crct:tion and Retention" 5-^_O3 I1 I Numbers a,:d Caf) citiesT 590.01_ 5-204.11 l uc:run and PlatemenO ^ 205.:1 '.cUps:e?fur: :nd.hiaintenancc Conformance with Approves Procedures cosstbility. iSgoptiea with Soap and Hand piping IHACCP Plans M 3-5fi2.(I SpceializaD Processing elhtKls' I L;ovva6 3-511^ Reduced oxygen packasting.criiei'ia'" I o-:,01.11 HandtDrvijuy.{;ica,u.:.- vvailabihr>' 5-103.1: Con Fonnanca with Apptu:ed procedure>` I 6-,30 i.! Hand Dnvr,!Pnnis:u:: 'ties:oic<eritical sem in ti:e tcueu:! 199')('ood Corr ni 105 L�-012-`"U.i)p0, CITY OF SALEM BOARD OF HEALTH Establishment Name: / _)�t 4// �� s 4i 9 Date: / 1 VI V Page:. Z of 4L> Item Code C-Critical Item DESCRIPTION OF VIOLATION / PLAN OF CORRECTION Date No. Reference R—Red ItemPLEASE PRINT CLEARLY Verified I 1 Ae } I S I Discussion With Person in Charge: Corrective Action Required: I ❑ No I ❑Yes I have read this report, have had the opportunity to ask questions and agree to correct all ❑ voluntary Compliance ❑ Employee Restriction/ s violations before the next inspection, to observe all conditions as described, and to comply Exclusion with all mandates of the Mass/Federal Food Code. I understand that noncompliance may ❑ Re-inspection Scheduled ❑ Emergency Suspension s result in daily fines of twenty-five dollars or suspension/revocation of your food p mit.��/• �- ❑ Embargo ❑ Emergency Closure ❑ Voluntary Disposal ❑ Other t h )t FORM 7348 HOBBS &WARREN - BOSTON f Violations Related to Foodborne Illness Interventions and Risk 3-501.14(C) PHFs Received at Temperatures Factors(Red Items 1-22) (Cont.) According to Law Cooled to 41°F/45'F Within 4 Hours.* PROTECTION FRO 61 CHEMICALS 3-501.15 Cooling Methods for PHFs 14 I Food or Color Additives 19 PHF Hot and Cold Holding 3-202.12 Additives* 3-501.16(B) Cold PHFs Maintained at or below 3-202.14 Protection from Unapproved Additives* 590.004(F) 41°F/45°F* 15 Poisonous or Toxic Substances 3-501.16(A) Hot PHFs Maintained at or above 7-101.11 Identifying Information-Original 140°F.* Containers* 3-501.16(A) Roasts Held at or above 130°F.* 7-102.11 Common Name-Working Containers* 20 Time as a Public Health Control 7-201.11 Separation-Storage* 3-501.19 Time as a Public Health Control* 7-202.11 Restriction-Presence and Use* 590.004(H) Variance Requirement 7-202.12 Conditions of Use* REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-203.11 Toxic Containers-Prohibitions* POPULATIONS(HSP) 7-204.11 Sanitizers,Criteria-Chemicals* 21 13-801.11(A) Unpasteurized Pre-packaged Juices and 7-204.12 Chemicals for Washing Produce,Criteria* 1 Beverages with Warning Labels* 11 7-204.14 Drying Agents,Criteria* 3-801.11(B) Use of Pasteurized Eggs* 7-205.11 Incidental Food Contact,Lubricants* 3-801.11(D) Raw or Partially Cooked Animal Food and 7-206.11 Restricted Use Pesticides,Criteria* Raw Seed Sprouts Not Served.* 7-206.12 Rodent Bait Stations* 3-801.11(C) Unopened Food Package Not Re-served.* 7-206.13 Tracking Powders,Pest Control and Monitoring* CONSUMER ADVISORY 22 3-603.11 Consumer Advisory Posted for Consumption of TIME/TEMPERATURE CONTROLS Animal Foods that are Raw,Undercooked or 16 Proper Cooking Temperatures for not Otherwise Processed to Eliminate PHFs Pathogens.* Efiearve 11112001 3-401.1 IA(1)(2) Eggs- 155°F 15 Sec. 3-302.13 1 Pasteurized Eggs Substitute for Raw Shell Eggs* Eggs-Immediate Service 145°F 15 Sec.* 3-401.11(A)(2) Comminuted Fish,Meats&Game SPECIAL REQUIREMENTS Animals- 155°F Sec.* 590.009(A)-(D) Violations of Section 590.009(A)-(D)in 3-401.1 l(B)(1)(2) Pork and Beef Roast- 130°F 121 Min.*1 catering, mobile food,temporary and 3-401.11(A)(2) Ratites,Injected Meats- 155°F 15 Sec.* residential kitchen operations should be 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs, debited under the appropriate sections Stuffing Containing Fish,Meat, above if related to foodbome illness Poultry or Raines- 165°F 15 Sec.* interventions and risk factors. Other 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks 590.009 violations relating to good retail 145°F* practices should be debited under#29- 3-401.12 Raw Animal Foods Cooked in a Special Requirements. Microwave 165°F* 3-401.11(A)(1)(b) All Other PHFs- 145°F 15 Sec.* VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 17 Reheating for Hot Holding (Blue Items 23-30) 3-403.11(A)&(D) PHFs 165°F 15 Sec.* Critical and non-critical violations, which do not relate to the 3-403.11(B) Microwave- 165°F 2 Minute Standing foodborne illness interventions and risk factors listed above, can be Time* found in the following sections of the Food Code and 105 CMR 3-403.11(C) Commercially Processed RTE Food- 590.00. 140°F* Item Good Retail Practices FC 590.00_ 3-403.11(E) Remaining Unsliced Portions of Beef 23. Management and Personnel FC-2 .003 Roasts* 24. Food and Food Protection FC-3 .004 18 Proper Cooling of PHFs 25. Equipment and Utensils FC-4 .005 3-501.14(A) Cooling Cooked PHFs from 140°F to 26. Water, Plumbing and Waste FC-5 .006 70°F Within 2 Hours and from 70°F 27. Physical Facility FC-6 .007 f to 41°F/45°F Within 4 Hours.* 28, Poisonous or Toxic Materials FC-7 .008 3-501.14(B) Cooling PHFs Made From Ambient 29. Special Requirements .009 Temperature Ingredients to 41°F/45°F 30. Other Within 4 Hours* *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. ( IMPORTANT MESSAGE ) ` FOR DATF0.� TIME •37 - III OF PHONE AREA CODE NUMBER EXTENSION U FAX U MOBIl F AREA CODE �MBER TIME TO CALL TELEPHONED PLEASE CALL CAME TO SEE YOU WILL CALL AGAIN WANTS TO SEE YOU I RUSH RETURNED YOUR CALL I WILL FAX TO YOU MESSAGE /� SIGNED �pp�/9J/ � p MADE IN4 .SLY A. NOTES c CITY OF SALEM, MASSACHUSETTS d BOARD OF HEALTH 9 120 WASHINGTON STREET, 4TH FLOOR SALEM, MA 01970 'r9 TEL. 978-741-1800 FAX 978-745-0343 STANLEY J. USOVICZ, JR. JOANNE SCOTT, MPH, RS, CHO MAYOR HEALTH AGENT August 15, 2003 Classy Chassis C/o Kevin & Paula Kefalas 4 Azalea Lane Peabody, MA. 01960 Dear Mr. & Mrs. Kefalas: The Board of Health has received a complaint regarding your business. The complaint states that an employee of Classy Chassis is taking the trash accumulated by your daily foodservice activities and throwing it away in a dumpster owned by the Salem Housing Authority located at 88 Essex Street, Salem. The Housing Authority has stated that no permission was granted to do this. You may recall in August of 1999, 1 spoke to you regarding this same issue occurring at an Andrews Street property. Upon receipt of this letter please send in writing, your business plan for disposing of accumulated wastes. Thank you. For the Board of Ilealth: Jeff Vaughan Sr. Sanitarian Cc: Salem Housing Authority COURT DOCKET NO. 9 CITATION NO CITY OF SALEM VIOLATION NOTICE A2 9 6 2 NAME (E((1-ASTTFF�II�RST INITIAL) S'T/REEJT/AJDDRESS CITY/TOWN STATE ZIP/,/ V/V LICENSE NO. LIC XP DATE DATE OF BIrRTH OWNNfA'S NA (LST FIRST,INITIAL) K i e✓ �e��l/� STRRAEETA1DR/ES//SSS CITY/TOWN STATE ZIP sT!> 7 REGISTRATION NO STATE EXP.DATE MAKET/P� YEAR COLOR DATE D VIOLATION TIME m ' DATE ILCITTIONWRITTEN RERs IIllllMAL fBfIMIN+ INJURY PM 1Q/ ONO S LOC -5'VIOLATION N��Y/� �G/FORCIN/G�DEPT OFFENSE CHAP 3 Cf. 91NES 1 �I .Air OFFICE D NO. TOTAL FINE $S� DUE OFFICER CE S COPY GIVEN TO VIOLATOR ❑ IN HAND X 0 / 1 0 ;kBY MAIL OT OCASH-PAY ONLY BY PO E,MONtY DE BY CHECK MADE PAYABL CITY CLERK CITY HALL 93 WASHINGTON STREET SALEM,MA 01970 TEL.(508)745-9595 X 251 1 HEREBY ELECT TO EXERCISE THE FIRST OPTION AS STATED ON REVERSE, CONFESS TO THE OFFENSE CHARGED,AND ENCLOSE PAYMENT IN THE AMOUNT OF $ CASE# SIGNATURE SEE OTHER SIDE FOR FURTHER INFORMATION ENCLOSE PAYMENT IN THIS ENVELOPE,PEEL AND SEAL wool wino rvv - ........... ---- - -- CITY OF.SALEM" a]-�y 3 �. � g I VIOLATION NOTICE A296. q NAME(LAST,FIRST,INITIAL) . I Z I I i ^ EETADDRESS I ' UCI V OWN STATE ZIP 2 LICENSE NO ILIC E%P DATE 7 A E FUIRTH �X{ I W ` OWNER'S NA (LA T,FIRST,INITIAL) V n i_c fYP/1/off j — uz STNEETAdDRES3 OW STATE ZIP O flEGISTRATION NO. STATE EXP �N�kFJPIMt( R COLOR I' DATE OF IOLATION TIME DATE CITATION WRITTEN PERgNa YES OYES `r Z -________ _I O ,. •/A PM fL ' ❑NO :f O 0 '. LOCATION F VIOLATION EN ORCING DEPT. �.f/ •? I ¢ OFFENSE •CJHAP. SECT. FINES - 0A T .� h w .> a a O CtIA IrED I OFFICER� D NO TONEL f1" $SG. i i J 4E � , j /L/Z 3J�..I DUE H .� .La I OFFICER CE�FI�S COPY GIVIEN TO VIOLATOR - / / / /'� - ❑ IN HAND Z , O r l X /7/_-�+. if//� c/j[2--, St"V MAIL. T Fd97L�CASH-PAY ONLY BY POST E,MONY -. 6 3a• - .a ER BL BY CHECK MADE PAYAE (n l.. fi ,,i (� '.a CITY CLERK W 1. r - •- CITY HALL '_1 _ 93 WASHINGTON STREET Z 0: 4r SALEM,MA 01970 Q uO~i m , ''r w j. U TEL.(508)745-9595 X 251 11 • i I HEREBY ELECT TO EXERCISE THE FIRST OPTION AS STATED ON z a rn w o C I" O' REVERSE, CONFESS TO THE OFFENSE CHARGED,AND ENCLOSE - m U Z PAYMENT IN THE AMOUNT OF " o .C Elli oNWa�p,n o I l $ CASE# U. <Ye h o C. j _ Ole 0 i SIGNATURE a5 w = w ° 1�, y�, /1 C.z SEE OTHER SIDE FOR FURTHER INFORMATION I U a 3 I v¢ I ENCLOSE PAYMENT IN THIS ENVELOPE,PEEL AND SEAL - - > o l J> a � ; vv C; z \ I 'a<LL I aao_ �2 CITY OF SALEM BOARD OF HEALTH Establishment Name: C /Lr_ !Sv / �tvSi.S' Date: C/o IGS/it? Page: of Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date No. Reference R—Red Item Verified _ PLEASE PRINT CLEARLY / Pr1 I I I I I I I I i I I I I II I I I I II I I I I I I I I I I I I I I I Discussion With Person in Charge: Corrective Action Required: I ❑ No ( ❑ Yes I have read this report, have had the opportunity to ask questions and agree to correct all ❑ Voluntary Compliance ❑ Employee Restriction/ 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(C) PHFs Received at'femperatures Violations Related to Foodborne Illness Interventions and Risk According to Law Coined to Factors(Items 1-22) (Cont.) 4 i'F/45'F 41'ithin 4 Hours. :` PROTECTION FROM CHEMICALS -501.15 Cooling Methods fur PH Fi yq Food or Color Additives 19 PHF Hot and Cold Holding ( 3-501 16(B) Cold PF[Fs Mainiamcd at or below 3-202.12 Additives* 590.004(F) 41`!45"F* 3-302.14 Protection front Unapproved:additives'' i-501.I6fAi Llot PHPs Maintained at co�above 15 Poisonous or Toxic Substances i 140'F. * 7-101.11 ldentdprig Information-Onginal 3-501.16(A) Roasts Held at of abok-e 130'F , Container," 7-102.11 Common Name- Working Containers 20 ( Time as a Public Health Control 7-201.11 Separation-Sha-aee' 3-501.i 9 Pune as a PubbL Health Control', 7-"_0111 Restriction-Presence and l;,;&' � 590004(H) Variance Rcyuiremrnt 7-202.12 C,uditi,SnS of lise' ( REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-20.11 'Toxic Containers-Prohibitions" POPULATIONS(HSP) 7-204.11 ' I Sanitizeta.Coterie-C'hemicals^ ( 7-204 12 (,Chemicals for Washing Produce,Criteria` ( 12] 3-801.1 I(:1) i lnpageerized Pre.r:tckaged Juices and 7-204.14 I Drying A'-enta. Criteria` ( Becerves with Wanting Labels* 7-205 1 I Incidental Food Contact,Lubricants* 3-8(11.11(B) Use of 1'.nsteurizect E„s 3-801 1 I{D1 Raw ur Partially Cooked Animal Fax!and 7-206.11 f Re:tricte:d Use Pe,ticidci,Criteria" Raw Seed Sprouts Not Solved. 7-206 12 TraRodci Bait Stationse 3-801.11(C) unopened Food Packane Not Re-served 7-2')6.13 Tracking Powders,Pea Qmlro(and ' Mumroring* CONSUMER ADVISORY 22 3-603A 1 Consumer Advisor Posted 1'or Consumption of TIME/TEMPERATURE CONTROLS Annual Folds That arc Raw. t)ncleran,krd or {b IProper Cooking Temperatures for PHFs Not Otherwise Processed to Eliminate Pith 3-401.11.A(1)(2) Eggs- I55'F In Sec. ^ i.;ena. i rto„ nzo.y 3-3+)'2.13 Pa;stem'rztd Eg,> Substitute for Raw Shell Eggs-Im mediate Service 14 SFl Sec* s-d' 3�UI IIIA){2) Comminuted Fish,Meats&Game EggsY i I Animals- 155"F 15 sec. e SPECIAL REQUIREMENTS 3.4U1A 3-401 (H)t 1)02) Polk and Beef Roast- 190"3 12.1 miff' 590 009(A)-(D) Violations of Section 590.009(A)-(D)in .1I(A)l1) Ratites,Injected Meats - I55`F IS sec. catering, utobile food. temporary and 3-401.1 I(A)(3) Poultr.q,Wild Game. Stuffed PHFs. residential kitchen operations should be Jtutnn,C ontaming Fish, Meat, ....Ju<u ..ill!Cl'I}le Poultry or Ratite;-165°P 15 ace. °° I above if retuned to foodborne illness 3401 11(C}(3} Whole-muscle, Intact Beef Steaks interventions and risk factors. Other 145'F* 590.009 violations relating to good retail 3-401.12 Rai'v Animal Frauds Conked in a I practices should be debited under#`!9 - Mirowave 165'F^ Special Reyutreinents. 3-401.11(A)(U(b) All Other PHFs-- 145"F 15 cec. 17 1 Reheating for Hot Holding VIOLATIONS R-LATED TO GOOD RETAIL PRACTICES 3-403.11(A)&(D) PHFs 165''F 15 sec. i (Items 23-30) 3-4(13.1 I(B) Mia owave- 165°F 2 Minute Standing, Critical and nun-�raicul viulationv, which do not relit,in the I Time* foodborne iHaess interrenrions and risk f ielors listed above, can be 3403.1 I(C) Commercially Processed RTE Food- ,found in rhe fnllnn•ir+g scunura of the hood Code and 105 C WR 140'17` 59o.000. 3-403 1 t(E) Remaining L;naicect Portions of Reef !tern Good Retail Practices FC 590.000 a 123. ' f.1anagement and Personnel FC-2 I .003 Roa ! ns ; 24. Fond and Food Protection FC-3 .004 yg Prdper Cooling of PHFs 25. Equipment and Utensils FC-4 ,005 3-501.14(A) Cooling Cooked PHFs from 140°F to 26. Water,Plurnbinq and+Haste FC-5 .006 !, 7WF Within 2 Hours and From 70'31 27. ! physical Facility PC--6 .007 to 41'3(45'3 Within 4 Hours. " ! 28. 1Poisonous or Toxic Materials FC-i 008 3-501.14(6) Cooling PHFs Made From Ambient 29. Special Requirements ( Dog Temperature Ingredients to 41'F145'F 30. ; Other Within 4 Hours' k Denote,critical nem in the ted:rul 1999 Food Cale of 10 CMR X90.000. t , CITY OF SALEM 51. BOARD OF HEALTH Establishment Name: (' ��s� �_ ��SSi_S Date: l /.� Page: wl of Item Code C-Critical Item / DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date No. Reference R—Red Item C'yl� Verified - PLEASE PRINT CLEARLY /-�^�,`� PA a 00 I I I I 1 I I I 1 I I I I I 1 I I I I I 1 I I 1 I 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/ inspection, to observe all conditions as described, and to Exclusion violations before the next ins P Ll Re-inspection Scheduled ❑ Emergency Suspension comply with all mandates of the Mass/Federal Food Code. I understand that noncompliance may result in daily fines of twenty-five dollars or suspension/revocation of ❑ Embargo ❑ Emergency Closure your food permit. • ❑ Voluntary Disposal ❑ Other: t 3-501 H(C) PHFs Recei,cd at Tengrerahn'es Violations Related to Focdbornc illness Interventions and Risk Actrt;;ioh to Uvv Ccolc t In Factors(items 1-22) (Cont.) 41'F/4S1`Within 4 Hours. PROTECTION FROM CHEMICALS 3-501,15 Cooilne N'lethods for PHFs j 14 Food or Color Additives lY PHP Hot and Cold Holding ' 3-501.16(B) C?rIJ PHFs Maintained :u os'below 5-202.12 Additives'' _5d0.004(Fr 4p•: 3-102 14 Protection trout Unapp:cneJ Addiuccn'' 3_j0Li6(1) Hot PHFa Mamhdncd at of abate I5 I Poisonous or Tnxic Substances i 4(t"F. I7-101,11 hlenbf)nngInformation-Original 3_A)LH)!At RoasisFoldatoraboveI-,O'F, Coata hers" 7-102 I I Common Naure-Working Containers" `0 Time as a Public Health Control 7-201.11 Separation-Stoiaac- z 501 19 Time as a Public Heath Co,nroP' 7-202.11 Restriction-Presence and L'se a i 51)0,004(H1i Pavanes Rcyuitememt 7-202.03,12 Conditions of Use* REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-203.11 'Toric Container-Pnihemic ns* POPULATIONS(HSP) 7-20.1.11 Sauitizei s.Criteria--C'hemicaF;' 7-204 12 Chenucals for Washing Pnxluce,()itrria* 21 i 3-801.1 1(A) L'npast�urized Pre-pnekazed Juices ted 7-204.14 DEying Agents.Criteria" ( f Becera'_cs with Warning i-,;bels" _ 205 11 Incidental Food Contact, Lubricants^ 3-801.11(B) L'se of I'isteutized FgggT Ball 3:30? i!(J) RaCooked Aortal F 7-20f,.1 f Restricted Use Pesticides, Critet itr' ( in o: P ' au y Furl and Raw Sced Sprouns Not Served. 7-206.12 Rodent Part Stations, � ': 1-80!.i?(C) linnpencd Ford Package Not Re-served. " 7-'06.13 Tracking Powders, Pest Contro!and -- Monitoring" CONSUMER ADVISORY TIMEITEMPERATURE CONTROLS 22 3-603.11 Consumer Advisory Posted for Consumption of 16Proper Proper Cooking Temperatures for Animal `Foods lira are Ran'. Undercooked ur PHFs Nut Otherwise Processed to Eliminate 3-401.11 A(t)(2) Eggs- 155`F 15 Sec Pathueens.'•' s-302.13 Pa;icunzW Eggs Substitute for Raw Shdl N.eds- Immediate Scn•iee 145`f-�t5sec" Egx•,s" 3-401 I L,A)(2) Comminuted Fish. Meats&Game Animals- 155`F 15 Scc. * i 3-401.11(Bu 1)(2) P(a'nandBeefRoa.St 130"F 121rnur' SPECIAL REQUIREMENTS 3-401.110)(2) Ratitvs.I»jceted Meats- 155'17 15 590 0r:9(A)-(U) Violations of Section 590.009(A)-(D)in sec. x catering, mobile food, temporary and 3-401.11 iA)(3) Poultry,Wild Game.Stuffed PHFs, j residential kitchen operations should he Stutun��Gontaming Fish. Nleat. .,..o„ca ..ndcr the : 7 0;.'),a,. ri..,.lJil Poultry or Ratites-165"F 15 sec " arnov if related to foodborne illness 3-401.1 10C)(3) Whole-muscle, Intact Beef Steaks intervention;and risk factors. Other 145'F 590.009 violations relating to good retail 13-401.12 Raw Animal Foods Cooked in a practices should he dehited under 1129-- Microwave 165`F" Special Requirements. 401.1BAi(1)lb) .Ail Other PHFs - t45'FI5sec. 17 Reheating for Hot Holding VIOLATIONS RELATED TO GOOD RETAIL PRACTICES l 3-103 1 t(AWD) PHFs 165'F 15 sec. (Items 23-30) 3-40111(B) Microwave- 16s F2 N4tnule Standing Crinral urd ova-cnticu/violations, which du not relate to the Timc" faudborue illness inlen,earian.c and risk:factory h.,lerl above, Barr be 3-403,11tC) Commercially Processed RTE Flood- lnnnd in the Inllow';ig secliana r.!the Food Code and 105(:.NR 140` I SV o0r). 3-403.11(E) Remaining Unsttced Portions of Beef ! Item I Good Retail Practices FC 590.000 RMASW 1 23. Mananement ami Personnel FC-2 _003 18 Proper Cooling of PHFs 24. Food and Food Protection FG-3 004 3-:i01.14(A) Cool ng Cooked PH iss if um 140'F to 25 Equipment and Utensils FC - 4 ,C05 26. W ater,Plumbinq and Waste FC-5 ,006 70'F Within 2 Hours and Froin 70'F 1 27, 1 Physical Facility FC --6 007 to 4l"F/45`F Within 4 Hoary * ! 28, i Poisonous or Toxic Materials FC-7 008 3-i01.14(B) Cooling PHFs Made From Ambient 1 29, I Special Requnements 009 -- IcruperatureIngredientsto41"R45`F 30. Other -- Within 4 Hours, S I,Vl I-,i: *D:notes eritiuil nim in the lederal 1999 Pow r}rte of I to C"'I11:90.000. CITY OF SALEMv MASSACHUSETTS BOARD OF HEALTH s 120 WASHINGTON STREET, 4TH FLOOR SALEM, MA 01970 TEL. 978-741-1800 MnYs FAX 978.745-0343 - STANLEY J. USOVICZ, JR. JOANNE SCOTT, MPH, RS, CHCS MAYOR HEALTH AGENT COMMONWEALTH OF MASSACHUSETTS PERMIT TO OPERATE A MOBILE FOOD SERVER In accordance with Regulations promulgated under authority of Chapter 94 , Section 305A and Chapter III, Section S of the General Laws a Permit is hereby granted to : Name : Kevin Kefalas Name of Establishment : Classy Chassis Cart #3 Whose Place of Business is : 4 Azalea Lane W. Peabody MA Date: 06/26/2003 To operate a Mobile Food Server in Salem Restrictions : Slush, lemonade and fried dough. Permit # : 010-03M Frozen Desserts/ Ice Cream: PERMIT EXPIRES December 31, 2003 HEALTH AGENT l CITY OF SALEM, MASSACHUSETTS ye BOARD OF HEALTH _i 120 WASHINGION STRh ET, 4TH FLOUR / q SALEM, MA 01970 � � ieF` TFL. 978-741-1800 FAX 978-745-0343 b STAVLt-V UsoviCt, JR. JOANNE SCOTT, MPH. RS, CHO ��✓ MAYOR Ht AL7H AGENT APPLICATION FOR A MOBILE FOOD SERVICE PERMIT ;/ � kr F�e $150 payable to The City of Salem, No Cash Name of Applicant K{VI fd 7W_5 Telephone#q` 8- -5'3-5 Address q Certified Food Manager Ar V-Z_V_ ( �et 111,5 Certificate # r � Name of Business G(<zs JV �lf�,srts �dd `5 _Telephone# Address I Manufacture Frozen Desserts? Yes No Type of Vehicle �L S C-41- t Registration# Location of Operation v-n41 j file ,,::: .- Name & Address Qf Licensed Food Service Establishment Serving as Base of Operation G4 TCc� ' > Telephone# 'I 2-- / vdO Location of Toilet & Handwashing/ Facilities Menu �„� � - SI r.S7t ,/�L�r Type of refrigeration: Ice Dry Ice G s ` Other Method for Cooking and/or Hot Holding: Gas rOther Method for Sanitizing: Chemical Hot Water (170 F) I have read and agree to abide by The Salem Board of Health Regulations regarding "Mobile Food Units & Pushcarts" and will notify the Salem Board of Health of any changes in this application. Pursuant to MGL C62C,S49A, I certify under the penalties of perjury that 1, to my best knowledge and belief, have filed all State tax returns and paid all State taxes required under law. SignatureSocial Security#or Federal ID# a -------------- �� ------o _ � --------------- -3 Revtu:d. 2n103 Permit# Check#&Date rS !n Roo ... c?6 W_.3 m What is this all about? Training Schedule CL 0 w 0 d ,00 2 Our training classes and certification exams meet AUGUSt 0- y s , 'c c m all the requirements of the state and local boards rn a ` 'Z3 c of health for an "approved food protection Monday August 11, 2003 3 'o e a N program." The class instruction is approximately King's Grant Inn o >, m ¢ d t E eight hours in length. At the end of the classroom Exit#21 North oa •y a instruction there is a general recap of the lessons Route 128 in Danvers, MA t 0 ¢ n a before the certification exam is given. ~ 0 When and where are the classes? Monday August 25, 2003 v Midtown Motel E m Choose a date and training location that is most Huntington Ave. Boston, MA W cc c convenient for you from the Training Schedule 0 0 0 _ printed on the right. All classes are scheduled E u 0 � S $ from 8:00 a.m. to 5:00 p.m. The exam is given September m o 0 0 0 = the same day at approximately 4:00 p.m. Monday September 29, 2003 How much will it cost? Midtown Motel t m 3 $125.00 per person, which covers the cost of Huntington Ave. Boston, MA U C @ c = c 3 a training, the course textbook, shipping and October o handling, the exam grading, certification, and t national registration. Monday October 6, 2003 rn ) ` 3 a King's Grant Inn Q> What do I do next? Exit#21 North M co ca a 0 i3 I Please fill out the attached registration printed on Route 128 in Danvers, MA 0 ,n x the left and mail it along with your payment to: 0 o Monday October 27, 2003 zMidtown Motel ARG Associales o. E Huntington Ave. Boston, MA 11 Heard Drive o ? 1 swich MA 01938 3 N o p November t0 o What happens next? Monday November 24, 2003 Lu c c c Upon receipt of payment we will send you a Food Midtown Motel m n v o Safety Coursebook, Study-Guide, and details Huntington Ave. Boston, MA .CLyo m about the class that you have chosen to attend. " 0 0 -L 5, December n o The space is limited, and acceptance will be a 0 made on a first come-first serve basis. If we are Monday December 8, 2003 0 0, o unable to accommodate your first choice, an King's Grant Inn z alternative date and/or location will be offered to Exit#21 North za N a accommodate your needs. Route 128 in Danvers, MA E 3 EE ¢ y If you have any questions please call: Monday December 22, 2003 W = g z m y Midtown Motel 0I3 — o (978) 356-4942 N M } ui w Huntington Ave. Boston, MA i ARG Associates, LLC is the right choice for you, I Our Company has been in business and conducting sucessfui Manager Certification Programs in Massachusetts since 1995. • Each instructor is an accomplished professional trainer as well as having had hands-on experience in the field as a manager, food safety consultant, and/or a food establishment inspector. • Our trainers have proven records of success in teaching students of all levels and abilities. • Training materials are offered in English and Spanish. • Classes are offered at times and locations that are convenient for you • The Food Safety Knowledge you gain can help protect your customers, your business, and your reputation. • We custom design Corporate Programs that meet your specific needs, and can train at your location. {`4 m = tAD N O = N is = 7 ^: Oi C O @ 'rx N i4 = N -1 C. C. N N r, = O C� a 0 m (D0 Mm m to JU U) z -0 M fD m (D (D i c y Gt. W t1 -i N N A' tD •a - N 0 '� '" tD 3 0) M0 M P+ CD<D L1 C�i� tD O II W ^r .C.r C {3' C C 3 cD C 3 r+ O >v M <D O C' tS1 fD n N N UPOP-99£ (8L6) Ileo aaGeueW u011301Oad poO:J PGIJRaa0 a OW0308 01 MON 43V 8F610 VH VIASd7 ant.rQ p.'vaH H X77 `sWvzZIossV92fV ..�'y ^- . "`F r'�.- ,. .- _,.V.r-yF.a-....-...-...y....-.......�..�..-..-.,.. , N4,r.,ip•.fi.n.w•.•eas.nw.u«�+r:vr,.-.,,...v...� THE COMMONWEALTH OF MASSACHUSETTS CITY OF SALEM Address: 120 Washington Street, 4th Floor BOARD OF HEALTH Salem, MA 01970-3523 FOOD ESTABLISHMENT INSPECTION REPORT Tel: (978) 741-1800 Fax: (978)745-0343 Name Date Tvoe of Oneration(j) Tvne of Insnection, &, ❑ Food Service �outine Address / Risk El Retail [:1 Re-inspection �2///P// h /�P Level ❑ Residential Kitchen Previous Inspection Telephone/ /�/( /i-/V ) s-3s - /��(�/ El Temporary � Date Owner �o // /f HACCP YIN ❑ Temporary Pre-operation '04r/�/s /�,, /,/_! I ❑ Caterer ❑ suspect illness Person in Charge(PIC) �� / Time ❑ Bed&Breakfast ❑ General Complaint In: El HACCP Inspector �•T"�C / 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 fRed Items). Anti-Choking Tobacco Violations marked may pose an imminent health hazard and require immediate corrective 590.009(E) ❑ 590.009(F) ❑ action as determined by the Board of Health. Local Law ❑ FOOD PROTECTION MANAGEMENT ❑ 12. Prevention of Contamination from Hands ❑ 1. PIC Assigned/Knowledgeable/ Duties ❑ 13. Handwash Facilities EMPLOYEE HEALTH PROTECTION FROM CHEMICALS El2. Reporting of Diseases by Food Employee and PIC El3. Personnel with Infections Restricted/ Excluded El 14. Approved Food or Color Additives ❑ 15. Toxic Chemicals FOOD FROM APPROVED SOURCE El 4. Food and Water from Approved Source TIMEITEMPERATURE CONTROLS(Potentially Hazardous Foods) El 16. Cooking Temperatures El 5. Receiving/Condition ❑ 6. Tags/ Records/Accuracy of Ingredient Statements El 17. Reheating El7. Conformance with Approved Procedures/ HACCP Plans El 18. Cooling PROTECTION FROM CONTAMINATION ❑ 19. Hot and Cold Holding El8. Separation/Segregation/ Protection El 20. Time as a Public Health Control El 9. Food Contact Surfaces Cleaning and Sanitizing REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) ❑ 10. Proper Adequate Handwashing ❑ 21. Food and Food Preparation for HSP CONSUMER ADVISORY ❑ 11. Good Hygienic Practices ❑ 22. Posting of Consumer Advisories Violations Related to Good Retail Practices (Blue Number of Violated Provisions Related Items) Critical (C) violations marked must be corrected To Foodborne Illnesses Interventions immediately or within 10 days as determined by the Board and Risk Factors (Red Items 1-22): of Health. Non-critical (N) violations must be corrected Official Order for Correction: Based on an inspection immediately or within 90 days as determined by the Board today, the items checked indicate violations of 105 CMR o Health. 590.000/Federal Food Code.This report, when signed below C N by a Board of Health member or its agent constitutes an 23. Management and Personnel (FC-2)(590.003) order of the Board of Health. Failure to correct violations 24. Food and Food Protection (FC-3)(590.004) cited in this report may result in suspension or revocation of 25. Equipment and Utensils (FC-4)(590.005) the food establishment permit and cessation of food 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: Inspector's Signature: ~� I Print: /// L ly-� PIC'sSignature: .,` to Print: Page4oa-Pages FORM 734A HOBBSIO,W/EN - BOSTON • "/ v Violations Related to Foodborne Illness Interventions and Risk Factors (Red Items 1-22) PROTECTION FROM CONTAMINATION 8 Cross-contamination FOOD PROTECTION MANAGEMENT 3-302.11(A)(1) Raw Animal Foods Separated from 1 590.003(A) Assignment of Resoonsibility* , Cooked and RTE Foods* 590.003(B) Demonstration of Knowledge* Contamination from Raw Ingredients 2-103.11 Person in Charge-Duties 3-302.11(A)(2) Raw Animal Foods Separated from Each Other* EMPLOYEE HEALTH Contamination from the Environment 2 590.003(C) Responsibility of the Person in Charge to 3-302.11(A) Food Protection* require reporting by Food Employees and 3-302.15 Washing Fruits and Vegetables Applicants* 3.304.11 Food Contact with Equipment and 590.003(F) Responsibility of a Food Employee or an Utensils* Applicant to Report to the Person in Charge* Contamination from the Consumer 3-306.14(A)(B) Returned Food and Reservice of Food* 590.003(G) Reporting by Person in Charge* Disposition of Adulterated or Contaminated 3 590.003(D) Exclusions and Restrictions* Food 590.003(E) Removal of Exclusions and Restrictions 3-701.11 Discarding or Reconditioning Unsafe Food* FOOD FROM APPROVED SOURCE 9 Food Contact Surfaces 4 I Food and Water From Regulated Sources 4-501.111 Manual Warewashing-Hot Water 590.004(A-B) Compliance with Food Law* Sanitization Temperatures* 3-201.12 Food in a Hermetically Sealed Container* 4-501.112 Mechanical Warewashing-Hot Water 3-201.13 Fluid Milk and Milk Products* Sanitization Temperatures* 3-202.13 Shell Eggs* 4-501.114 Chemical Sanitization-tem H, 3-202.14 Eggs and Milk Products,Pasteurized* p..P iig Concentration and Hardness 3-202.16 Ice Made from Potable Drinking Water* 4-601.11(A) Equipment Food Contact Surfaces and 5-101.11 Drinking Water from an Approved System* Utensils Clean* 590.006(A) Bottled Drinking Water* 4-602.11 Cleaning Frequency of Equipment Food- 590.006(B) Water Meets Standards in 310 CMR 22.0* Contac[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* 4 10 Proper,Adequate Handwashing Game and Wild Mushrooms Approved by 2301.11 Clean Condition-Hands and Arms* Regulatory Authority 2-301.12 Cleaning Procedure* 3.202.18 Shellstock Identification Present* 2-301.14 When to Wash* 590.004(C) Wild Mushrooms* 11 Good Hygienic Practices 3-201.17 Game Animals* 2-401.11 Eating,Drinking or Using Tobacco* 5 Receiving/Condition 2-401.12 Discharges From the Eyes. Nose and 3-202.11 PHFs Received at Proper Temperatures* Mouth* 3-202.15 Package Integrity* 3-301.12 Preventing Contamination When Tasting* 3-101.11 Food Safe and Unadulterated* 12 Prevention of Contamination from Hands 6 Tags/Records:Shellstock 590.004(E) Preventing Contamination from 3-202.18 Shellstock Identification* Employees* 3-203.12 Shellstock Identification Maintained* 13 Handwash Facilities Tags/Records: Fish Products Conveniently Located and Accessible 3-402.11 Parasite Destruction* 5-203.11 Numbers and Capacities* 3-402.12 Records,Creation and Retention* 5-204.11 Location and Placement* 590.004(J) Labeling of Ingredients* 5-205.11 Accessibility,Operation and Maintenance 7 I Conformance with Approved Procedures Supplied with Soap and Hand Drying /HACCP Plans Devices 3-502.11 Specialized Processing Methods* 6-301.11 Handwashing Cleanser,Availability 3-502.12 Reduced Oxygen Packaging,Criteria* 6-301.12 Hand Drying Provision 8-103.12 Conformance with Approved Procedures* -- •Dentes critical item in the federal 1999 Food Code or 105 Cb1R 590.000. CITY OF SALEM 2�/ BOARD OF HEALTH Establishment Name: ( " SS // ! .hl�-f_ti S Date:___(e IZA I.3 Page: of Z Item Code C-Critical Item / DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date No. Reference R-Red Item - Verified PLEASE PRINT CLEARLY rr ` //�� //�.r✓/1P_3 � �P �vil �r/�1`P�Y - �iJii /�Yi/J/i'd�irir�-,..1 Discussion With Person in Charge: Corrective Action Required: I ❑ No ( ❑ Yes I have read this report, have had the opportunity to ask questions and agree to correct all ❑ Voluntary Compliance ❑ Employee Restriction/ 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 o Embargo ❑ Emergency Closure your food permit' — — g ❑ Voluntary Disposal ❑ Other: 3-501.14(() PHFs Received at i-eniperatures Viorations Related to Foodborne Illness Interventions and Risk According to l,aw Cooled to Factors(items 1.22) (Cont.) 41"F/45'F)Within?Hours PROTECTION FROM CHEMICALS ( 3-501.1Cv11me Mc4mds for PRFs 14 Food or Color Additives ( 19 PHF Hot and Cold Holding 3-202.12 Additives 3-501.15(Bi Cold PHF> Ntaintatncd at or l)6iw 59ii.U04(Fl 41°(4S F* 3-302.1.1 Proicetion from th7appw•;:d Additives% g, Poisonous or Toxic Substances 1 3-50 L 1F,(A) Hot PHF,.Maintained at of above 7-10t.Il tdenttf}4ngIll lbrmaion-Original I 14WI-. Containers' 3-501.16(A) Roasts H ld'at o! above I 100 7-10'.41 Common:s ante -Working Conutiners 21) Time as a Public Health Control 7-'O-1 1 CommonSeparatio -Native - ?o ( 3-501 19 -(nae a,a Public H-'alth ControP' 7-202.11 Restriction-Presence and tics" 5S"d.004(H) Variance Rutuuxsnc:nt 7-202.12 Conditions of rise'° 7-211:.t1 Ioxic Coutaimns -Prohibitions" I REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-2(14.11 Sanitizers.Criteria-Chemicals' ( POPULATIONS(HSP) i 7-201 1' Chemicals for Washing Produce; Criletia ( 124 3-801.11(Al T)npacteurized Pre-packaged Juices and Bererage, with Warning Labels 7-2(14.11 Dndna Agents.Coram* ( ;-s01.11B! Use of Pasteurized E:e„s" 7-211;.11 hegnc! d Use esrciCoravdt, ,Criteda- i 13-801 11(D) Raw no, Partially Coked Animal Food and 17-2t 16.1 t Restric!ed Use Pesncidec,Critetia" ,, 2 Roc.'Seed Spn:uts Net Sened. 7-_116.1.. Rodent Bait Stations I ( 3-gOI.I I(C) Unopened Food Package Not Re-served. 7-206.13 Tiac•kicg Powders,Pest Control and I RAunitoring CONSUMER ADVISORY TIME/TEMPERATURE CONTROLS 22 3-603.11 Cvnsmner A6ittoty Posted for Crn,aimption of 1( ' Proper Cooking Temperatures for ( Animal Food;That are Raw.LJud.reooked or PHFs Not Uthertnise Processed to Eliminate Not 3-401.(1 At U(_') Eggs- 155''F I S Sec. ' 1 Pathogens.' F,... Immedi,ar Service 145°F15sec- Sit_ , Pasteurized Eggs Snhstitute fix Roc+•Shell 3-401.11(A)(2i CunwtinuterlFish. Meats SCratne L"'z Animals- 155"F 15 see. ' 3-101.11(,13)(I)(2) ( Pork.rndBeefRoast- 130"F 121 min* SPECIAL REQUIREMENTS 3-401.11(A)(2) Ratites,Injected Meal.,- I55`F 15 590 009(A)-(U) I Violations of Section 590.009,(A)-(,D) in sec * I { catering, mobile fix:d, temporaTS'and 3-401.11(A)(3) Poultry,Wild Game. Stuffed PHFs, residential kitchen operations should be ,Ntutrmg t-ontamung Fish,Moat. ....,.,..., ..oder the _;,,- t-t,. Poultry or Ratites-165'F 15 sec, above if related to foodborne illness 3-401 I I(C)(3) )'hole-muscle, Intact Beef Steaks interventions and risk factor's. Other 45°F' 590.009 violations relating to good retail 3-401.12 Raw Anined Food,Cooked in aI practices should be debited under#29- Microw'ave 1659=* i Special Requirements. 3-40111 W(U(b) All Uther PHF's-- 135"F 15 sec * 17 Reheating for Hot Holding j VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 3403.1 l(A)K(D) Pl1Fs 165''F 15 sec. (Items 23-30) 3-403 11(B) Micrt,wacc- 165"F 2 Mmnte Standing I Critical and an;7-,rntca?violations, :tWhich do ern;relate io lire Time" Grurlhorne dlnes's interventions and risk fucinr: lisled ubol e, ern be 3-403.1 t(C) Commercially Pioc"sed RTE Food- found in the foltoxWing seroma of the/'ood Code and 105 C6MR 14WF* 590.1X/0. 3-403,11(E) RetnaininelinslicedPortions ofBeef Nem I Good Retail Practices FC 590.000 Roasts 23. Management and Personnel FC -2 003 j Food and Fwd Protection FC-3 004 jK Proper Cooling of PRFs 124 r 3-501.14(A) Coolm,,C,ked PHFs from 130'F m) 25 ! Equipment and Utensils FC- 005 26. Water. Plumbinq and Waste FC-S 006 70"F Within 2 Hon's and From 70'F 27, Phys!ral Facility FC-5 .007 to 41'F/45"F Within 4 Hours " 28. ! Poisonous or Toxic,Matenals FC-7 ___008 3-501.14(B) Cooling PHFs Made From.Ambient �29 ---- Special Requirements I emperatine Ingredients to 41"Ft-15-F ( 30. Other ' Within 4 Hours:' I ''' "-"''`` Danom,cridc:d nem in the federal 1999 Fos+d Code o1 10. CMIZ 590.000. r CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH $ 120 WASHINGTON STREET, 4TH FLOOR i 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 MOBILE FOOD SERVER In accordance with Regulations promulgated under authority of Chapter 94 , Section 305A and Chapter III , Section 5 of the General Laws a Permit is hereby granted to : Name : Kevin Kefalas Name of Establishment : Classy Chassis Food Cart #4 Whose Place of Business is : 4 Azalea Lane Peabody, MA Date : 06/11/2003 To Operate a Mobile Food Server in Salem Restrictions : Sausages, Hot dogs, chips, soda. Permit #: 8-03M Frozen Desserts/ Ice Cream: PERMIT EXPIRES December 31, 2003 �,,Ole HEALTH AGENT 6�coxo CITY OF SALEM, MASSACHUSETTS �N BOARD OF HEALTH '� 120 WASHINGTON STREET, 4TH FLOOR ` * SALEM, MA 01970 syB TEL 978-741-1800 A'� FAX 978-745-0343 STANLEY USOVICz, JR JOANNE SCOTT, MPH, RS. CHO MAYOR HEALTH AGENT APPLICATION FOR A MOBILE FOOD SERVICE PERMIT ''//^ ,, / Fee $150 payable to The City of Salem, No Cash Name of Applicant FAN t,N 6,)<'? l9--:� Telephone# /— Address Y 42A /,e A-- Z e /Al Certified Food Manager 6a-t,& Ke—Fi l�f-�r Certificate # Name of Business C/4 51.\;, C*asS/-T Telephone# Address �$a�m e-, Manufacture Frozen Desserts? Yes No Type of Vehicle p-A C An! l Registration# Location of Operation 151;�Fa/.-orl /7,av,n Ai 6AI Name & Address of Licensed Food Service Establishment Serving as Base of Operation Gos 'tee Telephone# '7y0-1000 Location of Toilet & Handwashing Facilities / Menu SaL-s � f la ff D�G,_S ��vs�I �� .✓� 1 C��S Type of refrigeration' Ice Y Dry Ice_ G�s Other Method for Cooking and/or Hot Holding/Gas Y Other Method for Sanitizing: Chemical t Hot Water (170 F) I have read and agree to abide by The Salem Board of Health Regulations regarding "Mobile Food Units & Pushcarts" and will notify the Salem Board of Health of any changes in this application. Pursuant to MGL C62C,S49A, I certify under the penalties of perjury that I, to my best knowledge and belief, have filed all State tax returns and paid all State taxes required under law. / /f 032- G - 76 z3 Signature Social Security#or Federal ID# Date ^ � ---Trw✓� Revised 2/7/03 Permit# Check#&Date 5310 — /O C� ..:r w -.,,- ..n' ....+••..,s�.rs n...v. �.nr^^"v..rrr�r•....-•�v^',V,.•.^v,y_..ryy<„C"T^.'r'rxe'-•nww+-..-�- .-N.rM-..v..w-s.r'^^+,n'.n"y"..,-•„-w,r+',-.re»^^ w'rM'--ti.,� THE COMMONWEALTH OF MASSACHUSETTS CITY OF SALEM Address: 120 Washington Street, 4th Floor BOARD OF HEALTH Salem, MA 01970-3523 FOOD ESTABLISHMENT INSPECTION REPORT Tel: (978) 741-1800 Fax: (978) 745-0343 Name //jj Date j Tvne of Oneration(,s1 Irvine g of Inspectio C.-ll/sl l C!/(� jJ/}� /p ��/�� El Food Service P40utine Address / / 1 / Risk - ❑ Retail ❑ Re-inspection Level ❑ Residential Kitchen Previous Inspection Telephone 1 r _ �� / .. KAobile ,D,.atee,, El TemporaryL!d'Pre-o eration �elJ/�" HACCP YIN p Owner �p�j/jy-f I ❑ Caterer ❑ Suspect Illness Person In Charge(PIC) Time ❑ Bed&Breakfast ❑ General Complaint i In: ❑ HACCP Inspector �S� C'1��Z Out: Permit No. ❑ Other Each violation checked require-ss an explanation on the narrative page(s) and a citation of specific provision(s) violated. Non-compliance with: Violations Related to Foodborne Illness Interventions and Risk Factors (Red Items) Anti-Choking Tobacco Violations marked may pose an imminent health hazard and require immediate corrective 590.009(E) ❑ 590.009(F) ❑ action as determined by the Board of Health. Local Law ❑ FOOD PROTECTION MANAGEMENT ❑ 12. Prevention of Contamination from Hands ❑ 1. PIC Assigned/Knowledgeable/ Duties ❑ 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 TIMEITEMPERATURE CONTROLS(Potentially Hazardous Foods) ❑ 4. Food and Water from Approved Source ❑ 16. Cooking Temperatures ❑ 5. Receiving/Condition ❑ 17. Reheating ❑ 6. Tags/ Records/Accuracy of Ingredient Statements ❑ 18. Cooling ❑ 7. Conformance with Approved Procedures/HACCP Plans ❑ 19. Hot and Cold Holding PROTECTION FROM CONTAMINATION ❑ 20. Time as a Public Health Control ❑ 8. Separation/Segregation/ Protection REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) ❑ 9. Food Contact Surfaces Cleaning and Sanitizing ❑ 21. Food and Food Preparation for HSP ❑ 10. Proper Adequate Handwashing CONSUMER ADVISORY ❑ 11. Good Hygienic Practices ❑ 22. Posting of Consumer Advisories Violations Related to Good Retail Practices (Blue Number of Violated Provisions Related Items) Critical (C) violations marked must be corrected To Foodborne Illnesses Interventions immediately or within 10 days as determined by the Board and Risk Factors (Red Items 1-22): of Health. Non-critical (N) violations must be corrected Official Order for Correction: Based on an inspection immediately or within 90 days as determined by the Board today, the items checked indicate violations of 105 CMR o Health. 590.000/Federal Food Code.This report, when signed below c N by a Board of Health member or its agent constitutes an 23. Management and Personnel (FC-2)(590 003) order of the Board of Health. Failure to correct violations 24. Food and Food Protection (FC-3)(590 004) cited in this report may result in suspension or revocation of 25. Equipment and Utensils (FC-4)(590.005) the food establishment permit and cessation of food 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: Inspector's Signature: /�j Print: PIC's Signature: / Y0V •••fff •'( Y Print: 1 Page /oce2p ges FORM 734A HOBBS&WARREN -BOSTON Violations Related to Foodborne Illness I Interventions and Risk Factors (Red Items 1-22) PROTECTION FROM CONTAMINATION 8 Cross-contamination FOOD PROTECTION MANAGEMENT 3-302.11(A)(1) Raw Animal Foods Separated from 1 590.003(A) Assignment of Responsibilitv* Cooked and RTE Foods* 1 590.003(6) Demonstration of Knowledge* Contamination from Raw Ingredients 2-103.11 Person in Charge-Duties 3-302.11(A)(2) Raw Animal Foods Separated from Each Other* EMPLOYEE HEALTH - Contamination from the Environment 2 590.003(C) Responsibility of the Person in Charge to 3-302.11(A) Food Protection* require reporting by Food Employees and 3-302.15 Washing Fruits and Vegetables Applicants* 3.304.11 Food Contact with Equipment and 590.003(F) Responsibility of a Food Employee or an Utensils* Applicant to Report to the Person in Charge* Contamination from the Consumer 3-306.14(A)(B) Returned Food and Reservice of Food* 590.003(G) Reporting by Person in Charge* Disposition of Adulterated or Contaminated 3 590.003(D) Exclusions and Restrictions* Food 590.003(E) Removal of Exclusions and Restrictions 3-701.11 Discarding or Reconditioning Unsafe Food* FOOD FROM APPROVED SOURCE 9 Food Contact Surfaces 4 I Food and Water From Regulated Sources 4-501.111 Manual Warewashing-Hot Water 590.004(A-B) Compliance with Food Law* Sanitization Temperatures* 3-201.12 Food in a Hermetically Sealed Container* 4-501.112 Mechanical Warewashing-Hot Water 3-201.13 Fluid Milk and Milk Products* Sanitization Temperatures* 3-202.13 Shell Eggs* 4-501.114 Chemical Sanitization-temp.,pH, 3-202.14 Eggs and Milk Products, Pasteurized* Concentration and Hardness* 3-202.16 Ice Made from Potable Drinking Water* 4-601.11(A) Equipment Food Contact Surfaces and 5-101.11 Drinking Water from an Approved System* Utensils Clean* 590.006(A) Bottled Drinking Water* 4-602.11 Cleaning Frequency of Equipment Food- 590.006(B) Water Meets Standards in 310 CMR 22.0* Contact Surfaces and Utensds* 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* 10 Proper,Adequate Handwashing Game and Wild Mushrooms Approved by 2-301.11 Clean Condition-Hands and Arms* Regulatory Authority 2-301.12 Cleaning Procedure* 3.202.18 Shellstock Identification Present* 2-301.14 When to Wash* 590.004(C) Wild Mushrooms* 3-201 17 Game Animals* 11 Good Hygienic Practices 2-401.11 Eating,Drinking or Using Tobacco* 5 Receiving/Condition 2-401.12 Discharges From the Eyes,Nose and 3-202.11 PHFs Received at Proper Temperatures* Mouth* 3-202.15 Package Integrity* 3-301.12 Preventing Contamination When Tasting* 3-101.11 Food Safe and Unadulterated* 12 Prevention of Contamination from Hands 6 Tags/Records:Shellstock 590.004(E) Preventing Contamination from 3-202.18 Shellstock Identification* Employees* 3-203.12 Shellstock Identification Maintained* 13 Handwash Facilities Tags/Records:Fish Products Conveniently Located and Accessible 3-402.11 Parasite Destruction* 5-203.11 Numbers and Capacities* 3-402.12 Records,Creation and Retention* 5-204.11 Location and Placement* 590.004(1) Labeling of Ingredients* 5-205.11 Accessibility,Operation and Maintenance 7 I Conformance with Approved Procedures /HACCP Plans Supplied with Soap and Hand Drying _ Devices 3-502.11 Specialized Processing Methods* 6-301.11 Handwashing Cleanser,Availability 3-502.12 Reduced Oxygen Packaging,Cnlena* 6-301.12 Hand Drying Provision 8-103.12 Conformance with Approved Procedures* `I •Denotes critical item in the federal 1999 Food Code or 105 CNIR 590.010. I- eel CITY OF SALEM CAllzm 01111 / BOARD OF HEALTH Establishment Name: (711, 44_ d / •i�.Scf Date:�� Page: -2 of , z Item I Code I C-Critical Item I Y DESCRIPTION OF VIOL,(�TION/PLAN OF CORRECTION Date ' Pb. II Reference 11 R-Red Item - i -PLEASF PRINT CL,FARLY Verified V////i X;X4_ _ ry ,.1.f',P ,!h/rt,f,./� i r .r _z - 'flM it 1¢/�I_!_1 ./i�_�c.lL. �J�i//iG" iru✓: I ! / I I,\ 1 I �� j A/+Y? t./ •/�ri"!�b 7 �fr�1 Es�6'<.YG��-4� �YT'�-BJP �' (I �r)r�.!lirr.ri/lfi7/'iiJ.c I I . I I i I i I I I I I Discussion With Person in Charge: II Corrective Action Required: U No ❑ Yes I have read this report, have had the opportunity to ask questions and agree to correct all I ❑ Voluntary Compliance ❑ Employee Restriction/ violations before the next inspection, to observe all conditions as described, and to Exclusion comply with all mandates of the Mass/Federal Food Code. I understand that U Re-inspection Scheduled U Emergency Suspension noncompliance may result in daily fines of twenty-five dollars or sus ens.on/revocation of ❑ Embargo ❑ Emergency Closure your fpod permit. // ❑ Voluntary Disposal U Other: 3-501 1 f(Cq PHFs Reserved at Temperatures Vfofationa Related to Foodborne Hiness Interventions and Risk According to I..aw Cooled u, il Factors(items 1-22) (Cont.) 141�F/457 NVchin 1 Hours ' PROTECTION FROM CHEMICALS 1-501.15 Cooling Methods for PHF> jq ! Food or Color Additives ( l 19 PHF Hot and Cold Holding 3-5( 1 ,6,•B t Cold PIIFs :Maintained at o: heloW j 1-202.12 ,-lddinees'" 590.004(F) 41'145"F' 3-302.14 Protection fru?a Unapproved Addihtes`-' I ')j r Poisonous al,Toxic Substances 13-SU i.i6(A) HotPHEs T9utmained at or above 7-101.11 ldenuf}vtg Eniurmattwr-Original Container, 3-501.16(A) Ro.;sls HvIcl at cr she,e 130'F ; 20 Time as a Public Health Control 7-102.1 l C:ommou Nmue - Wcaking Containers' ( 3-501.19 ( Titne as a Public Health (,,Nitrol" 7-201,11 Separation-Steraire' 7 202 It Real ric*tun- Prescuce and Use'' 590.0U4iHt 'J.:r!.mce Requirer,tcnt 7-"6-2.12 Conditions;of Fisc" 7 203.1 1 Toxic C'ootoiner:--P!nhitntionc% REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-2(14.11 Senitizers.Criterui-Chemicals^ POPULATIONS(HSP) 17-20=4 12 Chemicals for Washing Province,Criteria` ( 127 3-8611.1 I l.A) Bc%Unpe ageu witzcdh Wai n,4xged,users and 7-21;3.14 Divirei Agents,C�,teria' r Use of Pa with Weaning Labels* 1 7-205.11 hicidental Food Contact,Lubricants'" I 3-801.11 H)i ( Use o or Legs^ 3-801 I1(D) ( Rew. of Pattiall} Cooked Animal i'ocri and 7-206.11 Restricted Use Pesticides,Criteria" 7-206,12 Rodent Bait Stations" Rao:Seed Sprouts Not Served. ,a ! 7-20.6.13 !racking,Puwdcra Fest Control and 3-801 1160) lJnopened Foul Package Nul Re-serves(. " Monitoring' � CONSUMER ADVISORY TIMEITEMPEWkTURE CONTROLS 22 3-603.11 Consamer Arb isory Posted for Consumption of ' Animal F(Kds Th,t are Raw,Undercooked or 16 I Proper Cooking Temperatures for Not Otherwise Processed to Eliminate PHFs ( Pathno• r+,.ecce ;;:co, 3-4ul.IIA(1)(2I Eg;;s- 155'F15Sec. Legs-Immediate Service 145'7,Ssec" ; 3-302.13 Pasteurized Eggs Substitute Ior Raw Shell 3-401 11(A)(2) Comminuted Fish.lvleais h Game i �"^''Y Am 'tnals- 155"F 15:,ec. SPECIAL REQUIREMENTS3 401.1H!(5)!2) Ratite+, Igieccct 3-401. (B)(I)(2) Potk and Beef Adcah- 155'7 15 Roast- 130"5 121 min" 590_009(A) (D) Violations of Section 590,009(5)-(1)) in sec. T caterin.o, mobile fait, teagrorar} and 3-401.11(Ad31 Poultry,Wild(3ame.Stuffed PHF,. !'esidential kitchen operations should be Jtutnng Containing Fish,Meat. ....o.,..., ..oder the _,.r q-t,.r, .>...,..,,,., Poultry or Ratites-165"7 15 see. " I above if related to foodbot ne illness 3-401 i I IC)(3) Whole-musele, intact Beet Steaky interventions and risk factors. Other I 45'F = 590.009 violations relating to goat[,,tail 3-401.12 Rath Animal Foods Cooked in a practices should be debired under#29- Micruwace 165`7';_ Special Requirernerr(s. 3-401.11(A)(1)(b) Ad I Other PHFs - 145''F li sec. I? Reheating for Hot Holding VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 3-403 1 I(A)K(D) PIIFs 165'F 15 see. " (Items 23-30) 3-403.11(B) Microwave- 165'F 2 Minute Standing ; Critical and non,anew(violations, whirl!do not retail,to the loodhorne dhress intervenrious mid risk(uetnr:,luteal above, cull he 6403 11(C) Co;rmerciall}Processed RTE Food- lnwnd bt theJollowin•g se(tion.s(?f the Food Code and 05 0'1R 14(1°7"" 590,000. 3-403 1 HE) Remaining Unsl!ced Portions of Beef Item I Good Retail Practices FC 5.40.000 Roasts23. Management and Personnel FC 2 .003 jg Proper Cooling of PHFs 24 Food and Food Protection FC--3 .004 25, 1 Eduipment and Utensils FC-4 .005 3-5UI.14(A) Cooling Coked PHFs front 140'F to p6. Wates Plumbing and Waste FC-5 .006 7V F Within'-) Homs and From 70"F 27 Physical Facility FC-6 .007 to 41'F/45'7 Within 4 Hours. "` 1 28. - PdsonouS or Toxic Materials ( FC-7 .008 3-501.14(B) Cwliug PHFs Made From Ambient 124 l Special Requirements 009 Temperature Ingredients to 41'F/45'F 30 ''. Other r Within 4 Hours' j ` Denow molal nem in the federal P)9')1'or,d c,ale,,n I O]C MR 590.000. _o CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH • 120 WASHINGTON STREET, 4TH FLOOR SALEM, MA 01970 TEL. 978-741-1800 FAX 978-745-0343 STANLEY USOVICZ, JR JOANNE SCOTT, MPH, RS, CHO MAYOR HEALTH AGENT COMMONWEALTH OF MASSACHUSETTS PERMIT TO OPERATE A MOBILE FOOD SERVER In accordance with Regulations promulgated under authority of Chapter 94 , Section 305A and Chapter III, Section 5 of the General Laws a Permit is hereby granted to: Name : Kevin Kefalas Name of Establishment : Classy Chassis Cart #1 #597-095 Mass Whose Place of Business is : 4 Azalea Lane W. Peabody MA Date : 04/24/2003 To Operate a Mobile Food Server in Salem Restrictions : Sausage, Kielbasa, hot dogs, chips, drinks . Permit # : 4-03M Frozen Desserts/ Ice Cream: PERMIT EXPIRES December 31, 2003 HEALTH AGENT M1 �coxolr CITY OF SALEM, MASSACHUSETTS rya' BOARD OF HEALTH a 120 WASHINGTON STREET, 4TH FLOOR a � a SALEM, MA 01970 TEL. 978-741-1800 FAX 978-745-0343 STANLEY USOVICZ. JR. JOANNE SCOTT, MPH. RS, CHO _ I / 1/•'�/ MAYOR HEALTH AGENT / J APPLICATION FOR A MOBILE FOOD SERVICE PERMIT //�/ Fee $150 payable to The City of Salem, No Cash Name of Applicant �i�' 466,9 /4 -S Telephone# 92,?-53.5 6FF y Address e2.fi Ze/a_ Cif A�� Certified Food Manager At. Lem— �F4 /Q S Certificate # 107'Z-? V& Name of Business /SSS% �G-r :51' mod '�' elephone# / 9 3G o 3G 99 Address 5,q A-,-, a-- Manufacture Frozen Desserts? Yes No Type of Vehicle //90 Registration# Location of Operation �sscyC Sf_ mq// a f wa�7r�yrfa..v� Name & Address of Licensed Food Service Establishment Serving as Base of Operation Go s/'Co Telephone# Location of Toilet & Handwashing Facilities Menu l{�/� s - S/r�S/.tis —k.,/testi — G��s - Type of refrigeration: Ice 4 / Dry Ice Gas Other Method for Cooking and/or Hot Holding: Gas Other Method for Sanitizing: Chemical Hot Water (170F) I have read and agree to abide by The Salem Board of Health Regulations regarding "Mobile Food Units & Pushcarts" and will notify the Salem Board of Health of any changes in this application. Pursuant to MGL C62C,S49A, I certify under the penalties of perjury that 1, to my best knowledge and belief, have filed all State tax returns and paid all State taxes required under law. Signature Social Secunty# or Federal ID# Date - 3 Z — 1 =��62 - = 23—Z003 Revised 2/7/03 Permit# Check#&Date ._.._. .. _ .. . .. ...a-,� ..w .. _.,ti.. ..�,..,... ...-,,, � -'�Waew*1^'wr'a-asa r•-i.xwF ie'+ �.x-..=-.o. ....-....+wm..-r.« T.. .-.,- rn.. r� THE COMMONWEALTH OF MASSACHUSETTS )► CITY OF SALEM BOARD OF HEALTH Address: 120 Washington Street, 4th Floor Salem, MA 01970-3523 FOOD ESTABLISHMENT INSPECTION REPORT Tel: (978) 741-1800 Fax: (978) 745-0343 NameDate Tvoe of Ooeration(sl Type of Inspection C(//Acr., ew.val-r x/131 J 1111 Food Service ❑ Routine Address // Risk ❑ Retail ❑ Re-inspection Y �Z^96i4 e,4,,P Level ❑ Residential Kitchen Previous Inspection Telephone //nn [Mobile Date: Owner //' HACCP Y/N ❑ Temporary []'Pre-operation �ceGi,✓,1 �//„�A �cF,y(,aj I ❑ Caterer ❑ Suspect Illness Person in Charge(PIC) „ Time ❑ Bed&Breakfast ❑ General Complaint In: 1.70 ❑ HACCP Inspector -f- - /iOut: Permit No. ❑ Other Each violation checked requires an explanation on the narrative page(s) and a citation of specific provision(s) violated. Non-compliance with: Violations Related to Foodborne Illness Interventions and Risk Factors (Red Items) Anti-Choking Tobacco Violations marked may pose an imminent health hazard and require immediate corrective 590.009(E) ❑ 590.009(F) ❑ action as determined by the Board of Health. Local Law ❑ FOOD PROTECTION MANAGEMENT ❑ 12. Prevention of Contamination from Hands ❑ 1. PIC Assigned/ Knowledgeable/ Duties ❑ 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 TIME/TEMPERATURE CONTROLS(Potentially Hazardous Foods) [1 4. Food and Water from Approved Source El16. Cooking Temperatures El 5. Receiving/Condition El 17. Reheating E) 6. Tags/ Records/Accuracy of Ingredient Statements El 18. Cooling ❑ 7. Conformance with Approved Procedures/ HACCP Plans ❑ 19. Hot and Cold Holding PROTECTION FROM CONTAMINATION ❑ 20. Time as a Public Health Control ❑ 8. Separation/Segregation/ Protection REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) ❑ 9. Food Contact Surfaces Cleaning and Sanitizing ElEl 10. Proper Adequate Handwashing 21. Food and Food Preparation for HSP CONSUMER ADVISORY ❑ 11. Good Hygienic Practices ❑ 22. Posting of Consumer Advisories Violations Related to Good Retail Practices (Blue Number of Violated Provisions Related Items) Critical (C) violations marked must be corrected To Foodborne Illnesses Interventions immediately or within 10 days as determined by the Board and Risk Factors (Red Items 1.22): of Health. Non-critical (N) violations must be corrected Official Order for Correction: Based on an inspection immediately or within 90 days as determined by the Board today, the items checked indicate violations of 105 CMR of Health. 590.000/Federal Food Code.This report, when signed below c N by a Board of Health member or its agent constitutes an 23. Management and Personnel (FC-2)(590.003) order of the Board of Health. Failure to correct violations 24. Food and Food Protection (FC-3)(590.004) cited in this report may result in suspension or revocation of 25. Equipment and Utensils (FC-4)(590.005) the food establishment permit and cessation of food 26. Water, Plumbing and Waste (FC-5)(590.006) establishment operations. If aggrieved by this order, you 27. Physical Facility (FC-6)(590.007) have a right to a hearing.Your request must be in writing 28. Poisonous or Toxic Materials (FC-7)(590.006) and submitted to the Board of Health at the above address 29. Special Requirements (590.009) within 10 days of receipt of this order. 30. Other DATE OF RE-INSPECTION: A Inspector's Signature: ��/� _ Print: PIC's Signature: Print: Page/of d Pages FORM 734A HOBBS&WARREN - BOSTON _ 1 Violations Related to Foodborne Illness t ; Interventions and Risk Factors (Red Items 1-22) PROTECTION FROM CONTAMINATION I8 Cross-contamination FOOD PROTECTION MANAGEMENT 3-302.11(A)(1) Raw Animal Foods Separated from �I 1 590.003(A) Assignment of Responsibility* Cooked and RTE Foods* J 590.003(B) Demonstration of Knowledge* Contamination from Raw Ingredients 2-103.11 Person in Charge-Duties 3-302.11(A)(2) Raw Animal Foods Separated from Each Other* EMPLOYEE HEALTH Contamination from the Environment 2 590.003(C) Responsibility of the Person in Charge to 3-302.11(A) Food Protection* require reporting by Food Employees and 3-302.15 Washing Fruits and Vegetables Applicants* 3.304.11 Food Contact with Equipment and 590.003(F) Responsibility of a Food Employee or an Utensils* Applicant to Report to the Person in Charge* Contamination from the Consumer 3-306.14(A)(B) Returned Food and Reservice of Food* 590.003(G) Reporting by Person in Charge* Disposition of Adulterated or Contaminated 3 590.003(D) Exclusions and Restrictions* Food 590.003(E) Removal of Exclusions and Restrictions 3-701.11 Discarding or Reconditioning Unsafe Food* FOOD FROM APPROVED SOURCE 9 Food Contact Surfaces 4 I Food and Water From Regulated Sources 4-501.111 Manual Warewashing-Hot Water 1 590.004(A-B) Compliance with Food Law* Sanitization Temperatures* 3-201.12 Food in a Hermetically Sealed Container* 4-501.112 Mechanical Warewashing-Hot Water 3-201.13 Fluid Milk and Milk Products* Sanitization Temperatures* 3-202.13 Shell Eggs* 4-501.114 Chemical Sanitization-temp.,pH, 3-202.14 Eggs and Milk Products,Pasteurized* Concentration and Hardness* 11 3-202.16 Ice Made from Potable Drinking Water* 4-601 5-101.11 Drinking Water from an Approved System* .11(A) Equipment Food Contact Surfaces and Utensils Clean* 11 590.006(A) Bottled Drinking Water* 4-602.11 Cleaning Frequency of Equipment Food- 590.006(B) Water Meets Standards in 310 CMR 22.0* Contact Surfaces and Utensils* Shellfish and Fish From an Approved Source 4-702.11 Frequency of Sanitization of Utensils and 3.201.14 Fish and Recreationally caught Molluscan 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 2-301.11 Clean Condition-Hands and Arms* J Regulatory Authority 3.202.18 Shellstock Identification Present* 2-301.12 Cleaning Procedure* 2-301.14 When to Wash* 590.004(C) Wild Mushrooms* 3-201.17 Game Animals* 11 Good Hygienic Practices 2-401.11 Eating,Drinking or Using Tobacco* 5 Receiving/Condition 2-401.12 Discharges From the Eyes,Nose and 3-202.11 PHFs Received at Proper Temperatures* Mouth* 3-202.15 Package Integrity* 13-301.12 Preventing Contamination When Tasting* 3-101.11 Food Safe and Unadulterated* 12 Prevention of Contamination from Hands 6 I Tags/Records:Shellstock 590.004(E) Preventing Contamination from I 3-202.18 Shellstock Identification* Employees* JI 3-203.12 Shellstock Identification Maintained* 13 Handwash Facilities J Tags/Records: Fish Products 3-402.11 Parasite Destruction* Conveniently Located and Accessible 5-203.11 Numbers and Capacities* 3-402.12 Records,Creation and Retention* _ 5-204.11 Location and Placement* 590.004(J) Labeling of Ingredients* - 7 I Conformance with Approved Procedures 5-205.11 Accessibility,Operation and Maintenance /HACCP Plans Supplied with Soap and Hand Drying Devices 3-502.11 Specialized Processing Methods* 3-502.12 Reduced Oxygen Packaging,Criteria* 6-301.11 Handwashing Cleanser,Availability 8-103.12 Conformance with Approved Procedures* 6-301.12 Hand Drying Provision *Denotes critical item in the federal 1999 Food Code or 105 CAIR 590.000. CITY OF SALEM BOARD OF HEALTH Establishment Name: �9lSi C��✓s r Date: 7 X.7 Page: of Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date No. Reference R-Red Item Verified PLEASE PRINT CLEARLY I ��T I I I II f�,4�;c .�/•ni-c r,..Y�iic C"n. � S 7.,r�� e�•c, >.� 7L Ul� I I I I I I I I I I I I I I I I I I I I I � I I Discussion With Person in Charge: Corrective Action Required: I ❑ No ( ❑ Yes I have read this report, have had the opportunity to ask questions and agree to correct all ❑ Voluntary Compliance ❑ Employee Restriction/ 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-fiv dollars s s�sioation of ❑ Embargo ❑ Emergency closure your,food permit. IIS ❑ Voluntary Disposal 0 Other: 3-5i)l 1,70imlion"Richitod so and filrk Fn Law raclxs(Itenis il.rmj sl, P/45-F M 4 PROTECTION FROM CHFWCALS CocJ:;Ic Methods foL PFF, 1 14 I Food or Gorr liddifives pq r-Hot ano Cold Holding PJ.-, %faip- u; holo3-�02,12 Addiii�es* 04+ 1 1-2Q.14 P,,)tvc1i,,n from Unapmowd 1.!6(,' �t PhTs abw� 15 Poisonous or Tunic Stibstinc-s 7-10 .11 ldcllfi; 1111"mi"Itioll --Gr,innal ,-50).11 j 10 VA) o,�,ts H,i 4 1 al�u:e 30,T. 7-102.11 Connl,aNacac Tme as Pnbll,ficaftv.Coonct I.j I &'PaW060e- P) Healn,Coi)tfvi R-AridiCill PICSe HLO and U:;, Varmino Neituil'Cl-,Old ;--fC 12 Ct ndw,ns ui t -;,y jREQUREMENTS FOR HIGHLY $I ISCEPHELF 7 2?'-,.11 Toxic Cimltalcol�,--plohibiti,;nO POPULAT:014-:1(HSP" 3-W I�11(A) !! 7-204.i-1 Chvillmils run h,o.hwe�Critella, Unpasleilli/od Prc-packqcd 7.FiCcr and �,ilh'Wavilin. Lib-!,� 7-204.'1 4 Drwig t'vrzn:I* 7-205,il incideptai =.',,ld C,-.iit.ic;,Lubricants'. -801.11113) 1 1 IS,of Pat I,.:;i-,,,l _Va ol Cooke,! 4ninlal Pcod and -1-206.11 Re,;trcted Use Pestic!'te's,Cliw:iu 7-1 Rxvv secc! �)Ptows?lot Set Rodent Raii,S;,oi-11":� "i;l.i (C) I:r,,:i:cnv.I Rugi P,Icj:a;c Not R :ser.ed 7-206.17 1; 1,achiyn Pow6crs, Nst Cmvro; and CONSUMER ADVISORY TIM-UTEMPERATURE C014TROLS 22 3-603.!1 C A&is.-xv Posted for of Proper Cooking Temperatures tot Ai,.�:Icd .,^e Raw, US:,lincook,.•d tp Piirs INO (nhCl".`lSc PMCeFSCd U1 FliML,ne 3--101.1 Ak Of 2) Ec"s- 1�5 F 1 S S",. 3 Uggq-Im;Tcdt ate cc I 15'F]5sv� - 0",12 17"A Egg> SLLb�d',V': 1.1, RIV,'StIcIl 3-40;.! A)(2) C,niniinutecl -;Ai.Menus C*m!c I ---s Animals- 155'F 15 ,cL' -,-40 1.11(B 1)(2) Pvk.md licef Roat,L - I-,OT !21 inii, SPECIAL REQUIREMENTS 'i()0,0tj' Viohitions of S,-c:.ion 590.UC',9.(,,%)-(D)in I(A�'�) R�L:itcs, Injected Mcai,- ;5VF 15 carenng, moo:le foot; jempOj*al y and iosident';' kitchen riperaticnis qi�iotfld ?,-401.11(A)t,3) Poultrv,Ladd(3ain,,. Stuffed POFs, Stuff.-ne G,atainuic Foi,1 NMI-a% J,:t',-,Aed unci,-r In,.;pprnpriatv sectioc4 Poultry or R3utes-16SOF 15 ;wc, un c: :If Y,"aicd le ft,lidbor.-w ih,ie,s 3-401 1 Whole-mu3cic, Intact Fevt ;rdencntnnfs, and risk fitctoi.. Uth,,:r 14,5'-F g,Ocnations jehidinto "nod rct-,;l 3-401.1-2, Rai, Anurnr FofAs Cooscd in a txmctice>,shnu:d be debij,-0 under st)) MiLnoa ave 16,:i' R"Cillirclile"I", AII(nh-r PHIP,, 1-5'F .5 ec fry Reheating for Hol Hoid;rg VCL41TIONS R-FLATED TO GOOD RETAA' PRACTICES 3-V3 I It A)&,tM v!IF! 16^`F I�sec. atelvis-)3,30). -4:-,3 11(-.,3) NI-m iv,,avc- i W'F 2 N4iriwc Slandim, elfucta the Ti le" anal r:\! hicffp, ("Ithe 3-403 11(0 Commewidi!)pjuct ;sed RTE Food- fmind u; ti,efiollmv,;w;sciwc, of the F..o:! awl :1)5 CA,,R !O'F- 3-4o3 I l(I�) F�-inwnia,-Unsiicd Portions of fiect ff,�m Guott Rollin Pracfices FC 1 &OOOdo--: RistMs` Venixtpmerit and Pa-,,rnne! FC--2 (103 211 Forare Fotyi rlr-�,zect�Ln -1 004 fg Propel Cooling of PHF!; 2 an-!utensl,.q i F+'-4 3-501,1-VA) Coolint Coci�cd PHI Cron, 1407, :o - W 2- at�. Plinu�,iin q arc;Vfast,: FC fXl'e' 7(i'F 14 nbin 7 Hours and From RT f,l .01 vs),-ai Facniov FC-6 06-1 ,)4PF/4571Vth,n I How, ep Poisorous i Toxic filjnni,ib i FC-7 .CO8 3-50:.! B) ('OokoF PIlk Matic Fjorn Anikiilt Requaemems "empevitme Im,vdims:.,41'-'.., 1 Other Within 4 Blurs" Dr,of,"IiTi,nt ltsl in',)v IeAru] 199,+hoed C,&v 10? THE COMMONWEALTH OF MASSACHUSETTS CITY OF SALEM Address: 120 Washington Street, 4th Floor BOARD OF HEALTH Salem, MA 01970-3523 FOOD ESTABLISHMENT INSPECTION REPORT / Tel: (978) 741-1800 Fax: (978) 745-0343 Name _ ( Date / I Tvne of Oneration(M Tvne of Insnection C- A/55V C 4//-? 1 d(7y ❑ Food Service ❑ Routine Address [r� Risk ❑ Retail ElRe -ins-inspection L/ f7-�+ /c Level El Residential Kitchen Previous Inspection Telephone < Li wMobile Date: Owner / ,/ HACCP )N ❑ Temporary Pre-operation V/� ❑ Caterer Suspect Illness Person In Charge(PIC) S�� Time El Bed&Breakfast El General Complaint I Inspector ! <474/76N !/1 e- ��r �- O A, � - ❑ HACCP �Y/ l�V� `-Y Out: Permit No. El Other Each violation checked requires an explanation on the narrative page(s) and a citation of specific provision(s) violated. Non-compliance with: Violations Related to Foodborne Illness Interventions and Risk Factors (Red Items) Anti-Choking Tobacco Violations marked may pose an imminent health hazard and require immediate corrective 590.009(E) ❑ 590.009(F) ❑ action as determined by the Board of Health. Local Law ❑ FOOD PROTECTION MANAGEMENT ❑ 12. Prevention of Contamination from Hands ❑ 1. PIC Assigned/ Knowledgeable/ Duties ❑ 13. Handwash Facilities EMPLOYEE HEALTH El2. Reporting of Diseases by Food Employee and PIC PROTECTION FROM CHEMICALS El3. Personnel with Infections Restricted/ Excluded El 14. Approved Food or Color Additives ❑ 15. Toxic Chemicals FOOD FROM APPROVED SOURCE El 4. Food and Water from Approved Source TIME/TEMPERATURE CONTROLS(Potentially Hazardous Foods) El 16. Cooking Temperatures El 5. Receiving/Condition El6. Tags/ Records/Accuracy of Ingredient Statements El 17. Reheating El7. Conformance with Approved Procedures/ HACCP Plans El 18. Cooling PROTECTION FROM CONTAMINATION ❑ 19. Hot and Cold Holding El8. Separation/Segregation/Protection El 20. Time as a Public Health Control El 9. Food Contact Surfaces Cleaning and Sanitizing REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) ❑ 10. Proper Adequate Handwashing ❑ 21. Food and Food Preparation for HSP CONSUMER ADVISORY ❑ 11. Good Hygienic Practices ❑ 22. Posting of Consumer Advisories Violations Related to Good Retail Practices (Blue Number of Violated Provisions Related Items) Critical (C) violations marked must be corrected To Foodborne Illnesses Interventions immediately or within 10 days as determined by the Board and Risk Factors (Red Items 1-22): of Health. Non-critical (N) violations must be corrected Official Order for Correction: Based on an inspection immediately or within 90 days as determined by the Board today, the items checked indicate violations of 105 CMR of Health. 590.000/Federal Food Code.This report, when signed below C N by a Board of Health member or its agent constitutes an 23. Management and Personnel (FC-2)(590.003) order of the Board of Health. Failure to correct violations 24. Food and Food Protection (FC-3)(590.004) cited in this report may result in suspension or revocation of 25. Equipment and Utensils (FC-4)(590.005) the food establishment permit and cessation of food 26. Water, Plumbing and Waste (FC-5)(590.006) establishment operations. If aggrieved by this order, you 27. Physical Facility (FC-6)(590.007) have a right to a hearing.Your request must be in writing 28. Poisonous or Toxic Materials (FC-7)(590.008) and submitted to the Board of Health at the above address 29. Special Requirements (590.009) within 10 days of receipt of this order. 30. Other DATE OF RE-INSPECTION: ��n; c Inspector's Si nature:�''^�- Print: Signature: �f f17Cr. PIC's Signature: Print: pn [( / 1_0 aj O �!7 Pa /YI L I "7 / g, of Pages FORM 734A HOBBS&WARREN -BOSTON Violations Related to Foodborne Illness Interventions and Risk Factors (Red Items 1-22) PROTECTION FROM CONTAMINATION S Cross-contamination FOOD PROTECTION MANAGEMENT 3-302.11(A)(1) Raw Animal Foods Separated from 1 1590.003(A) Assignment of Responsibility* Cooked and RTE Foods* 590.003(8) Demonstration of Knowledge* Contamination from Raw Ingredients 2-103.11 Person in Charge-Duties 3-302.11(A)(2) Raw Animal Foods Separated from Each Other* EMPLOYEE HEALTH Contamination from the Environment 2 590.003(C) Responsibility of the Person in Charge to 3-302.11(A) Food Protection* require reporting by Food Employees and 3-302.15 Washing Fruits and Vegetables Applicants* 3.304.11 Food Contact with Equipment and 590.003(F) Responsibility of a Food Employee or an Utensils* Applicant to Report to the Person in Charge* Contamination from the Consumer 3-306.14(A)(B) Returned Food and Reservice of Food* 590.003(G) Reporting by Person in Charge* Disposition of Adulterated or Contaminated 3 590.003(D) Exclusions and Restrictions* Food 590.003(E) Removal of Exclusions and Restrictions 3-701.11 Discarding or Reconditioning Unsafe Food* FOOD FROM APPROVED SOURCE 9 Food Contact Surfaces 4 Food and Water From Regulated Sources 4-501.111 Manual Warewashing-Hot Water 590.004(A-B) Compliance with Food Law* Sanitization Temperatures* 3-201.12 Food in a Hermetically Sealed Container* 4-501.112 Mechanical Warewashing-Hot Water 3-201.13 Fluid Milk and Milk Products* Sanitization Temperatures* 3-202.13 Shell Eggs* 4-501.114 Chemical Sanitization-tem H, 3-202.14 Eggs and Milk Products,Pasteurized* P 1.'-g � Concentration and Hardness** 3-202.16 Ice Made from Potable Drinking Water* 4-601.11(A) Equipment Food Contact Surfaces and 5-101.11 Drinking Water from an Approved System* Utensils Clean* 590.006(A) Bottled Drinking Water* 4-602.11 Cleaning Frequency of Equipment Food- 590.006(B) Water Meets Standards in 310 CMR 22.0* Contact Surfaces and Utensils* Shellfish and Fish From an Approved Source 4-702.11 Frequency of Sanitization of Utensils and 3.201.14 Fish and Recreationally caught Molluscan 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* Game and Wild Mushrooms Approved by 1 10 Proper,Adequate Handwashing Regulatory Authority 2-301.11 Clean Condition-Hands and Arms 2-301.12 Cleaning Procedure* 3.202.18 Shellstock Identification Present* 2-301.14 When to Wash* 590.004(C) Wild Mushrooms` 11 + Good Hygienic Practices 3-201.17 Game Animals* 2-401.11 Eating,Drinking or Using Tobacco* 5 Receiving/Condition 2-401.12 Discharges From the Eyes,Nose and 3-202.11 PHFs Received at Proper Temperatures* Mouth* 3-202.15 Package Integrity* 3-301.12 Preventing Contamination When Tasting* 3-101.11 Food Safe and Unadulterated* � 6 � � Tags/Records:Shellstock � 12 � Prevention of Contamination from Hands 590.004(E) Preventing Contamination from 3-202.18 Shellstock Identification* Employees* 3-203.12 Shellstock Identification Maintained* 13 Handwash Facilities Tags/Records: Fish Products Conveniently Located and Accessible 3-402.11 Parasite Destruction* 5-203.11 Numbers and Capacities* 3-402.12 Records,Creation and Retention* 5-204.11 Location and Placement* 590.0040) Labeling of Ingredients* 5-205.11 Accessibility,Operation and Maintenance 7 I Conformance with Approved Procedures Supplied with Soap and Hand Drying /HACCP Plans Devices 3-502.11 Specialized Processing Methods* 16-301.11 Handwashing Cleanser,Availability 3-502.12 Reduced Oxygen Packaging,Criteria* 6-301.12 Hand Drying Provision 8-103.12 Conformance with Approved Procedures* *Denotes critical item in the federal 1999 Food Code or 105 CDIR 590.000. t f CITY OF SALEM BOARD OF HEALTH Establishment Name: �� / C� / /S Date: (2. Page: of Item Code C-Critical Item DESCRIPTION OF VIOLATION / PLAN OF CORRECTION Date No. Reference R—Red ItemPLEASE PRMT CLEARLY Verified I _ I s ' — F Cj�—' i1 MC\ac,i LIZ t5 CAQ3(_6' c v I I I I Discussion With Person in Charge: Corrective Action Required: I LI Yes XUI 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 comply Exclusion r ❑ Re-inspection Scheduled ❑ Emergency Suspension 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 your food permit. ❑ Embargo ❑ Emergency Closure r ❑ Voluntary Disposal ❑ Other t FORM 7348 HOBBS &WARREN - BOSTON y; Violations Related to Foodborne Illness Interventions and Risk 3-501.14(C) PHFs Received at Temperatures Factors Red Items 1-22 Cont. According to Law Cooled to 41'F/45'F Within 4 Hours.* PROTECTION FROM CHEMICALS 3-501.15 Cooling Methods for PHFs 14 I I Food or Color Additives 19 PHF Hot and Cold Holding 3-202 12 Additives* 3-501.16(8) Cold PHFs Maintained at or below 3-202.14 Protection from Unapproved Additives* 590.004(F) 41'F/450F* f 15 Poisonous or Toxic Substances 3-501.16(A) Hot PHFs Maintained at or above 7-101.11 Identifying Information-Original140'F.* Containers* 3-501.16(A) Roasts Held at or above 130'F.* 7-102.11 Common Name-Working Containers* 120 Time as a Public Health Control 7-201.11 Separation-Storage* 3-501.19 Time as a Public Health Control* 7-202.11 Restriction-Presence and Use* 590.004(H) Variance Requirement 7-202.12 Conditions of Use* REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-203.11 Toxic Containers-Prohibitions* POPULATIONS(HSP) 7-204.11 Sanitizers,Criteria-Chemicals* 21 13-801.11(A) Unpasteurized Pre-packaged Juices and 7-204.12 Chemicals for Washing Produce,Criteria* Beverages with Warning Labels* 7-204.14 Drying Agents,Criteria* 3-801.11(6) Use of Pasteurized Eggs* 7-205.11 Incidental Food Contact,Lubricants* 3-801.11(D) Raw or Partially Cooked Animal Food and 7-206.11 Restricted Use Pesticides,Criteria* Raw Seed Sprouts Not Served.* 7-206.12 Rodent Bait Stations* 3-801.1)(C) Unopened Food Package Not Re-served.* 7-206.13 Tracking Powders, Pest Control and Monitoring* CONSUMER ADVISORY 22 3-603.11 Consumer Advisory Posted for Consumption of TIME/TEMPERATURE CONTROLS Animal Foods that are Raw, Undercooked or 16 Proper Cooking Temperatures for not Otherwise Processed to Eliminate PHFs Pathogens.* EBecbve 1/1/2001 3-401.11A(1)(2) Eggs- 155'F 15 Sec. 3-302.13 Pasteurized Eggs Substitute for Raw Shell Eggs* Eggs-Immediate Service 145'F 15 Sec.* 3-401.11(A)(2) Comminuted Fish,Meats&Game SPECIAL REQUIREMENTS Animals- 155'F Sec.* 590.009(A)-(D) Violations of Section 590.009(A)-(D) in 3-401.1l(B)(1)(2) Pork and Beef Roast- 1307 121 Min.*I catering, mobile food,temporary and 3-401.11(A)(2) Ratites,Injected Meats- 155'F 15 Sec.* residential kitchen operations should be 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs, debited under the appropriate sections Stuffing Containing Fish,Meat, above if related to foodbome illness Poultry or Barites- 165'F 15 Sec.* interventions and risk factors.Other 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks 590.009 violations relating to good retail 145'F* practices should be debited under#29- 3-401.12 Raw Animal Foods Cooked in a Special Requirements. Microwave 165'F* 3-401.11(A)(1)(b) All Other PHFs- 145'F 15 Sec.* VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 17 Reheating for Hot Holding (Blue Items 23-30) 3-403.11(A)&(D) PHFs 165'F 15 Sec.* Critical and non-critical violations, nhich do not relate to the 3-403.1 l(B) Microwave- 165'F 2 Minute Standing foodborne illness interventions and risk factors listed above, can be Time* found in the following sections of the Food Code and 105 CMR 3-403.11(C) Commercially Processed RTE Food- 590.00. 140'F* Item Good Retail Practices FC 590.00 3-403.11(E) Remaining Unsliced Portions of Beef 23. Management and Personnel FC-2 .003 Roasts* 24. I Food and Food Protection FC-3 .004 IS Proper Cooling of PHFs 25. Equipment and Utensils _ FC-4 .005 3-501.14(A) Cooling Cooked PHFs from 140'F to 26. Water, Plumbing and Waste I FC-5 .006 70'F Within 2 Hours and from 70'17 27• Physical Facility FC-6 .007 to 41'F/45'F Within 4 Hours.* 28. Poisonous or Toxic Materials FC-7 .008 3-501.14(B) Cooling PHFs Made From Ambient 129. Special Requirements .009 Temperature Ingredients to 41'F/45'F 30. I Other Within 4 Hours* *Denotes critical item in the federal 1999 Food Code or 105 CMR 590 000. CITY OF SALEM BOARD OF HEALTH Establishment Name: J �� Y �/ 6� �� J Date: /� _3 /� Page: / of t Item Code C-Critical Item DESCRIPTION OF VIOLATION / PLAN OF CORRECTION I Date $ No. Reference R—Red Item PLEASE PRINT CLEARLY Verified � I I �s I I I F g I I I I I � I I r I n A * Discussion With Person in Charge: Corrective Action Required: I ❑No I ❑Yes I have read this report, have had the opportunity to ask questions and agree to correct all ❑ Voluntary Compliance ❑ Employee Restriction/ 1 violations before the next inspection, to observe all conditions as described, and to comply Exclusion with all mandates of the Mass/Federal Food Code. I understand that noncompliance may ❑ Re-inspection Scheduled ❑ Emergency Suspension result in daily fines of twenty-five dollars or suspension/revocation of your food permit. � ❑ Embargo ❑ Emergency Closure ❑ Voluntary Disposal ❑ Other FORM 734B HOBBS &WARREN - BOSTON 1 Violations Related to Foodborne Illness Interventions and Risk 3-501.14(C) PHFs Received at Temperatures Factors(Red Items 1.22) (Cont.) According to Law Cooled to 41°F/45°F Within 4 Hours.* PROTECTION FROM CHEMICALS 3-501.15 Cooling Methods for PHFs 114 I Food or Color Additives 19 PHF Hot and Cold Holding 3-202.12 Additives* _� 3-501.16(B) Cold PHFs Maintained at or below 3-202.14 Protection from Unapproved Additives* 590.004(F) 41*F/45°F* 15 Poisonous or Toxic Substances _� 3-501.16(A) Hot PHFs Maintained at or above 7-101.11 Identifying Information-Original140°F* Containers* I 3-501.16(A) Roasts Held at or above 130°F.* 7-102.11 Common Name-Working Containers* 20 Time as a Public Health Control 7-201.11 Separation-Storage* 3-501.19 Time as a Public Health Control* 7-202.11 Restriction-Presence and Use* 590.004(H) Variance Requirement 7-202.12 Conditions of Use* REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-203.11 Toxic Containers-Prohibitions* POPULATIONS (HSP) 7-204.11 Sanitizers.Criteria-Chemicals* _ 21 13-801.11(A) Unpasteurized Pre-packaged Juices and 7-204.12 Chemicals for Washing Produce,Criteria* 1 Beverages with Warning Labels* 7-204.14 Drying Agents,Criteria* 3-801.11(B) Use of Pasteurized Eggs* 7-205.11 Incidental Food Contact,Lubricants* 3-801.1 l(D) Raw or Partially Cooked Animal Food and 7-206.11 Restricted Use Pesticides,Criteria* Raw Seed Sprouts Not Served.* 7-206.12 Rodent Bait Stations* 3-801.1](C) Unopened Food Package Not Re-served.* 7-206.13 Tracking Powders, Pest Control and Monitoring* CONSUMER ADVISORY 22 3-603.11 Consumer Advisory Posted for Consumption of TIME/TEMPERATURE CONTROLS Animal Foods that are Raw, Undercooked or 16 Proper Cooking Temperatures for not Otherwise Processed to Eliminate PHFs Pathogens.* EBecbve 11"2001 3-401.11A(1)(2) Eggs- 155*F 15 Sec. 3-302.13 Pasteurized Eggs Substitute for Raw Shell Eggs* Eggs-Immediate Service 145°F 15 Sec.* 3-401.11(A)(2) Comminuted Fish,Meats&Game SPECIAL REQUIREMENTS Animals- 155°F Sec.* 590.009(A)-(D) Violations of Section 590.009(A)-(D)in 3-401.11(B)(1)(2) Pork and Beef Roast- 130*F 121 Min.* catering, mobile food,temporary and 3-401.11(A , I Ratites,Injected Meats-155°F 15 Sec._* residential kitchen operations should be 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs, debited under the appropriate sections Stuffing Containing Fish,Meat, above if related to foodborne illness Poultry or Raines- 165°F 15 Sec.* interventions and risk factors.Other 3-401.1l(C)(3) Whole-muscle,Intact Beef Steaks 590.009 violations relating to good retail 145°F* practices should be debited under#29- 3-401.12 Raw Animal Foods Cooked in a Special Requirements. Microwave 165°F* 3-401.11(A)(1)(b) All Other PHFs- 145°F 15 Sec.* VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 17 Reheating for Hot Holding (Blue Items 23-30) 3-403.1 l(A)&(D) PHFs 165°F 15 Sec.* Critical and non-critical violations, which do not relate to the 3-403.11(B) Microwave- 165°F 2 Minute Standing foodborne illness interventions and risk factors listed above, can be Time* found in the following sections of the Food Code and 105 CMR 3-403.11(C) Commercially Processed RTE Food- 590.00. 140°F* Item Good Retail PracticesFC 590.00 3-403.11(E) Remaining Unsliced Portions of Beef 23. Management and Personnel FC-2 .003 Roasts* 24. Food and Food Protection FC-3 .004 18 Proper Cooling of PHFs 25. Equipment and Utensils FC-4 .005 3-501.14(A) Cooling Cooked PHFs from 140°F to 26. Water, Plumbing and Waste FC-5 .006 70°F Within 2 Hours and from 70°F 27. Physical Facility FC-6 .007 to 41*F/45*F Within 4 Hours.* 28, Poisonous or Toxic Materials FC-7 .008 3-501.14(B) Cooling PHFs Made From Ambient 29. Special Requirements .009 Temperature Ingredients to 41°F/45°F 30. Other Within 4 Hours* *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. - .,-+.+rr-ti...Y vw.y +. - r .. ...w.^4-v..- -.....�v...- 'd%%.,:-�-., v.w:'.iti,.ii. ✓'ww. �r .-"-�syr -a`• ... �.--.r Yv._ � ._c Tj<iE COMMONWEALTH OF MASSACHUSETTS CITY OF SALEM Address: 120 Washington Street, 4th Floor BOARD OF HEALTH Salem, MA 01970-3523 FOOD ESTABLISHMENT INSPECTION REPORT Tel: (978) 741-1800 Fax: (978) 745-0343 Name / / i Date Tvoe of Onerationftil Type of Inspection ❑ Food Service _ outine Address Risk ❑ Retail ❑'Re-inspection El Level Residential Kitchen Previous Inspection Telephone ljMobile Date: Owner /! / �T HACCP Y/N Temporary ❑ Pre-operation �(� K�p-/--/ H ❑ Caterer ❑ Suspect Illness Person in Charge(PIC) El Time EJ Bed &BreakfastIn: El HACCP General Complaint Inspector /��kC7- l/ /�C Out: Permit No. ❑ Other Each violation checked requires an explanation on the narrative page(s) and a citation of specific provision(s) violated. Non-compliance with: Violations Related to Foodborne Illness Interventions and Risk Factors (Red Itemsl Anti-Choking Tobacco Violations marked may pose an imminent health hazard and require immediate corrective 590.009(E) ❑ 590.009(F) ❑ action as determined by the Board of Health. Local Law ❑ FOOD PROTECTION MANAGEMENT ❑ 12. Prevention of Contamination from Hands ❑ 1. PIC Assigned/Knowledgeable/Duties ❑ 13. Handwash Facilities EMPLOYEE HEALTH PROTECTION FROM CHEMICALS El2. Reporting of Diseases by Food Employee and PIC El 14. Approved Food or Color Additives El3. Personnel with Infections Restricted/ Excluded ❑ 15. Toxic Chemicals FOOD FROM APPROVED SOURCE El 4. Food and Water from Approved Source TIMEITEMPERATURE CONTROLS(Potentially Hazardous Foods) El 16. Cooking Temperatures El 5. Receiving/Condition El6. Tags/ Records/Accuracy of Ingredient Statements ❑ 17. Reheating El 7. 18. Cooling 7. Conformance with Approved Procedures/ HACCP Plans � PROTECTION FROM CONTAMINATION ❑ 19. Hot and Cold Holding El8. Separation/Segregation/ Protection El 20. Time as a Public Health Control REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) ❑ 9. Food Contact Surfaces Cleaning and Sanitizing El❑ 10. Proper Adequate Handwashing 21. Food and Food Preparation for HSP CONSUMER ADVISORY ❑ 11. Good Hygienic Practices ❑ 22. Posting of Consumer Advisories Violations Related to Good Retail Practices (Blue Number of Violated Provisions Related Items) Critical (C) violations marked must be corrected To Foodborne Illnesses Interventions immediately or within 10 days as determined by the Board and Risk Factors (Red Items 1-22): of Health. Non-critical (N) violations must be corrected Official Order for Correction: Based on an inspection immediately or within 90 days as determined by the Board today, the items checked indicate violations of 105 CMR of Health. 590.000/Federal Food Code.This report, when signed below C N by a Board of Health member or its agent constitutes an 23. Management and Personnel (FC-2)(590.003) order of the Board of Health. Failure to correct violations 24. Food and Food Protection (FC-3)(590.004) cited in this report may result in suspension or revocation of 25. Equipment and Utensils (FC-4)(590.005) the food establishment permit and cessation of food 26. Water, Plumbing and Waste (FC-5)(590.006) establishment operations. If aggrieved by this order, you 27. Physical Facility (FC-6)(590.007) have a right to a hearing.Your request must be in writing :41 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: r Inspector's Signature: / / J/y'J Print: PIC's Signature: 7i_ - /G / /f Print:`-' G ` /�S Page/of Pages FORM 734A HOBBS&WARREN -BOSTON Violations Related to Foodborne Illness r^. Interventions and Risk Factors (Red Items 1-22) PROTECTION FROM CONTAMINATION 8 Cross-contamination FOOD PROTECTION MANAGEMENT 3-302.11(A)(1) Raw Animal Foods Separated from 1 1590.003(A) Assignment of Responsibility* Cooked and RTE Foods* 590.003(B) Demonstration of Knowledge* Contamination from Raw Ingredients 2-103.11 Person in Charge-Duties 3-302.11(A)(2) Raw Animal Foods Separated from Each Other* EMPLOYEE HEALTH Contamination from the Environment 2 590.003(C) Responsibility of the Person in Charge to 3-302.11(A) Food Protection* require reporting by Food Employees and 3-302.15 Washing Fruits and Vegetables Applicants* 3.304.11 Food Contact with Equipment and 590.003(F) Responsibility of a Food Employee or an Utensils* Applicant to Report to the Person inI Contamination from the Consumer Charge* 3-306.14(A)(B) Returned Food and Reservice of Food* 590.003(G) Reporting by Person in Charge* Disposition of Adulterated or Contaminated 3 590.003(D) Exclusions and Restrictions* Food 590.003(E) Removal of Exclusions and Restrictions 3-701.11 Discarding or Reconditioning Unsafe Food* FOOD FROM APPROVED SOURCE 9 Food Contact Surfaces 4 I Food and Water From Regulated Sources 4-501.111 Manual Warewashing-Hot Water 590.004(A-B) Compliance with Food Law* Sanitization Temperatures* 3-201.12 Food in a Hermetically Sealed Container* 4-501.112 Mechanical Warewashmg-Hot Water 3-201.13 Fluid Milk and Milk Products* Sanitization Temperatures* 3-202.13 Shell Eggs* 4-501.114 Chemical Sanitization-temp.,pH, 3-202.14 Eggs and Milk Products, Pasteurized* Concentration and Hardness* 3-202.16 Ice Made from Potable Drinking Water* 4-601.11(A) Equipment Food Contact Surfaces and 5-101.11 Drinking Water from an Approved System* Utensils Clean* 590.006(A) Bottled Drinking Water* 4-602.11 Cleaning Frequency of Equipment Food- 590.006(B) Water Meets Standards in 310 CMR 22.0* Contact Surfaces and Utensils* Shellfish and Fish From an Approved Source 4-702.11 Frequency of Sanitization of Utensils and 3.201.14 Fish and Recreationally caught Molluscan 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 Regulatory Authority Game and Wild Mushrooms Approved by 2-301.11 Clean Condition-Hands and Arms* 2-301.12 Cleaning-Procedure* 3.202.18 Shellstock Identification Present* 2-301.14 When to Wash* 590.004(C) Wild Mushrooms* 11 Good Hygienic Practices 3-201.17 Game Animals* 2-401.11 Eating.Drinking or Using Tobacco* 5 Receiving/Condition 2-401 12 Discharges From the Eyes,Nose and 3-202.11 PHFs Received at Proper Temperatures* Mouth* 3-202.15 Package Integrity* 3-301.12 Preventing Contamination When Tasting* 3-101.11 Food Safe and Unadulterated* 12 Prevention of Contamination from Hands 6 Tags/Records:Shellstock 590.004(E) Preventing Contamination from 3-202.18 Shellstock Identification* Employees* 3-203.12 Shellstock Identification Maintained* 13 Handwash Facilities Tags/Records: Fish Products Conveniently Located and Accessible 3-402.11 Parasite Destruction* 5-203.11 Numbers and Capacities* 3-402.12 Records,Creation and Retention* 5-204.11 Location and Placement* 590.004(J) Labeling of Ingredients* 5-205.11 Accessibility,Operation and Maintenance 7 I Conformance with Approved Procedures Supplied with Soap and Hand Drying /HACCP Plans Devices 3-502.11 Specialized Processing Methods* 6-301.11 Handwashing Cleanser,Availability 3-502.12 Reduced Oxygen Packaging,Criteria* 6-301.12 Hand Drying Provision 8-103.12 Conformance with Approved Procedures* •Denotes critical item in the federal 1999 Food Code or 105 CDIR 590.000. t CITY OF SALEM BOARD OF HEALTH a Establishment Name: / �S�� C l /" SS f _� Date: /�� Z— Page: of Item Code C—Critical Item DESCRIPTION OF VIOLATION / PLAN OF CORRECTION Date No. Reference R—Red Item PLEASE PRINT CLEARLY Verified � I I .o v ,,tet Imo, ,cam 4 I I tD 7-- Discussion _Discussion With Person in Charge: Corrective Action Required: Ilo I ❑Yes I have read this report, have had the opportunity to ask questions and agree to correct all ❑ voluntary Compliance !❑ ` Employee Restriction/ Li violations before the next inspection, to observe all conditions as described, and to comply Exclusion with all mandates of the Mass/Federal Food Code. I understand that noncompliance may ❑ Re-inspection Scheduled ❑ Emergency Suspension result in daily fines of twenty-five dollars or suspension/revocation of your food permit. ❑ Embargo ❑ Emergency Closure ❑ Voluntary Disposal ❑ Other M 7348 HOBBSaWARREN - BOSTON Violations Related to Foodborne Illness Interventions and Risk 3-501.14(C) PHFs Received at Temperatures Factors(Red Items 1-22) (Cont.) According to Law Cooled to 41"F/45°F Within 4 Hours.* PROTECTION FRO 0 CHEMICALS 3-501.15 Cooling Methods for PHFs 14 I Food or Color Additives 19 PHF Hot and Cold Holding 3-202.12 Additives* 3-501.16(B) Cold PHFs Maintained at or below 3-202.14 Protection from Unapproved Additives* 590.004(1`) 41°F/45°F* 15 Poisonous or Toxic Substances 3-501.16(A) Hot PHFs Maintained at or above 7-101.11 Identifying Information-Original 140°F.* Containers* 13-501.16(A) Roasts Held at or above 130°F.* 7-102.11 Common Name-Working Containers* 20 I Time as a Public Health Control 7-201.11 Separation-Storage* 3-501.19 Time as a Public Health Control* 7-202.11 Restriction-Presence and Use* 590.004(H) Variance Requirement 7-202.12 Conditions of Use* REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-203.11 Toxic Containers-Prohibitions* POPULATIONS(HSP) 7-204.11 Sanitizers,Critena-Chemicals* 21 13-801.11(A) Unpasteurized Pre-packaged Juices and 7-204.12 Chemicals for Washing Produce,Criteria* 1 Beverages with Waning Labels* 7-204.14 Drying Agents,Criteria* 3-801.11(B) Use of Pasteurized Eggs* 7-205.11 Incidental Food Contact,Lubricants* 3-801.11(D) Raw or Partially Cooked Animal Food and 7-206.11 Restricted Use Pesticides,Criteria* Raw Seed Sprouts Not Served.* 7-206.12 Rodent Bait Stations* 3-801.11(C) Unopened Food Package Not Re-served.* 7-206.13 Tracking Powders,Pest Control and Monitoring* CONSUMER ADVISORY 22 3-603.11 Consumer Advisory Posted for Consumption of TIME/TEMPERATURE CONTROLS Animal Foods that are Raw,Undercooked or 16 Proper Cooking Temperatures for not Otherwise Processed to Eliminate PHFs Pathogens.* E"ecsi 11112001 3-401.11A(1)(2) Eggs- 155°F 15 Sec. 3-302.13 1 Pasteurized Eggs Substitute for Raw Shell Eggs* Eggs-Immediate Service 145°F 15 Sec.* - - 3-401.11(A)(2) Comminuted Fish,Meats&Game SPECIAL REQUIREMENTS Animals- 155°F Sec.* 590.009(A)-(D) Violations of Section 590.009(A)-(D) in 3-401.11(B)(1)(2) Pork and Beef Roast- 130*F 121 Min.* catering, mobile food,temporary and 3-401.11(A)(2) Ratites,Injected Meats- 155*F 15 Sec.*I- residential kitchen operations should be 3-401.11(A)(3) Poultry,Wild Game, Stuffed PHFs, debited under the appropriate sections Stuffing Containing Fish,Meat, above if related to foodborne illness Poultry or Ratites- 165°F 15 Sec.* interventions and risk factors. Other 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks 590.009 violations relating to good retail 145°F* practices should be debited under#29- 3-401.12 Raw Animal Foods Cooked in a Special Requirements. Microwave 165°F* 3-401.11(A)(1)(b) All Other PHFs- 145°F 15 Sec.* VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 17 Reheating for Hot Holding (Blue Items 23-30) 3-403.11(A)&(D) PHFs 165°F 15 Sec.* Critical and non-critical violations, which do not relate to the 3-403.11(B) Microwave- 165°F 2 Minute Standing foodborne illness interventions and risk factors listed above, can be Time* found in the following sections of the Food Code and 105 CMR 3-403.11(C) Commercially Processed RTE Food- 590.00. 140°F* Item Good Retail Practices FC 590.00 3-403.11(E) Remaining Unsliced Portions of Beef 23. Management and Personnel FC-2 .003 Roasts* 24. Food and Food Protection FC-3 .004 18 Proper Cooling of PHFs 25. Equipment and Utensils FC-4 .005 3-501.14(A) Cooling Cooked PHFs from 140°F to 26. Water, Plumbing and Waste FC-5 .006 70°F Within 2 Hours and from 70°F 27. Physical Facility FC-6 .007 to 41°F/45*F Within 4 Hours.* 28. Poisonous or Toxic Materials FC-7 .008 3-501.14(B) Cooling PHFs Made From Ambient 29. Special Requirements .009 Temperature Ingredients to 41°F/45°F 30. Other Within 4 Hours* *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. *` CITY OF:SALEM, MASSACHUSETTS RD Y OF,FHiESALTu H.a.+1w +...-{.. .yJgg g ' rx..�£�{-:,,1c s-.' : ib a `.RyftdLJ,•.s'�« P t• -t s }" k. � 120 WASHINGTON STREET 4TH FLOOR x, SALEM, MA 01970 TEL. 978-741-1800 FAX 978-745-0343 STANLEY USOVICZ, JR. JOANNE SCOTT, MPH, RS, CHO MAYOR " HEALTH AGENT 'COMMONWEALTH OFMASSACHUSETTS 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: ; Kevin Kefalas Name of Establishment: Classy Chassis Cart #2 Address of Establishment : 4 Azalea Lane Type of Establishment : -Mobile Food Application'Date: 04/23/2002 Restrictions'- Sausage, fresh squeezed lemonade "`hot dogs, soda. Permit for Food Establishment 5-02M Frozen Desserts/Ice Cream . Permit * for. the Sale of- .Tobacco Products :' 1> B€ "i.t'-I.h ..k.r r:��3.�.,.- :�?^ '<„E .as Af': These-Permi{ts� Expire:December 31,x'2002 , 6 e-Y _ ,e t o t t 6 I +� :: �•w, .. E - S 1' { R•.t ,- . This permit -is not transferable and must be reissued upon change of ownership o'r.location."IThe permit must -be :postedlin a prominent location in the''.`EstablishmenEl o- 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. } q y } ` ! • ` HEALTH' AGENT ' , ; ' ' 1 € a . t' q � ,- l �'.�:i: ��"+"r�' .a 't.-9t S2 , y " i + a • . - a # + e * a !. a ,. s r a T i ♦ Y•. '!.Y'^`C `�PI-a n� f R }'` 'r o CITY OF SALEM, MASSACHUSETTS '� BOARD OF HEALTH 120 WASHINGTON STREET, 4TH FLOOR e SALEM, MA 01 970 TEL. 978-741-1800 FAX 978-745-0343 ✓0�t STANLEY USOVICZ, .1R ,JOANNE SCOTT, MPH, RS, CHO i MAYOR HEALTH AGENT APPLICATION FOR A MOBILE FOOD SERVICE PERMIT / Fee $40 payable to The City of Salem, No Cash Name of Applicant Kv/A/ lce/cr /c s Telepho/ne# 555=6 FS'y Address C,/ AZ4ZeA— s�y,gss Certified Food Manager ,04 v14 Ve F /q S Certificate # Name of Business ae ss� /�fcsSis ?c�ao/- `^'GTelephone# ISOF--7-113-Fz1,y Address So_ .-3 r- Manufacture Frozen Desserts? Yes No Type of Vehicle /9f% f Registration# Location of Operation !0 , .41 N d Name & Addresp of Licensed Food Service Establishment Serving as Base of Operation �rgS7a of '-� Telephone# ! 73'0 -/000 >> Location of Toilet & Handwashing Facilities U/3f rcP.� r — "b.r 6, Menu I e- Type of refrigeration: Ice Dry Ice Gas Other _ Method for Cooking and/or Hot Holding:/Gas Other___ Method for Sanitizing: Chemical r Hot Water (170 F) I have read and agree to abide by The Salem Board of Health Regulations regarding "Mobile Food Units & Pushcarts" and will notify the Salem Board of Health of any changes in this application. Pursuant to MGL C62C,S49A, I certify under the penalties of perjury that I, to my best knowledge and belief, have filed all State tax returns and paid all State taxes required under law. Signature �� / Social Security# or Federal ID# Date 2� I 032-- `�, o- 7kvZ3 --------------- --------------- ----------------------------------------- - ------------------------------- Revised 1020/98 Perr # Check#&Date �/as - i9-oa- e5 pn . le �� 7� T7 APR 19 2002 Cil y BOARD OF HE'A& ,.. .e„ i t . . i rf , s. Yr . •t ` , ' « `•u� ,i35.�.v Fra' CITY OF SALEM MASSACHUSETTS �. r g A,:"t+yk .a. $ti. ea ? 6'.x::'r""�'i�!`^i:;to" ''"'*'Y+l a}¢w 1.',�� $' 3,4r4'. tm, [' x t ** :�;.. -{ •B'4tJ0ARO'0Fr2-1EA'4.TH$� a• <* ';, a a 120 WASHINGTON STREET, 4TH FLOOR ` #.! - SALEM, MA 01970 R TEL. 978-741-1800 k , , FAX 978-745-0343 STANLEY USOVICZ, JR. JOANNE SCOTT, MPH, RS, CHo ' MAYOR HEALTH AGENT . . , COMMONWEALTH OF MASSACHUSETTS PERMIT TO OPERATE A FOOD ESTABLISHMENT x In accordance with regulations, ;promulgated under authority of �Chapter.l� 94, Section 305A and Chapter III, Section 5 of the General taws, to operate a Food Establishment in the City of Salem is hereby granted to: Owner' s Name : Kevin Kefalas Name of Establishment: Classy Chassis Cart #1 #597-095 Mass Address of Establishment : 4 Azalea Lane I ", Type� of. Establishment : Mobile Food - xApplication batel:R. 04f22/2002 b ^i . Res trictions: Sausage, Kielbasa, hot dogs; chips, drinks: Permit for Food Establishment 4`-02M Frozen Desserts/Ice Cream Permit for the Sale of Tobacco Products These Permits Expire' December 31, '20'12 ; This. permi.t is not transferable and must be reissued upon change of ” x owhbrship .ot.location. The permit must be posted in'a prominent .location; ' inithe Establishment: R. :. In accordancewiththe State Sanitary Code, before any renovations, improvements, 'oil equipment changes are"made, 'all plans for such"must 'he = submitted to and approved by the Salem Board of Health. pp �qxy, }p, ' HEALTHAGENT ;y�. ,Y, x` #'e.{ 3#S§- ^# ,[jgg Ali - .$�j'4��'„f ��" '2�1tl'�9;,`�='�'e-u^sy5g:'i',�y,}.Yyg s� '8' w,r a,{g5�t+ t �` yjS 3..k} +�'.� .. * '4` 6} 3 +P- 4CS# .r„'#iC d la? c o-T 1'T ..t K< 'r'r, sF7< Y^ ^ . 3 3 5W(j, �- . e Al ,� s. R v i♦ i"-`"M��?'r� - i'%'Y`ir� �. ,Q'y�'F.tti.,y *�rF t.w _'.ra ey r ' kqv ar r.. t�'4i4:��^ �y'aaw�`�;�.r",�eA}�fR� . a•^. T �tk,F CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH • 120 WASHINGTON STREET, 4TH FLOOR SALEM, MA 01970 TEL. 978-741-1800 FAX 978-745-0343 STANLEY USOVICZ, JR. JOANNE SCOTT, MPH, RS, CHO MAYOR HEALTH AGENT �v6oZ APPLICATION FOR A MOBILE FOOD SERVICE PERMIT Fee $40 payable to The City of Salem, No Cash Name of Applicant XeWN 16 f4/gs Telephone# S3-5-- 6 57Fy Address q Az,4 /--e e4� j Certified Food Manager 4k-L1 LA- c�a l�s Certificate # Y Name of Business G/arf y C11a ss�s 61'1-e•�ephone#/sz-�- Address Manufacture Frozen Desserts? Yes No Gtirg a Type of Vehicle /y'�`/ f r� vQ Ai Registration# Location of Operation X:54 IA+ a d✓ ✓7�74 Name & Address of Licensed Food Service Establishment Serving as Base of O_p/eration %s f� of `7-h ter, e— Telephone# Location of Toilet & Handwashing Facilities /yr 4 Menu Type of refrigeration: Ice Dry Ice / Gas Other _ Method for Cooking and/or Hot Holding: Gas Other___ Method for Sanitizing: Chemical c--'� Hot Water (170 F) I have read and agree to abide by The Salem Board of Health Regulations regarding "Mobile Food Units & Pushcarts" and will notify the Salem Board of Health of any changes in this application. Pursuant to MGL C62C,S49A, I certify under the penalties of perjury that I, to my best knowledge and belief, have filed all State tax returns and paid all State taxes required under law. Signature J/ Social Security# or Federal ID# Date --------------�--•-V-+-ry------6- a0L—Check# ----------- 0?2lf�r��2,3____ -----------------7---------- p -------------- Revised 10120/98 Permit# & Date ---------------- rn-) Tal TI wl Q la APR 19 2002 BOARD OF hEALTH � CITY OF SALEM" VIOLATION NOTICE. "A 9:6" ! {8 NAME(LAST,FIRST,INITIAL)ep - `/ h L) "'.J STRIPETADDRESS CITY(IOWN ' STATE -ZIP��,1y}��_(1- (' LICENSE NO. LICXP.DAtE f tpA E FBIRTH - j a) — xw OWNER'S NA .�(LAT,FIRST,INITIAL) ir � /y7Z � `t 0 m STRETADU ERESS OW STATE ZIP S y , REGISTRATION NO, rSTATE EXP. RCOLOR- 1'� DATt OF IOLATION IIITIME DATECITAT10N1W EN PEHso it l A WnOYESr NO 0 Q ;I LOCATION 4F VIOLATION EN ORCING DEPT, OFFENSE 4UE CT. FINES a z ry j a O i A O P 1 B 3 o iSw'�/l 7' j -r OFFICER L4 NO. T INE FINE "..3r u, Ln OFFICER CEERPF/I5iS COPY OWN TO VIOLATOR - IN HANDLn 'J O --. O I X 00Y MAIL ( (-a O T F Nt�CASH-PAY ONLY BY POST, E,MONY ` ER BY CHECK MADE PAYASL �+ I CITY CLERK ' W 1 —+ O I CITY HALL ''' V tr .. 93 WASHINGTON STREET +I i Z O o { — I SALEM,MA 01970 '' W rn z i TEL.(500)7859595 X 251 '`: V 2 p C I I I HEREBY ELECT TO EXERCISE THE FIRST OPTION AS STATED ON I 0 O g Z Q REVERSE,CONFESS TO THE OFFENSE"CHARGED,AND ENCLOSE -1 ` 0 a R M�m U z E PAYMENT IN THE AMOUNT OF " T cD 1 ( LL O� w -+'y, C O I $ CASE# co 0 Y Y Q F o / m O_ j I SIGNATURE �� z SEE OTHER SIDE FOR FURTHER INFORMATION �� ENCLOSE PAYMENT IN THIS ENVELOPE,PEEL AND SEAL" � VN z F1 I >Q aa0_ COURT DOCKET NO CITATION NO. CITY OF SALEM {� VIOLATION NOTICE A2962 NAME(I(LASTFI__I�RST,TINITIAL) STREET ADDRESS 1 � / CITY/TOWN STATE ZIP /�,?'cs.!'Y7 !/l.r,er w /y�ini.lei ,agC,�'' LICENSE NO f I LIC.EXP.DATE /� DATE OF BIRTH t OWNEER'S NAA,(LA T,FIRST,INITIAL) STREET ADD//REBS CITY/TOWN STATE ZIP 1 REGISTRATION NO STATE EXP DATE MAKE/rVPE YEAR COLORI DATE OF VIOLATION TIME, DATE CITATION WRITTEN FERSONAI. / INJORY �j `moi tet♦ / b ❑VES l3 rJfiyf r'1/ 1-]NO LOCATION F VIOLATION / ENFORCING DEPT fS_Sty sfrF.a� />1��i !AP ECT FINE OFFENSE ^ -T- ,CHAP SECT FINES B �/ � / �7G> cr•rp OFFICE I.D NO TOTAL FINE \! d,$£� h • .L�l�(� a3�J.,741' DUE $VG�JrC�t;� OFFICER CERT•IFtES COPY GIVEN TO VIOLATOR ❑ IN HAND XI �V MAIL DON6 MAIL`CAS�PLYBY E,MONEY ORDER CHECK MADE PAYABLEiTO:-- j _J CITY CLERK lo'-� �"- CITY HALL 93 WASHINGTON STREET SALEM,MA 01970 TEL.(508)745-9595 X 251 1 HEREBY ELECT TO EXERCISE THE FIRST OPTION AS STATED ON REVERSE, CONFESS TO THE OFFENSE CHARGED,AND ENCLOSE PAYMENT IN THE AMOUNT OF $ CASE# SIGNATURE SEE OTHER SIDE FOR FURTHER INFORMATION ENCLOSE PAYMENT IN THIS ENVELOPE,PEEL AND SEAL 1 r THE COMMONWEALTH OF MASSACHUSETTS i I N i Establishment Name /7 ..4- �y (/J� �/� Date r118 Address £6sP CJ Spree // Page-7L of-/— Item No. In the space below describe all violations checked on front page. /!h/)hi� /mss v =�4rk1��`✓ " 1rJe iJ !/ twat J �J,✓il�./P /i . �S =lint Z Z m m 0 �d m ,- . L v - iJ✓ /7/J� /J JIJ t-11�/"/JJJ/tel o LL Discussion with Management T 'I THE COMMONWEALTH OF MASSACHUSETTS Establishment Name //� � v Date 8 t / Address ��l�/ u/�rCc' //17C�// Page of-z Item No. In the space below describe all violations checked on front page. - 1.,4A" //I �4i&e C/./ln 4v'e ,W./)"7/, ,,.7� _ �S.fC'ix,n - �/,a/fes L�i,C.//,r/li7�i1+�.�[�is" �,��/.�✓iCS /J�1� {e../I./Ar�is� ,JS �i//�s/�•>/�.,,!� �.�+/`..fsilo, �l�J/r_� /t�1lf rNssrl.f}/ Z W / a - _fid �t +9c✓ tl/�rrr,i�� /J.*a C-4_.e1.t1-W /,n fi ;mai/.s/1i/ 0 m ��JJ'piJ/r7P�✓ ._.f�i�// P_/ !/i �Cls /a �yVA S".CJ.^/J .cl � - ( "i�l�,//' ✓la '.-✓'✓J✓ IJ,/�T' !7///�//s/./ /�!" w/�/Jll� ,�//�'d'/l�9//I� ^ ,/I.�a.s/'raid .fsf' ,mss',/�� ..,�i/Y r�s..Cl, iia✓r.�%/r LL Discussion with Management F(7 j x/12 f o4 170 INSIM INSIDE B-5 AREA AREA City of Salem City of Salem Veno , ., as n d ors Vendors Licensee 01 a Issued'.to: 02 Issued to: Name Paula =Aefalas Name Paula Kefalas License No. Address 4 Azalea lane License No. Address 4 Azalea Lane _ City/State 'Peabody, MA 01960 Peabody, M A 01960 Expires: 3/31/2002 Expires:3/31/2002 City/State y IDCZiTIOV: 'Essex/N�(a' ie�rCENtING BOARD LOCATION: Essex St./at fountaink. LICENSING BOARD ValidatingOfficial Signature Validating official Signature ' INSIDE AREA 4 i City of Salem Vendors License t issued to: 0 Name Paula KPfala$ 41 License No. Address 4 Azalea Lane i Expires:3/31/2002City/State Peabody, MA 01960 LOCP=. CarrQVCFpesiteLICEi`1SING BOARD Validating Official Signature CITY OF SALEM BOARD OF HEALTH Salem, Massachusetts 01974-3928 JOAN_NE SCOTT, MPH,RS,CHO HEALTH AGENT -, Tei:(978)741-1800 - Fax:(978)740-9705 COMMOWAEALTH OF MASSACHUSETTS , ' r, PERMIT TO OPERATE A MOBILE FOOD SERVER t � ♦ _ .1 y 5' ' • • In accordance-.with Regulations' promulgated under authority of Chapter 94, Section 305A "and'Cfiapter •III; Section 5 of the General Laws a Permit is hereby- granted' to: 1' AA-0 4, .;y Name.. ;Kevin,.ICefal'tas:.4,ga : �rx, :: -...` -: •.,`;" zi r4hr -Name�^.ofj'Establis,Yment,.: Crass ¢Chassis�Cartb, Y', ' R. .wYiose Place ',of;;'Biis nessj: s:V4'Azaletot1;ane W.` Peabody MA m,,,.. ,r�,r,•. . , - w,.F.. .. . b`ate::;'Q5f22%24'.01 `' off. m 3x: >, {.T,: •i,es,. _ _ ' To •Operatesa Moble FQoci§Server in : Salem . Restrict iOriS . Fried rdoligh '��fr'ench Fries;, -Fresh squezzed lemonade, drinks P;''Dermat `,6,.i.-.01e.<M zA Frozen,Dessertsf Ice'HCream ".;.:y '.�: •' «;,`H;'. S .:.nGs�, ^w,..y."wY,-<y' .�'`- f� tPERMIT EXPIRES December 31,-' 2001 < t, HEALTH AGENT y ' t .:, conmtT 6 Q� m n � CITY OF SALEM BOARD OF HEALTH Salem, Massachusetts 01970-3928 JOANNE SCOTT,MPH,RS,CHO .Q� V' NINE NORTH STREET HEALTH AGENT Tel (978)741-1800 Fax:(978)740-9705 APPLICATION FOR A MOBILE FOOD SERVICE PERMIT Fee $40 payable to The City of Salem, No Cash �/ Name of Applicant /C/ev7d/ /��es Telephone#/-47�-S3S-61 Address z/ 47- /f le.--- AXZ0t�� Certified Food Manager 7 a v/� rl j c�IaS Certificate # /D ` c, Name of Business -/,? cffassis Telephone# X297_ Address Manufacture Frozen Desserts? Yes No Type of Vehicle Registration# Location of Operation / o rr�r» ,.✓ — visT>rr{ / — .�� v� �� o°" /3'9/� Name & Address of Licensed Food Service Establishment Serving as Base of Operation o 's Telephone# y2F-� — Location of Toilet & Handwashing Facilities // s/y.^c{ ✓7t> —''nc'�� // � Menu �r��Db�C> _ �� `^' „ fir/mss. �rPs�ivo•�7cO�lG/tI �P_, i y Type of refrigeration: Ice Dry Ice G Other _ Method for Cooking and/or Hot Holding:, Gas r/ Other___ Method for Sanitizing: Chemical /� Hot Water (170 F) I have read and agree to abide by The Salem Board of Health Regulations regarding "Mobile Food Units & Pushcarts" and will notify the Salem Board of Health of any changes in this application. Pursuant to MGL C62C,S49A, I certify under the penalties of perjury that I, to my best knowledge and belief, have filed all State tax returns and paid all State taxes required under law. � W ,6Z3 14 Ll — tea/ Signature Social Security# or Federal ID# Date ---------------------------------------------------------------------------------------------------------------------- Revised 10/20/98 Permit 9 Checku&Datc 47 ,} CITY OF SALEM BOARD OF HEALTH Salem, Massachusetts 01970-3928 JOANNE SCOTT, MPH,RS,CHO HEALTH AGENT - Tel:(978)741-1800 Fax:(978)740-9705 COMMONWEALTH OF MASSACHUSETTS PERMIT TO OPERATE A MOBILE FOOD SERVER y t , In accordance with Regulations promulgated under authority of,- Chapter 94, Section 305A andChapterIII, Section 5 of the General-'Laws a Permit is hereby granted to: Name: Kevin Kefalas. Name of "'Establ 'ishme'nt : Classy Chassis Cart, #21"' WHose Place of Business isa, 4'-Azalea Lane .W.., Peabody ,Date: . . 05/22/2001" To. Operatea 'Mobile Food aServer in Salem:`<'=« =" Restrictions: Sausage;, -kelbasa;, hot dogscfiipsj drinksi" +: Permit '#: 5-01M Frozen Desserts/ ice -cream: { PERMIT EXPIRES becember�31, 2001 e F a s c � ((] HEALTH AGENT t . l , 1 t i 7 M. OWN M. ��C/MIIV6pp� CITY OF SALEM BOARD OF HEALTH Salem, Massachusetts 01970-3928 JOANNE SCOTT, MPH, RS, CHO !,- NINE NORTH STREET HEALTH AGENT Tel:(978)741-1800 APPLICATION FOR A MOBILE FOOD SERVICE PERMIT Fax. (978)740-9705 Fee $40 payable to The City of Salem, No Cash �/ Name of Applicant ��e�lA) )(e]l F0 /a S Telephone#/-978'^ -V3-5-- 6�/ Address I/ AZAZG -e- 1-,oA,e-- 14'ex-40d)7alf6a 1 Certified Food Manager Certificate # 70-7,14Ao Name of Business G/a ssv C-#a s5/S fad/ Ca.v. Telephone#/-So82-2y3- F2rf 2- Address Address j Sri Manufacture Frozen Desserts? Yes No l� 191j7 // Type of Vehicle &Rne Cr.r�rr 4rler Registration# Location of Operation Name & Address of Licensed Food Service Establishment Serving as Base of Operation z--Os-t" 's Telephone#978-7-- Location of Toilet & Handwashing Facilities MenuG��SS Type of refrigeration: Ice 4 Dry Ice Go s Other Method for Cooking and/or Hot Holding/Gas Other___ Method for Sanitizing: Chemical y Hot Water (170 F) I have read and agree to abide by The Salem Board of Health Regulations regarding "Mobile Food Units & Pushcarts" and will notify the Salem Board of Health of any changes in this application. Pursuant to MGL C62C,S49A, I certify under the penalties of perjury that I, to my best knowledge and belief, have filed all State tax returns and paid all State taxes required under law. �j Xo ^ -7� 7- . - /c o37'/E 3 Z2 ` Zoo l Signature Social Security# or Federal IDtt Date ----------------------------------------------------------�-j---------------------- --------------- Revised 10/20/98 Permit N Check#d Date Ol6 4�a-S- aa-a/ „,..--._.d,-�,er:�'. .« _.��„,.<+... .rte. ,r,,,.--,,..-m,»... �,.�,.�. :a^..•' .�- ......,«ew. CITY OF SALEM BOARD OF HEALTH Salem,-Massachusetts 01970-3928 JOANNE SCOTT,MPH,RS,CHO HEALTH AGENT Tel:(978)741-1800 ! ' •' Fax:(978)740-9705 COMMONWEALTH OF MASSACHUSETTS PERMIT TO. OPERATE A MOBILE FOOD SERVER ;.ra;;...4,.F: in accordance with Regulations' promulgated under authority of Chapter 94, section 305A' arid- Chapter: IIi, Section 5 of the General Laws a Permit is hereby granted_ 't-6, „ ` ' • ' ''` ' 1-Name 4Vlri,yKefalas 3;, ;,y1», V ,'ii„� = a ,t x,:, v A 'Name�of ,Establishment Classy'ChassistCart #1�#59,7=.095",Mass :r k t x ._ _ > ' Wkibse¢Place`ofs,Businesshs-:,4 'Azalea liane°W`' :Pe`abody MA a; )< sr7Date -05/22%200,1� t * }� �w - ==t To ,Operate; a' Mobile FoodI`Server in b ,Salem r o� iY ' car - x 5 4 4< to '•�-y...,. .y-.y_ e..,: r yz - ;> 'Restrictions":,, sausage, ,Kiel'basa, hot sdogs, chips, - _. - :.1,,t s Permits # Frozenx Desserts/ zIceY'Cream.''• " -a, s PERMIT, EXPIRE$r December 31,' 2001 , s a- - HEALTH AGENT ^: s 4 C� l �ONDIT 3 � p gBpIMIN6>�� CITY OF SALEM BOARD OF HEALTH Salem, Massachusetts 01970-3928 JOANNE JOANNE SCOTT,MPH,RS,CHO ` /.(Ji "" NINE NORTH STREET HEALTH AGENT �(' Tel.(978)741-1800 APPLICATION FOR A MOBILE FOOD SERVICE PERMIT Fax. (978)740-9705 Ye-VI Fee $40 payable to The City of Salem, No Cash Name of Applicant Ye vi N ale f /`i 5 Telephone#/-f Address 1-417 X,, Certified Food Manager Avla- l� �cr s Certificate # /a 7 2 Sc/6 Name of Business ck s5� e--Ar, Sis 9&o Gof' Telephone# Address Sir ✓h e Manufacture Frozen Desserts? Yes No Type of Vehicle /477 �Registrattiion# Location of Operation CAy,,,.I,o.� - Isis/rrc��7:-� - �� f� i�✓ D� �'C,� Name & Address of Licensed Food Service Establishment Serving as Base of Operation ef,�o is TeIep//hone# 97F-- 7S-e�— /0'00 Location of Toilet & Handwashing Facilities U�ST�re�Nr Yri�3I� Menu 5-C ezge — ,6Llxo-5a _ /-/,A eS — eZ", Type of refrigeration: Ice G/ Dry Ice G Other Method for Cooking and/or Hot Holding: as l Other__ Method for Sanitizing: ChemicalHot Water (170 F) I have read and agree to abide by The Salem Board of Health Regulations regarding "Mobile Food Units & Pushcarts" and will notify the Salem Board of Health of any changes in this application. Pursuant to MGL C62C,S49A, I certify under the penalties of perjury that I, to my best knowledge and belief, have filed all State tax returns and paid all State taxes required under law. ,. nom- 032-W-7bZ3 1474V za - 7-6OI Signature Social Security# or Federal ID# Date ------------------------------------------------------------------------------------------------------------------------- Revised 10/20/98 Permnq Checkkd Uate r�(�l�a 'l' —Q� THE COMMONWEALTH OF MASSACHUSETTS CITY` OF SALEM Address: 9 North Street Board of Health Salem, MA 01970-3928 FOOD ESTABLISHMENT INSPECTION REPORT Tel: (9781741-1800 Fax: (978) 740-9705 Name Date Tyne of Oneration(s) Tyoe.of Inspection ❑ Food Service P"Routine Address / Ris 11 Retail El Re-inspection ii�_5ii dpi Level ❑,��J�esidential Kitchen Previous Inspection Telephone C9 / 6Z Mobile Date:❑ Temporary ❑ Pre-operation Owner js HACCP Y/N ❑ Caterer ❑ Suspect Illness Person in Charge(PIC) i/ ii Time El Bed&Breakfast El General Complaint ❑ HACCP Inspector -7 - In: ❑ Other a e- Out: Permit No. W Each violation checked requires an explanation on the narrative page(s) and a citation of specific provision(s) violated. Non-compliance with: RED Violations (1-221 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. Local Law ❑ 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 TIME/TEMPERATURE CONTROLS(Potentially Hazardous Foods) ❑ 4. Food and Water from Approved Source ❑ 16. Cooking Temperatures ❑ 5. Receiving/Condition ❑ 17. Reheating ❑ 6. Tags/Records/Accuracy of Ingredient Statements ❑ 18. Cooling ❑ 7. Conformance with Approved Procedures/HACCP Plans ❑ 19. Hot and Cold Holding PROTECTION FROM CONTAMINATION ❑ 20. Time As a Public Health Control ❑ 8. Separation/Segregation/Protection REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) ❑ 9. Food Contact Surfaces Cleaning and Sanitizing ❑ 21. Food and Food Preparation for HSP ❑ 10. Proper Adequate Handwashing CONSUMER ADVISORY ❑ 11. Good Hygienic Practices ❑ 22. Posting of Consumer Advisories BLUE Violations (23-30) 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(RED Items 1-22): of Health. Non-critical (N)violations must be corrected immediately or within 90 days as determined by the Board Official Order of Correction: Based on an inspection of Health. today,the items checked indicate violations of 105 CMR C' N 590.000/Federal Food Code.This report,when signed below 23. Management and Personnel (Fc-2)(590.003) by a Board of Health member or its agent constitutes an 24. Food and Food Protection (FC-3)(590.004) order of the Board of Health. Failure to correct violations 25. Equipment and Utensils (FC-4)(590.005) cited in this report may result in suspension or revocation of the food establishment permit and cessation of food 26. Water, Plumbing and Waste (Fc-s)(sso.00s) establishment operations. If aggrieved by this order,you 27. Physical Facility (FC-6)(590.007) have a right to a hearing.Your request must be in writing 28. Poisonous or Toxic Materials (FC-7)(59o.om) 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 59M., r-6-14. Inspector's Signature: / / Print: PIC's Signature:/ �/'/� Print: Page of-K-Pages v U Violations Related to Foodborne Illness Interventions and Risk Factors (Red Items 1-22) PROTECTION FROM CONTAMINATION FOOD PROTECTION AND MANAGEMENT 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 3-302.11(A)(2) Raw Animal Foods Separated from Each EMPLOYEE HEALTH Other* 2 590.003(C) Responsibility of the person in charge to Contamination from the Environment require reporting by food employees and 3-302.11(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 3-701.11 Discarding or Reconditioning Unsafe FOOD F IOM APPROVED SOURCE Food* 4 Food and Water From Regulated Sources I; 9 Food Contact Surfaces 590.004(A-B) Compliance with Food Law* 4-501.111 Manual Warewashing-Hot Water 3-201.12 Food to a Hermetically Sealed Container* Sanitization Temperatures* 3-201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Warewashing-Hot Water 3-202.13 Shell Eggs* Sanitization Temperatures* 3-202.14 Eggs and Milk Products,Pasteurized* 4-501.114 Chemical Sanitization-temp.,pH, 3-202.16 Ice Made From Potable Drinking Water* concentration and hardness* 5-101.11 Drinking Water from an Approved System* 4-601.11(A) Equipment Food Contact Surfaces and 590.006(A) Bottled Drinking 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* 3-201.14 Fish and Recreationally Caught Molluscan 4-702.11 Frequency of Sanitization of Utensils*and Shellfish* Food Contact Surfaces of Equipment 3-201.15 Molluscan Shellfish From NSSP Listed 4-703.11 Methods of Sanitization-Hot Water and Sources* Chemical* Game and Wild Mushrooms Approved by 10 I Proper,Adequate Handwashing Regulatory Authority 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* ( 11 Good Hygienic Practices 5 Receiving/Condition 2-401.11 Eating,Drinking or Using Tobacco* 3-202.11 PHFs Received at Proper Temperatures* 2-401.12 Discharges from the Eyes,Nose and 3-202.15 Package Integrity* Mouth* 3-101.11 Food Safe and Unadulterated* 3-301.12 Preventing Contamination When Tasting* 6 Tags/Records:Shellstock f 1.2 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(7) Labeling of Ingredients* 5-204.11 Location and Placement* 7 Conformance with Approved Procedures 5-205.11 Accessibility,Operation and Maintenance /HACCP Plans Supplied with Soap and Hand Drying 3-502.11 Specialized Processing Methods* Devices 3-502.12 Reduced oxygen packaging,criteria* 8-103.12 Conformance with Approved Procedures* 6-301.1 6-301.1..2 Hand Hand Drying Cleanser,Availability g Provision *Denotes cntical nem in the federal 1999 Food Code or 105 CMR 590.000 THE COMMONWEALTH OF MASSACHUSETTS City of Salem •Establishment Name Date //Z>// J Address C/ 2P�/dD y> Page of Item No. In the space below describe all violations checked on front page. Ain) Inspection of this establishment was conducted in accordance with the State Sanitary Code for Food Establishments,Chapter X, 705 CMR 590.000./ygJe fol/I wing violations were observed: ;7 h/� zf�ri h//�I.. 4/r "'W "W//,v /> L/ AVA,1//1� ,dh>/illi/P F/r� G _ //r �-rr/s A///.,��-v /.fir✓ �i1�.JP/_S' �iut� �_ e i�/Ji��i�/ Fi /,�c/�,IZs4ph? /sfni�-fi/ //ri/I" t�jYl`/ d?/K'✓ /�(77>.J LJJrJ�� //Jii n ✓ ,�,/� ///.Ci1r1/ Discussion with Management 1 have read this report,have had the opportunity to ask questions and agree to correct all violations before the next inspection,to observe all conditions as described,and to comply with all mandates of Chapter X. I understand that noncompliance may result in daily fines of twenty-five dollars. J THE COMMONWEALTH OF MASSACHUSETTS City of Salem Establishment Name / � --7Date Address � � �n �� Page / of Item No. In the space below describe all violations checked on front page. A(n) A"e inspection of this establishment was conducted in accordance with the State Sanitary Code for Food Establishments,Chapter X, 105 CMR 590.000.The following violations were observed: �/1n.�f/jPv v !7//�J hi) / _ _/i •iii �i�il� _ii iliJ•i//i�iLi�e /�i� CL ••�f�P`'e /I<)i i_ iii J/i'�Pi-nw.i�j�/ � Discussion with Management I have read this report, have had the opportunity to ask questions and agree to correct all violations before the next inspection,to observe all conditions as described,and to comply with all mandates of Chapter X. I understand that noncompliance may result in dally fines of twenty-five dollars. THE COMMONWEALTH OF MASSACHUSETTS / City of Salem Establishment Name / � ��l/fJs Date Address � � Page / of Item No. In the space below describe all violations checked on front page. Ain) 6/i7`i e V7,]A4 1P inspection of this establishment was conducted in accordance with the State Sanitary Code for Food Establishments,Chapter X,/1105 CMR 590.000.The followin/q violations were observed: /Y rf9.c4 iJnsl/7�r �ii� r7_/) -`i_ei.7114< ;.`in,/i /.� Jar lii/Jr( .-Y✓Pl7Pv. r Discussion with Management I have read this report,have had the opportunity to ask questions and agree to correct all violations before the next inspection,to observe all conditions as described,and to comply with all mandates of Chapter X. I understand that noncompliance may result in daily fines of twenty-five dollars. r � ��ONUIT a CITY OF SALEM BOARD OF HEALTH Salem, Massachusetts 01970-3928 JOANNE SCOTT, MPH, RS,CHO NINE NORTH STREET HEALTH AGENT Tel:(978)741-1800 Fax:(978)740-9705 COMMONWEALTH OF MASSACHUSETTS PERMIT TO OPERATE A MOBILE FOOD SERVER In accordance with Regulations promulgated under authority of Chapter 94, Section 305A and Chapter III, Section 5 of the General Laws a Permit is hereby granted to: Name: Paula Kefalas Name of Establishment : Classy Chassis Food Cart #6 Whose Place of Business is : 4 Azalea Lane Peabody, MA Date: 09/28/2000 To Operate a Mobile Food Server in Salem Restrictions : Sausages - Kielbarsa - hot dogs - drinks Permit #: 15-OOM - Frozen Desserts/ Ice Cream: PERMIT EXPIRES December 31, 2000 �81r�XnC-Cii�� (� HEALTH AGENT 5 n � � 3 q CITY OF SALEM BOARD OF HEALTH Salem, Massachusetts 01970-3928 JOANNE SCOTT, MPH, RS,CHO / NINE NORTH STREET HEALTH AGENT Tel (978)741-1800 APPLICATION FOR A MOBILE FOOD SERVICE PERMIT Fax (978)740-9705 Fee $40 payable to The City of Salem, No Cash Name of Applicant 61/tA) Telephone# Address q 4z-AZe a /_A✓, 11/. A- . Certified Food Manager P" v Fa /¢S Certificate # Name of Business ro,,rW 70'—. Telephone# F'29Z Address Manufacture Frozen Desserts? Yes No Type of Vehicle ��v-� eGlr --/-` Registration# Location of Operation MAI,, f e,. iC�Y.r.�v c7AI 1714 L� � Name & Address of Licensed Food Service Establishment Serving as Base of Operation Telephone# Location of Toilet & Handwashing Facilities b Menu Mot �Sc� —trfo�iAa/,LS �1`��l`S Type of refrigeration: Iced//Dry Ice Gas Other _ Method for Cooking and/or Hot Holding: Gas Other Method for Sanitizing: Chemical t/ Hot Water (170 F) _ I have read and agree to abide by The Salem Board of Health Regulations regarding "Mobile Food Units & Pushcarts" and will notify the Salem Board of Health of any changes in this application. Pursuant to MGL C62C,S49A, I certify under the penalties of perjury that I, to my best knowledge and belief, have filed all State tax returns and paid all State taxes required under law. Signature Social Seculnt.�'N or Federal IDN D pate 4tJ ----------- ----- --- ff Revised 10/20/98 Permitil Checkk k Date C �+ CITY OF SALEM BOARD OF HEALTH Salem, Massachusetts 01970-3928 JOANNE SCOTT, MPH,RS,CHO NINE NORTH STREET HEALTH AGENT Tel:(978)741-1800 Fax:(978)740-9705 COMMONWEALTH OF MASSACHUSETTS PERMIT TO OPERATE A MOBILE FOOD SERVER In accordance with Regulations promulgated under authority of Chapter 94, Section 305A and Chapter III, Section 5 of the General Laws a Permit is hereby granted to: Name: Paula Kefalas Name 'of Establishment : Classy Chassis Food Cart #5 Whose Place of Business is: 4 -Azalea Lane Peabody MA Date: 09/28/2000 To Operate a Mobile Food Server in Salem Restrictions: Fried Dough - French Fries Permit #: 14-OOM Frozen Desserts/ Ice Cream: PERMIT EXPIRES December 31, 2000 VU HEALTH AGENT eo �r CITY OF SALEM BOARD OF HEALTH Salem, Massachusetts 01970-3928 JOANNE SCOTT, MPH, RS,CHO NINE NORTH STREET HEALTH AGENT Tei:(978)741-1800 APPLICATION FOR A MOBILE FOOD SERVICE PERMIT Fax:(978)740.9705 '! �j /Fee $40 payable to The City of Salem, No Cash Name of Applicant l, IE/"c t4S Telephone# Address G.elL- GN, t tf )40',?,/, j /' Certified Food Manager �� v/ � AW14 r i; Certificate #/ Name of Business C/Q sy cassis . Telephone# Address Manufacture Frozen Desserts? Yes No Type of Vehicle / vs�/ � r Registration# Location of Operation ./-,w Name & Address of Licensed Food Service Establishment Serving as Base of Operation m 1 os T-e o 'S Telephone# Location of T��-oiill'et & Handwashing Facilities Menu T�ki Type of refrigeration Ice_ Dry Ice__ Gas_ Other---- Method for Cooking and/or Hot Holding: Gas_ .— Other__ Method for Sanitizing: ChemicalHot Water (170 F)_ I have read and agree to abide by The Salem Board of Health Regulations regarding "Mobile Food Units & Pushcarts" and will notify the Salem Board of Health of any changes in this application. Pursuant to MGL C62C,S49A, I certify under the penalties of perjury that I, to my best knowledge and belief, have filed all State tax returns and paid all State taxes required under law. Signature / Social Security# or Feder l IDN �.L .,D tto ----------- - r ----- `, Revised IR24/98 Pemut ll CIC-ckx R Jaffe --- : ` sal 'K PG•.,lw r^"'}'Pb ..rar . .:e.`SBFIK.:.Fµ.rye i'4 r' 'rY N. t^,., n � .:�6w,•�' THE COMMONWEALTH OF MASSACHUSETTS City of Salem Establishment Name ( /Iegj s/// C� Date Address c/ rt�J /P� /�/1l �P�/�poyi /117 • Page / of � Item No. 1 In the space below/describe/ally violations checked on front page. Ain)/1 0-�1'e VW1 / ZW/S44nspection of this establishment was conducted in accordance with the State Sanitary Code for F81ad• blishments,Chanter X, 105 CMR 590.000.The following violations were observed: �)i%/ hP .S.�_ /�in/? rn— f-/ i P_�✓ /'_ZGv,Ii1r/, /J ,F < <- /3i)!� �ir.�.S fru Jnrn Pi�ii/gin P� ,2i 1 :� T / 1 Discussion with Management I have read this report,have had the opportunity to ask questions and agree to correct all violations before the next inspection,to observe all conditions as described,and to comply with all mandates of Chapter X. I understand that noncompliance may result in daily fines of twenty-five dollars. �.�oxar ® a - n � CITY OF SALEM BOARD OF HEALTH Salem, Massachusetts 01970-3928 JOANNE SCOTT, MPH, RS,CHO NINE NORTH STREET HEALTH AGENT Tel:(978)741-1800 Fax:(978)740-9705 COMMONWEALTH OF MASSACHUSETTS PERMIT TO OPERATE A MOBILE FOOD SERVER In accordance with Regulations promulgated under authority of Chapter 94, Section 305A and Chapter III , Section 5 of the General Laws a Permit is hereby granted to: Name: Kevin Kefalas Name of Establishment: Classy Chassis Food Cart #4 Whose Place of Business is : 4 Azalea Lane Peabody, MA Date : 09/26/2000, To Operate a Mobile Food Server in Salem Restrictions :' Fried Dough. & Cider -. Permit #: 13-OOM - Frozen Desserts/ Ice Cream: PERMIT EXPIRES December 31, 2000 HEALTH AGENT • �ONUIT ��oi,Mnuq Wim' CITY OF SALEM BOARD OF HEALTH Salem, Massachusetts 01970-3928 U�J�/� JOANNE SCOTT,MPH,RS,CHO ' J NINE NORTH STREET HEALTH AGENT Tel (978)741-1800 APPLICATION FOR A MOBILE FOOD SERVICE PERMIT Fax (978)740-9705 ' / 40 payable to The City of Salem, No Cash NameofApplicant ( dirt IhP (JQ Telephone# Address i \-eG rwIJD�� 1'x(1-G 1�.-(PCZ Certified Food Manage xt A \n- yE'fir_ . ii,r t Certificate # On Name of Business ( C� Telephone# ��SStc r� Address Manufacture Frozen Desserts? Yes No-Z 1,e Type of Vehicl ; ��`�`�Registration#_(., Location of Operation ny)Lo (°) O mCnOc 'fin Name & Addre,§ of Licensed Food Service Establishment Serving as Base of Operation ( C S�+�rrrse Telephone# 1 Location of Toilet & Hand`washing Facilities--ALS 1-kc ovl e Yo✓,104doo fT Menu T �( \ r-A Type of refrigeration: Ice ✓ Dry Ice Gas Other Method for Cooking and/or Hot Holding. Gas_d� Other___ Method for Sanitizing: Chemlcal_LL-' Hot Water (170 F) I have read and agree to abide by The Salem Board of Health Regulations regarding "Mobile Food Units & Pushcarts" and will notify the Salem Board of Health of any changes in this application. Pursuant to MGL C62C,S49A, I certify under the penalties of perjury that I, to my best kno ge and belief, have filed all State tax returns and paid all State taxes required and r w. Signature Social Securit # or Federal ID# Date ___G�___I-----------------------------�" ----------------------------------------------- , _______________________________-___________-_- Revised 10/20/98 Permit d �— ( Chcck!!R Date 671 ' THE COMMONWEALTH OF MASSACHUSETTS City of Salem Establishment Name Date ��jQSs,� � ! (/ Date Agor€SS Q/xJ/��/d ,` �/Vl//�G c �PIJ/r9 AP��/ S Page of Item No. In the space below describe all violations checked on front page. A(n) / /i_n//✓�!/ inspection of this establishment was conducted in accordance with the State San/itary Code for Food Est5blish/ments,Chaoter X, 105 CMR 59900.000.The folloowiinq violations were observed: %z4v l A Discussion with Management I have read this report, have had the opportunity to ask questions and agree to correct all violations before the next inspection,to observe all conditions as described,and to comply with all mandates of Chapter X. I understand that noncompliance may result in daily fines of twenty-five dollars. r1 • .e •A L S..Ii='.�'iY Y%b � •ir rn .r,. 'Y• .. n w . . y.r• THE COMMONWEALTH OF MASSACHUSETTS City of Salem Establishment Name G>/L/1s / Date Address �Q///C( / .,�e�� /'�s Page _of a Item No. In the sp pe—below describe all violations checked on front page. A(n) inspection of this establishment was conducted in accordance with the State �.Saniitt`ary Code for Food Estatris//hments,Chapter X, 105 CMR 590.000.The following violations were observed: or �L/ �< < _( a r 160. A Xe 16 440C .4 41,1 ,A.�_� .�/XJ�e✓ re��/iSeoz L_✓�)/-�l� 1J�9,y1 4 ✓.rt✓�t/� �' eo /,7 i Discussion with Management I have read this report,have had the opportunity to ask questions and agree to correct all violations before the next inspection,to observe all conditions as described,and to comply with all mandates of Chapter X. I understand that noncompliance may result in daily fines of twenty-five dollars. THE COMMONWEALTH OF MASSACHUSETTS City of Salem Establishment Name 914(JSX e'4'.o�/� Address /y a lw � /1 E'd ' lelo j.S Page f of J Item No. In the s ce/below describe all violations checked on front page. A(n) ✓ inspection of this establishment was conducted in accordance with the State nitary Code for Food E ablishmeents,Ch oter X, 105 CMR 590.000.The followinq violations were observed _ �� /n �i/1/ii ! 01 -tel/U?/��1• , i )// --.h_ n/ji/J �n .moi' �_Jr' �.�6iit�i� ��ii�'✓_t �L� /20 �_c��a�i2,�✓Uni"4�i�fi sl �� fiP_ ��/)r��s .��J�L/ Discussion with Management I have read this report, have had the opportunity to ask questions and agree to correct all violations before the next inspection,to observe all conditions as described,and to comply with all mandates of Chapter X. I understand that noncompliance may result in daily fines of twenty-five dollars. !MPO ANT MESSAGE FOR o OATF �F,! .TIM M OF S �� FHONF AREA CODE NUMBER EXTENSION ❑ FAX ❑ MOBII F i AREA CODE N�R TIME TO CALL TELEPHONED v l PLEASE CALL 4 CAME TO SEE YOU WILL CALL AGAIN WANTS TO SEE YOU RUSH RETURNED YOUR CALLI I WILL FAX TO YOU MESSAGE ,¢,,¢---k- ms//J C.lAv i2%�'�%12��-eGG4e71v' r SIGNED9 WrA lsv FORM 4U S V��7 MARE IN U 5 NOTES - � I 4 ( IMPORTANT MESSAGE ) FOR DATE "'"�`� TIMH�' � .M. OF PHONE AREA CODE NUMBER EXTENSION Cl FAX ❑ MOBIL��CCI SR TIME C E NUMBER TIME TO GALL TELEPHONED Z/ PLEASE CALL CAME TO SEE YOU WILL CALL AGAIN WANTS TO SEE YOU RUSH RETURNED YOUR CALL WILL FAX TO YOU MESSAGE +"' ( SIGNED Wraps. FORM 4UX13 V��7 MADE IN 0 A . i NOTES U' THE COMMONWEALTH OF MASSACHUSETTS City of Salem BOARD OF HEALTH FOOD ESTABLISHMENT INSPECTION REPORT Establishment Name Address ,73 GLs6or/7c S roc¢ �r�vl�dp� �ri�/sR /9�c3 Time: In Out Telephone �j 3 j- ��3 5/ Type of Establishment: ur posse: ";q J Food Service _71 Owner's Name ��/t//q+ �G"9�Y�a! , Retail Food autine G-� Follow-up Residential Kitchen Person in Charge pe76rlA2�.LI/Lr.�i �P, Y9r, Mobile Unit ( ( Complaint Temporary Food Service Invest gation Inspector's Name ��Z �, 7/G�, Catering Othe Besed on an inspection today,the Items checked below indicate the violated provisions of 105 CMR 590.000. Each item is followed by the applicable section of the Massachusetts regulation. Non-critical violations are marked under column"N"and critical violations are marked under column"C". Descriptions of each Item appear on the back of this form. Each violation checked requires an explanation on the narrative page(s). This report serves as official notice of violated provisions and official notice to correct said violations. Food `" 0C1 Sanitary Facilities N C 1. Food Supply .002 29. Water Source 015 2. Food Containers .002 30. Sewage 016 31. Cross-Connections .017 Food Protection 32. Toilets/Handwashing .018& .019 3. PHF Temperatures .004 33. Insects/Rodents 021 4. Facilities. Hot 3 Cold Storage •004 34. Plumbing .017 5. PHF Re-service .006 35. Toilet Rooms .018 6. Spoiled/Damaged Foods •003 36. Handwashing Areas .019 7. Food Protected .003 37. Garbage/Refuse .020 S. Food Thermometers .004 38. Outside Disposal .020 9. Cross Contamination .005 39. Outer Openings 021 10. PHFs thawed, cooked& cooled •005 40. Pesticide/Rodenticide Application 021 it. Food Handling .005 12. Dispensing Utensils .006 Physical Facilities _ 41. Floors .022 _ Personnel 42. Walls, Ceiling .022 _ 13. Employee Infections .00843. Lighting .023 _ 14. Employee Hygiene .009 44. Ventilation .024 _ 15. Employee Clothing .010 45. Dressing Rooms .025 Equipment A Utensils Other 16, Equipment/Utegsii Clean 6 Sanitized .013 46, Toxics .026 17. Food Contact Sur/aces •013 47. Premises .027 18. Non-Food Contact Surfaces .013 48. Living Areas .027 19. Food Contact Surfaces Clean .013 49. Linen .027 20, Non-Food Contact Surfaces Clean .013 50. Pets 027 21. Wiping Cloths •013 51. Bulk Foods .031 22. Dish/Warawashing Facilities .013 52 Salad Bars .032 23. Pre-Scraped, Soaked ,013 24. Wash/Rinse Water .013 No. of 13 Critical Items Violated �I 25_ Thermomaters/Test Kits .013 Il These items require immediate attention 26. Equipment/Utensil Storage .014 l 27 Single Service Articles ,014 Recewgd b f II -ted b 28 Single Service Re-UieOt2r<r SMOKING LAW COMPLIANCE-YES-NO-NA Reinspion"of Critical Itenls� FORM 734A (e&) HOBRS a WARREN TM CHOKE SAVER COMPLIANCE_YES_NO_NA Reinspection of Noncritical Items FOOD Full Item Descriptions C1 Food Source, approved, wholesale 2 Containers, properly labelled FQOD PROTECTION C3 Potentially hazardous foods at proper temperatures: 140°F or above,45°F or below, O°F; rapid cooling of cooked foods within 4 hours C4 Facilities to maintain product temperature C5 Unwrapped and potentially hazardous foods not reserved 6. Damaged, spoiled, returned foods segregated 7 Food protected during storage, preparation, display, dispensing, service, transportation 8 Thermometers provided, conspicuous, accurate 9 No cross-contamination 10 Potentially hazardous foods properly thawed, cooked, and cooled 11 Food handling minimized 12 Dispensing utensils stored PERSONNEL C13 Employees with infections restricted C14 Hands washed and clean; good hygienic practices 15 Clean clothes, hair restraints E,QQIPMENT & UTENSIL C16 Equipment, utensils sanitized (automatic and manual methods) 17 Food contact surfaces:designed, constructed, installed, maintained, located 18 Norrfood contact surfaces:designed, constricted, installed, maintained, located 19 Food contact surfaces clean, free of all cleansers 20 Non-food contact surfaces clean, free of all cleansers 21 Wiping cloths; clean, use restricted 22 Dish/Warewashing facilities: designed, constructed, maintained, installed, located,operated 23 Pre-flushed, scraped, soaked 24 Wash/Rinse water clean, temperature 25 Accurate thermometers, chemical test kits provided; instructions posted 26 Storage, handling of clean equipmenVutensils 27 Single service articles, storage, dispensing 28 No reuse of single service articles SANITARY FACILITIES C29 Water source; approved, hot b cold under pressure C30 Sewage and waste water disposal C31 No cross-connections, back siphonage, backflow C32 Toilets 8 Handwashing: number, accessible, design, installed C33 No insects or rodents; harborage prevented 34 Plumbing; installed, maintained 35 Toilet rooms enclosed, self-closing doors,fixtures good repair, clean, signs 36 Handwashing areas supplied with soap and towel dispensers, proper waste receptacles 37 Garbage and refuse: containers covered, adequate number, insect/rodent resistant,frequency, clean 38 Outside area: dumpster covered, construction, clean 39 Outer openings protected 40 Pesticides and rodenticides, proper application PHYSICAL FACILITIES 41 Floors constructed, maintained, clean 42 Walls, ceiling attached equipment; constructed, maintained, clean 43 Lighting provided as required, fixtures shielded 44 Rooms and equipment vented as required 45 Dressing, locker areas provided, clean OTHER C46 Toxics properly stored, labelled, used 47 Premises litter-free, unnecessary articles,cleaning maintenance equipment property stored. Authorized personnel 48 Llving/slesping quarters and laundry separate 49 Linen properly stored 50 No pets or other large animals except guide dogs 51 Bulk foods stored, labelled, dispensed 52 Salad bar operations prepared, refrigerated, displayed, protected THE COMMONWEALTH OF MASSACHUSETTS City of Salem Establishment Name C�ssy � Date s�s/lJ Address z3 dpr/Je ,y�iee� �46d�', /»I'� Page Z of .Z Item No. In the space below describe all violations checked on front page. A(n) �W( ��_inspection of this establishment was conducted in accordance with the State ' SSanitary Code for Food Establishments,Chapter X, 105 CMR 590.000.The following violations were observed: .liP/`�.s]`i � r�l Discussion with Management Il✓�fr'L�^ (� `` / have read this report, have had the opportunity to task questions and agree t0-cOrrect all violations before the next inspection,to observe all conditions as described,and to comply with all mandates of Chapter X. I understand that noncompliance may result in daily fines of twenty-five dollars. Z0 T CITY OF SALEM BOARD OF HEALTH Salem, Massachusetts 01970-3928 JOANNE SCOTT,MPH,RS,CHO NINE NORTH STREET HEALTH AGENT Tel:(978)741-1800 Fax.(978)740-9705 COMMONWEALTH OF MASSACHUSETTS PERMIT TO OPERATE A MOBILE FOOD SERVER In accordance with Regulations promulgated under authority of Chapter 94 , Section 305A and Chapter III, Section 5 of the General Laws a Permit is hereby granted to: Name : Paula Kefalas Name of Establishment : Classy Chassis Cart #2 Whose Place of Business is: 4 Azalea Lane W. Peabody MA Date : 05/25/2000 To Operate a Mobile Food Server in Salem Restrictions : One (1) raw food item prepared per surface . r Permit # : 8-OOM Frozen Desserts/ Ice Cream: PERMIT EXPIRES December 31, 2000 �r (� HEALTH AGENT 14 .conmrr CITY OF SALEM BOARD OF HEALTH Salem, Massachusetts 01970-3928 JOANNE SCOTT,MPH,RS,CHO "� NINE NORTH STREET HEALTH AGENT Tel:(978)741-1800 APPLICATION FOR A MOBILE FOOD SERVICE PERMIT Fax:(978)740-9705 Fee $40 payable to The City of Salem, No Cash Name of Applicant "I"' kk relcrS Telephone# 97� Address (q 7_/A Certified Food Manager Certificate� # Name of Business Ao-oojL'o✓/'Telephone# /So�_ Z�f3-892 Address Manufacture Frozen Desserts? Yes No Type of Vehicle vv5 tlt/ Cu rr1s Registration# Location of Operation �0A1 Name & Address of Licensed Food Service Establishment Serving as Base of Operation 1-�1.S-7'cO 'S Telephone# Location of Toilet & Handwashing Facilities s—, Z/" •'/ C"'�f r Menu �o�o�/"�vg� yic�vcl� i�S- r��sLi : c �/�� +v✓9� 7- Type Type of refrigeration: Ice Dry Ice �as Other Method for Cooking and/or Hot Holdin Gas Other Method for Sanitizing: Chemical Hot Water (170 F) I have read and agree to abide by The Salem Board of Health Regulations regarding "Mobile Food Units & Pushcarts" and will notify the Salem Board of Health of any changes in this application. Pursuant to MGL C62C,S49A, I certify under the penalties of perjury that I, to my best knowledge and belief, have filed all State tax returns and paid all State taxes required under law. Signature / Social Secun4y# or F eral t # Date Revised. 10/20/98 Permit# Check#&Date i Mb n 6 CITY OF SALEM BOARD OF HEALTH Salem, Massachusetts 01970-3928 JOANNE SCOTT, MPH, RS,CHO NINE NORTH STREET HEALTH AGENT Tel:(978)741-1800 Fax:(978)740-9705 COMMONWEALTH OF MASSACHUSETTS PERMIT TO OPERATE A MOBILE FOOD SERVER In accordance with Regulations promulgated under authority of Chapter 94 , Section 305A and Chapter III, Section 5 of the General Laws a Permit is hereby granted to: Name : Kevin Kefalas Name of Establishment : Classy Chassis Cart #3 Whose Place of Business is : 4 Azalea Lane W. Peabody MA Date : 05/25/2000 To Operate a Mobile Food Server in Salem Restrictions : Permit # : 7-OOM Frozen Desserts/ Ice Cream: PERMIT EXPIRES December 31, 2000 V HEALTH AGENT CITY OF SALEM BOARD OF HEALTH Salem, Massachusetts 01970-3/9/��2"{-8/ JOANNE SCOTT,MPH,RS,CHO t%/'`�— NINE NORTH STREET HEALTH AGENT -7 00 Tel-(978)741-1800 APPLICATION FOR A MOBILE FOOD SERVICE PERMIT Fax: (978)740-9705 /� Fee $40 payable to The City of Salem, No Cash Name of Applicant ke.CI7 AJ ��4 Ac S Telephone#9J- 3-3S--6W Address tl A z-A Le-A- ,40; Certified Food Manager Po a +Ct Fe, A S Certificate # Name of Business Telephone# /J - Zy3 •?Z9L. Address / Manufacture Frozen Desserts? Yes No v ' Type of Vehicle ra rA Registration# !UO Location of Operation S-r/em ©�ii✓lo✓v /iUo7�� 1'�G•�/c'��' m��J Name & Address of Licensed Food Service Establishment Serving as Base of Operation Telephone# Location of Toilet & Handwashing Facilities //�s/✓r/��pniio� 1� / Menu '51 + S,cJG r �c��i s� — ��TOo/G S Df'�, l - 5r✓S�f Type of refrigeration: Ice Dry Ices Other _ Method for Cooking and/or Hot Holding: was 1/95 Other Method for Sanitizing: Chemical IV Hot Water (170 F) I have read and agree to abide by The Salem Board of Health Regulations regarding "Mobile Food Units & Pushcarts" and will notify the Salem Board of Health of any changes in this application. Pursuant to MGL C62C,S49A, I certify under the penalties of perjury that I, to my best knowledge and belief, have filed all State tax returns and paid all State taxes required under law. Signature / v Social Security# or Federal ID Date -------------1 '" '^ ' l Revised1020/98 Permit q Checks!&Date :'?h.r.t`�`r�,•, .✓_ ..�.. i r. Y• ,A M'1M'..r'.f4rnu "IR. ....!".L.�iP r,r) FM N'�^L ft ice, { , �•rt• THE COMMONWEALTH OF MASSACHUSETTS City of Salem `BOARD OF HEALTH FOOD ESTABLISHMENT INSPECTION REPORT Establishment Name C/GjfS Date Address Time: In Out o.Z3 (J,16pr/�e 6�rcc� �QPU6o��/i /��iq D/q�CD Telephone Type of Establishment: n Purpose:Food Service R Retail Food Owner'shame / � out ne C!L/�r/ /(P Residential Kitchen Follow-uG Person in Charge n' Mobile Unit Complaint Temporary Food Service Investigation Inspector's Name �e /(, 1X0147e. Catering Lj Other Based on an inspection today,the Items checked below indicate the violated provisions of 105 CMR 590.000. Each item is followed by the applicable section of the Massachusetts regulation. Non-critical violations are marked under column"N"and critical violations are marked under column"C". Descriptions of each item appear on the back of this form. Each violation checked requires an explanation on the narrative page(s). This report serves as official notice of violated provisions and official notice to correct said violations. Food M C Sanitary Facilities N C 1. Food Supply .002P9• Water Source 015 2. Food Containers .00211' 30. Sewage 016 31. Cross-Connections 017 Food Protection 32. Toilets/Handwashing 018 & 019 3. PHF Temperatures .004 33• Insects/Rodents .021 4. Facilities. Hot 8 Cold Storage .004 34. Plumbing .017 _ 5. PHF R"ervice .006U 35. Toilet Rooms 018 _ 6. Spoiled/Damaged Foods .003 _ 36. Handwashing Areas .019 - 7. Food Protected .003 37. Garbage/Refuse 020 8 Food Thermometers - .004 _ 38. Outside Disposal .020 - 9. Cross Contamination .005 _ 39. Outer Openings 021 - 10. PHFs thawed, cooked 3 cooled .005 _ 40, Pesticide/Rodenticide Application 021 - 11. Food Handling .005 - 12. Dispensing Utensils .006 _ Physical Facilities _ 41. Floors .022 _ Personnel 42. Walls, Ceiling .022 - 13. Employee Infections .008 43. Lighting .023 - 14. Employee Hygiene .009 44. Ventilation .024 - 15. Employee Clothing .010 45. Dressing Rooms .025 - Equipment i UtensilsOther 16. Equipment/Utensil Clean b Sanitized .013 46. Toxics .026 17. Food Contact Surfaces .013 47. Premises .027 18. Non-Food Contact Surfaces .013 48, Living Areas .027 19 Food Contact Surfaces Clean .013 49. Linen .027 20. Non-Food Contact Surfaces Clean .013 50. Pets 027 21. Wiping Cloths •013 51. Bulk Foods .031 22. Dish/Warewashing Facilities .013 52. Salad Bars .032 23. Pre-Scraped. Soaked .013 24 Wash/Rinse Water .013 INo. of 13 Critical Items Violated _I 25 Thermometers/Test Kits .013 These items require immediate attention. 26. Equipment/Utensil Storage .014 27 Single Service Articles 01-d Rec v d by In p ted/by 28 Single Service Re Use .012 ��- !`1 A-� /��//1' SMOKING LAW COMPLIANCE_YESNONA Reinspect of n of Critical Items FORM 7NA r i Hoses 8 wARREN'm CHOKE SAVER COMPLIANCE-YES-NO-NA Reinspection of Noncritical Items * •Y- .. � '/'!+'r`4.`�„M' "��ry°17•Ne`.1":......(Hr.7-'�r'W7r.�T:+^N+...t'.�3....-.,+,..�^i,w'll,m.l.{"`, Y. ..z � , THE COMMONWEALTH OF MASSACHUSETTS City of Salem Establishment Name C 1assy C'�ass�s �U/� Date Address Page of .Z Item No. In the space below describe all violations checked on front page. A(n) DOi filial/ inspection of this establishment was conducted in accordance with the State Sanitary Code for Food Establishments,Chapter X. 105 CMR 590.000.The followinq violations were observed: 1rr�Cvi.LrJi/. ri/l/moi 14WIe iltJtJ�s iii1 d �V�� r/ 9 Discussion with Managements I have read this report, have had the opportunity to ask questions and agree to correct all violations before the next inspection,to observe all conditions as described,and to comply with all mandates of Chapter X. I understand that noncompliance may result in daily fines of twenty-five dollars. 3 CITY OF SALEM BOARD OF HEALTH Salem, Massachusetts 01970-3928 JOANNE SCOTT,MPH, RS,CHO NINE NORTH STREET HEALTH AGENT Tel:(978)741-1800 Fax:(978)740-9705 COMMONWEALTH OF MASSACHUSETTS PERMIT TO OPERATE A MOBILE FOOD SERVER In accordance with Regulations promulgated under authority of Chapter 94 , Section 305A and Chapter III , Section 5 of the General Laws a Permit is hereby granted to: Name : Paula Kefalas Name of Establishment : Classy Chassis Cart #1 #597-095 Mass Whose Place of Business is : 23 Osborne Street Peabody MA Date : 04/07/2000 To Operate a Mobile Food Server in Salem Restrictions : Hot dogs, kielbasa, tonic, slush Sausage or chicken One raw item E-I-o+ Permit # : 2-OOM clef Frozen Desserts/ Ice Cream: PERMIT EXPIRES December 31, 2000 1 (/ ''�&-A-t� HEALTH AGENT '�mv8 CITY OF SALEM BOARD OF HEALTH Salem, Massachusetts 01970-3928 JOANNE SCOTT,MPH,RS,CHO NINE NORTH STREET HEALTH AGENT Tel:(978)741-1800 Fax:(978)740-9705 MOBILE FOOD UNITS & PUSHCARTS REQUIREMENTS These regulations are in accordance with The State Sanitary Code of the Massachusetts Department of Public Health, 105 CMR 590.029. The Board of Health may impose additional requirements to protect against health hazards related to the conduct of the mobile food unit of pushcart and may prohibit the sale of some or all potentially hazardous foods. Therefore the Board of Health reserves the right to make individual determinations on each application. Such determinations will be based on good judgement and sound public health information. FOOD MANAGER CERTIFICATION IS REQUIREDOF ANY UNIT WHICH PREPARES POTENTIALLY HAZARDOUS FOODS. Requirements of All Units All units must comply with the following: • Mobile food units and pushcarts shall operate from a fixed, licensed food establishment and shall report at least daily to such location for all food, supplies and all cleaning, sanitizing, and servicing operations. The name and address of that licensed establishment will be required on the application form and will be subject to verification. • All units are required to have and use a food thermometer to check heating and holding temperatures. • All units shall obtain the use of toilet facilities where hand washing is available. All operators shall wash their hands after using toilet facilities and before returning to work. • All operators shall be clean in dress and appearance. The Mobile Food Service permit shall be prominently displayed on the cart or unit. All units must have refrigeration available which will maintain all potentially hazardous foods at a temperature of 40 F or lower. All units must have wiping cloths in sanitizing solution at the IJ�� /9 �712-aa-O • ��ONDIT c6y1NBPp CITY OF SALEM BOARD OF HEALTH Salem, Massachusetts 01970-3928 JOANNE SCOTT, MPH, RS,CHO _ NINE NORTH STREET HEALTH AGENT Tel (978)741-1800 APPLICATION FOR A MOBILE FOOD SERVICE PERMIT Fax:(978)740-9705 / r Fee $40 payable to The City of Salem, No Cash Name of Applicant r ¢� �n YSr� �rZ �. S Telephone# ,r, -C. r y Address?c,0,&r-- l�cx�n Ted )r-4 rx ,�Ag I n A n 1960 Certified Food Manager w0 a. rkC Certificate # 167,.1ki1K,7 Name of Business SS i ,-TJ Gn Telephone# Address ,V 076 ft-(A /,LgOe (-JJCSf 1� raIDa Manufacture Frozen Desserts? Yes No Type of Vehiclej�p61- aj)(,,k' /9 79' Registration# p > Location of Operation�P r)-P �� (-) S � hL/ 1Ce /Lai/ (X,rr�G "-,I- Name Name & Address of Licensed Food Service Establishment Serving as Base of Operation S><r'o-4 — C1 Telephone# r Location of/To//filet &((H��andwashing Facilities �.7 //ine-01 l�l�% arcC4.2 CIC Menu/ dby) , A//C/2!6 /7� Ni�iYI�C 0/7(-vchrpC- Type of refrigeration: Ice-' DryIce Gas Other Method for Cooking and/or Hot Holding: Gas ,�-' Other Method for Sanitizing: Chemical Hot Water (170 F) I have read and agree to abide by The Salem Board of Health Regulations regarding "Mobile Food Units & Pushcarts" and will notify the Salem Board of Health of any changes in this application. Pursuant to MGL C62C,S49A, I certify under the penalties of perjury that I, to my best knowle a and belief, have filed all State tax returns and paid all State taxes required 7un ' I /A / /`] �� /9 ?�- 7797 y/7/oaa Signature Social Security# or Federal ID# Date ---------------------------------------------------------------------------------------------------------------------- Revised 10/20/98 Permit# d ,-6b Check#&Dat e- -7-6b ��issy . �h',4s'f3p _ rQ��-_ F.e.� ��xsr /1 . /��9 --��olti__,�—llev�N_/e�.aC.9r�_ ow,..�. O�_ CL9 rte,,, G/ynSS:1' _fad .je.(�.!�'e�_ ./�vrf.�'G�.ar� _G _/�,s�/ !S/i�.._/F/�E._E/^`� /�C.N _/C9CiN�.— TX/lrS� _/N_f7 __ _ _. _ _ _..�_/��tii�t/?/�_Or,.Jyt_CmR.�ri�-_FZ�-9S�//I��7aY-S8._t1...c�%:PGe.w–J. �_ �/`K. .r9��l _ Tf<AT /Lc.–��Ac� �C/y - /Y��S__ G✓n/C�4/�. �,'4<P_i.ey-71/c,_!i�7_.--_ . /lrq�–Jb Ce/ //.:.-t_7�l�r/�e,_��u.,Txe—Oc Ne?_�9.�A 77/.�r it e�.oS— -- �-� -- =T—./?��L.">i7�xT�G Ne�olie�''\\G�o,c�.._rTnrio,�.F„"^^_�7Lc_. /'iwN�_5��v_�T [.�95_.o-Cc.J�_u.C�,T�_�J�,�.>JT�'�—_��S'»T_�a� _ _ --- _ Y^-h__/'Y_9;�a�–Z7/cr_�-le_7d Cl r�Tt3ic_L.in/c%�i�,�i�T T/�U.�_a��?d_I_a_ _ �P �a /=v-ti.�L!LySd�irTc_%7��r l��,r�.rT..� _ �,� - " 7�( �n ` _ — ---- I _ r.. --� - 40 1M'PQyOnRTANT MESSAGE ) FOR ( DATE ;-/LI-II 1Yl ITIIME LLIz 55 y- P, M OF PHONE (� AREA CODE NUMBER EXTENSION O FAX ❑ MOEIII F- ....CODE NUMBER TIME TO CALL TELEPHONED I '�/ PLEASE CALL V I CAME TO SEE YOU WILL CALL AGAIN WANTS TO SEE YOU RUSH RETURNED YOUR CALL WILL FAX TO YOU I III MESSAGE zeaa� ` SIGNED I fTo" FORM 4 - Y��7 MARE 1400 U S9 N OTES ..t��cµ,r=c�3( / szeiq 6,)�QU Tlevsf 9e Cep Ax-rckJ `96oAe& �osenrcar�i , _ COfilSOA) A9-N,46cmEaJ7- i _ I ,� r -y"' u _ ,�� - .--�' �� ---�.. ��. J /...�-- � �,. 1, � , . Iw �J,,,_ �� ,, ,- �� i ----- 0'1/07/97 BOH MEMORANDUM J MGI.Chapter 270, Section 16 "Whoever places, throws, deposits...any trash. upon any kind of public ciblic land;' coastal waters'...or`ori:theproperty g y p of another;, shall- be . punished by a fine of not more than $3,000.00 for the first offense and not more than $10,000.00 for each subsequent offense..." This law applies to cases where the illegal dumping is occurring on public property Yor water, or on the property of another person. I' I, /State Sanitary Code: 410.602 f f "The owner of any parcel of land, vacant or otherwise, shall be responsible for maintaining such parcel of land in a clean and sanitary condition and free from garbage, rubbish or other refuse. Fines are up to$500.00 for each offense. i ✓Chapter 266. Section 146 "Whoever ...deposits solid waste in a commercial disposal container of another without the, consent, of,the. owner...shall be punished by a fine of not less than ' $100:00,nor more than $1000`.00 This would not involve.,Healfh Department personnel. Instead it is would be a private ?' 6ivl snit of the "dumpst6r'ownedoperator against another individual. (Trash Tickets for Violations of BOH Reaulations#6 &#7 These may be used for lesser offenses in conjunction with our form "trash" letter. If you decide to order a clean up , the order should include the Law or Code citation, the length of time within which the order must be completed, the penalty, and the .'aggrieved clause." Je�� r DJ- cwt? 6114) e� joy 2 J 71 : . �i9 :. •:^Via:Ay. - i a - C�FIDIL{�_ �'gimaerP CITY OF SALEM BOARD OF HEALTH Salem, Massachusetts 01970-3928 JOANNE SCOTT, MPH,RS,CHO NINE NORTH STREET HEALTH AGENT Tel:(978)741-1800 Fax:(978)740-9705 COMMONWEALTH OF MASSACHUSETTS PERMIT TO OPERATE A MOBILE FOOD SERVER In accordance with Regulations promulgated under authority of Chapter 94, Section 305A and Chapter III, Section 5 of the General Laws a Permit is hereby granted to: Name: Kevin Kefalas Name of Establishment : Classy Chassis Food Cart #4 Whose Place of Business is : 23 Osborne Street Peabody, MA Date : 05/26/99 To Operate a Mobile Food Server in Salem Restrictions : Fries & Fried Dough & Lemonade Permit #: 8-99M Frozen Desserts/ Ice Cream: PERMIT EXPIRES December 31, 1999 HEALTH AGENT CITY OF SALEM BOARD OF HEALTH Salem, Massachusetts 01970-3928�J/�►��`� JOANNE SCOTT, MPH, RS,CHO4 NINE NORTH STREET HEALTH AGENT Tel: (978)741-1800 APPLICATION FOR A MOBILE FOOD SERVICE PERMIT Fax: (978)740-9705 // y Fee $40 payable to The City of Salem, No Cash '/ Name of Applicant Am') kAla l4 -5 Telephone# 531- 0Z3 f" Address Z3 nJrgs�wrAe 5t Certified Food Manager YQv1, FFG 1a 5 ertificate # A-77- ,?V& /A Name of Business C/Q ss%s �e�Lo.� e�/cTelephone# 53/- 023 Address S-Y ,� �-- - Manufacture Frozen Desserts? Yes No Type of Vehicle 197Sr Registration# Location of Operation S9/t m m doll Name & Address of Licensed Food Service Establishment Serving as Base of Operation ef o s fc o , 5 Telephone# Location of Toilet & Han dwashing Facilities Menu )5:�-,'ti549 O/e a/ 1�>o6-1q/-1 Type of refrigeration: Ice Dry Ice Ga - Other Method for Cooking and/or Hot Holding: as ( Other Method for Sanitizing: Chemical Hot Water (170 F) I have read and agree to abide by The Salem Board of Health Regulations regarding "Mobile Food Units & Pushcarts" and will notify the Salem Board of Health of any changes in this application. Pursuant to MGL C62C,S49A, I certify under the penalties of perjury that I, to my best knowledge and belief, have filed all State tax returns and paid all State taxes required under law. �!� Jj o3 2- 9�- 7�2 3 Signature ~"/[ Social Security# or Federal tD# Date / ---------------------------------------------------------------------------------------------------------------------- Revised 10/20/98 Permit d Check#B Date Z!'010 6 02 MF'�'yh .� ip' �Y��r - ��• �4� -.�"' �'£.. .. ' S ( /.s1 _n_ 5. . �'.1Lv'iL' i.S .. w+°4.<' ��oniaT,1,� 9aai�,sr CITY OF SALEM BOARD OF HEALTH Salem, Massachusetts 01970-3928 JOANNE SCOTT,MPH,RS,CHO NINE NORTH STREET HEALTH AGENT Tel:(978)741-1800 Fax: (978)740-9705 COMMONWEALTH OF MASSACHUSETTS PERMIT TO OPERATE A MOBILE FOOD SERVER In accordance with Regulations promulgated under authority of Chapter 94, Section 305A and Chapter III, Section 5 of the General Laws a Permit is hereby granted to: Name: Kevin Kefalas Name of Establishment : Classy Chassis Cart #3 Whose Place of Business is : 23 Osborne Street Peabody MA Date: 05/26/99 To Operate a Mobile Food Server in Salem Restrictions : Permit #: 9-99M Frozen Desserts/ Ice Cream: PERMIT EXPIRES December 31, 1999 lqr-A� i HEALTH AGENT v��COND T 0 n CITY OF SALEM BOARD OF HEALTH Salem, Massachusetts 01970-3928 /� JOANNE SCOTT, MPH,RS,CHO "1 _q�o NINE NORTH STREET HEALTH AGENT 1 Tel-(978)741-1800 APPLICATION FOR A MOBILE FOOD SERVICE PERMIT Fax (978)740-9705 //�� Fee $40 payable to The City of Salem, No Cash ,C NameofApplicant ev71v 1�fq/a s Telephone# 67-?/-- 023 Address 23 05Aor,L--- 51- Certified fCertified Food Manager /'� �a 16- las Certificate # /o 77-FyO �o av3 2/ _02 3e/ Name of Business G�aSS,' G�gsSis Ger hone# S Address S� / Manufacture Frozen Desserts? Yes No Type of Vehicle /77�- c�ie- Gmc:fes Registration# Location of Operation A-e� Name & Address of Licensed Food Service Establishment Serving as Base of Operation Go 571(f o " s Telephone# Location of Toilet & Handwashing Facilities e/155r Menu -:r 17'eo7L2/- - If,-T4- -e� Type of refrigeration: Ice " Dry Ice Gas Other__ Method for Cooking and/or Hot Holding Gas Other Method for Sanitizing: Chemical Hot Water (170 F)__ I have read and agree to abide by The Salem Board of Health Regulations regarding "Mobile Food Units & Pushcarts" and will notify the Salem Board of Health of any changes in this application. Pursuant to MGL C62C,S49A, I certify under the penalties of perjury that I, to my best knowledge and belief, have filed all State tax returns and paid all State taxes required under law. / 074;7/0 �6-76Z3 Signature V Social Security# or Federal ID# Date ---------------------------------------------------------------l------------------- ---9- --------------------------- Revised. 10/20/98 Perimt 9 Check#g Date 6�' .5 — // . .5.-,..,,,,..-Y`t.rrMrr'^..I -�v.wn . .....T.+a:f�r��'...�. .d`.,,.•..,-.,ry,,,.aY ^-.v.h..+.......+, , ,vi .^rs '^s THE COMMONWEALTH OF MASSACHUSETTS City of Salem BOARD OF HEALTH FOOD ESTABLISHMENT INSPECTION REPORT Establishment Name � AQ i Date 'q1Tahy Time: In Out Address C/ q� a �a lire s %��S d S•'/S�, Telephone �. ��/ Type of Establishment: Purpose: Food Service Routine Owner's Name /' Retail Food Follow-up - Residential Kitchen Person in Charge i Mobile Unit ,y Complaint Temporary Food ServicerwJ Investigation Inspeetoes Name Catering L Other Based on an Inspection today,the Items checked below indicate the violated provisions of 105 CMR 590.000. Each item is followed by the applicable section of the Massachusetts regulation. Non-critical violations are marked under column"N"and critical violations are marked under column"C". Descriptions of each item appear on the back of this form. Each violation checked requires an explanation on the narrative page(s). This report serves as official notice of violated provisions and official notice to correct said violations. Food M C Sanitary Facilities N C 1. Food Supply .00229. Water Source 015 2. Food Containers .002 30. Sewage 016 31. Cross-Connections 017 Food Protection 32. Toilets/Handwashing 018 & .019 3. PHF Temperatures .004 33. Insects/Rodents .021 4. Facilities. Hot 8 Cold Storage .004 34, Plumbing 017 _ 5. PHF Re-service .006 35. Toilet Rooms 018 _ 6. Spoiled/Damaged Foods .003 _ 36. Handwashing Areas .019 - 7. Food Protected .003 37. Garbage/Refuse .020 _ S. Food Thermometers •004 38. Outside Disposal .020 9. Cross Contamination .005 _ 39. Outer Openings 021 - 10. PHFs thawed, cooked d cooled .005 _ 40. Pesticide/Rodenticide Application 021 - 11. Food Handling .005 - 12. Dispensing Utensils .006 - Physical Facilities - 41. Floors ' .022 - Personnel �1 42. Walls, Ceiling .022 _ 13. Employee Infections •008 43. Lighting .023 - 14. Employee Hygiene •009 44. Ventilation .024 - 15. Employee Clothing .010 45. Dressing Rooms .025 - Equipment i UtensilsOther 16. Equipment/Utensil Clean 8 Sanitized .013 46. Toxics .026 17. Food Contact Surfaces .013 47. Premises .027 - 18. Non-Food Contact Surfaces .013 48. Living Areas .027 - 19 Food Contact Surfaces Clean .013 49. Linen 027 _ 20. Non-Food Contact Surfaces Clean .013 50. Pets .027 _ 21. Wiping Cloths •013 51. Bulk Foods .031 _ 22. Dish/Warewashing Facilities .013 52 Salad Bars 032 23. Pre-Scraped, Soaked .013 24. Wash/Rinse Water .013 �No. of 13 Critical Items Violated _I 25. Thermometers/Test Kits .013 These items require immediate attention. 26 Equipment/Utensil Storage .014 - 27, Single Service Articles .014 Received by Inspected by 28 Single Service Re-Use .012 �- / v SMOKING LAW COMPLIANCEYES_NO_NA Reinspection of Critical Items FORM 734A t1&W HORRS s WARREN TM CHOKE SAVER COMPLIANCEYESNO_NA Reinspection of Noncritical Items '1 � .-.n ; ..w r +. T• "" 'a `o..�.w+ ..!"r�tW, .r4p..ry ,r.....'-„r f., . . �?�tT r ❑•t.r y , r.,. -J ' THE COMMONWEALTH OF MASSACHUSETTS City of Salem J Establishment Name Date Address / Page 0 of .2 V2eaCA l4C /n/eST YCA/fatLe Item No. In the space below describe all violations checked on front page. Ain) inspection of this establishment was conducted in accordance with the State Sanitary Code for Food Establishments,Chaoter X, 105 CMR 590.000.The following violations were observed /'lNP /Girw e� ria ar ti Up/'T /,/ia S ./LFrN i... z err TG� 77-& O77ZGr /J �e9 ri GvL l 79 `//LGvi �K,-. S,aec-,�".c r• o.� ��co�a,.-r�,ai ..., SAr..:ri z_�� 771 o tii d / / TCr ovLS C/lrck l�•o< r3�..,. ...-l�.I .e... a Ceu Ts &,?U 00 Dom„�i a.,.�r�✓,.rte/ .�//T t v Discussion with Management I have read this report, have had the opportunity to ask questions and agree to correct all violations before the next inspection,to observe all conditions as described,and to comply with all mandates of Chapter X. I understand that noncompliance may result in daily fines of twenty-five dollars. cONU1T a m CITY OF SALEM BOARD OF HEALTH Salem, Massachusetts 01970-3928 JOANNE SCOTT,MPH,RS,CHO NINE NORTH STREET HEALTH AGENT _ Tel:(978)741-1800 Fax:(978)740-9705 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: Owners Name: Paula Kefalas Name of Establishment : Classy Chassis Cart #2 Address of Establishment : 23 Osborne Street Type of Establishment : Mobile Food Application ,Date: 04/15/99 Restrictions: One -(1) raw food item prepared per surface. Permit for Establishment 4-99M Frozen Desserts/Ice Cream Permit for the Sale of Tobacco Products These Permits Expire December 31, 1999 This permit is not transferable and must be reissued upon change of ownership or location. In accordance with the State Sanitary Code, all plans of renovations, improvements, equipment changes must be approved by the Health Department. l+/ HEALTH AGENT CITY OF SALEM BOARD OF HEALTH Salem, Massachusetts 01970-3928 JOANNE SCOTT,MPH,RS,CHO �_ r t NINE NORTH STREET HEALTH AGENT Tel (978)741-1800 APPLICATION FOR A MOBILE FOOD SERVICE PERMIT Fax:(978)740-9705 Fee,$40 payable to The City of Salem, No Cash NameofApplicant 10' nA ,. �P 4-lr�, Telephone#Q Address_- _t�bnc�� fl'1 C) N q.GO Certified Food Manager A"In& �G. C ertificate # 509 - e VU -Fo�9z c`,t, Name of Business � S elephoneiq�- 6J I y Address f�3 C Cal 16C CK' C�,' pr 1.<, M Manufacture FrozenDesserts? Yes NoP4 _.�r �RvcK �� 1cc64 Type of Vehicles 9 Me & r b �� ((��Registration# q`/ Location of Operation– or-)}�--��--.-=��.�–�1 �}l�} i� or-) Name & Address of Licensed Food Service Establishment Serving as Base of Operation r( ( (' c�'c Telephone# Location of Toilet & Harrl�dwashing Facilities C~ C - To C-e n -e I 1(- ) NL }iia 6o\ Q, \)o.,(- Menu )v.,rMenuy_�ca C�tOCt , �rA, . CfaC� e/ )i e 'iC)�cSc`a— lL'Ts _ l + rfi}�S, Type of refrigeration: lce�z Dry Ice Ga Other Method for Cooking and/or Hot Holding, Gas Other_ Method for Sanitizing: Chemical V Hot Water (170 F)_,_ I have read and agree to abide by The Salem Board of Health Regulations regarding "Mobile Food Units & Pushcarts" and will notify the Salem Board of Health of any changes-in this application: Pursuant to MGL C62C,S49A, I certify under the penalties of perjury that I, to my best knowle and belief, have filed all State tax returns and paid all State taxes required and aw. Signature Social Security# or Federal ID# Date ------------------------------------------------------------------------------- – ----- ------------------------- Revised 10120/98 Permit 9 Checks k Date—/ 1��3 THE COMMONWEALTH OF MASSACHUSETTS City of Salem 1 Establishment Namev�,fl �/��.S�.S/.� ��Q��'ToZ Date Address ��gp C Jj� Page _of Item No. In the s ppce Olow describe all violations checked on front page. A(n) inspection of this establishment was conducted in accordance with the State Sanitary Code for Food Est lidb shments,Chanter X, 105 CMR 590.000.The followinq violations were observed: Z5 '15�4140.0 his �J e/JY//,//_J/a ///�I//rI /"I/✓✓ f� f I'AK e �4/ � 5 -�i1 �:� ira�J�iary �% ice• ONO/16. 5�iir.� Discussion with Management \ 4 ^_. t r Ar. ( I have read this report, have had the opportunity to ask questions and agree correct all violations before the next inspection,to observe all conditions as described,and com ly h all mandates of/chapter X. I understand that noncompliance /may result in daaily)Ines of twenty-five dollars. J[j ley. l y 'V (y /moi /Aye.✓�lJ�/.[��" firm rfi/G� �rr✓i��/,lP_ ��.� min �� O�rols�sa � . a CITY OF SALEM BOARD OF HEALTH Salem, Massachusetts 01970-3928 JOANNE SCOTT,MPH,RS,CHO NINE NORTH STREET HEALTH AGENT Tel.(978)741-1800 Fax:(978)740-9705 COMMONWEALTH OF MASSACHUSETTS PERMIT TO OPERATE A FOOD ESTABLISHMENT In accordance with regulations promulgated under authority of Chapter 94 , Section 305A and Chapter III, Section 5 of the General Laws, to operate a Food Establishment in the City of Salem is hereby granted to: Owner' s Name: Paula Kefalas Name of Establishment: Classy Chassis Cart #1 #597-095 Mass Address of Establishment : 23 Osborne Street Type of Establishment : Mobile Food Application Date: 04/15/99 Restrictions: Hot dogs, kielbasa, tonic, slush Sausage or chicken One raw item Permit for Establishment 5-99M Frozen Desserts/Ice Cream Permit for the Sale of Tobacco Products These Permits Expire December 31, 1999 This permit is not transferable and must be reissued upon change of ownership or location. In accordance with the State Sanitary Code, all plans of renovations, improvements, equipment changes must be approved by the Health Department. HEALTH AGENT coworT,� n ��7MINB CITY OF SALEM BOARD OF HEALTH Salem, Massachusetts 01970-3928 JOANNE SCOTT, MPH, RS, CHO NINE NORTH STREET HEALTH AGENT Tel:(978)741-1800 APPLICATION FOR A MOBILE FOOD SERVICE PERMIT Fax. (978)740-9705 jFe 40 payable to The City of Salem, No Cash Name of Applicant (;Liv, C, t'1G. Gee elephone# 8 1 Address t'!�LS Cnrrne c' A , (oc) Certified Food Manager na c.Jr. K, he o S . Certificate # Ceti SG�S- a,A2, �z— Name of Business ( �a SC�� Cine,sS l C f Telephone#_g�:�t: U�3 Y Address-ijgu (3( Cne s I a L )r� ell o C) i o, e, c) Manufacture Frozen Desserts? Yes No 197E --Rvct I�lafc Type of VehicIC Imo( KA)CIRM(uskC Registration#_��CZ Location of Operationyp (y f fsj L, �a�� U ec /c')�S bL) �- he Ct J U -P SCLi -Pr,- , Name & Address of Licensed Food Service Establishment Serving as Base of Operation 0,,s C C31 Telephone# ) Location of Toilet & Handwashing Fa III tiesQ_C `Tn d i / U L�zrt� =tr ��w /�d�ri l>`vY �/ ��v�r /oaf Ch 9nMePze h r('es� ,� tcc�adi a Type of refrigeration: Ice V Dry Irce Gas Other Method for Cooking and/or Hot Holding: as Other Method for Sanitizing: Chemical Hot Water (170 F) I have read and agree to abide by The Salem Board of Health Regulations regarding "Mobile Food Units & Pushcarts" and will notify the Salem Board of Health of any changes in this application. Pur sua to MGL C62C,S49A, I certify under the penalties of perjury that I, to my best kno edge and belief, have filed all State tax returns and paid all State taxes required un er law / J Signature Social Security# or Federal ID# Date ---------------------------------------------------------------------------------------------------------------------- Revised 10/20/98 Permit H CheckH&Date ! g 9 Zh& 19 y r if THE COMMONWEALTH OF MASSACHUSETTS City of Salem Establishment Name j� �/ gr;{�js �Dp� --#' .00/ Date Address .� xalo� < /� / /- /w Page of �"" !Ji 1�e;7s Item No. In the s qce Pelow describe all violations checked on front page. Ain) ''`,,4z inspection of this establishment was conducted in accordance with the State Sanitary Code for Food E blishst`a ments,Chapter X, 105 CMR 590.000.The followina violations were observed: Ave 01 06:;w ell _/j!_ .//l✓�i�/l�_/1 ,��4 �//_ //7../_J_lle�/9 f r.'��//�� hiO //7s��c�✓ iii. �s�.s�v-ith �v� //�SDNt /�J�. A:,& 4eor".�?al/ �'.yam !e "/' Discussion with Management -) a a 1! c c!!!� G I have read this report, have had the opportunity to ask questions and agr "to cor t all violations before the next inspection,to observe all conditions as described,and to c mply wit II mandates of Chapter X. I understand that noncompliance may result in daily fines of twenty-five dollars. 1 p/� /j� A;A 0/z y /7`i�P �'uruy%P/Y/�////�P_ INTERNATIONAL 11! FOOD SAFETY COUNCIL°` :5o Soar Waamr nave,Wft yao•chiaw,IL 60606 LBoo.156.om•Fa 3m715.0" ............................................................................................................ PAULA KEFALAS kms, IANumbm cermcau1072846 \ ate Q3l18198 Coundl EWraUon Date: 3118103trquhWf FMP l NOTES i NOTES 1 j ( _IMPORTANT MESSAGE ) ` FOP' YV-, } L/ u A.M. OATF T 3 9 7 TIME 0 P.M. M t OF ��JJ PHONE 5 ,31 — C) 023 / AREA CODE NUMBE EX ENSICN O FAX ❑ MOBII F AREA CODE NUMBER TIME TO CALL TELEPHONED PLEASE CALL CAME TO SEE YOU WILL CALL AGAIN WANTS TO SEE YOU RUSH RETURNED YOUR CALL WILL FAXTO YOU MESSAGE &4 Q r SIGNED MA is FORM 4009 V��7 MARE IN U S A � 1 NOTES N AIR A;, A;•��X V, x 2- Z 3 - LY11 7 yl CITY,OF SALEM BOARD OF ALT "''Qeft.01970-,39 Saler�',Massai 12 -Ap JOANNE SCOTT,MPH,RS.CHO,- NINE NORTH STREET V- HEALTH AGENTdi(978)741-1800,"�, F ix: (978).740.9705 COMMONWEALTHgOF ;MASSACHUSETPS PERMIT ,TO'OP BILE F SERVER N, In accordance with Regulations promulgated under authority of Chapter I n 94, Section 305A' ,-id Chapter III,, Section 5 of the General Laws a Permit is hereby granted to: Name': Kevin' 'Kefalas .Name of Establishment : C assy Chassis Food Cart #4 . . Whose Place -of Business is: 13 Osborin"6 St'ree' t Peabody, MA Date: 05/21/98 , To Operate a Mobile Food .SerVer in = Salem' Restrictions : Fries&Fried Dou gh & Lemonade Permit # : 9-98M Frozen Desserts/ Ice Cream: PERMIT EXPIRES December 31, 1998 HEALTH AGENT 3 � � CITY OF SALEM BOARD OF HEALTH Salem, Massachusetts 01970-3928 JOANNE SCOTT, MPH,RS,CHO NINE NORTH STREET Tel:( 00 Fax'(978 HEALTH AGENT (978 74)7400-9-9 705 APPLICATION FOR A MOBILE q ,.5Y# -- FOOD SERVICE PERMIT d NameofApplicant �viA/ b-4710-5 Telephone/# 53/ _02-3 Address Z3 05 o i/^O— `571• �L' b d ✓`J MR ' Name of Businessc/a<4,� Terlephone# l -5,_ ,o P_ Address Manufacture Frozen Desserts? Yes No Type of Vehicle Registration# Location of Operation (howN T,v ✓ -� Name & Address of Licensed Food Service Establishment Serving as Base of Operation Telephone# Location of Toilet & Hand Washing Facilities Menu f l it 5r.en' Do��/, — fres` Irl /P.rzo�a�G Type of refrigeration: Ice � Dry Ice Gas Other l Method for Cooking and/or Hot Holding: Gas Other Method for Sanitizing: Chemical Hot Water(170 F) I have read and agree to abide by The Salem Board of Health Regulations regarding "Mobile Food Units & Pushcarts" and will notify the Health Department of any changes in this application. 6-- Z/–g? Signature Date Pursuant to MGL C62C,S49A, I certify under the penalties of perjury that 1, to my best knowledge and belief, have filed all State tax returns and paid all State taxes required under law. Social Security# or Federal ID# Signature Date April 1998 A 4 • ' r� THE COMMONWEALTH OF MASSACHUSETTS City of Salem Establishment Name &6ssy `�, ass/s eadj- y Date S a/- 9•$ Address !' z,?77us ec m P•fa44- Page of A/fV/A/ /gipF/PLdS -/,V &YI&In ("T"i, t Item No. In the space below describe all violations checked on front page. / A(n) /.�2P U M/AIG/e// inspection of this establishment was conducted in accordance with the State Sanitary Code for Food Establishments,Chanter X, 105 CMR 590.000.The following violations were observed: A L,P !ln7'&YDf,C/ / Gus/w9 7Z67 s r0/a s Fee cw ,e/rye- �Pv c/ aF Alit�_f rn A. /`JiJG C�fCS •� .Se. .S/.A,/.CG PCO —/A/S'/t�2 /OLT A44_�7, -J 7_0 APWs V tom, raRr. //ii�L f'em/,Y/oAnA O f7f7� P/l�1/YYl( d i! . S o`2-- 47 vnr.ee /2_ 457 Lriast �,r k, r ✓ % .Vr.H. mer ru i7 r� ✓ Discussion with Management I have read this report, have had the opportunity to ask questions and agree to correct all violations before the next inspection,to observe all conditions as described,and to comply with all mandates of Chapter X. I understand that noncompliance may result in daily fines of twenty-five dollars. Vit. g� CITY OF SALEM:BOARD OF HEALTH Salem, Massachusetts 01970-3928 JOANNE SCOT-r,MPH,RS,CHO NINE NORTH STREET HEALTH AGENT Ta:(978)741-1800 Fax:(9.78)740-9705 COMMONWEALTH OF MASSACHUSETTS PERMIT TO OPERATE A MOBILE FOOD SERVER In accordance with Regulations promulgated under authority of Chapter 94, Section 305A and Chapter III, Section 5 of the General Laws a Permit is hereby granted to: Name: Paula Kefalas Name of Establishment : Classy Chassis Food Cart #5 - 438-054 Whose Place of Business is : 23 Osborne Street Peabody MA Date: 05/21/98 To Operate a Mobile Food Server in Salem Restrictions : Hot dogs, sausage, cold drinks, chips Permit # : 10-98M Frozen Desserts/ Ice Cream: PERMIT EXPIRES December 31, 1998 HEALTH AGENT 3 - � a CITY OF SALEM BOARD OF HEALTH Salem, Massachusetts 01970-3928 JOANNE SCOTT, MPH, RS,CHO NINE NORTH STREET HEALTH AGENT Tel:(978)741-1800 Fax:(978)7Q-9705 APPLICATION FOR A MOBILE FOOD SERVICE PERMIT Name of Applicant jz2vrN K t /G 5 Telephone# 531- 02-?/ Address 23 0 54or•r�-e— 5-1 Name of Business G la ss� r" rat.r 4&-/ CvA�___Telephonc#_ - Address Manufacture Frozen Desserts? Yes_ _ No_ _ Type of Vehicle Registration# Location of Operation GoA) Nance & Address of licensed Food Service Establishment Serving as Base of Operation Telephone# Location of Toilet &!tHand Washing Facilities Mentir-/aaGi5 - Ssa_,.aSa. sS cella A,F-s -- GhJ�iS Type of refrigeration: Ice (v'� Dry Ice _ Gas __ Other_ Method for Cooking and/or Hot Holding: Gas Other__ Method for Sanitizing: Chemical_ _ Hot Water(170 F)_ I have read and agree to abide by The Salem Board of Health Regulations regarding "Mobile Food Units & Pushcarts" and will notify the Health Department of any changes in this application. _ Signature Date Pursuant to MGL, C62C,S49A, I certify under the penalties of perjury that I, to my best knowledge and belief. have filed all State tax returns and paid all State taxes required under law. e,5) 4116— -76 ,7 3 Social Security# or Federal ID# Signature f/� Date April 1998 THE COMMONWEALTH OF MASSACHUSETTS City of Salem Establishment Name Cosy Cf�dSS/S � Date ,s ar 98 Address (J v /� /�PU/N /1'P�4CdS r4V'7 Page ,of � Item No. In the space below describe all violations checked on front page. A(n) inspection of this establishment was conducted in accordance with the State Sanitary Code for Food Establishments,Chapter X, 105 CMR 590.000.The followma violations were observed' s"'Oulova �f /14 5 4 .,P-Yw aou4'0),W, C 11.12,4 cia ctp ifR° _ Y2o r(7Ft:'O,S1a q COGt.� DRlAlle f a,ov,w 17 arl2 Yl.S� kyou S /n/ 12AIZLI &7L rIi �p C oLlK�or� , n/ tSe hrrrryt� )1.4-n fvv,p -7V ,6e Or/ rS1 7zz G/ivi Y7 > GC ew tf 7)/Ii L 1. mrAi 10 Gfiiaa ('d7zlin,vnty. d�O,tr°cf 7'7DNS S`/a a�98'` / 7— � /rrr"i n/e n/i(_AFT 77d77-s 7t CDS y i tVOU i rn�LeieS -6 6'e aas oi//0"1-"77At) �ei.Ci. V /fir 7'-" ICP to r3>° .CY-np��/ /n/,CA41/72P11 ('00 � r - Discussion with Management I have read this report, have had the opportunity to ask questions and agree to correct all violations before the next inspection,to observe all conditions as described,and to comply with all mandates of Chapter X. I understand that noncompliance may result in daily fines of twenty-five dollars. ` ■ f ALEXANDER, FEMINO I& LAURANZANO ATTORNEYS AT LAW ONE SCHOOL STREET LEONARD F. FEMINO BEVERLY, MASSACHUSETTS 01915 THOMAS J. ALEXANDER TELEPHONE (978) 921-1999 MICHAEL C. LAURANZANO FAX (978) 921-4553 KIMBERLEY LORD DRISCOLL June 3, 1998 Ms. Deborah Burkinshaw City Clerk City of Salem 93 Washington Street Salem, MA 01970 RE: Paula Kefalas v. The Salem Licensing Board Civil Action No. 95-838B and 97-345A Dear Ms. Burkinshaw: As you know, during the last Council Meeting the Salem City Council had approved the Agreement for Judgment in the above matter. I have enclosed herewith a Release of All Demands for the Council and various board members to sign, which include the Mayor, Licensing Board, Salem City Council President, Board of Health President and Salem Redevelopment Authority. Would you kindly contact those individuals and have them come into the office to execute the release. If you have any questions,please call this office at your earliest convenience. Thank you for your assistance in this regard. Very Y Yom= onard F. Femino LFF/Imp Enclosure 11 loin MUTUAL RELEASE Now come the undersigned and, for good and valuable consideration paid, including, but not limited to, the obligations contained in the agreement for judgment filed in Essex Superior Court Civil Actions Nos. 95-838B and 97-345A (consolidated) , wherein Paula Kefalas is Plaintiff (hereafter referred to as Plaintiff) and Salem Licensing Board, John Boris, James Fleming, Samuel Papalardo, John Casey, Neil Harrington, Salem City Council, George A. Ahmed, Mark E. Blair, William Russell Burns, Jr. , John J. Donahue, David B. Gaudreault, Kevin R. Harvey, Sarah M. Hayes, George P. McCabe, Leonard F. O'Leary, Jane Stirgwolt, Stanley J. Usovicz, Jr. , Regina R. Flynn, Thomas H. Furey, William A. Kelley, Scott J. McLaughlin, Peter L. Paskowski, Salem Board of Health, Joanne Scott, Salem Redevelopment Authority, Joan Boudreau, Barbara Cleary, Robert Curran, William Guenther, Paul LIHeureux, William E. Luster, Donna Vinson, Craig Wheeler and City of Salem are Defendants (hereafter referred to as Defendants) , a copy of which agreement for judgment is attached hereto and marked "A, " enter into a mutual release as follows : 1 . The Plaintiff by these presents does for herself, her heirs, executors, administrators, successors, and assigns, remise and release and forever discharge the Defendants, and their heirs, executors, administrators, successors and assigns, of and from all and any manner of action and actions, cause and causes of action, suits, debts, dues, sums of money, accounts reckonings, bonds, bills, specialties, covenants, contracts, controversies, agreements, promises, variances, trespasses, damages, judgments, executions, claims and demands whatsoever, in law, in admiralty, or in equity, which against the said Defendants she ever had, now has or which her heirs, executors, or administrators, hereafter can, shall or may have for, upon or II by reason of any matter, cause or thing whatsoever from the beginning of the world to the date of these presents and more specifically those claims constituting the subject matter of the actions referenced in the agreement for judgment . 2 . The Defendants, by these presents do for themselves, their heirs, executors, administrators, successors and assigns, remise and release and forever discharge the Plaintiff, and her heirs, executors, administrators, successors and assigns, of and from all and any manner of action and actions, cause and causes of action, suits, debts, dues, sums of money, account reckonings, bonds, bills, specialties, covenants, contracts, controversies, agreements, promises, variances, trespasses, damages, judgments, executions, claims and demands whatsoever, in law, in admiralty, or in equity, which against the said Plaintiff they ever had, now have or which their heirs, executors or administrators hereafter can, shall or may have for, upon or by reason of any matter, cause or thing whatsoever from the beginning of the world to the date of these presents and more specifically arising out of those claims constituting the subject matter of the actions referenced in the agreement for judgment. EL--- Executed as a sealed instrument in one or more counterparts this day of 1998 . Witness Paula Kefalas City of Salem By its Mayor Witness Salem Licensing Board By Witness Salem City Council B4! VWitnessl Salem Board of Health By Witness Salem Redevelopment Authority eA 0" R'tft'ness By T . . ...... CITY OF SALEM BOARD OF HEALTH Salem, Massachusetts 01970-3928 JOANNE SCOTT,MPH,RS,CHO NINE NORTH STREET HEALTH AGENT Tel:(978)741-1800 Fax:(978)740-9705 COMMONWEALTH OF MASSACHUSETTS PERMIT TO OPERATE A MOBILE FOOD SERVER In accordance with Regulations promulgated under authority of Chapter 94, Section 305A and Chapter III, Section 5 of the General Laws a Permit is hereby granted to: Name: Paula Kefalas Name of Establishment : Classy Chassis Cart #1 #597-095 Mass Whose Place of Business is : 23 Osborne Street Peabody MA Date: 04/09/98 To Operate a mobile Food Server in Salem Restrictions : Hot dogs, kielbasa, tonic, slush Sausage or chicken one raw item Permit # : 5-98M PERMIT EXPIRES December 31, 1998 40-0�1�6� HEALTH AGENT 'is-sl-. �eF"r:.:1F'.-- _ —,w�... -+-•..�-,. - - c X31 i 1 CITY OF SALEM BOARD OF HEALTH Salem,Massachusetts 01970-3928 JOANNE SCOTT,MPH,RS,_CHO NINE NORTH STREET HEALTH AGENT Tel:(50B)741-1800 Tax:(508)740-9705 APPLICATION FOR A MOBILE FOOD SERVICE PERMIT Name of Applicant w I� Telephone# AW S31-02-3y Address -e- Name of Business C/oss/ cL/a ss.�r �.✓. Telephone# 5 R h Address Type of Mobile Food Service Permit / Basic Modified TypeofVehicle -�9 &wd "'Registration# Location of Operation ' Name&Address of Licensed Food Service Establishment Serving as Base of Operation Telephone# Location of Toilet&Hand Waftg Facilities• !/'sfc. cep/fc Type of refrigeration: Ice i/ DryIceGas Other Method for Cooling and/or Hot Holding- Gas t--� Other Method for Sanitizing- '. Chemical �/�Hot Water(170 F) I have read and agree to abide by The Salem Board of Health Regulations regarding "Mobile Food Units&Pushcarts" and will notify the Health Department of any changes in this application. Signature Date Pursuant to MGL C62C,S49A, I certify under the penalties of perjury that I,to my best knowledge and belief,have filed all State tax returns and paid all State taxes required under law. 032 - Y,�- 76 2- ��r;/ 9 -199,? Social Security#or Federal ID# Signature Date May 1995 3 F 'dtrr� CITY OF SALEM BOARD OF HEALTH Salem, Massachusetts 01970-3928 JOANNE SCOTT, MPH,RS,CHO NINE NORTH STREET HEALTH AGENT Tel (508)741-1800 Fax (508)740-9705 April 9, 1998 Deborah D'Alessandro 35 Pleasant Street Salem, MA. 01970 Dear Ms. D'Alessandro Building Inspector Kevin Goggin together with the Health Department inspectors will be conducting an inspection at 39 Prince Street on Thursday, April 16, 1998 at 10:00 A.M. In order to complete the investigation to determjne the cause of leaking into the first floor apartment, we will require access to the second floor apartment as well. Enclosed are release forms to be signed by your tenants allowing access if they are not present Please forward signed release forms to this department as soon as possible Thank you again for your cooperation. For the Board of Health . Reply to: 6anne Scott Virginia Moustakis Health Agent Senior Sanitarian cc- Building Inspector, Kevin Goggin Plumbing/Gas Inspector Councillor Peter Paskowskl JS/sjk c-vmd'a !� THE COMMONWEALTH OF MASSACHUSETTS City of Salem Establishment Name Date Address Page L of KFI// n/ l7 t �gLA.S Item No. In the space below describe all violations checked on front page. A(n) ,0&/j rn,/v Q e inspection of this establishment was conducted in accordance with the State Sanitary Code for Food Establishments,Chapter X, 105 CMR 590.000.The followinq violations were observed: ' iJa . r frn D,- _"jsjr,61c P_ ? rI .C'd.( Iry for u! /4y7' r1aa c .a . AA (pd gp4t n 6g23 ,t' v / 4 7rt7�lr", �i hr f/U,C 14 �p /na,n.-iryr A/ o,Pe)dur-Y r_,r'mC 04� /q,-)J�G,R �*k • G. rye �/a O/C/ • i CL S" Ys. t t b r i/< JJ n�l•a/ro �r h ,c>,urY7.rn '1•.,, � 7/r.1 ,f c. � c S., rny��rr rDro �n a,o� ., /• .YJLl� GGr b•�•r.a /�a,bvo �J'»-r.I,Oi.< r��r � n 'I;CCp- �G..IVr/.�i.vo Loo {J.FVI�bIJ.Pd �v/P�/a7r7n Pe,P'1'" - 7O,tf�' /n/ A&A�wt o� ,//,(r-M.Pc / lln..*Va' M) 7- Cr nlA2.r /a I4, 07 Le//Lt. rA7Nmemr-e 10, •f6i/bu r AYiiN,ll /JAt.(t�o� ��Ari[CPr� r-rlO/7 C /Y J�i�+,ed0 (iF r�r,,r rspr 7a 13a . Cn ->,g�c 0� / hPPd7i~. - �P,.�,Jmr ��s,c tma.r_ 'r/w-s7- o/.0 h'7 7,-c Tr7 A 40/i.PrXeC'- A'P �l ///r12.l�( 1�.< c1J. �Gr.H,.T�s.o.,rw..lf° Discussion with Management j a,C. I have read this report, have had the opportunity to ask questions and agree to correct all violations before the next inspection,to observe •4 all conditions as described,and to comply with all mandates of Chapter-X. I understand that noncompliance may result in daily fines of twenty-five dollars. �t • J CITY OF SALEM BOARD OF HEALTH Salem, Massachusetts 01970-3928, JOANNE SCOTT,MPH,RS,CHO NINE NORTH STREET HEALTH AGENT Tel:(508)741-1800 Fax:(508)740-9705 COMMONWEALTH OF MASSACHUSETTS PERMIT TO OPERATE A FOOD ESTABLISHMENT ' In accordance with regulations promulgated under authority of Chapter 94, Section 305A and Chapter III, Section 5 of the General Laws, to operate a Food Establishment in the City of Salem is hereby granted to: Owner's Name: Paula . Kefalas Name of Establishment : Classy Chassis Cart #1 #597-095 Mass Address of Establishment :• 23 Osborne Street Type of Establishment: Mobile Food Application Date: 04j10/97 \ Restrictions :'(Hot dogs, kielbasa ltonic, slush Sausage or chicken One raw item cQ . Permit for Establishment 7-97M - Frozen Desserts/.Ice Cream Permit for the -Sale of Tobacco Products These Permits Expire December 31, 1997 This permit is not transferable. and must be reissued upon change of ownership- In accordance with the State Sanitary Code, all plans of renovations, improvements, equipment changes must be approved by the Health Department . ((// HEALTH AGENT CITY OF SALEM BOARD OF HEALTH Salem, Massachusetts 01970-3928 JOANNE SCOTT,MPH,RS,CHO NINE NORTH STREET HEALTH AGENT Tel:(508)741-1800 Fax:(508)740-9705 APPLICATION FOR A MOBILE FOOD SERVICE PERMIT -� _ g 7O - k�VOCC(1 S ` 1 -U NameofApplicantTelephone Address Name of Business (' �a SS,� ChG sS'`C T C'cJ,)S Telephone# (c� (-A rre Address m e Type of Mobile Food Service Permit / Basic Modified V Type of Vehicle 7q of, L�4 Registration# Location ofOperation__0pL O -' YkePP Name&Address of Licensed Food Service Establishment Serving as Base of Operation J C,UC ]_ CC) Tele hone# Location of Toilet&Hand Washing Facilities �P n c Type of refrigeration: Ice_Lz--Yry Ice Gass Other Method for Cooking and/or Hot Holding: as 1/ Other Method for Sanitizing: Chemical L,� Hot Water(170 F) I have read and agree to abide by The Salem Board of Health Regulations regarding "Mobile Food Units&Pushcarts" and will otify th Health Department of any changes in this application. /7 `7 / / Signature Date Pursuant to MGL C62C,S49A, I certify under the penalties of perjury that I, to my best knowledge and belief,have filed all S tax re�p ll State taxes required under law. . � � � Social Security# or Federal ID# Signature Date Ur) CAf 1�oq//encs Drmurj �cSC�cd � May 1995 �-/-,, /' 'l� l � CSM /Y7 U /1 ��po S i(Ss v )0 /Sy Fi F e lgCV617777 d s'19 7 LK/vs , il2A 'vle /°ec�CLP Uskl „y THE COMMONWEALTH OF MASSACHUSETTS City of Salem Establishment Name // Date V-/0` q7 Address Page / of i Ko tn'/ter r Item No. In the space below describe all violations checked on front page. A(n) PA P�e N0,;Pt� inspection of this establishment was conducted in accordance with the State Sanitary Code for Food Establishments,Chapter X, 705 CMR 590.000.The followinq violations were observed: .c pie u2 r°rnir ALvSt/ Pee -ri9e, P/� /le7-Udc�.c 108-r eoo/r,-e� K/,c-A as rez M22/r Si ,,s d ?f dd4 i n2 PA-./, G?Ar r/v, C .i,r��a,r r7P / { le4°- eylv ��2/U 7%ni ?71 A4 rr////A-PY /A/ 77/V Fn/L n a/N .fe¢sf l i /7P��YIIIt�?fv7x12 i� PL t IGP _7,6ur ry rl) 7-a of P t"ep ,- L nl at O"F '7/? '04'- ” ;41 7 / r77" ` �XAn -rn,E-2 rncr�l_ Fepsff 17A/L(/ — �2/ 14y ct.S1770T II � h // -1111Vxx'n nrrC�So� NOG � li P 7a/2f// S .,9r0 /P4E1 r � Tz c,nAw /aGf wee C P7- Zy &, 0,ont7i-7-,,�W a;t'Aa s e nP,&2vns 6n(/ Pr lkd I-Aelve [ ,�or7/l1 n,i�Fr�,n.cPiC. )✓iPA797 OSrl'0,� ` S� acrs AAA � reL /JA 1, nr 1mor./rP/,✓f kf7 — AAA' / AY 'Id- /A P A Gk / ma_AP'�p au. Food /tzhrc n6/- 0Pn.,,v/J flAvP n nn.,, S/f .y f u� r,4e)l PA r / Discussion with Management n c I have read this report,have had the opportunity to ask questions and agree to correct all violations before the next inspection,to observe all conditions as described,and to comply with all mandatesyf-1�hapt�e]r X. I underst I'd that noncompliance rnay�rresullt in daily fines of twenty-five dollars. r.P. .0 y,mL1a A/ I f i M1 O CITY OF SALEM BOARD OF HEALTH Salem, Massachusetts 01970-3928 JOANNE SCOTT,MPH,RS,CHO NINE NORTH STREET HEALTH AGENT Tel:(508)741-1800 Fax:(508)740-9705 COMMONWEALTH OF MASSACHUSETTS PERMIT TO OPERATE A MOBILE FOOD SERVER In accordance with Regulations promulgated under authority of Chapter 94, Section 305A and Chapter III, Section 5 of the General Laws a Permit is hereby granted to: Name: Paula Kefalas Name of Establishment : Classy Chassis Cart #2 Whose Place of Business is : 23 Osborne Street Peabody MA Date: 05/20/97 To Operate a Mobile Food Server in Salem Restrictions : One (1) raw food item prepared per surface. Permit # : 10-97M PERMIT EXPIRES December 31, 1997 HEALTH AGENT CITY OF SALEM BOARD OF HEALTH Salem, Massachusetts 01970-3928 JOANNE SCOTT,MPH,RS,CHO VINE NORTH STREET HEALTH AGENT Tel:(508)741-1800 Fax:(508)740.97Q5 ., APPLICATION FOR A MOBILE FOOD SERVICE PERMIT Name of Applicant )2vly /�f9 X9-S Telephone# Address 23 os/o v� rf �eady Name of Business s s/ jc �oN Te a 54m Address Type of Mobile Food Service Permit Basic Modified (/ Type of Vehicle 19;7-? e�"6 h7p s/{s o�,on c.Registration# Location of Operation5er s��n�/,/�� ✓ � G Name&Address of Licensed Food Service Establishment Serving as Base of Operation �sAo-s T—>`7,'//I 1 Telephone# Location of Toilet&Hand Washing Facilities X37O�i� ` /1%ff LG Type of refrigeration: Ice DryIce Gas_ Other Method for Cooking and/or Hot Holding: Cias Other Method for Sanitizing: Chemical Hot Water(170 F) I have read and agree to abide by The Salem Board of Health Regulations regardin-7 "Mobile Food Units& Pushcarts" and will notify the Health Department of any changes in this application. � Signature) Date Pursuant to MGL C62C,S49A, I certify under the penalties of perjury that I,to my best knowledge and belief, have filed all State tax returns and paid all State taxes required under law. Social Security# or Federal ID# Signature Date 032 7K Z3 May 1995 ��✓u/ 5/�sZZ/ v 3 CITY OF SALEM BOARD OF HEALTH Salem, Massachusetts 01970-3928 JOANNE SCOTT,MPH,RS,CHO NINE NORTH STREET HEALTH_ AGENT Tel:(508)741-1800 Fax:(508)740-9705 COMMONWEALTH OF MASSACHUSETTS PERMIT TO OPERATE A MOBILE FOOD SERVER In accordance with Regulations promulgated under authority of Chapter 94, Section 305A and Chapter III, Section 5 of the General Laws a Permit is hereby granted to: Name: Kevin Kefalas Name of Establishment : Classy Chassis Cart #3 Whose Place of Business is : 23 Osborne Street Peabody MA Date: 05/20/97 To Operate a Mobile Food Server in Salem Restrictions : Permit # : 11-97M PERMIT EXPIRES December 31, 1997 HEALTH AGENT t�: CITY OF SALEM BOARD OF HEALTH Salem, Massachusetts 01970-3928 JOANNE SCOTT,MPH,RS;CHO NINE NORTH STREET HEALTH AGENT Tel:(508)741-1800 Fax:(508)740-970 APPLICATION FOR A MOBILE FOOD SERVICE PERMIT Name of Applicant Tele p hone# -5-31-02-3 y Address 2-3' 05&.,Asf Oe4L,11i irr9SS Name of Business "Telepho # Sri Address �'v' I./X�1]1 Type of Mobile Food Service Permit Basic Modified Type of Vehicle /979 e,,6,,G,1,. 1r-oe-Registration# Location of Operation Sa/-,.n aA l Name&Address of Licensed Food Service Establishment Serving as Base of Operation C o s fr'_o 's 1>-op;/` Te eph/one# Location of Toilet& Hand WashinGas- Facilities Ao7 i,,, - g,Ta_ Z- Type of refrigeration: Ice / Dry Ice s- Other Method for Cooking and/or Hot Holding: Gas 1- Other Method for Sanitizing: Chemical t/ Hot Water(170 F) I have read and agree to abide by The Salem Board of Health Regulations regarding "Mobile Food Units&Pushcarts" and will notify the Health Department of any changes in this application. � °�/v j / _,,®— s- Zo- '� 7 Signature Date Pursuant to MGL C62C,S49A, I certify under the penalties of perjury that I,to my best knowledge and belief,have filed all State tax returns and paid all State taxes required under law. O Z - -76 Z."3 Social Security#or Federal ID# Signature y Date 3- Zo -7l'� May 1995,/---.,—,,,s Ti CL 1 PEYED .1 NOV 1 b 1997 HEALTH DEPT. �r>c nnp- ('p / 1 S ` 11 l-41 a - -- - — --- ` . v -� \ C�(� c C cel C�.c) a T V C).�� nc��_ .n cI -c � � � i �� I R 1 • -L 'i clt �a r-)ms)--C- �c� c�\�3P � rc) \/ e_ dl (c��_ C,�a &c,J L he �st.c vnn A pe-)(-) a C ) 1GG� C) To C-C, r L��► �r_ec_cz�=�Qo I�c��A-a-2�e�- c_(, <. : � <� � .. ��- ' - i r --iMIBB i CITY OF SALEM BOARD OF HEALTH Salem, Massachusetts 01970-3928 JOANNE SCOTT,MPH,RS,CHO NINE NORTH STREET HEALTH AGENT Tel.(508)741.1800 Fax:(508)740-9705 December 1, 1997 Paula Kefalis Classy Chassis Food Concession 23 Osborne Street Peabody, MA 01960 Dear Ms. Kefalis: In accordance with the Board of Health Food Manager Certification your food operation must employ at least one full time Certified Food Manager. The Board of Health considers requests for variances to its regulations. Therefore, as a courtesy to you, I have placed you on the next Board of Health agenda, December 9, 1997, 7:30 P.M., 9 North Street, 1st Floor Conference Room, so that you may request such a variance. Please let me know if this time is not convenient for you. I am forwarding a copy of your letter of November 11 , 1997, to the Board members. Sincerely yours, For the Board of Health, `Joanne Scott Health Agent r Y CITY OF SALEM BOARD OF HEALTH Salem, Massachusetts 01970-3928 JOANNE SCOTT,MPH,RS,CHO NINE NORTH STREET HEALTH AGENT Tel:(508)741-1800 Fax:(508)740-9705 December 1, 1997 Paula Kefaks Classy Chassis Food Concession 23 Osborne Street Peabody, MA 01960 Dear Ms. Kefalis: In accordance with the Board of Health Food Manager Certification your food operation must employ at least one full time Certified Food Manager. The Board of Health considers requests for variances to its regulations. Therefore, as a courtesy to you, I have placed you on the next Board of Health agenda, December 9, 1997, 7:30 P.M., 9 North Street, 1 st Floor Conference Room, so that you may request such a variance. Please let me know if this time is not convenient for you. 1 am forwarding a copy of your letter of November 11, 1997, to the Board members. Sincerely yours, For the Board/of Health, �O nne Scott Health Agent THE COMMONWEALTH OF MASSACHUSETTS City of Salem BOARD OF HEALTH FOOD ESTABLISHMENT INSPECTION REPORT ah� z 4 io,- a Establishment Name �'CASsr� 3*0? �� ``/��`�� Date V, s/ Time: In Out Address Slaln.� (n.��.. �✓ Igw/ Telephone s"7/ _ 0�7 3 S Type of Establishment: Purpose: Food Service l Routine Owner's Name Retail Food �Eii/ v �eLAIiJ S Residential Kitchen Follow up Person in Charge Mobile Unit Complaint Temporary Food Service Investigation Inspector's Name .T. Catenng Othe, Z' Based on an inspection today,the Items checked below indicate the violated provisions of 105 CMR 590.000. Each item is followed bythe applicable section of the Massachusetts regulation. Non-critical violations are marked under column••N"and critical violations are marked under column"C". Descriptions of each Item appear on the back of this form. Each violation ,checked requires an explanation on the narrative page(s). This report serves as official notice of violated provisions and official notice to correct said violations Food M C Sanitary Facilities N C 1. Food Supply .00229. Water Source 015 2. Food Containers .002 30. Sewage 016 31. Cross-Connections 017 Food Protection 32. Toilets/Handwashing 018 & 019 3. PHF Temperatures .004 33, Insects/Rodents 021 _ 4. Facilities Hot b Cold Storage .004 34, Plumbing 017 _ 5. PHF Re-service .006 35. Toilet Rooms 018 _ 6. Spoiled/Damaged Foods .003 _ 36. Handwashing Areas .019 - 7. Food Protected .003 _ 37. Garbage/Refuse 020 _ 8. Food Thermometers .004 38. Outside Disposal .020 9. Cross Contamination .005 _ 39. Outer Openings 021 - 10. PHFs thawed, cooked d cooled .005 _ 40. Pesticide/Rodenticide Application 021 - 11. Food Handling .005 - 12. Dispensing Utensils .006 - Physical Facilities - 41. Floors .022 - Personnel 42. Walls, Ceiling .022 - 13. Employee Infections .00843. Lighting .023 - 14. Employee Hygiene .009 44. Ventilation .024 - 15. Employee Clothing .010 45. Dressing Rooms 025 _ Equipment i Utensils Other 16. Equipment/Utensil Clean d Sanitized .013 46. Toxics 026 17. Food Contact Surfaces .013 47. Premises .027 18. Non-Food Contact Surfaces .013 48. Living Areas .027 19. Food Contact Surfaces Clean .013 49. Linen .027 20. Non-Food Contact Surfaces Clean .013 50. Pets .027 21. Wiping Cloths •013 51. Bulk Foods .031 22. Dish/Warewashing Facilities .013 52 Salad Bars .032 23 Pre-Scraped. Soaked .013 24 Wash/Rinse Water .013 No. of 13 Critical Items Violated _I 25 Thermometers/Test Kits .013 Il These items require immediate attention. 26. Equipment/Utensil Storage .014 27 Single Service Articles ,014 Received by s ected be 28 Single Service Re-Use .012 SMOKING LAW COMPLIANCE-YES-NO-NA Remspectiolnn of Critical Items FORM 734A (11&w) HOBBSE WARREN TN CHOKE SAVER COMPLIANCE_YES_NONA Reinspection of Noncritical Items ' THE COMMONWEALTH OF MASSACHUSETTS City of Salem Establishment Name Date CIASs,. rc-, i Address Page a of Item No. In the space below describe all violations checked on front page. A(n) Ilve,ri)„a. i%61l //r:rinspection of this establishment was conducted in accordance with the State Sanitary Code for Food Establishments,Chapter X, 105 CMR 590.000.The following violations were observed: a Discussion with Management I have read this report,have had the opportunity to ask questions and agree to correct all violations before the next inspection,to observe all conditions as described,and to comply with all mandates of Chapter X. I understand that noncompliance may result in daily fines of twenty-five dollars. ,�•°°"" w, SALEM FIRE DEPARTMENT Fee Paid $1 .00 r 9 FIRE PREVENTION BUREAU "°°,•M.�'` PERMIT Date: S , 11.5' ;l r TO INSTALL LIQUIFIED PETROLEUM GAS STORAGE TANKS In accordance with provisions of Chapter 148, G.L., and Regulations made under authority thereof. Name: (� -✓ �"--� IxQG.,, Name: _�_ �_-_-- (Owne� ccupant), _ (Installer) Address: /� .-eliez ,4�(. �a�-r.�_ Address: PERMIT Is hereby granted to above listed Installer,to install L.P.G.tanks on the premises of the above listed owner or occupant. Number of Tanks: Capacity of Each Tank, 10 Total Storagr+• Date Permit Issued: �/9/9-7 i Inspector. '�Cfi�i dfFfre li�� Form N90L(Rev. 1183) (OVER) SALEM FIRE DEPARTMENT Fee Paid $10.00 e FIRE PREVENTION BUREAU PERMIT Date: TO INSTALL LIQUIFIED PETROLEUM GAS STORAGE TANKS In accordance with provisions of Chapter 148, G.L., and Regulations made under authority thereof. Name: (r"/e_� Name: .061__ I (o%knetfor Occupant) ,,// (Installer) Address , � Ua Address: PERMIT is hereby granted to above listed Installer,to Install L.P.G.tanks on the premises of the above listed owner or occupant. Number of Tairi Capacity of Each Tank, J Total Storage: 2 J Date Permit Issued: Inspector. (21- /A7i (Chief of Fire Department) 6/7 7Z,i (OVER) VV Form k90L(Rev. 1/93) CITY OF SALEM BOARD OF HEALTH Salem, Massachusetts 01970.3928 JOANNE SCOTT, MPH,RS,CHO NINE NORTH STREET HEALTH AGENT Tel.(508)741-1800 Fax:(508)740-9705 Paula Kefalas June 5, 1997 23 Osborne Street Peabody, Ma. 01960 Dear Ms. Kefalas: On Tuesday June 3, 1997, we received a complaint about your business located by the Visitors Center. The complaint was that an employee of yours was eating and drinking while cooking and not washing hands-just wiping them on clothes. On Wednesday June 4, 1997, at approx. 11:20 am, I saw something equally disturbing. An employee at the Visitors Center location was biting his fingernails, wiped his hand on his leg then after a few moments began preparing food. Please help make your employees understand that currently the two major reasons why food becomes contaminated is from: 1) Time /Temperature problems (Food is not stored at proper temperatures or food is left out of proper temperature for too long of a period), and, 2) Human / utensil contamination (Food is touched by employees with unclean hands, or touched by unsanitary utensils). I cannot stress enough the importance of the food service worker to simply understand how easy it is to contaminate food because of hand to mouth, or hand to body contact and not washing hands before food preparation. A possible alternative is to have the food service worker take the food order,place disposable plastic gloves on their hands,prepare the food, give the food to the patron, then remove the gloves exchange money and start process over again for next patron. If you have any questions please give me a call at 741-1800. 1 thank you in advance for your cooperation in this matter. Sincerely, e� ilghan Sanitarian .t k 3 5i CITY OF SALEM BOARD OF HEALTH Salem, Massachusetts 01970-3928 JOANNE SCOTT, MPH,RS,CHO NINE NORTH STREET HEALTH AGENT Tel:(508)741-1800 Fax.(508)740-9705 COMMONWEALTH OF MASSACHUSETTS PERMIT TO OPERATE A MOBILE FOOD SERVER In accordance with Regulations promulgated under authority of Chapter 94, Section 305A and Chapter III, Section 5 of the General Laws a Permit, is hereby granted to: Name: Paula Kefalas Name of Establishment : Classy Chassis Cart #1 Whose Place of Business is : 23 Osborne Street Peabody MA Date : 04/20/96 To Operate a Mobile Food Server in Salem Restrictions : Sell sausage, hot dogs , kielbasa, tonic, slush. One ( 1) raw food item prepared per surface. Permit # : 10-96M PERMIT EXPIRES December 31, 1996 HEALTH AGENT t1tP CITY OF SALEM BOARD OF HEALTH Salem, Massachusetts 01970-3928 JOANNE SCOTT,MPH,RS,CHO NINE NORTH STREET HEALTH AGENT Tel:(508)741-1800 Fax(508)740-9705 APPLICATION FOR A MOBILE FOOD SERVICE PERMIT Name of Applicant Pr,,, C/. I �P 1 q �c,(C Telephone#(,5 53 Address a,", C)SVvX4—C k.a e,.-L Pvr. . aAr. . 0 104 C�d NameofBusiness ( , C J C1,ccsC c T--,�1 t22n Telephone#',,=,b F0 c,�k pa a Address Type of Mobile Food Service Permit Basic Modified Type of Vehicle `A-� n;- T'c\uc K Registration# G L/�o -- Location of Operation 0 -F h A e e Name&Address of Licensed Food Service Establishment Serving as Base of Operation R c h `� S� �S1, ri< S� �,rcvett mlelephone#� Location of Toilet&Hand Washing Facilities of 1, /jr,ujhr/rn 1-/o k, C, E e•L Type of refrigeration: Ice ✓ Dry Ice GasOther Method for Cooking and/or Hot Holding:/Gas Other PC �e- Method for Sanitizing: Chemical/ Hot Water(170F) I have read and agree to abide by The Salem Board of Health Regulations regarding "Mobile Food Units& Pushcarts" and will no e Health Department of any changes in this application. Signature Date Pursuant to MGL C62C,S49A, I certify under the penalties of perjury that I,to my best knowledge and belief, have filed all State tPX*turns and p 'd 1 Sate taxes required y der aw. Social Security#or Federal ID# Signature O Date May 1995 THE COMMONWEALTH OF MASSACHUSETTS CITY OF SALEM HEALTH DEPARTMENT - 9 NORTH STREET, SALEM, MASS. 01970 Establishment Name lw," C Gf KT / _ 0,-<5111 CX65,5/S Date y/7 Address 1t�-(//nJ /l IataS/ / 04a ytjpGAS Page 2of a Item No. In the space below describe all violations chocked on front page. A/v J vS oKY7/l ✓ /uD( 4-1 )UC7�Z/l ro R 1— /l,//./. /1/9/Al0 ('A_n041?7r AL!_ .11/CF1A1-_ktr FC )QS 1�NP/n//ori Sirr/,cn/sac Ni, �ontF Tn /aY�xrvr� rxm.bMJF iSO°� Avr 1)v&c V 6A /r70 f Pr/ /ry 77n,Fo/G hOA ✓ O,t/ T!Pf-CY)O f Pd IQtJ/ K/F>_,&/.Co 112 AC_ ('4, ,AIPW T//V L////_ ✓i1ZYI 7RY'.f�/I�/l9nJ•'�7c /A/ ,�F�7?IClP,f�Q'11d.✓ 7�ti/� /Tams Td Aic' kv pr z 77h-A/n/7?nP17_h72. rk _'/Pirehl Ttrh/7S F/?F�,/J aJfIJ1 54A,1n7F% TD.Rc W qA,� uhAa/1_c/9' 7;%S77,0 af//7EzSr ,sr--R/,n,c < Tiv,� .PhS/iLrc /r,�r/I.Fi/P/r.IJA//_u /r-n Ll1G , tHEtT / 3 / � a , m71Jeecu /Alli/f /r// tr ri sr.77 r12�, ralAY Z"nV °x S/M YNf7?P /S 467 o t?4-75 I TG m;O ,e /lF 0,JP,5yl741v 10111, A,A'".o T// c74,'C - A n a ' (6,er lnilCr Ak SAN/7171-;0 a-t A0cA. /)>= 0,0P.P17;70A1 1,P,rI �C .S�u317` g - 71i//Ar tncr071FS -/t!!/„' cA>,/Yl N1n/L�f�9[G��9a.�- /�rr�_ r) (ARrs S7- HdAxr/717a �i/rJ>) 7� BF ,O�JRr^OO,Sf7� F.c'A-Y�J �'/lSTr6S �%J/JrF�/ 1iM, o/ c / ,v C fl'Ao i /7n LL a/Cn //fY 1,F' L?i -lG b leo to G�TIt,C u-1/7t/ CIGG .)<1V,0AZ4Wi4z r Lr4 L A4'.47,1-A)TA-)J/ /Pf"• Discussion with Management TO } „ pr1 14 TE TIME AM pIH . 1 1Q , "ia PM FROM AREA CODE OF 110. ((��_j�• j EXT.JI" I TTS E M FAX p ;4 E -- 1Vf s s E A - ;O E �--{' SIGNED . PHONED SAc.CH cI CALL RETURNED D I SWANTS 0EE YOU �„_J WAS IN ❑IW4L CALL_ ❑�V TE] AGAIN 7 TO / 1 DA ` l TIM i AM t JQ PM p 1 r FROM AREA CODE N H 0_4No. S-3i— 0.23r OF EXT. Il , � I IFAX# GG er E Nj'' '�yI° aoacj� 1 �a� E,' e^ I 4J V Y✓jC/1/1 nc!t 0 L K J f A) �/+C.al — I M E J (SIGNED r T— Date C Time 0--1, 40 � � MIL WHILE YOU WERE OUT M of Peon-r 1 Jr3l- O � 3 Z Area Code Number Extension TELEPHONED — Imo' PLEASE CALL CALLEDTOSEEYOU I 1 I WILLCALLAGAIN WANTS TO SEE YOU URGENT RETURNED YOUR CALL Message 1 Operator � AM PAD REORDER ®EFFICIENCY® azo-000 ■ c> i F 3 y, lF CITY OF SALEM BOARD OF HEALTH •. Salem, Massachusetts 01970-3928 JOANNE SCOTT,MPH,RS,CHO NINE NORTH STREET HEALTH AGENT Tel:(508)741-1800 Fax:(508)740-9705 COMMONWEALTH OF MASSACHUSETTS PERMIT TO OPERATE A MOBILE FOOD SERVER In accordance with Regulations promulgated under authority of Chapter 94, Section 305A and Chapter III, Section 5 of the General Laws a Permit is hereby granted to: Name: Paula Kefalas Name of Establishment : Classy Chassis Cart #2 Whose Place of Business is : 23 Osborne Street Peabody MA Date: 05/02/96 To Operate a Mobile Food Server in Salem Restrictions : One (1) raw food item prepared per surface . Sell gausage, hot dogs, kielbasa, tonic, slush Permit # : 12-96M PERMIT EXPIRES December 31, 1996 HEALTH AGENT 1�2 _ o o,.000 ueiow oeseribe an violations checked on front page. 111v_, rN4 ECYTIIf✓ It flS /rmt)uCT -,O OF Afdz2y/E rO R T- 1 . D rFIIQ!-hr" F004S Z1nsl�n/torl S(frnCr!/3P.c rIP/t1� m lvZZzxAi. 2Z224) ref LSD° ' flrr -�k0c -1V N 77.'-Ao/e- PAnI DN GPrr/,E i - l Sam h_F_1'rnc�rl Z-11U ,r 77eil}lJ97,177;e /x/ Z 9/r. /Tl7yl.S Tll R/ 1fPbZ `/0/7rrt7�- ("omA�nP32 rh fFrORc� 7JS f%hdrl�hL1 � - '�jv1117t71 TI1,,QF.t�All.=�h.LZi�4��;jT�.0 Ll�jTi=S7` .S r-.S'/�O.0 - ��FcNEt7- d - m S/n2"r f'Nt72P /S Ae'T 0 fl71,.QU 7V 150 Kr 1-,,c Q�iP,c'ann�i'�JLr/iir,yF."'.C+ V .5-rn� e._ a (6,?r fNte$r- /j- Sf1All 772tT3 Q7 A04Q E- r7,r_�,G'P�/jf70NRtf- �` �70f/f.'7 f'RC jj IL/?'�F.S -Stl,//f 1}!rl(...)i�{'/U r ::�r t d' wls ..Sr f✓'F-teYf, II'O rir D rn tSt�pr/ /JO c�l?T�h7,7?/ r'4 STro s "JLnr{S-./rlArA.1/l/i<�; (('z' /1/0` r^a` /l I,t - �tr/c,�i,.(>S a/ aJ - CZ !7` iy .�t_i17�fft.rl7"M/r,%Or F r •!y_t"�f1.f' t �r�„/Tfio��Konr'/'AGDt�7"Us°�c'cf�G%�. Y!i�cT�lvfr7l.7"l=n,r b�[.os�l -_ 7/ — > Tu/,LC / 1z117-1-1 a %(ti�FGU/�ifr/ 1 /'�h7 72/k CY,arf t✓�yy, -�Gy�'lnt� //yr.'//�r9i4- 4`r6l Discussion with Management s - CITY OF SALEM BOARD OF HEALTH Salem, Massachusetts 01970-3928 JOANNE SCOTT,MPH,RS,CHO NINE NORTH STREET HEALTH AGENT Tel:(508)741-1800 Fax:(508)740.9705 APPLICATION FOR A MOBILE FOOD SERVICE PERMIT Name of Applicant Q C�C k O C Telephone Address 3 ,��xct e _ C -V Name of BusinesCIO S Address Type of Mobile Food Service Permit CRITn Basic Modified Type \ n Type of Vehicle po S� ` n A Registratio 7 R0 c-v) Location of Operation of �� l T c en Sed 1 u Ccj j J n G- Name&Addre/ of Lice'nso Food Se�'ce EstablishMent Serving as Base of Operation �7r cC l 11��/4Telephone# II_ Location of Toilet&Hand Washing Facilities M T , I I, horn 4)je-" Type of refrigeration: Ice L,,'� Dry Ice Gas Other Method for Cooking and/or Hot Holding: Gas Other Method for Sanitizing: ChemicalJ�Hot ater(170 F) I have read and agree to abide by The Salem Board of Health Regulations regarding "Mobile Food Units &Pushcarts" and will notify Health Department of any changes in this application. /^ /n n�cuo ori/�/ Y�a Signature Date Pursuant to MGL C62C,S49A,I certify under the penalties of perjury that I, to my best knowledge and belief, have filed all State tax r and pair 1 to es required under w. C-)/C/- 3� x -29'7 ,�On P � /9� Social Security#or Federal ID# Signature Date May 1995 I� 4 _ F CITY OF SALEM BOARD OF HEALTH Salem, Massachusetts 01970-3928 JOANNE SCOTT,MPH,RS,CHO NINE NORTH STREET HEALTH AGENT Tel:(508)741-1800 Fax:(508)740-9705 COMMONWEALTH OF MASSACHUSETTS PERMIT TO OPERATE A FOOD ESTABLISHMENT In accordance with regulations promulgated under authority of Chapter 94, Section 305A and Chapter III, Section 5 of the General Laws, to operate a Food Establishment in the City of Salem is hereby granted to: Owner's Name: Paula Kefalas Name of Establishment : Richie' s Slush Address of Establishment : 23 Osborne Street Type of Establishment : MOBILE FOOD Application Date: 05/23/96 Restrictions : SLUSH ONLY Permit for Establishment 13-96M Frozen Desserts/Ice Cream Permit for the Sale of Tobacco Products These Permits Expire December 31, 1996 This permit is not transferable and must be reissued upon change of ownership. In accordance with the State Sanitary Code, all plans of renovations, improvements, equipment changes must be approved by the Health Department. HEALTH AGENT CITY OF SALEM BOARD OF HEALTH Salem, Massachusetts 01970-3928 JOANNE SCOTT,MPH,RS,CHO NINE NORTH STREET HEALTH AGENT Tel:(508)741-1800 fax:(508)740.9705 APPLICATION FOR A MOBILE FOOD SERVICE PERMIT 13~ Name of Applicant t QJ CA i,K� f fico �(ara Telephone#cC�g 62) Address A� n&bom e - r ee 6Y1 c. Name of Business c ku,%Sr C\v,2aL�, r„s�(\, Telephone# Address S'o Type of Mobile Food Service Permit Basic Modified ptjs� cjo- \L Type of Vehicle Registration# Ob/ Location of Operation / - 0 � .S' F,5�75'K, Sp Y- Name& Ad ss of Licensed Foodervice Establishment Serving as Base of Operation r,k( C-� s " 4 k Telephone# Location of Toilet&Hand Washing Facilities-4/( SA, �2p ror ryjglVt Type of refrigeration: Ice Dry Ice Gas Other Method for Cooking and/or Hot Holding.-, Gas Other Method for Sanitizing: Chemical Hot Water(170 F)_ I have read and agree to abide by The Salem Board of Health Regulations regarding "Mobile Food Units & Pushcarts" and will notify the Health Department of any changes in this application. f 1 ignature I Date Pursuant to MGL C62C,S49A, I certify un er the penalties of perjury that I, to my best knowledge and belief,have filed all S to t#returns poi all State taxes required under low., Social Security#or Federal ID# Signature Date May 1995 �w 7 � K 6 CITY OF SALEM BOARD OF HEALTH Salem, Massachusetts 01970-3928 JOANNE SCOTT,MPH,RS,CHO NINE NORTH STREET HEALTH AGENT Tel:(508)741-1800 Fax:(508)740-9705 COMMONWEALTH OF MASSACHUSETTS PERMIT TO OPERATE A MOBILE FOOD SERVER In accordance with Regulations promulgated under authority of Chapter 94, Section 305A and Chapter III, Section 5 of the General Laws a Permit is hereby granted to: Name: Kevin Kefalas Name of Establishment : Classy Chassis Food Cart #4 Whose Place of Business is : 23 Osborne Street Peabody, MA Date: 07/03/96 To Operate a Mobile Food Server in Salem Restrictions : Fried Dough & Lemonade Permit # : 14-96M PERMIT EXPIRES December 31, 1996 HEALTH AGENT 4 6 1� CITY OF SALEM BOARD OF HEALTH Salem, Massachusetts 01970-3928 JOANNE SCOTT,MPH,RS,CHO NINE NORTH STREET HEALTH AGENT I Tel:(508)741-1800 Fax:(508)740-9705 APPLICATION FOR A MOBILE FOOD SERVICE PERMIT Name of Applicant /le vi.vr9 /(/PS Telephone# 531- 023Y Address 22 05,6o. ,t,,0— 5t, , �� ry/q(od Name of Businesse/ass/CGcssiss Fao� Z'4iN• Telep one# ice Address Type of Mobile Food Service Permit Basic Modified (/ l�S 72.9' Type of Vehicles' Registration# Location of Operation /;///Gz-- Name&Address of Licensed Food Service Establishment Serving as Base of Operation Cos 0 's Telephone# Location of Toilet&Hand Was) Facilities M kt,& Type of refrigeration: Ice ! Dry Ice Gas Other Method for Cooking and/or Hot Holding: Gas Other Method for Sanitizing: Chemical l/ Hot Water(170 F) I have read and agree to abide by The Salem Board of Health Regulations regarding "Mobile Food Units&Pushcarts" and will notify the Health Department of any changes in this application. Signature Date Pursuant to MGL C62C,S49A, I certify under the penalties of perjury that I,to my best knowledge and belief,have filed all State tax returns and paid all State taxes required under law. Social Security# or Federal ID# Signature J� _ Jl Q: Date o3i - Vf1- -7623 7 -3 May 1995 7y0��y o 15—(,Z1,7 5 a � R fit CITY OF SALEM BOARD OF HEALTH Salem, Massachusetts 01970-3928 JOANNE SCOTT,MPH,RS,CHO NINE NORTH STREET HEALTH AGENT Tei:(508)741.1800 Fax:(508)740.9705 COMMONWEALTH OF MASSACHUSETTS PERMIT TO OPERATE A MOBILE FOOD SERVER In accordance with Regulations promulgated under authority of Chapter 94, Section 305A and Chapter III, Section 5 of the General Laws a Permit is hereby 'granted to: Name: Paula Kefalas Name of Establishment: Classy Chassis Food Cart #5 - 438-054 Whose Place of Business is : 23 Osborne Street Peabody MA Date: 08/16/96 To Operate a Mobile Food Server in Salem Restrictions: Hot dogs, sausage, kielbasa, soda, slush Permit # : 17-96M PERMIT EXPIRES December 31, 1996 HEALTH AGENT �j1, rp CITY OF SALEM BOARD OF HEALTH Salem, Massachusetts 01970-3928 JOANNE SCOTT,MPH,RS,CHO NINE NORTH STREET HEALTH AGENT Tel:(508)741-1800 Fax:(508)740-9705 APPLICATION FOR A MOBILE FOOD=SERVICE PERMIT Name of Applicant R)j l �(\ I'1 P tf) k, , 3 Telephone# 5 Address � - P G . Q -a_ r^) 19 !- 8 Name of Business o S S ( c ; Telephone# �� -Ogg e�' d IQ Address �D� Type of Mobile Food Service Permit Basic Modified 1 - / y 3� z�sy Type of Vehicle rkr v4- �lc�k v 1� Registration# c Location of Operation I/�n P_ D f�/C P �/ Ce CT cl In ec,fi C., u f �h Name&Address of Licensf Food Service Establishment Serving as Base of Operation J Co S l C'n 9 19 c �j d Telephone# 7 Location of Toilet&Hafid Washingilities —"Q ( Type of refrigeration: Ice DryIce Gas Other Method for Cooking and/or Hot Holding: Gas Other Method for Sanitizing: Chemical Hot ater(170 F) I have read and agree to abide by The Salem Board of Health Regulations regarding "Mobile Food Units&Pushcarts" and will notify e Health Departmenj of any changes in this application. Signature Date Pursuant to MGL C62C,S49A,I certify under the penalties of perjury that I,to my best knowledge and belief, have filed all S e t returns d ai all State es required under law. Social Security#or Federal ID# Signature Date 14 / r 'n c7S/ �C4t S 4 Q C.9 lC. ('�J CL-SC, 's ` S 1115 � May 1995 a C.�e�- Ll 3 TO //m DATE / TIME AM •P' FROMAREA CODE a NO.Nome -631—aa3Cf . O, OF N , EXTCcall- Say- 0922 ."E M / FAX# E � w,p27a r er �ow S M' s E: n W,i7. fG wi t is S PHONED ,Ij� 1 CALL DIRETURNED I WANTS TO El lw SIN ❑I SIGNAU ED O E ❑ =ir Kul BACK CALL SEE YOU AGAIN rCommuni cat ion RePmTt t'e4 t F 7 SALEM HEALTH L.FR 06 '87 '03: 5E F14 r4.$..t'Y't'i1l hi iM.ikt:Y 1.d#1.i 4a IIJ4 t'14161:1✓1144.'111.11 +'4t ti i i.4 Ki rrAftlGE '� PEMOtE TEFM2HAL TO, AFT TIME T{ME PAGES STATUS _- _._. ._'_ . . . .. _. . .. - t i" - i 1� T" 156te:;e331 04t@9 0rr4 'FY 02: 44 6 GT S }' 1 y� ltti#rxttai ti7ftxt }Tl4f34 + Fi • rga.444 art14lA l4it of ix Y* • / al / ta rit /7 rjifI l411itx 44i`I}ti ii • #iaV + t � 4r 0. `1 _ • ' t i To: �U y 1),q u fU PoR l ...................................................................................................................................................... Fax: 0/ 3 From: Date: q — q7 7 ....................................................................................................................................................... page(s) including this page. ....................................................................................... .............. .......................:.................... fax From the desk of... Joanne Scott,MPH,RS,CHO Health Agent Salem Board of Health 9 North Street Salem,Ma.01970 (508)141-1800 Fax:(508)740-9705 v CITY OF SALEM BOARD OF HEALTH Salem, Massachusetts 01970-3928 JOANNE SCOTT,MPH,RS,CHO NINE NORTH STREET HEALTH AGENT Tei:(508)741-1800 Fax.(508)7409705 COMMONWEALTH OF MASSACHUSETTS PERMIT TO OPERATE A MOBILE FOOD SERVER In accordance with Regulations promulgated under authority of Chapter 94 , Section 305A and Chapter III, Section 5 of. the General Laws a Permit is hereby granted to: Name : Paula Kefalas Name of Establishment: Classy Chassis Cart #1 Whose Place of Business is : 23 Osborne Street Peabody MA Date : 04/20/96 To Operate a Mobile Food Server in Salem Restrictions : Sell sausage, hot dogs , kielbasa, tonic, slash. One ( I) raw food item prepared per surface. Permit # : 1 10-96M PERMIT EXPIRES December 31, 1996 4 tJ HEALTH AGENT 4 R CITY OF SALEM BOARD OF HEALTH Salem, Massachusetts 01970-3928 JOANNE SCOTT,MPH,RS,CHO NINE NORTH STREET HEALTH AGENT Tel:(508)741-1800 Fax:(508)740-9705 COMMONWEALTH OF MASSACHUSETTS PERMIT TO OPERATE A MOBILE FOOD SERVER In accordance with Regulations promulgated under authority of Chapter 94, Section 305A and Chapter III, Section 5 of the General Laws a Permit is hereby granted to: Name: Paula Kefalas Name of Establishment : Classy Chassis Cart #2 Whose Place of Business is : 23 Osborne Street Peabody MA Date : 05/02/96 To Operate a Mobile Food Server in Salem Restrictions : One (1) raw food item prepared per surface. Sell sausage, hot dogs, kielbasa, tonic, slush Permit # : 12-96M PERMIT EXPIRES December 31, 1996 HEALTH AGENT CITY OF SALEM BOARD OF HEALTH Salem, Massachusetts 01970-3928 JOANNE SCOTT,MPH,RS,CHO NINE NORTH STREET HEALTH AGENT Tel:(508)741-1800 Fax:(508)740-9705 COMMONWEALTH OF MASSACHUSETTS PERMIT TO OPERATE A FOOD ESTABLISHMENT In accordance with regulations promulgated under authority of Chapter 94, Section 305A and Chapter III, Section 5 of the General Laws, to operate a Food Establishment in the City of Salem is hereby granted to: Owner' s Name : Paula Kefalas Name of Establishment : Richie' s Slush Address of Establishment : 23 Osborne Street Type of Establishment : MOBILE FOOD Application Date: 05/23/96 Restrictions : SLUSH ONLY Permit for Establishment 13-96M Frozen Desserts/Ice Cream Permit for the Sale of Tobacco Products These Permits Expire December 31, 1996 This permit is not transferable and must be reissued upon change of ownership. In accordance with the State Sanitary Code, all plans of renovations, improvements, equipment changes must be approved by the Health Department. HEALTH AGENT { { CITY OF SALEM BOARD OF HEALTH Salem, Massachusetts 01970-3928 JOANNE SCOTT,MPH,RS,CHO NINE NORTH STREET HEALTH AGENT Tel:(508)741-1800 Fax:(508)740-9705 COMMONWEALTH OF MASSACHUSETTS PERMIT TO OPERATE A MOBILE FOOD SERVER In accordance with Regulations promulgated under authority of Chapter 94, Section 305A and Chapter III, Section 5 of the General Laws a Permit is hereby granted to: Name: Kevin Kefalas Name of Establishment : Classy Chassis Food Cart #4 Whose Place of Business is : 23 Osborne Street Peabody, MA Date : 07/03/96 To Operate a Mobile Food Server in Salem Restrictions : Fried Dough & Lemonade Permit # : 14-96M PERMIT EXPIRES December 31, 1996 HEALTH AGENT a CITY OF SALEM BOARD OF HEALTH Salem, Massachusetts 01970-3928 JOANNE SCOTT,MPH,RS,CHO NINE NORTH STREET HEALTH AGENT Tel:(508)741-1800 Fax:(508)740-9705 COMMONWEALTH OF MASSACHUSETTS PERMIT TO OPERATE A MOBILE FOOD SERVER In accordance with Regulations promulgated under authority of Chapter 94, Section 305A and Chapter III, Section 5 of the General Laws a Permit is hereby granted to: Name: Paula Kefalas Name of Establishment : Classy Chassis Food Cart #5 - 438-054 Whose Place of Business is : 23 Osborne Street Peabody MA Date: 08/16/96 To Operate a Mobile Food Server in Salem Restrictions : Hot dogs, sausage, kielbasa, soda, slush Permit # : 17-96M PERMIT EXPIRES December 31, 1996 0. HEALTH AGENT The Evening News, Salem.Mass., Thursday, February 20, 1997 C3 MGM Ln ,... All • i It— illCity ed on sausage e ®r fla By MICHAEL,COHEN tained continuing economic harm, lowed to sell T-shirts or hot dogs .guaranteed a license. They were News staff,;: lost profits, and serious emotional without paying rent or city taxes. not, however, guarariteed.a spe ., distress and injury." Others complained about having cific location.And that's where the SALEM.^-'A woman suing to Reached at her home by phone to live or work with the constant dispute lies. sell bot ,d=rgs, kielbasa and Wednesday, Kefalas declined com- aroma of griLing sausages. Kefalas says she should keep the ;auaages where ewe wants to on menr, "We had fight, in the streets," locations near the Salem Common, city'streets now claims the mayor The suit,however,says tae city's said John Boris, chairman of the the fountain on Essex Street, and and others.consp4-ed to run her attempt to reg late the appearance Licensing Board. "A tour bus near the Visitors Center for as out o",b,=,ness. The city's lawyer and locations of her push carts, would pull up and two push carts long as she wants them. But the says u;J's baloney. and its failure to issue her licenses would run up and get into a fight city disagrees. For'mealy two years Paula Ke- in a timely manner each year, was over who got there first." "The Licensing Board is the en- falas ref Peabody has been suing all part of a malicious plot to put As a result, the City Council re- tity responsible for making the de- the city to r_tain three key down- her out of business. stricted the number of carts al- termination of location," Femino tocci locations for hr-r aausage and "The city of Salem vehemently lowed in Salem to five, and.em- said. "You're talking about police root-clog carts. That case is headed denies all of those claims," said powered the Licensing Board to powers here, of controlling public for tri-al in March. Leonard Femine, lawyer for the decide each year who gets the It- ways in the city. That power re- But last Kefalas filed a city. "There's no conspiracy, tenses and where the carts can set mains with the city." new,suit against 30 current and there's no nothing." up. The city also sought to control former;city,ofcicials who were in The problems with push carts "I think the vendors are a good the size and appearance of the some,ANay'livolved in regulating dates back more than five years, part of the economy. They add to push carts, requiring'them to get push-cart vendors in Salem. when some city businesses and the flavor of the city," Boris said. approval from the Salem Redevel- The:suit alhges city officials, residents called for a crackdown "But there has to be some control." opment Authority's Design Re- acting in concert, "have deprived, on the number and locations of the The licenses are given out by lot- view Board before hitting the and continue to deprive (Kefaias) carts. tett', but Kefalas and others who streets. of her.,libertv.and property rights Shops and restaurants saw the held licenses when the lottery first That regulation remains on hold while Kefalas'suit is.pending. ...and as a result(Kefalas)has sus- carts as unfair competitors, al- began were grandfathered and TOn^ DAT TIME AM I ��0/96 I .4.0o /$—MI H l FROM-ln _ 4�- � ARt.4 CODE H ?t,L O OFNO. N EXT. EMI IFAX# E Issi Q arc F /!t eue�h / Oop�9 v , PHO IED O O NED I WA O I W S IN ❑I WILLCALL ❑ UMENT❑ i 1 THE COMMONWEALTH OF MASSACHUSETTS CITY OF SALEM HEALTH DEPARTMENT - 9 NORTH STREET, SALEM, MASS. 01970 FOOD ESTABLISHMENT INSPECTION REPORT Establishment Name c/ sy chwss,s Date Address '--Ssrx ,;• r Ali Time: In Out Telephone Type of Establishment: _ Purpose: Owner's Name Kew Krf-:at Food Service Retail Food - Routine Residential Kitchen Follow-up Person in ChargeMobile Unit Complaint V Temporary Food Service Investigationation Ins eetors Name MA2k x Catering Othe Based on an inspection today, the items checked below indicate the violated provisions of 105 CMR 590.000. Each item is followed by PP theapplicable section of the Massachusetts regulation. Non-critical violations are marked under column"N"and critical violations are marked under column"C". Descriptions of each item appear on the back of this form. Each violation checked requires an explanation on the narrative page(s). This report serves as official notice of violated provisions and official notice to correct said violations. Food N C Sanitary Facilities N C 1. Food Supply .00229 Water Source 015 2. Food Containers 0021�1 30, Sewage 016 31 Cross-Connections 017 Food Protection 32 Toilets/HandwashIng 018 & .019 3. PHF Temperatures .00433 Insects/Rodents .021 4. Facilities. Hot & Cold Storage 004 34, Plumbing .017 5. PHF Re-service 006 35. Toilet Rooms 018 6. Spoiled/Damaged Foods .003 36 Handwashing Areas .019 7. Food Protected 003 37. Garbage/Refuse .020 8. Food Thermometers 004_ 38. Outside Disposal .020 9. Cross Contamination '.005 _ 39. Outer Openings 021 10. PHF's thawed, cooked& cooled .005 _ 40, Pesticide/Rodenticide Application 021 11, Food Handling 005 12. Dispensing Utensils .006 _ Physical Facilities 41. Floors .022 _ Personnel 42 Walls, Ceiling .022 13. Employee Infections .008 43. Lighting .023 14 Employee Hygiene .009 44, Ventilation .024 15 Employee Clothing .010 k 45 Dressing Rooms .025 Equipment& Utensils Other 16. Equipment/Utensil Clean & Sanitized 013 46. Toxics .026 17. Food Contact Surfaces .013 47. Premises .027 18 Non-Food Contact Surfaces 013 48. Living Areas .027 _ 19 Food Contact Surfaces Clean .013 49. Linen .027 _ 20 Non-Food Contact Surfaces Clean .013 50. Pets .027 _ 21. Wiping Cloths 013 51 Bulk Foods .031 _ 22. Dish/Warewashing Facilities .013 52 Salad Bars 032 23 Pre-Scraped, Soaked 013 24. Wash/Rinse Water .013 No of 13 Critical Items Violated _ 25 Thermometers/Test Kits 013 (These items require immediate attention 26 Equipment/Utensil Storage .014 27 Single Service Articles 014 Received,by, Inspected by 28 Single Service Re-Use 012 _ FORM 734A HOBBS&WARREN,INC 1985 i Full Item Descriptions Food C1 Food Source, approved, wholesome 2 Containers, properly labelled Food Protection C3 Potentially hazardous foods at proper temperatures: 140OF or above, 450F or below, OOF; rapid cooling of cooked foods within 4 hours C4 Facilit•ies to maintain product temperature C5 Unwrapped and potentially hazardous foods not re-served 6 Damaged, spoiled, returned foods segregated 7 Food protected during storage, preparation, display, dispensing, service, transportation B Thermometers provided, conspicuous, accurate 9 No cross-contamination 10 Potentially hazardous foods properly thawed, cooked, and cooled 11 Food handling minimized _ 12 Dispensing utensils stored Personnel C13 Employees with infections restricted C14 Hands washed and clean; good hygienic, practices 15 Clean clothes, hair restraints Equipment & Utensils . C16 Equipment, utensils sanitized (automatic and manual methods) 17 Food contact surfaces: design, constructed, installed, maintained, located 18 Non-food contact surfaces: design, constructed, installed, maintained, located 19 Food contact surfaces clean, free' of all cleansers 20 Non-food contact surfaces clean, free of all cleansers• 21 Wiping cloths; clean, use restricted - 22 Dish/Warewashing facilities: designed, constructed, maintained, installed, located, operated 23 Pre-flushed, scraped, soaked 24 Wash/Rinse water clean, temperature 25 Accurate thermometers, chemical test kits provided; instructions posted 26 Storage, handling of clean equipment/utensils 27 Single service articles, storage, dispensing 28 No re-use of single service articles Sanitary Facilities C29 Water source; approved, hot&cold under pressure C30 Sewage and wastewater disposal C31 No cross-connections, back siphonage, backflow C32 Toilets & Handwashing: number, accessible, design, installed C33 No insects or rodents; harborage prevented 34 Plumbing; installed. maintained 35 Toilet rooms enclosed, self-closing doors, fixtures good repair, clean, signs 36 Handwashing areas supplied with soap and towel dispensers, proper-waste receptacles 37 Garbage and ref.se: containers covered, adequate number,. insect/rodent resistant, frequency, clean 38 Outside area: dumpster covered, construction, clean 39 Outer openings protected 40 Pesticides and redenticides, proper application Physical. Facilities 41 Floors constructed, maintained, clean 42 Walls, ceiling, attached equipment; constructed, maintained, clean' 43 Lighting provided as required, fixtures shielded 44 Rooms and equipment vented as required 45 Dressing, locker areas provided used, clean other C46 Toxics properly stored,, labelled, used 47 Premises litter•-free, unnecessary articles, cleaning maintenance equipment properly 'stored. Authorized personnel 48 Living/sleeping quarters and laundry separate 49 Linen properly stored 50 No pets or other live animals except guide dogs •51 Bulk foods stored, labelled, dispensed �~ _ 52 Salad bar operationsprepared, refrigerated, displayed, protected THE COMMONWEALTH OF MASSACHUSETTS CITY OF SALEM HEALTH DEPARTMENT - 9 NORTH STREET, SALEM, MASS. 01970 Establishment Name c�a55/ c�aSSiS Date ?.//o/y4 Address 655ex s< Page_ of Item No. In the space below describe all violations checked on front page. Adds v1' On F4 ( r 14; . NrI IHc .�1,,.. , �F ✓a��. 7.i rx r<.-.�.�., ... 4.l-LL. c �f c.,,�.._ X_ n/ S f,, f. c,,... .•J.�_ ✓F..,/ /oSc Md S90.onw. T_in ]TJ O/tJN/✓ c._wd' SAeur✓ f7�jv�. � $er✓.uA Fo�cP Gii/'� Tu/�%�� %< sl,ii��. (b•��x. SNo�'�' Sle�✓e 5�:.. �C l..:f� �o/�..e./'C N(..S'�" S.• 4.✓o v.t . - m m m _ O - Z C 3 A m m O O' - S i m , a A r R g ; i Discussion with Management /A`J T' "� �'O L fj° e �� `"`� c� ✓� i Via�q�i✓h &/(q.�r O✓r Sr --f- . T i THE COMMONWEALTH OF MASSACHUSETTS Establishment Name C�CASSy �(SSIS Date 3- 9� AddressPage�of 1 7V &5- 1�,IC07-A7I AT Ff le nP/R Z- W X2/1,?e1VS 5t?,Pe Item No. ��I++n the space below describe all violations checked on front page. ZA-S1&rrION/ev7L 7Z-V ini GC60r?4arr,.f- aiYN Oki nrA-A V' ,TMY -C&` 69�oca U UU/IGL A£ ,i�L vL7 AA9)IC_,n 7)nL 0,4 I �rry�/�iP.PC�77oeV Ci;Paa �/ SUE ,APAPrnMPM Ta NRIA,1111V :7d cU77z P 67 7- �/""°� �,rL 15A7-hfsr I')- 77'2 aS/1xnr772I A17 �S'd LU T70 n/ Dir/ f-7/Y AP r�nr,��cl�riv,C �n n� iP7� a YhIwP 7U�GeLS Z W �,,aalma OP W6? TF a' ,cow b Y� �,c r• , r'7vp�-�^ m 0 'NZ- T^e /A5-M/9 A.11.1 1-14 717 cif- h<P.01 /,v r/PI°nl CaV641 ' r..ala e /.4-rrnrrt< J--A X5 E rc O J, A LL T Y14()6- IPea CI y/1 OP-P'P i/,m 7'1I '7-/Al (/(� OAP7 o,P Cnnrrc�/2 L%. /'n.�d (�liie 6,J C iilC 4iynxo ,3'9/J /3-�) 1t-0,aphr-AA 040124kA, r i IPS m tIP,� ?7�ar. z Discussion with Management A,u/ RVnR/11.1%v y F,10el 9/S IJDSen ,_Y6 ' AY KW,) rlF f7r4t� r r r Te rsdnaMoney,Order Not Valid Over$500 !� Mo 27 0+184 O p,�ys,Cl.> Pay Dare z201110la Orderrder Of �1 ; 'a, /n`r-{- Purchaurs S.gnamre ® Shawmut Banky C Purrhaser'S A Inas Shawmut Bank,N.A. '-p' Z.d L.r-�i i N Boston,Massacrol�611000 t o�Yggd u• 27564983�I' i 206[. 5O 117799 5112 0/9 0 P SALEM FIRE DEPARTMENT Fee Paid$10.00 FIRE PREVENTION BUREAU PERMIT Date: JUNE 26, 1996 TO INSTALL LIQUIFIED PETROLEUM GAS STORAGE TANKS provisions of Chapter 148, G.L.,and Regulations made under authority thereof. VIN KEFALAS, Name: FOOD CART (OwnermOccupant) SAME onstalleq OSBORNE STREET PEABODY Address: hereby granted to above listed installer,to install L.P.G.tanks on the premises of the above listed owner nt. . I Tanks, 1 Capacity of Each Tank* 20 Total Storagp- __20 JUNE 26, 1996 - g;hlef of Fire Department) (OVER) I -- I NUMBER FEE THE COMMONWEALTH OF MASSACHUSETTS Board of Health CitY..... of .......................Salem ............................. ---... PERMIT TO OPERATE A MOBILE FOOD SERVER PermitNo. ..8-9.5_.------... April_- 18"-----_19- 95 SII In accordance with Regulations promulgated under authority of Chapter 94, Section 305A and Chapter 111, Sertion 5 of the General Laws a Permit is hereby granted to: P A..K..S.aus.age__-..Kevin.RaFa.Las....... . ..�/i i#1.._.. ----------------------------------------- Whose place of business is---23 Osborne Street, Peabody, MA --_ ............._. ..._.._. ...._._...----- -------------------------------------- ......................... To operate a mobile food server in. Salem ICity or Town) I Permit ExpiresDe.C....3.1--------------...._........ ......19_95. NOTE: Uncooked sausaa on grill only — hot dogs in steam table only. WHITECOPY-Original PCr Applicant ______ __ _ __ _ PINK COPY - Mailed Immediately to Board Department of Public Health, State -"'"'"' -"' House, Boston, Mass. 02133. --- -- -------------------------- "----------------- of - - -- ---- -------... BLUE COPY - Board of Health ------MPli; �� ,, 1 �" ��''� � �� 1 J �� COURT DOCKET NO 4 CITATION NO CITY OF SALEM VIOLATION NOTICE A Q A/�((yy V O Z ' NAME(LAST,FIRST,INITIAL) KP,FaIas . Kevin , P STREET ADDRESS CITY/TOWN STATE ZIP Q3 0sb vne- 54., 'Peabr41 HA 0/14� LICENSE NO LIC EXP DATE DATE OF BIRTH /-3o z/)/o OWNER'S NAME(LAST,FIRST,INITIAL) KepaIII as , Wevih , /0 STREET ADDRESS CRY/TOWN STATE ZIP I . PEGISTRATION NO STATE I EXP DATE I MAKE/TYPE I YEAR COLOR DATE OF VIOLATI�OJNL TIMEDA/TE CTApT ON WR TT/EN FERsorvAL AM • �� si�" -/✓ °PM / c5 5' 9C Irvdu❑VES ❑NO LOCATION OF VIOLATION t EN�FOORCING DEPT /j�1 '544, Pf f7PCIffj1 OFFENSE CHAP SECT FINES A DepoS,i,,1 y 4rash s' 6 B LGte7/*Ma/ - ece4S in Ip.,.' Loi c'f Donk;-1 Zl,',�I J I IOFFICER ID TOTAL rFINE �r n� OFFICER CERTIFIES COPY GIVEN TO VIOLATOR ////+ y' ❑ IN HAND A?'-4 - ❑o-BY MAIL DbiNOT MAIL CASH- PAY ONLY BY POSTAL NOTE, MONEY %ORDER OR BY CHECK MADE PAYABLE TO CITY CLERK CITY HALL 93 WASHINGTON STREET SALEM,MA 01970 TEL.(508)745-9595 X 251 I HEREBY ELECT TO EXERCISE THE FIRST OPTION AS STATED ON REVERSE, CONFESS TO THE OFFENSE CHARGED, AND ENCLOSE PAYMENT IN THE AMOUNT OF CASE# SIGNATURE SEE OTHER SIDE FOR FURTHER INFORMATION ENCLOSE PAYMENT IN THIS ENVELOPE,PEEL AND SEAL SALEMBOARD of HEALTH 9 NORTH STREET• SALEM, MA.01970 • (508) 741- 1800 •FAX: (508) 740-9705 / JOANNE SCOTT,MPH, RS, CHO t� APPLICATION FORA MOBILE FOOD SERVICE PERMTI' FEE$25 NAME OF APPLICANT TELEPHONE# S3r. 02--?y ADDRESS L 05 Z Oo -Ale- NAME AlmNAME OF BUSINESS P9 TELEPHONE# SGI rr ADDRESS TYPE OF MOBILE FOOD SERVICE PERMIT BASIC MODIFIED TYPE OF VEHICLE GUr 6 rn931Cr REGISTRATION # GI G Tr O } LOCATIONOFOPERATION NAME&ADDRESS OF LICENSED FOOD SERVICE ESTABLISHMENT SERVING AS BASE OF OPERATION oso rv ��ti !�a r TELEPHONE # i-c i7_ clad-7'2 LOCATION OF TOILET&HAND WASHING FACILITIES Ile sf ".fin.- :r ryjq L• TYPE OF REFRIGERATION: ICE v DRY ICE GAS OTHER METHOD FOR COOKING AND/OR HOT HOLDING: GAS 1" OTHER METHOD FOR SANITIZING: CHEMICAL t- HOT WATER( 170 F IMMERSION) I HAVE READ AND I AGREE TO ABIDE BY THE SALEM BOARD OF HEALTH REGULATIONS REGARDING "MOBILE FOOD UNITS &PUSHCARTS,, AND WILL NOTIFY THE HEALTH DEPARTMENT OF ANY CHANGES IN THIS APPLICATIQ SIGNATURE PERSUANT TO MGL C62C,S49A, I CERTIFY UNDER THE PENALTIES OF PERJURY THAT I, TO MY BEST KNOWLEDGE AND BELIEF, HAVE FILED ALL STATE TAX RETURNS AND PAID ALL STATE TAXES REQUIRED UNDER LAW. SOCIAL SECURITY#OR FEDERAL IDENTIFICATION ## SIGNATURE 1 b`� ��17le "sem l un coo,eed sau sa � e is allowed I-o Goo Ked �.� eke grill 4-0 I q 7/ o'r /so ° F, /!07 dDpS a,e a!/owed 017 3, Sami /'fie✓ /-ays{ 1 arm ves1? da A/ a.-7d -/cS-kd wi 1�i lesf s�rrfp5 -- u resu/•As A7usf Ie eeeo,-at' d 6t l Y or, /of 9w�s y. view.%rls �Y by dgs iu.t;754 6e Sepaale 14-0.z-r v �Nsi�s �. 7h�aw G�wc+� CAl/ v��s-eol �pocl J Cr-oo,e2d c?�c✓ vMe'-do.rrClj Q�- � iii e 25� of O peYQ llo-2S Aqd( L �60or. (� . �ad•,� IYZU=� � .Sani ,�r�ecz� c2-f �e. �'� o-� o�PraErd.� P I SALEM FIRE DEPARTMENT Fee Paid $10.00 j FIRE PREVENTION BUREAU s MASS. REGISTRATION 597-095 MASS (96) PERMIT Date: APRIL 18, 1996 TO INSTALL LIQUIFIED PETROLEUM GAS STORAGE TANKS In accordance with provisions of Chapter 148, G.L., and Regulations made under authority thereof. Name: PAULA KEFALAS Name: FOOD CART (Owner or Occupant) (Installer) Address: 23 OSBORNE STREET PEABODY MA, Address: SAME PERMIT is hereby granted to above listed installer,to install L.P.G.tanks on the premises of the above listed owner or occupant. Number of Tanks: 1 Capacity of Each Tank* _ 20 _ Total Storage: 20gals. Date Permit I ued: /APRIL 18, 1996 �/�/� Inspector. �d.... ,-.^�G, • t -6c�.s?�,R4tAf— �"�''``� �(Cnlef of Fire Depanmonq Form N90L(Rev. 11113) (OVER) 1 ......................................... --------------------- - ---- -----.. SALEM FIRE DEPARTMENT ° 'h �.COMpA Fee Paid $10.00 FIRE PREVENTION BUREAU PERMIT Date: 5/2/96 FOR STORAGE OF LIQUIFIED PETROLEUM GAS In accordance with provisions of Chapter 148, G.L., and Regulations made under authority thereof. Name: Classie Chassie/Food Cart Name: Paula Kefalas 23 Osborne St. Peabody MA 01960 Same (Installer) Address: Address: PERMIT is hereby granted to store 201 h c- gallens-of Liquified Petroleum Gas,for use in an approved appliance. Subject to approval of Salem Gas Inspector, for piping and equipment. Date Permit Issued: 5/2/96 q."4 7,r.)rI ysm,H.. Inspector: _. rn T.T4114 ..fig Hud e,. (Chief of Fire Department) THIS PERMIT MUST BE CONSPICUOUSLY POSTED UPON THE PREMISES Form N901.(Rev, 1183) This permit will expire on a Change of ownership, burner or storage. .. ..-.................................................___..---_--_--._.--.___-.__--..__----.___---_--__-..____-..___..._ i (�% h T6 A%li2J P 3.16 592 175 US Postal Set'Wce Re4reipt for Certified Mail No Insurance Coverage Provided. Do not use for International Mail(See reverse) Sent to Sheet&Number Post Office,Slate.&ZIP Code Page $ Certified Fee Special Delivery Fee Restricted Delivery Fee m Return Receipt Showing to Whom&Date Delivered .n Realm Receipt Show'vg to Whom, Dare,&Addressee's Address 0 TOTAL Postage&Fees $ L7 Postmark or Dat& 0 LL U) a Stick postage stamps to article to cover First-Claes postage,certified mall fee,and charges for any selected optional services(See front). 1. If you want this receipt postmarked,stick the gummed stub to the right of the return address leaving the receipt attached, and present the artide at a post office service m window or hand it to your rural tamer(no extra charge). m 2. If you do not warn this receipt postmarked,stick the gummed stub to the right of the return address of the article,date,detach,and retain the receipt,and mail the article, N 3. If you want a return receipt,write the codified mall number and your name and address m on a return receipt card,Form 3811,and attach A to the front of the article by means of the gummed ends if space permits. Otherwise,affix to back of article. Endorse front of article RETURN RECEIPT REQUESTED adjacent to the number. 4. If you want delivery restricted to the addressee, or to an authorized agent of the, 0 addressee,endorse RESTRICTED DELIVERY on the front of the article. 'i 0 5. Enter fees for the services requested in the appropriate spaces on the front of this receipt. If return receipt is requested,check the applicable blocks in item 1 of Form 38113 ti 6. Save this receipt and present it if you make an inquiry. a' 3 mr� CITY OF SALEM BOARD OF HEALTH Salem, Massachusetts 01970-3928 JOANNE SCOTT,MPH,RS,CHO NINE NORTH STREET HEALTH AGENT Tel:(508)741-1800 Fax:(508)740-9705 May 6, 1996 Paula Kefalas 23 Osborne Street Peabody, MA 01960 Dear Ms. Kefalas: Please be advised that according to 105 CMR 590.000, "Minimum Standards for Food Establishments, State Sanitary Code Chapter X," and in particular section 590.029 and 590.001, a permit is required from the Salem Health Department to operate a slush pushcart in Salem. Sincerely yours, For the Board of Health, J' anne Scott, Health Agent cc: Robert Ledoux, Salem City Solicitor CERTIFIED MAIL: P 316 592 175 I , SENDER: I v •Complete items 1 and/or 2 for additional semces. I also wish to receive the I' a •Complete items 3,4a,and 4b. following services(for an % •Print your name and address on the reverse of this form so that we can return this extra fee card to you. W> -Attach this form to the front of the mailpiece,or on the back If sp does not 1, ❑ Addressee's Address ( permit. y •Wnte'Retwn Receipt Requested'on the mailpiece below t article number. 2. ❑ Restricted Delivery N ` « •The Return Receipt will show to whom the article was d Bred and the date n I c delivered. Consult postmaster for fee. Z 3.Article Addressed to: 4a.Article Number to Paula Kefalas P 316 592 175 E 23 Osborne Street 4b.Service Type �l a Peabody, MA 01960 El Registered ified rNi ❑ Express Mail ❑ Insured So a �a ❑ Return Receipt for Merchandise ❑ COD Q mp 7.Date of Delivery Z p 5.Received By: (Print Name) 8.Addtessee's Address(Only if requested W and fee is paid) t cc v H g 6.Signatur . (Addressee or Agent) 0 n I/ o Q 0 X S . ® f"Ps Form 3811, Decem er f sa Domestic Return Receipt UNITED STATES POSTAL SERVICE First-Class Mail Postage&Fees Paid I II USPS Permit No.G-10 1I • Print your name, address, and ZIP Code in this box • ; I Is! Jeri Health Department l JA AY 15 1996 Salem, Mass 01970