The URL can be used to link to this page

CONGRESS MARKET - ESTABLISHMENTS CONGRESS MARKET 95 CONGRESS STREET r di I v i o i t A 1 0 � v � n �I , I, Y d 0 n d �"' D,�a i $� r ,� a {+g Y � 6 ;{ I E' 3b ti i ii t R o .�'�yy�.�,}.fj '_ 'c'_ o _ _ cr_.__ _ �n �. �._ mom} P,s�..> �❑ =c G' w'�- : C..w is ��. c -c .�� rmv o - � -i% -_.v I t 0 4 �d i { q � �.. s. - �.. �'; l ' aZ '�'07 �� G �/ O� � �� ,�. 1� i...ow. 1� oEw'"'aT-3T Q Form C 10024 Massachusetts Department of Revenue 2010 - 2012 m Cigarette Excise Unit - r Retailer License for Sale of Cigarettes and Cigars and Smoking Tobacco OOp This License must be posted and visible at all times. Sales to persons under 1S years of age are prohibited by law. Application Number: AE232 License Number: Date of Issue: Federal Identification or Social Security Number: 452-45.4534 10024 07/3112012 -- --- --------------- -- --- - ---- - Mailing address for license: Retail sale location(it different than mailing address) SHREE LAXMI KRUPA INC CONGRESS STREET MARKET 11 KELLY CIRCLE 95 CONGRESS STREET LOWELL, MA 01854 SALEM, MA 01970 j This certifies that the taxpayer named above has paid the required license fee and is licensed to sell at retail at the address shown above until September 30,2012. This license is not transferable,and is subject to suspension for failure to comply with the law. Commonwealth of Massachusetts City of Salem Board of Health Kimberley Driscoll 120 Washington Street,4th Floor Mayor SALEM,MA 01970 Food/Retail Establishment Permit DATE PRINTED: 12/29/2011 ESTABLISHMENT NAME: Congress Market File Number:BHF-2004-000105 95 Congress Street Salem MA 01970 LOCATED AT: 0095 CONGRESS STREET SALEM, MA 01970 Permit Type Permit No. Permit Issued Permit Expires Fee Restrictions/Notes RETAIL FOOD BHP-2012-0185 Jan 1,2012 Dec 31,2012 $280.00 TOBACCO VENDOR BHP-2012-0196 Jan 1,2012 Dec 31, 2012 $135.00 Total Fees: $415.00 PERMIT EXPIRESDecember 31, 2012 Board of Health This Permit is not transferable and must be reissued upon change of ownership or location.The permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code,beofre any revonations,improvements,or equipment changes are made, all plans for such must be submitted to and approved by the Salem Board of Health. Page 1 r / CITY OF SALEM, MASSAc.HLiSF-1-I'S I�• 5 " BOARD OF WALTH 120 WASHINGTON S1"RHET,4"' Fu a tR -I"ii,. (978) 741-1800 Kh%JBERi.F_Y DRISC0LL FAx (978) 745-0343 NL11,OR LiatnLn dsalem.ccrm LARRY RAMI)IN,RS/6h:1 IS,CEM),CP-Dti 201_APPLICATION FOR PERMIT ftn TO OPERATE A FOOD ESTABLISHMENT C� NAME OF ESTABLISHMENT �{��s @ �j, tV t"LkQ,I TEL# ADDRESS OF ESTABLISHMENT FAX# MAILING ADDRESS(ifdifferentl EMAIL-Business': V)0fM()61.Ca1%.Website: OWNER'S NAME UhrC.- .ITEL# ADDRESS 4 6 9 C)06 �Z+ V' ke-fi LYN N 011D T. STREET y� CITY STATE ZIP CERTIFIED FOOD MANAGER`SNAME(S) t--• c— 8u I CERTIFICATE#(S) K$-wo3nii7 (Required in an establishment where potentially hazardous food is prepared) EMERGENCY RESPONSE PERSON L C. Iry 1 HOME TEL# x'017 ('� DAY,S.OPOPERATION'_ -,1 'Monday: ! .Tuesday- 1 ._-Wednesday'ol ,._ ;'`Thursday;. s.l: :';;Friday<:_: .i SatuNay Sunday HOURS OF OPERATION Please write in time of day. 13" - 111 firi 'saw,- 4Ip4n1ilk"-11pm 1 `gam- Alf%)! ywm, 11r �atty_ 411 �t♦m- 11Dtt) (For example Ilam-1 ipm) ! I 1 TYPE OF ESTABLISHMENTFEE taheck on RETAIL STORE YES ivt NO ft. 000-t0,0000ssq - 28 more man w,G q.It. =$4 - ------•--- ------------------------------------------------•------------ --------- RESTAURANT YES NO 'ass than 25 seats =$140 (Outdoor Stationary Food Cart$210) 25-99 seats =$280 more than 99 seats =$420 -- — — BED/BREAKFAST/ YES NO $100 CHILDCARE SERVIOESlNURSING HOME"•--•-----• -•-----•--------•---•-"-----------•--- ----- -• --• - ADDITIONAL PERMITS MAKE(not just serve)ICE CREAM, YOGURTISOFT SERVE NO TOBACCO VENDOR YES NO $13 ALL NON-PROFfT(such as church kitchens) NO '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 state tax required under the law. /81 Llrti I Al Signature IDate Social Security or Federal identification Number Updated 5/23/11 FOODAP201 Ladtp Check#&Date -6 7 ! ( tat if 14 1) Commonwealth of Massachusetts City of Salem Board of Health Kimberley Driscoll 120 Washington Street,4th Floor Mayor SALEM,MA 01970 Food/Retail Establishment Permit DATE PRINTED: 01/03/2011 ESTABLISHMENT NAME: LongressMarket File Number:BHF-2004-000105 95 Congress Street Salem MA 01970 LOCATED AT: 0095 CONGRESS STREET SALEM, MA 01970 Permit Type Permit No. Permit Issued Permit Expires Fee Restrictions/Notes RETAIL FOOD BHP-2011-0015 Jan 1,2011 Dec 31,2011 $280.00 TOBACCO VENDOR BHP-2011-0014 Jan 1, 2011 Dec 31,2011 $135.00 Total Fees: $415.00 PERMIT EXPIRES IDecember3l, 2011 Board of Health IUw ✓t� This Permit is not transferable and must be reissued upon change of ownership or location.The permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code, beofre any revonations,improvements,or equipment changes are made, all plans for such must be submitted to and approved by the Salem Board of Health. Page 1 f _ CITY OF SALEM, MASSACHUSETTS • BOARD OF HEALTH 120 WASHINGTON STREET,45'FLOOR TEL. (978) 741-1800 IQNfBERLEY DRISCOLL FAx(978) 745-0343 NtAYOR DGREENBAUN16i..SALEM.CONI DAVID GREENBAunf,RS ACTING HEALTH AGENT 2011 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT NAME OF ESTABLISHMENT CON-69t— SIS, '9- lMMY\l.1TEL# 17 7�+� �tlgl � ADDRESS OF ESTABLISHMENT Cc�l Vy sc S� . FAX# q1� S— O-7 41 18 MAILING ADDRESS(if different) i_ EMAIL-Business': �aC,okuk? jIDW f 1 fJA 'i CA\- CloYnWebsite: OWNER'S NAME TEL# (017 -- S (0a)_9 ADDRESS �} ) s� � �� • 4I LYNN M-}\. Nq 0� SttREET CITY STATE ZIP CERTIFIED FOOD MANAGER'S NAME(S) CERTIFICATE#(S) (Required in an establishment where potentially hazardous food is prepared) EMERGENCY RESPONSE PERSON HOME TEL# (DAYS'OFOPERATION,; ' ''.::Monday,,.=r-1" Tuesday . '-J-" `,;#;;'cFriday'. L :;:+S'atuNay,_,,, "^,Sundays. HOURS OF OPERATION �7 Pryt ! AM ?Mi AM �M 4M pM "41 -7-Nm MI p M PM pth PM Please write in time of day. ;/ — I' 7 --�I 17 -- 'I j 7 — 11"':7*' All 1 -7 — 1' — (For example 11 am-11 pm) TYPE OF ESTABLISHMENTFEE (check only). RETAIL STORE YES NO less than 1000sq.ft. 5$j0 1000-10,000sq.ft. 28 more than 1 0,000sq.ft. =$420 -------------------------- - -- – ------------------- ----------------------- ----------------------------------------------- RESTAURANT YES NO less than 25 seats =$140 (Outdoor Stationary Food Cart$210) 25-99 seats =$280 more than 99 seats =$420 ------------- ---------------- ---------------------- BED/BREAKFAST/ YES NO $100 CHILDCARE SERVICES/NURSING HOME--- ----------------------------------------------------------------------------------•-----------•-- ---------------------- ADDITIONAL PERMITS MAKE (not just serve) ICE CREAM, YOGURT/SOFT SERVES NO 25 TOBACCO VENDOR YE57 $13 ALL NON-PROFIT(such as church kitchens) NO '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 stre taxes equired under the law. 413 4 U441 111allID Signature Date Social Security or Federal Identification Number Revised 10n11l FOODAP201 Ladm Check#&Date Commonwealth of Massachusetts City of Salem Board of Health 120 Washington Street,4th Floor SALEM,MA 01970 Food/Retail Establishment Permit DATE PRINTED: 03/29/2010 ESTABLISHMENT NAME: Congress Market File Number:BHF-2004-000105 95 Congress Street Salem MA 01970 LOCATED AT: 0095 CONGRESS STREET SALEM, MA 01970 Permit Type Permit No. Permit Issued Permit Expires Fee Restrictions/Notes RETAIL FOOD BHP-2010-0185 Jan 4,2010 Dec 31,2010 $280.00 TOBACCO VENDOR BHP-2010-0186 Jan 4,2010 Dec 31,2010 $135.00 Total Fees: $415.00 PERMIT EXPIRES December 31, 2010 Board of Health This Permit is not transferable and must be reissued upon change of ownership or location.The permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code,beofre any revonations,improvements,or equipment changes are made,all plans for such must be submitted to and approved by the Salem Board of Health. Page 1 CITY OF SALEM, MASSACHUSETTS • BOARD OF HEALTH 120 WASHINGTON STREET,4"'FLOOR TEL. (978) 741-1800 KIMBERLEY DRISCOLL Fax(978) 745-0343 MAYOR DG;REENBAUM(G)SALEM.COM DAN7ID GREENBAUM, ACTING HEALTH AGENT 2010 APPLICATION FORPERMIT TO OPERATE A FOOD ESTABLISHMENT NAME OF ESTABLISHMENT W GkES� " AKTEl �- TEL# ?R - - --S q A ADDRESS OF ESTABLISHMENT �TJr C°IAYU,�R 3� g� FAX# 9 :2 2-- MAILING ADDRESS(if different) EMAIL-Business': Website: OWNER'S NAME LA Q-, P�-W L�. I TE # 0 7- S-39-6J ; ADDRESS 4,G S© St� r �- L N'`t M 7N. 049 or STREET 11 IA, nn CITY STATE g� ZIP '1> CERTIFIED FOOD MANAGER'SNAME(S) t__ & 6�ku CERTIFICATE#(S)K62 3W+/ (Required in an establishment where potentially hazardous food is prepared) EMERGENCY RESPONSE PERSON LAC/ BWHOME TEL# `70—" 6- 077 ; 1413rAXS QF°OPERA ION '• ;Mbpday i Twesday ( Ned'nes�ay d Tifitjlstlay :;u Fi dayi l Iuidiiyavw 3ynday ' HOURS OF OPERATION a+rt pt)l ofn P>n) Q ty 1q a+n em! ani- 4 ni A �,y3 qt1 0 y (�Crth pP r1 Please write in time of day. -7 - 10 17 , I O _Id d — 4 (For example 11 am-11 pm) - TYPE OF ESTABLISHMENT FEE (check only) RETAIL STORE YES NO less than 1000sq.ft. 1000-10,000sq.ft. =$280 more than I0,000sq.ft. - -------------------------------------------------------------- -------------------------- RESTAURANT YES NO less than 25 seats =$140 (Outdoor Stationary Food Cart$210) 25-99 seats =$280 more than 99 seats =$420 - __- BED/BREAKFAST/ YES NO $100 CHILDCARE SERVICESMURSING HOI ADDITIONAL PERMITS MAKE (not just serve) ICE CREAM, YOGURT/SOFT SERVE NO TOBACCO VENDOR YES NO OSP ALL NON-PROFIT(such as church kitchens) NO '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 pli state taxes required under the law. , -1 0A 223-88-5 58 Signature Date Social Security or Federal Identification Number zpm- Revised 424/07 FOODAP2008.adm Check#&Date /7t/ $ AMENDMENT OF LEASE, ASSiONMENT OF LEASE AND LANDLORD'S CONSENT a 3 lda AGREEMENT made this y of July,2012,by and between Luong Nguyen, Successor Trustee of the 99-101 Congress Street Realty Trust(hereinafter called the "Landlord'),Mercy Market, Inc.and Diep Do (hereinafter called the"Tenant/Assignor") and Shree Laxmi Krup,Inc. (hereinafter called the"Assignee")ti WHEREAS,the Landlord and Tenant entered into a lease for a portion of the building, consisting of 4000:�sf,located at 95 Congress Street,Salem,Massachusetts(hereinafter called "Leased Premises'7,by agreement entitled Lease dated October 30,2002(hereinafter called the "Lease");and WHEREAS,the Tenant/Assignor and Assignee have entered into a Purchase and Sale Agreement for the purchase and sale of the business known as Congress Street Market located at the Leased Premises(Business);and WHEREAS,the Tenant/Assignor is desirous of assigning the Lease to the Assignee foc the continued use of the Business; WHEREAS,the Assignee is desirous of adding two(2)additional five(5)year options to extend to the Lease; WHEREAS,the Landlord consents to the assignment of the Lease and the addition of the two(2)five (5)year options to extend to the Lease upon the following terms and conditions;and NOW THEREFORE,in consideration of One($1.00)Dollar and other valuable considerations paid by each party to the other,the parties hereto agree as follows:: .(f Z 1. The Tcnaur/Afgoor assigns all ofits right title and interest as Tenant in the Lease to the Assignee and the Assignee assumes and opm to be bound by and perform ald of the covenants,duties and obligations to be performed by Tenant under the Lease from and after the date ofitspurchase ofthe Btuvmm including payment ofrent,thereby refusing the, Tenant/Assignor from all further obligation under the Lease. Z The Landlord hereby consents to the assignment ofthe Lease by the Tenanf/Assignorto the Assignee. 3. The Landlord and Tenant/Assignor hereby represent that the Lease remains in full force and effect and that neither party is in default at the present time nor in violation of any of the terms and conditions of the Lease. KP 4. Paragraph 9 of the Lease is amended by adding"and fol'servicer at the: "convenience storelmarket". S. Paragraph 41 of the Lease amended by deleting said Paragraph 41 in its entirety and substituting in place thereofthe following new Paragraph 41: `OPTI.ON. Provided that the Lessee has not been in material default(after any applicable grace period)during the initial ten (10)year term ofthis Lease,the Lessee shall have three(3)consecutive options to extend this Lease for subsequent terms of five(S)years each upon the same terms and conditions except for the rent which shalt be adjusted as hereinafter set forth. The Lessee's option to extend must be, exercised by the Lessee at least six(6)months prior to the expiration of the original or extended term by written notice given to Lessor by certifred mail,return receipt requested,ofits intention to exercise said option to extend. 2 Red during each lease year of the option term shall be as follows: OS/IA3—04130/14 $3,300.00 per month 0511114—04130115 $3,350.00 per month 0511115—04!30116 $3,400.00 per month 05/1/16—04130/17 $3,450.00 per month 0511!1.7—04/30118 $3,$00.00 per month 05/11t8—04130/19 $3,55000 per month 05/1119—04130120 130000 per month 0511110—04130121 $3,65000 per month OSMf.—04/30/22 $3,700.00 permonth 0511122—04/30/13 $3,75000 per month OSTM-0413M4 $3,80000 per month 05/1114—04130/15 $3,850.00 per month 0SIY75—04130126 W00.00 per month 0511116-04/30@7 $3.950.00 per month W1127—MOM $000.00 per month 6. This Agreement shall not become effective unless and until the closing contemplated by said Purchase and Sale Agreement has Been co0summata 3 1. to nv otic way dors this Ag=umt nwft,cxftnd,or o&nvdw 2kff the tmw sadcovenays of Lmr- / 11� F,*C hm l oo sddo�lmn&mmd seals lids ,2 3—/ "Y of Lit-7 it ,2@12. Lwmftak v 6.uongYiOYCO,T Tam! PD VIM= Brian at the Salem Evening News: Phone: 978-338-2540 Fax: 978-927- 1.020 Once you have your legal ad call Brian to arrange billing and advertising 0095 Congress Street Congress Market City of Salem RETAIL FOOD - Food Establishment Inspection HACCP: n Item Status Violation Critical Urgency Telephone: T PROTECTION FROM CONTAMINATION ' 978.745-8918 i Food Contact Surfaces Cleaning and Sanitizing FAIL Critical U RED 'Owner: ; Comment:Sanitizer test strips must be provided at all times. Lac Bul 'PIC: Lac Bui _ Inspector: Elizabeth Salandrea Date Inspected:Correct By: 912912009 Risk Level: ;Permit Number: I BHP-2009-0200 Status: 4 SIGNED OFF i t#of Critical Violations: Time IN: I Time OUT: Urgency Description(s): BLUE: All other violations noted in the 9117109 inspection report have been corrected. Violations Related to Good Retail Practices (Critical violations must be corrected immediately or within 10 days)(Non-critical violations must be corrected immediately or within 90 days) City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741-1800 GeOTMSO 2009 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Oct 05,2009 } Page 1 of2 f Item Status Violation Critical Urgency RED:_ _ . . _ Violations Related to Foodborne Illness Interventionsi and Risk Factors (Require immediate corrective action) City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741-1800 GeoTMS®2009 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Oct 05,2009 ) Page 2 of R 0095 Congress Street Congress Market City of Salem RETAIL FOOD - Food Establishment Inspection HACCP: ❑ Item Status Violation Critical Urgency ,Telephone: PROTECTION FROM CONTAMINATION 978-745-8918 Food Contact Surfaces Cleaning and Sanitizing FAIL Critical ❑ RED ,Owner: Comment: No sanitizer was available in back room,and owner stated that establishment has been doing a minimal amount of a Lac Bui - wrapping of pre-cut meats.Provide sanitizer of proper concentration and test strips for the sanitizer at all times for area where PIC: - meat is being wrapped. J�`_(3�h�1t}�InL��r �K j Handwash Facilities YtX..t,Cl I W t FAIL Critical d❑ RED Lac BUI ✓Comment: Bathroom sink had no soap or paper towels.Provide soap and paper towels in wall-hung dispensers at all handwash ,Inspector: sinks at all times. 'Elizabeth Salandrea - TIMEITEMPERATURE CONTROLS(Potentially Hazardous Foods) Date Inspected:Correct By: Hot and Cold Holding FAIL Criticald❑ RED 9/17/2009 womment: Left Pepsi fridge at 50°F at time of inspection.Repair or turn down to maintain temperature of 41°F or below. I Risk Level: ,Permit Number: BHP-2009-0200 t Status: VIOLATION #of Critical Violations: 4 grime IN: Time OUT: Urgency Description(s): BLUE: Violations Related to Good Retail Practices (Critical violations must be corrected immediately or within 10 days)(Non-critical violations must be corrected immediately or within 90 days) City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741.1800 GeoTMS@ 2009 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Sep 21,2009 ) Page 1 of r Item Status Violation Critical Urgency RED: w Violations Related to Good Retail Practices (Blue Items) Violations Related t0 Food and Food Protection FAIL Critical BLUE Foodborne Illness Interventions and Risk Factors (Require v6mment: Employee drinks were observed in front deli case.Store employee items separately to prevent cross contamination. immediate corrective action —Some items had stickers on them with expiration dates that were different from the date on the packaging.Do not re-label items with expiry on dates different from the dates on the packaging. 40& iwconmh ttct*W (bels here were several packages of meat for sale in the freezer with no labels or dates on them.Any re-packaged meat for sale must be dated and labeled properly. Some items had price labels covering expiration dates.Do not cover expiration dates with labels. The following items were removed,outdated: 6 packages margarine 3 packages oscar mayer bologna 1 tropical queso cremita 5 tropical queso fresco ✓21 tropical gelatin deserts 1 tropical rice pudding 2 bottles tropical cream 1 carton eggs 1 can beets,dented 4 jars chicken bouillon 10 jars beef bouillon 4 boxes powdered beef bouillon 2 cases of beef bouillon 1 can goya tomato paste,dented 8 bottles lemon juice 13 mountain dew game fuel 10 mountain dew code red 2 grape crush 15 grape powerade zero boxes shredded wheat 10 boxes 100-cal snack packs 06 cans nestle table cream 3 bags pumpkin seeds 2 cans chef boyardee,dented 8 cans diced tomatoes 4 bottles ken's blue cheese dressing 7 cans goya tuna 8 boxes stovetop stuffing 1 jar smuckers sugar free jelly 2 cans sardines,dented 7 campbell's soup at hand 5 boxes taco shells 4 bottles pure country of 7 cans sugar free red bull Owner must closely monitor all expiration dates. City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741-1800 GeoTMS®2009 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Sep 21,2009 ) Page 2 of roe Item Status Violation Critical Urgency Equipment and Utensils FAIL Non-Critical BLUE t omment:Freezer needs visible,accurate Internal thermometer. V BBaack Ice cream freezer needs a visible,accurate internal thermometer. Wwo small countertop fridges in front need visible,accurate thermometers. dere is what appears to be mold growth on the ceiling of the walk-in cooler.Remove mold,repaint ceiling,seal seams,and repair any sources of moisture. Physical Facility FAIL Non-Critical BLUE Comment:Sink In bathroom is leaking.Repair sink to be free from leaks;please forward service invoice to the Board of Health. Reinspection in one week, all violations to be corrected. A, City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741-1800 GeoTMS02009 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts { Rev. Sep 21,2009 ) Page 3 oj'3 Commonwealth of(Massachusetts City of Salem s i• Board of Health 120 Washington Street,4th Floor IGmberiey Driscoll Mayor SALEM,MA 01970 Food/Retail Establishment Permit DATE PRINTED: 12/23/2008 ESTABLISHMENT NAME: Congress Market File Number:BHF-2004-000105 95 Congress Street Salem MA 01970 LOCATED AT: 0095 CONGRESS STREET SALEM, MA 01970 Permit Type Permit No. Permit Issued Permit Expires Fee Restrictions I Notes RETAIL FOOD BHP-2009-0200 Dee 23,2008 Dec 31,2009 $280.00 TOBACCO VENDOR BHP-2009-0201 Dec 23,2008 Dec 31,2009 $135.00 Total Fees: $415.00 PERMIT EXPIRES (December 31, 2009 Board of Health h� 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 l CITY OF SALEM, MASSACHUSETTS w + BOARD OF HEALTH 120 WASHINGTON STREET,4`FLOOR TEL. (978)741-1800 KIMBERLEY DRISCOLL FAX(978) 745-0343 MAYOR IDtONNt (a),SnLENI.COM -JANET DIONNE, ACTING HEALTH AGENT 2009 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT NAME OF ESTABLISHMENT 00-4 kl/:t Fl I <(f TEL# " 'I-/ R— ' 1� J!T_ d�7 QI 1 V ADDRESS OF ESTABLISHMENT A1C �11(7�r2SY ��'- >(AIQI'YL FAX# 9_7 K— 7) ! � 52 1 ) $ MAILING ADDRESS(if different) EMAIL- Business': ii ^^N ic�A Website: LAN I A OWNER'S NAME (�,yUI TEL# ADDRESS 4 6 5(-Dy� ST. I.YN N �— STREET CITY, STATE ZIP CERTIFIED FOOD MANAGER'S NAME(S) L4N G R)U J CERTIFICATE#(S) Kg)_00'0 4_7 (Required in an establishment where potentially hazardous food is prepared)Lt- EMERGENCY RESPONSE PERSON -Ac. �v f HOME TEL# I.DAYS OF..OPERATION" i " Monday*--`-1:' Tuesday 1 Wednesday:;.! :Thursday- j" - " Friday,, .i Saturday Sunday -" I HOURS OF OPERATION Please write in time of day. I VQD- ip� M-)�P�i gRm-'iI P' ' Sevin-141011 i q ry1M' w) grri l p'h) (For example 11 am-11 pm) r�(q( 0.n•r1_11 hJ P 'I TYPE OF ESTABLISHMENT FEE (check onlv). RETAIL STORE YES NO less than 1000sq.ft. =$70 1000-10,000sq.ft. Q-1280 more than I0,000sq.ft. =$420 - - RESTAURANT YES NO less than 25 seats $140 (Outdoor Stationary Food Cart$210) 25-99 seats =$280 more than 99 seats =$420 ---------------------------------------------------------- ------------ ---------------------------------------------------- ----------I-----------_---------- BED/BREAKFAST/ YES N ) $100 CHILDCARE SERVICES - ------------------------ ADDITIONAL PERMITS MAKE (not just serve) ICE CREAM, YOGURT/SOFT SERVE YF4 $25— TOBACCO VENDOR YES $135 ALL NON-PROFIT(such as church kitchens) NO '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,Saction 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 gll state taxes required under th> aIw.� � � ot Signature V Date Social Security or Federal Identification Number Revised 424/07 FOODAP2008.adm Check#&Date $ L.'2 F 0095 Congress Street Congress Market City of Salem RETAIL FOOD - Food Establishment Inspection HACCP: ❑ Item Status Violation Critical Urgency _Telephone: 978-745-8918 Owner: Lac Bui PIC: Lac Bui .Inspector: Elizabeth Salandrea Date Inspected:Correct By: 1/21/2009 Risk Level: Permit Number: i BHP-2009-0200 ;Status: SIGNED OFF 4 of Critical Violations: 0 Time IN: I Time OUT: f Urgency Description(s): I BLUE: All violations noted in the 1/12/09 inspection report have been corrected. Violations Related to Good C Retail Practices (Critical . Owner states this establishment is not cutting any meat currently, and also states he may begin cutting and violations must be corrected repackaging meat again in a few months. Owner is to notify Board of Health if/when he starts this operation again. immediately or within 10 days)(Non-critical violations must be corrected immediately I or within 90 days) City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741-1800 GeoTMS®2009 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Jan 21,2009 ) Page 1 of Item Status Violation Critical Urgency RED: Violations Related to Foodborne Illness Interventions and Risk Factors (Require immediate corrective action) XF City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741-1800 GeoTMS®2009 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Jan 21,2009 ) Page 2 oft 0095 Congress Street Congress Market City of Salem RETAIL FOOD - Food Establishment Inspection HACCP: ❑ Item Status Violation Critical Urgency (Telephone: TIMEITEMPERATURE CONTROLS(Potentially Hazardous Foods) 1978-745-8918 Hot andel mHolding FAIL Critical ❑d RED Owner: enta Freezer was at a temperature of 15°F.Turn down or repair to maintain temperature of 0°F or below. Lac Bui Juice fridge in back was at a temperature of 44°F.Turn down or repair to maintain temperature of 41°F or below. iPIC: ,David Bui Inspector: Elizabeth Salandrea Date Inspected:Correct By: 11/12/2009 Risk Level: Permit Number: BHP-2009-0200 !Status: VIOLATION #of Critical Violations: 2 Time IN: Time OUT: it Urgency Description(s): BLUE: Violations Related to Good Retail Practices (Critical j violations must be corrected immediately or within 10 N days)(Non-critical violations must be corrected immediately or within 90 days) City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741.1800 GeoTMS®2009 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Jan 21,2009 ) Page 1 of •e Item Status Violation Critical Urgency Violations Related to Good Retail Practices (Blue Items) Violations Related to Food an ood Protection FAIL Cdtiml BLUE Foodborne Illness Interventions I and Risk Factors (Require Comment:The following items were removed outdated: immediate corrective action) 2 hood sour cream 12 lunchables 7 tampico citrus punch 13 amp drinks 6 cans diet Pepsi 1 ocean spray cranberry juice , 1 sobe drink 7 sierra mist cranberry 7 hawaiian punch 5 grape tropicana twister soda 21 tropicana pink lemonade 13 tropicana flavor splash 12 diet dr pepper 27 coke zero 12 sprite zero 19 dasani plus 6 2L tropicana lemonade 11 red vault 25 vault 2 white pure country milk 1 chocolate pure country milk 5 diet caffeine free coke 1 minute maid of 16 peak iced tea 7 cans slim fast 2 kraft mayo wl olive oil 3 kraft mayo 2 boxes ice cream cones 2 wish bone dressings 1 Gains dressing 1 can swanson chicken 8 aunt jemima syrup 10 ocean spray cranberry sauce 9 boxes betty crocker scalloped potatoes 1 box pop secret light 3 nestle la lechera 12 cans goya kidney beans 5 jars minced garlic Owner to closely monitor all expiration dates. Equipments Utensils FAIL Non-Critical BLUE omment: Front deli case had broken thermometer.Provide new visible,accurate internal thermometer for this unit. VII beer cooler needs thorough cleaning on shelving,door tracks and floor. City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741-1800 GeOTMS®2009 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Jan 21,2009 ) Page 2 of Item Status Violation Critical Urgency I.kreezer did not have an internal thermometer. Provide visible,accurate internal thermometer for the freezer. i/Ight Pepsi fridge needs general cleaning in door tracks. ilk cooler needs general cleaning in door tracks. of coke fridges need general cleaning in the door tracks. Xrm ridge in aisle next to candles needs general cleaning. unit missing a thermometer.Provide visible,accurate internal thermometer for this unit. alk-in cooler has some staining that appears consistent with mold on seams on the ceiling.Investigate for sources of moisture, seal seams where necessary,and repaint ceiling. Physical F cildy FAIL Non-Cntical BLUE omment: Floor of the small beer cooler appears to be in disrepair,with a sign serving as the floor on one side.Repair floor of this cooler to be intact,impervious and easily cleanable. Reinspection in one week, all violations to be corrected. Owner states this establishment is not cutting any meat currently, and also states he may begin cutting and repackaging meat again in a few months. Owner is to notify Board of Health if/when he starts this operation again. y� City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741-1800 GeoTMS®2009 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Jan 21,2009 ) Page 3 of v 0095 Congress Street Congress Market City of Salem RETAIL FOOD - Food Establishment Inspection HACCP: ❑ Item Status Violation Critical Urgency Telephone: 1978-745-8918 I Owner: Lac Bui )PIC: I Dung Bui l l inspector: #David Greenbaum Date Inspected:Correct By: ®5/28/2008 Risk Level: a Permit Number: BHP-2008-0004 Status: SIGNED OFF i#of Critical Violations: 10 !Time IN: {Time OUT: .,Urgency Description(s): a BLUE: 9 All violations cited in the 5/21/08 inspection report have been corrected. Violations Related to Good Retail Practices (Critical violations must be corrected immediately or within 10 days)(Non-critical violations I must be corrected immediately or within 90 days) City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741-1800 GeoTMS®2008 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. May 29,2008 ) Page 1 of rl Item Status Violation Critical Urgency ` .5 ;Violations Related to ^ Foodborne Illness Interventions and Risk Factors(Require immediate corrective action) , City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741.1800 GeoTMS®2008 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. May 29,2008 ) Page 2 oft 0095 Congress Street Congress Market City of Salem RETAIL FOOD - Food Establishment Inspection HACCP: ❑ Item Status Violation Critical Urgency Telephone: PROTECTION FROM CONTAMINATION 97$-745-891$ ' Handwash F ies FAIL Critical ❑d RED owner: _ omment:The meat room hand wash sink has a hose attached to it. Hand wash sinks must be used for hand washing only. Lac Bui �FISe same hand wash sink missing paper towels. Provide disposable paper towels at this hand wash sink at all times. PIC: I Dung BuiT e rest room hand wash sink missing soap and paper towels. Provide soap and disposable paper towels at all times. Inspector: - TIMEITEMPERATURE CONTROLS(Potentially Hazardous Foods) David Greenbaum Hot and cold ing FAIL Critical ❑ RED Date Inspected:Correct By: omment:The Hussman freezer has a temperature of 20°F. Repair unit to maintain a temperature of 0°F or below. 15/21/2008 rThe obastalitos had temperatures of 103°F to 108°F. Hot potentiall hazardous foods must be held at a temperature of 140°F or higher. Risk Level: ] Violations`kelated to Good Retail Practices (Blue Items) I Food and Food Prot ction FAIL Critical BLUE 'Permit Number: co ant:There are some meat items that are not labeled. Properly label all meats. BHP-2008-0004 Status: The following items removed outdated: VIOLATION 13-Parkay spread I#of Critical Violations: 12-Dairy delight shakes 111$ 1 -dole juice 31 -Go6d Start formula Time IN: Time OUT: 27 Nestle Media Creme i \ _S�Betty crocker pie crusts Urgency Description(s): 2-Ben crocker cake mix BLUE: Closely monitor all expiration dates. Violations Related to Good Retail Practices (Critical Reinspection in one week. All violations to be corrected. Violations must be corrected immediately or within 10 3 days)(Non-critical violations it must be corrected immediately or within 90 days) e 9 City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741-1800 GeoTMS®2008 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. May 22,2008 ) Page I oft %1 4 Item Status Violation Critical Urgency RED: Violations Related to ' Foodborne Illness Interventions and Risk Factors (Require ` immediate corrective action) City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741-1800 GeoTMS®2008 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. May 22,2008 ) Page 2 oft .a _ .. u - m. . .. -... .. m. r... .^ 'u.i. `i ws+ .- '.y'i • m1 .... .rC � YT. M.i++)n5-Rw ..fA '1 Commonwealth of Massachusetts s City of Salem Board of Health 120 Washington Street,4th Floor lGmberley Driscoll Mayor SALEM,MA 01970 Foo"etail Establishment Permit DATE PRINTED: 0110312008 ESTABLISHMENT NAME: Congress Market File Numbm BHI'-200 4W l05 95 Congress Street - Salem MA 01970 LOCATED AT: 0095 CONGRESS STREET SALEM, MA 01970 Permit Type Permit No. Permit Issued Permit Expires Fee Restrictions I Notes RETAIL FOOD BHP-2008-0004 Jan 3,2008 Dec 31,2008 $280.00 TOBACCO VENDOR BHP-2008-0033 Jan 3,2008 Dec 31,2008 $135.00 Total Fees: $415.00 PERMIT EXPIRES IDecember3l,2008 Board of Health This Permit is not transferable and must be reissued upon change of ownership or location.The permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code;beofre any revonations,improvements,or equipment changes are made,all plans for such must be submitted to and approved by the Salem Board of Health. Page 12 of 28 e a CITY OF SALEM, IVMASSACEiUSEM BOARD OF HEALTH 120 WASHINGTON STREET,4" FLOO` r— TEL.(978)741-1800 ° �L-CEIVED KIMBERLEY DRISCOLL FAx(978) 745-0343 MAYOR 1S0=aSALEM.COM NOV 2 71007 EM JOANNE SCOTT, t iL HEALTH AGENT +LTH 2008 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT /� p NAME OF ESTABLISHMENT �_� CQRFi� I' 'ARK�T TEL# `I� O — / � 1 l ADDRESS OF ESTABLISHMENT �1S COhAfP,SC �I -- 4QIOM FAX# MAILING ADDRESS(if different) Wm EMAIL-Business': ' 0 C, 1M A 1\j'6Vk A C11�Website: OWNER'S NAME LCI C'_ 9-w 1 TEL# 00 1 ? CP 213 ADDRESS J4G (Z0k 1,t `I-:YhlN M k �))901`7- STREETr CITY STATE ZIP CERTIFIED FOOD MANAGER'S NAME(S) LhNc, [��ul CERTIFICATE#(S) 1' M?>211LY (Required in an establishment where potentially hazardous food is prepared)pQ EMERGENCY RESPONSE PERSON —kc, Mi HOME TEL# o� -'!5q6— 07') DAYS OF OPERATION Monday Tuesday c)Wednesday Thursday Fnday Saturday Sunday HOURS OF OPERATION : g O m q ril g Q m — Q-M Pleasemin time of day. (Forexamplellam-11pm1 lO1 ,r4 Io v h_ 10 r m lop) 11 p m 11 Pm" 8 v m - pl TYPE OF ESTABLISHMENT FEE (check only). RETAIL STORE YES NO less than 1000sq.ft. 1000-10,000sq.ft. _$280 more than 10,000sq.ft. - - ...J -- y------------------------- ----------- -------------------------------------------I --- -- --- -5—s'e— ...----------------------- RESTAURANT YES NO less than 25 seats =$140 (Outdoor Stationary Food Cart$210) 25-99 seats =$280 more than 99 seats =$4.20 -6 ED/B --------- ----------------------------------------------------------- — --------- ------------------------.......------------------------ REAKFAST/ YES NO $100 CHILDCARESERVICES--------------------------------------------------------------------------------------------- ---------------------- ADDITIONAL PERMITS MAKE (not just serve) ICE CREAM,YOGURT/SOFT SERVE YES $25 TOBACCO VENDOR YES NO $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. Pursuant to MGL Chapter 62C, Section 49A,I certify under the pains and penalties of perjury that I,to my best knowledge and belief,have fled all state tax returns and paid al}I state taxes required under the law. Signature I. Date Social Security or Federal Identification Number Revised 4/24/07 FOODAP2008.adm Checkft&Date )kh IID I 1� 16) 8 "D • 06 - 0095 Congress Street Congress Market City of Salem RETAIL FOOD - Food Establishment Inspection HACCP: ❑ Item Status Violation Critical Urgency Telephone: '.. _ 1 PROTECTION FROM CONTAMINATION 978-745-89 ' Food Contact Surfaces Cleaning and Sanitizing FAIL Critical ❑� RED 18 ., , Owner: °e +; n Comment:The blade of the meat cutting saw has an accumulation of food debris. The meat cutting saw must be properly cleaned Lac BUI .. , and sanitized after each use. $$PIC: = $Lac Bui ,' g Violations Related to Good Retail Practices (Blue Items) Inspector: a Physical Facility FAIL Non-Critical BLUE David Greenbaum Comment:The walk in ceiling has water damage and mold. Investigate the source of the leak and repair. Repair and clean the Date Inspected:Correct By: ceiling.Repinating is in order. 111/8/2007. GENERAL COMMENTS: Risk Level: , All other violations cited in the 11/1/07 inspection report have been corrected. s Permit Number: BHP-2007-0004+ .• Status: SIGNED OFF #of Critical Violations: 1 Time IN: Time OUT: Urgency Description(s): BLUE: Violations Related to Good .Retail Practices (Critical :violations must be corrected: immediately or within 10 iiays)(Non-critical violations" must be corrected immediately or within 90 days) City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741-1800 GeoTMS®2007 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Nov 08,2007 ) Page 1 oft . I J Item Status Violation Critical Urgency ;RED: Violations Related to 'Foodborne Illness Interventions and Risk Factors (Require "immediate corrective action) Cityof Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741-1800 GeoTMS®2007 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Nov 08,2007 ) Page 2 oft 0095 Congress Street Congress Market City of Salem RETAIL FOOD - Food Establishment Inspection HACCP: ❑ Item Status Violation Critical Urgency Telephone: PROTECTION FROM CONTAMINATION 978-745-8918 Food Contact Surfaces Cleaning and Sanitizing FAIL Critical ❑d RED Owner: Comment:The blade of the meat cutting saw has an accumulation of food debris. The meat cutting saw must be properly cleaned Lac Bui and sanitized after each use. PIC: alDZKY knives found in the meat room. All knives must be properly cleaned and sanitized after each use. Dung Bui / Inspector: rhes' /'anitizin solution in the meat room found too strong. Sanitizing solution of proper concentration must be readily available in David Greenbaum -t-tire meat room at all times. Date Inspected:Correct By: Handwash Facilities FAIL Critical ❑d RED 11/1/2007 Cy!ent:The front hand wash sink has no hot water. Estore hot water at a minimum temperature of 110°F to the front hand wash sink irpnediately. Risk Level /yThe m It room hand wash sink found completely obstructed. Hand wash sinks must be kept clear and accessible at all times. Permit Number: BHP-2007-0004 Phe meat room hand wash sink missing paper towels. Provide disposable paper towels in the wall hung dispenser at all times. Status: VIOLATION #of Critical Violations: 3 Time IN Time OUT: Urgency Description(s): BLUE: Violations Related to Good Retail Practices (Critical violations must be corrected immediately or within 10 days)(Non-critical violations must be corrected immediately or within 90 days) City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741-1800 GeoTMS®2007 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Nov 01,2007 ) Page 1o(2 a l Item Status Violation Critical Urgency RED: Violations Related to Good Retail Practices (Blue Items) Violations Related to Food and Food P,rolection FAIL Critical BLUE Foodborne Illness Interventions and Risk Factors (Require Comment:There are many price labels obscuring expiration/sell by dates. Do not obscure any expiration/sell by dates with price immediate corrective action) Lllpd5als. The following,items removed outdated: 3-Philadelphia cream cheese 17-Ne$tle media crema 6-Hunt's Manwich sauce 3:alad dressing L,,,"3' /3-Grey Poupon ' S-Ice tea Closely monitor all expiration dates. ere is food stored directly on the floor of the meat freezer. Store all food at least 6-8 inches off the floor. Equipmen4ane fisils FAIL Non-Critical BLUE Ct:The green Hussman cooler needs a thorough cleaning,including all shelves. LThein walls have an accumulation of food spills and splatter. Thoroughly clean the walls. 1. Th shelves of the meat walk in freezer need a thorough cleaning. Physics Facili FAIL Non-Critical BLUE omment:The meat room ceiling has areas of damage and mold. Repair and clean the meat room ceiling. The walk in ceiling has water damage and mold. Investigate the source of the leak and repair. Repair and clean the ceiling. GENERAL COMMENTS: Reinspection in one week, all violations to be corrected. o' `J t �b City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741-1800 GeoTMS@)2007 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Nov 01,2007 ) Page 2 oft 0095 Congress Street Congress Market City of Salem RETAIL FOOD - Food Establishment Inspection HACCP: ❑ Item Status Violation Critical Urgency Telephone: PROTECTION FROM CONTAMINATION 978-745-8918 Food Contact S as Cleaning and Sanitizing FAIL Critical d❑ RED Owner: C ment:The 3 bay sink has no faucet. Repair faucet so the 3 bay sink can be used to properly wash,rinse and sanitize all Lac BUI / equipment and utensils. PIC: j The meat saw has an accumulation of food debris. Thoroughly clean and sanitize the meat saw after each use. Dung Bui Handwash Facilities FAIL Critical RED Inspector: David Greenbaum Comment:There are dishes stored in the front hand wash sink. Keep hand wash sinks clear and accessible and used only for Date Inspected:Correct By: h_ain-6 washing at all times. 4/12/2007 TThe and wash sink in the meat room has a hose attached to the faucet. Remove hose and use the hand wash sink for hand Risk Level: washing only. TIME/TEMPERATURE CONTROLS(Potentially Hazardous Foods) Permit Number: Hot and Cold Holding FAIL Critical 0 RED BHP-2007-0004 mment:The walk in meat freezer had a temperature of 20°F. Repair unit to maintain a temperature of 0°F or below. Status: VIOLATION #of Critical Violations: 4 Time IN: Time OUT Urgency Description(s): BLUE: Violations Related to Good Retail Practices (Critical violations must be corrected immediately or within 10 days)(Non-critical violations must be corrected immediately or within 90 days) City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741-1800 GeoTMS®2007 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Apr 12,2007 ) Page I of 2 Item Status Violation Critical Urgency RED: Violations Related to Good Retail Practices (Blue Items) Violations Related to Food and Food Protection FAIL Critical BLUE Foodborne Illness Interventions and Risk Factors (RequireComment:There are price labels covering expiration/sell by dates. Do not cover any expirationtsell by dates with price labeles. (i' immediate corrective action) The following items found outdated: 1 -King fish 5-Hood sour cream 15-La yogurt 3-Egg 2-Newmans salad dressing ties�11A Whea 13 -Oxtail 10-Minute maid juice 1 -Salami 2-Kraft dips 6-Packagr of cheese Owner must closely monitor all expiration dates. Equipment and,Utensils FAIL Non-Critical BLUE Com int:The mop found stored in the bucket. Clean mop and store upside down not touching any surface to air dry. �heee(front Fogel deli needs a visible,accurate thermometer. PhyaLCOMMENTS: FAIL Non-Critical BLUE ta There is a gap at the bottom of the side receiving door. Provide a sweep at the bottom of this door. GEN Reinspection in one week, all violations to be corrected. City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741-1800 GeoTMS®2007 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Apr 12,2007 ) Page 2 oft 0695 Congress Street Congress Market I City of'Salem RETAIL FOOD - Food Establishment Inspection HACCP: Fl Item Status Violation Critical Urgency Telephone: PROTECTION FROM CONTAMINATION 978-745-8918 Food Contact Surfaces Cleaning and Sanitizing FAIL Critical y] RED Owner: Comment:The meat saw has an accumulation of food debris. Thoroughly clean and sanitize the meat saw after each use. Lac Bui PIC: GENERAL COMMENTS: Dung Bui All other violations cited in the 4112/07 inspection report have been corrected. Inspector: David Greenbaum Date InspecteddCorrect By: 4119/2007 Risk Level: i Permit Number: BHP-2007-0004 Status: SIGNED OFF #of Critical Violations: 1 Time IN: (Time OUT: Urgency Description(s): 1 BLUE: Violations Related to Good Retail Practices(Critical violations must be corrected immediately or within 10 days)(Non-critical violations must be corrected immediately or within 90 days) City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741.1800 GeoTMS®2007 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Apr 19,2007 ) Page 1 oJ'2 Item Status Violation Critical Urgency RED: Violations Related to Foodborne Illness Interventions and Risk Factors (Require immediate corrective action) V I/x City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741.1800 GeoTMS®2007 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Apr 19,2007 ) Page 2 of*2 CITY OF SALEM BOARD OF HEALTH Name of Establishment: Congress Street Market Address: 95 Congress Street Owner(s): Lac Bui Phone: 978-745-8918 January 4, 2006 The owner of this establishment presented plans for the addition of a meat cutting operation for review in accordance with the State Sanitary Code. The meat will be purchased from a Wholesaler. FLOOR PLAN All surfaces must be intact, impervious and easily cleanable. Therefore, the cement floor must be impervious. All refrigeration units must have accurate internal thermometers. Refrigerated food must be held at 41 degrees Fahrenheit or lower, freezers at 0 degrees Fahrenheit or lower. HAND WASHING A hand sink must be installed in this room. It must have a wall hung soap and paper towel dispenser, stocked at all times. THREE-BAY SINK A 3-bay sink will be used to Wash, Rinse and Sanitize all equipment used in the meat cutting operation. CLEANING/SANITIZING All meat cutting equipment must be cleaned and sanitized immediately after use. A sanitizer must be made daily at 200 parts per million (PPM), tested with the correct test strips, the results recorded on a log sheet for inspection by the Board of Health. A sanitizing spray bottle, with clean paper towels, must be at each work station. LABELLING All packages must be labeled with the kind of meat, the weight, the use-by date, the name and address of the Market. If the owner wants to start slicing deli meats at the front counter, he must present a separate plan to the Health Agent. An inspection of the added meat cutting area will be conducted on January 12, 2007 04- i6nne Scott Date Health Agent Lac Bui, owner Date r rl i i i S1 f COY• �,, �� -_. _ ..._ =.:1 t ,,,,, _tli- ,, r-.t. r _ WoY��o.b�e. � �ts� :�, , � �`' � �-�� .�f r •.s oma 1 �`�� c3.t tr ��i�• �" �S a.� `tea��C1 u� _-_�' � •(� NOV/28/2006/TUE 09:45 AM P, 001/001 F - y'�"'j'�•;-Y''q,!; 'i ` r !.. M •iii.hi/�i -. '^.e fi•,.1 �3- ,y N. Pe► iry',Aar�Om4 rih�s llAvi��11�4e�s�' 04/30/06 From the Desk of Dan McCready ''' Quality Control Manager ':''` y'`" Poultry Products,NE 11 Bemis Rd ; - Hooksett, NH Phone: 603-263-1602 Fax: 603-263-1684 E- mail: danrnCa7oocnew,com Please be advised that all products received and sold by Poultry Products Northeast to its customers, will be received and sold in a safe and wholesome condition. All products will be received, stored and delivered at temperatures specific to the product. All items will be received and sold with product integrity . and intact packaging. All items will be receibedand sold with an approved computer generated label.Information will be product specific with net weight entered per container. No products will be received or sold adulterated, under any definition of the United States Department of Agriculture'(USDA), the Food and Drug Administration (FDA), the Environmental Protection Agency(EPA) or the Federal Food, Drug and Cosmetic Act(FD&C Act). Poultry Products is a USDA inspected facility and conducts its processes under'a e Hazard Analysis and Critical Control Points (HACCP) system. Our HACCP ; programs are reassessed annually tR ensure products are protected from Chemical, Biological, and Physical hazards. All Quality Control product and packaging dispositions are final. Sincerely Dan McCready QC Manager x Z In �aFeooDs�A THE NATIONAL REGISTRY OF *x. _ FOOD SAFETY PROFESSIONALS® i� _ CERTIFIES ZO LAC BUI N.CERTIFIEDHAS SUCCESSFULLY SATISFIED THE REQUIREMENTS FOR � PddO SAFEN ANNALP3i THE FOOD SAFETY MANAGER CERTIFICATION EXAMINATION President• National Regisin•of Food Safely Professionals Jmvm;ee J./.inch is a division of 171mronmenCd liealth Testing.LLC ISSUE DATE:AUGUST 7, 2006 CERTIFICATE NO: KB20038447 hf,9Af@.I,V.fkdl9eN;l .,.... TEST FORM: KBA N0656 This tern0eme k nm.alid for inure Ilan Gar,rnrr rrom dau or gene. CITY OF SALEM BOARD OF HEALTH Name of Establishment: Congress Street Market Address: 95 Congress Street Owner(s): Lac Bui Phone: 978-745-8918 January 26, 2006 The owner of this establishment had presented plans for the addition of a meat cutting operation for review on January 4, 2007. ) QiWa - During a reifi �spection, following a complaint, on January 19, 2007, Senior Sanitarian//observed produce wrapping in an aisle of the store. This process was not discussed during the January 4th review, therefore, the owner was asked to appear before the Health Agent to discuss the plan for the entire establishment. The owner will conduct meat cutting only in the meat cutting room. Produce wrapping will take place in the area of the establishment with the two bay sink. One bay may be used for produce washing and the other for hand washing if a splashguard is placed between the two bays. In addition, there must be a sign in English and Vietnamese at the meat cutting single sink saying "hand-washing only." All other requirements of the January 4t'' review must be met and approved by the Board of Health, prior to beginning the meat cutting operation. ff'anne Scott Date Health Agent ifl'(Ar 4- 16- 0 Lac Bui, owner Date Memo to File: Congress St NAaret From: Joanne Scott 11 Date: Jan. 11, 2007 Following an inspection today by Janet Dionne, I called this establishment and spoke with Lac Bui regarding the pastillito temperatures, the deli area and the refrigeration units. The refrigeration units are not in use now but will be used when the meat cutting room is opened. The deli area does not use the slicing machine yet but will when the meat room is open and the 3-bay sink is available. The owner was told to stop selling the pastillittos because the correct temperature cannot be maintained as observed over the last three inspections. The owner will call on Monday to set up an inspection for the opening of the meat cutting room. CITY OF SALEM BOARD OF HEALTH �� r -� 3 / Establishment Name: � GYQaMSS° /</�J�7Z Date: e: ' _,� G Page: v of Item Code C-Critical Item/ DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date No. Refer ce R—Red Item Verified ."Y PLEASE PRINT CLEARLY /v7, L - /%1�iilda zllS)JgLo 4 il.i-e_71(n 77 -6--, 1 /fie -04)zz 1 Discussion With Person in Charge: Corrective Action Required: ' ❑ No ❑ Yes I have read this report, have had the opportunity to ask questions and agree to correct all ❑ Voluntary Compliance ❑ Employee Restriction/ inspection, to observe all conditions as described, and to Exclusion violations before the next ins P L3 Re-inspection Scheduled ❑ Emergency Suspension comply with all mandates of the Mass/Federal Food Code. I understand that noncompliance may result in daily fines of twenty-five dollars or suspension/revocation of ❑ Embargo ❑ Emergency Closure your food permit. 0 Voluntary Disposal ❑ Other: Violation,,;Related to Foodli Ifiness;*m'PirvPritions arid Risk 3--')0 PHF;Rtac�ivedt Tcnmciatme� According to Iaw Cooled b� Factors(items 1-22), (Cont) 41'FI4.5'F kkithin 4 floors. r, Mds for PHFs PROTECTION FROM CHENVCALS 1 3-501.15 (oolingetho 14 2ond or Color Additives 19 PHF Hot and Cold Holding 3-501,1f)(13) Cold PIlF_, Ivito-itained aa or Mass 1 3-202.12 Additi,;c,)l 59(004(117) 41'/453 F` 3-302.14 Praccbon fr(an Unapproed Addili,.es* 3-501 16(At !lot PHFc Maintained at or above 15 Poisonous m Toxic Sulcstsnces 140'1- 7-10i.11 Idenrit'\Ing Injorn-.14tron-otiginal 1-501 16(A) Roasts Held at orabot c 130,-F C raitainers, -/-]()2 it CornrnonNai:;v, Wnrkiro_. Consain,,s� 2h Time as a Public Health Control 1 3-501.19 T ime as a Public Health Control* 7-201 11 S,parad,-.rt Stnaqc- 7-202 11 Pm,,vncr and Lie' 590.004(fl) Vanari Requirement i 7-202.1= Conilitien, of REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) 7-204.11 'Saish;zels'Criteria-ria-chearric'!k.. _-801 ll(A� Unpastcus itat Pre-packaged Juices�nd 7-1-04.12 Chpinicals for W�shunc I'm(Itwe, Criteria 21 Beveiages with Warning Labcls� 7-20 Diving Agents.Criteria" III 7-205.: hicick-til,,; 5,vd Cur:aot.Lu-bri.-antO: I-X01,1 liB) Use ul'Pasteurized E'gs* '-_"Ooll Resiricted Lae Pt sticides.Cruerin' 3-S( !.i 1(3) Raw or Paitially Cooked Aminal Food avid Raw Seel Sorows Not Sart ed. :t I 7-206.12 Rexton: Bait 3-X01.1 I'C) I Inoicned R"I Packa,-,v Not Rc-served. 7-20 6 1 m;t FrackPowdeu, Pest Control aod Nthtiiitorhl CONSUMER ADVISORY TIMEITEMPERATURE CONTROLS 22 3-603.1 i Curisurner Advisory Posted for COusumptionol 16 Proper Cooking Temperatures for u iiial Food6,riiat are kaw. I mclercouked or Mrs Not Otherwise Processed to blinutriate 3-401.11 A(1)(2) h^gs- 15> i 1.5 Sec. RittiogenO cs-hairisc.3;aie Ser%ice 1+5°F15.,"' i 3-302.13 Pasteurized Eggs Substitute lot Raw Shell 3-401.t I(A)(q) U,mminuted Eish, Mc,E,'k.Game jEcgs* Animals- ]>5'F 15 szc. 3-401.11(13)(I)(2) Po:}.and f-io-1 Roa,'t 130T i^_1 nrht* SPECIAL REQUIREMENTS 3 101.i I A)Q) Ralies, injected Nfe%is- 155`15 15 ;90.009(A)-(D) Violations of Section 59R009(A)-(D) in sec. catering, mobile food, temporary and 3-401.1 It 03) Poultr),Wild Gi:rne,StuFi'c,i VHF;, residential kitchen operations should be Stuffing containing Fish,iVieat, detated under the appropriate sections Poultry or R--t4es-1659-1 above i;related to foodborne illness 3-401.1 "Alloh--muscle,Inta,I Becf Steaks interventions and risk factors. Other 1.45rT' 590.009 violations relating to good retail 3=101.12 Raw Annual Foods Conked in a pr.cliceg should be debited under #29- Microwave 165'F!< Special Requirements, 3-40i.I l(A)(1 1(b) All OtIva PHFs- l45°F 1S we, 17 Fzheahnq for Hot Holding VIOLATIONS 14 SLATED TO GOOD RETAIL PRACTICES ,403.11(A),vz(1)? PHF,, 165'F 15 sec. (Items 23-30) Mictowave- 165'17 2 Minute Standing Ciitical and non-critical violations. which do not relate to the Time* foodborne diness interventions andrink fti(tars fisted obove. can be ?-403.11(C) (701ruel L)J%PrOCC;S-d KI IF FINXI- ,found in thejollownig sec tions of the Foud Code and 105 CAIR 140TY 590 000. ;-403,11 W) Remaining-Up.slic--c! :'orlon;of Beef I Item Good Retail Practices FC590.000 Roasts= 1 23. Management and Personnel FC__2 .003 18 Proper Cooling of PHFs I 1 24. Food and Food Protection FG-3 .004 3-50 1.14(A) ! 25. Equipment and Utensils FC-4 1005 Cooling Cooked PHPs from t,10'F to 1 26, 'Water,Pluff binq and Lsto FC-5 .006 70'F Wil un 2 Hour,;and From MT j 27 Physical Facility FC--"6 I 007 L,141'F/45''P Within 4 Hours. 28 Poisonous or Toxic Materials FC-7 008 3-501.141 B) Coolia',,PFIFs Made From Ambient 29 Sorx;ial Requirements 009 ,I, 1P emperatute hwra'ii,nts to�']0F,'4,i offel _-- W hus 4 Hours* Deno.cratal!tern In mo ti"IGI1d c99 Font( ode.v U)",0912 590 Doo. CSI/TY lO,F SALEM 7 Establishment Name: C� �I�T S �C, /1`�1! / '1jl,C_(' I� HEAD Date 7 Page: �� of Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date No. Reference R—Red Item Verified PLEASE PRINT CLEARLY n ,4 Amo— - 71/ Aa- 417J,4# 417J,,4# y f kal_1�9 is S�/Y L� j /"14 A la/oc/ )D f dl e/ ,;&Z) 1228,' , Cees /J 45MI 4"sY CYZ?Z�l Discussion With Person in Charge: Corrective Action Required: I ❑ No I ❑ Yes c 2 I have read this report, have had the opportunity to ask questions and agree to correct all ❑ Voluntary Compliance ❑ Employee Restriction/ violations before the next inspection, to observe all conditions as described, and to Exclusion p ❑ Re-inspection Scheduled ❑ Emergency Suspension comply with all mandates of the Mass/Federal Food Code. I understand that noncompliance may result in daily fines of twenty-five dollars or suspension/revocation of ❑ Embargo ❑ Emergency Closure your food permit. 0 Voluntary Disposal ❑ Other: Pffs Received ji'lemperatures Violations Related to Foodborne fflnoss Interventions and RhO According to Law Conled to Factors(Hrows 1-22.) (Ccm- -1 I'F!4s F Within,4 Hours. UM CHEMICALS PROTECTION XRC Cooling Nl-lhod0ior Pfij-s 14 Food or Color Aoditives 19 PHF Hot and Cold Holding -,-20-1,12 Addw�* i 3-501.16(B) Chid PlIFt, Mhuritained at of be low 3-102.11 Protection from t iapproved 59o.00-i(Fi 41'Ai" F' I- flot PHF; Maintained at or above JS Poisonous or Toxic substances 50 1.16(A) 7-101 11 ldent:fyin.-!nto:manon-S;rigmal140'K Containers" ( 3-501.!b!?.) Roasts Held at orabove 13,)'F. I 7-10111 cofumon Nanto-Wnrl11--' 20 Time as a Public Health Control 7-20!.11 Separation-Sloiagc4 1-501.19 Ti in,, as Public Fealth Control -m.; i Restriction-- Presence an,: f 1L,;,- i'XW040-1) Variance Requi(ellICIL 7 202.12 Cordlit;,ris tot I ;o', 7 203.11 Toric Containers-Pwlliblfion'4I REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-204.11 Sajutizcr+,Critena-OtemicaW POPULATIONS(HSP) 7-204 1221 3-801 IPAT Uripp�,,;tcunzcd Pr.-packaged]nice-,air,] Cheinic-nis for Wttshuie Pr,�duc,,riwerr: 7-204.14 Divin, Air-nis.Crileux' Beverages with Warning lithels* 7-!05.11 Incidental Food Contact.Lubriclints- 3-801.11 Llw of Pasteurized ELos- 206.11 R:slr;-ted 1 1w Pcs1-ic;te-,, CHtenn, 39.01.1 1(D) Rcw-or Pculiall,,Cooked Annual Fool and Raw Seed Sprouts Not Set ved. 7-206.12 Rn,i.mt Bait Stathav, 7-206.13 TrLJiing Powders.Per t Ccincrol and (C) Unripened Forld Package Not Re-screed. CONSUMER ADVISORY TIMEITEMPERATURE CONTROLS 22 3-003.11 Consumer Advisory Posted for Consumption of 16 Proper Cooking Temperatures for Amnia! Fon,13%, I'liat arc Rav;. LJndcjL')okcd or PHFr Not Otherwise Processed to Eliminate Pathoens.- �"" "' 3-401.i lA(l)(2) Eggs- 1,55'F 15 Sec. 3-302.1" Pasteurizoo E 's Substitute Icl Raw Shelf 3-401 ll-A)(2,) Conimunuied F,-,h, Meats&GameElugs Aniurais- 155' 3-401.1 l(BA I it,b Fork and Beef Roast - i 30''F 121 min' SPECIAL REQUIREMENTS 3-40!.!I(A)(2) Rallies, Injected Mats- 15',)"F 15590 00t)(A'l-(D) Violations of'Section 590.009(A)-(D)in see. T i catering, mobile food. lernpotary and 3 401.11(A)(3) Poullq, Wild Game,Stuffed PIH-Fs, residential kitchen operations should be StuffingContaininy Fish. Meat, debited under the appropriate sections Poultivor Ratites"165'F 15 sec above if related to foodborne illness Whole-muscle,Intacr Beef Steal, interventions and risk !actors. Other 1 590.009 violations relating to good retail 3=401.12 Raw Animal Foock Co,.Aed in practices should be debited under#29-- Microwa"e I11. + Special Requirements. 3-40-I I(A)(I 0) All 01lict PHFs- 1.45'F IS ;cc, 17 Reheating for Hot Holding VIOLATIONS RrLATED TO GOOD RETAIL PRACTICES 3 101.11(A)&(M PHF,, 165`17 15 soc. * (Itenis 23-30) 1-403.1!(R) NEciuwa,c- 165'F2 %finitle Standut.; C,rocal and non-,rifira!violation.y. ithich do twi i clarc io tile );110 j)odborne illness intet vennons widrisk fi7cto,s IiAlcd above, can"'e 3-40,5.11(C) Comarroaliv Prccc;s--d P%'FF F"--d- finuld in the'folloe ing sections q{rite Food Codcand 103 CAIR 140T 590.000. 3-103.11(E! Remaining,Uisliced Portions of 13---ef 1 1 Item Good Rib-dPractices FC 590`000�- Roast;" 1 23. Management and Personnel FC -2 .003 18 Proper Cooling ol PHF., 1 24. Food and Foot Prour:tion FC-3 .004 1 25 Equipment and Utensils FC-4 005 3-501.W(A) Cooling Conked P.41-s from 14011--tc M� 'Alw,r.Plu!nbirio and Waste FC-5 70'F Wohin 2 ifour,-ind Front 70"F r-271 Pnysical Facility F(7-6 1 "007 To 4!' !45'F Wth;ri 4 Hours. 28 Poisonous or Toxic MalerWs FC-7 008 3-50114(B) Ct+-fie:' PHFs),,Ia,,!e Fran;Ambient - Scociai neQuirer Teurpei'anire Ingredients To 41'17145'F 30. Other Within 4I-fou,c* I N for 999 Fend t'od,or 10' CNIR;90 u00 Massachusetts Department of Public Health Salem Board Health F' S 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 I Type of Operation(s) Type of Inspection .�Y)lMS'S C �o-/ 1//G!'/'/O /- %� ❑ Food Service ❑ Routine � 'Risk Q' Retail El Re-inspection Address Level '❑ Residential Kitchen Previous Inspection Telephone y ny/� _ �� )5/LElMobile Date: ❑ Temporary s0'Pre-operation Owner HACCP YM 1 ❑ Caterer ❑ Suspect Illness Person i"n Charge(PIC) Time ❑ Bed&Breakfast ❑ General Complaint XIA � In: ❑ HACCP Inspector J_-/I,# Ll1 Out: Permit No. El Other Each violation checked requires an explanation on the narrative page(s) and a citation of specific provision(s)violated. Non-compliance with: Violations Related to Foodborne Illness Interventions and Risk Factors, Anti-Choking Tobacco Violations marked may pose an imminent health hazard and require immediate corrective 590.009(E) ❑ 590.009(F) ❑ action as determined by the Board of Health. FOOD PROTECTION MANAGEMENT -112. Prevention of Contamination from Hands ❑ 1. PIC Assigned/Knowledgeable/Duties ®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 F-1 4. Food and Water from Approved Source TIME/TEMPERATUREOONTROLS(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 .. ' ' [119. Hot and Cold Holding ❑ 8. Separation/Segregation/Protection ❑ 20.Time As a Public Health Control ❑ 9. Food Contact Surfaces Cleaning and Sanitizing REt,1UIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) ❑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. Number of Violated Provisions Related 1 ` 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): �G 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: S 5901nsp OFOr 14 tlac Inspector's Signature` Pnn!>. _�/A l,f Yl� i 41 I . I ltiYi.J YV.:i✓ Pageof Pages PIC's Signature: 't t,,� Print: IA_�(_ I) U� 1 _ ' J / Violations Related to Foodborne Illness Interventions and Risk Factors(items 1-22) PROTECTION FROM CONTAMINATION FOOD PROTECTION MANAGEMENT 18 Cross-contamination . i I 596.003(A) Assignment of Responsibility" I 3-3011](A)(1) Raw Annual Foods Separated from 590.003(B) Demonstration of Knowledge" I Cooked and RTE Fo(xls* 2-103.11 Person in charge-duties I I Contamination from Raw ingredients 3-302.11(A)(2) Raw Animal Foods Separated from Each EMPLOYEE HEALTH ( I Other' 2 590.003(C) Responsibility of the person in charge to I Contamination from the Environment require repotting by food employees and 3-302.1](A) Food Protection` applicants* 3-302.15 Washing Fruits and Vegetables 590.003(F) Responsibility Of A Fcod Employee Or An I a-309.11 Food Contact with Equipment and Applicant To Report To The Person In I Utensils* Charge* I Contamination from the Consumer 590.003(0) I Reporting by Person in Charge" I 13-306.14(A)(B) I Returned Food and Reservice of Food-* - 3 590.003(D) ( Exclusions and Restrictions* I I I Disposition of Adulterated or Contaminated _5_9.0.003(E) Removal of Exclusions and Restrictions I Food J 3-701.11 Discarding or Reconditioning Unsafe I FOOD FROM APPROVED SOURCE I Food* J 4 Food and Water From Regulated Sources 19 Food Contact Surfaces 590.004(A-B) Compliance with Food Law* 4-501.111 Manual Warewashing-Hot Water 3-201.12 Food in a Hermetically Scaled Container* Sanitization Temperatures* - 3-201.13 Fluid Milk and Milk Products* 14-501.112 Mechanical Warewashina Hot Water 3-202.13 Shell Eggs* I _ Sanitization Temperatures* 13-202.14 Eggs and Milk Products.Pasteurized' I 14-501.114 ( Chentical Sanitization-temp.,pH, 1 * J 3-202.16 ice Made From Potable Drinking concentration and hardness.nk ng Water' 14-601 1 I(A) Equipment Fwd Contact Surfaces and I 5-101.11 Drinking Water from an Approved System' I J Utensils Clean' 590.006(A) Bottled Drinking Water* I 590.006(B) Water Meets Standards in 310 CMR 22.0'' 14-fi02.1 I Cleaning Frequency of Equipment Food- Contact Surfaces and Utensilsk Shellfish and Fish Froman Approved Source 4-702.11 Frequency of Sanitization of Utensils and 3-201.14 Fish and Recreationally Caught Molluscan _ Shellfish* Food Contact Surfaces ntEquipment* 14-703.11 ( Methods of Sanitization-Hot Water and 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* Sources* Game and wild rooms Approved by 10 Proper,Adequate Handwashing Regulatory Auihodority I 12301.11 Clean Condition-Hands and Arens" ty 3-202.18 Shellstock Identification Present* I ( 2-301.12 Cleaning Procedure* 590.004(C) Wild Mushrooms' ( 2-301.14 When to Wash* 3-201.17 Came Animals* I l it I Good Hygienic Practices ( $ Receiving/Condition I 12401.11 Eating,Drinking or Using Tobacco* 3-202.11 PHFs Received at Proper Temperatures* I ( 2401.12 Discharges From the Eyes,Nose and 13-202.15 Package Integrity- ( Mouth" J 3-101.11 Food Safe and Unadulterated* 3-301.12 Preventing Contamination When Tasting*_ b Tags/Records:Shellstock 112 Prevention of Contamination from Hands 3-202.18 Shellstock Identification* I 590.004(£;) Preventing Contamination from 13-203.12 Shellstock Identification Maintained, I Employees* Tags/Records:Fish Products I 113 Handwash facilities 13-402.17 Parasite Destruction* Conveniently Located and Accessible 13-402.12 I Records.Creation and Retention* I 15-203.11 Numbers and Capacities* 590.004(1) I Labeling of Ingredients' 15-204.11 Location and Placement* 7 I Conformance with Approved Procedures 15-205.i 1 Accessibility,Operation and Maintenance /HACCP Plans I Supplied with Soap and Hand Drying 3-502.11 Specialized Processing Methods* Devices 3-502.12 Reduced oxygen packaging,criteria` I 6301.11 Handwashing Cleanser,Availability 8-103.12 Conformance with Approved Procedures* I 16-301.12 Hand Drying Provision *Denotes critical item in the federal 1999 Pond Code w 105 CMR 590.000. Massachusetts Department of Public Health Salem Board of Health 120 Washington Sreet, Division of Food and Drugs Salem, MA 01970-t35234 1h 190-35234`" Floor FOOD ESTABLISHMENT INSPECTION REPORT Tel. (978) 741-1800 Fax(978) 745-0343 Name ) / Date Tvoa of 0 eration(s) Tyge of Insoection l' j00reS; A,0.0 f all/'ee AV 7 `D7 I ❑ Food Service ❑ Routine Address Risk []Retail 9'Re-inspection O1�(�r/SF'P f Level ❑ Residential Kitchen Previous Inspection Telephone p- ❑ Mobile Date:/,? �� ' �9/� ❑ Temporary ❑ Pr peratio/� Owner / /J "ACCP YM I ❑ Caterer ❑ Suspect Illness Person in Charge(PIC)77i � �--1�`19" Ay�f li.0 Time ❑ Bed&Breakfast ElGeneral Complaint In: El HACCP inspector _ O Permit No. Other -// . � Out: Ll Each violation checked requ`-fres 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. 4.. ' FOOD PROTECTION MANAGEMENT� r�.�� " ', .-... ... � : ❑ 12. Prevention Of Contamination from Hands ❑ 1. PIC Assigned/Knowledgeable/Duties El,. b 13. Handwash Facilities EMPLOYEE HEALTH . _.. _. ._. ... _,-.,. ...�. . ... .. . . .. . . . , PROTECTION FROM CHEMICALS El 2.' Reporting of Diseases by Food Employee and PIC ❑ 14.Approved Food or Color Additives ❑ 3. Personnel with Infections Restricted/Excluded ❑ 15.Toxic Chemicals FOOD FROM APPROVED SOURCE" 71MEREMPERATUREC0NTROLS(Potentially Hazardous Foods E] 4. Food and Water from Approved Source ) ❑ 5. Receiving/Condition ❑ 16.Cooking Temperatures ❑ 6. Tags/Records/Accuracy of Ingredient Statements ❑ 17. Reheating ❑ 7. Conformance with Approved Procedures/HACCP Plans ❑ 18.Cooling PROTECTION FROM CONTAMINATION ❑ 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) 1-121. Food and Food Preparation for HSP ❑ 10. Proper Adequate Handwashing ❑ 11. Good Hygienic Practices CONSUMER ADVISORY ❑22. Posting of Consumer Advisories Violations Related to Good Retail Practices Number of Violated Provisions Related Critical (C)violations marked must be corrected To Foodborne Illnesses Interventions immediately or within 10 days as determined by the Board and Risk Factors(Items 1-22): of Health. Non-critical (N)violations must be corrected Official Order for Correction: Based on an inspection immediately or within 90 days as determined by the Board today, the items checked indicate violations of 105 CMR of Health. 590.000/federal Food Code. This report, when signed below O N by a Board of Health member or its agent constitutes an 23. Management and Personnel (FC-2) order of the Board of Health. Failure to correct violations 24. Food and Food Protection (Fc-4)(5550.090.0 044))) cited in this report may result in suspension or revocation of 25. Equipment and Utensils (FC-4)(590 005) the food establishment permit and cessation of food 26. Water, Plumbing and Waste (FC-5)(590.006) establishment operations. If aggrieved by this order, you 27. Physical Facility (FC-6)(590.007) have a right to a hearing. Your request must be in writing 28. Poisonous or Toxic Materials (FC-7)(590.008) and submitted to the Board of Health at the above address 29. Special Requirements (590.009) within 10 days of receipt of this order. _ 30. Other DATE OF RE-INSPECTION: s ssa�nsv��o�,s-ia ax Inspector's Signature: Print: _ .f�/ PIC'sSig:nature: ��n ((1 -' Print: I ti! 13 1! T I Page /of=Pages Violations Related to Foodborne Illness interventions and Risk Factors(items 1-22) PROTECTION FROM CONTAMINATION FOOD PROTECTION MANAGEMENT 18 Cross-contamination . I I 1 590.003(A) Assignment of Responsibility* i 3-302.1 I(A)(1) Raw Animal Foods Separated from 590.003(B) I Demonstration of Knowledge* I Cooked and RTE Foods* J 2-103.11 Person in charge-duties I I Contamination from Raw Ingredients 3-302.11(A)(2) Raw Animal Foods Separated from Each EMPLOYEE HEALTH Other" 2 590.003(C) Responsibility of the person in charge to I I Contamination from the Environment require reporting by foal employees and 13-302.1[(A) I Food Protection" I applicants* 13-30115 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 131 590.003(G) Reporting by Person in Charge` 3-306.14(A)(B) I Returned Food and Reservice of Food" _ 590.003(D) ( Exclusions and Resirictions* I I I Disposition of Adulterated or Contaminated 590.003(F.) I Removal of Exclusions and Restrictions Food 3-701.11 Discarding or Reconditioning Unsafe FOOD FROM APPROVED SOURCE Food* _ 4 Food and Water From Regulated Sources I 19 Food Contact Surfaces * 4-501.111 Manual Warewasbin 590.0(M(.4-B) Compliance with Food Law 6-Hot Water 3-201.12 Food in a Hermetically Scaled Container" ( Sanitization Temperatures* 3-201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Warewashino Hot Water 3-202.13 Shell Eggs* I SattitizationTemperatures* 3-202.14 Eggs and Milk Products,Pasteurized* I 4-501.114 I Chemical Sanitization-temp.,pH, 3-202.16 ( Ice Made From Potable Drinking Water* ( concentration and hardness. * _ 5-101.1 I Drinking Water from an Approved System" ( 14-601.1 1(A) Equipment Food Contact Surfaces and Utensils Clean' 590.006(A) Bottled Drinking Water* I 1590.006(B) Water Meets Standards in 310 CMR 22.0"' I 4-602.11 Conanine Frequency of Equipment Food- Contact Surfaces and Utensils*Shellfish and Fish From an Approved Source 4-702.11 Frequency of Sanitization of Utensils and 3-201.14 Fish and Recreationally Caught Molluscan Food Contact Surfaces of Equipment* Shellfish, 4-703.11 Methods of Sanitization-Har Water and 3-201.15 Molluscan Shellfish from NSSP Listed I Chemical* Sources* Game and Wild Mushrooms Approved by I 110 Proper,Adequate Handwashing Regulatory Authority 12-301.11 Clean Condition-Hands and Arens* _ 3-202.18 Shellstock Identification Present* ( 2-301.12 Cleaning Preedure* 590.004(C) I Wild Mushrooms* 2-301.14 When to Wash* 3-201.17 Game Animals* I 111 Good Hygienic Practices I 15 Receiving/Condition 2-401.11 Eating,Drinking or Using Tobacco* 3-202.11 I PHFs Received at Propel Temperatures* ( 2-401.12 Discharges From the Eyes,Nose and Mouth* 13-203-101.111 PFoodSa 2.1 I PackageSafe and Unadulterated Integrity' * I 3-301.12 Preventing Contamination When Tasting* ( I � b Tags/Records:Shelistock I 112 Prevention of Contamination from Hands 3-202.18 Shellstock Identification' I 590.004(E) Preventing Contamination from 3-203.12 Shelistock Identification Maintained'* Employees* 13 Handwash Facilities Tags/Records:Fish Products I ( Conveniently Located and Accessible 3-402.11 I Parasite Destruction" 3-402.12 Records.Creation and Retention* I ( 5-203.11 Numbers and Capacities* 590.004(J) Labeling of Ingredients* I 15-204.11 I Location and Placement* ( 5-205.11 I Accessibility.Operation and Maintenance T Conformance with Approved Procedures I ) /HACCP Plans I Supplied with Soap and Nand Drying 3-502.11 Specialized Processing Methods* I Devices _ 3-502.12 Reduced oxygen packaging;criteria* 6-301.11 Handwashing Cleanser,Availability 8-103.12 I Conformance with Approved Procedures* ( 16-301.12 Hand Drying Provision 'Denotes critical item in the federal 1999 Foal Cade of 105 CMR 500.000. r CITY OF SALEM % �, '/BO,ARD OF HEALTH �1 7 Establishment Name: . jngr�SS-V�1( ! Y�a�' ILc Date: a- `-/-t) 7 Page: o? of Item Code C-Critical Item✓ DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date No. Reference R—Red Item Verified "\ PLEASE PRINT CLEARLY - I // D a 7i`i _�- � -D-� h/,�/i�P_ hvo � -/�v'vr�'�Pr✓ �� 60.E �°��, ho,o x _2!o I I I . I 1 1 Discussion With Person in Charge: Corrective Action Required: I ❑ No I ❑ Yes I have read this report, have had the opportunity to ask questions and agree to correct all ❑ Voluntary Compliance ❑ Employee Restriction/ violations before the next inspection, to observe all conditions as described, and to Exclusion P ❑ Re-inspection Scheduled ❑ Emergency Suspension comply with all mandates of the Mass/Federal Food Code. I understand that noncompliance may result in daily fines of twenty-five dollars or suspension/revocation of ❑ Embargo ❑ Emergency Closure your food permit. �- 1 4' �(ti ❑ Voluntary Disposal ❑ Other: 50;.!v(C) PHFs Rec.etvedat Teti per:rare; Violations Retailed to Foodoerne Illness Interventions and Risk Azcording!o Lw,% CauEed ii, Factors(items 1-22) (Cont.) 31`;/4i'F:t'it1Ju-i Howl. " PROTECTION FROM CHEMICALS >01 15 Coohnu Methods for PHFs 14 Food or Color(Additives 19 PHF Hee and Coln Holding 30112 Additive: 1 3-501.!6(;) Cold Pl-IFa Maoiruucd at or bo9ow 590.rt:WFf 4i�145:F.„ 15 ( "s-702.14 Protection from Unappro'-ed Additive; 13-501 INW) tint PI,Fc fvloi;rtained at for above Poisonous or,Toxic Substances idO,F. � 11 7-ltil.ii Identd};ncinforn:abon-Original " - - --� Contamer-ix ( -;.501.16(A) Roasts Helu at or aboie 7-102.11 Cinewon N;me-Wurk:ne Conridr-crs" Zp Time as a Public liealih Control 7-10 LI 1 Sep::ruron-Storage'" j 3-501,19 Ti:n::as a Public Health Cunhul'" '7-702.11 Restriction-Presence and Usca `90.004t H} A.tricmce Regwremcnt 7-202.12 Conditions of Use' 7-203 11 Toric Contuneir. - ProhibitiontO REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-204.11 Sanitizeis,Qttenr- Che?tiicals^' POPULATIONS(HSP) 7-204.12 Chemicals]or Wai 1'ruduce.Ctiisi.": I : 2; 3-801.i 1(A) G nrastcunzed Prt-packaged Juices and 7-204.11, Drying iAgents.Criteria' Heveraees wide Vi nz Labels'^ ( 7-205.11 ,ncidemaiFnodCuntac:. Lubnctats' 3-80i.11(B) Useu Pt,tenrizedEi19 , 7-206 ll Restucted Use Pesticides.Criteria* 3-01,1 I+D) Rain cr Pa,tially Cooked Amm.+i `rod and Raw"Seed SPTC,ttls Not Served. "r 7-206.12 Rodent Bait Stations' i 3-S( I IIC; Unopened Food Package Not Re-served. 7-206.13 Ttackm; Powders,Pest Control and - Moniturin;t CONSUMER ADVISORY TIMEfTEMPER aTURE CONTROLS 22 -3-603.11 Consumer Advisory Polled for Consumption of Omni:d Foo&That arc Raw. Undercooked of A6 Proper Cooking Temperatures for PHFs Not Otherwise Presse;!:o Eliminate 3"40111At1)(2) Eggs- 155`F 15 Sec. Palhog,ns." gM himiedir r I 3-302.13 Pasieur;zeci Eggs Substitute+le fn_Raw Shell ate Scrvicc 14515sec: * 3-401.11(A)(2) Conuivimted Fish, Mtats&Game Lz)"'* Amrnals- 155-'F 1 sec. 3-401.11(B)(!)(21 Pork and Beef Roast- 130°F' 121 nits" i 'SPECiAL REQUIREMENTS 3-401.11(A)(2) Rattles, Injected Meats-- 1.55"F 15 59U 009(A4D) Violations of Section 590.009'A)-(D)in SVC. w ctucri::g, mobile food, temporary and 3--4ULI I(.A)(3) Poultry, Wild Game,Shifted PHFS. residential: kitchen operations should be Su)ifing Con:um;n_Fish,Meat; ti, under the ,3priropriate sections Poultr.of Ratites-165°F 15 sec. * above t I reiated to frr:)dborre illness 3-901.1 I(C)(3) Whole-muscle, Intact 8cef Steaks j interventions and risk factors. Other 450F" 590.009 violations telling to good retail 3-401 J2 Raw- Anima! Fonds Cooked in a i practices should br debited under#29-- Microwave 16517* Special Requirements. 3401.11(A)(1)(b) 111 Other PFIR,- 145`P15see. 37 Reheating for Hot Holding ViOLATIONS R FLATE-O TO GOOD RETAIL PRACTICES A-40`1.1 I(A)&(D) PHFs 165-17 i5 sec. * ( (Iterate 23-3€]) 3-403.11(8) Microwave 165°F2 Minute StandingI Cr+iitul rani non,r'i!md cioia!ior+s, which do wo rc'sue!o the 'Dime° foodborne illness brae;venurns we.1 ricd-filr t:,+s listed above, con be 3-403.1 I(C) Commercially ProCecSed RTE Fond- foeurd hi:hr j,a'(nr:Ing aertions of.1h,-Fw<I Cod( aid 105 CMR 14WF' j 500.000. 3-103.11(1'1) Remaining Unsficed Portions o!'Heel' i Item Good Retail Practices FCR596-- _3. ManagemFnt and Personnel FC--2 003 � 24, Food end Foal Protection FC--3 004 (g Proper Cooling of PHFs 25 Equi)=r:eni and Utensils FC-5 005 3 501.14(A) Cooling Cooked PHF:.from 140`F to - ----� . 26.---- Water.Piumbin4 and'iniasta I=C-5 .-006 70'F Within 2 Hours and Fromm 70`1' 27. FhVsica!Facdity FC-6 : 007 to 41-F/451F Within 4 Hour;. ` 28. Poisonous or Toxic Materials FC-7 ! .008 3-50114(T3) CoolingPF1FsMade From Ambient 29 SoeciaiReacnernents 009 Temperature Ingredients to 41'F/45`1 130. Other --- -� W n h i n 4 1[ourc:x :"„m,,,,nar�u•.. i Denotes cnucal itan m the+edeod !999 Food('ode or 10.5 CMR 590 000 0095 Congress Street Congress Market City of Salem RETAIL FOOD - Food Establishment Inspection HACCP: ❑ Item Status Violation Critical Urgency Telephone: PROTECTION FRO�,EONTAMINATION 978-745-8918 Handwash Fac,lies FAIL Critical RED Owner: _ C me Hot water in the bathroom had a temperature of 80°F. Restore hot water to a minimum temperature of 110°F immediately. Lac Bui TIMER ERATURE CONTROLS(Potentially Hazardous Foods) PIC: Hot and Cold Hold, FAIL Critical RED Dung Bui Inspector: C ment:The pastalitos had a temperature of 105°F. Maintain all hot foods at a minimum temperature of 140°F or higher.A econd temperature taken was 140.1°F. David Greenbaum Date Inspected:Correct By: 10/11/2006 Risk Level: Permit Number: BHP-2006-0044 Status: VIOLATION #of Critical Violations: 3 Time IN Time OUT: Urgency Description(s): BLUE: Violations Related to Good Retail Practices (Critical violations must be corrected immediately or within 10 days)(Non-critical violations must be corrected immediately or within 90 days) City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741-1800 GeoTMS®2006 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Oct 12,2006 ) Page I of 3 Item Status Violation Critical Urgency RED: Violations Related to Good Retail Practices (Blue Items) Violations Related to Food and Food Protection FAIL Critical BLUE Foodborne Illness Interventions and Risk Factors (Require Xchee t:Th ollwing items found outdated: na immediate corrective action) e Cerelaccerealer Farinauiceix barsp 1 -taco shell 7-Progresso soup Owner must sely monitor all expiration dates. Equipment a4nsils FAIL Non-Critical BLUE C he cornelius cooling unit needs a thorough cleaning. T True each in needs athorough cleaning. T sam nit needs a visible,accurate thermometer. T alk in fan cover has an accumulation of dust. Thoroughly clean the fan covers. e Ccol point cooling unit needs a visible,accurate thermometer. T ers ey ice cream freezer needs a visible,accurate thermometer. Th al each in by the milk needs a thorough cleaning. T Hus an wall reach in needs a thorough cleaning. -All elves need a thorough dusting and cleaning. Physica acili FAIL BLUE C m :There is water damage on the ceiling of the store. Investigate the source of the leak and repair. Repair the ceiling. T re is water damage and mold on the bathroom ceiling. Investigate the source of the leak and repair. Repair the bathroom ailing. Owner is installing new refrigeration units in this establishment. Owner must contact the Health Agent and submit a plan for this new equipment. GENERAL COMMENTS: 890:Reinspection in one week. All violations to be corrected. City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741.1800 GeoTMS®2006 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Oct 12,2006 ) Page 2 of Item Status Violation Critical Urgency IP�� City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741-1800 GeoTMS®2006 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Oct 12,2006 ) Page 3 of * . .a CITY OF SALEM, MASSACHUSETTS RECEIVED BOARD OF HEALTH 120 WASHINGTON STREET, 4TH FLOOR SALEM, MA 01970 DEC — 4 2006 TEL, 978-741.1800 CITY OF SALEM FAx 978-745.0343 BOARD OF HEALTH Kimberley Driscoll www.SALEM.COM Mayor JOANNE SCOTT, MPH, AS, CHO HEALTH AGENT 2007 APPLICATION rrFOR PERMIT TO OPERATE A FOOD /ESTABLISHMENT /� NAME OF ESTABLISHMENT ��yyl�t�C�L J� M AP2k I✓ I TEL# ADDRESS OF ESTABLISHMENT /� FAX#1� MAILING ADDRESS(if different)_=t EMAIL--Bustyess': 0,C-1 k4At p �aTi Vin. _/b TY) Owner's: I AC IPY )I; �� OWNER'S NAME LhC_ BUT y TEL# (4I' ! ADDRESS 46 �O� S - E - MN STREET CITY STATE ))((}} cc��t�OZIP} 1 !y CERTIFIED FOOD MANAGER'S NAME(S)__,AC u CERTIFICATE#(S)KR a1. � R44 (Required in an establishment where potentially hazardousfood is prepared)Lhp }--� EMERGENCY RESPONSE PERSON A BUl HOME TEL# 1 -51 (1 "07? 3 1 DAYS OF OPERATION Monday Tuesday Wednesday Thursday Friday Saturday Sunday HOURS OF OPERATION 3() a m a>n 6.30 am 6 j0 am Ei . 0 aIT- $; 30 an./ �O , DU p Kv Ij Please write in time of ri (For exampleltam-Heal iC) DoPM IU•.Ot) VIN) {0: 00 ptn 10:00{?' ' 41 oo Puy ii :00 ?'Vr1 - $ ° 00 ?n/ TYPE OF ESTABLISHMENT FEE (check onlay RETAIL STORE YES NO less than 1000sq.ft. 1000-10,00(Sq.ft. =$100 more than 10,000sq.ft. --...---.--- - - -- -- - --- ------ ---...-.-.- ----- $_ - - RESTAURANT YES NO Tess than 25 seats =$100 25-99 seats =$150 more than 99 seats =$200 BEDBREAKFAST YES NO $100 ------------_ . ...--.... .. .-. .-._...--.-... .. ......... ....... .... ... ... .... ..... ....... .- ........ ADDITIONAL PERMITS MAKE (not just serve) ICE CREAM, YOGURT, SOFT SERVE YES NO 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 tate la d paid all state taxes required under the law ) • �7 Signature( Date Social Security or ederal Identification Number - --- -- --- -- - ------ ------- --- ----------__��_ �d_/ - - - ----- Revised 7 it13106 FOODAP2007 adm Check#&Dale C}YL- d�=t. a�5 ��s. WL 1-77 ku -n Z & - r 714 V-14 commonw Mzsintlifiiijj�' Pik L 40A All 'It 3" - magas�6 Boir ll ealth�'�AI3� �f Healthf';ea K! ney Driscoll e 120 Washington Street 4th Floor' SALEM,MA 01970 Food/Retail Establishment Permit DATE PRINTED: 12/19/2006 ESTABLISHMENT NAME: Congress Market File Number BHF-2004-000105 95 Congress Street Salem MA 01970 LOCATED AT: 0095 CONGRESS STREET SALEM, MA 01970 Permit Type Permit No. Permit Issued Permit Expires Fee Restrictions/Notes RETAIL FOOD BHP-2007-0004 Dec 19,2006 Dec 31,2007 $100.00 TOBACCO VENDOR BHP-2007-0030 Dec 19,2006 Dec 31,2007 $50.00 Total Fees: $150.00 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 6 of 29 � a ( IMPORTANT MESSAGE ) FOR �/ DATE_n- ��16 - "TIME > M OF PHONF AREA CODE NUMBER EXTENSION U FAX U MOBN 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 FAX TO YOU MESSAGE Y SIGNED 0 S. FOR Woos MA INUSA. a NOTES r ( IMPORTANT MESSAGE ) FOR DATF TIME3 't. M Lr-Ne. 1 ,V\ OF C4iJVn,cSS yhVV RHONF - �Re - ev' AREA CODE NUMBER EXTENSION O FAX O MOBII G AREA CODE NUMBER TIME TO CALL TELEPHONED �11 PLEASE CALL CAME TO SEE YOU WILL CALL AGAIN WANTS TO SEE YOU RUSH RETURNED YOUR CALL 1) WILL FAX TO YOU MESSAGE yvC \l M 1\ v \s SIGNED FORM 4009 MADE IN U.S A r NOTES I . , CITY OF SALEM /J BOARD OF HEALTH of Establishment Name: Date:Date: I /�-0 Page: Item CodeC-Critical Item. DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date No. Referen R-Red Item Verified PLEASE PRINT CLEARLY , I C_ �_A///-As - �'h/�� Z2f /41 ',�� / a /1F' /4 Ppoor /i� .�v �n �7fi/t. �! fm,�1� > ho dha�G /how xh1w /a /�✓ -/ N"9 ` I Thorp liow MI),n-/ I NoSiGCr �l i?/moo "��oai J i . Shc�/l .071- 1 f ;_5 / /moi P® . T�/1 n a i. ��il� /{�iPr/'rr - - 7V Ll� Discussion With Person in Charge: Corrective Actionk€4aired `I o No I L3 les II have read this report, have had the opportunity to ask questions and agree to correct all ❑ Voluntarycompliance II ❑ 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 s spens ion/revocation of ❑ Embargo ❑ Emergency Closure your food permit. � ❑ Voluntary Disposal ❑ Oth"er: PHFs Reserved:rat Temperature, - -- Violations Relatedio Foodbome)lines lnrarventions and Ri>k Accordiin,to Uw Cooled to Factors(items I.22) (Cont.) 4I'F745'-F Within 4 Hours. " PROTECTION FROM CHEMICALS � 3 so 15 Cru! w,illedwds !or PHFs � 19 PHF Hot and Cold Holding 13 ! road or Cr lot Additives 1 q-5(11 MIR) Cold PHF,Maintained at of belnw 3-202.12 Additives" i I 540.00'i(F) 41`i45' F' 3-302.;4 Protection from 11);appro�ed Audaines' Poisonous or Totuc Substarces 1 3-507,i 6(A) Hut PHFs Alaintaiued at or above H`• _ 7-101.11 ldentilyxtty lnfun:mt:o„-Ogg,:el lir 'F I 3.501.16(A! Roasts Held at or above I30°F. Containers' 7-192 It Comrnon Nau:c -'Woking Conlainers., I 20 Time as a Public Health Control 7-_0111 Senarati+,:,—Jin:qee" 3-501 li Time as a Public Health ControN" j 7-201 1 1Rrcviction-Presonce and Use' 590.0040-1) Variance Requirement j 7-202.12 Condrtieus:,t useREOUIREMENTS FOR HIGHLY SUSCEPTIBLE ',-203 ; t Tmc Conn lncrr-ProhibL,ions" POPULATIONS(HSP) 7:04.!! Saniw evs,Crttena--Chemic:ds' 7-204.;2 Chemicals tor''+Vushmtc Pr,AUCL. r!eria". 71 3801.i:(A) Unpameurized Pre-paeksged Juices and j 7-20'4.1; Dr•,'ing,Ygents.Criteria I Beveral;es with Warming labels^ ! 7 205.11 6ici:9'aaul Foo"Contw t. l.ubrican!s" 3-901 A I(B 1 Use of f'astew ized Eqg,�° 3-801 111Di ' Raw or Partially Cooked Anunal Food and 7 206,11 Restricted Cee Fe=imides. Crtcna' R.aw Seed Sprouts Not Screed. 'A j 7 206 12 Rodent Bun °Rations" 3-e.OIA RC) I Unooeued rood Package Not ke-srrved. a, 7 206.13 Tracking Puirdera.Pes?Gmtr;:! and - -- - Yionitarina^ ! CONSUMER ADVISORY TIMEfrEMPERATURE CONTROLS 22 3-603,11 Consumer AdNisory Posted for Con.umption of Ammar Foods flat are Raw'.Undet'cooked or I6 Prooer Conking Temperatures for PHFs Not Otherwise Processed to Eliminate Pathug- + yr„nor l 401.7!A!ll(2) Egg,- 15?.°p 15 Sic. uts.'- Eggs- 1;,,, s�,t 3303.13 Pasteunred Fggs Subzuaue for Raw Shell f_gs mediate Service 14-. F,Scec 3-401,11(A)(!i Cotmninuted Fish. Mcaa;&:Gdnte Egi!sr Animals- 155•F 15;.cc. SPECIAL REQUIREMENTS 3-401.1IB),,I a1) Pork and Beef'Rust- 130+ 121 nilnT 3-401.1 I(A),2) Ratacs, Injecrd Picots- 755-F 15 I 590.009(A)-(D) Violations of Section 590.009(A)4D) in see. LL catering. mobile food• temporal,/ and -401.1 1(A)(i) Poultry,ch'i'd Game,SmfJ'cd I4iF,c, j residcutial kitchen operations should he Stuffing Cunl:u::;n g_i;h, Meat, j dc`rted under the appropriate sections Poultry or I:atite,-!65'1'15 sec. :, j above if related to foodborne illness 3-401.111C:1(i) Wholt-m::scle intact Beef Sl.aks � interventions and risk factors. Oilier i45=F.: 590.009 violations relatin= to food retail 34111.12 Raw Anima!F•.rvds Cooked in.: I putctices should be debited under#29 - Pdicrowa,e 165`F * Special Requirenteuta. 3-40111(A)(litb;; Al; GlitelPHFs- 1-15'F15scc ” 17 Reheating for trot Holding f VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 1 3-4n3.11/A)RCD) PH1v 155'F 15 sec. (Items 23-30) 3-403.1 UB} Alien_,.,ave- 165'F 2 ;Nlinu!e Standing Critirul and aur-rritir a[vioiairuras, ndrt,h Jit not relate:o tha Tone' loadhorne illness interventionsreef r iA la(toss listed above, ,an he I i C) Ganinownillp Processed RTE Food - fount,+ni du-Jirl/moiag /sections<+f tFee Food CCoderl105i C9.112 140''FT I 590.0/)0, serl l(E) ! e:ti,inin, Unsh,rdPorti:vr;ofBeef I item Good Retail Practices FC 1530.000---1 Burst:.' 23. Manaeeinent and Personnel rC-2 .003 j t8 Proper Cooling of PHFs 24, Food and Food Protection FC-3 11 .004 25 Eouipment and Utensils FC -4 .005 3-501 !4(A) Cuoiing Corked FHFs from ;4WF to 26, Water,Plumbinq and Waste FC-5 j .005 707 Within 2 ilours and Fr rn 70"F 27. --- physicrA Facili FC--6to 41`F/45"17 Withm 4 Hours. ' 128. Poisonous or l oris Materials FC--7 _.008 I 13-501 14i B l G atlinG PFIFs A'lade Fn vn.=unbien: 29. Soecial Rcnwrements - .009 j 'T emperattue ingredients;)41"F14`°;? ! 30. Other Within 4I-tours" ,-2a..< ' Dem de"mucal itan anlp ie crz: o)9q Fuvd i'.do o� lu?CN-IR;1)0000. CITY OF SALEM BOARD OF HEALTH Establishment Name: ��f S /Y 'Pt �I��/' � Date: / "� Page: of nem II Code C-Critical item �} DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date No. 3Reference_ R—Red item Verified 1) f PLEASE PRIM CLEARLY f - /)Zd -/" rlv?I'a 1 ,�' I I /�tii S /iii ter✓ Ted - _ I I t G "771,e 1,0e/e Oa7le_ lrl�� /.Tn4 Mmr�r I � I I l�°% -1/v 1 I 1 A&rnv pvwv Jt iii oma I_ _/� _Jt i7 Its �e 1 rY1U ? 121' X ./t 40, 45, Z' I tL p I [14V111d6 {�/?i�> - 1�1S�hl© r -r..�r � _;IVa 1114 �o h?4 Vii- /Gp I Discussion With Person in Charge: Corrective Action Required: � ❑ No � ❑ Yes ' I I have read this report, have had the opportunity to ask questions and agree to . •orrect all ❑ Voluntary Compliance ❑ Employee Restriction/ x lusion violations before the next inspection, to observe all conditions as described, nd to ❑ Re-inspection Scheduled ❑ Emergency Suspension t comply with all mandates of the Mass/Federal Food Code. I understand t t noncompliance may result in daily fines ofrtwenty-five' ,dollllarrss for su�sp/een a ,n,//rreevocation of ❑ Embargo ❑ Emergency Closure your food permit. �V c7 �---- ' { ❑ Voluntary Disposal ❑ Other: :..(,1 141 JEIPs Rec.eivect at'fcmperatures Violations Retatad to Foodborne ittness Interventions and Rlsx .according In Law Cr rtded to Factors(@oma 1-22) (Cont.) 41=F/45'F Vvithin 4 Huurc PROTECTION FROM CHEMICALS 3-301.i 5 Coo!tit, Methods for 1]4Fc 19 PHF Hot and Cold Holding j I14 IFood or Color Additives 3-50L 16B) ( Cold PHRa"ninlnined at of below "-203.12 AddiLiaas` j 5y0.0i!3(I7) 41"'145,F- -1-302.III Protection front(:napprowd Additi,,e," 3-501 I6(A) Hu;PHL; Maintained at or abov.- j 15 ( Poisonous or Toxic Substances 140'1- 1 7-101.11 Identifying tri onnaCh ig brm- ival 13-501 1.16(.1) R-oast,Heid at or aborae i30'F 4 20 ( 'Time ss a Public Health Control 1 7-102.11 Comm-si Name -1Yortine;Contmners" 3-50t..9 Time ai it P4J:c Health Contiol" 7-201.11 Separation-Storage" -1-m? 1I P-estr.ction--Pw• enc:and U,,e 1 ISS:i.0041Ht Vanence !<rqun-emrnt I7-203.1 Cn2di[iunn of( i�-o3.11 I Toxic Containers-Prohibitiuns" ( REGt;!REMENTS FOR HIGHLY SUSCEPTIBLE j 7-204.11 I Saatizers,Criteria --Chemicnls^ POPULAT€ONS(NSP) 21 3 :1('! (A) Lnriw;-cur'izcd P:,-fnvJ aged)races and ' 7-204.12 Chemicals for W'ashwg Produce,Criteria Bcver;ees waft Vvarnmc l.,abels' 7-204.14 Crying Atenu.Criteria" 3-80i,I VB 1 Ik:r of Pasteutized bgr,- 7-305.!' Incidental FoodComact. Lubricants" ;-80?,I I{U) Raw n-Patially C ixlked Animal Food arni 7-206.1! j Fe:.tricted Use Pe.ticides.Criteria" Raw$.ed S}truuss Not Served." 7-206.12 t•;o(ieat Bait Stations" j 34-)1.1I1C> Jnopencd I-O(A Package not Re-served- '' -.'-206.13 Tracking Ponders,Pest Control end Nlnnitorin�' CONSUMER ADVISORY T€MEITEMPERATURE CONTROLS 22 3 6C3 11 Consumer Adttsut.y Posted tot Consumption of , Animal Facia Th"t are Raw'-Undetcuoned or, In Proper Cooking Temperatures for Not O:hcrnlsr Processed in Flinunate PHFs yin.•:m.nogg„ ?-BOL I IA(I)0) Eggs- 155`F '5 Sec. l atholtans. ERgs-hinuediate Scrvl:e t45`Fl5sec* 3-302 1.'• Panteunmt Egg: substitute 6s Raw shell Eggs* 13-$OLEK.-1!IAI(2i Comminuted Fish,Meats&Gann Animals- 15517 15.ec. ^ ` j 3-40:.11(l3) tl)(2t Furl and BeefRoast- i30 F 121 min= SPECIAL REOLIMEMENTS 3-401.11(A)(2.) Ratites, Injected Meats - 155°F 15 Sh0.0(19G11 {[:) Violations of Section 590.( )9(A)-(D) in sec. catering. mobile food empoatr}`and 13-401.11(AH:J Poultry,Wild Gamc, Slotted PHFs, residential kitche- operations shcndd'oe Stuffing Containing Fish, Mear, debite- . . the appropriate sections Poultry of Ratite,.-165°P 15 sec. - e ifrelated to foodF.,;ne illness 3-401.11(00) Whole-muscle, ntact Peet Steaks inter -entions and risk tactors. Other 1Y5`P' I 590.009 violations teit;ting to go 3-401.12 Raw Animal Fogs Cooked in a pt'a.'ryceb 5hvuld'te ticbited uttclar o - d d rere Ca l 1 Microwave * speciai Requirements . 3-401.!I(,4){!pb) All Other PHFs Fs - 145`1' 15 sic. * ( �'� 17 Reheating for Hot Holding VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 3-403.11(A)&(D) PHFs 165'17 15 sec. * (Items 23-30) 3-403.11(8) Microsr ave- 165°F 2 Minute Standing Criiirai cow non-critical vi✓hmnn,,, 1011ch nor,not relate it,Me i Timc'" /ondbo,neiMirrs urea venttrns o.wd;iskf,rr o;rs huedabove, ion he 3-403.11fQ Commercially Processed RTE Food- I found in the,f,d/rotlin, ,se(.1 0,s of the Food Clue and/fay C'.tIR 14WF' i 5010(,Y). 3--403.11(8) Remaining Unslieed Portions of Beet I Rem Good Retort Practices 23, 1590.000 Roasts" - 23. Management anti Personne: I FC-2 .003 j 18 I Proper Cooling of PHFs I 124 Ford and Foal Protection FC-3 .00q 1 Z5. Eduionent?rd Uten,ds FC--4. 005 5(11 14(.,1) Coulin5 Cooked PHFs from 140"F to 1 26, Water, P!umb;nq and Wasie FC-5 006 70"F Within 2}-fours and From 70'F I ?7 Physical Fcdltf FG-6 j 007 to 41'FM 5"F Within 4 How s. " I 28 Poisonous or' oxrc Materials FC -7 .008 ;,Stl1.141 ti) Coding PHFs Made Froi:r Ambient I 29. Special Reounement, 009 i Temperutore htgredients to 41"Fr45°P i j 30 Other j ! Within 4 Hours ' Derot,,rnncA item it the n-pie:it 1999 Foat(:,&ur 105 0.11,,590 o0o -- 6 ` Massachusetts Department of Public Health Salem Board S Health M 120 Washington Street,4t" Floor Division of Food and Drugs Salem, MA 01970-3523 FOOD ESTABLISHMENT INSPECTION REPORT Tel. (978) 741-1800 Fax(978) 745-0343 Name /� {�/��y (, n Date Tyne of Operation(s) Tvpe of Inspection ❑ Food Service ❑ Routine Address / / Risk I� Retail ❑ Re-inspection Z?� r 19Level rn ❑ Residential Kitchen Previous Inspection Telephond ❑ Mobile Date: Owner i HACCP Y/N ❑ Temporary E] Pre-operation ❑ Caterer ❑ Suspect Illness Person in Charge(PIC) Time I ❑ Bed&Breakfast General Complaint In: El HACCP Inspector f 1� �� I Out: Permit No. ❑Other Each violation checked requires an explanation on the narrative page(s) and a citation of specific provision(s)violated. Non-compliance with: Violations Related to Foodborne Illness Interventions and Risk Factors Anti-Choking Tobacco Violations marked may pose an imminent health hazard and require immediate corrective 590.009(E) ❑ 590.009(F) ❑ action as determined by the Board of Health. FOOD PROTECTION MANAGEMENT ❑ 12. Prevention of Contamination from Hands ❑ 1. PIC Assigned/Knowledgeable/Duties ❑ 13. Handwash Facilities EMPLOYEE HEALTH - PROTECTION FROM CHEMICALS ❑ 2. Reporting of Diseases by Food Employee and PIC ❑ 14.Approved Food or Color Additives ❑j. Personnel with Infections Restricted/Excluded ❑ 15.Toxic Chemicals FOOD FROM APPROVED SOURCE F] 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 A 19. Hot and Cold Holding ❑ 8. Separation/Segregation/Protection [120.Time As a Public Health Control ❑ 9. Food Contact Surfaces Cleaning and Sanitizing REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) ❑21. Food and Food Preparation for HSP ❑ 10. Proper Adequate Handwashing CONSUMER ADVISORY F111. Good Hygienic Practices ` [122. Posting of Consumer Advisories Violations Related to Good Retail Practices Number of Violated Provisions Related Critical (C) violations marked must be corrected To Foodborne Illnesses Interventions immediately or within 10 days as determined by the Board and Risk Factors(Items 1-22): of Health. Non-critical (N)violations must be corrected Official Order for Correction: Based on an inspection immediately or within 90 days as determined by the Board today, the items checked indicate violations of 105 CMR of Health. 590.000/federal Food Code. This report, when signed below C N by a Board of Health member or its agent constitutes an 23. Management and Personnel (Fc-z) order of the Board of Health. Failure to correct violations 24. Food and Food Protection (FC-3)(5590.090.0 044))) cited in this report may result in suspension or revocation of v 25. Equipment and Utensils (FC-4)(590.005) the food establishment permit and cessation of food 26. Water, Plumbing and Waste (FC-5)(590.006) establishment operations. If aggrieved by this order, you 27. Physical Facility (FC-6)(590.007) have a right to a hearing. Your request must be in writing 28. Poisonous or Toxic Materials (FC-7)(590.008) and submitted to the Board of Health at the above address 29. Special Requirements (590.009) within 10 days of receipt of this order. 30. Other DATE OF RE-INSPECTION: S S90Mre dFor -IAdx 1 Inspector's Sigat%e:O� Print: / /Y�I��V�C YV `^�-n ./�l I l.rl'�Yj'^ J•fJ_� VI/ /of�_P, agesPIC's SignaturP � � l Violations Related to Foodborne Illness Interveolmns and Risk Factors(Items 1-22) PRO71icriON FROM CONTAMINATION FOOD PROTECTION MANAGEMENT j 8 I 590.(1031A) I i 3 10?.1!(A)(]) Raw Anunal Foods separated from 590.00VB) Dcmonsirstion of lLnou!leld e -)oii,-d and RPE F.)uds* 2-103.11 Perw,n in cha-ge--duties Contamination f-om Row lngreaters 3-302.11(A)12 Raw Anime.1 Foods Separated front Each EMPLOYEE HEALTH (,tllvr' I 2 590.0031C i Rewow�ibilitv of the Person in charge to I Contamination from the require repon ing by fo 3-302.11 A) Fnod Ilrotec"or 'ippli(Ntnts!" j 3-302.15 VVshinz Fruits and tit`,ge.table;; -,90f()03(F) Responsibility 0*'A F(,txl Employe OrAtt 3 30 1.11 Fool Contuawith Equipment a!v' Applictin t l'u'Repoit'lo'llie Pelson m lunills* Confaranationfrcirt Reporting be Per,ou in Charge! Pctor-iet:[Fwd and oe,,,rsicc.,tfFoid' 131 590.003(l)) Exchisionq and Restrictions" Disposition orAcatIteratsof ot rrmiminated :4').003(li� Reuw%al of Exclusions ar.6 Restrictions I Food [)!wnqdmgor[(econd!tionnw, Unsafe FOOD FROM APPROVED SOURCE Food I 41 1 Food and WvtcrFrom ripgvlatedsourres Food Contact Curfaves 1 590.00-1(1\-M Comp)ianrx with Food Leiw` Ill Manual Wmewitshing-i-Jot IN'ttel 3-201.12 Food in.a Herillet'cal1v Settled Contame<* i Sanitizatiun'ltmperatur( 3-201.;.3 I Fluid Mi 11,and Mi i k Pi oducts 1 4"5(11.112 Mec;:anica! Warewashing- flot,K?'wr 3-702.13 Shed Eggs''` Svn'rizati,m T-zwp-,iaturps` 4-5(A.1 14 chenlic'! �;imoj/.atioll-temp., PH, M02.J4 Eggs and Milk Ppjtfi.lCt:. !Jastuajized' -3 202.10 Ice Made Ftom Potabl, Drinking Witer' conccnirp!tort i1nd hardness. -1-601J !(A; Elinpin,n; Ford Contact.1avlac-s and -inkinz o -fiomm Auproed SysLcm- i IC Dt � Watcj Utere i Is Clean' 590.006(A) I Bottled Drinking Warr* -Itiattln^ Frccji-ctic� of Filtupment Food- -590 006(b j Water Meets Standard,; in 310 CMR 22.0'r 1 -1602.� � 11 - -1 Shelffish and Fish From an Approoed Souire Contest Surfaces and Utensils" 3-201.1.4 Fish and Rccr^ationally Caught fvfo!.usc.,n 4-702.; i Frerlrency of�Smifl7aticrt of Utensils and Fuod citnt:lct Surfaces of Equipment` shellilsh, 'i-7031 I Mo thuds of Sanitizi7ixt-Hot Water anci 3-201.:5 Molluscan Shelifish front NSSP listc,; 1 Chem:,al* Sources', Proper,Adequate Handw3shing Gamand V16d Mushroorni Approved by BI 2-301.11 Cftm Hands and Arips,z Repwatory Authority 3-20118 Sj!ej1stok Identiticaijon Present* 2-301 12 0callin'.1 FoNx-dore` J90.004(0 Wild Mushrooms' I j 2301 14 WIX11 toWash" 3-201.17 Game Animals; I 1i Food qygienk-praclicor Receiving/Condition Eatinsi,Drinking or Usipx'Fobaccol 3-202.11 PHFs Received it Proper Tempuatures' Discharge,;From tb-2 Eyes. N,%;e and 1 1-20'2 15 Package hiteeritv' Motal'.c 1 71 101.11 Food Safe tuid Unadulterated'* 3-301.12 Pre%cuttrig Contamination When'lasting* Tags/Records;Shellstock Ptevenfion of Contamination from Hands -201 16 shellstock lderlWCation ' I 590.:)Ufifi} �0.,-%enting Curnamination firr.,,, '-2031_ Shell,t,,ck Tdcnif"ication Islaint,'n,& Tags/Records: Fish Products Handwash Facilities; 3-402,11 ParasiE, Destruction- 5-201!1 Nhuphtrs and C,�xacitjes` ',-4}02.12 Records.Ciea!iov.and Retcriwyn`t !)90.00401 Labeling of Ingredients' 5-204.i 1 1 Location .r.d P��entemt 7 Conformanre with App.-oved Procedures 5205.71 j 'w,-essibility.Operitoon and Ma4tteiia!jcc I /HACCP Plans j I Supplied with 1;mtp and}sand 3-502.11 Specialized Processing M(-t1lo'N" I I I Deuces 13-:10:!.12 kt,hice6 oxvgen packag:pt�.criteria' 6-301.:1 Han,,J%vashi,'g Clca,:wr,Avui!tJnhty 6-301.i 2 klanj Dryllpt Rotision S-103.72 Cinfortr9no.-with A:,,lirmod Vtotedun-,;` actail the ieJ,aal 1999 Pond Chivol 10k;"NIR 590ff!(). CITY OF SALEM 1 BOARD OF HEALTH Establishment Name: Anrlross �wp ( I� I� �( t/. I Date: Page: of Item Code C-Critical item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date No. Reference R—Red Item Verified PLEASE PRINT CLEARLY j ( opn7 0 lir 1/V- bJ (l `r/) -iz) UZZ -) ih� . o6fk� haw l erg I n1 1� ink madl �A17 (1/g/-/�r,1116v- er ` I —1i /ItJ/W c; 1 { I Discussion With Person in Charge: Corrective'Action Required: I ❑ No I ❑ Yes I have read this report, have had the opportunity to ask questions and agree to correct all ❑ Voluntary Compliance Cl Employee Restriction/ violations before the net inspection, to observe all conditions as described, and to Exclusion P ❑ Re-inspection Scheduled ❑ Emergency Suspension comply with all mandates of the Mass/Federal Food Code. I understand that noncompliance may result in daily fines of twenty-five so"/rer�cation of Li Embargo ❑ Emergency Closure your food permit. V ❑ Voluntary Disposal ❑ Other: -507 7-4(C PI-;F,Kccety;it q Temperatures Violations Related to Foodborne Illness Interventions and Risk -lceordlnl'!:,Law Cried to Factors(Items 1-22) (Cont.) 41'`FI4ti'F W'ttnin d Hours. PROTECTION FROM CHEMICALS 1-50L15 Cooiaot^dethoda fix PHFs j 'y ;?HF Hut and Gose 14 Food nr Color Additives j fined g ?-50L ("Ad,!b(B7 f' Pl-tFaMa,ntalncdaL,rh,;kw 3-202.12 Additive ' 3-302.1-1 PrnV•ction from Unapproved Add:tiv,s, 3-501.i6(A) Hr, P F tarn tg Poisonous or Toxic substances j t . 1 , Mir: s„ed a. or above 7-101.11 Identifyine lntormnu,nl-Origimil 3-501 16,A) Containers^� Roasts Ftc'd at of above L>0°F 7-102.11 Coon Name-Workin5 Containers' j � 2;1 Time as a Public Health Cnntrol Common ')1.19 'Tiro=:as,.Pubic Health Control* 7 '0111 Sep.u-ation->irnacc` 3-5 - 7 202.11 Rersricnam-Presence and Use;' 59(0.004(,H) Variance Kcymrentent j 7202.12 Conditions of Usc" _'0?.I I 'i'oxi Conw:netn - Proh b;tious,; j REOULATIO 'S( FOR HIGHLY SUSCEPTIBLE POPULATION'S(FISP; 1-204.11 Canmicasfre.,Ws-Ch,ntica:r,' I 1 21 1 3-801.11(A) Un tsteurttedPre-packoisedhticesand 7-101.12 Chemicals fir W'ash:ng Pix-duce,Criteria' � P`' 7204.1.1 Dryul;_,Agents.Criteria' j j Bevcra?es c+iih Warnine,Lab?1.;^ j i-8(1! I1fB) Use of Pastemizea Ea^s'' j 7205.1 t Incidental Foolt'onLtrt. Lubricants 3-801 1 I!D) Rawor Partially Cooled Anuual Ftxld and 7-206 11 Restricted Use Pesticides Cnterui Raw Seed SM(, ;.ut Served. 't 1 7-201.12 Rodent Balt Stations' ( j 8(11.1 NC) Unopened Food Packagt Not Re-srrred. " 1'06.13 Trackinf Powder,,Pest Control and Monitoting" CONSUMER ADVISORY TIMEITEMPERATURE CONTROLS 22 3-603 11 Consumrr Advl=cry Posted for Consumption of Animal Foods That ate Ravi,Unciercunked or Ifi Proper Cooking Temperatures for Not Odtecwite Pmcesscd to Eliminate PHFs Pathngcns.^e,ersnt;ax01 3-&01.I LA( 1(2) Eggs- 155`F 15,Sec. 3_;0'.13 F.ISteurTzed Ette,Substitutc for Raw Shell Hfips brmeditvc Servicc 1-45° 15,,C 101.11(A)(2) Commmatedfish, Meats&Gamr " Animals- 155'17 15 sec. " SPECIAL REQUIREMENTS 3-4tll.I I(H)(1)( 2) Pork and Beef Roast- I30'F 121 min" ?-401.11(A)Q) Ratites. ht}cctcd Aleats-- 15SF 15 59U.O0O(A)-(D! Violations of Section 590.009tA)4D) in sec. " calering, mobile fond,temporary and 3-401.11(A)(3) Poultry, Wild Game, Snuffed PRFs, residential ',tncheri operations should be Stuffing Containing Fish, Meat, dehitcd under the appropriate sections Poultry or antes-!65'17 15 sec. above t'related to lix,:lbornc i!Incss 3-901.11(C)(3) Whole-muscle,Intact Beefsleaks Interventions and risk factors Other 1.15°F T 590.009 viol,tions reletiuv LO goad retail 3-901.32 Raw Anitmil Foods Conked in a practices shotild he debited under i/29- Mic.uwave 165"F* Sped:J Requirements. 340111(A)(l)t1)) Ali Other PHFs- 1.45''F15sec, i j 17 Reheating for He,Holding VIOLATIONS R.:LA7ED TO GOOD RETAIL PRACTICES t-403.11(A)&(D) PHFs 165'F 15 sec. ': ! (ltetns 23-30) 3-103.11(1) Nliciowave- 165"F2 6lintue Standine Critical and jion-(rhinal moll?tuns, whi.-h do mit,elute to the Time'' ( fnnd to rc 111ne5s oru•rvrntir,^s and rick f itt,rs listed ubm r, can be j 3-aWA I(C) Cunnueruully Ptocessed[:'['F.Food- i fow;d J, the follun ivg sertimrs g1'the Fund Code and 105 UNIX i ;40'F' 590.000_._ 3-103. I(i ) Reutamm;Uushcec Pnnions of Becf tte,r, Good Retail Practices FC 1 590.000 Roa.Us`. 23. Management and Per,„nnei FC-2 1 .003 Iii Proper Coaling of PHFs � ( 24. Foci and Food^raectian FC-3 1 004 ! 3-5(}1.14(4) Ceoline Cooked PHFs font Ido'F to 2 . Fguipmern.and Utensils FC--w 2E. Water, Plumbing and Waste FG-5 i 006 70'17 W'ithm 21[our.and From 70"F j 2i Phvslcal FaciNy FC-6 007- to?I"F/45"F Within d Hour. ` 28. Poisonous or Toxic Matanai, =C-7 .003 3-501.i 4(B) Coming PHFs Made From Ambient 129. Soee al Reouirements .009----- Temperature 09 _Temperature hteredients hi d1`F14 5-T j 30. Otter ! j W' u,in 4 Flourgs ��x,r..,nis'.dam, ' UemAre critical hero u,the foLial 191)9 F.od(As e or Ins Cot :590 000. Massachusetts Department of Public Health Salem Board of Health Division of Food and Drugs 120 Washington Street, 0 Floor 9 Salem, MA 01970-3523 FOOD ESTABLISHMENT INSPECTION REPORT Tel. (978) 741-1800 Fax (978) 745-0343 Name// �'�,r {�/��I`//, �i Dale,,_,, Tyge of Operation(s), Type of Inspection ❑ Food Service ❑ Routine Address J q RiskV- Retail �U'Re-inspection El Level Residential Kitchen Previous Inspection Telephone�'2Pj_ �/i /rY ��/ ❑ Mobile Date//�C Owner \/ 77 �J f uy�S "ACCP YM ❑ Temporary ❑ Pre-operation 1 /U1� 1�1)1 I ❑ Caterer ❑ Suspect Illness Person in Charge!(01 �I ��/ �`�t c Time El Bed&Breakfast El General Complaint In: El HACCP Inspector ` \X n VU I Out: Permit No. ❑Other Each violation'checked requires an explanation on the narrative page(s)and a citation of specific provision(s) violated. Non-compliance with: Violations Related to Foodborne Illness Interventions and Risk Factors Anti-Choking Tobacco Violations marked may pose an imminent health hazard and require immediate corrective 590.009(E) ❑ 590.009(F) ❑ action as determined by the Board of Health. FOOD PROTECTION MANAGEMENT. ❑ 12. Prevention of Contamination from Hands ❑ 1. PIC Assigned/Knowledgeable/Duties El® 13. Handwash Facilities EMPLOYEE HEALTH .. .. ' PROTECTION FROM CHEMICALS ❑ 2. Reporting of Diseases by Food Employee and PIC ❑ 14. Approved Food or Color Additives ❑ 3. Personnel with Infections Restricted/Excluded ❑ 15.Toxic Chemicals FOOD FROM APPROVED SOURCE , - TIMEREMPERATUREOONTROLS(Potentially Hazardous Foods E] 4. Food and Water from Approved Source ( Y r_ ) ❑ 5. Receiving/Condition ❑ 16. Cooking Temperatures ❑ 6. Tags/Records/Accuracy of Ingredient Statements ❑ 17. Reheating ❑ 7. Conformance with Approved Procedures/HACCP Plans ❑ 18. Cooling PROTECTION FROM CONTAMINATION ❑ 19• Hot and Cold Holding ❑ 8. Separation/Segregation/Protection ❑20.Time As a Public Health Control ❑ 9. Food Contact Surfaces Cleaning and Sanitizing REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) ❑21. Food and Food Preparation for HSP ❑ 10. Proper Adequate Handwashing ❑ 11. Good Hygienic Practices CONSUMER ADVISORY ❑22. Posting of Consumer Advisories Violations Related to Good Retail Practices Number of Violated Provisions Related Critical (C) violations marked must be corrected To Foodborne Illnesses Interventions immediately or within 10 days as determined by the Board and Risk Factors(Items 1-22): of Health. Non-critical (N)violations must be corrected Official Order for Correction: Based on an inspection immediately or within 90 days as determined by the Board today, the items checked indicate violations of 105 CMR of Health. 590.000/federal Food Code. This report, when signed below C N by a Board of Health member or its agent constitutes an 23. Management and Personnel (FC-2)(590A03) order of the Board of Health. Failure to correct violations 24. Food and Food Protection (FC-3)(590A04) 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)(590.00x) 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: 5501ns ft14 Ca l ! I Inspector's si ati re: Printf ,Z ,�; 1,v U ,I , �i u.rrk- l,vl6t4b-(2 PIC's"Signature: ( /(/!iC-�/I�J(/✓�''- Print:-f c� r�� Page-of Pages n� Violations Related to Foodborne Illness Interventions and Risk Factors(items 1-22) PROTECTION FROM CONTAMINATION FOOD PROTECTION MANAGEMENT 18 I Cross-contamination I I 590.003(A) Assignment of Responsibility* 3-302.11(A)(1) Raw Animal Foods Separated from 590.003(6) Demonstration of Knowledge* I Cooked and RTE Fouls* 2-103.11 Person in charge --duties I I Contamination from Raw Ingredients 3-302.11(A)(2) Raw Animal Foods Separated from Each EMPLOYEE HEALTH ( Otherr 2 590LW(C) Responsibility of the person in chafge to Contamination from the Environment --- require reporting by food employees and 13-302.11(A) Food Protection- _ applicants"' ( 3-302.15 Washing Fruits and Vegetables f 590.003(F) Responsibility Of A Food Employee Or An 13-304.11 Food Coma.t with Equipment and Applicant To Repurt To The Person In Utensils* Charge"' I Contamination from the Consumer 590.003(0) Reporting by Person in Charge'` I 3-306.14(<4)(B) Returned Food and Reservice of Food* 3I590.003(D) Exclusions and Restrict'ons* I I Disposition of Adulterated or Contaminated 590.003(F,) Removal of Exclusions and Restrictions Food 3-701.11 Discarding or Reconditioning Unsafe FOOD FROM APPROVED SOURCE Food* d Food and Water From Regulated Sources 19 Food Contact Surfaces 590.004(A-B) Compliance with Food Law* 4-501.I 1 I Manual Warewashing-Hot Water Sanitization Temperatures'" 13-201.13 Fluid in i Hermetically Scaled Container* ( 14.501.1 12 Mechanical Warewashin I-lot Water ( 3:.01.13 Fluid Milk and Milk Products* ( b- 3-202.13 I Shell Eggs* I Sanitization Temperatures* 3-2(12.14 ( Eggs and Milk Products,Pasteurized* I 4-501.114 I Chemical Sanitization-temp..pH, 3-202.16 I Ice Made From Potable Drinking Water* I concentration and hardness. '" _ 15-101,11 ( Drinking Water from an Approved System- ( 4-60i A I(A) Equipment Food Contact Surfaces and 590.006(A) I Bottled Drinking Water* ( __._.. Utensils Clean° J 59Q006(B) Water Meets Standards in 310 CMR 22.0* I 4-652.11 Cleaning Frequency of Equipment Food- Contact Surfaces and Utensils* Shellfish and Fish From an Approved Source I 4-702.11 Frequency of Sanitization of Utensils and 3-201.14 Fish and Recreationally Caught Molluscan Food Contact Surfaces of Equipment* Shellfish* 14-703.11 ( Methods of Sanitization-Hot Water and 3-201.15 Molluscan Shellfish from NSSP Listed Chemical" Sources* 110 Proper,Adequate Handwashing Game and Wild hfushrooms Approved by Regulatory Authority 2.301.11 Clean Condition-Hands and Arens* 3-202.18 I Shellstock Identification Present* I 2-301.12 Cleaning Procedure* 590.004(0) Wild Mushrooms* ( 2-301.14 When to Wash* 3-201.17 I Game Animals* I I FI I Good Hygienic Practices 5 Receiving/Condition I 2-401.11 Eating,Drinking or Using Tobacco* 3-202.11 PHFs Received at Proper Temperatures* I 1--401.12 I Discharges From the Eyes, Nose and 3-202.15 I Package Integrity" I Mouth* 3-101.11 I Food Safe and Unadulterated* I 3-301.12 Preventing Contamination When Tasting* ( 12 Prevention of Contamination from Hands 6 Tags/Records:Shellstock � I 3-202.18 I Shellstock Identification* ( 1590.004(E) Preventing Contamination from 3-203.12 Shellstock Identification Maintained* ( Employees* J TagslRecords: Fish Products ( 113 I Handwash Facilities 3402.11 Parasite Destruction* I I Conveniently Located and Accessible 3-402.12 I Records,Creation and Retention* I 15-2103.11 Numbers and Capacities* 590.004(1) ( Labeling of Ingredients' 15-204.11 I Location and Placement* :0511 Accessibility, . Operation and Maintenance 7 Conformance with Approved Procedures 5I /HACCP Plans I Supplied with Soap and Hand Drying 3-502.11 Specialized Processingh4e0tcxls'* Devices ti-301.11 Handwashin Cleanser, Availability 13-502.12 Reduced oxygen packag ng,criteria* I g } 8-103.12 Conformance with Approved Procedures* I 16-307.12 Hand Diving Provision _ `Denotes critiad item in the federal 1999 Fond Code of 105 CNIR 590.000. �p AjJ �il 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 �, ' f �� D�a I( Tvpe of Ooeration(s) Tyee of Inspection iP 15 (i/ � 4/A b I ❑ Food Service ❑ Routine Address r _ 1 L Rik ' Retail Re-inspection l 'rA&/A CS \�i-ivtioo71 Level Residential Kitchen Previous Inspection Telephone -u<-_ bi�sq ❑ Mobile Date: 54 f, Owner [I Temporary ElPre-operation �ri c � I . I ❑ Caterer ❑ Suspect Illness Person in Charge(PIC) Time ❑ Bed&Breakfast ❑General Complaint T In: p;_v ❑ HACCP Inspector 1 �� ,00 Out: Permit No. El Other /1. ,{ Each violation checker equires an explanation on the narrative page(s) and a citation of specific provision(s)violated. Non-compliance with: Violations Related to Foodborne Illness Interventions and Risk Factors Anti-Choking Tobacco Violations marked may pose an imminent health hazard and require immediate corrective 590.009(E) ❑ 590.009(F) ❑ action as determined by the Board of Health. _. Y FOOD PROTECTION MANAGEMENT _ El 12. Prevention of Contamination from Hands ❑ 1. PIC Assigned/Knowledgeable/Duties Ela ^_ 13. Handwash Facilities EMPLOYEE HEALTH - - ,......_ - ,. , , . " ., ; PROTECTION FROM CHEMICALS El 2. Reporting of Diseases by Food Employee and PIC14. -- ❑ Approved Food or Color Additives ❑ 3. Personnel with Infections Restricted/Excluded EI15.Toxic Chemicals FOOD FROM APPROVED SOURCE __! _" , ._ ❑ 4. Food and Water from Approved Source 'TIMEITEMPERATURE CONTROLS(Potentially Hazardous Foods)"'•' ❑ 5:"Receiving/Condition ❑ 16.Cooking Temperatures f❑ 6. Tags/Records/Accuracy of Ingredient Statements ❑ 17. Reheating ❑ 7. Conformance with Approved Procedures/HACCP Plans ❑ 18. Cooling ' PROTECTION FROM CONTAMINATION_ ❑ 19. Hot and Cold Holding ❑ 8" Separation/Segregation/Protection ❑ 20.Time As a Public Health Control ❑ 9. Food Contact Surfaces Cleaning and Sanitizing . REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) ❑21. Food and Food Preparation for HSP ❑ 10. Proper Adequate Handwashing \ p El 11. Good Hygienic Practices bONSUMER ADVISORY ❑ 22. Posting of Consumer Advisories Y Violations Related to Good Retail Practices Number of Violated Provisions Related Critical (C) violations marked must be corrected I 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, whensigned below C' N by a Board of Health member or its agent constitutes an 23. Management and Personnel (FC-2)(590.0 order of the Board of Health. Failure to correct violations 24. Food and Food Protection (FC-3)(sso.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 y 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: 5590IntpBClFo/m6400eC � ^- Inspector's Signature: / Print: PIC's Signature: (�Ai✓t �(/�-- Print: / �� ' I Pager ofd Pages Violations Related to Foodborne Illness Interventions and Risk Factors(Items 9-22) PROTECTION FROM CONTAMINATION FOOD PROTECTION MANAGEMENT 8 ( Crass-contamination 1 590.003(A) Assignment of Responsibility* ( 3-302.11(A)(1) Raw Animal Foods Separated 1'rum 590.003(B) I Demonstration of Knowledge* I Cooked and RTE Foods* 2-103.11 Person in charge-duties _� ( Contamination from Raw ingredients 3-302A 1(A)(2) Raw Animal Foods Separated from Each EMPLOYEE HEALTH I I Other* 2 590.003(C) Responsib'il'ity of the person to charge to I Contamination from the Environment require reporting by food employees and 3-302.11(A) I Food Protection's � applicants* 3-302.15 Washing Fruits and Vegetables 590.003(F) Responsibility Of A Food Employee Or An 13-304.1! Food Contact with Equipment and I 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* f 3 590.003iD) Exclusions and Restrictions* DisposNonofAdulterated orContaminated 590.003(E) Removal of Exclusions and Restrictions ( I Food 3-701.11 Discarding ru Reconditioning unsafe FOOD FROM APPROVED SOURCE Food* 4 Food and Water From Regulated Sources 19 Food Contact Surfaces 590.004tA-B) Compliance with Food law* 4-501 111 Manuai Ware.washing-Hot Water 3-201.12 Find in 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 blade From Potable Drinking Water* concenhation and hardness. * 5-LOI.I l Drinking Water from an Approved System' 4-601.11(A) Equipment Food Contact Surfaces and 590.006(A) Bottled Drinking Water* I Utensils Clean* 590.006(B) Water Meets Standards in 310 CMR 2201` 14-602.11 Cleaning Frequency of Equipment Food- 590.006(B) Surfaces and Utensils* ShelFish ash and Fish From an Approved Scarce i 4-7(12.11 Frequency of Sanitization of Utensils and 3-201.14 Fish and Recreationally Caught Molluscan ( ( Food Contact Surfaces of Equipment* Shellfish* 1-703.11 Methods of Sanitization-Hot Water and 3-201.15 Molluscan Shellfish from NSSP Listed ( Chemical* Sources* i ( 10 Proper,Adequate Handwashing Game and Wild Mushrooms Approved by 12-301.1 I Clean Condition-Hands and Armsa Regulatory Authority i n t 2-301.12 Cleaning Procedure* j --20_ 18 ShellsUxkldentificatinnPresent �' 590.004(C) Wild Mushrooms' ( 2-301.14 When to Nash* 3-201.17 I Game Animals* ( 1I Good Hygienic Practices g Receiving/Condition 2-401.11 I Eating,Drinking or Using Tobacco* 3-202.11 PHFs Received at Proper Temperatures* I 2-401.L2 I Discharges From the Eyes, Nose and f 3-202 15 Package bitegrity* Mouth* 3-301.12 Preventing Contamination When Tasting" • 3-101.11 � Food Safe and Unadulterated � 6 Tags/Records:Shellstock 12 Prevention of Contamination from Hands 3-202.18 Shellstock Identification * 590.004(E Preventing Contamination from 3-203 12 Shellstock Identification Maintained* Employees* Tags/Records:Fish Products 13 Handwash Facilities 3-402.11 Parasite Destruction' Conveniently Located and Accessible 3-402. Records.Creation and Retention* 5-203.11 Numbers and Capacities* 12 590.0012 Labeling of Ingredients' 5-204.1 i Location and Placement* 7 I Conformance with Approved Procedures 5-205,11 Accessibility_Operation and Maintenance /HACCP Plans I Supplied with Soap and Hand Drying 3-502.11 Specialized Processing Methods* Devices 3-502.12 Reduced oxygen packaging,criteria`` 6-301.11 Handwashing Cleanser,Availability 8-103.12 1 Conformance with Approved Procedures" 6-301.12 Hand Drying Provision Denotes critical item in the federal 199917^ ixl Cate or 105 CMR 590.000. CITY OF SALEM k BOARD OF HEALTH i EstablishmenYName: CC Date: S Ids/J6 Page: a of F Item Code C-Critical Item v DESCRIPTION OF VIOLATION/ PLAN OF CORRECTION Date No. Reference R—Red Item i_ 1 �r Verified PLEASti CLEARLY A)o..�) ✓)n4_ hJlJlA` CC `�ErRnINT� AJeJ ( {� ��l7F c/1G JJ(C� ��:{-- 'jo A-?lA�/nn of �/i, F]!2 cel F` I I znS�Indors tine i17--,-_ 41 Z I I ��r.r�-rR�lOn I 1 r 1 .g 1 F 1 � I � I k I I _ Discussion With Person in Charge: Corrective Action Required: I ❑ No ( ❑ !es t I have read this report, have had the opportunity to ask questions and agree to correct all ❑ Voluntary Compliance ❑ Employee Restriction 7 violations before the next inspection, to observe all conditions as described, and to Exclusion P ❑ Re-inspection Scheduled ❑ Emergency Suspension comply with all mandates of the Mass/Federal Food Code. I understand that ` noncompliance may result in daily fines of twenty-five dollars or susa sionp /revocation of ❑ Embargo ❑ Emergency Closure your food permit. ,•� ❑ Voluntary Disposal ❑ Other: t 3-50! 3,i/.') Pl-Fs kc,;vived at 1'empe;:eures Vintatio„e Relation,to Foodborne lltnees Interventions and RisA Accord:m*To Ia« Coale.<]to Facfars(Rema r-22) (Cont.) i 41"F.145'-F Withiu 4 Homs. . ! PROTECTION FROM CHEMICALS 3-'0''I5 1 co,)Ln-gMethods fo-PI-tFs 14 I Food or Color Additives 1 tgPifh Hof ano Cold Holding 202.12 Aldir„es'" I 50Li6(B) Cold Maintautedatofbrir)ro' 590,004(F) .11'/.45- F` 3-302.14 Protcctinn!too: thiapponed Addinves* j 15 Poisonous or Toxic Substances ,. ' ! 3-501.16(4) Hot FI-(Fs lbtai,aetacd at or above 7-10!.!1 ki.entif)urg Information-Ongi al• ( 3-501.;L�t) R-oasts Held a'�r:above 130'1'. " Containers' 7-102.11 C'orramon Nawo--Vwrkmd Cont 'atnet,' I 20 Time as a Public Health Control ! "0(.11 Sep.:ration- 3-XOIA') Time ac.aPublic He,dthCentrol* 1-7.02 11 Restriction-Pteuuce and Use' ( `9U i!01(H) `;nriwnee Requirenx'm. 20 .12 Ccmdrtnns ui(!s." j 77 3O 11 Toric Coutlincr,-Prohibition~''' REQUIR£MEN?"S FOR HIGHLY SUSCEPTIBLE ! 7-204.11 S11111I rS,Critene.-CttcntiCAO: POPJI.ATIONS(HSP) 1 )04 12 Chemicals lar WashingProducc. Cnteuai' I i 21 13-80;.!I(A) I Unpasreiar,edPic-packagedJaices.,nd 7-204.1-4 Drying:l,.etnts.Cnteria" I BeveraCes '.vith•rVarning labec J ; li es' -'-205 11 (teller~at `'nod Contact -501 11,BClse of Pasteo;ized Lubricants' I 3;:OI I I(D) R>;w or Pattr:ay Cooke-; .Aminal Food and ! "?206 11 Rcs0u:ted Use Pesticides•Crirerw* Raw Seed burouts Not Set ved. " 7-206.12 Rodent Balt StalionS" ' ;-t0 L i Ir < - V t(C:) C apeneti Fox{Puc4:a,�c For Re :;erred. 7-200.13 Pricking R,wdrrs Pal Control and Monitatin CONSUMER ADVISORY TIME/TEMPERATURE CONTROLS �2 3-603.!I Consumer.Advwory Posted for Con;umpf9on of Animal Foods That are Raw. lmdercookrc!to 16 1 Proper Cooking Tsmperahnas for ( PRFs Not Otherwise F'r curd to Ltilmrate ! '/ecnv� n:hJi 3-40!.11,1(1)(2)' Egg.- 155`r.15$e(:. I Yalho/g_ns." !ninredie�<e Seip.ice 145`FlSse� 3-31)'-.13 Pasternzed Eggs fiuh,,Ut !e f8_Raw Shell 3=401.11(A)(2) Comminurd Fish, R-leaf;&Game Animal s- 155'F 15;:ec. 'r s 4O I I01)(1)(2) Pork and Beet Roast- 130'F 121 rain'. SPECIAL RF.QUIREM'EWS 3-401.11(A)(-21;t Ranhas, Injected Meats- 155'F IS 590'{)`'!`''(A1-(D) Vieia:ions oCSeation 90.009(A)-(Dl in sec• c:tieri;;g• mobil, food, temporary-111d 3-401.1 !(A)(3) Poultry,Wild Game,Srufred PHFn. residential kitchen opc^rations .I'ould be Stuffing Containin,,Fish,Mew drl ited un&r the appropriate sections P-,uitry or Rutites-I659F:I5 sec. '° above if rc6,lert to foodbotnc iLness 3-?01.1 IWhole nmscle,Intact Ba�f Sleaks inter venlions and risk factors. Other 145 F;. 590.009 viota!ions rel:tin' to good retail 3 '-;01.12 kart Animal Foods Cooked in a pracucC s shotlid be debited under 1,129 - Micrus:ate 1059F' Snecial Requirement.. 17 i 1-401.I I(A)(1)(h) All Other PHFs- W'F IS sea * j Reheating for Hot Hooding VIOLATIONS RELATED'1"0 GOOD BETA&PRl CTICES 3-403.1:(A)&(D) MIN 165'l-' 13 sec. ' j (f(etns 23-30) 3-403.1!(B) Microwave- 165^F 2 At; cite Standing, Cridral and hurt---rilicut vinldtmns, which dr, nW relate to ikr Time': f nuluurre(lloess internt,wi,m; and risk rer<te,rs li;aeJ abora. tarn be 3-403.11(C) Cominat rally Pimessed RTE Food (at:nd tit llie jallamiag seniors e4 tire Fnn;l Cvde and 105 CJ-IR t40''F* 590.600. 3-403.11(E) RemiumrgUnshecdPot rion;ofBeel' F Item GoodttenulAractices FC 590.000 Roasts' I 23. Mananement and Personnel FC--2 .003 IS Proper Cooling of PtiFs 24. Food aid Food Protect:on FC--3 004 i 25 Equ,prnenf and U Wnsl!; FC-v .005 3-50:.14(A,) Cooling Couked PH Fs Cron 140`'F tit, ? - I fi 4taLr Plumb nq a::d Naste F„r 5 101115 70'F Wallin,2 I Iuurs an<I From 70'F 27. Phyuiral Facally P,-o" 007 -- ti/41`F/=45-F WSth,r1 Hours. 28. Poreoncus or Tonin Materials FC;--7 .008 3-5(11 1-%P) Coolin,,PHFt, Made Froni.3mblent 129, Specia Requiremonis Terapetat rte Ingredients to 41°17,/'45'F 30 Other Within 4ILnrs" ' Ucntdes rout n,1 vem ui the fMeral 01")Food Code or 105 CMR 5''ai:00. r• .. CITY OF SALEM , JI II BOARD OF HEALTH Establishment Name: �P�Rr S S NMrir fk'f Date: 'T r ?/.�r� Page: of ^ 1 Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date No. Reference R-Red Item .IY`' t - Verified L ' .�� , PLEASE PRINT CLEARLY •� �+ (']l� t/�� 1 y?"`�I Cv Kc N 1i-)z �)/' I TQ r '-a� K' ;z, ty.t t)( P/1nGt .4...�Sa j �, � i featratP�L Cartc� nkrl 1 r„ .nl Cq innr i !,-.1 �. _7nI V7 I3 S, I� Slr,p�l r of elf ,ll ��v11� If40(4it ! f': X}('TiETt l�r�"f—��C) - . -1 r � J I< t i`,f. :O; L_ ?��- <ll�f 4 ►��f"rl�c✓/ MLli d f � W-._0 7.� A/7J t " i : I c��^� �_ �,,. t� (�i(1o�-tf ✓ rRf a)�irlZlLlJc� ' ►% f Discussion With Person in Charge: Corrective Action Required: ❑ Noes r I have read this report, have had the opportunity to ask questions and agree to correct all ❑ Voluntary Compliance ❑ Employee Restriction/ y Exclusion violations before the next inspection, to observe all conditions as described, and to Re-inspection Scheduled El Emergency Suspension comply with all mandates of the Mass/Federal Food Code. I understand that noncompliance may result in daily fines of twenty-five dollars or suspension/revocation of Embargo ❑ Emergency Closure your food permit. r NU\ I ❑ Voluntary Disposal ❑ Other: 3 � Violations Aerated to Foodborne lJlnass interventions and RiskPN"e Recait:'dat'F' mperatutcs;lc-:ordin,to Lao:Coiled to Factors(items 1-22) (Corr.; -tr %1'S'F ttltiu d Hour, PROTECTION FROM CHEh'€€CALS ( 3-50! 15 :coling Mcurds t:)r PHFs 118 Food or Calor Additives I I i 9 PHF Hat and Cold Holding 3-501.16(1; 'old PffPs Maiw' ned at or belot4 3-202.12 AdditF:cc F ) 2-302 i- Protection tram l TnaPProt-ed Addni;ec* ( 1 590 00't(F) dl',r 55"r' , 3501,16(A) Hot PI-1Fs ktahn:d'i:ed a:.o-above (g Poisonous or Toxic Subsranoes lI 7-101.11 Identifyntglnhxmatnm-Or!ginat j !40'f'' ' iter," 3-A)l.lb(%�) Rcastc Held a! or above I3WE Conta ! ITime as a Public Health Control 17-102 11 Com!nun Name-'YVorkin;;Cnntainca' j 20 7-201.11 Szpararnn-Slurav,:' I 3-501 if) . Time as a Public Health tionhvl" 590.00411-1) varianov RcgmrentcmT 202.1 Re'6cton-r _,enu,.andLce,: 7-202.12 Condition,,of Uae" I 7-203,11 Toxic Containers-t'roh:b:,i �nsa' RECUIREPAFNTSFORHIGHLY SUSCEPTIBLE 7-20 4.11Sanitizers.Criteria-Chemicals` � , F'OPULATiDNS:;HSP) 7-2:04.(2 ( Chemical, for Washuic Produce,{:r.,eria j 21 1 3-BitL I It A) Crq,a;teurized Pre-packaged Iuicos and ! 7.204.74 I Dryotp Agents.Criteria' j ! Beverages with Wrunine i,abcls* 3-ft)!.11(B) Lse,4Pasteurieecl 7-2C5.i 1 Incidental Fovd Contact. Lubricants' j 3-&0:.E 1(I>) Naw or Partially 6xr.rd Animal P,exl and 7-206.1 I RMnt ed Lce Pesticide,.(Yrteria" oat,-Seed Sprnm;No,Setvt 7-7.06.12 Ncu!ent B::i+.S±a li;,.^s" 3-80 L i l if t ;htapcaed i;rwd PackaIle Kot Re-s:eyed. 7-206.i s j TrickingPnrder:, Pect Control and j :1M:nitorin;t* CONSUMER ADVISORY 22 3-603 11 Consumer A.!s-,sory Posted for Consumption of TI AEITEh4PERATURE CONTROLS Aninv. Foods-f Tat are Raw.Undcr.onked of J5 ! Proper Cooking Tarnperaiurzs for PHFs Not OtLeraise Processed to E;7i!ninate 3-40 1.1 11 A(l)(2) - - Pathogens Ut_) Eggs- 155'F 15 Sze. Eggs-firm 5'F]ediaee Service la 51ec, I :-zn? is Pasteunzod Lige,;Substitute fat Rats Shell B 3=t0!.;7;A)f2i Conuninn±cd 1^sh, Meat,V Ganz Animals- 155"F I� wc. * 3-401.1 IM),,t)(2) Pnrk and Leet Roast - 130'F 131 miu* I SPECIAL REOUIRENIENTS =1n1.t1t,A!!2) R.at!tes,hijccledMcats- 155="= 15 j90009(A)-(Q) V:olanons01Section 590.0119(A)-(D) in sec, catering, mobile('nod,temporary and 3401.; :t k)(3) Poultry,Wild Game,Sruftcd VHF., r,:sidential kitctxan operations should he Stuffing C ntainine Fish,Meat, I debited under the appropr;ate zect-onx Poultry or Rant"-165°F 15 sec. ( above if related to foodborac ilinecs ,-401.11(C)(13) i R'hok-urus,ie,Intact Becf Steaks interventions and risk factors. Other i 145 590.001> ,•iolations re?a!iu,, to good retail -?01.12 Raw Animal Foods Cooked in r, practices should be debited under //29- j Micturate 165'F " Sp nal Rei?u)renten .. 1 3-401 1 !(A)(I)(b) ! All Other PHF;- 145 IF 15 see, j 17 I Reheating for Hot Holding VIOL AT.tONS R>rLATED TO GOOD RETAIL PRACTICE'S 3-403.11(An0171) ( PHFs 165°F 15 sec. * j (terns 23-30) i 3-403.11lR) ( 1%4icrowave- 165.;F 2'vfinute Standing CliNcn?axd non-:,ihcal vrnkrt^mm ^..fnc(t do not oelate!o the Time* oodbnrnc dines.r and risk fiu:'ors lis!vd of of-e, can 1*e 3-403.111CI Coram rciall,,Ptaesced RTE Foul- ,1%:und in rite folloirry sarlmns of the Food C'oue and/i)i CMN, ` 140'F' 590.0!1!1 3-403.11(F) Renimnn,Unsliced Portions or Becf item Good Retail Practices FC ! 590.000 23. iVanagemen,and Pe!sonrtei FC-7 I .003 ! , 2d Fc,xd^nd Food P'etecrion FC--3 004 ! ag Proper Cooling of PHFs j _ 1 1 25. -po!pmed anri Utensils -C-4 .005 3-501.14,A! Coolutg Cooked PHFs front I40`F to 26 Watei.Plum;inq a,id Waste C-S .006 70`F Within 2 (Tours and Fruia 70"F --2i Phy,:ral rsci!ity Fr; --6. 007 --j to 41"Fl-15'F Within 4 Hours. ' i 23. Pcisonaus or Toric PIlateneis FC-7 .008 3-501.1401) C,ohng PHFs Made Ftmn AmMent 219. Spc-clai Rogulremeras 009 j Temperature Ingredients to 41 cF145`F 1 20 Other ) t Iry t(l:mdtlours.k Gcnotts enuc:!it-nn m the f•rler.tl 191)9 I-o,e1 Code or 104 I'M';59000o' Massachusetts Department of i.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 TYoe of Ooeration(s) Tvpe of Insoection Cts �S4 )-A&r� 1" 13/06 I ❑ Food Service Routine Address 9'�- WSf s4pl) Risk I Retail inspection Level Residential Kitchen Previous,/nsypaction Telephone s_�( ❑ Mobile Date: 61106 r 1 �J l HACCP;YM El Temporary ElPro-operation Owner h { 1 ❑ Caterer El Suspect Illness Person in Charge(PIC) I Time El Bed&Breakfast ❑❑ HACCP General Complaint In: ji Inspector \j oSPaJh i�Q��e Out-1 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 *4 ❑ 14.Approved Food or Color Additives ❑ 3. Personnel with Infections Restricted/Excluded ❑ 15.Toxic Chemicals FOOD FROM APPROVED SOURCE❑ Food and Water from Approved Source TIME/TEMPERA7URECQNTROLS(Potentially Hazardous Foods) 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 ti 9. Hot and Cold Holding ❑ 8. Separation/Segregation/Protection ❑20.Time As a Public Health Control ❑ 9. Food Contact Surfaces Cleaning and Sanitizing REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) ❑21. Food and Food Preparation for HSP ❑ 10. Proper Adequate Handwashing CONSUMER ADVISORY F111. Good Hygienic Practices ❑22, Posting of Consumer Advisories Violations Related to Good Retail Practices Number of Violated Provisions Related Critical (C) violations marked must be corrected To Foodborne Illnesses Interventions immediately or within 10 days as determined by the Board and Risk Factors(Items 1-22): of Health. Non-critical (N) violations must be corrected Official Order for Correction: Based on an inspection immediately or within 90 days as determined by the Board today, the items checked indicate violations of 105 CMR of Health. {, 590.000/federal Food Code. This report, when signed below C N by a Board of Health member or its agent constitutes an 23. Management and Personnel (FC-2) order of the Board of Health. Failure to correct violations 24. Food and Food Protection (FC-3)(590.0so.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: -- 55901nspeclFo 14c �, �J Inspector's Signature: ' �/ � ` Print: �nSp�L ' Inature: _ ---f- i - Page-',of-aa es PIC's Signature: I Print: 1 f� (' i�� f I g a, Violations Related to Foodborne Illness interventions and Risk Factors(items 1-22) PROTECTION FROM CONTAMINATION FOOD PROTECTION MANAGEMENT R ( Cross-contamination 1 I 1590.003(A) Assignment of Respornihility" ( 3-302.11(A)(1) Raw Aminal Foods Separated him 590.003(6) Demonstration of Knowledge` i { C;mked and RTE F(a)ds* 2-103.1 t Person in charge-duties Contamination from Haw Ingredients 3-10111(A)(2) Raw Aminal Foods Separated from Each EMPLOYEE HEALTH Other* 2 590.003(C) Rcsponsibilityr2Ftheperson incharge to Contamination!rom the Environment requirc reporting by food employees and 3-302.1 It A) Food Protection* � applicants* t 3-302.15 Washing,Fruits and Vegetables 590.003(Ft Responsibility Of A Fonid Employee Or rkni 3-3114.1: Food Contact with Equipmem and Applicant To ReportTo The Person In Utensils" Charge* j Contamination from the Consumer 590,001(G) Reporting by Person in Charge` 1 j 3-306.14(A)(B) Returned F(xxi and Reseivice of Foal„ 3 590.003(D) Exclusions and Res(ricTions* Disposition et Adulterated or Contaminated 590.003(E) Removal of Exctu,enms,and Restrictions ( Food I-701,11 Disearchug of Reconditioning Unsafe FOOD FROM APPROVED SOURCE y Food" ,� Food and Water From,Regulated Sources i 9 j Food Contact Surfaces j 4-NN I I1 Manual WarewashinHot Water 590.0fr4(A-B) Cornplienee with Food law* + b , 1 3-201.12 Food in it Hermetically Sealed Container" Sanitization Temperatures* 3-201.13 I F1uidMilk and Milk Pruduct,* j 4-5;11.1 12 Mechanical W'arewashim- Boot Water 202.13 Shell Lggs* Sanitization Temperatures* Che cal 13-202.l4 I Fggs turd Milk Product,.Pasteurized* 1,.50!•i 1-a concentration io Sanitization-ban-temp.,pH, i eotrcentrati+�n and hai'dnass.:' + 3-202.16 ice Made From Potable Drinking Water" t 14-60i I I(A) Fjuipment F(xrd Contact Surfaces and 5-101.11 Drinking Water from an Approved System* I +I Uten4ls Clean' 590.00(r(A) Bottled Drinking Water" 4-602.11 Cleaning Frequency of Equipment Food- 59tt.0(16(Bi Water Meets Standards in 310 CbIR 22.0* Conta�t Surfaces and utensils` Shellfish and Fish From an Approved Source 4-70111 Frequency of Sanitization of Utensils and ! t 3.201.14 fish and Recreationally Caught Molluscan. Food Contact Surfaces of E4uinment* Sheflns-h* 4-703.11 Methods of Sanitization-Hot Water and 3-201.15 Molluscan Shellfish from NSSP Listed j { Chemical* Sources* to Proper,Adequate Handwashing i i Game and Wild Mushrooms.Approved by 2-301,11 Clean Condition-}lands and Anus* Regulatory Authority_ j 3.202.18 Shellslock Identification Present* j 2 3(}i.12 Clearing Frcrcdnrc* 590.004(C) Wild Mushreams* ?-361.;-'. When to Wash* 3.201.17 Game Animals* 111 Good Hygienic Practices ! 5 Receiving/Condition j 2-401.11 Eating.Drinking or Using Tobacco* 3.202.11 PHFs Received at Proper Temper.rtures" 2401.12 Discharges From the Eyes,Now.and } 3-202.15 Package Integrity' Mouth^ 3-101,11 Food Safe and Unadulterated* 3-301.12 Preventing Contamination When Tastinll" 6 Tags/Records:Shenstock 12 Prevention of Contamination ffom Hands i 3-20118 Shellstock Identification ' 59f),(H)1(H) Preventing Contamination from Employers* 3-203.12 Sheilstock Identi fication Maintained" 113 Handwash Facilities TagslRecords:Fish Products 1 Conveniently Located and Accessible 3402,11 ParacitcDestruction* � { ( 3-102.12 Records,Creation and Retention* 5-•2.03.11 Numbers and Camien ces* 590.0(1#(1) Labeling of Ingredients' 15-204.11 Location and Placement* g Conformance with Approved Procedures 5-205.11 .Accessibility,Operation and Maintenance f IHACCP Plans t ( Supplied with Soap and Nand Dry+hg 1-562.11 Specialized Processing ivteihtxfs* Devicesj 3-502.12 Reduced oxygen packaori6-301.11 Handwaching Cleanser,Availability ng,criteria"` i ' b'-103.62 Conformance with Approved Procedure,,* , 6-301.12 Hand Drying Provision =:.'ren,les critical nem in+lie.`eJet:al 1994 Fxxi Cock or 10 CRIR 590 000 t� " 0095 Congress Street Congress Market City of Salem RETAIL FOOD - Food Establishment Inspection HACCP: ❑ Telephone: Item Status Violation Critical Urgency Nature of problem or correction 978-745-8918 Non-compliance with: Not Done Owner: Anti-Choking PASS ❑ Lac Bui Tobacco PASS ❑ PIC: : Dung BUI .. FOOD PROTECTION MANAGEMENT Not Done Inspector: PIC Assigned/Knowledgeable/Duties PASS ❑d RED David Greenbaum EMPLOYEE HEALTH Not Done Date Inspected: Correct By: Reporting of Diseases by Food Employee and PIC PASS ❑d RED 6/16/2005 Personnel with Infections Restricted/Excluded PASSd❑ RED Risk Level: FOOD FROM APPROVED SOURCE Not Done Permit Number: Food and Water from Approved Source PASS WRED BHP-2005-0248 Receiving/Condition PASS W RED Status: Tags/Records/Accuracy of Ingredient Statements PASS RED VIOLATION Conformance with Approved Procedures/HACCP PASSd❑ RED 1#of Critical Violations: Plans . 1 - PROTECTION FROM CONTAMINATION Not Done Time IN Time OUT: I Separation/Segregation/Protection PASS ❑d RED Notes: Food Contact Surfaces Cleaning and Sanitizing PASS RED 212. Proper Adequate Handwashing PASSd❑ RED Urgency Description(s): Good Hygienic Practices PASS ❑Q RED BLUE: Prevention of Contamination from Hands PASS RED Violations Related to Good Retail Practices (Critical Handwash Facilities FAIL Critical RED The bathroom sink is missing paper violations must be corrected towels. Provide disposable paper towels in immediately or within 10 the bathroom at all times. dayS)(NOn-Critical violations Keep the bathroom sink clear and accessible at all times. GeOTMS®2005 Des Lauriers Municipal Solutions, Inc. ( Rev. Jun 16,2005 ) Page I of r 0095 Congress Street Congress Market must be corrected immediately PROTECTION FROM CHEMICALS Not Done or within 90 days) Approved Food or Color Additives PASS ❑d RED RED: Violations Related to Toxic chemicals PASS RED Foodborne Illness Interventions TIMEITEMPERATURE CONTROLS(Potentially Haz Not Done and Risk Factors (Require Cooking Temperatures PASS RED immediate corrective action) Reheating PASS ./❑ RED Cooling PASSd❑ RED Hot and Cold Holding PASS ❑d RED Time As a Public Health Control PASS RED REQUIREMENTS FOR HIGHLY SUSCEPTIBLE PO Not Done Food and Food Preparation for HSP N/A 0 RED CONSUMER ADVISORY Not Done Posting of Consumer Advisories N/A 0 RED GeoTMS®2005 Des Lauriers Municipal Solutions, Inc. ( Rev. Jun 16,2005 ) Page 2 of 0095 Congress Street Congress Market Violations Related to Good Retail Practices (Blue Not Done Management and Personnel PASS ❑ BLUE Food and Food Protection FAIL Critical ❑ BLUE There are price labels covering expiration/sell by dates. Do not obscure sell by/expiration dates with price labels. 121 items were found outdated at the time of inspection. Owner must closely monitor expiration dates to insure all products for sale are not expired These violations are repeat violations, be advised that any future repeat violations of this nature will result in monetary fines being issued. Equipment and Utensils FAIL Non-Critical ❑ BLUE The following freezers and cooling units need visible accurate thermometers, Cornelius cooling unit, Fogel cooling unit and the long white freezer near produce rack The cornelius cooling unit needs a thorough cleaning. Water, Plumbing and Waste PASS ❑ BLUE Physical Facility FAIL Non-Critical ❑ BLUE The back receiving door has a gap at the bottom. Provide a sweep on the door. Poisonous or Toxic Materials PASS ❑ BLUE Special Requirements PASS ❑ BLUE Other-See Notes PASS ❑ BLUE Be advised that any establishment that leaves the door open is subject to monetary fines. GeoTMS®2005 Des Lauriers Municipal Solutions, Inc. ( Rev. Jun 16,2005 ) Poke 3 ora �:.;'j^',".?a"Mu'W.-.'"�p:y�`,. .w,f;{� s,.a�.W""amu .�4;-..4 ..,..,,•+e�s.:t„w•*,�+4�»_;.»wry -k�'-+,$°,4�,�.s.no -n+we=.e=�.i y....:m..�.BrdeF"S` ''p�"M.w':r�.`?Y••,�r+°-^�vr�• .v',+rIT, m:.{.; :y ,-.ti Ya;9 ..< 14 M'.. ♦ "'§:`+ ,.. q`.:' tr.��'Pa�'. ✓B'�.""qT'!R�'''.l�N�°»_'.:.:'71r�.�Te' Commonwealth of Massachusetts , , , Board.of Health ,ty 120 Washington Street,4th Floor SALEM,MA 01970 Food/Retail Establishment Permit DATE PRINTED: 01/02/2006 WHO'S PLACE OF BUSINESS IS: Congress Market Fite Number:BHF-2004-0105 95 Congress Street Salem MA 01970 LOCATED AT: 0095 CONGRESS STREET SALEM,MA 01970 Permit Type Permit No. Permit Issued Permit Expires Fee Restrictions!Notes RETAIL FOOD BHP-2006-0044 Jan 2,2006 Dec 31,2006 $100.00 TOBACCO VENDOR BHP-2006-0045 Jan 2,2006 Dec 31,2006 $50.00 Total Fees: $150.00 PERMIT EXPIRES IDecember3l, 2006 Board of Health J 'Phis 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 15 of 26 i CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH C1 9 U\71 O 120 WASHINGTON STREET, 4TH FLOOR �f SALEM, MA 01970 TEL. 978-741-1800 VVV OCC 0 5 2005 STANLEY J. USOVICZ, JR. FAX 978.745-0343 MAYOR WWW.SALEM.COM CITY OF SALEM JOANNE SCOTT, MPH, RS, CHO BOARD OF HEALTH HEALTH AGENT I I 2006 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT NAME OF ESTABLISHMENT O.ON GRZ,SS M AF rE I TEL# `/�1't1 R �1 0-C �7 J ADDRESS OF ESTABLISHMENT 6 C',ah�I-uss �r-Q& ) qcl l e �n0 Ty11 I" A i MAILING ADDRESS (if different) OWNER'S NAME L.--.AC j—:U-tI TEL# 'Y1 6 - OT)} t' ADDRESS 4 CITY L-' ,NlJ STATE M ZIP Qi q 0 S' CERTIFIED FOOD MANAGER'S NAME(S) CERTIFICATE#(s) i (required in an establishment where potentially hazardous food is prepared.) rj EMERGENCY RESPONSE PERSON UCC. t5(i) HOME TEL# HOURS OF OPERATION: Mon.8- to Tue. 1?-?oWed. '2-10Thu. $-)o Fri. 1-td Sat. 9-(t! Sun. lo-8 T I TYPE OF ESTABLISHMENT FEE (check oniv) f RETAIL STORE] YES NO / less than 1000sq.ft. 1000-10,000sq.ft. `__�--$---10�0�� more than 10,000sq.ft. $2 ------------ ---- NO less than 25 seats =$100 25-99 seats =$150 more than 99 seats =$200 -------- --------------------------- ---- --- --------------------------- ---------- --- ------------ -- BED/BREAKFAST YES NO $100 .......................... ....................... ........... ..------ .-------------------------------------- ------------------ ADDITIONAL PERMITS MAKE(not just,serve) ICE CREAM, YOGURT SOFTERVE YES NO $5, CTOBACCO VENDOR; 60t-0 YNO $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 lof Health. Pursuant to MGL Chapter 62C, Section 49A, I certify under the pains and penalties of perjury,that 1, to my best knowledge and belief, have filed all state tax returns and paid all state taxes required underl the law. Signatbre Date Social Security or Federal Identifi ration Number ------------------------------------------------------- ----Q--------------------,--------------------------------------------- Revised 11/03/05 FOODAP2.adm -C-h--e;#a Date 1 ,�/ .70 -0 I ,�a .1ry 4>M y.d w . Pw Y65.e2k�4dM'r> M\�\ ,F, whits F - 4n,- �r u'L']'•>r'+�t-en• � .saEst3.v4'r aef�.'M�arry 37 •e, �{c+T9 X �•*�' ti�� 1°� '�,�CITY�OF��S_ALEMM;MASSACHUSETTS ��u'v'"'°"� " t `�� r �`��` . 10F. x9 **,r apt�,�s.� "* �'�¢460AHD_OF:HEALIH g�g "+,- ,� x �•' �Y` �"".': • • ( 3 l eLw '� r�'.m :5 �`-,T.�I LN,' -?�4¢..._�'+1..�x "vt" �W. ..Mk::. -�•.�:. a `• A" 4 y„,120.,WASFIINGTON STREEi,14TF1,1'1:00R�j[fA'il" '. _ ., ,'"` r",;; v�" �'r�' `"�f`:�° cs,s•`'�a,:Y,�"'� +�'vx•;>,. �'�r: .ta SALEM MA 01970�;kfR='�•-sa•::€>-- - ' - :-. . ate.,-z;-,�r�"�-` TEL 978-741-1800 FAX 978-745-0343 Kimberley Driscoll WWWSALEM.COM Mayor JOANNE SCOTT, MPH, RS, CHO v-�� HEALTH AGENT �,j��i L Apri124,2006 Congress Market 95 Congress Street Salem, MA 01970 Dear Owner: On Wednesday April 12,2006 personnel from the Tobacco Control Program conducted a compliance check to determine if your permitted establishment would sell a tobacco product to a minor. A 17-year-old Female purchased cigarettes from a clerk in your store. Documentation is now on file at the Board of Health regarding that sale. Congress Market is in violation of Section III(A)of the Salem Board of Health Regulation Affecting the Purchasing of Tobacco Products. According to this section,the sale of cigarettes, chewing tobacco, snuff, or any tobacco in any of Its forms to any person under the age of eighteen shall be punished by a fine of (Two Hundred Dollar fine)for the Second offense. FOLLOWING THE THIRD (3RD)OFFENSE,THE BOARD MAY CONSIDER POSSIBLE REVOCATION OR SUSPENSION OF THE PERMIT. The North Shore Tobacco Control Program and the Salem Board of Health have worked with you and your employees to demonstrate methods to ensure compliance with this regulation Therefore, you are ordered to pay a fine of$200.00 for the violation stated above. A check or money order payable to the City of Salem must be at the Board of Health office, 120 Washington Street, 4th floor,within ten days of receipt of this notice. Should you be aggrieved by this Order, you have the right to request a hearing before the Board of Health. A request for such a hearing must be received In writing in this office of the Board of Health within seven (7) days of receipt of this Order At said hearing,you will be given the opportunity to be heard and to present witness and documentary evidence as to why this Order should be modified or withdrawn. You may be represented by an attorney. Please also be informed that you have the right to inspect and obtain copies of all relevant Inspection or investigation reports, orders, and other documentary Information in the possession of this Board, and that any adverse party has the right to be present at the hearing If you have any questions regarding this notification please call me at 741-1800. Sincerely yours, w f Cx-y( Yoanne Scott Health Agent JS/mfp CERTIFIED MAIL: 7003 3110 0005 1992 2315 cc North Shure Tobacco Control Program Chnslinn H,unngton, Board of Health Chairin.in dnd Members .s11 l a rW'ON .:p i'`C�'4;.::-rv:9ifr�a. :r ..ti 4 x i` _ •ar'it1i,�Nfic.:::; :., Eas'.,]^,' ' '.yVh;T %.3n.,,Nt.'''.,; 'y?tF'k:� .?S,'•:#.- '.rj�P +;,%'",y.:.5 .G�..,.'+3dv_ 'i,'.}.^ .{"Go. .,S,,.KY?iti:n,e.• •g+. r`;..4_xa.:,r,'':r•^r' 3,.w::: _.;,isr' _ _ - 3 : ^':�•>�. l ..,,, 3:a .., .. ;.a. ,.r . ,. ...,ea._... , •,//''' ..: :s.,Y ...:::Ya'.' .r,�'nC.':• .,-. ^rr-•.:p;r <.,f:-•.[nt:`� - »i;' .�'.�, ..�'...r..r - " .r,t,,.vro:"':v.:•.wx:=•:':..',.< ._ x. . -u�,v.a........ ._ x::.. ., :..,.:de.•, ,cam_+...,, .;"`._ ... •.hl:i'_..".'.., ..'� ...i•:rx.a.:.r.'- .:J':'l.- .'A -.,.i:..':i.,.i..:••:::i .:,i:'. _h. _r. r li \% ' I / I�l�l�'r'�`/�`I�Y�% I. 7 I l\"1\I\l\l I I ., Ix\ \ \ II� ` \ '\ \ \J�I�I\I\��I�Itil\Jti1�J�ltil\I\I�I`I\II\I\ `1 ✓\I\I\I\I\I\I\I\I\I\I\J\I\I\I\I\I\I\ \I\I ✓� I I\ \f\f l\r\J is \j\f\l\f\f\f\r\1\j\f\f \ J\J J\J\J\ \J\j\f\J\J\J\J\J\J\J\J\ \J\J J\J\J\J\J\ \ \ -n J\ N/N/ � J�J\J\J\J\J\J\J\J\J\J\J , \ J \J\J\J a \jNfNj\f\j\f\f\f\f\f\f\f\ \J\ J• T,I\I\J\I\J \J\ \ \il ' � J \ J\JIN 14i �J\7I 'g .'J\J\� ��J 11Tv�;�,Q'- \Jc�r(h`�.GtiY•'L'l,`.1\ , •.•. . . , . •. . 'J' J' J'\ : _ `l, / % '%\lt / r ��'�;l.�,J`\l i '.. .` \"l\',x\`:_>r.,`l`:'. :.\'+. ./\; ,r .'•;t\;:.>. .,,, r', .'J 00 UARS' , IBank'ofAmerica,� f• '1\� ACH'M'•0110001�J��\i'�J\J\��/�I�lam:/�/�l\Jt,,, ,.,,;�' .eN �• , . <.•. , /_.i 'i'.':;;� ; , ,=(. ::� ;�� f` '�/\/N/,X %X1\ X1`l i��`l�r �% is ''�` �l� �l % .`i`1 JFQR\`�Lq•, �LUC ,I�� g� ti%ll 'J, :4'.4s 0.1. •�(,'\(r\l\/i�(r`rr\(r\(,�%;,'tr\(.\f.\'/,tel;°... is\.r:'\lr\'. .�<' 'r', (. .(.' +.(P�:... �'i/,.>/l�\`l.\'J� (l\(j`/,\IJ\?. . . `�:\�i/`'/.,� ;;\'(,�/x��/i�/i`':i.\r't'`:' '•i•� ,` - .. •. `:.,;r,'`— ,�'� "!,�: i`_/__.. 0095 Congress Street Congress Market City of Salem RETAIL FOOD - Food Establishment Inspection HACCP: ❑ Item Status Violation Critical Urgency Telephone: I Violations Related to Good Retail Practices (Blue Items) 978-745-8918 Physical Facility FAIL BLUE Owner: Comment: Owner is installing new refrigeration units in this establishment. Owner must contact the Health Agent and submit a Lac BUI plan for this new equipment. PIC: GENERAL COMMENTS: Dung Bui 909:All violations cited in the 10/11/06 inspection report have been corrected. Inspector: David Greenbaum Date Inspected:Correct By: 1011912006 Risk Level Permit Number: BHP-2006-0044 Status: SIGNED OFF #of Critical Violations: 0 Time IN: Time OUT, Urgency Description(s): BLUE: Violations Related to Good Retail Practices (Critical violations must be corrected immediately or within 10 days)(Non-critical violations must be corrected immediately or within 90 days) City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741-1800 GeoTMSO2006 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Oct 19,2006 ) Page I oft Item Status Violation Critical Urgency RED: Violations Related to Foodborne Illness Interventions and Risk Factors (Require immediate corrective action) A i E< ir L' City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741.1800 GeoTMS®2006 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Oct 19,2006 ) Page 2 oft CITY OF SALEM; MASSACHUSETTS BOARD OF HEALTH 120 WASHINGTON STREET, 4TH FLOOR SALEM, MA 0 1970 TEL. 978-741-1800 FAX 978-745-0343 STANLEY J. USOVICZ, JR. JOANNE SCOTT, MPH, RS, CHO MAYOR HEALTH AGENT COMMONWEALTH OF MASSACHUSETTS PERMIT TO OPERATE A FOOD ESTABLISHMENT In accordance with regulations promulgated under authority of Chapter 94, Section 305A and Chapter III, Section 5 of the General Laws, to operate a Food Establishment in the City of Salem is hereby granted to: Type of Establishment: RETAIL FOOD Name of Establishment: Congress Market Address of Establishment: 95 Congress Street Owner's Name: Lac Bui Restrictions: Application Date: 12/3/2004 Permit for Food Establishment 157-05 Frozen Desserts/Ice Cream Permit for the Sale of Tobacco Products 38-05 These Permits Expire December 31, 2005 This permit is not transferable and must be reissued upon change of ownership or location. The permit must be posted in a prominent location in the Establishment, In accordance with the State Sanitary Code, before any renovations, improvements, or equipment changes are made, all plans for such must be submitted to and approved by the Salem Board of Health. HEALTH AGENT CITY OF SALEM, MASSACHUSETT6;�' M-V g UlyTO BOARD OF HEALTH yl 120 WASHINGTON STREET, 4TH FLOOR II/Iti NOV 3 0 2004 . q SALEM, MA 01970 ' TEL. 978-741-1800 gyp' FAX 978-745-0343 CITY OF SALEM STANLEY J. LISOVICZ, JR. JOANNE SCOTT, MPH, RS, CHO BOARD OF HEALTH MAYOR HEALTH AGENT 2005 APPLICATION FOR PERMIT TOOPERATE A FOOD ESTABLISHMENT NAME OF ESTABLISHMENT &)rJPP-SS k1,'1 -kJTEL# q-)L8 i-A�— 9119 ADDRESS OF ESTABLISHMENT J�- P�0 "Mss 05 I r'2e I34IP. il1.i r04 Off: o MAILING ADDRESS (if different)) OWNER'S NAME I-prl.1 6u )- TEL# tgg 06- Ojt3 ' ADDRESS '1 � q0t-ltd �+- Q-e CITY Li nr\- STATE ]\/)A ZIP Glow) CERTIFIED FOOD Li NAME(S) CERTIFICATE#(s) (required in an establishment where potentially hazardous food is prepared.) t EMERGENCY RESPONSE PERSON �� P` ' U I HOME TEL# til I �- D-636- HOURS -636-HOURS OF OPERATION: MonT-10 Tue.-)O Wed. -lu Thu. -)p Fri._ -/o Sat.g 11 Su00- 9 TYPE OF ESTABLIS OTR/ FEE check only RETAIL STORE YES NO less than 1000sq.ft. 0 1000-10,000sq.ft. =$100 t� 5 more than 10,000sq.ft. =$250 RESTAURANT YES NO //D less than 25 seats =$100 25-99 seats =$150 more than 99 seats =$200 BED/BREAKFAST YES NO $100 ADDITIONAL PERMITS MAKE (not just serve) ICE CREAM, YOGURT, SOFT SERVE NO TOBACCO VENDOR 51-05 YES NO $50 ALL NON-PROR:T(such as church kitchens) YES NO x25 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 bes kno�l�ed ge�a .d belief, have filed all tate t x returns and al state taxes required under the law I M (,�1/() �1�1'91 0 0�i` h J sg Signature Date' Social Security or Federal Identification Number ----------------------------------------------------------------- --+ /1— ----,-J 'I Revised 11/03/03 FOODAP2 adm Check#&Dat •. 9 dV l�7 I _ D - Massachusetts Department of Public Health Salem Board Health M S 120 Washington Street,0 Floor Division of Food and Drugs ' Salem, MA 01970-3523 FOOD ESTABLISHMENT INSPECTION REPORT Tel. (978) 741-1800 Fax(978)745-0343 Name Da#ey- Tyne c#Operationtst Tof Inspection C Al r f MA_r!S_S JN/�f1 K! G" ��/%d/'01 _❑./Food Service lff Routine Address Risk t Retail [I Re-inspection 9s r'+nnb"jr rr xr Leve ❑ Residential Kitchen Previous Inspection Telephoney� r9/,T E] Mobile Date: 1-7�^ HACCP Y/N 171 Temporary ElPre-operation Owner �Ur � ❑ Caterer ❑Suspect Illness Person in Charge(PIC) , Time F-1Bed&Breakfast El General Complaint ❑HACCP Inspector A_rir(? (r9fiFFnrf�el}ctu Out; I Permit Na. El Other Each violation checked requires an explanation on the narrative page(s) and a citation of specific provision(s) violated. Non-compliance with: Violations Related to Foodborne Illness Interventions and Risk Factors, Anti-Choking Tobacco Violations marked may pose an imminent health hazard and require immediate corrective 5go.00s(E) ❑ 59o.00s m ❑ action as determined by the Board of Health. FOOD PROTECTION MANAGEMENT ❑ 12. Prevention of Contamination from Hands ❑ 1. PIC Assigned/Knowledgeable/Duties ❑ 13.Handwash Facilities EMPLOYEE HEALTH PROTECTION FROM CHEMICALS ❑ 2. Reporting of Diseases by Food Employee and PIC ❑ 14, Approved Food or Color Additives ❑ 3. Personnel with Infections Restricted/Excluded ❑ 15.Toxic Chemicals FOOD FROM APPROVED SOURCE - TIME(TEMPERATURE CONTROLS(Potentially Hazardous Foods) ❑ 4. Food and Water from Approved Source ❑ 5. ReceivinglCondition ❑ 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) [121, Food and Food Preparation for HSP ❑ 10. Proper Adequate Handwashing CONSUMER ADVISORY [111. Good Hygienic Practices ❑22. Posting of Consumer Advisories Violations Related to Good Retail Practices Number of Violated Provisions Related Critical (C)violations marked must be corrected To Foodborne Illnesses Interventions immediately or within 10 days as determined by the Board and Risk Factors(Items 1-22): of Health. Non-critical (N)violations must be corrected Official Order for Correction: Based on an inspection immediately or within 90 days as determined by the Board today, the items checked indicate violations of 105 CMR of Health. 590.000/federal Food Code.This report, when signed below 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.o04) cited in this report may result in suspension or revocation of 5. Equipment and Utensils (Fc-0)(660.006) 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 7. Physical Facility (Fc-6)(590.007) have a right to a hearing.Your request must be in writing 28. Poisonous or Toxic Materials (Fca)(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 5NOlnspeciFolmS-14. Inspector's Signature Print: 2 j� +� PIC's Signature: Print: ,�" )� 1 ! I Page /of JPages �, v - Violations Related to Fqodborne Illness Interventions and Risk Factors(items 1-22) PROTECTION FROM CONTAMINATION FOOD PROTECTION MANAGEMENT 8 Gross-contamination I 59(}.003(.4) Assignruent of Responsibility" 3-;02.11(A)(J) Raw Animal Foals Separ.oed horn 590.003(13) I Demonstration of Knowledge` Coot:ed and PTE Foods,- 2-103.11 ( Pec,oe, in charge - duties Gootaminatio^7romRaw ingredients 3-30111(A)(2; Rav,Animal RAAs Senautted from Each EMPLO"EE HEALTH Othor' 2 590.003(0 Responsibility 0f the Person In clang, to ( Conram+ramn from the Fnvironment reu:ure reporting by fixxl emr,ioyees and 3-302 11(A) Focal Protection" applicants, 3-302.15 W ashmi>Fruits and Vegetables 590 0.03(F) hrsponstbihty Of.4 Nocxi F,mplogcc Or An 3-304.1 I Food Contac with Fcluiptnent and Applicant To Repent To The Pvrsou In ( Ltcn:'A " Chwee* I Contamination from the Consumer 540.t103(C;) Reporting by Person in Charge' 3-306.14(A)(B) Rvturned Food and Reseivice of Foo& 3 590.0030) Exclusions and ResttictionO I Duposdron of Adulterated or Contaminated 390.003(F) I:emoval of Exclusions amt Restrictions 1 FGoa 3-701.11 Discarding or Recondil ionmg Unsafe FOOD FROM APPROVED SOURCE P""d' di Food and Water From Reguiated Sources j rf Food Contact Surfaces 590.004(A-B) Compliance with f,'(k d Law` i s-501 l l l Manualp':rewa�hme-F(<i Water 3.201.12 F xd in a Iler:netically Sealed Container` SanitlZaimn i emperantres 'i-ml,t 3 Fluid Milk and Milk Products" 4-501 I I' Idecl:an:cai`h'•.,reuasLing-Efa Water 1 S:antiZati(ifl relunerdim'eSy 1-20113 Shell Eegs* ,. - . 4-.101,1 t Chruuez Soniization-temp PN, 203.11 hggs and Milk Pratucts. Pasteurized' ( f uatcznuao0u and ha+'dne:.c =2;72 Ili ice Made From Potable Drinking Nater` j ( 4-60!,11;,A) Equipucpt Ford Contact Surfaces and 5-101.11 Drinking Water from an Approved Svstevi' - pl Utensl!s Clea- 51)0.006(A) ( 5`10.006(.4) Bottled Drinking Water* I .i-602.11 Cletming Freyuencv of Equipment Fool- 590.006(B) Watt+ Meets Standards in 310 CMR_2.u` Coarser Surfaces and Utensde'" Sheliffsh and Fish From an Approved Source 4-702 11 Frequency of Smtitizahon of Utensils and 3-201,14 Fish and Recrext i onally Caught Mollucar. i Food Contact Surfaces at Hquinment2 4hetitish' 1 A"703.11 Methods of Sanitization - Hot Water and 3-201.15 Molluscan Shelifish front NSSP I steel I Chemica'^ Sources" ` Ip Proper,Adequate Handwashing Gdnfe and fleid Mushrooms Approved by n-301.11 Clean Cendiraa- bands and Arms°' Regula=err Authority ; -202.I8 Shellsioc:k idenriticarion Present, 2-30;.12 Clea t[ae,PrcxeduI.c•` 590.004(C:) Weld LluchrUf;ms* 2-30!.14. -When to V;011' 3-201.17 Came Anin:al5 ) '-I Good Hygienic Practices c ReceivinglCondidon 2-401.11i:ain:>, Drntkinc or U+ing Tobacc.:T - -- 2--101.12 Discharges From the Eye;,Nose and 3-302.i i PI!Fv 32ere:red at 1'xoner Temperatttrcr^ � 2(13.11 Paf:kaee In[eLrzity"' Month: i 3-301.12 Pre:eNing Con[ammation Who?Tasting 3-101.11 Fond Safe and Unadulterated" ( 12 Prevention of Contamination from Hands 6 Tags/Records!Shelistock ' n 1 590.00-1(E} Preventing Contanwtatiun ti'0m 3-202. Shlishxkldentification 3-203.12 Shelistock Identification Maimru Ped I En:ployeer' I Ta s/Records:Fish Products ( 73 Handwash Facilities Tags/Records: Garvemently Located and Accessible i 3-102.11 Pm'usite I)eshuction* X63,11 Numbers and Caoacities' 3-402.12 Rr:nn s,Creation an.i Retemum" 590.00-,N) Labeling of Ingredients" 5-20<7.t Locahol+. and Placement" q Conformance with Approved Puacedu+es ?-205.1; Acccssibdity,owranon",id�'lmndenance j 9upo!red.'eh.Soap and Hand Drytng 1HACCP Plans j I 3-51,7.1; SpeciahtedPmcessia,zAhefhods^ l Dav!i,a51 6-301.; : E'and,uashing Clean:.cr,Avsilsbility 3-502.12 Reduced oxygen packaging,criteria' I '3-103.12 Conformance with Auproved Proced;rps'; 1 6-3(11.13 Hand llrving Prn:iston f Deno;ev cranal gen:io the tcdeml vm)I-o�d code or 105 t'igk 5s(j NA) CITY OF SALEM BOARD OF HEALTH Establishment Name: Ci011`46549Z toll l Date: /oAg/le/ Page: Z of 3 Item Code C-Critical ItemDESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date No. Reference R-Red Item Verified PLEASE PRINT CLEARLY ii:r/K FOa-4/iirfi- iv7r4.lr as« iroa"o ouro,*or-ji A-I-- r r ip.f' doe INAjOfi"cr7orr: /;/- Mmirvemes emlor r - dsacew I✓&r .:V14'C- 0atrb1- WILL. coNn✓�Ju r-0 rA�J:ICL V Va.lfr-AA. d•t- ,EY1r�sra.✓ dKaCs 7A_ tl/o!_ M0&Nf 0 OdW ee& 4#V urv,r N&iOr A wrs'rdcE Ac , �.t Ket ��9c,ue.rtciD't� ?1C L//fc ^ "/4L&LIuS Gje_trq& UNrr *4r 4A AClJHJLdf'idd 4*9 rooa0 AxA091r. Mesifi/jmule-f/ C-GrCrd+r AntrAm O/s ujfrt WN't-K ftp GMtf- A'&c � f2utr✓ ( trJA , : I n�,reJ�Tai.,i c�,t,�r o•/�-. Z-T We S-Fadi 'e owsM mtjsr AE eMtrm 6Y PeN NAEw Ae vrmg- PNW77A/'t rr� .5l r Me.tiN-S- { �I 77 File-- dol CX 4,h4i 04,OVY dKdX"1.H4't1tNh IfL Qed. GllAOX. /I.4IPZ,#e ' II .trc_ FfrteK,�r( ��.rsst./� e%�oJw arcs ISK e4W MXAV- 140/714,C 1#Z- AXX7d11 I i.J 6 rterrRQ'I, I - 1 I Discussion With Person in Charge: Corrective Action Required: I ❑ No I El Yes I have read this report, have had the opportunity to ask questions and agree to correct all ❑ Voluntary Compliance ❑ Employee Restriction/ violations before the next inspection, to observe all conditions as described, and to Exclusion P ❑ Re-inspection Scheduled ❑ Emergency Suspension comply with all mandates of the Mass/Federal Food Code. I understand that noncompliance may result in daily fines of twenty-five dollars or syspension/revocation of L3 Embargo ❑ Emergency Closure your food permit. ^� I // 11 0 Voluntary Disposal ❑ Other: Violations Relszed to Foodborne Illness interventions ^(ii 14t( � PIII's Recer ed atT,l-irpen atures and Fisk According to law Coo':d to Factors f1tems 1.22) (Cont.) _CF/45'F Within 4 Hour a. ' PROTECTION FROM CHEMICALS ! s-501.1.5 Coohne Medluus for PH us ! 19 PHF Hot and Cold Holding -- 14 ( Food or Color Additives ;-501.!6(B) Cold PI-lFs Maintained at of below 3-202.12 Additives STl0:14(F) 4i`/45�F° 3-302 14 Protection trout hnapproNed Additrve;` I ;-54)L I6(Ai H„i PHFc Maintained at or above ! 15 Poisonous or Toxic Substances a 7-101.11 Idenohinelnforri„rtion-Original 140-fl,f 3->U L 16(A) Roasts Held at ur nboae 130°F, Cunt.;iueis" ! j 7-102.11 Crmmwn Name--WorkmA Conotiners- j 70 Time as 3 Public Health Control j 7 201.11 Separation- Stonier." 1 ( .i-:i01.19 T::rte as a Public HeJdi Control* 7-2+12.11 Restriction-Presence and Use, ! 59(i.004(H) Variance ReUmrenront j j 7-202.12 Condrtiorr ,of Ulc' ! 7-203.11 'Toxic Containers-Ptnhibitions* j RELSU€REMENTS FOR HIGHLY SUSCEPTIBLE j 7-204.11 R;,nitizers,Crites::- Chcmirds^' ! POPULATIONS(HSP) j 7-20.1.12 Chemicals for Washw.e Province,Crit.ria" j 21 i 3-:iw.11(A) Uripvaasteanze<i Pre-packaged)uice:.uid 8eve: cs Vv oral arnur_� t.,b.-1 7-204.74 Dtyuig Aeents.CriteriaT ! ( i-801.11(I,I U e of Pasteurized Eggs^ j 7-205.11 Incidem:d Food Contact.Lubricants' ! I >_g0: 11,P) Raw u-Partially Ccxrl:ed�Inimal Food and j 7-"_'06.11 Restricted Use Pesticides.Criteria* T?::w Sued SOmms Not Set;ed. ( 7 06.12 Rodent Bait Stations' I j 3-fi01.I1(C) Unu;rimd Food Package tint Re-served " ! r'206 1 3 Tracking Rrxders. Pest Control and i 1 Monitoun;;x. CONSUMER ADVISORY TIME/TEMPERATURE CONTROLS 22 3-603.11 Cunsunn AeNisor,p Posted B,=Consumption of 1 ,Sniaial Foods'I'hat are Raw. Under-coked or lfi Proper Cooking Temperatures for ,Not Otherwise Processed to hliunnate 1 PHFS i,alhu., 11:1"1 '1401.1IA(U(2) Segs- 155`F15Sec. ens.%erw>.�r; 8ges-himrecliate Service 115°1715se,:r 3 302.13 P.,steurired Eggs Substitute for Raw Shell 3-401.11(A)(2) Comminuted Fish, Meais r2.(lame Eg^s\ Animal,- 1155cT 15 sec. " SPECdAL REQUIREMENTS 3-401.11(B)(1)(2) Pork anti Beef Roast- 130''F 121 mini ! 3-401.1l(A)(2) Retires.Inje:,led Meals-- 155F15 590009(`)-(D) Violations of Section 'i90.009(A)-(ll) in sec. catering. mobile food,temporary and 3-401.11(A)(3) Poultry,Wild Game,Stuftrd PHF's, ; residential kitchen operations should he Sloffing Containing Fish. Meat, debited wider the appropriate sections Poultry or Ratites-165°F 15 sec I above if related to fra;db-irrie illness , 401 11(C)(3) Rfinle-niusee,Intact Beef Steaks interventions and risk factors. Other 145cF* 590.009 violations relaling to good retail }-401.12 Raw Animal Ponds Cooked in a practices ahould be debited under#29- Mt.^1'owave 165`F " ( Special Requirements. 3-101 1 I(A)(1)(b) All Oihci PHFS 141"F '5 qec. x ! 17 Reheating for Hot Holding j VIOLATIONS RetATEO r0 GOOD RETAIL PRACT)CEs 3-403.11(A)g(U) PHFS 165'-F 15 sec. ' I (lfotxtc 23-30) 3-403.11(8) Microwave- 165'F2 li'hilwe Standing I Crawal and wm-crincal violainm.r, whteh do not rehire lo, rh., I Tillie" fiao,lborne dlnesv irrrtr,-zahons raid riakjrrc iorx li.udd abore, can be -403.1 1(CI Connucres ally Processed RTE Food - ,fircdd:,d:e following,sections of die Flux!Code and!05 COIR 140T zeauoo. 3-403.11;F) Remaining Unsliced Portions of Beef tem Good Retail Practices FC ( 590.000 ag ! Roasts* 23. Manement=.nd Personnel FC -2 003 ! fg j Proper Cooling of PHFS : 24. Foos and Foo;Protection FG-3 ' 00: � 25 Equipment and utensils FC-4 .005 3-501.14(A) Cooling Cooked PHP::from 140'F to ! 1 26, 1'Uatar.P!umbinq ani Waste FC--5 .008 70"F Within 2 1 torus and From 70'F i 1 27. Physical raciav FC-6 i, 007 � to 41''F/45"F Within 4 Hours. W ! '28. Pu�soncus of To, Materials FC-7 .008_ 3-501.14(B) Cooling PHFS Made From Ambient 29, Speeia,Requirements A09 ! Ternpeianue lugredients to 41"17/45 F 30, Other Within 41lours" 5.rn::a<.z.a„ Dawes ex,ne.d,tem in the tedu al 1999 Foed Code or 105 C%fR 590 000. CITY OF SALEM BOARD OF HEALTH �/� �+ Establishment Name: CaN"ss' f'4 R r Date: /W9944 Page: 3 of Hem Code C-Critical item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date No. Reference R-Red Item Verified PLEASE PRINT CLEARLY IYA&ICA I S 6 rrr aD W-Mmnaw Gel .nstt._ /0IC, PXtk4d:C0. /A6 mr, I iA4truf Aten c,Mc ocetN o,lLy. /la/- e49dr s"M~ Ai' a°1� o.� htE"id t✓. � 1 I A'cf l4q I r v&o ik40A1N.-rd1� �fioe0 K. � I 1 1 I I I 1 l' Discussion With Person in Charge: Corrective Action Required: I ❑ No I ❑ !es ❑ Voluntary Compliance ❑ I have read this report, have had the opportunity to ask questions and agree to correct all 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 d 91ars or suspensiUn/revocation of ❑ Embargo ❑ Emergency Closure your food permit. S ❑ Voluntary Disposal ❑ Other: 1-;C) Violations Related to foodborne Illness Interventions and Risk 3-501 PHFs Recerved at TeomeraturasAUOREng to UW Curried to Factors(Items 1.22) (Cont.) 41`F/45 F Within 4 Hums. ' PROTECTION FROM CHEMICALS 3-50;.:5 Cool r;_Yctucds !or P:11's 14 Food or Color Additives ! 19 PHF Hot and`01d Holding 3-501.16;B) Cu:u HFs Maintamed at w below P 3202.12 Add idvcs 59U 004177 41'/451 17- 3-302.14 Protection Born Unapproved Add,tn'as" ( Il.lNA) Hot PHP;. M<ir:rained at or abote 15 Poisonous or Toxic Substances - 140'F 7-101.11 ldentnf}ing Information-(original ;-307.'.6(;1; Roasts Held at or above 7°0"P ' Cont,riaers, 7-102.11 Conlon N,me-Wurkirip Containers 2g : Time as a Pu¢!ic Health Control 7-201.11 Sepurati�,n-Suiayr„ ! 3-5(11.1e Time as aPubiicHealth Controlr 7-202.11 Restriction-Presetwe and Use :0.0Variance Regoirement 12 Con:tition;of Us.e" REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-203.11 Toxic Cuntainers-Prohibitionr," POPULATIONS(HSP' 7-204.11 Sanitizsrs.Criteria-Cl-emic ds* 7-204 12 Chemicals for W`ushine Produce,Criteria" 121 I =-SIH 7 I(A) Unposteun/ed Pre-packaged Juices and Be,eiages with Warnimz labels' 7-205.1-} Dryirq,.lgenrs.Criteria" ROIJ :(L) Use of Px.ie;;riced 7-205.i 1 Incidental Food Cun.r�t.I.nbr!cants' ( 3-301.1 1(11) Rav-or Pania!iv rooked Animal Fond and 7-206,11 I Restricted Use Pesi icldes.Criteria" ( Raw Seen Sprouts Nat Sen ed. '# 1 206.12 Rtxiznt Bait Station'•` 3$01.11 W) Unopened Food Pockaee Not Re-served-- - - 06.13 Tracking Powders,Pest Control and Muni,oring� CONSUMER AiaVISORY TIMEREMIPERATURE CONTROLS 22 3 603.! 1 Consumer Ad,asory Posted for Conwmption of lnintal Fwds That ate Raw, Undercooked or 76 I Proper Caking Temperatures for PHFs Not Otherwise Processes to Etitmnate 3401.i t A(U(2) Fgg,- 155"F 15 Sec Patho:;en:. Eggs-hrmnediate Service I19'F15sec, 3-302.73 Pasteuuzed Eggs Substitute lin Ram,Shell 3-401.i 1(A)(2) Corminnuted t�':h,MeatS k Ciante Eggs-` Animals 155'F I5 sec. * 3 401.110 (I)(z) Pork ad Let- 13011 n* SPECIAL REOWFIEMENTS 3-401.71tA) 71 Rahtrs, Injected Meats-- 155'F 15 590.009(A)-(Di tiiolabons of Sectio n 590.009(A)-(D) in --- Sec,1, :aterine. mobile fond,temporary ata 3-401.11(A)t3) Poultry,Wild Game, Stuffed PHFs, residcattalkitchen uperations,bouldbe Stutling G-ataining Fish, Meat. debited under the appropriate set tons Poultry or Ratite,-165"F 15 sec. r above if related to fnodhonic illness 3=401.1 It(7)(3) Vyliole-muscle. hitact Leet Steaks interventions and risk factors. Other 145°F r ( 500.009 violations telating to good retail 3.401.12 Raw Animol F,ods Cooked in a practices should be dobited under #29-- Micn>wa ve 165`f' Special lRequhetnents. 3=40171(A!(t)(b) AIIC)therPHF, - 1-45'F15sec. '' 17 Reheating for Hot Holding VIOLATIONS&eLATED TO GOOD RETAIL PRACTICES 3.403.11(A)&(D) PRFs. 165'F 15 sec. s` (Rents 23-30', ! ?-403.11(B) NJiciowave- 165`'1-2 N4iniiw Standing Cawal and non-r'raicai vtolamms, which do not velar. iu the TLrc* ,t u,dbcne dloers intetvennona and md,/:rtt,rs Ii.11vd above. <mn he 3-403.1 1(CI Commercially Prtcessed RTE Food- from",it;da fi,t/nwinq eer?inns of;ix Fuad C'n L and 105 C41R 140'T- .51;0.(100. 3-403.11(E) Renu:ping Unshcrd Portion;of Reef I ; item Good FT- if practires FC 1 580.000 Roasts` 23. fdenagerrent and Personae! FC -2 .003 j 18 ( Proper Cooling of PHFs 1 24. Food and Food Protection FG-3 004 f ?-501.14(,11 Cooling,Coo!:ed PHFs from 140"F,it) 25. Euua:mune and Utensils FC-4 .005 26. Nater, P!umbinq aur,Waste FC-5 .006 70'F R)lhm 2 Hour and From 70'F 27 Physical Fari6ty PC-6 ! 007 to-4 i'rR145"F tivitiiin 4 Hours. 'r ; ; 28. Poisonous or Toxic lolateriaic r G-7 AOL __) 3-501 14(B) Cooling PHFs Made From Ambient 29 Special Requirement; .009 Tmnpriature Ir,,tredienta to 4i"i"•hai`F 3r other I - ---- Within 4 Huuis:r ,:,,,,.,.t-�,.._�., ' Dcnoiec.Twral i<em in ihv lydual 199+Fond('ode or Ids CM 5'10000. -Massachusetts Department of Public Health Salem Board of Health 120 Washington Street,4t" Floor Division of Food and Drugs Salem, MA 01970-3523 FOOD ESTABLISHMENT INSPECTION REPORT Tel. (978) 741-1800 Fax (978) 745-0343 Name C Date TYoe of Ooerationfs) Tof Insoection 42-4 ❑ Food Service outine Address c..S C DNGx.�SF S S Risk Retail Re-inspection 11 Level ❑ Residential Kitchen Previous Inspection/1'X103 Telephone .7 �9., ❑ Mobile Date:/�Itiso Owner / HACCP Y/N El Temporary [I Pre-operation 4CTG ,Qu/ I ❑ Caterer ❑ Suspect Illness Person in Charge(PIC) \S0 Time ❑ Bed&Breakfast ❑ General Complaint Inspector In Permit No. El herCP �PPP/l °�JAO/✓37 l/719t fx 4.< out: 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. ,tgOD PROTECTION MANAGEMENT ❑ 12. Prevention of Contamination from Hands El 1. PIC Assigned/Knowledgeable/Duties V13. Handwash Facilities EMPLOYEE HEALTH PROTECTION FROM CHEMICALS '- ❑ 2. Reporting of Diseases by Food Employee and PIC ❑ 14. Approved Food or Color Additives ❑ 3. Personnel with Infections Restricted/Excluded ❑ 15.Toxic Chemicals FOOD FROM APPROVED SOURCE ❑ 4. Food and Water from Approved Source TIMEITEMPERATURE CONTROLS(Potentially Hazardous Foods) ❑ 5. Receiving/Condition ❑ 16. Cooking Temperatures ❑ 6. Tags/Records/Accuracy of Ingredient Statements ❑ 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) [:110. Proper Adequate Handwashing El21. Food and Food Preparation for HSP ❑ 11. Good Hygienic Practices CONSUMER ADVISORY [122. 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 ofCeaNh. 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 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 77 27. Physical Facility (FC-6)(590.007) have a right to a hearing. Your request must be in writing 28. Poisonous or Toxic Materials (FC-7)(590.008) and submitted to the Board of Health at the above address 29. Special Requirements (590.009) within 10 days of receipt of this order. 30. Other DATE OF RE-INSPECTION: S 5901n WIFOm 14 de 0ctor's r na re: Print: I 17s Signature: Print: !�V 7 IPage of?Pages 1 Vicriations Related to Foodborne Illness Interventions and Risk Factors(Items 1-22) PROTECTION FROM CONTAMINATION FOOD PROTECTION MANAGEMENT 8 C,ss-orpitamnaton Assignment of Respoiiabililv" I:A), !) Raw Anziu,il Foods Septuj:-'-U from 590.003(B) Dewonsoation of lviowled?w I C�r,ked RTE Foo,:sl 6utfes ingredients 110)(2) FLv, R1:0Separotedimi-,. Each EMPLOYEE HEALTH other, 2 500.00;(C) Rtqonsibifity of the person in chaige to Co,rfamradon,'roni the Eriv,ronnient require repornn�-,by fooci einployc0s and 1 Fr,,otl Fronection' applic-ults* Clashing Fnws and Vegetables !�tq)owibllit) Of A Fo(N! !�iwluyec Or An I Food Ck,:::jct with Equipment atrt alt T,t Report j'o The Person it ten"jz" Charge' I Contaminaton 6rom the oonLunr,w 4190.003(G) Reporting byllerwu in Charge- I _;-3(16.1 81 Returned Food and R,ser-ice of Fod' 3 5'--(;.003(1)) Exclusions and Restriction.,` I Dispositon of A Julteralad or Con,'am;rafed Removal of Ex:hiaions in)([Re,tricti,ins rood D;wa,ding or keconditionin,g Unsafe FOOD FROM APPROVED SOURCE 41 rood and Water From Regulat6a So0r:'CS Food Conta",Surfaces 1 590.004:,A.-B! Compliance with Food Uw 11I Manual Wuvtat,hiov-I'ot Water 20;.12 I _Food inn 141-rroelicalK Scaled Coutauwr4 j Sanitization'leiiiprattires' 4-501.1 1� M�Jiariicrl *rnewashim- 2u 1.13 Fluid Nfiik and Milk Product,,* ifet wlltef u She[] Egg," T--iilperatures" 0I.1 1 Chemic.-il --art:i,ation-tent,., p ,H 3-212 14 FggrandNfi'kl?:,�!�:ct� Pasteurized" 4 5 ' ' I 3-20::.16 Ice 0.4z,le Frani Potable DriPk:r,:t Watel' I 4-60;, i 11 A) Rqupartil Fo:i�t Cutnal Surfaces s and 5- ill 11 Drinking Water from an Apprnved System` utensil:&1 Cle."I.,i9U.i+Ubt Al I Bolfled'Diinking Watcr^ I 14-602.1 Clertiong f4equcicv of Fxtuq)naerrt Fmd- 590.006(B) Water Meets Standards in 3!0 CNIR 22.()l Contac %nrfieea and Uewsflg" Sheiffishnno'Fish From an Approved Source, 4-701l 1 FrPtlirei--cy of Sanitisation of Utensils and 3-10 1.14 Fish at,([Re.n-cationally CaLwhi Mu!ILISCJM Food('Onuau Surfaces of;-Qwloinerot Stw!l!jSh- 4 701 1 1 l0raluah or sanqiz;arvn- Hot Water and 15 -1 C,1. lJolluscan Shell fiQi from: T'i�ted i - Cienfical' smoceO Proper,Adenine Handwashing Garre and Wild Mushrooms Approved by Pegulatory Authouty I-Sri 1.11 Clean Coz:t."*iori-flands and Antis- 3-2,u2.1B Shellsttxk 1-tivritititatirn Piescrit, 2-301 12 Cleaninn 2-301.11 'A'hen L`Wash' Wild mus��'(V'ms* 3-201.17 Goi�ie Ait;rnals'r it I Good 1-yrlenir.Practices Receiving/Condition I 12-'i01.1I hat,re. Drjik:rjg or Uziril-Tohao.-4 3-202.i 1 P11B Received at Pmtrea T,,:,:neraturcc* I 2-10!.12 Discbargcs From the. Eves, Nose and 3 2u2 15 Package hitet,,rrty- " l"Lli I Food Safe and Unadulterared 3-30;.12 Preverutne When Tastin- 6 Tags/Records: Shellstock 12 i Prevention of Contamination from Hands fl5i7�004(-, ) Preventing I-nmanimatoat firi•a ,i-20J.14 1-2)i I- Shollm��'!k ld-nt;fication lvlajntain�u` i - Haedwash Fm'Ofties Tags/Records:Fish Products Ccnvenie'Ntly Located and Acce-sibt Nuinbers U�d Capacities"- 3-402.11 Parisirc Di�rirtwtion- 3-402,1.^. Records.Creation,in'Retention 5-203. Location and Placement' 590.0040) Labeling of Ingredients' i Acc-is;bilitv.Oitu,',L,,rz and.V! 7 Conformapre with Approved Procedures 1, MACCP Piano Soppliedwith Soap and Hand Onq.-". 1 Spt-cialize.,! ProcessfinF,Nletho<is' Cloaiscr, Av�,:lubditv 3-302.1-' RegRegion!od o�ygen packagm,,�,criteria' 1 o-103.11 1 Confo,,Tn.,.iicetvit!!Approi-e<il-r(xceduies' 6-:d01 I I ]land Drpmc:trov;iwn 'clloios ), jaical:w;"in the Uial J09', M CNIR 500,000. CITY OF SALEM BOARD OF HEALTH Establishment Name: ~,c/#1r r- Date: 4f--Id- 7 Page: a of Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date No. Reference R-Red Item Verified PLEASE PRINT CLEARLY Y)iNrvL 17 71(/1 t//nW /AA! T Y/PSL A<- IF }fes ///friiini� ` / /�• p - - / �/' c?S rlC •7YJ/L /< rA,C f- '.YY)/cc/A,o4rr/,Pn/., t/r e.,r�L ii�F'i5',:7Pi7irj o 71, ;N,!6n A1,7, fZX/D ,7-1 q/ err-AAl:a,. f 6/�/11s F_S 1)2�'r/AL1[i /ry .SPL19c�Iswc t 7c c 1I ' I 9L C'P/Gti�G Fix�rirFK_ A5 7' 14a vl_ A .Qn A-C�4 de // lv, k C //U A42L(_ /�HiI'�9 lYlsl e4t x5p ice/lsP/°?�2 [•!L-i7/7�aC I I I I rJ/ f 7X^ l IJFc��crzc..r PF��E Pwm"'0 fi/:?A LvPS & /^s/j'q } I I I Ila — /� : • �� /es CF` SnZ�qd A 6�1 EA�?" ez_ 86rei,a/</orJ j I I Sof /'i/i.�c ,t 90 ofi P rr/ ✓ I / /"i'nl�fC7 rJo r /71� P.Ce- I 7 Yllrbn� cS 'If,r,F•av, .44i-[i"e'f ` I I I I I /�P G/�//P /.c ?/ti�m�A•/rn.�e •r.�� I K//7✓se61A -/-A/,n i(akS e'w _ nr1 Sfo6 '�sw a ///PP/2�u Discussion With Person in Charge: Corrective Action Required: ❑ No ( ❑ Yes I have read this report, have had the opportunity to ask questions and agree to correct all ❑ Voluntary Compliance ❑ Employee Restriction/ inspection, to observe all conditions as described, and to Exclusion violations before the next ins p ❑ Re-inspection Scheduled ❑ Emergency Suspension comply with all mandates of the Mass/Federal Food Code. I understand that . noncompliance may result in daily fines of twee _five dol lllar {s gr suspension/revocation of ❑ Embargo C1 Emergency Closure F�' i your food permit. /�/��C/�/" , I , / ❑ Voluntary Disposal ❑ Other: 11 , 3-501.14K') PHFs Received at Temperahues Violations Related to Foodborne Illness Interventions and Risk According Io 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 3-501.16(B) Cold P1IFs Maim+ined at or beimv 3-2;)'.12 Additives* 3-302.14 Protection hour Unapproved Additivc x '-501.1(( 41 tPH1-15"F* 1; Poisonous or Toxic Substances 13-501.16{A1 Hot PHFs Maintained at or above I4(PF. ', 7-101.11 identifying Information- Onginal 3-501.In(A) - Containers' � Roasts Held at or above 1301F. `° 7-102.11 Common Name-Woking C'ontainerst 20Time as a Public Health Control 7-761 I 1 Separ,�[i�m-Ctorage"` 3-501.19 Timea,%a Public Health Control' j 590.004(11) Variance Rcuuirement 7-202.11 Restriction-Presence and Use 7-202.12 Conditions of Use" ( REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-203,11 'Toxic Container,-Prohibitions" ( POPULATIONS(HSP) 7-204.11 Smatizers.Criteria-Chemicals* 7-204.t2 Chemicals for Washing Produce,Criteria` ( ( 21 3-301.1](A) Unpasteurzed Pre-packaged Iuicec and 7-204.14 Drtiag ,4gents. Criteiial Beverages with Warning Labels* "7-2(13.1 I Incidental Food Contact,Lrhucanu" 3-8II t.I I(B) Use„f Pasteurized Egry:" 7-206.1 1 Restricted Use Pesucides,Criteria' ( ( 3-301.1 i QJ) Raw Sr d Sprly Cooked Annnui Faxl and 7-206.12 Rodent Bait Stations" Unts fined Food s Not eNotServed. 7-206.13 'Flocking Powders.Pest Control and ( 3-301.1 I,C1 Unopened Food Package Not Re-served. Monitoring" CONSUMER ADVISORY TIMEITEMPERATURE CONTROLS 22 3-603 11 Consumer Advisors Posted for('on.umlition of 16 j Proper Cooking Temperatures for Animal Fetxls"That:,re Raw.lincrcrcooked or PHFs Not Othernqse Processed to Eliminate Pathogens.* "1 v':zoar 3-40L I l At 1)(2) Eggs- 155'F I5 See. Eggs-immediate Scrvnce 145"F1 Stec" 3-302,t i Pastcw'u:ed EL-2!;Substitute for Raw Shell 3-401.11(A)(2) Comminuted Fish.Meats eft Game ms'''s% Animals- 15.5'F 15 sec. " 3-401.11(B)(1)(2) PoikandRcefRoast- 130`F121 min* SPECIAL REQUIREMENTS 3-401.11(A)(2) Ratites. Injected Meat: - 155"F 15 590-009(A)-(D) Violation>of Section 590.009(A).(D) in sec, * catering, mobile food, temporary and 3-401.11(A)(3) Poultry, Wild Game.Stuffed PHFs, residential kitchen operations should be Stuffing Containing FiA i,Meat, debited under the appropriate sections Pouitiv or Ratites-165'F 15 sec * above if related to foodborne illness 3-401.11(C)(3) Whole-muscle, intact Beef Stcaks interventions and risk factors. Other 145`F It 590.009 violations relating to ,,nod retail 3-401.12 Raw Aminal Foods Cooked in a practices shoLid be debited under#F 29-- Microwave 165'F T I Special Requirements. 3-401.11(Al(])(b) All Other PHFs-- 145'F 15 sec. 17 Reheating for Hot Holding VIOLATIONS RZLATED TO GOOD RETAIL PRACTICES 3403.11(,A)&t D) PIIFs 165'F 15 sec. * 1 (items 23-30) 3-403 11(B) Microwave- 165'F 2 Minute Standing Criti(al and non-critical violations, which do not ndole In the Tinue* I foodbinne illness cnervenrioru"and ru:Ir factors listed ahn:e.can 5e 3-403.11(C) Commercially Processed RTE Food- found in the following sections of!l:e Food Code and 105 CAIR 140'F' 59000. 3-403.11 tE) Remaining Unsliced Portions of Beef item Good Retail Practices FC 590.000 Roasts* 23. Management and Personnel FC-2 .003 I' i8 Proper Cooling of PRFs 24. Food and Food Protection FC-3 .004 25. Equipment and Utensils FC-4 .005 3-50t.!4(A) Cooling Corked PHFs iron 1409E 10 26. I Water. Plumbinci and Waste FC-5. .006 70'F Within 2 Hour's 2nd Frim 70"F 1 27. Physical Facility FC-6 007 to 4t'Fl45°F Within 4 Hours. * 28. Poisonous or To Materials FC--7 .00S 3-501.14(6) Cooling PHFs Made From Ambient 29, Special Requirements 009 Temperature Ingredients to 41'F/45'F 30 1 Other Within 4 Hours* ' Dmole,critical hent in the federal 1999 Food Code of 105 CNIR 590.000. CITY OF SALEM BOARD OF HEALTH Establishment Name: Date: //-/,2 Page: 3 of 3 Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date l No. Reference R—Red Item Verified PLEASE PRINT CLEARLY O/J�Ma F�e� /7�m c o n .clip/,iN c /-Iv d �lJ P// e /_/f.4 PL s .rh 7`A o it Cell Z/Se .4(i /,-4'X.01e(7�ir-r mrd ®Pe / nf,( //�!/iA e� �RSOrH.SihiLi 481 /StiBrl /�//laf .•��c N� .tom �c a / F%/ A�,t-.DIA 4r -n(ArZI� ' /oo a �i9tPv(S'Prl il�,�vha�7r-U/OloTim�� fXiCST CI NQS-`— �i.�/e, dii/_L � icciiP�F' �<'_,c(7c"� �/i.�ll�•:r-�l �irnr�rvt_on�/ O/.UA/P.�° II,P �7hD/R.x✓ �ivQnt/_ /.v rr �i�li-�,G,cer-ls�rrkcC . / I � I � 1 I &)eW'o/n/h.'774,c 9-/ -ii .fie th 7)7,,h9i_ALvA?s(S I �— /�a P�irYl i N r ArP•A�4L' 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/ violations before the next inspection, to observe all conditions as described, and to Exclusion P ❑ Re-inspection Scheduled ❑ Emergency Suspension comply with all mandates of the Mass/Federal Food Code. I understand that noncompliance may result in daily fines of twenty-five dol rs or suspension/revocation of ❑ Embargo ❑ Emergency Closure r% your food permit. 12,� A ❑ Voluntary Disposal ❑ Other: PHFs ReLcived lit TemperahLlres Vio:ations Related to Foodborne Inness Interventions and P;ik ,Ai,cording to taw Cooled to Factors(Items 1.22) (Cont) 41'F/45 F Wu hi 4 Hours. PROTECTION FROM CHEMICALS ( 3-50i )5 CQwir:;_Methods for PfiF, I :9 PHF Hat and Co!d Holding la ! Food or Coicr Additives _ (tl 1} i ( "Bi Coln PI IF. ,Vlaudinied at or below 3-202.12 Additives` YV.O0-t(F) 3-302.14 Protection from (Ltaptimied Additives" I x. 1.16(.4) Not PHF,M.:inlamed at or abov.c 15 Poisonous or Toxic Substances 1401'K 7-101.11 Identifying Information- Originil 3-50(.16(0) Roasts Held at or above i?C�°F. " Containers' 120 Time as a Public Health Control i 7-1Q3 1 ! Common Name-Workiar Coataineo,:t 7-201.11 Scomation-Stnraee, 501 1'J 1 ime.:s a Public Health Coatrul" 7-202 11 Re.t6ciinn-Prcausce and OIre* I ' S4p.0�li-I} Var:ace Requirement 7-202.12 Conditions of U'0- I RFOU€REMENTS FOR HIGHLY SUSCEPTIBLE 7-203 11 ( 'retic Container.-Prohibition,` I POPULATIONS(HSP) 7-20411 Sanitizers.C'titerm--Chenticas 7-'_'04.1 2 Chemicals for Washntg Produce,Criteria'' i 121 '-80i I t(A) IInpasa•unzed Prepackaged h(ices and j 7-20=1.14 Drti:, ,4g I Be':eoty swnh V:arning labck cats.Criteria' 7-205.11 Incidental Food Comact. Lubricant,^ I ?-501.11(t,) Use of Pa;teuuzerl E!_ga` 7-206.1, 3 301.1 1(0) Raw or Partially Co,)ked.4 micil Food astl Reiarmed Use Peso,ades.Cmeria' ( Rate S.xi Sr-routs Not Served. 7-206.12 Rodeo Ran Stations" ( i-80i, I(C) Unupe!�cd Food Package Not Re-eerYe<l. 7-206.13 'cracking Powder,',Fest Control and R4o:utorinr' CONSUMER ADVISORY 22 3-605 I I "On,,unter Advtwry Posted for C'on,ntnption of I6 Proper Cooking TIME/TEMPERATURE C Animal Foa1 i ls tat are Rait. Ihadercooled or f kiny T CONTROLS for T i PHFs Not t):uc=wise Processed to b;littunate -Cecx vv," 3-401.11A(l)(21 Fgg;- 1c:`F 15 Sec. Pathogens.' - -3O?Ci Pasteuvedt,ESubstitute fur flaw Shell Eggs-hu:nediute Service 1'15"PtSseq+ €�' 3-401.11(.)(2) Comminuted Fish,Meats,F Glom I FPk`.t Animals 15i'F 15 sec. F -401.1l(B 12( Pt � � SPECIAL REQUIREMENTS I - )( )( k and Bret Roast- ,30'F 1--1 nein 590'009(0)-(1)) Vlolalomc of Section 590.009(A)-(D) Ito -401.1 I(a)t2) Rzl:tes,Injected Meat,,- 155'F 15 sec. : catering. mobile food,temporary and 3-401.1 :(A)(3) Poultrt,Wild Game Stuffed PHFs, revcieatial kitchen operations should be. Stuffing Containing Fish, Meat, debited wider the appropriate s,,coons Pouitry or Ratites-td5°F l5 set. ' above if Felated to food'uonv:illness 401.11Wi(3) Whole-nu(SCle, intact Beet Steaks inte,weidions and r(ek factors. Other 145°F, 590.0119 violations relating (o good retail J1.12 Raw .4nitta;l Foods Cooked in a ounAlCCS should be debited under#29 - Micruwave 165`F* Special Requircrnents. 3 ,401,1 i(A)(t)(b) Alt Other PHF.s-- 149"F 15 sec 17 l Reheating for Hot Holding I VIOLATIONS R,:LA;EO TO GOOD RETAIL PRACTICES 3-403.11(A)&W) I PHF, lo5°F 15 sec. " ( (Iterm 23-30) i 3-40".11(H) Mierowace- i 65`F 2 alioute Si anding ( Grm(ai and nun-crifi.'Ai viulatromt. 11.11"JI do nut rrlarc to,he Titre" foodborne ithress...te,tenitote,cwd risA jrt ro;:c!Li nd above, can hr• 3-403.11(C) Comtnerc!alIv Possessed RTE Fool- l found hr the%aiGn,inq scctions of Mr,F'or'd Codte ami /03 C14R 1-h) Fr I 59n.0rr,,. 3-403.11(F) Reni:unm^tincheed Portions of Beef I Iters Geod Retailler<actices FC ' 590.000 Roasts' 22i. Manayerr:rnt and Perso nei 1 FC -2 1 OOc. i8 ( Proper Cooling of PHFs 24. Food and good Protection FC-'3 1 004 9-501 14(, > Z5Equipment and Utensils f=C -4 .005 �) Cuol�ng Cooked t HF,born 140 Flo 26. Water, Pkiribinq and Wast,: FC-5 1 .006 70`F Within 2 1[ours and From 70'F 27. Fhv^,ical FacilAv FC-6 .0011 to 4 i"F/45"F V dhin 4 Houri,. " ! 26 Poisonous of T,mc Mat&tiak FC - 7 .008 I 501.14(B) C'oohng PHFs Nlade Fnmi Amb!cnt 29 Specia;Requi:cntivds 009 'rempeiamre hk,credicnt,in 41`F/45`F ! 3o Othet j f Within 4 IIouts `L-mote>enn"al i!,lm m tier fed,•ral ;"99 Prod Cotle of i 03 CMR 5901100. ( IMPORTANT MESSAGE ) FOR 1^-C'-Y 1 �UA\�IO` A.M. DATE TIME -P.M. M` A L-pio- I Z OF q9 Cg onC�'(/'1eci��. AREA E NUMBER EXTENSION U FAX U MOBII F AREA CODE NUMBER TIME TO CALL TELEPHONEO PLEASE CALL CAME TO SEE YOU WILL CALL AGAIN WANTS TO SEE YOU RUSH RETURNED YOUR CALL i WILL FAX TO YOU MESSAGE K�1ow1�n�+�'Dro/:1�lrr�ion�( in N 'fl -, LMDN io - a ► SIGNED OPsFORM 4009 MARE IN U 5 A NOTES Massachusetts DepS artrhent of Public Health Salem Board Health r t20 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 J / Type of Operation(s) Type of Inspection C ot4rw& T F M d/I/Cic f� I `/I!2ct 0 IFood Service ❑ Routine 1 Address I Risk detail O-Re-inspection Of-c- e-m. 44'r,T r ST Level ❑ Residential Kitchen Previous Inspection Telephone ❑ Mobile Date: 41st f rrq R 97 R 1771 Temporary E] Pre-operation Owner Ga4C t+� HACCP YIN ❑ Caterer ❑ Suspect illness Person in Charge(PIC) Time I Permit No.❑ Bed&Breakfast [3 HACCP General Complaint Inspectors (rr[if tf7 r %4,j..„- I V,M Ft tJ Sr-1,c u 19 Out: ❑Other Each violation checked requires an explanation on the narrative page(s)and a citation of specific provision(s) violated. Non-compliance with: Violations Related to Foodborne Illness Interventions and Risk Factors, Anti-Choking Tobacco Violations marked may pose an imminent health hazard and require immediate corrective 590.009(E) ❑ s9o.009(F) ❑ action as determined by the Board of Health. FOOD PROTECTION MANAGEMENT ❑ 12. Prevention of Contamination from Hands ❑ 1. PIC Assigned/Knowledgeable/Duties ❑ 13. Handwash Facilities EMPLOYEE HEALTH PROTECTION FROM CHEMICALS ❑ 2. Reporting of Diseases by Food Employee and PIC [j 14.Approved Food or Color Additives ❑ 3. Personnel with Infections Restricted/Excluded ❑ 15.Toxic Chemicals FOOD FROM APPROVED SOURCE TIMErrEMPERATURE CONTROLS(Potentially Hazardous Foods) ❑ 4. Food and Water from Approved Source ❑ 5. Receiving/Condition ❑ 16.Cooking Temperatures ❑ 6. Tags/Records/Accuracy of Ingredient Statements ❑ 17. Reheating ❑ 7. Conformance with Approved Procedures/HACCP Plans ❑ 18. Cooling PROTECTION FROM CONTAMINATION ❑ 19.Hot and Cold Holding ❑ 8. Separation/Segregation/Protection ❑20.Time As a Public Health Control ❑ 9. Food Contact Surfaces Cleaning and Sanitizing REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) ❑21. Food and Food Preparation for HSP ❑ 10. Proper Adequate Handwashing CONSUMER ADVISORY ❑ 11. Good Hygienic Practices ❑22. Posting of Consumer Advisories Violations Related to Good Retail Practices Number of Violated Provisions Related Critical (C)violations marked must be corrected To Foodborne Illnesses Interventions immediately or within 10 days as determined by the Board and Risk Factors (Items 1-22): of Health. Non-critical (N)violations must be corrected Official Order for Correction: Based on an inspection immediately or within 90 days as determined by the Board today,the items checked indicate violations of 105 CMR of Health. 590.000/federal Food Code. This report,when signed below 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.o05) 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.o07) 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 59Wpe lFmm6146a Print: f PIC's Signature: �Ar" Print: Page of Pages Violations Related to Foodborne Illness Interventions and Risk Factors(Items 1-22) PROTECTION FROM CONTAMINATION FOOD PROTECTION MANAGEMENT 18 Cross c017tami'060r 1 590 003(.4) Aasigmmert of Responsib;!itva I 3-302.!1(: )t 1) Rau .amoral FcxK!s Seitar,110d fiom j ;i9D.003tB) D..nwnxtration of Kno.alyd�e' ( j Conked and RTE Food,'. 2-103.[I Persmt in charge- duucs j j Centavananon from Rase ingrorients 3 0211(A)i2) Raw AnimalF000kScpaia:cdfrom Each EMPLOYEE HEALTH Other' 2 500.001(0 Resprntsibility of the person in charge to I j Contamination from;ho Fnviromnen+ � fcqure reporting by food ,�nd 13-302 11(.A) Foo:I Prate:u,m' j applicants" j j 3-3w-1,5 _ Wa>hmeFiuitcand L'c,":r.,blr. 590 0030"; kesponstbihl}Of A Food Emplovee Or An I 3-304. Punct Curiae[��iht Equipmentand :'\pphcunt To Repots To The Person ht Utensils* Ch.'u' 0 I -,ontaminaron[torn the Consume, 590.003(G) Reportu:p by Pe=son in Chart-e' j j 3-306.1=,A)W) Km:rood Fu, land keseivice of Food- 3 590003i D) L:aclusionsand Resti ictions" I Disposlticn of Aduherated or Contamirated 190.0031E) Removal of Exclusions and Restrictions j Food 3 101.ii Disv:,rding,o: Rermdaioningl"ncafe FOOD F 30M APPROVED SOURCE Food g ' Ford am-)4Varer From.Rua:dated Sebrcos ! 19 Food Contact Surfaces 4-SU 1.11; ManualNarewashimg- ;lotWater I 159 01.121-Ii) rood In a I Ince with Ftatd Lmv' I S;mit.zation Temperature&r 3-201.12 Flodmil1-[erntetical lv Sealed Container' I w_f,()1 112 hlecirani�r blr,,-. ;aahin,, ( 3-201.13 Fluid Milk and Milk ProductsT j a1 [ktt bG'emr '-202.13 Shea Sanitiza tion.Temperz,ures- I rs" I I 4-30i.( 3-202.14 Age.and Riiik Products. Pasteuriz:d" I 1 Pi Chetmcai Sanitiauion-temp, pi[, conzentt ation y 3-302.its Ice Made from Potabic conking Water" 4-6111.144, hardness. 41 1 ! 4-ficH.1 I(4, Equipment Food Contact Surfscas and 5-1.01.11 Drinking Water from an Approved Svsu ni= I 1 U'i usils Clean' I '!>O.UU(1.4) Bottled Dtinkiin WateO 14-602.11 Cleanin^Frequency of Equipment or,& 590.00o(B) Water Meets.Strmdatds in 310 CMR 22 (" SheContact Surfaces and Utennds:: fish ash dna Featish Froman aughtApproeo Source ( ! 4 702.i 1 Fmquency of Sanitization of I itens!ls and +201 Id Fe;h and kecreationally Caught Rlollscan Shelltieh^ ( Foul Contact Surfaces of F:eEuioment^ '03.11 Metr:vds of Sanitization Ho: Water and 3-20 1.15 Molluscan SbcOfi.,h firm NSSP Listed Ci:emic.a' Sources` ( i t0 i Proper,Adequate H.ndwashing j Game and Wild Mushmorns Approved by , Haqutatn••q Authority i Cleave Condition--Rands and Arms* j 2 i 2.31}1.12 Cleaning Ptacedare" 3-_2 0. 18 Shellatock Identiticarion Present" 590A04(C) Wad Nlut hrooms` j 12-30L A \*;hen to Wa:;W, j 3-201.17 Gain: Anunals' I it I Good Hyg!enic Practices j I �-'11.11 Faring, Drinking of Lysing lobacco- j,y i Receiviny/Condition g i 3202.1 l PI Received at Proper Tanperatures e 2-401,12 Diwhsrgeu Frorn the Egos. Vose and 1-10'' 15 Package Intezditv;' j ( Mouth 3-10!.1•. Food Safe and Unadullerau_d' ( 3-301.1'_ Presenting Comamination When Tasting' j Tags/Records:Shellstock j 112 Prevention of Contamination from Hands j 3-2,1'_.13 Shellaicwk ldentrficatinn` j 590.00-(L) Preventing Contaimnation from I3-203.12 Shelklock kknhfration Maintained` Era*rdotres' Tags/Records: Fish Products 11g I Handwash Facilities j j 3-402.11 Pa nsitcDesi:u;non j ( Located and cess%b!e 311 Num'rers and Ca �,iiies- ?-;1)2.1"e Records.Creation end Retention' j 5-2(A.11 uxation and Placement '9C 1',04(.;) Labeling o4 Ingredients' ( 5-20511 Acvessibility.Operationandltaun- enatic- g j Conformance with Approved Procedures I i I 1HACCP Pians Scpptcd with Soap and Hand L'tying 13-502.11 Speouliml Prmes,ing Methods': j ( Or;vices j 3-50 .12 Reduced oxygen rack Igorg criteria„ 16-30!.;1 c.-lanai-a.nm Cle:mser.Awtilability 1, j !,-30t 12 1-lauu Poring prmisiou 3-]')3.12 Conformance with Approved Rroxdnre:," "Drnnte,cnn,nl item in the federai O')Fran!Code or m5 C NIR�4U.:A10 I' CITY OF SALEM BOARD OF HEALTH Establishment Name: Ce)" G<X3°S M,40c.rsv- Date: 4_ ,fin-e)a Page: h of � Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION _ Date No. Reference R-Red Item Verified // y PLEASE PRINT CLEARLY //-i 1 A./ v,,7� Jr h_Frt&c_. An A I n o A0.67 rC I I � I I 1 I 1 1 I 1 - I Discussion With Person in Charge: Corrective Action Required: I ❑ No I ❑ fes 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 E3 Embargo ❑ Emergency Closure your food permit. �� 0 Voluntary Disposal ❑ Other: 3-501 1-t(C) I'HFs Received at'retnprtatures Violations Related to Fnodbornr-IOness Interventions and Risk ,Accordin,to Law Cooled to Factors fltems 1-22) (Con;) .a I'F/4i`P Within 4 Hann. " 3-501.15 Crwline Moliods for PIIFs PROTECTION FROM CHEMICALS 19 OHF Holland Cold Holding 14 Food or Color Additives 3-202.i2 Additi•.esu 3-501.16(8) Cold PIIFs Mwnwined at or hclow 590.004(F 41'!45''F' 3-302.14 Pnde::iion loom Unapp n.eJ 3-50i.16(A) Hol PHFs Mamtai;:zd at of aline is Poisonous or Toxic Substances � ! i&0'F. '-10i.i 1 Lk;nttfyvtg Information-i!r,gir;1 t-501.16(A) Roasts Htld at or above i30-F Containers" 7-102.11 Common N:aae-Working Containers'" 70 I Time as a Public Health Control � 7-101.11 S,,,;;rahur"- i;oiuce" 13-Jii!..9 Time a a Publit. Heuith C,11111[1017' 7"20211 Re:a riction-Presence'a;d Use" i 590.004(H) Vat'rmce Regmrement 7 202.12 Ccnnhtin:ts of Use- 7-201.11 se"7-..03.11 Toxic Cintaincts-Prohibnions:. REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-204.11 Sanitize::.Cnrz::a - Chemt.als POPULATIONS(HSP) 7-204.!2 Chemicals rnr Wed^,m2 PnKluce;Criteria'' ( 21 13-,Lo111(A) unpasteurized Pre-packaged Juices and Beeera;;es with 1A'arni l: Labels" 7-204.14 Droin,AeCIIIS.CI'7:C1'lit� 3-801.1 I(B) Car of Pisteorized E-sT 7-2205.; I htcideutai Food Contact, L,:hrt.ants* 1 3-80I 11(D) Raw of Partially Cooked Annual Food and 7-206.11 Re,,tnoti-d Use Pesnctdes,Criteri?" Raw Seed Sprouts Not Served. i 7-206,12 Rodent Fait Stations* " 3-801.1 t(C) Unopened Food Package:Not Re-srned. 7-206,13 Tree:kine Powders, Pest Contra: ,mild I ),C6tnring" CONSUMER ADVISORY TIMElTEMPERATURE CONTROLS 22 3-603.11 Consnrner Advisory Posted for Consan:ption of .Animal Foods'I'hai are Raw. Undcrn00ked or 16 ' Proper Cooking Temperatures for Not()thencise Processed to Eliminate PHFs r,r,,n,.voa - :JJAIA(l)('_; E,gs- i55=F15See. Pathogcns." lets-lmmadtr;e Service 115'FlSsec" 3-302.13 Pasternied Eggs Substitute for Raw Shelf j ,s 33-A01U] 11(A1t21 t:ouunirmteu fah.Meats K GamEge 1'.J. i Animals " 153T :5 sec. a: SPECIAL REQUIREMENTS � 3-40111(A)(1)(2) Falk:and Beeedfvlc 1?155--F milt' ) 5g0M09(A)-(D) Violations of Section590.009(H)-(D)in 3-=4n1.11(Ai(2) Katuel, 5}jerted T�Ieat:- 155°F 15 - scc. i calerine, mobile food, temporary and 3-401.11(A)(3) Pool!:v,Wild Gam:. Stuffed IFF:, residential kitchen operations should be Stu{tutg Containing Fish,Meat, debited under the appropriate sections Poultry or Ratites-165'F 15 acc, " ! above if i clatod to lo(Abornc illness 3-401 I ItCa3) Whine nr,:ccl,. tnmet Reef Steaks interventions and risk factors. Other 145`F* 590.009 Violations rela0ug to ,00d retail 3-401.12 Raw Animal Foods C;n,f.ed in a I practices should be debited under##29 -- �\4icfowave 16')+ " Special Requirements. 3-401.1I(Al(1)(b) All Other PHFs - 1d5'F15see. ` 17 Reheating to,Hot Holding VIOLATIONS R_LATED TO GOOD RETAIL PRACTICES j 3-403,11rA)&JI) PHFs !65+ 15svt,. (Items 1-3-30) 3-403.11(6} Microw'%ave- 165' P 2 Minute Standing Grip,al and non-cnlical cinialione, which do wv relate to the Pune* j)odhorne illness inierrrntion.r and r,sh iclora lister(above, can he 3-403.1 l(C) Commercially Processed R Th Fuxl- ,fimnd in tire fe.W nring sections of the Food Code and 105(.MR .540.000. 3-403 1 1,,E) Remaining Un,hced Portions ud Beer I Item Good Retail Practices I FC 590.000 Rtatsls,* 23. Managemert aid Personnel i FC - 2 .003 18 proper Cooling of PHFs ( 24. Food and Food Protertion ! FC-3 .004 3-501 141A , 1 25. Equipment and Utensils FC-4 .005 Gxdmg Cooled t'NFs from 540'F'u} 28. Water, Plumb!nq and Waste FC-5 .006 70'F\Aifr:in 2 Hcros and From 70'F 2' 1 Rlysical Facility 1 FC-6 .007 rod"'F/d5'F Within 4 Y,00r3. ''` _28._ _Po_i..ono_us or Toxic Materials FC-7 .00E 3-501.1=4(6! Cooling PHFs Made Froin Ambient ( 129 Requirements .009 -- ----- Special R i '�� ' > . 30..n.n. Other l'zmpzranue ingredients to-4PG'4�F Within-4 Hours ''Dtnote�critical rte, in'4e'edrral JW )9 mood G, ern 105 L'911t 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 FOOD ESTABLISHMENT In accordance with regulations promulgated under authority of Chapter 94, Section 305A and Chapter III, Section 5 of the General Laws, to operate a Food Establishment in the City of Salem is hereby granted to: Type of Establishment: RETAIL FOOD Name of Establishment: Congress Market Address of Establishment: 95 Congress Street Owner's Name: Lac Bui Restrictions: Application Date: 1/2/2004 Permit for Food Establishment 245-04 Frozen Desserts/Ice Cream Permit for the Sale of Tobacco Products 55-04 These Permits Expire December 31, 2004 This permit is not transferable and must be reissued upon change of ownership or location. The permit must be posted in a prominent location in the Establishment, In accordance with the State Sanitary Code, before any renovations, improvements, or equipment changes are made, all plans for such must be submitted to and approved by the Salem Board of Health. HEALTH AGENT CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH � • 120 WASHINGTON STREET, 41H FLOOR L' SALEM, MA 01970 18 8 `200'3 TEL. 978-741-1800 - NOVi'1 V FAX 978-745-0343 �,(`(Y �/F� JAL[=IJI STANLEY USOVICZ, JR. .JOANNE SCOTT, MPH, RS, CHO BOARD F HEALTH M MAYOR HEALTH AGENT 2004 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT NAME OF ESTABLISHMENT &(/�)N6PP-ZR M Ji�2{�`�j TEL# �I q- T4�-- MIR ADDRESS OF ESTABLISHMENT MAILING ADDRESS(if different)L OWNER'S NAME , k, N()(� + l TEL#� ADDRESS 4--46 SC�(Llt} SJeeJ CITY i..-'y 1^,i N STATE M A ZIP "Cl0 s— CERTIFIED FOOD MANAGER'S NAME(S) CERTIFICATE#(s) (required in an establishment where potentially hazardous food is prepared.) EMERGENCY RESPONSE PERSON D1 0,1 (JC7 HOME TEL# HOURS OF OPERATION: Mon.ICTue. % Wed. IG Thu.4Fri. 114 Sat. Sun. d. TYPE OF ESTABLISH FEE check only RETAIL STORE YES NO less than 1000sq.ft. =$ 50 1000-10,000sq.ft. =$100 more than 10,000sq.ft. =$250 RESTAURANT YES NO less than 25 seats =$100 25-99 seats =$150 more than 99 seats =$200 BED/BREAKFAST YES NO $100 ADDITIONAL PERMITS MAKE (not just serve) ICE CREAM, YOGURT, SOFT SERVE Y NO $5 TOBACCO VENDOR 5'i5-¢y 6115 NO $50 ALL NON-PROFIT(such as church kitchens) 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 bes kno ledge-=Welief, have file all tate tax returns and I all state taxes req ed under the law. �RA 'PAX, Z- 3g'i � " Signatdre `Date Social Security or Federal Identification Number ------------------------------------------------------------- ---------------- Revised 11/03/03 FOODAP2.adm Check#&Dater--'------------------------------�¢.-3 3 CITY OF SALEM, MASSACHUSETTS -� BOARD OF HEALTH • • 120 WASHINGTON STREET, 4TH FLOOR SALEM, MA 01970 ,y TEL. 978-741-1800 '^q FAX 978-745-0343 STANLEY USOVICZ, JR. JOANNE SCOTT, MPH, RS, CHO MAYOR HEALTH AGENT COMMONWEALTH OF MASSACHUSETTS PERMIT TO OPERATE A FOOD ESTABLISHMENT In accordance with regulations promulgated under authority of Chapter 94, Section 305A and Chapter III, Section 5 of the General Laws, to operate a Food Establishment in the City of Salem is hereby granted to: Owner' s Name : Lac Bui Name of Establishment : Congress Market Address of Establishment : 95 Congress Street Type of Establishment : RETAIL FOOD Application Date : 05/06/2003 Restrictions: - Permit for Food Establishment 297-03 Frozen Desserts/Ice Cream Permit for the Sale of Tobacco Products 65-03 These Permits Expire December 31, 2003 This permit is not transferable and must be reissued upon change of ownership or location. The permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code, before any renovations, improvements, or equipment changes are made, all plans for such must be submitted to and approved by the Salem Board of Health. HEALTH AGENT -i'A CITY OF SALEM, MASSACHUSETTS ,e (%WON BOARD OF HEALTH 1,20 WASHINGTON STREVT, 4TH FLOOR SALEM, MA 01970 TEL- 978-741-1800 FAX 978-745-0343 STANLEY USOVICZ, JR. JOANNE SCOTT, MPH, RS, CHO MAYOR HEALTH AGFNT 2003 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT NAME OF ESTABLISHMENT CONI G 1ZESC, MRkE7 TEL# ADDRESS OF ESTABLISHMENT 9S- S'TR t 7 MAILING ADDRESS (1f different) qS Qnl �� SScLEm OWNER'S NAME TEL# '9 �_I -'-\q D 3 ADDRESS 44 '�O\k% CA , CITY ,LY hl h! STATE Kl A ZIP 01 L I O IZ�- CERTIFICATE#(s) (required in an establishment where potentially�hazardous food is prepared.) 4791 � "I J3 EMERGENCY RESPONSE PERSON V CP n HOME TEL#1 91& q 1-Sl -CO OO HOURS OF OPERATION: Mon1!;—Tue,-.yWed, 1 _Thu.4 S_ Fri. 4 S' Sat. 4 S Sun. �D TYPE OF ESTABLISHMEN �} FEE check only RETAIL STORE `YES NO a�/ �r less than 1000sq.ft. =$ 50 1000-10,000sq.ft. =$10 more than 10,000sq.ft. =$250 RESTAURANT YES NO less than 25 seats =$100 25-99 seats =$150 more than 99 seats =$200 BED/BREAKFAST YES NO $100 ADDITIONAL PERMITS MAKE ICE CREAM, YOGURT, SOFT SERVE YES, NO S +7� $5 TOBACCO VENDOR ES NO Gr ALL NON-PROFIT(such as church kitchens) YES NO $25i 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 besno ledge and belief, have filed all st to to returns and paid all state s re uired under the law . et br— Signature Date Social Security or Federal Identification Number Revised 11125102 FOODAP2.adm Check#8 Date i3z -( 041 o'41 03 NUMBER FEE -03 THE COMMONWEALTH OF MASSACHUSETTS ltl . .-. of .... .. .. . This1%, to Certify that ...... .......... NAME ADDRESS IS HEREBY GRANTED A LICENSE For ... in d ee.'Idar--_.....-......-...... ....--............ ........ ....... -------------- ..................---- ------ --------................ ...... ................... ....... .................... ..... ........................ ........... .......----............. ........... ....... This license is granted in conformity with the Statutes and ordinances relating thereto, and expires... ........ . ..............unless so Der suspended or revoked. ner suspended . !k ................... ....... .......... ..................... ..........................— ........................ ........ ...... ...... FORM S 433 A M 511K,N MI; BOSTON .......--... ....... .. T--....... .w.».+.*a......Hr......M,w�w�.++-.r+w.q v�nra,r'�a..nnr..,,,®^isiv,�-^••..+../ti-,•�«/.F'-.v,+^.a�v'x4^r'a.-.-....,.�- ti..,..:ia.r.�x,n.+n�wlw----'' e 2 , 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 jxne of Onerationl;] Tvne,of Inspection / /J'Y)9/2�S S' ///Q,,j*'er //- /7-o,3 �❑ Food Service �.outine Address g 4-, Risk Id Retail qe-inspection r/R e,f� DN �f Level ❑ Residential Kitchen Previous Inspection Telephone / r- ❑ Mobile Date://_/e--�3 Owner / A HACCP Y/N ❑ Temporary ElPre-operation lac_ ❑ Caterer ❑ Suspect Illness Person In Charge(PIC) "v Time ❑ Bed&Breakfast ❑ General Complaint In: ❑ HACCP Inspector, 1j%LCC S /� ��, � 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 Itemst 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 I ❑ 12. Prevention of Contamination from Hands ❑ 1. PIC Assigned/Knowledgeable/ Duties ❑ 13. Handwash Facilities EMPLOYEE HEALTH I 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 El 4. Food and Water from Approved Source TIME/TEMPERATURE CONTROLS(Potentially Hazardous Foods) El 16. Cooking Temperatures ❑ 5. Receiving/Condition El 6. 17. Reheating 6. Tags/ Records/Accuracy of Ingredient Statements El 7. 18. Cooling 7. Conformance with Approved Procedures/ HACCP Plans ❑ 19. Hot and Cold Holding S PROTECTION FROM CONTAMINATION El8. Separation/Segregation/ Protection El 20. Time as a Public Health Control ❑ 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: Inspector's Signature: .a-, Print: PIC's Signature: e -/�� /n( - Print: L/ A c- y,J f +" Page�of-APages FORM 734A HOBBS&WARREN -BOSTON ry 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 I 590.003(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 3-302.1 I(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)l 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 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* Approved by 10 Proper,Adequate Handwashing Game and Wild Mushrooms A Pp 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 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 CMR 590.000. CITY OF SALEM BOARD OF HEALTH 'r Establishment Name: Date: /1—/7- 0i Page: of Item Code C-Critical Item DESCRIPTIOWOF-VIOLATION/PLAN OF CORRECTION Dat e Verified 1 No. Reference R-Red Item -i „. PLEASE PRINT CLEARLY 1 14 Uv I �f.2.�d�t 14eQPM .t Ir \ I I 1 I 1 I � 1 . 1 ` 1 I � I Discussion With Person in Charge: Corrective Action Required: I ❑ No I ❑ fes 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 Cl Re-inspection Scheduled ❑ Emergency Suspension comply with all mandates of the Mass/Federal Food Code. I understand that noncompliance may result in daily fines of twenty-five dollars or suspension/revocation of ❑ Embargo ❑ Emergency Closure your food permit. n 0 Voluntary Disposal ❑ Other: 3 ;1 1.14(1') PHF:;Recetvc-1 Si Temperature!, Virnirtions Related to foodborne illness interventions and Ask Accorcir,io J.zrw 17,noled t,, F�aurs(!tetas 1 22) (Cont.) 4!`F,145'p IVI'hol 11 Nouns PRO rEffrON FROM CHEMICALS C(s,him, kh-thock-.,'-ir PHF; 14 '-ood or Color Additives 19 PHF Hot and Co!d Holding 3-202.12 additives3-:;f) 1 6tB) Cold pti-, cN1,1niz,ole" jt'n below 3-=02.14 protudion hum 'Unappiuwd Addiu,e:." 590.0:WF) =N-145"I'3- 1-i4i'F 3-501.16tA) Ho): P1 lFs Maintained etr AW,,e Is Poisonous offo,ric Substances 140T. 1 I-101.1i Identorinz Intorniation-Original 0 i OL\) Kln!Llts Held at at aboNe 130 F. 7 10111 Common Nature-Workin,n Containers` 20 Time as a Public 1-foealth Control 7-101 11 Fw,,aration-Storati.- 3-50!.i 9 Time as a Public I le,dth Conlru! 590.004(H) Vananc-- Reqwrcnient 7-202,11 Re>triciion-PrcsciicQ and Ursc�' 7-202.12 Cojjdjtjons of I TSe- REQUIREMENTS FOR HIGHLY SUSCEPTIBLE i 7-203.1 1 '1 LIXIe('Dillainoo; - Probibitiori POPULATIONS(HSP) 7-204.11 Snni6zers Crjero,- 7-104,i 2 Ch:nnicals *-Di %V;t�hjrt,�Produce,Criteria" 2( 3-801J I(A) Un pasteurized Pre-paekagedJuice,and 7-204.14 llcveiapes�%nh Warnin Dving-Agents. Crucria* g Labels' 3-01.1 I(B) Use 0'"astoul ized L,-,;:1 I. 7-205 !I hoQidewal R,d GmtacL,Lubricants- 3-801 11(D) Raw ci Naliall-Cooked Animal Food mid 7-206.i Re,tricted Use Pesticides,Cntefia*� I I I Raw Seed Sjnows N;,i Scrvect. 7-2(16.12 Rodent Bair Stattons* 1 3-801 1 IT) 1 -Unote:ned Food Package Not R+t-s,-r%cd 7-206-13 Track'n',Powders,Pest Control and CONSUMER ADVISOR`( TIMEITEMPERATURE CONTROLS 22 3-03.11 Consumer Advisor) Posted for C'Ou,uiortion of tfi Proper Cooking rempetatures,for I Ani�;ial I,od,' That L:ru Raw, I rid..-rcookcd or PHFs Nut Otlretwit Processed to hi:ntlaatc 3-�ii')Ll 1A(l)(2) Eggs- 155 T 15 Sec. cm, 3-302.i, 11a,aeutizca Ft, s Substitute for Raw Shell El,,gs-immediate Service;145'F15seci 3-447.11(A)1,2) Comminuted Fish. Meats & Gain,, Egle* Animals- 1:)5'F 15 pec. '' Pork and Beef Roust- 130"F t2l man` SPECIAL REQUIREMENTS 5900+5•)(A)-(D) Viols'ions of Seclion 90.009(A)-(D) in 3-40L 11 t,02) RatiteN, Iq[cctvd Nlu�ts- 15 9�F 15 ec catering,mobile lood, temporary and s 3-401.1 I(A)(3) Poultrv,Wild dame.Stuffixi llfiFt;' I residennal kochn operations should be StContainingaiL Containing Fish,Meat, debited cadet the approtiriatz lloulnv'orRatites-10'17 15 SCL, abow. if related in loodborne flltiesa 3-401.':1(CG) Whole-ntuicl�, L.tact Beef Stt-snt, interventions and risk factors. Other 145-F= 590.009 violationsrelatingto good retail 3-401.12 I Raw Amoral Foosis Cooked oi;I practises should be debired under #29- Miciowave 165'F i Special-Requircinerns. 3-401.11(A)(l)(to Ail Other PHFs - 145'F IS sec. t7 I Reheating for Hot Holding VIOLATIONS R.ELATED TO GOOD RETAIL PRACTICES 3-403 i I(A)&(D) PHF> 165Y 15scc. ^ i (Iteirti 23-3(i) 3-403.11(13) Nliciowaxe- 165'F 2 ivinule Standing Ctai,at and iww-crateal violarwro', which du not(elair to the Time* tiiodbuoie hwrtvntions ondnob factor's?Istel above, call be 3-91+3 11(C) G--triniercia!1) Pace,,.qed R rF Food- fillmd b� thefidtflivilllc.w<tions orlhe I-uod Cade,mrd 105 011, 1400F* 3=03.t I(E) ReriiaininL Unsiiced Portions of Reef from i Good Retail Practices FC590.000 23, Klarimtement and Personnel FC_ 003 Roasts" 24, FcixJ and Food Prote_tion FC-3 004 18 Proper Cooling of PHFs 25 Equipment and Utensils FC - 4 116 C 5 C�0� 1-451 14(A; CoohngC,okcd PIfFs front I lu'Fto 26. Water,Pluwbinq and Waste F 71'F Within 2 Ifiours and Froai'70'F 27 Physical Fa,-:11ty F 007 to 41 1-i45'F Within 4 liotir;, 28 Pdscinous or Toxic Materials F 008 3-591 14(B) Cooling PHFq Nli;de Front Ambient 2D Cpec:al Requlienients 004 Terriperinur, Ingredients to-il F/43' F j 30 other Within A Hout-O' j ' -..- Ian.de, 113I n.,te,crit i.a I nstn in the le&nd 1479 F'od Code''I toy CNI R 590 000. . •. �'.y -.R'a'•STLeMitaa+.rvd1'V.^•+oe�r"`as.n.•'yrfYe.cra.e..�ww''rw.w�ymy... ..... .. ., n...�r..� .....-� - .. 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 j"� Date/ Tyne of Onerationtst In ection // //0 /0,;1 El Food Service Routine 1 / Risk Retail ❑ Re-inspection Address /J �P C� _ Level ❑ Residential Kitchen Previous Inspection f Telephone ,�,J ,.�/O�r 917 D Mobile Date: Owner HACCP Y/N ❑ Temporary ❑ Pre-operation I ❑ Caterer El Suspect Illness Person in Charge(PIC) S�rn Time ❑ Bed&Breakfast ❑ General Complaint In: a HACCP IInspector VI;AMS727hi,51P.e.�^r,00Pf'AlA(7 till'? I Out: Permit No. ❑ Other Each violation checked requires an explanation on the narrative page(s) and a citation of specific provision(s) violated. Non-compliance with: Violations Related to Foodborne Illness Interventions and Risk Factors(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/ Duties13. Handwash Facilities EMPLOYEE HEALTH PROTECTION FROM CHEMICALS ❑ 2. Reporting of Diseases by Food Employee and FIC El 14. Approved Food or Color Additives 7 3. Personnel with Infections Restricted J Excluded U 15. Toxic Chemicals FOOD FROM APPROVED SOURCE [3 4. Food and Water from Approved Source TIMEITEMPERATURE CONTROLS(Potentially Hazardous Foods) ❑ 16. Cooking Temperatures El 5. Receiving/Condition © X8. Tags/Records J Accuracy of Ingredient Statements 17. Reheating yd ❑ El 7. Conformance with Approved Procedures 1 HACCP Plans 18. Cooling PROTECTION FROM CONTAMINATION 19. Hot and Cold Holding ❑ 8. Separation/Segregation/ Protection 20. Time as a Public Health Control REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) ❑ 9. Food Contact Surfaces Cleaning and Sanitizing .,r [3'21, Food and Food Preparation for HSP i'1 El 10. Proper Adequate Handwashing CONSUMER ADVISORY ❑ 11. Good Hygienic Practices ❑ 22. Posting of Consumer Advisories I t 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 jviolations 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 _ V 25. Water, Plumbing and Waste (FC-5)(590.006) establishment operations. If aggrieved by this order, you JOR v 27. Physical Facility (FC-6)(590.007) have a right to a hearing.Your request mustbe 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: if/ �Yt print: :r PIC's Signature. „/,.7 �] , t print: lv y.(../ ! � I I Page L of-4.�Pages FORM 734A HOBBS&WARREN - BOSTON Violations Related to Foodborne Illness Interventions and Risk Factors (Red Items 1-22) PROTECTION FROM CONTAMINATION 0 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 Contac[with Equipment and 590.003(F) Responsibility of a Food Employee or an Utensils* Applicant to Report to the Person in Contamination from the Consumer Charge* 3-306.14(A)(B)I Returned Food and Reservice of Food* 590.003(G) Repotting 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 gg 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 Game and Wild Mushrooms Approved by Regulatory Authority 2-301.11 Clean Condition-Hands and Arms 3.202.18 Shellstock Identification Present* 2-301.12 Cleaning Procedure* 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* 590.004(1) 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 to the federal 1999 Food Code or 105 CA1R 590.000. CITY OF SALEM BOARD OF HEALTH 1I11 Establishment Name: �Dnc/ erSS ;)a/e%r r Date: //- /0-03 Page: a of 7 Item Code C-Critical item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date No. Reference R—Red Item Verified PLEASE PRINT CLEARLY .evs e a"' Sr.-vip e da'e //yrs (-Agr,�wee Za Kc e- I C7/Jo�Y/i�/4 l��ersiv4 En�T C� er,C 4;e40 /s IA)S,- -7-S s S,4'7aZ1 r�/�I� zt J L �b7�Pooyn�%1lr,rr/..a, X1,2 Al "E7�9a/�vPs �ni(s /�Yls�/ n�r�s A&- , tiifa� o� ( �7 �S C /i�✓r -$ /'9 G —`�cs n E c;�e_ alv-aa /4 d 7&--;Ynb o F /-/e cr'� lnus7� Ae-, ('iA/0D-leC'4,le CD, e0G/-rI? jC4/axOr,9- 7'� m�'o X2 -/-;I 8 (✓_ �1-� /��p/� - 4;'2'W'IuP ./�I n7 P /7/a r X2 �cro /.1/4eGc t - s_z 0— �Y}rx �s FD/7d/7 S /7�irna� �Po��e�s CPc�c�G r 2:°�m{ flee se . clic U l5�G ),/AO& -DA19WS-y5s 8.0,?r Aa Gi n/4 .-_ _ - - Discussion With Person in Charge: � V T, Corrective"Action-Required: I o N-�.I�.0 !es 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 Emersion 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. `( l�— ❑ Voluntary Disposal ❑:> Other: i r PHFs Rec-iv.d nt'L:.nueratures Violations Related to Fondkorne Access Interventions and.Risk Arsn'ding,,to F,tt Cnn:•-d to Factors(items 1-22) ;Cont.) <t! la5'F\1'itiun.]Nours '^ j 3-501 15 Cooling Mcu:u:is for PROTECTION FROM CHEMICALS 1.9 j Food or Color Additives PHF Hr,*and Cold Hoiding I j ' 3 i('a, 60,) Coid PHFa Maintained,:t u, helm: 1 3-202.12 Addil,tes`x i 3-302.14 P:otect,on fro; : U ' t ( 59t1.0011F1 4!;��`' i-#° . r napp�o'.rd: c�:ti�es" 15 Poisonous or Toxic Substances ( ' SO!.ib(.\) :Ion PHF 140 F. ` ! 7-101.11 Identifying lntbt matiou --Onginal 3.501.i WA) Roastc l-Ie':d a ,i ., ..nuke i 30`F. j Container:" j It 20 Time as a Public Health Cordrrf 7-I0.'_.0 CouunoaVania-WorkinaCont.:ir:ors` � j ( 1 7.201 11 Separation-Stutal•e` j 3--301.19 T;n,c ac a Public I1'a tt;(ontrn!'^ j 7-21)2.1! Re>triUwm-Yres.nr. midi su j 590.001(H) ( Vauaece Regtuitutent i 7-202.12 Conditions tit Us"' 7-203.1; ltiric G'jilainers - Prohibitions' I REQUIREI9ENTS FOR HIGHLY SUSCEPTIBLE j 7-204.11 Sanitizers.Criteria-C'henticals„_ POPULATIONS{HSPl .�-2 , 121 13-F,01 H(A) tlnpasteunztd Pie-pa.kagcd Juicos and j tl-t.i:. Chera,�,dc for Washing 1 tahtce,Criteria" L_veiaeen with Wi.,rnir�Labels* 7_104.- 4 Di ging Agents.Crites ia" ' : ,R 1 t.«]} '• j j ?-205.11 Incidental Food C>ntati La:br,,•ants'^ L Use of 1 aso CITY OF SALEM BOARD OF HEALTH Establishment Name: �ith� C'F5 4 rvk�'7` Date: /i`'/o-� 3 Page: 3 of s Rem Code C—Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date No. Reference R—Red Item Verified PLEASE PRINT CLEARLY I G�SeLco 7Yle�I� ✓Z ��Ar� �p�oaov�7s >`' L77-i) /Ck as ,ee�zrPs T/fPoa�/Iorr` �Ord �i145ra,,-irl7VM17, W, kr�ee 7Yiecs/ti4 . .' I 7XI P e1nO7;7 Q ZZ/e s ll't'L �OeW s,olGls I� ` I I /�1n r. oPev4/i n,�'avroe ffiec PSsri ��/ /L P�Prrr�S I I I I I I I I ��.� � Goco7e its e Loses � Tie ✓�bo�� 9s foo�S!'i/3G� i \I IIfb XTIAlq//J'2 &//11-17 C171 uG)eZ OW a 'Men 7, _/� aS7y/&-*4GIfAW �A �Ps�Oi��S u/E Pe tin ed 0474fo "'/c 7 I Das teV AS •� /t ero-r` aVlVee "S 1qd111,5 e Ce VV Coir Af 7L-a' I I I ,�xYP,Prni,�a71".e �?7-azree 7`0 ,o,�°t�'�r�` r�fe closi,v� o� Tie �3�e�C�s�/mgc�' ups -1,aPw Ay vs- /ti.5,P4T7'i9 �eu I I G7`QLG /Ns�6Cf7ayls_(��f��ao�� xe�9 )A47Sew ane sh,-AF.,(y9as ,oasr•0/es / 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 y p ❑ Re-inspection Scheduled ❑ Emergency Suspension comply with all mandates of the Mass/Federal Food Code.`I understand that noncompliance may result in daily fines of twenty-five dollars or suspension/revocation of ❑ Embargo ❑ Emergency Closure your food permit.; • �f + - ❑'� Voluntary Disposal ❑ Other: :i-St)l.l-iiCl FH F3 deceived as Temperature; ' Violations belated to Fccdbnr»e Nfnee<Interventions anc.'Flisk AC.'0xdoI,-,Lo Lim,C(toled to Factors(items 1-22) (Cont.) In , I Wit;i I, ' f uj r PROTEC 1'ION FROM CHEMICALSJ 1g Coo�:;hE Methods fix PFfFq 15. PHF For and Coat Holding Food or Color Additives 3-S0 1,lhiji�, Gl%�-! PHFs at lit b(driv, 3-202.12 Addolvti,* 3-302 14 Phileclion from Unapprtr,,,d Addaki-s" J 5WI.004(F) 41 7;}'1-:.: 61,16(A) I-Ell PH Mioiomed at or abov� 15 Poisonous or Toxic Substances 7-101.11 IdentiNihe Information -0ril,,inal Containers, Roast; Held at ot above i 01:, 1 4 True as 3 Pubtic Health Contra0 11 Connuon.Name Working(.ianaine.si' 7-2i,?L 11 Separation-Stomiq-,* ss lih -wwo, '5oo.O.J4,11 1) Variance R,-quimiue-,i -t-202.I I Re:tcichuo-Presence and tlw�, i 71)'.12 Conditions of 1 N.' REGUIRENIENTS FOR HIGHLY SUSCEPTIBLE 7 20;.11 l'or ic Containers-Prohibitiors" POPULAT IONS(HSP) 7-204.11 Sallitizets.Cruer:a-Chelilicids' 21 -;-801 1 UA i -Unpr,iwumzcd Pre-pa&aa,xibili�cs and 7-?04.12 Chemicals for Washing Pnducc.Criteria'7-204.14 Be,eiaurc vvith Warnine I Dr�iru,Aaents.Criteria' 7-205,i 1 ftwideutat Food Contact, Lubicanvll of Pasteurize,: 3-301 11(P) R::v, or F'ji'tially Cooked Aaawl Food and 7-206.11 Resiri(ied I Ise Pvsticides,Criten-wi 7-206,12 Rodcnl Hatt Siaaorisl� Row Seed Sprouts Nt:i Se;,,cti. 3-501.11(C", I Inorcned Food Package N,A RC-SL J-Wd, 7-200.13 tiackirp,Powders,Pest Control and CONSUMER ADWOSORY TIMF/TEMPERATURE CONTROLS 22 11 Consunier-Advisory Vi,ste,l lot Coiicurnption of Proper Cooking Temperatures,for Annual Fur 0d.1'r11,'a arc kaw. Undercookcd of N,-,t Othen,;i-e Froces-qed to ElonitiXe PHFs 3-401-11 A(!)I 2) Eggs- ' P�ihogens. 1�5F i5 Sec.1 Subm 0-1 15 lixaeurizcd EuL,,� itute for Raw SitLV Egg� Immediatc Service I 4�,'F;�-,sec' 3-3 i -- Contininutel Fish.Meati&Gauic ,'uojnal;. 155'F 15 sec. 4 3-401.11(B)(1)(2) Polk and Beef Roast- 130'r 12 i win' j SPECIAL REQUIREMENTS 3-401.1;(A)(2) Ratites, lojected Wits 590 0 19(A'-`D) - 155'F I:, X Violations of Section:it)f)009(A)-(Dl in sec * ciierinl--, nu;b!le toad. temporary and 3-40!.1 (A)(3) Poaltr,,, Wild Garro.Stuffed PHFt, residenhod kitchen itwintions should be Stutfilh,Cuutawnw, Fish,Meat, du,hitod unAer the appropriate section, floultiry or Rattles-16i'f• 15 gt-c, ahovc if rciated to koodbornc illness 3-401,1 I(C)(3) Whole-muscle. Intact Bert Stc:fl,s interv-oticlns and risk faccols. Other 145'F= 590.009 violations relaftg to'good retail 3-401.12 Raw Animal RuNis Cooked in a practices should be debited under#29 - MicrowaNe 165'F Spe,ial Requirenicills. 3-401.1 JW(1)(b) All Caliet PHFs 145'17 15 sec. 17 J Rehestina for Hot Holding VIOLATIONS RELATED TO GOODRETAILPRACTICES 3-403.11(A)&(D) PFTF> !Wf- 15 sec. (Reins 23-30) 1-403,1103) Nficrowaw- 165'F 2 Minute Standin�,. Gillr al and 1,-a-crillcul Vi"'lotiotu, .,hick do nor i-clate to the fi,odhurne Kress inter;earivw and ri5k factuti tisfed above, cart be 3-4(13 1 (C) Commercially Processed RTE Food finipt"4":he fillloly,-'S&tie::., of the fitiod codt and 105 C'U'R lacpl,- 591).Ooo. 3-103.1 i(E) Remainute Unsliccd Portions of licef Item Good Retail Practices FC 590.000 2i klanaqemiont and Personnel FC—2 003 1 214. Food and Food Protection FG -3 004 Proper Cooling of PHFs 25. i Equipment and Utensils FC - 4 005 3-50L 14(,A) Cooling Cooked PTIFs foul 140'17 it) -,6. V4 sten.Pl,jobi..-io and Wasio 1 FC- 5- '006 70'F Within 2 Hours and From 70+ 27 Phy8ical Farthiv FC-8 007 to a]W45'F Within 4 Hents, 28. Poiccnous or Tom, Materials FG 7 .008 3-501.14113) Cooling PHFs Made Fi orn Ambient 1 29 Special Heowremmts 009 Temperature Ingiedivot;to4l'F/45'F M. Other Within 4 Hours' Nnoie,o4ec,1 itml ri the boeeml !;99 Fu,,j O'de ol 10�(71, tri Soo 00(1. CITY OF SALEM BOARD OF HEALTH Establishment Name: Ce-,.2f eessMa.,am-p f— Date: 11-10'-0 3 Page: of - Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date No. Reference R-Red Item Verified PLEASE PRINT CLEARLY �G �� ✓ S, r wa:wq u ri/v.e —un7o,P �r l5'P �7i,�fiP�/a✓ E//�i P,P S./a�c Si�/r o rP t�A-Gon- r7f�P�_-,'�*Zl 7 /I/aP /54ur o AK c[ sr De 7etr6h1 ,riot .v ,s{�r�i �9 "77 I dSt7_/v40�r77/9 i/ /172e 44,,'e e k /7u. 177--Ins f I I� /�2r�i�ii/L7 S`J ,n/l sa�r A/A/5,1(Z G!a 7;,e /f'ct ,P r -amu x I lam°' f vrr Pmi y0 �fn-.r � •� l'ONdri�/a� �<� A-/ 6-si �YJ'Joyr ��7G�/ �aSis�//o c,e rr/i�� ,, A11q Ao",011 -Al Lc7CI `Oda® 'Onese7r v ('A/& ,li,p - 7N6157 Wa a P � P� fr✓il G �� , A P 4�r� Food S��irC� Hest &io / I Discussion With Person in Charge: Corrective Action Required: ( ❑ No I ❑ Yes 1 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 L3Emergency 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 o Emergency Closure your food permit. l �! � ❑ Voluntary Disposal ❑ Other: '-5:)l 1.4,((" PHFs Revc;eed al'rem!erarure, ! Viofztions Related to Foodborne illness Interventions and Risk ( A:.cording to L-,,C.n+icd:o Factors(Items l-22) (Cont.) yF 4t'ithin•t i-lows. " PROTECTION FROM CHEMICALS 1 4-V)1,15 coolhtg&Ietho+h for 19 i PHF Hot ar.,'CGId Hoidi,^.g 14 Food or Colol Additives 3-501,th(it) Cold F'iIFt, Maintained:d or hchm: 2U'.L? Additi�es+ � I { •11"kill" ,.+: i 3-31;214 Protection from (htaprroved:\udu;re," 590.00.4 F'. I 1.16(A) Hot Pi 117:aaintnweJ at„ an"se r }; Poisonous or Toxic Substances i 7-10LIi ldentti',nnglnformation-Original ( 140°_. ` 2 :,W i6G',) Ra:eta Hrld:u n, ab-,ve !30".' Contauters'" 7-10211 Conmr,m Nauta-'vi urn me l'oa ta;net s' Y 211 rime as a Public Health Control ' -501 19 Tim, as a Public l-Ie,ihh CorlroP` f 7-201.1( Separation-Biuret e" 7-202.11 Re,tricuon--Presence and I T-0' 59:1.'O it tit 'vanane e Reyunrinent 17-2.02.12 CortToKic ons of er,, . REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-203,11 '1'r,eir,Container,,-Prohibi?`:ors` 04.11 Sanitizes s. Cntetia-Chemical•;-: POPULATIONS;HSP) , , > 121 3-801 f IIA) Unpnsleurizad Pre-paii.aged Juices and 7-2()4 12 ChemicalsN for a,inrig f rorhlte.Criteria* I kecerncv.s with Warning Labels`° I 7-204.14DtYin;, Agents,Crnrtia" --9f 1.11(B) Use of Past-wheel '1-2t1i.1 I lncidertal F„od Contact,Lubricants' 1 1 Raw or NW'!tally Cooked Animal Focxl and 7-ZOli.i ! Rearicted Use Pesticides,Cct?cries" 3-800 I I HA 1 Raw Seed Sprotnl R,H Cerced. '1-306.i 2 Riskin Bait Stations' j 7-70h.13 'Lrackin',Powders"Pest Control ;utd ! 3-8,01.1 I I, ) I I Jnopcned Food Paci:age N,,t Re-ser:ed. Momr,,nne' I CONSUMER ADVISORY TIME/TEMPERATURE CONTROLS 22 3-00' 11 Consumer Alvis„r} Posted for Cununapnon o1 .Annual B md<That are Rai, Undercooked of 1 16 Proper Cooking Temperatures for' Not Othenvi,e Processed a>Eliminate PH'rS Pallto4[dn5.', 3-40L1 !A(1)(2', Eggs- 155`'F15Sec Eg;;o- lmmedtate Sa'sice I-?S'F!S.eo` '-3;)3.13 P:im,nn .ed ELgs Substitute for Raw .'-hell E e 3-401 1t(A)l27 Comminuted 1+i:h.Bleats h Latae s" I \nimals- 15:.°F 15 sec. ' SPECIAL REQUIREMENTS 3-40!.11(Bn11(2) Pork andBcefRoast- 130`F 121 min". - 3-401.11(A)(2i Ratite:.. injected Ntcat:.-- 15 'F' IS 590 009(A)-(D) Violations of Section 590.009(A)-11ll}in ( .,ec. catering, mobile food, t- mporary an(! 3-401.11(A)(3) Pnnih, Wild Game.Staffed PF-1Fn, residential kitchen operations should be Stuffing Containing Fish, Meat. dchited under the appropriate sections Puulttt-or Raute,-165 F l5 sec ` above ifrcl.iied to foodborne illness 3-401.1 I(C)(3) Whole-muscle. Intact Bcaf Steaks interventions and risk factors Other 14.55 F'' I 590.009 violations relating to good ieuail 3-401.12 Raw Aruna' Fexxls C'oo'led in a practices should be debited under#729-- :Micro»ave 16J'` " Spm-1 Rcclaucinents. 3-401.11(A)(1)(b) All Other PHFi-- 145'F 15 sec. 17 Reheating tot Hot Holding VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 3-403 11tA)&ID) PIIFs 155"F 15 sec. iltelYis,13.36) 3-403.1((B) Microwave- 165"F 2 Minute Standing � Criiu.ai and non-ercieul :,ao(reicns, r'lrch du not relrtr to the Time* luodhorne ifhrecs h:te;r:ntto+rs;uu!risk tYtctorr hsted ebuve, can b,- 3--403 11(C) Commercially Prixessed RTE-Food- fituad in the 1,141owing ter Hurn of the Food Linde and 105 lCdIR 1400F' Sgt)of]i7, 3-403.11;E) Remainim;Uushced Pon ions of Bee( I item Good Retail Practices FC 590mo Resists" I 23.-_ I,Fanacement and Personnel FC--2 .003 18 Proper Cooling of PHFs 14 Fled and Fond Frateclion 1 FC--7 ,004 25. 1 Equipment and Utensils FC- 4 .005 3-SOi.1VA) Coming Cc edIII Fst4nml40tit) ?n xer. Plumbmgand Waste FC-3 .003 70"F Within 2 Hours and From 70"F 27 1 Pt,ys:gal Ferillty IFC-6 .007 ?o 41'P/45'F Within t Heats * 28. Peisoncus or (cx,c Materials FC -7 .008 3-501.14(B) Coolimr PHFs Made 1-four Amblem I 29. ! Special Requirements OG9 Temperature I on-cdicnts to 4 m_ 1 Other Within 4 Fleury- D<nn,cr ICI 1 Ctm m the lederal 1009 Mood Cale:,i 10 CAI R 5ri0;:00. CITY OF SALEM BOARD OF HEALTH Establishment Name:_K��Z�e _ < s Date: 6-1Z,$r /3 Page: of Item Code C-Critical Item✓ DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date r No. Reference R-Red Item Verified PLEASE PRINT CLEARLY I / �)n._Ii7Pv L��t hP.min �,oi ¢'e �A.rlii/P /lr� �t I / I I I I I I I I Discussion With Person in Charge: Corrective Action Required: I ❑ No I ❑ Yes I have read this report, have had the opportunity to ask questions and agree to correct all ❑ Voluntary Compliance ❑ Employee Restriction/ 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 twent -five d9llars or suspenstun/revocation of ❑ Embargo ❑ Emergency Closure I your food permit. / �f 1 //7 /I ,� ❑ Voluntary Disposal LI Other: !-��/-� V i 3-50Ll-4i0 T'iiFs Rece:ved at Temperatures Violations Related to Foodborne Illness intervenhons and Risk Accoi ding to Favr Ccatltd to Factors(Items 1-22) (Cont.) 41'F14_3'F I3'ithin.1 Hours. PROTECTION FROM CHEMICALS 3-591,15 Catling ttictha(s for PHF: 14 Food or Color Additives 19 PHF Hot and Cold Hoiding j ' i.K,1.kv B) Cold PHFs Maintained ai o( behow 3-202.12 •Additr.esD S)0.004(Pi 41'(45'F: 3-302.14 Protection from Unapproved Addimcs', 3.501,16([1) Hot PI:F,Nlair.:ani d at m'abuse 15 1 Poisonous or Toxic Substances 110`F 17-101.11 identrAing Information-Original 3,-501.10' Conuriners" Ai Roast, Held a .t t above 130'F 0 Time as a Public Health Control 7-102.11 Common Name--Working Containers' ( j t' Time as a Pohlie i Ical h Control" 7-201.11 Separation-Gnragc^' 3-5011 l i _ j 7-202.11 Restriction-Presence and T,'se` i 5uu.(a)1(H) Varj,.iicr Requirement j 7-202.12 Cundit,uns of Use'' 1 j 7-203.11 roxicContaincis-Rnhibitions' REQUIREMENT S FOR HIGHLY SUSCEPTIBLE 7-204.11 Sanitizers.Criteria-Chemicals* POPULATIONS(HSP) j 7-204 12 Chemicals for Washing Produce,Criteria' j I .^1 s-SU I.11(A) Unpa;tcurized Pm-packaged Juiced and j 7-204.14 DrYine Agents.Crttei ia'" Beverages with Wanting Labels' 7-205.11 Incidental Food Contact. Lubri.LmW, SO1.1!(B) Use of Fasr.urized Ears" j 3-s0I I1(D) Raw,or Partiiily Corr ed Animal Fotxi.Ind 7-206.1 I Restricted Use Pesticides, .'rrteti•.t'" l Rev: Seed Sprouts Not Served. 7-105,12 Rodent Bait Stations* j 3.sctLl ltC) Unopened Foud Package Not Rye woad r 206.13 Tracking Powders, Pest Control and j Moniiurmo* CONSUMER ADVISORY TIMEffEMPERATURE CONTROLS 22 ! 3-603.11 Consumer Advtsar) Posted for C'oncutnption of .4nim.d Foods,That are Raw. Undercooked or 16 Proper Cooking Temperatures forPHFs Not Bhct'wise Proce,sed ro Eliminate 3-401.11A(1)(2) Egss- 155'F15Sec. j Pathoe.ns. F; us-immediate Servicc 145F15sec; ( 3-301.1: Pastew;red Eggs Subsr.0;te for Ruv;Shell 3-d01 I1tA)(2) Camnenuied Fe;h, Nlcois 8:CameI E]tga" Animals- 155`F 15 sec. 3' SPECIAL REQUIREMENTS 3-401.11(Bal)(2) Pork Lind Beef Roast- 130"F 121 min* 5'J0009tAi-tUl Violations o(SecUon590009(4)-;Olin 3-4W.11(A)(2) Ratite,,Injected Meac, - 1 55'F 15 Se". � catering, mobile forld, temporary and 3-401,11(A)(3) Poultry,Wild Game.Stuffed PEF.., i residential kitchen operations should be ')tutting Gunta:nmg Fmh. mtear. .....;�,., ..Ildcl,fit(. .•;; _r.h e....t.,.,r., PouItry or Ratites-165F 15 sec ' I above if related to foodborne illness 3-401.11(C)G; Whole-muscle, hitact Reef Steak, ( imer:entions and risk faciurs. Qthcr 145'F* 590.009 violation,relating to good retail 3-401.12 Rjw Animal Foods Cooked in a practices should be debtrcd under#29 - Microwave 105`F x Special Requirements. 3-401.11(A)(11(b) All Other PHF;;-- 145'F 15 sec. j 17 Reheating for Hot Holding VIOLATIONS RELATED TO GOOD RETAIL PR4CTICES 3-403.11(A)R(D) PHF:, 165E 15 sec. °` (Itemc 23-30) 3-•i(13.11(B) Mi._rvwaie- 165` F 2 Minute Standing ( Ctilical and non-(riticul violation,, which 110 tier relate to the Time* Joodbornc'diness lntenentiony and nsk fa;:bn.s listed ubme. call be 3-403 !l(C) Cort rwiciall)Piocessad RT6 Food - ( Jnrrnd In the foNurrir;c;.iec'inns if ibe Faurl Code and 10`Cd•IR 140'F* j 5+10(1(10. 3-403 1 1(Y,) Rzmainine Unsliced Portions of Beef ( Item li Good Retail Practices FC 330.000 23. Management and Pvrsonnei FC - 2 .003 18 Proper Cooling of PHFs I 24, Food and Foal Protection _ - FG-3 004 l 25 Equipment and Utensils FC-4 .005 3--501.14(A) CoolinpGxtkcdPHEsfnxnl40'Ft° ! 26. Water PlumenOanoWaste lFG-5 Ooh '70•'F Within 2 Hours and From 7U"Fi ! 27 Phpsical Facility i FC- 6 .007 to 41`F145'F Within 4 Hour. * ! 128 Posonous or Toxic Materials FC - 7 .008 3S01.14i B) Coming PRFs Made From Ambient L29__1 Sosciai Raauirements .009 Temperature 1ngr,dients to 41'F/-45'F 30, Other Within 4 Hoare" ...... '- ' Igen,Ic„�rititfll item in Ihr tedcral 19+)9 Food Codc,s 105 C:\9R M.000, CITY OF SALEM BOARD OF HEALTH / Establishment Name: N�rc t �e /.I �� / ✓/i/ii�.�P Date: ��7 O�3 Page: of Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date No. Reference R—Red Item Verified PLEASE PRINT CLEARLY a ly ,I/It- ,fir//s�/.trr —ih ,�1AA d i�i'� /fi/t/S� b� /�/✓)�7/fC/G /`Ji�PrlJ/LlUtf �/t�J�JPr �y/i14YiinT �Gr d'iP C / A17 /J>Lii��/iiiY iG /J!/�Si CX II Discussion With Person in Charge: Corrective Action Required: I ❑ No I ❑ Yes I have read this report, have had the opportunity to ask questions and agree to correct all ❑ Voluntary Compliance ❑ Employee Restriction/ inspection, to observe all conditions as described, and to Exclusion violations before the next ins p ❑ Re-inspection Scheduled ❑ Emergency Suspension comply with all mandates of the Mass/Federal Food Code. 1 understand that noncompliance may result in daily fines of twenty-five dollars or suspension/revocation of ❑ Embargo ❑ Emergency Closure your food permit. ❑ Voluntary Disposal 0 Other: 3-501 14(C) PHFs Recen'ed at'remheratnrec !Violations Related to Foodborne Illness Interventions and Risk According to Lav:Cooled to Factors(Items 1-22) (Cont.) 41'x145"F Within 4I-Iours. PROTECTION FROM CHEMICALS 3-501.15 Cooling Methods tot YHF, 1and Cold Holding 1.y Fwd or Color Additives 9 PHF Hot 3-501.16(8) Cold PifFs Llainiamed at or helow 3-20212 Additises' � 54U.004i F1 41`145,F': "t,302.14 Protection front Iinahpnwed Additives# 3-50I.I6LV Hot Pf{Fs Maintained at o1 abrne. 1j Poisonous or Toxic Substances ' 7-101.11 ldenuljvie Information--original 1 Conhmlers" 3-301.16(A) Roasts Held it a;above !30 F. 7-102.11 Common Name-Working ContaintmO ( zO I Time as a Public Health Control 1 3-501 t9 Tuna as s Public Health Control" 7-201.11 Separation-Storage" I j9(}.004(Hi Vananee Ru!uiremeut 7-202.11 Restriction -Presence and tile" I 1 7-202.12 C'onditiom ut U,� T 7-203.11 riceCic Containers-- Prohibitions* ( REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-204.11 Sano izers.Criteria-C'hewicaW POPULATIONS(HSP) 7-2(i.} I'? Chenurtls for Washing Puxhice,Cri t:ria" ( 121 3-801.1 I(A) Unpasteurized Prc-packaycd Juices and 7-204.14 Drying Agents.Criteria,: 1 lNe of P s with ed E"A'g L.,hels' 7?05.11 Incidental Fond Contact,Lubricants* 3-SOI.I1 t ) tine or Pasteurized Eggs^' 7-206.11 Restricted Use Pesncides,Criteria' i-8tii.11(D) Rawor Pat?tail} C<a}:e Animal Fcxx'.and I Rack Seed SUnatis Not Scrved. * 7-200.12 Rodent Bait Stations 3-801. 1(C) ilnupened Food Package Not Re-served. " 7-206.13 'I'rtcking Poskders, Pest Control and Monitoring` CONSUMER ADVISORY TIMEREMPERATURE CONTROLS 22 3-603.11 Consumer Advisoty Posted fo, Constunpnon of 1h IProper Cooking Temperatures for Annual Foods'Ihat are Raw, Undercooked or PHFs Not Otherwise Precz,sed to Eliminate .3-40!.11 A(1)(2) Eggs- 155''-F 15 Sec. Pad;nt.enc..: 3-30^_.1 3 Pasteunzcd Eggs Substitute for Raw Shell Eggs-Immediate Service 145'Ftisec' if g�' 3-101 I I(A)12) Comminuted Fish. Meats 8c Game Fgg'W Animals- 155"F 15 sec. ;: SPECIAL REQUIREMENTS � i-401.1 l(A)(1)("_') Rxk and Beef ed ast Me - 130'F1215 59000,}(A)-(U) Violation.;of Section 590.009(A)-(I)) in 1-401.1 l(.A)(2) Ratites,Injected Meats- 155'F li ec :, catering, mobile food, temporary and 3-401.11(A)(3) Poultry,Wild Game.Stuffed PHF+, residential kitchen operations should be Muttrng containing Fish, :Meat, ..,..c:to., wailer the a;r-,;r i,.6. Poultrxoi Rautes-165=1` 15 sec " 1 above ificlated to foodborne illness 3-401 11(C)(3) Whole-muscle, Intact Beef Steaks interventions and risk factors. Other 145`F" 590.009 cioleuions relating to good retail 3-!01.12 Raw Animal Foods Cooked in a I practices should be debited under#29- Microwave 165`F* Special Requirements. 3-401.1 I(A)10)(b) All Other PRFs -- 145'F 15 sec. " 17 Reheating for Hot Holding VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 403.11(A)X(D) PHFs 165"F ij sec. ` (Items 23=30) 3-403.1 1(B) I Mictowave- 165°F 2 Nitrate Standing I Crin(al and non-critie(t tiolation.s, which do not relate to the Tune* (amdhorne illness inletrei,60us and tisk actor. listed(&erre, can he 3-40111(C) Commercially Processed RTE Food- I found&r :he(olloxici;sec iior:a cJ the Fond lode and 105 CAIN 140`F* 590.080. 3-403 1 1(E) Remaining Unsliced Portions of Beef Item Good Retail Practices FC 590.000 I Roasts'' 2' ! Management and Personnel FC-2 .003 1 g Proper Cooling of PHFs 24. Food and Food Prolectior IFC-3 .004 25 Ec uiornent and Utensils FC-4 .005 3-501 14(A) Cooling Cooked PRFs from 140-17 to 26. 1 Water, Plurnbioq and Waste I FC-5 006 i 70'F Within 2 Hours and From 70'1- 'lis 27. i Pnysical Facility FC-6 .007 to 41"F/45'F Within 4 Hours. ` 2a Poisonous o! I ox!c Materials FC-'7 .008 3-501.[4(B) Coling PHFs Made From Ambient 1 29 '�, Special Requirements .009 Icmper,iture Ingredients to4PR45'F 30. ,other Within 4 Hours `Denote,critical vein in[lit tedcral I`1a19 Fo,xl cafe ur H)5 CSllt 590000. ( IMPORTANT MESSAGE ) FOR as -e DATE 4 1 �9. 0 - A.M. TIME 2.P.M. M OF / PHONE AREA CODE NUMBER EXTENSION O FAX O MOBII F AREA CODE /UMBER TIME TO CALL TELEPHONED PLEASE CALL CAME TO SEE YOU I WILL CALL AGAIN WANTS TO SEE YOU I� RUSH RETURNED YOUR'CALL II WILL FAX TO YOU MESSAGE Y SIGNED Ps M MADE IN U.S.A. NOTES ( IMPORTANT MESSAGE ) FOR D S P- DATF 4y',2 0' G TIME l0 P.M. � 7 OF Q �7 G �i// PHONE / / 0 - / `Y l- 7000 AREA CODE NUMBER EXTENSION D FAX D MOBIL F AREA CODEj NUMBER TIME TO CALL/ TELEPHONED PLEASE CALL h CAME TO SEE YOU WILL CALL AGAIN �1 WANTS TO SEE YOU I II RUSH RETURNED YOUR CALL �I WILL FAX TO YOU MESSAGE / �/l/S /1 D �/V\ U�✓G�VI � SIGNED Vrop's FORM 4009 MARE IN U 5 A NOTES ( IMPORTANT MESSAGE ) FOR A.M. DATF �^`_�p�_i�.�.�' TIME— P.M. %� OF r PHONE q � _ c/I — /p DO p 'AREA CODE NUMBER EXTENSION O FAX O MOBII F AREA CODE / NUMBER TIME TO CALL TELEPHONED All CALL /r CAME TO SEE YOU I II WILL CALL AGAIN WANTS TO SEE YOU II RUSH RETURNED YOUR CALL II WILL FAX TO YOU MESSAGE C.11i SIGNED FORM 4009 MADE IN U 0 NOTES a 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 Facsimile Transmittal To: f1� l v�nea %�ow cS /'✓vat( Fax # q? 9 7V7 aoao RE: AJvw Co/o-7 a l /c/tee Date Page(s): including this cover# Message: C�s rpa o e�?e dl / a,7 !,1 VI2C � IA >PvlC , 9 -fin JP•J /i 2✓ 7fs�o-w Board of Health News ----------------------------------------------------------------For Your Information Office Hours: Effective September 3, 2002 through June 27, 2003 ; Monday, Tuesday, & Wednesday 8:00 AM to 4:00 PM Thursday 8:00 AM to 7:00 PM Friday 8:00 AM to 4:00 PM Do Salem Residents Know ? —Applications for a permit to remove exterior paint are required by the Salem Board of Health. No fee for permit and electric sanding is not permitted. Regulations for home owners and painting contractors are available. HP Fax Series 900 Fax History Report for Plain Paper Fax/Copier Joanne Scott Salem BOH 978 745 0343 Apr 17 2003 9:55am Inst Fax Date Time T= Identification Duration EW es Apr 17 9:51am Sent 99787412020 3:51 7 OK Result: OK - black and white fax CITY OF SALEM BOARD OF HEALTH / Establishment Name: �[/P .c t �a ij/ �l/ii�.�n 7Z Date: 7 D�3 Page: of Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date No. Reference R=Red Item Verified PLEASE PRINT CLEARLY , I / ? A/1L �J .9/7'7/ICYG /�>L�Pr/_li�l/J! . l�2cJ/7 Pr o9JJ/liii� 7� 9` Zje ae� l CYIJr,�Pr� I Ire ow S.,C 4 'r &ePS��iLi i/SL'2� C„� Ile-. I � I � I � I � I � I I � I I . Discussion With Person in Charge: Corrective Action Required: I ❑ No ❑ !es 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: FAX 4-70o' -7 CZ0 4 a gaac� Liam ii CITY OF SALEM,MASSACHUSETTS . LICENSING BOARD 95 MARGIN STREET P.O.BOX 1042 hna TEL 744.0171 EXT.30 Chairman.Harold F.Blake.Jr. CLERK James M.Fleming JUDY DAVENPORT John H.Casey ROUTING SLIP The Salem Licensing Board requires that each applicant have the appropriate Departments sign this Routing Slip ,and return it to the Licensing Department before licenses will be issued. BUSINESS NAME: Congress Street Market LOCATION• 95 Congress Street TYPE OF LICENSE: Package S+Ore Beer and Wine License APPLICANTS NAME : Mercy Market, Inc. , c/o Diep N. Do, President Residence: 44-46 South Street, #1 City: Lynn State: mA Zip: 01905 Telephone: 781-596-0773 TO ALL DEPARTMENTS: your signature on this form is notifying Licensing that all requirements of your department have been met, at which time the Licensing Board will iss a nse. Salem for' Cc ission One Sa m G en/ lanning Dept. Sign Rekiew Planning Dept. One Salem Green Salem Health Department 9 North St. Fire Prevention 29 Ff2rt Ave. Building Inspector / Occupancy One Salem(( Green i/ �?Partment of Public Serve es T Water Dept. (for billing purposes) One Salem Green CITY OF SALEM ��,� (' BOARD OF HEALTH -��,��'.I' # Establishment Name: t )Yf10f5 Uri — Date: Page: of Item Code C-Critical item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION _ Date No. Reference R–Red Item Verified I 1 P EASE PRINT CLEARLY o'7Y L /-C_0-707 1 CCA-40 i.o�l r0n ( faO C*- , I I rG///I A.f_nIV S C ll°rAi1 .�� M /SYI(1] Y1 <ZIw e /0 1Z r y I41li'm P 1 ��. I. /;r )�'� ' 1 )/P N)",a ( C c rXQZ��C� �i� . �(a r4— 2 4'€XY1rw Ulm+ \�� 1 t �i/�1 d c I Aew / l J � tt p� YH �i (�A4a . T / I1A YM ,` 7��//�S .J CSW/. HCI�r �C rif ,/tnC f 14- IS �!�Lkl ''�2 Sz)L,r. - t 1444,17 Xe . 7l0YI /n D77�/ }, � - ( 'Jv�- �/ t\(��lQ(✓ (1t7 —/',c.! ;?eu _ i,/ t)Plia( (4- "J'_')t-_ )nV, i— A)On r,L –I , hq� Ckc 6 j _lam . 1 ( Ti--)�r_ � - 5��/�/•l C� � 1�_ / �, % Y Q!�'I 1��'l �Y'��l-c l��/ANrv�/[_-I r . _?J iV\ (or. J/Sf —yAI21zA - CGtij_r '1 A t,4�C/ �na�ir �,c Nliiin �TirnPr! fV1/1)r�ln 7 r� l lr 1 n3t(o _ Discussion With Person in Charge: Corrective Action Required: I ❑ No 142''Yes 1 I have read this report, have had the opportunity to ask questions and agree to correct all ❑ Voluntary Compliance ❑ Employee R{{estriction/ violations before the next inspection, to observe all conditions as described, and to Exclusion - P Re-inspection Scheduled ❑ Emergency Suspension comply with all mandates of the Mass/Federal Food Code. I understand that e noncompliance may result in daily fines of twenty-five dollars or-suspension/revocation of Embargo ❑ Emergency Closure your food permit. A � �r11� _ ❑ Voluntary Disposal ❑ Other: • f ?HF%kr.rrved ar Temperatures ! P FactViolators (i Related) (Cal,),,Foodborne/tineas interventions and Fisk Aecotd:nlg+u I.m Cooled to Factors(items 142} (Can „ 41`W45'!-NVuJun 4 Hews. PROTECTION FROWCHEMlCALS i 330'.;5 I C:n+di:i;±lliedInds for YHFc j 19 i PHF Hot anal Cold Holding to Fond or Color Additives ! 3-501.I6(E Cold PHI-.,Maintained at or below ! 3-202.11 Addvi%ce " 1 5y0,1iO4(f')) 3-302.14 Protection irorn Unapproved .zdgLhars" j j 2 501 161A) [int PHFs !ltaintamcd at ur above 115 Poisono+ss or Toxic Substances j 140r'F. 7-101.11 Identitling Information-Ori6i,d Co:uaiver, 13-501,i 6(A) kuusts Held at or above 130'F. ' - 20 j Time as a PuNic Health Control -i C12,11 Cuimr•,;n Nantc-bt uri<ine(.'o;ttamers'' j j 1 Separmion-Sturagc" j 3-501 19 Tim 7-201.1c as a Public S lcairi;Control` � `90 G04(rIi ( V,jriance Requirement 7-202 11 Rentricrion,-FYcsencc and llse'� � 1 � 7 20?.12 Conu:6rnc of Use" REQts1REMENPS FOR 14IGHLY SUSCEPTIBLE 7-21Sat is Con:,,ine rr) Prohibitions" POPULATIONS(HSP) 7-204.11 Sanitizers.Cn+er.a-Chou irds'' 7-2CH.12 ChEmica!s to Washing Produce,Criteria" ! 21 3-80! I FA) Lnplmcun/ed Pr.-packaged Juices and 7-20=:.14Ds Diving,Agrnis.C:iteun'' I Beveriges vmh !d'ar'ning L,abcls^'" j `t-20511 3-801,11(B) Use ofPasten:i7edh . (.0 Raw of Painaily Cookod Animal Rkdand I ?-'06.11 Res!ric!.d Use Pe;reides,C'riten:t" Rua,Seed;routs Not Served. '.` 1 7 206.12 Rodent Bait StatiunsM {-SOL!t(C') Unopened P}rai Packaic Not Rc-::er ed. a, ,7?06.13 Tnr:kd:g Powder:,Pest Coutrol and I - Ylo:n:orinr,* CONSUMER ADVISORY TIMEtTEMPER4TURE CONTROLS 22 5-(03 11 Consumer Advisory Punted 1'ot Consumption of Annual Foods That.:re:Law-,Undercooked or to I Proper Cooking len+oaratures for PHFs Not Otherwise Processed to Elinnn.ne ! 41. ;- ; 7 Pathogens. `tl=cse�;;vn:m _ 1 I3F,gr7)t_) Eggs- 755"FiSSe.:. Eggs-Ju mediate Surer 145'P75sec+ I 3-30`_'.!3 Pasteur+?ed E,,, s Substnuio fo! Raw Shell 3-401.1'.(5)(1) Comminuted Fi.,h,Nieats&Game j Egg'" Animals- 155 T 15 3-401.11(It);1)(2) Purk and BeeCRoast 130 F 121 min'- j SPECIAL REQUIREMENTS 3401.1l(5N2) c.itites, Injected Meats- 155'F15 590 60((A)-(D) Violations of,Section 590.009(A)-(D) in sec,- caterin;a. mobile food, temporary and 3-401.11(A)(3) Poultr:,Wild Game.Su; fed PHFs, residential kitchen operatiuns should he Sol Containing Fish,MCA, debited under the appropriate s.ctions i P,)ultry or Ratites-165°F 15 sec. 4' j above if related to litodhorrie illness 3-101.11(CV3) R4role-muscle,Intact Beef Steals � intervention;and rill, lactors. Otber 1.15°P^ '+90.1)09 violations rel:uing-lo good'):tai! 3-407.12 Raw Around Foods Cooked in a piactices shutad be debited under /!^_9- Microwa,e ;65'F* S u tai Re4tsircnrcnts. r "- 3-401 A!(AI(1)+b) All(Hier PFIFs- 145"F 15 sec, + 17 Reheating for Hot Holding VIOLA Ill RilTED TO GOOD RETAIL PRACTICES 3-403.11(A)ll PI-IFsI65"F 15scc. (ftetrA23-30) 3-40 11(R) Microwave- 165"F 2 Nfinule Standing Ctinral and non-rritical viohniure, i;such do nor rerun to tiw Trove^' f odho,me i(h:e^s inrerrve tions paid+;sf,tu-tors listed ober., ran be 3-403.11 i(') Commercially Ptocessed RTE Food- finn:d is the folhn, eg;ei cions of the Food Cl,.da and 105 C4?X 141)"F` J SiU.ti(i0 'i 401.1 lirJ Remaining Lnshr;d Portions of Beef I item Good Retail Practices FC -j 59G.000---� Roasts'` j 23. Monaoamen'and Personnel FC-2 .003 J j 1g Proper Coming of PHFs 24. Food and Fool F'toteci;on F C-_3 004 25 Equipn;cra and utens!!s FC,--a .005 .5(11.14(.1) Cooligg Cooked PHFs Cram 740`F to 26 Walcr.Plurnt);nq end Waste FC-5 .006 70`;'Within 2Ilours mt d From 70`F I ( 27 Phvs!cai Facility -6 ,007 � to 4l-F/-45'F Within 4 floors.' ! 26 Poisonous or 7crsc t,!sierials FG--7 .008 3 501.14(U') Cooling PHFs Made.From Ambient .! ( 29 SiDetal Requ•rements 009 T(smpuature Lrg ediems to 41`Fi F 00. her Willis 1•flours r j ""`^ " 1:+e110,11x Cl ilei')m the[,dun[ 1999 Paoa G,de.-r 105 l'tv1R 590000. IMPORTANT MESSAGE ) FOR �Y-%V I DATE -Z,3 'sg TIME &' IJ P.M. M T IZACPI Yf.O�-�63A OF PHONE Q-W- 210 ^ OSCI.3 AREA CODE NUMBER EXTENSION D FAX D MOR'u F AREA CODE NUMBER TIME TO CALL TELEPHONED PLEASE CALL 5f CAME TO SEE YOU WILL CALL AGAIN WANTS TO SEE YOU RUSH RETURNED YOUR CALL WILL FAX TO YOU MESSAGE SIGNED FORM 4009 MADE IN U 5 A NOTES Y 5?-Nl a tD j H6 i'�VHl l'O �\rJ)vLy }r-�►..1 l�i L 61 b�. 4-Z 1..SryJ`l61 C,a jH i'1p.ilAF� 1`1�/_ti�il {�� Na L'1.\:9 v R (A� ' C:ITY OF SALEM, MASSACHI?SF Y'S' BOARD of H£\rn I 120 WASHINGI'ON STRI'•:F_T,,i"'PL<u/R KI1vII31ZRLFY 1)RISCOLL _f EL. (978) 741-1800 NLU'OR F,�x (978)745-0343 Iramdinnsalem.com LARRI'RANIUIN,RS/M.]IS,CI 10,CP.I-S I IF.AIXI IAGENT This Form will be collected duffing your next Board of Health inspection. QUESTIONAIRE -GREASE TRAPS 2009 1. NAME OF ESTABLISHMENT: ez CT% 2. ADDRESS OF ESTABLISHMENT: 3. DOES YOUR ESTABLISHMENT HAVE A GREASE TRAP? �) } 4. WHAT SIZE GREASE TRAP DOES YOUR ESTABLISHMENT HAVE? CAPACITY IN GALLONS 5. HOW IS THE GREASE TRAP MAINTAINED? ON A DAILY BASIS? BY AN IN-HOUSE PERSON OR BY AN OUTSIDE CLEANING SERVICE? 8. WHAT IS THE FREQUENCY THAT THE GREASE IS REMOVED FROM THE TRAP? 7. WHAT IS THE NAME OF THE FIRM WHO REMOVES AND/OR PICKS UP THE GREASE FROM YOUR ESTABLISHMENT? 8. WHAT 1S THE DATE OF YOUR LAST INVOICE FROM THE REMOVAL FIRM?