The URL can be used to link to this page

COURT HOUSE DELI - ESTABLISHMENTS COURT HOUSE DELI 60 WASHIGTON STREET li ii 6 II f 0060 Washington Street Court House Deli City of Salem FOOD SERVICE ESTABLISHMENT - FOOD SERVICE Inspection HACCP: ❑ Item Status Violation Critical Urgency Telephone: Violations Related to Good Retail Practices (Blue Items) 741-1183 Equipment and Utensils FAIL Non-Critical BLUE Owner: Comment: Dry storage shelves in basement are exposed wood.Shelves must be made impervious and easily cleanable.This to be Suzanne E. Hensley completed by next routine inspection. PIC: Suzanne Hensley Inspector: Elizabeth Salandrea Date Inspected:Correct By: 7/24/2008 Risk Level: Permit Number: BHP-2008-0295 Status: SIGNED OFF #of Critical Violations: 0 Time IN: Time OUT: Urgency Description(s): BLUE: ' All other violations noted in the 7/15/08 inspection report have been corrected. Violations Related to Good Retail Practices (Critical violations must be corrected immediately or within 10 days)(Non-critical violations 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. Aug 01,2008 ) Page I oft Item Status Violation Critical Urgency 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. Aug 01,2008 ) Page 2 oft Y ,* 0060 Washington Street Court House Deli City of Salem FOOD SERVICE ESTABLISHMENT - FOOD SERVICE Inspection HACCP: ❑ Item Status Violation Critical Urgency Telephone: PROTECTION FROM CONTAMINATION 741-1183 Separation/Segregation/Protection FAIL Critical RED Owner: //Comment: Refrigerator in kitchen had meats above ready to eat items.Store potentially hazardous items below RTE items to Suzanne E. Hensley prevent cross contamination. PIC: Food Contact Surfaces Cleaning and Saniti g FAIL Critical ❑� RED � y ,,5 ._{1.�0Q Suzanne Hensley (/Comment: Both cutting boa ds i kitch�are stained and scored. Replace or resurface cutting boards. Inspector: �at slicer has accumulation of food debris.Thoroughly clean and sanitize the meat slicer. Elizabeth Salandrea ��+ Date Inspected:Correct By: Cket of sanitizer in kitchen too strong. Provide sanitizer of proper concentration at all times. Date Inspected: TIME/TEMPERATURE CONTROLS(Potentially Hazardous Foods) HotandCol olding FAIL Critical ❑Q RED Risk Level: ommant: Salad unit in kitchen at approximately 50°F.Lunch meats and chicken/tuna salad discarded from top of unit and other potentially hazardous items in bottom compartment put into large refrigerator. Do not use unit until holding at 41°F or lower. Permit Number: BHP-2008-0295 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®2008 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Jul 16,2008 ) Page 1 oft Item Status Violation Critical Urgency RED; Violations Related to Good Retail Practices (Blue Items) Violations Related to Food and F d Protection FAIL Critical BLUE Foodborne Illness Interventions omment: Personal drink observed in salad unit.Store employee drinks separately to prevent cross contamination. and Risk Factors (Require Equipments Utensils FAIL Non-Critical BLUE immediate corrective action) Zom ent: Large fridge in kitchen needs thorough cleaning along the bottom and door tracks. f in kitchen need general cleaning. 6 <eIelving with toasters need general cleaning. ,.6/'I'd unit needs general cleaning inside and on top in edges around containers. —Mop stored in bucket.Store mop hanging to air dry. elves muffin mix is on in basement need thorough cleaning. �y sstorage shelves in basement are exposed wood.Shelves must be sealed to be impervious and easily cleanable. �6ay sink must be labelled wash,rinse and sanitize. 544 fridge at door needs general cleaning in door tracks. °-:oke fridge behind counter has broken thermometer.Provide new visible,accurate internal thermometer. Physical Fac.ty FAIL Non-Critical BLUE mment: Light cover in hallway to restrooms is missing.Replace cover. 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®2008 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Jul 16,2008 ) Page 2 oft Commonwealth of Massachusetts City of Salem s • Board of Health 1Gmbedey Driscoll 120 Washington Street,4th Floor Mayor SALEM,MA 01970 Foo&Retail Establishment Permit DATE PRINTED: 01/08/2008 ESTABLISHMENT NAME: Court House Deli File Number:BHF-2004-000156 60 Washington Street Salem MA 01970 LOCATED AT: 0060 WASHINGTON STREET SALEM, MA 01970 Permit Type Permit No. Permit Issued Permit Expires Fee Restrictions/Notes FOOD SERVICE BHP-2008-0295 Jan 7,2008 Dec 31,2008 $280.00 ESTABLISHMENT Total Fees: $280.00 PERMIT EXPIRES December 31, 2008 Board of Health This Permit is not transferable and must be reissued upon change of ownership or location.The permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code,beofre any revonations,improvements,or equipment changes are made,all plans for such must be submitted to and approved by the Salem Board of Health. Page 7 of 11 „. CITY OF SALEM, MASSAMUSEM fl`” BOARD OF HEALTH >m 120 WASHINGTON STREET,e FLOOR TEL.(978) 741-1800 KINMERLEY DRISCOLL FAx(978) 745-0343 MAYOR JJQDTT SALEM.COM JOANNE SCOTT, HEALTHAGENT 2008 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT NAME OF ESTABLISHMENT ( 'i�4t Lf I7 De � TEL#_ 9'7}?— 7f/- ADDRESS OF ESTABLISHMENT 66Ill 3]6 11 � 57 FAX#r MAILING ADDRESS(if different) EMAIL-Business': Website: OWNER'SNAME ':�uza-,Dy9.r?wc le-j� TEL# -77f' 7'<S��y ADDRESS 31 #01 1-C�V— d , �PYY7 STREET ((�� CITY STATE ZIP CERTIFIED FOOD MANAGER'S NAME(S)_SkJaV)n& HPns. le- CERTIFICATE#(S) L07 ,V-,?q4' (Required in an establishment where potentially hazardous food is prepay d) EMERGENCY RESPONSE PERSON S9 Ah tP. G lf'oe;Ie—V HOME TEL# 9Jf'7,�Z - DAYS OF OPERATION Monday Tuesday Wednesday Th F day Saturday, Sunda HOURS OF OPERATION t d (� • 3 Jyt Seri SbM crj Please write infimeofday � :� �m : b: CJD A x '36 Ar>h � R1� 4%llaOGr {Forexenm-ltwn) ' Zt:oo., m �'olJ , +�!0f1 �yl ; Sj.�U1- 3y� 8tya4rr,` YYt TYPE OF ESTABLISHMENT FEE (check only RETAIL STORE YES NO less than 1000sq.ft. =$70 1000-10,000sq.ft. =$280 more than 10,000sq.ft. =$420 .--- - -- J§ ------------------------- ----- -�- .....- --------...---------....----------•------ ----- --........-...--------.......-------- RESTAURANT YES NO lessthan25seats =$140 (Outdoor Stationary Food Cart$21 25-99 seats =$280 more than 99 seats =$420 -- - - -----------*....... . BED(BREAKFAST( YES NO $1. .4.0------ CHILDCARE SERV(CES.. ........... ... ... -..._.... -- ADDITIONAL PERMITS MAKE (not just serve) ICE CREAM, YOGURT/SOFT SERVE YES NO $25 TOBACCO VENDOR YES NO $135 ALL NON-PROFIT(such as church kitchens) YES NO $25 "Please pay total with one check payable to the City of Salem. This Permit is not transferable and must be reissued upon change of ownership.The Permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code, before any renovations, improvements, or equipment changes are made,all plans for such must be submitted to and approved by the Salem Board of Health. Pursuant to MGL Chapter 62C,Section 49A,I certify under the pains and penalties of perjury that I,to my best knowledge and belief,have filed all state tax returns and paid all state taxes required under the law. Signature Date Social Security or ederal Identification Numb ----- _------------------"-- - —�_— Revised41241p (70DAP2d6&am Check Date_ A33 f Massachusetts Department of Public Health Salem Board of Health Division of Food and Drugs 120 Washington Street,4'h Floor g Salem, MA 01970-3523 FOOD ESTABLISHMENT INSPECTION REPORT Tel. (978) 741-1800 Fax(978) 745-0343 Name ti Date Type of 0 eration s Tvpe of Inspection 7J<se ) {p', Food Service utine AddressF �� ^ Riskl ( El Retail 1E] Re-inspection Level ❑ Residential Kitchen Previous Inspection Telephone ( _ ' ❑ Mobile Date �//7�! HACCP YM ❑ Temporary ❑ Prezope'Fation 1'' Owner 17< n lotO n S ❑ Caterer El Suspect Illness Person in Charge(PIC) - t Time El Bed&Breakfast El General Complaint ❑ HACCP Inspector �� out-2:--7. Permit No. ❑Other Each violation chec ed requires an explanation on the narrative page(s) and.a citation of specific provision(s)violated. Non-compliance with: Violations Related to Foodborne Illness Interventions and Risk Factors Anti-Choking Tobacco Violations marked may pose an imminent health hazard and require immediate corrective 590.009(E) ❑ 590.009(F) ❑ action.as determined by the Board of Health. F006 PRoTEcti611'MANAGEiaENT t, '„ t 'k z �"2_0j '--,&1,2.'--,®b1,2. Prevention of Contamination from Hands ❑ 1 PIC Assigned/Knowledgeable/Duties ❑ 13 Handwash Facilities EMPLOYEE HEA.,.LT.�H ,.ws.,. Oarar D",PROTECTION me ❑ q 2. Reporting of Diseases by Food Employee and PICS»-- � =�4I El 14.Approved Food or Color Additives ❑ 3. Personnel with Infections Restricted/Excluded r3 ❑ 15.Toxic Chemicals „.FOOD FROM APPROVED SOUHCE„„s. ❑ 4. Food and Water from Approved Source I„TIME/TEMPERATURE CONTROLs(Potertlalty Haizardous Fgoids) k+.mn,�� =moi i a k,m„., 6 .o a,®..�_a5w=n .m. k•�,,..,N��a..i..:: v... ...0n ❑ 5. Receiving/Condition ❑ 16.Cooking Temperatures ❑ 6. Tags/Records/Accuracy of Ingredient Statements ❑ 17. Reheating ❑ 7. Conformance with Approved Procedures/HACCP Plans ❑ 18.Cooling )'PROTECTIUN FROM CONTAMINATIDN * ' '�, '• :s `�"`";`"'"gg `' ❑ 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}" F El 21. Food and Food Preparation for HSP 171 10. Proper Adequate Handwashing ❑ 11. Good Hygienic Practices Ip ;CONSUMER.ADVISORY � '.�:;�a�„��,uc, i a0000 E122. Posting of Consumer Advisories Violations Related to Good Retail Practhe, Number of Violated Provisions Related Critical (C) violations marked must be corrected To Foodborne Illnesses Interventions immediately or within 10 days as determined by the Board and Risk Factors(Items 1-22): of Health. Non-critical (N) violations must be corrected Official Order for Correction: Based on an inspection immediately or within 90 days as determined by the Board today, the items checked indicate violations of 105 CMR of Health. 590.000/federal Food Code. This report, when signed below N by a Board of Health member or its agent constitutes an ,23. Management and Personnel (FC-2)(550.003) order of the Board of Health. Failure to correct violations -,74 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 r26. 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:59JMnWtF0i -14.a � �J n n �� Inspector's Signature: Print: �- 1 .F'_ /Jr/i _ t ,hh / PIC's Signature: w rmt. 'S11ZCF/, 1 C Cr �t;),Page i of C.,P.ages G Violations Related to Foodborne Illness Interventions and Risk Factors(items 1-22) PROTECTION FROM CONTAMINATION FOOD PROTECTION MANAGEMENT S Cross-contaminafion r- II 590.003(A) Assignment of Responsibility" 3-302.11(A)(1.) Raw Animal Foods Separated from �I 590.003(_B)_ Demonstration of Knowledge* � Cooked and RTE Foods* 2-_103.11Person in charge-duties �� Contamination from Raw ingredients 3-302.1.1(.A)(2) Raw Animal Foods Separated from Each EMPLOYEE HEALTH Other* 2 590:003(C) Responsibility of the person in charge to Contamination from the Environment require reporting by food employees and 3-302.11(A) Food Protection* applicants* 3-302.15 Washing Fruits and Vegetables 590,003(F) Responsibility Of A Fund Employee Or An 3-304.11 Food Contact with Equipment and Applicant To Report To The Person In - Utensils* Charge' Contamination from the Consumer 590.003(G) Reporting by Person in Charge* 3-306.14(A)(B) Returned Food and Reservice of Food* 3 590.003(D) Exclusionsmid Restrictions* Disposition of Adulterated or Contaminated 590.003(E) Removal of Exclusions and Restrictions - Food 3-701.1.1 Discarding or Reconditioning Unsafe FOOD FROM APPROVED SOURCE Fes* 4 Food and Water From Regulated Sources 9 Food Contact Surfaces 590.004(A-B) Compliance with Food law* 4-501.tI I Manual Warewashing-Hot Water 3-201.12 Food in a Hertneticall Sealed Container* Sanitization Tem eratures* 3-20113 Fluid Milk and Milk Products* 4-501.11.2 Mechanical Warewashing-Hot Water 3-202.13 Shell Eggs* Sanitization Temperatures* 3-2(12.14 Eg=s and Milk Products,Pasteurized* 4-501.114 Chemical Sanitization-temp.,pH,- 3-202.16 Ice Made From Potable Drinking aoncenconcentration and hardness. Water' " 5-101.11 DrinkingWater from an Approved System* 4-601.11(.0) Equipment Food Contact Surfaces and 590.006 A) 'Bottled DrinkingWater* Utensils Clean* 4-602 590.006(B) Water Meets Standards in 310 CMR 22.0* .11 Cleaning Frequency of Equipment Food- Contact Surfaces and Utensils' Sbeliflsh and Fish From as Approved Source- 4-702.11. Frequency of Sanitization of Utensils and 3-201.14 Fish and Recreationally Caught Molluscan Food Contact Surfaces of E ui ment* 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 Re utafo Authority 2-301.1.1 Clean Condition-Hands and Arens* 3-20218 Shellstock Identification Present* 2-301.1.2 Cleaning Procedure* 590.004(C) Wild Mushrooms* 2-301.14 When to Wash* 3-20117 Game Animals* II Good Hygienic Practices g Receiving/Condition 2-401.11 Laing,Drinking or Using Tobacco* 3-202.11. PHFs Received at Proper Temperatures* 2-401,12 Discharges From the Eyes,Nose and 3-202,15 Package Inteit * Mouth* 3-101.11. Food Safe and Unadulterated* 3-30112 Preventin Contamination When Tasting* 6 Tags/Records:Shellstock 1.2 Prevention of Contamination from Hands 3-202.18 Shellstock Identification* 590.004(E) Preventing Contamination from 3-203.12 Shellstock Identification Maintained' Em to gees* 9 Ta s/Records:Fish Products 13 Handwash Facilities 3402.11 Parasite Destruction* Conveniently located and Accessible 3-402.12 Records,Creation and Retention* 5-203.11 Numbers and.Capacities* 590.004(:1) Labeling of Ingredients' _ 5-204.11 Location and Placement* 9 Conformance with Approved Procedures 5-205.11 Accessibility,Operation and Maintenance /HACCP Plans Supplied with Soap and Nand Drying -3-502.11 S ecializedProeessin Methods* IDevices 3-502.1.2 Reduced oxygen packaging.criteria* 6-301.11 Handwashing Cleanser,.Availabilit 8-103.12 Conformance with A. roved Procedures* 6-301.,12 Hand Dr g Provision Denotes critical item in the Weral 1999 Food Code or 105 CMR 590.000. - - i - CITY OF SALEM / BOARD OF HEALTH Establishment Name: CDC .Ir l Ovie ! fP 1 t Date: IIS I /`�� Page:a`- of a Item Code, C=Critical ttemr "v- , 'DESCRIPTION OF VIOLATION/PLANOF,CORRECTION r ., Date No. Reference R-Red Item < `� ��. >,. _ ` `."°° d :' '' '` Verified F ' --- "' 'n PLEASE PRINT CLEARLY + h- "er) hclnd LIQ 2 7c �- 3A—t plcc r r nza 10 , on{— 1—li `7 (/ U Ae Sq2 I I o)A J , O)4 c/ ALI to o I a s ATC( f I A r �2,. -'Q1 ( S 1 ti/1P� Ll 1 Y S✓ c. . I I I / i - i - r ofA s Discussion With Person in Charge: Corrective Action Required: ❑ No 0 Yesi I have read this report, have had the opportunity to ask questions and agree to correct all ❑ Voluntary Compliance u Employee Restriction/ inspection, to observe all conditions as described, and to Exclusion violations before the next ins P m�-Re - sni pection Scheduled ❑ Emergency Suspension comply with all mandates of the Mass/Federal Food Code. I understand that noncompliance may result in daily fines of twenty-five dollars or suspension/revocation of o Embargo ❑ Emergency Closure your food permit. /` �� t ❑ Voluntary Disposal ❑ Other: U F_ 5O I.I 1(c) PHFs Romved of Temperatures Violations Related to Foodborne Illness interventions and Risk A(wording to Law Coaled w Factors(ReM 1-22) {Cant.} coolin,'MLhods'for PHFsPROTECTION FROM CHEMICALS Food or Color Additives LL9 PHF Hot and Cold Holding L!�_ — —7�(__ A-501.16()S) Cold PFIFsMeimaifred at or below _3 202 12 ld;ti�Nc � 1 — 4V/45"F` _3-30114 Protection from 11 _j L3-_�0A'� Hat PHI-�Maintained at or above i 5 PtTfsunaus of Toxic substances 1400F, 1(11.'11 Identifying Intonteloon -Otiginal I kraasis Held at oraboce 130"T, 20 _T�i�Weasa Public Health Control -- -- 7-102.11 CkermlonNnine--workin L 9 izod—-1 hat a�a 1�blw Health comjoV T_q��t_)w tion-St2�� T�a —7,26 1 1!-- T'L1_e stanceZ qfowql) 7-202.11 Rc&viclion-Pxe&eocc and Urv,* 7-202A2 Conditions of Use' REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7_iO3'11 Toxic ContamcrProhibitions* POPULATIONS(HS 7-204.1 Sanhi:/ers, ria-Chemicils, Q!rL_ 21 3-801.1 t(A)TU'np4qtemizt'A'Po--pacfaged Juices and 7-204�12 Chenlicals for cc' clitciW 7-104,14 Di�ing4,cvtr.Criteria�� - _____LB_cw1aaes lVith wao rtall.Labels' � -205,11 Incidental F�mxl Cort act, 1 3-80:.11(B) Use of lswtcuozeq_L��____ .... .....cants.................. 34WAI(D) 7-206.11 Restricted Uw Pcoicides%Critnial wd --- Raw Sc t'd Sprout.Ro �� onitorin _��_____________� ' 6.12 1 Rodent Elit soitious� _Lj�!;�L� Lled��'ood Packa'c Not Re-,wrved6,13_j Track-ing Powders,fc�i Control and t-CY, - _ CONSUMER ADVISORY TIMEITEMPERATURE CONTROLS 22 3(,O' 11 Corsumer,-Mvisoi y ftcot>d P)r Coh.munption of proper—Cooking Temperatures for PHFs SotOtIleTwIse PoKxoseal to Eliminate Fg�'- 155F 15 sec. o; 145�'I`15rec, Fg&,-Substitute to:Raw Shell _'T4TIJl(Aa2) cormlalluted Fish,meati&{sante Allunals 135"F OSeC - SPECIAL REQUIREMENTS -:1 -461.11(H)(1)(,2) Pork and Fect R�xoa -I 30"F121 tiri I 3-41)1.11 fl-w_!I allies, meod Mc4v,- 155 F 1.5 _T9*1�_(R)9(A)_(i)J Vicjlanons of Section �90,009W-(D) aoc , —cataing. aud'7�I 7:01-1I(A)(3) rloaluy'lWdGruric Stuflc( rcsidenbal kitchen operations should be Stidffnog Containing Fish-Meal, t debit under the appropriate sections leoultiv or Rootes-165""T15 sec. alluve if related to ftrodhOrne lnlwas 3-401.11(C)(3) Whole-rnusdIntact Bect'Steaks inter ventioni and risk factors Other 590.009 violationv relating to good retail pray s 3-461.12Foi' l- aw Animal )ds Cooked lira should he debited roller 429 - Special ffequircrncrrts. -ic�owave 16.5'F Al�they PHY, - 14517 15 sec Reheating for Hot Holding VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 340T1 FXF&(F)) PHA; 165'F Ifl sec.'" (Reals 23-30) 3_403TI(i) Microwave- }f:5°r 'Minute Standini, Cri:is-ai antirum-,riw,'al vioiahons, which do Yogi realre in dir, Time, foodborne illness%ntervnt;oayand ro;kja(iors livied above, (an be 3-403.11 tC) Commereialht Pl:tx'nsaQd RTF Food- licind in thafillowing secriorts of the Food Codc art(?105 OUR 40'W .500.000. 3403,11(E) TIC111allan unsheed Portions or Beef Item t Good Retail Practices � TFJ T-5-116-00-0 23 1 M FC -2 1 003 Limage-Te�'-tanq perlonnpi----- 7oodand Food Paaectlz� C- 3 004 r 4, a' F L Cooling of PHFs 25, FC-4 '005 :3-50L14(A) Cool ing Cool ooi PHFs Iron)) If 40PF li( 26, Water,Plurntal 'NLlstt 5 W6 "'W17 Within 2 lfours 411d From 71) F 97, Phy�,cra Facility to 4!'1/45 F Within 4 Hours. 28 # Poisoqous or Tow Materials I F(" -7 003 3501.14(E) Coolingif riTPW7 PHFs Made From AiZoolt _ 1309 o,41�FNYF 30. Other Temperaiurc holredmia ------j L________'NV1tIon 4_11our4 J)Mlies critical Itern in lhr r'Wler'fl NT)F'aal C'gfor 105(AIR 590 000, Massachusetts Department of Public Health Salem Board of Health Division of Food and Drugs 120 Washington Street,41"Floor 9 Salem, MA 01970-3523 FOOD ESTABLISHMENT INSPECTION REPORT Tel. (978) 741-1800 Fax (978) 745-0343 Namer w,4X 4 f' D9te Type of Operations) Type of Inspection - ( 1 1 e I 1t Q'J - Food Service ❑ Routine Address !_ J f B` Risk ❑ Retail F❑ Re-inspection V aA Level ❑ Residential Kitchen Previous Inspection Telephone �( w t EI Mobile Date: 1e2 &13t37*Owner HACCP YM ❑ Temporary ❑ Pre-operation )7C A^ t /7�f ❑ Caterer ❑ Suspect Illness Person in Charge(PIC) Time Time ❑ Bed&Breakfast El General Complaint `� In: 1.40 ❑ HACCP ` Inspector � AC Pr. 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 correct'ye 590.009(E) ❑ 590.009(F) ❑ action as determined by the Board of Health. V1 �o� , C0rr-e,_k-,Cj , -.FOOD PROTECTION MANAGEMENT71=19, I" T Wim ' ❑ 12. Prevention of Contamination from Hands ❑ 1. PIC Assigned/Knowledgeable/Duties ❑ 13 Handwash Facilities EMPLOYEE HEALTH"` trir( t� i rr-o-x- w g u r P'� �.PROTECTfONFROMCNEMICAI$ h., �.,", 7.m",,... ❑ 2. Reporting of Diseases by Food Employee and PIC -u 3❑ 14.Approved Food or Color Additives ❑ 3. Personnel with Infections Restricted/Excluded ❑ 15 Toxic Chemicals .„FOOD FROM APPROVED ❑ 4. Food and Water from Approved Source TIM&OAPERATURE cohTROLs(Potemi city Hazardous Food3)' "=y5 w ❑ 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=,r- „� r m k - i'. El 19. Hot and Cold Holding m.04:", 7_', .t I ❑ 8. Separation/Segregation/Protection ❑20.Time As a Public Health Control ❑ 9. Food Contact Surfaces Cleaning and Sanitizing r,R04 FOR MAW I Y SUSCEPTIBLE POPULATIONS(HSP) [:121. Food and Food Preparation for HSP ❑ 10. Proper Adequate Handwashing ❑ 11. Good Hygienic Practices CONSUMERADVISORY c °i`°""i' " ,�`"'qp 'w,' ❑22. Posting of Consumer Advisories Violations Related to Good Retail Practices Number of Violated Provisions Related Critical (C) violations marked must be corrected To Foodborne Illnesses Interventions immediately or within 10 days as determined by the Board and Risk Factors(Items 1-22): of Health. Non-critical (N) violations must be corrected Official Order for Correction: Based on an inspection immediately or within 90 days as determined by the Board today, the items checked indicate violations of 105 CMR of Health. 590.000/federal Food Code. This report, when signed below by a Board of Health member or its agent constitutes an 23. Management and Personnel (FC-2)(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-a)(sso.00s) the food establishment permit and cessation of food 26. Water, Plumbing and Waste (FC-5)(590.006) establishment operations. If aggrieved by this order, you 27. Physical Facility (FC-6)(590.007) have a right to a hearing. Your request must be in writing 28. Poisonous or Toxic Materials (FC-7)(590.008) and submitted to the Board of Health at the above address 29. Special Requirements (590.009) within 10 days of receipt of this order. 30. Other DATE OF RE-INSPECTION: S5901nspeclFom614 Cx Inspector's Signature: ' Print: /)A MrAAD PIC's Signature: Q Print: Page-of-L Pages 67J Violations Related to Foodborne Illness Interventions and Risk Factors(items 1-22) PROTECTION FROM CONTAMINATION FOOD PROTECTION MANAGEMENT S Cross-contamination I 590.003(B) Demon ent�ofResponsibility' 3-30211(A)(1.) Raw Animal Fmis Separatedfrbm 590.003(A) Assi€n -� _ _�'on of Knowledge* -" Cooked and RTE Foods* 2-103.11 Person in charge-duties Contamination from Raw Ingredients 3-302.1 I(A)(2) Raw Animal Foods Separated from Each EMPLOYEE HEALTH Other* 2 5901013(C) Responsibility of the person in charge to Contamination from the Environment require reporting by food employees and 3-302.11(A) Food Protection*' a }licants* 3-302.15 Washin Pruits and Vegetables 590.003(F) Responsibility Of A Food Employee Or An 3-304.11 Food Contact with Equipment and Applicant To Report To The Person In Utensils* Charge* Contamination from the Consumer 590.003(0) Reporting by Person in Charge* 3-306.14(A)(B) Returned Food and Resetvice of Food* 31 590.003(D) I Exclusions and Restrictions* Disposition of Adulterated or Contaminated 590.003(E) Removal of Exclusions and Restrictions Food 3-701.11 Discarding or Reconditioning Unsafe FOOD FROM APPROVED SOURCE Food* 4 Food and Water From Regulated Sources 9 Food Contact Surfaces 590.004(A-B) Compliance with Food Law* 4-501 Tl I Manual Warewashing-Hot Water 3-201.12 Food in it Hermetically Sealed Container* Sanitization Tem eratures* 3-201.13 Fluid Milk and Milk Products* 4-501.1 t2 Mechanical Warewashm,Hot Water 3-202.13 Shell Eggs* Sanitization Tem eratures* 3-202.14 Eggs and Milk Products,Pasteurized* 4-50 LI 14 Chemical Sanitization-temp.,pH, 3-202.16 Ice Made From Potable Drinking Water* concentration and hardness. * 5-101.11 Drinking Water from an Approved System* 4-60L I I(A) Equipment Food Contact Surfaces and 590.006(A) Bottled Drinking Water* Utensils Clean* 590.006(B) Water Meets Standards in 310 CMR 22.0* 4-602.11 Cleaning Frequency of Equipment Food- Shellfish and Fish From an Approved Source Contact Surfaces and Utensils* 4-702.11 Frequency of Sanitization of Utensils and 3-201.1,4 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 MushroomsApprovedby Regulatory Authority 2-301.11 Clean Condition-Hands and Arms* 3-202.18 Shellstock Identification Present* 2-301.1.2 Cleaning Procedure* 590A04(C) Wild Mushrooms* 2-301.14 When to Wash* 3-201.17 Game Animals* 11 Good Hygienic Practices Receiving/Condition 2-401.11 Eating,Drinking or Using Tobacco* 3-202.11. - PHFs Received at Proper Temperatures* 2-401.1.2 Discharges From the Eyes, Nose and 3-202.15 Package Inteit=* Mouth* 3-101.11 Food Safe and Unadulterated* 3-30112 Preventing Contamination When Tasting" 6 Togs/Records:Shellstock 12 - Prevention of Contamination from Hands 3-20118 Shellstock Identification* 590.004(F) Preventing Contamination from 3-203.12 Shellstock Identification Maintained* Employees* Tags/Records:Fish Products 13 Handwash Facilities 3-402.11 Parasite Destruction* Conveniently Located and Accessible 3-402.12 Records,Creation and Retention* 5-203.11 Numbers and Capacities* 590.004(J) Labeling of Ingredients' 5-204.11 Location and Placement* '7 Conformance with Approved Procedures 5-205-11 AccessibilitI, Operation andMaintenance /HACCP Plans Supplied with Soap and Hand Drying 3-502.11 Specialized Processing Methods* Devices 3-502.12 Reduced oxygen acka>ing.criteria* 6-301.11 Handwashi ag Cleanser, Availability 5-103.12 Conformance with A.. roved Procedures" 6-301.12 Hand Dn Provision *Dewtes critical item in the Win a] 1999 Food Code or 10�CMR 590.000. 0060 Washington Street Court House Deli City of Salem FOOD SERVICE ESTABLISHMENT - FOOD SERVICE Inspection HACCP: ❑ Item Status Violation Critical Urgency Telephone: PROTECTION FROM CONTAMINATION 741-1183 Food Contact Surfaces Cleaning and Sanitizing PASS d❑ RED Owner: Comments: Suzanne E. Hensley Violations Related to Good Retail Practices (Blue Items) PIC: Equipment and Utensils FAIL BLUE Suzanne Hensley Comments:Southbend oven requires thorough cleaning. Owner to have cleaned within one week. Inspector: John Gehan GENERAL COMMENTS: Date Inspected:Correct By: 5/2/2007 All violations unless noted have been corrected. Risk Level: Permit Number: BHP-2007-0235 Status: SIGNED OFF #of Critical Violations: 0_ Time IN: Time OUT: Urgency Description(s): BLUE: Violations Related to Good Retail Practices (Critical violations must be corrected immediately or within 10 days)(Non-critical violations must be corrected immediately or within 90 days) City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741-1800 GeoTMS®2007 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. May 02,2007 ) Page I oft f Item Status Violation Critical Urgency RED: Violations Related to Foodborne Illness Interventions and Risk Factors (Require immediate corrective action) City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741-1800 GeoTMSO 2007 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. May 02,2007 ) Page 2 oft 0060 Washington Street Court House Deli City of Salem FOOD SERVICE ESTABLISHMENT - FOOD SERVICE Inspection HACCP: ❑ Item Status Violation Critical Urgency Telephone: PROTECTION FROM CONTAMINATION 741-1183 Food Contact urfaces Cleaning and Sanitizing FAIL Critical ❑� RED Owner: Comment: No sanitizer available at inspection. Bleach bought at time of inspection. Suzanne E. Hensley PIC: _ utting boards stained and scored. Resurface or replace boards. Suzanne Hensley —fdleat slicer has accumulation of food debris. Thoroughly clean and sanitize slicer. Inspector: Violations Related to Good Retail Practices (Blue Items) John Gehan Equipment and Utensils FAIL BLUE Date Inspected:Correct By: I omment:True refrigerator requires general cleaning. 4125/2007 Risk Level: Southbend oven requires thorough cleaning. ar metal refrigerator requires thorough cleaning. Permit Number: BHP-2007-0235 �h€r or toasters require general cleaning. Status: ',GCoke refrigerator behind cash register shelves require general cleaning. Open #of Critical Violations: Front,coke refrigerator requires general cleaning of bottom and in the door acks. 1 Time IN: Time OUT: Urgency Description(s): BLUE: Violations Related to Good Retail Practices (Critical violations must be corrected immediately or within 10 days)(Non-critical violations must be corrected immediately or within 90 days) City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741.1800 GeoTMS®2007 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Apr 25,2007 ) Page I oft Item Status Violation Critical Urgency RED: Violations Related to Foodborne Illness Interventions and Risk Factors (Require immediate corrective action) fl 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 25,2007 ) Pager 2 of 2 "40.A. r 1' � � ? � 4' q ,�, CommonwealthrtotMrisachusetts�+�,�r� ,#�, ''"�' �'•`. � ��g' 0 ,t^TM4"tt'3; ° r*xp 1np'!W- A r "4 >• 'Boa dot Health °d r 5jf ', 4kt{`�IM ix�3�t',,+�^°$ m v'�.»$ w 8+ •' IClmbedey Ddscoil i ^120 Washington Street,4th Floor a ' ... ��., Itr, �t",N Mayor SALEM,MA 01970 Food/Retail Establishment Permit DATE PRINTED: 01/02/2007 ESTABLISHMENT NAME: Court House Deli File Number:BHF-2004-000156 60 Washington Street Salem MA 01970 LOCATED AT: 0060 WASHINGTON STREET SALEM, MA 01970 Permit Type Permit No. Permit Issued Permit Expires Fee Restrictions/Notes FOOD SERVICE BHP-2007-0235 Jan 2,2007 Dec 31,2007 $150.00 ESTABLISHMENT Total Fees: $150.00 PERMIT EXPIRES December 31, 2007 Board of Health This Permit is not transferable and must be reissued upon change of ownership or location.The permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code,beofre any revonations,improvements,or equipment changes are made,all plans for such must be submitted to and approved by the Salem Board of Health. Page 4 of 20 l CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH 120 WASHINGTON STREET, 4TH FLOOR SALEM, MA 01970 TEL. 978-741-1800 FAX 978-745-0343 Kimberley Driscoll www.SALEM.COM Mayor JOANNE SCOTT, MPH, RS, CHO HEALTH AGENT 2007 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT NAME OF ESTABLISHMENT [��f_1460 S e� � ! TEL# 5 7 R( - I ADDRESS OF ESTABLISHMENT 6 457 �AX# MAILING ADDRESS(if different) ...— EMAIL--Business': Owner's: S tz�thh P N '1 5�T �GYV1caS ;JP k OWNER'S NAME SL�Zc� lrYt2 �• PYxS TEL# ��QQ N. ��1 l ADDRESS 3 1 ( 1yL � 1\J, a )eymYL(L2 0 ! '7D STREET CITY ��STATE ZIP CERTIFIED FOOD MANAGER'S NAME(S) �U 2(A [n�F—14 'P in CERTIFICATE#($) (Required in an establishment where potentially hazardous food is prepared) t EMERGENCY RESPONSE PERSON /{ay HOME TEL#' q7 2-7 q_C 95� DAYS Of OPERATION ', Monday Tuesday Wednesday I Thursday ,_ Friday A Saturday Sunday HOURS OF OPERATION � 1 1c(� tip Please write tndmeofday. 44%OC) pm (Far examolellam-lloml `�0 ADf �Y TYPE OF ESTABLISHMENT FEE (check only) RETAIL STORE YES NO less than 1000sq.ft. =$ 50 1000-10,000sq.ft. =$100 more than 10,000sq.ft. =$250 -...--.-... - --- ---- -- _ ..-. .-- --- -- _ -- ----- .. .... ... ......... ------------ ---- - _ --- ... . RESTAURANT YES NO less than 25 seats 25-99 seats 100 more than 99 seats =$200 _._..... _... ...--- --- _._..,NO-------- --- ----- - -- -- -- - - ---- -- -..--..-.. -... .... - . BED/BREAKFAST YES NO $100 ........ --------- ... ................. -.... .. - ... ... ..... ...._.... - - ADDITIONAL PERMITS MAKE (not just serve) ICE CREAM, YOGURT, SOFT SERVE YES $5 TOBACCO VENDOR YES $50 ALL NON-PROFIT(such as church kitchens) YE 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 pequry that I,to my best knowledge and belief, have fit U all state tax rel, usan state taxes required under the law- gnat ate Social Security or Federal Identification Number --------------------------------- ------------- - - ------------------------------------------- - -- ----------------------------------------- Revised - - - - ----- ------ -- - -- - ------ --------- ------ --------- ------- Revised 11113106 FOODAP2007.adm Check#&Date -Z 0060 Washington Street Court House Deli City of Salem FOOD SERVICE ESTABLISHMENT - FOOD SERVICE Inspection HACCP: ❑ Item Status Violation Critical Urgency Telephone: PROTECTION FROM CONTAMINATION 741-1183 Handwash Facilities PASSd❑ RED Owner: Comments: Front hand wash sink missing"hand wash only"sign. Provide sign. Suzanne E. Hensley PIC: Violations Related to Good Retail Practices (Blue Items) Suzanne Hensley Food and Food Protection PASS Critical BLUE Inspector: Comments: Mayonaise holding at 53°F at salad unit. PHF to be holding at 41°F or below as mandated. Mayp discarded and John Gehan changed at inspection. Date Inspected:Correct By: 11/17/2006 Chicken salad holding at 51°F at salad bar. chicken salad moved to refrigerator that holding at 41°F. Risk Level: Tuna salad holding at 45.8°F at salad bar. PHF to be holding at 41°F or below as mandated. Salad moved to refrigerator that is holding at 41°F. Permit Number: Salad unit holding at 54°F at time of inspection. Owner to have unit repaired so that temperature maintains at 41°F or below as BHP-2006-0084 mandated. Owner to fax over invoice to BOH upon repair of unit. Status: True unit in back has uncovered foods. All foods in storage must be covered. SIGNED OFF #of Critical Violations: Equipment and Utensils PASS BLUE 0 Comments:Back true unit requires general cleaning. Time IN: Time OUT: Salad unit requires thorough cleaning. Urgency Description(s): BLUE: Toasters require general cleaning. Violations Related to Good Both front coke units require general cleaning. Retail Practices (Critical violations must be corrected There is an accumulation of grease on side of fryolator. Thoroughly clean unit. 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. Nov 27,2006 ) Page 1 of Item Status Violation Critical Urgency RED: GENERAL COMMENTS: Violations Related to All violations have been corrected from 11106 report. Foodborne Illness Interventions and Risk Factors (Require immediate corrective action) City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741-1800 GeoTMS®2006 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Nov 27,2006 ) Page 2 oft `0060 Washington Street Court House Deli City of Salem FOOD SERVICE ESTABLISHMENT - FOOD SERVICE Inspection HACCP: ❑ Item Status Violation Critical Urgency Telephone: PROTECTION FROM CONTAMINATION 741-1183 Handwash Facilities FAIL RED Owner: ,,Comment: Front hand wash sink missing"hand wash only"sign. Provide sign. Suzanne E. Hensley PIC: Violations Related to Good Retail Practices (Blue Items) Suzanne Hensley Food and Food Protection FAIL Critical BLUE Inspector: Comment: Mayonaise holding at 53°F at salad unit. PHF to be holding at 41°F or below as mandated. Mayp discarded and John Gehan changed at inspection. Date Inspected:Correct By: 11/17/2006 /Chicken salad holding at 51°F at salad bar. chicken salad moved to refrigerator that holding at 41°F. Risk Level: ,/Tuna salad holding at 45.8°F at salad bar. PHF to be holding at 41°F or below as mandated. Salad moved to refrigerator that is holding at 41°F. ..-- -Permit Number: (Salad unit holding at 54°F at time of inspection. Owner to have unit repaired so that temperature maintains at 41°F or below as BHP-2006-0084 mandated. Owner to fax over invoice to BOH upon repair of unit. Status: ✓T ur a unit in back has uncovered foods. All foods in storage must be covered. Open #of Critical Violations: Equipment and utensils FAIL BLUE 2 �ment: Back true unit requires general cleaning. Time IN: Time OUT: —Salad uunit requires thorough cleaning. Urgency Description(s): BLUE: T rs require general cleaning. Violations Related to Good — Both front coke units require general cleaning. Retail Practices (Critical violations must be corrected `Sbereis g/umulation of grease on side of fryolator. Thoroughly clean unit. 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. Nov 20,2006 ) Page I oft -' Item Status Violation Critical Urgency RED: Violations Related to Foodborne Illness Interventions and Risk Factors (Require immediate corrective action) U 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. Nov 20,2006 ) Page 2 oft 0060 Washington Street Court House Deli City of Salem FOOD SERVICE ESTABLISHMENT - FOOD SERVICE Inspection HACCP: ❑ Item Status Violation Critical Urgency Telephone: FOOD PROTECTION MANAGEMENT 741-1183 PIC Assigned/Knowledgeable/Duties PASS Vj RED Owner: I Non-compliance with: Suzanne E. Hensley Anti-Choking PASS PIC: Suzanne Hensley Tobacco PASS Inspector: John Gehdn '�, EMPLOYEE HEALTH Reporting of Diseases by Food Employee and PIC PASS RED Date (Correct By: IR$P�41@�6 Personnel with Infections Restricted/Excluded PASS ❑ RED Risk Level FOOD FROM APPROVED SOURCE Food and Water from Approved Source PASS ❑d RED Permit Number: — BHP-2006-0084 Receiving/Condition PASS RED Status: OpenTags/Records/Accuracy of Ingredient Statements PASS RED #of Critical Violation Conformance with Approved Procedures/HACCP Plans PASS RED 2 Time IN: Time OUT: Urgency Description(s): BLUE: Violations Related to Good Retail Practices (Critical violations must be corrected immediately or within 10 days)(Non-critical violations must be corrected immediately or within 90 days) City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741-1800 GeoTMS®2006 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Jul 18,2006 ) Page I of Item Status Violation Critical Urgency RED: PROTECTION FROM CONTAMINATION Violations Related to Separation/Segregation/Protection PASS ❑Q RED Foodborne Illness Interventions and Risk Factors Food Contact Surfaces Cleaning and Sanitizing PASS Q RED (Require immediate corrective action) Proper Adequate Handwashing PASS RED Good Hygienic Practices PASS 0 RED Prevention of Contamination from Hands PASS RED Handwash Facilities FAIL 0 RED Comments: No soap dispensing in mens room. Provide soap. Hand wash sink next to ware wash machine obstructed. Sink to be made easily accesible. remove any items from in front of sink. PROTECTION FROM CHEMICALS Approved Food or Color Additives PASS ❑d RED Toxic Chemicals PASSd❑ RED TIMEITEMPERATURE CONTROLS(Potentially Hazardous Foods) Cooking Temperatures PASS RED Reheating PASS RED Cooling PASS ❑d RED Hot and Cold Holding PASS 0 RED Time As a Public Health Control PASS 0 RED REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) Food and Food Preparation for HSP PASS RED CONSUMER ADVISORY Posting of Consumer Advisories PASS RED 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. Jul 18,2006 ) Page 2 of Item Status Violation Critical Urgency Violations Related to Good Retail Practices (Blue Items) .Food and Food Protection FAIL Critical BLUE mments: Uncovered foods in True unit. All foods must be covered. Sa"ndwich area had uncovered food. Unit requires covers for all foods. Coke machine behind counter had expired milks. Discard milks and monitor dates closely. �onal drinks behind counter. Personal items to be stored away from prep areas and in designated employee areas. Equipment and Utensils FAIL BLUE t✓e6m-ments:Star Metal Unit requires thorough cleaning. oke refrigerator behind counter had broken thermometer. Provide visible and accurate thermometer. — Coke refrigerator in front requires general cleaning. k,96'eral cleaning of shelves beneath counter required. L Water, Plumbing and Waste PASS BLUE Physical Facility FAIL BLUE _ mments: Dry storage area shelves have exposed wood. All shelves to be made easily cleanable and impervious. Shelves to be completed by next routine inspection. Management and Personnel PASS BLUE Poisonous or Toxic Materials PASS BLUE Special Requirements PASS BLUE Other-See Notes PASS BLUE GENERAL COMMENTS: 700: 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. Jul 18,2006 ) Page 3 of Item Status Violation Critical Urgency v 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. Jul 18,2006 ) page 4 of `�4�°b"k}<' �� 'aMM•.,Li'ait& L+wlFk''�" �i*�1'�. � �'Iw4�4�65i�i,�� '. _ �£,:' • , Commonwealth of Massachusetts r. Board of Health 120 Washington Street,4th Floor e SALEM,MA 01970 Food/Retail Establishment Permit DATE PRINTED: 01/03/2006 WHO'S PLACE OF BUSINESS IS: Court House Deli Pile Number:WIF-20040156 60 Washington Street Salem MA 01970 LOCATED AT: 0060 WASHINGTON STREET SALEM,MA 01970 Permit Type Permit No. Permit Issued Permit Expires Fee Restrictions/Notes FOOD SERVICE BHP-2006-0084 Jan 3,2006 Dee 31,2006 $150.00 ESTABLISHMENT Total Fees: $.150.00 PERMIT EXPIRES December 31, 2006 Board of Health _ This Permit is not transferable and must be reissued upon change of ownership or location.The permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code,beofre any revonations,improvements,or equipment changes are made,all plans for such must be submitted to and approved by the Salem Board of Health. Page 6 of 23 I 1 CITY OF SALEM, MASSACHUSETTS W BOARD OF HEALTH s 120 WASHINGTON STREET, 4TH FLOOR D O SALEM, MA 01970 �eroxa TEL. 978-741-1800 STANLEY J. USOVICZ, JR. FAx 978-745-0343 DEC MAYOR W W W.SALEM.COM JOANNE SCOTT, MPH, RS, CHO CITY OF SALEM HEALTH AGENT BOARD OF HEALTH 2006 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT NAME OF ESTABLISHMENT(nqty=.'/ C DPI 1 TEL# 919— -I*1 — U�AS3 ADDRESS OF ESTABLISHMENT [I/L-:Z Yl DYI MAILING ADDRESS (if different) OWNER'S NAME SG{ZQ1yN� F • G7 P{/ $ � _TEL# 4?�-Z�S—��c� ADDRESS G CITY /6L(4. STATE Li-.• zip ZD CERTIFIED FOOD MANAGER'S NAME(S) TIFICATE#(s) /d' S (required in an establishment where potentially hazardous food is prepared.) EMERGENCY RESPONSE PERSON HOME TEL# HOURS OF OPERATION: Mon.-z Tue.__1IVed._VThu.� Fri.__kegat. Sun. 5 Po-51014L TYPE OF ESTABLISHMENT FEE (check only) RETAIL STORE YES NO less than 1000sq.ft. =$ 50 1000-10,000sq.ft. =$100 more than 10,000sq.ft. =$250 ................... ........... ..... .. . ..................................................................... RESTAURANT Y S NO I��O� less than 25 seats =$100✓ 25-99 seats =$150 more than 99 seats =$200 ............. ------------------- BED/BREAKFAST ----NO-------------------------------......---------------------....... . ---------- $100--------------. ADDITIONAL PERMITS MAKE (not just serve) ICE CREAM, YOGURT, SOFT SERVE Yom` ^ $5 TOBACCO VENDOR - YES $50 ALL NON-PROFIT(such as church kitchens) YES O $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 a I state tax returns and paid all state taxes required under the law. v to ZignatUl ghte Social Security or Federal Identification Number --------JV-------------------------------------------------------------------------------------------------------------------------- Revised 11/03/05 FOODAP2.adm Check#&Date4(g'74!� /,a �/S0 ` .f^ffs`T-A ... .,.+.,,.,n.�s. ...+.x+. .,�y..:,.nr'i:N.r ,.«..� }r _-�..- .•.'K r.. . 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 ( Dae T of Ooeration(s) 2mof Inspection 4Food Service c� Routine Address Risk ❑ Retail ❑ Re-inspection Telephone V - Level ❑ Residential Kitchen Previous Jnspection ( ❑ Mobile Date:)a/ t Owner HACCP YM El Temporary ElPre-operatidh' ❑ Caterer ❑ Suspect Illness Person in C arge`(PIC) `\ Time ❑ Bed&Breakfast ❑ General Complaint Inspector In:.D Permit No. ElHACCP n Out. ❑ Other Each violation Z-hecked 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 El 12. Prevention of Contamination from Hands ❑ 1. PIC Assigned/Knowledgeable/Duties EMPLOYEE HEALTH El13. Handwash Facilities PROTECTION FROM CHEMICALS ,b.. ❑ 2. Reporting of Diseases by Food Employee and PIC 4 El 3. Personnel with Infections Restricted/Excluded El 14.Approved Food or Color Additives FOOD FROM APPROVED SOURCE -- ' ,__., t 15. Toxic Chemicals ❑ 4. Food a4Water from Approved Source TIME/TEMPERATURE CONTROLS(Potentially Hazardous Foods) ❑ 5. Receiving/Condition ❑ 16. Cooking Temperatures ❑ 6. Tags/Records/Accuracy of Ingredient Statements ❑ 17. Reheating ❑ 7. Conformance with Approved Procedures/HACCP Plans ❑ 18.Cooling PROTECTION FROM CONTAMINATION "` " ❑ 19. Hot and Cold Holding ❑ 8. Separation/Segregation/Protection ❑20.Time As a Public Health Control ❑ 9. Food Contact Surfaces Cleaning and Sanitizing REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) „ El 10. Proper Adequate Handwashing E] 21. Food and Food Preparation for HSP CONSUMER ADVISORY..; El 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. ` C , 590.000/fe_ral Food Code. This report, when signed below 23. Management and Personnel (FC-2)(590.003) by a Board of Health member or its agent constitutes an 24. Food and Food Protection (FC-3)(590.004) order of the Board of Health. Failure to correct violations 25. Equipment and Utensils (FC-4)(590.005) cited in this report may result in suspension or revocation of 26. Water, Plumbing and Waste (Fc-5)(590.006) the food establishment permit and cessation of food establishment operations. If aggrieved by this order, you 27. Physical Facility (FC-6)(590.007) have a right to a hearing. Your request must be in writing 28. Poisonous or Toxic Materials (FC-7)(590.008) and submitted to the Board of Health at the above address 29. Special Requirements (590.009) within 10 days of receipt of this order. 30. Other DATE OF RE-INSPECTION: 5:5901nspecfForm6-14.Ecc 1 Inspector's Signature: Print: �G PIC's Signature: Print: C Pager of�Pages i ` Violations Related to Foodborne Illness Interventions and Risk Factors(items 1-22) PROTECTION FROM CONTAMINATION FOOD PROTECTION MANAGEMENT 8 Cross-contamination 1 590.003(A) Assignment of Responeibiliryp' 3-302.11(.x)(1) Raw Animal Foods Separated from 590.003(B) Demonstration of Knowledge" Cooked and RTE Foods+` 2r 103.11 Person m change--duties Contamination from Raw ingredlonts 3-302.11(0)(2) Raw Animal Foods Separated from Each EMPLOYEE HEALTH other'- 2 590.003(C) Responsibility of the person in charge to Contamination from the Environment require reporting by food employees and 3-302.11(A) Food Protection* applicants' 3-302.15 WashineFlUMand Vegetables 590.003(F) Responsibility Of A Food Employee OrAn 3-3047Food Contact with Equipment and Applicant To Report Tone Person In Utensils* Chaise" Contamination from the Consumer 590.003(G) Re orting b Person in 3-306.14(A)(B) 'Returned Food and Rewtrdee of Food* 3 590.003(D) Exclusions and Restrictions* Disposition of Adulterated or Contaminated 590.003(E) Removal of Exclusions and Restrictions Food 3-701..11. Discarding or Reconditioning Unsafe FOOD FROM APPROVED SOURCE Food* 4 Food and Water From Regulated Sources 9 Food Contact Surfaces 590.004(A-B) C<zrn Bance withFa>dLaw" 4-50L111 Manual Wmewashing-HotWater 3-201,12 Food in a Hermetically Sealed Container* Sanitization,'pem eratures* 3-201.13 Fluid Milk and MilkProduets* 4-501..1.12 Mechanical W'arewashina Flot Water 3-202.13 Shell E,,-s* Sanitization Temperatures* 4-301.114 Chemical Sanitization-tem pl-I, 3-203-14 Segs and Milk Products.Pasteurized* concentration and hardnesspa'I 3-202,16 ice Marie Front Potable Ddnkin;Water" 4-601.11(A) Equipment Forxt Contact Surfaces and 5-101.11 Drinkin r Watcr from alt A roved System*' Utensils Clean-* 590.006(A) Bottled DrinkingWater* 4-602.11 CleaningFrequency ofEquipment 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 3-20'1.14 Fish and Recreationally Caught Molluscan Ford Contact Surfaces of Equipment* Shellfish* 4-703.11 Methods of Sanitization-HotWaterand 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* Sources* 1p Proper,Adequate Hantlwashing Game and Wild Mushrooms Approved by Reaulatory Autho6t 2-301.11 Clean Condition-Hands and Arman' 3-20218 Shellstoek Identification present* °c=Ut.12 Cleanim*Procedure* 590.004(C) Wild Mushrooms' 1, 2-301.f�4-- ,,. When to Wash" 3-201.17 Game Animals,: oS 11 ` gGood Hygienic Practices $ Receiving/Condition v27=1Qi 11 +1 i Eating. Drinking,or Using Tobacco* 3-202.11 Pl1Fs Received at Proper Tenp peratures" 2-401.112--,J Discharges Front the Eyes.Nose and 3-202.15 Packagehu ia-ity* Mouth" 3-101.11 Food Safe and Unadulterated '" 3-301.12 prevetnin Contaminaflon When Tastin=* 6 Tags/Records:Sheilstock 12 Prevention of Contamination from Hands 3-202.18 Sliclkut ck Identification' 590.004(E) preventing Contamination from 3-203.12 Shellstock Identification Maintained* Employees* Tags/Records:Fish Products 13 Handwash Facilities 3-002.11 Parasite Destruction" Conveniently Located and Accessible 5-20311 Numbers and 3-402.12 Records.Creation and Retention* 5-204.11 Location and plla acemmentaent* * 59(.0040) Labeling of Ingredients' 7 Conformance with Approved Procedures 5-205-11 Accessibilit O eration and Maintenance. lHACCP Plans Supplied with Soap and Hand Drying 3-502.11 S ecialized Processin>Mt1hads* Deves 3-502.12 Reduced oxygen packaging,criteria" 6-301.1.1 I°isndwashin Cleanser.Availability 8-103.1.2 Conformance with Approved Pro:edtues' 6-301.12 Hand Drvin*Provision '"Denotes critical item tit the.federal 1999 Food Code or 105 CNIR 590.000. i t CITY OF SALEM / BOARD OF HEALTH / Establishment Name: Cs�1Jt"I /c (24 Date: �I�"� 7 jPage: of ` Item Code C-Critical Item DESCRIPTION OF VIOLATION_-/_PLAN OF CORRECTION Date No. Reference 'R—Red Item Verified PLEASE PRINT CLEARLY T 'd�L( C c n o �l t - - �cr1 / G L M4 ll In 4, ftYrt ci 1 a �j s A1C Q04-� [ c 1 _4� 3 l a , G f .1 lf�:OMAAACAI-N c G A- 7G/ c3 S r 6 Discussion With Person in Charge: Corrective Action Required: ❑ 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: i {{ t { 3-541.14(C) PHFs Received at Temperatures Violations Related to Foodborne Illness Interventions and Risk According to I.iw Cooled to Factors(items 1-22) (Cont.) 41'F/45'F Within 4 Homs. ^ PROTECTION FROM CHEMICALS 3-501.15 Cooling Methods for PHFs 14 Food or Color Additives 14 PHF Hot and Cold Holding 3-501.16(B) Cold PRFs Maintained at or below 3-202.12 Protection 590.004(F) 41V45'F* 3-302.'l4 Protection from lxic n rosea Additives* 3-501.16(.A) Hot PHFs Maintained at or above 15 Poisonous or Toxic Substances a 40°F. * 5 7-101.17 identifying Information-Original 3-501.16(A) Roasts Held at or above 130'F, Containers* 7-102.11 Common Name-Workim,Containers" 20 Time as a Public Health Control 7-201.l 1 Separation-Stora*e' 3-501.19 Time as a Public Heal[h Conhol* 7-202.11 ReWiction-Presence and Ilse* 590.004(H) Variance Re ulcemem 7-202.12 Conditions of Use- 7-203.11 Toxic Containers-Prohibi,tiouss` REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-204.11 Sanitizers,Criteria-Chemicals* POPULATIONS(HSP) _ 7-204.12 Chemicals for Washine Produce,Criteria=' �� 3-301.7 3(A) Unpasteurized Pre-packaged Juices and Beverages with 4kiuriine Cabelsa' 7-204.14 D>� Agents.Criteria* 3-gOl.l i(B) Use of Pastenrized'E��s* 7-205.11 Incidental Food Contact,Lubricants` 7106,117801 Restricted Use Pesticides-Criteria* 11(D) Rav, nr Partially Conked Animal Food and Raw Secd S xtouts Not Served.* 7-206.12 RodTraci Bait Stalls," 3-S01.I I(C:) Unopened Food Package Not Re-served. 7-?06.13 Tracking Powders,Pest Control and Monitoring* CONSUMER ADVISORY TIMEITEMPERATURE CONTROLS 22 3-603.11 Consumer Advisory Posted for Consumption of Ariunai Foods That are Raw- Undercooked or 16 Proper Cooking Temperatures for _ PHFs Not Otherwise Processed to'Blimmate 3-40'LIIA(1)(2) Eggs- 155'17 75 Sec. Pathogens.* E gs-Immediate Service 145'F15sec* 3-302.13 Pasteurized Eggs Substitute for Raw Shell 3-401.11(A)(2) Comminuted Fish,Meats&Game E s* Animals- 155'F 15 sec.,e 3-401.1](B)(1)(2) Pork and Beef Roast-130'F 121 min* SPECIAL REQUIREMENTS 3-401.11(A)(2) Ratites, Injected Meats-155'F 15 S90-009(A){D) Violations of Section 590.009(A)-(D)in sec. * catering, mobile food, temporary and 3-401.11(A)(3) Poultry, Wild Game, Stuffed PIFs, residential kitchen operations should be ' Stuffing Containing Fish, Meat, debited under the appropriate sections Poult< or Ratites-t 65`F 15 sec * above if relatedto foodborne illness 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks interventions and risk factors. Other 145'17* 590.009 violations relating to good retail 3401.12 Raw Animal Foods Cooked in a practices should be debited under#29- Miciowave 165°F* Special Requirements. 3401.11(A)(1)(b) All Other PHFs- 145'F15 sec. 17 Reheating for Hot Holding VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 3-403.1 J(A)&(D) PHFs 165'F 15 sec. * (Items 23-30) 3-403.11(B) Microwave-165°T'2 Minute Standing Critieal and non-critical violations, which do not relate to the Time* fcoutborne illness interventions and riskfactors listed above, can be ,-403.11(C) Commercially Processed RTE Food- found in the following sections of the Food Code and 105 CMC{ 1.40°F* 590006_. 3-403.1.1(8) Remaining Unsliced Portions of Beef Item Good Retail Practices FC 580.000 Roasts* 23. Mana ement and Personnel _ FC-2 .003 1g Proper Cooling of PHFs 24. Food and Food Protection _ FC-3 .004 25 Equipment and Utensils FC 4 __.005 _ 3-501.14(A) Cooling Cooked PHFs from 140'F to 26 W ater, Plumbin and N,'aste FC 5 .006 7(1°17 Within 2 Hours and From 70°F 27. Ph Asir-al Facilily FC -6 .007 to 41'F/457 Within 4 Hours. * 28. Poisonous or Toric Materials FG-7 .008 3-501-'14(173) Cooling PHFs Made From Ambient 29. S sena(Re uiremanis 009 Temperature Ingredients to 41`F/45-F 30, Other Within 4 FIours'� rot r-ve-z�o� -- '*Denotas critical item m the federal 1999 Foal Code of 105 CMR 590-000. rx CITY OF SALEM 4 , BOARD OF HEALTH Establishment Name: f r I-1oJle (Deg Date: 1r Page:_`— of nem Code C-Critical item DESCRIPTIONOF VIOLATION/PLAN OF CORRECTION Date pp - - Verified i No. Reference R-Red Item PLEASE PRAT CLEAR 14 i 4 n G i r 0% — o° n SJR f a�sy3.a .r Discussion With Person in Charge: - - Corrective Action Required: ❑ No Yes -r 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, tobserve all conditions as described, and to Exclusion o 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 suYension/revocation of ❑ Embargo" ❑ Emergency Closure your food permit. -.v ❑ Voluntary Disposal ❑ Other: 42 *. -. s ' 3-501.14(C) PHFs Received at Temperatures Violations Related to Foodborne Illness Interventions and Risk According to Law Cooled to Factors(items 1.22) (Cont.) 41'F/45°F Within 4 Hours. M PROTECTION FROM CHEMICALS 3-501.15 Cooling Methods for I'HFs 14 Food or Color Additives t9 PHF Hoo and Cold Holding 3-501.16(B) Cold PHFs Maintained at or below 3-202.]2 Ad uves" 590,004(F) 4lV45'F* 3-302.14 Protection from Una roved Additives* 3-501.16(A) Hof PHFs Maintained at or above 15 Poisonous or Toxic Substances t4O'F. � 7-101.11 1'dentitying Information-Original 3-501.1.6(A) Roasts Held at or above 130°F. Containers* 7-102.11 Common Name-Working Containers* 20 T1me as a Public Health Control 7-201.11 Separation-Stonixe* 3-501.19 Time as a Public Health Control* 7-202.11 Restriction-Presence end Use* 590.004(11) Variance Re uireaient 7-202.12 Conditions of tfse* 7-203.11 Toxic Containers-Prohibitions, REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-204.11. Swatizets,Criteria-Chemicals* POPULATIONS(HSP) 7-204.12 Chemicals for Washing Produce_Criteria" 2.t 3-801.11(A) Unpasteurized Pre-packaged Juices and Beverages with Warnin;I-,abcls* 7-204.14 Drving A eats,Criteria* - --- �� r'� 7-205.11 Incidental Food Contact.Lubricants* 3-801.11(B) Use of Pasteuuzed ESflsM 7-206.11 Restricted Use Pesticides. Cri tela* 3-801A 1(D) ,Raw or Partially Cooked Animal Food anti Raw Seed S rout's Not Setved. .F 7-206.12 Rodent Bait Stations* 3-801.11(C) Unopened Food Package Not Re-served. 7-206.13 Tracking Powders,Pest Control and Monitoring* CONSUMER ADVISORY TIMEITEMPERATURE CONTROLS 22 3-60111 Consumer Advisory Posted for Consumption of 16 Proper Cooking Temperatures for Animal Foods That are Raw.Undercooked or PHFs Not Othcrwist Processed to Eliminate 3-401.11A(ll(2) Eggs 155°E 15 Sec. Pathogens Lfiv 'Qt Ti a-Lnme.drate Ser¢ice 145°F15sec* 3-3On.t3 Pasteurized Eggs Substitute for Raw Shell 3-401.11(A)(2) Comminuted Fish,Meats&Game E s Animals- 155'F 15 sec. 3-40 1.11(B)(1)(2) Pork and Beef Roast -13O"F 121 min* SPECIAL REQUIREMENTS 3-401.1l(A)(2) Ratites,Injected Meats-155'F 15 590.009(A)-(D) Violations of Section 590.009(A)-(D)in sec, * catering,mobile food, temporary and 3-401-11(A)(3) Poultry, Wild Game,Stuffed PMI's, residential kitchen operations should be Stuffing Containing Fish,Meat, debited wider tire appropriate sections Poultry or Ratites-16Y+ 15 sec. " above if related to foodborne illness 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks interventions and risk factors. Other 145°F* _ 590.009 violations relating to good retail 3-401.12 Raw Animal Foods Cooked in a practices should be debited under/129- Microwave 165`F Special Requirements. 3-401._]l(A)(1)(b) All Other PHFs-145'F15 sec. 17 Reheating for Hot Holding VIOLATIONS RELATED TO GOOD RETAIL PRACTICES _T403 I(A)&(D) PHFa 165'F 15 sec. * (Items 23-30) 3-403.11(B) Microwave-165°F2 Minute Standing Critical and non-critical violations, a hich do not relate to tate Times' ,foodhorne illness interventions and risk factors listed above., can be 3-40311(C) Commercially Processed R"FE Food- found in the fellenving sections of the Food Code aro!105 CMK 14WF* -590-000. 3-403.11(E) Remaining Unsliced I'a ions of Beef Item Good Retail Practices FC -r 590.000 ' - - Roasts* 23. Mama ementand Personnel FC-2 .003 ---- --__-___-.___ ---- Ig Proper Cooling of PHFs 24. Food and Food Protection _.... FC-3 .604 25 Equipment and Utensils FC 4 _ .005 _ 3-501.1.4(rl) Cooling Cooked PHFs from 1�°F t'o 26 Water,Plumb in and W asie FC 5 006 7WF Within 2 flours and From 7(°F 27 Physical Facilit _ FC__6 _007-- to 07to 41°F/45°F Within 4'Hours.* 28. Poisonous or Toxic Materials FC-7 .008 3-501.14(3) Cooling PHFs Made From Ambient 29. S ecial Re uiremonts .009 Temperature Ingredients to 41°F/45cF �t -30._......._Other Within 4 Hours"` 'Denotes critical ican in the federal 1999 Food Code or 105 CMR 590.000. r. �qn r r.•y •rw ♦ •rwp. V f`t�e',/�.j.�.Y�r,n.r .-�� Y1y�yry�M-T+'M.��1Gp..�'' T.. ,Al.�1Htis-..Y�.-Yr•..d.�. . a. n.3. r m Massachusetts Department of Public Health Salem Board of Health 120 Washington Street,4,h Floor Division of Food and Drugs Salem, MA 01970-3523 FOOD ESTABLISHMENT INSPECTION REPORT Tel. (978) 741-1800 Fax (978) 745-0343 NameI t]J Date Type of Operation(s) !, Rouof Inspection X Food Service ❑ tine Address is Retail Re-inspection Telephone _ ❑ Mobile Date: Level ❑ Residential Kitchen Previous ILpspe/ction 9&3/C)5-- 3[t)S OwnerHACCP Y/N ❑ Temporary ElPre-operation i/F ❑ Caterer ❑ Suspect Illness Person in Charge(121C) Time ❑ Bed&Breakfast ❑ General Complaint In:�.30 ❑ HACCP Inspector Q Out:1 a 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 EMPLOYEE HEALTH E] 13. Handwash Facilities .., PROTECTION FROM CHEMICALS ❑ 2. Reporting of Diseases by Food Employee and PIC �T El 14.Approved Food or Color Additives ❑ 3. Personnel with 1lifections Restricted/Excluded ❑ 15.Toxic Chemicals FOOD FROM APPROVED SOURCE ❑ 4. Food and Water from Approved Source' TIME/TEMPERATURE CONTROLS(Potentially Hazardous Foods) ❑ 5. Receiving/Condition ❑ 16.Cooking Temperatures ❑ 6. Tags/Records/Accuracy of,ingredient Statements ❑ 17. Reheating ❑ 7. Conformance with Approved Procedures/HACCP Plans ❑ 18. Cooling PROTECTION FROM CONTAMINATION ' , ❑ 19. Hot and Cold Holding ❑ 8. Separation/Segregation/Protection ❑20.Time As a Public Health Control M1 ❑ 9. Food Contact Surfaces Cleaning and.Sanitizing REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) El 10. Proper Adequate Handwashing [121. Food and Food Preparation for HSP ❑ 11. Good Hygienic Practices CONSUMER ADVISORY - ❑22. Posting of Consumer Advisories Violations Related to Good Retail Practices Number of Violated Provisions Related ritical (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 ofcHeaN 590.000/federal Food Code. This report, when signed below 23. Management and Personnel (FC-2)(590.003) by a Board of Health member or its agent constitutes an 24. Food and Food Protection (FC-3)(590.004) order of the Board of Health. Failure to correct violations 25. Equipment and Utensils (Fc-a)(sso.00s) cited in this report may result in suspension or revocation of 26. Water, Plumbing and Waste (FC-5)(590.006) the food establishment permit and cessation of food establishment operations. If aggrieved by this order, you 27. Physical Facility (FC-6)(590.007) have a right to a hearing. Your request must be in writing 28. Poisonous or Toxic Materials (FC-7)(590.006) and submitted to the Board of Health at the above address 29. Special Requirements (590.009) within 10 days of receipt of this order. 30. Other DATE OF RE-INSPECTION: Inspector's Signature: Print: PIC's Signature: Print Q 5 Page I of-/.Pages] Su2a n rWte• Violations Related to Foodborne Illness interventions and Risk Factors(items 1-22) PROTECTION FROM CONTAMINATION FOOD PROTECTION MANAGEMENT R Cross-contamination I 1 590.003(A) 11Assignment of Kesponsibilit}'" 3-302.1l(A)d) Raw Animal Foods Separated fiom 590.003(B) Demonstration of Knowledge* Cooked and RTE Foods" 2-10311 Person in shame-duties Contamination from Raw Ingredients 3-302.1 1(A)(2) Raw Animal Foods Separated from Each EMPLOYEE HEALTH Other* 2 590.003(C) Responsibility of the person in charge to Contamination from he Environment require reporting by food employees and 3-302,11(A) Food Protection* a licams* 3-302.15 Washing Fruits and Velgetables 590.003(F) Responsibility Of A Food Employee Or An 3-304.1.1 Food Contact with Equipment and Applicant To Report To The Person In Utensils* Change* Contamination from the Consurnei 590.003(G) Re (mina b Person in Char e* 3-306.14(A)(B) Returned Fond and Reservice of Food* 3 590.003(D) Exclusions and Restrictions' Disposition of Adulterated or Contaminated 590.003(I Removal o Exclusions and Restrictions Food 3-701.11 Discarding or Reconditioning unsafe FOOD FROM APPROVED SOURCE Food* 4 Food and Water From Regulated Sources 9 Food Contact Surfaces _ 590.OU4lA-B) Compliance with Food Law* 4-501 HI Manual Warcwashing-IIotWater 3Hermetically-201-12 Food in Hermetically Sealed Container* Sanitizat on pem eraarxes* 3-201.1.3 Fluid Milk and Milk Products* 4-501.112 Mechanical Warewashrng-Hat Water 3-202.13 Shell E_�*s* Sanitization Temperatures* 3-202.14 Ewes and M.iik Products.,Pasteurized" 4-501.114 Chemical Sanitization-temp..pH, concentration and hardness. 3-202.16 Ice Made From Potable Drink,inLVN ater* 5-1.01.11 Di inkin- Water from an A moved System* 4-601.11(.0.) Equipment Food Contact Surfaces and Utensils Clean* 590.006(A) Bottled Drin(:ing Water* 4-602.11 Cleaning Frequency of Equipment Food- 590.006(B) WaterMeets Standards in 310 CMR 22.0' Contact Surfaces mid Utensils* Shellfish and Fish From an Approved Source 4-70111 t§equency of Sanitization of Utensils and 3-201.14 Fish and Recreationally Caught Molluscan Food Contact Surfaces of E tri meat* Shellfish* 4-703.11 Methods of Sanitization-Hot Water and 3-201.15 Molluscan Shellfish from NSSP listed Chemical* Sources`" to Proper,Adequate Handwashing Game and Wild Mushrooms Approved by 2-301.11 Clean Condition-Hands and Anne* Re ulato Authodf 3-202.18 Shellstock Identification Present* 2-301,12 Cleallm"Procedure* 590.004(C) Wild Mushrooms* 2-301.1.4 When to Wash* 3-201.17 Game Animals* it Good Hygienic Practices g Receiving/Condition 2-401.11 Eating,Drinking or Urine Tobacco* 3-202.11 P}IFs Received at Pro or Tein statutes'" 2-401.12 Discharges From the Eyc s,Nose and 3-20215 Packawe IntMonths` 3-101.11 Food Safe and Unadulterated* 3-30112 Preventing Contamination When Tasting* 6 Tags/Records:Shellstock 12 Prevention of Contamination from Hands 3-202.18 Shellstock Identification* 590.004(E) Ptevendng Contaunination from - 3-203.12 Shellstock Identification Maintained* r F,m to ees' Tags/Records: Fish Products 13 Handwash Facilities 1 3-402.11Parasite Destruction'' Conveniently Located and Accessible 3-402.12 Records,Creation and Retention* 5-203.1.1 Numbers and Ca.aeities't 590.00411) Labeling of Ingredients' 5-204.11 Location and Placement* 7 Conformance with Approved Procedures 5-205.11 Accessibility,O eration anti Maintenance lHACCP Pians Supplied with Soap and Hand Drying Devices 3-502.11 Specialized ProcessinE Methods* 6-30 3-502.12 Reduced oxygen packaging,criteria` 1,11 Handwashinw Cleanser.Availability 8-103.12 Conformance with A xoved Pro eedures„ 6-301.12 Hand Drvim,Provision *Demote,critical]tem i❑lire federal 1999 Fc>ud Code or 105 CNIR 590.000. CITY OF SALEM T f BOARD OF HEALTH 3 Establishment Name: CZ( a�S 1..[P O Date: �f� i� Page: Z of Z Item Code C—Critical Item 3 DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date ` �t No. Reference R—Red Item Verified . PLEASE P INT CLEARLY - 3 �LL 11(7 CPO CA l I :.f n t J d4 61 7 _ A i h w✓ ko 6,n r n. 4 b s e JA A , _g r ? I i iC �r I II Y Discussion With Person in Charge: Corrective Action Required: ❑ No / Yes ! a ❑ Voluntary Compliance ❑ Employee Restriction/ I have read this report, have had the opportunity to ask questions and agree to correct all Exclusion - violations before the next inspection, to observe all conditions as described, and to ❑ Re-inspection Scheduled ❑ Emergency Suspension .comply with all mandates of the Mass/Federal Food Code. I understand that noncompliance may result in daily fines of twenty-five dollars 7r-sp7yon/revocation of ❑ Embargo ❑ Emergency Closure your food permit. ❑ Voluntary Disposal ❑ Other: r I R A:,-. « 3-50114(C) PHFs Received at Temperatures Violations Related to Foodborne Illness Interventions and Risk According to law Cooled to Factors(Items 1-22) (Cont.) 41'F/45°F Within 4 Hours.' PROTECTION FROM CHEMICALS 3-501.15 Coolin- Methods forPHFs 14 Food or Calor Additives 19 PHF Hot and Cold Holding 3-202.12 Addvncs` _ 3-501.16(B) Cold PI We Maintained at or below 590.004(F) 41'/45°F 3-302.14 Protection oisonou from Unapproved Additives* 3-501.16(A) Hot PHFs Maintained at or above IS Poisonous or Toxic Substances - 14WF. '* 7-101.11 identifying Infoa'matSon-Orig nal 3-501.16(A) Roasts Held at or above t30°F. Containers' 7-102.11 Common Name-Working*Containers* 20 Time as a Public Health Control 7-201.17 Se aration-Storage* 3-501-19 Time as a Public Health Control* .� 590.004(H) variance Re uitement 7-202.11 Restriction-Presence and Use' 7-202.12 Conditions of Ilse" REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-203.1.1 Toxic Containers-Prohibitions' POPULATIONS(HSP) 7-204.11 Sanitieet's,Criteria-Chemicals* 7-204.12 Chemicals for Washin Pzochrce,Criteria* 21 3-801_11(A) UnpasteurSzed Pre-packaged Juices and 7-204.14 Drvin A Buts.Criteria' Beverages with Warning Labels* 7=205.11 Incidental Food Contact. Labricants* 3-801 ll(B) Use ofPasteud7ed'L,s* 7-206.11 Restricted Use Pesticides Criteria* 3-80IAI(D) Rain or Partially Cooked Animal Food and Raw Seed S routs Nof Served.'i ,7-206.12 1 R<xicnf Bait Stations" 3-90 1.11(C) Uno ened Food Packs>e NoC Ra-served. 7-206.13 Trackmo Powders,Pest Control and MrautorinR* CONSUMER ADVISORY TIME(TEMPERATURE CONTROLS 22 3-603.11 Consumer Advisory Pasted for Consumption of I - Animal Foods'rhat are Raw,Undercooked or 16 Proper Cooking Temperatures for PHFs Not Otherwise Processed to Eliminate 3-401.1 IA(7)(2) Eggs- l55°FtS Sec. Patho-'ens.* Ersecnve vuaoa� Eggs-tainnediaLe Service 145°F15sw 3-302.13 1 Pasteurized Eggs Subsouite'lor Raw Shell 3-401.11(A)(2) Comminuted Fish, Meats&Game Ee s* Animals- 155°F 15 sec. " 3-401.1 l(B)(1)(2) Pork and Beef Roast- 130'F 121 rain* SPECIAL REQUIREMENTS 3-401.1I(A)(2) Ratites, injected Moils-1.55'F 15 590.009(s1)-(D) Vio1a[ious of Section 590.009(A)-(D)in sea * catering. mobile food, temporary and 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHBs, residential kitchen operations should be Staling Containing Fish, Meat, debited under the appropriate sections Pottl t or Rat les-165°F 15 sec. sabove if related to foodborne illness 3-40LI 1(C)(3) Whole muscle,Lrtact Beef Steaks interventions and risk factors. Other 145°F* 590.009 violations relating to good retail 3-401.12 Raw Animal Foods Cooked in a practices should be debited under ff29- Microwave 165'F* Special Requirements. 3-401-11(A)(1)(b) All Other PHFs-1.45°F15sec. * 17 Reheating for Hot Holding VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 3-403.11(A)K(D) PEN 1650F 15 sec. :': (Items 23-30) 3-403.11(B) Microwave- 165°F 2 Minute Standing Ci-iacal and non-critical violations, which do not relate to the Time* foodborne iilness into vention.s and risk factors listed obove, ran be 3-40111(C) Commercially Processed RTE Food- ,found in the following sections of the Food Code and 10.5 CMR 140°F* 590.000. 3-403,11(E) Remaining Unsliced Portions of Beef item Good Retail Practices_ FC 590.Qo0 Roasts* 23. Management and Personnel ___ FC-2 .003 Ig Proper Cooling of PHFs 24 Food and Food Protection FC -3 .004 25 _. .Eqipment and Utensils uFC 4 .005 3-501.W(A) Cooling Cooked PHFs from 140'F to _25_.___ 26 Water Plumbing and Waste FC-5 .006___ f - - }-Within 2 Flours and From 70°F 27 Ph sical F_ae_ility 70 FC 6 .007 to 41'F/45°F Within 4 Hours. * 28. Poisonous or Toxic Materials FC-7 1 .008 3-501.14(B) Cooling PFIFs Made From Ambient 29. S coral Re uiremenks __ .009 Temperature htgredients to 41'FI45°F 30.____Other_ -� Within 4 flours srwto,�,m,ea-zsc *Deno[as�xitical item in the federal 7999 Food Coda or 1 US CMR 59Q-OOQ I� CITY OF SALEM9 MASSACHUSETTS BOARD OF HEALTH s y{ 120 WASHINGTON STREET, 4TH FLOOR SALEM, MA 01970 TEL. 978-741-1800 FAX 978-745-0343 STANLEY J. USOVICZ, JR. JOANNE SCOTT, MPH, RS, CHO MAYOR HEALTH AGENT COMMONWEALTH OF MASSACHUSETTS PERMIT TO OPERATE A FOOD ESTABLISHMENT In accordance with regulations promulgated under authority of Chapter 94, Section 305A and Chapter III, Section 5 of the General Laws, to operate a Food Establishment in the City of Salem is hereby granted to: Type of Establishment: FOOD SERVICE Name of Establishment: Court House Deli Address of Establishment: 60 Washington Street Owner's Name: Suzanne Hensley Restrictions: Application Date: 12/4/2003 Permit for Food Establishment 114-04 Frozen Desserts/Ice Cream Permit for the Sale of Tobacco Products These Permits Expire December 31, 2004 This permit is not transferable and must be reissued upon change of ownership or location. The permit must be posted in a prominent location in the Establishment, In accordance with the State Sanitary Code, before any renovations, improvements, or equipment changes are made, all plans for such must be submitted to and approved by the Salem Board of Health. HEALTH AGENT CITY OF SALEM, MASSACHUSETTS � BOARD OF HEALTH 7k 3 120 WASHINGTON STREET, 4TH FLOOR Nov 17 2003 SALEM, MA 01970 TEL. 978-741-1800l., I f 0�' JAL[=M FAX 978-745-0343 B0ARID r- ; HEALTH STANLEY USOVICZ, JR. JOANNE SCOTT, MPH, RS, CHO MAYOR HEALTH AGENT 2004 APPLICATION FOR PERMIT TO OPERATE A.L {''t FOOD ESTABLISHMENT ]�'2 � , o � NAME OF ESTABLISHMENT D( /t[9L4CP V.1L TE8L# 91 R- 7,91 oO3 ADDRESS OF ESTABLISHMENT CD Was A w' !?-:din S-t- Scd PI`"wa,, MAILING ADDRESS (if different) ) - OWNER'S NAME , Suq axne P,2111 s tI��TEL# 37g-74-5-495.3 ADDRESS ' e'�L � I�. G CITY ISICL-I P M STATE ZIP q CERTIFIED FOOD MANAGER'S NAME(S) .2 Q E ON5 AIERTIFICATE#(s)_/a7,qEy5" (required in an establishment where potentially hazardousfood is prepared.) EMERGENCY RESPONSE PERSONp q s/ / 3 6:0U f}IY1 -r-o *-:00 r FrI 3&rn 2 Selma Sop dv/ HOURS OF OPERATION: Mon.--t,,-Tue.—jZ Wed.-,,,LThu._ Fri. GSat. Ll' Sun. 1/' TYPE OF ESTABLISHMENT FEE check only RETAIL STORE YES NOless than 1000sq.ft. =$ 50 r� 0 / 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 YES NO $5 TOBACCO VENDOR YES NO $50 ALL NON-PROFIT(such as church kitchens) YES NO $25 Please pay total with one check payable to the City of Salem This Permit is not transferable and must be reissued upon change of ownership. The Permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code, before any renovations, improvements, or equipment changes are made, all plans for such must be submitted to and approved by the Salem Board of Health. Pursuant to MGL Chapter 62C, Section 49A, I certify under the pains and penalties of perjury that I, to my best k owledge and belief, ave f e all state tax returns and paid all state taxes required under the law. � R W-9P4 Frll# n1 (2-549-37/6 09 natur Dat Social Security or Federal Identification Number --------------------------------------------------- - // ------ --------- - --------------------------- Revised 11/03/03 FOODAP2.adm Check#&Date /��/O �/�S 3 Massachusetts Department of Public Health Salem Board of Health 120 Washington Street, 4'h Floor Division of Food and Drugs Salem, MA 01970-3523 FOOD ESTABLISHMENT INSPECTION REPORT Tel. (978) 741-1800 Fax (978) 745-0343 Name Dation(s) Type of Inspection e-vu/r msda raLtZ of 0 FoodTService ®-Routine Address 6A14 r M 10II531"t S` Risk ❑ Retail ❑ Re-inspection Telephone Level ❑ Residential Kitchen Previous Inspection y/- / ❑ Mobile Date: Owner HACCP Y/N El Temporary ElPre-operation v 1&NruE ❑ Caterer ❑ Suspect Illness Person in Charge(PIC) s. Time ❑ Bed& Breakfast ❑ General Complaint CP inspectorh 4 ires an Out: Permit No. ❑ Other Each violation checked requexplanation on the narrative page(s) and a citation of specific provision(s) violated. Non-compliance with: Violations Related to Foodborne Illness Interventions and Risk Factors Anti-Choking Tobacco Violations marked may pose an imminent health hazard and require immediate corrective 590.009(E) ❑ 590.009(F) ❑ action as determined by the Board of Health. FOOD PROTECTION MANAGEMENT ❑ 12. Prevention of Contamination from Hands ❑ 1. PIC Assigned/Knowledgeable/Duties ❑ 13. Handwash Facilities EMPLOYEE HEALTH El 2. FROM CHEMICALS 2. Reporting of Diseases by Food Employee and PIC _ El3. Personnel with Infections Restricted/Excluded El 14.Approved Food or Color Additives FOOD FROM APPROVED SOURCE ❑ 15.Toxic Chemicals ❑ 4. Food and Water from Approved Source TIMErfEMPERATURE CONTROLS(Potentially Hazardous Foods) ❑ 5. Receiving/Condition ❑ 16. Cooking Temperatures ❑ 6. Tags/Records/Accuracy of Ingredient Statements ❑ 17. Reheating ❑ 7. Conformance with Approved Procedures/HACCP Plans ❑ 18 Cooling PROTECTION FROM CONTAMINATION 19. Hot and Cold Holding ❑ 8. Separation/Segregation/Protection ❑ 20.Time As a Public Health Control ❑ 9. Food Contact Surfaces Cleaning and Sanitizing REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) El 10. Proper Adequate Handwashing El21. Food and Food Preparation for HSP ❑ 11. Good Hygienic Practices CONSUMER ADVISORY ❑22. Posting of Consumer Advisories Violations Related to Good Retail Practices Number of Violated Provisions Related Critical (C) violations marked must be corrected To Foodborne Illnesses Interventions / immediately or within 10 days as determined by the Board and Risk Factors (Items 1-22): / of Health. Non-critical (N)violations must be corrected Official Order for Correction: Based on an inspection immediately or within 90 days as determined by the Board today, the items checked indicate violations of 105 CMR ofd _aN_ 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 94/Food. and Food Protection (FC-3)(590.004) order of the Board of Health. Failure to correct violations 25. Equipment and Utensils (FC-4)(590.005) cited in this report may result in suspension or revocation of 26. Water, Plumbing and Waste (FC-5)(590.006) the food establishment permit and cessation of food establishment operations. If aggrieved by this order, you 27. Physical Facility (FC-6)(590.007) have a right to a hearing. Your request must be in writing 28. Poisonous or Toxic Materials (FC-7)(590.008) and submitted to the Board of Health at the above address 29. Special Requirements (590.009) within 10 days of receipt of this order. 30. Other DATE OF RE-INSPECTION: S:50MVWFor -14.doc Inspector's Signs tu Print: PIC's Signature: Print: G _ p Page Of�Pages �. IlPii I - . Violations Related to Foodborne Illness Interventions and Risk Factors(items 1-22) PROTECTION FROM CONTAMINATION FOOD PROTECTION MANAGEMENT H Cross-contamination 1 590.003(A) Assignment of Responsibility" 3-302.11(A)(]) Raw Animal Foods Separated from 590.003(8) Demonstration of Knowledge* Cooked and RTE Fluids" 2-103.11 Person in charge-duties Contamination from Raw Ingredients 3-30111(A)(2) Raw Animal Foods Separated from Each EMPLOYEE HEALTH Other" 2 590.003(0) Responsibility of the Person in charge to Contamination from the Environment require reporting by food employees and 3-302.11(A) Food Protection* ah>licants* 3-302.15 Washing Fruits and Ve,,etables 590.003(F) Responsibility Of A Foci Employee Or An 3-3041 11 Food Contact with Equipment and Applicant To Report To The Person In Utensils" Charge* Contamination from the Consumer 590.003(6) Reporting b j Person in Charge* 3-306.14(A)(B) Returned Food and Reservice of Food* 3 1 590.003(D) I Exclusions and Restrictions* Disposition ofAduiteratedor Contaminated 590.003(F) Removal of Exclusions and Restrictions Food 3-701.11 Discarding or Reconditioninglinsafe FOOD FROM APPROVED SOURCE Food* 4 Food and Water From Regulated Sources 9 Food Contact Surfaces 590.004(A-B) Compliance with Food Law* 4501.11 1 Manual Warewmhing- [lot Water 3-201.12 Food in a llennetiwtl Sealed Containerx Sanitization-lean eratures* 5,, � 3-201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Warewashina Hot Water 3-202.13 Shell Es* Sanitization Tem oeratures' 3-202.14 Eizs and Milk.Products.Pasteurized" 4-501.114 Chemical Sanitization-tellip.,p I, concentration and hardncsc, 202.16 Ice Made Froin Potable Drink ng Water" 4-601.1](A) Equipment Food Contact Surfaces and 5-1.01,11 Drinking Water from an Approved System* 590.006(A) Bottled Drinking Water* Utensint* 4-60'.11 Cleaningng Is FrePregnency of Equipment Food- 590.006(B) Watei Meets Standards in 310 CMR 22.02" Contact Surfaces and Utensils* Shellfish and Fish From an Approved Source 4-702.11 Frequency of Sanitization of Utensils and 3-201.14 Fisch and Recreationally Caught Molluscan Food Contact Surfaces of Equipment* Shellfish* 4-703.11 Methods of Sanitization --Hot Water and 3-201.15 Molluscan Shellfish front NSSP Listed Chemical* Sources* 10 Proper,Adequate Handwashing Game and Witd Mushrooms Approved by Re ulato Authori X30711 Clean Condition-Hands and Arens" 3-202.18 Shellstock Identification Present* 2301.12 _C cananq Procedure* 590.004(0) Wild Mushrooms* 2-30114 When to Wash* 3-201.17 Game Animals* 11 Good Hygienic Practices g Receiving/Condition 2-401.11 Patin-, Drinking or Using Tobacco* 3-20111 PRFs Received at Pro er Tem heratures* 2-401.1.2 Discharges Froin the Eyes.Nose and 3-202.15 Package integrity"` Month* 3-101.11 Food Safe and Unadulterated* 3-301.12 Preventing Contamination When Tastin g 6 Tags/Records:Shellstock 12 Prevention of Contamination from Hands 3-202.18 Shellsttxk Identification* 590.004(E) Preventing Contatminadon from 3-203.12 Shellstock Identification Maintained* Employees* Tagsgs/Records:Fish Products 13 Handwash Facilities 3-402.11 ParastRe Destruction* Conveniently Looted and Accessible 5-20311 Numbers and Ca a 3-402.12 Records.Creation and Retention" me* 5-204.11. Location and Placement* ent 590.004(.1) Labeling of Ingredients' 7 Conformance with Approved Procedures 5-205.11 Accessibility,Operation and Maintenance 1HACCP Plans Supplied with Soap and Hand Drying 3-502.11 S ecinlized Processing Methods* Devices 3-502.12 Reduced oxygen Packaging,criteria* 6-301.11 Handwashing Cleanser, Availability 8-103.12 Conformance with Approved Piocedures" 6-301.12 F-Iand Drvina Provision 'Denotes critical i1ein in the federal 1999 Pond Code or 105 CNIR 596900. I CITY OF SALEM BOARD OF HEALTH = Establishment Name: (norlAr Adiiar Date: L Page: Z of 2 item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date - - . :Verified c NO. Reference R-Red Rem PLEASE PRINT CLEARLY /✓Ac L;t rlNIr 6 d r C /Q MS UL Gt /Qr7 (/1f S fiJr Avf tfT rJ C�LtE C 1 tGa �,f1 d YKwe / C K T ,wts5 f-4, u -X- 4"41-04- LWtr, 0e, Aa i wnL zwtr- l• r r . tr N V truer a f O Discussion With Person in Charge: Corrective Action Required: '❑ No ❑ Yes have read this report, have had the opportunity to ask questions and agree to correct all ❑ voluntary Compliance o Employee Restriction p pP Y 4 9 Exclusion violations before the next inspection, to observe all conditions as described, and to ❑ Re-inspection Scheduled ❑ Emergency Suspension r comply with all mandates of the Mass/Federal Food Code. I understand that noncompliance may result in daily fines of twenty-five dollars or suspension/revocation of ❑ Embargo ❑ Emergency Closure „your food permit. ❑ Voluntary Disposal ❑ Other: t y � 3-501.14(0) PHFS Received at Temperatures Violations Related to Foodborne fitness Interventions and Risk According to Law Cooled to Factors(items 1-22) (Cont.) 4VIF145°F Within 4 Hours. PROTECTION FROM CHEMICALS 3-501.15 Coolie Methods for PHFS 19 14 Food or Calor Additives PHF Hot and Cold Holding 3-501.16(B) Colo PHFS Maintained at or below 3-20212 Additives" 590.004(F) 41°145'f* 3-30214 Protection front Unapproved Additives* 3-501.16(A) Hot PHFS Maintained at or above 15 Poisonous or Toxic Substances Y40'F. 7-101.11 'ldentifying Information-Origiral 3-501.1.6(A) Roasts Held at or above 130'17. Containers' 7-102.11 Common Name-Workinn Containers* 20 Time as a Public Health Control 7-201.11 Se araGon-Stora e" 3_ml.19 Time as a Public Health Conn`al* 7-202.11 Restriction-Presence andllse* 590.0(Wt7i} Variance Re uirement 7-202.12 Conditions of Use* 7-203.11 Toxic Container,-Prohibitions* REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-204.11 Sanitizets.Criteria-Chemicals* POPULATIONS(HSP) _ 7-204.12 Chemicals for Washing Produce,Criteria* 2T 3-801.1 I(-A) Unpasteurized Pre-packaged Juices and Beverages with Warnin_1.abals* 7-204.14 Dr°Ina t. cuts. Criteria - F 7-205.11 Incidental Food Contact,Lubricants* 3-SOI..i i(B) Use of Pasteurized Bees* 7-206.'1 1 Restricted Use Pesticides.Criteria* 3-80 1A I(D) Raw or Partially Cooked Annual Food and Raw Seed Sprouts Not Served.'" 7-206.12 Rodent Bait Stations" 3-80'1.11(C) Uno Unopened Food Package Not Re-served. 7-206,13 Tracking Powders,Pest Control and Monitoring* CONSUMER ADVISORY TIMEJTEMPERATURE CONTROLS 22 3-603.11 Consumer Advisory Posted for Consumption of Animal Foods 19tat erre Raw. Undercooked or 16 Proper Cooking Temperatures for Not Otherwise Processed to Eliminate PHFS r 6v. u^r.¢ooi 3-40L11A(1)(2) Eggs- 155F15Sec. Patho ens . ere, B rt,a-Ittntedrate Service 5sec* 3-302.13 Pasteurized Eggs Substitute for Raw Shell 3-401.11(A)(2) Comminuted Fish,Meats&Game Eggs* Animals- 155'F 15 see. )' 3-401.1l(B)(1)(2) Pork and Beef Roast- 130T 121 min* SPECIAL REQUIREMENTS _ 3-401.11(A)(2) Ratites,Injected Meats- 155'F 15 590-009(A)413) Violations of Section 590.009(A)-(D)in sec.* catering, mobile food, temporary and 3-401.11(A)(3) Poultry,Wild Game,Stuffed PRFs, residential kitchen operations should be Stuffing Containing Fish, Meat, debited wider the appropriate sections Poultry or Ratites-165'.F 15 sec. = above if related to foodborne illness 3-401.11(C)(3) Whole-muscle,I tart Beef Steaks interventions and risk factors. Other 145'F* 590.009 violations relating to good retail __3-_401 12 Raw Animal Foods Cooked in a practices should be debited under#29- Microwave 165'F* Special Requirements. 3-401,11(A)(1)(b) All Other PHFS- 145'F 15 sec. 17 Reheating for Hot Holding VIOLATIONS RELATED TO GOOD RETAfL PRACTICES 3-403.1](A)&([)) PHFS 165'F 15 sec. * (Items 23-30) 3-403.11(B) Microwave- 165'F 2 Minute Standing C itk:al and non-critical violations, which do not relate to the Time* foodborne illness interventions and risk j$ctors listed above., can be 3-40111(C) Commercially Processed RTF Food- found in the following sections of the Food Code and/OS CMR 140'F* 590.000. 3-403.1.1(17,) Remaining Unsliced Portions of Beef Item Goad Retail Pracetces_ FC 580.00A Roasts* 23. Mona ement and Personn_e_I _. FC-2 .003 18Proper Cooling of PRFs 24. Food and Food Protection _ __ FC-3 .004 25 Equi went and Utensils FC 4 .005 3-501.14(A) Cooling Cooked PHI'ts from 140"'F to - - - -- 26. Water,Plumbing and Waste FC-5 .006__ 70°F Within 2 Hours and Front 70'17 __27__ Ph rico!Facility FC-6 .007 to 41'17/45'F Within 4 Hours. * 28. Poisonous or Toxic Materials FC_-7 -60 3-501.14(13) Cooling PHFS Made Front Ambient 29. S ecial Re uiremen s .009 Temperature Ingredients to 41'F745'F 30 Other Within 4llours,* S 5POP,11b,06ao Denotes critical item In fht federal 1999 Food Code or 305 CNIR 590,000. Massadhusetts Department of Public Health Salem Board of Health 120 Washington Street,4`" Floor Division of Food and Drugs Salem, MA 01970-3523 FOOD ESTABLISHMENT INSPECTION REPORT Tel. (978) 741-1800 Fax (978) 745-0343 Name Date T e 0 eration s Type of�l� nsoection CQVRfi Neil 's Qom/ �a ?+/ S ood Service 0-Routine Address (i✓/�3�/d NGtrol✓ Risk Li Retail ElRe-inspectionttooe Telephone El Residential Kitchen Previous Inspection /1 ❑ Mobile Date: Owner HACCP YM ❑ Temporary ❑ Pre-operation 56/07* 'r- fig ❑ Caterer ❑ Suspect Illness Person in Charge(PIC) Time ❑ Bed&Breakfast ❑ General Complaint S�Mic In: [_1 HACCP Inspector n r v n� Out: Permit No. ElOther 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 - _. El12. Prevention of Contamination from Hands E] 1. PIC Assigned/Knowledgeable/Duties V3 Handwash Facilities EMPLOYEE HEALTH a PROTECTION FROM CHEMICALS ❑ 2. Reporting of Diseases by Food Employee and PIC ❑ El 3. Personnel with Infections Restricted/Excluded 14.Approved Food or Color Additives FOOD FROM APPROVED SOURCE El15.Toxic Chemicals a° ❑ 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'S _" ❑ 19. Hot and Cold Holding EV Separation/Segregation/Protection ❑20.Time As a Public Health Control 9. Food Contact Surfaces Cleaning and Sanitizing REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) El 10. Proper Adequate Handwashing El21. Food and Food Preparation for HSP ❑ 11. Good Hygienic Practices CONSUMER ADVISORY' ❑22. Posting of Consumer Advisories Violations Related to Good Retail Practices Number of Violated Provisions Related Critical (C) violations marked must be corrected To Foodborne Illnesses Interventions immediately or within 10 days as determined by the Board and Risk Factors(Items 1-22): of Health. Non-critical (N)violations must be corrected Official Order for Correction: Based on an inspection immediately or within 90 days as determined by the Board today, the items checked indicate violations of 105 CMR ofC eaNh. 590.000/federal Food Code. This report, when signed below 23. Management and Personnel (FC-2)(590.003) by a Board of Health member or its agent constitutes an 24. Food and Food protection (FC-3)(590.004) order of the Board of Health. Failure to correct violations 25. Equipment and Utensils (FC-4)(590.005) cited in this report may result in suspension or revocation of 26: Water, Plumbing and Waste (FC-5)(590.006) the food establishment permit and cessation of food establishment operations. If aggrieved by this order, you 27. Physical Facility (FC-6)(590.007) have a right to a hearing. Your request must be in writing 28. Poisonous or Toxic Materials (FC-7)(590.008) and submitted to the Board of Health at the above address 29. Special Requirements (590.009) within 10 days of receipt of this order. 30. Other DATE OF RE-INSPECTION: S 5901 V5 lFom 14.de < I lfiector' Si ure: ;:f Print: b94214- PIC's Signature: �. �/D Print: ,ZLI - ! iP h / Page of ZPages Violations Related to Foodborne illness Interventions and Risk Factors(items 1-22) PROTECTION FROM CONTAMINATION FOOD PROTECTION MANAGEMENT 1 Cross-contamination 1 590.003tA) Assignment(if onsibility* 3-30_.11(A}(1) Rain animal Foods Separated Roti -t � �90.003(B) I)ettwnstrnionofKnowledge* Cooked and RlFFoods' 2-103.11 Person in charge--duties Contamination from Raw-Ingredients 3-302.11(A)(2) Raw Animal Foods Separated from Each EMPLOYEE HEALTH Other" 2 590.003(C) Responsibility of the person in charge to Contamination from the Environment require reporting by food employees and 3-302.11(A) Food Protection* applicants* 3-30215 Washing Fruits and Ve,,edables 590.003(F) Responsibility OfA Fond Employee Or An 3-304.1.1 Food Contact with Equipment and Applicant ToRepot2 To The Person ht Utensils* -21a]Le Contamination from the Consumer 590.003(G) Reporting b Person in Char e* 3-306.14(A)(B) Returned Foci and Resei vice of Food* 3 590.003(D) Exclusions and Restrictions* Disposition of Adulterated or Contaminated 590.003(E) Removal of Exclusions and Restrictions Food 3-701..11 Discarding or Reconditioning Unsafe FOOD FROM APPROVED SOURCE Food* 4 Food and Water From Regulated Sources 4 Food Contact Surfaces 590.004(r-B) Com liance with Food Law" 4-501.111 Manual Warewashing-Hot Water 3-201.12 Food in a Hermetically Sealed Container` Sanitization Tem.eratures* 3-201.13 Fluid Milk and Mill:Products" 4-501.112 Mechanical.Ware.mashing-Hot Water 3-202.]3 ShcltP-,s* Sanitization Tem eratnres* 3-202.14 E gs and Milk Prodnets-Pasteurized* 4-501.114 Chemical Sanitization-temp.,pH, concentration and hardness, * 5-L 3-202,16 O1-11 Ice Made From Potable Ddnkfn Later* 4-60LI I(A) Equipment Fixx1 Contact Surfaces and Drinking Water from an A n'otied Svstetn' Utensils Clean* 590.006(A) Bottled Drinking Water* 4-60211 Cleaning Frequency of Equipment Food- 590.006(B) Rater Meets Standards in 310 Cb112 22.0' Contact Surfaces mid Utensils* She/!fish and Fish From an Approved Source 4-702.11. Frequency of Sanitization of Utensils and Ml.l4 Fish and Recreationally Caught Molluscan Food Con 'tact Surfaces of Fs ui meat* Shellfish* 4-703.11 Methods of Sanitization-'Hot Water and 3-201.,15 Molluscan Shellfish from NSSP Listed Chemical* Sources* to Proper,Adequate Handwashing Game and Wild Mushrooms Approved by Regulatory Authority 2-301.11. Clean Condition--Hands and Arms* 3-202.18 Shellstock Identification Present* 2-301-12 Cleaning Procedure` 590.004(C) Wild Mushrooms* 2-301.14 When to Wash* 3-201.17 Game Animals* ll Good Hygienic Practices Receiving/Condition 2401.11 Eaton ,Drink,in or Using Tobacco* 3?0211 PI Fs Received at Proper Temperatures;, 2-401.12 Discharges From the Eyes.Nose and 3-20215 Package Integrity" Mouth* 3-101.1.1 Food.Safe and Unadulterated* 3-301.12 _Preventing Contamination Whem Tastim r' 6 Tags/Records:Shelistock 12 Prevention of Contamination from Hands 3-202.18 Shellstock Identification* 590.004(E) Preventing Contamination from 3-203.12 Shellstock Identification Maintained* Em l.a gees* Tags/Records:Fish Products 13 Handwash Facilities 3-402.11 Parasite Destruction" Conveniently Located and Accessible 3-402.12 Records.Creation and Retention' 5-203.11 Numbers and Capacities* 59Q0(kl(:I) Labeling of Ingredients' 5-204.11 Location and Placement* 7 Conformance with Approved Procedures 5-205.11 Accessibility,Operation and Maintenance /HACCP Plans Supplied with Soap and Hand Drying 3-502,11 Specialized Processing Methods* Devices 3-502.12 Reduced oxp en ackaging,criteria* 6-301_11 Handwashing Cleanser.Availabilit 8-103.12 Conformance withApEroved,Procedures' 6-30112 Hand Drying Provision *Denotes critical item in the fuleral 1999 Food Code or 105 CNN 590.000- CITY OF SALEM BOARD OF HEALTH Establishment Name: Cad/01r td-twJ45� 04�" Date: n Page: CZ of Ca Item Code C-CriticalItem DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date No. Reference R—Red Item Verified PLEASE PRINT CLEARLY f -Too'L . f O Y Annj! 1 0 [� SSLWA upefn1drI 1 - i (ti,Lb n 411 rw x , P ,<I J t ) Discussion With Person in Charge: Corrective Action Required: ❑ No ❑ Yes have read this report, have had the opportunity to ask questions and agree to correct all ❑ Voluntary Compliance ❑ Employee Restriction/ 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 su - sion/revocation of ❑ Embargo ❑ Emergency Closure your food permit. ❑ Voluntary Disposal ❑ Other: 3-50L '(C) PHFs Received at'remperatures Violations Related to Foodborne Illness interventions and Risk Acoording to lAw Cooled to Factors(items 1-22) (Cont) 41'F/45".F Within 4 Hours. " PROTECTION FROM CHEMICALS Jg 3-501.15 Caatin�Methods for PHFs I4 Food or Color Additives PHF Hot and Cold Harding - 3-501.16($) Cold PRFs Maintained at or below 3-202.12 Additives* 590.004(F) 41145°F" 3-302.14 Protection from Una) roped Additives* 3-SOl.lfi(A) Hot PHFs Maintained at or above 15 Poisonous or Toxic Substances 40°F. * 7-101.11 'klentlfying Informationimation-Original 3-501.16(A) Roasts Held at or above 130°F. Containers* 7-102.11 Common Name-Workin.1 Containers* 20 Time as a Public Health Control 7-201.1 4Se_oration-Storole'= 3-501.79 Time as a Public Health Control* 7-202(1 Restriction-Presence and Use* �)O 4(H) Variance Re uirement 7-202.12 Conditions of Use" 7-?03.'11 Toxic Containers-P ohibi vns%` REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATtONS(HSP) 7-204.11. Sanitrzers,Critena-Chemicals° -- 7-204.12 Chemicals for R (shine Produce.Criteria* Zl 3-501.'(7(A) Unpasteurized Pre-packaged Juices and 7-204.14 Beverages with Warning Labels" Dt in A eats,Criteria" 1-205.I Incidental Food Contact.Lubricants* 3-801._11($) Use of Pasteurized Egos' 7-206.11 Restricted Use Pesticides,Criteria* 3-801A I(D) Raw or Partlalty Cooked Animal Food and Raw Seed S*rout s]Not Served. 7-206.12 Rodmt Bait Stations" 3-801.13(C) Unopened Food Package r%e Re-served. " 7-206.13 Tracking Powders,Pest Control and Motritorin�" CONSUMER ADVISORY TIMEfrEMPERATURE CONTROLS 22 3-603.11 Consumer Advisory Posted for Consumption of I6 Animal Foods That are Raw, Undercooked or Proper Cooking Temperatures for PHFs Not Otherwise Processed to Eliminate 3-401.11A(i)(2) Eggs- 155`F Is Sec. Patho ens* Eat Lnmedtate Service 145*Fl5see* 3-30v.13 Pasteurized F ggs Substitute for Raw Shell 3-401.11(A)(2) Comminuted Fish,Meats e&Game E e; Animals- 155°F 15 sec. '" 3-401.11(13){7)(2) Pork and Beef Roast-130°F 121 min* SPECIAL REQUIREMENTS 3-401.11.(A)(2) Ratites,Injected Meats- 155°F 15 590 0090)4D) Violations of Section 590.009(A)-(D)in sec.* catering, mobile food,temporary and 3-401.11(A)(3) Poultry,Wild Game, Stuffed PHFs, residential kitchen operations should be Stuffing Containing Fish, Meat, debited under the appropriate sections Poultry or Ratites-165°F 15 sec. " above if related to foodborne illness 3-40,1.11(C)(3) Whole-muscle,intact Beef Steaks - interventions and tisk factors. Other 1450F* 590.009 violations relating to good retail 3-401.12 Raw Animal Foods Cooked in a practices should be debited under f129- Microwave 165"F* Special Requirements. 3-401A I(A)(1)(b) All Other PHFs-145°F 15 see. * I7 Reheating for Hot Holding VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 3-40111(A)&(I)) PHFs 165°P 15 see. * (Items 23-30) 3-1493.1 l(73) Mict'owave- 165°F 2 Minute Standing Critical and non-critical violations, which do not relate to the Time* foodborne illness interventions and risk factors listed above can be 3-403.1 1(C) Commercially Processed RTE Food- found in the foilowing sections of the Food Code and 105 CMR 140°F* 590.000. -- 3-4(13.t1(E) Roasts*ng Uusliced I'ortiems of Beef Item Good d --- ractices, FC .0 0.000 Roasts* 23. Mona ement and Personnel... _ FC-2 .003 1g Proper Cooling of PHFs 24. Food and Food Protection FC-3 004 25 __ E ui rnent and Utensils FC 4 .005_ 3-501..14(A) Cooling Cooked PHFs from 140'F to 26 _ _Water, Piumhin and Waste FC 5 '_.006 70`F Within 2 Flours and From 70°F 27. Ph sical Facility FC-6 .007 to 41"F/45"F Within 4 Hours. * 28. Poisonous or Toxic Materials FC--7 1 .008 - -------------------- 3-501.14(B) Cooling PHFs Made FromAmbient 29. S ecial Re uiremonts Temperature Ingredients to 41°F/45°F 30. Other Within 4lIcursx s=,l m- `Denotes critical item in Iha federal 1999 Food Code or 105 CMR 590.000. Massachusetts Department of Public Health Salem Board of Health 120 Washington Street,4r"Floor Division of Food and Drugs Salem, MA 01970-3523 FOOD ESTABLISHMENT INSPECTION REPORT Tel. (978) 741-1800 Fax) ax 978) 745-0343 Name P ✓S� Date eon s T e of Inspection `/ rv© O Routine Address Risk ❑ Retail Re-inspection U Level E] Residential Kitchen Previous Inspection Telephone/ _ � ❑ Mobile Date:'`- /y-Q3 Owner / HACCP YM ❑ Temporary ElPre-operation iLum ti ❑ Caterer ❑ Suspect Illness Person in Charge(PIC) Time ❑ Bed&Breakfast ❑ General Complaint C- d2- In: ❑ HACCP Inspecto �jd��Xp , (/ uy c7s 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) [:1 590.009(F) ❑ action as determined by the Board of Health. :FOOD PROTECTION MANAGEMENT „, ,? ❑ 12. Prevention of Contamination from Hands ❑ 1. PIC Assigned/Knowledgeable/Duties _ EMPLOYEE HEALTH y ❑ 13. Handwash Facilities -- -- �-.. .-. PROTECTION FROM CHEMICALS , ❑ 2. Reporting of Diseases by Food Employee and PIC - v E] 3. Personnel with Infections Restricted/Excluded ❑ 14.Approved Food or Color Additives ,.FOODfROM APPROVED SOURCE El 15.Toxic Chemicals _'� � ,:,,_ ' "�� ❑ 4. Food and Water from Approved Source TIME/rEMPERATURE.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 t ❑ 8. Separation/Segregation/Protection ❑20.Time As a Public Health Control ❑ 9. Food Contact Surfaces Cleaning and Sanitizing REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) El 10. Proper Adequate Handwashing El21. Food and Food Preparation for HSP ,.CONSUMER ADVISORY " ❑ 11. Good Hygienic Practices A u.. _ ❑22. Posting of Consumer Advisories Violations Related to Good Retail Practices Number of Violated Provisions Related Critical (C)violations marked must be corrected To Foodborne Illnesses Interventions immediately or within 10 days as determined by the Board and Risk Factors(Items 1-22): of Health. Non-critical (N) violations must be corrected Official Order for Correction: Based on an inspection immediately or within 90 days as determined by the Board today, the items checked indicate violations of 105 CMR of Health. 590.000/federal Food Code. This report, when signed below 23. Management and Personnel (FC-2)(590.003) by a Board of Health member or its agent constitutes an 24. Food and Food Protection (FC-3)(590.004) order of the Board of Health. Failure to correct violations 25. Equipment and Utensils (FC-4)(590.005) cited in this report may result in suspension or revocation of the food establishment permit and cessation of food 26. Water,Plumbing and Waste (FC-5)(590.006) establishment operations. If aggrieved by this order, you 27. Physical Facility (FC-6)(590.007) have a right to a hearing. Your request must be in writing 28. Poisonous or Toxic Materials (FC-7)(590.008) and submitted to the Board of Health at the above address 29. Special Requirements (590.009) within 10 days of receipt of this order. 30. Other DATE OF RE-INSPECTION: S'590Ms IFom -fa.. ns ector's na - Print: 3 e PIC's Signature: ej _ Print: S G p Page of a Pages .r r� v �3"�� 1-13 -Oe74 Violations Related to Foodborne Illness Interventions and Risk Factors(items 1-22) PROTECTION FROM CONTAMINATION FOOD PROTECTION MANAGEMENT S Cross-contamination '1 I 590.003(A) I Assignment of Responsibility* 3-302.11(A)(1) Raw Animal Foods Separated from 590.003(B) I Demonstration of Knowledge" Cooked and RTE Foods* 2-303.11. Person in charge-duties Contamination from Raw Ingredients 3-302.11(A)(2) Raw-Animal Foods Separated from Each EMPLOYEE HEALTH Other* 2 590.003(0) Responsibility of the person m charge to - Contamination from the Environment require reporting by food employees and 3-302.11(A) Food Protection' applicants* 3-302.15 Washirig Fruits and Vegetables 590.003(F) Responsibility OF A Food Employee Or An 3-304.11 Food Contact with Equipment and Applicant To Report To The Person In Utensils* Charge" Contamination from the Consumer 590.003(G) Reporting by Person in Charge* 3-306.I4(A)(B) Returned Food and Reseryice of Food* 3 590.003(➢) Exclusions and Restrictions* Disposition of Adulterated or Contaminated 590.003(E) Removal of Exclusions and Rest fictions Food 3-701.11 Discarding or Reconditioning Unsafe FOOD_ FROM APPROVED SOURCE Food* 4 Food and Water From Regulated Sources L9 Food Contact Surfaces 590.004(A-B) Compliance with Food Law* 4-501.1.11 Manual Warewashing-Hot Water 3-201.12 Foal in a Hermetically Seated Container* Sanitization Temperatures* 3-201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Warewashim-HotWater 3-202.13 Shelf Ev s* _ Sanitiiation Temperatures" 3-202.1.4 Eggs and Milk Products.Pasteurized* 4-50t.114 Chemical Sanitization-temp.,pH, concentration and hardness. 'k 3-202.16 Ice Made From Potable Drinking Water* 4-601.11{A) Equipment Fond Contact Surfaces and 5 101.11 DrinkingWater from an Approved System" Utensils Clean* 59(W06(A,) Brittled Drinking Water' 4-602.11. Cleanim7 Frequency of Equipment Food- . 590.006(B) Water Meets Standards in 310 CMR 22.0"` Contact Surfaces and f Food- 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 Gama and Witd Mushrooms Approved by Repu,atory Authortt 2-301.11 Clean Condition-Hands and Arms"` 3-202.13 Shellstock Identification Present* 2-301.12 Cleaninv Procedure* 590.004(C) Wild Mushrooms* 2-301.14 When to Wash* 3-201.17 Game Animals* 11 Good Hygienic Practices g Receiving/Condition 2-401.11 Eating,Drinki",or Usin*'Pobawo°' 3-202.11. PHFs Received at Pieper'pent arcuates* 2-401.12 Discharges From the Eyes, Nose and 3-202.1.5 Package integrity* Mouth* 3-101.11 Food Snfe and Unadulterated* 3-301.12 Preventiae Contamination When Tastiness' 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" Em lovees* Tags/Records:Fish Products L13 Handwash Facilities 3-402.11 Parasite Destruction* Conveniently Located and Accessible 3-402.12 Records.Creation and Retentitm* 5-203.11 Numbers and Capacities* 590.004(7) Labeling of Ingredients' S-204.11 Location and Placement* 7 Conformance with Approved Procedures 5-205.11 Accesstbil tv_Operation and Maintenance 1HACCP Plans Supplied with Soap and Nand Drying 3-502.11 S ecializxtiProcessrngMethods* Devices 3-502.12 Reduced oxygen aekane.criteria* 6-301.11 Handwashin Cleanser,Availability 8-103.12 Conformance with Approved Procedures'" 6-301.12 Hand Drim�Provision ''Denotes critical item in the teaJeui! 1999 Fatd Curie or I05(.NIR 590.000_ CITY OF SALEM BOARD OF HEALTH Establishment Name: / dt 2-1001 . , if 61 Date: Page: a of _ x nem Code —C-critical nem DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date- No. Reference R-Red Item '. Verified I. PLEASE PRINT CLEARLY dow dU n/ 17L i x 4a, a / ce fit C ?Zia 92 4 .E[/ r't/ r 6�-,4' — '.to2 /;! fp s i l 1 Zt2 4: L A 7 n alis / /t9tidG�+Xs/IrN9' i r ,E'A171 SV P, (fit Discussion With Person in Charge: Corrective Action Required: ❑ No n 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 ❑ Re-inspection Scheduled ❑ Emergency Suspension comply with all mandates of the Mass/Federal Food Code. I understand that nonC,ompliance may result in daily fines of twenty-five dollars or suspension/revocation of ❑ Embargo L) Emergency Closure El your food permit. "" - p ❑ Voluntary Disposal ❑ Other: 3-50L14(C) PHFs Received at Temperatures Violations Related to Foodborne Illness Interventions and Risk According to Law Cooled to Factors(items 1-22) (Cont.) 41'F45'F Within 4 Hours. PROTECTION FROM CHEMICALS 3-SO f.1519 CoolowMethods'for PHFs 14 Food or Color Additives PHF Hot and Cold Holding 3-501.16(13) Cold PHFs Maintained of or below 3-202.12 Additives* 590.004(F) 41'/45'F* 3-302.14 Protection frcun'Unan.roved Additives* Poisonous or Toxic Substances 3- 501.16(A) Hot PF[Fs Maintained at or above 15 140°F. * 7-101.11 Identifying Information-Oxigina( 3-50 L 16(A) Containers* Roasts Held at in above 130'F. 7-102.11 Common Name-Working Containers` 20 Time as a Public Health Control 7-201,11 Separation-Slot aize 3-50119 Ti me as a Pub]is Health Control* 7-202.11 Restriction-Presence and Use* 590.004(17) VarianceRecuirement 7-202.12 Conditions of JJ se* 7-203.11 Toxic Containers-Prohibitions* REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-204.11 Satutizers.Criteria-Chemicals* POPULATIONS(HSP) _ - 7-204.12 Chemicals for Washing Rndnce. Criteria* 21 3-SOL i 1(A) Unpasteurized Pre-packaged Juices and 7-204.14 Drying Agents,Criteria* Beverages with Warning Labels* 7-20511 Incidental Food Contact,Lubrcants* 3-801.11(8) Use of Pasteuriied 7-206.11 Restricted Use Pesticides,Criteria* 3-80t.I I(D) Raw or Partially Cooked Antinial Fond and Raw Seed Sprouts Not Served. r 7-20fi.12 Rodent Bait Stations* Raw Uno-ened Fcxxl Packs>e Not'ke-served. 7-206.13 Tt ackm,;Powders, Pest Control and Monirorine' CONSUMER ADVISORY TIME[TEMPERATURE CONTROLS 22 3-603.11 Consurner Advisory Posted for Consumption of 1.6 Proper Cooking Temperatures for Animal Foods That are Raw,Undercooked or PHFs Not Otherwise Processed to Elitninute 3-401.11 All)(2) Eggs- 155°F 15 Sec. Pathogens.4 """11 -amt L_ s-Immediate Service 14.517 15see`R 3-302.13 Pasteurized Fogs Substihne for Raw Shell 3 401.11(A)(2) Comminuted Fish.Meats&Game Animals-1553F 15 sec. I` 3-401.11(H)('1)(2) Pork and Beef Roast- 130'F 121 min* SPECIAL REQUIREMENTS _ 3-401.11(A)(2) Ratites, Injected Meats- 155'F 15 590.009(A)-(D) Violations of Section 590.009(A)-(D)in See . catering,mobile food,temporary and 3-401.11(A)(3) Poultry,Wild Game.Stuffed PHFs, residential kitchen operations should be r Stalling containing Fish,bleat, . i _; biicd to der the ayyrnja is Poultry or Ratites-165'F 15 sec. * above if related to foodborne illness 3-401 A l(C)(3) Whole-muscle, Intact Beef Steaks interventions and risk factors. Other 145'F 590.009 violations relating to good retail 3-401.12 Raw Animal Foods Cooked in a practices should be debifed under #29- Microwave 165`F* Special Requirements. 3-401.11(A)(1)(b) All Other PHFs- 145'F'15see. 17 Reheating for Hot Holding VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 3-403.11(A)&(D) PHFs 165°F 15 see. * (Items 23-30) 3-403.11(B) Microwave-165'F 2 Minute Standing Critical and non-critical violations, which do not relate to the Time* foodborne illness interventions and risk faclors listed above, can be 3-403.11(C) Commercially Processed RTL'Food- "found in the fallowing sections of the Food Cade and 105 CAIR 1400F* 590.000. 3-403.11(E) Remaining Unslieed Portions of Beef t Item iGcod Retail Practices lzc 590.000 Roasts' _23 Management antl Personnel i FC-2 .003 1R Proper Cooling of PHFs �24 1 Food and Food Protection! FC-3 .004 25 Equipment and Utensils FC 4 .005 3-501.14(A) Cooling Conked PHFs front 140 E to 1 26 Water,Plumbinq and Waste FC 5 _ .006 70'F Within 2 Hams and From 70°F7. Ph steal FacilityFC-6 .007 to 41`F145°F Within 4 Hours- ` ! 28. ! Poisonous or Toxic Materials FC-7 760'81 3-501.14(B) Cooling PHFs Made From Ambient 1_ze_ Special R�eruirements .009 Temperature Ingredients to 4I'FJ45`F . 30. Other Within 4 Hours* *Dangles critiatl stern in nre'tederal 1999 Food Code or 105 CMR 594,000. IMPORTANT MESSAGE FOR DATE TIMEZZ M _ OFL:� � PHONE AREA CODE NUMBER EXTENSION ❑ FAX ❑ MOBILE AREA COO E NU BER TIME TO CALL TELEPHONED PLEASECALL CAME TO SEE YOU WILL CALL AGAIN WANTS TO SEE YOU RUSH RETURNED YOUR CALL WILL FAX TO YOU MESSAGE SIGNED Y_�� MADE M U0S. . NOTES +.pr r.P.'4 4Y LJ. y;lM im'( y�iJa 4 f YaStrR .�q,` T^ '+M.crr•u Rh rYl(. ."3t y1i�'�?^ °l` ll'Wl'; ? fi n'` '` _ ' ' -m w CITY OF SALEMg MASSACHUSETTS nr BOARD OF HEALTH 120 WASHINGTON STREET, 4TH FLOOR SALEM, MA 01970 .� TEL. 978-741-1800 FAX 978-745-0343 STANLEY J. USOVICZ, JR. JOANNE SCOTT, MPH, RS, CHO MAYOR HEALTH AGENT COMMONWEALTH OF MASSACHUSETTS PERMIT TO OPERATE A FOOD ESTABLISHMENT In accordance with regulations promulgated under authority of Chapter 94, Section 305A and Chapter III, Section 5 of the General Laws, to operate a Food Establishment in the City of Salem is hereby granted to: Type of Establishment: FOOD SERVICE Name of Establishment: Court House Deli Address of Establishment: 60 Washington Street Owner's Name: Suzanne Hensley Restrictions: Application Date: 12/2/2004 Permit for Food Establishment 118-05 Frozen Desserts/Ice Cream Permit for the Sale of Tobacco Products These Permits Expire December 31, 2005 This permit is not transferable and must be reissued upon change of ownership or location. The permit must be posted in a prominent location in the Establishment, In accordance with the State Sanitary Code, before any renovations, improvements, or equipment changes are made, all plans for such must be submitted to and approved by the Salem Board of Health. HEALTH AGENT 1� CITY OF SALEM, MASSACHUS \�A „ BOARD OF HEALTH 4V9/ a120 WASHINGTON STREET, 4TH FLOG SALEM, MA 01970 NOV 3 0 TEL. 978-741-1800 2004 FAX 978-745-0343 STANLEY J. USOVICZ, JR. JOANNE SCOTT, MPH, R5, CHO CITY OF SALEM BOARD OF HEALTH MAYOR HEALTH AGENT 2005 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT NAME OF ESTABLISHMENT (,OC2(�lk0c,`�SC L J _ 1 ` TEL# Q Z?—Z 111,P3 ADDRESS OF ESTABLISHMENT CEJ WZXS� 1'0 5-40" Sf S_�eS MAILING ADDRESS (if different) OWNER'S NAME ('(.Z_/ {'l y'I e- n 5 /T�TEL# ADDRESS Cl. CITY �x_�P_vri STATE— Q. ZIP n /9 7dA CERTIFIED FOOD MANAGER'S NAMES) g( 7UtivP/ / 4,.0BERFICATE#(s)__ �5 (required in an establishment where potentially hazardous food is prepared.)) EMERGENCY RESPONSE PERSON &A ;Z(A ) �ti S I e V HOME TEL# 7k— S- S3 HOURS OF OPERATION: Mon. ✓Tue. --'Wed. ✓Thu._ Fri.—J,,elSat. v Sun. 0C t 0k7 TYPE OF ESTABLISHMENT FEE check only RETAIL STORE YES NO less than 1000sq.ft. =$ 50 1000-10,000sq.ft. =$100 more than 10,000sq.ft. =$250 RESTAURANT YES NO less than 25 seats =$100 / 25-99 seats =$150 more than 99 seats =$200 BED/BREAKFAST YES NO $100 ADDITIONAL PERMITS MAKE (not just serve) ICE CREAM, YOGURT, SOFT SERVE YES $5 TOBACCO VENDOR YES y� $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 beliea sled all stale tax returns and paid all state taxes required under the law. Signatur /�, 7,0 V Date 61 Social Security or Federal Identification Number -------------------------------------------------------------------�-.-s-.c------------- --'/- -_----- "Lt6 - Revised 11/03/03 FOODAP2.adm Check#&Date 7� L1_—��0 T _ ,��axolr CITY OF SALEM, MASSACHUSETTS v�' '� BOARD OF HEALTH .t 120 WASHINGTON STREET, 4TH FLOOR a a I �` SALEM, MA 01970 a` ��- - TEL. 978-741-1800 �J'�'� 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 : Suzanne Hensley Name of Establishment : Court House Deli Address of Establishment : 60 Washington Street Type of Establishment : FOOD SERVICE Application Date : 01/13/2003 Restrictions : Permit for Food Establishment 253-03 Frozen Desserts/Ice Cream Permit for the Sale of Tobacco Products These Permits Expire December 31, 2003 This permit is not transferable and must be reissued upon change of ownership or location. The permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code, before any renovations, improvements, or equipment changes are made, all plans for such must be submitted to and approved by the Salem Board of Health. HEALTH AGENT - / ` .� CITY OF SALEM, MASSACHUSETTS BOARD OF *sAcrx 120 WASHINGTON srnccr, «rx pt_oov s^Lc*. mAo| ero ` TeL 978'7v/-/ 800 `===, FAX X78-745-0343 sr^NLs, usov/c'. Jv. Jo`wxsSCOTT, MPH, e� cxo wArop osxLrxaocVr 2DQ3APPLICATION FOR PERMIT TO OPERATE /\ FOOD ESTABLISHMENT NAME OFESTA8 S ADDRESS OFESTABLISHMENT 970 MAILING ADDRESS (if different) ADDRESS CITY STATE ZIP OZ (required in an establishment where potentially hazardous food is prepared.) ^-----~--- EMERGENCY RESPONSE PERSON 4�41'/ v7» �f /'x7 _--' — '—��_— HOURS OF (}PERAT|ON� Mon. ue, d. hu. ' Fri. n|TYPE OF ESTABLISHMENT ---- FEE check only RETAIL STORE YES NO less than1U00aq.ft. =$ S8 1080^10.088sqft =$10O more than 1O.U0Ooq.ft. =$250 RESTAURANT YES NO z�; ~7 ^/ less than 25seats =$100 25-99 seats =$150`' an 98 than ~ more seats �$2O0 BED/BREAKFAST YES NO $100 ADDITIONAL PERMITS MAKE ICE CREAM, YOGURT. SOFT SERVE YES NO $5 TOBACCO VENDOR YES NO $50 | ! ALL NON-PROFIT(such aschurch kitchens) YES NO %25 ! Please pay total with one che,;k payable tothe City ufSalem This Permit is not transferable and must be reissued upon change of ownership. The Permit must be posted immprominent location iwthe Establishment. {naccordance with the State Sanitary Code, before any renovations, improvements, or equipment changes are made, all plans for such must besubmitted tmand approved bythe Salem Board of Health. Pursuant to MGL Chapter 62C, Section 49A, I certify under the pains and penalties of perjury that 1, to my best knowledge and belief, have filed all state tax returns and paid all state taxes required under the law, •r.r .r `�•vr�.�-'srs/>bM++7�rWwi'_'..., v«i �,m+ryY"/usJ'±n..w.wM++n,�c:"fyYr'�`^"a...-rr..-c.ei...t+ry+�.vk�+:r.=v..*.+win...l+.A:. -FHE 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 Type ofOJleration(s) 'Tvge of Inspection P Food Service `p Routine AddressRis ElRetail ElRe-inspection t�np Level � ElResidential Kitchen Previous Inspection Telephone y' _ _ yh7( ❑ Mobile Date: Owner / HACCP Y/N" ❑ Temporary ❑ Pre-operation El Caterer ._._4S ❑ Suspect Illness Person In Charge(PIC) Time00El Bed&Breakfast ElGeneral Complaint In: [IHACCP Inspector Out: Permit No. ❑ Other Each violation checked requires an explanation on the narrative page(s) and a citation of specific provision(s) violated. Non-compliance with: Violations Related to Foodborne Illness Interventions and Risk Factors (Red Items) Anti-Choking Tobacco Violations marked may pose an imminent health hazard and require immediate corrective 590.009(E) ❑ 590.009(F) ❑ action as determined by the Board of Health. Local Law ❑ FOOD PROTECTION MANAGEMENT ❑ 12. Prevention of Contamination from Hands ❑ 1. PIC Assigned/Knowledgeable/ Duties ❑ 13. Handwash Facilities EMPLOYEE HEALTH PROTECTION FROM CHEMICALS ❑ 2. Reporting of Diseases by Food Employee and PIC ❑ 14. Approved Food or Color Additives ❑ 3. Personnel with Infections Restricted/ Excluded ❑ 15. Toxic Chemicals FOOD FROM APPROVED SOURCE TIMEITEMPERATURE CONTROLS(Potentially Hazardous Foods) El 4. Food and Water from Approved Source El 16. Cooking Temperatures El 5. Receiving/Condition El6. Tags/ Records/Accuracy of Ingredient Statements El 17. Reheating [17. Conformance with Approved Procedures/ HACCP Plans E] 18. Cooling ❑ 19. Hot and Cold Holding PROTECTION FROM CONTAMINATION ❑ 20. Time as a Public Health Control ❑ 8. Separation/Segregation/ Protection REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) ❑ 9. Food Contact Surfaces Cleaning and Sanitizing ❑ 21. Food and Food Preparation for HSP ❑ 10. Proper Adequate Handwashing CONSUMER ADVISORY ❑ 11. Good Hygienic Practices ❑ 22. Posting of Consumer Advisories Violations Related to Good Retail Practices (Blue Number of Violated Provisions Related Items) Critical (C) violations marked must be corrected To Foodborne Illnesses Interventions \�J 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 4. 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: Print: - PIC's Signature: &* „i Print Pagelof G.Pages FORM 734A HOBBS&WARREN '-BOSTOe 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 w1.=' 590.003(A) Assi nment Of Res onsibilit * Cooked and RTE Foods* H590.003(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 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 Charge* Contamination from the Consumer 3-306.14(A)(B) Returned Food and Reservice of Food* 590.003(G) Reporting by Person in Charge* Disposition of Adulterated or Contaminated 3: 590.003(D) Exclusions and Restrictions* Food 590.003(E) Removal of Exclusions and Restrictions 3-701.11 Discarding or Reconditioning Unsafe Food* FOOD FROM APPROVED SOURCE 9) Food Contact Surfaces 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 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* 4-703.1 I Methods of Sanitization- Hot Water and 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* Sources* `<..10' Proper,Adequate Handwashing Game and Wild Mushrooms Approved by 2-301.11 Clean Condition-Hands and Arms* Regulatory Authority 2-301.12 Cleaning Procedure* 3.202.18 Shellstock Identification Present* 2-301.14 When to Wash* 590.004(C) Wild Mushrooms* 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* .12Prevention of Contamination from Hands 6 Tags/Records:Shellstock 590.004(E) Preventing Contamination from 3-202.18 Shellstock Identification* Employees* 3-203.12 Shellstock Identification Maintained* 13 Handwash Facilities Tags/Records: Fish Products Conveniently Located and Accessible 3-402.11 Parasite Destruction* 5-203.11 Numbers and Capacities* 3-402.12 Records,Creation and Retention* 5-204.11 Location and Placement* 590.004(7) Labeling of Ingredients* 5-205.11 Accessibility,Operation and Maintenance 7` Conformance with Approved Procedures /HACCP Plans Supplied with Soap and Hand Drying Devices 3-502.11 Specialized Processing Methods* 6-301.11 Handwashing Cleanser,Availability 3-502.12 Reduced Oxygen Packaging,Criteria* 6-301.12 Hand Drying Provision 8-103.12 Conformance with Approved Procedures* •Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. CITY OF SALEM ^B�ntOARD OF HEALTH Establishment Name: COy z NwC t Date: 03 Page: of Item Code C-Critical item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date i No. Reference R—Red Item - - Verified PLEASE PRINT CLEARLY `ti�n�- �c� �icl�L,'Z✓l 1ZtxY\ CC�C� �S-'�" �3f�5 l.�t-iC/7 97 ZN AX-(7 `` c-6 -kc-o 4Fk- k-. 6-E : 75 � c� z �n s 05= s (P S� trr3,`n S - KIC 6{ 4\\ T ca-(Z"7t cam ey50� i 5 n. \ r c>n -ro � r)�� rn ir1c� � � 2 c'✓ � t r tx�S . yvA6C 67 ?<1 IZcT7 G`� C� JhOJ�� Gv1c G� . _ Discussion With Person in Charge: Corrective Action Required: ❑ No ❑ 111on S 1 have read this report, have had the opportunity to ask questions and agree to correct all ❑ Voluntary Compliance ❑ Employee Restricviolations before the next ins ection, to observe all conditions as described, and to Exclusion p ❑ Re-inspection Scheduled ❑ Emergency Suspecomply with all mandates of the Mass/Federal Food Code. I understand thatnoncompliance may result in daily fines of twenty-five dollars or suspension/revocation of ❑ Embargo ❑ Emergency Closu your food permit. ❑ Voluntary Disposal ❑ Other: �S C l rti 3-501.14(0) PHFs Received at Temperatures Violations Related to Foodborne Illness Interventions and Risk According to Lain Cooled to Factors(items 1-22) (Cont.) 4I'F/457 Within 4 Hours. PROTECTION FROM CHEMICALS 3-50115 CoolingMethods for PHFs 14 Food or Color Additives 19 PHF Hot and Cold Holding 3-202.12 Additives* 3-501.16{B) Cnld PHF,Maintained at or below -302.14 Protection from Unat roved Addi[ives'x i90.004tF) 41'05'F� 3-50 L Poisonous or Toxic Substances 16(A) Hot PIFs Maintained at or above IS ' 7-101.11 ]den fang[ntormn140`F tion-Oripnal 1 3-501.16(.A) Roasts Held at or above t30'F. Containers" ZQ Time as a Public Health Control 7-102 i1 Common Narne-Working Containers'" 7.201.11 Se aration-Storage"` 3-501.19 Time as a Public Health Control* 7-202.11 Restriction-Presence and Use" 590.004(H) Variance RecuSrement 7-202.12 Conditions of Use, 7-203.11 Toxic Containers-Prohibitions'' REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-204.11 Sanitizets.Criteria Chemicals- POPULATIONS(HSP) - 7-204.11 Chemicals fw-Waehin=Produo,e Criteria* 21 3-801.11(A) Unpasteurized Pre,p ckaged juices and Beverages with Warning Labels* 7-204.14 �Drvim�Agents, Giterra* 3_80L1I(B) Use of PasteurizedEggs* 7-205.11 Incidental Food Contact,Lubricants* 7-206-11 Restricted Use Pesticides,Catena 3-801.11(D) Raw or Partially Cooked Animal Food and 7206.1.2 Rodent Bait Stations*' Raw Seed Sprout,Not Served. 3-801.11(C} UnFood Package Not Ite-sen'ed. 7-207-206.13 Traekmg Powders,Pest Control and -2Ene - Monitoring- CONSUMER ADVISORY TIMEITEMPERATURE CONTROLS 22 3 603.17 Consumer Advisory Posted for Consumption of I6 Proper Cooking Temperatures for Animal Foods That r Raw,Undercooked w' PHFs Not Otherwise t se Processed ro Eliminate 3-401.11A(1)(2) Eggs l55'F 15 See. Pathogens."; hi-s-Immediate Service 14�oFl Ssec* 32102.13 Pasteurized F,;s Substitute for Raw Shell 3 401.11(A)(2) Comminuted Fish,Meats&Game Animals-155'F 15 sec. 3-401.11(13)(1)(2) Pork and Beef Roast- 13(YF 121 turn* SPECIAL REQUIREMENTS 3-401.1 i(A)(2) Ratites, 6tjected Meats-1.55°F 1 590.009(A)-(D) Violations of Section 590.009(A)-(D) in sec * catering mobile food, temporary and 3-40111(A)(3) Poultry,Wild Game.Staffed PHF,, residential kitchen operations should be Stuffing Containing Fish,Meat, debited under the appropriate sections Poultry or Ratites-165'F 15 sec. * above if related to foodborne illness 3-401 A I(C)(3) Whole-muscle, Intact Beef Steaks interventions and risk factors. Other 145°F* 590.009 violations relating to good retail 3-401.12 Raw Animal Foods Cooked in a practices should be debited under 4129- Microwave 165`F* Special Requirements. 3-401.11(Atf)(b) All 0tber PHFs- 145°F15 sec. * 17 Reheating for Hot Holding V10LAT/ONS RELATED TO GOOD RETAIL PRACTICES 3-403.11(A)&(D) PHFs 165`F 15 sec. " (Items 23-30) 3-103.11(13) Microwave-165'F 2 Minute Standing Critical and non-critical violations, which do not relate to the Time* ,foodborne iltuess inlervenrions and risk factors listed above, can be 3-403.11(C) Commercially Processed RTE Food- found in the]`olicm,ing sections of the Food Code and 105 GYTR 14WIF! 590.000. 3-40'.II(E) Retraining Unsliced.Portion.,of,Beef Item Good Retail Practices FC 590.000 Roasts` _23 _Management and Personnel '.. FC-2 .003 lg Proper Cooling of PHFs 24 Food and Food Protection FC 3 .004 -, - - 25 Equipment andd FC Utensils _ _ FC 4 -- --- 70'F 3-501.14(A) Cooling Cooked PFIFs from 140`F to 26 W ti er Plumbin and waste FG 5 .006 70'F Within 2 Hours and From 70'F 27. Physical Facility FC-6 .007 to 41°F/45'17 Within 4 Hours.* 28. ! Poisonous or Toxic Materials FC-7 .008 3-501.14(B) CoolingPHFs Made From Ambient 29- Special Requirements_ _ - .009____-f Temperature Ingt-ediems to 41'F145'F 30, -Other Within 4 Hours*. 'Dcnolea critical item in(tae federal 1999[-tied Code or 10i CMR 590.000. COURT DOCKET NO. CITATION NO. CITY OF SALEM �• VIOLATION NOTICE PD 1167 NAME(LAST,FIRST,INITIAL) e,± e STREET ADDRESS / �L (-CITY/TOWN STATE ZIP LICENSE NO. LIC.EXP.DATE DATE OF BIRTH OWNER'S NAME(LAST,FIRST,INITIAL) STREET ADDRESS CITY/TOWN STATE ZIP REGISTRATION NO. STATE EXP.DATE MAKE/TYPE YEAR COLOR DATE OF VIOLATION TIME DATECITATION WRITTEN PER50W El Am iwuev Li Pm El YES LOCATION OF VIOLATION C'041,07- )4 6, yj— ENFORCING DEPT. OFFENSE �u.�e JL%7'n/�f /R/.-t CHAP. SECT. FINES y c B C OFFICER/ � I. TOTALF NE $ ✓ /�,'t'rit+ (S DUE OFFICER CERTIFIES C PY GIVEN TO VIOLATOR ❑ IN HAND XiV-��-'�i! ,G. El MAIL DO NOT MAIL CASH-PAY ONLY BY POSTAL NOTE,MONEY ORDER OR BY CHECK MADE PAYABLE TO: CITY CLERK CITY HALL 93 WASHINGTON STREET SALEM,MA 01970 TEL.(508)745-9595 X 251 1 HEREBY ELECT TO EXERCISE THE FIRST OPTION AS STATED ON REVERSE, CONFESS TO THE OFFENSE CHARGED,AND ENCLOSE PAYMENT IN THE AMOUNT OF $ CASE# SIGNATURE SEE OTHER SIDE FOR FURTHER INFORMATION ENCLOSE PAYMENT IN THIS ENVELOPE,PEEL AND SEAL Y ��y,�yy�. yy1AAvv .Y{ - .o.�:'am.:.'-r.+dN+c.' O�04'�fbl�3'�iRi�YSW'3kS£IS2YMSt4 c5r�� yr i r 'ri L•Y�py.' n ?J ay'a'`r wf `r' ,' t-x + <. iHb.u, ,a,p(a •`*'. laa��VE KB�a zx. NG •N r a ' ¢w,e n?`a.� *x s ° r d ,' i SOVEREIGN BANKNEWENGLAND ; + ' <^' v i CHESTNUT TS REST INVESTMENTS, , ;,,A DIVISION OF SOVEREIGN BANK v nx vt� in.y:}t s a fetes c DBA IN A PIG'S ENE > %. 5-7515/110 saa v <. ,i"•w da.. w^.am a', xx `"fr^f . s + t w% ,/ d x r?x +fir 148 DERBY$TREET r t Tm ' v �a'4f "r kt �°,�h'si,'a"'"1 ' A s.SALEM' MAr0191U> "p ' d «E�ir .,,1, •7t � a�rxrT �"S4rm�.»n-A v+s yr d ml {s ,,m sf.¢•;. Ye -kF-fp ae P� �-�*^o-xwS ro� - {� � r'TO. � T* �` anrtr �i xa3kroPx di» _ 'w+'w."�G "e'vkt"ih � Ax..,t.5 Y h zkt /�•y/�/ I� 4 'y c PAY TO.THE• �+rt`v Err > •a*e-. '� •=s <y a+w�s � ;.; ORDER OF 7�a•,„, . A1`1 DOLLARS F "*>. I e% Omk,��/A� �/ i/ i r �I.A. .at 1'i++t� r4skCa is ,✓ ;:s' .�". ,w '' F.. r,} x kldvu c x = .+ lr - .>ks. .* way. r `n, t v i •rc - �t d}. ?><. * sl (Y�� a ^Ya Rr matey -ro" B "r lr v. . n do !> Sdb to ##�� ,ox .a��f +. i {21. rm✓+,C,YutW w -M '""' � s,ro r nE.C` dd W�, REET INVESTMENTS, 44 CHESTNUT ST . f ,A' + x I i5r +•' J MEMO i4.... � �• �`I RWS0. i9P �.. N _ u'01&t3211' r01L075L50i: ' 7i0f]00Lii071I' « luf SJ r r � ....-.»e•......r. +�w,�.ww+nw»-� -- ,Ra 4 r t�,� s'- 'rn' I. f t�.G 1'r*.,s �`d tV' ti a s #�. ♦ x m r g t s�nr �c 4rfr 1f�° * v ;r kt ff = h.`�. fr r C✓ i k' �,tw'.IEG at y I m w ,DiE 2 4 '> '}+ i W O W ; l f� Q00 tirx pFQtri .rry. y�tt yN ut..,«o ;d+ rpt. ¢O ❑ z7 `r•4fr ❑ �:�NW tZ¢Nw Z p Sf 1 'r xrtvs "rn .e r. 'u + frCk".. wa' a aQZ +.�. :Q , . O.K < ,.-,.: u'� �, it a y:ER s z W W fW.f .-^�` r kgt \w vq,N; M i O .,i rx .W W > ma O ''w W �.. § . ¢ r F. A. x ¢ c r( # .. ¢ , a<w g W Q G «.. Z ,3s. ,'. . O W '...0 a w:a -w n•. J F 3: f' Y� fir �i 4 trta[ 5 F F-Z� O i41Gxf IMA 'hl..I- RU r `S O rn O—m ¢ t,r ¢ ZW �, ) 'r -: 0# O¢ Z i�^ z Alj s+��, .q x�'F �T „1 a Z't.'NF+.. to l- !d fs�u"` 2 N . wl. 7ir'S� ,,hh..i> a r SOI^W Wtd r OW ""ifW.lt� 2U .W � v LLp �1, 3p� o ..,KV o"S''' Tn istti �� 1 1 z+r.. > �. am nt`rI¢. x ¢w � �i O Or. Tx Y tfjj fnw, E, F r q f7 > 3! \\ rta'r a x } Zam ww .� Z u'ls... d ae•' i sY p ix- O v� fa y� °f # .. fs.. '� W y O > oo,iii Qn wO Ett ��M !'p' u y�j v. v1 tl,kt aZ Jay�o U=w O F fi m .�' W[ .h'�. QQ Y ti'.' w `a h ._.. 'L lfl Q Q .. Z 1 s , k f r LL Yv Qw war - w _ p .� .. axoz � � F.W .«P• ¢x� �-N)n m CU Q i 00 a 1ar F �zo r• a m LL= uj w4z R z Ur '• �0 JOF pW n o g w 1 LL o¢+ wUz W y ~„ - Y nl O 3 LL �+M- Z p O OP S a w w `V LL O y ¢� O Y^ 029t"+ir a+ mm� yr m I xl >n Wr ti 0Ogj + wmw . r :�w O.z w a a», o ).t a A w : -., O r s�-�• �` t m w w. a - Z i s'r f u ¢ \� _ t . . qs�M a LLrl , r LL i 7ra4'� ,udd. �rt7Y >ti =W r• U R T N J O NC! `r ¢1 e'1 ❑ J O Q ) N U _ 11RT DOCKET NO'1 T -�' y, : ,E. z �"�"'4S�'Y�'rt a 1 t t• ,R- / .Sgat LATIONNdPYx NAJAE,(LAST FIRST;}NRNL) 57 STREETADDRESS .y CITV//OWN STATE ZIP i s M: I i tyk i :1.(�8- cS ,.` .�: : , =:.0 9 () r } 1�7�f S s 1� �+` .vJ lc LICENSE NO. .LIG EXP.DA E DATE OF BIRTH r •4`. { .� D ca CA _ fir. ; 'k 1 }�} pk i x"/-=�Deaq' F>E * O R'S NAME(LAST,FIRST,INITIAL) 0 a)C�D x102 moCZt/ RI = S EETADDRESS CITY/-OWN STATE ZIP o l.F REGISTRATION NO STATE EXP DATE. .MAKERYPE C ! YEEARAR COLOR - Q S ! J l t _ aFri ' ulommlN1. £ DATE OF VIOLATION TIMEDATE CITATION WRITTEN !, Y�. Iwu LJYES � E]Am o.,l—B: .-03 OPM I-D O�"s' L❑J NO' ; ! {{ ` �k X, 1M1 (� I CATION OF VIOLATION (t '7— /IENFORCING DEPF •, i5t M3 i t l OFFENSE�/Ij /D n.� / CHAP.SECT , NES ( iA l{hal t A J }�'fhT fpSJ ) { f"l4 b`'t fYt _a t OFFICER TOTA 'J G FINE V ® !s "( - DUE i , 1.1a r OFFICER CERTIFIESCOPY GIVEN TO VIOLATOR s Cr, ) 's � ! fl`.V� � 0.1 ti - E t t a k< IN ND" 4 t.`3 Fr sf BY MAII- L •- -; ,.00 NOT MAIL CASH`PAY ONLY BYPOSTAL NOTEMONEY ,. ,f-F {° c 111 %11 rti r ORDER OR BY CHECK MADE'PAYABLE TO. _ Ct 1 ©a� CIN CLERK CRY HALLb�t, ( 93 WASHINGTON STREET y; .,c �}( t t 'TELMA01970 TEL:(509)745-9595 X-251 dHEREBY ELECT TO EXERCISE THE FIRST OPTION IbS STATED ON ""�iIAeF �} 5 - ;REVERSE,CONFESS TO THE OFFENSE:CHARGED,RND`ENCLOSE t PAY.MENT.IN THE AMOUNT OF CASE# .- IGNATURE SEE,OTHER-SIDE FOR FURTHER INFORMATION ,) .v ENCLOSE PAYMENT IN THIS ENVELOPE,'PEEG AND SEAL' e " 5 I A izd,S,M' $� e€r� At � Jt.� .13?r . .+ a•.._ .f, v3�r k{, i £ 4'A�$ C.�.s r;� # i'4-:i;I COURT DOCKET NO. CITATION NO. • CITY OF SALEM PD q q 11 CJ c VIOLATION NOTICE. NAME(LAST,FIRST,INITIAL) �L STREETADDRES ��. CITY/TOWN STATE ZIP DSk D LICENSE NO. LI .EXP.DATE DATE OF BIRTH OWNER'S NAME(LAST,FIRST,INITIAL) L STSEETADDRESS CITY/TOWN STATE ZIP o e�ol9�Lucr_Lc�i.-Lq��"�$'fJ ,QZ�em7'YI�c. v!9'Y REGISTRATION NO. STATE EXP.DATE MAKE/TYPE YEAR COLOR DATE OF VIOLATION TIME DATE CITATION WRITTEN PERSONAL AM IMURY ❑YES ❑PM —03 [-1 NO LOCATION OF VIOLATION U,�`�- �.� ENFORCING DEPT. L� o ctLr OFFENSE T P.CHASECT. FINES r u P ti °S 6 B C OFFICERI.D.NO. TOTALFINE @@ J` l/ DUE W /DO OFFICER CERTIFIES COPY GIVEN TO VIOLATOR ❑ IN HAND X �J' �lXf (�Q/ El AIL MAIL DO NOFT MAIL CASH-PAY ONLY BY POSTAL NOTE,MONEY ORDER OR BY CHECK MADE PAYABLE TO: CITY CLERK CITY HALL 93 WASHINGTON STREET SALEM,MA 01970 TEL.(508)745-9595 X 251 1 HEREBY ELECT TO EXERCISE THE FIRST OPTION AS STATED ON REVERSE, CONFESS TO THE OFFENSE CHARGED,AND ENCLOSE PAYMENT IN THE AMOUNT OF $ CASE# SIGNATURE SEE OTHER SIDE FOR FURTHER INFORMATION ENCLOSE PAYMENT IN THIS ENVELOPE,PEEL AND SEAL CRATION NO. CITY OF SALEM pry e+ +�:,r>tn VIOLATION NOTICE . ` p> a M O 90!:Sg 1' .t.�}i ISM MX ETADDRESS - CflYf10w�N STATE"- ' ZIP m - - VY li0 gla's y1i Oji V, lGNr kz Z LICENSE NO. UC EXP DATE DATE Of BIRTIi 'ik .. ; OWNERS NAME(LAST F7 M17m) p vvllLk-rrc� C' i mm to S ET DDRESS CITY,70NM STAT .ZIP G, Q At D m l�aa�a�sl�s �y/ Sf $dem /rrd mt97 <v 5EG15RiAnoN rio; ssTaTE EaP'paYE " `` - `{;'s -'$ ' a F y«R, Url IsS �omTnmi RATE OF VIOLATION TIME "'A DATE ORATION WRRTEN �wu"aa'N' !. Ei� ry bvEs — m I OC3 oPM -OZ d3 ONO Z LOCATION OF VIOLATION QCIL( EN RCING DEPT - i• —{ O / qN OFFENSE r CHAR'SECT E r' Z . f", to , 1.7 J SNE U t OFFICER CERTIFIES COPY GIYENTO,',JIOLATOR p HAND : �* x 14 a e ri'3k I . :Q s O ❑ BY MAIL 5,;o DO NOY MAIL CASH-PAY ONLY BY POSTAL NOTE;MONEY r. z z li ORDER OR.BY CHECK MAGE PAYABLE TO ,k s ,y s-r .✓ t �s x at >�sr �-�'0* M a asctrrctiER a ' GIfY HALL �:, e ,�eyxi7 t'xca -.aR * u"`Tn ', :93 WASFiINGiT1N STREEC - -Q :? .TEL S1970 N9 7ALEM MA¢5,9595-X 251 .� iI .. . t ) 1 HEREBY ELECT TO EXERCISE THE FIRST OPTION AS STATED ON .a 'O ,.I TiEVERSE,CONFESS TO THE OFFENSE'CHARGED;ANb ENCLOSE._. .4. AYMENT7N THE AMOUNT OF _ - -CASE# C r .. GNATURE 77 SEE OTHER SIDE FOR"FURTHER INFORMATION 'ENCLOSE PAYMENT IN THIS ENVELOPE,PEEL AND SEAL "I�n ` y , Z {4 ti r ki I n p 4 SBO-`ARD OFE�ALT • 1p .a 1 • �R 7>20 WnsHi' GTO l T.REETh^"4TH Opf 9,+70r TEL 9�787,h4"1i800f� RA w � +' ��"� d` '"gy"�k FAX978 745 0343rr#i, ^'� av N� '� etc ,y.} 3•� 5TANLEYY`USOVICZv3 ,. `J R" sir r+,`y{ A..�c^a -�S` �"i'$,' - i 'w•- ,� �R�� C1=10 � ,. r ��r � r+� � ✓+ 'p��-� �}°'m Sr} 4 # t � fill, � Iq'k �`Y� R rY f'L-jh"{``-(��..� �. w F ,kn,°ate' ..i. k CONIl�IONWEALTH OF 1�fP;SS MMUSE T5 ` , �� OPERATE *<FOOD STABIiISFIMENT '1f 'PIn accordance w� h egul�at�ons promu6lga't d nderl authoripy f Cha�ter` k IT,^ +w �'dC ^R'?M1%A'a 9 Section 3OSA , nd Chat r III ection of the GeneralxLawsi to operate OAaewadmoeraj�ru�edossE�.�+r,E.ows`tasf��ma.pAi�'beaE'`8sl2K(�1r..ahbmlzm?eaaennsrnhtimet,e':�nnet�hus e�6�et0�y CHiWot,ua�ssohe, Dn'a'Sge�"ryylt°loi en+rwm-S�`?tY.sreeeYdP�'Keb{WNW"" lz � = c i 4 Y' S These ermts i e becen Y OU a „ '� * , This permrt s ot, rans ,�erabl�e iust ere s `ue�d ,upon change of �>� '{ ownership ca ' on Th'ees ymust a oto sn a prominent ocation e r M" ivt'ti 4 ;S�Af _ "spa �4 iay�t�he 4YE}[stabli�shmeat "� a k r s # ; a '9 Njy4 Trq 2'N 'r,.xE is In accordance wit the Sta e ani am Code efome in ranova no�improy�ens, or 'equipmnc geaar�e all' ptSbe� sub;matteRA do d approveilby e Salem Boar of Health �' `" x ,,,% 4' -1 L� p�✓f, .` +t �Y fLb `i"'C 'ie�a �> `�'' b A' 4'yh. Fi�. �� 3X�� . arks+ IRS-ii. �. '� .IiEAliTH AGyyENT1117 mom y a r. �µ �` �z� CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH 120 WASHINGTON STREET, 47H FLOOR � t£ SALEM, MA 01970 t�{An !3 ti$ )jj tlpp��/�j tlpp TEL. 978-741-1800 FAX 978-745-0343 j..v Cre� STANLEY USOVICZ, JR. JOANNE SCOTT, MPH, RS, CHO MAYOR HEALTH AGENT CITY 07 SALEM HEALTH DEPT. 2002 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT ry NAME OF ESTABLISHMENT t , taL.t 1c ��" //140-LtS P bie. ) TEL# i.G ADDRESS OF ESTABLISHMENT d &jh l Y A-teNy1 �{ S0t--1eM , 0J a, 61 c 70 MAILING ADDRESS(if different) �i OWNER'S NAME S L( 'Z q hVICe. � • �2Y154G �y TEL# l7S ✓7�(-5 ��{S3 ADDRESS a I pi I V4- CITY Sa.1PW STATE a ZIP U _ CERTIFIED FOOD MANAGER'S NAME(S)� yW-L' .��CERTIFICATE#(s) (required in an establishment where potentially hazardous food is prepared.) EMERGENCY RESPONSE PERSON,'5Q*7-A h 11'(2 r-, 2i%e- HOME TEL# DAYS/HOURS OF OPERATION: Mon. :. Tue._.,,,fvved. Past• o F yr. TYPE OF ESTABLISHMENT FEE check only RETAIL STORE YES 10 ��0� $40 RESTAURANT INO , $40 BED& BREAKFAST YES AbD $40 ADDITIONAL PERMITS MAKE ICE CREAM, YOGURT SOFT SERVE YES $5 TOBACCO VENDOR YES NO 10 NO CHARGE FOR NON-PROFIT(suc as church kitchens) PLEASE INCLUDE COPY OF TAX EXEMPTFORM 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 MGI Chapter 62C, Section 49A, I certify under the pains and penalties of perjury that 1, to my best knowledge and belief, have filed all state tax returns and paid all state taxes required under the law. Signat6fe Dailf Social Security or Federal Identification number Revised 11/1/01 foodap2.adm Check#&Date 3 II -;L ino/ .--. - ... .a: �`�,.,,.v-Ty.y....r,. ��.�... ..,.�..r�.,..y ..;v..i,r,,..........,�...�+w-+-�^^,n-�:'ti.s-�.+..;��...m+.vnT^++'^i'."'.-^t^"...m._.>._,._...�.-..-r'- -••---..-...-_.._.,.Y..--. 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/ T fOperation(s) Type of Inspection C ) 9' Z Food Service KI Routine Address Riskt Retail Re-inspection ,0 Level ❑ Residential Kitchen Previous Inspection Telephone _ �/� ❑ Mobile Date: Owner _ HACCP Y/N ❑ Temporary ❑ Pre-operation ❑ Caterer ❑ Suspect Illness Person in Charge(PIC) Time ❑ Bed 8 Breakfast ❑ General Complaint In: ❑ HACCP Inspect0r Out: Permit No. ❑ Other Each violation checked requires an explanation on the narrative page(s) and a citation of specific provision(s) violated. Non-compliance with: Violations Related to Foodborne Illness Interventions and Risk Factors (Red Items) Anti-Choking Tobacco Violations marked may pose an imminent health hazard and require immediate corrective 590.009(E) ❑ 590.009(F) ❑ action as determined by the Board of Health. Local Law ❑ FOOD PROTECTION MANAGEMENT ❑ 12. Prevention of Contamination from Hands ❑ 1. PIC Assigned/ Knowledgeable/ Duties ❑ 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) El 4. Food and Water from Approved Source C116. Cooking Temperatures El 5. Receiving/Condition El 17. Reheating El6. Tags/ Records/Accuracy of Ingredient Statements El7. Conformance with Approved Procedures/ HACCP Plans El 18. Cooling ❑ 19. Hot and Cold Holding PROTECTION FROM CONTAMINATION ❑ 20. Time as a Public Health Control ❑ 8. Separation/Segregation/ Protection REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) ❑ 9. Food Contact Surfaces Cleaning and Sanitizing ❑ [1 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: Prin[: /f PIC's Signature: Print: /4 / / Page-/of Oages FORM 734A HOBBS&WARREN -BOSTON 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 L'_ 590.003(A) Assignment of Res oonsibilit * Cooked and RTE Foods* 590.003(B) Demonstration of Knowledge* Contamination from Raw Ingredients 2-103.11 Person in Charge-Duties 3-302.1 l(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 ,T"` Applicants 3.304.11 Food Contact with Equipment and 590.003(F) Responsibility of a Food Employee or an Utensils* Applicant to Report to the Person in Charge* Contamination from the Consumer 3-306.14(A)(B) Returned Food and Reservice of Food* 590.003(G) Reporting by Person in Charge* Disposition of Adulterated or Contaminated 3S90.003(D) Exclusions and Restrictions* Food 590.003(E) Removal of Exclusions and Restr coons 3-701.11 Discarding or Reconditioning Unsafe Food* FOOD FROM APPROVED SOURCE 9` Food Contact Surfaces 4 Food and Water From Regulated Sources 4-501.111 Manual Warewashing-Hot Water 590.004(A-B) Compliance with Food Law* Sanitization Temperatures* 3-201.12 Food in a Hermetically Sealed Container* 4-501.112 Mechanical Warewashing-Hot Water 3-201.13 Fluid Milk and Milk Products* Sanitization Temperatures* 3-202.13 She]] 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* Y0 Proper,Adequate Handwashing Game and Wild Mushrooms Approved by Regulatory Authority 2-301.11 Clean Condition-Hands and Arms* 2-301.12 Cleaning Procedure* 3.202.18 Shellstock Identification Present* 2-301.14 When to Wash* 590.004(C) Wild Mushrooms* 11 Good Hygienic Practices 3-201.l7 Game Animals* 2-401.11 Eating,Drinking or Using Tobacco* 5 Receiving/Condition 2-401.12 Discharges From the Eyes,Nose and 3-202.11 PHFs Received at Proper Temperatures* Mouth* 3-202.15 Package Integrity* 3-301.12 Preventing Contamination When Tasting* 3-101.11 Food Safe and Unadulterated* 12 Prevention of Contamination from Hands 6' Tags/Records:Shellstock 590.004(E) Preventing Contamination from 3-202.18 Shellstock Identification* Employees* 3-203.12 Shellstock Identification Maintained* Handwash Facilities Tags/Records:Fish Products Conveniently Located and Accessible 3-402.11 Parasite Destruction* 5-203.11 Numbers and Capacities* 3-402.12 Records,Creation and Retention* 5-204.11 Location and Placement* 590.004(J) Labeling of Ingredients* 5-205.11 Accessibility,Operation and Maintenance 7 Conformance with Approved Procedures /HACCP Plans Supplied with Soap and Hand Drying Devices 3-502.11 Specialized Processing Methods* 6-301.11 Handwashing Cleanser,Availability 3-502.12 Reduced Oxygen Packaging,Criteria* 6-301.12 Hand Drying Provision 8-103.12 Conformance with Approved Procedures* •Denotes critical item in the federal 1999 Food Cade or 105 CMR 590.000. 4 4 CITY OF SALEM y i BOARD OF HEALTH 4 Establishment Name: �n� �» ma xi Date: 1� �z Page: of 2 Item Code C'-Critical Item DESCRIPTION OF;VIOLATION7 PLAN OF CORRECTION _ Date No. Reference R'—Red Item "' i" '�` ` Verified i+' 9 •� - ,PLEASE PRINT CLEARLY ti 5• _ ". 4 Ik s r 2 ell' { Discussion With Person in Charge: Corrective Action Required: ❑ No LJ 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 comply Exclusion with all mandates of the Mass/Federal Food Code. I understand that noncompliance may ❑ Re-inspection Scheduled ❑ Emergency Suspension result in daily fines of twenty-five dollars or suspension/revocation of your food permit. ❑ Embargo ❑ Emergency Closure } _ ❑ Voluntary Disposal ❑ Other I t FORM 734B HOBBB &WARREN - BOSTON i Violations Related to Foodborne Illness Interventions and Risk 3-501.14(C) PHFs Received at Temperatures Factors(Red Items 1-22) (Cont.) According to Law Cooled to41°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 3-202.12 Additives* 3-501.16(B) Cold PHFs Maintained at or below 3-202.14 Protection from Unapproved Additives* 590.004(F) 41°F/45°F* 15 , Poisonous or Toxic Substances 3-501.16(A) Hot PHFs Maintained at or above 7-101.11 Identifying Information-Original 140°F.* Containers* 3-501.16(A) Roasts Held at or above 130°F.* 7-102.11 Common Name-Working Containers* Lao- Time as a Public Health Control 7-201.11 Separation-Stora e* 3-501.19 Time as a Public Health Control* 7-202.11 Restriction-Presence and Use* 590.004(H) Variance Requirement 7-202.12 Conditions of Use* REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-203.11 Toxic Containers-Prohibitions* POPULATIONS(HSP) 7-204.11 Sanitizers,Criteria-Chemicals* '21 3-801.1 l(A) Unpasteurized Pre-packaged Juices and 7-204.12 Chemicals for Washing Produce,Criteria* Beverages with Warning Labels* 7-204.14 Drying Agents,Criteria* 3-801.11(B) Use of Pasteurized Eggs* 7-205.11 Incidental Food Contact,Lubricants* 3-801.11(D) Raw or Partially Cooked Animal Food and 7-206.11 Restricted Use Pesticides,Criteria* Raw Seed Sprouts Not Served.* 7-206.12 Rodent Bait Stations* 3-801.11(C) Unopened Food Package Not Re-served.* -7-206.13 Tracking Powders,Pest Control and Monitoring* CONSUMER ADVISORY 22 3-603.11 Consumer Advisory Posted for Consumption of TIME/TEMPERATURE CONTROLS Animal Foods that are Raw, Undercooked or 16 Proper Cooking Temperatures for not Otherwise Processed to Eliminate PHFs Pathogens.* Effective 11112001 3-401.11A(1)(2) Eggs- 155°F 15 Sec. 3-302.13 Pasteurized Eggs Substitute for Raw Shell Eggs* Eggs-Immediate Service 145°F 15 Sec.* 3-401.11(A)(2) Comminuted Fish,Meats&Game SPECIAL REQUIREMENTS Animals- 155°F Sec.* 590.009(A)-(D) Violations of Section 590.009(A)-(D)in 3-401.11(B)(1)(2) Pork and Beef Roast-130°F 121 Min.* catering,mobile food,temporary and 3-401.11(A)(2) Ratites,Injected Meats- 155°F 15 Sec.* residential kitchen operations should be 3-401.1I(A)(3) Poultry,Wild Game,Stuffed PHFs, debited under the appropriate sections Stuffing Containing Fish,Meat, above if related to foodbome illness Poultry or Ratites- 165°F 15 Sec.* interventions and risk factors. Other 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks 590.009 violations relating to good retail 145°F* practices should be debited under#29- 3-401.12 Raw Animal Foods Cooked in a Special Requirements. Microwave 165°F* 3-401.11(A)(1)(b) All Other PHFs- 145°F 15 Sec.* VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 17 Reheating for Hot Holding (Blue Items 23.30) 3-403.11(A)&(D) PHFs 165°F 15 Sec.* Critical and non-critical violations, which do not relate to the 3-403.11(B) Microwave- 165°F 2 Minute Standing foodborne illness interventions and risk factors listed above, can be Time* found in the following sections of the Food Code and 105 CMR 3-403.1l(C) Commercially Processed RTE Food- 590.00. 140°F* Item Good Retail Practices FC 590.00 3-403.1l(E) Remaining Unsliced Portions of Beef 23. Management and Personnel FC-2 .003 Roasts* 24. Food and Food Protection FC-3 .004 Proper Cooling of PHFs 25. Equipment and Utensils FC-4 .005 3-501.14(A) Cooling Cooked PHFs from 140°F to 26. Water, Plumbing and Waste FC-5 .006 70°F Within 2 Hours and from 70°F 27. Physical Facility FC-6 .007 to 41°F/45°F Within 4 Hours.* 28, Poisonous or Toxic Materials FC-7 .008 3-501.14(B) Cooling PHFs Made From Ambient 29. S ecial Requirements .009 Temperature Ingredients to 41°F/45°F 30. Other Within 4 Hours* *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. ~ 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 TXpe of Operation(s) T f inspection Food Service Routine Address Risk ❑ Retail ❑ Re-inspection r Level J/,//2 ❑ Residential Kitchen Previous Inspection Telephone _ //r ��' ElMobile Date: Owner !( ( HACCP Y/N 11 Temporary ElPre-operation 1. ❑ Caterer ❑ Suspect Illness Person in Charge(PIC) Time ❑ Bed 8 Breakfast ❑ General Complaint In: ❑ HACCP Inspector Out: Permit No. ❑ Other Each violation checked requires an explanation on the narrative page(s) and a citation of specific provision(s) violated. Non-compliance with: Violations Related to Foodborne Illness Interventions and Risk Factors (Red Items) Anti-Choking Tobacco Violations marked may pose an imminent health hazard and require immediate corrective 590.009(E) ❑ 590.009(F) ❑ action as determined by the Board of Health. Local Law ❑ FOOD PROTECTION MANAGEMENT ❑ 12. Prevention of Contamination from Hands ❑ 1. PIC Assigned/Knowledgeable/ Duties ❑ 13. Handwash Facilities EMPLOYEE HEALTH PROTECTION FROM CHEMICALS ❑ 2. Reporting of Diseases by Food Employee and PIC ❑ 14. Approved Food or Color Additives ❑ 3. Personnel with Infections Restricted/ Excluded ❑ 15. Toxic Chemicals FOOD FROM APPROVED SOURCE TIMElTEMPERATURE CONTROLS(Potentially Hazardous Foods) ❑ 4. Food and Water from Approved Source ❑ 16. Cooking Temperatures ❑ 5. Receiving/Condition ❑ 17. Reheating ❑ 6. Tags/Records/Accuracy of Ingredient Statements ❑ 18. Cooling ❑ 7. Conformance with Approved Procedures/ HACCP Plans ❑ 19. Hot and Cold Holding PROTECTION FROM CONTAMINATION ❑ 20. Time as a Public Health Control ❑ 8. Separation/Segregation/ Protection REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) ❑ 9. Food Contact Surfaces Cleaning and Sanitizing ❑ 21. Food and Food Preparation for HSP ❑ 10. Proper Adequate Handwashing CONSUMER ADVISORY ❑ 11. Good Hygienic Practices ❑ 22. Posting of Consumer Advisories Violations Related to Good Retail Practices (Blue Number of Violated Provisions Related Items) Critical (C) violations marked must be corrected To Foodborne Illnesses Interventions immediately or within 10 days as determined by the Board and Risk Factors (Red Items 1-22): of Health. Non-critical (N) violations must be corrected Official Order for Correction: Based on an inspection immediately or within 90 days as determined by the Board today, the items checked indicate violations of 105 CMR 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: i/ Print: PIC's Signature: 4--Y/ Print: Page/ of ges FORM 734A HOBBS a W REN -BOSTON //- /� j 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 -"±fl 590.003(A) Assi omen[of Res onsibili[ * 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 590.003(C) Responsibility of the Person in Charge to 3-302.1 l(A) Food Protection* require reporting by Food Employees and * 3-302.15 Washing Fruits and Vegetables Applicants 3.304.11 Food Contact with Equipment and 590.003(F) Responsibility of a Food Employee or an Utensils* Applicant to Report to the Person in Charge* Contamination from the Consumer 3-306.14(A)(B) Returned Food and Reservice of Food* 590.003(G) Reporting by Person in Charge* Disposition of Adulterated or Contaminated 31' 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 4i 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* '10 Proper,Adequate Handwashing Game and Wild Mushrooms Approved by 2-301.11 Clean Condition-Hands and Arms* Regulatory Authority 2-301.12 Cleaning Procedure* 3.202.18 Shellstock Identification Present* 2-301.14 When to Wash* 590.004(C) Wild Mushrooms* 1 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* 5.12;: Prevention of Contamination from Hands Tags/Records:Shellstock 590.004(E) Preventing Contamination from 3-202.18 Shellstock Identification* Employees* 3-203.12 Shellstock Identification Maintained* F-13 Handwash Facilities Tags/Records: Fish Products Conveniently Located and Accessible 3-402.11 Parasite Destruction* 5-203.11 Numbers and Capacities* 3-402.12 Records,Creation and Retention* 5-204.11 Location and Placement* 590.004(J) Labeling of Ingredients* 5-205.11 Accessibility,Operation and Maintenance 7, 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 Establishment Name: CQ�l t-�S� t Date: Z4��z Page: of Item <, Code - C-Critical Item # DESCRIPTION OF VIOLATION / PLAN OF CORRECTION Date N .Reference R=Red Item ` - ' .y , .Verified . ....;✓� LEA No. SE PRMT`CLEARLY b';u bibs ant2 - C) o0 s - �-- Discussion With Person in Charge: Corrective Action Required: ❑`No ' . LI 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 comply Exclusion with all mandates of the Mass/Federal Food Code. I understand that noncompliance may❑ Re-inspection Scheduled Ll Emergency Suspension result in daily fines of twenty-five dollars or suspension/revocation of your food permit. ❑ Embargo ❑ Emergency Closure ❑ Voluntary Disposal ❑ Other ' FORM 7348 HOBBS &WARREN - BOSTON Violations Related to Foodborne Illness Interventions and Risk 3-501.14(C) PHFs Received at Temperatures Factors(Red Items 1-22) (Cont.) According to Law Cooled to 41'F/45'F Within 4 Hours.* PROTECTION FROM CHEMICALS 3-501.15 Cooling Methods for PHFs E1L Food or Color Additives 19PHF Hot and Cold Holding 3-202.12 Additives* 3-501.16(B) Cold PHFs Maintained at or below 3-202.14 Protection from Unapproved Additives* 590.004(F) 41'F/45'F* „1L Poisonous or Toxic Substances 3-501.16(A) Hot PHFs Maintained at or above 7-101.11 Identifying Information-Original 140'F.* Containers* 3-501.16(A) Roasts Held at or above 130'E* 7-102.11 Common Name-Working Containers* .:20 Time as a Public Health Control 7-201.11 Separation-Storage* 3-501.19 Time as a Public Health Control* 7-202.11 Restriction-Presence and Use* 590.004(H) Variance Requirement 7-202.12 Conditions of Use* REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-203.11 Toxic Containers-Prohibitions* POPULATIONS(HSP) 7-204.11 Sanitizers,Criteria-Chemicals* 21 3-801.1 l(A) Unpasteurized Pre-packaged Juices and 7-204.12 Chemicals for Washing Produce,Criteria* Beverages with Warning Labels* 7-204.14 Drying Agents.Criteria* 3-801.11(B) Use of Pasteurized Eggs* 7-205.11 Incidental Food Contact,Lubricants* 3-801.1 l(D) Raw or Partially Cooked Animal Food and r7-206.13f 206.11 Restricted Use Pesticides,Criteria* Raw Seed Sprouts Not Served.* 206.12Rodent Bait Stations* 3-801.11(C) Unopened Food Package Not Re-served.* Tracking Powders,Pest Control and. Monitoring* CONSUMER ADVISORY 22 3-603.11 Consumer Advisory Posted for Consumption of TIMEITEMPERATURE CONTROLS Animal Foods that are Raw,Undercooked or 16 : Proper Cooking Temperatures for not Otherwise Processed to Eliminate PHFs Pathogens.* Eeectiva 11112001 3-401.11A(l)(2) Eggs- 155'F 15 Sec. 3-302.13 Pasteurized Eggs Substitute for Raw Shell Eggs* Eggs-Immediate Service 145'F 15 Sec.* 3-401.1l(A)(2) Comminuted Fish,Meats&Game SPECIAL REQUIREMENTS Animals- 155'F Sec.* 590.009(A)-(D) Violations of Section 590.009(A)-(D)in 3-401.1l(B)(1)(2) Pork and Beef Roast- 130'F 121 Min.* catering,mobile food,temporary and 3-401.11(A)(2) Ratites,Injected Meats- 155'F 15 Sec.* residential kitchen operations should be 3-401.11(A)(3) Poultry,Wild Game, Stuffed PHFs, debited under the appropriate sections Stuffing Containing Fish,Meat, above if related to foodbome illness Poultry or Ratites- 165'F 15 Sec.* interventions and risk factors. Other 3-401.1l(C)(3) Whole-muscle,Intact Beef Steaks 590.009 violations relating to good retail 145`F* practices should be debited under#29- 3-401.12 Raw Animal Foods Cooked in a Special Requirements. Microwave 165'F* 3-401.11(A)(1)(b) All Other PHFs- 145'F 15 Sec.* VIOLATIONS RELATED TO GOOD RETAIL PRACTICES F-177 u Reheating for Hot Holding (Blue Items 23-30) 3-403.1 l(A)&(D) PHFs 165'F 15 Sec.* Critical and non-critical violations, which do not relate to the 3-403.11(B) Microwave- 165'F 2 Minute Standing foodborne illness interventions and risk factors listed above, can be Time* found in the following sections of the Food Code and 105 CMR 3-403.11(C) Commercially Processed RTE Food- 590.00. 140'F* Item Good Retail Practices FC 590.00 3-403.1l(E) Remaining Unsliced Portions of Beef 23. Management and Personnel FC-2 .003 Roasts* 24. Food and Food Protection FC-3 .004 F-T,18,,;:. Proper Cooling of PHFs 25. Equipment and Utensils FC-4 .005 3-501.14(A) Cooling Cooked PHFs from 140'F to 26. Water, Plumbing and Waste FC-5 .006 70'F Within 2 Hours and from 70'F 27. Physical Facility FC-6 .007 to 41'F/45'F Within 4 Hours.* 28. Poisonous or Toxic Materials FC-7 .008 3-501.14(B) Cooling PHFs Made From Ambient 29. Special Requirements .009 Temperature Ingredients to 41'F/45'F 30. Other Within 4 Hours* *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. r..�.'"..y..�._�'".'^.�s.^i^"-�".v'+.r+�.r•31�ef•1siM.�:.I�Ri"�t.w'.i.&�Lt.....W.--W'L•.-rte""^^-""'^^""."•"G,:V+`r-v+v.-•,ra.✓q�+�ws�.�-+s--'..^y..ri'ay`ya-.,rp-ir`...,�..•.«r^. E THE COMMONWEALTH OF MASSACHUSETTS CITY OF SALEM Address: 120 Washington Street, 4th Floor e BOARD OF HEALTH Salem, MA 01970-3523 FOOD ESTABLISHMENT INSPECTION REPORT Tel: (978) 741-1800 Fax: (978) 745-0343 Name . Date Type of Operation(s) Type f In i Food Service Routine Address __ Risk ❑ Retail ❑ Re-inspection Level ElResidential Kitchen Previous Inspection Telephone 51 ❑ Mobile Date: Owner ,-7 HACCP Y/N ❑ Temporary ❑ Pre-operation ❑ Caterer ❑ Suspect Illness Person In Charge(PIC) / Time ❑ Bed 8 Breakfast ❑ General Complaint . / In: ❑ HACCP Inspector �� Out: Permit No. El Other s v I Each violation checked requires an explanation on the narrative page(s) and a citation of specific provision(s) violated. Non-compliance with: Violations-Related to Foodborne Illness Interventions and Risk Factors (Red Items) Anti-Choking Tobacco Violations marked may pose an imminent health hazard and require immediate corrective 590.009(E) ❑ 590.009(F) ❑ action as determined by the Board of Health. Local Law ❑ FOOD PROTECTION MANAGEMENT ❑ 12. Prevention of Contamination from Hands ❑ 1. PIC Assigned/ Knowledgeable/ Duties ❑ 13. Handwash Facilities EMPLOYEE HEALTH ❑ 2. Reporting of Diseases by Food Employee and PIC PROTECTION FROM CHEMICALS ❑ 3. Personnel with Infections Restricted/ Excluded El 14. Approved Food or Color Additives ❑ 15. Toxic Chemicals FOOD FROM APPROVED SOURCE El 4. Food and Water from Approved Source TIME/TEMPERATURE CONTROLS(Potentially Hazardous Foods) El 16. Cooking Temperatures EJ 5. Receiving/Condition El6. Tags/ Records/Accuracy of Ingredient Statements El 17. Reheating El7. Conformance with Approved Procedures/ HACCP Plans El 18. Cooling PROTECTION FROM CONTAMINATION ❑ 19. Hot and Cold Holding ❑ 20. Time as a Public Health Control 8. Separation/Segregation/ Protection REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) 9. Food Contact Surfaces Cleaning and Sanitizing El❑ 10. Proper Adequate Handwashing 21. Food and Food Preparation for HSP CONSUMER ADVISORY ❑ 11. Good Hygienic Practices ❑ 22. Posting of Consumer Advisories Violations Related to Good Retail Practices (Blue Number of Violated Provisions Related Items) Critical (C) violations marked must be corrected To Foodborne Illnesses Interventions immediately or within 10 days as determined by the Board and Risk Factors (Red Items 1-22): of Health. Non-critical (N) violations must be corrected Official Order for Correction: Based on an inspection immediately or within 90 days as determined by the Board today, the items checked indicate violations of 105 CMR of Health. 590.000/Federal Food Code.This report, when signed below C N by a Board of Health member or its agent constitutes an 23. Management and Personnel (FC-2)(590.003) order of the Board of Health. Failure to correct violations 24. Food and Food Protection (FC-3)(590.004) cited in this report may result in suspension or revocation of 25. Equipment and Utensils (FC-4)(590.005) the food establishment permit and cessation of food 26. Water, Plumbing and Waste (FC-5)(590.006) establishment operations. If aggrieved by this order, you 27. Physical Facility (FC-6)(590.007) have a right to a hearing.Your request must be in writing 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: 4_f? Print: (' PIC's Signature: Print: G./ 4 Page 1/ of ages FORM 734A HOBBS&WARREN - BOSTON ll Violations Related to Foodborne Illness Interventions and Risk Factors (Red Items 1-22) PROTECTION FROM CONTAMINATION ; 8 Cross-contamination FOOD PROTECTION MANAGEMENT 3-302.11(A)(1) Raw Animal Foods Separated from 1 590.003(A) As si omen[o'! f Res onsibilit * Cooked and RTE Foods* H590.003(B) Demonstration of Knowledge* Contamination from Raw Ingredients 2-103.11 Person in Charge-Duties 3-302.11(A)(2) Raw Animal Foods Separated from Each Other* EMPLOYEE HEALTH Contamination from the Environment '2 590.003(C) Responsibility of the Person in Charge to 3-302.11(A) Food Protection* require reporting by Food Employees and 3-302.15 Washing Fruits and Vegetables Applicants 3.304.11 Food Contact with Equipment and 590.003(F) Responsibility of a Food Employee or an _ Utensils* Applicant to Report to the Person in Charge* Contamination from the Consumer 3-306.14(A)(B) Returned Food and Reservice of Food* 590.003(G) Reporting by Person in Charge* Disposition of Adulterated or Contaminated 3°' 590.003(D) Exclusions and Restrictions* Food 590.003(E) Removal of Exclusions and Restrictions 3-701.11 Discarding or Reconditioning Unsafe Food* FOOD FROM APPROVED SOURCE 9 Food Contact Surfaces 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* 10 Proper,Adequate Handwashing Game and Wild Mushrooms Approved by Regulatory Authority 2-301.11 Clean Condition-Hands and Arms* 2-301.12 Cleaning Procedure* 3.202.18 Shellstock Identification Present* 2-301.14 When to Wash* 590.004(C) Wild Mushrooms* 11 Good Hygienic Practices 3-201.17 Game Animals* 2-401.11 Eating, Drinking or Using Tobacco* 5 Receiving/Condition 2-401.12 Discharges From the Eyes, Nose and 3-202.11 PHFs Received at Proper Temperatures* Mouth* 3-202.15 Package Integrity* 3-301.12 Preventing Contamination When Tasting* 3-101.11 Food Safe and Unadulterated* 'iT Prevention of Contamination from Hands F-6 Tags/Records:Shellstock 590.004(E) Preventing Contamination from 3-202.18 Shellstock Identification* Employees* 3-203.12 Shellstock Identification Maintained* 13 Handwash Facilities Tags/Records: Fish Products Conveniently Located and Accessible 3-402.11 Parasite Destruction* 5-203.11 Numbers and Capacities* 3-402.12 Records,Creation and Retention* 5-204.11 Location and Placement* 590.004(]) Labeling of Ingredients* 5-205.11 Accessibility,Operation and Maintenance X73 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. - E CITY OF SALEM r BOARD OF HEALTH i Establishment Name: C�� «C�.>� r� �Ql Date: �� Page: of Item Code C—Critical Item DESCRIPTION OF VIOLATION [PLAN OF CORRECTION Date No.r Reference R:—Red Item a"' �, '� '' ` Verified PLEASe PRINT CLEARLY ' "f" '' .. V v C Cie i- l h� to c\c-\e- 0 .IxkTZ CSn - ; /1 . t c — k � r-N G s F Discussion With Person in Charge: Corrective Action Required: ❑No ❑Yes i c, 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 comply Exclusion ❑ Re-inspection Scheduled ❑ Emergency Suspension with all mandates of the Mass/Federal Food Code. I understand that noncompliance may result in daily fines of twenty-five dollars or suspension/revocation of your food permit. E ❑ Embargo ❑ Emergency Closure ❑ Voluntary Disposal ❑ Other r�� )FORM 7348 HOBBS & WARREN - BOSTON Violations Related to Foodborne Illness Interventions and Risk 3-501.14(C) PHFs Received at Temperatures Factors(Red Items 1-22) (Cont.) According to Law Cooled to41*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 3-202.12 Additives* 3-501.16(B) Cold PHFs Maintained at or below 3-202.14 Protection from Unapproved Additives* 590.004(F) 41°F/45°F* 15 ° Poisonous or Toxic Substances 3-501.16(A) Hot PHFs Maintained at or above 7-101.11 Identifying Information-Original 140°F* Containers* 3-501.16(A) Roasts Held at or above 130°F.* 7-102.11 Common Name-Working Containers* 20 Time as a Public Health Control 7-201.11 Se aration-Storage* 3-501.19 Time as a Public Health Control* 7-202.11 Restriction-Presence and Use* 590.004(H) Variance Requirement 7-202.12 Conditions of Use* REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-203.11 Toxic Containers-Prohibitions* POPULATIONS(HSP) 7-204.11 Sanitizers,Criteria-Chemicals* 21< 3-801.11(A) Unpasteurized Pre-packaged Juices and 7-204.12 Chemicals for Washing Produce,Criteria* Beverages with Warning Labels* 7-204.14 Drying Agents,Criteria* 3-80L11(B) Use of Pasteurized Eggs* 7-205.11 Incidental Food Contact,Lubricants* 3-801.1 I(D) Raw or Partially Cooked Animal Food and 7-206.11 Restricted Use Pesticides,Criteria* Raw Seed Sprouts Not Served.* 7-206. Rodent Bait Stations* 3-801.11(C) Unopened Food Package Not Re-served.* 7-206.1133 Tracking Powders, Pest Control and Monitoring* CONSUMER ADVISORY 22 3-603.11 Consumer Advisory Posted for Consumption of TIME/TEMPERATURE CONTROLS Animal Foods that are Raw,Undercooked or i 16 Proper Cooking Temperatures for not Otherwise Processed to Eliminate PHFs Pathogens.* Eff ctive 11112001 3-401.11A(1)(2) Eggs- 155°F 15 Sec. 3-302.13 Pasteurized Eggs Substitute for Raw Shell Eggs* Eggs-Immediate Service 145*F 15 Sec.* 3-401.11(A)(2) Comminuted Fish,Meats&Game SPECIAL REQUIREMENTS Animals- 155*F Sec.* 590.009(A)-(D) Violations of Section 590.009(A)-(D) in 3-401.11(13)(I)(2) Pork and Beef Roast- 130°F 121 Min.* catering,mobile food, temporary and 3-401.11(A)(2) Ratites,Injected Meats- 155°F 15 Sec.* residential kitchen operations should be 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs, debited under the appropriate sections Stuffing Containing Fish,Meat, above if related to foodbome illness Poultry or Ratites- 165*F 15 Sec.* interventions and risk factors. Other 3-401.)1(C)(3) Whole-muscle,Intact Beef Steaks 590.009 violations relating to good retail 145°F* practices should be debited under#29- 3-401.12 Raw Animal Foods Cooked in a Special Requirements. Microwave 165°F* 3-401.11(A)(1)(b) All Other PHFs- 145°F 15 Sec.* VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 17 Reheating for Hot Holding (Blue Items 23-30) 3-403.1 l(A)&(D) PHFs 165*F 15 Sec.* Critical and non-critical violations, which do not relate to the 3-403.11(B) Microwave- 165°F 2 Minute Standing foodborne illness interventions and risk factors listed above, can be Time* found in the following sections of the Food Code and 105 CMR 3-403.11(C) Commercially Processed RTE Food- 590.00. 140°F* Item Good Retail Practices FC 590.00 3-403.11(E) Remaining Unsliced Portions of Beef 23. Management and Personnel FC-2 .003 Roasts* 24. Food and Food Protection FC-3 .004 '"£18'=< Proper Cooling of PHFs 25. Equipment and Utensils FC-4 .005 3-501.14(A) Cooling Cooked PHFs from 140*F to 26. Water, Plumbing and Waste FC-5 .006 70°F Within 2 Hours and from 70*F 27. Physical Facility FC-6 .007 to 41°F/45*F Within 4 Hours.* 28. Poisonous or Toxic Materials FC-7 .008 3-501.14(B) Cooling PHFs Made From Ambient 29. Special Requirements .009 Temperature Ingredients to 41°F/45°F 30. Other Within 4 Hours* *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. CITY OF SALEM BOARD OF HEALTH Establishment Name: Date: /(6 /_ Page: of13 Item Code , g C Critical Item DESCRIPTION OF VIOUATION/ PLAN OF CORRECTION ' Date i No. .Reference 'R "`Red Item; - Verified .c- PLEASE PRINT CLEARLY 6 d '1-;6L F i Or t i s� f Discussion With Person in Charge: Corrective Action Required: ❑No ❑Yes I have read this report, have had the opportunity to ask questions and agree to correct all ❑ Voluntary Compliance ❑ Employee Restriction i i Exclusion violations before the next inspection, to observe all conditions as described, and to comply t with all mandates of the Mass/Federal Food Code. I understand that noncompliance may ❑ Re-inspection Scheduled ❑ Emergency Suspension result in daily fines of twenty-five dollars or suspension/revocation of your food permit. ❑ Embargo ❑ Emergency Closure t L ❑ Voluntary Disposal ❑ Other FORM 7348 HOBBS & WARREN - BOSTON 14(C) PHFs Received at Temperatures ~ Violations Related to Foodborne Illness Interventions and Risk 3-501. According to Law Cooled to Factors(Red/terns 1-22) (Cont.) 41°F/45°F Within 4 Hours.* PROTECTION FROM CHEMICALS 3-501.15 Cooling Methods for PHFs iIIc14:":. Food or Color Additives LL9 . ", PHF Hot and Cold Holding 3-202.12 Additives* 3-50P"16(B) Cold PHFs Maintained at or below 3-202.14 Protection from Unapproved Additives* 590.004( F) 41°F/45°F* 1$ Poisonous or Toxic Substances 3-501J6(A) Hot PHFs Maintained at or above 7-101.11 Identifying Information-Original 140°F.* Containers* 3-501.16(A) Roasts Held at or above 130°F.* 7-102.11 Common Name-Working Containers* 1,20 1 Time as a Public Health Control 7-201.11 Separation-Storage* 3-50!.19 Time as a Public Health Control* 7-202.11 Restriction-Presence and Use* 590.004(H) Variance Requirement 7-202.12 Conditions of Use* REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-203.11 Toxic Containers-Prohibitions* POPULATIONS(HSP) 7-204.11 Sanitizers,Criteria-Chemicals* ;'21" 3-801.1 I(A) Unpasteurized Pre-packaged Juices and 7-204.12 Chemicals for Washing Produce,Criteria* Beverages with Warning Labels* 7-204.14 Drying Agents,Criteria* 3-801.1l(B) Use of Pasteurized Eggs* 7-205.11 Incidental Food Contact,Lubricants* 3-801.11(D) Raw or Partially Cooked Animal Food and 7-206.11 Restricted Use Pesticides,Criteria* Raw Seed Sprouts Not Served.* 7-206.12 Rodent Bait Stations* 3-801.1 1(C) Unopened Food Package Not Re-served; 7-206.13 Tracking Powders,Pest Control and Monitoring* CONSUMER ADVISORY 22 3-603.11 Consumer Advisory Posted for Consumption of TIME/TEMPERATURE CONTROLS Animal Foods that are Raw, Undercooked or 16Proper Cooking Temperatures for not Otherwise Processed to Eliminate PHFs Pathogens.* EHech a 11112001 3-401.11A(1)(2) Eggs- 155*F 15 Sec. 3-302.13 Pasteurized Eggs Substitute for Raw Shell Eggs* Eggs-Immediate Service 145°F 15 Sec.- 3-401.11(A)(2) Comminuted Fish,Meats&Game SPECIAL REQUIREMENTS Animals- 155*F Sec.* 590.009(A)-(D) Violations of Section 590.009(A)-(D)in 3-401.1 l(B)(1)(2) Pork and Beef Roast- 130°F 121 Min.* catering,mobile food,temporary and 3-401.1l(A)(2) Ratites,Injected Meats-155°F 15 Sec.* residential kitchen operations should be 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs, debited under the appropriate sections Stuffing Containing Fish,Meat, above if related to foodborne illness Poultry or Ratites- 165°F 15 Sec.* interventions and risk factors. Other 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks 590.009 violations relating to good retail 145°F* practices should be debited under#29- 3-401.12 Raw Animal Foods Cooked in a Special Requirements. Microwave 165°F* 3-401.11(A)(1)(b) All Other PHFs- 145*F 15 Sec.* VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 17 Reheating for Hot Holding (Blue Items 23-30) 3-403.11(A)&(D) PHFs 165°F 15 Sec.* Critical and non-critical violations, which do not relate to the 3-403.11(B) Microwave- 165°F 2 Minute Standing foodborne illness interventions and risk factors listed above, can be Time* found in the following sections of the Food Code and 105 CMR 3-403.11(C) Commercially Processed RTE Food- 590.00. 140°F* Item Good Retail Practices FC 590.00 3-403.11(E) Remaining Unsliced Portions of Beef 23. Management and Personnel FC-2 .003 Roasts* 24. Food and Food Protection FC-3 .004 18. Proper Cooling of PHFs 25. Equipment and Utensils FC-4 .005 3-501.14(A) Cooling Cooked PHFs from 140°F to 26. Water, Plumbing and Waste FC-5 .006 70°F Within 2 Hours and from 70°F 27. Physical Facility FC-6 .007 to 41017/45017 Within 4 Hours.* 28. Poisonous or Toxic Materials FC-7 .008 3-501.14(B) Cooling PHFs Made From Ambient 29. Special Requirements .009 Temperature Ingredients to 41°F/45°F 30. Other Within 4 Hours* *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. C ,6 n ,o CITY OF SALEM BOARD OF HEALTH Salem, Massachusetts 01970-3928 JOANNE SCOTT, MPH, RS,CHO NINE NORTH STREET HEALTH AGENT Tel:(978)741-1800 Fax:(978)740-9705 COMMONWEALTH OF MASSACHUSETTS PERMIT TO OPERATE A FOOD ESTABLISHMENT In accordance with regulations promulgated under authority of Chapter 94 , Section 305A and Chapter III, Section 5 of the General Laws, to operate a Food Establishment in the City of Salem is hereby granted to: Owner' s Name : Suzanne Hensley Name of Establishment : Court House Deli Address of Establishment : 60 Washington Street Type of Establishment: FOOD SERVICE Application Date : 12/26/2000 Restrictions: Permit for Food Establishment 173-01 Frozen Desserts/Ice Cream Permit for the Sale of Tobacco Products These Permits Expire December 31, 2001 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. HEALTHGENA T > CONOIT DEC 1 6 2000 CITY OF SALEM CITY OF SALEM BOARD OF HEALTH HEALTH DEPT. Salem, Massachusetts 01970-3928 JOANNE SCOTT, MPH, RS,CHO NINE NORTH STREET HEALTH AGENT Tel:(978)741-1800 Fax:(978)740-9705 2001 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT NAME OF ESTABLISHMENT rt a :FZ OLt S� r /io t 1 TEL# Q7r— :1 y3^I/I ADDRESS OF ESTABLISHMENT �� /71 IiJ//� S �0.l(OIM , t' U- ` O 019 MAILING ADDRESS (if different) !!// ` OWNER'S NAME � TEL# �:d — ✓3 ADDRESS / CITY STATE ZIP O CERTIFIED FOOD MANAGER'S NAME(S) QyICATE#(s) O � (required in an establishment where potentially hazardous food is prepared.)/ EMERGENCY RESPONSE PERSONcSaJ22.h - , "C& TEL# _7 -S(o / / ESTABLISHMENT ✓'0 #nonsmoking F$440 heck only RETAILSTOREYES RESTAURANT 61P NO #seats BED& BREAKFAST YES d93:P $40 ADDITIONAL PERMITS MAKE ICE CREAM, YOGURT SOFT SERVE YESN $5 TOBACCO VENDOR YES O 10 NO CHARGE FOR NON-PROFIT I'su as church kitchens) PLEASE INCLUDE COPY OF TAX EXEMPTFORM 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 taxes required under the law. "_e / all -,1,4 tign6le DW Social Security or Federal Identification Number -------------------------------------- ------ /-/ G��f�---------------------------- ------------------ Revised 11/21/00 foodap2.adm Check#8 Date 0'4 A71 % /Z —o 6 y �r- �+..a» +w�4..:r..in.^...�r.,;,,tal^^Ww.P'A�:..*.a...:ue.4.,r:.X^ti.h- 6ww�Y�iF�+4wa,t3.�N..: *w�A'idnr,�„dM�ir+4i+�..:�.+�.r a«. •:;.^.: E COMMONWEALTH OF MASSACHUSETTS CITY OF SALEM Address: 9 North Street Board of Health Salem, MA 01970-3928 FOOD ESTABLISHMENT INSPECTION REPORT Tel: (978) 741-1800 Fax: (978) 740-9705 Name ` Date a of Operation(s) T. a of Ins ection 7/16/41 Food Service Routine Address Risk Retail 11 Re-inspection Level ❑ Residential Kitchen Previous Inspection Telephone q 7 t ❑ Mobile Date: Owner / Y ❑ Temporary ❑ Pre-operation ( HACCP Y/N ❑ Caterer ❑ Suspect Illness Person in Charge(PIC) Time ❑ Bed&Breakfast ❑ General Complaint �r Y ti ❑ HACCP Inspector I^� 1-1 Other Out: Permit No. Each violation checked requires an explanation on the narrative page(s) and a citation of specific provision(s) violated. Non-compliance with: RED Violations (1-22) Related to Foodborne Illness Interventions and Risk Factors Anti-Choking Tobacco Violations marked may pose an imminent health hazard and require immediate corrective 590.009(E)❑ 590.009(F)❑ action as determined by the Board of Health. Local Law ❑ FOOD PROTECTION MANAGEMENT ❑ 12. Prevention of Contamination from Hands ❑ 1. PIC Assigned/Knowledgeable/Duties ❑ 13. Handwash Facilities EMPLOYEE HEALTH PROTECTION FROM CHEMICALS ❑ 2. Reporting of Diseases by Food Employee and PIC ❑ 14. Approved Food or Color Additives ❑ 3. Personnel with Infections Restricted/Excluded ❑ 15. Toxic Chemicals FOOD FROM APPROVED SOURCE TIMEfrEMPERATURE CONTROLS(Potentially Hazardous Foods) ❑ 4. Food and Water from Approved Source ❑ 16. Cooking Temperatures ❑ 5. Receiving/Condition ❑ 17. Reheating ❑ 6. Tags/Records/Accuracy of Ingredient Statements ❑ 18. Cooling ❑ 7. Conformance with Approved Procedures/HACCP Plans ❑ 19. Hot and Cold Holding PROTECTION FROM CONTAMINATION ❑ 20. Time As a Public Health Control ❑ 8. Separation/Segregation/Protection REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) ❑ 9. Food Contact Surfaces Cleaning and Sanitizing ❑ 21. Food and Food Preparation for HSP ❑ 10. Proper Adequate Handwashing CONSUMER ADVISORY E111. Good Hygienic Practices ❑ 22. Posting of Consumer Advisories BLUE Violations(23-301 Related to Good Retail Practices Number of Violated Provisions Related Critical (C)violations marked must be corrected To Foodborne Illnesses Interventions F21 Immediately or within 10 days as determined by the Board and Risk Factors(RED Items 1-22): of Health. Non-critical (N)violations must be corrected immediately or within 90 days as determined by the Board Official Order of Correction: Based on an inspection of Health. today,the items checked indicate violations of 105 CMR C N 590.000/Federal Food Code.This report,when signed below 23. Management and Personnel (Fc-2)(590.003) by a Board of Health member or its agent constitutes an 24. Food and Food Protection (FC-3)(590.004) order of the Board of Health. Failure to correct violations 25. Equipment and Utensils (Fc 4)(550.005) cited in this report may result in suspension or revocation of 6. Water, Plumbing and Waste (FC-5)(sso.00s> the food establishment permit and cessation of food establishment operations. If aggrieved by this order,you 27. Physical Facility (FC-5)(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: ^ f A Print: j(\(\ICC W i I _ PIC's Signature: Print: IAZA _ D Page of Pages Violations Related to Foodborne Illness Interventions and Risk Factors (Red Items 1-22) PROTECTION FROM CONTAMINATION FOOD PROTECTION AND MANAGEMENT 8 Cross-contamination 1 590.003(A) Assignment of Responsibility* 3-302.11(A)(1) Raw Animal Foods Separated from 590.003 B Demonstration of Knowledge* Cooked and RTE Foods* O g 2-103.11 Person in charge-duties Contamination from Raw Ingredients 3-302.11(A)(2) Raw Animal Foods Separated from Each EMPLOYEE HEALTH Other* 2 590.003(C) Responsibility of the person in charge to Contamination from the Environment require reporting by food employees and 3-302.1l(A) Food Protection* applicants* 3-302.15 Washing Fruits and Vegetables 590.003(F) Responsibility Of A Food Employee Or An 3-304.11 Food Contact with Equipment and Applicant To Report To The Person In Utensils* Chare* Contamination from the Consumer 590.003 G Reporting by Person in Charge* 3-306.14(A)(B) Returned Food and Reseryice of Food* 3 590.003(D) Exclusions and Restrictions* Disposition of Adulterated or Contaminated 590.003 Removal of Exclusions and Restrictions Food 3-701.11 Discarding or Reconditioning Unsafe FOOD FROM APPROVED SOURCE Food* 4 Food and Water From Regulated Sources ;: 9 Food Contact Surfaces 590.004(A-B) Compliance with Food Law* 4-501.111 Manual Warewashing-Hot Water 3-201.12 Food 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 Made From Potable Drinking Water* concentration and hardness* 5-101.11 Drinking Water from an Approved System* 4-601.11(A) Equipment Food Contact Surfaces and 590.006(A) Bottled Drinking Water* Utensils Clean* 590.006(B) Water Meets Standards in 310 CMR 22.0* 4-602.11 Cleaning Frequency of Equipment Food- Shellfish and Fish From an Approved Source Contact Surfaces and Utensils* 3-201.14 Fish and Recreationally Caught Molluscan 4-702.11 Frequency of Sanitization of Utensilsand Shellfish* Food Contact Surfaces of Equipment* 3-201.15 Molluscan Shellfish From NSSP Listed 4-703.11 Methods of Sanitization-Hot Water and Sources* Chemical* F,Game and Wild Mushrooms Approved by ,0( Proper,Adequate Handwashing Regulatory Authority 2-301.11 Clean Condition -Hands and Arms* 3-202.18 Shellstock Identification Present* 2-301.12 Cleaning Procedure* 590.004(C) Wild Mushrooms* 2-301.14 When to Wash* 3-201.17 Game Animals* '11 '.. Good Hygienic Practices 5 Receiving/Condition 2-401.11 Eating,Drinking or Using Tobacco* 3-202.11 PHFs Received at Proper Temperatures* 2-401.12 Discharges from the Eyes,Nose and 3-202.15 Package Integrity* Mouth* 3-101.11 Food Safe and Unadulterated* 3-301.12 Preventing Contamination When Tasting* 6 Tags/Records:Shellstock 12 Prevention of Contamination from Hands 3-202.18 Shellstock Identification* 590.004(E) Preventing Contamination from 3-203.12 Shellstock Identification Maintained* Employees* Ta s/Records:Fish Products 13 ' Handwash Facilities 3-402.11 Parasite Destruction* Conveniently Located and Accessible 3-402.12 Records Creation and Retention* 5-203.11 Numbers and Capacities* 590.004(J) Labeling of Ingredients* 5-204.11 Location and Placement* Conformance with Approved Procedures 5-205.11 Accessibility,Operation and Maintenance /HACCP Plans Supplied with Soap and Hand Drying 3-502.11 Specialized Processing Methods* Devices 3-502.12 Reduced oxygen packaging,criteria* 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 1999 Food Code or 105 CMR 590.000. T * M_'.' roe iMr T...Y"�-'{ i+" .:.^e^.aSt,. �,N.•yb z4r'S:�n a`.>6".ph!✓A.r�: ..,.6..�, -cg^. �°%r.,.p+r .r• .. i `. THE COMMONWEALTH OF MASSACHUSETTS City of Salem Establishment Name Date 7�00/ Address (00 Page Z of Z Item No. In the space below describe a violations checked on front page. A(n) inspection of this establishment was conducted in accordance with the State Sanitary Code for Food Establishments,Chapter X, 705 CMR 590.000.The following violations were observed: -5 - /I £ _n -t-. \ l - 37 i` �F 1 .s r IF 7 S r— . c A fin . x1 t I Sh zl of ; n S C rn c � V Discussion with Management I have read this report,have had the opportunity to ask questions and agree to correct all violations before the next inspection,to observe all conditions as described,and to comply with all mandates of Chapter X. I understand that noncompliance may result in daily fines of twenty-five dollars.