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CRUNCHY GRANOLA BABY - ESTABLISHMENTS &rcL4-- (?ra.nole, � '7� V �I V f' 4 COURT DOCKET NO. CITATION NO. CITY SALEM PD 604 VIOLATION NOTICE NAME(LAST,FIRST,INITIAL) Je,ln ; - CLc- Ko 'c Q Se".4 S/tl; �1 STREETADDRESS CITY/TOWN STATE ZIP A4 6V LICENSE NO. LIC,EXP DATE DATE OF BIRTH KRt OWNERS NAME(LAST,FIRST,INITIAL) / f STREE,TTADDRE Sl CITY/TOWN STATE ZIP cr / `xsP 5-z! 0)92,� REGISTRATION NO. STATE EXP.DATE MAKE/TYPE YEAR COLOR DATE OF VIOLATION TIME DATE CITATION WRITTEN PEFSONAL ❑AM IWURY ❑PM DYES ❑NO LOCATION OF VIOLATION -c �C L+'r(H'4,;0lQ EN FORCING DEPT ?�li/q$(.41rff1 s- G�, tL� `�UF"i OFFENSE / CHAP. SECT FINES E C OFFIC)F�RI.D.NO. TOTAL IFIN DUEIs ,,OFFI E_R CERTIFIES COPY GIVEN TO VIOLATOR ❑ IN HAND X /e%fi/ l.G��A� �BY MAIL AS 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 1 +H4YV0. t 4 ,cYp �:... dal, *�V Commonwealth of Massachusetts .ice d*IN,�ti+�+�1 City of Salem-v; Board of Health IGrn dey Dnst�oll 120 Washington Street,4th Floor r ayor., SALEM,MA 01970 Food/Retail Establishment Permit DATE PRINTED: 01/04/2007 ESTABLISHMENT NAME: Crunchy Granola Baby LLC File Number:BHF-2006-000037 72 Washington Street Suite 2 SALEM MA 01970 LOCATED AT: 0072 WASHINGTON STREET 2 SALEM, MA 01970 Permit Type Permit No. Permit Issued Permit Expires Fee Restrictions/Notes RETAIL FOOD BHP-2007-0310 Jan 4,2007 Dec 31,2007 $50.00 Total Fees: $50.00 PERMIT EXPIRES December 31, 2007 Board of Health This Permit is not transferable and must be reissued upon change of ownership or location.The permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code,beofre any revonations,improvements,or equipment changes are made,all plans for such must be submitted to and approved by the Salem Board of Health. page 2 of 3 CITY OF SALEM, MASSACHUSETTS BOARD of HEALTH 120 WASHINGTON STREET,4TH FLOOR - SALEM, MA 01970 TEL. 978-741-1800 FAx 978-745-0343 Kimberley Driscoll WWW.SALEM.COM Mayor JOANNE SCOTT, MPH, RS, CHO HEALTH AGENT 2007 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT NAME OF ESTABLISHMENT Cr NAME (1 lO` �\\� t TEL# LA " V%1� ADDRESS OF ESTABLISHMENT_,aV \\(1(T ll7Y1 C FAX# MAILING ADDRESS(if different) EMAIL--Business': (( Owner's: r� OWNER'S NAME C\0 �" (I A CI S� TEL# ADDRESS Q � l U� � 9TREET CITY STATE ZIP CERTIFIED FOOD MANAGER'S NAME(S) CERTIFICATE#(S) (Required in an establishment where potenti ltt�y}haazzardo{us food is repay d) nrt EMERGENCY RESPONSE PERSON,\ rR �f�..Vy HOME TEL# 1 t} —J 7 (��(� OAYSOFOPERATION Monday Tuesday Wednesday Thursday Friday Saturday Snnday ROURS OF OPERATION Please write in time of day. (For example 1tam41pmi TYPE OF ESTABLI�HFM NT FEE (check only) RETAIL STORE YE NO less than 1000sq.ft. =$ 50 1000-10,000sq.ft. =$100 more than 10,000sgA =$250 - - - --... .. .... --------- ----- ----.---....----- ------------------ ------- YES NO less than 25 seats $100 25-99 seats =$150 more than 99 seats =$200 --........_.. .... ... ... ...- ... __;__ ..... -- - - ......_...... ---- -_ -- --... ...._....------- -- BED/BREAKFAST YES NO $10o ADDITIONAL PERMITS MAKE (notjust serve) ICE CREAM, YOGURT, SOFT SERVE YES $5 TOBACCO VENDOR YES O $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 1, to my best knowledge and belief, ha e filed ail-stat a re ns ad paid all stateto er quired under the law. O t 4s 41o01 3 3 Si nature Dae Social Security or Federal Identification Number - --------------------------------------- --------------------------------------------- Revised 11/13/06 FOODAP2007.adm Check#&Date r Commonwealth of Massachusetts City of Salem Board of Health Kimberley Driscoll Mayor 120 Washington Street,4th Floor SALEM,MA 01970 Food/Retail Establishment Permit DATE PRINTED: 0712512006 WHO'S PLACE OF BUSINESS IS: Crunchy Granola Baby LLC - File Number:BHF-2006-0037. 72 Washington Street Suite 2 SALEM MA 01970 LOCATED AT: 0072 WASHINGTON STREET 2 SALEM, MA 01970 Permit Type Permit Issued Permit Expires Fee Restrictions t Notes RETAIL FOOD Jul 25,2006 Dec 31,2006 $50.00 Total Fees: $50.00 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 hoard of Health. Jul 11 06 01 : 34p Joanne Scott Salem HCH 978 745 0343 p. 2 CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH 120 WASHINGTON STREET, 4TH FLOOR i} SALEM, MA 01970 TEL. 978-741-1800 FAx 978.745.0343 Kimberley Driscoll WWW.SALEM.COM Mayor JOANNE SCOTT, MPH, RS, CHO HEALTH AGENT 2006 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT NAME OF C6TABLISHMENT I'U �IrMo)a baby,LLLTEL# 97 8 _N1 0&X) ADDRESS OF ESTABLISHMENT 1�o WOS\1\C'C- AX:n : . .�Jkk MAILING ADDRESS (if different) c 1 (� OWNERS NAMF S1 D Q ci- �Ql �3(11��1TEL# n,. -I 79-- L/5 -&�'q b ADDRESS p71 ww� %� CITY, STATE_ MA ZIP p1G CERTIFIED FOOD MANAGER'S NAME(S) CERTIFICATE#(s} (required in an establishment where potentially hazardous food is prepared.) ^ EMERGENCY RESPONSE PERSON )et)n� C �`` Y1C7\4 HOME TEL#_9 g 7�lS �3c1 HOURS OF OPERATION: Mon.60'LTue.IO-�Wed.lO b Thu. 10--1 Fri.lo�-7 Sat. to-S Sun._)a-q TYPE OF ESTASLISHMFEE (check only) RETAIL STORE ES NO less than 1000sq.ft. _$50 1000-10,000sq.1t. =$100 more,than 10,000sq.ft. =$250 - ........................ - .............................. ---------- RESTAURANT YES NO loss 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 YESONO $5 TOBACCO VENDOR YES $50 ALL NON-PROFIT(such as church kitchens) YES $25 'Please pay total with one check payable to the City of Salem . This Permit is not transferable and must be reissued upon change of ownership.The Permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code, before any renovations,improvements, or equipment changes are made,all plans for such must be submitted to and approved by the Salem Board of Health. Pursuant to MGL Chapter 62C, Section 49A, I certify under the pains and penalties of perjury that I, to my best knowledge and belief, h e filed all state tax returns and paid all state taxes required under the law. U&nU\Q -1 �0 Olo o-yb343o (Sigture Date Social Security or Federal Identification Number -- .......... - - - _.... - -------------- ------------------------- Revised 11/03/05 FOODAP2.adm Check4&Date 7; it JUL 11,2006 01:22P 978 745 0343 page 2 CITY OF SALEM ti BOARD OF HEALTH } Establishment Name: Cru -1 u &b4 Date: Page: t of 1 Item Code - C-Critical nem DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date s; No. Reference R--Red Item - Verified PLEASE PRINT CLEARLY - O P r r4 I n P/ L / c�G nn 1n 1 /.7( /1 ,' ,z T / i l ;Y z� + i f _ 4 Discussion With Person in Charge: Corrective Action Required: ❑ No ❑ Yes I have read this report, have had the opportunity to ask questions and agree to correct all ❑ Voluntary Compliance ❑ Employee Restriction/ Exclusion ` violations before the next inspection, to observe all conditions as described, and to ❑ Re-inspection Scheduled ❑ Emergency Suspension comply with all mandates of the Mass/Federal Food Code. I understand that noncompliance may result in daily fines of twenty-five dollars or suspension/revocation of ❑ Embargo ❑ Emergency Closure your food permit. 0 Voluntary Disposal 0 Other: 3-50114(C} 'PRFs Received of Temperatures Violations Related to Foodborne Illness Interventions and Risk According to Law Cooled to Factors(Items 1-22) (Cont) _ 41°F/45`1-Within 4 Hours. PROTECTION FROM CHEMICALS 3-501.15 Cooling Methods for PHF,, 1g 1q Food or Collar Additives PHF Hot and Cold Holding 3-501.16(6) Cold PRFs Maintained at or below 3-20?.12 Additives't 590.004(F) -II°Iq5°F" 3-302.14 Protection fCQm)lira) roved Additives" - 15 Poisonous at Toxic Substances 3-501,16(A) Hot PHFs Maintained at or above 14WF. * 7-101.12 ldentltyung Information-Original 3-501.16(A) Roasts Held at or above 130`F- " Containers* 7-102.11 _ Common Name-Working Containers* 20 Time as fl Public Health Contra) 1-201.11 Se arstion-Storage*' 3-501 J I Time as a Public Health Control* 7-202.11 Restriction-Presence and Use 590.004(H) Variance Re nirentent 7-202.12 Conditions of Use" 7-20:3.11 Toxic Containers-Prohibitions' REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-204.11 Sanitizers,Criteria-Chemicals^' _ POPULATIONS(HSP) 7-204.12 Chernicals for Washin�Produce, Criteria°' 21 3-801,11(A) Unpnsteurized Pre-packaged Juices and _ -�--- Beverages with Ila,ntngLabels- 7-204.14 fJrving r encs.Criteria* -�--- 3-801 11(H) Use of Pasteurized lees* 7-205.11 Incidental Food Contact.Lubricants* 3-801.1 t(D) Raw or Partially Coked Anneal Food and 7 1-06.11 Restricted Use Pesticides.Criteria* Raw Seed Snouts Not Served. 7-206.12 Rodent Bait'Stations* 3$01.11(0) Unopened Food Package Not Re-served. 7-206.13 Tracking Powders,Pest Control and Monitoring* CONSUMER ADVISORY TIMEITEMPERATURE CONTROLS 22 3-603.11 Consumer A tvisory Posted for Consumption of Animal Foods That are Raw.Undercooked or 16 Proper Cooking Temperatures for PHFs Not Otherwise Processed to Eliminate 3-401.1 lA(U(2) F Pathogens. ,,s- 155`F 15 Seca b ss-Lmmednate Service 145°F15sec* 3-302.13 Pasteurized Eggs Substitute for Raw Shell 3-001.11.(A)(2) Commiratted Fish,Meats&Game Eggs!' Animals- I55'F 15 sec. * 3-40 1.1 1)(2) Pork and Beef Roast-130'F 121 min* SPECIAL REQUIREMENTS 3-401.1 I(A)(2) Ratites,Injected Meats- 155'F 1.5 59Q009(A)-(D) Violations of Section 590.009(A)-(D) in sec, * catering.mobile ford,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 Pouhr or Ratites-165°P 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 74-M 12 Raw Animal Foods Cooked in a practices should be debited under#29- Micxawave 165`F* Special Regnuements. 3-401.-11(A)(1)(b) All Other PHFs-145'Fi5sec * 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 Ct itical and non-critical violatim?e which do not relate to the Time* foodborne illness inteivention.s and risk factors lister)above can be 6-403.11(C) Commercially Processed RTE Food- ,found in die following sections of the Food Code and 105 CMR 140"F* 590.000, 3-,03. 11(E) Remaining Unsliced Portions of Beef Item Good Retail Practices FC 590.000 Roasts* 23. Management 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(r1) 70'F W Conked ours from 140'0 to 26. Water,Plumbin and Waste FC 5 .006 7 'F'Within 2 hours and From 70'1? 27. Physical Facility ---k -6 1 .007 to 41'F/45'F Within 4 Hours. * 28. Poisonous or Toxic Materials FC--7 '', .008 3-501.14(6) Cooling;PRFs Made From Ambient _29. 5 ecial Re uiremenis - _ .009 Temperature Ingredients to 41`F/45'F 30, Other Within 4I-Fours* ss�orag,m.�ea-z.m� Denotes Critical item in the fo demd 1999 Food Code or 105 CMR 590.000. IMPORTANT MESSAGE FOR��e DATE �� TIME �'P.M. M OF PHONE AREA CODE NUMBER EXTENSION ❑ FAX (� MOBILE AREA CODE NUMBER TIME TO CALL TELEPHONED PLEASE CALL CAME TO SEE YOU WILL CALL AGAIN WANTS TO SEE YOU RUSH RETURNED YOUR CALL WILL FAX TO YOU p- MESSAGE SIGNED FORM 4009 .fir FORMADE IN U.S.A. NOTES a IMPORTANT MESSAGE FOR DATE 5 ?i'Q� TIMEw%� A.M. M ' OF PHONE AREA CODE NUMBER EXTENSION ❑ FAX ID MOBILE AREA CODE N MEER TIME TO CALL TELEPHONED I Ll�rpl-EASE CALL. CAME TO SEE YOU °. WILL CALL AGAIN WANTS TO SEE YOU RUSH. RETURNED YOUR CALL ! WILL FAX TO YOU MESSAGE SIGNED MFORM 009 AAIN NOTES i� .5I2La- 6� _ /6 h4 y _=��49� 17 Lh - Zo�z, din _Guy -- s &A, i,V ' ' I 512l o f essa�� tv Ccc �e }HCl l� �o S2 Up I - ---- -- -- - - - - f CITY OF SALEM BOARD OF HEALTH Name of Establishment: Crunchy Granola Baby Address: 72 Washington Street Owner(s): Jennie Cudmore & Jennifer Smith Phone: 978-745=8396 71f/-0800 A4, 2006 Joi-( la, The proposed new owner of this establishment presented plans for this establishment for review in accordance with the State Sanitary Code. ITEMS FOR SALE All food items displayed and offered to the public must be from a source permitted as a Wholesaler from the Mass Department of Public Health. There will be no food preparation at this establishment. FLOOR PLAN All surfaces must be intact, impervious and easily cleanable. All refrigeration units must have accurate internal thermometers. Refrigerated food must be held at 41 degrees Fahrenheit or lower, freezers at 0 degrees Fahrenheit or lower. EXPIRATION DATES All expiration dates on products must be clearly visible. Out dated items must be promptly removed from display. EXTERMINATION Monthly services of a Licensed Pest Control Operator are required. Please keep receipts for inspections. RESTROOMS The restrooms must have a sign directing employees to wash their hands before returning to work. Outside area of premises must be kept clean and sanitary. An opening inspection will be conducted on July 24th. a,4 11 AA, Jddnne Scott Date Health Agent 13 . 0 fJnnie Cudmore Date