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CRUSTYS PIZZA ETC - ESTABLISHMENTS CRUSTY'S PIZZA ETC. 177 FORT AVENUE SEASONAL 0 d u .I i ' I a 7 Massachusetts Department of Public Health 120W Board SHealth Division of Food and Drugs SalSal Washington Street,4'"Floor em, MA 01970-3523 FOOD ESTABLISHMENT INSPECTION REPORT Tel. (978) 741-1800 Fax (978) 745-0343 Name Dat T e of.0 eration s Tvne of Insnection CV v S z -7]Z7 Ci7 ood Service ❑-Ffoutine Addressr Risk ElRetail El Re-inspection ( Level ❑ Residential Kitchen Previous Inspection Telephone ❑ Mobile Date: OwnerHACCP WN El Temporary ElPre-operation �2 c7�a cf Sca�o ❑ Caterer ❑ Suspect Illness Person in Charge(PIC) �J�o d Time ❑ Bed&Breakfast El General Complaint In: ❑ HACCP Inspector o .-.ro " Out: Permit No. ❑Other Each violation checked requires an explanation on the narrative page(s) and a citation of specific provision(s)violated. Non-compliance with: Violations Related to Foodborne Illness Interventions and Risk Factors Anti-Choking Tobacco Violations marked may pose an imminent health hazard and require immediate corrective 590.009(E) ❑ 590.009(F) ❑ action as determined by the Board of Health. FOND PROTECTION MANAGEMENT +� »„� „;.„,,', ,', ❑ 12. Prevention Of Contamination from Hands ❑ 1. PIC Assigned/Knowledgeable/Duties ❑ 13 Handwash Facilities I EMPLOYEE HEALTH ' w] PROTECTION FROM CHEMICALS ❑�2. Reporting of Diseases by Food Employee and PIC -»- ��°» -�»• »- `' El14.Approved Food or Color Additives ❑ 3. Personnel with Infections Restricted/Excluded ❑ 15 Toxic Chemicals t`FOOD FROM APPROVED SOURCE a'TIME/TEMPERATURE CONTROLS(Potentially Hazardous Fcaods) 171 4. Food and Water from Approved Source ) .� .u., e�I�"n-a .n4ov t......... ❑ 5. Receiving/Condition ❑ 16. Cooking Temperatures ❑ 6. Tags/Records/Accuracy of Ingredient Statements ❑ 17. Reheating ❑ 7. Conformance with Approved Procedures/HACCP Plans ❑ 18.Cooling m°° ❑ 19. Hot and Cold Holding PROTECTION FROM CONTAMINATION°`" ° � ,.;.�..,`� 9 ❑ 8. Sep aration/Segregation/Protection El 20.Time As a Public Health Control IUy9. Food Contact Surfaces Cleaning and SanitizingREQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP), ❑ 21. Food and Food Preparation for HSP ❑ 10. Proper Adequate Handwashing ❑ 11. Good Hygienic Practices „CONSUMER ADVISORY L' [122. Posting of Consumer Advisories Violations Related to Good Retail Practices Number of Violated Provisions Related Critical (C)violations.marked must be corrected To Foodborne Illnesses Interventions immediately or within 10 days as determined by the Board and Risk Factors(Items 1-22): of Health. Non-critical (N) violations must be corrected Official Order for Correction: Based on an inspection immediately or within 90 days as determined by the Board today,the items checked indicate violations of 105 CMR of Health. 590.000/federal Food Code. This report, when signed below C°` N by a Board of Health member or its agent constitutes an 23. Management and Personnel (FC-2) order of the Board of Health. Failure to correct violations 24. Food and Food Protection (FC-3)(5590.090.0 044)) cited in this report may result in suspension or revocation of 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)(59o,00s) 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:50Mre IFum 14 d. Inspector's Signature: --/4 � Print: -0/#j I zd PIC's Signature: --,<) Print: - � r rC- Page_of ages { U ' d . � J Violations Related to Foodborne Illness Interventions and Risk Factors(items 1-22) PROTECTION FROM CONTAMINATION_ � FOOD PROTECTION MANAGEMENT S Cross-contamination I 1 590.003(A) Assignment of Responsibility* 3-30211(A)(]) Raw Animal Foods Separated from 590.003(B) Demonstration of Knowledge* Cooked and RTE Foods* 2-103.11 Person in char e--duties Contamination from Raw Ingredients - 3-302A I(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) I Food Protection* applicants* 3-302.15 Washing Fruits and Vegetables 590.003(F) Responsibility Of A Fad 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) Repocting by Person in Charge* 3-306.14(A)(B) Returned Food and Reservice of Food* 3 590.003(D) Exclusions and Restrictions* - Disposition of Adulterated or Contaminated - 590.003(E) Removal of Exclusions and Restrictions Food 3-701.1.1 Discarding or Reconditioning Unsafe FOOD FROM APPROVED SOURCE Fad* 4 Food and Water From Regulated Sources 9 Food Contact Surfaces 590.004(A-B) Compliance with Food Law* 4-501.171 Manual Warewashing-Hot Water 3-201.12 Food in a Hermetically Sealed Container* Sanitization Tem ratures* 3-201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Warewashing-Hot Water 3-202.1.3 Shell Eggs* Sanitization Temperatures* 3-202.14 Eggs and Milk Products.Pasteurized* 4-501.11.4 Chemical Sanitization-temp.,pH, 3-202.16 Ice Made From Potable Drinking Water* concentration and hardness.'" 5-101.11 DrinkinE Water from an Approved System* 4-601.11(A) Equipment Food Contact Surf=aces and Utensils Clean* 590.006(.A) Bottled Drinking Water* 590.00((}3) Water Meets Standards in 310 CMR 22.O* 4-602.11 Cleaning Frequency of Equipment Food- 590.006(B) Surfaces and Utensils* Shellfish and Fish Froman Approved Source 4.702 11 Frequency of Sanitization of Utensils and 3-20.1.14 Fish and Recreationally Caught Molluscan Food Contact Surfaces o1 Equipment* Shellfish* 4-703.11 Methods of Sanitization-HotWaterand- 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* Sources* 10 Proper,Adequate Handwashing Re MatoAuthori Game and uttild Mushrooms Approved by 2-301.11 Clean Condition-Hands and Arms" 3-202.18 Shellstock Identification Present* 2-301._12 Cleaning Procedure* 590.004(C) Wild Mushrooms* 2-30L14 When to Wash* 3-201.1.7 Game Animals* 11 Good Hygienic Practices 5 Receiving/Condition 2-401.11 Eating,Drinking or Using Tobacco* 3-202.1.1 PHFs Received at Proper Temperatures* 2401.12 Discharges From the Eyes, Nose and 3-20115 Package liue it * Mouth* 3-101.11. Food Safe and Unadulterated* 3-301.12 Preventing Contamination When Tasting* 6 TagslRecords:Shellstock 12 Prevention of Contamination from Hands 3-202.18 Shellstock Identification* 590.004(E) Preventing Contamination from 3-203.7.2 Shellstock Identification Maintained* Employees* Tags/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* q Conformance with Approved Procedures 5-205.11 Accessibility.Operation and Maintenance IHACCP Plans Supplied with Soap and Hand Drying 3-502.11 Specialized Processing Methods* Devices 3-502.12 Reduced ox den packagaing,criteria* 6-301.17. Handwashing Cleanser,Availability 8-103.12 Conformance with A. roved Procedures* 6-301.1.2 Hand Drying Provision *Denotes critical item in the federal 1999 Food Code or 105 CNIR 590.000. I CITY OF SALEM BOARD OF HEALTH Establishment Name: C ✓�s y �< z 7 S Date -712,15 -) Page: of Z item Code, -Critical item �„ DESCRIPTION OF VIOLATION/PLAN OF CORRECTION z Date —� — w,.,• sr Verified ? No Reference ', R—Red item �� ° ,� x ! ' JS - `F s� �` •-PLEASi` 2j Jit e a a rn2 ✓_CJ G��1 tV�' I v Z V aAA o J-P g Y"t ! uo C_ 6rS ✓-c QO t re C\f V-0-1/4-0 (_LP CA In 141 e N C e_-'o r-4 L, 1 G n P l 5 e a�,rz c� . l�e S V,f i Il 1 17/�� N � U2_ r of I[ W �n/� �� t S' f 1/1 rt��tn'v-I f � .t ✓� G6'}�/t .. 5Gttnt Zo iVkC G#" v /.L�//^ vSP e Zf (V S S P .vj, C( / _CArt ' h 2 y' pc t t'Y1-f 1i L'z 4L J [ l.X_.✓-Sly' ��Ca v !-FIS /. LM J SF- Y7e C O\.2^'Z,O�- 9 Y ➢ ti StcB✓ tA C' r i V- \,/".vS _LZLtmin- .v l� G KYtiv2 g i I�vi t� ¢ trac !1 Uo1Je -�vc.rV e C�� AL ✓is / or If t pun. Al\' e l un t 1 /t�fir. f a . U<,e - t Discussion With Person in Charge: V Corrective Action Required: ❑ No ❑ Yes { I have read this report, have had the opportunity to ask questions and agree to correct all ❑ Voluntary Compliance ❑ Employee Restriction / violations before the next inspection, to observe all conditions as described, and to Exclusion P ❑ Re-inspection Scheduled ❑ Emergency Suspension comply with all mandates of the Mass/Federal Food Code. I understand that noncompliance may result in daily fines of twenty-five dollars or suspension/revocation of ❑ Embargo ❑ Emergency Closure i your food permit. ❑ Voluntary Disposal ❑ Other: v v Violations Related to Foodborne/fines(interventions and Risk FF5{1i-14(C- T--[Pf1,R,Re--.iw�d�ii Tenn}' r<atures Factors(item 1-22) (cont.) According i a Lai Cooled to 411745'F Wdhili,4 Hours- PROTECTION owsPROTECTION FROM CHEMICALS for PHFS L 14 Food or Color Additives 19 PHF Hot and Cold Holding ll� 2012 ho,,e, Sol Cold PHFs Maintained at or btlj,,w 59(}4){4(pi 4P/45°F` 3-302,14 protection froze Additives" 95 3-M)I,INA) [lot PHFsz, l%1 rasii)adilt or above i 4 Poisonous or Toxic Substances MOT' I Iderrifying infollyrallon -00ginldl 13.501.16{A) Wx1slts held at or above 130'f, -i 1-02-11— comrllonN�tnsc - Workim,Coutailler L?O Time as a Publiu-H—eatth Cc�ntrw 1 1-;6 i.19 Tons-,as a Public flealth Control' Re,t,'c6on Presence and t, c- [El) )�)4 Reqlae),11t ................... 7-,262.12 ar of -- 7-2(7311 Toxic Container.-Prohibitions* REOUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-2 .1 i Saniwer,,C-rilerir, cherllic:iW POPULATIONS NSP 7-2()4.12 Cficliticals forNushi21 bill 11(A) Unjaiqicurizetl frre-pacPaged Juices wid ci�,Vrs�scc,Clitc(W� 1- 04 I4 x � ifievrfraees kvills 3-SWAI(B� /-205,11 Incidental f-ood Contact.Lubijeants' —-Ilse2ir paltellsi:,n4 El;el 7-206.11 lxostrwts�d uw PeNticides,criterial —3T, Rx)d awi --;a W-_-5-q Sinouts lNot Served I 7 206.1y 7-246 '13 T��Xlenl—`I�t slatill, �118 LT�l �—1 LPace d�L 11�01 'I ljcking Pcesileri,I s[Control andIaL�01 Re served. Mclailoritro, CONSUMER ADVISORY TIMEITEMPERATURE CONTROLS 22 3L0., I I i COroumas'elyNory Posted for Evgaintations of Anivillsil F,ods 41ralary Raw. Undercooked ej 16 Pm�r Cooking Temperatures for--7 PRFs �;vl Othem iw Pirxx�,qsed to F11imirl 3P,zh "VO; 3 40 1�I I A(I)(2) EL 255 ti 1.5 S,�c. --- ItLjucdiaic Service 3-30113 1 Ps,qteurucd Egiz 5rljisiirlj�for flue Shell 1-40IJI(A)(2) colitilanwed Fkh-ktellts& ('enlic Animals l5i`'F 1i��Cc. 3-40 1 I I(B)k ly 2) Polls; and 13'eef Rcmm 13W F121 aull. SPECIAL REQUIREMENTS 3-40LI](A)(s) Ranle,�, InIcMAINTral� -1�5�F 1� r�tf)) 77icjaii-lm�of Section J90,N)WA) (D) ill catering, mobile fwd, temporal v and FIHAJ,3) loritr l�ji�(;aial,—$t�a�tt i1i4f,1 rcsiderdlat kitchen opeiatitm�,Aicsuld lbL sloff,nig Confaildrig Fish, Nleat, d fubiled under llw appropriate ns or kaiics-1659' t5 aticw if iclaled it)foodborne illness (0)1 1—It r ij —'Nholo, —Rzr—Sicaks iritLvwnvrars arldrisk factors. %cr 145"T* 1 590.009 violatioi)i relatinc to tlooei retail 3-401A02 Raw Anicial Foisrk cook Ill a rwacticc%ihould he debited under#29 - Microwave 10"'F spoeial Requircillems- t401,11(A)(I)(b) A2j()tiler fsHF,, 1451T 2s sea Reheating for Holding 57 VIOLATIONS RELATED TO GOOD RETAIL PRACTICES ,--13,1 ITA)&707PHls 10'F Ifi%,cc, (Itevirr 23-30) 3-403.11(13)(13) Microwave- 12 7"T'2 lsslimvc,SlantingW'd vlotrilions, a-hich do stoi relate to the -TIF�— 1,110e, i ftsodfiOrne dincss ijicesv�!wionvatrd rokfa(tors listed rlhoi,e, wn be 7— 463TI FC� Comfilervialh Piocessed RTF Fold11 foliltdill lhi joilowin,:re trans of(hG Food Code wed 105 C11)? 140`F* 590,06X). -Wal-n—? 3-403 1 I(E) Remaillift" unsficed Portions of Beef I FC -590.0W -23, Management QFC_-2 tind Food Prolecitor, FC 004 Proper Cooling of PHFs --c'— -------4--------1 -- -__ I-VA) Cooling Cookcit VHF� from 14WIto -2L------L-EtIciPEMIt afsf-ul"ils- I FC-4 IL Ir 26, Watel, W 70'T Within 2 11(wsl and Front 70-F aQq aS s) -5 %6 27, 1 hvsval Facill1v -6-- 007 smTnaasor Toxic Materilils o 2 _R Lrs 4l'F145'FWithin 4 Hourt,. FFC Coolunt PRR Made From Ambient neolls Temperature ingredientx,to 41 j _1Kitbin 4 Ilolirs;' Denotes crlucll Item,ill lhx lovmsl 191)1)i'otxl C'x1r,of 105 C1,11i 590 Calf), CITY OF SALEM BOARD OF HEALTH Establishment Name: Ty IDate: /3 /b 7 Page: of <item, -Code FW C-Critical Item DESCRIPTION OF VIOLATION/PL AN OF,CORRECTION� . >-�r= DatVerified No. Reference R-Red Item ° k ';, PLEASE PRINT CLEARLY ` u YOu / V -/ O GDP GGA c- k t" " L O_v tel. 11 \I i 614 e,7 re 640 /A 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 i your food permit. �� ❑ Voluntary Disposal ❑ Other: 0 � ; Si31 sdit: �j P}dFq�Reu sued u'1'esssperatuxos Violations Related to Foodborne f toes interventions and Risk According to Law Cooled to Fasfors(Items 1.22) (Carry.) I1 F/45"F Within 4 Khoo (`o ohR"1tt tho&for PHR PIR TEC` ION FROM CHEMICALS pttF t[et and W d Holding LLA-'____��_ Food or Coipe Additivzs ._. �j`.5W 10(fli Cold PHFs Mainti oned at or Wow 2(x7.12 { ,4tiittti,,.s' 3 3(12.'Id Prolectlon frosu i na�sruvec€ Adc'itives" � ( """ "-" � _._...._ I t 501.16(A) !lot PHF,Sf xn aiued at o shove 1 W Poisonous or-Tede Substances x 1 140'F, , I 7-f01.1i W nUtgtng lnforut.,lion -Onigiral r #_t its(Aj Rfxistsfihila;above 1300F,'o...— . Time as a Puisne Health Control ? 10211 CcinmoeName 4ksiki*itan.ii'Ler. �.... ___.. .- LI} R crta,au-1'z,a:n< mksx ¢�.al'nEdzrHe�i9ttaCott4�trf' ll 7-20 1.t} Se ao a,tian-Stenic — ,- - ----- - 59E7.'i{Ta+Ti) �Vmraaxt kita:niene 7 242.t2 Condatrans of LL sem* EQtl9tEPtNENTS FOR HIGHLY SUSCEPTIBLE E 7-10111 To tc t wxtatnae, P alzsba.am>' PC PULA7I NS HSP _ (2(?4.11 Sannsreia Cresta sa Chcwiciis s---t--� Sit A!"Al 1. f€ pas 6 racd Juices;iesd.__... ? 7�,b3.72 t'hc nu +l for t� iah .t rn(tue.t {tiia-ia" -- kir ser taeo with `lamins.#,ab-N- 04.14 I)x, t�,>xenta.C nt tis" ,._.... 3-SW,s,,`I3t [ ,t Pa tcurxu d antic; ntnl k M>d(untr �.Tatht,c.�nts= � 1 3-W1.11(1)) Raw orllafoa(tv Gk-.d Animal Coad awi L tx.° 2f �,roctea3l sr Ne vudt mesa a" I RIMc e d+)x,iuLv Not het tc a r-200.12 Ralc nl ES,ti St itiam .�„i ,_S{,( 1. lC C nsi twit T`aai Facia,c Lor Re-"well_ x 7-206.1'3 'Soo Lin{,PoNvdera P st Cunto'al und..... hlanuona �. CONSUMER ADVISORY TIME(TEMPERATURE CONTROLS_ �22 � 0 vIs €3 � Canwini i oss Pouted tvr Consumption o£ f6 Proper Cuakmg Temperatures too Ana i[} rcx 5 that arc Raw,Urrdera,oked oa PHFs ...... 1 ( Not t7th r E<,. 1'ras.ase+ o}luitinuu^ 340i.1.1Afl i{1} t.tg (Ss x. 154c �i-3(�r +. ks3t ,ri.ad F. 4aFrai fU ctai kxw.L,hell Fc-IasnEodatw 5ervu; 145f15585.:= } £s 3-401.1l(A)(2) C omanitt¢ts t 7 i,h, Me i�.4 Grans_ Anm ats 1551'.15 ser SPECIAL REQUIREMENTS 4C11.P{H)t1)r2) r1ofkand 13Qct Rovq- 1 )U1121niin 5, .1k9(Arci 3VictathistsL[Seetle>ia 9C (7)s3s11-fT>),tn 3 4r11.31(11)t2}.� It sines,Ins c�cal Slerta 1 5 [ 1 5 I catcreoa rtxi!>ili scxxl tcntporary and j res*df1ia€kitchenoper umns shUuld be 3-40yb lid(i7irne' �tuffro 11 Smiling Contting Fish,Moat. � � � Lief to undiI Site apprcrprtatc sect tons Poo Itry or kanlos I 65'F I S uc s' f Axwe if fel iaed to fbodhorac rltness 5�1 tltC7(3i J} le-n3n cie tieact IS t§tris ) into ve Cxnrs a*sd risk Ncfcors Otbicr 145 It 541)009 t iolaiticu ,rela[inc to maxi retail ._ ..... 3-401 I2 kau �1re9m�ai Foods Ct><rKe{t r«,a _A practices ,1�atirld E tlefiitcxi under#x'29- _ liictow:ar l6° f* _ `'spenai ku}trirc,3xetts. 140f A(Ai(I}(b) Iti t)thei s'HI v 145"F it _ec. Reheating tar Hot balding _ VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 3-1(?311(0.)MD) PHF, 165')F 15 wc.. ._ w (lterus23 0) 34W.1 I fB) NTu.towavc iU5' F 2 tslnitttc St.andin t res:r 7:v, °ru r riu rt ,tu�tdisrns wl'ich do nos "ckur eo ow . T inl ea. _ _ roodhorne.tlnes�.hue't crrtlans acftms F ved above <vn be 3-405,11(C;) j 0morterc reuly Praeesc,slRTU'i'and- f(,soui it, �wrwns of the Food Code snot 105 CFi41t 40'h item m �Gzvd Retail Pratres 3443.71(f} 2einainin'q Ungliced portions ifcicfC 580006 .s- , 24 Ata d Food tardy r urneE _ r rC 3 004 k costo of PHF, ?4 1-j;,)d and Paat Proiei non FC 3 .004 �tg Proper Cooling at PHFs { _._C. ..._.......n �.1§ f-� Up t>��tc?nt�tdt}cv�25iCrs QFC 7 _f?Q'� s .i-5(J1.k#(A) � Cen7hne Ctwkd.PHFc traru IQir"F to- 70'T o j �c 3.nta4er i`si�rFnng snc.'^7 iste i FC S �Otk _ , ii 7rt I Within 2 x{acrs and Frim 701' j �27' ty Q FC�,j�007 co1V :F7a9Ft4at1tin4How " 128 Posinn� nrTnx�cMteras FC .W 7 � 2 i �....�...._...._.._._.__..._.,.- , ^a S�t?E'i rE Ruseanrii T t}t?9 { t ,,znlon kF(F�1te,le.k�utsr.lit?btatat t } �c __. � _ re m(4ritcsre hj�r.dicuts to411`/45'F %(111"n 4 s'tours" ,lemrtea aitrml aiwn;a id,;i�,kx„t NIP 3 ar:3 f:;u:te ee t05 C MR 5o";i00 IMPORTANT MESSAGE FOR �/ `n. 7 DATE J " 1 � -7 TIMEZ .M. M— OF i PHONE -- D AREA CODE NUMB EXTENSION U FAX U MOBILE AREA CODE >14BER TIME TO CALL TELEPHONED PLEASE CALL CAME TO SEE YOU WILL CALL AGAIN WANTS TO SEE YOU RUSH RETURNED YOUR CALL L WILL FAX TO YOU MESSAGE SIGNED FORM 400fj 1_ MADE IN U.S. NOTES I PPORTAPJT MESSAGE FOR DATE wZ `O 7 TIME/� • .M 77 PHONE IO I AREA CODE NUMBER E77ENSION ❑ FAX Q MOBILE AREA CODE UMBER TIME TO CALL TELEPHONED PLEASE CALL CAME TO SEE YOU WILL CALL AGAIN WANTS TO SEE YOU RUSH RETURNED YOUR CALL WILL FAX TO YOU MESSAGE Ll� r I SIGNED FOMARMGEIN 4U .A 9 NOTES IMPORTANT MESSAGE FOR— DATE OR DATE n I TIME M OF ce / PHONE. l.�l a.� a043 AREA CODE NUMBER EXTENSION U FAX U 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 MESSAGE SIGNED MADE U0O9 NOTES 0177 Fort Avenue Crusty s Pizza Etc. City of Salem FOOD SERVICE ESTABLISHMENT - FOOD SERVICE Inspection HACCP: ❑ Item Status Violation Critical Urgency Telephone: FOOD PROTECTION MANAGEMENT 825-0004 PIC Assigned/Knowledgeable/Duties PASS RED Owner: Robert Soohoo Non-compliance with: Anti-Choking PASS PIC: _Robert Soohoo Tobacco PASS Inspector: John Gehan EMPLOYEE HEALTH Date Inspected:Correct By: Reporting of Diseases by Food Employee and PIC PASS RED 4/13/2007 Personnel with Infections Restricted/Excluded PASS RED Risk Level: FOOD FROM APPROVED SOURCE Permit Number: Food and Water from Approved Source PASS 0 RED BHP-2007-0451 Receiving/Condition PASS 0 RED Status: SIGNED OFF Tags/Records/Accuracy of Ingredient Statements PASS 0 RED #of Critical Violations: 1 Conformance with Approved Procedures/HACCP Plans PASS ❑ RED 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 GeoTMSO 2007 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Apr 17,2007 ) Page 1 of • Item Status Violation Critical Urgency RED: PROTECTION FROM CONTAMINATION Violations Related to Separation/Segregation/Protection PASS RED Foodborne Illness Interventions and Risk Factors (Require Food Contact Surfaces Cleaning and Sanitizing PASS RED immediate corrective action) Proper Adequate Handwashing PASS ❑ RED Good Hygienic Practices PASS RED Prevention of Contamination from Hands PASS RED Handwash Facilities PASS ❑d RED PROTECTION FROM CHEMICALS Approved Food or Color Additives PASS ❑d RED Toxic Chemicals PASS RED TIME/TEMPERATURE CONTROLS(Potentially Hazardous Foods) Cooking Temperatures PASSd❑ RED Reheating PASS ❑Q RED Cooling PASS RED Hot and Cold Holding PASS ❑d RED Time As a Public Health Control PASS RED REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) Food and Food Preparation for HSP PASS ❑d 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®2007 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Apr 17,2007 ) Page 2 of Item Status Violation Critical Urgency Violations Related to Good Retail Practices (Blue Items) Food and Food Protection PASS BLUE Equipment and Utensils PASS BLUE Water, Plumbing and Waste PASS BLUE Physical Facility PASS BLUE Management and Personnel PASS BLUE Poisonous or Toxic Materials PASS BLUE Special Requirements PASS BLUE Other-See Notes PASS BLUE GENERAL COMMENTS: This establishment has met all requirements to open for the season. 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 17,2007 ) Page 3 of N a Com�`monw alt+hogf Mgassachusetts s eY r `Eft ay�� .�i '�,�;,'�� • � �"�!»" �` 34 City of Sale�m�y� r a - x % * � � s a w�x �°* Q �i. '°c�4«'° 4 'rt r sk fi r q ♦ ` i N- +"' .,w+{x x Board of Health ,* � e ' v ��IGmbeftey unscottcolI �? ��., `� a.. `+xxr t s.. 6•� ,t � q,�u„a,,��Fµ� �.+"w�'S ��},,,.r'�Mayor� .e uM'"�' y, ys. '^ pv. "' '-Y"" t.^�'"S vs`.+'1. —r -.r}Y.?— F .•.r 1+ #�-Snrr"r 51�k SA� ,� firx - 3 •r,: Food/Retail Establishment Permit DATE PRINTED: 04/09/2007 ESTABLISHMENT NAME: Crusty s Pizza Etc. File Number:BHF-2004-000158 177 Fort Avenue Salem MA 01970 LOCATED AT: 0177 FORT AVENUE SALEM, MA 01970 Permit Type Permit No. Permit Issued Permit Expires Fee Restrictions/Notes FOOD SERVICE BHP-2007-0451 Apr 9,2007 Dec 31,2007 $100.00 ESTABLISHMENT TOBACCO VENDOR BHP-2007-0454 Apr 9,2007 Dec 31,2007 $50.00 Total Fees: $150.00 PERMIT EXPIRES December 31, 2007 Board of Health This Permit is not transferable and must be reissued upon change of ownership or location.The permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code,beofre any revonations, improvements,or equipment changes are made,all plans for such must be submitted to and approved by the Salem Board of Health. Page 1 of 2 CITY OF SALEM, MASSACHUSETTS o , BOARD OF HEALTH RECEIVED 120 WASHINGTON STREET,4TH FLOOR SALEM, MA 01970 APR — 2 2007 TEL, 978-741-1800 FAx 978-745-0343 EM Kimberley Driscoll WWW'SALEM.COM -:kLTH Mayor JOANNE SCOTT, MPH, RS, CHO HEALTH AGENT 2007 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT�y NAME OF ESTABLISHMENT— r� ��- � -2 A rL} G TEL# 9 T9 -R ?,' ' l ADDRESS OF ESTABLISHMENT�� 1"d.?t I,\!E. FAX If MAILING ADDRESS(if different) ,7,, f, EMAIL-- Liusiness: _. -. O'%nu"':jtrsh -&m , __ A Caw-- OWNER'S NAME1 r� a TEL# I a -`Lr ADDRESS I- „I�j�rcl SI P ezt J2.VI. 9A 01\1 00 STREET !J ` CITY ;STATE ZIP -*$ CERTIFIED FOOD MANAGER'S NAME(S) 1LE}Y � 25 CERTIFICATE#(S) (Required in an establishment where potentially hazardous food is prepared) EMERGENCY RESPONSE PERSON �G V\LVT C &n-, HOME TEL#DAYSOF # Pleasewriteoftla,, _ MoltdaY TUB�Sds aY� WedU`sdaY U(tSdaY F>i�Y L' SatgU(daY A`bY-' HOURS ri OPflIAflof , (for exampleliam-ttaml ! I 1 TYPE OF ESTABLISHMENT FEE (check onl RETAIL STORE YES (�Oless than 1000sq.ft. 1000-10,000sq.ft. =$100 more than 10,000sq.ft. =$250 -- -..---- ..... - .. ----- -- - - - - -- ..._. RESTAURANT YE NO -- -- les s than 25 seat-s 25-99 seats =$150 more than 99 seats =$200 _........... .... ... ... - ...-..........__.......-............ --- .... ------------ ----------- -- --- ---- BEDJBREAKFAST YES NO $100 ADDITIONAL PERMITS MAKE (not just serve) ICE CREAM, YOGURT, SOFT SERVE YES TOBACCO VENDOR YES NO (:b5> ALL NON-PROFIT(such as church kitchens) YES (: C $25 *Please'paytotal 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 i "prominent location in the'Estabiishment', ^dn 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. Pursua 1 M - 'hapter 62C, Section 49A, I certify under the pains and penalties of perjury that I, to my best knowledge and belief, hav all s ate to turns and paid all state taxes required under the law. - ' �©� b16 •68 •��3 Sign: t Dat Social Security or Federal Identification Number ---- - - -- - ---- ---------- Re. -------- - Re.vised 1 1/1 3/0 6 1`00DAP2007.ad Check#&0ate 0177 Fort Avenue Crusty s Pizza Etc. City of Salem FOOD SERVICE ESTABLISHMENT - FOOD SERVICE Inspection HACCP: ❑ Item Status Violation Critical Urgency Telephone: PROTECTION FROM CONTAMINATION 825-0004 - Food Contact Surfaces Cleaning and Sanitizing FAIL Critical ❑d RED Owner: .-�,., 1, F Comment:Sanitizer not available until late in inspection. Sanitizer to be readily available at each work station and at three bay Robert Soohoo daily. PIC:. u `sn Handwash Facilities FAIL Critical ❑J RED Robert Soo 00 ,, Comment: No soap at sink in restroom. Provide soap. Inspector. z, , John Gehan Date Correct By: Iiggy £i li Risk Level `` Permit Number: _: BHP-2006-0431' , Status: ; SIGNED OFF #of Critical Violations: 3 Time IN Time OUT. Urgency Description(s): BLUE: Violations Related to Good Retail Practices(Critical violations must be corrected immediately or within 10 ._ days)(Non-critical violations must be corrected immediately or within 90 days) City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741-1800 GeOTMS®2006 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Sep 14,2006 ) Page 1 of Item Status Violation Critical Urgency RED: 4y, Violations Related to Good Retail Practices (Blue Items) I Violations Related to _ Food and Food Protection FAIL BLUE Foodborne Illness Interventions" and Risk Factors(Require Comment: Beverage air unit has uncovered foods. All foods in storage must be covered. immediate corrective action) Equipment and Utensils FAIL Critical BLUE Comment: Ice cream unit requires thorough cleaning. Same unit missing thermometer. Provide visible and accurate thermometer. Ocean spray refrigerator requires general cleaning. Beverage air unit requires general cleaning. Freezer requires general cleaning. Nortake unit has accumulation of grime and requires thorough cleaning. Trash barrel and wall behind require thorough cleaning. Sandwich unit has knives stored incorrectly. knives to be stored in designated rack. Cutting board at sandwich station is stained and scored. Replace or resurface board. Knives have accumulation of food. Thoroughly clean and sanitize knives. knives not properly washed at time of inspection. sanitizer to be made daily. Mop stored incorrectly. Store mop so that it is hung and allowed to air dry. Oven vent requires cleaning. Due Feb.06. Side of pizza oven requires thorough cleaning. GENERAL COMMENTS: 819:AII violations from 9-7-2006 have been corrected. Thabk you. 17 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. Sep 14,2006 ) Page 2 oft a 0177 Fort Avenue Crusty s Pizza Etc. City of Salem FOOD SERVICE ESTABLISHMENT - FOOD SERVICE Inspection HACCP: ❑ Item Status Violation Critical Urgency Telephone " n FOOD PROTECTION MANAGEMENT 825-0004 rt .' ,. PIC Assigned/Knowledgeable/Duties PASS ❑ RED Owner: ; Noncompliance with: Robert Soohoo •,. pass PIC Anti-Choking�?", .x, Robert Soohoo .." Tobacco PASS Inspector: John Gehan EMPLOYEE HEALTH Date � e r Correct By: Reporting of Diseases by Food Employee and PIC PASS ❑J RED Personnel with Infections Restricted/Excluded PASSd❑ RED Risk Level FOOD FROM APPROVED SOURCE Permit Number. __ Food and Water from Approved Source PASS ❑J RED BHP-2006-0431. Receiving/Condition PASS '] RED Status: Open ', Tags/Records/Accuracy of Ingredient Statements PASS RED #of Critical Violations: Conformance with Approved Procedures/HACCP Plans PASS ` RED 3 a r Time IN:. ime 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. Sep 07,2006 ) Page I of Item Status Violation Critical Urgency RED: PROTECTION FROM CONTAMINATION Violations Related to Separation/Segregation/Protection PASSd❑ RED Foodborne Illness Interventions and Risk Factors (Require Food Contact Surfaces Cleaning and Sanitizing FAIL Critical I] RED immediate corrective action) �0mments:Sanitizer not available until late in inspection. Sanitizer to be readily available at each work station and at three bay daily. Proper Adequate Handwashing PASS ❑J RED Good Hygienic Practices PASS RED Prevention of Contamination from Hands PASS RED Handwash Fa "' FAIL Critical ❑J RED Comments: No soap at sink in restroom. Provide soap. PROTECTION FROM CHEMICALS Approved Food or Color Additives PASS 0 RED Toxic Chemicals PASS ❑N RED TIME/TEMPERATURE CONTROLS(Potentially Hazardous Foods) Cooking Temperatures PASS ❑,/ RED Reheating PASS RED Cooling PASS ,/❑ RED Hot and Cold Holding PASS RED Time As a Public Health Control PASS RED REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) Food and Food Preparation for HSP PASS ❑d RED CONSUMER ADVISORY Posting of Consumer Advisories PASS ❑d 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. Sep 07,2006 ) Page 2 of 4 Item Status Violation Critical Urgency Violations Related to Good Retail Practices (Blue Items) Food and Food Protection FAIL BLUE comments: Beverage air unit has uncovered foods. All foods in storage must be covered. Equipment and Utensils FAIL Critical BLUE 'Co–C-mments: Ice cream unit requires thorough cleaning. ✓Same unit missing thermometer. Provide visible and accurate thermometer. ,Oce ray refrigerator requires general cleaning. Beverage unit requires general cleaning. I Free quires general cleaning. offake unit has accumulation of grime and requires thorough cleaning. LXfSsh barrel and wall behind require thorough cleaning. \Sandwich unit has knives stored incorrectly. knives to be stored in designated rack. -,C�tNing boarich station is stained and scored. Replace or resurface board. ,,_Knives have accumulation of food. Thoroughly clean and sanitize knives. knives not properly washed at time of inspection. . . sanibzer to be made daily. .o"tbred incorrectly. Store mop so that it is hung and allowed to air dry. , vent requires cleaning. Due Feb.06. of pizza oven requires thorough cleaning. Water, Plumbing and Waste PASS BLUE Physical Facility PASS BLUE Management and Personnel PASS BLUE Poisonous or Toxic Materials PASS BLUE Special Requirements PASS BLUE Other-See Notes PASS BLUE 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. Sep 07,2006 ) Page 3 of Item Status Violation Critical Urgency GENERAL COMMENTS: Z38:Owner to fax over last three months of extermination reports to BOH. 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. Sep 07,2006 ) Page 4 of r i 0177 Fort Avenue Crusty s Pizza Etc. City of Salem FOOD SERVICE ESTABLISHMENT - FOOD SERVICE Inspection HACCP: ❑ Item Status Violation Critical Urgency Telephone: ` " a FOOD PROTECTION MANAGEMENT ;825-0004 " PIC Assigned/Knowledgeable/Duties PASS U RED Non-compliance with: Robert Soohoo r Anti-Choking PASS PIC. Robert Soohoo, Tobacco PASS Inspector: It EMPLOYEE HEALTH John Gehan, " Y Date Inspected: Correct By Reporting of Diseases by Food Employee and PIC PASS d❑ RED 3/23/2006 _" Personnel with Infections Restricted/Excluded PASS ❑ RED Risk Level:' FOOD FROM Arr ROVED SOURCE Permit Number Food and Water from Approved Source PASS ❑d RED BHP-2006-0431 t 'r Receiving/Condition PASS ❑d RED Status ; Open = rc & _ - Tags/Records/Accuracy of Ingredient Statements PASS ❑d RED #.Ot CfIYIC81 VIOIatiORS '- Conformance with Approved Procedures/HACCP Plans PASS RED ,Time IN. Y Time OUT: Urgency Description(s) ; BLUE � x 0 -. Violations Related to Good Retail Practices(Critical =' violations must be corrected = - immediately or within 10 days)(Non-critical violations must e�corrected immediately b or within 90 days) m t 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. Mar 23,2006 ) Page 1 of Item Status Violation Critical Urgency RED: PROTECTION FROM CONTAMINATION Violations Related to Separation/Segregation/Protection PASS ❑J RED Foodborne Illness Interventions" and Risk Factors (Require Food Contact Surfaces Cleaning and Sanitizing PASS ❑� RED immediate corrective action) Proper Adequate Handwashing PASS 0 RED Good Hygienic Practices PASS 0 RED Prevention of Contamination from Hands PASS RED Handwash Facilities PASS RED PROTECTION FROM CHEMICALS Approved Food or Color Additives PASS RED Toxic Chemicals PASS 0 RED TIMEITEMPERATURE CONTROLS(Potentially Hazardous Foods) Cooking Temperatures PASSd❑ RED Reheating PASS Q RED Cooling PASS Q RED Hot and Cold Holding PASS RED Time As a Public Health Control PASS 0 RED REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) Food and Food Preparation for HSP PASS Q RED CONSUMER ADVISORY Posting of Consumer Advisories PASS ❑d 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. Mar 23,2006 ) Page 2 of Item Status Violation Critical Urgency Violations Related to Good Retail Practices (Blue Items) Food and Food Protection PASS BLUE Equipment and Utensils FAIL BLUE Leomments: Properly clean and sanitize all utensils prior to opening. L<epair broken right door handle on Beverage Air unit. Water, Plumbing and Waste FAIL BLUE �mments:Water temperatures above temperatutre at time of inspection. Water temperature to be held between 110°-130°F. Owner adjusted thermostat at time of inspection. Monitor temps for safety reasons. Physical Facility PASS BLUE Management and Personnel PASS BLUE Poisonous or Toxic Materials PASS BLUE Special Requirements PASS BLUE Other-See Notes PASS BLUE GENERAL COMMENTS: .634:Mop to be stored correctly by hanging up to allow air and prevent growth of bacteria. 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. Mar 23,2006 ) Page 3 of W+fh'Fr '^ r'�""a,'t}7k`�fi1}�`'.x. d'.?e :.u,'fJtyrµ: .}lyy, '}.M'�, k..-x- rw-.....t -�F.f-t ... aa,.....vF-• ay* x R iP'iJ. .rw :L", "-k�A(N>Y' '+a. ,de, ':,�.y„yx `-' ;W.R e ge Ii�Y��9�U Mak7:•fih b'amw_i?"�w; r'rt �.tr+�s Fw•a , ...cG-:+`.x'! ^'e••.-. NF" fir." 4 �a4i .s. x+�+f AYo �'+MJ#7Yf fin..... '. r . Commonwealthof Massachusetts. City of Salem + " .Kimberley Drist�ll Board of Health Mayor 120 Washington Street,4th Floor SALEM,MA 01970 DATE PRINTED: 03/21/2006 WHO'S PLACE OF BUSINESS IS: Crusty s Pizza Etc. File Number:BHF-2004-0158 177 Fort Avenue Salem MA 01970 LOCATED AT: 0177 FORT AVENUE SALEM, MA 01970 Permit Type Permit No. Permit Issued Permit Expires Fee Restrictions/Notes FOOD SERVICE BHP-2006-0431 Mar 21,2006 Dec 31,2006 $100.00 ESTABLISHMENT TOBACCO VENDOR BHP-2006-0430 Mar 21,2006 Dec 31,2006 $50.00 Total Fees: $150.00 PERMIT EXPIRES December 31, 2006 Board of Health —11-19 Page 1 of 3 1 i CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH s 120 WASHINGTON STREET, 4TH FLOOR SALEM, MA 01970 TEL. 978-741-1800 STANLEY J. USOVICZ, JR. FAx 978-745-0343 MAYOR WWW.SALEM.COM JOANNE SCOTT, MPH, RS, CHO HEALTH AGENT 2006 APPLICATION FOR PERMIT TOOPERATE C�C� PERATE A FOOD ESTABLISHMENT NAME OF ESTABLISHMENT_ t ( 9I A5��S� T)T 5A-L%' A 7- CTEE,L## 07Z-' j QOM ADDRESS OF ESTABLISHMENT l 11 ib "LE `wM, IWA 0161-70 MAILING ADDRESS (if different) -- OWNER'S NAME QLj�S o TEL# L ]-- Z21-!269'3 ADDRESS 23 CRD12OO N CITY A l L2T-OM STATE Mak ZIP DZl CERTIFIED FOOD MANAGER'S NAME(S) Qpgfy—� Sc7j-1-(t�D CERTIFICATE#(s) � (required in an establishment where potentially hazardous foodis `prepared.)mk-- HOURS /- EMERGENCY RESPONSE PERSON N�kN C� k � HOME TEL# HOURS OF OPERATION: Mon. Tue. Wed. Thu. Fri. Sat. Sun. TYPE OF ESTABLISHMENT FEE (check only) RETAIL STORE YESNO less than 1000sq.ft. =$ 50 1000-10,000sq.ft. =$100 more than 10,000sq.ft. =$250 ----------- --- -------- ---------------------------------------------- --s-than --ea-- -------... ---....... - RESTAURANT 'YES NO les25 sis' -'$100 25-99 seats =$150 ll�P more than 99 seats =$200 ...... -----------------------------------------------------------------------------------.......----- BED/BREAKFAST YES N00 $100 ...--------------------------------------------------------------------------------------------------------------------------- p,ppITIONAL PERMITS MAKE (not just serve) ICE CREAM, YOGURT, SOFT SERVEO $5 CYETOBACCO VENDOR �P1�Q $50 ALL NON-PROFIT(such as church kitchens) U $25 *Please pay total with one check payable to the City of Salem , ��JJJ 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. D52. Signatufe C Date Social Security or Federal Identification Number -------------------------------------------------------------- ---------------------------------------- ----------------------------- Revised 11/03/05 FOODAP2.adm Check#&Date ./250� n,. "'v(^'--15.� .. pQr�r.w.J+L��tipC4".' � ', .....- . .._:.. -6. .,, :y.^.. '..v�_....H .;-WLMa..+s^-^r^i*'....- .n....✓ ....rn ,.-rr .. - 5. Massachusetts Department of Public Health Salem Board of Health 120 Washington Street,4`" Floor Division of Food and Drugs Salem, MA 01970-3523 FOOD ESTABLISHMENT INSPECTION REPORT Tel. (978) 741-1800 Fax(978) 745-0343 Name V Dat J Type of Operation(s) T e of Ins ection 1"t 1 r ZZ� / 1/ �FoodService Routine Address Rik ❑ Retail ❑ Re-inspection Telephone r Level ❑ Residential Kitchen Previous Inspection Elu Mobile Daterr s Owner HACCP Y/N El Temporary El Pre-operation ❑ Caterer ❑ Suspect Illness Person in Charge(PIC) Time ❑ Bed&Breakfast ❑ General Complaint inspector In: J El HACCP ns P l P Out: Permit No. ❑ Other Each violation checked r quires an explanation on the narrative page(s) and a citation of specific provision(s)violated. Non-compliance with: Violations Related to Foodborne Illness Interventions and Risk Factors Anti-Choking Tobacco Violations marked may pose an imminent health hazard and require immediate corrective 590.009(E) ❑ 590.009(F) ❑ action as determined by the Board of Health. FOOD PROTECTION MANAGEMENT - ❑ 12. Prevention of Contamination from Hands ❑ 1. PIC Assigned/Knowledgeable/Duties ❑ 13. Handwash Facilities EMPLOYEE HEALTH '`• . PROTECTION FROM CHEMICALS ❑ 2. Reporting of Diseases by Food Employee and PIC ❑ 14.Approved Food or Color Additives ❑ 3. Personnel with Infections Restricted/Excluded 15.Toxic Chemicals FOOD FROM APPROVED SOURCE ❑ ❑ 4. Food and Water from�Approved Source TIMErrEMPERATURE 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 . Food Contact Surfaces Cleaning and Sanitizing REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) i ❑ 21. Food and Food Preparation for HSP ❑ 10. Proper Adequate Handwashing ❑ 11. Good Hygienic Practices _CONSUMER ADVISORY;.,,"_ ❑22. Posting of Consumer Advisories Violations Related to Good Retail Practices Number of Violated Provisions Related Critical (C) violations marked must be corrected To Foodborne Illnesses Interventions immediately or within 10 days as determined by the Board and Risk Factors(Items 1-22): of Health. Non-critical (N) violations must be corrected Official Order for Correction: Based on an inspection immediately or within 90 days as determined by the Board today, the items checked indicate violations of 105 CMR of Health. 590.000/federal Food Code. This report, when signed below 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 6. 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:59pMVp fFom 14.dxnYe ) Inspector's Signature: \ Print: PIC's Signature: Print - Paged of ages Violations Related to Foodborne Illness Interventions and Risk Factors(items 1-22) PROTECTION FROM CONTAMINATION•-^ FOOD PROTECTION MANAGEMENT K Cross-contamination 1 590.003t A) Assignment of Res for ibility* )-302.11(A)(1) Raw Animal Foods Separated from 590.003(B) Demonstration of Knowledge* Cooked and RTE Foods" 2-103.1.1 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 in charge to Contamination from the Environment require reporting by foal employees and 3-302.1 1(A) Foorl Protection* a h licants* 3-302-15 W�itc and Vegetables 590.0030-) Responsibility Of A Food Employee Or An 3-304.11 Food Contact with Equipment and Applicant To Report To The Person Tn Utensils* Charge* Contamination from the Consumer 590.003(G) Re orhn by Person in Charge* 3-306.14(A)(B) Returned Food and Reservice of Foal* 3 590.003(13) Exclusions and Restrictions* Disposition of Adulterated or Contaminated 590.003(E) Removal of Exclusions and Restrictions Food 3-701.11 Discarding or Reconditioning Unsafe FOOD FROM APPROVED SOURCE Food* 4 Food and Water From Regulated Sources 199 Food Contact Surfaces F4-501.112 .111 Manual Warewashin Hot Water 590.004(A B) Com liance with Food Lair° - - 3-201,12 Food in a Ilennetica[ly Sealed Container" Sanlfizztion fern eratures* 3-201.13 Fluid Milk and Milk Products* . Mechanical Warewashing-Hot'' Water 3=202.13 Shell Eags* Sanitization Temperatures* 3-202.14 Eggs and Milk Products,pasteurized" .114 Chen cal Sanitization-temp.,pH, concentration and hardness. v` 3-202.16 Ice Made Front Potable Drinking Water* 4-601.11(A) Equipment Frxxl Contact Surfaces and 5-107.11 Drinking Watcr from an Approved Svstem" Utensils Clean" 590.006(A) 13ott1ed Drinking Water* 4_602.11 Cleaning Frequency of Equipment Food- 590.006(B) Waist Meets Standards in 310 CMR 22.0* Contact Surfaces and Utensils* Shellfish and Fish From an Approved Source 4-702,11 Ficiluency of Sanitization of Utensils and 3-201.14 Fish and Recreationally Can,, Molluscan Food Contact Surfaces.of Equipment* Shellfish* 4-703.11 Methods of Sanitization--Hot Water and 3-201.15 Molluscan Shellfish from NSSP tasted Chemical* Sources" 10 Proper,Adequate Handwashing Game and Wild Mushrooms Approved by Reaulatort,Authority 2-301.7 1. Clean Condition--A.nhds and Arms* 3-202.18 Shellsto k Identification Present* 2-301.12 Cleaning,Procedure* 590.004C) Wild Mushrooms* 2-301.14 When to Wash" 3-201.17 Game Animals" 11. Good Hygienic Practices S ReceivingiCondition 2-401.11 Eating,Drinking or Using Tobaccol` 3-202.11 PHFs Received at Proper Tetn eratnres," 2-401.12 Discharges'Yrotn the Byes.Nose and 3-202-15 Month* 3-101.11 Food Safe and Unadulterated* 3-301.12 Preventing Contamination When Tasting* 6 Tags/Records:Shenstock 12 Prevention of Contamination from Hands 3-202.18 Shchstock Identification* 596.004(E) Preventing Contamination from 3-203.12 ShellstockIdentification 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* 5205.1.1 Numbers,and Capacities*- 590.004(7) Labeling of Ingredients* 5-264.11. Location and Placement* 7 Conformance with Approved Procedures 5-205.11 Accessibility, Operation and Maintenance fHACCP PlansSupplied with Soap and Hand Drying Devices 3-502.11. S ecialized Processin Methods* = 3-502.12 Reduced oxv=cn packaging,criteria* 630111 Ilandwashing Cleanser.Availxbilit 8-103.12 Conformance with A roved Procedures* 6-301.12 Hand Dryin�Provision '"Denote;critical item to ilie federal 1999 Food Code or 105 CldR 590,00(). ".N d0.. ...:j .. CITY OF SALEM BOARD OF HEALTH / Establishment Name: Cr✓S� r I�,ZZc� Date: /n / o Page: of Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date No. Reference R—Red Item -•.'. A PLEASE PRINT CLEARLY - Verified t1c z2 PZA n ' Al r ct&ry U ! U 1 39:4,1 / GC n YlP no/ . I r v '}' Pr& I✓1 AQPJ�j) 1,20 I Cor,h I 14 V,(S Gni � � ✓ _ Discussion With Person in Charge: Corrective Action Required: ❑ No Yes ❑ 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 I comply,with all mandates of the Mass/Federal Food Code. I understand that noncompliance may result in daily fines of twenty-five dollars or suspension/revocation of ❑ Embargo ❑ Emergency Closure your food permit. ❑ Voluntary Disposal ❑ Other: 3-501_I4((-,) PHFs Received at Temperatures Violations Related to Foodborne Illness Interventions and Risk According to taw"ailed td Factors(items 1-22) (Cont.) 41"F/451'F Within 4 Hours. "' PROTECTION FROM CHEMICALS 3-501.15 Cooling Methods for PHFs 14 Food or Color Additives 19 PHF Hot and Cold Holding - 3-501.16(13) Cold PIIFs Maintained at or below 3-302.12 Aotectis'e 590.004(F) 41°/45° F* 3-3(Y1.14 Protection from Lina r rowed Additives* 3.501,16(A) Hot P11Fs Maintained at or above 15N7-2011 Poisonous or Toxic Substances 14WR 7-101.11CoIdentainers- Information-Original 3-501.16(A) Roasts Held at or above 130°F. Containers* Common Name-Working Containers* 20 Time as a Public Health Control Se..aration-Storage" 3-501.19 Time as a Public Health Control* Restriction-Presence and Use" 590.004(H) Variance Re uirement Conditions of Use* 7303.1.1 1 Toxic Containers,-Prohibitions* REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-204.11, Sanni7ers,Criteria-Chemicals- POPULATIONS(HSP) _ 7-204.12 Chemicals for W shineProduce Criteria* 21 3-801.11(A) 1npi teurized Pre-packaged Jatoes and Beverages with Warning Labc]L 7-204.14 Ihwng Agents.Criteria* 7-205.11 Incidental Food Contact. Lubricants" 3-801._1.1(B) Use of Pasteurized Eggs* 3-801 i(D) Raw or Partially Cooked Animal Food and 7-206.11 Restricted Use Pesticides, Criteria*' Raw Seed S routs Not Sen ed. 7-206.12 Rodent Bait'St'xuorrs* 3-801.11(C) Una e�ned Food Pucka e Not Re-served. 7-206.13 Tracking Powders,Pest Control and Monitoring* CONSUMER ADVISORY TIMEITEMPERATURE CONTROLS 22 3-60311 Consumer Adeisory,Posted for Consumption of Animal Foods'1'hat are Raw,Undercooked or 16 Proper Cooking Temperatures for PHFs Not Otherwise Processed to Eliminate 3401.I1A(1)(2) F„),;- 155'F 15 Sec. Patio ens *ErfacnveV,'-X1 I b ts-Inunedtate Service 145°F15sec* 3-302.13 Pasteurized Eggs Substitute for flaw Shell 3-401.11(A)(2) Comminuted Fish,Meats&Game E gs* Animals-155'F 15 sec. * 3-401.11(B)(I)(2) Pork and Beef Roast-13WF 121 nun* SPECIAL REQUIREMENTS 3-401.11(A)(2) Ratites,Injected Meats-155'F 15 590-009(A)-(D) Violations of Section 590.009(A)-(D)in sec. m catering. mobile food, temporary and 3-401.11(A)(3) Poultry,Wild Game, Stuffed PHFs, residential kitchen operations should be Stuffing Containing Fish, Meat, debited under the appropriate sections Poultry or Ratites-165`F 15 sec. * above if related to foodborne illness 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks interventions and Disk factors. Other 145°F* 590.009 violations relating to good retail 3-401.12 Raw Annual Foods Cooked in a practices should be.debited under#29- _ Microwave 1650F* Special Requirements. 3-401.11(A)(I)(b) All Other PHFs-145'F 15 see. I7 Reheating for Hot Holding VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 3-4003.11(.A)&(D) PHFs 165°F 15 sec. * (Items 23-30) 3-403.11(B) Microwave- 165°F 2 Minute Standing Cruncal mul non-critical violations, which do not relate to the Time" .foodborne illness interventions and risk factors listed above,, can be 3-403.11(C) Commercially Processed I2TE Food- ,found in the fotlou-tng sections of the Food Cade and 105 CMR '14WF* 590.000. 3-403.1.1(B) Remaining Unsliced Portions of Beef Wem Good Retail Praeiice_s FC 590.000 Roasts* 23. Manaament and Personnel__..._ FC-2 .003 Ig Proper Cooling of PHFs 24. Food and Food Protection FC 3 .004 - 25. Eui ment and Utensils __FC 4 _ _A05 3-501.14(A) Cooling Cooked PHFs from 140`F to 26, Water, Plumbin 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(3) Cooling PHFs Made Front Ambient 29. S genal Re uirements .008 Temperature ingredients to 41'F/45-F 30. Other Within 4 Hours'% ` `"` "r'"�sJ"' 'Denotes crioca1 item'm the tvlera1 1999 Food Code or 105('MR 590.000. IMPGRXANT MESSAGE FOR DATE 3'o2�- O/o TIME le"14 P.M. Mea; L}OGhO c?) PHONE AREA CODE NUMBER EXTENSION U FAX U MOBILE AREA CODE NUMBER TIME TO CAUL TELEPHONED PLEASE GALL _ CAME TO SEE YOU WILL CALL AGAIN WANTS TO SEE YOU RUSH RETURNED YOUR CALL WILL FAX TO YOU MESSAGE � SIGNS FORM 4009 MADE IN U.S.A. NOTES _ IMPORTANT MESSAGE FOR � ) ( d DATE a- TIME ApficnP.M. M i�ab��-t Sdoh� OF PHONE ARFA CODE NUMBER EXTENSION Q FAXM0 (VI-1 �q 0� ❑ MOBIL 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 MES SA E u a5 an �flx-�ec-4 iarL �i e--)c)enIna 0n �� r �q+s ren r, 5f�eet �o h Mon d SIGNED ::Ll- nil, V FORM 4009 MARE IN U.S.A. NOTES '+ �,"' tai J., '; v� t�'•..�,. �+. a a::� S ,� � � � w t�- 3 + �kW y,� �t] A j9!f�y �ayiF'. xd.i�':ir �� '*4 : . ' ti SALEM�4MASSACHUSETTS TI. .. .__:120 WASHINGTON STREET, 4TH FLOOR +" SALEM, MA 01970 ,. TEL. 978-741-1800 FAX 978-745-03.43 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: Crusty s Pizza Etc. Address of Establishment: 177 Fort Avenue Owner's Name: Robert Soohoo Restrictions: Application Date: 2/24/05 Permit for Food Establishment 283-05 Frozen Desserts/Ice Cream Permit for the Sale of Tobacco Products 62-05 These Permits Expire December 31, 2005 This permit is not transferable and must be reissued upon change of ownership or location. The permit must be posted in a prominent location in the Establishment, In accordance with the State Sanitary Code, before any renovations, improvements, or equipment changes are made, all plans for such must be submitted to and approved by the Salem Board of Health. (/ HEALTH AGENT ` CITY OF SALEM MASSACHUSETTS ' BOARD OF HEALTH 120 WASHINGTON STREET, 4TH FLOOR �o SALEM, MA 01970 'f EL. 978-741-1800 FAX 978-745-0343 STANLEY J. LISOVICZ, JR. JOANNE:,SCOTT, MPH, RS, CHO MAYOR HEALTH AGENT 2005 APPLICATION FOR/PERMIT TO OPERATE A FOOD ESTABLISHMENT NAME OF ESTABLISHMENT l >y t,�c�. ` q 9 A 4"ILTEL# q72 ' B23. C)17 Ll ADDRESS OF ESTABLISHMENT MAILING ADDRESS (if different) ( ' OWNER'S NAME Jq0 \ (� _TEL# ADDRES CITY STATE d. A ZIP CERTIFIED FOOD MANAGER'S NAME(S) �� q�CERTIFICATE#(s):s3aQ7 'S (required in an establishment where potentially hazardous food is prepared.) EMERGENCY RESPONSE PERSON QQrQA LZ_l,)1Ad -- HOME TEL#_ // / `LS HOURS OF OPERATION: Mon. Tue. ✓ Wed. Thu. \/ Fri. Sat. t� Sun. '>1 JJ1t -tip TYPE OF ESTABLISHMENT _ V z FEE check only RETAIL STORE YES less than 1000sq.ft. NO 100n-10 0nnsn.ft. =$Inn more than 10,000sq.ft. =$250 RESTAURANT YE NO �� less than 25 seats =$10 25-99 seats _$150 �d SFS 1 S C/ v more than 99 seats -$200 BED/BREAKFAST YES 5100 ADDITIONAL PERMITS MAKE (not just serve) ICE CREAM, YOGURT, SOFT SERVE YES $5 TOBACCO VENDOR ` �N-O�y� $50 ALL NON-PROFIT(such as church kitchens)• Q� YES l J $25 Please pay total with one check r 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. hIIISIHIIII Li P.'IGI 01;11)41 QC, Section 49A, Icuitily under the pilus ❑nd ponallies of perjury 111th I, to 1111, hest knowledge ,Ind bell t, have filed all stale 4c< [Gloms and paid all state taxes required under the law. - Siynatul is - Dutu 113 1 Social Security or Federal Identification Nu111bor --------- ---- - — ----- ----------------------------------------------- ------- - - � -- - - 3��` R,-ei�;r,1 11:11 ;U1 f' N AI'7 adm Chcrb.:: - r City of Safem, Massachusetts Fire Department-_ R o 48GaJayette5heet s Grove Salem, �(assacfiusetts 01970-3 S SEP 2 7 2005 Fire Prevention DaVLJIV Cody Te[ 978-744-1235Bureau Chief FaX 978-745-4646 CITY OF SALEM 978-745-7777 9;x-744 6990 _ BOARD OF HEALTH fcodyCsalemcom rCrusty's Pizza C177 Fort Avenue Dear Sir/Madam: MAINTENANCE, CLEANING, AND TESTING OF FIXED FIRE EXTINGUISHING SYSTEMS. MAINTENANCE, CLEANING OF HOOD AND DUCT SYSTEMS WHERE COOKING GREASE IS GENERATED................. The Salem Fire Prevention Bureau requires that all hood and duct systems are to be cleaned from the cooking area (hood) in the kitchen, all the way to the extreme end of the duct. THIS CLEANING WILL OCCUR ON A QUARTERLY BASIS. A certificate showing the name of the company, the person, and the date of the cleaning shall be posted near the hood area. The certificate will indicate what work was performed, and will also indicate areas not cleaned. ALL FIXED FIRE EXTINGUISHING SYSTEMS ARE TO BE TESTED AND CHECKED SEMI- ANNUALLY. THIS TEST WILL ALSO INCLUDE A TEST OF THE INTERIOR FIRE ALARM SYSTEM. The cleaning company and the fixed extinguishing service company shall<file—within_(5)-five`-dam after the work is performed, a-report with the-Salem Fire-Prevention —Prevention—Bureauu of all their activities relative to the above listed systems. The report shall also list any and all deficiences of the systems and the remedial action to be taken. Failure to adhere to this public safety requirement will result in the shut down of the systems. Prior to resuming operations an inspection will be conducted by this office. Per Order qlfq Lt. Erin Griffin Date of Conveyance Fire Marshal FORM BIR (4105) This is YOUR SECOND'NOTICE;please remedy this situation immediately. r FAILURE TO RESPOND WILL BE INTERPRETED TO MEAN-THAT THIS OFFICE WILL "ORDER A CEASE OF OPERATIONS UNTIL YOUR REQUIRED COOPERATION"IS'"RESUMED:—^T __. _�_ — - 1 -- ---- —FILE _Cc: _ Licensing Health Building FILE $ City of Salem, Massachusetts Fire Department 48 Lafayette Street .� Salem, tilassarhusetts 01970-3695 7ireTreventian Chief Tel 978-744-1235 - Bureau 978-744-6990 Fax 978-745-4646 973-745-7777 MAINTENANCE, CLEANING, AND TESTING OF FIXED FIRE EXTINGUISHING SYSTEMS. MAINTENANCE, CLEANING OF HOOD AND DUCT SYSTEMS WHERE COOKING GREASE IS GENERATED. . . . . . . The Salem Fire Prevention Bureaurequiresthat all hood and duct systems are to be cleaned from the cooking area (hood) in the kitchen, all the way to the extreme end of the duct. THIS CLEANING WILL OCCUR ON A QUARTERLY BASIS. A certificate showing the name of the company, the person, amd the date of the cleaning shall be posted near the hood area. The certificate will also indicate areas not cleaned. All fixed fire extinguishing systems are to be tested and checked SEMI—ANNUALLY. This test will also include a test of the interior fire alarm system. The`cleaning_companyand the fixed extinguishing service company shall file witn (5) five days after the work is performed, a report with the Salem Fire Prevention'-- - _. — �b �Bureau-of `all- their activities re-lative to the aove listed systems-. The report shall also list any and all deficiencies of the systems and the remedial action to be taken. Failure to adhere to this public safety requirement will result in the shut down of the systems. Prior to resuming operations an inspection will be conducted by 4Marshal Date of Conveyance: ' ,d? V, L / CODE COMPLIANCE Workshops on New Massachusetts Fire Safety Act The Department of Fire Ser- cially the new automatic sprinkler Workshops were held at Marble- vices and the Department of requirements for certain places head High School, Western New Public Safety held a series of joint of assembly; a review of the Act's England College in Springfield, workshops on Chapter 304—The new inspection and enforcement Bridgewater State College, the Massachusetts Fire Safety Act of procedures for both fire and build- John F. Kennedy Middle School in 2004 - for both ing officials, Florence and Department of Fire fire and build- and additional Services in Stow. ing inspectionimpacts to the officials. Eleven "The average State Buildin Chapter 304 - The Massachu- g setts Fire Safety Act of 2004 workshops wereattendance at Code. was signed into law by Governor held between Fire Marshal Romney in August 2004. One of March 1e,, reach- January and each workshop Stephen Coan the most important features of this rand Public new law is that certain nightclubs, ng more than was over 100 Safety Commis- bars, dancehalls, discotheques sial public of- sioner Thomas and other places of assembly facials with cern- attendees �� Gatzunis were must install sprinklers within three ing thi concern- presenters years to protect their patrons from ing this important at all of the fire. In general, facilities that hold fire safety legislation. The average workshops with support from De- 100 patrons or more must install attendance at each workshop was partment of Fire Services Legal automatic extinguishing systems. over 100 attendees. Counsel, Steve Rourke and Peter Each workshop provided the fol- Senopoulous, and Department More detail on Chapter 304- lowing: an overview and history of Public Safety staff, Brian Gore The MA Fire Safety Act of 2004 of The Massachusetts Fire Safety and Tom Riley. All were available - may be found on the DFS Act of 2004, a direct result of the following their presentations to an- website at www.mass.gov/dfs/ tragic Station Nightclub fire of swer questions from local fire and news-events/press/taskforce/ 2003; a summary of the fire safety building officials. sprinklersin3years.htm. requirements of the Act, espe- Beware Fire Suppression Technician Fraud The Massachusetts State Fire C ust be kept-handyfor review by If the manager of the restaurant is Marshal Office licenses peoplefhefire prevention.officer.., available, they should accompany and companies that perform work If you were not aware that the the technician during the inspec- on commercial fire suppression company was scheduled to do tion and ask questions about the systems in restaurant kitchens. the work, contact the office of the work that is being performed. Over the past several months our suppression company to verify Regular hood cleaning is also es- code compliance officers have that the technician should be on sential to preventing grease fires. run into a rash of unlicensed and site. People have been posing as The fire code regulationulation on com- unscrupulous people performing employees of legitimate com a- mercial fire suppression systems work fire suppression systems. Hies. is 527 CMR 10.03 8 and can be d Sometimes the people are not Ask to see the technician's li- viewed on our website at: www. sensed to the work, they cense; match the picture on the mass.gov/dfs/osfm/fireprevention/ shoddy worrkk that does not meett back to the individual's face. cmr/. If you have an questions code, and some pretend to do y y work when in reality none is done. Always ask for a receipt, if the about commercial fire suppression Followin are some ti s for restau- nvoice/receipt does not have the systems, please contact your local g p company name listed on the top, fire prevention office of the Office rant owners and managers: this should raise some red flags. of the State Fire Marshal at (978) Commercial fire suppression Pay for services by check instead 567-3375. systems must be serviced twice of cash. Paying by cash makes a year by a licensed professional; fraud harder to track. Cocumentation of.the inspection 5 DFSQ Summer 2005 l��%� 0177FortAvenue City of Salem Crams Pizza Etc. FOOD SERVICE ESTABLISHMENT - FOOD SERVICE Item Status Violation Type Urgency Name GruStys Pizza£tC Non-compliance with: Done Address" 0177 FO.rt Avenue„*, 3,• Anti Choking PASS Tobacco PASS 7eIep1lot�e '^&25,,OQ0�•, M FOOD PROTECTION MANAGEMENT Not Done Owner, ;Robert,5oohoo PIC Assigned / Knowledgeable/ Duties PASS RED PIC Rotiert Soahoo ' EMPLOYEE HEALTH Not Done inspector DavM"Greenbaum 7 Reporting of Diseases by Food Employee and PIC PASS RED Personnel with Infections Restricted/Excluded PASS RED FOOD FROM APPROVED SOURCE Not Done FIsk Levg1 „ Food and Water from Approved Source PASS RED FIACCP `No Receiving/Condition PASS RED Correct By ;z Tags/Records/Accuracy of Ingredient Statements PASS RED Conformance with Approved Procedures/HACCP Plans PASS RED Perinit Nurilber f%BHP 2004 00392 a, PROTECTION FROM CONTAMINATION Not Done S�Lus StSIGNED,QFF Separation/ Segregation/ Protection PASS RED of Critical Ylolatlons 1 Food Contact Surfaces Cleaning and Sanitizing PASS RED Proper Adequate Handwashing PASS RED Good Hygienic Practices PASS RED w` Prevention of Contamination from Hands PASS RED 7imeIN �< C1tIT,w Handwash Facilities FAIL RED Notes , Restore hot water to hand wash sink in first bathroom . Urgency Descriptions) s r PROTECTION FROM CHEMICALS Not Done i Approved Food or Color Additives PASS RED violations Related toGood Retail Toxic Chemicals PASS RED Practices(Cntical`violations must be r i` F'corrected mmediateryor wdhin 10� ;iiays)(Non-Cntical vrplations must be Ta. GeoTMS®2004 Des hurlers Municipal solutions,Inc. COMMONWEALTH OF MASSACHUSETTS Page 1 0177 FoitAvenue City of Salem Cru s Pizza Etc. FOOD SERVICE ESTABLISHMENT - FOOD SERVICE Item Status Violation Type Urgency TIME/TEMPERATURE CONTROLS Not Done corrected lmmedlately or wlthln 9Q , (Potentially Hazardous Foods) da Cooking Temperatures PASS RED "1 Reheating PASS RED Uloletrons Related to Foodborne Illness Cooling PASS RED interventwns and Risk Factors.(Regm ` Hot and Cold Holding PASS RED lmmedlate corrective achori) .,' Time As a Public Health Control PASS RED REQUIREMENTS FOR HIGHLY Not Done SUSCEPTIBLE POPULATIONS (HSP) a Food and Food Preparation for HSP PASS RED CONSUMER ADVISORY Not Done Posting of Consumer Advisories PASS RED u w Violations Related to Good Retail Practices Not Done (Blue Items) Management and Personnel PASS BLUE Food and Food Protection PASS BLUE Equipment and Utensils PASS BLUE l a Water, Plumbing and Waste PASS BLUE Physical Facility FAIL BLUE Replace water stained ceiling tiles by 3 bay sink. M ; Poisonous or Toxic Materials PASS BLUE " Special Requirements PASS BLUE Other- See Notes PASS BLUE z y w laspectbrSignature < PIC i urc G"TMS®7004 Des taurfers Municipal Solutions,Inc. COMMONWEALTH OF MASSACHUSETTS Page 7 i rl „J. 0177FOItAvenue City of Salem CrILEW q Pizza Etc, FOOD SERVICE ESTABLISHMENT - FOOD SERVICE Item Status Violation Type Urgency �ha,►tle. ,,,Grus�y s,PizzafLC,• r Non-compliance with: Done 0177 Boit Avenue. Anti-Choking PASS Addfess Tobacco PASS 7ekiphpne. , 825 OQ04, FOOD PROTECTION MANAGEMENT Not Done ChA/ne�: ;Robert,Soohoo PIC Assigned / Knowledgeable / Duties PASS RED P1G Robert Soohoo EMPLOYEE HEALTH Not Done Reporting of Diseases by Food Employee and PIC PASS RED 1y4pector z Davrc! Greenbaum Personnel with Infections Restricted/Excluded PASS RED pRltepµ ;3%105, FOOD FROM APPROVED SOURCE Not Done , F Food and Water from Approved Source PASS RED iAGGP, 'No ` r Receiving/Condition PASS RED Tags/Records/Accuracy of Ingredient Statements PASS RED IC ' $y Conformance with Approved Procedures/HACCP Plans PASS RED txHrnllk=Nuln}Ier, BHP 2004,.Q039 , ,'{ PROTECTION FROM CONTAMINATION Not Done �S1ka>t1IP., �IG�IEDtOFF , _ , Separation/ Segregation/ Protection PASS RED �of Critical Y�olstlons 1' Food Contact Surfaces Cleaning and Sanitizing PASS RED Proper Adequate Handwashing PASS RED Good Hygienic Practices PASS RED Prevention of Contamination from Hands PASS RED 7me1• '�; `a +� OUT s5 h Handwash Facilities FAIL RED Restore hot water to hand wash sink in first bathroomNj . 'r,Urg�n4y pescnption(s) PROTECTION FROM CHEMICALS Not Done Approved Food or Color Additives PASS RED Vio6at10riS1el6ted to Good Retail y Toxic Chemicals PASS RED ArGtCcesCri�caLtviolations must be b3 5 F f f FrAirected immediately or within SO "day5)i;No[t cditical violations must be sY,5 ceon�s®xgoaoeaLeurie�sMunkipaisoiudone Ine. COMMONWEALTH OF MASSACHUSETTS Page 1 0177 Fort Avenue City of Salem Crus s Pizza Etc, FOOD SERVICE ESTABLISHMENT - FOOD SERVICE Item Status Violation Type Urgency TIME/TEMPERATURE CONTROLS Not Done Cor�eCtgd immediately or within 94 ( (Potentially Hazardous Foods) + Y ), Cooking Temperatures PASS RED Reheating PASS RED ViolatwAs'Related to Foodborne IIIneSsa Cooling PASS RED (nterventtOns and Risk Factors(Requil Hot and Cold Holding PASS RED ;:Immediate Corrective action) Time As a Public Health Control PASS RED ` REQUIREMENTS FOR HIGHLY Not Done SUSCEPTIBLE POPULATIONS (HSP) r , Food and Food Preparation for HSP PASS RED CONSUMER ADVISORY Not Done Posting of Consumer Advisories PASS RED l< Violations Related to Good Retail Practices Not Done k (Blue Items) Management and Personnel PASS BLUE Food and Food Protection PASS BLUE Equipment and Utensils PASS BLUE Water, Plumbing and Waste PASS BLUE Physical Facility FAIL BLUE r Replace water stained ceiling tiles by 3 bay sink. Poisonous or Toxic Materials PASS BLUE Special Requirements PASS BLUE Other- See Notes PASS BLUE Y ➢ S / `S 5 nlb Inspector Signature PIC i urc GeoTMs®:°°°Des vu"ersmunicipal solutions,Inc. COMMONWEALTH OF MASSACHUSETTS Paget CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH a gt 120 WASHINGTON ST EET, 4TH FLOOR 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: Crusty s Pizza Etc. Address of Establishment: 177 Fort Avenue Owner's Name: Robert Soohoo Restrictions: Application Date: 1/13/2004 Permit for Food Establishment 258-04 Frozen Desserts/Ice Cream Permit for the Sale of Tobacco Products 61-04 These Permits Expire December 31, 2004 This permit is not transferable and must be reissued upon change of ownership or location. The permit must be posted in a prominent location in the Establishment, In accordance with the State Sanitary Code, before any renovations, improvements, or equipment changes are made, all plans for such must be submitted to and approved by the Salem Board of Health. U HEALTH AGENT Vs ' CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH • 3 120 WASHINGTON STREET, 4TH FLOOR SALEM, MA 01970 TEL. 978-741-1800 FAX 978-745-0343 STANLEY USOVICZ, JR. ,JOANNE SCOTT, MPH, RS, CHO MAYOR HEALTH AGENT 2004 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT NAME OF ESTABLISHMENT C(- �� 2.2A TEL# // `9?2�i 825 'v��L{ ADDRESS OF ESTABLISHMENT fiUryf, MAILING ADDRESS (if different) --` `_ OWNER'S NAME 'k� a soi>� 00 TEL# C1 TZ ( Zoq 3 ADDRESS U S1``1GW(V\i-� Nte., _,_. - CITY StfA/L, STATE LIP ( J7 \\g CERTIFIED FOOD MANAGER'S NAME(S) SCXIvIejC� CERTIFIATE�#(s) (required in an establishment where potentially hazardous food is prepared.) EMERGENCY RESPONSE PERSON HOME TEL# HOURS OF OPERATION: Mor.l ue.e-Wed. `� Thu. L-- Fri. Sat. '�'— Sun. �— TYPE OF ESTABLISHMENT FEE check only RETAIL STORE YES ® /8,,0`/ less than 1000sq.ft. =$ 50 7 1000-10,000sq.ft. =$100 more than I0,000sq.ft. =$250 RESTAURANT YES NO less than 25 seats =$100 25-99 seats =$150 more than 99 seats =$200 BED/BREAKFAST YES $100 ADDITIONAL PERMITS MAKE (not just serve) ICE CREAM, YOGURT, SOFT SERVE YES NO $5 TOBACCO VENDOR (MD NO $50 ALL NON-PROFIT(such as church kitchens) YES NO $25 Pleasa- Nay total w h 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 MG hapter 62C, Section 49A, I certify under the pains and penalties of perjury that I, to my be k ge an'd elief, have filed all state tax returns and paid all state taxes required under the law. SignDate Social Security or Federal Identification Number ---------------- Revised 1V103�FCODAP2.adm Check#&Date ( ( ISO— 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 Date T e of O erasion s Tvoe of Inspection if s s /n /fey Food Service ❑ Routine i Address dX4 V Risk ❑ Retail e-inspection I Telephone Levee ❑ Residential Kitchen Previous Inspection ,1 ❑ Mobile Date: Owner HACCP MR ❑ Temporary ❑ Pre-operation Aoalilllijp / ❑ Caterer ❑ Suspect Illness Person in Charge(PIC) Time ❑ Bed&Breakfast ❑ General Complaint In: El HACCP Inspector Out: Permit No. El0 herr O Each violation checked requires an explanation on the narrative page(s) and a citation of specific provision(s)violated. Non-compliance with: Violations Related to Foodborne Illness Interventions and Risk Factors Anti-Choking Tobacco Violations marked may pose an imminent health hazard and require immediate corrective 590.009(E) ❑ 590.009(F) ❑' action as determined by the Board of Health. FOOD PROTECTION MANAGEMENT ;; .. . . ; , ❑ 12. Prevention of Contamination from Hands ❑ 1. PIC Assigned/Knowledgeable/Duties ❑ 13. Handwash Facilities EMPLOYEE HEALTH" ; PROTECTION FROM CHEMICALS ❑ 2. Reporting of Diseases by Food Employee and PIC ❑ 14. <Approved Food or Color Additives j , El 3. Personnel with Infections Restricted/Excluded `FOOD FROM.APPROVED SOURCE ' `� �:", ' � - `J " � .' l ❑ 15.Toxic Chemicals :TIME/TEMPERATURE CONTROLS P ❑ 4. Food and Water from Approved Source ( otentially Hazardous Foods)'-,' .4. ❑ 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'`v '-� ❑ 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 L121. Food and Food Preparation for HSP ❑ 11. Good Hygienic Practices :i CONSUMER ADVISORY ' , ' ' „ ; : ,' s -" jlil _ ❑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): Fa of Health. Non-critical (N) violations must be corrected immediately or within 90 days as determined by the Board Official Order for Correction: Based on an inspectiontoday, 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 cited in this report may result in suspension or revocation of (FC-4)(590.005) the food establishment permit and cessation of food 26. Water, Plumbing and Waste (FC-5)(590.006) establishment operations. If aggrieved by this order, you 27. Physical Facility (FC-6)(590.007) have a right to a hearing. Your request must be in writing 28. Poisonous or Toxic Materials (FC-7)(590.008) and submitted to the Board of.Health at the above address 29. Special Requirements (590.009) within 10 days of receipt of this order. 30. Other DATE OF RE-INSPECTION: s:ssoinsa��Fomrs-,o.eoc Inspector's Signature: Print: qq Pages] PIC's Signature: Print: Pag�of' Pa 1 Violations Related to Foodborne Illness Interventions and Risk Factors Iltell 1-22) PROTECTION FROM CONTAMINATION FOOD PROTECTION MANAGEMENT u-—sccontame irtion I 1 591f003(Al) I Ifflive I R 1,A)( Rav lin'Tai o( s Senrul from 590 001(5) I norrill"Ifion of Vilowled"', Contamination from f7aw ingredients -3-5(—)21 I(A�)(2) -Kakk—Animal Foals Separated firoin Each EMPLOYEE HEALTH 0iii Grovartri—from the Environment 00—,(C) Respomibilitycif the li in Lhargo to nulti i rc i�pov i o',by r(Kyl chill and 3302.11(.4) Food ProtecllooT 3-30115 Wasl Guns and Ve"rulbi'ns 590,00=(F) Responsibility Of A Food EmplowOr 'or 3-104.11 Ford Contact with Equipment and Applicant To Rcfafrt To'll Fell In -Uniiilr ir Chat cc* Uontannimeren from ri Consumer 590.003(G) bi,Person in Charoe, Returned Food and—Rcseryice of Food* 3 590.003(D) Exchriionis and Riuitl;cffons- 590 .003(L) Removal of Exclusioirq and Restrictions of Adulterated or Coniamunated Fool 370LII Difcurding or Roconditioning Lasalle FOOD FROM APPROVED SOURCE 4 Food and Water From Regulated Sources ) Food Contact Surfaces �1 590"004(A-13) _�-jnn Iiance A ith�Kod I av,� T4�0 I I1 320L12 FoodmaHerinefica . algid C orilluner I Mcchanimil Wirroaia,�tnm-iffil, Water Fluid Milk and Milk Products* 4-202.13Sfitil i Sanitization Temperalurti 1 -- 4->01-114 Cliciewal Saint,zation-torrill ji 1. 11-20114 Fees arid Milk Pro1lar,Paileurizedii �ojrccntf utionand hardncs. 1 3-302.'16 Ice Made Fi oal Potable Drinkinti W1-1111 ! — 5-101.l I Drinkina 1k'ater from an A )rfived Svqte;n* 4-1(01.1 ](A) Equipment food Contact Surfaces and Utensils Glean' r,90,006W — -L11W1nL)rl 11"no�WatW 4-602,11 (71--arrin,Frequancy of Equimueait Food- 590,006(11) Water Meets,Siraudkirds in 310 CMR 22.0* Contact Surfaces and Ircirii1s, Shoiffish and Fish From an Approved Source -- - d-902 11 Frequency of Sanitization ofUtensilsand -TTA-- Food Coll SurfacesEquipment*-201 14 1 and Recreationally caught'N'Tolhowan - ShellfiA* 4-70351 Methods of Sanitization—Hot Waterand T-20115 Chemical,: SoUTC00 10 Proper,Adeq--uoteftndwa—shinq Game and Wild Mushrooms Approved by 1-301.11 Clean Condition--Hands and Aril �Aulhon _ o- 3-202.19 Shellstock Identification fdcsem- 2-30IJ2CI ,eflimi, �Prxedwc' 590.004(0:) "Vild mushrill i 2-301.14 When to wash* 3-201.17 Game Animals* Good hygienic Practices R0cervmq/Ca-n—dtion --- 2-401,11 1''atin 9-1—D—rinkim-t1—INInoTobaclo- Rurcc ived at Proper Tern fs* 2401,12 Disctatrl Froin the Eycs.Nose and 3-20215 Mouth* —Preveatm-e Contamination When T�iidl �1-10 1.11 Food SaE and Urladulm;aW jy Prevention of Contamination from Hands TagiliflRecords:Sherstock 5q().()o-1(E) preventing Contneriarilar from 3-202.18 Shelklock Idoinification 3-203,12 Shelkiock Identification Maintained"I I Handwash Facilities Tags/Records: Fish Products Conveniently Loca red and Accessible 402.11 Parai Deshiliction' $'-03.11 Numbers3-402.12 Records.Creation and Rcterl and tap aa�Lcsl 590,004(7) Labeling of Ingredients* 5-204.11 Locil and Flaroment, 7 5-205-11 Conformance with Approved Procedures sAccessibilitX, 0��ralhoi and�-Nlunwnw�ic� /HACCP Plans - Supoilod with Soar and Hand Drying — Devices, 3-502,11 Speciiii Procesmn,Methods* I----- ='d I 6-301.ti Handwartuna 0clul A%ailaltl 3-502.12 de, -a,,nia,crilrria* Reduccd ox �cn ack 8-101=12 =Coi�ifmirvmde with Amproverl Pioc durl Denoie,critical ileal ill the fedeial 19W 1i Coilf,or 10,5011159(3-000. CITY OF SALEM BOARD OF HEALTH Establishment Name: Date: �a�Q/�'� Page: z of 2— Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date No. Reference R—Red Item Verified .PLEASE PRINT CLEARLY 00t,- tiVgJr Cc .-116O I aj 16 fffh 4 J f f>PcsC-n 1'e-&-roxr— dX 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, ve,, ollars or suspension/rev cation of ❑ Embargo ❑ Emergency Closure your food permit. � / o ❑ Voluntary Disposal ❑ Other: y U 3-501.14(7) PHFs Received at'lemperatures Violations Related to Foodborne fitness Interventions and Risk According to l-aw Cooled to Factors(Items 1-22) (Cont.) _ 41"F/45`(F Within 4 How s. PROTECTION FROM CHEMICALS 3-501.15 Coolie-Methods for FRFs 14 � Food or Color Additives 19 PHF Hot and Cold Holding 3-202.12 Additives 3-50't.16(B) Cold PHFs Maintained at or below 't 590.004(F) 4F/45'F- 302.14 Protection from Unapproved Additives* 3-501.16(A) Hot PHFs Maintained at or above 1s Poisonous or Toxic Substances 7-101.11 Identifying 140"F Information-Original 3-501.16(A) I Roasts Held at or above 130'F. Containers` 7-102.11. Common Narne-Workinn Containers* 20 Time as a Public Health Control 7-201.11 Separation aration-Stora e" 3-501.19 Time as a Public Health Control* 7-202.11 Restriction-Presence and Use* 590.004(H) LVariarcc Re ❑irement 7-202.12 Conditions of Use- 7-203.11 Toxic Containers-Prohibitions* REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-204.11 Sarunzers,Criceria-Chemicals` POPULATIONS(HSP) 7-204.1'2 Chemicals for Washing Produce.Criteria* ZI 3-$07.11(.A) Cnpasteurfzed Pre-packaged Juices and "* Beverages with Warm*>Labels* 7-204.14 Dr in A eats,Criteria -- 3-80111(B) Use of Pasteurized Eye*. 7-205,11 sIncidental 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'` 3-80 L I I(C) Unopened Food Packs=e Not Re-served. 7-206.13 'Fra king Powders,Pest Control and Monitoring" CONSUMER ADVISORY TIMEITEMPERATURE CONTROLS 22 3-603,11 Consumer Advisory Posted for Consumption of Annul Foods'That are Raw,Undercooked or I6 Proper Cooking Temperatures for PHFs Not Otherwise Processed to Eliminate_3-70LL1A(i)(2) Eggs- 155°F 15 Sec. Pathe �nro*E1"o,-'"'0" E>as-Imnrediatc Service 145'F15sec* 3-302.13 1 Pasteurized Eggs Substitute for Raw Shell 3-401.11(A)(2) Comminuted Fish,Meats&Game E S* Animals-155'F 15 sec. 3-401.1 l(B)(1)(2) Pork and Beef Roast-130°F 121 min* SPECIAL REQUIREMENTS 3-401.11(A)(2) R mites,Injected Meats-155'F 15 590.009(A)-(D) Viola ions of Section -590.009(A)-(D)in sec. * catering, mobile food, temporary and 3-401.11(A)(3) Poultry, Wild Came, Stuffed PHFs, residential kitchen operations should be Stuffing Containing Fish,Meat, debited under the appropriate sections Poultry or Ratites-165°1715 sec. " above if related to foodborne illness 3-4011 tin(3) Whole-muscle,Intact Beef Steaks interventions and risk factors. Other 145'17* 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(.4)(1)(b) All Other PHFs- 145'F 15 sec. I7 Reheating for Hot Holding VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 3-403.I1(A)&(1)) PHFs 165'F 15 sec. * (Items 23-30) 3-403.11(B) Microwave- 165°F 2 Minute Standing Critical and non-critical violations, which do not relate to the Time* .foodborne illness interventions and risk facam-.c listed above, can be 3-40111(C) Commercially Processed I2TE Food- found in the following sections of the Food Code and 105 C6IR 140'F* 590.000. 3-403.11(E) Rennahnng Unsliced Portions of Beef item Good Retatt_Pr_aetices_ FC 590.600 Roasts* 23. Managementand Personn_ei__QFC-2 .003 18 Proper Cooling of PHFs 24. Food and Food Protection __ - '_ FC-3 _ 004 _25._ E ui ment and Utensils FC 4 .005_ 3-501.14(A) Cooling Cooked PHFs from 140°F to 26. Water,Piumbing and Waste FC-5 006 - _- 70`17 Within 2 Flours and From 70°F 27. Physical Faoiiity _ F-C-6 007 to 41.°F/4511F Within 4 Hours. * 28. Poisonous or Toxic Materials FC-7 .008 3-501_14(13) Cooling PHFs Made From Ambient 29, Sp©Dial Requirements .009 Temperature Ingredients to 41°F145'F 30.-.--,-,-, Other Within 4 Hours* rssor *Denotes critical item in the t?deral 1999 Food Code or 105 CMR 590.600- Massachusetts Department of Public Health Salem Board of Health 120 Washington Street,4'" Floor Division of Food and Drugs Salem, MA 01970-3523 FOOD ESTABLISHMENT INSPECTION REPORT Tel. (978) 741-1800 Fax(978) 745-0343 Name ^�US�r f z Date T e f 0 eration s Tvpe of Inspection /J 8 ood Service routine Address �.� FU�` Risk ❑ Retail ElRe-inspection Telephone Level El Residential Kitchen Previous Inspection 478"8Z�'Odd M ❑ Mobile Date: OwnerHACCP Y/N El Temporary [IPre-operation 076$AJ?� SlJA DO ❑ caterer ❑ Suspect Illness Person in Charge(PIC) r/a1M�c Time ❑ Bed&Breakfast ❑ General Complaint In: El HACCP InspectorElOthert0 6-r66NrS Out:ut: Permit No. 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 V3 Handwash Facilities!'2� EMPLOYEE HEALTH .� -. TION PROTEC E] 2. Reporting of Diseases by Food Employee and PIC ` FROM CHEMICALS ' ❑ 3. 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 TIMEfrEMPERATURE CONTROLS(Potentially Hazardous Foods) ❑ 5. Receiving/Condition ❑ 16. Cooking Temperatures ❑ 6. Tags/Records/Accuracy of Ingredient Statements [117. Reheating ❑ 7. Conformance with Approved Procedures/HACCP Plans ❑ 18. Cooling 7CTION FROM CONTAMINATION ..-,. -"" [319. Hot and Cold Holding Separation/Segregation/Protection F-120.Time As a Public Health Control O 9Food Contact Surfaces Cleaning and Sanitizing�� REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP);:.. El 10. Proper Adequate Handwashing [121. Food and Food Preparation for HSP ❑ 11. Good Hygienic Practices CONSUMER ADVISORY ❑22. Posting of Consumer Advisories Violations Related to Good Retail Practices Number of Violated Provisions Related Critical (C)violations marked must be corrected To Foodborne Illnesses Interventions 3 immediately or within 10 days as determined by the Board and Risk Factors(Items 1-22): J 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 ealNth. 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 4. Food and Food Protection (Fc-3)(sso.00a) 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 25. 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 FT129. Special Requirements (590.009) within 10 days of receipt of this orer. 30. Other DATE OF RE-INSPECTION: 4 Y S:5901nVwFom 14.do l� '/ �v l Inspector's Signature- Print: PIC's Signature: //,!� '�- Print: '%C� A^ n Page / ofPages U Violations Related to Foodborne Illness Interventions and Risk Factors(items 1-22) PROTECTION FROM CONTAMINATION FOOD PROTECTION MANAGEMENT 8 Cross-contamination I 5901003(A) Assignment of Responsibility* 3-302.11(A)(1) Raw Animal Foods Separated from 590.003(B) Demonstration of Knowledge* Cooked and RTE Foods" 2-103.11 Person m charge-duties Contamination from Raw Ingredients 3-30111(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) Fnnd Prctection" applicants* 3-302.15 Washing thousand 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', CharContamination from the Consumer 590.003(G) Rc ortinA by Persson in Charge' 3-306.14(A)(B) Returned Food and Resenice of Food* 3 590.003(Dl Exclusions and Restrictions* Disposition of Adulterated or Contaminated 590.003(E) Removal of Exclusions and Restrictions Food 3-702.11 Discarding or Reconditioning Unsafe FOOD FROM APPROVED SOURCE Food- 4 Food and Water-From Regulated Sources I L9_ Food Contact Surfaces 590.004(A-B) Compliance with Food Law* 4-501,111 Manual Warewashing-Hot Water 3-201,12 Food in a t3ermetitaUv Sealed Container* SanitI7262n`l i nl ernttnes* 3-201.13 Fiuid Milk and Milk Products, 4-501.112 Ntedianical Warewashing-Hot Water 3-202.13Shell E===*s* Sanitization Tem tet'atuies* 3-202.14 Eggs and Milk Products.Pasteurized* 4-501.114 Chemical Sanitization-temp„pH, concentration and hardness, " 3-202,16 Ice Made Front Potable Driril;in2,Water* 4-601.11(,A) Equipment Food Contact Surfaces and 5-101.11 Drink ino W ater from an A }roved System" 590.006(A) Bottled Drinking Water* 4-602.11 Cleaning Clean* ggFrequency of Equipment Food- 590.006(13) Water Meets Standards in 310 CMR 220* Contact Surfaces and Utensils* Shellfish and Fish From an Approved Source 4-702.11 Frequency of Sanitiv itiwt of Utensils and 3-201.14 Fish and Recreationally Caught Molluscan Food Contact Sarfaces of E q ju meat* Shellfish* 4-703,11 Methods of Sannization--HotWaterand 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,t8 Shellstoek Identification Present* 2-301.12 Cleanim*Procedure* 590D04(C) Wild Mushrooms' 2-301-14 W9ten to Wash" 3-201.17 Game Animals* 11 Good Hygienic Practices Receiving/Condition 2-401.11 Satin=,Drinkin ar Using Tobacco" 3-202.11 PRFs Received at 2-401.12 Dtshargei From the Eyes,Nose and 3-20115 Package ante it•* Month* 3-101.11 Food Safe and Unadulterated * 3-301-12 Preventing Contamination When Tastio=* 6 Tags/Records:Shelistock 12 Prevention of Contamination from Hands 3-202.18 Shelktock Identification' 590.004(E) Preventinl,Contamination from 3-203.12 Slaeltstock;identification Maintained* Em rlo�ees* Handwash Facilities Tags/Records:Fish Products 13 Conveniently Located and Accassibte 3--902.11 Parasite Destruction* 3-402.12 Records.Creation and Retention* 5-203.11 Numbers and Ca acittes" 590.0040J 1 Labeling of Ingredients* 5-204.11. Location and Placement* ry Conformance with Approved Procedures 5-205.11 Accessibility,O eration and Maintenance IHACCP Pians Supplied with Soap and Hand D,ying 3-5021 t Specialized Processing Methods' Devices 3-502.12 Reduced ozvgen ackaQing,criteria* 6-301.1.1 Handwashing C*eattser,Availabil it 8-103.12 Conformance with Approved Proeedur& 6-301.12 FIan d thyinO Provision "Denote,critical itein in the.fedora] 19119 Food Calz or 105 CMR 596.OW CITY OF SALEM BOARD OF HEALTH / Establishment Name:Co?vSY" $ ®/Z ►4 Date: ZO/f� Page: of Item Code C-Critical item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date ` - No. Reference R—Red Item Verified k - PLEASE PRINT CLEARLY.. 2r L .t y fl4t.�z r,c /✓�vr c u J ear d sP/us A.+9 rr6WApb I Oto• Ea oUF t cc�a,J .fr.o .arr w1r, _k t. S uN 1Q� NIMS /SrrSI-Af hGH Ort KII kG.�Me 6f$ X. B C / I�C.i I � NiN(r AK Cdr S AW 1 Pr'Q N f/nrd /s r-d rSu rra 44 0 />✓ r cele vrgp 4W c4_-#rfv AA IYAlNks /Nair "drS Ssrr-� A S'eo*P. 4e-o' 014 t4*41J 5;O/#7Z" f oP la ritm /4S b/If"& 04 ;-" fI/ rJ/L rr✓ R TkK/f•) - t� f'�enP GNB"/'� og ,1^ 4 /q Ottsr� Sir„ MIs'SfNdt rdtM 0"tt0e- Sctrl-f Ar (W mwo N t" a e_ M eeF s. 4r a nr. 40AVC0IS rflt "*,o A14 n'o140. (?S5*Uiil • R �. �G� ^ .t/ N� or4f��. e: t�mvStM/A rrt C'21 A" Q /NS►06 ,fire do Discussion With Person in Char 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-fi a dollars or suspension/revocation of ❑ Embargo ❑ Emergency Closure your food permit. � ❑ Voluntary Disposal ❑ Other: s' . 3-50 L 1.4(C) PHFs Received at Temperatures Violations Related to Foodborne Illness Interventions and Risk According to Iaw Cooled to Factors(items 1-22) (Cont.) 41'F/45'F Within'4 Hours. PROTECTION FROM CHEMICALS 3-501.15 Cooling Methods for PHFs 1q Foad or Color Additives 19 PHF Hot and Gold Holding - 3-501.16(B) Cold PFIFs.Maintauied at or below 3-302.14 Protection 3-202.12 A �k 590.004(F) 410/45'F° 15 Poisonous or Toxic Substances from Una t roved Additives* 3-501.16(A) I1ot PHFs Maintained at or above 40"F. * 7-1011 t Containers information-Orib nal 3-50116(A) Roasts Held at or above 130'F. Containers' 7-102.1 t Common Name-Working*Containers* 20 Time as a Public Health Control 7-201.11 -SeT41 at,(),,-Stol ape* 3-501.19 Time as a Public Health Control* 7-202.11 Restriction-Presence and Use* 590.004(H) Variani;c Re uirement 7-202.12 Conditions of Use" - 7-203.1.1 Toxic Containers-Prohibitions" REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-204.11 Sanitizers,Criteria-Chemicals" ii4 POPULATIONS(HSP) 7-204.1.2 Chemicals for Washine Produce,Criteria* 21 3-8011](A) Unpasteurized Pre-packaged Juices and 7-204.14Dt vt ants.Criteria' _ Beverages with Warning Labels* 7-205.11 Incidental Food Contact.Lubricants* 3-80I(B) Use of Pasteurized Er!rs* 7-206.1 I Restricted Use Pesticides.Criteria* 3-801.L11(A} Raw or Partially Cooked Animal Food and Raw Seed S> 7-2066 rours Not Served. 7-20 12 Rodent Bait Stations* 3-801.11(C) Unopened Food Package Not Re-served. .'13 'I'rtcking Powders,Pest Control and L- I Monitoring=" CONSUMER ADVISORY TIME/TEMPERATURE CONTROLS 22 3-60111 Consumer Advisory Posted for Consumption of Animal Faxls That are Raw,Undercooked or 16 Proper Cooking Temperatures for Not Otherwise, Processed to Elinunate, PHFs _r ;as r,a,auoi 3-401.1 1 A(1)(2) Eggs- 155°F 15 Sec. Path trueetr�*" E>es-Inunediatc Service 145'F15sec* 3-31)2.13 Pasteurised Eggs 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-130'F121 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 sec. * catering, mobile food,temporary and 3-401.1.1(A)(3) Poultry,Wild Came, Stuffed PHFs, residential.kitchen operations should be Stuffing Containing Fish.Meat, debited under the appropriate sections Poultry or Ratites-165°F 15 see. '` above if related to foodborne illness 3-401.11(C)(:3) Whole-muscle,Intact Beef Steaks interventions and risk factors. Other - 145'F* 590.009 violations relating to good retail 3-401.12 Raw Animal Foods Cooked in a practices should be debited under#29-- Microwave 165'F* Special Requirements. 3-401 11 Afi Other PHFs- 745'F 15 sec * 17 Reheating for Hot Holding VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 3-403.11(A)&(D) PHFs 165'F 15 sec. * (Items 23-30) 3-403.1](B) Microwave-165"F 2 Nitrate Standing Critical and non-critical violations, which do not relate to the Time* ,foodborne illness interventions and risk factors listed above, can be _ 1-404 11(C) Commercially Processed RTE Foal- found in the following sections of the Food Code and 105 CMR 140'F* 590.000. _ 3-403.11(E) Remaining Unsliced Portions of Bee Item Good Retail Practices FC 580.000 m 23. Mang ement and nntl d PersonneFC-2 .003 Personnel IA Proper Cooling of PHFs 24_. Food and Food Protection FC-3_ .004 25 Equipment and Utensils FC 4 j_ '005 3-501.14(A) Cooling Coked PHFs from 140'F to 26. Water, Plumbin end Waste FC 5 .006 _ 70'F Within 2 Hours and From 70'F 27. Ph sical Facilits, FC-6 .007 to 41"F/45"F Within 4 Hours. * 26. Poisonous or Toxic Materials FC-7 .008 3-501.14(3) Cooling PHFs Made From Ambient 29_ S ectal R uirements _ _ _.009 Temperature Ingredients to 41"F/45'F 30 .Other _ _ Within 4 Hours,r ss�om",wma-zr.,r '* Denotes critical item in tha tealeral 1999 rood Code or 105 CNIR 590.000. CITY OF SALEM BOARD OF HEALTH Establishment Name: C /t Ufa" ff' (�/7JL� Date: r'6�oy Page: of Item Code C-Critical nem DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date i No. Reference R—Red Item Verified +; PLEASE PRINT CLEARLY - G �Kff� t? Ctir caKi�t K tfrts .A .� cCC/0j(/ A-r wby Faa o /u-r AKo S flee/1vdA* Ct&rf + ) /94LA614 A4�4- 06#4 j41jrrfN6- A1r/ds40L& f&J&ZS" &diner Ois'Per to cLS it, wic ev" Z� r1C ColtLtwb tlri rs f4ttO A 911Gloy+# Com_& 4raN8 #.+sfo6 owsi eur 07 t/ C wAu3 "Ft_f"Rr W.0 re," tiedt.S mleo pt W[ ditWvo( C.r-trtMet�i ci es rMd v t+�e�e A"O A+fWO O AAA- 6"110MILPT. Z, C /t'ru e-�G sew n uef o f I`k�AB ce•��r✓r►rrf I a�f MvN- / �i�o teE AT- ALL W .lif-f-ic fr Ar 444 nAoffior 01 FetF1A1 ftlf PEi2.� sr /tom wftd f L 6 /�/4�1r,�ifrtVet u�o li-e�r�r tMk ea &.*r Fgoo r dr4vt/ t � Discussion With Person in Charge: Corrective Action Required: ❑ No ❑ Yes Emloee I have read this report, have had the opportunity to ask questions and agree to correct all ° Voluntary Compliance ° Exclusion Restriction/ 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 Y noncompliance may result in daily fines of twen -five dollars or suspension/revocation of ❑ Embargo ❑ Emergency Closure your food permit. i " / - ❑ Voluntary Disposal ❑ Other: 3-501,14(L.) PHFs R;ceivezl at-[emperatures Violations Related to Foodborne illness interventions and Risk According to Iaw Cooled to Factors(items 1.22) (Cont,) 41°Ft451F Within 4'Hours. PROTECTION FROM CHEMICALS3-507.15 Coolian Methods for PHFs 14 Food or Color Additives 19 PHF Hot and Cold Holding --- 3-501.16(B) Cold PHFs Maintained at or below 3-202_12 Additivei* 590.004(F) 41V45°b* 3-302.'14 Protection front Una roved Additives* 't-501.16(A) Hat PHFs Maintained at or above 1=515 Poisonous or Toxic Substances 40°F. * 7-101.11 Identifying Lnf<xntation-Original C3-501.16(A) Roasts Held at or above 130°F. * Containers' 7-102.11 Common Narne-Working Containers* 20 Time as a Public Health Control 7-201.11 Se ararion-Storage* 3-501.79 Time as a Public Health Control* 7-202.11 Restriction-Presence and Use's 590.004(H) ttalianu Re uirement 7-202.12 Conditions of Use" 7-203.11 Toxic Containers-Prohibitions' REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-204.11 Smritizers,Cri feria-Chemicals°` POPULATIONS(HSP) 7-204.12 Chemicals for Washing PrOdtiCe,Criteria* 21 3-801 A 1(A) Unpasteurized Pre-packaged Juices and 7-204.14 Dain r ents.Criteria* Beverages with Warning Labels* 7-295.t .Incidental Food Contact.Lubricants* 3-801.11(B) Use of Pateurized Ei_' 7-206.11 Restricted Use Pesticides. Criteria* 3-801.11(D) Raw,or Partially Cooked Animal Food and Raw Seed S rout's Not Served. .F 7-206.12 Rodent Bait Stations* 3-90t.I I(C) Uno erred Food Packa,c Not Re-served * 7-206.13 'Tracking Powders,Pest Control and Monitoring* CONSUMER ADVISORY TIMEfTEMPERATURE CONTROLS 22 3-603.11 Consumer Advisory Posted for Consumption of Animal Foods`That are Raw.Undercooked or 16 Proper Cooking Temperatures for PHFs Not Otherwise Processed to Eliminate 3-401.1IA(1)(2) Egg - 155'F 15 Sec. Patho��ens.*c"�"°a':''2e0r b rgs-Immediate Service 145°F15sec* 3-302.13 Pasteurized Ems Substitute for Raw-'shell 3-401.11(A)(2) Comminuted Fish,Meats&Game Eggs* Animals- 155°F 15 sec. Ir 3-401.11(B)(1)(2) Pork.and Beef Roast- 130°11121 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 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 3-401.71(C)(3) Whole-muscle,hitact Beef Steaks interventions and risk factors. Other 145°F„ 590.009 violations relating to good retail 3-401.12 Ravv Animal Fends Cooked in a practices should be debited under/129- Micmwave 165°F* Special Requirements. 3-401.1 BAKI)(b) All Other PHFs- 145°F 15 sec. 17 Reheating for Hot Holding VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 3-403.11(A)&(D) PHFs 165"F 15 sec. x: (Items 23-30) 3-403.11(B) Microwave- 16.5°F 2 Minute Standing C meal and non-critical violations, which do not re7are to t&e Timc* foodborne illness interventions and risk foz tors listed obove, can be 3-403.11(C) Commercially Processed RTE Food- ,found in the following sections of the Food Code and 105 CMN 140"F* 590.000. 3-403.11(E) Remaining Unsiiced Portions(if Bee Item Good Retail Practices FC 500.000 _ Roasts* 23. Mana emeni and Personnel... __ FC=2 1 .003 18 Proper Cooling of PHFs 24. Food and Food Protection FC-3 0004 25_____ Egui ment and Utensils FC 4 _ .005 3-50t.1.4(A) Cooling Cooked PHFs from 140'F to 26. _ Water,Plumbin and Waste FC 5 _.00_6_ 70`F Within 2 Hour and and From 70°F 27. Ph sicai Facile_ to 41°F45°F Poiso Within 4 Hours. * 28. nous or Toxic Materials C-7 .008 3-501.14(11) Cooling PHFs Made From Ambient ?9_ S eclat Re uirements - 009 Temperature Ingredients to 47°F/45°F 30.__ Other Within 4 Hours's s Denotes criricaI item m fire federal 1999 Food Code or i 05 CMR 590.000_ COURT DOCKET NO. CITATION NO. CITY OF SALEM 108 PD 1 Y!t>� VIOLATION NOTICE r NAME(LAST FIRST,INITIAL) C' tA57TIJ .�j.32A e7-C, STREET ADDRESS • CITY/TOWN STATE ZIP / v'7 '��7- 9'rc LICENSE NO. LIC.EXP.DATE DATE OF BIRTH f OWNERS NAME(LAST,FIRST,INITIAL) oo"/e-90. al1PIle/ STREETADDRESS CITY/TOWN STATE ZIP /7? /oe* /fxP REGISTRATION NO. STATE EXP.DATE I MAKE/TYPE YEAR COLOR DATE OF VIOLATION TIME DATE CITATION WRITTEN PERSONM- El Am / IWURY 0 YES 7 LI /�?s 6Y ONO LOCATION OF VIOLATION ENFORCING DEPT. / fv71 t OFFENSE - CHAP.,S€CT. FINES C A r9tL.kev af✓ t/ v os• B 7- ' C OFFICER./ A LL I.D.NO. TOTALFINE @ - C3 ✓l/'/Am7 11-S DUE s � �� . OFFICER CERTIFIES COPY GIVEN TO VIOLATOR ❑ IN HAND X /�/rj7fL�(.L� �LC� ❑ BY 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)745A595 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 RT DOCKET NO. CITY OF SALEM PD q ©p� VIOLATION NOTICE 1 V NAME(LAST,FIRST,IN - (' v S 'T i E7z, j STREETAD- ESS CITYITOWN STATE ZIP ± lee �d e 7�kx O/9y 'LICENSE NO. LIC.FXR DATE DATE OF BIRTH '{ 1 OWNER'S NAME(LAST,FIRST,INITAL) _A 4 SooJfdo O P.e)'"' I ' STREET ADDRESS CITY/TOWN STATE 21P 'J i i 7/7 foR dixe REGISTRATION NO. STATE EXP.DATE MAKE/I1'PE I YEAR COLOR I DATEOFVIOLATION TIME DATE CITATION WRITTEN PEI NA I DAM ❑lw yYESPM .' LOCATION OF VIOLATION ENEjJFjGil�CjOB?i� OFFENSE __ CHAP. SEC�Td FINES {1 A Ltgve JJ/10 051,11N JJ0 �`611 1 apo.0 foams S�,ar✓�ce ',. B P� OFFICER E I.D.NO. TOTAL (//o/O FINE DUE OFFICER CERTIFIES COPY GIVEN TO VIOLATOR -j f, ! ❑ IN HAND . ! ):x �. �<�.' '�'�/�/ ❑ BY MAIL DO NOT MAIL CASH-PAY ONLY BY POSTAL NOTE,MONEY ORDER OR BY CHECK MADE PAYABLE TO: CITY CLERK j CITY HALL 1 93 WASHINGTON STREET -' SALEM,MA 01970 TEL.(508)745-9595 X 251 A HEREBY ELECT TO EXERCISE THE FIRST OPTION AS STATED ON REVERSE,CONFESS TO THE OFFENSE CHARGED,AND ENCLOSE :PAYMENT IN THE AMOUNT OF ,1 CASE# .4 ( iSIGNATURE i� SEE OTHER SIDE FOR FURTHER INFORMATION ENCLOSE PAYMENT IN THIS ENVELOPE,PEEL AND SEAL CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH • - 120 WASHINGTON STREET. 4TH FLOOR SALEM, MA 01970 •' TEL. 978-741-1800 FAX 978-745-0343 STANLEY LISOVICZ. JR. . -JOANNE SCOTT, MPH, RS, CHO MAYOR HEALTH AGENT 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 : Robert Soohoo Name of Establishment : Crusty' s Pizza Etc . Address of Establishment : 177 Fort Avenue Type of Establishment : FOOD SERVICE Application Date : 05/13/2003 Restrictions: Permit for Food Establishment 298-03 Frozen Desserts/Ice Cream Permit for the Sale of Tobacco Products 66-03 These Permits Expire December 31, 2003 This permit is not transferable and must be reissued upon change of ownership or location. The permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code, before any renovations, improvements, or equipment changes are made, all plans for such must be submitted to and approved by the Salem Board of Health. HEALTH AGENT CITY OF .SALEM, MASSACHUSETTS • BOARD OF HEALTH ♦ 120 WASHINGTON STREET, 4TH FLOOR SALEM, MA 01970 TEL. 978-741-1800 FAX 978-745-0343 STANLEY USOVICZ, JR, JOANNE SCOTT, MPH, RS, CHO MAYOR HEALTH AGENT 2003 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABBLISEMENTT NAME OF ESTABLISHMENT �y"v $�ti 1,} 1 2ZA �Q– TEL# 77I 4 Z S ' 0Q0 rn(� ADDRESS OF ESTABLISHMENT krC-, MAILING ADDRESS (if 7different) r �" OWNER'S NAME abn __.Jl�)vt(X1 TEL# ADDRE z SCJ Sha(*,3 Q1, 4 A\N-Q,, CITY �W� T STATE ZIP i �*/✓/ CERTIFIED FOOD MANAGER'S NAME(S) )4 C ntfncY CERTIFICATE#(s}` �. (required in an establishment where potentially hazardous food is prepared.) EMERGENCY RESPONSE PERSON HOME TEL# HOURS OF OPERATION: Mon./Tue.✓ Wed. ✓ Thu. Y" Fri. f Sat. P– Sun. TYPE OF ESTABLISHMENT FEE check only RET.�;2 STORE YES NO less than 1000sq.ft. =$ 50 more than 10.000sq.fi. =$250 RESTAURANT YE NO I-s WCanseatts =$100 25-99 seats =$150 more than 99 seats =5200 BED/BREAKFAST YES NO $100 ADDITIONAL. PERMITS MAKE ICE CREAM, YOGURT, SOFT SERVE YESn TOBACCO VENDOR E5 NO C&6. $5 ALL NON-PROFIT(such as church kitchens) YES 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 o' perjury that I, to my best knowledge and belief, have filed all state tax returns and paid all state taxes reouired under the law. �7 Signature i ,1 W� 'yam f N Date 1,/�O Social Security or Federal Identification Number Revised 11/25/02 D00DAP2.adm Check#&Date_ /Ud y Inspection of -- v I � � Date /��••3 Time Name %!/77!/1 . ,� Y Y�<71 Address 122 �C�� r/✓� Owner �L/` �� V Tel. No. Type of Inspection lr Inspector hr)rC r1/�/C J ( ' ) Remarks and Violations are listed below: v A Report Received by: _ Inspsc{ion of l •�,. 7 \ - U� Cy, '— Date // J U/l�-> Time Name /e-'U0'P)zr. Address Owner Jr/� ✓�f Tel. No. Type of Inspection C �� ( � '7 �rfG 1 > �� Inspector J ( ' I Remarks and Violations are listed below: r - U,t7, r Report Received by: i *a�1O1 3 ��•�e 70 sin - ,, I door *fie IZ.4nGE Sub Sift rw� firEE:2 OVEN 3 If�Gr,d�c,ctcr 47 �UI\FK CFt : Mac O ��wt stG�,nless sraA fable , E �0 Sod+, hyo ►1,ccht� Mill J Slusl+.- i. .•.�+ +`"�r----,.-^",+w`fMK-arwvi.�„e�e,wrt�dlMnW�Ot•'�..++•...,n,,,N•s.'"+(xiS.Y }•1c".Y41+'(""...-^pw,RylN.ii�47�T"'rre.r=i.eye.0ttirw:w++YWr+rvwrww'ew+,..ws--io,..�n. THE COMMONWEALTH OF MASSACHUSETTS CIYY 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 at Operations) Type of Inspection S Cod Service ❑ Routine Address Risk ❑ Retail ❑ Re-inspection Level J ) El Residential Kitchen Previous Inspection Telephone 9 i _ }f" _ Q c / 1 ❑ Mobile Date: Owner ; { qJJ HACCP Y/N ❑ Temporary ❑ Pre-operation ❑ Caterer ❑ Suspect Illness Person in Charge(PIC) Time ❑ Bed&Breakfast ❑ General Complaint In: HACCP Inspector - Out: Permit No. A) 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 ❑ 73. Handwash Facilities EMPLOYEE HEALTH El2. Reporting of Diseases by Food Employee and PIC PROTECTION FROM CHEMICALS El3. Personnel with Infections Restricted t Excluded El 14. Approved Food or Color Additives FOOD FROM APPROVED SOURCE ❑ 15. Toxic Chemicals F-1 4. Food and Water from Approved Source TIMEJEMPERATURE CONTROLS(Potentially Hazardous Foods) ❑ 5. Receiving/Condition ❑ 16. Cooking Temperatures El6. Tags 1 Records t Accuracy of ingredient Statements El 17. Reheating ❑ 7. Conformance with Approved Procedures 1 HACCP Plans ❑ 18. Cooling PROTECTION FROM CONTAMINATION El 19. Hot and Cold Holding F120. Time as a Public Health Control ❑ 8. Separation/Segregation/Protection ❑ 9. Food Contact Surfaces Cleaning and Sanitizing REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) El21. Food and Food Preparation for HSP ❑ t0. 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 0 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)(590.064) 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: LPIC's spector's Signature: print !n y / 1� I Signature: Print: y \ _..E.t"7 Page!or Pages FORM 734A HOBSSJ 41 - OSTON Violations Related to Foodborne Illness = Interventions and Risk Factors (Red Items 1-22) PROTECTION FROM CONTAMINATION 8 Cross-contamination FOOD PROTECTION MANAGEMENT 3-302A I(A)(1) Raw Animal Foods Separated from 1 590.003(A) Assignment of Responsibili[ * Cooked and RTE Foods* 590.003(B) Demonstration of Knowledge* Contamination from Raw Ingredients 2-103.11 Person in Charge-Duties 3-302.11(A)(2) Raw Animal Foods Separated from Each Other* EMPLOYEE HEALTH Contamination from the Environment 2 590.003(C) Responsibility of the Person in Charge to 3-302.11(A) Food Protection* require reporting by Food Employees and 3-302.15 Washing Fruits and Vegetables Applicants 3.304.11 Food Contact with Equipment and 590.003(F) Responsibility of-a Food Employee or an Utensils* Applicant to Report to the Person in Charge* Contamination from the Consumer 3-306.14(A)(B) Returned Food and Reservice of Food* 590.003(G) Reporting by Person in Charge* Disposition of Adulterated or Contaminated '3j 590.003(D) Exclusions and Restrictions* Food 590.003(E) Removal of Exclusions and Restrictions 3-701.11 Discarding or Reconditioning Unsafe Food* FOOD FROM APPROVED SOURCE 9 Food Contact Surfaces 4' Food and Water From Regulated Sources 4-501.111 Manual Warewashing-Hot Water 590.004(A-B) Compliance with Food Law* Sanitization Temperatures* 3-201.12 Food in a Hermetically Sealed Container* 4-501.112 Mechanical Warewashing-Hot Water 3-201.13 Fluid Milk and Milk Products* Sanitization Temperatures* 3-202.13 Shell Eggs* 4-501.114 Chemical Sanitization-tem H, 3-202.14 Eggs and Milk Products,Pasteurized* P'P gg Concentration and Hardness 3-202.16 Ice Made from Potable Drinking Water* 4-601.11(A) Equipment Food Contact Surfaces and 5-101.11 Drinking Water from an Approved System* Utensils Clean* 590.006(A) Bottled Drinking Water* 4-602.11 Cleaning Frequency of Equipment Food- 590.006(B) Water Meets Standards in 310 CMR 22.0* Contact Surfaces and Utensils* Shellfish and Fish From an Approved Source 4-702.11 Frequency of Sanitization of Utensils and 3.201.14 Fish and Recreationally caught Molluscan Food Contact Surfaces of Equipment* Shellfish* 4-703.11 Methods of Sanitization- Hot Water and 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* Sources* .:10a 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* 2301.14 When to Wash* 4(C) Wild Mushrooms* 3-201. 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,es,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* Prevention of Contamination from Hands 6 Tags/Records:Shellstock 590.004(E) Preventing Contamination from 3-202.18 Shellstock Identification* Employees* 3-203.12 Shellstock Identification Maintained* 13 Handwash Facilities Tags/Records: Fish Products Conveniently Located and Accessible 3-402.11 Parasite Destruction* 5-203.11 Numbers and Capacities* 3-402.12 Records,Creation and Retention* 5-204.11 Location and Placement* 590.004(J) Labeling of Ingredients* 5-205.11 Accessibility,Operation and Maintenance 7 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 BOARD OF HEALTH Establishment Name: C<�U S f �� Zz Date: /3 Page: of Ffl Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date 4` No. Reference R—Red Item Verified 3 PLEASE PRINT CLEARLY i /l 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/ inspection, to observe all conditions as described, and to Exclusion violations before the next ins P ❑ Re-inspection Scheduled ❑ Emergency Suspension comply with all mandates of the Mass/Federal Food Code. I understand that noncompliance may result in daily fines of twenty-five dollars or suspension/revocation of ❑ Embargo ❑ Emergency Closure your food permit. ❑ Voluntary Disposal 0 Other: 3-501.14(C) PHFa Recj ved at Tenifecrialuele 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. clij! PROTECTION FROM CHEMICALS 3-5()1.15 Loo in, Methocis for PlIF., Food or Color Additives 19 PHF Hot and Cold Holding [ 3_202 12Additives 3-50LM(B) Cold P1IFs Maintained at or below iu� 590.004(F) 41'/45°F,73-302,14 Protection horn Unwed Additives*__ 3-501. i 6(A) Hot.P1417s Maintained at of above 15 Poisonous or Toxic Substances 7-101.11 Identifying Information-Original 71-501.16(A) Roasts Held it or above 13WE Containers` 7-102,11 Coalition Naine-Working Containers* [:20 Time as a Public Health Control 7-201.11 Separation-Stoi ace* 3-501A9 Time as a Public Kcart FIC-olarle 7-20111 Restriction-Presence and Use'" 5}0,004(14) Variance Requirement 7-202.12 conditions at Use* 7-203.11 ruXiC Containers_Prolaintions* REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-2()4.11 Sanitizers.Criteria-Chemists* POPULATIONS(HSP) 21 3-801,11(A) Unpasteurized Pre-packaged Juice's and 7-204.12 Chemicals for)yasninPr(Auce,�CCiteriae 7-204.14 DrymeAgents Criteria* Beverages with Warning Labels* 7-205,11 incidental Food Contact,Lubricants* 3-801.I l(B) Use of Pasteurized E-s- 7-206.11 Restricted Use Pesticides,Criteria* 3-801 iltD) Raw or Partially Cooked Amaral Food and - Raw Seed Sprouts Not Served. 7.206.12 Rodent Bait Stations' 7-20(1.13_-Tracking Powders,Pest Control and 3-801.11(C) Unopened Food Package Not Re-served. 1 Mommiringt CONSUMER ADVISORY TIMEITEMPERATURE CONTROLS 22 3-603.11 Consumer Advisory Posted for Consumption of Animal Foods'lliat are Raw, Undercooked or Proper Cooking Temperatures for PHFs Not Otherwise Processed to Eliminate 3-401.IIA(1)(2) Eggs- 155`1` 15 Sec. - P,it '. -oaf Eian-Immediate Service 145F].Ssec* 3-302,13 Pasteurized Eggs Substitute for Raw Shelf 3-401.'1 I(A)(2) Comminuted Fish. Meats&Game Animals- 155'F 15 sec. "' - SPECIAL REQUIREMENTS 3-401.11(B)(1)(2) Pork and Beef Roast- 130°F 121 mily, 3-401,11(A)('2) Raines, Injected War.,- 155'F 15 590.009(A)-(D) Violations of Section 590.009(A)-(D)in Sec, a catering, mobile food,temporary and 3-401.11(A)(3) Poultry,Wild Game. Stuffed PHFN, residential kitchen operations should be Stuffint,Containing Fish,Meat- debited under the appropriate sections Poultry or Ratites-165'F 15 sec. above if related to foodborne illness 3-401.'11((2)(3) Whole-muscle, intact Beef Steaks interventions and risk factors. Other 145'F 44 590.009 violations refining to 1pixt retail 3-401.12 Raw Animal Fonds Cooked in a practices should be debited under#29- Microwave 165°F* Special Requirements. 3-40 1.11(A)(1)(b) All Other FHFq 145+ 15sec. ' 17 Reheating for Hot Holding -VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 3-403.11(A)&(D) PflFs 165'F 15 sec. ' (items 23-30) 3-403,11(13) Microwave- 165'F 2 Minute Standing Critical and non-critical violations, which ea not relate to the Thile, laodborne illness interventions and risk factors listed above, call be 3-403.11(C) Commercially Processed RTE Food- found in the following sc(tioin of the Food Code and 705 CWR 140°F* 590.000. 3-403.I I i E) Remlining Unslicial Portions of Beef item i Good Retail Practices FC 590.000 Roasts" 1 23. Management and Personnel FG -2 .003 18 Proper Cooling of PHFS 4. __ Food and Food Protection FC-3 .004 25, Equ tiprntrt and Ulons.1s FC-4 005 3-501A4(A) Cooling Cooked 1`111's from 1,40'F to - ---------- -- ------- - 26. Water, PlumontLand Waste FC-5 .006 i JWF Within 2 Flours and From 70'F 27 1 Physical Facility FC-6 .007 -i to41'F/45'I:Withm4Hours. 1 28. Poisonous or Toxic Materials FC-7 .008 3-501.14(B) Coolin - --iz PHFr Made 2a From Ambient Special RRequirementsremeRequirements0()9 Temperature Ingredients to 41-F,/45'F 130 Other Within 4 Hours* *Donotc,evident item mthe federil 19()9Food Code oi 105 CIMR 590.000. IMPORTANT MESSAGE FOR DATE �/a'6 TIME S P.M. M—&1'/�P-•�-�- - OF PHONE AREA CODE NUMBER EXTENSION ❑ FAX O 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 MESSAGE SIGNED ps FORM 40 ��.��//// MADE INU.S.A. % II NOTES i I IMPORTANT MESSAGE FOR DATE .3_' a a-®� TIME a %o M��IZ�6� OF PHONE AREA CODE NUMBER EXTENSION O FAX O MOBILE '` AREA CODE UMBER :TIME TO CALL TELEPHONED PLEASE CALL: CAME TO SEE YOU WILL CALL AGAIN` WANTS TO 9EEXDU RUSH RETURNED YOUR CALL WIE FAX TO YOU MESSAGE SIGNED 09 W*ps FORM 40 MARE IN 009 PPW