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DELEOS PIZZA - ESTABLISHMENTS DELEO'S PIZZA 28 NORMAN STREET w F ' ' I U Ali 3 H ki1 g- zc)w rn,9 e"� � t7 ( sem - /S-V i • • CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH .120 WASHINGTON STREET,4."FLOOR TEL. (978) 741-1800 KIINIBERLEY DRISCOLL FAx(978) 745-0343 MAYOR IMANCINIC[f�SALEht.COM JANET MANCINI, ACTING HEALTH AGENT 2009 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT NAME OF ESTABLISHMENT min IS pi n TEL# 27L -740 — 28Q ADDRESS OF ESTABLISHMENT 29 Norman 3k• FAX# l Q - 140- 2-71 a MAILING ADDRESS(if different) _ EMAIL- Business': Website: OWNER'S NAME22,�6`lCQ TEL# Q72-538 -1a73 J4 ADDRESS Fu1t00 s1• An_.� PeabOduMFl 0)=Inn STREET CITY V STAE ZIP�a, CERTIFIED FOOD MANAGER'S NAME(S) &'Ion' CERTIFICATE#(S)1 �LL0 red D d S (Required in an establishment where potentially hazardous food is prepa EMERGENCY RESPONSE PERSON HOME TEL# DAYS OF OPERATION i 'Monday.. ';i - Tuesday Wednesday, p..;Thursday r,i s': friday. I I Saturday 1 Sunday HOURS OF OPERATION Il,00_lo'ao.1t,00-I0 00;11:00- I0!oo lltOU Il poal'.o0 -11!00 II:UU �o Please wale in time of day 11•OC l0 00 M ( v Wn) gM /'M pIM PM 9M PH AH PM R PM PM For example 11am-11 TYPE OF ESTABLISHMENT FEE (check only) RETAIL STORE . YES NO less than 1000sq.ft. =$70 1000-10,000sq.ft. =$280 more than 10,000sq.ft. =$420 ---------------------------------------------------------------------------------------------------------------le--ss-----than------25-----s-eat------------------=-$140-- 40 RESTAURANT YES NO s (Outdoor Stationary Food Cart$210) 25-99 seats =$280 more than 99 seats =$420 ------------------------------------------------------- -- -------------------------------- ......................................................... YES NO $100 CHILDCARE SERVICES/NURSING HOME----- ADDITIONAL PERMITS . ---------- MAKE (not just serve) ICE CREAM, YOGURT/SOFT SERVE YES O $25 TOBACCO VENDOR YES NO $135 ALL NON-PROFIT(such as church kitchens) YES NO $25 'Please pay total with one check payable to the City of Salem. This Permit is not transferable and must be reissued upon change of ownership.The Permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code, before any renovations,improvements,or equipment changes are made,all plans for such must be submitted to and approved by the Salem Board of Health. Pursuant to MGL Chapter 62C,Section 49A,I certify under the pains and penalties of perjury that I,to my best knowledge and belief,have filed all state tax return$and paid all state taxes required under the law. lol[cq n, S? - 4 - y90110-9() - JL Signator Date Social Security or Federal Identification Number Revised 424/07 FOODAP2008.adm Check#&Date Commonwealth 0fMassachusetts s e City of Salem Board of Health lGmberieyDriscoll yam' 120 Washington Street,4th Floor Mayor ^�d SALEM,MA 01970 Food/Retail Establishment Permit DATE PRINTED: 01/1212009 ESTABLISHMENT NAME: Deleo's Pizza Fite Number:BHF-2004-666164 28 Norman Street Salem MA 01970 LOCATED AT: 0028 NORMAN STREET SALEM,MA 01970 Permit Type Permit No. Permit Issued Permit Expires Fee Restrictions I Notes FOOD SERVICE BHP-2009.0360 Jan 9,2009 . Dec 31,2009 $140.00 ESTABLISHMENT Total Fees: $140.00 PERMIT EXPIRES December 31, 2009 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 Y CITY OF SALEM, MASSACHUSETTS + • BOARD OF HEALTH 120 WASHINGTON STREET,4 ..FLOOR TEL. (978) 741-1800 KIMBERLEY DRISCOLL FAZ(978) 745-0343 MAYOR IDIONNE&ALEM.COM , JANET DIONNE, ACTING HEALTH AGENT 2009 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT NAME OF ESTABLISHMENT TEL# `F 7e rg 71 r7`/O Z a c, ADDRESS OF ESTABLISHMENT_ Z & /-loo< ✓Ld ✓l i/ 5 I` FAX# MAILING ADDRESS(if different) EMAIL-Business': Website: OWNER'S NAME T21'7 / (7 d�e SLG///1 c .�f —TEL# ADDRESS STREET CITY STATE ZIP CERTIFIED FOOD MANAGER'S NAME(S) CERTIFICATE#(S) (Required in an establishment where potentially hazardous food is prepared) EMERGENCY RESPONSE PERSON HOME TEL# (DAYS OF OPERATION Monday;c ! z` T_uesd .Wednesd Thulsd `"Frids I . ' Murday I Sunday HOURS OF OPERATION Please write in time of day. /• i Q // /0 /-/O / `i0 i /l lc� / l / Ii o /i•� a Forexamplellam-11pm i TYPE OF ESTABLISHMENT FEE (check only) RETAIL STORE YES NO less than 1000sq.ft. =$70 1000-10,000sq.ft. =$280 more than 10,000sq.ft. =$420 --------------------------------------------g ---------------------------------------------------------------------------------------------------- RESTAURANT NO less than 25 seats =$140 (Outdoor Stationary Food Cart$2 25-99 seats =$280 more than 99 seats =$420 ----------BR--------------FA-----/----------------------YE-----S----------NO-------------------------------------------------------------------------------------$---10-------- BED/ EAKST0 CHILDCARE SERVICES ADDITIONAL PERMITS MAKE(not just serve) ICE CREAM, YOGURT/SOFT SERVE YES NO $25 TOBACCO VENDOR YES NO $135 ALL NON-PROFIT(such as church kitchens) YES NO $25 *Please pay total with one check payable to the City of Salem. This Permit is not transferable and must be reissued upon change of ownership.The Permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code, before any renovations, improvements, or equipment changes are made,all plans for such must be submitted to and approved by the Salem Board of Health. Pursuant to MGL Chapter 62C,Section 49A,I certify under the pains and penalties of perjury that I,to my best knowledge and belief,have filed all state tax returns and paid all state taxes required under the law. Signature Date Social Security or Federal Identification Number Revised 424/07 FOODAP2008.adm Check#&Date -..sIf,- -,..., ,. ,„. -.. .- ;i -A ..,t „!.;c$.#w - :".nn ter;.�.•r ',"u'I � i,:l' ,ik ­)w'. Massachusetts Department of Public Health Salem Board of Health Division of Food and Drugs 120 Washington Street,4'h Floor 9 Salem, MA 01970-3523 FOOD ESTABLISHMENT INSPECTION REPORT Tel. (978) 741-1800 Fax (978) 745-0343 NameIP - `� D to Type of OoerationN) Tvoe of Inspection ' P f )1:Z-2,g;- Food Service ❑ Routine Addressa� fMG I Isk ' Retail E'Re-inspection Level ❑ Residential Kitchen Previous Inspection Telephone ❑ Mobile Date: OwnerHACCP Y/N ElTemporary ElPre-operation ❑ Caterer ❑ Suspect Illness Person in Chardemfcj Time ❑ Bed&Breakfast ❑General Complaint _� In:&,) i [_1HACCP Inspector Out:;? Permit No. El Other I Each violation checked requires an explanation on the narrative page(s)and a citation of specific provision(s)violated. Non-compliance with: Violations Related to Foodborne Illness Interventions and Risk Factors 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 PROTECTIONMANAGEMENTui.^�iSt»_ Sra;«%�,% � El 12. Prevention of Contamination from Hands ❑ 1 PIC Assigned/Knowledgeable/Duties ❑ 13 Handwash Facilities -mn nrs°mi x y, 1 " EMPLOYEE HEALTH -FAR' �'� R� apt r5"E AZ0 IF PROTECTION FROM CHEMICALS El 2. Reporting of Diseases by Food Employee and PIC w »,.»- Mw4h•-�� �:. �- � '=i Nay �� � _•') � �_� ❑ 14.Approved Food or Color Additives ❑ 3. Personnel with Infections Restricted/Excluded ❑ 15.Toxic Chemicals CFOOD FfioM APPRoyED$OURCkt ,4,�� TM!.!'.X1;T t TIME/TEMPERATURE CONTI301.S l- _-1-1-1-1-1 -1 Mlalty HaxaMous ❑ 4. Food and Water from Approved Source i_y�� ' , n a." u . , a.",. m ,, L ❑ 5. Receiving/Condition [116.Cooking Temperatures ❑ 6. Tags/Records/Accuracy of Ingredient Statements ❑ 17. Reheating ❑ 7. Conformance with Approved Procedures/HACCP Plans ❑ 18.Cooling yt PROTECTION FROM CONTAMINATION"= �' �'"""� ❑ 19. Hot and Cold Holding 4 0 9 cd+awrre w_wrcu..m++.w��am`bare G �.&' ivfiu��i��'E�ws.. i,Jy6tdt ❑ 8. Separation/Segregation/Protection ❑20.Time As a Public Health Control ❑ 9. Food Contact Surfaces Cleaning and Sanitizing '';REOUIREEFENTs FOR HiG:F(i,yBUSCEPT'ILE,POPULATfi)N§(HAP) ❑21. Food and Food Preparation for HSP ❑ 10. Proper Adequate Handwashing - El 11. Good Hygienic Practices ;CONSUMER ADVISORY ";� :+ 'j,` ❑22. Posting of Consumer Advisories Violations Related to Good Retail Practices Number of Violated Provisions Related Critical (C) violations marked must be corrected To Foodborne Illnesses Interventions immediately or within 10 days as determined by the Board and Risk Factors(items 1-22): of Health. Non-critical (N) violations must be corrected Official Order for Correction: Based on an inspection immediately or within 90 days as determined by the Board today, the items checked indicate violations of 105 CMR of Health. 590.000/federal Food Code. This report, when signed below C` by a Board of Health member or its agent constitutes an 24. Food and Food Protection 23. Management and Personnel (FC-2)(590.0 4) order of the Board of Health. Failure to correct violations (Fc-4)(59cited in this report may result in suspension or revocation of 25. Equipment and Utensils (Fc-a)(ss0. 0oo5)) 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 (Fo-6)(590.007) have a right to a hearing. Your request must be in writing 28. Poisonous or Toxic Materials (FC-7)(590.006) and submitted to the Board of Health at the above address 29. Special Requirements (590.009) within 10 days of receipt of this order. 30. Other DATE OF RE-INSPECTION: s:sso��r�o.�x�a eon Inspector's,Signature: '� \ Print: /� I PIC's Signature: Prints T�"-� / f -C!s2 'I�} , Page oil Pages _ v c� Violations Related to Focidborne Illness Interventions and Risk Factors(items 1-22) PROTECTION FROM CONTAMINATION FOOD PROTECTION MANAGEMENT E8 Cross-contamination 1 590.003(A) Assignment of Responsibility* 3-302.11(A)(1) Raw Animal Foods Separated from 590.003(B) Demonstration of Knowledge* - Cooked and RTE Foods* 2-103.11. Person in charge-duties Contamination from Raw Ingredients 3-30211(A)(2) Kaw Aminal 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) P a Brants* 3-302, Food Protection*Food Fruits and Ve etables 590.003(F) Responsibility OPA Fool Employee Or Au 3-304.11 Foci Contact with Equipment and Applicant To Report To Ttte Person In Utensils* Charge* Contamination from the Consumer 5%003(6) Re ordng b Person in Charge* 3-306.14(A)(I3) Returned Food and Reservice of Food* 3 590.003(D) Exclusions and Re actions* Disposition otAdulteratedorContaminated 590.003(E) Removal of Exclusions and Restrictions Food 3-701,11 Discarding or Reconditioning Unsafe FOOD FROM APPROVED SOURCE Food* 4 Food and Water From Regulated Sources 9 Food Contact Surfaces 590.004(A-B) Compliance with Food Law* 4-501.t11 Manual Warewashing-Hot Water 3-201.12 Food in a Hermetically Sealed Container* Sanifization Tem eratures* 3-201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Warewashina I1ot Water 3-202.13 Shell Eggs* Satirization Tem eratures* 3-202.14 Eggs and Milk Products.Pasteurized* 4-501.114 Chemical.Sanitisation-temp.,pH, 3-202.16 Ice Made From Potable Drinking Water* concentration and hardness. " 5-101.1.1 Drinking Water from an Approved System* 4-601,1.'[(A) Equipment Food Contact Surf=aces and 590.006(A) Bottled Drinking Water* Utensils Clean* 590.006(B) Water Meets Standards in 310 CMR 22.0* 4-602.11 Cleaning Frequency of Equipment Food- Shellfish and Fish Froman Approved Source Surfaces and Utensils*e 4-.702.11 Frequency of Sanitization of Utensils and 3-201.14 Fish and Reereaiionally Caught Molluscan Food Contact Surfaces of E ni menO Shellfish" 4-703.11 Methods of Sanitization-Hot Water and 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* Sources* 10 Proper,Adequate Handwashmg Game and Wild Mushrooms Approved by Regulatory Authority 2-301.11 Clean Condition-Hands and Arms* 3-202.18 Shellstock Identification Present* 2301..12 Cleaning Procedure* -590.004(C) Wild Mushrooms* 2-301.14 When to Wash* 3-201.17 came Animals* 1.1 Good Hygienic Practices 5 Receiving/Condition 2-401..11 Eatin ,Drinking or Using Tobacco* 3-202.11 PHFs Received at Proper Temperatures* 2-401.12 Discharges From the Eyes,Nose and 3-202.1.5 Package Integritv, Mouth* 3-101.11. Food Safe and Unadulterated* 3-301.12. Preventin Contamination When Tastin 6 Tags/Records:Shellstock 12 - Prevention of Contamination from Hands 3-202.18 Shellstock Identification * 590.004(E) Preventing Contamination from 3-203.12 Shellstock Identification Maintained* Employees* Tags/Records: Fish Products 13 Handwash Facilities 3402.11 Parasite Destruction* Conveniently located and Accessible - 3-402.12 Records,Creation and Retention* 5-203.11. Numbers and Capacities* 590.004(J) Labeling of Ingredients' 5-204.11 Location and Placement* 9 Conformance with Approved Procedures 5-205.11 Accessibility,Operation and Maintenance /HACCP Plans Supplied with Soap and Hand Drying _ 3-502.11 Specialized Processing Methods* Devices 3-502.12 Reduced os gen acka 'n criteria* 6301.11 Hindwashing Cleanser,Availability 8-103.12 vailabilit- 8-103.12 Conformance with Approved Procedures* 6-301.12 Hand Drvin*Provision *Denotes critical item in the'tetlend 1999 Food Code or 105 CM.R 590.000. - .. 4 Massachusetts Department of Public Health Salem Board of Health Division of Food and Drugs 120 Washington Street, 4th Floor 9 Salem, MA 01970-3523 FOOD ESTABLISHMENT INSPECTION REPORT Tel. (978) 741-1800 Fax (978) 745-0343 Name T D to a of O eration s Tvoe of Insoection I ) Q Z 1 ( �/ Food Service Routine Address4n Risk ❑ Retail Re-inspection C9_F5Level ❑ Residential Kitchen Previous Ipspection Telephone ❑ Mobile Date: r] Owner HACCP YM ❑ Temporary ❑ Pr o(�te (ionJ` ` ,t� I ❑ Caterer ❑ Suspect Illness Person in Charge(PIC) t Time _ ❑ Bed&Breakfast ❑General Complaint In:4, p l,� ❑ HACCP Inspector Out: Permit No. ElOther Each violation checked requires an explanation on the narrative page(s)and a citation of specific provision(s)violated. Non-compliance with: Violations Related to Foodborne Illness Interventions and Risk Factors Anti-Choking Tobacco Violations marked may pose an imminent health hazard and require immediate corrective 590.009(E) ❑ 590.009(F) ❑ action as determined by the Board of Health. "" ° ❑ 12. Prevention of Contamination from Hands ;,FOOD PROTECTION MANAGEMENT,q-.�.,,�,�„ _„; ..��Hm, ,,,,�,r r, ❑ 1 PIC Assigned/Knowledgeable/Duties ❑ 13 Handwash Facilities �EMPLOYEE n •T �•. a s+ n r n „ - � 1 PROTECTION FROM CHEMICALSw a ❑ 2. Reporting of Diseases by Food Employee and PICT ����� = � � - � � ' r� _ ❑ 14.Approved Food or Color Additives ❑ 3. Personnel with Infections Restricted/Excluded ❑ 15.Toxic Chemicals E�FOUD FROM APP-o"P SQUR �'p a ,�.s:�'..°.:`�.,s` t ;, s a'�€ El4. Food and Water from Approved Source r1TIMEJTEMPERATURE CONTROIs @oternlally HassaPooUs Foods)` 1.1mc,5a. ,W '- v. p"4.,Ix 1,uM,,i'. ,.-w.M& �'wi L 6�SqG DuaaL u,.Awsaaaz ❑ 5. Receiving/Condition ❑ 16. Cooking Temperatures ❑ 6. Tags/Records/Accuracy of Ingredient Statements ❑ 17. Reheating ❑ 7. Conformance with Approved Procedures/HACCP Plans ❑ 18.Cooling mTql� 9. Hot and Cold Holding p PROTECTION FROM CONTAMINATION': F a r t " d 9 ❑ 8. Separation/Segregation/Protection ❑20.Time As a Public Health Control ❑ 9. Food Contact Surfaces Cleaning and Sanitizing !jr REQUIREMENTS FOR HIGHLY 0IfSCEPTI6LE PQPULATIONS(HSP) ❑21. Food and Food Preparation for HSP ❑ 10. Proper Adequate Handwashing ❑ 11. Good Hygienic Practices CONSQf4gR ADVISORY'„„=��„"_�„„ ,„ ,„�'y�' " "�' ❑22. Posting of Consumer Advisories Violations Related to Good Retail Practices Number of Violated Provisions Related Critical (C) violations marked must be corrected To Foodborne Illnesses Interventions immediately or within 10 days as determined by the Board and Risk Factors(Items 1-22): of Health. Non-critical (N) violations must be corrected Official Order for Correction: Based on an inspection immediately or within 90 days as determined by the Board today, the items checked indicate violations of 105 CMR of Health. 590.000/federal Food Code. This report, when signed below C' by a Board of Health member or its agent constitutes an . Management and Personnel (FC-2)(590.0 order of the Board of Health. Failure to correct violations 24. Food and Food Protection (FC-3)(590..004)) cited in this report may result in suspension or revocation of 5. Equipment and Utensils (Fc-4)(590.005) the food establishment permit and cessation of food 26. Water, Plumbing and Waste (FC-5)(590.006) establishment operations. If aggrieved by this order, you 27. Physical Facility (FC-6)(590.007) have a right to a hearing. Your request must be in writing 28. Poisonous or Toxic Materials (FC-7)(590.008) and submitted to the Board of Health at the above address 29. Special Requirements (590.009) within 10 days of receipt of this order. 30. Other DATE OF RE-INSPECTION: S,5001nspWFom 14 0o �61'N r� a2�2 24 Inspector's Signature: Print: PIC's Signature: ` t✓/ (,&�-K�-t Print: 7_0 C7 C t' l/ 21 v4 Page of Pages v Violations Related to Foodborne Illness Interventions and Risk Factors(items 1-22) PROTECTION FROM CONTAMINATION � FOOD PROTECTION MANAGEMENT 8 Cross-_ contamination f r 15,96.003(A) I Assignment of Responsibility*_ 3-302.11(A)(1) Raw Animal Foods Separated from - 1 590.003(B) Demonstration of Knowledge* � Calked and RTE Foods* 271.03.11 Person in charge-duties Contamination from Raw Ingredients 3-302.11(A)(2) Raw Animal Foods Separated from Each EMPLOYEE HEALTH Other- 2 590.003(C) Responsibility of the person in charge to Contamination from the Environment require repotting by foal employees and 3-302.11(A) Food Protection* applicants* 3-302.15 Washinc Fruits and Ve efables 590.003(F) Responsibility Of A Food Employee Or An 3-304.11. Food Contact with Equipment and Applicant To Report To The Person In Utensils* Charge' Contamination from the Consumer 590.003(G) Reporting by Person in Char!e* 3-306.14(A)(B) Returned Food and Resetvice of Food* 31 590.003(D) Exclusions and Restrictions* Disposition of Adulterated or Contaminated 590.003(F,) Removal of Exclusions and Restrictions Food - 3-701.11 Discarding or Reconditioning Unsafe FOOD FROM APPROVED SOURCE Food* 4 Food and Water From Regulated Sources FT Food Contact Surfaces 590.004(A-B) Compliance with Food Law* 4-501.111 Manual Warewashing-Hot Water 3-201.12 Food in a Hermetically Sealed Container* Sanitization Tent eratures* 3-201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Warewashing-Hot Water 3-202.13 Shell Eg s* Sanitization Temperatures* 3-202.14 Eggs and Milk Products.Pasteurized* 4-501.114 Chemical Sanitization-temp.,pH, 3-202.16 Ice Made From Potable Drinking Water* concentration and hardness.* 5-1.01.1.1 Drinking Water from an Approved System* 4-601.11(A) Equipment Food Contact Surfaces and 590.006(A) Bottled Drinking Water* Utensils Clean* 590.006(B) I Water Meets Standards in 310 CMR 22.0* 4-602.11 Cleaning Frequency of Equipment Food- Shellfish and Fish From an Approved Source Contact Surfaces and Utensils`" 4-702.11 Frequency of Sanitization of Utensils and 3-201.14 Fish and Recreationally Caught Molluscan Food Contact Surfaces of Equipment* Shellfish* 4-703.11 Methods of Sanitization-Hot Water and 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* Sources* 10 Proper,Adequate Handwashing Regulatory Authorit Game and uMushrooms Approved by 2-301.1 1, Clean Condition-Hands and Arms* 3-202.18 Shellstock Identification Present* 2-301.12 Cleaning Procedure* 590.004(C) Wlld Mushrooms* 2-301.14 When to Wash* 3-201.17 Game Animals* 11 Good Hygienic Practices g Receiving/Condition 2401.11 Eating,Drinkina or Using Tobacco* 3-202.11 PHFs Received at Proper Temperatures* 2-401.12 Discharges From the Eyes,Nose and 3-202.15 Packa a tette it * Mouth* 3-101.11. Ford Safe and Unadulterated* 3-30L 12 Preventing Contamination When Tasting* 6 Tags/Records:Shellstock t72 Prevention of Contamination from Hands 3-202.18 Shellstock Identification* 590.004(E) Preventing Contamination from 3-20312 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(J) Labeling of Ingredients' 5-204.11 Location and Piacernent* � Conformance with Approved Procedures 5-205.11 Accessibility.Operation and Maintenance /HACCP Plans Supplied with Soap and Nand Drying 3-502.11 Specialized Processing Methods* Devices 3-502.12 Reduced oxygen packaging,criteria* 6-301.11 Hindwashin Cleanser,Availability 8-103.12 Confoemance with Approved Procedures* 6-301.1.2 Hand Drying Provision "Denotes critical itenr in the federal 1999 alai Code or 105 CMR 590.000. CITY OF SALEM f BOARD OF HEALTH Establishment Name: W c 10-S �22:7,LL Date: t I Page: of _ Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION'; Date No. Reference - R-Red Item ' I r I I - Verified (' PLEASE PRINT CLEARL/Y I " " f� Q qn C I.G r nCY!— � iA t ! ( 1vpnt�7 re s _ \j . t 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 R striction Exclusion violations before the next inspection, to observe all conditions as described, and to 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. C//'- Lc� � ❑ Voluntary Disposal ❑ Other: 11 17 ar -j';T-t 7,, CFem cs Violations Related to Foodirorne Iflness Interswntions and Rlsk P, PHT,Re,,,io Lae, Coded to Factors(items 1-22) (Coat.) 1 F/45'F Within Hour, PROTECTION FROM CHEMICALS 3-5011,15 Conlin,,Nleilrods for PRFs PHF Hot and Cold Holding 1=4 ' Cold PHFv Moinnotaxi at or below 590J)(WT-) 11°145°F- ?-3{)2.14 1 Protection from Addinves" t Taxis I ';-501,16(A) I b)t PHFg Maintwised at or above LL-5— T 1401'. 101.11 Identifying tntomlolior- Odgaial I 3-501,WA) Poams field ar orabove 130'F 1 Trine as a Public Heafth Control 7 102,11 Common Nam�� -WorkL�e 7-201.11 Seoul adoq Tic, 19 1 Ti ai�as a vubtw,Health Control, 90, 0d FI) ��Vartat}eRecatrement �� 52 11 pf,"itricc and U.1* 7.202712 e-­ondisiZcf Use REQUIREMENTS FOR HIGHLY SUSCEPTIBLE -7 203 11 Taxic Counnneri, Prolahuion,* POPULATIONS(HS 7 204A 1 sanvi7tis,crilerni-chelmc:kls" 7-2(4.12 Chenucals for Wu,hing VrcWncc,Cineda" 21 -80 1,11(A) Unpaqte ".it Pre,n6'aged juices and Rever"tees with 7-204,14 -DINIn" Avein, 7,205,11 fin;idnital l:31x1(A,,ntact,I mbficarns' I�8011'(81 I'll--ofpalwurY�( i 9Ef---- ------- 1-801.11(D) Raw or Pailial[�Cooked-Amarial Food and -7-206, fkiedCsePeqieides Crifctia� ' . i 7-206.12 Roilent B�Iit sukdons* — — Raw Sued�,proin��Nal, r-. �l L _� 8L I I() ax n�d I ood Pad,a, Not R, 7 _'06.13 1 'fiacking fesmler-�,Pest Control and _Lj��_ _ Manila in,-, CONSUMER ADVISORY TIME(TEMPERATURE CONTROLS 22 3-003, 11 Aniaml FcKylK That art,Raw, Undas")Ined ui 16 Proper Cooking Temperatures-for r— P"Fs Not Otlrtts�nw Processed to Elitninare. diateSznvic� i i5'F15icC1 13 ubsunitefolRaw shell F gs 1,55'F 15 S-x� 715T-J,I Awc, 71.11(A)i2) cmoe.wtoleif 'T wail am e _ il ' AramaLs,--! F 15 1SPECIAL REQUIREMENTS 40L 1 I(Ifs I i(2) flofk end Beet Rtmst -1WT121 au —- 0---(D) in- 1-4101.11("02) 1 Ratam fidw;,d Wits - 1�5 3F 1ISJ$ection 75 ,009(A)- cateringmobik food,temporary and 3-40L I I(A)f3) poultrti, Wild Garne, Stuffloj PHFs, ri,,mdewal kitchen opcoatims,hould bm sojffiniL Cornailung FisbMeal, debited under the appropriate Poullry or,Raines,IWI15 sec '° afiove if r hued io fixAN)rne illness 3-401.1)tC)(;) Whok-mw,,,:IoIntact Becf Sicak.g intin ventionq and riA bactors, Other 1145 T 590.009 violations g relatniI to o(yj rc I FT4-01pactices hould be debitW under# - 29 12 Ra� Arronal Isx)rb,Cooked in a 165-T } Special Requirements, I,HfAr(l)(b) JA110thetinil-s- 1-19`1 1` 17 Reheating for Hot Holding VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 3403A)(A)&-il)s PIF 165'F 1,sec. 31 (items 23-30) 40B) Microwave- I65'1-2 Nfinvie StandingCi inral and non-criaeal violalwo's,'which do nal reiezo-in titsI fijoelborne illness imerventi,smy"ind i iskjacrom tivied above, cam be 3-4()3.I I(C) I Comirencialh,Pisees,rd RIF Fotxi- finerid in thejoilon ujgseciions(,q the Food Code and 105 C,,WR I 140'F 3-45}3.11(F.1 Remainin"UnFliced Portions,of l}1-1-1 Fc; 5! wo Roas!,O 23� Lnt and perzon FC -2 .003 24, Food and Food Protection ling of PHF.% FC '3 004 Proper Coo :-,f-'T- 5 C and(AE 'Si tF6 3-501.T4(A) Cwhin,C(s)ki�K'PHF� into l4l)'17 to ---------- aterI Fc Wc '0'1'Within 2 flours and From'01 27. PhyLv�affjcfity to _ Poisonous or Toxic Mvier Ws I 3 FC.-7 008 50 1 �B) Cooling,PHFs Madc From Ambient Tcaipvrature hogredieim to 41N-/45�F Other Within , HmmrO lsencltea critical nem m thr redeml 1999 Fom!C,Ae or 105 Ckflt 590 nor, CITY OF SALEM BOARD OF HEALTH Establishment Name: I / IPo Date: d Pager of Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date No. Reference R-Red Item Verified PLEASE PRINT CLEARLY I VeA C A r LA (112r Q I (1 I0"I G / I c-;v 1'Cj A-I _P Q 42, , sin6n, > n G L)Xl C v - 4o re t if - n z reS G b a (L ( APO d c,� (-o' Ji— ur 1 JvL W 1 C, CG� - r r.n / 14 r iDes +,-,iLI Discussion With Person in Charge: Corrective Action Required: D No es I have read this report, have had the opportunity to ask questions and agree to correct all ❑ Voluntary Compliance ❑ Employee Restriction/ Exclusion t violations before the next inspection, to observe all conditions as described, and toRe-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. A Voluntary Disposal ❑ Other: C/ICS< < 3-501 J,I(C) PRFs Received at Temperatures Violations Related to Foodborne Illness Interventions and Risk Aceording to Iaw Cooled to Factors(items 1-22) (Cont.) 14I'FJ45°F Within 4 Homs. PROTECTION FROM CHEMICALS 3-501.15 Cooling,Methods for PHFs 1.4 Food or Color Additives 19 PHF Hot and Cold Holding 3-501,16(B) Cold PHFs Maintained at or below -5202 Addnrves* 590.004(F) 41'/45° F* 3-30214 Protection from Cna roved Additives* Poisonous or Toxic Substances - "3-SOL 16(:a) Hot PHFs Maintained at or above 15 7-101.11 Identifying Information-Original 140'F. *3-501.16(A) Roasts Held at or above 130'F. Containers'" 7-102.11 Common Name-Wnrkin° Containers* 20 Time as a Public Health Control 7-201.I 1 Separation-Stora e' 3-501.19 Time as a Public Health Control* 7-20211 Restriction-Presence and Use" 590.064(H) Variance Requirement 7-202.12 Conditions of Use* 7-203.1.1 Toxic Containers-Prohibitions" REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-204.11 SantuzersCriteria-Chemicnlsx POPULATIONS(HSP) 7-204.12 Chemicals for 14 ashin¢Produce,Criteria' 21 3-80111(A) Unpasteurized Pre.-packaged Juices and 7-204.14 Dtvin A cuts.Criteria* Beverages with Warning,Labels* 7-205.11 Incidental Food Contact.Lubricants*' 3-80t.11(B) Ilse of Pasteurized Eecs* 7-206.11. Restricted Use Pesticides,Criteria* 3-801,1.1.(D) Raw or Partially Cooked Animal Food and Raw Seed Sprouts Not Served. Tracking ,F 7-206.12 cBait Stations- Focal Package hot Re-served, 7-206.13 Tracking Powdc,rs,Pest Control and 3-801.11(C) Unopened F Monitorrnn* CONSUMER ADVISORY TIMEITEMPERATURE CONTROLS 22 3-603.11 Consumer Advisory Posted for Consumption of :16 Proper Cooking Temperatures for Animal Foods That are Raw,Undercooked or PHFs Not Otherwise Processed to Eliminate 4 _-40 1.i.l A(1)(2) Eggs- 155F 1.5 Su. Pathogens . E��`"" 0' Fees-hnmcLluue Service 145`115sec*. 3-302.13 Pasteurized Eggs Substitute for Raw Shell 3-401.11(A)(2) Comminuted Fish, Mears&Game Bus* Animals-155°F 15 sec. * 3-401.11(B)(1)(2) Pork and Beef Roast - 130'F 121 min* SPECIAL REQUIREMENTS 3-401.11(A)(2) Ratites, Injected Meats-155'F 1.5 590A09(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 PlIll residential kitchen operations should be Stuffing Containing Fish,Meat, debited under the appropriate sections Point roc Rtitites-165°F 15 sec. r. above if related to foodborne illness 3-401.11(C)(3) Whole muscle,'Intact Beef Steaks interventions and risk factors. Other 45'F a 590.009 violations relating to good retail 3-401.12 Raw Animal Foods Cooked in a practices should be debited under#{29- Microwave 165'F* Special Requirements. 3-401.11(A)(I)(b) All Ofher PHFs-145'F'15 sec. 17 Reheating for Hot Holding VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 3-403.1 1(A)&(D) PHFs 165°F 15 sec.^ (Items 23-30) 3-403.11(B) Microwave-165°F 2 Minute Standing Collectl and non-critical violivions, which do not relate to file Time* ,foodborne illness interventions and risk factors li.i ed above, cern he 3-403.11(C) Commercially Processed RTF Food- found in the following sections of the Food Code and 105 CMR 140'F` .590.000. 3-4o3.I I(P) Remaining Umficed Portions of Beef Item Good Retail Practices Fc 59A.000 Roasts* 23. Mena ement and Personnel FC-2 .003 18 Proper Cooling of PHFs 24. Food and Food Protection _ FC-3 .004 _ 3-501.14(A) Coating Cooked PHFs from 140°F to 25. Equipment and Utensils FC--4 .00526. Water, Plumbin and Waste FC 5 .006_ 70°F Within 2 Hours and From 7U'F 27. Ph site]Facili FC-6 I .007 to 41°FJ45°F Within 4 Hours. * 28. Poisonous or Toxic Materials FC-7 1 .008 3-501.14(B) Coolim,PHFs Made From Ambient 29. S eciai Re ulrements 1 .008 Temperature frigredients to 41°F145°F 30.____ _Other _-- Within 4 Hours* ss;inminmxazm. °;Denotes critical item in dw federal 1999 Food Code or 105 ChIR 590.000. Massachusetts Department of Public Health Salem Board of Health Division of Food and Drugs 120 Washington Street,4t"Floor 9 Salem, MA 01970-3523 FOOD ESTABLISHMENT INSPECTION REPORT Tel. (978) 741-1800 Fax (978) 745-0343 Name Date T of Operations) Type of Inspection r 4 Q Food Service ❑ Routine Address Risk LJ Retail ;] Re-inspection c,^ Level ❑ Residential Kitchen Previous Inspection Telephone Xo D ❑ Mobile Date: �s� Owner HACCP YM ❑ Temporary ❑ Pre-operation TJ V ❑ Caterer ❑ Suspect Illness Person in Charge(PIC) Time ❑ Bed&Breakfast ❑ General Complaint El Inspector ��p Outad Permit No. ❑ Other-_ CP Each violation checked requ res an explana on 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 l5so.009(E) [I590.0 action as determined by the Board of Health J( o�o "FOODPROTECTION MAyAEMENT - u-, �� f ❑ 12. Prevention of Contamination from Hands ❑ 1 PIC Assigned/Knowledgeable/Duties ❑ 13. Handwash Facilities EMPLOYEE HEALTH 1 w. . ...., h.m.�..,.aw.. .� PROTECTION FROM CHEMICALS F' a t xw am wm , r_ e tib ❑ 2. Reporting of Diseases by Food Employee and PIC `�� '•� u I G k� _- - M a=_ ._ •���s ❑ 14.Approved Food or Color Additives ❑ 3. Personnel with Infections Restricted/Excluded ❑ 15.Toxic Chemicals S,FOOD FROM APPROVED SOURCE "TIME(TEMPERATURE CONTROLS Potential) Hazardous Foods - t ❑ 4. Food and Water from Approved Source ( y ) ❑ 5. Receiving/Condition ❑ 16.Cooking Temperatures ❑ 6. Tags/Records/Accuracy of Ingredient Statements ❑ 17. Reheating ❑ 7. Conformance with Approved Procedures/HACCP Plans ❑ 18.Cooling "PROTECTION FROM CONTAMINATION!`- `� '" -` "" �'R` ` ` El 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 21. Food and Food Preparation for HSP ❑ 10. Proper Adequate Handwashing El11. Good Hygienic Practices FCONSUMER ADVISOAY ❑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 XN by a Board of Health member or its agent constitutes an 23. Management and Personnel FFo2)(s order of the Board of Health. Failure to correct violations 24. Food and Food Protection (Fc-3)(ss0.004)).00a) 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: sssomspecrFo,me-ia.em � r Inspector's Signature: Print: \J PIC's Signature: �� �. , ( / , l t Print: ��� i - / G G/ .� Page of___�Pages Violations Related to Foodborne Illness Interventions and Risk Factors(items 1-22) PROTECTION FROM CONTAMINATION FOOD PROTECTION MANAGEMENT S Cross-contamination 1 590.003(A} AssignmenlofResponsibility* 3-302.1](A)(]) Raw Animal Foods Separated from 590.003(6) Demonstration of Knowledge" Cooked and RTE Foods* 2-103.11 Person in char e-duties Contamination from Raw Ingredients 3-302.1.1(A)(2) Raw Animal Foods Separated from Each EMPLOYEE HEALTH Other* 2 590 M(C) Responsibility of the person in charge to Contamination from the Environment require reporting by fixxt employees and 3-302.11(A Food Protection* applicants* 3-302.15 Washing Fruits and Vegetables 590.003(F) Responsibility Of A Food Employee Or An 3-3(4.11. Pond Contact with Equipment and Applicant To Report To The Person In Utensils* Charge* Contamination from the Consumer 590,903(G) Reporting by Person in Charge* 3-306.14(A)(B) Returned Food and Resetvice of Fuad* 3 590.003(D) Exclusions and Restrictions* Disposition of Adulterated or Contaminated 590.003(E) Removal of Exclusions and Restrictions Food 3-701.11 Discarding or Reconditioning Unsafe FOOD FROM APPROVED SOURCE Food* 4 Food and Water From Regulated Sources 9 Food Contact Surfaces 590.004(A-B) Compliance with Food law* 4-501.71 I i 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 3-202.13 Shell Eggs* Sanitization Temperatures* 3-202.14 .E >s and Milk Products.Pasteurized* 4-501.114 Chemical.Sanitization-temp.,pH, 3-202.16 Ice Made From Potable Drinking Water* concentration and hardness. 5-101.11 Drinking Water from an A roved System- 4-601..11(A) Equipment Food Contact Surfaces and Utensils Clean* 590.006(A) Bottled Drinkingads 4-602.1 t Cleaning Frequency of Equipment Fund- 59(L006(B) Water Meets Standards in 37.0 CMR 22.04c * Shelflrsh and Fish From an Approved Source Contact Surfaces and Utensils 4-702-11. Frequency of Sanitization of Utensils' 1 . and 3-20.1.14 Fish and Recreationally Caught Molluscan Food Contact Surfaces of Equipment* Shellfish* 4-703.11 Methods of Sanitization-I-Iot Water and 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* Sources* 10Proper,Adequate Handwashing Game and Wild Mushrooms Approved by Re ulato Authorit 2-301.11 Clean Condition-Hands and Arms* 3-202.18 Shellstock Identification Present* 2-301.12 Cleaning Procedure* 590.004(C) Wild Mushrooms* 2-301.14 When to Wash* 3-201.17 Game Animals* 11 Good Hygienic Practices 5 Receiving/Condition 2401.11 Eating,Drinking or Using Tobacco" 3-202.11 PFIFs Received at Proper Temperatures* 2-401.12 Discharges From the Eyes,Nose and 3-202.15 Package Integrity* Mouth* 3-101.11 Food Safe and Unadulterated* 3-301.12 Preventin Contamination When Tastin " 6 Tags/Records:Shellstock 12 Prevention of Contamination from Hands 3-202.18 Shellstock Identification* 590.004(E) Preventing Contamination from 3-203.12 Shellstock Identification Maintained* Employees* Tags/Records: Fish Products 13 Handwash Facilities 3402.11 Parasite Destruction* Conveniently Located and Accessible - 3-402.12 Records, 5-203.11 Numbers and Capacities* Creation and Retention* 5404.11 Location and Placement* 590A04(1) Laabelingg of Ingredients` 7 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 oxygen packaging,criteria* 6-301.11 Handwashin Cleanser,Availability 8-103.12 Conformance with A. roved Procedures* 6-301.12 Hand Dr u Provision *Denotes critical item in the Weral 1999 Food Code or 105 CMR 590.000. 5 Massachusetts Department of PubliciHealth Salem Board of Health p 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 Type of Operation(s) Type of In \ cv J ®, Food Service ❑"Routine AddressRisk LJRetail E) Re-inspection 7 v .1rA Level ❑ Residential Kitchen Previous Inspection Telephonea� ❑ Mobile Date: (a( )�� Owner -r HACCP YM ❑ Temporary ❑ Pre-operatwn I (t ll ❑ Caterer ❑ Suspect Illness Person in Charge i Time ❑ Bed& Breakfast ❑ General Complaint In: 11: da' El HACCP Inspector O Out:W A,) - Permit No. El Other Each violation checked requires an explanation on the narrative page(s) and a citation of specific provision(s) violated. Non-compliance with: Violations Related to Foodborne Illness Interventions and Risk Factors Anti-Choking Tobacco Violations marked may pose an imminent health hazard and require immediate corrective 590.009(E) ❑ 590.009(F) ❑ action as determined by the Board of Health. FOOD PROTECTION MANhAdEMENTf_,` m o,,,_.,._..,„„„„", „��� El12. Prevention of Contamination from Hands El 1. PIC Assigned/Knowledgeable/Duties ❑ 13. Handwash Facilities PROTECT{ON FROM CHEMICALS ❑ 2. Reporting of Diseases by Food Employee and PIC ❑ 14.Approved Food or Color Additives ❑ 3. Personnel with Infections Restricted/Excluded 6 >,� . � �� ❑ 15.Toxic Chemicals fiFOOD FROM APPROVED SOURCE„„I;.„„„.n,.„, , ,,E, :„,.,-: ..,e ...',.»,.w r..�,�-� � F-14. Food and Water from Approved Source , TIME/rEMPERATURE CONTROLS(PotentWlly Hazardoys Foods) �;� w 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 PRbTECTION FROM CONTAMINATIOPF """"'� r "�" ❑ 19. Hot and Cold Holding • :a .. .. ! �+ve„iw„.:e'i: ,.0 ,�,,.�.a:;..,- ...s.._., .al le ..4� m r;� -i,.e.,..:««t L❑ 8 Separation/Segregation/Protection El 20.Time As a Public Health Control 9. Food Contact Surfaces Cleaning and Sanitizing REQiJIREMENTS FQR,HIGHLV�USCEPTTIBLE pUPULAr10NS(HSP ❑ 21, Food and Food Preparation for HSP ❑ 10. Proper Adequate Handwashing P CONSUMER ADVISORY ❑ 11. Good Hygienic Practices - ❑ 22. Posting of Consumer Advisories Violations Related to Good Retail Practice's Number of Violated Provisions Related Critical (C) violations marked must be corrected To Foodborne Illnesses Interventions ❑A immediately or within 10 days as determined by the Board and Risk Factors(items 1-22): of Health. Non-critical (N)violations must be corrected Official Order for Correction: Based on an inspection immediately or within 90 days as determined by the Board today, the items checked indicate violations of 105 CMR of Health. 590.000/federal Food Code. This report, when signed below by a Board of Health member or its agent constitutes an 23. Management and Personnel (Fc-2) order of the Board of Health. Failure to correct violations 24. Food and Food Protection (FC-3)(5590.90.0 0044))) cited in this report may result in suspension or revocation of -25. Equipment and Utensils (FC-4)(590A05) 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:5XInvecfFot 6-14.Cw r Inspector's Signature: PIC's Signature: a Print: - - Page of 7Pages */ V/ c Violations Related to Foodborne Illness Interventions and Risk Factors(Items 1-22) PROTECTION FROM CONTAMINATION FOOD PROTECTION MANAGEMENT 8 Cross-contamination 1 596.003(A) Assigumentof Responsibility* -� 3-302.11(A)(1) Raw Animal Foods Separated from 590.003(B) Demonstration of Knowledge* Cooked and RTE Foods* 2-103.11. Person in charge-duties Contamination from Raw ingredients 3-302.11(A)(2) Raw Animal Foods Separated from Each EMPLOYEE HEALTH Other- 2 590.003(0) Responsibility of the person in charge to Contamination from the Environment require repotting by food employees and 3-30211(A) Food Protection* applicants* 3-302.15 Washing Fruits and Vegetables 590.003(F) Responsibility Of A Food Employee Or All 3-304.11 Food Contact with Equipment and Applicant To Report'ro The Person In Utensils* Charge* Contamination from the Consumer 590.003(G). Reporting by Person in Charge* 3-306.14(A)(B) Returned Food and Resetvice 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 Ford* 4 Food and Water From Regulated Sources 9 Food Contact Surfaces 590.004(A-B) _Compliance with Food Law* 4-501..111 Manual Warewashing-Hot Water 3-201.12 Food in a Hermetically Sealed Container* Sanitization Temperatures, 3-20113 Fluid Milk and Milk Products* 4-501.112 Mechanical Warewashing-Hot Water 3-202.13 ShellEggs* Sanitization Temperatures* - 3-202.14 Eggs and Milk Products,Pasteurized* 4-501.114 Chemical.Sanitization-temp.,pH, 3-202.16 Ice Made From Potable Drinking Water* concentration and hardness. * _ 5-101.7.1 Drinking Water from an Approved System* 4-601.11(A) Equipment Food Contact Surfaces and Utensils Clean" 590.006(A) Bottled Drinking Water* 4-60211 Cleaning Frequency afiEguipmentFood- 590.DOfi(33) Water Meets Standards in 310 CMR 220* 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 E ui meat* Shellfish* 4-703.11 Methods of Sanitization-Hot Water and 3-201.15 , Molluscan Shellfish from NSSP Listed Chemical* Sources* 10 Proper,Adequate Handwashing Game and Wild Mushrooms Approved by Re2ulatory Authority 2-301.11 Clean Condition-Hands and Arms" 3-202.18 Shelistock Identification Present* 2-301.12 Cleaning Procedure* 590.004(C) Wild Mushrooms* 2-301.14 When to Wash* 3-201.17 Game Animals* 1.1 Good Hygienic Practices 5 Remiving/Condition 2401,11 Eating,Drinkinor Using Tobacco* 3-202.11 PHFs Received at Proper Temperatures* 2-401.12 Discharges From the Eyes, Nose and 3-202.15 Package lmeit y* Mouth* 3-101.11 Food Safe and Unadulterated* 3-301.12 Preventing Contamination When Tasting* 6 Tags/Records:Sheiistock 12 Prevention of Contamination from Hands 3-202.18 Shelistock Identification* 590-004(E) Preventing Contamination from 3-203.12 Shelistock Identification Maintained* Em to ees* Tags/Records: Fish Products 13 Handwash Facilities 3-402.11 Parasite Destruction* Conveniently Located and Accessible 1 .3-402.12 Records, Numbers and Capacities* Creation and Retention* 5-203.11 590.004(1) Labeling ling of Ingredients' 5-204.1.1 Location and Placement* g Conformance with Approved Procedures 5-205.11 Accessibility,Operation and Maintenance fHACCP Plans Supplied with Soap and Hand Drying 3-502.11 S ecialized Processin Methods* Devices 3-502.1.2 Reduced ox en �acka 'na-criteria* 6-30111 Handwashin Cleanser, Availability 8-103.12 Conformance with A roved Procedures' 6-301.1.2 Hand DryingProvision 'Denotes critical item in the Cedeial 1999 Foal Cale or 105 CMR 590.000, CITY OF SALEM BOARD OF HEALTH Establishment Name: I/e �c �i 27c Date: 0, Page: _2 of Item Code- - - C-Critical Item y DESCRIPTION OF.VIOLATION/PLAN OF CORRECTION Date No. " Reference R-Red Item - - 4 Verified r x „ .r ._ . .. 9. PLEASE PRINT CLEARLY J _ . n - n i I r !n e P s _ n C f a 6 -SD \i -1v 7 r d- 'S rr r, c�'nStw Discussion With Person in harge: 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 t noncompliance may result in daily fines of twenty-five dollars or suspension/revocation of 1( ❑ Embargo ❑ Emergency Closure your food permit. / ❑ Voluntary Disposal ❑ Other: — arr PITFs Received Violations Related to Foodborne 11triess interventions and Risk fiv-.cordin.,,to Lae Cowed to Factors(item 1-22) (Cont) 'IF/4S"F Within" Korjrs. 5 0K)IM"Nlethcs&for PHFs PROTECTION FROM CHEMICALS 1=4 Fund- for Additives 19 PHP Hot and Cold Holding 3750TIO(lhr Cold PI-lFr;Maintained at or below -3-2021-2 k(kirtivc,",r 590 Otgff) 1:�;2 14 Protection from Unapproved E3-501,16(A) Iflit IIHF�x1itireamed�lt or above i�- Poisonous or Toxic Substances 140'F. 101AI Identifying labor ination-- Original -,50116(Ar Ra its Held ai i)�, ,lbeye 13011F. 7Y Time as a Public Heafth Control 7-10111 culaillon Name - riellrk�9*collull"I"Irl- i 3-icil it) Thno as a Public Itilidd)C troy 7-20 IA I Se caution L -L— 11 -- ��9��t(IFI Vcriance R turement 7-202.11 Restriction-prescrlco twit U�et � 220LE T)adi;i(�nT of Uso' REQUIREMENTS FOR HIGHLY SUSCEPTIBLE '7-243.11— Toxic Containcil,-Prohibbkrrrsl� POPULATIONS(HSP 204 IT 2 Ti77-s-o TTI -TTnc Irre ri zoll Pr�-pactigod Ances acrd 7-204.1 Chnnicak for Wa�hi gYrodirce)clitolial Recxraes ivith V"'al'uh 7 04,11 tllLfLtl—�I� ±-- Usx lel'Partturized 7-205,11 Incidental Fr�xJ (Aelt�e:t, I.Amfi=as' Raw or Partiall,,C,ruked.Auirnal Fooll aird -206-T-1 --'Fcs!,i,tedL,7, Fle,ticides.Crites ul' m St M Smo A tai Not Set vcd 7 200.12 _Rodent Bolt Stations (C) 7106 1- tracking Prnsdec;,P,,s[('OwTol and CONSUMER ADVISORY F22 -1 3 ZF I i on clF 'nMEITEMPERATURE CONTROLS I �lilwll I K els'fleu urc Raw, Undercooked<;rlb Proper Cooking Temperatures for I , - PHFs Not Othcru ise Poxesse-d it)Irlinintare, 3 401A IA(l)(,-') Fggs- 15S,F 15&c. 30TI 3' ll�i3teliqy-{Ftp:, Sulhsfitutc fol Raw Stillln�mcdiar-e Service 115'Fl 5sec- cornininated Frth,Shex t crarilf, Animals- i5,S`F Is sec SPECIAL REQUIREMENTS 3 403.1 t1,8)(I Poll. and Bet' Puast 1301' 121 ruin' R title, livect, �A)-(D) in 3-40p�wmm-kl)) I C"Ts"fioll v90A09i -,d catering s mobilo toirl,lempori stuf� ruand TA,l 11,A)(3; (L;l,7nike,, ,,,11 1 resident"A-kitchen opciations, shoald be Stuffing Cont-Aming Fish,Meat, debit under the appropriate.sections Po -2TI!ltr I or klltuel,-165°1,fly st a. aboya if rolaiod to foodborne illnost; 3-401.11iCh3) whole ryloi,,Clemtwr3eefsoraks Intel vafdome and risk factors, Other 1451F590.009 violations reltaing to giAxi retail ,J-+41.12 16% Amoral Fixle Ct%iked ma pracficcS should be debited under 1129 - Nliclo�save 16F Special Requirements. 3-401,11(,A)(1)(b) All OtherPHFs - 145`f 15 scc I I I Reheating for Not Holding -VIOLAT16JVS RELATED TO GOOD—RETAIL—PRACTfCES i 5 TI I(A)&{D) PlIF, 165`F 15 see -1 - (Items 23-30) ring wh;vhdoFro n rolat, io iilo 3 403T(B) Mmowtrvc- 1(,5"F 2 Minmw Star; Time, 'foodborne ifinesT illferve'lliurly anti ri-,kfiu tors li vied above can be ii 1--- 7 1-11,8 3-403.11(C) con3wrClattv Proes,�7cd F,I E rood- finind er the frill orung seen ons of Ae Fo,,rl Code aid 105(14R 1-#0'1° .1,90.000, r--- -- "-,- --- -- - --- - ----- ---- 3-40`3 11(F i Remaining Unshced Porulims,or Beef Item Good Retail Practices 23- 1 ML9aqeimint and 3qrcnJ FC -_2 .003 24, T Food and Food Prolr.�tiori FC- 3 00,+ 18 Proper Cooling of PHFs --------- _E plient _q _arg i,�le i�Lb i FC-4 OIA4(A) Cmrhng Corrkd PFIFs hour 14OFF10 A�l ---------- 26 Water Plunubm arld'�Last,� FC-5 .006 70'1 Within 2 Hours and From 701, 27 1 _q_ Physical Facility FC-6 1 007 w 4 I'F'45'F Within 4 Hours, , t,- P000noos or Toxic foat 'ris F�L!7 008 3-501.t4tI3j foalingS is! PHF,,Nhrd��Rwn Ambient 009 Tempetticite to 411-745"F Other Within 4 Ilours Commonwealth of Massachusetts ) • City of Salem Board of Health Kimberley Driscoll 120 Washington Street,4th Floor Mayor SALEM,MA 01970 Food/Retail Establishment Permit DATE PRINTED: 01/07/2008 ESTABLISHMENT NAME: Deleo's Pizza File Number:BHF-2004-000164 28 Norman Street Salem MA 01970 LOCATED AT: 0028 NORMAN STREET SALEM, MA 01970 Permit Type Permit No. Permit Issued Permit Expires Fee Restrictions/Notes FOOD SERVICE BHP-2008-0244 Jan 4,2008 Dec 31,2008 $140.00 ESTABLISHMENT Total Fees: $140.00 PERMIT EXPIRES (December 31, 2008 Board of Health This Permit is not transferable and must be reissued upon change of ownership or location.The permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code,beofre any revonations,improvements,or equipment changes are made,all plans for such must be submitted to and approved by the Salem Board of Health. Page 9 of 25 Y CITY OF SALEM, MASSAC HUSEM BOARD OF HEALTH 120 WASHINGTON STREET,4"'FLOOR TEL. (978)741-1800 KIMBERLEY DRISCOLL FAX(978)745-0343 MAYOR ISCOTrOSALEM.COM JOANNE SCOTT, HEALTH AGENT 2008 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT NAME OF ESTABLISHMENT 0 Lc L cz- 0 '_5 to ( 2 2A TEL# 9-"'90 -rct-O 2 &190 ADDRESS OF ESTABLISHMENT ,1 8 /Yo re ✓t 0 iti 5 7 FAX# MAILING ADDRESS(if different) EMAIL-Business': Website: OWNER'S NAME 7 ©!'7 ( r- 7r Kit ✓/ t 4 TEL# �� 3I 66nl ADDRESS 431Ye, 2711y1Ehv1 SY (/'v`7✓3.9d `l t/71� /Y6o STREET CITY STATE ZIP CERTIFIED FOOD MANAGER'S NAMES) %oi'7 C,,r1 K c( R 62 CERTIFICATE#(S) 3 ST2T>6 (Required in an establishment where potentially hazardous food is prepared) 3 3 5- 3 6 8 S" EMERGENCY RESPONSE PERSON HOME TEL# DAYS OF OPERATION 1 Monday Tuesday Wednesday Thursday Friday Saturday Sunda HOURS OF OPERATION �g Please write in tire of day. N1 - i c9 7 V ! �,_ (0 • / (� - /tl // - /(� // ' /V for example 11 am-11 m TYPE OF ESTABLISHMENT FEE (check only) RETAIL STORE YES NO less than 1000sq.ft. =$70 1000-10,000sq.ft. =$280 more than 10,000sq.ft. =$420 ------------------------ ..... ....---------------------------------- ----t-h- ......---- RESTAURANT E NO less than 25 seats =$140 (Outdoor Stationary Food Cart$210) 25-99 seats =$280 more than 99 seats =$420 BED/BREAKFASTI YES $100 CHILDCARE SERVICES ----------------------------- ---------------------------- ---------- ADDITIONAL PERMITS MAKE (not just serve) ICE CREAM, YOGURT/SOFT SERVE YES $25 TOBACCO VENDOR YES $135 ALL NON-PROFIT(such as church kitchens) YES NO $25 `Please pay total with one check payable to the City of Salem. This Permit is not transferable and must be reissued upon change of ownership.The Permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code, before any renovations, improvements,or equipment changes are made,all plans for such must be submitted to and approved by the Salem Board of Health. Pursuant to MGL Chapter 62C,Section 49A,I certify under the pains and penalties of perjury that I,to my best knowledge and belief,have filed all state tax returns and paid all state taxes required under the law. SIL n -077 Signature Date Social Security or Federal Identification Number -------------- ----------'-------'----- J 7- -q-7-----)--'7-'--------- - ------------------------ Revised 4/24/07 FOODAP2008.adm Checkd&Dare S 10 r`ep�!" ,. r »-.- a>"'+.roi�.��a'�`A�f..,},.3.'�r .,.ed,#.F'�•�tVv.FRAl j1.,I l:^.+iti.w+'rsi. ^r-n..s-K1u..�47n0�A[Y,r}.`J�v ., yS"�+i«*v-!w*f .I'. 'F. +w� Massachusetts Department of Public Health Salem Board of Health 120 Washington Sreet, Division of Food and Drugs Salem, MA 01970-t35234 1h 190(35234'" Floor FOOD ESTABLISHMENT INSPECTION REPORT Tel. (978) 741-1800 Fax (978) 745-0343 Name Dat ' e of O erasion s T e of Ins action ��z° GI's S I Z 0 Food Service outina AddressQ Risk ❑ Retail ElRe-inspection Level ❑ Residential Kitchen Previous Inspection Telephone a �O� ❑ Mobile Date: ❑( Temporary 1 p ❑ Pre-operation ,Owner HACCP YIN� ❑ Caterer El Suspect Illness ` Person in Charge(PIC) Time ❑ Bed& Breakfast ❑ General Complaint In:3 /- E] HACCP Inspector Out:5, / } I Permit No. 1 ❑ 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. r FOo..D PROT EC710N MANAGEMEttr " , ' []f 12. Prevention of Contamination from Hands ❑ 1. PIC Assigned/Knowledgeable/Duties ct -� . ❑ 13 Handwash Facilities `EMPLOYEE HEALTH - s _ .' .s„K_m PROTECTION FROM CHEMICALS ;.' x g ?m°a r u ' `-'; '" yn.+,, .�.- �mna,.'. �3 s,�h�t«,.�u € ,x.t,n ❑ 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 ` ` .TIMERATUREONTROL0t ( C3 6eMlall � 4. Food and Water from Approved d Source ErrEMp t t x t� x � , µ� YH&is!?ardaus Faids)� ❑ 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.-, i °`"- "r "` _' ' °� El 19. Hot and Cold Holding ❑ F8. Separation/Segregation/Protection ❑20.Time As a Public Health Control ❑ 9. Food Contact Surfaces Cleaning and Sanitizing REQUIREMENTS FOR HIGHLY SU§CEwr aLE POPULATIONS(HSP)„ - ❑21. Food and Food Preparation for HSP ❑ 10. Proper Adequate Handwashing "CONSUMER ADVISORY.;. w-,:e:f�,. ».. '` ❑ 11. Good Hygienic Practices - 4 m _-_ ❑22. Posting of Consumer Advisories Violations Related to Good Retail Practices Number of Violated Provisions Related Critical (C) violations marked must be corrected To Foodborne Illnesses Interventions immediately or within 10 days as determined by the Board and Risk Factors(Items 1-22): of Health. Non-critical (N) violations must be corrected Official Order for Correction: Based on an inspection immediately or within 90 days as determined by the Board today, the items checked indicate violations of 105 CMR of Health. 590.000/federal Food Code.This report, when signed below C ` Ni'' by a Board of Health member or its agent constitutes an 23. Management and Personnel (FC-2)(590.003) order of the Board of Health. Failure to correct violations 24. Food and Food Protection (FC-3)(590.004) cited in this report may result in suspension or revocation of 25. Equipment and Utensils (FC-4)(590.005) the food establishment permit and cessation of food 26. Water, Plumbing and'Waste (FC-5)(590.006) establishment operations. If aggrieved by this order, you 27. Physical Facility (FC-6)(590.007) have a right to a hearing. Your request must be in writing 28. Poisonous or Toxic Materials (FC-7)(590.008) and submitted to the Board of Health at the above address 29. Special Requirements (590.009) within 10 days of receipt of this order. 30. Other DATE OF RE-INSPECTION: swans�o� 14.m Inspector's Signature:. \ / Print: - I I PIC'sSignature: Print:' PageC90 -�of ZPages VV r Violations Related to Foodborne Illness Interventions and Risk Factors(items 9-22) PROTECTION FROM CONTAMINATION FOOD PROTECTION MANAGEMENT S Cross-contamination 1 59O.003(A} Assignment of Responsibility* 3-302.11(A)(]) Raw Animal Foods Separated from 590.003(B) Demonstearion of Knowled e"` - Cooked and RTE Foods* F2-103.11 Person in charge--duties �z-----------� Contamination from Raw ingredients 3-302.11(A)(2) Raw Animal Foods Separated from Each EMPLOYEE HEALTH Other* 2 590.003(C) Responsibility of the person in charge to Contamination from the Environment require repotting by foot employees and 3-302.1 I(A) Food Protection* applicants* 3-302.1.5 Washin Fruits and Ve ztables 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* Chargee* Contamination from the Consumer 590.003(0) Re orting b Pzrson in Charge* 3-306.140A)(B) Returned Food and Reservice of Food* 3 590.003(D) Exclusions and Restrictions* Disposition of Adulterated or Contaminated 590.003(E) Removal of Exclusions and Restrictions Food 3-701.11 Discarding or Reconditioning Unsafe FOOD FROM APPROVED SOURCE Food` 4 Food and Water From Regulated Sources 9 Food Contact Surfaces 590.004(A-B) Compliance with Food Law* 4-501.111 Manual Warewashing-Hot Water 3-201.12 Food in a Hermetically Sealed Container* Sanitization Temperatures* 3-201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Warewashing-Hot Water 3-202.13 Shell Eggs* Sanitization Temperatures* 3-202.24 B==s and Mitk Products,Pasteur zed* 4-501.114 Chemical Sanitization-temp_,pH, 3-202.16 Ice Made From Potable Drinking Water" concentration and hardness. lk 5=101.1.1 DrinkingWater from an Approved System* 4-601,11(A) Equipment Food Contact Surfaces and 590.006(A) Bottled Drinking Water* Utensils Clean* ui 590.006(B) Water Meets Standards in 310 CMR 22.0* 4-602.11 Cleaning Frequency q Y ofEquipment F A P She/tllsh and Fish From an Approved Source Contact Surfaces and Utensils* 4-702.11 Frequency of Sanitization of Utensils and 3-201.14 Fish and Recreationally Caught Molluscan Food Contact Surfaces of ni ment* Shellfish* 4-703.11 Methods of Sanitization-HotWaterand 3-201.'15 Molluscan Shellfish from NSSP Listed Chemical* Sources* d0Proper,Adequate Handwashing Reulato Aufhortt Ge and Witt Mushrooms Approved by 2-301.11 Clean Condition-Hands and Arms* uf 3-202.18 Shellstock Identification Present* 2-301.12 Clearing Procedure* 590.004(C) Wild Mushrooms* 2-301.14 When to Wash* 3-201.17 Game Animals* 11 Good Hygienic Practices y Receiving/Condition 2-401.11 Eating,Drinking or Using Tobacco* 3-202.11. PHFs Received at Proper Temperatures* 2401.1.2 Discharges.From the Eyes,Nose and 3-202.1.5 Package hue it=* Mouth* 3-101.11 Food Safe and Unadulterated* 3-301.12 Preventing Contamination When Tastin 6 Tags/Records:Shellstock 12 Prevention of Contamination from Hands 3-202.18 Shellstock Identification* 590.004(E) Preventing Contamination from 3-203.12 Shellstock Identification Maintained'K Em to ces* Tags/Records:Fish Products 13 Handwash Facilities 3-402.11 Parasite Destruction* Conveniently Located and Accessible 3-402.12 Records.Creation and Retention* 5-203.11. Numbers and Capacities* 590.004(J) Labeling of Ingredients' 5-204.11 Lcwation and Placement* � Conformance with Approved Procedures 5-205.11 Accessibility.Operation and Maintenance /HACCP Plans Supplied with Soap and Hand Drying _ 3-502.11 Specialized ProcessingMethods* Devices 3-502.1.2 Reduced oxygen packaging,criteria* 6-301.11 Handwashing Cleanser,Availability 8-103.12 Conformance with Approved Procedures* 6-301.12 Hand D h=Provision -Denote9 truncal item in the federal 1999 Foal Cale or 105 CMR 590.000. { CITY OF SALEM 1 BOARD OF HEALTH F' Establishment Name: 12e (0 1)1-7,7-4 Date: 12 I,�� ,-,� Page: � of Item Code C-Critical Item - . , DESCRIPTION OF VIOLATION/PLAN OF CORRECTION ; .; Date _ - � x �.1 f' _ v r � m �� No Reference R-Red item a Fa k ,. - r r1a crs PLEASE PRINT CLEARLY z n J `- x Verified (d Cts , T � n /'o r 1! 1 S 2raarP (� �. vii GrP ccV( . UG)6 4�r l ` t r v CPra � Discussion With Person in Charge: Corrective Action Required: ❑ No Yes s I have read this report, have had the opportunity to ask questions and agree to correct all ❑ Voluntary Compliance ❑ Employe Restriction Exclusion b violations before the next inspection, to observe all conditions as described, and to ❑ Re-inspection Scheduled ❑ Emergency Suspension t comply with all mandates of the Mass/Federal Food Code. I understand that noncompliance may result in daily fines-of-twenty-five dollars or suspension/revocation of ❑ Embargo ❑ Emergency Closure your food permit. L) /' ❑ Voluntary Disposal ❑ Other: 1,4 t pifFs Recimd at Temperatures Violations Related to Foodborne Illness Interventions and Risk According to Law Cooled In ILII Factors(item 1-22) (Cont) 41'TAYF Within 4 Hows, PROTECTION FROM CHEMICALS 3-501A Cooliw,Mcdlo&for PfIFs F.7- Food or Color Additives Li9— PHF Hot and Gold Holding LY 50!.16(B) Cold PHFs Maintained at or baloa .3-202.12 590 W4(F) 41°/45`T" 3-30114 protection frmoj!2appt d Additives` � 1,3{i:;A;: Hot PHFc Maintained at or above 1 5— Poisonous or Toxic Substances i 46T" 101.11 Identifying Infoluntion--Original I t. I. Rosn�aHeld at or above 130FL oiaauun� 7-102,11 Common Name - Workoe,Coouoner,* Time as a Public Health Control 7=201.13 --,S�� ararom-Sint 3-i0--F'--=TTJLmc,as7a Public 110althConarol------- s9(l.004fld) VnrliLan R 7-20111 Rosh ic6on-Pfe!anee and ll_c� 7-202,12 Condo;ons of kjso* TMI 11 ToXiQ Coin —prolnbhwusa REOUMEMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSPS 1 201.11 SJOitiZecS,Criteria—CIICIIACNW --- -�T 21 1-80 1 11(A) Unparcunxcd Pre-packaged Ji6ces and :2 -Ii—Thouicais forWashiL� Cincria" —7---204.7 t DrArnzAget te.L rntria T tlofl?aqcurind Fc-s if-7-2(-11T7- 7-206.11 Rcs;trided Uw Pesticides,Crrunw� F�75TO I I(D) a, or Fatiiah�Cook,,,dAromal FcsA and FLvy, Sc t Served 7-206.12 Rodent Boa Siauons Ultropened Ftxxf Paclzagc Not Re-,wroe d. 7 206,11 Tracking Pmderq.Pts[Contra!and Monirofh CONSUMER ADVISORY TIMEOEMPERATURE CONTROLS 21 3-00111 mor'Aalaisokv ptea�d folTon";;n0tant of 16 Proper Cooking Temperatures for Ania%A RNA,That art Raw,Undercooked u; PHFSNo! 0fl1tsrw;se to 14,14"Innaw 3 403.1) F.ggs- I 55'F 15 5��c. Padswms.< —L Pers llmrate S lVill,l5sec 3("2 11 P",der 'nrucd Fgi,:-Subsiihat for Raw She'! 1,`i 'ZI wmq) Comminuted Fish, Meats& Cizin Aniumis 154T 15 sec- * SPECIAL REQUIREMENTS 3 3-401.11(B)d)(27 PoA and Beef Roast 1301121 min* catering, mobile t'(x)d,teen y acid violaticins of Section .590.(-A)9(A)-(D) in 3-401.11(A)(2) Rautclnliecl�Al Meats 155'F 15 3-401.24(A)(3) Poultrp,Wild Garne.'Suirled Plik, residefdtal kitchen operations should be So4fing('01taining Fish, Meat, i debited under the appropriate se.ci[011s 22yltrx or Ratizos-165'1 15 sec. above if related to feodhorne illness whole-musde,Intact lie'Steaks interventions and dsl, factins Other 14J1, 590.009 violations reladrig, to 0001 retail 31x01.12 Raw Annual Foixls C(xilecd in a Practices should be debited under#29 - Microwave 165'F* Special Requirements, 1401,11(Al(l)tb) ,M1 Othei RHFs - I w5°F 15 sec. L? Reheating for Hot Holding VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 3-iO3,11(A)&{}3} PFIFs 165'T 15 wc. (Items 23-30) 2403.11(5} 4Qtcowirvc- 165-F 2 fvlufu',e Slandin Crn�wl apid nor-crifirai v Iaiwn,�,which do not relan,io the 1-Inne'- jnodhorne ifl�wss bo0Ver1:0W0nd rc�kjactors lisnut ahuvecon be -7 Comarterci N pnucess'�j R1 finwd in ojMv food Code and)05 CMR T4 I- I ,90.000. ;1(11111 L11-_71 - -- -5 3-403,11(E) Remaining Unsitced Portions of Beef Him—T Goo-d-fi-&-m-11-P-rac-tices Roast * 23, —1 tAa-n,.- FC 2 i 003- Spment and Personnel T- FC .004 Proper Cooling of PHFs FC-4 005 Confine Cooked PKF� from 140'F t 26, 'Na,re IFC a _ 70'F Within 2 Hours and From 70'1' i FC ZG�-.007 In 41'F/45'F Within 4 Horns. 2T P�oisotvajs or Toxic IvIlass4s" Lr:s:,-7 '608 3-501.24{5) Cooling PHFs Made From Ambient 29 Tcraperaurre latuedients to 41'F/45'F 10, Other With'n 4 Hours 'Detwies critical aert)in iha leita"11 1999 Foml Oxie or 165(MR 591)UtA 0028 Norman Street Deleo's Pizza City of Salem FOOD SERVICE ESTABLISHMENT - FOOD SERVICE Inspection HACCP: ❑ Item Status Violation Critical Urgency Telephone: Violations Related to Good Retail Practices (Blue Items) 740-2800 Equipment and Utensils FAIL BLUE Owner: Comment: Small white freezer requires general cleaning. Tomi Gjikuria PIC: Can opener requires general cleaning. Owner states he is discarding it. Tomi Gjikuria Pizza refrigerator requires general cleaning with emphasis on door gaskets. Inspector: John Gehan Meat slicer requires general cleaning. Date Inspected:Correct By: Physical Facility FAIL BLUE 4/25/2007 Comment:Any water stained ceiling tiles must be replaced by next routine inspection. Risk Level: Permit.Number: BHP-2007-0308 Status: SIGNED OFF #of Critical Violations: 0 Time IN: Time OUT: Urgency Description(s): BLUE: Violations Related to Good Retail Practices (Critical violations must be corrected immediately or within 10 days)(Non-critical violations must be corrected immediately or within 90 days) City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741.1800 GeoTMS®2007 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Apr 25,2007 ) Page I oft Item Status Violation Critical Urgency RED: Violations Related to Foodborne Illness Interventions and Risk Factors (Require immediate corrective action) City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741-1800 GeoTMS®2007 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Apr 25,2007 ) Page 2 oft COURT DOCKET NO. CITATION NO. CITY OF SALEM VIOLATION NOTICE P® 6 0 4 2 NAME(LAST,FIRST,INITIAL) /♦I STREET DRESS CITY/TOWN STATE ZIP ,r /�' LICENSE NO. i LIC.EXP.DATE DATE OF BIRTH OWNER'S NAME(LAST,FIRST,INITIAL STREETADDRESS CITY/TOWN STATE ZIP REGISTRATIOWNO. STATE I EXP,DATE MAKE/TYPE YEAR COLOR DATE OF VIOLATION TIME DATE CITATION WRITTEN PERSONAL ❑AM INJURY ❑PM ❑VES ❑NO LOCATION OF VIOLATION ,� �LZL EN ORCING DEPT. OFFENSE / l CHAP. SECT FINES Apo B ,37Yc 6n;gr� D OFFICER i 7 p LD.NO. TOTAL .VjF)'7"'j FINE DUE g2;�� OFFICER CERTIFIES COPY GIVEN TO VIOLATOR [:1IN HAND �BY MAIL aj IDO NOT MAIL CASH-PAY ONLY BY POSTAL NOTE,MONEY ORDER OR BY CHECK MADE PAYABLE TO: CITY CLERK CITY HALL 93 WASHINGTON STREET SALEM,MA 01970 TEL.(508)745-9595 X 251 1 HEREBY ELECT TO EXERCISE THE FIRST OPTION AS STATED ON REVERSE, CONFESS TO THE OFFENSE CHARGED,AND ENCLOSE PAYMENT IN THE AMOUNT OF $ CASE N SIGNATURE SEE OTHER SIDE FOR FURTHER INFORMATION ENCLOSE PAYMENT IN THIS ENVELOPE,PEEL AND SEAL ` WORM {Vf + ,:'u o^ . ,,, y,.[,g.� 0 r(<,D w ,: TSE' c.p-3"E r may'xw ry s° 'f X '` -': .r"<' r As.'cF +✓F",�+' 11 ,.r} 'Y'Sc -. o w 1�E�1�0-'C � t ]{ vM1`:��,cw'sjy�,w•Ss �hts %;:s� � r s � I icw w• r f�-.-.s�,4��- ' , COURTDOCKETNO <-T "r,AW4C 5'!S'tA 'CR ON NO}�x a CITY OF SALEM- -p ALEM p meg" «ter r: S" h, r�xa VIOLATION NOT10EfY � -L;,:+ NAME MSF FlRSsr WRUOJ gKO '� E 9 1 s �` F ` `" _' ' "�•'%4" t7Ct ...z, Q4o"I - F lt$i# #rl lel �i*•-1 F " t gl #�� DRESS ,- CITY/TOWN STATE / .I I LICENSE NO. X TE DATE OF BIRTH to ER'S NA/ME(LAST,FIRST,INITIAL) O m 9J car)q 6 L 0 CT 9 NN ET DO SS CITY WN STAT P .. REGISTRATIO NO. STATE EXP.DATE I MAKEfr0E EAR COLOR DATE OF VIOLATION TIME DATE CITATION WRITTEN PER.. IMURY �• v\ (� -+p PM OYES \ ❑No a $ LOCATION OF VIO TION ICING D PT. _2g 'dot- W OFFENSE// CRAP. SECT. FINES 0 /(11�.jo wQ l� e/AI .0 B O c 07 V/E�(/��Ct/R 9d F1J `T �(-R l' l: I.D.NO. TpNEL DUE bFI CERTIFIES COPY GIVEN TO VIOLATOR 61Jm //� ❑ IN HAND r o x X �j / , 7�,.�1 I' m \. V MAIL i 133 z 'DO NOT MAIL CASH-PAY ONLY BY POSTAL NOTE,MONEY j t. O y ORDER OR BY CHECK MADE PAYABLE TO: I- !I zz CITY CLERK I = I CITY HALL 93 WASHINGTON STREET SALEM,MA 01970 TEL.(508)745-9595 X 251 HEREBY ELECT TO EXERCISE THE FIRST OPTION AS STATED ON REVERSE, CONFESS TO THE OFFENSE CHARGED,AND ENCLOSE I PAYMENT IN THE AMOUNT OF O 3 1 0 O $ CASE N zo r c z C� mp Dy n x U1 SIGNATURE �. c- SEE OTHER SIDE FOR FURTHER INFORMATION ',. 4A ENCLOSE PAYMENT IN THIS ENVELOPE,PEEL AND SEAL r \ rn vu Q Om 1p N Sla o Ii �.� c� N p O o OD i x We niiT {monwealth ofMassachusetts v^s�.{ q .*G "^ Z, Salem t P w; ' - ` !� k Board of Health ICmb6dey Dnsooll .' 120 Washington Street;4th Floor' ; Mayor .-7 SALEM,MA 01970 Food/Retail Establishment Permit DATE PRINTED: 01/04/2007 ESTABLISHMENT NAME: Deleo's Pizza File Number:BHF-2004-000164 28 Norman Street Salem MA 01970 LOCATED AT: 0028 NORMAN STREET SALEM, MA 01970 Permit Type Permit No. Permit Issued Permit Expires Fee Restrictions/Notes FOODSERVICE BHP-2007-0308 Jan 4,2007 Dec 31,2007 $100.00 ESTABLISHMENT Total Fees: $100.00 PERMIT EXPIRES 'December 31, 2007 Board of Health _ >r� This Permit is not transferable and must be reissued upon change of ownership or location.The permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code, beofre any revonations,improvements,or equipment changes are made,all plans for such must be submitted to and approved by the Salem Board of Health. Page 3 of 3 CITY OF SALEM, MASSACHUSETTS • BOARD OF HEALTH 120 WASHINGTON STREET, 4TH FLOOR I SALEM, MA 01970 TEL. 978-741-1800 FAx 978-745-0343 Kimberley Driscoll WWW.SALEM.COM Mayor JOANNE SCOTT, MPH, RS, CHO HEALTH AGENT 2007 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT NAME OF ESTABLISHMENT L. 6 0 S � t*� 2 �� TEL# Y f ff �7Q 0 Z 8 0 o 2. �L ADDRESS OF ESTABLISHMENT P / LJ` K, v`2.47Y S FAX# x d ree d jK"Z MAILING ADDRESS(if different) _ EIMAIL--Business': Owner's_ OWNER'S NAME To 6YIleatf2 t P TEL# ADDRESS 673 1Y0r1T1'11-_-t`tD St Af0t301) `.1 1*74 0/? �'O STREET CITY STATE ZIP CERTIFIED FOOD MANAGER'S NAME($) f Ut`7 { Cz J, (Cc i Yt t CERTIFICATE#(S) (Required in an establishment where potentially hazardous food is prepared) EMERGENCY RESPONSE PERSON t- C9/ / C y tG1Ltf} HOME TEL# OAYSOFOPERATION MondayTuesday Wednesday Thursday Friday� Saturday Sunday HOURS Of OPERATION Please 1 Please write In time of day. ` to T It 1`0 tt - t O T l( - to It - t O ffor example Ilam-110m) l TYPE OF ESTABLISHMENT FEE (check only) RETAIL STORE YES NO less than 1000sq.ft. =$ 50 1000-10,000sq.ft. =$100 more than 10,000sq.ft. =$250 _.. ....._...- _ ----------- --_--- --- ._- ---- -- ---------- --... --...._-...---....._..... .._.-...---- RESTAURANT Y NO less than 25 seats $1U0 25-99 seats =$150 more than 99 seats =$200 ..._......_... .... - -- NO___--- --..- ----- - .. - .. ..- - ........ ...... - .................. - BEDIBREAKFAST YES $100_ --_ ----- ----- - .-,.. ...-- ---------.....................- ................... ......._ .....-..... ......-..... ADDITIONAL PERMITS MAKE (not just serve) ICE CREAM, YOGURT, SOFT SERVE YES NO $5 TOBACCO VENDOR YES NO $50 ALL NON-PROFIT(such as church kitchens) YES NO $25 `Please pay total with one check payable to the City of Salem. This Permit is not transferable and must be reissued upon change of ownership. The Permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code, before any renovations, improvements, or equipment changes are made, all plans for such must be submitted to and approved by the Salem Board of Health. Pursuant to MGL Chapter 62C, Section 49A, I certify under the pains and penalties of perjury that I, to my best knowledge and belief, have filed all state tax returns and paid all state taxes required under the law. GL�CCAc Signature Date —Social Security or Federal Identification Number ------------- -- ------------- ----- --------- ------------ ------- ------------------------------ ----------- ------------- ---------- --------- ------- Revised 11/13/06 FOODAP2007.adm Check#&Date _ 0028 Norman Street Deleo's Pizza City of Salem FOOD SERVICE ESTABLISHMENT - FOOD SERVICE Inspection HACCP: ❑ Item Status Violation Critical Urgency Telephone: PROTECTION FROM CONTAMINATION 740-2800 Food Contact Surfaces Cleaning and Sanitizing FAIL Critical RED Owner: Comment:Cutting boards resting on trash cans. Store in proper designated area. Tom! Gjikuria PIC: Sanitizer reading too strong. Adjust sanitizer to proper ppm. Tom! Gjikuria Handwash Facilities FAIL RED Inspector: John Gehan Comment: No paper towels in dispenser. Provide paper towels. Date Inspected:Correct By: 10/30/2006 Violations Related to Good Retail Practices (Blue Items) Risk Level: Equipment and Utensils FAIL BLUE Comment: General cleaning of pizza refrigerator. }Permit Number: General cleaning of sandwich refrigerator. BHP-2006-0052 Status: SIGNED OFF #of Critical Violations: 2 Time IN: Time OUT: Urgency Description(s): BLUE: Violations Related to Good Retail Practices (Critical violations must be corrected immediately or within 10 days)(Non-critical violations must be corrected immediately or within 90 days) City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741-1800 GeoTMS®2006 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Oct 30,2006 ) Page I oft Item Status Violation Critical Urgency RED: Violations Related to Foodborne Illness Interventions and Risk Factors (Require immediate corrective action) City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741-1800 GeoTMS®2006 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Oct 30,2006 ) Page 2 oft Massachusetts bepartment-of Public ;!Health Salem Board of Health Division Of Food and Drugs '120 Washington Street,41h Floor 9 Salem, MA 01970-3523 FOOD ESTABLISHMENT INSPECTION REPORT Tel. (978) 741-1800 Fax(978) 745-0343 Name Date Type of Operation(s) it of Inspection 61-Food Service ❑ Routine Address IRisk ❑ Retail ©Re-inspection Level ❑ Residential Kitchen Previous Inspection Telephone ❑ Mobile Date:G/(fir,, Owner HACCP YM ElTemporary ElPre-operation ❑ Caterer ❑ Suspect Illness Person in Charge(PIC) j Time ❑ Bed&Breakfast ❑ General Complaint In: 11, ❑ HACCP Inspector allOut: / Permit No. ❑Other Each violation-checkdd 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 N 1,FOOD PROTECTION MANAGEMENT ," ,4,a �.„:s ,. .,, El12. Prevention of Contamination from Hands ❑ 1 PIC Assigned/Knowledgeable/Duties El `(Af 6 l V� l 13. Handwash Facilities f EMPLOYEE HEALTH "°'� 4 �a I �, Food s « ._ F,,.•s E ai i'PROTECTIGN FROM CHEMICALS` E] 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 SQyRCE m,X��,.,,,.,5,,, El 4. Food and Water from Approved Source "71ME/TEMPERATUREOONTROLS{PotenUaily Hazardous Foods) - �' xu ❑ 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'-,--- "'�' i IW ( El19. Hot and Cold Holding ❑ S. Separation/Segregation/Protection ❑ 20.Time As a Public Health Control ❑ 9. Food Contact Surfaces Cleaning and Sanitizing j,REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULAT10NS(HSP)„ ❑21. Food and Food Preparation for HSP ❑ 10. Proper Adequate Handwashing t`CONSUMEH'ADYISORY w .. s -G; 3 ❑ 11. Good Hygienic Practices - ❑22. Posting of Consumer Advisories Violations Related to Good Retail Practices Number of Violated Provisions Related Critical (C)violations marked must be corrected To Foodborne Illnesses Interventions immediately or within 10 days as determined by the Board and Risk Factors(Items 1-22): of Health. Non-critical (N)violations must be corrected Official Order for Correction: Based on an inspection immediately or within 90 days as determined by the Board today, the items checked indicate violations of 105 CMR of Health. 590.000/federal Food Code. This report, when signed below + " 'N"'; by a Board of Health member or its agent constitutes an 23. Management and Personnel (FC-2)(590.0 order of the Board of Health. Failure to correct violations 24. Food and Food Protection (Fc-3)(590.0054)) cited in this report may result in suspension or revocation of 25. Equipment and Utensils (Fc-5)(550.005) 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: ss9orusPecrForm&ie.doc Inspector's Signature: I Print: PIC's Signature: I' ���a� Prink D dL t Z K ! Page of ages Violations Related to Foodborne illness Interventions and Risk Factors(items 1-22) PROTECTION FROM CONTAMINATION FOOD PROTECTION MANAGEMENT 8 Cross-contamination 1 590.003(A) Assign ent of Responsibility* 3-302.11(A)(1.) Raw Animal Foods Separated from 590.003(B) Demonstration of Knowledge*. Cooked and RTE Foods* 2-103.11 Person in charge-duties Contamination from Raw Ingredients 3-3021.1(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 repotting by food employees and 3-302.11(A) Food Protection* applicants* 3-302.15 WashingFruits and Veetables 590.003(F) Responsibility Of A Fool Employee Or An 3-304.11 Food Contact with Equipment and Applicant To Report To The Person In Utensils* Char c* Contamination from the Consumer 590.003(0) Reporting by Person in Charge* 3-306.14(A)(B) Returned Food and Reservice of Food* 3 590.003(D) Exclusions and Restrictions* Disposition of Adulterated or Contaminated 590.003(E) Removal of Exclusions and Restrictions Food 3-701.1.1 Discarding or Reconditioning Unsafe FOOD FROM APPROVED SOURCE Food* q 1 Food and Water From Regulated Sources 9 Food Contact Surfaces 590.004(A-B) Compliance with Food Law* 4-501111 Manual Warewashing-Hot Water 3-201.12 Fax)in a Hermetically Scaled Container* Sanitization Tem eratmes� - 3-20113 Fluid Milk and Milk Products* 4-501.112 Mechanical Warewashing-Hot Water 3-202.13 Shell Eggs* SatritizationTem eratures* 3-202.14 E >s and Milk Products.Pasteurized* 4-501.114 Chemical Sanitization-temp.,pH, 3-202.16 Ice Made From Potable Drinking Water* concentration and hardness. " 5401.11 Dr skin Water from an Approved System* 4-601.11(A) Equipment Food Contact Surfaces'and 590.006(A) Bottled DrinkingWater* Utensils Clean* 590.006(B) Water Meets Standards in 31.0 CMR 22.0* 4-602.11 Cleaning Frequency of Equipment Fwd- Shelttlsh and Fish From an Approved Source Contact Surfaces and Utensils* 4702.11. Frequency of Sanitization of Utensils and 3-201.14 Fish and Recreationally Caught Molluscan Food Contact Surfaces of Equipment* Shellfish* 4-703.11 Methods of Sanitization-Hot Water and 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* Sources* 10 Re MatoAuthorlt Proper,Adequate Handwashing Game and Mushrooms Approved by 2-301.11 Clean Condition-Hands and Arms* Aut 3-202.18 Shellstock Identification Present* 2-301..1.2 Cleaning Procedure* 590.004(C) Wild Mushrooms* 2-301.14 When to Wash* 3-201.17 Came Animals* 11 Good Hygienic Practices 5 Receiving/Condition 2-401.11 Eating,Drinking or Using Tobacco* 3-202.11 PHFs Received at Proper Temperatures* 2-401.12 Discharges From the Eyes,Nose and 3-202.1.5 Package Inti it * Mouth* 3-101.11 Fwd Safe and Unadulterated* 3-30112 Preventin Contautination When Tasting* fi Tags/Records:Shellstock 1.2 Prevention of Contamination from Hands 3-202.18 Shellstock Identification* 590.004(E) Preventing Contamination from 3-203.12 Shellstock Identification Maintained* Employees* Tags/Records: Fish Products 13 Handwash Facilities 3-402.11 Parasite Destruction* Conveniently Located and Accessible 3-402.12 Records.Creation and Retention* 5-203.11 Numbers and Capacities* 590D04(J) Labeling of Ingredients' 5-204.11 Location and Placement* 7 Conformance with Approved Procedures 5-205.11 Accessibility,Operation and Maintenance /HACCP Plans Supplied with Soap and Hand Drying 3-502.11 Specialized Processing Methods* Devices 3-502.12 Reduced oxygen packaging.criteria* 6-301.11. Handwashin Cleanser,Availability 8-103.12 Conformance with Approved Procedures* 6-301.12 Hand Drying Provision Denotes critical Item in the federal 1999 Food Code or 105 CNIR 590.000. - Massachusetts Department off ,Publi_c,Heclth Salem Board of Health Division of Food and Drugs $120 Washington Street,4'" Floor 9 Salem, MA 01970-3523 FOOD ESTABLISHMENT INSPECTION REPORT Tel. (978) 741-1800 Fax (978) 745-0343 Name Date I Tvpa of 0 eration(s) Type of inspection 06 Mood Service �] Routine Address Risk ❑ Retail [ Re-inspection Level ❑ Residential Kitchen Previous Inspection Telephone J �Q ' El Mobile Date: ) ,,� 1t3/Q Owner HACCP YIN El ElPre-dperatlon 'I ❑ Caterer ❑ Suspect Illness Person in Charge(PIC) Time i ❑ Bed&Breakfast ❑ General Complaint In: 'f'(5 ❑ HACCP Inspector Out: L 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) ❑ 599.009(F) ❑ action as determined by the Board of Health. FOOD PROTECTION MANAGEMENT Z__1_1__..'1­1x. r _a ,„-�-i� ❑ 12. Prevention of Contamination from Hands ❑ 1. PIC Assigned/Knowledgeable/Duties �� � � ,µ r . _ ❑ 13 Handwash Facilities EMPLOYEE HEALTH ,. 7'PROTECTIO4FR6M CHEMIQAIS ew 3 "� ` si r [12. Reporting of Diseases by Food Employee and PIC t Approved Food Color Additives ❑ 14.Approved Food or Color Additives ❑ 3. Personnel with Infections Restricted/Excluded ❑ 15.Toxic Chemicals `.FOOD FROM APPROVED SOURCEpk�."" `"""�w� „-.nMEfrEMPERATURE EONTAOLS(Polentlally Hazardous Fopds)`°'""':°: [:14. Food and Water from Approved Source R -d ba q mA ❑ 5. Receiving/Condition ❑ 16. Cooking Temperatures ❑ 6. Tags/Records/Accuracy of Ingredient Statements ❑ 17. Reheating ❑ 7. Conformance with Approved Procedures/HACCP Plans [118.Cooling )"PROTECTION FROM CONTAMINATION'"', '��'t "`�"s" '""""'� ❑ 19. Hot and Cold Holding l ❑ 8. Separation/Segregation/Protection ❑20.Time As a Public Health Control 9. Food Contact Surfaces Cleaning and Sanitizing ;REQUIREMENTS FOR HIGHLY SUSCEPTIBLEPOPULATIONS(HSP)7 ❑21. Food and Food Preparation for HSP ❑ 10. Proper Adequate Handwashing CONSUMEflADVISORY=' ��.. "' Ay ,„„"� T4 ay a " ❑ 11. Good Hygienic Practices " E122. Posting of Consumer Advisones'� Violations Related to Good Retail Practices Number of Violated Provisions Related Critical (C)violations marked must be corrected To Foodborne Illnesses Interventions immediately or within 10 days as determined by the Board and Risk Factors(Items 1-22): of Health. Non-critical (N)violations must be corrected Official Order for Correction: Based on an inspection immediately or within 90 days as determined by the Board today, the items checked indicate violations of 105 CMR of Health. 590.000/federal Food Code. This report, when signed below C N" by a Board of Health member or its agent constitutes an 23. Management and Personnel (FC-2)(590.0 order of the Board of Health. Failure to correct violations 24. Food and Food Protection (FC-3)(590.0044)) cited in this report may result in suspension or revocation of _25. Equipment and Utensils (FC-4)(590.005) the food establishment permit and cessation of food 26. Water, Plumbing and Waste (FC-5)(590.006) establishment operations. If aggrieved by this order, you 27. Physical Facility (FC-6)(590.007) have a right to a hearing. Your request must be in writing 28. Poisonous or Toxic Materials (FC-7)(590.008) and submitted to the Board of Health at the above address 29. Special Requirements (590.009) within 10 days of receipt of this order. 30. Other DATE OF RE-INSPECTION: S,50i Vs fFom 14.d Inspector's Signature: Print: PIC's Signature: ,�/] Print: r Pagett-of ') Pages �l c!�--1 -, I,�J �y Violations Related to Foodborne illness Interventions and Risk Factors(items 1-22) PROTECTION FROM CONTAMINATION FOOD PROTECTION MANAGEMENT g Cross-contaminator , 1 1 590.003(A) Assignment of Responsibility* 3-302.11(A)(1) Raw Animal Foods Separated from 590.003(B) Demonstration of Knowledge* - Cooked and RTE Foods* 2-103.11 Person in charge-duties Contamination from Raw Ingredients - 3-302.11(A)(2) Raw Animal Foods Separated from Each EMPLOYEE HEALTH Other* 2 590.003(C) Responsibility of the person in charge to Contamination from the Environment require reporting by food employees and 3-302.11(A) Food Protection* applicants* 3-302.15 -Washing Fruits and Vegetables 590.003(F) Responsibility Of A Food Employee Or An 3-3(A.I 1 Food Contact with Equipment and Applicant To Report To The Person In Utensils* Charge* Contamination from the Consumer 590,003(G) Reportin 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 Food* 4 Food and Water From Regulated Sources 9 Food Contact Surfaces 590.004(A-B) Compliance with Food Law* 4-501.1.11. Manual Warewashing-Hot Water 3-201.12 Food in a Hertnetiealty Sealed Container* Sanifization'rem eratures" 3-20113 Fluid Milk and Milk Products* 4-501.112 Mechanical Warewashing-Hot Water 3-202.13 Shell Eggs* Sanitization Temperamres* 3-202.14 Eggs and Milk Products.Pasteurized* 4-501.114 Chemical Sanitization-temp., pH, 3-202.16 Ice Made From Potable Drinking Water* concentration and hardness. '" 5-10111 Drinking Water from an Approved roved S stem* 4-601.1[(A) Equipment Food Contact Surfaces and 590.006(A) Bottled Drinking Water* Utensils Clean* 590.006(B) Water Meets Standards in 310 CMR 22.0* 4-602.11 Cleaning Frequency of Equipment Food- Contact Surfaces and Utensils* Shellfish and Fish Froman Approved Source 4-70211 Frequency of Sanitization of Utensils and . 3-201.14 Fish and Recreationally Caught Molluscan Food Contact Surfaces of Equipment* Shellfish* 4-703.11 Methods of Sanitization-Hot Water and 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* Sources* 10 Proper,Adequate Handwashing Game and Wild Mushrooms Approved by Regulatory Authorityren2-301.11 Clean Condition-Hands and As'` 3-202.18 Shellstock Identification Present* 2-301.12 Cleaning Procedure* 590.004(C) Wild Mushrooms* 2-301.14 When to Wash* 3-201.17 Game Animals* 11 Good Hygienic Practices 1 ReceivinglCondition 2-401..11 Eating,Drinking or Using Tobacco* 3-202.11. PHFs Received at Proper Temperatures* 2401.12 Discharges From the Eyes, Nose and 3-202.15 Package Integrity* Mouth* 3-101.11 Food Safe and Unadulterated* 3-301.12 Preventing,Contamination When Tasting* Tags/Records:Shellstock 12 Prevention of Contamination from Hands 3-202.18 Shellstock Identification* 590.004(F) Preventing Contamination from 3-203.12 Shellstock Identification Maintained* Em to ees* Tags/Records:Fish Products 13 Handwash Facilities 3-402.11. Parasite Dcstruction' 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 AccessibilitL,Operation and Maintenance 7HACCP Pians Supplied with Soap and Hand Drying 3-502.11 Specialized Processing Methods* Devices 3-502.12 Reduced oxygen packindna.criteria* 6 301.11 Handwashin Cleanser,Availability 8-103.12 Conformance with A. zrovedProcedures* 6-301..1.2 HandDrvin Provision *Denotes critical item in the Weral 1999 Foxxl Code or 105 CMR 590.000. - CITY OF SALEM BOARD OF HEALTH Establishment Name: I l Date: Page: PZ of a Rem Code C-Critical item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION te Verified Da No. Reference R—Red Item ' PLEASEPRINT CLEARLY r�t i� tu k In L;l r)D nCk1 Y USE M �)vt, rK r t . l( RU q ,.T dL 'r Discussion With Person in Charge: Corrective Action Required: ❑ No es I have read this report, have had the opportunity to ask questions and agree to correct all ❑ Voluntary Compliance ❑ Employee Restriction/ Exclusion violations before the next inspection, to observe all conditions as described, and to 121c Re-inspection Scheduled ❑ Emergency Suspension comply with all mandates of the Mass/Federal Food Code. Fl understand that '+ 't noncompliance may result in daily fines of twenty-five dollars or suspension/revocation 'of ❑ Embargo ❑ Emergency.Closure i your food permit. cccC'4y ❑ Voluntary Disposal ❑ Other: 14P 3-501.14(C) FKTTJ-tece"dot I claperatures Violations Related to Foodborne fitness Interventions and Risk According to Law Cooled to Factors(Items 1-22) (Cont) 4 t'F/45'F Within 4 Hours. PROTECTION FROM CHEMICALS 3-501.15 -Cooling Methods for PtttS F-14 Food or Color Additives P19 PHF Hot and Cold Holding 3-501.168) Cold PJIFs Maintained at or below 3-2022 12 Additivcs�� 590.004(F) 410/45'F� 3-3(Y1.14 Protection from Ul - F 3-501.1 6( Maintained PI-lFs Maurined at or above15 -Poisonous or Toxic Substances ,A') 14WR 7-101.11 Identifying Information-Original 3-501.16(A) Roasts field at or above 130'F. Containers" 20 Time as a Public Health Control- 7-102,11 Common Name< Working Containers, 7-201.1 I 9e-.station-Storage*` 3-501.19 Time as a Public HathC6ruroP, 5,0 590,004tH) 7-202.11 Restriction-Presence and Use, 7-202.12- Conditions of Use* REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-203.11 'Foxic Containers- Prohibi Lions* 7-204.11 Samuzen,Criteria - Chenlicalilw POPULATIONS(HSP) .1 I(A) Unpasteurized P rc-packaged Juices air -20 - I with Waltri 7-204J2 Chemicals for Washing Produce,Criteria 21 1d 7-2 4 I� -2!h"-'& Criteria* Beverages wid', ng I abols' 7-205.11 Incidental Food Contact, Lubricants* 3-801..11(11) Use of Pasteu� 7-206.11 Restricted U'Se Pesticides. Criteria(* 3-801.1 I(D) Raw or Partially Cooked Annual Food and 7-206.12 Rodent Bait Stations* - Raw Seed.SProuts Not Served. Tracking Powders,Pest Control and 3-801.1 1(C) Umo erred Faxi Parka re Not Re-served, 7-206.13 CONSUMER ADVISORY TIMErrEMPERATURE CONTROLS 22 3-603.11 Consumer Acbisory Posted for Consumption of 16 Proper Cooking Temperatures for Aninial Foods That are Raw. Undercooked or PHFs Not Otherwise Processed to Eliminate 3-401.1.1 A(1)(2) Eggs- 155'F 15 Sec. - pinho"ens * EELLIntmediate Service 145°F15sec* 3302.13 Pasteurized Eggs Substitute for Paw Shell 3-001.11(A)(2) Comminuted Fish, Meats &-Came Eggs* Animals- I i5'F 15 see. * - SPECIAL REQUIREMENTS 3-401.1 Pork and Beef Roast - 130�'F 121 rain* 3-401.11(A)(2) Rattles, 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 12ultr�or Barites-165'F IS sec. x� above if related to foodborne illness 3-401.1 NC)(3) Whole muscle, Intact Hocl,Steaks Interventions and risk factors, Other 145°F* - 590.009 violations relatingto good retail 3-401.12 Raw Animal Foods Cooked in a practices should be debited ander#29 Microwave 165'F Special Requirements. 3-401A I(A)(1)(b) All Other PEFF's-- 145'F 15 see, rL17 --Reheating for Hot Holding VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 3 403.11(A)&(I)) PHFs 165'F 15 sec, (items 23-30) 3-403.11(B) Microwave- 165'F 2 Minute Standing, Ciincal and non-critical violations, which do not relate to the Time* foodborne citnucs inteivenhons and fiskjoctors listed above, can be 3-403.11(C) Commercially Processed RTE Fund- found in the following sections of the Food Code and 125 CMR 14W F" 590.000. - 3-10111(E) Reautinhu,Unsheed Portions of Beef -Item Good Retail Practices _ FC 590.OA0 Roasts' 23. Marra anent and Personnei FC-2 .003 r1S Proper Cooling of PHF5- 24, Food and Food Protection FC-3 004 3--501.14(A) Eclat FC-4 '005 ------------ Cool Cooling Cooked PHFs from 140°F to 26. Water, P FC�-5 W6-- 70'F Within 2 flours and From 70'F 2-7, Physical Facility__-- FC--6 1 .007 to 41'F,45'F Within 4 Hours. T 28, Poisonous or Toxic Materials FC-7 .008 -7 3-501 14(B) Cooling P1 lFs Made Front Ambient 29-, S eciai Re uirements .009 Temperature Ingredients,to 41'1',/45'F _39, Other I Within 4 Hours* Denotes critical item in the.iodem 1 1999 Food Code or 105 CMR 590,000. ' .. ., .�.o ...'�. r^ft .:.U.^-�.._.�'.. ...o-t.♦:a,r•-4 . � r ' . �'•.w . -- ,...^....,, . r...r. a Massachusetts Department of Public Health Salem Board of Health 120 Washington Street,0 Floor Division of Food and Drugs Salem, MA 01970-3523' FOOD ESTABLISHMENT INSPECTION REPORT Tel. (978) 741-1800 Fax (978) 745-0343 Name ' n Date �000Orvion(s) Tvoe of Insoection Jos- Routine Address �� Risk ❑ Retail [7J Re-inspection 1 Level ElResidential Kitchen Previous Inspection Telephone � El Date: Ownery HACCP Y/N ❑❑ Temporary mpo Caterer ary ❑ Pre-operation ❑ Suspect Illness Person in Charge(PIC) Time ❑ Bed& Breakfast ❑ General Complaint " In. El HACCP Inspector h-� Permit No. El Other z � Out:) ��J Each violation checked requires an explanation on the narrative page(s)and a citation of specific provision(s)violated. Non-compliance with: Violations Related to Foodborne Illness Interventions and Risk Factors Anti-Choking Tobacco Violations marked may pose an imminent health hazard and require immediate corrective 590.009(E) [_1 590.009(F) ❑ action as determined by the Board of Health. FOOD PROTECTION MANAGEMENT n y ' �;, ❑ 12. Prevention of Contamination from Hands ❑ 1. PIC Assigned/Knowledgeable/Duties - `- - T ❑ 13. Handwash Facilities EMPLOYEE HEALTH PROTECTION FROM CHEMICALS' ❑ 2. Reporting of Diseases by Food Employee and PIC k A t"a .- El3. Personnel with Infections Restricted/Excluded ❑ 14. Approved Food or Color Additives „FOOD FROM APPROVED SOURCE _ ' E] 15.Toxic Chemicals - M '� `TIELTEMPERATURE CONTROLS P `- ❑ 4. Food and Water from Approved Source ( otentially Hazardous Foods) " ❑ 5. Receiving/Condition ❑ 16.Cooking Temperatures ❑ 6. Tags/Records/Accuracy of Ingredient Statements ❑ 17. Reheating ❑ 7. Conformance with Approved Procedures/HACCP Plans ❑ 18. Cooling PROTECTION FROM CONTAMINATION : :; `" ❑ 19. Hot and Cold Holding ❑ 8. Separation/Segregation/Protection _ ❑20.Time As a Public Health Control ❑ 9. Food Contact Surfaces Cleaning and Sanitizing REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) ,. El 10. Proper Adequate Handwashing ❑ 21. Food and Food Preparation for HSP ❑ 11. Good Hygienic Practices n'-0ONSUMER ADVISORY. e ❑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-a)(sso.00s) cited in this report may result in suspension or revocation of 26. Water, Plumbing and Waste (FC-4)(590.006) the food establishment permit and cessation of food establishment operations. If aggrieved by this order, you 27. Physical Facility (FC-6)(590.007) have a right to a hearing. Your request must be in writing 28. Poisonous or Toxic Materials (FC-7)(590.008) and submitted to the Board of Health at the above address 29. Special Requirements (590.009) within 10 days of receipt of this order. 30. Other DATE OF RE-INSPECTION: ss�,= ,Fo .,< �eccwlt� 3, ams Inspector's Signature: Print:g \ Pa PIC's Si nature: ( Prink ) Page) of�Pages /`� �`f�ll� c Ccl 70(( 7 / iT�/KLLLZI � 1 Violations Related to Foodborne Illness interventions and Risk Factors(items 1-22) PROTECTION FROM CONTAMINATION atzovt FOOD PROTECTION MANAGEMENT 8 Cross-contamination t ofkesponttbilt_fy* 3-30111(A)(1) Raw Anmal foodsSeparated from � itanofKnowled e4` Cooked and RTE Foals* harge-duhe, Contamination from Raw Ingredients 3-302.1 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 foal employees xmd 3-302.1 t(A) Food Protection- 3-302,15) rotection*3-302.15 Washing Fruits and Ve*enables 590.003(F) Responsibility Of A Food Employee Or An 3-304.11 Food Contact with Equipment and Applicant'ro Report To The Person In Utensils* Char*e" Contamination from the Consumer 590.003(G) Re ortind b Person in Chuge* 3-306.14(A)(B) Returned Food and Reservice of Food" 3 1 590.003(0) Exclusions and Restrictions* - Disposition of Adulterated or Contaminated 590.003(E) Removal of Exclusions and Restrictions Food 3-701.11 Discarding or Reconditioning Linsafe FOOD FROM APPROVED SOURCE Food" 4 Food and Water From Regulated Sources 9 Food Contact Surfaces 590.004(A-B) Compliance with Food l.aw"` 4-501.111 Manual Warewashing-Hot Water 3-201.12 Foal in a Hermeticail e Seated Containers` Sanitization Tem eratares"` 3-201A3 Fluid Milk and Milk Products* 4-501.112 Mechanirnl Warewashin;-slot Water 3-202.13 Shell Enns* Sanitization Tem eratures* 3-202.14 4-501.114 Chemical Sanitization-temp., pH,andMilk Products.Pasteurized- concentration and hardness. 3-202.16 tee Made Front Potable Drinking Water* 4 5-1.01.11 DrinkingWater from an Approved System* -601.11(A) Equipment Food Contact Surfaces and Utensils Clean* 590.006(A) Bottled Drinking Water* 4-602.1 1 Cleaning Frequency of Equipment Food- 590.006(B) Water Meets Standards in 310 CMR 22.0* Contact Surfaces and Utensils* Shellfish and Fish Froman Approved Source 4.702.11 Frequency of Sanitization of Utensils and 3-201.14 Fish and Recreationally Caught Molluscan Food Contact Surfaces of P, ui menO Shellfish"-` 4-703.11 Methods of Sanitization-Hot Water and 3-201A5 Molluscan Shellfish from NSSP Listed Chemical* Sources* 10 Proper,Adequate Handwashing Game and Wild Mushrooms Approved by Regulatory Authorit 2-301.11 Clean Condition-Hands and Amts" 3-202.1.8 Shellstock Identification Present* 2-301-12 Cleaninn Procedure* 590.004(0) Wild Mushrooms* 2-301-14 When to WasWl 3-201.17 Game Animals* IG Good Hygienic Practices g Receiving/Condition 2-401.1I Eating,Drinkin,or Usin&Tobacco* 3-202.11. PHFs Received at Proper Temperatures* 2-401.12 Discharges From the Byes,Nose and 3-202.15 Packa e hnegrhvMouth* 3-101.11 Food Safe and Unadulterated* 3-30112 Preventing Contamination When Tasting" F-69 6 Ta siRec ords:Shellstock 12 Prevention of Contamination from Hands 3-202.18 Shellstock Identification* 510.004(E) Preventing Contamination from 3-203.12 - Shellgtock Identification Maintained* Employees* Tags/Records:Fish Products 13 Handwash Facilities 3-402.11 Parasite Destruction* Conveniently Located and Accessible 3-402.12 Records,Creation and Retention* 5-203.11 Numbers and Capacities* 590.004(1) Labeling of Ingredients' 5-204.1.1 I coat on and Placement* 9 Conformance with Approved Procedures 5-205.11 Accessibility.0 aeration and Maintenance IHACCP Pians Supplied wfth Soap and Nand Drying 3-502.11 S ecialized Processin Methods* Devices . ig,criteria* 601 Handwashnin Cleanser,Availability Reduceoxygen 6-301.12 Hand Dr i 8-103.12 Conformance with At rvedProcedures *Provision '"Denotes critical item in the federal 1999 Food Code of 105 CMR 590.o0o. i CITY OF SALEM BOARD OF HEALTH Establishment Name: 1 f Q o2Zc, Date: t II `t L 3 Page: of Item Code C-critical nem DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date No. Reference R—Red Item - A .-. Verified p.. ..PLEASE PRINT CLEARLY ` -a I , h ►' ev . r o 1 4 I , f '% oe 6 Sh i/ t brCG -0)V. Cl rte. LG A O 3- Mt 11 eA0 L F I 3 3�a I� rill r e Lo 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 dbmply 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. C `. ❑ Voluntary Disposal ❑ Other: 3-501.14(C) PHFs Received at T nnperatures Violations Related to Foodborne Illness Interventions and Risk According to Iaw Cooled to Factors(items 1.22) (Cont.) 41'F145'F Within 4 Hours. PROTECTIONPROM'CHEMICALS3-501.15 CoolanaMednodsfor PJ-Ts I4 Food or Color Additives 19 PHF Hot and Cold Holding 3-501.16(11) Cold PRFs Maintained at or below '3-202.12 Additives'x 590.004(F) 41"145°F* 3-302.14 Protection from Una roved Additives* 140'F. 3-501.I6(A) Hot PRFs Maintained at or above lg Poisonous or Toxic Substances - 7-101.11 Identifging lnfonnafion-Ch'iginal 3-501.16(A) Roasts Held at or above 130'F. Containers' I- o2.I I Common Name-Working Containers* 2() Time as a Public Health Control 7-201.11 Sc aration-Stoiartel` 3-501.19 Time as a Public Health Control- 7-20111 Restriction-Presence and Use* 590.004(H) Variance Re uirement 7-202.12 Conditions of Use* 7-203.11 Toxic Containers-Prohibitions* REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 72I SCPOPULATIONS(HSP)riteria- a 7-204.12 Chemicals for Washing Produce,Criteria* 21 3-801,11(A) Unpasteurized Pre-packaged Juices and Bever tees with R ening L;abeh 7-204.14 Drying Foodents, Contact, 3-80 i..11(B) Use of Pasteurized E� s* 7-205.11 Restricharid;nted Food Contact. ,CriteraLubricants* 3-801.11(D,) Raw or Partially Cooked Animal Food and 7-206.1 t Restricted Use Pesticides.Criteria'" Raw Seed Sprouts Not Served. 't 7-206.12 Rodent Bait'Stations* 3-801.11(C) Uno erred Foci Packs=e Not Reserved. 7-306.13 "Cracking Powders,Pest Control and Monitoring* CONSUMER ADVISORY TIMEREMPERATURE CONTROLS 22 3-603.1 I Consumer Advisory Posted for Consumption of Animal Friods Ilan are Raw.Undercooked or 1b Proper Cooking Temperatures for PHFs Not Otherwise Processed to Eliminate 3_ _ ." En,�9�a,;,.aunr _ 401.L lA(1)(2) Eggs- t555`5'3 F 15,Sec. Pathogens. E >s-Imm�edratc Service 145°F]Ssec* 3-302.13 Pasteurized figgs Substitute for Raw Shell 3-401..11.(A)(2) Comminuted Fish,Meats&Geune E. °r Animals- 155'F 15 sec. 3-401.11(13)(1)(2) Pork and Beef Roast- 13WF 121 nrin* SPECIAL REQUIREMENTS 3-401.11(A)(2) Ratites,Injected Meats- 155°F 15 590909(`'1)-(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 Poultr or Barites-165°F 15 sea. ,. 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 Foals Cooked in a practices should be debited under#29- Microwave 165'F* Special Requirements. 3401.11(A)(1)(b) All Other PHFs-145'F 15 sec. * L7 Reheating for Hot Holding VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 3-403.11(A)&(D) PRFs 165'F 15 sea. " (Items 23-30) 3-403.11(B) Microwave-165°F 2 Minute Standing Critical and non-rritical violations, which do not relate to tate Time* foodborne Illness interventions and risk jo(tors listed above, can be 3-401 11(C) Commercially Processed RTE Food- found in the frillorving sections of the Food Cade and 105 CMI[ 140'F" 590.000. 3-403.11(E) Remaining Unsliced Portions of Beef item Good Retat7 Practices_ FC 590.000 Roasts* 23. Marra ament an_d Personnel FC-2 .003 18 Proper Cooling of PHFs 24. Food and Food Protection FC--3 .004 Eguipment and Utensils _ FC 4 .005 3-501,14(A) Cooling Cooked PHFs from 140'F to 2)6Water.Plumbht and W aste FC-5 006 70'F Within 2 Hours and From 70°F 27. -Physical Facili _ FC-6 , ' .007 to 41.°17(45'F Within 4 Hours. * 28. Pofsoncus or Toxic Materials FC 3-501..14(13) Cooling PHFs Made From Ambient 29. S ecial Requirements _ - .009 -- Temperature Ingredients to 41°FI45°F 30. Other - Within 4 Hours* tr nava-=m,� "Denotes critical ilem in Inc f,Aleral 1999 Food Code or 105 CNIR 590000. f µ � j CITY OF SALEM BOARD OF HEALTH f Establishment Name: —l k j2zoo Date: t / Page: of Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date No.. Reference R—Red Item Verified PLEASE PRINT CLEARLYR r7JI e Ik Jo s i t Tl1/1 .f c r A l t 4 k `r L f T 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/ violations before the next inspection, to observe all conditions as described, and to Exclusion c P Re-inspection Scheduled ❑ Emergency Suspension comply with all mandates of the Mass/Federal Food Code. I understand that S noncompliance may result in daily fines of twenty-five dollars or suspension/revocation of ❑ Embargo ❑ Emergency Closure ,your food permit. lG r C-'N ❑ Voluntary Disposal ❑ Other: ri r 1 A 3-501 I4(C) PHFs Received at Temperatures Violations Related to Foodborne Illness Interventions and Risk According to I.aw Cooled to Factors(Items 1-22) (Cont.) 41°F145,F Within 4 Hours. PROTECTION FROM CHEMICALS 3-50'1.15 Coohm,Methods for PHFs ---- ----- 19 PHF Hot and Cold Holding 14 Food or Calor Additives 3-50L 16(B) Cold PHFs Maintained at or below 9-202.12 Addutvest 590.004(F) 41145 F* I-302.14 Protection from Toxic Additives" 3-501.I6(A) Ilot PHFs Maintained at or above 15 Poisonous or Toxic Substances 4WF. * 7-101.11 Identifying Information-Original 3-501.16(A) Roasts Held at or above 130'F. Containers* 7-1.0211 Common Name-Workim*Containers* 20 Time as a public Health Control 7-201.1 I -T501-19 Time as a Public Health Control* 7-20211 Restriction-Presence and Use* 590.004(H) Variance Re tarement 7-202.12 Conditions of Use* 7-203.1.1 Toxic Containers-Prohibitiom * REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-204.11 Sanitizers,Criteria-Chemicals* POPULATIONS(HSP) 7-204..2 Chemicals for Washine Produce, Criteria* 21 3-801.11(A) Unpasteurized Pre-packaged Juices and Beverage;:with Warning Labels* 7-204.14 Diving Agents.Criteua* 3-801 A I(B) Use of Pastem ized Eees^ 7-205.11 Incidental Food Contact. Lubricants -7-206.1 1 Restricted Use Pesticides.Criteria* 3-801A 1(D) Raw or Partially Cooked Animal Food and 7-206.12Rodent Bait Stations* Raw Seed S?routs Not Served. ' 7-206.13 Tracking Powders,Pest Control and 3-801.11(C) �Jno rened Foe{Packa<:e Not Re-served. Monitoring,,* CONSUMER ADVISORY TIME/TEMPERATURE CONTROLS 22 3-603.11 Consumer Advisory Posted for Consumption of 16 Proper Cooking Temperatures for Animal Foods That are Raw,Undercooked or PHFs Not Otherwise Processed to Eliminate 3-401.113(7)(2) I,ps- 155°F ISSec. Pathe ens ''eC""�iJ01 fi cs-Lrtmedrau Service 1.45°F15sec* 3-302.3 Pasteurized Figs Substitute for Raw Shell 3-401.11(A)(2) Comminuted Fish, Meats&Game. E gs* Animals- 155"F 15 sec. 3-401.11(3)(1)(2) Pork and Beef Roast- 130"F 1.21 min* SPECIAL REQUIREMENTS 3-401.11(A)(2) Ratites, Injected Meats-155°F 1.5 590.009(A)-(D) Violations of Section 590.009(A)-(D)in see. * catering, mobile food,temporary and 3-401.11(A)(3) Poultry, Wild Game,Stuffed PHFs, residential kitchen operations should be Stuffing Containing Fish,Meat, debited under the appropriate sections Poultry or Ratites-165'1" 15 sec. * above if related to foodborne illness 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks interventions and risk factors. Other 145-F* 590.009 violations relating to good retail 3-401.12 Raw Animal Foods Cooked in a practices should be debited under/129- Microwave 165'F* Special Requirements. 3-401.1 i(A)(1)(b) All Other PHFs- 1.45'F 15 sec. a7 Reheating for Hot Holding VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 3-403.11(A)&(D) PHFs 165°F 15 sec. * (Itetns 2.3-30) 3-403.11(B) Microwave 165'F 2 Moune Stmdina Critical and non-critical viololions, Which do not relare.to the Time* foodborne illness intervenlions and riskfadors listed above. can be 3-403.11(C) Commercially Processed RTE Food- ,found in rhe following sections of the Food Code and 105 CMR '140°F* 590.000. 3-403.11(1".) Remaining Unsliced Portions of Beef Item Good Retail Practices FC 590.000 Roasts* 23. Mena ement and Personnel FC-2 .003 -----_.---...--- lA Proper Cooling of PHFs 24 Food and Food Protection _ _ FC-3 .004 25 _Equipment and Utensils 3-501.14(�A) Coollng Cooked PHFs from 140cF to 26 water._Plumbing and Waste FC S .606 70"F Within 21tours mrd From 70'F 27. Physical Facility _._ FC-6 .007 to 41'1"(45"F Within 4 Homs.'" 28. Poisonous or Toxic Materials IC- 7 .008 3-501.14(1?) Cooling PHFs Made From Ambient _29_ S eclat Re uiremenis .009 Temperature ingredients to 41'F/45'F 30 Other Within 4 Hours" ssarro,enmal.zao 'Denotes critical iters in the federal 1999 Food Cale or 105 CMR 590,000. Massachusetts Department of Public Health Salem Board of Health 120 Washington Street, 4th Floor Division of Food and Drugs Salem, MA 01970-3523 FOOD ESTABLISHMENT INSPECTION REPORT Tel. (978) 741-1800 Fax (978) 745-0343 Name DatType of Operation(s) Type of Inspection I ,0 1�)Z�n I,jEl Food Service ❑ Routine AddressRisk ❑ Retail ] Re-inspection Level ❑ Residential Kitchen Previous Inspection TelephoneElMobile Date: n1191,gf OwnerHACCP YM ElTemporary ElPre-operationG ( �, ElCaterer El Suspect Illness Person in Charge(PIC) < Time E] Bed&Breakfast E] General Complaint n In: 3--' ❑ HACCP Inspector 0 Permit No. ❑Other Each violation checked equires an explanation on the narrative page(s) and a citation of specific provision(s) violated. Non-compliance with: Violations Related to Foodborne Illness Interventions and Risk Factors Anti-Choking Tobacco Violations marked may pose an imminent health hazard and require immediate corrective 590.009(E) ❑ 590.009(F) ❑ action as determined by the Board of Health. FOOD PROTECTION MANAGEMENT ❑ 12. Prevention of Contamination from Hands ❑ 1. PIC Assigned/Knowledgeable/Duties [:113. Handwash Facilities EMPLOYEE HEALTH ...._ _. . ` PROTECTION FROM CHEMICALS El 2. Reporting of Diseases by Food Employee and PIC El3. Personnel with Infections Restricted/Excluded ❑ 14.Approved Food or Color Additives ' FOOD FROM APPROVED SOURCE ❑ 15.Toxic Chemicals ❑ 4. Food and Water from Approved Source " " " TIME/TEMPERATURECONTROLS(Potentially Hazardous Foods) ❑ 5. Receiving/Condition ❑ 16.Cooking Temperatures 1 ❑ 6. Tags/Records/Accuracy of Ingredient Statements ❑ 17. Reheating ❑ 7. Conformance with Approved Procedures/HACCP Plans \ ❑ 18. Cooling PROTECTION FROM CONTAMINATION" ❑ 19. Hot and Cold Holding ❑ 8. Separation/Segregation/Protection ❑20.Time As a Public Health Control ❑ 9. Food Contact Surfaces Cleaning and Sanitizing REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) El 10. Proper Adequate Handwashing ❑21, Food and Food Preparation for HSP ❑ 11. Good Hygienic Practices ': CONSUMER ADVISORY,_ ❑22. Posting of Consumer Advisories Violations Related to Good Retail Practices Number of Violated Provisions Related Critical (C)violations marked must be corrected To Foodborne Illnesses Interventions 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 ofHealth.-W? 590.000/federal Food Code. This report, when signed below 23. Management and Personnel (FC-2)(590.003) by a Board of Health member or its agent constitutes an 24. Food and Food Protection (FC-3)(590.004) order of the Board of Health. Failure to correct)violations 25. Equipment and Utensils (FC-4)(590.005) cited in this report may result in suspension or,revocation of 26. Water, Plumbing and Waste (FC-5)(590.006) the food establishment permit and cessation of food establishment operations. If aggrieved by this order, you 27. Physical Facility (FC-6)(590.007) have a right to a hearing. Your request must be in writing 28. Poisonous or Toxic Materials (FC-7)(590.008) and submitted to the Board of Health at the above address 29. Special Requirements (590.009) within 10 days of receipt of this order. 30. Other DATE OF RE-INSPECTION: s:ssoi�soecrro,msta.em 1 ! ! Inspector's Signature: Print: / D P PIC's Signature: - /iK c f• Print: T� j,� 7(Kul l /I Page of ,Pages Violations Related to Foodborne Illness Interventions and Risk Factors(Items 1-22) PROTECTION FROM CONTAMINATION FOOD PROTECTION MANAGEMENT Cross-contamination t I 590.003(A) I -Assignment(if Responsibility" 3-302.J 1(A)(1) Rau Animal Foods Separated from 590.003(B) Denvinsoation of Knowledge* Cooked and RTE Foals* 2-103.1 t s Contamination from Raw Ingredients 3-302A 1(.A)(2) Rav, Animal Foods Separated from Each EMPLOYEE HEALTH Other, .590.003(0) Responsibility of the person in charge to Contamination from the Environment require reporting by food employee,and :3-302�11(A) food Protection' applicants* 3-302.15 Washing Fmits and�Vegelable, 590.003(F) Responsibility Of'A Food Employee Or An 3-304.11 point Contact with Equipment and Applicant To Report To The Peron In Utensils* Charee* Contamination from the Consumer 590.003(6) Re Cortina b Person n Char e* � W. -3-306.14(A)(8) Returned Food and Rescry ice,of Food' .1 590.003(DI 'Lclusions and Restrictions*, Disposition ofAdufteratedor Contaminated 590,001( Exclusions at of Exclusions and Restrictions Food 3-70L I t Discarding or Reconditioning Unsafe FOOD FROM APPROVED SOURCE Frx)d* 4 Food and Water From Regulated Sources 9 Food Contact Surfaces 590.004(A-B) Compliance with Food Law'1 4-501.111 Manual Warcwashmg-Hot Water 3201.12 Food in a Hermetically Scaled Container* Sanitization Temperatures, _ 3-201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Aare.Aashins-Hot Water 3.202.13 Shelf fig.gs* -- Sanitization Temperatures* 3-20114 Eggs and Milk Products.Pasteurized* 4-50t.114 Chemical Sarutizaiton-temp.,PH, 3-202.16 Ica Made From Potable Drinking Water- concentration and hardnes.s. ;' 5-'101,11 Drink 4-60 1.11(A) Equipment Food Contact Surfaces and 590.006(A)- Britf]M�a�tcr* I ftensils Clean-- 590,006(F3) Water Meets Standards in 3 10 CMR 22.0* F4-6022.1-1 Cleaning Frequency ot Equipment Food- She#hsh and Fish From an Approved Source_ Contact Surfaces and Utensils'r - 4-702.11 Frequency of Sanitization of Utensils and 3-201.14 Fish arid Recreationally Caught M011USCRu Food Contact Surfaces of Equipment' Shellfish* 4-703�I I Metbo&of Sanitization-Hot Water and 3-201,15 Molluscan Shellfish from NSSP Listed Chemical* Sources* Game and Wild Mushrooms Approved by 10 Proper,Adequate Harid;ias-hlng REZulatory Authority 2-301.11 Clean Condition-Hands and Anmlc 3-20118 Shellstock.Identification Present* 2-301.12 C inim,Procedure* 590.004(C) Wild Musmorans* 2-301.14 When to Wash* -� Good Hygienic Practices 3-201.17 Game Animals* L-L'- ReceivinglCondition 2-401.I1 Einim Drinking or UsingTobacco* 3-202.11 PHFs'Received at Proper Temperatures, 2-401,12 Discharges From the Eyes, Note and -3-202.15--- Mouth* 3-101.11 Food Safe and Unadulterated 3-301,12 preventing Contamination NN'ben'fastin.0' F-6 Tags/Records:Shellstock 12 _ Prevention of Contamination from Hands 3-202AS Shellstock Identification 590.004(F) preventing Contaminationfrom 3-203,12 Shellstock Identification Maintained* r--, Employees* ; Tags/Records:Fish Products Handwash Facilities - Conveniently Located and Accessibie 402.11 Parasite Destruction' -- 3-402.12 Records.Creation and Retention* 5-2203.11 Numbers and Capacifics* 590.0()4(1) Labeling of Ingredients' 5204.11 Lavation and Placement* Conformance with Approved Procedures 5-20-5,11 AccessibifiE,.Oporalion and Nlaintenance L /HACCP Plans Supplied with Soap and Hand Drying 3-502.11 Specialized Processing Methods, -- Devices 3-502.12 Reduced oxygen packaLnng,criteria" 6301.11 flandwashing Cleanser,Availabilit: 8-103.12 Conformance with Approved Procedures* 6-301.1.2 �HandDnmZ�Provision Denotes crifical hem in the[e&ial 1999 Food Code or 105 CIMIZ 590,000, CITY OF SALEM BOARD OF HEALTH / Establishment Name: 1), 22G— Date: Page:_ Of Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date No. Reference R—Red Item - Verified - I PLEASE PRINT CLEARLY It cc_ - _ iij f k k } r f d ' P � Discussion With Person in Charge: Corrective Action Required: ❑ No Yes All I have read this report, have had the opportunity to ask questions and agree to correct all L3 Voluntary Compliance LlEmployee Restriction/ violations before the next inspection, to observe all conditions as described, and to Exclusion P Ll Re-inspection Scheduled ❑ Emergency Suspension ' comply with all mandates of the Mass/Federal Food Code. I understand that noncompliance may result in daily fines of twenty-five dollars or suspension/revocation of ❑ Embargo ❑ Emergency Closure your food permit. �— (� / e r y LIVoluntary Disposal ❑ Other: 1� 3-SOI,14(Cj PHFs Received at Temperatures Violations Related to Foodborne fitness 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 Coolim,Methods for PHFs 14 Food or Color Additives 14 PHF Not and Cold Holding 3-501.16(B) Cold PFIFs Maintained at or below 3-202.12 Additives" 590.004(F) 41%45°F* 3-30214 Protection from Unapproved Additives* 3-501.16(.4) Hot PHFs Maintained at or above 15 Poisonous or Toxic Substances 140'F. * 7-101.11 Identifying information-Original 3-501.16(A) I Roasts Held at or above 130'F. Containers" 7-102.11 Common Name-Workim*Containers* Time as a Public Health Control 7-201.11 Separatio -Stoge" 3-501.19 Time as a Public Health naControl* 7-202.11 Restriction-Presence and Use* 590,004(H) Variance Requirement 7-202.12 Conditions of Use* 7-203.11 Toxic Containers-Prohibitions" REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-204.11 Sanitizets,Criteria-Chemicals* POPULATIONS(HSPL� 7-204.1.2 Chemicals for Washin¢Produce,C'iteria"` 21 3-901..11(A) Unpasteurized Pre-packaged Juices and'Y 7-204.14 Dt •in ants,Criteria' Beverages witharnme labels* 7-2Q5.t1 Incidental Food Contact.Ltthricants* 3-b01.11(B} Use of Pasteurized E los° 7-206.1 1. Restricted Use Pesticides.Criteria* 3-30111(D) Raw or Partially Cooked Animal Food and Row Seed 5 aontc NoC Served. - 7-20612 Rodent Bait Stations* 1-801.11(C) Una cried food Packs'e Not Re-server! 7-206.13 Tracking Powders,Pest Control and ;4tonitodnn* CONSUMER ADVISORY TIMEITEMPERATURE CONTROLS 22 3-603-11 Consumer Advisory Posted for Consumption of Animal Foots'That are Raw.Llnderaroked or 16 Proper Cooking Temperatures for PHFs Not Otherwise Processed to Eliminate Patho 3-401.11.A(])(2) Eggs- 155`'F 15 Sec. ns* Eggs-hmnediate Service 145'F15sec* 3=302.13 Pasteuneed Eggs Substitute for Rata Shell 3-401.11.(A)(2) Comtninuted Fish,Meats&Game E s* Animals-155'F 15 sec. "' 3-401.11(13)(1)(2) Pork and Beef Roast- OWE 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 * catering,mobile food, temporary mid 3-40L 11(A)(3) Poultry,Wild Game, Stuffed PHRs, residential kitchen operations should be Stuffing Containing Fish, Meat, debited under the appropriate sections Poultry or Ratites-165°F 15 sec. * above if relatedto foodborne illness 3-40111(C)(3) Whale-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 I65'F* Special Requirements. 3-401.1 I(A)(1)(b) All Other PHFs-145°F 15 sec. * 11 Reheating for Hot Holding VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 3-403.11(A)&(D) PHFs; 165'F 15 sec.* (Items 23-30) 3-403.11(B) Microwave-165°N 2 Minute Standing Critical acrd non-critical violations, which do not relate to the Time* foodborne Illness interventions and risk factors fisted abnre, can be ,403.11(C) Commercially Processed RTE Food- found in the following sections of the Fond Code and 105 CMR 1400,F" 590.0(X). 3-403.1 i(F) Remaining Unsliced Portions of Beef Item Good Retail Practices FC 580 000 Roasts,: 23. Manan ement and Personnel FG-2 .003 1g Proper Cooling of PHFs -24. Food and Food Protection _....- FC 25 ____ __E ui ment and Utensils FC 4_ .005 3-501.14(A) Cooling Cooked PHFs from 140'F to 26 Water,PI_umhin and Waste FO 5 .006 70°F Within 2 Homs and From 70'F 27. Physical Facility FC-6 1 .007 to 41.°.F/45'F Within 4 Hours. * 28. Poisonaus or Toxic Materials FC-7 .008 3-501.14(B) Cooling PHFs Made From Ambient 29__ S acral Fie uiremants _ .009 Temperature Ingredients to 41'F/45'17 30 .Other --........--_---- Within 4 Hours* Denotes critical item in the fMeral 1999 Food Code or 105 CMTs 590-000, i 'S - tamer.>.. 2wytc�JE-'%f `�w +'rR«:,..,,ewamoa�.x„ a • .f"mv«'a�y �ri`sd�eta-, :'e'I�z "a�. hee* A .u ':KS , ',•r yt *.Xda, °-�V �'.ti"CSO^ [•�r+a6�/vq�.?�dm�-,t.+psR.'^ka^3rm 'S�'r�d"'�"9�_4R'1!n"Yt'4"P -N�+r,-rve+m•w�-,n.r^Y`+x*[+Mna'Fv';,�R � .' «a. - R' n a .fit„�A, ...,r•.. ` Commonwealth of Massachusetts. City of Salem Board of Health 120 Washington Street,4th Floor s e SALEM,MA 01970 1waFood/Retail Establishment Permit wofr DATE PRINTED: 01/02/2006 WHO'S PLACE OF BUSINESS IS: Deleo's Pizza File Number:BHF-2004-0164 28 Norman Street Salem MA 01970 LOCATED AT: 0028 NORMAN STREET SALEM,MA 01970 Permit Type Permit No. Permit Issued Permit Expires Fee Restrictions/Notes FOOD SERVICE BHP-2006-0052 Jan 2,2006 Dec 31,2006 $100.00 ESTABLISHMENT Total Fees: $100.00 PERMIT EXPIRES December 31, 2006 Board of Health This Permit is not transferable and must be reissued upon change of ownership or location.The permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code,beofre any revonations,improvements,or equipment changes are made,all plans for such must be submitted to and approved by the Salem Board of Health. Page 20 of 26 CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH / a 120 WASHINGTON STREET, 4TH FLOOR � SALEM, MA 01970 TEL. 978-741-1800 DC �P FAx 978-745-0343 C17), ?��� STANLEY J. USOVICZ, JR. eQ pQ MAYOR W W W.SALEM.COM qAO l``S JOANNE SCOTT, MPH, RS, CHO oF&4/��f� 4f HEALTH AGENT �I4py 2006 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT '7 NAME OF ESTABLISHMENT O LSI JF Cl S /P1 Z ZA TEL# qre r—'10 z 0 0 ADDRESS OF ESTABLISHMENT MAILING ADDRESS (if different) OWNER'S NAME %©/�J / C7 �IILZi ✓c i lA TEL# ADDRESS CITY f X915 oed STATE /"//7 ZIP 0/ Y E O CERTIFIED FOOD MANAGER'S NAME(S) 7©l9 i 6,Yi/G<l ej ACERTIFICATE#(s) 3 3 5--3 6 -s- (required (required in an establishment where potentially hazardous food is prepared.) EMERGENCY RESPONSE PERSON HOME TEL# HOURS OF OPERATION: Mon.//-io Tue.//-to Wed. //-lo Thu. //-io Fri.//-/O Sat. i-/0 Sun.//-to TYPE OF ESTABLISHMENT FEE (check only) RETAIL STORE YES NO less than 1000sq.ft. =$ 50 1000-10,000sq.ft. =$100 more than 10,000sq.ft. =$250 ------- - U - ---------------------- --- ------ --- --------------------------------------------------- ---------------- -----------_----- ---------------- RESTAURANT NO less than 25 seats $100 I ` qq o V more seats =$150 T lJ more than 99 seats =$200 BED/BREAKFAST YES NO $100 ------------ -------- --------------------------------------------------------------...------------------------------------------------------.....-------- ADDITIONAL PERMITS MAKE (notjust serve) ICE CREAM, YOGURT, SOFT SERVE YES NO $5 TOBACCO VENDOR YES NO $50 ALL NON-PROFIT(such as church kitchens) YES NO $25 *Please pay total with one check payable to the City of Salem . This Permit is not transferable and must be reissued upon change of ownership. The Permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code, before any renovations, improvements, or equipment changes are made, all plans for such must be submitted to and approved by the Salem Board of Health. Pursuant to MGL Chapter 62C, Section 49A, I certify under the pains and penalties of perjury that I, to my best knowledge and belief, have filed all state tax returns and paid all state taxes required under the law. Signature Date Social Security or Federal Identification Number ------------------- ------------------------------------------------- --------------- ------------ --- ----------------------- ------------------ Revisedll/03/0 FOODAP2.adm Check#&Datea�� /���/ 1'J' LCk k Sp'C 'X I•s k s s� "irt htA"/r%s r 3.r L✓+x£ $�rt'[v � _ t' t .yI -�+ �? LICEN,SE?40 �5'r . ?, 4t IIC EXPYIATE>r"Y DATE(JFSIRTI'I _ ( / NAME(LAST FIRST WItNL� &.�6 .j �.J( i t (Y (I4 t S ADIDRR/1ESSS....M�/ c� CITY/TOWN /S'TTAT/EE -ZIP/f, /'� "4I J�'^+I'M'+'. J :J&,on . •'•i7 et 7V REGISTRATIONNO.-. .,STATE' EXRDATE -MAXE"PE YEAR CALOR - - sd � •�F ,t �Pb : R DATE OF VIOLATION. TIME DATE CITATION WRITTEN Iwu ❑AM LIVES O Q PM - NO En t LOCATION OF VIOLATION ENFORCING DEPT Q �$ !Uaajm$N Sian, irl ot-r It EOFFENSE CHAP. SECT. FINES I X 1Y7 , AC'mf 4Jb a ba fol�c�iar7 o f vvv � Inc A(1 Ln So,rC) ��U2a �rRS w ° ,T? cc Itil vfi2rvss p `� - C P-elari5 pWI '2 1 O k O-F;CER / LD.NO. TOTAL ! j p¢O i.i uJ* a� i o I ER CERTIFIES COPY GIVEN TO VIOLATOR F p a a Q S 6 / ❑ IN HAND 4 Z BY MAIL �' Yyl 60 NOT -PAY ONLY BY POSTAL NOTE,MONEY 11� EE ORDER OR BY CHECK MADE PAYABLE TO: II a CRY CLERK Q CITY HALL p�p' 93 WASHINGTON STREET SALEM,MA 01970 TEL(508)745-9595 X 251 1 HEREBY ELECT TO EXERCISE THE FIRST OPTION AS STATED ON a Q REVERSE, CONFESS TO THE OFFENSE CHARGED,AND ENCLOSE ¢° w I PAYMENT IN THE AMOUNT OF 1 O i $ LASEN i. SIGNATURE ' F SEE OTHER SIDE FOR FURTHER INFORMATION - 4;' ENCLOSE PAYMENT IN THIS ENVELOPE,PEEL AND SEAL 0028 Norman Street Deleo's Pizza City of Salem FOOD SERVICE ESTABLISHMENT - FOOD SERVICE REINSPECTION Inspection HACCP: ❑ 'Telephone: T Item Status Violation Critical Urgency Nature of problem or correction 740-2800x, TM Non-compliance with: Not Done Owner Q. Anti-Choking PASS ❑ iTomi Gjikuria Tobacco PASS ❑ PIC: .." TOmI FOOD PROTECTION MANAGEMENT Not Done Tor4-tor:GJIkUrla PIC Assigned/Knowledgeable/Duties PASS d❑ RED Inspec :David Greertbaum` '. EMPLOYEE HEALTH Not Done Date Inspected: Correct By: = Reporting of Diseases by Food Employee and PIC PASSd❑ RED Personnel with Infections Restricted/Excluded PASS ❑d RED Risk Level: FOOD FROM APPROVED SOURCE Not Done Permit Number.+ Food and Water from Approved Source PASS ❑d RED 1314-2005- fr Receiving/Condition PASS RED Status: " "` ' " Tags/Records/Accuracy of Ingredient Statements PASS ❑Q RED FULL COMPLY ` _ - #of Critical Violations T *.q Conformance with Approved Procedures/HACCP PASS ❑d RED Plans PROTECTION FROM CONTAMINATION Not Done Time IN. Time OUT' Separation/Segregation/Protection PASS ❑d RED x Notes t r Food Contact Surfaces Cleaning and Sanitizing PASSd❑ RED 271: - Proper Adequate Handwashing PASSJ❑ RED I' Urgency Dekrlptlon(s): Good Hygienic Practices PASSd❑ RED BLUE: s Violations Related to Good Prevention of Contamination from Hands PASS RED Retail Practices (Critical Handwash Facilities PASS ❑d RED violations must be corrected= immediately or within 10 days)(Non-critical violations GeoTMS@ 2005 Des Lauriers Municipal Solutions, Inc. ( Rev. Sep 06,2005 ) Page 1 of 0028 Norman Street Deleo's Pizza must be Corrected Immediately PROTECTION FROM CHEMICALS Not Done Or within 90 days) Approved Food or Color Additives PASS Q RED RED. v T Violations Related to Toxic Chemicals PASS O RED FOOdborne Illness Interventions'",, TIME/TEMPERATURE CONTROLS(Potentially Haz Not Done and Risk Factors (Require cooking Temperatures PASS ❑d RED immediate corrective action) Reheating PASS RED Cooling PASS ❑J RED Hot and Cold Holding PASS ❑d RED Time As a Public Health Control PASSd❑ RED REQUIREMENTS FOR HIGHLY SUSCEPTIBLE PO Not Done Food and Food Preparation for HSP PASS ❑J RED CONSUMER ADVISORY Not Done Posting of Consumer Advisories PASS RED Violations Related to Good Retail Practices (Blue Not Done Management and Personnel PASS ❑ BLUE Food and Food Protection PASS ❑ BLUE Equipment and Utensils PASS ❑ BLUE Water, Plumbing and Waste PASS ❑ BLUE Physical Facility PASS ❑ BLUE Poisonous or Toxic Materials PASS ❑ BLUE Special Requirements PASS ❑ BLUE Other-See Notes PASS ❑ BLUE Owner shall use a spray bottle not used by another product for sanitizing solution. All violations cited in the 8/29/05 inspection report have been corrected. GeOTMS®2005 Des Lauriers Municipal Solutions, Inc. ( Rev. Sep 06,2005 ) Page 2 of 0028 Norman Street Deleo's Pizza GeoTMS®2005 Des Lauriers Municipal Solutions, Inc. ( Rev. Sep 06,2005 ) Page 3 of 0028 Norman Street Deleo's Pizza City of Salem FOOD SERVICE ESTABLISHMENT - FOOD SERVICE Inspection HACCP: ❑ Telephone: Item Status Violation Critical Urgency Nature of problem or correction 740-2800 Non-compliance with: Not Done Owner: Anti-Choking PASS EJT t � Tomi Gjikurla.. - ;_ p Tobacco PASS ❑ PIC TOmI GjlkUrla- FOOD PROTECTION MANAGEMENT Not Done PIC Assigned/Knowledgeable/Duties PASS ❑J RED Inspector: x David Greenbaum,= EMPLOYEE HEALTH Not Done Date Inspected: Correct By: - Reporting of Diseases by Food Employee and PIC PASS ❑d RED 8/29/2005 Personnel with Infections Restricted/Excluded PASS ❑d RED ,Risk Level: FOOD FROM APPROVED SOURCE Not Done 'Permit Number T Food and Water from Approved Source PASS ❑d RED BHP-2005-0150 1 = Receiving/Condition PASS ❑/ RED Status: 2^ & w Tags/Records/Accuracy of Ingredient Statements PASS ❑d RED VIOLATION #of Critical Violations Conformance with Approved Procedures/HACCP PASS ❑d RED Plans 3 41 Time IN tr = Time OUT. - Notes. 260' w Urgency Description(s)' BLUE: Violations Related to Good Retail Practices (Critical violations must be corrected immediately or within 10 days)(Non-critical violations GeoTMS®2005 Des Lauriers Municipal Solutions, Inc. ( Rev. Aug 29,2005 ) PaQe 1 of 3 0028 Norman Street Deleo's Pizza must be Corrected Immediately PROTECTION FROM CONTAMINATION Not Done or within 90 days) a T Separation/Segregation/Protection PASS RED RED. Food Contact Surfaces Cleaning and Sanitizing FAIL Critical ❑� RED I he cutting boards are stained and Violations Related to Foodbornelllness Interventions scored. R surtace or replace all cutting boards. and Risk Factors (Require < The nitizer at the counter was too weak immediate corrective action) the spray bottle did not work. Provide sanitizing solution of proper concentration in a working spray bottle at all work stations at all times. Proper Adequate Handwashing PASS RED Good Hygienic Practices PASS ❑J RED Prevention of Contamination from Hands PASS Q RED Handwash Facilities FAIL Critical 0 RED _ T soap dispenser at the cookline andwash sink needs to be refilled. PROTECTION FROM CHEMICALS Not Done Approved Food or Color Additives PASS 0 RED Toxic Chemicals PASS ❑d RED TIME/TEMPERATURE CONTROLS(Potentially Haz Not Done Cooking Temperatures PASS 0 RED Reheating PASS RED —� Cooling PASS Q RED Hot and Cold Holding FAIL Critical ❑d RED Th cooling nit oppisite the oven had a Moeratur of 50"F. Repair unit to y temperature of 41°F or below. reachin had a temperature of pair unW maintain a temperature orb w. Walkin h a temperature of 46"F. Repair unit to aintain a temperature of 41°F or be Time As a Public Health Control PASS d❑ RED REQUIREMENTS FOR HIGHLY SUSCEPTIBLE PO Not Done Food and Food Preparation for HSP PASS yj RED CONSUMER ADVISORY Not Done Posting of Consumer Advisories PASS ❑J RED GeOTMS®2005 Des Lauriers Municipal Solutions, Inc. ( Rev. Aug 29,2005 ) Pave 2 of 0028 Norman Street Deleo's Pizza Violations Related to Good Retail Practices (Blue Not Done Management and Personnel PASS ❑ BLUE Food and Food Protection PASS ❑ BLUE Equipment and Utensils FAIL Non-Critical ❑ BLUE T anope has an accumulation of rime. T oughly scour canopener. The a ha led knives need a thorough cl ingw6cifically the handles. hes Iving in the walkin has an a mutation of grime. Thoroughly clean all shelving. Theyread freezer needs a visibli, accurate L�ermometer. Water, Plumbing and Waste PASS ❑ BLUE Physical Facility FAIL Non-Critical ❑ BLUE Ther re many missing/damaged ceiling 11 in backrooms. Replace all mis ' g/damaged ceiling tiles The ki f ring needs a thorough cl g under all racks. Poisonous or Toxic Materials FAIL ❑ BLUE Special Requirements PASS ❑ BLUE Other-See Notes PASS ❑ BLUE 5;__�t"1 GeoTMS®2005 Des Lauriers Municipal Solutions, Inc. ( Rev. Aug 29,2005 ) Page 3 of CITY OF SALEM MASSACHUSETTS BOARD OF HEALTH _ 120 WASHINGTON STREET, 4TH FLOOR SALEM, MA 01970 TEL. 978-741-1800 FAX 978-745-0343 STANLEY J. USOVICZ, JR. JOANNE SCOTT, MPH, RS, CHO MAYOR HEALTH AGENT COMMONWEALTH OF MASSACHUSETTS PERMIT TO OPERATE A FOOD ESTABLISHMENT In accordance with regulations promulgated under authority of Chapter 94, Section 305A and Chapter III, Section 5 of the General Laws, to operate a Food Establishment in the City of Salem is hereby granted to: Type of Establishment: FOOD SERVICE Name of Establishment: Deleo's Pizza Address of Establishment: 28 Norman Street Owner's Name: Tomi Gjikuria Restrictions: Application Date: 11/24/2004 Permit for Food Establishment 68-05 Frozen Desserts/Ice Cream Permit for the Sale of Tobacco Products These Permits Expire December 31, 2005 This permit is not transferable and must be reissued upon change of ownership or location. The permit must be posted in a prominent location in the Establishment, In accordance with the State Sanitary Code, before any renovations, improvements, or equipment changes are made, all plans for such must be submitted to and approved by the Salem Board of Health. HEALTH AGENT / CITY OF SALEM9 MASSACHUSETTS .� BOARD OF HEALTH /-/^�,�jy�(� s s rV ry 93 120 WASHINGTON STREET, 4TH FLOOR �7ys 0I' SALEM, MA c TEL. 978-741'1800 3.n>970 �O"4 o FAX 978-745-0343 V" G STANLEY J. LISOVICZ, JR. JOANNE SCOTT, MPH,-RS, CH j��y� MAYOR HEALTH AGENT 'AT //R 2005 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISMf IN, NAME OF ESTABLISHMENT U LFL iF :S to/ e72 4 TEL# `% c'd L/ Zc�4� ADDRESS OF ESTABLISHMENT 2C? /YC 9 /"Wly St S,#9 t /`9 M0 L9/I �t7 MAILING ADDRESS (if different) OWNER'S NAME ` / 0/-) / (7.7 1 k LI 0- 1 ✓f TEL# ADDRESS/Y0f27-t4 /`ID S � CITY f1� tgt' J'�) / STATE t"74 ZIP c9/ `� 6O CERTIFIED FOOD MANAGER'S NAME(S) TO/"`I t C:jiKirtPiA CERTIFICATE#(s)3.35'_�6 -I- (required in an establishment where potentially hazardous food is prepared.) EMERGENCY RESPONSE PERSON HOME TEL# HOURS OF OPERATION; Mon) - IJ' Tue.1l-lO Wed.11_IGThu. 1`!d Fri.//-1( Sat. N-!0 Sun. l l-to TYPE OF ESTABLISHMENT FEE check only RETAIL STORE YES NO less than 1000sq.ft. =$ 50 1000-10,000sq.ft. =$100 more than 10,000sq.ft. =$250 RESTAURANT YES NO / less than 25 seats =$100 l� 25-99 seats =$150 more than 99 seats =$200 BED/BREAKFAST YES NO $100 ADDITIONAL PERMITS MAKE (not just serve) ICE CREAM, YOGURT, SOFT SERVE YES NO $5 TOBACCO VENDOR YES NO $50 ALL NON-PROFIT(such as church kitchens) YES NO $25 Please pay total with one check payable to the City of Salem This Permit is not transferable and must be reissued upon change of ownership. The Permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code, before any renovations, improvements, or equipment changes are made, all plans for such must be submitted to and approved by the Salem Board of Health. Pursuant to MGL Chapter 62C, Section 49A, I certify under the pains and penalties of perjury that I, to my best knowledge and belief, have filed all state tax returns and paid all state taxes required under the law. Signature Date Social Secu it or Federal Identification Number csaz i.�C- - �A--- - -------------------------��_�4141�22� ----------------------'----- --- ---- - --------------- Revised 11/03/03 FOOD .adm Check#&Date /59-3 //�r ;✓ CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH �. 120 WASHINGTON STREET, 4TH FLOOR SALEM, MA 01970 TEL. 978.741.1800 FAX 978-745-0343 STANLEY J. 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: Type of Establishment: FOOD SERVICE Name of Establishment: Deleo's Pizza Address of Establishment: 28 Norman Street Owner's Name: Tomi Gjikuria Restrictions: Application Date: 12/4/2003 Permit for Food Establishment 93-04 Frozen Desserts/Ice Cream Permit for the Sale of Tobacco Products These Permits Expire December 31, 2004 This permit is not transferable and must be reissued upon change of ownership or location. The permit must be posted in a prominent location in the Establishment, In accordance with the State Sanitary Code, before any renovations, improvements, or equipment changes are made, all plans for such must be submitted to and approved by the Salem Board of Health. HEALTH AGENT .P a CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH • • ' 120 WASHINGTON STREET, 4TH FLOOR SALEM, MA 01970 TEL. 978-741-1800 FAX 978-745-0343 STANLEY USOVICZ, JR. JOANNE SCOTT, MPH, RS, CHO MAYOR HEALTH AGENT 2004 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT NAME OF ESTABLISHMENT 0CL /`0-) P% 22A TEL# `aid'' rVL9 ' ?,et9J' ADDRESS OF ESTABLISHMENT Of? M P9 A/ 5HL 6d'7 "'7 Pq 0/-j 7') MAILING ADDRESS (if different) OWNER'S NAME , 7-,Q 6.7 i K t+ ✓1 1 P TEL# ADDRESS CITY_ STATE. _ ZIP CERTIFIED FOOD MANAGER'S NAME(S) i oelI �i y i K it1Q i.Q_CERTIF!CAfEi#(s)-� 3S3 lQ J (required in an establishment where potentially hazardous food is prepared.) EMERGENCY RESPONSE PERSON /�/-it C7,<%/ktj4,r ,J HOME TEL# HOURS OF OPERATION: Mon.fl- 10Tue.11- to Wed. (I• !0 Thu. it, to Fri.//-I/ Sat. 11- rt Sun./(-/o TYPE OF ESTABLISHMENT FEE check only RETAIL STORE YES less than 1000sq.ft. =$ 50 1000-10,000sq.ft. =$100 9 2 Q more than 10,000sq.ft. =$250 RESTAURANT YES NO J less than 25 seats =$100 25-99 seats =$150 more than 99 seats =$200 BED/BREAKFAST YES O $100 ADDITIONAL PERMITS MAKE (not just serve) ICE CREAM, YOGURT, SOFT SERVE YES $5 TOBACCO VENDOR YES N $50 ALL NON-PROFIT(such as church kitchens) YES NO $25 Please pay total with one check payable to the City of Salem — This Permit is not transferable and must be reissued upon change of ownership. The Permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code, before any renovations, improvements, or equipment changes are made, all plans for such must be submitted to and approved by the Salem Board of Health. Pursuant to MGL Chapter 62C, Section 49A, I certify under the pains and penalties of perjury that I, to my best knowledge qnd belief, have filed all statQ tax returns and paid all�t tax�re ire de law. Signature Date Social Security or Federal Identification Number -- -- ----- -------- - -------------// �I Revised 11/03/03 FOODAP2.adm Check#&Date 1*"x lam. ,.. n. ,..".-.f F: gyp'. Y: • ` � y..i µ-..,v. .. nL1` i Massachusetts Department of Public Health Salem Board of Health 120 Washington Street,41" Floor Division of Food and Drugs I Salem, MA 01970-3523 FOOD ESTABLISHMENT INSPECTION REPORT Tel. (978) 741-1800 Fax (978) 745-0343 Name Date T e of 0 eration s Tvpe of Inspection Food Se vice Routine Address ❑ Retail D r Risk ❑ Re-inspection Telephone Level ❑ Residential Kitchen Previous Inspection M ❑ Mobile Date: Owner�� HACCP Y/N [I Temporary E] Pre-operation /v ❑ Caterer ❑ Suspect Illness Person in Charge(PIC) ElBed&Breakfast ❑ General Complaint Inspector OuEl HACCP t: Permit No. ❑ Other Each violation Ofecked 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 El 14 Approved Food or Color Additives ❑ 3. Personnel with Infections Restricted/Excluded FOOD FROM APPROVED SOURCE ❑ 15.Toxic Chemicals ❑ 4. Food and Water from Approved Source TIME/TEMPERATURE CONTROLS(Potentially Hazardous Foods) ❑ 5. Receiving/Condition ❑ 16. Cooking Temperatures ❑ 6. Tags/Records/Accuracy of Ingredient Statements ❑ 17. Reheating ❑ 7. Conformance with Approved Procedures/HACCP Plans ❑ 18. Cooling PROTECTION FROM CONTAMINATION - ❑ 19. Hot and Cold Holding ❑ 8. Separation/Segregation/Protection F] 20.Time As a Public Health Control 9. Food Contact Surfaces Cleaning and Sanitizing REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) 10. Proper Adequate Handwashing El 21. Food and Food Preparation for HSP ❑ ❑ 11. Good Hygienic Practices CONSUMER ADVISORY ❑ 22. Posting of Consumer Advisories Violations Related to Good Retail Practices Number of Violated Provisions Related Critical (C) violations marked must be corrected To Foodborne Illnesses Interventions Z 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.aN590.000/federal Food Code. This report, when signed below 23. Management and Personnel (FC-2)(590.003) by a Board of Health member or its agent constitutes an 24. Food and Food Protection (FC-3)(590.004) order of the Board of Health. Failure to correct violations 25. Equipment and Utensils (FC-4)(590.005) cited in this report may result in suspension or revocation of 26. Water, Plumbing and Waste (FC-5)(590.006) the food establishment permit and cessation of food establishment operations. If aggrieved by this order, you 27. Physical Facility (FC-6)(590.007) have a right to a hearing. Your request must be in writing 28. Poisonous or Toxic Materials (FC-7)(590.008) and submitted to the Board of Health at the above address 29. Special Requirements (590.009) within 10 days of receipt of this order, 30. Other DATE OF RE-INSPECTION: S'590/nspeclFortM'40.tlCc Inspector's Signatur Print: PIC's Signature: �" Prink 1 Pagel 0f 2"Pages Tc9t'� l C> y k /2/�9 C . Violations Related to Foodborne Illness Interventions and Risk Factors(items 1-22) PROTECTION FROM CONTAMINATION FOOD PROTECTION MANAGEMENT N _ Cross-contamination 1 590,003(A) Assi mment of R,es tonsibility* 3-302.11- (A)(]) 2 Raw Animal Foods Separzued hom 590.003(B) Demonstration of Knowled*e* Cooked and RTE Foods 12 2-103.11 Parson in ch:u e--duties Contamination from Raw ingredients 3-30111(A)(2) Raw Animal Foods Separated from Each EMPLOYEE HEALTH Other* 2 590.003(0) Responsibility of the person in charge to Contamination from the Environment require reporting by food employees and 3-302.11(A) Food Protection" applicants* 3-302.15 WashingFitiusandVe�etabies 590.003(F) Responsibility Of A Food Employee Or An 3-304.1.1 Food Contact with Equipment and Applicant To Report To The Person In Utensils* Charge* Contamination from the Consumer 590.003(0) Re orcin by Person in Charge* 3-30 114(A)0 ) Returned Foci and Resen ice of Fund'" 3 590.003(D) I Exciustonsand Restrictions* Disposition of Adulterated or Contaminated 590.003(E) Removal of Exclusions and Restrictions Food 3-701.11. Discarding or Reconditioning Unsafe FOOD FROM APPROVED SOURCE Food* 4 Food and Water From Regulated Sources 9 Food Contact Surfaces 590.004(A-B) Compliance with Food Law* 4-501,111 a1anne l Warewashing-Hot Water 3-201.12 Food in a Hermetically Sealed Container* Sanitization lem eratures* 3-201,13 Fluid Milk and MilkProduets* 4-501..112 Mechanical Warewashing HbtWater 3-20213 Shell Eg*s* Sanitization Temperatures* 3-20214 Eggs and Milk Products,Pasteurized" 4-501.114 Chemical Sanitization-temp.,pH, 3-202.16 Ice Marie Frorn Potable Drinking Water antcenn,ation and hardne s, * 's 4-601.11 kA) Equipment Food Contact Surfaces and 5-101-11 Drinking Water from an Approved System Utensils Clean- S90.006( Bottled Drinking Water* 4{02,11 Cleaning Frequency ofEquipment Faad- 590.006(B) Water Meets Standards in 310 CMR 22.0* Contact Surfaces and Utensils' Shellfish and Fish From an Approved Source 4-742.t 1. Frequency of Sanitization of Utensils and 3-201.14 Fish and Recreationally Caught Molluscan Food Contact Surfaces of E ui menta Shellfish* 4-703.11 Methods of Sanitization-Har Water and 3-201.15 Molluscan Shellfish from NSSP Listed Chenucsil* Sources 1Q Proper,Adequate Handwashing Regulatory Aurhorish Game and Murooms Approved by 2-301.11. Clean Condition---Hands and Arms* Authority 3-202-18 Shellstock Identification Present" 2-301.12 Cleaning Procedure* 590.004(C) Wild Mushrooms* r 2-301.14 When to Washy' 3-201.17 Came Animals* J1 Good Hygienic Practices g ReeeivinglConditian 2401.11 F.,at3n ,Drinking,or Using Tobacco* 3-:02.11 PI Received at Proper Tetn eramires;k 2-401.12 Discharges From the Eyes,Nose and 3-202-1.5 Package bacauit * Month* 3-101.11 Fad Safe andUnadulterated* 3-301.12 Preventing Contamination When Tastin r* ---Sheilstock 12 Prevention of Contamination from Hands 6 Tags/Records: 3-202.18 Shellsta-k Identification* 590.004(E} Preventing Contamination from 3-203.12 Shellstock'Identification Maintained`" Handwash Facilities Tags/Records: Fish Products 13 Haash . Conveniently Located and Accessible 3-402..1 1Parasite Destruction"; 3-402.12 Records,Creation and Retention* 5-2203.1"( Numbers and Ca acitiess 590.0(1-1(J) Labeling of Ingredients" 5-204.11 � Location and Placement* q Conformance with Approved Procedures 5-205-11 Accessibility_O ep ratmn and Maintenance MACCP Plans Supplied with Soap and Hand Drying Devices 3-50211 Specialized Processing 4cthals* 6-301.11 HandwashirwCleansei.Availab111C 3-502.12 Reduced oxygen packaging,criteria" 5-103.12 Conformance with Approved Procedures* 6-301.12 Hand Dtyin>Provision "Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. CITY OF SALEM BOARD OF HEALTH ' Establishment Name: Date: �r`l Page:_ of Z Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date No. Reference R-Red Item - - Verified PLEASE PRINT CLEARLY c 2 d J7 dWFlo? of494Khn L r/!1 all a s�A d r d ,pp�L Ar AV- 0A.1v r u Y/ 1/3 C "_ A490!tWtr �I W t t-I �I Discussion With Person in Charge: Corrective Action Required: ❑ No ❑ Yes I have read this report, have had the opportunity to ask questions and agree to correct all ❑ Voluntary Compliance ❑ Employee Restriction/ Exclusion violations before the next inspection, to observe all conditions as described, and to ❑ Re-inspection Scheduled ❑ Emergency Suspension comply with all mandates of the Mass/Federal Food Code. I understand that noncompliance may result in daily fines of twenty-five dollars or suspension/revocation of ❑ Embargo ❑ Emergency Closure your food permit. le-' ( fJA < ❑ Voluntary Disposal ❑ Other: I i a k � . p A 3-501.14(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 41-lours. PROTECTION FROM CHEMICALS 19 3-501.15 Cooling Methods for PHFs 14 Food or Color Additives PHF Hot and Cold Holding 3-501.16B) Cold PHFs Maintained at or below AddifiNcs" 3=262.12 590.004(F) 47't45`Fa 3-302.14 PDO- GIIOn from trnap roved Additives* 4-501,16(,A) f for PHF,Maintained at or above 15 Poisonous or Toxic Substances 140"F. * 7-101.11 Identifying fi formation-Original 3-501.1.6(A) Roasts Held at or above 130°F. Containers* 7-102.11 Common Name-Workino Containers* 24 Time as a Public Health Control 7-201.11 Se.aration-Stomae'; 3-501-19 Time as t,Public Health Central* 7-202.1.1 Restriction-Presence and Use* 5u7rement 90.004(H) Variance Re 7-202.12 Conditions of Ilse* 7-203.11 Toxic Contarnars-Prohibanim , REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-204.11 Sarritizers,Criteria-Chemicals* POPULATIONS(HSP) 7-2(4.12 Chemicals for Washine Produce,Criteria* 21 3-801A IfA) Unpasteurized Pre-packaged Juices and 7-204.14Drvin�A*eats.Criteria* Bevernees with Wmnine Labels, 7-205.11 Incidental Food Contact,Lubricants* 3-801.1 1(6) Use of Pastern zed Eees* 7-206.1 I Restricted Use Pesticides.Criteria* 3-801-11(D) Raw or Partially Cooked Animal Food and Raw SceciS)routs Not Served. 7-206.12 Rodent Bait'Stations* 3-801.11(C) (in cued Food Pa.:ka=e No[Re-served. 7-206.13 Tracking Powders,Pest Control and Monitoring* CONSUMER ADVISORY TIMEITEMPERATURE CONTROLS 22 3-603.1 I Consumer Advisory Posted for Consumption of Animal FIs That are Raw.Undercooked or 16 Proper Conking Temperatures for PHFs Nat Otherwise Processed to Eliminate 3-401.1 IA(1)(2) Eggs- 1.55°F 1.5 Seo. 1'athn c-ns * -nuwv, +gaol E>>s-InmtediateService 145'F15sec* 3-302.13 Pasteurized Eggs Substitute for Raw Shell 3-401.11(A)(2) Commented Fish, Meats&Ganic E s* Animals- 155'F 15 sec. * 3-401.I1(B)(1)(2) Pork and Beef Roast- 130'F 121 min* SPECIAL REQUIREMENTS 3-401.11(A)(2) Ratites, Injected Meats-155'F 15 590.009(A)-(D) Violations of Section 590.009(A)-(D)in 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 Poultr,or Ratites-165'F 15 sec. * above if related to Foodborne illness 3-40111(C)(3) Whole-muscle,Intact Beef Steaks interventions and risk factors. Other 145°F* 590.009 violations relating to good retail 3401.12 Raw Animal Foods Cooked in a practices should be debited under #29- Microwave 165'F* Special Requirements. 3-401_11(A)(1)(b) All Other PHFs- 145°F 15 sec. * 17 Reheating for Hot Holding VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 3-403.11(A)&(D) PHFs 165°F 15 sec.* (I terns 23-30) 3403.11(B) Microwave-165°F 2 Minute Standing Critical and non-f.riticat violations, tehwit do not relate to the Time* foodborne ithiess interventions and risk factors fisted atone, can be 3-403.11(C) Cormnercially Processed RTE Food- found in the follou ittg,sections of the Food Code and 10.5 CMR 1.4WT* 590.000. _ 3-4011.1(E) Remaining Unsliced Portions of Beef Item Good Retail Practices FC 590.000 Roasts* 23. Mona ement and Personnel FC-2 .003 - --------------- 18 Proper Cooling of PHFs 24. Food and Food Protection FC-3 .004 25._____E_t uipment and Utensils PC 4 .005 3-501.1.4(A) Cooling Cooked PHFs from. 140'F to 26. Water,Plumbin and W este FC S 006 70°F Within 2 flours and From 70'1' 27. Ph sisal Facili FC-6 I .007 to 41''F/45'F Within 4 Hours. * 28. Poisonous or Toxic Materials FC-7 1 .008 3-501.14(6) Cooling PHFs Made From Ambient 29_ S ecial fte uirements _ .008 Temperature htgredicros to 4l F145'F .....,_ 1her Within 4 HorrB" rsrrra�.,nxxFs.a�� Denotes critical item in the federal 1999 Foal('ode or 165 CMR 590000. , 1d' 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 DateT e O erasion s Type of Inspection l�f_C�O 1 r- 7_M S a-04 pod Service ❑ Ryutine Address p� �0� �� Risk E] Retail ORe-inspection Telephone 7 Level El Residential Kitchen Previous I spection 1/0 2 00 ❑ Mobile Date: </1 JA Owner HACCP Y/N ❑ Temporary ❑ Pre-operation r-l!)&t Gfl"lA IfIA ❑ Caterer ❑ Suspect Illness Person in Charge(PIC) Time ❑ Bed&Breakfast ❑ General Complaint ` ' o- In: ❑ HACCP Inspector,.,,,;,,, y/ K r Out: Permit No. El Other Each violation checked requires an explanation on the narrative page(s) and a citation of specific provisions) 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 - El3. Personnel with Infections Restricted/Excluded ❑ 14.Approved Food or Color Additives FOOD FROM APPROVED SOURCE - El 15.Toxic Chemicals ❑ 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 ❑ 9. Food Contact Surfaces Cleaning and Sanitizing REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) ` El 10. Proper Adequate Handwashing El21. Food and Food Preparation for HSP ❑ 11. Good Hygienic Practices CONSUMER ADVISORY ❑22. Posting of Consumer Advisories Violations Related to Good Retail Practices Number of Violated Provisions Related Critical (C) violations marked must be corrected To Foodborne Illnesses Interventions Q 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 of Health. today, the items checked indicate violations of 105 CMR �- 'N , 590.000/federal Food Code. This report, when signed below 23. Management and Personnel (FC-2)(590.003) by a Board of Health member or its agent constitutes an 24. Food and Food Protection (FC-3)(590.004) order of the Board of Health. Failure to correct violations 25. Equipment and Utensils (FC-4)(590.005) cited in this report may result in suspension or revocation of 26. Water, Plumbing and Waste (FC-5)(590.006) the food establishment permit and cessation of food establishment operations. If aggrieved by this order, you 27. Physical Facility (FC-6)(590.007) have a right to a hearing. Your request must be in writing 28. Poisonous or Toxic Materials (FC-7)(590.008) and submitted to the Board of Health at the above address 29. Special Requirements (590.009) within 10 days of receipt of this order. 30. Other DATE OF RE-INSPECTION: 55901nsp¢CfFOmS-I4.Occ igna Print: PIC's Signature •� Print: 7 o/-�/ / CrL / /I 1 v7 , Pager. of�Pages rw .. Violations Related to Foodborne Illness Interventions and Risk Factors(items 1-22) PROTECTION FROM CONTAMINATION FOOD PROTECTION MANAGEMENT 8 Cross-contamination 1 590.003(A) Assi�tment oP Res onsibibty* 9-302.11(A)(1) Raw Animal Foods Separated from 590.003(13) Demonstration of Knowiedq�e* _ Cooked and RTE Foods- 2103,11 oods`2103 11 Person in 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 food employees and 3-302.1 1(A) Food Protection* a licants* 3-302.15 Washine Fruits and Vegetables 590.003(F) Responsibility Of A Food Employee Or An 3-304.11 Food Contact with Equipment and Applicant To Report To The Person Lt Utensils"' Charge* Contamination From the Consumer g90.003(G) Reporting by Person in Charge* 3-306.14(A)(B) Returned Food and Resetvice of Fax(' 3 590.003(D) EXclusionS and Restrictions* Disposition of Adulterated or Contaminated 590.003(E) Removal of Exclusions and Restrietinns Food 3-701.11 Discarding or Reconditioning Unsafe FOOD FROM APPROVED SOURCE Food* 4 Food and Water From Regulated Sources 9 Food Contact Surfaces 590.004(±_B) Compliance with Food Law" 4-501.111. Manual Warewashing-HotWater Sanitization Icmeratures' 3-201.12 Food in a Hermetically Sealed Container* 4-501.112 Mechanical W srewashino Hot Water 3?01.13 Fluid Milk and Milk Products* 3-202.13 Shelf Eggs* Sanitization Tem eratures* 3-202.14 E as and Nfilk Pro ucts.Pasteurized" 4-501.114 Chernical S r itization-temp.,pH, concentration and hardness 3-202.16 Ice Made From Potable Drinkimz Water'k 4 5-101.11 DrinkmL Water from an A roved Svstem'r -6011.. I tA) Equipment Food Contact Curfaces and Utensils Clean' 590.006(A) Bottled Drinl:ingWater! 4-602.11 Cleaning Frequency ofEquipment Food- 590.006 BO Water Meets Standards in 310 CMR 220'" Contact Surtaccs air(]Utensils* She/fish and Fish From an Approved Source _4702,11 Frequency of Sanitization of Utensils and 3-21)1.14 Fish and RecmationalIyCaught Moll uscan Food Contact Surfaces ofE ui meat* Shellfish* 4-703.11 Methods of Sanitization-Hot Water Burd 3-201.15 Molluscan Shellfish from NSSP Listed Chernical* Sources" 10 Proper,Adequate Handwashing Game and Wild Mushrooms Approved by Regulatory Authority 2x301.11 Clean Condition-Hands and Arms* - 3-202.1.8 Shellstock Identification Present" 2.301,12 Clcanin'Procedure* 590.004(C) Wild Mushrooms* 2-301.14 When to Wash* 3-201..17 Game Animals" 11 I Good Hygienic Practices 5 Receiving/Condition 2-401.11 Eatin>,Drinkim,or Usute Tobacco* 3-202.11 PHFs Received at Pro}er Temper atureg* 2-401.12 Discharges From the Eyes-Nose and 3-202.15 Parka e Into it°"` Mouth` '-101.11 Food Safe and Iinadulteratcd* 3-301.12 Preventive Contamination When Tastin'* 6 Tags/Records:Shsllstock 12 Prevention of Contamination from Hands 59Preven 3-202.18 Sheltslockldentification* 0.004(E) Ennplocmg Contamination from 3-203.12 Shellstock Identification Maintained"` Ha ndash Facilities w Tags/Records: Fish Products 13 Conveniently(.ocatedand Accessible 5-203.11 Numbers and 3-402.12 Rearrds.Creation and Retention* Ca acities* 59 02.12 ) Labelingof Ingredients' 5-204.11 Location turd Placement" 7 Conformance with Approved Procedures 5-20511 Accessibility,o aeration and Maintenance /HACCP Plans Supptiod with Soap and Hand Drying 3-502-11 Specialized Processing Methods* Devices 3-502.12 Reduced oxygen aet:agin ,cri�erla* 6-301.1.1 Ilandwashine Cleanser.Av.dlabilit 8-103.12 Conformance with 9 iroved Fracerhues 301.13 timid Dryin Provision , *Denotes critical item in rhu federal 1999 good Code or 105 CMR 590At>0. CITY OF SALEM nn f BOARD OF HEALTH 4 Establishment Name: Oktsa s ?I.1z' - Date: Page: of � Item Code c=Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date x No. Reference R—Red Item - - Verified .. Oi / PLEASE PRINT CLEARLY F p T I l 1 r F ti r 111,9 Al r 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 C?"r violations before the next inspection, to observe all conditions as described, and to ❑ Re-inspection Scheduled ❑ Emergency Suspension comply with all mandates of the Mass/Federal Food Code. I understand that noncompliance may result in daily fines of twenty-five dollars or suspension/revocation of ❑ Embargo ❑ Emergency Closure your food permit. �� L C c(J4 � 'k ❑ Voluntary Disposal LlOther: 3-501.1d(Cj PRFs Received at'femperatures Violations Related to Foodborne illness Interventions and Risk According to I.aw Cooled to Factors(items 1-22) (Cont.) 41°F/45`B Within 4 Homs. PROTECTION FROM_ _CHEMICALS 3-501.15 Cooling Methods for PHFs 14 Food or Color Additives 19 PHF Hot and Cold Holding 3-202.12 AdditAdditives*- -- 3-501.16(B) Cold PHFs Maintainul at or betov,- 590.004(F) 41745°F' 3-302.14 Protection from Unapproved Additives* 4-SO1.4(F) Hot 45c F Maintained at or above 15 Poisonous or Toxic Substances 40'F. * 7-101.1,1 Containers Information-Original 3-501.16(A) Roasts Held at or above 130°F.* Containers` 7-102.11. Common Name Working Containers* 20 Time as a Public Health Control 7-201.11 Separation-Stortae"' 3-501.19 Time as a Public Health Control* 7-202.11 Restriction-Presence and Ilse* 590.004(1-1) Variance Re niremerlt 7-202.12 Conditions of Use, 7-203.1.1 Toxic Containers-Probibi ons* REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-204.11 Sarnnzers,Criteria-Chemicals* POPULATIONS(HSP) 7-204.12 Chemicals for Wishing produce.Criteria* 21 3-801.'11(A) Unpasteurized Pre-packaged Juices and 7-204.14 Drying Agents,Criteria* Beverages with Warning labels* 7-20.5.11 Incidental Food Contact. Lubricants* 3-801.17(B) Use of Pasteurized files* 7-206.11. Restricted Use Pesticides, Criteria* 3-801.1 1(D) Raw or Partially Cooked Animal Food and Raw Seed Sprouts Not Served. 7-206.12 Rodent Bait Stations* 3-801.11(C) Una ened Food Package Not Re-serves(. �` 7-206.13 'I'rackingPowders,Pest Control and MonrTorinR* CONSUMER ADVISORY TIMEITEMPERATURE CONTROLS 22 3-603.11 Consumer Advisory Posted for Consumption of Animal Foods That are Raw.Undercooked or 1b Proper Cooking Temperatures for PHFs Not Otherwise Processed to Elarinate 3-40'L11A(1)(2) Eggs- t55°F 1.5 Sec. Pathogens.*ere�n.r v;;a�wi htmiedtntx Service 1450F15se& 3-302.13 Pasteurized Eggs Substitute for Raw Shell 3-401.11(A)(2) Comtninated Fish,Meats&Game E es' Animals- 155'F 15 sec. 3-<401.11(B)(t)(2) Pork.and Beef Roast-130-F 121 min* SPECIAL REQUIREMENTS 3-401.11(A)(2) Ratites,Injected Meats-155'F 15 590.009(A)-(D) Violations of Section 590.009(A)-(D)in sec. + catering, mobile foul,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 risk factors. Other - 145017' 590.009 violations relrting to good retail 3-401.12 Raw Animal Foods Cooked in a practices should be debited under i{'29- Microwave 165`F* Special Requirements. 3-401A I(A)(1)(b) All Other PHFs- 145'14 15 see. 17 Reheating for Hot Holding V10LAT10NS RELATED TO GOOD RETAIL PRACTICES 3-403.11(A)&(D) PHFs 165'F 15 sec. * (Items 23-30) 3-403.11(B) Microwave-165' U2 Minute Standing Critical rued non-critical violations, which do not relate to the Time* foodborne,cllners inteivenlions and risk faciors listed above, can be 3-403.11.(C) Commercially Processed RTE Foal- found in the folloning sections of the Food Code and 105 CMR 140°F 590.000. - -- - 3-403.11(E) Remaining Unsliced Portions of Beef item Good Befall Practices. FC 580.000 Roasts' 23. Mang ement antl Personnel __.._____ FC-2 .003 18 Proper Cooling of PHFs 24. Food and Food Protection FC-3 .004 _ 3-501.14(A) Cooling Cooked PHFs front 140`14 to 25 EquiRment and Utensils FC 4 005_ 26 Water, Plumbin and Waste FC a 006 70°F Within 2 Hours and From 70'F 27. Physical Facility FC-6 .007 to 4l'F/45°F Within 4 Homs. * 2& Poisonous or Toxic Materials FC-7 .008 3-501.14(B) Cooling PHFs Made From Ambient 29. S ecial Re uirements _ Temperieure Ingredients to 41'1'/45'F3_0. Other'-'----_-_.__. ---------..._.....------- Within 4 Hours:" aswuamm,a�znoU 'Denotes critical item in the(deal 1999 Food Code or 105 CMR 590.000. 6 _ Massachusetts Department of Public Health Salem Board of Health 120 Washington Street, 4th Floor Division of Food and Drugs Salem, MA 01970-3523 FOOD ESTABLISHMENT INSPECTION REPORT Tel. (978) 741-1800 Fax (978) 745-0343 Name Date Tvpe of Ooerationfs) �Ipe of Inspection [SO p �� A /9/ 0 Food Service 0- Routine Address98 NGRM $� Risk El Retail ElRe-inspection Telephone Level ❑ Residential Kitchen Previous Inspection ?s OU Jtf ❑ Mobile Date: /ZA3/05 OwnerHACCP Y/N [ITemporary ElPre-operation SUM/ / /e /.4- ❑ Caterer ❑ Suspect Illness Person in Charge(PIC) Time ❑ Bed&Breakfast ❑ General Complaint In: ❑ HACCP Inspector0. PKK t; ff64v ✓. Amtj3rArvP Out: Permit No. ❑ Other Each violation checked requires an explanation on the narrative page(s) and a citation of specific provision(s)violated. Non-compliance with: Violations Related to Foodborne Illness Interventions and Risk Factors Anti-Choking Tobacco Violations marked may pose an imminent health hazard and require immediate corrective 590.009(E) ❑ 590.009(F) ❑ action as determined by the Board of Health. FOOD PROTECTION MANAGEMENT _. El 12. Prevention of Contamination from Hands Fl1. PIC Assigned/Knowledgeable/Duties 21/3. Handwash Facilities EMPLOYEE HEALTH _ PROTECTION FROM CHEMICALS ❑ 2. Reporting of Diseases by Food Employee and PIC El3. Personnel with Infections Restricted/Excluded El 14.Approved Food or Color Additives ❑ FOOD FROM APPROVED SOURCE 15.Toxic Chemicals _ ❑ 4. Food and Water from Approved Source TIME/TEMPERATURE CONTROLS(Potentially Hazardous Foods) ❑ 5. Receiving/Condition ❑ 16.Cooking Temperatures ❑ 6. Tags/Records/Accuracy of Ingredient Statements ❑ 17. Reheating ❑ 7. Conformance with Approved Procedures/HACCP Plans ❑ 18. oling PROTECTION FROM CONTAMINATION 19. Hot and Cold Holding El 8. Separation/Segregation/Protection El 20.Time As a Public Health Control L✓I 9. Food Contact Surfaces Cleaning and Sanitizing REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) " ❑21. Food and Food Preparation for HSP ❑ 10. Proper Adequate Handwashing ❑ 11. Good Hygienic Practices rCONSUMER ADVISORY..... ❑ 22. Posting of Consumer Prlv-.„ories Violations Related to Good Retail Practices Number e''Violated Provisions Related Critical (C) violations marked must be corrected To Foa,iborne Illnesses Interventions immediately or within 10 days as determined by the Board and F sk Factors(Items 1-22): of Health. Non-critical (N)violations must be corrected Of': .al Order for Correction: Based on an inspection immediately or within 90 days as determined by the Board t 1._y, the items checked indicate violations of 105 CMR of earth. 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)(590.004) order of the Board of Health. Failure to correct violations 25. Equipment and Utensils (FC-4)(590.005) cited in this report may result in suspension or revocation of 26. Water, Plumbing and Waste (FC-5)(590.006) the food establishment permit and cessation of food establishment operations. If aggrieved by this order, you 27. Physical Facility (FC-6)(590.007) have a right to a hearing. Your request must be in writing 28. Poisonous or Toxic Materials (FC-7)(590.008) and submitted to the Board of Health at the above address 29. Special Requirements (590.009) within 10 days of receipt of this order. 30. Other DATE OF RE-INSPECTION: S /20/N s:S01nsWfForm 14 Coc / e Sig re: Print: PIC's Signature: ,V �' Print: Page of 2'Pages Violations Related to Foodborne Illness Interventions and Risk Factors(items 1-22) PROTECTION FROM CONTAMINATION FOOD PROTECTION MANAGEMENT F R Cross-contamination 1 I 590.003(A) Assignment of Res3-302.11(A)(1) Raw Animal Foods Separated from 590.003(B) Demonstration of Knowledge* Cooked and I2TE Foods"` 2-103.11 Person in charge-duties Contamination from Raw Ingredients 3-302.11(A)(2) Raw Animal Foods Separated from Each EMPLOYEE HEALTH Other* 2 590M03(C) Responsibility of the person in charge to Contamination from the Environment require reporting by food entplovees and 3-302A I(A) Food Protection* applicants* 3-30115 Washing Fruits and Vegetables 590.003(F) Responsibility Of A Food Employee Or An 3-304.11 Food Contact with Equipment and Applicant To Report To The Person In Utensils* Change* Contamination from the Consumer 590.003(03) Rc ortina b Person in Charge" 3-306.14(A)(B) Returned Food and Reset vice of Food* 3 590.003(D) Exclusions and Restrictions* Disposition of Adulterated or Contaminated 590.003(f) Removal of Exclusions and Restrictions Food 3701.11 Discarding or Reconditioning unsafe FOOD FROM APPROVED SOURCE Food* 4 Food and Water From Regulated Sources 9 Food Contact Surfaces 590.004(A-B) Compliance with Food Law* 4-501.111 Maruil Warewashing-Hot Witter 3-201_72 Food in a IIe inctically Sealed Contatnar* Sanitization Temperatures* 3-201.13 Fluid Milk and Milk Froducts* 4-501.112 Mechanical Warewashing-Hot Water 3-202.13 Sanitization Temperatures* _ 3-202.14 E tits and Milk Products-Pasteurized" 4-501.114 Chemical Sanitization-temp.,pH, 3-202.16 ice Made Pram Potable Drinkin,Watc i'% concentration and hardness. 5-101.11 Drinking Water from an Approved System', 4-601 11(A} Equipment Food Contact Surfaces and Utensils Clean" 590.0(ti(A} Bottled Drinking y`iater* 4-(02.11 Cleaning Frequency of Equipment FLY4- 590.006(B) Water Meets Standards in 31.0 CMR 22.0* Contact Surfaces and Utensils* Shellfish and Fish From an Approved Source 4-70111 Frequency of Sanitization of Utensils and 3-201.14 Fish and Recreationally Caught Molluscan Food Contact Surfaces of Equipment* Shellfish* 4-703.11 R4ethocisofSanitization-HotWaterand 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* SourceO 10 Proper,Adequate Handwashing - Game and Wild Mushrooms Approved by 2-301.11 Clean Condition--Hands and Arms* ` Re Mato Aufhori 3-202.15 "hellstock Identification Present* 2-301.12 Cieaninv.Procedore" 590.004(C) Wild hI'lshro0ms* 2-301.14 When to Wash"` 3-201.17 Game Anal,�,5* 11 Good Hygienic Practices 5 Receiving/Condition 2-401.11 Satin*,Drhtk,in or Usina Tobacco" 3 202.11. PI-1Fs Received at Pro lei Teinpc azures` 2-401.12 Diwitarges From the Eyes-Nose and 3-202.15 Package Integrity* Mouth* 3-101.11 Food Safe and Unadulterated'" 3-301.12 Preventin*Contamination When Tustin 6 Tags/Records:Sheilstock s ' 12 Prevention of Contamination from Hands 3-202.13 Shellstock Identification. lti 590.004(E) Preventing Contamination from 3-203.12 Shellstock Identification Maintained" c Enr hwees` Tags/Records: Fish Products 13 Handwash Facilities 3-402.11 Parasite Destination* Conveniently Located and Accessible 3-402.12 Re orbs,Creation and Retention"` 5-303.11 Numbers and Ca acifies* 590.004(1) Labeling of Ingredients* 5-204.11 Location and Placement* 7 Conformance with Approved Procedures 5-2(15.11 Accessibility, O eratit}at azul Maintenaitce fHACCP Plans Supplied with Soap and Nand Drying 3-502.11 S ecialized Processing Methods* Devices 3-502.12 Reduced oxygen packaging,criteria" ,-30tH llandwashinizCleanser. Avarlabilit 3-103.12 Conformance with Approved Procedures" 6-301.12 Fla tdUryin«Prodrsian ,n Denote,critical item in tlge Ruderal 1999 Food Code or 105 CMR 590,000. CITY OF SALEM BOARD OF HEALTH Establishment Name: OsGd; �y "Olzm4 Date: Page: of i= item Code C-Critical item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date No. Reference R—Red Item Verified -PLEASE PRINT CLEARLY ' e'-, — i A1,016 s G' InP� li PGS n/ P� �dx QI�S dze, S4 ers e 7' 7nsL e T�Gtis e P n'e l a �eAarAl­ o d /.e v Let 7- as ,,P k1 ti 4 eS .Luh O)P ;,7 /41 S/LS c v Discussion With Person in Charge: Corrective Action Required: ElNo ElYes s I have read this report, have had the opportunity to ask questions and agree to correct all ❑ voluntary Compliance ❑ Employee Restriction/ e 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 'da�lfaes or suspension/revocation of ❑ Embargo ❑ Emergency Closure your food permit. ❑ Voluntary Disposal ❑ Other: ILIv r r 3-50 L 14(C) PIIFs Received at Temperatures Violations Related to Foodborne illness Interventions and Risk According,to Iaw Cooled to Factors(items 1-22) (Cont.) 4FF/4VF Within 4 Hours. PROTECTION FROM CHEMICALS3-501.15 Cooling Methods for PHFs 1=414 Food or Color Additives 19 PHF Hot and Cold Holding 3-501.16(11) Cold P1I17s Maintained at or below -3-202.12 Additiws'r 590D04(F) 41"/45' F* 3-302.14 Protection from Una roved Additives* _T50 1.I(i(A) Hot PHFs Maintained at or above t5 Poisonous or Toxic Substances 140"F. * 7-101.11 Identifying Information-Otiginai 3-501.16(A) Roasts Held at or above 130'17. Containers* 7-102.11 Common Name-Working Containers* Time as a Public Health Contra) 7-201.11 sepal ation-Storaee* 3-501.19 Time as a Public Health Control* 7-202,11 Restriction-Presence and Use' 590.0040-I) Variance__ Re uircxnent 7-202.12 Conditions of Use` 7-203.1.1 Toxic Containers-Prohibitions* REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-204.11 Sanitizers,Criteria-Chemicals* POPULATIONS(HSP) 7-204.12 Chemicals for Washing Produce.Criteria* 21 3-801.11(A) Unpasteurized Pre-packaged Juices and 7-204.14 Din ei*ents,Criteria` Beverages with Warning Labels* 7-205.11 Incidental Food Contact,Lubricants* 3-801,11(B) Use of Pasteurized'Ee,«s* 7-206.11 Restricted Use Pesticides.Criteria* 3-801,11(D) Raw nr Partially Cooked Animal Food and Raw Seed S�roufs Not Served. 7206 'x 7-206.12 Rodent Bait derns"` 3-801.11(C) Unopened flood Package Not Re-served- - -'13 'Cracking Powders,pest Control and Monitoring* CONSUMER ADVISORY TIMEJTEMPERATURE CONTROLS 22 3 603.1 I ,onsnmcr Advisory Posted for Consumption of 16 Proper Cooking Temperatures for Animal Foals That are Raw.Undercooked.or PHFs Not Otherwise Processed to Eliminate _ Pathovens'.*Era°n,a+n,7oai 3-401.LlA{7)(2) Eggs- 1.55`F 15 Sec. Eggs-lmmediateService 145°Fl5sec* 3-31)2.13 Pasteurized Eggs Substitute for Raw Shell 3-401.11(A)(2,) Comminuted Fish, Meats&Game Feet* Anituals- 155'F 15 sec. s 3-401.11(B)(1)(2) Pork and Beef Roast - 13WF 121 min* SPECIAL REQUIREMENTS 3-401.11(A)(2) Ratites,Injected Meats 155`F 15 590.009(A)-(D) Violations of Section 590.009(A)-(D)in sec. _ I 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-16517 J5 sec. * above if related to foodborne illness 3-401,11(C)(3) Whole-muscle,Intact Beef Steaks interventions and risk factors. Other 1450F* 590.009 violations relating to good retail. 3-401.12 Raw Animal Foods Cooked in a practices should be debited tinder#29- Microwave 165'F* Special Requirements. 3-40L11(A)(1)(b) All Other PHFs-145'F 15 sec. 17 Reheating for Hot Holding VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 3-403.11(A)&(I)) PHFs 165°F 15 sec. * - (.items 23-30) 3-403.11.(12) Microwave- 165°F 2 Minute Standing Gritrca'and non-critical violations, ivinch do nar relate to the Tune` foodborne illness Nina ventions and risk factors listed above can be 3-403.11 IC) Conunercial ly Processed RTE Food- found is the following,sections of the Food Code and 105 CMR 140°F* 590.000. --90. ------- 3-408.7.1(B) Remaining Unslieed Portions of Beef item and Refait Practicas FC 980.000 Roasts` 23. Manaclement and Personnel_ FC-2 .003 13 Proper Cooling of PHFs 24._ Food and Food Protection -._ FC--3 _ .004 26 Equipment and Utensils FC 4 .005 3-501.14(A) Cooling Caked PHFs from 140'F to ------ -- -�--- --- 26. _ Water,Plumbic and Waste FC 5_ .006 ai 70'F Within 2 Hairs and From 70'F 27. Ph sicai FacilitesFC-6 .007 to 41'F/45'F Within 4 Hours. * 28. Poisonous or Toxic Materials FC-7 .008 3-501.14(B) Cooling PHFs Made From Ambient 29- 5 ecial R uirements _ _ .009 Temperature htgredientsto4l`F/45`17 39r_.._._ -Other Within 4 Hours" i 11101 &­Vi2'm, °Denotes critical item in tha iaderzl 1999 Food Code or 105 CMR 590000. 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 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 : Tomi Gjikuria Name of Establishment : Deleo ' s Pizza Address of Establishment : 28 Norman Street Type of Establishment : FOOD SERVICE Application Date : 02/11/2003 Restrictions: Permit for Food Establishment 275-03 Frozen Desserts/Ice Cream Permit for the Sale of Tobacco Products These Permits Expire December 31, 2003 This permit is not transferable and must be reissued upon change of ownership or location. The permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code, before any renovations, improvements, or equipment changes are made, all plans for such must be submitted to and approved by the Salem Board of Health. HEALTH AGENT CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH • a 120 WASHINGTON STREET, 4TH FLOOR SALEM, MA 01970 sp�,p 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 ESTABLISHMENT NAME OF ESTABLISHMENT DC eP 0 /S b0/ 2Z c l TEL# 9?�8 ;;'�Y O 2 S O 0 ADDRESS OF ESTABLISHMENT 2 6> /Yo N VMI r:1 ;`I S f . 569 LIFZ'7 L71'9 D/ 9 IrC MAILING ADDRESS (if different) OWNER'S NAME / C9/`/)l G�/�K (A fQ- 1 uQ TEL# 9-7 C3 ADDRESS 0'Z L y/y/y�/'tEL /J Sf CITY PEtA /'1 O D `/ STATE /`1 6-9 ZIP cq/ 6 G> CERTIFIED FOOD MANAGER'S NAME(S) 7_01W GJ/K ctrl i✓J CERTIFICA #(s) PA`/y //Y c• �/,'V c.93 (required in an establishment where potentially hazardous food is prepared.) EMERGENCY RESPONSE PERSON 701'?/ Cy/�CirW /0 HOME TEL#ff&53166' D / HOURS OF OPERATION: Mon//-/0 Tue.// /DWed.//_toThu.// /0 Fri.//=// Sat/t' /0Sun.//-/ 0 TYPE OF ESTABLISHMENT FEE check only RETAIL STORE YES NO less than 1000sq.ft. =$ 50 1000-10,000sq.ft. =$100 more than 10,000sq.ft. =$250 RESTAURANT YES NO J O 3 less than 25 seats =$100 25-99 seats $ 0 more than 99 seats =$200 BED/BREAKFAST YES NO $100 ADDITIONAL PERMITS MAKE ICE CREAM, YOGURT, SOFT SERVE YES NO $5 TOBACCO VENDOR YES NO $50 ALL NON-PROFIT(such as church kitchens) YES NO $25 Please pay total with one cheek payable to the City of Salem This Permit is not transferable and must be reissued upon change of ownership. The Permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code, before any renovations, improvements, or equipment changes are made, all plans for such must be submitted to and approved by the Salem Board of Health. Pursuant to MGL Chapter 62C, Section 49A, I certify under the pains and penalties of perjury that I, to my best knowledge and belief, have filed all state tax returns and paid all state taxes required under the law. Signature 2kurt 1U Date2 Social Security or Federal Identification Number -----��©tom-- -- ��/G;-LL- Revised 11/25/02 FOOD .adm Check#8 Date /05fi/" ,.w�-t•�s...B�4 "At'.15'(P^�Sj,.4;aM.�fa.rr�h., w-;r. �,,4 . � .. . .. - 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 Operation(s) Tvpe of Inspection 2 Z /a' -0 3 Food Service ❑ Routine Address Risk ❑ Retail ❑ Re-inspection Level ❑ Residential Kitchen Previous Inspection Telephone e F) 7 yn. ❑ Mobile Date: /02 •R 3. 0 3 Owner HACCP Y/N ❑ Temporary ❑ Pre-operation 77"M rT j a- ❑ Caterer ❑ Suspect Illness Person in Charge(PIC) Time ❑ Bed&Breakfast ❑ General Complaint Inspector 7 Pfin 07,WY I/ F Gf d- Out: Permit No. ❑Other Each violation checked requires an explanation on the narrative page(s) and a citation of specific provision(s)violated. Non-compliance with: Violations Related to Foodborne Illness Interventions and Risk Factors Anti-Choking Tobacco Violations marked may pose an imminent health hazard and require immediate corrective 590.009(E) ❑ 590.009(F) ❑ action as determined by the Board of Health. FOOD PROTECTION MANAGEMENT ". ❑ 12. Prevention of Contamination from Hands El 1. PIC Assigned/Knowledgeable/Duties EMPLOYEE HEALTH `" - ❑ 13. Handwash Facilities [1 2. FROM CHEMICAL2. Reporting of Diseases by Food Employee and PIC S El 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 TIME/TEMPERATURE CONTROLS(Potentially Hazardous Foods) ❑ 5. Receiving/Condition ❑ 16. Cooking Temperatures ❑ 6. Tags/Records/Accuracy of Ingredient Statements ❑ 17. Reheating ❑ 7. Conformance with Approved Procedures/HACCP Plans [118. Cooling PROTECTION.FROM CONTAMINATION ❑ 19. Hot and Cold Holding ❑ 8. Separation/Segregation/Protection ❑20.Time As a Public Health Control ❑ 9. Food Contact Surfaces Cleaning and Sanitizing REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP). F1 10. Proper Adequate Handwashing El 21, Food and Food Preparation for HSP ❑ 11. Good Hygienic Practices CONSUMER ADVISORY ❑22. Posting of Consumer Advisories Violations Related to Good Retail Practices Number of Violated Provisions Related ❑. Critical (C) violations marked must be corrected To Foodborne Illnesses Interventions 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 cited in this report may result in suspension or revocation of (Fc-a)(sso.00s) the food establishment permit and cessation of food 26. Water, Plumbing and Waste (FC-5)(590.006) establishment operations. If aggrieved by this order, you 27. Physical Facility (FC-6)(590.007) have a right to a hearing. Your request must be in writing 28. Poisonous or Toxic Materials (FC-7)(590.008) and submitted to the Board of Health at the above address 29. Special Requirements (590.009) within 10 days of receipt of this order. 30. Other DATE OF RE-INSPECTION: S Wfaspe Forme-iaeoc Irfepe1 n� Print: ( A q PIC's Signature. " (` c`\ Print: P J �/ vL/n ! d Page of- Pages t f � Violations Related to Foodborne Illness interventions and Risk Factors(items 1-22) PROTECTION FROM CONTAMINATION FOOD PROTECTION MANAGEMENT 8 Gross-contamination 1 590.003(A) Assi t, trent ofRe;s onsibitityt` 3-302.11(A)(1) Raw Animal RwdsSeparated from i90.003(B) Demonstr anion of Knowledge* Cooked and RTF.Foods* 2-103.11 Person in charge.--duties Contamination from Raw Ingredients 3-302,11(A)(2) Raw Animal Foods Separated from Each EMPLOYEE HEALTH Others' 2 590.003(0) Responsibility of the person in charge to Contamination from the Environment require reporting by food employees and 3-302A I(A) Foal Protection* a licants* 3-302.15 Washing Fruits and Vegetables 590.003(F) Responsibility Of A Food Employee Or An 3-304.11 Food Contact with Equipment and Applicant To Report To The Person In Utensils" Cha,,e'" Contamination from the Consumer 590.003(G) Re ortin by Person in Char e* 3-306.14(A)(B) Returned Food and Reservice of Food` 3 590.003(D) Exclusions and Restrictions* Disposition ofAdulteratedor Contaminated 590.003([;) Removal of Exclusions and Restricticros Food 3701.11 Discarlingoi Reconditioningllnsafe FOOD FROM APPROVED SOURCE Food" 4 Food and Water From Regulated Sources 9 Food Contact Surfaces 590.004(A-B) Compliance with Food Law's 4-501.111 Manual W arewashing- [lot Water 3-201.12 F<nd in aHennetically Sealed Container* Sanitization Icm era[ures* 3-201.13 Fluid Milk and Milk Products* 4-501.1.12 Mechanical Warewashino Ant Water 3-202.13 ShellFi-s" Sanitization Temperatures" 3-202.14 Eggs and Milk Products.Pasteurized* 4-501.114 Chemical Sanitization-temp.,pH, concentration and hardness. V202,16 hs Made Froin Potable Drinking;Water" 4-601,11(.A) Equipment Food Contact Surfaces and 5-101.11 Drinkin Water from tat Approved Sy aern�" Utensils Cleans' 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 acid Utensils* Shellfish and Fish From an Approved Source 4_70211 Frequency of Sanitization of Utensils and 3-201.14 Fish and Recreationally Caught Molluscan Focal Contact Surfaces of E-ni meat* Shellfish* 4-703.11 MethodsofSanitization-HotWaterand 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* Sources* 10 Proper,Adequate Handwashing Came and Wild Mushrooms Approved by 2-301.11 Clean Condition-Hands and Arms" fie alato Authori 3-202.18 Shellstock Identification Present* -2-30112 Cteanin Procedure* 590.004(C) Wild Mmitiocros* 2-301.14 When to Wash* 3-201.17 Burne Animals" 21 Good Hygienic Practices L5 Receiving/Condition 2-401.11 Patina, Drinkin or Using Tobacco' 3-202.11 P1IFs Received at Pro ner Tem neratures" 2-401.1.2 Discharges From the Eyes.Nose and 3-202.15 Packagelnte¢rit y` Mouth* 3-101.1.1 Food Safe and Unadulterated* 3-301.12 PreventinG Contamination When Tastiri 6 Tags/Records:Shallstock 12 Prevention of Contamination from Hands 3-202.13 SheltAock Identification* 590.004(E) Preventing Contatnination from 3-203.12 Shellstock Identification Maintained* Em tUees* D struction13 Handwash Facilities Tags/Records: Fish Products Conveniently Located and Accessible 3-402.11. Patasne, * 3-0-02.12 Records,Creation and Retentions7203.11 Numbers and Capacities"- Labeling of Ingredients* 5-204.11 Location and Placement* 590.004(7) 9 g 505,11 Accessibili , 0aand n Conformance with Approved Procedures Supplied with Soap and n Drying7 lHACGP Plans 3-502.11 Specialized ProcessingMethods* Devices 3-502.12 Reduced oxygen naekaRin ,criteria" 6-301.1.,1 ]land Drvao Cleanser,Availability 8-103.12 Conformance with A }roved Procedures* 6301.12 Fland Drvinv Provision "Denote.,critical item in the federal 1999 Food Code or 105 CMR 590.000. CITY OF SALEM BOARD OF HEALTH F Establishment Name: T La'-y J /011 Date: / 30- 03 Page: of n2 Item Code C=Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date No. Reference R—Red Item Verified -. PLEASE PRINT CLEARLY 1. 4 / 3 f T, fe'. k � 1 4 , Discussion With Person in Charge: Corrective Action Required: ❑ No ❑ Yes a 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 :.s comply with all mandates of the Mass/Federal Food Code. I understand that noncompliance may result in daily fines of twenty-five dollars orsuspension%revocation of L3Embargo LlEmergency Closure your food permit. j ❑o ❑ C c.rt �. ,IE Voluntary Disposal Other: { r A- -7501 PHFs Received at'Femperatures Violations Related to Foodborne Illness Interventions and Risk According t0 Law Cooled to Factors(items 1-22) (Cont.) 41'F145'F Within 4 Hours. 3-501.15 Cooling Melhods lot FHFs PROTECTION FROM CHEMICALS 19 PHF Hot and Cold Holding 14 i Food pr Color Additives 202.12 Additives* 3-501.16(B) Cold PIiFs Maintained at or below �90.004(�_ 41 Y45'F* 30214 Protection from Toxic S caved cess ves* 3-501.16(X) Hot PI IFs Maintained at or above Ig Poisonous or Toxic Substances 140"F. 7-101.11 Identifying Information-Original 3-501.16(A) Roasts Held at or above 13WIF Containers" - 7-102.11 Common Name-Working Cantainere" 20 Time as a Pubic Health Control 7-201.11 Se aruion-Storz e" 3-501.19 - Time asaPublic F-IealthContttit` g - 590.004(H) Var�ixnce Rcc uirement 7-202.11 Restriction-Presence and Use, _ 7-202.12 Conditions of ers REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-203.11 '1'oxicCinrtainera-Prohibitions" POPULATEONS(HSP} 7-204.11 Sanhzeis.Criteria Chemictts' - --- - 7-204.12 Chemicals for Washm r Produce.Criteria* 21 3-801.1.1(A) Onpasteurifed Pre-packaged Junes and 7-204.,14 Drying Agents.Cnteria'rBeletases with W rrnax Libels e 7-205.11 Incidental Food Contact, Lubricants- 3-801.11(B) Use of Pasteurized E-'s* 7-206.11 Restricted Use Pesticides,Criteria* 3-801.I I(D) Raw or Partially Cooked Animal Food and Raw Seed Sprouts Not Served * "7-26.12 Rodent Bait Stations* 3-801.tl(C) Unopened Food Package Not Re-served 7-2006.13 Tracking Powdets, Pest Control and --- Monitarine,* CONSUMER ADVISORY _ TIME)TEMPERATURE CONTROLS 22 3-603.11 Consumer Advisory Posted for Consumption of 16 Proper Cooking Temperatures for Anunal Foods'That are Raw- Undercooked or PHFs Not Otherwise Processed to Eliminate 3-401.11X(1)(2) Eels- 1557 15 Sec. Pathogens,, '"eCtli`' rzoar Eggs-Immediate Service 1 .iF15see* 3-302.13 Pasteurized Eggs Substitute for Raw Shelf 3-401.1 I(A)(2) Comminuted Fish.Meats&Garvie Animals- 155'F 15 sec. 3-401.11(B)(1)(2) Pork and Beef Roast- 13WF 121 rnhY� SPECIAL REQUIREMENTS 3-401.11(A)('2) Ratites, Injected Meats-155°F 15 590.009(A)-(D) 1 Violations of Section 590.009(A)-(D)in sec_* catering, mobile food, temporary and 3-401.11(.9)('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.'1.1(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 165cF* Special Requirements. 3-401.1 1(A)(1)(b) ,All Other PI-I s - 145'F 15 sec. of Reheating far Hot Holding VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 3403,1 1(A)&(D) PRFs 165'F 15 sec. * (Items 23-30) 3-403.11(H) Microwave- 165'F 2 Minute Standing Critical and non-crilicat violations, which do not relate to the Time" foodborne illness inters entions and risk factors listed above, can be 3403.11(C} Commercially Processed RTE Food- found in the following sections of the Food Code and 105 CMR 14(f'F* -590.000. _ 3-403,11 tE) Remaining Unsticed Portions of Beef f than I Good Retail Practices FC 590.000 Roasts* 23 PAanagamenl and Personnel ' FC-2 ,003 lg Proper Cooling of PHFs 4.24 I 1 Food od and Food Protection FC 3004 25 mi i Egwp 'nt and Utensils FC_-A_,_ 005 3-501.14(A) Cooling Cooked PHFs from 140'F to -- - 26. • Water P;umbin and Waste 1 FC-5 006 70'F Within 2}lours and From 70`F 27, 1 Physical Facility [ F0-6 .007 to 41'F/45'F Within 4 Hours * _28 Poisonous or Toxic Matenais I FC-7 .00t3 3-501.14(B) Cooling PHFs Made From Ambient 29 Special Reulq remenis _009 'Temperature In;;redientsto4l'F145'F 30 Other Within 4 Hours* ` "`"` Denotra critieaI item.in the federal 1999 Food Cate or I W CMR 590.000. P 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 /7 Date T e of O eration s T e of inspection Do Z t� c d a o'Z'oa3 Food Service Routine Address Risk ❑ Retail ❑ Re-inspectionC-q J 7' Level ❑ Residential Kitchen Previous Inspection Telephone ❑ Mobile Date:,S �R d 7- 9 Owner . HACCP WN ❑ Temporary ❑ Pre-operation ❑ Caterer ❑ Suspect Illness Person in Charge(PIC);;g Time E-] Bed&Breakfast El General Complaint In: ❑ HACCP Inspector S Out: Permit No. ❑Other Each violation checked requires an explanation on the narrative page(s) and a citation of specific provision(s) violated. Non-compliance with: Violations Related to Foodborne Illness Interventions and Risk Factors Anti-Choking Tobacco Violations marked may pose an imminent health hazard and require immediate corrective 590.009(E) ❑ 590.009(F) ❑ action as determined by the Board of Health. FOOD PROTECTION MANAGEMENT ❑ 12. Prevention of Contamination from Hands ❑ 1. PIC Assigned/Knowledgeable/Duties El 13. Handwash Facilities EMPLOYEE HEALTH PROTECTION FROM CHEMICALS - ❑ 2. Reporting of Diseases by Food Employee and PIC El3. Personnel with Infections Restricted/Excluded El 14.Approved Food or Color Additives FOOD FROM APPROVED SOURCE ❑ 15.Toxic Chemicals ❑ 4. Food and Water from Approved Source TIMEITEMPERATURE CONTROLS(Potentially Hazardous Foods) ❑ Cookin pe 5. Receiving/Condition E] 16. g Temperatures ❑ 6. Tags/Records/Accuracy of Ingredient Statements ❑ 17. Reheating ❑ 7. Conformance with Approved Procedures/HACCP Plans ❑ 18. Cooling PROTECTION FROM CONTAMINATION ❑ 19. Hot and Cold Holding ❑ 8. Separation/Segregation/Protection ❑20.Time As a Public Health Control ❑ 9. Food Contact Surfaces Cleaning and Sanitizing REQUIREMENTS FOR HIGHLY.SUSCEPTIBLE POPULATIONS(HSP) El 10. Proper Adequate Handwashing El21. Food and Food Preparation for HSP ❑ 11. Good Hygienic Practices CONSUMER ADVISORY ❑ 22. Posting of Consumer Advisories Violations Related to Good Retail Practices Number of Violated Provisions Related Critical (C) violations marked must be corrected To Foodborne Illnesses Interventions 3 c 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.N 590.000/federal Food Code. This report, when signed below 23. Management and Personnel (FC-2)(590.003) by a Board of Health member or its agent constitutes an 24. Food and Food Protection (FC-3)(590.004) \ order of the Board of Health. Failure to correct violations 5. Equipment and Utensils (FC-a)(sso.005)--`, 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 29. Special Requirements (590.009) within 10 days of receipt of this order. 30. Other DATE OF RE-INSPECTION: 5:5901n5pectForm614.0ac Inspector's Signature: 'nt•®'�✓"' PIC's Signature: Print: Pagel of Pages 4 1 Violations Related to Foodborne Illness Interventions and Risk Factors(items 1-22) PROTECTION FROM CONTAMINATION FOOD PROTECTION MANAGEMENT 8 I Cross-contamination 1 590.003(A) Assignment of Responsi n try" 3702.1 I(A)(1) Ratio Animal Foods Sepmat<d from 590.003(B) Demonstration of Knowledge* Cooked and RTE Foods" 2-103.11 Person in charge- duties Contamination from Raw Ingredients 3-30111(A)(2) Raw Animal Foods Separated from Each EMPLOYEE HEALTH Other" 2 s90.003(C) Responsibility of the person in charge to Contamination from the Environment require reporting by food employees and 3-302.11(A) Food Protecbon* applicants,* 3-302.15 Washin�Fruits and Vegetables 590.003(F) Responsibility Of A Food Employee Or An 3-304.1.1 Food Contact with Equipment and Applicant To Report To The Person In Utensils!' Chargel, Contamination from the Consumer 590.003(G) Reptating by Person in Charge* 3-306.14(A)(B) Returned Food and Resei vice of Food* 3 590.003(D) Exdusionsand Restrictions" Disposition of Adulterated or Contaminated 590.003(E) Removal of Exclusions and Restrictions Food 3-701.11 Discarding or Reconditioning Unsafe FOOD FROM APPROVED SOURCE Food* 4 Food and Water From Regulated Sources 9 Food Contact Surfaces 590.004(A B) Coni jance with Food Law* 4-501.111 Manual Warewashing-Hot Watcr 3-201.12 Foul in a Hermetically Sealed Container"` Sanitization Temperatures* 3-201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Warewashing-HotWater 3-202.13Shell Eggs* Sanitization Temperatures'" 3-202.14 E=gs and Milk'.Products,Pasteurized* 4-501.114 Chemical Sanitization-temp.,pH, concentration and hardness 3-102.1G Ice Made Front Potable Approved 45 vt to 4-601.11(A) Equipment Food Contact Surfaces and 5-101.11 Drinking Water from an A rroled Svsfam* lean- 590.006(A) Bot0edDrinking Water* Cleaninnsih Crequ 590.006(B) Water Meets Standards in 310 CMR 22.0- 4-602.11 Cleaning Surfaces n Of Equipment Food- 590.006(B) Surfaces and CJttnsils* Shellfish and Fish From an Approved Source 4-702.11 Frequency of Sauitizatiot of Utensils and 3-201.14 Fish and Recreationally Caught Molluscan Food Contact Surfaces of E ui tnent* Shellfish* 4.703.11 Methods of Sanitization- Hot Water and 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* sources* 10 Proper,Adequate Handwashing Game and Wild Mushrooms Approved by Reguiatcoy Authori 2-301.11 Clean Condition-Hands and Arms* 3-202.18 Shellstrx:k Identification Present* 2301.12 Cleanim-Procedure'" 590.004(C) Wild Mushrooms* 2-301.14 'Allen to Wash" 3-201.17 Came Animals* 11 Good Hygienic Practices 5 Receiving/Condition 2-401.11 Eatin ,Drinkin or Usinc Tobacco* 3-20111 PIIFs Received at Pro ger Tem ieratures* 2-401.12 Discharges From the Eyes.Nose and 3-202.15 Package lute it, Month* 3-101.11 Food Safe and Unadulterated 3-301.12 Preventing,Contamination When Tustin=* 6 Tags/Records:Shellstock 12 Prevention of Contamination from Hands 3-202.18 Shelktock identification* 590.004(E) Preventing Contamination from 3-203.12 Shellstock Identification Maintained* Em lovees* Tags/Records:Fish Products 13 Handwash Facilities 3-402.11. Parasite Destmction* Convenientfy Located and Accessible 3402.12 Records.Creation and Retention* 5-203.11 Numbers and Ca acities* 590.004(l) Labeling of Ingredients` 5-204.11 Location mid Placement* 7 Conformance with Approved Procedures 205.11 Accessibility,Operation and Maintenance IHACCP Plans Sunolied with Soap and Hand Drying 3-502.11. S ecialized Processin>Methods` Devices 3-502.12 6-301.11 Handwashing Cleanser.Availability 8-103.12 I Conformance with Approved Procedures°` 6-301.12 Hand Dtyin=Provision Denotes critical item in the federal 1999 Food Code or 105 C N1R 590.000. CITY OF SALEM'�I. t BOARD OF HEALTH Establishment Name: �Jlez_tr_c� S ��z2A Date: a2 3- d Page: a of oZ 6 Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Vete No. Reference R.—Red Item. ?' E Verified ,t PLEASE PRINT CLEARLY • / �,�r f=r milia,� . , ,e �J i rl ti� ,, Ir q F 9- //ir P v/s�f SPP Q . P� 2or�PP�f /4f e d'Y�'?'Kk A/9 D if L61 F YZD ! - r Pj�t�` T ., AI CS CL - Discussion With Person in Ch rge• _/Lp-� sf0�+� rt/C a--> 067W Corrective Action Required: ❑ No I ❑ Yes have read this report, have had the opportunity to ask questions and agree to correct all ❑ voluntary Compliance ❑ Employee Restriction/ Exclusion' :. . violations before the next inspection, to observe all conditions as described, and to ❑ Re-inspection Scheduled ❑ Emergency.Suspension j F comply with all mandates of the Mass/Federal Food Code. I understand that 'b noncompliance may result in daily fines of twenty-five dollars or suspension/revocation of ❑ Embargo ❑ Emergency Closure your food permit. 1�e> )6EC r r6le6(Yr j i (/� ❑ Voluntary Disposal` �❑ Other: 3-501.14(C) PHFs Received at'remperatures Violations Related to Foodborne Illness interventions and Risk According to Law Cooled to Factors(Items 1-22) (Cont.) _ 4t`F145°F Within 4 Horns-M PROTECTION FROM CHEMICALS 3-501.15 CGP11❑ Meth PHFs Food or Color Additives 19 PHF Hot and Coldold Holding 14 3-501.16(11) Cold PHFs Maintained at or below 3-202.12 Additives'* 590.004(F) 41°145"FI: 3-302.1.4 Protection from Unapproved Additivts* 3-501.16(A) Hot PHFs Maintained at or above Ij Poisonous or Toxic Substances 140°F. * 7-10111 Identifying In'formation-Original 3-501.16(A) Roasts Haid at or above '130°F. Containers* - 7-]02.11 Counnon Name-Working Containers* 20 Time as a Public Health Control 7-201-L1 Se arntion-Sforage* 3-501_(9 Time as a Public Health Control` 7-202.11 Restriction-Presence and Use* 590.004(1-1) Variance Re uuerrent 7-202.12 Conditions of Use* 7-203.'(1 Toxic Containers-Prohibitions* REQUIREMENTS FORNIGHLYSUSCEPTIBLE 7-204.11 Sanitizcrs.Criteria-Chemicals* POPULATIONS(HSP) _ 7-204.1.2 Chemicals for Washing Produce, Criteria* 21 3-801.11(A) Unpasteurized Pre packaged Juices and 7-204.14 Drving Agents.Criteria* Beverages with Warning Labels* 7-205.11 Incidental Food Contact,Lubricants* 3-801.11(B) Use of Pasteurized)Eggs* 7-2(16.11 Restricted Use Pesticides,Criteria'" 3-801.1.1(D) Raw or Partially Cooked Animal Food and Raw Seed Sprouts Not Served ' 7-206.12 Rodent Bait Stations* 3-801.11(0) Unopened Food Pucka e Not Ru-servecL 7-206.13 Tracking Powders, Pest Control and R4uni sarin r CONSUMER ADVISORY _ TIME/TEMPERATURE CONTROLS 22 3-603.11 Consumer Advisory Pasted for Consumption of Proper Cooking Temperatures for Animal Foods'lliat are Raw.Undercooked or PHFs Not Otherwise Processed to Gluuinate �,0 PadaOt, ns e- ova r r ooi 3-401.11A(1)(2) Eggs- Ii5`F1nSec. F s-Immediate Service 14S°F15secc* 3-302.13 Pasteurize{Ea„s Substitute for flaw Shell 3-401.11(A)(2) Comminuted Fish.Meats&Game i rahnals- 155"F l5 sec. 3-401.11(11)(1)(2) Pork and Beef Roast- 130°F121min* SPECIAL REQUIREMENTS _ 3-401.1 I(A)(2) Rahtes,Injected Meats- 1.55`F 15 590.009(A)-(D) Violations of Section 590.009(A)-('D)in see.* catering, mobile food, temporary and 3-401.11(A)(3) Poultry,Wild Game.Stuffed PHFs, residential kitchen operations should be Stuffing Containing Fish,Meat, debited under the appropriate sections Poultry or Ratites-Itis-F 15 sec. * above if related to foodborne illness 3-401.1 I(C)Q) 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 Crooked his practices should be debited under#29- Microwave 165`F* - Special Requirements. 3-401.11(A)(I)(b) All Other PHFs-- 145"F 15 sec. 17 Reheating for Hot Holding VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 3-t03.11(A)&(D) PHFs 1WF 15 sec. *_ _ (Items 23-30) 3-403.11(43) Microwave-165°F 2 Montle Standing Ot arcal and non-critical violations, which do not reline to the Tithe* foodborne illness Interventions and risk factors listed above, can be 3-403-1 I(C) Commercially Processed RTE Food- ,found to the following sections of the Food Coyle and 105 CMR 14WF*, 590.000. 3-403.11(E) Remaining Unsliced Portions of Beef I item Good Retail Practices FC 590.000 Roasts* v" 23 Management and Personnel ( FC 2 .003 ""--"- 24 Food and Food Protection FC 3 .0041 18 proper Cooling of PHFs - and ---- 125 I E�cu�ent and Utensil _ FC-4 _.00.5_ _____ 3-501.14(A) Cowling Cooked PIFs front 140'F to 26 j Water.Plumbinq and waste _FC _S _ .006 70'F Within 2 Hours and From 70'F 27. Physical Facility -�FC-6 .007 to 41'F/45 1,Within 4 Flours.' 28,_ I-Poisonous or Toxic Materials I FC 7 ..008 3-501.14(11) Cooling PHFs Made From Ambient 29 Special Requirements 009_ Temperature Ingredients to 41°F/45`F L 30. Other - Within 4 Hour* "Denotes critical item in the federal 1999 pond Ctxle or 105 011Z 590.000. R 1 wrv:.,+`.rw•.�+�r*r,....+-�^�.....�.r.,..yn.-�7�.X w.+i�.,..+�+a+mv+^ry�4'�sW�vw.iF'>d1.��+sS✓4c...�z�.�.�'v+�m,....-:..s:.-a-. u..v 4: THE COMMONWEALTH OF MASSACHUSETTS CITY OF SALEM BOARD OF HEALTH Address: 120 Washington Street, 4th Floor Salem, MA 01970-3523 FOOD ESTABLISHMENT INSPECTION REPORT Tel: (978) 741-1800 Fax: (978) 745-0343 Name �'� Date Ty�oeration(s) Tyne-of Inspection DG Li=LS A A 6 �1-0-q Food Service [21 Routine Address Risk ❑ Retail 19Re-inspection iY ����� •_7` Level ❑ Residential Kitchen Previous Inspection Telephon% O ElMobile Date: S- -0�2 Owner - I HACCP Y/N ❑ Temporary ❑ Pre-operation ❑ Caterer ❑ Suspect Illness Person in Charge(PIC) Time El Bed&Breakfast El General Complaint /h In: ❑ HACCP Inspector V Out: Permit No. EDOther.,.u<�,a K/c Each violation checked requires an explanation on the narrative page(s) and a citation of specific provision(s) violated. Non-compliance with: Violations Related to Foodborne Illness Interventions and Risk Factors (Red Items) Anti-Choking Tobacco Violations marked may pose an imminent health hazard and require immediate corrective 590.009(E) ❑ 590.009(F) ❑ action as determined by the Board of Health. Local Law ❑ FOOD PROTECTION MANAGEMENT ❑ 12. Prevention of Contamination from Hands ❑ 1. PIC Assigned/ Knowledgeable/ Duties ❑ 13. Handwash Facilities EMPLOYEE HEALTH PROTECTION FROM CHEMICALS ❑ 2. Reporting of Diseases by Food Employee and PIC ❑ 14. Approved Food or Color Additives ❑ 3. Personnel with Infections Restricted/ Excluded ❑ 15. Toxic Chemicals FOOD FROM APPROVED SOURCE TIME/TEMPERATURE CONTROLS(Potentially Hazardous Foods) El 4. Food and Water from Approved Source El16. Cooking Temperatures El 5. Receiving/Condition ❑ 17. Reheating ❑ 6. Tags/ Records/Accuracy of Ingredient Statements t ❑ 18. Cooling ❑ 7. Conformance with Approved Procedures/HACCP Plans El 19. Hot and Cold Holding PROTECTION FROM CONTAMINATION ❑ 20. Time as a Public Health Control ' ❑ 8. Separation/Segregation/ Protection REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) El 9. Food Contact Surfaces Cleaning and Sanitizing El 10. Proper Adequate Handwashing El 21, Food and Food Preparation for HSP CONSUMER ADVISORY ❑ 11. Goad Hygienic Practices ❑ 22. Posting of Consumer Advisories Violations Related to Good Retail Practices (Blue Number of Violated Provisions Related Items) Critical (C) violations marked must be corrected To Foodborne Illnesses Interventions immediately or within 10 days as determined by the Board and Risk Factors (Red Items 1-22):' of Health. Non-critical (N) violations must be corrected Official Order for Correction: Based on an inspection immediately or within 90 days as determined by the Board today, the items checked indicate violations of 105 CMR of Health. 1 590.000/Federal Food Code.This report, when signed below C N by a Board of Health member or its agent constitutes an 23. Management and Personnel (FC-2)(590.003) order of the Board of Health. Failure to correct violations 24. Food and Food Protection (FC-3)(590.004) cited in this report may result in suspension or revocation of 25. Equipment and Utensils (FC-4)(590.005) the food establishment permit and cessation of food 26. Water, Plumbing and Waste (FC-5)(590.006) establishment operations. If aggrieved by this order, you 27. Physical Facility (FC-6)(590.007) have a right to a hearing.Your request must be in writing 28. Poisonous or Toxic Materials (FC-7)(590.008) and submitted to the Board of Health at the above address EH.29. Special_Requirements (590.009) within 10 days of receipt of this order. 30. Other DATE OF RE-INSPECTION: Inspector's Signature: Print: PIC's Signature: L< < ,` I C (� Print: O �� / /:�=f�.,, ( � ,r1 Page�of a Pages FORM 734A HOBBS B WARREN -BOSTO lJ �I U'l v Violations Related to Foodborne Illness r Interventions and Risk Factors (Red Items 1-22) PROTECTION FROM CONTAMINATION t8 Cross-contamination FOOD PROTECTION MANAGEMENT 3-302.11(A)(1) Raw Animal Foods Separated from 1 i 590.003(A) Assignment of Responsibility* Cooked and RTE Foods* 590.003(8) Demonstration of Knowledge* Contamination from Raw Ingredients 2-103.11 Person in Charge-Duties 3-302.11(A)(2) Raw Animal Foods Separated from Each Other* EMPLOYEE HEALTH Contamination from the Environment <2.3 590.003(C) Responsibility of the Person in Charge to 3-302.11(A) Food Protection* require reporting by Food Employees and * 3-302.15 Washing Fruits and Vegetables Applicants 3.304.11 Food Contact with Equipment and 590.003(F) Responsibility of a Food Employee or an Utensils* Applicant to Report to the Person in Charge* Contamination from the Consumer 3-306.14(A)(B) Returned Food and Reservice of Food* 590.003(G) Reporting by Person in Charge* Disposition of Adulterated or Contaminated 3" 590.003(D) Exclusions and Restrictions* Food 590.003(E) Removal of Exclusions and Restrictions 3-701.11 Discarding or Reconditioning Unsafe Food* FOOD FROM APPROVED SOURCE Food Contact Surfaces Food and Water From Regulated Sources 4-501.111 Manual Warewashing-Hot Water 590.004(A-B) Compliance with Food Law* Sanitization Temperatures* 3-201.12 Food in a Hermetically Sealed Container* 4-501.112 Mechanical Warewashing-Hot Water 3-201.13 Fluid Milk and Milk Products* Sanitization Temperatures* 3-202.13 Shell Eggs* 4-501.114 Chemical Sanitization-temp.,pH, 3-202.14 Eggs and Milk Products,Pasteurized* Concentration and Hardness* 3-202.16 Ice Made from Potable Drinking Water* 4-601.11(A) Equipment Food Contact Surfaces and 5-101.11 Drinking Water from an Approved System* Utensils Clean* 590.006(A) Bottled Drinking Water* 4-602.11 Cleaning Frequency of Equipment Food- 590.006(B) Water Meets Standards in 310 CMR 22.0* Contact Surfaces and Utensils* Shellfish and Fish From an Approved Source 4-702.11 Frequency of Sanitization of Utensils and 3.201.14 Fish and Recreationally caught Molluscan Food Contact Surfaces of Equipment* Shellfish* 4-703.11 Methods of Sanitization- Hot Water and 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* Sources* 10 Proper,Adequate Handwashing Game and Wild Mushrooms Approved by Regulatory Authority 2-301.11 Clean Condition-Hands and Arms*3.202.18 Shellstock Identification Present* 2-301.12 Cleaning Procedure* 2-301.14 When to Wash* 590.004(C) Wild Mushrooms* 11 Good Hygienic Practices 3-201.17 Game Animals* 2-401.11 Eating, Drinking or Using Tobacco* 5 Receiving/Condition 2-401.12 Discharges From the Eyes,Nose and 3-202.11 PHFs Received at Proper Temperatures* Mouth* 3-202.15 Package Integrity* 3-301.12 Preventing Contamination When Tasting* 3-101.11 Food Safe and Unadulterated* 12> Prevention of Contamination from Hands '. 6 Tags/Records:Shellstock 590.004(E) Preventing Contamination from 3-202.18 Shellstock Identification* Employees* 3-203.12 Shellstock Identification Maintained* 13 Handwash Facilities Tags/Records: Fish Products Conveniently Located and Accessible 3-402.11 Parasite Destruction* 5-203.11 Numbers and Capacities* 3-402.12 Records,Creation and Retention* 5-204.11 Location and Placement* 590.004(J) Labeling of Ingredients* 5-205.11 Accessibility,Operation and Maintenance 7 Conformance with Approved Procedures Supplied with Soap and Hand Drying HACCP Plans Devices 3-502.11 Specialized Processing Methods* 6-301.11 Handwashing Cleanser,Availability 3-502.12 Reduced Oxygen Packaging,Criteria* 6-301.12 Hand Drying Provision 8-103.12 Conformance with Approved Procedures* •Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. CITY OF SALEM R2-7-114 BOARD OF HEALTH Establishment Name: SZ),- i r.c /�z 7114 Date: (- a 3 Page: 2 of 'k Item Code C-britical ItemDESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date No. Reference R—Red Item Verified PLEASE PRINT CLEARLY nn � �� . ✓ 03 t C�7 P k5 L L fin♦ J a / -A CG7 PSS r t a `A I ; r �t 1 ' Discussion With Person in Charge: Corrective Action Required: ❑ No ❑ Yes v I d have read this report, have had the opportunity to ask questions and agree to correct all ❑ Voluntary Compliance ❑ Employee`Restriction/ vi lations before the next inspection, to observe all conditions as described, and to Exclusion a" Q p ❑ Re-inspection Scheduled ❑ Emergency Suspension comply with all mandates of the Mass/Federal Food Code. I understand that honcompliance may result in daily fines of twenty-five dollars or suspension/revocation of" ❑ Embargo ❑ Emergency Closure your food permit. C' Cf C t(_/'Yc L- 0 Voluntary Disposal ❑ Other: 3-501.1I(Ci PH FsReczivedatTemperatales Violations Related to Foodborne Illness Interventions and Risk According to Law Cooled to Factors(items 1-22) (Cont.) 41 'F/45'F Within 4 Nouns. PROTECTION FROM CHEMICALS 3-501.15 ILoling Methods for PHFs 14 Food or Color Additives 19 PHF Hot and Cold Holding 3-202.12 Addit'ivcs' 3-501.16(B) Cold PRFs Maintained at or below 590.004(F) 41'/45'F' 3-302.14 Protection from Una roved Additives' 3-501.16(A) Hot PHFti Maintained at or above 15 1 Poisonous or Toxic Substances 7-101.11 Identifyinny Intilnnsuna-Original Containers*_ _ _ 3-501.10(A) Roasts Heldat os'ub�_ra 13(T'F 7-102.11 Common Name-Workn,Containers" �� Tame as a Public Health Control 7--307.11 Separation-Stora e* 3-501.19 Time as a Public Health Control* 7-202.71 Restriction-Presence mid Use* .90.004(1 Variance Recuirernent 7-202.12 Conditions of Use' 7-203.31 toxic Containers-Prohibitions* REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-204.11 Sanitizers,Criteria-Chemicals* POPULATIONS(HSP) 7-204-12 Chemicals too Washing Produce,Criteria* 21 3-801.11(A) Unpasteurized Pre-packaged Juices and Beneraz,es with Watton"Labels* 7-204.14 Drving Agents,Criteria* 3-801.11(B) Use of Pasteurized 1• ns* 7-205.11 Incidental Food Contact,Lubricants* 3-301.11(D) Raw of P.u2ia115 Cooked Animal food and 7-206.12 Rodent Bait Stations* 3- 7-206.11 Restricted Use Pesticides,Criteria* Raw Seed Sprouts Not Served * 7-206.13 Tracking Powders,Pest Control and 801.11(C) Unopened Food Package Not Re-served. Monitoring* CONSUMER ADVISORY TIME/TEMPERATURE CONTROLS 22 3-603.11 Consumer Advisory Posted for Consumption of 1h Proper Cooking Temperatures for Animal Foods'Htat are Raw.Undercooked or PHFs Not Otherwise Processed to Eliminate 3-401.11A(t)(2) Ecus 155'17 li Sec. en Pathogs o'.1, ^�o� L_,,s-lmmecinne Service 1 J5'Fl5sec" 3-302.1.3 Pasteurized F.-Is Substitute for Raw Shell 3-401.11(A)(2) Comminuted Fish.Meats&dame E-°* Animals-155°F tS sec. SPECIAL REQUIREMENTS 3-401.11(B)(1)(2) Pork and Beef Roast- 130'F121 min* 3-401.11(A)(2) Ratites, Injected Meats-155'F 15 SJ0.009(A)-(D) Violations of Section 590.009(.AF(I))in sec. * catering, mobile foal, temporary and 3-401.11(A)(3) Poultry,Wild Game. Stuffed PHFs, residential kitchen operations should be Stutlins Containing Fish,Meat, dehited under the appropriate sections Pouitng o'Ratites-165'1715 sec. * above if related to foodborne illness 3-401.1 1(C)(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 I65`F^ Special Requirements. 3-401.17(A)(I)(b) All Other PHFs--145'F 15 see. y7 _ Reheating for Hot Holding VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 3403.11(A)&(D) PFIFs 1651715 sec. x: (Items 23-30) _3-403.1 I(B) Microwave- 165'F 2Minute Standing Critical and non-critical violations, which do not relate to the Time* foodborne illness beementions and risk7ainors fisted above; car he 3-403.11(0) Commercially Processed RTE Food- found in the fotlowhig section,,orf the Food Code and 105 CbIR 1400F* 590.000. 3-403-1.1(13) Remaining Unsliced Portions of Beef 1 item Good Retail Practices 4 VC 590.000 Roasts* �23 fAanagement and Personnel i FC-2 .003 1g Proper Cooling of PHFs �24 Food and Food Protection 1 FC--3_ .004 25- uipnt andFC-4 '005 Ulens 3-501.14(A) Cooling Cooked PHFs from 140'F to 26 Wq temP nb Q and�W rite -FC 5 006 70'F Within 2 Hems and From 70".17 27. Physical Facility 1 FC-6 .007 to 41'F/45"F Within 4 Hours. * 23y Poisonous or Toxic Materials 1 FC-7 .008 3-501.14(B) Cooling PHFs Made From Ambient 29.__LSpecialRequirements .009 Temperature Ingredients to 41'F/95'F - 30 Other -------- _-__- --�I Within 4 Hours* ss+em�m,rsan© *Denotas crifiril item in the federal 1 y9J Food Code or 105 CR9R 594.OQ(l. THE COMMONWEALTH OF MASSACHUSETTS CITY OF SALEM Address: 120 Washington Street, 4th Floor BOARD OF HEALTH Salem, MA 01970-3523 FOOD ESTABLISHMENT INSPECTION REPORT Tel: (978) 741-1800 Fax: (978) 745-0343 Name n Date Tvo0bt r i n .uIn i g S/a '7103 FService Ro ne Addressa� N ,S,t. Risk LJ Retail ElRe-inspection Level ❑ Residential Kitchen Previous Inspection Telephone 4/rS ElMobile Date:a- 7-03 Owner - HACCP Y/N ❑ Temporary ❑ Pre-operation TOM " 1 / ❑ Caterer ❑ Suspect Illness Person in Charge(PIC) Time ❑ Bed&Breakfast ❑ General Complaint In: ❑ HACCP Inspector V 11-14A Out: Permit No. EJ Other c zL/1'/� Each violation checked requires an explanation on the narrative page(s) and a citation of specific provision(s) violated. Non-compliance with: Violations Related to Foodborne Illness Interventions and Risk Factors (Red Items) Anti-Choking Tobacco Violations marked may pose an imminent health hazard and require immediate corrective 590.009(E) ❑ 590.009(F) ❑ action as determined by the Board of Health. Local Law ❑ FOOD PROTECTION MANAGEMENT ❑ 12. Prevention of Contamination from Hands ❑ 1. PIC Assigned/Knowledgeable/ Duties ❑ 13. Handwash Facilities EMPLOYEE HEALTH ❑ 2. Reporting of Diseases by Food Employee and PIC PROTECTION FROM CHEMICALS El3. Personnel with Infections Restricted/ Excluded El 14. Approved Food or Color Additives ❑ 15. Toxic Chemicals FOOD FROM APPROVED SOURCE El 4. Food and Water from Approved Source TIMEITEMPERATURE CONTROLS(Potentially Hazardous Foods) El 16. Cooking Temperatures El 5. Receiving/Condition „-.- ❑ 6. Tags/ Records/Accuracy of Ingredient Statements ❑ 17. Reheating El7. Conformance with Approved Procedures/HACCP Plans El 18. Cooling PRO ECTION.FROM CONTAMINATION El 19. Hot and Cold Holding 8 Separation/Segregation/ Protection ❑ 20. Time as a Public Health Control El 9. Food Contact Surfaces Cleaning and Sanitizing REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) ❑ 10. Proper Adequate Handwashing ❑ 21. Food and Food Preparation for HSP CONSUMER ADVISORY ❑ 11. Good Hygienic Practices ❑ 22. Posting of Consumer Advisories Violations Related to Good Retail Practices (Blue Number of Violated Provisions Related Items) Critical (C) violations marked must be corrected To Foodborne Illnesses Interventions immediately or within 10 days as determined by the Board and Risk Factors (Red Items 1-22): of Health. Non-critical (N) violations must be corrected Official Order for Correction: Based on an inspection immediately or within 90 days as determined by the Board today, the items checked indicate violations of 105 CMR of Health. 590.000/Federal Food Code.This report, when signed below C N by a Board of Health member or its agent constitutes an 23. Management and Personnel (FC-2)(590.003) order of the Board of Health. Failure to correct violations 24. Food and Food Protection (FC-3)(590.004) cited in this report may result in suspension or revocation of 25. Equipment and Utensils (FC-4)(590.005) the food establishment permit and cessation of food 26. Water, Plumbing and Waste (FC-5)(590.006) establishment operations. If aggrieved by this order, you 27. Physical Facility (FC-6)(590.007) have a right to a hearing.Your request must be in writing 28. Poisonous or Toxic Materials (FC-7)(590.008) and submitted to the Board of Health at the above address 29. Special Requirements (590.009) within 10 days of receipt of this order. 30. Other DATE OF RE-INSPECTION: Inspector's Signature:iJ/ - ` Print: PIC's Print: Pa Signature `- 7 e of -.Pa g �cr-mac C. [�cUtccc . � g / des g FORM 734A HOBBS&WARREN - B STON Violations Related to Foodborne Illness Interventions and Risk Factors (Red Items 1-22) PROTECTION FROM CONTAMINATION_ 8Cross-contamination FOOD PROTECTION MANAGEMENT 3-302.11(A)(1) Raw Animal Foods Separated frqm - 1;` 590.003(A) Assi nment of Res onsibilit * 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'I 590.003(C) Responsibility of the Person in Charge to 3-302.11(A) Food Protection* require repotting by Food Employees and 3-302.15 Washing Fruits and Vegetables Applicants 3.304.11 Food Contact with Equipment and 590.003(F) Responsibility of a Food Employee or an Utensils* Applicant to Report to the Person in Charge* Contamination from the Consumer 3-306.14(A)(B) Returned Food and Reservice of Food* 590.003(G) Reporting by Person in Charge* Disposition of Adulterated or Contaminated 3-, 590.003(D) Exclusions and Restrictions* Food 590.003(E) Removal of Exclusions and Restrictions 3-701.11 Discarding or Reconditioning Unsafe Food* FOOD FROM APPROVED SOURCE 9 Food Contact Surfaces 4 Food and Water From Regulated Sources 4-501.111 Manual Warewashing-Hot Water 590.004(A-B) Compliance with Food Law* Sanitization Temperatures* 3-201.12 Food in a Hermetically Sealed Container* 4-501.112 Mechanical Warewashing-Hot Water 3-201.13 Fluid Milk and Milk Products* Sanitization Temperatures* 3-202.13 Shell Eggs* 4-501.114 Chemical Sanitization-temp.,.pH, 3-202.14 Eggs and Milk Products,Pasteurized* Concentration and Hardness* 3-202.16 Ice Made from Potable Drinking Water* 4-601.11(A) Equipment Food Contact Surfaces and 5-101.11 Drinking Water from an Approved System* Utensils Clean* 590.006(A) Bottled Drinking Water* 4-602.11 Cleaning Frequency of Equipment Food- 590.006(B) Water Meets Standards in 310 CMR 22.0* Contact Surfaces and Utensils* Shellfish and Fish From an Approved Source 4-702.11 Frequency of Sanitization of Utensils and 3.201.14 Fish and Recreationally caught Molluscan Food Contact Surfaces of Equipment* Shellfish* 4-703.11 Methods of Sanitization- Hot Water and 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* Sources* 00 Proper,Adequate Handwashing Game and Wild Mushrooms Approved by Regulatory Authority 2-301.11 Clean Condition-Hands and Arms* 2-301.12 Cleaning Procedure* 3.202.18 Shellstock Identification Present* 2-301.14 When to Wash* 590.004(C) Wild Mushrooms* "11 Good Hygienic Practices 3-201.17 Game Animals* 2-401.11 Eating,Drinking or Using Tobacco* 5 Receiving/Condition 2-401.12 Discharges From the Eyes,Nose and 3-202.11 PHFs Received at Proper Temperatures* Mouth* 3-202.15 Package Integrity* 3-301.12 Preventing Contamination When Tasting* 3-101.11 Food Safe and Unadulterated* 12 Prevention of Contamination from Hands :6; Tags/Records:Shellstock 590.004(E) Preventing Contamination from 3-202.18 Shellstock Identification* Employees* 3-203.12 Shellstock Identification Maintained* Handwash Facilities Tags/Records: Fish Products Conveniently Located and Accessible 3-402.11 Parasite Destruction* 5-203.11 Numbers and Capacities* 3-402.12 Records,Creation and Retention* 5-204.11 Location and Placement* 590.004(1) Labeling of Ingredients* 5-205.11 Accessibility,Operation and Maintenance 1 Conformance with Approved Procedures Supplied with Soap and Hand Drying /HACCP Plans Devices 3-502.11 Specialized Processing Methods* 6-301.11 Handwashing Cleanser,Availability 3-502.12 Reduced Oxygen Packaging,Criteria* 6-301.12 Hand Drying Provision 8-103.12 Conformance with Approved Procedures* *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. CITY of SALEM BOARD OF HEALTH Establishment Name: Date: 'a 9-03 Page: "2. of ,ff , i Item Code C'=Critical Item `f t" DESCRIPTION OF VIOLATION / PLAN OF CORRECTION Date No. Reference R—Red Item -. :. ` .z.�'ra•„ PLEASE cLenaw : 3. Verified r A/v PWc Af.I•VSP /r/, < nik 'r2> P e( R r o /� / 2><f 2 Q•PP� / t o79 r•7.C((�9 �7P - Qr . r Vi/7-n 7/ r .� >/P�vt �- (AC-L- A!_ ni`aPo (3 I (Acx i » - 7 c/.v/4 _/i ,�r.�•e l��el� e e ,sn � .- /d.6e i e a��ce s a3 -f de 2eG P��S / �PLGi t L -fa �. /Ylcr/�R.o_o� U —/ / /1/ L lk Z / A14*) / 6 9�✓ Q ,17 t! G / S OFC�i - tizinr Sn/ fim, o �e 11 tl /! a i —isi�lG�P/jitc�' 3- e X vo �7 ac n� /e n0 fiGriny i) chr U j v f Oocf 7�iN S ✓ -n Ea'�tGYJ —9G5dP.5 Discussion With Person in Charge: ,' Corrective Action Required: ❑ No - ❑Yes . S. I have read this report, have had the opportunity to ask questions and agree to correct all ❑ Voluntary Compliance ❑ Employee Restriction/ z " violations before the next inspection, to observe all conditions as described, and to comply Exclusion witheall mandates of the Mass/Federal Food Code. I understand that noncompliance may ❑ Re-inspection Scheduled ❑ Emergency Suspension result in daily fines of twenty-five dollars or suspension/revocation of your food permit. ❑ Embargo ❑ Emergency Closure ^ r O pct L /c /1cvi c S ❑ Voluntary Disposal ❑ Other FORM 7348 HOBBS & WARREN - BOSTON Violations Related to Foodborne Illness Interventions and Risk 3-501.14(C) PHFs Received at Temperatures Factors(Red Items 1.22) (Cont.) According to Law Cooled to 41*F/45°F Within 4 Hours.* PROTECTION FROM CHEMICALS 3-501.15 Cooling Methods for PHFs L14:! Food or Color Additives 19 PHF Hot and Cold Holding 3-202.12 Additives* 3-501.16(B) Cold PHFs Maintained at or below 3-202.14 Protection from Unapproved Additives* 590.004(F) 41°F/45°F* ri15 Poisonous or Toxic Substances 3-501.16(A) Hot PHFs Maintained at or above 7-101.11 Identifying Information-Original 140°F* Containers* 3-501.16(A) Roasts Held at or above 130°F.* 7-102.11 Common Name-Working Containers* 20 Time as a Public Health Control 7-201.11 Separation-Storage* 3-501.19 Time as a Public Health Control* 7-202.11 Restriction-Presence and Use* 590.004(H) Variance Requirement 7-202.12 Conditions of Use* REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-203.11 Toxic Containers-Prohibitions* POPULATIONS(HSP) 7-204.11 Sanitizers,Criteria-Chemicals* ;'`21 3-801.11(A) Unpasteurized Pre-packaged Juices and 7-204.12 Chemicals for Washing Produce,Criteria* Beverages with Warning Labels* 7-204.14 Drying Agents,Criteria* 3-801.11(6) Use of Pasteurized E s* 7-205.11 Incidental Food Contact,Lubricants* 3-801.11(D) Raw or Partially Cooked Animal Food and 7-206.11 Restricted Use Pesticides,Criteria* Raw Seed Sprouts Not Served.* 7-206.12 Rodent Bait Stations* 3-801.11(C) Unopened Food Package Not Re-served.* 7-206.13 Tracking Powders, Pest Control and Monitoring* CONSUMER ADVISORY 22 3-603.11 Consumer Advisory Posted for Consumption of TIMETEMPERATURE CONTROLS Animal Foods that are Raw, Undercooked or Proper Cooking Temperatures for not Otherwise Processed to Eliminate PHFs Pathogens.* Ettecl,a 11,1200, 3-401.11A(l)(2) Eggs- 1557 15 Sec. 3-302.13 1 Pasteurized Eggs Substitute for Raw Shell Eggs* Eggs-Immediate Service 145°F 15 Sec.* 3-401.11(A)(2) Comminuted Fish,Meats&Game SPECIAL REQUIREMENTS Animals-155°F Sec.* 590.009(A)-(D) Violations of Section 590.009(A)-(D) in 3-401.11(8)(1)(2) Pork and Beef Roast- 130°F 121 Min.* catering,mobile food,temporary and 3-401.11(A)(2) Ratites,Injected Meats- 155°F 15 Sec.* residential kitchen operations should be 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs, debited under the appropriate sections Stuffing Containing Fish,Meat, above if related to foodborne illness Poultry or Ratites- 165*F 15 Sec.* interventions and risk factors. Other 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks 590.009 violations relating to good retail 145°F* practices should be debited under#29- 3-401.12 Raw Animal Foods Cooked in a Special Requirements. Microwave 165°F* 3-401.11(A)(1)(b) All Other PHFs- 145°F 15 Sec.* VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 17++'< Reheating for Hot Holding (Blue Items 23-30) 3-403.11(A)&(D) PHFs 165°F 15 Sec.* Critical and non-critical violations, which do not relate to the 3-403.11(B) Microwave- 165°F 2 Minute Standing foodborne illness interventions and risk factors listed above, can be Time* found in the following sections of the Food Code and 105 CMR 3-403.11(C) Commercially Processed RTE Food- 590.00. 140°F* Item Good Retail Practices FC 590.00 3-403.11(E) Remaining Unsliced Portions of Beef 23. Management and Personnel FC-2 .003 Roasts* 24. Food and Food Protection FC-3 .004 Proper Cooling of PHFs 25. Equipment and Utensils FC-4 .005 3-501.14(A) Cooling Cooked PHFs from 140°F to 26. Water, Plumbing and Waste FG-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(8) Cooling PHFs Made From Ambient 29. Special Requirements .009 Temperature Ingredients to 41°F/45°F 30. Other Within 4 Hours* *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. THE COMMONWEALTH OF MASSACHUSETTS ` CITY OF SALEM BOARD OF HEALTH Address: 120 Washington Street, 4th Floor Salem, MA 01970-3523 FOOD ESTABLISHMENT INSPECTION REPORT Tel: (978) 741-1800 Fax: (978) 745-0343 Name Date Type of Operation(s) TTvoe of Insoection '� - Z �,� Food Service ❑ Routine Address /. . �I y2 _ Rik ❑ Retail ❑ Re-inspection Level ❑ Residential Kitchen Previous Inspection Telephone _ ( v ❑ Mobile Date: Owner - HACCP Y/N EJ Temporary ElPre-operation ❑ Caterer ❑ Suspect Illness Person in Charge(PIC) Time ❑ Bed& Breakfast ❑ General Complaint In: 4. HACCP Inspector Out: Permit No. .4, Other Each violation checked requires an explanation on the narrative page(s) and a citation of specific provision(s) violated. Non-compliance with: Violations Related to Foodborne Illness Interventions and Risk Factors (Red Items) Anti-Choking Tobacco Violations marked may pose an imminent health hazard and require immediate corrective 590.009(E) ❑ 590.009(F) ❑ action as determined by the Board of Health. Local Law ❑ FOOD PROTECTION MANAGEMENT ❑ 12. Prevention of Contamination from Hands ❑ 1. PIC Assigned/ Knowledgeable/Duties ❑ 13. Handwash Facilities EMPLOYEE HEALTH PROTECTION FROM CHEMICALS ❑ 2. Reporting of Diseases by Food Employee and PIC ❑ 3. Personnel with Infections Restricted/ Excluded El 14. Approved Food or Color Additives ❑ 15. Toxic Chemicals FOOD FROM APPROVED SOURCE El 4. Food and Water from Approved Source TIMEITEMPERATURE CONTROLS(Potentially Hazardous Foods) El 16. Cooking Temperatures El 5. Receiving/Condition El 17. Reheating El6. Tags/ Records/Accuracy of Ingredient Statements ❑ 7. Conformance with Approved Procedures/ HACCP Plans El 18. Cooling El 19. Hot and Cold Holding PROTECTION FROM CONTAMINATION ❑ 20. Time as a Public Health Control ❑ B. Separation/Segregation/Protection REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) ❑ 9. Food Contact Surfaces Cleaning and Sanitizing El❑ 10. Proper Adequate Handwashing 21. Food and Food Preparation for HSP CONSUMER ADVISORY ❑ 11. Good Hygienic Practices ❑ 22. Posting of Consumer Advisories Violations Related to Good Retail Practices (Blue Number of Violated Provisions Related Items) Critical (C) violations marked must be corrected To Foodborne Illnesses Interventions immediately or within 10 days as determined by the Board and Risk Factors (Red Items 1-22): of Health. Non-critical (N) violations must be corrected Official Order for Correction: Based on an inspection immediately or within 90 days as determined by the Board today, the items checked indicate violations of 105 CMR of Health. 590.000/Federal Food Code.This report, when signed below C N by a Board of Health member or its agent constitutes an 23. Management and Personnel (FC-2)(590.003) order of the Board of Health. Failure to correct violations 24. Food and Food Protection (FC-3)(590.004) cited in this report may result in suspension or revocation of 25. Equipment and Utensils (FC-4)(590.005) the food establishment permit and cessation of food 26. Water, Plumbing and Waste (FC-5)(590.006) establishment operations. If aggrieved by this order, you 27. Physical Facility (FC-6)(590.007) have a right to a hearing.Your request must be in writing 28. Poisonous or Toxic Materials (FC-7)(590.008) and submitted to the Board of Health at the above address 29. Special Requirements (590.009) within 10 days of receipt of this order. 30. Other DATE OF RE-INSPECTION: I / Inspector's Signature: Print`: I/ Y PIC's Signature: Print: Page/or Pages FORM 734A HOBBS&WARREN -BOSTON/� Violations Related to Foodborne Illness " Interventions and Risk Factors (Red Items 1-22) PROTECTION FROM CONTAMINATION 8 Cross-contamination FOOD PROTECTION MANAGEMENT 3-302.11(A)(1) Raw Animal Foods Separated from 590.003(A) Asm nment of Responsibility* Cooked and RTE Foods* 590.003(B) Demonstration of Knowledge* Contamination from Raw Ingredients 2-103.11 Person in Charge-Duties 3-302.11(A)(2) Raw Animal Foods Separated from Each Other* EMPLOYEE HEALTH Contamination from the Environment 590.003(C) Responsibility of the Person in Charge to 3-302.11(A) Food Protection* mow_ require reporting by Food Employees and 3-302.15 Washing Fruits and Vegetables ar 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 1-3, 590.003(D) Exclusions and Restrictions* Food 590.003(E) Removal of Exclusions and Restrictions 3-701.11 Discarding or Reconditioning Unsafe Food* FOOD FROM APPROVED SOURCE 9 Food Contact Surfaces Food and Water From Regulated Sources 590.004(A-B) Compliance with Food Law* 4-501.111 Manual Warewashing-Hot Water Sanitization Temperatures* 3-201.12 Food in a Hermetically Sealed Container* 4-501.112 Mechanical Warewashing-Hot Water 3-201.13 Fluid Milk and Milk Products* Sanitization Temperatures* 3-202.13 Shell Eggs* 4-501.114 Chemical Sanitization-temp.,pH, 3-202.14 Eggs and Milk Products,Pasteurized* Concentration and Hardness* 3-202.16 Ice Made from Potable Drinking Water* 4-601.11(A) Equipment Food Contact Surfaces and 5-101.11 Drinking Water from an Approved System* Utensils Clean* 590.006(A) Bottled Drinking Water* 4-602.11 Cleaning Frequency of Equipment Food- 590.006(8) Water Meets Standards in 310 CMR 22.0* Contact Surfaces and Utensils* Shellfish and Fish From an Approved Source 4-702.11 Frequency of Sanitization of Utensils and 3.201.14 Fish and Recreationally caught Molluscan Food Contact Surfaces of Equipment* Shellfish* 4-703.11 Methods of Sanitization- Hot Water and 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* Sources* 10: Proper,Adequate Handwashing Game and Wild Mushrooms Approved by Regulatory Authority 2-301.11 Clean Condition-Hands and Arms* 2-301.12 Cleaning Procedure* 3.202.18 Shellstock Identification Present* 2-301.14 When to Wash* 590.004(C) Wild Mushrooms* 3-201.17 Game Animals* 11 Good Hygienic Practices 2-401.11 Eating,Drinking or Using Tobacco* 5 Receiving/Condition 2-401.12 Discharges From the Eyes, Nose and 3-202.11 PHFs Received at Proper Temperatures* Mouth* 3-202.15 Package Integrity* 3-301.12 Preventing Contamination When Tasting* 3-101.11 Food Safe and Unadulterated* 12.:•'': Prevention of Contamination from Hands 6 Tags/Records:Shellstock 590.004(E) Preventing Contamination from 3-202.18 Shellstock Identification* Employees* 3-203.12 Shellstock Identification Maintained* 13°' Handwash Facilities Tags/Records: Fish Products Conveniently Located and Accessible 3-402.11 Parasite Destruction* 5-203.11 Numbers and Capacities* 3-402.12 Records,Creation and Retention* 5-204.11 Location and Placement* 590.004(J) Labeling of Ingredients* 5-205.11 Accessibility,Operation and Maintenance 7w Conformance with Approved Procedures Supplied with Soap and Hand Drying HACCP Plans Devices 3-502.11 Specialized Processing Methods* 6-301.11 Handwashing Cleanser,Availability 3-502.12 Reduced Oxygen Packaging,Criteria* 6-301.12 Hand Drying Provision 8-103.12 Conformance with Approved Procedures* •Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. ` BOARD OTH Establishment Name: Date:ite4 ICI)z Page: �' of No. Code C—Critical itam f ; T DESCRIPTION OF VI LA71ON J PLAN OF CORRECTION Date � Na.' Refiereoca R—Red item .` ' „: ? v - - Verifieda PL se PRIM CLEARLY y. r s F k` t k 4 t f t� It F Discussion With Person in Charge: Corrective Action Required: p Np ' ❑Yes } ❑ voluntary Compliance ❑ Employee Restriction J Exclusion 'r ❑ Re-inspection Scheduled ❑ Emergency Suspension r ❑ Embargo ❑ Emergency Closure ❑ Voluntary Disposal ❑ Other FORM 7348 (REV. 7/2000) HOBBS a WARREN, INC. - BOSTON This Form Approved by the Department of Public Health Violations Related to Foodborne Illness Interventions and Risk 3-501.14(C) PHFs Received at Temperatures Factors(Red Items 1.22) (Cont.) According to Law Cooled to 41°F/45°F Within 4 Hours.* PROTECTION FROM CHEMICALS 3-501.15 Cooling Methods for PHFs 14 Food or Color Additives 19 PHF Hot and Cold Holding 3-202.12 Additives* 3-501.16(8) Cold PHFs Maintained at or below 3-202.14 Protection from Unapproved Additives* 590.004(F) 41°F/45°F* 15 Poisonous or Toxic Substances 3-501.16(A) Hot PHFs Maintained at or above 7-101.11 Identifying Information-Original 140°F.* Containers* 3-501.16(A) Roasts Held at or above 130°F* 7-102.11 Common Name-Working Containers* 20 Time as a Public Health Control 7-201.11 Separation-Storage* 3-501.19 Time as a Public Health Control* 7-202.11 Restriction-Presence and Use* 590.004(H) Variance Requirement 7-202.12 Conditions of Use* REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-203.11 Toxic Containers-Prohibitions* POPULATIONS(HSP) 7-204.11 Sanitizers,Criteria-Chemicals* 21 3-801.11(A) Unpasteurized Pre-packaged Juices and 7-204.12 Chemicals for Washing Produce,Criteria* Beverages with Wanting Labels* 7-204.14 Drying Agents,Criteria* 3-801.11(B) Use of Pasteurized Eggs* 7-205.11 Incidental Food Contact,Lubricants* 3-801.11(D) Raw or Partially Cooked Animal Food and 7-206.11 Restricted Use Pesticides,Criteria* Raw Seed Sprouts Not Served.* 7-206.12 Rodent Bait Stations* 3-801.11(C) Unopened Food Package Not Re-served.* 7-206.13 Tracking Powders,Pest Control and Monitoring* CONSUMER ADVISORY 22 i 3-603.11 Consumer Advisory Posted for Consumption of TIME/TEMPERATURE CONTROLS Animal Foods that are Raw,Undercooked or 16 Proper Cooking Temperatures for not Otherwise Processed to Eliminate PHFs Pathogens.* EBectse...12001 3-401.11A(l)(2) Eggs- 155°F 15 Sec. 3-302.13 Pasteurized Eggs Substitute for Raw Shell Eggs* Eggs-Immediate Service 145°F 15 Sec.* 3-401.11(A)(2) Comminuted Fish,Meats&Game SPECIAL REQUIREMENTS Animals-155°F Sec.* 590.009(A)-(D) Violations of Section 590.009(A)-(D)in 3-401.11(B)(1)(2) Pork and Beef Roast- 130°F 121 Min.* catering,mobile food,temporary and 3-401.11(A)(2) Ratites,Injected Meats- 155°F 15 Sec.* residential kitchen operations should be 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs, debited under the appropriate sections Stuffing Containing Fish,Meat, above if related to foodborne illness Poultry or Ratites- 165°F 15 Sec.* interventions and risk factors. Other 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks 590.009 violations relating to good retail 145°F* practices should be debited under#29- 3-401.12 Raw Animal Foods Cooked in a Special Requirements. Microwave 165°F* 3-401.11(A)(1)(b) All Other PHFs-145°F 15 Sec.* VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 17 Reheating for Hol Holding (Blue Items 23-30) 3-403.11(A)&(D) PHFs 165°F 15 Sec.* Critical and non-critical violations, which do not relate to the 3-403.11(B) Microwave- 165°F 2 Minute Standing foodborne illness interventions and risk factors listed above, can be Time* found in the following sections of the Food Code and 105 CMR 3-403.11(C) Commercially Processed RTE Food- 590.00. 140°F* Item Good Retail Practices FC 590.00 3-403.11(E) Remaining Unsliced Portions of Beef 23. Management and Personnel FC-2 .003 Roasts* 24. Food and Food Protection FC-3 .004 18 Proper Cooling of PHFs 25. Equipment and Utensils FC-4 .005 3-501.14(A) Cooling Cooked PHFs from 140*F to 26. Water, Plumbing and Waste FC-5 .006 70°F Within 2 Hours and from 70°F 27. Physical Facility FC-6 .007 to 41°F/45017 Within 4 Hours.* 26, Poisonous or Toxic Materials FC-7 .006 3-501.14(6) Cooling PHFs Made From Ambient 29. Special Requirements .009 Temperature Ingredients to 41°F/45°F 30. Other Within 4 Hours* *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. 'D -DeLeo ' s AN, 25 Norman Street, Salem, MA �978� 740-2800 - Fax (978) 740-2772 DAILY SPECIAL •• • SPECIAL x 2 Large Cheese Pizzas 2 Slices of Pizza r $13.99 + Tax and a Soda or Water t Additional Toppings$1.20 each. $3.50 + Tax -r GARLIC BREAD ,•, Garlic Bread ...................................................... $1.49 NEW! WE NOW ACCEPT Imported Romano, Mor2arella, &Tomatoes ........ ^- OVEN FRESH CALZONES -- IMSA ESS Med. Lg. BasiC CalZOne Mozzarella, ricotta,provolone $5.50 $6.50 AoddfmonaVegbtlieoToapt pp ! section below. $1.25 $1.50 """' GOURMET PIZZAS - A Additional Meat To$iping Choose frrnn topping selectaons at pizza section below. $1.35 $1.50 Med. 1.91 ^� TRADITIONALCALZONES -•• BLANCO ............................................. $7.49 $9.89 Provolone,Romano,Mozzarella,Ricotta Cheese,Imported Olive Med. Lg. Oil,Fresh Garlic and NO Tomato Sauce, Meatbafl Calaone (Madewith weabah,tare,gaamhchm&&o4ne aaex} $6.50 $7.99 New York Calzme Male am memgawnbasAwYAStAKau $6.50 $7.95 CHICKEN BROCCOLI BLANCO ........$10.25 $13.49 BrOCCOli a flleeSe (Broccoli,(Leese&Seasoning) $6.50 $7.49 Bianco Pizza with Chicken&Broccoli Coldcntand Cheese (Ham,Chet&salami) $6.99 $8.75 SggpldntPam.CalT.One (Made with Cheese,Sauce&Eggpimt) $6.50 $7.49 CHIARE ZA .... $7.49 $9.89 Spinach,and Cheese {spinach,chum&seasomaT $6.50 g7.49 Tomato Sauce,Mozzarella Cheese Fresh Tomato Slices, SteakBotnb (MadewitRata sdani,Pellets,Moshmane,onion,Cheese&steal] $6..99 $$.75 Prosciutto,Imported Olive Oil and Romano Cheese. IlaAahhan (Made with Pineapple,Sam&Cheese) $6,94 &.75 RAGGIANTE . $9.49 $12.49 ..................................... Steak o Finer (steak,Cheese&S ashde $6.99 8.75 Marinated Chicken Breast,Roast Peppers and Tomatoes. Buffalo Finger CalzoIIe- (hkWewith Ho[HudaloFmgers $8.50 $10.50 ' Provolorte&Mariamlia Cheese) Chicken rip Calzme (Made with MarinatedCNckmand Cheese) $6.99 $8.75 DELEO'SFIIMT .............................. $9.49 $12.49 Pepperoni,Artichoke Hearts,Mushrooms,Green Peppers, Chicken P (Mzdewith Chi ken�ag M aze $7.99 $9.99 and Mozzarella. Cheese,Tomazo Sauce,m Aovokme Chet) Veggie Cahme• (madewith Pocwshawchemshccsraschema $6.99 $8.99 DELIZIA ............................................. $8.49 $11.29 much of Fresh Garlic,Tomatoes,Fresh Peppers,Broccdi,Mushrooms&onion) Ricotta Cheese,Sweet Sausage,Mozzarella and Fresh Garlic. Side of Sauce .45C each PartyHAWAIL4N........................................ $7.49 $9.89 made the same as e but approxhmately tw1Ce the SIZC- 15.00 HEARTH BAKED PIZZA imported Baked Ham,Pineapple Chunks and Mozzarella. -- -r Med. Lg. BUFFALO CHICKEN PIZZA .............. $7.49 $10.09 Cheese (Traditional) .,,.._.,,.. $5,49 $7.69 Chicken Fingers,Mozzarella Cheese,Tomato Sauce Thick Crust ............................................ $6.49 $8.89 and Hot Sauce, DeLeo's Combo (5 items for the price of 4) ... $9.49 $12.49 NEW YORK STYLE PIZZA .................$8.99 $10.79 Veggie Combo ........................................ $9.49 $12.49 Mozzarella,Plumb Tomatoes,Garlic,Basil,and Meat Combo ....................................... .. $9.49 $12.49 NO Tomato Sauce, The Works (9 Items for the price of 6) ............. $11.49 $14.89 ......................... $1.00 $1.20 PICCANTE ........................................ $9.49 $11.29 Toppings ........................ Hot Cherry Peppers,Pepperoni,Sweet Italian Sausage MEAT VEGETABLE OTHER and Mozzarella. Canadian Bacon Onions ' Hot Cherry Peppers Extra Cheese, Imported Pepperoni Broccoli Florets Tomato Slices Feta Cheese, SQUISTO ..............••.............. $9,49 $12.49 Genoa Salami Wbite Mushrooms Black Olives Ricotta Cheese, Black Olives,Fresh Tomatoes,Roasted Peppers,Pepperoni, Ground Beef Fresh Explant Fresh Garlic, pP pp Baked Ham Spinach Anchovies Mozzarella,and Romano cheese. Prosciutto Artichoke Hearts Pineapple 1LB•Q• CHICKEN PIZZA ............. $7.49 $10.09 *Marinated Chicken Green peppers Bahian Sausage Roasted Peppers Marinated Chicken,Mozzarella Cheese,Tomato Sauce and Barbecue Sauce. *Steak (*Marinated Chicken&Steak Toppings we Double Priced) .�. SAPORITO .........................................$8.49 $11.25 LF2Oinch*'pizza Size Pizza Sliced Prosciutto and White Onions,over Tomato Sauce, Mozzarella,Riwua and Romano Cheese. cut in squares CHICKEN PARMIGIANA................... $7.49 $10.09 �a 9 j,gg pe7 Made with Ch cken F nge s,Tomato Sauce,Mozzarella,and tp topping Provolone Cheese. *Although we try our best, we cannot be held responsible for the temperature of dinners or subs that are delivered. $1.00 charge on aft defiveries.,($1.50 charge to Marble(read.)$10.00 Minimum for Delivery. ►.. PLATES MARINATED SIMS Cheeseburger Plate ........................................... $5.50 Marinated Chicken Tip Sub .......................... $4.60 Chicken Finger Plate ......................................... $5.50 Chicken kabob Sub (Lettuce,Tomes o,Feta&Greek Dressing .......... $5.05 Boneless Buffalo Fingers ................................... $5.99 Served with French Pries and Onion Rings. Hawaiian Chicken Tip Sub (Pineapple&Teriyaki Sauce)...... $4.99 Chicken Tip Club .............................................. $4.99 ^• DINNERS ^' Marinated Steak Tip ......................................... $4.75 Steak Tip Bomb atam sakurd.Peppers,mushrooms,omens&cheese)......... $5.09 Chicken Tip Dinner ........................................... $6.25 Chicken Tip Bomb(xam,salami.P%TM,Mmhrmo ,owom&cheese).... $4.99 Steak Tip Dinner ................................................$6.50 We can add Teriyaki,Barbecue,Honey Mustard or Red Hot Sauce to any Sub. Combo Steak& Chicken Dinner ....................... $6.50 Served with French Pries, Onion Rings,Salad and Pita Bread, STEAK SUBS ~ . Med. Lg. Plain ........................................................ $3.60 $4.05 ^' RICE PLATES ^' Cheese Steak ........................................... $3.99 $4.30 Chicken Tips with Rice Pilaf.............................. $5.99 Steak Bomb ............................................. $4.25 $4.75 Steak Tips&Veggies with Rice Pilaf...............................$6.25 Add toppingsfor.100 each - ExtraCbeese.450 Steak Tips with Rice Pilaf.................................. $5.99 Chicken &Veggies with Rice Pilaf..................... $5.99 ... GARDEN FRESH SALADS - ~ PASTA ~ Garden .............................................................. $3.50 Ziti .................................................................... $3.50 Caesar ............................................................... $3.75 Antipasto ........................................................... $4.25 Ziti with Meatballs ............................................ $4.25 Chef.................................................................. $4.25 Ziti with Chicken Parmigiana ............................ $5.49 ............................................. 3.95 Greek .................. $ Ziti with Veal Parmigiana .................................. $5.59 Tuna .................................................................. $4.25 Ziti with Eggplant Parmigiana .......................... $4.99 Chicken ............................................................. $4.25 Chicken, Broccoli & Ziti ................................... $5.75 Seafood ............................................................. $4.25 AUPastas served with Pita Bread. Garden Salad with Marinated Chicken ............. $4.50 Garden Salad with Steak Tips ........................... $4.75 HOT SUBS Med' Lg. Greek Salad with Marinated Chicken ............... $4.95 Cheeseburger ................................................... $2.99 Caesar Salad with Marinated Chicken .............. $4.95 Cheeseburger Sub ............................................ $4.05 All Salads areserved with Homemade Pita Bread and choice of Italian,Greek,Caesar,Blue cheese mLee Dressing. MeatantParmigiana .................................. . $4.20 BxtraPitaBread.500-BdraDressing.350each-AddeatraChicken$1.00 Meatball .................................................. $3.603.66 $3.99 Veggie Stir Fry ........................................ $3.05 $3.45 ••• SIDE ORDERS ~ Chicken Veggie Stir Fry ..................................... $4.75 Med. Lg. Pastrami ............................................................. 4.20 French Fries ............................................ $1.99 $2.70 Chicken Parmigiana ...........................................$4.75 Homemade Onion Rings ........................ $1.99 $2.70 Veal Parmigiana (100% Real) ............................. $5.50 Mozzarella Sticks ..................................... $3.69 $5.09 B.L.T. ....................................................... $3.60 $4.05 Chicken Wings ........................................ $3.99 $5.59 Buffalo Finger Sub ................................. $3.99 $4.50 Hot Buffalo Wings ................................... $4.29 $6.09 Boneless Buffalo Fingers ........................ $4.39 $6.09 COLD Chicken Fingers ...................................... $3.99 $5.59 Genoa Salami & Cheese .......................... $3.90 $4.30 Fried Mushrooms ................................... $1.99 $3.09 American Cold Cut ............................................ $4.30 Chicken Salad (White) $3.90 $4.30 lalapeno Poppers ................................... $4.09 $6.09 Ham and Cheese .................................... $3.90 $4.30 Pizza Rolls ............................................... $1.69/ea. Italian Cold Cut .............:........................ $3.90 $4.30 Seafood Salad .........................................: $3.35 $3.60 ' I / • Imported Prosciutto ................................ $4.05 $4.45 1 Roast Beef............................................... $4.05 $4.55 Tuna ........................................................ $3.90 $4.30 Oven Baked Turkey Breast ..................... $3.90 $4.30 Veggie ...................................................... $3.05 $3.45 r r Try any Large Sub on Homemade Pita Bread. _ _ • _ Extra Cheese on any Sub add.450-Peggies added to Hot Subs.100 NEW! WE NOW ACCEPT a 'VISA ® AMERIMN a► - ® MR6ESS DELIVERY POLICY- $1.00 Charge on all Deliveries. ($1.50 charge to Marblehead.) $10.00 Minimum for Delivery. 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JOANNE SCOTT, MPH, RS, CHO MAYOR HEALTH AGENT September 30,2003 DeLeo's C/o Tomi Gjikuria 28 Norman Street r Salem, MA.01970 , Dear Mr.Gjikuria: In accordance with Chapter 111, Sections 127A and 127B of the Massachusetts General laws, 105 CMR 400.00: State Sanitary Code, Chapter I: General Administrative Procedures and 105 CMR 410.000: State Sanitary Code,Chapter ll: Minimum Standards of Fitness for Human Habitation, an inspection was conducted of your business at 28 Norman Street in the City of Salem, Massachusetts, by Jeff Vaughan,Sanitarian of the Salem Board of Health on September 30,2003.The following violations of the State Sanitary Code were noted, as checked ; _X_ CMR 410:600 Storage of Rubbish and Garbage _ CMR 410:601 Collection of Rubbish and Garbage X CMR 410:602 Maintenance of Areas Free From Garbage and Rubbish(A through D) _ BOH Regulation#7 Description of Violations: See Enclosure(s) 410.600: Storage of Rubbish and Garbage (A) Garbage or mixed garbage and rubbish shall be stored in watertight receptacles with tight-fitting covers. Said receptacles and covers shall be of metal or other durable, rodent-proof material. Rubbish shall be stored in receptacles of metal or other durable, rodent- proof material.Garbage and rubbish shall be put out for collection no earlier than the day of collection. (B) Plastic bags shall be used to store garbage or mixed rubbish and garbage only if used as a liner in watertight receptacles with tight-fiting covers as required in 105 CMR 410.600(A)provided that the plastic bags may be put out for collection except in those places where such practice is prohibited by local rule or ordinance,or except in those cases where the Department of Public Health determines that such practice constitutes a health problem. For purposes of the preceding sentence,in making its determination,the Department shall consider,among other evidence of strewn garbage,torn garbage bags,or evidence of rodents. (C) The owner of any dwelling that contains three or more dwelling units,the owner of any rooming house,and the occupant of any other dwelling place shall be responsible for providing as many receptacles for the storage of garbage and rubbish as are sufficient to contain the accumulation before final collection or ultimate disposal, and shall so locate them to be convenient to the tenant that no objectionable odors enter any dwelling. (D) The occupants of each dwelling, dwelling unit, and rooming unit shall be responsible for the proper placement of her or his garbage and rubbish in the receptacles required in 105 CMR 410.600(C)or at the point of collection by the owner. 410.601: Collection of Garbage and Rubbish The owner of any dwelling that contains three or more dwelling units,the owner of any rooming house,and the occupant of any other dwelling place shall be responsible for the final collection or ultimate disposal or incineration of garbage and rubbish by means of: (A) The regular municipal collection system; or (B) Any other collection system approved by the Board of Health; or (C) When otherwise lawful, a garbage grinder which grinds garbage into the kitchen sink drain finely enough to ensure its free passage,and is otherwise maintained so as not to create a safety or health hazard;or (D) When otherwise lawful, a garbage or rubbish incinerator located within the dwelling which is properly installed and which is maintained so as not to create a safety or health hazard; or (E) Any other method of disposal which does not endanger any person and which is approved in writing by the Board of Health (see 10410.840) 410.602: Maintenance of Areas Free From Garbage and Rubbish (A) Land: The owner of any parcel of land,vacant or otherwise, shall be responsible for maintaining such parcel of land in a clean and sanitary condition and free from garbage, rubbish, or other refuse.The owner of such parcel of land shall correct any condition caused by or on such parcel or its appurtenance which affects the health or safety and well-being of the occupants of any dwelling or of the general public. (B) Dwelling Units: The occupant of any dwelling unit shall be responsible for maintaining in a clean and sanitary condition and free of garbage, rubbish, other filth or causes of sickness that part of the dwelling which s/he exclusively occupies or controls. (C) Dwellings Containing Fewer Than Three Dwelling Units: In a dwelling that contains fewer than three dwelling units,the occupant shall be responsible for maintaining in a clean and sanitary condition free of garbage, rubbish, other filth or causes of sickness the stairs or stairways leading to her or his dwelling unit and the landing adjacent to her or his dwelling unit if the stairs, stairways, or landing are not used by another occupant. (D) Common Areas: In any dwelling,the owner shall be responsible for maintaining in a clean and sanitary condition free of garbage, rubbish, other filth or causes of sickness that part of the dwelling which is used in common by the occupants and which is not occupied or controlled by the occupant exclusively. (1)The owner of any dwelling abutting a private passageway or right-of-way owned or used in common with other dwellings or which the owner or occupants under her or his control have the right to use or are in fact using shall be responsible for maintaining in a clean and sanitary condition free from garbage, rubbish,other filth or cause of sickness that part of the passageway or right-of-way which abuts her or his property and which s/he or the occupants under her or his control have the right to use, are in fact using,or which s/he owns. Board of Health Regulation#7 Section 3.10: Containers or Bundles of Household and Ordinary Commercial Waste, Garden and Lawn Waste: These shall be placed at the outer edge of the sidewalk appurtenant to the premises of the owner not later than 7:00 a.m.on the day of collection and not before 6:00 p.m. on the day preceding the day of collection, and shall be removed from the sidewalk on the same day as emptied. No commercial establishment shall place or cause to be placed more than four barrels or other containers of ordinary commercial wastes or any extraordinary commercial or industrial wastes or tree waste upon any sidewalk or way for disposal. You are hereby Ordered to make a good faith effort to correct these violations within 24(twenty four)hours of receipt of this notice. Failure on your part to comply within the specified time will result in a complaint being sought against you in Salem District Court. Should you be aggrieved by this order, you have the right to request a hearing before the Board of Health. A request for said hearing must be received in writing in the office of the Board of Health within 7 Days of receipt of this order. At said hearing,you will be given an opportunity to be heard and to present witness and documentary evidence as to why this order should be modified or withdrawn. You may be represented by an attorney. Please also be informed that you have the right to inspect and obtain copies of all relevant inspection or investigation reports, orders, and other documentary information in the possession of this Board, and that any adverse party has the right to be present at the hearing. One or more of the above violations constitutes a condition which may endanger or materially impair the health or safety and well-being of the occupant(s)or the general public. If you have any questions, kindly contact this office at(508)741-1800. For the Board of Health: Reply to: ianne Scott Jeff Vaughan Health Agent Sr.Sanitarian CC: c-g-trash CITY OF SALEM HEALTH DEPARTMENT • Salem, Massachusetts 01970 Trash Letter Violations To: A evs �/ Date:_ 1z� Address: �Z3, s-12,e-er; Time: City / State: ssg 6/, Property At: a� /Logy s-,eez> Violation Numbers: ,/600: Storage of Rubbish and Garbage _ 601: Collection of Rubbish and Garbage 602: Maintenance of Areas From Rubbish and Garbage B.O.H. 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