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DOC RYANS PUB & GRUB - ESTABLISHMENTS FDOCRYAN'SPUB & GRUB TTE STREET 6 G' F'. r 6 w N I O N -a fl 14' �o A, �y'caa�(r J1.,a Yv� b oto�-f to i Clb C-old ska .. G y .. t yy� ; , ....w.•«•^� *t° 74 a �.d- i2 ri i:tyw �rj+Ft. ♦ y w,..,.-. >.*.let'�i=4in�ol++ �.. ..v+MF'i-cx""'+A'w..v' �`kJntmn.Y. nAv.vhro'.+J`kW '^ er4' •^?g ^+.»^4 .,i;n-t?sY^,VIt�^a.,,r- , r�.,o+,..i-,a-ri:s^ae s.•�5nvms';-r°'.+ r , --°T+ xr'a' m-a, .-•.+,�.^ y^�. Commonwealth of Massachusetts City of Salem Board of Health 120 Washington Street,4th Floor a SALEM,MA 01970 Food/Retail Establishment Permit DATE PRINTED: 01/02/2006 WHO'S PLACE OF BUSINESS IS: Doc Ryan's Pub & Grub File Number:BHF-2004-0167 109 Lafayette Street Salem MA 01970 LOCATED AT: SALEM,MA 01970 Permit Type Permit No. Permit Issued Permit Expires Fee Restrictions/Notes FOOD SERVICE BHP-2006-0056 Jan 2,2006 Dec 31,2006 $200.00 ESTABLISHMENT Total Fees: $200.00 PERMIT EXPIRES December 31, 2006 Board of Health This Permit is not transferable and must be reissued upon change of ownership or location.The permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code,beofre any revonations,improvements,or equipment changes are made,all plans for such must be submitted to and approved by the Salem Board of Health. Page 23 of 26 l CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH j 120 WASHINGTON STREET, 4TH FLOOR ///--- .,.. SALEM, MA 01970 �nNe TEL. 978-741-1800 DEC STANLEY J. USOVICZ, JR. FAx 978-745-0343 C�� MAYOR ,4?005 WWW.SALEM.COM JOANNE SCOTT, PH, RS, CHO e 04RD O�OF 4 y HEALT 2006 APPLICATION FOR PERMIT TO, OPERATE ✓A! FOOD ESTABLISHMENT NAME OF ESTABLISHMENT DCRY4-0,3 1 u fJ TEL# T7067Y5yV 9;7 ADDRESS OF ESTABLISHMENT MAILING ADDRESS —if(if different) OWNER'SNAME 6 !Qf- LA$ ��• �.;,clwf /� pTE/L/#grZ Y7'/••6�2 I�slu ADDRESS `, DUQQf)C._ �` /�' Sl7 - s9�a CITY S-AL2aM STATE nAA ZIP 6 71!� CERTIFIED FOOD MANAGER'S NAME(S)Ge-4 ROzQ5 SIA�CERTIFICATE#(s) (p d (required in an establishment where potentially hazardous foodhiss prepared.) EMERGENCY RESPONSE PERSON `i_hoA4-1U Ry79A HOME TEL# /q 7P `SW HOURS OF OPERATION: Mon�><I Tue.,5cl WedJZ-<I Thu.I2 —C.1 Frigjd SatjC/. Sun.Q —C/ TYPE OF ESTABLISHMENT FEE (check only) RETAIL STORE YES QLO less than I000sq.ft. =$ 50 1000-10,000sq.ft. =$100 more than I0,000sq.ft. =$250 ............................................................. RESTAURANT less than 25 seats =$100 �Q more seats =$� more than 99 seats $200 ... .. ................................ . . ............... ............ ..----.... BED/BREAKFAST YES NO $100 ADDITIONAL PERMITS -------------------------------------------------------------------------------------------------------------------------- MAKE (not just serve) ICE CREAM, YOGURT, SOFT SERVE YES d $5 TOBACCO VENDOR YES $50 ALL NON-PROFIT(such as church kitchens) YES $25 *Please pay total with one check payable to the City of Salem . This Permit is not transferable and must be reissued upon change of ownership.The Permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code, before any renovations, improvements, or equipment changes are made, all plans for such must be submitted to and approved by the Salem Board of Health. Pursuant to MGL Chapter 62C, Section 49A, I certify under the pains and penalties of perjury that I, to my best knowledge and belief, have filed all state tax returns and paid all state taxes required under the law. �(_ OLI ` 34SS355 Signature Date Social Security or Federal Identification Number ---------------------------------------------------------------------------------]] ----------------------------------------- Revised 11/03/05 FOODAP2.adm Check#&Date 10 ' l0 A(�( [ CITY OF SALEM BOARD OF HEALTH Establishment Name: mac, tZ\Ira's Pvf3 Date: bl z8 0\, Page: of t Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date No. Reference R—Red Item - Verified PLEASE PRINT CLEARLY bti5e 1] v?OtJ oZ� or G\�ANIy� o� o�.iN�251b �t T'\iI =STa US\�t+�t.v�' ra 1 0. n Dr�vlo C� � '-t.1P,A.,M N7 So� N 'N�tJ crau�,cr_ t b'W I k-a n-,"n ' ATT -r 7-)v r, �-j r S 7�\ I, \p r� ,t i I i - F } Discussion With Person in Charge: Corrective Action Required: ❑ No ❑ Yes I have read this report, have had the opportunity to ask questions and agree to correct all ❑ Voluntary Compliance ❑ Employee Restriction/ violations before the next inspection, to observe all conditions as described, and to Exclusion p ❑ Re-inspection Scheduled ❑ Emergency Suspension comply with all mandates of the Mass/Federal Food Code. I understand that noncompliance may result in daily fines of twenty-five dollars ods spension/revocation of ❑ Embargo ❑ Emergency Closure your food permit. ❑ Voluntary Disposal ❑ Other: c I .3-561.14(C.) 'PHFs Received at Temperatures Violations Related to Foodborne fitness Interventions and Risk According to Law Cooled to Factors(items 1-22) (Cont) 41°F/45`F Wain n 4 Hours. PROTECTION FROM CHEMICALS 5-01,15 Cooling Methods for PHFs 1=4 Food or Color Additives 19 _PHF Hot and Cold Holding Food 3-501,16(13,) Cold Piff's Maintained at or below 3-20112 Additivesr 590004(F) 41145*F* f3-102.14 Protection m'ioon I t roved A(IdltjveS* 't-501.16(A) ]lot PHFsMaintainedat or above 15 Poisonous or Toxic Substances 140°F. * 7-101.11 identitprig Information-Orifi 3-501.1.6(A) Roasts Held at or above 130'F. Containers" L 20 Time as a Public Health Control 7-10211 Common Name- Working`Containers* 7-201.11 Separation-Storaec'c 3-501.19() Time as a public Health Control* - '90.004(H) 7-202,11 Restriction-presence and Use O ()4(EH) E VarianEie ttitement �� 7-202.12 Conditions of Use, 7 containers-Prohibitions(`1-203.11 Toxic REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-204.11 Sanitizers,Criteria- Chemicals* POPULATIONS(HSP) 21 3-SOL AI(A) Unpastem ized Pre-packaged Juices and 7-20-1.12 Chemicals for Washirip Produce,Criteria" _j-_204 14__Fing Agents Criteria, Be�ciages with 1,karning I abels� 3-90 1.11(B) Use of Pasteurized El;gso 7-205.11 Incidental Food Contact. Lubricanrsa I -_�csafictcd Use Pesticides.Criteria* 3-80 1,111(D) RavvolPiulia . 206.11 Mir Cooled Animal Food and Raw Seed Sprouts Not Served. 200.12 Rodent Bart Stations' - 3-901.11(C) Unopened Food package Not Re-served. 7-206.13 Tracking Powders,Post Control and L_ Monitoring* CONSUMER ADVISORY TIMEITEMPERATURE CONTROLS3-603.11 22 Consumer Advisory Posted for Consumption of Proper Cooking Temperatures for Animal Fa-ds,rbal are Raw, Undercooked or PHFs Not Otherwise Processed to Eliminate 3401.I IA(l)(2) Eggs- 155'F 15 Sec. Pathogens.*F"""' Ergs-hmnediate Service 145°F75sec* 3-302.13 Pasteurized Eggs Substitute for Raw Shell 3-401.11(11)(2) Comminuted Fish,Mears&GameFes'" Arnawk- 155°F 15 sec. * 3-401.1 I(B)(1)(2) Pork and Beef Roast 130 121 titin* 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 7401 1 I(Ahl) Poultry, Wild Came,Stuffed PHFs, residential kitchen operations should be Stuffing Containing Fish,Meat, debited under the appropriate sections Poultryon Ratitics-165'l-, 15 sec. above if related to foodborne illness 3401.1 l(C)(3) Whole-muscle,Intact Beef Steaks interventions and risk factors. Other - 1450F* 590.009 violations relatingto good retail 3-401 12 Raw Animal Foods Cooked in a practices should be debited under#29- Microwave 165F* Special Requirements. 3401.11(A)(lrb) All Other FHFs 145'F 15 sec. LFI7 _Reheating for Hot Holding VIOLATIONS RELATED TO GOOD RETAIL PRA C T/CES 3-403,11(A)&(t)) PHFs 165°F 15 sec. (Items 23-30) 3-403.11(B) Microwave-165°F 2MIaLue Standing Critical and non-critical violations, which do not relate to the Tons* foodborne illness iutervenlionr�and risk fiuiurs lisled above, can be 3-403.11(C) Commercially Processed RTE Food- found in the following sections of the Food Code and 105 CHR 14WF* 590.000. 3-403.1](E) Remaining Unsliced Portions of Beef Item GoodRetailPractices FC 590,000 Roasts* 23. Manarement and Personnel . FC-2 .003 18 Proper Cooling of PHFs 24, Food and Food ProtectionFC 3 .004 25 __E 3-501.W(A) Cooling Cooked PHFs from 140°F it) - FC-4 n05 26, Water,Plumbing and Waste FC-5 .006 70'F Within 2 flours and From 70'F 2-7 - Physical Facilites_ FC--6 o07 or 4 l')F/45'F Within 4 Hours. 1 28. Poisonous or Toxic Materials RG_7 _60-8 3-501.'14(B) Cooling PFIFr,Made From Ambient 29, Special Requirements _009 Temperature Ingredients to 41 017/45'F __30,------ G1her _ Within 4 Hours* Denotes critical ierri in the.federal 1999 Food Code or 105 CMR 590-000. v��oxlar�b CITY OF SALEM, MASSACHUSETTS LICENSING BOARD 120 WASHINGTON STREET �Iss��Frr SALEM, MA 01970 DAVID J.SHEA.CHAIRMAN FFIITEL. 978-745-9595 ExT. 5648 JOHN H.CASEY �C/.fig FAX 978-744-6775 RICHARD C.LEE BARBARA A.SIROIS KIMBERLEY DRISCOLL CLERK OF THE BOARD MAYOR March 27, 2007 RECEIVED ED APR - 2 2007 Tho_mas_J Ryan CITY OF SA,EM Doc Ryan's Pub Boj Ao OF HEALI afayette-Street Salem, MA 01970 ?f Dear Mr. Ryan: At a regular meeting of the City of Salem Licensing Board held on Monday, March 26, 2007, a Hearing was held regarding a complaint received regarding patrons on a licensed premise after closing. At this time the Board wishes to notify you that the Alcohol License issued to Rhino Corp. d/b/a Doc Ryan's Pub & Grub at 109 Lafayette Street is suspended for 1 day effective April 2, 2007. The License should be turned in to the Licensing Board, 120 Washington Street at 8 a.m. on Monday, April 2, 2007 and can be picked up at 8:00 a.m. on April 3, 2007. If you have any questions, do not hesitate to contact me. Sincerely, I FOR THE LICENSING BOARD Barbara A. Sirois Clerk of the Board Cc: Chairman David J. Shea and Board Members Mayor Kim Driscoll, City Solicitor Beth Rennard, Board of Health, Police Chief Certified mail: 7004 1350 0003 6157 9348 ^TX"^v'^vaTMwrb�5 S y M G u rri a,rry,,r.,�¢r z < •�s4''+Fkr, a"k+"`''so .:irk �y ""'� }y� �. �r� '. � * 'tea µ`x�;y)"-W�.+9+ ,�f,'.>;e�*��" 4 ��`w�°'�-.mac k��..a+ �.'Slkr��_. �� "j M '8`�Yr`� rs e ✓4U ` �a�� r. „$' ig .� K� ommonwealt6 of Massachusettss �tp FCity of Salem. Board of Health IGmbelley Dnscoil 1120 Washington Street,4th Floor, MByOf .. Y SALEM,MA 01970 Food/Retail Establishment Permit DATE PRINTED: 01/10/2007 ESTABLISHMENT NAME: Doe Ryan's Pub & Grub Fife Number:BHF-2004-000167 109 Lafayette Street Salem MA 01970 LOCATED AT: SALEM, MA 01970 Permit Type Permit No. Permit Issued Permit Expires Fee Restrictions I Notes FOOD SERVICE BHP-2007-0380 Jan 9,2007 Dec 31,2007 $200.00 ESTABLISHMENT Total Fees: $200.00 PERMIT EXPIRES ;December 31, 2007 Board of Health This Permit is not transferable and must be reissued upon change of ownership or location.The permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code,beofre any revonations,improvements,or equipment changes are made,all plans for such must be submitted to and approved by the Salem Board of Health. Page 1 of 1 r CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH 120 WASHINGTON STREET, 4TH FLOOR - SALEM, MA 01970 TEL. 978.741-1800 FAx 978.745-0343 Kimberley Driscoll wwwsALEM.coM Mayor JOANNE SCOTT, MPH, RS, CHO HEALTH AGENT 2007 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT NAME OF ESTABLISHMENT 20tf �f/fr��s / (>B TEL# // ) ADDRESS OF ESTABLISHMENT /D� /i lr�}��' �' S7� FAX# C `� f T yL) -�r3e ' MAILING ADDRESS(if different)_-le2-7_Gr7,�ir '�Tt�. EMAIL--Business': Owner's: OWNER'S NAME "jDlnl)-e ✓ TEL# C9?f> RVs%- 1!50- ADDRESS JADDRESS % 1027 %�S �)� �� 'z%� k//7 /?r/4 8"'?�10 STREET CITY STATE ZIP CERTIFIED FOOD MANAGER'S NAME(S) `` y CERTIFICATE#(S) (Required in an establishment where potentially hazardous food is prepared) EMERGENCY RESPONSE PERSON potentially HOME TEL$ f f Zz f SAYS OFOPERATION Monday _ Tuesday Wednesday Thursday --friday—i—Saturday Sunday HOURS OFOPERATION y/. Please write In time of day. trot example 11afn4lourl '/:Or7.'A�+'r /=DD i4+^"r Il: ,¢... /:U O�ryr+. / 'O u•.5•.« :a C :a-�+ /: o �r.•, 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 - --- --------Y_.. ------- _---- - ..._... ....... .... - - --- les-- _. -- --- .--- RESTAURANT YES NO less than 25 scats $100 25-99 seats =$150 more than 99 seats = 2007 - .. - --- - --- ...... --- - ---...._..-- ----- - -....----$"16-6, $"1 - , --- ----- ----- ..._:..- --- -- - BED/BREAKFAST YES NO $100 ---- ------ - - ---- - - ..-.. .._. ------ ----- .....I. ..... - - ----......... ......._.-._. ADDITIONAL PERMITS MAKE(not just serve) ICE CREAM, YOGURT, SOFT SERVE YES $5 TOBACCO VENDOR YES $50 ALL NON-PROFIT(such as church kitchens) YES $25 'Please pay total with one check payable to the City of Salem. This Permit is not transferable and must be reissued upon change of ownership. The Permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code, before any renovations, improvements, or equipment changes are made, all plans for such must be submitted to and approved by the Salem Board of Health. Pursuant to MGL Chapter 62C, Section 49A, I certify under the pains and penalties of perjury that I, to my best knowledge and belief, have filed all state tax ret s and paid all s'-.ate taxes req fir-e^dyunder the law. � y' U 7 Sign ure D to Social S curity or Federal Identification Number - ---------- ----- -- - - - - — ---Q-- -------------------------------....------------- Revised 11113/06 FOODAP2007.ad Check#&Date _ CITY OF SALEM, MASSACHUSETTS 019) BOARD OF HEALTH 120 WASHINGTON STREET, 4TH FLOOR SALEM, MA 01970 TEL. 978-741-1800 FAx 978-745-0343 Kimberley Driscoll WWW.SALEM.COM Mayor JOANNE SCOTT, MPH, RS, CHO HEALTH AGENT June 28, 2006 Thomas Ryan, Owner Doc Ryans Pub 109 Lafayette Street Salem, MA 01970 Dear Mr. Ryan: In accordance with M.G.L. 111 section 30, the Salem Board of Health suspends your Food Permit immediately because an imminenent health hazard is found to exist based upon observations by a Sanitarian on June 15, 2006 and based upon information received during a hearing held on June 28, 2006. These observations and information include the following: • No Certified Food Manager working at the establishment full time • A lack of understanding among employees as to who is the person in charge • Lack of contact information for the owner • Potentially hazardous food being prepared in home kitchens for service to patrons • No sanitizing solution • Dishwasher not operational • Refrigeration not operational • Hand washing sink not being used for handwashing • Lack of updated information being provided to the Board of Health Therefore, you are hereby ordered to close Doc Ryans Pub, effective immediately. You may not re-open the establishment until you complete the following: • a valid 2006 Food permit from the Board of Health • comply with all aspects of the Food Code as verified during an inspection by a Board of Health Sanitarian • enroll in a Food Manager Certification Program • supply a list of employees and their positions City of Salem, .Massachusetts Fire Department 48 Lafayette Street David W Cody Salem, Massachusetts 01970-3695 Fire Prevention Chief ?ef 978-744-1235 Bureau 978-744-6990 Fax978-745-4646 978-745.7777 dcody@salem.com Order#2005-2 Mr.Thomas Ryan Rhino Corp.DBA Doc Ryan's Pub&Grub 109 Lafayett Street Salem,MA 01970 January 17,2006 Dear Mr.Ryan: As a result of the tragic nightclub fire in Warwick,Rhode Island,the Commonwealth of Massachusetts enacted Chapter 304 of the Acts of 2004,An Act Relative to Fire Safety in the Commonwealth. Section 5 of this new law added Massachusetts General Law chapter 148, section 26GI/2 which requires every building or portion thereof,of public assembly,with a capacity of 100 persons or more that is designed or used for occupancy as a nightclub,dancehall,discotheque,bar or for similar entertainment purposes to be equipped with an adequate system of automatic sprinklers. Upon review it has been determined that the above referenced establishment falls under this new law. You are hereby ORDERED to comply with the provisions of the statute in accordance with the following schedule: 1. Plans and specifications for an adequate sprinkler system as required by statute shall be submitted to this office with a copy to the building inspector no later than May 15, 2006. 2. The sprinkler system must be completed no later than November 15,2007. You are strongly urged to take appropriate action at this time in order to meet the compliance deadlines of the new law. Under provisions of M.G.L.c. 148,s. 26GI12,you have the right to appeal this order to the Commonwealth's Automatic Sprinkler Appeals Board,P.O. Box 1025, State Road, Stow,MA 01775, within 45 days after service of this letter. If you have any questions please contact Salem Fire Prevention at(978)745-7777. So I Chief Cc: File lding Licensing Health t6` i VQ r r, ,Y l�. __ �4 �6 t_' i�`fi L ,7_ iS �� !�� --i-- ,� s ------- -------- ----- __--�-- . _ __� \ � �� \ � �� ,\ �` �. `� CITY OF SALEM, MASSACHUSETTS s n BOARD OF HEALTH s 120 WASHINGTON STREET, 4TH FLOOR SALEM, MA 01970 TEL. 978-741-1800 FAx 978-745-0343 W W W.SALEM.COM JOANNE SCOTT, MPH, RS, CHO Kimberley Driscoll HEALTH AGENT Mayor July 7, 2006 Thomas Ryan, Owner Doc-Ryans-Rub 109 Lafayette Street Salem, MA 01970 Dear Mr. Ryan: Based upon an inspection by Board of Health staff and completion of the items listed in the June 28, 2006 letter suspending the permit to operate a food establishment, the Salem Board of Health reinstates your Food Permit, effective immediately. Sincerely, Joanne Scdtt Health Agent Received by the owner in hand on June 28, 2006 1 N D i. 6 � t ' t i i ��T :v; 1 4 J-1 r l:u V � �.�+.J .v - IMPORTANT MESSAGE i FOR DATE TIM P.m M PHONE 02- A EA C-1� ODE NLIM ER EXTENSION O FAX ❑ MOBILE AREA CODE NUM R TIME TO CALL TELEPHONED C PLEASE CALL CAME TO SEE YOUWILL CALL AGAIN WANTS TO SEE YOU RUSH RETURNED YOUR CALL WILL FAX TO YOU MESSAGE Vic. R1 i N SIGNED 7 OMFOR 4009 MADE N U.S.A. NOTES STAFF/INSPECTIONAL MEETING January 19, 2006 AGENDA FOOD INSPECTION �• Kalamari's 62. HOUSING • 31-33 Salem St • Rainbow Terrace • COF Inspections 3. EMERGENCY PLANNING:.// �" . • Neia • Trainings: January 25`h 5:30-7 pm . • Special Populations i TRASH • Ward/Peabody✓ • 35 Andrew St '✓ • Home Depot/Fafard'/ • 1 DiPietro Ave- con't to 2/10✓ • 39R Clark St. EDUCATIONAL SEMINARS • PPE Training Jan 11`h NSCC Danvers=� • ID- Tyngsboro April 12thi_/ 06� NURSING / • Needles-Franklin St Pk ✓ • Fit Testing 7 CLERICAL • Overtimel/ • Permit renewals/unpaid taxes • FinancesL/ r8. OTHER • Odor- Crystal Auto hearing c� / • Total Fitness Highland Avenue ! / • Jackson St rodents/trash reports from A-1? �/ a�. • SESD trucks- odor 700 Do - _ L i ��,1�� f. ��'�'�t�111 U} ani\ '� �� SALEM PROPERTY MANAGERS, INC. 102 LAFAYETTE STREET, SALEM, MA 01970 S P M I (978)745-4961 •Fax (978)745-4345 JUN 9 2.2006 June 8,2006 CITY OF SALEM BOARD OF HEALTH Doc Ryan's& Crib 109-Lafayette-Strcet Salem,MA 01970 Attn: New Management Dear Neighbors: Please be informed that Salem Harbor CDC owns the building located at 8-10 Peabody Street (behind your location), and that the alley located between the two properties is part of our property. For the past two weeks,we have been finding construction material left at the alley, which we have been obligated to remove for pick up. Please do not dispose of your debris or trash at this alley anymore. We don't know where exactly you are supposed to put you trash for pick up, you should verify that with the properties owner, however, we will not be responsible anymore to remove any of the debris of trash left there from your business. If we find anything left there other than our tenant's disposals, we will report it to the property authorities. We appreciate your cooperation in maintaining our properties clean and safe of all debris. Re pectfuli Nelly atos Property Manager Salem Property Managers Inc. Agent for Salem Harbor CDC Cc: Board of Health Sanitation Dept. CODCITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH 120 WASHINGTON STREET, 4TH FLOOR SALEM, MA 01970 TEL. 978.741.1800 FAx 978-745-0343 Kimberley Driscoll WWW.SALEM.COM Mayor JOANNE SCOTT, MPH, RS, CHO HEALTH AGENT June 27, 2006 Thomas J. Ryan Owner Doc Ryan's Pub 109 Lafayette Street Salem, MA 01970 Dear Mr. Ryan: The Board of Health has received information that you may not own Doc Ryan's Pub any longer. It is critical that the information for the Food Permit for this establishment is accurate. Therefore, you are required to appear for a hearing on Wednesday, June 28, 2006 at 9 AM at the Board of Health Office, 120 Washington Street, 4`h Floor to clarify this issue. Failure to appear may result in suspension or revocation of the permit and closure of the establishment. Sincerely, Joanne Scott Health Agent Cc: Salem Licensing Board Hand delivered to establishment Hand delivered to Thomas Ryan, 4 Dundee Street, Salem, MA present all information to the Health Agent Should you be aggrieved by this Order, you have the right to request a hearing before the Board of Health. A request for such a hearing must be received in writing in this office of the Board of Health within seven (7) days of receipt of this Order. At said hearing, you will be given the opportunity to be heard and to present witness and documentary evidence as to why this Order should be modified or withdrawn. You may be represented by an attorney. Please also be informed that you have the right to inspect and obtain copies of all relevant inspection or investigation reports, orders , and other documentary information in the possession of this Board, and that any adverse party has the right to be present at the hearing. Sincerely, 9Joan"nett Health Agent Received by the owner in hand on June 28, 2006 CITY OF SALEM, MASSACHUSETTS m BOARD OF HEALTH s 120 WASHINGTON STREET, 4TH FLOOR SALEM, MA 01970 TEL. 978-741-1800 FAx 978-745-0343 Kimberley Driscoll WWW.SALEM.COM Mayor JOANNE SCOTT, MPH, RS, CHO HEALTH AGENT June 27, 2006 Thomas J. Ryan Owner Doc Ryan's Pub 109 Lafayette Street Salem, MA 01970 Dear Mr. Ryan: The Board of Health has received information that you may not own Doc Ryan's Pub any longer. It is critical that the information for the Food Permit for this establishment is accurate. Therefore, you are required to appear for a hearing on Wednesday, June 28, 2006 at 9 AM at the Board of Health Office, 120 Washington Street, 4th Floor to clarify this issue. Failure to appear may result in suspension or revocation of the permit and closure of the establishment. Sincerely, Joanne Scott Health Agent Cc: Salem Licensing Board Hand delivered to establishment Hand delivered to Thomas Ryan, 4 Dundee Street, Salem, MA Memo to File: Doc Ryan's Pu I From: Joanne Scott Date: July 5, 2006 Thomas Ryan spoke with me, and Sanitarian John Gehan, today regarding re-opening this establishment. He is signing up for the July 11`h & 25`h Food Manager Certification course at the Hill Top Restaurant. George DesJardins will be employed full time as the Certified Food Manager until Mr. Ryan is certified. All food will be prepared on site and include hot dogs,pizza, wraps and sandwiches. Mr. Ryan will,supply a list of employees and their responsibilities. Mr. Ryan will call for a re-opening inspection. r J CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH s 120 WASHINGTON STREET, 4TH FLOOR SALEM, MA 01970 TEL. 978-741-1800 FAx 978-745-0343 Kimberley Driscoll WWW.SALEM.COM Mayor JOANNE SCOTT, MPH, RS, CHO HEALTH AGENT June 28, 2006 Thomas Ryan, Owner Doc Ryans Pub 109 Lafayette Street Salem, MA 01970 Dear Mr. Ryan: In accordance with M.G.L. 111 section 30, the Salem Board of Health suspends your Food Permit immediately because an imminenent health hazard is found to exist based upon observations by a Sanitarian on June 15, 2006 and based upon information received during a hearing held on June 28, 2006. These observations and information include the following: • No Certified Food Manager working at the establishment full time • A lack of understanding among employees as to who is the person in charge • Lack of contact information for the owner • Potentially hazardous food being prepared in home kitchens for service to patrons • No sanitizing solution • Dishwasher not operational • Refrigeration not operational • Hand washing sink not being used for handwashing • Lack of updated information being provided to the Board of Health Therefore you are hereby ordered to close Doc Ryans Pub, effective immediately. You maV not re-open the establishment until you complete the following: • a valid 2006 Food permit from the Board of Health • comply with all aspects of the Food Code as verified during an inspection by a Board of Health Sanitarian • enroll in a Food Manager Certification Program • supply a list of employees and their positions • present all information to the Health Agent Should you be aggrieved by this Order, you have the right to request a hearing before li the Board of Health. A request for such a hearing must be received in writing in this office of the Board of Health within seven (7) days of receipt of this Order. At said hearing, you will be given the opportunity to be heard and to present witness and documentary evidence as to why this Order should be modified or withdrawn. You may be represented by an attorney. Please also be informed that you have the right to inspect and obtain copies of all relevant inspection or investigation reports, orders , and other documentary information in the possession of this Board, and that any adverse party has the right to be present at the hearing. Sincerely, �Joanne Scott Health Agent Received by the owner in hand on June 28, 2006 Life. Made Easier. I North Shore Elder Services,Inc. 978-750-4540 www.nselder.org _ CITY OF SALEM BOARD OF HEALTH / Establishment Name: �� a S Date: / f n Pager of Ci�__ _ Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date No. Reference R.—Red Item. - - ,.. Verified .... .. .PLEASE PRINT CLEARLY 1S I JLf 1NaS l O�(i +0 re l) 1D6-y1 I l.ueh2 1 -A� C1 on nionn _ - - r 2 n. o I r J - w e )e _ ICs Q S C- Y 4&A Dlt"ILL��-WQIZ MWHIL Qde 00 APu / a S 2 . v) S b Le C 6o- r Gtr Y M U-S rwnl n.- r. Q 4COU12 c 4 Y a - , = a12 00 QA 3 c r — S V1 r QXJ N 1 -Thar (P - s ag 1) Discussion'With Person in Charge: Corrective Actio Required: ❑ No El Yes hd this report, have had the opportunity to ask questions and agree to correct all ❑ Voluntary Compliance LI Employee Restriction/ ave read ppExclusion 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 suspension/revocation of ❑ Embargo ❑ Emergency Closure your food permit. 1 G ❑ Voluntary Disposal ❑ Other: ,ti -Roccived—at Tee-111"Iturs iol;,tions Related to Foodborne Illness Interventions and Risk I Acotdim,to Law Cooled to �ac 0 S(!tams 1-22) (Coot.) 41"F145'FWithin 4Houi 3-501.15 CottInta Methods for IIHFs PROTECTION FROM CHEMICALS PHF Hot and Cold Holding ---- 14 Food or Color A'Idifives 3-501,16(15) Cold PHFs Maintained at or below 590,004(F) 4145`F� 3-362 14 Protection from Un approved itivcs* 1-501.16(A) Hot PFFIll ain(ainedator%bovc =IS 140"F. 7-1)1.11 Moot ifyi ug!morin i on-011 1mal ?:-501 16(,A) toyists Held at of abl", 130-F fainter Wt ' ETT,"mn*��r�—aPbll,��—Heaitih Control a a b blit He ea 7-102.11 Cottimcn NKnQ Wirrkin oat ams L2-0 35 I-I,) Ti�"' a are a 7�Cora'ol; Scraracion Stolat", Variance 590.004(A) Variance 7-202.11 Restriction-?xence and Use" 7-202.12 Conditions of tis REQUIREMENTS FOR HIGHLY SUSCEPTIBLE q -1-203.I I TxocoGallainors-Prolu,ouons, POPULA I JHSP 7-204.11StuntizmCriteria-Chemic ala I npameurizcd Pre packaged Juic-'s and 7-201.12 Chemicals tol �a,�bunfl -Crllma* Beveranes with 'Aarni!I)L1-ain6n__ 7-204.14 ,L" -2auq;A&en�F cnieva-L-- 3-8()l lq�) --- 7-205.11 incidental Food Contact, Lubricants* 3-$01.11(27} Raw im Partially CoA'edAnirnal Kvid and 7-:706 11 Restaffed Usc Pesticides. Cotcrm* 7-206.12 Rodent Bait Stations" i-tl,)I�jl L__�no��ejed Fond package Not R med Ta-etN dor 'Yackin' ,'Post control and CONSUMER ADVISORY T IMEJTEMPERATURE CONTROLS 22 3-603�11 CGasum.,r Aclrisory Po,aed for Consumption of Anitral Frantiz floa are Raw. Undertatalked or Proper Cooking Temperatures for Nlot Offs rtviw Processed to Dirninate F6- WiFs &41,o�-`111z��3 4-401.1 Fathm-eno 155, F 15 Sec. 01 THA(l)(2) E402 1-- Pwaeuiafod Egg,;Subrtitinte for Raw Shell fran" E"'es-InurtedouL So;vice ki-9,F1 5scc-.- Ea c 3-401.11(A)(2) Comminuted Fish,Meats&Game -7- Ate wads- 13Y 15 sec. t SPECIAL REQUIREMENTS 3-4O—1.11(B)(1)(2) Pork and beef Roast- 130"F 121 min* 709(A)-1,D-- --Violations of Section 590.09kA)-(D) III —1 � 0 4-401.11(A)(2) Rn"ics,Injected Meals- 155`F15 entering, mobile food.temporary and See * 3-401.11{A)(3) Poultry,Wild Game,Stuffed PlIf's, remderitial kitchen operations dtould be Stuffing Containing Fish,morn. i debited Leader the appropriate scontris Poultry of Rantis-165T 15 see. above if related to foodborne illness I I—ic;t T)—wv-holl-nru scl--a' intact Rect Steffi interventions and risk factors. Other 145"F* 590 009 Violations rehitin.,to-('led retail 461.12 Raw Animal Food,Cooked in a practices should be debited under Ing-- Miuuwave 165'1- Special Requilemerts. 3-40 1A I(A)(1)(b) All Other PHFq- 145'F 15 sec, Rohaatlng for Mot Holding VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 3-403 II(A)&0)) PHI s 165')F Is cc. (items 23-30) 4-403.11(B) Miuorvave- 165'F 2 Nfinat, Standing Criiwal aildnon-i-rificial vli)Zalitn?s, ivInich do nor rehate to the foodhorne.iliness imui verinjotits,and risk-facuars listed Ohara. (an be 3-40111(C) Corninerci4il,/processed RTL Food- found in lbefollowinq sartfini,c of the food Code and 105 CMR 140 Ft -590.10(y I). — --- ---- 3-401.1 3-403.11 E) Rcinailling unsficed Portiong of Beef Iterr Good Retaff Practices PDO Frost,` n3 ' Management and?e 01--- Fc -00��' 24. Food and Food Protection FC-3 004 Proper Cooling of PHFis -FG—T-T—I)o -i5--— , �—,Pt anoTU-t�,r sil- -7j 7oo 7,11g Cooked PHI�s from 140'17 to '�F- f� a -5 Vial", I _funnbtnq_,�v�d Waste �07' Within 2 Hours lind From 701"F o-'- pi-tv'sical Facility FC-6 t .007 to 41'F/45'F Within 4 Hours. --Zi—-PcZ—nous cr'-fo—xic mat;�'—aj-s * Pp-7 .008 Special Regynamants -001) Cooling PHFi;Mad- From Ambient Ternpioature Ingredients to 41'F/45'F 14ithit14 jlajjrt," ----j critical the tedel al [1A9 Fr o(l Code of 105 CAIR 590 000. CITY OF SALEM BOARD OF HEALTH ! I Establishment Name: „ a► L Date: y Page: Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date No. Reference R—Red Item Verified ` ...../ PLEASE PRINT CLEARLY . 1_ �'� C -^- - ✓ oeo n V a - m i /3 C I,r a C " all G� U . S n C IQ V Q 6 OTA S v Q C�2 Q l I 'erf Discussion With Person in Char a f � Corrective Action Required: ❑ No ❑ Yes 9 � ❑ Voluntary Compliance ❑ Employee Restriction/ I have read this report, have had the opporTunity t ajitlons and agree to correct all Exclusion violations before the next inspection, to observe all conditions as described, and to ❑ Re-inspection Scheduled ❑ Emergency Suspension comply with all mandates of the Mass/Federal Food Code. I understand that noncompliance may result in daily fines of twe ty-five dollars or susp nsion/revocation of ❑ Embargo ❑ Emergency Closure your food permit. ( y-- ❑ Voluntary Disposal ❑ Other: i 3-501.14(C)� PHFs Received at Temperamies I�Iiolations Related to Foodborne Illness Interventions and Risk According to Saw Cooled to Factors(items 1.22) (Cont.) 41 T/45".P Within 4 Hours. PROTECTION FROM CHEMICALS 3-501,15 Cooling Methods for PRFs 14 Food or Color Additives 19 PHF Hot and Cold Holding ------ 3-501.16(B) Cold PEIFs Maintauied at or below 3=202.12 Addtuvcs" 540.004(F) 41°/45°F` 3-302.14 Protection from Unappitived Additives* 3-50'1.16(A) Rot PHFs Maintained at or above 15 Poisonous or Toxic Substances 40°F. * 7-101.11 Identifying Information-Ocigina] 3-501.16(.A) Roasts Held'at or above 130°F. * Containers* 2102.11 Common Nacre--Working Containers'" 20 Time as a Public Health Control 7-201.I 1 5e aratiou-Storage" 3-501.19 Time as a Public Health Contfal* 7-202.11 Restriction-Presence and Ilse°" -90.004(H) Variance Re uirement 7-202.12 Conditions of Use* 7-203.11 Toxic Containers-Prohibitions", REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-204.77. Santtizers,Criteria-Chemicals* POPULATIONS(HSP)- -- 7-2(1.1.12 Chemicals for W tshing Produce, Criteria'" 21 3-80'1.11(A) Unpasteurized Pte-packaged Juices and 7-204.14 Di vin Agents.t;nteua" Beverages with Warning Labels* 7-205.11 Incidental Food Contact, Luhri m71 ' 3-901,11(B) Use of Pasteurind F - 7-206.11 Restricted Use Pesticides. Criteria* 3-801.11(t)) Raw or Partially Conked Anima]Food and Raw Seed Sprouts Not Served. 7-206.12 Rodent Bail Stations" 3_801.11{C) Uno eued Food Pucka<., 7-206.13 Tracking Powdtrs,Pest Control and eNo[Re-served. MouitonnR* CONSUMER ADVISORY TIMEITEMPERATURE CONTROLS 22 3-603.11 Consumer Advisory Posted for Consumption of Amoral Foods That are Raw.Undercooked or 16 Proper Cooking Temperatures for PHFs Not Otherwise Processed to Eliminate _ Patho,ens 3-401.11A(1)(2) Eggs- 155"F15 Sec. 'race°� na;wi Eggs-hamtechate Service 145"F15sec* 3-302.13 Pasteurized F;ggs Substitute for Raw Shell 3-401.11(A)(2) Comminuted Fish,Meats&Game E s'" Animals- 155°F 15 sec. it 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 sea. * catering.mobile food, temporary and 3-401.11(A,)(3) Poultry,Wild Came, Stuffed PHFs, residential kitchen operations should be Stuffing Containing Fish, Meat, debited under the appropriate sections Poultry or Ratites-165'17 15.sec. * above if related to foodborne illness 3-401.1 1(,C)(3) Whole-musele,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. 3401A I(A)(1)(b) Alt Other PHFs-745'F 15 sec. * 17 Reheating for Hot Holding VIOLATIONS RELATED TO GOAD RETAIL PRACTICES 3-403.11(A)&(I)) PHFs 165'F 15 sec. * (Items 23-30) 3-403.11($) Microwave- 165"F 2 Minute Standing Critical acrd non-critical violations, which do not relate to the Time* foodborne illness interventions and risk factors listed above, can be 3-403.11(C) Crnatereialh,Processed RTE Food- found in the following sections of the Food Code and 105 CMR 140'F" 590.000. 3-403.11(E) Remaining Unsliced Portions of Beef Nem Good Retait Pr_ac--cgs FC 59D.000 Rants` 23. Mang ement and Personnel _ __ FC 2 003 1g Proper Cooling of PHFs 24. Food and Food Protection _-- _' FC-3 004 25 __E w ment and Utensils _FC 4 A05 3-501.14(A) Cooling(coked PHFs from 140°P to 26 Water.Plumb>n and W aste _FC-5 006 70'F Within 2 Hours and From 70'F 27. Ph sisal Facility_____ FC-6 .007 -- to 41"F/45'F Within 4 Hours. ` 2& Poisonous or Toxx Materials FC-7 .00II _ 3-501.14(B) Cooling PRFs Made From Ambient 29. S acral R uirements .009 Temperature Ingredients to 41°F/45'F 30 _ Other Within 4Hours:' Denotes critical item in the laterid 1999 Food Code or 105 CNIR 590-000. r Item Status Violation Critical Urgency Violations Related to Good Retail Practices (Blue Items) Food and Food Protection PASS BLUE Equipment and Utensils PASS BLUE Water,Plumbing and Waste PASS BLUE Physical Facility PASS BLUE Management and Personnel PASS BLUE Poisonous or Toxic Materials PASS BLUE Special Requirements PASS BLUE Other-See Notes PASS BLUE GENERAL COMMENTS: 712:The deli unit in the kitchen is to be removed. The ice machine needs to be serviced and repaired to good working order. The menu for this establishment is going to be pizza and hot dogs at this time. A full time Certified Food Manager must be employed at this establishment. The 3 bay sink at the bar is sufficient for this menu only. Owner must contact the City of Salem Licensing Board to verify that the menu for this establishment is sufficient. Should the menu at this establishment change the owner must present a revised menu to the Health Agent for approval. This establishment has complied with all other requirements to reopen. City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741-1800 GeoTMS®2006 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Jul 31,2006 ) Page 3 of 109 Lafayette Street Doc Ryan's Pub & Grub City of Salem FOOD SERVICE ESTABLISHMENT - FOOD SERVICE Inspection HACCP: ❑ Item Status Violation Critical Urgency Telephone: FOOD PROTECTION MANAGEMENT 978-745-8927 PIC Assigned/Knowledgeable/Duties PASS RED Owner. Noncompliance with: Rhino Corporation PASS _... Anti-Choking PIC: Ivan Sone Tobacco PASS Inspector. DaVld'Greenbaum EMPLOYEE HEALTH Dale d Gre e b Correct By: Reporting of Diseases by Food Employee and PIC PASS ❑J RED 7/31/2006 Personnel with Infections Restricted/Excluded PASS 0 RED Risk Level: - FOOD FROM APPROVED SOURCE 'Permit Number Food and Water from Approved Source PASS d❑ RED BHP-2006-0056 Receiving/Condition PASS ❑./ RED Status: SIGNED OFF Tags/Records/Accuracy of Ingredient Statements PASS ❑d RED #of Critical Violations: Conformance with Approved Procedures/HACCP Plans PASS RED 0 Time IN: Urgency Description(s): BLUE: Violations Related to Good Retail Practices (Critical violations must be corrected immediately or within 10 days)(Non-critical violations must be corrected immediately or within 90 days) City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741-1800 GeoTMS®2006 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Jul 31,2006 ) Page I of • Item Status Violation Critical Urgency RED c= _""` PROTECTION FROM CONTAMINATION Violations Related to Separation/Segregation/Protection PASS 91 RED r = Foodborne'Illness Interventioni.s and Risk Factors (Require,,.,, ,. Food Contact Surfaces Cleaning and Sanitizing PASS ❑d RED immediate'cofrective action) Proper Adequate Handwashing PASS ❑d RED Good Hygienic Practices PASS d❑ RED Prevention of Contamination from Hands PASS RED Handwash Facilities PASS RED PROTECTION FROM CHEMICALS Approved Food or Color Additives PASS RED Toxic Chemicals PASSd❑ RED TIME/TEMPERATURE CONTROLS(Potentially Hazardous Foods) Cooking Temperatures PASS ❑d RED Reheating PASS RED Cooling PASS ❑d RED Hot and Cold Holding PASS ❑d RED Time As a Public Health Control PASS ❑d RED REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) Food and Food Preparation for HSP PASS ❑d RED CONSUMER ADVISORY Posting of Consumer Advisories PASS (] RED City of Salem Board of Health 120 Washington Street 4th Floor SALEM MA 01970(978)741-1800 GeoTMS®2006 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Jul 31,2006 ) Page 2 of CITY OF SALEM BOARD OF HEALTH 120 WASHINGTON STREET, 4TH FLOOR SALEM, MASSACHUSETTS 01970-3523 Thomas J. Ryan Owner Doc Ryan's Pub 109 Lafayette Street Salem, MA 01970 CITY OF SALEM, MASSACHUSETTS a BOARD OF HEALTH :€ 120 WASHINGTON STREET, 4TH FLOOR SALEM, MA 01970 TEL. 978-741-1800 FAx 978-745-0343 Kimberley Driscoll WWW.SALEM.COM Mayor JOANNE SCOTT, MPH, RS, CHO HEALTH AGENT June 27, 2006 Thomas J. Ryan Owner Doc Ryan's Pub 109 Lafayette Street Salem,I MA 01970 Dear Mr. Ryan: The Board of Health has received information that you may not own Doc Ryan's Pub any longer. It is critical that the information for the Food Permit for this establishment is accurate. Therefore, you are required to appear for a hearing on Wednesday, June 28, Office, 120 Washington Street 2006 at 9 AM at the Board of Health O g , 4`h Floor to clarify this issue. Failure to appear may result in suspension or revocation of the permit and closure of the establishment. Sincerely, Joa�ott Health Agent Cc: Salem Licensing Board Hand delivered to establishment Hand delivered to Thomas Ryan, 4 Dundee Street, Salem, MA CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH 120 WASHINGTON STREET, 4TH FLOOR SALEM, MA 01970 . _ TEL. 978-741-1800 FAX 978-745-0343 STANLEY U. LISOVICZ, UR. .JOANNE SCOTT, MPH, RS, CHO MAYOR HEALTH AGENT 2005 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT 7 NAME OF ESTABLISHMENT cic L �y��s f"� TEL Igo ADDRESS OF ESTABLISHMENT MAILING ADDRESSX S (if different) �- Q . �c 1\ l3� y OWNER'SNAME 40 CcVperc±l lcr\ CTkrp� R�wr�� TEL# (ti9� 2ys F91'7 ADDRESS I . 0 • �lcx 213)- ( `fy8 9VN- X 9y CITY STATE /LiA ZIP O/Yr/ CERTIFIED FOOD MANAGER'S NAME(S) -Well !CVG CERTIFICATE#(s) 23 q565) G -V 1Qr4inS 30 ) 1100 . (required in an establishment where potentially hazardous flood is prepared.) EMERGENCY RESPONSE PERSON &Alr, HOME TEL# _Tue. II' I°Wed.II' IA Thu. II I A Fri. III A Sat. S- I A Sun. A^HOURS OF OPERATION: Mon. I TYPE OF ESTABLISHMENT FEE check only RETAIL STORE YES !O) less than 1000sq.ft. =$ 50 1000-10,000sq.ft. =$100 more than 10,000sq.ft. =$250 RESTAURANT ES NO less than 25 seats =$100 25-99 seats =$150 more than 99 seats =$200 BED/BREAKFAST YES U $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 eturns and paid all state taxes required under the law. O - 3V 4553 Signature Date (h Social Security or Federal Identification Number ------------- --- ---------------------------------------- - Rev )3/09 FOODAP2.adm Check#&Dale IMPORTANT MESSAGE FOR A.M. DATE TIME M OF PHONEBAREA% T��! OOE NUMBER EXTENSION U FAX U MOBILE AREA CODE BER TIME TO CAU.- TELEPHONED ALLTELEPHONED PLEASE:GALL CAME TO SEE YOU 1 WILL CALL AGAIN WANTS TO SEE YOU RUSH RETURNED YOUR CALL WILL FAX TO YOU MESSAGE SIGNED FORM 40O Y_�� MADE IN U.S.A. NOTES Examination Form i._ Certificate No. 2'7 M Ole Certification ServSca TO RAMON HERNANDEZJEREZ for successfully completing the requirements set by the National Restaurant Association Educational Foundation for the ServSafes Food Protection Manager Certification Examination, which is recognized by the International Food Safety Council. Presented by the National Restaurant Association Educational Foundation 8/15/01 DATE OF EXAMINATION This ServSafs Certification Is valid for 5 years. Check with your local health department for their specific requirements. t ' ELLEN MOOR-E, FMP SENIOR VICE PRESIDENT LEARNING AND CERTIFICATION DIVISION l National Restaurant Association ®esuawaeseuannmde�an[duauaaroadetla EDUCATIONAL FOUNDATION ®2GOo-xaa� xstAcsnaalronF�Caca�rarAaUa, W1601 r.0107 www.nraef.org ArnoN Vs-0 De Z; FI) ln/eN� Q 1c9A06 mA �l�� —� ►� � gc6 'TIO(viA� - I'YI� �j4( cc w 6 uj IMPORTANT�11 MESSAGE FOR L , A.M. DATE /J TIME M 4.AC�-�-1 I OF 2/03/yl 5 PHONE AREA CODE NUMBER EXTENSION O FAX ❑ MOBILE AREA CODE NUMBER TIME TO CALL TELEPHONED PLEASE CALL CAME TO SEE YOU WILL CALL AGAIN WANTS TO SEE YOU - RUSH: RETURNED YOUR CALL WILL FAX TO YOU MESSAGE I SIGNED asTFO 4009 if M. MAO IN U.S.A. NOTES CITY OF SALEM, MASSACHUSETTS ml� BOARD OF HEALTH e. _ 120 WASHINGTON STREET, 4TH FLOOR 9 SALEM, MA 01970 .yB TEL. 978-741-1800 Q" 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: Doc Ryan's Pub & Grub Address of Establishment: 109 Lafayette Street Owner's Name: Rhino Corporation Restrictions: Application Date: 11/26/2003 Permit for Food Establishment 31-04 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 ofAHealth. HEALTH AGENT • CITY OF SALEM, MASSACHUSETTS e F�'Jqlmnll? BOARD OF HEALTH • + 120 WASHINGTON STREET, 4TH FLOOR NOV 25 2003 a SALEM, MA 01970 TEL. 978-74 1-1 800 CIN OF SALEM FAX 978-745-0343 BOARD OF HEALTH STANLEY USOVICZ, JR. JOANNE SCOTT, MPH, RS, CHO MAYOR HEALTH AGENT 2004 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT NAME OF ESTABLISHMENT Doo- Ryan s Ptvha Gr v TEL# 99a�7 '9 ^nys-?9a ADDRESS OF ESTABLISHMENT )Oq tcT��t+k Strkk-� SoIek1 MSI Ql /T/ MAILING ADDRESS (if different) r OWNER'S NAME R�lino CofPoT&Ajt,. TEL# Cq�t) 9yy-9'39 ADDRESS o9 L,,fti 044 Sf rP2+ CITY Sw tw. STATE IINA ZIP G 19JG CERTIFIED FOOD MANAGER'S ^I.AME(S) -nYrJ K!14n _CERTIFICATE#(s) 13�i5d5I Co.r)ns I)ese ks G (required in an establishment where potentially hazardous food is prepared.) EMERGENCY RESPONSE PERSON �Rff j 9JML\, HOME TEL# 6 7*162V F YAM d A drm A iy HOURS OF OPERATION: Mon.l t Tue.l M Wed. t M Thu. I A/A Fri.�Sat.—Sun. I /}M TYPE OF ESTABLISHMENT FEE check only RETAIL STORE YES NO less than 1000sq.ft. =$ 50 J/-0/ 1000-10,000sq.ft. =$100 c/ more than 10,000sq.ft. =$250 RESTAURANT YES NO less than 25 seats =$100 25-99 seats =$150 more than 99 seats =$200 BED/BREAKFAST YES NO $100 ADDITIONAL PERMITS MAKE (not just serve) ICE CREAM,YOGURT, SOFT SERVE YES $5 TOBACCO VENDOR YES gNO' $50 ALL NON-PROFIT(such as church kitchens) YES $25 Please pay total with one check payable to the City of Salem This Permit is not transferable and must be reissued upon change of ownership. The Permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code, before any renovations, improvements, or equipment changes are made, all plans for such must be submitted to and approved by the Salem Board of Health. Pursuant to MGL Chapter 62C, Section 49A, I certify under the pains and penalties of perjury that I, to my bestnowled d belief, have filed all stat t returns and paid all state taxes required under the law. rQ�s'vtPr 11 8 00_3 0V-3Y`/5-5-3? Sign u,e Date Social Security or Federal Identification Number ----------- ----------------------------------------------------- Revised ------------------------- ----------------Revised 11/03/03 FOODAP2.adm Check#&Dateo� CITY OF SALEM BOARD OF HEALTH Establishment Name: Date: 7— G - d t/ Page: of / Item Code c-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date No. Reference R—Red Item Verified PLEASE PRINT CLEARLY Dcam✓ .P y �� (:Y. U; at eX -7 L art /L-t,&- c a CLQds-If s _ d 5(-74G . D ry c ✓ .P� 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. 11 Voluntary Disposal ❑ Other: 3-501.14(C:) PHFs Received at Temperatures Violations Related to Foodborne Illness Interventions and Risk According to Law Cooled to Factors(items 1-22) (Cont.) 41`F/45'F Within 4 Hours. PROTECTION FROM CHEMICALS3-501.15 Coolim,Methods for PHFs 14 Food or Color Additives 19 PHF Hot and Cold Holding 3-501.16(11) Cold PHFs Maintained at or below 3-202.12 Additives* 590,004(F) 41 V45'F* 3-302.14 Protection from Unapproved Additives* 4-501.16(A) Hot PHFs Maintained at or above 15 Poisonous or Toxic Substances - 40°F. 7-101.11 Identifying Information-Ori nal Container3-50L16(A) Roasts Held at or above 130'F. Ctias* 7-1.0211 Common Name-Workim,Containers" 24 Time as a Public Health Control 7-201.1 1 Se natation-Storage°, 3-501.19 Time as a Public Health Control* 7-202,11 Restriction-Presence and Use'f 590.004(11) VarianceRe augment 7-202.12 Conditions of Use 7-203.11 Poxie Containers-Prohibitions` REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-204.11 Sanitizers,Criteria-Chenricals* POPULATIONS(HSP) 7-2TIJ.2 Chemicals for Washing Produce,Criteria* ZI 3-801.11(A) Unpasteurized Pre-packaged Juices and 7-204.14 Beverages with Worming Labels* Dr•Ina A eats,Criteria* 3-W1.11(B) Use of Pasteurized E yes* 7-205.11 Incidental Food Contact. Lubricants' 3-801.11(D} Raw or Pm�tially Calked Animal Fail and 7-206.1 1. Restricted Use Pesticides,Criteria* Raw Seed Sprouts Not Served. 7-206.12 Rodent Bait Stations* 3-901.11(C) Unopened Food-Package Not Re-served. 7-206.13 'tracking Powders,Pest Control and Monitoring* CONSUMER ADVISORY TIMEITEMPERATURE CONTROLS 22 3-603.11 Consumer Advisory Posted for Consumption of Annual Foods That are Raw,Undercooked or 16 Proper Cooking Temperatures for . PHFs Not Otherwise Processed to Eliminate 3401.11A(ll(2) Eggs- 1.55"17 15 Sec. Pathogens "'a 111111POO, E �s-hmnediatc Service 145°F•15sec -3-302.13 Pasteurtred Eggs Substitute for Raw Shell 3-401.11(A)(2) Comminuted Fish, Meats&Game Eggs! Animals- 155°F 15 sec. 3-401.11(B)(1)(2) Pork and Beef Roast-13WF 121 min* SPECIAL REQUIREMENTS 3-401.11(A)(2) Ratites.Injected Meats- 155'17 1.5 590,009(A)-(D) Violations of Section 590.009(A)-(D)in sec.* catering, mobile food,temporary mid 3-401.1.,1(A)(3) Poultry,Wild Gane, Stuffed PIIFs, residential kitchen operations should be Stuffing Containing Fish,Meat, debited under the appropriate sections Poultr r or Ratites-165017 15 sec. S, 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 1129- Microwave 165OF* Special Requirements. 3-401,11(A)(1)(b) All Other PHFs-- 145'14 15 sec. 17 Reheating for Hot Holding VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 3-403.11(A)&(D) PHFs 165°F 15 sec. * (Items 23-30) 3-403.11(B) Microwave- 165° F2 Minnie Standing Critical and non-critical violations, which do not relate to the Time* foodborne illness interventions and i isk flu tors listed above, can be 3-403.11(() Commercially Processed RTE Food- found in zhe follroviug sections of the Food Code and 105 CMR 140'F* _590.000. - O - 3-463.L1(E) RemainingUnslfcedPorrionsofBeef item Good Retain Practices FC - -590-OPD__ Roasts* 23. Manor ement and Personnel_ FC--2 .003 18 Proper Cooling of PHFs 24__ Food and Food Protection - FC-3 .004 25 EgLipment and Utensils FC 4 .005 3-501.14(A) Cooling Cooked PHFs from 140'F to - 26. Vt ater,Plumbin and Waste FC S .006 70'17 Within 2:Flours and From 70°F 27. _Phsical Faci{ity_____ FC-6 .007 to 41.`F/45°F Within 4 Hours. * 28. Poisonous or Toxic Materials FC-7 .008 3-501.14(B) Cooling PHFs Made From Ambient 20. S eeial R uirements .Ogg Temperature Ingredients to 4I'F/45'F 30.____ Other �- Within 4 Hours" '*Denotes critical item in nig foderal 1999 Food Code or 105 CMR 590.000. CITY OF SALEM BOARD OF HEALTH Establishment Name: CI .� Date: �� G - o f/ Page: of / Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date No. Reference R-Red Item Verified PLEASE PRINT CLEARLY /ate s G/f _-�4 E . r0 oc(f vf, do Pv f -7 e k' 011prr( . arm n r a [fie.• 750C-A Q r 5 ' fir✓ S ! 2! tv rQ ,%cru-mr{ 3 1 Sr-7k o-- dod� c la- I d sig O we I ( ✓.P lerl 49Cnr--- P41W f Discussion With Person in Charge: Corrective Action Required: ❑ No ❑ Yes f ❑ Voluntary Compliance ❑ Employee Restriction/ I have read this report, have had the opportunity to ask questions and agree to correct all Exclusion violations before the next inspection, to observe all conditions as described, and to ❑ Re-inspection Scheduled ❑ Emergency Suspension f 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 ❑ Voluntary Disposal ❑ Other: i 3-501.14(() PHFs Received at'femperatures Violations Related to Foodborne Illness interventions and Risk According tcrLaw Cooled 1'0 Factors(items 1-22) (Cont.) 41'F/45'F Within 4 Homs. PROTECTION FROM CHEMICALS 3-501 15 C<xzhm Methods for PHFs 1q Food or Color Additives 19 PHF Hot and Cold Holding 3-501.16(B) Cold PEIFs Maintained at or below 3-202.12 Additnes" 590.004(F) 41'145°F- 3-302 14 Protection from Unapproved Additives* 3-501.16(A) Hat PHFs Maintained at or above 1.5 Poisonous or Toxic Substances 40`F'. 7-I0L1 l Identifying Information-Original 3-501.16(A) Roasts Heid at or above 130°F. Containers* 7-102.11 Conunon Name-Working Containers` 20 Time as a Public Health Control 7-201.11. Separation-Story e* 3-501.19 Time as a Public Health Control* 7-202.'Ll Restriction-Presence and Ilse* 590.004(H) Variance Re uirement 7-202.12 Conditions of t7sc* 7-203.1.1 Toxic Containers-Prohibitions* REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-204.11 Satntizets,Critelia-Chemicals* POPIONS(HSP) 7-204.12 Chemicals for Washing Produce,Criteria"` 2t 3-80 1ll((A)A) Unpasteurized Pre-packaged Juices and 7-204.14 Drying Aeents,Criteria" _ Beverages with Aar nine Labels* 3-801.11(13) Use of Pasteurized E gs* 7-205.11 Incidental Food Contact.Lubricants* 7-206.1 I Restricted Use Pesticides.Criteria" 3-80,1.11(17) Raw or Parnaily Cooked Animal Fwd and Raw Seed Sprouts Not Served. * 7-206.12 TrackiRodenng Bait Powders, 3-801,11(C) Unopened Fwd Package Not Re-served. * 7-206.13 'Cracking Powders,Past Control and Monitoring* CONSUMER ADVISORY TIME/TEMPERATURE CONTROLS :7302 3.11 Consumer Advisory Posted for Consumption of Animal F(xxls That are Raw.Underamked or Proper Cooking Temperatures 4orNot Otherwise Processed to Eliminate PHFs3-401.LIA(l)(2) F„gs- t55`F t5 Sec. PathogensE gs-Immediate Service 145`Fl5sec* .73 Pasteurized Eggs Substitute for Raw Shell 3-401.11(A)(2) Comminuted Fish,Meats&Game Es sir Animals- 155'17 t5 sec.* 3-401.11(13)(1)(2) Pork and Beef Roast-130°F 121 nen* SPECIAL REQUIREMENTS 3-401.11(0.)(2) Raeites,Injected Meats- 155'F 15 590.009(A)-(D) Violations of Section 590.009(A)-(D)in see. * entering, mcibile food, temporary and 3-401.LI(A)(3) Poultry,Wild Game, Stuffed PHFs, residential kitchen operations should be Stuffing Containing Fish, Meat, debited under the appropriate sections l'oultr w Katites-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)129- Micr-owave 165°F* Special Requirements. 3401AI(A)U)(b) All Other PHFs-145°F15see. 17 Reheating for Hot Holding VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 3-403.11(A)&r(D) PHFs ,165°F 15 see. * (items 23-30) 3-403.11(B) Microwave-165°F 2 Minute Sfandine Cruical and non-critical violation, which do not relate to the Time* foodborne illness interventlom and risk factors listed above, (an be 3-403.11(C) Commercially Processed RTE Food- 'found in the fallorning sections rlf the Food Code and /05 CMR '140°F' 590.000. 3-403.11(Fs) Remaining Unsllced Portions of Beef Item Good Retail Practices FC 590.000 Roasts" 23. Mena ement_and Persom�el _FC-2 .003 18 Proper Cooling of PHFs 24 Food and Food Protection t FC-3 1 .004 25. Equipment and Utensils FC 4 .005 3-501.14(A) Cooling Cooked PHFs from 140'F to p6. Water,Plum6in and W este FC 5 006 70'F Within 2 Hours and From 70°F 27. Physical Facility FC-6 1 .007 to 4 PF/45°F Within 4 Hours. * 28. Poso ( nin- or Toxic Materials FC-7 .008 3-501.14(B) Cooling PHFs Made From Ambient 29. S ecial fie utrements _ .009 Temperature Ingredients to 41°F/45`F -30....... Other Within Hours* s ao- n.eazdo< '°Denotes critical item in the.federal 1999 Food Code or 105 CNIR 590.000. CITY OF SALEM /� BOARD OF HEALTH Establishment Name:_ UC_ JCLII I U� C;1 rob Date: �9'a�G( O� I Page: of Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date No. Reference R—Red Item .. Verified PLEASE PRINT CLEARLY W . os/4p ' _osb7 G ,_M (i- -1-e a hou f, agenlho . A-� i -ir pcle- AUei)� t719H- a r 1.2 eS A AV- 17-17d &,vcyi 61 ' 2/i kt 17a,1_4 -&4e_ a Sia men Lho rxerr f vvlv�l co -lacf a / e SOZ/"/ J7b Ian S. :4 i i 2 e h S Discussion With Person in Charge: Corrective Action Required: ❑ No ❑ Yes ❑ Voluntary Compliance ❑ Employee Restriction/ ? I have read this report, have had the opportunity to ask questions and agree to correct all Exclusion violations before the next inspection, to observe all conditions as described, and to ❑ Re-inspection Scheduled ❑ Emergency Suspension comply with all mandates of the Mass/Federal Food Code. I understand that noncompliance may result in daily fines of twenUt -five-five d�uspension/revocation of ❑ Embargo ❑ Emergency Closure your food permit. ❑ Voluntary Disposal ❑ Other: 'f 3-501.14(C) PHFs Received at Teratperatm'es Violations Related to Foodborne Illness Interventions and Risk According to Law Cooled to Factors(Items 1-22) (Cont.) 41'F(45'F Within 4 Hours. " PROTECTION FROM CHEMICALS 3-501.75 - Cooling Methods for PHFs 14 Food or Color Additives 19 PHF Hot and Cold Holding 3-50L76(B) Cold PITFs Maintained at or below 3-202.12_ Additives* 590.004(7) 41°145'F* 3-302.14 Protection from th ar roved Additivest 3-501.16(A) Hot PHFs Maintained at or aboue 1=555 Poisonous or Toxic Substances 40°F.* 7-101A L 1 identifying Information-Original 3-50 L 16(A) Roads Held at ar above 130°F. Containers" 7-102.11 Common Name-Working Containers* 20 Time as a Public Health Control 7-201.11 Separation-Slot age" 3-501,19 Time as a Public Health Control` 7-202.11 Restriction-Presence and Use" 590.004(H) Variance Recuh�etnent 7-20112 Conditions of Use* 7-203.1.1 Toxic Containers-Prohibitions* REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-20411 Sanitizers.Criteria-Chemicals* POPULATIONS HSPS 7-204.12 Chemicals for Washing Produce, Criteria" 21 3-802.1I(A) Unpasteurized Pre-packaged Juices and 7-204.14 Divirr, Agents-Criteria* Bevcra e es with Skarmnq Labels` 3-80i.1l(B) Use of Pasteurized h s* 7-205.11 Incidental Food Contact,Lubricant_s" - 7-206.1 I Restricted.Use Pesticides,Criteria" 3-30t 11(D .) Rax or Partially Cooked Animal Food and Raw Seed Sprouts Not Served 7-20612 Rodent Bait Station,* 3-801.11(C;) Unopened Food Package Not Re.-served. 7-206.13 Tracking Powders, Pest Control and Monitoring" CONSUMER ADVISORY _ TIMEITEMPERATURE CONTROLS 22 3-603.11 Consumer Advisory Posted for Consumption of Annual Nxxls 9'hat arc Raw.Undercooked or 16 Proper Cooking Temperatures for Not Otherwise Processed to Eliminate PHFs �, 3-401.11A(1)(2) Fees- 155°715 Sec. Pathoscas 3-302 13 Pasteurized F s Substitute for Paw Shell E s-Immediate Service 145`P15sec* o0 Fa>g* 3-401.11(A)(2) Comminuted Fish.Meats&frame Animals- 155°F l5 sec. 3-401.11(73)(1)(2) Pork and Beef Roast-'130"F121ass 0 SPECIAL REQUIREMENTS 3-401.11(A)(2) Ratits,Injected Meats- 155'F 15 590-009(A)-(D) I Violations of Section 590.009(A)-(D)in ec. * catering,mobile food, temporary and 3-401.11(A)(3) Poultry,Wild Game.Stuffed residential kitchen operations should be Stuffing Containirw Fish,Meat, debited under the appropriate sections Poultry or Ratites-165°F 15,sec. * above if related to foodborne illness 3-401.11(12)(3) Whole-muscle, Intact Beet Steaks interventions and risk factor's. Other 145'F* 590.009 violations relating to good retail 3-461.12 Raw Animal Foods Cooked in a practices should be debited under#29- Micaowave 165'F* Special Requirements. 3-461.1](A)(1)(b) All Other PHFs -- 145'F 15 sec. 17 Reheating for Hot Holding VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 3-403.1 HA)&(D) PRFs 165'F l5 sec. * (Items 23-30) 3-403.11(13) Microwave- 165'F 2 Minute Standing Critical and non-critical violations, which cto not relate to the Time* .fi'radborne i97reess int¢r-ventlons and risk f scim-v listed above, can be 3-403,11(C) Commercially Pnx.essed RTE Food- found its the following sections of sive Food Code and.1 U5 CNIR 14017* 590.000. 3-403.11(E) Remaining Unsliced Portions of Beef item Good Retail Practices 1 FC 590.D00 Roasts` �F 23 _ Management and Personnel t PC-2 .003 lg Proper Cooling of PHFs 24. Food and Food Protection 1 FC-3 .004 25. _ _Equipment and Utensils__ FC 4 005 3-501.14(A) Cooling Cooked PHFs from 140'7 to '.. 26. Water.Plumbing and Waste 1 FC-5 006 70'F Within 2 Hours and From 70'F 27 Physical Facility : FC-6 .007 to 41'7145'F Within 4 Hours. * t_28 -Poisonous or Toxic Materials I FC-7 .008 7 - 3-501.14(B) Cooling PHFs Made From Ambient . 29 Special Requirement 009 i Temperature ingredients to 41'F145'F 30 Other. --------- ----_,- J Within 4 Hours* s+xm„nirarse„r. Denoted critical item in the federal 1999 Food Code of 105 CMR 590.000. CITY OF SALEM BOARD OF HEALTH Establishment Name: a✓rs Date: 7— /9-0V Page: / of I Item Code C-critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date No. Reference - R-Red nem Verified PLEASE PRINT CLEARLY - / o(.U�tPr orvr /'Itis "Serf-tad -{'/a-o• /a -ae a ✓Pnv,.cr�i�r ll7,s PsJa sub stio cv/// no 07 R- fac Pa, aC rh,s , ti a �e�l CIS /3 Ike lxa e L-� . 07 t 's R-770 A0 C169=s ` .w t Qo p l ✓ - 51;G( _ Tr! ie- C4 c� u>a i 0,0 1,4 ha ICIAI&Is� . -Z &1'-7_C,, err 4 , i x f 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/ inspection, to observe all conditions as described, and to Exclusion violations before the next ins p L) Re-inspection Scheduled ❑ Emergency Suspension comply with all mandates of the Mass/Federal Food Code. I understand that noncompliance may result in daily fines of twenty-five dollars or su ension/revocation of ❑ Embargo ❑ Emergency Closure your food permit. /) l�� ((( ❑ Voluntary Disposal LlOther: 3-5)l14(C) FHFs Received at Temperatures Violations Related to Foodborne Illness Interventions and Risk According to Law Cooled to Factors(teems 1.22) (Cont.) 41'F/45`F Within 4 Hours.* PROTECTION FROM CHEMICALS 3-501.15 Coolinu Methods for PHFs 14 Food or Color Additives ]9 PHF Hot and Cold Holding 3-501.16(B) old Pl-Ifts;Maintained at or below 3-202.12 Additives* 590.004(17) 41°145°F'" 3-302.14 Protect ton from Una n roved Additives* '1-501.16(A) Hot PHFs Maintained at or above is Poisonous or Toxic Substances 7-I0Lll Identifying infonuation-Original 140"F Containers* 3-50116(.4) Roasts Held at or above 130'F. 7-102.11 Common Name-Working Containers* 20 Time as a Pubife Health Control 7-201.11 Se.ar don-Stora=e* 3-501,19 Time as a Public Health Control` 7-202.11 Restriction-Presence and Use* 590.004(H) I Variance Requirement 7-202.12 Conditions of Use" 7-203.1.1 Toxic Containers-Prohibiticas* REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-204.11 Sanitizers,Criteria-Chemicals* POPULATIONS(HSP) 7-204.12 C'henncak for Wash t..L Produce,Criteria"` 21 3-801_I I(A) Unpasteurized Pre-packaged Juices and 7-20114 Drying A eats,Criteria"` Beverages with Warning,Labels* 7-205.1,1 Incidental Food Contact,Lubricants* 3-801.11(B) Use of Pasteutized Eegs* 7-2016.'11 Restricted Use Pesticides.Criteria* 3-801,11(11) Raw or Partially Cooked Animal Fad and Raw Seed S gouts Not Served.,F 7-206.12 Rodent Bait Stations" 3-801.11(C} Uno erred Faxi Package Not Re-served. _` 7-206.13 '(racking Powders,Pest Control and Monitodna* CONSUMER ADVISORY TIME/TEMPERATURE CONTROLS 22 3-603.11 Consumer Advisory Posted for Consumption of Animal Funds That are Raw, Undercooked tar f6 Proper Cooking Temperatures for PHFs Not Otherwise Processed to Elinanate 3-407.1 IA(1)(2) -Eggs - 155`17 15 Sec. Patho*aris'Enecn�ovveooi E�gs-hmnediate Service 145°Flisec* 3-302.13 Pasteurized Fggs Substitute for Raw Shell 3-401.11(A)(2) Comminuted Fish,Meats ek Game Animals- 155°F 15 sec. 3-401.11(B)(1)(2) Pork and Beef Roast -139°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 3-401.1.1(A)(3) Poultry,Wild Game,Stuffed PRFs, residentialkitchen operations should be Stuffing Containing Fish,Meat, debited under the appropriate sections Poula� or Ratites-165`17 I S sec. * above if related to foodborne illness 3401.11(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 Caked in a practices should be debited tinder Il29- Mictowave 165'F* Special Requirements. 3-401 A I(A)(l)(b) All Other PHFs-1.45'F 15 sec. 11 Reheating for Hot Holding VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 3-403.1](A)€e(I)) PHFs 165'F 15 sec.._ (items 23-30) 3-403.11(B) Microwave- 165'F2 Minute Standing Critical and nim-critical violations, which do not relate to the Time* foodborne illness tareiventions and riskhistone listed above can be; 3-403A I(C) Commercially Processed R'FE Fund- ,found in the following sections of the Food Code and 105 C.WR 140'F* 590.000. 3-403.11(E) Remaining Unsliced Portions of Beef Item Goad Retail Fraet(ces � FC 690.000 Roasts" 23. Management and Personnel_____ FC-2 .003 -- 24. Food and Food Protection FC--3 .004 1g Proper Cooling of PHFs -_ _�-_ Equipment and Utensils _ FC 4 _ . .005__ 3-501.14(A) Cooling Cooked PHFs from 140'F to 26. Water,Plumbing and Write FC 5 1.0_06 70'17 Within 2 Hours and From 70°F 27. -Physical Facilit TC 007 - -- to 4 FF(45'F Within 4 Hours.* 28. Poisonous or Toxic Materials FC-7 .008 3 501.14(B) Cooling PRFs Made From Ambient 29. S ecial Re uiremsnts _ j .009 Temperature Ingredients to 41'17/45°'F 3 - - - -_I,_.__-_.------ Within 4Hours"" ss•or�,n,,ac.a.a.,, *Denotes critical item in the fcderal 1999 Food Coda or 105 CMR 590000. COURT DOCKET NO. Q CITATION NO, CITY OF SALEM aT I� VIOLATION NOTICE A 2912 NAME(LAST,FIRST,INITIAL( f/ S bb ' arVh STREETADDRESS rrCITY/TOWN STATE ZIP sr a?lem,mo vniv LICENSE NO. / LIC.EXP.DATE DATE OF BIRTH OWNERS NAME(LAST FIRST,INITIAL) " r orafi STREETADDRESS r CITY/TOWN STATE ZIP 6el Z e ST. S�71e ti iOlq REGISTRATION NO. STATE EXP.DATE MAKE/TYPE YEAR COLOR DATE OF VIOLATION TIME DATE CITATION WRITTEN ERSONAL J "o �❑TJ�M T "�✓CX ' WUR YES El NO LOCATION OF VIOLATION ENFORCING DEPT. J IO Lrr v S Pz � OF {t4 rJ OFFENSE CHAP. SECT FINES A { t t D o' r B OFFICE �R �.// I.D.NO. TOTAL $ �//� fJ \/? /}:...1. " OFFICER CERTIFIES COPY GIVEN TO VIOLATOR L/ f ,�1�`�// � //� I❑ INHAND X / r ! �/'/-40),iIfo L�-.BY MAIL DO NOT MAIL CASH-PAY ONLY BY POSTAL NOTE,MONEY ORDER OR BY CHECK MADE PAYABLE TO: '�J 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 M SIGNATURE SEE OTHER SIDE FOR FURTHER INFORMATION ENCLOSE PAYMENT IN THIS ENVELOPE,PEEL AND SEAL I COURT DOCKET NO. - - — -- CITATION NO CITY OF SALEM N VIOLATION NOTICE AG a L12 ,�, �p NAME(LAST,FIRST,INITIAL) - M - ,� Gw o 0 STREET ADDRESS CITY/TOWN STATE ZIP' yic:. 0 S D a Sr Sc�le�r� i11�1 any ui LICENSE NO. LIC.EXP.DATE GATE OF BIRTH OWNERS NAME(LAST,FIRST,INITIAL) STREET ADDRESS CITY/TOWN STATE ZIP .Z �i L eSr, I 761 - I REGISTRATION NO. /STATE EXP DATE I MAKE/TYPE YEAR COLOR > . F' DATE OF VIOLATION TIME DATE CRATION WRITTEN PERSONAL — GKM �•t�� 0 YES 02 11 Alw �O ❑NO 6>: lf1 LOCATION OF VIOLATION ENFORCING D L U� � 1 JI L Sa lem �oo r a s 7 OFi 4/t�+ a� ` Ln OFFENSE CHAP. SECT. FINES Rm- m 0 B �o?-�S�'oj� r c C 1 OFFICER D.NO. TOTAL fi CQ FINE $ •c� -/__J DUE Ty OF610ER CERTIFIES COPY GIVEN TO VIOLATOR - [` ❑ IN HAND T'n ?I , X a ®'EYMAIL , DO NOT MAIL CASH-PAY ONLY BY POSTAL NOTE,MONEY TL ORDER OR BY CHECK MADE PAYABLE TO: ._. CITY CLERK CITY HALL W L 93 WASHINGTON STREET V W C u SALEM,MA 01970 TEL.(508)745-9595 X 251 I HEREBY ELECT TO EXERCISE THE FIRST OPTION AS STATED ONOa W W o K -F REVERSE, CONFESS TO THE OFFENSE CHARGED, AND ENCLOSE �. 2� LII PAYMENT IN THE AMOUNT OF W N O $ CASE# C Q O W CD O ❑ ZgOy N O QLO LL - 0 (� SIGNATURE O 0 O X Z LL SEE OTHER SIDE FOR FURTHER INFORMATION m J ENCLOSE PAYMENT IN THIS ENVELOPE,PEEL AND SEAL U d F O p i U O. DD w L I--O c d OQ F- <M - Q¢ w a0 Massachusetts Department of Public Health Salem Board of Health 120 Washington Street,4°i Floor Division of Food and Drugs Salem, MA 01970-3523 FOOD ESTABLISHMENT INSPECTION REPORT Tel. (978) 741-1800 Fax(978) 745-0343 Na^j� Date Tvoe of 0 eration(sl Type of Inspection Y � � f(�4 lav& d' G 2- 2 b ©'Food Service ❑ Routine Address (� �rLr S� Risk c El Retail 0'Z-inspection Level ❑ Residential Kitchen Previous Inspection TelephoneWq _ 9 g 9 ❑ Mobile Date:v7 e da f Owner HACCP V/-N-- ❑ Temporary ❑ Pre-operon J Efv - t- W ,w ❑ Caterer ❑ Suspect Illness Person in Charge(PIC) yce�o➢ J Time El Bed&Breakfast El General Complaint In: ❑ HACCP InspectoO (, fA iS r'1'!44 V 0 V-7 P4le-j y Out: Permit No. ❑ Other Each violation checked requires an explanation on the narrative page(s) and a citation of specific provision(s)violated. Non-compliance with: Violations Related to Foodborne Illness Interventions and Risk Factors Anti-Choking Tobacco Violations marked may pose an imminent health hazard and require immediate corrective 590.009(E) ❑ 590.009(F) ❑ action as determined by the Board of Health. FOOD PROTECTION MANAGEMENT _ _ .. .. . ❑ 12. Prevention of Contamination from Hands ❑ 1. PIC Assigned/Knowledgeable/Duties ❑ 13. Handwash Facilities EMPLOYEE HEALTH _ PROTECTION FROM CHEMICALS ❑ 2. Reporting of Diseases by Food Employee and PIC .w 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 TIMEITEMPERATURE CONTROLS(Potentially Hazardous Foods) ❑ 5. Receiving/Condition ❑ 16. Cooking Temperatures ❑ 6. Tags/Records/Accuracy of Ingredient Statements [117. Reheating ❑ 7. Conformance with Approved Procedures/HACCP Plans ❑ 18.Cooling 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) El21. Food and Food Preparation for HSP El 10. Proper Adequate Handwashing ❑ 11. Good Hygienic Practices CONSUMER ADVISORY" ❑22. Posting of Consumer Advisories Violations Related to Good Retail Practices Number of Violated Provisions Related Critical (C) violations marked must be corrected To Foodborne Illnesses Interventions immediately or within 10 days as determined by the Board and Risk Factors(Items 1-22): Q of Health. Non-critical (N) violations must be corrected Official Order for Correction: Based on an inspection immediately or within 90 days as determined by the Board today, the items checked indicate violations of 105 CMR of Health. 590.000/federal Food Code. This report, when signed below C' N' by a Board of Health member or its agent constitutes an 23. Management and Personnel (Fc-2) order of the Board of Health. Failure to correct violations 24. Food and Food Protection (FC-3)(590.0so.004) cited in this report may result in suspension or revocation of 25. Equipment and Utensils (FC-4)(590.005) the food establishment permit and cessation of food 26. Water, Plumbing and Waste (FC-5)(590.006) establishment operations. If aggrieved by this order, you 27. Physical Facility (FC-6)(590.007) have a right to a hearing. Your request must be in writing 28. Poisonous or Toxic Materials (FC-7)(590.008) and submitted to the Board of Health at the above address 29. Special Requirements (590.009) within 10 days of receipt of this order. 30. Other DATE OF RE-INSPECTION: s59onspenFom54.aoc Print: PIC's SignaturPrint �a r PageZ of a-Pages e P G i 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) Aasignmertt of Res ojisibility* 3-302.11(A)(]) Raw Animal Eoods Separated from 590.003($) Demonstration of Knowledge* Cooked and RTE Foods* 2-]03.17. Person in charge-duties Contamination from Raw Ingredients 3-302.11(A)(2) Raw Aiumal Foods Separated Treat Each EMPLOYEE HEALTH Other- 590-001(c) ther-590.003(0) Responsibility of the person in charge to - Contamination from the Environment require repotting by food employees and 3-302.1 1(A) Food Protection* a ilicants* 3-3021.5 Washing Fruits and Vegetables 590,003(F) Responsibility Of A Foal Employee Or Au 3-304.11 Food Contact with Equipment and Applicant To Report To The Person In Utensils* Charger Contamination from the Consumer 590.003({3) Reporting by Person in Charge* 3-306.14f k)(B) Retutmed Food and Resetvice of Food* 3 590.003(D) Exclusions andResrrictions* Disposition of Adulterated or Contaminated 590.003(E) Removal of Exclusions and Restrictions Food 3-701.11 Discarding or Reconditioning Unsafe FOOD FROM APPROVED SOURCE Food" 4 Food and Water From Regulated Sources 4 Food Contact Surfaces 3-201.4(A-B) Com hh mac welt Food Lau*�� 4-501.ll 1 Manu hI-IVution er shmg-Hot Water 3-201 J2 Food in t Heunetically Scared Container* Samnzation Cetn ierahires* 3-201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Warewaahintlist Water 3-202.13 Shell Eg-ms* Sanitization Tem cratures* 3-202.1.4 Eggs and Milk Products.Pasteurized* 4-501. 4 Chemical Sarn di ationt-temp., pH, 3-202.16 Ice Made From Potable Drinkino Water* concentration and ha dress. 5-101.11 Di i riki og Water ft:om an A rovedS stem" 4-601.11(A) Equipment Food Contact Surfaces and 590.006(A) 'Bottled Drinkin Wster* Utensils Clean* 4-602.21. Cleaning Frac uene of E ui hment Food- 590.006(B) Water Meets Standards in 310 CMR 22.0* Contact Surfaces and Utensils°= Shellfish and Fish From an Approved Source 4-702.1] Frequency of Sanitization of Utensils and 3-201.14 Fish and Recreationally Caught Molluscan Food Contact Surfaces of E ui tient* Shellfish* 4-703.11 Methods of Sanitization-Hot Water and 3-201.15 Molluscan Shellfish from NSSP Listed C.hemlcat" Sources+ 14Proper,Adequate Handwashing Came and Wr7d Mushrooms Approved toy Re Mato Authorit 2-301.11 Clean Condition-Hands and Arms* 3-202.18 Shellsiock Identification Present* 2-301.12 Cleanin,Procedure" 590.004(0) Wild Mushrooms* 2-301.14 When to Wash* 3-201.17 Game Animals* t1 Good Hygienic Practices 5 ReceivinglCondition 2-401.11 Eating,Drinking or Using Tobacco"` 3-202.11 Pill's Received at Proger Tem aratures* 2-401.12 Discharges From the Eyes, Nose and 3-202.15 Packa elaterity* Mouth* 3-101.11. Food Safe and Unadulterated* 3-301.12 Preventin,Contamination When't'astia-" 166 Tags/Records: Shelistock L1.2 Prevention of Contamination from Hands 3-202.18 Shelletock Identification* 590k04(E) Preventing Contamination from 3-203.12 Shellstock Identification Maintained'" Ent hlo� Handwash Facilities TagslRecords:Fish Products 13 Conveniently Located and Accessible 3-402,11 1 Parasite Destruction* - 3-402.12 Records.Creation and Retention* 5-203.11 Numbers and Ca acities„ 590.004(7) Labeling of Ingredients" 5-204.11 Location and Placement* 9 Conformance with Approved Procedures 5-205.11 Accessibiht Oieration and Maintenance IHACCP Plans Supoded with Soap and Nand Drying 3-%2.11 Seeialized Processing Methods* Devices 3-502.13 Reduced exvRen neka 'nQ.criteria* 6-301.17. Handwashin Cleanser, Availability 6-103.12 Conformance with A proved Prixedures* 6-301.].2 Hand Dn7ng Provision *Denotes critical item in the tederal 1999 Food Code or 105 CDM R 590 000- CITY OF SALEM BOARD OF HEALTH Establishment Named 0C eVdLNrs &CS d lift v,-S Date: 2 Z6 O Page: 2 of Z Item Code C-Critical nem DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date No. Reference R-Red Item Verified PLEASE PRINT CLEARLY L J' NU"L� v t� AS O tls ^r C �� r Y f i 1 E S "a 1 f Y ri _3(r_ V'L lJ A f� 9�fI'HE R / G n 0 fV A. Discussion With Person in Charge: Corrective Action Required: ❑ No ❑ Yes I have read this report, have had the opportunity to ask questions and agree to correct all ❑ Voluntary Compliance ❑ Employee Restriction/ inspection, to observe all conditions as described, and to Exclusion violations before the next ins p ❑ Re-inspection Scheduled ❑ Emergency Suspension comply with all mandates of the Mass/Federal Food Code. I understand that noncompliance may result in daily fines of twenty-five dollars or suspension/revocation of ❑ Embargo ❑ Emergency Closure your food permit. © Q 13 Voluntary Disposal ❑ Other: 3-501.14(() PHFs Received at Tet»peratures Violations Related to Foodborne Illness Interventions and Risk According to Low Cboled to Factors(Items 1-22) (Cant.) F_ 1I'F/45° WiPnn 4 Hours. " PROTECTION FROM CHEMICALS 3-501.15 Ctx finc Methods for PHFs 14 Food or Color Additives t9 PHF Hot and Cold Holding 1-202.12 AddniGes* 3 501.16(B) ("odd PRFs Maintained at or below 590.004(F) 41'(45°i +-302.14 Protection froze Unad�punad Atid[tives'F ;_501.Ifi(Aj Hot PHFs iilaintavted at or above I5 Poisonous or Toxic Substances 140°F. r. 7-101.11 Identifying Information-Original 3-SOi.J6(A) Roasts Held at or above 130`F. containers" - 7-102.11 Comtnon Name-Worlgin�Containers* 20 Time as a Public Health Control 3-5 7-201A 1 Separation-Storage* 01.19 Time as a Public Health Control 7-202.11 Restriction-Presence and Use* 590.004(11) Variance Requirement 7-202,12 Conditions of Use" 7-203.71 TPOPULLAA Toxic Containers-Prohibitions" REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-204.11 Sanitizers.Criteria-Chemicals* TIONSS(HSP) 7-204.1.2 Chemicals for Washing Ploduce.Criteria* 21 3-801,11(A) Unpasteurizzd Pre packaged Juices and 7-204.14 Drving Agents, Criteria" Beveraees with Warning Labels* 7-205.1.1 Incidental Food Contact,Lubricants" 3-801.11(B) Use of Pasteurized Hors* 7-206.11 Restricted Use Pesticides,Criteria* 3-801.110 Raw or Partially Cooked Animal Food and Raw Seed S xouts Not Served 7-206.12 Rocket Bait Stations" 7-206.13 Tracking Powders,Pest Control and 3-801,11(C) Unopened Food Package Not Re-served. " Monitoring* CONSUMER ADVISORY TIMEITEMPERATURE CONTROLS 22 3-603-11 Consumer Advisory Posted for Consumption of' F6 Proper Cooking Temperatures forAnimal Foods That are Raw.Undercooked or F6 Proper Cooking Temperatures for PHFs Not Otherwise Processed to Eliminate 3-461.17A{1)(2) Eggs- 155'F 14 Pathogens. Sec F.;Rs-Immediate.Ser vice 115"Fl Fsee* 3-302.13 Pasteurized Eggs Substitute for Raw Shell 3-401.11(A)(2) Comminuted Fish.Meats R Game Eu '* Animals-i55"F 15 sec. r; 3-401.11(B)(1)(2) Pork and Beef Roast-730°F121 nun' SPECIAL REQUIREMENTS 3-401.11(A)(2) Ratites, Injected Meats- 155°F 15 590.0{)9(A)-(D) Violations ofSection 590.009(A)-(D) in sec.* catering,mobile food, temporary and 3-401.11(A)(3) Poultry,Wild Game, Stuffed PHFs residential kitchen operations should be Stuffing Containing Fish,Meat, debited under the appropriate sections Poultry or Ratites-165°F l5 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 Bard retail 3-401.12 Raw Animal Foods Cooked in a L practices should he debired under#329- Microwave 165''F* Special Requirements. 3-401.11(A)(U(b) All Other PHFs - 145'F 15 sec. 17 Reheating for Hot Holding VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 3-403A I(A)&(D) PFIFs 165`F 15 sec. ,; (Items 23-30) 3-403.1.1(B) Microwave-165'F 2 Minute StandiMe Critical mrd non-critical violations, which eta not relate to the Time* foodhorne illness{nterrentfons and risk(actors listed above, can.be 3-403.11(C) Commercially Processed RTE Food- found in the following secttolo of the Food Code and.105 Cthih' 140"'F* 590.000. 3-403.11(E) Remaining Unsliced Portions of Beef I Item Good Retail Practices FC 590.000 Roasts` . 23 Manage mant and Personnel IFC-2 .003 1g Proper Cooling of PHFs i_24 Food and Food Protection __ FC 3 004 25 Egwpment and Utensils _ _FC 4 .005 3-501.14(A) Cooling Conked PHFs from 140'F it) 126 Water.Plumbing and Waste FO-5 ,006_ 70'F Within 2 Hours and From 70'F 27. i Physical Facility FC-B 007 to 41'F/45'1-Within 4 Hours, " ;-23__ I Poisonous orToxlc Materials FC-7 .005 3-501,14(B) Cooling PHFs Made From Ambient 29 Special Requirements _ _ .009 Temperature ingredients to 41°E145`F 30 Other _ I� *1)cnotas crifica item in tile federal 1999 Pard Code or I0 CMR 596 060. 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 D to Tvoe of Ooeration(s) T e o Inspection Doc, a v.4/✓S Ve 00-V j /8, t7`7f ood Service outine Address rf�r Risk ❑ Retail ❑ Re-inspection Telephone _,. , Level,,t E] Residential Kitchen Previous Inspection d /� Y/N [I Temporary Mobile Date: Owner HACCP Temporary Pre-operation , Ly12/t �ll � ❑ Caterer ❑ Suspect Illness Perspr;in Charge(PIC Time ❑ Bed&Breakfast ❑ General Complaint Ins ecto L In: ❑ HACCP Out: Permit No. ❑ Other Each violation checked requiresr 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 - El 2. Reporting of Diseases by Food Employee and PIC - PROTECTION FROM CHEMICALS El3. Personnel with Infections Restricted/Excluded E] 14.Approved Food or Color Additives FOOD FROM APPROVED SOURCE E] 15.Toxic Chemicals ❑ 4. Food and Water from Approved Source TIMEITEMPERATURE CONTROLS(Potentially Hazardous Roods) ❑ 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. $eparation/Segregation/Protection E)20.Time As a Public Health Control Y99 Food Contact Surfaces Cleaning and Sanitizing REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) 10. Proper Adequate Handwashing ❑ 21. Food and Food Preparation for HSP ❑ ❑ 11. Good Hygienic Practices CONSUMER ADVISORY' i ❑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 / 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 ofd 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 24. Food and Food Protection (FC-3)(590.004) order of the Board of Health. Failure to correct violations 5. Equipment and Utensils (Fc-4)(550.005) cited in this report may result in suspension or revocation of the food establishment permit and cessation of food 26. Water, Plumbing and Waste (FC-5)(590.006) establishment operations. If aggrieved by this order, you 27. Physical Facility (FC-6)(590.007) have a right to a hearing. Your request must be in writing 28: Poisonous or Toxic Materials (FC-7)(590.008) and submitted to the Board of Health at the above=address 29. Special Requirements (590.009) within 10 days of receipt of this order. , ! 30. Other DATE OF RE-INSPECTION: s:ssoinspecrFomsra.ex nsp ctor's Si t e• -y Print: e7o. d� PIC's Signature:& Print: Page of.3 Pages Violations Related to Foodborne Illness interventions and Risk Factors(items 1-22) PROTECTION FROM CONTAMINATION FOOD PROTECTION MANAGEMENT 8 _ Cross-contaminatidii 590.003(A) I Assignment of Responsibility' 3-301.11(A)(]) Raw Annual Foods Separated from 590.003(B) Demonstration eA Knowledge" Cooked and RTE Fowls"` 2-103.11 Person in charge-duties Contamination from Raw Ingredients 3-302.t1(A)(2) KawAnitualFoods Separated from Eac�h EMPLOYEE HEALTH_ Other' 2 590.003(0) Responsibility of the person in charge to Contamination from the Environment require repotting by food employees and 3-302.1](A) I Food Protection' applicants*, 3-302.15 Washin Fruits and Vegetables 590.003(F) Responsibility Of A F txxl Employee Or An 3-304.1 I 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 Charee* 3-306.14(A)(B) Returned Food and Res ervice of Food' 3 590.003(l)) Exclusions and Restrictions* Disposhion 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 _ I 4 Food and Water From Regulated Sources 9 Food Contact Surfaces 590.004(A-B) Compliance with Food Law`" 4-501.11 1. Manual Warewashing-Hot Water 3-201.12 Food in a Hermetically Sealed Container* Sanitization Tem eratures* 3-201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Warewashing-Hot Water 3-202.13 Shell EPgs* Sanitization Temperatures* 3-202.14 Eg<>s and Milk Products,Pasteurized* 4-501..114 Chemical Sanitization-tamp.,pH, 3-202.16 Ice Made From Potable Drinkim*Water* concentration and hardness.`* 5-101.11 Drinkin Water from nn A roved S stem* 4-60 1 - Equipment Food Contact Sol faces and 590.006(A) Bottled Drinking Water Utensils Clean 590.006(B) Water Meets Standards in 310 CMR 22-0" 4-602.1 1 CleaninContactg Frequency of Equipment Food- Shellfish and Fish From an Approved Source Surfaces and Utensils* 4-702.11 Frequency of Sanitization of Utensils and 3-201.74 Fish and Recreationally Caught Molluscan Food Contact Surfaces of E ui men!' Shellfish* 4-703.11 Methods of Sanitization-Hot Water and 3-201.15 Molluscan Shellfish from NSM?Listed Chemical' Sources* 10 Proper,Adequate Handwashing Regulatory Anthovit Game and Mushroorns Approved by 2-301.11 Clean Condition-Hands and Arms* Aut 3-202.18 Shellstock Identification Present" 2-301_12 Cleanin, Procedure' 590.004(C) Wild Mushrooms' 2-301.14 When to Wash' 3-201.17 Game Animals* 11 flood Hygienic Practices g Receiving/Condition 2401.11 Eatin ,Drinking or tisin,Tobac O 31-20-1.11 PHFs Received at Pro ter Tem erasures* 2-401.12 Discharges From the Eyes,Nose and 3-202.1.5 Package hue� - Mouth* - - 3-101.11. . Food Safe and Unadulterated* 3-301..12 Preventiu Contanunation When Tasting*' 6 Tags/Records:Shellstock 12 Prevention of Contamination from Hands 3-202.18 Shellstock Identification590.004(E) Preventing Contamination from 3-203.12 Shefiselck Identification Maintained, Enitio ees' Tags/Records:Fish Products 13 Handwash Facilities 302.11 - Parasite Destruction* Conveniently Located and Accessible 3-402.12 Records.Creation and Retention* 5-203.11 Numbers,or Ca acities* 59(t904(1) Labeling of Ingredients' 5-204.11 I tteation and Placement* q Conformance with Approved Procedures 5-205.11 Accessibility. O erarion and Maintenance 1HACCP Plans Supplied with Soap and Hand Drying 3-502.11 S.eCodized ProcessingMelhods* Devices 3..502.1.2 Reduced ox°gen aeka 'ng-criteria'' 6-301.11 Hindwashing Cleanser,Availability 8-103.12 Conformance with Approved Procedures* 6-301.12 Hand Drvin«Provision "Denotes critical item in the redo,11499 Food Code or 105 CMR 590,000. CITY OF SALEM Q � BOARD OF HEALTH Establishment Name: 01iL.. /t.C/G�S /9c/ IS Date: 4-/9-011 Page: 2" of � Item Code c-critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date ry No. Reference R—Red.Item Verified PLEASE PRINT CLEARLY <i /L P_ /'OG7/6� P� rr r p ti C .r �J�[ �/r•�� Y- -P .z`�// / r a/ ' /r/e,t 25- — c' 'Aolz'/ % aF /Ce .} 2l� — i, A'.t / 41PCIlk #i✓g '" .fi .c<ir : wed 2S O/� s�7oi. 6/ [fie �. ,� . / !f �` / ,( 7.F"iP/f` rrW—_ kip t _ Z — Na �� u:�ti /S /A/ .V .S '- ,_ as `7vaG he, 6 k6f'5Pa"" Z7 -LGL //'✓� L �/ /Sf77c�r! (aAPG( , f(l � L � 7 P ,//tr / A/ - P c O.�d h G/q"S`7/i (✓ �P�Nti� Gn / / �.r ,moi / r Discussion With Person in Charge: Corrective Action Required: ❑ No ❑ Yes f, I havo read this report, have had the opportunity to ask questions and agree to correct all ❑ Voluntary Compliance L3 Employee Restriction/ i 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. /f /r , �� ❑ Voluntary Disposal ❑ Other: r. 3-501.1.4(C) PHFs Recei ved at Temperatures Violations Related to Foodborne Illness Interventions and Risk According to l.aw Cooled to Factors(items 1.22) (Cont.) _ 41`F(45°F WiBtin 4 Hours. PROTECTION FROM CHEMICALS 3-50.13 -- CoolingMethods for PHFs 14 Food or Color Additives 19 PHF Hot and Cold Holding 3-501.A6(B) ColdPHFs Maintained at or below 3-202.12 Additives* 590.004(F) 41"'/45-F"* 3-302.14 Protection from Unapproved Additives'r 3-501,16(A) HotP1iF's Maintainedat ac above 15 Poisonous or Toxic Substances 40°F. 7-101.11 Identif;'ingBrfannation-Original 3-501.16(A) RoastFHeldatotabove 130°F. Containers'" , 02.11 Co[mnon Name-Workinn Containers* 20 Time as a Public Health Control 7-201.11 Separation-Sloratte" 1-501.1.9 Time as a Public Hcalth Control* 7-20271 Restriction-Presence and tJse'F 590.004(F1) Vaai�ement 7-202.12 Conditions of Use" 7-203.11 Toxic Container.-Prohibitions* REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-204.11 Sanitizers.Criteria-Chemicals* POPULATIONS(HSP} 7-204.12 Chemicals Tor Washing Produce.Criteria* 21 3-801. I(A) Unpasteurized Pre-packaged Juices and Bevcra ges with Warning Labels* 7-2(14.14 Incide Amenia,Contact, 3-801.11(6) Use of Pasteurized E0Rs* 7-205.1.( Incidental Food Contact,In,nbrioants* 7-206.11 Restricted Use Pesticides,Criteriax 3-801A I('D) Rai, or Partially Cooked Animal Food and TiRaw Seed Sprouts Not Served. * 7-206.13 7-206.12 i ackrn-,Rodent Bait Station,,*Powders, P, Pest Control and �e 3-901.11(C) Unopened Food Packa 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 3-401.11A(1)(2) Eggs- 155'F 1� Sec. Pathogens.*`re"'"0"' Lc s-fin mediate Service 14s°FI5sec* 3-302.13 Pasteurized Eggs Substitute for Raw Shell 3 40 1.1 1(A)(2) Comminuted Fish.Meats K Game Animals-155°F 15 sec. "` 3-401.11(6)(1)(2) Pork and Beef Roast-130°F121min" SPECIAL REQUIREMENTS _ 3-401.11(A)(2) Ratites,Injected Meats- 1.55°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) Pouloy,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 145-F* 590.009 violations relating to ;ood retail 3-401..12 Raw Animal Foods Cooked in a practices should be debited under#/29- Microwave 165°F* Special Requirements. 3-401.11.(A)(1)(b) All Other PHFs-145'F l5 sec. * - 17 Reheating for Hot Holding VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 3-403.11(A)&(D) PHFs 165F 15 sea * (Items 23-30) 3-403.11(B) Microwave- 165°F 2 Minute Standing Critical and non-critical violations, which du not retate to the Time* fixulborne illness irrterventionv rind risk factors listed aboee, cart he 3-403.11(C) Commercially Processed RTE Fool- found ie the following sections of the Food Code and 105("AIR 140°F* 590.000, _ 3-403A I(E) Remaining Unsliced Portions of&xf I item Good Retail Practices ITC- 59 00 00 23. - Mana ement and Personnel FC-2 .003 Roasts^ -. __.-�-. 9 _ -- 24. I Food and Food Protections FC -3 .004 1g Proper Cooling of PHFs I i + 25. 1 Equipment and Utensils FC-4 .005 3-501.14(A) Cooling Cooked PHFs Prom 140'F to 26. Water Plumbing and Weste - FC 5 .006 70'F Within 2 Hours and From 70°F ' 27. Ph sinal Facild FC-6 .007 to 41'-145°F Within 4 Hours. * 28 I Poisonous or Toxic Matenals 1-FC-7 .008 3-501.1413) Cooling PHFs Made From Ambient 23 S emal Requirement _ j o09 Temperature tnkn-Micrus to 41°F145°17 30 Other Within 4 Hours'* Dent¢,craIca I iter)to the fedem11999 Fwd Code or IOi CNIR i90ooll. CITY OF SALEM BOARD OF HEALTH Establishment Name: npc / "i f�,� < 9 y 5 �%w 8 Date: -,?- 19-01 Page: 3 of 3 Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date No. Reference -R—Red Item Verified PLEASE PRINT CLEARLY 1-3 P 1AVtJW 0 /ii uN . :/F —/Tri PCS N/ E' /-L CX' 4c A ,Q ,rkP/ L'f �/WI-7'1Z/ll,C /f✓ /!/&r /C 1)1-4,1 Cb- 7!IS 7/ (+'7/ ti,F'In Crr TUIr C f' T�_- f//Smz'e (ye ed / 7)10 7 74�Lt0 G P.eUcf` 7a7' / Required: ❑ No ❑ Yes Corrective Action Re Discussion With Person in Charge: 4 t ;• ❑ Voluntary Compliance ❑ Employee Restriction/ / I have read this report, have had the opportunity to ask questions and agree to correct all Exclusion violations before the next inspection, to observe all conditions as described, and to ❑ Re-inspection Scheduled ❑ Emergency Suspension comply with all mandates of the Mass/Federal Food Code. I understand that noncompliance may result in daily fines of twenty-five dollars or suspension/revocation of ❑ Embargo ❑ Emergency Closure your food permit. ❑ Voluntary Disposal 0 Other: 3-SUi.14((,',) PHFs Received atT�m)eratures Violations Related to Foodborne Illness Interventions and Risk According to Law i:ooled to Factors(Items 1-22) (Cont.) 41'F145'F V�ithin 4 Hours. PROTECTION_ FROM CHEMICALS 3-SOLI CoolincMethods for PHFs J4 Food or Color Additives 19 PHF Hot and Cold Holding �� --- -- 3-50L16(B) Cold PHFs Maintained at to below 3-202.12 Additives °'9(1004(17'3 41°1:45=I�"' 3-30214 Protection from Unar. oved Additive&* - FS Poisonous or Toxic Substances 3-501.16(A) Hot PHFs Maintained at or above 7-101.11 Identtt}vrgInformation-Original � 140F. Containers* 3-501.16(A) Roasts Held at or above 130'F. 7-10111 Conant n i Lame-Warkin Containers* 20 Time as a Public Health Control 7-201..11 Se aratiau-storree* 3-501.19 Time as a Public I-Iealt'h Control* 7-202.11 Restriction-Presence mid Use* 590.604(11) Variance Reg uthernent 7-202.12 Conditions of Use* 7-203.11 J'oxicContainers-Prohibitions- REOUIREMENTSFORHIGHLYSUSCEPTIBLE 7-204.11 Sanitizers.Criteria-Chemicals* POPULATIONS(HSP} _ 7-204.11_ Chemicals for Washing Pioduce,Criteria" 21 3-8(}l.).1(A) Unpasteurized Prepackaged Juices and Bev et a-es with W annmu Labels* 7_204.14 Drwm�Agents-(c[teriu* 3-S01.11(B) Use of Pasteurized Eggs* 7 265-1.1 Incidental Food Contact,Lubricants" 7-206.11 Restricted Use Pesherdes,Criteria* 3-801 1 f(D) Ran or Partially Cooked Animal Food and Raw Seed S routs Not Served. 7-206,12 Rodent Bait Stations" 3-801.11(C) Uro tuned Food Paeka=e Not Re-served. ` 7-206.13 Tracking Powders,Pest Control and Monitotine" CONSUMER ADVISORY TIME/TEMPERATURE CONTROLS 22 3-603.11 Consumer Advisory Posted for Consumption of Animal Foals That are Raw. Undercooked or Ili Proper Cooking Temperatures for Not Otherwise Processed to Eliminate PHFs :�vr2rror 3-401.11A(1)(2) Erns 155'F I3 See. Patho ons.* h,-s-lmmedi rte Service 145°F15secc* 3-302.13 Pasteurized Eggs Substitute for Raw Shell E Comminuted Fish.Meats&Game 3-401.11(A)(2) s' Animals- I55'F 15 sec. "` 3-401.11(H)(1)(2) Pork and Beef Roast- 130'F 12'1 ruin'* SPECIAL REQUIREMENTS 3-401.11(A)(2) Ratites, Injected Meats-155"F 15 590.009(A)-(p) Violations of Section 590.009(A)-(D)in Sec * catering,mobile food, temporary and 3-401.11(A)(3) Poultry,Wild Game, Stuffed PHF,, residential kitchen operations should be Stuffing Containing Fish,Meat, debited tinder the appropriate sections Ponitry or Ratites-165'17 15 sec. * above if related to foodborne ilbtess 3-401,11(C)(3) Whole-mmele,Intact Beef Steaks interventions and risk'Pactors. Other 145017* 590.009 violations relating to good retail 3-401.12 Raw Animal Foods Cooked hi a practices should be debited under 4129- Microwave 165'F* Special Requirements. 3-401.11(A)(1)(b) AtIOther PHFs-145'F15sec . ` 17 Reheating for Hot Holding VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 3-403.1I(A)&(D) PI1Fs 165"F 15 sec. " (Iterns 23-30) 3-403.1.1(13) Microwave-165'F 2 Minnie Standing, Critical and non-critical violations, which do not reline to the Time* ,foodborne illness interventions and risk factors listed above, can be 3-403.11(C) Commercially Processed I2TE Food- found in the following sections of!Fee I-ood Code and 105 CAIR 140-F* 590.000. _ 3-403A1(E) Remaining UnslicedPortions ofBee f Item Good Retail Pro ctices i FC 590.000 Roasts* j 23_ Management and Personnel FC-2 .003 18 Proper Cooling of PHFs 1 24 yFood and Food Protection FC_3 004 25 Egwpment and Utensils FC 4 ,005 _ 3-501.14(A) Cooling Cooked ourPFIs from 1m 70 to 1`26 Water Plumbing and W aste ) FC 5 .006_._ 70`17 Within Z Houts and From 70°F 27 ! Physical Facility FC-6 .007 to 41'F145'F Within 4 Hours. * r 28_ Poisonous or Toxic Materials FC-7 .008 3-501.14(B) Cooling PHFs Made From Ambient 1_29 pecial Requirement 009 i-- - ---- --- -Temperaarre frun-edients to 41"F/4:5'17 30 , Other ------------- Within 4 Hours* * Denote,critical item in the iedernl 1999 Ford Care or 103 CA4R 190.000. IIMMP,ORTANT MESSAGE FOR DATE J1 ��)�� TIMEP.M. M �7 l OF I/ 1 1 V PHONE 91Z AREA CODE NUMBER EXTENSION ❑ FAX ,�AMOBILE AREA CODE NUMBER TIME TO CALL TELEPHONED 11 PLEASE.CALL 1-61 CAME TO SEE YOU WILL CALL AGAIN WANTS TO SEE YOU RUSH RETURNED YOUR CALL WILL FAX TO YOU MESSAGE 71 5 cf JG• 1 r 4c�ef na-"A 0 a. n. SIGNED WOR 4 09 MADE S.A. a Z,—, +3n'w'i*" lfw'} wtM• y FJd t,y., (wyf'q Y' rt , x S.< r , M .,,. 1 '5,.� r ' " 11 Y 5101 r'�g5e- �. u_ . ; °� f.. CITYeOF ,SAL'EM�MASSACHUSETTS y '� ,'�"a+R.St1•% a0 BOARD,OF HEALTH , - 3 U 120 WASHINGT,ON,ST,REET 4TH FLOOR +=4f ySALEM MA 01970 t rr. 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: Doc Ryan's Pub & Grub Address of Establishment: 109 Lafayette Street Owner's Name: Rhino Corporation Restrictions: Application Date: 12/16/2004 Permit for Food Establishment 237-05 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 120 WASHINGTON STREET, 4TH FLOOR o' SALEM, MA 01970 TEL. 978-741-1800 FAX 978-745-0343 STANLEY J. USOVICZ, JR. JOANNE SCOTT, MPH, RS, CHO MAYOR HEALTH AGENT 2005 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT �q NAME OF ESTABLISHMENT 06C �Vy1A1� t L&6. TEL# 47 ADDRESS OF ESTABLISHMENT k8 9 L4 EA MAILING ADDRESS (if different) OWNER'S NAMEITEL ADDRESS OUPiVIOFS CITY �Q zQ STATE ZIP 0/9 CERTIFIED FOOD MANAGER'S NAME(S y[SCERTIFICATE#(s) �C� (required in an establishment where potentially hazardous food is prepared.)ti EMERGENCY RESPONSE PERSON l A&%%AkS ./ HOME TEL# iv ,eek -4 d / HOURS OF OPERATION: Mon S- ; Tuef- ) WedIfL1_Thu.0'I Fri.a0`/ Sat.P`/ Sun.0 —/ TYPE OF ESTABLISHMENT FEE check only RETAIL STORE YES NO less than 1000sq.ft. =$ 50 / 1000-10,000sq.ft. =$100 Bbl-, more than 10,000sq.ft. =$250 RESTAURANT YES O — less than 25 seats =$100 25-99 seats =$150 more than 99 seats =$200 BED/BREAKFAST YES $100 ADDITIONAL PERMITS MAKE (not just serve) ICE CREAM, YOGURT, SOFT SERVE YES $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 hest novelle belief, have filed all stat tax returns a d aid all state taxes e wired under the law. C lk % tr oy Its y`�s Signature Date Social Security or Federal Identification Number ---------------------------- --------------------------------- Revised 11/03/03 FOODAP2.adm Check#&Date 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 Nam Date T/1 e of O eration s Tvoe of Inspection G)zb Food Service L!]'Routine Address 11)q / _ Risk E] Retail ElRe-inspection LGt Level ❑ Residential Kitchen Previous Inspection Telephone �.g . .. El Mobile Date: Owner HACCP YM El Temporary ❑ Pre-operation j pCotp=tan EICaterer ❑ Suspect Illness Person in Charge(PIC) Time ❑ Bed& Breakfast ❑ General Complaint In: ❑ HACCP Inspector .0 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 __ , m ❑ 13. Handwash Facilities EMPLOYEE HEALTH PROTECTION FROM CHEMICALS" ❑ 2. Reporting of Diseases by Food Employee and PIC El 14.Approved Food or Color Additives El3. Personnel with Infections Restricted/Excluded ❑ 15.Toxic Chemicals FOOD FROM APPROVED SOURCE _ _ TIMEITEMPERATURE CONTROLS(Potentially ) ❑ 4. Food and Water from Approved Source olentiall 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),' E]21. Food and Food Preparation for HSP El 10. Proper Adequate Handwashing ❑ 11. Good Hygienic Practices "CONSUMER ADVISORY _ LL ❑ 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 5. Equipment and Utensils (Fc-a)(sso.00s) cited in this report may result in suspension or revocation of 25. Water, Plumbing and Waste (FC-5)(590.006) the food establishment permit and cessation of food establishment operations. If aggrieved by this order, you 27. Physical Facility (FC-6)(590.007) have a right to a hearing. Your request must be in writing 28. Poisonous or Toxic Materials (FC-7)(590.006) 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,501nsceOFO�14.d c Ins a e: Print: PI s Signature: Print: 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) Assr„nment of Responsibility* 7302.1 (A)(]) Raw Animal Foods Separated from 590.003(B)_ Demonstration of KnoHiedge* Cooked and RTE Foods* 2-103.11. Person in charge-duties Contamination from Raw Ingredients 3-302.1 1(A)(2) Raw Aninial Foals Separated from Each EMPLOYEE HEALTH Other* 2 590.003(0) Responsibility of the person in charge to Contamination from the Environment require reporting by foal employees and 3302.11(A) Food Protection" applicants" 3-302.15 Washin Fruits and Vegetables 590.003(1`_) Responsibility Of A Foal Employee Or Air 3-304.11 Food Contact with Equipment and Applicam To Report'f o'Ilse Person In Utensils* Charge' Contamination from the Consumer 590.003(G) Re ortin by Person in Charge* 3-306.14(A)(B) Returned Food and Reservice of Food* 31 590.003(D) Exclusions and Restrictions* Disposition of Adulterated or Contaminated 590.003(E) I Removal of Exclusions and Restrictions Food 3-701.11 Discarding or Reconditioning Unsafe FOOD FROM APPROVED SOURCE Food'` 4 Food and Water From Regulated Sources 9 Food Contact Surfaces 59U04(A-B) Compliance with Food Law" 4-501..111 Manual Warewashing-HotWater 3-201.12 Foci in it Hermetically Sealed Container* Sanitization Tern eratures* Products* 4-501.112 Mechanical Warewashing-Hot Water 3-201.13 Fluid Milk and Milk Pxodncts* r 3-202.13 Shell E.-ds* Sanitization Temperatures* 3-202.1.4 E r rs and Milk Products.Pasteurized* 4-501.114 Chemical Sanitization-temp., pH, 3-202.16 Ice Made From Potable Drinkin Water'" concentration and hardness. ' 4-601A I(A) Equipment Food Contact Surfaces and 5-101.11 Drinking Water Ecom an AppllAed S stem' Utensils Clean* 590.006(A) Bolded Drinkin Water* 4-602.11 Cleaning Frequency of Equipment Food- Shellfish Water Meets Standards in 310 CMR 22.0"` Contac Surf cgs and Utensils* 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 ment* Shellfish* 4-70111 Methods of Sanitization-I-lot Water and 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* Sources* 10 Proper,Adequate Handwashing Game and Wild Mushrooms Approved 0y 2-301.11 Clean Condition-!-lands and AnnO Re Mato Autharit 3-202.18 Shellstock Identification Present* 2-301.12 Cleanin Proredroc* 590.004(0) Wild Mushrooms* 2-301.14 When to Wash* 3-201.17 Game Animals* 11 Good Hygienic Practices 5 Receiving/Condition -401.11 Eating,Eatin ,Drinkin or UsingTobacco* 3-202.11 PHFs Received atProper Temperatures* 2-401.12 Discharges From the Eyes, Nose and 3-202.t5 Package Integrity- Mouth* 3-101.11 Food Safe and Unadulterated* 3-301.12 Precentin>Contamination FVhen Tustin" (> 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* Empkpees* Tags/Records:Fish Products 13 Handwash Facilities 3-402.11 Parasite Destruction* Cenvenlent(r Located and Accessible 3-402.12 Records,Creation and Retention* 5-203.11 Numbers and Capacities* 590.004(7) Labeling of Ingredients' 5-204.11 Lamion and Placement* 7 Conformance with Approved Procedures 5-205.11 Accessibility.O)eration and Maintenance /HACCP Pians Supplied with Soap and Hand Drying 3-502.11 -specialized Pmeessing Methods* Devices . f0 .1HadwshhCleanser, Avrlam3-50212 Reduced oxygenen packaging,criteria* ut 8-103.12 Confo mance wi h A roved Procedures„ 6-301.12 Hand Dryin Provision "Denotes critical item in the federal 1999 Food Code(a 105 CMR 590000. y Massachusetts Department of Public Health Salem Board of Health 120 Washington Street,4'h Floor Division of Food and Drugs Salem, MA 01970-3523 ,FOOD ESTABLISHMENT INSPECTION REPORT Tel. (978) 741-1800 Fax (978) 745-0343 Name /1 / Date T e of 0 erasion s Type of Inspection V 4 GYUb Food Service [a'Routina Address I Risk ❑ Retail ❑ Re-inspection Telephone Level El Residential Kitchen Previous Inspection ❑ Mobile Date: OwnerI HACCP YM [I Temporary E] Pre-operation Y ❑ Caterer ❑ Suspect Illness Person in Charge(PIC)I Time ❑ Bed& Breakfast ❑ General Complaint In: El HACCP Inspector, r 0 2 Out: Permit No. ❑ Other Each violation checked requires an explanation on the narrative page(s)and a citation of specific provisions)violated. Non-compliance with:'..41 "'> 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 El 14.Approved Food or Color Additives FOOD FROM APPROVED SOURCE El 15.Toxic Chemicals ❑ 4. Food and Water from Approved Source TIME/rEMPERATURECONTROLS(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 [:]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 immediately or within 90 days as determined by the Board Official Order for Correction: Based on an inspection of Health. today, the items checked indicate violations of 105 CMR .C .. N* 590.000/federal Food Code. This report, when signed below 23. Management and Personnel (FC-2)(590.003) by a Board of Health member or its agent constitutes an 24. Food and Food Protection (FC-3)(590.004) order of the Board of Health. Failure to correct violations 25. Equipment and Utensils (FC-4)(590.005) cited in this report may result in suspension or revocation of the food establishment permit and cessation of food 26. Water, Plumbing and Waste (FC-5)(590.006) establishment operations. If aggrieved by this order, you 27. Physical Facility (FC-6)(590.007) have a right to a hearing. Your request must be in writing 28. Poisonous or Toxic Materials (FC-7)(590.008) and submitted to the Board of Health at the above address 29. Special Requirements (590.009) within 10 days of receipt of this order. 30. Other DATE OF RE-INSPECTION: S:590In OForm 14.dw n Ins 151' Print: PICS Signature: Print: Page of_Rages U j I Violations Related to Foodborne illness interventions and Risk Factors(items 1-22) PROTECTION FROM CONTAMINATION _FOOD PROTECTION MANAGEMENT K Cross-contamhatan 1 590.003(A) Assignment of Responsibdrty* 3-302.11(A)(]) Raw Animal Foods Separated from 590.003(B) Cooked and RTE Foods* 2-103.11Person m charge-duties Contamination from Raw Ingredients 3-302.11(A)(2) Raw Anneal 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* a. tlicants* 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* Charge* Contamination from the Consumer 590.003(G) R�Person in Charge* 3-306.14(A)(B) Returned Food and Reservice of Fend- 3 590.00130)) Exclusions.and Restrictions* Disposition of Adulterated or Contaminated 590.003(F) Removal of Exclusions and Restrictions Food 3-701.11 Discarding or Reconditioning I nsafe FOOD FROM APPROVED SOURCE Food" Food and Water From Peculated 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 Tem eratures* 3-201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Warewashing-hot Water _ Sanitization Temperatures* 3-202.73 Shell Ea s* 4501.111 Chemical Sanitization-tem H, 3-202.14 Eg rs and Milk Products.Pasteurized* p'p 3-202.16 Ice Made Froin Potable Drinkine Water" concentration and hardness.'r 5-101.1.1 Drinkht Water from an A roved Svstem* 4-601-11(A) Equiprnent Food Contact Surfacer and 590.006(A) Bottled Drinkin Water* Utensils Clean* 4-602.11 CleaningFrequcncyofEquipmentFtnd- 59(1.006(B) Water Meets Standards in 310 CMR 22.0"' Contact Surfaces and Utensils` Shellfish and Fish roman Approved Source 4-702.1 t 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* Ig Proper,Adequate Handwashing Game and Wild Mushrooms Approved by fte alatoryAuthority 2-301.11. Clean Condition-Hands and Awns* 3-202.18 Shellstack.Identification Present* 2-301..1.2 Cleaning Procedure* 590.004(C) Wild Mushrooms* 2-301.14 When to Wash* 3-201.17 Game Animals* I rf Good Hygienic Practices 5 Receiving/Condition 2-401.11 EatinR:Dritiking or Using Tobacco"`_ 3-202.11 PHFs Received at Propea:Temperatures* 2-401.12 Discharges From the Eyes, Nose and 3-202.1.5 Packaae hnegrit * 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 Sheilstock Identification* 59Q004(E) Preventing Contamination from 3-203.12 Shellstock Identification tdainlained', Emrlovees* Tags/Records:Fish Products 13 Handwash Facilities 3-402.1I ParasiteDestruetion* Conveniently Located and Accessible 3-402.12 Records. Creation and Retention* 5-203.11 Numbers and Ca acaies" 590.0040) Labeling of Ingredients' 5-204.11 Location and Placement* 7 5-205.11 Accessibilit . 0)eIationandMaintenance Conformance with Approved Procedures IHACCP Pians Supplied with Soap and Hand Drying 3-502.11 S ccialized Processing Methods* Devices (x30111 Handwashm Cleanser,Availability 3-502,1'_ Reduced oxvaen acka do ,criteria . ry 8-103.12 Conformance with A. roved Procedures` i 6-301.12 Hand Drvin�Provision "Denotes critical itern in the wdetal 1999 Fsoal Code a it)5 CiYtR 590.600. CITY OF SALEM BOARD OF HEALTH Establishment Name Ida0,10 Y Date: Page: 02.. of_ Item Code c-Critical Rem DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date No. Reference R—Red Item Verified PLEASE PRINT CLEARLY 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 P ❑ Re-inspection Scheduled ❑ Emergency Suspension comply with all mandates of the Mass/Federal Food Code. I understand that noncompliance may result in daily fines of twenty-five dollars or suspension/revocation of ❑ Embargo ❑ Emergency Closure your food permit. ❑ Voluntary Disposal ❑ Other: 3-501,14(C) PHFs Received at Temperatures Violations Related to Foodborno Illness Interventions and Risk According to Law Cooled to Factors(items 1-22) (Cont) 41'F/45'F Within 4 Hours. " PROTECTION FROM CHEMICALS 3-501.15 Cooling Methods for PHFs tq Food or Color Additives 19 PHF Hot and Cold Holding 3-202.12 Additives* 3-501.76(H) Cold PHFs Maintained at or below 590.004(f) vl'145'F`* 3-302.1,4 Protection from Una toted Additives* 3-501.16(A) Hot PHFs Maintained at or above 15 Poisonous or Toxic Substances eo'F. 7-101.11 Identifying Information-Original 3-501.16(A) Roasts Held at or above 1.30''F. Containers* 7-102.11 Common Name-Working Containers' 20 Time as a Public Health Control 7-201.I I Separation-Storage* 3-5,01,3-501,19 Time as a Public Health Control* 7-202,11 Restriction-Presence and Use* 590.004(H) Variance Requirement 7-202.12 Conditions of Use, 7-20311 '1oxicContainers-Prohibitions* REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-204.11 Sanitizers.Criteria-Chemicals^ POPULATIONS(HSP) 7-204.'12 Chemicals for Washing Pioduce,Criteria* 21 3-801.11(A) Unpasteurized Pre-packaged Juices and 7-204.14 Drying Agents.Criteria" Bereta es with Warning Labels* 7-201,11 htcidentat Food Contact,Lubricants* 3-801,11(B) Use of Pasteurized Em*s* 7-206.11 Restricted Use Pesticides,Criteria* 3-801.1 I(D) Raw of Partially Cooked Animal Food and Raw Seed Sprouts Not Served 7-206.12 TruckRodening g Pow err,P* 3-801.1.1(C) IJno ened Food Packa�c Not Re-served. " 7-206.13 Tracking Powders,Pest Control and Monitoring` CONSUMER ADVISORY TIMEITEMPERATURE CONTROLS 22 3-603.11 Consumer Advisory Posted for Consumption of Animal Foods'that are Raw,Undercooked or 16 Proper Cooking Temperatures for Not Otherwise Processed to Eliminate PHFs 3-401..1 I At 1)(2) Eggs- 155'F 15 See. Pallautens Eggs-Immediate Service,145'F1.Ssec* 3-302.1.3 Pasteurized Eggs Substitute for Raw Shell 3-401.11(A)(2) Comminuted Fish.,Meats&Game Eggs* Animals- 155'F 15 sec. ', 3-401.11(B)(1)(2) Fork 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 Poultry or Ratites-165°F 15 sec '" above if related to Foodborne illness 3-401.11(C)(3) Whole-muscle, induct Beef Steaks interventions and risk factors, Other 145'F 4 590.009 violations relating to goal 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. I7 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'F 2.Minnie Standing Critical and non-critical violations, which do not relate to the Tuner` foodborne illness interventions and risk factors listed above, carr be 3-403.1.1(C) Commercially Pi crossed RTE Fail- found in the following sections of the Food Cade and 105 04)? 140017* 590.000. 3-403-11(E) Remaining 1Jnsliced Portions of Beef Item I Good Retail Practices IPC 590.000 Roasts" 2_3_'_ Management and Personnel FC-2 .003 Proper Cooling o1 PHFs 24 1 Food and Food Protection FC 3 .004 1g �-------- - -- 25 I, Equipment and Utensils ,..FC 4 3-501.14(A) Cooling Cooked PRFs from 140'F to i26, 1 Water.Plumbin and Waste FC 6 .00� _.. - -- -- 70'F Within 2 Hours and From 70'F 27. Physical Facility tFC-6 .007 to 41°17145'F Within 4 Hours, * 2a. Poisonous or Toxic Materials t FC-7 .tioa 3-501.14(B) Cooling PHFs Made From Ambient 29. Special Beguirements : .009 Temperature ingredients to 41"F/45`17 . 30 Other � Within 4 Hours* *Denotes critical item in the federal 1999 Food Code or I On CA1R 594000. I CITY OF SALEM A BOARD OF HEALTH Establishment Name: _ ) < Y Date: Page: of Item Code C-critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date No. Reference R-Red Item - 'Verified PLEASE PRINT CLEARLY S p i� i Discussion With Person in Charge: Corrective Action Required: ❑ No o Yes I have read this report, have had the opportunity to ask questions and agree to correct all ❑ Voluntary Compliance ❑ Employee Restriction/ inspection, to observe all conditions as described, and to Exclusion violations before the next ins p ❑ Re-inspection Scheduled ❑ Emergency Suspension .comply with all mandates of the Mass/Federal Food Code. I understand that noncompliance may result in daily fines of twenty-five dollars or suspension/revocation of ❑ Embargo ❑ Emergency Closure your food permit. ❑ Voluntary Disposal ❑ Other: 3-501.14(C) PHFs Received at Temperatures Violations Related to Foodborne illness Interventions and Risk According to Lain Cooled to Factors(Items 1-22) (Cont.) _ 41'F/45"F Within 4 Hours. " PROTECTION FROM CHEMICALS =>>-501.15 Cooling Methods for PHFs 14 �� Food or Color Additives I9 PHF Hot and Cold Holding 3 202.13 Nd�ees* _ 3-50L16(H) Cold PIi'Fs y4aintalned at t'>r below 3 303.14 Protection iromUnapp oved Additives 590.003(F} dl'/45'F 3-501.16(A) Hot PRFs Maintained at or above IS Poisonous or Toxic Substances 140"P 7-101.11 Identifying Information-Original 3-501.16(.A) Roasts Held at or above 110'F.`r containers'r 7-102.11 Common Name-Workinv Containers* 20 Time as a Public Health Control 7.201.11 Separation-Storage* 3-501,19 Time as a Public Health COffir01" 7-202.11 Restriction-Presence and Use`" 590.004(H) Variance Recun ement 7-202.12 Conditions of Use- 7-203.11 Toxic Containers-Prohibitions* REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-204.11 Sanitizers,Criteria-Chenacak* POPULATIONS(HSP} 7-204.12 Chenucals for Wash=Produce,Criteria* 21 3-801.11(A) Unpastcuriaed Pre-packaged Juices and 7-_204.14 Diving,Agents,Crneua* Bevel nt;es with TAarningLobels* 3-801.1 I(B) Use of Pasteurized bands" 205.11 Incidental Food Contact,LubricantsK 3-801.11(Dj Raw or Partially Cooked Animal Foal and 7-206.11 Restricted Use Pesticides,Criteria* Raw Seed Sprouts Not Served 7-206.12 Rodent Rale Stations* 3-801_I I(C) Unopened Food Package Not Re-served. * 7-206.13 Tracking Powders,Pest Contra)and Monitoring* CONSUMER ADVISORY TIME/TEMPERATURE CONTROLS 22 3-603.11 Consumer Advisory Posted for Consumption of 16 Proper Cooking Temperatures for Animal Foods'fbat are Raw,Undercooked ce PRFs Not Otherwise Processed to Eliminate 3-401.I1A(1)(2) Eggs 155"F 15 Sec, Patho,,ons z e ve, oe ' [.--s-Immediate Service 145`'F1.5sec^ 3-302.13 Pasteurized Eggs Substitute for Raw Shell Foos* 3-401.11(A)(2) Comminuted Fish.,Meats&Gain Aminals- 155'F 15 sec. n, 3-401.11(B)(1)(2) Pork and Beef Roast- 130'F 121 min* SPECIAL REQUIREMENTS 3-401.11(A)(2,) Ratites,Injected Meats- 1.55'F 15 590.009(A)-(D) Violations of Section .590.009(A)-(D)in sec. * catering, mobile food, temporary and 3-401.11(A)Q) Poultry,WiM 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 3-401.1l(C)(3) Whole-muscle,Intact Beef Steaks interventions and risk factors. Other 1450F 9e 590.009 violations relating to good retail 3-401.12 Raw Animal Foods Cooked in a practices should be debited under#29- Miorowave 565°F* Special Requirements. 3-401.11(A)(1)(b) All Other PHFs-145'F 15 sec. I7 Reheating for Hot Holding VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 3-403.11(A)&(D) PHFs 165'F 15 sec. x (Items 23-30) 3-40111(B) Microwave- 165'F 2Minute Standing Critical and non-critical violations, which do not relate to the Time* joadaorne ilheess intervenrions and risk jacsors listed above, can be 3-403.11((") Commercially Processed R"CF3 Food- jound in the fiallowim,sections of the Fond Code and 105 CAdR 140'F.. 590.000. 3-403.11(E) Remaining Unsliced Portions of Beef Item Good Retail Practices FC 640.000 ; Roasts" 23. _Manac3ement and Personnel FC-2 .003 ! IS Proper Cooling of PHFs 24 Food and Food Protection FC -3 .004 25 Equipment and Utensils _ FC 4 005 3-501.14(A) Cooling Cooked PHFs front 140°F to 26. W atec Plumbing and W ante FC-5 006 7WF Within 2 Hours and From 70`F 1I-27. Physical Facllit FC-6 .007 to 41°F/450F Within 4 Hours. * 128 Poisonous or Toxic Materials FC-7 .008 Y. 3-501.14(B) Cooling PRFs Made From Ambient 129 LSpecial Requirements .009 Temperature ingredients to 4l"F/4$'F 30. L6ther ____ - �,�.._--- .... . ---- Within 4 Hottrs* *Denotes criticat horn in the federal 1999 Foot Code or 105 CMR 590.0011. 6 2oG � j 0 ; ��v► � � rPe n �G�m C 198) q`Is - 03y3 r� r� ) Qn Oar Pv� «w) gys- ,3917 C �en ! Iver Pl4h n TED) C 3 s I� VVV V APR 0 a 2005 CITY OF SALEM BOARD OF HEALTH r r MI� r+ �c�I,n� 1 S 71> �\ :2 ►zcA Pc�� ,rhe. n SAN DW��I U U IT �3WSIW+W -7 p 9%t 3Q l� t/ ��Ii V I\VII I'JI APR 0 5 2005 CITY OF SALEM BOARD OF HEALTH IV " c ki C CITY OF SALEM BOARD OF HEALTH ` CITY OF SALEM BOARD OF HEALTH Establishment Name: f-A> JP�e-.. '; Date: -/ - G J Page: / of / Item Code C-Critical Item OF VIOLATION/PLAN OF CORRECTION Date No. Reference R—Red Item Verified. - • PLEASE PRINT CLEARLY _ f r v O t b I S-h vubd 4 /5 n I� BJP/ iPlI m 1-7 .. 4 D-r _ l7 D F ,7 r (V4//�N ti /t9 C c� r/ �Q/— 7 -f dl -,4 (rC>i I(✓ Lv/ Ll�l 6V f/l1 /0--" ' kj*-G 5 h0 e 14 d P,h[--Std Of ✓pB �-d �a Jcls 1 v Discussion With Person in Charge: CorrectivY Action Requir d: ❑ No ❑ Yes Y - / : I have read this report, have had the opportunity to ask questions and agree to correct all L3 Voluntary Compliance ❑ Employee Restriction Exclusion violations before the next inspection, to observe all conditions as described, and to ❑ Re-inspection Scheduled ❑ Emergency Suspension ` comply with all mandates of the Mass/Federal Food Code. I understand that noncompliance may result in daily fines of twenty-five dollars or suspension/revocation of ❑ Embargo ❑ Emergency Closure your food permit. ❑ Voluntary Disposal ❑ Other: t 3-501.14(C} PRFs Received at Temperatures Violations Related to Foodborne Illness Interventions and Risk According to law Cooled to Factors(items 1.22) (Cont,) 41°'F/45'F Within 4 Hours. PROTECTION FROM CHEMICALS 3-501.15 Coolie-Methods for PHFs 14 Food or Color Additives 19 PHF Hot and Cold Holding 3-501.16(13) Cold PRFs Maintained at or below 3-302.14 Protection 3-202.12 Ad a 590.004(F) 41°745°F' Pooisisonous or Toxic Substances from Unapproved Additives* 3-501.16(A) }lot PHFs Maintained at or above 19 40°F. 'K 7-10t.1 1 Identifying Information-Original 3-SO1.16(A) Roasts Held at or shove 130°F. Containers" 7-102.11 Comuron Name-Workin-Containers* 20 Time as a Public Health Control 7-201.11 Se.aration-Stora e* 3-507.19 TimeasaPublicHealthCon tmt' 7-202.11 Restriction-Presence mud Use* 5c)0.004(H) Variance Re larval", 7-202.12 Conditions of Ilse.* 7-203.11 Toxic Containers-Prohibitions" REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-204.11 Sanitizers,Criteria-Chemicals* POPULATIONS(HSP)_ 7-204.12 Chemicals for Washing Produce,Criteria* 21 3-80'1-I I(A) Unpasteurized Pre-packaged Juices and Beverages with Warms labels* 7-204.74 Dr �lng� gets,Criteria`" -- 7-205.11 Incidental Food Contact,Lubricants* 3-901A I(B) Use of Pasteurized Ewes* 7-206.11. Restricted Use Pesticides.Criteria* 3-801.11(D) kava or Partially Cooked Anneal Food and 7-206.72 Rodent Bait Stations* Raw Seed Sprouts Not Served. 7-206.13 MTrestacking Pomlers,PControl and 3-;101.17(C) Uno erred F<md Paeka>e Not Re-served. Monnorin-' CONSUMER ADVISORY TIMFITEMPERATURE CONTROLS 22 3-603.71 Consumer Advisory Posted for Consumption of 16 Proper Conking Temperatures for Animal Foods That are Raw.Undercooked or PRFs Not Otherwise Processed to Eliminate _ Pathe ens ' rv�r vaom 3-401.11A(1)(2) Eggs- 155`F 1.5 Sec. _tE ,-immediate Service 1450F15sec* 3-302.13 Pasteurized Eggs Substitute for Raw Shell. 3-401.11(A)(2) Comminuted Fish,Meats&Game E s* Animals- 155°F 15 sec. 3-401.11(8)(1)(2) Pork and Beef Roast-130°F 121 min* SPECIAL REQUIREMENTS 3-401.11(A)(2) Ratites, injected Meats-155°F 15 590.O09(A}(D) Violations of Section 590.009(A)-(D)in sec, * catering, mobile food,temporary and 3-401.11(A)(3) Poultry, Wild Game,Staffed PHFs, residential'kitchen operations should be Stuffing Containing Fish, Meat, debited under Cite appropriate sections PoLdtr 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 145°F* 590.009 violations relating to good retail 3-401.12 Raw Animal Foods Cooked in a practices should be debited under t{29- Mierowave 165'F* Special Requirements, 3401.11(A)(1)(b) All Other PHFs -145Tt5see. 17 Reheating for Hot Holding VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 3403.11(A)&(D) PHFs 165'F 15 sec. * (items 23-30) 3-403.11(B) Microwave-165' F2 Minute Standing Critical and non-critical violations, which do not relate to the Time` foodborne illness interventions and risk factors listed above can be; 1403 11(C) Commercially Processed RTF Food- found in the following sections of the Food Code and 105 CMR 140°F* 590.000. 3-403.1.1(E) Reninning Uri Portions of Beef Item Good Retail Practices FC 590.000 Recasts,_ 23. Mane ement and Personnel FC-2 .003 1g Proper Cooling of PHFs 24. Food and Food Protection FC-3 .004 3-501.14(A) Cooling=Cooked PRFs f om 140`P to 25 E ui meni and Utensils FC 4 005 26. Water. Plumbing and Waste FC 5 .006 70°I'Within 2 Hours and From 70°F 27. Physical Facilites_ _ FC-6 .007 to 41°F/45°F Within 4 Routs. " 28. Poisonous or Toxic Materials FC-7 .008 3-501.14(B) Cooling PHFs Made From Ambient 29. S ecial R uiremenis .009 Temperature Ingredients to 41°F/45°F 90 _ Other _ -... Within 4 8ourss sror -,n*;ee.z.uo'Denotes critical item in tux federal 1999 Food Code or 105 CMR 590000. 109 Lafayette Street Doc Ryan's Pub & Grub City of Salem FOOD SERVICE ESTABLISHMENT - FOOD SERVICE Inspection HACCP: ❑ Telephone: 3' Item Status Violation Critical Urgency Nature of problem or correction 978-745-8927 Non-compliance with: Done Owner f 9 )LI Anti-Choking PASS ❑ Rhino Corporation Tobacco PASS ❑ PIC FOOD PROTECTION MANAGEMENT Done inspector '' - r PIC Assigned/Knowledgeable/Duties PASS ❑d RED David Greenbaum I * EMPLOYEE HEALTH Done Date Inspected: Correct By: i` Reporting of Diseases by Food Employee and PIC PASSd❑ RED 4/6/2005 Ln T Personnel with Infections Restricted/Excluded PASS ❑./ RED Risk Level. : 'V �v ZZ'tl m FOOD FROM APPROVED SOURCE Done Permit Number, $ T Food and Water from Approved Source PASS RED BHP-2005-0353 x; Receiving/Condition PASS ❑J RED Status: Tags/Records/Accuracy of Ingredient Statements PASS RED SIGNED OFF11 4 Conformance with Approved Procedures/HACCP PASS - ❑d RED #of Critical Violations: Plans PROTECTION FROM CONTAMINATION Done ` Time IN Time OUT . Separation/Segregation/Protection PASS ❑ RED Notes. " s Food Contact Surfaces Cleaning and Sanitizing PASSd❑ RED 68 T k w a ,y � � �n Proper Adequate Handwashing PASS d❑ RED Urgency Description(s): Good Hygienic Practices PASS ❑Q RED BLUE. Prevention of Contamination from Hands PASS RED Violations Related to Good I Retail Practices(Critical £ s Handwash Facilities PASS RED violations must be correctedp immediately or within;10 i days)(Non critical violations e , GeoTMS®2005 Des Lauriers Municipal Solutions, Inc. ( Rev. Apr 07,2005 ) Page 1 of 109 Lafayette Street Doc Ryan's Pub & Grub must be corrected Immediately PROTECTION FROM CHEMICALS Done or within 90 days) s Approved Food or Color Additives PASS ❑d RED RED Violations Related to Toxic chemicals PASS RED Foodborne Illness Interventions TIME/TEMPERATURE CONTROLS(Potentially Haz Done and Risk Factors (Require Cooking Temperatures PASS ❑d RED immediate corrective action) Reheating PASS ❑Q RED Cooling PASS ❑d RED Hot and Cold Holding PASS ❑d RED Time As a Public Health Control PASSd❑ RED REQUIREMENTS FOR HIGHLY SUSCEPTIBLE PO Done Food and Food Preparation for HSP PASS Q RED CONSUMER ADVISORY Done Posting of Consumer Advisories PASS ❑d RED Violations Related to Good Retail Practices (Blue 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 The following items must be corrected within 6 months: -The ceiling in the storage closet to be repaired. -Kitchen ceiling must be repaired. -Utility closet must be finished. Owner will notify the Board of Health prior to expanding the food menu. All other requirements to open have been met. GeoTMS®2005 Des Lauriers Municipal Solutions, Inc. ( Rev. Apr 07,2005 ) PaQe 2 of 109 Lafayette Street Doc Ryan's Pub & Grub GeoTMS®2005 Des Lauriers Municipal Solutions, Inc. ( Rev. Apr 07,2005 ) Page 3 ora 1 CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH 120 WASHINGTON STREET, 4TH FLOOR c SALEM, MA 01 970 TEL. 978-741-1800 INK - FAX 978-745-0343 STANLEY J. USOVICZ, JR. JOANNE SCOTT, MPH, RS, CHO MAYOR HEALTH AGENT 2005 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT NAME OF ESTABLISHMENT TEL# ADDRESS OF ESTABLISHMENT MAILING ADDRESS (if different) OWNER'S NAME TEL# ADDRESS 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# HOURS OF OPERATION: Mon. Tue. Wed.—Thu.—Fri.—Sat.—Sun.— TYPE ed. Thu. Fri. Sat. Sun.TYPE OF ESTABLISHMENT FEE check only RETAIL STORE YES NO less than 1000sq.ft. =$ 50 1000-10,000sq.ft. =$100 more than 10,000sq.ft. =$250 RESTAURANT YES NO less than 25 seats =$100 25-99 seats =$150 more than 99 seats =$200 BED/BREAKFAST YES NO $100 ADDITIONAL PERMITS MAKE (not just serve) ICE CREAM, YOGURT, SOFT SERVE YES 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 ------------------------------------------------------------ Revised 11/03/03 FOODAP2.adm Check#&Date J � 109 Lafayette Street Doc Ryan's Pub & Grub City of Salem FOOD SERVICE ESTABLISHMENT - FOOD SERVICE Inspection HACCP: ❑ Telephone: Item Status Violation Critical Urgency Nature of problem or correction 978-745-8927 Non-compliance with: Not Done Owner: Anti-Choking PASS ❑ Rhino Corporation Tobacco PASS ❑ PIC:` k: FOOD PROTECTION MANAGEMENT Not Done �David Lonergan * PIC Auuignud/Knuwludguublu!DutlLu PASS ❑Y RED Inspector: David Greenbaum EMPLOYEE HEALTH Not Done Date Inspected: Correct By: Reporting of Diseases by Food Employee and PIC PASS ❑d RED 10/19/2005 Personnel with Infections Restricted/Excluded PASS Q RED Risk Level: x FOOD FROM APPROVED SOURCE Not Done Permit Number: Food and Water from Approved Source PASS ❑J RED BHP-2005-0353 Receiving/Condition PASS ❑d RED Status: w Tags/Records/Accuracy of Ingredient Statements PASS ❑d RED SIGNED OFF sb - Conformance with Approved Procedures/HACCP PASS ❑d RED of Critical Violations. Plans 2 PROTECTION FROM CONTAMINATION Not Done Time IN: Time OUT... Separation/Segregation/Protection PASS RED Notes: .w Food Contact Surfaces Cleaning and Sanitizing FAIL Critical ❑d RED The interior panel of the ice machine has 357 =' - an accumulation of grime. Thoroughly �? & �, .f. 4 clean and sanitize the panel. Proper Adequate Handwashing PASS ❑d RED Urgency Description(s): t BLUE: - t Good Hygienic Practices PASS Q RED Violations`Related to Good Retail Practices (Critical Prevention of Contamination from Hands PASS RED violations must be corrected; Handwash Facilities PASS RED immediately or,withir 10 days)(Non-critical violations'% s GeOTMS®2005 Des Lauriers Municipal Solutions, Inc. ( Rev. Oct 20,2005 ) Page 1 of3 109 Lafayette Street Doc Ryan's Pub & Grub must be corrected Immediately PROTECTION FROM CHEMICALS Not Done or within 90 days) Approved Food or Color Additives PASS ❑d RED RED: Violations Related to Toxic chemicals PASS ❑J RED Foodborne Illness Interventions TIME/TEMPERATURE CONTROLS(Potentially Haz Not Done and Risk Factors (Require cooking Temperatures PASS RED immediate corrective action) Reheating PASS RED Cooling PASS RED Hot and Cold Holding PASS RED Time As a Public Health Control PASS ❑d RED REQUIREMENTS FOR HIGHLY SUSCEPTIBLE PO Not Done Food and Food Preparation for HSP PASS Q RED CONSUMER ADVISORY Not Done Posting of Consumer Advisories FAIL Non-Critical ❑d RED Post a consumer advisory. Information given at time of inspection. 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 Provide visible accurate thermometers in all cooling units and freezers. Water, Plumbing and Waste PASS ❑ BLUE Physical Facility FAIL Non-Critical ❑ BLUE There is a hole in the wall by the ice machine. Repair wall and repaint. All unfinished surfaces in the storage room must be nonpourous and easily cleanable. Poisonous or Toxic Materials PASS ❑ BLUE Special Requirements PASS ❑ BLUE Other-See Notes PASS ❑ BLUE All other requirements to operate a food establishment have been met. GeOTMS®2005 Des Lauriers Municipal Solutions, Inc. ( Rev. Oct 20,2005 ) Page 2 of 109 Lafayette Street Doc Ryan's Pub & Grub GeoTMS®2005 Des Lauriers Municipal Solutions, Inc. ( Rev. Oct 20,2005 ) Page 3 of