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DODGE STREET BAR & GRILL - ESTABLISHMENTS "v DODGE STREET BAR & GRILL 7 DODGE STREET A i) I 9 a 4 1 O M h � V VO `4- N O 'M1 V L• A E C S v � y � 3 n ^'N ' Q' J I � 0 1.61 4 a Commonwealth of Massachusetts * " City of Salem Board of Health Kimberley Driscoll 120 Washington Street,4th Floor Mayor SALEM,MA 01970 Food/Retail Establishment Permit DATE. PRINTED: 01/06/2011 ESTABLISHMENT NAME: Dodge Street Bar & Grill File Number:BHF-2004-000168 7 Dodge Street Salem MA 01970 LOCATED AT: 0007 DODGE STREET SALEM, MA 01970 Permit Type Permit No. Permit Issued Permit Expires Fee Restrictions/Notes FOOD SERVICE BHP-201"243 Jan 1,2011 Dec 31,2011 $280.00 ESTABLISHMENT Total Fees: $280.00 PERMIT EXPIRES IDecember 31, 2011 Board of Health � #1 This Permit is not transferable and must be reissued upon change of ownership or location.The permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code,beofre any revonations,improvements,or equipment changes are made, all plans for such must be submitted to and approved by the Salem Board of Health. Page t CITY OF SALEM, MASSACHUSETTS • BOARD OF HEALTH 120 WASHINGTON STREET,41..FLOOR TEL. (978) 741-1800 KIN BERLEY DRISCOLL FAx(978) 745-0343 MAYOR 1)(221?fiN1inDMn[! AI.i�N1.CONI DAVID GREENBAum,RS ACTING HEALTH AGENT 2011 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT q NAME OF ESTABLISHMENT �flflCs� SrUei /P --t(G-Ab �C- TEL# 97, ,�J '013 / ADDRESS OF ESTABLISHMENT I)OD6 e c51 5kL i&— FAX If �I MAILING ADDRESS(if different) EMAIL- Business': Website: OWNER'S NAME V AtJ1L �l>-11—) n�'0� TEL# ICX✓ ADDRESS I� I LAW69-711-r— �llt✓ � Q.lq (/LAA' Q (17l } STREET ((���� ���� CITY Lr/ STATE ZIP p CERTIFIED FOOD MANAGER'S NAME(S) AtJd YtL1;5 yin' S �_ CERTIFICATE#(S)XEcQDX- OJO / (Required in an establishment where potentially hazardous food is prepared) /� EMERGENCY RESPONSE PERSON �Rlk- -2�,r -1 .S/ HOME TEL# 9-22 "/vel 1—dZ6 �/ � I::DA.Y.SOF,APERATIOW° I ;tMonday._:�: i -=.MTuesday" °>Wednesday .;-.;`I-,Thursday• Frid ="-;'Saturday:. rli`:'. ESuoday,; Please wHOURS rite in OFOmeofday, 12,Frrt- IArn IZrdM. 1AM IZym—IA.w !LZpm-Iq,�; IZpT I/d�L � 12Q�-19 + ,I G®dWt� ��t{ (For example 11 am-11 pm) JJ TYPE OF ESTABLISHMENT FEE (check oniv) RETAIL STORE YES less than 1000sq.ft. =$ 70 1000-10,000sq.ft. =$280 more than 10,000sq.ft. =$420 RESTAURANT YE NO less than 25 seats =$140 (Outdoor Stationary Food Carl$2 25-99 seats =$280v more than 99 seats =$4 e BED/BREAKFAST/ YES NO $100 CHILDCARESERVICES/NURSING HOM-- ------------------------------------------------------------------------------------------------------------------------------ ADDITIONAL PERMITS MAKE (not just serve) ICE CREAM, YOGURT/SOFT SERVE YES N $25 TOBACCO VENDOR YES N $135 ALL NON-PROFIT(such as church kitchens) YES N $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 retums a s to taxes required under the I X53% 1a Signature Date Social Security or Federal Identification Number Revised 10n1I I FOODAP201 Ladm Check#&Date a 9 11���1 10 S�„ •�L�` / aj' / l Salem Board of Health Massachusetts Department:of., Public Health „ . ,h Division of Food and Drugs I f 4 120 Washington Street,4 Floor Salem, MA 01970-3523 FOOD ESTABLISHMENT INSPECTION REPORT Tel. (978) 741-1800 Fax (978) 745-0343 Name / Dade Type of Ooeration(s) Tyee of Insoection F T-Food Service ❑ Routine Address ^ i 1 tiD � � / Rusk ❑ Retail [ale-inspection Telephone 4 'I MC�b �f Level ❑ Residential Kitchen Previous Inspection �/� 3�7 ❑ Mobile Date: � ❑ Temporary ❑ Pre-operation i + Owner h(�i/1✓ I• "ACCP YM i❑ Caterer l I / AJtf1 El Suspect Illness Person in Cha ge(PIC) Time ❑ Bed&Breakfast ❑General Complaint In: y� ❑ HACCP Inspector �n 1 f 7 Out:q . )i Permit No. ElOther Each violation checked riWuirs an explanation on the narrative page(s) and a citation of specific provision(s)Violated. Noncompliance 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. LFOOD PROTECTION MANAGEMENT _ "" 1 ❑ 12. Prevention of Contamination from Hands ❑ 1. PIC Assigned/Knowledgeable/Duties El- 13. Handwash Facilities EMPLOYEE HEALTH_v ,.. - - _ - - - - - .` PROTECTION_N_FRFROM CHEMICALS - - ❑ 2. Reporting of Diseases by Food Employee and PIC . -- ❑ 14.Approved Food or Color Additives ❑ 3. Personnel with Infections Restricted/Excluded _ -,f_ ❑ 15.Toxic Chemicals [FOOD FROM APPROVED_SOURCE 1 ❑ 4. Food and Water from Approved Source 'LTIME/TEMPERATURE CONTROL_S(Potentially Hazardous Foods) ❑ 5. Receiving/Condition ❑ 16.Cooking Temperatures _ F ❑ 6. Tags/Records/Accuracy of Ingredient Statements ❑ 17. Reheating ❑ 7. Conforrnanc'e 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 (REQUIREMENT$FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP)' ❑21. Food and Food Preparation for HSP ❑ 10. Proper Adequate Handwashing ❑ 11. Good Hygienic Practices t_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 andRisk Factors(items 1-22): of Health. Non-critical (N)violations must be corrected Official Order for Correction: Based on an inspection immediately or within 90 days as determined by the Board today, the items checked indicate violations of 105 CMR of Health.' 590.000/federal Food Code. This report,when signed below c x p g 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)(sso.00a) order of the Board of Health. Failure to correct violations 25. Equipment and Utensils (Fc-3)(590.005) cited in this report may result in suspension or revocation of the food establishment permit and cessation of food mater, 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,5XMSP�0m 14E Inspector's Signature: i .� Print: _N_ PIC's Signature: ` Print: /� 1 Page_of Pages a'; r Violations Related to Foodborne Illness Interventions and Risk Factors(Items 1-22) PROTECTION FROM CONTAMINATION FOOD PROTECTION MANAGEMENT ( Cross-contamination 3-302.11(A)(i) Raw Animal Foods Separated from 1 590.003(A) Assignment of Responsibility* Cooked and RTE Foods* 590.003(B) I Demonstration of Knowledge* Contamination from Raw Ingredients 2-103.1 I Person in charge-duties 3-302A 1(A)(2) Raw Animal Foals Separated from Each Othcr EMPLOYEE HEALTH Contamination from the Environment 2 590.003(C) Responsibility of the person in charge to 3-302.11(A) Foal Protection- require reporting by food employees and 3-302.15 Washing Fruits and Vegetables applicants* 13-304,1 l Food Contact with Equipment and 590.003(F) Responsibility Of A Food Employee Or An Utensils* Applicant To Report To The Person In I Contamination from the Consumer 1 Charge* --- 590.003(G) Reporting by Person in Charge' I 1 3-30fi.14(A}tB) Resumed Food and Ro of Food* Disposition of Adulterated or Contaminated I I 3 1590.003(D) Exclusions and Restrictions* Food _ __ 590.003(E) Removal of Exclusions and Restrictions I3-701,11 Discarding or Reconditioning Unsafe FOOD FROM APPROVED SOURCE Ford* ' 4 Food and Water From Regulated Sources ( 9 Food Contact Surfaces -- 590.004(A-B) Compliance with Food Law" ( 4-501.111 Manual Warewashing-Hot Water 3-1.01.12 Foolt ma Hermetically Sealed Container* ( Sanitization Temperatures* .I 3-201.13 Fluid Milk and Milk Produco* ( 14-501.112 Mechanical Warewashing-Hot Water 3-202.13 Shell Eggs* Sanitization Temperatures* l 3-202.14 Eggs and Milk Products. Pasteurized* I 14-501.114 I Chemical Sanitization-temp.,pH, 3-202.16 Ice Made From Potable Drinking Ware,^ concentration and hardness. 5-101.11 1 Drinking Water from an Approved Svstem* 14-601'1 I(A) Equipment Food Contact Surfaces and 590.006(A) Bottled Drinking Water' I Utensils Clean* 4-60?.i I Cleaning Frequency of Equipment Food - 590.00ti(B) Water Meets Standards in 3 10Approved ved Source Contact Surfaces and Utensils* Sheldish and Fish From an Approved Source 4-702.11 Frequency of Sanitization of Utensils and I 3-201.14 Fish and Recreationally Caught Molluscan I Fax Shellfish* l Contact Surfaces of Equipment* Mol 3-201.15 Molluscan Shellfish from NSSP L sted J l * I I 703.11 Methods of Sanitization-Hot Water and i Chemical* Sources* Game and Wild Mushrooms Approved by 110 ( Proper,Adequate Handwashing J Regulatory Authority ( 2-301.11 1 Clean Condition-Hands and Arms* 3-20218 1 Shellstock Identification Prescnt* 2-301 12 Cleaning Procedure* 590.004(C) Wild Mushrooms- 1 2-301.14 When to Wash* � 3-201.17 Game Animals* ( 11 I Good Hygienic Practices 5 Receiving/Condition 2401.11 Eating,Drinking or Using Tobacco* 3-202.11 PHFs Received at Proper Temperatures* 12-401.12 I Discharges From the Eyes,Nose and 3-202.15 Package Integrity" Mouth* 3-101.11 Food Safe and Unadulterated* 3-301.12 Preventing Contamination When Tasting* 6 Tags/Records:Shellstock 112 Prevention of Contamination from Hands 3-202.18 Shellstock Identification * 590.004(E) Preventing Contamination from IJ 3-203.1_ ShellstockldentiGcationMaintaitted* F Employees* Tags/Records;Fish Products 1 113 Handwash Facilities 3402.11 I Parasite Destrncdon" Conveniently Located and Accessible 3-402.12 Records,Creation and Retention* 5-20.3.11 Numbers and Capacities* � 590.004(1) Labeling of Ingredients' ( 15-204.11 Location and Placement* T Conformance with Approved Procedures I 5-205.11 Accessibility,Operation and Maintenance 1 fHACCP Plans Supplied with Soap and Hand Drying ' 3-502.13 Specialized Processing Methods* Devices 3-502.12 Reduced oxv£en packaging,cnteria* 6-301.11 I Handwashing Cleanser, Availability 8-103.12 Conformance with Approved Procedures' 6-301.12 Hand Drying Provision k Denoteceritical item inthe federal 1999 Fond Cadeof 105 CNIR 590.600. CITY OF SALEM BOARD OF HEALTH o� Establishment Name: I /o��C <, / 31� Date: �/ / / 11 Page: of PLAN Item Code C—Critical item '' DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date. No. Reference R-Red Item Verified II^^rr PLEASE PRINT CLEARLY )O 1 i +41' � � } j� Il I6I �tr� /� 1�9cGi� r'e/( ua✓� c; oc .�oc7J ✓ O A A15 - n()n�r r� r./. I� �=/� , nz., I . I -- I I I I I I I I i DD ucsission With Person in Charge: Corrective Action Required: I ❑ No � Yes I I have read this report, have had the opportunity to ask questions and agree to correct all ❑ Voluntary Compliance ❑ Employed 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 I ❑ Embargo ❑ Emergency Closure your food permit. ❑ Voluntary Disposal ❑ Other: 3-501.14(C) PHFs Received at Temperatures Violations Related to Foodborne Illness Intementions and Risk According to Law Cooled to Factors(hams 1-22) (Cont.) 41'FJ45°F Within 4 Hours. 3-501.15 Cooling Methods for PHFs PROTECTION FROM CHEMICALS ! ( 19 PHF Hot and Cold Holding 14 Food or Calor Additives 3-501.16(B) Cold PRFs Maintained at or below 3-202.12 Additives'^ 1 590.004(8 41°145°F* 3-302.14 Protection from Unapproved.Additives° 1 3-50 L I6(A) Hot PRFs Maintained at or above 15 Poisonous or Toxic Substances 140 * 7-101.11 Identifying Information-Original 3-501.16(A) Roasts Held at or above 130'R * I Containers* 20 Time as a Public Health Control 7-102.11 Common Name-Working Containers* ! ! 7-201.11 Separation-Storage* i 3-501.19 Time nc a ie Health Control' [ 590.004(H) Variance Requequitzmem ! 7-202.11 Restriction-Presence and Ilse° f! 7-202.12 Conditions of Use* REQUIREMENTS FOR HIGHLY SUSCEPTIBLE E 7-203.11 Toxic Containers-Prohibitions* POPULATIONS(HSP) 7-204.11 Sanitizers.Criteria-Chemicals* 21 1-801.11(A) Unpasteurized Pre-packaged lutces and i 7-204.12 Chemicals fire Washing Produce,Criteria* Beverages with GVartting Labels* 7-204.14 Diving Agents.Criteria* { 3-801AMB) Use of Pasteurized Eunv 7-205.11 Incidental Food Contact.Lubricants* ( 3-801.11(D) Raw or Partially Cooked Animal Food and 7-206.11 Restricted Use Pesticides.Criteria* ! Raw Seed Sprouts Not Served' ` 7-206.12 Rodent Bair Stations* 3-801-II(C) Unopened Food Package Not Re-served. 7-206.13 Tracking Powders,Pest Control and " Monitoring* CONSUMER ADVISORY TIMEIfEMPER4TURE CONTROLS 22 3-603.11 Consumer Advisory Posted for Consumption of 16 Proper Cooking Temperatures for Animal Funds That are Raw,Undercooked or PHFs Not Otherwise Processed to Eliminate Pathogens.'rTM`°"` 3 40t.IlA(I)f2) Pegs- 155FI5 Sec. rnzoe Substitute f 3-30 Eggs-immediate Service 145'F15sec� 2.23 Pasteurized Eggs a Raw Sltetl 3-401.11(A)(2) Comminuted Fish.Meats&Game Ems* .Animals-155°F 15 see. * SPECIAL REQUIREMENTS 3.401.11(B)(i)(2) Pork and Beef Ruast- 130'F 121 min* 590.009(A)-(D) Violations of Section 590.009(A)-(D)in 3401.11(A)(2) Ratites,Injected Meats-155*F 15 sec.* catering,mobile food,temporary and 3-401.11(A)(3) Poultry-,Wild Game,Stuffed PHFs, residential kitchen operations should be Stuffing Containing Fist h.Meat. debited under the appropriate sections Poultry or Ratites-165°F 15 sec. * above if related to foodborne illness 3-401.11(C)(3) Wh6le-muscle,Intact Beef Steaks 1 interventions and risk factors. Other 145°F yf ( 590.009 violations relating to good retail 3-401.12 Raw Animal Foods Cooked in a practices should be debited under#29- Micmwave 165`F 4 Special Requirements. 3401.11(A)(1)(b) All Other PHFs-145'F 15 sec.¢ 17 Reheating for Not Holding VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 3-403A 1(A)&(D) PHFs 165-F 15 sec.* ! (Items 23-30) f 3.403.11($) Microwave- 1650 F 2 Mmute Standing Critical and non-critical violations, which do not relate to the Time* foodborne illness interventions and risk factors listed above, can be 3-103.11(C) Commercially Processed RTE Food- found in the fallowing sections of the Food Code and 105 041? 140°F* 590.000, 3403.11(E) Remaining UrislicedPord(msofBeef % Item E Good Retail Practices 1 FC 590.000 Roasts* i 23. 1 Management andPsrsonnel ! FC-2 .003 18 Proper Cooling of PHFs , 1 24. 1 Foal and Food Protection I FC-3 .004 i 1 25, I Equipment and Utensils FC-4 00.5 3-501.14(A) Cooling Cooked PHFs from 140`F to ; 26. Water.Plumbing and Waste ! FO-5 .006 70*F Within 2 Hours and From 70`F ! 27. Physical Facility FC-6 .007 to 4I`F/45°F Within 4 Hours. * 28. Poisonous or Toxic Materials ! FC-7 .008 i 3-501.14(6) Cooling PHFs Made From Ambient I 1 29. ` Special Requirements ` .009 I Temperature Ingredients to 41'F/45°F ! 30. 1 Other ! ! Within 4 Haus* D::nores crifieal iu.min the federei 1999 Fuad Cafe v 105 CMR 590.000. t r s ) Massachusetts Department of. Public Health . Salem Board of Health ( 120 Washington Street,4'"Floor -Division of Food and Drugs gg Salem, MA`01970-3523 FOOD ESTABLISHMENT INSPECTION REPORT fr Tel. (978) 741-1800 Fax(978) 745-0343 Name Type of Operation(SI Type of Insoection Food Service J@ Routine Address ' li, n Retail ❑ Re-inspection l Level ❑ Residential Kitchen Previous Inspection Telephone • �(�� El Mobile Date: Owner 1 I HACCP Y/N El Temporary ❑ Pre-operation T'j�A!1 I ❑ Caterer ❑Suspect Illness Person in Charge(PIC) ~ Time rEl Bed&Breakfast El General Complaint Ins{{*�S ❑ HACCP InspectorJ K� Oujr� ��� Permit No. ElOther Each violation checked re unres an explanation on the narrativ4iigais)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. f [FOOD PROTECTION MANAGEMENT o 1 ❑ 12. Prevention of Contamination from Hands 1. PIC Assigned/Knowledgeable/Duties EMPLOYEE HEALTH'- - s El 13. Handwash Facilities y PROTECTION FRGM CHEMICALS ❑ 2. Reporting of Diseases by Food Employee and PIC ❑ 3. Personnel with Infections Restricted/Excluded E] 14.Approved Food or Color Additives ❑ 15.Toxic Chemicals L FOOD FROM APPROVED SOURCE TIME/TEMPERATURE CONTROLS Potential) Hazardous Foals) ❑ 4. Food and Water from Approved Source �_ ,. _ (Potentially y - ❑ 5. Receiving/Condition [116. 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 L REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) El21. Food and Food Preparation for HSP El 10. Proper Adequate Handwashing ❑ 11.Good Hygienic Practices (CONSUMER ADVISORY, „,. El 22. Posting of Consumer Advisories Violations Related to Good Retail Practices Number of Violated Provisions Related Critical (C)violations marked must be corrected To Foodborne Illnesses Interventions immediately or within 10 days as determined by the Board and Risk Factors(items 1-22): of Health. Non-critical (N)violations must be corrected Official Order for Correction: Based on an inspection immediately or within 90 days as determined by the Board today, the items checked indicate violations of 105 CMR' of Health. 590.000/federal Food Code. This report, when signed below c x by a Board of Health member or its agent constitutes an 23. Management and Personnel (FC-2)(590.0 4) order of the Board of Health. Failure to correct violations. 4. Food and Food Utensil on (FC-3)(590.004) cited in this report may result in suspension or revocation of 5. Equipment and Utensils (FC-a)(sso.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)(590.006) 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 501nspe For 14 as /(,. i O� ' I Inspector's Signature: / Print: ( , ()� PIC'sSignature: Print: rA�l�-' Y{ aSU 1. I Page4!S$7 Pages I r Violations Related to Foodborne Illness interventions and Risk Factors(items 1-22) PROTECTION FROM CONTAMINATION ( g Cross-contamination FOOD PROTECTION MANAGEMENT 3.302.11(.A)(]) Raw Animal Foods Separated from ( 1 590,003(.Al Assignment of Resnonsibility'" Caked and RTE Fails* 590.003(B) Demonstration of Knowledge" ( Contamination from Raw Ingredients 2.103,11 Person in charee-duties 1 3-302A I(A)i2) Raw Animal Foods Separated from Each 1 Other` EMPLOYEE HEALTH ( Contamination from the Environment 2 590.003(.C) Responsibility of the person to charge to 3-30211(A) Food Protection* require reporting by food employees and 3-302,15 Washing Fruits and Vegetables applicants* 3-304.11 Food Contact with Equipment and 590,003(F) Responsibility Of A Fad Employee Or An Utensils* Applicant To Report To The Person In Contamination from the Consumer 11 Charge* 3-306,14(A)(B t Returned Food and Reservice of Food* 1 590.003(G) Reporting by Person in Char ze* Disposition of Adulterated or Contaminated 3 590.003(D} Exclusions and Restrictions* Food { 590.003(13) ( Removal of Exclusions and Restrictions 3-701.i i Discarding or Reconditioning Unsafe Food* FOOD FROM APPROVED SOURCE 1 o Food Contact Surfaces Food and Water From Regulated Sources 4 ' ( 4-Slti.11l Manual Watewashing-HatWatar 590.0(t4(A-B) Cum'fance with Food Law' SaniBzation Temperatures* 3-201.12 Food in a Hermetically Scaled Container* j 14-501.112 Mechanical Warewashing-Hot Water MU 3-201.13 Fluid Milk and MProducts* Sa»tization Temperatures* 3-202.13 j Shell Eggs* 1 14-501,114 Chemical Sanitization-temp.,pH, i ( 3-20114 I Eggs and Milk Products.Pasteurized* t I concentration and hardness." ( 3-20116 � Ice Made From Potable Drinking Water" 1 ( 4-6011 l(A) Equipment Food Contact Surfaces and 5-101.11 Drinking Water from an Approved System* Utensils Clean* 590.006(A) Bottled Drinking Watcr* iI { 4-602.11 Cleaning Frequency of Equipment Fad- I ( 590.006tB) Water Meets Standards in 310 CNIR 220' ( Contact Surfaces and Utensils* i Shellfish and Fish From an Approved Source I 4-702,11 Frequency of Sanitization of Utensils and 3.201.14 Fish and Recreationa)ly Caught Molluscan Fad Contact Surfaces of Equipment* Shellfish* 4-703,11 irfethods of Sanitization-Hot Water and 3-20L15 Molluscan Shellfish from NSSP Listed Chemical* Sources* ( 10 Proper,Adequate Handwashimg Game and Wild Mushrooms Approved by 2-301.11 Clean Condition-Hands and Arms* Regulatory Authority1 f 1 3-202.15 ell us 2-301 14 When to Wash*identification Freaent* 2-301,12 Cleaning Procedure* WMus1 590.004{C} Wild Mushrooms* 1 ( I1 ( Good Hygienic Practices 3-201,17 Game Animals* g Receiving/Condition 2-401.11 Eating,Drinking or Using Tobacco* 3-202.11 PHFs Received at Proper Temperatures* I '-401.L2 Discharges From the Eyes,Nose and Mouth" j 3-20215 Package Integrity* 3-301.12 Freventing Contamination When Tasting* Tags/Records:Sheilstock 1 {.}01,11 Safe and Unadulterated* # ( 12 Prevention of Contamination from Hands }� 6 ags 3-20^_.18 SheIistockIdentification' j 590,004(E) Preventing Contamination from Employees* 3-203.12 Shellstock Identification Maintained' ' 13 I Handwash Facilities Tags/Records:Fish Products Conveniently Located and Accessible 3-402.11 Parasite Destruction* ( 5-203.11 Numbers arid Capacities* ( 3402.12 Records,Creation and Retention* 1 5.20411 Ixication and Placement* 590.0(14f!} Labeling ofingredients° 1 ( 2 Conformance with Approved Procedures 5-2(15.EI Accessibility,Operation and Maintenance y Supplied with Soap and Hand Drying IHACCP Plans Devices 3-502,11 Specialized Processing Methods* � 6-30111 Handwashing Cleanser,Availability 3-50112 Reduced oxygen packaging.criteria* i � 6-301.12 ( Hand Drying Provision 5-103,12 ( Conformance with ApotovedProcedures * *Denotes critical item in the federal 1999 Food Cale or tu5 CNR 590(KK;. i CITY OF SALEM l 1 BOARD OF HEALTH Establishment Name: Date: /�t//i� Page: P� of r?-.. Item Code C-critical Item v DESCRIPTION OF VIOLATION/ryJJLAN OF CORRECTION Date. No. Reference R—Red Item Verified �,, P EASE PRINT CLEARLY -Sbl.f14' �.(1G .n 71, lr �l y 3 (( ✓ a- 1-zr ,vu�d 14-0 he_ (A)( IV-r> T i r T I I�cisr� O/1 ..K U/h.J C n�) d(2s I4 d,, ­41-�-c- &4 - r IST so1. 13 )j (C LJUue a\(C,&j Ooi44 C�0i;17,4 T sire`-zE�r 7 V tz ChCI�✓Y"O /-t I1)AA,n. A^ t I �I.'1� I_LT/ t�r,o� 11`u,9 -4o 1 ch�1 r e 1 I•a - I� ( 5�7 i v( a 1ile, _e v� /�'� 1, = 1.��/.f'n�/t fl e, ire t� 1 7,1n1241-11 IG®,K+A vF' l(� ✓ �z I/IC� AJ.0-0 �nIt n��OC��rnL � car c, �l/? rn-� r AtC � �b r1/_ MU51, I � `� a7g ,..t��' ✓ Sh+n,'�-z�, /��iM541n i )C +t✓ 1-Iv'< CAl` Discussion With Person in Charge: i _ Corrective Action Required: I ❑ No res - ❑ 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 cv inspection Scheduled ❑ Emergency Suspension comply with all mandates of the Mass/Federal Food Code. I understand that noncompliance may result in daily fines of twenty-five-dollars or suspension/revocation of ❑ Embargo ❑ Emergency Closure your food permit. ;/ a _❑ Voluntary. Disposal ❑ Other: 4 3-501.14(0) PHPs Received at Temperatures IVloWtons Related to Foodborne Illness interventions and Risk According to Law Cooled to Factors(items I-22) (Cont.) 41'F/450F Within 4 Houm PROTECTION FROM CHEMICALS 3-501.15 Cooling Methods for PHFs 14 Food or Color Additives f 19 PHF Hot and Cold Holding j 3-501.16(B) Cold PI-IFs Maintained at or below i 3-202.12 Additives* 590.004(F) 4101450 F* 3-302.14 Protection from Unapproved Additives" ( 4 t-501.16(X) Hot PHFs Maintained at or above 15 Poisonous or Toxic Substances - 7-101.11 Identifying Information-Original 140°F. Containers* 3-501.16(A) Roasts Held at or above 130°F. 7-102.11 Common Name-Working Containers* j f 20 Time as a Public Health Control tf 7-201.11 Separation-Storage* i { 3-501.19 Time as a Public Health Control* I f 7-202.11 Restriction-Presence and Use* ( 1 590.004{11) Variance Requirement 7 7-202.12 Conditions of Use* ! REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 4 7-203.11 Toxic Containers-Prohibitions* POPULATIONS(HSP) 7-204.11 Satutizers.Criteria-Chemicals* 7-204.12 Chemicals for Washing Produce.Criteria* � 21 3-801.1](A) Unpasteurized Pre-packaged Juices and .Beverages with Warning Labels* 7-204.14 Drying Agents,Criteria* 3-801.11(B) Use of Pasteurized Eggs* 7-205.1 i Incidental Food Contact.Lubricants* i 3-801.11(D) Raw or Partially Cooked Animal Fad and g 7-206.11 Restricted Use Pesticides,Criteria' f Raw Seed Sprouts Not Served.* { r 7-206.12 Rodent Bait Stations* ( 3-841.11(0) Unopened Food Package Not Re-sewed. 7-206.13 Tracking Powders, Pest Control and Monitoring* CONSUMER ADVISORY TIMEITEMPERATURE CONTROLS 22 3-603.11 Consumer Advisory Posted for Consumption of 16 Proper Cooking Temperatures tar Animal Foals That are Raw-Undercooked or Plifes Not Otlterwrie.Processed to Eliminate 3-401.IlA(1){2} Eggs- 155`F 15 Sec. Pathogens-*¢- '.rnrzoer Eggs-Immediate Service 145'Fl5sec• 3-302.13 Pasteurized Eggs Substitute for Raw Shell 3401.11(X)(2) Comminuted Fish.Meats.&Game Eggs" Animals-1550F 15 sec. * SPECIAL REQUIREMENTS 3.401.11(B)(i)(2) Pork and Beef Roast- 130OF 121 nun* 590.009(A)-(D) Violations of Section ,590.009(A)-(D)in 3-401.11(A)(2) Ratites,Injected Meats-1550F 15 catering mobile&xxi temporary and sec. 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-]65'F 15 sec. * above if related to foodborne illness 3-501.11(C)(3) Whole-muscle,Intact Beef Steaks interventions and risk factors. Other 1450F* 590.009 violations relating to good retail 3-401.12 Raw Animal Foods Corked in a practices should be debited under#29- Micmwave 1650F* Special Requirements. 3-401.11(A)(1)(b) All Other PHFs- l45°F 15 sec. ° ! 17 Reheating for Hot Holding I VIOLATIOAIS RcLATED TO GOOD RETAIL PRACTICES 3-403.41(A)&(D) PHFs 165'T 15 sec. * (Items 23-30) 3-403.11(B) Microwave- 165`F 2 Minute Standing Critical and non-critical violations,which do not relnk•to the Time* foodborne illness interventions and risk factors listed abate, can he 3403,11(Q Commem ally Processed RTE Foal- found in the following sections of the flood Code and 105 CMR 1400E 590,000. 3403.11(E) Remaining Unsliced Portions of Beef ( Item ': Good Retail Practices I FC590.WO i Roasts" } 123. i Management and Personnel FC-2 .003 i 1y} Proper Cooling of PHFs i 1 24. I Food and Food Protection I FC-3 .004 1 25. Equipment and Utensils IFC-4 d .005 , 3-501.14(A) Coating Corked PHFs from 1400E to 25, ! Water.Ptumbinq and W site j FC-5 1006 700F Within 2 Hours and From 700E 27. Physical Fac@y FC-6 .007 to 410F/45'F Within 4 Hours. * 1 28. Poisonous or'tack Materials + FG-7 .008 i 3-501.14(8) Cooling PHFs Made From Ambient 129. Special Requirements 009 1 Temperature Ingredients to 41 0171450F 30. i Omer ! Within 4 Hours" 'Denores critical iwin in the federal 1999 Fuad Cole or 105 C.MR 590.000. CITY OF SALEM � ( ) �7 ' BOARD OF HEALTH Establishment Name: I /U�\<v Civw�� r�uc r-/_^i. /( Date: C/�� �, Page: 7' of 3 Item " Code C-Critical Item j DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date No. Reference R-Red Item Verified PLEASE PRINT CLEARLY I� �f 3 i�x_,� ✓ n(f ,0f, c( 4-. _.G/cl"hello clr I— I 1 v I h'c, 'A'7 XC 0/1 (nAkta411-1 I V I iri�o I'L4 (4 I)L I I I I j I I I , Discussion With Person in Charge: corrective Action Required: ❑ No I ] Yes r� 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 LI Suspension comply with all mandates of the Mass/Federal Food Code. I understand that noncompliance may result in daily fines of twe -five dollars or suspension/revocation of ❑ Embargo L3 Emergency Closure your food permit. =--` ❑ Voluntary Disposal ❑ Other: ( 3-501.14(C) PHFs Received at Temperatures Viotattons Related to Foodborne Illness interventions and Risk j According to Law Cooled to Factors(#ems 1-22) (Cont.) ( 41'171457 Within 4 Hours, PROTECTION FROM CHEMICALS ( 3-501..15 Cooling Methods for PHFs 114 ( Food or Color Additives ( ! 19 PHF Hot and Cold Holding i 3_50L16(B) Cold FUR%Maintained at or below 3-202.12 Add lives* ( 590.004(F) 410145n F* 3-302.14 Protection from unapproved Additives" ( i-501.16(A) Hot PHFs Maintained at or above ( 1g Poisonous or Toxic substances ( * 7-101,11 Identifying Information-Original 140 F. Containers* 3-501.16(A) Roasts Held at or above 130017. ° ( 20 Time as a Public Health Control 7-102.11 Common Name-Working Containers* ( I ( 3-501.19 Time as a equiHealth Control* Separation-Storage* 590.004(H)04(H} Vari f7-202.11 Restriction-Presence and Use* j Variance Requirement { 7-202.12 Conditions of Use* REQUIREMENTS FOR HIGHLY SUSCEPTIBLE ( 7-2033.11 Toxic Containers-Prohibitions* POPULA17oNs(HSP) ( 7,-204.11 Sanitizers.Criteria-Chemicals* I 21 3-!801.11(A) Unpasrewized Pre-packaged lmees and 7-204.12 Chemicals for Washute Produce,Criteria* I .Beverages with Warman,labels* 7-204.14 Drvine Agents.Criteria* I 3-801.11(6) Use of Pasteurized Eggs* I 7-205.11 Incidental Food Contact,Lubricants* i 3-801.11(D) Raw or Partially Cooked Animal Food and ( 7-206.11 Restricted Use Pesticides,Criteria* I Raw Seed Sprouts Not Served. X06.12 (Indent Bait Stations* I 3-801.11(C) Unopened Food Package Not 7-206.13 Tracking Powders,Pest Control and Monitoring* CONSUMER ADVISORY TIMErTEMPERATURE CONTROLS 22 3-603.11 Consumer Advisory Posted fur Consumption of 16 Proms Cooking Temperatures tar # Animal Foods That are Raw.Undercooked or PHFS j Not Otherwise Processed to Eliminate Patbogenss*Erle' 3 i -401.I1A(i)(2) Eggs- 155`F 15 Sec. ,naa: Eggs-Immediate Service 145`Fi5sec* 3-302.13 Pasteurized Eggs Substitute for Raw Shell 3401.11(A)(2) Comminuted Fish.Meats&Game Eggs' Animals-155`F 15 sec. SPECIAL REQUIREMENTS 3401.11(B)(1)(2) mi Pork and Beef Roast- 130°F 121 n' ( 3-401.11(A)(2) Ratites,Injected Meats-155°F i5 ! 590.004(,0)-(D) Violations of Section 590.009(,0)-(P)in sec.* j 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 3-101.11(C)(3) Whole-muscle,Intact Beef Steaks interventions and risk factors. Other 145°F* 590,009 violations relating to good retail 3-401.12 Raw Animal Foods Cooked in a { practices should be debited under#29- Microwave 1657* i Special Requirements. 3401.11(A)(1)(b) All Other PRFs- 145'F 15 sec.° ( 17 Reheating for Hot bolding I VIOLA77ONS R FLATED TO GOOD RETAIL PRACTICES 3403.1I(A)&(D) PHFs 165"F 15 sec. * (hems 23-30) 3-a03.1I(B) Microwave- 165`F 2 Minute Standing Crilicul wrd non-critical violations,which do not relate to the Time* foodborne illness interventions and risk factors listed above, can be 3403.11(C) Commercially Processed RTE Food- found in the follo"ing sections of the Food Code and 105 CMR 140*P 590.000. 3-403.11(E) Remaining Unsliced Portions of Beef i item 1 Good Retail Practices ; FC 590.000 Roasts* 123. 1 Management and Personnel ! FC-2 .003 ( 18 Proper Cooling of PHFs 1 24. 1 Food and Food Protection I FC-3 i .044 ; 1 25. '; Equipment and Utensils I FC-4 i .005 i 3-501.14(A) Cooling Cooked PHFs from 140`F to ij Water.Plumbing and Waste ! FC-5 .006 70`17 Within 2 Hours and From 70`17 27. Phvsical Facility FG-6 .008007 to 41`F145'F Within 4 Hours. * 1 28. Poisonous o Toxic Materials � FC-7 � .008 3-501.14(6) Cooling PHFs Made From Ambient 129. ( Special Requirements .009 i Temperature Ingredients to 41'F)45`F i Other } Within 4 Hours* "Denoren mtvcal ivmir.the f-decal 1999 Fond Code ut IV C NIR X90.000. ' - P 'it ,,.td r-wi 'hc>a-+r+�1dT-��. `�T,3a!"Ov- rt i , Massachusetts Department of Public Health Salem Board of Health ." Division of Food and Drugs 120 Washington Street,4r"Floor I, 61 h Salem, MA 01970-3523 FOOD ESTABLISHMENT INSPECTION REPORT , Tel. f918) 741-1800 Fax (978) 745-0343 Name ^JI � J / MAO Type of Ooeration(s) Type of Insoection �U1�jP S ef'JG( + i i 1.l �l�1AO I �M-Food Service Edoutine Address f -} �x��� _ L Ri"sk I Retail ❑ Re-inspection �'rvaa Level ❑ Residential Kitchen Previous Inspection Telephone �r1 �/L�� f��3 rI ❑ Mobile Date: Owner 'T v HACCP Y/N El Temporary `Y ElPre-operation I ❑ Caterer ❑ Suspect Illness Person in Charge(PIC) I Time ❑ Bed&Breakfast El General HACCP Complaint In: >c0.J El Inspector jD5P \ I Out,,,,r 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 El12. 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 [114.Approved Food or Color Additives E] 3.3. Personnel with Infections Restricted/Excluded El_ 15.Toxic Chemicals : FOOD FFIOM APPROVED SOURCE ' El 4. Food and Water from Approved Source i TIMEITEMPERATURE CONTROLS(PotentiallyHazardous Foods)" - ❑ 5. Receiving/Condition ❑ 16.Cooking Temperatures ❑ 6. Tags/Records/Accuracy of Ingredient Statements ❑ 17. Reheating ❑ 7. Conformance with Approved Procedures/HACCP Plans ❑ 18. Cooling PROTECTION FROM CONTAMINATION -' ❑ 19. Hot and Cold Holding , ❑ 8. Separation/Segregation/Protection ❑ 20.Time As a Public Health Control ,®.Food Contact Surfaces Cleaning and Sanitizing ;REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP)' ❑21. Food and Food Preparation for HSP ❑ 10. Proper Adequate Handwashing ❑ 11. Good Hygienic Practices CONSUMER ADVISORY ❑22. Posting of Consumer Advisories r Violations Related to Good Retail Practices Number of Violated Provisions Related Critical (C) violations marked must be corrected To Foodborne Illnesses Interventions immediately or within 10 days as determined by the Board and Risk Factors(Items 1-22): of Health. Non-critical (N)violations must be corrected Official Order for Correction:Based on an inspection immediately or within 90 days as determined by the Board today, the items checked indicate violations of 105 CMR of Health. 590.000/federal Food Code. This report, when signed below c x by a Board of Health member or its agent constitutes an 23. Management and Personnel (FC-2)(590.003) order of the Board of Health. Failure to correct violations _24. Food and Food Protection (FC-3)(590.004) cited in this report may result in suspension or revocation of 25. Equipment and Utensils (FC-4)(590.005) the food establishment permit and cessation of food 26. Water, Plumbing and Waste , (FC-5)(590.006) establishment operations. If aggrieved by this order, you t27. 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 590MVs (Fo.m 144 �{ � (6 a0/a� Inspector's Signature:�_-��,_ - Print: PIC's Signature: /// ) ( ' _ Print: r /� (((;J•••rrr�iit"""P f / Page of ages i (,(11� U 1 )( - r Violations Related to Foodborne Illness Interventions and Risk Factors(items 1-22) PROTECTION FROM CONTAMINATION FOOD PROTECTION MANAGEMENT 3 Cross-contamination I 590,003(A) Assignment of Responsibility* I 3-302-1](A)(]) Raw Animal Foods Separated from 590.003(B) Demonstration of Knowledge," I Cooked and RTE Foods* 2-103.11 Person in charge-duties I I Contamination from Raw Ingredients 3-302.11(A)(2) Raw Animal Foods Separated from Each EMPLOYEE HEALTH I Other* 2 590.003(C) Responsibility of the person in charge to I Contamwafmn from the Environment I require reporting by to 3-302.11(A) Fond Protection, .. . . . ....� applicants* 13-302.15 Washing Fruits and Vecetables --- 590.003(F) Responsibility Of A Food Employee Or An 3-304.1•! Food Contact with Equipment and Applicant To Report To The Person In I Utensils* Charge" I I Contamination from the Consumer 590.(A)3(G) Reporting by Person in Charge* ( * ( : 13-30ti.14(A}tB) Returned Fcod and Resct'vice of Food' 3 � 590.003(D) Exclusions and Restrictions* Dispos.dionotAdulterated orContaminated 590.003(8) Removal of Exclusions and Restrictions I Food 3-701.1 1 Discarding or Recouditi<mmg unsafe FOOD FROM APPROVED SOURCE Roel* d Food and Water From Reguiated Sources 1 9 Food Contact Surfaces 590.0(9(A-B) Compliance with Food law* 4-501.111 Manual Warewashin2-Hot Water 13-201.12 Food in a Hermetically Scalcd Container* I Sanitization Temperatures' 3-201 13 Fluid Milk and Milk Products* I ( 4-501.112 Mechanical Warewashiny Hot Water ( Sanitization Tem uralures*3-202.73 � Shell Eggs* _� • 3-202 W Eggs and Milk Products. Pasteurized" ( 4-501.114 Chemical Sanitization-temp.,pH, 3-202.16 Ice Nlade From Potable Drinking Water" ( concentration and hardness. 5-101.11 I Drinking Water from an Approved System' I 4-601.11(A) Equipment Food Contact Surfaces and 590.006(A) Battled Drinking Water* Utensils Cleatr" J 1 590 006(13) Water Meets Standards in 310('MR 22.0* ; 4-602.11 Cleaning Frequency of Equipment Fexxf- Shellfish and Fish Fiom an Approved Sourre Contact Surface.and Utensils" i I 3-201.14 Fish and Recreationally Caught Molluscan 4-70111 Frequency of Sanitization of Utensils andFood Contact Surfaces of Eouipmer Shellfish'" 4-703.11 Methods of Sasuization-Hot Water and 3-201.15 Molluscan Shellfish from NSSP Iisted I Chemical* Sources* ( 110 Proper,Adequate Handwashing Game and Wild Mushrooms Approved by ( ; '2.301.1] Clean Condition-Hands and Arms" Regulatory AuthorBy I 3-202 IS Shellstock Identification Present' 1 2-301.12 Cleaning Prcu:edure* 590.004(0) Wild Mushrooms* I 2-301.11 When to Wash* - ----- 3-201.17 Game Animals* I if Good Hygienic Practices 5 Receiving/Condition 2401.11 Eating,Drinking or Using Tobacco* 3-202.11 PHFs Received at Proper Temperatures* � � 2-401.12 Discharges From the.Eyes.Nose and 3-202.15 Package Integrity- Mouth* 3-101.11 Food Safe and Unadulterated* I 3-301.12 Preventing Contamination When Tasting* b TagstRecords:Shelistock I 112 Prevention of Contamination from Hands 59200-1(F,) Preventing Contamination from 3-202.Ix Shelistock identification * ; ' :•g 3-203 12 Sheilshick Identification Maintained- I I Employees* 1I I Tags/Records:Fish Products I 13 Handwash Facilities 3-402.11 Parasite Destruction* Conveniently Located and Accessible 1 ( 3-402.12 Records,Creation and Retention* 15-203.11 Numbers and Capacities- 590.0040) Labeling of Ingredients' ( 5-204.11 Location and Placement* -- - 7 Conformance with Approved Procedures ( 5-205.11 Accessibility.Operation and Maintenance /HACCP Plans I Supplied with Soap and Hand Drying Devices 3-503.11 Specialized Processing Methods* I 6-301.11 Handwaslune Cleanser, Availability 3-502.12 Reduced oxygen packaging.criteria* 1 8-103.12 Conformance with Approved Procedures''` I I fi-301.12 Hand Diving Provision Denotes critical item in the federal 1990 tool Code ur 105 CN1R 590DOO. CITY OF SALEM - BOARD OF HEALTH Establishment Name: ck-_[" Date: n Page: of Item Code C-Critical Item DESCRIPTION OF VIOLATION/FILM OF CORRECTION Uaf" �i No. Reference R-Red Item Verified `�� l ilk- �p� �/.S..Sp �e'e-' f—/.,�n SE PRINT CLEARLY t 4&jiz, 13 S,cl(7 b+-'4,i;A Icy 1 J,- Al ,JPld ,4 r(Qc�/,r 1T7 -�'4 ;, �0 �, 1'e J-� I . j . r o - - I -IJcl ,cis A)QQAaJ jp�- L . -h/P d ,t) k,,Jrho., ti)irk), " - F x ( lei 4:�, ` K//, I= -0 DP—,/9 L / / l ( p F 1� �.><�/ �3,../- -✓� vr� �,v�l'Luu�.�ii/ne C'1'�PC�'�C/�{ r_10-tO+/"Awvj .4'n k ril�VO �n.7 0l� LiAeJi i IAr//, vi ! �/� lid ,�(,C'sr,.✓,r_. 116. Discussion With Person in Charge: Corrective Action Required: I ❑ 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 'Re-inspection Exclusion „ ;� P .�I R le nspection 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 s I your food permit. _ Ir ❑ Voluntary Disposal ❑ Other: 1 I - J4((:1 PHFs Received at Temperatures Violations Retailed to Foodborne Illness Interventions and Risk I Aceording to La" Cooled to Factors((terns 1.22J (Cont.) l I=F/45`F Within 4 Holds, *' PROTECTION FROM CHEMICALS I .i-501 15 1 Coolinn Methods for PHFs 14 1 f Food or Color Additives 19 ' PHF HW and Goid Holding 3-SO1.16(g) Cold PHFs MainLinetl at or below -202,12 .;ddifiNCO 59U 00-10-1 41'145`F- 3-302.14 Protection hon}IlnapPro'ed Additives` 1 aj06t:�j llot Z'HF:lfuintainec3 at or above j 1.5 Poisonous or Toxic Substances i.l 101.11 1 idenvNinit tnfcamminn ou;;inal I !4O-Y. '_.J.-Rt,+sts Hdd at or atwve 1300F,t'laitain e --1 im-c as a Public Health Control 10"in: 11 , n)nn �amc " R, rk - —_-. _-.____ '_SP: 19 Fim<' .,•.a Public Iieaith Con "I •-2t1t 7', S<pa,sutjn_- Senn};'•' - ..- __ '-e4)11 i { 1:L'PtJici:nn " Pr's(nra nn�i i •: ' : _ "._ ...-.__-.._ .,- _� � __.S_.____,—_�-____ .—� r---- - - - i 17-7.;12.12 -: '03 11 -- ,:•it (:,rxatn.t; - PnN:tbs.''.at REQUIREMENTS FOR HIGHLY SUSCEPTIBLE -- - - POPULATIONS(HSP i 04.11ioi( S:utnrxf`,.i:nteru•-Ch_; ..at5^ -- _.-W_.&hw_v _-__t_..__ f t1 Sr)t ii3Aj �}iapa+,eua•;`d- s.f:nl lu}cev mxi , �r i - --._ .- - - ----- - t °rr:,.rer naY, Rai:;iaa lai:el•," 7 104 11 [h"wnu Aarntn.('na•,1s' t_-'--*-------_--1-----.-----.—_ }- , A'!! 1',ii• i`.,c"f j':,`t< Irt.•d i.dc.` �l,'S,il lucid:ebi! Z.>raltlnn,r !ahr;.at;,�;--_... -6,110 ! iin�lt(:: [lt! \'}i`oL•. _. t ! • a`t^,.':i !' vl ti's=:%.tC. iti O: )(,•-<,�t'.�I ii; �Qn _�_'.. .�__._--1-1___-1-1_ _ -1__-1-1-1__ .-. _E•}''i_i',r r.N I -------- _. CrJ"dSUP,tEG{ hf?YiSGRt' t:',7 }, . 'tY.:`A,C:: Z::y M,;'t iP<Ct,i hs i_trih ttI3ii•zk ai ,. TIM EfCFFAF'Ef3ATE3t4F CONTROLS 16� Propel Coo&.i,:r�len:Pr+..th«r;-<of- - ! , t.f�St:rvr•i.,'' ,' i , . 0j,", .t,. ;' 1';i.r- j 'i.' , t'•.,t: i ,.:- S.6'�!;a:' ! �P.,t`.',51x•. -._ .-i , -1-1-1-1 ,-1-1 -1 -1 ... .. ., - - _•_•-_..._- -- -__ .. 1 {_.._ k I --1. •! - .. . .r , ..O,.1 I'.A, . . F ,JI, 1;.I a's) . Vii:.. -, "i')-, 1 � . .•f1,: '..:,ry� ,>.ir. l.i:. . .-., i � 'I. •,a`r; �r't`, iitr ai''i"`'p:.,lt -1,-1-1-1. i , l li Y ,:w Ilei- u�44 ryi::Q, . . . ' j,j '_� trr t't•1 i Ln-r,:J Y<..... ..j=5..,., a ;F'::PCi:CC: t't7 h:r90i7it ' _ _ _ _ __ _ _ ,____., - ._. _._ _ -1_-1-1 -1 _,: •-E - ._ f'V,:\ _ ._- _ ._ _ _..I ' Zq � r'•uP,: Contin;+4f?HFS - _ _ _ __ _-.^` _-�"'� ._ __._. _ t�'__._.__ ri i 5 ", ; 5 n �•• Fd:� .,`-Fh Cdr, i 0(ii _.. _ _ 3 �t)! t.lilj, I t',.p4.L.: i tf I'; \'7 h.Y t'i,:A}r=¢;1' .d �_`_______ '•ti.^ k.. ., a: �'('i „ ohi - - CITY OF SALEM BOARD-OF HEALTH S Establishment Name: / s , � `- Date: /��� Page: of Item Code C–Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date. No. Reference R-Red Item Verifled',z) / t 1 PLEASE PRINT CLEARLY / I . r o 7 (j�2 7_?0- ,#C 5 -(1j f,✓42 t (n K jv it, itWUn f AI3+ QQl —ACC �r �/i " 0/_0`7d �d- t _--jl,lyy / tJe 1 J fi ioi�l-(� ^/ BUJ LX% /s� �C'nfiS /✓i 1 'C/r7YU��1-1 if I Al I 49c, G"t r �'e,V S,/7r l eco iv.i L vLOM/ Jo(3c, V/t J 10cYv't G r'" h'G T If 51 cG.J� G4 o rn'� Discussion With Person in Charge: Corrective Action Required: I ❑ No b 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 LD Re-inspection Scheduled ❑ Emergency Suspension comply with all mandates of the Mass/Federal Food Code. I understand thah� noncompliance may result in daily fines of twenty-five dollars or sus ension/.revacatibn of ❑ Embargo ❑ Emergency Closure your food permit. . % � ❑ Voluntary Disposal ❑ Other: 1 � I 3-5111 14((') PHFs Received at Temperatures Violations RelaW to Foodborne Illness Interventions and Risk Ackwiliug to Lau Cooled to Factors(Itetos 1-22) (Cont) 1 41'F45`F Within 4 Hours. PROTECTION FROM CHEMICALS 3-501.15 Cooling,Methods for PHFs 14 Food or Color Additives I + 19 PHF Hot and Cold Holding 3-202,12 Additix' ,, 3-5O1.1fi(B) Cold PH Maintained at or below 590(y)4(f ) -11`1.43°F- 3-30114 Protection from UnapPro%ed Additives, 13-50 L 1(n;%) I lot PHFs Maintained at or above IS i Poisonous or Toxic Substances 140'F. 101.11 ; Idcatufymt gtnfrnma:ion -Onyinal I _ - t 1 1 htA; RFhtvtt Hrld at or abu,e 1311°F. * ! ontainerc` - --- 7 102.11 _ ;_Columna\'am; � N',n•k,�;�+,l urns:n." 1 Lip Time as a Public Health Contra! � •-'�u !'r l Cimc as a Public I Ieal'h Control ! 1-201.11 r 1',rar:c R04M .oclit ' 7- )2.11 ke+victim -Ptrscncc aid Lx•' E 7-202.12 Condition,of t rsc" I 7-'0 I1 loxii C'wdsinrt: -- Prohiht:r,x:, REOUiREMENTS FOR HIGHLY SUSCEPTIBLE 4.11 Sannizerl,itnr,i;: -Chnuic.rie^-~� POPULATIONS(HSP) �.�6 ,+fQr -- 21 ;-50111(A) 1'upaaeurl�t:d Pre-pa�k.tged Attics and I -4.1_ Chenoral, t':n_ncc f.m;•,:a" (_._— —.------__—'_ -- — 1 Bev-ta^es with 4i-;trnins ,.h.•Is' 'i 204 1•r Di 4wcnti,.Criteria" t•----+---- ; ---- �. _ -Rot 11.01( S;ce of Pa.teln i,-cd , �(}511ln_id;:rtalf:xxlCurtarttxEi,ut::,m_" (io H,uorPars1kCt+)k:,l Aminal Frxnt.and rr i;ry--I i K, 1T-•-. Ror,6i'nn:LeBdrnDsSel:nPeO>nliStn'drl Cnten:, .0 . i — . 2 _ - I i .66 IJ r !'rdapL'?} :'✓Asia-. 1'"):t ^9Sn� d:r2 _-__-_-.____..-__ -_ __._ _— ._...�-_._ .�__.-.___.-_J 1 , aC i.a9, T&E,' FN1PF.R,AT4s:,t; tCit4T',:nL�< „r,'.nln:t t.;:;; r 1'1,t, i ':'C t,rt�crin!�fisln,:i 1 i,n T i Pr;nor t:nokEna Ten,Pnrait,r•s tor i ( - , « •�l h'txt ;, i,.,. 1; . , 1 ij i +i^ i: .....•drre ':e�:nr t -'- _`--- --'-'�-- -'-- -- -------- -- __ .�,L "CII s , .. i,r,. -- C:ir`4L. 14'1i.,tin i.fii _, r.`^. : Ei); I tc,i .`,'1. , , t - .. :9„tit leer r.r. q?, .� ){rl'' 3i .' . i'1:',.. t.:'tt<,I"&{ t: :olid t :. ,.:.i4 R: , t:,:. _ tin":% i s iii:- r . 'i::-`U ' ,�.. •: . . . .., .. ,. ,..:+t:a i , , - F 01 zit mG top Kil ;,„”? , -•" Cjm •E4Z �.i � - . 9end 23-.i ) bt:;o.•::, br , lLiur n;: (7r,.r.eta,. :.<.»- r•,.. :rn, rl. ':,;. u2r,1:,", ria ',:W,"- ,, ','. 1. •1';n:c __ 'n,.;:i::;rr:, r'l r, .»,,n„tt, :n: nu: rt:� tt[to,'tL a.?;itiol :_«i2.; 1tCi Cormier s.ilir l7o.:��...i'i"Irl-•+ai ., .n:::'<. .. P''+ " :'a fdoi! Id.; , lt+; ;sen' Good Reta„F_r_act;ces-- _-Fi`- _ : -580[300 I 1.,. 2.i Lid`lii�,"i�:•"1 rtl Put:^.{:P,11--_- - i YC' --�� -� :74�, Ig Proper Cooling o4 PHFs .'i (� �ryA_-_ ni it ,It t4(A Cool +C, t I`' -: n: l itFto 7.) 1:Wilh t 2 Ho., ,eid From 1 ?; _ ?r3,a,cri - - tn, x k.d PHO t. -- ,F,,:Ic r�' Y lin.J'_t u, le_ ----_1 CC- -- ----I '- 5 �-- 'a(ro, - --' FC c107 p li!tf;ltt' lin«s� � Z� � P..,)r:pj rt ?��x,C°h3ti-r,a!; _ : � , . - ; Gita -fir' 6liill I C, w,Pi 1F. }q;;Jr E-r:nr Att:hleut '_ ''t._. _�'.•'a:;a;F;f:K:ir�p:(?(t_---_. -_. ___ _ -_ - __ -•'_ _ i ,. ,,inporautre lit,red:et t"Lil"P:135'f: ' ..,� . .. r:''ty,,..e.1 A�' L1.,Gsja7..a.,.iN., ... eP v 4'r.(..,,Y.MI.►/ „O..M4"!he✓�S�'q.I.�r.!".f �ijjTA �`'r+�'--r�^"�' +"t�•,,r!� � ' r I Massachusetts Department of Public Health Salem Board of Health Division of Food and Drugs 120 Washington Street, 4'h Floor 9 Salem, MA 01979-3523 11 FOOD ESTABLISHMENT INSPECTION REPORT ,. t' :Tel. (9781,741161800 Fax(978) 745-0343 Name �_ / D fe Type of Ooeration(s). Tyge of Inspection 1 _A I GP ,I(�( t l' r' l� /ln�d I$7,Food Service ❑ Routine Address I Un P isk L] RetailRe-inspection Level ❑ Residential Kitchen Previous ns action Telephone f 'c 3 ❑ Mobile Date: 7 ❑ Temporary �� Owner �l !'1 HACCP YIN ❑ Pre-op ra ion ik I ❑ Caterer ❑ Suspect Illness Person in Charge(PIC) J n Time ❑ Bed&Breakfast ❑❑ HGeneral ACCP Complaint ( / In: a� Inspector o 11 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 - -- - El 14.Approved Food or Color Additives ❑ 3. Personnel with Infections Restricted/Excluded ❑ 15.Toxic Chemicals , FOOD FROM APPROVED SOURCE , E] 4. Food and Water from Approved Source TIME/rEMPERATURE CONTROLS(Potent ali 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 — -- El 19. Hot and Cold Holding ❑ 8. Separation/Segregation/Protection ❑20.Time As a Public Health Control ❑ 9. Food Contact Surfaces Cleaning and Sanitizing ` REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP)' ❑21. Food and Food Preparation for HSP ❑ 10. Proper Adequate Handwashing ❑ 11. Good Hygienic Practices CONSUMER ADVISORY i [:122. Posting of Consumer Advisories Violations Related to Good Retail Practices Number of Violated Provisions Related Critical (C) violations marked must be corrected To Foodborne Illnesses Interventions immediately or within 10 days as determined by the Board and Risk Factors(Items 1-22): of Health. Non-critical (N)violations must be corrected Official Order for Correction: Based on an inspection immediately or within 90 days as determined by the Board today, the items checked indicate violations of 105 CMR of Health. 590.000/federal Food Code. This report, when signed below C __N7 by a Board of Health member or its agent constitutes an 23. Management and Personnel (FC-2)(590.003) order of the Board of Health. Failure to correct violations 24. Food and Food Protection (FC-3)(590.004) cited in this report may result in suspension or revocation of 25. Equipment and Utensils (FC-4)(590.005) the food establishment permit and cessation of food i 7 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 5001nVwfFom 140oc IInspector's Signature: ` j f,-I-Print: PIC'sSignature: / �i ^ Print: "ryti �rV//Pl<V4( I Page/ of_Z Pages ll ) � Violations Related to Foodborne Illness Interventions and Risk Factors(items 1-22) PROTECTION FROM CONTAMINATION FOOD PROTECTION MANAGEMENT ( 8 Cross-contamination I 590.003(A) Assignment of Responsibility* I 3-302.11(A)(I) Raw Animal Foals Separated from 590.003(B) Demonstration of Knowledge* ( Cooked and RTE Faxls* 2-103.11 Person in charge--duties I Contamination from Raw Ingredients 3-302A 1(A)(2) Raw Amoral Foods Separated from Each -I EMPLOYEE HEALTH Other" 2 590.003(C) Responsibility of the person in charge to Contamination from the Environment - require reporting by focal employees and 3-30111(A) Food Protection- applicants* 3-302.15 Washing Fruits and Vegetables 590.003(F) Responsibility Of A Faxl Employee Or An I 3-31)4.1 i Food Contact with Equipment and Applicant To Report To The Person In Utensils* Chargc* I Contamination from the Consumer 590.003(G) Reporting by Person in Charge* I 3-306.14(A)(B) Returned Foal and Reservice of Fax['* 11 590.003(D) Exclusions and Restrictions* I ( Disposition of Adulterated or Contaminated 590.003(B) Removal of Exclusions and Restrictions I Food 1 3-701.1! Discarding or Reconditioning Unsafe FOOD FROM APPROVED SOURCE Faxf* d Food and Water From Regulated Sources 9 Food Contact Surfaces 110.0041A-131 Compliance with Food Law" j 1-50L I 1 Manual Warewashmg-Hot yYater 3-201.12 Food in a Hermetically Scaled Container* ( Sanitization Temperatures- 3-701.13 Fluid Milk and Milli Products* ( 4-501.112 Mechanical Warewashing-Hot Water 3-202.13 Shell Eggs* I Sanitization Temperatures* 13-202.14 Eggs and Milk Products.Pasteurized' I ( 4-501.114 Chemical Sanitization-temp.,pH, 3-202,16 I Ice Made From Potable Drinking Water' I concentration and hardness. 5-101.11 Drinkutg Water from an Approved System` I 4-601.11(Al Equipment Food Contact Surfaces and 590.006(A) Bottled Drinking Water* 4-602.11 1 11 Cleaning Coontact eiFrequency of Equipment Food- 590,006(B) Water Meets Standards to 310 CMR 22.0* I ( . ntact Shellfish and Fish From an Approved Source I Surfaces and Utensils` 4-702.11 Frequency of Sanitization of Utensils and 3-207.14 Fish and Recreationally Caught Molluscan I Food Contact Surfaces of Equipment* Shellfish` 4-703-11 Methods of Sanitization-Hot Water and 3-201.15 Molluscan Shellfish from NSSP Listrd I Chemical` Sources* 110 Proper,Adequate Handwashing Game and Wild Mushrooms Approved by Reoulatory Authority 2-301.11 Clean Condition-Hands and Anus* 3-202.18 Shellstnek Identification Present* I 2-301.12 Cleaning Procedure* 590,004(C) Wild Mushrooms- ( j 2-301.1,4 When to Wash* 3-201.17 Game Animals* I 111 j Good Hygienic Practices g Receiving/Condition I 12-401.11 Eating,Drinking or Using Tobacco* _ I 3-202.11 PIIFs,Received at Proper Temperatures e I I 2-401 12 Discharges From the Eyes, Nose and 13-202.15 Package Integrity* ( Doth' _-- __- 4-101.11 Food Safe and Unadulterated* I ( 3-301.12 Presenting Contamination When Tasting* 6 Togs/Records:Shelistock I 112 ! Prevention of Contamination from Hands 3-202.18 Shellstoek Identification" 590.0(tf(F) Preventing Contamination front 3-203.12 Shellstock Identification Maintained" (, Employes'k Tags/Records:Fish Products I 113 Handwash Facilities - 3-402.11 Parasite Destruction* I Conveniently Located and Accessible 13-402.12 I Record;,Creation and Retention* 15-203.11 Numbers and Capacities* 5)0.0040) Labeling of Ingredients' 5-204.11 Location and Placement* ( , Conformance with Approved Procedures 15205.11 Accessibility._Operation and Maintenance IHACCP Plans I Supplied with Soap and Hand Drying 3-502 17 Specialized Processing�tetixxls* Devices 16-301.11 Handwashing Cleanser,Availability 13-502.12 Reduced oxyger.packaging,crneria* ( - -- 18-103.12 Conformance with Approved Procedures* ( ( 6-301.12 Hand Drying Provision "Denotes crai:al item in the(edet.d I tt99 prxxl Cale rn 105 Cbl It 590.000. s � CITY OF SALEM BOARD OF HEALTH ff Establishment Name: "Dj, �i,r9n� r—�c/J. G� Date: ���,z) Page: a— of Item Code C—,Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTICiN! No. Reference R—,Red Item .VerItleil; PLEASE PRINT CLEARLY - - - 1-9(:.7=5 f fAr . , !I�✓r Mt>j, of _ ��. . �Os�, f l � i I } L I f L �r t I 'e b I iii a t . 3 Discussion With Person in Charge: Corrective Action Required: I ❑ No - - I have read this report, have had the opportunity to ask questions and agree to correct all "O—Voi�nfary Compliance ❑ Employee Restriction inspection, to observe all conditions as described, and to Exclusion violations before the next ins P ❑ Re-inspection Scheduled ❑ Emergency Suspension* t comply with all mandates of the Mass/Federal Food-Code.Luaderstand that noncompliance may result in daily fines of twenty-fivve�-do lars-or suspension/revocation of ❑ Embargo ❑ Emergency Closure l i ' Your food permit. ❑ Voluntary Disposal ❑ Other: s U 4 501 Wit:) PHFs Retxtved at-Pemperatores Violations Related to Foodborne Illness Interventions and Risk p According to Law Coutcdt}� Factors(Itahts l-22) (Cont) j -31=F/45'C Within•t Hours ' PROTECTYON FROM CHEMICALS Qndin"M1lolho&for PHFs j 114 Food or Color Additives ( j 14 PHF Not and Eaid Holding r\ j 3-50'..168) Cotd PFIF>Maiut.nned at or below- 3-202.1' dd m es` 5400i! i 3-302.14 Pitxecuon from Ltnat>,ri-,%vd -11`14 ',}" is Poisonous or Toxic SubstanctIs 3-51)i ibt.\) Sint PH1= %timminedatoraboW j li;i.11 tdcn;it 'ute to motion itn}ira' u,40 ? + • J'iii , .i:}lt'd.i:,g 9but'C lil1'i•, j 1'- -'-- „!{) Time ns a Public Health Control ill'_ 11 (o:ans:p �, t - ,.. — . _—.. .----._' I! 131,1 7-212.1? 't, (',+.nftiion. ,dl• C; I „iti !1 ositmoi: -t'ti ;:b::,,)u. - REOUiREMENTSFoRHIGHLY. S"USCEPTIBLE _._-_ ----__--_ _.- -- --- . _ POPULATION'S HSPJ _ r 1 Ud.t I g,in;t-r,, m:,..d.^ - ------ --- - --"-- -- )f)4 ! <'Lr„a,al. ''tt 1'NtCX i':a E "t _! -���i ii.'•.,i trt)1;,I u:!,nd Pre-;z:c;;:a:d kuiec wtd r__.__ ._- _ RC'+Yf,_.°t.Cp ti'rth 4't,:I")+q*' £•'.3?.)s15' ru-t.14 ! Drtnr: ls'er(\. , r^:r.:" - - --'----_-- 7 ^tis i' 6t:v,•ri+', ;:xv,l('vn;�..!. lah=:.:+n,,. .� _—�_ .____-_� __. _ -=---._�i-__:--- --------- .----- _.._.1 -t,ta MO) i::;a- , -P,ir ti;,',_,as:.1 :°into„tl i=i',<l en.iv - I :+j8 !_ i Rtx tier »_ ., r e., I it{_. ..{ ii r:•RU” .::Y.; Il.:; U, �dt:l v:1 t r 1 3 1 1 CONSUMER Ar)/;S0F`0' T1McrEF. PF RT JRE CUNTs 0...,.r .:14ti1 i'•r♦t, iin:F ....♦. {'Yt.ie:'.,.Y)I:C C: Festnp@:alt.:^5 t04 i. cl , n i j t , Its..•\ '' i i 1 t - t , r . .•i:a i.P+ !1.,'i-'Yt(i',,,y « ., ..- .... � _ s,-..... �,:f:i..n ,. ., .!°1•i,rYT 'i•_'.71'ii, j \lytt}U d,• (P.t' i. dnd;itI C:�' I... . ... ... .. ... to i, ., '::: •,•<.h'.. ., i r + I }.:Lt, 1 '.L i'. :". : ' .. ... ♦ .e .i .... '..),L!" r ,.i'.,.r ,1^ . 4`14 t1Ft i i - -n)a;..i.c.:!' i':r�;. J" .' ♦r lr-t! i : y r i i19tt' ,;::'L*d f^e'Y'ir?e'-':aCt,r•C:, :"<; j,=G O{5i} l', i f:'riaw:g La\b't:J ;4 P weer Cooling of PHFS ;_t" r,-.v' it=s.,� ^ot_,'t c-f, . - - cr;- - , ✓,.< c\n'1=na!'.aS.r. t'H?�: r'ou' l.ttwi i .,. r 7 . `.4111: .r ' i.t.'t..., r . .uCi 7,11 r :J Massachusetts Department of Public Health Salem Board of Health Division of Food and D;u_ 120 Washington Street,4'" Floor Salem, MA 01970-3523 FOOD ESTABLISHMENT INSPECTION REPORT Tel. (978) 741-1800 Fax(978) 745-0343 Name � , , J Ee t Tvpe of Ooerationfsl. Tvpe of Insoection IAC\� Q QTY �f, Idl ��1 -Rd=Food Service ❑ Routine Address -7 k ❑ Retail 1XRe-inspection T Level ❑ Residential Kitchen Previous Inspection Telephone C)(� El Mobile Date: Tu ❑ Temporary ❑ Pre-operation Owner fun r �7h V�. HACCP Y/N ❑ Caterer ❑ Suspect Illness Person in Charge(PIC) c L r Time ❑ Bed&Breakfast ❑❑ HGeneral ACCP Complaint In:s i(J InspectorJ 7J {y�f Out; �� Permit No. El Other Each violation checked re4i`res an explanation on the narrative page(s) and a citation of specific provision(s)violated. Non-compliance with: Violations Related to Foodborne Illness Interventions and Risk Factors Anti-Choking Tobacco Violations marked may pose an imminent health hazard and require immediate corrective 590.009(E) ❑ 590.009(F) ❑ action as determined by the Board of Health. FOOD PROTECTION MANAGEMENT ❑ 12. Prevention of Contamination from Hands ❑ 1. PIC Assigned/Knowledgeable/Duties ❑ 13. Handwash Facilities EMPLOYEE HEALTH . . . ...._ .. ., . PROTECTION FROM CHEMICALS ❑ 2. Reporting of Diseases by Food Employee and PIC ❑ 14. Approved Food or Color Additives ❑ 3. Personnel with Infections Restricted/Excluded ❑ 15.Toxic Chemicals FOOD FROM APPROVED SOURCE . . - - - - TIMEITEMPERATURE CONTROLS(Potemlatty Hazardous Foods) ❑ 4. Food and Water from Approved Source ❑ 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 POPULATtONS(HSP) ❑21. Food and Food Preparation for HSP ❑ 10. Proper Adequate Handwashing CONSUMER ADVISORY " ❑ 11. Good Hygienic Practices __... W ❑22. Posting of Consumer Advisories Violations Related to Good Retail Practices Number of Violated Provisions Related Critical (C) violations marked must be corrected To Foodborne Illnesses Interventions immediately or within 10 days as determined by the Board and Risk Factors(items 1-22): of Health. Non-critical (N)violations must be corrected Official Order for Correction: Based on an inspection immediately or within 90 days as determined by the Board today, the items checked indicate violations of 105 CMR of Health. 590.000/federal Food Code. This report, when signed below C'N by a Board of Health member or its agent constitutes an 23. Management and Personnel (FC-2)(s90.0 order of the Board of Health. Failure to correct violations 24. Food and Food Protection (FC-3)(590.0044))) cited in this report may result in suspension or revocation of 25. Equipment and Utensils (Fc-a)(sso.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: 5 5001ns IF.m 14 tl n. Inspector's Signature: Print:` �1 �QJ I 77 PIC's Signature: Print: / �� I Page-L of liP,ages fi Violations Related to Foodborne Illness Interventions and Risk Factors(items 1-22) PROTECTION FROM CONTAMINATION FOOD PROTECTION MANAGEMENT ( 8 1 Cross-contamination 1 1 590.003(A) I Assignment of Responsibilitv* I 3-302.11(A)(1) Raw Animal Foods Separated from 590.003(B) Demonstration of Knowledge'' I Calked and RTE Fkxxis* 2-103.11 Person in charge-duties I _ I Contamination from Raw Ingredients 3-302.11(A)(2) Raw Animal Foods Separated from Each EMPLO`rEE HEALTH I Other' 2 590.003(C) Responsibility of the person to charge to I I I Contamhation from the Environment require reporting by food employees and 3-302.11(A) Foal Protection' applic:uhts* 3-302.15 Washing Fruits and Vegetables 590.003(F) Responsibility Of A Food Employee Or An I ( 3-304.11 Food Contact with Equipment and Applicant To Report ro The Person In Utensils* Charge' I Contamination from the Consumer 590.003(6) Reporting by Person in Charge' I ( 3-306.14(A)(B) I Returned Food and Resetvice of Food,- 131 590.003(D) Exclusions and Restrictions* I ( I Disposition of Adulterated or Contaminatod 1590.003(P.) Removal of Exclusions and Restrictions I Food 3-701.11 Discarding or Reconditioning Unsafe FOOD FROM APPROVED SOURCE Fcwd* J d Food and Water From Regulated Sources 19 Food Contact Surfaces _ 590.004(A-B) Compliame with Food law* 4-501.11 I Manual Warewashing-Hot Water 3-201.12 Food in a Hermetically Scaled Container* Sani6zation'fentperatures* 3-201.13 Fluid Milk and Milk 33oducus` I I 501.1 i_ A?ech mieal Warewashing-Hut Water 3-202.13 Shelf Eggs" Sanitization Temperatures* 3-202.W I Eggs and Milk Products.Pasteurized -501.114 Chemical Sanitization-temp.,pH, 1 3-202.16 I Ice Made From Potable Drinking Water, concentration and hardness. ., 5-101 11 I Drinking Water from an Approved System- 4-60) 1 kA) Equipment Food Contact Surfaces and 590.006(A) Bottled Drinking Water* ( iJtensi!s Clean* ! 4-602.11 Cleaning Frequency of Equipment Food- 590.0(6(B) Water Meets Standards in 310 CMR 22.0„ ( Contact Surfaces and Utensils J Snelifish and Fish From an Approved Source ( ( -1-702.11 ContFreqact S of Sanitization si Utensils and 3-201.13 Fish and Recreationally Caught Molluscan F,vxl Contact Surfaces of Equipment* i Shellfish* ( f-703.11 Methods of Sanitization-HotWaterand 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* Sources* ! 10 ( I Proper,Adequate Handwashing Game and Mid Mushrooms Approved by Regulatory Authority 2_x0'. 1 i Clean Condition-Hands and Arms" 3-202.18 Shellstock Identification Present'" I 2-301.12 Cleaning Procedure* 590.003(C) Wild Mushrooms` 2-301.14 When to Wash* 3-201.17 Game Animals* t1 I Good Hygienic Practices 5 Receiving/Condition I 2-4oL I i Eating,Drinking or Using Tobacco'. f 3-202.11 PHFs Received at Proper Temperatures* I 2-01.12 Discharges From the Eyes,Nose and 3-202.15 Package lntep-rity' I Mouth* 3-101.11 Food Safe and Unadulterated* ( 3-301.12 Preventing Contamination When Tasting* h Tags/Records: Shelistock I 112 Prevention of Contamination from Hands 3-202.18 Shellstock Identification* I 590.0(4(E) Preventing Contamination from 3-203.12 ShellstockldenoiicationMaintaine& I Employees* Tags/Records:Fish Products ! 113 Handwash Facilities 13-402.11 Parasite Destruction- I Conveniently Located and Accessible 3-402.12 Records.Creation and Retention* I 15-203.11 Plumbers and Capacities* 5-204.11 Location and Placement* 590.004(1) Labeling of Ingredients' I g i Conformance with Approved Procedures I 5-1-05,11 Accessibility,Operation and Maintenance 7 i Conformance with Approved Procedures IHACCP Plans Supplied with Soap and Hand Drying 3-502.11 I Specialized Processing Methods* Devices 6-301.11 Handwashme Cleanser,Availability 3-502.12 Reduced oxygen packaging.criteria* I Y - ( 8-103.12 Conformance with Approved Procedures^ I 16-301.12 Hand Drvicg Provision 'Denotes criticsi item in the federal 1999 Food Cate of 105 CMR 590.00(). CITY OF SALEM BOARD OF HEALTH Establishment Name: -Pnl� fXf�Lr (�2. GI Date: I/-- /z �3 Ci PageQ of Item Code C-Critical Item°� DESCRIPTION OF VIOLATION/PLAN OF CORRECTION - Date No. Reference R-Red Item Verified PLEASE PRINT CLEARLY - e I 3 � � I I I Discussion With Person,in Charge: I Corrective Action Required: I ❑ NoLg.1es` I have read this report, have had the opportunity to ask questions and agree to correct all Voluntary Compliance ❑ Employee Restriction/ r 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. —z ❑ Voluntary Disposal ❑ Other: r 3-5U1.)4(Ca PHFs Received at Temperatures _ Violations Rotated to Foodborne illness Interventions and Risk Acc'urdi it,to IaH Cowled to ' I Factors(Items 1-?Z) (Cont) ( I I'F/I Within 4 Hours. * _7 PROTECTION FROM CHEMICALS I 13-501.15 Cooling Methods for PHFs 1 14 I Food or Color Additives I 1 19 PHF Hot and Cold Holding 1 3-50!,16(B) Cold PHFs Maintained at or below :1-2f)2.12 I Addttivcc' ` 590.001(1-) 41"1^45`F- 1 3-302.14 I Plotectiort from Unapproved Addittt•e.' I 1-501 IMA) ( Ilot VHF:Maintained at or above IS Poisonous or Toxic Substances 140'R 7 101.11 Iclent i tying infix mat:on - t h il,m tl I t-iia I f}.i) 1 R,.•.15t,,H,Id at or abot'e 1301% Container:^ Coram,»t nkat -- N„' 1 i 261 ' Time as a Public Health Control 102.11 -{'inv•a5 a Pubfio Iicalth Control' I - ! `9U."itu 4ti ! V„':'tL:c Rc"ttir;anCli( ?-202.1! ! Rc^tri,_rc»t - Prrsea.r.ma l," -- j --`----�---- i 7-'02.12 C,autu,txt:of t jac" 7-''03 11 f\'.ic C'untaincl: -4'toi:;h:::uu, REQUIREMENTS FOR HiGHLY SUSCEPTIBLE -- -- ------- POPULATIONS(HSP) � ..-ZOd.i l Saniutrtti.C'riuvi:+ -Cin•oric:dc' 7-204 12 C'ho!ti c:dt f n t;u` ::.n.t' 13t t-Soil I NA) i L:npactcurved Pre-pael.aeed Ames and � hl ,P:<\d�icr_o i it , E2etier;,,P,,\tfti, Si'@9S1 n121,af,ClSi 7 101,14 Urine Aac:no.Cnt:•ria' ! 305 i t lmidt•r,tal 14xA Contact. [abr!;an:c`_ .� `-fiU_ I lilir� t,;;of Pa.tr;ui,:rd F:es” --- -- - i-;,9! 1ltitf ! t+.iworPafnsUyi:,t,Icd:1n?i�,:dt=cx,dand it,.irirhtti t'.ac 1'e`nade^ Ciael.e'_._._--� k r tx.d �t?^r,,ai, Lo; ce;t.•} 106.!2 o - : f,,toi,u:B,ri:`at'�'.'if 1:. M"Itl ------ ----- _e'---._ -._... 7`.tc}ao-4ERAS}V1SOR� T9$1FJTEM EftA'12 R£ t OtdTi3OL y ! 22 T`t`" 1 i ' t'ov'cw:ic, .,?.,-.i r.. t 1n Prapet Coot'n,y aenperasu,ea f•ir ! 1D 1i t: F'HFS -- tom rdiatc Se ',,r -h _c ~,•t�!.,�.„-t, ,.,�°r.. ..,,. ,.te � REi3t;tR EPS ..J"ry 11AL � s.` •,+:.� S. �,.\, .; ',.,:.i n i'• •t" ���' 1`j l i � .. 1 .. • . ! � CSi+`,�a,d :H:,I I:[:: fO,?:i. k ':h, Uv'". 8;iii ENTS �.1' I It! '! ,"F'l, ri.,tts11 ,. ' : 'f.d:• i1 --:It.r!^ ;'iiC, til I': i > 1 FStt. '1i. , t .ICI::%;'(7 '.a:Cr tri: t.0r„•, }- . .:. 11 ! fic,',c •:';;s to: 1-i<,!'.. +it' A TEt; 70 i,:\1i:.f i)i t'�!'• i:.e`'i ,• ••r. �ta'C,tti«1-i£if - 40:+.I I`$j I �1 fi.:n: �,.:; Ir.i' . : S.::ntlr Siandtrp C'•, . ., .;:',. ,-, ir,•.,., . 'f. .. .. .r?<... .,'vs . ,., __ ( 1:irC — .-_ ,.'"r rJL /t:ti'. 'r1-,r„nt,.q, ,.: ,,;,t Ju,:Cn ('.(��.;i�:„e ;dtt l•p omwn I'I'it 1'h tn,.,., "t�- t',.u! ,,, a; , { .,.,C ren . :.y, ?r,.,.l:•.,.iP,a..: [4S, t{ 4i.; f: 51°U. ,2r1+v;rno" L.n>::..'ti (',"rt..a':t`f t<,c;i ! !tent , Goc\d Xeis+f practices rc 590.000_ . a;:d_PgrFUr.pt•:._-.- _-'-�_n.. 'r_ _sill- 24 ~f, '-o;1^;t t8 I Proper Cooling of PHFS { -- -- 2' - _=j,p- a., --_- ------- 26. � _ � pm:;nt.anr;Utersrs ' f:' : a� ' • sol ll(A) I Cwhat.(':xi,,c,{P1iI=? irrn: Iu: 2f' _ �_':7 v`.,�s.P_!t.:'ibi:+x:,nt;:Y_'.• c(:- r : 1 I F1i'tilr.nItollf,wil FrIan T!''i' ; 27 F-t tits -- - - -- ----- ---'-F('-d CC, - - I G' ;1-f-rlj \t tinni{�;a. i 2r _-'e•:>n,.is: i 'o>•,:Fd;te+u's FC. -7 00� - _ ul.t�,ih, + Crolit:i. Pi{F� 's'Eda�� F+ :m �ttai-trn •• r� tn£'re,i I,1;1 t,• �1•i ��•tist •fl' r.,.wi:. .F a .1 „ .nt, f.v, t.. r - i , 'vv't"+i:.3,r..N+YA&..nyxrt a=!'r+ .L.,.:,?f, raAw'4."-r. ".'<I.11a.9 °a y. ry z Massachusetts Department of Public Health Salem Board of Health 120 Washington Street,4th Floor Division of Food and Drugs ) Salem, MA 01970-3523 FOOD ESTABLISHMENT INSPECTION REPORT Tel. (978) 741-1800 Fax (978) 745-0343 Name ) 1 r ,, Datg_ Tvoe of Operation(sl Type of Inspection S' I .4- ( u c� � �o fl't�C% 12 Food Service ®'Routine Address Risk ❑ Retail ❑ Re-inspection Q� acv C Level ❑ Residential Kitchen Previous Inspection Telephone �( J C� El Temporary Date: Owner �r , HACCP Y/N ❑ Temporary ❑ Pre-operation r (1r�'$� ❑ Caterer ❑Suspect Illness Person in Charge(PIC) yf-^? n Time El Bed&Breakfast El General HACCP Complaint Inspector 10, <^� C� y��f(rf Out _ Permit No. ❑ Other Each violation checked requires an explanation on the narrative page(s)and a citation of specific provision(s)violated. Non-compliance with: Violations Related to Foodborne Illness Interventions and Risk Factors Anti-Choking Tobacco Violations marked may pose an imminent health hazard and require immediate corrective 590.009(E) ❑ 590.009(F) ❑ action as determined by the Board of Health. FOOD PROTECTION MANAGEMENT—-—— ". _.:" El 12. Prevention of Contamination from Hands F-11. PIC Assigned/Knowledgeable/Duties � E3 13. Handwash Facilities EMPLOYEE HEALTH'" "` " • -° PROTECTION FROM CHEMICALS ❑ 2. Reporting of Diseases by Food Employee and PIC ❑ 14.Approved Food or Color Additives ❑ 3. Personnel with Infections Restricted/Excluded _ ❑ 15.Toxic Chemicals FOOD FROM APPROVED SOURCE �„..:.;.`;a„. ..�:.::.':`.:�::;"�"•,"�.. ...'.: ❑ 4. Food and Water from Approved Source TIME%TEMPERATURE CONTROLS(Potentially Haiardous 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 SUSCEPTIaLE POPULATIONS(HSP) ❑21. Food and Food Preparation for HSP ❑ 10. Proper Adequate Handwashing El 11. Good Hygienic Practices - CONSUMER ADVISORY ❑22. Posting of Consumer Advisories Violations Related to Good Retail Practices Number of Violated Provisions Related Critical (C) violations marked must be corrected To Foodborne Illnesses Interventions immediately or within 10 days as determined by the Board and Risk Factors(Items 1-22): of Health. Non-critical (N) violations must be corrected Official Order for Correction: Based on an inspection immediately or within 90 days as determined by the Board today, the items checked indicate violations of 105 CMR of Health. 590.000/federal Food Code. This report, when signed below C N by a Board of Health member or its agent constitutes an 23. Management and Personnel (FC-2)(s90.0 order of the Board of Health. Failure to correct violations 24. Food and Food Protection (Fc-3)(Sso.004)) cited in this report may result in suspension or revocation of 4125. 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 7. 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 SWIpo Fom 14 dw f a a t Inspector's Signature: ` /,0, V '- Print: l� ," PIC's Signature: Y� Print: rr 1"re�U y I Page oft Pages r Violations Related to Foodborne Illness Interventions and Risk Factors(Items 1-22) PROTECTION FROM CONTAMINATION FOOD PROTECTION MANAGEMENT ( S Cross-contamination I 51)6.003(A) Assignment of Responsibility` ( 3-302.11(A)(1) Raw Animal Foods Separated from 590.003(B) Demonstration of Knowledge* ( Cooked and RTE Foods* 2-103.11 Person in charge-duties I ( Contamination from Raw ingredients 3-302.11(A)(2) Raw Annual Foods Separated from Each EMPLOYEE HEALTH Other, 2 590.003(C) Responsibility of the person in charge to I Contamination from the Environment require reporthig by food employees and I J-302.11(A) Food Protection* applicants' ( 3-302.15 Washing Fruits and Vegetables 590.003(F) Responsibility Of A Fixed Employee Or An 3-304.11 Food Contact with Fgntpment and Applicant fo ReportTo The Person In Utensils* Charge" Contamination from the Consumer 590.003(6) Reporting by Person in Charge` I 3-306.14(A)(B) Returned Food and Resenice of Foo& _ 11 590.003(D) Exclusions and Resttictlon,* i Disposition of Adulterated or Contaminated 1590.003(E) Removal of Exclusions and Restrictions E Food 3-701.11 Discarding or Reconditioning Unsafe FOOD FROM APPROVED SOURCE Food1c 4 I Food and Water From Regulated Sources ( 9 Food Contact Surfaces - 590.004(A-B) Compliance with Food Law* 4-501.1 .1 Manual Warewashing-Hot Water 3-201.12 Fccd in a Hermetically Scaled Container* Sanitization Temperatures* 3-201.13 I Fluid Milk and Mil.Products* +-501.1 12 Mechanical Warewashing-Hot Water 13-202.13 I Shell Eggs* ( Sanitization Temperatures* 3-202.14 ( Eggs and Mitk Pnxfucts.Pasteurized* 4-501.114 Chemical Sanitvation-temp., pH, 3-202.16 ( Ice Made From Potable Drinking Water* I concentration and hardness.'p-- 1 4-601.11(:�) Equipment Foot Contact Surfaces and 5-101.11 Drinking Water from an Approved System' ICtensils Clean` 1590.006(A) Bottled Drinking Watcr* I --- 590.006(B) Water Meets Standards in 310 CMR 22.0" ( 4-h0e.1 t Cleaning Frequency of Equipment Food- Shel Fish and Reerea[io Contact Surfaces and Utensils* _ 3-201.14 Fish sh and Fish Froman approved Source ( ( 4-702.11 Frequenev of Sanitization of Utensils and nally Caught Molluscan Food Contact Surfaces of Equipment* Shellfish* I 14-703.11 Methods of Sanitization-Hot Water and 3-201.15 I Molluscan Shellfish from NSSP Listed I Chemical* Sources'' 10 Proper,Adequate Handwashing Game and Wild hfushrooms Approved by Regulatory Authority 12-301.1 l Clean Condition--Hands and Arens'' f j 3-202.18 I ShelLitock Identification Preserat ( 12-301.12 Cleaning Procedure* 590.004(C) Wild Mushrooms* I 12-301.14 When to Wash* 3-201.17 Game Animals* I 111 I Good Hygienic Practices I g Receiving/Condition 1 12-401.1 i Eatme.Drinking or Using Tobacco* 3-202.11 PHFs Received at Proper Temperatures e 2-401.12 Discharges From the Eyes, Nose and 3-202.15 Package Integnty, I Mouth* 3-101.11 Food Safe and Unadulterated* I 3-301 12 Preventing Contamination When Tasting* 6 Tags/Records:Shellstock 112 Prevention of Contamination from Hands 3-202.18 Shellstock Identification* 590.004(E) Preventing Contamination from 13-203.12 Shellstock Identification Maintained* I Employees* Tags(Records:Fish Products I 113 I Handwash Facilities 1 3-402.17 Parasite Destruction' Conveniently Located and Accessible I I 3-+02.12 ( Records,Creation and Retennun': ! 15-203.11 Numbers and Capacities* 590.004(J) Labeling of Ingredients' I 15-204.11 Location and Placement* 7 Conformance with Approved Procedures ( I 5-205.11 Accessibility,Operation and Maintenance I /HACCP Plans I Supplied with Soap and Hand Drying 3-502.11 Specialized Processing Methods* I Devices - - 3-502.12 Reduced oxygen packaging.criteria* I 16-301.11 Handwashmg Cleanser,Availability 8-103.12 Conformance with Approved Procedures* I 16-301.12 Hand Drying Provision `Denotes critical item in the federal 1999 rood Cude of 105 CMR 5900o. ! CITY OF SALEM j ( BOARD OF HEALTH Establishment Name: � lx/O 1' y MorYI Ih�1 alt �_ Date: ��i /C)Cs Page: of Item Code C-Critical Rem V. ., DESCRIPTION OF VIOLATION I PLAN OF CORRECTION nate No. Reference R-Red_ Item - -y- - - I Verified PLEASE PRINT CLEARLY i rn KI Itkcti rAJPfl o n�� 4 / fit'"` / ` „ny c"I u' / �. ✓ l 7, FY�1 (���a » f �1rorLxn. �� IA) A)nA ,4- i Prs— -'- 6 JP •1 S 166 VZ4 //J, ,2C f��c 0— 14 iii I hr (ice.IVA &b Gloo/i n} _ �2— to � I�S.ewL ✓l rtr l 1 �'Z(,�2,1 iz �ri1�.CP l_ ��o /P � ✓1! OD �n � fn �< Ith/� ( �4X `r/�r>./ �rcc �fr II 14- 1,511 4 1,51( v /1 1Jr,1 k-.n r-,aI& NS2,2 OU o C/ d i i ��.rl ✓ilk`' % �- fJr� (K, n C,> >(n t 101agWA doo;j I Discussion With Person in Charge: Y I Corrective Action Required: I ❑ No �I 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 toExclusion violations before the next ins P WRe-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 I'M,R,xvelwd at Teutivetatures Violations Related to Foodborne fitness Interventions and Risk j Ammuy to cAmd Ill Factors(Woos hzvf (Cont.} r willua J Films Conline Nloth(ed:,eor PHFr PROTECTION FROM CHEMICALS j 19 PHF Not and Cold Holding Food or Color Additives I low IqBI mitt PHF, Mtnn!,:lewd at or Felow 2011' 590�fr_rl(i-) I`AF, 3-M2 14 Prs)tQEojqn trout Unjpproved ekddiliye;' L91" !MAI 10 •00 Momminad at 0,above us j Poisonous or Toxic Substances toy F trims Hold at or ahme i OE 0 o,4 I I OsinpueoNanw- 20 1 ime as a Pubfi�.Heath Control I 3-5l)1.il! Vitneeke,a ioiblic iloalart Cculi'lln p::ab,n S 1411 Eqx Sam= v1stons Reurow"Iew 7-202,11 Rezt6ouo - ard I e' WIMA2 7-2w i I REOWREVENTS FOR HIGHLY SUSCEPTIBLE 7-204.1 i S'nililer;,CrIncrill -chemical,i- POPULATIONS(BISP) it 'Ahl.1 KAI Unpomsuh,J WE well 7-2i[Wll Cheinicats ter kvwhing I"miln.e.(jitedal Mumma;ME %terion; 1 all 7-204 14 D34ing Avtmt.Critcria' ;t()(.1133) L'so m N,wuH&d Few--,-2os it lanidtinal isvil Cmra,,i.latboisants i 'AOL I lop and 7-200.11 R,!s:rlEledI:,;eP.m.a&S climm, lI I kati':Sned Set wd, 7.206.12 medcril Bail sumoln'- I Aw P 11=101 P.Wits"PC.Omer and Ll_-"�l L munkomw CONSUMER ADVISORY 22 3-in 11 Awtvam AQAM% Pl;ZCJ 10t CoWumptionol TIME/TEMPERATURE CONTROLS I 'v 16 Proper Cooking Temperatures forur n)1-Uirmoue pows 3AW A i Ar W_'t llep- 150F 15 Sm 1 15 T15mo. 1OUILA P:.,tnarlr,�j lot'Wam Slid] 141M.I RAU h C nrenertmated Pali. Mews& timer` I LAN, sAwds SPECIAL REOUIREMENTS 3 401.1 RR iqk md But 119mv 11041 121 nun, Rolit'-, hitnoed MLI:ts 15i 5904111)(Ardl %!mktt!or),,v! Sv�nnni `''tit(X)'if 3,'..I )) in sm catorio . rrobik,. add ecewlcikllz:l kittefl oper:tt 1011 s Anjo Id he 3 40I.IRA),3) llmfltr� ';N ild Ghee. Started ibufir,e('e)o1ankinog Idean, debo-d tadcl the ajyrop:ldte ,entonis P,eltry or Kum"165 41 15 see. tltyvve it roL�,al ul 41erelb"nil- illms�, 340L I h C15 j wfsfe-musstc laser Beef Slesks irtrmontionsjnc 6* itedom Oiher 145* t 590.ei(U) relating to stxel retail 3-()I.1:: R.m Nunuel 100 C toed to a 11na(ices hi2100 Iv JeltitExi under 029 - 105,F itntleorelticnt" 340LI QAK0h) Ali CXM, PHR- 14T F 15 gm 17 l Rafroding for Hot Holding I VVLAV0!VVS RCLATED TO GOOD RETAIL PRACTICES f'tloi pill,- 165,F 15 sc;. (lieurs 23-3,0) 1-1011 WH) Nimmavc 165' F2TvWwcSmnEhm;; tjob '?*0 now,nioul 1W,,M;0le" ,chink dr,no; r c;olc to file Fine, feenei!;iserew iibYsl eak'l V•Me-ny,ont`rz;h fiti riii-C loud aborn, ort be, { 3-40,3.11(C) R11 Fast- fomroi,n:he j:J;,)oot&, �ea:ols- of6ehnid Conteand oii Cerfl? 3403 1 RE) Realainiq,L elslwed Pat tines of beer I lRarer (_C,qqa Retail Pracbccs _j Proper Cooling of PHFs 24, Fono,�lnd( Xyl:Pd rmuct:ein 4__ 4_7 25 EqUIP1111M)d UW013 00-11 %11_14A) Cg"by:coths PRIA, how I=te) 'I)J:Wit hill 2 !Inurs wel Front 7W F 0 n;4 1705 T Wake 4 Ihm, so Ponsom er Tori: %Iatc,;a!l —7-7-00,8 151) AIB) CmArw PHIS Made Fmm AnNees -,noias 11 Temperature hwred4;m�te,41'F/41 Twilun 4 ihem, 1,le�,Ae,,rnicai iteiv I rte P kni 1W)le Pan?U&N 1051 NHOWAl"' +' CITY OF SALEM BOARD OF HEALTH / Establishment Name: �� , Date: 1 (n r7 Page: of —. Item Code C-Critical item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date ` No. Reference R-Red Item / 'Verified PLEASE PRI[JT CLEARLY I J• S�� /I ��.� 1�� ,r` a/�,n/Z GJ_on (dor( Cn S ' IIQCIlfi/G /'f I^f,.,..� /). JPi+ . „-. /�9�1.) + , CJ V C I n _I C� - a Zvi. �! < � v, 0 ����,�() ,�z"�� hu,�Q(s IAJ woad n-4- r( col,.�� �l5 o� 1) lt�i4/�e �. � / ref IA aM)2 a � Al Discussion With Person in Charge: Corrective Action Required: ❑ No I Ll Voluntary Compliance ❑ Employee Restriction/ I have read this report, have had the opportunity to ask questions and agree to correct all I violations before the next inspection, to observe all conditions as described, and to � Exclusion j e-Inspec ❑tion Scheduled Emergency Suspension comply with all mandates of the Mass/Federal Food Code. I understand that y noncompliance may result in daily fines of twenty-five dollars or suspension/revocation of U Embargo ❑ Emergency Closure our food permit. yG ❑ Voluntary Disposal ❑ Other: l :->�U.I-hC) Pi{Fs Rete:cedat'l'emper.nores Violations Related to Foodborne Illness interventions and Rtsk A_cording>to la%N Cccled to Factors(items 1.22) {Cont.) .I'P145`F Within 4 Fioa!s. ' PROTECTION FROM CHEMICALS 1 3-501 1, Coolin}V Methods forPHF:, j ?9 PHF Hot and Cold Holding 14 Food or Color Additives ( 1-501 16(12: Cold 1'HF,;vi::udunrcd at or below 3-202.12 Addib�es* j 590 004(F) 41- 1S"F- 3-302.ib Protection from Unaopruced Addittces* j ',-;r 1.MIA; Ito. VHF: Maiai,)ired at�.,r above i 15 Poisonous or Toxic Substances ( ! !40'F 7.101.11 Identifyum Information-Oiginal j 3-_40t.16(.a) Ru;tst;lied at or,br ae l30"F � Contuiaers" j 7-102, 11 O,anrnon Namr e-Wrking Cotiaincit' ' 20 I Time ars a Pubac Heal`h Central j 7='01.11 Separation- Slnrsee,. j 3-50L 19 :ime as a Public Hea':th('on:vol'' 17 202 11 Restriction-Presence aitd tire% 59U.Cudt Ht Varl'vncz K quireilient j 17-202.12 Conditions of Ilse"' 7-?03 11 Toxic Coida;rer::--I obit itioa" REQUIREP41ENTS FOR HIGHLY SUSCEPTIBLE j 7-204.1! Sanitizers.Cnter:o-Che!nica!s^ j POFULATiON3(HSP) 7-203.12 Chenr,cals for Washing Produce. Criteria' j 21 3-80!.H(A) I Unpa.aeun+ed Pre-packaged Juke~and 1 j Beverages with li',,rrring I.als J 7-204.14 Fit Agents.Criteria" 1 3-9( 1.1 UB) j Use of Pa,tcutized P!,as^ j 7-205 11 Incidental Food Contact, Luhricants 3-SU7 1 LD7 Rina or Par.:;!a Coaxed Animal Fust sad 7 2UG.11 Rearicted Use Pesticides Criteria , j kaU Se:rt Sn-out;,Not Scr"ed. '# 7-206.12 Rodent Bart Stations'' j 3-SOI.I NC) Unopened Fo`)ci Package Not R:-sarvcd "" I 7-206 13 Trcking Powders, Pest Control and Monitoring^ CONSUMER ADVISORY TIMEITEMPERATURE CONTROLS 22 3-1603.1 ! Consumer Ad,,mory Posted for Consumption of Am mei F,xAs 'that are Raw. UrdercoiSed or 15 j Proper Cooking Temperatures for PHFs Not Otbeiwise Processed to Eliminate 3-40 Ll l,ki•1)(2) Fggs- 1Sj°F 15 Sec. ens. --- '-+0'..13 PasEgg's teerized Eg ;ubStaute for Raw Shell j hips hnmediatc Ser%-Ice 145"Fl5wc^ `` ` 3-=101.11(A)(2) Comminuted Fish, Meat,,4c Game nk Animals- I55'F I5 sec. * 3-401.11(B);I) 2) Po, ,. SPECIAL REQUIREMENTS ( and Beef Runs S 3G"F 7_I min 3_401.1I(A)(2) Racks,injected Meats- ?55`F 15 590.009(A)-(D) Violations of Section 590.009(,0-t D} in sec. catering. mobile food,ten,'porary and 3-401.1 I(A)(3) Poultry,Wild Came, Stuffed PHFs, residential kit,Lett operations shouid be Stuffing Contacting Fish, Meat, debited under the appiopr tate sections j Poultry or Ratites-165°17 15 sec. " ! above if related to foodborne illness 3-401.11(C)(3) Whole-muscle, Intact Bect Steaks interventions and risk factors. Other 14501* 590.009 violations relating to good retail 3-401 J2 Raw .Annual Foods Cooked in a puualCCS SIIOIAICI he debited under#29- Microwave lfi5'F" Special Requirements. 3-101.11(A)(11Ib) AllOther PH's- 14YF15see. 17 Reheating for Hot Holding ( VIOLATIONS Rr LArED TO GOOD RETAIL PRACTICES 3-403.11(A)&(1)) PHI+s ;65'1715 see. j (I"ems 23.30) 3-403.11(B) Microwave- 165"F 2 Minute Standimt Critud:inti non-rrai(.:a cr,:irtmrw,, which vin not refute rn d;r Time' ft odbornr•diners ire venisums rind risk tu(turs lisi.d above, ran he 3-403.11(C) Commercially Processed RTE Foo!- jrnnd in the,l.oUrni itrg<(r!u>ns.vr rbc ,r'crnd Code nod l r)5 011? 140°F`r 5610.000. -- - -- 3-403.1 I(E) Remmning L'nsliced Portions of Br-ef ; Item ( Goad Retail Practices FC ( 590.000 Roast"t 23. Manavemen!and Personnel FC -2 .003 j 18 j Proper Cooling of PHFs 2- =cod and Food Piste lion FC-3 .004 25,3-501.14(,0 Cooling Cooked PHF,,from 140-P to 27, � waiipmert bi Utensils FC-4 n;;5___- 20 ! Water,Flurr�binp_and Waste FC--S �� ,006 � 70-F Within 2 Koar,;and From 7l)'F I--27 Physical Facility ' . FC-6 .007 j to-11'Ftd5'F Within 4 Hours. ' 1 23. Poisonous or Toxic Matbrials FC -7 .00£9 J 3-50E Idl H; Cooling PFIFs Made Fenn:\mMent 29 : Specal Rrcluts meas C09 Tzntperamfe htgredienrs to 41�F/-15"F 1 30. Other ---_ -� Within 4 Hours """'"""'S'` 'Dem acs enu,al iit in m IN,(;d:ra! 161)4 fond Code to 105 Ch1R 5410 000. Commonwealth of Massachusetts s e City of Salem Board of Health lQmberley Driscoll 120 Washington Street,4th Floor Mayor SALEM,MA 01970 Food/Retail Establishment Permit DATE PRINTED: 01/04/2010 ESTABLISHMENT NAME: Dodge Street Bar & Grill File Number:BHF-2004-000168 7 Dodge Street Salem MA 01970 LOCATED AT: 0007 DODGE STREET SALEM, MA 01970 Permit Type Permit No. Permit Issued Permit Expires Fee Restrictions/Notes FOOD SERVICE BHP-2010-0061 Jan 4,2010 Dec 31,2010 $280.00 ESTABLISHMENT Total Fees: $280.00 PERMIT EXPIRES IDecember3l, 2010 Board of Health l /1A ) 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 CITY OF SALEM, MASSACHUSETTS • BOARD OF HENLTH 120 WASHINGTON STREET,4"'FLOOR TEL. (978) 741-1800 KIMBERLEY DRISCOLL FAX(978) 745-0343 MAYOR DGREENBAUMOONALENI.COM DAVID GREENBAUM, ACTING HEALTH AGENT 2010 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT NAME OF ESTABLISHMENT 1 �Q ("LiL-�- TEL# ADDRESS OF ESTABLISHMENT FAX# MAILING ADDRESS(if different) EMAIL-Business': Website: y OWNER'S NAME �� P2�s ( _ TEL# ADDRESS Ir� 1 L\y1(�1dIS + �r� Wv' �l�t� STREETp CITY STATE ZIP CERTIFIED FOOD MANAGER'SNAME(S) �� 'f�o&IJ 'S\ CERTIFICATE#(S) 3y130laq (Required in an establishment where potentially hazardous food is prepared) EMERGENCY RESPONSE PERSON HOME TEL# I:tDAYS OF QP,ERATIONP!-�,;--Monday„-pkim uesd"aj� j fNednes ayx ; ;Tfiijisday f 4 Fi day , '. ; Saturtlay'. ;::'.jam°Sygda`y I HOURS OF OPERATION I $AM- IlAv,,4 $Awe- I ttw '9A - l Am 1FAM - I/lvw! FAM-I it Y1 $AT, - w I A j 10,p ov-I,d.+W Please write in time of day. I i i (Forexamplellam-11pm) TYPE OF ESTABLISHMENT FEE (check onlvl RETAIL STORE YES NO less than 1000sq.ft. =$ 70 1000-10,000sq.ft. =$280 more than 10,000sq.ft. =$420 - ----------------------------------------------- -------- RESTAURANTYES NO less than 25 seats =$140 (Outdoor Stationary Food Cart$21 25-99 seats =$280— more than 99 seats =$420 BED/BREAKFAST/ YES $100 CHILDCARESERVICES/NURSING HOME------------------------------------------------------------------------------------------------------------------------------ ADDITIONAL PERMITS MAKE (not just serve) ICE CREAM, YOGURT/SOFT SERVE YES $25 TOBACCO VENDOR YES $135 ALL NON-PROFIT(such as church kitchens) YES O $25 *Please pay total with one check payable to the City of Salem. This Permit is not transferable and must be reissued upon change of ownership.The Permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code, before any renovations, improvements,or equipment changes are made,all plans for such must be submitted to and approved by the Salem Board of Health. Pursuant to MGL Chapter 62C,Section 49A, I certify under the pains and penalties of perjury that I,to my best knowledge and belief,have filed all state tax returns paid,a state taxes required under the law. s-1-6 3 618 0 2- Signa[ur Date ( L Social Security or Federal Identification Number Revised 424/07 FOODAP2008.adm Chak#&Date��9 /:2/.Zf('�� $ y �' �ti Massachusetts Department of Public Health Salem Board of Health Division Of Food and Drugs 120 Washington Street,4'" Floor 9 Salem, MA 01970-3523 FOOD ESTABLISHMENT INSPECTION REPORT Tel. (978) 741-1800 Fax (978) 745-0343 Name Da a Tyoe of Ooerationfsl Type of Insoection Food Service 'Routine Address I�� n I Risk ❑ Retail ❑ Re-inspection 'Y ` �, Levet E] Residential Kitchen Previous Inspection Telephone -1 do t ❑ Mobile Date: I Q 7j � HACCP Y/N ❑ Temporary ❑ Pre-oe '(tire' Owner r 1/N� ij i I ❑ Caterer ❑ Suspect Illness Person in Change(PIIC) ` Time El Bed&Breakfast El General Complaint In:6, ❑ HACCP Inspector i1Lf� , , � , Oug; � Permit No. ❑Other Each violation checked requires an expTaation on the narrative pagd(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', " R ❑ 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 P ❑ 14.Approved Food or Color Additives ❑ 3. Personnel with Infections Restricted/Excluded ❑ 15.Toxic Chemicals FOOD FROM APPROVED SOURCE ❑ 4. Food and Water from Approved Source TIME/rEMPERATURE CONTROLS(Potentialry 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) ❑21. Food and Food Preparation for HSP ❑ 10. Proper Adequate Handwashing ❑ 11. Good Hygienic Practices CONSUMER ADVISORY ' ❑22. Posting of Consumer Advisories Violations Related to Good Retail Practices Number of Violated Provisions Related Critical (C)violations marked must be corrected To Foodborne Illnesses Interventions immediately or within 10 days as determined by the Board and Risk Factors(Items 1-22): of Health. Non-critical (N)violations must be corrected Official Order for Correction: Based on an inspection immediately or within 90 days as determined by the Board today, the items checked indicate violations of 105 CMR of Health. 590.000/federal Food Code. This report, when signed below 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)(55990.0 0.0044))) cited in this report may result in suspension or revocation of 25. Equipment and Utensils (FC-4)(590.005) the food establishment permit and cessation of food �j' 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 55o�nspeaFo 14 me Q� J� _� 2 Inspector's Signature: � d /�,__ Print: a �p�.( l_ - I 1 PIC's Signature: I � l •/ Print: a-- y!� Q{(�0��' 4 ��`-2/`.'c`'- I Paged of�Pages I Violations Related to Foodborne Illness Interventions and Risk Factors(items 1-22) PROTECTION FROM CONTAMINATION FOOD PROTECTION MANAGEMENT 8 Cross-contamination " I I 590.003(A) Assignment of Responsibility ( 3-302.11(,A)(]) Raw Animal Foods Separated from 590.003(Bl Demonstration of Knowledge* I Cooked and RTE Foods j 2-103.11 Person in charge--duties ( I ( Contamination from Raw ingiedlents 3-302.11(A)(2) Raw Animal Foods Separated from Each EMPLOYEE HEALTH I Other" 2 590.003(C) Responsibility of the person in charge to I Contamination from the Environment I require reporting by food emp!oyces and 3302.1 [(A) Food Protection' applicants* 3-302.15 Washing Fruits and Vegetables f 590.003(F) Responsibility Of A Food Employee Or An 3-304.I 1 Food Contact with Equipment and Applicant 7'o Report To'i he Person In ( Utensils* Charge' I Contamination from the Consumer 590.003(G) Reporting by Person in Charpe* I ( 3-306.14(A)(B) Returned Food and Rescrviee of Food` 13 590.003(1)) Exclus.ons and Rcstrctions" I Disposition of Adulterated or Contaminated 590.003(F) Removal of Exclusions and Restrictions I Food 3-701.1 I Discarding or Reconditioning Unsafe FOOD FROM APPROVED SOURCE Fes"` 4 Fond and Water From Regulated Sources 9 Food Contact surfaces - 590.00d(A-B) Comp!i:mce with Food Law" I 4-501.1111 Manual Warewashing-Hot Water 3-201.12 Food in a Hermetically Sealed Container` I Sanitization Temperatures'" 3-201.13 ( Fluid Milk and Milk products* 4-501.112 Mechanical Warewashing-trot Water 3-202.13 Shell Eggs* I Sanitization Temperatures* 13-202.14 E gs and M"P-Pnvducts, Pasteurized* I 4-501.114 Chemical Sanitization-temp.,pH, 13-202.16 fee Made From Potable Drinking Water* ( concentration and hardness. 15-101.1 l Drinking Water from an Approved System* ( f-601.11(A) I Equipment Food Contact Surfaces and 590A06(A) Bottled Drinking Water* I Utensils Clean' 590 006(B) Water Meets Standards in ?10 CMR 22j)* 4-601..11 Cleaning Frequency of Equipment Food- 590 Surfaces and Uteusils`k 1 I She;ifish,and Fish From an Approved Seures 4-702.11 Frequency of Sanitization of Utensils and 3-201.14 Fish and Recreationally Caught Molluscan I Food Contac[Surfaces.of Equipment" Shellfish* 1 I 703.11 Methods of Sanitization-Hot Water and 3-201.15 Molluscan Shellfish from NSSP Listed I Chemical* Sources* Game and Wild Mushrooms Approved by 114 I Proper,Adequate Handwashing Regulatory Authority ( 2-301.11 Clean Condition-Hands and Arms* 1 h 3-_0...18 Shcllstcxk Idennfitatiun Present ( 2-301.12 Cleaning Procedure* I 590.004(0 Wild Mushrooms` 2-301.14 When to Wash" 3-201.17 Game Animals* I 111 Good Hygienic Practices Receiving/Condition ! 2-401.11 Eating,Drinking or Using Tobacco* $ 13-202.11 PHFs Reived at Proper Temperatures* I I 2-401.12 Discharges From the Eyes,Nose and ' 3-202A5 ( Package integrity* ( Mouth` 3-101.11 I Food Safe and Unadulterated* ( 3-301.12 Preventing Contamination When Tasting* 6 TagslRec0rds:Sheilstock I ( 12 Prevention of Contamination from Hands 3-202.18 Shellstock Identification" 590.OiW(E) Preventing Contamination from 3-203.12 Shetls:oek ldentilication Maintained* Employees* - Tags/Records:Fish Products 113 I Handwash Facilities 3-402.11 ! Parasite Destruction* I ( Conveniently Located and Accessible 3-402.12 I Records.Creation and Retention* I 15-203.11 Numbers and Capacities* 590,00401, ( Labeling of Ingredients` I 15-244.11 Location and Placement* 7 Conformance with Approved Procedures I ( 5-205.11 Accessibility,Operation and Maintenance /HACCP Plans I Supplied with Soap and Hand Drying Devices 3-502.11 Specialized Processing Methods* I ------ 3-502.12 Reduced oxygen packaging,criteria* ( 16-301.11 Handwashing Cleanser,Availability 6-301.12 Hand Drying P Provision 19-103.12 I Conformance with Apnroved Procedures" I ( Denote,critical nem in the federal 1999 pond Code of 105 CNR 590.000. CITY OF SALEM �I - i BOARD OF HEALTH `� p� 3 Establishment Name: r,, ,,, Date: "yiZl/� �fl Page: of Item ' Code C-Critical Item v DESCRIPTION OF VIOLATION]-PLAN OF CORRECTION nate No. Reference R-Red Item - - Verified j�'7 n ' / 11 PLEASE PRINT CLEARLY � { 1 , J Mi5�llc � rt, �IOCJP/ GO�,T�i .� r Tn. _ �1 � , e'1.7 � ' n V t t W/a-ler uP r-�--( /ln TZJ c{TSa'1 .,t tC�cJl� n v AJond..5 (_'1S�i/1,r✓Gi / _ _.� jk- �. L2/��. I• ��7A/I G.71AnUf Il��n��^O r�C `�<. ��S iry Q.Pt�/� ��Y7�1G� �'f�'G/I,.w / -�'. E n ./I 1 ��Orin/ ✓ n 1. InC Cc/L) /YL Q U/ecx 0 } i]J �•l��l' I( ;���C� I�I�-<�Y _ �:�lM� "(-)4-- Il= ls- NXX 40 ,r l WiC�ii2� /A .- )AL len Vn b�7 i 0.SL a•,�.E- ln, a � j Discussion With Person in Charge: I Corrective Action• equired: ( ❑ No fes 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 fi7rRe-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 rs or suspension/revocation of ❑ Embargo ❑ Emergency Closure your food permit. ❑ Voluntary Disposal ❑ Other: Violations Related to Foodborne illness fnr,r antfians and Risk, 1,.-, rartars life=1-22) (Cont) ! Houl 3, -501 1 C, dia W[,"F� PROTECTION FROM CHEMICALS 'and Cold'Holairij k if WA 14 Food or""Additiviai -o�.II,.B) PlIF"kb1Qv,;nuJ at 12 A,I(Iime�. I i9k)0040 F, ,36114 holcumn front Umolawed Port Nil:. %bir:aiud aaoi ab-A,, IF i Pniscrious or Toxic SubstAnres 140 F Wi.li 4t,"nurving, lni,�Invlllnn-Ougmal LsW!F' , Ccnnaie?er, i i 20 Tint,asa Ribli,Hon;tn Cordial 14,12,11 Cosnnn,n Nanw Omtajrra,�' lleaidf -_9I.€! svipwation-slorrige, '',marcf: 7-2'ij.1 i Re'viction- Frc�Ancc idid U,0, 7-202.12 condojtm,of I REQUIREMENTS FOR HIGHLY SUSCEPTIBLE -1 !(1,, t! Toxic.Comanio, f1njJiibr:on�! POPULATIONS lHSP) 7-204.11 S:kaitivci%,('ritt-ii -Chvi;6c,N- 7-2Unp.rietirwd Ne-pa,1,ogeJ Jtm�� ad Rc`(J4.12 Cfi,mic�t!s foi WjAwi!11ro"hict"Ciito6o, 7-104,14 1 1 i, 1 d3l 1,",wl' pa�waln;f,l F=", 2'), '1 R�kl Cvraaci. I or i,:qlmijv 0�)!�J Alismal Ftxvj'jqd ?-20,—, t"v f�;Iv, St�,d �;pnvjl�'Not S. 7 206.12. R,xl,:w lijit Siaiiovk� I if(', 14YK! RIJaW' N'l Rc Wr,Cll, ? "On !3 1 racking Po% dvr•,, P-s(Conir"I and CONSUMER ADVISORY 3 4,0 11 1 Con'tww'I itl��wry Po- TIME/TEMPEPATURE CONTROLS 'tt,j kir of Proper Cooking Temperatures for A,�ioifl F,��4 fhai nr• Ray. Uridemx>i cd u; PRFs N.ccz,,,:ec :,,idimln.tuv �J 'M- 3 151-l5w. 0".i t v-Me;,r,,-J F.�-; k.1 R� ShOl Commmlw�d i i�b, -Wat� ("taniv 40!.1 Wk, "'mitnak- I�-,)T I�wc. Poit Jiecl Rwst 1101' 12i SPECIAL REQUIREMENTS -40 1.11(A)t 2) in i , (�J� alld 3-401.11fAif31 Poultry, V.ild(;,nw, Swifed 111F,, A 10chn op;,.�ii ui,s:,4rwid te 'S'w(fl,ig Gvunlimg F6?1,Mat. 04"Kic"; i1w I-!", to illr.v Inu,ci B�,;f Sir!8ks a!)d i isI, (�I,it)", Olbrr 145'1* r0i"af, to f,(Xxi retail ltn% Animal Fvd,Cca)k�,d in a lvv&bilc-fi uo&,#29 105'f 3-4101 1I(A)(1)'b) All Otlw - 14S"F t5 <ec 17 Reheating tot Hot Holding VIOLATIONS RELATED TO GOOD RETAIL rRACTICES i403.11 PA,i&w) Pi-l'i 1r,51 15 Wc., (Iltufs 23-30) 403A i'li) 16`' F- lilm, lf(I'nit,i,,�lt,;!Acts,, ,:a,,"ta,::,,t,>,r.t:l,-,.Aj,ztt:::" I';t,d,u,,,te r,mbr: 3-40 i I(C) Comm"'n'ral;u� P1 R*f E tKal If"wid;11!k'. "?,t, a- "i:,',,.F, ode tv,j 11)i ("A 11,1 140 -rvzJ•iou iw;_ -7 3-403 R(rriaj;ari0:,1Fkwtd I I Ft", ; 530.6Q0 and Per\3ar,ne; Proper Cooling of PHFS 2•1 FwV,Pnie%G� and FG-.4 co4uv,CkA)K!,d PHFc Imm 140 Ful j i 26, Wate:,P4,rnbna nd vvA,,,te 1 FC-5 1 00b 70% wiihm , Hour"aIlj From 7f'-F= of FC2k�, -u CX)7 (Xif, 3,301A l(E) Coolinl-PHFh Made lion0jnbie�q ... .... Fonperawre!ngre,lieni, C'mc! Within 4 11z lct,! W99 59,lhiii, t CITY OF SALEM IBOARD OF HEALTH f{ Establishment Name: _RiA2, 6e , /I Date: 4'�/1 D_ Page: of ` Item Code C-Critical Item DESCRIPTION OF VIOLATION/ PLAN OF CORRECTION' Date - No. Reference ,R-Red Item „3 - - - Verified PLEASE PRINT CLEARLY "' , - _ �,.- ���-,tn ., (-'n, Arco.✓ I ` /1 /aYX-- 4 112,ll.•� r? x� 1 � I 1 1 E Discussion With Person in Charge: Corrective Action Required: ❑ No _ LIfes I have read this report, have had the opportunity to ask questions and agree to correct all ❑ Voluntary Compliance ❑ Employee/IRestriction/ 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"susorr/revocation of ❑ Embargo ❑ Emergency Closure your food permit. _� ❑ Voluntary Disposal ❑ Other: E4it'` Pi;FA WwiwL3 a i 'I ncpcxat Tri ct; Violations Related to Foodborne Illness tnfervenFrons and Risk :kcck,rtiing ic,lay. Ctxbid n) Factors(Ilms I-M (Cont.) l 'F14`1� SS,;tbhi ! 4 1 PROTECTION FROM CHEMICALS tv PHF� I 19 PHF Hat and Cold Holding 1 14 Food or Color Additives 3-5{tiANB) coo!111IFS%liunt-owd alol i"A"W 3-302,14 pro,ltct;oa from Poisonous a:Toxic Substanctial 14(; F fleld azo! :ibove I 30'F, 20 Time as a Public Health Control Colmilon N,;Qw T'ilne :n a lluhiic I loald)Control 7 20 LI! !;•",4,aukn sto;ace' ?-202.11 Restriction-Pr-,,vnce wid U, ' L 7-2o2.i 2 Cclldiuovm of k, 203 It Toxic Cosilaula -, REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(14SP) 7-201.11 'Napitizer;,Crlt��roi- (hl:vucak' t N01 !!�A, 1-1)4, k h�nii�ai�for Ax hii�g ho�At,,�c Ciilwiia"... 8�,m%o 7-7CritrVoi' -t Cvwwt,l4ibi i,,wiw Animal FiKd sulci Uw Peqicl(le, (:,itelul' R,m Sproul, ,wt :'m-m 1. 7-1200.12 Rodtw S!atw 20o 13 I Cracking Powder: rest(Amvcl wid Monitorol", CONSUMER ADVISORY 22 40- 11 Ck):)tumeT Pti�l,j vil TIME/TEMPERATURE CONTROLS owillootl a of t Proper Cooking Tempalaturils 101 F,kvd, 111m�Izv Ra", PHF� i to EUrimat-c 1 .#U 1 J;Al 1)("1 ..k!n,,' l5i'r 15 . 13,cc SA,sww� f6: R,,.w 5;1101 Nfcat. 6,1tt1. A!6111.11, 1 15 -;-40L 11(B);I Pj and Bee! kimst 13ff,F I e i i4ow SPECIAL REQUIREMENTS Vik3.iai(,n (,I S,��I4,o J,OA)')�A) ([ " t 41 11.11 iA)( RMUC', Wlu,' 15i F 15 in srr zov" irt—bil:, fkxld, woipoiai.v and '-4W.I IfAi,'i) Poulin, wild Giunc3 Sra[Ced PHF-s, kiichc-n opo,;ttiolis Alould h-- iuiffilw Ctint-mong Fish. Me8l, 6,ohiicd oi,,lur Vie appv:nrlate ;"llows Rlultry or kaow -i6,51' t5 T;o'. ^ aliuve ;f ivfj!,,d In�Txxfhoml: illiws� 5-401.1 Ifc)13, finvici B:d st^aksl ictot veruonand &* 1s;mirr Odwy 145"F rehim it""okki felail 5AWJ-1 R:m Anumil Cookvd m a �lio'ild be de' ;wd u-ithrr#29 - 1 !0'1- * v!Other Pffl:� - 1.i5"1T 17 Reheating tor Hot Holding VIOLATIONS RELATED TO GOOD RETAk PRACTICES )1A!(A)&i DI PUI I tiltins 23.39) 3 40:^.I!(B) Miotoav - Jo5" F 2 klmuie Stlndint uiitl:i!40d ,at "'Wi,l"Jo imii relate to Mr Tom' dl,ZTT« Till,lwawny iW can Lc RTF h,.)d Tw,6,%m oi;hc Code(tid Itti '11-11? 3-40 3 11(E) Remaining Un,,Ii-:tid I'vnions of Bc,A I L FC _ _; S."114" ,lT onn�. (10 39i i,nri Pu I's Plovet cooling 01 PHFa 24, FC 'i i20- E-qi,!i,,iy*jjt arta Utenvils i 1-c- 20ro5 A-501,14(A) C(h441,,Coohrd 111117s frow, 14(ff u, FC We 70"1 %,thin 2 I four:taid From 701' FC-6 i`A)7 t,.41 '1/45'f }within 4l-fouvit eftor •7w, r�c T 00P 3 501 Wilt PUFT,'0,du Viom Ambient I'mitowiTue hlgrvditmu,1"41-015•F Within.1 19 ( Ak5ly'h-3o(, Massachusetts Department of Public Health Salem Board of Health Division of Food and Drugs 120 Washington Street, 4'" Floor 9 Salem, MA 01970-3523 FOOD ESTABLISHMENT INSPECTION REPORT Tel. (978) 741-1800 Fax (978) 745-0343 Name \ / Dat f vpe of Ooeration(sl Tyge of Insoection Dlrl r_f! �iJloo_� f l 4( ( -L(21r,/ Food Service ❑ Routine Addressf� r 1 Ribk El Retail aRe-inspection I/,^rirla IP rA Level ❑ Residential Kitchen Previous Inspection �- ' I Telephone 4 9 El Mobile Date: OwnerHACCP YM{ ElTemporary ElPre-operation r / D/) El Caterer El Suspect Illness Person in ChaFge(PIC) I �" Time ❑ Bed&Breakfast ❑❑ HGeneral ACCP Complaint Inspector �� ou _�. Permit No. El Other Each violation checked requires an explanation on the narrative page(s) and a citation of specific provision(s)violated. Non-compliance with: Violations Related to Foodborne Illness Interventions and Risk Factors Anti-Choking Tobacco Violations marked may pose an imminent health hazard and require immediate corrective 590.009(E) ❑ 590.009(F) ❑ action as determined by the Board of Health. FOOD PROTECTION MANAGEMENT ',:, .,,. '•` - . . ... . . ❑ 12. Prevention of Contamination from Hands ❑ 1. PIC Assigned/Knowledgeable/Duties ❑ 13. Handwash Facilities EMPLOYEE HEALTH .. PROTECTION FROM CHEMICALS ❑ 2. Reporting of Diseases by Food Employee and PIC ❑ 14.Approved Food or Color Additives ❑ 3. Personnel with Infections Restricted/Excluded . " - ,,,,r ❑ 15.Toxic Chemicals FOOD FROM APPROVED SOURCE ..,: .. ., . •-.-. TIMErrEMPERATURE CONTROLS(Potentially Hazardous Foods ❑ 4. Food and Water from Approved Source ( Y ) ❑ 5. Receiving/Condition ❑ 16. Cooking Temperatures ❑ 6. Tags/Records/Accuracy of Ingredient Statements ❑ 17, Reheating ❑ 7. Conformance with Approved Procedures/HACCP Plans [118.Cooling PROTECTION FROM CONTAMINATION ` ' - ❑ 19. Hot and Cold Holding ❑ 8. Separation/Segregation/Protection [120.Time As a Public Health Control ❑ 9. Food Contact Surfaces Cleaning and Sanitizing REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) El 21. Food and Food Preparation for HSP 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): of Health. Non-critical (N) violations must be corrected Official Order for Correction: Based on an inspection immediately or within 90 days as determined by the Board today, the items checked indicate violations of 105 CMR of Health. 590.000/federal Food Code. This report, when signed below C N' by a Board of Health member or its agent constitutes an 23. Management and Personnel (FC-2)(590.003) order of the Board of Health. Failure to correct violations 24. Food and Food Protection (FC-3)(sso.00a) cited in this report may result in suspension or revocation of 25. Equipment and Utensils (FC-4)(590.005) the food establishment permit and cessation of food 26. Water, Plumbing and Waste (FC-5)(590.006) establishment operations. If aggrieved by this order, you 27. Physical Facility (FC-6)(590.007) have a right to a hearing. Your request must be in writing 28. Poisonous or Toxic Materials (FC-7)(590.008) and submitted to the Board of Health at the above address 29. Special Requirements (590.009) within 10 days of receipt of this order. 30. Other DATE OF RE-INSPECTION: S 590Mns tFor 14r Inspector's Signature: Print: �f^ PIC's Signature: Print: I 4� / I Page_of tpages �pI, /% ��Ll1, ,row Violations Related to Foodborne Illness Interventions and Risk Factors(Items 1-22) PROTECTION FROM CONTAMINATION FOOD PROTECTION MANAGEMENT ( 8 Cross-contamination 1 590.003(A) Assignment of Responsibility* 3-302.11(A)(]) Raw Animal Foods Separated from 590.003(8) Demonstration of Knowledge* Cooked and RTE Foals* 2-103.11 Person in charge-duties ( Contamination from Raw Ingredients 3302.1 I(A)(2) Raw Aminal Foods Separated from Each EMPLOYEE HEALTH I Other 2 590,003(C) Responsibility of the person in charge to j Contamination from the Environment require reporting by food employees and j 3-302.11(A) Food Protection^ applicants* 3-302.15 Washing Fruits and Vegetables j 590.003(F) Responsibility 01 Foci Employee Or An ( I 3-30}.l 1 Fond Contact with Equipment and Applicant To Report To The Person In Utensils"` Charge' I Contamination from the Consumer 590.003(G) ( Reporting by Person in Charge* ( 3-306.14(A)(B) ( Returned Foal and Reserlice of Food* 3 590.003(D) Exclusions and Restrictions* Disposition or Adufterated or Contaminated 59Q0031E) Removal of Exclusions and Restrictions I I Food 3-701.11 Discarding or Reconditioning Unsafe FOOD FROM APPROVED SOURCE Food* 141 Food and Water From Regulated Sources j ( 9 j Food Contact Surfaces j 590.004(A-B) Compliance with Food Law* 4-5(1.1:1 Manual Warewashing-Hot Water 3-201.12 Ford in a Hermetically Scaled Container* Sanitization Temperatures" J-201.13 Fluid Milk and Milk Products* 4-501.1 t2 Mechanical Warewashing-Hot Water 3-202.13 shell Eggs" Sanitization Temperatures* J I vntion-temp.,pH, � 3-2(}2.14 eggs and Milk Products,Pasteurized* � �. 4-501.1 14 Chemical Saniti 3-202.16 ( Ice Made From Potable Drinking Water* concentration and hardness. 5-101.11 Drinking Water from an Approved System" I 14-601.1 1(A) Equipment Food Contact Surfaces and 590.006(A) Bottled Drinking Water* Utensils Clean' J 590.006(B) Water Meets Standards in 310 CMR 22.014 ( 4-602.11 Cleaning Frequency of Equipment Food- Contact Surfaces and Utensils* Shellfish and Fish From an Approved Source ;_702.11 Frequency of Sanitization of Utensils and 3-201.14 Fish and Recreationally Caught Molluscan Foal Contact Surfaces of Equinmel Shellfish* 4-703,11 I Methods of Sanitization-Hot Water and 3-201.15 ( Molluscan Shellfish from NSSP Listed Chemical* sources* Game and Wild Mushrooms Approved by 110 I Proper,Adequate Handwashing Rego/story Authority 2-301.11 Clean Condition-Hands and Arms* 3-202.18 Shellstock Identification Present` 1 2-301.12 Cleaning Procedure* I 590.004(C) Wild Mushrooms* j 2-301.14 When to Wash* 3-201.17 Game Animals* I If ( Good Hygienic Practices g Receiving/Condition 2-401.11 Eating,Drinking or Using Tobacco* I 3-202.11 PHFs Received at Proper Temperatures' 2-401,12 Discharges From the Eyes,Nose and j 3-202.15 Package Integrity' * 3-301.12 Preventing Contamination When Tasting* 3-101.11 Food Safe and Unadulterated j 6 Togs/Records:Shellstock ( 12 Prevention of Contamination from Hands 3-202.16 Shellstock Identification` 590.004(E) Preventing Contamination from 3-203.12 Shellstock Identification Maintained* Employees* Tags/Records:Fish Products 113 Handwash Facilities - 3-402.11 Parasite Destruction' Conveniently Located and Accessible 1 3402.12 Records.Creation and Retention` j 5-:03.11 Numbers and Capacities:: of 5)0104(1) LabelingIn j 5-204.11 1xication and Placement* 9 redientr j --- 7 Conformance with Approved Procedures 15-205 11 Accessibility,Operation and Maintenance IHACCP Plans Supplied with Soap and Hand Drying Devices 3-502.11 Specialized Processing Methods* ( 3-502.12 Reduced oxygen packaging.criteria* 6-301.11 Handwashing Cleanser, Availability 8-103.12 Conformance with Approved Procedures* ( 6-301.12 Hand Drying Provision Denolet critical item in the federal 1999 Fond Code of 105 CMR 590.006, CITY OF SALEM ,� BOARD OF HEALTH J Establishment Name: I Uc/ C���i1,r F r_vr , t' Date: I a[o/J Page: of .._2) Item,'- Code , C-Critical Item DESCRIPTION OF VIOLATION/ PLAN OF CORRECTION `Date No, Reference R—Red Item � _ � � � Verified - ,. a .. PLEASE PRINT CLEARLY 7 FV-(1cy10 J., 6) C - d_I.0 �_< Ne_ I hCG) CO/t'n r✓ (-.r.t.N�" 4- 4 f j Z_zT.t 1 1 <ZIY ltw.K N IJ/,r N 0 p(`{ t7l' ,ir,�n,'),/tel 1� ed /' 'Z,/- 4, MC,Y o 14 )0-e:;A— r 9 ?U) r!-" ('l I. 73) e'' V I 5 t I 1 I i I 1 [Discussion With Person in Charge: 1 Corrective Action Required: ❑ No s/ have read this report, have had the opportunity to ask questions and agree to correct all ❑ Voluntary Compliance ❑ Employee RestrictionExclusion iolations 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: 7 :_3tii i4rr"; j PFiF'x !2ec•'ttcd nt TetP,ix.va�rea J,olations Related to Foodborne Illness interventions and Risk i A.:cro;,:firk;tc,Iao, Coolad io Factors(items fd'.°) {L'orrt} &1-izhia a {;ow<. t 1.iet.h,-0, :r FIX PROTECTION FROM CHEMICALS i 19 PIT tftFt and Card Holding t•t , Food or Color Additives ;i Si1!.Jh(bz Wd MR&Mainuine,l al m boI,rw -20212 i :idouit:s 5�i?•,{rc1w(F'; -t 3-302.11 ProtrcLrnefront tlnjprarrwed kidins,cs"" ?- +',.tht:ti Erni }'alt :.i:in;atnetta:t,rab:+e-e j (, Poisonous of Toxic Substances I E9€.i i lila;nni}uip?tnionn:a:on -Ovicinal a R v,[' t"ontainers- Re v,[:Held n;u( shove ks0'1' 7 102 11 C�utcnaon?lame - Workire C'uut:unerr,` � 1 Xll � i Trme as a Public HeaRh Control f 3 110 19 , 'Ciin�+.;,a 1'ul+iic I-ieal�;=t'oniral*' 7_,r{}i.i[ Jparatt<,n- Stnrnge' X90' )0- !i H} var:anxReauireu.eur U 7-<'+;2.i1 Etestt'iN:on �Prescncc:axllr^" = .- '-'tt'.'..32 Condition"utllsc" � t-?03 t 1 Tcr:ic C raltainel; -- Prchiht:i.rr.," j REQUIREMENTS FOR HIGHLY SUSCEPTIBLE � %-iUl.l� SanitircrY,Crih'ri:+-Chesoicn!e' POPULATIONS(FISP) 1, i I It ( +401 tl(Al Unp:,icurv:.dPte-!sae.3:;rr�IJuices:nid 7-_t)a. ! t`ttetuualt in Washt['.a.:f'ni(ii�i.C:titori,t' ! E i ftel~`r,s:tes,*-itt� tl`arctn l.abcJs' i 7-'tl=.l-I ( k>tliuz Agent<.<Yfrcria" i j 7 2t}5 11 Iad&Wal Wd Cor O.Luh+'mastq' a.t N 11133, Fa v! Pa,fewiy 5vo i 4 2JJ i.i ltt:} F.:t,..:r:'.cri,.at'r<:+wr:u.tniinal l=txxi dnd t G.!! R::u lard the Ye,ricuics,C.rrtei i'f` 9e'G l.ront"N'a srrtc.?. 17-206.12 R'Xient Belo suin„n,- j :11LI Irl;: la"r n'ed N<Xl Pnc!'dge 'Nol kc-aencrl ' 700 is 'I'Waul;f'<,;t-dc::. Pe.t(�,,ruwA drd j ?Snaittnine' CONSUMER A£tk1SOFiY "MEITEMPERATURECONTROLS 22 ?:,='s : ! tecc:iF:r.1,it;s:•nt3lr.:taJi,u.Cnt:ninptionot i Arvin;It ,=•NSI. €[},,t.ire Rao', t_'ralerax=ked iv j 16 Proper Cooking Terri Aures for +"VJ' i :got ot Chher.'i,:e Pr<.cctiszd m;?Eimatare 3 401 11 A(1 t(2i esti.. 1500 5 tic.:. r., In;,s_krunedidte 5craic,' 143 F5>e:. 144.13 t':...t<•t=.rtaA Fep:: `ii'bsiuln:• f„r Rae:Shea 1401.11t:1)tD CommirutcdFith. Mews F. ti:nrw Animal, 153 F 15 sc<.. ” SPECIAL REQt;IFet~MEN•ES i 3 �IOi.tRoppol tint and Beef Roast - 12)T 121 nun' � I --{'- 5�};t.?N19t: WD) \i-,? ti,•n• (,I .Seeiit}n ?3#l.tkiyrA;-!D1 in ((A}{''} Bailee>. loiec::�d Adc:tt� 55+ IS E! . kSm pct, .: eriiC, rtt+:i'Sii.tirrcf. ieinporAlt' and ?-&MA I(Atl tj I'azdtrt,Wild(aux•. Stuffed I'lit s, i rc,tu,-ut:ai kitchen opI,tanon5•lvtuld he Stntltnc Gntt:ur;tnk Fish.hf>e[• ; d0hil cd trade; flm aei lions Pmluy ot•(iaities4650 15 Rev, :II 've if rckil d to iU'alhornu i11nG45 3-40I.[;tCV A � Imart Hntsl an< � in:cr;rntititi:wod rill: f.lvior; (W)CT 1451, e 5Q0.009 vx)iation,rclntat. to go vd retail 14K:1.12 R,ry .Anhnal Fuuls Cooked in a jna:tico. .,lim0d be dcbited under H'_t) _ Micwwyc 452 i;a::cia tt:<!uttetn:;;tta. `=4t'iIHA}(i)th) ( All OthtiPl{f. 1-i5'I' 15sec 17 ; E Reheating for Hut Holding 1 VIOLATIONS RELATED TO GOOD RETAIL PRACTWES j 3-403.111.Ali,ilpl I'IIF, tb5'F- 13 set:. ^ E (Renis, ?i-,111) 3-40111 CHI Micnniave161"P 2 Want Funding � t.•Rt:"(r:Wd•:waw.it.,n i•r<.•',rrr ml. t,'tttriz:;r�,rru r't'lUtz r(>tlic `fuao' InedFr i ni„ rlL.r'rt uu,,i ...;, ,r.ai r't:r-1Uc lure;;• ,rfw['( (an be ItC) C oannumial!y Processed RIT I•,a,d r=,and ArhdJ:dt "Pig the F',,,rl Codc,n d)()'*CUR W0 T' 5"V Cro(r __. 3.11( :) Renuunine Unowed Portion„1'lie,:! tram Geod Retartr'sractices _ t ' 5.40.Oti0-_i m3, . _ _".larta ^mc��and,�?�.il7vne; --- �_Fq ;C -? tQ~.— i 18 f Proper Cooling of PHFS j is.. . F0')d and F<xxi Prceect'nr I PC -,i Crt'4 m_I - ! empl,iet:r sn_Uwe 4 , Ctmhur('rxrk,dPlil-s from 140T14, ?h 4'va`ar.??Ln,binq.tnn`+`ri3�re ! fC'-� Ci(�G i. - --- -. -- -- 7WF MAhtn 2 Wry and From ?'3`I' � 1 C•7, _: F'nvsi,-al Facni':v 140 1 , 0 to 4)"F'/<5 h 44-tthtn?Huui:•. ° j ` 2it j-Po:s;i_us or Tcw.:tAa2 ,in er_ s 1 FC-7 ! Ot?%s _ I ti! !Ft Hi CoolingPFiF.. .`Vi:aie Fn;,i Ambienti ;"23 Temperdutre 6[tredi<ut*n,4114457 ti•'itiitn 4 iii,ur" `b`roh nwai"mm the lows l iv`1v morn?(AM,105 Chtlt 590 06 L Commonwealth of Massachusetts e City of Salem Board of Health rimberley Driscoll r 120 Washington Street,4th Floor Mayor SALEM,MA 01970 Foo&Retail Establishment Permit DATE PRINTED: 12/23/2008 ESTABLISHMENT NAME: Dodge Street Bar & Grill File Number:BHF-2004.000168 7 Dodge Street Salem MA 01970 LOCATED AT: 0007 DODGE STREET SALEM, MA 01970 Permit Type Permit No. Permit Issued Permit Expires Fee Restrictions/Notes FOOD SERVICE BHP-2009-0202 Dec 23,200$ Dec 31,2009 $280.00 ESTABLISHMENT _ Total Fees: $280.00 PERMIT EXPIRES December 31,2009 Board of Health This Permit is not transferable and must be reissued upon change of ownership or location.The permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code,beofre any revonations,improvements,or equipment changes are made,all plans for such must be submitted to and approved by the Salem Board of Health. Page t CITY OF SALEM, MASSACHUSETTS r BOARD OF HEALTH 120 WASHINGTON STREET,4`FLOOR TEL. (978) 741-1800 KIIvBERLEY DRISCOLL FAx(978) 745-0343 MAYOR IDIONNr6(OL$4LEAL.COM JANET DIONNE, ACTING HEALTH AGENT 2009 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT NAME OFESTABLISHMENT �9L �I22Lf fr7"Q(U- TEL# �lAJ ADvIIEJJ VF EJi AULiJHIVIEI`11 j �{.- Z_ IM— FAX NHi MAILING ADDRESS(if different) EMAIL- Business': {NTy�GVciSYL� CP/� Website: OWNER'S NAMEPAN� �iSLSi�I .. �r2//_ / TEL# ADDRESS t4AA STREET V 'CITJ STATE ZIP' CERTIFIED FOOD MANAGER'S NAME(S) )F AI-)C- �R`4S�s'� CERTIFICATE#(S) (Required in an establishment where potentially hazardous food is prepared), I nip /� - EMERGENCY RESPONSE PERSON ��P�\f19GJLSl HOME TEL# 17CS" l��_60Sl I-DAYS OF OPERATION' I :Monday" -Tuesday Wednesday,,-1 : Thursday '1'. Friday-' Saturday: . i ' 'Sunday 1 HOURS OF OPERATION Please write in time of day. 1 PPW� )Adh IoleM-IQm: i aPi�-IA�l (a9n.'�x1�M1t; 131,t -1Att+ I aP�.- �AKf! 1a,�w. (For example l lam-11 pm) _ ! TYPE OF ESTABLISHMENT /�� FEE (check onlvl RETAIL STORE YES WO / less than 1000sq.ft. =$ 70 1000-10,000sq.ft. =$280 more than 10,000sq.ft. =$420 ------------------------------------------ - - ---- ----------------------------------------------------------------------------------------------------- RESTAURANT ES NO less than 25 seats =$140 (Outdoor Stationary Food Cart$210 25-99 seats = 28 more than 99 seats =$420 - - .............. ------------------- ------ ----------------------- BED/BREAKFAST/ YES O $100 CHILDCARESERVICES ---------------------------------------------------------------------------------------------------------------------------- ADDITIONAL PERMITS MAKE (not just serve) ICE CREAM, YOGURT/SOFT SERVE YES $25 TOBACCO VENDOR YES $135 ALL NON-PROFIT(such as church kitchens) YES O $25 *Please pay total with one check payable to the City of Salem. This Permit is not transferable and must be reissued upon change of ownership. The Permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code, before any renovations, improvements, or equipment changes are made,all plans for such must be submitted to and approved by the Salem Board of Health. Pursuant to MGL,Chapt r 62C,Section 49A, I certify under the pains and penalties of perjury that 1,to my best knowledge and belief,have filed all state tax recur a aid 'll stat taxes required under the law. Signatuk, - Date / Social Security or Federal Identification Number Revised 424/07 FOODAP2008.adm Check#&Date ,. s.:x..;. v,P,Ys...:a., .:...'.s"".°-"f:n,.,� �:iJ,.g `� -'ti,`��.irt.. :,."�">g--- `.f':,ci,• �.as;:f`;rF. :�;T .n.. n}r ::n ' t.s ycy . My File Edit Edit Tools Help y{, - p (' - M1 litt (3i AW Detail D { - - . �Account IM80051 Notes/SCLocation 17 DODGE STREET - - - - Effective Date ;011022009_ Acct owner DODGE STREET BAR 6 GRIL" - II Customer File Acct cusl FDODGE STREET BAR&GRIL Reset Payment Year-Mo Cat Bill NSC ;Ong Billed A­11ctivity- ' Unpaid Bal : Due Now ( Payment Ainount -1 Allocate Payment 2006-03 UB-U i 378028 El, 35640 .356.40 .00 J 00 On: 2006.04 UB-U ! 381114 [w1 35646 .356.40 00 00 0.00, Apply Payment J, 2006-056 B_U _ 384926 [v] 44550 -44550 .00 .00 0.00' 2006-06 UB-U 388317 [»] _ _ ___ _356.40' _ _ -356.40 _ .00 _ .00 _ 000, Bill Info I; 2006-07 UB-U 391420 356.40, -356.40 00 .00 000 Effective Dale {` 2006.08 UB-U 395230 [y] 356.40, -356.40 00 .00 0:00: i 2006-09 UB-U 395474 356.40 -356.40 .00 .00 0.00 2006.10 UB-U 401741 .00: .00 00 .00 0.00: '• - 2006-11 UB-U 405550 Evi- j _ _ _ .00_; _ .00___ _ __ 00 .00_ _ _ _ 0_.0.0_, 2006.12 UB-U 414103 _0 375.20, -375.20 .00 .00 0.00: 2007-01 UB-U 418728, �� 375.20. -375.20 .00 .00 O.0O3 2007-02 UB-U _ 420400 375.20 _ -375.20 _.00 __ .00 _ _ _ _0.00 2007-03 UB-U 428753 ) .00, .00 _ .00 00 D.f10 _2007-04 UB-U _ 433233 [✓j 93.80; -93.80 _ .00 _ .00 0.00 - - 2007.05 UB-U 434815 _[�j 93.801 .93.80 .00 .00 - 0.00. - - 2007-06 UB-1-1 439966 [j 187.601 -187.60 .00 .00 000 2007.07 UB-U 447561 Evi- 187601 -187.60 .00 .00 0.00; 2007.08 UB-U 449240 656.60; -656.60 .00 .00 -000, . . - 2007-09 UB-U 454463 281.401 -281.40 .00 .00 0.00, 2007-10 UB-U i 462132 281.40 -281.40 .00 .00 0.00 _. . . ... ..__.._ .. .0. . ...- ...0. -; 2007-11 UB-U 467340 J _ 150.08: _ -150.08 _.00 _ _ .00 0,001i 2007-12 UB-U 468956 EVI ( 187.60: -187.60 00 .00 0.00 - - 2008.01 66-U 476583 C I 187.60 -187.60 .00 .00 0.00; _2008-02 UB-U 478184 !"�� i 281.40 -281.40 00 .00 000; 2008-03 UB-U 483361 C 1 87.38, -87 38 _ 00 .00 _0 00; 2008-04 UB-U 491022 187.60: -187.60 .00 .00 000; 2008-05 UB-U 496210 [Mj 187.60; -187.60 .00 .00 0.00 2008-06 UB-U 497832 103.18 _103.18 00 00 600, 2006-07 UB-U 505491 187.60' -187.60 00 .00 0.00. 2006-08 UB-6 3 510678 G ; 159.361 -159.36 00 .00 000' 2008.09 UB-U ': 515446 [� i 179.26' -40.92 14038 140.38 140.38, �P 200610 UB-U 519944 G _1_99.20; -------- _- .00---- -- -203.78 --203.78 -- 203.78;'1 D -' _2008.11 -UB-U_ --525147-�-2 24900 -- ---_ -_.00 --- 252.06 -- - --252.06 MZ�10. 2520 pD 2008.12 UB-U ' 529928 [] 19920 .00 199.50 199.50 _ 19950, ,- ,2009-01 UB-U 53441810.00 199.20 19920 199.20 o en I Total.. unow ^ _y Total payment 994 / Totald 99492] unpaid lJ .. i CITY OF SALEM .! PUBLIC PROPERTY DEPARTMENT KIMBERLEY DRISCOLL MAYOR 120 WASFIING'PON STREET 0 SALEM,MASSACHUSETTS 0197 Tmt 978-745-9595 ♦ FAS:978-740-9846 RECEIVED June 9, 2008 !JUN 9 2008 CITY OF SALEM City of Salem Licensing Board BOARD OF HEALTH David Shea, Chairman RE: D ge Street Bar& Grille 7 Dodge Street, Salem Dear Mr. Shea The owners of the above property have requested an increase in the allowed occupancy and submitted an architect's as-built plan of the building. This department has reviewed the plan and have agreed that an increase in occupancy to 181 persons would be code conforming. t 4 I Sin c*asE. McGrath Th AIA Assistant Building Inspector/Local Inspector CC: file, Mayor's Office, Fire Prevention ealth Dept., ,f ��j 4 ���A���c ��, 1 7. Massachusetts Department of Public Health Salem Board of Health u 120 Washington Street,0 Floor Division of Food and Drugs Salem, MA 01970-3523 FOOD ESTABLISHMENT INSPECTION REPORT Tel. (978) 741-1800 Fax (978) 745-0343 Name �j /� , Date / Type of Ooeration(s). Type of Insoection I /y b��r!/ _ I �12-1 ��f !/(�} Q-Food Service © Routine Address l Risid ❑ Retail ❑ Re-inspection I �� _ i r -N/ Level ❑ Residential Kitchen Previous Inspection Telephone I �_ 1 � ❑ Mobile Date: Owner At �r., 7� ' HACCP YM El Temporary El Pre-operation Tom! �� s I ❑ Caterer ❑ Suspect Illness Person in Charge(PIC) I u / Time ❑ Bed&Breakfast ❑ General Complaint ❑ HACCP Inspector P4c�- I Out:S Permit No. ❑Other Each violation checked requites an explanation on the narrative page(s)and a citation of specific provision(s) violated. Non-compliance with: Violations Related to Foodborne Illness Interventions and Risk Factors Anti-Choking Tobacco Violations marked may pose an imminent health hazard and require immediate corrective 590.009(E) ❑ 590.009(F) ❑ action as determined by the Board of Health. FOOD PROTECTION MANAGEMENT, ❑ 12. Prevention of Contamination from Hands ❑ 1. PIC Assigned/Knowledgeable/Duties ❑ 13. Handwash Facilities EMPLOYEE HEALTH - -, PROTECTION FROM CHEMICALS" -'" - ❑ 2. Reporting of Diseases by Food Employee and PIC ❑ 14.Approved Food or Color Additives ❑ 3. Personnel with Infections Restricted/Excluded y . ❑ 15.Toxic Chemicals , FOOD FROM APPROVED SOURCE TIME/TEMPERATURE CONTROLS Potentlali Hazardous Foods ' ❑ 4. Food and Water from Approved Source ( Y ) ❑ 5. Receiving/Condition ❑ 16.,Cooking Temperatures ❑ 6. Tags/Records/Accuracy of Ingredient Statements ❑ 17. Reheating ❑ 7. Conformance with Approved Procedures/HACCP Plans ❑ 18.Cooling -PROTECTION FROM CONTAMINATION— - "'- ` ". " """ ❑ 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) ❑21. Food and Food Preparation for HSP ❑ 10. Proper Adequate Handwashing ❑ 11. Good Hygienic Practices CONSUMER ADVISORY -„ ❑22. Posting of Consumer Advisories Violations Related to Good Retail Practices Number of Violated Provisions Related Critical (C) violations marked must be corrected To Foodborne Illnesses Interventions immediately or within 10 days as determined by the Board and Risk Factors(Items 1-22): of Health. Non-critical (N) violations must be corrected Official Order for Correction: Based on an inspection immediately or within 90 days as determined by the Board today, the items checked indicate violations of 105 CMR of Health. 590:000/federal Food Code. This report, when signed below C x by a Board of Health member or its agent constitutes an 23. Management and Personnel (FC-2)(Ss0.0 order of the Board of Health. Failure to correct violations ,�24. Food and Food Protection (Fc-3)(sso.004)) cited in this report may result in suspension or revocation of 25. Equipment and Utensils (FC-4)(590.005) the food establishment permit and cessation of food 26. Water, Plumbing and Waste (FC-5)(590.006) establishment operations. If aggrieved by this order, you 27. Physical Facility (FC-6)(590.007) have a right to a hearing. Your request must be in writing 28. Poisonous or Toxic Materials (FC-7)(590.008) and submitted to the Board of Health at the above address 29. Special Requirements (590.009) within 10 days of receipt of this order. 30. Other DATE OF RE-INSPECTION: /I 1 Jv S 590,nspecfFom5.14 tloc JV• / P Inspector's Signature: �\ !x J (_�"'-Print: PIC's Signature: hint: V-( P r A—< rage Cb 3 rages i Violations Related to Foodborne Illness Interventions and Risk Factors(items 1-22) PROTECTION FROM CONTAMINATION FOOD PROTECTION MANAGEMENT 18 Cross-contamination 1 1590.003(A) Assignment of Responsibility" 3-302.11(AX]) Raw Annual Foods Separated from { 590.003(B) Demonstration of Knowledge" Cooked and RTE Foods* 2-103.11 Person in charge--duties I Contamination from Raw Ingredients 3-302.11(A)(2) Raw Annual Foods Separated from Each EMPLOYEE HEALTH Other- 2 590.003(C) Responsibility of the person in charge to I Contarnnatnm from the Environment require reporting by food employees and { 3-302.11(A) Food Protection' { applicants" { 3-3021.5 Washing Frits and Veeetables { 590.003(F) Responsibility Of A Frrxt 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(6) Reporting by Person in Change* ( { 3-306.14(A", Returned Fond and Reservice of Foaxl" 3 590.003(D) Exclusions and Restrictions* I Disposition of Adulterated or Contaminated 590.003(E) Removal of Exclusions and Restrictions I Food 3-701.11 Discarding or Reconditioning Unsafe FOOD F90M APPROVED SOURCE Food* d Food and Water From Regulated Sources { 9 Food Contact Surfaces 590.004(A-B) Compliance with Food Law it 4-501.111 Manual Warewashing-Hot Water 3-201.12 Food in a Hermetically Scaled Container* I Sanitization Temperatures* 3-201.13 Fluid Milk and Milk Prcxlucts* 4-501.112 Mechanical Warewashing-Hot Water 3-202.13 Shell E-s* I Sanitization Temperatures* { 3-'_02 14 Eggs and Milk Products.Pasteurized^ { 14-50 t.i 14 Chemical Sanitization-temp., pH, _ concentration and hardness. '" J 3-202.16 ice Made From Potable Drinking Water"` I I 1-60 1.7,(A) Equipment Frn7d Contact Surfaces and { 5-101 11 Drinking Water from an Approved System' { J { 590.006(A) Bottled Drinking Water* { Utensils Clean- 4-602.1 lean" 590 Ot)fi(B) Water Moots Standards m 310 CMR 220" I 4-602'1 t Cleaning Frequency of Equipment Food- 590 and Fish From an Approved Source { _ FrequeContacncy cySurfacesSar and Utensils* 4-702.1 I Frequency of Sanitization of Utensils and 3-201.14 Fish and Recreationally Caught Molluscan Focal Contact Surfaces of Equipment* Shellfish' 4-1113.11 Methods of Sanitization-Hot Water and i 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* Sources* I ip I Proper,Adequate Handwashing Game and Wild Mushrooms Approved by Regulatory Authority 2-301.1 1 Clean CondiConditionCondition-Hands and Aims* { 3-202.18 Shellstock Identification Present" { 12-301.12 Cleanimp Procedure* 590.004(C) Wild Mushrooms* I 12-301.14 When to Wash* 3-201.17 Game Animals* { it { Good Hygienic Practices { 5 Receiving/Condition I { 2401.11 Eating,Drinking or Using Tobacco* { 3-202.11 PHFs Received at Proper Temperatures I 12-401,12 Discharges From the Eyes, Nose and 13-202.15 Package Integrity` { out 3-101.11 Food Safe and Unadulterated* 3-301.12 Preventing Contamination When Tasting"_ { 6 Tags/Records:Shelistock 112 Prevention of Contamination from Hands 3-202.18 Shellstock Identification` I 590.004(E) Preventing Contamination from 3-203.12 ShellstockIdentification Maintained" { Employees* 1 { TagstRecords:Fish Products I 113 ( Handwash Facilities { 3-402 1] Parasite Destruction' Conveniently Located and Accessible I { { -- I 3-402.12 Records,Creation and Retention" 15-203.11 Numbers and Capacities* _ 590.004(.!) Labeling of Ingredients' 15-204.11 Location and Placement* 9 Conformance with Approved Procedures 15 205.11 Accessibility.Operation and Maintenance _) MACCP Plans Supplied with Soap and Hand Drying Devices 3-502.11 Specialized Processing Methoxls-* Dev __- - i 3-502.12 Reduced oxygen packaging,criteria* { { 6-301.11 Handwashing Cleanser,Availability- 8-103.12 Conformance with Approved Procedures* { 16"301.12 Hand Drying Provision 'Denotes endo]nem in the federal 1999 rood Cate ui 105 CMR 590 000 CITY OF SALEM BOARD OF HEALTH S` Establishment Name: 1/� y� C n 1 ire, ! / Date: Imo_ �_�_ -/,1 Page: of 3 Item Code C-Critical Item - �! J DESCRIPTION OF VIOLATION/ PG%N OF CORRECTION ' Date No. Reference. R-Red Item - Verified PLEASE PRINT 'CLEARLY/I f I �'4- ilt !/ �IU.)(Q 1(�r�r` � tC lel l< I/1 K . 'iMj 4 AA /1 n /1 JCJ S � Anr✓. - �I V T-1 ( JPfsInr _ VPAAlam uofd,7 cJPG/j 1 i 0 n4-- (. //11,1- N4,.,,% V, i lnA ., cue . Aio, L. r2-dc .1`571_„ �'r:/11 I , 4— nJ Y1 N J A)o P CT4 (iULCr/71/�C 1, A,, ,1 r 7�/� l — ��✓!I i / 4 lci U-TV) I/L � � � � .-1 �(IA��1`�I�fD . IIxL,�G/ �1, ,v ,., �i , �l- 1(�iI G�i! iJ�d GJ TAd,I.�2/yro� S 1 L J0_� ,,Q� G Aln� �S� c n �c C�S�n 7 n � '� _ -1 1 1`J / rl �� -n c� 1 Jr„� ice) J.�r _ c;1.07% cJ ro / I� 10,4 CL >>.�-� . L 1 Discussion With Person in Charge: I Corrective Action Required: I ❑ 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 suspens-ion/revocation of ❑ Embargo ❑ Emergency Closure ;your`food permit. ❑ Voluntary Disposal O Other: } i— — Violations Related to FoodborneWpes,Inenventfore;and RJISA Factors filem 1-22j (Cont) Wilhirl,l Roam PROTECTION FROM CHEMICALS 0HF' HF Hart and Or Id HoWin 14 Food or Color Additives 19 i P 3-201 121 Addjjiv,-S" Cold PFIF� bi47ow 3-36114 N-clecilial from Unalipro%-ed mditivc ' the 1`11! 1"ilaintaincaj at III above Poisonous of Toxic Substances Orl"itial Ro.=,ae HcId at A ahovl: j'i0`F' Comallw", iTime as a Public Health Comtroll 7 102 H Nan,& - W'wllifla 2o &PUIL ! .5 SlvlalC" In]1 1 !� finli:as "i Pubfif�I Icallb Control Rcqri,,fll)n -Vcs,,ciw't and ljm�" 7--102.1.1 Condmom of Uso' AEOUIREMENTS FOR HIGHLY SUSCEPTIBLE !m't I -1`icljIibI:i(al4 POPULATIONS(HSP) 204 11 Crut-3 ii-- 21 qeuri'mi I"e'-1 ild,Iged Pmt$"Ild 7.�C4.Q Chenkaf,"or'A whilig l'!odacc.Clitezia, .1z 7-?04,14 Drying Avera:,CrneviIo I I fI I':':of 7 20,11 f Intidenial FoW('untac,, iliNicariW ?-:5oi.;ij)l i k"v, 'r Paiuidi l G okvJ Auinial Rwid and 7-21){x.!t ko�trmed,UBc Pexricvie,,Cnren I:,' 7.206.!2 Rci,icn, Bell sl:tlion��' Rr 1"6 13 j 'I'laci,iraz N,+deri, Comi-0 and CONSUMER ADVISORY TIMEITEMPERATURE CONTROLS F-22 7 Consullwr A6ii,('ry flml2j 1,ir Crin"'InIntionol 'vii1t;'ll 1""0' fhal iift R'ew' Under"Xiicd o2 16 Proper Cooking`1 ernperatures for Noi to Mirmiale PHFs ,-•s.., 3 401 1[Arl a-,! r.lvk- 15 S F 15 Sck% lmw.dlatc Servik-c 145`t cirimanIIII'd "Icam ti 6,1111c Andii;6 155 t it, NT)t 1 y2l SPECIAL REOUIREMENTS 401.1 I I'vil, and li,-el Rom 1,;O�f 121 nun' 3-4ol.1 (AP-,) Kalilc� lilf t; lioo�d I�S'� I 'it)DWINA) IDt Vic lanoo,of'sLcticill A) 'aw -(D.) in , inn I g, moki',' tmtprai, acid 0cii.:n op-,r dolts Ivakld he fil"i, d undc, t13e .mltoijs Pouln',rx t5,,:c. 'at'v"I-' if f;ijtcd III foodtx.m: ilh: St 3-401,tfiC):3j Whole-musle, Inuict B ,d Waks inici ivdiowand risk facw-,z. Other 1459;t 59000() vi,,Iafirlim rclatinlp tcl;;okxl ri;tllid 3 410 i,12 RawAntatal FoidiCwk,:d iv a ix'cu tire, Jik a I PJ1 lie ikhilwd aiidtr#2t9 - '401 ll(A)(I)(b) All Othei Nli--+ 1.15'l 15 se, 17 Reheating for Hot Holding i VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 1403.1 l(A)&'{0i IIHI, W'r 1 23-30) t..I{}3.61{Li} lic�opool. ,Ilim-h du lift; reiatcw It( i-103.t 1(C) Cowmxcialiv fhteased RTE.l-,Nd- 140 F� UnslwtW Porticac of lice' 22 kltwicrner 1 4-ic PPTwi:nel 18 Proper Cool:ng of PHF5 21, FkvK!�irid F,xvi rc 'Wt I tl 2S, lq�.ipn,�.,w m�;N�Is4a c- 3-501A NA) 0xiling,Ciltkcd PHF� from 1401:W Wal�-I,-P.iuly,6m,cl." I--l' � 7001,Within 2 1 k,w,and From WIT i 27 PlvSv"d F(,-I; I r,07 ii, f 115:F Will it)'I P>mWH - -21 Will) Coul;I)L'PHF�M—v& Fv-coirempizi5 lo Within 4'Pmr, WS CITY OF SALEM I BARD OF HE LTH Establishment Name: o ckp S7Y / � � �-, ( Date: lc��0� /` Page: of 2 I Item. Code C- al Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION . . Date No. Reference R-Red Red Item Verified PLEASE P INT CLEARLY f V* ki F�`� � s�l - (� I�ac�r �"X�,.r-�l�sr- �O�-"l✓���5/rt-a/F1Z ,✓� � �i'�c?�-rr.�1... �t/� In) L k I f 1 Discussion With Person in Charge: Corrective Action Required: I ❑ 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 1 Re-inspection Scheduled ❑ Emergency Suspension ccrnply 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 youkood permit. ❑ Voluntary Disposal 0 Other: r ; ;--- ..:,., R,^._tved at 3'cmPera:,tres Ytat»tion6 Related to Faadbotna Illness Interventions and Risk j i-cot JinL t:,Lac. ('tx)t•^d to Factare(Items 1-22) (Cont.) _ i t'Z:(4`.,`F Within I Hout;. rt. ctxd':n.,A3-t.t wf tot pfiFs PROTECTION FROM CHEMICALS i 19 r t'HF Hat and Poid Holding j 14 ? '! Food or Color Additives i '�-5tt?.t6tF.t; `dot:(T':its;YSuhu .>t' <Einu{s: ; ,w 'tt< i.+_?{t?.d2 I lillttitt\+l:?" 159i:o('4+ t•; °14511 F, I j ;i-302 14 Pa2ecuon(Cvaa kfisappniltnl Addittvcs` 4 161'1) 1101 PHF.if; m iniled of or atx,ve, C I. 4 ? Poisonous or TOXIC Suust rotes i ± E ` R11.ti ! k?rint:tying int„rtnat,.on - ttnniani ' F€c#d:,(::-nbuve !3(s`i•, * Contain,," 2() T iron as s public Health Control 7 102 11 1 Common Name - Nbrkin i ontainerN i I 3-5r)i 1,; 'ilrnn a.a Putrtic Health(7on,rol, ! S•:patauon -Sinriken: Re:l;iction - B-c:� c ; nc ,unt ( ; 1 }}) Va1c{u,r .oe,;airc,ncat 7-20112 Gutd flow, of lka E ?-'it3 }i Taric.Cuntama.,: -P ftbEhi:ums* ( REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) 7-204.11 Sannrers,Criteria—C'hetnic.:,i.' {aCe-(S;16.:t,wu ttt?CC:i 4tiG '-'_tlt.i' t:'Etcnu,:+6 tot i@'a>hu5¢t P!ndtE:;c;Cutct ia` i 1 1 '; 20.4 14 Dain,:A4tente.Crwria' I t3c,er.ea,will,Narnit? E ab Is ! 7 ^t}$ i€ lwidt•ntalR,slC'untar.t. Ivini'Iuros t : :.-h0ESiiF33 Z':xt,tPa>fa•nraxJt:.�;'�* E <.SJ1 ll{t t} J{,, rfl.,':il€r C, '1-5nrtnai F,XK3:}n,t ! 7-21)6 11 RJANGted tsr Pr.>*iclde:.,Cutena . 7-21)6.12 Ra><Icn: l3ett stations- 1 r{', j )-06 I? 4 =fr,wking Pm44fets.P-`st Cootrtl and i I ps Munit,,rin I ' CONSUMER ADVISORY TIME/TEMPERATURE CONTROLS j 22 ?+0, , t i E i',"nsunut :Atlasort i;,.t•:;I lo,Ccinswi,ptiun of 25 Proper Cooking Temperatures for Foo;Eft k:;w PHFs €'tF+t•s;ad E,"l=luntna's f 3-,1011!.kti+{t. fi;g:- Ii5'F !`5e,.. ( ( €, Vadutean, _F, Y.et;<- Ian1+<'diate 4er'?t:' 1,451.tS:,ec I .!'• 3 ,i# ,t.•Stttautttt•• iu<K:tu Sliell �01,11W(2) Corrininated H h. S4rtr<& Gantc Aninvils 1:251= i�sec. ` SPEC3.AL REQUIREMENTS . 3 01.1 t(8)(f}:2t Ptxl, arc': iS�et R+)ast 13{1`1=121 ti,it,` n).t00QtA) 1177 Vi<�I:u:,7n.tai fit':tioo `90,Cl{i'OA)-(D) to • � ?'qt;1.'.?(A7t?` }i.,tires. l�tjccr�d l,lcat* - l55':-' I` C&t1*.rin C. rl objlt 6:x41. ,I:mporai Y and 3 401.1 1(A)+3j f'nullr}. Wild Baine,Stuffed PHFi, � 'c'•t.t>vtii_at 01,hcn oporatioos:.ftcttlld lie SuEfl)ue C'ni+.arung Fish, Me :u, d&;ie,i oodki dic approprintc. .iiott.s P:,uitry ur R."oles-1 t,5'P I{ sic. , AN,w it icj,;,cA to ftnx'•koow 61110s 3-401.111013) !Vll•,le-ntu!;"1V_ #nt:,ct Beof jt;d.s Int.r:'enUnlla arW ris!fF:cto-, Other 1451-+ gt)(}(9 viollilu,os rebtin, to=„otK.i rata!! 3-=1'J;.12 iia% Amortl i oW,i Cook,d in a � Itr;t�+ic'�s ,hooW Isc d6itai under #29 - E Microw,oe 1(,5, ye."Ctat K:tlitirt'tn..alt�. .\it(kl:niPHF� 1.45`F15se, i 17 Reheating tot Hot Holding ( VIOLATIONS RELATED rO GOOD RETAIL PRACTICES 03.111,A)A-(ll) PHF, 165=1' 15 eca, - (Itctrai:23.303 3 -t0'.€i(I') ?. i00%vaw- ]h5'112 Siandinn Cn="rui,:t,: mm-crlol:a+ ,tl�<,n;.,lrs, xtr+th rtc'ntl' tetWC n3«;c `f)niC"' lrrorthrr+'d%t LteOa ?nk tl4==tFi,nt, <rtl+i kJaciorr ;,t"d,u,orr tatibe i:OnnnL3"ja{?V I'10i:'.cABd FT'I'.L'tgvl. '<dOti<h'f;< )l+lr+,t Rla, z. ,,rRV tS-:ire!'OUtl l`e•e.iP tUh l/!1.5 {'tt:`h' 1-403,1 I(L) Renrunirw t;ntilc'ed Portik:ns of Ito:( itarn 1 Good Retail Practices _ FC5.90AtXi _ r r?. m Ma='rat v.roro'and Percofn.W--- ---'--F FC 1 om laP er Pro Cooling of FHFs ; and-a:rd t'ro+<.,i;nr Ff, ::1_ 1 (v4 xb, i.Fn , 'on u?&na:?s _..__..�.W_`. f^_.,s �`_-r,O5"` ' S(S1 i{(r',S :"'Jun:Cool't'd PRF< Patau 1'117'F=ta. ia 1 25 Lr a!s3t,F'{Lt:tbii; .+rd 'J cs',C IFC-a 006 -{ 7(1'F,Vithln 2 ?Iona:,,td {'rout 79-6: ! ::'r, P'tyyicai Faa it+. F{,_tt .iri?'T v: 41^F/45'F Witiati l Knit';: ° � .�L}. � pfPS4i5Gtid_ri T7k:+..tf3tPf��3i5 i FC -i i ,008 3-501.14(8) Carding f'Hh,Made Front knihient ' -T--- ---- } ! Titriperaturvingrcdiowtit,at:t.t•tr`F 3G. , tltrn. j \Vittttn 4 1lour<"' tis:final ate,?.,a,n;1,,1,1,: 1`;'%'t 1ond(",)die"r 1 JS€ Mt{590 ON ) Massachusetts Department of Public Health Salem Board of Health 120 Washington Sreet, Division of Food and Drugs Salem, MA 01970-t35234 1h 190-35234'" Floor FOOD ESTABLISHMENT INSPECTION REPORT Tel. (978) 741-1800 Fax (978) 745-0343 Name I Date Type of Operation(s) Tyge of Insoection I/- 61 _7 A/1�/ 1 St)rJ f �� I1141 Q I d_Food Service ❑ Routine Address disk -- ❑ Retail ® Re-inspection Level ❑ Residential Kitchen i Previous/Inspection Telephone ❑ Mobile Date: RA x,�fU� Owner �` . I HACCP YM El Temporary ❑ Pre-dperation �-V n y �I �•) ' I ❑ Caterer ❑Suspect Illness Person in Charge(PIC) I l Time ❑ Bed&Breakfast ❑ General Complaint In ❑ HACCP Inspector O Permit No. El Other Each violation checked iequil'e§ ari explanation on the narrative page(s)and a citation of specific provision(s) violated. Non-compliance with: Violations Related to Foodborne Illness Interventions and Risk Factors Anti-Choking Tobacco Violations marked may pose an imminent health hazard and require immediate corrective 590.009(E) [1 590.009(F) ❑ action as determined by the Board of Health. FOOD PROTECTION MANAGEMENT ❑ 12. Prevention of Contamination from Hands ❑ 1. PIC Assigned/Knowledgeable/Duties EMPLOYEE HEALTH El 13. Handwash Facilities .. ... .�. .... . , PROTECTION FROM CHEMICALS ❑ 2. Reporting of Diseases by Food Employee and PIC El 14.Approved Food or Color Additives E] 3. Personnel with Infections Restricted/Excluded ❑ 15.Toxic Chemicals FOOD FROM APPROVED SOURCE" -, . . TIMErrEMPERATURE CONTROLS(Potentially Hazardous Foods) ' El 4. Food and Water from Approved Source _ ❑ 5. Receiving/Condition ❑ 16. Cooking Temperatures ❑ 6. Tags/Records/Accuracy of Ingredient Statements ❑ 17. Reheating ❑ 7. Conformance with Approved Procedures/HACCP Plans ❑ 1 B. Cooling PROTECTION FROM CONTAMINATION_ •' �'`,, _ ❑ 19. Hot and Cold Holding ❑ 8. Separation/Segregation/Protection El20.Time As a Public Health Control Eq 9.-Food Contact Surfaces Cleaning and Sanitizing n REOUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP)" ❑21. Food and Food Preparation for HSP El 10. Proper Adequate Handwashing ❑ 11. Good Hygienic Practices : CONSUMER ADVISORY ,. . „. El 22. Posting of Consumer Advisories Violations Related to Good Retail Practices Number of Violated Provisions Related Critical (C)violations marked must be corrected To Foodborne Illnesses Interventions immediately or within 10 days as determined by the Board and Risk Factors(Items 1-22): of Health. Non-critical (N)violations must be corrected Official Order for Correction: Based on an inspection immediately or within 90 days as determined by the Board today, the items checked indicate violations of 105 CMR of Health. 590.000/federal Food Code. This report, when signed below C 'N by a Board of Health member or its agent constitutes an 23. Management and Personnel (Fc-z)(sso.0 order of the Board of Health. Failure to correct violations 24. Food and Food Protection (FC-s)(sso.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: S501n,UFom i<O / \ - Inspector's Si Signature: Print: �' I Ick lir, (/ PIC's Signature: // _ Print: _ �-! f J V - Page of-Pages V i �f Violations Related to Foodborne Illness interventions and Risk Factors(items 1-22) PROTECTION FROM CONTAMINATION FOOD PROTECTION MANAGEMENT 18 Cross-contamination I 1 590.003(A) Assignment of Responsibility" 3-302.1 I(A)(1) Raw Aminal Foods Separated from 590.003($) Demonstration of Knowledge" Cooked and RTE Foods' 2-103.11 Person in charge--duties Contamination from Raw Ingredients 3-302.11(A)(2) Raw Animal Foods Separated from Each EMPLOvEE HEALTH I Other' 2 590.003(C) Responsibility of the person in charge to I I Contamination from the Environment require reporting by food employees and 3-302.1](A) Food Protection' applicants* 13-302.15 WashingFruns and Ve•aetables 590.003(Fl Responsibility Of A Food Employee Or An i z-307.11 Food Contact with Equipment and Applicant To Report To The Person In I I I Utensils* Charge* I Contamination from the Consumer 590.(H)3(Ci) Reporting by Person in Charge` 3-306.14(A)(R) ( Returned Food and Reservice of Food* 13 590.003(D) Exclusions and Restrictions* I Drsposihon of Adulterated or Contaminated 590.003(F,I Removal of Exclusions and Restrictions I Food 3-701.11 Discarding or Reconditioning Unsafe FOOD FROM APPROVED SOURCE Food' 4 I Food and Water From Regulated Sources I ; 9 Food Contact Surfaces 590.004(A-B) Compliance with Food Law" I 4-5(11.11 L Manual W'nd Temperatures*Hot Water 3-201.12 Food in a Hermetically Scaled Container* Sanitization Temperatures* 3-201,13 Fluid Milk and Milk Products* 14-501•) 12 Mechanical 4Yarewashind Ilot Water 3-202.13 1 Shell Eg-as* I Sanitization Temperatures" 3 202.14 Eggs and Milk Products.Pasteurized" I 14-501.114 ( Chemical Sanitization-temp.. pH. 3-202.16 Ice Mai' Potable Drinking Water"` concentration and hardness. K 5-101.11 I Drinking Water from an Approved System- I 14-601.11(A) Equipment Food Contact Surfaces and 590.006(A) Bottled Drinking Water" ( Utensils Clean' 4-602.11 Cleaning Frequency of Equipment Food- 591)006($) Water Meets Standards in 310 CMR 22.0*` ( Shellfish and Fish From an Approved Source I Contact Surfaces and Utensils* 14zation of Utensils and 3-201.14 Fish and Recreationally Caught Molluscan -702.11 Frequencyof Saniti I ( Fo<ui Contact Surfaces of Equipment* Shellfish" ( 4.703.11 I Methodso£Sanitization-Hot Water and 3-201.15 Molluscan Shellfish from NSSP Listed ( ChemicaP` Sources* j 11) Proper.Adequate Handwashing Game and Wild Mushrooms Approved by Clean tion-Hands and Arms 12-301.11 ClCondi * Regulatory Authority I 13-702.18 Shellst<xk Identification Preacnt* i I 2 301.12 Cleaning Procedure* 590.004(0) Wild Mushrooms* I ( 2-;01.13 When to Wash* 3-201.17 Game Animals* I it Good Hygienic Practices g Receiving/Condition ( 2-40 LA I Eating.Drinking or Using Tobacco* 3-202.1 1 PHFs Received at Proper Temperatures" 1-401.12 Discharges From the Eyes, Nose and 3-202 15 Package Integrity* i I Mouth* 3-101.11 Food Safe and Unadulterated* 3-301.12 Preventing Contamination When Tasting"` 6 Tags/Records:Shelistock ( 12 Prevention of Contamination from Hands ( 3-202.18 ShellsaxkIdentification' 1590.004(E) Preventing Contamination from 3-203 12 Shelistock Identification Maintained* Empioycesx 1 I Tags/Records;Fish Products 13 Handwash Facilities - 3402.11 Parasite Destruction i I Conveniently Located and Accessible 3-402.12 Records.Creation and Retention" 5-203.11 Numbers and Capacities* 590.004(1) I Labeling of Ingredients' I 15-204.11 Location and Placement* 7 I Conformance with Approved Procedures ( 15-205.11 Accessibility,Operation and Maintenance /HACCP Plans I Supplied with Soap and Hand Drying 3-502.11 I Specialized ProcessineMethods* Devices 3-502.12 ' Reduced oxygen packaging,criteria* i 6-301.11 Handwashing Cleanser, Availability 18-103.12 ( Conformance with Approved Procedures* 16"301.12 Hand Drying Provision *Denotes critical nem in the federal 1999 Ford Code of 105 CbiR 590.000 CITY OF SALEM BOARD OF HEALTH Establishment Name: T�C19 <z2_"'ek /yIILL w7 , !f Date: 1 ��l�t7 Page:(511 of e­4— Item - item Code C-Critical nem ! _ J DESCRIPTION OF.VIOLATION/ PLAN OF CORRECTION , Date t No. Reference R-Red Item A - - Verified PLEASE PRNIT CLEARLY �1I� f /1 f I . )l. II — kar I') 1, 1c _A41ss,na P,4_ /41AAleTl C1 --vol (4 44(arY/1 (�Y7 I V1774 (A CLC 6 tqr-, vj Ve d.,d . 6�-� , O C ik Z_-7) Q 1 ,1ya h (OUX/'fn' �J2,r�t�fLwfi fi 721 711�u�m c,l� ,�— A C), ri�, 1 I I I s I I } 1 i 1 I Discussion With Person in Charge: Corrective Action Required: I ❑ No 1`7 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 suspension/revocation of ❑ Embargo ❑ Emergency Closure yodr food permit. 0 Voluntary Disposal ❑ Other: Nits Re�ivtoi at TcmFtmatures Vtalations Hafat%d fa Foadtsorne fttr:esa Interventions and Risk f :Ctvowding to lxu CcAAW to Fuators(hemst-22,i (Cont) ( 4i"Ff=OFWffbin4Htnu+. ' 1.75 Cikain2 rvt�thWa 4,r PHFt� gq Food or Color Additives PROTECTION FROM CHEMICALS 19 PHF Not and Gold Holding i 3..;01.1+:(B; notd PTIF� Mlein:,in(:d at cr ty tlo i i.2{,2.12 1 ,.ddtttvc<�` YJi�i7.}.r +,r;; ti,1; ., 11:4' F^ J ?-30"214 Pnnechonhonttna},pruiedA•tuit,vc+° j z 501 Ahik IN151'sPtArainedaturahoy ( t> Poisonous or Toxic Substances j ! 7 101 11 ( Iticmlfytng infoAmilon-- Omr incl _ iatnsHtJdatoraheveIWE o- C"ontniner.:" i ( ., i 20 � ; Time as a Public Hoehn Control 7 { .iQ II } Coarurtnhiatne -it;: !> I"ime a%a t'ubtic lar,:tlrh(rant„f' ! ?-3(jLtl ! Srpi:ataon--Sin.a¢e' i y E 7-202.11 Re<trictitw -Presr_t,ce,w:i i'ariance Reiattircmew t 7-20112 Candttium of Uw” i-203 i I roxic Containetz-Profnhviam" POPUFREMEhS FOR ti3taFiLY SUSCEPTIBLE" 20d.lI Jmrn:zet}.Cnte;i.+-C'hanic::lc' ( POPULATSUN:i(FtaP) ' # 21 !WE 1HAi � Unpatrrirt:nl i're�l,a<lagnri Jtri.rs atiei 7-2104.12 Oromeak for WaNhh.tt P:oduu Ciiwz4x t I Rclereee.;?pub t�;n-nsn I,ai.�,i.:'. j7-'04.I4 Oryinfi.Arents.t7neria" • �t)!.l;Ilia Ln to 7-2it5.i i lnc:idrmil F-•�xl Carta='t. 1_uh,ivant.s` 310L 1:00 ! haw m l'atuAl t, oked.Animal RxA and f 7-'2'06).E I Rewwd t'ee Pvio ,lee.(Am Ni- j ! R..�'tir:d:+l)t„u(t\'t,t Srrv<'d. j 73156.12 1L,4(t^nt Bait tituta„n;' � '. t:t;l.ii:{;:_{._t: r,net.c,tirc><,t? Ps�kacvl4.•tR,re-*ved. ” 710&11 i 'i}athnt};Ymuic'r< F?,;at C•uniru!and ^,4unnotin„' { CONSUMER ADVISORY ! 22 3 t,a): !1 C.t'Grn,r;zr.qtr:•.+u,ry I'tntrc! `.qtr C oa,tanp:iun of Pro TIME/TEMPERATURE CONTROLS ( ,.,i i e.KF thin .tri R ('nder"A,ed n; iCe Proper Cooking Temperatures for ( ! Ya.,:`zsed to L•iiininatc F'HFs 1 3 .101 IJA l C Egg, 355 155 ! I ' 3 : 3 FtY.d:abc :t.,)t..,S• :.0sao.. ur or +:w StrlfX < inrdac Stmc I511nP . . -#01.11(:17(,'_) l C;mminan-d Uiah, %testo&(,ante i'r'.,� . I Anin,ais iS5 F15 src. MY tUR)t12) i=,ttl. and Et;coRoast ?;f7't' 12i nein* SPECIAL REQUIREMENTS t ivi)Osta{.tit-tt); Vrt•i•ett,•;;: (,I Section :,90JX)9(A) (DI in ,40i-;I(rt}t.'+ Ratirr, L,iettcd :Beata - t55 'r If, ! • y. � 'ar4±!jtg. moInl%, ltt)l, temporary and l : 00 A UAKY Aw try,old Gat,,,..;.tu NJ PHRS. I r:'+ht naal kiwhr.n of=c'r,niatt::,h„uld be St,ttlntz;C:t,ntaitnnt! iib17. Eroleai, t.i ltft;ti nndt'S'I(t( apprt;}'r)ntt:'�i>';It)r11 :f r,:Lu'd It)h'WIN'rnv ittucsS j 340t.t}tC)r3r 'hc,ie ntn"vl Intact ftet:F'itcakt crverat.or;:anr. tic} i' ciory Chhcr I 05:1: :. {9{}.{tQ0 t•uiiafluus relating,to ftotxi rkJaA 34WA2 Raw ntdrnal Ft+43+0,okcd in a I,r':uticC�shoidd he debttex' uitt;er#29 .. I lticrowmi: 169F=` `sp+'axial I(t'y:nr'dritzatt<. 340I.IHW(l,(b) .AII(hl)et I'IIF+- 145`F 15 src. ^ . 17 Reheating for Not Holding i VIOLADONS RELATED TO GOOD RETAIL PRACTTIS 3-1031 PAM), I't-AV 165'`F 13 S”. (ltx.tatc 21-30) l ;-FO?.I ICU: hAkrusavo 10" F2 Lome tiWnding ('11M Nal non ,otrrr:t a of ,'two:, wilfthdo no! rrFurri,t ifir E 'Finn:" ; tru,dhnrne M,No; .rhr,:•rr<nt,•�n.r,+nrt,r=.t)ur t.,r;t lig;.:tt rsi.rmr c,rn L„ E{ 3-4 3.}i iC:) Cunrn:Iriully Pt e,<;=c:•`d RTIC 1"wh knad rt t,'it)'Haan(.rrr•S :;:rrir rc:.:l;fie'Pool(ode triad)r6 t AIA I y-1," t 1 .• (' ' i- 1 Goan Retad Practians "-'r FC 590.000 { C" i l'1•.: L.:namiue nsl:ced l ordone of HyrE' .— - Finast>r _,t - FC--:? ; 003 j 23. t�nanac gym,-rtf unr}Per.��nr;�f -� .x ) c )c n,d Fkx6 Ute:,s:!- .. .2222 �._....- ._ : 2A f Ft=xs and Fexxi Prcit:rtion � FC� 3 Cdin F€a Proper Cooling of PNFs ,__ -._. -.�_F_ 4 j 06^ r ? %I1AA7 ( Ca•1toc Ctehd PHlh N+"r. Idly€ h, � !_r__. -:_ tl_P_ _.. ._ :._ _-_ - .__ { W 'tt afor,Pia.tnta,n :,rc'iNaste 1 F C-S OGti ' 70'E W'iti,m? ti•,ur.and Frvm'7+T'i' _ _- - - : r,. rnvs;c•U'rac:city i FC.-U. .CiJ7 --i «,-, + 12P P,�e,maw a Tor;c A4uwwis i FC 008 50i. -- 3 50i.t4 fl) C Aing l HFE Made ETom Ainbtent j .tat ~i_eaa F. ukem vat .2. 2.. _- 009 1'f/s5`F4t;ttun t Ht.ur::. ' Tem erattwe Ingedimas to d)'t-fd5 'r" : cine: : ',Vithin 4lbAir�k . .",.,•.'•'.. `Len.dr,rnucal Ger.:utrhr ides: ivy?QW(New Ion toot 50,111 2 _ • i Commonwealth of Massachusetts s • City of Salem Board of Health IGmberley Drisooll 120 Washington Street,4th Floor Mayor SALEM,MA 01970 Foo"etail Establishment Permit DATE PRINTED: 01/08/2008 ESTABLISHMENT NAME: Dodge Street Bar & Grill File Number:BHF-2004-000168 7 Dodge Street Salem MA 01970 LOCATED AT: 0007 DODGE STREET SALEM, MA 01970 Permit Type Permit No. Permit Issued Permit Expires Fee Restrictions/Notes FOOD SERVICE BHP-2008-0293 Jan 7,2008 Dec 31,2008 $280.00 ESTABLISHMENT Total Fees: $280.00 PERMIT EXPIRES lDccember3l, 2008 Board of Health q"VLVvN,IC 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 10 of 11 Y R� CITY OF SALEM, MASSACE IUSEM t BOARD OF HEALTH 120 WASHINGTON STREET,4"r FLOOR �arnNstl�' 'ItL.(978) 741-1800 KIMBERLEY DRISOOLL FAx(978) 745-0343 MAYOR TS(DTTOSALEM.COM JOANNE SCOTT, HEALTH AGENT 2008 APPLICATION FOR PERMIT TO OPERATE A FOOD �E7STABBLIS+HLMENT NAME OF ESTABLISHMENT I&D? % 9U&"'lUe- LL TEL# 7�7Y� r�7 ADDRESS OF ESTABLISHMENT I �L) V),moi SI CAl-f- t FAX# ,JI HJ / MAILING ADDRESS(if different) ] L EMAIL-Business': SNnn I FD lam' udme S)x-lf i• co'k_ Website: J'Ww rid e-5 1 t Krl •f V7 _ OWNER'S NAME 4;?_A QL O17`2 &J� TEL# p ADDRESS 100 C4 VI(V 5 AA)'- AJe /'/7��^� 'V, I�(C+//� D�/7 STREET CITY STATE 2 ZIP CERTIFIED FOOD MANAGER'S NAME(S) T fi _A Pa_f s� n CERTIFICATE#(S) 3LI 3064 (Required in an establishment where potentially hazardous food is prepared) EMERGENCY RESPONSE PERSON 7R A" L Pu's Sd'T7_1 HOME TEL# Z30- DAYS OF OPERATION I Monday Tuesday Wednesday Thursday Friday Saturday Sunday HOURS OF OPERATION ;ypM— \Agyn — qPN — y\0M ilj9M — L4prn — t ) Owl Please write in time of day. A A (For example 11 am-11 pm) IAl"A IAM I NPA_ - 1 -Q V'k I A JwI I !� I TYPE OF ESTABLISHMENT FEE (check only) RETAIL STORE YES (I�IO� less than 1000sq.ft. =$70 CO 1000-10,000sq.ft. =$280 more than 10,000sq.ft. =$420 -- -- -- --� ------------------------------------------ -- ---�--.._.- -- -------------- $1-4 ..... RESTAURANT YES NO less than 25 seats =$140 (Outdoor Stationary Food Cart$21 25-99 seats =$280 more than 99 seats =$420 — ..... ----------------- ....----------------------------------------------........ BED/BREAKFAST/ YES / 10-1 $100 CHILDCARE SERVICES. //........ ADDITIONAL PERMITS MAKE (not just serve) ICE CREAM, YOGURT/SOFT SERVE YES CO--) $25 TOBACCO VENDOR YES (�n $135 ALL NON-PROFIT(such as church kitchens) YES N $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 fled all state tax returns and paid all Kstates required under the law alsl� 57�3d9� o� a Signature Date Social Security or Federal Identification Number Revised 4/24/07 FOODAP2008 adm CheckN&Date la $ f� •V007 DODGE STREET Dodge Street Bar & Grill City of Salem FOOD SERVICE ESTABLISHMENT - FOOD SERVICE Inspection HACCP: ❑ Item Status Violation Critical Urgency Telephone: PROTECTION FROM CONTAMINATION 745-0139 Handwash Facilities FAIL RED Owner: omment: Bathroom off of back room must be either a bathroom or storage. Remove appliances if going to be storage. Provide Frank P. Presutti, Jr. paper towels,soap and hot water if a bathroom. PIC: Frank P. Presutti, Jr. Inspector: John Gehan Date Inspected:ICorrect By: 10/2712006 Risk Level: Permit Number: BHP-2006-0057 Status: Open #of Critical Violations: 3 Time IN: Time OUT: Urgency Description(s): BLUE: Violations Related to Good Retail Practices (Critical violations must be corrected immediately or within 10 days)(Non-critical violations must be corrected immediately or within 90 days) City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741-1800 GeoTMS®2006 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Oct 26,2006 ) Page 1 of Item Status Violation Critical Urgency RED: Violations Related to Good Retail Practices (Blue Items) Violations Related to Food a�C�, en't:'Victory ction FAIL Critical BLUE Foodborne Illness Interventions and Risk Factors (Require unit has uncovered foods. All foods must be covered. immediate corrective action) Llpife found with accumulation of food debris. Thoroughly clean and sanitize knives after each use. sauce bowl on top of sauce container. Clean and sanitize after each use. --W�alkin had uncovered food. All foods must be covered. oing stored on oven. PHF to be stored properly in appropriate places. Equipment and Utensils FAIL BLUE ment:Victory unit requires thorough cleaning. e reezer in kitchen requires general cleaning. ,—Sbalves above food prep area requires general cleaning. .,ca on .,can has accumulation of grime. Thoroughly clean and sanitize opener. Blodgett oven requires thorough cleaning. i /Seff'itiz�mg log not up to date. Log to be maintained daily. Microwave requires general cleaning. ite frezer m hall way requires general cleaning. j' Serwahite refrigerator in bar requires thorough cleaning. re in bar area must be handle side up in container. Physical Facility FAIL BLUE o ment: Many spots of the kitchen have loose and chipping paint. Remove any chipping paint. Repaint surface. 'Entire kitchen,walls,floors and ceilings requires thorough cleaning. Other-See Notes FAIL Critical BLUE omment: Cigarette butts found in an ashtray in back hallway. No smoking is allowed in any massachusetts establishment. Owner subject to a monetary fine starting at$100.00. City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741-1800 GeoTMS®2006 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Oct 26,2006 ) Page 2 of Item Status Violation Critical Urgency GENERAL COMMENTS: Owner to fax over extermination reports to boh. City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741.1800 GeoTMS®2006 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Oct 26,2006 ) Page 3 of 0007 DODGE STREET Dodge Street Bar & Grill City of Salem FOOD SERVICE ESTABLISHMENT - FOOD SERVICE Inspection HACCP: ❑ Item Status Violation Critical Urgency Telephone: PROTECTION FROM CONTAMINATION 745-0139 Handwash Facilities PASS ❑./ RED Owner: Comments: Bathroom off of back room must be either a bathroom or storage. Remove appliances if going to be storage. Provide Frank P. Presutti, Jr. paper towels,soap and hot water if a bathroom. PIC: Frank P. Presutti, Jr. Inspector: John Gehan Date Inspected:Correct By: 10/27/2006 Risk Level: Permit Number: j BHP-2006-0057 Status: SIGNED OFF #of Critical Violations: 0 Time IN: Time OUT. Urgency Description(s): BLUE: Violations Related to Good Retail Practices (Critical violations must be corrected immediately or within 10 days)(Non-critical violations must be corrected immediately or within 90 days) City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741-1800 GeOTMSO2006 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Nov 13,2006 ) Page 1 of Item Status Violation Critical Urgency RED: Violations Related to Good Retail Practices (Blue Items) Violations Related to Food and Food Protection PASS Critical BLUE Foodborne Illness Interventions and Risk Factors (Require Comments:Victory unit has uncovered foods. All foods must be covered. immediate corrective action) Knife found with accumulation of food debris. Thoroughly clean and sanitize knives after each use. hot sauce bowl on top of sauce container. Clean and sanitize after each use. Walk in had uncovered food. All foods must be covered. Bacon being stored on oven. PHF to be stored properly in appropriate places. Equipment and Utensils PASS BLUE Comments:Victory unit requires thorough cleaning. White freezer in kitchen requires general cleaning. Shelves above food prep area requires general cleaning. Can opener has accumulation of grime. Thoroughly clean and sanitize opener. Blodgett oven requires thorough cleaning. Sanitizing log not up to date. Log to be maintained daily. Microwave requires general cleaning. White frezer in hall way requires general cleaning. Small white refrigerator in bar requires thorough cleaning. silverware in bar area must be handle side up in container. Physical Facility PASS BLUE Comments: Many spots of the kitchen have loose and chipping paint. Remove any chipping paint. Repaint surface. Entire kitchen,walls,floors and ceilings requires thorough cleaning. Other-See Notes PASS Critical BLUE Comments:Cigarette butts found in an ashtray in back hallway. No smoking is allowed in any massachusetts establishment. Owner subject to a monetary fine starting at$100.00. City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741-1800 GeoTMS®2006 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Nov 13,2006 ) Page 2 of Item Status Violation Critical Urgency GENERAL COMMENTS: All violations have been corrected from routine inspection (10/06). City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741-1800 GeoTMS®2006 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Nov 13,2006 ) Page 3 of YA 0007 DODGE STREET Dodge Street Bar & Grill City of Salem FOOD SERVICE ESTABLISHMENT - FOOD SERVICE Inspection HACCP: ❑ Item Status Violation Critical Urgency Telephone: Violations Related to Good Retail Practices (Blue Items) 745-0139 Physical Facility FAIL BLUE Owner: Comment: Back area has many water stained ceiling tiles. Find source of leaks and repair. Replace any damaged tiles. Frank P. Presutti, Jr. PIC: Walk in refrigerator has tiles that are missing at baseboard. Replace tiles. Frank PresuttiNancy Presuit light cover missing over white kenmore freezer. Provide cover. Inspector: John Gehan GENERAL COMMENTS: Date Inspected:Correct By: All violations have been corrected unless noted. 3/29/2007 Risk Level: All physical facilities violations mut be corrected by next routine inspection. Permit Number: BHP-2007-0189 Status: PARTIAL COMPLY #of Critical Violations: 0 Time IN: Time OUT: Urgency Description(s): BLUE: Violations Related to Good Retail Practices (Critical violations must be corrected immediately or within 10 days)(Non-critical violations must be corrected immediately or within 90 days) City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741-1800 GeoTMS®2007 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Mar 30,2007 ) Page 1 oft Item Status Violation Critical Urgency RED: Violations Related to Foodborne Illness Interventions and Risk Factors (Require immediate corrective action) i City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741-1800 GeoTMS®2007 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Mar 30,2007 ) Page 2 oft CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH 120 WASHINGTON STREET, 4TH FLOOR SALEM, MA 01970 TEL. 978-741-1800 FAX 978-745-0343 Kimberley Driscoll www.SALEM.COM Mayor JOANNE SCOTT, MPH, RS, OHO HEALTH AGENT 2007 APPLICATION FOR PERMIT ERMIT(}TO OPERATE A FOOD ESTABLISHMENT NAME OF ESTABLISHMENT . 'z0ap� ^- J�%L`z?�t- d kq ,i, �C�t fU✓.(S TEL#-_—�-• R7 J �GjI3 JG^ ADDRESS OF ESTABLISHMENT hOh0-T- �i�i FAX It vk- MAILING ADDRESS (if different) EMAIL--Business': Owner's: OWNER'S NAME )it Aub. �17 �11 �) TEL# ADDRESS ru UUM( `Ilf,We_ kLf7PNul� AAA- �1`Ir_( STREET STATE ' f zip/ CERTIFIED FOOD MANAGER'S NAME(S) T- APrk fa CITY 1 K- ,) rn CERTIFICATE#(S) r (Required in an establishment where potentially hazardous food is prepared) EMERGENCY RESPONSE PERSON HOME TEL# OAYS Of OPERATION Monday Tuesday Wednesday Thursday Friday Saturday Sunday HOURS OF OPERATION Please write indmeotday. 9pk , fkA 49M- {Arh 149tH- IpM 4ymiAn1 g9M-IAV0 191'1-lAm (ZQm-1AWMI (For example ttam-11um) j 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 ES NO less to 25s:ats .� =%tno 25-99 seats -„=$150 more than 99 seats ....._.. - . .. - ... .... . .......... ... --- ..-... .._.. ...... __$100..... _ _ _ _ ... .. . ...-.-...... ... . BED/BREAKFAST YES O ------.------ ---- ---- . ..-_...-.... --. .. ..._ ...... .... _.. - ..... ..._............ .... ---- ADDITIONAL . .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 $25 'Please pay total with one check payable to the City of Salem. This Permit is not transferable and must be reissued upon change of ownership The Permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code, before any renovations, improvements, or equipment changes are made, all plans for such must be submitted to and approved by the Salem Board of Health. Pursuant to MGL Chapter 62C, Section 49A, I cerhfy under the pains and penalties of perjury that i, to my best knowledge and belief, have fled all state tax returns and paid all state taxes required under the law !2� 5 Jat� 6121a1-�laa-�' Signature Date Social Security or Federal Identification Number — - ---- --------------- ----- ------------- ---- ---- ----- ---- ---- ----------- ----­---------- ----------- ----- - --------- ----- --- Revised 11113/06 FOODAP2007 adm ✓Checkg&pate _4.1/4r(D /1"OVA4 _ s f ._w 'cw.g':'-t '.'kd f Y .f 4. � ` .�i" �., ^".Y z,t -+IAs •r�r f�..�+ �-,a�g-ek#W"�^f^k'a ih F,� 'f, ~"`.�M,.—,mil' +f�`` P•B:�L+.tllyd.+Med}mr u. 4 a +«: i ,. 01Co+mymon' eealth4.o�ff Massachusetts + ��y»Fae O' "Y } i ? .'•-[ ! r s. � °�'""•h"rr .•'�- � 'f •f ..t.,.�. �e�'+.' ,." Y^�" raX r r�., " _.'S } f � � .r:Y�'sm .n� �yqq,,-ry.�F 'a`kCity�Of SBIem �iph ,mss,> *�'� ��Y ,.s• ty .!.<ti.m,_..'s: y�+ �€yffE,t�. 'v, .f �� ^�t�.'t^'Evs�i���P t� �irv+:.:T..75"-`�°%^t...�t 'rct�`: �`:.,'6'se ";�.....'� �' ..f jµ`4k.•.. ' 3"�`W.;.�.. :-}a'y..r,M„lityxy t Y..,Yiq :'n`li:C :2"w,St « V Health �g M' r FGmtieiley Dnscoll -� •120 Washuingtob$treetr4th Floor:.";.; -'• ' -�-z'% yy ,; `- :.. SALEM,MA 01970 Food/Retail Establishment Permit DATE PRINTED: 12/20/2006 ESTABLISHMENT NAME: Dodge Street Bar & Grill File Number:BHF-2004-000168 7 Dodge Street Salem MA 01970 LOCATED AT: 0007 DODGE STREET SALEM, MA 01970 Permit Type Permit No. Permit Issued Permit Expires Fee Restrictions/Notes FOOD SERVICE BHP-2007-0189 Dec 20,2006 Dec 31,2007 $150.00 ESTABLISHMENT Total Fees: $150.00 PERMIT EXPIRES December 31, 2007 Board of Health This Permit is not transferable and must be reissued upon change of ownership or location.The permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code,beofre any revonations,improvements,or equipment changes are made,all plans for such must be submitted to and approved by the Salem Board of Health. Page 7 of 18 Ake Commonwealth of Massachusetts City of Salem Board of Health 120 Washington Street,4th Floor SALEM,MA 01970 Food/Retail Establishment Permit DATE PRINTED: 01/02/2006 WHO'S PLACE OF BUSINESS IS: Dodge Street Bar& Grill File Number:BHF-2004-0168 7 Dodge Street Salem MA 01970 LOCATED AT: 0007 DODGE STREET SALEM,MA 01970 Permit Type Permit No. Permit Issued Permit Expires Fee Restrictions/Notes FOOD SERVICE BHP-2006-0057 Jan 2,2006 Dec 31,2006 $150.00 ESTABLISHMENT Total Fees: $150.00 PERMIT EXPIRES December 31, 2006 Board of Health U This Permit is not transferable and must be reissued upon change of ownership or location.The permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code, beofre any revonations,improvements,or equipment changes are made,all plans for such must be submitted to and approved by the Salem Board of Health. Page 24 of 26 CITY OF SALEM, MASSACHUSETTS �oU O 0 BOARD OF HEALTH I((( U -1 I�tlla s 120 WASHINGTON STREET, 4TH FLOOR 1' SALEM, MA 01970 DEC 0 82005 TEL. 978-741-1800 STANLEY J. USOVICZ, JR. FAX 978-745-0343 CITY OF SALEM MAYOR WWW.SALEM.COM BOARD OF HEALTH JOANNE SCOTT, MPH, RS, CHO HEALTH AGENT 2006 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT (� NAME OF ESTABLISHMENTi ADDRESS OF ESTABLISHMENT 4 5 1 1 SAt�W MAILING ADDRESS (if different) �p /� OWNER'S NAME 1FQ-A ?0x � TEL# 'ry3 ,q ADDRESS )�) LMJI&10--kti CITY PSfAkkAA, STATE �'KeL ZIP CERTIFIED FOOD MANAGEI@S NAME(S) - x,<,1-1M_CERTIFICATE#(s) --5LJVIO`� (required in an establishment where potentially tt hazardous food is prepared.) EMERGENCY RESPONSE PERSON '`�i�h� 1 50 V I HOME TEL# l TO '/o �`�, 3 YkA HOURS OF OPERATION: Mon. JL'Tue. Wed. Thu. Fri. Sat. Sun. 1 QM TYPE OF ESTABLISHMENT FEE (check only) RETAIL STORE YES NO less than 1000sq.ft. --$ 50 1000-10,000sq.ft. =$100 more than 10,000sq.ft. =$250 -- - -- - ------------------ ---------------- ...................... RESTAURANT ES NO /�� less than is seats $100 l/5/_ 25-99 seats =$150 more than 99 seats =$200 BED/BREAKFAST .. YES ..NO- ..-----------------------------------------------------------------...........$100............... - -------------------------------------------------------------------------------------------------------- ACCITIONAL PER111TS MAKE (not just serve) ICE CREAM, YOGURT, SOFT SERVE YES $5 TOBACCO VENDOR YES $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 knowled a f, have filed all sate tax re ms and paid all state taxes required under the law. II � � 02 � Signature ate Social Security or Federal Identification Number ------------------------------------ --------------------------------------- ---------------------------------------------- Revised 11/03/05 FOODAP2.adm Check#&Date -- --- ----- �/Sd f 0007 DODGE STREET Dodge Street Bar & Grill City of Salem FOOD SERVICE ESTABLISHMENT - FOOD SERVICE Inspection HACCP: ❑ (, Telephone: Item Status Violation Critical Urgency Nature of problem or correction 745-0139 Non-compliance with: Not Done Owner: Anti-Choking PASS ❑ Frank P. Presutti, Jr. Tobacco PASS ❑ PIC: k P. Presutti, Jr. FOOD PROTECTION MANAGEMENT Not Done Frank C P. _ PIC Assigned/Knowledgeable/Duties PASS ❑d RED InspJanet Dionne EMPLOYEE HEALTH Not Done Date Inspected: Correct By. Reporting of Diseases by Food Employee and PIC PASSd❑ RED 411512005 Personnel with Infections Restricted/Excluded PASS RED Risk Level: FOOD FROM APPROVED SOURCE Not Done Permit Number: Food and Water from Approved Source PASS RED BHP-2005-0311 Receiving/Condition PASS 0 RED Status: Tags/Records/Accuracy of Ingredient Statements PASS 0 RED Open #of Critical Violations: Conformance with Approved Procedures/HACCP PASS Q RED Plans 2 Time IN: Time OUT Notes: 99: Urgency Description(s): BLUE' Violations Related to Good Retail Practices (Critical violations must be corrected , immediately or within 10 days)(Non-critical violations GeoTMS®2005 Des Lauriers Municipal Solutions, Inc. ( Rev. Apr 22,2005 ) Page I of a 0007 DODGE STREET Dodge Street Bar & Grill must be corrected immediately PROTECTION FROM CONTAMINATION Not Done or within 90 days) Separation/Segregation/Protection FAIL Critical RED W ictory fridge raw meat stored above soup. RED: all raw meats to be stored below all ready Violations Related to to eat foods to prevent cross contamination Foodborne Illness Interventions Food Contact Surfaces Cleaning and Sanitizing PASS ❑ RED and Risk Factors (Require Proper Adequate Handwashing PASS RED immediate corrective action) Good Hygienic Practices PASS RED Prevention of Contamination from Hands PASS RED S� Handwash Facilities FAIL Critical ❑J RED gland sink missing soap.provide soap at all times. ens restroom missing employees must wash hands sign. provide sign PROTECTION FROM CHEMICALS Not Done Approved Food or Color Additives PASS ❑d RED Toxic Chemicals PASS ❑d RED TIMEFFEMPERATURE CONTROLS(Potentially Haz Not Done Cooking Temperatures PASS ❑d RED Reheating PASS ❑Q RED Cooling PASS RED Hot and Cold Holding PASSd❑ RED Time As a Public Health Control PASS RED REQUIREMENTS FOR HIGHLY SUSCEPTIBLE PO Not Done Food and Food Preparation for HSP PASS RED CONSUMER ADVISORY Not Done Posting of Consumer Advisories PASS RED GeoTMS®2005 Des Laurlers Municipal Solutions, Inc. ( Rev. Apr 22,2005 ) Page 2 of 0007 DODGE STREET Dodge Street Bar & Grill Violations Related to Good Retail Practices (Blue Not Done Management and Personnel PASS ❑ BLUE Food and Food Protection PASS ❑ BLUE Equipment and Utensils FAIL Critical ❑ BLUE unitizing log being kept.sanitiing log to be maintained daily nitizer on hand reading above 200ppm ✓sanitizer to be at ppm of 50-100ppm. Vee scoop for ice machine broken cracked, replace ice scoop Ice scoop container had accumulation of mold and debris- thoroughly clean and sanitize container and label it ICE SCOOP ONLY. �-ice scoop stored incorrectly. Ice scoop to be stored handle side up in ice �g fridge where milk is stored,missing thermometer. provide visible accurate thermometer maintained at 41°f or below as mandated. ldar-no sanitizer available at time of N `nspection. Provide sanitier in spray type bottles at all times. L/,Nhite stand up freezer needs general cleaning of food debris. clean unit. ,./Microwaves need general cleaning. �ns stored on floor.store off floor at least 6-8 inches tory fridge, kenmore freezer had some uncovered food. all food in storage must be covered at all times �ay sink missing"sanitize"sign. provide sign. w -in fridge missing thermometer. rovide visible accurate thermometer maintained at a temperature of 41°f or below as mandated. Water, Plumbing and Waste PASS ❑ BLUE GeOTMS®2005 Des Lauriers Municipal Solutions, Inc. ( Rev. Apr 22,2005 ) Page 3 of 0007 DODGE STREET Dodge Street Bar & Grill Physical Facility FAIL ❑ BLUE t/stablishment needs general cleaning of food prep,and back areas. ns restrooms needs new toilet paper roll. replace. Poisonous or Toxic Materials PASS ❑ BLUE Special Requirements PASS ❑ BLUE Other-See Notes PASS ❑ BLUE GeoTMS®2005 Des Lauriers Municipal Solutions, Inc. ( Rev. Apr 22,2005 ) Paw 4 of 0007 DODGE STREET Dodge Street Bar & Grill City of Salem FOOD SERVICE ESTABLISHMENT - FOOD SERVICE REINSPECTION Inspection HACCP: ❑ Telephone: Item Status Violation Critical Urgency Nature of problem or correction 745-0139 Non-compliance with: Done Owner: Anti-Choking PASS ❑ Frank P. Presutti, Jr. Tobacco PASS ❑ PIC: Frank P. Presutti, Jr. FOOD PROTECTION MANAGEMENT Done - PIC Assigned/Knowledgeable/Duties PASS 91RED Inspector: Janet Dionne EMPLOYEE HEALTH Done Date Inspected: Correct By: Reporting of Diseases by Food Employee and PIC PASS ❑d RED 4/22/2005 Personnel with Infections Restricted/Excluded PASS RED Risk Level - FOOD FROM APPROVED SOURCE Done Permit Number: Food and Water from Approved Source PASS 0 RED BHP-2005-0311 Receiving/Condition PASS ❑ RED Status. Tags/Records/Accuracy of Ingredient Statements PASS RED Closed Conformance with Approved Procedures/HACCP PASS Q RED #of Critical Violations: Plans PROTECTION FROM CONTAMINATION Done Time IN Time OUT: Separation/Segregation/Protection PASS RED Notes: - Food Contact Surfaces Cleaning and Sanitizing PASS RED 109: Proper Adequate Handwashing PASS 0 RED Urgency Description(s): Good Hygienic Practices PASS RED BLUE: Prevention of Contamination from Hands PASS 0 RED Violations Related to Good Retail Practices (Critical Handwash Facilities PASS 0 RED violations must be corrected immediately or within 10 days)(Non-critical violations GeoTMS®2005 Des Lauriers Municipal Solutions, Inc. ( Rev. Apr 26,2005 ) Page I oft 0007 DODGE STREET Dodge Street Bar & Grill must be corrected immediately PROTECTION FROM CHEMICALS Done or within 90 days) Approved Food or Color Additives PASSd❑ RED RED: Violations Related to Toxic chemicals PASSd❑ RED Foodborne Illness Interventions TIMEITEMPERATURE CONTROLS(Potentially Haz Done and Risk Factors (Require Cooking Temperatures PASSd❑ RED immediate corrective action) Reheating PASSd❑ RED Cooling PASS ❑d RED Hot and Cold Holding PASS ❑Q RED Time As a Public Health Control PASS ❑Q RED REQUIREMENTS FOR HIGHLY SUSCEPTIBLE PO Done Food and Food Preparation for HSP PASS ❑d 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 GeOTMS®2005 Des Lauriers Municipal Solutions, Inc. ( Rev. Apr 26,2005 ) Page 2 oft !-j f ' CITY OF s4i=F-m. MASSACHUSETTS 77 . BOARD OF HEALTH 120 WASHINGTON STREET, 4TH FLOOR SALEM, MA 01970 TEL. 978-741-1800 FAX 978-745-0343 STANLEY J. USOVICZ, JR. JOANNE SCOTT, MPH, RS, CHO MAYOR HEALTH AGENT COMMONWEALTH OF MASSACHUSETTS PERMIT TO OPERATE A FOOD ESTABLISHMENT In accordance with regulations promulgated under authority of Chapter 94, Section 305A and Chapter 111, 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: Dodge Street Bar & Grill Address of Establishment: 7 Dodge Street Owner's Name: Frank P. Presuffi, Jr. Restrictions: Application Date: 12/7/2004 Permit for Food Establishment 206-05 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 17 b r CITY OF SALEM, MASSACHIUSETRe�,V,,' BOARD OF HEALTH s 120 WASHINGTON STREET, 4TH FLOOR D SALEM, MA 01 970 DEC , TEL. 978-741-1800 3 ?pQ¢ 0 FAX 978-745-0343 CITY STANLEY J. USOVICZ, JR. JOANNE SCOTT, MPH, RS, CHO BOARD pFSAt pW MAYOR HEALTH AGENT NE 2005 APPLICATION FOUR PERMIT TO OPERATE A FOOD ESTABLISHMENT ATN NAME OF ESTABLISHMENT I n`�Y& ADDRESS OF ESTABLISHMENT -�- -he)06 ; STUfT SXM IAAA-6V)+0 MAILING ADDRESS (if different) OWNER'S NAME ](L,A rJV,_ A"O`r) TEL# ADDRESS 124 1. vilkkol ,Tb Of, AY)iL CI it iR ST TE KA ZIP 01,W) CERTIFIED FOOD MANAGER'S NAME(S) VaaNL QQhsJYR CERTIFICATE#(s) 3413p6q (required in an establishment where potentially hazardous food is prepared.) y EMERGENCY RESPONSE PERSON1�1�C `CIVZ.SJ I'� HOME TEL Ak- HOURS OF OPERATION: Mon. V°ue. tI roved. 11"Thu. 1 VJ`_Fri.I3V(-Sat. f ,I P'_Sun.j '10_ TYPE OF ESTABLISHMENT FEE check only RETAIL STORE YES U less than 1000sq.ft. =$ 50 1000-10,000sq.ft. =$100 more than 10,000sq.ft. =$250 RESTAURANT ES NO �0�'05 less than 25 seats =$100 25-99 seats =$15 more than 99 seats =$200 BED/BREAKFAST YES 6D $100 ADDITIONAL PERMITS MAKE (not just serve) ICE CREAM, YOGURT, SOFT SERVE YES O $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 52C, Section 49A, I certify under the pains and penalties of perjury that I, to my best knowlgggd belief, have filed all state tax r urns and paid all state taxes required under the law. I-?_— z, o V. ill - (o`I' `{oa-Y Signatu Date / Social Security or Federal Identification Number -------- -------- - ------ -- ----- - --- -- - ----- Revised ---Revised 11/03/03 FOODAP2.adm Check#& Date yyn5 la--d CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH 120 WASHINGTON STREET, 4TH FLOOR a SALEM, MA 01970 .� TEL. 978-741.1800 FAX 978-745-0343 STANLEY J. USOVICZ, JR. JOANNE SCOTT, MPH, RS, CHO MAYOR HEALTH AGENT COMMONWEALTH OF MASSACHUSETTS PERMIT TO OPERATE A FOOD ESTABLISHMENT In accordance with regulations promulgated under authority of Chapter 94, Section 305A and Chapter III, Section 5 of the General Laws, to operate a Food Establishment in the City of Salem is hereby granted to: Type of Establishment: FOOD SERVICE Name of Establishment: Dodge Street Bar & Grill Address of Establishment: 7 Dodge Street Owner's Name: Frank P. Presutti, Jr. Restrictions: Application Date: 12/11/2003 Permit for Food Establishment 167-04 Frozen Desserts/Ice Cream Permit for the Sale of Tobacco Products These Permits Expire December 31, 2004 This permit is not transferable and must be reissued upon change of ownership or location. The permit must be posted in a prominent location in the Establishment, In accordance with the State Sanitary Code, before any renovations, improvements, or equipment changes are made, all plans for such must be submitted to and approved by the Salem Board of Health. HEALTH AGENT n e CITY OF SALEM, MASSACHUSETT ...�• .; BOARD OF HEALTH (ie� ,- • 120 WASHINGTON STREET, 4TH FLOOR SALEM, MA 01 970 DEC 4 —2003 TEL. 978-74 1-1800 FAX 978-745-0343 CITY OF SALEM STANLEY USOVICZ, JR. ,JOANNE SCOTT, MPH, RS, CHO BOARD OF HEALTH MAYOR HEALTH AGENT 2004 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT NAME OF ESTABLISHMENT N1')DD6-F, STQL&f &Tt" 6�IZ44, TEL# q-'f' 3y' --6)39 ADDRESS OF ESTABLISHMENT 4 DOD" 6S1t elm MAILING ADDRESS (if different)) OWNER'S NAME �, 1L P450-m JlL TEL# Of f�W dbS ADDRESS 100 UVIIXSa0& AIL CITY STAT kAA- ZIP Ol<i/`S CERTIFIED FOOD MANAGER'S NAME(S)�AW- f2esO-7--ji :Trq_CERTIFICATE#(s) -ZZ L/ / (required in an establishment where potentially hazardous food is prepared.) ti EMERGENCY RESPONSE PERSON T IfktJV- ht6T11) HOME TEL# HOURS OF OPERATION: Mon.1'1 Tue.N'/ Wed. q-1 Thu.y-1 Fri. /Pl Sat. 12'/ Sun./k 1 I\ P► TYPE OF ESTABLISHMENT FEE check only RETAIL STORE YES less than 1000sq.ft. =$ 50 1000-10,000sq.ft. =$100 more than 10,000sq.ft. =$250 RESTAURANT YES NO 1 V b 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 $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, Ir certify under the pains and penalties of perjury that I, to my bestwledge and belief, have filed ig re , �tt/tax�turns and paid all st�a taxes r 0ireluid er the law. � � ZDV OZ6/M S bate / Social Security or Federal Identification Number ---=----=-------------------3--------------------------------------------------------------------------------------------------- Revised 11/03/03 FOODAP2.adm Check#&Date %�n�• /r�-'Y' 'Q-3 CIL 71- 1 5 �� � G � 7V 3g5 f# 3I i i Massachusetts Department of Public Health Salem Board of Health 120 Washington Street,4th Floor Division of Food and Drugs Salem, MA 01970-3523 FOOD ESTABLISHMENT INSPECTION REPORT Tel. (978) 741-1800 Fax (978) 745-0343 Name ON Tyoe.of Ooeration(s), Tyoe of Inspection Oo()fIF rme-xr &c a 6yLea /0//l�Qy Food Service El Routine Address �� Jc Risk [-IRetailLE Re-inspection Leveled El Residential Kitchen Previous Inspection Telephone P ❑ Mobile Date: Owner let�Awr PN frd rl d X HACCP Y/N ❑❑ Caterer El ❑ Pre-operation ❑ Suspect Illness Person in Charge(Plc) Time El Bed& Breakfast El General Complaint Inspector In El Other rFrlvCeGr1P�.AzJxA � Out: Permit No. Each violation checked requires an explanation on the narrative page(s) and a citation of specific provision(s)violated. Non-compliance with: 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 El2. Reporting of Diseases by Food Employee and PIC ❑ 3. Personnel with Infections Restricted/Excluded [:114.Approved Food or Color Additives FOOD FROM APPROVED SOURCE El 15.Toxic Chemicals ❑ 4. Food and Water from Approved Source TIMErrEMPERATURE CONTROLS(Potentially Hazardous Foods) ❑ 5. Receiving/Condition [116.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 Q,,19'. Food Contact Surfaces Cleaning and Sanitizing REOUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) E] 10. Proper Adequate Handwashing E]21. Food and Food Preparation for HSP ❑ 11. Good Hygienic Practices CONSUMER ADVISORY ❑22. Posting of Consumer Advisories Violations Related to Good Retail Practices Number of Violated Provisions Related Critical (C)violations marked must be corrected To Foodborne Illnesses Interventions immediately or within 10 days as determined by the Board and Risk Factors (Items 1-22): of Health. Non-critical (N) violations must be corrected Official Order for Correction: Based on an inspection immediately or within 90 days as determined by the Board today, the items checked indicate violations of 105 CMR of C Health. 590.000/federal Food Code. This report, when signed below 23. Management and Personnel (FC-2)(590.003) by a Board of Health member or its agent constitutes an 24. Food and Food Protection (FC-3)(590.004) order of the Board of Health. Failure to correct violations 25. Equipment and Utensils cited in this report may result in suspension or revocation of (FC-4)(590.005) the food establishment permit and cessation of food 26. Water, Plumbing and Waste (FC-5)(590.006) establishment operations. If aggrieved by this order, you 27. Physical Facility (FC-6)(590.007) have a right to a hearing. Your request must be in writing 28. Poisonous or Toxic Materials (FC-7)(590.008) and submitted to the Board of Health at the above address 29. Special Requirements (590.009) within 10 days of receipt of this order. 30. Other DATE OF RE-INSPECTION: S 501n9 dFom6-14 ooc J,Inspector's Signature h i1 �' /= Print: r I ,t PIC's Signature: �" � Print: Page ( of /Pages . - Violations Related to Foodborne Illness Interventions and Risk Factors(items 1-22) PROTECTION FROM CONTAMINATION FOOD PROTECTION MANAGEMENT_ _ 3 Crass-con:aminzrion 1 1 590.003(A) ASSiglltnentOt Re.sponsib:lit}" I 13-307.11(A)t 1) Rim Ani:ral Foods Se1'araed tion 590.00A(W Demonctralion of Knowledge; Cook ,i and RTE F u&* 2-103.11 Persou in charge --duties ( Contamination from Raw Ingredients 3-302.1 1041(2) Raw Animal Foods Separated from Each EMPLOYEE HEALTH Othcr' 500.003(C) Rrsponsibilil.;of the person in charne to Contamination from!!,,a Ervironment r require reporting,by foal employees and 3-302 11tH) Raul Protec.t:on- applicants* 3-3w.1,5 GVaahrne Fruits and Vegetables 590 003(F) Respnnsibility Of A Prod Employee Or An _ *i �4.?1 Food Contact with Equipment and Applicim: To Report To The Person In ! ! !r" Lttenci , Charge" ( Contam.hattbn from the Consumer i 590.003(G) Reporting by Person in Charge^ 3-306.14(Ae B) Reuuned Fund And Rctiereice of Fool,':' 3 1590.00,0) Erclusvms and Reshietions" Dicposll:cr.of Adulterated or Contaminated 790.003+E) Removal of Exclusions and Restrictions Food 3-701.i I Dis,arding or Re_onditiomng 1'ncafe FOOD F 30M APPROVED SOURCE Food 41 Fond and(Nater From,Regulated Sources ( 9 Food Contact Surfaces 590.004(,",-B) Compliance with Yood Law" I +-5Ol 111 Manual Warewashmg-Hot Water 1 3-201.12 Pkd in a IIeunetiodly Sealed Container" Sant:mtinn'I'emperatares'* j 3-201.13 Fluid b4ilk and Mdk Products* I ( 4-501.112 h�L nbanical Warew'ashing-I-1ot Water ! 3-202.13 Shelf Eggs* ' Sanitization Temrpeiuies' � 3-20'_.14 IsRgsandMilkProduct,. Pasteurized^ ! d-i0i.tl-! Clrztmeat;anitizstion temp„ pH, 3-202.16 Ice blade From Potable Drinl:in_- Yater' � ! coneennation and hardness. " l 4-601.11;A) Equipment Fcxt:_)Contact Surlaczs and +-101.11 DrinkmaW'ateri'nnu:m.4pla-oredS}stem" Utensll: C-leanx 590.006(A) Bottled Drinking Water' G?+t;7,I1 Cleaning Freynencv of Equipment Food- 590.006(B) Water Meets Standards to 310 CNIR 22 0" Contact Surfs el,and 1ltatcils" Shellfish and F;sh From an Approved Source 1 4-701.i i Frcqueucy of Sanitization of Utensil,,and 3-201.14 Fish and Kecrcalinnallp Caught Molluscan Foal Contact Surfaces of Euuiprnent* Shellfish^ 1 � 4-703.I I htethodc of J:+mii'n+tion-Hot Wateruxi 3-201.15 Molluscan Shellfish lion NSSP Listed Chemical SOLRCC,0 ( to Proper,Adequate Handwasning Game and Wild Mushrooms Approved by „ Regulatory Authority --301.1! Clean Cor:drzion --Fiands and.4nr.:. 3-202 18 Shellclock Identification PrestaA* ! 1 2-301.12 Cleaning Pteeed:arc' I 7?Q0041C; W'dd Muchrrotm' 2-301 W W1icn to Wish* :3-201.1 r Wsnte Annuals* ' I t Good Hygienic Practices S Receiving/Condition 2-40 m 1 11 Eating, Drl Ingot Ucing Tobacco' 3-302.1 t Plies Recz,rid at Proper Temperatures" 2-4;1 L 12 Di;scl:m res Froin the Eyes.Note:rod 3-20'.17 Package httegnh•" klonth" 3-(01.113-301.1^_ I'reronting Contamination W?:en Tasting Food Safe and Unadulterated" ( 2G Prevention of Contamination train Hands 1 6 1 Tags/Records:Shelistock 3-202.,E SbelLoakldentificatinn" I 790.0"WE) Prc,-entiug Couhnnination from 3-103.12 Shell mck Wnufreation Maimained' 1 Er,-,pioveee:: Tags!Records: Fish Products 13 Handwash Facilities j 3402.11 Parasite De:diucrion* Conveniently Located and Accessible 3'2'03.1 I Ntanb ets and Capacitics° -40'_,12 Records,Creation and Retention* Labeling of Ingredients' `-24,.11 Location and Placement" 5`)O.tiO4t.li g 9 7 Conformance with Approved Procedures - ( `-205 11 Accessibrii;y, Operation and Maouemmce /HACCP Plans Suppdcd with Soup ono hand Drying z -ti_. - - Dev:ce? T Yi Specialized PincesAng Methods* � 3-502.12 Kcduced oxygen packs__IDR,criteria" ! ti-301.:7 Iandwssi;:n Cle.u::,er.Avai:alnh;y 9-103.12 Conibrmance with Apptoced Pnxerlores' 6-361.12 Hand Draini_>Provision ''Deno.dc naval nem i❑Ih:;Iedasi N90 Fnwi Code of 105 CKIR 50:),0(10 CITY OF SALEM BOARD OF HEALTH . Establishment Name: n0006* yr, 6A0t--j- IvAil.L Date:,`,/a//r/a L4 Page: Z of 2 Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date l No. Reference R—Red Item Verified PLEASE PRINT CLEARLY �/ c C�,�Tt,rlt�' /�JA,tet s �PNIr err„fid f:�n _ I vi a//� a L ria�' cu.Jl�ic� rM.✓,� ,g t���I rJ,�,�rt�n. mf-�L c�v"tt��>�- tl�dL►a-n�rf case , � ��(�/ail /�rs�a��te,✓ �i"a� t � . I 1 1 h Discussion With Person in Charge: Corrective Action Required: I ❑ No I ❑ Yes 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 L3 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 El Embargo ❑ Emergency Closure your food permit. �> /// � ❑ Voluntary Disposal ❑ Other: r li 3-i"L:'1(C; PHFs Reczrved at il'emperatures Violations Related to Foodborne Illness Interventions and Risk According to Law Cooled to Factors(items 1.22) {Cont.) 4i^FA5-F Within d Hours. ' ! PROTECTION FROM CHEMICALS ( +-'')1,15 CooImg 1v1cJIA i for PHE±. td Food or Color Additives 19 PHF Hot rind Cold Holding 3-ti01.16(B� Cold NIPS Maintained at or below 3-202.12 Additives' 5v 1)O*F) =:1'/45° 3-302.14 Pro!ectiou from 1 inaoproitd Additives* 3.501.16(A) i(oin t FHF; Maintaed at or above 15 I Poisonous or Toxic Substances - �dO,F 7-101.i 1 itlenUtyurc Inio±'m.a:on- Or:gmai ;-Sill.i{,(A) Ruasfs Held at ui above 130°F. Containers" - 7-102.1 1 I Conuuon Name-Working C'ontainera* � � 21) Time as a Public Health Control 7-20 1.11 Separation-Stellate; 3 `''-'1.19 Time as a Public RCalth C'ontiol* 7-202,11 ( Re;trichon-- Presence and Lae" 590.004(H) Vari;iuce Requirement 7 203,11 'toxic on;of Use" REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7 ?ri3.1 l ( toxic Container!. - Prnlrh,tions" POFUE.A'liOtaS(HSP; 7-2011.11 ( Sanitizers.Criteria--C'beniic,ds^ .i 3-So! I i L1) Unpasieunred Pre-parkaged Juices and 7-1030'' ( Chemicals for lVashme Produce,CI iteria" !: , 7-204.!,f Dryin,Agents.CriteriaT Be,eraees with Warning 1..abels' ' 7-205.1 1 Incidental Food Contact, Lubricants 1 ?-SoI IItB) i Use of Pastearized E'ne;` i ; .0I.I it D) I Raw or Partial ly Cookeu.Animal F.-a,d and 7-206.1; Rectrictcd Use Pesticides.Criteria* ; Raw, v 1 Not x 7-206.12 Rodent Bait Stations" ( See:.5 gouts ! r t Szrved. ' j 3-90 L i t(C) Uncpencd Few I] Package Not Re-served "06.t 3 rrzr:kmg Powder:,Pest Control and Monitoring T CONSUMER ADVISORY TIME/TEMPER'%TURE CONTROLS 22 3-603.11 Consa:aei Advisory Posted for Consumption of Animal Foods'That are Raw Undercook,-d or Iti Proper Cooking Temperatures for Not Othcncrc Processed to Eliminate PHFs E""'1n:aoor 3-41)1.1 iA(U(2) Eggs- 155'F IS -302.13 Paseun Sec. j F'atteliti ;.- Eggs-hnmediate Service 14-7'15sec* 3Teti Flag: Subetitaie P.rc Raw Shell 3-401.11(A)(2) Comminuted Fkh,Mzats &GauzeI ( Eggs* Animals- Is5'F 15 se(. '' 3-401.11(6);I)(2) Pork and Beef Roast- 130'T 1'21 min t SPEC€AL REOU€REMENTS 3-d,tl.11(AI(2) Ratitcs, InjenedMzats- 155"Fi5 590 009(A':(D) Violations of Section i90.009(A)-(D)in sec, + catering, mobile food. temporary sod 3-401.1 I(A)(3) Poultry,Wild Game. Stuffed PHFs, residential kitchen operations should be Stuffing,Containing Fish, Meat, dchited under the appropriate;sections Poultry or Ratites-165`F 1:5 sec. "` above;f rciatdd to i:xrdbornc il!n ess 3-40!.11(C)(3) Whole-muscle Intact P,eef Steaks noterventions and risk factors. Other 145°F 590.009 violations relating to good retail 3-401.12 Raw Aminai Fords Cooked in a I pfact;cea should be debited under /129- Microvave 16.5"'F* Special Requirements. -401.1 1(A)f i 1(b) :All Mier PHFs-- 145'''F 15 sec 17 Reheating for Hot Holding ( ViOLATIONS R;LATED TO GOOD RETAIL PRACTICES 3-403.11(A)&(')) PHPa 165'F 15 ;cc. " ( (items 23.30) 3-403.11(6) Microwave- Itis° F2 'Minute Standing I cluirvri and non-rri!ira!viok+iro":x, IVII0Z donot relate to the fiauHrrrne illness intc,ventions and itsk t e twx hw.,V above, curt be C3-403.11(C) Commercially Processed RTE Fciod - i fmirxal in the jDUnm-n{g svrtiruis of the F(,a«Code and 105 Chlk 14071 590.901). 3-403.11(F) Renan inng ilitsliced Portions of beef I r_Item wood Retail Practice., FC 590.000-1 Roasts* 23. ktar+atiem=nt and Persornel FC-2 .003 1 Ift Proper Coaling of PHFs 24. Food and Food Protection FC 3 .004 � 25. Gquioment sad Utensils FC-4 005 3-501 1-4(A) Cooling Cooked PHFs from 140`F to c - ----- i 26 Water, Plumbino and Waste FC-r� ; X06 70 F W:thin 2}lours and From 70'F i 27. Physical Facility FC-6 I, .007 � :o 41'8145`F Within a Hours. * 28. Poisonous or Toxic A4ate.-As FC 7 .008 J 3-50! id(B) Cooling PHF:.Made From Ambient ( 29. Special Rcevirements .009 Temperature hitTedients to 11t'F/d5`F 30, Gtl:er Within 4 Hours t 111,F,, 1,,11-21, 4 Despite,critical Item In ih'.Federal I09'i Fond Codt.,r 105 CNIR 590 n0o. Massachusetts Department of Public Health Salem Board of Health 120 Washington Street,4'" Floor Division Of Food and Drugs Salem, MA 01970-3523 FOOD ESTABLISHMENT INSPECTION REPORT Tel. (978) 741-1800 Fax (978) 745-0343 Name � Date Tvpeof Ooeration(s Type of Insoection D6 D6 D&IF 4n&&r ImR t a&f- /o/Sr ay 9�Food Service i0-RSutine Address Risk ❑ Retail ❑ Re-inspection "7 060« Si` Level ❑ Residential Kitchen Previous Inspection I Telephone `715-`6/79 rs-�, El Mobile Date: Owner HACCP Y/N ❑ Temporary ❑ Pre-operation r 44141( P!t&TLf M 19 J ❑ Caterer ❑ Suspect Illness Person in Charge(PIC) S ' Time ❑ Bed&Breakfast ❑ General Complaint Ins ector In: ElHACCP P i*414 (LAK t✓b A-uM 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 ❑ 14. Approved Food or Color Additives ❑ 3. Personnel with Infections Restricted/Excluded ❑ 15.Toxic Chemicals FOOD FROM APPROVED SOURCE TIMEITEMPERATURE CONTROLS Potential) Hazardous Foods ❑ 4. Food and Water from Approved Source (Potentially ) ❑ 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 VEJ Separation/Segregation/Protection El 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 E] 10. Proper Adequate Handwashing ❑ 11. Good Hygienic Practices CONSUMER ADVISORY ❑22. Posting of Consumer Advisories Violations Related to Good Retail Practices Number of Violated Provisions Related Critical (C) violations marked must be corrected To Foodborne Illnesses Interventions immediately or within 10 days as determined by the Board and Risk Factors(Items 1-22): of Health. Non-critical (N) violations must be corrected Official Order for Correction: Based on an inspection immediately or within 90 days as determined by the Board p 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 4. Food and Food Protection (FC-3)(590.004) order of the Board of Health. Failure to correct violations 25. Equipment and Utensils (FC-4)(590.005) cited in this report may result in suspension or revocation of 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:1 6 S 5WMSre UFO/ 14 dO ?/�� (/ Inspector's Signatures ! -e C�_ A I __ Print: I Q PIC's Signature: I ✓r-ca_rPrint "��N u '� �t I Page of ✓Pages K'Wations Related to r-crodborric-1111ness !m4orventions and Risk Fachirs(ftems 1-22) PROTECIAON FRON1 CONTAMINATION FOUL)PROTEClr�N MANAGEMENT grss-c,-,olom;natlon 1 --90003('0 102.1 1 L'00, f�-,10 F!',\ Aniand Foo-6 11 i ('A.oked and RTC Food.,'c 2-103 11 ion in ch:,x,e--dutie, I Contamaiatrrn hum Rau iri 3-;02.1 IIA if 7) Rt:v, Animal F(,tyJ,,Separated trom Each EMPLOITE HEALTH ottwr" I 5' Conminnatiop,tiom 7,e)L)i)A03f("i R,-�p,mibdib. of ttic-per,on In tbaigu v, ilquia, by f,;,;d employeff,and Yrtt 11L WR applicants, 13 -02.Ce W,.ifinn:rru:i'ajitf Vc;Otabjes 590 05-,{F) Reilrumabifiiy Of A FoiA rjnp!u.vte Of An 3-30-1.: i Food Contact with Equipment and \pplicarit To Report To rhl Pcrson b,. UfCrmls" I Charge i- Contamun.1tion ftor:din.Consumer 590.00+((i) E,-Portirw by Person in Charge* 3-306.14(A)t N) Rvairred Ftx;,;and of Fond" 3 '-MI D) Exc1n.,jorts and 1,C,,rfi,ctiuns* Disoo:4,al orAduYelatec!of Coiiamirated 59ff f1f I i([;' Remo�al of'Exclinsion z ami kQ,tr:vi;on, Food 101 11 1);,cmilng u! Prcorkdktionnu!I rsafc FOOD F-10M APPROVED SOURCE 4 1 Food and I'Vate, i rm;Prgolted Sour-es Fred Contact Surizces 590 W4(A-Bt Compinticewith P(Rd Le, I I I N',mimal rkaj�wwhin�q Hot-Water Sarnttznvoii r�mperat:,r-s: - 201.12 rend in a fierntelicaNy Sealed C ontairwi^ 3 -,Oil 13 Fluid Milk ono Mill:Pr,)duc:s .1-5(11 1 ill M-dranif;ji Warewx;hira- -lot W"Vel. SnnitrattionTeulp�ral 3-2 1-3 S1101 El�gs 3-501,11 oiclitir'd sarntiz'��uon-tmip.' J)H' 3-202.1 Pecs and Milk Projitets. Paskliiwed 3'02.10 Ice tMad, Pruitt Portbie Dunking Water 4-60 L! 1 F ri Corinto Surfaces and 5-101.11 Di i ithirin,Wates from an Aflprnved SVsIem�t '--,f)o.00f(A) lit;fircd Drinking,Water'r Utensfls Ctcanl !-W' I I (De.ining Fottitienc, of Equipitaii',*FuoJ- 590.001,(B) Witter hurts�nkndiud!, ir 310 CN4R 12.W . coma,; surface:aird Lieriqils. SPell!;sh ana Fo5h From,an 4pproma Sounco. F ^-'NA 14 Nsh 4-702,;i '!'c,�4"e1WY Of S�'IiJzN!t.0 01'Ute"LlitS Ind FmA C-tuact Surfaces Of i�LjVipinenl* -7,)-..11 Meflio&6- H' ot W:ir"and 3-%61.17 Molluscan Sheilfish fron, NSSP Li,ted Chemic Sourcesl Proper,Adequate HarulwaLMnip Game ivml M/d Approved by Requfatoty ALIftrit, 2 11 Clean Cojt(Niion - Hands nid Armh" 3-202.58 Sh,11stock I'dentific-aum Preseni- -(:1.12 Uenning, Prix 2-3W.id When Ln\N*&�Itl� 500.00 41:" Wild NlustuoonL'il '-201 17 Gamie Ainjuahs" 11Good Hygienic Practices -!01 11. E it Dr nhaw or LN;na Toba(:co-- fleceivingiCondition 2-10 1.12 D;scfil-iz�s Morn the Ntx--•rnd 3-262.: PtlFs R,ceiyed ,,Prop-t YvinprratumO I 'I3-2112 ii Package hit,,,mty* Moont" 3-301.12 i 'revenfint,C.mtomiriation Whcri Twine I Fort I S;i fe find t.T a s]I if te qj i,�Z(I Tags/Records,She(lstonk Prevention of Coritairrdnstion from Hands 3-202.18 ShePctock identification ' '90F) Prcvcc,.,irl, From 3-203.11 Qhefisto.'k Identification Maintained"' EnrplU)cec^ lags/Records:Fish Products Hnr.dv;ash Ficilties, CQ::vvmenthl LOCI-t6d and A-cwm`vie it Piias:te Destpiction" 12 Recv,-ds,Creadvn and Petcnti,m Loituai and Placemen'' `90.GMI.P) Labeling of ingredients' 7 Conformance with Approved Procedures I 5-20,i,i Actes'mbiky. Operation an'-, Maintellaric, iHACCP Ptz :; I I D,p n- 1 S:-polad with Soap and Hand o.7 i i i es 11 Spe,:ah7cd P:oe,',;utc Methods- I I o-3('i.] 1 fiandw:e�hurnz0e.ar�cr. Avuflitbifity Reduced oxygen pact'al-ing,crit,ria 1 -103.12 Conformirv_-e mith Approve,4 Pioc&d:ces" 6-301.12 !land DrvmG 1.'.,n,le,crtit-41 nem:n the federal F,,wl 0, e or "6 CMR i0ls OW. CITY OF SALEM /1 BOARD OF HEALTH / Establishment Name: Obl)&E SYA&igf - /Art t-GKt&_ Date: /a/t�d-e Page: 2 of Item Code C-Critical ItemDESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date No. Reference R—Red Item _ Verified PLEASE PRINT CLEARLY tuEs tt►t /r.4c� Eeb�tO Qr�v. t bo<or.G+sr� tw�r .k /E.r.Nct .a,r6) AAWlill I 2S tr� ✓ArfdO � .J�rFOP n .Yr.,iwrtit Jzd./rti�r/�/Bv �,/D G 1'NrP112- g i Germ..r� /Sr,yHr17J' Seto-s✓� !> .s�(t rc"Ctii . -11C 10G4 C. A--t.` C'L4T,,A& ffvAl>r,OT r 2.5 rI�C � �a hhAs ,a,s t4�er,rAut/Qnr/ ot- ltnia '00AIS to-HO rWfA/Oso' PeO.- d06mAt✓ GUCAri ASK N, i I I r - A(toUt n&F S.onrt tr7 Zt Ftp _ALAr Orf 1W FW(K CZIvA.nozr A-r— A-u— V7.u,FS I ��? td ad r.nlc" art i'1 iSrf & Aw w ./=,e Gierf6 �OaiCf*,e Pv54— ieJ 0IN1NG A"A r e�Glwfll uf►QSteF-tNtS' ./9Fs"•A9N ["D X'fr OdODS I rr�tJdO t'15taP+' //�(f.dCaiM r rJ C'�ad2GF Discussion With Person in Charge: I Corrective Action Required: I ❑ No ( ❑ fes i 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. 0 Voluntary Disposal ❑ Other: ! i-i,)l.i-I(%} PHSc iirrrieect,n'1'c nuxratums Violations Related to Foodborne Illness Interventions and Risk According to I aw Coined to Factors(items T-221 (Cont.) 4t"F'+5'F Within d Hoots. x PROTECTION FROM CHEMICA 5 501 IS Bolin;,?.5.- wds(orPfibs 14 Food or Color Additives li 1 P'F Hot and Cold Holding 3-5U1.!6(Lt) i"oldP;IF:,Maintained itorbeluw 3-202.12 Additives" 590,0fWF) 3-302.14 Protection (turn Unamuot'ed Additive,` -501.16iA) Hot PHFs Nlawtamed at ur abrne I t5 Poisonous or Toxic Substances j 7-101.11 Identifying lnkn-:t:.rinon--Orig40'ins) ( - '-SO Roast's Heid lit or above 130'F, Con!mrers" � ! 7-102 11 Common Name-WorkIne containers' <0 j Time as a Public Health Control 7-201.11 Senaruion-Siw gee' i 3-50?.19 Time as a D!bhc H,aith Cur•)roll j 7-202 I I Restriction-Presenceand Uses I � .UGh H) I Vat'iance Requirement 202.12. Conditions of Use" 7-203.11 roxlc Containet., --Prohibitions" REQUIREMENT:S FOR HIGHLY SUSCEPTIBLE j 7-204.11 Sanitizers,Criteria- Ch..::ikals'" , 2t ! 3POPULATIONS(HSP) -801.1!(A) Unoastvarized Prv-'acka^ed Juices and 7-204.12 Chemicals G,r wasting Produce Criievia' i Beve:a}-es wr8t b�'.0 nmg L:tbets'. J j 7-20-4.14 Drying Agents.Crtter;a" 3-80l.i l(F) Use:d'P:::tentized Eect' j j 7-205.11 Incidental Food Contact Labne,mts" 13 u'01.I}:p) Rawur Pa tially Cooked Animal Fond mut 720611 Restricted Use Neslic tries.Cascara:* hiCu ;.cod Sprouts Not Served. ' 17-206.12 Rodent Bait Sutton," ! y-gO) 11(C) t)nuptt?ed Paxi Package tint Re-sewed. " 7-206.13 Tracking Powders,Past ConttcLmd Monitoring- CONSUMER ADVISOR'/ 12 3-c0_.': ! Consum.r Aevisory Poston for Consumption of TIMEtTEMPERATURE CONTROLS Anii:•at F( 16 are Raw, Undercooked on 16 Proper Cooking Temperatures for I PHFs ! `x`^t!')thetwnsc rrocee5cd to Eliminate Ile, 3-401.11A(I)(2) ELits- 155'F15Sec. "case.^era.,.r: .)o, u I Eggs-bunteriiate Service 145°'15scc 3-3C2.I i faste::n.zd Cg2s Substitute for Rats Shell i3-401.11(A)(2) Commutnted fish:,A1c.us Fc Dante Eggs« An I inais - I55'F I>sec. ' SPECIAL REQUIREMENTS 3-40 L 1 I(13)(1)(2) Park and Recl'Roast- 130'F 121 min$ 59O 0,09(A) , r c } -40L11(A)(,.) Ratrtcc, (njectcdA9cats-155'F IS i ,D) Violations of Section 590.ti(1J(A)-(P in seC. :r cateringg, inutile far[, lemporary and 3-401.11(Au 3) Poultry,Wild Gamc, Stuffed PHPs, re;.idential kilchen operations should he ! Stdfing Corrminirw Fill, Nlear, dehited w',der the appropriate secu-ous Poulby or katitcs-165T 15 sec. ibcve if related to foodborne illness _i-1O1,11(C)(3) Whole-muscle, Intact Beef Steaks inrenvs?tions and risk factors. Other 145°F 590.009:dolations relating to good retain 3-401A2 Raw Animal Foods Cooked in ai prauice,should be debited under#29-- Microwave 165"F* Special Requirements. 3401 11(A)(1)(b) All OtherPHFs- 145c 15 see. ^ I 17 j Reheating for Hot Holding VIOLATIONS RrFLA TED 7.O GOOD RE rAIL PRACTICES 403.11(A)&i D) PHhs 165''15 sec. * j (Jms 23 te -30) 3-403.11(B) MiLRMuve- ld5o F 2 Minute Standing_ Critical an<'non-critical t^olatimm 'much do opr relate to the Time"- joodbarae dlneis rnrenention,s rand risk fiu-tors ti.,ted above, can be '-403.11 CC) Commercially P.o,,essed RTE Fo,)d- found in the fill/tieing ser nuns nI the(a,rl Cede and 105 C'AIR 140°17'' _500,00(1, 3--:03.1 HE) Unsliced Portions of Beet Item Good Retail Practices FC 530.000 Roasts* 1 23. r/enaltemont and Peronnel FC-2 .003 18 Proper Cooing of PHFs 24. Food and Focxi Protection FC-3 .004 j 25 tq:::Pmeni and utensils FC-4 .005 1-501.14(A) Coding Cooked PHI-s from 140`'10 2' Water,F'!umbinq and trdasie Fr;--5 006 I 70'F Within 2 hour::and From 70'F 127 Physical Fnci!:ry FC-6 007 to 41"F/45"F Within 4 Hours. '' 28. Poisonous or"Toxic,Material FC--7 .008 4 1.14(B) Cooling PHFs Made From Amb'ent j 29Specia!RCgllil'sments 009 Tempe:atweIngredients to4i�F745"F 30, Other 1 I Within 4Hours wr,,::,,.za., *I gem ae� 1-Tnsal gem In the[`doral 1094 B,I0,lode of 105 UNM 590 0401, 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 n 3' Date Tvpe"of ODeration(s), Typelof Inspection Po%WfG Sf .(' IP 9e 9,0164- -/1-011 I [ErFoodService 1Z utine Address �� Risk ElRetail Re-inspection o Level ❑ Residential Kitchen Previous Inspection Telephone 7yS� 3g EI Mobile Date:3 .-3_pt/ Owner �P Ao.n HACCP WN El Temporary El Pro-operation -'ediN/ PPSrei T/ Tie I ❑ Caterer ❑ Suspect Illness Person in Charge(PIC) S + Time ❑ Bed&Breakfast ❑ General Complaint � I inspector Out: HACCP Permit No. ❑ Other p (/ /L/rvs�rnkrs � o Each violation checked requires an explanation on the narrative page(s) and a citation of specific provision(s) violated. Non-compliance with: Violations Related to Foodborne Illness Interventions and-Risk Factors Anti-Choking Tobacco Violations marked may pose an imminent health hazard and require immediate corrective 590.009(E) ❑ 590.009(F) ❑ action as determined by the Board of Health. FOOD PROTECTION MANAGEMENT _ ❑ 12. Prevention of Contamination from Hands ❑ 1. PIC Assigned/Knowledgeable/Duties ❑ 13. Handwash Facilities EMPLOYEE HEALTH PROTECTION FROM CHEMICALS El2. 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 ❑ 4. Food and Water from Approved Source TIME/TEMPERATURE CONTROLS(Potentially Hazardous Foods) ❑ 5. Receiving/Condition ❑ 16. Cooking Temperatures ❑ 6. Tags/Records/Accuracy of Ingredient Statements ❑ 17. Reheating ❑ 7. Conformance with Approved Procedures/HACCP Plans ❑ 18. Cooling PROTECTION FROM CONTAMINATION ❑ 19. Hot and Cold Holding ❑ 8. Separation/Segregation/Protection ❑20.Time As a Public Health Control 0 9. Food Contact Surfaces Cleaning and Sanitizing REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) ❑21. Food and Food Preparation for HSP [110. Proper Adequate Handwashing ❑ 11. Good Hygienic Practices CONSUMER ADVISORY ❑ 22. Posting of Consumer Advisories Violations Related to Good Retail Practices Number of Violated Provisions Related Critical (C) violations marked must be corrected To Foodborne Illnesses Interventions immediately or within 10 days as determined by the Board and Risk Factors(items 1-22): of Health. Non-critical (N) violations must be corrected Official Order for Correction: Based on an inspection immediately or within 90 days as determined by the Board today, the items checked indicate violations of 105 CMR of Health.N 1 590.000/federal Food Code. This report, when signed below 23. Management and Personnel (FC-2)(590.003) by a Board of Health member or its agent constitutes an 24. Food and Food Protection (FC-3)(590.004) order of the Board of Health. Failure to correct violations 25. Equipment and Utensils (Fc-a)(sso.00s) cited in this report may result in suspension or revocation of 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)(990.008) and submitted to the Board of Health at the above address 29. Special Requirements (590.009) within 10 days of receipt of this order. 30. Other DATE OF RE-INSPECTION: 5 5XInsp aFom 14 do Inspector's Signature: Z//," Print: PIC's Signature: Print: fr y y Pr-e S V hli Page of Pages Violations Related to Foodborne Illness Interventions and Risk Factors(ltefrts 1-22) PROTECTION FROM rONTAPL]NATii°Pi FOOD PROTECTION MANAGEMENT j S Gross-contarrdrttfrr, � i 5041.0031 A) Assignment of ResponsibilitvT 3-302.11(A)(I) Rim Animal Foods Separated from 590.003(B) Demonstr nun,*,of Knouirdge.* Cook,d anti R'I'F.Fends* 2-103.111 Person in charge-duties I on'a;;inatian frnn-,FtaIv tngredent; 3-302.11tA.i(2) K.;st Animal FtKtds Separated front Each EMPLOYEE HEALTH I (uhr: 2 590.003((') Renpom,ibility of the,-r-rsor ut charge a; 1 I Contamfnatton f.•orn zre Environment ! require reporting by food employees and I ?-102.1 l(A) Foal Protection" `v ashin,Favits and b egetables f 590 003(F) Responsibility 011 A?ood Employer Or An 3-70d.1 1 Food Contaa with 1-,gtnp-rent and Applicant To Report Tn The Person in ( fLen als* Charge' Contammawn r.an;the Consumer 490 003(G) Reporting n by Person in C'hat,r" 3-:06.1-U Rrhuned Food and Rc:;.:n^ce of"Food' ( 1 31 590.003(D) Hxclumonsand R:strictions" ( I DISpositionofAdulterated orContarninatnd 1590.U;;3(i ) Remove:(of Exefusion;and Restretions. Foo.-' -701.11 Discarding or Reconditioning Lnsaf, FOOD FROM APPROVED SOURCE Foody 41 ( Food and Water Free-Pegutatecl sources ( E 9 Food Contaot Surfaces 590.0040-B) Compliance as--itt-.Food Lat,-r I 4-501.1 11 Manual Warewa,hn;;- Hot Water 3-201.12 I Food in a Hermetically Sealed Container* Sanitization Temperate:<s=` � 3 301.13 Fluid Milkand bulk Products` 4-501.112 lvfeclr:nl,al We.r:v.ashin1_lint Water I ?.,2;;2 13 Sheli Eggs:' Sanitizaoon Tcn;p:r-hr e.x „ ( 4-501,114 t_'hrmicalSanitization-temp.,pH, -..02.14 Eggs.aril bulk F'nxiucu.Pasteurized' concenhation and hardreas. ,a i-202.16 ( Ice blade From Potabic Drinking Water' i 4-601.11(A) F o;-p-.rent Food Contact Sm-faces and 15-i(ll 11 Drinking Water from an Approved Svcrc n' 590.006(At Bottled Drinking Water;' I Utruein Frequency ^ 4-603.11 t.'Iraninn Frznuency of gmpm:n: Fond- I _590 0ph(B) Water Meets Standards rt 3 10ppr CMR 22.0" : Contact Su fr.ces and Utensils' I 5hel'iish,and Fist;Front an Appro��ad Saui ce ' 4-702.11 Freyueuc} of Sanitization of Utensils and 3-201.11 Fish and Recreat6.tnally Caught_vIollu.,can Food Contact Sur!aers of Equi pntcut' Shellfish" ( 4-703?1 Ncthods of Samtizaiwn-- lint Water and 3-201.15 bloiiuscau Shellfish from NSSP Listed i Chernical* ' Sources` 1 IE) Propar,Adequate Handwashing i Game and WAI A3ushruoms Approved by Repotae:ry Authority 2-301.1 1 Clean Cim5tron-Hands.,nd Aims" 1 1-30i.i2 1 Cle.nrnuFroct-durc- 3-202.18 I Shrllslcxk klenUticntnm Pascal" � � I 590.004;0) Wild Mu:;h ro n t, 2-301,14 1 Whcu to WaslIT 3-20;.17 GameAnim;;4; ` I I ]1 ( 1 GoodHvglenicPractices l c Receiving/Condition ! i 2-401.11 _P,omc. Drnkirnl�or Using Tobabco* 3-202.11 PHFs Received at Propel Temperatures" j 12-40 J.i 2 Discharge~ From the Eyes, No,,e and 3 202 IS Package hue,Tuy* 1'i0titb"" I ?-lUL(I Fcxxl Safe and Unsduluortted 3-301.(?. Prevenhng Cun;aminab,m NN%Imi 1-astirm* 16 ( I Tags/Records:Shellstock 112 Prevention of Contamination from Hands 3-202,18 Shelictmi,identificataon k 590.004iE) Pretentmg Con.-;trivtatic t:from 11-203,12 ShellstcvI, IdentificationMauttained' Employee,* Tags/Records: Fish Products 13 Handwash Fachnies 13-402.11 ParasiteDe.;truction` I - � Crrvenient,yLo:atedardAcce.smw 1 I n1n e I I5�c'3l1 INrnnnrrsand Capaen,es* i 3-40_.•.. Records.Creation and 590.004i.I;; Labeling of Ingredients" 5-2tW.1 l f-ax;ation and Placement" Conformance with Approved Procedures 5 2i?.i li I A.resc;hility,0;,cr.,t,.,n.and Ma;nt iuuic_e j /HACCP Plans I ( SuUphad veil`,Snap and Hand Dry,ng 3-S02.11 Specialized Pro essing Methods* I Davtcas 3-502.12 1 Reduced Oxygen packagir;=,critetia'r ( 16-30111 l-f.,n2wad,.;o:z Cir rr,• , Availability 8-103,12 Conformance v,ith Approved Procedures' I 16-301.12 1, Hand t)ryin;t Provision Petioles iritical urn in:he led<ral 1 nyq Fnnd C,dc 111 105 CIOR?90,00;:. CITY OF SALEM BOARD OF HEALTH Establishment Name: 1?rJ1-)a2 .Slmee7` &e 91- L1 e/G` Date: 3- 3-0y Page: of a Item Code c-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date No. Reference R-Red Item Verified PLEASE PRINT CLEARLY 1X01 A,5 pG 1`77i--? IVc tea.f i:/G G (//0 leel , nl 3 - 3-04/ L" V; s, Ft 7`a,- /7�apOE r />itve ZC 7 I l te I I T y i�KrC 7ll� f /IGr ,7 7 �rCn fc'ro At e 'x . I I ti + I Discussion With Person in Charge: Corrective Action Required: I ❑ No I ❑ Yes F 1 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 LI Suspension rcomply 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. _ _ i�r ❑ Voluntary Disposal ❑ Other: PHFs Rccvi ved at Tconocratures Violations Re!ated to Foodborne illness lmervenlions acrd Rih Accordin.,to---mv C tvrl d:to Factors(Items 1-22) (Cont.) 41'D45'F Vy:!hm 4 Hours. PROTECTION FROM CHEN41CALS 15 Nleth"& i Phr He!and�;old Holding 14 Food or Color Additives I 3-210� I' Adoitives� 6+1 FAH, Maintaine I it or belnkv 14(F) 11'/4J, F' 14 Pmwenion front Unappaned Addiuwsr 5'j 1.1 ot Aol Hol PHFs IvLditaned at oi abiwe j FS Poisonous or Toxic Substances -101.1 I Idenlibinc Infortnalion-Chi,,inat I I Containers'" F"10, at:v above 13p I, Common Nmint--WoiRin,Containers,* ]-one as a Public Hnaivh-ontrol ',-^_(17.11 Separation-SloiaR(-" Time ,.,;a Public ficallh C'ontrol'' 5130.004(H; Vane.ncc Rcquneuwna 7-202,11 Restriction-Presence and Us, 7-202.12 Conchn ow of Us,' 7-20-3.11 Toxic Containcrs-Prohibifions" REQUIREMFNTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(NSP) ?-2011.11 Sanitizet.�.Critena-ChendcalsT 21 3-,Si-2,1�I I(A Uoo&;tc:t-izzd Prc-pa.--Ikiwcd buicc,and 7704.1: Chemicals for Washing Produce,Critvria� btenw,-; with'A"rnii 7-204.14 Di via-,,Agents,CrncriW 7-10511 Incidental Food Contact, Lubricants- I(B) Use of Pastern:red F 3 -'0 1 11(P, Raw or'vart:,d�) Coo.�c.l Annual Food and 7-206.11 Restricted Use Peiticides,Cra�tjal ' 4 RawSet-d sprouts Not Served. 9-206.12 Rode-tit Ban Stations* I(C) lllnupcned FwK! PackagL Not Rc-wrkod 7-206.13 Tracking Po%kders,Pent Comm!and monnorille" CGNSUMER ADVISORY TIME/TEMPERATURE CONTROLS 22 61:?A I --Om.uyncr A.dv:sot.Pnst,-11 for Conv;uniptjon of to Proper Cooking Temperatures for Annual Foods't'hat are Ruw. Undcrcool,cd or PHFs Nnt Othc,-RiFe Processtj to Eliminate Fr1-rll'/r 3-401.11A(1)(I) Eggs- 155'F I f Sec. P:31 I,,igers,-' I R,sto:ny-,d E---: SIdISIKU'L' 1'01�Ra,: Shell l7g,,q-Ininiedian: &-rvicc 14'; Fi5�ec 3 401 11(:a)(21c(minninated F1 d),NJIalts&Gam.: E'_'as' Ainnals- 155-F 15 scc. 4 340117(R)(1);?) Pork and Bcvf Ro,,ust- 130-F 121 inin SPECIAL REQUIREMENTS i1�0 L119(A) (D) iolLtions ofSeclion 59f,,009(A)-( ) in 341ILI)(A;12) Ran les, hijucted Wais- 155T I we. 111".1"le trod. tennperaly au 'I 3-4J 11.11(A)(3) Poultrv,Wd.l game. Solffed VIII-s' jenadenliq! kilohm operations should be Stuffing Conlainirn,Fish,Meat, debited uwei-t1w apprnprial, cetions Poultry or Rabies-165'F 15 cc abov.., if related to loodborric iliness 1(C)(-", Whole-muscle, tanner llcet Steak,' 04her 145'F 590.009 violations telaling to gOod retail 3—"(J1.12 Row Ani-oal Foods Cooked in a pr,1Ltn,US Sh011id odChitcd under-4/29 - Miciawave 165--F 1 Special -Requirernent;. 3-401.1 I(A"(1)(b) All Other PHF,; 145'T 15 sec j F7 Reheating far Hot Holding V.10L4 TIOIVSRELA TED TO GOOD RETAIL PRACTICES 3-403.11(A)&(D) P1 IFs 165 T I 5 sc,. ': (1tenis 23-30) 3-403 11(B) Nficrowave- 165' F 2'Nlimae Standing C,iawl a,hich do not riaw to the Tune laodb,wic iYness entions risk listed ubov.,.% can be 3-403 11:10 Connaercialiv P;o.essed RTE Food- 16und in ting ,,(tow ,j!be Food Code and 105 CA-IR 14WP io()(wo. 3-403.11(E) RcmF ;np,Undiced Portinis,of Beef Item Good RefPh'Practices FC 590.000 1 23, Manacterneit and Pei sonne! 1 FC-2 .003 24 Food and Food Pmlcction FC- 3 '004 IN Proper Cooling of PHFs 25. Equ'pmen!and --------- FC-4 .005 ?-501 MCA) HWFto 26. Water'PIwobiciq and Waste FO-5 '006 70'F Within 1. tions and From 70-17 27 Physi,A Fwfli.iy i F---6 007 toAl'F/45'F Within 4 Honr< * 23 1 Pulsonous or Toxic Mal.rials I FC- 7 005 3-501.14(B) Cooling PHFs Made From.Ambien' 19 qpmiEtl Requiremenls .339 Temperature !n.gledicnts to-I'F/45'F 30 Other Within 4 }lours' — ti-lc;sliral itan in the.ederai 191,1)Food Cojen+ 105 CNIP 90.00d. Massachusetts Department of Public Health Salem Board of Health 120 Washington Street,41" Floor Division of Food and Drugs Salem, MA 01970-3523 FOOD ESTABLISHMENT INSPECTION REPORT Tel. (978) 741-1800 Fax (978) 745-0343 Name I Date jyne of Operation(sl Type of Insoection 2>9/9l;v ,� ,e s,4k1't_4 1 �- 2_1741 I CY Food Service EIKRoutine El 7 �t Risk Retail El Re-inspection Q ae Level ❑ Residential Kitchen Previous Inspection Telephone 7 3 9Hs5- /x/39 ❑ Mobile Date: Owner [] Temporary Elre P -operation rl�oa4t.A i-) HACCP Y/N Pkecurr/ sR I ❑ Caterer ❑ Suspect Illness Person in Charge(PIC) Time ❑ Bed& Breakfast ❑ General Complaint El HACCP Inspector In Permit No. ElO herr _.D�.f�PPir7✓�/J I V,?Kl fic_y4rk1 Out: Each violation checked requires an explanation on the narrative page(s) and a citation of specific provision(s)violated. H.� 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 1. PIC Assigned/Knowledgeable/Duties El13. Handwash Facilities _EMPLOYEE HEALTH E] 2. Reporting of Diseases by Food Employee and PIC PROTECTION FROM CHEMICALS [13. Personnel with Infections Restricted/Excluded [:114.Approved Food or Color Additives FOOD FROM APPROVED SOURCE EI 15.Toxic Chemicals ' ❑ 4. Food and Water from Approved Source TIME/TEMPERATURE CONTROLS(Potentially Hazardous Foods) ❑ 5. Receiving/Condition ❑ 16. Cooking Temperatures ❑ 6. Tags/Records/Accuracy of Ingredient Statements ❑ 17. Reheating ❑ 7. Conformance with Approved Procedures/HACCP Plans ❑ 18. Cooling PROTECTION FROM CONTAMINATION ❑ 19. Hot and Cold Holding ❑ 8. Separation/Segregation/Protection ❑20.Time As a Public Health Control P/9. Food Contact Surfaces Cleaning and Sanitizing REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) El 10. Proper Adequate Handwashing EI21. Food and Food Preparation for HSP ❑ 11. Good Hygienic Practices CONSUMER ADVISORY ❑22. Posting of Consumer Advisories Violations Related to Good Retail Practices Number of Violated Provisions Related Critical (C)violations marked must be corrected To Foodborne Illnesses Interventions Z C immediately or within 10 days as determined by the Board and Risk Factors(Items 1-22): of Health. Non-critical (N) violations must be corrected Official Order for Correction: Based on an inspection immediately or within 90 days as determined by the Board today, the items checked indicate violations of 105 CMR of C eaNh. 590.000/federal Food Code. This report, when signed below 23. Management and Personnel (FC-2)(590.003) by a Board of Health member or its agent constitutes an 24. Food and Food Protection (FC-3)(590.004) order of the Board of Health. Failure to correct violations 25. Equipment and Utensils cited in this report may result in suspension or revocation of (FC-4)(590.005) the food establishment permit and cessation of food 26. Water, Plumbing and Waste (FC-5)(590.006) establishment operations. If aggrieved by this order, you 27. Physical Facility (FC-6)(590.007) have a right to a hearing. Your request must be in writing 28. Poisonous or Toxic Materials (FC-7)(590.008) and submitted to the Board of Health at the above address 29. Special Requirements (590.009) within 10 days of receipt of this order. _ 30. Other DATE OF RE-INSPECTION: 3 sssornsaecrro ms.14 da I5 e ra .. T ifitC. Print: . 17 PIC's Sign: _ ` Print: I Page ofd Pages Violations Related to Foodborne Illness ' interventions and Risk Factors litems 1-22) PROTECTION FROirt CONTAM€NAT€ON FOOD PROTECTION MANAGEMENT 81 tC,�s, co:;tanrrro&on i 590.003(A) 3-3.02.11(A)"') Raw.knnn:, Separated fn,m 590.0060) D.nwnstraiton of Knoutiedgr' i Crrxked and R1 P,Food:. 2-11); Person, u.dtarge - duties fromRaw'rgntdenrs 3-302 11(A)(2) R v. Animal Foods Separated front Each Eiu1PLOYEE HEALTH Other' 2 590.003(C) Respunsi•oihty idthc pot•.,n in clta:ee to ! Ccnt;;:r;inai«,n front th-'•6rvltonnrerii require reporting by fc•od employees trai 3-?02.i 1(A; Fabd'<otection- applicants"` Fruits and Viceetable.s I ;90.003(F) Respons,bilht 01 A Fo id Employee Or An i i i(pl.I I Fjojt Couta.t with Equipt::ent and Applicant To Ri:purr To Thr i'eison InLt•_nsds s Chat ee- I Crinatinnation frorr,the Consucei t r",( * I 3 +0 r 11( 1{L) I Remi:icdl'ood and c �i `t^ 5)O.JO' G) kepnrline by Prison in Ch:u,ea !• r+, t tl '-alto c: 3 590.0030)) E'm.lusionsaadResttietions' I I spositionorAduiter=xdorC,onraminamd 590L003(i ) I Reri of Exclusions anti Restm_tions `: Fend 1.7C!. ! Discarding rr Rcenndi6kinmg Unsafe FOOD FROM APPROVED SOURCE Fjod I 4 Food and Water Fro,,-,Reguiated Sources ' ' 9 Food Contact Surfaces 590 JU•1tA-3) Crcnpbanre ix itb Fuel La"* d-50!.111 Manual`Waxnwash'nc Hot Winer 3-20;.1_' ! r. Se: r3 ntn Sanitization ?empe:aturenr F::od in a Hennr i tllp dcd.o: mere � I 1-101 t? Fluid PAilk aID.4 MilkP:odnets* i d-K 1.1!2 Meehauical Warewashing-Hot Water i Jz,:rtt ration"pemperatures' 3-202.13 Shell Egs" a-561114 (-ltemic,:; ianiri:abon-tents ill, 3?0:.111 Evgs and Milk Pnxlucts.Pasteurized.° 1•.} .3-202.16 Ice Made Front Potable Drinkir:a Water* c,-:uxrirattnn znd haidness. " j-I0 Br�nkuirWatc•rtrnmanApproved S}stei::" �-601,11(i=) EquitmentFoodConnie: Surfacesand sten+ils Clean` I3ottlecl f,rinlur_Water, 4-602.1! Cleaning F,,mwrn-v of D,lu:prri Focal- 540!06(;3) Water Contact Sarfa:.es.md Utensi!e"Meet Standards in 310 CMR 22.04 'treltli>h and Fisn Frain an Approved So:rn' I 44-7)2.11 Fieyuenc}^.:f San:62iLua of Utensil..and .3-20:.14 Flah and RecreaJoraly Caught Rh;lluneaii Food Contac Su-faces of Equipnxent* 1 ll, 3- 01.15 klollu=can Shellfish from NSSP Listed 4-103.1! Methods f Sraatizatian-Ior Water and Chee;ieal'" Sources* ( I ?I) : Proper,Adequate Handwashing Game ana wild Mushooms Approved bo I ( 2_�,�1111 :dean Cuuon--Farads end!,anis* Regulatdry Authority ' 1'202.18 ShellsuckIdenOticatioi: Prestnt* 2->01 12 C`leamn_r:o.:cdurc" 590.00=iC) Wild Xlushro,ms* 2-301 11 When to W'aslt" 201.17 Gam: Animals" I 1 t Good Hygienic Practice; I $ Receiving/Condition 12-401.i i Ea:m)'. tricking or Using Tob,tco' 3-202.11 PI-IFs Re(Ttved at Pt'oper Ten:peraturm" '401 12 Drat haiges From the fives, None and 3-202 15 Package inreinity- ; Mouth- 3-161.1! Fond Safe and Unadultcrared ! 3-301.17 Preventing Contanaraion IUhen Tasting" i * I I g Tags/Records:Shellstock I 122 Prevention of Contamination from Hands 3-"20'.14 Shellstock identification* ( 5J0.COd{Tai Pretenung(•omd:nin:atien from 12 Shellsinrk identification Via:ntaineix Fngrinyecn' I Tags/Records:Fish Products i 113 ! Handwash Facilities j S 11 Parasite Dcsiructlorv, I CunwuYentl,Loca'ud and Accessibt, 13 402.12 Recorri ,Cre,ition.rod Peteutioa4 I ''-=•x'3.1: Numbers and Cap:acities^ ' 1510.004(1} Labeling of Ingredients' 5-294.11 Location ant Placement` 5-^_0.'5.11 .accesrd Giiihr,Op`r:lt:•..et and-M Maintenance a Conformance with Approved ProceduresS::ppi;ed with Sa:p and Han D y+rig j /HACCP Plans Device, i z-562.1: Specialized Processing tvtedt�sle* r..zl} L U Handaasninc Cleanacr, Av:r:iu!;,iity 3-512.12 I Reduced ozy;;en packagirig.criteria' I g-1(3.12 Conformance wah Approved Pioccdurer> 6-31.1 12 Hand Dr}'ing i iovi�intr Donor o ttical nem i::the t,:d.ud 1999 Find Co1r of 105 i\ill 590.0119. CITY OF SALEM BOARD OF HEALTH Establishment Name: Ai,oa r�r2/[1i Date: :�- 3-0q Page: Of lL Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date No. Reference R-Red Item Verified , PLEASE PRINT CLEARLY /Inii is✓� �.�� /��a,i�en j vs�o ��yi�r cO /eii r�I� �o6lBUJ//Y I//v 4h>,v. v0<'/?,, Awn 717" 7./>7/ , PSA !//S//3/P /7r��i Par J`�J{Pi/ dis ff/2 vFG /1/P•P�/ 7liliJfill!/� /'l.oiv.n/A,ilCi I GZM �i7,NG S - 11//� L .�-1�2u .cIAI<, " wds6 �.Pr,use — .SRN/ rl2e J 171�r?4 n/PPIA !/iSiXLP 17f-1,0, 07e i PmmntTi� CE/v n.2 e '"7n .or,op 9t/O��/C }�7/I.P�Iiio� SG/cU h"X/il/O .XWI-bP -iii "YP,P/nA- 4jp.,9%/c .Sallee- O A7 7IPPSIIaa fG SeOZ �iy • I fii f�,P,zyP.r-, f�'/I�Y.A'//in r^i� h6 i�vS�r'.�/n�i�`,O..r/_c I / �I i a7 �P.rn/.S,°_S A/ePd n oP�r/P/2�rL v�eurr/.rg O/ SI',�uG�dk�L �!-�!?�Ierr�s ile, 9c°e -C-eO,,el 7e/ �,c�n��i-2PZ Y� AlPc aCQ zclte -S/rye u/b I / ✓Sl�o �/°P/7a?�(PP Oe. S��,SYLPI�z ,bl&ced /.f/`l2 .S'a,/ -/72zF eDxZ,_4iKPlf - I Lir/3aGLe� "/LP .SC'ao� iii Lc�" I ✓ f�r>re,eav�ua78.e � � (g %RST Coy/�O G /3idr,Y�Lr/ I � Foos! r�rnds / I v S�yyi �`/'L1/U9 leaf GO d- ?,iLadRS e u P „Ve% 77SS/C vk M raff_acs u3 ra Jr gli�u(lry �GY e.FC.(/�T�K� ra�v V C/�icl Prie Discussion With Person in Charge: �` r�QO� S Corrective Action Required: I ❑ No I ❑ fes 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: , 1 3-501. 4(C) PHFs Rect,ivcu at Trlpceqtt,a, Violations Related to Foodborne Illness 7.qt,,rverrf;or,,5 And Risk A,C,lolipe to Law C poled to Factors(items 1-22) (Cont.) l: 17CVftluu 4 dmt!e 10:A5 Cilchn",Al,IL,lds for PHF,, PROTECTION FROM CHEMICALS 14 Food or Color Additives 19 PFF Hot and"'old Holding 3-20112 Additi,es3' ;,-50 I 6th) CoJa VfW;Maintained al or belo-, 3-302. from tjoaL)Pj'j,%ej Zkddifivc,' i-501 1n,A) Hot di>l�s it ot Poisonous or Toxic cobsartres 7-101,11 Identilyniz Information-- 0jiginal Roast: in ca above I3OT Containers), 7-m.11 T�ma as a foblt-L H&Oi-.Control 7-,01 11 separation-Still lu?(!* ill It) Time zi it Public Health Corl-,(O. 7-202.11 Restriction-Presence and [T;e)I sl,(WO,hl Ill valmno:Requimrivril 7-202.12 Coadfl!,WS Of Use' REOWREIVIENTS FOR HIGHLY SUSCEPTIBLE ?_1203.1 1 '1,,xic Container:,-llrt,hibniuns' POPULAT!ONS(HSP) 7-20411 Sanitim s. Criteim-Chcrnicids4 21 3.Ff:1 I !(A) Unp3,t,,tir;z..,d Juice;and -1-2o4 1. Ch--micru:for Wa,zhing PIOCILICC,Ciilcria` Bel,lefitllell W`;l xVa rn�nz I I 7-204.14 Drvim2 Alents.Criteiiie` I 3-M;1.L(B) Use opiotclu;,e 11d j,", � 7-205 11 Incidental Food Contact LutricalW, 348(1I i(Di Raw o: PiutiaTGciolod Animal Food,and 7-206.11 Restricted Use Pesticides,Criteri,,,.t Bast Seed Sprotiis Not Seived. 7-206 12 Rodent Bait Stations! 3­'�()!.j`(C) Unopened Rsid Pack,,v Not R­ served. 7-206.13 '}Packing Powdet t, Pest Control and CONSUMER ADVISORY Z2 3-603.11 Curisurne. Advisoi,Posted fiA C011Sa:R!Pii01,of TIMEfTEMPERATURE CONTROLS Paii,rA Foods Fhw'ire Raw.Loderoitiked oi- 16 Proper Cooking Temperatures for PHFs Not Otherwi,- "ImiesNed to Ei'iniiiate 3-x101.1 I A(I a2l) Ee,s- 155`F 15 See patio".", ;_30,21 i 3 Paslcijrrzed EggsSubi-fitirle tor Rau Shell Fogs-Immediate Scrvic� 145"] 3-401.1 1(A)(21Comminuted Fish.Ittloing&G-ime El-gs I Animals- 155'F 15 sec 3-401.11( e P)(I)i?) Pork and Pcej'Roast- 130'5121 min' SPECIAL REQUIREMENTS 3-4U iJ It A)(21 Ratitee, Injmd JNJI-�ats- 155'F 15 590009(A)-(D) violations or Section 4,90.009(AF_(D) In sec. Latering, mobile food, tempotury and 3-401.1}(A)(3) Poultry, Wild Gitine. Stuffed IIHFe rccdmtial Kitchen operalion,,should be Stulfin,,Coutanime, Fish,Meat, abit,--di under the appropriate s-it,tions Poulny or Ratites-165'F 15scc. ' ahcrla,-if related to troeborne illness 3--401 A 1(010,) Whole-muse?c, intact Beef SteaIzs 1 nterveril ions and risk Factors. Othcr 115'F` 5.90 009,on!a,,u)ns relatin- togotid ietad 3-4101.12 Raw Annual Foods Cooked in a practices should be debitea under i/20— 1%,lictowave 165'F I Special Rcyinreiocrits. 3-40 i.1 i All Othet PHFs 145'F 15 sec. 17 i Reheating to.,Hot Holding VIOLATIONS R-LATED TO GOOD RETAIL PRACTICES 3-40 ,11(,%)&,(D) PRE, 165:F 15 sec. (Items 23-30) 401.11(3) Nl:cwwaie- 1650 F2. Miouic Standing Critical lio,10,,iont, ohich d,net relate to the 1,4*1%t 1171,1,'t Z 40t-:e,%fiO H V on I I rink,luc!oa s listed rih,4e, cm,he 3.4i':' 11(C) Comintuciai l}Prouv,sed RTE Fend- i Jmmd 4;; ecii();,, o_(the bo,d C,,el,,and 105 CAM 140'F* 3-403 1 ItE) Remaining Uns'liced Portions of(feet Item i Good Retail Practices PC 590.000 2" Manaciement ci,xl Peniornel FC— rJC3 '--G^ I Foocland Fucil Protection FC—3 1'104 Proper Cooling of PHFs 1 Fquipmont end Utensils • FC—4 005 _�01 IVA) Cnotin,_,Co,1ed PHF,;from 140-F to Vv Pter. FItirnhurl and Waste 1! FC-5 1-, 70'F Withia 21 loon,and From Aff 27, t Phvsicai Facifit, FC-6 007 -,)4VF/45'FWithir,4 Hour,, 1 - 7 2.5, , Poisonous or-foxic MailerinIs FC 008 3-50L14M) C001111g PHFs Made From Arnbi,,rul 29, Special Rcqtflrismerits 009 a rempeiature In'tedicni;to 4 t"F/15 F 30 Other Within I Hours' Dept(,,criii-,;i;item i,t li.e 1744 U,xl OtJ'o, 105 C.MR y, l/ew sa W-R, CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH 120 WASHINGTON STREET, 4TH FLOOR SALEM, MA 01970 TEL. 978-741-1800FAX 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 : Owner ' s Name : Frank P. Presutti, Jr. Name of Establishment : Dodge Street Bar & Grill Address of Establishment : 7 Dodge Street Type of Establishment : FOOD SERVICE Application Date : 05/19/2003 Restrictions : Permit for Food Establishment 299-03 Frozen Desserts/Ice Cream Permit for the Sale of Tobacco Products These Permits Expire December 31, 2003 This permit is not transferable and must be reissued upon change of ownership or location. The permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code, before any renovations, improvements, or equipment changes are made, all plans for such must be submitted to and approved by the Salem Board of Health. HEALTH AGENT �f 6�„ce CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH 120 WASHINGTON STREET. 4TH FLOOR SALEM, MA O1 970 TEL 978-741-1800 FAX 978-745-0343 STANLEY USOVICZ, JR JOANNE SCOTT, MPH. RS, CHO MAYOR HEALTH AGENT OAPPLICATION ION FOR PERMIT' (��7i0 OPERATE A FOOD ESTABLISHMENT NAME NAME OFESTABLISHMENT / A 1/ I � [ i^c (( I TEL# ADDRESS OF ESTABLISHMENT //, C` i( S 1 MAILING ADDRESS (if different) Se,�C RR G OWNER'S NAMECCI'i � 11Pf f.�tU ( b R— TEL# ! ),V 7C/i-ol3 / ADDRESS CITY STATE AAA ZIP i7 /57 O CERTIFIED FOOD MANAGER'S NAME(S)Q b/i PPrt(u44," f/� CERTIFICATE#(s)c� 0 (required in an establishment where potentially hazardous food is prepared.) EMERGENCY RESPONSE PERSON M� 4 Cy PN IF0 41 HOME TEL# 92 D 9R70(7 ' '7 .� HOURS OF OPERATION: MonTue 4 ((A0 Wed. Lf LGThu. 'HO Fri. `In Sat. '-lyv Sun.�I ��V 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 ES NO less than 25 seats =$100 25-99 seats =$15 more than 99 seats =$200 BED/BREAKFAST YES NO $100 ADDITIONAL PERMITS MAKE ICE CREAM, YOGURT, SOFT SERVEOE VO $5 TOBACCO VENDOR $50 ALL NON-PROFIT(such as church kitchens) YES $25 Please pay total with one cheek payable to the City of Salem This Permit is not transferable and must be reissued upon change of ownership. The Permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code, before any renovations, improvements, or equipment changes are made, all plans for such must be submitted to and approved by the Salem Board of Health. Pursuant to MGL Chapter 62C, Section 49A, I certify under the pains and penalties of perjury that I, to my bZkoe)qIedge and belief, have filed all state tax re,urns and paid IIs ate t xes re uired under the law r)f 617P ri� bate Social Security or Federal Identification Number ------- - ------------ Revised 1125/02 FOODAP2.adm Check#8 Date 4iJ? . ..._. ...-.-.r ^•�v--�....o«,mss-.w.. - . ,.. .�-. .-.ay.n-•+..rw,wa..fr.-.r�^w�,^^..4"s.w.r,.,+.+.+p'wrf.,w,n-..+,...:�.�wr.•--•..-»..-..,,_....- ..«..a r THE COMMONWEALTH OF MASSACHUSETTS w CITY `OF SALEM BOARD OF HEALTH Address: 120 Washington Street, 4th Floor Salem, MA 01970-3523 , FOOD ESTABLISHMENT INSPECTION REPORT Tel: (978) 741-1800 Fax: (978) 745-0343 Name // Date Tvoe of Ooerationfe„1 Tvng of Inspection &d� ST %o.0 sA �i/l."�� 9'lgl" [Food Service ('Routine AddressS'�f' Risk El Retail ElRe-inspection �+-�' Level ❑ Residential Kitchen Previous Inspection o Telephone /'7 ❑ Mobile Date: Owner HACCP YIN ❑ Temporary ❑ Pre-operation Lit,4a/r v/leSo Yli" ❑ Caterer ❑ Suspect Illness Person in Charge(PIC) rr Time ❑ Bed 8 Breakfast ❑ General Complaint In: 3-00 ❑ HACCP Inspector -i-�« / I Out: Permit No. ;W_02 ❑ Other Each violation checked requires an explanation on the narrative page(s) and a citation of specific provision(s) violated. Non-compliance with: Violations Related to Foodborne Illness Interventions and Risk Factors (Red Items) Anti-Choking Tobacco Violations marked may pose an imminent health hazard and require immediate Corrective 590.009(E) ❑ 590.009(F) ❑ action as determined by the Board of Health. Local Law ❑ FOOD PROTECTION MANAGEMENT ❑ 12. Prevention of Contamination from Hands ❑ 1. PIC Assigned/ Knowledgeable/ Duties 9/13. Handwash Facilities EMPLOYEE HEALTH PROTECTION FROM CHEMICALS El2. Reporting of Diseases by Food Employee and PIC ❑ 14. Approved Food or Calor Additives ❑ 3. Personnel with Infections Restricted/ Excluded ❑ 15. Toxic Chemicals FOOD FROM APPROVED SOURCE TIME/TEMPERATURE CONTROLS(Potentially Hazardous Foods) El 4. Food and Water from Approved Source El 16. Cooking Temperatures El 5. Receiving/Condition ❑ 6. Tags/Records/Accuracy of Ingredient Statements El 17. Reheating El7. Conformance with Approved Procedures/ HACCP Plans El 18. Cooling [1 19. Hot and Cold Holding PROTECTION FROM CONTAMINATION ❑ 20. Time as a Public Health Control ❑ 8. Separation/Segregation/Protection REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) ❑ 9. Food Contact Surfaces Cleaning and Sanitizing ElEl 10. Proper Adequate Handwashing 21. Food and Food Preparation for HSP CONSUMER ADVISORY ❑ 11. Good Hygienic Practices ❑ 22. Posting of Consumer Advisories Violations Related to Good Retail Practices (Blue Number of Violated Provisions Related Items) Critical (C) violations marked must be corrected To Foodborne Illnesses Interventions immediately or within 10 days as determined by the Board and Risk Factors (Red Items 1-22): of Health. Non-critical (N) violations must be corrected Official Order for Correction: Based on an inspection immediately or within 90 days as determined by the Board today, the items checked indicate violations of 105 CMR o Health. 590.000/Federal Food Code.This report, when signed below C N by a Board of Health member or its agent constitutes an 23. Management and Personnel (FC-2)(590.003) order of the Board of Health. Failure to correct violations 24. Food and Food Protection (FC-3)(590.004) cited in this report may result in suspension or revocation of 25. Equipment and Utensils (FC-4)(590.005) the food establishment permit and cessation of food d 26. Water, Plumbing and Waste (FC-5)(590.006) establishment operations. If aggrieved by this order, you ✓ 27. Physical Facility (FC-6)(590.007) have a right to a hearing.Your request must be in writing 28. Poisonous or Toxic Materials (FC-7)(590.008) and submitted to the Board of Health at the above address 29. Special Requirements (590.009) within 10 days of receipt of this order. 30. Other DATE OF RE-INSPECTION: Inspector's Signature: Print: ��.U-v°.c-f✓�-..._ �T«L. ' GSA yti.�uN PIC's Signature: Print: Page / of�? Pages k 3 FORM 734A HOBBS&WARREN - BOSTON Violations Related to Foodborne Illness Interventions and Risk Factors (Red Items 1-22) PROTECTION FROM CONTAMINATION S Cross-contamination FOOD PROTECTION MANAGEMENT 3-302.11(A)(1) Raw Animal Foods Separated from 1 590.003(A) Assignment of Responsibility* Cooked and RTE Foods* 590.003(B) Demonstration of Knowledge* Contamination from Raw Ingredients 2-103.11 Person in Charge-Duties 3-302.11(A)(2) Raw Animal Foods Separated from Each Other* EMPLOYEE HEALTH Contamination from the Environment 2 590.003(C) Responsibility of the Person in Charge to 3-302.11(A) Food Protection* require reporting by Food Employees and 3-302.15 Washing Fruits and Vegetables Applicants* 3.304.11 Food Contact with Equipment and 590.003(F) Responsibility of a Food Employee or an Utensils* Applicant to Report to the Person in Charge* Contamination from the Consumer 13-306.14(A)(B)I Returned Food and Reservice of Food* 590.003(G) Reporting by Person in Charge* Disposition of Adulterated or Contaminated 3 590.003(D) Exclusions and Restrictions* Food 590.003(E) Removal of Exclusions and Restrictions 3-701.11 Discarding or Reconditioning Unsafe Food* FOOD FROM APPROVED SOURCE ( 9 Food Contact Surfaces 4 I Food and Water From Regulated Sources 4-501.111 Manual Warewashmg-Hot Water 1 590.004(A-B) Compliance with Food Law* Samhzatwn Temperatures* 3-201.12 Food in a Hermetically Sealed Container* 4-501.112 Mechanical Warewashing-Hot Water 3-201.13 Fluid Milk and Milk Products* Sanitization Temperatures* 3-202.13 Shell Eggs* 4-501.114 Chemical Sanitization-tem H, P.P 3-202.14 Eggs and Milk Products. Pasteurized* Concentration and Hardness* 3-202.16 Ice Made from Potable Drinking Water* 4-601.1 l(A) Equipment Food Contact Surfaces and 5-101.11 Drinking Water from an Approved System* Utensils Clean* 590.006(A) Bottled Drinking Water* 4-602.11 Cleaning Frequency of Equipment Food- 590.006(B) Water Meets Standards in 310 CMR 22.0* Contact Surfaces and Utensils* Shellfish and Fish From an Approved Source 4-702,11 Frequency of Sanitization of Utensils and 3.201.14 Fish and Recreationally caught Molluscan Food Contact Surfaces of Equipment* Shellfish* 4-703.11 Methods of Sanitization- Hot Water and 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* Sources* 10 Proper,Adequate Handwashing Game and Wild Mushrooms Approved by ' Regulatory Authority 2-301.11 Clean Condition-Hands and Arms 2-301.12 Cleaning Procedure* 3.202.18 Shellstock Identification Present* 2-301.14 When to Wash* 590.004(C) Wild Mushrooms* 11 Good Hygienic Practices 3-201.17 Game Animals" 2-401.11 Eating,Drinking or Using Tobacco* 5 Receiving/Condition 2-401.12 Discharges From the Eyes,Nose and 3-202.11 PHFs Received at Proper Temperatures* Mouth* 3-202.15 Package Integrity* 3-301.12 Preventing Contamination When Tasting* 3-101.11 Food Safe and Unadulterated* 12 Prevention of Contamination from Hands 6 Tags/Records:Shellstock 590.004(E) Preventing Contamination from 3-202.18 Shellstock Identification* Employees* 3-203.12 Shellstock Identification Maintained* 13 Handwash Facilities Tags/Records: Fish Products Conveniently Located and Accessible 3-402.11 Parasite Destruction* 5-203.11 Numbers and Capacities* 3-402.12 Records,Creation and Retention* 5-204.11 Location and Placement* 590.004(J) Labeling of Ingredients* 5-205.11 Accessibility,Operation and Maintenance 7 Conformance with Approved Procedures Supplied with Soap and Hand Drying /HACCP Plans Devices 3-502.11 Specialized Processing Methods* 6-301.11 Handwashing Cleanser,Availability 3-502.12 Reduced Oxygen Packaging,Criteria* 6-301.12 Hand Drying Provision 8-103.12 Conformance with Approved Procedures* - •Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. CITY OF SALEM ' BOARD OF HEALTH Establishment Name: _�� / cr �. 4 /.ter. // Date: P Page: m? of J Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date No. Reference R-Red Item Verified PLEASE PRINT CLEARLY s4. "�v� / _/_ - o.. ., c'� �-.,• ,.✓.�... e.��ii. Q.;�/ tet, ,.., ��/_ - �/� /f/oe..c ..✓ I I ,� �edF � I I I ,., ' I I I 4) Discussion With Person in Charge: Corrective Action Required: I d No I ❑ Yes I have read this report, have had the opportunity to ask questions and agree to correct all o_�Voluntary Compliance ❑ Employee Restriction/ violations before the next inspection, to observe all conditions as described, and toExclusion comply with all mandates of the Mass/Federal Food Code. I understand that El Re-inspection Scheduled ❑ Emergency Suspension noncompliance may result in daily fines of twenty-five dollars or suspension/revocation of ❑ Embargo ❑ Emergency Closure your food permit. ��- ❑ Voluntary Disposal ❑ Other: ter- _2 _ r-- _ - -- s 3-501.14(0) PI-IFs ke,eived at Temperatur,; Violations Related to Foodbome Pleess Interventions and Risk According to Luw-Cowled to Factors(items 1,T) (Cont.) 41`F/45'F Within 4 Iicurs. ` j ;-5ol.13 Cooling Methods for PHF< PROTECTiC('t FROM CHEMICALS 14 I ( 19 PHF Hot and Cold Holding j Food or Color Additives j 3202.12 Additives` 3-501 tri(B) Cold PIIFs Slainmined at or below 13-302.14 Prourction from Unapproved Additr ec* 3-SOl.Ib(1 i [Iot PI IFs Maintained at u+ aboer ( 15 Poisonous or Toxic Substances 7-101.;1 LlentdlinginfbrnlaLon -Ontriral ( SO].16(A) Roasts Heldatofabove 130'F t•trntdlllel S" 7-'.o2.1 I Co:ynnrat Name - Worldn;*Containers* 120 Time as a Public Health Control I 7-201.I i Separation-Sinrage^ 3-501 19 Time as a Public Health Control' ' - 7-202.1 1 Restriction-Pre,ence and I:se' { 1590.004(1-11 Variance Requirement 7-202.12 Conditions of Uvz' 7 203 11 i iWC C'onauner,--Pmblhflions„ POPULLATIOATIO N FOR HIGHLY SUSCEPTIBLE REQUIREMENTS 7-_'04.11 S niuzets.Critetia--Chemicals',` ( NS(HSP) j '7-2G-{ I? Chemicals ibr t54t.hmg ftlxince; Criteria, ( 21 3-801.11(A) Unpasteurized Pre-packaged luice;i and 17-204.14 Dtt n,Agenc;,Cr+ter;a* I Beverages with Warning l +bels'- ( t 3-80Lt1(B) Use of i'asteuri'zed @ggs* j i 7-201 11 Inciaental Food Cuntact,Labticants" 3-901 11(D) Raw of Partially Cooked Annnal Fond and 7-2.06.11 Restricted Use Pesticide,,Criteria- j Raw Seed Sprouts Not Seracd. 17-10&12 Rodent Bait Stauonse I j 3-801.11((7) Unopened Focal Package Not Re-sen'ed. " 7-1.06.13 Tracking PowderN,Pest C.ouuol and PQonitonni CONSUMER ADVISORY TIMEfTEMPERATURE CONTROLS 22 3-603.11 Consumer Advisory Posted for Consumption of Ammal Foods That are Raw. Undercooked or 16 Proper Cooking Temperatures for Not Otherwise Processed to Eliminate PRFs 3-40:.1 1 At 1)(2) Egg:_ 155'F i 5 Sec. i Pathogens,' 3-302.13 Pastetumd Eggs Substitute for Raw Shell E;;gs. lend,drift,Servos: 145"Fl i;ei x €g� 3-401 1 I(A)(2) Cotmnimited Fish. Mems&Game Eggs. Animals- 155`F 15 sec. " ! I3-401.1UBr(1)(2) ( Poikand Beef Roast- i30`F121nunX SPECIAL REQUIREMENTS S90009(A) (D) V'iolatiansofSedion--5tJ0.t109(A)-(lllin 3-401.1l(A)(2) I Ratites,Igjected Mean. - 155 T 15 '- catering, mobs de Roel, temporary and 13-401.11(9)(3) Poultry,Wild Game.Stuff-c. FHA,; residential kitchen operations should be ,1tn11mg unith mte2 fish,Meat, ! ,..J,,.., ,..;idea' the Pouttty or Ratites-165'F 15 sec i above if related to foodborne.illness 1 3-101 11(C)(3) Whole-muscle,Intact Beet Steaks i interventions and risk factors. Other 145'F 590.009 violations relating to good retail 3-401.12 Raw Aemial F,cds Cooked in a practices should be debited tinder#29- NI:crowave 165`F* Special Requirements. 3-401.11(A)0)(b) ;All Other PHFs - 145'F 15 sec. % I 17 I Reheating for Hot Holding VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 3-401.11(A)&lD) PIIFs 165'F 15 sec. ' i (Items 23-30) 3-403.11(B) Microwave- 165J F 2 Mmute Standing ) Crituai and non-critical violations, which do not relate to the + Time" (eodhurne ithress ailerrentiou,s and risk factors listed ubme, can be 3=03.1 I(C) Comnxrcially Priwessed RTE Food- (mod in the f ollowing sections of the Food C odc and Ins G1/1? 1400P** 540.000. 3-403.11(E) Remaining Gnshced Portions of Beer j item Good Retail Practices FC 590.000 Roasts* I 123 Manaqement and Personnel FC-2 .003 18 Proper Coaling of PHFs ! 24� Food and Food Protection FC-3 .004 25 _W - Equipment and Utensils FC-4 .005 - 3-501.14(At Cowling Gx,kcd Y}[Fs from 140"F to 26. ' ater,Plumbing and Waste '� FC-5 .006 7r'F Within 2 flours and From 70'F ! 27 ! Physical Facility ' FC-6 .007 ! to 41°F)45'F Within a Hone: 28. I Poisonous or Toxic Materials FC-7 .008 ! 3-501.I4(B) Cooling PHFs Made From Ambient ! 29. Special Requirements .009 ! Tcutperature ingredients to41"F/45'F 30 Other ! Within 4 I-Iours" t Demdea erd+cal item in the federal 1999 Food rode o+ 105 CN41R 590.000. 1 L ^ I �./�^.q-w.T.,:.+w.y'+v.wr"�..nww.wv. war+«.•+ro.m::-w,.,es'r`+n�...r•^+.c�cN r+R++M4:ifa-+qt+nsV'K'Wwwe••T+r^ea:MiSaaaj*-'r''Wwsr w�wr-a:'Lw�ai ., THE COMMONWEALTH OF MASSACHUSETTS CITY OF SALEM Address: 120 Washington Street, 4th Floor BOARD OF HEALTH Salem, MA 01970-3523 FOOD ESTABLISHMENT INSPECTION REPORT Tel: (978) 741-1800 Fax: (978) 745-0343 Name ,,\\ // Date Type of Ooeration(j) Tvoe of Insoection C )0,/, �r/ltrr /f.n�Y -A l�c,'�� y/o15-� ERrFood Service ❑ Routine Address o Risk ❑ Retail ❑ Re-inspection 17 T Level ❑ Residential Kitchen Previous Inspection Telephone (9?g) O/.T 9 ❑ Date: Owner HACCP Y/N ❑ Temporary El Pre-operation ❑ Caterer ❑ Suspect Illness Person in Charge(PIC) `�Aak �> I Time ❑ Bed&Breakfast ❑ General Complaint //leSor/'i In: //.pa El HACCP U 6e Inspector ❑-"- Out: Permit No. EVOther ,cam, nw,v n Each violation checked requires an explanation on the narrative page(s) and a citation of specific provision(s) violated. Non-compliance with: Violations Related to Foodborne Illness Interventions and Risk Factors (Red Items] Anti-Choking Tobacco Violations marked may pose an imminent health hazard and require immediate corrective 590.009(E) ❑ 590.009(F) ❑ action as determined by the Board of Health. Local Law ❑ FOOD PROTECTION MANAGEMENT ❑ 12. Prevention of Contamination from Hands ❑ 1. PIC Assigned/ Knowledgeable/ Duties ❑r13. Handwash Facilities EMPLOYEE HEALTH El2. Reporting of Diseases by Food Employee and PIC PROTECTION FROM CHEMICALS ❑ 3. Personnel with Infections Restricted/ Excluded El 14. Approved Food or Color Additives ❑ 15. Toxic Chemicals FOOD FROM APPROVED SOURCE [1 4. Food and Water from Approved Source TIME/TEMPERATURE CONTROLS(Potentially Hazardous Foods) ❑ 16. Cooking Temperatures El 5. Receiving/Condition ❑ 17. Reheating ❑ 6. Tags/ Records/Accuracy of Ingredient Statements ❑ El 7. Conformance with Approved Procedures/HACCP Plans 18. Cooling El 19. Hot and Cold Holding PROTECTION FROM CONTAMINATION ❑ 20. Time as a Public Health Control ❑ 8. Separation/Segregation/ Protection REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) ❑ 9. Food Contact Surfaces Cleaning and Sanitizing ElEl 10. Proper Adequate Handwashing 21. Food and Food Preparation for HSP CONSUMER ADVISORY ❑ 11. Good Hygienic Practices ❑ 22. Posting of Consumer Advisories Violations Related to Good Retail Practices (Blue Number of Violated Provisions Related Items) Critical (C) violations marked must be corrected To Foodborne Illnesses Interventions immediately or within 10 days as determined by the Board and Risk Factors (Red Items 1-22): of Health. Non-critical (N) violations must be corrected Official Order for Correction: Based on an inspection immediately or within 90 days as determined by the Board today, the items checked indicate violations of 105 CMR of Health. 590.000/Federal Food Code.This report, when signed below C N by a Board of Health member or its agent constitutes an 23. Management and Personnel (FC-2)(590.003) order of the Board of Health. Failure to correct violations 24. Food and Food Protection (FC-3)(590.004) cited in this report may result in suspension or revocation of (/ 25. Equipment and Utensils (FC-4)(590.005) the food establishment permit and cessation of food 26. Water, Plumbing and Waste (FC-5)(590.006) establishment operations. If aggrieved by this order, you i,f/ 27. Physical Facility (FC-6)(590.007) have a right to a hearing.Your request must be in writing 28. Poisonous or Toxic Materials (FC-7)(590.008) and submitted to the Board of Health at the above address 29. Special Requirements (590.009) within 10 days of receipt of this order. 30. Other DATE OF RE-INSPECTION: Inspector's Signature: % / Print: PIC's Signature: Print: Page/of_? Pages FORM 734A HOBBS&WARREN - BOSTON Violations Related to Foodborne Illness Interventions and Risk Factors (Red Items 1-22) PROTECTION FROM CONTAMINATION 8 Cross-contamination FOOD PROTECTION MANAGEMENT 3-302.11(A)(1) Raw Animal Foods Separated from 1 590.003(A) Assignment of Responsibility* Cooked and RTE Foods* 590.003(B) Demonstration of Knowledge* Contamination from Raw Ingredients 2-103.11 Person in Charge-Duties 3-302.1 I(A)(2) Raw Animal Foods Separated from Each Other* EMPLOYEE HEALTH Contamination from the Environment 2 590.003(C) Responsibility of the Person in Charge to 3-302.11(A) Food Protection* require reporting by Food Employees and 3-302.15 Washing Fruits and Vegetables Applicants* - 3.304.11 Food Contact with Equipment and 590.003(F) Responsibility of a Food Employee or an Utensils* Applicant to Report to the Person in Charge* Contamination from the Consumer 3-306.14(A)(B) Returned Food and Reservice of Food* 590.003(G) Reporting by Person in Charge* Disposition of Adulterated or Contaminated 3 590.003(D) Exclusions and Restrictions* Food 590.003(E) Removal of Exclusions and Restrictions 3-701.11 Discarding or Reconditioning Unsafe Food* FOOD FROM APPROVED SOURCE 9 Food Contact Surfaces 4 I Food and Water From Regulated Sources 4-501.111 Manual Warewashmg-Hot Water 590.004(A-B) Compliance with Food Law* Sanitization Temperatures* 3'201.12 Food in a Hermetically Sealed Container* 4-501.112 Mechanical Warewashing-Hot Water 3-201.13 Fluid Milk and Milk Products* Sanitization Temperatures* 3-202.13 Shell Eggs* 4-501.114 Chemical Sanitization-tem H, 3-202.14 Eggs and Milk Products,Pasteurized* p..p gg � Concentration and Hardness 3-202.16 Ice Made from Potable Drinking Water* 4-601 11(A) Equipment Food Contact Surfaces and 5-101.11 Drinking Water from an Approved System* Utensils Clean* 590.006(A) Bottled Drinking Water* -- 4-602.11 Cleaning Frequency of Equipment Food- 590.006(B) Water Meets Standards in 310 CMR 22.0* Contact Surfaces and Utensils* Shellfish and Fish From an Approved Source 4-702.11 Frequency of Sanitization of Utensils and 3.201.14 Fish and Recreationally caught Molluscan Food Contact Surfaces of Equipment* Shellfish* 4-703.11 Methods of Sanitization- Hot Water and 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* Sources* 10 Proper,Adequate Handwashing Game and Wild Mushrooms Approved by G Regulatory Authority 2-301.11 Clean Condition-Hands and Arms 1 2-301.12 Cleaning Procedure* 3.202.18 Shellstock Identification Present* 590.004(C) Wild Mushrooms* 2-301.14 When to Wash 11 1 Good Hygienic Practices 3-201.17 Game Animals* 2-401.11 Eating, Drinking or Using Tobacco* 5 Receiving/Condition 2-401.12 Discharges From the Eyes,Nose and 3-202.11 PHFs Received at Proper Temperatures* Mouth* 3-202.15 Package Integrity* 3-301.12 Preventing Contamination When Tasting* 3-101.11 Food Safe and Unadulterated* 6 I Tags/Records:Shellstock I 12 Prevention of Contamination from Hands 590.004(E) Preventing Contamination from 3-202.18 Shellstock Identification* Employees* 3-203.12 Shellstock Identification Maintained* 13 Handwash Facilities Tags/Records: Fish Products Conveniently Located and Accessible 3-402.11 Parasite Destruction* 5-203.11 Numbers and Capacities* 3-402.12 Records,Creation and Retention* 5-204.11 Location and Placement* 590.004(7) Labeling of Ingredients* 5-205.11 Accessibility,Operation and Maintenance 7 ( Conformance with Approved Procedures Supplied with Soap and Hand Drying /HACCP Plans Devices 3-502.11 Specialized Processing Methods* 6-301.11 Handwashing Cleanser,Availability 3-502.12 Reduced Oxygen Packaging,Criteria* 6-301 12 Hand Drying Provision 8-103.12 Conformance with Approved Procedures* Dentes critical item in the federal 1999 Food Code or 105 CMR 590.000. CITY OF SALEM BOARD OF HEALTH Establishment Name: �o�ae Sr�c�¢r �9-r 6 ' ee Date: S��S�3 Page: of -� nem ode C-Critical item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date No. Reference R-Red Item PLEASE PRINT CLEARLY Verified ///F lw vu S rfl /mss, efS ? yPrc r:a.✓ c�cYco�, l��C — ( lCca,o // �f I �7 - fl�to/cr-✓ C�v�olart a,.. e�ecTO�r�e i— .�,s,.-o( Sir3�c II a7 I - TO,�¢r Ncrc� .s' To.ler SCAT I Ia 7 - /i.�e � d /�.y�•/�/u-.,r.v r,,-� .s ti<r O/J¢2i JTIN� 02 i%frt�c/<,.�,rf/ 5;..�..o is �.•er D��-z.nr��'� /rlPc//.�.�,c-o/ !/��.-r F9�.•.r /mor oQc�-q rl�✓9 d I - vPti r �iS?+i /�f ii'T /Lc cam{ TL �e /'�.-c/✓c�..cr� i7o�j'�.rTc�✓. �7 I - s�iteA i✓e.�ol� 7,7 �r o2'iJ i9�i Z� .�a/rliL 7o r+»/cc G° l��«.� F.o.j`_ _ I ' d7 <l� 4 a// /vec 2/A- c 70 /h y/cc it S. orri Egz- `� Csr.ar /J�P4 II .•yi.o rcR.'a� I Discussion With Person in Charge: Corrective Action Required: I ❑ No I ❑ 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. 'W4" i�9�� ❑ Voluntary Disposal ❑ Other: 4 iDi 14(Ci i'HFsT,-cewed at '✓iclations Related b7 FrrdSnrpe Illness Interventions Pit,'Risk Accetdir_o•:.­a Cooled to Factors(Items 1-22) (Cont.) I -I'Ft45'F\`riti:ri I:::nr, ' PROTECTION FROM CHEMICALS Ctr,liu) Method, _,w PIiSs p!i Pill:Not and Cold Holding ?g Food or Coffer Additives �,-5nL l6t TS': C ithl FI-}Fs .Maint.uu:d at :;r 3�(t�_l2 Addititos' ( ' 590.00kr) 71'/45'-," -302­14 Protectiu.: troth lJnapprtn;d Additnc:.' ' =-%l 160: get}'HS:. n,taintaineA at vi LbebC 1E Poisonous or Toxic Substances 140`5. 7 PQ Il hicnnfwtgInformation Original 3-501.i6(A) 1>, H :6 I F Containers, oasts H.-Id at or a.,ore 1F .. 'f:ine as a Public.Health Control � 7 10" it Gmnum Name-1Vorkine Containers' 7-207 11 Separation-Swaim' 3-50!.:9 Tom as a Public Health ControP' � 1 7-202,11 Re>triUwn-Presence and tbci)' 590.00',"H) Variance Requitenunt 1 7-203.12 conditions of U'c' 7-203.11 'fox;.;Container,-Prohibitions' ( REUQUIREMF-.NTS FOR HIGHLY SUSCEPTIBLE 7-:U4.Ii Srni:ii?rs.Cntcrin-Chc:ncak',. ' POPt.ILAT`:{3Pdu(:ISP) 21 1 340.11(A) Unpa� 7.20.4 12 C'hruucals fur Wast-nag Produce, C7i:era'. ( ! !,,w Lzd Fre"r ekaeed iuicas and 7 7U4.14 DI?iaw:A:,Cntg Crireri a.` 1 fle, gee,,vith ' i 3-501.1:(B) L'iseol'Pasteuu,cdEg�psT j 7-105 It Incidental}roti;Cuut_ct,Lnhricani.," ( 3-80 1,I !(D) Raw or Panel!) C Coked.tounal Foo,! and 11 Re:trictrd Use Pesuetde,.Crneua Rau'-Seal Spr•:rs Not Served. °: 7-206 12 Roden &ut Stations" ( 3-80l. i(C) 17nopen,..it Tkwd Packa¢e Not Rc-sereed 7 2(16.13 Trackin�t,Powders, Peet Control and Munitorinn CONSUMER ADVISORY TIMEiTEMPERATURE CONTROLS 22 3-003.:1 Con.umcr Adtisore Posted lin"C:onsu:up:-lou of .1n:u::n P:xids That ire Raw. Und,-!coked or Zf, Proper Cooking Temperatures for I *(.,;;!-:;i:envis; Froczssed to Linomat: PHFs rrem:o ves,e: 3--01.11 At f)(2) E l - 155,'.F '5 ;ec. Rrhoaens. E.rw-Immcdtate SerNice i-tS Flis:.c" I =-301 1' Pasteunml Egg,hubetiune fol Rata Slit!] 3-101.1I(A)(2) C•ummimued Fish, Mc us R Game Annuals- 155`5 15 s:c. " SPECIAL REQUIREMENTS 3-401.11(A) 2) RafiFortand HecfRoa,ted Nic - 130'5 121 min, 590.U09(.A)-(D) Violations of Section 590.009(A)-(D) m I3-401.tI(Ai(2) Ratites,InjectcdMeatc- 155'Flo I sec. ' catering, mobile food, lemporay and -4UL1I(A)(=) Ponitry, Wild Game. Stuffed PIiFc, res:dcntial kitchen oPcrations should be stin*fing cont.,uung fish.Nle,:. cl•ited under the appropriate section, Poultry or Ratites-i65T 15 sec, ' above li re7a;e(: t0 ibodboi ne ilh):oss 3-4(11 1 l(C)(3) Whole-muscle.Intact Beef Sieaks ( interventions and risk factors. Other I45`F I590 009 viohilions relaiirg to goon retail 3-401 12 R.aw Ama:al Foods Cooked in a I pr:actiecs shou;d be debited under#29 -- Mia'owave 165`1 " �pcciai Requiten':nis. 3-401.11(A)tl)(b) All Outer PHI-, - 1.75'F 15cec 17 Reheating for Hot Holding WOLATIONS R.ef-ATED TO GOOD RETAIL PRACTICES ?-903.1I(:A)K([)) PHFsIn5'F15sec. (Iterro23.30) 3-403 11(B) Niia'owatr- 165' F-' Minute Standing ( C,ittcal and richt-rrrrir::',iri.nions, tvh,cii do not ref' e it;he •I'ntte" foorthc•nu•:?btesa nvrn•cmions«rid+'tok Jactrr htiui abavv, can b,- i 3-403 1 11 Ci Commerciall} Pra:esed R'i E F•ard- ( ,(aarnd in ihr.(u?6,:rmy srcaon,,.Plie F':,od Code"wd MO5(';tIR 140`q'i 59).ORn• 3-403.1 I1E) Remaining Uoidiced Portions ui Bt::'I ( item--- Goad RPfali Prae.Icas ! FC 590.000 23._ Mana4ement and='2'=cnnsl Fi,--.^. .003 7 g Proper Cooling of PHFs -24 F^od ann Fox Protecticn ( FC-3 .004 3-501.1 ii At Cool in,Conked PHFs from 14OcF u• i 25 Equipment and Utensils FC-4 .005 26. Water.P:wrbu:q and Waste FC-5 .006 70'117 Within' Hours and From 70'F ' 27 Physical Fe^div FC-6 007 to 41"1/45'5 Within 4 Hoare, ', 28. Poisonous or Iwir.Mats-iak I PC -' j .008 �I 3-50I.14(B) Cooling PHFs Made Fr:,:v Ambient ' 29--- SPe is Reruirements 009 Temperature ingredients to 4l'FJ45�FI 30, I Other Riit}un 4 Hours.: I'll,'­' I 'beno,e,/meal nom:n the ndrral 1999 f w,d Code o: 10,"MI,`,90 Ono. CITY OF SALEM \ BOARD OF HEALTH Establishment Name: S�—'LeeT .Qae 'A G-e.lL Date: -ev-s / , Page: 3 of -3 Item /Code c-critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION I Date No. Reference R-Red Item Verified _ \ PLEASE PRINT CLEARLY a7 / n!� T .Y o.loti J G c L/ A . /� r.L/ Aile�a L�\ / / CS f Ad. /�•_ rT _ mi, r • U ! J �Z .� 7 — /�iJ.�.. 1. .�.• ��..�. /cci /s»�J,i'-�P S^��/i>/ �.�-.� �-_ .. rr r�.-� F/�n /. 1 ri � r v 7,21- /r e' 7L/Pl cT I ✓ / A {////A /loc cSe..J /'Io,n... FJ�..✓ .>-�, �.a.,c.,>,.c /t..,...f„ s.>�. /c...,,../<� ' ✓./�ij S0.4i T%T aTinN .n ..� Nci JZ,.PF �L'X7g'iCr++.w.ATC- /�yJ�v7/�/i �..J irliGc•� /// Discussion With Person in Charge: Corrective Action Required: I ❑ No WY Yes I have read this report, have had the�opportunity to ask questions and agree to correct all a' Voluntary Compliance ❑ Employee Restriction/ ection, 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 daily1fines of twenty-five dollars or suspension/revocation of ❑ Embargo ❑ Emergency Closure your food permit. `� 0 _Voluntary Disposal 0 Other: 3-5Ot.14(C) PHPs,RCce:vd it Violaiions,Related to Foodborne Illness InterventOns and Risk Ac;c.rer;„,,1,,I.av,Cooled to Factors(ire ms 1-22) (Cont.) 41'F,145` Wi0im 4 Hours. 3-50i. Coo:li, fol NiF, PROTECTION FROM CHEMICALS 19 PHF Hot and Cold Holding 14 Food or Color Additives 3-202.iv” Additive,* 3-501J643) Colc! PPFi M-In!.uacd at of below 3-302.14 Prot Ilion troir,Unapproved Additi,e,, IS Poisonous or Toxic Substances 3-50:.10(1,%) Hot PI IF,, Nia� at oi afawe 1 140T, e 7-101.!l Iderinf)uirt Infortillition-06gimil 3-501..,6(A) I:o::..t> Hold it oi atove 130'F 2e j Time as a Public Health Control 7-102.11 Corninon Name-Working Contairem 3-501"1 Tont. as j Pjbhc I Lcihh Control 7_101 11 Separation-Stet age' 7-202 It Resoictioll -Presence a:]J Use r 7-20? 12 Conchtions of(:,,O REWREMENTS FOR HIGHLY SUSCEPTIBLE 726311 'toxic Contudoeis-Piohibition0- POPULATlONS(HSP) 7 _'U4.11 Sanitizeis.Criteria-Chcini(,als* 21 1-',Z0!. ](A) I 1nj­srqcur*.,�,cI Pre-packaged Juices and 7-204.12 Chemicals for Wt�,shin2 Prodvcc,Ci4oriu� &tercazcs wih Nvarnin:i Lahel�t 7-2-M4.14 Diylag Aget*:.Criteriar 3 8o:. 7(P) Use J I Pasteurized Ei... 3-20! t I tD) Pax� ��i Partialk Coolsmi Aroavi Foodand 7-2406.11 Restricted Use Pewcidc, Critena- Ra" Seed Spr,-t. Not Set ved. 7-2.-gh I' Rodent Ban Stafionsi 7-1106.13 Tracking Powders, Pest Control and 1(c) Unopened Food Package N,,,Re-servo(I tvlonitonrvz' CONSUMER ADVISORY TIMF/TEMPERATURE CONTROLS ?2 3-603.11 Consumer Adyisbry Posted fir Consumption of Amnisi Foo,lsghat are Ram,.lhictel_U,oked or 16 Proper Cooking Temperatures for PHFs %vNot Other ;Ne Proceqs,d to Eliminate 3-401.1 i At 1)(21 Eggs- 155"F15 See. Fg"q- tmwdlato Servic",1.45'F 15w,. 13 PsSt�w I led F�'gs Stdt,tiortc hot Raw Shell 3-401.1 l(%)(2) Comminuted Fish.Nlrats & Game Ardinals- 155'F 15 see. 4 SPECIAL REQUIREMENTS 3-40 1.11(BR l)(2) Pork and Beef Roast- 13W F 121 Iran- VioLitions of Section 590.(K)9(A)41rr in 3-101.11(A)(2) Ratites, Injected Nleat;- 155T I S90009(A)-(D) I I calcrin,c, mobile hX)d, lernporarN and 3-40 1.11(A)(3) 1?0111hp, %kild G111110.Scuffed PHI'S, residential latchen operations should be Shut firg Containing Fish,Meat, debited under the appropriate sections Poultl I v or Ratites-165'F 15 see, above if related to foodborne illness 3-401 1 l(C)(3) Whole-muscle. Intact Beef Steaks interventions and i;,It Factors. Other 145'F 1 590.009 violat;ons relating to 1,,00d retail 1-401 12 Raw Animal Foode C(x)ked in a I practiccs should no detnted wider #29- Microwave 165°F* Special Requirements 3-401.1 ItAal)(b) -,\It Other PHF3-- 145'F 15 sec. 17 Reheating tot Hot Holding VIOLATIONS R_:LATER TO GOOD RETAIL PRACTICES 3403.11(AWD) PHFN 165,F ;5 see. 4 (1herlIN 23-30) 3-403.11(13) Microwave- 165'F 2 Minnie Standing uwynqlf,�-;W non-,:r;qcol i ioiuiicns; lint relax,to the Time" r' o� Time" ifluess itovi-vuab and wk facio,, li%red above, ten be 3-403 1 K') Commercially Processed RTE Food- fnymd in the following saliva, rj tl;e!uod Codeand)o5 CAIR 140'F* 5S10.00(i. 3-403.11(E) Remaining Unsitcod Portions of Beef Item Good Retail Ptactices, 1 F0 590.000 Rortstti* 23 Ivianaflement and Porscnnej FC-2 .003 m Proper Cooling of PHF-s i 24 Foo,and FOod"rolecti.-n FC 3 004 25. Equipment and Lftort�ils FC-4 005 3-501. .0 A' Cool to,G,okcd PHFs from i 4WF to 26. Vv�ilr,Plumand Wa�dt I F(,--S ON----z---1 70 F Within 2 1 h,urs art,,! From 70'F 1 27 1! Plycical Fac!hty FC-6 .007 to,l 'F/15'F Wthin 4 Hours. 28, Poisonous of Toxic;Materials FC-7 .CO8 3-501.41B) 29, i Spocial Paqu:rcments CKC) Cooling PHI-s Made Huni Ambient I reraperature Ingredients to 41'F!4-'F i 1 -3o ---1-atip: Wit him,l Hours- Donme,,,ilic-I aern inthetedcral 194y rtu>d Cca1e ur 1F-UN-11Z 390.01)0. ( IMPORTANT MESSAGE ) FOR C���.�{.+-n-�r�'a DATE ❑ AREA CODDEE-- NUMBER ^EfpQgPNv, ❑ M I t F(/r?" cG/z2 71GG/J/-lJ/c3/ AREA CODE NUMBER TIME TO CALL TELEPHONED PLEASE CALL CAME TO SEE YOU WILL CALL AGAIN WANTS TO SEE YOU RUSH RETURNED YOUR CCA/LL I WILL PAX TO YOU MESSAGE SIGNED /� � FORM 4`OOB//J MADE IN U.S.A NOTES THE COMMONWEALTH OF MASSACHUSETTS �� r E hro rrr 14A 17,41 Establishment Name }� Date Address "I.� Page / of j 7 l�nnF I Item No. In the space below describe all violations checked on front page. FI>~. Y e II l f r .J 1✓? '7 ' . -� « .� /., �F�/? 'r ��+_ Cil,/�Y 5.��lln,�H (Jn,Jn .�., l-n.^,L r..• / u6/r �l, n-fR_,.1, ` ..o J�?11 rPU )<•_.� ✓O r�.).r P.�•r'�-1' rye :f.t.'���s-wci �,Fr._G, tom. .••< i„� _ /I� I � — l�f V/P..�rfc.l <,�In .�n._�,l !.l A.,s.tlt,.ar, ��' ✓-s...t3� �i�v1Ux 1/a(_L, -rrJf?N,•)n�EOr �J I ( p .-,csl l//!!A / S/!✓A/ -��>.0,v' r ✓'-,r✓7'1 p,tlF C!<}._I r I_ l✓.'f /.Y ta N.ar, '-t`l.7 1,/,mel/ Ie4✓. e �i.C>r i 4, ;�f. � L t � r�// -l-/„�,as �,,+l,r//5 i��1/✓v,o �, ��rcl��.a-t'•__.lyr _ rr,�.L,r,.�F m l.vv; e/1�,1/n-dl vr� Pi/ •,! 1,.r ! =fin ate,:rhr •/i p = Tc' a_ f7n •1�/. �`>/1 /,/.1 nim x% �/i'a . O,J, � ,.7�y.a/I/ �I`�'%//__• rf<L4 4 / lS n[` 1�'yL_r. 4/!-ll F�_a .4 a _( ✓rf c-w!e r'd,. . -- •-�F�//S (),IIP-r•� !A r /`d .! ,o ,a_-I .� �1i0_ /A-fr.lV � 1..I)Af''d'I.//�l J V0-4P-!/ 1N 4 �./?rv'!`7!'..r.! loeq l f/,I r ' �F_ar7� + •--'A 7�1✓Irl ...• All 51iA's r �! -�P�re� nor,✓ •� /.t./i rr / It l:�<.-� �_, :l A-wf.�)' +-ll r� ✓t1.l�r1 YL�(..✓w -,f Discussion with Management / 4 `4o 6p�z- / Ixe-, 1, ,J.)•JZ. Plvlr �e - 14/, (, 6-o'e U/2P/ nir rn 4-17 ^15�. / pro � /+/rte. �,A 14-rk?vj -e tj May 14 03 04: 24p Alice Berkeleu 508-862-0105 p. l PILGRIM HOSPITALITY, LLC 98 West Border Road Malden, 0211$ Phone: (781) 388-1131-1—Fax: (508) 862A103 Web Side: PilgrimHospiudity.com CONFIRMATION OF SERVSAFE CLASS COMPLETION To Whom it May Concern: This will confirm that: Frank Presutti of Dodoe Street Grille. Salem. MA has completed the following ServSafe Sanitation Certification Course and passed the required examination_ Location: Hilltoo Steak House_ Saunus. MA Date: Aor. 2 &Aor. 16. 2003 Test Date: Aor. 16. 2003 Educational Foundation Certificate# 237033 The certificate is in the process ofbeina mailed and has not vet arrived from the National Restaurant Association. Alice Berkeley Administration &Marketing Director May 14, 2003 CONSULTING, TRAINING&MANAGEMENT FOR THE HOSPITALITYINDUSTRY r Massachusetts Department of Public' Health Salem Board of Health Division of Food and Drugs t a � -4120 Washington Street,4th Floor 9 Salem, MA 01970-3523 FOOD ESTABLISHMENT INSPECTION REPORT Tel. (978) 741-1800 Fax (978) 745-0343 NameDa / Tyoe of Ooerationfs) Type of Insoection �/3AV,C- r/ -,J 'B/2,t tr--,(2, �( I Food Service El Routine - Address 50 1 Risk ❑ Retail �Re-inspection Level ❑ Residential Kitchen Previous Inspection Telephone '� f � v 0 ❑ Mobile Date: l­75 q,Owner I ? 3' HACCP YM El Temporary ❑ Pre-oppest lame '�",� I ❑ Caterer Suspect Illness Person in CAarbe(PIC) Time ❑ Bed&Breakfast ❑ General Complaint - In:S Z� ❑ HACCP Inspector ( � )_ i 1pp Out:S t Permit No. El Other Each violation checked requires an explanation on the narrative page(s) and a citation of specific provision(s)violated. Noncompliance 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 : . _ El13. Handwash Facilities EMPiOYEE HEALTH _ ...--..... _.-. . .., S PROTECTION FROM CHEMICALS ❑ 2. Reporting of Diseases by Food Employee and PIC ❑ 14. Approved Food or Color Additives ❑ 3. Personnel with Infections Restricted/Excluded ❑ 15.Toxic Chemicals FOOD FROM APPROVED SOURCE - ' ' - • TIME/TEMPERATURECONTROLS(PotentiallyHaiaidousFoods)" ❑ 4. Food and Water from Approved Source E] 5. Receiving/Condition El 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) ❑21. Food and Food Preparation for HSP ❑ 10. Proper Adequate Handwashing ❑ 11. Good Hygienic Practices CONSUMER ADVISORY ❑22. Posting of Consumer Advisories Violations Related to Good Retail Practices Number of Violated Provisions Related Critical (C)violations marked must be corrected To Foodborne Illnesses Interventions immediately or within 10 days as determined by the Board and Risk Factors(Items 1-22): of Health. Non-critical (N)violations must be corrected Official Order for Correction: Based on an inspection immediately or within 90 days as determined by the Board . today, the items checked indicate violations of 105 CMR of Health. 590.000/fedpg eral Food Code. This report, when signed below c N b a Board of Health member or its agent constitutes an 23. Management and Personnel (FC-2)(590.003) y g 24. Food and Food Protection (FC-3)(590.004) order of the Board of Health. Failure to correct violations 25. Equipment and Utensils (Fc-a)(sso.00s) cited in this report may result in suspension or revocation of the food establishment permit and cessation of food . 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 r 29. Special Requirements (590.009) within 10 days of receipt of this order. 30. Other DATE OF RE-INSPECTION: S590MpeftPo 14Cx Inspector's Signature: \ 1'�X Print: �_I _ PIC's Signature: ,. Print: D V1 `"- Page-4 a2--Pages 4 Violations Related to Foodborne Illness Interventions and Risk Factors(items 1-22) PROTECTION FROM CONTAMINATION FOOD PROTECTION MANAGEMENT ( 8 j Cross-contamination 1 59O.003(A) Assignment of Responsibility` 3-302.11(AH I) Raw Animal Foods Separated from 590.003(6) Demonstration of Knowledge* ( Caked and RTE Foods* 2-103.11 Person in charge-duties ( ( Contamination from Raw ingredients 3-302.11(A)(2) Raw Atoned F,sits Separated from Each EMPLOYEE HEALTH I I Other` 2 590.003(C) Responsibility of the person in charge to Contamination from the Environment require reporting by fond employees and 3-302.11i_A) Food Protcction' applicants" 3-302.1.5 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 I Utensils* Charge* ( Contamination from the Consumer 590.003(G) Reporting by Person in Charge* 3-306.14(A)(B) Returned Food and Reservice of Food' 3 590.003(D) Exclusions and Restrictions"' Disposition of Adulte+ated or Contaminated 590.003(F) Removal of Exclusions and Restrictions ( I Food 3-701.11 Discarding mReconditioning Unsafe FOOD FROM APPROVED SOURCE ! Fes* J 4 Food and Water From Regulated Sources 9 i 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 Contamer* ( Sanitization Temperatures* - 3-201.13 Fluid Milk and Milk Products* 14-501.11_' Mechanical Warewashinn Hot Water 3-202.13 Shell Eggs* Sanitization Temperatures* - 3-202.14 Eggs and Milk Products,Pasteurized* I 14-501114 Chemical Sam diation-temp.,pH, 3-202.16 ice Made From Potable Drinking Water" _concent and hardness. * J 5-101.11 Drinking Water from an Approved System' 4-661.11(A) Equipment Fond Contact Surfaces and 590.006(A) Bottled Drinking Water* ` Utensils Clean' 590.0(6(B) Water Meets Standards in 310 CMR 220' 14-602.11 Cleaning Frequency of Equipment Recreationally Caught Molluscan Food- Shellfish Surfaces and Utensils* J ( ( 4-700 11 ( Frequency of Sanitization of Utensils and 3-201.14 Fish Fish and iso and Fish Froman Approved Source ( Fain Contact Surfaces of Equipment* Shellfish' 14-703.11 I Methods of Sanitization-Hot Water and 3-201.15 Molluscan Shellfish from NSSP Listed I Chemical" - - Sources* t0 Proper,Adequate Handwashing Game and Wild Mushrooms Approved by I 2-301.11Regulatory Authority Clean ConCondition-Hands and Anns* 3-202.18 Shellstock Identification Present'" 2-301.12 Cleaning Procedure* 590.004(C) Wild Mushrooms* 2-301.14 When to Wash* 3-201.17 ( Came Animals* 11t Good Hygienic Practices 5 ( Receiving/Condition 2-401.11 Eating,Drinking or using Tobacco* 3-202.11 ( PHFs Received at Propel'Temperatures* 2-401.12 Discharges From the Eyes, Nose and 3-202.15 Package Integrity* Mouth* 3-101.11 Food Safe and Unadulterated* 3-30112 Preventing Contamination When Tasting* � 6 Tags/Records:Shellstock 12 Prevention of Contamination from Hands 3-202.18 Shellstock Identification* ( 590.004(F;) Preventing Contamination from 3-203.12 Shellstock Identification Maintained* Employees* i Tags/Records: Fish Products 13 Conveniently nveniently Locay Located and Accessible Facilities 3-402.11 Parasite Destruction* Co 3-402.12 Records, Numbers and Capacities* 590,004(J) Creation and Retention* � - 590.004(J) ( Labeling of ingredients' 5-204.11 Location and Placement* 7 I Conformance with Approved Procedures 5-205.11 Accessibility,Operation and Maintenance /HACCP Plans Supplied with Soap and Hand Drying 3-502.11 Specialized Processing Methods* Devices 3-502.12 Reduced oxygen pack;taing.criteria` 6-301.11 Handwashing Cleanser,Availability 8-103.12 Conformance with Approved Procedures* 6-301.12 Hand Drying Provision T Denotes critical item in the tedeial 1999 F(xA Code or 105 CMR 590.000. ti CITY OF SALEM F BOARD OF HEALTH ,f Establishment Name: 12e472 -r- r-. , 1, Date: i Page: of Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date No. Reference R—Red Item Verified PLEA§E PRINT CLEARLY Lr a2/ o4- (6 1_>A 'e - J ' '� I �� �4./�,+ �►,� o �. � -�i,s 1 ��lrl— Sh�/ t � ��«r ,n K, �J� , 1 I � I l '' I 1. sl xt 1' { I � I � I ❑ No ❑ es Discussion With Person in Charge: Corrective Action Required: I ol / I have read this report, have had the opportunity to ask questions and agree to correct all untary Compliance ❑ Employee Restriction violations before the next inspection, to observe all conditions as described, and to ❑ Re-inspection Scheduled ❑ Emergency Suspension comply with all mandates of the Mass/Federal Food Code. I understand that noncompliance may result in daily fines of twenty-five dollars or suspension/revocation of ❑ Embargo ❑ Emergency Closure your food permit. �— ❑ Voluntary Disposal ❑ Other: i -=30 -��kf,) P!lFi,I2eca,ved at'temperatures Violations Related to Foodbcrne tliness Interventions and Risk ,according to 1.aw Cooled to Factors(Items 1-2.2) (Cont.) 41`F/45"FCrirhin'Humra PROTECTION FROM CHEMICALS j I5 Fooling Nlethcd; ;or PHFs j j 14 Food or Color Additives j 19 PHF Het and Coi,!"folding 3-1,0;.JoW) Cold Pl-:F;. \ic:msniedatofbelow 3-20'_.12 Additive:` 590.004(F) 4i'7450F- 3-302.14 Protection from l!uappimedAddur`es* 3.5Oi.lfijA1 IIotFI-i P. fvTaiu[amedrtoraboee j 15 Poisonous or Toric Substances 7101.11 Identifying Inform,,twit -ori; 40 F' " l inai i..01.1(,, 1' Rc•a ` ' I Coutainery' i0 ) lets Hew at or above t-(,"F. ; j 7-102 11 Cununou Nance: -Working Container." j 211 lime as a Public Health Control �. i_S01 10 Time;;s a Pvbitu Health Control* 1 7--02.11 Separation- Preseo' SYtI.OD-tfI-II �lariaincReadi:on:eut ' 7.2(}2.11 Restriciior,-Prsenee turd Ilse' j 7-202.12 Conditions of Use- 7-203 o" I REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7.2 a.C 03 11 Toxic Casnetets - Pmhihitioas" j j 7-..04.11 Sanitizeiiterr.+-ChemicPOPULATIONS(HSP)`is^ 1" ( :-SO( IUA) ij ps } � S 7=_'01 1'2 C6emicais for Washnte Produce,Criteria", ( I " n icu,ire:;P,e-lac;a ed Mires and 7-204.14 Dt}ing Agents.Criteria`" j Be�-e,.fees t+•rth lTr.trraing',:tbels;: j ;-nCUsP or Pastoul ed E" 7-205.11 Incidental Food Contact. Lubricants^ j i.tltB1 720n.1 l Resiricrcd Use Pectieides.Criienn' j ( SdOl.i l(Cr) Raw or Partially C<x':ked Ammai Fond and 7-206.12 Ratan Bait Stations" j Raw;iced Sprouts Na Nni . " - j ,-ROI !I(C'i Unop,+ud Faxi Packaget, i.:+i Rc-served. 7-206.13 Tracking Powders,Fes[Control and � vTonituring CONSUMER ADVISORY TIMEICEMPER IkTURE CONTROLS 22 ?-60; I I Con,omer Advisory Posted for C'oasuniption of .Animal Foos"I'Mt are k::w, Undercooked or 16 Proper Cooking Temperatures for PHFs I Not gtl,erw >e Pn;cess.,d[.;Eliminate --FOLIIA(I+(2) Eggs- 155=rI5See.. 1'athos;en:.4" ` Eggs-inmiediate Seta ice 135'Fl.isec* I 3-302.1; 1`;Mcuri ped Eggs Jubatimie for Raw Shell 3-401.11(A;('2) Commmunal Fish. Meats&.(.:fine Eggs* Antacds- 155'F 15 sec. 'f j 3-401-11 Polk and Hoof Roast- 13tP F 121 min" j SPECIAL REQUIREMENTS 3-401.1 i(A)(2) Ratites, lniccted Meat;-155'F i5 5?i)lit}`)( '%-(C) Violations of Section :Sy0.009(A)-(ll)in sec. '" catering. mobile food,temporary and 3-401 1 t(A)t3) Poultry. Wild Game,Stuffed PHFs. residential kitchen op_ratiuns should be SluOiug Containing Fish,hlea:, debit:-.I Under the appropriate sections Poultry or Rar:ts-l65,F 15 sec ' above if related to foodborne illness j 3=+01.1 i(C)(r) Whole-muscle,haact Bzef Steaks inteweutions and risk lactore Other _ 145`17 * 590.009 violations relarinv t �� o good retail. 3-901.12 Raw Animal Foods Conked in a pracu ct.:,.lonld be debited ur:det /r129- Microwave 165"F Special Requirements. 3,401.11(AW):b) All Other PHFs- 145'F 15 wc. j 17 Reheating for Hot Holding VIOLATIONS R-LAIEO TO GOOO RETAIL PRACTICES ;-403.i 1(A)3e(D) PHFs 165`F 15 sec. ^ (Items 23-30) 3-403.11(B) Nlicrowave- 165'1:?Monne Standing Critics?cad non-rr'iticai iiuk:nw;r, wbit 1,Gr, trot,elate to the Timc' foodnome dii,ess interver„ion, and i isk het tors lived oiwve, con be 3-403.)1(C) Comrncrcrelly Puoce.ssed RTE Food- /r„uui in fire foRmrirg sections of the Fc,o,'(aitr a;Id 105(1111? 140'F' 590.000. 3-403.11(F) Remmrmg I'rsh,•ed P`,,rtions of Reef Item Good Ret»if Practices FC .5o0.000 Ron„ts' 23. vAanacenion,and aereonnel FG - 2 003 j t g j Proper Cooling of PHFs 24 F�.xxi zed Fox Prete:!ion FC-3 004 25. Fquipnent and 1 rns;ls FC -4 .(106 3-50114(A) Cooling CookedPHFsfrom i4O'Fto ( 25. Watei,PlumNnoand Was,c FC-5 .005 70"F Within 2 flours and From 70'F 2?. Physical Fac:lily FC-C .007 j to 41-F/45"F Within 4 Hour., 28. Poisonous or Toxic Niater:als PC-7 I .008 3-5oI Id(B) C,'xfling PHR Mimic From Ambient 1 29, Special Rci0ren6ntt; j 009____ Tempiaturelwaedien,sto41`F/4i'F 50. UG:®r Within 4 hours" ' Dffi otca cnt:cai item ur chi:id:r.,i 1094 Pond Code or 105 CMI:`90:+00. Massachusetts Department of Public Health Salem Board of Health 120 Washington Street, Division of Food and Drugs Salem, MA 01970-35230 Floor FOOD ESTABLISHMENT INSPECTION REPORT Tel. (978) 741-1800 Fax (978) 745-0343 Name j� I 1 - Dat7 Type of Ooeration(s), Type of Inspection l/�rllA � l Kit t` C))IZ, if t'n 1 (r�(O Food Service 0Routine Address ` 1 I C o Risk n Retail []'Re-inspection Level ❑ Residential Kitchen Previous Inspection Telephone .--7 J (/ El Mobile Date: TL{�' r)l T�ci t z(Z 54 i-- Owner �` HACCP YIN ❑ Temporary ❑ Pre-o eration )-cool � p^.. t (� I I ❑ Caterer ❑ Suspect Illness Person in Charge(PIC) Time ❑ Bed&Breakfast ❑General Complaint / fw In: �� ElHACCP _ Inspector v Y I ��nr.XX I Out: �� Permit No. El Other Each violation checked requires an explanation on the narrative page(s) and a citation of specific provision(s)violated. Non-compliance with: Violations Related to Foodborne Illness Interventions and Risk Factors Anti-Choking Tobacco Violations marked may pose an imminent health hazard and require immediate corrective 590.009(E) ❑ 590.009(F) ❑ action as determined by the Board of Health. FOOD PROTECTION MANAGEMENT 1—— ❑ 12. Prevention of Contamination from Hands ❑ 1. PIC Assigned/Knowledgeable/Duties � " ' - - -� --x - - El 13. Handwash Facilities EMPLOYEE HEALTH _ . . . PROTECTION FROM CHEMICALS ❑ 2. Reporting of Diseases by Food Employee and PIC ❑ 14.Approved Food or Color Additives ❑ 3. Personnel with Infections Restricted/Excluded ❑ 15.Toxic Chemicals - FOOD FROM APPROVED SOURCE', 'TIME/TEMPRT EAURE CONTROLS(Potentially Haiardous Foods ' E] 4. Food and Water from Approved Source ( y )' ❑ 5. Receiving/Condition [116.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) El21. Food and Food Preparation for HSP ❑ 10. Proper Adequate Handwashing ❑ 11. Good Hygienic Practices :,CONSUMER ADVISORY ❑22. Posting of Consumer Advisories Violations Related to Good Retail Practices Number of Violated Provisions Related , Critical (C) violations marked must be corrected To Foodborne Illnesses Interventions immediately or within 10 days as determined by the Board and Risk Factors(Items 1-22): of Health. Non-critical (N)violations must be corrected Official Order for Correction: Based on an inspection immediately or within 90 days as determined by the Board today, the items checked indicate violations of 105 CMR of Health. 590.000/federal Food Code. This report, when signed below 7C 'N 24. Food and Food Protection (FC-4)(559(Fc-2) by a Board of Health member or its agent constitutes an 23. Management and Personnel 90 0 4)) order of the Board of Health. Failure to correct violations 0,00 ) cited in this report may result in suspension or revocation of 25. Equipment and Utensils (Fc-a)(ss .00s) the food establishment permit and cessation of food 6. Water, Plumbing and Waste (FC-5)(590.006) establishment operations. If aggrieved by this order, you 27. Physical Facility (FC-6)(590.007) have a right to a hearing. Your request must be in writing 28. Poisonous or Toxic Materials (FC-7)(590.008) and submitted to the Board of Health at the above address 29. Special Requirements (590.009) within 10 days of receipt of this order. 30. Other �. DATE OF RE-INSPECTION: S 5901nspeIXFoimbl4 tloc �� Inspector's Signature: Print: n� PIC's Signature: Print: rF iy�w PO t["4ez Page oP�Pages Violations Related to Foodborne Illness Interventions and Risk Factors(items 1-22) PROTECTION FROM CONTAMINATION FOOD PROTECTION MANAGEMENT 18 Cross-contamination I 596.003(A) Assignment of Responsibility* 3-302.11(A)(]) Raw Annual Foods Separated from 590.003(B) Demonstration of Knowledge* I Cooked and RTE F(xds* 2-103.11 Person in charge-duties I Contamination from Raw ingredients 3-302.11(A)(2) Raw Animal Foods Separated from Each EMPLOYEE HEALTH Other' 2 590.004(C) Responsibility of the person in charge to I Contamination Gom the Environment require reportuu,by foot(employees and i 3-302.11(A) Food Protection- applicants': ( 3-302.15 Washing Fruits and Vegetables f 590.003(F) Responsibility Of A Fotxl Employee Or An 13-304.11 Food Contact with Equipment and Applicant To Report To The Person in utensils* Charge" I Contamination ftom the Consumer 590.003(03) Reporting by Person in Charge" I 13-306.14(A)(Bi Returned Food and Resen ice of Food* 3 590.003(D) Exclusions and Restrictions* I Disposition of Adulterated or Contaminated 590.003(E) Removal of Exclusions and Restrictions I Food 3-701 It Discarding of Reconditioning Unsafe FOOD FROM APPROVED SOURCE F(x da' 4 Food and Water From Regulated Sources I 19 ( Food Contact Surfaces 590.004(A-B) Compliance with Food Laws i 4-501.111 Manual Warewashmg-Hot Water 7 3-201.12 I Food in a Hermetically Sealed Container* I Sanitization Temperatures* 3-201.13 Fluid Milk and Milk Products* I ( 4-501.112 Mechanical Warewashing-Hot Water 3-202.13 Shell Eggs* Sanitization Tem cratures* 4-501,114 Chemical Sanitiiation-temp.,pH, 13?02.14 F,ggs and Milk Products,Pasteurized'' 3-202.16 Ice Made From Potable Drinking Water* concentration and hardness. 5-101.1 I Drinking Water from an Approved System' i 4-601.1 1(.A) Equipment Food Contact Surfaces and 590.006(A) Bottled Drinking Water* I Utensils Clean* 1590 006(B) Water Meets Standards in 310 CNIR 22.0" ( 4-602.11 Cleaning Frequency of Equipment Food- Contact Surfaces and Utensils* Shellfish and Fish From an Approved Source I ( 4-702.11 Frequency of Sanitization of Utensils and 3-201.14 Fish and Recreationally Caught Molluscan I Faxl Contact Surfaces of Eympment* Shellfish* 14-703.11 :Methods of Sanitization-Hot Water and 3-20115 Molluscan Shellfish from NSSP Listed I Chemical* Sources* 1fi Proper,Adequate Handwashing Game and Wild Mushrooms Approved by Regulatory Authority 2-301.11 Clean Condition-Hands and Arms'' 3-202.18 I Shellstock Identification Present* I ( 2-301.12 Cleaning Pr(.x:edure* 590.004(0) I Wild Mushrooms* I 12-301.14 When to Wash* 3-201.17 Game Animals* I I tl I Good Hygienic Practices I S Receiving/Condition i 2-401.11 Eating,Drinking or Using Tobacco* 3-202.11 PHFs Received at Proper Temperatares'; I 2401 12 Discharges From the Eyes,Nose and 13-202.t5 Package integrity' Mouth` 3-101.11 Food Safe and Unadulterated* 3-301.12 I Preventing Contamination When Tasting* 6 Togs/Records:Shellstock 112 Prevention of Contamination from Hands 3-202.18 Shellstock Identification''` I 590.004(E) Preventing Contamination from 3-20142 Shellstock Identification Maintained" I Eunvlovees* Tags/Records:Fish Products 113 Handwash Facilities 3-402.11 Parasite Destruction* I Conveniently Located and Accessible 3-402.12Records.Creation and Retention* I s-2-03.11 Numbers and Capacities* 590.004U) Labeling of Ingredients' 15-204.11 I Location and Placement* 7 Conformance with Approved Procedures 5-205.11 I Accessibility,Operation and Maintenance I IHACCP Plans ( Supplied with Soap and Hand Drying 13-50.11 Devices " I Specialized 13-502.12 Reduced oxygen packaging,criteria* 6301 11 Handwashing Cleanser,Availability 8-103.12 Conformance with Approved Procedures` I 16-301.12 Hand Drying Provision Denotes critical item in the federal 1999 Fond Code of 105 CMR 59(10(10. k CITY OF SALEM ` BOARD OF HEALTH Establishment Name: �MIG> Iq_ r--I-r9e—, zl F Date: (o Page: of �. Item Code C—Critical Item DESCRIPTION OF VIOLATION./PLAN Ok CORRECTION Date No. Reference R—Red Item - Verified IIl PLEASE PRINT CLEARLY % I s7oLI1 frl „n 7�, y �ISs,nq r4_ 14"j-1J4_ . 1_71-4 F (a 1-) 2 h n(d ops rA-1 A&r4 ,�S . CInC41\_ 64.00,,e) k !C.(J-,-, .S . AC ,.n./r-7LM „ I n �lO"rnc� o � ,.Lo �Jllrr � cJn.-1— S� GI Y-Pcajr, _Xn -fTn/ <4n,n (J S1U/cAlJA _rt CI fK—'A rail/O_ t / Cil I CPr4, M.,ISI � ✓a�L� I krqw ' Discussion With Person in Charge: Corrective Action Required: ❑ No tea 1 have read this report, have had the opportunity to ask questions and agree to correct all ❑ voluntary Compliance LI Employee Restriction s Exclusion c violations before the next inspection, to observe all conditions as described, and to p” Re-inspection Scheduled LI Emergency Suspension ' comply with all mandates of the Mass/Federal Food Code. I understand that 1 noncompliance may result in daily fines of twenty-five dollars or suspension/revocation of ❑ Embargo ❑ Emergency Closure your food permit. ` — ❑ Voluntary Disposal ❑ Other: 1 3 5f1 ;-I(C:) PHFs ftecc:vrd it Temperatures Violations Re.ated to Foodborne ltlness litterverrtiorm and Risk according to 11•N'Cooled to Factors(Items 1.22) (Cont,! 11:. - - -•; t 4s,Ftisithin 4 Hours. " j PROTECTION FROM CHEMICAL3.501.:5 C:,;obng 1%1etn:od:•for PHF's + i 14I Food Or Color A 19 PHF Hot Pnr'.dditivas ' +,oitl Hrtding i 3-S0I IldB; Coll Pf IF- Maintained ar or below 3-202.12 Additi%cs` 3-302.14 Poteanun from l9000.4(F) 41"-5F 3-5C 15 Jot PiiF:. Ntaintamed al or above j 1.5 Poisonous or Toxic Substances 140'1'. K 7-101.11 Identifying Information-(trlginal 'i-'i0!..16 ,4) Roach Geld:a Conounerr" ( ur above 130`F j 7-192,11 Common Narua--4v'ofam'�CnneiineW 20 Time as a Public Health Control 7-20L I 1 Sep"FaLion--s]urave* -501.1" Time a>a Public Health Control' 7-202 I 1 12eatriction Presence and Use j 59iSUU4(111) Variance I2equitement 7-202.12 Conditions of Lis:' 7-203 11 Toole Containers-Ptohfbitions* REOULAT! NS( FOR NSGHLY SUSCEPTIBLE 2W.1 7 S.mit;zets.Cntens-Chenr,cals' POPULATsO955(HSP) 7-20-1 17 Cimu'cals iia'Washing Product,Criteria* j 21 3-SO!.!!(A) ( Cttpastenrved Pre-pacl:u,Ied juices ani: 7-20f 14 Diving A?tents.Criteria.r tteart.iges •Nnh Warning labels* 7-205.11 Incidental Food Contact. LubncarhoI ; 13-801.11(H) i Use of Rtsteoiizzd Fa;;:!' ,� I3-SOLI R.av;of Pat'.la'!p Cooked Animal Kind and 7-2-06. .1; Restricted lira f o•,ticium Cri tern: j 7-206.12 Rodent Bait Stations Ra'm Sued SPrimtF ..".ui Sersed. .n 7-206 13 Tricking P+ovderv, Pest Control andi I > S'•!LI I(CJ ( Unorened Fo:n? Package Not Re-served. Monitorin,�,x CONSUMER ADVISORY 22 360;.11 Coniumer,Advisory Potted fur Consumption of TIME/TEMPERATURE CONTROLS Am_nnjl F'onds'Mat.:re Raw.Undercooked o! 1 lk Proper Conking Temperatures for PHFs ( Not r)therr.i:.e Processed to Elimin.,tc 3-40i.! IAIII(2) Egg;- IS;i''r 1.5.Rea -; �rimd C,_gn Subsrune ;o; Raw Shell F:gg;- innnediatc Service 145'P15nec^� � -''12.1 3 Paste 3-401.11 W(2) Comtninutcd Fish, 6-Scat,&Game Fres* Animals- 155'F 15 sec. SPECIAL'REOUIREM ENTS 3-101.11( 1l:"i)(2) Pork and Beef Roast - i;0`Fi_irain 5g0.00ci(A)-(i�) Violations ef'Section590.tif9(A)-(D)in >-101.1t(A)(2) Ranter,injected bleat - 155''F 15 . sea- catering_ mobile foI R!, ternpurary and 1 3-4:11.11(A)(') Poultr;,Wd,;Game.Sniffed PHFs rr1tden4isl kitcleu opetalions shouid be Stuffing Containing Fish. :Meat, debited under the appropriate Sections Pouitry or Ratites-165°F 15 sec. above if related to foodborne illness 3-401.1ItC1(3) Whole-nmscfe,Intact Beef Steaks interventions and risk factors. Other 145" '* 590,009 violations rela0r•e to rood retail 3 401 12 Rail-Animal Foods Cooked in a p:actices should be debited ander 1529- Mluoviatve 165'-F* Saeid:Requac mnits. I 3-401.111 Aa 1 t(b} All Other PHFs-- 1 45"F 15 see. ' I' Reheating for Hot Holding VIOLATIONS R-LATED TO G000 RETAIL PRACTICES : :-403.11(AA(D) PHF, 165`F15so,-. (Items 23-30) 3-bi3.1 1(B) Microwave- 165°F 2 AQuuue Standing ( Ctitrcal and nun-critical i tohwon,, which do not relate!o the j Time* 1odborne illnesi hitei venriorrs and riskja,tors listed,lbove, coin be i 3-403.11(C) Commerc•ialby Processed RPE Food- !nun,:fi,t)-r.jblGnoh;,5 settir.-=s of the Fond Cvue and 105 C.b1R -------------- --- --------- ---- 3-403.;1(li) Remaining Unahced !'croons of Be of tem rood Retail Practir?s IFC 590.000 Roast::' 23, Idanaoemem and Personnel FC-2 .003 ;A Proper Cooling Of PHFs 1 24. Food and Fend F:vtorhon FC-; .004 1 25. Equipment ana Utcnsi's FC-4 :005 3-501 14(A) Cool Cooked PH Fs from 1,10F to ( 20. Water,Rumbinq and Wast FU'-5 .006 70°F Within 2 1Innrs and From 70"F 27 Pnvs4:al Fac;tty FC-6 rW to 41°FhtS"F Within 4 Hours. t28. Poisonous or Toxic Vaterc-Js FC - 7 .008 3-501 Win) Cuohng P1IF5 Made FuanAmbient 29 1 ScC-cial Requirema-t; -- I -009� Tetnperc:ure ingredients to 41`Fi45"F 30. 1 Utter W]if. .11 loo:r* •„nmn.:�.:a.. 'Denote,mond item In Ihr(odor dl 1999 Food Cods or 105 t'h'til 590 00:1. CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH ( � 120 WASHINGTON STREET, 4TH FLOOR SALEM, MA 01970 nNe TEL. 978-741-1800 FAx 978-745-0343 W W W.SALEM.COM Kimberley Driscoll JOANNE SCOTT, MPH, RS, CHO Mayor HEALTH AGENT January 5, 2006 Frank Presutti Dodge Street Bar&Grill 7 Dodge Street Salem,MA 01970 Dear Mr. Presutti, The City of Salem Water Department has notified us that your water service has been restored and payments have been received. Therefore,all food operations at Dodge Street Bar&Grill, 7 Dodge Street, Salem,Massachusetts are approved to resume effective January 5,2006. Sincerely, ne Scott Health Agent CITY OF SALEM, MASSACHUSETTS 3 ';gtt BOARD OF HEALTH +9 120 WASHINGTON STREET, 4TH FLOOR SALEM, MA 01970 "Ne TEL. 978-741-1800 FAx 978-745-0343 Kimberley Driscoll WWW.SALEM.COM Mayor JOANNE SCOTT, MPH, RS, CHO HEALTH AGENT January 5, 2006 Frank Presutti Dodge Street Bar & Grill 7 Dodge Street Salem, MA 01970 Dear Mr. Presutti: The City of Salem Water Department has notified us that your water service has been shut off. Lack of water service to your establishment creates an imminent health hazard requiring immediate suspension of the food establishment permit. Therefore, all food operations at Dodge Street Bar & Grill, 7 Dodge Street, Salem, Massachusetts, shall immediately cease and desist. This emergency closure shall be in effect until the Salem Water Department notifies the Board of Health that water service has been restored. 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, 120 Washington Street, 4`" Floor, within ten 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, Joa��-� /�eliueresa� t' t Health Agent �r>rSU7�/ . ' 0\ CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH a 120 WASHINGTON STREET, 4TH FLOOR SALEM, MA 01970 TEL. 978-741-1800 FAx 978-745-0343 W W W.SALEM.COM Kimberley Driscoll JOANNE SCOTT, MPH, RS, CHO Mayor HEALTH AGENT January 5,2006 Frank Presutti Dodge Street Bar&Grill 7 Dodge Street Salem,MA 01970 Dear Mr. Presutti, The City of Salem Water Department has notified us that your water service has been restored and payments have been received. Therefore,all food operations at Dodge Street Bar&Grill, 7 Dodge Street, Salem,Massachusetts are approved to resume effective January 5, 2006. Sincerely, )oanne Scott Health Agent r J CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH 120 WASHINGTON STREET, 4TH FLOOR SALEM, MA 01970 TEL. 978-741-1800 FAx 978-745-0343 Kimberley Driscoll WWW.SALEM.COM Mayor JOANNE SCOTT, MPH, RS, CHO HEALTH AGENT January 5, 2006 Frank Presutti Dodge Street Bar & Grill 7 Dodge Street Salem, MA 01970 Dear Mr. Presutti: The City of Salem Water Department has notified us that your water service has been shut off. Lack of water service to your establishment creates an imminent health hazard requiring immediate suspension of the food establishment permit. Therefore, all food operations at Dodge Street Bar & Grill, 7 Dodge Street, Salem, Massachusetts, shall immediately cease and desist. This emergency closure shall be in effect until the Salem Water Department notifies the Board of Health that water service has been restored. 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, 120 Washington Street, 4'h Floor, within ten 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. C°�y /0 shed an bo-% 6/410 Sincerely, /- ✓Joanne Scott Health Agent �rESU7�/ . �Vk L __ CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH 120 WASHINGTON STREET, 4TH FLOOR SALEM, MA 01970 TEL. 978-741-1800 FAx 978-745.0343 W W W.SALEM.COM Kimberley Driscoll ,JOANNE SCOTT, MPH, RS, CHO Mayor HEALTH AGENT January 5,2006 Frank Presutti Dodge Street Bar&Grill 7 Dodge Street Salem,MA 01970 Dear Mr. Presutti, The City of Salem Water Department has notified us that your water service has been restored and payments have been received. Therefore,all food operations at Dodge Street Bar&Grill, 7 Dodge Street, Salem,Massachusetts are approved to resume effective January 5,2006. Sincerely, oanne Scott Health Agent CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH i 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 January 5, 2006 Frank Presutti Dodge Street Bar & Grill 7 Dodge Street Salem, MA 01970 Dear Mr. Presutti: The City of Salem Water Department has notified us that your water service has been shut off. Lack of water service to your establishment creates an imminent health hazard requiring immediate suspension of the food establishment permit. Therefore, all food operations at Dodge Street Bar & Grill, 7 Dodge Street, Salem, Massachusetts, shall immediately cease and desist. This emergency closure shall be in effect until the Salem Water Department notifies the Board of Health that water service has been restored. 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, 120 Washington Street, 4`h Floor, within ten 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, ���� y� C ✓Joanne Scott Health Agent Pest control Service A9 reement\ B & B PEST CONTROL 0 7871 29 School Street JAN 3 0 2006 SAUGUS, MASSACHUSETTS 01906 (781) 599-4317 ' CITY OF SALEM BOARD OF HEALTH CUSTOMER SERVICE LOCATION �O�c� S'T/�Efa' -e•L�e STREET // c /� 12 CITY S ATE dZIP PERSON TO BE CONTACTED SERVICE PHONE PHONE / TYPE OF PROPERLY TO BE SERVICED DPT 5 ICE BEGINS EXIRATION DATE RENEWALTO BE PERFO MED Z4" OA/ El MONTHLY ) ❑QUARTERLY ❑OTHER GETS TO BE CONTROLLED GD --------------------- ----- ------ --------- --------- ------ SPECIAL INSTRUCTIONS Q/ � ' - ------------- ------ ---- ----- �_6�-------- e -------------------------------------- ------------------------------------------------------------------------------------------------------------------- TERMS AND CONDITIONS ,,F_e zva G� Z--ev' � �� r ams � Z �- SERVICE GUARANTEE: We agree to apply chemicals to control above-named pests in accordance with terms d conditions of this Service Agreement. All labor and materials will be furnished to provide the most efficient pest control and maximum safety required by federal,state and city regulations. SERVICE RENEWAL:This agreement shall be for an initial period of one year, and will renew itself annually unless either party cancels this agreement by giving thirty days written notice before any expiration date. D V5_i ANNUAL AGREEMENTCHARGE $ iBCOMPANAY1 �! DATE INITIAL SERVICE CHARGE $ , �� �AUTHORi DS URE) MONTHLY/QUARTERLY PAYMENTS $/� F CUSTOMER DATE (AUTHORIZED SIGNATURE) J • I I � -� - - -I- T -� - --� -- -1-7 ----- - } i I , I I - I ---'-- ! r --- r r I I ' I r i STRUCTURALLAYCUT IL 4 MassaNusetts Department of Public Health Salem Board of Health 120 Washington Street, 41h 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 TYoe of Ooeration(s) Type of Inspection / \ le-a V /rR f;;t!)0 I ❑ Food Service ❑ Routine Address ( A Risk ` ❑ Retail � l F!� ❑ Re-inspection Telephone ' C-r ` Level ❑ Residential Kitchen Previous Inspection ,; (l � ❑ Mobile Date: _ Owner T ' HACCP YM ❑ Temporary ElPro-operation s/1 fC 7 ,)-a c (l ❑ Caterer ❑Suspect Illness Person in Charge(PIC) t ' Vr "" 'a ' Time ❑ Bed&Breakfast ❑ General Complaint In: fL;,?yam ElHACCP El Inspector g // Permit No. Other 1L � 2;GF0 Each violation che6ed 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 E] 13. Handwash Facilities EMPLOYEE HEALTH El2. Reporting of Diseases by Food Employee and PIC PROTECTION FROM CHEMICALS ❑ El 3. Personnel with Infections Restricted/Excluded 14.Approved Food or Color Additives FOOD FROM APPROVED SOURCE El 15.Toxic Chemicals ❑ 4. Food and Water from Approved Source TIMEfTEMPERATURE CONTROLS(Potentially Hazardous Foods) ❑ 5. Receiving/Condition [116. Cooking Temperatures --❑ 6. Tags/Records/Accuracy of Ingredient Statements ❑ 17. Reheating ❑ 7. Conformance with Approved Procedures/HACCP Plans [118. Cool`ng w PROTECTION FROM CONTAMINATION 19. Hot and Cold Holding [1 8. Separation/Segregation/Protection ❑20.Time As a Public Health Control w ❑ 9. Food Contact Surfaces Cleaning and Sanitizing REQUIREMENTS FOR,HIGHLY SUSCEPTIBLE POPULATIONS(HSP) E]21. Food and Food`Preparation for HSP E] 10. Proper Adequate Handwashing ^❑ 11. Good Hygienic Practices CONSUMER ADVISORY ❑22. Posting of Consumer'Advisories Violations Related to Good Retail Practices Number of Violated Provisions Related Critical (C) violations marked must be corrected To Foodborne Illnesses Interventions immediately or within 10 days as determined by the Board and Risk Factors (Items 1-22): of Health. Non-critical (N) violations must be corrected Official Order for Correction: Based on an inspection immediately or within 90 days as determined by the Board today, the items checked indicate;violations of 105 CMR of C ealNth. 590.000/federal Food Code. This report, when signed below 23. Management and Personnel (FC-2)(590.003) by a Board of Health member or its agent constitutes an 24. Food and Food Protection (FC-3)(590.004) order of the Board of Health. Failure to correct violations 25. Equipment and Utensils (FC-4)(590.005) cited in this report may result in suspension or revocation of 26. Water, Plumbing and Waste (Fc-6)(660.006) the food establishment permit and cessation of food establishment operations. If aggrieved by this order, you 27. Physical Facility (FC-6)(590.007) have a right to a hearing. Your request must be in writing '28. Poisonous or Toxic Materials (FC-7)(590.008) and submitted to the Board of Health at the above address 29. Special Requirements (590.009) within 10 days of receipt of this order. i 30. Other DATE OF RE-INSPECTION: \�1\ S ssomspecFomre-ia eac C) fn n- Inspector's Signature: \ /,(/' Print; -7 PIC's Signature: Print: �' Page( o0ftges rfNti � (�r� «�.' � Violations Related to Foodborne Illness Interventions and Risk Factors(Items 1-22) PROTECTION F-OM CONTAMINATION FOOD PROTECTION MANAGEMENT 8 Cros s-,:or'.'amh"a ti:)n 1 1 500.003kA) A&aignmeld of Responsibility; 3-302.1 if,,%1(1) XawAnini,,i Foods,Sep,-'atvd from qq Demonstration of Knowledge' Cooked and wfFo'G>" 2-101.11 Pei sou in chall,le—d1luies Conhi,,wriattin'-oin Raw.rgredionts 3-302.1 I(Aj(2) Raw,loansil Foods Separated from Fach EMPLOYEE HEALTH Other: 2 590 003(Q Responsibility of the person oi chnig, to Contamination irotn?he Fnvironni-N requiv,,repotting by food employees and. j -i02 I]:,\) f......A Plotection, applicants* 3-30? I Washim-,Frullh, and Vega:.Nes 590.003'F,i Responsib0ity Of A Fo.,d Ernployee Or Pui 3-304 11 J-txid Cwniact with Equilimcn-tand Applica.-tt To Refswt To The Pcr,a)n In :JLeu'1!S1 ChatCorr„mina;ion fru”,the 00115biner 590.003(G) Repotting b,,Person in Charge! -300.14(A)(W) Returued Food 1-.nd Reservim of Food:' 1 5P0.00(l)) Exclusionsaiic[Rcstiiction,�' Disposition of AA;,tewted or Contaminated 5uo.00-'(F') Keronval of Exclusions and Restrictions j Food Discarding or ReCOM11110m)IS'UnEafe FOOD FROM APPROVED SOURCE Fccd* 4 Food and Water From Regulated Sources 9 Food Contact surfaces 4 5u1.i i i Nlaou,!Warewashim:-Hot W:�,,r 590.004(A-B) Compliance�rth Bind Lav,* 3-2u1 12 Food ,na Hot'!-591 112 !1ICCh.'61;L.11 1A'.Arcv;ashj-,,,- ,a Water -i--'o 1.13 Fluid Milk and Milk Pioducts' I t Sanitization on Tvura�ires� 3-202.13 Shell Fogs' iI 3-202 14 Ea-s; and Milk Products. Pasteurized" 4-50;.!I-, Chemical Sanitization-temp.,W) . 3-202.16 [cc Made Fiom Potable Drinking WfdeT=' C011-lentration and hardness. '" 4-60 i t%) Equipment I-xd Contact Surfaces and 5-l".1 11 lormkwl�, Water f.-oionn Approved Syitem" Cleaning Clean- 59'!aIL!6(Ai Bottled DrinkingWater* 4 602.11 Cleaning Frequency(it F(punment Food- �'190 Ooh(B) Water Meet;.Sf�ndardq m3 10 CMR 22.04 Coma,L and Utensils" I Shellfisr,and Fish From an Approved Source 4-702.11 Frequi-iwy of Sanifization of Utensiis and 3-201.14 Fish and ReCofatiofl,311V Caught N10111jo:?n Food Contact Surfaces of Equipment"' Shellfish" .1-703.:I x1elb-sts ofsaiutie�ivlr—Hot Water and A5 Molluscan Shellfish from NSSP Listed Clivaiical' Soure2s" zfi Proper,Amquahi I-i3ralwashing Came and Wild Mushrooms 4pproved by Regulatory Authority 2-301.11 Clean Conditicii--Hand'sand Anie,' 2-301 12 Cleaning Proczdui-L� 3-202.18 S11,1�11:40LI<Mem,fi(ation PresenC' 5901.00 I(C) Wild Niliishroonu,' to wash' 3-1.01.17 Came Animals* if Good Hygienic Practices Receiving/Condition -4011 11 Eating,Dcism.mg,,; U<ing Tnbarco i 3-202.11 fd-Ms Received at Pioper'(eniperawrPs* Discharges From the Eves, Nose and 3-202.15 Pdckage hitepritv- lvlouth^-- i 3-�30 i.12 ore venting Contamination When'Casting" 3-1 ril I I Food Safe and Unadulterated 6 Tags/Records:Shellstock 12 Prevertion of Contamination from Hands 3-20118 Shellfauck ldctification* Poeve,&r.-Coida;uirvqinn from -3-203.12 Shellsto'k Identification Nlamm:md" EmPIu,,c.-,s* Tags/Records:Fish Products 13 handwash Facilities Con,enlertly LOCPrEldmd Accessinle 3-402,11 Parasite Destruciton 1 Numbers rend Ctipacifiegi-' --i-,102.1 2 Records.Cteation and Reteiuiun" Location and Placement' �i,)0.0040) Labeling of Ingredients* 7 1 5- I I kccr�s;bduv,Oociation Xxi Mainknance Conformance With Approved Procedures I /HACCP Plans I &ipplxd with Soap and Hand Drying 3-502.11 Specialized Proces!,:a',Meflvxk* Dewces 3-502.12 Reduced oxyzen pael.agmg.criteria` 6-30i.1 I Handwashm',Clean,;cr,Availability 6-�Cl 12 Hand Drying Provi,iun e-103.i 1 Conformance with Approved Procedures" Dei.ot,,,cTiA4:0 neni ia*e lej,!Ial 19911 FoNj Cod-or to'.0IN CITY OF SALEM --� BOARD OF HEALTH Establishment Name: Date: i Z�GrS�� Page: e�'_ of Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date No. Reference R-Red Item Verified I_ yy,� ` PLEASE PHINTJI^CL'EAflLY ( /I 11LotcJ iO4) . A 5'5,�/� .t � 'l /U_N )S/Y/ �r,)U/YL/1 / / fi/TrGiC-1 d Zqi r_-1 ,/A_aJ I 0_A 16 rlr� IP/ l� t . l irk . 17J2. �r 1 I �vcvll tom ) _ a r CL), I � hL CJL�l�,� l.�,crl—//1s�,�>,�_ r y Q� {�ki� 6� ��✓�..�-�o�;�,-� �rR -� I I I I 1 I � I Discussion With Person in Charge: Corrective Action Required: ❑ No Yes I have read this report, have had the opportunity to ask questions and agree to correct all / - Voluntary Compliance ❑ EmployeRestriction/ violations before the next inspection, to observe all conditions as described, and to Exclusion p ❑ Re-inspection Scheduled ❑ Emergency Suspension Amply with all mandates of the Mass/Federal Food Code. I understand that noncompliance may result in daily fines of twenty-five dollars or suspension/revocation of ❑ Embargo ❑ Emergency Closure your food permit. ❑ Voluntary Disposal ❑ Other: I — - PHFs Rcceired�-yC'� at'1'c++neratures Violations Related to Foodborne Illness Interventions and Risk -S(1'. Ac,ording t,;lav+Cooled to Factors(items 1-22) (Cont) i -}i`I',j?,5'F Within Hours. ' PROTECTION FROM CHEMICALS I `'t.15 C.A0611a Methais for PHFc J 119 ( PHF Hot and Gold Holding 19 ( rood of Color Additives 3-501.16(B) ( uAd PFIFn M,ou ain,,d aux below - 13-202.12 Add)necs'' 59piu?4iF) al'715'I-: 3-302.14 Protection from unapproved Additives* I z 5+,,, ® ' I IF1.3; till[PIPs Maintained at or aboie I,5 Poisonous or Toxic Substances Hot P " 7-101.11 IdentityutcInformation- Original ( I ' 3-50).16(�,) Roasts,I �W at ar ab+:�e 150'F. r Containers" ' 7-102.11 Common Name-Workiro,ConCtiners' 2t) Sime as it Public Health Control 7-301.11 Sc Patation-Stoi age z-5(1L 14 Time as e Public Health Council" 7-20.111 Restriction-Prescnee and Use" � i 59(Y.0041Hi Variance Requirement 7-20-_'.12 Conditions of Use" 7-203 11 i 'Io:)c Container.- Prohibition,°' POPU REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-204.11 ( Sanitizers.Criteria-C'h,emic;ls-'� LnPUI-AT:IONS(HSP) 7-204.12 ( Chetnic•als for Washing Produce,Criteria" i 'i 3-901 IDA! Unpasteuuied Pte-par)aged Juices and + fieverages with Warning I-abets'^ 7-204.14 hr}in :agents.Criteria" i ? -X")1, 11:e of Paveudzed E_.1 7-205,i i Incident. Food Concoct,Lubricants` j 3.c0t.1 (r.2'J Rask Raor Parnsllti l'lr;xed Anneal Food and 1-206.11 Restricted Use Pesticides.Criteria" ( I Raw Sled Sprnuta itiot Sewed. # 7-206,12 Rodent B.:it Stntiona" 3-901.I I(Ci Unopened x d Pac ige Not Re-sevedr _06.13 I'rckmg Powder::,Pest Control and Munitnring* CONSUMER ADVISORY TIMENEMPER ITURE CONTROLS 22 -,-603 11 Consumer Adv!soty Posted for Consumption of Animal Foods that are Raw, Un&rcuoked or 16 ••f Proper Cooking Temperatures for ivot O)hei wise Processed to Eiorunate I PHFs Pathe?ane..r, s,,r„ v,;•,,�, 3-401.1 1 A(I)(2) Fygs- I S?'F 15,Sec. Eggs-Immediate Service 145°Fl 5�ec' 3-30"_'.13 Pu;teuriz�d F,ges Sub:,utute for Raw Shell E s 3-401.t 1(A)(2) Comminuted Fish,A4eats&Game i Animals- 155'14 15 sec,. * SPECIAL REQUIREMENTS 13 40-401.11(B)(1){Zi Pork and Beef Roast Meats 15 121 min'" ` 590,000(A)-(Di 4iolatiors of Section 59CW09(A)-(D) in 3-401.11(A)(2) Ratites,injected Meats- 155"F IS sec, ; catering. mobile food,temporary and 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs, residential kdchen operations should be Sniffing Containing Fish,Meat, debited under the approruiatc sections Poultry or Ratites 165"F 15 scc. abovo if related to Ltx)dbarne illness 3-401 11(C)13) Whole-muscle, Intact Beef Steaks intervcndons and risk factors. Other 145°F T $90.009 Violations relating to good rctzal 3401.12 Rau An notal Foods Cooked in it I practices <horld be debitadunder#29-- Microwave 165`F* Snecta!Requircm.nts 3401.1 i(A)(I)i h) All other PIIFs- 145"F 15 see. 17 Reheating for Hot Holding ( VIOLATIONS RuLATED TO C400D RETAIL PRACTICES 3-403.11(A) (D) III IN 165"i 13 scc. ` � (lteaac 3-403.11(B) Microwave- 165'F 2 Minute Standing Ceutal and non, critical viulalronv. i.hich d»aa!relate to the -_ - - Timeskvvibuane:lh:esv iaten,oaianv and rir6 f'ncturi listed teebore. Can be -403.11(0) Commcnially Piot essed RTE Food- 1umd;n ,he fi)hou;i,;g sectrnns of the Fond Code and 105 CMR 140"F' J 590.000. 3-103 1 I(F) Remaining U'nshced Portions of ficef item--- Good Retail Practices FC 590.000 Roasts* i 23. Maragement and Personnel FI'-2 .003 I 18 i Proper Cooling of PHFs 24 Fcu.d and Ford Protect:nn PC-3 .004 '25. Ecluxroent aro Uiensiis FC- 4 .005 3-5(}t. 4(,1) Cooling Conked PHPs from 140`P to 21, 'A'amr,Flu,nlin.;and Waste FC-J 1 006 707 Within 2 Hour:art.]From 70"F 27, Fhvs:ca:FaNity FC-6 .007 to I I"F/45`F Within 4 Hours. ` I 28. Poisonous or Text,, Materials FC -7 1 .008 j 3-501 14+11) Coolim*PHFs Mad, 'Front Ambient � 29. Special Requirements '�� 009 Temperature Ing edients, 4l"F/45°p ( 30. Other Within 4Ilour,::: ^ Dem•tee amwl item In till fade,al 1994 Food('•;de or 10'`CMIt Suit 0oO. r. MaSS8 1Usetts Department of Public Health Salem Board of Health 120 Washington Street, 4'" Floor Division of Food and Drugs Salem, MA 01970-3523 FOOD ESTABLISHMENT INSPECTION REPORT Tel. (978) 741-1800 Fax (978) 745-0343 Name I� ( 1 G/ i-(,7 Dates / Throe of Oneration(s) Jyoe of Insoection / _ �1f`O �� /7l/yf�� �FoodService Routine Address Rini' El Retail ElRe-inspection��r� �"P C-, Level ❑ Residential Kitchen Previous Inspection Telephone �/!/ S_ &y 3 r1 ❑ Mobile Date: 7/ Owner i HACCP Y/N El Temporary ❑ Pre-operation rdiil �. 71 �Sufi�7 %. I ❑ Caterer ❑Suspect Illness Person in Charge(PIC) ' Time ❑ Bed&Breakfast ❑ General Complaint inspector In: o)-r}J ElHACCP p U Sen . IC OG.Xl Out:�yz9 Permit No. ❑ Other Each violation checked iequires an explanation on the narrative page(s) and a citation of specific provision(s) violated. Non-compliance with: Violations Related to Foodborne Illness Interventions and Risk Factors Anti-Choking Tobacco Violations marked may pose an imminent health hazard and require immediate corrective 590.009(E) ❑ 590.009(F) ❑ action as determined by the Board of Health. FOOD PROTECTION MANAGEMENT ❑ 12. Prevention of Contamination from Hands ❑ 1. PIC Assigned/Knowledgeable/Duties El 13. Handwash Facilities EMPLOYEE HEALTH i E] 2. Reporting Of Diseases by Food Employee and PIC PROTECTION FROM CHEMICALS ❑ 14.Approved Food or Color Additives ❑ 3. Personnel with Infections Restricted/Excluded ❑ 15.Toxic Chemicals FOOD FROM APPROVED SOURCE ❑ 4. Food and Water from Approved Source TIMErrEMPERATURE CONTROLS(Potentially Hazardous Foods) ❑.5. Receiving/Condition ❑ 16.Cooking Temperatures ❑ 6. Tags/Records/Accuracy of Ingredient Statements ❑ 17. Reheating -❑ 7. Conformance with Approved Procedures/HACCP Plans ❑ 18. Cooling PROTECTION FROM CONTAMINATION ❑ 19. Hot and Cold Holding ❑ 8. Separation/Segregation/Protection ❑20.Time As a Public Health Control _V9. Food Contact Surfaces Cleaning and Sanitizing REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) El 10. Proper Adequate Handwashing [:] 21. Food and Food Preparation for HSP � E1,11 1. 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 w and Risk Factors(items 1-22): of Health. Non-critical (N) violations must be corrected ^ Official Order for Correction: Based on an inspection immediately or within 90 days as determined by the Board today, the items checked indicate violations of 105 CMR ofC eaNh. 590.000/federal Food Code. This report, when signed below 23. Management and Personnel (FC-2)(590.003) by @ Board of Health member or its agent constitutes an order of the Board of Health. Failure to correct violations 24. Food and Food Protection (FC-3)(590.004) cited in this report may result in suspension or revocation of 25. Equipment and Utensils (FC-4)(590.005) the food establishment permit and cessation of food 26. Water, Plumbing and Waste (FC-5)(590.006) establishment operations. If aggrieved by this order, you 27. Physical Facility (FC-6)(590.007) have a right to a hearing. Your request must be in writing 28. Poisonous or Toxic Materials (FC-7)(590.008) and submitted to the Board of Health at the above address 29. Special Requirements (590.009) within 10 days of receipt of this order. 30. Other DATE OF RE-INSPECTION: r S 5901nspecfForm614 da Inspector's Signature: Print: ����k l IJ_ PIC's Signature: '-/"� Print: XrrrrCtf C��J�" I Page'of:Z Pages Violations Related to Foodborne Illness interventions and Risk Factors(items 1-22) PROTECTION FROM CONTAMINATION FOOD PROTECTION MANAGEMENT Cross contamipa"lon 590.00Ql A) I Assignment of Ret.pt•nSibilitVT :2.1 1(,Aifl) Paw Animal Food::Separated from 590.003(fi) Dcnionstra(ion o'Kn(iwjzdgc* COokedw:6 P,1-1; Fvvls' 2-103.1 I PersoDincharge-dutics j Contamination from rlji,ingredients 3-301.1 1(A)(2) Raw Annual Fomk Sepaxiitcd from, Each EMPLOYEE HEALTH Other": 2 590,003(C) Responsibility of the Itc-mlir in charel-in "onfaininaPon from the Environment require reportine, by fw-1 employees and Food Picreviion, applicants*` ! 3-?02.1.': Washing FtuiL,,;nn1 Veactables 590 003(F) Responsibility 01' A rood Fmpl,-,.vee Or An 1 3 10 1.1 1 F.,.(d Culn1u.with Equipment and Applicant To R-,porl'lb lite Person]it j uten"lls* Charge j Contamination from the Consumer 590.003(15) Reporting- by Person in Charge* I 3 316.14(A)(B) Returned izuodarki Rci,cr-,ictof Ftywig' 131 500.00(D) Exclu.,jonsand Rest,ictions* Oispos!tio,-or Aclulieratpd or Cirtarniowtod 1590.003(F) Removal of Exclusions and Restrictions Food 3-701.11 or Reconditioning Unsatc FOOD FROM APPROVED SOURCE Food, 41 rood and Water From ll6gu!atud Sources j j S Food Contact Surfaces 590.00chA-B) Compliance with FGod Law* 4-501,111 Manuel WarewashlilL-'Hol Water 3-201.12 Food in it Hermetically Scaled Container' faniti�,iti�-il'ieliiperaturesA 3-201.13 Fndd Milk turd Milk Itioducal," 4-56i.!12 Tvlechanica� Warewashing-Hot Witter Snniti7mi,,n Tcmpciatuies' 3-202.13 Shell Fl-s� 3 20114 Eggs and Milk Pixx;ucts.Pasteurized' "'.-501.1!4 Chemical Sanitization- temp.,PH, 3-202.16 Ice Made From Potable Drinking Water' concentration and hardness. * I 5-1101.11 Drinking Water from an Approved System' j -tT01 1 1l A) Equipment(rood Contact Surfaces and Utees'is C:ean- 590.006(A) Buttied Drinking Water' 4-60111 CIC�Hqlllg Frequency )I Equipment Food 590 006(B) `ikra�r Meets Stindards in 3 10 CMR 22.04 Contact Surfaces and IA,nsils* Shefifish,and Fish From an Approved Source 4-702,11 3-201,14 Fish and Recreacionally Caught Molluscan Frequenc% of�:nritmktion of Utensils and shellfish, Food ?n'tact Surfaces of Equipment" I 3-2('1.15 MolluscanSticlifish from NSSP Listed -1-7ffi.I I Mcthods of Smitizat:vn -Hot Water and I Chelincid, Sources* Proper.Adequate Handwashir Game and iWdMushrooms Approved by 2.300.11 Regulatory Authonlj, Clem Condition-I-Iandi;ondi Arins- 3-202.18 SheJktock Identification Present* 1 2-301J2 Cleaning Procedure, 590.004(C) Wild Mushrooms*- 1 2-301.14 When it)WaSIV 3-201.17 Game Animals* 13 ! Goad Hygienic Practices 1 2-401.11 pacing,Drinking or Using Tubaccol' 51 Receiving/Condition 1 3-202.11 PITFs Received at Proper Temperatures* i 2-401.12 Discharges From the Eyes. Nose and 3-202.15 Package Integrity" Preventing Cmaanrination'�NTcn Tastfin,* 3-101.11 1--(xxl Safe and Unadulterated 12 1 1 6 Tags/Records:Shefttonk 12 Prevention of Contamination from Hands 3-?(12.15 Shellstmk Identification 4 590.004(r) Preventing Contain;qation front 3-203,12 Shellstoch Identification Maintained" Enlplrivc.-� TagslRecords:Fish Products 13 Handwash Facilities 3-102.1i Pau--,isite f)cs1ruaion* Conveniently Located and Accessible -, )3 3-402.;2 Records,Creation aid Retcnwm' 5- `11 .11 j Nuniticri;and CavaciucsA 590.0040) j Labeling of ingredients' j 5-204.1 i Location xid Placement' 7 Conformance with Approved P.ocedures 5-205.11 Access:bdity. C)Petation and Maintenance Suppled ahil;Snap and Hand Drying/HACCP Plans 3-50-1.11 Devices Specialized Processing M--thods� (;.101.'. 1 HandwO-to:o Clcjnser,Ai,,d;alnljty 3-502J2 Reduced oxygen packaging,cri let W 8-103.12 Cunfoinnince will)Approved Procedures' 6-?0l 12 j [land Dmr;z Prociaon Denules Critical item in Iliv federal 1999 Fend CWe-), i()5 C.N11Z J001100 € t CITY OF SALEM BOARD OF HEALTH Establishment Name: �cl c, 54;Y� -. �G/ E rr,// Date: /9.//,6)�� Page: of Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN 00 CORRECTION Date l No. Reference R-Red Item /. Verified (�. h PLEASE PRINT CLEARLY I�(I1L, tV-1 Aker .4' CO2� jsl�-���l_I/4- i 12af,��l�� 1✓1t5�,V ��}- o�,�-,nSk/ � r)41,- A 1 S.-� �� � O P/V) fM) r,M kud 14 J- L ?l Ins L� �Yt.ka l tSJ /rl d� �PGuna '�2� ''�� i. 1 .752- 53 J- M '4H , P,nc ,3- >)n„1,��. , h ,1) �,� "ko ci, C. *' /71. U-u I_ t! ..3 _ �i Con "/Vu/ .h IUCV Q�JA ri&-A,'AA . �12t.t`fi�Z ��a . r^�kh�.c CC-96ADj�J:f �t � (��r )Ojc. d� �,>1G ��� h�-�d -��.,k1 . ✓Z1213 44- i'11� ✓,PmvYv� �lr� ,.�9r- IJOe tl,o /'Uoc.n, e�c "too"'k i�i L t/A cul S�A�f Discussion With Person in Charge: Corrective Action Required: ❑ No I 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 6r reply with all mandates of the Mass/Federal Food Code. I understand that U ngncompliance may result in daily fines of twenty-five dollars or suspension/revocation of ❑ Embargo ❑ Emergency Closure your food permit. L �-/ ❑ Voluntary Disposal ❑ Other: = SG7 74r{ ' 'aFs l:ec,^lout at"Ccmperatura Violations Related to Foodborne Illness Interventions and Risk According to 1;)w Coo{ed co Factors(items 1-22) (Cont.) j -WF/4 Within 4 Hank. ' PROTECTION FROM CHEMICALS 3 `()7.15 ( Cooling Methods for PH Fs j 19 PHF Hot and Cold Holding 14 Food or Color Additives 3-50 i.0703 i Cold PHF N9suntaiucd at or below 3 2(x_.12 Additive.* i90.004F) =w1'r45=1` 13.302 14 Protection from tl:raPpmved Additive," ! 3.507 ,tai tint PI-iFb iYiairaai:ied at or ab.0 15 Poisonous or Toxic Substances 7-101.11 ldenntynr_ trtbrm.dn;n-Ou.nrat 140"h * -- Container." slit INA) RtiwstsHeld atorabmfe7?0�3 . 7-102A iCommon Name - Working Containef s* 2i'` j Time as a Public Health Control 7-201.11 Separation-Storage" 3-501 19 - T:rre as a PHblir Health Cuno'ol* 7-202 11 Resniction-PrescaceandUse" ( 59000-4;_H) Variance Requirement 7-202.12 Condilurns of l!so- 7-203.11 `7-'_03.11 'foxicContainer.-Pn;hflmtoms" REQUIRGMEWSFOR HIGHLY SUSCEPTIBLE 7-201.11Sanitizerv,Criteria-Chemicals" POPULATIONS(HSP) 1-'lif.12 Chemicals for`h'ushmg Produce,Criteria" 121 '-St 1,1 1(A) Unp;steunzed Pre-packaged 316ces and Bevetagcs with V:�Irmne LaLols:. : '7 204.1.1 Dryir:g Agems,C•raenaT ( z �r(;1.11(:>) C nr.of Pasteurized ries' 7 205.11 Incidental Food('Omsk Lubrrcants� ( ! 1-80 L! i(fl' Raw or Pawfisi! r ' }' rooked Animal Focxl and 7 876.11 Restricted lis:Pes+.icides, Criteria* Raw;:;ed;;prnots Not Served. ! 7-206.12 Rodent Bait Stations' ( 3-50 L 11(C) Unopeneu rood Packa!2e Not Re-served. 7-206.13 Tracking Powdtrs.Pest Control and monitucin;**" CONSUMER ADVISORY TIMEITEMPERATURE CONTROLS 22 3-603 11 Consumer Advisory Rrsted for C,wmmption of tfi Proper Cooking Temperatures for Animal Foods That are Raw.Undetcooked or PHFs j Not(lth•_ri.--iso Processed to t;limnuue 1-401.1]Akl),'2) Beg,- ;5i'F15Sec. Pathogen::.'. "'e= rvao J-302.'3 Pasteunzed E g b:Ibstimte for Rays Shell Eggs-hrmrediate Service 145`Fl5sec* I't's 3-401.11(Al(2) Comminuted Fish, Meats&Gana hggs` Animals- 155`F Ili sec. 3401.1 lt,t;)(I1(^_1 Pork and Beet Roast- 130`F 121 min* SPECSAL REQUIREMENTS 3401.1I(A)(2) Ratites, fnjected Meats- 155�F 15 590009(A)-1D) Vioia.ions of Section 590.009(A)-(D) in sea* catering, mobile food, temporary and 3-401.(1(,A)(3) Poultry,Wild Game, Scuffed PFIFs, icsiden6al kitchen opera lions should be Smffins;Ointaining Fish. Meat, ! •' debited wider the ppropriare sections Poult,y or Ratltes-165°F 15 see. " ' allow if rehiwd to i00dborne ifines5 3-401.1 I(C)(.") Whole-muscle,Intact Beet Steaks interventions and risk factors. Other 1.15°F* 590.009 notations relating to good reiail 3-401.12 Raw Animal F,,ods Cooked in a ( practices slionid be debited rider #29- Ntwcwuwave 165`1* Special Reeuneinen?s. 3-001.1 li.4t(7)(b) All Other PHF,- 11;'F 15 sec. 17 Reheating for Hot Holding VIOLATIONS RrLATE?TO GOOD RETA,'L PRACTICES 3-40.11(,Ai&i D) PHF, 165'F 15 sec. ° (IItetres 23-30) 3 3403.11(B/ Miuvwave- 16.5'F 2 Minute Standint, � C,in, un:!our;-eriti::a[�.�wuduhnru, i,hieh do Pint relate to the Time" ; f(iodberne illness ir,t.•rvoaians unri risk f.,u«r.i lived above, ,an Ile 3-403.11(C) Commercially Pi(tctssed RTE Food- ,/mid in the Jolho,,mg s'eellomc o/rhe Food Code and !05 CMR 140'F" 590.006. _ (E) Remainint UMhced Portions of Beefi ( Item Gond Retail Practices FC 1590,000 Roasts'. 73. IvIanaparcntnt and Personnel FC -2 .003 24. Food and Food Pmt-,ction FC--3 004 18 Proper Cooling of PHFs ! 25 Equ:pmen;and Uteosi!s FC-4 .005 3-50I.74(A) Coohne Cooked PHF. Fool 140`'F to 126. Water, ! .umbinp and VJ?ste FC_5 I 005 70'1.5'alu o 2 flours and From 70"1 27 Phvsi•-al F"ecw6h/ FC-6 j .007 J to 4l`F/45"F Within 4 Hours. 1 ! 28. Po!sonous o:Toxc t„letenals -C--7 Lwa 3-50!.14(B! Cooling PHFa Made From Ambien ,-'p =racial Rea Aements (lp9 Temperature Ingredients to 41°17745"j; i 30. Other \\hthin 4 l?our.:` ""'r""'='F'-"'• Dena mucal RCry in whr fedei al 1991)Farad w de or los CNIR 590 000. 4 is .:s CITY OF SALEM BOARD OF HEALTH Establishment Name: 711,e _ �%o -;I-e r Cat. ) / Date: (7 lo<" Page: c of Item Code C-Critical Item v DESCRIPTION OF VIOLATION/PLAN OF CORRECTION /' 'bate `r No. Reference R-Red Item Verified PLEASE PRINT CLEARLY c; a�a �1h.),,P_ 7�/vI? �au�r.��wrn� I— S ,n r A)onN 40 1,a 4 �.Yl��.� r10'11 Q4n ,il c.{1'�— n/noc �Ccr• ._` _ .4 UJ �ju) r2sca-n�_f" t�.`l� in t fll Mr L �,u(A uV+,.,�, I J,.,., /`A,.{'P,l 1'), 4 �Y)op r,17�C l iLt 1 il�.,A n ,/Z z_Z C-) n o ptr� ei /I. h e o/ /J�Io1 ? (l u��n�. C 7 a�✓J I _ /� \ `\ rr _ r _ /J -V,,+-)-V,,+-)�7 %�� /7.1��d/1 r�Cl,J ,�� / T`l.� 1�C,7r�n ,.� � 1�.�., ulr-�7„nt0 bve,��� -/./,rtr c:w . .JJ? /a- /�n � rill. Lr�, � 4 L2Z (OLA 1 / �l r.oV� ,N 1/1/— A)00_f 4 L�A'7� ( XJrrAn n j` /i'i A&A I- J J ` r�-� ��,� Ir- ������.1� �a� -�-v h� �G� ,�n��<r�s�►� l��fLi�_s-;�,,.n al��-1 1 I1 5�c, Sun hol iia 4 �ex- Voenl>• r,14)✓l� VL;' I � �J IdJ- 19,1) qk,, I? AJaa 14AjkXl(JM _k(4.ki'" ova lc� cW- b) ,.r (.)ja 1 I . r Discussion With Person in Charge: Corrective Action Required: I ❑ No I ❑VY_es01 1 have read this report, have had the opportunity to ask questions and agree to correct all Ll Voluntary Compliance ❑ Employee Restriction/ violations before the next inspection, to observe all conditions as described, and to Emersion P t e-inspection Scheduled ❑ Emergency Suspension dimply with all mandates of the Mass/Federal Food Code. I understand that noncompliance may result in daily fines of twenty-five d or suspension/revocation of ❑ Embargo ❑ Emergency Closure your food permit. ❑ Voluntary Disposal ❑ Other: r r - 3-SUI ll(C'i FEIFs Recetced at-lemperature; Violations Related to Foodborne);mess interventions and Aiak `.c,:c)rding to law Cooled iu Factors(!terns 1.22) (Cont.) 1 4lT145c F V,i;hin 4 H(w;. ' PROTECTION FROM CHEMICALS j 3-'i}' 15 1 Cal Method,for PHFa j 14 Food or Color Additives ( 19 j PHF Hat and Coid Holding j 3-501.164 Coil PEIi?;:Ftain:.rn:nd at o<below 3-202.).2_ Additn-es'" 590.00-1(F) 41%45" F-4 3-30114 Protection from Unap^raved Addtncs> 3-_501 16(A) I Ho'PHFs Maintained at or abrve j 1g Poisonous or Toxic Substances " 7-101.11 Identifying Information-03 i;;tn4WE al 3-Sol I !6(.0 I Reals Held at or above 130'F. k Containers" j 7 102 11 Conation Name-Working Conaainet+" j 'rg Time as a Public Health Central j 7-101.11 Separation-SLa'aee" Time a>a Public Heath Centfut* j ! r j 59'l.t)041 Hi \'Iii!Once Rego,i,'ment'7-2t}2.11 Restriction-presence and Use i 7-202.12 Conditions of Use Tonic Containers-Prohibi8ons4 j REOUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-204.11 Saritizers.Criterw-Chem-also` j POPULATIONS Al j 7-204 12 Cheimcals for Washm',Pruduee,Cii!,ria* j 121 ; 3-SU1.I i(-k) C::p,tetcurizcd?rrpachaged Juices and j 7-204.14 Drying Agents.Criteria' Bevctac•e;.w,*h U:at:a,:,g F;tbcls* 3-901.11(B) l:se of Pasteurized Flies* � j 7-205.11 UrcidentaE Filed Contact, ,Criteria* 13-801.11;D) Raw or Partially Cooked Animal 'rood and ( 7-206.1] ' Restricted Use Pesticides,Criteria* Kavv Soed>jl N't.served j 7-206.12 Rodent Bait Slaloms'' 7-206.13 'I'neking Powders,Pc,[Control and j j -801.11(C) Jnop:ned Food Package Not Re-served. " Monitoring* CONSUMER ADVISORY TIME(fEMPERATURE CONTROLS 22 3-603 11 Consumer Advisory R;stcd for Consumption of 16 Proper Cooking Temperatures for, Animal Food '1'l:at are Raw. Undercooked at � PHFs I Not Oti!erwise Procr,::rd to Elinnnate 3-40 L I i A{1)Q) Eggs iii°P 15 Sec. P;uhogenS.':cnz,.;.E,,,,.a,• Lege luuuediate Service 045'FL5scl 3.302. Pacieunaed tags Stih,titute for Raw Shell 3-401.1 I(A)(2) Comminuted Fish,Meat:,& Game Et,gs Anunais - I55'F E5 sec. j3-401.11(B)(I)(2) Pork and B,efRoast- 130`6' 1?Irvin* j SPECIAL REQUIREMENTS 3-401.1 1(A)(2) Rattles, lnjectcd Meat:. -155'F 15 I 590 009(A)-(D) Violaitons of Section 590.009(A)-(ll)in sec. ': ( rs.ierit:g, minim e food, temporary and 3-401.11(21)({) Poultry,Wild Game, Stuffed PFfFs, residential kitchen operations should he Stuffing Con,atmng Fish,,MeaY dehited unuer the approp-ia(e•iecticns „ Poultrym Ratites-165`F 15 sec. * above if reinted to foodborne ilines.s i 3-40L!1(C)(3; L'srole-masdr,,Intact Bcef Stacks interventions and risk factt)rs. Other 145-* 5u;1.009 N-iolaticns relating to gond ta;tait 3401.12 Raw Animal Foods Cooked in a ( pracitms should be debited under 1/29- Microware !95`1` S(,ectal Recuiiemcnts. 3401.11(AI(lRh) j Al! Other PHFs- 1115 F 15 sec 17 Reheating for Hot Holding ✓IOLATioNs n.:LA T E'J TO GOOD RETAIL PRACTICES 3-403.11(A)&(D) ( PHFs 165'F 15 aec. ° (helps 23-30, 3-403.11(B) Microwave- 165'F 2 Mill Standing i Criae ul and r;mt-,•rite at vwtalions. mirirh do nut relate to the Times' !nn,1lwrne rLh;.sv interretdion.s„rid,btk iixxars!mated ahnrz, can be 3-403.11(Ci Commercially Pira-"sed RTE Food - !onnd n,u'tt'ftbow;ng .sr;lions ri the Food C,de mid 165 Cl 140"F- 3-4011 I(E; 40'F"3-401.11(E, Realm nine UnsheedPortions,ofBeef Item Good Retail Practices ,-'C ( 590.000 i Floosie* 23. lalar+aaernent and Personnel FC - 2 I 003 18 j Proper Cooling of PHFs j e4. Food and Food Pro:ec:tion FC-3 i .004 25_ Equipment and Utensils FC-4 005 j 3-501.14(A) Co ling Cooked PFFFs fr:nn 140"F m t , ,and,, 26. lJater,F'Ium.,i.v an�. n'aste FC-5 A06 � 7WI7 Within 2 Hours and From 70'F 27. Phvsiral Faci6ly FC--6 007 to 41'Fl45'F Vv ohm 4 Hours. '" � ?P poisonous cr roxs,tviatrria's FC, -7 . 080? :_501.14(B) Cooling PFIFs Made Prim]Amt+tent 29. Special Reow: menu OOq "I'emprrttture L:zredients tri 41"F'4� P 30 Other - -- Within 4 hours •:.N,r,:c..,,.z:,,. ' Dniol,s crme'l item 111hr Rderd 11)"')F•,o•d Code or 105 CNIR 5"tl:`010. _h 0007 DODGE STREET Dodge Street Bar & Grill City of Salem FOOD SERVICE ESTABLISHMENT - FOOD SERVICE Inspection HACCP: ❑ Item Status Violation Critical Urgency Telephone: I PROTECTION FROM CONTAMINATION 745-0139 Handwash Facilities FAIL Critical Se RED Owner: ,-96mment: Back bathroom missing soap and paper towels. Provide soap and towels. Frank P. Presutti, Jr. PIC: ere is no paper towel at back hand wash sink. Provide paper towels. Frank P. Presutti, Jr. Violations Related to Good Retail Practices (Blue Items) Inspector: Food and Food Protection FAIL Critical BLUE John Gehan Date Inspected:Correct By: —Comment:Victory unit has uncovered foods. All foods must be covered. 3/22/2007 .--White Kenmore freezer requires organization. PHF must be separated from ready to eat foods. Risk Level Equipment and Utensils FAIL BLUE Permit Number: I comment: Blodgett oven requires thorough cleaning. BHP-2007-0189 Status: --Sanitizing log not up to date. Log to be maintained daily. Open I -Sanitizerreading to strong. Sanitizer to be reading between 50-100ppm as mandated. #of Critical Violations: Il 3 L�Small white refrigerator at bar requires general cleaning. Time IN: Time OUT: Physical Facility FAIL BLUE Urgency Description(s): Comment: Back area has many water stained ceiling tiles. Find source of leaks and repair. Replace any damaged tiles. BLUE: Violations Related to Good Walk in refrigerator has tiles that are missing at baseboard. Replace tiles. Retail Practices (Critical light cover missing over white kenmore freezer. Provide cover. violations must be corrected immediately or within 10 days)(Non-critical violations Other-See Notes' FAIL Critical BLUE must be corrected immediately lx-omment:There are cigarette ashes on the floor of the back bathroom. Smoking is not permitted in any establishment. Owner or within 90 days) subject to monetary fine. City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741.1800 GeoTMS®2007 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Mar 22,2007 ) Page 1 of • Item Status Violation Critical Urgency RED: Violations Related to Foodborne Illness Interventions and Risk Factors (Require immediate corrective action) City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741-1800 GeoTMS®2007 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Mar 22,2007 ) Page 2 oft