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E W HOBBS INC - ESTABLISHMENTS ftNIVERSAL® UNV-12110 MADE IN USA SUSTAINABLE MN RECYCLID FORESTRY FORESTRY CONTENT10%® 11 Cooed Fber Sourd" FDST w d'ropremwg 11 H^AI a:/24/84 12:13 KFL — GEOCHRON 4 9787450343 1,10.049 D01 i KRUEGER Phone:(978)667-6900 Fax(876)6676999 FOOD Email:dkrueger®kfl.com �® LABORATORIES, INC. 45 Manning Road,Billerica,MA 01821.3934 www.kii.com FACSIMILE TRANSMITTAL FORM FAX #: (978) 667-6999 Date: 6/1/2011 PLEASE DELIVER TO: Joanne Scott Salem Health Department 978 745 0343 Pages to Follow: 3 Sender's Name: Sherida George DOCUMENTS TO Certificate of Analysis for KFL Sample Numbers: FOLLOW: 92219.21 (E W Hobbs) PLEASE NOTE: All analytical results should be considered preliminary and are subject to further review until the final report is Issued. If problems are experienced with this transmittal, please call(976)667-6900. P:/24/84 12:13 KFL - GEOCHRON 4 9787450343 NO.049 P02 CKRUEGER for he Food industry FOO 45 Manning Road. BIIIefiCa,MA 01821-3934 JO LABORATORIES, INC. ` '978-6666,6900•f 978-6671-6999 CERTIFICATE OF ANALYSIS Submitted by: Date Reported: 5/31/2011 Date Received:5/23/2011 Everett Hobbs E.W. Hobbs 207 Fort Avenue Salem, MA 01970 Reference: Sampling Month -May 2011 PO#: Description Your Sample Number Our Lab Number Ice Cream 207 Fort Avenue, Salem, Sampled 5/22/11 92219 14°F Coffee STANDARD PLATE COUNT cfu/g 1000 COLIFORMS-VRB cfu/g <1 Standard Plate Count should be less than 50000 ofu/g. Coliforms should be less than 20 cfu/g. Methods: APHA,Standard Methods for the Examination of Dairy Products, 16th Ed., 1992, Parts 6.2 (Standard Plate Count)and 7.8(Coliforms). By: 20742 25153 2125 92219(5/31/2011) Page 1 of 1 0:/24/84 12:13 KFL - GEOCHRON 4 9787450343 N0.049 P03 Analytl[al Services KRUEGER for the Food Industry . FOOD 45 Manning Road,Billerica,MA 01821.3934 INC. www.kfi.com•dkrueger®kfl.com J®LABORATORIES, C 979.667.6900.f 979.667-6999 CERTIFICATE OF ANALYSIS Submitted by: Date Reported.- 5/31/2011 Date Received:5/23/2011 Everett Hobbs E.W. Hobbs 207 Fort Avenue Salem, MA 01970 Reference: Sampling Month -May 2011 PO#: Description Your Semple Number Our Lab Number Ice Cream 207 Fort Avenue,Salem, Sampled 5/22/11 92220 14°FM&M STANDARD PLATE COUNT cfu/g 8000 COLIFORMS•VRB ctu/g <1 Standard Plate Count should be less than 50000 cfu/g. Coliforms should be less than 20 cfu/g. Methods:APHA, Standard Methods for the Examination of Dairy Products, 16th Ed., 1992, Parts 6.2 (Standard Plate Count)and 7.8(Coliforms). By* 20742 25153 2125 92220(5/31/2011) Page 1 of 1 0:/24/84 12:13 KFL - GEOCHRON a 9787450343 110.049 PO4 services KRUEGER for thelfirFolodt Industry FOOD 45 Manning Road,Billerica,MA 01821-3934 INC. www.kfl.com•dkruegerg ULCOm J®LABORATORIES, C978-667.6900•f 978.667-6999 CERTIFICATE OF ANALYSIS Submitted by: Date Reported.- 5/31/2011 Date Received:5/23/2011 Everett Hobbs E.W.Hobbs 207 Fort Avenue Salem, MA 01970 Reference: Sampling Month- May 2011 PO#: Description Your Sample Number Our Lab Number Ice Cream 207 Fort Avenue, Salem, Sampled 5/22/11 92221 14°F Coconut Chip STANDARD PLATE COUNT cfu/g 11000 COLIFORMS-VRB at U/9 <1 Standard Plate Count should be less than 50000 cfu/g. Coliforms should be less than 20 cfu/g. Methods: APHA, Standard Methods for the Examination of Dairy Products, 16th Ed., 1992, Parts 6.2 (Standard Plate Count)and 7.8(Coliforms). By� 20742 25153 2125 92221 (5/31/2011) Page 1 of 1 CITY OF SALEM `,�tt f 1 BOARD OF HEALTH / Establishment Name: C )f1J� l C I I�1I Date: S/Ac. /I Page: of Item Code C—Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION I Date No. Reference R—Red Item Verified PLEASE PRINT CLEARLY . I _ ,f - I I �_f I bill 014 V1^r C t'yil_+ r`r �� f `Q a I rrl("'f}LG' Ir �^ � `)r y3ft�i� fN . I 1 � 61i 7re,1'cn I I I I � I 1 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 Li Re-inspection Scheduled ❑ Emergency Suspension comply with all mandates of the Mass/Federal Food Code.J understand that noncompliance may result in daily fines of twenty-fiv -Mars or suspe ion/revocation of ❑ Embargo ❑ Emergency Closure your food permit. /T l74/ ( /// /71 ❑ Voluntary Disposal 0 Other: 3.501 40 PHFsReceived atTemperatuecs Viotafions Related to Foodborne fitness intementions and Risk According to Law Cooled to Factors(Item 1-22) (Cont.) 41'Ft45*F Within 4 Haus. CHEMICALS 3-501.15 Cooling Methods for PHFs PROTECTION FROM 14 } I i 19 PHF Hot and Cold Holding Food to CA r Additives + 3-501,16(B) Cold PRFs Maintained at or below 3-202.12 Additives* 590.0W(F) 410/45'F* 3-302-14 Protection from Unapproved Additives* } •3 f I -50 t.16(A) Hot PHFs Maintained at or above 15 Poisonous or Toxic Substances 140 7-101.11 Identiryng Information-Original . � 3-501.16(A) Roasts Held at or above, 1300F. Containers" " 20 rime as a Public Stealth Control 7-102.11 Common Name-Working Containers* 1 4 7-201.11 Separation-Storage" } } 3-501,19 Time as a Public Health Control* 7-202.11 Restriction-Presence and Use* } 590.004(H) Variance Requirement } { 7-02.12 Conditions of Use* } REQUIREMENTS FOR HIGHLY SUSCEPTIBLE } 7-20111 I Toxic Containers-Prohibitions* } POPULATIONS(HSP) 7-204.11 Sanitizers.Criteria-Chemicals' 7-204,12 Chemicals few Washing Produce,Criteria* 21 3-801.])(A} Beverages wit Pre-packaged Juices and Beverages with Warning Labels* 7-204A4 Drving Agents.Criteria* } 3-80]-11(B) Use of Pasteurized Eggs* 7-205.11 Incidental Food Contact Lubricants* 3-801.11(D) Raw or Partially Cooked Animal Fad and 7-206.11 Restricted Use Pesticides,Criteriat' Raw Seed Sprouts Na Served * 4 7-206.12 Rodent Bait Stations* 3-80L i I(C) Unopened Foal Package Not Re-scrvod. 7-206.13 Tracking Powders,Pest Control and Monitcsing* CONSUMER ADVISORY TIMEfI EMPERATURE CONTROLS 22 3-503.11 Consumer Advisory Posted for Consumption of { Animal Fads Thai are Raw.Undercooked or 16 Proper Cooking Temperatures for PHFS Na Otberwise-Processed to Eliminate E)Sce,e inzar!r 3-40i.IlA(I)(2) Eggs- 155`F 15 See. Patbogam, Eggs-immediate Service 145'Fi5see. 3-30113 Pasteurized Eggs Substitute for Raw Shell 1 344)1.11(A)(2) Comminuted Fish.Meats&Game Ea { Animals-155'F 15 sec.* SPECIAL REQUIREMENTS 3401.11(B)(1)(2) Pork and Beef Roast- 130'F 121 min* 3-401.11(A)(2) Ratites,Injected Meats- 155'F 15 590-009(A)-(DI Violations of Section .590.009{A)-(D)in see * catering,mobile food,temporary and 3-401.11(A)(3) ( Poultry,Wild Game,Staffed PHK residential kitchen operations should be 1 Stuffing Containing Fish,Meat, debited under the appropriate sections Poultry or Ratites-I65'F 15 sec, * above if related to foodborne illness 3-301.I1(00) Whole-muscle, intact Beef Steaks interventions and risk factors. Other 145°F* 590.009 violations relating to good retail 3-401.12 Raw Animal Fads Cooked in a { practices should be debited under#29- Microwave 165'F* i Special Requirements. 3-401:11(A)(1)(b) All Other PHFs- 145°F 15 sec, 17 Reheating for Hot Holding } VIOLATIONS R ELATED TO GOOD RETAIL PRACTICES 3403Al(A)&(D) PHFs 1657 15 sec. * } (Iteans23-30) 3-403.11(B) Microwave- 165'F 2 Minute Standing Critical and non-critical violations, which do not relate to the Time* I foodborne illness interventiaac and risk factors listed above, carr be 3-403.11(C) Commercially Processed RTE Food- found in the following.sections of the Food Code and 105 CMR 140" 590,000. 3403.11(E) Remaining Unsliced Portions of Beef 1 item : Good Retail Practices ' FC 590.000 Reas4s* 1 23. Managsmeni and Personnel FC-2 .003 0 18 Proper Cooling of PHFs } 124. i Food and Food Protection 1 FC-3 .004 125. 1 Equipment and Utensils I FC-4 .005 3-501.14(A) Cooling Cooked PHFs from 140`F to 26, Water.Plumbno and Waste I FC-5 .006 70`F Within 2 Hours and From 70OF ! 27. Phvsicai Facilty FG-6 W7 I to 41`F/45'F Within 4 Hours. * 1 28. ' Poisonous or Toxic Materials FC-7 .008 i 3-501.14(B) Cooling PHFs Made From Ambient 29. Special Requirements .009 Temperature ingredients to 41'FI45°F 30, 1 Other Within 4 Hours* -lkntin%cotical jwm in the L-doral 11,399 Foal Cmie w 105 C.MR 590.000. CITY OF SALEM BOARD OF HEALTH / Establishment Name: 1-T� � — �C Q CfE��t, Date: a 31 / /I Page: of Item Code I C-CrItrcal Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION I Dere. No. Reference R—Red Item +I Verified PLEASE PRINT CLEARLY �1 n C fM I/lei rn_-O°,a " CT f �`�w�t��-kr;�r�tr� -�w -fes//o�.�rn� we,� rno-l�• I I �'r�v�cle- wee I I—(n c.,✓� 5� c�(�ef7,�.r —{-�x TC,cQ h c�-t�,r��m . I I I I I��^t 1.1 I'c�p ee I�p v P✓t rw)+r Ccy 4 m On M e h u harm d cep d moi- -{vault. c (tePA( f v'pnq-et, s -I o cr d4p I i I I i pRrvyi if r til• v i I i I _ Discussion With Person in Charge: Corrective Action Required: I Cl 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 ❑ 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'r sus ension/revocation of ❑ Embargo ❑ Emergency Closure your food permit / /f )� //d/ ❑ Voluntary Disposal ❑ Other: F 3-501.14(C) PHFs Received at Temperatures Violations Related to Foodborne Illness,Interventions and Risk According to Law Cooled to Factors(Item 1-22) (Cant.) . 41'F/45°F Within 4 Hdqrs.,* PROTECTION FROM CHEMICALS 1 3-501.15 Cooling Methods for PHFs 14I Foo 1 or Color Additives I 1 19 1 PHF Hot and Cold Holding 3-50L16(B) Cold PHFs Maintained at or below3-202.12 Additives* 1590.004(F) 41°/45°F* 3-302.14 Protection from Unapproved Additives* 1 15 Poisonous or Toxic Substances i 3-501.16(A) Hot PHFs Maintained at or above 7-101.11 I Identifying Information-Original 140T Containers* I 3-501,16(A) Roasts Held at or above 130°F. * i 7-102.11 Common Name-Working Containers* 1 1A Time as a Public Health Control 17:.02.11 Separation-Storage" 1 3-501.19 Time as a Public Health Control* ' 7-202.11 ,Restriction-Presence and Use* 1 � 590.L104(H) Variance Requirement � 1 7-202.12 Conditions of Use* REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 1 7-203.11 Toxic Containers 11 Co -Prohibitions* 7-204.11 em .Criteria Chemicals* 1 POPULATIONS(HSR) 7-204.12 Chemicals for Washing Produce,Criteria* 21 3-801.11(A) Unpasteurized Pre-packaged Iuices and 1 7-204,14 1 Drying Agents.Criteria* Beverages with Warning Labels* 1 7-205.11 1 Incidental Food Contact,Lubricants* 1 3-501.11(8) Use of Pasteeurized Eggs* 1 3-801.11(D} Raw or Partially Cooked Animal Food and i 7-206.11 1 Restricted Use Pesticides,Criteria* 1 Raw Seed Sprouts Not Served 7-206.12 1 Rodent Bait Stations* 1 � 3-801.11(C) Unopened Food Package Not Re-served. 7-206.13 ( Tracking Powders,Pest Control and Monitoring* CONSUMER ADVISORY TIMEITEMPERATURE CONTROLS 22 3-603.11 Consumer Advisory Posted for Consumption of 16 Proper Cooking Temperatures for I Animal Foods That are Raw.Undercooked or PHFs Not Otherwise Processed to Eliminate 340i.]IA(1)(2) Eggs- 155°F 15 Sec. Pathogens.*r""'°°'"'T"" Eggs-Immediate Service 145°F ISsec* 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 3-401.11(8)(1)(2) Pork and Beef Roast- i30°F 121 min* SPECIAL Violations of Section 590,009(A)-(D)in 3 d01.11(A}(2) sec*s,Injected Meats-155°F 15 catering,mobile food, temporary and 3401.1 t(A)(3) Poultry,Wild Game,Stuffed PHFs, I residential kitchen operations should be Stuffing Containing Fish,Meat, debited under the appropriate sections Poultry or Ratites-165°F 15 sec. * above if related to foodborne illness 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks interventions and risk factors. Other 145°F* 590.009 violations relating to good retail 3-401.12 Raw Animal Foods Cooked in a practices should be debited under#29- Microwave 165°F* I Special Requirements. 3.401.1](A)(1)(b) All Other PHFs-145°F 15 sec. 1 17 i Reheating for Hot Holding VIOLATIONS R LATED TO GOOD RETAIL PRACTICES 3-403.11(A)&(D) PHFs 165°F 15 sec.* I (Items 23-30) 3-403.11(B) Microwave- 165°F 2 Minute Standing f Critical and non-critical violations,which do not relate to the Time* I foodborne illness interventions and risk factors listed above, can be 3403.11(0) Commercially Processed RTE Food- found in the following sections of the flood Code and 105 CMR 140°F* I 590.000. ' 3403.11(E) Remaining Unsliced Portions of Beef ( Item I Good Retail Practices FC 1 590.000 1 Roasts' 123. 1 Manailement and Parsonnel FC-2 1 ,003 .1 1 1g 1 Proper Cooling of PHFs ' 24. 1 Food and Food Protection FC-3 1 .004 i 25. Equipment and Utensils FC-4 1 .005 3-501.14(A) Cooling Cooked PHFs from 140°F to ( 26, Water.Piumbinq and Waste i FC-5 .006 70°F Within 2 Hours and From 70T 27. Physical Facility ! FC-6 to 41°F/45'F Within 4 Hours.* 28. Poisonous or Toxic Materials i FC-7 .008 3-501.14B) Coaling PHFs Made From Ambient 29. I Special Requirements ,009 I Temperature Ingredients to 41°F145°F I i I Other ! 1 I Within 4 Hours* $.,<a,2 'Dmotes critical item in the federal 1999 Fool Code or 105 CMR 590.000. 11/20/4: 10:15 KFL — GEOCHRON 4 9787450343 NO.050 DOS J Kq W ER Phone:(978)667-6900 GOD Fax;(978)667-6999 fL Email:dkrueger(Qk9.com Website:w .kfl.com ® LABORA7om% INC. 45 Manning Road,Billerica,MA 01821 USA FACSIMILE TRANSMITTAL FORM FAX#: (978) 667-6999 Date: 10/5/2010 PLEASE DELIVER TO: Joanne Scott Salem Health Department 976 746 0343 Pages to Follow: 3 Sender's Name: Van Lavoie DOCUMENTS TO Certificate of Analysis for Sample Numbers: FOLLOW: 90013-915 PLEASE NOTE: All analytical results should be considered preliminary and are subject to further review until the final report is issued. If problems are experienced with this transmittal, please call(978)667-6900. 11/20/4: 10:15 KFL — GEOCHRON 4 9787450343 NO.050 D02 _ Anaiytical Services KwEGER for the Good Industry FOOD 45 Manning Road,Billerica,MA 04821-3934 W WW.kf,COM•akruegerakfl.COM ..,@ LABQRA ows, SNC. 978667.6900•f 978.667.6999 CERTIFICATE OF ANALYSIS Submitted by: Date Raparted: 1014110 Date Received: 10/1110 Everett Hobbs E.W. Hobbs 207 Fort Avenue Salem, MA 01970 Reference: Sampling Month-October 2010 PO k Description Your Sample Number Our tab Number Ice Cream 207 Fort Avenue, Salem, Sampled 10/1/10 90013 8°F Vanilla STANOARO PLATE COUNT efulg 48000 COLIFORMS-VRB dullg <1 Standard Plate Count should be less than 50000 cfu/g. Coliforms should be less than 20 cfu/g. Methods:APHA, Standard Methods for the Examination of Dairy Products, 16th Ed., 1992, Parts 6.2 (Standard Plate Count)and 7.8(Coliforms). 19832 24081 2125 90013(1014/10) Page 1 of 1 11/20/4: 10:15 KFL — GEOCHRON -� 9787450343 N0.050 003 ` I �/,,� Analytical ServlceS KwEGER for the Food Industry FOOD 45 Manning Road,Billerica,MA 018213934 .r®LABORATORIES, INC. ww 978-com• O#f 9 er®Icf-6999 979•fi67.6900+f 979-667.6999 CERTIFICATE OF ANALYSIS Submitted by: Date Reported 1014/10 Date Received: 10/1110 Everett Hobbs E.W. Hobbs 207 Fart Avenue Salem, MA 01970 Reference: Sampling Month-October 2010 PO#: Description Your Sample Number Our tab Number Ice Cream 207 Fort Avenue,Salem, Sampled 10/1/10 90014 8+F Coffee STANDARD PLATE COUNT efutg 30000 COLIFORMS-VRB duly <1 Standard Plate Count should be less than 50000 cfu/g. Coliforms should be less than 20 cfulg. Methods:APHA,Standard Methods for the Examination of Dairy Products, 16th Ed., 1992, Parts 8.2 (Standard Plate Count)and 7.8(Coliforms). By: 19832 24081 2125 90014(10/4/10) Page 1 of 1 11/20/4: 10:15 KFL - 6EOCHRON 4 976'7450343 N0.050 904 KRUEGER Analytical Services for • the Food Industry FOOD 45 Manning Road,Billerica,MA 01921-3934 INC. www.kfl.com•dknleger®kfi.com _�AABORATORIES, C979.667.6900+f 978.667.6999 CERTIFICATE OF ANALYSIS Submitted by. Date Reported: 1014/10 Date Received.' 10/1110 Everett Hobbs E.W. Hobbs 207 Fort Avenue Salem,MA 01970 Reference: Sampling Month-October 2010 PO = Description Your Sample Number Our Lab Number Ice Cream 207 Fort Avenue, Salem, Sampled 10/1110 90015 8°F Maple Walnut STANDARD PLATE COUNT cftUg 8100 COLIFORMS•VRB cfu/g <1 Standard Plate Count should be less than 50000 cfu/g. Coliforms should be less than 20 cfu/g. Methods:APHA, Standard Methods for the Examination of Dairy Products, 16th Ed., 1992, Parts 6.2 (Standard Plate Count)and 7,8(Coliforms). By:11y, 19832 24081 2125 90015(1014/10) Page 1 of 1 0:/31/4: 42:05 KFL - GEOCHRON 4 9787450343 NO.040 901 \ I Es ER Phone:(976)667-6900 Fax:(978)667-6999 FoOD Email:dkrueger®k9.wm Websile:www.kft.com J® LABDPAMR12 y INC. 45 Manning Road,Billerica,MA 01821 USA FACSIMILE TRANSMITTAL FORM FAX#: (978)6674999 Date: 9/15/2010 PLEASE DELIVER TO: Joanne Scott Salem Health Department 978 746 0343 Pages to Follow: 3 Sender's Name: Van Lavoie DOCUMENTS TO Certificate of Analysis for Sample Numbers: FOLLOW: 89781-783 PLEASE NOTE: All analytical results should be considered preliminary and are subject to further review until the final report is issued. If problems are experienced with this transmittal, please call(978)667-6900. 0:/31/4: 42:05 KFL — GEOCHRON 4 9787450343 NO.040 1704 ` I I Anatvticat Services KRUEGER for the Food industry . FOOD 45 Manning Road,Billerica,MA 018213934 J®LABORATORIES, INC. 9781-66 6900-f 978-667-6999 CERTIFICATE OF ANALYSIS Submitted by. Date Reported: 9/14/10 Date Received: 9/9/10 Everett Hobbs E.W. Hobbs 207 Fort Avenue Salem, MA 01970 Reference: Sampling Month-September 2010 PO#: Description Your Sample Number Our Lab Number Ice Cream 207 Fort Avenue, Salem, Sampled 9/9/10 89783 10°F Frozen Pudding STANDARD PLATE COUNT cfutg 1100 COLIFORMS-VRB efulg <1 Standard Plate Count should be less than 50000 cfu/g. Coliforms should be less than 20 cfu/g. Methods APHA, Standard Methods for the Examination of Dairy Products, 16th Ed., 1992, Parts 6.2 (Standard Plate Count)and 7.8 (Coliforms). 644 By: i 19735 23974 2125 89783(9/14/10) Page 1 of 1 0:/31/4: 42:05 KFL — GEOCHRON a 9787450343 NO.040 P03 hiCKRUEGER for the Fod ndustry FOOD 45 Manning Road,Billerica,MA 01821.3934 www.kfl.com•dkruegerOkfl.com .�®LABORATORIES, INC. 978.667-6900•IF 978.667.6999 CERTIFICATE OF ANALYSIS Submitted by: Date Reported: 9/14/10 Date Received: 9/9/10 Everett Hobbs E.W. Hobbs 207 Fort Avenue Salem, MA 01970 Reference: Sampling Month•September 2010 PO#: Description Your Sample Number Our Lab Number Ice Cream 207 Fort Avenue, Salem, Sampled 9/9/10 89782 10°F Uh-Oh Oreo STANDARD PLATE COUNT ofu/g 1500 COLIFORMS-VRS clulg <1 Standard Plate Count should be less than 50000 cfu/g. Coliforms should be less than 20 cfu/g. Methods:APHA, Standard Methods for the Examination of Dairy Products, 16th Ed., 1992, Parts 6.2 (Standard Plate Count)and 7.8 (Cotdorms). By:139 19735 23974 2125 89782 (9114/10) Page 1 of 1 0:/31/4: 42:05 KFL - GEOCHRON 4 9787450343 NO.040 1702 Analytical Services KRUEGER for the Food Industry • FOOD 45 Manning Road,Billerica,MA 01821-3934 �®LABORATORIES, INC. www.kfl.com• 0-f9 8-667-com 978-667.6900•f 978-6fi7-6999 CERTIFICATE OF ANALYSIS Submitted by. Date Reported: 9/14/10 Date Received.' 919/10 Everett Hobbs E.W. Hobbs 207 Fort Avenue Salem, MA 01970 Reference: Sampling Month-September 2010 PO#: Description Your Sample Number Our Lab Number Ice Cream 207 Fort Avenue, Salem, Sampled 9/9/10 89781 10"F Coffee STANDARD PLATE COUNT duig 1300 COLIFORMS-VRO du/9 <1 Standard Plate Count should be less than 50000 cfu/g. Coliforms should be less than 20 cling. Methods:APHA, Standard Methods for the Examination of Dairy Products, 16th Ed., 1992, Parts 6.2 (Standard Plate Count) and 7.8(Coliforms). ey:61� 19735 23974 2125 89781 (9/14/10) Page 1 of 1 0:11014: 10:32 KFL — GEOCHRON 4 9767450343 KU,015 901 I •"W83ER Phone:(976)667.69600 Fax:(978)667.6999 F000 Email:dkruegerQk6.wm J6• om LA80RA oFve% INC. 45 Manning Road,Billerica,MA 01621 USA FACSIMILE TRANSMITTAL FORM FAX S: (976)6676999 Date: 8124120.10 PLEASE DELIVER TO: Joanne Scott Salem Health Department 978 746 0343 Pages to Follow: 3 Sender's Name: Van Lavoie DOCUMENTS TO Certificate of Analysis for Sample Numbers: FOLLOW: 89597-599 PLEASE NOTE: All analytical results should be considered preliminary and are subject to further review until the final report is issued. If problems are experienced with this transmittal, f please call(978)667.6900. 0:/10/4: 10:32 KFL — GEOCHRON a 9787450343 NO.015 902 Anai cal Services KRUEGER for the Food industry FOOD INC. 45 ManMng Road,Billerica,MA ot921-3934 JAI LABtJRATt ms, NC978-667-6900•f 978--667-6999 CERTIFICATE OF ANALYSIS Submitted by: Date Reported: 8/23/10 Date Received 8/17/10 Everett Hobbs EW Hobbs 207 Fort Avenue Salem, MA 01970 Reference: Sampling Month-August 2010 PO#: Description Your Sample Number Our Lab Number Ice Cream 207 Fort Avenue, Salem, Sampled 8/17/10 89597 8°F Coffee Oreo STANDARD PLATE COUNT cfulg 2600 COLIFORMS-VRB cin/g 8 Standard Plate Count should be less than 50000 cfu/g. Coliforms should be less than 20 cfu/g. Methods:APHA, Standard Methods for the Examination of Dairy Products, 16th Ed., 1992, Parts 6.2 (Standard Plate Count)and 7.8(Collforms). By: i 19652 23883 2125 89597(8123/10) Page 1 of 1 0:110/4: 10:32 KFL - 6EOCWON 9?8745O343 - NO.015 903 Analytical Services KRUEGER for the Food lndusttY • FOOD 45 Manning Road,Billerica,MA 01821-3934 W W W.kfl.com-dkrueger6kfl.com LABORATORIES, INC. 978.667.69M-f 978.667.6999 CERTIFICATE OF ANALYSIS Submitted by: Date Reported: 8123110 Date Received: 8117110 Everett Hobbs E.W. Hobbs 207 Fort Avenue Salem, MA 01970 Reference: Sampling Month-August 2010 PO#: Description Your Sample Number Our Lab Number tee Cream 207 Fort Avenue, Salem, Sampled 8117110 89598 86F Chocolate STANDARD PLATE COUNT chdg <250 COLIFORMS-VRB cta/g <1 Standard Plate Count should be less than 50000 cfulg. Coliforms should be less than 20 efuig. Methods:APHA, Standard Methods for the Examination of Dairy Products, 16th Ed., 1992, Parts 6.2 (Standard Plate Count)and 7.8(Coliforms). BY: 19652 23883 2125 89598(8/23/10) Page 1 of 1 0:11014: 10:32 KFL - CEOCHRON 4 9787450343 NO.015 D04 t AnalVdCal Services KRUEGER for the Food industry FOOD 45 Manning Road,Billerica,MA 01 821-3 93 4 . JoLABORATORIES, INC. ww 978.com 900-IF9 8.6676999 976.667-69p6•f 978.667.6994 CERTIFICATE OF ANALYSIS Submitted by: Date Reported 8123110 Date Received: 8/17110 Everett Hobbs E.W. Hobbs 207 Fort Avenue Salem, MA 01970 Reference: Sampling Month-August 2010 PO#: Description Your Sample Number Our tab Number Ice Cream 207 Fort Avenue, Salem, Sampled 8117110 89599 8°F Vanilla STANDARD PLATE COUNT afu/g 1300 COLIFORMS-VRO cfu/g 1 Standard Plate Count should be less than 50000 cfulg. Coliforms should be less than 20 cfu/g. Methods APHA, Standard Methods for the Examination of Dairy Products, 16th Ed., 1992, Parts 6.2 (Standard Plate Count)and 7.8(Coliforms). By: 19652 23883 2126 89689(8/23110) Page 1 of 1 i CITY OF SALEM ii 11''^^ BOARD OF HEALTH r i' b b<, �CQ C"-P ", m Date: L4 I 1 I U Page: I of Establishment Name: 1 � , Item Code C-Critical Rem DESCRIPTION OF VIOLATION/PLAN OF CORRECTION No. Reference R-RedfRem I . PLEASE PRINT CLEARLY r%S./. .VBrRied , ho�VYl r tt f2 ��ll r)Clot' Cr -qcx) ( r)ol r avta -RbrA Imo( P. i C.�'ec'.r✓Vl ., t.L�CL.� f��lY1 -r-1f�QA7 .P,C + �Yr ��aP V1ra�,P b��h �rf, >v � � I 0DMVt- I t � v I I i .BPSy ,�rraLr�i cap - -(/1 � Iii I I I 1 I Discussion With Person in Charge: Corrective Action Required: ❑ No 1,0 ,res I 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 Ll Re-inspection Scheduled ❑ Emergency Suspension comply with all mandates of the Mass/Federal Food Code. I understand that noncompliance may result in daily fines of twenty-five do/lllarsPor suspension/revocation of ❑ Embargo ❑ Emergency Closure tyour food permit. ( % // ❑ Voluntary Disposal ❑ other: ?-501 i4((l) PHFtReceivedat'remperalures Violations Related to Foodborne Illness interventions and Risk According to U% Cooled h) - Factors(Items 1-22) (Cont) 41'F/45"1=Vv`it6in 4 Hnw'i. ' PROTECTION FROM CHEMICALS 1 3-501.15 Cooliaa ,4ethod,tar PHFt. 14 I Food or Color Additives ( 19 PHF Hot and Glild Holding 3-20212 Addrtit'es" 501.16(B) Cold PHFs Maintained at or below � i 3-302.14 Protection front UnannroNed Adti 590(kµ{ry n ei' 41`1.45°F^ t 13-501.16(.�i IInt i'HF:Maintainedatorab.me ( IS Poisonous or Toxic Substances ; !(11.11 klcnuf^im> lntinmauon - Oin,inal t'antainerr, I — ¢-if:l 16{.0 Ro.,at.Hcfd at or abore 130"1., +__ iti2.t I _ C,,fnnrn3:;tianr;?-- 14'nriar3;;C'uur,,.:o,:r>� '4) Time as a Public Health Cantroi -i ;C f.: ( firm'a�a Putrhi i lealrh Conu'al I 1 '(11.7 1 �S<la,:u.ton- Srw:t'e" -'-----� - 7-:'()2 Own- Prru.ncc.tud i ,r' � _- y_- t_:c ftca�tiirt^nlent —1 j 7-102-12 C,aalituo:,of t1w, i '.Ot 11 1,+xii:Cuntumcre —Pn>inhc .;rr REOUFREMENTS FOR HIGHLY SUSCEPTIBLE (-- — ---- of -- POPULATIONS(HSP) -2J4.11 Santuzrrr'.Crilcri,, -Owmii.,is --- -- ( 21 1 +-tit)! : i(.-t) l 1'npa,lcnrt.cd Prt:pitd:,i_ed Jmtas and 7-'04 12 t'ficn wale foi tv at hw V, , n< ur:_.C wi I,n)' t poor ..___._.__, Re�er,+'es iv±d: viarniat labais^ t 7 104 id Urvntz 4arot<.Cntciia_ r ?05 i fInctd:rtal 1 axf C'unta_a 1:dr:ta:nS.'IWill t' ,•f F'a.teua<ed Ecg ?-SPI.;i;ll) i�,rn or Pnihaif•:Crvai,.J Animal Fh,d.md i ?-2C)6.11 ' i<a�uu:l,nl t`nt Pe>ryader' i'.uei i.+-__- ( 1 ��_—_-'�''"—"- ? ver}O.12 3:,nlc.^.I 1i_dq 'Ili:Hawt:.' - --1'= 2 -- if !'..,o C'e.:,:tar \< R�:r^t,_r4 ' '06l i 'Er.trl.t,tg) •:.0 i;r:. l': .. . ;;n;.•d .r.:., -'---' - --" _ _.. ._ _- '--- --_-- CONSUMER ADVISORY TIMErrEl'_:PERATURE CONTROLS = t 11,(?: i; 1-l7,5 , __r.. iwu,ip�or-_- i n;^.:I F�9\t, 111a:.tre Proper Cooking Tempe:aluies lar ' PHFs ,S ,5,•ri trilla'r .:ess,_.t :^ii;limtnarc YF1: -�.. _ ti,I.. lift. f .. Ra., Shelf 7 2 1 1 .r (:.. ,�: . Shelf r.i im;oad.ate Ser-i i ;5"i' c .. �,. . -'; .l :.au. ..J (-r.h. 'I... ::: t,:',is #.'1 #!'!3'if ✓Z; PEO "fid I:i:i Ru rt t' �'± 1:1 r"ii, --- -------- RFG3$.slRFMENTS - • ':)f.. �ilf ' ( ii.pie�, 4'HPct',i 3i:it5 i:5 i^ .t• i' . 'l•. stci3i,il :'R,tM;ji.?;-{i)'t '!i Ca'.•`Rlie,. 1i11+l4l"loobt lcr,p;-raland i X11:told tie 3111 110l,'?) I louirt.,.. R lid C';wpi:, t,i:'I:J#,tr,rt onric'T. , rI, Dl"Irt It, <r."t 1,.1:Ie i �': ❑r. .,:0 'f;: I'6..v., .,. . . . ........: .. ']i '33#: ,.xi Sq: d.$#t;r _._ .__ _.. _... .poor , t i R:i.cefm<3 nor H)t V IL _ .. i(A)K4itF � !'i[t (ci i= #- :c; "_ _- _ tiieriss 2;_311: -703.1 Ii k1) i 11ir:,'•.,ar.. if,5', _ :l i:ati�'Se:'.Uu} i;:i<', r zr.,. ., r, . .. r. d`J. . '+. :,r•;rh•IO•qti ihC�. .r , t--i'i?.11i{'} � Cnm:nct:ta(h�4ho,:..c3 'i'.( F ,'+t Jc•u',:rrr:>r<i„ ..n,::., .,.. : :i:r �',,,Ic.'f'�d:':::..t ivy!-;;1' :40' iI(L) iRrmatn3n:;L'n,lir•ed P,, 'nLI!c it!'14;,'i Ys:n CL',ncd Retarr Pr.tciices ^FC SSpALX1 manacem+rl a:,(j P-:r.::X.:r^, X, - ; Proper Cooling of PHFs 1 1 '': -- _x.and aa,4'•pt aGun --- -- FC ?. vC: 1- sol 141A) ` t'MriFlii±ix,.tr,{j F'F{f.F3,.,tn 1,1(" i 2F Yr e'c-r r i:,r,r;n ;1 un,;4Jt:t.• , FC- : : 7G"F WantIt ? HvtS: P r -- -- ----- i, i r x:41 114.1 1 lYitlnn.t 'r,-'u _C _r. _-7 00T, - iSUl.i•iiB3 (',v.he PHF. Ma t- lrwm imi+tri,t _. _~ ?i;•K,:.•t R,' ;�r_,v..,rs .. . ._ prop- _ T,•mi:rratute Iuerrc5::i.;.t., :i°F,:5 1' '=` - - . - -- ._- _. -- -_ -_-_ ----i ---. --^ . .. -.-_: � t};4 ' i�,.,,.^ .^s.it:::.9. r n. I,•.a9.�: i•;"J i'..;o,i(�.,.�ig.., I J•:.''i K"i�.:+,n! CITY OF SALEM BOARD OF HEALTH I Establishment Name: g04'i ' Q W Date: L4 t 1 I Page: of Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date No. Reference R-Red ItemVerified j PLEASE PRINT CLEARLY ' s I A <e asoY)o o( nQy, Iin(T �n nPrI-, vt tYA l CO t1 r1 C,( - �rfYy 1i (o (I n I k j I VN r1a/V 1/`P 1/1 Q+F (,—A'._)1D /X'.[ 104 C��l 1 fAL'd f r)V Vli y rp i: t' tI rl1 �I Ih. I �t0; r� C'In ado,. I I _ � I ll1 IA o rr C_--k-.e —1/t, 0^n "\('�A n i ( 5'(1`0 In-<-p,r 1✓� nn.. I Pre ,,nk nr �cx A cin, �n{,.,r k`� ,�-1 ��_ �n A flt •-�•f`PA7 t�Y cJ•ci r . ,tom C'��r.f z. J j rr� 1 I ( f/6 ✓ t A r-.f l IC-1-ki 7 w c4� r 1a .In _4r"v r r y1 rr� ( A Ire �,v r I h t't -r1":,iv. 1 I VLQ rr'f 1t/1 r_r o m f_-ir}P 4�r rs -tw1 C N•i 1 T P <T r f 1 A I i )/\ i 1i' It ,r rQ� r � Rr�• r�� t 1�rTnr � f2l�r � ` ,11IH ?71r1r �nr/1 t� i1 IIS/ 2__ �t�nr l r vfi 1 t( •/J Q fYCP 1) r t r', I `J41 rr 413 r/ its, �e-r � l �A ern r�_-0r '�'. '1ln � �Ianrn J'.Or/7.Tr I < /,n r7 r� �.. - . L y �1� r �r1r10CVI 11/t1 0 -r C n^.Crn r•n_ (a �l 1< . l 1 rlryn)l I� .r. t\() IM P 0+1 r': V) r t cz n I Discussion With Person in Charge: Corrective Action Required: I ❑ No f ❑ Yes I have read this report, have had the opportunity to ask questions and agree to correct all ❑ Voluntary Compliance ❑ Employee Restriction inspection, to observe all conditions as described, and to Exclusion violations before the next ins P ❑ Re-inspection Scheduled ❑ Emergency Suspension comply with all mandates of the Mass/Federal Food Code. I understand that noncompliance may result in daily fines of twenty=five dollars,or suspension/revocation of ❑ Embargo ❑ Emergency Closure your food permit. � ❑ Voluntary Disposal ❑ Other: Violations Related to Foodborne fitness Interventions ?-501 )4(C) PRFs Received at Temperatures end Risk According to Lau Cooled to Factors(ltewls 1-22) (Cont) 41'P/45`F Within-1 Ham's. PROTECTION FfIOM CHEMICALS { 13-501.1 S { Ctv ing Methods for PHFs { { 14 { Food or Color Additives { { 14 PHF Hot and Gold Holding { -203 12 Add cs'" I ' SUL16B} Cotd P14(F) Maintained at or bzlnw `:90.0E}+(F I 41`/45`F' { 3-30114 Protection front UnapprmedAdditives T-51)1 16(A) IIntPHPsli;tintainedaturat+ove Poisonous or Toxic Substances A 140F.* 7 101.11 { hh;nutymg Infolmatxm - Un'-ina! ' s.5 r , u; t 1 1,,1 #) R{wst>Hcld at t tbo%e 130`h. Containers- — — _if{ 2-I_ Tfiimmet'a.,ssaaPubc Health h Control ; 102.J13 Cotnntn \am - 44„ F c 1 l'ubinAeatthCbnunl - Sapauzan-Siu 7-2h02.1( Res[ irhon -ir:•unrc u.i l .c" U. — hc,;uitonoa( i{ 7-162-1 Condition:ofi)Yo' i 7-203 11 I Toxic C'ontamcc -Prohrbr,rc=nt` REQUIREMENTS FOR HIGHLY SUSCEPTIBLE T"04.11 Senitc:et'ti.Cntere+ -Chct,{it:,k { POPULATIONS(HSP} 1 7 •, �. . a i I ?E I t-Stiff I iF A) { linpaatw gyred Pre pn�}aged Juice.mtil i -..04.1., f ('hcnucals fn{ t;'a�hu3 l k':,drier; , ui { a' ! i tsr:.':ozes is iFf, tiltminc labcly r2U4 1•i 1)i'»tli;rluretc.Cntnrta' ----"-...--- : t--.-+----.. I ------------------ , S01 ? 205 I t Lt.i&ntal F++.id Contac'1,Ltdvu::inn' --- -- v .t J1 I i,il) k:F,v=rr Pully'', '2-v)kM Animat F{r,d ami I '+^Uo.it Re.vi�led t"Sc Pe-twt'4!e . �__ : iLn, S::c: `iL'.r;ty •v„ Ser wd. i 1-:06.12 t ii4skt?: 13,:11 S'tlHon _ '-'"------ - _4 +_ti, E:'f'- f , .. ' F")d 1';'.i:bad No It- o)'; i=� '}1.F.i.tnr i.rad:,,.P•'sl ut:d - �--- - - -- --.____.-- ----------J , CONSUME- 4V-VjS"1Y I 4innmar TIM EITi:MPEPATUIRE CONTROL „ r i ::;,r uv: , tire' tt: Cent to{;1;„;,r,•f la i Propo Cooking Tontper a[trr c fo: : •. ...:.v:1v. tt,: (hill'S:r•'1 F _ �- - — - - :i+E.I (- t _ _ :L F.cGtUir1E'[NENTS ?�_.. ._ n. J r}4ii `.i�L.f3i13.t U° !;.•,,i'.r =.•L' 'lt J'�::'fit..(i}'i !n `i -. � $dL• •. ... i '. I Gi.';'t1: .. 'i?lt: ItkFc.. t"::rx.,,Ctt,t ..y$ i { 4t'i l j,r'.,):-{,—__ Pp;ltF i3 1�3., •__.`i: . . - 'li. ',.., ta,.:a-" t'':3:<C.rin:i .hJ;t i:` - 1 u�t ro . ._021...1 I. ,. •��t:; ,._ ,t. .!: t:Y.d, !i•. 'd.! ,. , .. .. .i. i+:. r ,. . :},�,, 4 ,. _ ., .. .: t �:::J.:.,.•1321 = . . . , .,i:, r t e 1Y t it_ I { t{)' CHI ,U: (: l: .cc _.I (;a?tdi�.2J•Ts3} 3,1 i,b” 16>' ! ' 41:mr.•St:rrdin;: It dr. .:o, :;h:r<. : %:i•. .fir..M, -7n'St , r.t:,,a1 :r.r."ust tiA:rr:r1'=:uf Gi:: ,.. nutie int ,3:, �,. �, . . .. . :it, F✓:'[t ti�0:%:': .::1 <,is r':.,`7. r —_—.. ` nr!Fr.rcttces... 59D.Of { 1t , .1{..) ( )U F" 1,('ed i•oi t•t.rls:,i hc�t'I I .ten, -1 ;;noa Rr- ---- -- -- --- -- � --- -- '='K" -- � - - -- ' n3,ac."mr,--1 a,a Pec n,;te; _ _ _ i_FC , 3 Pto erC•oolin ofPHFs ! t 18 _�--_.-__g.. 25 G u,^n,r;n+ano __ _ _ ,— St'i i !(A) i +,',ndinC Cr'c)Atfl E`H(=t b.qt? }-i:i'E-b. 1 i_ z-_- - : I 1 %r =i'i a1Gf 3'L";�:F•�'1'6 lVrot.; i F('._: : 7ti P\'.;thrn: IEirur:snl Crain !a"i rt'ys n'ra�. - --- - --- - - ---- IJ.4 �t;3i F Gl,hitt-1 Pt,gk' _ _.'Oa J,�Jau:'`'SX,.^n,•, : FC - _OGG i 3 501 idtBj C'nFdu:e Pt IF: ''M.,de Hnm Amhdt,t — �.-: I • ;',r:....� .-,,:.:al t.crr'. r:',. is i ..,, '.'n..,l: �•. „ .,.,:'�;. a ,r, 07/14i10 09:06 KFL — GEOCHRON 4 9787450343 NO.001 D01 G—m m Phone:(078)667-6900 1"U O D Fax:(978)667-6999 Email:dkrueger@k0.com 1 Webalte:www.k0.com U J® eop m% INC. 45 Manning Road,Billerica,MA 01821 USA FACSIMILE TRANSMITTAL FORM FAX#: (978) 667-8989 Date: 7/14/2010 PLEASE DELIVER TO: Joanne Scott Salem Health Department 978 746 0343 Pages to Follow: 3 Sender's Name: Van Lavoie DOCUMENTS TO Certificate of Analysis for Sample Numbers: FOLLOW: 69154-156 i PLEASE NOTE: All analytical results should be considered preliminary and are subject to further review until the final report is issued. If problems are experienced with this transmittal, please call(978)667-6900. 07/14/10 09:06 KFL - 6EOCHRON 4 9787450343 1,10.001 1702 KRUEGER Anarytical Services e for the Food Industry FOOD 45 Manning Road,Billerica,MA 018213934 �®LABORATORIES, INC. 978-667-6900 of 9978-667.69M CERTIFICATE OF ANALYSIS Submitted by: Date Reported: 7/13/10 Date Received: 7/8/10 Everett Hobbs E.W. Hobbs 207 Fort Avenue Salem, MA 01970 Reference: Sampling Month-July 2010 PO#: Description Your Sample Number Our Lab Number Ice Cream 207 Fort Avenue, Salem,Sampled 7/8/10 8°F 89154 Vanilla STANDARD PLATE COUNT efulg 4000 COLIFORMS-VRB clulg <1 Standard Plate Count should be less than 50000 cfu/g. Coliforms should be less than 20 efu/g. Methods:APHA, Standard Methods for the Examination of Dairy Products, 16th Ed., 1992, Parts 6.2 (Standard Plate Count)and 7.8 (Coliforms). By: 19476 23690 2125 89154(7/13/10) Page 1 of 1 07/14/10 09:06 KFL — GEOCHRON 4 9787450343 NO.001 D03 _ KRUEGER Analytical Services for the Food Industry FOOD 45 Manning Road,Billerica,MA 01821-3934 com JAABORATORIES, INC. 978.66 69 0-f 978.6667-69 9 CERTIFICATE OF ANALYSIS Submitted by. Date Reported: 7/13/10 Date Received: 7/8/10 Everett Hobbs E.W. Hobbs 207 Fort Avenue Salem, MA 01970 Reference: Sampling Month -July 2010 PO k Description Your Sample Number Our Lab Number Ice Cream 207 Fort Avenue, Salem, Sampled 7/8/10 BOF 89155 Pistachio STANDARD PLATE COUNT Cfo/g 1800 COLIFORMS-VRB Cfulg <1 Standard Plate Count should be less than 50000 Cfu/g. Coliforms should be less than 20 cfu/g. Methods: APHA, Standard Methods for the Examination of Dairy Products, 16th Ed., 1992, Parts 6.2 (Standard Plate Count)and 7.8(Coliforms). By: G! 19476 213690 2125 89155(7/13/10) Page 1 of 1 07/14/10 09:06 KFL - GEOCHRON 4 9787450343 NO.001 904 1 KRUEGER analytical Services C for the Food Industry • FOOD 46 Manning Road,Billerica,MA 01821-3934 www�® om LABORATORIES, INC. 978.66 6900•f 978r@-667-6M c CERTIFICATE OF ANALYSIS Submitted by..- Date Reported: 7/13/10 Date Received: 7/8/10 Everett Hobbs E.W. Hobbs 207 Fort Avenue Salem, MA 01970 Reference: Sampling Month-July 2010 PO#: Description Your Sample Number Our Lab Number Ice Cream 207 Fort Avenue, Salem, Sampled 7/8/10 8°F 89156 Blueberry STANDARD PLATE COUNT cfulg 500 COLIFORMS-VRB cfulg <1 Standard Plate Count should be less than 50000 cfu/g. Coliforms should be less than 20 cfu/g. Methods: APHA, Standard Methods for the Examination of Dairy Products, 16th Ed., 1992, Parts 6.2 (Standard Plate Count)and 7.8(Coliforms). By: f�f, 19476 213690 2125 89156(7113/10) Page 1 of 1 06/24/10 15:40 KFt_ — GEOCHRON 4 9787450343 NO.195 D01 1 I w�t *lwwiR Phone:(978)6674900 FbOD Email:dkruaget@kfi.com aget@k8.om Website:www.k0.com e LABDRA`@REA INC. 45 Manning Road,SHWica,MA 01821 USA FACSIMILE TRANSMITTAL FORM FAX#: (978) 6674999 Date: 6/24/2010 PLEASE DELIVER TO: Joanne Scott Salem Health Department 976 746 0343 Pages to Follow: 3 Sender's Name: Van Lavoie DOCUMENTS TO Certificate of Analysis for Sample Numbers: FOLLOW: 88965-967 PLEASE NOTE: All analytical results should be considered preliminary and are subject to further review unfit the final report is issued, If problems are experlenced with this transmittal, please call(978)867.6900. 06/24/10 15:40 KFL — CEOCPRON i 9787450343 NO.195 P02 I - Analytical services KRUEGER for the Food Industry - !F'w p�/� T INC. 45 Manning Road,Billerica,MA 01621.3934 CABC)RA oms, C WWW -c�69M#f 976.667.6999 CERTIFICATE OF ANALYSIS Submitted by: Date Reported: 6124/10 Date Received: 8/21/10 Everett Hobbs E.W. Hobbs 207 Fort Avenue Salem,MA 01970 Reference: Sampling Month-June 2010 PO#: Dawnption Your Sample Number Our Lab Number Ice Cream 207 Fort Avenue, Salem,Sampled 6120/10 88965 10°F Kahivachip STANDARD PLATE COUNT Wig 11000 COLIFORMS-VRB cfu/g <1 Standard Plate Count should be less than 50000 cfulg. Coliforms should be less than 20 cfu/g. Methods:APHA, Standard Methods for the Examination of Dalry Products, 16th Ed., 1992, Parts 6.2 (Standard Plate Count)and 7.8(Coliforms). BY= } 19392 23600 2125 88965(6/24/10) Page 1 of 1 06/24/10 15:40 KFS - C,EOCHRON 4 979?450343 N0.195 903 • 1 I . Analytical Services KRUEGER for the Food industry FOO 45 Manning Road,elileriCa,MA 01821-3934 www.kfl.Com•dkruegerOW.Com ® CAOB RA ows, INC. 978.667.6900•f 978667.6999 CERTIFICATE OF ANALYSIS Submitted by: Date Reported: 6124/10 Date Received: 6/21/10 Everett Hobbs E.W. Hobbs 207 Fort Avenue Salem, MA 01970 Reference: Sampling Month-June 2010 PO#: Description Your Sample Number Our tab Number lee Cream 207 Fort Avenue,Salem,Sampled 6120110 88966 10°F Vanilla STANDARD PLATE COUNT afufg 1900 COLIFORMS-VRB efulg <1 Standard Plate Count should be less than 50000 cfulg. Coliforms should be less than 20 cfuig. Methods:APHN Standard Methods for the Examination of Dairy Products, 16th E&, 1992, Parts 6.2 (Standard Plate Count)and 7.8(Coliforms). By: e<j 19392 23600 2125 88966(6/24/10) Page 1 of 1 - 0624/10 15:40 KFL - GEOCHRON i 9757450343 N0.195 D04 • I ��// Analytical Services {\,wMR for the Food Industry FOOD 45 manning Road,Billerica,MA 018213934 /� j`p��/��/+� ` E�# wwW.kfl.com•tlkrueger4kfl.com Joy{.f�lLi\,JRl1 ms, Ii VC. 978-667-8900•f 978.667•$999 CERTIFICATE OF ANALYSIS Submitted by: Date Reported: 6/24110 Date Received., 6/21110 Everett Hobbs E.W. Hobbs 207 Fort Avenue Salem,MA 01970 Reference: Sampling Month-June 2010 PO#: Description Your Sample Number Our tab Number tee Cream 207 Fort Avenue, Salem,Sampled 6120110 66967 10°F Coconutchip STANDARD PLATE COUNT etu/g 1600 COLIFORMS-VRB eftill; <1 Standard Plate Count should be fess than 50000 cf l/g. Coliforms should be less than 20 cfulg. Methods:APHA, Standard Methods for the Examination of Dairy Products, 16th Ed., 1992, Parts 6.2 (Standard Plate Count)and 7.8(Coliforms). BY: 6Ci 19392 23600 2125 88967(6/24/10) Page 1 of 1 05/27/10 14:15 KFL — GEOCHRON -? 9787450343 NO.087 1?01 f WMER Phone:{978}667-6900 0 d Email: (978}667-099 l:dkrueger@k0.com wabske:w .kllxom LABOMIO E` INC. 45 Manning Road,Billerica,MA 01821 USA FACSIMILE TRANSMITTAL FORM FAX M (878)6674999 Date: 5/2712410 PLEASE DELIVER TO: Joanne Scott Salom Health Department 978 746 0343 Pages to Follow: 8 Sender's Name: Van Lavoie DOCUMENTS TO Certificate of Analysis for Sample Numbers: FOLLOW: 88686.688 PLEASE NOTE: All analytical results should be considered preliminary and are subject to further review until the final report is issued. If problems are experienced with this transmittal, please call(978)887.6900. 05/27/10 14:15 KFL - GEOCHRON 4787450343 N0.087 P02 Analytical Services KRUEGER for the Food Industry FOOD 45 Manning Road,B111e6ca,MA 018213934 www.kfl.com•dkrUeger@kfl.com �AABoRA oms, INC. 976.667.6900.f 976.667-6s99 CERTIFICATE OF ANALYSIS Submitted by. Date Reported: 6/24/10 Date Received: 6120/10 Everett Hobbs E.W. Hobbs 207 Fort Avenue Salem,MA 01970 Reference: Sampling Month-May 2010 PO#: Description Your Sample Number Our tab Number Ice Cream Sampled 5/20/10 6°F Chocolate 88686 STANDARD PLATE COUNT du/g 15000 COLIFORMS-VRB C" '1 Standard Plate Count should be less than 50000 cfulg. Coliforms should be less than 20 cfu/g. Methods:APHA, Standard Methods for the Examination of Dairy Products, 16th Ed., 1992, Parts 6.2 (Standard Plate Count)and 7.8(Coliforms). By: O0 19282 23467 2125 88686(6124/10) Page 1 of 1 r 05/27/10 14:15 KFL - OEOCK%N a 9787450343 N4.087 D03 KNEAnalytical ServlCeS C7�R for the Food Industry 43 Manning Road,Billerica,NSA 018713934 www.kftcom•dkrueger*kftcOm �4LABO6 TORIcS, INC. 978.667.6900•f 978.667-6999 CERTIFICATE OF ANALYSIS Submitted by. Date Reported: 5/24110 Date Received. 5/20/10 Everett Hobbs E.W. Hobbs 207 Fort Avenue Salem, MA 01970 Reference: Sampling Month-May 2010 PO#- Description Your Sample Number Our tab Number Ice Cream Sampled 5/20110 6°F Vanilla 68687 STANDARD PLATE COUNT W/O 18000 COLIFORMS-VRB duto <1 Standard Plate Count should be less than 50000 cfu/g. Coliforms should be less than 20 cfu/g. Methods:APHA, Standard Methods for the Examination of Dairy Products, 16th Ed., 1992, Parts 6.2 (Standard Plate Count)and 7.8(Coliforms). w 19262 23457 2125 88687(5124/10) Page 1 of 1 05/27/10 14:15 KFL — GEOCHRON 4 9787450343 NO.087 904 KRUEGER Analytical services for the Food Industry FOOD 45 Manning Road,Billerica,MA 01621-3934 wwwJ®LABORATORiES, INC. 978.66 6900•f 978-667-6999 CERTIFICATE OF ANALYSIS Submitted by: Date Reported.* 5/24/10 Date Received. 5/20/10 Everett Hobbs E.W. Hobbs 207 Fort Avenue Salem, MA 01970 Reference: Sampling Month-May 2010 PO#: Description Your Sample Number Our Lab Number Ice Cream Sampled 5/20/10 60F Strawberry 88688 STANDARD PLATE COUNT c}utg 4200 COLIFORMS-VRB Gfu/g <1 Standard Plate Count should be less than 50000 cfu/g. Coliforms should be less than 20 cfu/g. Methods:APHA, Standard Methods for the Examination of Dairy Products, 16th Ed., 1992, Parts 6.2 (Standard Plate Count)and 7.8 (Coliforms). By % 19262 23457 2125 88688(5/24/10) Page 1 of 1 f CITY OF SALEM I� BOARD OF HEALTH / Establishment Name: _^k.fJ, rl �J��5 — c- f , i Date: C- ho Page: / of Item Code C-Critical ItemDESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date tt No._ 'Reference - R-Red Item ' I - 1 '"`, '� - - Verified PLEASE PRINT CLEARLY .�� / / 1 flY1 (-)n-PA'trw,,/ V11C1i7�P1 II /1 rn�P 41(,1_(1 �nItt siclo � IV11T0 �!'vA.// SdjF��1i1� I C-�.JC,t 5 �v1rt'r .c c f-4+C1 Ct k I I-t A --+-!'1�t ;,tl l/1G [tiPuV I V) -)+Z44 r Qlp50--Pfcsz of r p (1 CAC2 r`t-t SC-A vid I A Ac (I t v)i t. j r i V(0v3too -sV4Ci41 (-,,(Arvrd V)ctm(-/ <�nik I( x -�ihI- � 0,60 1-117l)(.p I � I - j hD nywn knop k`Qo✓1 r I I l I V �ni'�r-crxn j y I j I r Discussion With Person in Charge: 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/ Exclusion violations before the next inspection, to observe all conditions as described, and to ❑ Re-inspection Scheduled ❑ Emergency Suspension comply with all mandates of the Mass/Federal Food Code. I understand that noncompliance may result in daily fines of twenty-five dollars or suspension/revocation of ❑ Embargo ❑ Emergency Closure your food permit. /�! ,�� r ❑ Voluntary Disposal ❑ Other: i'4t(- I'l"FS >j TcrtP<-v[urcS Violations Ru;iW to Foedborne illness Interventions and Risk j Aroudi,,,g to Uv 000od n7 Factors(Rems 1-'K1) {Cont) -t0 F1,45 F Within 4 PROTECTION FROM CHEMICALS "Or PH K 14 Food or Color Additives PHF 401 and Ce'd Hoiding CoM P111i'i fila,qt,Jn,,I at m blow 3-202,12 t AddniwO 5141 Ot"i I : 1-302,1.1 Protection from nci at 15 Poisonous or Toxic Substances I(Ii.I I Idomilryini, tntnimmort- Ori-nna, (,oiaaiper, 1211 Tim as a Nh!ic Hc,,tth Contmi -I"o I.11 S,-pal atwo- sn),age" .2{}2.I! Rcntriclion -Vmstfvx and U,c' conditioll,of Llso, REOUtREMEN'tS FOR HIGHLY SUSCEPTIBLE 7.,1}.2 if I Tmi,Ctjmfuti.!s- POPULATIONS(HSP) 21 1 X0 t I I(A? and 7-20441� ("hemicapi,for Awho.c,ilmjaw�Ciimia' 7-204 14 Di infif Amnu.Craci,41' L 05,11 la;:i&rnal I,Xyj cvvlact, k,,*o�*ilamAj Ck.,i„d AnitfiA Fvd ji.d 1-206.11 I%iv Cri'win Rw., S,cel sprow, Scrw tL 1 7-2'00.12 R'NI,fit 7 206,1, Tracknig,PmWvr,,� fl.,,m Controf and 'i 801.1 if iwd FkNxi F%1,I,ai!, �N,�! R,:-en. c& "vionilorin"l, I CONSUMER ADVISORY 22 3 11 1 CNI'Alifl,"I Ao,ifort i,oit,:d zor Cowurnlition oi, TIMEITEMPERATURE CONTROLS nw,l an, 16t Proper Cooking Tempe:atures for PHFs 3 V)t I Ali j 3 1 1,:. F,,q-Suhtimw kn kxkv shcll 1 40 1 (A)i 0)"13111111twd 1,1,h, Meat, k: ("'nur I i t_,,,.,- Anlwals 155 F j5 sec. 3-401.1 1(13?j 1;i2} SPECIAL REQUIREMENTS Vid!jwln-of i�'Cliop .4,1 iL)) in ziwrii•g, mobil:load,fempor4t v and 3 40! i ItAif 1) P'lalirN,Wild Gann, 5tu0e(l PITF. \hotfldhe ihnifynnz"oulainmL,F1311. NI"t, dt-,biwo, uloler flic 2pprupmitc ;emow, P,mltry or kiimws 165`f' 15 joodborn.:flil"C"o 3-401A I(C)13} IN'I w I r ntut le. In I a C I Ijnd insi, Ift�,1017`i Other j it II 145"F 4 590 t1f`19 viohluon�r0m ai , ;o md rehuf 3 4)L I" Raw lintaW Fuixt,Ctw)k,:d in a prifoke\'hooij be cict,fted undtl #29 - r ;tflero:varr 10J,� 11 '401,1 I(Aiil)(b) \It Oflvm 11141 c. 14i"t- IK 'e, I 17 E Reheating for Hot Holding VIOLATIONS RELATED TO GOOD RETAt PRACTICES 3 .103.11(A)&I D t PtIj,,, 165'rF 15 wi% (ftenii 2,`t-30) 3.403.11(H) f2 TVjiruite Stjndia� donol iniac P,th, 3-4(0.1 It(7) RTF?tvid nli1:ji'1!Z'10;kq n!':Pe,,d('rdeand M; CMR i-401F1 •y(%vuu T Geod—fietwil- FC 590.000 ;-40 1 I(Fi Reimmmwl Vwlwed Pwrion,,of fict:j' I - I - i koassnw 23 rilanacernE ns and Ppft,wnef f C 2 (*,3 F 0�,Itf-.,d Fom 0 F( CKfil Proper Cooling of PHFs F C 3-SOI 14iA) C,X&'d 14M7 to 2f) 26" �!,mmg )b /0'1' Within 2 Hours and 1,'roin'101' K.- 00-i to 41'F/45 F'vVitbin 4 How of T,,mc 008 3 501 14(6i Cioliw; PHF..`vladc Fi,al Ainbiem Within 4 )Imn' jr Commonwealth;of Massachusetts f e City of Salem Board of Health IGmbefley Driscoll 120 Washington Street,4th Floor Mayor SALEM,MA 01970 Food/Retail Establishment Permit DATE PRINTED: 04/01/2010 ESTABLISHMENT NAME: E.W. Hobbs File Number:BHF-2004-000133 7 Island Avenue Salem MA 01970 LOCATED AT: SALEM, MA 01970 Permit Type Permit No. Permit Issued Permit Expires Fee Restrictions/Notes FOOD SERVICE BHP-2010-0392 Apr 1,2010 Dec 31,2010 $140.00 ESTABLISHMENT FROZEN DESSERTS BHP-2010-0393 Apr 1,2010 Dec 31,2010 $25.00 RETAIL FOOD BHP-2010-0394 Apr 1,2010 Dec 31,2010 $70.00 Total Fees: $235.00 PERMIT EXPIRES (December 31, 2010 Board of Health n 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 HEALTH 120 WASHINGTON STREET,4"'FLOOR TEL. (978) 741-1800 KINEBERLEY DRISCOLL FAZ(978) 745-0343 MAYOR DCRITNBAUMaa ALEh9.COhf DAVID GREENBAIIn1, ACTING HEALTH AGENT 2010 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT NAME OF ESTABLISHMENT -3 4,C lnr TEL# 1�" �y 5 '7�9 ADDRESS OF ESTABLISHMENT �nS- 96 TbC� .pp 11i)P FAX At MAILING ADDRESS(if different) r _1 \ EMAIL- Business': (x1�10bb Q `G)crY-(Gd •(U ! Website: OWNER'S NAME pnv\b� TEL# G 7nn55' ADDRESS ICll.t✓1�.t AY, COGm mill. 0IQ7(7 STREET ^' /�C T�Y t�l- STATE ZIP CERTIFIED FOOD MANAGER'S NAME(S) a r'N 1 0 S /��' J�?� CERTIFICATE#(S) ��cjw5&7q (Required in an establishment where potentially hazardous food is prepared) ' EMERGENCY RESPONSE PERSON HOME TEL# DAYS OF OPERATION. j Monday _' Tuesday. - Wednesday, Thursday 'Friday Saturday Sunday HOURS OF OPERATION i Please write in time.of day. (For example 11 am-11 pm) ) I' TYPE OF ESTABLISHMENT FEE (check onlvl 7 RETAIL STORE NO less than 1000sq.ft. =$70 1000-10,000sq.ft. =$280 more than 10,000sq.ft. =$420 ------------------------------------------------- ------- - --------------------------------------------------------------------- ----- ------------------------- 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 NO $100 CHILDCARE SERVICES/NURSING HOME ----------------------------------------------------------------------------------------------------------------------------------------------------- ADDITIONAL PERMITS MAKE (not just serve) ICE CREAM, YOGURT/SOFT SERVE 41, NO $25 TOBACCO VENDOR NO $135 ALL NON-PROFIT(such as church kitchens) YES NO $25 *Please pay total with one check payable to the City of Salem. This Permit is not transferable and must be reissued upon change of ownership. The Permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code, before any renovations, improvements,or equipment changes are made,all plans for such must be submitted to and approved by the Salem Board of Health. Pursuant to MGL Chpter 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 r 2!6re d paid t e taxes required under the law. J 3/3l /a niy- coy �7A I ba`te�- r Social Security or Federal Identification Number Revised 424/07 FOODAP2008.adm Check#&Dates'(ib ",�///!j/, $ 10/16/09 09:17 KFL — GEOCHRON 4 978 745 0343 NO,126 901 , E �[�� - • AMER Phona (978}667$9D8 a+t Fax:(978)867.8999 -' com ,F FWD Ema*dkruaprQkft.wm Webs.JQ iP1 wom rl�i INC. ter".M:t9W 021 USA , 45 Manning Road,astlarita.MA 018Y1 USA FACSIMILE TRANSMITTAL FORM FAX#: (979)6674999 Date: 10/16/2009 PLEASE DELIVER TO: Joanne Scan Salem Health Department 978 745 0343 Pages to Follow: 3 Sender's Name: Van Lavoie DOCUMENTS TO Certificate of Analysis for Sample Numbers: FOLLOW: 86523-525 PLEASE NOTE: All analytical results should be considered preliminary and are subject to further review until the final report is issued. If problems ar"xpenenced vift this transmittal, please call(978)667$900. 10/16/09 09:17 KFL - GEOCHRON i 978 745 0343 NO.126 f)02 KNEGER Anallrtlral Services _ C//++r�/� for the ADW Industry Foo 45 Scanning Road.6111erlca,MA 01821-3934 — 9 LABQRA ows, wc. `978 omd0 f 97sMffivi`sus CERTIFICATE OF ANALYSIS Submitted by. Date Reported: !0/14109 Date Received: 1018/09 Everett Hobbs E.W. Hobbs 207 Fort Avenue Salem, MA 01970 Reference: Sampling Month-October 2009 PO#: Description Your Sample Number Our Lab Number Ice Cream Sampled 10/8/09,60F,Chocolate 86523 STANDARD PLATE COUNT. chug 1900 COLIFORMS-VRS chug <1 Standard Plate Count should be less than 50000 cfu/g. Coliforms should be less than 20 cfu/g. Methods:APHA,Standard Methods for the Examination of Dairy Products,161h Ed., 1992,Parts 6.2 (Standard Plate Count)and 7.8(Coliforms). By. 18444 22535 2125 86623(10114109) Page 1 of 1 ' I 0/16/09 09:17 KFL - GEOCHRON 978 745 0343 N0.126 IP03 ' d i 11(151 aEVc� Analytical Services ��cav� GE for the Food Industry 1ow 45 Manning Road,Billerica.MA 018213934 � Rte. www.kfi.com•dkrueger®kn.com 41--$AABoRAToRiEs, iNc. 976-667.6900-1979-667.6999 � CERTIFICATE OF ANALYSIS Submitted by: Date Reported. 10114/09 Date Received, 10/8/09 Everett Hobbs E.W. Hobbs 207 Fart Avenue Salem,MA 01970 Reference: Sampling Month-October 2009 PO 4: Description Your Sample Number Our Lab!Number Ice Cream Sampled 1018109,60F, Coffee 86524 STANDARD PLATE COUNT etWg 1700 COLIFORMS-VRt3 ctu19 <1 Standard Plate Count should be less than 50000 cfu/g. Coliforms should be less than 20 cful9. Methods:APHA,Standard Methods for the Examination of Dairy Products, 16th Ed., 1992,Parts 6.2 (Standard Plate Count)and 7 8(Coliforms). By: 18444 22535 2125 86524(10/14x09) Page t of 1 _ 10i16i09 09:17 KFL - GEOCHRON 970 745 0343 NO.126 904 ([�U�/+ Analytical Servkes 1 1��1vr�Kt�,r��n}wv7r�c�RC for� �y� - FOOD 45 Manning Read.Billerica.MA 01821-3934 l 1 ♦�p�/�y}1��f�tT�1 C!�ytt tt��{/++ www,kfl.com-dkrueger®kfl.conr _l�`i?'1BVRl'rt owsr- wc. 978.667-6900-f978-667.6999 -� 1 CERTIFICATE OF ANALYSIS Submitted by: Date Reported: 10114/09 Date Received: 10/8!09 Everett Hobbs E.W. Hobbs 207 Fort Avenue Salem, MA 01970' Reference: Sampling Month-October 2009 PO 0. Description Your Sample Number Our Lab Number Ice Cream Sampled 1018109.60F,Pistachio 86525 STANDARD PLATE COUNT ciuJg 2700 COLIFORMS-Y1 allwo <1 Standard Plate Count should be less than 50000 cfutg. Coliforms should be less than 20 cfut9. Methods:APHA,Standard Methods for the Examination of Dairy Products, 16th Ed., 1992,Parts 6.2 (Standard Plate Count)and 7.8(Coliforms). 1 By,-29 18444 22535 2125 86525(10114109) Page 11 of 1 10/07/09 12:47 KFL — GEOCHRON 4 978 745 0343 N0.069 D02 AnalytlCal ServlCOS KRUEGER for the Food Industry FOOD 45 Manning$toad 6nlertca.AAA 01821.3934 �yff I� Www.kf.com•dkruegerfkfl.com ��!LAB4RAINC.TORIE% 978.667-6990•f 978.667-6949 CERTIFICATE OF ANALYSIS Submiffed by. Date Reported. 10009 Date Received: 9128109 Everett Hobbs E.W. Hobbs 207 Fort Avenue Salem, MA 01970 Reference: Sampling Month-September 2009 PO#- Description Your Sample Number Our Lab Number Ice Cream Sampled 9128/09,8°F, Frozen Pudding 86383 STANDARD PLATE COUNT dulb 20000 COLIFORMS-VRB cfutg <1 Standard Plate Count should be less than 50000 cfu/g. Coliforms should be less than 20 cfu/9. Methods:APHA,Standard Methods for the Examination of Dairy Products, 16th Ed., 1992,Parts 6.2 (Standard Plate Count)and 7.8(Coliforms). BY: 18401 22487 2126 86383(1012!09) Page 1 of 1 10/07/09 12:47 KFL — GEOCHRON -� 978 745 0343 N0.0B9 1?03 ' tI KRUEGER Analytical Services for the Food industry FOOD 45 Manning Road.Billerica,MA 01821-3934 �®LABORATORIES, INC. hie-667 6900•F978-667-6999 CERTIFICATE OF ANALYSIS Submitted by. Date Reported: 1012109 Everett Hobbs Date Received: 9/28/09 E.W. Hobbs 207 Fort Avenue Salem, MA 01970 Reference: Sampling Month-September 2009 PO A. Description Your Sample Number Our Lab Number Ice Cream Sampled 9128/09,8°F,Strawberry 86384 STANDARD PLATE COUNT COLIFORMS-VRB o�9 <1 Standard Plate Count should be less than 50000 cfu/g. Coliforms should be less than 20 cfu/g. Methods:APHA, Standard Methods for the Examination of Dairy Products, 16th Ed., 1992, Parts 6.2 (Standard Plate Count)and 7.8(Coliforms). By: 1 18401 22487 2125 86384(10/2/09) Page 1 of 1 10/07/09 12:47 KFL - GEOCHRON i 978 745 0343 NO.OB9 004 Analytical for eood Services • Foou 45 Manning Road,Billerica,MA 018213934 —.®LABORATORIES, INC. "n"9 s`-66 6900-f 9878-666999 CERTIFICATE OF ANALYSIS Submitted by: Date Reported: 1012109 Date Received: 9/28/09 Everett Hobbs E.W. Hobbs 207 Fort Avenue Salem, MA 01970 Reference: Sampling Month-September 2009 PO#.- Description .Description Your Sample Number Our Lab Number Ice Cream Sampled 9128/09,8°F, Pistachio 86385 STANDARD PLATE COUNT cfufg 710 COLIFORMS-VRI3 cfufg 1 Standard Plate Count should be less than 50000 cfu/g. Coliforms should be less than 20 cfu/g. Methods:APHA, Standard Methods for the Examination of Dairy Products, 16th Ed., 1992, Parts 6.2 (Standard Plate Count)and 7.8(Coliforms). Br� 18401 22487 2125 86385(1012/09) Page 1 of 1 10f07/09 12:47 KFL — SEOCHRON 4 976 745 0343 NO.069 1?01 �I �(�M <1r ER Phone:(976)667.6900 N�� Fax(976)6670999 Email'tlktuegoOk6.com Webaile:www.k6.com Ueo m w% INC. 45 Manning Road,Billerica.MA 01821 USA FACSIMILE TRANSMITTAL FORM FAX#;W91$67411109 Date: 10t7J2009 PLEASE DELIVER TO: Joanne Scat Salem Health DepertmeM 878 746 8348 Pages to Follow: 3 Sender's Name: Van Lavoie- DOCUMENTS TO Certificate of Analysis for Sample Numbers.- FOLLOW: umbers.FOLLOW: 86383-385 PLEASE NOTE: All analytical results should be considered preliminary and are subject to further review until the final report Is issued. if problems are experienced with this transmittal, please call(978)667-6900. 08/13/09 11:53 KFL — GEOCHRON 4 978 745 0343 NO.217 D01 F1 rtlumy�.�.� ER Phone:(978)6675900 FOOD Fax:(976)667.6999 Erred;dkmageQk0.wm Webade:www.k9win, AILID BORA1oRi a INC. 46 Manning Road,Billerica,MA 01621 USA FACSIMILE TRANSMITTAL FORM FAX#: (978)667.6999 Date: 8/13/2009 PLEASE DELIVER TO: Joanne Scott Salem Health Department 978 745 0343 Pages to Follow: 3 Sender's Name: Van Lavoie DOCUMENTS TO Certificate of Analysis for Sample Numbers: FOLLOW: 85700-702 PLEASE NOTE: All analytical results should be considered preliminary and are subject to I{1 further review until the final report is issued. If problems are experienced with this transmittal, please call(978)667.6900: OB/13/09 11:53 KFL - GEOCHRON 4 976 745 0343 NO.217 POP Ana"Cal ServlCeS, KRUEGER for the Food Industry FOOD 45 Mannln9 R08d,Billerica,MA 01821.3 � corn � ABoRA TORIES, INC. ww 979-tom 9 D#f 9 0.667 69 9J8.667.69D0�f 9Jfi•667•fi999 CERTIFICATE OF ANALYSIS Submitted by: pate Reported: 811210$ Date Received: 8/10/09 Everett Hobbs E.W, Hobbs 207 Fort Avenue Salem, MA 01970 Reference: Sampling Month-August 2009 PO#: Description Your Sample Number Our Lab Number Ice Cream Sampled 8/10109,4°F, Black Raspberry 85700 STANDARD PLATE COUNT efu/g 670 COLIFORMS-VRB efulg c1 Standard Plate Count should be less than 50000 cfufg. Coliforms should be less than 20 cfu/g. Methods:APHA,Standard Methods for the Examination of Dairy Products, 16th Ed., 1992,Parts 6.2 (Standard Plate Count)and 7.8(Coliforms). By: 18230 22275 2125 85700(8112109) Page 1 of 1 I 08/13/09 11:53 KFL - GEOCHRON 4 978 745 0343 NO.217 PO4 Analytical SendW4 KRUEGER for the Food Industry Foo® 45 Manning Road,Billerica.MA 0182f-3M www.kfi.com•dkrueger®kfi.com - LABORATORIES, INC. 978667.6900•f 978.667.69W I CERTIFICATE OF ANALYSIS Submitted by: Date Reported: 8112109 Date Received: 8110109 Everett Hobbs E.W.Hobbs 207 Fort Avenue Salem, MA 01970 Reference: Sampling Month-August 2009 PO a: Description your Sample Number Our Lab Number Ice Cream Sampled 8110109,4°F, Peanut Butter Cup 85702 STANDARD PLATE COUNT efulg 1400 COLIFORMS-VRB efu/g <1 Standard Plate Count should be less than 50000 cfutg. Coliforms should be less than 20 cfu/g. Methods,APHA,Standard Methods for the Examination of Dairy Products, 16th Ed., 1992, Parts 6:2 (Standard Plate Count)and 7.8(Coliforms). By'. 18230 22275 2125 85702(8112/09) Page 1 of 1 06/13/09 11:53 KFL - GEOCHRON 4 978 745 0343 NO.217 D03 Analytical Senates KRUEGER for the Food Industry `O0D 45 Manning Road,Billerica,MA 418213934 ' LABORATORIES, INC. www.Rn.c •dxrueg 66mn 976.657.7-690D•f 976.58.667.7*6999 CERTIFICATE OF ANALYSIS Submrtted by: Data Repotted: 8112109 Date Received: 8110109 , Everett Hobbs E.W. Hobbs 207 Fort Avenue Salem, MA 01970 Reference: Sampling Month-August 2009 PO Al Description Your Sample Number Our lab Number Ice Cream Sampled OilOID9,4°F, Rainbow 85701 STANDARD PLATE COUNT "111 `250 COLIFORMS-VRB cfulg <1 Standard Plate Count should be less than 50000 efulg. Coliforms should be less than 20 cfulg. Methods:APHA, Standard Methods for the Examination of Dairy Products, 16th Ed., 1992, Parts 6.2 (Standard Plate Count)and 7.8(Coliforms). By"a 18230 22275 2125 85701 (8/12109) Page 1 of 1 07/28/09 13:01 KFS - GEOCHRON 4 976 745 0343 NO.115 901 I t KWEGy�SCI► ER Phone:(978)667.6900 (*� Fax:(978)667-6999 FbOD Email:O$im"er@k0.com Ale LABDRAIOm% INC Website:www k9.com 45 Manning Road,Billerica,MA 01621 USA FACSIMILE TRANSMITTAL FORM. FAX#: (978)6674999 Date: 7/28/2009 PLEASE DELIVER TO: Joanne Scott Salam Health Department 978 746 0943 Pages to Follow: 3 Sender's Name: Van Lavoie DOCUMENTS TO Certificate of Analysis for Sample Numbers: FOLLOW: 85508-510 PLEASE NOTE: All analytical results should be considered preliminary and are subject to further review until the final report is issued. If problems are experienced with this transmittal, please call(978)887.8900. 07/28/09 13:01 KFL - GEOCHRON 4 976 745 0343 NO.115 004 - Analytical SBNICBS KRUEGER for the Food Industry • FOOD 45 Manning Road,alllerIcaa,MA 0182t•3934 �\ —AABORATORIES, INC. www.kfi.com•dxrueg com 978 \ 978-667-6900•f 978.6678.667.6999- CERTIFICATE OF ANALYSIS Submitted by. Date Reported: 7127109 Date Received., 7122/09 Everett Hobbs E-W. Hobbs 207 Fort Avenue Salem, MA 01970 Reference-, Sampling Month -July 2009 PO d. Description Your Sample Number Our tab Number Ice Cream Sampled 7/22/09,8°F,Chocolate 85510 Marshmallow STANDARD PLATE COUNT Gfu/9 X250 COLIFORMS-VRS ofulg <7 Standard Plate Count should be less than 50000 cfu/g. Coliforms should be less than 20 cfu/g. Methods:APHA, Standard Methods for the Examination of Dairy Products, 16th Ed., 1992, Parts 6.2 (Standard Plate Count)and 7.8(Coliforms). ey:� 18173 222052125 85510(7/27/09) Page 1 of-11 , 07/28/09 13:01 KFL - GEDCHRON i 978 745 0343 NO.115 903 Analytical Services KRUEGER for the food Industry FOOD 45 Manning Road,Billerica,MA 01821-3914 �®LABORATORIES, INC. www.kfl.com• 0-f 9 B-ffi7-6%9 976.667.6900•f 978-667-b994 CERTIFICATE OF ANALYSIS Submitted by: Date Reported: 7127109 Date Received: 7122109 Everett Hobbs E.W. Hobbs 207 Fort Avenue Salem, MA 01970 Reference: Sampling Month-July 2009 PO#: Description Your Sample Number Our Lab Number Ice Cream Sampled 7/22109, 8"F,Chocolate 85509 STANDARD PLATE COUNT efu/g 2400 COLIFORMS-VRI9 efu/g <1 Standard Plate Count should be less than 50000 cfu/g. Coliforms should be less than 20 cfu/g. Methods:APHA, Standard Methods for the Examination of Dalry Products, 16th Ed., 1992, Parts 6.2- (Standard Plate Count)and 7.8(Coliforms). By: 18173 22205 2125 85509(7/27/09) Page 1 of 1, 07/26/09 13:01 KFL — GEOCHRON 4 978 745 0343 NO.115 002 hFservices for e od Industry FOOD 45 Manning Road,Billerica,MA 01921=393A www.kfi.com.dkrueger®kfl.com �®LABORATORIES, INC. 978.667-6900•f 978-N7-6999- CERTIFICATE 78.667.6999CERTIFICATE OF ANALYSIS Submitted by: Date Reported: 7/27/09 Date Received: 7/22/09 Everett Hobbs E.W. Hobbs 207 Fort Avenue Salem, MA 01970 Reference: Sampling Month-July 2009 PO M. Description Your Sample Number Our Lab Number Ice Cream Sampled 7/22/09, 8°F,Vanilla 85508 STANDARD PLATE COUNT cfufg 17000 COLIFORMS-VRB ofuig 2 Standard Plate Count should be less than 50000 cfu/g. Coliforms should be less than 20 cfu/g: Methods.APHA, Standard Methods for the Examination of Dairy Products, 16th Ed., 1992, Parts&.2 (Standard Plate Count) and 7.8(Coliforms). BY: 1817322205 2125 85508(7/27/09) Page 1 of 1 ,08/20/08 12:51 KFL - GEOCHRON y 19787409705 NO.193 002 I Ana/lrtlCal Services KRUEGER for the Food Industry FOOD 45 Manning Road,Billerica,MA 01821-3934 INC. www.kf.com•dkrueger*kfl.COm �®LABORATORIES, N978-667.6900•f 979-667-6999 CERTIFICATE OF ANALYSIS Submitted by: Date Reported: 6/18/08 Date Received: 8/13/08 Everett Hobbs E.W. Hobbs 207 Fort Avenue Salem, MA 01970 Reference: Sampling Month -August 2008 PO#: Description Your Sample Number Our Lab Number Ice Cream Sampled 8/13/08, 8°F, Coconut Chip 81456 STANDARD PLATE COUNT cfu/g 6300 COLIFORMS -VRB cfu/g `1 Standard Plate Count should be less than 50000 cfu/g. Coliforms should be less than 20 cfu/g. Methods:APHA,Standard Methods for the Examination of Dairy Products, 16th Ed., 1992, Parts 6.2 (Standard Plate Count)and TO(Coliforms). By- 17019 20867 2125 81456 (8/18/08) Page 1 of 1 018/20/08 12:51 KFL - GEOCHRCM y 1978?409?05 _ N0.193 903 KRUEGER for one ood services ndo ry I • iF,Q�OD T INC. 45 Manning Road,Billerica,MA 01621.3934 ; Je WORA IORIE,S, CX978-66 6900-f 97g 8 667.6999 CERTIFICATE OF ANALYSIS Submitted by: Date Reported: 8118108 Date Received., 8/13/08 Everett Hobbs E.W. Hobbs 207 Fort Avenue Salem, MA 01970 Reference: Sampling Month-August 2008 PO A* Description Your Sample Number Our Lab Number Ice Cream Sampled 8713108,8°F, Black Raspberry 81457 STANDARD PLATE COUNT ctuig 690 COLIFORMS-VRB afulg <1 Standard Plate Count should be less than 50000 cfutg. Coliforms should be less than 20 cfulg. Methods:APHA, Standard Methods for the Examination of Dairy Products, 16th Ed., 1992, Parts 6.2 (Standard Plate Count)and 7.8 (Coliforms). By. 17019 20867 2125 81457(8118108) Page 1 of 1 _+08/20/08 12:51 KFL - GEDCKRON a 19787409705 N0.193 1?04 Ana"ICal services KRUEGER for the Food Industry FOOD 45 Manning Road.Billerica,MA 01821.3934 www.kfl com•dkrueg"kfl.com J�LABORATORIES, INC. 978.597.6900•f 976-667-6999 CERTIFICATE OF ANALYSIS Submitted by: Date Reported: 8/18108 Date Received: 8113108 Everett Hobbs E.W. Hobbs 207 Fort Avenue Salem, MA 01970 Reference: Sampling Month-August 2008 PO A Description Your Sample Number Our Lab Number Ice Cream Sampled 8/13108,8°F,Chocolate Marshmallow 81458 STANDARD PLATE COUNT cfutg 4200 COLIFORMS -VRB cfulg <1 Standard Plate Count should be less than 50000 cfuig. Coliforms should be less than 20 cfulg. Methods:APHA, Standard Methods for the Examination of Dairy Products, 16th Ed., 1992, Parts 6.2 (Standard Plate Count)and 7.8(Coliforms). By: 17019 20867 2125 81458(8118108) Page 1 of i I 68/20/08 12:51 KFL — 6EOCHRON > 19787409705 NO.193 1?01 K1WEGER Phone:(978)667-6900 FDODGFax:(978)667.6999 Email:dkruegor@kfi.com 7y+v Website:www.kfi.com LABom�y Ram INC. 45 Manning Road,Billerica,MA 01821 USA � FACSIMILE TRANSMITTAL FORM FAX#: (978) 667-6999 Date: 8/20/2008 PLEASE DELIVER TO: Joanne Scott Salem Health Department 978 740 9705 Pages to Follow: 3 Sender's Name. Van Lavoie DOCUMENTS TO Certificate of Analysis for Sample Numbers: FOLLOW: 81456 458 PLEASE NOTE: All analytical results should be considered preliminary and are subject to further review until the final report is issued. If problems are experienced with this transmittal, please call(978)667.6900. 0:10814: 01:44 IFL — GEOCHRON i 978 745 0343 NO.016 901 KwwER Phone:(078)667-69M G� Fez(978)687-8999 FOOD Email dkruelierWcom ..i® LABmmomE A INC. 05 Mmft Road,euledes. °MA oi�kusn FACSIMILE TRANSMITTAL.FORM FAX IL: (676)6674989 Date: 6/19/2009 PLEASE DELIVER TO: Joann*Scott Salem HmIth Department 978 746 0348 Pages to Follow: 5 Sender's Name: Van Lavoie DOCUMENTS TO Certificate of Analysis for Sample Numbers: FOLLOW: 85092-096 PLEASE NOTE: Ali analytical results should be considered preliminary and are subject to further review until the final report is issued. If problems are experienced with this transmittal, please call(978)667-6900. 0:/08/4: 01:44 KFL - GEOCHRON + 978 745 0343 NO.018 G02 I iduKRUEGER for Me ii y foOD 45 Manning Rwdti 811lerina,MA 0182 7 3 934 www.kfl.Can•okrueWr®kH.Com -'�@ UBORAtiORIES, INC. 979.667.6900.f 978.557.6999 CERTIFICATE OF ANALYSIS Submitted by: Date Reported.' 6/19109 Data Received: 6N 5/09 Everett Hobbs E.W. Hobbs 207 Fort Avenue Salem, MA 01970 Reference. May 2009 Resampling PO t: Descrlptim Your Semple Number Our Lob Number Ice Cream Sampled 6/15109,4°F,Chocolate 85092 STANDARD PLATE COUNT dulg 1500 COLIFORMS-VR9 Child <1 Standard Plate Count should be less than 60000 du/9. Coliforms should be less than 20 ding. Methods:APHA,Standard Methods for the Examination of Dairy Products, 16th Ed., 1992, Parts 6.2 (Standard Plate Count)and 7.8(Coliforms), 18047 220612125 0092(6/19/09) Page 1 of 1 0:/08/4: 01:44 KFL — GEOCHRON 4 978 745 0343 NO.01B W3 Ana! t KRUEGER for co Musw FOOD 45 Manning Road,selerx;a,MA OIM-3934 www".com•dkruegerW.com .��LABORATORIES, INC, WS-W-65110.f 979.667.609 CERTIFICATE OF ANALYSIS Submitted by. Date Reported: 6/19/09 Date Received: 6115109 Everett Hobbs E.W.Hobbs 207 Fort Avenue Salem, MA 01970 Reference: May 2009 Resampling PO Al Desa0on Your Sample Number = Our Lab Number Ice Cream Sampled 6115109,4°F,Coffee 85093 STANDARD PLATE COUNT di9 980 COLIFORMS•HRS etude c1 Standard Plate Count should be less than 50000 cfut9. Coliforms should be less than 20 ctu/g. Methods:APHA,Standard Methods for the Examination of Dairy Products, 16th Ed., 1992,Parts 6.2 (Standard Plate Count)and 7.8(Coliforms). 10047 220S12125 85093(6119109) Page 1 of 1 0:/06/4: 01:44 KFS — GEDCHRON a 978 745 0343 N0.018 904 I KRUEGER Analytical Services for the Food lndustry FOOD 45 Manning Road,Billerica,MA 61821-3934 www.kftmmodkruageMfl.com J LABORATORIES, IMC, 978.6W-69DO.f 978-667•6999 CERTIFICATE OF ANALYSIS Submilled by: Date Reported: 6/19109 Everett HobbsDate Received., 6/15109 E.W. Hobbs 207 Fort Avenue Salem, MA 01970 Reference: Sampling Month-June 2009 PO fl: Desc*ion Your Sample Number Our lab Number Ice Cream Sampled 6115109,80F,Chocolate Marshmallow 85094 STANDARD PLATE COUNT efuf0 640 COLIFORMS-URB chNg <1 Standard Plate Count should be less than 50000 cfu/g. Coliforms should be less than 20 cfu/g, Methods:APHA, Standard Methods for the Examination of Dairy Products, 18th Ed., 1992, Parts 6.2 (Standard Plate Count)and 7.8(Coliforms). Sqj'-� 18040 22062 2125 85094(6119/09) Page 1 of 1 0:/06/4: 01:44 KFL — GEOCHRON + 978 745 W43 NO.018 005 Analytical services KRUEGER for the Food Industry FOOD 45 Manning Road,Billerica,MA 01821-3934 www.kfl.com•dkrueger*kfl.com �®LABORATORIES, INC. 978.667.6990•f 978-667.6999 CERTIFICATE OF ANALYSIS SubmWed by: Date Reported. 6/19/09 We Received., 6/15109 Everett Hobbs E.W. Hobbs 207 Fort Avenue Salem, MA 01970 Reference: Sampling Month-June 2009 Description Your Semple Number Our Lab Number Ice Cream Sampled 6115109, 8°F, Frozen Pudding 85095 STANDARD PLATE COUNT dWg 490 COLIFORMS-VRO cfufg <1 Standard Plate Count should be less than 50000 cNig. Coliforms should be less than 20 cfulg. Methods:APHA,Standard Methods for the Examination of Dairy Products, 16th Ed.. 1992,Parts 6.2 (Standard Plate Count)and 7.8(Coliforms). 18048 22062 2125 OW95(6/19/09) Page 1 of 1 0:/I08/4: 01:44 KFL — MOCHRON a 978 745 0343 NO.018 006 t KRUEGER Analytical services for the Food Industry A ' FOOD 45 Manning Road.Billerica.MA 018213934 ®LABORATORIES, INC. wwwOn-W-601 1997e 69i-6999 CERTIFICATE OF ANALYSIS Submitted by. Date Reported: 6119109 Date Received: 6115109 Everett Hobbs E.W. Hobbs 207 Fort Avenue Salem,MA 01970 Reference: Sampling Month-June 2009 PO Al Description Your Semple Number Our Lab Number Ice Cream Sampled 6/15109, 8017,Maple Walnut 85096 STANDARD PLATE COUNT dU/g 990 000FORMS-VRB dulg 1 Standard Plate Count should be less than 50000 cling. Coliforms should be less than 20 cfu/g. Medrods:APHA,Standard Methods for the Examination of Dairy Products, 16th Ed-, 1992, Parts 6.2 (Standard Plate Count)and 7.8(Coliforms). 18048 22062 2125 85098(6119109) Page 1 of 1 f� i Commonwealth of Massachusetts i City of Salem Board of Health Kimberley Driscoll 120 Washington Street,4th Floor Mayor SALEM,MA 01970 FooWRetail Establishment Permit DATE PRINTED: 12/30/2008 ESTABLISHMENT NAME: E.W. Hobbs File Number:BHF-2004-000133 7 Island Avenue Salem MA 01970 LOCATED AT: SALEM, MA 01970 Permit Type Permit No. Permit Issued Permit Expires Fee Restrictions/Notes FOOD SERVICE BHP-2009-0338 Dec 30,2008 Dec 31,2009 $140.00 ESTABLISHMENT FROZEN DESSERTS BHP-2009-0339 Dec 30,2008 Dec 31,2009 $25.00 RETAIL FOOD BHP-2009-0337 Dec 30,2008 Dec 31,2009 $70.00 Total Fees: $235.00 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 BOARD OF HEALTH 120 WASHINGTON STREET,4"FLOOR TEL. (978) 741-1800 s- s KIMBERLEY DRISCOLL FAx(978)745-0343 �,,", V /`'� NL.),YOR IDIONNE(oSALEN1.COM DEC t) JANET DIONNE, 42008 ACTING HEALTH AGENT L • .,, 'A'-CM r11A: Q7'! 2009 APPLICATION1 FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT 9 NAME OF ESTABLISHMENT W. �h� �r)� A i'1[_• TEL# q ( 0 - 7(45 0R ADDRESS OF ESTABLISHMENTS'aO�I r-06 AU Q• FAX# MAILING ADDRESS(if different) -7Ts)c- rip AI)o ( orn MA. 01Q70 EMAIL-Business': Website: OWNER'S NAME FCxfP%#t �(:�JJCrC �/n� � h��^ p TEL# �n ADDRESS � �`C n/l &l lr� 11 R�Y1 L/YI 01 STREET n / CITY STATE jun 21P1 CERTIFIED FOOD MANAGER'S NAME(S) l �CA(�S ��b6� CERTIFICATE#(S) 11 A21m—j /�-�T` (Required in an establishment where potentially hazardous food is prepared) EMERGENCY RESPONSE PERSON HOME TEL# I DAYS OF OPERATION-r I Monday Tuesday 1 Wednesday. 1 'Thursday 'i -Friday ! Saturday I Sunday I HOURS OF OPERATION Please write in time of day. jl- 'o )I -- IbPal i II- top,, ! 9'1 -�►��-v�; (For example 11 am-11 pm) i i / TYPE OF ESTABLISHMENT FEE (check only)' RETAIL STORE YES NO less than 1000sq.ft. _$ 7 1000-10,000sq.ft. 280 more than I0,000sq.ft. =$420 RESTAURANT YES NO less than 25 seats $14 (Outdoor Stationary Food Cart$2 25-99 seats = 80 more than 99 sr-sts =$420 - ---------------------'---'--------------------------------- -------- -------------------------------------------------------------------------------- 00----- BED/BREAKFAST/ YES NO $100 CHILDCARESERVICES ------------------------------------------------------------------------------------------------------------------------- ADDITIONAL PERMITS MAKE (notjust serve) ICE CREAM, YOGURT/SOFT SERVE YES NO TOBACCO VENDOR S NO $135 ALL NON-PROFIT(such as church kitchens) YES NO $25 *Please pay total with one check payable to the City of Salem. This Permit is not transferable and must be reissued upon change of ownership. The Permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code, before any renovations, improvements,or equipment changes are made,all plans for such must be submitted to and approved by the Salem Board of Health. Pursuant to MGL Chapter 62C,Section 49A, I certify under the pains and penalties of perjury that I,to my best knowledge and belief,have filed all state tax returns p 'd all st a required under the law. __ 7:7z iC 21006 0/(-/ 7 7. ' Si ure Date r Social Security or Federal Identification Number Revised 424/07 FOODAP2008.adm Check#&DateZ%/h4, �Sdt $ 4121� L - Ya 0:111184 04:34 KFL — GEOCHRON -� 978 745 0343 N0.002 901 • Phone:(878)687-MO • v0D Ems:ftuagm C�A� wER 667-6999 gk8.wm AL LAaomiomie% INC. 45 Man"Road,Worm.MA io az�u n FACSIMILE TRANSMITTAL FORM FAX#: (878)667-0888 Date: M212009 PLEASE DEUVER TO: Joanne Scott Salem Health Department 878 746 834.1 Pages to Follow: 3 Sender's Name: Van Lavoie DOCUMENTS TO Certificate of Analysis for Sample Numbers: FOLLOW: 84873-875 PLEASE NOTE: All anatytial results should be considered preliminary and are subject to further review until the final report is issued, 1 If problems are experienced with this transmittal, please call(978)667-6900. 0:i11iB4 04:34 KR. - GEOCHRON i 976 745 0343 NO.002 904 I Analytkat Services KWEGER for the Food industry FWD 45 Manning Road,Billerica,MA GIM 3934 .�®LABORATORIES, INC. """"°978.667.6900•r 9k71 78-66 .6999 40 CERTIFICATE OF ANALYSIS Submitted by. Date Reported 5/29109 Date Received: 5/26/09 Everett Hobbs E.W. Hobbs 207 Fort Avenue Salem,MA 01970 Reference: Sampling Month-May 2009 PO A Description Your Sample Number Our Lab Number Ice Cream Sampled 5/25/09,4°F,Coffee 84875 STANDARD PLATE COUNT dWg 250000 COUFORMSB-VRB Chd9 <1 Standard Plate Count should be less than 50000 cfu/g. Cotiforms should be less than 20 cfu/g. Methods:APHA, Standard Methods for the Examination of Dairy Products, 16th Ed., 1992,Parts 6.2 (Standard Plate Count)and 7.8(Coliforms). By: 17971 21972 2125 84875(5/29/09) Page 1 of 1 0:/11/84 04:34 KFL — GEOCHRON + 978 745 0343 NO.002 002 I KRUEGER form Food Industry . FOOD 45 Manning Road.Blllenca.NIA 018213934 www.kfl.com•dkruegerOkn.com �®LABORATORIES, INC. 97&667-6908•f 978.667.6999 CERTIFICATE OF ANALYSIS Submitted by: Date Reported: 5/29/09 Dare Received.' 5126/09 Everett Hobbs E.W. Hobbs 207 Fort Avenue Salem, MA 01970 Reference: Sampling Month-May 2009 PO A Description Your Sample Number Our Lab Number Ice Cream Sampled 5125/09,4°F,Vanilla 84873 STANDARD PLATE COUNT efufg 4100 COLIFORMS•VRB cfufg <1 Standard Plate Count should be less than 50000 efu/g. Coliforms should be less than 20 cfulg. Methods.APHA,Standard Methods for the Examination of Dairy Products, 16th Ed., 1992, Parts 6.2 (Standard Plate Count)and 7.8(Coilforms). By� 179_71021972 2125 84873(5/29/09) Page 1 of 1 0:/11/84 04:34 KFL - GEOCHRON i 978 745 0343 NO.002 PW I KRUEGER for the Food Industry • FoOD 45 Manning Road.Billerica.MA M821.3934 �®LABORATORIES, INC. woww79- m 69�f97 O7 CERTIFICATE OF ANALYSIS Submitted by: Date Reported: 5129109 Date Received. 5126109 Everett Hobbs E.W. Hobbs 207 Fort Avenue Salem, MA 01970 Reference. Sampling Month-May 2009 PO A. Description Your Sample Number Our Lab Number Ice Cream Sampled 5125109,4°F, Chocolate 84874 STANDARD PLATE COUNT 7 fY/e 50000 COLIFORMS-VRB d7d9 <1 Standard Plate Count should be lass than 50000 cfufg. Coliforms should be less than 20 cfu/g. MCBrods:APHA,Standard Methods for the Examination of Dairy Products, 16th Ed., 1992, Parts 6.2 (Standard Plate Count)and 7.8(Coliforms). BY 1797121972 2126 84874(5/29109) Page 1 of 1 I � CITY OF SALEM BOARD OF HEALTH ' Establishment Name: f u 1+obb5 Date: Slaa /oq Page: ! of Item Code C-Critical Item DESCRIPTION OF VIOLATION/ PLAN OF CORRECTION - Date No. Reference R-Red Item Verified PLEASE PRINT CLEARLY RV) one ins ta5D9 (_*0n o'-fitto cr>.fi(( -iWe I. - 1 rout t'+0 I I 1 V r 1 1 S I I I U�_ cinl-f-�r rnr� 1 I 1p I 1, Ir Discussion With Person in Charge: Corrective Action Required: ❑ No ❑ Yes I have read this report, have had the opportunity to ask questions and agree to correct all ❑ Voluntary Compliance ❑ Employee Restriction/ Exclusion violations before the next inspection, to observe all conditions as described, and to ❑ Re-inspection Scheduled ❑ Emergency Suspension comply with all mandates of the Mass/Federal Food Code. I understand that f noncompliance may result in daily fines of twenty-five dollars or suspension/revocation of El Embargo ❑ Emergency Closure ( your food permit. / / /t e„ ❑ Voluntary Disposal ❑ Other: i 1-110 Walafforlis Rollifedto Foodborne f1frivils Interventions and Risk to UN, Ckojcd to Factors(items 1-"") {Cont. 3-i;ii 15 C'x'Imt!M'Lhkxjo roT "I?K, PRGTEC'nON FROM CHEP41CALS PHF Hot and Cold Holding Food ci� Color Additives !.�W�16f �k� COW PHZ�.-"Vl�,lint"Jmd it ur kdlow 3-2")2,12 5 1 Qq4 i 3-102,14 pr,A.o!m Ima t ilaixll"".ed Ic E Poisonous at Toxic subidancea at w aboN e 101.11 Origimu W.a,t,.WId at ilr lbute I 10 T, Time as a Public HeAlln Control 102,1 i Ck�ntmlmN:tlne F) 1`11;- a�, I V,�bfi:,1 lc4of!l Control 7-20 1.11 '�qr�aioo-llr-,,u lice w)d i,tC' 7-202.32 Cmlldll:oyi,uf Uie, REOUREMENTS FOR 4lGHLY SUSCEPTIBLE 2W it 'to�ic Col�tainm POPULATIONS(HSP) 204. S�nizizer4.crilcrw -Cbcmil.�ik- ti,:vrx�l�ullfclt' re iml:L,ia�d )jlkeq and 7-2(4.12 for Wa.hiflg cfitozial 7-.t;4,14 Di-yingAgellts, CrltrrlW' 20 i 1i lm'id-mwl F:,xl Contx-t� I Albxi,.;,mv I Mit ?;t�!ewwd LQgn l i(1-1: or 0,o',o Aamml Fillij and 7-208.i I R".lrm,d Usv lle>ti,ides Criteria' SL."u �l�n'kw4 N,t sctycd. I IC; 1,;nor"Zeki F,nXi rqll,�,�wc Ne. t.7 1 20t: i I T"acking Powde,Z. and M oni ton ii CONSUMER ADWSORY �t�kol,, TIMErrEMPERATURE CONTROLS 16 ProperCoclking tamperetwestor A-imni 1'h„, arc tinder 0 A,kxd in PHFs pfoccssed to Flinlumile 3 JIM I i A(l)(-, 155'F I,,SSC. F Fi�:',,ihsiitolr ll;i R:;,,�SliOl (i:jna SPECIAL REWREMENTS j 3401.1I,B)(Ill 2) jjP�jtj pf,(i J>-Qj R0:t,,3 J01 I'; nin, Vi!,Ix,,m: IA Stmnoii in 44vl�i 11,A)f lllicv�ld I i5 F 15 sea. il, mobil- ilAxL te'lipilrally alld 4WAI{A)f Pokiltr, Vioild 6�tiilt�. "Ituff-d 1114F�l ru,sid,"I.al op-n:,tkirs,hhid tv Cltf(bllv C,mu .qv lniI-Ih, Meltilebtle" undu the aj,prvjnjatc ;wiou l'oldw,o.kafitCti-i 65'A 15 wc. � ubov,: ;f wLtwiji itliovd1lorliv 4!lws� "N110C mll"rIv, (wa,t f Slm,> -ik CjctrirC lo,,old retail 1.12 Rapt Aijini,t (:illskul in IV ex-bitcli uodtr #24) - Mwtowalv lb�,; sp',Vlai Rev!'ireliumt�. 3401 1](A)(i0l All OtImm JIIJFs- l411, 1s 17 Reheating for Hot Holftq i WOLATIONS RELATED TO GOOD RETAIL PRACTICES 3-'03Al(A)&tD1 [10, t(,5'F 15 ;ct , I Oienl5 �-403.1 I"B) Microwim- 165 P Minule Stjndik� i • seri,h ulonii; eiale le) hC 4'r 11±C) t coals ur,?ail y CAP? 511n),twl,k iEi 111 KLI�1411111 laser Griod Relzalf practxes Fr 5q q1_1 90 i 1R Proper Cooling of F;Hrs -21, F Plltll, (ron, 144)'I'lo 29 '005 vva-lre 1- 1) VLlb '0,F Willim 2 llour<and From 70"V 27, E`,m,svai Fa,ilipy PC.- 007 Nlatez;3Is F-C, -7 1 ,X8 5,01 (4(331 Cvoliu_ PHFo Kllv Flom Amb,cm ( IMPORTANT MESSAGE j FOR DATE /TIME M Chw )ej- Robbs OF (ow ��(�bb1s - lay l22lows PHONE AREA CODE NUMBER EXTENSION ❑ FAX ❑ MOBP F AREA CODE NUMBER TIME TO CALL TELEPHONED PLEASE CALL AA CAME TO SEE YOU WILL CALL AGAIN WANTS TO SEE YOU RUSH RETURNED YOUR CALL I WILL �FAX TO YOU MESSAGE icl_s actloN — Abd,c Vo ,sc► -o0ULQ SIGNED J Q/-\ IEFORM 4009 CCCC�/��//��r��1//// MARE IN U.0 - - 1 NTS Mi /t 2 t-o3® LEM —/' -- BOARD OF HEALTH Establishment Name: F �. b�, l to C�11QO n /(J 1)r �(n l Date: L4 I ► IOcf Page: I of „ nem Code, C-critical ItemDESCRIPTION OF VIOLATION/PLAN OF CORRECTION, , Date i No. "' Reference R—Red Item _ - Verified PLEASE PRINT CLEARLY y jt(i Irv, hon 1Inc- 1 tom_ ne4l 'n U-irt S condfp r- d a and -f6 -I (l rte c ergs I v�--st��1 • `-� I `' I AA1 o41 .,r Yv c t'f novViagN -o o0eh have lwn l I } I , r 1 1 Discussion With Person in Charge: Corrective Action Required: ❑ No ❑ res 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 'I comply with all mandates of the Mass/Federal Food Code. li understand that E noncompliance may result in daily fines of twenty-five dollars or suspension/revocation of ❑ Embargo ❑ Emergency Closure I your food permit. A // / LiVoluntary Disposal 0 Other: Violations Related to Foodbotne Illness Intervoritions and Risk it,Lav: (wl,rd to Factors(Ilenis 1,22) (Cont} 4 i7/45-IT Wirhiq i Hour,. PROTECTION FROM CHEMICALS Coolin-, M�.Uw& for PHF W PHF Hat and Cold Holding 14 Food or Color Additives 4n: piliti Cold %N*nu,in"i at or tJow 'kdamvc�.r 59(1 MU,�F 3-302A4 Protection front UirapproVed Ndditivc4 lf)(A) Hot %fainunedat,i! above 15 Poisonous or Toxic Substances 101AT 10"ne;tvin., Wommwon - kirwiti'l Rwm'1i0d at i", 'thovc 130'T' Cortaiiw, 24) Time as D Public He3lih Conti of -i-i(12,11 Codinion Name Work;n-.(-'owadm:ns' a Public l9ealth('o9w;! 770t�jl &-F�ewa!e'q -S41 r ag— '7-20111 A)111-:rTill V�riar.,e 7-20112 condi(ion,of Use 7 10! 11 HIGHLY SUSCEPTIBLE - Torii.Coitiairw .. prohlbizion" REQUIREMENTS FOR 7-N4.1 t Sjjjij;,Cjr;'Crile-a POPULATIONS(HSP' 21 1 t A Pie 1,a.,raLed Jtfitesaid 7-3[A,12 Cjje)iii,-iils fi)i W&hwg llr,xJitcc,C itzlill :1 .:raves with Warning,Labels' 7-204,14 Drying'Aqzew .crurria- �-S(J! WR: 1-i:of'r'a>tvuii7ed E--,' 7 3 ,Q i I. rDl tw or Padiah,,OyAwdAnimal Ftkd and 7-206-11 lie,iri,leci tl.�c Pvoiode,�,Critcrial� 7-206.1 1 Nk�l 2 Rkxlenl P"tit Sr'aroTW !iop"ned K<X4 pticl;a:i Nol Re-sCnv.'[' -06 1-1 5ack:ng Pander,. Pem Uontrdand t4onitoring' CONSUME?ADVISORY 22 3 Ou, 1 i 4.0ow,ter P(KtcJ 1;,r('(nu:-unPti'jn of, 'nMEITEMPERATURE CONTROLS A�4,ti�d FKNi, I Wt an Undcro-)kcd 16 Proper Cooking Temperatures for f`r xxstwd:q Eliminate PHFs 5,ee' 0 � .I Pl-evz n7,:d for Raw Shell I CRc" Meat�&6am, Aninens 155'`.7 ff ize4. ,' 2) Poll, and beel Rq"'et 1 '0'F 121 111in, SPECIAL REQUIREMENTS --401.1 J(AR2) Rather, Iwflk'tai Nitav, - 955 F Is 59'� if', Vid,iiow,ta Seclu,n catffrw, , inohilc foxi-lemporat y:Ind pouir",IN lid ramr, sirlife'l r,'10011 A i.itOwn Z;lkocld N" Sw0mv Contuniny Fisli.Mc;'L' fh' ajjjrf,,rrjdtC F"111tr v of Ratite S-I e,51'I if related to ftx0!xwue dljws� ( reatt, , ,t XI.cr '�V' Intact Be, iwj �entioii�and risk fa�lor to glood retail 3-4d 1,12 RaA'Aninial Fo,ids in a prak'ticcs Jirr,rld i',e dchned under#29 - %Iiclowate 10F" 111 Nit] 11fils 145'+ 15 se,: 17 Reheating for Hot Holding VIOLATIONS RELATED T!1 GOOD RETAIL PRACTICES 1-'03.11(Atl`(1)) 041., t65,1- 15 we. (Iteni,23,411 41)3.11(B) 41 icwts a%.L- 10,FI ,Nitnute Swvafiln' C+:;i zli W'd�'wr. ,riPf:al wl'irhdo 1w; r"-tafe';O Itz" Tiniel looliorty': and r1.4-fl,iz,rc hsiedtwo ve, on be 3-403.1 J !wwti in cti,an,til 0e;Food Code and gni CtIR 3403,1 I(F) Remainin', pwdion'or liwt etall Practices ;rf, 5.90.00 PC 2 003 23 1 1 24� 14 Proper Cooling of PHFs nd Raid PrNeclk,, 3 CW)4 144A) Ct�lj illL coot"'d P1 IF,,, t,ow 1 4 i,F n' F7-�5 and F -4 005 M, Wozrti,Ploribnq�Pd',Nu�te Fc'-5 oo(3 1(1 F widirn 2 flour:old From 79'1 FaOity PC-6 to.4117-15"F Withinl Houf: 00,s.mojt,or T^rc kla�er,as i PC-7 Goit +,501,1401) Cooline PlifNip& Fiont Aiab!_i,! L2:1, Tonf,crature ljigredwrM 1,,4 11145 . '-Oult-t Wrthin4b,AiW ...... 10/14/06 11:31 KFL - GEOCHRON -� 978 745 0343 N0.226 001 fVmER Phona:(976)667-6900 GG Fax:(978)667-6999 f ooD Emad:dkruepr(ilikOxam .�® corn LAeo pmoRIESy INC. 45 Maming Poed,aaed2 ce,SMA 01 1 USA FACSIMILE TRANSMITTAL FORM FAX#: (978) 667-6999 Date: 10/14/2008 PLEASE DELIVER TO: Joanne Scott Salem Health Department 978 745 0343 ; Pages to Follow: 3 1 Sender's Name: Van Lavoie DOCLiMENTS TO Certificate of Analysis for Sample Numbers: FOLLOW: 81979-981 PLEASE NOTE: All analytical results should be considered preliminary and are subject to further review until the final report is issued. If problems are experienced with this transmittal, please call(978)667.6900. 10/14/08 11:31 IFL — GEOCHRON 978 745 0343 NO.228 904 ,S1 Anarydcal ServkeS jEGER for the Food rndusw FOOD 4S manning Road,Billerica.RIA 018213934 www.kn.com•dkrusgerM.com —.0®LABORATORIES, INC. 976.667.6900•f M-60-M CERTIFICATE OF ANALYSIS Submitted by. Date Reported: 10/10/08 Date Received: 10/7/08 Everett Hobbs E.W.Hobbs 207 Fort Avenue Salem,MA 01970 Reference: Sampling Month-October 2008 PO# Description Your Sample Number Our lab Number Ice Cream Sampled tOR/06,4"F,Frozen Pudding 81981 STANDARD PLATE COUNT cfutg 2800 COLIFORMS-VRS cfulg <1 Standard Plate Count should be less than 50000 cfulg. Coliforms should be less than 20 efu/g. Methods:APHA.Standard Methods for the Examination of Dalry Products, 16th Ed., 1992,Parts 6.2 (Standard Plate Count)and 7.8(Coliforms). By: 17203 21083 2125 81981 (10/10/08) Page 1 of 1 10/14/08 11:31 KFL — GEOCHRON a 978 745 0343 NO.228 003 I KRUEGER for meF000dl services ustry, FOOD 45 MannIn0 RON,BBtenca,MA 01821-3934 wwwAfLoom.dknmWr®kn.cxun �®WORATORIES, INC. 979-car-69M•f M-reg-11999 CERTIFICATE OF ANALYSIS Submitted by: Date Reported: 10/10/08 Date Received: 10/7/08 Everett Hobbs E.W. Hobbs 207 Fort Avenue Salem,MA 01970 Reference: Sampling Month-October 2008 PO# Description Your Sample Number Our lab Number Ice Cream Sampled 10/7/08,4°F,Oreo 81980 STANDARD PLATE COUNT cfulg 2300 COLIFORMS-VRB cfulg 7 Standard Plate Count should be less than 50000 chdg. Coliforms should be less than 20 cfu/9. Methods:APHA,Standard Methods for the Examination of Dairy Products, i 8th Ed., 1992,Parts 8.2 (Standard Plate count)and 7.8(Colftonns). By: 17203 21083 2125 81980(10/10/08) Page 1 of 1 10/14/08 11:31 KFL - GEOCHRON a 978 745 0343 NO.22B 902 Ana(yMI Servies KRRuEGER for the food industry FOOD 45 Maiming RMd,88larlo,AAA 01821.3930 .�®L`�A C�- tt,,�� WWW.kn.Wm-dkrusger®kh.com ABORATORIES, wc. 979687-6900-f 978.667.6999 CERTIFICATE OF ANALYSIS Submitted by. Date Reported. 10/10/08 Date Received: 10/7/08 Everett Hobbs E.W. Hobbs 207 Fort Avenue Salem, MA 01970 Reference: Sampling Month-October 2008 PO 9. Description Your Sample Number Our Lab Number Ice Cream Sampled 10/7/08,40F,Black Raspberry 81979 STANDARD PLATE COUNT cfuig 400 COLIFORMS-VRB efafg <1 Standard Plate Count should be lees than 50000 cfulg. Cofitorms should be less than 20 cfu/g. Methods:APHA, Standard Methods for the Examination of Dairy Products, 16th Ed., 1992,Parts 6.2 (Standard Plate Count)and 7.8(Coliforms). By:� 17203 21083 2125 81979(10110/08) Page 1 of 1 _09/11/08 07:23 KFL - GEOCHRON i 19787409705 1`10.081 P01 i i • W EG ER Phone:(978)667-6900 G Fax:(978)667-6999 FOOn�Dnpw�7�C� INC. Email:dkrueger@kB.com J® LAeo ��y rym C45 Manning Road,Billerica,IrMA 0 821 USA FACSIMILE TRANSMITTAL FORM FAX#: (976) 667-6999 Date: 9/11/2008 PLEASE DELIVER TO: Joanne Scott Salem Health Department 978 740 9705 Pages to Follow: 3 Sender's Name: Van Lavoie DOCUMENTS TO Certificate of Analysis for Sample Numbers: FOLLOW: 81661-663 PLEASE NOTE: All analytical results should be considered preliminary and are subject to further review until the final report is issued. If problems are experienced with this transmittal, please call (978)667-6900. 09/11/08 07:23 KFL — GEOCHRON 4 19787409705 140.081 1?02 KRUEGER for the otos industry FOOD 45 Manning Road,Billerica,MA 01821-3934 �®LABORATORIES, INC. ""s s-6c 6900.978-667-69 9 CERTIFICATE OF ANALYSIS Submitted by., Date Reported: 9/9/08 Date Received: 9/5/08 Everett Hobbs E.W. Hobbs 207 Fort Avenue Salem, MA 01970 Reference: Sampling Month-September 2008 PO A Description Your Sample Number Our Lab Number Ice Cream Sampled 9/4/08,6°F, Frozen Pudding 81661 STANDARD PLATE COUNT cfu/g <250 COLIFORMS -VRB cfu/g <1 Standard Plate Count should be less than 50000 cfu/g. Coliforms should be less than 20 cfu/g. Methods:APHA, Standard Methods for the Examination of Dairy Products, 16th Ed., 1992, Parts 62 (Standard Plate Count)and 7.8 (Coliforms). By-j") 17095 20954 2125 81661 (9/9/08) Page 1 of 1 09/11/08 07:23 KFL — GEOCHRON 4 19787409705 N0.081 1?03 KRUEGER for rhe Food industry FOOD 45 Manning Road,Billerica,MA 01821.3934 1®LABORATORIES, INC. WW 978.66 6900•f 978.667.6999 CERTIFICATE OF ANALYSIS Submitted by. Date Reported: 9/9/08 Date Received. 9/5/08 Everett Hobbs E.W. Hobbs 207 Fort Avenue Salem, MA 01970 Reference: Sampling Month-September 2008 PO#: Description Your Sample Number Our Lab Number Ice Cream Sampled 9/4/08,6°F, Chocolate 81662 STANDARD PLATE COUNT cfu/g 2200 COLIFORMS-VRB cfu/g <1 Standard Plate Count should be less than 50000 cfu/g. Coliforms should be less than 20 cfu/g. Methods:APHA, Standard Methods for the Examination of Dairy Products, 16th Ed., 1992, Parts 62 (Standard Plate Count)and 7.8 (Coliforms). By. 17095 20954 2125 81662(9/9/08) Page 1 of 1 09/11/08 07:23 KFL - GEOCHRON 4 19787409705 140.081 PO4 b Analytical ServlceS KRUEGER for the Food Industry FOOD 45 Manning Road,Billerica,MA 01921.3934 �®LABORATORIES, INC. www.kfi.com• 0-f 9 8-667-com 978-667-6900•f 979-667.6999 CERTIFICATE OF ANALYSIS Submitted by: Date Reported: 9/9/08 Date Received., 9/5/08 Everett Hobbs E.W. Hobbs 207 Fort Avenue Salem, MA 01970 Reference: Sampling Month-September 2008 PO A Description Your Sample Number Our Lab Number Ice Cream Sampled 9/4/08,6°F, Rainbow 81663 STANDARD PLATE COUNT cfulg 2800 COLIFORMS-VRB cfu/g <1 Standard Plate Count should be less than 50000 cfu/g. Coliforms should be less than 20 cfu/g. Methods:APHA, Standard Methods for the Examination of Dairy Products, 16th Ed., 1992, Parts 6.2 (Standard Plate Count)and 7.8(Coliforms). 17095 20954 2125 81663 (9/9/08) Page 1 of 1 0?/14/09 12:28 KFL - GEOCHMN 4 19?Et7409705 t�N0J/ 0J�1��2 Po1 KweP ER Phonic(978)667-6900Fax:(97B)66T6999 FOOD Email:dkruegerQkfi,com Website:w .kkoom a LABOPATOIaM INC. 45 Manning Road,aillerioa,MA 01821 USA I FACSIMILE TRANSMITTAL FORM FAX #: (978) 667-6999 Date: 7/14/2008 PLEASE DELIVER TO: Joanne Scott Salem Health Department 978 748 9785 Pages to Follow: 3 Sender's Name: Van Lavoie DOCUMENTS TO Certificate of Analysis for Sample Numbers: FOLLOW: 81061-063 PLEASE NOTE: All analytical results should be considered preliminary and are subject to further review until the final report is issued. If problems are experienced with this transmittal, please call(976)667-6940. 07/14/28 12:28 KFI - GEOCHRON 19787.109705 N0.012 004 Rnatyticat SetVICeS 1 KRUEGER for the Food Industry FOOD 45 Manning Road,Billerica,MA 01821-3934 COM LABORATORIES, INC. wwu978-tr m• 0-f 9 8-667 6999 878-667.6900•t 978-667-6999 CERTIFICATE OF ANALYSIS Submitted by., Date Reported: 7/14/08 Date Received: 7/8/08 Everett Hobbs E.W. Hobbs 207 Fort Avenue Salem, MA 01970 Reference: Sampling Month-July 2008 PO#: Description Your Sample Number Our Lab Number Ice Cream i^ Sampled 718108,4°F,Chocolate +' 81063 v ---_ STANDARD PLATE COUNT du/9 750 COLIFORMS-VRB cfu/g <1 Standard Plate Count should be less than 50000 cfu/g. Coliforms should be less than 20 cfu/g. Methods:APHA, Standard Methods for the Examination of Dairy Products, 16th Ed., 1992, Parts 6.2 (Standard Plate Count)and 7.8(Goiiforms). By: 16890 20711 2125 81063(7/14/08) Page 1 of 1 _07.'14/08 12:28 KFL — GEOCHPON > 19?87409705 NO.012 003 _ i theicryKRUEGER for Analytical services FOOD 45 Manning Road,Billerica,MA 018213934 INC. www.kfl.com•dkruegerOkf.com -do LABORATORIES, C 978-667-6900•f 878.667.6999 CERTIFICATE OF ANALYSIS Submitted by. Date Reported. 7/14/08 Date Received: 7/8/08 Everett Hobbs E.W.Hobbs 207 Fort Avenue Salem, MA 01970 Reference: Sampling Month-Juty 2008 PO#: Description Your Sample Number Our Lab Number Ice Cream Sampled 718/08,4°F,Maple Walnut 81062 STANDARD PLATE COUNT cfu/g 20000 COLIFORMS-VREI cfu/g 1 Standard Plate Count should be less than 50000 cfu/g. Coliforms should be less than 20 cfu/g. Methods:APHA, Standard Methods for the Examination of Dalry Products, 16th Ed„ 1992, Parts 6.2 (Standard Plate Count)and 7.8(Coliforms). By, 16890 20711 2125 81062(7/14/08) Page 1 of 1 07%14i08 12:28 KFL - GEOCHRON 3 19787409705 N0.012 902 4 'P. kal KrR�UEGER for the Food Indust v FOOD 45 Manning Road,Billerica,MA 01821-3934 www.kfi.com•dkrueger*kfl.com �®LABORATORIES, INC. 978.667.6900•f 979-667-6998 CERTIFICATE OF ANALYSIS Submitted by: Date Reported: 7114/08 Date Received., 718/08 Everett Hobbs E.W. Hobbs 207 Fort Avenue Salem,MA 01970 Reference: Sampling Month-July 2008 PO#.- Description :Description Your Sample Number Our Lab Number Ice Cream Sampled 718/08,4°F, Chocolate Chip 81061 STANDARD PLATE COUNT cfu/g 7700 COLIFORMS-VR8 cfu/g <1 Standard Plate Count should be less than 50000 cfu/g. Coliforms should be less than 20 cfu/g. Methods: APHA, Standard Methods for the Examination of Dairy Products, 18th Ed., 1992, Parts 6.2 (Standard Plate Count)and 7.8(Coliforms). = By:�11 16890 20711 2125 81061 (7/14/08) Page 1 of 1 06/23/08 12:53 KFL — GEOCHP011 4 19787409705 1U.056 D03 Anatirtical l ces KRUEGER for the Food Industry a FoOD 45 Manning Road,Billerica,MA 018213934 J®LABORATORIES, INC. 978.66 6900*f 978-667-6999 CERTIFICATE OF ANALYSIS Submitted by: Date Reported: 6/23/08 I Date Received: 6/17/08 Everett Hobbs E.W. Hobbs 207 Fort Avenue Salem, MA 01970 Reference: Sampling Month -June 2008 PO k: Description Your Sample Number Our Lab Number Ice Cream Sampled 6/17/08, 8°F, Kaluha Chip 80894 STANDARD PLATE COUNT cfu/g 14000 COLIFORMS-VRB cfufg <i Standard Plate Count should be less than 50000 cfu/g. Coliforms should be less than 20 cfu/g. Methods:APHA, Standard Methods for the Examination of Dairy Products, 16th Ed., 1992, Parts 6.2 (Standard Plate Count)and 7.8 (Coliforms). By: 16823_220625 2125 80894 (6/23/08) Page 1 of 1 06/23/08 12:53 KFL - GEOCHRON 4 19787409705 NO.056 1702 KRUEGER for thelFood industry FOOD 45 Manning Road,Billerica,MA 018213934 www.kfl.com•dkrueger®kfl.com �®LABORATORIES, INC. 978-667-6900•f 978-667-6999 CERTIFICATE OF ANALYSIS Submitted by: Date Reported: 6/23/08 Date Received: 6/17/08 Everett Hobbs I E.W. Hobbs 207 Fort Avenue Salem, MA 01970 Reference: Sampling Month • June 2008 PO k: Description Your Sample Number Our Lab Number Ice Cream Sampled 6/17/08, 8°F, Strawberry 80893 STANDARD PLATE COUNT cfu/g 1500 COLIFORMS-VREI cfu/g <1 Standard Plate Count should be less than 50000 cfu/g. Coliforms should be less than 20 cfu/g. Methods: APHA, Standard Methods for the Examination of Dairy Products, 16th Ed., 1992, Parts 6.2 (Standard Plate Count) and 7.8 (Coliforms). s 9 ayifie 16823 20625 2125 80893 (6/23/08) Page 1 of 1 i 06,23/08 12:53 ISFL — GEOCHROII > 19787489705 NO.056 PO4 \I iAnalytical Services KRUEGER for the Food Industry FOOD 45 Manning Road,Billerica,MA 018213934 � com ®LABORATORIES, INC. www.kfi.com•dxrueg 8-667 6999 978-667-6900•f 978-667-6999 CERTIFICATE OF ANALYSIS Submitted by: Date Reported., 6/23/08 Date Received: 6/17108 Everett Hobbs E.W. Hobbs 207 Fort Avenue Salem, MA 01970 Reference: Sampling Month - June 2008 PO#: Description Your Sample Number Our Lab Number Ice Cream Sampled 6/17/08, 8°F, Maple Walnut 80895 STANDARD PLATE COUNT cfu/g spreader COLIFORMS-VRB cfu/g <1 Standard Plate Count should be less than 50000 cfu/g. Coliforms should be less than 20 cfu/g. Methods: APHA, Standard Methods for the Examination of Dairy Products, 16th Ed., 1992, Parts 6.2 (Standard Plate Count)and 7.8 (Coliforms). d 9 By: 16823 20625 2125 80895(6/23/08) Page 1 of 1 06/04/08 14:06 kFL - GEOCHRON a 19707409705 00.011 D04 it services KRUEGER for theFoodt industry • F AoOD A T11 INC. 45 Manning Road,BNterica,MA 81821-3934 ' LABORAMRIESI INC. 978.667-69M•f 978-567-6999 CERTIFICATE OF ANALYSIS Submitted by. Date Reported- 6/4/08 Date Received., 5/29/08 Everett ob E.W. Hobbs 207 Fort Avenue Salem, MA 01970 Reference., Sampling Month-May 2008 PO A Description Your Sample Number Our Lab Number Ice Cream Sampled 5/29/08,40F,Coffee 80765 STANDARD PLATE COUNT cfu/g 3500 COLIFORMS-VRB cfu/g <t Standard Plate Count should be less than 50000 cfu/g. Coliforms should be less than 20 cfu/g. Methods:APHA, Standard Methods for the Examination of Dairy Products, 16th Ed., 1992, Parts 6.2 (Standard Plate Count)and 7.8(Coliforms). By. T 16768 20555 2125 80765 (6/4/08) Page 1 of 1 3 06/04/08 14:06 KFL - GEOCHRO14 19787409705 t�'.011 D©j KRUEGERAnafYtfcal services �1 n for the Food Industry FOOD 45 Manning Road,Billerica,MA 01 8 21 39 3 4 LABORATORIES, INC. '"'s e=s`s°i sno•f978-667-6999 CERTIFICATE OF ANALYSIS Submitted by: Date Reported. 6/4108 ��""' Date Received. 5/29/08 Everette .� v E.W.Hobbs 207 Fort Avenue Salem, MA 01970 Reference: Sampling Month-May 2008 PO#: Description Your Sample Number Our Lab Number Ice Cream Sampled 5/29/08,4°F, Strawberry 80764 STANDARD PLATE COUNT cfu/g 11000 COLIFORMS•VRB cfu/g <1 Standard Plate Count should be less than 50000 cfu/g. Coliforms should be less than 20 cfu/g. Methods: APHA, Standard Methods for the Examination of Dairy Products, 16th Ed., 1992, Parts 6.2 (Standard Plate Count)and 7.8(Coliforms). ff( - By. i 16768 20555 2125 80764(6/4/08) Page 1 of 1 I. r OFu104108 14:06 KFL — GEOCHRON 19?87409705 N0.011 902 Analytical Services KRUEGER for he Food ndustry FOOD 45 Manning Road,Billerica,MA 01821-3934 www.kfl.com•dkrueger*kfl.com ..r�i LABORATORIES, INC. 976-667-6900•IF 976-667.6999 CERTIFICATE OF ANALYSIS j Submitted by., Date Reported: 6/4108 Date Received: 5/29108 Evere obbs E.W. He s 207 Fort Avenue Salem, MA 01970 Reference: Sampling Month - May 2008 PO tt: Description Your Sample Number Our Lab Number Ice Cream Sampled 5/29/08, 40F, Vanilla 80763 STANDARD PLATE COUNT cfu/g 8700 COLIFORMS-VRB cfu/g <1 Standard Plate Count should be less than 50000 cfu/g. Coliforms should be less than 20 cfu/g. Methods:APHA, Standard Methods for the Examination of Dairy Products, 16th Ed., 1992, Parts 6.2 (Standard Plate Count)and 7.8 (Coliforms). { By. 16768 20555 2125 80763(6/4/08) Page 1 of 1 I r Z- _ _ CITY OF SALEM BOARD OF HEALTH iEstablishment Name: \r W ` �i� Date: �� Page: I of Item Code c-Critical nem DESCRIPTION OF VIOLATION/PLAN OF CORRECTION nate No. Reference R—Red Item - '" " " - . . , . Verified PLEASE PRINT CLEARLYd ' +"-In, t) )Cj� r -)Ylcq11tQ -foll�t �r� t,�;l�" v, II�1 ct1 use CuCCe4�"�� (-IooYer � (�) -'/ i . � be lured I �. i1 L1 �O VY1Q i✓�TCI Sr 1��11 f�P rcr� —, )ry �f 'L4 f 1 t O( `h'O OI)j . IV t I i I i � ttie�tu rern Qin �� o r>P n .v e keen Sa1�'�ii ed• w .�cinrtQr;an- I . � I I I Discussion With Person in Charge: Corrective Action Required: I ❑ No I ❑ res I have read this report, have had the opportunity to ask questions and agree to correct all ❑ Voluntary Compliance ❑ Employee Restriction/ Exclusion violations before the next inspection, to observe all conditions as described, and to ❑ Re-inspection Scheduled ❑ Emergency Suspension comply with all mandates of the Mass/Federal Food Code. I understand that .. noncompliance may result in daily fines of twenty;five dollars or suspension/revocation of ❑ Embargo ❑ Emergency Closure your food permit. Ll Voluntary Disposal U Other: I 3-301,14iC t FJIFs Rveeii.:ii at'fmiperaluxee Victorians Related to Foodborne fitness Interventions and Risk According to tat,':C,toild is Factors(Itms 1,22) (Conf,) .; Wid:ill'l Aoins, PROTEC'nON FROM CHEMICALS 't ;fit 15 ctxilljua Nlol"A,for PliF! 19 0HF Hot and Cold Holding 14 1Food or Color Additives I , I 1i 50!.16(B) Cold PHFS Nlrlpt.mem t'w i'clow A("cvcs .1 l !45 r' 3,1024[4 firk,teclitnt front tinapprw.,ed Addno�e:' 3-.5!)i 1!1ix) Poisonous or Toxic Substances l4b'F kicinifying inforlimuln (inginal t-501 16"Al Held at"( ahovC I jWF Contauwn�� Time As a Public Heafth Conlooll 7, 6' 11 G�rnrnon Name- WorkingConlaolov,' 20 .lot I1 svvaratlon.. S1,"iige ["��qrioioa -vo'��rmv and U'e� 7.202.12 of Uqc" (onnnSct� P'T(1111 i't ',jr POPULATIONS(HSP) '03 it REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-164.11 'Sjnn`i-/er,'Crneria-Chetilic;'W 1 7-X04,12 Chenlicaf�fo;:NN w mn.g Poxllwc" C I itemal wid Nith 7-'204,14 I'l-mig Avcm!,Urlicnit, 7 204,11 Incido'lltal Fisx]Ut•ntam,I uhi imn,- lil" oC:,,Lt 1� �� j Rtiool% l Animal I-(x and RC�qricl'-d I:,c PC,tik ldv" Cl itcl m� I Pav 'S' :d �inroui' Not S-lvcd. 7 206 13 lr�ickllq; Contiol and F,"i Pawk2ji� No,' RC NlowlotinnCONSUMER ADVISORY TIMErTEMPERATURE CONTROLS 22 140".11 Ctnqmlcy Ail, Poq',d for i"nismopLion.)I Aloilill Fci to Proper Corking TemperLtures for PHFS 1 i ?:(q Ofllerui'e flmd'!cs"� its!Jilmnwe 3 21}t 11 A(I)k-") Egg,- 155'F 15 Scc, JIM i I I.J i at c.4;., 1 C t 145,'F1 5 ''St;:.I' i%:"VcIM4t'd Fvg,. !.OtVtWW J1;1 R11W Y)III i-4hl,IliA)(2! Comwqtuied & Ga;nc Aninials- 15'1'F 15 w'. iAol.I((D)(lp 2) Po(� tnd HM kixtgi 12" nitn' SPECIAL REOU19ENIE14TS 590(h r'4f Am D) ot S&uon >4 Ril)(9(A) D) in scz. cawring, !.c,npotary acid 3-401.1 It A0 Poalm,Wild Gallic, Stufled PH!Fs' ;cmil-mllal kocilCn Aoold bc Solffine Clmtaimnu Fish- Nfeaf, 6chtL'd ande; the apllri,pno' "c1c"tolls Poultry or Icatilci 10,F 15 S-:c. 3frcliod tof-X>JK)r1w 11111055 bllai-t B04SICAS illw1wiltion-,aod risk factors Othff vtolatiolls idmino)flood rctaj! +-4+11.1_2 Rfm Animil 14'zfqjs lj,t; pram,em;hnujd biiitijiLd under #29 - Mictowdw 1651. , iS-11.1:ili Pequiirmlem' 3-40JANAAI)th) Ali Othet Pl{F:- 145-1: t 5 cc 17 Refleating for Hot Holding VIOLATIONS RELATED TO C,'000 RETAIL PRACTICES 3 0-1.11(A)&iDt 115i,F 15 eCc' ^ I Otenl'4 Nhcoteave, 165' r", ri;tlai do nal tdatc:•,du him, 1 I �iG,. UH111 end li"A lot wrc li'.l('J above, C'm bi, - -403 1!(( ) Comm er,citly Pq'� ��A cRTF K-cJ !ma'd o! eh" !">od awi 10i CMR , !4()'Fl T 3-410 1 I(E i Pernaillm, un:liced Bec" I tem_ i GeMrifetaPpractieva 50,000 Proper Cooling of PHFS Fc�,,d z�nd v,xid Poxt,-tion FC 18 1, (A 5 E uip_nm!_aqd U Len�qo i-501.14(A) Car roc Cwkudi Plll-s I'ma) 14fff torc-5 I w�' 7011;W*ithin 2 1 ltur,�nd Front 10-'1' 2i, FC-6 1 rA7 it,41"F4145 F Within 4 Hoiis Prion,,or"t.w Nfat'n"% I F(, --7 1 003 3-f01.l4lit) (,'(q-,Iivo PHF:,Mi,de FrouiAnitnem Tccn 1k`'f attice hil:redicnv;to 41'F!45 witin n 4 licul ,ilc,vte,cnttcal uc,n m the hdec,i i^"9 fowl C1;de VY#4i t.:.`.fii:59=.)td i!;. ( IMPORTANT MESSAGE ) FOR ff I S Z DATE 2yb) 01 TIME M Jobb s OF PHONE AREA CODE NUMBER EXTENSION ❑ FAX ❑ MOBII F AREA CODE NUMBER TIME TO CALL TELEPHONED ' I PLEASE CALL CAME TO SEE YOU WILL CALL AGAIN WANTS TO SEE YOU RUSH RETURNED YOUR CALL I WILL FAX TO YOU MESSAGE Q IIw C -I��, CZ dA fT—��. n /l. SIGNE /�t�� YYY�� OD 14009 �IIIli MAOt IUSA NOTCS ( IMPOR_TAIW MESSAGE ) I FOR DATE �� I I p_TIME )', S',P MII) h, OF I4nkhr��-. n �9 PHONE C17�4 /Qx - -77("9 1 AREA CODE NUMBER 'EXTENSION O FAX ❑ MOW F AREA CODE NUMBER TIME TO CALL TELEPHONED PLEASE CALL CAME TO SEE YOU I I WILL CALL AGAIN WANTS TO SEE) ��---{I RUSH RETURNED YOUR CALL I WILL FAXTO YOU MESSAGE= LUO,)jJ k1 -P All DAVM ' WLPIr-VIVi.t-t s SIGNE.I*�'e� YYYYY-�-= FORM O09 Yiii MAGE IN 5 A I T GDiON f !6 7 Island Avenue E.W. Hobbs City of Salem FOOD SERVICE ESTABLISHMENT - FOOD SERVICE Inspection HACCP: ❑ Item Status Violation Critical Urgency Telephone: FOOD PROTECTION MANAGEMENT 745-7691 PIC Assigned/Knowledgeable/Duties PASS 2_1 RED Owner: Non-compliance with: Everett W. Hobbs Anti-Choking PASS PIC: Charles Hobbs Tobacco PASS Inspector: David Greenbaum EMPLOYEE HEALTH Date Inspected:Correct By: Reporting of Diseases by Food Employee and PIC PASS RED 3/27/2008 _ _ _ Personnel with Infections Restricted/Excluded PASS RED Risk Level: FOOD FROM APPROVED SOURCE Permit Number: Food and Water from Approved Source PASS RED BHP-2008-0430_ Receiving/Condition PASS Q RED Status: SIGNED OFF Tags/Records/Accuracy of Ingredient Statements PASS RED #/of Critical VIOlatlonS: Conformance with Approved Procedures/HACCP Plans PASS Q RED 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 GeoTMS02008 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Apr 02,2008 ) Page / of �r �I Item Status Violation Critical Urgency RED: PROTECTION FROM CONTAMINATION Violations Related to Separation/Segregation/Protection PASSd❑ RED Foodborne Illness Interventions and Risk Factors (Require Food Contact Surfaces Cleaning and Sanitizing PASS [VI RED immediate corrective action) Proper Adequate Handwashing PASS [ RED Good Hygienic Practices PASS 0 RED Prevention of Contamination from Hands PASS RED Handwash Facilities PASS EVI RED PROTECTION FROM CHEMICALS Approved Food or Color Additives PASS RED Toxic Chemicals PASS 0 RED TIMETTEMPERATURE CONTROLS(Potentially Hazardous Foods) Cooking Temperatures PASS RED Reheating PASS �/❑ RED Cooling PASS ❑ RED Hot and Cold Holding PASS 0 RED Time As a Public Health Control PASS RED REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) Food and Food Preparation for HSP PASS 0 RED CONSUMER ADVISORY Posting of Consumer Advisories PASS 0 RED City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741-1800 GeoTMS®2008 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Apr 02,2008 ) Page 2 of Item Status Violation Critical Urgency Violations Related to Good Retail Practices (Blue Items) Management and Personnel PASS BLUE Food and Food Protection PASS BLUE Equipment and Utensils PASS BLUE Physical Facility PASS BLUE Water, Plumbing and Waste PASS BLUE Poisonous or Toxic Materials PASS BLUE Special Requirements PASS BLUE Other-See Notes PASS BLUE GENERAL COMMENTS: All requirements to open have been satisfied. Owner to start with popcorn, ice cream and soda. Owner will call the Board of Health for an inspection prior to opening the grill side. Opening is scheduled for March 29, 2008. City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741-1800 GeoTMS®2008 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Apr 02,2008 ) Page 3 of 3 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: 0312412008 ESTABLISHMENT NAME: E.W.Hobbs y File Numbef:BHF-2004000133 7Island Avenue Salem MA 01970 LOCATED AT: SALEM,MA 01970 Permit Type Permit No. Permit Issued Permit Expires Fee Restrictions 1 Notes FOOD SERVICE BHF-2008-0430 Mar 24,2008 Dec 31,2008 $140.00 ESTABLISHMENT FROZEN DESSERTS BHF-2008-0431 Mar 24,2008 Dec 31,2008 $25.00 RETAIL FOOD BHP-2008-0429 Mar 24,2008 Dec 31,2008 $70.00 Total Fees: $235.00 PERMIT EXPIRES IDecember3l, 2008 Board of Health This Permit is not transferable and must be reissued upon change of ownership or location.The permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code,beofre any revonations,improvements,or equipment changes are made,all plans for such must be submitted to and approved by the Salem Board of Health. Page 2 of 3 QTY OF SALEM, MASSACHUSETTS BOARD OF FIEALTH e 120 WASHINGTON STREET,4T"FLOOR TEL. (978) 741-1800 KIMBERLEY DRISCOLL FAX(978) 745-0343 RECEIVED � MAYOR isCOTT(a)SALEM.COM E D JoANNE SCOTr, MAR - 5 2008 r, HEALTHAGENT CIT Y OF SALEM r BOARD OF HEALTH 2008 APPLICATIONFORPERMIT TO OPERATE A FOOD ESTABLISHMENT NAME OF ESTABLISHMENT t—e W• )J0)DbS T!I( p TEL# y` `76111 I ADDRESS OF ESTABLISHMENT nl� 7_J } A,Ve - FAX# MAILING ADDRESS(if different) EMAIL-Business': ad Ohba cc )r-Qs�.(La� Website: OWNER'S NAME Ever-124 )A(5)6I�s // TEL# G7` - 74y-7631 ADDRESS -7 -T�Gni) A,le• �l,M X44 ON76 STREET ` \ CITY STATE ZIP CERTIFIED FOOD MANAGER'S NAME(S)C ha ruS ��>�J CERTIFICATE#(S) (Required in an establishment where potentially hazardous food is prepared) EMERGENCY RESPONSE PERSON HOME TEL# DAYS OF OPERATION Monday Tuesday Wednesday Thursday Friday Saturday Sunday HOURS OF OPERATION _ Please write in time of day. 0— to (Forexample iiam-11pm) P � TYPE OF ESTABLISHMENTFEE (check only) RETAIL STORE YES NO less than 1000sq.ft. =$70 1000-10,000sq.ft. =$280 more than 10,000sq ft. =$420 -------------------------------------------------------------------------------------- RESTAURANT NO less than 25 seats =$140 (Outdoor Stationary Food Cart$21(4) 25-99 seats =$280 more than 99 seats =$420 -------------------- - ------ - -- --------------------------------------------------------------------------- --..... BED/BREAKFAST/ YES NO $100 CHILDCARESERVICES-------------------------------------------------------------------------------------..------------------------------- ADDITIONAL PERMITS MAKE (not just serve) ICE CREAM, YOGURT/SOFT SERVE YE NO $25 TOBACCO VENDOR S NO $135 ALL NON-PROFIT(such as church kitchens) YES NO $25 'Please pay total with one check payable to the City of Salem. This Permit is not transferable and must be reissued upon change of ownership.The Permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code, before any renovations, improvements,or equipment changes are made, all plans for such must be submitted to and approved by the Salem Board of Health. Pursuant to MGL Chapter 62C,Section 49A, I certify under the pains and penalties of perjury that I,to my best knowledge and belief,have filed all state tax returns and paid all s Is taxes r quired under the law �t �t rV 'I ,P>1— 33 -vr6 OSO- i �-0383 Signature Date Social Security or Federal Identification Number Revised 4/24/07 FOODAP2008.adm Check#&Date X $�? 10/18/07 15:12 KFL - GEOCHRON -� 978 745 0343 NO.182 1?01 II aW � • ax:(978)667-6999 GGw � Phone:(978)657-5900 FoOD Email dkrueger@kfl.com Websile:w Afl.mrn ® L,ABoRAZOR M INC. 45 Manning Road,Billerica,MA 01821 USA FACSIMILE TRANSMITTAL FORM FAX #: (978) 667-6999 Date: 10/18/2007 f PLEASE DELIVER TO: Joanne Scott Salem Health Department 978 740 9705 Pages to Follow: 3 I Sender's Name: Van Lavoie DOCUMENTS TO Certificate of Analysis for Sample Numbers: FOLLOW: 78232.234 I i i I I I PLEASE NOTE: All analytical results should be considered preliminary and are subject to further review until the final report is issued. If problems are experienced with this transmittal, please call (978)667-6900. 10/18/07 15:12 KFL — GEOCHRON i 976 745 0343 NO.182 1?02 KRUEGER Analytical ServlceS for the Food Industry FOOD 45 Manning Road,Blilerlta,MA 01821-3934 — LABORATORIES, INC. "n"9 8--667 69oo:IF978-6W-6999 i I �I CERTIFICATE OF ANALYSIS Submitted by. Date Reported: 10/17107 Date Received: 10/12/07 Everett Hobbs E.W. Hobbs 207 Fort Avenue Salem, MA 01970 Reference: Sampling Month-October 2007 PO#. i Description Your Sample Number Our Lab Number ice Cream Sampled 10/12107,4°F, Chocolate Chip 78232 STANDARD PLATE COUNT afulg 2200 COLIFORMS-VRB cfu/g <1 Standard Plate Count should be less than 50000 cfu/g. Coliforms should be less than 20 cfu/g. Methods:APHA,Standard Methods for the Examination of Dairy Products, 16th Ed., 1992, Parts 6.2 (Standard Plate Count)and 7.8(Coliforms). By: 16054 19640 2125 78232(10/17/07) Page 1 of 1 10/18/07 15:12 KFL - GEOCHRON 4 976 745 0343 NO.182 003 KRUEGERAnalytical services C� for the Food Industry FOOD 45 Manning Road,Billerica,MA 01821-3934 -W®LABORATORIES, INC. 978.667-SBW-f 79 667-eM CERTIFICATE OF ANALYSIS Submitted by: Data Reported., 10/17/07 Date Received: 10112107. Everett Hobbs E.W. Hobbs 207 Fort Avenue Salem,MA 01970 Reference: Sampling Month -October 2007 PO A Description Your Sample Number Our Lab Number Ice Cream Sampled 10112107,4°F,Oreo 78233 STANDARD PLATE COUNT GIulg 1100 COLIFORMS-VRB cfulg <1 Standard Plate Count should be less than 50000 cfu/g. Coliforms should be less than 20 cfu/g. Methods:APHA,Standard Methods for the Examination of Dairy Products, 16th Ed., 1992,Parts 6.2 (Standard Plate Count)and 7.8(Coliforms). By: 16054 196402125 78233(10/17/07) Page 1 of 1 10/18/07 15:12 KFS — GEOCHRON 4 978 745 0343 NO.182 1?04 KRUEGER Analytical SeNlces for the Food Industry FOOD 45 Manning Road,Billerica,MA 01821-3934 INC. www.kfi.com•okrueger41k6.com �®LABORATORIES, N 978.667.6900•f 978.667-6999 CERTIFICATE OF ANALYM Submitted by: Date Reported., 10117/07 Date Received., 10/12/07 Everett Hobbs E.W. Hobbs 207 Fort Avenue Salem, MA 01970 Reference., Sampling Month-October 2007 PO#.- Description Your Sample Number Our Lab Number Ice Cream Sampled-10/12/07;4°F;Pumpkin 78234 STANDARD PLATE COUNT cfu/g 1300, COLIFORMS•VR8 cfu/g <1 Standard Plate Count should be less than 50000 cfu/g. Coliforms should be less tharr20'cfu/g�, Methods:APHA, Standard Methods for the Examination of Dairy Products, 16th Ed., 1992, Parts 6.2 (Standard Plate Count)and 7.8(Coliforms). By: 16054 19640 2125 78234(10/17/07) Page 1 of 1 09/10/07 15:42 KFL - GEOCHROH > 19787409705 NO.005 1?01 - MEG ER Phone:(978)667-6900 Fax:(978)667-6999 FoO p Email:dkrueger@k0.com , wp� Website:www.kf.com J® LABo RAo fa 'm INC. 45 Manning Road,Billerica,MA 01821 USA 1 FACSIMILE TRANSMITTAL FORM FAX#: (978) 667-6999 Date: 9/10/2007 PLEASE DELIVER TO: Joanne Scott Salem Health Department 978 740 9705 Pages to Follow: 3 Sender's Name: Evangeline Lavoie DOCUMENTS TO Certificate of Analysis for Sample Numbers: FOLLOW: 77817-819 PLEASE NOTE: All analytical results should be considered preliminary and are subject to further review until the final report is issued. If problems are experienced with this transmittal, please call (978)667-6900. 09/10/07 15:42 KFL - GEOCHRON 4 19787409705 NO.005 902 Services KRUEGER for theFotodt Industry FOOD 45 Manning Road,Billerica,MA 01821-3934 www.kfl.com A LABORATORIES, INC. 978-6900•f 978-667-6999 CERTIFICATE OF ANALYSIS Submitted by. Date Reported: 9/10/07 Date Received: 9/4/07 Everett Hobbs E.W. Hobbs 207 Fort Avenue Salem, MA 01970 Reference: Sampling Month-Septamber 2007 PO A Description Your Sample Number Our Lab Number Ice Cream Sampled 9/4/07, 6°F,Coffee 77817 STANDARD PLATE COUNT cfu/g <250 COLIFORMS-VRB afu/9 'Cl Standard Plate Count should be less than 50000 cfu/g. Coliforms should be less than 20 cfu/g. Methods:APHA, Standard Methods for the Examination of Dairy Products, 16th Ed., 1992, Parts 6.2 (Standard Plate Count)and 7.8(Coliforms). By: 15897 119454 21125 77817 (9110/07) Page 1 of 1 09/10/07 15:42 KFL — GEOCHROII 4 19787409705 NO.005 D03 AnalServices KRUEGER for theFototlt Industry . FOOD 45 Manning Road,Billerica,MA 01821.3934 �®LABORATORIES, INC. W 978.667.6900•f978-667-6999 CERTIFICATE OF ANALYSIS Submitted by: Date Reported: 9/10/07 Date Received: 9/4/07 Everett Hobbs E.W. Hobbs 207 Fort Avenue Salem, MA 01970 Reference: Sampling Month-September 2007 PO#: Description Your Sample Number Our Lab Number Ice Cream Sampled 914/07,6°F,Chocolate Chip 77818 STANDARD PLATE COUNT cfulg 710 COLIFORMS-VRB cfu/g <t Standard Plate Count should be less than 50000 cfu/g. Coliforms should be less than 20 ctu/g. Methods:APHA, Standard Methods for the Examination of Dairy Products, 16th Ed., 1992, Parts 6.2 (Standard Plate Count)and 7.8(Coliforms). By{� 15897 19454 2125 77818(9/10/07) Page 1 of 1 I 09/10/07 15:42 KFL — GE01_HRON a 19787409705 h10.005 004 Analytical Services KRUEGER for the Food Industry FOOD 45 Manning Road,Billerica,MA01821.3934 J LABORATORIES, INC. www.kfi.com 978-667.6900•f 976 6671.69 9 CERTIFICATE OF ANALYSIS Submitted by: Date Reported: 9/10107 Date Received: 9/4/07 Everett Hobbs ` E.W. Hobbs I` 207 Fort Avenue Salem, MA 01970 Reference: Sampling Month-September 2007 PO A. i Description Your Sample Number Our Lab Number Ice Cream Sampled 9/4/07,6°F,Chocolate 77819 STANDARD PLATE COUNT cfu/g <250 COLIFORMS-VRB cfu/g <1 Standard Plate Count should be less than 50000 cfu/g. Coliforms should be less than 20 cfulg. Methods:APHA, Standard Methods for the Examination of Dairy Products, 16th Ed., 1992, Parts 6.2 (Standard Plate Count)and 7.8 (Coliforms). By:gne7l J 15897 19454 2125 77819(9/10/07) Page 1 of 1 Massachusetts Department of Public Health Salem Board of Health Division of Food and Drugs 120 Washington Street,4'6 Floor 9 Salem, MA 01970-3523 FOOD ESTABLISHMENT INSPECTION REPORT Tel. (978) 741-1800 Fax (978) 745-0343 Name / Date TYoe_of Ooeration(s), Tyoe of Inspection //z 1,31 I Food Service ©Routine Address Risk ' 9-Retail ElRe-inspection 26S t ')n-, �>7 A I�� Level ❑ Residential Kitchen Previous Inspection Telephone - ❑ Mobile Date: OwnerI HACCP YM ❑ Temporary ElPre-operationC/I k � t_e 1� k �c I ❑ Caterer ❑ Suspect Illness Person in Charge(PIC) LL �.� �I ! I Time ❑ Bed&Breakfast El General HACCP Complaint c.� In: Inspector �VI Out: Permit No. El� 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 El_ 15.Toxic Chemicals FOOD FROM APPROVED SOURCE `�, '_ "" '_,71-", ." TIMElrEMPERATURE CONTROLS(Potentially Haiiidodi 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 POPULATIONS(HSP) ❑21. Food and Food Preparation for HSP ❑ 10. Proper Adequate Handwashing El11. 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)(590.004) cited in this report may result in suspension or revocation of i 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 5801nIp Fom 14 t Inspector's Si atur • Print:--� PIC'sSignature: Ow i Print: I PageZof ?-Pages /r ..K./ i i R Violations Related to Foodborne Illness Interventions and Risk Factors(Items 1-22) PROTECTION FROM CONTAMINATION FOOD PROTECTION MANAGEMENT 18 ( Cross-contamination 1 590.003(A) Assignment of Responsibility* 3-302.11(A)(1) I Raw Annual Foods Separated from 590.003(B) Demonstration of Knowledge" I Cooked and RTE Foods" 2-103.11 Person in charge-duties j Contamination from Raw Ingredients 3-302.11(A)(2) Raw Animal Foods Separated from Each EMPLO"EE 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 13-302.11(A) Food Protection" applicants* 3-30115 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 To The Person In I Utensils* Charge* Contamination from the Consumer 590.003(G) Reporting by Person in Charge* I 13-306.14(A)(B) I Returned Food and Reservice of Food' J 3 ( 590.003(D) Exclusions and Restrictions* ( IDisposition OfAdulterated orContaminated 590.003(E) Removal of Exclusions and Restrictions Food 3-701.11 Discarding or Reconditioning Unsafe FOOD FROM APPROVED SOURCE Fcod* _ d Food and Water From Regulated Sources j 19 Food Contact Surfaces 590.004(A-B) Compliance with Food Law* ' 4-50 L I 1 Manual Ware.washmg-Hot Water 13-201.12 Foal in a Hermetically Sealed Container* I Sanitization Tenmeratures* 3:.01.13 I Fluid Milk and Milk Products'" ( 4-501.112 Mechanical Warewashing-Hot Water 3-202.13 Shell Eggs* I Sanitization Temperatures* 3-202.14 Eggs and Milk Products.Pasteurized* ( 4-501.114 Chemical Sanitization-temp.,pH, concentration and hardness. 3-202.16 Ice Made tPotable Drinking Water' 14-601.11(A) Equipment Food Contact Surfaces and 5-101.11 Drinking Water from an.4pproved System" j Utensils Clean- 590.006(A) Bottled Drinking Water* I 590 006(B) Water Meets Standards in 310 CMR 22.0* j ( ='-60271 I Contact Surfaces an of Equipment Food- Shellfish and Fish From an Approved Source I Contact Surfaces and Utensils* 4-702.11 Frequency of Sanidzatton of Utensils and 3-201.14 Fish and Recreationally('aught Molluscan I I I Food Contact Surfaces of Equipment* _ Shellfish* 14-703.11 I Methods of Sanitization-Hot Water and 3-201.15 Molluscan Shellfish front NSSP Listed I Chemical" Sources* to Proper,Adequate Handwashing Game and Wild Mushrooms Approved by 1 11 Cl 301 2- . ean Condition-Hands and Anus" _ Regulatory Authority I I 1 3-202.18 Shellstock Identification Present* ( 12-30112 Cleaning Procedure* i 590.004(0) Wild Mushrooms* I ( 2-301.14 When to Wash* 3-201.17 Game Animals* I 11 t I Good Hygienic Practices 5 Receiving/Condition ( 12401.11 Eating.Drinking or Using Tobacco* 3-202.11 I PHF's Received at Proper Temperatures* 12-401.12 I Discharges From the Eyes, Nose and 3-202.15 I Package Integrity' I Mouth* 3-101.11 I Food Safe and Unadulterated* I 3-30 t.i2 I Preventing Contamination When Tasting* j 6 j Togs/Records:Shellstock I 112 Prevention of Contamination from Hands j 3-202.18 Shellstock Identification * j 590.004(E) Preventing Contamination from 3-203.12 Shellstock Identification Maintained* I Eumlovees* Tags/Records:Fish Products ( 113 I Handwash Facilities 3402.11 Parasite Destruction' I Convenienty Located and Accessible 3-402.12 Records,Creation and Retention* I i 5-203.11 Numbersand Capacities* - 590.004(7) I Labeling of Ingredients' I 5-204.11 Location and Placement* f 7 Conformance with Approved Procedures I 5-205.11 Accessibility.Operation and Maintenance /HACCP Plans I ( Supplied with Soap and Hand Drying 3-502.11 Specialized Processing Methods* Devices - - 3-502.12 Reduced oxygen packaging.criterial' ( 6-301.11 Handwashing Cleanser,Availability 18-103.12 Conformance with Approved Procedures- 16-301.12 Hand Drying Provision *Denotes critical item in the federal 1909 Fowl Code or 10fi CGbiR 590.000. )4 t CITY OF SALEM BOARD OF HEALTH Establishment Name: tv �0 Date: 717 1n_) Page: of Item Code . , -Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION tt Date R (( No. Reference` R-Red Item . - ; Verified PLEASE PRINT CLEARLY " ro 1)ou<.rz.r�l �teAAA. (T �. p✓S-s-r, Vivi/ / �/ - - t- - . - tf)t/oC-7 n.'�, crn 2`1'f U' Yrn��Ir, >�,i0 Gr ✓O/.� C t I th I ( V � aoP t� lof 5//�2�lcn I - 1Yj6-11•I to\1n t'f (7(� I_l ,� V/c,r ,t✓os C,(A( Qv�0- C1yC' /'V.(/> r,., 11014 .//ri [/ ✓LC c' /_ vlDvI. i ler,Ali nP (( U I A) .T rL7n pA \.)vt � II/'!,- C)c v-P � G' C !t n2 arut / LP G N t n c L)[n 1+ n p(�_ I__) A'bL- �l li f va 1n �-iA 4w4-e- � y I �1lbUtl:�l \)1 \7 C� rw 0C C %, GV` / 1/7St..�,nCI'%t.rte. I�ft to nw ��.r o r ).,t i l V0G,( n✓RC C'.>d P .tr4_0 (o r, 171 T r'9 /.> i f , v- aC C,t_ InD .r e_ rJC IJ Ufa rv9r„n [ I].,I r. t11 °1Zo\A1(i � r �Or� In Items Discussion With Person in Charge: Corrective Action Required: I ❑ No I El fes I have read this report, have had the opportunity to ask questions and agree to correct all ❑ Voluntary Compliance ❑ Employee Restriction Exclusion 'k 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 Ij noncompliance may result in daily fines of twenty-five dollars'or suspension/revocation of ❑ Embargo ❑ Emergency Closure your food permit. — // ❑ Voluntary Disposal ❑ Other: s � , PIIF.Recx-ivcd at Tesi es Violations Related to Foodborne Illness We"erilloos and Risk to Ia-,, Cooled to Factors(lflaftff I-&j (Cont) I wilhin Hllla� % C,61l, V,Fh�t'& rw VIIF PROTECTION FROM CHEMICALS I ;9 i PHF Hot and Cold Holding 14 Food or Color Additives i{i! ;6(Bi Colil at or liclow 02' - 2 1 ,-302,14 Ptotccnon froka Unakifin,ed A4daiws 15 Poisonous at Toxic Substances I lol I'lli", "Aainlawed;q Air aly 7 1{11.)1kJ l.)l I oitit'ving tnitamatum - Original 1<3fW R Hod a or awvc IjO'i it 20 Time as a Public Health Council ')-'0 0 1'ioi,�ti,, :! Mablio 11ealth Cocirl3l' 7-201.1 i 'Slidi�lukln slolagc�' I I Kcqrict too P;z,si fict,mid L Vr.r:aPce Requirctilenk 7-202,12 of Uw 7 203 11 Toxic Conlalwl: - REOUIREMENTS FOR HiGHLY SUSCEPTIBLE 1-204.11 POPULATIONS{HSP) -'S'�1,�1('%'� I 2 for-%',aVd, ..e, 7 204,14 Criwrilf 'Ath VN'irnillf,'1ab'W Nui'!11 6) t.'sc o pwiewiz�'d )-'05 105 11 Intilitwal Fes.xj Contact, Littiticants, 11�11ti,,li J,,CjXjj,,d l5dnolill F=Kid 7- ljtn.t! Rc,li-10rj Ps,ticide, ( ritell t' Kid Rjj:'r Sixd Sprott, N,1 scf4c4 i-204.12 1"Xient Balt statlom' 7 -06 13 13 1 T;Wk le' Plla der;; t"M(";;)tTU I-ind CONSUMER ADVISORY 2- -1 'W 1: (it TIMEITEMPERATURE CONTROLS I SA Proper Cooking Temperatures for Hsx!, I'tia, it.,, Ru:,'. k2l1&rCwkv'J o PHFs 061fwim: lo 11hiOnAte 4(1! 1 JA(1)(-') _ft� ' I � F�ggsI'i'F 13 E eg, Jinall-diiae qer icL 1F,51--!Spec� i7q:;"'Litieutilzi- rlil R;Aw slicif Aiiitmtls- !3Y'F is sec. B)t Ill SPECIAL REQUIRFMCENTS ( Owl, 1�nd 13��et Rkxisl - 11WT 12; mill nf Section �()OJI(OiAl-j Di in ' (A)i" Rallt, Ing,'t:d Mv,t�' - 155 F F`I c`L. ' "'Wriag, :Tlohili, li%x.1, icinporetcy and Z 3 401,1�tA) 1) i1rialtr NN ild Claim: Stutted PITT. j tcmdl'IWad kitchen opcil:flors Aould tie, swffl,ig('0111:1ilong F1.0, Melli, dchi-,d an&f t(,-, appri.priate ,`0'liolll Poultzv or R,ows t5sci. lo ftxKlburyle 3-till.i I fC)13 lllwe t B,:'f smd.s 111;-i vl;llticiqlc alid risf: ra-'-tors' Other 10"1' s9o.`titti violation',ronin, i(";(yksd r (0 pra,iwQx tiridvt #29 - )tau Awiwil Fo,&Cwkcd to a SP'!cfal 40 1A I?A i(!;f b; All 01thei PHF, - 14f 'I' !' spa , j IT Reheating for Hot Holding i VIOL A DONS REI.Arw To aclon RETAIL PRAcTwEs -;W',I I i A)&f 0) 165"F 15 sec (Itensiz 11-30) w3.1 ltii) Nficlimllyc- 1(5°P 2 R1,atrr;landing Ci"o:^a( 1!0"v I i0i'tpov't, .ii'lth do;iw relate;')tile inx- Comfner,,iitilv Prtx.,,':d RIJ-,KxNi Pin ofad Practices C I 590.0w 1 1 _40 3 11(F) Rolimillin-U;0lord pvrtit"Is of bc 2 3, Ma"we';Twili and Per�tinnei Fe - 2 003 4 c�-cu Food Freiecti(�n FC- 3 004 [if Proper Coaling of PHFs ['-5--' T, -T 1!3 ,EqLt;lnwni ind wensilo F" - 4 006 501 1'16\�) Cooling Cool,rd i'Hl-',q trein 1401 U) - - .-- I-.- T - I 1_26 Water,Ri.mblicanw.viel-t, 7u'i� within ? Haar:icid Froll0ti'l j ;j- ------ -- —- Phv�ic�g Factittv FC-6 '001 t,l 4 1 r J-145 F W-i-Hil-1 How!, 2s I PCQC;wui 0T"!Xlc FC' -7 ow '3 5f)1,141 B) CiWil,g PHR,Made Flom Ambicw 009 Tcaiperaltire it) 411,M"F, r -7 W'dhi ii 4 1 lk-ar, CITY OF SALEM BOARD OF HEALTH 1 Establishment Name: Date: 9//") Page: of Item Code C—Critical uem; DESCRIPTION OF VIOLATION/PLAN'OF CORRECTION Date No. Reference R—Red Item - .- - Verified PLEASE PRINT CLEARLY 1 h! IZ42 -//7u/�/-(I in d7 I I ti k I ' I I I 1 � 1 fl � J � Discussion With Person in Charge: Corrective Action Required: I ❑ No I ❑ Yes i I have read this report, have had the opportunity to ask questions and agree to correct all ❑ voluntary Compliance ❑ Employee Restriction Exclusion violations before the next inspection, to observe all conditions as described, and to ❑ Re-inspection Scheduled ❑ Emergency Suspension comply with all mandates of the Mass/Federal Food Code. I understand that noncompliance may result in daily fines of twenty-five dollars or suspension/revocation of ❑ Embargo ❑ Emergency Closure your food permit. j /�/ / �/ �� / ❑ Voluntary Disposal ❑ Other: '50, Violations Related to Foodhaine fitness Intprytintionr and Risk i fitco,,,liv to oolcd to Factors(Recta 1-22) (Coat.) ';'F -145`F Widi;u 4 Hoaj,z PROTECTION FROM CHEMICALS t C'mfing. M4 thfxj�for pHFf, 19 i PHF riot and Good Holding 14 Food or Color Additives I(ve, COtt PfIFS M=utc-ituxj at or t"Al"V 202-32 A(Uow, i IS ,-30')A4 i,16i A", Hol.i-H!s Maintained.q(f, abow Plet6on from Ad,hfty�s' Poisonous at Toxic Substances 146 F. 101.11 i(Itntolvina infift imii^n 7 102,11 Coianeon Narre -- Woeki7)L 21) Time at,a Pubile He3tth Control 1 7-2ol.I Stpttiuuon- slom,C" 7.2i)2.1 i lIft*trichor) -pff"tiWo alij U,,;" Vdr':M:•e R04tlirl 11n 7 202.12 Coad,kiow ttf U�,;' 7 2w, i I Toxic REQUIREMENTS FOR 41GHLY SUSCEPTIBLE -1204.1! Sdchj,__ejq.Crh(.rla he micfi!c' Poput iamof,is(HSP) 12 01,nllicals*,)I Waslurp, Cluez 21 11(A� Pic 1,aaaged juicts wid Bwwruaeit. wa)!*1jg I'aliels, 204 14 Di-vinit Aract,,Criteria' WB) of pwtelliized Ee'-n, air!.: 1w) K,itt-kr llaivaib;CAR)ked Aoiniiii Flux!anal?-'206-11 Rtt�iricwd t tfe Pe,ticidef,Criteli ti' 1 7-206.12 KIfticill lt8lh st:tlltqlt, i:tiw St"d !fpiroai,Not Served, 1:z Tracking Po%td,fr:, P-�s( aztd Ufl"P�fie,l pai:t aec Nol Re-,Crvefl, CONSUMER ADVISORY TIMEITEMPERATURE C014TROLS 22 1 f cfalApfl,:l Nci,itawpw,�j fwr Cmi(Ifrfpdkm of 16 Proper Cooking Teriperatutes fit F,xo,'that;irc ftw�v. Uriden.utl,,vd of PHFs �fot ice lfr�%,Sswd to FEMinate 3 101.1 IArl!(c; i I kel;gf- 155'F St:,'� 1 ;iiii'l P.i,lello/c,l F.F}v s,h:twule rot R,1W S101haMdi;tCL I F Conwidnw,di \4�-,t,� G�mw SPECIAL REQUIREMENTS 4,01.1 ulfhJ}i2) i "k)rt. ::fitj f,.at kt,ai,j j,)(r 1� I'] njj0 i sW)f if;Q(A)-�D in 4",1.i I(A){ K,life,, b.i,-ocd M"Itt, - 1�5-V is `acflila. 111011flz tkiscL tt�mporw and 3 401,1 It Ap,3) AwhT.�, W;ld(Lawe, Staffed 111ii-1, (",ld,nl:A kiwficil itlxlal;unAloilld be Ciaffillg 03al3Ining Fish, Meat, dehilcd tm-14:r the appropriate :ek tioaft P,miuyor it t,,c. I 41XIVC if I`QklttA 10 f01Xjbk)rnU iljl',CSI 3-401A hcyli tivact BCJSICAs wici venlila,--aild ris6 flactorq. Other 14,501, 't 5t)0.009 viol2tifillc Telauff,to t!m)d retail Anuu3l F0`Xl'(1'LX"6.Cd In 11 I pmojtot h(iftli be debits d zjtidt•r #29 - 163'F , I Sr-lxial kcqldrenlxjts 3-401A I(A)(I)i1i) All Othti Pit] 1,151: 15 icc I I 17 Reheating for Hot Holding VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 3403.1 IfA)&(0i lfhlft 10�T 35w, Ofewt,23-3!I7 3-40-1.11 lF) T, swffli.ng 11;;reel ::•hlule d"t,to; l't the T:rile' ;op tit �ii 41'" :4 f"t 1.'1,l;.)11.y f?h 1 r,A-lot i,fr, lixtvdaiwvr, f on be 403.1 i t C) Cornificicialb, III) Kx+d It,-attl ttf tb,fi,i h,wi,ig,ern,-ri, ,1 the F,wel Code aild 1,)i('114 R Wi0`1 ,,,9tt f100, --- 1--- - --- j-403 ! fE) Reinamin-, L:w1w.ftl Pi t' ilea! Good Retail Prochae� — -- - -- AC L9L '1'1a!aQf!ty1t'r4 a0t,'Pta4onvei I F(; i %3 18 proper Coaling of ptirr, F,"t!Iil Flied Pmitfctfoll i FC 3 W4 and Utensils f FC,-4 005 3-501A4(A) C(hling C;xfk;"d pfll-< hom 1 lf)'17 to �c "; - -6 Water,R��mbrltiand 11joste im 7t F Within I Hour,and From 70�1' ------------- - thn�ral ra-lqy FC,-G 007 26, P,10qj,s Cr T,),,, 50I.14(fi) Cocfipl�,Ptll-s Mi4cle Frout Ambient RxalirernentF 11 T rcinpaittlup litgre'lielti,l"4 1,I,i45 F Within 4 non.In th,L,kczt' IWN FiftiC, !,r,f 105 Ch71i 08/13/07 14:38 KFS -- CEOCHRO14 � 19787409705 NQ.038 903 - Analytical Services KRUEGER for the Food industry FoCID 45 Manning Road,Billerica,MA 016211.3934 www.kfi.com•dkruegerOkfl.com __�®LABORATORIES, INC. 976-667.6900•f 979667.6999 t CERTIFICATE OF ANALYSIS Submitted by: Date Reported. 8/13107 Date Received: 816107 Everett Hobbs E.W. Hobbs 207 Fort Avenue Salem, MA 01970 I Reference: Sampling Month -August 2007 PO A. ° Description Your Sample Number Our Lab Number i Ice Cream Sampled 616107,6°F, Kahlua Chip 77508 STANDARD PLATE COUNT Ofuig 400 COLIFORMS-VRB ofu/g <1 Standard Plate Count should be less than 50000 cfu/g. Coliforms should be less than 20 cfulg. Methods:APHA,Standard Methods for the Examination of Dairy Products, 16th Ed., 1992, Parts 6.2 (Standard Plate Count)and 7.8(Coliforms). By:`a(/y 15804✓19343 2125 77508(8/13107) Page 1 of 1 08/13/07 14:38 ICFL - GEOCHRON 4 19787409705 tlo.038 D04 Anall(tiCal Services KRuEGER for the Food Industry FOOD 45 Manning Road,Billerica,MA OIM-3934 www.kfixom•dkrueger@kfl.com LABORATORIES, INC. 978.667.6900•IF 978.667.6999 i CERTIFICATE OF ANALYSIS Submitted by: Date Reported: 8/13/07 Date Received: 8/6107 Everett Hobbs E.W. Hobbs 207 Fort Avenue Salem, MA 01970 e Reference: Sampling Month-August 2007 PO A. ! Description Your Sample Number Our Lab Number Ice Cream Sampled 8/6107,6°F, Oreo 77509 STANDARD PLATE COUNT ctutg 910 COLIFORMS-VRB cfulg <1 Standard Plate Count should be less than 50000 ctulg. Coliforms should be less than 20 cfu/g. Methods:APHA,Standard Methods for the Examination of Dairy Products, 16th Ed., 1992,Parts 6.2 (Standard Plate Count)and 7.8(Coliforms). ey:t� 15804 19343 2125 77509(8113/07) Page 1 of 1 08/13/07 14:36 KFL – GEOCHRON 4 19787409705 NO.038 D02 l MEGER for the ndustry FOOD 45 Manning Road,Billerica,MA 01921.3934 — LABORATORIES, INC. ww 978-com•tl *f 97 -667.6om 9T9-fifi1�6900•f 979-fifi7�fi999 CERTIFICATE OF ANALYSIS Submitted by: Date Reported: 6/13/07 Date Received. 8/6/07 Everett Hobbs E.W. Hobbs 207 Fort Avenue Salem, MA 01970 Reference: Sampling Month -August 2007 PO A. i Description Your Sample Number Our Lab Number Ice Cream Sampled 816/07,6'F, Marshmallow 77507 STANDARD PLATE COUNT cfu/g 750 COLIFORMS•VRB cfu/g <1 Standard Plate Count should be less than 50000 cfu/g. Coliforms should be less than 20 cfu/g. Methods:APHA,Standard Methods for the Examination of Dairy Products, 16th Ed., 1992,Parts 6.2 (Standard Plate Count)and 7.8(Coliforms). B 15804 19343 2125 77507 (8/13/07) Page 1 of 1 07/18/07 09:18 KFL — GEOCHRON i 19787409705 NO.004 904 _ KRUEGER for anaNncat services the Food industry FOOD 45 Manning Road,Blitenta,MA 01821-3934 om IS LABORATORIES, INC. X978 6i6WO:f978 6571-69M I _ Il i CERTIFICATE OF ANALYSIS V 1 Submitted by.- DateReported, 7!17!07 Date Received: 7/10/07 Everett Hobbs " E.W. Hobbs 207 Fort Avenue Salem, MA 01970 Reference: Sampling Month-July 2007 PO#.- Description :Description Your Sample Number Our Lab Number Ice Cream Sampled 7/10/07,8°F,Cookie Dough 77237 STANDARD PLATE COUNT cfu/g 570 COLIFORMS-VRB cfu/a <t Standard Plate Count should be less than 50000 cfu/g. Conforms should be less than 20 cfu/g. Methods:APHA,Standard Methods for the Examination of Dairy Products, 18th Ed., 1992, Parts 8.2 (Standard Plate Count)and 7.8(Coliforms), By: 15704 19227 2125 77237(7/17/07) Page 1 of 1 07/18/07 09:18 KFS - UEOCI-PON 4 19-67409705 NO.004 D01 l 2ER Phone:(978)667.6000 Fboo Fax:(978)66 -6999 R.Gorn Email:dknaeger�k8.aom KRuE t' ``fit �n website:www.kfl.com 1 ABO RA 0RIM INC. 45 Manning Road,BR NOW,MA 01821 USA I FACSIMILE TRANSMITTAL FORM FAX#: (978) 6676999 Date: 7/18/2007 PLEASE DELIVER T0: Joanne Scott Salem Health Department 976 740 9705 Pages to Follow: 3 Sender's Name: Evangeline Lavoie DOCUMENTS TO Certificate of Analysis for Sample Numbers: FOLLOW: 77235-237 PLEASE NOTE: All analytical results should be considered preliminary and are subject to further review until the final report Is issued. If problems are experienced with this transmittal, please call (976)667-6900, 07/18/07 09:18 KFL — 6EOCtRON 4 19787409705 NO.004 D02 KRUEGER analytical services for the Food industry FOOD 45 Manning Road,Billerica,MA 01821.3934 INC. WWW.kfi.com.dkrueger®kfl.com Ji>?)LABORATORIES, C 978.667.6900•f 979.667-6999 CERTIFICATE OF ANALYSIS i Submitted by. Date Reported: 7/17/07 Date Received: 7/10/07 Everett Hobbs E.W. Hobbs 207 Fort Avenue Salem, MA 01970 Reference: Sampling Month-July 2007 PO#.- Description :Description Your Sample Number Our Lab Number lee Cream Sampled 7/10107,6-F, Pistachio 77235 STANDARD PLATE COUNT cfu/g <250 COLIFORMS-VRB cfu/g 1 Standard Plate Count should be less than 50000 ding. Coliforms should be less than 20 duig. Methods:APHA,Standard Methods for the Examination of Dairy Products, 16th Ed., 1992,Parts 62 (Standard Plate Count)and 7.8(Coliforms). I F By:7Y p�f� i r Ijj 15704 19227 2125 77235(7/17107) Page 1 of 1 4 07/18/07 09.18 KFS - GEOCHROI i 19787409705 N0.004 903 ll KRUEGERAnalytical Services for the Food industry FOOD 45 Maratha Road,alilenca,MA 01821.3934 - AABORATORIES, INC. WAV979 667.6900,f 99778-6867-6999 CERTIFICATE OF ANALYSIS Submitted by: Date Reported: 7117107 Date Received: 7110/07 Everett Hobbs EW. Hobbs 207 Fort Avenue Salem, MA 01970 Reference; Sampling Month-July 2007 PO#: Descdpwn Your Sample Number Our Lab Number Ice Cream Sampled 7/10107,6°F,Raspberry Sorbet 77236 STANDARD PLATE COUNT cfu/g <250 COLIFORMS-VRB du/9 <1 Standard Plate Count should be less than 60000 cfu/g, Coliforms should be fess than 20 cfu/g. Methods:APHA,Standard Methods for the Examination of Dairy Products, 16th Ed., 1992,Parts 6.2 (Standard Plate Count)and 7.8(Coliforms). I By: 15704 19227 2126 77236(7/17/07) Page 1 of 1 h 06/13/07 13:19 KFS - C-€OCHRON 4 19787409705 N0.019 D02 1I KRUEGER Analytical Services for the Food Industry -{ - FOOD 45 Manning Road,Billerica,MA(0213934 - INC. WWW.kfl.com•dkrueger®kfl.com --�O LABORATORIES, C 978.667-MO•f 978.667.6999 CERTIFICATE OF ANALYSIS Submitted by: Date Reported: 6/11/07 Date Received., 615107 Everett Hobbs E.W.Hobbs 207 Fort Avenue Salem,MA 01970 Reference: Sampling Month -June 2007 PO#. Description Your Sample Number Our Lab Number Ice Cream Sampled 6/5/07,8°F,Vanilla 76891 STANDARD PLATE COUNT cfulg 2100 COLIFORMS -VRB cfu/g <t Standard Plate Count should be less than 50000 cfu/g. Coliforms should be less than 20 cfu/g. Methods:APHA,Standard Methods for the Examination of Dairy Products, 16th Ed., 1992,Parts 6.2 (Standard Plate Count)and 7.8(Coliforms). RECEIVED JUN 13 2001 ByA N 16589 19099 2125 76691 (6111107) Page 1 of 1 66/13/07 13:19 KFL - 6EOCHRON 19787409705 NO_019 904 oil Analytical Services _ ICRUEGER for the Food Industry FoOD 45 Manning Road,Billerica,MA 01821-3934 _j www.kfi.com•dkrueger®kfi.com �®LABORATORIES, INC. 978-667-69DO•1978-667-6999 CERTIFICATE OF ANALYSIS Submitted by: Date Reported., 6/11/07 Date Received: 615107 Everett Hobbs E.W.Hobbs 207 Fort Avenue Salem, MA 01970 Reference: Sampling Month-June 2007 PO A Description Your Sample Number Our Lab Number Ice Cream Sampled 6/5/07,8°F, M 8 M 76893 STANDARD PLATE COUNT cfuig 1500 COLIFORMS-VRB cfu/g <1 Standard Plate Count should be less than 50000 cfu/g. Coliforms should be less than 20 cfu/g. Methods:APHA,Standard Methods for the Examination of Dairy Products, 16th Ed., 1992,Parts 6.2 (Standard Plate Count)and 7.8(Conforms). JUN 3 2001 rA AL"M By- 1658919099 2125 76893(6111/07) Page 1 of 1 06/13/07 13:19 KFL — GEOCHRON 4 19787109705 NO.019 901 KwEG ER Phone:(978)667-6900 FoG.O D Fax:(979)667-6999 Email:dkrueger@kfl.com , •w opnI� Websile:www.k6.com LABo ® RAmm y INC. 45 Manning Road,Billerica,MA 01821 USA FACSIMILE TRANSMITTAL FORM FAX#: (978) 667-6999 Date: 6/13/2007 PLEASE DELIVER TO: Joanne Scott Salem Health Department 978 740 9705 Pages to Follow: 3 Sender's Name: Evangeline Lavoie DOCUMENTS TO Certificate of Analysis for Sample Numbers: FOLLOW: 76891-893 JUN 12 2007 PLEASE NOTE: All analytical results should be considered preliminary and are subject to further review until the final report is issued. i If problems are experienced with this transmittal, please call(617)876.9118. 06/13/07 13:19 KFS — 6EOCHRON d 19787409705 N0.019 D03 Analytical Services_ KRUEGER for the Food Industry - FoOD 45 Manning Road.Billerica,MA 01821.3934 j WWW.kfi.com*dkrueger®kfl.com _AABORATORIES, INC. 978.667-69M•f 978.667.6999 a CERTIFICATE OF ANALYSIS l Submitted by: Date Reported: 6/11107 Date Received: 6/5107 Everett Hobbs E.W. Hobbs 207 Fort Avenue Satem, MA 01970 Reference: Sampling Month -June 2007 PO#: Description Your Sample Number Our Lab Number Ice Cream Sampled 6/5/07,8°F, Strawberry 76892 STANDARD PLATE COUNT cfuig 1600 COLIFORMS -VRB cfu/g <1 Standard Plate Count should be less than 50000 cfu/g. Coliforms should be less than 20 cfu/g. Methods:APHA,Standard Methods for the Examination of Dairy Products;16ttl Ed., 1992.Parts 6.2 (Standard Plate Count)and 7.8(Coliforms). qq CCE ED ', JUN 13 2001 Ry: 15589 19099 2125 76892(6/11/07) Page 1 of 1 s / 20& 0 9 05/23/07 08:58 KFL — GEOCHRON -) 19787409705 NO.037 D03 lI Analytical for e Food Services • FOOD 45 Manning Road,Billerica,MA 01821-3934 J®LABORATORIES, INC. ww 978.66 6900•f 978.6667.69 9 CERTIFICATE OF ANALYSIS Submitted by: Date Reported: 5/21/07 Date Received: 5/14/07 Everett Hobbs E.W. Hobbs 207 Fort Avenue Salem, MA 01970 Reference: Sampling Month-May 2007 PO#: Description Your Sample Number Our Lab Number Ice Cream Sampled 5/12/07, 6°F,Chocolate Chip 76580 STANDARD PLATE COUNT cfu/g 410 COLIFORMS-VRB efuig <1 Standard Plate Count should be less than 50000 cfu/g. Coliforms should be less than 20 cfu/g, Methods:APHA, Standard Methods for the Examination of Dalry Products, 16th Ed., 1992, Parts 6.2 (Standard Plate Count)and 7.8(Collforms). C� eLrs OF c�P� yCN oOFN Bygrd� :! 15501 18988 2125 76580(5/21/07) Page 1 of 1 i 05/23/07 08:58 KFL — GEOCHRON > 19787409705 NO.037 1702 i Anatcal Services KRUEGER for the Food i dustrit FOOD 4s Manning Road.Billerica,MA 01821-3934 �®LABORATORIES, INC. '°"978 67 6900-f 978-667-6999 CERTIFICATE OF ANALYSIS Submitted by. Date Reported: 5/21/07 Date Received: 5/14107 Everett Hobbs E.W. Hobbs 207 Fort Avenue Salem, MA 01970 Reference: Sampling Month-May 2007 PO A Description Your Sample Number Our Lab Number Ice Cream Sampled 5/12/07,6-F,Vanilla 76579 STANDARD PLATE COUNT cfu/g 370 COLIFORMS-VRB cfu/g <1 Standard Plate Count should be less than 50000 cfu/g. Coliforms should be less than 20 cfu/g. Methods:APHA, Standard Methods for the Examination of Dairy Products, 16th Ed., 1992, Parts 6.2 (Standard Plate Count)and 7.8(Coliforms). Mev _P�EN�,M By-A 15501 18988 2126 76579(5/21/07) Page 1 of 1 05/23/07 08:58 KFL - GEOCHRON 4 197B7409705 N0.037 PO4 AnalydCal SerVICeS KRUEGER for the Food industry FOOD 45 Manning Road,Billerica,MA 01821.3934 www.kfi.com•dkrueger®kfl.com J®LABORATORIES, INC. 978-667-6900•f 978.667-6999 CERTIFICATE OF ANALYSIS Submitted by. Date Reported: 5/21/07 Date Received: 5/14/07 Everett Hobbs E.W. Hobbs 207 Fort Avenue Salem, MA 01970 Reference: Sampling Month-May 2007 PO Description Your Sample Number Our Lab Number lee Cream Sampled 5/12/07, 6°F, Strawberry 76581 STANDARD PLATE COUNT cfu/g <250 COLIFORMS•VRB cfu/g <1 Standard Plate Count should be less than 50000 cfu/g. Coliforms should be less than 20 cfulg. Methods:APHA, Standard Methods for the Examination of Dalry Products, 16th Ed., 1992,Parts 6.2 (Standard Plate Count)and 7.8(Coliforms). CEI��CL) MAY 2 3 2007 CII Y Ur o"_,vl t30ARD OF HEALTH By� 15501 18988 2125 76581 (5/21/07) Page 1 of 1 7lsland Avenue E. W. Hobbs City of Salem FOOD SERVICE ESTABLISHMENT - FOOD SERVICE Inspection HACCP: ❑ Item Status Violation Critical Urgency Telephone: I FOOD PROTECTION MANAGEMENT 745-7691 PIC Assigned/Knowledgeable/Duties PASSd❑ RED Owner: Non-compliance with: Everett W. Hobbs Anti-Choking PASS PIC: Charles Hobbs Tobacco PASS Inspector: John Gehan EMPLOYEE HEALTH Date Inspected:Correct By: Reporting of Diseases by Food Employee and PIC PASS ❑� RED 5/24/2007 Personnel with Infections Restricted/Excluded PASS ❑d RED Risk Level: FOOD FROM APPROVED SOURCE Permit Number: Food and Water from Approved Source PASS RED BHP-2007-0428 Receiving/Condition PASS ❑Q RED Status: VIOLATION Tags/Records/Accuracy of Ingredient Statements PASS RED #of Critical Violations: I Conformance with Approved Procedures/HACCP Plans PASS ❑d RED 0 Time IN: Time OUT Urgency Description(s): BLUE: ` Violations Related to Good f 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. May 24,2007 ) Page I of Item Status Violation Critical Urgency RED: PROTECTION FROM CONTAMINATION Violations Related to Separation/Segregation/Protection PASSd❑ RED Foodborne Illness Interventions and Risk Factors (Require Food Contact Surfaces Cleaning and Sanitizing PASSd❑ RED immediate corrective action) Proper Adequate Handwashing PASS ❑J RED Good Hygienic Practices PASS RED Prevention of Contamination from Hands PASS 0 RED Handwash Facilities PASS RED PROTECTION FROM CHEMICALS Approved Food or Color Additives PASS RED Toxic Chemicals PASS RED TIME/TEMPERATURE CONTROLS(Potentially Hazardous Foods) Cooking Temperatures PASSd❑ RED Reheating PASS 0 RED Cooling PASS 0 RED Hot and Cold Holding PASS RED Time As a Public Health Control PASS 0 RED REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) Food and Food Preparation for HSP PASS RED CONSUMER ADVISORY Posting of Consumer Advisories PASS RED City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741-1800 GeoTMS®2007 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. May 24,2007 ) Page 2 of Item Status Violation Critical Urgency Violations Related to Good Retail Practices (Blue Items) Food and Food Protection PASS BLUE Equipment and Utensils PASS BLUE Water,Plumbing and Waste PASS BLUE Physical Facility PASS BLUE Management and Personnel PASS BLUE Poisonous or Toxic Materials PASS BLUE Special Requirements PASS BLUE Other-See Notes PASS BLUE GENERAL COMMENTS: This establishment is opening its grill side of the buisness on May 26, 2007. All requirements to open have been met and are satisfactory. 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. May 24,2007 ) Page 3 of 7 Island Avenue E.W. Hobbs City of Salem FOOD SERVICE ESTABLISHMENT - FOOD SERVICE Inspection HACCP: ❑ Item Status Violation Critical Urgency Telephone: FOOD PROTECTION MANAGEMENT 745-7691 PIC Assigned/Knowledgeable/Duties PASS ❑d RED Owner: Non-compliance with: Everett W. Hobbs Anti-Choking PASS PIC: Charles Hobbs Tobacco PASS Inspector: EMPLOYEE HEALTH David Greenbaum Date Inspected:Correct By: Reporting of Diseases by Food Employee and PIC PASS RED 4/5/2007 Personnel with Infections Restricted/Excluded PASS [� RED Risk Level: FOOD FROM APPROVED SOURCE Permit Number: Food and Water from Approved Source PASS RED BHP-2007-0428 Receiving/Condition PASS RED Status: SIGNED OFF Tags/Records/Accuracy of Ingredient Statements PASS RED #Of Critical Violations: Conformance with Approved Procedures/HACCP Plans PASS RED 0 Time IN Time OUT. Urgency Description(s): BLUE: Violations Related to Good Retail Practices (Critical violations must be corrected immediately or within 10 days)(Non-critical violations must be corrected immediately or within 90 days) City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741-1800 GeoTMS®2007 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Apr 06,2007 ) Page 1 of Item Status Violation Critical Urgency RED: PROTECTION FROM CONTAMINATION Violations Related to Separation/Segregation/Protection PASS RED Foodborne Illness Interventions and Risk Factors (Require Food Contact Surfaces Cleaning and Sanitizing PASS ❑d RED immediate corrective action) Proper Adequate Handwashing PASS RED Good Hygienic Practices PASS RED Prevention of Contamination from Hands PASS RED Handwash Facilities PASS RED PROTECTION FROM CHEMICALS Approved Food or Color Additives PASS 0 RED Toxic Chemicals PASS RED TIMEfTEMPERATURE CONTROLS(Potentially Hazardous Foods) Cooking Temperatures PASS RED Reheating PASS RED Cooling PASS RED Hot and Cold Holding PASS RED Time As a Public Health Control PASS 0 RED REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) Food and Food Preparation for HSP PASSd❑ RED CONSUMER ADVISORY Posting of Consumer Advisories PASS RED City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741.1800 GeoTMS®2007 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Apr 06,2007 ) Page 2 of Item Status Violation Critical Urgency Violations Related to Good Retail Practices (Blue Items) Food and Food Protection PASS BLUE Equipment and Utensils PASS BLUE Water, Plumbing and Waste PASS BLUE Physical Facility PASS BLUE Management and Personnel PASS BLUE Poisonous or Toxic Materials PASS BLUE Special Requirements PASS BLUE Other-See Notes PASS BLUE GENERAL COMMENTS: This establishment is opening the ice cream and popcorn side of the business on April 7, 2007. Owner will call the Board of Health one week prior to opening any other food services for an opening inspection. All other requirements to open for the ice cream and popcorn side have been satisfied. City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741-1800 GeoTMSO 2007 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Apr 06,2007 ) Page 3 of y�.'y qa Yp,`a y,y'yftjv;qp4 V'Y'!i.' �a4..:�1,,.0{"SP� A. Y"✓✓Y✓�' *i{v '�h '��t�_ .✓5Y Yt',y YV..Y.' ^"" (^''��4.�!#�.°.M^�lV •`L-TM4 ��s �Yw' .��. �'W..''qr£.-��43. .4 'k r - �+� M1*w:r-• ik,;ono.,morntak... r,..s;'C ..ecw.w. Commonwealth,of Massachusetts ti.r� �.Mj,. Aw}i' �.^-..,�„ rF;, :. -y'.r.:grtw- .* ' r ,3' '4'i;,. 'k ,ar,.,}y+h>~ j.. ,:. 'iM::, "-^ ,"it r y ...r ;e..'.�'.x 5:...y..:is' m,;.'4sr.=�$ c, r Ci of SBlemr �'� ; f "t a Board of Health i°;.:# z: s �Il ..IQmbeilb iey Driooil Ill. ,� ,_. ti+ -i20Washin ton Stree4 4th Floor".;< '.ox?`:' *. a:. .�,:.at' y .� SALEM,MA 01970 Food/Retail Establishment Permit DATE PRINTED: 03/07/2007 ESTABLISHMENT NAME: E.W. Hobbs File Number:BHF-2004-000133 7 Island Avenue Salem MA 01970 LOCATED AT: SALEM, MA 01970 Permit Type Permit No. Permit Issued Permit Expires Fee Restrictions/Notes FOOD SERVICE BHP-2007-0428 Mar 7,2007 Dec 31,2007 $100.00 ESTABLISHMENT FROZEN DESSERTS BHP-2007-0430 Mar 7,2007 Dec 31,2007 $5.00 April-Oct. / WATER SOURCE: CITY WATER SEWER DISP: CITY WATER RETAIL FOOD BHP-2007-0431 Mar 7,2007 Dec 31,2007 $100.00 Total Fees: $205.00 PERMIT EXPIRES December 31, 2007 Board of Health *W4-c� V This Permit is not transferable and must be reissued upon change of ownership or location. The permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code, beofre any revonations, improvements,or equipment changes are made, all plans for such must be submitted to and approved by the Salem Board of Health. Page 1 of 1 CITY OF SALEM, MASSACHUSETTS BOARD HEALTH S � �q ,,,,.� s 120 WASHINGTON STREET, 4TH FLOOR � � `�'1P.�e SALEM, MA 01970 TEL. 978-741-1800 FFR 2 72007 FAx 978-745-0343 CITY OF SALEM Kimberley Driscoll www.sALEM.coM BOARD OF HEALTH Mayor JOANNE ScoTT, MPH, RS, CHO HEALTH AGENT 2007 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT NAME OF ESTABLISHMENT I•-o W, F�(OID+1S ttine TEL# 7Y- 7'-•l�' 7(,G ADDRESS OF ESTABLISHMENT :;3' - ALg FOlfy 4e. FAX# MAILING ADDRESS(if different) -7 -T-JarXA Ave, EMAIL--Business': Owner's: OWNER'S NAME 1—::ijor94 \,(F, 4A bc, t - TEL# qn- ADDRESS -7 �SlCtr"X_�l Ave lJtrY) M o )q7(3 STREET '' ✓✓ � 1CITY STATE ZIP CERTIFIED FOOD MANAGERS NAME(S) CERTIFICATE#(S) 1 ;;booS/V7 T (Required in an establishment where potentially hazardous food is prepared) e� EMERGENCY RESPONSE PERSON l t LOL ��C1 HOME TEL# q7t --7(4 ' 6 -S I DAYS Of OPERATION Monday Tuesday Wednesday Thursday Friday Saturday Sunday ROUASOFOPIRATIOM 1 Please write in timeefday. 11Aft)-4" 0 - lop') I (OP,n, il- VI w IopNl IO- I}prn to- Ilp'n [Fdrexamplettam-11pm1 - - i TYPE OF ESTABLISHMENT FEE (check oniv) RETAIL STORE (YES 3 NO less than 1000sq.ft. =$ 50 ��— 1000-10,000sq.ft. 4/=$100 more than 10,000sq.ft. =$250 - - - - ------ -------------- - -- - - ------ ---------- ... ..._.. .--.... - ....-...... - - - -- --- RESTAURANT YES NO less than 25 seats 25-99 seats =$150 more than 99 seats =$200 . .......... . .._.T..-._...--. ... ....- - - --- ---- ----- ---- ---- -._. -..._. --- --._. .-._..--- .-- ---------------------- - -.-.... ... BED/BREAKFAST YES NO 51"0,-0 ------------- ---- --------- .. .... -- ..... ....---..... .....-. .....- --- ...--.... ........ .... ..... --- ADDITIONAL PERMITS MAKE (not just serve) ICE CREAM, YOGURT, SOFT SERVF YES NO $5 TOBACCO VENDOR S NO $50 ALL NON-PROFIT(such as church kitchens) YE_S NO $25 Please pay total with one check payable to the City of Salem. This Permit is not transferable and must be reissued upon change of ownership. The Permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code, before any renovations, improvements, or equipment changes are made, all plans for such must be submitted to and approved by the Salem Board of Health. Pursuant to MGL Chapter 62C, Section 49A, I certify under the pains and penalties of perjury that I, to my best knowledge and belief, have filed all state tax returns and paid all state taxes required under the law Signature ✓ Date 'Social Security or Federal Identification Number - — — --------------- ----- ----- - ----- - ------------ ---------------- ------ ---- ----- - --- ----- Revised t I03/0b FOOf)AP2007 adm Check#8 Dat IMAORTANT MESSAGE FOR 6onnnc A.M. DATE �� 3/ 0�7 TIME _1—LP. MI OF PHONE AREA CODE NUMBER EXTENSION O FAX ❑ MOBII F TELEPHONED AREA coV/Di / NUMBER TIME TO CALL PLEASE CALL CAME TO SEE YOU I WILL CALL AGAIN WANTS TO SEE YOU I RUSH RETURNED YOUR CALL I WILL FAX�TO YOU SIGNED 1 FORM 4009 -- MADE IN U.S.A. NOTES ( IMPORTANT MESSAGE ) FOR ff DATE TIME -� P.M. M OF PHONE AREA CODE NUMBER EXTENSION 0 FAX 0 MOSII G AREA CODE NU BER TIME TO CALL TELEPHONED PLEASE CALL CAME TO SEE YOU WILL CALL AGAIN WANTS TO SEE YOU I RUSH RETURNED YOUR CALL WILL FAX TO YOU MESSAGE �-�� ✓ b(o /S D/I -A 41� -9/S DJ? A�z2i S � SIGNED uDj FORM N HOSES ENDEAVOUR CORPORATION Consultants in the Engineering Sciences 34 Rockland Sveet,Swampscott,MA 01907 781.581.2454 9 March 2007 REPAIR SPECIFICATION For CRACKING DISTRESS in CONCRETE FLOOR SLAB Including the addition of a HIGH-PERFORMANCE COATING E. W. HOBBS,Inc.,ICE CREAM PARLOR 1. Seal all cracks with R41; 2. Treat slab with Epoxoprime 201; 3. Treat slab with Tneme-Glaze 280 Preparations and application procedures to be in accordance with the manufacturer's recommendations. See attachments. R16HTER 6RQOP, I H ( . FAX X 8 3jc' To., Wi6te Hobbs is From: Pam Runge Company: !Company: Righter Group, Ina Fax: 978-7444646 y Fan: (800)988-9824 a Phone: y Phone: (978)642-2315 Date f Time. 318107 3:26 PM Total Pages Sent(induding this one) 7 CormmeMS: MR 690, K. 11 Upas D* Wlakow A 01687 it OMMI ha: 8M9).1410 www. -771 , t Epoxoprime"I" SERIES 201 OEM MMM htodbficd h4liolo ne F4rosy COi1NDU f figh-ad-sls rnaistme b+4rmnr q oay Paul for primigg ca ram,nesod and drywall.Also as a shand3bme anc- cmr clear floor scaler. CM Clear Noce:Rpuuer chalk add yellow witb sgtl conceded esposum or UV and artificial lighting Leek of veno. lathe,incomplete misb%mpeanlyeation a the Pete of brawn thatnnit mboo diive*Dol carbon numislde during 2pplim6n and initial singes of eurmg may cause amine bhmh,possibly affecting adhesion of subsr- gnunruptaim. Stra Meld SURFtWFfl1ER/P C1H Series 63.1SAID,1314214.21$219 ®� mine:A repair kir of 811,with Pan C fumed itin. t available:fru nnall ppr representative orng repairs For moat ca:endve rryroin and additional mlurmadun,wnott your T.enum mprcasmmtnc orTnemew'I'cibnieal Scrvires TOWS Series 204 210,222.213,224,117,2311,137,270,273,275,280,281,282,434,435. FLOOD AND pati 10A10a1 Note.8efc(h)We applicable mpwat Hato sheet fur culur avolabi8ly and Ink iouml infurmatum- Pmpate surfimcs 11 enedmd raimbk faregxttttre and fer4reL' HOWOM(DAWF Allow new macaw to ease 28 days Verify drytsss by eating for mnh utrw•vh a"plastic film npcdown real(Rufererwe.•1xrm D 4263).Should mnMNm be dettered,pert rm'ionA rJ Ten Method fur hlcac,a- uM Moisture Vapor Faoraiun Ram of Cmerrm SubBulu Using Anhydriim raiders Chkuidt"(Reference ASTM 1+1869).Moisture cone out a,csnxd duce pounds per 1,188)a0 ft in a 24 how pudud.Shut-bbut ser na.rhanieally abrade•In no"urc luitence,curing mnapnumlx,hardeners,bealera and urha6 cranrunmAnts and u pwvulc eurLrc pmhle(Rnfomnec SSPE:-ST+I3,)C71)f:51b 3 ruse 0) lmgr snots and other ravitics should be bllvd with rrcwnmontbx!fill"or surfacer. VfRnW CRi!)iAE Allow new on—to ar 28 dm Aborrive Magor mechanically abrade concrete m seem,lab=,harm relvau aV,amts,curing"mspounds,hard nen;uidas aril oder rmnmiamnn:ud to provide sufiax pen file (Rn fit.Pence SSPC-Sp13). CMU Alhar new mortar a rust 28 days Surftcer mart be chain,dry roam)and free of all coownironu Gavel all psotutivns and motrar spate, OM4YIdL Band joint compound smwtth and Ycmhet edge. WOM Sind wegit meaA SmI knom and pinch packets,Nit etaf,a and and huhu Imus primer Is Mpronad. PREM AYFOIEDS1IRM 0astact year Tnv.ee rcpnaamoutim AIL SUMM Hat be clean,r:lmi,*dry and(ret of Petr grease,cmng ebmpnunds/soden,barricades and uhm,ma ranr- nnnm.Appl'rcmion Will alarm seaidusl duMa fmna surface pte4handoo pm"ss but not puddird wirer, glistening conerem ser inhenml)y war cauterize. VOUVAf SOLIDS I'm%(nbiaxO RKOMMEBDE)DR Ctmeaete:Rruisamtat:&0 m 120 mils(150 to 315 truernm)per coat.Verdea b 41)to 6.0 mils(1(m)in 1 SO IrMmms)per omr. Dlyaram A Wood.4.11 to ho mils(1114)u 150 nostrum)per rust—swn cants applied of 30 u 45 Prime: mmnml, an IN 'R•mpeverace Maaiawsa Recast Time its,Pi■ee is service 1 7,'1--(24-C) 24 hours 1 7,4 Musa I Curing Flint,varies wnh aufine n mptmum,ab ats"mcr.t,humidity and film dikimma VeufOa lwoun When used as a tink fining or in civItes d amt;pmAdt adetpwu•nnrdntion din!",application and cam.Reremue ventilation giridulines contained in the latest"litbm of AW WA D 102 Note:If Series 2DI it mud as the priom Gtr a trimer syaem,the=I=applir dem should coke place while the Seder 201 is still mckv, gpi=Hy rip to fiver lumen,nnccmi.,aggnyme shuuld bre VItly bVIDLILAal into the primer sn u pomtitk mouth In hold the maraca in place when ejuriel,Wher,tie Sen v 21116 until ata veatiral rix hadrnnol pdmcr fns,a thin film syst"q the 201 vluruki M•nlivived in dry tram(widvxu urnxding the 24 hour mann wuuhe,.I f Serka 201 is Iasd ;a the punier fur the Scdcs 2711 or 275 Soamlok ysx• the Sears 201 should be Aimed u nail up fur appmai- ,mmly one to liter hours dcyxrading upon empcmwre but nor allowed in dry hard. VIRILE ORCAYI( Undansitill COMPOUNDS 0,211hb/gnllun (25 grams/litre) NUMBER(i(DRPONENIS 7bn:pan A and Part R C para A m I Patz R by"al urw) PALN11iHG PART A PART a Yield(sabred) Hxtn frig,Kit 255 gn14m drums 1-55 gallon drinn 165 gallons I ware Kit 7-5 gallon pails ( 1.5 Ration tall 15 evlhms l ,.tea I Small Kit 2-1 cadhm cans I.1 Rnilon can 3 Raihms rabluhd J.."Im Mrd nwarmuesoiaa mdsari value moo.lEr.0.mnbDst vn.d ,.ma6nY isalnras In Fir no owe bddnl m odbarmma w ymms area ta.Dant meter 6 calm.mdld!rr ha rE lerrv.ma a My_n,mlls.6rT„o,xe r„b.q,.ry,lar. 201 i i mEaREn(ai(avERASE 1.014 sptil ay B/gni(.39.4 m=/L in 25 mic.ms).See APPIX.A190N Fin cwecrytc mrux. NET WEG111RAWON 9.511±0.2Slbs(4.31 ±.11kilt(ndx"q STOW TEMPERAfiM Minimran 40-F(4-Q Mnsbnym 90°F(32°() NotC Material should be Attired a tnnpnratuma between 70"Ir mid 9a"P(21"C wJ 32°G)for at lust 4.4 hour print to use, REAEER�mRERESSfANEE ())r))I%,ntinuoU4230"1r(121°CJ hrtcnnitkat2N'F(I35°() SHELF VIE 12 mouth,Na iox ou um"Nsonge mmpearue. FUSH FBI-SETA N/A IFAITiI R SAFETY 'fids product amtai s chemical ingraGemx which are considered haxovlous.Bcavl tannins h6rl warning and Material Safety Data''liver for Implant health ami ctliet)'information print In the Int•of this product.Keep out of the reach of ChUdsea. I i (OYERAGiMS Boli tc commencing,nbems and tbonAighle mal dhc StmnllrieW Installation and Application Guide for drmn. Dry fdW I what MWSas PUGGI (Microns) 1 (Microns) I (ma/Gal) Horizontal 6.0-120(I so-FIS) ii 6.1"Zi)(1W3115) I 134-267(122-24.8 Verticil 4.0.6.0 (11fi-151{1 1 4.0•(AO Tim-150) 267-4111(24.8.3731 .illow Fr nn•npmy and rurfnee Megeduitks and rvwdcJAim rhdrknuxr is mmndis M the nearest 11.5 mil ret S microns Application of coaling below ndnimum or above nauthar m recoesweoded dry film thicknesses may adversely aRect coating performance. NO* Use a ferizble.pwrrl drill wish a PS Jiffy blade,Shpwly mix 2 parts A tompmunk and while ur.&r agitation add 1 (urr Is compmene and mix lion minimum of Iwo miourer.Ensure,that All Part H is blalulad with)cart A by acraping the pail wJl with a flL.ble spatula. NOW A large volume of material will set up quickly if not applied or raloced in ynhene.caution:Do not reseal mixed mateAal.An explosion ha s rd may be created. 1101 OFF 25 an 311 ounuaw as 75"F(24"Q Ma(erial n'mpu mars shove NI"11(.L"C)will signsfirnndy.educe the pot life. 11NM Normally not required.Mev(Mn up ou S?;or 1/4 pmt(1911 mL)to impose appocadou pmperdes.Brush and mll applications use No 3 Thimhcr tar No 471ldnmr.Spray opplieationa use No 42 Thinner TEMPERATURE REOUIRM111 Surface&rap rratsae:Minimum of 55°F(13°f),opdmon,65'110,FD°F(19%m 27°C),m.,imum of 90"17 aadpnvwc ICmprtamtt a1nAlld be at lout 5"F(39O above the dew paint. MaterM Tkamperature:Mr ofinim o application,handling and pr basso ice she mAl"ial temperature during application should be bawam 711°1+wsd cit"fr(21eC and AM) 'IL•mpl:nmre will affaa the work"t),Corel tem- ' peramwa incressw viscosity and decrease wud glailky.Warm tempaatw'es will Jecirear viscosity mid shorten put bit APPUtA1WN fnU111MEIt Brush,roll".syuregc and aides spray. Roller:Use h G 3 8"m 1/P' I hug 1Pr° q J nap,shad nsunnt,woven fabric m0ee ewec Brush:Use high glmllav synthetic or nylon brisde bmsh Norhnolal:,%gvc ee and bxkmll.Brush mall treat,only. VWdcal:ROIL spray;rod backml or abrim spray tussal on rubstate conditions Brush smAll oras only. Spray appli itiun awpmcmc incishr a Gm)"King"4501 or 50 aide"spiny prarp ar,bier nines,spray equip- emir ad equal or greater configuration and capabdin•.Pump agscmbly should include a moistum TIRE,and oiler,air regulamr with gnal,T and fluid neer drain volve When 41,aymg there non IfheMT coakinga,a high pte,qure rnandnW I and 60 mesh filter is recommended.Use a t/8"to 1/:'1.0 material hose(4,Wt1 S,DM psi woddrig pressure tater!). A G.Niro,gum to cqunr4ent may,be used lice prcfermd rips with oriftes mussing{rum.019"W.033"AwId f be mounted in n Cmc,I Lr).BAC 14orwuhg/0uard assembly.The nlggeste l operating air pressure Is 80 to 90 pxi. Spraying should be considered as As gleam to Broader the material to the surface and should be followed by beckrolling. jCIFAnGP Flushwrd clean all e(pripmentimmedntcl)•alieruae with xykneur MEK. INEMIO iWIIAf13O1a0a3 VE FAM las HAM.BE It.I1.POAlf win as"swam nanpM hem eo0ona 191 Rot odea Act MIEPay,tie 1RE1u11RR OaWIE011M!AIGW PAmmISNrIOE It IIEUgFAtlf"TNR WWirR,IXPIBS[O0I INTIB,IPACRa61811RINNIO70,/dl L9TI[I raaAn7 to MMEAt1UR OI IIMM fora WtUal PROBIL Ban at so muMis iter IOn01EM IRt uscAosIaI ON INF all GFIEOt M Arai Ids odaahr.anal new Town(suar4.ba.ad M In xqftwwnl d as awatl a Il .A.ddeae ask"AT sopWndsdiis,laws Is saw Was.nNMsaOair rhAam hwsfsMia mtW pse.mlmi.1. 1, onrawMe nupall.mWsum nese saa.WIN WpOIGIR also fiNctMI5,BUT ADI 11uIE010.I)(1:10IN01 at(ONSIGOtS1a OIJUG6 FOR IOSI"Bilis,L857am,InUIE TO FIRSON Of WfPi(IROMMIRL aIUMS B RE OINIPMR@LB CUS14MATUL LOB)SMALL 11 arms 101XE REIfL bloc mdudnekr Iebmml,laws le aradd Ee 6.Frywr dmehka"a Raaai rraaa al as asap red pow away rGAhmr Weluw.kO presses man sea*Wild Be me"mleasen rd Ina(,par rule as dtadd rim Tasman 4-",—0)l epreue0 nmmmn.As UlAlmle4tdaea redad4.1,hart,Imwll npltady&. mw did b sm"daar taraAurid wd p auks est usMitm art OBu. RFAU(OAMa MtU1E0IAM p1111(O IN 1[A /GOO(OI"W[OIRL maS N1.RSSOUI 6A 170'1371 01:1 m1D8R1 eas,Meme.mm (VDAT801)201 Til ii -Cftaz 68Fd(oE5(RMM01I Mrdified RJyumine Epoxy COMM LUR A gba�+like rxww aA n tusistmu emtng for"Us,Mlingn,ikwm and Whet aurfxcn mJaam to froquem fa m r rid hot wirer and dAmm em c4A24mhtg.UWd as a topcaaVseakT for heavy duty Wall and Ormr systems rx In a anlndahme high-pwform noe function.Cxcellem chemical.Attain-and abniikt rmlaa cu to,A varkty of sahstaeev. (OIDMS Available in the 16 suntnrd Smax5hkid colts&Spuiai cxAm available,flrasa mntoot your TrmAec fc'Pm' *vwd von.Node:Rpuokv data aro)ynUmv with ago,exlepded u(xxuut to W uel sdifaial Iii K*(au- non should he taken when wIcOng whirr and light(a ld mkas.Lack of voititaim.htannpiew mixing, miscatalyrr0on As the use of Ixmtela that ems au!"d0oxkk and radam myna odds during applkntlon mut instal gaga of ming may cause amore Molt,posltbly 2111fec g adheswn of witsaweru WpAxM, F91SM Glom.(RIAT YpPdirakm pnwidrx an orange peel 0m6k) watift litiliplitill WKK4WVAM 50*xi 6}-1500,130.234,2111.77W Nott A kVuit kit of YR,with RM C tanted sixes,b MUattfe for - 11001 Axl Wait 40AT166t small pmhW,%w6c*tg mwim.For more exterailw repairs and a"fionai Irfism ttion.t,nieR your Tnemer rcpt tvatwe mr TAtumse Tedi,cal Services. MM Go ICS41A :sr4fOio llm(X'mica 20),20;2U5 (:MU:SuMpraning rover Wkd CAMU Vnod 0v Drywalr Self-tadming rs SvTies 201.203 RFIRIA oMTF(69 Scrlc 210,237,M 27U.273 TIhm Serio 73.291;190,VA.294.295.297.1074,1611. Pnpav surku hit Period xukthk for exputum and fimvide.facto W the appropriate primer daa sheet fru specific n.Txxmnerniatkxse When self-priming. i90UK(fM(MQT Allow naw curalUa to five Ri dayA VdIry dryncm by tuning Int mogur with o"pkwc frim ape cmn 0.v."tRv4inmtt AMM D 4263)Should nioname he kiecm(perform SMsrxardTax bloat)fvr Merua r- OR Wait bre Vapor Panasimv gate of Commm SUMinm Liahtg Anhydnxw Citclum Chlade'(Reft"te Ase F 18K)bTniffmr coni nut not to excecdthme,paunds pa 2,900 ay it in a 24 hue period.Abe e iaai en rnvelamcwiy Was*to umvn*iafmnce,mring(xtn4xwhhds,hudemns,seakw and other ODAMM- Im mt and W pmvidh-slufave,pnlhke,liege vokha hurl Mh.r cavAlm should be filled with rarumu eluted fillet ar aurfaW,,(Refem1XV OW-WOM1ACE(a WRI M3) M(MIIfAL WRIUMC Allem new entente to cum 28 tktys.AlAwim Maes w mechanically uTaadc connele W mmove lahante, finm reicase aRmR eating dWnisio da,tiatcim",sealers aref other comnmi ama and nI pmvide surface pruf0u.(Refercsxe SSPWPI3) ( IN Allow,mets mortar to curt 28 days.Surfaces Anna N!dean,dry.ataud and fi v of sit cowmnilaras.Lcw.4 all pminakxa and am a,sputmr,Far pinhole(ant aurfwt.vac tv eam ncAtvllsd aurha:tr/hlkT/pwchex. JUISWO Must be damn,dry amt free 44,gra and Oche mMamWhuus "MMfSoIM, io0*tmbxcm) REEdMYt80091 Htvhaagk(x0at 120 m0a(159 to 305 ntkrtxvd pcT ma. Vertical:4.0(0 8.0 tale 1100 W 205 tak lard)per can Additional c u may Is,maned far appe mune rpr Mding. CIMIM6 T6Hf T AnpmNore 1bTbp 1b PTA"in SeMee { 75"N SM°C.7 I 8-2e fa um 24 hour.. { I Note:IF mae torn 24 boom have ehapsW lanwcen Low.the coated aurfacc must be merlwnkally ahmded M.4ore tapcoating Vowif oiNK 0 z 0 .Rause (0111=11S• 125 gnrmsAltnr TWITIM OSIAtf` 1,604 mil sq h/pi i i9.4 nfJL at 25 micpoiw).Svc APPLICATION for mvendge mMa 0111480((oMPoi✓fNIS Two:I'm A a0d Pan 0(1 Pans A to 1 Pan It by volumel Ram PART A PAST 9 When Wmd {IAilic Kit { 25 gailm pwbs { 1.5 K411 n pml 15 gallon,4568 L) { ! T Small Kit ( 2.1 gaihm am { I-1 gaikav tarty 3 napkins(I I:S L) OEIMRM7MPCRdM00M' 11.85 x 0.25 0s(5.37 x.12 kW mixed 1 I PdObdWlJtddWaa twar6urUT+diatar6etr a0lwtaMr.rir rp6ppaMaO ctan.h.msmad,0)pubrcYtpeMmn � fWm IpJ�1kJ tan nA etllaptl U Wa m1 naps 1�Ip.aa wmmxm.In miW IHasYdra pJ rnaprear. i tl khP 25,1440,M 41k`.mv_(iurgtanY.Iru. 280 f l.— SIRIES 280 Slow 1611111111111111 Minimum 4"(44:) Mmnhmm 9f PF(U%') Noir.Material Mimi d he atonal at knptrAmw Fmwecn NPF and 90OF(21T anal M)for at k-Am 01 hours poor tv roc f5gPIP1mRES6 a (ray)corabloom 25fI F 021°(;1 hnenrili m 275°F 03.5"0 W(H 12 months A n:ummerakd srcaage umrpenWtt. f11tS8OU-SM WA HFA(11185 M 'Mis pnaltat tontulnn elaanicai mgM11,111i;wldt'h ate consiJcK'd haa111(SOM Retool azuuainer tuhet warning MY)Material SO"Qat•%Shea'.for)mdasnant IMIkh amt solely Infixmatbrn priur to doe use of(Ids prtxluct. xcep oat of the reach alid adays. ("GE MW &4rne carmaxitcft ofMrin amt dnrow(itty read dw Smd.Mlorld Ingaumwtt trod Aigrihatimn ONrka fir liana Dry xu+s f teed irk � $4 FvGd (misrmts) I pmonoms) W/CosO j fdatPlanntt 60.12.+)(150.34A) 6.0-120114305) 131.267(12-'-24&t 1 vutk5d 4.".0 (1oo-u15) 4.01110 (10114205) 200401(1MM,3) I Allow fm,m xspmq.surLsee irregd:%ndes mal wast:.t'don th)canta b rcamo derl m the OVA"0.5 ami or 5 mil- crom.Application rM aroatib){hebw ntlniomm or above marimmlt caaomntcpded dry Bbb tbkkbasea may adverstdyallea coating patlosmoutra e MW Use u vmplt4 s(aul drill whh a FS fdfy hhuh;.:una4y mix 2 pant A tsr,grroe v.and wbk-under agualWn add 1 part d arnporern ani mix for a""Mm of two tronuiv.liruutu dun al€Part a a bktsdcA with part A by scnpng dm pall wait%with a SeaB)lc•simoila.Apply the muted nmtatlai widen put Mc iimiGc after aRitamm. .Nott A large mimm of Material will m up gllKltly If oat YWoml or reduced in mlume carodmr Do cwt cereal wdmd mneedat.An explication barard may be r eaa a. POTIMf 25 W 30 minima,at 70-F OPQ 15 U, m 11AyF(IMI a W 10 mimnel of WF(32TJ innemmpg nwaaial iCrtilh'1Yaulce will sigoffimuly reduce the pm lik, . MUM Narnully nor FeWinll.May thin up to It*W K ry'nt(190 MIL)Ix 01011 W h%VWW App%MtiW poapemes. Snub and mol app0aation car No.Manor or t2 71droo r. I INl,�d7U2FAFlWyFMEMf 9wfoceTooperomro:Minimum of 55rp(id"C.).Wldmum 65"F to R0°P(IMU)27.0,Mulmum ar 9(Y'F { (3m),Thu sabarue unpecalure shoal lar at tow 5"F(3'C)altrn the dew"it.To aWhl outitumMg, concrete twipmetute ahmdd be maMiizool ur In a descending(emp truntre trade. 'aiWeriai�, For optimum applicaiion,handling and pcef0nmince,dte*stern)Imperatore dm- iryl application slamid be hutwern 7(Y F and 9(n(2101(:and 32^0.7am,pereture win agent tote watuatdlhy. € I%"IMNraluota locnow v1M0my Asti tfo mw.-v,%vie i0ty.VPbou tempcimitma wits chxreaw VIKMOy and j d,onen put life. ANU(WOa(Od W, 0rudi,muer,squct`gm and aids%StaAY. Roder.Use With 9tadity 3/5'W 1/2'nap,slud mi%imu,waver P.dtrie roller met. Hcueh,Un'hildt gtamfy syNhatc or niton brick lorualt. ifasiaoa(at:Stpnecpec ata]lmritmll.11(usi,sarill ens mily. veraleak gal ce sprty ant)lvx9.•tr&snub urmll areas tmiy. j Spray application equipment Includes a Crtaco°King"45:1 or 56:1 aUltvis Nm0•parry or other airless spray i rqufimunrd of etpu!or grunt vonfigurrrm and arpabibit 1'ump asseondty should aaltNe a mOhbase trap Ami oiler.air a gtadtr with pw and gold md>rt t6airi valFe.whr„slot**these nm ra eted Garish. a high pica%tae mmTIW and fib ox-sh Uhat is nwvnuimrrclwl.Um to W to I/2"M.rradcrial Iu se(4,011111- 5,000 psi wtoidtis pra'nxire rmfigl).A Grata slier gun or.quivakw awry be used.Mut p(ekrai t lm with i mifites tonging form.019"to.033-should be cramped in a Grano N.U.W lhauing/GuaN aeveniltly-'Rte suggested opmath,g pressure shmad be trctwac'rr 3,500 and 4,500 psi at the tFm(approR#rmrdy 80 to 90 pd „penning air pnssurcl.8;waylaR tmpnld mly be aaaadered as moramr to transfer dw material to the + surface and nboald be Mmvd by lawkwHiap. (1(PkIM flush mrd clear all cgmpmwn bum(haely at"uw with xylem or MEK. j -values amy wry with color: atddR t U M N al BUTS lataOCtoast bWm.at.moms rat as IN 1=40 aF."6raawoo IN f mkAa mu"dlanaURM tv. ml 101WiSR KIWO90umnuonsda 90 two]AIR=Iatltaa;tAM6St8 a win.W,#MIII tat=1MAY Wal,wtUl y0Aw AOMtr011Ma%fmA Pto oria 44,10finodaoFAIM�d Mt�ss�6mdbm19 0 WAM 11111 U110 n d rWomrvdiadu Em Wdbr�mrrtaab 611�m inmuts014 aambealutls AkunmM(o blbbw@a011t1 tdON{l4gtffd4/Neitwo HI,tg6'$dar�lrYt""HOW palm u5IWS NM iDl4Bata2mft0(tN�ItlttRIWARS®11Y01�atlaatOttRlR/Nfdal 5055) 1*Wb.Who Ismtitral IYONNnr1(cMnatMnoaatwnaimMdemtnmd maieKt%t 41 oftiaMnammpk taU*Wm dremwdaalms0moser j con d6adboarNBduMraa W)mu(rmowr mhsutanan 16nn aaralmral,maonMrpp,+m oil mtamnu.badbere udwrmaorl manbamuamr tpdsrrtf..doe bs,xdd er rmaaa ry vamo rd at a m casae.wt RRnmdt au alto. Is[r[tatmnletstwst0e rdlhtU to ' tloombroutahut.traadrntduomettaant 0LIt141Yf1a() aaaAkaetm rctAmsO)m egussa specialty Resin Systems Data Sheet Degadur® R41 Primer/Sealer Fast wring."Iftow tfree,2-compoerer+t, 100%mac&4 inavocryrgb6ased„/ow wacos* penefraWM prbnedseallerfw vary/dense or weak con"We sturfacea Product Profile: R41 is a low viscosity resin which is mored with up to 25%Womponerd to prime concrete. it penetrates,s&engthiins,and reinfiarross the substrate- AD primers should Completely seal the concrete surface resutUng in a uniform satin finish. Resin Properties: Form Supplied Uauid Viscostiv 150 24314 mm cuo 11-14 sec 1Ascosity ASTM D2393 j 5—25 tiros Density 8.10 bs4w. DDT gassiTication 11 f0mmable Lion Class 3 UN 1866 i Shelf We i Minimum 6 months Physical Performance Properties: Co MdW of Thermal Ern 3.5 (in.lin P F x 101) Tensile Strength ip$il ASTM D538 3,5W Terelie Modulus(psi x 906] ASTM D638 2.1 Elongation at Rupbue[0/91 ASTM D636 1.3 4hom Hardness I61 A$TM PZ240 75 j Water Absorption 15144 his] ASTM 0570 0.06 Water Vapor Transmission ASTM E96 Meihod"A":0.0 Q 6 mile (g1m2124 hoursl Method"E':2 5 tt 9 mils Electrical Resistivity ASTM D257 Vol: 2.5 x 1076 ohmicm Surf. 6 x 1012 Chin Surface Degadw systems require a dean and dry substrate free of off,grease,wax, Preparation: solvents,suing membranes and any other oontaminants. Shot blast concrete to i provide an open surface and to remove tines,laitanoa and unsound concrete. j Surface must be primed with appropriate primer. Bond Teat: "Welded°bond,unique to Degadur systems,allows them to meet specific For industrial flooring overlays,bond testsmust be conducted to d lermine adequacy of surface preparation and bond. i See Bond Test InstrucUbn Guide. Specialty Resin Systems1-BOD-477-4545173 interstate Lam SRS DEGADUR 203-75"191(fax) Waterbury,CT 06705 !ffrrn:FfwTh&tCu 1nomH" wwwapeciallynishisystarmcom I Degadur R41 Application Information: Typical Application Rate 100 sq.ftJgal. Dry Film Thickness(theoretical) 12—15 mils pot Ufa 70"F(20'C) 10—15 mites Cure Time 68°F f20e Ct 30—45 minutes Application Temperature 14°F—104°F fie-Coat Time 66°F(20°Cf 30—45 minutes Mixing instructions: This product must be mixed with appropriate amounts of i-Component and Powder Hardener just prior to application. Batch Size I i cal. Pavder Hardener I See Mbdnq Chart Broadcast Rata(20-30 mesh) i c 4 tbaJi 00 so.ft.as required Aft contents ofdrum orpall beA edispenta g. Mixing of resin components and Powder Hardener Is done at the job site according to manufacbtWs instructions. Mixing is generally done in f small batches with plastic buckets and an electric d nh with a spoofed mixing blade avall"from the menufaclum. Fast curing g Degadur R41 is mixed just prior to use and must be applied immediately. Any broadcast medium must be clean,dried and bagged, Chemical Resistance: See Chemka;Resistance Chart Storage: Keep oovl and dry and out of direct swiligtd. Liss as indicated on labst. Read and understand product labels and manufacturer's Material Safety Data Sheets prior to use. iTechnical Application and engineering servkas are available from SRS. Services Support: may include step-by-step problem solving in such areas as problem assessment,material selection,and development of job procedures. Wanrattty: Information available upon request. Precautions& For flammability and odor infonnalion,refer to apptcation guides and Urnitabions: Material Safety Data Sheet prior to use. Most reactive resin syr have a very low vapor permeability and act as vapor banters. Therefore, substrate must be protected against rising moisture. For application in food processing plants,the odor from uncured resits may require special ventilation andlor removal of foodstuff. 3 AYaa2. Ab lives reserved. Specialty Reale+Systema-SRS-m e DMWon of Ratan Amada LLC,a subatdlaryof Dogma Cmpaafion. Dagada and ft SRS logo amraglsbredhademmks, Actin/wmedona+Msrerarranb in tlda documentere behaved to be aasurate at the time otpubiroptkn,but Depose Corpoream and ft alHhatas mike no repaseniaBon or . warier(ywNlrn>spectdraeiatkld+Mkfgbuirrotev+hedto,any+savNaobtaNedatkskaf'eagammdofanYproOOW dff+t Aa irdamadon and afefemants are intended fa persons havi g due requited skid and kdowfiow ant do no[rehave the userbom wsdtYinBtne aritetrlhty atAe4dadregon a»d statarrenls gMan fsaspec�tpwpoaa pita to use. rhea 4VA089W of such Inknfreddn of alatemAt5le of users sole dlstvebw andnick,wnWW arty 4abeiyon Me part of Dogma Conwomm ass affdletaa. Nadhkgbetaineft�lbeaenebNadasa/t7enaeofa................4,J.,.hXaeaafanypapriereyrgglds. • HOBBS ENDEAVOUR CORPORATION fOa 34 Rockland Street SHEET NO /) OF 9 1 Swampscott,Massachusetts 01907 CALCULATED BY " DATF 781.581.2454 978.744.4646 CHECKED By DATE / SCALF � NGlr �✓ � l yo' ..Atr � 7jv I ✓ � 1 J6 comet- q; � roe 4B ZROwale . h J r �✓ td'r f �a;rd . C PRODUCT 207 09/20/06 14:35 KFL - 6EOCHRON 19787409705 NO.100 902 I i KRUEGER Phone(617)876-9118 Fair )876-0572 FOOD Email dkrueger@kfi.com Website www.kflcom ®LABORATORIES, INC. 711 Concord Avenue,Cambridge, MA 02138-1002 USA CERTIFICATE OF ANALYSIS Submitted by: Date Reported: 9118/06 Date Received: 9/12/06 Everett Hobby K�V Obbs , 207 FortAvenue Salem, MA 01970 Reference: Sampling Month -September 2006 PO#: Description Your Sample Number Our Lab Number Ice Cream Sampled 9112/06,4°F,Vanilla 74353 STANDARD PLATE COUNT cfulg 350 COLIFORMS-VRB efulg <1 Standard Plate Count should be less than 50000 cfu/g. Coliforms should be less than 20 cfu/g. Methods:APHA, Standard Methods for the Examination of Dairy Products, 16th Ed., 1992, Parts 6.2 (Standard Plate Count)and 7.8(Cofdorms). By: 14751"18061 2125 74363(9/18/06) Page 1 of 1 0920/06 14:35 KFL - GEOCHRON 4 19787409705 NO.100 P03 ll 1 . KRUEGER Phone(517) 876-9118 FC Fax(617) 876.0572 OO® Email dkrueger@kfl.com Website www.kfl.com ®LABORATORIES, INC. 711 Concord Avenue,Cambridge,MA 02138-1002 USA CERTIFICATE OF ANALYSIS Submitted by: Date Reported., 9/18/06 Date Received. 9/12/06 Everett Hobbs E.W. Hobbs 207 Fort Avenue Salem, MA 01970 Reference: Sampling Month -September 2006 PO#: Description Your Sample Number Our Lab Number Ice Cream Sampled 9112/06,4°F,Coffee 74354 STANDARD PLATE COUNT cfu/g <250 COLIFORMS•VRB cfu/g <1 Standard Plate Count should be less than 50000 cfu/g. Coliforms should be less than 20 cfu/g. Methods:APHA, Standard Methods for the Examination of Dairy Products, 16th Ed., 1992, Parts 6.2 (Standard Plate Count)and 7.8 (Coliforms). Dy: 14751 18061 2125 74354(9/18106) Page 1 of 1 10/11/06 15:04 KFL - GEOCHRON 4 19787409705 NO.202 IP02 KRUEGER Phone 16171 876.9118 Foou Email dFax(617) 876.0572 krueger@Kfi-Com website www.kfl.com I®LABORATORIES, INC. 711 Concord Avenue,Cambridge, MA 02138.1002 USA CERTIFICATE OF ANALYSIS Submitted by. Date Reported: 10/11/06 Date Received: 10/5/06 Everett Hobbs E.W. Hobbs 207 Fort Avenue Salem, MA 01970 Reference: Sampling Month-October 2006 PO#: Description Your Sample Number Our Lab Number Ice Cream Sampled 10/5/06, 6°F, Coffee 74616 STANDARD PLATE COUNT efu/g <250 COLIFORMS-VRB cfu/g <1 Standard Plate Count should be less than 50000 cfulg. Coliforms should be less than 20 cfu/g. Methods:APHA, Standard Methods for the Examination of Dairy Products, 16th Ed., 1992, Parts 6.2 (Standard Plate Count)and 7.8(Coliforms) BY-06 14834 18156 2125 74616(10/11/06) Page 1 of 1 10/11/06 15:04 KFL - 6ECCHRON 4 19787409705 NO.202 904 KRUEGER Phone(617) 876.9118 Fax(617) 8760572 FOOD Email dkrueger@kfl.com Website LABORATORIES, INC. 711 Concord Avenue,Cambridge, MA 02138 002 USA CERTIFICATE OF ANALYSIS Submitted by: Date Reported: 10/11106 V Date Received..,,1015106 I Everett Hobbs E.W. Hobbs 207 Fort Avenue Salem, MA 01970 i Reference: Sampling Month-October 2006 PO p: Description Your Sample Number Our Lab Number Ice Cream Sampled 10!5106,6°F,Strawberry 74618 STANDARD PLATE COUNT cfulg 510 COLIFORMS -VRR cfulg <1 Standard Plate Count should be less than 50000 cfulg. Coliforms should be less than 20 cfulg. Methods:APHA, Standard Methods for the Examination of Dairy Products, 16th Ed., 1992,Parts 6.2 (Standard Plate Count)and 7.8(Coliforms). I i f By 14834 18156 2125 74618(10111/06) Page 1 of 1 10/11/06 15:04 KFL - GECCHRDN 4 19787409705 ND.202 903 KRUEGER Phone(617)876-9118 Fax(617)876-0572 FOOD Email dkrueger@kfl.com ®LABORATORIES, INC. 711 Concord Avenue.Cambridge,eMAl02 te a 1002 us CERTIFICATE OF ANALYSIS Submitted by: Date Reported., 10/11106 Date Received: 10/5106 Everett Hobbs E.W. Hobbs 207 Fort Avenue Salem, MA 01970 Reference: Sampling Month-October 2006 PO#: Description Your Sample Number Our Lab Number Ice Cream Sampled 1015/06,6°F,Vanilla 74617 STANDARD PLATE COUNT efulg 3700 COLIFORMS-VRB cfulg <1 Standard Plate Count should be less than 50000 cfu/g. Coliforms should be less than 20 cfulg. Methods: APHA, Standard Methods for the Examination of Dairy Products, 16th Ed., 1992, Parts 6.2 (Standard Plate Count)and 7.8(Coliforms). BY: 14834 18156 2125 74617(10/11/06) Page 1 of 1 j 09/20/06 14:35 KFL - GEOCHRON 4 19787409705 NO.100 IP04 9 i ' KRUEGER Phone(617)876-9118 FGOOD Fax(617) 876-0572 OOD Email dkrueger@kfl.com .®LABORATORIES, INC. 711 Concord Avenue, Cambridge, MA/02138 002 USA j 1 CERTIFICATE OF ANALYSIS Submitted by: Date Reported: 9/18/06 Date Received., 9/12/06 Everett Hobbs E.W. Hobbs 207 Fort Avenue I Salem, MA 01970 Reference: Sampling Month- September 2006 PO#: Description Your Sample Number Our Lab Number Ice Cream Sampled 9/12/06, 4°F, Frozen Pudding 74355 STANDARD PLATE COUNT elf U/9 <250 COLIFORMS-VR8 cfu/g <1 Standard Plate Count should be less than 50000 cfu/g. Coliforms should be less than 20 cfu/g. Methods:APHA, Standard Methods for the Examination of Dairy Products, 16th Ed., 1992, Parts 6.2 (Standard Plate Count)and 7.8(Coliforms). i By:�'Jq 1475'1'18061 2125 74355 (9/18/06) Page 1 of 1 7 Island Avenue E.W. Hobbs City of Salem FOOD SERVICE ESTABLISHMENT - FOOD SERVICE Inspection HACCP: ❑ Item Status Violation Critical Urgency Telephone: FOOD PROTECTION MANAGEMENT 745-7691 PIC Assigned/Knowledgeable/Duties PASS RED Owner: Non-compliance with: Everett W. Hobbs - Anti-Choking PASS PIC: Priscilla Hobbs Tobacco PASS Inspector: . . EMPLOYEE HEALTH John Gehan Date - Correct By: Reporting of Diseases by Food Employee and PIC PASS ❑d RED llgypyg40& Personnel with Infections Restricted/Excluded PASS RED Risk Level: FOOD FROM APPROVED SOURCE Permit Number. Food and Water from Approved Source PASS [ RED BHP-2006-0442 Status: Receiving/Condition PASS OV RED Open Tags/Records/Accuracy of Ingredient Statements PASS [/01 RED #of Critical Violations: Conformance with Approved Procedures/HACCP Plans PASS a RED 1 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. Sep 19,2006 ) Page 1 of Item Status Violation Critical Urgency RED: PROTECTION FROM CONTAMINATION ' Violations Related to Separation/Segregation/Protection PASS RED Foodborne Illness Interventions and Risk Factors (Require, Food Contact Surfaces Cleaning and Sanitizing FAIL Criticald❑ RED immediate corrective action) Comments:Sanitizer to strong at time of inspection. Sanitizer changed at time of inspection to proper parts per million. Proper Adequate Handwashing PASS ❑J RED Good Hygienic Practices PASS Q RED Prevention of Contamination from Hands PASS ❑J RED Handwash Facilities PASS RED PROTECTION FROM CHEMICALS Approved Food or Color Additives PASS RED Toxic Chemicals PASS ❑J RED TIME/TEMPERATURE CONTROLS(Potentially Hazardous Foods) Cooking Temperatures PASS ❑d RED Reheating PASS RED Cooling PASS ❑d RED Hot and Cold Holding PASS RED Time As a Public Health Control PASSd❑ RED REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) Food and Food Preparation for HSP PASSd❑ RED CONSUMER ADVISORY Posting of Consumer Advisories PASS (] RED City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741-1800 GeoTMS®2006 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Sep 19,2006 ) Page 2 of Item Status Violation Critical Urgency Violations Related to Good Retail Practices (Blue Items) Food and Food Protection PASS BLUE Equipment and Utensils FAIL BLUE Comments: Small brown GE refrigerator at end of counter requires general cleaning. Ice cream units require general cleaning. Ice cream units missing thermometers. Provide visible and accurate thermometers. Sanitizing log not up to date. Log to be maintained daily. Water,Plumbing and Waste PASS BLUE Physical Facility PASS BLUE Management and Personnel PASS BLUE Poisonous or Toxic Materials PASS BLUE Special Requirements PASS BLUE Other-See Notes PASS BLUE GENERAL COMMENTS: 824: City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741-1800 ail GeoTMS®2006 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Sep 19,2006 ) Page 3 of ( IMPORTANT MESSAGE ) FOR 1 (,�, � DATE ��J�� .-,1�1� TIME/ -YZAA' M I .NTP/A,�I OF PHONE { 7 (45 AREA CODE NUMBER ENTENSICN U FAX U MOBII F AREA CODE NUMBER TIME TO CALL TELEPHONED 11 PLEASE CALL CAME TO SEE YOU 1 WILL CALL AGAIN WANTS TO SEE YOU RUSH i RETURNED YOUR CALL / gWILL FAX TO YOU MESSAGE ��/?� /5nn - �✓� - O SIGNED �A09 MA UO MA N U.5 A 4 1 NOTES 0726/06 11:31 KFL - GEOCHRON a 19787409705 NO.235 D01 l KWEG ER Phone:(617)876-9118 G.O D Fax:(617)676-0572 11o�JJ Emaa:dkrueger@k0.com ®LABORAIURIES, INC. 711 concord Avenue,Ca bade,MAO 9e FACSIMILE TRANSMITTAL FORM FAX#: (617) 876.0572 Date: 7/26/2006 PLEASE DELIVER TO: Joanne Scott Salem Health Department 978 740 9705 Pages to Follow: 3 Sender's Name: Evangeline Lavoie DOCUMENTS TO Certificate of Analysis for Sample Numbers: FOLLOW: 73765-767 PLEASE NOTE: All analytical results should be considered preliminary and are subject to further review until the final report is issued. If problems are experienced with this transmittal, please call(8 17)876-9118, 07/26/06 11:31 KFL — GEOCHRON a 19767409705 N0.235 PO4 KRUEGER Phone: (617)876.9118 Fax:(617)876-0572 FOOD Email:dkrueger@kfi.tom Websi4[L®LABORATORIES, INC. 711 concord Avenue, Cambridge,, MAr021311 7002 USA CERTIFICATE OF ANALYSIS Submitted by: Date Reported, 7125/06 Date Received: 7/18106 Everett Hobbs E.W. Hobbs 207 Fort Avenue Salem,MA 01970 Reference: Sampling Month-July 2006 PO k Description Your Sample Number Our Lab Number Ice Cream Sampled 7118/06, 10°F, Chocolate Marshmallow 73767 STANDARD PLATE COUNT cfu/g 680 COLIFORMS -VRB cfulg <1 Standard Plate Count should be less than 50000 cfuig. Coliforms should be less than 20 cfu/g. Methods: APHA,Standard Methods for the Examination of Dairy Products, 16th Ed., 1992, Parts 6.2 (Standard Plate Count)and 7.8 (Coliforms) By: 14670 17838 2125 73767(7125/06) Page 1 of 1 07/26/06 11:31 KFL - GEOCHRON -� 19787409705 NO.235 1?03 KRUEGER Phone:(6171876-9118 FOOD Fax: (6171876.0572 Email: dkrueger@kfi.Com INC. Website:www.kfl.com 4[LOLABORATORIES, N711 Concord Avenue, Cambridge,MA 02138-1002 USA CERTIFICATE OF ANALYSIS Submitted by: Date Reported: 7125/06 Date Received: 7/18/06 Everett Hobbs E.W.Hobbs 207 Fort Avenue Salem,MA 01970 Reference: Sampling Month -July 2006 PO#: Description Your Sample Number Our Cab Number Ice Cream Sampled 7118/08, 10-F,Oreo Vanilla 73766 STANDARD PLATE COUNT cfuig 2500 COLIFORMS-VRB cfuig <1 Standard Plate Count should be less than 50000 cfu/g. Coliforms should be less than 20 cfu/9. Methods: APHA,Standard Methods for the Examination of Dairy Products, 16th Ed., 1992, Parts 6.2 (Standard Plate Count)and 7.8 (Coliforms). By: 6, 1457017838 2125 73766(7/25108) Page 1 of 1 07/26/06 11:31 KFL — GEOCHRON -) 19707409705 NO.235 002 KRUEGER Phone:(617)876-9118 FOOD Fax:(617)876.0572 Email: dkrueger@kfl.Com JOLABORATORIES, INC. 711 Concord Avenue, Cambridge, USAA CERTIFICATE OF ANALYSIS Submitted by Data Reported. 7/25106 Date Received: 7/18/06 Everett Hobbs E.W. Hobbs 207 Fort Avenue Salem,MA 01970 Reference: Sampling Month-July 2006 PO Al Description Your Sample Number Our Lab Number Ice Cream Sampled 7/18/06, 10°F, Coffee Oreo 73765 STANDARD PLATE COUNT efulg 780 COLIFORMS•VRB cfulg 16 Standard Plate Count should be less than 50000 cfulg. Coliforms should be less than 20 cfu/g. Methods:APHA, Standard Methods for the Examination of Dalry Products, 16th Ed., 1992, Parts 6.2 (Standard Plate Count)and 7.8(Coliforms). By: 14570 17838 2125 73765(7125/06) Page 1 of 1 08/16/06 15:36 KFL - GEDCHRON -> 19787409705 NO.344 904 i KRUEGER Phone:(617)876-91118 FaX:(617)876-0572 FOOD Email: dkrueger@kfl.com Webslte:WWW.kfl,COm 19LABORATORIES, INC. 711 Concord Avenue, Cambrldge,MA 02136-1002 USA CERTIFICATE OF ANALYSIS Submitted by: Date Reported: 8114106 Date Received: 819106 Everett Hobbs E.W. Hobbs 207 Fort Avenue Salem, MA 01970 Reference: Sampling Month-August 2006 PO#: Descr4Dtion Your Sample Number Our Lab Number Ice Cream Sampled 8/9/06,6°F, Vanilla 74026 STANDARD PLATE COUNT cfu/g 670 COLIFORMS-VRB cfulg 3 Standard Plate Count should be less than 50000 cfulg. Coliforms should be less than 20 cfulg. Methods:APHA,Standard Methods for the Examination of Dairy Products, 16th Ed., 1992, Parts 6.2 (Standard Plate Count)and 7.8(Coliforms). 8y: 14654 17942 2125 74028(8/14106) Page 1 of 1 r 013/16/06 15:36 KFL - GEOCHRON 4 19787409705 N0,344 903 KRUEGER Phone:(617)876.9118 Fax:(617)8760572 FOOD Email:dkrueger@kfl.COm 41 -0®LABORATORIES, INC. 711 Concord Avenue,Cambridge, mAt021361002 USA CERTIFICATE OF ANALYSIS Submitted by. Date Reported: 8114106 Date Received., 819/06 Everett Hobbs E.W. Hobbs 207 Fort Avenue Salem, MA 01970 Reference: Sampling Month•August 2006 PO Al Description Your Sample Number Our Lab Number Ice Cream Sampled 819/06, 6°F,Chocolate Chip 74027 STANDARD PLATE COUNT cfulg 1300 COLIFORMS-VRB du/9 <t Standard Plate Count should be less than 50000 cfu/g. Coliforms should be less than 20 cfu/g. Methods:APHA,Standard Methods for the Examination of Dairy Products, 16th Ed., 1992,Parts 6.2 (Standard Plate Count)and 7.8(Coliforms). By lao 14654 17942 2125 74027(8/14/06) Page 1 of 1 08/16/06 15:36 KFL - 6EOCHRON i 197B7409705 NO.344 902 KRUEGER Phone:(617)876-9118 Fax: 876.0572 FOOD , Walk dkrueger@kN.com �AABQRATQRIES, INC. 711 Concord Avenue,Cambridge,MA 021-74-10W USA CERTIFICATE OF ANALYSIS Submitted by. Date Reported., 8/44/06 Date Received: 8/9/06 Everett Hobbs E.W. Hobbs 207 Fort Avenue Salem,MA 01970 Reference: Sampling Month-August 2006 PO#: Description Your Sample Number Our Gab Number Ice Cream Sampled 8/9!06,6'F,Chocolate 74026 STANDARD PLATE COUNT cfulg <250 COLIFORMS•VRB cfulg 1 Standard Plate Count should be less than $0000 cfulg. Coliforms should be less than 20 cfulg. Methods:APHA,Standard Methods for the Examination of Dairy Products.16th Ed., 1992,Parts 62 (Standard Plate Count)and 7.8(Coliforms). ey.�& 1 14654 17942 2125 74026(8/14/06) Page 1 of 1 i OThis recognizes that y W .00 t has c:omple•'e°�the°requirements for 9 N atx o naaRcrwnk:n u conducted by r v ARC of Date complNe�edd°rtheast Massachusetts F? The Amencan Red Cross)/ . as vand for cO this tend to Year(')from com lelian bate This recognizes that C0 M N r c�4 llobbs Y O a has coml e�cc�f�tc requircments tor a Adult C!'ItlAEA as 3 conducted tx ra v ARC of tiorteast Massachusetts c Date completed /��//?�ptlp r' The Amencau Red Crag Jtee°gtla¢+Ihi>cendic:ne as valid for war(s)from completion dale 0626/06 16:08 KFL - GEOCHRON d 19787409?05 ND.094 D01 ! 1 Kkmm Phone:(617)67&9116 G'~0� Fax:(617)87"572 fL EnmW dkrue9erakfi. o ® WDRAioranINC. 711ConcoraAvenue.CamMd MA-O0R13�6- FACSIMILE TRANSMITTAL FORM FAX#: (617)876-0572 Date: 6/26/2006 PLEASE DELIVER TO: Joanne Scott Salem Health Department 878 740 9705 Pages to Follow: 3 Sender's Name: Evangeline Lavoie DOCUMENTS TO Certificate of Analysis for Sample Numbers: FOLLOW: 73432-434 i PLEASE NOTE: f All analytical results should be considered preliminary and are subject to further review until the final report is issued. If problems are experienced with this transmittal, please call(617)67"118. ( IMPORTANT. MESSAGE ) FOR _ A. DATE TIM,�E21 - M 1_ '1 �J3 AI i. OF �hb� .—(,/�,(o MI.tnN� PHONE �'�`� Il4. AREA CODE NUMBER EXTENSION O FAX Q MOBII F AREA CODE NUMBER TIME TO CALL TELEPHONED I PLEASE CALL CAME TO SEE YOU �I WILL CALL AGAIN WANTS TO SEE YOU 1 RUSH RETURNED YOUR CALL WILL FAX TO YOU (M(�ESSAGE _1-r-P, C--AKJl Mggt / I-h 7 aJr ��i91c/ / A 7l r n ow 37 m�l SIGNED r FEn 4009 M IN U S.A. NOTES (.M-�--- and "-tom///Q C LJG_(�tf�C.G1f'�� y �� 06/26/06 16:08 KFL - GEOCHRON a 19787409705 NO.094 PO4 } t KRUEGER Phone:(6171876-9116 Fax:(617)876-0572 FOOD Email:dkrueger@kfl.COm 4[L®LABORATORIES, INC. 711 Concord Avenue, Cambridge, MAt02138 002 USA CERTIFICATE OF ANALYSIS Submitted by. Date Reported: 6/23/06 Date Received: 6/19/06 Everett Hobbs E.W. Hobbs 207 Fort Avenue Salem,MA 01970 Reference: Sampling Month -June 2006 PO#: Description Your Sample Number Our Lab Number Ice Cream Sampled 6/19/06, 12°F, Coffee 73434 STANDARD PLATE COUNT cfulg <250 COLIFORMS•VRB cfulg <1 Standard Plate Count should be less than 50000 cfu/g. Coliforms should be less than 20 cfu/g. Methods:APHA,Standard Methods for the Examination of Dairy Products, 16th Ed., 1992, Parts 6.2 (Standard Plate Count)and 7.8(Coliforms). 14459 17719 2125 73434(6/23/06) Page 1 of 1 06/26/06 16:08 KFL - GEOCHRON a 19707409705 NO.094 903 I t KRUEGER Phone:t617)876.9118 Fax: (6171876 0572 FOOD Email:dkrueger@kfl.com INC. Website:www.kfl.com AABORATORIESr N 711 Concord Avenue,Cambridge.MA 02138-1002 USA CERTIFICATE OF ANALYSIS Submitted by Date Reported: 6123106 Date Received: 6/19106 Everett Hobbs E.W. Hobbs 207 Fort Avenue Salem,MA 01970 Reference: Sampling Month-June 2006 PO#: Description Your Sample Number Our tab Number tee Cream Sampled 6/19106, 12'F,Chocolate 73433 STANDARD PLATE COUNT cfufg 420 COLIFORMS-YRB ofuig `1 Standard Plate Count should be less than 50000 cfulg. Cofiforms should be less than 20 cfu/g. Methods:APHA,Standard Methods for the Examination of Dalry Products, 16th Ed., 1942,Parts 6.2 (Standard Plate Count)and 7.8(Coliforms). By: ` n 1445917719 2125 73433(6/23!06) Page 1 of t 06,,26'06 16:08 KFL GE()CHRON 3 19787409705 N0.094 1?02 KRUEGER Phone:(617)876-9116 Fax:(617)876.0572 FOOD INC. Email:dkrueger@kfi.com 41 -06LABORATORIES, N 711 Concord Avenue,Cambridge,MAt02138-1002 UsAA CERTIFICATE OF ANALYSIS Submitted by: Date Reported: 6123/06 Date Received: 6119/06 Everett Hobbs E.W. Hobbs 207 Fort Avenue Salem,MA 01970 Reference: Sampling Month-June 2006 PO Al: Description Your Sample Number Our Lab Number Ice Cream Sampled 6119106, 124F,Chocolate Chip 73432 STANDARD PLATE COUNT cfutg 560 COLIFORMS-VRO efu/g <1 Standard Plate Count should be less than 50000 cfulg. Coliforms should be less than 20 efu/g. Methods:APHA,Standard Methods for the Examination of Dairy Products,16th Ed., 1992,Parts 6.2 (Standard Plate Count)and 7.8(Coliforms). 41 By. LXI h 14459 17719 2125 73432(6123106) Page 1 of 1 MAY-31-06 01 :44 PM GEOCHRON�KRUEGER 6i7 661 Bi48 P. 04 *; KRUEGER Phone: (6171876-9118 Fax: (617)8760572 FOOD Email: dkrueger@kfl,com WWWARCOM R ...AABORATORIES, INC. 711 Concord Avenue, Cambridge, MAt02138-1002 USA - Y' CERTIFICATE OF ANALYSIS Submitted by: Date Reported. 5126106 Date Received: 5123106 Everett Hobbs E.W. Hobbs 207 Fort Avenue Salem, MA 01970 Reference: Sampling Month- May 2006 PO#. Description Your Sample Number Our Lab Number Ice Cream Sampled 5/23/06, 10°F. Coconut Chip 73214 STANDARD PLATE COUNT cfu/g <250 COLIFORMS -YRB cfu/g <1 Standard Plate Count should be less than 50000 ctu/g. Coliforms should be less than 20 cfuJg. Methods:APHA, Standard Methods for the Examination of Dairy Products, 16th Ed., 1992, Parts 6,2 (Standard Plate Count)and 7,8(Coliforms). i P _ I f By 14371 17613 2125 73214 (5126106) Page 1 of t I _ MAY-31-06 01 :43 PM GEOCHRON�KRUEGER 617 661 0148 P- 03 KRUEGER Phone:(6171876-9118 Fax: (6171 876-0572 FOOD Email: dkrueger@kfl,com _ Website:www kfl.com _- �C?1LABORATORIES, INC. 711 Concord Avenue, Canlbrldge, MA 0 21 3 8-1 002 USA .1 CERTIFICATE OF ANALYSIS Submitted by. Date Reported. 5/26106 3- Date Received: 5/23106 Everett Hobbs E.W. Hobbs 207 Fort Avenue Salem,MA 01970 Reference: Sampling Month - May 2006 PO#. Description Your Sample Number Our Lab Number Ice Cream Sampled 5/23/06, 10°F. Chocolate 73213 STANDARD PLATE COUNT cfulg <250 COLIFORMS -VRB cfulg <1 Standard Plate Count should be less than 50000 cfulg. Coliforms should be less than 20 cfu/g. Methods:APHA, Standard Methods for the Examination of Dairy Products, 16th Ed., 1992, Parts 6.2 (Standard Plate Count)and 7.8 (COliforms) By. 14371 17613 2125 73213(5126106) Page 1 of 1 MAY-31-06 01 :42 PM GEOCHRON,KRUEGER 617 661 0148 P. 02 KRUEGER Phone. (617)876-9118 cOaD Fax:(617)876.4572 f Email. dkrueger@kfl.Com ✓�l ABORATORIES, INC. 7'11 Concord Avenue, CambridgeeMAt02`1385t-1 02 USA - t fCERTIFICATE OF ANALYSIS ` Submitted by: Date Reported: 5/26106 Date Received* 5/23/06 Everett Hobbs E.W Hobbs ! 207 Fort Avenue Salem, MA 01970 Reference: Sampling Month - May 2006 PO 4: Description Your Sample Number Our Lab Numbor Ice Cream Sampled 5123106, 10°F.Vanilla 73212 STANDARD PLATE COUNT — __-- --—__ ctulg � 330 f COLIFORMS -VRB Cfulg t1 Standard Plate Count should be less than. 50000 cfu/g. Coliforms should be less than 20 cfu/g Methods: APHA, Standard Methods for the Examination of Dairy Products, 16th Ed„ 1992, Parts 6.2 (Standard Plate Count)and 7.8(Coliforms) j I- A _ r j: r, i By i t_ I 14371 17613 2125 73212 (5126/06) Page 1 of 1 i 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 //'' '' �'{` T� / / // Date Tvpe of Ooeration(s) Tyge of Insoection -i C e Cream CI Pit( lD�/=/�(o I JE Food Service ❑ Routine Address ��G G /�� Risk LJ Retail ❑k Re-inspection U Level ❑ Residential Kitchen Previous Inspection Telephone,ggg EI Mobile Owner hj� h 1L7/L / HACCP Y/N ❑ Temporary ❑ Pre-operation Allpr , 171J/7bs I ❑ Caterer ❑ Suspect Illness Person in Charge(PIC) t �y/�� /� ��S Time El &Breakfast El General Complaint In: E-1 HACCP Inspector J, -1yW / t o I Out:O Permit No. ElOther Each violation checked requires an explanation on the narrative page(s) and a citation of specific provision(s)violated. Non-compliance with: Violations Related to Foodborne Illness Interventions and Risk Factors Anti-Choking Tobacco Violations marked may pose an imminent health hazard and require immediate corrective 590.009(E) ❑ 590.009(F) ❑ action as determined by the Board of Health. FOOD PROTECTION MANAGEMENT ' •- ❑ 12. Prevention of Contamination from Hands ❑ 1. PIC Assigned/Knowledgeable/Duties El_ _ _ _ 13. Handwash Facilities EMPLOYEE HEALTH "• •" PROTECTION FROM CHEMICALS ` ' '• "• ❑ 2. Reporting of Diseases by Food Employee and PIC ❑ 14.Approved Food or Color Additives ❑ 3. Personnel with Infections Restricted/Excluded ` [115.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 ❑ 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)(590.90.0 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 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. O�thherr� , �(( \\�{\ l((✓/I DATE OF RE-INSPECTION: sssoinspecrForme-,o d.---) Ins ehor'br atu : ' Print: PIC's b`ignature: Print: Page /of+a Pages 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* 3-302.11(A)(]) Raw Annual Foods Separated lone 590.003(B) I Demonstration of Knowledge` Calked and RTE Foods* 12-103.1 t Person in charge-duties Contamination from Raw Ingredients 1 3-302 1 1(A)13) Raw Anitnal Foods Separated from Each EMPLOYEE HEALTH i Other* 2 590.003(C) Responsibility(it the person to chatge to Contamination from the Environment require reporting by food employees and 3-302.1 I(A) Food Protection' I applicants* 3-302.15 Washing Fruits and Vegetables 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 Utensils* Charge* Contamination from the Consumer 590.003(G) Reporting by Person in Charge* 3-306.14(A)(4) Returned Food and Reservice of Food* f 3 590.003(D) Exclusions and Restrictions* Disposition ofAdulterated or Contaminated 590,003(E) Removal of Exclusions and Restrictions Food 3-701,11 Di;ru'ding or Reconditioning unsafe FOOD FROM APPROVED SOURCE Food* 4 Food and Water From Regulated Sources 9 Food Contact Surfaces 590.0(A(A-B) Compliance with Food Law" 4-501.111 Manual Warewashing-Hot Water 3-201.12 Food in a Hermetically Scaled Container* ISanitization Temperatures* - 3-201.13 Fluid Milk and Milk Products* ( 4-501.1 12I Mechanical Warewashing-Hot Water 3-202.13 Shell Eggs* I ! Sanitization Temperate f 3-202.14 Eggs and Milk Products,Pasteurized` 14-501.114I Chemical Sanitization-temp.,pH, 3-202.16 I Ice Made From Potabh;Drinking Water" concentration and hardness. „ 5-101.11 Drinking Water from an Approved System- 4-b01.1 I(A) Equipment Fond Contact Surfaces and Utensils Clean" 590.006(A) Bottled Drinking Water* ( 4-602.11 CleanFrequency ing 590.006(B) Water Meets Standards in 310 CMR 22.0* Contact Surfof Equipment Food- acEs 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 I Food Contact Surfaces of Equipment" Shellfish* ( 4-;03.15 I Methods of Sanitization--Hot Water and 3-201.15 Molluscan Shellfish from NSSP Listed Chemical'' Sources* --- - 10 Game and Wild Mushrooms Approved by I I Proper,Adequate Handwashing Regulatory Authority .1-301.11 Clean Condition-Hands and Anns* .3-202.18 Shellsutck Identification Present* 2-301.12 Cleaning Procedure* 1590.004(C) I Wild Mushrooms" I ( 2-301.14 When to Wash* 3-201.17 Game Animals* I I it I Good Hygienic Practices g Receiving/Condition I ( 2401.11 Eating,Drinking or Using Tobacco* 3-203.11 PHFs Received at Proper Temperatures* 12-401 12 Discharges From the Eyes,Nose and 3-102A5 t5 Package Integrity" Mouth* �-101.11 Food Safe and Unadulterated* ( 3-301.12 Preventing Contamination When Tasting* 6 Tags/Records:Shelistock 112 Prevention of Contamination from Hands I 3-202.18 Shellstock Identification" ( 590.004(F) Preventing Contamination from 13-203.12 Shellstock Identification Maintamed" I Employees* Tags/Records:Fish Products ( 113 Handwash Facilities 3402.11 Parasite Destruction* Conveniently Located and Accessible 3-402.12 Records,Creation and Retention* 5-203.11 Numbers and Capacities` 590.004(J) ( Labeling of Ingredients* 5-204.11 Location and Placement* 7 Conformance with Approved Procedures 5-205.11 Accessibility,Operation and Maintenance IHACCP Plans I Supplied with Soap and Hand Drying 13-502.11 Specialized Processing Methods* I Devices 3-502.12 Reduced oxygen packaging.criteria* 16-301.11 Handwashing Cleanser,Availability 8-103.12 Conformance with Approved Procedures-Denotes cutical nem in the federal 1999 Foal Cade or 105 CMR 590.000. CITY OF SALEM BOARD OF HEALTH / d Establishment Name: �'(N T�6 U5 SCC (,Y('Q/�l W �2/// Date: /is/o� Page: a of oz Item Code C-Critical nem DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date No. Reference R-Red Item Verified i PLEASE PRINT CLEARLY r t n Oaf iii - it)/'U /q1% IS SS I cv(j+ 1 a Ya cy . (0,62-h-fllz a� ' �/ishrnv�� /�r// rtaf 12e /til/ lrrr�5/ 1 aZz"d 45, j 1 I � 4-/1 rghee Vita7�oqs 6jr,4d ,-n 6/2-51d lQ /1)Saoc-1707C 121KV-eX � I r I / � I I s 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 LI 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 Cl closure rr' your food permit. 0 Voluntary Disposal ❑ Other: i 3-51;1.%4(() PHFs Recroe,_i it Temneratures laciatrons Related to Foodoorne Illness Interventions and Risk Accutding to Len-Cooled to Factors(items 1.22,) (Cont.) I 4 i"F(45Y`rv'i:hir:4 Hours. PROTECTION FROM CHEMICALS C- cling A'W)od,. 'or I f4Fe I 1 i j Food or Color Additive, ( 19 PHF Hit ar:d Cold Holding Cahi Pill's z-202.12 AdditiW'1 Pill's Slainhm:ed at or beL�so 3"302.14 Protcctiun froet Unapp-os'ed,Vditives* ( ")00041 F) 41'14>" P- 3-50 " 3-501.IN-s) Hot FRFs tMainta tied at or above j 15 Poisonous or Toxic Substances j 140'F. 7-101.11 Identifying Information-Oi i;;:nul VA) Roasts!field at or abs we ;)O'Li Containers" j 7-102 1 1 Conunon Nome--%t,Irkmg Containers` j ( 20 Time as a Public Health Control j 3-501.1 Time as;t Public Health Control* 7-201.11 Separation-Sloraee`' j 7-202 11 Restriction-Preseoce and Use `9U.Uli'1W i Varl:mce Requirement 7-202.12 Conditions of L!sc* 7-?03.1 1 Toxic C'onta:net,- Prohibitions, REOUiREMEN i S FOR HIGHLY SUSCEPTIBLE POPULATSONS(HSP) 7-204.1; Saran zets,Cnterla-Chendcals'` j �. v �., yr, j 21 ; 3-BC,:.:!(A) Ujip tsreurrzed Prt-packaged Juice.and 7 '_.C4 1_ Chemicals for .vash,tu 1 :donee.Criteria- Beve:u^ens w-rh Vraimnq T abeks j 1.205.14 Drying Agents.Comact, ;-801,11(Bl Us:+:fP3steutiaedE,!,:�* T ?OS,i; IoeideuLti r:n>tI Curiact,Lnbneants* ( 3-803.11 iDi Raw or Paetially Cooked Animal Food and 7.206.1; Restricted Usr Pe:ticidce,Criteria" Few Seed%)routs Noi crNzd. f 1 7-206.12 Rodent Ban Sotlions' x-fiC'I 11(C; Lhnupened Food PacLa„: 1ed Re-served. 7-206.13 -Frocking Powders,Pest Control and Monitorial* CONSUMER A1'.VISORY TIMEITEMPER4TURE CONTROLS 22 3-603.: 1 Consumer Arivieorp Posted for Consumption of 16 Proper Cooking Temperatures for Animal FrIods'l'bat arc Raw. Undercooked of PHFs tint i)tirermn::e Processed to)ahmurn[c 3-401.I1A(1)(2) Fgg.- I5;'F 15 Sec. Eglec futn-ediau,Serv)ce 145`F15sec'' i '-'`)= l; £',ateuna^r t,gg,Subsrittrtc•Fat Rs+v Shell 3-401.11(5)(2) Comminuted Fish,Meats k Gamc i Eegs' Ammals - 155'F 15 sec. " SPECIAL REQUIREMENTS L)(2) Pub-and b"I'Roust - 130"F 121 min' j 3-401.11(A)(2) Ratacs. injected Mcats-155°F 15 590.0(19;A)-lD) Violations o Section 590.009(A)-(D) in Sec. w catering. alobile foo(1,temporaq and 3-401.1 I(A):3) Poultry, Wild Game, Stuffed PHFs, !:itches operation~ ,should he Slit"ing Cont.unm„Fish, Meal, debited under the appropriate sections Prndtr;or R,ti[es-165°F t5 sec. '' above if related to foodltxxne illness 3-101.11(C:)(3) Whole-muscle,Intact Reef'Steaks interventions and risk tactor. Other 145`F 590.009 violations relating io good retail l 3.501.12 Roti,Animal FoWs Cooled in a ; practices should be debited under#29 - ntiavw4ve 165'F'" Special Reg[tivenlents. 3-=t01.111A)(I 0) Alt Cthcr PHFs- 1.15°F 15 se. ' j 17 Reheating lir Hot Holding VIOLA TIONS RELATED TO C-.'OOD RETAIL PRACTICES 2-403.11(A)&'(D) PHF,, 165`F 15 so:. (penis 23-30), 3-4U3.11(b) Microwave- Itis"F 2 Minele Stand.ine I Critical w,.1 non-r oval vinlao nt.s, i;hich th,,u,r relate to the Time" j faodburna IMI4s.c eilervenrions and rLsd hectors listed nbure, ian be 3-403.11(C) Cunm orctaliy firacecsed RTE Food- j (n;md fir: 8:r j'oih'wito' section,,of ine Nnod C e"C and 107 Cult 3-103 1 Illi) Reinaining Unshced Portions of Reel' ' Item Good R¢tail Frachces FC 590.000 j Ruae;t:+ y ( 23. Management and Personnel FG-2 .008 j 18 Proper Cooling of PHFs 24. Footl and Food!Protection FC- 3 004 5, Eouipmnnt and Utensils FC -4 .Co5 3-501 1'1('3) Cooling C,okcd PHFs from 140'F a) j , 26. Mater,Plumbn :rtro and ante FG-5 1 006 7WF Within 2 Hone;and From 70°F 27 Phvsical Fad i!y FC-6 .007 j to 41-F/45,F Within 4 Hours. ' ( 28 Poisonous or Toxic Meter alk , ;--7 ! .008 13-501.1'1(S) Cooling PF£Fs lviad: From Ambient 1 29, Sp^rini R=quire.:-:cote ; .00", I T 'I°Ff45`<, 30. Otho! ,emperaturalm,redientsto- _ Within 4 Hours 'Derat-,anneal iaan m:hr lode"al 199`+Good C,ife or W!,CNIR 590 MID, Massachusetts Department of Public Health Salem Board of Health Division of Food and Drugs 120 Washington Street,4M Floor 9 Salem, MA 01970-3523 FOOD ESTABLISHMENT INSPECTION REPORT Tel. (978) 741-1800 Fax(978) 745-0343 Name / Date TYoe of Ooeration(s) Type of Inspection�+C114Za �j�7��/1/.• ❑>rood Service ❑ Routine Address �D5' T /L Ris / ❑ Retail ❑ Re-inspection rl r^ Level ❑ Residential Kitchen Previous Inspection Telephone may_ L, ��%� _ 9/ ❑ Mobile Date'. Owner TY HACCP Y/N [__1 Temporary �n-rre-operation ` ❑ Caterer ❑ Suspect Illness Person in Charge(PIC)jf1 J t Time ❑ Bed&Breakfast ❑General Complaint In: ElHACCP Inspector \�. �l Y�n� 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 - ._ . J ❑ 12. Prevention of Contamination from Hands ❑ 1. PIC Assigned/Knowledgeable/Duties EIa 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 El_ 15.Toxic Chemicals FOOD FROM APPROVED SOURCE , ' """ ""_ ❑ 4. Food and Water from Approved Source TIMEIfEMPERATURE CONTROLS(Potentially Hazardous Foods) ❑ 5. Receiving/Condition ❑ 16. Cooking Temperatures ❑ 6. Tags/Records/Accuracy of Ingredient Statements ❑ 17. Reheating ❑ 7. Conformance with Approved Procedures/HACCP Plans [118.Cooling PROTECTION FROM CONTAMINATION ' ' ' ❑ 19. Hot and Cold Holding ❑ 8. Separation/Segregation/Protection ❑20.Time As a Public Health Control ❑ 9. Food Contact Surfaces Cleaning and Sanitizing REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) E]21. Food and Food Preparation for HSP El 10. Proper Adequate Handwashing ❑ 11. Good Hygienic Practices CONSUMER ADVISORY E]22. Posting of Consumer Advisories Violations Related to Good Retail Practices Number of Violated Provisions Related Critical (C) violations marked must be corrected To Foodborne Illnesses Interventions immediately or within 10 days as determined by the Board and Risk Factors(Items 1-22): of Health. Non-critical (N)violations must be corrected Official Order for Correction: Based on an inspection immediately or within 90 days as determined by the Board today, the items checked indicate violations of 105 CMR of Health. 590.000/federal Food Code. This report, when signed below N by a Board of Health member or its agent constitutes an 23. Management and Personnel (FC-2)(990.003) order of the Board of Health. Failure to correct violations 024. Food and Food Protection (FC-3)(590.004) cited in this report may result in suspension or revocation of i 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 t0 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 5WbN lcfFo -10 do n Inspe'cto s ligre: Print: -{ I PIC s Signafur I� Print: ( ,�i � '�_��rl� Page (Of Pages y .. Violations Related to Foodborne Illness Interventions and Risk Factors(items 1-22) PROTECTION FROM CONTAMINATION FOOD PROTECTION MANAGEMENT j S Cross-contamination j j 1 590.003(A) Assignment of Responsibility* j 3-302.11(A)(1) Raw Animal Foods Separated from 590.003(B) Demonstration of Knowledge" j Cooked and RTE F,xols* ( 2-103.11 Person in charge-duties Contamination from Raw Ingredients ---1 3-302.11(A)(2) Raw Animal Foods Separated from Each EMPLOYEE HEALTH Other` 2 590.003(C) Responsibility of the person in charge to l ( Contamination from the Environment require reporting by food employees and 3-302.11(A) Food Protection^ applicants* 3-302.15 Washing Fruits and Vesetables 590.003(F) Responsibility Of A Food Employee Or An 3-304.11 Food Contact with Equipment and Applicant To Report To The Person In Utensils* Charge* Contamination from the Consumer 590.003(6) Reporting by Person in Charge` j j 3-306.14(A)(B) Returned Food and Reservice of Food* j j 31 590.003(D) Exclusions and Restrictions* I Disposition of Adulterated or Contaminated j 590.003(E) Removal of Exclusions and Restrictions Food 3-701.11 Discarding or Reconditioning unsafe FOOD FROM APPROVED SOURCE Food* 4 Food and Water From Regulated Sources j 9 Food Contact Surfaces 590.004(A-B) Compliance with Food Law* j 4-501.111 Manual Warewashine-Hot Water j 3-201.12 Food in a Hermetically Sealed Container* j Sanitization Temperatures* j 3-20 L13 Fluid Milk and Milk Products* j 4-501.112 Mechanical W arewashina Hot Water j 3-202.13 Shell Eggs* I Sanitization Temperatures* j 3-202.14 Eggs and Milk Products.Pasteurized* j 14-501.114 Chemical Sanitization-temp.,pH, j 3-202.16 j lee Made From Potable Drinking Water- concentration and hardness. ,k J 5-101.11 j Drinking Water from an Approved System` 4-601.11(A) Equipment Food Contact Surfaces and Utensils Clean`" j 590.006(A) Bottled Drinking Water* ( 4-603.11 Cleaning Frequency of Equipment Food- 590,006(B) Water Meets Standards in 310 CMR 22.0* i Contact Surfaces and Utensilsk j ShelNrsh and Fish From an Approved Source j - - -- 4-702.1 1 Frequency of Sanitization of Utensils and 3-201.14 Eich and Recreationally Caught Molluscan Food Contact Surfaces of Equipment' Shellfish* ( 3-201.75 Moltun.an Shellfish from NSSP Listed 4-703.11 Methods of Sanitization-Hot Water and Chemical* Sources* ( to Proper,Adequate Handwashing j Game and Wild Mushrooms.Approved by 30111 j 2- Clean Condition-Hands and Anus* Regulatory Authority j 3-202 18 Shellstock identification Present* j 2-301.12 Cleaning Procedure* j j 590.004(C) Wild Mushrooms` ( j 2-301.14 When to Wash* j 3-201.17 Game Animals* ? ! it Good Hygienic Practices j g j Receiving/Condition j j 2-401.11 Eating,Drinking or Using Tobacco* j 3-202.11 ( PHFs Received at Proper Temperatures* j 12-401.12 Discharges From the Eyes, Nose and Mouth* 3-202.1 ( Package ay* * j � 3-301.12 Preventing Contamination When Tasting" j 3-101.171 ( Food Safee and nd Unadulterated j j 6 Togs/Records:Shellstock ( 12 4 Prevention of Contamination from Hands j 3-202.18 Shellstock Identification* ( 590.004(F) Preventing Contamination from j 3-203.12 Shellstock identification Maintained", ( Employees* j TagslRecords: Fish Products j 13 Handwash Facilities j j 3-402.11 Parasite Destruction* j Conveniently Located and Accessible j 3-402.12 Records,Creation and Retention* j 5-203.11 Numbers and Capacnies* t Labeling of Ingredients' j 5-204.11 Location and Placernent* j 5)0.604(!) ( 9 9 j j 5-205.11 Accessibility,Operation and Maintenance j 7 ( Conformance with Approved Procedures I Y• /HACCP Plans Supplied with Soap and Hand Drying 3-502.11 j Specialized Processing Methods* Devices j 3-502.12 Reduced oxygen packaging,criteria* ( 6-301.11 Handwashing Cleanser,Availability j j 8-103.12 Conformance with Approved Procedures- ( 6-301.12 Hand Drying Provision j "Denotes critical item in the federal 1994 Fond Code o 10 CMR 590.000. ~ CITY OF SALEM S - e��Q� BOAR/D OF HEALTH /25/��j Establishment Name: ��r�l� Date: / Page: of Item Code C—Critical ItemDESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date 1 .• No. Reference R-Red Item Verified PLEASE PRINT CLEARLY - 14-e - '0 In iii sp0r_-1-71W , (Il ��dU�' Pd �-Phx_ -4/1o1clj1*7 C7 1 I7c-e_ Cream ha a/ erF' �[aeGlo7 / 74 /e ll _ Sc� C'r:°a�x -fin /7of ba_S=i� ih, Nd orrhl OK rd .bu /n cfD I I S'�tuhlishrr��rr f hos t 3adhl;irl h', .-36 jam s _ 3� 4CD�rhonof` 9111't 1.d /1 4hr) E I n —Th/,o AS i I Discussion With Person in Charge: Corrective Action Required: I ❑ No I ❑ Yes ❑ Voluntary Compliance ❑ Employee I have read this report, have had the opportunity to ask questions and agree to correct all 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 twe�, y-five d la s or suspension/revocation of ❑ Embargo ❑ Emergency Closure your food permit. / / 13 Voluntary Disposal ❑ Other: >HFsRecerred:ft Temperatures Violations Related to Foodborne litnes3 Interventions and Risk =,ccurdins to t..rv. Coolyd to Factors(items 1-22) (Cont.) j41`17,45'F t4 nhin 14?uurs PROTECTION Ff{Oh4 CHEMICALS 3-501.i5 Coolitt}t Metbods for PHFs j Iq Food or Color Additives (4 I PHF Het and Cold Holding -501.16�1I Cold PI-IF.,Maintaiaed at or bdov' 3-20112 Add Iittrs' 59()001(F) ;I'/1S"F` i 302.14 Protection from(inaPPrm-ed Additives"= j ! ( ( -501.16(:1) Hot PHFs H9:)ff mined at or abrrde 15 Poisonous at Toxic Substances ( MOT, 1 7-101.11 Identifying Information-Ongmal I 3-SOi.i 6(,1) k`(a l{e!d at or shove 130`'1 . '" Containers- ( 20 Time as a Public Health.Control 7-102.1 I Comnum D]an:e--Working Containers* Time cs a Public Health Coan"oll 7-_01.11 Sennration-Stontt=,e' iry0.00-;I-]) 17-202 11 Restriction-Presence and Use" ( I - 'Jai ian.e Requircn;ent 7-202.12 Conditions of Use* 7-203 11 Tunic Containers-Prolnhitinns* REQUIREMENTS FOR HIGHLY SUSCEPTIBLE. ( , , I-2 J4.11 Sariitizers,Critena --Chemindt� POPULATIONS(HSP) 71_04.12 Chemicals forW'ashm!es'rodt:ce,Cnterio. 121 i 3-501.1 I(A) LnFas:curl::ed PrepackogedJuice:;anti Beretn+,es with *arning tabcls 7-204.1.1 I)4it:g Attems.C'ntcria' ;_801 li(h) floe of PatemiZed F.e_s` 'i 20:5,i I incidental Fond Contact. Lobneums V-200.11 ttenincted Use Pesticides.Criteria* j 3-80111(P) Raw or Partially Cooked Animal Food and R.tee Seed Sprouts Not Served. 7-206.12 Rodent Ban Stations" I `:, ;Xi!1.11(C) ljmnenedF,,"d Packae, Not Re-served. 7-206.13 'tracking Poxders. Pest Cnntroi and (Monitoring* CONSUMER CONSUMER ADVISORY TIMEfTEMPERATURE CONTROLS 22 3-60? I Consumer Advis,ay Posted for Consumption of ! I :knimal Foods"I'i t.tt are K.:v;, ihndct'ar)ked at to Proper Cooking Temperatures for PHFs Not C}tl;erwc;e Proce,fed tc Liini n tte Pathoaena." i-1t'tLIIA(I)(2) Eggs- ISS"F 15 Sec. E>s s hmnediate Service 145`PlSsec* 3 302.,.1? Pasteurizes Hi i Substitute for Raw Shell -5 3-401.11(A)(2) Comminuted Fish,Meats&Game I gags Animals- 155^F 15 .sec. 3-401 l l(B)(I)(2) Pork and Beef Roast- 130"F 12J ruin," SPECIAL REQUIREMENT'S 401.11(A)(2) ;2a•:t:tes,Injected Meats- 155°F IS S90 009(A)-(u) V:0IaJ0nS Of Section 590,009(A)-(U) in catering. mobile Lotti, temporary and 3-401-11(3)(3) Poultry,W'ildGan:e.Staffed PI-IFs, residettral kitchen operations should be Stuffing Containing Firh,Meat, debited under the approp,into sections Poultry ur Rarites-165°f IS swc. ` lhove:f rc`ated to iirodborn: illness 3-401.1IoCi(3) ''Whole-muscle, Intact Beef Steaks Interventions and risk factors. Other 14J"F* 5907.009 violations relating to cood retail 3-401 12 Raw Animal Food,Cooked in a � prt:c!iccs should be debited under 1129 - Mictowat-e 165'F` ! Special Requirements. 3-401.1 i(A)(1)(b) All Other PHFs- 145"P I-,sec. " 17 Reheating for Hot Holding VIOLATIONS RaA'TEo TO G000 RETAIL PRACTiCEs 3-403.11(A)K(P) PHFs 165F 15.sec. = I (Iteotc 23.34) i-403 I IB! Mit rowave. 165°F 2 Minute Standina C+itrcai and nnro-rrr?irnl eio,awr,s, which do not reiarr to the Time* iirodborne 111nes.s iwvi ventions and;if-4 lined abnrr, cmt bc. 443.11(C) Commercially Processed RTE Food- Linaid if:a;a jo1h.•ing se,"inu.e q('i1:e Food rode mid 105 CMR 3-I03.11(FJ Remainine Pnilieed Portions of Bcef Item Good Retail Practices FC 590.000 Ko,)sts" V 23. M-naoe:r:ent std Personnel FC-2 .003 j IS Proper Cooling of PHFs I ! 24 Focd and=nod Protection FC-3 .004 3-5 r cr +. • _ 25 Equipment and Utensils FC-4 .00b (}1 14(,'1) Cooling 'ookedl PHFs, om 140 Pto 26 Water P:umbi-g a,"d Wr,ste rC-5 AOF 702E Wlsh,n 2 Flour mid From 702E ! 27 Ptrysical Facil:iv FC--6 00i to 41"F/45"F Within.: How s. " 25. '--isor.pus or Tnx:r klatctia!s -C. -7 ! ,008 I 3-501,11(B) Cooling PHFs Made From Ambient ( ! 29 Soeael Rsquirente,ds Tempriattire Ingredientstu41"Fr45F 30, Other Within 4 Hours" *Dc!x,te>Ct itmll oero m,int We"al 1091)Fond Cnde ur 105 CKIR 50 000 tAft + "ok Alf r.,,•i" W,4i s'' 14� sX,—;'.a4. v Commonwealth of Massachusetts j City of Salem Kimberley Driscoll Board of Health Mayor 120 Washington Street,4th Floor SALEM,MA 01970 Food/Retail Establishment Permit DATE PRINTED: 03/30/2006 WHO'S PLACE OF BUSINESS IS: E.W. Hobbs File Number BHF-2004-0133 7 Island Avenue Salem MA 01970 LOCATED AT: SALEM,MA 01970 Permit Type Permit No. Permit Issued Permit Expires Fee Restrictions/Notes FOOD SERVICE BHP-2006-0442 Mar 29,2006 Dec 31,2006 $100.00 ESTABLISHMENT FROZEN DESSERTS BHP-2006-0440 Mar 29,2006 Dec 31,2006 $5.00 April-Oct./ WATER SOURCE: CITY WATER SEWER DISP: CITY WATER Total Fees: $105.00 PERMIT EXPIRES (December 31, 2006 Board of Health 4�0 . I This Permit is not transferable and must be reissued upon change of ownership or location.The permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code,beofre any revonations,improvements,or equipment changes are made,all plans for such must be submitted to and approved by the Salem Board of Health. Page 1 of 1 R a CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH 120 WASHINGTON STREET, 4TH FLOOR SALEM, MA 01970 TEL. 978-741-1800 FAx 978-745-0343 Kimberley Driscoll WWW.SALEM.COM Mayor JOANNE SCOTT, MPH, RS, CHO HEALTH AGENT 2006 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT NAME OF ESTABLISHMENT -lU .� Ins y�C_ \ +\TEL# 911 FrI 7� S- 76 91 ADDRESS OF ESTABLISHMENT bS • .1 q/ 1—d)r M L; e _ MAILING ADDRESS Of different) OWNER'S NAME `,\ etv+T TEL# 7,0 ADDRESS ��S LZr A U 'e CITY CZ'-�-alSTATE !7�snnz zip 01 '9 -7'0 CERTIFIED FOOD MANAGER'S NAME(S) '�rlpS C- N4b(7 _CERTIFICATE#(s) (required in an establishment where potentially hazardous food is prepared.) EMERGENCY RESPONSE PERSON (1tKIC'S t- A6 HOME TEL# y��7�r•� 7Q.3 HOURS OF OPERATION: Mon. 1 -1 Tue. ItV Wed. Ih10 Thu. I1-10 Fri. 11�o Sat. N-10 Sun. TYPE OF ESTABLISHMENT FEE (check only) RETAIL STOREYES -NO less than 1000sq.ft. =$ 50 1000-10,000sq.ft. =$100 more than 10,000sq.ft. =$250 RESTAURANT YES NO less than 25 seats =$100 25-99 seats =$150 more than 99 seats =$200 YES------NO-------------------------------------------------------------------------------------$100 ---- ADBED/BREAKFAST - - - I --TS-- - ................................................................ -------------------------------------------..........---- DITIONAL PERMI MAKE (not just serve) ICE CREAM, YOGURT, SOFT SERVE j® NO $5 TOBACCO VENDOR YES � $50 ALL NON-PROFIT(such as church kitchens) YES $25 *Please pay total with one check payable to the City of Salem . This Permit is not transferable and must be reissued upon change of ownership. The Permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code, before any renovations, improvements, or equipment changes are made, all plans for such must be submitted to and approved by the Salem Board of Health. Pursuant to MGL Chapter 62C, Section 49A, I certify under the pains and penalties of perjury that I, to my best knowledge and belief, have filed all state tax returns and paid all state taxes required under the law. &J% lyak*4A- 312440lo vIt ZJap Sir �- Signature Date Social Security or Federal Identification Number li -------------------------------------------------------------- ---------- Revised 11/03105 FOODAP2.adm Check#&Date 3-2,90 ✓/�(p/��i �' � p0 CITY OF SALEM BOARD OF HEALTH Establishment Name: Date: Page: o4 Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date No. Reference R-Red Item Verified PLEASE PRINT CLEARLY I . I I I 1 1 - 1 1 1 i j 1 I Discussion With Person in Charge: I 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/ Exclusion violations before the next inspection, to observe all conditions as described, and to ❑ Re-inspection Scheduled ❑ Emergency Suspension comply with all mandates of the Mass/Federal Food Code. I understand that noncompliance may result in daily fines of twenty-five dollars or suspension/revocation of ❑ Embargo ❑ Emergency Closure your food permit. 11 Voluntary Disposal 13 Other: 3-SUI, 4((-,) PHFs Received at Temperatures Violations Related to Foodborne illness Interventions and Risk Aceorimg to Law Coiled to Factors(items 1:2) (Cont.) 41-F/45F Within 4 Hours. PROTECTION FROM CHEMICALS 3-501,15 Confine Mcd;ods for PHI--'s 14 Food of Color Additives 19 PHF Hot and Cold Holding 1-501,16(B) Cold P1E17s Maintained it or below 3-202.12. Additives* 590.004(F) 41','45°F` 3-302 14 Protection from Unapproo-ed Additives* ( 3-501.16(A) Hot PHF: Maintained at or above 15 Poisonous or Toxic Substances 140'17 ' 7-lot.]l Identifying Information-Orwinal 3-501.16(A) Roasts Held at or above 130°F. Containers 20 Time as a Public Health Control 7-102.11 Name-Working Container," 3-501 19 Tim?as a Public Hcalth ContmN� 720L1] Separati Separation-Storage" � 7-202 t1 Restriction-Presence and Use* 590.004(H) V_riam:eRequircntem 7-203.13 Conditions of Use REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-203 It Toxic Container,-Prohibitions"' � POPULATIONS(HSP) 7-204.11 Sanitizera,Criteria-ChzmicalsT i 7-204.12 Chemicals for Washing Produce,C moria" 121 3-801 H(A) Unpasteurized Pre-packaged Juices and 7-204.14 Drying Agents.Criteria" Bevetages with Warning Iabets" 3-X01.11(B) Use(if PastemizedEggs' 7-205.11 Incidental Food Contact. Lubricants^ 3-801,11(l)) Raw or Paoially Cooked Annual Fond and 7-206,11 Restricted Use Pesticides. Criteria* ( Raw Seed Sprouts Kot Sen ed. # 7-206.12 Rodent Bait Stations` 3.801.11(0 Unopened Poxi Yad:ag• :' " p c Not Re-served. 7?06.1 t Tracking Powdrrc,Pest Control and Monitoring* CONSUMER ADVISORY TIMElTEMPERATURE CONTROLS 22 3-603.11 Consumer advisor} Posted for Consumption of Animal Foods'Fhat ace Raw.Undercooked or 16 Proper Cooking Temperatures for PHFs Not Otherwise Processed to Eliminate , ter�c,.2,. .toor 3-101.I1A(1)(2) FigPmhngons.'* gs- 155`FISSec. Eggs-himiedion:Scrvo:c 145'F 15sec" 3-302.13 P::;teunz_d Eggs Substitute for Raw Shell 3-401.11(A)(2) Comminuted Fish,Meats&Gaute Eegs� Animals- 155'F 15 sec. 3-401.11(b)(1)(2) Pork and Beef Roast- 130`F 121 nein' SPECIAL REQUIREMENTS 3-401.11(A)(2) Ratites, injected pleats- 155'F 15 590009(A)-(D) Violations of Section 590.009(A)-(D) in seC. * ( catering. mobile food,temporary and 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs, residential kitOwn operations should be Sinning Containing Fish,Meat, debited under the appropriate sect tons Poultry or Rams-165'F 15 sec. * above if related to foodborne illness 3-401.11(C)(3) Whole-muscle, Intact Boef Steaks interventions and tis}: IUrtors. Other 145'F 590.009 violations relating t:)good retail 3-401.12 Raw Animal Fools Cooked in a )nactices should be debitrel tinder N29-- Mictowave 16i`F* Special Requirelncnts, 3-401.i I(A)(1)(h) Ali Other PHFs- 145'F 15 sec. j 17 Reheating for Hot Holding ( VIOLATIONS R ZATED TO GOOD RETAIL PRACTICES 3-403.11(AWD) PHFs 165`'17 l5 sec. * ( (lte:tts 23-30) 3-40111(B) Microvoave- 165'F 2 Minute Standing ( Critical an(!nor,- N(:-Nrul riulehom,, i,hich;G,nor ieluw to the Time` foodborne illness nuervennom east risk jartors listed above, (zap be 3-403.11(C) Commercially Processed RTh Food- I found to the fcllowiug• wo'licteo of the Food Code and JO) C IR 140"F 590.000- 1 3»1U3.11(E) Remaining Unsliced Portions of Reef Item Good Good Retail Practices FC 590.000 -� Roasts' 23. Maratiement and Personnel FC--2 .003 IR Proper Cooling of PHFs 24, Food and Food Piotaction FC-3 .004 25. Equama rf and Utensils FC- 4 .005 3-501.14(A) Cooling Cooked PHFs from 140`F to j 261 Water, Piumbino and Waste FC-5 006 70'F Within 2 flours olid From 70-F ( 27 Physical Facility FC-6 007 f to 4PF/45T Within 4 Hours. ` 128. Poisonous cr Toss-Materials FC. -7 1 .008 3-501.1443) Conlin_*PfiFs Made From Ambient i 29, Special Rotiorements 009 Temperature Ingredients in 41°045�F L30. Other Within 4Ilours- °""'"..•'^:'"° ' Denotzs enucil nen in the trderal 1999 Fond C�de or 105 C NIR 590 000. CITY OF SALEM BOARD OF HEALTH Establishment Name: Date: Page: o4 Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date l No. Reference R—Red Item Verified PLEASE PRINT CLEARLY 1 1 - 1 1 ` I 1 I � 1 I I I I 11 I 1 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/ Exclusion violations before the next inspection, to observe all conditions as described, and to ❑ Re-inspection Scheduled ❑ Emergency Suspension #Comply with all mandates of the Mass/Federal Food Code. I understand that noncompliance may result in daily fines of twenty-five dollars or suspension/revocation of Li Embargo L3 Emergency closure your food permit. ❑ Voluntary Disposal ❑ Other: 1 PHFs I2eLeived at Temperatures Violations Rotated to Foodborne Illness interventions and Risk According to Law Coy iicd to Factors(items 1-22) (Cont.) -11=F/45'F Within; Hums PROTECTION FROM CHEMICALS ( 13-_101 15 Conlin*,Methods for PHFs 14 ( Food or Color Additives I I 19 I PHF Hot and Cold Holding t-501.16(_'.) Cold PHFs Maintained at or below j 3-202J2 Additncarr 590.001(F 4t` 3-1()114 Protection from Unapproved Additives 3-501.I6(A) Hut PHFs itlaintained at or above j 1S Poisonous or Toxic Substances - 7-i 01.11 Identifying Irform:nu st--Onginal i-501.16(A) Roasts Held at or above 130'F. Containers" - 7-102.11 Common Nance-Workin;;Containers'° j 12ij Time as a Public Health Control 7-'01.11 Sep:uatiun-Storage'. i 3-501-19 Timc as a Public Healdn Comrol j 590.0011H) Variance Rcquircment 7-202.11 Restriction-Presence and Use ' I j 7-202.12 Conditions of 1_7s01 17-203.11 -Conic Container-- Prohibitions' REQUIREMENTS FOR HIGHLY SUSCEPTIBLE I HSP 7-204.11I Sanitizcr;,Criteria --Chemicals" POPULATIONS{ ) 7-204.12 Chemicals for Washing Produce,Citeria^ 121 1-301.11(A) Unpasteurized Pre-packaged Juices mid 7-20.1.14 Drying Agents.Cruet iaT j Bevetuzas with ikaim c;'.-bels- 17-2205.11 Incidental Rod Contact. Lubncnnts° 13-80;.i1(B) Lisle of Pasteurized H,gs* 7-206.1 l Restricted Use Pesticides.Criteria* ! 3-301.11 i D) Raw ur Partially Cc,uked Animal Food and Raw Seed Sprouts N'<'t Served. 7-20b.12 Rodent Bait Stations' I I ;-80L 111Ci Unopened F(xA Packa;;e Not Re-served. 1-2`06 13 -iral Powders. Pest Control and - - - Monituring' CONSUMER ADVISORY TIMEITEMPERATURE CONTROLS 22 3-603.11 C'Imsnm-'r.Adersury Posted for Consumption of Annual Foods neat arc Raw. Undercooked or i6 Proper Cooking Temperatures for PHFs Not Otherwise Processed to Floninate r r esme no, 3 .,;)1 11.4(ll(21 Eggs- 155"F !S,lea. Pathollens,a Eggs-Immediate Service 145'Fl5i&. * 3-3u2.13 I Pasteurized Eggs Substitute for Raw Shell 3-401.11(A)(21 Comminuted Fish,Meats&.Game I 1 EKg" Animals- 155P 15 sec. ' 3-401.11(6)(1}2) Pork and Beef Ro:tst- 130`F 121 min* 1 SPECIAL REQUIREMENTS 3-40 1.11(A)(2) Ratites. fruected Neats- 155'F 15 500 004(A)-(D) Viulri ions of'Section 590.009(A)-(D) in sec catering, mnbde food, temporary and 3-401.11(A)t') Poultry,Wild Came, Stuffed PHFs, residential: kitchen operations should be Stuffing Cuntauum;Fish, Meat, debited under the appropriate sections j Poultry or Ratites-165"F 15 pec. " above i`relat d to foodhorne illness 3--101.':1(C)(3) Whole-muscle. Inract Beef Steaks interventions and risk factors. Other 145'F 590.004 violations relating to good retail :5-401.12, Raw Animal F(x;ds Ccx>ktd in a practices should be debited under #29- Microwave 165"F* Special Requirements. 3-4'01.11(Au l lib) All Other PHFs- 145"F 15 gee j 1 Reheating for Hot Holding I VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 13-403.11(A')&(D', PHF, 165"F 15 sec. ' I (heirs 23.30) 3-703.11(8) Microwave- Itis' F2 Minute Standing I Ctaaa;and non-critical vtuleawits, -dish do act re!ate to the Time* j (nodbornr illness inurventions and risk i+ttors listed above, con be, i-403,11(C) Commercially Processed RTE Food- I fot:trd in the;"Mmink sectionsu(dre Feud Codc aitd 105 CAIR j 140'F* .590.000 3-403.11(E) Remaining Unshced Portions of Beef Item Good Retail Practices FC 5,90.660---1 Routs* 1 23. Maragement and Personnel FC-2 .003 j 18 Proper Cooling of PHFs '-4 Food and Food Protection FC-3 .004 2F. Equipment and Utensils FC-4 .005 J 3-5(11.14(A} Cowling Couked PHFs from 140'F to �6.n C-5 .005 ( Water,r,umbinq and Waste F 700FWithin 2 1-irurs and Float 70'F 127 Physical Facility Fr-5 007 ) to 41`F/15"F within 4 Hours. &t ( 215. Posonous c1 Tx c Ma?aria's FC-? AO£ 0-501 14(13) Gxnlmg PHFs Made Front Ambient 29. Special RCgnirements .009 f Temperature Ingredient;to 41'F/45"F 30. 0861 Within•I hours." *Denotes critical item m 1ha steral 1(KN final Code or los 044 590 nb0. CITY OF SALEM II II `` rr .(�,,,� /1BOARD OF HEALTH / Establishment Name: E -W • b17Y_l S L[-K(�_ l V Date: �i�3� l�(O Page:�r_-� of item Code C-Critical item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date No. Reference R—Red Itemt .PVerified PLEASERINT CLEARLY -�n ?r. hum o rh'is �Stz�hli �ht��rr t ao+ed 4kv � 1it) WiOa . I v-ev i>J I I I�cc( fG� fP�1 F �S tea�l l Sly In a n F h� t�'SPi�f I/j rm-NIA mzym ) 4100 'b, J)14d Or baa 9m . /9i, A 2 -fa 1,6h7'0rr1 L 1 a,019 6, .1 M root, /A o K'F 1 kvl(p hooh /ii►mo ��. ire it . I / I { I I I 'i IDiscussion With Person in Charge: Corrective Action Required: I ❑ No ( ❑ les I have read this report, have had the opportunity to ask questions and agree to correct all ❑ voluntary Compliance ❑ )Employee fusion Restriction/ Exclusion € violations before the next inspection, to observe all conditions as described, and to ❑ Re-inspection Scheduled ❑ Emergency Suspension comply with all mandates of the Mass/Federal Food Code. I understand that noncompliance may result in daily fines of twenty-five dollars or suspension/revocation of ❑ Embargo ❑ Emergency Closure your food permit. j� ❑ Voluntary Disposal 0 Other: 3-N L!AC) 7 IFS Recened at :eniperuures ! Violations Related to Foodborne illness Interventions and Risk Aceorclaw to 1 tw Cooled to Factors(items t-22) (Cont.) a1`F;45'F Within 4 Hums. ` PROTECTION FROM CHEMICALS Cooling,Methods for PHF's 14 Food or Color Additives ( 19 PHF flat and Cold holding 3-501.16(B) Cold PEFS Maintained at or below 3-202.12 Additive>' 3-302.1.1 Protection from 15:approved !=vc(dinYe��k ( 540.00-417) 4 PI-,,c"F" 3-50L Ib(A) ilot PHF:i\-taintained at ur above j 15 Poisonous or Toxic Substances 40'> s l 7-101.11 Identifpa-)norma;nn-Ori=final ;_iii} ib . ' Conuuncrs' - (A) RuasfHe'd at or above 130"F 7-102.11 20 Time as a Public Health Control Cummer:Name - N'urking Ccatainccs* Time an a Public liealdi CuntroP 201.11 Separation Storage,` ( 5y0,0U4(FL) Vari;.ncc Rr:!uirnureni 7-202 11 Rcstrioho n--Prescacc and U.e'" 7-202.12 Condition:;of Use" 7-203 11 Toxic Contain,o,-1-,i u!,:hiiions'; � F1EOI iREtdENT$ FOR HIGHLY SUSCEPTIBLE 17-204.11 Sanitizers.Criteria --Chemic+is° i POPULAT='ONS(HSP) 7-204 j2 Chemicals for Washi ne Produce,Criteria* I 21 -''-801.11:A) Unpastenied Pre-packaged Juice,and 7-20=1.14 Drying Agents.Criteria* Bcveiages with Warning I abeis^ W)1,111B; Use of?astetrizedf 7-205.11 Incidental Food Com:ct,Lobr!can±s' 3401.1 i(D's Raw of Partial! r- i 7-206,11 Restricted Use Pesticides,Criteria" ( y _,Not S.Animal P:au1 and I - ( Ra�,v Seed Sprouts Not Sated. '" 7-206.12 Roticnt Ban Stations" 3-80:.; i(C) Unopened mood Package Not Re-served. 7-206 1'3 'f'mckutg Powders,Pest C nirol and Monitoring* CONSUMER ADVISORY TIMEITEMPERATURE CONTROLS 22 3-60.3 11 Consumer Advisory Posted for Consumption of Animal Foodss'Mat ore Rate, Undercooked at 16 Proper Cooking Temperatures for I Not Otherwise Processed to Eliminate PHFS - e i-.101.11 A(I 2) F, s- 5= Pathogens.` )( sg L. F 5 Sec. FYgs.fn?tmediate Scrvl,e 145`Fl5sec* 3-362.13 Pasteurized f:ggs Subsntute for Raw Shell 3-401.11(A)(2) Gomtmnated Fish,Meats&Gaon• Eg,rs Animals- 155T I i sec. * 3 401 I1(B)cl i(2) Perk and Beef Roast- !30'1- 121 urn; j SPECIAL REQUIREMENTS s9U.009(A) (D) Violations of Section 59-0.009(A)-(D)in 3-401.1 1(AN2) R.:htes; lnjeaed l,leata- 1:i3'F 15 - sac.., catering, mobil; food, teniporary and 3 401.11(A)(3) Poultrv,Wild Wine, Stuffed PHFs, residential kitchen operations should be Stuffing Containing Fish, Nieat. ticbited under the appropriate sections Poultry or Ratite., 165'T 15 see. ' above it related to f oodborno illness 3-401.11(C)(3) Whole-mingle, Intact Beef Steaks i Interventions and risk factors, Other 145°17 r 590.009 violation::relating to good retai l 3-401.12 Rat, Animal Foods Conked in a pracucc� sheold be debiied under /129 Mic,owave 165°F* Special Rcquiremerits. 3401.11(A)(1)(b) All Other PHFs 145`1' 15 see. 17 Reheating for Hot Holding VIOLA TIONS R.=LATED TO GOOD RETAIL PRACTICES 3-403 11(A)&(D) PHI, IWT 15 sec. N' 1 (Items 23-30) 3-403.111 B Miciov%ave- 165°F 2 Minute Slandina Citic l and)tr, . itn.ul tvotunon.s, :cinch do.:w relate to the Time" rand rrrn, oboe^s inren-entiacs and risk jo,tars listed above, eon bt 3-403.11((:; Comroercially Processed RTE Food fowidin the-otlonwig so:60ms n)the Food Crile and 105 C171? 14(T`Ft 5yo.ow 3.303 I I(E) R,-maining Unsliecd Pottiuns of Beef ritem Gaod Retail Practices FC 500.000 Roasts* 23. Managcment and Personnel FC-2 .003 18 Proper Cooling of PHFs 124. Frcd acid Food?rotect:on -___FC -3 A04 25. Ega:pmsni ane!Utersi!s FC-4 .005 3-501 14(A) Cooling Cooked PHFs fiom 140`F to 12 •Anil„r,FumS nq and Waste r G-5 .00u j 7WIP Within 2 flours and From W F 27. Physical Faciity FC--6 007 to 31°F/45"F Within 4 Hours. ' 28. Poisonrus or Toxic M1daioria:s Fr,-7 .00E j 3-501,14(B) C olun,PHF;Made Front Ambient 29 Speclel Pedu:renenis Temperature hvuedients to11'F/45'17 1 13o. Other W ith n 4 Hour,.` ,'•or,,,y„:.;.,a,.,, Denote;:cnncal item:n the fared 1799 food Code or 1u5 CNIR°911900. J 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 'L I F _ ,(/� /� Date T e of Operation(s), Tvpe of Insoection , �1•"�' W-)SZ_ - ' ,K '0 l • rim 12113)1 Utp AFood Service ❑ Routine Address �p Risk LI Retail PiRe-inspection 4l)� on-4- So A" e_ Level M ❑ Residential Kitchen Previous Inspection Telephone �4 i /i ❑ Mobile Date:3/ Q 1`t0 1- ❑ Temporary Owner �IJP� I, t < HACCP Y/N I ❑ Pre-oyer loess I i u ❑ Caterer El Suspect Illness Person 1h Charge(PIC) I (� I_f Time ElBed& Breakfast El General Complaint I Chtivi.OS 1TD: kq In: ❑ HACCP Inspector /� �L n� I 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 [114.Approved Food or Color Additives ❑ 3. Personnel with Infections Restricted/Excluded Ela ,_ _ 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 [117. Reheating ❑ 7. Conformance with Approved Procedures/HACCP Plans [118. Cooling PROTECTION FROM CONTAMINATION - .,. ❑ 19. Hot and Cold Holding ❑ 8. Separation/Segregation/Protection ❑20.Time As a Public Health Control ❑ 9. Food Contact Surfaces Cleaning and Sanitizing ; REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) ' ❑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-z) order of the Board of Health. Failure to correct violations 24. Food and Food Protection (FC-3)(5590.090.0 044))) cited in this report may result in suspension or revocation of 25. Equipment and Utensils (FC-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. X30. Other DATE OF RE-INSPECTION: S 5901nsp¢Ef��FIIOnIM-10 d. fl/ I nsp&or's i u Print: I � ptI1 1�AAl „ �. IsI Snature: /7. Print: Page-/of9 a esIICi�/� / Violations Related to Foodborne illness Interventions and Risk Factors(items 1-22) PROTECTION FROM CONTAMINATION FOOD PROTECTION MANAGEMENT ( 8 Cross-contamination I 1 590.003(A) Assignment of Responsibility* 3-302.11(A)i 1) Raw Animal Foods Separated from 590.003(B) Demonstration of Knowledge* I _____ Cooked and RTE Foods* J 2-103.11 Person in charge-duties I Contamination from Rawingradrents 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 require reporting by food employees and 3-302.11(A) Food Protection* applicants* 3-302.15 Washing Fruits and Vesetables 590.003(F) Responsibility Of A Food Employee Or An 3304.11 Food Contact with Equipment and Applicant To Report To The Persun In Utensils* Charge* Contamination from the Consumer 590.003(6) Reporting by Person in Charge* I 3306.14(A)(B) Returned Food and Reservice of Food' 13 590.003(D) Exclusionsand Restrictions* Disposition of Adulterated or Contaminated 590.003(F) Removal of Exclusions and Restrictions I Food 3-701,11 Discarding or Reconditioning Unsafe FOOD FROM APPROVED SOURCE Food* J f 4 Food and Water From Regulated Sources 19 Food Contact Surfaces - 590.004(A-B) Compliance with Food law* 4-501 111 Manual Warewashing-Hot Water 3-201.12 Food in a Henncticall}Sealed Container* Sanitization Temperatures* - 13-201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Warewashing-Hot Water 13-202.13 Shell Eggs* Sanitization Temperatures"` 3-202 14 _ Eggs and Milk Products.Pasteurized* ( 4-50!•114 Chemical Samdiation-temp.,pH, 3-202.16 I Ice Made From Potable Drinking Water* concentration and hardness. * J 15-101.I 1 I Drinking Nater from an Approved System" I 4-601.1 E(A) Equipment Food Contact Surfaces and Utensils Clean* 590.006(A) Bottled Drinking Water" I 1 -- l 590.006(B) Water Meets Standards in 310 CMR 22.0* I 4-60-n.11 Cleaning Frequency oi�Equipment Food- J Shellfish and Fish From an Approved Source Contact Surfaces and Utensils* 4-702.11 Frequency of Sanitization of Utensils and �-201.14 Fish and Recreationally Caught Molluscan Feud Contact Surfaces of Equipment* Shellfish* 4-703.11 Methods of Sanitization-Hot Water and 3-201.15 Molluscan Shellfish from NSSP Listed I - -- Chemical" Sources* ( 10 Proper,Adequate Handwashing Game and Wild Mushrooms Approved by Regulatory Authority 2-301.11 Clean Condition-Hands and Arms* 3-202.18 Shellsttsk Identification Present* I 2-301.1'2 Cleaning Procedure* I 590,004(C) Wild Mushrooms* I 2-301.14 When to Wash* 3-201.17 I Game.Animals* I 111 I Good Hygienic Practices g ( Receiving/Condition I 2-401.11 Eating,Drinking or Using Tobacco* 3-202.11 I PHFs Received at Proper Tempzratures* 12-401.12 Discharges From the Eyes, Nose and 13-202.15 I Package Integrity- I Mouth 3-101.11 Food Safe and Unadulterated* 3-301.12 Preventing Contamination When Tasting* 1 12 Prevention of Contamination from Hands 6 Tags/Records:Shellstock i I 3-202.18 Shellstock Identification" i 590.1)(41 F) Preventing Contamination from 3-203.11 ShellstockIdentification Maintaine& ( Employees* Tags/Records:Fish Products I 113 Handwash Facilities 3-402.11 Parasite Destruction* I Conveniently Located and Accessible 3-402.12 ( Records.Creation and Retention* I 15-203.11 Numbers and Capacities`, t Labeling of Ingredients* 15-204.11 Location and Placement* 5)0.004(J) ( 9 9 � 7 Conformance with Approved Procedures 15-205.11 Accessibilitv,Operation and Maintenance I /HACCP Plans 1 Supplied with Soap and Hand Drying 3-502.11 Specialized Processing Methods* Devices - 6-301.11 Handwashing CleanrAvailability 13-502.12 ( Reduced oxygen packaging,criteria* se , 8-103 12 I Conformance with Approved Procedures- � 6-301.12 Hand Drying Provision I 'Denales critical item in the fedeud 1999 Food Code of 105 CMR 590.000. 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 ame Date Type of Ooeration(s1 Tyge of Insoection U/• J� S f le- a AA--( .__/�PG✓1� V3U��o 4E Food Service ❑ Routine Addresses �U Cyt �lG� Risk ❑ Retail ❑ Re-inspection �•i Level�} ❑ Residential Kitchen Previous Inspection Telephone .y y� irl ❑ Mobile Date: Owner �uP . /r_. r/ _ / C HACCP YM I Ll Temporary ED'Pre-operation Illness❑ Caterer ❑ Sus Suspect Illness Person in Charge(PIC) j�`1 Time ❑ Bed&Breakfast ❑General Complaint Inspector /� , /�� ( � p I 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 ❑f 1. PIC Assigned/Knowledgeable/Duties - .w. , " . "• " " _"" •� ", e , , ❑ 13. Handwash Facilities EMPLOYEE HEALTH PROTECTION FROM CHEMICALS ❑ Z. 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 " „ "' I ❑ 4. Food and Water from Approved Source " TIMEITEMPERATURE CONTROLS(Potentially Hazardous Foods)" ❑ 5. Receiving/Condition f^ [116. Cooking Temperatures ❑ 6. Tags/Records/Accuracy of Ingredient Statements ❑ 17. Reheating ❑ 7. Conformance with Approved Procedures/HACCP Plans `Y El18. Cooling PROTECTION FROM CONTAMINATION "'1 19. Hot and Cold Holding 166 ❑ 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 by a Board of Health member or its agent constitutes an 23. Management and Personnel (FC-2)(990.003) 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 yj 27. Physical Facility A bl, (FC-6)(590.007) have a right to a hearing. Your request must be in writing r 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 501nspadFo 14 me In'spectoYs$ignature: Print` PIC's Signature•. �2Hx ��^ pmt'(Jr1(.ri r`- �C.�,�� I Page_of Page I 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* 3-302.11(A)(I) Raw Animal Foods Separated from 590.003(B) Demonstration of Knowledge" I Cooked and RTE Fou i 12-103.11 Person in charge-duties I Contamination from Raw ingredients 3-302.11(A)(2) Raw Animal Fucxls Separated from Each EMPLOYEE HEALTH Other. J 2 590.003(C) Responsibility of the person in charge to ( Contamination from the Environment require reporting by food employees and 3-302.11(A) Food Protection* applicants* 3-302.15 Washing Fruits and Vegetables 590003(F) Responsibility Of A Raid Employee Or An 3-3(A.I 1 Food Contact with Equipment and .Applicant To Report To The Person In Utensils* Charge* Contamination from the Consumer 590.(X)3(G) Reporting by Person in Charge` 3_306,14(A)(B) ( Returned Food and Rose ice of Food" 3 590.003(D) Exclusions and Restrictions* I Dispositicn of Adulterated or Contaminated 590.003(F) Removal of Exclusions and Restrictions I I Food 3-701,11 Discarding or Reconditioning Unsafe FOOD FROM APPROVED SOURCE Food* 4 Food and Water From Regulated Sources 19 Food Contact Surfaces 590.004(A-B) Compliance with Food Law" I 4-501.111 Manual Warewashing-Hot Water 3-201.12 F.wd in a Hermetically Sealed Container* I I Sanitization Temperatures* 3-201,13 Fluid Milk and Milk Products* 14-501.112 Mechanical Warewashino Hot Water 3-202.13 Shell Eggs* I Sanitization Temperatures* 13-202.14 I Eggs and Milk Products.Pasteurized' I 14-501.114 I Chemical Sani zation-temp.,pH, concentration and hardness. " 13-202.16 Ice Made From Potable Drinking Water' 4-60(.I l(A) Equipment Food Contact Surfaces and 5-101 11 Drinking Water from an Approved System' I Utensils Clean' 590.006(A) Bottled Drinking Water" I -- 1590.006(B) Water Meets Standards in 310 CMR 22.0'' 4-602.11 Cleaning Frequency of Equipment Food- Shellfish and Fish From an Approved Source Contact Surfaces and Utensils* 4-7(12.11 Frequency of Sanitization of Utensils and 3-201.14 Fish and Recreationally Caught Molluscan Food Contact Surfaces of Equipment* Shellfish* 1-703.11 Methods of Sanitization-Hot Water and 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* Sources* ( ( 10I Proper,Adequate Handwashing Game and Wild Mushrooms Approved by ( 2-31 i1.I I Clean Condition-Hands and Arms* Regulatory Authority _ 3-202.18 Shcllstock Identification Present' I 12-301.12 Cleaning Procedure* 590.004(C) I Wild Mushrooms' I 12-301.14 When to Wash* � 3-201.17 Game Animals* 111 1 Good Hygienic Practices g ReceivinglCondition I 2-40L11 Eatine.Drinking orUsing Tobacco* 3-202.11 PIIFs Received at Proper Temperatures e I 2-101.12 I Discharges From the Eyes, Nose and 3-202.15 I Package Integrity' ( Mouth* 3-101.11 I Food Safe and Unadulterated* I 3_301.12 I Preventing Contamination When Tasting* I 6 I TagslRecords:Sheilstock I ( 12 Prevention of Contamination from Hands 3-202.18 Shellstck Identification* i 590.004(E) Preventing Contamination from I3-203.12 Sheilstock Identification Maintained'* Employees* Tags/Records:Fish Products I 113 I Handwash Facilities 3-402-11 Parasite Destruction" I I Conveniently Located and Accessible ( 13-402.12 Records, Numbers and Capacities*ds,Creation and Retention* I -__ 590.004(1) Labeling of Ingredients" ( i 5-20`.11 Location and Placement* _ 9 Conformance with Approved Procedures 5-205.11 I Accessibility.Operation and Mainten urcc I IHACCP Plans ( ( Supplied Mtn Soap and Hand Drying 3-502.11 Specialized Processing Methods* Devices 3-502.1o Reduced oxygen packaging,criteria* 16-301.11 ( Handwashing Cleanser, Availability 1 _ * I 8-103 12 Conformance with Approved Procedures* ( 16-301.12 Hand Drying Provision *Denotes critical neon in the federal 1999 Fond Code or 105 CMR 59(1.000. L CITY OF SALEM //11 BOARD OF HEALTH Establishment Name: r l�P Z __ Date: 3�3v�Ulo Page: a19- of < Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date No. Reference R—Red Item Verified ' F PLEASE PRINT^CLEApI`/ l'le✓i� _ I � T 1;_1 7rL WLP 7`1'3 /Y�iI h�ii ///nn� it>I/ S�2.Qei �✓f/FI/ �O_�/nY ff y a 'KPa_v yv�® -oza ,r - I �.. It�%riirtf' �h� OiyQi I =_�, ��✓��► mea--- cabwns�.�,�c' 1 I �- - �iiv�? is niter�o r✓�.��/ �� Ni.c I-xovZee to Ze— Wa� %Pc ffzi1--:bs C`rn - wok Xranh"d'i _e'k Discussion With Person in Charge: 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/ violations before the next inspection, to observe all conditions as described, and to Exclusion '.� P ❑ Re-inspection Scheduled ❑ Emergency Suspension comply with all mandates of the Mass/Federal Food Code. I understand that noncompliance may result in daily fines of twenty-five dollars-or suspension/revocation of ❑ Embargo ❑ Emergency Closure _ your food permit. £, /,//� ❑ Voluntary Disposal ❑ Other: 1 5;r1 llt C.': ?HFI,Received:t Temperatures Violations Related to Foodbotne ittaess Interventions aad Risk 4czording to l.aeCovicd to { Factors(!terns 1-`2) (Con.) .I I'F745-F Within 4 Hours. " { PROTECTION FROM CHEMICALS { 3 "()1 l.j Cnnlin^_Methods for PHFI, ! IJ Food or Color Addilfves { lir PHF Hot and Cold Holding { :50 1.lot';) Cold PtIFs Maintained at or below 3-202.12 Adiditivc:'t 1 1 3-302.I4 Protection lion iJnaS90.o(71(F) 41V4•t F" uproccd A:id:ircP:r' -502160) i-IotPHF, M1^.nunained at or aba':e { 15 Poisonous or Toxic Substances ;40-F 7-101.11 !denvt;me Information-Orieinai i Conte-finers' 1 3-501.16(A) Roasts Held ;it or above 130`B. ' 7-10111 Commuu Nwirut-`h�orkinu,Contain:n+ { { 26 { Time as a Public Health Control 1 ;1-5U'•.19 Time a,a Public Health Control"7-:1101.11 Separation-Stir:ay.•e" ( I7-20211 Restriction-Plesenc:and Use" ( 500,004(H) VariancoRevuirement 7-202.i2 Conditions r.!'[ L;'.� . 7-203 i l Ts+c Coutcin.:r.<-Pr•-r;:b;tioae' REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-20'1.: ! Smtitizec..C }items-C!:cmic.;;s;, 1 POPULATIONS(HSP) 72o=, 1:' C:Benueals 'or WashuutIII odne ,Criteria, ! I2? 1X)1.11(A) Unpasteurized Pre-packagedJuires and i j 7 2Ud.l-f Dt ging Ascats.Critc;ia' Eevera2es with Warning labels 7-2(15.11 Inc•idcate! "'Aid Cor:srt,LoNlLants* { 3-801.1 It B) U;e of Pasteurizer! Eves* ! ; - i 341)1.1 i(U) Raw or Partially Cooled Animal Fund and ted 7-206.11 Rrs+ricLbe Pegirirleg, Crarc:r I Raw Seed Sprouts Not Served. " 7-20o 72 R+xlcnt R iia St vat,as' ( I i_LI t(C1 Unopened 17,xPackage Not Re-serv,.dv: 7 206.13 'Frock mg Powder.,Feu Conn.;{ and ' Yhmibrr:rg* CONSUMER ADVISORY TIMEITEMPERATURE CONTROLS 22 3-603 11 Consumer Advisory Posted for Consumption of Annual Foods That are Raw, Undercooked ur (F Proper Conking Temperatures lar PRFs Not Otherwise Processed to Elirmnate 3-401.11A(1)(2) Egg,,- l ji`F 15 Sec,. Patho,cus.4' -- Eggs-t:umediau:Sc!'=ia flit"F75se.' 3-302.13 Pasleunzed Egg;Substitute Fur Raw Shell Lg s• 3-4U1.11!An2) Comminuted Fich, Nl is[i Gime 1' LL Animals 1�5'F 15 sa.. T SPECIAL REQUIREMENTS 3 401.11 lri1(l,Q) Part, :Ind F,eef Roast- 13-D+ 121 nir."' { 3-401.1 UA)(2) R:rota, eco.;inj r Tr s: -a:s-- 155-F 15 T)U.00a(A)-(U) Violations of Section 590.009(A)-(D)in - sec, caterin„ mobile food,temporary and 3-401.1 UA10) Poulbq,Wild G<nue.:iRated P91-sl I residential kitchen operations.diouid be StufLn, Conr:uong Fish.NTait, 1 debited under:he appropriate sec:ions I'c,ultry of Karns-165`F IS se:. * ! above if related to foodborne illness 3-41.11(00) 't,"hole-muscle,Intact Ht-e! Steaks interventions and risk factors. Other k 590.009 violations relating to rood retail i 3-401 12 Raw Animal Foudk Conkcd in a practices should be debited under,729 - I ivi::auw.rve 165`1' * Special Requirements. 3-401AI(A1 (l!(b) `,11 Othc;PHFs-- 145`F 15 sec ` 17 I Reheating for Hnt Holding VIOLATIONS R-LArED TO GOOD RETAIL PRACTICES PHty 165''17 15 sec. ' (Reins 23-30) 3-403 11(B) Microwave- 165°F 11 Mi rule Standinu Critical turd tion-rritical waitrons, ishick do not relate to tire Time* ,/riodbornc d(¢ev.r nrtervenHuns;:nd riskJi+<tura tided above, ran be 3-403A 1(C) Commerualiv Proce,,sed R•t E Fond- found in theJollou Ing vection of the Food Code and 105 CUR 3-40?.!i(L) Penunn;r.;'Uns!ieedPorticnudBeef l )fet�GaadRetailPractices FC 530.000 1 RnaSW - 23. Manaqement and Personnel PC-2 .003 lA I Proper Cooling of PHFs i 24 Food and Food Prolcrtion FC-3 : .005 ! 25. Equioment and Utensils FC-4 1 .005 3-311.1-'(A) Coolinc Cooked Pl-1F: Iron 140`F to ! 25. Water,Plurnbiro and Waste FC-5 1 .006 ! 70'1 Wn}im 211:juia and Frrm?0`F i ( 27. Physical Farift,, FC-6 .007 I to 41-F74J'F W;?hie.1 Hours. * 23. Poisonous or l oxlc Materials FC-7 .003 ?-50iJ4(Ht Cooing PI-IFs 14ade ham Ambi ent 1.29.__ Special RegWremerts .009 Tentpetattue ingredienis to 4'.'=F(a5'F 30 Other -_. --- Within:Hours* „wr..,n;,tq�rig, i ' Denok�:rrrc.d nau In tier Fa:e::d 190');(mdoAe or 105 CN1R 590000 i CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH 10120 WASHINGTON STREET, 4TH FLOOR SALEM, MA 01970 TEL. 978-741-1600 FAX 978-745-0343 STANLEY USOVICZ, JR. JOANNE SCOTT, MPH, RS, CHO MAYOR HEALTH AGENT COMMONWEALTH OF MASSACHUSETTS PERMIT TO OPERATE A FOOD ESTABLISHMENT In accordance with regulations promulgated under authority of Chapter 94 , Section 305A and Chapter III , Section 5 of the General Laws, to operate , a Food Establishment in the City of Salem is hereby granted to: Owner' s Name: Everett W. Hobbs Name of Establishment : E.W. Hobbs, Inc. Address of Establishment : 205-207 Fort Avenue Type of Establishment : RETAIL FOOD Application Date : 04/04/2003 Restrictions: Permit for Food Establishment 283-03 Frozen Desserts/Ice Cream 17-03 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 T CITY OF SALEM MASSACHUSETTS , BOARD OF HEALTH 120 WASHINGTON STREET, ATH FLOOR SALEM, MA 01970 TEL. 978-741 -1800 FAX 978-745-0343 STANLEY USOVICZ, JR. JOANNI- SCOTT. MPH, RS, CHO MAYOR HEALTH AGENT 2003 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT NAME OF ESTABLISHMENT_ Uj? � _�n( TEL# 62K 74�' �{pq l ADDRESS OF ESTABLISHMENT orb,!. - 'DO7 T;rl Ave - f a Gl(f-1�6 MAILING ADDRESS (if different) tt�� OWNER'S NAME �;Jprt j hl":� TEL# G7K- ADDRESS t MC4400 kt^k CITY 'bbin STATE Mk zip ON-16 CERTIFIED FOOD MANAGER'S NAMES}- Qr�,rjk ljo6 C CERTIFICATE#(s) (required in an establishment where potentially hazardous food is prepared.) "74(4- 70:31 EMERGENCY RESPONSE PERSON B4 7414&+,�� HOME TEL# G 79r- 7q5-7.c1) HOURS OF OPERATION: Mon.1116 Tue.ILJO Wed. I I Thu. i -18 Fri. 1-10 Sat. )`10 Sun.1 1- j6 TYPE OF ESTABLISHMENT FEE check only RETAIL STORE YES NO less than 1000sq.ft. =$ 50 1000-10,000sq.H. =$100 more than 10,000sq.ft. =$250 "q-63 RESTAURANT RESTAURANT YES NO less than 25 seats =$100 25-99 seats =$150 more than 99 seats =$200 BED/BREAKFAST YES NO $1Q0 ADDITIONAL PERMITS MAKE ICE CREAM, YOGURT, SOFT SERVEYE N00--4 - $5 TOBACCO VENDOR S I O\ $50 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 beTow dge and belief, have filed all st to t x returns and paid all state taxes required under the law. Signature Date Social Security or Federal Identification Number Revised 11/25/02 FOODAP2.adm Check#&Date ,;bo7 y12'X 3 l SEP-12-03 11 :48 AM GEOCHRONKRUEGER 617 661 0148 P. 03 KRUEGER Phone:(617)876-9118 FOOD Fax:(617)878-0572 Emalt dkrueger@kfl.com Website:www.kfl.com -.d@LABORATORIES., INC. 711 Concord Avenue,Cambridge,MA 02138 CERTIFICATE OF ANALYSIS Submitted by: Date Reported. 9/10103 Date Received., 918103 Everett Hobbs E.W. Hobbs 207 Fort Avenue Salem, MA 01970 Reference: Sampling Month -September 2003 PO#: Description Your Sample Number Our Lab Number Ice Cream Sampled 918/03,8°F,Chocolate 63605 STANDARD PLATE COUNT cfulg 400 COLIFORMS .VRB cf ulg <1 Standard Plate Count should be less than 50000 cfuig Coliforms should be less than 10 cfu/g. Methods:APHA, Standard Methods for the Examination of Dairy Products, 16th Ed., 1992, Parts 6.2 (Standard Plate Count)and y.8(Coliforms). By:t�q 11122 13624 2125 63605 (9/10/03) Page 1 of 1 SEP-12-03 11 :49 AM GEOCHRON�KRUEGEJR 617 661 0148 P. 04 ��'n�I.:- KRUEGER Phonw (617)876-9118 Far.(617)8764572 fit FOOD Email: dkrueger@kfi.com Wabsite:www.kfl.com 711 Concord Avenue,Cambridge,MA 02138 JOLABORATORIES, INC. 1 . CERTIFICATE OF ANALYSIS Submitted by. Date Reported, 9!10103 Date Received., 918/03 Pa Everett Hobbs E.W. Hobbs 207 Fort Avenue Salem,MA 01970 Reference: Sampling Month- September 2003 PO Description Your Sample Number Our Lab Number Ice Cream Sampled 9/8/03,8°F, Strawberry 63606 STANDARD PLATE COUNT cfU/q 550 COLIFORMS-VRB cfutg <1 Standard Plate Count should be less than 50000 cfu/9. Coliforms should be less than 10 cfutg- Methods:APHA, Standard Methods for the Examination of Dairy Products, 16th Ed., 1992,Parts 62 (Standard Plate Count)and 7.8(Coliforms). 7V_l 11122 13626 2125 63606(9110103) Page 1 of 1 SEP-12-03 11 :48 AM GEOCHRONiKRUEGER 617 661 0148 P. 02 KRUEGER Phone: (617)876-9118 Fax:(617)876-0572 sy.,. {<. FOOD Email:dkrueger@kfl.com Website:www.kfl.com ®LABORATORIES, INC. 711 Concord Avenue,Cambridge, mA 02138 CERTIFICATE OF ANALYSIS ; ;. Submitted by: Date Reported: 9/10103 t.,. Date Received: 918103 Everett Hobbs E.W. Hobbs ;s 207 Fort Avenue Salem, MA 01970 Reference. Sampling Month-September 2003 PO X Description Your Sample Number Our Lab Number Ice Cream Sampled 9/8/03,8°F.Vanilla 63604 STANDARD PLATE COUNT cfu/g 510 COLIFORMS-VRB cfulg 51 Standard Plate Count should be less than 50000 cfu/g. Coliforms should be less than 10 cfu/g. Methods:APRA,Standard Methods for the Examination of Dairy Products, 16th Ed., 1992, Parts 6.2 (Standard Plate Count)and 7.8 (Coliforms). By. 11122 13624 2125 63604(9110/03) Page 1 of 1 x 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 Ooeratiohis) Tvoe of InsoecUgnn %YOvHf /Ge GP.eA.•.. -i GR ��d�vl [�Food Service U'Routine Address Risk ❑ Retail ❑ Re-inspection as r- ao a T .9vc� a Telephone Level ElResidential Kitchen Previous Inspection 7 Y.+-• 7l 9/ ❑ Mobile Date: Owner HACCP YIN ❑ Temporary ❑ Pre-operation J6 Ue_ � /-4zle ❑ Caterer ❑ Suspect Illness Person In Charge(PIC) / Time ❑ Bed&Breakfast ❑ General Complaint Inspector In: //'Oa ❑ HACCP Out: Permit No. ❑ Other Each violation checked requires an explanation on the narrative page(s) and a citation of specific provisions) violated. Non-compliance with: 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 ❑ r 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 El 4. Food and Water from Approved Source TIME/TEMPERATURE CONTROLS(Potentially Hazardous Foods) El 16. Cooking Temperatures El 5. Receiving/Condition El 17. Reheating El6. Tags/ Records/Accuracy of Ingredient Statements El7. Conformance with Approved Procedures/ HACCP Plans El 18. Cooling El 19. Hot and Cold Holding PROTECTION FROM CONTAMINATION ❑ 20. Time as a Public Health Control ❑ B. Separation/Segregation/ Protection REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) ❑ 9. Food Contact Surfaces Cleaning and Sanitizing ❑ ❑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 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: �j � z��`I Print: PIC's Signature: Print Page__/of J Pages FORM 734A HOBBS&WARREN - BOSTON Violations Related to Foodborne Illness Interventions and Risk Factors (Red Items 1-22) PROTECTION FROM CONTAMINATION e 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 Inqredients 2-103.11 Person in Charge-Duties 3-302.11(A)(2)1 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 Contac[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)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 1 I 1 Manual Warewashing-Hot Water 590.004(A-B) Compliance with Food Law* Sanitization Temperatures* 3-201.12 Food in a Hermetically Sealed Container* 4-501.112 Mechanical Warewashing-Hot Water 3-201.13 Fluid Milk and Milk Products* Sanitization Temperatures* 3-202.13 Shell Eggs* 4-501.114 Chemical Sanitization-tem H, 3-202.14 Eggs and Milk Products,Pasteurized* p�.P gg Concentration and Hardness 3-202 16 Ice Made from Potable Drinking Water* 4-601.11(A) Equipment Food Contact Surfaces and 5-101.11 Drinking Water from an Approved System* Utensils Clean* 590.006(A) Bottled Drinking Water* 4-602.11 Cleaning Frequency of Equipment Food- 590.006(B) Water Meets Standards in 310 CMR 22.0* Contact Surfaces and Utensils* Shellfish and Fish From an Approved Source 4-702.11 Frequency of Sanitization of Utensils and 3.201.14 Fish and Recreationally caught Molluscan Food Contact Surfaces of Equipment* Shellfish* 4-703.11 Methods of Sanitization- Hot Water and 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* Sources* 10 Proper,Adequate Handwashing Game and Wild Mushrooms Approved by Regulatory Authority 2-301.11 Clean Condition-Hands and Arms* 2-301.1Cleaning Procedure* 3.202.18 Shellstock Identification Present* 590.004(C) Wild Mushrooms* 2-301.144 When to Wash* 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* 6 � Tags/Records:Shellstock 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,Cntena* 6-301.12 Hand Drying Provision 8-103.12 Conformance with Approved Procedures* *Denotes critical item in the federal 1999 Food Code or 105 COIR 590.000. CITY OF SALEM BOARD OF HEALTH Establishment Name: E4/ 4'ar Date: /0 jr Page: J of Item Code C-Critical item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date No. Reference R—Red Item Verified PLEASE PRINT CLEARLY I I I I I I II �� I iti<:,e�c 7i� � i/P l/e//w_ r U--� ii.•-:T 1ir� i9 Srs./moi/ ��:Lef vo I I I I I I I I I I I I I C/X7CR....�Ar/erf `I rMa� 7�s!vo,TJ.@.[i+-ori-.Trro e� I 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/ 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 twe ty-five dollars or s sl enqsion/revocation of ElEmbargo ❑ Emergency Closure your food permit. 0 Voluntary Disposal ❑ Other: 3-501.!4(0) PH FS Received at'r:rtlperatores Violation Related to Foodborne illness Interventions and Risk According to I aw Cooled to Factors(ttems 1-22) (Coni.) 41`I=i45"F G�ithin4 Hours ' PROTECTION FROM CHEMICALS 3-501.1 Ctwihtg h1r;ixxta fill PHFs -20" l2 Additives* ' 19 PHF Hot and Cold Holding 14 Color Additives 3-ii-J1,16(fl) Cold PHFs\^.a;ntsinr .a (it Leto � � 5+)(},(;p4{F? 3-302 I-4 Pn aeUiul?fr�rtn I_rn;+ppt+ned :�ddi[is c•:S 41"/45F".i 1-5Ul.lo(A; Hut PHhF Maintained et in ahov,e 1s Poisonous or Toxic Substances 7-101.P Ident;ft5ue Infurmenon-Orr{mal 501.16tA1 ;?oasts 1Ie3d at ar above 30`F Crnuainers` 20 Time as a Pubitc Health Control I O--t.I l Counnon Na:ue-Working Crnnaiuei's` '11-50L I q limo ati a Public Hevth ContrOV' 72-01.!1 Separation-Stouiec" i90.004(H) Valiance Requ,cement j 7-202.11 Retiriction-Presence and Usc" 7-?02.12 Curdmons of i3ae' 710? 11 Toxic Containers--Prohibitions" REQUIREMENTS FOR HIGHLY SUSCEPTIBLE %-204.I1 Smutizerc Criteria-Chenrcals^ POPULATIONS(HSP) 7-2012 Chenuc•uls fur Wa,hing Produce, Ciiterie' 21 3-8ULIl(.v) Unpaatwuliz-d Pie-packagedluices and 1 B-�ciclaes with Wmiin, 1„+bels^ 7-204.11 Uryrnq Agents•Critetia" roFPasrnrizedE- ;<gs^ 7-205 If ( htcidenta(Food Contac; Lui+n.an[s" -&01.11(8) Cis 3-801 11(D) Raw(it Partially Cooked Annual F,-roti olid 7-^06.11 Restricted Joe Pesticides,Cracria"" ( f !int.- Seed Sprouts Not tierted. :: 7-206 12 Rodent Bait Stations' 3-g01.! 1(C) Unopened Fox! Package Not Re-served 1?06 13 I Tracking Powders,Pes:Control and 1 Mun,tunne' CONSUMER ADVISORY 2.2 1-,113,t 1 Consumer Ad.isore Posted Its Cunslunpuon it TIMEITEMPERATURE CONTROLS anima'! Foods 7-hat are Raw,t ndercuokrd or 16 I I Proper Cooking Temperatures forI Not Otherwise Frocessed to Eiinunate PHFs nr.n.t'!'I,', Pinhocene.`.: ' t IA(I)(2) Eggs- I55`F IS Sec -1-302 1', Postcmrtrc: E<-^ Substitute Po! Raw Shell Eggs-immediate Service 145'F1>,ect °'t'' 3-401 t 1(A)(2) Comminuted Fish. htenis R (lame Eggs. .1u+taals- 155°F 15 sec. " SPECIAL REQUIREMENTS 3-401.11(Bu 1 N2) Pork and Baef Roast- 130'F 121 min- 3-101.1 in"3-101.' I(A)f2) Rui,tes, hticcted hgea[s - 155"F 15 l 59CW09(A)-(D) Vmlationc o3 Serum[ 590.(H)9(AF(D)in sec cawing, mob,ic food, temporary end 3-401.11(A)(31 Poulin,Wrld Gam: Stuffed PHFr, residential kitchen operations Should be Rwf6ug Containing Fish, Meal, debited under the appropriate szcrions Pouitty or Ratites-165'F t5 sec " above if related to foodborne ili iesa 3-401.11(00) W'hoic-m t;cic, Intact Beef Steaks interventions and risk Factors. Other I+5''F" S90.009 ynlations relating to-0od reutil 3-401.12 Raw Animal Fo><!s Corked in a Practices should be debited under#29- Microwave I65`F I Special Requirements. 3-401.11(A)(10) All other PHFs - 145:F 15 sec. 17 Reheating for Hot Holding VIOLATIONS R-LATED TO GOOD RETAIL PRACTICES 3--,03.1I(A)8c(D) PF1Fs 165"F 15 sec. * (Items 23-30) 3-403.11!B) Microwave- 165-F 2 Minute Standing Criticrd sad lova-c0bec!ri+.,'utions, which do not relate to the Time" loudhonre dl„rss interveu*:orfs anti risk acto,�.s listed above, can be 403.1 1(C) Commercial ly Pt cx:evsed RTE Food- � brand b, the(Doul ilce se;tinea Of the Food Cade a„d 105 G11K ! t40"F" 590.090. 3-403 t 1Q Remaining l;'nsliced Portions of Beef I Item Good Retail Practices FC 590.000 Roasts', 1 23. Manatiemenl and Personnel FC-2 .003 i8 ( Proper Coaling of PHFs j 24. 1 1 Food ann Food F'mtccbon FC-3 .004 25 Equ¢men:and Utensils FC -4 ,005 1-501.14(A) Cooling Cooked PHFs from 140'F to ( 9E. Water,Plumbino and b\raste FC-S .006 70"F Within 2 Houls and From 70`F 27 Physical Facility FC--6 .007 1u 41'F/45'F Withal 4 Hour,. " 28. Poisonous or Toxic lc atenals 1 FC-7 .008 - 1'em�eraturein��•�dicnts[udl'F745"F 2'1' SpecialHegu:remenis .009 Conon ,liLl-NB) r PHFI Ma.rle From Ant rent 30 01hor I- a - Within 4 Flours'" l_.:,,,. ` Monerae critical;tem;n the fedeo.,i 1499 F,x,d Code.o, 105 C NIR i9(i.000. CITY OF SALEM BOARD OF HEALTH Establishment Name: Date: SI3 Page: / of / Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date No. Reference R—Red Item Verified PLEASE PRINT CLEARLY J d Discussion With Person in Charge: Corrective Action Required: I ai'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. ❑ Voluntary Disposal ❑ Other: L 3-501 14(,') PHFs Rcceiced at Temperatures Violations Related to FaoaBorne/Rness Interventions and Risk Aceorcinr to Law,Covled to Factors(items 1-22) (Cont.) 41'F/457 W%ittoa 4 Howie PROTECTION FROM CHEMICALS ( 3-5U I.13 C ohnF Methods far PHFs 14 I Food or Coffer Additives ( ( 19 PHF Hot and Cold Holding 3-501.16(B) Cdd PIFs Mahcat%d at of below ! 3-201.12 Additil.es" 590.00=(F) 41'/45` F* 3-302.14 Protection from Unapprused Add iti es` 3-501.i6(A) I1VL Pr1Fb Mainiaincd at or above 19 Poisonous or Toxic Substances 140'F. , 7-101.11 Idenuf}^.ng Information - Original ( 3-501.1ill Roasts 11� containers- 7-102,11 ontainers' ld at or aho�r 134!'F 7-102.1 1 Qnnnani Name--Workm;,Containers' 2i) Time as a Public Health Control 7-3G1.11 3-501.19 Tillie as a PnhhC Health C�Un'rol* Separation-Stontcc" j 7-202.11 Restriction-Presence and Use'" '5t)(004(H) Vary uuc Rcyun'anenl 7-202.12 Conations of Use' REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-203.11 Toxic Coatsincrs-Prohibitions* 7-204.11 Saniiizeis.Cineria-C'hemicais^ POPULATIONS;HSP) 7-204.12 Cheuneals for Waghintt Prxtuce,CriteriaA 121 3-801.11(A) Unpasteurized Pre-packaged Juice;and 7-204.14 Drying Aaents.Criteria* Beveraces with W nrning LaMls- 7-205.11 hicidenud mood Coota,t. Lubrie;mt�* 3 801.11(B) Use of Pasteurized Logs- 7-206.11 ags^7-206.!1 Restricted Use Pesti(,des,Cnreria* I 1 801.1 l(D) Rasa or Partially Cooked Anunal Food and Rav:Seed Sprouts Not Served 206.!-2 Rodent Bali Stations"' 3-801.11(C) Unortned Food Package Not Re wr•;ed. " 7-206.13 Tracking Pomdets,Pest Contrnl and Momtor'uwl CONSUMER ADVISORY TIME)TEMPERATURE CONTROLS 22 3-603.11 Consumer AdGisory Posted for Consumption of Animal Food,That are Rae, Undercooked or PHFs Ili i I Proper Cooking Temperatures ice NotOtherwise Procc,s,-d rn Eliminate 3-401.11 A(1)(2) Eggs- 155'F 15 Sec. Padwa;.as.' 3-302.13 Pasi municd Eggs Substittte for Raw She]] Egg - Imme Imre Service 145°Fl Ssec, Eggs. 3-401.1 I(A)(2) Comminuted Fish. MeaLq&Game Aninials 155'F 15 sec. * SPECIAL REQUIREMENTS 3-401.1 IIA){^) Ratites,Injected 3-401.11(B)(1)(2) Pork and Beef at _ 155°F 1? 1305 121 mor% .g0.009(A)-(D) Violations of Section 590,009(A)-(U) in Meats eMean. sec. " catering, mobile food, lemporary and -401.11(A)(3) Poultry,Wild Game.Stuffed PHF,, residenlml kitchen operations should be Stalling Ursit:unmt Fish. ll4rai, u.,�,«.., .,adei'the err r•?priest.. o..,.....,, Poultry or Ratites-165'F l5 sec "' above. if related to toodborne ilhress 3-401.11(C)(,) Whole-muscle,Intact Beef Steaks interventions anti risk factors. Other 145'F* ! 590.009 violations relating to good retail 3401.12 Raw Auimal Foods Cooked in a practices should he debited under 1129- ( Microwave 165`FSpecial Requirements. 3-401.11(.A)(1)(b) .All Other PHI-;; - 145"F 15 eee. 17 Reheating for Hot Holding VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 3-403)IIA)&tD) P1IFs 165'F 15 sec. * ( (Items 23-30) 3-403.11(B) Microwave- 165`F 2 Ylinute Standing Critical and non-critical violations, which do not rela(t,to the 'Pune* I loodhorni,iilncsc baenwitioms and risk jzctnts listed above, call be 3-403.11(0 Commercially Processed RTE Food- lound in the frllutritr,g se(lions n(the Food Code and 10.5 CMR 14WF' I 590 000. 3-403.1 1(E) Remaining Unvliced Portions of Beef I '� Item I Good Retail Practices I� FC590.000 Roasts'' 23. Man•om geent and Personnel FC-2 .003 I ---------1--- a 18 Proper Cooling of PHFs I ' 24 Fnod and Fox Piotection I', FC-3 004 i 25 Equipment and Utenods FC- 4 .005 3-501.14(A) Cowling Cooked PHFgfrom 140`Ft° ili 26. WaterPlmnMngand Waste FC-5 .009 70'F Within^ Hours enol From 70`5 127 Physical Facility FC --8 ( .007 to 41'F/45'F Within 4 Hours, 4 1 28 t'o!sonous or Toxic lArrienars FC_ _-_7 _ .008 3-501.14(B) Cooling PHPs Made Flom Ambient 24, Special Requirements 009 Temperature ingredients to 4I'F/45'1 30. Other Within 4 Hours` ' Denote,eiifiat item in the federal 1449 Food Code of 105 C19R 39U,OOu, +r"`iv�wsw '.e-.+.-.",r"-.,,r`...n+e.r.T-,n„•-..*,..,-....�.-- a--"`w.... -.s... ^k i 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 Tvoe of Ooeration(sl Type of Inspection G/. �i�( �/�/,j ErFood Service P`Routine Address Risk ❑ Retail ❑ Re-inspection 90s-- 309 F6/zT .9vF Level � ❑ Residential Kitchen Previous Inspection Telephone /,27\ kyr ��/ CY J El Mobile Date: Owner / HACCP Y/N El Temporary [e/Pre-operation Z Ue 11,_ 7' !&r ❑ Caterer ❑ Suspect Illness Person in Charge(PIC) C,// •.rCi Time El Bed 8 Breakfast El General Complaint fi / -In: ❑ HACCP Inspector . . /`a 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 (Red Items). Anti-Choking Tobacco Violations marked may pose an imminent health hazard and require immediate corrective 590.009(E) ❑ 590.009(F) ❑ action as determined by the Board of Health. Local Law ❑ FOOD PROTECTION MANAGEMENT ❑ 12. Prevention of Contamination from Hands ❑ 1. PIC Assigned/Knowledgeable/ Duties ❑ 13. Handwash Facilities EMPLOYEE HEALTH PROTECTION FROM CHEMICALS ❑ 2. Reporting of Diseases by Food Employee and PIC ❑ 14. Approved Food or Color Additives ❑ 3. Personnel with Infections Restricted/ Excluded ❑ 15. Toxic Chemicals FOOD FROM APPROVED SOURCE TIME/TEMPERATURE CONTROLS(Potentially Hazardous Foods) El 4. Food and Water from Approved Source [116. Cooking Temperatures El 5. Receiving/Condition El 17. Reheating El6. Tags/ Records/Accuracy of Ingredient Statements El7. Conformance with Approved Procedures/ HACCP Plans El 18. Coaling 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 ❑ 21. Food and Food Preparation for HSP ❑ 10. Proper Adequate Handwashing CONSUMER ADVISORY ❑ 11. Good Hygienic Practices ❑ 22. Posting of Consumer Advisories Violations Related to Good Retail Practices (Blue Number of Violated Provisions Related Items) Critical (C) violations marked must be corrected To Foodborne Illnesses Interventions 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 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: '�- PIC's Signature: ' Print: Page-of�) Pages FORM 734A HOBBS&WARREN - BOSTON f r Violations Related to Foodborne Illness �� I Interventions and Risk Factors (Red Items 1-22) PROTECTION FROM CONTAMINATION t FOOD PROTECTION MANAGEMENT 8 Cross-contamination 3-302.11(A)(1) Raw Animal Foods Separated from 1590.003(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 -I 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 Contac[with Equipment and 590.003(F) Responsibility of a Food Employee or an Utensils* Applicant to Report to the Person in -- Charge* I Contamination from the Consumer 3-306.14(A)(B) Returned Food and Reservice of Food* 590.003(G) Reporting by Person in Charge* Disposition of Adulterated or Contaminated 3 590.003(D) Exclusions and Restrictions* Food 590.003(E) Removal of Exclusions and Restrictions 3-701.11 Discarding or Reconditioning Unsafe Food* FOOD FROM APPROVED SOURCE 9 Food Contact Surfaces 4 Food and Water From Regulated Sources 4-501.111 Manual 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-temp.,pH, 3-202.14 Eggs and Milk Products,Pasteurized* Concentration and Hardness* 3-202.16 Ice Made from Potable Drinking Water* 4-601.11(A) Equipment Food Contact Surfaces and 5-101.11 Drinking Water from an Approved System* Utensils Clean* 590.006(A) Bottled Drinking Water* 4-602.11 Cleaning Frequency of Equipment Food- 590.006(B) Water Meets Standards in 310 CMR 22.0* Contact Surfaces and Utensils* Shellfish and Fish From an Approved Source 4-702.11 Frequency of Sanitization of Utensils and 3.201.14 Fish and Recreationally caught Molluscan Food Contact Surfaces of Equipment* Shellfish* 4-703.11 Methods of Sanitization- Hot Water and 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* Sources* C 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* 5 Receiving/Condition 2-401.11 Eating,Drinking or Using Tobacco* 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* J � 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* 590.0040) Labeling of Ingredients* 5-205.11 Accessibility,Operation and Maintenance 7 I Conformance with Approved Procedures /HACCP Plans Supplied with Soap and Hand Drying Devices 3-502.11 Specialized Processing Methods* I 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 CNIR 590.000. CITY OF SALEM BOARD OF HEALTH Establishment Name: "g Date: v/3/o Page: Z of J Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date No. Reference R—Red Item Verified p / PLEASE PRINT CLEARLY ra,t T I I I I I � Discussion With Person in Charge: Corrective Action Required*TV No pYes 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 suspensio, revocation of ❑ Embargo ❑ Emergency Closure your food permit. / // ( ,f' ❑ Voluntary Disposal ❑ Other: v I IJ 3-50 LIV(C) PHFSRecgivoda; 7smperntmrs Violations Related to Foodborne Illness Interventions and Risk .According to I.aw Cooled to Factors(Items 1-22) (Cont) 41=F%45'15 NN'ithin 4 Homs. PROTECTION FROM CHEMICALS 5-501,15 Cooling Nleihsxls for PHFs I ld � Food or Color Additives ( � 19 PHF Hot and Cold Holding j 3-501.16(B) Cold PHFs Maintained at or below ! 3-202.12 Additnes` 590.004(7) 41x145' F' 3-302.14 Protection form Unapinoved Addni%es' I ,-501.16(,\i I flet PHFs Maintained at of aho-,e j 15 Poisonous or Toxic Substances 7-101.11 identifNiag Information-Ori-,mal ; SOl.lfi(:1` 'coasts Heidat of above 13O'15 _ I C'outainers-. 7-102.1 1 Common Nume-Workm-�Containers" 20 Time as a Public Health Control '7-201.I i Separation-Storage" ( . 3-501.19 Time as a Public Health Cuntml 7-202.11 Restriction-Presence and Ilse' i 1 590.004(H) 1'artauce Requirement 7-202.12 Condi ions of Isc'' 7-203.11 Toxic Containers - Prohibitions* REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-204.11 Sanitizets.Criteria-Chemicals' POPNS(HSP} 7-204.1_'. Chemicals for Washing Produce,C'riteriai: � ( 21 3-801.1?(A):\) ( Unpastcurirad Pre-packaged Juices and 7-204.14 Drying Agents.Criletia" Beveraces with Warning Labels' ??05.1 l htcidemal Food Contin. I-,ubriennts"' 3-801.11(B) Use of Pasteurized Ephs* ?-206.11 Restricted Use Pe.iticrdes,Crneria'" Ra 3 801 ll(D) ( Raw o, Partially routs NoCookedAni mai F.x,cl and 7-'_06.12 Rodent Bait StaunnsxRawSccd Spt Setvre! " 3-801.11(C) I Unopened Food Pack '�ie Not Re-served. " 7-20A.13 Tracking Powders,Pest Contra(and i Rlumtorine" CONSUMER ADVISORY TIME/TEMPERATURE CONTROLS 22 3-603.11 Crmsumer Adviscuy Posted liar Con.unrPiacm of Animal Fixxt. chat circ Raw.Underrnoked or 16 ( I Proper Cooking Temperatures for I PHFs Not Otherwise' Processed to Eliunna:e 3-401.11 A(1)(2) Eggs- 155'F 15 Sec Patho_*cnc," 'nE"' v..,vnr Eggs-Immediate Setvico 145°FI ssec- 3-302.1 s Pasteurized Eggs Substitute for Raw Shell 3-401.1 I(A)(2) I Comminuted Fish. Meats 3 Game I F^gs, Animals- 155'F 15 sec. SPECIAL REQUIREMENTS 1-401.11(A)(2) Kati te,,Injected Meats- 3-401.1 U13)(1)(2) ( Pot 1, Beef Roast - 130'F 15, °F 15 1,21 min- 500.009;A)-(D) I Violations of Section 590,009(A)-(D) in - 155 seg * carerine, mobile lboil, temporary and 3-401.11(A)(3) Poultry. Wild Game. Staffed PHFs, I I residential kitchen operations should be "tufnngl.ontainingFish, Nleat, i ..,,./a<., .:adertherroiti,:r. ,,,.,:,,..,, Poultry or Radles-165'F 15 sec * above if related to foodborne illness 3-401.1 I(C)(3) Whole-muscle, Intact Beaf Stcaks interventions and risk factors. Other 1.45'F 1' I 590.009 violations relating fu good retail 3-401.12 Raw Anunal Foods Cooked in a I practices should be dabtted under #29- Microw'ave I65`F* Special Requirements. 3-401.1 1(A)(1)(b) All Other PHFs-- 145'F 15 sec. * I 17 Reheating for Hot Holding VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 3-40111(A)K(D) PHFs 165"F 15 sec. * i (Items 23-30) 3-403.I 1(B) Microwave- 165`P 2 Minute Standing ( Critical and non-crnicul violations, which do not telaie to the 'I'inte* 16odhorne ilhnest interventions and riot factors listed above, can he 3-403.11(C) Commercially Processed RTF Food- (uund in the following s'e(ti✓m u)'the food Code and 105 CAIR 14017,: .590.000. 3-409.11(P,) Remaining Unaliced Portions of Rcef I I Item I Good Retail Practices FC 590.000 Roasts" 123.- - [ Man_tgement and Personnel FC-2 .003 113 Proper Cooling of PHFs 1 1 24 Food and Food Protection FC-3 .004 r j 25. Equipment and Utensils �, FC-4 005 3-i01,14(A) Cooling Cooked PIIFs from 14WF to j 26 Water, Plumninq and W a;te FC-5 006 70'F Within 2 Hours and From 70'F 27 Physical Facility FC-6 007 to 411-'145`1 Within 4 Hour.,. 1' 1 28. I Poisonous or Toxic Materials FC-�7 .008 3-501.14(3) Cooling PHFs Mode From Amhwin 29_}_Special Requirements 009 Temperature Ingredients to 41'F/45'F 30 1 Other Within 4 Hours^ ..1 2n:, 'Denote,critical drat in the tis l 1999 Foxl Cock ui I On CNiR 590.00(1. CITY OF SALEM BOARD OF HEALTH Establishment Name: Date: Page: of Item Code C-Critical nem DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date No. Reference R—Red Item Verified PLEASE PRINT CLEARLY I I I I I I I I I I I I I � I � 1 Discussion With Person in Charge: Corrective Action Required: I ❑ No I ❑ Yes 1 have read this report, have had the opportunity to ask questions and agree to correct all ❑ Voluntary Compliance ❑ Employee Restriction/ Exclusion violations before the next inspection, to observe all conditions as described, and to ❑ Re-inspection Scheduled ❑ Emergency Suspension comply with all mandates of the Mass/Federal Food Code. I understand that noncompliance may result in daily fines of twenty-five dollars or suspension/revocation of ❑ Embargo ❑ Emergency Closure your food permit. 0 Voluntary Disposal ❑ Other: I-I(C) PHFs Received.n Temperatures -- - Violations Related to Foodborne Illness Interventions and Risk According to law Cooled to Factors(items 1.22) (Cont) 41-F/45'F Withi it 4 Haas. PROTECTION FROM CHEMICALS i 3"50 i.15 Cooling Methods for Pl4F's 14 Food or Color Additives 119 PHF Hal and Cold Holding 3-50 t.16(P) Cold PI IN.Mai tamed at o: below 3-202.12 Additives'" 590 W O F) 41 V45°F. 3-302.14 Protection front Unapproved Additives" ( 3.501 1(i(A) Hit PHFs Maintained it or above 15 I Poisonous or Toxic Substances 7-101.11 Identif'-ntg Information-Original i 140'5. " Qmtainers*' 3-501.16(A) Roasts Held at or above 130`F. 7-102,11 Common Name-Working,Containers" ( 20 Time as a Public Health Control 201.11 Separation-Storage" 3-501'14 Time as a P�blic Health Control* 7-202 11 Restriction-Presence and Ilse" 59(j.004(H) Variance Requirement 7-202.12 Conditions of Use' 7--203 If Toxic Containers-Prohibitions* REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 17-204.11 Sanitizels.Crirern.-Chemicals'^ POPULATIONS(HSP) 121 j 3-501.1!(.4t Unpasteurized P-e-pa:;kagrel Juices and 7-204.L Chemicals for Washing Pnxlucr, Criteria* � 7-204.1.1 DrvinuA9enls.Cnreim* Beve;aees With R,nnine Is,bels^ I ( 3-80!.11(B) Use of Pa;teurized E,e;;s* 7-21)5.1 ( Incidental Food Contact, Lubricants- ( 3-801 1 liD) 1 F:aw or Partially Cooked Animal F(x)d and 1 7-206.11 Restricted Lsc Pesticides,Criteria* j R:nv;;eed Sprouts Not Served. "# 7-206,12 ( Rodent Bait Stations' xs01.t1(C) i Unopened Food Pa';age tint Re-served. ' 7-206.13 ( Tutckatg Powders.Pest Control and Monitoling" CONSUMER ADVISORY TIMEITEMPERATURE CONTROLS 22 3-005.1 1 Consumer Advisory Posted for Consumption of Anitn.d F(KUN That ate R.aW-Und crooked of 16 Proper Cooking Temperatures for Not Othcrrire Processed to Ehmrniate PHFs -. 5.-r-.._ting 3 401 11 Al)(2) Fggs- 155°F 15 Sec. Pathogc ,,* Egep-Immediate Service 145"F7 5sec^ 3 ,0?.13 PasteenvM Egg,Substitute lot kaw Shell 340L11(A)(2) Comminuted Fish, Mears&Game Eses* Animals- 155°F 15 sec. " SPECIAL REQUIREMENTS 3dOl.i 1(A)(2) Ratitess;,Injected Meats 155'F IS 3-401.11(8)(1)(2) Pork: Beef Roast - 130"5 121 mit;* SPECIAL Violations of Section 590.009(A)-(D) in sec. , catering, mobile food,tcmpordry and 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHF%, residential kitchen operalion,should he Stuffing Cuntaiuiug Fish,Meat, debited under the appropriate sections Poultry or Ratites 165°F 15 se,. " alcove if related to foodborne i iIness 3-401A hQ(3) I Whole muscle,Intact Beef Steaks interventions and risk factors. Other 145`1* 590.009 violatianc relating to good retail 3=401.12 Raw Animal Foodc Conked in a ( practices. should be debited under#29-- 1MIdlowa e 165`F x SptLidl Rcoluircinuitts. 3-401.11(A)(,I t(b) All Other PHFs- Ids"F i5 see * 17 I ( Reheating for Hot Holding VIOLATIONS RGLATED TO GOOD RETAIL PRACTICES j 3-403A1(A)&(D) ( PHFs 165'F15sec. (Tte1tt523-311) 3-403.11(B) Microwave- 165°F 2 Muwle Standing Critical and non-Cri0cal violations. irhic'h do not ielatr to the Tine' ,foodborne illness inter:emions and,ioA [ars rrs'uteri above, Can he 3-403.11(C) Commerdally Processed RTE Food- &nogg(in the foOur:-inq.wrtiotcof du'Food Cade and I05 Ctlk 140'F" 590.000. 3-403.11(E) Rentainitg Unshed Portions of Beef Item Good Retail Practices FC 590,000 Roasts* "3_ Managereent and Personnel FC - 7_ .003 13 Proper Cooling of PHFs r 24 Foa9 and Food Protection FC-'3 004 25 Equipment and Utensils FC-4 , .005 3-501 I4(A) Cooling Cooked PHFs f4om 14WFto j 26 Water,Plumbirq and Waste FC-5 .006 70"F Within 2 Flours and From 70'F 27. PhVsicN Facihtv FC-6 1 .007 to 41"5/45'F Within 4 Hours. " 28. Poisonous or Toxic tvtatenals FC--7 I .008 3-501.14(13) Cooling PHFs Made Front Arnbient 29 Special RequirementsOC) 5 - -- 'Fempectture Ingredients to 41°F/45rF 130 Other Within 4Ilours, e i Denu;rs cuuc:al item m the(dernl 00')Fond i'.,&or 105 Ch1R 59011(10. x4 CITY OF SALEM BOARD OF HEALTH Establishment Name: Date: Page: of c Item Code C-critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date No. Reference R—Red Item Verified PLEASE PRINT CLEARLY , . I , I . I ll . I 1e ; j 1 , I I I � I � I � - I T Discussion With Person in Charge: Corrective Action Required: I ❑ No ❑ les 'r have read this report, have had the opportunity to ask questions and agree to correct all ❑ Voluntary Compliance ❑ Employee Restriction/ Exclusion violations before the next inspection, to observe all conditions as described, and to ❑ Re-inspection Scheduled ❑ Emergency Suspension comply with all mandates of the Mass/Federal Food Code. I understand that noncompliance may result in daily fines of twenty-five dollars or suspension/revocation of ❑ Embargo ❑ Emergency Closure :.your food permit. 0 Voluntary Disposal ❑ Other: 3-501 14(C) r,IFs Received ar Temperatures Violations Related to Foodborne Illness Interventions and Risk 4:corctmg f u 1.rnCooled to Factors(items 1-22) (Cont,) -{;'FI=S c ib'uh;r,4 Flours. " PROTECTION FROM CHEMICALS 3-50!.I5 ("ooL'n_ Ytrth x+s for PHFs 14 Food or Color Additives ! 119 PHF Hot and Cold bolding 3-202.12 Additives" ! 3-501.1(i(6) Cold PHFc maintained at of below 3-30114 Protection from unapproved Additives" ( 3-501,160 Hol PHFs M1 nintained at or abo+;c 15 Poisonous or Toxic Substances 140,f,, , II 7-101.11 Identifying Information-01 winai Containers" 3-50t.16(A) Roasts Held at or above 130'F. , 7-102 11 Cuuunon Name-Wr+rkinu Containers, 20 -ime as a Public Health Control 7-701.11 Separation-Sbxage" 1-501.1') Time its it Public Health Control r I j7-202.11 Restriction-Presence and Use' ' 5',10.00411 U, lLirimse Requireunon; i 7-202.12 Conditions oft;sa" 7-203 i I 'tori.•Container.;-Prohibitions" REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPU .ATIONS(HSM 7-21W.11 Svnitizers,Criteria --ChemicalsT I n I r _ _.' 7-20-112 Chewit,als for Washmc,Produce,Crauria" I ; )01.1 (.4) 1'cras �al reed Pie-};ac}:aged Juices and 7-204.1: Dtym,I Agents.Crtteri::' Beveta'es with 'Narnine ixibels* 3-801,;I(B) U::rnfPa,;temizrdE�_cs^ 7'!05,1 1 Incidental Frxxl Contact.Lubrtran!r� 3-80i,110)) Rats u,Partially Cooked Aplrnal F:xA add 7-^06.11 ke�incted Use Pesticides.Criteria* Raw Seed Sprouts Not Sc:a:d, 7-205.12 Rexient Bait Stations' t_g01.I 1(C Uno ,ted Food Package Ne 7-206 13 Tnlckme Powders, Pcst Crrntru! and I _ ) p' '' t R--,served. Monitoring ( CONSUMER ADVISORY TIMEJTEMPER 1TURE CONTROLS 22 3-603.11 Consumer Advisory Posed for Comumprion of Anint.:1 Foods' at hat are Raw.Lindeuuoked or PHFs Lb III Proper Cooking Temperatures for No; 0,therwisr Proo-ssed to Eliminate l i-401.1 IAll)(2) iggs- 151"F 15 Sec. 1'eitra^ens T =r•�.--,.�r::,^:,r; Eggs-iuuuediate.Service Ia5-P15secx =-303.1 3 Pasteunzr'Eggs Subatiunr for Rata Shell 3-401.1)(A)(2) Cunnnuurted Fish,M4cats&Gatire I EF,2S* Animals- 155'F 15 sec, ' I SPECIAL REQUIREMENI-S 3-401.11(B)(1)(2) Pork and Beef Roost- 130"F 121nrin" ( s• i:. ;G91A`!tJ r' r 401.11(A)Q) Ratites,Injected Meals -.135'F 15 ) ( r ) V tolaltons of Section 59p.0Q)(A)-(D) in 3-401.1 sec. " catering. mobile food,temptnary and i 3.401.11(A)(?) Poultry,Wild Game, Stuffed PHFs, residential kitchen uperatirms should he Stuffing G)ntaming Fish, Meat, dehitcd under the appropriate sections ! Poultry or Ratite -165",15 sec. " _ ! above if related to frodinornc ilhiess 1 3-901.!1(47)(3) Whole-nnnscle, Intact Beef Steaks I fntcrvent:ons and risk factors. Other 1450P 590.009 violations ielaling to good retail 3401.12 Raw Animal Foals Cranked in a practices should be debited wader N29- Microwave 165'F` Special Requirements. 3-401.11(A)(1)(b) All Other PHFs- 145`F15src. ` 17 Reheating for Hot Holding VIOLATIONS R._LATEL)TO GOOD RETAIL PRACTICES 3403.11(x)&(I)) PHFs 165'F 15 sec. ,. (Items 23-30) 3-403,11(6) Microwave. 165'F 2 Minute Staadm'- Crinra!w0non-.rincul viuln;rr+++s, which, Jr,itw:elute vi'111C Time' l`oorihomr illness inter n+e::I;nr,,r deed riak,li,,r.,,-s list:ei abnrc. can Lr: 3-403.11(C) Commercially Processed RTE Food- (o:md m the following svriions ref the Fool Code arri 105 CMR 140"F' 590 000 3-403.11(E) Remaining I aisliced Portionsof Beef I ifem Good Retail Practices FC 590.IIIIII Roasts r. 23. Mananement and Personnel FC- 2 .003 J8 Proper Cooling of PHFs 24 Fwd and Fox F vieciion PC-3 004 25 egtripmerd sad Ut2nsPs FC-4 .005 3-50LI-I(A) Cookie Cooked PHFs from 14W to --P5---_-- Water.Plurrlbinq and Waste FC--5 .CO6 70'F Within 2 Hour.;and Front 7O'F27. Physical FaciAv PC-6 007 to 4 i'F/45'17 Within.1 Hours, W j ;2 poisonous or Tox c Materials ;C -7 .008 1-50L14(B) Cooling Pf IFs made From.lmb;ent i 129 Special Requ:remoraS .603 I 'remrie'l eIngredienrsto41`Fl45`F 30. Other j WohinIHours r 'u"or: Deuotrs critical rem m the Wei al I'r99 Foal Curr or Io5 0,11,590 i0n. Sanitizer Concentration Log Street 2004 To_ Date Time Conc Init - Date Time Conc Init - Date Time Conc (nit - Date Time Conc (ni I - 1 I ` I I I I I I i Date = The day and month Time= The time of day Conc= The concentration of the sanitizer according to the test kit. I Init. = The initial of the person making up and testing the sanitizer L CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH _ 120 WASHINGTON STREET, 4TH FLOOR s SALEM, MA 01970 fi TEL. 978-741.1800 o*_ 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: E.W. Hobbs Inc. Address of Establishment: 207 Fort Avenue Owner's Name: Everett W. Hobbs Restrictions: Application Date: 4/2/2004 Permit for Food Establishment 288-04 Frozen Desserts/Ice Cream 17-04 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 71r '� CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH 3 i 120 WASHINGTON STREET, 4TH FLOOR SALEM, MA 01970 TEL. 978-741-1800 FAX 978-745-0343 STANLEY USOVICZ, JR. JOANNE SCOTT, MPH, RS, CHO MAYOR HEALTH AGENT 2004 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT NAME OF ESTABLISHMENT L• W' I-1 ( J �nC �TE�L# ��(7�� 74� �� -76q] ADDRESS OF ESTABLISHMENT- a0� t r—O!' Aura �;l r.4 V.A. ©l o MAILING ADDRESS (if different) : lIel n z OWNER'S NAME EIL'rre-�v HCI TEL# T?16- 7LILI. 703 ADDRESS -7 Ave CITY S4(cm STATE ZIP ()197() CERTIFIED FOOD MANAGE .lrc R'S NAME(S) �a6 CERTIFICATE#(s) (required in an establishment where potentially hazardous food is prepared.) EMERGENCY RESPONSE PERSON IIS HOME TEL# q�� _ICICII HOURS OF OPERATION: Mon. 1H16 Tue.1-a Wed.11-10 Thu.l1-l0 Fri. II-10 Sat. )I-V Sun. 11-10 TYPE OF ESTABLISHMENT✓ FEE check only RETAIL STORE NO less than 1000sq.ft. =$ 50 1000-10,000sq.ft. =$100 6 more than 10,000sq.ft. =$250 RESTAURANT YES NO less than 25 seats =$1 25-99 seats 50 more than 99 seats =$200 BED/BREAKFAST YES NO $100 ADDITIONAL PERMITS MAKE (not just serve) ICE CREAM, YOGURT, SOFT SERVE _ YES NO $5 TOBACCO VENDOR S NO 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, 1 certify under the pains and penalties of perjury that I, to my best knowledge and belief, have filed all state tax returns and paid all state taxes required under the law. SignatureZC,1,.,'te i✓. 11�p� y Date y(/Zf of Social Security or Federal Identification Number - ------------ ----------------------------------- Revised 11/03/03 FOODAP2.adm Check#&Date a-/,I 7 Massachusgtts Department of Public Health Salem Board of Health 120 Washington Street,4t" Floor Division of Food and Drugs Salem, MA 01970-3523 FOOD ESTABLISHMENT INSPECTION REPORT Tel. (978) 741-1800 Fax (978) 745-0343 Name // Date Type of Ooerationisl, Type of Insoection E GiU ' A/O -Z S, -7-A.)G I �/ /e) [-Food Service ❑ Routine Address)DS-�LJ AcJl� , I Risk ElRetail ElRe-inspection Telephone I Level ❑E] Residential Kitchen Previous Inspection _ Mobile Date: yea ^/lo q/ Owner HACCP YINElTemporary re-operation IFdcvc-/-/ /t.l . 4) I ❑ Caterer ❑ Suspect Illness Person in Charge(PIC) /)r/ S�i��iw /+vt I Time ❑ Bed&Breakfast ❑ General Complaint Inspector �Y In. Permit Na. ❑Other CP T.s� �. � 7ii� Out: Each violation checked requires an explanation on the narrative page(s) and a citation of specific provision(s) violated. Non-compliance with: Violations Related to Foodborne Illness Interventions and Risk Factors Anti-Choking Tobacco Violations marked may pose an imminent health hazard and require immediate corrective 590,009(E) ❑ 590.009(F) ❑ action as determined by the Board of Health. FOOD PROTECTION MANAGEMENT " ❑ 12. Prevention of Contamination from Hands ❑ 1. PIC Assigned/Knowledgeable/Duties El 13. Handwash Facilities EMPLOYEE HEALTH PROTECTION FROM CHEMICALS ❑ 2. Reporting of Diseases by Food Employee and PIC ❑ F13. Personnel with Infections Restricted/Excluded 14.Approved Food or Color Additives FOOD FROM APPROVED SOURCE ❑ 15.Toxic Chemicals ❑ 4. Food and Water from Approved Source TIME/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 ❑ 9. Food Contact Surfaces Cleaning and Sanitizing REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) , El 10. Proper Adequate Handwashing F121. Food and Food Preparation for HSP , ❑ 11. Good Hygienic Practices . CONSUMER ADVISORY .. " ❑22. Posting of Consumer Advisories Violations Related to Good Retail Practices Number of Violated Provisions Related Critical (C) violations marked must be corrected To Foodborne Illnesses Interventions immediately or within 10 days as determined by the Board and Risk Factors(Items 1-22): of Health. Non-critical (N) violations must be corrected Official Order for Correction: Based on an inspection immediately or within 90 days as determined by the Board today, the items checked indicate violations of 105 CMR of Health. 590.000/federal Food Code. This report, when signed below C N 23. Management and Personnel (FC-2)(590.003) by a Board of Health member or its agent constitutes an 24. Food and Food Protection (FC-3)(590.004) order of the Board of Health. Failure to correct violations 25. Equipment and Utensils (FC-4)(590.005) cited in this report may result in suspension or revocation of 26. Water, Plumbing and Waste (FC-5)(590.006) the food establishment permit and cessation of food establishment operations. If aggrieved by this order, you 27. Physical Facility (FC-6)(590.007) have a right to a hearing. Your request must be in writing 28. Poisonous or Toxic Materials (FC-7)(590.008) and submitted to the Board of Health at the above address 29. Special Requirements (590.009) within 10 days of receipt of this order. 30. Other DATE OF RE-INSPECTION: S ssorrispec�Foma-ia eoc Inspector's Signature: 4/ A -1 Print: PIC's Signature:( pr �lj I Print: G ��j,.,r� JI Page 7 of,2 Pages Violations Related to Foodborne illness f ,Interventions and Risk Factors(items 1-22) PROTECTION FROM CONTAMINATION FOOD PROTECTION MANAGEMENT t3 I ;r ss vntam:hef+ntt � 590.003(A) Assignment iii'Re�pomiLitity" 1-302.11(A)(U Raw Annud Foods bepar:aed front 590.003(I3) Denumetration of Knov Ieclgct 1 I Cooked gad RTF hondc* 2-103.11 Person is charge duties Ccntamrrration from.Raw ingrrdients 33G2.11(A',2) I Raw Animal F',vxls Scparatedfiow Each EMPLOYEE HEALTH Others 2 .590.003(0) Resprats+bslity of the person in chatge bJ Ccntam+nation from tt:e Eavaunvvrnr require tep,snnc 1:q foo.Lemplovee,and 3-302.11(A) _ Focvi Protection_• applicants* 3-30' 1°. '.v as hin±,:F•[uitsandVccehthles ?90 003(F) Responsibility OC A Ftexi Employee Or An 3-303.11 Fool Contac!u,th Equ[nment and Applicant To Report To The Perscn in I Tten all"* Chafgrr G_-ntam,naticn ttom the Consumer 570 0()3(G) Reporting h) Person in Chn[se! j 3-306.1='A)(`r.) j R•_turncd F(.od ar..i c:escrsle.e of}-ood* 131 590.003(1)) Excht,ionE and Resti ictions* ! ! I Dsposifion of 4dv!ter2'ea of Ca^mmina:ed 594.00YE, Removal of Exclusions and Resirict:,,ns I I Food 3-7111.1 : Discanhn.,or Re:conditi+-ning Unsafe FOOD FROM APPROVED SOURCE F' ud" 4 Food and Walor From Regu)3ted Sources 9 Food Contact Surfaces - 590.0t14,A-Bt j Compliance with Fuad Late-" j 4-501 111 !iann.a i\ uewashmg-Hu[Water i-201.12 Fnod in a Heruteacadly Jaaled Cont:;iner* 5auitizan an'I-e;ttrerabares" 4-50:.1 17 W-ccho-'cal W'ar wash':;g-'lot Water1 3-20 t.Ci Fluid Milk and N1;ih PruaueW - 2 r „• x :ianiiiration'remp�ratures" 3-20? 11 Shell Ens t-5'?],i 14 Cheenr•al Sanitia:iva-temp pH. 3-202 14 ( Eggs and :bulk Prtduct:;. Pasmo:ized" :?0-2.15 ! Ice Made From Potable Drinkin"Water 3-601,11 and harrlaes;; 'r + 13�t01.1 L(d) Equilxncnt ktoud Q,riecl Surfaces and S-101.11 ! Drinking Water Fenn an Aptn'ovrd Syaten:" S90.006(A) Flottlec te Df War* Utensil:Cleaa' 59(),006(B) ( 4-602.11 Cleaning Fftqueng10t equipment Food- I I Water Meets Standards+n-; nn 10 CMR 0"', j Contact Surtac-s and Utensils She,'t;sh and F?;h From an Approved Source - 4-701-.1 1 � Frequz,-,cy of Sanitizs±u;,uY Utensils and 3-201,id Fish and Re,.reationally C'augh't Mol'!!scan I Food Contact surhtces of FrinipntcnF- Shentish" 4-703.±1 M?thuds of Smnitzatlon-1-l"\4'aterand 3?01.15 Molluscan Shellf,h from NSSP Li,tcd ( j Ch.=mica P" { Sources'' j lit Proper,Adequate Handwashing Game and WiVMushrooms,4,nproved by 7-9;+l.ii Clean Cordi:ion-Hands%md Anns Regulatory Authority 3-202.18 ihellst,)(,l.identification Present* I 2.301 it Caeamn-2 FRtCVdnrC* 590.004;C) Wild blushnwms' i ( 2-301.11 hlhett to)"lash" 3 201.17 Game Anim:tis"- Good Hyg;enic Practices y Receiving/Condition I E 2-101.11 Eating,Drinking ur Usial'1'ubaccu" 3?02.11 ( PHFs Received it Prupet Tentperattm;s* i 2-•401.!:: Dischxrg.:s Pn+n;the E}es, Nose and 3=202 15 Package Integrity' Month* 3-101.11 Ptwd Safe nn:1 Pnadu!terated* 3-301,12 Prevcntmg Contamination When Tastio2 � .i Tags/Rocords:She•lstock 12 Prevention of Contamination from Hands 1203.13 shell�sta;k Idero.ificatiun ' 590:00-0[E) PreventingContan:inaGco from Eli';-tnVG'C.,. 3-2 12 Shel'stocl Identi8cotion Maintained" Tanv'Record>-:Fish Products =3 HanC'NBEh Facilities ;;oovemc,,11y Located and Accessible ! 3-402.11 Parasite Dreation a' I 5-201.11 Numbers and Cc:pacities* 3-4(;1.:2 Records.Creation and Re!ention* 5-204.11 [ncv,nn and Yhwemert* 59G.004(c) t.abeiing of Ingredients" 3-'M5,;.I Accessibility.Orerahrm and Maintenance � 7 I Conformance with Approved Procedures /HACCP Pians j Suprtied with Soap and Ha^d Drying 3-502.11 Specialized Process;ng Methods`. (, 1 ; Devices i 3-502.12 Reduced oxy,oll packaging,ct:teria" j 5 301.t 1 ! ffandwashine Cleanser,Availabilin, j 8-10312 C'onfo:mance with Approved Procrdurec` 5-301 l2 Haul Drying;Pax-;,ton Uerotzs critical nsnt in:S;fedei al 19-+9 Ford Oxte u, :35 CMI:590001'. ICITY OF SALEM r / / BOARD OF HEALTH Establishment Name: ,' 6 .E " S /_ o.�i�/ Date: ��it �G/ Page: of r Hem Code C-Critical nem DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date No. Reference R—Red Item Verified PLEASE PRINT CLEARLY / I I � 1 I � 1 I 1 � I I Discussion With Person in Charge. Corrective Action Required: I L3 No Y No ( es 1 ❑ Voluntary I have read this report, have had the opportunity to ask questions and agree to correct all liance C] Employee Restriction Comp / 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 twee•y-five dollars o7rsu�ussp�eennsion/revocation of Ll Embargo ❑ Emergency Closure your food permit. / C`f1�//�'/ l x/66, iC� ❑ Voluntary Disposal 0 Other: M ' '=.:�I 1-�,':'' :'?iFs liecetve;t ar'i t!tuier:iurrs Violations Related to Foodborne fitness interventions and Risk gccordi::�to?ane Cooled no Factors(Items 1.22) (Cont) =4 i-FI?yF\t%tibio 4 glow s. PROTECTION FROM CHEMICALS 3-50' 151 Cooling M"-thuds for Pl*''s to PHF Hot and Cold Holding 13 Food or Color Additives O1 16:13) Coid Pill',.Maintained at or below, 3 '_(12.12 Addibve`' 3 5540))(14(17) I - 4 L5, P -302.1+ Protection for T xic Substances Aiidnives^ 3-501,16i A) I9ut PHFs Maintained r.r or abo%e I tj Poisonouunr .oxic.,ubstancas 14o'F 7-IU1.I1 Identifying lntormotion-Criguml ( 3-50iJ6(A) Roasts Held at orabove 130`F. Container's' 7-102.11 Common Name- Wotidne Containers' 120 Titre as a Public Health Control 3-504 19 Time rte.a Public Health Contin'.* ;>-201.11 Scparation--Stonne* f 7-202 11 RestriUiun--Po-sence and Usz." `9',J'('4(H) Ydriance Requirement 7-202.12 Cond,6ons tit 110;' 7-203 11 'toxic Containers-ProluNtionsi` � REQUIREMENTS S FOR HIGHLY SUSCEPTIBLE 7-204.11 Sanitize);.Criteria--Chericats' POPULATIONS(HSP) 7-204 !2 C'he ric.Js for Washing Produce,Criteria" 21 ' 3-801.1 i1A) L.gsa!roiitized Pr,-paekag d?mce;.and j � 7-204.14 D:)ifie Apert!s,Crrteria"' $m-filces with Wcu•n:n�, I sbels� 1 801.11(8) Use Itt'Pa<tetuizedEegs; 17'05.1 i Incidental Food Contact Ia!xtcants"' i ',801.I liD3 Ra•s �� 17-206.11 Restricted Use Pesticn.les.Cnteria* ! I i Partially Cwked Annual Food and Kra'S,ed Sprouts Not Se:vcd. 7-206.12 Rotlent Bait Stations" 3-*;!I.1 I(r') Unopened Porti Pack32c Not Re-se*sed r' 7-206.13 Tracking Powders, Pest Control and Lioninxing' CONSUMER ADVISORY TIMEITEMPERATURE CONTROLS 22 3-(103.1 I Consume.,Ae!vomry Posted for Consumption of ( Anima: Foods That are Raw.Underavked or lb I Proper Cooking Temperatures for ( K..: Cnherwit r Preceswil to Elinunate PHFs 34t;1,11A{710) 155=F 15 Sec.. ia3-30".13 P.:steunzer.Egg,Substitute for Raw Shell Eggs-hnmediate Service 145'Fl5set:- 3-401.111021 Cummnnued Fish. Meats&Game I F.¢es' Adinida- 155'5 15 sec. " SPECIAL REQUIREMENTS 3-401.11 i I(N)(1)(2) Fork and Beef Rnaat- 130"F !?I min* 3-401.:1(A)(2) Ratires.Injected Mens- 155'F 15 590 D) Violations of Section 590.009.3)-(D) in sec. 1 I : ilerirt:, mol),le food, temporary and 3-401.11(A)(3) Poultry,Wild Garne,Srufi'cd PHT's, residential kitcherf operations should be Stuffing Containing Fish,Meat, debited unucr the appropriale sections Poultry or Ratite:-165°F 15 sec. :, above iflelawd to foodborne illness 1 3-101.11(C;(=) Whole muscle,Intact Beet Steaks inrerrendons t:nd risk factors Other 590.009 violations rclatine to good retail 34)1.i'_' Rani Animal Foods Cooked in a practices should be debited under #29- Microwave 165°i' ' Special Requirements. 3401.1 1(A)(()i b) All O?Ler PRFs 14s"F 15 rec. ' j 17 Reheating to, Hot Holding VIOLATIONS RJLATED TO GOOD RETAIL PRACTICES 3-403.i 1(A)&(Il) PHF, I65'F 15 sce. f Reins 23-30) 3-403.11(H) Microwave- 165`F 2 J9unne Standing C)uuwi and narrrrrrirr.!vioArtunes, wbich,:o not relate Gr the Time* )uodburne :11ness iwvrvemions and tisk fur;errs Ilsird above. can be 3-40311 tC) Comnu:roially Processed hrE Food- iow;d is oq• secur>nt,of!kc Fasts"ode.....1105'Cdil; I d0'F1 590.019u. 3-103,11(E) Remaining Unsl,til Portion;of Beef Item Good P.elaii Practices FC 590.000 Roasts+ e3. Management a,-.d Pcrsonn?1 FC --2 .003 18 Proper Cooling of PHFs '4, Food and Feat Protection FC- 004 1 1 25. Equi,,^,mens and Utensils FC-4 005 ? 301.14(1) Cn;line Cookcd 111117h fruit] 140°Fto ; 26. Water, ? i CITY OF SALEM BOARD OF HEALTH Establishment Name: ,X-. /U)• s1L)e, Date: VI�2 IG Y" Page: of Z Item Code c-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date No. Reference R—Red Item Verified / PLEASE PRINT CLEARLY Uzi s�„/f h_i.! _ f c%�ti��iJr.�i 11i�e'z 1 I � I 1 i L/ v /ZYc r I I I I I I � i I I Discussion With Person in Charge: Corrective Action Required: I ❑ No I ❑ Yes I 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 li corhply 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 5')1.! ::'C:) PIIF,Received:! Fe!llperntur�s Vinlations Retarw to Foodborne Illness Interventions and RisA A0.C1Ii!lg Io L,tv. C:,rAe'i In Factors(kerns 1-22) (Cont.) i I'F/45'F Vefthii 4 Hours. PROTECTION FROM CHEMICALS `;;l 15 1 -Iin "V o... method",for rTLF' 14 Food or Color Additives 19 PHF Her and Cold Hc!dinij 3-.;l)!.i6N;) CAd!"II-s Maintained at ot feleA 20112 Additives _i900011' ) 4 i F, 1 102,14 protection front unapproved Addiuv",' is Poisonous or Toxic Substances3-50L 10(A) I[,,! PHP:; "aintained at or above lyi.F 7-101.I 1 Identi6'Iriiz i f"nn-llun -01i:"inal ]6(A) Roasts Held at or above I Time as a Public lifialth Control 7-102.11 Common Narn,;-Working Containers 201.11 Separation-Storage i VII in Tim,,-I, ; Pol)Pc I-le,id,comio!* 7'-20111 Re,,trj;,twn-Piclem-c and Uce* e)u04(1-1) Variance Requirement 7-202.12 condn"J!.s of L'ie* -2,11 1 t Toxic Ctjuaine,,, REOUIREMENTS FOP. HIGHLY SUSCEPTIBLE POPULATIONS(HSP) 7 204.11 Said'i7eiv,Criteria- 21 hek) Unp,,steirrized Pie-paclkaged furces wid 7-104.12 Cberiica,�s lot 1,Vushim,Produce.Criteria' 7-204.14 DrNing Agents.Crite!m! 13'�,vriages with VvarninL Lat 7-205.! ; I I I I 1 13 Use of Pasteurized F_as- 7-205.! Incidental Food Cutajrt,Lubricant 1; LV(D) Raw or Parti*,111) Coib ed Animal Ftxxt o1 nd 7-206.11 Reqn,'ted Use Pamicides,Criteria' 7-206.12 Raxicnt Bari Station,- i Raw Seed Spoils Not Seri's ed. 1 3-1a)1.11(C) Unopened Package Not Re:sen ed 1-2(16.13 'Tracking Powders,Pest Control and toringo CONSUMER ADVISORY TIMFJTEMPER'4TUPE CONTROLS 22 1-603 11 Consumer.Advisory Posted for Con,umption of Anneal FC)CIIIF'fhai src Raw. I indercooked or 16 Proper Cooking Temperatures for Not ot(4ho,wisc Frocevsel-o Eliminate ;-40 1.11.-%(!)(?) Egcs- 154FF 15 Svc. Patho"ns-* L,-)!i-Immediate Service I,15'Fl;scl^ 3-3u2.13 Pas-uried Fggs Subs6wte for Raw Shell 3-401.11(A)(2) Comminuted Fish. Cattle Animals- 155'F 15 sec. ': 401.11(B)(1)(2) Pork and Beef Roast- 130'F 12I aiiO SPEClAL REOUIREMENTS 3-401.11(A)(2) Ratites. Injected Meats-1554'F 15 590.009(Ar-(D) Victimtons of'Section 590.0()9(A)-(D) in see. cT.tcriq,. moiNle food. temporary atilt 3.101 11(,A)Q) Poultry.Wild Game, Stuffed PIT17i, rcsident,,ti kilchen opciations sitould. be Stuffinc Coranirara,Fish,Me-,L. 61,felrcd wider the appropriate sections Poultrveff Ratilcc-165`7 15 sec. above if ieeo:cd to R)udborne ilRic,,s 340 1.1!(0(4) Nli'hole-muscle, Intact Pcel'Steaks interventions and risk factors. Other 145-F 590.009 violations relating to good reloil 1 3-401.12 Ram Animal Foods Cooked in,I i prac:iccs should be debited under 1129 - Microwave 165"F" Special Requ:ierrmits. 3-40! ]I G,)(I ab) All Other PHFs - 145'F 15 sec. 17 Reheating for Hot Holding VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 3-403.11(A)&(D) PH Fs 165%= 15 sec. (gems 23-30) 3-407.11(8) Mie rowavc- 166°F 2 Minute Standin,-, Critical ani'fum-,"ritical wk;�h do nat'clate to file, Titu-11 frindlawn,:tl/r.,,sy mtei!lentiors and risk.lacfor,-,listed,obot,e, ton he 3-403.1 It C) Commercially Pt ocessc-I RTE Food feland in so./ion." of the F-.. C ode and i05 CAIR 14017' 590.000. 3-403,1 I(fii Renianim.-,UnAived Fortionsof Beef film Good Retail Practices Fr 590.000 Roasts, 23. Management and Personnel r"-2 .003 tg 14 Food and FoxRotecaort FC--3 Mi Proper Cooling of PHFs 25, Equipment and Utenlas FC_-4 '005 ,501.14(A) Cooling Cooked PHFS final 140J,t 25 Vdater Flumbina and tVnE,t, F0 - 5 .006 70:F Within 2 Mows and Fr,mn 70'F 27. PhyectiJ Fam!fltv FC-6 007 to 41'=7%45"F Within 4 Hotir;. * 26 Pnisnou-of Toxic lvate;i& FC- 7 .608 3-5ul.14(B) Cooling P1 lFs Made.From Ambient 29 Scecial ROCIL'iremerts 009 inperaitire Ingredients to 41''7/45'F Other Within 4 lkstre:z E)La1IleaCIaIGjI ileal at rjx fl&,lal 1994 Food rade or 105 CNIR 59;7 000, OCT-10-05 11 :40 AM GEOCHRON�KRUEGER 617 661 0148 P. 01 yD11cy. _ I�nv�V tR Phone:(617)876-9118 GG _ Fax:(61T)876-0572 IZJ O O Email:dkrueger@k8.com pe Website:www.k8.com LABO PATO RIES, INC. 711 concord Avenue,Cambddge,MA 02138- _ r FACSIMILE TRANSMITTAL FORM FAX#: (617) 876-0572 t' Date: 1011012005 1 PLEASE.DELIVER TO: Joanne Scott Salem Health Department 978 740 9705 1 Pages to Follow: 3 Sender's Name: Francine Davis DOCUMENTS TO Certificate of Analysis for Sample Numbers: 1 FOLLOW: 70915-17 r , - i k u: j a , r s 1 PLEASE NOTE: All analytical results should be considered preliminary and are subject to further review until the final report is issued. ' If problems are experienced with this transmittal, t please call(617)876-9118. OCT-10-05 11 :41 AM GEOCHRON�KRUEGER 617 661 0148 P. 02 G'7 .a KRUEGER Phone; (617)876-9118 Fax: (6171876.0572 FoOD Email:dkrueger@kfl.Com Website:WWW.kfl.COM -AABORATORIES, INC. 711 Concord Avenue,Cambridge,MA 02138-1002 USA , r' CERTIFICATE OF ANALYSIS Submitted by: Date Reported: 10110105 :;- Date Received: 10/3105 1 Everett Hobbs E.W. Hobbs rt??' 207 Fort Avenue Salem, MA 01970 Reference: Sampling Month-October 2005 PO A. Description Your Sample Number Our Lob Number F Ice Cream Sampled 10/3/05, 10°F,Vanilla 70915 STANDARD PLATE COUNT cfulg 3200 COLIFORMS-VRB cfu/g <1 vi y Standard Plate Count should be less than 50000 cfu/g. k� Coliforms should be less than 20 cfulg. Methods:APHA,Standard Methods for the Examination of Dairy Products, 16th Ed., 1992,Parts 6.2 (Standard Plate Count)and 7.8(Coliforms). C: Al" 7y By. ,I 13628 16679 2125 70915(10/10/05) Page 1 of 1 y �1� OCT-10-05 11 :42 RM GEOCHRONiKRUEGER 617 661 0146 P. 03 �� 11 u" KRUEGER Phone: (617)876-9118 Fax:(617)876-0572 FOOD Email: dkrueger@kfl.com Website:www.kfi.com ®LABORATORIES, INC. 711 Concord Avenue,Cambridge,MA 02138-1002 USA CERTIFICATE OF ANALYSIS Y e'. Submitted by: Date Reported., 10/10105 Date Received: 1013/05 Everett Hobbs E.W. Hobbs ' 207 Fort Avenue Salem, MA 01970 n I Reference: Sampling Month -October 2005 PO#: Descrl bon Your Sample Number Our Lab Number Ice Cream Sampled 10/3105, 10°F,Coffee 70915 is a STANDARD PLATE COUNT cfu/g 470 �t COLIFORMS -VRB Cfulg <1 Standard Plate Count should be less than 50000 cfu/g. Coliforms should be less than 20 cfulg. `I Methods:APHA,Standard Methods for the Examination of Dairy Products, 16th Ed., 1992, Parts 6.2 (Standard Plate Count)and 7.8(Coliforms). .a j; Yr y" i 1 S By 'I 1362816679 2125 70916(10/10/05) Page 1 of 1 3%1 s-'y r OCT-10-05 11 :42 AM GEOCHRON�KRUEGER 617 661 0148 P. 04 lk; 3YI KRUEGER Phone:(617)876-9118 Fax:(617)876-0572 FOOD Email:dkrueger@kfl.COm Website:WWW.kfl.COM ®LABORATORIES, INC. 711 Concord Avenue,Cambridge, MA 02138-1002 USA v., CERTIFICATE OF ANALYSIS 1"i Submitted by: Date Reported: 10/10105 1 Date Received: 10/3/05 Everett Hobbs d^1 E.W. Hobbs 207 Fort Avenue Salem, MA 01970 'N Reference: Sampling Month-October 2005 PO#: s Description Your Sample Number Our Lab Number Ice Cream Sampled 10/3/05, 10°F,Blueberry 70917 Z STANDARD PLATE COUNT cfu/g 380 !A } COLIFORMS-VRS cfu/g <t Standard Plate Count should be less than 50000 cfulg. y'! Coliforms should be less than 20 cfulg. Methods:APHA,Standard Methods for the Examination of Dairy Products, 16th Ed., 1992, Parts 6.2 (Standard Plate Count)and 7.8(Coliforms). w; 's r' By: i.' 13628 16679 2125 70917(10/10105) Page 1 of 1 OCT-03-05 01 :09 PM GEOCHRONzKRUEGER 617 661 0148 P. 01 yi i t s . KRUM ER Phone:(617)876"9118 Fax:(617)8760572 FOODEmit:dkrue9er&9.con) , w Webslte:w,v.v.k8.com W ® Bopwo RIES, INC. 711 Contort Avenue,Cambridge.MA 02138- FACSIMILE 2136FACSIMILE TRANSMITTAL FORM F" FAX#: (617) 876-0572 7. . Date: 10/3/2005 a PLEASE DELIVER TO: Joanne Scott Salem Health Department 978 740 9705 u Pages to Follow: 3 Sender's Name: Francine Davis = A , DOCUMENTS TO Certificate of Analysis for Sample Numbers: r- FOLLOW: 70212-14 t. s s ' 3 � 1 . '! Lq r OCT 9 3 2005 § CITY OF SALE BOARD OF HEA MH t PLEASE NOTE: t All analytical results should be considered preliminary and are subject to further review until the final report is issued. If problems are experienced with this transmittal, please call(617)876-9118. s OCT-03-05 01 :09 PM GEOCHRON�KRUEGER 617 661 014e P. 02 KRUEGER Phone:(617)876-9118 Fax:(617)876-0572 FOOD Email:dkrueger@kR.00rn Website:wvvw.kfi.COM 41L®LABORATORIES, INC. 711 Concora Avenue,Cambridge, MA 02138-1002 USA CERTIFICATE OF ANALYSIS y. Submitted by. Date Reported: 9/16105 Date Received. 9/12t05 Everett Hobbs E.W. Hobbs k. 207 Fort Avenue Salem,MA 01970 Reference: Sampling Month-September 2005 PO 'I Description Your Sample Number Our Lab Number Ice Cream Sampled 9112105,4°F,Vanilla 70712 9f, STANDARD PLATE COUNT dulg 5200 COLIFORMS-VRB du/g 4 Standard Plate Count should be less than 50000 cfu/g. Coliforms should be less than 20 cfu/9. Methods:APHA,Standard Methods for the Examination of Dairy Products, 16th Ed., 1992,Parts 6.2 (Standard Plate Count)and 7.8(Coliforms). OCT 0 3 2005 CITY 0- C1 SALEM BOARD OF HEALTH sr By: Page 1 of I 13554 16588 2125 70712 (9116/05) OCT-03-05 01 : 10 PM GEOCHRONzKRUEGER 617 661 0140 P. 03 �vrya 3, KRUEGER Phone:1617)876-9118 Fax:(617)876-0572 FOOD Email:dkrueger@kfl.COm # WebSite:WWWkfI.COm 4ILeLABORATORIES, INC. 711 Concord Avenue,Camorldge, MA 02138-1002 USA CERTIFICATE OF ANALYSIS Submitted by: Date Reported: 9/16105 Date Received: 9/12105 £ Everett Hobbs E.W. Hobbs ' 207 Fort Avenue r,,•' Salem, MA 01970 Reference: Sampling Month -September 2005 PO A. `i Description Your Sample Number Our Lab Number 9fIce Cream Sampled 9/12105,4°F, Strawberry 70713 �� — } . STANDARD PLATE COUNT cfulg 810 COLIFORMS-VRS efulg 1 I Standard Plate Count should be less than 50000 ctu/g. ColNorms should be less than 20 cfulg. ..'. Methods:APHA,Standard Methods for the Examination of Dairy Products, 16th Ed., 1992,Parts 6.2 (Standard Plate Count)and 7.8(Coliforms). OCT 03 2005 CITY ()F adLEM BOARD OF HEALTH By __1 s: 13554 16588 2125 70713(9116105) Page 1 of 1 OCT-03-05 01 : 10 PM GEOCHRON�KRUEGER 617 661 0145 P. 04 K RU EGE R Phone:(617)876-9118 Fax:(617)876-0572 FOOD Email:tikrueger@kfl.com -AABORATORIES, INC. 711 Concord Avenue,Cambridge, MAt02138-1002 USA r CERTIFICATE OF ANALYSIS i Submitted by: Date Reported.' 9116/05 Date Received: 9112/05 Everett Hobbs E.W. Hobbs 207 Fort Avenue Salem, MA 01970 Reference: Sampling Month-September 2005 PO#: Description Your Sample Number Our Lab Number 1'. Ice Cream Sampled 9112!05,4°F, Blueberry 70714 STANDARD PLATE COUNT cfulo <250 COLIFORMS-VRB cfu/g <1 Standard Plate Count should be less than 50000 cfulg Coliforms should be less than 20 cfutg. x,. , Methods:APHA,Standard Methods for the Examination of Dairy Products, 161h Ed., 1992,Parts 6.2 r, (Standard Plate Count)and 7.8(Coliforms). n. . r OCT 93 2005 ` CITE' OF SALEM ¢' BOARD OF HEALTH S,.!J i, By: 'S fy <' ' 13554 16588 2125 70714(9116105) Page 1 of 1 SEP-29—OS 02 :37 PM GEOCHRON�KRUEGER 617 661 0140 P. 01 ft ,..E i UM ER Phone:(617)976-glia _ KRo D Fax:(617)9760572 KREMU:dkrueger@k9.com Fo Website:wwwAll.com y '! ®LABOIt=RIES, INC. 717Concord Avenue,Camt dge.MA0213& t FACSIMILE TRANSMITTAL FORM FAX AI: (617) 876-0572 i - i Date: 9/29/2005 i i PLEASE DELIVER TO: Joanne Scott Salem Health Department 978 740 9705 Pages to Follow: 3 Senders Name: Francine Davis {: DOCUMENTS TO Certificate of Analysis for Sample Numbers: FOLLOW: 70712-14 F _ a q" { i PLEASE NOTE: All analytical results should be considered preliminary and are subject to further review until the final report is issued. If problems are experienced with this transmittal, please call(617)876-9118. SEP-29-05 02 :38 PM GEOCHRONIKRUEGER 617 661 0146 P. 02 i.l 1 3 3na KRUEGER Phone:Fax:(617)876-0572 FOOD Email:dkrueger@Xfl.Com ; website:www.kfl.com ; 4 '__.09LABORATORIES, INC. 711 Concord Avenue, Cambridge, RAA 02138.1002 USA i CERTIFICATE OF ANALYSIS t Al Date Reported: 9116105 f Submitted by: Date Received: 9112105 i q. Everett Hobbs E.W. Hobbs 207 Fort Avenue ( Salem, MA 01970 Reference: Sampling Month-September 2005 PO A , sr! Description Your Sample Number Our Lab Number Ice Cream Sampled 9/12/05,4'F,Vanilla 70712 STANDARD PLATE COUNT cfulg 5200 i '. COLIFORMS-VRB cfulg 4 Hi -` Standard Plate Count should be less than 50000 cfu/g. Coliforms should be less than 20 cfulg. A #; Methods:APHA,Standard Methods for the Examination of Dairy Products, 16th Ed., 1992, Parts 6.2 (Standard Plate Count)and 7.8(Coliforms) N fry By: 1 13554 16588 2125 70712(9116/05) Page 1 of 1 SEP-29-05 02 :38 PM GEOCHRON�KRUEGER 617 661 0148 P. 03 X., KRUEGER Phone:(617)876-9118 Fax-(617)876-0572 g, Email:dkrueger@kfl.cOM FOOD website:WwwARCOM LAI -®LABORATORIES, INC. 711 Concord Avenue,Cambridge,MA 02138-1002 USA CERTIFICATE OF ANALYSIS Submitted by: Date Reported: 9116105 Date Received. 9112105 i. Everett Hobbs E.W. Hobbs 207 Fort Avenue Salem,MA 01970 PO Reference: Sampling Month-September 2005 #. Description Your Sample Number Our Lab Number lee Cream Sampled 9/12/05,4°F,Strawberry 70713 STANDARD PLATE COUNT cfu/g 810 COLIFORMS-VRB cfu/g Standard Plate Count should be less than 50000 cUg. Coliforms should be less than 20 cfu/g. Methods:APHA, Standard Methods for the Examination of Dairy Products, 16th Ed., 1992, Parts 6.2 (Standard Plate Count)and 7.8(Coliforms). icy Page 1 of I 13554 16588 2125 70713(9/16105) AUG-le-05 04-;49 PM GEOCHROH�.KRUEGER 617 661 0148 P. 04 KRUEGER Phone: (617)876-9118 Fax:1617)876-0572 i. FOOD Email:dkrueger@kfl.COM Website;W",kfl.corn Fnf AABORATORIES, INC. 711 Concord Avenue,Cambridge, MA 02138-1002 USA l Vis: Vi CERTIFICATE OF ANALYSIS Submitted by, Date Reported: 8118/05 N Date Received: 8116105 Everett Hobbs E.W.Hobbs 207 Fort Avenue W Salem, MA 01970 Reference: Sampling Month -August 2005 PO#' Description Your Sample Number Our Lab Number Ice Cream Sampled 8/16f05,8°F,Coffee 70508 STANDARD PLATE COUNT cfulg <250 COLIFORMS-VR8 cfulg <1 Standard Plate Count should be less than 50000 cfulg, tgr Coliforms should be less than 20 cfulg. Methods:APHA,Standard Methods for the Examination of Dairy Products, 16th Ed,, 1992,Parts 6,2 (Standard Plate Count)and 7.8(Coliforms). 11 80,1,9 yr 31 13487 16503 2125 70508(8118105) Page 1 of 1 46 AUG-I8-05 04 :48 PM GEOGHRON�KRUEGER _ 617 661 0148 P_82 .Ft. . KRItEGER Phone:r617i 876-9118 Fax.1617) FOOD Email:dkrueger@ktl.0com Website:www.kfi.com AABORATORIES, INC. 711 Concord Avenue,Cambridge, MA 02138.1002 USA x" +r' CERTIFICATE OF ANALYSIS Submitted by: Dare Reported: 8/18105 Date Received: 8/16/05 Everett Hobbs E.W. Hobbs 207 Fort Avenue Salem,MA 01970 Reference: Sampling Month-August 2005 P{)#: Description Your Sample Number Our Lab Number ice Cream Sampled 8116105,8°F,Rainbow 70506 „a _ w STANDARD PLATE COUNT cfulg <250` COLIFORMS-VRB cfurg <1 ^' Standard Plate Count should be less than 50000 cfulg. i, Coliforms should be less than 20 cfu/g.Methods: APHA, Standard Methods for the Examination of Dairy Products, 16th Ed, 1992,Parts 6.2 (Standard Plate Count)and 7.8{Coliforms}. 'sr z>>" {l. o UG ty '9 0 A17 Opp h gy:•Ag is �•"t 13487 16503 2125 70506(8118/05) Page 1 of 1 JUL-29-05 02 :49 Pm GEOCHRONKRUEGER 617 661 0148 P. 02 KRUEGER Phone: (617)876-9118 Pax: (617)$760572 FOOD Email:dkrueger@kfI-[0m Website;VA'VW.kfI.00rh -AABORATORIES, INC. 711 concord Avenue, Cambridge, MA 02138-1002 USA CERTIFICATE OF ANALYSIS Submitted by. Date Reported: 7129105 Date Received: 7/25/05 Everett Hobbs E.W. Hobbs 207 Fort Avenue Salem, MA 01970 Reference: Sampling Month -July 2005 PO Description Your Sample Number Out Lab Number Ice Cream Sampled 7/25/05, 14'F, Vanilla 70225 STANDARD PLATE COUNT cfu/g 650 COLIFORMS-VRB cfuig <1 Standard Plate Count should be less than 50000 cfu/g. Coliforms should be less than 20 cfu/g. Methods: APHA,Standard Methods for the Examination of Dairy Products, 16th Ed., 1992, Parts 6.2 (Standard Plate Count)and 7.8(Coliforms). T- By; 13396 16392 2125 70225(7/29/05) Page 1 of I JUL-29-05 02 :50 PM GEOCHRON�KRUEGER 617 661 0148 P. 03 X:i KRUEGER Phone:(617)876-9118 Fax:1617)8760572 FOOD Email:Clkrueger@kfi.Com Website:WYMARCOM @LABORATORIES, INC. 711 Concord Avenue,Cambridge, MA 02138-1002 USA CERTIFICATE OF ANALYSIS Submitted by., Dale Reported: 7/29/05 Date Received: 7/25/05 Everett Hobbs E.W. Hobbs 207 Fort Avenue Salem, MA 01970 Reference: Sampling Month -July 2005 PO#: i I Description Your Sample Number Our Lab Number Ice Cream Sampled 7/25105, 14°F,Strawberry 70226 STANDARD PLATE COUNT cfu/g 330 COLIFOR11113-VRS CTU/9 <1 Standard Plate Count should be less than 50000 cfufg. Coliforms should be less than 20 cfu/g. Methods:APHA, Standard Methods for the Examination of Dairy Products, 16th Ed., 1992, Parts 6.2 (Standard Plate Count)and 7.8(Coliforms). By: 13396 16392 2125 70226(7129/05) Page 1 of 1 JUL-29-05 02 :50 PM GEOCHRONZKRUEGER 617 661 0140 P. 04 " KRUEGER Phone:(617)876.9118 ' Fax: 1617)8764572 FOOD Email; dkrueger@kfl.com WebSite:WWW.kfi.COM is JOLABORATORIES, INC. 711 Concord Avenue,Cambridge, MA 02138-1002 USA CERTIFICATE OF ANALYSIS ' Submitted by: Date Reported: 7/29/05 Date Received., 7/25/05 Everett Hobbs zi E.W. Hobbs 207 Fort Avenue Salem, MA 01970 v .i Reference: Sampling Month -July 2005 PO H: l;. I ". Description Your Sample Number Our Lab Number Ice Cream Sampled 7/25/05, 140F, Pistachio 70227 ?;. STANDARD PLATE COUNT cfu/g <250 COLIFORMS-VRB ctuig <1 Standard Plate Count should be less than 50000 cfu/g. Coliforms should be less than 20 cfu/g. d; Methods: APHA, Standard Methods for the Examination of Dairy Products, 16th Ed., 1992, Parts 6.2 ii (Standard Plate Count)and 7.8 (Coliforms). Y �I }4 t h.. i By: w1 1 it. S - Page 1 of 1 13396 16392 2125 70227 (7/29/05) JUN-30-05 01 :53 PM GEOCHRONIKRUEGER 617 661 0140 P. 01 i s j KRUEG ER Phone:(617)876-9118 Fax:(617)876-0572 O D Email:dkrueger@k6.com Website:Ww Afl.corn -' LABD RAID RIES, INC. 711 Concord Avenue.Cambridge,MA 02138- _; FACSIMILE TRANSMITTAL FORM FAX#: (617) 876.0572 i Date: 6/30/2005 PLEASE DELIVER TO: Joanne Scott r• Salem Health Department 978 740 9705 t t; Pages to Follow: 3 Sender s Name: Francine Davis DOCUMENTS TO Certificate of Analysis for Sample Numbers: �a FOLLOW: 69980-82 �p05 r,. JAN 3 0 G>,� OF HSP(N BpPt�D t i I flr:' ft PLEASE NOTE: All analytical results should be considered preliminary and are subject to further review until the final report is issued. 1 � If problems are experienced with this transmittal, please call(617)876.9118. JUN-30-05 01 :55 PM GEOCHRON/KRUEGER 617 661 0148 P. 04 I i� KRUEGER Phone: 1617)8769118 Fax: (617)876-0572 v" FOOD Email: dkrueger@kfl.Cbm .e It J®LABORATORIES, INC. 711 Concord Avenue,Cambridge,, MA021 81002 USA i, CERTIFICATE OF ANALYSIS 5. Submitted by: Date Reported: 6130105 Date Received: 6125/05 N' Everett Hobbs ,L, E.W. Hobbs l ` 207 Fort Avenue i Salem,MA 01970 I : Reference: Sampling Month -June 2005 PO#: Description Your Sample Number Our Lab Number Ice Cream Sampled 6/25105,8°F,Vanilla Peanut Butter 69982 STANDARD PLATE COUNT Cfulg 880 COLIFORMS-VRS dulg <1 Standard Plate Count should be less than 50000 cfutg. ~ Coliforms should be less than 20 cfulg. Methods:APHA,Standard Methods for the Examination of Dairy Products, 16th Ed., 1992, Parts 6.2 (Standard Plate Count)and 7.8(Coliforms) -r. Gry �0F HEp��H too vf . 3= .r �r Y, By: V✓I Page 1 of 1 r 13307 16287 2125 69982(6/30105) Y* JUN-30-05 01 :55 PM GEOCHRONiKRUEGER 617 661 0140 P. 03 { KRUEGER Phone: (617)876-9118 Fax:(617)876-0572 FOOD Email: dkrueger@Kfl.CDM Website:WWW.kfl.COM J®LABORATORIES, INC. 711 Concord Avenue,Cambridge, MA 02138.1002 USA r� CERTIFICATE OF ANALYSIS Submitted by.- Date Reported: 6130/05 Date Received: 6/25/05 Everett Hobbs E.W. Hobbs 207 Fort Avenue Salem, MA 01970 Reference: Sampling Month-June 2005 PO#: F; Description Your Sample Number Our Lab Number Ice Cream Sampled 6/25/05,8°F, Frozen Pudding 69981 STANDARD PLATE COUNT cfu/g <250 s COLIFORMS -VREI cfulg <1 M Standard Plate Count should be less than 50000 cfu/g Coliforms should be less than 20 cfu/g. Methods:APHA,Standard Methods for the Examination of Dairy Products, 16th Ed., 1992,Parts 6 2 (Standard Plate Count)and 7.8(Coliforms). , G\�OO Q SOP } 1� 13y. L ` 13307 16287 2125 69981 (6130/05) Page 1 of 1 JUN-30-05 01 :54 PM GEOCHRONzKRUEGER 617 661 0148 P. 02 KRUEGER Phone!(617)876-9118 Fax:(617)876-0572 V FOOD Email:cikrueger@kfl.COM Website:VAqW-kfl.CDM ®LABORATORIES, INC. 711 Concord Avenue,Cambridge, MA 021381002 USA CERTIFICATE OF ANALYSIS Submitted by: Date Reported. 6/30105 Date Received., 6125105 Everett Hobbs E.W. Hobbs 207 Fort Avenue Salem, MA 01970 Reference: Sampling Month -June 2005 PO 9: Description Your Sample Number Our Lab Number Ice Cream Sampled biu"eberry 69980 STANDARD PLATE COUNT ef U/0 <250 COLIFORMS -VRS Cf U/g <t Standard Plate Count should be less than 50000 cfulg. Coliforms should be less than 20 cfulg. Methods:APHA,Standard Methods for the Examination of Dairy Products, 16th Ed., 1992, Parts 6.2 (Standard Plate Count)and 7.8(Coliforms)- C 0 By: Z94 13307 16287 2125 69980(6130/05) Page 1 of 1 7 Island Avenue E.W. Hobbs City of Salem FOOD SERVICE ESTABLISHMENT - FOOD SERVICE REINSPECTION Inspection HACCP: ❑ Telephone: Item Status Violation Critical Urgency Nature of problem or correction 745-7691 Non-compliance with: Done Owner: Anti-Choking PASS ❑ Everett W. Hobbs Tobacco PASS ❑ PIC: FOOD PROTECTION MANAGEMENT Done - Inspector: PIC Assigned/Knowledgeable/Duties PASS RED Janet Dionne EMPLOYEE HEALTH Done Date Inspected: Correct By: Reporting of Diseases by Food Employee and PIC PASS RED 5/27/2005 Personnel with Infections Restricted/Excluded PASS ❑J RED Risk Level: FOOD FROM APPROVED SOURCE Done Permit Number: - Food and Water from Approved Source PASS �/❑ RED BHP-2005-0453 Receiving/Condition PASSd❑ RED Status: Tags/Records/Accuracy of Ingredient Statements PASS ❑Q RED Closed - - Conformance with Approved Procedures/HACCP PASS RED #of Critical Violations:.. Plans PROTECTION FROM CONTAMINATION Done Time IN. Time OUT I Separation/Segregation/Protection PASS 0 RED Notes: Food Contact Surfaces Cleaning and Sanitizing PASS ❑d RED 182. Proper Adequate Handwashing PASS ❑d RED Urgency Description(s): Good Hygienic Practices PASS ❑J RED BLUE: Prevention of Contamination from Hands PASS ❑J RED Violations Related to Good Retail Practices (Critical Handwash Facilities PASS ❑O RED violations must be corrected immediately or within 10 days)(Non-critical violations GeOTMS®2005 Des Lauriers Municipal Solutions, Inc. ( Rev. May 31,2005 ) Page 1 oft 7lsland Avenue E.W. Hobbs must be corrected immediately PROTECTION FROM CHEMICALS Done or Within 90 days) - Approved Food or Color Additives PASS ❑Q RED RED: Violations Related to - Toxic chemicals PASS 0 RED Foodborne Illness Interventions TIME/TEMPERATURE CONTROLS(Potentially Haz Done and Risk Factors (Require Cooking Temperatures PASS RED immediate corrective action) Reheating PASS RED Cooling PASS ❑d RED Hot and Cold Holding PASS ❑J RED Time As a Public Health Control PASS RED REQUIREMENTS FOR HIGHLY SUSCEPTIBLE PO Done Food and Food Preparation for HSP PASSd❑ RED CONSUMER ADVISORY Done Posting of Consumer Advisories PASS 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. May 31,2005 ) Page 2 oft f w " CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH 120 WASHINGTON STREET, 4TH FLOOR SALEM, MA 01970 TEL. 978-741-1800 FAX 978-745-0343 _ STANLEY J. USOVICZ, JR. JOANNE SCOTT, MPH, RS, CHO MAYOR HEALTH AGENT COMMONWEALTH OF MASSACHUSETTS PERMIT TO OPERATE A FOOD ESTABLISHMENT In accordance with regulations promulgated under authority of Chapter 94, Section 305A and Chapter III, Section 5 of the General Laws, to operate a Food Establishment in the City of Salem is hereby granted to: Type of Establishment: FOOD SERVICE Name of Establishment: E.W. Hobbs Inc. Address of Establishment: 207 Fort Avenue Owner's Name: Everett W. Hobbs Restrictions: Application Date: 3/21/05 Permit for Food Establishment 289-05 Frozen Desserts/Ice Cream 15-05 Permit for the Sale of Tobacco Products These Permits Expire December 31, 2005 This permit is not transferable and must be reissued upon change of ownership or location. The permit must be posted in a prominent location in the Establishment, In accordance with the State Sanitary Code, before any renovations, improvements, or equipment changes are made, all plans for such must be submitted to and approved by the Salem Board of Health. HEALTH AGENT .! CITY OF SALEM, MASSACHUS �L BOARD OF HEALTH `� $2 120 WASHINGTON STREET, 4TH FLOOR I I / 2005 ffiffi SALEM, MA 01970 TEL. 978-741-1800 :f i 3ALEft' FAX 978-745-0343 Ci!`%�ii,u ,1F STANLEY J. USOVICZ, JR. JOANNE SCOTT, MPH, RS, CHO HEALi I-; MAYOR HEALTH AGENT 2005 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT NAME OF ESTABLISHMENT r—. 1- r T/]G TEL# CI79' '744t'p - 701 ADDRESS OF ESTABLISHMENT__;to6' 2oq rQr� Ave. MAILING ADDRESS (if different) q OWNER'S NAME �IJFrQ•}t AveTEL# q7g'-/qq_w' 3) ADDRESS 7 �s iaeo A /� CITY -SCtC.tr111 STATS M�} ZIP VIN r� CERTIFIED FOOD MANAGER'S NAME(S) NP15L,1I6_ )49�) S CERTIFICATE#(s) �iYlccrits -)k k16S (required in an establishment where potentially hazardous food is prepared.) EMERGENCY RESPONSE PERSON r►Kr`e� ]4C Cb _HOME TEL#_q'7y5 7Uu1• 0) HOURS OF OPERATION: Mon.&JkTue. 0ATWed.10 )0 Thu.10-10 FriJO-10 Sat.JO-)O Sun. W-JO TYPE OF ESTABLISHM FEE check only RETAIL STORE Sw NO less than I000sq.ft. =$ 50 C� 00-1 =$100 more than 10,000sq.ft. =$250 O RESTAURANT NO S less than 25 seats =$100 25-99 seats =$150 more than 99 seats =$200 BED/BREAKFAST YES NO $100 ADDITIONAL PERMITS MAKE (not just serve) ICE CREAM, YOGURT, SOFT SERVE NO $5 TOBACCO VENDOR S NO $50 ALL NON-PROFIT(such as church kitchens) 45__tRS� 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. i Pursuant to MGL Chapter 62C, Section 49A, I certify under the pains and penalties of perjury that I, to my best knowledge and belief ve filed all Slate lax r turns and paid all state taxes required under the law. l 11110! 0 0?n- I�O3%3 Signaturer Da et Social Security or Federal Identification Number ----------------------------------------------------------------44-� --------------------,--------------------------------- Revised 11/03/03 FOODAP2.adm Check#& Date r 11/07/4: 47:14 KFL - GEOCHRON i 9767450343 P10.095 902 I KRUEGER Analytical services for the Food Industry FOOD 45 Manning Road, Billerica,MA 01821.3934 J®LABORATORIES, INC. X978-667-69 0-f 978-667-6999 CERTIFICATE OF ANALYSIS Submitted by: Date Reported: 8/4/2011 +EverettHobbsl Date Received..,7/26/2011 E.W. Hobbs 207 Fort Avenue Salem, MA 01970 Reference: Sampling Month -July 2011 PO st: Descdplion Your Sample Number Our Lab Number Ice Cream 207 Fort Avenue, Salem, Sampled 7/26/11 92849 12°F Vanilla STANDARD PLATE COUNT of U/9 270 COLIFORMS•VRB ofu/g 1 Standard Plate Count should be less than 50000 cfu/g. Coliforms should be less than 20 cfu/g. Methods: APHA,Standard Methods for the Examination of Dairy Products, 16th Ed., 1992, Parts 6.2 (Standard Plate Count)and 7.8(Coliforms). By l/ 20908 26456 2125 92849(8/4/2011) Page 1 of 1 11107/4: 47:14 KFL - BEOCHRON 4 9787450343 1,10.095 D03 Analytical Services for he Fod Industry FOOD INC. 45 Manning Road,Billerica,MA 01821-3934 com LABORATORIES, Cww 978-6V- •dkrueg 8-667 6999 978-667-89110+f 978-66T-6999 CERTIFICATE OF ANALYSIS Submitted by: Date Reported, 8/4/2011 Date Received:7/26/2011 Everett Hobbs E.W.Hobbs 207 Fart Avenue Salem, MA 01970 Reference: Sampling Month -July 2011 PO A' Description Your Sample Number Our Lab Number Ice Cream 207 Fort Avenue,Salem,Sampled 7/26/11 92850 12°F Coffee STANDARD PLATE COUNT cfafg 260 COLIFORMS-VRB cfu/g <1 Standard Plate Count should be less than 50000 cfu/9. Coliforms should be less than 20 cfu/g. Methods:APHA, Standard Methods for the Examination of Dairy Products, 16th Ed., 1992,Parts 6.2 (Standard Plate Count)and 7,8(Colitorms). By: 20998 25456 2125 92860(8/412011) Page i of i 11/07/4: 47:14 KFL - C-EOCHRON 3 9787450343 NO.095 1?04 1 ` Services t KRUEGER for hetFoodt industry 'FOOD 45 Manning Road,85lerica,MA 01821-3934 JS LABORATORIES, INC. WW 875-667.6 •f 978-6671-6999 CERTIFICATE OF ANALYSIS Submitted by: oats Reported: 8/4/2011 Date Received:712612011 Everett Hobbs E.W. Hobbs 207 Fort Avenue Salem,MA 01970 Reference: Sampling Month -July 2011 PD#. Description Your Sample Number Our Lab Number Ice Cream 207 Fort Avenue,Salem,Sampled 7126/11 92851 12°F Frozen Pudding STANDARD PLATE COUNT cfu/g 340 COLIFORMS•VRB Cf U/9 <1 Standard Plate Count should be less than 50000 cfu/g. Coliforms should be less than 20 cfu/g. Methods:APHA,Standard Methods for the Examination of Dairy Products, 16th Ed., 1992, Parts 6.2 (Standard Plate Count)and 7.8 (Coliforms). By: 20998 25456 2125 92851 (81412011) Page 1 of 1 1110714: 47:14 KFL - GEOCHRON 4 9787450343 NO.095 D01 KRUEGER Phone:(978)667-6900 FOOD Fax:(978)667-6999 Email:dkruegerftfl.com Website:www.ktl.com ® LABORATORIES, INC. 45 Manning Road,Billerica,MA 01821-3934 USA FACSIMILE TRANSMITTAL FORM FAX *: (978) 667-6999 Date: 8/8/2011 PLEASE DELIVER TO: Joanne Scott Salem Health Department 978 745 0343 Pages to Follow: 3 Sender's Name: Sherida George DOCUMENTS TO Certificate of Analysis for KFL Sample Numbers: FOLLOW: 92849.51 (E.W. Hobbs) PLEASE NOTE: All analytical results should be considered preliminary and are subject to further review until the final report is issued. If problems are experienced with this transmittal, please call(978)667.6900. 11.'04 84 12:33 I'FL — GEOCHRON — 9584450343 110.006 D02 Analytical Services - KRUEGER for the Food Industry FOOD 21 Alpha Road,suite D,Chelmsford,MA 01824 www-kfi.com•dkrueger®kfl.com �®LABORATORIES, INC. 978-256-1220•f 978-256-1222 CERTIFICATE OF ANALYSIS Submitted by: Date Reported: 5/29/2012 Date Received:5/19/2012 Everett Hobbs E.W. Hobbs 207 Fort Avenue Salem, MA 01970 Reference: Sampling Month -May 2012 PO#. Description Your Sample Number Our Lab Number Ice Cream 207 Fart Avenue, Salem, Sampled 5/19/12 96067 12°F Cafe Oreo STANDARD PLATE COUNT cfu/g 340 COLIFORMS-VRB cfu/g <1 Standard Plate Count should be less than 50000 cfu/g. Coliforms should be less than 20 cfu/g. Methods:APHA, Standard Methods for the Examination of Dairy Products, 16th Ed., 1992, Parts 6.2 (Standard Plate Count)and 7.8 (Coliforms). By: 22224 26860 2125 96067 05.29.12 13:09 Page 1 of 1 1 11/04,84 12:33 KFL - GEOCHRON , 978745©343 110.Doc, D03 KRUEGER Analytical Services _ for the Food Industry FOOD 21 Alpha Road,Suite D,Chelmsford,MA 01824 www.kfi.com•dkruegerOkfl.com �®LABORATORIES, INC. 978-256-1220•f 976.256-1222 CERTIFICATE OF ANALYSIS Submitted by: Date Reported: 5/29/2012 Date Received 5119/2012 Everett Hobbs E.W. Hobbs 207 Fort Avenue Salem, MA 01970 Reference: Sampling Month -May 2012 PO#: Description Your Sample Number Our Lab Number Ice Cream 207 Fort Avenue, Salem, Sampled 5/19112 96068 12°F Maple Walnut STANDARD PLATE COUNT cfu/g 770 COLIFORMS -VRB cfu/g <1 Standard Plate Count should be less than 50000 cfu/g. Coliforms should be less than 20 cfu/g Methods: APHA, Standard Methods for the Examination of Dairy Products, 16th Ed., 1992, Parts 6.2 (Standard Plate Count)and 7.8 (Coliforms) By: 22224 26860 2125 96068 05.29.12 13.09 Page 1 of 1 11,04 '84 12:33 KFL - GEOCHROH > 9787450343 1,10.00E PO4 KRUEGER Analytical Services for the Food Industry FOOD 21 Alpha Road,Suite D.Chelmsford.MA 01824 �®LABORATORIES INC. www.kfl.com•20-dkrf 9 8-256.com f 976-256-1220•f 978.256-1222 CERTIFICATE OF ANALYSIS Submitted by. Date Reported. 5/29/2012 Date Received:5119/2012 Everett Hobbs E.W. Hobbs 207 Fort Avenue Salem, MA 01970 Reference. Sampling Month - May 2012 PO#: Description Your Sample Number Our Lab Number Ice Cream 207 Fort Avenue, Salem, Sampled 5/19/12 96069 120F Grasshopper STANDARD PLATE COUNT cfu/g 610 COLIFORMS •VRB cfufg <1 Standard Plate Count should be less than 50000 cfu/g. Coliforms should be less than 20 cfu/g. Methods:APHA, Standard Methods for the Examination of Dairy Products, 16th Ed., 1992, Parts 6.2 (Standard Plate Count)and 7.8 (Coliforms). By. Z9 22224 26860 2125 96069 05.29.12 13:09 Page 1 of 1 11'04. 84 12:33 PFL — GEOCHR011 > 9757450343 110.006 DOl KRUIDG ER Phone:(978)256-1220 O D Email: (976)256-1222 l:dkrueger@k8.com nf1p� p1c�C+ Website w kfi.com ® LAepW mimam INC. 21 Alpha Road,Suite D.Chelmsford,MA 01824-4172 USA FACSIMILE TRANSMITTAL FORM FAX M (978) 256.1222 Date: 6/7/2012 PLEASE DELIVER TO: Larry Ramdin Salem Health Department 978 745 0343 Pages to Follow: 3 Sender's Name: Sherida George Documents to follow: 96067-69 (E.W. Hobbs) PLEASE NOTE: All analytical results should be considered preliminary and are subject to further review until the final report Is issued. If problems are experienced with this transmittal, please call (978)256-1220. V KRUEGER Analytical Services _ for the Food Industry FOOD 21 Alpha Road,Suite D,Chelmsford, MA 01824 www.kfl.com •dkrueger@kfl.com �®LABORATORIES, INC. 978-256-1220•f 978-256-1222 CERTIFICATE OF ANALYSIS Submitted by., Date Reported: 6/21/2013 Date Received:6/12/2013 Charles Hobbs E.W. Hobbs 207 Fort Avenue Salem, MA 01970 Reference: Sampling Month -June 2013 PO#: Description Your Sample Number Our Lab Number Ice Cream 207 Fort Avenue, Salem, Left Spigot Sampled A0789 6/12/13 187 Vanilla STANDARD PLATE COUNT Cfu/g 330 COLIFORMS -VRB Cfu/g <1 Standard Plate Count should be less than 50000 cfu/g. Coliforms should be less than 50 cfu/g. Methods: APHA, Standard Methods for the Examination of Dairy Products, 16th Ed., 1992, Parts 6.2 (Standard Plate Count)and 7.8 (Coliforms). By: 23747 28602 5523 A0789 06.21.13 15:05 Page 1 of 1 KRUEGER Analytical services _ for the Food Industry FOOD 21 Alpha Road,Suite D,Chelmsford, MA 01824 www.kfl.com•dkrueger@kfl.com J® LABORATORIES, INC. 978-256.1220•f 978-256-1222 CERTIFICATE OF ANALYSIS Submitted by- Date Reported: 6/21/2013 Date Received:6/12/2013 Charles Hobbs E.W. Hobbs 207 Fort Avenue Salem, MA 01970 Reference: Sampling Month -June 2013 PO#: Description Your Sample Number Our Lab Number Ice Cream 207 Fort Avenue, Salem, Center Spigot A0790 Sampled 6/12/13 18°F Swirl STANDARD PLATE COUNT cfu/g 3800 COLIFORMS -VRB cfu/g <1 Standard Plate Count should be less than 50000 cfu/g. Coliforms should be less than 50 cfu/g. Methods:APHA, Standard Methods for the Examination of Dairy Products, 16th Ed., 1992, Parts 6.2 (Standard Plate Count)and 7.8 (Coliforms). By: l 23747 28602 5523 A0790 06.21.13 15:05 Page 1 of 1 ii KRUEGER Analytical Services for the Food Industry FOO® 21 Alpha Road,Sulte D,Chelmsford, MA 01824 www.kfi.com•dkrueger@kfl.com �®LABORATORIES, INC. 978-256-1220•f 978-256-1222 CERTIFICATE OF ANALYSIS Submitted by. Date Reported: 6/21/2013 Date Received:6/12/2013 Charles Hobbs E.W. Hobbs 207 Fort Avenue Salem, MA 01970 Reference: Sampling Month -June 2013 PO#: Description Your Sample Number Our Lab Number Ice Cream 207 Fort Avenue, Salem, Right Spigot A0791 Sampled 6/12/13 18°F Chocolate STANDARD PLATE COUNT cfu/g 250000 COLIFORMS -VRB cfu/g <1 Standard Plate Count should be less than 50000 cfu/g. Coliforms should be less than 50 cfu/g. Methods: APHA, Standard Methods for the Examination of Dairy Products, 16th Ed., 1992, Parts 6.2 (Standard Plate Count)and 7.8 (Coliforms). By: 23747 28602 5523 A0791 06.21.13 15:05 Page 1 of 1 KRUEGER Analytical Services CC for the Food Industry f00� 21 Alpha Road,Suite D,Chelmsford, MA 01824 www,kfl.com•dkrueger@kfl.com — LABORATORIES, INC. 978-256-1220•f 978.256-1222 CERTIFICATE OF ANALYSIS Submitted by, Date Reported: 6/21/2013 Date Received:6/12/2013 Charles Hobbs E.W. Hobbs 207 Fort Avenue Salem, MA 01970 Reference: Sampling Month -June 2013 PO#: Description Your Sample Number Our Lab Number Ice Cream 207 Fort Avenue, Salem, Sampled 6/12/13 A0792 14°F Vanilla STANDARD PLATE COUNT cfu/g 10000 COLIFORMS -VRB cfu/g <1 Standard Plate Count should be less than 50000 cfu/g. Coliforms should be less than 20 cfu/g. Methods: APHA, Standard Methods for the Examination of Dairy Products, 16th Ed., 1992, Parts 6.2 (Standard Plate Count)and 7.8 (Coliforms). 23747 28602 5523 A0792 06.21.13 15:05 Page 1 of 1 KRUEGER Analytical Services for the Food Industry FOOD 21 Alpha Road,Suite D,Chelmsford, MA 01824 www.kfl.com•dkruegerOkfl.com / LABORATORIES, INC. 978-256-1220•f 978-256-1222 CERTIFICATE OF ANALYSIS Submitted by: Date Reported: 6/21/2013 Date Received 6/12/2013 Charles Hobbs E.W. Hobbs 207 Fort Avenue Salem, MA 01970 Reference: Sampling Month-June 2013 PO#: Description Your Sample Number Our Lab Number Ice Cream 207 Fort Avenue, Salem, Sampled 6/12/13 A0793 14°F Oreo STANDARD PLATE COUNT cfu/g 990 COLIFORMS-VRB cfu/g <1 Standard Plate Count should be less than 50000 cfu/g. Coliforms should be less than 20 cfu/g. Methods:APHA, Standard Methods for the Examination of Dairy Products, 16th Ed., 1992, Parts 6.2 (Standard Plate Count) and 7.8 (Coliforms). By: \ 23747 28602 5523 A0793 06.21.13 15:05 Page 1 of 1 ii Analytical Services KRUEGER for the Food Industry FOOD 21 Alpha Road,Suite D,Chelmsford,MA 01824 www,kfl.com•dkrueger@kfi.com LABORATORIES, INC. 978-256.1220•f 978-256-1222 CERTIFICATE OF ANALYSIS Submitted by. Date Reported: 6/21/2013 Date Received:6/1212013 Charles Hobbs E.W. Hobbs 207 Fort Avenue Salem, MA 01970 Reference: Sampling Month -June 2013 PO#: Description Your Sample Number Our Lab Number Ice Cream 207 Fort Avenue, Salem, Sampled 6/12/13 A0794 14°F Chocolate Chip STANDARD PLATE COUNT cfulg 8200 COLIFORMS-VRB cfu/g <1 Standard Plate Count should be less than 50000 cfu/g. Coliforms should be less than 20 cfu/g. Methods:APHA, Standard Methods for the Examination of Dairy Products, 16th Ed., 1992, Parts 6.2 (Standard Plate Count) and 7.8 (Coliforms). By''.. , 23747 28602 5523 A0794 06.21.13 15:05 Page 1 of 1