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EDGEWATER CAFE - ESTABLISHMENTS A ` EGEWATER CAFE 155 WASHINGTON STREET o 0 II s .I n II Y II D a a 6 I 4ef.Z's City of Safem, Wassachusetts 'Fire (Department 48 Laffayette Street �Davi�`w. copy Fire Prevention Bureau Chief Salem, 911assackusetts 01970-3695 29 Tort Avenue 978-744-6990 TeC978-744-1235 7el978-745-7777 d`ody@safem.com ('ax978-745-4646 `Pax,978-745-9402 VIOLATION NOTICE Edgewater Cafe Monday October 19, 2009 155 Washington Street Salem, MA 01970 An inspection of your facility on Friday October 16, 2009 revealed the violations listed below. ORDER TO COMPLY: Since these conditions are contrary to law, you must correct them upon receipt of this notice. An inspection to determine compliance with this Notice will be conducted on TO BE DETERMINED at / / If you fail to comply with this notice before the reinspection date listed, you may be liable for the penalties provided for by law for such violations. Violation Code Article Division Page Count 10.03.1 means of egress 10.03 1 0 0 Tables and chairs removed to make room for entertainment, SHALL NOT BE PLACED IN EXIT AISELS. Any obstacle which may interfere with the means of egress or escape from any building or other premises, or with the access to any part of said building or premises by the fire department in case of fire, shall be removed from aisles, floors, halls, stairways and fire escapes . Doors and windows designated as exits shall be kept clear at all times . 10.03.1 means of egress 10.03 1 0 0 Remove table and chairs set-up so as to block the exit from the Cantina Room. Any obstacle which may interfere with the means of egress or escape from any building or other premises, or with the access to any part of said building or premises by the fire department in case of fire, shall be removed from aisles, floors, halls, stairways and fire escapes. Doors and windows designated as exits shall be kept clear at all times . RECEIVED 10/19/2009 17:53 OCT 2 2 2009 Page 1 lir 6ALEfv) ;CARE! OF HEALTH City of,Salem, Massachusetts Fire Department 48 Gaffayette Street (David Wocf C y Fire 4'r'eventiox bureau Cfiief Safem, 31assachusetts 01970-3695 29(Fort Avenue 978-744-6990 Tef978-744-1235 `Ief978-745-7777 dco6y@sakm.com Fax978-745-4646 Tx(978-745-9402 VIOLATION NOTICE X 8olloran, Jr. , Charles R Dennis Moustakis Inspector Occupant/Owner CC: Chief David Cody Salem Building Inspector Licensing Board Salem Board of Health File 10/19/2009 17:53 Page 2 tt Commonwealth rof Massachusetts s F City of Salem Board of Health Kimberley Driscoll E 120 Washington Street,4th Floor Mayor �y SALEM,MA 01970 FooNRetail Establishment Permit DATE PRINTED: 12/23/2008 ESTABLISHMENT NAME: Edgewater Cafe File Number:BFIF-2003.000003 155 Washington Street Salem MA 01970 LOCATED AT: 0155 WASHINGTON STREET SALEM,MA 01970 Permit Type Permit No. Permit Issued Permit Expires Fee Restrictions/Notes FOOD SERVICE BHP-2009-0203 Dec 23,2008 Dec 31,2009 $280.00 ESTABLISHMENT Total Fees: $280.00 PERMIT EXPIRES December 31,2009 Board of Health This Permit is not transferable and must be reissued upon change of ownership or location.The permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code,beofre any revocations,improvements,or equipment changes are made,all plans for such must be submitted to and approved by the Salem Board of Health. Page 1 a CITY OF SALEM, MASSACHUSETTS BOARD OF HE,ILT14 120 WASHINGTON STREET,4`FLOOR TEL. (978) 741-1800 KIMBERLEY DRISCOLL FAx(978) 745-0343 MAYOR IDIONNEOSALEM.COM JANET DIONNE, ACTING HEALTH AGENT 2009 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT NAME OF ESTABLISHMENTYG�Rt, w (��pce TEL# 07k-77L/o �GGG9 ADDRESS OF ESTABLISHMENT t. iPrRl��,� cT FAX# Q? i 7YG — (j.2 1) MAILING ADDRESS(if different) t EMAIL-Business': F m_Arn r4.raf-,e_ ,&" Website: 1&ti"u, cu wbt Qiiil - aco-, OWNER'S NAME tkIA✓t`t TEL# 7 `/ 734 ADDRESS ( � oUS C'_1t%-70 STREET CITY STATE // ZIP CERTIFIED FOOD MANAGER'S NAME(S) l i iSLti�i CERTIFICATE#(S) S3 k b loaf (Required in an establishment where potentially hazardous food is prepared) /� EMERGENCY RESPONSE PERSON C (1 5 (r /al�.l HOME TEL# 97L I VV 00!_ DAYS OFOPERATION,_.x ;Monday ;Tuesd I Wednesda .. . .`.t Thursda '; Friday SatuMa 1 = 'Sunda HOURS OF OPERATION Please write in time of day. j) )3 (j j11t t3 U Air- Mj P 1V So yawl I :3 0 1.111304^ (For example 11 am-11 pm) It !( uL vv. I I Qt) ;� I 1 iUd >A. I .U U I •Ov +M ;d U l+. 1. CStJ �.�, TYPE OF ESTABLISHMENT FEE (check only) RETAIL STORE YES NO less than 1000sq.ft. =$ 70 1000-10,000sq.ft. =$280 more than 10,000sq.ft. =$420 --------------------- ------------------------------------------------------------------------------------------------- ----- O RESTAURANT ES NO less than 25 seats =$140 (Outdoor Stationary Food Cart$210 25-99 seats =$280 more than 99 seats =$420 BED/BREAKFAST/ YES $100 CHILDCARE SERVICES ADDITIONAL PERMITS MAKE (notjust serve) ICE CREAM, YOGURT/SOFT SERVE YES NO $25 TOBACCO VENDOR YES NO $135 ALL NON-PROFIT(such as church kitchens) YES NO $25 *Please pay total with one check payable to the City of Salem. This Permit is not transferable and must be reissued upon change of ownership.The Permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code,before any renovations,improvements, or equipment changes are made,all plans for such must be submitted to and approved by the Salem Board of Health. Pursuant to MGL Chapter 62C,Section 49A, I certify under the pains and penalties of perjury that I,to my best knowledge and belief,have filed all state tax returns a p ' all stale taxes required under the law. 1l000, .75-F 16,E Signature . - Date Social Security or Federal Identification Number ------------------------ p --------- Revised 424/07 FO,ODAP2008.adm Check#&Datee 1 �,}� (1�1q- $ _ `�,..-,. S .. y >.r-•-;: i,.e4 ':a:'sr9��nrf'lfl.r�y'N�,rtLl.�M,;+J's"Y.a'ivrt�' (e'+iryR.T.v 'rE..,�ef.':1 ...¢'."'�". �.'}+r+me .,+,J Y.;=.p :-'S°�-,,^,�' p.�n ., 1 1' • F �- 'y Massachusetts Department of Public Health Salem Board of Health Division of Food and Drugs 120 Washington Street,4r"Floor g Salem, MA 01970-3523 FOOD ESTABLISHMENT INSPECTION REPORT Tel. (978) 741-1800 Fax(978) 745-0343 Name (� n Date Type of Operation(s) Type of Inspection s Food Service � Routine Address �/ 11 Risk I Retail ❑ Re-inspection SRP Level ❑ Residential Kitchen Previous Inspection Telephone I S (l C/ r 1 /�a '3,( , 1 El Mobile Date: Owner I \ YlJ r _ HACCP YM El ElPre-operation ❑ Caterer ❑ Suspect Illness Person in Charge(PIC) /� Time El Bed 8 Breakfast El General Complaint ( _ '�f1 'P In , P :� l5 ❑ HACC Inspector 0 a A Out: ' �'I Permit No. ❑Other Each violation checked requires an explanation on the narrative page,(s) and a citation of specific provision(s) violated. UNon-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)IT" 590.009(F)Ie action as determined by the Board of Health. F06D PROTECTION MANAGEMENT ;, - �w t . ❑ 12. Prevention of Contamination from Hands ❑ 1 PIC Assigned/Knowledgeable/Duties ❑ 13 Handwash Facilities g EMPLOYEE HEALTH "�� ay Irk ctit 'x( a7n � . ..;-,..a«;,P » ...�.,� E `4 'tea..'-: A- Lt�',:l'( !':PROTECTI(2N FROM CL�EMICALS'��r ''��'t a ""„1,`�s"��-e^r-��.� vm _'nn'' . ❑ 2. Reporting of Diseases by Food Employee and PIC ��_��.... �,� mOr a� � �� ,�� -a [114.Approved Food or Color Additives ❑ 3. Personnel with Infections Restricted/Excluded ❑ 15 Toxic Chemicals FOOD FROM APPROVED SOURCE `,'�-r ,; .�,4��s.r,_..7i 27. ".,`-' '.T-1MEITEMPERAYURE CONTROLS`W Potemlal HaXardous 0a ds �g -' ❑ 4. Food and Water from Approved-Source (y m p (fir ��ty "- ) �[ 5. Receiving/Condition ❑ 16. Cooking Temperatures cE] 6. Tags/Records/Accuracy of IngredierifStatements ❑ 17. Reheating ` . cw❑ 7. Conformance with Approved Procedures/HACCP Plans ❑ 18. Cooling l ' M El 19. Hot and Cold Holding #PROTECTION FROM CONTAMINATION '7' tr h20.Time As a Public Health Control v8 Separation/Segregation/Protection ❑ 9PFood Contact Surfaces Cleaning and Sanitizing %AtQU1REMENTS FOR kG'LYSU-$;EPTiBLE El21. Food and Food Preparation for HSP El 10. Proper Adequate Handwashing ❑ 11. Good Hygienic Practices UM El ADVISORY 6 ao w �4 rc� �a,s,a m ❑22. Posting of Consumer Advisories Violations Related to Good Retail Practices Number of Violated Provisions Related Critical (C) violations marked must be corrected To Foodborne Illnesses Interventions immediately or within 10 days as determined by the Board and Risk Factors(items 1-22): of Health. Non-critical (N)violations must be corrected Official Order for Correction: Based on an inspection immediately or within 90 days as determined by the Board today, the items checked indicate violations of 105 CMR of Health. 590.000/federal Food Code. This report, when signed below C 23. Management and Personnel (FC-2)(590.003) by a Board of Health member or its agent constitutes an 24. Food and Food Protection (FC-3)(590.004) order of the Board of Health. Failure to correct violations 25. Equipment and Utensils - .(FC-a)(sso.00s) cited ir(this:report may result in suspension or revocation of `the food establishment permit and cessation of food 26. Water,Plumbing and Waste (FC-5)(590.006) establishment operations. If aggrieved by this order, you 27. Physical Facility (FC-6)(590.007) have a right to a hearing. Your request must be in writing 28. Poisonous or Toxic Materials (FC-7)(590.008) and submitted to the Board of Health at the above address F-R29. Special Requirements (590.009) within'10 days of receipt of this order. p- $0. Other DATE OF RE-INSPECTION: , U Y1(R�I�C�f` 5:5901nspecfForm6-f4.tlxN tv 1 a�' Ci.^:cr ,rl , -{-r) �ww U (�/ G�_' DtAit a r o Inspector's Signature: U B Print: PIC's Signature:' , Print: Page of 3Pages Violations Related to Foodborne Illness , Interventions and Risk Factors(items 1-22) PROTECTION FROM CONTAMINATION FOOD PROTECTION MANAGEMENT S Cross-contaminatron 1 590.003(A) Assignment of Responsibility* 3-3011.1(A)(]) Raw Animal Foots Separated from 590.003(B)_ Demonstration of Knowledge* _ - Cooked and RTE Foods* 2-103.11. Person in charge-duties Contamination from Raw Ingredients 3-302A I(A)(2) Raw Animal Foods Separated from Each EMPLOYEE HEALTH Other" 2 590.003(C) ,Responsibility of the person in charge to Contamination from the Environment require reporting by food employees and 3-302.11(A) Food Protection" applicants* 3-302.1.5 Washing Fruits and Vegetables 590.003(F) Responsibility Of A Food Employee Or An 3-304.11 Food Contact with Equipment and Applicant To Report To The Person In Utensils* Charge* Contamination from the Consumer 590,003(G) Reporting by Person in Charge* 3-306.14(A)(B) Returned Food and Reserviee of Food* 3 59UO3(D) Exclusions and Restrictions* Disposition of Adulterated or Contaminated 590,003(E) Removal of Exclusions and Restrictions _ Food 3-701.11 Discarding or Reconditioning unsafe FOOD FROM APPROVED SOURCE Food* 4 Food and Water From Regulated Sources 9 Food Contact Surfaces 590.004(A-B) Compliance with Food Law* 4-501.111 Manual Warewashing-Hot Water 3-201.12 Food in a Hermetically Scaled Container* Sanitization Tem eratures* - 3-201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Warewashing-I-Iot Water 3-202.13 Shell Eggs* Sanitization Temperatures* 3-202.1.4 Eggs and Milk Products,Pasteurized* 4-501..114 Chemical Sanitization-temp.,pH, 3-202.16 Ice Made From Potable Drinking Water* concentration and hardness.* 5-101.11 Drinking Water from an Approved System* 4-601.11(A) Equipment Food Contact Surfaces and Utensils Cleats* 590.006(A) Bottled Drinking Water* 4-6021 590.006(8) Water Meets Standards in 310 CMR 22.0* . 1 Cleaning Frequency of Equipment Fool- Contact Surfaces and Utensils* Shetffsh and Fish From an Approved Source 4-70111 Frequency of Sanitization of Utensils and 3-201.14 Fish and Recreationally Caught Molluscan Food Contact Surfaces of Equipment* Shellfish* 4-703.11 Methods ofSarritization-Hot Water and - 3-201-15 Molluscan Shellfish from NSSP Listcd Chemical* Sources* 10 Proper,Adequate Handwashing Game and Wild Mushrooms Approved by Regulatory Authority 2-301.11 Clean Condition-Hands and Arms* 3-202.18 Shellstock Identification Present* 2-301.12 Cleaning Procedure* 590.004(C) Wild Mushrooms* 2-301.14 When to Wash* 3-201.1.7 Game Animals* 1t Good Hygienic Practices 5 Receiving/Condition 2-401.11 Eating,Drinkin or Usin Tobacco* 3-202.11 PI-IFs Received at Proper Temperatures* 2-401.12 Discharges From the Eyes, Nose and 3-202.15 Package Integrity* Mouth* 3-101.11 Food Safe and Unadulterated* 3-301.12 Preventing Contartnnation When Tasting* Tags/Records:Shellstock 12 Prevention of Contamination from Hands 3.202.18 Shellstock Identification* 590.004(F,) Preventing Contamination from 3-203.12 Shellstock Identification Maintained* Employees* - Tags/Records:Fish Products 13 Handwash Facilities 3-402.11 Parasite Destruction* Conveniently Located and Accessible 3-402.12 Records,Creation and Retention* 5-203.11 Numbers and Ca achies* 590.004(7) Labeling of Ingredients' 5-204.11 Location and Placement* 9 Conformance with Approved Procedures 5-205.11 -Accessibility.Operation and Maintenance /HACCP Plans - Supplied with Soap and Hand Drying 3-502.11 S ecKalized Processin ,Methods* Devices 3-502.12 Reduced bx en acka 'ng,criteria* 6-301.11 Handwashing Cleanser,Availability 8-103.12 Conformance with A. roved Procedures's 6-301.12 Hand Drying Provision *Denotes critical item in the federal 1999 Foal Code of 105 CNIR 590.000. �-�- k2, CITY OF SALEM J BOARD OF HEALTH Establishment Name: C�i 1�P \.-2 C�o IL. (2(-\ Date: - 6 Page: of 3 ,Item i ,Code C-Critical Itelh J eDESCRIPTION OF VIOLATION 1 PLAN OF CORRECTION �,o Date .No." 'Reference °R-Red lterri �" .mss lzs, �,rz,f �F- : °, ;;•v"� .,�,,: _ �.-s :a• - .e� .,; 'z �, fens:, s y j. Vered �.�a i¢�' S- - • '¢�.� PLEASE PRINT CLEARLY _ � a .GsF." RA ,:`r' rJie A o..-P..V — r'O.in v o,a�V r`��'N\�.bN 0 a.-a.r 7(7 , Mn,1 nN r.a IU I' � OO� n(JPen01" V LVn PAY D M ,f l N\A.A� i� 1. 'k/l ,' �lA ./P �(/� (/�� l,_1y, ��y) l�--(- ` ' A 1 /,Ly "'Vl%I AA0 t�.v �t'.(I AO n0 AA--,Q (-7,1 A A AXX 11170 .1IA 0o fS �a r .,VJA S`1 /AA o1 61270 _AA 0BIL, -C7) ��.�cn`� (_"-'A_A Di(P 5 D.nn I,� MA An/SOA `'� AI/ (X_ �(M-1.1 AA .0,n .,CAW _ �l it Des � 4{ `_ EV-19 / ' ._(A' Q'TAl /1s i e in � . " fn 0 -6DV— t o T,Z)h 0.91 +'O/V'o 0 A A 0 IV P1 AQ A),-nom! Mn m >✓n.(a yy All P d.10 TAA f1 o_D A i l it$ s .-A_� AA n 47, uA.P�9 f J at_.V is 4 , r.\ -',71coil UJn,A V _7Pnrva.� Klb .nl �o� <� `�✓l Sn 1PE � Pa OF-,ti(Q1�JU � / 0 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 C) 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 twe ty fiv do'larsar-suspension/ evocation of ❑ Embargo ❑ Emergency Closure your food permit. �� ---� ' ❑ Voluntary Disposal ❑ Other: F 14(C) PIJFsReceived atl`cm craturca Violations Related to Foodborne illness interventions and Risk According to 1-4m Cooled to Factors i7tertra 1-22) (Cont:) -4 1`F/45'F Within 4 Hours 3-502.35 Cooling Medio&for PHFs PROTECTION FROM CHEMICALS k9 i PHF W and Cold Holding 1=4 Food or Color Additives 3-56' Tb(B} CoMPHF.s, anaamedatrirbelvw 72-0112 Ad t2 590,00 40;� 4 1 V45"F, 3502 14 s' 3-50 1,16(A) lint PHI-,k4ainlained at or above Poisonous or Toxic Substances i4WR 3-561.'16(A) Roaste Held at or above 13W"t-, * I 01.11 k1olauvina,loticluranial-- Orli'mal —--------4 Containers, Time as a Public Heafth Control 7-20 t.I I S ation-Strn!E � 3-564 19 'tame as a Public Health cotaroF IZ n I -1-20111 Re'wictio.n -PreStoce w1d Use* ls%-oo ift Var tj-IIE--ea -Irinicnt- 71102.42 Conditiom of U0' REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-10111 Toxic Containers-prolnlrinorl * POPULATIONS(HS 7-204. --S�anhi7tJsToteria-Clicinici,ts' PS 1 21 !-&')1-tl(A) Unpimerinzed Pfe-padkiged linces and 7-?(14.12 eh'nnicais for n�a�hing llrodiice�Clitorie Reverans with W, labols' 7 —�—W� 2,04,14 Di Ni i t Agect, — U_ 3-801 II(Bi le ot Pwtcull�T 7-205,11 Incidental Fla)d Cvtaacr,.IAmi is nits 1-- 11— F 7-20k 1 i Rosincll,�!t�.Rc Pe�ticides,Critenal '1-801.i 1(D) Raw or P�uljaflv Cck+ed Animal Food and I -3 —f ' r " t -- Seed-S IT uui Not Served. 206.12R(Aca S111sulos 011�alI Ld ,Lx Not—:1! j 106 111rackiftgPol% esPsLColurklland4a CONSUMER ADVISORY 22 r- 3 11 Con�unior Aavisllw� Posted 11or Consumption of TIMEITEMPERATURE CONTROLS A,ninal Raw, Underclx)kcd or [16 FrOiiF Cooking Temperatures for I,(q Othet ise Pru ceased w Elinanal, PHFS 3_,161.1. Egg�s- 155'F 15 Ser� 1' I"'isteurized Fg Substitute for Kliw Shell 3=401.11i in fl Meats& Game Aninials- 15517 I sec SPECIAL REQUIREMENTS 1.401.11(B)t I)Q) Park and Beet Roast - 130'F 121 min 'i-401.11(A)t Rafires, troectldMlats l75'FJ5 590.009(A)-0) 'Vielanons of Section 590XX)9(A)-(D) in sec. . I catering, rriolli1c."ai,temporary and I�11(A)(i) Poultry, Wild Game, Staffed PHFs, rcmdmlial kitchen operations should be sniffing Containing Fist", Sliest, debited under the appropriate sections above if reJated to fe<xlborne i Ilness 3-401.1 NC0) whole-musde, Intact Beef Steaks irrei veinions, and risk factors. Other 540.009 violations rehouirt, to good retail 3-401.42 R41 Annual Pads Corked in a practices should be debited under #29.- Mictowave 165'F Special Requirements. �451 5 )(1)( b,) MJ45"F 15 sec,i Other PliFs ii —1 17 Reheating for Hot Holding VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 3-46TIUAWD) PHFs 165°F 15,wc. (Items 23-30) ,37403.1l(B) Micruwave- 165 F2 Minute Standing; Coyi.lw7 and non-crifical r1olation,;, witich do rias reiate ie ahe Time'" ,alund in thejollouing secrion3 of the Food Code and 105 Otfl? T403.1 ll(') cornmexcialh, lme�le�i�TEI Tooli 140'P; 3-403A I(E) Remanuro, Unrliced Portions of Beef Item Good Retail Practices T FC 590wo Roa�l'* 23, Management and Personnp! FC -2 '003 24, Ing of PHFs FvyJand Food Prcle�tion FU --3 f)04 --Ig i;r—�'Cool 25 �Ec(upment and Utenstls FC-4 00 1,4(A) Eltl ing Cook,d PI lFs ftom 14Y F to -- 26, in Ivv aa F�-5 (M _qapul 70'F Within 2 Horns and From 70"1" 27, Phya�-,qi Faclfty_ —4-TC-tT- .001--- ------- to 41'14/4'5�F Withar 4 Hours. 26� Poisonous N Toxic Matenjis 3 501 14(B) Coolhw PHFI,Made Front Ambient T-ts '009 TerntIcrauvre Ingredients lo 41'F-'/45'F Within4 HouiO I CITY OF SALEM BOARD OF HEALTH Establishment Name: P rpt M1 D11 . 1 ('1 Date: r - q-n Pager_ of 2 Item '.:Code. ;C-Critical Item,.-._. , ,s r DESCRIPTION OF,VIOLATION/PLAN OF CO RECTION y� j�" <t f; Date No. w`` Reference R=Red Item` '� ^" %' "" : F 'aa.-�� rrv�rUa'G�...rrx _'a 5 r, 'r ,r .,c" r ,� y Verified.°', r ' ,: fS6c' r ,� Ih$'' "` s� >> PLEASE PRINT CLEARLY .?• "��"k H` ".'. 3 01 AAA Al\ �JAA 1 - t(o-r) - I C1-0 f � � L-1 0A �OG I i I r s S - Discussion With Person in Charge: Corrective Action Required: ❑ No ❑ Yes I have read this report, have had the opportunity to ask questions and agree to correct all ❑ Voluntary Compliance ❑ Employee Restriction/ Exclusion violations before the next inspection, to observe all conditions as described, and to ❑ Re-inspection Scheduled ❑ Emergency Suspension comply with all mandates of the Mass/Federal Food Code. I understand that noncompliance may result in daily fines of twenty-five dollars or suspension/revocation of ❑ Embargo ❑ Emergency Closure your food permit 1,-�� ❑ Voluntary Disposal 0 Other: 0 1 1 4(C) !"Hfrs Reocivcd atTerriperatures Violations Related to Foradocirr fitness Interventions and Risk Xx:ordinc,,to Law Cooled to Factors(items 1-22) {Cone) Coolim,Methods for PHFs PROTECTION FROM CHEMICALS PPF Hot and Gold Holding Food or Color Additives ---+� -:1- 3-50r 16(ff) PHF,�Maintainod at or ba&,w 7 202 12 Arid, , ,l 4014Y3 F* 3-3024ijPrat hon frox 1,1�00 ) 11FIFs Maintained at of luArve LL5— Poisonous or Tox c Substances -1U1.]£ �identl5inglnto.tnasun-Oria�na1,'o * -- -Rixiso;Held at or (bore 1301 , conudncrs� 20 Time�as a Public Health Control ..—arcon Nam, )rko,�L(<sluolrer' M211 26—1 �-Rl 1.19 Tiar"ax a tubtic iif'aldr Control, i-j T ion--Sausage 7-20111 Restriction- Fr"' nce and I�� 5,)ww(H) st '�C* 7-2 202.12 Coilfifions of f.iw, RFOUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-203,11 Toxic CxjwrruroProhibi:iins" POPULATIONS 121 ?--Ml—iI(—A)- 7-204�12 Chollicals for I Modirce,Cliterial i ffeveraaes with Warnii!�,Tabolr* 7-20414 Divi L U l-801.1 I(B) t 7 ltscidcnial Fooll Corriict LlibricantO x205.T 3-801A I(D) Raw or Panmtl�Cooked Animal frood arid Resmuled U"Fie, 7-206.11 - , , " ..1, i , I R,'M SL(c - oNits NOt Srf'Vcd. 206.14 I Rodent Bwt Stalll)M 7-306.I3 TNIcking Powderi,Pest Control and CONSUMER ADVISORY 11 �-P-�r-,rt—edfor(--mi�umption of TIMMEMPERATURE CONTROLS etilruml arc Raw. Undelowked o: PrjpW—Cooking Temperatures for dc�rwis PHFs OPrcAvused.Fs 1714irinaic 1,cu --Tifil.1141I)(2) F'.ggs- 15,,'F 15 5cc, 1l 145'1`15sec' R:xteuF rizcd g4l S�ibswwe for RAw Shel c. comillinuted Fi"hmeat &Garne SPECIAL REQUIREMENTS 40 1,11 f 13)(1)(2) Plffk and M, fluxtsl 130'1 121 n)in* Rofires, 590,009(A)-(D) Viohflion,of Ssctforr --)90.009(A)-(D) in - 155�F 15 ssc Cateringmobilc k-Kxl,temporaiv and .5-401—11(A) NailmWild Giame, $tufTed PHFs, reaidrnt of kitchen operations should be Sluffo')gConlawing Fish, Meat, JeNwd under the appropriate seviions Poultry or llllnf�' -1 15 scc. above if iolaiedtofix)dhorne illnoss �1-401—l1tC1(3, Imact I3evf Steaks interwntions and risk f2clors, 45 T' 590.009 violatioliq relating tio good retail 1-401J2 Raw Amirult Fclxk Cooked in a I practices should be debited under#29.- —� Micfowaw-1651- spmal Requirements, —7NII(�thlrt N IF,- NTT uses 4FI i 7i ,�T(1)�to J7:� Reheating for Hot Holding VIOLATIONS RELATED TO GOOD RETAIL PRACTICES _3 103.5(A}&(ffi -0-11, 165')3 15 sw<, (items 23-30) 1-40111(B) Microwave- 165'F 2 Nlinwe, Standing Gitirai and non-crideal vivlvowas which(it)nor iare is the Tuve "foodho me dlnesr in tc l;very i ons,mi)i iskjlcf torr H wc,d abwc. ran be 3-403.11(C) I C )naceroirrlfy Prop^csed RTE KglxI ficind in the4linwiq 4ections of;hc Food Code and 105 CXIR Remainim',Unrileed Portions of ficof 2 003 Roast"r 23 Managenent and Per sonnel ------- 1=8 Proper Cooling of PHFs 2R d Food and Foccl-Prolectly, FG 3 .004 25- I Ecicilpn+ant and itensils FC-4 005 3-S{11.l4(A) Cwfiag Cooked PHF's 6m 1-4ff to ---- 26, 1 FC-5 i 'U'f;Within 2 flour- and From 70'r 27 PhliGical Facil'i F('-- 007 -iflink 4 f four. Lo 4 1 1-74Y F W, Poisonous or Toxic t FC-7 S)1.14(B)i Cooluig PHFr Made Front Arnbicut 1 Special R,3 wrerflerric Temperawre brzrcdreisg to 41'1,/45F L36 3 the IV,111 ill the fOdfflll 1999Foix3 C,Ae,r 1OCN-11090600. CITY OF SALEM Y , h BOARD OF HEALTH / Establishment Name: -&C,) _C a+e r Co- Date: Ir�'I I IO$ Page: of t ?Item ;Code c=CrRicaItem i� g 's DESCRIPTION OF.VIOLATION/ PLAN OF CORRECTION " d ° �'"x Date . I' h F s, � Verified ° NO. Reiefence R-Red Item -'PLEASE PRINT CLEARLY ^'' «<&(Ai VOY) C7-Q0A y,I taivrt YecQ vel v -Cl.rz 't� �L �� { Fact `2C, (_AA\IlVln, t Vt2 cIr1114Jnzsler raps (1/I } InCC I -)h fLKY C .)HC1CrC -ir . - 1 �Irc>fr-xf4 ;,n5 VN i . i� l/ c`i 4(Z'rip 4 i I I } I Discussion With Person in Charge: Corrective Action Required: ❑ No ❑ Yes f 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 otwentw five dollars or suspension/revocation of ❑ Embargo ❑ Emergency Closure your foo(�permit. \1 • �T�W �I 1 \ l ❑ Voluntary Disposal ❑ Other: .a +- PIfFs_ReUived at Temwr_11eUW`s`_ Violations Related to Foodborne illness interventions and Risk Acemolifo,to Law Caned to Factors{{tents 1-22) (Cont) 4FF/4f`1 Within 4 Hows, r PROTECTION FROM CHEMICALS 3-501A5 or Ig PHF Hot and Cold Holding lA Food or Color Additives 350I.16(13) cold PUTS Maintained at of beIou 720212 Addtn,c, 590004(1`) 41`'/45°J 3-30114 Parusailon fLS romL2al �_ _F Poisonous or Toxic Substances 3-510 ir�t—PHfi,l47iunFdaedt o,above _w � J(H 11 Idenotyingintomwoln- tigntal '4( F. Cniitaxner .501 16iA) Roasts Held at or above 130"F, 7-102,01 CoTime as a Public Health Control xlamorrNanoe� �Arork Ti a Public flealth CorntroV 3501 _19 —7j- So sonnet-Slon� 7-' At i-20111 Rests icnon -Prcscnco:and Usoi* 590'1 lffi) Variance 7-202.12 condid(ZI f�Use - Toxic Colnairall� REQUIREMENTS FOR HIGHLY SUSCEPTIBLE /-203 t I F_T POPULA IONS HSP) r-204.1 —sallilizers,—Crile ria-clicolic—als� 21 3_80 1,11(A) Uniniqleurizos!flre-pacl:kged Joices and 71 ti �21)4,12 ("litolial -204 14 hrf 7 ()4 14 IL -i( li� fisc 011 P�a leu'17�d L 7_205.11 Incidental Fl,ld Comact,Luhrj<amts'` - IL �_ t-801.11(0) Rziwor Paruah,,Crioko.d Auntud Food and L"-_200 Rs�iiict�d Uw Pe nudes-Cntekia* kawSd Sprouts INot Sti'ved. Rodent Bait slatlr,lls� 7-206.12 lT_("__1_�—___ f rt��_scrved 1 -061 Tracking Powders, Pool Control and L Mrromrjn�� CONSUMER ADVISORY 22 3 IF '011iaaoPoer Advison Posr�,d for Consumption of TIME/TEMPERATURE CONTROLS Ztool f,�,,o&'that are Raw, Unaurrcookcd or Proper Cooking Temperatures for— PHFs Not Othorm isc Precr ssc.d to 11 Inlinate 3-x401.11 Sf 11(2) Ettlps- 155,F 15 rxhate.rierviuc 14.501`15,wl lli_"teun:rd ";5rifluil 71 cl'w sbe�7 Comminuted Fish, ivleats&(Ain{ sec_ SPECIAL REQUIREMENTS -40LI l(I3)0)(2) Pork and Bt-cf koast - OiltF121 noin- catering. rnobilc.toxxi,temporary and 59010091 i)-(D) Violations of Se,1non 590.009(A)-(D) in 3-40 1.11(A)(") Ra rtes lttju� d kivats- '15's F 15 461 11(A)( Pouhrq, Wild(liarne,$tuffed PI-IFs' rcmdenliai kitchen operations should fool Sitjffjrnz Containing Fish, Meat, johited under the ippropriate sections alrove if Jated to lbodborne I 11noss 101 H(C)(3) WhoIle-mu-cAe. hailli HeJ Storolks interventions and risk factors, Other -1451;* 5140,009 violations relsain to eon] retail 111 Raw Anirnal F(lildr Cooked in a practices shosild he debited under 7129 - Miclowil" 1051:* ------4 SP("Cjal Rquircluents, All Officy PHF� - 1451 17 Reheating for Hot Holding W VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 34011](A)&(1)) 1`14FS 1(5°F l5c, (Retais 23.30) 1-40111(B) Microwave-169°r 2 lrllolute Standing Ct ivrai f2od non-croical n-hirlo do no; rebate to Ilse Time" ,foodborne illness unei ventionv and nskjacrorr listed above can be 3- 63.1 Conanexcially Piocesso.d RIE.Food finind in theftWou-mg e(fionx of so,Food Cade and Jo5 CMR 3-417311{E) Resnamirn, Unshoed Poruvris ofTicef 5.90000 Ts oasts 23, f - an -mand personnel FG 2 1003 Proper Cooling of PHFs X24, Frc)d rid road Proltv.tiori FC- 3 1 '004 ?bEn�uipnu>iti and tltarisrs FG 4 _605 -{ 3-501,140) Cololina Col&,oi PHFs from l4ff to 26, Waux'Rhurri I FC-5 1 Xx5 ba 701P Within 2 flours,sad From 701" 2T I Physsiral Facility FC Z G �007 Lo 4 1"F/45'F Within 4 Homs. 28 wecraS us or To4c Mater Is '008 501 1403) Cooling PHFc Mado Foam Amilicnit 29, P jyirer"' an Doll Temperature Ingrediclas u,41'F/45CF Within 4 lfours Per"tes Critical item ill m, 19,99 Rlod C'Kie.a"105(11".1k,590 00(l, Massachusetts Department of Public Health Salem Board of Health 120 Washington Sreet, Division of Food and Drugs Salem, MA 01970-t35234" Floor FOOD ESTABLISHMENT INSPECTION REPORT Co Tel (978) 741-1800 Fax(978) 745-0343 Name I Dater Type of Operations) Type of Inspection r1, f I W'Food Service Routine Address ` 1A 11 Risk LJRetail (❑ Re-inspection Level ❑ Residential Kitchen Previous Inspection Telephone /f ElMobile Date: -a/J Owner ' ' HACCP YM El Temporary ElPre-operation ❑ Caterer ❑ Suspect Illness Person in Charge IC) Time ❑ Bed&Breakfast ❑ General Complaint In: [IHACCP Inspector Out -a 4 Permit No. El Other i s Each violation heck d requires an explanation on the narrative pages)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 4, ❑ 12. Prevention of Contamination from Hands ❑ 1 PIC Assigned/Knowledgeable/Duties ❑ 13 Handwash Facilities y EMPLOYEE HEALTH PROTECTION FROM CHEMICALSIIP1 2. Reporting of iiseases by Food Employee and PIC •®w,• ��m ,. . ❑ 14.Approved Food or Color Additives ❑ 3. Personnel with Infections Restricted/Excluded X15.Toxic Chemicals FOOD FROM APPROVED SOURCE" ❑ 4. Food and Water from Approved Source ' 1mErrEMPERATURE CONTROLS(Pootentlally Hazardous Foods) � t Z5. Receiving/Condition ❑ 16.Cooking Temperatures ❑ 6. Tags/Records/Accuracy of Ingredient Statements ❑ 17. Reheating ❑ 7. Conformance with Approved Procedures/HACCP Plans ❑ 18. Cooling 4 - ma >1119. Hot and Cold Holding PROTECTION FROM CONTAMiNAT10N � �i � � ❑ 8 Separation/Segregation/Protection ❑20.Time As a Public Health Control a ❑ 9. Food Contact Surfaces Cleaning and Sanitizing )....REQU]REMENTS FOR LYSUSCE(?1' HIOHIBLE.PQPULATIONS[HSP)- ❑21. Food and Food Preparation for HSP ❑ 10. Proper Adequate Handwashing ❑ 11. Good Hygienic Practices $`CONSUMERADVISORv„„:dW a ❑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)(590.0 order of the Board of Health. Failure to correct violations 24. Food and Food Protection (FC-3)(990.0044))) 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)(51,.,,8) 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: qp 7 S:5901nVwtFom 14,tl n Inspector's Signature: / Print: PIC's Signature: A /f Print: I 6 �`luJ1_ f Page of� Pages +' 7 f - t Violations Related to Foodborne Illness Interventions and Risk Factors(items 1-22) PROTECTION FROM CONTAMINATION FOOD PROTECTION MANAGEMENT 8 Cross-contamination 1 590.003(A) Assignmentof Responsibility* 3-302.11(A)(]) Raw Animal Foods Separated frrnn 590.003(B) 1 Demonstration of Knowledge* Cooked and RTE Foals* - 2-103.11. Person in char e-duties Contamination from Raw Ingredients 3-302.11(A)(2) Raw Aminal Foods Separated from Each EMPLOYEE HEALTH Other- 2 590.003(C) Responsibility of the person in charge to Contamination from the Environment require reporting by food employees and 3-302A I(I Food Protection* applicants* 3-302.15 --Washuig Fruits and Vegetables 590.003(F) Responsibility Of A Food Employee Or.An 3-304.11 Food Contac'with Equipment and Applicant'fo Report To The Person In Utensils* Charge* Contamination from the Consumer 590.003(G) Reporting by Person in Charge* 3-306.14(A)(B) Returned Food and Reservice of Food* _ 3 590.003(D) Exclusions and Restrictions* - Disposition of Adulterated or Contaminated - '� - 590.003(E) Removal of Exclusions and Restrictions Food 3-701.11 Discarding or Reconditioning Unsafe FOOD FROM APPROVED SOURCE Food' g 4 Food and Water From Regulated Sources FT Food Contact Surfaces 590.004(A-B) Compliance with Food Law* 4-501.111 Manual Warewashing-Hot Water 3-201.12 Food in a Hermetically Sealed Container* Sanitization Tem eratures* - - - 3-201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Warewashina Hot Water 3-202.13 Shell Eggs* Sanitization Temperatures* 3-202.14 4-501.114 Chemical Sanitization-temp.,pH, 3-202.16 Ice Made From Potable Drinking Water* concentration and hardness. lk 5-101.11 Drinking Water from an Approved System* 4-601.11(A) Equipment Food Contact Surfaces and 590.006(A) Bottled Drinkin Rater* Utensils Clean* 590.006(8) I Water Meets Standards in 310 CMR 22.0-` 4-602.11 Cleaning Frequency of Equipment Food- Contact Surfaces and Utensils* 5he/illsh and Fish From an Approved Source 4-702.11 Frequency of Sanitization of Utensils and 3-20L14 Fish and Recreationally Caught Molluscan Food Contact Surfaces of Equipment', Shellfish* 4-703.11 Methods of Sanitization-HotWaterand 3-201.15 Molluscan Shellfish from NSSP Iisted Chemical* Sources* 10 Proper,Adequate Handwashing Game and Wild Mushrooms Approved by Regulatory Authority 2-301.11 Clean Condition-Hands and Amts" 3-202.18 Shellstock Identification Present* 2-301.1.2 Cleanin*Procedure* 590.004(C) Wild Mushrooms* 2-301.14 1 When to Wash* 3-201..17 Game Animals* it Good Hygienic Practices g Receiving/Condition 2401.11 Eating,Drinking or Using Tobacco* 3-202.11 PHFs Received at Proper Temperatures* 2-401-1.2 Discharges From the Eyes,Nose and 3-202.1.5 Package Integrity* Mouth* 3-101.11. Food Safe and Unadulterated* 3-301.12 Preventing Contamination When Tasting* 6 TagsfRecords:Sheilstock 12 - Prevention of Contamination from Hands 3-202.18 Shellstock Identification* 590.004(E) Preventing Contamination from 3-203.12 Shellstoek Identification Maintained* Em to ees* Tags/Records:Fish Products 13 Handwash Facilities 3402.11 Parasite Destruction* Conveniently Located and Accessible 5-203.11 Numbers and Ca acities* of Ing 3-402.12 Records, and Retention* 5-204,1.1. Location and Placement* 590.004(7) Labeling of Ingredients* 7 Conformance with Approved Procedures 5-205.11 Accessibility,Operation and Maintenance /HACCP Plans Supplied with Soap and Hand Drying 3-502.11 Specialized Processing Methods* Devices 3-502.12 Reduced oxyj4enpackattirrg.criteria* 6-301..11 HalldwashinE Cleanser,Availability 8-103.12 Conformance with A roved Procedures* 6-301.12 Hand D -n*Provision *Denotes critical item in the Federal 1999 Food Code or 105 CMR 590.000. C� r CITY OF SALEM Y Its BOARD OF HEALTH Establishment Name: 1- � ro y} r !� Date: � _ Page:-�– of 1 Item Code C—,Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION « � X 4, Date No Reference R Red item" y' .� '& ' ¢' ' �a -*x -^`` '� �' '``. * Venfied�i x .e y'�„a r.`+;x..''A r PLEPSE PRINT CtEARLYs",u fr u., c � �k G�„ ,,,�� C-) ch, r I� It -lC Q C ross I,J4 K—t, cam( 111D-e aLi ' u c Z os : ✓� .) /��t Its L � C�0,12 ( rf r -- 1 L / V1 V7 lQ r ,e– I l/ I J` .-�iM r- 7 j Discussion With Person in Charge: f , S 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 i 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 lnoncompliance may result in daily fines of twe vyy-five dollars or s spension/revocation of ❑ Embargo L] Emergency Closure your food permit. { ❑ Voluntary Disposal ❑ Other: M �r� —� I t ` ' { 4( Violations Related to Foodborne,illness Interventions and Risk Acewding to Low Ccx)led to Factors(Ifolits,1-22) (Cont) 31TV45F Within 4 Hows, 501,15 OxAing Methods for PRFs PROTECTION FROM CHEMICALS PHF Hot d Cold He 1=4 Foodor Color Additives Lj_9 anIding 3-301-36(B) Coh!,PHFs Maintained at or below 3-202,12 Additive, 590.004(F) 3-302,14 Prowcooll front Una) roved Aidditivss" Poisonous or Toxic Substances Wk) I lot PI-ill's or above LL�_--- ±140'F, :--t tme ing.alftsination -On nuf, lor�., ;_501 16(A) Roasts H(d at or above 130017, L-20 Time as a Public Health Control 7 102,11 CointuonName--WorLin �oai tin rs" T261'I I W.19 Tim,_ae a Public Health com scion Ec 7-202.11 Restriction-pf"stace arill Use* Variance R t_1 atur�ov�llt 7-202-12 Conditions crf T.lsv REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-203,11 _Toxic("out tinea, Prohibi!torcs* POPULATIONS(HS 7-204.11 samtizers,Criteria -choaiuls 21 1-801A I(A) Pre-packaged Joicts arid 7-204,12 ClrenlicaL�for WasNLS-Lf�L'shcc;cntelia� i 14 Criterial, -1-205,11 Incidental 1,-(Xvj Contact, 80 1 11(13�_ Ul�c of PasteukiL7�ed�l_, idearns' t� ?206.(1GPettiides,criteml* t01 11(D) Raw or partially Ctxlked Animal Rxid awid Raw S"Zd S rants Not S��lycd. 7-'06.E R�slejn Bait�iations 7-106 13 Tracking Powders,P-,Si Control and Nj( milothla, CONSUMER ADVISORY 22 3-0W.Il Colpunwr Atjyjsery Posted lot cmistirliption of TIMEITEMPERATURE CONTROLS ,sqimA F,N�ds I'lial.are R:iw, tynderkxloked or Proper Conking Tomperatutes for Othcrwise PRwcssed to Oinina,ac PHFs dot 3401 3I A(I1(2i Fgg1,55'F 15 S,,c. U311 PzuruA Egg,SLibstituiv foe Raw Shell_3 zo 02. O,� L I I(_M(i i Aitimais - 155'T 1sec SPECIAL REOUIREMENTS sw), and beclFR(Risl 1:10'f' 12! rAn, — 590 fy)(xi%) or sectio', Raritc�,lnjeoc4 %Iciits- 155 3F 15 catering, mobil,,: kxxitemporary and till I remde "it kitchen operaflrtlls,�l ould he Sniffing Corrainim, Fish,tviela, debited under tile appropriate sections L bove if related to foodborne ilhws.s .3 407 11 fA)1�7) _LoilLtr�-or Rallies-165"T'1 Ssec. i-401.11((7)(33 Wh,)lemundu, Inwo Becf Sicaks interventions and risk faclors. Odwx r 1459; 590.009 violatiooq relaiin, to gokxJ r0haj 1 I 3-40TJ2 Raw Arornal Foods Cooktil in a pactices should be debiteduaider #29 - Nficgowavc 16x'F 4pe(,ial Requirements. 1 All Ottver PIIF[ 1451: 15 w,. 17 Reheating for Hot Holding VIOLATIONS RELATED TO GOOD RETAIL PRACTICES OTI I f Pflf, 165"F 15 sec, (steres 23-30) ; 40311(g) z,,0w8N"- 165"P2,kiinule Standing Clitiew and non-(Ilowal do nol relare to tiw Time" f(wdiporne illnes,s o1cWVCn1',los and rUja(lors liwedabtile, (an be 3-403.1 I(C) Pfccesscd RTE Focid- fiflund in the,jot'')i,akqsecnions of Ac,Food Code curd 105 C,14R 14011F90,0(4 340! 11(F) RemtenniLos ,,7i7w ciZsor"lcei hort ocad Roan!Practices T FC 590 0tt0 Roams* [IR .1 and Per FC -2 A— Wla9f__1!i1_— ------------ Proper C;Z51n—g at PHFs Food and Food Prolecti0o, 3 004 ry 25 E uip�ls, FC-74 005 L _,und 19 OxAial,Cookisi PHFs from 140-F to I- -- - t�LnL ,_2q, FC-5 70017 Within 2 lloufs and From 70"F 27 Phwcal racittv to4Fi45'FWifhjn4fk)um. 1 h1_51— P 101, 14(W (7ooling PHFs Made Nom Arnbwal l i 29 ; S ELKIqyementF, r -,-- Tempc(aaac lmyedienrs to 41°F/45F 30.... Within 4 Hairs` Dcnotoc critical item in the 1,040 al 199k3 lloml(")&or 105 Calk 591}CWN', CITY OF SALEM — 9 / BOARD OF HEALTH t� r�01 r Establishment Name: ��ywq-1r � Date: A'=- Page: ofCC7 itemt, Code C-Critical Item � '1 n DESCRIPTION OF VIOLATION/ PLAN OF CORRECTION 8 = Date No. Reference R-Red Item Verified, P 6is!F PRINT CLEARLr 1 - '1G t c v l flo ?c of Jr,-4-)r A r , r rT in V14 �A, j2 e d -4v Le 1 f i , 04 , 4 Ak5) -- Y nS /1 Discussion With Person in Charge: Corrective Action Required: ❑ No 4 or!Yes f 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 \^ Emersion P .� iR s ❑pection Scheduled Emergency Suspension comply with all mandates of the Mass/Federal Food Code. I understand that CCCrrr -noncompliance may result in daily fines of t linty-five dollars o suspension/revocation of LlEmbargo ❑ Emergency Closure your food permit. �� ❑ Voluntary Disposal ❑ Other: iz((.) Ptifs>h-utied at 7-ar+aptritnres Motet€ons Related to Foodborne illness Interventions and Risk E Sc tirding to Lau Cwl,-d to 91 Factors(items 1.22) (Cant) Fi45 6 tttstl}m�3 HotiaS. PROTECTION FROM CHEMICALS �C HF K&i thCol far PUPS l" _ ._......v.._._._........... �14 � fsNf Hat and Gold t3ss6t9tng —...�.� Food or Cafar Addissves i 'L 14 _ �I "3 50! 76ffri C r i I PN}s Maintained at or below (E 2 _L A(kut nes P � ( 5W.'X)4 ti 404t i _ 3-302,14 Psomionfrominaxro`z9c'��iditatie.ti._._._.,I � 2.>nl INA) IfrtPHs '�fauttai3aedutwr=it+ova €sonous or Toxic Substances il� _.. °4C i lOt.l t ( fCP nU�4tiig fzifour,t on-F3i�e,m u � � 3.1C�d f hl la � �'a-els tfeEd �air a� e kat#°[�� f"<>ntnsnc:e,- Time as a Public Health Control r... .._._-_ -i- _ -' F f ! Common Nance W cidun,L rur itsr r,' i ------f-- _____�._ i > IiM tl I "ssn.. a,a PublicHeaktlt f`orseroi^ 72�011 to ,L,�P! i auvn Stora r }j pp rt } inttanc Ru urr�'Inew r. ts`a.Il ( t2t4nc6on-Prca.cns,aad,tw__._._�.�._ _�...._... _......t-_.._..__�.._. ...__ .----1 r7 )2.12 C`onditirnss of t sQ REQUIREMENTS FOR HIG14LY SUSSCEPTIELE t ?i'f3 t fl I`vst C asst nzr prola be esus+ POPULATICYNSHS(__P nta4.a'11 Sanitveis Criteria Chunicijs s1 tetn:LrdPrctasxagcdjuiotsand .,._ ....._� "a 'a34t" t.heastts aE�;for`h+qhs _,.... _ - L----� ! f3c�rt nzte runh Y+ itnntg f skr.,Is 7164,44 !!,Naas 9asuta Lcuisi IlS.f� Incidental Fxxl4untactLAN ie.amts td UP .....-._.. � 5.{ttal.(1t13} r2 auerYaii�3taLuakc.f -�itnaEFc>odzsatd '4th.s f kc a ttese t aadeti_t n€etr t�� rt m d Sprouts 'pct Sertic d ' i _..,_..,_. 7-21% 12 Rak,nt Bait 4r inims t w tied Ncxxd Pack3g4• 'Vnt R� ,una.S, 7-206.13 Tr 06.13 aclKivu; +ral4i .P,'m Control and �..__�_.._..._..-. -..._ i gvnito tin _ _ CONSUMER ADVISORY _ _ 3 Pa 11 i Csvooinasuiami tut semAd.s scrs sPeor slt2 A,f,oLr'nao,e.rmuwxiifpeudons cof TIMEMPE ATURE CONTROLS thn Proper Cookin Tem oatues far 3dieis est sinnee 1 3-401 1 1'1(l t(2) Fib: 1 55 F 15 S t Pasfxr Tns _ z.3t," ! z f�csr aas S7.ba 4.it^st�rufr fe Eiau 41s-1 � __ _ 1 g��r Isati utt aec..5.�iu t S5 t'35se� ff X461 r,(A)(2 Cumrninmed Fon, Meats d. Game. Anni+ate 155"F f.- se SPECIAL REQUIREMENTS 4t11 k `t3 (I l Peak and Beet Roast 130'F 12i rnin* • ) I Ssit0E3ckt�i aT}a i R€I ) nfineitctt'recti€n 59f3(Yi' Ee 1-(i a;rrt 3 4111 itAt{<} i H+tiles li Rc' ❑ LlceFs ( F 15 d II 1 ceft ring. tn,!tsfe itxrcf tet*rp irar autd � `-- r, t`caulent,af knchea oc:atirinw shoald be, 1 3 401 11tA}t3j f ouitry,W 0d same, Stu1 ed MT s, �Fidtug Omt attuat,Fish Meat, tichi d urm}or*tit appropriz tc section,, Pouf(rauskat, csd05115seo " _ 1 alxAc if r.�,hiied to ftlodi-A)"flC ibnoss >-A6i 1 tCtf3j Pate nivacSe s.aca hcc# [eakR kwerw Yiras a-id 11v factorl Other 45 ) x 90.009 violattci s retutin(� to rood.ictal s -401.12 Ban,Animal i asci Co, cd in a_..__ � w coces hould tv,debitczi under>r 29- 14acu9suast 16,5`F* i S>e�iat ICe aretrs.;tt2's. � ',-kfji.lits5)(1)tbt 'U, (Xtier t'ifFS -14c5 15 sec.�, :_......�...� �..(�.._____,_.��._.... ._.._....i S r } heating for Not Holding VIOLATIONS RELATED 7Q GOOD RETAX PRACTICES i 103.11 I A)&t13e Iliff` d6° f 15 wc," (Itenri 23-301) i dt);r.1,1 f,Bj Uiics'awate f6y. F 2 Atnau e Standing 1 {'Y ri:r of and rra r rriin czr s re air-stn xrrr€F dv r ra rarer to inm y.- fin ea1 tnodhorn< +tAxss iMei untiaiirs id ri i,,t'r ws 1 W <f 'rhorle om Lc f >463 1 l(C'? L<ims'xrresafly Pec,::c.cd R11.Fa`x'xt ,uunad of sf e fol >iu ib ri r�i t;`the nc+ud Code ruarr Ifa'�t Lok taxi' 9 ci �` ftsrn Gaod Rtttart aracirccs ,_.,�FC5901160 3-40:§ I!((t} Resp iinin�,t.nshced C*orMaiis of,i3eef _._. _ Ftoast�* 21 lt-n„4artac?n ne t nrstl F'�r �r x i L,FG00' 3 ?& f.x3d 3 d Fait Pro4Frt3on Ft, 3 x.:404 [g i Proper Cooling of PNFs ! I a _..LEgt i,amzsi arncY Uiesi s_. ... FC` 4 .3-501.f4(A) tafdugt xwk:dPHF°sfiom 140'Tt'a 2S �Vlaer.Pitt sgmGiN se FC 5 ��QOb { 7,0"F Within 2 Hours and From 74`F �L �Fh,mss�= Pa,.hty �C ` pearrts o Inwoatei'ai: rG I 40841 1I4w 3-'63.14tiil fooling VHF `,dodo From Ambietti ! e, n opr^4.iat t2'=ci.i Te sntwamre fu r-dic utw to 4YT145T 30 -- hr' _ ... .. ._.� ._..-__...._ _.,. ._, .__,i... ........Wi Witfizts�' Ilcxzr. . �. 3 ...,,.a,z ;.rilieaf Bell.is ih, t jural. 19'74 4 o,xi C,c yr 10 CNW 54;9 DiX, r i CITY OF SALEM Establishment Name: �JT1I '�7L' BOARD OF HEALTH l�lal(v // C Date: 1Pager of S� Item Code: 59 ;c-Critical Item p DESCRIPTION OF VIOLATION/PLAN OF CORRECTION' 0;; Date � , w No "Reference'' R=Red Item " . .�;; `� .v f,,^^ - �� +I- > Verified _ k`. %a ` ' PLEASE PRINT CLEARLY'''"' � f 64 C S �W>� �nl ,� K, C no- /A/ ase/ 09 * G non s-ArA Ll- uw O qr 9-- j lc en e ( c/P..) bw�w J22k43v-ems W1 Inc fes}- v5 c- Ve �( i�1� \KJs�N C c?I- Glr�vvi UI��. line CrUcLo Cep tit- de o L - CC#,(-e4P c r«C(, d >_, a >! S o ,v 64- c. QIQ�- CJf��P„✓*rlti '. 32�s �( r� 4( G�tl�t GOrcFfai( r �(1� ,4od 0�7 4- [oSY -I' U4t�l- In C-taf kYTb1a7I(_d_? v, 4 'Ri M (k//i1 S v/> c I�(2}.gU J G � `��_ 11 G I UAAM_ of /1,D/e(/ (n 4,, � �: C�✓r, F✓1 S,"?�cn-7ibs-t Y< `� �- rNr�� iJo„? ��h-� � �Q� �v✓ � d cin WL S G{' Cly c, t,/Y�s�o(F 4” 4t*-v -:i'R L Discussion With Person in Charge: � � San. ii z S t o� �'�cCij 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 l noncompliance may result in daily fines of tw my-five dollars or/s�u,/spension/revocation of LI Embargo ❑ Emergency Closure your food permit. �(� r� �/ ❑ Voluntary Disposal ❑ Other: �_ c 7 Reorlr,ca at-Fmrl;e,-;w—res � Violations Related to Foodborne fitness Intementions,and RAsk According to Larv� Cooled of Factors(items 1-22) (Cont) PROTECTION FROM CHEMICALS _LxLlm,Nl,�fh ,for 14- Food or Color Additives AHF Hot and Cold Fielding 3-202,12 3-501 16(Bi Cold PHFs Mainukined at or below 590 0(9(F} 3-,'M2.14 Prowcii on from UnA2�Led Add it kve q 4iV450 F, LL5-- Poisonous Substancesh(A) Hol PHF�MDmorinedat of above 1401. I I O J A I Now fying Info)ni'lli off--06,;,j Dal I Colnauufrs� 3-501,M(A) R(KlMs lie Ida[or abuse 130'F, I L102 it Confroon Name - Workjr,� onoull rs* L20 Time as a Pubfie HealthControl Torr:as a Ndic I lealth=Control' 7 V�riancrl'Zeomrement -20111 Restricooll-Pr, and I e- -Fairfidom of rJse �2--L)2 12 7 20311 Toxic Fb,-Italvlo —pfohfbuions* REQUIREMENTS FOR HIGHLY SUSCEPTIBLE J 201.'I Sanu,7,;rs,Crilt,,rul POPULATIONS(HS 7-2DZQ ftnjajs heAliho 1 3-S(! 1 I(A) Unpmeurizcd Pre-pa raged JuILZ a,T-- 7 204vith t arras -Fab is' �14 DrAn, Az nt�.C,rirevix� Bevf�otfvef; Dann Ae" 1-205.17 8@4 19(1#1- 4--L�of—Palwulllerl 11�a � hwid,nial r.,NxI Contact,Labiwarnvf D. �'nal F'XI C uk 1, -801 11(D) Roxor Ploualiv Cooktd Animal Ford and -205..! ReNls i u -d U�v Pvlquade� Cri te k ra 7 7-206.1� Rodeln B"a sraiom* Not Served Llw tie ecj��)n lat,�, . 7-206-f 3 Trickmg Control and morn - CONSUMER ADVISORY TIMEfTEMPERATURE CONTROLS 22 3-60' 11 Coneuomr An%oory Isysted ii)r Cowulniltion of-I Proper Cooking Temperatures for-- Am mM F,,clds Putt are Raw, undercooked of N' PHFS ol(Ahs lwilw Processed to p1hrunale —- � 3-401.230(11{"z) Patterns Egg�;- 155,F, 15 StC. kis-lirrmuli in vicc 1 591 5sec� Mmellnicli suh+litwr to! Raw Shell 40ITI(Ah") Colinninated Fi,,b—Meats tx.Ganiv 3-401.11(H)k I)f2) Pork and Beei Riva 13Y01' 12i arin* SPECIAL REQUIREMENTS Rauics, 7��FDTT ViQldt'Oo,�Of Sec Clico 590XX)9fA)-( "in hvjwcd N[vats - 155 15 catering. rnohil(�ftYxL tefriputary and 3-401.11(A)(3) Prrultrv,Wild 6arne,Sulfred PKFs, i resident deml kitchen be "iioifluit."Comaudokg Fish,Meal, debited folder the appropriate iection& _L)oft,�r ltahw, j 65°F 15 s,c. drove if related it)fixAbornc i Ill,c&s 3-401JJff7Y3) interventions and risk Inctors, 0ibff 590.009 violations relatin�to 000d retail iacticeshould be debited under 1129 - Nfictowaw 1651' Spl,cml Requircrtlotits- -3461 11(A)tlahj All(hheiPHFf 1451E 15 Sec.. ' I I 17 Reheating for Hof HoTd—mg— VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 15osC, A (items 23-301 3-403.11(B) Microwave- 105'F,3 klunfle standing Crizical awl non-crulcal vioicawns, whicitz do nor elate fo rise Tune" frvelbi'me duress infer vention;and risk factors hofklabove, (on be 3-403.11(C) Comm erciativ Procrlsscd RTE Food filgend in aecfionv or fire foad Code and 105 CAIR 590.OW. 3-463.13(E) Run tering UnOwe(t Portions ol`T,cei ttern 1 1-.1--l-,,---------,------�—,-- ------------ ppp Row", -23� i Mona niKlalandm Per 1 FC �2--4A 24, i Food and Food Proirr�joo 3 i 004 1=8 Proper Cooling of PHF -a6,-, FO-,4 005 ..... __q CoofinR Cookod PHF',s rom I )'F t ---------- E yipmr Ltalivterl�L15 501 Ti(A) 2f 2u, i worst,Pfurnbm(Lfou 70-f;W'nion 2 Flours and Frola 70"T, .......y5eal T FC-6 007 Poi sl�us or Tom Materials FC-7 OOS —14(b—) — Co.ohng,PI-fFs Made Froln Ambient 241, R�qulrenfsr*, 009 from 140��ro, Id F Temperature Injorecinnas to 411,/45` -3 F Other Within 110111`0 Denotes ailvaa It"I ill the titik,si 1449 Foml C,Ae(x 105 ClAk 590 00o CITY OF SALEM BOARD OF HEALTHr��al�oy' � Establishment Name: L_�� U)4-Lu �c I� Date !'D 4=' Page: Of Item Code, C Critical Item „a tDESCRIPTION OF VIOLATION/PLAN OF CORRECTION ` Date -£ No Reference v R Red Item ` ,� ,r ;,• , -s�-� , -. ,.n y - z a - a't Verified - .w,.,,1t„ f 7 ,'„ _. t%, "`rs: &. ..• kEASEPRYNV CLEARLY- A, r5__ P �� f �,_CI �� Gc/1 l� B^ S Al, 44 -S ICS. CC � - F �Jt :l)rA c i iz PCftr I 1!Y /1 \iTC Dlit < cto (L&i efefnd1� . ! y✓wrl r SY o /K Yid _)P = r , /� ieli 56 l_-A_:,0" k�r)L,4 J, -n�tJ �/Q C -h v. AA. S N ofJ KP C�L'/ lr7 I+ rC �� IfcL /lxr7grl1 LjP -7,pJ-, cJ uA � i I 1l1 P9g4fwJ'b hLY " Z4 l cTn �4f� Discussion With Person in Charge: Corrective Action Required: ❑ No Cl❑ Voluntary Compliance ❑ Employee Restriction/ Yes F f I have read this report, have had the opportunity to ask questions and agree to correct all Exclusion } violations before the next inspection, to observe all conditions as described, and to El 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 oft wenty-five dollars or suspension/revocation of ❑ Embargo ❑ Emergency Closure {{11 your food permit. I/ J ❑ Voluntary Disposal ❑ Other: pfR,s Received at Temperalures Violations Related to Foodborne Iffness Interventions and Risk AixnTding to Lair Cooled u) Factors(Iterrils,1-22) (Cont) 2f 1145'F Within 4 Riau s 54'j -- ' , Cordite,Imet-hod&Por PflFs PROTECTION FROM CHEMICALS l,,-31-- -------� Food or Color Additives PHF M and Wd Holding L-14-- ---- 1 5�)1 OB) C old PHFs Maintained at or below ^ �201 12 Ackbdrval� 590,0041", 410/45�1 3-30114 Pitactlion train Substances Kit PHFs Maintained at or above L LSL Poisonous or Toxic, 140'F,* -7-101 Resists field at or above 130Ji. i 20 Time as a Public Health Control : 7-102.11 Cerramon Name - W�orlking Covain'1,* =, --- 7 201-11 Sega la bell sh) I :�T:i1jn�:a as a Public 1 foal I h Cont to, - ap 1 I,-a , 7-20111 Retvic6orl-Prescilcr and UltlV."anct Pe arrenzent� 7-202.12 Condition,of USQ, REOUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-163 H Toxic POPULATIONS(H 7-204.11 Sannizets,Criteria chcodcafs' 7-204.12 Chcjldcrd.�fill 1 1 21 -801 1 IT Unpa,aeurized Pte-parkaged Allots and 7— — - -- -' I Revcr"cs with W 7-?04 T�4 �rrhtA�nt, Criv�rial —n� h �-S(li llffll of Paqcaniaed Falls' 7-205,11 Incidlintal Femid Contact,IAmncants" Raw orPutiadl 0 s�k al AM In a I F00d W)d 7-206AT-��R,Z Man use Tic—Itic'-de.,Tri—tel le-* �- +c Pc 7-206.1-2 RodianB R to Scrd Sprouti Not Selrvcd. - ait stalitsc� -,-L------t-v Un farted h'! k a" hot R e 8'��c d 206,11 Tucking fo,%doci, Control and ��e "Rnn CONSUMER ADVISORY 2" y fiosaej for Centiouiption 01 I6 � Proper TIMErrEMPERATURE CONTROLS Anirntl 1�-�&Thai are Raw. LndLT"x)ked ia Cooking Temperatures for Not Oth,-m ise flacessed to Flicninate PHFs 401.11 Alt 1( j Fggr. 155 T' 15 Sel,'. ,('113 Pastenrizzd Substitute lor Rtats,Shell Flan- - Anneals- I�5"F i�sec. ' SPECIAL REQUIREMENTS 73,4�-11 1(B]a 1)(2) Ptak and 13�,et Rtmkt I'0'f 121 min* i-4hLlV0Q" Rollie, In.e I ctcd I I c. -I-s-1 1�5 F 15 -5 9_0-0 0-9 FIVT—(D l4ailoos ca'Sectitan 1)0.0159(A)-(D)in J % * ' catcring. mobil c food,temporary and I(A)(3) porthrN,Rhdd Game,-ST led-P-FFs, rcmdeuiLal UtchQn operations vhrruld lie sloffolti-Cont mink Fish, Steal, i debit under the appropriate ,eclectns Poultry or Rattles-165"F iS sec. above,if ichued fit ftx)dhorrw illness 3-401.1 JiC)(3; Whole manic. Intact 13,trf Steaks y itnervoodons and risk factors, Other 14.51' 590.00c; viidatiohrelating toilood retail 1-401A- Raw Aninou faeld (,caked in a— prachicesshoilld be debited under 1/29 - Microwave 16,5'F sp,cial Rekluit-crilcim" I(A)(i)(b) All Othei 1x18--5-- 1451 15 mc I loi� TIN J� S'qkLA-- Reheating for Not Holding TED TO GOOD RETAIL PRACTICES 349.1)(A)&,d)%i P141-7 1651lF ( wc. (Idents 23-30) 310"3.1,B) icroxavc- 165 F2 Milulw Seeadin, Criiewl ty,d reln-(roscril volkutont, i0nch do nnetate,fI yhr foodborne illwss inierlantiottv and rixkjacrvrs lived aht)ve' can be 'mohcj_c C'm 3403.7 I(C) -I '�'iwi' '11v Picessed RIF ood- found fit the fohnivoN sechons of hze Food Code and)05 CAIR C d 596.0(x2 3.403.11(E) Rennuning Unsliced Petitions of ficer I rn Good Retail Practices rc 59attoo 1 qqsrneni and Per onnel FG -'2 1 24, Fond andFooriW�t��W-n FC 368E �j Ig Proper Cooling of PHFs - 2 25 Eguipn enLccjd Uten ihi005 3 -SOL ThA) 0xil ing Cookcd PHI-',s frorn 14(}°F ul - 2f3, 1 let P111 qLTd'V:t�Le FC-5 1 006 ' water ' en"i 70"IT Within 2}Inure and From1011 T-Phyv,,--ai-F T- -1- acids FC-6 007 to.11'1,745 F Within 4 fiou,, 003 29 ocall Requiromenh, 14 13 f Coating PHFs Made From Ambient ------ Temperithale lnyccdientz fil,IPF/45T -�O, Other DMI'les critical Item is the le,lez'l 1999 Focla C'Ae at 10 5("IR Sift,000 r CITY OF SALEM / BOARD OF HEALTH (o IJJ j 1 Establishment Name: �vci�} Z. Civ Date: 1` Page: of S- eem Code- C-Critical Item U V '' `DESCRIPTION OF VIOLATION/PLAN OF CORRECTION =e..' Date No Reference• R-Red Item >- _ "` _"An r' Verified _ � PIEASE�PRINT CLEARL -N� -I n 3�� IS n1pQcLi -( I hZ o cC.'d, C1 c(ae -� r r/147,,d)'1 E J ChLIC, (c rid— 10.5,1V —�v c -acf )'1' 4rza ca-n ,4)t r- ckch 'L((Ao -r- 410 k � QQ t rvltCC eS ��S�MC I-�/ eClr / TlC 1� 1 E l(_)P7A4f t -- I� r , D 13�rs 911 cDzn Aa-an 7 �p �11fA..✓1 i n�/� � U , Discussion With Person in Charge: Corrective Action Required: Li V'rs I have read this report, have had the opportunity to as 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 t enty-five dollars or suspension/revocation of ❑ Embargo ❑ Emergency Closure your food permit. ` �(0 %�f�� i/ _ 1 r �" / / `� l ❑ Voluntary Disposal ❑ Other: } , �� / _ 5Oi tis C: Pubs Rev turd tt Cooled ttWrrs - Violations Refuted to Foodborne tffnass fnterventians and tusk � Accordin hCooled o f.au to Factors(Iteins 1.22) (Cont.) t ,r 1V45'IF Wrdn*r l How s. .* _ f 3 .,J1.t5 Car9mz41s.t,'ttxEs,orP¥{Fs PROTECTION FROM CHEMICALS 4 Food or Color Additives.._........_ ........__._..._ L!9— ' _ PHF Hat and Cold Holding � ' � — _._. g —� -202-12 kdthnv� k 3-501.16(B) cold PHi s Nlatntxined at or below i ._.._ .__.. .--.� � T-1 c30fNi'tF) fl`"145"1 -3ST214 Protection frotirl,napPrt�,-era ldthi ��s" � -�t;I WA) t int PHF Mauttait�ed at or above FS Poisonous or Toxic Substances _ _ 1 SO'F. tS1.11 Idenin npintdintatxn ort rod t ; ft i6'A) RIveie odatorabove l3I'T I Time as a Public Health Co 102.11 CommonNixme Work; sxriners' _ as Cuhtar,i-3eaFth t un£ro2°_� 7-202-11 - RestnctIon-Frestocc attd Use>R —� 1 4OA04(H) Vart tzerr,Rr uircnr nt 7202.t2 CbndtaoneofTtse 7-1011 t Toxic Curnam..as Pxohibi.t+as IRESu9ENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS HSPS _ I r!' Sanst zrt, f riterr a ChenucFS----� (((""" ( 7 '104.1.2 <lutat ds for 1§ tsfi F q_daicr E utenax' t �' "801 'ItA} tinFa,t urtccd Pte-packaged Juic"and 7204,14 Dr in A tr.Crit tta 'Je t+ es with R arnic!e i,.ab,.ls f' 807I B) U=. of Pa t aerredl: s __ �i?5.11 Inctd ntal t<xxl t oniau I�F.v aans' � t----- �� 7 X06.i t T{es,nei d Use Pe rttirtes t„nteri t. 3-SO i i I(D! k tw or P tiretit C(Kok d Aminal l ud and 205.12 R(ydcni Bail smtions. __ R tx 4c d iprom� `trot sowed e -i .-R(#1 t 3!( r1.C5 iecl Frexx Pakate Nl of R served. - , .�a&.E TraaktngP>e>-dzrc. P ssf.'�enanlasd --� — —.— -- Noattorin CONSUMER AOVISORY TIMEITEMPERATURE CONTROLS 22 � 3-60, r I Consur r v Attiisorc Puatotl for( ottstturotion of ssatttt t uxh ilr.i are Raw, t?nderax)ked cr 16 Prapgr Cooking Temperatures Oar \at Otto t e ;sc Pcx eased t Eliminate _ PHFs _ r 4-40Lti'ktl f'3 Tr1,, IS;i°F 15S c �( !.._._ ,. _ F s r s.mrnxdE a Se ice 1,15T 3 t' .tot t tr d Cmc.h rbanrntr for [taw Shell .'-1}pLSttA1l2t--- CoznnunaYAitt.h, "vle.¢;st. teane An+riot,- 17.,,c• _.--4 SPECIAL REQUIREMENTS _ t , tpi.t s(7Js{t s(t) Pork and Sed Ratst 1301' ill mi0 .—•.�. ._.._ ._._ Ra rtes.Goiec d 12ents- 105 F l.SVioi ar'tt,cr Sudan ^t'30i.f}tt`)tAj-(U}in sec _ ( c atstrtn mobile tcxxi tempo, ary and 401.11(A)(1) Voahry,Wild Game,Stu+ e.d PHJ n,, remdi oral I iteecn operaticros should be I Sa�f}r tr,'Corn loom btsft 4i tc III, 3 deblo d olider the appropriate sections i tultr}tt Rnttes 365"F t5ve above if hlted to loodbornillness r401.1'tC}(3i Whole—muscle, rt act lie f St=ks i irlteiscnttons turd tisk bicfors Othou 145 t _ _ 5()),009 v iNations rclatink to wod retail i 3-40j �� R tw mai F c >ds Ccokrci ort r ,oracdccs,hould be debited under#29 - 4Ste owave Ibs 1 Spcmal Rtgtiirettxebts- s 4139-It(A)fi3rb) All Other Rli1 v 145,F 5 sec. Reheating for Hat Holding y VIOLATIONS RELATED TOC GOOD RETAIL PRACTICES s_iO3.41(A)&i1.)) I'll l}s 1b5"C 17 se, '"' _ _ --f (lir mr:24_3fM} -. 403.5 3{tsj� Microwaer- 16, b 2 R9ratrss siaadin ` Ctet t u+d nrtn erotica? w<<<tt:rn.i: which do nn; xlatr :n t(ur Time, � foodborne dhiess rnurverr an„ ural risk ipetors liurd above.con be, 3-403 11 tt'j E an aerriaily Pox see R FE F+xxf- fmm i nr Toe f tFt>x t tk w ions n/the Food£'orae and 1(15 CibiR 14p b- )ti ftttd 3-443.1 E(E) I Ron fining t ndwed PornensrtP`liee€ ', t#snt j Gaod Rata+1 F°raahces _ __ fC �590.ODt7 .... I, 1s,est # ,^3 M'ranumet t aid t'ar anrPt . 3-56t.14(A) ""— PraripdH1;C—(H-K—(i—PHFsIl.tm l4t)`f'ta.—. i' 24 Fods eansac�d}•'orta�!8 Cooling at PHFa a _ FC i 004 2n 005` t 26 Water Plcrribin� Waste FG 5 '006 70'1-- Yithn t Hours and From?;° cn - tj QFC 6007 1 i to 4 1-i45'F Within=t Hou28 o_x�e Rstet Et_ Z cs 3-301.141b) Clxah w FH&Made Front t'kmblent � ! �9 � Spec�R�etrerrsnts Wq 1 ' Tcmp,rmtare lntredicim it, 1'1945`F t 3U Othrt - ( Within_4_I4outss �ll ne v.rzn::aticm in zhr ltc!rtJl •i9l'esxl Gila cr 765(lKlt`,9£S!i(30�� Massachusetts Department of Public Health Salem Board of Health Division of Food and Drugs 120 Washington Street,4'h Floor 9 Salem, MA 01970-3523 FOOD ESTABLISHMENT INSPECTION REPORT Tel. (978) 741-1800 Fax (978) 745-0343 Name Date T of Ooeration(s) Tvoe of Insoection ohxltm Food Service LJ Routine Address _ Risk RetaiRe-inspection I C Level ❑ Residential Kitchen Previous Inspection Telephone 1� ❑ Mobile Date: (c,4,lvq Owner ( � HACCP YIN ❑ Temporary ❑ Pre-operation ❑ Caterer ❑ Suspect Illness Person in Charge(PIC) 1, Time ❑ Bed&Breakfast ❑General Complaint In: / a5 - ❑ HACCP Inspector Out: - Permit No. ❑Other Each violation checked equires; an explanation on the narrative page(s) and a citation of specific provision(s)violated. Non-compliance with: p 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, y� ; `�"'� I�� L. .. w am- -112. Prevention of Contamination from Hands ❑ 1 PIC Assigned/Knowledgeable/Duties EMPLOYEEHEALTH arr* rt-7 El 13. Handwash Facilities PROTECTION FROM CHEMICALS,F,1 jRa ❑2 Reporting of Diseases by Food Employee and PIC "�' ,,,en u , !ut --� " ��( •� ' K�._'� .)=n-r ❑ 14.Approved Food or Color Additives ❑ 3. Personnel with Infections Restricted/Excluded _ ❑ 15 Toxic Chemicals g OanURGE n 4. Food and Water from Approved Source ource 15T,IMM_EMPERATURECONTROL6(Ptitentlal HazardoiF is) ❑ 5. Receiving/Condition ❑ 16. Cooking Temperatures ❑ 6. Tags/Records/Accuracy of Ingredient Statements ❑ 17. Reheating ^ ❑ 7. Conformance with Approved Procedures/HACCP Plans ❑ 18. Cooling ,mom ❑ 19. Hot and Cold Holdin "PROTECTION FROM CONTAMINATION' i« p t 9 A a,r<. El 8. Separation/Segregation/Protection ❑20.Time As a Public Health Control ❑ 9. Food Contact Surfaces Cleaning and Sanitizing -REQUIREMENTS FOR HIGHLY SUSCEPTIBLEPOPULATIONS(HSPj ❑21. Food and Food Preparation for HSP ❑ 10. Proper Adequate Handwashing ❑ 11. Good Hygienic Practices ;`,CON$uMER:ADYISORY4 i-41-1-�^, ❑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-s)(590.0so.004) cited in this report may result in suspension or revocation of 25. Equipment and Utensils (FC-4)(590.005) the food establishment permit and cessation of food 26. Water, Plumbing and Waste (FC-5)(590.006) establishment operations. If aggrieved by this order, you 27. Physical Facility (FC-6)(590.007) have a right to a hearing. Your request must be in writing '28. Poisonous or Toxic Materials (FC-7)(590.008) and submitted to the Board of Health at the above address 29. Special Requirements (590.009) within 10 days of receipt of this order. 30. Other DATE OF RE-INSPECTION:( I //,�// 5:5.901n5pecfFortMr 1O.dx '\ In\l�` /{ ,� , VY4JJ(( �' �l Inspector's Signature: t z/_ Print.- 1 PIC's Signator :, Print:) �1 , Page /of +2 Pages IJT Violations Related to Foodborne Illness Interventions and Risk Factors(items 1-22) PROTECTION FROM CONTAMINATION FOOD PROTECTION MANAGEMENT 8 Cross-contamination 1 590.003(A) Assignment of Respansibility* 3-302.1 l(A)(1) Raw Animal Foods Separated from 590.003(B) Demonstration of Knowledge* Cooked and PTE Foods* 2-103.11. Person in charge--.duties Contamination jrom Raw Ingredients - 3-302.11(A)(2) Raw Animal Foods Separated from Each EMPLOYEE HEALTH Other* 2 590:003(C) Responsibility of the person in charge to Contamination from the Environment require reporting by food employees and 3-302.11(A) Food Protection* a !licants* 3-302.15 Washing Fruits and Vegetables 590,003(F) Responsibility Of A Foci 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' 3-306.14(A)(B) Returned Food and Reservice of Food* 31 590.003(D) Exclusions and Restrictions* Disposition of Adulterated or Contaminated 5%003(E) Removal of Exclusions and Restrictions Food 3-701.1.1 Discarding or Reconditioning Unsafe FOOD FROM APPROVED SOURCE Four* 4 Food and Water From Regulated Sources 9 Food Contact Surfaces 590.004(A-B) Compliance with Food Law* 4-501.111 Manual Warewashing-Hot Water 3-201.12 Foodin a Hermetically Sanifization'fem eratures* _Sealed Container* - 3-201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Warewashing-HotWater 3-202.1.3 Shell Eggs* Sanitization Temperatures* � 3-202.L4 E gs and Milk Products.Pasteurized* 4-501.114 Chemical Sanitization-temp.,pH, 3-202.16 Ice Made From Potable Drinking Water* concentration and hardness. S-LOI..l.l Drinkin Water from an Approved System*- 4-601.11(A) Equipment Food Contact Surf=aces and 590.006(A) Bottled DrinkingWater* Utensils Clean* 590.0(16(B) Water Meets Standards in 310 CMR 210* Contact Cleaning Frequency of Equipment Food- 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* 4-703A I Methods of Sanitization-IIot Water and 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* Sources* 1Q Proper,Adequate Handwashing Game and Wild Mushrooms Approved by Regulatory Authority 2-301.11 Clean Condition-Hands and Arms* 3-202.18 Shellstock Identification Presem* 2-301.1.2 Cleaning Procedure* 590.004(C) Wild Mushroori 2-301.14 When to Wash* 3-20117 Game Animals* 11 Good Hygienic Practices S ReceivingfCondition 2-401.11 Eating,Drinking or Using Tobacco* 3-202.11 PHFs Received at Proper Temperatures* 2-401,12 Discharges From the Eyes, Nose and 3-202.15 Packa re hrte it * Mouth" 3-101.11 Food Safe and Unadulterated* 3-301.12 PreventingContamination When Tasting* 6 Tags/Records:Shellstock 1.2 Prevention of Contamination from Hands 3-202.18 Shellstock Identification * 590.004(F) Preventing Contamination from 3-203.12 Shellstock Identification Maintained* Employees* Tags/Records:Fish Products 13 Handwash Facilities 3402.11 Parasite Destruction* Conveniently Located and Accessible - 3-402.12 Records,Creation and Retention* 5-203.11 Numbers and Capacities* 590.004(J) Labeling of Ingredients' 5-204.11 Location and Placement* 9 Conformance with Approved Procedures 5-205.11 Accessibility.Operation and Maintenance /HACCP Plans - Supplied with Soap and Hand Drying 3-502.11. Specialized Processing Methods* Devices 3-502.12 Reduced oxygen packatting,criteria* 6-301.11 Handwashing Cleanser,Availability - in Provision 8-103,12 Conformance with Approved Procedures* L±-301 12 HandDry *Denotes critical item in the federal 1999 Fond Code or 105 CMR 590.000. CITY OF SALEM . - y BOARD OF HEALTH G`Establishment Name: o� { <�lo� Date: !h/a_r/11 Page: r ofg Item Code >y C-cdtical Item= .? 3 DESCRIPTION OF VIOLATION l PLAN OF CORRECTION t. s = . > Date '- No Ceferenoe R-Red Item e ' a -• -"" `z` ��! '4 '" - " '- Verified .,,.a h:`% �. �, 4F. �� kr PLEASE PRINT CLEARLY - £f �7. of yIR v Or /I Ci 17ri, D n/1 101.1 � r^✓ n _n If - � . _ yy ;r K a _ r Discussion With Person in Charge: e Action Required: ❑ No � Yes Correctiv d 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 twe�ve dollars or suspension/revocation of ❑ - Embargo ' '❑ Emergency Closure your food permit. �c �� DL Voluntary Disposal ❑ Other: 714-i(T-)- PfWReceived ati';;"—Peratulal Violations Raestal to Foodborne illness bitervenfirole and Risk a ccording I o Ta , Coolcd to Factors(fteft 1-22) {Cont] tai F/45'F Wiflim 4 Rt urs. PROTECTION FROM CHEMICALS I C'. ,ojh for P 3-501,15 IQ j Food or Color Additives FHF Hot and Cold Holding 6, r cr,"PM, 'it or below , 2)212 -7 4 Pi4511 F, 3-302-14 prowcuou firon Additl�os- L") 111"'ApEn"Ld I ,. O 1,16W Hia vflntainetl at or abow PursoZus or Toxic Substances 7 101.11 ldorilifyinlz Intormailon--,06"ime, 140'F. I Rooas Heid at or above 130'1-. Teas a Public Health Control 7-101",11 Comnion Name-Work;no Connurien�, ")—Ij Tioc,as a Public Health Control 7-201.11 -s2a, - 7-202_il Rolltriction-Po"'wnze will 1 17 7-20112 condilions of Usc, 7-103 11 Toxic Cointainers -ProldbmonREQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS -TT; � 'r °04 12 cfiotiicaLs for hui. - riaI Bevraaes with Wancin, labols* i 2Q�14 Di Firer hr -2 05,11 lic-id-,mml f-,Nxl("ontict,1-tibricants' �-,W 1.110 it E Ras or Ilankill,,C<,,okrd Anuria! Foot!and : aw sttdSpn' 7:06.11RcncndT ,t711 rats-Not Sewed R(Acm Bart Statiori ' 7-2Qf5 23 rrackin'!Po%tderil Pest Control and Im CONSUMER ADVISORY 22 -60 1 F. Coivzuolor W�isory ponr,al for Coosunipuon of TIMErrEMPERATURE CONTROLS I �inter lal Fxxle That art T,. W. 16 Proper Cooking Temperatures for I PHFs Not 0dierc-ise Pica,Stied to Flnnmate ariml I` 1' -ImL 1-11, P�.saelm7z,�,F.q.�suilsallit"fon R�aw Shell munc(li4tic sciivicc 145"F -C, 1-4 Commitured Fi�h, %cfews&Ciarric 15,n'F 15src, Pod,iind BQet Roast -1304-, 121-- SPECIAL REQUIREMENTS 401 1 lli)(1)(T o19 717 J_�o 1 11(,k)f -RI-1 t-It e--�,frau—t�d M v—m,�---1—�5 T, 590,009 7X; 7D)7 1�1�jvq oil in atcringmllbik, tood,temporal v and 3-40LIVAYI) flouitry,Wild Game,$Vlird IIHFs rcmdfmlial kitchen operations S1,n(bli'L Cfvmiin��,FmhMeal, dclooiJ underthe appropri Poultrvo Ka6tvg-l65'T-' 15 sec. ifrclated to fix)dhorric ithicsa 3.-101,11(C)(3.) I1-)taC-z-11CJ sicaks ni t5c tons tnd rick factors. oilicir 1451T 540.009 violations relatint, to"ooj retail 3-40IJ2 Kaa Antarlil V�,xk Co,rk�d in a pia t,ces Miould be debited under#29 - 1 Special Requircinents .1-401,11 lAKO(b) All Other I-lHi-s-- 145'1-- 15 ec, EC7 Reheating lot Hot Holding VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 11[!, 1651 15sec 1, (Iterris 23-30 1 3-403.11(b) 'Microwave- 16s, 12 mirca,slandira, crov-aiand non rrocal vioknul?o, which do??,), -daw in nip. TirtrO I n ftlo,,�htlrne rflneiis one,wnnons,cia mkj (tors lived above, ((411 be 3-403.11(C) Commercially Prrxesscd RTE Kxxi- found in qf th.Food Code cud 10,i CMA! 140'P90J)00, 2----j-d- Rellitillin" unsficed Portions of Boef 3403.11{C i� tom Good 590 000 !,23, 1 Maaagemcrt and Per onnelFC 2 f 00 Proper Cooling of PHFS 3 1 24, Food and Food Protection FC 3 001 7--- 1 25 i_%gaip shLarld FC -4 OOA 7�01 T4t k) oldirry((xk,xl PhFi; fono 1401 Flu, 1 Wallis F =5 O'F Witbin 2 Hours and From-10,F a Facility "Phy.. 1 Pwonoula or Tovc Mate FC -7 008 FC 8 .6Q7 to 41 1-14Y F W"illcia 4 Homy.' Cooliiw Pi1R Vi t& From Awbi�w To I 14(b) .9 Kia!Rp,�O ments 0 Tatnparawry ingredients to 410F14517 —W-41no 4 lhlurs` -I)MAINIcrillull item ill ilk 11)99 FomIC,,Je,,v 105(Alt 590(X)r IMPORTANT MESSAGE FOR M An�.nuyS OF PHONE AREA CODE NUMBER EXTENSION O FAX O MOBILE AREA CODE NUMBER TIME TO CALL TELEPHONED PLEASE CALL CAME TO SEE YOU WILL CALL AGAIN WANTS TO SEE.:YOU RUSH .--... .RETURNED YOUR CALL WILL FAX TOYOU MESSAGE 15'Lllc� � 1 ( 5fi a t960rOh f�4�JvJq na c� ._/T�' SIGNED FORM MADE IN U.S..A JUL.-22-2888 89 :46 PM POWER 9787414326 . . _ .. .._ .. / P_81 aenuttlank Health Dept. too , l Attn: Joanne Scott wok , FAX 978-745-0343 Re; tench behind The Edgewater retaurant 7 I called this morning to report that on Sunday, there was a very bad odor coming from the back of The Edgewater. There are dumpsters in the back which are the possible culprits. If they are, the owner should make sure they are emptied more regularly; especially in hot weather. Thank you. Sandra Power i I of t 7122M 10:20 AM JUL-22-2008 09 :21 PM POWER 9787414326 P_01 abouvblwk Health Dept. Attn: Joanne Scott FAX 978-745-0343 Re: Stench behind The Edgewater retaurant 7/29/08 I called this morning to report that on Sunday, 7/27, there was a very bad odor coming from the back of The Edgewater. There are dumpsters in the back which are the possible culprits. If they are, the owner should make sure they are emptied, more regularly, especially in hot weather. Thank you. Sandra Power I of 1 7122168 16:20 AM HACCP Risk Assessment City/Town of: Salem, MA • e , - Establishment Name Edgewater Cafe In redients F v Source ' " ' Address g z 155 Washington St., Salem, MA 01970 Chicken Cesar Salad: _ Person-in-Charge Romaine lettuce US Foodservice and/or Agar Dennis Moustakis Cesar dressing BFG Information for the Risk Assessment was obtained by: Shredded parmesan cheese BFG ❑ Observation of Suspect Food/Process Chicken Agar ❑ Observation of General Food Handling and Sanitation Practices ❑ Interview with Food Employee Responsible for Preparing Implicated Food. ® Interview with Person-in-Charge or Other Employee Weight/Volume of Suspect Food Prepared or Served: Dates of Investigation:Tuesday May 27,2008 PLEASE PRINT CLEARLY Describe Product Flow :Describe Environmental Data Collected to Verify HAZARDS Describe Corrective and Preventive Measures pate Control or Lack of Control of Hazards. -Contamination Initiated - Verified (Preparation Steps) Survival Who,What,Where,When a -Proliferation (Include changes in food handling procedures,orders . for conecfioq embargoes/disposals,food employee restrictions,food safety training,emergency suspensions and closures,etc.) ❑CCP Romaine lettuce: lettuce is delivered At time of inspection,container of lettuce in the Cover all foods in storage to prevent cross- (Critical from either US Foodservice or Agar deb unit was not covered. contamination. Control twice a week.It comes in pre- Point) packaged,pre-washed bags,and is stored in the walk-in fridge in its original bags.At time of inspection, walk-in fridge was 32e17.When needed,one bag of the lettuce is taken out and put into a plastic container in the True deli unit for use.At time of inspection,True deli unit was 35°17. Gloved hands are used to take lettuce from this container&put in a dish to be served for salads. Page: Number—of HACCP Risk Assessment Report Form(Updated 09/05) Cesar dressing: cesar dressing is delivered from BFG every two weeks,and stored in its original jug ❑CCP on a shelf in the dry storage area. When needed,a new jug is taken out, chilled in the walk-in fridge,and poured into a small,covered container with a dedicated ladle in the True deli unit to be used.At time of inspection,walk-in fridge was 32°F and True deli unit was 35°F. Shredded parmesan cheese:parmesan At time of inspection,container of parmesan Cover all foods in storage to prevent cross- cheese is delivered from BFG every cheese in the deli unit was not covered. contamination. ❑CCP two Weeks,and stored in its original bag in the walk-in fridge.It is - transferred to a shallow,covered container,also stored in the walk-in, and stored there until needed at the cookline.It is then put in a smaller container as needed in the True deli unit to be used.Gloved hands are used to take cheese from this container&put in salads.At time of inspection,walk-in fridge was 32°F and True deli unit was 35°F.At time of inspection,walk-in fridge was 32°F and True deli unit was 35°F. Page: Number_of_ HACCP Risk Assessment Report Form(Updated 09/05) Chicken:chicken breasts are At time of inspection,knives at the deli units were All knives must be properly washed,rinsed& delivered fresh from Agar once a being stored between the two refrigeration units. sanitized and stored in a proper knife rack,not week.They are stored in their between equipment. ❑CCP original bags in the walk-in fridge until needed.At time of inspection, walk-in fridge was 32T.When needed,chicken breasts are taken out a few at a time,pounded with a tenderizer on a clean,sanitized prep table,and put directly on the grill. Once grilled,they are put into the convection oven to ensure they are - - cooked thoroughly.After cooking is finished,they are placed in shallow, covered containers in the walk-in to cool&be stored for use.One such container per day of chicken breasts is put into the Continental deli unit for use,still covered.At time of inspection,Continental deli unit was 39T.When a Cesar salad is ordered, one chicken breast is taken out,sliced at the deli unit on a cutting board,put on a small dish in the convection oven to wane,and the warmed slices are put on top of the salad to be served. Comments: At time of inspection, there were some uncovered containers of food in the walk-in fridge. All foods in storage must be covered to prevent cross- contamination. Page: Number_of_ HACCP Risk Assessment Report Form(Updated 09/05) 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 _ Date Tvoe of Overation(s) Type of Inspection j I n / h Food Service Routine Address ' RF k r Retail S Re-inspection Level ❑ Residential Kitchen Previous Inspection TelephoneElMobile Date: Owner A HACCP Y/N ❑ Temporary ❑ Pre-operation OpAnl'l ❑ Caterer ❑ Suspect Illness Person in Ch. Time ❑ Bed&Breakfast ❑ General Complaint In: .5V ❑ HACCP Inspector O ' r)nPermit No. ❑ Other Each violation chec k ed 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'7_`" ,.„"„ „�,;�',' ��``�,�5„„� ❑ 12. Prevention of Contamination from Hands ❑ 1 PIC Assigned/Knowledgeable/Duties ❑ 13 Handwash Facilities {� EMPLOYEE HEALTH .....11 x _n, r .n PROTECTION FROM CHEMICALS`"w'm"N ❑ 2. Reporting of Diseases by Food Employee an' ' d PIC ❑ 14. Approved Food or Color Additives ❑ 3. Personnel with Infections Restricted/Excluded ❑ 15.Toxic Chemicals ' FOOD FROMAPPROVED SOURCE,,,,,.,,w., ,��, y,„_,�,�,a'a„;,` ,„,m,;.�,,,„„1 *SME/TEMPERATUIi.ECONTROLS(PoteMlallyHazardousFoodsj„ "` ❑ 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 „ "� ' 19. Hot and Cold Holding PROTECTION FROM CONTAMINATION a �; � T ,� 'j ❑ H 9 ❑ 8. Separation/Segregation/Protection ❑20.Time As a Public Health Control E-19. Food Contact Surfaces Cleaning and Sanitizing ;REOUIREM6NTS FOR HIGHLY SUSCEPTIBLE PQpULAT10NS(HSP);,.„ ❑21. Food and Food Preparation for HSP ❑ 10. Proper Adequate Handwashing ❑ 11. Good Hygienic Practices CONSUMEri'ADVISO(iV „ii a', �z,.;". : ,. r.-NN PIMEIIPOF� 7, •. ❑22. Posting of Consumer Advisories Violations Related to Good Retail Practices Number of Violated Provisions Related ❑ x 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)(990.004) 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)(590.067) 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,580InVnWo/ -14.Coc Inspector's Signature: Print: 1\Jl PIC's Signature:/ �� Print: 1 Page 1 orPages Violations Related to Foodborne Illness Interventions and Risk Factors(items 1-22) PROTECTION FROM CONTAMINATION FOOD PROTECTION MANAGEMENT 8 Cross-contamination 1 590.003(A) I Assignment of Responsibility' 3-302.11(A)(]) Raw Animal Foods Separated from 590A03(B) Demonstration of Knowledge* Cooked and RTE Foods* 2-10311 Person in charge-duties Contamination from Raw ingredients 3-302,11(A)(2) Raw Animal Foals Separated from Each EMPLOYEE HEALTH Other* 2 590 003(0) Responsibility of the person in charge to Contamination from the Environment require repotting by food employees and 3-3021.1(A) Food Protection* applicants* - 3-302.15 _-Washing Fruits and Ve*etables 590.003(F) Responsibility Of A Fax!Employee Or An 3-304.11 Food Contact with Equipment and Applicant To Report To The Person In Utensils* Charge" Contamination from the Consumer 590 003(G) Reporting by Person in Charge* 3-30614(A)(,B) Returned Food and Reservice of Food* 3 590.003(D) Exclusions and Restrictions* Disposition of Adulterated or Contaminated 990.003{E) Removal of Exclusions and Restrictions Food 3-701.11 Discarding or Reconditioning Unsafe FOOD FROM APPROVED SOURCE Food* 4 Food and!Nater From Regulated Sources 9 Food Contact Surfaces 590.004(A-B) Compliance with Food Law* 4-501..111 Manual Warewashing-Hot Water 3-201.12 Food in a Hermetically Sca ed Container* Sanifization Tem eratures"` 3-201.13 Fluid Milk and Milk Products" 4-501.112 Mechanical Warewashing-Hot Water 3-202.13Shell Eg s* Sanitization Temperatures* 4-501.114 Chemical Sanitization-tem H, 3-202.14 Fags and Milk Products.Pasteurized* temp.,p 3-202.16 Ice Made From Potable Drinking Water* concentration and hardness. 5-101.11 Drinking Water from an Approved System* 4-60111(A) Equipment Food Contact Surfaces and 590.006(A) Bottled Dr skin Water* Utensils Clean* 590.Ot 6(B) Water Meets Standards in 310 CMR 22.0" 4-602.11 Cleaning Frequency of Equipment Food- Contact Surfaces and Utensils* Shellfish and Fish From an Approved Source 4-702.11 Frequency of Sanitization oT'Utensils and 3-201.14 Fish and Recreationally Caught Molluscan Food Contact Surfaces of Equipment* Shellfish* 4-703-11 Methods of Sanitization-HotWaterand 3-201.15 Molluscan Shellfish from NSSP Iisted Chemical* Sources* 10 Proper,Adequate Handwashmg Game and Wild Mushrooms Approved by Regufatoty Author' 2-301.11 Clean Condition-Hands and Arms* 3-202.18 Shellstock Identification Present* 2-301.12 Cleaning Procedure* 590.004(C) Wild Mushrooms* 2-301.14 1 When to Wash* 3-201..17 Game Animals* 11 Good Hygienic Practices 5 Receiving/Condition 2-401.11 Eating,Drinking or Using Tobaceo* 3-202.1.1 PHFs Received at Proper Temperatures* 2401,12 Discharges From the Eyes,Nose and 3-202,15 Package Ince it * Mouth* 3-101.11 Food Safe and Unadulterated* 3-301.12 Preventing Contamination When Ta,± * 6 Tags/Records;Shellstock 12 Prevention of Contamination from Hands 3-202.18 Shellstock Identification* 590.004(E) Preventing Contanhination from 3-203.12 Shellstock Identification Maintained* Em to vers, Tags/Records:Fish Products 13 Handwash Facilities 3-402.11 Parasite Destruction" Conveniently Located and Accessible 3-402.12 Records.Creation and Retention* 5-203.11 Numbers and Ca acities* 590.004O Labeling of Ingredients' 5-204.1.1 Location and Placement* 7 Conformance with Approved Procedures 5-205.11 Accessibility,Operation and Maintenance 1HACCP Plans Supplied with Soap and Hand Drying 3-502.11 Specialized Processing Methods* Devices 3-502.12 Reduced oxygen packaging,criteria* 6-301.11 Hindwashing Cleanser,Availabilit 8-103.12 Conformance with Approved Procedures* 6-301.12 Hand Drying Provision °Denotes critical item in the federal 1999 Foal Cade or 105 CMR 590.000. N i CITY OF SALEM ' BOARD OF HEALTH 3 Establishment Name PAcv c.4l ,- rbl e Date: Page:d of Rem Code,,, C-Cntical Item r �. DESCRIPTION OF VIOLATION/ PLAN OF CORRECTION s Date �= .,h„, x ,r„ a ._, .,r v u =.. „� v*r ',�y-,� tcj a� Verified No. ( `Reference ' R=Red Item f` a' - �'` ` ` .. r " -�`% �% "^-"`PLEASE PRINT CLEARLY - y �h43 C,- CY2 ,D ^ lere cT \l(Inf-7 Ic A,Pl lk,� -f- A- ,S I 17 !)v n r-.1 - Jac+ /)0V C doc"'7,n; 7!1 _ 1 tlpn(<tiP niY✓ /i a, 1� ' ��1� n�/ ( _o, n -rl -F-AIN 1 .>_ vn , / n p 7c Hie Vff) -' -�Q chic /1 1 ncr � a h LV - t ` -�,1nr. N 6G: 0). a {s! �C' tr 0515 vto2 iv. j 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 obselrve�l conditions as described, and to Re-inspection Scheduled ❑ Emergency Suspension I comply with all mandates of the Mass/Feder_al Food Code. I understand that ti noncompliance may result in daily fines of twen .y.-five dollars o suspension/revocation of ❑ Embargo ❑ Emergency Closure l I:your food permit. ❑ Voluntary Disposal- ❑ Other: Violations Related to Foodborne Illness Interventions and Risk E Accordiri., to Lack Cooled to Factors(Iterria 1-22) (Confit F/45-F 44ed in 4 Hours Co<Aon,MeLhod,�for l"IfFs PROTECTION FROM CHEMICALS Food or Color Additives 1.9 PHF Hat and Cold Holding 3-SCi I6(B) Cot PHF jnctlfled at orfe� dt,v, 4-202,12 Arlddne,`° 590,004(() 4 i 145`F 3-30114—' Posceta m '= i lint PHI 3axntaitted at or above 15 i Poisonous or Toxic Substances (03.11 Identifying Irift);inanon -Oliginal 3 Puams licId at orsboe 130'F. -7-i-02 11 I comillon NName- INork inL Cowwocr,�m Tiale as a Public Haaah Coll"o, 19 T Tam a,a ti� Time as a ITUblic ficafilt cornrti� T2 1.IT- Var 7-202.11 Rostric6on -Pre,,wnce art! Uee" -V, 4 tinct _a Ree uir,.msae 7-20112 cwldoions of tjsv" REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-203.11 Toxic Fontarrror,�Prohibition_" POPULA IONS(HSP 7-204.11 Sanitizers,Criteria-chemictils, 21 3-,0 1.1 i(A) Unpa;teurized Pre-packaged Joices and 7-2(NA2 1111111'iJ-sfor— rd�tcc"C;iteliT- 7-2(9,14 Boomices with wartring Labolst, 3-80t.IVB� U�e of Tlaqetjfiz�d fcein'� Tic)T 11 Incidental F,n)d("oranct.tvhricants'� --- IT e -S51.. 1 Al(l)) and i-206-f I RoNnicled Is Ye etc Raw Sv(,d "So outs-Not'set veil. 7-206.12 Rotten B6t scitiom, 1- -Eulcqiened Potxi Packj�Re, serve witaig,11,evdet,� P�,,Control ad =Monilorinc" CONSUMER orr"'nipti iT-T�,-oTjT-f A 1N isok'c Pr ted for on'T� 1 2 TIME/TEMPERATURE CONTROLS F Uiiaol FX%[ that ar",kaw, Undei"ked ci Proper Cooking Temperatures loi7-- PHFs or Otle"m iso Processed to I-Hiiwiciw 'ath(..m 3-0,11A(1)(2) F-.e&s- 155'F 15 Sec. k-302.1'� eo Pi�tnzcd Fq,��Scbsimae tat RAw Shel! jj��L�,iLL Service 115'l?)5s( 7'z-45-i.n(,w,5 coraminweii Aiijumis SPECIAL REQUIREMENTS ;-401.1€(H)t€)f2) I Rwl�: and Beef Roast 110"F121 niirte 155F15 vi(-'Nlions of Section 5'90.(X)9(A)-(D) it, caterins, g. molmle bxId,ternporary and K- 3 40 1. 1(A)(3) Poultry,Wild Game, Stuffed PITFs, rcasident'lal kitchen operations should N 'niffinigCont ening Fish.Mat, debited under the appropri ate sections Poilittv oi.ka.titcs.-i 65"'T"'15 s(-c. abwve if related to foodborric ilhisss Whole-nmede-Intact Beef Steaks interventions and risk factors, OrbeT 590,009 violations,relating to Good letai! To I_-A2 lom AMTZ-[Fcws CCxZ-dn1a inactices 'hould tv debited under#29 \Iicrowave 165'F M Special Requirements. ?-40IAI(Po(l)ib) All(Aber NIF,-- 145'2 15 zeta. Reheating for Hot Holding VIOLATIONS RELATED TO GOOD RETAIL PRACTICES - ;03,11 fAi CD) Pffi;, 165'F 15 sec.t (heins 23-30) I-403.11(B) Microwave- 165'F 2I1 ante Standing Cjiti,wi rwl ewn-ethical rio,','damt, w0ch r no ?e1are to the Time" can be -403A](C) i Comm]Ciatly Process'tj RTF 1 TIT- 140"P §p txr 1 3-403.11{F3) Rerninnin. Unsliced PorEittits o(TicPet Item Good riehrdPrqEuces ----- -J-"FC 596.00-0- "1 Roasts, 23, Vanapf,,TLo�nt ersannei Fc�--? ig Proper Cooling of—PHFs — rte FC-a .006 7501 14(A) Ox4ing Cwkcd PHFs from 140'F I(,,, 26 1 Watel,Plurpri 10'F Within 2 flours and Front 70`'1' 27 ly6caif`r i lit 1 007 _Ph_f _jq ------- ---------- to 41"FI45 F W'dirin 4 fiowr, n 26, i Pmonous or Toxic Malerials I FC-7 i 008 r;501 14(b) i7coling PI-FF s Madc Front Arnbrzon -9 Tempffature lngredientr it,4101-iii5Omer ------------- ...... crnwit stic in the 1",larni 1949 F('Cx1 C'Xie or 195(Alu 59r,0& r CITY OF SALEM BOARD OF HEALTH Establishment Name:rLa. Date: i �r�� 3 Page:_ of nem Code C 7Cntical nem DESCRIPTION OF VIOLATION!PLAN OF CORRECTION �� Date a ,� Verified IN Reference R'=Red Item 'i -f u s r. .'' '' y,s q, r " z."'� a: 3 6• . > .t=� ...., PLEASE PRINT CLEARLY ` 1S— SUI. _j Jsx,/ i_ .-.00�l r: .✓-- I �.�., �.n['� S; �' �. i �- n,v 1'1') 5 r �n lam,: r h�•nr^ 12f,Pn So.j T a -1l L i I 1 r 0 (^P , i n A G+ _ iI 10.l iPj f- be s (Y h i i i I Discussion With Person in Charge: Corrective Action Require : ❑ Nod Yes jI 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/,F`� eraFo tlCode. 1undersynd that 1 noncompliance may result in daily fines of twenty-fivefive dolspension/revocation of ❑ Embargo ❑ Emergency Closure your food permit. ❑ Voluntary Disposal ❑ Other: 4 i 4 14(Cl ..'-__PDFsReiiviedatTemperatures Violations Rotated to Foodborne illness tntemenikNts and Risk � cxnrdiu to taw C pled to Factors(items I-22) (Cons) {'-__ I1 €745 F Within 4 Hours. v PROTECTION FROM CHEMICALS ��i 3 5t1t r; CHWF'Rot o an hods for PHPs #4 -t--- ' Food or Color Additive& � Gly � ��_ � PHF HM and Cold Holding -- 3 5O, I6(6) Cold Pffl s Maintained at or below F3-202,12 [ Additiaes* ... a90 004(F1 3-30 14 � Protectibnfrozril;nalwovedAddinves" IS Poisonous or Toxic Substancex _ 3 6{)1161 A) lint PhlFs Maintained at or above , t _ 140"=. lot 11 klanil ut #nfoomrson Original, y t MIA) Roasts llcdd at or )bove 130"F.' _ coirtdit ers -""' -- W— 20 _ Time as a Public Health Control 7,102,11 Common Name R ,r3 n.Container, - 7-201.11 Sa aiaexan-5tnrszc �a � `r 461 l5 ___,__ PLmesasaPubfieldeatth£ontrot3'� 7-262.11 Re itictian -Pre.na and t e* 4{Loki(11) �� Variut e Re niaittctr 7-202.12 Conditions of Usc* REOUIREMENTS FOR HIGHLY SUSCEPTIBLE r-303.11 Toxic C ontainet Prohibiiioas° POPULATIONS(HSPP-L� _ 7.204.11 Samttzers Criteria Chcntic� - -- 7 2(ki.12 Chcnitcais for Wash❑ >I root i^e Crita@a�' 21 3-54? 13 FAj o Istcurixcd Pre Packaged Juices and with �atei 7 204 i4 CrtriLtA_$ . abv5* � t Patcurir<d t 1 7-205.11 Inadental Food vnta' Imbiican s � [ ,ni 7-206.11 tZ ien U,st Pe udes C item uis?-807 t}x#03�k2aw or Paii3:2i1 C�7krd ihnnnal Fond tmd s�---- n � R iu be e d S 3rnTve':Sersca. k7-206.!2 Rodent Bait snaions _- �_ 13-ttG,.i tf+�) Unc cnec#Pax#Pack "sUt Re-server!. 1 r 3)6,13 'Backing Poecders,P.rsi C-antroi and '- 'vloniterin _� ( CONSUMER ADVISORY _ Tlh@E(TEMPERATURE CONTROLS 22 I I Coawuci Advisory floxwd for Consumption of Amaral I (J That ire,Raw,Undercooked rr 16 Proper Cooking Temperatures for PHFs Out Ota i c ise Pns e svc d to Fltfnlnate _ 3-40T I1 A(I)(2) F.i ge- 155 c 15 _ 1 Vie-hnnxd;uo.Sc.re-ice t�5 I'ISsec'. i 1-302.13 1' steuntu S FgPs Substitute fete Raw Shea _.__ ._ __ J 3-�k01.11.{A)f21 CinnitiRnate,i Fish,itgea s A (;eine --. IAntniLts -I I # ae SPECIAL REQUIREMENTS 3-46Lf l(B)(t)(2) Pirrk and but Roast -110 t 121 prink ----- . --. 59,10090)-(D) Vtolu tont of Set€toot e0,{l{)9{Aj{L)) in 3.401.1 t(A)C2) Ft Dine ,lnjcel r7 Mcais 1 5 F IS u catering motel t x d tetnporary and , 401A i(A)r3j � Pouitrv. R'dd CiLntc. Stoned I'liFs, I residenr-af kitchen operations hould he snifTingConranan"Fish,Moat, debited tinder fire appropriate sections Poultry or Raures-I 65'F 15 see.-' abocc if telatocl to fox #bonw. tilness 3401.11{03) J450 e-mapetu Intact I'3ecf5rua s intertiutlt on3 and that: factors. Other_ aS t 590.009 violations relarin}t to good retail 3401,12 R iw A_n4LrLnl#cauls Ccmkcd in a ( prat rices should be debited under/#29 - _ mialowit-e h65T,* _ _ ( Special Reelttircinunts.. -4t)1.I I(Al(i)(b) Ah Otear PHI 145"F 15 sec:. L!7 Reheating for Hot Holding�1 VIOLATIONS PELAATED TO GOOD RETAIL PRACTICES 33-103.1I(A)&,(J)) Pf tI s WIT 15 sec.* (Items 23-30) 13.1 l(b) 4lrucswavt 765 F 2 M n ne Stundiag CrWe-al and non-eraical vi(aahoxs; whit.h dry inn�;elate to elm - __ T'irle"' _ _ 0odhcrneWoess neervenrionsandiisOmforstirtedsa"ive, ("Inb: 3-403.1 I{C}— Comerciatis Pro sea ATF Fx - found in the foilon-mg sections of theF'cood Code rind 105 CUR f 4(:) F 3-403AI(E).� ( Remannin,bns#iced Portions of Beef Fits 590,000 Roasts* 23..,,-. Mc'neet and Per onnel I FC ? i Ig Proper Cooling of PHFs 124 FoxA raid Food Protect o _ FC 9 125 LF3*P , ntandUterisas,- _ Fc a 005 —3 3-5{3Li.4(A) Coal Ing Caof,idPHFsfron1,4)'FYo 26 Yr'ator,Pk€rnbnq-utdINa,te �FC S } 0(k 1 70°F Will:n 21 ours and From 7.T'F �2 �- .1 - t 7 Pols no Cac�€tY FC' 6 IX}7 t<i 11 FI45 h W t1=in 4 Hotii ° � 28 i Poisonous of Toxic Miaiea)€aFi G 7 f t}OS j 3-301-t4(13j C oohng PIFF,,4:,d,Front Aunblent f I SP�Ia€R-guiremaris .069 , caiperature Ink edicias N.41'F,,WF C}ther _ -_.._ -_ . ! _ _ zwt -- Within a IILii,r.- '73 n.,t,s critieai item m the tr lenr VY0 Pocxt C:eide ea 105 CMR 590 000 Massachusetts Department of Public Health Salem Board of Health Floor Division of Food and Drugs 120 Washington Street,4'" 9 Salem, MA 01970-3523 FOOD ESTABLISHMENT INSPECTION REPORT Tel. (978) 741-1800 Fax (978) 745-0343 Name n Date T of 0 eration(s) Tvoe of Inspection o t Food Service ❑ Routine Address ) G SRisk / Retail 10 Re-inspection Level ❑ Residential Kitchen Previous I spection Telephone ❑ Mobile Date: �� Owner 4 HACCP YM El Temporary ElPre-operatio� i ❑ Caterer ❑ Suspect Illness Person in Charge(PIC) Time ❑ Bed&Breakfast ❑ General Complaint In:ld e5, ❑ HACCP Inspector I c Out:ll...7-'> 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) E] 590.009(F) ❑ action as determined by the Board of Health V l'J 10- yp 1 -FOOD)PROTECTION MANAGEMENT ;„, '_ .... t'�_; _��t El 12. Prevention of Contamination from Hands ❑ 1. PIC Assigned/Knowledgeable/Duties � EMPLOYEEHEALTH'--& r El 13. Handwash Facilities '.,..I j PROTECTION FROM CHEMICALS I ❑'2.Reporting of Diseases by Food Employee and PIC ' _ r�� -�-_E .e��=r'a 1' 1-� ❑ 14.Approved Food or Color Additives ❑ 3. Personnel with Infections Restricted/Excluded ❑ 15.Toxic Chemicals y,FOOD FROM APPROVED SOURCE.;;„;,,;,„„R.� 1�TIME/TEMPERATURE CONTROLS(06466ally Ha ardous Foods) ""�;` ❑ 4. Food and Water from Approved Source q rq ❑ 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 FCR HIGHLY SUSCEPTIBLE POPULATIONS(HSP)„41 _ El 21. Food and Food Preparation for HSP ❑ 10. Proper Adequate Handwashing ❑ 11. Good Hygienic Practices CONSUMER ADVISORY ❑22. Posting of Consumer Advisones Violations Related to Good Retail Practices Number of Violated Provisions Related Critical (C) violations marked must be corrected To Foodborne Illnesses Interventions immediately or within 10 days as determined by the Board and Risk Factors(Items 1-22): of Health. Non-critical (N) violations must be corrected Official Order for Correction: Based on an inspection immediately or within 90 days as determined by the Board today, the items checked indicate violations of 105 CMR of Health. 590.000/federal Food Code. This report, when signed below ,w N by a Board of Health member or its agent constitutes an 23. Management and Personnel (Fc-2)(ss0.0 order of the Board of Health. Failure to correct violations 24. Food and Food Protection (FC-3)(550.0044))) cited in this report may result in suspension or revocation of 25. Equipment and Utensils (FC-4)(590.005) the food establishment permit and cessation of food 26. Water, Plumbing and Waste (FC-5)(590.006) establishment operations. If aggrieved by this order, you 27. Physical Facility (FC-6)(590.007) have a right to a hearing. Your request must be in writing 28. Poisonous or Toxic Materials (FC-7)(590.008) and submitted to the Board of Health at the above address 29. Special Requirements (590.009) within 10 days of receipt of this order. 30. Other DATE OF RE-INSPECTION: s=X,nVedF�,4da n Inspector's Signature: _ Print: 1 PIC's Signature: c�- _'� Print: U�r ��- -\ . 1 Page_of-i Pages Violations Related to Foodborne Illness Interventions and Risk Factors(items 1-22) PROTECTION FROM CONTAMINATION � FOOD PROTECTION MANAGEMENT S Cross-contamination l I 590.003(A) Assignment of Responsibility* 3-302.11(A)(1) Raw Animal Foods Separated from 590.003(6) Demonstration of Knowledge* Cooked and RTE Foods* 2-103.11 Person in charge- duties Contamination from Raw ingredients 3-302.1.1(A)(2) Raw Animal Foals Separated from Each EMPLOYEE HEALTH Other* 2 590:003(C) Responsibility of the person in charge to Contamination from the Environment require reporting by foot employees and 3-302.11(A - Food Protection* _ applicants* 3-302.15 Washing Fruits and Ve rztables 590.003(F) Responsibility Of A Fated Employee Or An 3-304.11 Food Contact with Equipment and Applicant To Report To The Person In I)tensils* Char e* Contamination from the Consumer 590-003(17) Reporting by Person in Charge* 3-306.14(A)(B) Returned Food and Reserviee of Food* 3 590.003(D) Exclusions and Restrictions* Disposition of Adulterated or Contaminated 590.003(1) Removal of Exclusions and Restrictions Food 3-701.1.'1 Discarding or Reconditioning Unsafe FOOD FROM APPROVED SOURCE Food* 4 Food and Water From Regulated Sources 9 Food Contact Surfaces 590.004(A-B) Compliance with Food Law* 4-501.111 Manual Warewashing-Hot Water 3-201.12 Food in a Hermetically Sealed Container* Sanitization Tem eraturea* 3-201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Warewashing-HotWater 3-202.13 Shell hags* Sanitization Tem eratures* 3-202.14 Eos and Milk Products.Pasteurized* 4-50t.1 14 Chemical Sanitization-temp., pH, 3-202.16 Ice Made From Potable Drinking Water* concentration and hardness. * 5-101.11 .Drinking Water from an Approved System* 4-601.11(A) Equipment Food Contact Surfaces and 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 Shellfish* Food Contact Surfaces of Equipment* 4-703.11 Methods of Sanitization-Hot Water and 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* Sources* 10 Proper,Adequate Handwashing Regulatory Authorit Game and uMushrooms Approved by 2_301.11 Clean Condition-Hands and Arms* 3-202.18 ShellstockIdentification Present* 2-301.12 Cleaning Procedure* 590.004(0) Wild Mushrooms' 2-301.14 When to Wash* 3-201.17 Game Animals* if Good Hygienic Practices Receiving/Condition 2401.11 Eatin ,Drinkin or Usdn Tobacco* 3-202.11 PRFs Received at Proper Temperatures* 2-401.12 Discharges From the Eyes,Nese and 3-202.15 Package Integrity* Mouth* 3-101.11, Food Safe and Unadulterated* 3-301.12 Preventing Contamination When Tasting* 6 Togs/Records:Shelistock 12 Prevention of Contamination from Hands 3-202.18 Shelistock Identification* 590.004(E) Preventing Contamination from 3-203.1.2 Shellstock Identification Maintained* Em loyees* Tags/Records:Fish Products 13 Handwash Facilities 3402.11 Parasite Destruction' Conveniently Located and Accessible 3-402.12 Records,Creation and Retention* 5-203.11 Numbers and Capacities* Location and Placement* 590.1)04(7) Labeling of Ingredients' _ 7 Conformance with Approved Procedures 5-205.11 Accessibility,Operation and Maintenance /HACCP Plans Supplied with Soap and Hand Drying 3-502.11. Specialized Processing Methods* Devices 3-502.12 Reduced oxygen acka hv,criteria* 6-301.11 Handwashin Cleanser,Availability - r 8-103.12 Conformance with Approved Procedures* 6-301.12 Hand D -mProvision '*Denotes critical item in the federal 1999 Trod Cade or 105 CMR 590.000. Commonwealth of Massachusetts City of Salem Board of Health IGmberley Driscoll 120 Washington Street,4th Floor Mayor SALEM,MA 01970 Food/Retail Establishment Permit DATE PRINTED: 01/08/2008 ESTABLISHMENT NAME: Edgewater Cafe File Number:BHF-2003-000003 155 Washington Street Salem MA 01970 LOCATED AT: 0155 WASHINGTON STREET SALEM, MA 01970 Permit Type Permit No. Permit Issued Permit Expires Fee Restrictions/Notes FOOD SERVICE BHP-2008-0302 Jan 7,2008 Dec 31,2008 $280.00 ESTABLISHMENT Total Fees: $280.00 PERMIT EXPIRES December 31, 2008 Board of Health This Permit is not transferable and must be reissued upon change of ownership or location.The permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code,beofre any revonations,improvements,or equipment changes are made,all plans for such must be submitted to and approved by the Salem Board of Health. Page 3 of 5 a CITY OF SALEM, MASSAC HUSEM _ � c BOARD OF FIEALTH 120 WASHINGTON STREET,4"FLOOR KIMBERLEY DRISCOLL FAX(978)745-0343 RECEIVED MAYOR TSCOTTOSAt EM.COM NOV 3 0 2007 JOANNE SCOTT, CITY OF S, -_,-, HEALTH AGENT BOARD OF HEALTH 2008 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT ��,,//�� NAME OF ESTABLISHMENT f de(.f r G4 TEL# 971-44D- 40�CC ADDRESS OF ESTABLISHMENT 15Sw0d k I," FAX# MAILING ADDRESS (if different) S EMAIL-Business': �" Website: OWNER'S NAME 1.� hhVit h � 1TEL#17�-- q 73 ADDRESS f b gc WVI4- 01f1l0 STREET CITY STATE ZIP CERTIFIED FOOD MANAGER'S NAMES) 1%Au !J Nh,- kU CERTIFICATE#(S) (Required in an establishment where potentially hazardous food is prepared) EMERGENCY RESPONSE PERSON��lx.x �l Uk k-A, HOME TEL# �/l� �o% X134 DAYS OF OPERATION I Monday Tuesday Wednesday Thursday Friday Saturday Sunda HOURS OF OPERATIDNq� (1,� lzh .�.PK [,t ).A- ay. A- j�� I'' Please vette in time of day For example 11am-11 m l 1 TYPE OF ESTABLISHMENT FEE (check only) RETAIL STORE YES 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 Fcod Cart$210-; 25-99 seats =$280 more than 99 seats =$420 BED/BREAKFAST/ YES $100 CHILDCARE SERVICES ADDITIONAL PERMITS MAKE (notjust serve) ICE CREAM, YOGURT/SOFT SERVE YES $25 TOBACCO VENDOR YES $135 , 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 fled all state tax returns and paid all state taxes required under the law. _ Signature Date Social Security or Federal Identification Number --------------------- ----__----a-- ----- ------ --J-------------- --' Revised 4/24/07 FOODAP2008.adm Check#&Date� 7 ; �rrjn $ !�" 0155 Washington Street Edgewater Cafe City of Salem FOOD SERVICE ESTABLISHMENT - FOOD SERVICE Inspection HACCP: ❑ Item Status Violation Critical Urgency Telephone: PROTECTION FROM CONTAMINATION 740-4669 Handwash F sties FAIL Critical ❑ RED Owner: Comment: Kitchen hand wash sinks temperature are both above 135°F. Sinks temperatures to be maintained between 110°-130°F. Dennis Moustakis Violations Related to Good Retail Practices (Blue Items) PIC: Food and Food Prot ' n FAIL Critical BLUE BJ Swain Inspector: omment: Pe al ice cream found in dry storage freezer. All personal items to be stored in designated areas. John Gahan scoop at bar rest on ice. Ice scoop to be stored in separate tabled container or in ice with handle exposed and not touching ice. Date Inspected:Correct By: 7/1912007 Equipment and Utensils \� FAIL BLUE Risk Level: '-e mment:Walk in refrigerator floor requires general cleaning. t Permit Number: �� half beneath back can opener requires general cleaning. BHP-2007-0175 Mfreral oven requires general cleaning. Status: afina unit requires general cleaning. Open #of Critical Violations: Physical Facility FAIL BLUE 2 Time IN: Comment:There are water stained ceiling tiles above the restrooms. Find source of leak and repair. 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. Jul 19,2007 ) Page I oft ' Item Status Violation Critical Urgency RED: Violations Related to Foodborne Illness Interventions and Risk Factors (Require immediate corrective action) City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741-1800 GeoTMS®2007 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Jul 19,2007 ) Page 2 oft CITY OF SALEM �90ARO OF HEALTH ent Name: Page: of Establishment Date: Item v, Code 3 C-Critical item vfaro- DESCRIPTION OF,VIOLATION PILAN OF,,CORRECTION No./0" Refervoce 7 R-Red Item PLEASE PRINT CLEARLY Verified V W-1 With ==7[ Corrective Action Required:With Person in Charge: orrective Action Required: L) No U Yes I have read this report, have had the opportunity to ask questions and agree to correct all D voluntary Hance 0 Employee Restriction violations before the next inspection, to observe all conditions as described, and to Exclusion comply wit 11 Q Re-inspection Scheduled U Emergency Suspension with all mandates of the Mass/Federal Food Code. I understand that y noncompliance may result in daily fines of twenty-five dollars or suspension/revocation of U Embargo U Emergency Closure your food permit. Ll Voluntary Disposal 0 Other: SU t 7 k1 3 Pt€Nv Rau+vuet�;Temper turas Violations Iterated to Foodborne Illness Interventions and Risk � � �A s xdin to Lain Cklukd to )Factorstltefttst•°V) {Cant.) _ 2 at4� F14aEhan.}Ha�itts. * . S Sit! ,5L uotine bfethaxts .for 1'HFs _ PROTECTION FROM CHEMICALS t i PHS Fart and Cold Harding Food or Calor Additives V "( � 34 � �.,..„� �3-50!,16(W � ColdPItPs Maintainedat orbelow {{ 3 26?.3a AQkLut �* _ 590,0040:} 42 45`t t . tUAdditve:"-. i02I4 otec St?, tficA} Ilxi'13I S#irnvniuer3 to nbo4'c Poisonous or Toxic Substances 1407 7 [01.1£ �1QurtUtyin(Zlnfaun,t nn -C)itginc. � t X t 16f 1\1 ��R�ir��<�t�sElrid iioc above t d`t�- ne . ..,.�. Contatos,._._. -. TT rme as u Public Health Control -- a 10-1I C�<mmer Nara- VY onkin"C ono tutus*� I 1 .._. -1 nm.,,x, a i'ubfiu I-lealih('anhtrE' �.. 7-2-0t.]I sr iatitn-Stolage 2}L d t Retl icoon- 7-202.12conliltR)nS(if!)So' — REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 't`o:tc f;tmtaxnax Pt'ntiafrt;tont POPULATIONS P _ 04.f1 snntuzecs Criteria chcntiu fs, r 'r1 I .--dt'1 ' iii t'iYpsrt,rrzrc�#z"i ta.F:,YK,.dStricec u1 '7-2(9,12 !"heroic th€or vvashut .§ au+tce (atuz aa' f ' 3e seta es with `kaunne Lribcis" 7-204,14 i7 thtt Aec tits C ttzci t Y _ _ 77 L — ttt�� -- I Incidental fo,xi i cotMI nNi ants' - 3_g0 i i(r)} "'xw or Putirttl t Lixxkcrl Anttnn3 l2u>d and 7 206.t I ftc�nleo-i INV pe bt idc+ C rsf tit* -Ran, Ss d Stacnu!t Not Seroc3 7 2700.12 Rodent 13tit So mons i-t;(.l f tir ? Rot 1,-206.33 i'r i long Pocadets,I est c0unril and ` '""'". ioaitorinc:_ _ CONSUMER ADVISORY 22 3 kO 11 Consnmet Ailvisory a`osted&u C mtsiun(tion of TIMEfTEMPE3ATURECONTROLS AniuilFrca3 04at oreff,m,Underax&edor 16 � r Proper Cooking Temperatures for 3 'got t)Utexuise Pev:c sled to 1 ' cnnaa¢ L _ PHFs g, !55 15 S c - Yanc�e e. 1 t _ Fcis sinrir us tic 7zriu ti5.f,i's5ec-= 3.3G t? t i Piat art drt Suhantutc for RAWshell � "3-4:5l'.1 1( i Cimnadmued Fish. Nteats& Glint: _ -}.Antraeis. 1 5 i 15 e REG}iliREt9ENTS 441.1'(iIj(I1il}_I Ptkatnd_iicct Rotst- 130"F121 I21 Bain r--------SPECIAL L RE catering --- t- --- 5901009(M th3) I Vic.tat, nN of SuYi(ur 1590.00%A)-11))in i 3-4`01 SI(02 Ronlm Iniecl d mcet 15 F 9s ((( mol)il t xxt temporary and 401.11{.A}t3j Poultr), Wild Gime, Stuffed Plat's, � � � reaYrlc.rli ih S:rYcOen ap tattcrrs shat[d be Sniffing ciinwuinlgFish,?teal � t ciehis a und;rilx aPpsoprtatc vec.taoaax Pouirrs'viftantas-i6S1 i5scc. jaL%oveift.htedtottKAboni Mom r ��i4hct -nmuie Incictl3ecP t aks�� a;c et.tiottsaiidrtskfn #ors. 011cr 3-401 Iltt. t.}; { 5()0.00( )vieia Yrinv rrlattng to good retail 1401 12 Raw Animal f nits Ccokcd m a pr unccs ,IYcalc(bedeblEC I uncle;h'29- _ Slicrovasu 165`f * _ 4pi tat lte}tiitcr3w i - 401 ttfAt(i){bi A11 CRhet Pffs, - 14S t 15 srt E7 � laheatin p Ior trot Huidemg _. _i VIOLA TICi s RELATED TO 0000 RETAIL PRACTICES 3-?fD3.lIfA}&{71} Pi-i7^s i65'F 71arc. '^ (Aetaas23,,30) 37lG3.f IFFT. bHcruwat< j(;Y'F 2 Minnie Standing Czizircti rzt:d non-trim al lalaAuras:inirich dei no;reitae to thn, __ 'Tiara* f=arxtie orne toners hat<a+earlicns renis'a i.k factecs fate d above, am be T 3.I I(C) Gamzaerciatly Prorassud R't'ki f� ld-- /reared in thefadtmmoi: recf'o s of Me Fond Code and 1(i5 CUR 3atrF° � ai2tx: .._.____�... --_. ---- ( -Good Rstsrr Pracztcos 'u _FC s96 000 _ r -463,1 4i,'t Rc�n uniri 1,n,wed Portiom of 4cef ( It . R testas 12n E N3a uavt '+*net cri iia €G ' 003 Rod iind Foorl Protection k8 Proper Cooling of PRFs c - r — _ t ur{insent a� Wena+s _ -,.FC f 56t Id(A) l+xiti.teC ak dPtIIY< foul 'i'te 26 Ja'pr PlIur rgand Wa^te C 5 .00n 5Gt.141It' f3ao 4Vzztnnttie '_`:aitilrcax ;�o'F I �� Physa f'FAg11ty C �OOi I v0cl W1hin " Hours. - � � 2S #_Frxsonoas o,,T Stec M to aals I FC 7 1-2008 1 ��„....14(b) � Iimxranrrc (tn,edienk t:,47"tieiit Other r i 8 Sjxec Rt3=;�tament ,a._t3Ei9 ._._.� In NfFs mil de i rani Airib ._... ,. �-Within 4 liuAuY * --- Dcthta�criflc r2 itmn�itis i {cis;i94'l f of 'C+zh c.=. kilS#�45,`t 5'Ji�C1�('-_ - Large Format Box # 2 - 2-(c) Doc # 2,C> Image # IMf..\ L 0155 Washington Street Edgewater Cafe City of Salem FOOD SERVICE ESTABLISHMENT - FOOD SERVICE Inspection HACCP: ❑ Item Status Violation Critical Urgency Telephone: PROTECTION FROM CONTAMINATION 740-4669 Food Contact Surfaces Cleaning and Sanitizing PASS RED Owner: Comments:Cuttung boards stained and scored. Resurface or replace boards. Dennis Moustakis PIC: Sanitizer reading to strong. Sanitizer to be at 50ppm as mandated. Dennis Moustakis Violations Related to Good Retail Practices (Blue Items) Inspector: Food and Food Protection PASS Critical BLUE John Gehan Date Inspected:Correct By: Comments: Utensils beibg stored incorrectly. Utensils to be stored in proper containers. 1119/2007 Walk in refrigerator has un covered foods. All foods must be covered. Risk Level Food being stored directly on walk in floor. All foods in storage must be 6-8 inches off of the floor. Permit Number: Frylo boy refrigerator has uncovered foods. All foods must be covered. BHP-2007-0175 Status: Equipment and Utensils PASS BLUE SIGNED OFF Comments: Back can opener requires general cleaning. -Wof Critical Violations: 0 Shelf beneath same opener requires general cleaning. Time IN: Time OUT: Walk in Floor requires general cleaning. Urgency Description(s): Walk in shelves have accumulation of grime. Thoroughly clean shelves. BLUE: Frigidaire freezer requires general cleaning. Violations Related to Good Retail Practices (Critical Aquafina refrigerator requires general cleaning. violations must be corrected immediately or within 10 days)(Non-critical violations must be corrected immediately or within 90 days) Cit of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970 978 741-1800 Y 9 ( ) GeoTMS®2007 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Jan 22,2007 ) Page 1 oft r Item Status Violation Critical Urgency RED: GENERAL COMMENTS: Violations Related to All violations have been corrected from 1/11/07. Foodborne Illness Interventions and Risk Factors (Require immediate corrective action) s 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. Jan 22,2007 ) Page 2 oft 0155 Washington Street Edgewater Cafe City of Salem FOOD SERVICE ESTABLISHMENT - FOOD SERVICE Inspection HACCP: ❑ Item Status Violation Critical Urgency Telephone: PROTECTION FROM CONTAMINATION 740-4669 Food Contact Surfaces Cleaning and Sanitizing FAIL RED Owner: meni: Cuttung boards stained and scored. Resurface or replace boards. Dennis Moustakis PIC: Sanitizer reading to strong. Sanitizer to be at 50ppm as mandated. BJ Swain Violations Related to Good Retail Practices (Blue Items) Inspector: Food and Food Protection FAIL Critical BLUE John Gehan Date Inspected:Correct By: 26mment: Utensils beibg stored incorrectly. Utensils to be stored in proper containers. 1/1112007 �wilk inrefrigeratorhas un covered foods. All foods must be covered. Risk Level oo�d being stored directly on walk in floor. All foods in storage must be 6-8 inches off of the floor. Permit Number: - + Io boy refrigerator has uncovered foods. All foods must be covered. BHP-2007-0175 Status: Equipment and Ut nsils FAIL BLUE Open /Comment: Back can opener requires general cleaning. #of Critical Violations: helf bene 2 ath same opener requires general cleaning. Time IN: Time OUT: / �1Nalk in floor requires general cleaning. Urgency Description(s): W9 in shelves have accumulation of grime. Thoroughly clean shelves. BLUE: ngidaire freezer requires general cleaning. Violations Related to Good Retail Practices (Critical -Aquaf n1 a refrigerator requires general cleaning. 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. Jan 11,2007 ) Page 1 oft Item Status Violation Critical Urgency RED: Violations Related to Foodborne Illness Interventions and Risk Factors (Require immediate corrective action) City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741-1800 GeoTMS®2007 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Jan 11,2007 ) Page 2 oft CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH 120 WASHINGTON STREET, 4TH FLOOR - SALEM, MA 01970 TEL. 978-741-1800 FAx 978-745-0343 Kimberley Driscoll WWW.SALEM.COM Mayor JOANNE ScoTT, MPH, RS, CHO HEALTH AGENT 2007 APPLICATION FOR PERMIT TO OPERATE A FOOD/ESTABLISHMENT NAME OF ESTABLISHMENT_ � �=C — TEL ADDRESS OF ESTABLISHMENT 1 S� LA,&C,1n t 4-x� FAX# 1�Jd 7L� �'a�i 1 v MAILING ADDRESS (if dtifferent)_)__ ^Q A9 EMAIL-- Business': Ci "-kns Cbanf?A- +Cc,�-Ac t ul{mow Owner's: OWNER'S NAME DWOr11. �/"� TEL# -q)j -tai/-73119 ADDRESS 1 (2W IA w1c SIF}IS>� 1A, 4 C7/5?0 STREET T' CITY STATE ZIP CERTIFIED FOOD MANAGER'S NAME(S) �Q�1 n" r UL n ba& CERTIFICATE#(S) j2 Ate•, n ►tet n, c) 2c,�y b Fi (Required in an establishment where potentially hazardous food is prepared) ' EMERGENCY RESPONSE PERSON HOME TEL# OATSOFOPERATION Monday Tuesday Wednesday Thursday Friday Saturday Sunday NO URS OF OPERATION Uk W ! j {•oma b Pi ease write in time of dap. _ `•,3a -�t}`' �i:So �•3 _i(:jc.s ( � -y¢t5u Etz I �,„4 1 w -til 14�W i1'3L� ;}� Iterexemnleilam-11pm1 I ? ` rn i A,,. �M � /�^ t A^- iz J TYPE OF ESTABLISHMENT FEE (check only) RETAIL STORE YES NO less than 1000sq.ft. =$ 50 1000-10,000sq.ft- =$100 more than 10,000sq.ft. =$250 -- ----------- ---- ------- - - - --------- --- - - - .. _..... ... e. -- - -- ...- -a ---... - ^ - - ...-- RESTAURANT NO less than 25 seats $100 25-99 seats =$150 more than 99 seats 20 BEl D--/"B, -,R--EAKFAS.. T ...YES- — -._.N.._O-.-----.-- -------- - ------------- ---_......$1_1`0-- - ----- .------ - ----- ----- .------- ._.----- 0 .... -... - _.....--...-.-_....-. ... _..._...... ......_....... ----- - ------ - ........ ADDITIONAL PERMITS MAKE (not just serve) ICE CREAM, YOGURT, SOFT SERVE YES NO $5 TOBACCO VENDOR YES NO $50 ALL NON-PROFIT(such as church kitchens) YES NO $25 *Please pay total with one check payable to the City of Salem. This Permit is not transferable and must be reissued upon change of ownership. The Permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code, before any renovations, improvements, or equipment changes are made, all plans for such must be submitted to and approved by the Salem Board of Health. Pursuant to MGL Chapter 62C, Section 49A, I certify under the pains and penalties of perjury that I, to my best knowledge and belief, have fileedd_ayl state tax returns and paid all state taxes required under the law. Signature Date Social Security or Federal Identification Number ------- ----- ------------------------- --------------------------------------- ------ -------- - - ------- -------- ...----- ------------------------------ Rcvised 11113/06 FOODAF2oo7.adm VCheck#B Date 3 514�h' _ 1�. o5 Q - $ �.B-6.00 +A' k �pr }}-m i+�e s T`: t,�y��..�1+°f e• njy � 3y }P�'�'^ i � CommonY�w¢slth,tof Maa ssachusetts gpz 'x " {A 'C( • fity1 '� va'�+ .-df '�" B 8[d Of Health°S i. 'k.y3.i 2i �T a� ;r2+.xr.+ .'`Jri � ,'.,, -^u ''�',pi � w . i � ti � IGmbefiey Dnscoll� .� 1tom, YI 120 Washington Street,4th Floor Y.(.. SALEM,MA 01970 Food/Retail Establishment Permit DATE PRINTED: 12/20/2006 ESTABLISHMENT NAME: Edgewater Cafe File Number:BHF-2003-000003 155 Washington Street Salem MA 01970 LOCATED AT: 0155 WASHINGTON STREET SALEM,MA 01970. Permit Type Permit No. Permit Issued Permit Expires Fee Restrictions/Notes FOOD SERVICE. BHP-2007-0175 Dec 20,2006 Dec 31,2007 $200.00 ESTABLISHMENT Total Fees: $200.00 PERMIT EXPIRES (December 31, 2007 Board of Health This Permit is not transferable and must be reissued upon change of ownership or location.The permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code,beofre any revonations,improvements,or equipment changes are made,all plans for such must be submitted to and approved by the Salem Board of Health. Page 2 of 8 ( k Massachusetts DepartmenVof Public Health Salem Board of Health Division of Food and Drugs 120 Washington Street,0 Floor 9 a Salem, MA 01970-3523 FOOD ESTABLISHMENT INSPECTION REPORT Tel. (978) 741-1800 Fax(978) 745-0343 Name ` \ Date Type of Ooeration(s) Type of Inspection I In -E /f CG d ®' Food Service ❑ Routine Address t IJ24 ` Risk / / ❑ Retail f Re-inspection ^ a' Level ❑ Residential Kitchen Previous Inspection El Mobile Date: (O T a Owner HACCP Y/N ❑ Temporary ❑ Pre-operation nn 1 I ❑ Caterer ❑ Suspect Illness Person in Charge(PIC) Time ❑ Bed&Breakfast ❑ General Complaint r� Inc 1,1,7_)o ❑ HACCP Inspector Q�a Out:7,2,-r Permit No. ❑ Other Each violation chetiked req fires 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) ❑pP 590.009(F) ❑ action as determined by the Board of Health. ?FOOD PROTECTION MANAGEMENT,„' ,;,,�-„�`��,".W;:,!-k' r^moi rF4`. ❑ 12. Prevention Of Contamination from Hands ❑ 1. PIC Assigned/Knowledgeable/Duties' ❑ 13 Handwash Facilities EMPLOYEE HEALTH + 197177 PROTECTION FROM CHEMICALS s ❑ 2. Reporting of Diseases by Food Employee and PIC mm=a h • +r N-=+= tl ❑ 14.Approved Food or Color Additives ❑ 3. Personnel with Infections Restricted/Excluded ❑ 15 Toxic Chemicals , FOOD FROM APPROVED SOURCE, ;'A 7,05- �:;m ''flME/rEMPERATURECONTROL6 LS(Poterrtlally Hazardous Faads) 51 , ❑ 4. Food and Water from Approved Source E,4 E] 5. Receiving/Condition y El 16.Cooking Temperatures ❑ 6. Tags/Records/Accuracy of Ingredient Statements ❑ 17. Reheating ❑ 7. Conformance with Approved Procedures/HACCP Plans ❑ 18.Cooling "PROTECTION FROM CONTAMINATION'R El 19. Hot and Cold Holding e.�"am„ t [18. Separation/Segregation/Protection [120.Time As a Public Health Control ❑ 9. Food Contact Surfaces Cleaning and Sanitizing REGuIREMENTS FOR HIOHLV SUSCEPTIBLE PQPULATtQNS(H&);_! ❑21. Food and Food Preparation for HSP ❑ 10. Proper Adequate Handwashing ❑ 11. Good Hygienic Practices :CONSUMENADVISORY= ❑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 NLL' by a Board of Health member or its agent constitutes an 23. Management and Personnel (FC-2)(S9o.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-71(590,00s) and submitted to the Board of Health at the above address 29. Special Requirements (590.009) within 10 days of receipt of this order. 30. Other DATE OF RE-INSPECTION: S.5001n,p Fc m 14.d. 0 0 n Inspector's Signature: Print: OC n 'dA iPIC's Signature: Print: "'; ' I ( Page ofPages 4- i , Violations Related to Foodborne Illness Interventions and Risk Factors(ftents 1-22) PROTECTION FROM CONTAMINATION FOOD PROTECTION MANAGEMENT 8 Cross-contamination , 1 596.003(A) I Assignment of Responsibility* 3-30211(A)(]) Raw Animal Foods Separated from F003(B) Demonstration of Knowledge Cooked and RTE Foods* 3.11 Person in charge--duties Contamination from Raw Ingredients 3-302.11(A)(2) Raw Annual Foods Separated from Each EMPLOYEE HEALTH Other- 2 590.003(C) Responsibility of the person in charge to Contamination from the Environment require reporting by foal employees and 3-302.11(A) I Food Protection* applicants* 3-302.15 Washing Fruits and Vegetables 590.003(F) Responsibility Of A Food Employee Or An 3-3(4.11 Food Contact with Equipment and Applicant To Report To The Person In Utensils* Charge* Contamination from the Consumer 590.(X)3(0) Reporting by Person in Charge* 3-306.14(A)(B) Returned Food and Reservice of Food* 31 590,003(D) Exclusions and Restrictions* Disposition of Adulterated or Contaminated 590.003(E) Removal of Exclusions and Restrictions Food 3-701J 1 Discarding or Reconditioning Unsafe FOOD FROM APPROVED SOURCE Food* 4 Food and Water From Regulated Sources r9 Food Contact Surfaces 590.004(A-B) Compliance with Food law* 4-501..111 Manual Warewashing-Hot Water 3-201.1.2 Faat in a Hermetically Sealed Container* Sanitization Temperatures* 3-201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Warewashing-Hot Water 3-202.13 Shea Ears* Sanitization Temperatures* 3-202.1.4 Eggs and Milk Products,Pasteurized* 4-501.114 Chemical.Sanitization-temp.,pH, 3-202.16 Ice Mads From Potable Drinkin*Water* concentration and hardness. * 5-101..1.1 DrinkingWater from an Approved System* 4-ti01_I1(Aj Equipment Food Contact Surfaces and 590.006(A) Bottled DrinkingWater* Utensils Clean* 590.006(B) Water Meets Standards in 310 CMR 22.0* 4-602.11 Cleaning Frequency ol'Equipment Food- Shellfish and Fish From an Approved Source Contact Surfaces and Utensils* 4-702.11 Frequency of Sanitization of Utensils and 3-201.14 Fish and Recreationally Caught Molluscan Food Contact Surfaces of Equipment" Shellfish* 4-703.11 Methods of Sanitization-Hot Water and 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* Sources* 10 Proper,Adequate Handwashing Regulatory Authority Game and uMushrooms Approved by 2-301.1.1 Clean Condition-Hands and Arms* 3-202.15 Shellstock Identification Present* 2-301.12 Cleattine Procedure* 590.004(C) Witd Mushrooms* 2-301.14 When to Wash* 3-201_17 Game Animals* I1 Good Hygienic Practices 5 - Receiving/Condition 2-401.11 Eating,Drinking or Using Tobacco* 3-202.11 PHFs Received at Proper Temperatures* 2-401.12 Discharges From the Eyes, Nose and 3-202.15 Package Integrity* Mouth* 3-101.11. Food Safe and Unadulterated* 3-301.12 Preventing Contamination When Tasting* 6 Tags/Records:Shellstock 12 Prevention of Contamination from Hands 3-202.15 Shellstock Identification* 590.004(E) Preventing Contamination from 3-203.12 Shellstock Identification Maintained* - Employees* Tags/Records: Fish Products 13 Handwash Facilities 3-402.11 Parasite Destruction* Conveniently Located and Accessible 3-402.12 Records.Creation and Retention* 5-203.11. Numbers and Capacities* 590.004(J) Labeling of Ingredients* 5-204.11 Location and Placement* ry Conformance with Approved Procedures 5-205.11 Accessibility,Operation and Maintenance fHACCP Plans Supplied with Soap and Hand Drying 3-502.11 Specialized Processin Methods* Devices _ 3-502.12 Reduced oxMn packaging,criteria* 6-301.11 Handwashin Cleanser, Availability 8-103.12 Conformance with A. roved Procedures* 6-30112 Hand Drvin2 Provision '*Denotes critical item in tie federal 1999 Fwd Cade or 105 CMR 590.000. - CITY OF SALEM / BOARD OF HEALTH / Establishment Name: E (� i La Date: !Z:) (! / _ �e Page:_L2q' of Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OFCORRECTION Date No. Reference R-Red Item Verified } .. PLEASE PRINT CLEARLY r 6 1 !A ! -eI - ...:n I 1 -!anl d L s L tl e a f z i f Discussion With Person in Charge: Corrective Action Required: ❑ No Yes tx 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 g comply with all mandates of the Mass/Federal Food Code. I understand that ,4t noncompliance may result in daily fines of twenty-fi e dollars or suspension/.evocation of ❑ Embargo ❑ Emergency Closure T your food permit. ❑ Voluntary Disposal ❑ Other: 3-501.14(C) PHFs Received at'I'emperatures Violations Related to Foodborne Illness Interventions and Risk According to Iaw Cooled to Factors(items 1-22) (Cont.) _=I1°F145`F Within 4 flours. * PROTECTION FROM CHEMICALS 3-501.15 Carling Methods for PHFs 14 Food or Color Additives 19 PHF Hot and Cold Holding 3-501.168) Gold P1iFs Maintained at or below 3-203.12 Addukes* 590,004(F) 41"145°F* 3-302.14 Protection firomUnar roved Additives* 3-501.16(A) Hot'PHFs Maintained at or above 1 j Poisonous or Toxic Substances 140°F. 7-101.1.1 Identifying Information-Original 3-501.16(A) Roasts Held at or above 130'F.' Containers" 7-102.11 Common Name-Working Containers- 20 1 Time as a Public Health Control 7-201.11 Se aration-Storaee" 3-501.19 Time as a Public Health Cori 7-202.11 Restriction-Presence mud User 590.004(H) Variance Re uirement 7-202.12 Conditions of Use" 7-203.11 Toxic Containers-Prohibitions* REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-204.11 Sanitizers,Criteria-Chemicals* POPULATIONS(HSP) 7-204.12 Chemicals for Washine Produce,Criteria* 21 3-801.1 I(A) Unpasteurized Pre-packaged Juices and 7-204.74 Drvin A ente,Criteria` Beverages with Wartine labels* 7-205.11 Incidental Food Contact,lubricants* 3-801.11(B) Use of Pasteurized Ee,,s* 7-206,11Restricted Use Pesticides.Criteria' 3-801.11{)) Raw or Partially Clwked Antmal Food and Raw Seed Sprouts Not Served * 7-206.12 Rodent g Po dens,Petatuars'I 3-801.11(0) lino iened Foaf Packa>c Not Re-served. 7?06.13 Tracking Powders,.Pest Control and Monitoring' CONSUMER ADVISORY TIME/TEMPERATURE CONTROLS 22 3-603.1 I Consumer Advisory Posted for Consumption of 1fi Proper Cooking Temperatures for Animal Foods Mature Raw.Undercooked or PHFs Not Otherwise Processed to Eliminate 3-401.11A(])(2) Eggy. 155F1sSec. Pathogeny Cfflrnl I ^nor Ti ts-hnmedtatt Service 145"Fl Ssec* 3-302.13 Pasteurized l,ggs Substitute for Raw Shell 3-401.11(A)(2) Comminuted Fish,Meats&Game H sir Animals- 155'F 15 sec, * 3-401.11(B)(I)(2) Pork and Beef Roast-130'F 121 min* SPECIAL REQUIREMENTS 3-401.11(A)(2) Ratites,Injected Meats- 155°F 1.5 590.009(A)-(D) Violations of Section 590,009(A)-(D)in sec.* catering, mobile food,temporary and 3-401_11(A)(3) Poultry,Wild Game,Stuffed PIfFs, residential kitchen operations should be Stuffing Containing Fish,Meat, debited under the appropriate sections Poultr or Ratites-165gF I S sec. * above if relatedto foodborne illness 3-901.1.1(0(3) Whole-muscle,Intact Beef Steaks interventions and risk factors. Other 145'F* 590.009 violations relating to good retail 3-401.12 Raw Animal Foods Cooked in a practices should be debited under/129- Mictowave 165`F* Special Requirements. 3-401.11(A)(1)(h) All Other PHFs-145°F15sec. * 17 Reheating for Hot Holding VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 3-403.1](,A)&([)) PHN 165'F 15 sec.i. (Items 23-30) 3-403.11(B) Microwave- 165'F 2 Minute Standing Critical and non-critical violations, which do not relate to the Time0c foodborne illness irnerventlons and risk factors listed above, can be- 3-403.11(C) Commercially Processed RTE Food- finntd in the following sections of the Food Code and 105 CMR 140'F* 590.000. 3-403.11(P) RemainingGnslicedPortions ofBeef Item Good Retail Practices FC 590.000 Roasts* 23. Marra ement and Personnel FC-2 .003 18 Proper Cooling of PHFs 24. Food and Food Protection FC_3 _ .004 3-501.14(A) Coolie Cooked PHFs from 140"P to 25 Equipment and Ufonslls FG 4_ .0105 Cooling 26 Water,Plumbinq and Waste FC 5 ,006 70'F Within 2 Hours and From 70'.F 27. Ph slcai Facility_ _____ FO-6 .007 to 4I'FJ45°F Within 4 Hours. * 28. Poisonous or Toxic Materials FC-7 .008 3-501_14(13) Cooling PHFs Made From Ambient 29. _ S eeia!Re uirements _ .009 Temperature higredients to 411'/45'F 30 Other Within 4 Hours* Denotes critical item In the{'\lend 1990 l'oml Code or 105 CMR 590060. Massachusetts Department of Public Health Salem Board of Health Division of Food and Drugs 120 Washington Street,0 Floor 9 Salem, MA 01970-3523 FOOD ESTABLISHMENT INSPECTION REPORT Tel. (978) 741-1800 Fax (978) 745-0343 Name Date T e of 0 ion(s) T e.of Inspection . r c7 04 �FoodService outine Address Risk [I Retail Re-inspection � Level ❑ Residential Kitchen Previous Inspection Telephone Q�G HACCP YM ElElMobile Date:,2(` P U Owner Temporary ❑ Pre-operation 1 S ❑ Caterer ❑ Suspect Illness Person in Charge`(PIC) Time E] Bed&Breakfast E] General Complaint .I '- In: JQ ElHACCP Inspector Out/e? 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. �! F06iD PROTECTION MAHAOEMEN7 ';- ; -'�u �� " E i 2. Prevention of Contamination from Hands E] 1 PIC Assigned/Knowledgeable/Duties �� a 13. Handwash Facilities j EMPLOYEE HEALTH - PROTECTION FROM CHEMICALS ❑�2 Reporting of Diseases by Food Employee and PIC =.ve F Food _=t o Additives ❑ 14. Approved Food or Color Additives ❑ 3. Personnel with Infections Restricted/Excluded ❑ 15.Toxic Chemicals ' FOOD FROM AVPROVEDSOURCE , _"��.„..,.,�„„;;;,k„�:,„„u�„.,�„;,,�.m„ , TIMErrEMPERATURE CONTROLS`(Potemlally Haiardos uFoods) E] 4. Food and Water from Approved Source �_ i � o RR-6 Receiving/Condition El 16.Cooking Temperatures -6 ❑ 6. Tags/Records/Accuracy of Ingredient Statements ❑ 17. Reheating ❑ 7. Conformance with Approved Procedures/HACCP Plans ❑ 18. Cooling `PROTECTION FROM CONTAMINATIONS i r " �19• Hot and Cold Holding #❑ 8. Separation/Segregation/Protection E120.TimeFAs 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 VCONSUMERAbVISORY:"" ❑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 ?C 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)(550.005) establishment operations. If aggrieved by this order, you 27. Physical Facility (FC-6)(590.ov) have a right to a hearing. Your request must be in writing 28. Poisonous or Toxic Materials (FC-7)(59o.00s) and submitted to the Board of Health at the above address 29. Special Requirements (590.009) within 10 days of receipt of this order. 30. Other DATE OF RE-INSPECTION: Sys ,s��Fo .,<da cx j /A- ;voG Inspe'ctor's Signature: - � Print: PIC's.Signature: \_i[ Print: � � Page ofj ges Violations Related to Foodborne Illness Interventions and Risk Factors(items 1-22) PROTECTION FROM CONTAMINATION FOOD PROTECTION MANAGEMENT 8 Cross-contamination 1 596.003(A) AssignmentoFResponsibility* 3-302.11(A)0) Raw Annual Foods Separated from 590.003(B) Demonstration of Knowledge* Cooked and RTE Foods* 2-103.11 Person in charge-duties Contamination from Raw Ingredients 3-302.1.1(A)(2) Raw Animal Fords Separated from Each EMPLOYEE HEALTH Other' 2 590.003(C) Responsibility of the person in charge to Contamination from the Environment require reporting by food employees and 3-302.11(A) Foal Protection* applicants* 3-302.15 Washing Fruits and Vegetables 590.003(F) Responsibility Of A Foal Employee Or An 3-304.11. Foal 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)(B) Returned Foal and Reservice of Food* 3 590.003(D) Exclusions and Restrictions* Disposition of Adulterated or Contaminated 590.003(E) Removal of Exclusions and Restrictions Food 3-701.1.1 Discarding or Reconditioning Unsafe FOOD FROM APPROVED SOURCE Food* a Food and Water From Regulated Sources 9 Food Contact Surfaces 590.004(A-B) Compliance with Food Law* 4-501.111 Manual Warewashing-Hot Water 3-201.12 Food in a Hermetically Sealed Container* Sanitization Temperatures* - 3-201.13 Fluid Milli and Milk Products* 4-501.112 Mechanical Warewashino Hot Water 3-202.1.3 Shell Enos* Sanitization Temperatures* 4-501.11.4 Chemical Sanitization-tem H, 3-202.14 E sand Milk Products.Pasteurized" concentration and hardnessp* p 3-202.16 Ice Made Fmrn Potable DrinkingWater* 4-601..11(A) concentration Ford Contact Surfaces and 5-'101.11 Drinkin Water from an Approved System* 590.006(A) Bottled Drinking Water* Utensils Clean* 590.006(B) Water Meets Standards in 310 CMR 22.0* 4-602.11 Cleaning Frequency of Equipment Food- Shellfish and Fish Froman Approved Source Contact Surfaces and Utensils* 4-702.11. Frequency of Sanitization of Utensils and 3-201.14 Fish and Recreationally Caught Molluscan Food Contact Surfaces of E ui ment* Shellfish* 4-703.11 Methods of Sanitization-flat Water and 3-201.15 Molluscan.Shellfish from NSSP Listed Chemical* Sources* ip Proper,Adequate Handwashing Game and Wild Mushrooms Approved by Regulatory Authority 2-301.1 t Clean Condition-Hands and Arms'` 3-202.18 Shellstock Identification Present* 2-301.1.2 Cleanin Procedure* 590.004(C) Wild Mushrooms* 2-301.14 When to Wash* 3-201.17 Game Animals* II Good Hygienic Practices - Receiving/Condition 2-401.11 Eating,Drinkin or UsingTobacco* 1 513-202.11 PHFs Received at Proper Temperatures* 2-401.12 Discharges From the Eyes, Nose and 3-202.1.5 Package Hue it * Mouth* 3-101.11 Food Safe and Unadulterated* 3-301.12 Preventing Contamination When Tasting* Tags/Records:Shellstock 12 Prevention of Contamination from Hands 3-202.18 Shellstock Identification * 590-004(F) Preventing Contamination from 3-203.1.2 Shellstock Identification Maintained* Emloees* Tags/Records: Fish Products 13 Handwash Facilities 3-402.11 Parasite Destruction* Conveniently located and Accessible 3-402.12 Records,Creation and Retention* 5-203.11 Numbers and Capacities* Location and Placement* 590904(7) Labeling of Ingredients' 7 Conformance with Approved Procedures 5-205.11 -Accessibility,Operation and Maintenance tHACCP Plans Supplied with Soap and Hand Drying 3-502.11 Specialized Processing Methods* Devices 3-502.1.2 Reduced oxygen packaging,criteria* 6-301.11 Handwashin Cleanser,Availability 8-103.12 Conformance with Approved Procedures* 6-301.12 Hand Drying Provision 'Denotes critical Item in the federal 1999 rood Cate or 105 CMR 590.060. - CITY OF SALEM rr BOARD OF HEALTH 0..)'! Establishment Name: -�r�_r I�� Date: / Pager of _ Item Code C-critical Iteri DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date No. r Reference R-Red Item. } •PLEASE.PRM. LEARLY Verified v lI r ' 1• / gi7lir �.. / r Cz C O A QM l CYJ l CGn Ap —on c D �. fi I (l 14 o° ' Irl �7 0� ` C ~✓ e , Q � G _�• _ ✓ l .A Discussion With Person in Charge: Corrective•Actio Required: ❑ No ❑ Yes ".t 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 0twenty-five oosuspee _s"iort/rev f ion of ❑ Embargo ❑ Emergency Closure your food permit. P rf ❑ Voluntary Disposal ❑ Other: 3-501.14(07) PHFs Received at Temperatures Violations Related to Foodborne Illness Interventions and Risk According to Iaw Cooled to Factors(items 1-22) (Cont) 41°F(45°F Within 4 Hours. PROTECTION FROM CHEMICALS 3-501.15 Coaling Methods for PHFs 1A Food or Color Additives 19 PHF Hot and Cold Holding -r A 3-501.168) Cold PI lFs Maintained at or w belo 3-21)2.12 Additives � 590.004(F} 41°!45°Pr' 3-302.14 Protection oisonou foam lxic 1 rosea Additives" t-501.1(i(A) Hot PHFs Maintained at or above IS Poisonous or Toxic Substances 140"F. * Containers'7-101.11 ntinerinfonnation-Original 3-501.16(A) Roasts Field atorobove130'F. * Co 7-102.11 Common Name-Working Containers- 20Time as a Public Health Control 7-20'1.11 I Separation-Stora e* 3-501.79 Time as a Public Health Control* 7-202.11 Restriction-Presence and flee'" 590.004(H) Variance Re uirentent 7-202.12 Conditions at Use" 7-203.11 Toxic Containers-Prohibitions* REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-204.11 Sanitizeis,Criteria-Chemic 1sT POPULATIONS(HSP) 7-204.1.2 Chemicals for Washing Produce, Criteria* 2;1 3-801.11(A) Re verages with Warning Labels-"Xismunzed Pre-packaged Juices and Be 7-204.14 Drvin ents.Criteria* - 3-801.11Bj Use of Pasteurized Fens* 7-205.11 incRestntal Food Contact.Lubricants* 3-801.11(D) Raw or Partially Cooked Animal Food and 7-206.11 Restriricted Use Pesticides.Criteria* Raw Seed S gouts Not Served.,F 7-206.12 Rodent Bait Stations'" 3-801.11( .0) Unoerred Foci Package Not Re-served. " 7-206.13 'Frocking Powders,Pest Control and Monitaiing* CONSUMER ADVISORY TIMEITEMPERATURE CONTROLS 22 3 603.7 I Consumer Advisory Posted for Consumption of Anunal Foods That are Raw.Undercooked or 16 Proper Cooking Temperatures for PHFs Not Otherwise Processed to Eliminate 3-4107.11A(1)(2) E'(,g,s- 1.55°F 1.5 Sec. Pathogens.* Pff"',-„vvirbha, 6 rqs-hinne,drate Service 145°F15see= 3-302.13 Pasteurized Eggs Substitute for Raw Shell 3-401.11(A)(2) Comminuted Fish,Meats&Came F gs^ Animals- 155`F 15 sec. 3-401.11(B)(1)(2) Pork.and Beef Roast- l31'F 121 min* SPECIAL REQUIREMENTS 3-401.11(A)(2) Ratites,Injected Meats-155°F 1.5 590.009(A)-(D) Violations of Section 590.009(A)-(D)in sec._ catering,mobile food, temporary and 3-401.-11(A)(3) Poultry,Wild Game,Stuffed PRFs, residential kitchen operations should be Stuffing Containing Fish,Meat, debited under the appropriate sections Pouter,or Ratites-165°F IS sec. * above if related to fcxidborne illness 3A01A 1( )(3) Whole-muscle,hitact Beef Steaks interventions and risk factors. Other 145°F r 590.009 violations relating to good retail 3-401.12 Raw Animal,Foods Cooked in a practices should be debited under#29- Microwave 165`F* Special Requirements. 3-401.11(A)(1)(b) All Other PHFs-145°F 15 sec. 17 Reheating for Hot Holding VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 3-403.11(A)8-(D) PHFs 165°.F 15 sec. * (Items 23-30) 3-403.11(B) Microwave-165°F 2 Minute Standing Critical and non-critical violations, avhich do not relate to the Time' foodborne illness interventions and risk factors listed above, can be 3-403.11(0) Commercially Processed RTE Food- found in rhe following sections of the Food Code and 105 C!VR 140"F'" 590.01)0. 3-403.1.1(Fs) Remaining Unsliced Portions of Beef Item Caaod Retail Practices FC 580.000 Roasts"` 23. Mans amentand Personne_I_ FC-2 003 1g Proper Cooling of PHFs 24._ Food and Food Protection FC-3 .004 . _ 3-501.14(.1) Coolhig Cooked PHFs from 140`F it) 25 E ui ment and Utensils FC4 .0_0526. Water,Plumbirat and Waste FC 5 .006 70-F Within 2 Hours and From 70"F 27. Physical Facile_ FC-6.' .007 to 411-'F/45"Frs.F145"F Within 4 Hou * 28. Poisonous or Toxic_Materials __ FC-7 .008 3-501.14(B) Cooling PI[Fs Made From Ambient 29. S eciai Re utrements j .009 Temperature lugredients to 41`F/45°F 30 Other -� -----__ ------_..._.._---- Within 4 Hours'% or n,ra:m� �'Denotes critical itcra in the Wexal 1999 Food Code or 105 CMR 590.000. CITY OF SALEM BOARD OF HEALTH Establishment Name: Ec Lr z coDate: / Page: cif, Item Code C-Critical item DESCRIPTION OF VIOLATION/PLAN OV CORRECTION Date No. Reference R-Red Item - Verified " PLEASE PRI T EARLY `f (� 2 S E}} ' k ti c I Lc PPS ojj"' i12 ki, a ;k I �t t , Xk� i - I --- 1 c i c i Discussion With Person in Charge: Corrective Action Required: ❑ No Yes ❑ Voluntary Compliance ❑ Employee Restriction/ 1 have read this report, have had the opportunity to ask questions and agree to correct all Exclusion violations before the next inspection, to observe all conditions as described, and to Re-inspection Scheduled ❑ Emergency Suspension comply with all mandates of the Mass/Federal Food Code. I understand that noncompliance may result in daily fins-of-twe`nt�ivettollar Fsuspens vocation of Embargo ❑ Emergency Closure your food permit. ❑ Voluntary Disposal ❑ Other: 3-50 t.Id(C� PHFs Received at Temperatures Violations Related to Foodborne fitness Interventions and Risk According to Law Cooled to Factors(items 1.22) (Cont.) 41°F1451T Within 4 Hours. PROTECTION FROM CHEMICALS 3-541-15 Cooluu,Methods for PRFs 14 Food or Color Additives 19 PHF Hot and Cold Holding 3-501.16(B) Cold PHFs Maintained at or below _T20212 Additives 590.004(F) 41`!45°F- 3-302 .'14 Protection from Una> roved Additives` r5 Poisonous or Toxic Substances - i-501.16(A) Hot PHFs Maintained at or above 14WR* 7-101.11 Identifying Information-Original3-501.16(A) Roasts Held at or above 130'17. Containers" 7-102,11 Common Narne-Working,Containers* 2U Time as a Public Health Control 7-201.11 1 Separation-Stoi a=c* 350L19 Time as a Public Health Control* 7-202.11 Restriction-Presence and Use* 590.004(H) Variance Requirement 7-202.12 Conditions of Ilse* 7-203-11 Toxic Containers-Prohibitions* REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-204.11 Sahnuzers,Criteria-Chenic ds* POPULATIONS(HSP) 7-204.12 Chemical for Washing Produce,Criteria"' 21 3-801.11(A) Unpasteurized Pre-packaged Juices and 7-204.14 DirzA guts,Criteria* ;Beverages with Warning Labels- 7 205 11 abels*7-205-11 Incidental Food Contact.Lubricants* 3-801.11 B) Use of Pas eurized Byes' 7-206.11 Restricted Use Pesticides,Criteria* 3-801.11(D) Raw or Partially Cooked Animal Food and Raw Sced S hrouts Not Served. 7-206.12 Rodent Bait Stations3-80'1.1 I(C) Uno ened Food P tcka=e Not Re-served. i 7-206.13 Tracking Powders,Pest Control and Mmtitarinn* CONSUMER ADVISORY_ TIMEITEMPERATURE CONTROLS 22 3-6 3.1I Consumer Advisory Posted for Consumption of Animal Foods'lliat are Raw, Undercooked or PHFs 16 Proper Cooking Temperatures for Not Otherwise Processed to Eliminate 3-401.1.1 A(1)(2) I' gs- 155 F 15 Sec. is- Pathos ns necnve roi L Lmnedtate Service 145�F15sec* 3-30'2.13 Pasteurized Eggs Substitute for Raw Shell 3-401.7I(A)(2) Comminuted Fish,Mcats VSs Game E gs7r Animals-155°F 15 sec.'e 3-401.11(13)(1)(2) Pork and Beef Roast-130°F 121 min* SPECIAL REQUIREMENTS 3-401.11(A)(2) Retires,Injected Meats-155°F 1.5 590.009(A)-(D) Violations of Section 590.009(A)-(D)in sec. * catering, mobile food, temporary and ,-401 JI I(A)(3) Poultry, Wild Came, Stuffed PHFs, residential kitchen operations should be Stuffing Containing Fish,Meat, debited under the appropriate sections Poultry or Ratites-165°F 15 see. " above if related to foodborne illness 3-401.11(C)(3) Whole-nnrscle,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 1429- Microwave 165°F* Special Requirements. 3-401-11(A)(1)(h) All Other PHFs- 145°F 15 sec 17 Reheating for Hot Holding VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 3-403.11(A)&(D) PRFs 165°F 15 sec. * (items 23-30) 3-403.11(B) Microwave- 165°F 2 Minute Standing Critical and non-crilical violations, which do not relate to the Time* foodborne illness interventions and risk fto tors lisuvrabove, (an be ,-403.11(C) Commercially Processed RTF Food- found in the following sections ojthe Food Code and 105 CMR '140°F* 590.000. 3-403.11(13) Remaining Unsliced Portions of Beef Item Good Retail Practices - FC 590.009 Roosts* 23. Management and Personnel _ 'FC--2 .003 18 Proper Cooling of PHFs 24. Food and Food Protection FC-3 .004 25. Equipment and Utensils FC 4_ .005_ 3-501.14(A) Cooling Cooked PHFs from 140`F to 26. ---- Water.Plumbin and Waste FC 5 .006_ 70°F Within 2 Hours and From 70°F 27. Ph sinal Facilit _ FC-6 1 .007 to 41°F1450F Within 4 Hours. ' 28. Poisonous or Toxic Materials FC-7 1 .008 3-501.14(B) Cooling PRFs Made From Ambient 29. S ectal Requirements uirements .009 Temperature lugredients to 41"F145°F 30 Other -k S'.51rxeibVck6-2 drc Within 4 Hours Denotes critical item in the.federal 1999 Food Code or 105 CMR 596.000. CITY OF SALEM _ BOARD OF HEALTH Establishment Name: C� CG Date: G Page:_ of Item Code C—critical Item DESCRIPTION OF VIOLATION/PLA OF CORRECTION Date No. Reference R-Red Item - Verified rPLEASEPQI T CLEARLY.. F� F der- rfry rt S v O E i. i' E ti 1t , F • Discussion With Person in Charge: Corrective Action Required: ❑ No Yes ❑ Voluntary Compliance ❑ Employee Restriction/ I have read this report, have had the opportunity to ask questions and agree to correct all Exclusion violations before the next inspection, to observe all conditions as described, and to /e-inspection Scheduled ❑ Emergency Suspension comply with all mandates of the Mass/Federal Food Code. I understand that noncompliance may result in daily fines gtwent rj If ve�c otta or su 4/revocation of ❑ Embargo ❑ Emergency Closure y` your food permit. / r ❑ Voluntary Disposal 0 Other: #` 3-501.14(0) PHFs Received at Temperatures Violations Related to Foodborne Illness Interventions and Risk According to taw Cooled to Factors(Hems 1-22) (Cont.) 41'F/45°F Within 4 Hours. PROTECTION FROM CHEMICALS3-501.15 Coolim,Methods for PHFs 14 Food or Calor Additives-- --- 1g PHF Hot and Cold Holding 3-501.16(B) Cold PHFs Maintained at or below 3-202.12 Additkec* 590.004(F) 41°I45°F 3-302.'(4 Protection from Una roved Additives'( IS Poisonous or Toxic Substances 3-501.16{A} I-lot PHFs Maintained at or above 40'F. * Gm 7-101.11 Identifying ntie ]nfocmation-Orionnal 3-501,16(A) Roasts Held atorabove130'R 7-1021'1 Common Name-Working*Containers* 20 -50Time as a Public Health Control 7-201.11 Separation-Stotaecs, 31.19 Tirne as a Public Health Control* 7-2021.1 Restriction-Presence and Use' 590.004(H) Variance Rc-uirement 7-202.12 Conditions of Use* 7-203.11 Toxic Containers-Prohibitions* REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-204.11 Sanitizers,Criteria-Chemicals'' POPULATIONS(HSP) 7-204.12 Chemicals for Washing Produce,Criteria* 2I 3-x01.17(A) Unpasteurized Pre-packaged Juices and 7-204.14 Dain*. ents,Criteria* Beverages with Wartime Labels* -- 7-205.11 Incidental Food Contact.Lubricants* 3-S0t_l I(B) Use of Pasteurized Ee,es* 7-206.1 1. Restricted Use Pesticides. Criteria* 3-801.1.1.(1)) Raw or Partially Cooked Animal Focal and Raw Seed S routs Not Served. ,k 7-206.12 Rodent Bait Stations': 1-801, Il(C) Unoened Food Pacl:a>e Not Re-served. " 7-306.13 Tow ng Powders,Pest Control and Monitoring* CONSUMER ADVISORY TIMEITEMPERATURE CONTROLS 22 3-603.11 Consumer A fvisory Posted for Consumption of 16 Proper Cooking Temperatures for Animal Foods"I'hat are Raw.Undercooked or PHFs Not Otherwise Processed to Eliminate 3-401.L1A1 ^ Patho^ens.*Os,61a vrrnooi { )(�} Eggs- 155'F 7 5 Sec. E>es-humediate Service 145'F15sec" 3-302.13 Pasteurized Eggs Substitute for Raw Shell 3-401.11(A)(2) Comminuted Fish,Metals&Game E gs.r Animals-155'F 15 sec. * 3-401.11(13)(1)(2) Pork and Beef Roast-130'F 121 min* SPECIAL REQUIREMENTS 3-401.11(A)(2) Ratites,Injected Meats-155°F 15 590.009(A)-(D) Violations of Section 590.009(A)-(10)in see. . catering, mobile food,temporary and 3-401.11(A,)(.3) Poultry,Wild Game, Surfed PHFs, residential kitchen operations should be Stuffing Containing Fish, Meat, debited under the appropriate sections Poultry or Ratites-1651715 see. % above if related to foodborne illness 3.401.t 1(C)(3) Whole-muscle,Intact Beef Steaks - interventions and risk factors, Other I450F* 590.009 violations relating to good retail 3-401.12 Raw Anneal Foods Conked in a practices should be debited under 6'29- Microwave 165'F* Special Requirements. 3401AI(A)(i)(b) All Other PHFs- 1,45'F15see. ` 17 Reheating for Hot Holding VIOLATIONS RELATED TO GOOD RETAIL PRACTICES -1-403.1](A)&(D) PHFs 165'F 15.sec. * (items 2330) 3-403.11(B) Microwave- 165°F 2Minute Standing Critical and non-critical violations, which do not relate to the Time* foodborne illness interventions and iiskfitctors listed above, can be 3-403.11(C) Commercially Processed RTE Foal- ,found in the following sections of the Food Code and 105 CMR 14WIF, 590.000. 3-403.1.1(E) Remaining UnslicedPortions of Beef Item Good Retail Practices fC 580.000 --- Roasts" 23. Mona event and Personnel FC-2 .003 18 Proper Cooling of PHFs 24. Food and Food Protection .004 25. _Equipment and Utensils --FC-4---- .005 3-5(7].14(A) Cooling Cooked PHFs from 140'F to 26 yvater, Plumbing and Waste FC-5 006 70°F Within 2 Hours and From 70'F 27. Ph ssical Facilites FC-6 .007 to 41'F/45'F Within 4 Hours.* 28. Poisonous or Toxic Materials FC-7 .008 3-501.14(11) Cooling PI lFs Made From Ambient 29. S ectal Re uiremems 009 Ternpetnture hngredients to 41'F/45-F 30. _,0ther Within 4 Hours'" *Denotes critical item in the fMerel 1999 Foal Code or 105 CMR 590,000. Massachusett's Department of Tub�lic Health Salem`Board of Health 120 Washington Street,4'" Floor Division of Food and Drugs Salem, MA 01970-3523 FOOD ESTABLISHMENT INSPECTION REPORT Tel. (978) 741-1800 Fax (978) 745-0343 Name � Dart,, Tvpe of 0 eration(s) Type of Inspection /t Y F®" Food Service G❑rEloutine Address �, { Risk' `❑ Retail 0 Re-inspection Isk2Telephone 1 Level ❑ Residential Kitchen Previous ction P J - ,6 _ ❑ Mobile Date: ,7,07g, Owner "� HACCP Y/N ❑ Temporary ❑ Pre- peration (n, aCJ. ❑ Caterer ❑ Suspect Illness Person in Charde'(PIC) J. �* `�' ' Time El Bed& Breakfast El General Complaint 1 n In:�} L El HACCP inspector PtL Otffc� 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. t FOOD PROTECTION MANAGEMENT El12. Prevention of Contamination from Hands E] 1. PIC Assigned/Knowledgeable/Duties EMPLOYEE HEALTH -• E] 13. Plandwash Facilities ; � PROTECTION FROM CHEMICALS ❑ 2. Reporting of Diseases by Food Employee and PIC _ k- W: ❑ 14. Approved Food or Color Additives ❑ 3. Personnel with Infections Restricted/Excluded 1 ,.FOOD FROM APPROVED SOURCE ; , El 15.Toxic Chemicals ❑ 4. Food and Water from Approved Source • TIME/TEMPERATURE CONTROLS(Potentially HaiaidouiFood§)° '. ❑l 5. Receiving/Condition ❑ 16. Cooking Temperatures a"W El°'6. Tags/Records/Accuracy of Ingredient Statements E] 17. Reheating ❑ 7..'Conformance with Approved Procedures/HACCP PlansOn 18. Cooling y. ` PROTECTION FROM CONTAMINATION' - a ;❑ 19. Hot and Cold Holding ❑ 8. Separation/Segregation/Protection Ell 20.Time As a Public`Health Control { El 9. Fp od Contact Surfaces Cleaning and Sanitizing �-REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) El 10: Proer Adequate Handwashing ; • 11. Good Hygienic Practices [121. Food and Food Preparation for HSP p �« El �° CONSUMER ADVISORY. , , ,, =� • . .- � ,-• -� \ s ❑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 i Official Order for Correction: Based on an inspection immediately dwithin 90 days as determined by the Board today, the items checked indicate violations of 105 CMR ofHealth. t 590.000/federal Food Code. This report, when signed below 23. Management and Personnel (FC-2)(5900 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 11 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. SpecialRequirements (590.009) `� within 10 days of receipt of this order. 30. Other ` DATE OF RE-INSPECTION 5:501nsWfForm.14 dW ,� Pi Inspector's Signature. \�� Print: PIC's Signature: Print: Page .-rof_�?ages �T N � l Y Violations Related to Foodborne Illness interventions and Risk Factors(items 1-22) PROTECTION FROM CONTAMINATION FOOD PROTECTION MANAGEMENT 8 Cross-contamination 1 590.003(A) 4esi-nment of Res7xmetfibt}"b 3-302.11(A)(l) Raw Annual Foods Seprratcd from 590.003(B) Dcmonstrilion of Knowledbe"`. _ Cooked and RTEFoods* 2 103.11. Pcrnon in char),e-cluhe5 Contamination from Raw Ingredients 3-302A 1(A)(2) Raw Animal Foods Separated from Fact, EMPLOYEE HEALTH Other' 2 590.003(0) Responsibility of the person in charge to Contamination rrorn the Environment require reporting by foot employees and 3-302.11(A) Food protection* a rlicmus* 3-302.t5 1%Jashin=Fruitsaad Ve.*stables 590,003(F) Responsibility Of A Foul Employee Or An 3-304.11. Food Contact with Equipment and Applicant To Repot To The Person In Urensils* Char,e+ Contamination from the Consumer 590.003(G) Re Orrin b Person in Charee* 3-306.14(A)(B) Returned Food and Reservice of Food* 31 590.603(D) I Exclusions and Restrictions* Disposition of Adulterated or Contaminated 590.003(E) Removal of Exclusions and Restrictions Food 3-701.11 Discarding or Reconditioning Unsafe FOOD FROM APPROVED SOURCEFood*4 Food and Water From Regulated Sources 9 Food Contact Surfaces 590.004(A-B1 Compliance with Food Law'r 4-5O1.11 I Manual Wn pera Brat-Hot Watet 3-201,12 Food in a Hermetically Sealed Container* S ech WarewaTem eratures"' 3-201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Warewashing-Hot Water 3-202.13 Shell Eggs* Sanitization Temperatures* 3x02,}4 E<<s and Mil Produces.Pasteurized* 4-501.114 Chemical Sanitization-temp.,pH, concentration and hardness r 3-202.16 Ice Made From Potable Drinking Wafer'" - 5-101.11 Drinkin Water front an A C Approved System* 4-(i01.11(A) Equipment Food Contact Surfaces and 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* Sheiffish and Fish From an Approved Source 4-702.11 Frequency of Sanitization of Utensils and 3-201.14 Fish and RecreationallyCaught Molluscan Food Contact Surfaces of E ul.mens* Shellfish* 4-703.11 Methods of Satntization-Hot Water and 3-201.15 Molluscan Shellfish from NSSP listed _ Chemical* Sources* 10 Proper,Adequate Handwashing Game and Wild Mushrooms Approved by 2-301.11 Clean Condition-Hands and Arms* Reau,litory Authont 3-20218 Shellstock Identification Present* 2-301.t2 Clearing?Procedure* 590.004(C) Wild Mushrooms* 2-301.14 When to Wash* 3-201.17 Game Animals* ll Good Hygienic Practices Es Receiving/Condition 2-401-i 1 Eatin ,Drinking or Usrn "Pobacco* 3-20111 PHFs Received at Proper Temperatures 2-401.12 Discharges From the Eyes, Nose and 3-202.15Package Inte rit;* Mouth* 3-101.11 Food Safe and Unadulterated* 3-301.12 Preventing Contamination LVhen Tasting" [, Tags/Records:5heilstock 12 Prevention of Contamination from Hands 3-202.18 Shellstock Identification* 590.004(F.) Preventing Contamination from 3-203.12 Shellstock Identification Maintained" Empto ccs* Tags/Records:Fish Products 13 Ha Facilities 3-402.11 Parasite Destmctiun* Convenieniry Located and Accesslbfe 3-403.12 Records.Creation and Retention' 5-203.11 Numbers and Capacities - 590.004(1) Labeling of Ingredients' 5-204.11 Location andPlacernent* 7 Conformance with Approved Procedures 5-205...1 Accessibility, Operation and Maintenance /HACCP Plans Supplied with Soap and Nand Drying 3-502.11 S ecialized Processing Methods* Devices 3-502.1.2 Reduced osvgen racks ng,criteria* 6-301.11 HiadwashinE Cleanser,Availability 8-(03.12 Conformance with A. xoved Procedures'K 6-301.12 Hand Dr in*Provision *Denotes critical item in the ted�'al 1999 Pa)d Code or 765 C1NR590.6(10. ,`F 5 �,7r 4 CITY OF SALEM F ( BOARD OF HEALTH Establishment Name: t Date: e2 L Page:_ of,__':2 Item .Code. C-Critical Uem . DESCRIPTION'S OF VIOLATION/PLAN OF CORRECTION - pate No. Reference R—Red item Verified PLEASE PRINT CLEARLY }'Ne- r bra ow d C (Ocm °'- L.), /Y? l 1 �fi .D I n \. n \ An/l 4 �L J a Ine t^ � ym G43 n t . Discussion With Person in Charge: Corrective Action Required: C3 No ' Yes have read this report, have had the opportunity to ask questions and agree to correct all Voluntary Compliance ❑ Employee Restriction/ 'r Exclusion violations before the next inspection, to observe all conditions as described, and to ❑ Re-inspection Scheduled ❑ Emergency Suspension ,A comply with all mandates of the Mass/Federal Food Code. I understand that noncompliance may result in daily fines of twenty fiVe dollars-oT su pension/revocation of ❑ Embargo ❑ Emergency Closure your food permit. 0 Voluntary Disposal 0 Other: 'k µ 3-501,T4(C) PHFc Received n Temperatures Violations Related to Foodbarne illness lnte;ventions and Risk According to Law Cooled to Factors(items 1.22) (Cont.) 41'F/45'E Within 4 Hours. PROTECTION FROM CHEMICALS'* 3701.15 Cooling,Methods for PHFs 14 Food or Color Additives 19 PHF Hot and Cold Holding 3-501.16(B) Cold PlIFs Maintained at or below 3-202.12 ProtectAdditiion .• 590.004(F) 41%45'F^ 3-302.(4 Protdcllott,from77hat roved Additives* r-7-_ Poisonous or Toxic Substances 3-501.1(i(A} Rot PHFs Maintained at or above 40°F. " 7-101.11 Id'enflfyittg Information-Original 3-501.16(A) Roasts Held at or above li0'F, Container* 7-102.11 Common Name--Workinn Containers'" 20 Time as a Public Health Control 7-201.11 Se araiion-Stora e° 3-007.19 Time as a Public HealthContr7l* 7-202.'11 Restriction-presenceazidtJse* 590.004(H) Variance Requirement 7-202.12 Conditions of Use" 7-203.11 Toxic Containers-Prohibitions REOUIREMENTSFORHIGNLYSUSCEPTIBLE 7-204.11 Sanitiaets,Criteria-Chemicals* POPULATIONS(HSP) 7-204.12 Chem3-8 icals for Wsshin Ptndnce. Criteria* 21 01.11(A) Unpasteurized Pre-packaged Juices and _ Beverages with Warning label%- 7-204.74 Drvina A guts,Criteria* ,3-801.11(B) Use of Pasteurized Eggs* 7-205.11 Incidental Food Contact,Lubricants' 7-206.11 Restricted Use Pesticides,Criteria* 3-801.11(D) Raw or Partially Cooked Anhnal Food and Raw Seed Sprouts Not Setved. 7-206.12 Rodent Bait Stations' 3_g0'1.11(C) Uno erred Foci parka=e Not Re-served. * 7-206-'13 'Frackmg Powders,Pest Control and Monitoring* CONSUMER ADVISORY TIMElTEMPERATURE CONTROLS 22 3-603.11 Consumer Advisory Posted for Consumption of Animal Foods That are Raw.Undercooked or PHFs 16 Proper Cooking Temperatures for Not Otherwise Processed to Eliminate 3-401.LIA('I)(2) I,gs- t55 FtsSec. i'athorcns * 'tscno,,r r-,poi Eggs-Immediate Service 145'Fl5sec* 3-302.13 Pasteurized Eggs Substitute for Raw Shell 3-401.1](A)(2) Comminuted Fish,Mears&Game Eggs* Animals- 155'F 15 sec. 3-401.11(B)Mi,2) Pork and Beef Roast-130'F 121 min* SPECIAL REQUIREMENTS 3-401.1 I(A)(2) Ratites,Injected Meats-155'F 15 590.009(A)-(D) Violations of Section 590.009(A)-(D)in sec,* catering, mobile food,temporary and 3-401.1.1(A)(3) Poultry,Wild Game, Stuffed PRFs, residential kitchen operations should be Stuffing Containing Fish, Meat, debited ander the appropriate sections Poultry or Ratites-1653F 15 sec. i• above if related to foodborne illness 3401.11(C(3) Whole-muscle,Intact Beef Steaks interventions and risk factors. Other 145°F* 590.009 violations relaftng to good retail 3-401.12 Raw Animal Foods Cooked in a practices should be debited tinder fY29- Microwave 165'F* Special Requirements. 3-401.11(A)(1)(h) All Other PHFs-145'F'15see, ;' 17 Reheating for Hot Holding VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 3-403.11(A)&(D) PHF,165'F 15 sec. * (Items 23-30) 3-403.11(B) Microwave-1650 1,2 Mande Standing Critical and ruin-critical Volatrons, which do not relate to the Time` firodborne illness interventionsi-fa and riscrors fisted above, can he 3-403.1 1(C) Commercially Processed RTE Food- found in the following sections of the Food Code and 105 CMR 140°F* 590.000. 3-403.11(E) Remaining Unsliced Portions of Beef item Good Retail Practices___ fC 590.0!70 Roasts* 23. Mand oment and Personnel, _ FC-2 .003 18 Proper Cooling of PHFs -24. Food and Food Protection _ FC-3 .004 25. _..Equipment and Utensils _ FC-4 _ .005 3-501 14(A) Cooling Cooked PFIFs from 1,40'F to 2i Water.Plumbin and Waste FC 5 006 --- 70°F Wit'hut 2 Hours and From 70'F 27 Physical Facili FC-6 .007 to 41.'F)45'F Within 4 Hours. * 28. Poisonous or Toxic Materials FC-7 .008 _7501 14(B) Coling P1IFs Made Prom Ambient 29. Special Requirements .009 Temperature Ingredients to 410F145'F Within 4 flours sssromr� amo 'R Denotes critical item in the lederal 1999 Food Code or 105 CMR 590 000. Y j§ •.+r'• " . Ya ws ,4 ays :,5., r .. ,..' .. x. "ss�.?,�v�y.}.+J0.r 5 a`�w '...r S ..+v v.,...w.-. w ,:4.'R 'r&+5,,. x - ,.. -.. .. ., rw:... "-•mr'TN1r�."+a.N�• Commonwealth of Massachusetts City of Salem Board of Health 120 Washington Street,4th Floor SALEM,MA 01970 IR^-�Ute �$l ZVI �~= Food/Retail Establishment Permit DATE PRIM rED: 12/14/2005 WHO'S PLACE OF BUSINESS IS: Edgewater Cafe File Number:BHF-2003-0003 155 Washington Street Salem MA 01970 LOCATED AT: 0155 WASHINGTON STREET SALEM, MA 01970 Permit Type Permit No. Permit Issued Permit Expires Fee Restrictions/Notes FOOD SERVICE BHP-2005-0514 Dec 14,2005 Dee 31,2006 $200.00 ESTABLISHMENT 57-06 Total Fees: $200.00 PERMIT EXPIRES December 31, 2006 Board of Health This Permit is not transferable and must be reissued upon change of ownership or location. The permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code, beofre any revonations, improvements,or equipment changes are made,all plans for such must be submitted to and approved by the Salem Board of Health. Page 1 of 1 CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH ( 120 WASHINGTON STREET, 4TH FLOOR SALEM, MA 01970 TEL. 978-741-1800 STANLEY J. USOVICZ, JR. FAX 978-745-0343 MAYOR W W W.SALEM.COM JOANNE SCOTT, MPH, RS, CHO HEALTH AGENT 2006 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT NAME OF ESTABLISHMENT. L��-h C�LA'r� TEL# r ADDRESS OF ESTABLISHMENT o1G-l`)SGl bt MAILING ADDRESS (if different) ,, I �d OWNER'S NAME TEL#�7r}- �I-73 �O ADDRESS 3 T CITY STATE ZIP d CERTIFIED F O0 MANAGER'S NAME(S) AfA_ lNwo CERTIFICATE#(s) t .pQ /Ga/ (required in an establishment where pd enttiially hazardous food is prepared.) EMERGENCY RESPONSE PERSON IA°k4i �Q HOME TEL# HOURS OF OPERATION: Mon.k I\ fue.n It Wed. 1t-(IThu.tt- 11 Fri.14-it Sat.!'- // Sun.0 -/( TYPE OF ESTABLISHMENT FEE (check only) RETAIL STORE YES VO less than 1000sq.ft. =$ 50 1000-10,000sq.ft. =$100 more than 10,000sq.ft. =$250 --- -------- - -------------------,��- ---.......----.......---------......-------------.---2, ..-------- --........------------------------------------.- RESTAURANT /rta I NO ^ '0� less than 25 seats =$100 `�/ , l] 25-99 seats =$150 more than 99 seats - ---------------------------------------------------------------------------------*--------- BED/BREAKFAST YES N ' $100 ADDITIONAL PERMITS -----------------------------------------.....-------------------------------------------------------------_-------------- i MAKE (not just serve) ICE CREAM, YOGURT, ovr I SERVE YES $5 TOBACCO VENDOR YES $50 ALL NON-PROFIT(such as church kitchens) YES $25 *Please pay total with one check payable to the City of Salem . This Permit is not transferable and must be reissued upon change of ownership. The Permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code, before any renovations, improvements, or equipment changes are made, all plans for such must be submitted to and approved by the Salem Board of Health. Pursuant to MGL Chapter 62C, Section 49A, I certify under the pains and penalties of perjury that I, to my best knowle�ief all state tax returns and paid all state taxes required under the law. 013- (o,- °� Signature Date Social Security or Federal Identification Number ------------------------------------------------------------------------------------- ----------------------------------------------- Revised 11/03/05 FOODAP2.adm Check#&Date 1A 1�79�9 0155 Washington Street Edgewater Cafe City of Salem FOOD SERVICE ESTABLISHMENT - FOOD SERVICE Inspection HACCP: ❑ Telephone: nem Status Violation Critical Urgency Nature of problem or correction 740-4669' Noncompliance with: Not Done Owner Anti-Choking PASS ❑ x Dennis Moustakis Tobacco PASS ❑ PIC en MOUStak D6nlS IS - FOOD PROTECTION MANAGEMENT Not Done Innis r PIC Assigned/Knowledgeable/Duties PASS RED David Greenbaum EMPLOYEE HEALTH Not Done Date Inspected: Correct By: Reporting of Diseases by Food Employee and PIC PASS (] RED 13/10/2005 Personnel with Infections Restricted/Excluded PASS 0 RED Risk Lever FOOD FROM APPROVED SOURCE Not Done Permit Number Food and Water from Approved Source PASSd❑ RED BHP-2005-0084 a Receiving/Condition PASS RED Status: Tags/Records/Accuracy of Ingredient Statements PASS RED SIGNED OFF Conformance with Approved Procedures/HACCP PASS RED #Of Critical Violations: Plans 2 _ = PROTECTION FROM CONTAMINATION Not Done Time IN: Time OUT: Separation/Segregation/Protection PASS RED Notes: Food Contact Surfaces Cleaning and Sanitizing FAIL Critical ❑v RED Cutting boards arevstained and scored. 17: Resurface or replace cutting boards. Proper Adequate Handwashing PASS - 0 RED Urgency Description(s): Good Hygienic Practices PASS RED BLUE: Violations Related to Good Prevention of Contamination from Hands PASS RED Retail Practices (Critical Handwash Facilities FAIL Critical ❑d RED Hand wash sink by walkin obstructed. Violations must be corrected Hand wash sink must be clear and immediately or within 10 accessible at alltimes. days)(Non-critical violations GeoTMS®2005 Des Lauriers Municipal Solutions, Inc. ( Rev. Mar 11,2005 ) Page 1 oft 0155 Washington Street Edgewater Cafe must be Corrected Immediately PROTECTION FROM CHEMICALS Not Done of within 90 days) Approved Food or Color Additives PASSd❑ RED RED, Violations Related to Toxic chemicals PASSd❑ RED Foodborne Illness InterventlonS TIME/TEMPERATURE CONTROLS(Potentially Haz Not Done and Risk Factors (Require Cooking Temperatures PASSd❑ RED immediate corrective action) Reheating PASS ❑J RED Cooling PASSd❑ RED Hot and Cold Holding PASSd❑ RED Time As a Public Health Control PASSd❑ RED REQUIREMENTS FOR HIGHLY SUSCEPTIBLE PO Not Done Food and Food Preparation for HSP PASS ❑Q RED CONSUMER ADVISORY Not Done Posting of Consumer Advisories PASS ❑d RED Violations Related to Good Retail Practices (Blue Not Done Management and Personnel PASS ❑ BLUE Food and Food Protection PASS ❑ BLUE Equipment and Utensils PASS ❑ BLUE Water, Plumbing and Waste PASS ❑ BLUE Physical Facility PASS ❑ BLUE Poisonous or Toxic Materials PASS ❑ BLUE Special Requirements PASS ❑ BLUE Other-See Notes PASS ❑ BLUE GeoTMS®2005 Des Lauriers Municipal Solutions, Inc. ( Rev. Mar 11,2005 ) PaQe 2 oj2 �. Q .r y =+Ft1•a*. w ..Rt :Me34nY^�."Si7 " :`j A ++Y=+,mte4* F + .+nWw, _>.,�.r*'ivar4 `54+-a5y "5.,..r .at .. 9 CITY`CF.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: Edgewater Cafe Address of Establishment: 155 Washington Street Owner's Name: Dennis Moustakis Restrictions: Application Date: 11/18/04 Permit for Food Establishment 26-05 Frozen Desserts/Ice Cream Permit for the Sale of Tobacco Products These Permits Expire December 31, 2005 This permit is not transferable and must be reissued upon change of ownership or location. The permit must be posted in a prominent location in the Establishment, In accordance with the State Sanitary Code, before any renovations, improvements, or equipment changes are made, all plans for such must be submitted to and approved by the Salem Bold of Health. HEALTH AGENT r ~ CITY OF SALEM9 MASSACHUSETTS .*. BOARD OF HEALTH _ 120 WASHINGTON STREET, 4TH FLOOR o SALEM, MA 01970 .� TEL. 978-741-1800 FAX 978-745-0343 STANLEY J. LISOVICZ, JR. JOANNE SCOTT, MPH, RS, CHO MAYOR HEALTH AGENT 2005 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT NAME OF ESTABLISHMENT S I(^ lr X 12 �rA�ti TEL# !Ta-7L/Al -Z/�7� ADDRESS OF ESTABLISHMENT MAILING ADDRESS (if different) OWNER'S NAME V)Ul1J-hq lei ) TEL# 91,E-7��/-��/ ADDRESS /. CITY STATE I111fISC ZIP CERTIFIED FOOD MANAGER'S NAME(S)gzttio CERTIFICATE#(s) hi S' S" (required in an establishment where potentially hazardous food is prepared.) EMERGENCY RESPONSE PERSON 1lzQ%v MI:,A_4gkCi_ HOME TEL#QJ-N d -*,*Cel HOURS OF OPERATION: Mon. 11 Tue1�eIl Wed.11- (I Thu.Jl-II Fri.1l-(1Sat.]1 -1) Sun.14-1I TYPE OF ESTABLISHMENT FEE check only RETAIL STORE YES O less than 1000sq.ft. =$50 1000-10,000sq.ft. =$100 more than 10,000sq.ft. =$250 RESTAURANT YE NO less than 25 seats =$100 25-99 seats =$150 more than 99 seats $200 BED/BREAKFAST YES $10 ADDITIONAL PERMITS MAKE (not just serve) ICE CREAM, YOGURT, SOFT SERVE YES NO $5 TOBACCO VENDOR YES NO $50 ALL NON-PROFIT(such, as church kitchens) YES NO $25 Please pay total with one check payable to the City of Salem This Permit is not transferable and must be reissued upon change of ownership. The Permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code, before any renovations, improvements, or equipment changes are made, all plans for such must be submitted to and approved by the Salem Board of Health. Pursuant to MGL Chapter 62C, Section 49A, I certify under the pains and penalties of perjury that I, to my best kn dge and beli f, h ✓e filed all state t x returns and paid all state taxes r wired under the law. 012 Signature Date Social Security or Federal Identification Number ------------------------------------------------------------------------------------------------'-------------------------------------- Revised 11/03/03 FOODAP2.adm Check#&Dale 3 7y7 10/22/2008 07:51. 7815927641 PAGE 01/01 190 SIMPam;.$!C 0! Lynn,MA 0'190;! Vakc 761-597..27:11 % ::A.i Exterminators: :, 800-5..".5+t82:i Fu 781-597.76[1 Fjna4:T1in(n(li�ilr,�dF,rminalors C01n w .,Jexlem @1. 1 yy,,1 From: Zzk� 7o• ' Faac �+ it Pa es: company!-�.� Date: CC: Re: 8'Urgenot El For Revue' 0 Please Comment ❑Please Reply , O Please Recycle �o n CITY OF SALEM9 MASSACHUSETTS BOARD OF HEALTH _ 120 WASHINGTON STREET, 4TH FLOOR SALEM, MA 01 970 ' = 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: Edgewater Cafe Address of Establishment: 155 Washington Street Owner's Name: Dennis Moustakis Restrictions: Application Date: 12/11/2003 Permit for Food Establishment 180-04 Frozen Desserts/Ice Cream Permit for the Sale of Tobacco Products These Permits Expire December 31, 2004 This permit is not transferable and must be reissued upon change of ownership or location. The permit must be posted in a prominent location in the Establishment, In accordance with the State Sanitary Code, before any renovations, improvements, or equipment changes are made, all plans for such must be submitted to and approved by the Salem Board of Health. HEALTH AGENT z7 y { CITY OF SALEM, MASSACHUSETTS '71s Pmz- c� B dee BOARD OF HEALTH s 120 WASHINGTON STREET, 4TH FLOOR' SALEM, MA O1970 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 h:' [I-0 1644:m, 06:r- TEL TEL# Oq7F -7yU- ADDRESS OF ESTABLISHMENT a�S� ht k Ines Si— MAILING ADDRESS (if different) :Lin 0 OWNER'S NAMETEL# ADDRESS �3 S 1 CITY S ... STATE zip 0/S7U CERTIFIED FOOD MANAGER'S NAME(S) ei: CERTIFICATE#(s) e§ (required in an establishment where potentially hazardous food is prepared.) 1 cjG3 EMERGENCY RESPONSE PERSON De-n r1�1 10G-3h- ql� HOME TEL# 9.2 k ,7vc1, HOURS OF OPERATION: Mon JI / Tue.)4Wed.0,q-Thu._io;1L Fri. it 1 Sat. II I Sun.�13- TYPE OF ESTABLISHMENT FEE check only RETAIL STORE YES N less than 1000sq.ft. =$ 50 1000-10,000sq.ft. =$100 more than 10,000sq.ft. =$250 RESTAURANT ES NO less than 25 seats =$100 25-99 seats =$150 more than 99 seats 4%m� BEDIBREAKFAST YES NO $100 ADDITIONAL PERMITS MAKE (not just serve) ICE CREAM, YOGURT, SOFT SERVE YES NO $5 TOBACCO VENDOR YES NO $50 ALL NON-PROFIT(such as church kitchens) YES NO $25 Please pay total with one check payable to the City of Salem This Permit is not transferable and must be reissued upon change of ownership. The Permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code, before any renovations, improvements, or equipment changes are made, all plans for such must be submitted to and approved by the Salem Board of Health. Pursuant t MGL Chapter 62C, Section 49A, I certify under the pains and penalties of perjury that I, to my best k nd lie e filed �Iat�t �� rurns and paid raall s�te �equired under the law. Signature 1 Date / Social Security or Federal�ldentlfl atlon Number ------------------------------------------------------------------------------------------------------------------------------------- Revised 11/03/03 FOODAP2.adm Check#8 Date 3 /4� —3-03 Massachusetts Department of Public Health Salem Board ofSHeaith 120 Washington Street,4'" Floor Division of.Food and Drugs Salem, MA 01970-3523 FOOD ESTABLISHMENT INSPECTION REPORT Tel. (978) 741-1800 Fax(978) 745-0343 Namej} Dat Type of Operation(s) T e of Inspection n r�Vod Service ��R9utine Address Risk H Retail (�Fie-inspection 1,5k bkshl Level ❑ Residential Kitchen Previous Inspection Telephone ❑ Mobile Date: B�/��0o Owner HACCP YIN Temporary ❑ Pre- per d El Caterer ❑ Suspect Illness tu Person in h n (PI Time El Bed& Breakfast El General Complaint In: ❑ HACCP Inspector Out: Permit No. ❑Other Each viola Ian c ecked requires an explanation on the narrative page(s) and a citation of specific provision(s)violated. Non-compliance with: Violations Related to Foodborne Illness Interventions and Risk Factors Anti-Choking Tobacco Violations marked may pose an imminent health hazard and require immediate corrective 590.009(E) ❑ 590.009(F) ❑ action as determined by the Board of Health. FOOD PROTECTION MANAGEMENT. - _._ ❑ 12. Prevention of Contamination from Hands ❑ 1. PIC Assigned/Knowledgeable/Duties ❑ 13. Handwash Facilities EMPLOYEE HEALTH PROTECTION FROM CHEMICALS ❑ 2. Reporting of Diseases by Food Employee and PIC ❑ 14, Approved Food or Color Additives ❑ 3. Personnel with Infections Restricted/Excluded ❑ 15.Toxic Chemicals FOOD FROM APPROVED SOURCE - -- TIMEiTEMPERATURE CONTROLS(Potentially Hazardous Foods) ❑ 4. Food and Water from Approved Source ❑ 5. Receiving/Condition [116, Cooking Temperatures ❑ 6. Tags/Records/Accuracy of Ingredient Statements ❑ 17, Reheating ❑ 7. Conformance with Approved Procedures/HACCP Plans ❑ 18. Cooling PROTECTION FROM CONTAMINATION ❑ 19. Hot and Cold Holding ❑ 8. Separation/Segregation/Protection ❑20.Time As a Public Health Control �. Food Contact Surfaces Cleaning and Sanitizing REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) ❑21. Food and Food Preparation for HSP [110. Proper Adequate Handwashing _ - ❑ 11.Good Hygienic Practices CONSUMER ADVISORY ❑22. Posting of Consumer Advisories Violations Related to Good Retail Practices Number of Violated Provisions Related Critical (C) violations marked must be corrected To Foodborne Illnesses Interventions 1G) immediately or within 10 days as determined by the Board and Risk Factors(Items 1-22): of Health. Non-critical (N)violations must be corrected Official Order for Correction: Based on an`inspection immediately or within 90 days as determined by the Board today,the items checked indicate violations of 105 CMR of Health. 590.000/federal Food Code.This report, when signed below N ' by a Board of Health member or its agent constitutes an 23. Management and Personnel (FC-2)(590.003) 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 X25. 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)(59o.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 5901ns0�',FnmS,4.Joc i I`sp or i to e•` _ Print: P ' ign r : Print: en n l s �C i Page__/of_6V1agcs Violations Related to Foodborne Illness Interventions and Risk Factors(items 1.22) PROTECTION FROM CONTAMINATION_ FOOD PROTECTION MANAGEMENT S Cross-contaminathon 1 1 590.003(A) 1 _Assl invent of Responsibility3-302.11(A}(1) Raw Animal Foods Separated Prom 590.003{I3} Demonsu.ationt of Rnouledge" Coked and RFE Foods" 2-103.11 Person in '1-111 duties Contamination from Raw ingredients 3-302.1.](A)(2) Ravi Animal Foods Separated from Each EMPLOYEE HEALTH otbar` 2 59WW3(C) Responsibility of the person in charge to Contamination from the Environment require roporting by food employees and 3-302.11(A) Fod Protection" a nlicants" 3-302.15 Wasirav Fruits and Vegetables 590,003(F) Responsibility Of A Food Employee Or An 3-304.11 Boal Contact with Equipment and .Applicant To Report To The Person In Utensils* Clare'* Contamination from the Consumer 590.003(G) Re tortino b Person in Charge` 3-306.14(A)(B) Retu tnld Food and Reservice of Food* 3 590.003(0) Exclusions andRestdctions* Disposition of Adulterated or Contaminated 590003(E) Removal of Exclusions and Restrictions Food 3-701.11 Disearding or Reconditioning Unsafe FOOD FROM APPROVED SOURCE Food* 4 Food and Water From Regulated Sources 9 Food Contact Surfaces 590.004(A-R) C.ompli Ince with Food Lan" 4-561.Li l Manual Warewushing-Hof Water 3-201.12 Food in a Hermetical) Scaled Container* S nitization Pent eratures` } 4-501.112 Mechanical W itrewashing Hot Water 3-201..13 Fluid Milk and:Milk Products* 3-202.13 Shell E-as* S.anazarion Tem eratures* 3-202.14 Fa=s and Nlilk Praiacts-Pasteurized* 4-501.114 Chemical Sanitiuttion-temp.,pH, concentration and hardness. 'k 3-202.16 Ice Made From Potalle Drinking Water* 5-1.01.11 Drinkitt Water from an A n'oved Svstern'" 4-601_11(A) Fduipment Food Contact Surfaces and 590.006(A) Bottled Drmkin 1A'ater* Utensils Clean" 540.006(8) Watec Meets Standards in 310 CMR 22.0" 4 602'11 Cleaning Frequency of Equipment Food- Shellfish and Fish From an Approved Source Frequency cy of Sanitization and tionUteofl t -1-702.11 Frequency of Sanitizatian of Utensils and 3-20114 Fish and Rlcreationa7ly Caught Molluscan Food Contact Surfaces ofui ment- Shellfish* 4-703.11 Methods of Sanitization-Hot Water and 3-201.15 Molluscan Shellfish from NSSP L led Chemlcal'�' Sources* 1g Proper,Adequate Handwashing Game and Wild Mushrooms Approved by 2-301.1 1 Clean Condition-Hands and Arms" Requtatory Authority 3-20218 Shellstock Identification Prescm" 2-30112 Cleatnn*Procedure* 590.004(0) Wild Mushrooms* 2-301.14 When to Wash* 3-201.17 Game Animals* 11 Good Hygienic Practices g Receiving/Condition 2-401 I L Ending,Drinkim,or UsingTobacco* 3-26)2.11 PI1Fs Received at Pr er Tent eratures* 2-401.12 Discharges From the Eyes, Nose and 3-202.1.5 Packa e huegrit " Mouth* 3-101.11 Food Safe and Unadulterated* 3-301..12 Preventing Contamination When Tasting"' TagsiRecords:Shellstock 12 Prevention of Contamination from Hands 3-202.18 Shellstock Identification* 590.004(E) Preventing Contamination from 3-203.12 ShelFfock Identification Maintained* Ent levees* Tags/Records:Fish Products 13 Handwash Facilities 3-402.11 Parasite Destruction* Conveniently Located and Accessible 3-402.12 Records.Creation and Retention* 5-203.11 Numbers and Capacities," 590.004(7) Labeling of ingredients' -5-204.11 I-ocation and Nacernem* 7 Conformance with Approved Procedures 5-205.11 Acceseibility.Operation and Maintenance /HACCP Plans Supplied with Soap and Nand Drying Devices vces 3-502.11 S ecialized Processing Methods* 6-301.11. Den Cleanser, Availability 3-502.12 Reduced ax an tack-lino-,criteria* 8-103.12 Conformance with A Troved Proedures" 6-301.12 Hand Drying Provision "Denotes critical acnn in the federal 1999 Fond Code 01 105 CAIP 590.000. CITY OF SALEM S BOARD OF HEALTH / Establishment Name: P; ,Ge Q ( Date: glZ��C� Page: 0? of C_ Item Code c-critical tte ' DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date No. Reference R—Red Item Verified PLEASE PRINT CLEARLY -. -- a 11� /tn &19,7'r had o Ccom U0Off' S - U Ni 1 l' All dYIS C / D V ILI to yT'a Discussion With Person in Charge: Corrective Action Required: ❑ No ElYes have read this report, have had the opportu/eall�conditions ask questions and agree to correct all ❑ Voluntary Compliance ❑ Employee Restriction/ violations before the next inspection, to obse as described, and to Exclusion P ❑ Re-inspection Scheduled ❑ Emergency Suspension comply with all mandates of the Mass/F,� derdFood Code. I understand that noncompliance may result in daily fines of-t�venty-five dollars or suspension/revocation of ❑ Embargo ❑ Emergency Closure your food permit. �� ❑ Voluntary Disposal ❑ Other: i 3-50L24(C)��PHFs Received at Temperatutes Violations Related to Foodborne Illness Interventions and Risk According to taw Cooled Eo Factors(items 1.22) (Cont.) 41'F(45'F Within 4 Hours_x PROTECTION FROM CHEMICALS 3-501.15 Cooling Methods for I'HF's 14 Food or Color Additives PHf Not and Cold Holding 14 3-202.72 Additives" 3-501.16(8) Cold PHFs Maintainer(at or below 590004{F) 41%45'5` 3-302.14 Protection from Una roved Additives* 3-500.1 (T) Hot PHFs Maintained at or above 15 Poisonous or Toxic Substances 4WEA 7-101.11 Identifying fnionrrttion-Ori�.nal 3-501,16(A,) Roasts Held at or above 130°5. ' Containers," 7-102.11 Common Name-Working Containers* 20 Time as a Public Health Control 7-201.11 Separation-Storage* 3-501.19 Time as a Public Health Control* 7-202.11 Restriction-Presence and User 590.004( Variance Re uirement 7-202.12 Conditions ofUict 7-203.11 'Toxic Containers-Prohibitions* REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-204.11 Sanitize",Criteria-Chemicals* POPULATIONS(HSP) 7-204.1.2 Chemicals for Washing Produce,Criteria" 21 3-SOY..I 7(A) Unpasteurized Pre-packaged Juices and Beverages with Warning Labels* 7-204.14 Drina A grits,Criteria'" - - 7-205.11 Incidental Food Contact,Lubricants* 3-801,11(B) Uae of pasteurized C Fr es* 7-206.1 I Restricted Use Pesticides.Criteria* 3-80I1l(D) Raw or Partially Cooked Animal Food and Raw Seed Sprouts Not Served.'r 7-206.12 Rodent Bait Stations* 3-g01.11(C) Unopened Food Paeka>e Not Fe-served. 7-206.13 'Pricking Powders,,Pest Control and Monitoring* CONSUMER ADVISORY TIMEITEMPERATURE CONTROLS 22 3-603.11 Consumer Advisory Posted for Consumption of Animal Foods That are Raw.Undercooked or I6 Proper Cooking Temperatures for PHFs Not Otherwise Processed to Elnuinate 3-307.1 I A(])(2) Eggs- t55 F I S Sec. Pinh rrcns !retd�a -vzoor h yes-hnnredratc Service 145 FiSsec' 3-302.13 Pasteurized Eggs Substitute for Raw Shell 3-401.11(A)(2) Comminuted Fish,Meats r&Game La-'s* Animals-Beef R 15 sec. ie SPECIAL REQUIREMENTS 3-401.11(B)(1)(2) Pork and Beef Roast- 131}°F 121 min* 3-401.11.(A)(2) Ratites,Injected Meats- 155'F 15 590.009(A)-(D) Violations of Section 590.009(A)-(D)in sec. * catering, mobile food, temporary and 3-401.11(A)(3) Poultry,Wild Game,Stuffed PFIFs, residential kitchen operations should be Stuffing Containing Fish,Meat, debited under the appropriate sections Poultr or Ratites-165'F 15 sec. " above if related to foodborne i'tlness 3-401A 1(C)(3) Whole-muscle,intact Beef Steaks interventions and risk factors. Other 145°F* 590.009 violations relating to good retail 3-401.12 Raw Animal Foods Cooked in a practices should be debited under N29- Microwave 165°F* Special Requirements. 3-401.11(A)(I)(b) All Other PHFs-1.45'F 15 sec I7 Reheating for Hot Holding VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 3-403.11(AA(D) PHFs 165°.5 15 see. * (Items 23-30) 3-403.11(B) Microwave-165'F 2 Minute Standing Critical and non-critical violati no, which do 110t)elate to the Time* foodborne illness interventions and risk factors ILted above can he 3-403.11(C) Commercially Processed RTE Ford- found in the following sections of the Fool Code and 105 CMR 140'F` .590.000. -- - ____.,--.. 3-403,11(E) Remaining Unsliced Porpons ofBecf i (tem r-- Good Retar7 Practices FC 590.000 Foists* 23. Management and Personnel __. .._' FC -2 .003 gg Proper Cooling of PHFs 24. Food and Food Protection _ FC--3 .004 25 ____ _Equipment and Utensils FC 4 .005 3-501.14(A) Cooling Cooked PHFs from 140`P to 26 _ ` _Water Plumbin and Waste FC 5 _I .006__ - --- 70°5 Within 2IIours and From 70'5 27. Physical Facility FC-6 1 .007 to 41.`F145°F Within 4 Hours. * 28. Poisonous or Toxic Materials FC-7 .008 3-501.14(B) Cooling PRFs Made Front Ambient 29. S euial Re uirements _ __ .009 Temperature Ingredients to 41'F145°F 30 Other Within 4 Flours'x '°Denotes critical item io the federal 1999 Food Code or 105 CMR 590.000. r Massachusetts Department of Public Health Salem Board of Health M 120 Washington Street,4th Floor Division of Food and Drugs 1 Salem, MA 01970-3523 FOOD ESTABLISHMENT INSPECTION REPORT Tel. (978) 741-1800 Fax(978) 745-0343 Name Date Tie of Operation(s) T,�e of Ins ec�tion I l) Rr Food Service ©© outi� ne Addressry Risk 171 Retail FI Re-inspection I 0 Level ❑ Residential Kitchen Previous Inspection Telephone _ r ❑ Mobile Date: F-1Temporary ❑ Pre-operation Owner HACCP YIN sTi ❑ Caterer [ISuspect Illness Person in Charge(PIC) me 171 Bed& Breakfast General Complaint In: C]El Inspectorn'o Out: Permit No. ❑Other Each violation checked requires an explanation on the narrative page(s) and a citation of specific provision(s)violated. Mon-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 [115,Toxic Chemicals FOOD FROM APPROVED SOURCE ❑ 4. Food and Water from Approved Source f TIMEfTEMPERATitItECONTROLS(PoteMiagj+_HazardausFood _ 11 ❑ 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 [9/8. Separation/Segregation/Protection ❑20.Time As a Public Health Control [V9. Food Contact Surfaces Cleaning and Sanitizing REQUIREMENTS FOR HIGHLY.SUSCEPTIBLE POPULATIONS(HSP) ' ❑ 21. Food and Food Preparation for HSP ❑ 10. Proper Adequate Handwashing . CONSUMER ADVISORY, -: [111. Good Hygienic Practices [122, Posting of Consumer Advisories Violations Related to Good Retail Practices Number of Violated Provisions Related Critical (C) violations marked must be corrected To Foodborne Illnesses Interventions immediately or within 10 days as determined by the Board and Risk Factors (Items 1-22): of Health. Non-critical (N)violations must be corrected Official Order for Correction: Based on an inspection immediately or within 90 days as determined by the Board today,the items checked indicate violations of 105 CMR of Health. 590.000/federal Food Code.This report,when signed below C' .N ' by a Board of Health member or its agent constitutes an 23. Management and Personnel (FC-2)(590.003) order of the Board of Health. Failure to correct violations ( 5 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)(590.006) and submitted to the Board of Health at the above address 29. Special Requirements (590.009) within 10 days of receipt of this order. 30. Other DATE OF RE-INSPECTION: 16 / to q 5:5901nspe(dff/or�m�6d0.Joc v li 4 I s e t •'s " na re Print: f IC' Signature: Print: Page_of _Pages v C Violations Related to Foodborne Illness Interventions and Risk Factors(items 1-22) PROTECTION FROM CONTAMINATION FOOD PROTECTION MANAGEMENT S Cross-contamination -- - 1 590.003(A) AssigimentafRespwisibilrty*_ 7302.11(A)(1) Rau -lnimalFoods ..- 5eparatedfrom 590.003(B) Demonstraion of[ Knowledge* Cooked and RTE Foods* 2-103.17. Persi>n in charge-duties Contamination from Raw ingredients 3-302 1 I(A)(2) Raw Animal Foals Separated from Fach EMPLOYEE HEALTH Other* 2 590.003fG Responsibility of the person in charge to Contamination from the Environment require reporting by food employees and 3-302.11.{A) Food Protection* a_tliumts' 3-302.15 Washing Fruits and V eeetables 590-003(F) Responsibility Of A Food Employee Or An 3-304.17. Food Contact with Equipment and Applicant To Report To The Person In (hen,110. Charge'" Contamination from the Consumer 590.003(C1) Re Cortin by Person in Charge'" 3-306.14(A)(B) Returned Food and Reservice of Food" 3 590.003(D) I Exclusions and Restrictions* Disposition of Adulterated or Contaminated -90.b03(F,) Removal of Exclusions and Restrictions Food 3-701.11 Discarding or Reconditioning Unsafe FOOD FROM APPROVED SOURCEHood* 4 Food and Water From Regulated Sources 9 Food Contact Surfaces 590.004(A-B) C<nnpliancewithFoodLaw 4-50(.1.71 Manua(Warewashing-HotWater 3-201.12 Food in a Hermeticaliv Sealed Container* Siminzation Tent eratures* 3-201.13 Fluid,Milk and Milk Products* 4-501.712 Mechanical Warewashine Hot Water 3-202.13 Shell Eg s* Sanitization Temperatures* 3-202.14 Eggs and Milk Products.Pasteurized'" 4-501.114 Chemical ion and hard temp., pH, 3-202.16 Ice Made From Potable Drinking Water* concentration and hardness. 5-1.0111 Drinking Water from an Approved System' 4-601.11(A) Equipment Food Contact Surfaces and 590.006(A) Bottled DrinkingWater* Utensils Clete* 590.00643) Water Meets Standards in 310 CMR 22.0" 4-602.11 Cleaning Frequency of Equipment Food- Contact Surtaces and Utensils'' Shellfish and Fish From an Approved Source 4-7102,11 Frequency of Sanitization of Utensils and 3-201.14 Fish and Recreationally Caught Molluscan. Foal Contact Surfaces of E ui ment* Shellfish* 4-703-11 Methods of Sattitization-Hot Water and 3-201.15 �Molluscan Shellfish from NSSP Lasted Cheudcal* Sources* 10 proper,Adequate Handoeshing Game and Wild Mushrooms Approved by Regulatory Atchorit 2-301.11 Clean Condition-Hands imd Arms* 3-202.18 Shellstock Identification Present* 2-36(12 Cleaning Procedure:,--- 590.004(C) roeedare'%590.004(C) Wild Mushrooms* 2-301.14 When to Wish* 3-201.17 Game Animals* l.i Good Hygienic Practices 5 Receiving/Condition 2-40117 Satin ,Ddrdcing or UsinE Tobacco" 3-202.11 PHFs Received at Pro er Tem c'om'es* 2-401.12 Discharges From the Eyes, Nose and 3-202.15 Package Lite it * Mouth* 3-101.11. Food Safe and Unadulterated* 3-301.12 Prevent m=Contamination When lasting* Tags/Records:Shellstock 12 Prevention of Contamination from Hands 3-202AS Shellstock identification" 590.004(E) Preventing Contamination from 3-203.12 Shellstock Identification Maintained* Em'levees* Tags/Records;Fish Products 13 Handwash Facilities 3--402.11 Parasite Destruction* Conveniently Located and Accessible 3-402.12 Records.Creation and Retention* 5-203.11 Numbers and Capacities" 590.004(7) Labeling of Ingredients' 5-204.11 location and Placement* 7 Conformance with Approved Procedures 5-205-17 Accesibilit O aeration and Maintenaticc /HACCP Plans Supplied with Soap and Hand Drying 3-502.11 Devices 3-502.12 Reduced oxvgen xeka>Co<>,cr[teria* 6-301.11 HaudwashJn Cleanser,Availabihtro 8-103.12 Conformance with A. raved Procedures'" [:6:30112Hand Dridng Provision "Denolev critical item inthe vocal 1999 Food Code a] 105 CMR 590.000. 4 CITY OF SALEM BOARD OF HEALTH Establishment Name: ��C{Pl tY1Q��1-P Date: 8�� 6 Pager of Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date No. Reference R—Red ItemVerified _. PLEASE PRINT CLEARLY 1A SDe (" ) f o _W � / Sf a h1d OilI- . Ali I k7 V N /G _��arwc hod Q -2u a /1 y r a LO � (' n IlJ C . t I C a q l -Q s A' A)l ei e J J 'r Discussion With Person in Charge: Corrective Action Required: ❑ No ❑ Yes I have read this report, have had the opportunity to ask questions and agree to correct all ❑ Voluntary Compliance ❑ Employee Restriction/ 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-f�dolollla-rss or suspension/revocation of ❑ Embargo ❑ Emergency Closure your food permit. 11 Voluntary Disposal ❑ Other: -i-T01 14(6PHFs Received at'Femperatures Violations Related to Foodborne Illness Interventions and Risk According to Iaw Cooled to Factors(items 1-22) (Cont.) 4 t T/45`F Within 4 Homs. ` PROTECTION FROM CHEMICALS 3-501.15 Cooling Methods for PHFs l PHF Hot and Cold Holding Ia Food or Color Additives 9 g 3-501.16(B) Cold PIII^s Maintained at or below 3-202.12 Additivcs* 590.004(F) 41'145'F* 3-30114 Protection from Una r,roved Additives" 3-501.16(A) Hof PHFs Maintained at or above IS Poisonous or Toxic Substances 7-101 A I Identifying Information-Original Containers" 3-50116(A) Roasts Heid at or above 130`F. 7-102.11 Common Narne-Workinrt Containers" 20 Time as a Public Health Control 7-201.11 Se aration-Shan e' 3-501.19 Time m a Public Health Control* 1-202.11 Rt'zYriction-Prc sent©and Use" 590.004(H) varitmcc Re augment 7-202.12 Conditions of It,,- 7-203.11 Toxic Containers-Prohibitions* REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-204.11 Sanitizers.Criteria-Chemicals* POPULATIONS(HSP) _ 7-2(4.12 Chemicals for Washing Produce,Criteria' ZI 3-801.'11(A) Lnpa4curized Pre-packaged Juices and _ Bevaraees with Warding I.;abet r 7-204.14 Dreinr. encs.Criteria* 3-801.11(B) Use of Pasteurized Ergs* 7-205.11 Incidental Food Contact,Lubricants* 3-801.1.1(D) Rain or Partially Corked Animal Food and 7-206.'1 t Restricted Use Pesticides, Criteria* Raw Seed SprouPartially Not Served. l 7-206.12 TruckiRodenng Bait Stations' 3-SOL 1l(C) Unopened Food Package Not Re-served. It 7-206.'13 'I'racking Powders,Past Control and Monimrinr* CONSUMER ADVISORY TIMEREMPERATURE CONTROLS 22 3 603.11 Consumer Advisory Posted for Consumption of 16 Proper Cooking Temperatures for Animal Foods-Tha(are Raw.Undercooked or PHFs Not Otherwise Processed to Eliminate 3-401.1IA(1)(2) Frgs- 155 F 15 Sec. Pathogens-* �ro a,E vrrzoor 6 es-Immediate Service 145'F15sec* 02.13 Pasteurized Eggs Substitute for Raw Shell 3-401.11(A)(2) Comminuted Fish, Meats&Game 3 ' Anneals- 155'F 15 sec. ,K 3-401.11(8)(1)(2) Pork'.and Beef Roast - 130"F 121 min* SPECIAL REQUIREMENTS 3-401.11(A)(2) Ratites, Injected Meats- 155'F 15 590,009(A)-(D) Violations of Section 590.009(A)-(D)in sec,* catering,mobile food, temporary and 3-401.11(A)(3) Poultry, Wild(:tame,Stuffed PFIFs, 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,hitact Beef Steaks interventions andrisk factors. Other 145'F* 590.009 violations relating to good retail 3-401.1.2 Raw Annual Foods Cooked in a practices should be debited under#29- Microwave 165'F* Special Requirements. 3-401.11(A)(1)(b) All Other PHFs- 1.45'F 15 sec 17 Reheating for Hot Holding VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 3-403.11(A)&(D) PHFs 165'F 15 sec. * (Items 23-30) 3-403.11(8) Miceawave.165°F 2 Minnie Standing Critical and non-critical violalion.s. nbich do not relate to the Time* foodborne illness hurt vention.s and risk factors listed above., can be 3-403.11(C) Commercially Processed RTE Food- ,found in the following sections of the Food Code and 105 CMR 140'F* 590.000. 3-403.11(F.) Remaining Unslieed Portions of Beef Item Good Retail Practices _ FC 590.000 Roasts* 23. Manaosment and Personne_I_ FC-2 .003 1g Proper Cooling of PHFs 24. Food and Food Protection _ FC-3 .004 25 __Equipment and Utensils FC 4__ .0_05 3-501-14(A) Cooling Cooked PEIFs from'140'F to 28 Water.Plumbin and Waste FC 5 .00_6 70'F Within 2 Hours and From 70'F 27. Ph sical Factli FC-6 A07 _ t _ to 41.`JF/45°F Within 4 Hours. * 28. Poisonous or Toxic Materials FC-7 .008 3-501..14(li) Cortina,PHFs Made From Ambient 29. S oeial Re uirements -_ _ .009 Temperature'Ngredientsto4l°F/4YF 30 Other - Within 4 Hours* srvor aw,.,mszm,� *Denotes critical item in the federal 1990 Food Code or 105 CN1R 590,000. CITY OF SALEM f BOARD OF HEALTH Establishment Name: GGf Q Date: t- Page: of- A hero Code C—Critical item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date No. Reference R—Red Item - - - Verified ' PLEASE PRINT CLEARLY G �eA2Sc �✓ d r�2 LI cLL/ PS r4lee d a NSG Sjrwq AA,ll is l-ac c/ctc /ani �' aLl�ig h 1Cnlw"� rL U #7h,--' G e' ' % Ure Z /S a / GcJaf c �, d Q c,umv/ 07-, o � dee ovYe. a a)42 /S Cly t J7 Jn / i yr Gv 'Lo n-Ly he/'o N/ aj i 1 had S / the frc iYJaeo CLeQ.h f- C?�'L'_SL 1Q r l2 GL( o d n LP O OF 0r' oW S Trlhaveread th Person in Charge: Corrective Action Required: ❑ No ❑ Yes is 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-fi dollars or suspension/revocation of ❑ Embargo ❑ Emergency Closure your food permit. j —� e ? ❑ Voluntary Disposal ❑ Other: J-501 PF1Fs RrA;eived at'Petnperatrues Violations Related to Foodborne illness Interventions and Risk - According to taw Cooled to i Factors(Items 1-22) (Cont) 141°Ft45"F Within 4 Fouts, PROTECTION FROM CHEMICALS 3-501.15 i Cooling Methods for PHFs 14 _ Food or Color Additives 19 PHF Hot and Cold Holding 202.12 Addrtn_es ---- 3-501.16(13) Cold PFIFs Maintained at or below 3 3- * 590.004(F) 41%45°F- 302 14 Protection from 1Lna r roved Addi vas* 3-501 ]6(A) Hct PHFs;Maintained at or above 1.5 Poisonous or Toxic Substances ` 140"F, 7-101.11 1'dentit}hnglnfix¢nation-Original 3-501.16(A) Roasts Held at or above I3o°F. Containers* 7-102-11 Common Name-Workmo Containers* 20 Time as a Public Health Control 7-201.11 Se paratien-Storage* 3-5ol.19 Time as a Public Health Control* 7-202.11 Restriction-Presence and Use 590.004(H) Variance Rej uirement 7-202.12 Conditions of Use* 7-203.11 Toxic Containers-Prohibitions* REOUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-204.11 Sanitizets.Criteria-Chemicals* POPULATIONS(HSP) 7-204.12 Chemicals for Washing Produce,Criteria* 21 3-801.11(A) Unpasteurized Pre-packaged Juices and Beverages with Warning Labels* 7-204.14 Davin A eats,Criceria* 3-801 l I(B) Use of Pasteurized Eges* 7-205.11 incidental Food Contact. Lubricants* 3-80].11(IJ) Raw or Partiall Cooked Animal Foodand 7-206.11 Restricted Use Pesticides.Criteria* y Raw Seed S}routs Not Served. 's 7-206.12 Rodent Bait Stations" 3-801.1](C} Uno coed Food Packa=e Noe Re-served. 7-206.13 Tracking Powders,Pest Control and Monitoring* - 9 CONSUMER ADVISORY TIMEITEMPERATURE CONTROLS 22 3-603.11 Consumer Advisory Posted for Consumption of Animal Foods That are Raw,Undercooked or 16 Proper Cooking Temperatures for PHFs Not Otherwise Processed to Eliminate 401.1 IA(1)(2) Eggs- 155`17 7.5 Sac- I'sCh '"taewvo 1/1,P3,11 ECKs-Immediate Service 145°Fl Ssec* 3-302.13 Pnsteurized Eggs Substitute for Raw Shell 3-401.1I(A)(2) Comminuted Fish, Meats&Game E¢gs" Animals- 155°F 15 sec.'" 3-401.11(11)(1)(2) Pork and Beef Roast - 130"F 121 mini` SPECIAL REQUIREMENTS 3-401.11(A)(2) Ratites, Injected Meats- 155°F15 590.009(A)-(D) Violations of Section 590.009(A)-(D)in see. * catering.mobile food,temporary and 3-401.11(A)(3) Poultry,Wild Game,Stuffed PRFs, residential kitchen operations should be Stalling Containing Fish,Meat, debited under the appropriate sections Poultr or Ratites-165°F IS sec.x above if related to foodborne illness 3-40LI I(C)(3) Whole muscle,Intact Beef Steaks interventions and tisk factors. Other 145°F* 590.009 violations relating to good retail 3-401.12 Raw Animal Foods Cooked in a practices should be debited under#29- Microwave 165°F* Special Requirements, 3-401.11(A)(1)(b) All Other PHFs-- 145°F 15 sec. 17 Reheating for Hot Holding VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 3-403.11(.4)&(D) PHFs 165°F 15 sec. :;; (Iter15 23-30) 3-403.11(B) Microwave-165°F 2 iVlinute Standing Critical and non-critical violations, which do not relate to the Times` foodborne illness interventions and risk Rectors listed above, can be 3-403.11(,C) Commercially Processed RTE Food- found in the followbig sections of the Food Code and 105 CMR 140°F21 590.000. 3-4o3.11(E) Reauung Unshced Portions of Beef Item Good Retail Practices_ FC b8D.000 m _ Roasts* 23. Martagement and Personnel__ FC-2 003 1=818 Proper Cooling of PHFs 24. Food and Food Protection FC--3 604 25___ Equipment and Utensils _ FC 4 _ .005 3-501,14(A) Carling Cooked PHFs from 140°F to P6. Water Plumbing and Waste FC 5 .006___ 70°F Within'2 Flours and From 70°F 27. Ph dual Facilites___..- FC-6 1 .007 to 41°F/45°F Within 4 Hours. `" 23. Poisonous or Toxic Materials FC-7 .008 3-501.14(11) Cooling PHFs Made From Ambient 29. Special Requirement„ _ __ _ 1 .008 Temperature Ingredients to 41°F1457 30 _..- Within 4 Hours* tr r,wz:v, Denotes critical item in the Iuteral 1999 Food Code or 105 CMR 590.000. CITY OF SALEM BOARD OF HEALTH Establishment Name: /� >� Date: 211ZIdy Page: of Item Code C—critical Item DESCRIPTIONOF VIOLATION/PLAN OF CORRECTION Date No. Reference R—Red Item - Verified PLEASE PRINT CLEARLY -- - l-s- ,skpedlu b l ?4 Ye s- 6� f o 1 tl� If. - S f ty S Discussion With Person in Charge: Corrective Action Required: ❑ No ❑ Yes r I have read this report, have had the opportunity to ask questions and agree to correct all ❑ Voluntary Compliance LJ Employee Restriction/ violations before the next inspection, to observe all conditions as described, and to Exclusion P El 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 dfllfErrs or suspension/revocation of ❑ Embargo ❑ Emergency closure your food permit. -� ❑ Voluntary Disposal ❑ Other: r a , 3-501.1A(C) PHFs Received at"Temperatures Violations Related to Foodborne Illness Interventions and Risk According to Law Cooled to Factors(items 1-22) (Cont.) 4PF/45°F Within 4 Homs. PROTECTION FROM CHEMICALS 3-SOi.iS Cootie==Methods forPHFs 14 Food or Color Additives v 19 PHF Hot and Cold Holding 3501.16(6) Cold PHFs Maintained at or below 3-202.12 Additne�r 590.004(F) 41'145° F- 3-302 14 Protection from Una r roved Additives* 3-501.16(A) Hot PHFs Maintained at or above 1-5Poisonousor Toxic Substances 40"F. 7-101.11 identifying Information-Or igina( 3-501.16(A) Roasts Held at or above 130°F. Containers" 7-102.11 Common None-Working Containers* 2U Time as a Public Health Control 7-201.11 Separation aration-Storatsel' 3-501.19 Time as a Public Health Condor- 7-202.11 ontrol* 7-202.1 t Restrrcti on-Pretience and User 540.004(H} Variance Requirement 7-202.12 Conditions of Ilse* 7-203.11 Toxic Containers-Prohibitions* REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-204.11 Saortizers.Criteria-Chemicals* POPULATIONS(HSP) - - - 7-204.12 Chemicals for Washine Produce,Criteria" 21 3-801.11{A) Unpasteurized Pte-packaged Juices and Beverages with Warning labels* In 7-204.14 ieats.Criteria* 3-Sol, Use of PasteurizedE,,p- 7-205.11 Incidental Food Contact,Lubricants* 7-206.11 Restricted Use Pesticides,Criteria* 3-80L1 t(D) Raw or Partially Cooked Animal Food and Raw Seed Sprouts Not Served.'* 7-266.12 Rodent Bait Stations* 3-801.1102) Unopened Food Packa e Not Re-served. 7-206.13 Trac.kmg Powders,Pest Control and Monitoring* CONSUMER ADVISORY TIMEITEMPERATURE CONTROLS 3 603.1 I Consmner Advisory Posted for Cousumptian of Amaral Foals`Chat are Raw.Undercooked or 16 Proper Cooking Temperatures for PHFs Not Otherwise Processed to Elimurate 3-401.11A(l.)(2) Eggs- 155°F15Sec. Patho ..na*En°�a,-- Jnr F rs-bamedrate Seraice 145°P15sec* 3302.13 Pasteurized Eggs Substitute for Raw Shell 3-401.11(A)(2) Comminuted Fish,Meats&Game E s` Arinnals- 155°F 15 sec. * 3-401.11(B)(1)(2) Pork and Beef Roast-130°F 121 min* SPECIAL REQUIREMENTS 3-401.11(A)(2) Ratites, injected Meats-155°F 15 590.009(A)-(D) Violations of Section 590.009(A)-(D)in sec. * catering, mobile food, temporary and 3-401.11(A)(3) Poultry, Wild Game,Stuffed P1117S, residential kitchen operations should be Staffing Containing Fish, Meat, debited under the appropriate sections Poultr or Ratites-165°.F 75 see.. a` above if related to foodborne illness 3-401.1 UC)(3) Whole-muscle,lutact Beef Steaks interventions and risk factors. Other I45".F* 590.009 violations relating to good retail 3-401.12 Raw Animal F<xxis Cooked in a practices should be debited under#29- Micruwave 165°F* Special Requirements. 3401_11(A)(1)(b) All Other PRFs- 145"F'15 sec. 11 Reheating for Hot Holding VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 3-403.11(A)&(D) PHFs 165°F 15 sec. * (Items 23-30) 3-403.11(B) Microwave-165"F2 Minute Standing Critical mrd non-critical violations, which do not relate to the Time" foodborne,illness interventions and risk fitctors listen above., can be 3-403.11(C) Commercially Processed RTE Food- found in the follorviug sections of the Food Code and 105 CMR 140"F, 590.000. 3-403.I I(F) Remaining Unslieed Portions of Bee( ltem Good Retail Practices_ FC 590.000 Roasts* 23. _Yanaementand Personnel_-_ FC-2 .003 IS Proper Cooling of PRFs 24. Food and Food Protection FC--3 .004 25 __ _ Equipment and Utensils FC 4 .005 _ 3-501.14(.1) Cooling Cooked PHFs from 140°F to 26 Water,Plumbin and Waste PC 5 .0_06___ 70°F Within 2 Hours and From 70"F 27. Physical Facility FC-6 .007 to 41"F/45°F Within 4 Hours. * 28. Poisonous or Toxic Materials FC-7 .008 3-501.14(B) Cooling PHFs Made From Ambient 29. S eeial Re uirements _ .009 Temperature Ingredients tc)41°F/45°F 30,__ Other ) Within 4 Hours* ss�oro"awrsa..a� -°D) notes critical item w the fedmil 1999 Food Circle or 105 CNIR 590-000. Massachusetts Department of Public Health Salem Board of Health 120 Washington Street,4t"Floor Division of Food and Drugs Salem, MA 01970-3523 FOOD ESTABLISHMENT INSPECTION REPORT Tel. (978) 741-1800 Fax (978) 745-0343 Name Dge Tv�e of Oneration(s) Type of Inspection �V/� ❑ Food Service [l�Routine Address Risk LlRetail E] Re-inspections A/n c t�i in, / ,�� Levg�A ❑ Residential Kitchen Previous Inspection Telephone 417 ) 7 669 PV ❑ Mobile Dater-,fig-OS OwnerHACCP YM El Temporary E] Pre-operation / F_N Ail S N c Tn P /S ❑ Caterer ❑ Suspect Illness Person in Charge(PIC) Time ❑ Bed&Breakfast ❑ General Complaint In: El HACCP Inspector 04Y/ G r,r✓g VA4 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. evention of Contamination from Hands F] 1. PIC Assigned/Knowledgeable/Duties 13. Handwash Facilities EMPLOYEE HEALTH _ PROTECTION FROM CHEMICALS ❑ 2. Reporting of Diseases by Food Employee and PIC El 14 Approved Food or Color Additives ❑ 3. Personnel with Infections Restricted/Excluded FOOD FROM APPROVED SOURCE ❑ 15.Toxic Chemicals _. ❑ 4. Food and Water from Approved Source TIME/TEMPERATURECONTROLS(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 REOUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) ❑ 10. Proper Adequate Handwashing El21. Food and Food Preparation for HSP ❑ 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 1 immediately or within 10 days as determined by the Board and Risk Factors(Items 1-22): of Health. Non-critical (N) violations must be corrected Official Order for Correction: Based on an inspection immediately or within 90 days as determined by the Board today, the items checked indicate violations of 105 CMR of Health. 590.000/federal Food Code. This report, when signed below 23. Management and Personnel (FC-2)(590.003) by a Board of Health member or its agent constitutes an '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 ER29. Special Requirements (590.009) within 10 days of receipt of this order. 30. Other DATE OF RE-INSPECTION: S:501nV mFon 614.mo Inspector's Signature Print: PIC's Signature: �_ Print:1 N I Paged of Z-Pages Violations Related to Foodborne fitness interventions and Risk Factors(Items 1-22) PROTECTION FROM CONTAMINATION FOOD PROTECTION MANAGEMENT 8 Cross-contamination 1 590.003(A) 11 Assi=nment of Res tonsibility* 3-302.11(A)(1) Raw Animal Foods Separated from 5590 RII(B) Demonstration of Knowledge* Cooked and.R PP F oods"' 2-103 11 Person m huge-- duties Contamination from Raw ingrodients 3-302.1'1(1)(2) Raw Animal Foods Separated from Each EMPLOYEE HEALTH Other* 2 590.003(C) Responsibility of the person in chaige to Contamination from the Environment require reporting by'fo<xt employees and 3-302.11(A) Food Protection* apapllcams* 3-302.15 Washing Fiuo,and Vegetables 590,003(F) Responsibility Of A Food Employee Or An 3-304-11 Food Contact with Equipment and Applicant To Report To The Person In Utensils"' Charger Contamination from the Consumer 590.003(G) Reporting by Person in Char e" 3-306.14(A)(13) Returned Foci and Reservice of Fad* 3 590.003(D) Exclusions and Restrictions* Disposition of Adulterated or Contaminated 590.00'3(E) Removal of Exclusions and Restrictions Food 3-701.11. Discarding or Reconditioningtinsafa FOOD FROM APPROVED SOURCE Fee& 4 Food and Water From Regulated Sources 9 Food Contact Surfaces _ 590.004(A-B) Com liance with Foodl aw's 4-501.11 i. Manual Watcuasbing-Hot Water 3-201..12 Foal in a Hermetically Sealed Container* S tnihzatiort em eratures* 3-201.1.3 Fluid Milk and Milk Products* 4-501.112 Mechanical Warewashinb Hot Water 3-202.13 Shell Eggs* Sanitization Temperatures' 3-202.1.4 Eses and Milk Product,,.Pasteurized* 4-501.114 Chemical Sanitization-temp.,pH, concentration and hardness. * 3-202.16 Ice Made From Potable Drinking Water" 5-1.01.11 Drinking Water from an Approved System" 4-601.11(A) Equipment Contact Surfaces and Utensils Clean* 590.006( Bottled Drinking Water* 4-602.11 Cleaning Frequency of Equipment Food- 590.006(13) WaterMeets Standards in 310 CMR 22.0* Contact Surfaces and Utensils* Shellfish and Fish Froman Approved Source 4-702.11 Frequency of Sanitization of Utensils and 3-201.14 Fish and Recreationally Caught Molluscan Food Contact SurfaceOmen Shellfish* 4-703.11 Methods of Sanitization-Hot Water and 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* Sources* lg Proper,Adequate Handwashing Game and Wild Mushrooms Approved by Reulato Authodt 2-301.11 Clean Condition-HandsandArms* 3-202.18 Shellstock Identification Present* 2-301_12 Cleaning Procedure` 590.004(C) Wild Mushrooms* 2-301.14 When to Wash"` 3-201.17 Game Animals* 1.1 Good Hygienic Practices 5 ReceivingiCondition 2-401.11 Eatin ,Drinkin or Lasing Tobacco* 3 202.11 Pl:Fs Received at Pro ter Tetn teratures'r 2-401.12 Discharges From the Eyes.nose and 3-202.15 PackaeeIntezrity* Month* 3-101.11 Food Safe andnudulterued'" 3-301.12 Preventing Contamination''Alien Tasting* 6 Tags/Records:Shellstock 12 Prevention of Contamination from Hands 3-202.18 Shellstock Identification* 590.UU4(E) Preventing Contamination from 3-203.12 Shellstock Identification Maintained' Ern Aovees" Tags/Records:Fish Products 13 Handwash Facilities Conveniently Located and Accessibie 3-402.11 Parasite Destruction* 3-402.12 Records.Creation and Retention* 5-203.1.1 Numbers and Ca.acities'" 590.004(.1) 5-204.11 Location mid Placement* Labeling of Ingredients" 7 Conformance with Approved Procedures 5-20311 Accessibility,O aeration and Maintenance. lHACCP Plans Supplied with Soap and Hand Drying 3-502.11 S ecialized Processing Methods* Devices 3-502.12 Reduced oxygen ackagine,criteria* 6-301.11 1landwashina,Cleanser.Availability 8-103.12 Conformance with A roved Pnx:ednres"' =6301.12 Hand Dr'vin>Provision I)enote;critical item in Ihc.trite,a)1999 Food Code or 105 CMR 590,000. CITY OF SALEM BOARD OF HEALTH I Establishment Name: TNF Date: Ay Page: of Z em Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date o. Reference R—Red Item Verified PLEASE PRINT CLEARLY ' S,q" �` �3 ✓ �- G.-9s �1Ni'Jrnr s.+F S� !✓,cJ' " w �dfN� yt .�", GN Ip v S Q ) Pr9 >q�;AtZ41 4C- r --�/A{,�o I�✓r! N 1✓ ✓ . � 17 itJ �Rn' m3` i Y f z 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/ is 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-fiv dollars or susp�ocation of ❑ Embargo ❑ Emergency Closure your food permit. G/ ❑ Voluntary Disposal ❑ Other: :i 3-501.14(0) PRFs Received at Temperatures Violations Related to Foodborne Illness Interventions and Risk According to Law Cooled to Factors(items 1-22) (Cont.) __41.017/45°F Within 4 Hours. PROTECTION FROM CHEMICALS 50t.15 Co Coolin Methods for PHFs 14 � Food or Color Additives 19 PHF Hot and Cold Holding lo 3 20212 Additives* 3-501.16(B) Cold PRFs Maintained at or bew 590.004(F) 4l°/45'Fa, 3-302.14 Protection frotn Una .roved addrtweg 3-501.16(A) Hot PRFs Maintained at o'above 15 Poisonous or Toxic Substances I40gF." 7-701.11 Identity5ng Information-Original 3-501.16(A) Roasts Held at or abuse 130'F. Containers* 7-102.11 Cornmon Name-Working Containers* 20 Time as a Public Health Control 7-201.1.1 Separation-Sloan e' 3-501.19 Time as a Public Health Control* -cr-- 590.004(H) VwianceRa Requirement 7-20111 Restriction-Presence and Use* 7-202.12 Conditions of Use* 7-203.11 `1'oxicContainers-Prohibitions* REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-204.11 Sanitizers.Criteria-C'henacalsT POPULATIONS(HSP) 7-204.1.2 Chemicals Por Wastar r Produce,Criteria* 21 3-80L l I(A) Unpasteurized Pre-packaged Juices and 7-204.14 Drying Agents,Cutatra* 6eyera es with Warning Labels* 3-801.11(B) Use of Pasteurized E T1s* 7.205.1.1 Incidental Food Contact,Lubricants* 7-206.11 Restricted Use Pesticides.Criteria* 3-801.1.1(D) Raw of Putially Cooked AnimalFod and Raw Seed Sprouts Net Served. 7-206J.2 Rodent Bait Stationsa 3-801.11(C) Unopened Food Packa*e Not Re-served. 7-206.13 Tracking Powders, Pest Control and Monitoring* CONSUMER ADVISORY TIME(TEMPERATURE CONTROLS 22 3-603.11 Consumer Advisory Posted for Consumption of 16 Proper Cooking Temperatures for Animal Foods'I'led are Raw.Undercooked or PHFs Not Otherwise Processed to Eliminate 1A(1)(2) Eggs- 155'F 15 Sec. Path(),ens F qs-,Immedi ate Service, 1 J5'F7.5sec* 3-302.1.3 Pasteurized Eggs Substitute for Raw Shell 3-401.11(A)(2) Comminuted Fish,Meats&Game F,ggsa Animals- I55'F 15 sec. 3-401.1 l(B)(1)(2) Pork and Beef Roast- 1.30°F 121 min* SPECIAL REQUIREMENTS 3-401.11(A)(2) Ratites,Injected MeatS- 155°F 15 590.009(A)-(D) Violations of Section 590.009(A){D)in sec.A: catering, mobile food, ternporary and 3-401.11(A)(3) Poultry,Wild Game, Stuffed PHFs residential kitchen operations should be Stuffing Containing Fish,Meat debited under'the appropriate sections Poultry or Ratites-I65".F 15 sec * above if related to,foodborne illness 3-40L11(C)(3) Whole-mnscde,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#P29- Microwave 1WF* Special Requirements. 3-401.11(A)(1)(b) All Other PHFs-145'F 15 sec. 19 Reheating for Hot Holding VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 3-403.11(A)&(D) PHF,165"F 15 sec. * (Items 23-30) 3-403.1.1(B) Microwave-165"F 2 Minute Standing Critical and non-critical violations, which do not relate to the Time* foodborne ifbeess interventions and risk factwa listed above, can be 3-403.11(C) Commercially Processed RTE Food- 'found in the following se(tions of lite Food Code and 105 C'WR 14WF* 590.000. 3-40111(Et Remaining Unsliced Portions of Beef Item Good Retail Practices '; FC 590.000 I Roasts* 23. _ Management and Personnel FC-2 .003 1g Proper Cooling of PHFs 24 Food and Food Protection FC 3 004 _ 25 _Equipment and Utensils _ --_FC 4 005 _ 3-501.14(A) Cooling Conked PHFs from 140'F Co 26 Water Plumbing and Waste FC-5 .006 70'F Within 2 Hours and From 70'F 27. Physical Facility FC-6 .007 to 41'F/45'F Within 4 Hours.* 28. 1 Poisonous or Toxic Materials FC -7 .008 3-501.14(6) Cooling PRFs Made From Ambient 29 Special Requirements .009 'remperature fngredientc to 41-F/45'F 30 I Other Within 4 Hours* *Denotes cri@cal item in the rederal 1999 Food Codc or 105 CNIR 590.000. c. . rj ' CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH 120 WASHINGTON STREET, 4TH FLOOR SALEM, MA 01970 TEL. 978-741-1800 FAX 978-745-0343 STANLEY USOVICZ, JR. JOANNE SCOTT, MPH. RS, CHO MAYOR HEALTH AGENT CATERING NOTIFICATION FORM FEE: $25/Event $200/Year 00/,Ox Date of Application: vq A)dRRV /g,ado Date of Event: 7An uc(k. 1/o, oo q Check#: !o a Check Date: � p Name of Catering Business: C 1'4 Address of Catering Business: �%t ,hC� >'°e Owner of Catering Business: \�QV�In"�\ rnlhAI��G1� Address of Owner: Name of Customer: q�� Address of Event: Menu: T Or l�l7xs�h -f ��S.at,sy�/ f eh�G��N. i.(J//LQS' Q/lll� "YIQ(1�AS —O �7PiP /.LD /T/'G .QC yD1</iFY �AP�1iEiN./dUKtO GdiycdG�f� too�p 4XsA�ri��eta i`i��'t�� c/�par�� nLyo�c �i e- caterapp revised 11/25/02 i rc� .CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH • • 120 WASHINGTON STREET, 4TH FLOOR SALEM, MA 01970 TEL. 978-74 1-1800 FAX 978-745-0343 STANLEY LISOVICZ, JR. JOANNE SCOTT, MPH, RS, CHO MAYOR HEALTH AGENT COMMONWEALTH OF MASSACHUSETTS PERMIT TO OPERATE A FOOD ESTABLISHMENT In accordance with regulations promulgated under authority of Chapter 94 , Section 305A and Chapter III , Section 5 of the General Laws, to operate a Food Establishment in the City of Salem is hereby granted to: Owner' s Name : Dennis Moustakis Name of Establishment : Edgewater Cafe Address of Establishment : 155 Washington Street Type of Establishment : FOOD SERVICE Application Date : 01/07/2003 Restrictions: Permit for Food Establishment 226-03 Frozen Desserts/Ice Cream Permit for the Sale of Tobacco Products These Permits Expire December 31, 2003 This permit is not transferable and must be reissued upon change of ownership or location. The permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code, before any renovations, improvements, or equipment changes are made, all plans for such must be submitted to and approved by the Salem Board of Health. ` - HEALTH AGENT CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH 120 WASHINGTON STREET, 4TH FLOOR SALEM, MA 0 1 970 TEL. 978-741-1 800 FAX 978-745-0343 STANLEY USOVICZ, JR. JOANNE SCOTT. MPH. IRS, CHO MAYOR HEALTH AGENT 2003 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT NAME OF ESTABLISHMENT:�—^�� ...,TEL#_JZL-1y0- 9&62_ ADDRESS OF ESTABLISHMENT e;:;—I MAILING ADDRESS (if different). OWNER'S NAME-beiayits mvcwb44K� TEL#C ADDR CITY STATE 01 ZIP a—97-4 CERTIFIED FOOD MANAGER'S NAME(S) -L)gjNiNCERTIFICATE#(s)-2.+;Mx/-- (required in an establishment where potentially hazardous food is prepared.) EMERGENCY RESPONSE PERSOND"'411',. HOME TEL# JZJ-74111-69C3 V1R61A#,4 gloaSJIX46s HOURS OF OPERATION: Monti- 11 Tue.0,11t Wed.0-11 Thu. 0-111 Frill. rt Satt- 0 Surilk-le TYPE OF ESTABLISHMENT FEE check only RETAIL STORE YES less th�a`nI000sqft =$ 50 1000-10,000sq,ft. =$100 more than 10,000sq,ft. =$250 RESTAURANT ES NO less than 25 seats =$100 (�-25'-99 s4its---, Q=I150� mo seats =$200 BED/BREAKFAST YES tO $100 ADDITIONAL PERMITS MAKE ICE CREAM, YOGURT, SOFT SERVE YES 670D $5 TOBACCO VENDOR YES $50 ALL MON-PROFIT(such as church kitchens) YES WO $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 1, to my best nowledge and belief, have filed all state tax returns and paid all st e taxes requi ed under the law. hou I clx/cz- q Signature Date Social Security dcEa en 1 Ica Ion u Revised 11/25102 FOODAP2.adm Check#&Date dao(' a-19-0 X ,o -o .�. �. . ..... ..._ .. _... ..-+w..'.,.rv�-�..-.:.,,w.wrw--..r..., -r.-....,+..- v_v^ a---'...-••+'---mr��.�yd•+r..w...N- -...-- _...�.r�...,�..�..-.'�,.�,-.".. .... i fHE 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 r- Date Tvoe of Ooerationts) Igoe of Inspection X Food Service Routine r AddressRisk b Retail Re-inspection (/.7 t 11✓1 t�}1 J� 1 Level In /) ❑ Residential Kitchen Previous Inspection Telephone Q _ _ j/V El Mobile Date: Owner u HACCP Y/N El Temporary L1Pre-operation �nj 4t✓i ❑ Caterer ❑ Suspect Illness Person In Charge(PIC) Time ❑ Bed&Breakfast ❑ General Complaint ' In: ❑ HACCP Inspector -7i A Y (- ,GIJ6 Out: Permit No. ElOther 11 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 El 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 TIMEITEMPERATURE CONTROLS(Potentially Hazardous Foods) El 16. Cooking Temperatures El 5. Receiving/Condition ❑ 17. Reheating ❑ 6. Tags/ Records/Accuracy of Ingredient Statements ❑ 18. Cooling ❑ 7. Conformance with Approved Procedures/HACCP Plans PROTECTION FROM CONTAMINATION ❑ 19. Hot and Ela Pu Holding 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 O immediately or within 10 days as determined by the Board and Risk Factors (Red Items 1-22): of Health. Non-critical (N) violations must be corrected Official Order for Correction: Based on an inspection immediately or within 90 days as determined by the Board today, the items checked indicate violations•of,105 CMR of Health. 590.000/Federal Food Code.This report, when signed below C N by a Board of Health member or its agent constitutes an 23. Management and Personnel (Fc-2)(590.003) order of the Board of Health. Failure to correct violations 24. Food and Food Protection (FC-3)(590.004) cited in this report may result in suspension or revocation of 25. Equipment and Utensils (FC-4)(590.005) the food establishment permit and cessation of food 26. Water, Plumbing and Waste (FC-5)(590.006) establishment operations. If aggrieved by this order, you 27. Physical Facility (FC-6)(590.007) have a right to a hearing.Your request must be in writing 28. Poisonous or Toxic Materials (FC-7)(590.008) and submitted to the Board of Health at the above address 29. Special Requirements (590.009) within 10 days of receipt of this order. 30. Other DATE OF RE-INSPECTION: Inspector's Signature: Pri f: ` �i /t /�/ C �� PIC's Signa u 1� _ Print: t/ Y Y Y page/of ZPages FORM 734A HOBBSa WARREN -BOSTON Violations Related to Foodborne Illness r Interventions and Risk Factors (Red Items 1-22) PROTECTION FROM CONTAMINATION '8 Cross-contamination FOOD PROTECTION MANAGEMENT 3-302.11(A)(1) Raw Animal Foods Separated from 1 I 590.003(A) Assignment of Responsibilit * Cooked and RTE Foods* 590.003(B) Demonstration of Knowledge* Contamination from Raw Ingredients 2-103.11 Person in Charge-Duties 3-302.11(A)(2) Raw Animal Foods Separated from Each Other* EMPLOYEE HEALTH Contamination from the Environment 2 590.003(C) Responsibility of the Person in Charge to 3-302.11(A) Food Protection* require reporting by Food Employees and 3-302.15 Washing Fruits and Vegetables Applicants* 3.304.11 Food Contact with Equipment and 590.003(F) Responsibility of a Food Employee or an Utensils* Applicant to Report to the Person in Charge* Contamination from the Consumer 3-306.14(A)(B) Returned Food and Reservice of Food* 590.003(G) Reporting by Person in Charge* Disposition o/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 g Food Contact Surfaces 4 Food and Water From Regulated Sources 4-501.111 Manual Warewashing-Hot Water 590.004(A-B) Compliance with Food Law* Sanitization Temperatures* 3-201.12 Food in a Hermetically Sealed Container* 4-501.112 Mechanical Warewashing-Hot Water 3-201.13 Fluid Milk and Milk Products* Sanitization Temperatures* 3-202.13 Shell Eggs* 4-501.114 Chemical Sanitization-tem H, 3-202.14 Eggs and Milk Products,Pasteurized* * p i':g 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* 2-301.12 Cleaning Procedure* 3.202.18 Shellstock Identification Present* 2-301.14 When to Wash* 590.004(C) Wild Mushrooms* 4 11 Good Hygienic Practices 3-201.17 Game Animals* 2-401.11 Eating,Drinking or Using Tobacco* 5 Receiving/Condition 2-401.12 Discharges From the Eyes,Nose and 3-202.11 PHFs Received at Proper Temperatures* Mouth* 3-202.15 Package Integrity* 3-301.12 Preventing Contamination When Tasting* 3-101.11 Food Safe and Unadulterated* 12- Prevention of Contamination from Hands 6 Tags/Records:Shellstock 590.004(E) Preventing Contamination from 3-202.18 Shellstock Identification* Employees* 3-203.12 Shellstock Identification Maintained* 13 Handwash Facilities Tags/Records:Fish Products Conveniently Located and Accessible 3-402.11 Parasite Destruction* 5-203.11 Numbers and Capacities* 3-402.12 Records,Creation and Retention* 5-204.11 Location and Placement* 590.004(J) Labeling of Ingredients* 5-205.11 Accessibility,Operation and Maintenance 7' Conformance with Approved Procedures Supplied with Soap and Hand Drying /HACCP Plans Devices 3-502.11 Specialized Processing Methods* 6-301.11 Handwashing Cleanser,Availability 3-502.12 Reduced Oxygen Packaging,Criteria* 6-301.12 Hand Drying Provision 8-103.12 Conformance with Approved Procedures* *Denotes critical item In the federal 1999 Food Code or 105 CMR 590.000. CITY OF SALEM BOARD OF HEALTH Establishment Name: Date: �� Page: of Z Item Code C-Critical Rem DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date No. Reference R-Red Item Verified --- PLEASE PRINT CLEARLY i I-) \ �1 tom , 6- . L� `s /i G -! -Y t 5 e Discussion With Person in Charge: Corrective Action Required: ❑ No ❑ Yes I have read this report, have had the opportunity to ask questions and agree to correct all ❑ Voluntary Compliance ❑ Employee Restriction/ inspection, to observe all conditions as described, and to Exclusion violations before the next ins P El Scheduled ❑ Emergency Suspension i comply with all mandates of the Mass/Federal Food Code. I understand that noncompliance may result in daily fines of twenty-five dollars or suspension/revocation of ❑ Embargo ❑ Emergency closure your food permit. ❑ Voluntary Disposal ❑ Other: r r, 3-501.14(C) PRFs Received at Tentperaturres ; Violations Related to Foodborne Iciness Interventions and Risk According to Law Cooled to Factors(Items 1-22) (Cont) _ 41`F(45'F Within 4 Hours. PROTECTION FROM CHEMICALS 3-501,1 Cot>]in Metho s for PRFs Food or Color Additives 19 PHF Hot and Cold Holding 14 3-501.16(B) Cold PHFs Maintained at or below 3-202.12 Adchtives* 590.004(F) 404Y lo" 3-302.14 Protection from Unapinaved Additives' 3-501 I6(.1) Hot PHFs Maintained at or above IS Poisonous or Toxic Substances 140°F. 7-10'1.I1 Id<mtit}>inglnformation-Original 3-501.16(A) RoastsHeldatorabove 130'F.* Containers* 7-102.11 Common Name-Working Containers' 20 Time as a Public Health CoMral 7.201.L1 Separation-9tora e" 3-501,to Time as a Public Health Control* 7-202.11 Restriction-Presence and 11se'r 590.004(1-1) Variance Rer uirement 7-202.12 Conditions of Use" 7-203.11 Toxic Containers-Prohibitions' REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-204.11 Sanititzrs.Criteria-Chemicals* POPULATIONS(HSP 7-204.12 Chemicals for Washln Prixlnce.Criteria* 21 3-SOI.LICA) Uneasteuriza;d Pre-packaged.Inters and Beverages with Warning Labels* 7-204.14 Drying Agents,Criteria' 3-501.1'1(B) Use ofPasteurized Eggs* 7-205,11 Incidental Food Contact Lubricants* 7-2061.11 Restricted Use Pesticides.Criteria* 3-30111(D) Raw or Pa tially Caked Animal Food and Raw Seed Sprouts Not Served -' 7-206,12 Rodent Bait Stations* 3-801.11(C) Unopened Food Package Not Re-served. s= 7-206.13 Trackmn,Powders, Pest Control and Monitoring* CONSUMER ADVISORY TIMEJTEMPERATURE CONTROLS 22 3-603.11 Consumer Advisory Pasted for Consumption of Animal Raids That are Raw. Undercooked or 16 Proper Cooking Temperatures for Not Otherwise Processed to Elurinate PHFs �r ray.-, .2uoi 3-401.11A(1)(2) Eggs- 155'F 15 Sec. Pathogens.* Figs-Immediate Service 115'FImccg 3-302.13 Pasteurized Fggs Substitute for Raw Shell 3-401,1 I kA)(2) Comminuted Fish,Meats&Game Ea, '' Animals- 155'F 15 sec. 3-401.1l(B)(1)(2) Poi kand Beef Roast- 13WF12lTrial SPECIAL REQUIREMENTS 3-401.11(A)(2) Ratites,Injected Meats-155"F 15 590.009(A)-(I)) Violations of Section 590.009(A)-(D)in sec- * catering, mobile food, temporary and 3-401.11(A)(3) Poultry,Wild Game.Stuffed PHFs, residential kitchen operations should be Stuffing Containing Fish,Meat, debited under the appropriate sections Poutti y or Ratites-165'F 15 sec. * above iii related to foodborne illness 3-401-11(C)(3) Whole-muscle„Intact Beef Steaks interventions anti 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#t29- Microwave 165'F* Special Requirements. 3-401.11(A)(1)(b) All Other PHFs--145'F 15 sec, I7 Reheating for Hot Holding VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 3-403.1.1(A)&(,D) PI s 165'F 15 sec. * (Items 23-30) 3-403.L1(B) Microwave-165'F 2 Minute Standing Critical and non-critical violations, which do not relate to the Time* foodborne illness indernenrions and rfek factors listed aboie, can he 3-403.1.1(C) Commercially Processed RTE Food- found in the following sections of the Food Code and 10.5 CMR 14WF- 590.000. 3-403.11(E) Remaining Unsliced Portions of Beef Item Good Retail Practices FC 590.000 Roasts* 23. Management and Personnel { FC-2 .003 tg Proper Cooling of PHFs 24. Food and Foci Protection FC_-3 .004 - - 3-501.14(A) Coating Conked PHFs from 25. E m ment and Utensils FC 4 ,005 140'F u> 26, Water,Plumbin and W aste _ FC-5 ,006 70°F Within 2 Fernand From 70°F 27, I Physical Facility - FC-6 .007 _1 to 41°F/45'F Within 4 Hours. * 28. Poisonous or Toxic Materials FC-7 .008 3-501.14(6) Cooling PER Made From Ambient 29, I Special Requirements ____009 'temperature Ingredients to 41'FI45'F 30. =C ither _______. _-i_,-____ -t Within4Hours* 2.n.Y - *Denote,Criliad iters in the'Cederal 1499 Food Code bt 10CMR 590.000. i THE COMMONWEALTH OF MASSACHUSETTS CITY OF SALEM Address: 120 Washington Street, 4th Floor BOARD OF HEALTH Salem, MA 01970-3523 FOOD ESTABLISHMENT INSPECTION RE ORT Tel: (978) 741-1800 Fax: (978) 745-0343 Name Al jte� T f r i n of Insgection 07 El R Food Service El Routine Address Rl etail ❑ Re-inspection Level ❑ Residential Kitchen Previous Inspection Telephone l ❑ Mobile Date: Owner - // HACCP YIN ❑ Temporary ❑ Pre-operation ❑ Caterer ❑ Suspect Illness Person in C arge(PIC) Time El Bed&Breakfast El General Complaint L7 In: HACCP Inspector 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 ❑ 2. Reporting of Diseases by Food Employee and PIC PROTECTION FROM CHEMICALS El3. Personnel with Infections Restricted/ Excluded El 14. Approved Food or Color Additives ❑ 15. Toxic Chemicals FOOD FROM APPROVED SOURCE El 4. Food and Water from Approved Source TIMEJEMPERATURE CONTROLS(Potentially Hazardous Foods) ❑ El 5. Receiving/Condition 16. Cooking Temperatures ❑ 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 ❑ 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 of Health. 590.000/Federal Food Code.This report, when signed below C N I 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: Pr' PIC's Signature: Print: age�of es FORM 734A HOBBS&WARREN -BOSTON Violations Related to Foodborne Illness Interventions and Risk Factors (Red Items 1-22) PROTECTION FROM CONTAMINATION 8 Cross-contamination FOOD PROTECTION MANAGEMENT 3-302.11(A)(1) Raw Animal Foods Separated from 1 590.003(A) Assi omen[of Res onsibilit * Cooked and RTE Foods* 590.003(B) Demonstration of Knowledge* Contamination from Raw Ingredients 2-103.11 Person in Charge-Duties 3-302.11(A)(2) Raw Animal Foods Separated from Each Other* EMPLOYEE HEALTH Contamination from the Environment 2) 590.003(C) Responsibility of the Person in Charge to 3-302.11(A) Food Protection* «W" require reporting by Food Employees and Applicants* 3-302.15 Washing Fruits and Vegetables 3.304.11 Food Contact with Equipment and 590.003(F) Responsibility of a Food Employee or an Utensils* Applicant to Report to the Person in Contamination from the Consumer Charge* 3-306.14(A)(B) Returned Food and Reservice of Food* 590.003(G) Reporting by Person in Charge* Disposition of Adulterated or Contaminated 3 590.003(D) Exclusions and Restrictions* Food 590.003(E) Removal of Exclusions and Restrictions 3-701.11 Discarding or Reconditioning Unsafe Food* FOOD FROM APPROVED SOURCE 9 Food Contact Surfaces 4 Food and Water From Regulated Sources 4-501.111 Manual Warewashing-Hot Water 590.004(A-B) Compliance with Food Law* Sanitization Temperatures* 3-201.12 Food in a Hermetically Sealed Container* 4-501.112 Mechanical Warewashing-Hot Water 3-201.13 Fluid Milk and Milk Products* Sanitization Temperatures* 3-202.13 Shell Eggs* 4-501.114 Chemical Sanitization-tem H, 3-202.14 Eggs and Milk Products,Pasteurized* Hardness* P gg Concentration and 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* 2-301.12 Cleaning Procedure* 3.202.18 Shellstock Identification Present* 2-301.14 When to Wash* 590.004(C) Wild Mushrooms* 11 Good Hygienic Practices 3-201.17 Game Animals* 2-401.11 Eating,Drinking or Using Tobacco* 3 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* 1.2' Prevention of Contamination from Hands I:6 Tags/Records:Shellstock 590.004(E) Preventing Contamination from 3-202.18 Shellstock Identification* Employees* 3-203.12 Shellstock Identification Maintained* 13 Handwash Facilities Tags/Records: Fish Products Conveniently Located and Accessible 3-402.11 Parasite Destruction* 5-203.11 Numbers and Capacities* 3-402.12 Records,Creation and Retention* 5-204.11 Location and Placement* 590.004(J) Labeling of Ingredients* 5-205.11 Accessibility,Operation and Maintenance 7 Conformance with Approved Procedures Supplied with Soap and Hand Drying /HACCP Plans Devices 3-502.11 Specialized Processing Methods* 6-301.11 Handwashing Cleanser,Availability 3-502.12 Reduced Oxygen Packaging,Criteria* 6-301.12 Hand Drying Provision 8-103.12 Conformance with Approved Procedures* •Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. CITY OF SALEM BOARD OF OF HEALTH Establishment Name: Date: / Page: of Item Code >' C" Critical Item, DESCRIPTION OF VIOLATION/ PLAN OF CORRECTION M Date �No. Reference �R'—Red Items ' '; '� ,. w ,.� T ,. PLEASE PRirrr CLEARLY' :.;n P, a Verified All Z6 Z Discussion With Person in Charge: Corrective Action Required: `" ❑ mo` ❑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 comply Exclusion with all mandates of the Mass/Federal Food Code. I understand that noncompliance may ❑ Re-inspection Scheduled ❑ Emergency Suspension result in daily fines of twenty-five dollars or suspension/revocation of your food permit. ❑ Embargo ❑ Emergency Closure ❑ Voluntary Disposal ❑ Other FORM 734B HOBBS &WARREN - BOSTON Violations Related to Foodborne Illness Interventions and Risk 3-501.14(C) PHFs Received at Temperatujes; Factors(Red Items 1.22) (Cont.) According to Law Cooled to 41*F/45*F Within 4 Hours.* PROTECTION FROM CHEMICALS 3-501.15 Cooling Methods for PHFs X14' Food or Color Additives 19`> PHF Hot and Cold Holding 3-202.12 Additives* 3-501.16(B) Cold PHFs Maintained at or below 3-202.14 Protection from Unapproved Additives* 590.004(F) 41°F/45°F* ;,15:. Poisonous or Toxic Substances 3-501.16(A) Hot PHFs Maintained at or above 7-101.11 Identifying Information-Original 140°F* Containers* 3-501.16(A) Roasts Held at or above 130°F.* 7-102.11 Common Name-Working Containers* II':"20' Time as a Public Health Control 7-201.11 Separation-Storage* 3-501.19 Time as a Public Health Control* 7-202.11 Restriction-Presence and Use* 590.004(H) Variance Requirement 7-202.12 Conditions of Use* REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-203.11 Toxic Containers-Prohibitions* POPULATIONS(HSP) 7-204.11 Sanitizers,Criteria-Chemicals* 521 S' 3-801.11(A) Unpasteurized Pre-packaged Juices and 7-204.12 Chemicals for Washing Produce,Criteria* Beverages with Warning Labels* 7-204.14 Drying Agents,Criteria* 3-801.11(B) Use of Pasteurized Eggs* 7-205.11 Incidental Food Contact,Lubricants* 3-801.11(D) Raw or Partially Cooked Animal Food and 7-206.11 Restricted Use Pesticides,Criteria* Raw Seed Sprouts Not Served.* 7-206.12 Rodent Bait Stations* 3-801.11(C) Unopened Food Package Not Re-served.* 7-206.13 Tracking Powders,Pest Control and Monitoring* CONSUMER ADVISORY 22 3-603.11 Consumer Advisory Posted for Consumption of TIMEITEMPERATURE CONTROLS Animal Foods that are Raw,Undercooked or 16:' Proper Cooking Temperatures for not Otherwise Processed to Eliminate PHFs Pathogens.* EHectW 11112011 3-401.1IA(1)(2) Eggs- 155°F 15 Sec. 3-302.13 Pasteurized Eggs Substitute for Raw Shell Eggs* Eggs-Immediate Service 145"F 15 Sec.* 3-401.11(A)(2) Comminuted Fish,Meats&Game SPECIAL REQUIREMENTS Animals- 155*F Sec.* 590.009(A)-(D) Violations of Section 590.009(A)-(D) in 3-401.11(B)(1)(2) Pork and Beef Roast- 130°F 121 Min.* catering,mobile food,temporary and 3-401.11(A)(2) Ratites,Injected Meats-155°F 15 Sec.* residential kitchen operations should be 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs, debited under the appropriate sections Stuffing Containing Fish,Meat, above if related to foodborne illness Poultry or Ratites- 165°F 15 Sec.* interventions and risk factors. Other 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks 590.009 violations relating to good retail 145°F* practices should be debited under#29- 3-401.12 Raw Animal Foods Cooked in a Special Requirements. Microwave 165°F* 3-401.11(A)(1)(b) All Other PHFs- 145°F 15 Sec.* VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 17 , Reheating for Hot Holding (Blue Items 23-30) 3-403.11(A)&(D) PHFs 165°F 15 Sec.* Critical and non-critical violations, which do not relate to the 3-403.11(B) Microwave- 165°F 2 Minute Standing foodborne illness interventions and risk factors listed above, can be Time* found in the following sections of the Food Code and 105 CMR 3-403.1I(C) Commercially Processed RTE Food- 590.00. 140°F* Item Good Retail Practices FC 590.00 3-403.1 I(E) Remaining Unsliced Portions of Beef 23. Management and Personnel FC-2 .003 Roasts* 24. Food and Food Protection FC-3 .004 18, Proper Cooling of PRFs 25. Equipment and Utensils FC-4 .005 3-501.14(A) Cooling Cooked PHFs from 140°F to 26. Water, Plumbing and Waste FC-5 .006 70°F Within 2 Hours and from 70°F 27. Physical Facility FC-6 .007 to 41*F/45*F Within 4 Hours.* 28. Poisonous or Toxic Materials FC-7 .008 3-501.14(B) Cooling PHFs Made From Ambient 29. Special Requirements .009 Temperature Ingredients to 41°F/45*F 30. Other Within 4 Hours* *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. ' CITY OF SALEM, MASSACHUSETTS LICENSING BOARD r 120 WASHINGTON STREET 978-745-9595 ext.421 NOTIFICATION FORM IF YOUR APPLICATION INCLUDES THE SERVING OF FOOD YOU MUST HAVE THIS FORM SIGNED BY THE HEALTH DEPARTMENT PRIOR TO SUBMITTING YOUR APPLICATION TO THE LICENSING BOARD. (this form MUST be signed and returned with your application). ct" NAME OF BUSINESS � � C,A r-,e Corporate name: d/b/a: LOCATION: /S j w✓aSl� / // � �, TELE. # 97S ' TYPE OF LICENSE Cw~} L�,CU1-- CA T-2-- APPLICANTS INFORMATION ' / � Name: J ch V1 t ) yJ4 U4�14 1) Home address:�3 0,4 n -�-;j City: Arcti.. State: U. Zip:c)i�,7o Home tele. # q7�- 7°/ `1-69G 3 HEALTH AGENT/INSPECTOR'S COMMENTS: ealth Age notification form a a CITY OF SALEM, MASSACHUSETTS \�L LICENSING BOARD 120 WASHINGTON STREET 978-745-9595 ext.421 NOTIFICATION FORM IF YOUR APPLICATION INCLUDES THE SERVING OF FOOD YOU MUST HAVE THIS FORM SIGNED BY THE HEALTH DEPARTMENT PRIOR TO SUBMITTING YOUR APPLICATION TO THE LICENSING BOARD. (this form MUST be signed and returned with your application). NAME OF BUSINESS Corporate name: Edgeway Corporation d/b/a: Edgewater Cafe LOCATION: 155 Washington Street, Salem, MA 01970 TELE. # 978-740-4669 TYPE OF LICENSE Annual all alcoholic 7 day license APPLICANTS INFORMATION Name: Dennis Moustakis Home address: 32 Dearborn street City: Salem State: MA Zip: 01970 Home tele. # 978-744-6963 HEALTH AGENT/INSPECTOR'S COMMENTS: S ealth Agent notification forth CITY OF SALEM, MASSACHUSETTS LICENSING BOARD 120 Washington Street Salem, MA 01970 978-745-9595 ext. 421 Chairman,Harold F.Blake,Jr. Stanley J.Usovicz,Jr. lama M.Fleming Mayor ROUTING SLIP John H.Casey Clerk,Judy Davenport The Salem Licensing Board requires each applicant to have the appropriate Departments sign this Routing Slip and return it to the Licensing Board Office prior to the issuance of a license. BUSINESS NAME Ca vCrZ Corporate name: _ d/b/a: Vxi, XbL- 0144 -1— LOCATION: L%-A-s Tele. #gljl'- 7'?6 TYPE OF LICENSE: <_�C djSc-vj sa APPLICANTS NAME: �p1 l yl t� lat. }A kt5 Residence Street: a 3.)e,9fz(0c-wl S( Home tele. # 97 f-7'"1 V City: (J `, State: t.J Zip:5/S 1 ci TO ALL CITY DEPARTMENTS: your signature on this form is notifying the Licensing Board that all requirements of your department have been met, at which time the Licensing Board will issue a license. Salem Hi oric Co mi sion 120W a ingto Street Si Revie /Planning Dept. 120 Washington Street %Iern Health Department 12,00 Washington Street Fire Prevention 29 F Ave. c Building Inspector Washington Street D artment Public Services (Water Dep ) 120 Washington Street routing slip r.. 4 r 1Y �,rs•Ffj'*.L� hits, t � Cv 101 J i lwjj 0 b ry.M1T O � UP 100 2��^"'Q,nw ✓, i I ,y', t wry�.c ... t.t� + ✓ I s:Tt" +�xqy -x.� ��: xGROS$A .5ry3770SFi i"r � vi$<,+t .�;i 4 x r F� hk �:7y r`*t r s c 4i r� r dn#z f5 a `Mdby4�F `�+a r J� Sharon H. McCabe 330 Maple Street Lynn, MA 01904 (781) 599-1299 August 14, 2003 Re: Sery-Safe Certification Course Dear Owner/Manager: I am pleased to invite you and your staff members to a food certification course offered locally at the Edgewater Caf6, 155 Washington Street, (old Salem News building) Salem, MA 01970. The class is scheduled for three Wednesday evenings September 24, 2003 —October 15, 2003. The meeting time is 6:00 p.m.— 8:30 p.m. The format will be class instruction for the first three meetings. The test will be given on October 15, 2003. The fee includes the cost of the Serv-Safe Essentials Course book. Everyone attending must purchase his or her own book. The test answer sheet is provided with the purchase of each book. The fee is one hundred and sixty-five dollars ($165.00). Please submit a check, or money order made out to me, Sharon McCabe along with the application by September 17, 2003. If you need additional information, please call me at 781599-1299, or e-mail questions to Pixzie9@aol.com Sincerely, Sharon H. McCabe Certified Food Safety Instructor ' r S.McCabe Food Safety Services Application for Sery-Safe Certification Course Name of Establishment: Tel# Name of Person Attending Class: Tel# Cost Fee: $165.00 Please check if you desire Spanish Serv-Safe course book Check/money order payable to: Sharon H. McCabe Mailing address: (please include full address) Sharon H. McCabe 330 Maple Street Lynn, MA 01904 (781) 599-1299 E-mail: pixzie9@aol.com CITY OF SALEM �t BOARD OF HEALTH : 0 Establishment Name1O[-�f'^ l 44e, Date: n a Page: / of Item Code C-Critical Item DESCRIPTION OF VIOLATION / PLAN OF CORRECTION Date h Verified No. Reference R-Red It ;, PLEASE PRINT CLEARLY x x R 15dv5 '4 Si->• R Ab laser o / [/ a ,0 54eh I54 '/21e 14 -e m? ii � � nn__'•r(l0 /_ .3 / [ /fie� �/Lt td "(10 S c. 7h! 5f-7t utu>r U ) / u n a fav �ry s../ /[/ Gn SSS r Discussion With Person in Charge: Corrective Action Required: ❑ No ' ❑Yes t I have read this report, have had the opportunity to ask questions and agree to correct all ❑ Voluntary Compliance ❑ Employee Restriction/ ti violations before the next inspection, to observe all conditions as described, and to comply Exclusion F with all mandates of the Mass/Federal Food Code. I understand that noncompliance may ❑ Re-inspection Scheduled ❑ Emergency Suspension result in daily fines of twenty-five dollars or suspension/revocation of your food permit. ❑ Embargo ❑ Emergency Closure ❑ Voluntary Disposal ❑ Other i FORM 734B HOBBS & WARREN - BOSTON Violations Related to Foodborne Illness Interventions and Risk 3-501.14(C) PHFs Received at Temperatures Factors(Red Items 1-22) (Cont.) According to Law Cooled to 41*F/45°F Within 4 Hours.* PROTECTION FROM CHEMICALS 3-501.15 Cooling Methods for PHFs 14j, Food or Color Additives 19 PHF Hot and Cold Holding 3-202.12 Additives* 3-501.16(B) Cold PHFs Maintained at or below 3-202.14 Protection from Unapproved Additives* 590.004(F) 41°F/450F* 15,F Poisonous or Toxic Substances 3-501.16(A) Hot PHFs Maintained at or above 7-101.11 Identifying Information-Original 140°F.* Containers* 3-501.16(A) Roasts Held at or above 130°F.* 7-102.11 Common Name-Working Containers* 20 Time as a Public Health Control 7-201.11 Separation-Storage* 3-501.19 Time as a Public Health Control* 7-202.11 Restriction-Presence and Use* 590.004(H) Variance Requirement 7-202.12 Conditions of Use* REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-203.11 Toxic Containers-Prohibitions* POPULATIONS(HSP) 7-204.11 Sanitizers,Criteria-Chemicals* ' .21<`" 3-801.11(A) Unpasteurized Pre-packaged Juices and 7-204.12 Chemicals for Washing Produce,Criteria* Beverages with Warning Labels* 7-204.14 Drying Agents,Criteria* 3-801.11(B) Use of Pasteurized Eggs* 7-205.11 Incidental Food Contact,Lubricants* 3-801.11(D) Raw or Partially Cooked Animal Food and 7-206.11 Restricted Use Pesticides,Criteria* Raw Seed Sprouts Not Served.* 7-206.12 Rodent Bait Stations* 3-801.11(C) Unopened Food Package Not Re-served.* 7-206.13 Tracking Powders,Pest Control and Monitoring* CONSUMER ADVISORY 22 3-603.11 Consumer Advisory Posted for Consumption of TIME/TEMPERATURE CONTROLS Animal Foods that are Raw,Undercooked or ;i16„. Proper Cooking Temperatures for not Otherwise Processed to Eliminate PHFs Pathogens.* Er/ective 11112001 3-401.11A(l)(2) Eggs- 155*F 15 Sec. 3-302.13 1 Pasteurized Eggs Substitute for Raw Shell Eggs* Eggs-Immediate Service 145°F 15 Sec.* 3-401.11(A)(2) Comminuted Fish,Meats&Game SPECIAL REQUIREMENTS Animals-155°F Sec.* 590.009(A)-(D) Violations of Section 590.009(A)-(D)in 3-401.11(B)(1)(2) Pork and Beef Roast-130°F 121 Min.* catering,mobile food,temporary and 3-401.11(A)(2) Ratites,Injected Meats- 155°F 15 Sec.* residential kitchen operations should be 3-401.11(A)(3) Poultry,Wild Game, Stuffed PHFs, debited under the appropriate sections Stuffing Containing Fish,Meat, above if related to foodbome illness Poultry or Ratites- 165*F 15 Sec.* interventions and risk factors. Other 3-401.1l(C)(3) Whole-muscle,Intact Beef Steaks 590.009 violations relating to good retail 145°F* practices should be debited under#29- 3-401.12 Raw Animal Foods Cooked in a Special Requirements. Microwave 165°F* 3-401.I1(A)(1)(b) All Other PHFs- 145°F 15 Sec.* VIOLATIONS RELATED TO GOOD RETAIL PRACTICES d'r19' Reheating for Hot Holding (Blue Items 23-30) 3-403.11(A)&(D) PHFs 165°F 15 Sec.* Critical and non-critical violations, which do not relate to the 3-403.11(B) Microwave-165°F 2 Minute Standing foodborne illness interventions and risk factors listed above, can be Time* found in the following sections of the Food Code and 105 CMR 3-403.11(C) Commercially Processed RTE Food- 590.00. 140°F* Item Good Retail Practices FC 590.00 3-403.11(E) Remaining Unsliced Portions of Beef 23. Management and Personnel FC-2 .003 Roasts* 24. Food and Food Protection FC-3 .004 1S". Proper Cooling of PHFs 25. Equipment and Utensils FC-4 .005 3-501.14(A) Cooling Cooked PHFs from 140°F to 26. Water, Plumbing and Waste FC-5 .006 70°F Within 2 Hours and from 70°F 27. Physical Facility FC-6 .007 to 41°F/45°F Within 4 Hours.* 28. Poisonous or Toxic Materials FC-7 .008 3-501.14(B) Cooling PHFs Made From Ambient 29. Special Requirements .009 Temperature Ingredients to 41°F/45°F 30. TOther Within 4 Hours* *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. 3' CITY OF SALEM BOARD OF HEALTH Establishment Name: EdA 11,1U04 o11 ( ¢ Date: Page: / of / Item Code C-Critical Item DESCRIPTION OF VIOLATION / PLAN OF CORRECTION Date , Reference R'-Red Items fi �' % .Verified PLEASE PRINT CLEARLY Mei wr{ r 5 ttl? s . p fir! . qd � le-.1 l ;� . n�os�ol L i - Plea e�>.�,r1 ok j .k4 KS % [` e w// ho7mY. K "'I (yin QrPa 4 0 / P"d nC doet /i o 3 b 5/-7 k \ ate+ t 4v 0je 1_149,j_ h 07 t / HO Jin 1 G .P i+ . 4 C4,✓M 7/( h d Snuv! S i �l - n,. 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 ❑ VoluntaryCompliance ❑ Employee Restriction/ violations before the next inspection, to observe all conditions as described, and to comply Exclusion "i ❑ Re-inspection Scheduled ❑ Emergency Suspension 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 your food permit. ❑ Embargo ❑ Emergency Closure {' ❑ Voluntary Disposal ❑ Other 4 FORM 734B HOBBS a WARREN - BOSTON Violations Related to Foodborne Illness Interventions and Risk 3-501.14(C) PHFs Received at Temperatures Factors(Red Items 1-22) (Cont.) According to Law Cooled to 41'F/45°F Within 4 Hours.* PROTECTION FROM CHEMICALS 3-501.15 Cooling Methods for PHFs 14'i` Food or Color Additives 19 PHF Hot and Cold Holding 3-202.12 Additives* 3-501.16(B) Cold PHFs Maintained at or below 3-202.14 Protection from Unapproved Additives* 590.004(F) 41°F/450F* 'x'':15': Poisonous or Toxic Substances 3-501.16(A) Hot PHFs Maintained at or above 7-101.11 Identifying Information-Original 140°F* Containers* 3-501.16(A) Roasts Held at or above 130°F.* 7-102.11 Common Name-Working Containers* ' 20. Time as a Public Health Control 7-201.11 Se aration-Storage* 3-501.19 Time as a Public Health Control* 7-202.11 Restriction-Presence and Use* 590.004(H) Variance Requirement 7-202.12 Conditions of Use* REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-203.11 Toxic Containers-Prohibitions* POPULATIONS(HSP) 7-204.11 Sanitizers,Criteria-Chemicals* 21 3-801.11(A) Unpasteurized Pre-packaged Juices and 7-204.12 Chemicals for Washing Produce,Criteria* Beverages with Warning Labels* 7-204.14 Drying Agents,Criteria* 3-801.1 I(B) Use of Pasteurized E s* 7-205.11 Incidental Food Contact,Lubricants* 3-801.11(D) Raw or Partially Cooked Animal Food and 7-206.11 Restricted Use Pesticides,Criteria* Raw Seed Sprouts Not Served.* 7-206.12 Rodent Bait Stations* 3-801.11(C) Unopened Food Package Not Re-served.* 7-206.13 Tracking Powders, Pest Control and Monitoring* CONSUMER ADVISORY 22 3-603.11 Consumer Advisory Posted for Consumption of TIME/TEMPERATURE CONTROLS Animal Foods that are Raw,Undercooked or f 16Proper Cooking Temperatures for not Otherwise Processed to Eliminate PHFs Pathogens.* HlecNve vvzoot 3-401.11A(1)(2) Eggs- 155°F 15 Sec. 3-302.13 Pasteurized Eggs Substitute for Raw Shell Eggs* Eggs-Immediate Service 145°F 15 Sec.* 3-401.11(A)(2) Comminuted Fish,Meats&Game SPECIAL REQUIREMENTS Animals- 155°F Sec.* 590.009(A)-(D) Violations of Section 590.009(A)-(D) in 3-401.11(B)(1)(2) Pork and Beef Roast-1307 121 Min.* catering, mobile food,temporary and 3-401.11(A)(2) Ratites,Injected Meats- 155°F 15 Sec.* residential kitchen operations should be 3-401.11(A)(3) Poultry,Wild Game, Stuffed PHFs, debited under the appropriate sections Stuffing Containing Fish,Meat, above if related to foodbome illness Poultry or Ratites- 165°F 15 Sec.* interventions and risk factors. Other 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks 590.009 violations relating to good retail 145°F* practices should be debited under#29- 3-401.12 Raw Animal Foods Cooked in a Special Requirements. Microwave 165°F* 3-401.11(A)(1)(b) All Other PHFs- 145°F 15 Sec.* VIOLATIONS RELATED TO GOOD RETAIL PRACTICES t 17 Reheating for Hot Holding (Blue Items 23-30) 3-403.11(A)&(D) PHFs 165°F 15 Sec.* Critical and non-critical violations, which do not relate to the 3-403.11(B) Microwave- 165°F 2 Minute Standing foodborne illness interventions and risk factors listed above, can be Time* found in the following sections of the Food Code and 105 CMR 3-403.11(C) Commercially Processed RTE Food- 590.00. 140°F* Item Good Retail Practices FC 590.00 3-403.11(E) Remaining Unsliced Portions of Beef 23. Management and Personnel FC-2 .003 Roasts* 24. Food and Food Protection FC-3 .004 18'- Proper Cooling of PHFs 25. -Equipment and Utensils FC-4 .005 3-501.14(A) Cooling Cooked PHFs from 140°F to 26. Water, Plumbing and Waste FC-5 .006 70°F Within 2 Hours and from 70*F 27. Physical Facility FC-6 .007 to 41*F/45°F Within 4 Hours.* 28, poisonous or Toxic Materials FC-7 .008 3-501.14(B) Cooling PHFs Made From Ambient 29. Spa ial Re uirements .009 Temperature Ingredients to 41°F/45°F 30. Other Within 4 Hours* *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000.