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FOODIES FEAST - ESTABLISHMENTS t #1a/ld Yh'C7 n n Commonwealth of Massachusetts r City of Salem Board of Health Kimberley Driscoll 120 Washington Street,4th Floor Mayor SALEM,MA 01970 Food/Retail Establishment Permit DATE PRINTED: 06/16/2011 ESTABLISHMENT NAME: YMCA - Foodie's Feast File Number:BHF-2009-000010 40 Leggs Hill Road YMCA Cafe MARBLEHAD MA 01945 LOCATED AT: SALEM, MA 01970 Permit Type Permit No. Permit Issued Permit Expires Fee Restrictions/Notes FOOD SERVICE BHP-2011-0476 Jun 10,2011 Dec 31,2011 $140.00 ESTABLIS14MENT Total Fees: $140.00 PERMIT EXPIRES IDecember 31, 2011 Board of Health This Permit is not transferable and must be reissued upon change of ownership or location.The permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code, beofre any revonations, improvements,or equipment changes are made, all plans for such must be submitted to and approved by the Salem Board of Health. Page 1 CITY OF SALEM, MASSACHUSETTS • 'f BOARD OF HEALTH 120 WASHINGTON STREET,4..FLOOR TEL. (978) 741-1800 K1NDERLEY DRISCOLL FAX(978) 745-0343 MAYOR DGREENBAUNI a&ALEM.COM DAVID GREENBAUM,RS ACTING HEALTH AGENT 2011 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT NAME OF ESTABLISHMENT r0odi @ Sr¢as TEL# Q/1k ADDRESS OF ESTABLISHMENT b� Le aCI S WI 1\ Vl� 'O DD qA 019 AX# 01K �JJ MAILING ADDRESS(if different) (1 -- (� EMAIL-Business': MA.?Ed%(A'RJKEEpF(Z(O(� kALL-bvkk Website: lA/1IVI toolII IeS$ eD.<_+ Wryi OWNER'S NAME ✓1 �tG -- Lpzo( S TEL# lnl ~I '�J`2 "Y PW ADDRESS R/ 0rVkt�G SI Kpb M of o1915 STREET CITY STATE ZIP ,t •r CERTIFIED FOOD MANAGER'S NAMES) 1 CERTIFICATE#(S) V A (Required in an establishment where potentially hazardous food is prepared) EMERGENCY RESPONSE PERSON yk ,01 Ct- h Le S HOME TEL# 617 DAYSOFOPERA?ION I Monday. T Wednesday *Thursday- s Fdd 'Saturda A ' =F"Sundaye"" HOURS OF OPERATION l7 �/P� 7P j 7 7P 7 �,' ' �� y Please write in time of day. a r /p - /''1 am— ^� aM— M rh �p/rt R/rl— /0 /OLW) For exam e1lam-11 m ! I TYPE OF ESTABLISHMENT FEE (check only) RETAIL STORE YES 0 less than 1000sq.ft. =$70 1000-10,000sq.ft. =$280 more than 10,000sq.ft. =$420 ---------------- ---------- RESTAURANT YES NO less than 25 seats $140 (Outdoor Stationary Food Cart$210) 25-99 seats =$280 more than 99 seats =$420 - BED/BREAKFAST/ -------------------------------------------------------------------------- ---------------- O $100 YESN CHILDCARESERVICES/NURSING HOME---------------------------------------- ----------- - ------------------------------------------------------------------ ADDITIONAL PERMITS MAKE (not just serve) ICE CREAM, YOGURT/SOFT SERVE YES ® $25 TOBACCO VENDOR YES (12D $135 ALL NON-PROFIT(such as church kitchens) YES O) $25 *Please pay total with one check payable to the City of Salem. This Permit is not transferable and must be reissued upon change of ownership.The Permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code, before any renovations, improvements,or equipment changes are made,all plans for such must be submitted to and approved by the Salem Board of Health. Pursuant to MGL Chapter 62CgeSn 49A.I certify under the pains and penalties of perjury that I,to my best knowledge and belief,have filed all state tax returns paid al tate to urider the law. /i Q e� Signature Date I Social Security or Federal Identification Number Revised 10f71II FOODAP201 ludim Check#&Date CITY OF SALEM BOARD OF HEALTH Establishment Name,]cx-D 1 i;5 ('GAS L��( 1+1 L� �) Date: Page: of� Item Code C—Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date, No. Reference R-Red Item - Verified PLEASE PRINT CLEARLY dP " � L 1 ►1�vol � a)T+0 C FoLlpwt N ,n Uv 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 con ns as described, and to ❑ Re-inspection Scheduled ❑ Emergency Suspension Lnoncompliance th all mandates of the Mass/Federal Fookode. understand that may result in daily fines of twenty-frs or suspension/revocation of ❑ Embargo ❑ Emergency Closure permit. L3Voluntary Disposal ❑ Other: 3-501.14(0 PHFs Received at Temperatures Violations Related to Foodborne Illness Interventions and Risk According to law Cooled to Factors(Items 1-22) (Cont.) 41`7'/45'F Pvithm 4 Hour PROTECTION FROM CHEMICALS 3-50t.15 Cooling Methods for PRFs 14 Food or Color Additives Fig Hot and Cold Holding 3-202.12 Additives*' 3-501.16 (B) Cold PRFs Maintained at or below 590.004(F) 4101450 F* 3-302_14_ Protection from Unapproved Additives'k 15 Poisonous or Toxic Substances 3-501.16(A) Hot PHFs Maintained at or above 140°F. $ 7-101.11 identifying Information-Original 3-501.16(A) Roasts Heid at or above 1.300F. " Containers* 7-102.11. Common Name-Working Containers* 20 Time as a Public Health Control 7-201.11 Se aration-Stora * 3-501:19 Time as a Public Health Control* 7-202.11 .Restriction-Presence and Use* 590.004{11) Variance Requirement 7-202.12 Conditions of Use* 7-203.11 Toxic Containers-Prohibitions* REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-204.11 Sanitize".Criteria-Chemicals* POPUE ATIONS HSP 3-841.11{A) Unpasteurized 7-204.12 Chemicals for Washing Produce,Criteria* 21 zed Pre-packaged Juices and :Beverages with Warning Labels* 7-204.14 ems.Criteria* J-801AI(B) Use of Pasteurized Eggs* 7-205.11 Incidental Food Contact Lubricants* 3-801.1 I(D) Raw of Partially Cooked Animal Food and 7-206.11 Restricted Use Pesticides;Criteria* Raw Seed S ns Not Served.* 7-206.12 - RGdent'Bait Stations* 3-801.11(Q Unopened Food Paclea*e Not Re-served. 7-206.13 Tracking Powders,Pest Control and Mowtcxin *e CONSUMER ADVISORY TIME(L EMPERATURE CONTROLS 22 3-603.11 Cousumer Advisory Posted for Consumption of 16 Proper Cooking Temperatures for Animal Foods That are Raw,Undercooked or PHFs - Not Otherwise Processed to Eliminate Pathogens.' 3-401.11A(I)(2) Eggs- 155°F 15 Sec. e"QCv6nrza�r Eggs-Immediate Service 145'F15sec• 3-302.13 Pasteurized Eggs Substitute for Raw She11 E 3-401.11(A)(2) Comminuted Fish.Meats&Game Animals-155'F 15 see. " 3.401.It(B)(1)(21 Pork and Beef Roast-130'F 121 min* SPECIAL REQUIREMENTS 590.409(A 3-461.11(A)(2) Ratites,injected Meats-155'F 15 590-009(A)-(D) Violations of Section 590.(}(}9{A)-{D)an Sec.* catering,.mobile food,temporannand 3401.11(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 it related to foodborne illness 3401.11(C)(3) Whole-muscle,Intact Beef Steaks interventions and risk factors. Other 145°F 4, 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. 17 Reheating for Hot Holding WOLA77ONS RELATED TO GOOD RETAIL PRACTICES 3-103AI(A)&(D) PHFs 165°F 15 sec.* (Items 23-30) 3.403.11(B) Microwave- 1650 F 2 Minute Standing Critical,mid non-critical violations,which do not relate to the Timc* foodborne illness interventions and risk factors listed above, can he 3-403.11(C) Commercially Processed RTE Food- found in thefollowing sectionsof the Food Code and 105 CMR 140°F* 590.000. 3-403.11(E) Remaining Unsliced Pardons of Beef j Iter i Good Retail Practices , FC 590.000 Roasts` L23. I Management and Personnel ' FC-2 .003 1g Proper Cooling of PHFs 124. i Food and Food Protection I FC-3 .004 1 25. Equipment and Utensils i FC-4 .005 3-501.14(A) Cooling Cooked PHFs from 140`F to i �, Water.Plumbingand Waste FC-5 .006 1 70'F Within 2 Hours and From 70'F 27. Physical Facility F, - .007 to 4I'F/450F Within 4 Hours.* 128. ' Poisonous or Toxic Materials f FC-7 ,008 3-501.14(B) Cooling PHFs Made From Ambient 29 -Special R uiremeMs 1 .009 1 Temperature Ingredients to 41'F/45°F 30 I Other -- Within 4 Hams* 'Denotes critical item in the federal 1999 FwA Cale w'105 CMR:90.000. CITY OF SALEM BOARD OF HEALTH Name of Establishment: Foodies Feast Address: 40 Leggs Hill Road Owner(s): Angelia L. Lewis Phone: 617-852-4566 The proposed new owner of this establishment presented a Floor Plan and Menu for review in accordance with the State Food Code. The floor plan and menu are both approved as presented. Any changes to the floor plan and menu must be approved by the Board of Health prior to implementing them FLOOR PLAN A Hand Sink is located in the food service area. The hand sink must have a wall hung soap and paper towel dispenser. These must be stocked at all times. Hand sinks must be used for hand washing only. All floors, walls, and ceilings where food, utensils, paper products, etc, are stored, prepared or served must be intact, impervious, and easily cleanable. MENU/FOOD PREP A review of the menu was conducted. Food items will be made and packaged at Foodie's Feast in Marblehead. All food items must have proper labeling in accordance with the Food Code. Any other pre-made items not made at Foodie's Feast, must be purchased from a wholesaler licensed by the State. Fruits and vegetables for fruit salads must be washed prior to preparation. All food must be held at 41°F or lower, or 140°F or higher, at all times. Therefore, soups must be brought to boiling before being held hot and transported to this location. There may be no bare hand contact of ready-to-eat foods. Gloves, tongs, or tissues must be used when handling such food. Soups will be prepared at Foodie's Feast and brought to this location. A stem type thermometer must be provided to test the temperature of the soups at least every 2 hours, to ensure they are being held at 140°F or higher. Owner to provide utensils for service to be held in a clean and sanitized container and wash rinsed and sanitized daily. There is no area for ware washing at this location. All utensils and equipment are to be transported to and from Foodie's Feast in a clean and sanitary manner and washed, rinsed and sanitized daily. CERTIFICATION There must be a Certified Food Manager working at this establishment full time. When a CFM is not onsite there must be a Person-in-Charge (PIC) who is fully trained in sanitation techniques and has a thorough understanding of the operation. EXTERMINATION Monthly services of a Licensed Pest Control Operator are required. Please keep receipts for inspections. An initial inspection must be conducted prior to this establishment opening for service. Also, a copy of a signed contract must be provided to health inspector prior to opening. SANITIZING SOLUTION Sanitizing Solution must be accessible at each station and for the patrons' tables. Test strips corresponding to the kind of sanitizer, must be on hand to check concentration of solution. Solution must be made daily, tested, and the results recorded on a log sheet for examination by Board of Health inspectors. Outside area of premises, including the dumpster area must be kept clean and sanitary. A change of ownership inspection will be conducted the week of May 30, 2011. David Greenbaum Date Senior Sanitarian Angeli L. Lewis Date i ALL Rmdw I Freezer Trepkare NanhIXel Tngicere I � ®I fL_=_J I Nectars I I 1 I I I 1 1 1 I I I 1 , I I I I I I I i I I 1 I I j i I I I I CaaNne I I Nester I I ------_--J `--------------------------- Ground Level Floor Plan Scale 1/4":; 1'-0" Foodies Feast - YMCA 40 Leggs Hill Road, Marblehead MA 01945 Sheet A-101 FOODIE'S FEAST CAFI` TO PLACE YOUR ORDER FOR QUICK PICKUP CALL:781-639-1104 Please notify your server if anyone in your party.has any Food allergies before placing your order. Breakfast Foodie's homemade'legendary'scone or rock cake Baked fresh every morning 2.16 Bacon OR ham,with egg&cheese on English muffin 4.00 Tomato OR spinach,with egg&cheese on English muffin 4.00 Omelets of the day with fruit cup and toast 7.50 Ham,egg,cheddar and salsa wrap with lettuce 4.25 Tomato,egg,cheddar and salsa wrap with lettuce 4.25 Bagel,smoked salmon,cream cheese,onion&caper 8.25 Fruit salad cup/bowl 3.25/4.25 Fruit salad w/plain yogurt cup/bowl 3.75/4.75 Side of toast,or a bagel 1.00 Add cream cheese,tomato, peanut butter or honey +.75 Splendid one-of-a-kind sandwiches $7.06 ea. Served on your choice of locally-sourced bread with lettuce,tomato, Cucumber and a pickle spear and cup of daily changing salads. Herb-crusted roast beef with horseradish dressing Lavender-roasted chicken breast w/sour cream dill mayo Chicken Caesar wrap Spicy chicken with blue cheese dressing Fresh roasted turkey breast with cranberry sauce Black forest ham with Dijon mustard Curried chicken salad with raisins Classic chicken salad with grapes White albacore tuna salad with celery and onion Traditional egg salad with celery and anion Fresh mozzarella,lettuce,tomato and pesto Chick-pea hummus and fresh vegetables on choice of wrap Foodie's BLT with mayo on 7-grain bread Combo:any half sandwich&cup of soup or side salad Slice of quiche of the day-$4,with cup of soup or side salad-$7.06 Brilliant homemade soups and salads Fresh made soups...ask about our daily specials 4.25 Foodie's Feast turkey black-bean chili 4.50 Garden salad with balsamic vinaigrette 3.75/4.75 Caesar's Salad 4.25/5.25 Any salad above w/chicken,egg salad or tuna salad +2.75 Dressings: blue cheese,balsamic vinaigrette,Caesar Week-end brunch! until 11a.m. Omelets,Eggs Benedict,breakfast burritos—come in and see our seasonal specials! 114 WASHINGTON ST. MARBLEHEAD, MA 01945 (781)639-1104 x EXAM FORM NO. 4453 ServSafe CERTIFICATE NO. 6479048 xR P x� J� S {3,r x _ s r +• fi Se#vSa#Am'e@ Cert/ficati®n { jp K x 2 f, � _ t •4w•. .fr ka D THEA E �KES:S:'LERy s for successfully completing the standards set forth for the ServSafe®Food Protection Manager Certification Examination, which is accredited by the American National Stan��ards Institute (ANSI)—Conference for Food Protection (CFP). i 5/19/2009 DATE OF EXAMINATION 5/19/2014 DATE OF EXPIRATION Local laws apply.Check with your local regulatory agency for recertification requirements. NATIONAL -- — RESTAURANT ® David Gilbert ASSOCIATION o Chief Operating Officer,National Restaurant Association #0655 Executive Director, National Restaurant Association Solutions t 02009 National Restouram Association Educational Foundation.All rights reserved.ServSafe'and the ServSafe logo are regained trademarks of be National Restaurant Associatian Educational Foundation, and used under license by National Rastsurent Association Solations,LLC,a Malty owned subsidiary of the National Restaurant Association. This dncument cannot he reproduced or altered. 00121102 y.0903 I � 1313 ', �'v�� .-_.ru.a,A,•,,:�,o,yryi,m¢�,.^:>aco rax _.-.... ORDER: 176226. teamges@hotmail.com [1095121 (1095121 617-304-0114 FOODIES FEAST FOODIES FEAST @ THE YMCA PAUL BAKER 40 LEGGS HILL ROAD 114 WASHINGTON STREET SALEM,MA 01970 MARBLEHEAD,MA 01945 06!04/09 72 NATHAN WALLICK NET 30 06/04/09 Uc.#:36247 CPC COMMERCIAL PEST CONTROL $34.00 INSPECTED UNDER OR BEHIND ALL EQUIPMENT WHERE POSSIBLE.CHECKED GLUEBOARDS AND REPLACED,NO SUBTOTAL $34.00 PEST ACTIVITY FOUND AT THE TIME OF THIS INSPECTION.RECOMMENDED TO EMPLOYEE THAT SHE EMPTY BARREL THAT TAX $0.00 ESPRESSO MACHINE DRAINS INTO ON A DAILY BASIS. TOTAL $34.00 GB!72MB MOUSE GLUE BOARDS 0.0000% EA 3.0000 TECHNICIAN SIGNATURE CUSTOMER SIGNATURE GENERAL ENVIRONMENTAL SERVICES,INC. INVOICE "TEAM GES" 930 Eastern Avenue Malden,Massachusetts 02148 (761)321.4633-(781)321.9528 Fax INVOICE: 444715 lana teamges@hotmail.com DATE: 08/06/09 ORDER; 180196 (109512[ [109512] 617-304-0114 FOODIES FEAST FOODIES FEAST @ THE YMCA PAUL BAKER 40 LEGGS HILL ROAD 114 WASHINGTON STREET SALEM,MA 01970 MARBLEHEAD,MA 01945 06106/09 - 72 NATHAN WALUCK NET 30 06106709 Lia*36247 i CPC COMMERCIAL PEST CONTROL $34.00 INSPECTED CAFE AREA CHECKED AND DATED G.B,*S.CHANGED ANY DIRTY AS NEEDED.NO PEST PROBLEMS SUBTOTAL $3400 FOUND AT THIS TIME. TAX _ $0.00 TOTAL $34.00 GB f 72MB MOUSE GLUE BOARDS 0.0000% EA 3.0000 TECHNICIAN SIGNATURE CUSTOMER SIGNATURE Charges outstanding over 30 days from the date of service are subject to 172%n finance charge per month or annual percentage rate 18%. Customer agrees to pay accrued expenses in the event of collection. Massachusetts Department of Public Health Salem Board of Health 120 Washington Street,0 Floor Division of Food and Drugs Salem, MA 01970-3523 FOOD ESTABLISHMENT INSPECTION REPORT Tel. (978) 741-1800 Fax(978) 745-0343 Name _ Date Type of Ooeration(s) Typs of Ins tion Food Service Routine Address Risk Re-inspection Level gRetail Residential Kitchen Previous Inspection Telephone i1 JJ n ' ❑ Mobile Date: OwnerHACCP Y/N El Temporary [IPro-operation t E 9, ❑ Caterer ❑Suspect Illness Person in Charge(PIC) Tim ElBed&Breakfast [I General Complaint o _ (oEl HACCP Inspector v Out?): 2121 Permit No. ElOther Each violation checked requires an explanvon 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)Z 590.009(F) action as determined by the Board of Health. FOOD PROTECTION MANAGEMENT ❑ 12. Prevention of Contamination from Hands ❑ 1. PIC Assigned/Knowledgeable/Duties EMPLOYEE HEALTH - ❑ 13. Handwash Facilities - y -- - PROTECTION FROM CHEMICALS ❑ 2. Reporting of Diseases by Food Employee and PIC ❑ El 3. Personnel with Infections Restricted/Excluded 14.Approved Food or Color Additives ❑ 15.Toxic Chemicals LFOOD FROM.APPROVED SOURCE; 4. Food and Water from Approved SourceTIMElTEMPERATURE CONTROLS(Potentially Hazardous Foods) ❑ 5. Receiving/Condition ❑ 16. Cooking Temperatures ❑ 6. Tags/Records/Accuracy of Ingredient Statements ❑ 17. Reheating ❑ 7. Conformance with Approved Procedures/HACCP Pians ❑ 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 LREQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS-(HSP): ❑21. Food and Food Preparation for HSP [110. Propelr Adequate Handwashing ❑ 11.Go'd�Hygienic Practices I _CONSUMER.ADVISORY - aQ 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-criticalt(N)wiolations 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 Z_ N by a Board of Health member or its agent constitutes an 24. Food and Food.erotection (Fc-a)(590.0o4)) 23. Management and Personnel (Fc-z) order of the Board of Health. Failure to correct violations �l so.o V 25. Equipmen�tand Utensils (FC-4)(590.005) cited in this report may result in suspension or revocation of 26. Water,Plumbing and Waste (FC-5)(590.009) the food establishment permit and cessation of food Oestablishment 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.0o6) 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 }RRE-INSPECTION:. � S. SBJIrupxfFomb-fl.tivc l'^ ��`�O �i� Inspector's Signature: I Print: I ( � t / PIC's Signature: Print: M LA u rt dAkl Page ` of Pages F 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) AssignmentofResponsibility* 3-302.11(A)(]) Raw Animal Foods Separated from Cooked and RTE Foods* 590.003(B) Demonstration of Knowledge* Contamination from Raw ingredients 2-103.11. Person in charge-duties 3-302A 1(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 * Applicant To Report To The Person In - Utensils Contamination from the Consumer Charge' 3-306.14(A)(B) Returned Food and Reservice of Food* 590.003(G) Reporting b Person in Charge* 3 590.003(D) Exclusions and Restrictions" Dispositbn of Adulterated or Contaminated Food 590.003(E) Removal of Exclusions: Restrict ons 3-701.11 D sc eding or RewndiGoning Unsafe FOOD FROM APPROVED SOURCE Food* q 1 Food and Water From Regulated Sources FOK Food Contact Surfaces 590.004(A-B) Compliance with Food Law* 4-501.111. Manual Warewashing-Hot Water 3-201.12 Foot]in a Hermetically Sealed Container* Sanitization Ter eratures* _ 3-201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Warewashing-Hot Water 3-202.13 Shell Eggs* Sanitization Tem eratures*- 3-202.1.4 Eggs and Milk Products.Pasteurized* 4-501.114 Chemical.Sanitisation-temp.,pH, 3-202.16 Ice Made From Potable Drinking Water* concentration and hardness. * 5-101.11 Drinking Water}iom an Approved System** 4-601A I(A) - Equipment Food Contact Surfaces and Utensils Clean* 590.006(A) Bottled Drinking Water* 590.006(B) Water Meets Standards in 310 CMR 22.0" 4-602.11 Cleaning Frequency of Equipment Food - 590,006(B) ish 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 E ui ment* Shellfish* 4-703.11 Methods of Sanitization-Har Water and 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* Sources* 10 Proper,Adequate Handwashing Regulatory Authority Game and Witt orushrooms Approved by 2-301.11 Clean Condition-Hands and Arms* 3-202.18 Shellstock Identification Present* 2-301..1.2 Cleaning Procedure* 590.004(C) Wild Mushrooms* 2-301.14 When to Wash* 3-201.17 Game Animals* 11 Good Hygienic Practices g Receiving/Condition 2401.11 Eating,Drinkin or Using Tobacco* 3-202.11 PFIFs Received at Proper Temperatures* 2-401.1.2 Discharges From the Eyes,Nose and 3-202.15 Package hrte rit y Mouth* 3-101.11 Food Safe and Unadulterated* 3-30'L.12 Preventing Contattnnation When Tasting* 6 Tags/Records:Shellstock 12 Prevention of Contamination from Hands 3-202.18 Shellstock Identification* 590.004(F.) Preventing Contamination from- 3-203.1.2 Shellstock Identification Maintained* Em to ees* - TagslRecords:-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* ? Conformance with Approved Procedures 5-205.11 Accessibility,Operation and Maintenance IHACCP Plans Supplied with Soap and Hand Drying 3-502.11 Specialized processing Methods* Devices 3-502.12 Reduced oxygen packaging,criteria* 6-301.11. Handwas;hing Cleanser, Availability 8-103.12 Conformance with Approved Procedures* 6-30 .1.2 Hand-Drying Provision Denoty critical item in the federal 1999 Yogi Cale or 10 CMR 590.006. CITY OF SALEM � (} BOARD OF HEALTH Establishment Name: 1 U d Date: ea� O Page: 01 of J_ Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION gate. 140. Reference R-Red Item Verltied PLEASE PRINT CLEARLY I �f�.35, /� c lJ' .� A � l_J (� .UD f () s -1-i IVA _ _ AL J _1n .q n U - s r� �D E n wcQ mac_ 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 ❑ 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 �orr�suspension/revocation of ❑ Embargo ❑ Emergency Closure your food permit. IVB ❑ Voluntary Disposal ❑ Other: 3-501.14(C) PHFs Received at Temperatures F Violations Related to Foodborne Illness Interventions and Risk According to law Cooled to Factors(Items 1-22) (Cont) 41'F/45°F Within 4 Hours. PROTECTION FROM CHEMICALS__ 3-501.15 Cooling Methods for PHFs 14 Food or Color Additives 19 PHF Hot and Cold Holding 3-50L16(B) Cold PI s Maintained at or below 3-202.12 Additives* 590.004(F) 41'145°F* 3-302.14 Protection from Unapproved Additives" 15 Poisonous or Toxic Substances 3-501.16(A) Hot PHFs Maintained at or alcove 140'1 7-101.11 Identifying Information-Original 3-501.16(A) Roasts Held at or above 130'F. Containers* 7-102.11, Common Name-Working Containers* 20 Time as a Public Health Control 7-201.1.1 Separation-Storage* 3-501.19 Time as a Public Hepith Control* 7-202.11 .Restriction-PresenceandUse* 590.004H) Variance Re uixement 7-202.12 Conditions of Use* REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-203.11 Toxic Containers-Prohibitions* POpULAT1ON5 HSP 7-204.11 SanChemicals Criteria i Chemicals, 21 3-801.11(A) Unpasteurized Pre-packaged Juices and 7-204.12 Chemicals for Washing Produce,Criteria* Beverages with Warning-Labels* 7-2074.14 'ng- encs.Criteria* 3-801.11(B) Use of Pasteurized Eggs* 7-205.11 Incidental Foo Contact,Lubricants* 3-801.11(D) Raw or PartiallyCooked Animal Food and 7-206.11 Restricted Use Pesticides,Criteria* Raw Seed S rts 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 TIME/TEMPERATURE CONTROLS 22 3-603.11 Consumer Advisory Posted for Consumption of 16 Proper Cooking Temperatures for Animal Foods That are Raw.Undercooked or PHFs Not Otherwise Processed to Eliminate 3-401.I1A(1)(2) Eggs- 155°F 15 See. Patho ens'*E" il. 1�f E Immediate Service 145'F15sec* 3-302.13 I Pa zed Eggs Substitute for Raw Shell 3-401.11(A)(2) Comminuted Fish.Meats&Game E Animals-155'F 15 sec. * 3.401.11(B)(1)(2) Pork and Beef Roast-130'F 121 min* SPECIAL REQUIREMENTS 3-401.11(A)(2) Ratites,Injected Meats-155'F 15 590.009(A)-(D) Violations of Section 590.009(A)-(D)in S".* catering,mobile food, temporary and 3-401.11(A)(3) Poultry,Wild Game,Staffed PHFs, residential kitchen operations should be Stuffing Containing Fish,Meat, debited under the appropriate sections Poultry or Ratites-165'F 15 sec. * above if related to foodborne illness 3401,11(0)(3) Whole-muscle,intact Beef Steaks interventions and risk factors. Other 145'F* 590.009 violations relating to good retail 3401.12 Raw Animal Foods Cooked in a practices should be debited under#29- Microwave 165°F* Special Requirements. 3.401.11(A)(1)(b) All Other PHFs-145'F 15 sec. 17 Reheating for Hot Holding VIOLA77ONS RELATED TO GOOD RETAIL PRACTICES 3-403A1(A)&(D) PHFs 165'F 15 sec.* (Items 23-30) 3403.11(B) Microwave- 165'F 2 Minute Standing Critical,and non-critical violations,which do not relate to the Time* foodborne illness interventions and risk factors listed above, can be 3-403.110 Commercially Processed RTE Food- found in the following sectionsofthe Food Code and 105 CMR 1400F* 590.000. 3403.11(E) Remaining Unsliced Portions of Beef Hem Good Retail Practices I FC 590.000 Roasts* 23. __ Management and Personnel FC-2 003 18 Proper Cooling of PRFs 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 to2� Water.Plumbing and Waste FC-5 .006 1 70'F Within 2 Hours and From 7WF 27. Physical Facility FC-6 .007 to 41'F/45'F Within 4 Hours. * 26. Poisonous or Toxic Materials FC_7 .006-1 3-501.14(B) Cooling PHFs Made From Ambient 29. -Special Requirements ,009 Temperature Ingredients to 41'F/45'F 1 30. 1 Other Within 4 Hours* ssxi zn 'Denotes critical item in the federal 1999 Food Cale or 105 CMR 590.000. sy,' '.!\- _ � -.�.-.w} .�.-.. .).1{.l �:'j �i�TMr ,�, '•_1 �t .7, rt_rw l,'wy-e+. w'�'.61'F9''S.I�.�..Yw,..vt liti -*r�.. '�+-.. , ,. . .r',,•,r� �' k Massachusetts Department of Public Health Salem Board of Health 120 Washington Street,a Floor Division of Food and Drugs r Salem, MA 01970-3523 FOOD ESTABLISHMENT INSPECTION REPORT Tel. (978) 741-1800 Fax(978) 745-0343 Namell (� ^ Date T e of O eration s T e f inspection Fr)(`,-XkD pJ PSS 1�-(0 O) N Food Service IXI Routine Address [� (� Risk ❑ Retail ❑ e-inspection 40 AN,,P_C1 CSC kA\ ` , E'4 Level ❑ Residential Kitchen Previous Inspection Telephone11 0 ❑ Mobile Date: \' Owner HACCP Y/N ❑ Temporary ❑ Pre-operation VOAv , ❑ Caterer ❑ Suspect Illness Person in Charge(PIC) �/ _ n . Time ❑ Bed&Breakfast ❑ General Complaint El HACCP Inspector a�-P/Y�I P O :: aC Permit No. ❑Other\'l o � Out::24i/ Each violation checked requirean 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-ChokingTobacco �q \ 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 PROTECTIONMANAGEMEKrT; ,,,, � „50_ s ❑ 12. Prevention of Contamination from Hands - ❑ 1 PIC Assigned/Knowledgeable/Duties ❑ 13. Handwash Facilities r EMPLOYEE HEALTW �N � .�.�i�si:�a� s €, Sc»,., .PROTECTION FROM CHEMICALS y�T'' e ? EI-2. Reporting of Diseases by Food Employee and PIC ' �m� __ El14.Approved Food or Color Additives E] 3.*Personnel with Infections Restricted/Excluded ❑ 15 Toxic Chemicals FOOD FROM APPROVED,SOURCE lel " �"'�g '_''-, �.,"°'",�,6i ij „+r r UTIMEFIEMP6RATURE CL7NTROL6(Pofenfla0y FTa'zerdpus Foods) `� I . ❑ '4' Food and Water from Approved Source l%L., " " ,a , ❑ 5. Receiving/Condition ❑ 16. Cooking Temperatures t`. .. ❑ 6i? Tags/Records/Accuracy of Ingredient Statements El 17. Reheating i0-7. Conformance with Approved Procedures/HACCP Plans El 18. Cooling o I PROTECTION FROM CONTAMINATION` f f�� El 19. Hot and Cold Holding ❑i 8. Separation/Segregation/Protection ❑20.Time As a Public Health Control ❑ 9. Food Contact Surfaces Cleaning and Sanitizing F EQUIRENlENTS F-6 R-HIOHIY SUS6EPTIBLEPO00LATIONS El21. Food and Food Preparation for HSP ❑10. Proper Adequate Handwashing ❑ 11. Good Hygienic Practices . CONsUMEIY ADvISORY.I"., mµ°4°`"` .,�„. �,?j..; �"'° ❑22. Posting of Consumer Advisories Violations Related to Good Retail Practices Number of Violated Provisions Related Critical (C) violations marked must be corrected To Foodborne Illnesses Interventions immediately or within 10 days as determined by the Board and Risk Factors (Items 1-22): of Health. Non-critical (N) violations must be corrected Official Order for Correction: Based on an inspection immediately or within 90 days as determined by the Board today,the items checked indicate violations of 105 CMR of Health. 590.000/federal Food Code. This report, when signed below 23. Management and Personnel (FC-2)(590.003) by a Board of Health member or its agent constitutes an 24. Food and Food Protection (FC-3)(590.004) order of the Board of Health. Failure to correct violations 5. Equipment and Utensils (FC-a)(sso.005) cited in this report may result in suspension or revocation of 25. Water, Plumbing and Waste (FC-4)(590.005) 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 (FCa)(59o.005) and submitted to the Board of Health at the above address 29. Special Requirements 1(590.009) within 10 days of receipt of this order. 30. Other DATE OF RE-INSPECTION d_A)e S:5eaMspecrF.r 14.e -VAC) Inspector's Signature: 6V-VkX'Q_ � V A Print: •� U� l . ^ PIC's Signature: , Print: Page of Pages Y" � Violations Related to Foodborne Illness Interventions and Risk Factors(items 1-22) PROTECTION FROM CONTAMINATION FOOD PROTECTION MANAGEMENT F g Cross-contamination 1 590.003(A) Assignment of Responsibility 3-3011 I(A)(1) Raw Animal Foods Separated from 590.003(B) Demonstration of Knowledge* - Cooked and RTE Foods* M03.11 Person in charge-duties Contamination from Raw ingredients 3-302.1 l(A)(2) Raw Animal Foods Separated from Each EMPLOYEE HEALTH Other' 2 590.003(0.) Responsibility of the person in charge to Contamination from the Environment require reporting by foal employees and 3-302.11(A) Foci Protection* applicants* _ 3-302.15 Washing Fruits and Ve 'etables 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* Char e* 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* 4 Food and Water From Regulated Sources 9 Food Contact Surfaces 590.004(A-B) Compliance with Food Law* 4-501..111 Manual Warewaehing-Hot Water 3-201.12 Food in a Hermeticall•Sealed Container* Sanitization Teu eratures* 3-201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Warewashing-I-lotWater 3-202.13 Shelf Eggs* Sanitization Tent cratures* 3-202.14 Eggs and Milk Products.Pasteurized* 4-501.114 Chemical Sanitization-temp.,pH, 3-202.16 Ice Made From Potable Drinking Water* concentration and hardness. * 5-101.11 Drinking Water from an Approved System* 4-601_H(A) Equipment Food Contact Surfaces and 590.006(A) Bottled Drinking Water* Utensils Clean* 590.006(B) Water Meets Standards in 310 CMR 22.0* 4-602.11 Cleaning Frequency of Equipment Food- 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 Game and Wild Mushrooms Approved by Reoulatort,Authorft 2-301.11. Clean Condition-Hands and Anes* 3-202.18 Shellstock Identification Present* 2-301..12 CleaningProcedure* 590.004(C) Wild Mushrooms* 2-301.14 When to Wash* 3-201.17 Game Animals* 11 Good Hygienic Practices 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 1 Food Safe and Unadulterated* 3301,12 PreventingContamination When Tasting* 6 Togs/Records:Shellstock 12 Prevention of Contamination from Hands 3-202.18 'Shellstock Identification* 590.004(E) Preventing Contamination from 3-203.12 Shellstock Identification Maintained* Em to gees* 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 Capacifies* 590.004(7) Labeling of Ingredients' 5-204.11 Location and Placement* 7 Conformance with Approved Procedures 5-205.11 Accessibility.Operation and Maintenance /HACCP Plans Supplied with Soap and Hand Drying 3-502.11 Specialized Processing Methods* Devices 3-502.1.2 Reduced ox en tackaug,criteria* 6-301.11 - Handwashing Cleanser,Availability 8-103.12 Conformance with Approved Procedures* 6-301.1.2 Hand Drying Provision Denotes critical item in the Weis]1999 Foal Code or 105 CNIR 590.000. ,lr P v 4 1 CITY�0F•SALEM l � BOARD OF HEALTH Establishment Name: '()�)C�c P �,a Date: Page: 2 of-2 Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date No. Reference R-Red Item Verified II ,� PLEASE PRINT CLEARLY Il v ._F, '1e r�i � „ rn� - I , .e _ ,a ✓n� �f ��( iG �AU'O ✓i.� / 'l/b-t '-P� / 4 } r(,�_ l 6"'A„ A I:1 nn i 1 (t j T (�0.1, 1 - /;✓Q ( 1 ,-,Rn.1.pfeg� 10 �09 /_t rn:,..I Inn �.n_ �( 4. /ln_ tnrn teQc ��{ t o O ' nn 1 - - - 1 _0 0 A (1n 4vQ n.(nn . .Q m O H V I Discussion With Person in Charge: Corrective Action Required: 1,4rr 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 t P ❑ Re-inspection Scheduled ❑ Emergency Suspension ,comply with all mandates of the Mass/Federal Food Code. I understand that noncompliance may result in daily fines of twenty-five dollars orrssu(s�pension/revocation of ❑ Embargo ❑ Emergency Closure your food permit. ❑ Voluntary Disposal ❑ Other: i u' y 'I 3-Sf!1141CPRFs Received at Temperatures Violations Related to Foodbarne Illness Interventions and Risk According to Law Cooked to Factors(Items 1-22) (Cont.) 41`.F/45`F Within 4 How s. * _ PROTECTION FROM CHEMICALS 3-501.15 Coolim,Ylethods for PHFs 14 Food or Color Additives 19 _ PHF Hot and Cold Holding 3-202.12 Additives* 3501.16(13) Cold PHFs Maintained at or below 590.(Xg(Fi 410/45`1" 3-302.14 Prtiieetion from Unapproved Additives` 1 --- 15 Poisonous or Toxic Substances -501.16i.A) l int PHF>Maintained at or above 7-I6L11 Identifying Info marlin Original 1 146 1. * Y 6I R(tacis Held at or above 130'F'r Container. r f 20 Time as a Public Health Control ' i + rlUt ' Comnnm\ e Vtcinnki C mtnnr+• � '- - — — Ftmr as a Public Health Controtk Sga men Sturm C - - - - --� )r)ru}�#}i} —�4 r {r-eer.Nu!LLLlU 7-262.1 1 I Iaetit a1 <a- 2rr u.ncc and I. r --- -- 7-20..12 Condition,of REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7 '.',03.l i Toxo.f int[meru Probibz on3'" Z(Yt.l i _ :aann�retti C ritcrrn C`iicrnic els' POPULATIONS{HS�_ _ 7204.12 Chvnucalti tolccclitetia, 13n 4tearizcd Jryiaolaacd Jies wall w l & a'uid3 kdlomy la6as" } 7 20-1 14 D ;mg Aa vote.Criteria < kt7! 7 1 5, Be rvAuw Putt i.ind t `—'�'—._._li 765.11 Laud of 11 l >rxl e uniZu Lib lean a' r t2-"nr i t se Pr nv,de' Cnce[i 3 ICI)} (tiro vi Pin i,�tl v 1ek d Animal Fix--laird R+ , Srrnuts hkij S,ryc r ' 7 -206.12 teal i is i lainmN _..� .F'--g6,�ll Cj r: c ccs Ft:ki P c V< 706.1 e I ru k nl,P 4Ndvr I v r anti.,!a.id "._-.'-- '-- --r'--- - =--. CONSUMER ADVISORY 22 El6 TIME/TEMPERATUREPr CoCONTROLS ok og 7O n aeratures for 11�C x sui a1, tdd+rs4�2 v„ r li for aryn ef� 1 ( Nor to l Sc 'ten cht i 3101.134(1 ( AFL- 55F155 1 t 7 x[mcdi«c Ser-tic- t a Il�srcti , 3021 t 1 1 Iz .ry d E,-z,c,S 113at int tta Sia is t — _ --r _ R _ SPECIAL REQUIREMENTS u# r tr( 1 ) A Iii nnn` � . -._ tJi.! tin rc1 v t?; ,i Swats 151 Ile.inti,. IJx Ct t z mp ui al v and .3-4(11,11 A pl Poi tr,,Wdd(Jame, Swl rd PHFs, rv.Mj n Al kitchen of [-,ti,ons Ilnuld be j Su 1'n,�=Con nt xn+;Fish hie.;(. (.:.hit c ljnd;�r til at,i�rol3ritat< c,lt(3As i r .It's sr x �,,,., 1 ;T s rte:_" ix,ry t vl,t,t'd , 8 3 4 J; G r �tSrti t e t 1 Oi E• -. x •,c ; i p7 }t.R�,=eaom3 for Halt Frcfdir+y i VIOLA}`iC3:NS REL4TED f6 G000 REYA1d. FRaxr.,TfC"i_ST-- )3.111 to 1i.)..-I it{I Ic `a ' cC -- -�j (Ileraaw2"t 10) 3 *6x.1 iFt; lhuuu !ve Irl [`<?v1lnu.r St4n,li[a„ I coozavid r,1 n r ical , 11 ,r.: Vwrh .'o un< r+rc ver 11u' �. f atrraG<?7 s „r nrr1nr < drr {Jxr.rr li31e fr tr. (im tr itC;a �( mn�eseia�iv Pa ex,�.:c:7 Ft V F; ki-� in,17. 111;;-ser [ r r? A) F aU rJttfl 4r 3 3 I t., Rv nt min-,Lr�i <.ei Pe.nao �n1 t3 s� ttertt ' G00(t Rsfa17 Practices FC 590 0(X7 . k nasi s - s Managerner4 and t'Cr m , rf _l I (1(1 f -- .'- '- - .2rwk1 dF(x yFrots ticn Proper Coling of PHFs t 05 - — -2> � eaans Utr us Fr a OU S,1E)" io s._ _ ___ _._._- I 2 J to ' FG-5 Or_ ,01, 4fihln 7 Lonr will ._i . FC-s1 307 � t J }liS.F\5 t.rza t H1w[ ° --� 4 2Zt pP,S o s,.,r7 2x Ei 1u els 1 FC 7 OOo r-3-561 IT -_ (m`uf,,PTYF 'lLilics FrontAmbientL. 9 Spa-;A Raitieolnari xi. Pa try r rau¢o nvred cols a ', Fi45`F � F`)`' r?ttiF- _- -- _ . ._... _ N iEt m d Hvxn "` CITY OF SALEM, MASSACHUSETTS CITY OF SAQEW OF HES LTH BOAkb WTfLt)kTfj S-I'R T,4"FLOOR TEL. (978) 741-1800 1CMBERLEY DRISCOL.L FAx(978) 745-0343 MAWI W1e of Establishment: Leggs Hill YMCA (W'"' °S`"''"LCCm1 Address: 40 Leggs Hill Road �nN''r ��;;''yy,'N,l Paul Baker ACTINGxr: cf'rgt;� 1 one: -639-1104 Fax: 617-304-0114 The owner of this establishment/cafe presented a Floor Plan and Menu for review in accordance with the State Food Code. This food establishment area is on the first floor of the new Leggs Hill YMCA. FLOOR PLAN A Hand Sink is located in the food service area. The hand sink must have a wall hung soap and paper towel dispenser. These must be stocked at all times. Hand sinks must be used for hand washing only. All floors, walls, and ceilings where food, utensils, paper products, etc, are stored, prepared or served must be intact, impervious, and easily cleanable. Additional storage for dry goods under the stairs. Again, this areas must be intact, impervious and easily cleanable. MENU/FOOD PREP A review of the menu was conducted. Most food items will be made and packaged at Foodie's Feast in Marblehead. All food items must have correct labeling in accordance with 105 CMR 590 and the Federal Food Code. (information was given at time of review) Any other pre-made items not made at Foodie's Feast, must be purchased from a wholesaler licensed by the State. This cafe will offer pre-made sandwiches including chicken salad, egg salad, tuna salad, bagels and other baked goods, Jimmy Dean sandwiches, Fresh fruit etc. Fruits and vegetables for fruit salads, must be washed prior to preparation. All food must be held at 41'F or lower, or 140°F or higher, at all times. Therefore, soups should be brought to boiling before being held hot and transported to this location. There may be no bare hand contact of ready-to-eat foods. Gloves, tongs, or tissues must be used when handling such food. Soups to be prepared at Foodie's Feast and brought to this location. A stem type thermometer must be provided to test the temperature of the soups at least every 2 hours, to ensure they are being held at 140°F or higher. Owner to provide utensils for service to be held in a clean and sanitized container and wash rinsed and sanitized daily. There is no area for ware washing at this location. All utensils and equipment are to be transported to and from Foodie's Feast in a clean and sanitary manner and washed, rinsed and sanitized daily. Owner to provide documentation of this practice in the form of a letter stating how utensils will be washed, rinsed, sanitized, transported and stored, to prevent contamination of utensils. Owner would also like to use bagged ice for drinks. Provide a few ice scoops per day that are washed, rinsed and sanitized and properly stored for service of ice. Ice scoop to be stored in ice with handle up to prevent contamination from hands. CERTIFICATION There must be a Certified Food Manager.working at this establishment full time. When a CFM is not onsite there must be a Person-in-Charge (PIC) who is fully trained in sanitation techniques and has a thorough understanding of the operation. EXTERMINATION Monthly services of a Licensed Pest Control Operator are required. Please keep receipts for inspections. An initial inspection must be conducted prior to this establishment opening for service. Also, a copy of a signed contract must be provided to health inspector prior to opening. SANITIZING SOLUTION Sanitizing Solution must be accessible at each station and for the patrons' tables. Test strips corresponding to the kind of sanitizer, must be on hand to check concentration of solution. Solution must be made daily, tested, and the results recorded on a log sheet for examination by Board of Health inspectors. Please contact the Licensing Board to determine if a Common Victualler's License is required because you had a question regarding seating at this establishment. Outside area of premises, including the dumpster area, must be kept clean and sanitary. Please call one week prior to opening to schedule an opening inspection. Janet Mancini Date Acting Health Agent Paul Baker Date I CITY OF SALEM > BOARD OF HEALTH t Establishment Name: I�Di\L 5 I= 5 i Date: Page: of_ t Rem Code C Critical Item DESCRIPTION OF.VIOLATION/PLAN OF CORRECTION ,x Date; i No Referent . R Red ItemAl v.' PLEA E PRINT CLEARIW < - , 'Verified 3y � �Q}V - 7 ` F� _'� r ! ! a O7`CF� f kA _ V 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 I comply with all mandates of the Mass/Federal Food Cade. t understand that } noncompliance may result in daily fines(f_tw my-five dollars or suspension/revocation of ❑ Embargo ❑ Emergency Closure your food permit. ti ❑ Voluntary Disposal ❑ Other: i S i Fils—Recliv—ed it 1'euiperatures Violations Related to Foodborne fitness Interventions and Risk j According to Ltrii Cooitd to Factors(Ifistur 1-22) {Cont) i 4 FFi45`,F Within 4 lhrrrrs 7,, CuKifiRiI PHR PROTECTION FROM CHEMICALS , P14F Hot and Cold Holding 91 Food or Color Additives Cold PHFS Maintitoret 1-50!,16(B) or below, 20?!2 --�Aidhit vc, 4 1V45°F4-302.74 , 3 501 16�A) Ifint PHF.Maintained arow�above . froal I nar sfanees Pol;;n�saor Toxic sub infolination 06*ma� Conramer, -102,11 Cny caK i oi I Na m ti-- W o I k i IILI n-�r Time as a Public Health Control 7 'rime as a Public Health CowroV 7-20t.1 1 in -k-- — V"wian��e.�uircl eat 7-202- ResHctiorr-Prescirc,and 7-20112 Curdilion,of Use 7-10111 REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-204.11 Sam,i7ev;,Criteria-chcoriciils* POPULA IONS{HSP} 7-2(9,12 Chonricids fax 2TT'-1"01" I I tA7) I!I rpmti�ur i zml flic-pai,,fagcd I vict, iod C_menal iaf flw(ares with 7 204.14 _RDjjj _�Crirei 8 — - - --1— -- --1—--- 3 8( trot Pd,,TcIoi7x!d -1-iOB-1 I Incidnaiii food conZlt. 'I),Iliuil� .7 F-- -- 1 1 I(D) Raw or frailiall,.Ciiokcd ADirrod RX.J Jail ided U,�e Peheides, critraoil -ITww st-�d sllan ri het Salved . 7-206.12R"icni liiit Staoom' La8 Llll 7-_06.13 Tracking Pinders,Pest Control and klom(Lv In�---i CONSUMER ADVISORY TIME/TEMPERATURE CONTROLS —'Ihai'arckaw—U—ndercoolrdioa of or 16 Proper Cooking Temperatures Not Odrer�ise Proce.",,�,d to Flioamize -: PHFs i,r,��,,? Pat �-,1 7- 6i-I i At I 1(2) F'gte- 1,55,T 154 c. 114neurjruiTe --- g,�substitulr for RAW shell 401,11IA)(2) Comminuted Fi,%hMeats k Gwrx: Ardwak- 1551,' 1 SPECIAL REQUIREMENTS ,140LIl(B)05i21 Pori. and Beel Roast 130"1' 121 minx —T—005 17) 71 T --+- - - violwilws 0�-.Secboa 590AW(A'-(D) in 1553FI5 caterinp, mobil c food,temporal Vaild 7-40I I I(A)(97 PoultrN,Wild Game,Stritied liliFs, ri:sidcw�.J 00ian operations Awrild be siolfilkg COnfaiiiing, Fish, 106at, debited under She appropriate wcltrxls !L)Illr�rvo•�6tiws-10 f 1,5 sec. al-Kwe if relaIi,,d to fi:;ridborne Illness _;-401.11(Q3, Whole-musole, intact flei!f Steaks Inter velditios and risk ructors. Other 145"T 590.()09 violatioTrs rotating I<) sood retail =101.12 r'k ari in a 13rnCticcsshoi4drIc debited under#29 - --- Special I I(A)(lt(b) ,Vl(kher PHF1451P 15 sec 17 ReheatFnq—for�io-t o—Iding lding VIOLA TIONS RELATED TO'GOOD RETAIL PRACTICES 3-403.71{A}&(5) IIHE,Ib5°F 15 se .I (Iterns 23-30) 7 403.11(B) Microwavc-165'F 2 klimie-SiandinI, Ciiacedsir d non-i,wewl vi<eKwoni, ivinch do no rabate to Me Time' fioistriorne illness ihiferveiloons and risk fintors licfedirbove, (air be corienexciarity farina in thejoleiwing sections the Food Code m2d 105 C'MR 140'P, jt0a Cood Retail Practices C 590,00 3-403.11E( i Remamire, Uwlv�ed Portions of li�ef FC -2 1 003 24 and Food Proiection F Proper Cooling of PHFs C 3 1 .004 LL8 equipment and Tl,- FC---4- -005 -501.1 Ai I I — --�-- 26, 1 Watar� wasto F�-zi 006 ---------- i 7vF Within 2 Flours imil From 70`l' iT FC--6 007 to 41 F/45 F Within 4 How 28 i Poisonous or To=Materrais SPC-7 X008 D—501 1 Coolitig PHFs Made Inken Ambient009 Tempatiortc lnj,�,rediiatts 1(141 1F/45� cithe, ---I----------- 'Within 4 1b)VIO Commonwealth of Massachusetts ° t City of Salem Board of Health Kimberley Driscoll 120 Washington Street,4th Floor Mayor SALEM,MA 01970 Food/Retail Establishment Permit DATE PRINTED: 05/15/2009 ESTABLISHMENT NAME: Foodie's Feast File Number:BHF-2009-000010 40 Leggs Hill Road YMCA Caf6 SALEM MA 01970 LOCATED AT: SALEM, MA 01970 Permit Type Permit No. Permit Issued Permit Expires Fee Restrictions/Notes FOOD SERVICE BHP-2009-0462 May 15,2009. Dec 30,2009 $140.00 ESTABLISHMENT Total Fees: $140.00 PERMIT EXPIRES IDecember3O, 2009 Board of Health This Permit is not transferable and must be reissued upon change of ownership or location.The permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code,beofre any revonations,improvements,or equipment changes are made,all plans for such must be submitted to and approved by the Salem Board of Health. Page 1 CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH 120 WASHINGTON STREET,4°`FLOOR TEL- (978) 741-1800 KIMBERLEY DRISCOLL FAX(978) 745-0343 MAYOR IMANCiNI@s41.EYt.CONI JANET MANCINT, ACTING HEALTH AGENT 2009 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT NAME OF ESTABLISHMENT TEL# ADDRESS OF ESTABLISHMENT FAX# MAILING ADDRESS(if different) EMAIL- Business': \n ��JSr` T OLt� Website: �`�rJt��3 �c- Pc` 1 r Cc�J` OWNER'S NAME \�(rCV��"_ (?� '_ TEL �\ I • "zs��c- \1u t ADDRESS i r2 `1-"/\/� S�YL '\ ��FtJ. V�'h ��f�t STREET CITY � , STATE ��IP CERTIFIED FOOD MANAGER'S NAME(S) r" � ��-/'-'VL"t � CERTIFICATE#(Sj r�yrs — (Required in an establishment where potentially -hazardous food is prepared) \!V�, \' �7 G 7 1 L r EMERGENCY RESPONSE PERSON \� ` `� �" 7ENOME TEL# 6 (1- ��t pltt l DAYS AFOPERATION. Monday`. ::;( Tuesd Wetlnesda' Thursda Fid Saturday,'' , Sunda , HOURS OF OPERATION , G •30 t--A C. ,3 o e_,,..1 .3 o cl. 7' 'ta G.3o Ft 1 i,• 1� n j C� 3o c H Please wide in time of day. o g Uu as .Nl 1� ^A i $ ,O o JO!.q (For example ilarn4lpm) ; SCS sn' 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 - ... ... .........••....... ................---... ----•......... - RESTAURANT 10E a NO less than 25 seats (Outdoor Stationary Food Cart$210) 25-99 seats = more than 99 seats =$420 - - - ---------------------------------- -------------- --- BEA ... ---•------- BEDRKFASTI YES Nb $100 CHILDCARE SEFtYICES/NURSING HOME...... - .... ................ -----------_.---- ........ ADDITIONAD PERMITS MAKE (not just 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 filed all slate tax returns and paid all state taxes required under the law. Signature Date Social Security or Federal Identification Number Revised 424/07 FDODAP2008.adm Checkt!&Date Commonwealth of Massachusetts City of Salem Board of Health Kimberley Driscoll 120 Washington Street,4th Floor Mayor SALEM,MA 01970 Food/Retail Establishment Permit DATE PRINTED: 01/04/2010 ESTABLISHMENT NAME: YMCA- Foodie's Feast File Number:BHF-2009-000010 40 Leggs Hill Road YMCA Cafe SALEM MA 01970 LOCATED AT: SALEM, MA 01970 Permit Type Permit No. Permit Issued Permit Expires Fee Restrictions/Notes FOOD SERVICE BHP-2010-0048 Jan 4,2010 Dee 31,2010 $140.00 ESTABLISHMENT Total Fees: $140.00 PERMIT EXPIRES December 31, 2010 Board of Health This Permit is not transferable and must be reissued upon change of ownership or location.The permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code,beofre any revonations,improvements,or equipment changes are made,all plans for such must be submitted to and approved by the Salem Board of Health. Page 1 CITY OF SALEM, MASSACHUSETTS • �i M BOARD OF HEALTH +5% 120 WASHINGTON STREET,4"FLOOR TEL. (978) 741-1800 KIMBERLEY DRISCOLL FAX(978)745-0343 MAYOR - DGREENBAUM&ALEM.COM DAVID GREENBALim, ACTING HEALTH AGENT 2010 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT NAME OF ESTABLISHMENT ' V�D13(� � 1 N C TEL# �Sl `G —ItO I` ADDRESS OF ESTABLISHMENT Lf y �-�5S S 0 ' FAX# MAILING ADDRESS(if different) ✓� '� AAV-t C�( C EMAIL-Business':�GtcJ CCI /Y-+� S1 -LuN Website: l �5 'A -C-Q� OWNER'S NAME ` IQ) TEL# 6r7 -3JLt —U(1� ADDRESS L4:2c-1 V� Si (�`t ✓�f`tl1ti � A-A,� 1--D\4 L t STREET CITY STATE ZIP CERTIFIED FOOD MANAGER'S NAME(S) ^ C SL ��- CERTIFICATE#(S) 4 (1-3 (Required in an establishment where potentially hazardousfoodis prepared) EMERGENCY RESPONSE PERSON_ OCA � \ �� HOMETEL# tDAYSjO OPERPSIQN"� Mpnday EVA1 da ; yVJednestlay Thursday ?' - F,n ay � Saturday '��Sundayx HOURS OF OPERATION j Please write in time of day. 1a^ti— j� '— ^�` 2aW I-7c,, (For example 11am-11 ! -7, (>M j Z f�.M `7 ✓ti n �✓�-1 G !ti vet. S �✓� TYPE OF ESTABLISHMENT FEE (check only) RETAIL STORE YES NO less than 1000sq.ft. =$ 70 1000-10,000sq.ft. =$280 more than 10,000sq.ft. =$420 --- ------------------------------------------- - -- ------------------------------------------------------------------------ --------------- RESTAURANT YE NO less than 25 seats _ 140 (Outdoor Stationary Food Cart$210) 25-99 seats more than 99 seats =$420 -- ----------------------YES" '--- -------------------------------------------------------------------------------------------- BED/BREAKFAST/ YNO $100 CHILDCARE SERVICES/NURM SING HO -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ADDITIONAL PERMITS MAKE (not just serve) ICE CREAM, YOGURT/SOFT SERVE YES $25 TOBACCO VENDOR YES $135 ALL NON-PROFIT(such as church kitchens) YES NO $25 'Please pay total with one check payable to the City of Salem. This Permit is not transferable and must be reissued upon change of ownership.The Permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code, before any renovations, improvements,or equipment changes are made, all plans for such must be submitted to and approved by the Salem Board of Health. Pursuant to MGL Chapter 62C,Section 49A,I certify under the pains and penalties of perjury that I,to my best knowledge and belief,have filed all state tax returns and paid all state taxes required under the law. Signature - Date Social Security or Federal Identification Number, ------------------ - ------ -- -------- - Revised 424/07 FOODAP2008.adm Check#&Date $ 07/13/2009 12 : 12 :54 PM -0400 POWERED BY ORCAFAR PACE 2 OF 3 FAX YMCA of the North Shore To: 0a Ujj (Tye e h b 0 t41 Date: It 0 jd From: 6a�-e r Im @ Lynch/van Otterloo Y MCA CC: Pages to follow: Comments:_ b11(t)VA` Thr t711A )Q4 �cr Bered7cawshad Benml791een9 BMAITem CepeAm wvkhrw* MMMoodl9aamp" Salem YMCA YMCA YMCA YMCA YMCA YMCA YMCA 245CaaMSeeM 254Ess ftw P.O.Boa 173 71MWbSftM 110Ccxftftd 94PlmmaMS9eM OnesekmGeeo Savoy,Ma 01915 Be",va 01915 Be1sM.Ma 01915 Gaweahe,Me 01930 Ipaewva M908 MaA4dwitme 01915 Selma Mm 01970 M9224M 97B-W4= 978A'tiAM 978-7BWO 979x56= 7810-00 978444-01 Fax97B.=7802 978.97/.5530 978.921.8070 978183.3114 978.3Ni.00 n1.839D190 978.740.9188 07/13/2009 12: 12 :54 PM -0400 POWERED BY ORCAFAX PAGE 1 OF 3 FAX To: From: Marblehead YMCA Fax Number: 9787450343 Fax Number: 7816390190 Phone: Company: Date: July 13,2009 Total Pages: 3 Subject: Fax from YMCA of the North Shore-Marblehead SuWoem Of CartfiC MMVffi Theidom9aft wrtteinee iAftg McMe and ercyeR&hneMsblNs messapa are iNendedta Ne ettlusire use of Ne awrossee(sl sw mwamen mmiderdel w pnNlaged idnmaeon.tlynu e<enaA Ne emnded reclPldx.em/dissemin�On a Ary9caOon al Nisidmmelion Is sOIUltprONOiletl.Pyou Aeve received Nis Im�in artor, please notlryvs immeQmely.PlaazaddeAe Nis massage and 6Aits edechmems.TM1enkynu. Memo: DEVICE NAME:Lynchfven Ottedoo YMCA DEVICE MODEL:UX-B800SE LOCATION:40 Leggs Hill Road,Marblehead,MA FILE FORMAT:PDF RESOLUTION:FINE Thisfar originatedfiam a Whaleback Systems OAcalrato Fax Server Reliable Document Delivery•Everylime. 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