FUEL JUICE & COFFEE BAR - ESTABLISHMENTS FUEL JUICE & COFFEE BAR
196 ESSEX STREET
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Elizabeth Salandrea
From: carey murphy[fuell96@yahoo.comj
Sent: Monday, March 30, 2009 2:11 PM
To: Elizabeth Salandrea
Subject: Re: Servsafe classes
Hey Liz. . .
I finished the servsafe course a couple of weeks ago. .
My Cert # is: xe20353354
ANSI Program
Scored a 94 . . . Beat that! !
Carey Murphy @ Fuel Coffee & Juicebar
--- On Fri, 2/20/09, Elizabeth Salandrea <ESalandrea@Salem.com> wrote:
> From: Elizabeth Salandrea <ESalandrea@Salem.com>
> Subject: Servsafe classes
> To: fuell96@yahoo.com
> Date: Friday, February 20, 2009, 11:53 AM Hi Carey,
> We have flyers in the office from some different companies for
> servsafe classes, but nothing electronic, so here are some links:
> http://www.easternmassfoodsafety.com/
> http://www.pilgrimhospitality.com/courses.html
> http://www.argassociates.com/
> The closest locations to us are Eastern Mass Food Safety with some
> classes in Somerville, ARG in Danvers, and Pilgrim Hospitality does
> Salem sometimes and also Somerville and Saugus. Please let me know
> which course you're signing up for and forward a copy of the
> confirmation letter to me (or I can pick it up next Friday at the
> re-inspection) .
> Thank you!
> Liz
1
`i 0198 Essex Street Fuel
City of Salem
FOOD SERVICE ESTABLISHMENT - FOOD SERVICE Inspection
HACCP: ❑
Item Status Violation Critical Urgency
Telephone: Violations Related to Good Retail Practices (Blue Items)
741-0$50.. Other-See Notes FAIL BLUE
Owner: Comment:PIC's servsafe certification has expired.PIC states he is registered for exam on March 13th 2009.Please forward copy of
Christopher Silva now certificate to the Board of Health when received,
PIC:
Carey Murphy
Inspector:
<Elizabeth Salandrea
Date Inspected:Correct By:
2/2712009
Risk Level:
Permit Number:
BHP-2009-0230
=Status:
SIGNED OFF
1#of Critical Violations:
0
Time IN;. Time OUT:
Urgency Description(s):
BLUE: All violations noted in the 2120109 Inspection report have been corrected.
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
GeoTMSQ 2009 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Mar 04,2009 ) Page 1 of'2
' Item Status Violation critical Urgency
Violations Related to
Foodborne Illness Interventions
and Risk Factors (Require
immediate corrective action)
jV
City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741.1800
GeoTMS®2009 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Mar 04,2009 ) Page 2 of
r=
0196 Essex Street Fuel
City of Salem
FOOD SERVICE ESTABLISHMENT - FOOD SERVICE Inspection
HACCP: ❑
Item Status Violation Critical Urgency
Telephone: PROTECTION FROM CONTAMINATION
741-0850 Separation/Segregation/Protection FAIL Critical ❑d RED
Owner: ✓omment: Continental fridge had bacon stored above fruits&vegetables.Organize fridge to properly separate potentially
Christopher Silva hazardous items from ready to eat items.
PIC: Food Contact Surfaces Cleaning and Sanitizing FAIL Critical 66 RED
Carey Murphy ✓comment: Cutting board at sandwich unit is stained&scored.Resurface or replace cutting board.
Inspector: anitizer bottle was too strong at time of inspection.Provide sanitizer of proper concentration(50-100ppm)at all times.
Elizabeth Salandrea Violations Related to Good Retail Practices (Blue Items)
Date Inspected:Correct By: Equipt and Utensils FAIL Non-Critical BLUE
me
2/20/2009 omment:Silver fridge downstairs had an accumulation of water in the bottom.Investigate source of water and repair if necessary.
Risk Level: i Other-See Notes - FAIL BLUE
Comment: PIC's servsafe certification has expired.PIC must register to re-certify and forward proof of registration to Board of
Permit Number: Health within one week.Inspector will email course information to PIC.
BHP-2009-0230
'Status: __Qhu( "�0 I M- ko(;I
, PARTIAL COMPLY
I#of Critical Violations:
2
+Time IN: - Time OUT:
Urgency Description(s):
BLUE: Reinspection in one week, violations to be corrected.
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®2009 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Feb 23,2009 ) Page 1 oft
1.
r
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
GeoTMSO 2009 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Feb 23,2009 ) Page 2 oft
1 Commonwealth of Massachusetts
s f City of Salem
Board of Health lQmberiey Driscoll
120 Washington Street,4th Floor Mayor
SALEM,MA 01970
Food/Retail Establishment Permit
DATE PRINTED: 12/29/2008
ESTABLISHMENT NAME: Fuel
File Number:BHF4004-000130 196 Essex Street
Salem MA 01970
LOCATED AT: 0196 ESSEX STREET
SALEM, MA 01970
Permit Type Permit No. Permit Issued Permit Expires Fee Restrictions/Notes
FOOD SERVICE BHP-2009-0230 Dec 29,2008 Dec 31,2009 $140.00
ESTABLISHMENT
Total Fees: $140.00
PERMIT EXPIRES December 31, 2009
Board of Health
This Permit is not transferable and must be reissued upon change of ownership or location.The permit must be posted in
a prominent location in the Establishment.
In accordance with the State Sanitary Code,beofre any revonations,improvements,or equipment changes are made,all
plans for such must be submitted to and approved by the Salem Board of Health. Page 1
J CITY OF SALEM, MASSACHUSETTS
+ • BOARD OF HEALTH
120 WASHINGTON STREET,4"�FLOOR
TEL. (978)741-1800
KIIvIBERLEY DRISCOLL FAX(978) 745-0343 RECEIVED
MAYOR IDIONNE&ALEM.COM
JANET DIONNE, MC 12608
ACTING HEALTH AGENT C:
2009 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT
NAME OF ESTABLISHMENT-- -EJ CO,\'� ZU iC.eEG 2 TEL# `� tf)'{ OSO
ADDRESS OF ESTABLISHMENT t "1 (t nm&k_ FAX#
MAILING ADDRESS(if different)
S "
EMAIL-Business': q Website:
OWNER'S NAME J' 61i1 Lj�_� 1 —TEL# —7VJr6Gn3
--
ADDRESS (0(0 K)UQW, S; �IA � /Y) A, V��7�
STREET —CITY, STATE ZIP
CERTIFIED FOOD MANAGER'S NAMES) u 2eu-\ M(Jr7qh�r CERTIFICATE#(S) �_WW
(Required in an establishment where potentially hazardous food ls,frepared) Co eco ', j17"'u7'-7)
EMERGENCY RESPONSE PERSON l-tl MV a�� vG HOME TEL# ��Q
DAYS OF OPERATION Monda Tuestl W da' - •Thutsd Friday 1 Saturday :. I Sunda
HOURS OF OPERATION j —7 I
Please write in time of day. I�Gm'�OP^ 7Gm''OQy,` /QIM-I�Pr'� �Grl-'IOfN. �Gn.- fdu n-'.
For example 11 am-11 pm ±:
TYPE OF ESTABLISHMENT FEE (check only)
RETAIL STORE YES NO less than 1000sq.ft. =$ 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 =$280
more than 99 seats =$420
------------------------------------------------------------ ---
BED/BREAKFAST/ YES N $100
CHILDCARESERVICES--------------------------------------------------------------------------------------------------------------------------
ADDITIONAL PERMITS
MAKE (not just serve) ICE CREAM, YOGURT/SOFT SERVE YES $25
TOBACCO VENDOR YES $135
ALL NON-PROFIT(such as church kitchens) YES 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.
Pursua t MGL Chapter 62C,Sect' n 49A.I certify under the pains and penalties of perjury that I,to my best knowledge and belief,have filed all state tax
returns aid all state taxes r ui under the law.
-9"Q, O - dGSS�
Signator Date Social Security or Federal Identification Number
Revised 424/07 FOOD 2008.adm Check#&Date 7�9�?a/YT�i $
y
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0196 Essex Street Fuel
City of Salem
FOOD SERVICE ESTABLISHMENT - FOOD SERVICE Inspection
HACCP: ❑
Item Status Violation Critical Urgency
Telephone:
741-0850
Owner:
Christopher Silva
APIC:
Carey Murphy
Inspector:
Elizabeth Salandrea
Date Inspected:Correct By:
111/10/20
Risk Level:
iPermit Number:
BHP-2008-0234
Status:
SIGNED OFF
J#of Critical Violations:
.0
ITime IN: Time OUT:
Urgency Description(s):
BLUE: All violations noted in the 11/3/08 inspection report have been corrected.
Violations Related to Good
Retail Practices (Critical
violations must be corrected I
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®2008 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Nov 17,2008 ) Page I of
,•r
�Y
' Item Status Violation Critical Urgency
Violations Related to
Foodborne Illness Interventions
and Risk Factors (Require
immediate corrective action)
i
City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741-1800
GeoTMS®2008 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Nov 17,2008 ) Page 2 oft
+r .
r.
0196 Essex Street Fuel
City of Salem
FOOD SERVICE ESTABLISHMENT - FOOD SERVICE Inspection
HACCP: �]
Item Status Violation Critical Urgency
Telephone: PROTECTION FROM CONTAMINATION
1_741-0850 Food Contac Surfaces Cleaning and Sanitizing FAIL Critical WF_ RED
tOwner: Contac
No sanitizer was available at time of inspection.Sanitizer must be available at all workstations at all times.
DHandwash acilities
ChristopherSllva, FAIL Critical (] RED
(PIC: Comment: Hot water at handwash sink recorded at 107.9°F.Turn hot water up to ensure minimum temperature of 110°F is
1 Carey Murphy,. maintained.
Inspector: _ Violations Related to Good Retail Practices (Blue Items)
t Elizabeth Salandrea Food and Food Protectionj1/ FAIL Critical BLUE
Date Inspectedf correct By: �ment:There were uncovered foods in the fridge downstairs and in the 2-door fridge upstairs.Cover all food in storage to
i 11/3/2008 prevent contamination.
— Equipmen nd Utensils FAIL Non-Critical BLUE
tRisk Level:
on rent: Counter display unit needs general cleaning in the door tracks.
I Permit Number: reezer at front counter needs general cleaning and defrosting.
)BHP-2008-0234
Status:
VIOLATION z
#of Critical Violations:
3
.i Time IN: Time OUT:
1 �—
Urgency Description(s):
BLUE: Reinspection In one week, all violations to be corrected.
Violations Related to Good q`
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
GeoTMSID 2008 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev, Nov 03,2008 ) Page 1 of'2
p
r Item Status Violation Critical Urgency
`RED: ----- ----_ ��
,Violations Related to
Foodborne Illness Interventions
and Risk Factors (Require
immediate corrective action)
l
City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741-1800
GeoTMS®2008 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Nov 03,2008 ) Page 2 oft
f
0196 Essex Street Fuel
City of Salem
FOOD SERVICE ESTABLISHMENT - FOOD SERVICE Inspection
HACCP: ❑
Item Status Violation Critical Urgency
Telephone: '• PROTECTION FROM CONTAMINATION
741-0850Food Contact Surfaces Cleaning and Sanitizing PASS Critical RJ RED
Owner: y Handwash Facilities PASS Critical ❑J RED
Christopher Silva Violations Related to Good Retail Practices (Blue Items)
PIC: - Equipment and Utensils FAIL Non-Critical BLUE
Carey Murphy Comments:Shelves in the continental reach-in fridge have areas of rust and chipping paint.Repaint/reseal shelves to make
Inspector: +. impervious and easily cleanable.
Elizabeth Salandrea Physical Facility PASS Non-Critical BLUE
Date Inspected:Correct By:
14/3/2008
Risk Level:
Permit Number:
BHP-2008-0234
Status:
SIGNED OFF
1#of Critical Violations:
0
ITime IN: Time OUT:
;Urgency Description(s):
BLUE: All other violations noted in the 3/27/08 inspection report have been corrected.
,Violations Related to Good
Retail Practices (Critical Shelves of continental reach-in fridge to be repainted/resealed by next routine inspection.
violations must be corrected
!immediately or within 10
days)(Non-critical violations
:must be corrected immediately
'or within 90 days)
t —- - - .._
City of Salem Board of Health 720 Washington Street,4th Floor SALEM MA 01970(978)741-1800
GeoTMS®2008 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Apr 09,2008 ) Page 1 oft
Y
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®2008 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Apr 09,2008 Page 2 oft
' 0196 Essex Street Fuel
City of Salem
FOOD SERVICE ESTABLISHMENT - FOOD SERVICE Inspection
HACCP: ❑
Item Status Violation Critical Urgency
Telephone: PROTECTION FROM CONTAMINATION
7_4_1-085.0 Food Contact Surfaces Cleaning and Sanitizing FAIL Critical ❑d RED
Owner: a/mment:Cutting board stained and scored.Resurface or replace cutting board.
Christopher Silva Handwash Facilities FAIL Critical RED
PIC: �� /
Carey Murphy °eornment: Coffee observed in handwash sink.Handwash sink to be used for handwashing only.
Inspector: I�water at handwash sink measured 107°F.Turn up to ensure hot water reachs minimum temperature of 110°F.
Elizabeth Salandrea Violations Related to Good Retail Practices (Blue Items)
Date Inspected:Correct By: Equipment nd Utensils FAIL Non-Critical BLUE
3/27/2008
-- - ----- ---- - - omment: Muffin freezer in basement needs general cleaning and de-icing.
Risk Level:
Shelves in the continental reach-in fridge have areas of rust and chipping paint.Repaint/reseal shelves to make impervious and
Permit Number: easiryaeanabte• 4;y r roill'te-
_ BHP-2008-0234 6easter needs general cleaning.
Status:
ree
VIOLATION zer in kitchen needs general cleaning and de-icing.
#of Critical Violations: PhysicalFacility FAIL Non-Critical BLUE
?me IN —Time-0i mComment: Employee restroom has some water stained ceiling tiles near light.Replace tiles.
hili g tile missing in basement near stairs where pipe is running.Replace tile and seal around pipe.
Urgency Description(s):
BLUE: ghts in basement not working.Replace bulbs to ensure lights are in good working order.
Violations Related to Good GENERAL COMMENTS:
Retail Practices (Critical
violations must be corrected Reinspection in one week, all violations to 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®2008 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Apr 02,2008 ) Page / of
f item Status Violation Critical Urgency
RED:
Violations Related to
Foodbome 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®2008 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Apr 02,2008 ) Page 2 qf2
Commonwealth of Massachusetts
City of Salem
s
Board of Health IGmbefley Driscoll
120 Washington Street,4th Floor Mayor
SALEM,MA 01970
Food/Retail Establishment Permit
DATE PRINTED: 01/07/2008
ESTABLISHMENT NAME: Fuel
File Number:BHF-2004-000130 196 Essex Street
Salem MA 01970
LOCATED AT: 0196 ESSEX STREET
SALEM, MA 01970
Permit Type Permit No. Permit Issued Permit Expires Fee Restrictions/Notes
FOOD SERVICE BHP-2008-0234 Jan 4,2008 Dec 31,2008 $140.00
ESTABLISHMENT
Total Fees: $140.00
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 13 of 25
.r
CITY OF SALEM, MASSAC HUSSEM
S a BOARD OF HEALTH
120 WASHINGTON STREET,4'"FLOOR
TEL.(978)741-1800
KIMBERLEY DRISC OLL FAX(978)745-0343
MAYOR LSCOff a SALEM.COM
JOANNE SCOTT,
HEALTH AGENT
2008 APPLICATION(��FOR'P�E�RMIT TO OPERATE A FOOD ESTABLISHMENT
NAME OF ESTABLISHMENTrt�1(( x7 }U C mac' in TEL# DE
-`-�1 1t)"
ADDRESS OF ESTABLISHMENTT W C, SSCK �} FAX#
MAILING ADDRESS(if different)
EMAIL-Business': Website:
OWNER'S NAME �r��0��� t U�� TEL# �, /� �tIC7 ���
ADDRESS ••,.0 X) SI — tit f� I yY 1 P QP_)b
STREET n/^� /� rn CITY STATE ZIP
CERTIFIED FOOD MANAGER'S NAME(S) l cteeC,1 4 I lue pb CERTIFICATE#(S) �SS(09�
(Required in an establishment where potentially hazardous fo "is repared)
EMERGENCY RESPONSE PERSONCb CfU feHOME TEL
DAYS OF OPERATION Monday Tues Wednesd Thursday Friday Saturday Sunda
HOURS OF OPERATION )
Please write in 6me of day. "�-. m �Cftri'j a rn`f
/�+rm gym- ;m
Forex ample)tam-11pm) �
TYPE OF ESTABLISHMENT FEE (check only)
RETAIL STORE YES NO less than 1000sq.ft. =$70
1000-10,000sq.ft. =$280
more than I0,000sq.ft. =$420
- - - -- ......... ..............._.--.------ • ----------- ��-^�^�,
RESTAURANT YES NO less than 25 seats (--_-ipl4y,/
(Outdoor Stationary Food Cart$2 1 25-99 seats =$280
more than 99 seats =$420
........... ... . .... - ... ------- . .... -------••--- ... -
BED/BREAKFAST/ YES NO $100
CHILOCARE SERVICES. ... - -
-
--...----- -
ADDITIONAL PERMITS
MAKE (not just serve) ICE CREAM, YOGURT/SOFT SERVE YES $25
TOBACCO VENDOR YES NO $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 state tax
ilk
all a taxes required under the law.
lO 013 09-3c)qSS- y-
Signature,, Date Social Security or Federal Identification Number
- ------ - ----- -- - - ---
------------------ 1t1Q;---- ---
Revised 4124107 FOODAP2008.adm Check#&Data f„_ j�__W ---1-_
;9196 Essex Street Fuel
City of Salem
FOOD SERVICE ESTABLISHMENT - FOOD SERVICE Inspection
HACCP: ❑
Item Status Violation Critical Urgency
Telephone: Violations Related to Good Retail Practices (Blue Items)
741-0850 Food andFood Protection FAIL Critical BLUE
Co
Owner: ' mment There is food stored directly on landing. Food to be stored 6-8 inches off of the floor.
Christopher Silva
PIC: L1 C5omriental unit temperature reading at 52°F. Unit to be maintained at 41oF or below as mandated.
Ross Phillips Equipment and Utensils FAIL BLUE
Inspector:
John Gehan omment: Frigidaire unit requires defrosting and general cleaning.
Date Inspected:Correct By: vera nit handles require thorough cleaning.
8/20/2007
Risk Level: anitizing log not being maintained daily. Log to be maintained on a daily basis.
Physical Facility FAIL BLUE
Permit Number:
BHP-2007-0152 _,,.G mment: Dry storage downstairs has water stained ceiling tiles. Find source of leak and repair. Replace any damaged tiles.
Status: Employee restroom downstairs has water stained ceiling tiles. Find source of leak and repair. Replace damaged tiles.
Open
#of Critical Violations: estroom also has damged file around vent. Repair or replace tile.
1 Liere is a water stained ceiling tile over the soup containers. Find source of leak and repair. Replace damaged tile.
Time IN: Time OUT:
ear trash container near sandwich unit requires thorough cleaning.
Urgency Description(s): GENERAL COMMENTS:
BLUE: All violations to be corrected with in one week. A reinspection will be conducted at this time.
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 Lauders Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Aug 23,2007 ) 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. Aug 23,2007 ) Page 2 oft
CITY OF SALEM
BOARD OF HEALTH
Establishment Name: ry.0 Date: -76 -7 L6, Page: of
Item Code C=Critical Item:. .. DESCRIPTION OF VIOLATION/PLAN OF CORRECTION ° nate
No. Reference R-Red Item . �• "" '* "''s � Verified
PLEASE PRINT CLEARLY ,,/7 /
PYA W(/"-�. !// 3 (1 '&1A J
I -r
I/IOC. /YY7S d�iY1G//�
,S�jj✓r / % � . Y))/ Ur ru?? �v(/A i.7ntR-cam' �+�9 .iL
441 /P/L't..G v' /� Z �1(/1 A ry .z_G
Z
t
e
i
Discussion With Person in Charge: 12,SS f7� ��t`�5 Corrective Action Required: ❑ No LI 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
G noncompliance may result in daily fines of twenty-five dollars or suspension/revocation of ❑ Embargo ❑ Emergency Closure
mit
your food per . �' i
` "� ❑ Voluntary Disposal ❑ Other:
`f
TLmOeTatures
P s Received at
Violations Rotated to Foodborne fitness Interventions and Risko doli,;to haw Cooled to
Factors(Items 1-22) (Cont) 'I'Within 4 How s_
5c)1 15 PROTECTION FROM CHEMICALS Coolie,, Methods for PRFs1= Food�r Color Additives
LL9 PHF Hot and Cold Holding
50'4 77
]�(B) Cold Pf F104amraiiied at or below
4-20.'-..12 Af"tivcO '590,o44a-) 410/45'1 k
3-30214 Prosetion froth 7— —�
,,I ji�,7
D_5 Poisonous or Toxic Substances A) His 1111Fc Maintainedat or above
1401'.
7-101.11 I Identifying Information -Original
1-501.16( ko;ist.,Held ai orabov
20 1 Time as a Public Heafth Control
-Ti"0'2,11 Common Name - Work'n
3-501 19 Tiim7,,,as a Public stealth Conjj�ol,
'7..2011# StLmtij�,"
scitrowfH) variaw k uientcat
7-'01111 Req,icoop-Pw,�nce and Use'
7-20112 Condition:.of Use"
7-20111 REQUIREMENTS FOR HIGHLY SUSCEPTIBLE
7204,1'11 Sanitizers,Criteria --Chenuc.,NPOPULATIONS
21 40,1.11(A) Utipmierfrized Pre-pacj_aged Juices and
__04.12 eolicab�les.lw, ce!clitel I a,
1)�1711 r2ill_11
7-204 14 Dr ia�A fcnls:Crit�rixr RewW
raees with araiil�
Pastcurizcd
)�T Inuid, C'o TfA 80 1"B t Ne of
-ili , I -mal N-A n ibriL UiW�
7 �3-f;011
-206.11 lkc�ijictcd Use Pe�ticides,Criteria, d and
7 206.12 Rodew B,at staliojk,� if
22
v -sensed_
7 206.11 lr�tckitig Pntcl Ld 1`�Lxxl Pati Not Re
ers,P��K Control and 1,,AL_
CONSUMER ADVISORY
TIMEITEMPERATURE CONTROLS 22 3bOr 1 1 1-1 oaminox Aoeiso,y_Pwed for
1,111tion of
16 Proper Cooking Tempm atures hir-- "Uiawl Fiods That are Raw Undercooked or
PHFs Not Otherwise Pnx:e�qsed to Eliminate
Egg 135'F I."S�c.
-
3.401.111(1)(2}- — Patfiol�emE
145`115sec 3-302A 1 pasteurz A Eggz;Substitute for R^sh
401-II(A)(2) concyanuiehFilli "vlE.ais& (Tin'lc
Anitnals- I s'F 15 se '
401.11($)(1)(21 Poit, and Beet Roast 130"'F 121 nxiiESPECIAL REQUIREMENTS l
3-40 1.11(A)(2) RatI10, lniwed k1c4ts-- 155 F 15
PTO \710allonOf ��Iclltni 590.(X)9iA)-(I))in
4sec. * I Catering, 'nobilc fix)d.terrifforiti v ford
7
ilouTtr 51'8d(-,atne_Sw7fe 1'csIdcut,'at kitchen operations should he
Stuffing Containing Fish,Meal, debited under the
oi 15 Sec.
abiuve,if related to fkx)dl)orne illness
3-401.11(Q31 VLoh nms lc lotact Bcef Sleaics inict vention.s and risk factors. Other
1451;< .590.009 viohuiom relating to good retail
7401.1i Raw Aninuil Pktiods C(xZed in a practices should tv-debited under#29 -
Microwave l65"F* Ste-ciii Requirements-
-AbOtheill TiF,-- 1451 15 sec� , I
L_1�7 Reheating for tiet Holding VIOLATIONS RELATED TO GOOD RETAIL PRACTICES
3-103,1]{A}&-(D)_ PHF15 sec. (lients 23.30)
1403.(3(fl) kliciomwr- 165'F2 Nfiiiaw Stafidinl,, Crnuw;and wff-c roical which do fuis roate;,)file
Time,
iliffess ilifei ventioiry and w-'sk,or:tors Lvied above. can be
3-#93.11(C} Comimesci2llY Processed RTE'Kiod- Ic trtzd(/in the,401101wng eeciioffa of she For;d Code wid 105(".IVR
90.
3-403�1 I'F Reircinnal,, Unsliced Portions of Beef them - Good Rotad Practices fi_C 7 590.(7411
Roast,* L 23Persannal FC -2
24, Footl and Food Proleclion FC -3
EE8 __�raf;�r Cooling—ot P"FS ------
50IA4(A) _,L------L�(Iu fam-ent and-j LterLS-P 2---- -F C_
Cool ing Cooktd PHIfs fron) 140'F to -26, wfeef, abm it A Ifa s Le FC
fi�� -i3_7
7WF Within 2 Hours and From'10-F T7, —------_F
w 41'FIA5'F W'ithin 4 Hifurr.
Po�sor,.ous or To)dc bleieo�fjs FG-7 1 008
3-501 Ii(B) Cooling PHFs Made From Ambient 009
—4—
IT
Temperature bigredicni�to 41�1145_F so r
Dcnvie s ritical ileal M I ee 1b3ci al 13^,9 Foxi C,Ae,,T I0<CN-lU 5911 rsq),
0196 Essex Street Fuel
City of Salem
FOOD SERVICE ESTABLISHMENT - FOOD SERVICE Inspection
HACCP: ❑
Item Status Violation Critical Urgency
Telephone: Violations Related to Good Retail Practices (Blue Items)
741-0850 Equipment and Utensils FAIL BLUE
Owner: Comment: Both freezers downstairs require general cleaning. Remove ice from one outside bathroom.
-
Christopher Silva
PIC: Upstairs freezer requires general cleaning. -
Chris Silva Broken refrigeration unit to be repaired or discarded by next routine inspection.
Inspector:
John Gehan Physical Facility FAIL BLUE
Date Inspected:Correct By: Comment: Front door has visible air gap. Provide seal to prevent entrance.
1/29/2007
Risk Level:
Permit Number:
BHP-2007-0152
Status:
SIGNED OFF
#of Critical Violations:
0
Time IN: Time OUT:
Urgency Description(s):
BLUE:
Violations Related to Good
Retail Practices (Critical
violations must be corrected
immediately or within 10
days)(Non-critical violations
must be corrected immediately
or within 90 days)
City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741.1800
GeoTMS®2007 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Jan 29,2007 ) 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 29,2007 ) Page 2 oft
♦ w
CITY OF SALEM, MASSACHUSETTS
i BOARD OF HEALTH
120 WASHINGTON STREET, 4TH FLOOR
SALEM, MA 01970
i
TEL. 978-741-1800
Fax 978-745-0343
Kimberley Driscoll WWW.SALEM.COM
Mayor JOANNE SCOTT, MPH, RS, CHC}
HEALTH AGENT
2007 APPLICATION FOR (PERMIT TO OPERATE A FOOD E--S�TABLISHMENT
NAME OF ESTABLISHMENT-1 6.0.0 - ( 1 Ce 4-a+cC- TEL# / f/
ADDRESS OF ESTABLISHMENT v FAX# -
MAILING ADDRESS (if different)
EMAIL--Business': 11 ^— Owner's:
OWNER'S NAME r�7r (ix TEL#-y�/7I J�t",J[�+a6 ,(�
ADDRESS 1(0(0 i1JQR ('L '9 /r
- - 6 )-b
STREET /A �y� CITY STATE ZIP
CERTIFIED FOOD MANAGER'S NAME(S) `.SVSG( 1 � CERTIFICATE#(S) SS-3 C`r(1 /
(Required in an establishment where potentially hazardous food is prepared) j
EMERGENCY RESPONSE PERSONLCtQL 1u � 102 u° 1 HOME#c lir S �LI4r-�ib3
—Q i
_OAYSOFOPERATION Monday Tuesday Wednesday Thursday Friday Saturday Sunday
HOURS OF OPERATION 1� 7 1 s /
Please write In time of day. ,{M—/`''P .._/� .. /r+^ /� +^-! 74"
(for examplellam-llpm) 1 i� —', �1,
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 YES NO less than 25 seatsCt9%
25-99 seats =$150
more than 99 seats =$200
-- ...._.......... . .. - - .... ... ...
.... ...
- - - ...-.-....
BEDIBREAKFAST YES NO $100
- - ------------ ----- ----- ...-....-.... .---- ----- ___ ..---------- ...... - ...........---- ------............-..... .
ADDITIONAL PERMITS
MAKE(not just serve) ICE CREAM, YOGURT, SOFT SERVE YES $5
TOBACCO VENDOR YES $50
ALL NON-PROFIT(such as church kitchens) YES $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.
k,su3n toMGL Chap 62CSection 49A, cenify under the pains and penalties of perjury that I, to my best knowledge and belief.
its e Date Social Securityrity oal Identification Number
--- - --- -- --- ---------- --
--- -- - --- ---- -- -
----
Revised 11/13106 FOODAP2007.adm JCheck#8 Dale 3-�U � �"
J,
,� � st,%y kiti�v'rS� yy?,r# �% 1�++•��j,+v����id��.rq *la�¢r��1 t �� P��t�� aw ',_' a '' .T���e3,F�.k�'
a4x
n Yt -4i, ft erlf-' e 1 he'd e 6+
-s' rsa, .utet : ,mac }
�„�,tCommonwealth of Massachusetts� iT' � �+� .,
w.. x � � ai 2, s:w✓ar '�. 'rn t+w fis 4� s '� r• '1 •r. h
z4 �-n���_ r �.�=- °..:. ,.�,ry,.._ ��,�:�:� t � �. „ , _ , . �Mayor_���R �.r•_ .x
SALEM,MA 01970
Food/Retail Establishment Permit
DATE PRINTED: 12/20/2006
ESTABLISHMENT NAME: Fuel
File Number:BHF-2004-000130 196 Essex Street
Salem MA 01970
LOCATED AT: 0196 ESSEX STREET
SALEM, MA 01970
Permit Type Permit No. Permit Issued Permit Expires Fee Restrictions/Notes
FOOD SERVICE BHP-2007-0152 Dec 20,2006 Dec 31,2007 $100.00
ESTABLISHMENT
Total Fees: $100.00
PERMIT EXPIRES iDecember 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 4 of 16
IMPORTANT MESSAGE
FOR
DATE `�yr/ TI-TIME
M
OF
PHONE
AREA CODE NUMBER EXTENSION
U FAX
O MOBILE
AREA CODE Nl}MBER TIME TO CALL
TELEPHONED PLEASE CALL
CAME TO SEE YOU WILL CALL AGAIN
WANTS TO SEE YOU RUSH
RETURNED YOUR CALL WILL FAX TO YOU
MESSAGE
SIGNED
Mw TOFS, EDM
40
MADE IN U.S.A.
NOTES
Nov-17-94 O5:44P P.O1
Pest Control ServiceAgreement
. ,✓To ✓ s& s PEST CC rTROL
7808
29 School Street
SAUGUS, 781)MPSWHUSFTTS O1906
J (781) 5994317
911MiR �
20
---NlL ucn• .. _-_.. RnNsuu lu uL uwmwnsinwn MawL
:.,I.:
IMI NINL IrYL VI YNVYVIV Ni NI':Nvlfl'II - _
I
^FIWIf.F RF.f;INti w}iM1N NTS! / Y'MWI giFVICE BF VENiVN LU
11 NiNLr• 1QUAMERIr• I ,OTHER
iyX.
I
I
' n
II
�IlS Ai �✓ �d� Mt.r ;Y��S/ �`✓, ��z fir �%'t•rTs .
II �Q/Z rEri7 /!O:'rf./,~ �i:'� S/?liiN.(. vd:ii✓ ::! ./
30Nu✓.zy/f�zz�-
���
S �T z Zav� �� Z
SCRVICE GUARANTEE:We agree to apply chemic.Is to control above-nam d sls in accurdam;e will)Inrm and conditions of this
Service Agreement. All lannr ana malarial,,well he h:rnished to provide Ino st eHicienl pest centro)end Imwmum safety requi.en by
federal.Slate end rily m9ilabons.
SERVICE RENEWAI:Thic ddreenlenl shall be for nn Initial period of one year,and will renew itself annually utile .;oilher party cinr-eh.
tills uglooniont by giving thirty days written notice Dense any expiration date.
zo_ __._
ANNUAL �-
AGRCEMENTCHARGE _
/r nr
INITIAL SERVICE CHARGE s.2(—. ,,?) NY DATE
of vnlo,n',
MONTHLrlOUARTERLY PAYMENTS $ FOR
CUSTOMERDATE
(/ullII4NIhLl::u;rNllYlii
Nov-17-94 05:42P P.01
Pest Control Service Agreement
7- 13 & 8 PEST CONTROL 7806
,111�w 0,ore7�( 29 School street
5;0
SAUGUS, MASSACHUSETTS 01906
(7W M-4317 ,
5L.ILI 1.111M
:ATY:.DITFn.71P pmvo roAF roNrAcur, nrunx
rNrNr
x/970
..........
IAIV IZP-,WiiT WiiW mfi,LWA )Il
I t, ONTHLY ]QUARTERLY I
L
I OTHER
12
Z7/ lases
-7,
iiSERVICE GUARANTEE:We agree to apply chemicils.10 contiol.above-n ptsain mccuoj,,row wiljn torrivs and cond;loon7 of thi.,
All labor and matonaffs;will bo fu-nishod to provido oaf ctficient pest control and maxtinurri safely re.clijired fly
1040,41,%late
SERVICE RENFWAI TIM, h-li be for of)initial period of one year,and will renew iipill annually unless P.ilhMi parly concois
?7
ot
71'
- /In 'c
Oospl.7ffid nt/p
this agr"rnc -by gwr4thitty,days written notice kicloca any"piratian dads
ANNUAL
AGREEMENT Ct IARGE $
Y
?I I '""110f1LW C
INITIAL SERVICE CHARGE $
IV 61
MONTHLY/QUARTERLY PAYMENTS S P C,
FOR
'TC)ME
CUSTO Ell- DAIh
. ............... .......
Yb w,.+ ,.......,.h f+' ,*r�^„ ..„ w.,R,. x w- � y. .��1 vtw...;.• ku'Tuwry �c� h., v><# �.* � '
.�+ae+'�,c 3e �k..C,.=� r�;h,t:-� « ,�r?t�°-�.�.a� tl 'z4t"err, ds `�SS�k`�.e�+���s'I*.,,. `.«"'s�' r. S�w�'i� �.!a�k -•
� �Commonwealth of Massachusetts ,, , '., .y P;
Board of Health
120 Washington Street,4th Floor
e SALEM,MA 01970
Food/Retail Establishment Permit
DATE PRINTED.llkN01/03/2006
WHO'S PLACE OF BUSINESS IS: Fuel
File Number:BHF-2004-0130 196 Essex Street
Salem MA 01970
LOCATED AT: 0196 ESSEX STREET
SALEM, MA 01970
Permit Type Permit No. Permit Issued Permit Expires Fee Restrictions/Notes
FOOD SERVICE BHP-2006-0108 Jan 3,2006 Dec 31,2006 $100.00
ESTABLISHMENT
Total Fees: $100.00
PERMIT EXPIRES December 31, 2006
Board of Health t
This Permit is not transferable and must be reissued upon change of ownership or location.The permit must be posted in
a prominent location in the Establishment.
In accordance with the State Sanitary Code, beofre any revonations,improvements,or equipment changes are made,all
plans for such must be submitted to and approved by the Salem Board of Health. Page 1 of 9
CITY OF SALEM, MASSACHUSETTS
BOARD OF HEALTH
� s 120 WASHINGTON STREET, 4TH FLOOR
SALEM, MA 01970
TEL. 978-741-1800
STANLEY J. USOVICZ, JR. FAX 978-745-0343
MAYOR WWW.SALEM.COM Q B
JOANNE SCOTT, MPH, RS, CHO &0(4-Z, '° '1100SHEALTH AGENT FS
� °pyq<F
2006 APPLICATION FOR PERMITTOOPERnAT�EQA FOOD ESTABLISHMENT
NAME OF ESTABLISHMENT )PXy"`� "� `�0`CC�e TEL# I L 03o()
ADDRESS OF ESTABLISHMENT
MAILING ADDRESS (if different)
1 _.
OWNER'S NAME TEL# (4
ADDRESS I (i O Iv��
CITY Cv>` STATE MA— ZIP OW26 -
CERTIFIED FOOD ANAGER'S NAME(S) JL CERTIFICATE#(s)�
(required in an establishment where potentially hazardous food is preppa�red.
EMERGENCY RESPONSE PERSON t^fnQt l�1 ` 33 "HE TEL -7
HOURS OF OPERATION: Mon. -1 Wed.`J /o Thu Fri. �•I Sat.�l Sun. 7-/a
TYPE OF ESTABLISHMENT FEE (check only)
RETAIL STORE YES NO less than 1000sq.ft. =$ 50
1000-10,000sq.ft. =$100
more than 10,000sq.ft. =$250
.... ..... ......-
. .... .
RESTAURANT YES NO les q 25seatc -�+n�'
�O 25-99 seats =$150
3 more than 99 seats =$200
--------------------------------------------------------------------------------------------------------
BED/BREAKFAST YES NO $100
.......... ....... ....................... .................... . ........ ............... ............... ...... -......................
ADDITIONAL PERMITS
MAKE(not just serve) ICE CREAM, YOGURT, SOFT SERVE YES $5
TOBACCO VENDOR YESN $50
ALL NON-PROFIT(such as church kitchens) YES N $25
*Please pay total with one check payable to the City of Salem .
This Permit is not transferable and must be reissued upon change of ownership. The Permit must be posted
in a prominent location in the Establishment.
In accordance with the State Sanitary Code, before any renovations, improvements, or equipment changes
are made, all plans for such must be submitted to and approved by the Salem Board of Health.
Pursuant to MGL Chapter 62C, Section 49A, I certify under the pains and penalties of perjury that I, to my best
ovule ganelielf, have filed all state tax returns and pS0,ccall state taxes requiredunder thelaw.
�' , oy3��iSignat re Date l Security or Federal Identification Number
-------------------------------------------------------------------------------------------- -------------------------
Revised 11/03/05 FOODAP2.adm Check#&Da4x0I
0196 Essex Street Fuel
City of Salem
FOOD SERVICE ESTABLISHMENT - FOOD SERVICE Inspection
HACCP: ❑
Item Status Violation Critical Urgency
Telephone: _ Violations Related to Good Retail Practices (Blue Items)
-6741-0850 Food and Food Protection FAIL BLUE
Owner: , Comment: Ice scoop stored incorrectly. Scoop to be stored with exposed handle or in designated ice scoop holder.
ristopher Silva Equipment and Utensils FAIL BLUE
PIC:
:Carey Murphy Comment:Cutting board stained and scored. Resurface or repace board.
Inspector: Frigidaire freezer requires general cleaning.
John Gehan
Cabinets beneath processor requires general cleaning.
Date v A,.. Correct By:
Ioffs/20A. True drink unit requires general cleaning on bottom.
!'Risk Level: continental refrigerator requires general cleaning.
'Permit Number: Physical Facility FAIL BLUE
BHP-2006-0108 Comment: Employee restroom door is in disrepair. Re
Status pair door.
Open GENERAL COMMENTS:
#of Critical Violations: 808:
0 ;,
Time IN: Time OUT: _
Urgency Description(s):
BLUE:
Violations Related to Good
Retail Practices (Critical
violations must be corrected
immediately or within 10
days)(Non-critical violations
must be corrected immediately
or within 90 days)
City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741-1800
GeoTMS®2006 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Sep 13,2006) Page/ of
Item Status Violation Critical Urgency
RED: II
Violations Related to + r _nsa
Foodborne Illness Interventid '
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®2006 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Sep 13,2006 ) Page 2 oft
-1
0196 Essex Street Fuel
City of Salem
FOOD SERVICE ESTABLISHMENT - FOOD SERVICE Inspection
HACCP: ❑
Item Status Violation Critical Urgency
Telephone: PROTECTION FROM CONTAMINATION
-741-0850 Handwash Facilities PASS ❑d RED
Owner: Violations Related to Good Retail Practices (Blue Items)
:Christopher Silva
Food and Food Protection PASS BLUE
PIC.
Carey Murphy Equipment and Utensils PASS BLUE
Inspector: €
z f Physical Facility PASS BLUE
John Gehan-
Date Inspected Correct By. GENERAL COMMENTS:
316/2006 All citations noted on 3/6/06 have been Corrected.
Risk Level: _ 1 j
- i 4
Permit Number.." ° r
BHP-2006-0108
Status:
FULL COMPLY
#of Critical Violations:
0
Time IN: _ Time OUT:
Urgency Description(s): µ
BLUE:
Violations Related to Good
Retail Practices (Critical
violations must be corrected
immediately or within 10
days)(Non-critical violations
must be corrected immediately
or within 90 days)
City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741-1800
GeoTMS®2006 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Mar 13,2006 ) 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®2006 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Mar 13,2006 ) Page 2 oft
0196 Essex Street Fuel
City of Salem
FOOD SERVICE ESTABLISHMENT - FOOD SERVICE Inspection
HACCP: ❑
Item Status Violation Critical Urgency
Telephone: FOOD PROTECTION MANAGEMENT
741-0850 " _ PIC Assigned/Knowledgeable/Duties PASS RED
Owner:
Non-compliance with:
Christopher Silva
-: - Anti-Choking PASS
PIC:
Carey M u rphy Tobacco PASS
Inspector: a
John Gehan EMPLOYEE HEALTH
Date Inspected: Correct By: Reporting of Diseases by Food Employee and PIC PASS ❑d RED
3/6/2006 Personnel with Infections Restricted/Excluded PASS RED
Risk Level
FOOD FROM APPROVED SOURCE
Permit Number: Food and Water from Approved Source PASS 0 RED
BHP-2006-0108 Receiving/Condition PASS RED
Status:
OpenTags/Records/Accuracy of Ingredient Statements PASS d❑ RED
-x
#of Critical Violations. ' Conformance with Approved Procedures/HACCP Plans PASS RED
3
Time IN: Time OUT:
Urgency Description(s):
BLUE: }
Violations Related to Good
Retail Practices (Critical
violations must be corrected
immediately or within 10
days)(Non-critical violations
must be corrected immediately
or within 90 days)
City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741-1800
GeoTMSO 2006 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Mar 06,2006 ) Page I of
Item Status Violation Critical Urgency
RED: PROTECTION FROM CONTAMINATION
Violations Related to Separation/Segregation/Protection PASSd❑ RED
Foodborne Illness Interventions
and Risk Factors (Require Food Contact Surfaces Cleaning and Sanitizing PASS ❑d RED
immediate corrective action)
Proper Adequate Handwashing PASS RED
Good Hygienic Practices PASS RED
Prevention of Contamination from Hands PASS RED
HandwashhFFacilities FAIL RED
✓comments: Front handwash sink had accumulation of food on bottom. Hand wash sink are to be used for handwashing only.
PROTECTION FROM CHEMICALS
Approved Food or Color Additives PASS 0 RED
Toxic Chemicals PASS ❑J RED
TIME/TEMPERATURE CONTROLS(Potentially Hazardous Foods)
Cooking Temperatures PASS 0 RED
Reheating PASS RED
Cooling PASS Q RED
Hot and Cold Holding PASS RED
Time As a Public Health Control PASS RED
REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP)
Food and Food Preparation for HSP PASS RED
CONSUMER ADVISORY
Posting of Consumer Advisories PASS RED
City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741-1800
GeOTMS®2006 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Mar 06,2006 ) Page 2 of
Item Status Violation Critical Urgency
Violations Related to Good Retail Practices (Blue Items)
Food and Food Protection FAIL Critical BLUE
Comments: Uncovered foods found in front Frigidaire freezer. All foods in storage are to be covered.
Equipment and Utensils FAIL Critical BLUE
/comments: Bottled water refrigerator missing thermometer. Provide visible and accurate thermometer.
w white Frigidaire Freezer requires thorough cleaning.
L_-c;�abinets behind main counter require thorough cleaning.
p0bntinental refrigerator missing thermometer. Provide visible and accurate thermometer.
�efifinental refrigerator fan has accumulation of dust,cover requires general cleaning.
'—Powers refrigerator downstairs requires general cleaning.
VBeep freezer in downstairs storage area missing thermometer: Provide visible and accurate thermometer.
✓Sanitizer not readily available at time of inspection. Sanitier must be readily available at each work station with proper ppm,s.
Water, Plumbing and Waste PASS BLUE
Physical Facility FAIL Non-Critical BLUE
✓Comments: Front floor behind counter has chipping paint. Floor must be repainted/resealed within two weeks of inspection.
Management and Personnel PASS BLUE
Poisonous or Toxic Materials PASS BLUE
Special Requirements PASS BLUE
Other-See Notes - PASS BLUE
GENERAL COMMENTS:
513:
City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741-1800
GeoTMS®2006 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Mar 06,2006 ) Page 3 of
MassachOsetts Department of Public Health Salem Board of Health
120 Washington Street, 41" Floor
Division of Food and Drugs Salem, MA 01970-3523
FOOD ESTABLISHMENT INSPECTION REPORT Tel. (978) 741-1800 Fax(978) 745-0343
Name -- > Dae Tyne of Operation(s) Tyne of Inspection
7I 1 e -F I tfl J� ® Food Service ❑ Routine
Address Risk ❑ Retail ® Re-inspection
I n Level ❑ Residential Kitchen Previou$$ Inspection
Telephone �- ❑ Mobile Date://( fJS
Owner HACCP Y/N ❑ Temporary ❑ Pre-operation
p I V' ❑ Caterer El Suspect Illness
Person in Charge(PIC) ' Time ❑ Bed& Breakfast ❑General Complaint
Ins ector In: l,:r- ❑ HACCP
p Out: Permit No. ❑ Other
Each violation checked requires an explanation on the narrative page(s) and a citation of specific provisions) violated.
• Non-compliance with:
Violations Related to Foodborne Illness Interventions and Risk Factors 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
EMPLOYEE HEALTH El13. Handwash Facilities
PROTECTION FROM CHEMICALS
❑ 2. Reporting of Diseases by Food Employee and PIC
El3. Personnel with Infections Restricted/Excluded El 14. Approved Food or Color Additives
' FOOD FROM APPROVED SOURCE El 15.Toxic Chemicals_ _
❑ 4. Food and Water from Approved Source ) TIMEITEMPERATURE CONTROLS(Potentially Hazardous Foods) d
❑ 5. Receiving/Condition ❑ 16. Cooking Temperatures
❑ 6. Tags/Records/Accuracy of Ingredient Statements [117. Reheating
❑ 7. Conformance with Approved Procedures/HACCP Plans ❑ 18. Cooling
PROTECTION FROM CONTAMINATION • -_ - ❑ 19. Hot and Cold Holding
❑ 8. Separation/Segregation/Protection ❑20.Time As a Public Health Control
❑ 9. Food Contact Surfaces Cleaning and Sanitizing REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP)
El 10. Proper Adequate Handwashing El21. Food and Food Preparation for HSP
'
El 11. ADVISORY 11: Good Hygienic Practices � - � e .= n•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
ofc 1 Nth. 590.000/federal Food Code. This report, when signed below
23. Management and Personnel (FC-2)(590.003) by a Board of Health member or its agent constitutes an
24. Food and Food Protection (FC-3)(590.004) order of the Board of Health. Failure to correct violations
25. Equipment and Utensils (FC-4)(590.005) cited in this report may result in suspension or revocation of
26. Water, Plumbing and Waste (FC-5)(590.006) the food establishment permit and cessation of food
establishment operations. If aggrieved by this order, you
,27. Physical Facility (FC-6)(590.007) have a right to a hearing. Your request must be in writing
28. Poisonous or Toxic Materials (FC-7)(590.008) and submitted to the Board of Health at the above address
29. Special Requirements (590.009) within 10 days of receipt of this order.
30. Other /\ DATE OF RE-INSPECTION: /�
5:590NspecfFom,514.Coc � \ N`T�_� ) ,'/
Inspector's Signatur : n 8 Print:
PIC's Signature: /t R° Print: / 7 j Page of Pages
Violations Related to Foodborne Illness
Interventions and Risk Factors(items 1-22)
PROTECTION FROM CONTAMINATION
FOOD PROTECTION MANAGEMENT S Cross-coreamination
1 590.003(A) Assignment of Responsibility* 3-302.1 l(A)(1) Raw Animal Foods Separated from
590 003(B) Demonstration of knowledge* Conked and RTE Foods*
2-103.11 Person in charge-duties Contamination from Raw Ingredients
3-302.11(A)(2) Raw Animal Foods Separated from Each
EMPLOYEE HEALTH Other*
2 590.003(C) " Responsibility of the person in change to Contamination from the Environment
require reporting by fool employees and 3-302.1 1(A) Food Protection'"
applicants* 3-302.15 Washin Fruits and Vegetables
590.003(F) Responsibility Of A Food Employee Or aln 3-304.11 Food Contact with Equipment and
Applicant To Report'ro The Person In Utensils"
Charge* Contamination from the Consumer
590.003((3) Reporting by Person in Charee* 3-306.14(A)(B) Returned Food and Reseavice of Food*
3 590.003(D) Exclusions and Restrictions* Disposition of Adulterated or Contaminated
590.003(t) Removal of Exclusions and Restrictions Food
3-701.11 Discarding or Reconditioning Unsafe
FO.O_ D 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
3-201.1.2 Food in a Hermetically Sealed Container* Sanitization Teioperatures*
3-201.13 FhridMilkandM'ilkPrroducts* 4-501.112 Me�lnicalWarewashing-HotWater
3-202.13 Shell Ears*
Sanitization Temp eratures*
3-202.1.4 E =s and MilkPiaducts,Pastenrized* 450CTI 4 Chemical Sam tivation-temp.,pH,
3-202.16 Ice Made From Potable Drinking Water* concentration and hardness.
5-101.11 Drinkiu Water from an A roved/ stem* 4-601.11(A) Equipment Food Contact Surfaces and
590.006(A) Bottled Drinking Water* Utensils Clean*
4-602.11 Cleaning Frequency of Equipment Food-
590.000(B) Water Meets Standards in 310 CMR 22.0* a and Utensils*
i
SheiNlsh and Fish From an Approved Source 4-702.1 I Frequency Contact Surfaces
Sanitization Utensils and
3-201.14 Fish and Recreationally Caught Molluscan Foci Contact Surfaces of Equipment*
Shellfish* 4-703.11 Methods of Sanitization-Hot Water and
3-201.15 Molluscan Shellfish from NSSP Listed Chemical*
Sources* 14 Proper,Adequate Handwashing
Game and Wild Mushrooms Approved by
Regulatory Authority 2-301.11 Clean Condition-Hands and Arms-
202,18
nns*202.18 Shellstock Identification Present* 2-301.12 Cleaainn Procedure*
590.004(C) Wild Mushrooms* 2-301.14 When to Wash*
3-201.17 Game Animals* I1 Good Hygienic Practices
S Receivinglcondition 2-401.11 Eating,Drinking or L'sin Tobacco*
3-202.11 PHFs.Received at Proper Temperatures*
'--401.12 Discharges From the Eyes, Nose and
3-202.15Packa a Irate it * Mouth*
3-101.11 Food Safe and Unadulterated* 3-301.12 Preventing Contamination When Tasting"
6 Tags/Records:Shellstock 1.2 Prevention - Contamination from Hands
3-202.18 Shellstock Identification * 590.004(E) Preventhrg Contamination from
3-203.12 Shellstock Identification Maintained* Em lo'ers*
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 Caution 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 1 Specialized Processing Methods* Devices
3-502.12 Reduced ox• enacka do<._criteria* 6-301.11 Handwashin Cteansei,.4vuilabilit
8-103.12 Conformance with A� roved Procedures* 6-301.12 Hand Drvim,Provision
*Denotes critical item in the federal 1999 Food Cotte or 105 CMIZ 590.000_ -
v
CITY OF SALEM - ,
rrBOARD OF HEALTH _
Establishment Name: �' �/t c a C44-pe Date: I Ci/6 Page: of C
Item Code C-critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date
. No. Reference R—Red Item - Verified
a ; .. PLEASE PRINT EARLY
Alo(284 f-0 -
S
8
j
! Discussion With Person in Charge: Corrective Action Required: ❑ No s
#rave read this report, have had the opportunity to`�sk questions and agree to correct all -0--voluntary Compliance ❑ Employee Restriction/
/ Exclusion
violations before the next inspection, to observe alp conditions as described, and to ❑ Re-inspection Scheduled ❑ Emergency Suspension
comply with all mandates of the Mass/FederYFo d Code. I understand that
{noncompliance may result in daily fines
of
(ent✓five dollar sus/pension/revocation of ❑ Embargo L3- Emergency Closure
your food permit. ! // /
❑ Voluntary Disposal ❑ Other:
1p
3-561 J 4(C) P;HFs Received at Temperatures
Violations Related to Foodborne Illness Interventions and Risk According to Law Cooled 1'o
Factors(items 1-22) (Cont.) 41'F145'F Within 4'H'ours,
PROTECTION FROM CHEMICALS 3-501.15 Cooling Methods forPHFs
1=414 Food 19 or Color Additives PHF Hot and Cold Holding
3-202.12 Addpn)es'" -
3-501.16(B) Cold PFIFs Maintained at or below
-
3-30114 Protection from Una)proved Additives* 590.064(F) 41'f45° F*
15 Poisonous or Toxic Substances 3-501-16(A) lint PHFs Maintained at or above
40°F. *
7-101.11 Identifying fim
fozatirnt-Original 3-50116(A) Roasts Held at or above 130'17. *
Containers*
7-102.11 Compton Name-Working Containers* Time as a Public Health Control
7-201.11 Se.oration-Storage* 3-501-19 Time as a Public Health Control*
7-202.11 Restriction-Presence and Use'k 590.064(H) Variance Re Virentent
7-202.12 Conditions of tJse*
7-203.11 1 Toxic Containers-Prohibitions* REQUIREMENTS FOR HIGHLY SUSCEPTIBLE
7-204.11. Sanitizers,Criteria-Chemicals* POPULATIONS(HSP)
7-204.1.2 Chemicals for Washitt Prodace,Criteria` 22 3-801.11(A) Unpasteurized Pre-packaged Juices and
Beverages with Warning,f abel5*
1-204.14 Dam A eats,Cnteria*
7-205.11 Incidental Food Contact. Lubricants* 3-801.-1 I(,B) Cie of Pasteurized)x*s*
7.206.11 Restricted Use Pesticides, Criteria* 3-801.1 I.(D) Raw or PactiaHy Cooked Animal Food and
Tr
Raw Seed S)routs Not Served
7-266.12 Rodent Bait Stations* 3-80' 1111(C) Uno)ened Fond Package Not Re-served.
7-?06.13 Tracking Powders,Pest Control and
Monitoring*
CONSUMER ADVISORY
TIMEITEMPERATURE CONTROLS 22 3-60311 Consumer Advisory Posted for Consumption of
lfi Proper Cooking Temperatures for Animal Foods Mat are Raw- Undercooked or
PHFs Not Otherwise Processed to Eliminate
3-401.L1A(1)(2) Eggs- 155`177.5 Sec.
Pathogens:*cff"',"'1'12001
Ergs-Lrmtediate Service 145'F15sec* 3-302.1' Pasteurized Eggs Substitute for Raw Shell
3-401.11(A)(2) Comminuted Fish,Meats&Game
Aniumis-155°F 15 sec.
3-401.11(13)(()(2) Pork and Beef Roast-130'F 121 min*. SPECIAL REQUIREMENTS _
3-401.11(A)(2) Ratites,Injected Meats-155'F 15 596.009(A)-(D) Violations of Seetion 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 wider the appropriate sections
Poultry or Ratites-165'F 15 sec. * above if related to foodborne illness
3-401.11(C)(3) Whole-muscle,Intact Beef Steaks interventions mid risk factors. Other
145'P" 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.
3401A I(A)(1)(b) All Other PHFs- 1450F 15 sec.
47 Reheating for Hot Holding VIOLATIONS RELATED TO GOOD RETAIL PRACTICES
3-403.11(A)&(D) PHFs: 165'F 15 sec. * ([tetxrs 23-30)
3-403.11(6) Microwave- 165°F 2 Minute Standing Critical and non-critical violations, which do not relate to the
Time* foodborne illness interventions and risk fi7ctors listed above, ran be
i-403.11(C) Commercially Processed RTE Food- fon ul in the following sections of the Food Code and 105 CMR
140114* .590.(1(10.
3-463.1.1(E) Remaining Unsliced Portions of Beef item Cvood Re[ait Practices FC 59tl.0A0
-- e
Roasts* _.___ersonnel _ FC-2 .003
23. Mona ement and Personnel,_
ig Proper Cooling of PHFs 24. Food and Food Protection_-__ FC-3 .004
25. Eui went and Utensils _ _FC 4 .005
3-501-1.4(A) Cooling Cooked PHFs,from 140'F to 26 Water, Phimbin and W aste FC-5 .006
70'17 Within 2 Hou s and From 70°F 27. Ph sica Facilit _ FC-6 007
to 41'Fl45'F Within 4 Hours.* 28. Poisonous or Toxic Materials FC-7 1 .008
3-501,14(B) Cooling PHFs Made From Ambient 29 Special Requirements _ .009
Temperature Ingredients to 41"P/d5°F 30 ___ Other
Within 4 Hours*
Denotes critical ilem in the federal 1999 Food Code or 105 CMR 590000.
e I
7-M,"77- ,..•". ice" . .. ..Ys,. ..j•^ty..
Massachusetts Department of Public Health Salem Board S Health
M 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 Dat Type of O eration s Type of Inspection
r I It75' Food Service ® Routine
Address / Ris Retail Q Re-inspection
t0 Level ❑ Residential Kitchen Previou Inspection
Telephone ❑ Mobile Date: ji jt7 r
171 Temporary ElPre-opration
Owner r i HACCP YtN ❑ Caterer ❑Suspect Illness
Person in Chafge{ I } t/ Time ❑ Bed& Breakfast ❑General Complaint
In:("30 ❑HACCP
Inspecfpr Out •ntp Permit No. ❑Other_
Each violat on 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`.,;; , , , ._ x . ... '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 TIMETEMPERATURE CONTROLS(Potent afiy Hazardous Foods)
❑ 4. Food and Water from Approved Source
❑ 5. Receiving/Condition ❑ 16.Cooking Temperatures
❑ 6. Tags/Records/Accuracy of Ingredient Statements ❑ 17. Reheating
❑ 7. Conformance with Approved Procedures/HACCP Plans ❑ 18. Cooling
' PROTECTION FROM CONTAMINATION a El 19.Hot and Cold Holding
❑ 8. Separation/Segregation/Protection ❑20.Time As a Public Health Control
❑ 9. Food Contact Surfaces Cleaning and Sanitizing a REQUIREMENTS FOR.HIGHLY SUSCEPTIBLE POPULATIONS(HSP)
❑21. Food and Food Preparation for HSP
❑ 10. Proper Adequate Handwashing
CONSUMER ADVISORY -
❑ 11. 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 s'
immediately or within 90 days as determined by the Board today,the items checked indicate violations of 105 CMR
- oWeaith. 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)(550.003} 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 e�
29. Special Requirements (590.009) within 10 days of receipt of this order.
30. Other DATE OF RE-INSPECTION: vL
Inspector's Signature: Prink:
PIC'sSignature: Print: i U Page`=ofages
------------
Violations Related to Foodborne Illness
interventions and Risk Factors(items 1-22)
PROTECTION FROM CONTAMINATION
FOOD PROTECTION MANAGEMENT S Cross contamination
1 590A03(A) Assignment of Res ongddlily' 3-30111(A)(1) -Raw Animal Foocls Separated from
590.003(B) Demonstration of Knowledge" Cooked and RTE Foals*
2-103.11. Person in charge-duties Contamination from Raw tngredients
3-302.11(A)(2) Raw Anonal Foods Separated from Each
EMPLOYEE HEALTH Other"
2 590.003fC) Responsibility of the person in charge to Contamination from the Environment
require repotting by foaxl employees and 3-302.11(A) Food Protection` '
a flh::.mts* __ _ 3-302.15 Washin Fruits and Ve etables
590.003(F) Responstbi(ity Of r1 Fwxi 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
590.0030 Removal of Exclusions and Restrictions Food
3-701.11 Discarding or Reconditioning Unsafe
FOOD FROM APPROVED SOURCE Food*
q 1 Food and Water From.Regulated Sources L9 Food Contact Surfaces
590.004(A-B) .{:otn>liance with Food Lavrr 4-501.111, Manual Warewashing-Hot Water
3-201.12 Food in a Hermetically Sealed Container* Sanitization'Iem eratures*
3-201.13 Fluid Milk and Milk Products* 4-501.113 Mechanical Warewashing Hot Water
3-202.13 Shell Eggs* Sanitization Tent eratures*
3-202.14 Eggs and Milk Products.Pastentized*
4-501.114 Chemical Sanitization-temp.,pH,
3-202.16 Ice Made From Potable Drinking Water* concentration and hardness.
4-601.11(x1) Erluipneat Food Contact Surfaces and
x101.11 Drinkin�Water frotn an.4 roved S :stem* Utensils Clean*
590.006(A) Bottled Drinking Wafet 4-602.]1 Cleaning Frequency of Equipment Food-
590.006(B) Water Meets Standards in 310 CMR 22-0"
S
Shellfish and Fish From an Approved Source Contact urfaces and Utensils*
4-702.11 Frequency of Sanitization of Utensils and
3-201.74 Fish and RecrearionaBy Caught Molluscan ,Food Contact Surfaces of H ui meat*
�... MShellfish* 4-703.11 Methods of Sanitization-Hot water and
13-201.15 olluscan Shellfish from NSSP Listed Chemical*
Sources` 111 Proper,Adequate Handwashing
Game and Mushrooms Approved by 2-301.11 Clean Condition-Hands and Arms°`
Reaulato Aututhorft _
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.I Good Hygienic Practices
5 Receiving/Condition 2-401.11 Eating,Drinking or Usin Tobacco*
3-202.11 PHFs Received at Pro er Tem erahtres" 2401,12 Discharges From the Eyes, Nose and
3-202.15 Parka e 7hte it-* Mouth*
3-101.11 Foul Safe and Unadulterated* 3-301..t2 Prcventing Contamination When Tastin
6 Tags/Records:Sheilstock t2 Prevention of Contamination from Hands
3-202,18 Shellstock Identification* 590.004(E) Preventing Contamination from
3-203.12 SheiNtock Identification Maintained" Em to gees*
Tags/Records:Fish Products 13 Handwash Facilities
Conveniently I acated and Accessible
3502.11 _Parasite Destruction*
- 3-402.12 Records.Creation and Retention" 5-203.11 Numbers and Capacities*
590.004(1) Labeling of Ingredients" 5-204.11 Location and Placement*
7
Conformance with Approved Procedures
5-205.11 Accessibility,Operation and Maintenance
IHACCP Pians Supplied with Soap and Hand Drying
3-502.11 Special i7.ed Processing Metltcufs* Devices
3-502.12 Reduced oxygen packaging.criteria* 6-301.11 I-Iandwashin Clesnser,Acailabillt
8-103.12 Conformance with A. roved Procedures* 6-301.12 Hand Drying Provision
r Denotos critical item in the W ial i 999 Food Code or 10: CMR 590.000.
t ,
CITY OF SALEM
c BOARD OF HEALTH
,gt Establishment Name: �EZ2-ef– = J ry i Date: — Page: �Z of
Item Code C-Critical nem DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date
No. Reference R-Red Item. Verified
i EASE PRINTCLEARLY I'* 1 I -
o P
w n t1cls
L I J a C
t
' r l . C sk P12-112-1w
y
_250 (p n e L
,
d
f
�51I ,1 D
�.
W-�4 Cc,( c- f 2e
ry
i , _
175GO Jj 2 cg c, c/ he I/1�,� .�
.I Discussion With Person in Charge: Corrective Action Required: 1. ❑. No Yes
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
f domply with all mandates of the Mass/Federal Food Code. I understand that
t .noncompliance may result in daily fines of twenty-five dollars or suspension/revocation of ❑ Embargo ❑ Emergency Closure
:your food permit. Voluntary❑ Voluntary Disposal ❑ Other:
3-501 14(C) PHFs Received at 9-emperatures
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 Met cods for PHFs
1=414 I9 Food or Color Additives - PHF Hot and Cold Holding
3-202.12 Additives"
3-501.16(8) Cold PHRs Maintained at or below
590.004(F) 41°145°F*
3-3(Y2.14 Protection Pram Toxic
Substances
Additives* 3-501.16(A) Hot PHFs-Maintained at or above
IS Poisonous or Toxic Substances -
7-101.11140°F.
'Identifying Information-Original
*..
3-SOLl(iG'-W Roasts Held at or above 130°F.
Containers* "
7-102.11 CommonName-Working Containers* 20 Time as Public Health Control
7-201.17 Se oration-Stora e* 3-501.19 Time as a Public Health Control*
7-202.11 Restriction-Presence and User
590.004(11) Vtu-iahee Ke uirement
7-202.12 Conditions of Use"
7-203.11 Toxic Containers-Prohibitions* REQUIREMENTS FOR HIGHLY SUSCEPTIBLE
7-204.11 Sattifrzers,Criteria-Chemicals* POPULATIONS(HSP)
7-294.12 Chemicals for Wash in I''mdaee. Criteria"` 3-80-i 1(A) Unpasteurized Pre-packaged Juices and
7-204.14 !Drying Agents,Criteria*
Beveraees with Warning Labets*
7-205.11 Incidental Food Contact, Lubricants* 3-801.11(B) Use of Pasteurized Fees* -
3-801.11(D) Raw or Pmtially Cooked Animal Food and
7-206.11 Restricted Use Pesticides.Criteria* Raw Seed Sprouts Not Served.
7-206.12 1 Rodent Bait Stations' 3-$01.11(C:) Unopened Food Packs�e Not IZe-served.
7-206.13 'Cracking Powders,Pest Control and
Monitorim** r'
CONSUMER ADVISORY
TIME/TEMPERATURE 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 Oiherwise Processed to Eliminate
3-401110(1)(2) Eggs- 155°F 75 Su.
Pathogens.*c""I"'
E=gs-humediate Service 145°F15sec" 3-302.13 Pasteurized Eggs Substitute for Raw Shell
3-401.11(0)(2) Comminuted Fkh,Meats<4c Game B fs*
Animals-155°F 15 sec.
3-401.11(B)(1)(2) Pork and Beef Roast-13WF 121 nrrn* SPECIAL REQUIREMENTS r
3-401.1 t(A)(2) Ratites,Injected Meats- 155°F 1.5 590-009(A)-(D) Violations of Section 590.009(A)-(D)in i
sea* entering, mobile food, temporary and
3-401.1.1(A,)(3) Poultry,Wild Game,Sniffed PUTS, residential kitchen operations should be
Stuffing Containing Fish,Meat, debited under the appropriate sections
Poultry or Ratite's-165"F 15 sec.s, above it related to (bodborue illness
3-101.11(C)(3) Whole-muscle,Intact Beef Steaks interventions and risk factors. Other �.
145°F* 590.009 violations relating to good retail
3401.12 Raw Ani nal Foods Cooked in a practices should be debited under/129-
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)&(D) PHF, 165°F 15 sec.'" (Items 23-30)
3-403.11(B) Mica'owave- 165°F 2 Minute Standing Critical and"non-critical violations, which do not relate to the
Time* foodborne diners interventions and risk factors Listed above, ecru be
3-403.11(C:) Commercially Processed RTE Food- found in the fbllowtrtg sections of the Fond Code anc7105 CfIR
140°F* 590.000.
3-403.11(E) Remaining Unsliced Portions of Beef Item Good Retail Practices FC 530.000
Roasts* 23. Managamerit and Personnel FG-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 Cooked PHFs from 140°F it) -26. Waw
- --- -- --- ---
FC 5 .
70°F Within 2 Hours and From 70"F Plunibaigand Waste 006___ _
27. Ph siaai Facility_ - FG-6 .007
to 41.7/450F Within 4 Hours. 28. Poisonous or Toxic Materials FC-7 .008
_T-MI 14(BCoolimg PHFs Made From Ambient 29. S eeial Re uiremeuts - .009
Temperature Ingredients to 41°F/45°F 30, Other
Within 4 Hours"
Denotes critical item in the foVral 1999 Food Code or 105 CMR 590000.
0196 Essex Street Fuel
City of Salem
FOOD SERVICE ESTABLISHMENT - FOOD SERVICE Inspection
HACCP: ❑
Telephone: hem Status Violation Critical Urgency Nature of problem or correction
741-0850 -compliance with: Not Done
Owner: Anti-Choking PASS ❑
Christopher Silva Tobacco PASS ❑
PIC
FOOD PROTECTION MANAGEMENT Not Done
Kristin Rodgers PIC Assigned/Knowledgeable/Duties PASS ❑d RED
Inspector:
`r David Greenbaum. EMPLOYEE HEALTH Not Done
Date Inspected: COrreCt By: Reporting of Diseases by Food Employee and PIC PASSd❑ RED
3/9/2005 Personnel with Infections Restricted/Excluded PASS Q RED
Risk Level:
FOOD FROM APPROVED SOURCE Not Done
Permit Number: Food and Water from Approved Source PASS RED
BHP-2005-0205 Receiving/Condition PASS ❑d RED
Status: m a L Tags/Records/Accuracy of Ingredient Statements PASS ❑d RED
SIGNED OFF Conformance with Approved Procedures/HACCP PASS ❑d RED
#of Critical Violations: Plans
1 PROTECTION FROM CONTAMINATION Not Done
Time IN: - Time OUT: Separation/Segregation/Protection PASS ❑d RED
Notes: Food Contact Surfaces Cleaning and Sanitizing FAIL Critical ❑d RED Front cutting board is stained and scored.
13 ❑
Resurface or replace cutting board.
Proper Adequate Handwashing PASS ❑d RED
Urgency Description(s): Good Hygienic Practices PASS ❑d RED
BLUE:
Violations Related to Goo_d Prevention of Contamination from Hands PASS ❑d RED
Retail Practices(Critical ' Handwash Facilities PASS ❑d RED
violations must be corrected
immediately or within 10
days)(Non-critical violations
GeoTMSO 2005 Des Lauriers Municipal Solutions, Inc. ( Rev. Mar 10,2005 ) Page I o{2
0196 Essex Street Fuel
must be corrected Immediately PROTECTION FROM CHEMICALS Not Done
or within 90 days) Approved Food or Color Additives PASS ❑d RED
RED'
Violations Related to ^ Toxic Chemicals PASS ❑D RED
Foodborne IIlness InterventlonS TIMEITEMPERATURE CONTROLS(Potentially Haz Not Done
and Risk Factors (Require Cooking Temperatures PASS RED
immediate corrective action)` _
Reheating PASS Q RED
Cooling PASS ❑Q RED
Hot and Cold Holding PASS ❑J RED
Time As a Public Health Control PASS ❑d RED
REQUIREMENTS FOR HIGHLY SUSCEPTIBLE PO Not Done
Food and Food Preparation for HSP PASS ❑d RED
CONSUMER ADVISORY Not Done
Posting of Consumer Advisories PASS ❑Q 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 Non-Critical ❑ BLUE Floor under continental cooling unit needs
a thorough cleaning and sweeping .
Poisonous or Toxic Materials PASS ❑ BLUE
Special Requirements PASS ❑ BLUE
Other-See Notes PASS ❑ BLUE
GeoTMS®2005 Des Lauriers Municipal Solutions, Inc. ( Rev. Mar 10,2005 ) Page 2 oft
..2AV�`
fr x, 7 I irei _ x x- ..k v � Y-T*` •..ad Y3' +
s�+. �);:.-.'.c
:.1^-..i
CITY OF SALEtrI;MASSACHUSETTS
BOARD OF HEALTH
3F 120 WASHINGTON STREET, 4TH FLOOR -
o SALEM, MA 01970
TEL. 978-741-1800
FAX 978-745-0343
STANLEY J. USOVICZ, JR. JOANNE SCOTT, MPH, RS, CHO
MAYOR HEALTH AGENT
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: Fuel
Address of Establishment: 196 Essex Street
Owner's Name: Chris Silva
Restrictions:
Application Date: 12/2/2004
Permit for Food Establishment 144-05
Frozen Desserts/Ice Cream
Permit for the Sale of Tobacco Products
These Permits Expire December 31, 2005
This permit is not transferable and must be reissued upon change of
ownership or"location. The permit must be posted in a prominent location
in the Establishment,
In accordance with the State Sanitary Code, before any renovations,
improvements, or equipment changes are made, all plans for such must be
submitted to and approved by the Salem Board of Health.
HEALTH AGENT
CITY OF SALEM';MASSACHUSETTS
BOARD OF HEALTH
i e
gt 120 WASHINGTON STREET, 4TH FLOOR
a SALEM, MA 01970
q� TEL. 978-741-1800
FAX 978-745-0343
STANLEY J. USOVICZ, JR. JOANNE SCOTT, MPH, RS, CHO
MAYOR HEALTH AGENT
2005 APPLICATION FOR PERMIT
TO OPERATE A FOOD ESTABLISHMENT
-7 7kV?SO
NAME OF ESTABLISHMENTTiCeQ� IS,L EL#
ADDRESS OF ESTABLISHMENT lgfO
MAILING ADDRESS (if different) �—
OWNER'S NAME / NJ S IInVL �\ I(J C' TEL# � �� (3��
ADDRESS/ (D(P N� 1�S -
CITY_71�� Pw STATE_M,4 ZtP 7a
CERTIFIED FOOD MANAGER'S NAME(S)�G�C'_v✓ apL _CERTIFICATE#(s)���
(required in an establishment where potentially hazardous food is prepared.)
D2 L"�'�S eaRty
EMERGENCY RESPONSE PERSON 0-Ci(Le (YuaAkT�S,)u"a HOME TEL# V�5
HOURS OF OPERATION: Mon /�WedZThu�/ /6 Fri. I Sa�
Sun
TYPE OF ESTABLISHMENT FEE check only
RETAIL STORE YES NO less than I000sq.ft. =$ 50
1000-10,000sq.ft. =$100
more than 10,000sq.ft. =$250
RESTAURANT ES NOless than 25 seats =$100
25-99 seats =$150
more than 99 seats =$200
BED/BREAKFAST YES Q�b $100
ADDITIONAL PERMITS
MAKE (not just serve) ICE CREAM, YOGURT, SOFT SERVE YES $5
TOBACCO VENDOR YES $50
ALL NON-PROFIT(such as church kitchens) YES /NO $25
Please pay total with one check
payable to the City of Salem
This Permit is not transferable and must be reissued upon change of ownership. The Permit must
be posted in a prominent location in the Establishment.
In accordance with the State Sanitary Code, before any renovations, improvements, or equipment
changes are made, all plans for such must be submitted to and approved by the Salem Board of
Health.
P rs nt to"eve
, Section 49A, I certify under the pains and penalties of perjury that I, to my
bet filed all state tax returns and paid all state taxes required under the law.
I,o O 3 SS7
Signatu a Date Social Security or Federal Identification Number
--------- -------- - ------ -- ----- ----- -- - -----
Revised
---Revised 11/03/03 FOODAP2.adm Check#&Date
Y'
CITY OF SALEM9 MASSACHUSETTS
+'t BOARD OF HEALTH
120 WASHINGTON STREET, 4TH FLOOR
'•�o SALEM, MA 01970
TEL. 978-741-1800
FAX 978-745-0343
STANLEY J. USOVICZ, JR. JOANNE SCOTT, MPH, RS, CHO
MAYOR HEALTH AGENT
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: Fuel
Address of Establishment: 196 Essex Street
Owner's Name: Chris Silva
Restrictions:
Application Date: 12/11/2003
Permit for Food Establishment 154-04
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
u CITY OF SALEM, MASSACHUSETTS
BOARD OF HEALTH
s/ 3 • 120 WASHINGTON STREET, 4TH FLOOR _U+ir'Frod
SALEM, MA 01970 bit
TEL. 978-741-1800 p ,� 1 WEALTH
FAx 978-745-0343
STANLEY LISOVICZ, JR. JOANNE SCOTT, MPH, RS, CHO
MAYOR HEALTH AGENT
2004 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT �l
NAME OF ESTABLISHMENT I ' I TEL/# IA'_ 7yI
ADDRESS OF ESTABLISHMENT 1 / b Ssek S-t ' alen'L
MAILING ADDRESS (if different)
OWNER'S NAME , 11/J/I1 TEL#
Ibb 7`ly - o5t�
ADDRESS (
CITY ti( STATE MA ZIP 01,370
CERTIFIED FOOD MANAGER'S NAMES) cre itl'q1. CERTIFICATE#(s) 3q
'� F Z8
(required in an establishment where potentially hazardous food is prepared.)
EMERGENCY RESPONSE PERSON � ` �'I �1J� HOME TEL#—/Y
HOURS OF OPERATION: Mon.7-S Tue. 7-5 Wed. 7-S Thu. 7-S Fri.7-S Sat. 7-S Sun. 7 S
TYPE OF ESTABLISHMENT /-pro FEE check only
RETAIL STORE YES N . less than 1000sq.ft. =$ 50
/ i 0 1000-10,000sq.ft. =$100
! 7 I more than 10,000sq.ft. =$250
RESTAURANT YES NO less than 25 seats =$10
25-99 seats =$150
more than 99 seats =$200
BED/BREAKFAST YES NO $100
ADDITIONAL PERMITS
MAKE (not just serve) ICE CREAM, YOGURT, SOFT SERVE YES $5
TOBACCO VENDOR YES $50
h 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.
P nt o GL Chlihave
, Section 49A, I certify under the pains and penalties of perjury that I, to my
b t o d filed all state tax returns and paid all state taxes required under the law.
LO 9 7
Signature Date Social Security or Federal Identification Number
-------------------------------------------------------------------------------------------------------------------------------------
Revised 11/03/03 FOODAP2.adm Check#&Date ill—) )a,3'-0-?
i 4 i�
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 Dat fOSerations T f inspection
ice tine d FA
ou
Address SV� Risk ❑ Retail ❑ Re-inspection
Telephone
Level [I Residential Kitchen Previous Inspection
.7y�^ ��
❑ Mobile Date:
-Owner HACCP Y/N ❑ Temporary ❑ Pre-operation
C 41 A4 4r TV e UA ❑ Caterer ❑ Suspect Illness
Person in Charge(PIC) Time ❑ Bed& Breakfast ❑ General Complaint
r444ft AidfoA In: ElHACCP
Inspectorilqww Am Out: Permit No. ❑ Other
Each violation checked requires an explanation on the narrative page(s) and a citation of specific provision(s) violated.
Non-compliance with:
Violations Related to Foodborne Illness Interventions and Risk Factors Anti-Choking Tobacco
Violations marked may pose an imminent health hazard and require immediate corrective 590.009(E) ❑ 590.009(F) ❑
action as determined by the Board of Health.
FOOD PROTECTION MANAGEMENT ❑ 12. Prevention of Contamination from Hands
❑ 1. PIC Assigned/Knowledgeable/Duties
El 13. Handwash Facilities
EMPLOYEE HEALTH
PROTECTION FROM CHEMICALS
❑ 2. Reporting of Diseases by Food Employee and PIC
❑ 14.Approved Food or Color Additives
❑ 3. Personnel with Infections Restricted/Excluded
El 15.Toxic Chemicals
FOOD FROM APPROVED SOURCE - -
❑ 4. Food and Water from Approved Source TIME/TEMPERATURE CONTROLS(Potentially Hazardous Foods)
❑ 5. Receiving/Condition ❑ 16. Cooking Temperatures
❑ 6. Tags/Records/Accuracy of Ingredient Statements ❑ 17. Reheating
❑ 7. Conformance with Approved Procedures/HACCP Plans ❑ 18. Cooling
PROTECTION FROM CONTAMINATION ❑ 19. Hot and Cold Holding
❑ 8. Separation/Segregation/Protection ❑ 20.Time As a Public Health Control
❑ 9. Food Contact Surfaces Cleaning and Sanitizing REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP);._;
El 10. Proper Adequate Handwashing E]21. Food and Food Preparation for HSP
❑ 11. Good Hygienic Practices CONSUMER ADVISORY,
❑22. Posting of Consumer Advisories
Violations Related to Good Retail Practices Number of Violated Provisions Related
Critical (C)violations marked must be corrected To Foodborne Illnesses Interventions
immediately or within 10 days as determined by the Board and Risk Factors(Items 1-22):
of Health. Non-critical (N) violations must be corrected Official Order for Correction: Based on an inspection
immediately or within 90 days as determined by the Board today, the items checked indicate violations of 105 CMR
of Health. 590.000/federal Food Code. This report, when signed below
r1
23. Management and Personnel (FC-2)(590.003) by a Board of Health member or its agent constitutes an
4. Food and Food Protection (FC-3)(590.004) order of the Board of Health. Failure to correct violations
25. Equipment and Utensils (FC-4)(590.005) cited in this report may result in suspension or revocation of
the food establishment permit and cessation of food
26. Water, Plumbing and Waste (FC-5)(590.006) establishment operations. If aggrieved by this order, you
27. Physical Facility (FC-6)(590.007) have a right to a hearing. Your request must be in writing
28. Poisonous or Toxic Materials (FC-7)(590.006) and submitted to the Board of Health at the above address
29. Special Requirements (590.009) within 10 days of receipt of this order.
30. Other DATE OF RE-INSPECTION:
S:5MnsceUFo� 14.000
Inspector's Signator Print:
PIC's Signature: Print: Pagel of 2-Pagesare �l✓I- �
Violations Related to Foodborne Illness
Interventions and Risk Factors(items 1-22)
PROTECTION FROM CONTAMINATION
FOOD PROTECTION MANAGEMENT R Cross-contamination
1 590.003(A) A.csipment of Responsibility- 3-302,11(Ahl) Raw Animal Foots Separated from
540.003(B) Demonstration of Knowledge"` Cooked and RTE Foods*
2-103.11. Person in charge-duties Contamination from Raw ingredients
3-302.4I(A)(2) Raw Anlrnal Foods Separated foam Each
EMPLOYEE HEALTH_ _ Other'
2 590.003(0) Responsibility of the person in charge to Contamination from the Environment
require reporting by food employees and 3-302.1](A) Faxi Protection"
a plicants* 3-302.15 tiVaslin Fruits and Ve_etables
590.003(F) Responsibility Of A Food Employee Or An 3-304.11 Food Contact with Equipment and
Applicant To Repott'Fo The Person In Utensils"
Char*e* Contamination from the Consumer
590.003(G) Reortin*b Person in Charge* 3-306.14(A)(B) Returned Food and Reservice of Food*
3 590.00303) Exclusions and Restrictions* Disposition of Adulterated or Contaminated
590.003(3) Removal of Exclusions and Restrictions Food
3-701.12 Discarding or Reconditioning Unsafe
FOOD FROM APPROVED SOURCE Food*
4 Food and Water From Regulated Sources L9 Food Contact Surfaces
590A04(A-B) Com}liance with Food Lawes', 4-501.111 Manual Warewashing-Hot Water
3-201.12 Food in a Hermetically Sealed Container* Sanitization Tem eratures*
7201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Warewashing-Hot Water
3-202.13 Shell En s* Sanitization Tcm eratures*
3-202.14 4-501.114 Chemical Sanitization-temp.,pH,
concentration and hardness.
3-202.16 tee Made Froin Potable Drinking Witter"
,o
4-601..11(A) Equipment Foal Contact Surfaces and
5-101..1.1 DrinkingWater from an Approved Systems Utensils Clean*
590.006(A) Bottled Drinking Water* ___ _
590.006(B) Water Meets Standards in 3l0 CMR 22.0* 4-602.11 Cleaning Frequency of Equipment Food-
Contact Surfaces and Utensils;'
Shellfish and Fish From an Approved Source 4-1021 1 Frequency of Sanitization of Utensils and
3-201.74 Fish and Recreationally Caught Molluscan Food Contact Surfaces of E m menti
Shellfish" 4-703.11 i Methods of Sanitization-IIot Water and
3-201.45 Molluscan Shellfish from NSSP Listed Chemical"
Sources* to Proper,Adequate Handwashing
Game and Wild Mushrooms Approved by 2-30
Re Mato Authorit 1.11 Clean Condition-Hands olid Arins-
3-202.18 Sheilstoek Identification Present" 2-30 L 12 Cleanln�;Procednrc*
590.004(0) Wild Mushrooms* 2-301.14 When to Rash"
3-201.17 Game Animals* 1.1 Good Hygienic Practices
F5-- Receiving/Condition 2-401.11 Eating.Drinking or Using Tobacco*
3-202.71 PHFs Received at Ria ei Temperatures, 2-401.12 Discharges From the Eyes, Nose and
3-202.15 Parka>e hue rit ^' Mouth-
3 101.11
outh*3-101.11 Food Safe and Unadulterated* 3-301.12 Preventing,Contamination When Tastina"
6 TagsiRecords:Shelistock - 12 Prevention of Contamination from Hands
3-202.18 Shelistock Identification* 590.004(3) Preventing Contamination horn
3-203A Shellstock Identification Maintained* IEmployees*
Tags/Records:Fish Products 13 Handwash Facilities
Conveniently
3--402.11 Parasite Destruction*
Located and Accessible
3-402.12 Records-C7eation and Retention* 5-203.11 Numbers and Capacities*
590,0040) Labeling of Ingredients' 5-204.11 I-oration and Placemenr"
ry Conformance with Approved Procedures
5-205.11 Ag,+essibility.OLerationand Maintenance
/HACCP Plans Supplied with Soap and Hand Drying
3-502.11 S eciatizecl Processmg Methods* Devices
3-502.12 Reduced oxo.,en nick a nna.crikeria'". 6-301.14 Handwashing Cleanser,Availabdit
8-103.12 Conformance with Approved Rocedures„ 6-301.12 Hand Dmina Provision
*Denotes critical item in the fcdera!1999 Food Code or IOi CMR 590.000.
CITY OF SALEM
BOARD OF HEALTH `
Establishment Name: Date: 9Page: of Z
Item Code C-critical Item DESCRIPTIONOF VIOLATION/PLAN OF CORRECTION Date
No. Reference R-Red Item - Verified
PLEASE PRINT CLEARLY
}' Ilt1't 4;f hen�tFPY1;+2
Ai [c>s Z04 t vN r!' M /Ludt DtF
t'r 6 49 / t✓ L"'ellT
2S t� 6� O�c�,c.� Gf1E�zecr4 �a+rx+� it t-if
717 C e .t Jt9 r< aA_ / t r ACr ,✓X 4 - r
tkiL"
Ft t f
v
as ,� t=o•+�
is
Pic
Discussion With Person in Charge: Corrective Action Required: ❑ No ❑ Yes
I have read this report, have had the opportunity o')'2k questions and agree to correct all ❑ Voluntary Compliance ❑ Employee Restriction/
violations before the next inspection, to obsery all onditions as described, and to Exclusion
p ❑ Re-inspection Scheduled ❑ Emergency Suspension
comply with all mandates of the Mass/Feder Fo d Code. I derstand that
noncompliance may result in daily fines of ent -five dollar suspe ion/revocation of ❑ Embargo ❑ Emergency Closure
your food permit. 0 ❑ Voluntary Disposal ❑ Other:
3-501.4(C) PHFs Received at Temporamres
Violations Related to Foodborne Illness Interventions and Risk According to,I vw Cooled to
Factors(items 1.22) (Cont.) 41°FI45°F Within 4'Hours.
PROTECTION FROM CHEMICALS
-T-To 1. Cool3nv Methods for FHFs
----- -- 19 PHF Hot and Cold Holding
3-202.12 Addniv
1q Food v cs°"Color Additives 3-501.16(B) Cold PHFs Maintained at or below
590.004{3) _ 41°/45° F'"
3-302.14 Protection from Unapproved Additives* 4-5(31.4(F) 41 PHFs Maintained at or above
15 Poisonous or Toxic Substances
140'F. *
7-101..11 identifying information-Original 3-50116(A) Roasts Held at or above 130'F.
Containers"
7-1.02.11 Common Name-Workin.-Containers* 20 Time as a Public Health Control
7-201.17 Separation aration-Storaee* 3-501.19 . Time as a Public Health Control*
7-202.11 Restriction-Presence and Use*
590.004(H) 4ariatnt2Re uirement
7-202.12 Conditions of Use"
7.203.11 Toxic Containers-Prohibitions` REQUIREMENTS FOR HIGHLY SUSCEPTIBLE
7-204.11 Samhzers,Criteria-Chemicals* POPULATIONS(HSP)
7-204.12 Chemicals for Washing Produce,Criteria" 21 3-&01.1 I(A) Unpisnurized Prc-packaged Juices and
7Da 'in A eats,Criteria*
Beverages with Warning labels"
-204.14
3-80 1.l 1(B) Use of Pasteurized Eggs*
7-205..1 Restricted
Food Contact. . Criteria*
3-807.11(D.} Raw or Partially Cooked Animal Food and
7-206.11 Restricted Lse Pesticides. Criteria
Raw Seed Sprouts Not Served.
7-206.72 Rodent Bait Stations* 3_90p,17(C) Uno enedPood Package NotRe-served
7-206.13 Tracking Powders,Pest Control and
Monitorin«
CONSUMER ADVISORY
TIMEITEMPERATURE CONTROLS 22 3-603.11 Consumer Advisory Posted for Consumption of
16 Proper Cooking Temperatures for
Animal Foods That are Raw,ilndercooked or
PHFs Not Otherwise Processed to Eliminate
3-401.1.1A(I)(2) Fags- t5SPi5See.
Patho-ons * 000
F ¢s-Immediate Service 145'Fl5sec* 3-302 11 Pasteurized Fggs Substitute for Raw Shell
3-401.11(A)(2) Comminuted Fish,Meats&Game
E as*
Animals- 155°F 15 sec. '#
3-401.1l(B)(1)(2) Pork and Beef Roast-130°F 121 min* SPECIAL REQUIREMENTS
3-401.11(A)(2) Ratites,injected Meats-I55'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
Poultry or Ratites-165'F 15 sec. * above if related to foodborne illness
3-401.11(C)(3) Whole-muscle,Intact Beef Steaks interventions and risk'factors. Other
145°F* 590.009 violations relating to good retail
3-401.12 Raw Animal Foods Cooked in a practices should be debited under#29-
Microwave 165'F Special Requirements.
3-401_71(Aulub) kllOther PHFs-- 145'F'15sec.
*
17 Reheating for Hot Holding VIOLATIONS RELATED TO GOOD RETAIL PRACTICES
3-403.11(A)& PHFs 165°17 Ih sec. * (items23-30)
3-403.11(B) Microwave-765°F 2 Minute Standing Critical and non-critical violations, which do not relate to the
Times' foodborne illness interventions and risk factors fisted above, can be
3-403.11(C) Conunercially Processed RTE Fwd- found in the following sections of the Food Code and 105 CMR
'l40°F: 590.000.
3101 11(E) Remaining Unsliced Portions M Beef item Good Retatt Practices FC 590.000
Roasts" 23. Kana anent and PersonnelFC-2 .003
1g Proper Cooling of PHFs 24. Food and Food Protection FC--3 .004
25. E�uipmeM and Utensils FC-4 .005
3-50114(A) Cooling Cooked PHFs from.140'3 to -----__-- -� - -- --
26. Water,Pliajj and Waste FC-5 .006__
7093 Within 2 Hours and From 70'F 27. Ph sical Facile FC-6 .007
to 41°F/4S11F Within 4 Hours. * 28. Poisonous or Toxic Materials FC-7 .008
3-501.14(B) Cooling PHFs Made From Ambient _29. S ecial Re ]airemants .000
Temperature Ingredients to 41'F/45`'F 3o. Other
____-----_`------
Within 4 Hours' ssvoro.un F:ax.o-,�
,'Denotes critic.]item in the fodend 1999 Fo(A Code or 105 CMR 590900.
.,'a'r`r--�....-e-ti ..-•---•..-r.w---.,..�.....-...,..-,.,.,,:.,..�.,..a-....`^""".-iyn.w...rnn.q+T.+w.-i+.-�nw..-wJ^^'"".'+"";d^-•+.+^.'--`-r^'-...^^.....-i.�...,,.wr�•-•-..h.v..=
THE COMMONWEALTH OF MASSACHUSETTS
CITY OF SALEM Address: 120 Washington Street, 4th Floor
BOARD OF HEALTH Salem, MA 01970-3523
FOOD ESTABLISHMENT INSPECTION REPORT Tel: (978) 741-1800 Fax: (978) 745-0343
Name Date Type of Operation(slf In i
F U&4' 2 /� ptf PIrood Service Routine
Address Risk ❑ Retail ❑ Re-inspection
S' _3 y Level ❑ Residential Kitchen Previous Inspection
Telephone ,7y/^ AA ❑ Mobile Date:
OwnerHACCP Y/N ElTemporary ElPre-operation
/S ,,TY4_11 ❑ Caterer ❑ Suspect Illness
Person in Charge(PIC) ,. y Time ❑ Bed&Breakfast ❑ General Complaint
In: ❑ HACCP
Inspectoyy.,� 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. revention of Contamination from Hands
El 1. PIC Assigned/Knowledgeable/Duties
13. Handwash Facilities
EMPLOYEE HEALTH
El2. 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
TIMEITEMPERATURE CONTROLS(Potentially HazardousFoods).
❑ 4. Food and Water from Approved Source
❑ 16. Cooking Temperatures
❑ 5. Receiving/Condition
❑ 17. Reheating
❑ 6. Tags/ Records/Accuracy of Ingredient Statements
❑ 18. Cooling
❑ 7. Conformance with Approved Procedures/ HACCP Plans
PROTECTION FROM CONTAMINATION El 19. Hot and Cold Holding
❑ 20. Time as a Public Health Control
5s.-,8 Separation/Segregation/ Protection
REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP)
❑ 9. Food Contact Surfaces Cleaning and Sanitizing
ElEl 10. Proper Adequate Handwashing 21. Food and Food Preparation for HSP
CONSUMER ADVISORY
❑ 11. Good Hygienic Practices ❑ 22. Posting of Consumer Advisories
Violations Related to Good Retail Practices (Blue Number of Violated Provisions Related
Items) Critical (C) violations marked must be corrected To Foodborne Illnesses Interventions
immediately or within 10 days as determined by the Board and Risk Factors (Red Items 1-22):
of Health. Non-critical (N) violations must be corrected Official Order for Correction: Based on an inspection
immediately or within 90 days as determined by the Board today, the items checked indicate violations of 105 CMR
of Health. 590.000/Federal Food Code.This report, when signed below
C N by a Board of Health member or its agent constitutes an
„� 3. 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
L/ 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:
/ ns,fetor's rgna fe: Print:
PIC's'Signature: Print: 'C /, J ( �'�� Page of 2-Pages
Y
L/ it V
FORM '/34A HOB BS&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 nment of Responsibility* Cooked and RTE Foods*
590.003(B) Demonstration of Knowledge* Contamination from Raw Ingredients
2-103.11 Person in Chare-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 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 Surfaces4* 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*
3-201.17 Game Animals* 11` Good Hygienic Practices
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 grit
Intey* 3-301.12 Preventing Contamination When Tasting*
3-101.11 Food Safe and Unadulterated* 12 I' 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
/HACCP Plans Supplied with Soap and Hand Drying
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.
If
CITY OF SALEM
BOARD OF HEALTH
Establishment Name: FC/ eL Date: Page: of Z
Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date
i No. Reference R—Red Item Verified
. PLEASE PRINT CLEARLY
N
✓ �Sr�� id K
�/AsZP4 /y�o (i/
Kee
I'� 2 S — l d .3 e < ,3—/S s .�/� // �lidSlj •, �Si ry s e " / Z e
Ile— Q$ o VG
�fF 2 l5dff es i -L. Se Cc letl Af�tZ--
i
Ae v�p la e 6V A p a
8 G — .ate -711&1 '1,710d 2WAKC - G 71 s L f �7t S
�vSioQ a X01 P� � N ti 74 G 6V110
:� z s - each-i•v ,et�zQ� /.s�s�sU vs�v31-e �'cca,�'a � P�'��itt¢ e
tic tii ✓Ps Gr eKs .y ' s : v 'e , �,eew ,&' e S P u
c'..e,P�i�"iC�R e �,e�T7` /7r1� �os� i.v ✓�e.s/�j e
�'a
s
SH /1-/ A,,,> CA
.,FP&� 6cfT v° _
T e, e�
Discussion.With Person in Charge: Corrective Action Required: ElNo ❑ Yes
µ,
t. 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 -bnditions as described, and to Exclusion
P , ❑ Re-inspection Scheduled Ll 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 3ension/revocation of ❑ Embargo ❑ Emergency Closure
_t
ermit.
your food p ❑ Voluntary Disposal ❑ Other:
3-301,14(C) PRFs Receivcd at Temperatures
Violations Related to Foodborne Illness Interventions and Risk According to Law Gor;led to
Factors(items 1-22) (Cont.) 4 I'FI45"F Vv shin 4 Hours.
PROTECTION FROM CHEMICALS 3-.�O].Vi CoofillK Methods for PHFs
-14 - Food or Color Additives boi: PHF Hot and Cold Holding
3-501,16(B) Cold PfIFs Maintained at or below
3-202,12 Additives" 590.004(17) 41`!45°F-
3-302,14 Protection lrourLhyauroveLVIdjukes*
- 3-501 A6(A) Hot PHFs Maintained at of above
LL5_ Poisonous or Toxic Substances 140'F.
7 101.11 ldennf�rinq Information-Original -
Containers- 3-501-16(X) --Roasts Held at or above 13WF
- [-20 Time as a Public Health Control
3-501.19 Time as a Public Health CoritroP'
7-102.11 Common Name-Workini, Containers*7-201 11 Separation-Star age"
7-202.11 Restriction-Presence and Use"` 590,004(H) Variance Recuira It
7-20112 1 Conditions of Use'
7-203.11 1 oxic Containers -Prohibitions"' REQUIREMENTS FOR HIGHLY SUSCEPTIBLE
7-204,11 Saniti7ers.Criteria-Chemicals* POPULATIONS(HSP)
7-204.11 Chemicals for Washin>Produce.Criteria*_ 21 3-801.11(A) Unpasteurized Pre-packaged forces and
7-204.14 Drying Agents.Criteria* I Beverages with Warning Labels'*7-205.11 Incidental Food Contact,Lutuicants* 3-801.1 I(B) Use of Pastern ized E--s*
7-206.11 Restricted Use Pesticides,Criteria" 3-801 11(D) Raw or Partially Cooked Arrairal Food and
R,,m Seed Sprouts Not Served.
/-206A2 Rodent Bait Stanons* -
7-206.13 Tracking,Powders, Pest Control and 3-801.11(C} I Jinolicned Food Package Not Re-served,
Monitornitz' CONSUMER ADVISORY
TIME[TEMPERATURE CONTROLS3-603.11 22 Consumer Advisory Posted for Consumption at
16 Proper Cooking Temperatures for Animal Foods That are Raw, Undercooked or
PHFs Not Otherwise Processed to Eliminate
3-401.IIA(1)(2) Eggs- 155°F 15 Sec. patjaOgerv,.*
Ea,�"s-Immediate Service 1450FISscc* 13 Pasternized E''s Substitute for Raw Shelf
3-401_i 1(A)(2) Comminuted Fish. Nfeals, &Game
Annuals- 155'F 15 see. '
3-401.11(B)(1)(2) Polk and Beef Roast- 130'F 121 narr, SPECIAL REQUIREMENTS
1-401.11(A)(2) Ratites,Injected Meats- 1.55°F 15
590.009(.A)-(1)) Violations of Section 590.009(A)-(D)in
sec * catering, mobile food, temporary and
3-401.11(A)(3) Poultry,Wild Claire,Stuffed PHFs, residential kitchen operations should be
Stuffing Cortmonn.-Fish,Meat, debited under the appropriate sections
Poultry or Raties-165'17 15 sec, above if related to foodborne illness
3-401-1 I(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 Annual Funds Cooked in a practices should he debited under #29 -
Microwave 165'F* Special Requirements.
3-40 1.11(A)(U(b) All Other PHFs 149'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(13) Microwave- 165'F 2 Minute Standing Critical and non-critical violations, which da not relate it)the
Fine* foodborne illness ilaeri,entiorcy antirisk(actors listed above, can be
3-4()3.11(C) Commercially Processed RTE Food- found in rhe follaning sections(f the Pond Code and 105 CMR
-
140°F* 590.000. -59-cho-0-07
3-403.1 I(E) Remaining Unsliced Portions of Beef Item Good Retail Practices FC
Roasts* X23. Management and Personnel FC--2 '00
Proper Cooling of PHFs 24. Food and Food Protection FC-3 004 1
M,_ Equipment and Utensils 4 '005
3-501.14(A) Conlon,Cooked PHPs front 140'F to �26. Viater, Plumunq and Waste FC-5 .006 i
70'F Within 2[tours and From 70'F __iT_Physicai Faoilit -FC-6-007
to 41'F145"1 Within 4 Hours. 28 i Poisonous or Toxic Materials
FC-7 .008
3-501.14(B) Cooling PHFs Made From Ambient 29. S ectal Requirements �009
Temperature Ingredients to 41'F/45°F 30. other
Within 4 Hours"
Dencre,criliclo item in tire fie&i a] 1999 Food Cafe or J Is CMR 590.000.
CITY OF SALEM, MASSACHUSETTS
BOARD OF HEALTH
• 120 WASHINGTON STREET, 4TH FLOOR
SALEM, MA 01970
TEL. 978-741-1800
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 : Chris Silva
Name of Establishment : Fuel
Address of Establishment : 196 Essex Street
Type of Establishment : FOOD SERVICE
Application Date : 02/25/2003
Restrictions:
Permit for Food Establishment 276-03
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
`' oxolr CITY OF SALEM, MASSACHUSETTS
BOARD OF HEALTH
3 '4. 120 WASHINGTON STREET, 4TH FLOOR
SALEM, MA 01970
TEL. 978-741-1800
�MCJe FAX 978-745-0343
STANLEY USOVICZ, JR. ,JOANNE SCOTT. MPH, RS, CHO
MAYOR HEALTH AGENT
2003 APPLICATION FOR
'PERMIT TO OPERATE A FOOD ESTABLISHMENT
T
NAME OF ESTABLISHMENT ✓�- I TEL# /79' 7-Y/ `e�>10SU
ADDRESS OF ESTABLISHMENT 112
MAILING ADDRESS (if different)
OWNER'S NAME (fitr5 IV TEL#'F7Ff- 7-JIy'oT&_;2�
X
ADDRESS A� )0 1rRf:!7l S �_-
CITY !c&,& STATE /"A ZIP 0/9 70
CERTIFIED FOOD MANAGER'S NAME(S) ZXri$ Silva CERTIFICATE#(s) /O_7�4/
(required in an establishment where potentialrd
potentially ha aou`s fo d is prepared.) �r
EMERGENCY RESPONSE PERSON Ort S ✓i4ry HOME TEL#
HOURS OF OPERATION: Mon.7-1 Tue.?-'I Wed. W R Thu. 7-'l Fri. 7"7 Sat. - 7 Sun. �-
TYPE OF ESTABLISHMENT FEE check only
RETAIL STORE YES NO less than 1000sq.ft. =$ 50
1000-10,000sq.ft. =$100
JJ more than 10,000sq.ft. =$250
RESTAURANT YES NO -O� less than 25 seats =$100
25-99 seats 50
more than 99 seats =$200
BED/BREAKFAST YES NO $100
ADDITIONAL PERMITS
MAKE ICE CREAM, YOGURT, SOFT SERVE YES NO $5
TOBACCO VENDOR YES NO $50
ALL NON-PROFIT(such as church kitchens) YES NO $25
Please pay total with one check
payable to the City of Salem
This Permit is not transferable and must be reissued upon change of ownership. The Permit must
be posted in a prominent location in the Establishment.
In accordance with the State Sanitary Code, before any renovations, improvements, or equipment
changes are made, all plans for such must be submitted to and approved by the Salem Board of
Health.
PLArsuant to MGLC.,hapter 62C, Section 49A, I certify under the pains and penalties of perjury that I, to my
IynowVedge elief, have filed II state tax returns and paid all state taxes required.under the law.
Signatur@ I
Date Social Security or Federal Iden fication Number
----------- — -- --- ------------ -- -- - --- —_- -- -- -- -
Revised 11/25/02 FOODAP2.adm Check#&Date 7�`��— a2 -I;z tl_3
;fl a,
4
a
CITY OF SALEM, MASSACHUSETTS
BOARD OF HEALTH
120 WASHINGTON STREET, 4TH FLOOR
SALEM, MA 01970
TEL. 978-741-1800
FAX 978-745-0343
STANLEY USOVICZ, JR. JOANNE SCOTT, MPH, RS, CHO
MAYOR HEALTH AGENT
2003 APPLICATION{F-OR PERMIT TO OPERATE A FOOD ESTABLISHMENT
f
NAME OF ESTABLISHMENT Qk\ \t _e 3 (0gaTEL# n
`179 -__7t4I -6,f50
ADDRESS OF ESTABLISHMENT I q(� ase 0 CT"
MAILING ADDRESSifdifferent) ONS
OWNER'S NAME N(L 7oy k e'er �: I VB TEL#9?9 -711q-6g3
ADDRESS IPrP �b46 ST
CITY " rh STATE P1 it ZIP 015-7
CERTIFIED FOOD MANAGER'S NAME(S) e' CERTIFICATE#(s) C51I 9�
(required in an establishment where potentially hazardous food is prepared.) Ct7
P-71114-61C
EMERGENCY RESPONSE PERSON `�KQ� '"' �9 �k OME TEL# 9*'yA-3'y7 "49
HOURS OF OPERATION. �� CS rh)
TYPE OF ESTABLISHMENT FEE check only
RETAIL STORE YES NO less than 1000sq.ft. =$ 5
1000-10,000sq.ft. 00
more than 10,000sq.ft. =$250
RESTAURANT NO less than 25 seats =$100
25-99 seats =$150
more than 99 seats =$200
BED/BREAKFAST YES NO $100
ADDITIONAL PERMITS
MAKE ICE CREAM, YOGURT, SOFT SERVE YES $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.
WE
Chapter 62C, Section 49A, I certify under the pains and penalties of perjury that I, to my
nd belief, have filed all state tax returns and paid all state taxes required under the law.
Signatu a Date Social Security or F deral Identification Number
- - ---- -- ---------------------------------
Revised 11/25/02 FOODAP2.adm Check#&Date
k Holly D. Zhang
American Account Manager
Red Cross 285 Columbus Avenue
Boston,Massachusetts 02116
of Massachusetts Bay (617) 375-0700 phone x 374
(617)375-0727 fax
ZhangH@usa.redcross.org
October 17, 2002
Ms. Joanne Scott
Town of Salem
Board of Health
Re: Restaurant/ Food Service Training and Certification
M.G.L. Chapter 94: Section 305D
Dear Joanne:
It was a pleasure to speak with you today about the Chokesaver with Restaurant Emergencies course. The
following is a brief summary of the skills that Restaurant and Food Establishment employees will learn in just
two hours:
1. Recognizing an Emergency
2. Emergency Action Steps; Check, Call, Care.
3. Protecting Yourself
• Good Samaritan Laws
• Obtaining consent
• Preventing disease transmission
• Demonstrate Glove Removal
4. Before Providing Care
5.Prioritizing Care
• Demonstrate conscious choking skills (Adult, Child& Infant)
• Have students practice abdominal thrusts.
• Demonstrate unconscious choking skills (Adult, Child&Infant)
6. Wounds
• Controlling severe bleeding
• Care for Burns
Course Materials: 2 Adult Choking Posters(One side English,the other in Spanish).Each participant receives
a`Til Help Arrives Booklet and a wallet card"Emergency action steps to save a life".
Course Cost: $240.00 flat fee for a maximum of 20 employees.It is$7.00 per person over the maximum.
Certificate: A"Chokesaver"certificate(wallet size)will be sent approximately 10 days after course completion
and it does not have an expiration date.
For the M.G.L Chapter 94: Section 305D go to http://www.state.ma.us/legis/laws/mgl/index.htin then
click on"Link to a specific Chapter or Section"then fill in the Chapter and or section number.
Please call me with any questions you may have or to schedule a class for a"best time"in January or February.
Thank you for your interest!
Best regards,
United*Way Visit us at www.bosionredcross.org
� s pl, '
wh
X f t
Un
X ( { 4 r
r First Ald
Training
P O Box 3x02 ,
- Salem,MA 0 .
978-744=4799
www.whensecondscounttnet
ATTENTION
Did you knowthat'the State of Massachusetts.Code for Food Establishments, Chapter X,105
CMR 590.004(E),states..."each food establishment having a seating•capacity of 25 persons or:.:
more shall:
(1) Have on its premises :while food isbeing-served, an employee framed m.inaiwal
procedures approved by:the Department ofPublic Health to remove food_lodged in a
person's throat;and
(2) Makeadequate-provision for insurance to cover erriployees trained m rendering such
assistance."
Are' you prepared to comply with the code?
When Seconds Count •a CPR&First Aid Trainmg Company is working with the City of Sale{tit
Board of Health to provide you and your employees with the trammg neces isary tp fulfill the
requirements of the state code We have developed a course specificallylfor'restaurant employees i
that wit l train them to effectively be,able to perform the'Ilemilicti Maneuver and otter necessary
procedures to`remove food lodged in'a person's throat
We are gfferrii
ag this class on Monday,December 2,20Q2 from 6 OD p m ui hl 7 3D p m,
.W
edncsday,December,4,2002 from:9 00 a iii.una1100 a m,'Monday,Dumber 9, 2002
&am 6 00 p m,until 7 30 p:m and Wednesday,Deceiiiber 11,2002 fmm 2 00 p m nntrf
3 30 p.m All,classes will be held af,the Enterprisd`Center at Salem State College,I21 Lorwg
Avenue;Salem_Pre re stration is re uired ass ace is limited
q p ;
If-you are unable to attend,one ofthese courseuffenngs,Please`comact'If'h'en Sermyds t^oumtt�
schedule a course'at your locatio&or'ours We also catty a wide.variety`of First Aid.$WO ies an +
bamer.deuices tp`aid in the:successful,sanitary an"d-994 food rertioval
t
For more information,please ca11978-744-47"-Wask;how you,can receive
' `_Face Shield Key;Cham r �'
f " �
Smee Y
970
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YJhen Seconds Count ti 3
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p - � l'{ > '._,r� �"5.. ?c:� t%K.N47! s -.,k s�' `r : r a-e x $��.3i� e ,✓`�iiH` �k"y2s,;� ;j�s� 'sa y° � M�tf' R. gr r'r i �H fi�'�. :
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CONDIT • "
` CITY OF SALEM, MASSACHUSETTS
�+ o 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:
LOCATION:
TELE. # 1
TYPE OF LICENSE ��a^r�m v C 1—
� F�
APPLICANTS INFORMATION
Name:
Home address: ! ��
City: Ir i State: 1M Zip: C>Irl'it�'
Home tele. #
HEALTH AGENT/INSPECTOR'S COMMENTS:
pie. R'-">4Wjej p/,
Hi;0th Agent
notification forth
THE COMMONWEALTH OF MASSACHUSETTS
CITY OF SALEM
BOARD OF HEALTH Address: 120 Washington Street, 4th Floor
Salem, MA 01970-3523
FOOD ESTABLISHMENT INSPECTION REPORT , Tel: (978) 741-1800 Fax: (978) 745-0343
NameDate T f r i n T In i n
w� �' Food Service Routine
Address is El Retail ❑ Re-inspection
r Level ❑ Residential Kitchen Previous Inspection
Telephone 92
i//, ,�(j
Y C..TT El Mobile Date:
Owner ` \ HACCP YIN ❑ Temporary ❑ Pre-operation
❑ Caterer ❑ Suspect Illness
Person in Charge(PIC) t Time ❑ Bed 8 Breakfast ❑ General Complaint
In: ❑ HACCP
Inspector Out: 1j�. Permit No. ❑ Other
Each violation checked requires an explanation on the narrative page(s) and a citation of specific provision(s)
violated. J 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 [1 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
El 17. Reheating
ED6. Tags/Records/Accuracy of Ingredient Statements
El7. Conformance with Approved Procedures/ HACCP Plans ❑ 18. Cooling
El 19. Hot and Cold Holding
PROTECTION FROM CONTAMINATION
❑ 20. Time as a Public Health Control
8. Separation/Segregation/Protection
l� 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 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 Signatu e: Print:V
/ 1
PIC's Signature: Print: Page/_Bdf_�Pages
/ V,
FORM 734A HOB 5 WAR EN -BOSTOI�H
Violations Related to Foodborne Illness
Interventions and Risk Factors (Red Items 1-22) PROTECTION FROM CONTAMINATION
S Cross-contamination
FOOD PROTECTION MANAGEMENT 3-302.11(A)(1) Raw Animal Foods Separated from
L 590.003(A) Ass, nment of Responsibility* Cooked and RTE Foods*
590.003(B) Demonstration of Knowledge* Contamination from Raw Ingredients
2-103.11 Person in Charge-Duties 3-302.11(A)(2) Raw Animal Foods Separated from Each
Other*
EMPLOYEE HEALTH Contamination from the Environment
2"a 590.003(C) Responsibility of the Person in Charge to 3-302.11(A) Food Protection*
require reporting by Food Employees and
Applicants* 3-302.15 Washing Fruits and Vegetables
-F: 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
44 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* Concentration and Hardness* P
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 2-301.11 Clean Condition-Hands and Arms*
Regulatory Authority
2-301.12 Cleaning Procedure*
3.202.18 Shellstock Identification Present* 2-301.14 When to Wash*
590.004(C) Wild Mushrooms* 11 Good Hygienic Practices
3-201.17 Game Animals* 2-401.11 Eating,Drinking or Using Tobacco*
5 Receiving/Condition 2-401.12 Discharges From the Eyes,Nose and
3-202.11 PHFs Received at Proper Temperatures* Mouth*
3-202.15 Package Integrity* 3-301.12 Preventing Contamination When Tasting*
3-101.11 Food Safe and Unadulterated* L12 Prevention of Contamination from Hands
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*
i
•Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000.
CITY OF SALEM
� p BOARD OF HEALTH
Establishment Name: '�--cDate: Page: z of Z"
Item Code c-critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date
No. Reference R-Red Item Verified
PLEASE PRINT CLEARLY
�4
_i
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 ❑ Employee Restriction/
violations before the next inspection, to observe all conditions as described, and to Exclusion
p ❑ Re-inspection Scheduled ❑ Emergency Suspension
- comply with all mandates of the Mass/Federal Food Code. I understand that
noncompliance may result in daily fines of twenty-five dollars or suspension/revocation of ❑ Embargo ❑ Emergency Closure
your food permit. ❑ Voluntary`Disposal ❑ Other:
A
3-501,14(C) PHFs Received at Temperatures
Violations Related to Foodborne Illness Interventions and Risk According,to L. tw Cooled to
Factors(items 1-22) (Cont.) 41'F!45°1`Within 4 Horns,
PROTECTION FROM CHEMICALS 3-561.15 Cooling Nflcthods for PIIFs
14 Food or Color Additives 19 -- PHF Hot and Cold Holding
3-501,16(Bi Cold PHFs Maintained it or below
3-20112 Additivas* 590.004(F) 41'i45"F*
3-302.14 Protection ftorn:fJnappmved Additives* {7501.160) Hot PHFs Mainuined at(it aboNe
Poisonous or Toxic Substances
14WR
11-10t'j I Identifying Inforinalion--Original
-1-501.16(A) Roasts Held at or above 1307-w—
Containers"
7-102.11 Counnon Name - Workiru, Containers* 2=0Time as a Public Health Control
7-201,11 Separation-Storage- 3-50119 Time ze;a Public Health Control"
7-202.11 Restriction-Presence and Use* 540.004(1) Variance Requirement
7-202.12 Conditions of I I Ts,*
7-20; 11 '1 oxic Containers-Prohibitions* REQUIREMENTS FOR HIGHLY SUSCEPTIBLE
7-204.11 Sarindiets.Criteria-Chemicals* POPULATIONS(HSP)
7-204.12 Chemicals for Washing Produce,Criraria"- 21 3-801.1.FA) Unpasteurized Pre-packaged Juices and
Beveracer with)Varnim,Label,*
7-204.14_ Dy ing Agents.�Critcrj,0
7-20� 11 Incidental Food Contact,Lubricants* 3-8(11.11(8) Use of PasteuriEd
7-206A1 Restricted Use Pesticides.Criteria*' 3-80L l 1(D) Raw ka Rulially Cooked Amaral Food and
Raw Sc'rd S gouts Not'Served.
7.306.1.2 Rodent Barr Statioro'! 3-801,1 I(C)
Uno xned Food Packa=e Not Re-served.
7-206,13 Tracking Powders,Past Control and
— I
Monitoring` CONSUMER ADVISORY
TIMEITEMPERATURE CONTROLS 22 3-60111 Consumer Advkotv Posted for Consumption of
16 Proper Cooking Temperatures for Annool Foods That are Raw.Undercooked or
PHFs Not OlhenNise Processed to El i annane
Patfiowns,A
1-401.11 A(0(2) Eggs- 155'F 15 Sec
t-Immediate Service 1450f15secl 3-3021,113, 1 Pastetnized Eggs Substitute for Raw Shell
401.11(A)(2) Comminuted Fish.Meats&Game
Aturnals- I 55'F 15 sec. *
3-401.11(8)(1)(2) Peak and Beef Roast- 130'F 121 min:1 SPECIAL REQUIREMENTS
3-401.11(A)(2) Ralitct,, Injected I'vicars- 155'F I5 Violations ol Sect-ion 590.009(A)-([))in
sec, catering, mobile foods temporary and
3-401.11(A)(3)
Poultrv'Wild Game, Sniffed 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 foradborne illness
3-401,1 l(C)(3) Whole-muscle. Intact Beef Steaks interventions and risk factors. Other
145°F I -- 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 see.
F71-7 - Reheating for Hot Holding -VI—OLAfl-ONS RELATED-To GOOD RE-ml PRAc
3-403.11(A)&(D) PHFs 165'F 15 sec. 1: (Items 23-30)
3-403,11(B) Microwave-165' P 2 Minute Standing; Critical and non critical violations, which do not relate to tire
Tirne* foodborne dhiess inten,endons and risk factors listed above, cart be
3-403.1.1(C) Commercially Processed RTE Food- found in the following sections of the Food Code and 105 011?
140+` 590.0(k).
3-403.11(E) Rentainine Unsliced Portions of Beef --Item Good Retail Practices FC 590.000
Roasts* 2-3_,_ Manaa(Lrnent and Personnel FC-2 .003
Proper Cooling of PHFs 24. Food and Food Protection 1 FC-3 .004
25, E Ui meat
and Utensils FC-4 005
3-501.14(A) Conlin,Cooked PI Ms from 140'F to 26. Water, Plurnbin�- FC-5 --.005
0-0.6.
70'F Within 2 Hours and From 70'F sinal�Faci�tl -6 .007 1
Ph scal Facifit
to 41'F/4501-Within 4 Hours. 28, r 1 Poisonous or Toxic Materials FO-7
9,
- --
Cooling PHFs Made From Ambient I Special Requirements_ 009
i Temperature Ingredients to 41°F145'F 30. { Other -
Within 4 Hours'*
Denote,crilroat itorn in the tc&ril 1999 1,w)d Code or 105 CMR 590,000.
i
fy Ski
i
1 a'� vtv J Esi'r'Y'C/ E/
IMPORTANT MES GE
DATIME P.M.
M , a S
OF 3i 7=ZTI
PHON
A o BER sla
D FAX
D MOBILE
AREA CODE NUMBER TIME TO CALL
TELEPHONED PLEASE CALL
CAME TO SEE YOU WILL CALL AGAIN
WANTS TO SEE YOU RUSH
RETURNED YOUR CALL WILL FAX TO YOU
MESSAGE
SIGNED '
0 FORM Yc
09 �/—
MADE IN U.S.A.
i
CITY OF SALEM
BOARD OF HEALTH
Establishment Name: �io/ ;7:ii4 (Z p _6 Date: ,g At/ 1A 3 Page: of
Item `. Code C—Criticalltem $ g DESCRIPTION OF VIOLATION / PLAN OF CORRECTION Date
No. Reference z R—Red Item_ - " e "' Verified °c
PLEASE PRINT CLEARLY
i
t;
r
i
x
z�
1
d Discussion With Person in Charge: Corrective Action Required: ❑ No', I UYes
, C
j 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
L) 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
r
t ❑ Voluntary Disposal ❑ Other
i
� FORM 7348 HOBBB 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
1L Food or Color Additives 19 PHF Hot and Cold Holding
3-202.12 Additives* 3-501.16(8) Cold PHFs Maintained at or below
3-202.14 Protection from Unapproved Additives* 590.004(F) 41*F/45°F*
Fs15 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* 1.20Time 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'r 3-801.11(A) Unpasteurized Pre-packaged Juices and
7-204.12 Chemicals for WashingProduce,Criteria* Beverages with Warning Labels*
7-204.14 Drying Agents,Criteria*
7-205.11 Incidental Food Contact,Lubricants* 3-801.11(B) Use of Pasteurized Eggs*
7-206.11 Restricted Use Pesticides,Criteria* 3-801.1 l(D) Raw or Partially Cooked Animal Food and
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
16Proper Cooking Temperatures for not Otherwise Processed to Eliminate
PHFs Pathogens.* Effective 1/1/2001
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
3-401.1l(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*
3-401.1l(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
3-403.11(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 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. Other
Within 4 Hours*
*Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000.
CITY OF SALEM
J BOARD OF HEALTH
Establishment Name: `-fixe .A9.04 (� L Date: 1-17- d 3 Page: 02 of .2,
Item Code C Critical Item DESCRIPTION, OF VIOLATION / PLAN OF CORRECTION Date
No. Reference R'—Red ItemVerified'
PLEA5E.PRINT CLEARLY -
i
YQ
t
!21 / / ✓
"SO -1444 A 14111 5 Ge '1
s h0 Cv/
Az CO,uTA-d 7-
A
A / "P /> h. fid
} A
Ili•'•
n
w U
r
e
Discussion With Person in Charge: Corrective Action Required: ❑ No ❑Yes
E
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
❑ Re-inspection Scheduled ❑ Emergency Suspension
with all mandates of the Mass/Federal Food Code. I understand that noncompliance may
y result in daily fines of twenty-five dollars or Lnsivocation of your food permit. 1:1Embargo ❑ Emergency Closure
v _ ❑ Voluntary Disposal ❑ Other
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
14'; Food or Color Additives 19 PHF Hot and Cold Holding
3-202.12 Additives* 3-501.16(8) Cold PHFs Maintained at or below
3-202.14 Protection from Unapproved Additives* 590.004(F) 41°F/45°F*
X15. 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* r;2l 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* 3-801.1l(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
16"' Proper Cooking Temperatures for not Otherwise Processed to Eliminate
PHFs Pathogens.* Effective 1/1/2001
3-401.1lA(1)(2) Eggs- 155°F 15 Sec. 3-302.13 1 Pasteurized Eggs Substitute for Raw Shell Eggs*
Eggs-Immediate Service 145°F 15 Sec.*
3-401.1l(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(6)(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
3-403.11(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. 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.
r;
CITY OF SALEM
p BOARD OF HEALTH
t
k
Establishment Name: T�2 I� �P/�� Date: /— 1-7- 03 Page: of I
i DESCRIPTION OF VIOLATION / PLAN OF CORRECTION 0' Z s Date
"Item Code C-Critical Item ` -
Reference R.-Red Item, - a '" � bfEASE PRirrr 8LEnnw \ * a a• Verified
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Discussion With Person in Charge: r 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 comply
1 ❑ 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
f
FORM 7348 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
14:1 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*
Poisonous or Toxic Substances 3-501.16(A) Hot PHFs Maintained at or above
7-101.11 Identifying Information-Original 140°E*
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* v21 3-801.11(A) Unpasteurized Pre-packaged Juices and
7-204.12 Chemicals for Washine 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
r7-206.13
206.11 Restricted Use Pesticides,Criteria* Raw Seed Sprouts Not Served.*
206.12 Rodent Bait Stations* 3-801.11(C) Unopened Food Package Not Re-served.*
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
16 Proper Cooking Temperatures for not Otherwise Processed to Eliminate
PHFs Pathogens.* Ebecti a 11'12111
3-401.11A(1)(2) Eggs- 155°F 15 Sec. 3-302.13 1 Pasteurized Eggs Substitute for Raw Shell Eggs*
Eggs-Immediate Service 145°F 15 Sec.*
3-401.1l(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(6)(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
3-403.11(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
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. Other
Within 4 Hours*
*Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000.
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