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Commonwealth of Massachusetts Form 4--System Pumping Record
Massachusetts
System Pumping Record
System Owner System Location
Spencer Contracting Spencer Contracting
P.O. Box 875 h Lillian Rd
Salem, MA, 01970 Salem, MA, 01970
(978)-741-8000 x (978)-741 -8000 x
Peter Holland
Type: Emergent Routine
Cesspool: No Yes Septic Tank: No Yes
Date of Pumping::-to Quantity Pumped: 1000 Gallons
System Pumped By: Wind River Environmental,LLC Permit#:
Contents Transferred to:
Ipswich Water
Contents Disposed at: Treatment Plant
Ipswich, MA 01938
Date: d/O � Pumper Signature: jo
Condition of System/Other Comments
i
RECEIVED
CITY OF 241 V=P 4
BOARD OF HEALTH
Dep Approved Form-12/07/95
f
CITY OF SALEM
I ) BOARD OF HEALTH
p
Establishment Name: l O L, Ili i 0� �(1/P A Date: Page: of
Item Code C-Critical Item DESCRIPTION OF VIOLATION/ PLAN OF CORRECTION.„. , „ N, Date
Nom Reference R`Red Item xF� �` . 'r '� '�- y Verified
rEt !^
ids RtS.a�r.23�..Y rs'2" ' ?��. ;t•. PLEASE PRINT CLEARLY"�`-' a -^• ,," e '- �''�, '..,%r
�� ill lvlU� �msi /r�sr� .Mori o� Q
Scasi�
/J-)(7,s C-7 e--
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Discussion With Person in Charge: Corrective Action Required: a No ❑ Yes
I have read this report, have had the opportunity to ask questions and agree to correct all ❑ Voluntary Compliance ❑ Employee Restriction/
violations before the next inspection, to observe all conditions as described, and to Exclusion
{ P ❑ Re-inspection Scheduled O 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 0 Other:
F,-5( i J PFIF�Received at Temperatures
Violations Related to Foodborne illness interventions and Risk AccoTdilig 10 Law Copied to
Factors(Itoms,1-22) (Cont) I IF/45"T WithmI Hours,
'15 Coto wMethods tor PRFs
PROTECTION FROM CHEMICALS
19 PHF Hat and Cold Holding
14 Food or Color Additives
3 202,_ Additive,* 1 501.16(B) Cold PHFs Meiroaned at or b-low
590(X)4(F) 41 /45`F'
3-30114 Protection fromj.J.naL)L)romd Addifiv�s".__ -7y —1("—A) Maimahwd at or above
P .
olsonctuat or Toxic Substances i 40'F.
iO'fI I klentifying Information- Original
�o`o`Rwrts Held at or ibove 130'F,
N I
cmlaamer�' Time as a Public Health Control
la,
102 1 C 'r";
""HI CumnionName-Workin 1-501 19 Timr as a Public I lealth Control`
a, an
Luce and Use* L� A-)
1-20111 Restriction-Pres,
L�L-21Q2 12 _Conditions of Uw' REQUIREMENTS FOR HIGHLY SUSCEPTIBLE
7-203.11 Toxic Or)taineu,-Prohibitions' POPULATIONILS(HSPS
_
^04.11 —Samt—iZers,_CriteH8-che--nicals,
7-20412 Chtlliicafl for Wash S�c AIL
a*
rt
7-204,14 Ur�je Aventr. P: —
3.801.11(13) Uof-PaqcurIze
Incidratat Food Contact,lAiNicajiW
I R )-bOLI[(D) Raw or Parvativ Clikiked Animal Focal arid
-4�� — Rau 5e cid . o t Servcd. *
2R,A
or'IliE:1:i__rT1
Il06 13 Jr4c ngPmoJer,ol_i,m Controlan_d
_ I I J((,) I- Foul Packagc NoRc-sensed.
_� , (
,virmlto
-1
CONSUMER ADVISORY
22 3 TIMEITEMPERATURE CONTROLS I it for Consarnittion of
Proper Cooking Temperatures for AnimA f,lods Matare Raw, Undercookcd is
PHFs Not Otheru ise Png!ossed In Elimindue
3-401 IIA(l)(21 Egg.�- 1,51,F 15 Sec. Patfiov'cm_ Fps In3mcdt to her ice .
F�15 3'102.0 m
fl; eurrred Fgi.: Substitute fol RAW Shelf
40IJI(02) Cormoinuted Fi<h,Meats&Game
SPECIAL REQUIREMENTS
<E01.1 t(13) (2Pork and Beef Roast - 130"F 121 nun*
')
5-401.11{A}{2) cxmm IcI4 section 0.009IA)-(D)in
Rail lulecrod Meats- 155�F 15 1
scc. I cawrin P. rnobile "id, temporary and
3.40 1.11(A)(-3) Poultry,Wild Game Stuffed PHFs, E reside tit kitchen o1 `rations should he
Siliftig Containing Fish, Steal, debit ander the appropriate sections
floulov or Riltnes-I 65"T lfisec. above if rclawd to fbodtlorne jflncss
�3 401 1 It C)�3) Whole muscle,Intact Recf Steaks Interventions and risk factors, Other
NTT 590.009 violations retailing to goorl retail
40112 1 taw Animal Flads Ctloict(l in practiccs should be debited under#29 -
Nliclowavc eclat Requirclnentr.
(I') A ()tker PHf7'S-- 145'17 15 sm,
]I S7—
L!7 Reheating for Hot Holding VIOLATIONS RELATED TO GOOD RETAIL PRACTICES
457311 (DI'IfFs 165"F 15 sec. ;^ {Items 23-30)
3-403.17(Bj _Microwavc-165°F 2 Minute Standirv,
Cri6 al alld nun-rrvical vioallwnst 1s1?ich do nal reiate to the
lime" fiwelhortre illness onetverviorwand risk jfactors liqed above, cam be
(c) 1 Commercially Porxcsscd RTF.Kx)d- filund or the-filIb*.rP;,000;w?x of the,Food Code rued 105('Xll?
140'F 90.00a
Remaining'Uirskeed Portions of limf jtom Good
al;5;Wcf;Ws 1
FC 590,000
-
ltoast.,� 23. a eTcrit ani Per a
T4, i Food and Food Protection FG 3 1 004
Ig Proper CoolingbfPKF5
FC 4 i 005
''I-501.14(A) Coillintz Cookd PHF's forni 140"F to
26 yVattrJjlurntangand Waste FG-5 006
70'F Within n 2 1 fours and From 70'F T 1 fl!�ys;,al Fact�L FC-6'_80_ Dtierai R_._u iremenM rtanais - 007
to4J`F/45'F1A"itbin4 Hows,
01 4(B) Cooling PHFx Made From Ambient
Terriperatore Ingredients to 41'1,'/45'F F
Within 4 Hours
Dcnotes m1=1 item in lht lottemfl 1994 Food("We or 105(Mit 591)00k