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GOURMET FARE - ESTABLISHMENTS Fsov/»Kt rw " Leff r�•t.,se.R.c, oat a•.sl.+eri� /H4Clf-.ru, of �ox M��>..,t i 3 4 ' O 5 W n m c = m � mm e - v r i e y ! # 1 r. 1 AMW »;�:_ s^www,,. _• r,'�x'".i. 4. .,�u.� ..cy �� ._ VFW 1 1 CITY OF SALEM BOARD OF,HEALTH �. SALEM, MA SAOCHUSETTS 01970-3523R 9 5 70- 5238 1d S05.210 �• 0004380921 OCT26 2007 1 7005 311 ❑�n.a 716❑ ,µ` MAILED FROM ZIPCODE 01970 LU ,V E. � ` Joann ch z "� �� Moonpe Drive Bo ord, MAO 21 - r 019703S230-1 U�CL41MECU u»c i ■ Complete items 1,2,and 3.Also complete A. Signature - item 4 if Restricted Delivery is desired. 0 Agent X ■ Print your name and address on the reverse 0 Addressee so that we Can return the card to you. B. Received by(Printed Name) C. Date of Delivery.. Attach this card to the back of the mailpiece, i 1 or on the front if space permits. 1 D. Is delivery address different from ttern tT ❑Yes I I. Article Addressed to: It YES,enter delivery address below: 0 No a fine I I yah �o��onn "Dr . 3. Service Type - I 1 X dr ..✓��Vll � �'� CI Certified Man 0 Express Mali VOv'LKG� rlly l O Registered ❑Return Receipt for Merchandise i 0 Insured Mail 0 C.O.D. 4. Restricted Delivery?(Extra Fee) 0 Yes 12. Article Number (ransrer/om service 7abeJ 7005 3110 0000 7160 4740 Ps Form 3811,February 2004 Domestic Return Recelpt 1025e5�02-M-15401 i CITY OF SALEM9 MASSACHUSETTS HEALTH AGENT n 120 WASHINGTON STREET, 4TH FLOOR SALEM, MA 01970 TEL. 978-741-1800 FAX 978-745-0343 KIMBERLEY DRISCOLL JSCOTT@SALEM.COM MAYOR JOANNE SCOTT HEALTH AGENT Joann Hatch 42 Moonpenny Drive Boxford, MA 01921 RE: Gourmet Fare Dear Ms. Hatch, The Salem Board of Health suspended the food service permit for your business, Gourmet Fare, 73-75 Wharf Street, in Salem, MA on October 9, 2007 for repeat critical violations. This office has received reports that you are currently entering this establishment late at night to bake and prepare food items to be sold at your other business the Rose Medallion. As your food permit is currently suspended you are not allowed to cook, bake or otherwise prepare•any,food items at the Gourmet Fare. Preparing food at the Gourmet Fare will place the food permit for the Rose Medallion in jeopardy and you will risk permanent revocation of the food permit for Gourmet Fare. Should you have any questions or concerns you can contact the Board of Health office at 978-741-1800. Sincerely, Reply to: oanne Scot David Greenbaum Health Agent Sanitarian Cc: Anne Lee;Rose Medallion Regular Mail CERTIFIED MAIL 70053110 0000,7160,.4740, - CITY OF SALEM BOARD OF HEALTH �. 120 WASHINGTON STREET, 4TH FLOOR SALEM, MASSACHUSETTS 01970-3523 _ I 7005 3110 0000 7160 4641 �' a RECEIVE® DEC 3- 2007 CITY OF SALEU BOARD OF HEALTH Joanne Hatch 1y 02 1A $ 05.210 42 Moonpenny Drive 0004380921 NOV 09 2007 Boxford, MA 01921 �+ MAILED FROM ZIPGODE 01970 2 NIXIE- 019 4E 1 39 51/29/07 RETURN TO: SENDER UNCLAIMED q I`` UNABLE TO FORWARD _ I 90: 01970382399 *1969-00978-09-3e i I ■ Complete items 1,2,and 3.Also complete A. Signature 1 item 4 if Restricted Delivery is desired. X 0 Agent 1 ■ Print your name and address on the reverse 0 Addressee I - so that we can return the card to you. I B. Received by(Printed Name) C. Date of Delivery I ■ Attach this card to the back of the mailpiece, I or on the front if space permits. ; D. Is delivery address different from Rem 17 ❑Yes 1. Article Addressed to: If YES,enter delivery address below: ❑ No ' Joanne Hatch 1 1 42 Moonpenny Drive 1 - Boxford, MA 01921 I 3. Service Type jaGertifled Mail 13 Express Mall 1 E3 Registered 0 Return Receipt for Merchandise 0 Insured Mail 0 C.O.D. i (73 Pickering rf) mp 14. Restricted Delivery?(Edra Feel 0Yes 1 2. Article Number 7005 3110 0000 7160 4641 I (Transfer from service Ishan ;�_Ps Form 3811,February 2004 _ Domestic Return Receipt 102595-02=M-1540 —I I CITY OF SALEM, MASSACHUSETTS 3 HEALTH AGENT 120 WASHINGTON STREET, 4TH FLOOR SALEM, MA 01970 TEL. 978-741-1800 FAX 978-745-0343 KIMBERLEY DRISCOLL JSCOTT@SALEM.COM MAYOR JOANNE SCOTT HEALTH AGENT November 9, 2007 Joanne Hatch 42 Moonpenny Drive Boxford, MA 01921 Dear Ms Hatch: The Salem Board of Health requests your presence at the next Board of Health meeting to discuss possible revocation of your permit for Gourmet Fare, located at 73 Pickering Wharf, Salem, MA. The meeting Wll be held Tuesday, November 13, 2007 at City Hall Annex, 120 Washington Street 3rd floor conference room @ 8:00 p.m. If you have any questions, contact me at 978-741-1800. Sincerely, a For the Board of Health )oanne Scott,4Healthi`Agent JS/mfp cc: Christina Harrington, Chairperson of the Board of Health and Members CERTIFIED MAIL 7005 3110 0000 7160 4641 & REGULAR t Ll it ` - r f r J 41 F I y +tP t CITY OF SALEM BOARD OF HEALTH Establishment Name: Date: Page: of ,Hem, Code C—Critical Item >, - 'DESCRIPTION OF VIOLATION/PLAN OF CORRECTION' - > Date No.:.. .Reference% R—Red Item .- .. ;, "y s - _ .. Verified ,. .-.,- - ,,. ,r.., 6. ' PLEASE PRINT CLEARLY� '` '' � � ., 1 - 1 I � I I 1 1 1 I Discussion With Person in Charge: Corrective Action Required: ❑ - 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 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: 501.1-(0 PHFs Kea•tvedat'femperatures Violations Rotated to Foodborne Illness Interventions and Risk Accerding to Law Culled a+ Factors(item 1.22) (Cont.) _ I 31'F/-15°F Within i Riau s, � fur PHP Coiling PROTECTION FROM CHEMICALS - - , 3501 l4 g 4lethod: , { 1 19 1 PHF Hot and Cold Holding { { 14 Food or Color Additives 3-SOf.1hrB} C'oldPHFsMarntainedat;rtt'a1ua, ?-2(}2.12 ! Addutvcs'r { 590(9MO i 41`1.45'F- 3-302,14 Prutccii�in from I Tiappro,ed Addih4e1„ { 3-501 INA) hot llflfs Iainlained at or above Poisonous or Toxic Substances { ( 1401'. x 1-101.4 i khmfif Y ging lnkamat;on -Om,inai { ! { ?-St`r1. Ruaets Held at or shove. I{0°h Coataiuen' 1 20 { Time as a Public Health Control j { 7-10211 C:ornmmn Nanta Workin„Cvwmnku.,* { - 7-201.1 l Separation -Smrap� ': { ( 3 501i9 Time as a Public:Health tonU=ol` SnU.n04r H1 7-202.1': Rcrtriction-Prescnc. and U: e { T'ariastct:ReUuircnict¢ _-� { 7-202.42 G,ndrtlkmn of Use" E { 7 03 11 I'mi,t:csnuuuers-i4onthi(,on,i { REQUIREMENTS FOR HIGHLY SUSCEPTIBLE { 7<04.t A Sanitizerti,Criurn., -C"tzmic:dc' { POPULATIONS(HSP) { 7-20-'4.12 Chemical"for Vr".tsh uie Vro fitcc.Ct itol ia'' sl ;.Sg1.11(APre-packaged) linpaitem'tzed Pre-paaged Juices and { 7-20-4.1.3 Gryine Acems.Cnwr"sa' � _ ( Revels?es with Warning Labels.;: { { i 5-RUI.)1113) 2';.of Pastemized Enjas0 {7-20511 Incidental l-ocid Ci'rzta,�?.luilrl^_sn;s` { 7-206.11 Re,tnc!ei t_:r Pe,tzcoir< C,:te,1.t'. { ''-SU'i,l itl_t) Raw or Pattntily G+zkr•d Animal Pexnl and { { Raw Sred Sprrmts Not Sclsed. 7-206.12 RtxEc•nt 4taii \,„ ton tt- E . { 13X01.1(0 { t1u0P:nedF6.x4PaLfaeVtiutPe-.Wrncd. * { 7 206 I? i'+,.king Poiidv,:' P"I't Ciaw(l and "._.- Monitoring: CONSUMER ADVISORY TiMEIPEMPERATURE CONTROLS 22 3 ti0: 11 Consumer Achisory Posted for C mi"muption of r'vmnmll F'gi& Mat arc Raw-, t?ndetuxtke,i,n 16 Proper Cooking Temperatures for PHFs Not Other i4 ise F'nx•esse.d to klimmatc 3--tO1.I1A(i1121 Egp- 15.`, F155:.. t 15"F15�ee, E i-302.13 PiNtcurved Fgk,Siihantuiv for RLtw Sh M ` x.,4nl.itt:1n 21 C'crcntuinwedFi: '&;Its . ciam, ,4nimaii- t `tt: ' t i"_l min { SPECIAL REQUIREMENTS { 3-401.11(f3)ti}:_ir Ptek.+nd i3,•o'::'?ta�st ' �.4:zi.I41Alt2i R:titc-. I1nr.tcci �4:.,is- 155F1`• 590(H9(A)-t F7} Vic,luittrn,ofSection `19()-t WA}-(D) in s x i:aicnng, mobih,turd, temporal y and 3-401.11fA}r3} Poaltr},t;'ild G;mic. Stuifed PRFs:, ( TC,iI&Rl:ai fitchen operations should he Ct+ztl'nze C ont:,naa);Ficb, pleat, fl{ dehued tutder the appropriate .ecitusts Po+tliry or Rabies lh5'F LIS%cc. ` alarve if rclatw to lbodhvrnc ithioss 3-401.I I1Cy3; `vhole-mar•lc, zllwi: Re.t Sl;ans interventions and risk fuctors Othor 5140.009 violattcnta retatini to wod mttu! 3-401.12 kary rinial CC.*,ked w it prattieec .,honld tv debited wider h'29 .- 1 Miciowa•:c lb"F-* Special Requirenwilts, i 3.401ll(At(!)(b) All OtherP11F= ty='1 0 sec '" j { i7 Reheating for Hot Holding { VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 3-103.11sA)&Ito PHI�> l6i F I� cc, I ( (Items 23-A 3.403.11(B) Microwave- it,5"I" 2 itlmw-- Standing Critir•ni and non-,ritwa1 ct:rhnuurs. which do no; neknv io IN I nue frn)elhorne illness miei cclniww and riskfat tore li;wd echo„r. curt Pr 3-403.11((`) C ouirnetcixll:Pru.r:.a:d RTF Fuld fi,lind in:ke fri(lot+u+g ;cr ti,»1a ql the(livid Code and J'Ii 1',14!{ 14(;'F' tlt1. 3-441'1.1 ltEi Pcmaimn"I't"t •t•d pocticmof Ac�ci ttem Good Retail Practices I FC 6911.000 ` � _._ 3 Managnmeni and Personnel FC 2 I 1703 { 18 Proper Coaling of PHFs { 1 24 FivJd and"rood Protection iFC--3-{ .004 1 25. Equipment and Utensils FC - 4 1705 3-501.14(:1) Cuuline Ctx,6•td PHFt intim I4U)T t„ _26 _ Water,PlumbinG ntld W nste FC-5 00b 70'F Within 2liour>and From TYi -_1 27 Phvsmat Facilit rL-_ FC-6 .601 to 41"Fl45'F N'ititin 4 Hnuts '• ' ^8. Poisonous or Toxic Muterials j FC-7 4 OpH� 3501.14(}3;, Cr,;;tit1,�;PHFs'Me& From Ambient 29 _i Spec�ai R,,%sremetits__- . --. -----J 009---" E'cm4rratare lnRmi{ict:tx to-ii"(1135:F 1_30 J Othei %vithm a I!iv1re- •..s,: 'Lenotez+.nhcat ven, a,he Ir.a�•al !^n:+Fut•;t r,',;3..-�105 1 ,4t1;top r,(f) 't CITY OF SALEM BOARD OF HEALTH Establishment Name: Date: Page: of Item Code C-Critical Item DESCRIPTION OF VIOLATION/ PLAN OF CORRECTION Date I No. Reference R—Red Item - Verified j - PLEASE PRINT CLEARLY � I I I 1 1 i 1 I 1 1 l f _ I I - I 1 x - I = 1 I I I Discussion With Person in Charge: Corrective Action Required: I ❑ No I ❑ Yes 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 Exclusion j p ❑ Re-inspection Scheduled ❑ Emergency Suspension i comply with all mandates of the Mass/Federal Food Code. I understand that j noncompliance may result in daily fines of twenty-five dollars or suspension/revocation of ❑ Embargo ❑ Emergency Closure j your food permit. ❑ Voluntary Disposal ❑ Other: S -5a+1 14(1 PItF<Reasved at Temperatures Violations Related to Foodborne fitness Interventions and Risk Accol ling to Law('cilia to 1 Factors(Metras 1.2c) (Cont.) l 41-1'/45°F Within.1 Hisus PROTECTION FROM CHEMICALS 3-501 i Cry+line Meth xIs bitt'€$F'> la) PHF Hot and Cold Holding f 14 I Food or Color Additives I 3-50!.16(6) rote€PRFs i'intntamed at rn bctow 3-202.12 r`.:€uttti.:sF j 59{I.Ut}i{Fl 41`,'4;"1'^ I 3.3()2.14 i Ptrne+ltonlormUnainal"!'c! <'��i:iits•.es^ z.jt)i.sti(h) tinil'}ii,ltisinratnect.,t„rat'otc 15 Poisonous of Toxic Substan±;et; 140'F, * 101.11 ! kh ni+f�wtl f::rtna :.n - Un .sa' k i_5(:1 16lA) { kit>t.fidd at or aboyc 136'!: Containers' I 7�i0_' 1 t Ceunnxm�i:,s,r-- ti'.,rliiti::C',nri:un r�" ' 20 1 , Time as a Public Health Contso$ f s ( 3-5(ii 1; I'imc as a Public Ifealth Control, 7-200]l Stprrati�ai - Stmar:•,` i 7.202.11 Rc,t;ict;oa+-Pr'umz .uz:€L'•:r' j 5`10-!)US(Hi VarianceReyuireuzent j 7-202.12 , oral+tions z f;iac` 7 '_03 11 '1:"ac f;sntuilwi – Pmiiabi:usn" { REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 17-26d.1 ! Soniti-rcrs,;:.ntc>c+�-C`hradC,:€s" � POPULATIONS{HSP) 7-204,12 Chcntivai:.t;sr \�n.hn:i~k':«1+u.'e.C,itecia' 21 ! t. :}t.11i,1j l:up::atcros'rx$Preliacknl;ediwce$azul �7-'t)4 14 Ur.nzK r cot..Critcria" ` ( 6eiefal with Warning i,ab:+€s°7.''QS.ii � � $midrnt�t:exit_t,n;a,t.t.u?m,caz,t;:__ ..._._� ! 3-801 il(Rt 1.::,•,�f'Pa�tr•tnircd 's:t!Ns" i 3-W.I 1tUt 2.,w or Pett sally rrAnimal Rvd and _205.11 R(,in.tcd t'Sr Pv,oies Cote+ia` no,NorSejv:'d.7Rs, 5r-'d Slip 7-1-06.12 Rrxient 13a+: Seniw,z" I i 3 901 1 HCC j Uw)pened Vuod Package N,ot R,,:nerved 7206,13 "i racRrng F,r,der.. P-IL(:vnttot and Ionitolarz CONSUMER ADVISORY ! 22 3!601 11 01"M+ncr 'ViIi ory Posted Grz('rntsunzpti,m of I TIMElTEMPERATURE CONTROLS Aa,inaai FcKf<1~116.4 are Raw. Unc$er+:.x,krd+, ' 16 1 Proper Cook:ny Temperature,for � I + Rot fJti)envis:•$Rix:csscd to PGnnn.atr. PHFs 3 .10i IIA(t if 4" ! Pathaems ` "".."""": a 3o.1.13 P.,ek':u'srcdFi¢g:SuhSG£uAfill R;au•51ac1E F:»•t-inial;rlt.tte 're:•'t:'c f'5'1=.t;e::� L,,P, I ?-40Lli(A){L) Crminin wt d FiU!" :a>&63+:r� 1 .--.. i;:,:<. i SPECIAL REQUIREMENTS 3-401.11031t 1/2) pork ;;nd ti,:Olip tea i €7`F €21 mis,* S<t (+x> t 3-401.11(A)('i t:ant.,, lnic.�:'.t lh.,tr 1zS F $> 11 ) tA) ($7) Viulalion�n1 Section .`�.)0AX)9(A14D) in ,;atcrutg. tnuhilc,ti,'lod. ten+polary and sec. 3-401-11(Ali"+j ! Ponitr} Xii0r,t,am:: Ssufre;lill al:q rcnid::nr,alkitchenoperitions,houidbe { Stuffnw t'vaiwnc f eb- Meat. (WhInd under 1110 appropriate R-nitry'tn tiattaci-1SYF s5 s.:c. alswe if related to iiiodhornc dlnoi, j 3-µ01.11+C),3} Vtt.;e-;Ftus:ti kuact lsc,f il;alcs i ntcry ntioetc a++d ri::h factctrc 00(,r 590.009 violaticmv relatinc to<lood ruia:i 3-4()1.€2 Ra•aAnitn;.al F•+*tis Coo kcal ir a practit es iliwild he debited under h'29 . %411:iimurs in3 t" Special Regtdreillem, 3-40111(A)(10) AU rhher 1114F, - 141,!: 1'^.ec i7 Rehelbrig ter trot Holding t VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 3-403.11(A),�(D) PRI., 7+551' €;sec. (itents23-30) 3-4011 l(R; furu:;aic- ?65`F: litn :•:alai ling {i C,riti:ul:uu)non•r'r/twal rir iaf;,w+a, xhtvl«de nuz +flute;,=elle "Pine" i h%ndh+'rna•rltncss nuns�eetints incl rz+6-Jir<tvrs lictrd r.bo:< r,ut G+• '-103.11(("t C+smtn,:ie+.til,Pr+.e.*>.11'T L F,un$ (mend in th,foiliavnty lw<tiutra ul the Four!Cod'-will 100 4",i,1H l4ti'l, aaa. i 1-40311($.) RrmainenatV �l:.t•d Pt,:tiore,rf Beef i Item Gnod Ratait Practices FC ' 590,000 - — —'- i F,:..a�t,j ! 23 _ ' Managerri and Personnel FC - .+)O 18 ( Proper Cooling oP PHFa � 24. Fcotl:znd Food Protection ._ _. . TFC:...d� I 001 _._.. ! 1`25 Equipment and lAssrsis FC- 4 006, 3-501.1 d(A) Ctndine C"x,!.cd?HrNs tole €:t}`F t„ 25. Watot.Plcnabin,virl Waste Fr'-5 6,ls ._.__ f .�..._ ' 7ti'=:Within 1 3 four:aIle€Fri;rn 70"1: _....... __.._. ._.... 27. F'h,,rsnai Facdih• FC-6 f 007 t„41"F"t-15`F V Sting 4 Hutu::. " 7 ! 2b ( Prn,nn,sss nr Torg.Materials ---- F('-—71 _603 -- 3 501.14(61 Coilli +{,PHFr hide Rant Ambzeot ..�. Specie!Reouiremenis trl9 Fmpera+are Sartre:$'cotste,4VP'14S F L30._ Other J 1`.'irhin.,Hour" 'Mil"Ies rnocA tbsm is ire Cr.k:r:d l++'^)t'oj t,� is,r 1 it's t.'.tR 441+0 pfd; CITY OF SALEM BOARD OF HEALTH Establishment Name: Date: Page: of Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date No. Reference R—Red Item Verified - PLEASE PRINT CLEARLY 1 I � I I I I I 1 I I I 1 I 1 1 I 1 I 1 i j I j Discussion With Person in Charge: Corrective Action Required: I E2No ❑ Yes I have read this report, have had the opportunity to ask questions and agree to correct all ❑ Voluntary Compliance ❑ Employee Restriction/ Exclusion violations before the next inspection, to observe all conditions as described, and to ❑ Re-inspection Scheduled ❑ Emergency Suspension comply with all mandates of the Mass/Federal Food Code. I understand that noncompliance may result in daily fines of twenty-five dollars or suspension/revocation of ❑ Embargo ❑ Emergency Closure your food permit. ❑ Voluntary Disposal ❑ Other: } - t" -;_5'11.14(r�j F}JFs Rea'ived nt'I'entperatures f Violations Related to Foodborne fitness lntcfirvcri3ons and Pisk .According zo IAv C poled to k Factors(item f-22t "Cont.) ( -II-Fl45''PWiiltin4Homs. t_501.15 Ccxding Riethod,for PHF, PROTECTION FROM CHEMICALS 14 Food or Color Additives ! 19 PHF Hot and Cold Holding 3-202.12 idd nrus. 3 Stet 16(15) Cold PHFn Maint.,ined at or Wtac 590.0040,1 31'!-15" F" 3-302.14 Protect,znCroml7aa>pnr,edNddins'es' j 2.501.16(Az Ilot PHFe ai.niained at of aboee 1 Is Poisonous or Toxic Substances M140'F j 7 101.11 kh rtt�Yymr intorioat,on -Olj,,inai Rimsts Held at ur above 1301% " {�LHita3l:Ct::' 7.102.11 Common Narce-- Workiii j{',*arati:�r ' I i 20 Time as a Public Health Control E 7-201.11 3.501.i� Time as a Public Ilea!}h Cfa1trol' Slwage` I Sapar:a'ut - 7.202.11 Ra:rriction-Pns:a=:c,uz i i.;:c" � 'I90.t14NHi Variance Requirement i 7-202.12 Cundnioon of 7-203'[l t„xit Cs,rtacn .';, -#'rc,}uhi;:tPOPULATIONS(HSP) 7-204.11 y; #. REQUIREMENTS FOR HIGHLY SUSCEPTIBLE ii '! Sanitiziira,C'riteri, C'hearicok, 7-2{4.12 Chemical:,for�X;:'huar Vroda't'.Critcun' 21 j 3-M)t H(A) Unpaoteuntcd Pre-hacLiged James,and i t3everaee.Will, Warninc Labats^ 7-2ti4.14 Drying Aeetu,.C'rite ia” ROL i N$) tA:of Pa tcuriced l pis" 7-205,11 In.id,qu;i) P+xxl Cont:zct. 1,ibi:c:uits" 7-200.11 Rein tcl•`d Unr Pe,.ri�zde;,('nreic�i. 1.301,110)) Raw or Rvtmlly Cook-,-d Animal Irzx,d and j Ray.St ad Sprouts No Sri vvd. ' � 7-206.12 j K,xtor,; li'1,t St;+Uon�' Li tC} Ur.+tpVtted (4xri Pacl;apc i�ui Ra-xrr.cri ?-206 13 i Tracking Pna,lcr:. P,si C'olluGl and `=-.- -- I MuaiaKin CONSUMER ADVISORY TIMEITEMPERATURE CONTROLS 22 3{i(}: 11 ('nnywnor A ,;so v Portal for( onsumplion Of :Animal r+xx1.'l'hat arc Kau, CinderOKAVd ca J6 Proper Cooking Temperatures for I FttFs Not+7therwisc l'r<x^rssrd to 1•:timinare i 3 -10I 1I,A(E'(=t 1'-tS)r, IS'z"F i?S:c. Pathugene.` ?-30_'..1 i Pastconted Fagg..5,�bshtan•in, RawSheii iznu:c:+3::a-ticr:'tcr 145T)Sec' 140 1.11(0 2) Canntntuted Fifa, ATcati& (tams' { Animals t i5 7: SPECIAL REQUIREMENTS 3-401.11(13)(1 n,2) Pork. and ti:•oi Roast !,;0`}= 12i n,in* 3-401.I1(A)(2t Kai±iii e, lnlrt'cd S4Vnts 155 F 15 590009!A)-(T)) Violunoo,of Section 590.009(A)-(D) in j tact• catering. motile food.tenip+rrary and � -401-11iAN3) Pnu3r . GVilri Gar lie, Scut,`ed PFI( rcmdttiliat kitchcn operations 1iould be St.�ffnre t:,ataznmz;i=zsE� twtraz, debited under the appropriate eectl.nzs P:n,it;y ni Wiaw. IWI7 15 arc. " alloseif'rel.ucd to foodbnxnu illnos,, 3-401,t!iC)+±} ',',holt-mut: v; iivact lscct Sleat.l � Intel veations and risk tactors. Otho is 3'F x, 590.009 violations relating to amok rel.u! I ,3.41)1.12 Rnw .Aahnai F7c*x11:,C,xiked to a I juactices,hook! 1v debited under #29 I lficro:.a:c 165'F^ Spcelal Kequilenicnts, 3-401.11(Alfl)ihl Al!01hnl1HF,, -- 145,F15sec 17 Reheating for Hat Holding VIOLATIONS R.rLATED TO GOOD RETAIL PRACTICES 3-103.11(A)h:(1)) PHl'; if"Vj: €7,wc. '" ( (11et,rs23-30) ;403.11(B) ?+TzrroWsn.- 165'F 2 nlumtr Setnding Criin',U and non-rrilreal viii Uip Ins, mNch Flo da; rehire in IIIc Vince" foo dho me d hwtf s rnwi,venrionx and risk,jar tors li cud above, car:hr 3-403.111S(7} Commcresativ Pnxss:d RT'l:Kod. fimnd in the f dl.nrmy scrtinn,of the Food Code,nid)05 C.lo? 140.14' T- .__....-.. 3-403 11W I Kcmnimn,Ln,iwiid Portivic r}f ticct llem Good Rotarf Practices T FC 1 590.00D i Roca"$ 1 23. 1 k4anatterrment and Personnel .-_-_ _FC 2 _ 1303_ 18 Prapat Cooling at PHF, i 12=t Fmo and Forxi Protrrtion FC 3 ! 004 25. _LE yip Utensils _ FC—a COC 3-501.14(Ar Cr xdutg C'cx.,kcd PHM from lid)'tr to 2f -�--i Wates,Piumbin4.er:d Waste FC-5 I ?Oc ( ' 7u`F ' ithvt 2 Hour: ,nd From 171' _ 27 � Phys�da!Facili(y_ _ FC-5 j 1107 ! (i' I1 '1'!45`F' ilhia,t H'°utr. ° �28 1 t'asnn7,us orTnb, tna_enais -_-�C -?_ y 003 -- -i 3-SUL H(1i) Cooling PHF:.Mad. Fount Ambzeut f 29 Special Rc-nuirernanis - -} — T..mixcanzrc snare%1irntsit,dt`PdJSF ( I_3Q:_ --; Oiher— it hi It 4 lttxnO *I)em;ks.nticai item n the t.d^rn' i`:'�t F,n.d C.nk o= i'tS:'`.Ilt 54e}60G f CITY OF SALEM BOARD OF HEALTH t Establishment Name: Date: Page: of Item, Code C-Critical item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date I f No. Reference R—Red Item - Verified } PLEASE PRINT CLEARLY J 1 { I 1 f . I 1 I 1 I I f z I I I Discussion With Person in Charge: Corrective Action Required: I ❑ No I ❑ Yes I have read this report, have had the opportunity to ask questions and agree to correct all ❑ Voluntary Compliance El 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: C r _ :_SI}1.14110 PHRReccrved ail Tctoper.ttur:z k Violations Related to Foodburnt)t&cess rrttervw6w)s and R;sk A,,vording w Lay. w 1! Factors(Items 1-22,) (Cont.} ii 4I'F/45�F Within 4 Hawe, PROTECTION FROM CHEMICALS 5+11.15 _ C.x)hnp bizth da for PFIFS I j 14 1 Food or Color Addbives ! 19 { PHF Hot and Cold Holding I "?==2{12.12 Aridth*.c<` 2.50! ,le)(B) Coal PHt�.Matnt.,inect 3t,W 11,:11 a' i j 590014(1-) 41"W`F' 3-302.14 ('cotciLanItowltaai';rn' ect:'ldd+trve.' j , { 3.5()t.€()(, ) IItr1 PI{I !Lt:3inEA[LtP.G.it,3C Sib:;t',' i 75 l Poi.torous or Toxic Substances 1 I(il.i 1ld::rnrtyrt't Infta;P.E=r,t n- €111}ina! ! 14€1'r. #6t Ai Rr.3s[s Hcici at,.,t':tbuc•c I+(t`I' ( Container's" i 24 I Time as a Public Health Control j j 7.10'_.11 Covera"n\an;r '.�.rr1.m;;C'•eratn�r.'` , ;_SUI.f> '1'irreacaYuhtic:Iteatrht°onn;rt' I 7-20 t.1; S'^"' 'Ct:::t- .t"iit)Yoj:e" t . `' j `rtU(N}ItH) variance Rec+nirrmca; j j 1-202.11 j Pe:t6c,inn -$,'se nee and 7-202.12 1 Toon ;loom{,�of j REQUIREMENTS FOR HIGHLY' USCEPTIBLE 7-203 204 it j Tank. i ri.Cr•:'t'. i Ptt•hemi nW POPULATIONS(HSP) 7-204.{1 � Sanitizcr,.Crnrri;r-Chi-rnic:r#a' � 7-204.12 rr ( � ,�,( ' 3- til I ItAl Unpa.rem'rr.ed Pre-pad:agcd ltn,•es wid 4,1 j t nu.:,v!s fen h'a:hnr},t'xuia«,t'titet:n' ) Rcr,,a'•es with Warning I abe)z' 7 305.14 hi(iti,;.i1_rnt�.;�rtsrria'r j t-801.11011 Use of Pastrtvi&rd Lgp,' j j ?-205.1 i huidenfai h:xx€C+:at act. Luhriaant�" j ?-801.1 Itt)) Paw or Pamntl:. G+ok:�d.Snirna} Pcxni.rad ( j 7-206.11 Rc.,ri':r,:.t t st Pe,ocidee Cntewi'' ! j 7-206.12 12; CITY OF SALEM BOARD OF HEALTH Establishment Name: . Date: Page: of Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date No. Reference R—Red Item Verified PLEASE PRINT CLEARLY - I 1 I I 1 1 1 1 I 1 I I I I 1 1 I Discussion With Person in Charge: Corrective Action Required: ( ❑ No I ❑ Yes ' / I have read this report, have had the opportunity to ask questions and agree to correct all ❑ Voluntary Compliance ❑ Employee RestrictionExclusion violations before the next inspection, to observe all conditions as described, and to ❑ Re-inspection Scheduled ❑ Emergency Suspension comply with all mandates of the Mass/Federal Food Code. I understand that noncompliance may result in daily fines of twenty-five dollars or suspension/revocation of ❑ Embargo ❑ Emergency Closure your food permit. ❑ Voluntary Disposal ❑ Other: 3.501 143(7) KIP,Reoeivrd t'remperalures Violations Related to Foodborne Illness tnterventians and Rlsk According to lav CwhA kr Factors(items 1-22) (Cont.) +)+ -11'1:45 F Within d Hotur+. PROTECTION FROM CHEMICALS 3-501 1 , ('001inm,W.Lho& for PHF� 1 i 19 I PHF Fiat and Gold Holding 14 Fuad or Color Additives 1 55.16(8) Cold PRFs Mainfw=f at or Belo, 7-21)2 12 Additives ' i 3(;0()(lt{}=) ll'lti"h` 3-302.14 Pri•tcclinnfrontt;,:,rpurer:ed::d,tit,ees' 3Sir 1.INA) Hot PHF�Mainlained:ttorabo% 1 iS Poisonous or Toxic Substances ! 1 7 101.11 Identifying tnfol oration - t}agma, I40,F a Rtxists Held at ut at+ove I IWF. 7 102,11 1 21) Time as a Public Health Control } 3-501 1+.r Timn as a Public health Control, 720t.11 sopaisuc"n-5totape' � 7-202.11 Rest;icton -Pr•:zenccandL,t" 51)0.004(11) � Varianu:KcUdtrcment 7-202.12 C Judilion,of Uie' REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-203 t1 Tc4,;Comainoil Proittl=n,on" E 7-204.11 sawuzcct,Cd-,i -Cbcn:i.;:N- POPULATIONS(HSP) 7-'_(1`1.!2 Ch:.nu:-:als i�=t'y}�;tchlug frodncr.Gitctia' � � 21 3-sr)I, t(.'i) � t)npa.ctcunic;ti Yr;:-pac i.ated Stites wed 7-204.14 _ Gninx Acevi�.Cowria' 1 Betetaees rvith Warnin„labels' 7-205.11 tnt.idemai F.xxl-'uRl,,ct. lalbt:e.u,ls" .�-RUt.I i(B) L'f.P of Pa�temized 7-206.11 tt,.tneie,l t';:e Ye.hcides t7tietta" E t-blti.11(ll) Raw ur Patitaliy Gvkrd Animal FtrrJ and 1 kau st,t d Cpnnui Not Served. - 7-206.12 j Ro,irnt Bait sr„ttnnr 3.8(;l 1h(:) Un(Nnncd hixxi Pae.}.aRr Not Re-<crve:l. ^ 7,206,11 hacking Po.:,l:;rs, Pest C'ontr�! iud Munitnrint" CONSUMER ADVISORY TIMEPfEMPERATURE CONTROLS 22 34103.11 C( occutum Ativisor_r Poioed for Clan nnsption of Al'iutal I-,oJ th t.uc Raw. Undcrax,ked c: 16 Proper Cooking Temperatures for �; t w . > t. F PRFs rid e}Lterv,i._e F r(x!cs&-wd to Eliminate _3-401 11 At L(2i F.,t;:- 155`F 155::,:. !}tgs-hnux�diatc Sero;v t i5"Y15sec + :3U?.13 ! P..stcant,:d F.gg, S:ehstitu9r Fol Raw Mid] 3-401.11FA}(2• Comminute 17s's`" I d t�:..h. 1lcats.4 i,amc see. ' ! SPECIAL REQUIREMENTS ?-•30E.t1([3)(i)_2. Ptrtiand t".tctRtxrst ili)"1. 121ndn 590()19(.1)-il)) Vic•Allot,ofSection 500.(k19(A) (1:D) in ?-4101.11(A) Ratner., ",I, j,, - i1< F IS E sec, " E catering. inohilc.fixxl,temporary and 3 401.I1(Ato 3) Poulin,Wii,i Gone, Stuffed PliFs, � rcmdent„d kitehen operations should he Sntfiin'C'r,a'anun+;Fist:,Maar, dch led under the appr,�nnate we tion. t'�,ultry ur Kahle+-los"t 15:;r,:. atuive it r.hucd to loodhorriv ilhtcss 3-401.1k0i'l, Vtsulc-nw:;•le, tn.act B3 vf..te.d:s ) iniervent)on:and risk factors. Chher 1451P; ! 590.009 cioiationc relating to„ooiJ rettul 3-401.12 R.,% Amnv,l h+xxk(:atk:d w a pi notices should he debited under #29 -- Mictowa,.v 1(75'h Spzelal Requirenl.Wt, 3.401 11tA)tl,,,b) Ali C.h mi l'l t!';.. 1.15'"1 17 Reheating for Hot Holding ( VIOLATIONS RELATED TO GOOD RETAIL PRACTICES ( 3403.11(A)f(t3} Pl4k 165`F 15 cec. - (Items 23-30) ;-407.11(B) Nliauwave if s"P 2 Minuie Standing Ci Wrol and nun-e ritmai viowiaoa.t, which&01107 relare t„thr 7111 ` foodborne ffln:si inurventu,ns ovoid rctkJai tare hiad above. on La 3-403.i I(C) Connnerol4v Prixec;.,d FT'h.}+krt found in the folknong ser boots of the•Food Code and 103(:411? 1-10 p= Se(i.0(Kr. 3-403,11(E) ( Remal ning Lot Iwcd Pot oom of ileef i (Fair Good Retail Practices rC 590.000_ 23 Management and Personnel FC -.2 .OW 24 Food and Food Protection i FC "3 W4 18 Proper Cooling of PHFs -2iiEquipment and 0tens!!n FC- --'-- -- ---. _ - I tt05 f - ---.� 5 501.1 4rA) J C<x,hret(:x,i,rd PRFs lour,, i41t`P Yo 1 2F.- I Wafer.Piombmo:v,u Waste I FC-5--- -"Oct- -- 1WF} ithm 2 lfiwr�;nd I`rom 1 i 1 ' }'• � ' " ' 27. PhysicalFacdit FC-6 00f - o -. _ _ . - t.+41'-1-!15r F Within 4 Hows * � E8 J Pason,nls or-Toxic-Material-----s I FC -7 O06 3-501.14(8) C•rx,lim,,,PHFs Mads Front Aint+u•ot 29 Snot:taf RnauiremanisFA - Tentpetutare inrrcdie;ttts a, d1`'i445'}• _3O; , Other ___ - Witbin.' hottr,r 'hetn,ke muc,d nem in ti. l;,kao: i",+r p,n,i t:<,dr or V+�t'\-(it 5+3+)f7tNl S 1 CITY OF SALEM BOARD OF HEALTH . I S Establishment Name: Date: Page: of Item Code C-Critical Item DESCRIPTION OF VIOLATION/ PLAN OF CORRECTION Date No. Reference R—Red Item Verified PLEASE PRINT CLEARLY + s I � I � I II� I 1 it I 1 I 1 t = 1 I t I � � 1 Discussion With Person in Charge: I Corrective Action Required: I ❑ No I ❑ Yes I have read this report, have had the opportunity to ask questions and agree to correct all ❑ Voluntary Compliance ❑ Employee Restriction/ Exclusion violations before the next inspection, to observe all conditions as described, and to ❑ Re-inspection Scheduled ❑ Emergency Suspension comply with all mandates of the Mass/Federal Food Code. I understand that t noncompliance may result in daily fines of twenty-five dollars or suspension/revocation of ❑ Embargo ❑ Emergency Closure your food permit. ❑ Voluntary Disposal ❑ Other: : 50114((:! PllFt+Re,r•n'rditTemperatutoc Violations Relater!to Foodborne Illness lntPrvanlmrst and Risk Acc,udina lot l.anC(x.,icd to 1 Factors(ileacs i-22) (Cont) -;P17/451 Within,i How, for I'l-fF< PROTECTION FROM CHE41ICALS 3-5011`+ Co ling Mcdtod, 14 Food oe Color Additives 19 PHF Hot and Cold Holding }} 35()linfB! Cold PHt'sltfmntatnut.t(,nb-ic+,v 3-202 12 .tIrbi,v;<` 590.004f t) 41'745° I` 3-302.14 E P=otcction Irolu Un,:[ntro',td �U:tii,s'es' E Polsoncuo or Toxic Substances 3-50 I.IfifAi 14 Ptif c pisintainecl ai o,: at, 15 uer 7 101.11 1 Idom,itufyInf; CITY OF SALEM BOARD OF HEALTH Establishment Name: Date: Page: of Item Code C-Critical Item DESCRIPTION OF VIOLATION/ PLAN OF CORRECTION Data No. Reference R—Red Item - Verified PLEASE PRINT CLEARLY J I 1 I 1 1 I 1 I t I ' I 1 I 1 I , Discussion With Person in Charge: Corrective Action Required: I ❑ No I ❑ Yes I have read this report, have had the opportunity to ask questions and agree to correct all ❑ Voluntary Compliance ❑ Employee Restriction/ Exclusion violations before the next inspection, to observe all conditions as described, and to ❑ Re-inspection Scheduled ❑ Emergency Suspension comply with all mandates of the Mass/Federal Food Code. I understand that noncompliance may result in daily fines of twenty-five dollars or suspension/revocation of ❑ Embargo ❑ Emergency Closure your food permit. ❑ Voluntary Disposal ❑ Other: 3-:iol )a(i') PHFsRrcovedat'fen,)',ei.tetras I Violations Related to Foodborne Illness Interventions and Risk According to I.avCooled to Factors(items 1-22) (Cont) 41`F/4S"F Within a H(,w', - PROTECTION FROM CHEMICALS 3-501 15 Cooling Methrx&for PHFs { { 14 i Food or Color Additives { { 19 PHF Hot and Gold Holding F { ## 2 S()! l6ff3) toll PHF.S Maintained at,wt hclfm i900(f4iH .41/45°F' 3-302.14 1 Proteciton front I, ritippro,cd Nddnives' � { Poisonous or Toxic Substtnses 3-j0 t 96tH) Hol PFlFs ititainiaiued at or abuvc ' ; i 1(11.12 ', Ltenti rytnc Inti»may nn -uri�ina1 ( IdU'F. ` F ' " i � ? S1N.i6(.A) Rt4(sisHeld atarabove t30•'1'. Containers * { 7 102,11 C:e;innn,n,;an�r--'rL'�trI:i n)!C•.rnt;un„rn" ! i 20 Time as a Public Health Control if 3-501.F7 rim,.as a Public Ifealth conu'oi* f { 7.201.11 ( Svnatstiun - Sturap&' { 720111 Restiict,nn - Pr..anectold t.S: ")U.t.}04+H) Variance Requitement { { 7-202.12 corrillio3 ;of i lbv' { 7.303 t 1 Tuxis Cuntaimt,.-Nuh,he„rr REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) { 7-204.11 Naniiizor .c6len;'--L'ne,nic:,ts" i 21 ( 3-Rt)t.t itnt 1!npasreuriud}'rc-pack ( aged Juices wid 7-204.12 C[miacals )i A%,,hing t':+tch(ce.{.iittiia' j { �7-2(34 14 E3rwna Ai�ents.Cnn ri:s„ { Reveraets with Warning I,ihcis' f--?OS l i :, �r { a80i.I 1113) k 1':.:of ptctemized Inch. ni.,i F.x.! t n ,ct.i uht:carus' Z.};p(,t i(i)} ! Raw or Partudiv Ctokrd Anima! Food anti { 7-206.11 Reatrided Use Pe,iiadeas C,uteua' ( Rea'5c:'d Spann;hot Served. ' { 7-206.12 K+,eiea: B<:=t l(sti,v;^" i { .3 XuI i iii"� ( t,n„pened (+coli Pacl:agv Not Re ,,crvccl. { 7-2_06 1 '1'rerkill P„v+d;:a=,1'.•st rbntrcl and 10onitarul— CONSUMER ADVISORY TIME/TEMPERATURE CONTROLS 22 3.003.1 I Con,unier.Advo ory P ed 1;ir Con,reuptiun(,i ` lutintal F'+rsl,'11rat are Raw Underaroked ci 16 Proper Cooking Teaiperaturus for Pi(Fs E No!(Ithem ise Priccessed it)Eliminate 3,101 I l Ai t i{�: Fg}t�- I t5'F i 5 5��::. � � t'atho;:,en+.'” r I i-30" ,13 i Pxstearizcd Egg;St+hstiiutr tot Raw Shell ec { i-It}1.71(A}f�r t•,.mciiintac'd rich, 1R::.t�A ti.nnr t:ge•4 .hnintand lite! ;' E5 sec.. SPECIAL REQUIREMENTS { ;-401.tf1Rt', 1(i,i?7 rrt. and Etc.! kuaei- I3t7`fi' 12I m,in' ; 590,00,4A)-(0) Violatrow,of Section 5't{),(}p9(A) (C)t in 3-401.11(A)(,2-) Rincs, Sn}card Mai.- i 7't•• IS catering. iriobt)::total-lemporwy and 3 401,11(Aic3) Poultry, W ltd{iauue,Sturted I'liPs, � residential l.itchtn opciations should he Sn,fthm Coni unmg Fish. h1d;u, debited txuder the appropriate sections Poulir< or P: tncs-165'P 25 its. ° abovo It related to foodbornti Idljios 3-401AIWI1,3t ;'Dote-ilin:c'.lfwttr Gccf:iteaks intei ventions and risk factors Other 14s"F ` i 590.SN)() violations relating to good retail i3-4x0).12 R..:': - wowl Fciirre Oxtlied w it � practi(es should h debited under 1129 - 1licrouuve I,> :'F 11 SpoCial Reyuirctnents. 3-401.11(.A)(1)(b) { Vi Othci PIJF� - 1.15°}: 15 xcc { 17 , Reheating for Hot'Holding { VIOLATIONS R_LATED TO GOOD RETAIL PRACTICES { 3-.103.1ItAh4'(D) Pfli'., 16+'F IS se,. - { (Items 23-30) 3 403.11113} >.ficntu at.- tt•5"F: ,LI(nu'e,standing Ciap ai and giro-,rtn(al t'iutabom, which do imi relat.w fit,, T Ime' foodhorne dG,cs, inua w'itt,ono and nak Jd(u,rc li vi A alove. .or be 3-403.11(C) GimrnerPialiy Pirwe.ied RTE Ftxx1 - ; f<noirt in the jollnic-nig sernrnte of the Foil(-ogle ritrr)//!i f;bgk > r Item Good Retail Practices _____ -590.itOD 3-4f13 1 It F, Rrniaming L:nthced I ortiim�al'G,'cl l _.-.1 23. Management and Personae! FC 2 fi 003 ; Proper Coohn of PHFS l 24 _Food and Food Protection _FC 3 j_294__ , I 18 g { 25. Eftopmept and Uteoatla — FC-4 005 _l 3-501 14(A Cot ling OKA,,d PFIF,s trim 140`F to -26"- '-"' J ag, Watai,Ptutnbniy and Waste FC-5 j rJQti if)"F Within 2 flour,and From 71x'1' 1 1 27 Phps,ca!Factluv ! FC-6 .031 iI, 1 [„ !!'F/44'F Within 4 Hnu(r. ! 2-3 Pesnnus or Tws Materials ---..--- FC - 008 ---- 1_ 3.5( 1.1.1tt) r",ylitt,;PCF: M3e Front 4rrhieut �°9._.--- S ectal R"(ulrernentc j '--�--- ' 1 T.snjwaorrc fiwred;crts l„41F/'}5•`r" { Within thtttn' 'I,enoh'<�nttcat nem rt 3hi ia!vr.,i 1'+'1`t Po:<I('(hiC,_r 1(IS( !+Ttr 50,t tq)p a � CITY OF SALEM BOARD OF HEALTH Establishment Name: Date: Page: of { item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date i No. Reference R—Red Item Verified s PLEASE PRINT CLEARLY } I j t F I 1 I 1 I - 1 I i . I 1 I l I 1 I " f I Discussion With Person in Charge: Corrective Action Required: ( ❑ No I ❑ Yes I have read this report, have had the opportunity to ask questions and agree to correct all ❑ Voluntary Compliance ❑ Employee Restriction/ p pP Y 4 9 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 i noncompliance may result in daily fines of twenty-five dollars or suspension/revocation of ❑ Embargo ❑ Emergency Closure your food permit. ❑ Voluntary Disposal ❑ Other: S i..5t11,14(C; flfff,�,Rek,:,wd at I Violations Rotated to Foodborne Illituse,interventions and Risk Atvoiding it)Linv Cooled i,: Factors(items 1-221 (Cont.( -W):/45`F Within A H,itas PROTECTION FROM CHEMICALS C;.xiliag Nlcthods for VHF(, PHF Hot and Cold Holding 14 Food or Colo,Additives 1-501.16(() Cold PHI 3-102,14 Protection from I Ado;til,e" '3-S.M,WA) I int PHF;%faintainedator atr,,vc 15 Poisonous of Toxic sut'rnaicert 7 t(ll.11 Idi'litifyWit tni"i 111a!;On - Orlg17 3-5(;IA6(A) k,,;ists 1-10dat orabove l.iO'F 20 Time as a Public Health Confool 77 102 11 i 3-501.19 riav�as a liubfii�lic-alth Control 7-201,11 S�Viij:jLjon- 7-2(12.1': licilrim'-n-Pr-s(oxWkl u,", �1)0.004�lb varimce 7-202.12 Cinid!titnof i 7 2w 11 To�i�Contaluei' -rrt'10':�ooi` REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 1-"04.11 Njriv (:I" POPULATIONS(HSP) 7-2(4-!'2 OwnucziLk fir Aa:hhw Qitcti'a'� if 1-801 1 I(A) Unpsleurizcd Pri-packaixd Ji6ctl Wid Rever"Ie'es with Warniog lal)'As' 7204,14 Dl�ing Av-mv.Crm�riil- S01.1103) (if Pastewizrd EngN 7-205,11 ( incidental )-,�.xJ Cor�tx 1, 1 A!N 3-Wl,I 1(0) Raw or liailial),,Cooki�d Altimil Food ami 7-206.11 C,itwa� I I Itim tied sintsuli !rot'scrwJ- 7-206.12 RkKicni B,I;t 1 3 go 1,1 j(C) Uwipoiett fkxxi Package Not Rv.ik rved, 1 206 1-', hacl:iiis;P...tdc-';' ('ontro aw'i Mot'iwrin.�'- CONSUMER ADVISORY 22 3.6U3,11 llo,;lod for CollionipLionoi, TIME/TEMPERATURE CONTROLS )1111,11 Foyj z Prat are Raw Undert"ikcd v; 16 Proper Cooking Ternpot stores let Not Othei,�i��e Processod to Elinowtke 3 401 1)A(l;(2., F'; I F I i-3()2.13 PLeteilrp/cd Ffig!�suhstiluo-lot R'ov Shelf i��' 1 151-1,5st C 3-4 0 1.11 i A)(2) comoljnlq.^d f i'li, Moav:X• 0:133m AwilIM,, .55 F t5 arc' ' - , SPECIAL REQUIREMENTS;-401.1I' I(!tO rk :�nI�lR4s,"l 110'! !)1lol -T4i)I i I(A)( Ratite" lww'A M,"t, 15^'F Itt 590,009(A)-if)) f vidjwtoN ni Section 59t) 09tAI (D) in I cainrin it. moln1c,IutKI,lentpurai v and 3 401,fl(A)(3i PoWiry, 1N111 '�wdted PFF" I it"Nidenlial kitchvit operaliolls%hould 1s' Staffing Confaniin8 Fish. Mea., debited under thQ appropnatc ';Wlom 15aNwc if whited it)fkx0horrit;itlnosg 3-401.11t0l';, Wh,))e,mw.dv intact lleJ S:calks i interventions and risk faclorq ()di(.*,r 590.009 Violation';relatin" to cood retuji 1-401,12 Fo,6 C,K)kcd in it 1,dcbitcil tjo&r #29 Siptc,-cial Requircnwnts 17 I 3-401 INA)•I:tlro Atr)tl,e-i PHFc-- i45'Flisc. At"heating for Hot Holding VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 3-.103.111 Awl) 011-, I t)5T 15 qtc. (Items 23-30) Coiv,zl ivjdnor-r rawal *w1eiritioni, i4w,h do n;nrelate to fit, anbc 3-403.111 C) Coininercoillv Pwt?��ed R'lVKv,,d- Anind in tit'ji�,Howing srrtirnu of M,!Food C-dv and 10-5(A,11? 3-40 J I(F) R,aiaintrk,,I iwivvd K,rtwri,of Ht,cl 1 I her" Good Retail Practices FC 1 590.000 23Management and Persmne! FC .2 18 i Proper Cooling of PHFs c-)d:ind Food Prol�tioo 3 (44 I k25 Ecluip_rneri Land Utensils F', 005 3 q0I I-IfA) ("tolieg i:,K'Kott f1fiFs from 140q7 tit 26,-- Water,Plumbiriq.and Wasti) FC-5 00t, 711'1, Wilhot 2 1 louf,,.:nd Frant 'i:) I 27 Physicie FaLifity FC-6 1107 to 4 I'F/414 F Witidu 4 Hiitw, 26 Poisonous or Trix,L !,%lenals; FC -7 1 1111 3501,14(f3) Cx,lin,PHFN Wdc ftom AtribirN 2 T' , virenteritn 00,q ,speciaL�S Tcoqvraiwe 1o41"F/4-1N F -A-PILt, U.S. Postal Sery im. CERTIFIED MAILT,, RECEIPT _n (Domestic Mail Only;No Insurance Coverage Provided) OFFICIAL DISE t` Postage 1$ O Cerdlled Fee O Return Re Fee reeI PosMmk M (Endomem Required) Here O ReeM0 Dell Fee r (Endorsemem Required) rR M Total Postage&Fees .$ ul p Sent To O M1 55iee4 bpi.IVa; orPoBoxNa .. ........................................................................._....... d6:8fete,LPW :r Certified rec 1pProvides: tesimeal am ever•ooaa w+ei ad ■ A unique Identifier for your mailplece ■ A record of delivery kept by the Postal Service for two years important ail my ONLY be combined with First-Class Mails or Priority Mall®. ■ Certified Mail Is notavallable for any class of international mail. ■ NO INSURANCE COVERAGE IS PROVIDED with Certified Mail. For valuables,please consider Insured or Registered Mail. ■ For an additional fee,a Return Recelftmay be requested to provide proof of delivery.To obtain Return Receipt service,please complete antl attach a Retum Receipt(PS Form 3811)to the article and add applicable postage to cover the fee.Endorse mailpkfce Retum Receipt Requested".To receive a fee waiver for a duplicate return receipt,a USPSe postmark on your Certified Mail receipt is required. ■ For an additional fee, delivery may be restricted to the addressee or addressee's authorized agent.Advise the clerk or mark the mailplece with the endorsement'Restricted-Delivery. ■ If a postmark on the Certified Mall receipt is desired,CIease present the arti- cle at the post office for postmarking. If a postmark on the Certified Mail receipt is not needed,detach and affix label with postage and mail. IMPORTANT:Save this receipt andpresent it when making an intjuiry. Internet access to delivery Information is not available on mall addressed to APOs and FPOs. ^ 6 CITY OF SALEM, MASSACHUSETTS �! HEALTH AGENT 1 120 WASHINGTON STREET, 4TH FLOOR $ SALEM, MA 01970 TEL. 978.741-1800 FAX 978.745-0343 KIMBERLEY DRISCOLL JSCOTT@SALEM.COM MAYOR JOANNE SCOTT HEALTH AGENT November 9, 2007 Joanne Hatch 42 Moonpenny Drive Boxford, MA 01921 Dear Ms Hatch: The Salem Board of Health requests your presence at the next Board of Health meeting to discuss possible revocation of your permit for Gourmet Fare, located at 73 Pickering Wharf, Salem, MA. The meeting Will be held Tuesday, November 13, 2007 at City Hall Annex, 120 Washington Street 3d floor conference room @ 8:00 p.m. If you have any questions, contact me at 978-741-1800. Sincerely, For the Board of Health )oanne Scott,4Healthjt`Agent JS/mfp cc: Christina Harrington, Chairperson of the Board of Health and Members CERTIFIHD MAIL 7005 3110 0000 7160 4641 & REGULAR U.S. Postal Service,. o CERTIFIED MAIL. RECEIPT (Domestic Mail Only;No Insurance Coverage Provided) I� I� I�� OFFICIAL r- Postage $ E3 CerdtlBd Fee M O Retum Receipt Fee Postmark O (Endorsement Required) Here M Reetdcted 139,1-ryFee r= (Endorsement Required) r=l M Total Postage&Fees ,$ L1l Sera To O r'0'W&W Apr:Nti.'--------------------------------------------------------------------- wMfloxNo. Cdywrtete,ZIPW :rr r Certified Mall Provides: ("wad)zoozsear'ooecuuojsd ■ A malling receipt is A unique Identifier for your mailpleoe ■ A record of delivery kept by the Postal Service for two years Important Reminders: ■ Certified Mail may ONLY be combined with First-Class Maile or Priority Made. ■ Certified Mall Is notavailabfe for any class of International mall. • NO INSURANCE COVERAGE IS PROVIDED with Certified Mall. For valuables,please consider Insured orppRegissytered Mail. p • delivery.TolobtaainfReturn Receipt servfr plewercomplettee and ash a Return Receipt(PS Form 3811)to the article and add applicable postage to cover the fee.Endorse mailpiece"Retum Racelpt Requested".To receive a fee waiver for a duplicate return receipt,a USPSe postmark on your Certified Mail receipt is required. ■ For an additional fee, delivery may be restricted to the addressee or addressee's authorized agend.Advise the clerk or mark the mailplece with the endorsement"Restricted Defivery". ■ If a postmark on the Certified Mail receipt is desired,please present the arti- cle at the post office for postmarking. If a postmark on the Certified Mail receipt is not needed,detach and affix label with postage and mail. IMPORTANT:Save this receipt andpresent it when making an inquiry. Internet access to delivery information Is not available on mail. addressed to APOs and FPOs. F� lr t CITY OF SALEM, MASSACHUSETTS �! HEALTH AGENT 120 WASHINGTON STREET, 4TH FLOOR SALEM, MA 01970 TEL. 978.741.1800 FAX 978-745-0343 KIMBERLEY DRISCOLL JSCOTT@SALEM.COM MAYOR JOANNE SCOTT HEALTH AGENT Joann Hatch 42 Moonpenny Drive Boxford, MA 01921 RE: Gourmet Fare Dear Ms. Hatch, The Salem Board of Health suspended the food service permit for your business, Gourmet Fare, 73-75 Wharf Street, in Salem, MA on October 9, 2007 for repeat critical violations. This office has received reports that you are currently entering this establishment late at night to bake and prepare food items to be sold at your other business the Rose Medallion. As your food permit is currently suspended you are not allowed to cook, bake or otherwise prepare any food items at the Gourmet Fare. Preparing food at the Gourmet Fare will place the food permit for the Rose Medallion in jeopardy and you will risk permanent revocation of the food permit for Gourmet Fare. Should you have any questions or concerns you can contact the Board of Health office at 978-741-1800. Sincerely, Reply to: 0. e Scott David Greenbaum Health Agent Sanitarian Cc: Anne Lee, Rose Medallion Regular Mail CERTIFIED MAIL 7005 3110 0000 7160 4740 ( IMPORTANT MESSAGE ) + FOR �SP� CIG-� /�[�. DATE TIME 120 P . M Qin/iina//�: 1� OF PHONE AREA CODE NUMBER EXTENSION O FAX ❑ MOEIII F AREA CODE NUMBER TIME TO CALL I TELE ` PH ,.,,.. r ..., PLEASE CALL AM E TO SEE YOUU WILL CALL AGAIN WANTS TO EE YOU RUSH O f YOUR CALL WILL FAX TO YOU I,MESSAGE Y✓(�J��( 1Q /�rrn.�J T.nCl fi ii� I� /j 6/� ('p2 G SIGNED MOC FORM 3 MARE 5 A � I NOTES I I I , I IMPORTANT MESSAGE FOR �/� ,!}�A� DATE � 7 TIME 2�P.M.7 M �/ OF PHONE' AREA COOE NUMBER EXTENSION ❑ FAX ❑ MOEIII F AREA CODE UMBER TIME TO CALL TELEPHONED PLEASE CALL CAME TO SEE YOU I I� WILL CALL AGAIN v I WANTS TO SEE YOU ' I RUSH RETURNED YOUR CALL] WILL FAX TO YOU MESSAGE + SIGNED MADE IIN U.S ..A. 4 NOTES IMPORTAMT MESAtG�E/ _ FOR -- -- - -�-.�. DATE 9'-!b AL�TIME y � Pdrm. OF PHONE AREA CODE NUMBER EXTENSION ❑ FAX ❑ MCL571 Filu/J! �.a�O�rtn 1� (a,�.t-G �'iV2_� EA CODE NUMBE� TIME TO CALL TELEPHONED� ^ PLEASE CALL CAME TO SEE YOU 1� WILL CALL AGAIN WANTS TO SEE YOU RUSH RETURNED YOUR CALL ��1j WILL FAX TO YOU k N MESSAGE • /M.� 1J(i/��ni,a eg la a_7au epi J II SIGNED f FORM 4009 MARE IN U 5 A r � T N0iE5 i IMPORTANT MESSAGE ) FOR _ A.M. DATE �' - TI E� MI OF PHONE AREA CODE NUMBER EXTENSION ❑ FAX IF MOBI AREA CODE /WMBER TIME TO CALL - TELEPHONED CPLEASE CALL CAME TO SEE YOU I� WILL CALL AGAIN - WANTS TO SEE YOU f 4 RUSH RETURNED YOUR CALL f WILL FAX TO YOU SSAGE � SIGNED qg%ps FORM 4009 MAGE IN U.S.A. t NOTES a IMPORTANT MESSAGE FOR �G7iNiv/� 3s A.M. DATE �'-� 7--h-7 TIME ��M17r M OF PHONF 9 -7-g- 7�'�0 UVV2-Z 2 AREA CODE NUMBER EXTENSION ❑ FAX O MOE3P G AREA CODE NUMBER TIME TO CALL TELEPHONEDLEASE CALL CAME TO SEE YOU WILL CALL AGAIN WANTS TO SEE YOU I RUSH RETURNED YOUR CALL WILL FAX TO YOU k u MESSAGE S41LO, •so c-f'&� SIGNED cpz) � FORM 4009 MAGE IN U S A NOTES IMPORTANT MESSAGE--) FOR DATE " 7-4 7 TIME . / .M. M .i OF PHONE AREA CODE NUMBER EXTENSION �AREA-COOE N,UbMBER TIME TO CALL TELEPHONED (/'PLEASE CALL CAME TO SEE YOU I WILL CALL AGAIN I WANTS TO SEE YOU RUSH RETURNED YOUR CALL WILL FAX TO YOU MESSAGE 71 i ` SIGNEID w� MAAOE IIN U.S ...A. NOTES INSPECTION TIMELINE: GOURMET FARE January 9,2006 Routine Inspection • No Sanitizing solution available in establishment. • Dishwasher not working. • The kitchen hand wash sink completely obstructed. • Kitchen hand wash sink missing disposable paper towels. • Asked to see extermination invoices. None available February 13,2006 Re-inspection • There still no sanitizing solution available. • The dishwasher still not working. June 19,2006 Routine Inspection • Potentially hazardous foods stored above ready to eat food in reach in units. • Improper use of the 3 bay sink. • Improper washing and sanitizing of dishes and utensils • Employees observed eating and drinking in food prep areas • The kitchen hand wash sink obstructed • No hot water in the establishment • Asked to see extermination invoices. None available November 30, 2006 Routine Inspection • Numerous dirty dishes throughout the kitchen • Improper use of the 3 bay sink • Employees food and drinks observed in the kitchen • Kitchen hand wash sink found obstructed • Asked to see extermination invoices. None available December 8, 2006 • During a hearing in front of the Health Agent the owner was restricted to preparing only non potentially hazardous foods. June 11, 2007 Routine Inspection • Lack of sanitizing solution in the establishment • The back hand wash sink found obstructed • Back hand wash sink missing disposable paper towels • The back hand wash sink used for cleaning dirty utensils • Refrigeration units with PHF stored above RTE food June 13,2007 • A hearing was conducted to determine if this establishment could resume preparing PHF June 21, 2007 Re-inspection • Norlake freezer has an accumulation of ice • Same unit requires thorough cleaning • Gaps around the screen door • Back door is obstructed September 10,2007 • A customer filed a complaint with the Board of Health that they saw rodents and rodent droppings in the Gourmet Fare. Sanitarian,David Greenbaum conducted an inspection based on this complaint and observed rodent droppings in the utility closet and on the corner prep table. Sc; tc::ibcr 11, 2007 • I lealth Agent,Joanne Scott and Sanitarian,David Greenbaum returned to the Gourmet 1':ire and suspended the Food Service Permit due to the severe rodent infestation. October 9, 2007 An inspection was conducted because of continued complaints at the Gourmet Fare. • At that time rodent droppings were observed throughout the kitchen, in a large pan of prepared apple crisp,as well as, in equipment and utensils. • 1 i he establishment was ordered to close completely ,i ,��SS�''•4.jo-zr :i.*" •'. :i"rs+("' :, ': i �i�:;t'i. .�,�c;;t"�&`'� q: :: _..<: ra ,yid �t ��;�-w�.i=:: ;'�=.r`.::`i" ?•'" . �• y �7y'.t...� Giou 4ok;cs r,�re. t ° W; // t"r o errirt 5'orirt, � } n brd elr 'farts��virt tie ".;�-: �ier+oss �rart �rsard fs+�+c"c; pp+ts, 7Ciere. w:7r �e a: tn qz taSit'l 4:t 1I Aim 1 �V�5�._._,!�� _ i • . 1 I I ,�I n .,4 AkA ?44,41 lv,41 ss� j . " ;x 6 { 4,s�. 'S'.±�„4-�S•"�'N� � ��9I. �<p. ..0 �'� M'f". .. , + ..W" J�•.'( T -•.�tb ��R'.T. i�`rw s W Y.".3, f ." . 'f- !. iniR6 ' '` s,^m'SK'4 �`K"•",3 :K .:1 * - v !TmonweatthIf Massachusetts � "r. - 3 • �.,0. ,s'�'b''yata,?'i' -t- !'�!:,"�+ P;:�'b+r'r tPe; ti ;� ' _�+ `U ` 'f 5 `. "3 `''�CCii oI'S I m - "�'� � ' ''• r� � �k t .T . .�«.•,�'> �- .� ♦ � 4x ' ,. Ay;xnY+'�s». '«i.+Y,3"a�+...• ;rK,tm.-?'» r...-,t :;�."��:i `,S m.4r •� %, wa+� yy�. " k 16%+.' 5 r...> 4V.�'•. P6. � � :T h "rF S.'3: r f..:.. •'tr, •'_ ' Board of Health« ',� ;•` i:`.: n.';�i, .Ai:� ..S�..x-n' '"t'*fir".. � 'rc. :... . n$IGmbene Oris. toil's a„ t120 W s s ashiu on Stree t x 1 rrK Mayor h .. .-^.:'=s^,., .... ;t" r 4.ui - `;vV Y Y.v,{;, _ vt'•� �'' SALEM,MA 01970 Temporary Food Permit DATE PRINTED: 04/26/2007 ESTABLISHMENT NAME: Gourmet Fare File Number:BHF-2003-000007 73 Wharf Street Salem MA 01970 LOCATED AT: 0073 WHARF STREET SALEM, MA 01970 Permit Type Permit No. Permit Issued Permit Expires Fee Restrictions/Notes TEMPORARY FOOD BHP-2007-0471 Apr 26,2007 Apr 29,2007 Food to be Served;Cookies,Coffee, &Tea Total Fees: PERMIT EXPH2ES April 29, 2007 Board of Health _ Page 1 of 1 CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH 3 120 WASHINGTON STREET, 4TH FLOOR SALEM, MA 01970 TEL 978-741-1800 FAX 978-745-0343 JOANNE SCOTT, MPH, RS, CHO Kimberley Driscoll HEALTH AGENT Mayor APPLICATION FOR A TEMPORARY FOOD SERVICE PERMIT FEE: 1-3 DAYS= $200 r j��`r � 4-7 DAYS= $300 MORE THAN 7 DAYS= $400 C I a /\1 CHECK PAYABLE TO THE CITY OF SALEM, NO CASH NAME OF EVENT J I LL VI C, v ig-S - Vli 0_h OLA LOCATION DATE(S) OF EVENT 4,,A(1 - 07 I -/ p �7 NAME OF APPLICANT To 0-vi h.o- f-�0.+CL1 TELEPHONE# l7 �- PP I - (O I S ADDRESS l o o n - o✓1 Y1 � NAMEOFBUSINESS (gM(AgYIM0+n �Yo TELEPHONE# a22-7` S_ ADDRESS PICLeV-�n!� (JAAt2t,-- + S � (�/ CERTIFIED FOOD MANAGERS NAME �� OQV1 YIQ I LL4dA CERTIFICATION# (SYl A PLAN OF THE ESTABLISHMENT IS: ENCLOSED DRAWN ON THE BACK TYPE OF REFRIGERATION: _GAS _ ICE DRY ICE OTHER METHOD FOR COOKING/HOT HOLDING. GAS _OTHER METHOD FOR SANITIZING: _7 CHEMICALL �+ OTHER SOURCE OF FOOD: NAME: GO(xr IMOT PaKe- ADDRESS PjC Le r_Z'YkC� W 4C.1'_F FOODS TO BE SERVED INCLUDING INGREDIENTS AND METHOD OF PREPARATION •J I HAVE READ THE BOARD OF HEALTH, 'REQUIREMENTS FOR TEMPORARY FOOD ESTABLISHMENTS I HAVE HAD THE OPPORTUNITY TO ASK QUESTIONS REGARDING THOSE REQUIREMENTS I UNDERSTAND THEM, AGREE TO ABIDE BY THEM AND UNDERSTAND THAT FAILURE TO DO SO WILL RESULT IN REVOCATION OF MY TEMPORARY FOOD ESTABLISHMENT PERMIT PERSUANT TO MGL C62C, S49A, I CERTIFY UNDER THE PENALTIES OF PERJURY THAT I, TO MY BEST KNOWLEDGE AND BELIEF, HAVE FILED ALL STATE TAX RETURNS AND -�PAID ALL�STATE TAXES REQUIRED UNDER LAWL�t/VLV1-Q- _ Q7 'F S ATURE DATE SOCIAL SECURITY OR FEDERAL ID# ---------------------------------------------------------------------------------------------------------------------------------------- TEMPAPPL REVISED 1125M2 PERMIT p CHECK#S DATE �� ovr- 0,A " U p to v�` l Y+ 0073.Wharf Street Gourmet Fare City of Salem RETAIL FOOD - Food Establishment Inspection HACCP: ❑ Item Status Violation Critical Urgency Telephone: PROTECTION FROM CONTAMINATION 745-9190 Food Contact Surfaces Cleaning and Sanitizing FAIL Critical RED Owner: ,, Comment:There is no sanitizing solution available. Sanitizing solution of proper concentration must be readily available at all Joanne L. Hatch - work stations at all times. PIC. _ The dishwasher was not working at time of inspection. Dishwasher must be operational during all business hours. " Handwash Facilities FAIL Critical ❑d RED Inspector: David Greenbaum { Comment: The kitchen handwash sink found completely obstructed. Handwash sinks must be kept clear and accessible at all Date Inspected: Correct By: _ times,and used for handwashing only. 1/9/2006 Kitchen handwash sink missing paper towels. Provide disposable paper towels at the handwash sink at all times. Risk Level: Permit Number: BHP-2006-0095 ,'', Status: VIOLATION #of Critical Violations:. - 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 GeoTMS®2006 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Jan 10,2006 ) Page I oft Item Status Violation Critical Urgency RED: Violations Related to Good Retail Practices (Blue Items) Violations Related to i Food and Food Protection FAIL Critical BLUE Foodborne Illness Interventions \ and Risk Factors (Require f Comment:There is food stored directly on the freezer floor and kitchen floor. All food must be stored at least 6-8 inches off the floor. immediate corrective action) Equipment and Utensils FAIL Nan-Critical BLUE Comment:The mikcrowave has an accumulation of food spills and splatter. Thoroughly clean the microwave. \ The Kenmore freezer is missing a thermometer. Provide a visible,accurate thermometer in this freezer. �j The Kenmore oven has an accumulation of food debris. Thoroughly clean oven. The Duke oven needs a thorough cleaning. There are dirty racks and trays. Thoroughly clean all racks and treys. All tables and work surfaces have an accumulation of food debris and splatter.Thoroughly clean and sanitize all tables and work \vJ surfaces. Physical Facility FAIL Non-Critical BLUE Comment:All floors,walls and surfaces need a thorough cleaning including under and around all equipment. The establishment is in need of a complete reorganizing and cleaning. GENERAL COMMENTS: 416: 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 Jan 10,2006 ) Page 2 oft 4 0073 Wharf Street Gourmet Fare City of Salem RETAIL FOOD - Food Establishment Inspection HACCP: ❑ Item Status Violation Critical Urgency Telephone: PROTECTION FROM CONTAMINATION 745-9190 Food Contact Surfaces Cleaning and Sanitizing FAIL Critical RED Owner, Comment:There is no sanitizing solution available. Sanitizing solution of proper concentration must be readily available at all Joanne L. Hatch work stations at all times. PIC: The dishwasher was not working at time of inspection. Dishwasher must be operational during all business hours. Joanne Hatch GENERAL COMMENTS: Inspector: David Greenbaum 475:AII other violation cited in 1/9/06 inspection report have been corrected. Date Inspected: Correct By: 2/13/2006 Risk Level: Permit Number: BHP-2006-0095 Status: SIGNED OFF #of Critical Violations. 1 Time IN Time OUT: Urgency Description(s): BLUE: Violations Related to Good Retail Practices (Critical violations must be corrected immediately or within 10 days)(Non-critical violations must be corrected immediately or within 90 days) City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741-1800 GeoTMS®2006 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Feb 14,2006 ) 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 GeoTMSO 2006 Des Launers Municipal Solutions, Inc Commonwealth of Massachusetts ( Rev. Feb 14,2006 ) Page 2 oft f 0073 Wharf Street Gourmet Fare City of Salem RETAIL FOOD - Food Establishment Inspection HACCP: ❑ Item Status Violation Critical Urgency Telephone: PROTECTION FROM CD)ITAMINATION _74_5-9190 Separation/Segre ion/Protection FAIL Critical 66 RED Owner: Co ent:There is chicken stored above other food items in the Green World reach in. Store all potentially hazardous foods below Joanne L. Hatch ady to eat food to prevent cross contamination. PIC: Food Contact SU65ces Cleaning and Sanitizing FAIL Critical RED Joanne Hatch C ent:The 3 bay sink is completely cluttered and obstructed with dishes and utensils.The 3 bay sink must be kept clear and Inspector: ccessible and used in a three part system to wash,rinse and sanitize all dishes and utensils. David Greenbaum 5ygienic re pans encrusted with chocolate on the stove. All pans must be properly cleaned and sanitized after each use. Date Inspected:Correct By: GoodPr ces FAIL Critical � RED 6/19/2006 Risk Level: ent:There was evidence that employees are eating in the kitchen area. Employees must eat in a designated breakroom to t cross contamination. Handwash Facilit FAIL Critical 0 RED Permit Number: BHP-2006_0095 _ /rehot he kitchen hand wash sink found completely obstructed. Keep hand wash sinks clear and accessible at all times. Status: Thehot water in this establishment due to the hot water heater not working. Owner must repair the hot water heater and VIOLATION rewater immediately. # of Critical Violations: 4 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. Jun 21,2006 ) Pagel oft Item Status Violation Critical Urgency RED: Violations Related to Good Retail Practices (Blue Items) Violations Related to Equipment and Utensils FAIL Non-Critical BLUE Foodborne Illness Interventions and Risk Factors C nt: .he Kenmore freezer is missing a thermometer. Provide a visible,accurate thermometer in this freezer. (Require immediate corrective The en has an accumulation of food debris and grease. Thoroughly clean the stove. action) _ _ Th is an umulation of ice build up in the walk in freezer. Thoroughly defrost and remove all ice build up. hAe needs a thorough cleaning and organizing. T micro a has an accumulation of food spills and splatter. Thoroughly clean the microwave. T iter table has an accumulation of food debris. Thoroughly clean the mixer table. T Green World cooling unit has an accumulation of food spills and splatter. Thoroughly clean this unit. Physicacility s FFAIL Non-Critical BLUE m t: The flooring throughout the establishment needs a thorough cleaning,including under and around all equipment. T ere is an area of unfinished wood on the end of the counter. This area to be made impervious and easily cleanable. �,There.js a hole in the ceiling above the 3 bay sink. Seal this hole. is entire establishment is in need of a thorough cleaning and organizing. GENERAL COMMENTS: 668:Reinspection will be in one week, all violations to be corrected. U 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. Jun 21,2006 ) Page?oft 007?*Wharf Street Gourmet Fare City of Salem RETAIL FOOD - Food Establishment Inspection HACCP: ❑ Item Status Violation Critical Urgency Telephone: Violations Related to Good Retail Practices (Blue Items) 745-9190 - Physical Facility FAIL Non-Critical BLUE Owner: Comment: There is a hole in the ceiling above the 3 bay sink. Seal this hole. Joanne L. Hatch GENERAL COMMENTS: PIC: Joanne Hatch 684:All other violations cited in the 6/19/06 have been corrected. Inspector David Greenbaum Date Correct By 166 Risk Level: ' Permit Number: BHP-2006-0095 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®2006 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Jun 29,2006 ) 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. Jun 29,2006 ) Page 2 oft 0073 Wharf Street Gourmet Fare City of Salem RETAIL FOOD - Food Establishment Inspection HACCP: ❑ Item Status Violation Critical Urgency Telephone: 1 PROTECTION FROM CONTAMINATION 745-9190 Food Contact Surfaces Cleaning and Sanitizing FAIL Critical RED Owner: C ent:There are numerous dirty dishes throughout the kitchen. All dishes and utensils must be properly cleaned and sanitized Joanne L. Hatch i fter each use. PIC' T bay sink is cluttered with dirty dishes. all dishes must be properly cleaned and sanitized. Joanne Hatch Goo yg"mc Practices FAIL Critical ❑d RED Inspector: David Greenbaum Com t: Employees drinks observed in the kitchen area. Employees must eat and drink in a designated employee area to pr ent cross contamination. Date Inspected:Correct By: 11/30/2006 Hand2h Facilities FAIL Critical ❑d RED Risk Level: Com .The kitchen hand wash sink found with pails and utensils in it and obstructed. Hand wash sinks must be kept clear and a ssible at all times and used for hand washing only. Permit Number: BHP-2006-0095 Status: VIOLATION #of Critical Violations: 4 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. Nov 30,2006 ) Page 1 of Item Status Violation Critical Urgency RED: Violations Related to Good Retail Practices (Blue Items) Violations Related to Food and Food rotection FAIL Critical BLUE Foodborne Illness Interventions and Risk Factors (Require . CA ment: Paper products stored directly on the floor. All paper products must be stored at least 6-8 inches off the Floor. immediate corrective action) Equipment and Uten 'Is FAIL Non-Critical BLUE C em The Kenmore oven needs a general cleaning. T uke n has an accumulation of food debris on top. Thoroughly clean the top of the oven. The more freezer has an accumulation of food spills and splatter. Thoroughly clean the freezer. T Itchen prep tables need a thorough cleaning and organizing. Th icrowave needs a through cleaning. g tT foo tale has an accumulation of food debris. Thoroughly clean the scale. All king trays have an accumulation of food debris. Thoroughly clean all baking trays. LT5earadirty food bins in the Green World reach in. Thoroughly clean all food bins. The cks of the Green World reach in have an accumulation of mold. Thoroughly clean all racks. en World reach in needs a thorough cleaning and organizing. e front reach in freezer needs a general cleaning. The nt microwave needs a general cleaning. Physica acility FAIL Non-Critical BLUE 69 ment:The flooring throughout the establishment needs a thorough cleaning including under and around equipment. The tire establishment is cluttered and disorganized. The establishment must be thoroughly cleaned and organized and all items pertinent to the business must be removed. GENERAL COMMENTS: 1037:Reinspection in one week, all violations to be corrected. Due to the constant state of disorganization and repeat violations the owner may be required to attend a hearing in front of the Health Agent. 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. Nov 30,2006 ) Page 2 of - frd 7 1 Item Status Violation Critical Urgency 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. Nov 30,2006 ) Page 3 of 0073 Wharf Street Gourmet Fare City of Salem RETAIL FOOD - Food Establishment Inspection HACCP: ❑ Item Status Violation Critical Urgency Telephone: PROTECTION FROM CONTAMINATION 745-9190 Food Contact Surfaces Cleaning and Sanitizing PASS Critical RED Owner: Comments:There are numerous dirty dishes throughout the kitchen. All dishes and utensils must be properly cleaned and Joanne L. Hatch sanitized after each use. PIC: The 3 bay sink is cluttered with dirty dishes. all dishes must be properly cleaned and sanitized. Cynthia Nadeau Good Hygienic Practices PASS Critical Q RED Inspector: David Greenbaum Comments: Employees drinks observed in the kitchen area. Employees must eat and drink in a designated employee area to Date Inspected:Correct By: prevent cross contamination. 12/19/2006 Handwash Facilities PASS Critical ❑d RED Risk Level: Comments:The kitchen hand wash sink found with pails and utensils in it and obstructed. Hand wash sinks must be kept clear and accessible at all times and used for hand washing only. Permit Number: BHP-2006-0095 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®2006 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Dec 20,2006 ) Page 1 of Item Status Violation Critical Urgency RED: Violations Related to Good Retail Practices (Blue Items) Violations Related to Food and Food Protection PASS Critical BLUE Foodborne Illness Interventions and Risk Factors (Require Comments: Paper products stored directly on the floor. All paper products must be stored at least 6.8 inches off the floor. immediate corrective action) Equipment and Utensils PASS Non-Critical BLUE Comments:The Kenmore oven needs a general cleaning. The Duke oven has an accumulation of food debris on top. Thoroughly clean the top of the oven. The Kenmore freezer has an accumulation of food spills and splatter. Thoroughly clean the freezer. The kitchen prep tables need a thorough cleaning and organizing. The microwave needs a through cleaning. The food scale has an accumulation of food debris. Thoroughly clean the scale. All baking trays have an accumulation of food debris. Thoroughly clean all baking trays. The are dirty food bins in the Green World reach in. Thoroughly clean all food bins. The racks of the Green World reach in have an accumulation of mold. Thoroughly clean all racks. The Green World reach in needs a thorough cleaning and organizing. The front reach in freezer needs a general cleaning. The front microwave needs a general cleaning. Physical Facility PASS Non-Critical BLUE Comments:The flooring throughout the establishment needs a thorough cleaning including under and around equipment. The entire establishment is cluttered and disorganized. The establishment must be thoroughly cleaned and organized and all items not pertinent to the business must be removed. GENERAL COMMENTS: 1073:AII violations cited in the 11/30/06 inspection report have been corrected.} Owner is restricted to preparing foods that are not potentially hazardous. Prior to resuming the preparation of! PHF the onwer must submit a plan to the Health Agent for approval: City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741-1800 GeoTMS®2006 Des Ladders Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Dec 20,2006 ) Page 2 of Item Status Violation Critical Urgency 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. Dec 20,2006 ) Page 3 of r I , CITY OF SALEM BOARD OF HEALTH Name of Establishment: Gourmet Fare Address: 73 Wharf Street Owner(s): Joanne Hatch Phone: 978-745-9190 Date: December 8, 2006 �a During an inspection by Board of Health Sanitarian David Greenbaumbbserved many violations observed consistently over the past several inspections. These include, but are not limited to, obstruction of the hand wash sink, lack of sanitation, and lack of organization. These conditions may be critical and increase the risk of foodborne illness. Therefore, the owner was asked to appear before the Health Agent to discuss these violations. The owner is ordered to cease preparation of potentially hazardous foods such as meat items, pasta dishes, and soup until the Board of Health determines in writing that such food preparation may resume. In addition, preparation of such potentially hazardous foods is suspended until the owner presents a plan showing that those foods will be prepared in accordance with the State Food Code. I � i'O1c�na2G (Joanne Hatch Date Joanne Scott Date caner Health Agent .N 0073 Wharf Street Gourmet Fare City of Salem RETAIL FOOD - Food Establishment Inspection HACCP: ❑ Item Status Violation Critical Urgency Telephone: PROTECTION FROM CONTAMINATION 745-9190 Food Contact Surfaces Cleaning and Sanitizing FAIL Critical RED Owner: Comment:There is only one bottle of sanitizer available at time of inspection. Sanitizer to be readily available at all work stations Joanne L. Hatch with proper concentration. PIC: Handwash Facilities FAIL Critical ❑d RED Joanne Hatch Comment: Back hand wash sink obstructed at time of inspection. Hand wash sink to be clear and accessible at all times. Inspector: John Gehan Same sink has no paper towels. Provide paper towels. Date Inspected:Correct By: Same sink has utensils stored in it. Sink to be used for hand washing only. 6/11/2007 Risk Level: Permit Number: BHP-2007-0293 Status: Open #of Critical Violations: 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 GeoTMS®2007 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Jun 11,2007 ) Page 1 oft t�. Item Status Violation Critical Urgency RED: Violations Related to Good Retail Practices (Blue Items) Violations Related to Food and Food Protection FAIL Critical BLUE Foodborne Illness Interventions and Risk Factors (Require Comment: Norlake freezer has uncovered foods.All foods must be covered. immediate corrective action) There are food products stored directly on the floor. All foods and food products must be 6.8 Inches off of the floor. Green world refrigerator requires organization to prevent cross contamination. Equipment and Utensils FAIL BLUE Comment: Norlake freezer has accumiation of ice. Find source of leak and repair. Same unit requires thorough cleaning and organization. Microwave requires general cleaning. Green world refrigerator requires thorough cleaning. There is a strong odor upon opening of doors. Find source of odor and discard. Same unit has no visible thermometer. Provide visible and accurate thermometer. Physical Facility FAIL BLUE Comment: Door open at time of inspection. Door to remain closed to prevent entrance of rodents and or insects. The entire back area requires general organization. Mobility throuought the kitchen area is difficult due to a large amount of inventory. Passage ways must be clear and accessible. Other-See Notes FAIL BLUE Comment:The back door is obstructed. Door should be clear and accessible. GENERAL COMMENTS: All violations to be corrected within one week. A routine inspection will be conducted at this time. 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. Jun 11,2007 ) Page 2 qf 2 0073 Wharf Street Gourmet Fare City of Salem RETAIL FOOD - Food Establishment Inspection HACCP: ❑ Item Status Violation Critical Urgency Telephone: PROTECTION FROM CONTAMINATION 745-9190 Food Contact Surfaces Cleaning and Sanitizing FAIL Critical ❑d RED Owner: Comment:There is only one bottle of sanitizer available at time of inspection. Sanitizer to be readily available at all work stations Joanne L. Hatch with proper concentration. PIC: Handwash Faci'ties FAIL Critical ❑d RED Joanne Hatch Comment: Back hand wash sink obstructed at time of inspection. Hand wash sink to be clear and accessible at all times. Inspector: John Gehan •-same sink has no paper towels. Provide paper towels. Date Inspected:Correct By: Same sink has utensils stored in it. Sink to be used for hand washing only. 6/1112007 Risk Level: Permit Number: BHP-2007-0293 Status: Open #of Critical Violations: 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 GeoTMS®2007 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Jun 21,2007 ) Page I oft Item Status Violation Critical Urgency RED: Violations Related to Good Retail Practices (Blue Items) Violations Related to Food and Food Protection FAIL Critical BLUE Foodborne Illness Interventions and Risk Factors (Require Comment: Norlake freezer has uncovered foods.All foods must be covered. immediate corrective action) —There are food products stored directly on the floor. All foods and food products must be 6.8 inches off of the floor. reen world refrigerator requires organization to prevent cross contamination. Equipment and Utensils FAIL BLUE omment: Norlake freezer has accumlation of ice. Find source of leak and repair. Same unit requires thorough cleaning and organization. Mi —crowave requires general cleaning. ,,Green world refrigerator requires thorough cleaning. There is a strong odor upon opening of doors. Find source of odor and discard., ,,Same unit has no visible thermometer. Provide visible and accurate thermometer. Physical Facility' FAIL BLUE ,,comment: Door open at time of inspection. Door to remain closed to prevent entrance of rodents and or insects. .,-The entire back area requires general organization. JVldbility throuought the kitchen area is difficult due to a large amount of inventory. Passage ways must be clear and accessible. Other-See Notes FAIL BLUE /Comment:The back door is obstructed. Door should be clear and accessible. GENERAL COMMENTS: All violations to be corrected within one week. A routine inspection will be conducted at this time. 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. Jun 21,2007 ) Page 2 oft CITY OF SALEM BOARD OF HEALTH Name of Establishment: Gourmet Fare Address: 73 Wharf Street Owner(s): Joanne Hatch Phone: 978-745-9190 Date: June 13, 2007 In December 2006, the Salem Board of Health limited the preparation of food at this establishment because of repeat food code violations. The owner indicates that she has hired a full time cook and part time cleaner to assist her at this location. The last routine inspection on June 11, 2007, indicated a lack of organization. However, Ms. Hatch indicates that that was due-to construction of a shelf. She further indicates that the establishment is now organized, sanitary and in complete compliance with the Code. The Board of Health will conduct a reinspection of this establishment and make a determination at that time if the suspension of potentially hazardous food preparation may be lifted. In addition, Ms. Hatch has presented plans for an additional establishment, the Rose Medallion Tea Room pat 184 Essex Street that will be receiving potentially hazardous foods prepared at the Gourmet Faire. Ms. Hatch understands that the Gourmet Faire must comply with the Food Code if this establishment will supply the food as she plans. A reinspection will be conducted on June 18, 2007. -12%e W")y be ao es{Qbhstincu� rvlelto-ve� 14- ks e��e.i l�vsi�ou � 4"'L-d' ocvYvn nne Hatch Date Joan cott / Date Owner 0_13_07 Health Agent Y ' UNDERCOOKED FOODS If you plan not to sell undercooked foods, you menu must state this. EXTERMINATION Monthly services of a Licensed Pest Control Operator are required. Please keep receipts for inspections. SANITIZING Sanitizing Solution must be accessible at each prep station and for the patrons' tables. Test strips corresponding to the kind of sanitizer, must be on hand to check concentration of solution. Solution must be made daily, tested, and the results recorded on a log sheet for examination by Board of Health inspectors. Solution may be made in the food prep sink and spray bottles may be filled there. Spray bottles with clean paper towels may be used, as well as wiping pails with wiping clothes always held in the solution in the pail. The owners plarf to use an NSF approved dishwasher with a final rinse of 180degrees. 4// eQdijaju,464 -o/ he h1nr- QPPf^"e1- Areas outside of premises, including the dumpster area, must be kept clean and sanitary. 46anne Scott/ Date Health Agent J ne Hatch Date O ner r 0073 Wharf Street Gourmet Fare City of Salem RETAIL FOOD - Food Establishment Inspection HACCP: ❑ Item Status Violation Critical Urgency Telephone: Violations Related to Good Retail Practices (Blue Items) 745-9190 Equipment and Utensils FAIL BLUE Owner: Comment: Norlake freezer has accumlation of ice. Find source of leak and repair. Joanne L. Hatch PIC: Same unit requires thorough cleaning of bottom area. Joanne Hatch Physical Facility FAIL BLUE Inspector: Comment: Screen door has visible air gaps. Gaps to be sealed to prevent entrance of insects/rodents. John Gehan Other-See Notes FAIL BLUE Date Inspected:Correct By: Comment:The back door is obstructed. Door should be clear and accessible. 6121/2007 Risk Level: GENERAL COMMENTS: All violations from June 11, 2007 have been corrected unless noted. Permit Number: BHP-2007-0293 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. Jul 18,2007 ) Page 1 oft at ' Item Status Violation Critical Urgency RED: Violations Related to Foodborne Illness Interventions and Risk Factors (Require immediate corrective action) City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741-1800 GeoTMS®2007 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Jul 18,2007 ) Page 2 oft i CITY OF SALEM BOARD OF HEALTH Establishment Name: Gour-" f F-oree Date: R -//- 07 Page: i of 'i Item Code C-Critical nem DESCRIPTION OF VIOLATION/PLAN OF CORRECTIONI Date fNo. Reference R-Red Item - Verified i PLEASE PRINT CLEARLY I (fin In , n -fa q ro� � Connn/ui" � , LA1GS C,�// w� d rrylP6;_P1q-1im o - v fit {'. GYC 14 l�eii!'N v�S-2i JQc� 11b JE.-l4 Sr Cln2d a vc�,> / e� u� 46 4,4o �)Oa /-k, d JVIhe r2 , aOn-7Q�"��i `a1DA� /1ia'7I� /i �a Sv� U/c�5 G� Q ,� L r�r LS/P,� ��s-/� r�,�/-/i-o/ �J/?�ro�- � r� / ✓/O/��i� r� / />Q•,Q�I� I ✓fa-Yt UPMdP �,? dati nosh Qe-�-1z-�1/ S2✓U/�5 h�� yI0-/ 6u-,�" ' l/P✓/�.v� cit S/nG/ Ock� a70DGr A `/6 -1t/� i7-/ -14a CGrX� D�_ 2� �v��v� �hsnQ lan , Ddb U-05 ll�l�y O/ /� -7 ` I C��=/,?. r..�d .sl�r� � � MGti�! eu-f�?u•,�ff� �a�dn,��.�s awl �/ 7'dDo��/� w.�•e o6u��/ L �k�• la/pe�r��w.� 3 �aC,[Jaq�o{ �i>�s �h �yaPz �Y Q�cl -�G�vd 1�vdd.�v/-s -Je-✓ c�rs�'�,�i aSfP�f sire 49 ImV h4oe_ V'a.du'lpew tvI/, n r lyl �d/t q 4 d4k IaO '9 AO ctvn p[�'is �1",00 e b/u ir�Gu �` a��•3� - l C��s� U��r! h 1 I vw9t, i e� 64 hl5 �// -(-4 o rl�sf -�•- �,'i I P� /�//5h�.�!-• Le-��I I�-ier�s ave �u�•�-;' a-, ve /n�P-��% is �u-�.d��; ��/ 1 amu, �ia�d O-� llama /•f1 -s.1�.Los �h /s>v/��ti �r�� d� r�`elol WI�Cu �s _ Cd>lc�iir�l� QGIG//ri _: i�lr��/ S� lC � Q•P 77i5 �cussion With Person in Charge: V` t{�� ' Coirective Action Required: I ❑ No I ❑ Yes I have read this report, have had the [opportunity to ask questions and agree to correct all ❑ Voluntary Compliance ❑ Employee Restriction/ Exclusion violations before the next inspection, to observe all conditions as described, and to ❑ Re-inspection Scheduled ❑ Emergency Suspension comply with all mandates of the Mass/Federal Food Code. I understand that noncompliance may result in daily fines of twenty-five dollars or suspension/revocation of ❑ Embargo ❑ Emergency Closure your food permit. ❑ Voluntary Disposal ❑ Other: f NiYF Recr)wd at Fempetaidies Viiihilions,Related to Foodborne Illness Interventions and Risk Ar, *Sing tri Lav, Cooled to Factors(Items,1-22) (Cont.) :3`t r-i:;-b Within 4 How PROTECTION FROM CHEMICALS for PHFs Food or Color Additives PHF Hot and Cold Holding ('Od PRFs 'Maint:,ined arm below 3 302,14 Protection front I Inappowed Additives, Is Poisonous or Toxic I Im FHF4�: Mairr;aned at or abow 14l; F !oI.I I ldcsvt.tping trifni ination--Original Rkiato Ht Id at or abow I 1011F, Containzr't` ZO I Time as a Public Health Control 7 1C12.?I ConnnotiName -'Aor*t,Coatajteere' I1 I'lin,as a Public lieribit Control 1-2()I.11 1 S�paj,jb,,q-Slorallc" 7-202,11 Peatr;ciiori-Pp,st-rim and L,c' L.-:`..-.--:..- 't i;'in(v Requirv,imit 7-21021.12 GjndjtioyiS of UW RrOUIREMENTS FOR H;CHLY SUSCEPTIBLE 7 203AI ToKk CoittLiriot; - Probtbi�wml' 7-204.11 sailhizerq,Crater!:, -Clemic;dc, j POPULATIONS(HSP) 7-204.12 Chnrnic,0�,for tVir,hioy lliodswc.t':fitetial -11 1-Si)I I I G") 'Unlpawtjrl;�d Ili c-p�t ittlgcd Juices and Warnitip 1-�ls�lsl 7-20.4,14 Dh,,nw, -�wv.mt.Criwria -— 1,1 iscarils' �.S't L":•t 4 xl5 I I Incidtin"') clnl�tl. Dl� —1 1.1 H�D) K��'v yr Pat I laliv 0,ol"d Aratinal Folid and 7-206.11 kc�sirici�ai UIsfle�iitiriet,,0ita itel I ,t Xa� S,�-d �'Jlrolvty N�'t sltrVed. 7-2ft 12 Roilew B;iirt Siaoom,' I [ "-2ifi; 13 Ttackcn�Powdcc, P,,�i Control and --I X I.) r Ur-opeiwd F;xki Puckaci: 'vQi Rc sQrverl, CONSUMER'ADVISORY 2' TIME/TEMPERATURE CONTROLS 1 j f lal'isom Puwir 1%'r Cl:Aisuraption of, 16 1 :ono:,I€ 'I bat irc R:Lw, Underooikcd is ii Proper Cooking Terrippiatures tar PHFs to F.Iiiiinate 3 401 11 A(I;(-) rggs- I Si'F 15 S,,c. f7l'gs-lmnr�dcqc Service 14 VT 15-'N 11 F'ai%>uhzufql,• for [Law Shelf i 4i)[A 1(Ark c(ilinvinuted Fitih, Meats& Cijinv Anhivtk. t351' 15 se,:. ' 4 40 1.11(Hy 1.)i 2) Pirti, and Bcel Roam LWY 121 ntiO iSPECIAL REOWREMENTS i h)I.I I(A)i 2) Ritiiie��, Injeocti Mv�il�s 155 i, L', Vic.,141101i, (if Secdoii 90.(X)9(A)-(I-))in stc. i'iiluillrt- ln')hdo lcKXL kenipolaty and 3 .101 II(AY-4) flinflb 'Wild Ciatnc, Stuffed PHFs' c:td�'nllal':dchcll oftLTations 'hould he SIuRme Containing Fish, Meat, I dekled uwkr IN,,appropriate seclloni P,)Illtr,;'or RjEncs-1(5"Y 15 qcC. alti,ve -f FtAwcd to fxillhornu fflncsc 3-401.111 C)(;" Intact [itcf Steaks trit'n keo0ow;and ri,k Cac-lflrs. Othr 145"'F 1 "140.009 violatiorrc relaimp to pood retail 3-401 J''' liam Annnal Fk,tds Cv,,kcill in a ! jftsclw"S buld6ls debited under #29 - Miclowave 1(1.5 F spc%n'd 145'1 15 wc It E Reheating for Hot Holdbiq__... VIOLA DONS RELATED TO GOOD RETAIL PRACTICES 3 4011.11(A)&,t D) 31f-[P, 165'4, 15 se, (Helg'N:?3-30) 3 4W.I I(b) Nlicrolyaw- 1654,12 Mwine SLandiar, Ciii rola;rlw-rnl!a! lvi'Wi donol telarc to dt� Tj tile� 1 'V rola; locellt)rn in te,wnti,a,s. j��')i,A pyc tc,re b lt,,j j(,oj;C, ,li n bl, , 403.1 it C) Climincrcralb, Piove�'scJ RTF Kt," grana ie flo-1,41,awns rvcrzna,i,,Ithc font d Cdo awl YO CUR 140V` 3-403 1 I(E) Rciriarlifiv, uns1wed Portions of Beel Item Good Refad practices I FC t__5_90.000 2 R,ia,,I,* 23 Psin'Mr,ut Proptur Cooling of PHFs 24 FEg--- ---L-00-3i Food pr'lectlo, FC 3 004 Equ;pn_,�.ni,�qrLy�,!tnsiti I'C. 4 A05 5()1,14(A) C(k'fi1)gCfX)J,(d PHFs frtml I i4)'F to 1 1- -- ---- Y�ater,i�lt:,nbllici rtrc"'lasle i FC-5 1 ow 70J:Within.7 1 fours a !Y : FC -t4 1, 007 . ------ il,4! J 145 P Within I Hoirrs, 26, T-osir Maipn�ls - 1-11- - - - - -- -0:- 7-- L008 ; '5CjI.i4iB) Cooling Pi lFs Made Flour Ambient9 009 Tciniterature it,41 1145'F Within 4 How', Oer.40-1111cll ittil)ill It,letletif CITY OF SALEM II BOARD OF HEALTH 1 Establishment Name: Date: Page: of I Rem Code C-Critical Rem "DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date No. Reference R-Red item Verified �. PLEASE PRINT CLEARLY ' SP"L_' I - - ' ? 'nn/'s Ja _ 1� I®I��1�,: /oH -fes 0 ,I1 _�6 lePS /N,[�54 -4,,All I a All 14,4. //, ,'�7 1/x1 14f' s is y^ c vt Aln.n 'a A/4/o 12,10l2araciL ] / f/1/! nn1_1 /,l 141) .IDS C i JP Lo ✓>di4_"'_ m/.s' . Discussion With Person in Charge: h!>C d z? p„/'1 Corrective Action Required: I z) No I ❑ Yes I have read this report, have had the opportunity to ask questions and/ agree to correct all ❑ Voluntary Compliance ❑ Employee Restriction/ inspection, to observe all conditions as described, and to Exclusion violations before the next ins P ❑ Re-inspection Scheduled ❑ Emergency Suspension comply with all mandates of the Mass/Federal Food Code. I understand that noncompliance may result in daily fines of twenty-five dollars or suspension/revocation of ❑ Embargo ❑ Emergency Closure your food permit. ❑ Voluntary Disposal 0 Other: 3-=,l'A PHVb Rccnwi;al`ernpcaaLores Violations Related to Foodborne fitness interventions and Risk A-cm diat:to f,at Ckx,lod to Factors(items 1-22) (Cont) Wili,in,l Hans PROTECTION FROM CHEMICALS tor VHFf. 1 19 PHF 401 and Cold Holding 14 Food or Color Additives I c()1.16(H) CoW pl[!Fs"Molnu6ned at or ball ?-202,12 Additives* 5,K€A)ArW) 3-302,14 Protccuor;fronk Ljnappn,ned Adffitive�' ,� % ',-501.161A) i lot Hll- laintatried at or abovePoisonous or Toxic Substances IF 101.11 ldcritifyiny lntonn,;twn-- Oiwinal '40'F tolltailler,; 1.1(VA Rwst�H.id;ct or above 130"F, 102,11 i20Time as a Public Health Control 7-20!.11 1 1� Timt as a Public)lealth Control' SQ'xtmlion- Sloagc" Rcvi,oion -pFcc�Dec'ud uscV,danc°ReQuiremolt 7-202.12 Condpi"n"ot Usc, 7 203 11 Toxic Colllalncla - PluNboion'! REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7 204.1; Saawzn i,Criiuri.i—Ch:,lic,N I POPULATIONS(HSP) 7-,@1.12 ChoidcAk for 1Nashjcg Ilmdmv,Ctitci;at 21 "8;11 tMo Unl,cqrcuw.cd PW-llDd,JgCd JUJICS alld vl;h Wanzilig iabh' 7 204.14 Di,onc Auvws.Crwria` 1._205 1! InctilLmW Food(A,nt.w.Imb)IcalIN, f B� 17 ,�of E"c" �-W] I 10)r i'a" or Pa4i,afl,, CoAd Aufmal Food and kc,kncl�d Lse Pe,lici,les,Cntvna� R,i., Seed Siloam Nut S(, 7 206.12 Rolow B:Iil Sl:tooTc,1 Unopened F�Kd PjCj agl Nut Re,wrvol, .?06C? T(acking Powicri, fl�t Control and CONSUMER ADVISORY 22 3 4,0� 11 op.<wwr Aotisory lou Cooliuliptitjn of TIMEttEMPERATURE CONTROLS Proper Cooking Temperatures for iW, Thai arc lz;,w, Underox,kcd ci PHFs Oflwr,;i'se prk,vc�rd ta Eimmate 3 401.11.1(1 t(s} Fp"' 155 )") ,,o_ P-,;ronticd Ft,t-Ss,bsionit4 for Raw Shell Fgl,,s lniiwdiole Sei,.wc 1451'15,ec Nlcat�& 3 401.11(9){1;12) 11(hk and li,d I 11)'F 121 mir, SPECIAL REQUIREMENTS Vi�lao,11),oi Sccbw in 4 L'i 0)(2i lltlecl A Mv,ltb - 195 F I food,i,mporuty and llowtr ,Nk ild f Bluffed ' kilchcn op,riltiOns should he � Soiffi)'i,v Contaming Fish,Meal, dc�h�lcd imdtn-the apprupriaw �Wjoils poultrV014 15 scc. above it related to fo(Ahorric i IiCl'3) Whole aw.,wlc, inlac.1 (avcf Steaks iWei ventions and ri::k faclorq. Other W;"F , 5QO,091)viofwioos retalinlg iorl,rxl retail I '1-401.12 Raw Annual HhO,('iwk(;d in a pifwbete 0widd iv debited under #29 - 165,F I 3-401 IliA)(1)(h) All 01hel llllrs-- W's,F 15 tC, I? Reheating for Hot Holding j VIOLA TIONS RELATED TO GOOD RETAIL PRAcrtms 3-iO3,11{A)&(1)) piff", !P5"F 1': 21-30) (Li) %lonmva%,e- 165" l, 2 Mlaw"siartjia, rl.m ;:z),J,r:r,rim al wwmway. :+hiri too noi relate to der laic ind nA jaror,, hqrdaboi e, r an be 3-4r)3.1 I Con,fociJally RTF hxki - _'WzOro j z", Food C.dflnd 105 CAIR 14WF: ,A03,1 I(F) Rcmainin, Un,li,td Portions of Ficel : item Gond Rerad Practices Fe 590,W0 manmirmco al IFC, P NO 24 xid*irl�Fow Ftoemiw C- 3 Proper Cooling of PHFs 004 i n: —A 3 005 501 141 A) Ctohng Co�&,d iran W0"F to Ut-�IISI!3 C , Vvafor4 P41mbma;,Jld VV,tslre FC-.5 i 006 70"F Within 2 Hour:and From WY F I Phys,,-a:,Fac lite FC—6 007 w4l'F/45`F 41'itlda4 HOUB (.,t T�4r F-C _-7 008 z_501 14(H) Cooling PHF Made From Awbicni 009 1 '17cmPCrawre ln!;reklicllts(("WF/45 W*rlhin 4 t k4w, era dracal cm,n the 1V!,19 Fkl;xi(*,.!,,,r 165 "It,590 i CITY OF SALEM BOARD OF HEALTH 2 Establishment Name: Date: q- I/- 0 7 Page: 3 of Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTIONDate 3 No. Reference R-Red Item 1 Verified PLEASE PRINT CLEARLY -�F/GTIp_ I �YY�iP796i I " J ` r„Ae2 -)V,-/� -hJ 1/Par� PS li7 5 PCn � e�.� I � i I T F I I I Discussion With Person in Charge: I Corrective Action Required: ❑ No I ❑. Yes I have read this report, have had the opportunity to ask questions and agree to correct all ❑ Voluntary Compliance ❑ Employee Restriction/ Exclusion violations before the next inspection, to observe all conditions as described, and to ❑ Re-inspection Scheduled ❑ Emergency Suspension comply with all mandates of the Mass/Federal Food Code. I understand that noncompliance may result in daily fines of twenty-five dollars or suspension/revocation of ❑ Embargo ❑ Emergency Closure your food permit. l Is nn nw w � ❑ Voluntary Disposal ❑ Other: n_ /t - V P7iFsfiev.sv..d:,(Temperntures j Violatiorm Related to Foodborne Illness Interventions and Risk 1 According{o Lau t(,tied to Factors(itet»s Y-22} (Cont) i :I FAVI-Within 4 Hours ° PROTECTION FROM CHEMICALS -. 5 C,<rlin*Wi.'r:sdi run p1iP, j 14 i Food or Color Additives I j 19 PHF Hot and Gold Holding Codd FF1lrs',Via'int,ined at(,.T below i-202.12 I Atutives'" ,}7'/.tC<,F, 3 3t}"_.14 Protect;{:n front?inappn»ed Addhitre' I i 1S Poisonous or Toxic Substances f 3 :ti1,10(.`) If,wpi'fl Maintausetlatorabwe }{j'7 tttl.i? idctnilyingtnfolmation--Clugsna unta+herrI1.t 601 Ru;+<(c Held at or above 130,Ji' ` 7 102,11 Cotmuon ti:,n,c Workin,;C'<tnrntncrs` j 120 Time as a Public Health Castro! 7-2(71.11 Srpaiauon--SI,I t1'. Vinic as a l`ubhc ltnalth Cona'ol' 7.2{)2.17 Rcstricimn - Pr,•acnce and i;,,;+ ! 5«t1,nr)t�}it i'ar;ancc:PO4t)rcnrent j j 7.202.12 Condition"of Uso' � j 7-11)i 11 '1'r,xic Container. -Prol,ihi:iuus; REOWREMENTS FOR HIGHLY SUSCEPTIBLE i 7-2{}4,11 Sanirveis.CIriicrra -ChemicnN4 j POPULATIONS(HSP) 21 ?. C`?.:?t'0 I 1'r:p:,'a,urinxtPrspud:aycdJuicesand 7.2a 04.7.-t C"h,:noeals for li'ashiult 17,xlue:c,C:titctia` i ( Hr';Cr,tees\,=ith Watitin•labcis 1 ,-204.14 Di ting Acetic,Lrit'.'rta' ! _ , �' I ?-2{75Ji ht;:id.uis) Fcaxli't•n'act. lw,h:ictuds' .11iHt j 1..:otPaocu,izcdLa¢a' j ? 5=}?.,!+,Ctt I it,:t „r Paill'i 1, Ci+;i.o•d Animal l=oud and 7°Ofi.(i t{et�t,cie,1 Us+a Pe>ticcdeb.(,file[s,"� I St,•d S1FranS;hot Set vc^l. ' + 7-206.12 12t'cicat Bait S1ab0n,1- i t 1%nop,ted?'',nxi packdpc Not Re-serol * j ',?Ofi 13 '1,acling P,»rde:;. Yrsr Control and , kloniutri n;++� CONSUMER ADViSORY 71MElTEMPERATURE CONTROLS i 22 ? b•;; t i 1 Co:,,wwr Asl}isory'P(wd for Ccntsumption td I ( x:.itut i 1',„x{,'than,ac•k.,w Under.xxiked in lb Pieper Cooking Temperatures tar PHFs Not Odin;'.i;x Pr<,c:essed;o Flinnnare ! 3.10i'lIA(ll(.:) 1:n;r 15z`F15S,:i. ( Pa,ft,{:,'•.n:,. :"" '.,:"`., k:.. I j t-;: .'.3 1 I'.:iA:ariE;d E gj- 5t,ha-ti:,ne for Raw Shell E¢ef-luui=adinic Ser:'iu' ('15"i�35>er ?-40Llit:\}(:; Qnn❑nrua<:df'ish. n^,cu+.,4 (;sns, ff Annual,-, Ii5 _ 15 SPECIAL REQUIREMENTS 3 401.1 kB)(1)f2t Putt ar,d l'icel Roast LOT- 121 stink j 5,)r, tor{ i . - -i-401.11(Ail 2. Raines, li,irucd War, 15S F 15 {p .t;,Lh 4'ivla0,*r,>tri Section 5){)(}0t)it\}-(p) in illcr3ng. tnt=bib: fix>d,tet:tpt,r:tt3• and 401.11(An1101111n,{1 1' ,11n.Wild(;sue.stufted YliF 'sI z. nd.nttal kilchen opoatinas iitould he i Swftnri Gainowny, Fi h. ht:.at, d1=b,ic.d widei the appropriate sec'tious P+nhrvot Ranter-i65`F 15 s='c. " a€x,+r it tta;ttrd G+f.nrlht,rni diruss 3-401ANCII3; i\'ii,,tc-nm,:'!c.Intact li.vf Slrak' int,cr,,cjttion�and risk factor.:. Wier WST - 540,0011 vtolarun,s relalin:.' to Yoixl rctai! 3-401.12 Rm% Aninud Foxit,C oolt:d n+a 7'r,t:tttt:s;itauid 1v debited under #29 - lficeu:.save 165'F * Sp,'ciat R?ytnronictttt. H(A)(11fh1 All Oihet1>111s-- 145'F[5S et: } l`t Reheating for Hot Holding VIOGAVONS RFLATFD TO GOOD RETAIL PRACTICES 1-403.111A)&lfr) Pll4'n 165"F 15 sec_ " (Iterns 2,'4-311) ' 1.403.1 if B) Ntcrouavc i(5'F). R7,num Standitt;r ( C,(ri,:ri rzrn?r::m-t rvr<r.( ricd:nn;r,;, :,vrkh lr'am rclau;r,thr Tinic' ,f ux:$crnC i7L+ers tna,r vrnti.ns urhl+isl'Jitt torr Itair•d orf nrc', u+x br 3-403.11(C) Commercia!l+,pi.t t".'ed RTE 1•,xw' - I ((`+na:'rr rAe,f?,lSn:vie ,e'i^iprcr,,ofd;a fi:urt{'ode turd 121 f,§fk 1.40'1'` ( 40. 13403 I i,Fi Remuntin L'nshced Portions of Her! i 7tont r good Rea iii practices ---� I FC ` 590.000.- , IFC__- 24. r Ftr,d anis Foe profer?�tr.+ � FC �3 � 004 !-� E 1Y E Proper Cooling of PHFs I ...- ._ i 004--- 26., C_t�uiprr,r:nt,nal Uit n uo I FC-a __.005 i-501.14(A) Cix,liug Choked PHF° from 144fi'tr' '° . .!_Vtat�r. t,a=ir.,r�g;no'Nusto ! FC-5 ( O(rti - 7U"F Wahm 2)Tours and From T1°F €27 Pnvs,cal Fa0iry FC-6 i .067 I to 41-1145'F Within 4 Honr:. ' 2e _ Pu,-:mr us.,t Tnw `Aide,ol, FC-7 , 008 1.1413) Coolin{t,PHPa'.viade From Ambient r � 23 �So°+:,��p.,qu,rer,'alts Tcmperature Ingredient.,to41"F?45`F i Within 4 Ht mr<x ` 1)rm.tes�nnc,t:,cm m ih.-is laced i':uu Pont S;,uk•,��i n5('kilt 5'h a}(jn CITY OF SALEM BOARD OF HEALTH Establishment Name: Date: 1 o -c,• c5 Page: of Z Item Code ' ' C-Critical nem DESCRIPTION OF VIOLATION/ PLAN OF CORRECTION I Date 1 No. Reference - eem _ Verified RfR Rd It ' 1 14 PLEASE PRINT CLEARLY � RaaG4, , vPaa to Cc .. ca\ nti�JQ c'1= 41 c +I e_ 1r a \mss-A77'c3-4 Ncac fM'YNvar,-,N6'l Y>T1C�T1- a {I N t- In", . I Gc,<-•.--. :`•kt�,�-, c 1 ,tet P.c). .,� a „-��. � Ya.a n O-T�-\'?.Cl_ F cow J j — r>L, 'Po r \1_t1\,a. h N r I - Q, A 7 ka T\yGl \S wc\ L\� r ,�� _. T\> - (l:•y \ tJo .7- r9r -7' E,_ 4 \-.ta I i Discussion With Person in Charge: Corrective Action Required: ❑ No ❑ Yes I have read this report, have had the opportunity to ask questions and agree to Correct all ❑ Voluntary Compliance I ❑ 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 o twenty/-five dollars or suspension/revocation of 13 Embargo ❑ Emergency Closure your food permit. //A,�� / /T��1� (1 llf��/ /�yz / ❑ Voluntary Disposal ❑ Other: V { ?Sr1 Ilft;, { PFf:�sR�.�+v?dat'i'ennper;nures Violations Related to Foodborne Illness interventions and Risk { Accor lifl.g to Iwo` Coot�j to Factors{helots 1-22) (Coot) '.6'ilhil"! Hour'. " f I PROTECTION FROM CHEMICALS ! ;.Sift i9 } C'«,tiat irk hq i fo PHF> 1 { ; 19 PHF Hot and Cold Holding I 14 I { Food or Color Additives :"qty t 1 tgBfil CoM FHFs Maaat,i ted at or b&,w 3-2.02,P I Additives* { 590 00z(l ; -?):'p q'F- -21(72.14 Protedion front Unaopnned Additavcs' I . a i, h ) iir:t E'Ftl-s Ptamtamod ator abort i - t t_'r I in Poisonous or Toxic Substances i lU'F=. 101.11 klcntifyinie infinmat,crn - Orl2inal Sill icn.l, k,.,istt.Hdtl;tt w above 1,101, E Cant.uner<' 7 102.11 Common 7Vame Working Contmuar," 20 Time as a Public HealthControl ' i ?-'+iii in 19'lrnc•as a I'uhEic fl::ilth Cortrol' I 7-201.11 Separation-Storage' { { `9tr.!}t)trgtt 14'ari;nce Requirentuat i I7.202.}I Rcstrictirrn -Preu�nu.urdL<c" I 17-202.12 C'undina»t,of Oke" i REOLAREMENTS FOR HIGHLY SUSCEPTIBLE { 7-203 t l Toxic Contamece.- Pcniub,:,on,T 'r-204.11 Sanitirer�,Coteri:t -Ci«anicis` I POPULATIONS(HSP) -'0-11.12 ch+.•=tacaln fol tiN ziu h:ug,l'ro�ltce;Clai:rni, I ( 21 i ;-ti(41 t it:�j { E�ny,r•:ttors<r:!!`rr-{`zckacccf lttic�t�s and 7-204.14 Drvinr.A tent Criteria I { { 0,'rrraee: will `;'aroin"Iob i5* 1 I i±P>: 1 T:?r of Parte.tn i.'.••rI li0g,'7 -05,11 Incidental F.kxi Contact.Luhrirants' 13-1;0!.i I(DI i R m,or F':,tx:,tl1`.C+sti r,f Aaimal Food and 7-70».t i ke;ii ir:Ird tine Pe,fienlce.Criteria` ( I i;,:,: 5c:•J •:t=r„uts 1�`e'servrti. i 7-206.12 Rodent Boll S1;Nnma" I 3-Kt;l I IOC;: i {,n,lp;.,ell F:Xai Pat{.ai'C l' r RV-served 1-20( 13 Tracking Nnrtkn Yta[Control and € I MouitodngCONSUMER ADVISORY TiMEttEMPERATURE CONTROLS 22 dt; 11 t"'=:-+owci .Adit.,oit P+nted tin C(womption of Al,ilt,ai Fnrxi� fhat:n: Rau'. Llideramked to 16 Proper Cooking Temperatures for ;;,t r7tii<;r,.Ise:t'r,ress,:d:=r 1-4nanaw 3 4! PHFs ('sifto;:cos..` • ....,.. .:• U( llAfll(li F.ggr- 155 I5&S c. I t'.5`t'} .1 1 P„snr,:rtr:d F.ggr Subsulaw Ill! Raw Shell T>g4s� Inu,t•tliatcSer•n;v5:et t I ` 3-401.11107, Camnn ,ied Fi:.h. gear:ti ton Animals li5'F 15 cc•c. ' i :iPEC1AL REQUIREMENTSi40t.ii(B)(I)(2) Purkand BeriRoast 1)U"1- 121ndn° I 5,p.{yiy;Ai-(f1) Vi,.ld}tr+n,c.lSe,ttou ?9ti.fX)'aSA!-{Din 'i-4t)LIl(A)(:) Ratite,, 6tject.d S1eeA 155T15 I tit•:. * 1 c awring, iriolit,,fiord,temp irary and ? 401.1i(A)+3) I Pr.idtr},Wild(lame,Stuffed Ptil-'.; rt.i,h•ni=�il kitchen operation;.Aviuld be Swftmg Coni,thung Fish. Meat, t:ehaod miler the approPriatc ;croons Poultry yr kautcs-165 P IS,:ec. ` LY=4t if rt:l,uw to lokfillv,rne tilnes� j 3-401.11tC)(3r Intact 8ce4iteak, I ie;ervention.anci 04. faclorq. Other I las°F': 51)0.00k) ,•ii=latinnS reiatin” of Mi retail 3=•+01.1'_ Raw Anowil Foods Cwked m it � ,n.:c,icev,houij he dcbitcd under il29 - t %Iii1owaw I05'F* Spc'ial Itecytiircments t-40I.1 I(A)(1)(b) At! (Rnei PiIFs - 145-F 15 tic 117 Reheating for Hot Holding VIOLA TIONS RELATED TO 0000 RETAIL PRACTICES -403.1)(A)Sc(1)) PHF.> 1f)5,1� 15 sec ° fliebrs 23.30) ( ;..tU':,!i(B) +;iiirnw'at. it'i F 2 Mmn.e Standing Cobra: zn:7 n rn-, wtt Ott rr,=:'.r,r, ,. s;,'alh kora; ,vlaa-, to the T7 me" fnedhc•ni. +rid ro4 Jit,tor:1;,led oliove, int be 3-i 03.11 tC) I Cumrnercialiv Pro.es;,ed RTF lrxui- f fut.nu int tilt,.'nji•n,.:rt,S�:rrtr,n, r:l ih.;t-,wd Cadeand I05 CAflt -T ti—" 140311([if Remaining, Uakhced Por r"ions of ii,.c.l (tent I Good Retail Practices T FC —"' 590.000 i 23-- --'.§anuynmeni and Per_,uind ... .._. LF(:_"-2 .Y 00= ._ Proper Conlin of PHFs Rr0 ar��!rood_Frniec•aor !=C- 3 A8 P g 56TI41'l) 25. £aglpfr en+ ndUtn -.4 _005 n _26, _ 1 ,_ yJaht..FiurzirnnQ.ir:aWa�te I FC-5 27 n "z or Toxo M,renals __.. . ....1 76`F Within'2 Hours and From 71PF - ' _ FC-6 , .067 1 to 41'Fl45^P W`ithm 4 Hou( t � zts. Fors---c t : FC -_ i_--- 3501.F7(B) CooliugPHFsMade FroniAmbient t SG t other 'Pemprramrela 'f>41''fP3SF } Within 4llcnars'redients" `Deno tes'ritnat liar,is Iha Ir,kxai 1•)091 oml GA "r IO5('tit)t 591t of K, CITY OF SALEM BOARD OF HEALTH Establishment Name: Go , r v Date: 1 U- q-01 Page: 2 - of Item. Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date No. Reference R-Red Item - - Verified PLEASE PRINT CLEARLY -- SQ.rD v�� T\ c S3 F� c� 7 tJ �v5 '\3 T h V � I �;ST u�,3 v� ��t-c- �,❑ .� ��, h,� T\�3 �0��-�'C e ? I j 11L kx_-�rrr4,Z 7- 64 ? R°3 V,,t1 72,73 G�,as��,o r�-�o �i,t--,✓ v�-c,a,� ��ti. "t-�� C��-�s��,� i ��..�� vti.�V I 1 n I Discussion With Person in Charge: Corrective Action Required: I ❑ No I ❑ Yes 1 have read this report, have had the opportunity to ask questions and agree to correct all ❑ Voluntary Compliance ❑ Employee Restriction/ Exclusion violations before the next inspection, to observe all conditions as described, and to ❑ Re-inspection Scheduled ❑ Emergency Suspension comply with all mandates of the Mass/Federal Food Code. I understand that noncompliance may result in daily fines of twenty-fivesdollars or suspension/revocation of ❑ Embargo ❑ Emergency Closure your food permit. ❑ Voluntary Disposal 0 Other: Plff,s Ret6v4d at Temperatures Violations Related to Foodborne Illness Interventions and Risk i Ac:cots;ia',to 1-a v. Cooled to Factors(Items 1.22) (Conk) { 41-F/-6'F Within 4 Hows. PROTECTION FROM CHEMICALS ( .k Ct „ins Slcthoxl,for PHIPs f i iJ Food or Color Additives ( ( PHF Hot and Cold Holding Cutrl PHF"Nlnintaiue i at err b.'low ?-:402.14 I Prowetion front Unapnro:eu Addittvec" ( }t } .t t�4:i"F` t SloI A6{.`} H,il PHF� Maintained at or abt,ve ( .15 Poisonous or Toxic Substances ( 14011 i 101.11 Idt;rtt i'ymg lntinut.dion -Ut'rrma! t;i�tt int At 1 ( Containers, Ru,.sn fie t d at or of ovc 130°F 7 102.11 ! C.nttmofi Nam; 44'orkir,;;t-:msair,crr:, ( I ?1) Time as a PubPc Health Control I '-20I.I 1 I se a moStorage', i3.50; i^ Tio.e as a Puhlie Health ConlinV _( 1 ','.?()2.11 n s90904tFV;oit iwReitircnt ctto „nrel �e . __ .. 7-202.12 condition"of Use" 7 21}3 11 lvxic Clnttameo,-Piohihi6iillsn ( REOUfPEMENTS FOR HIGHLY SUSCEPTIBLE 7.204.11 Snnnizer�.Cnterir-Chr+tric:to° POPULATIONS(HSP) i 7-304.12 C•hcnocais Ax washing,t'rodi ice,Ciiier+a � "1 j t-S+11.1!(A) 0n,v',1euri4ed F"te-Irackarn:i fuicec wid F3owr.,ees with Warning lalliAt,s. ( 720114 Dr lingr'1t:Caa'.' Yneria" ( }-;itiE.ilfB, 1:. •t+FPastrnrir+'d1;eg^` 7 2Q5.1 i ( la,:id:arial F<4x1 C'uniact.1z+hricart,' I ^3-gttt.l I(D) R;, or t'aaxtally l,.xtkerl Anillial F(xxl.md ( 7-21)6.11 Ra,tnch:d Csc Pe„idles,C7+terta: 1 Rai: S:<d:prnat,M1ut Servr3. ' j 7-606.1„ Rtxiem Bot Si:tiwln ` x111.1 itC;, t.wvoi:d Fi.xi Padmgr Nol Re-served i 206 i. T aCk,ag clone lc r;,}>•rtt Control and { Monitoring' CONSUMER ADVISORY i 72 :`,gin,rant..r.Ad.is•.,-4F:xtei7i=,rf'cnt.<.nmPtionof TIMEITEMPERATURE CONTROLS i 'onn i )� d,That Po Rook, CConsal ipti or 16 f Proper Cooking Temperatures for ;,,t t)tla:t'c,ise I"nxeseil to G.tianunue ij PHFs 3-4C1i 1I,4(llit; F.g ., g - 155 F 15 SaC. 1'arixe�ta..1 ""'-I "'p0' - t :k. Invuadrne Ser:!a• I a5"i't i>ec E t 3U".3' }revLetinr::,i Fgsa SLit" ,tut,• ttt: RaIW Shed 3-401.11(A)f:) Comminuted Fi,,h, Meat vR (1mic Animate- ti; 'F 15 ser. ( 3-401.1 1(11)0}t2) ! Pork and I'i,et Roast I T 121 min; SPECIAL REQUIREMENTS ;-=IOi.31(r'S}t?j Haute,• lniecr::d %ala 155 F 1.5 I Syli},x)t,t i-J)" Vi(411i=�t;:+;; Section 5'){l,(t{)9(.A) (D) in ser.. � II � �raterane: rnchii, (i.nrct, temp+:rary.tnd ?=20i.tI(A)+'{} Poidtr},Y1ildGame, Snrfte,lPH1; *c:sit,:'nt,:+it:itcltenopolinionvshould he Stuffwe C'onrutnng Ftsh,bleat, 1 oehot.d u.ndcr the appruprove wk-lions } Rvdiry or Raow%-1654, 15 sec. ` Aw,,'e if elated to fxxtfxrrnc• iltn,s5 3-101,1 tC1t3r While rnwcic Intact BeJslcak, imerventionc and rise faits: Other W51 ' 590.(Y)i) i aul:mow;relating to notal retail .i-40!•12 {taw Amtuai f'inul,Co,ikcd w a ( pian.ec :honld be debited under #29 - pilclow me 165"F Sprrlat ketuirrnt+stts. ,' -101 11(A)(I)(h) .M1 Onto PHI s.- 1.15`.1'15 sec " l 117 Reheating for Hat Holding ( VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 3.403.11(A}ttD) ( P11F:. 165`Fl5sec. - ( ftvms23-?(H 3 403,11(8) tificorwave- 100' F2 10inui,Staudinr I C ais it=md nrrr-r riinau r+ul.:&=ars, vtdrh do i1w"eta,In rGc � Ium i Irroahnrncirlvcsaiivenen6onyondn:AJilt torrti,ted aFnverrnbf, Commercially Prones>rd RIF F«x,d- fi,a+nt L,.1te'.7;,1;,4t w,:cr+ion t(if the Piaui Code curd 105 t•hfh i ( 140°F* i ."7i;.Rtrr . _- .-_ ...__ .._ —.--.._.. .__� — -. � 3�443 11(F) Rcmwning Lrmhtcu Porciun+nl'tiec{ � hent Gaod Rararf?Pratt?ces FC 590,6DD ltet;t,t..ro �.+. "2anaeme+•t and Per;unnei FC ? 003 i , 21 Fca,Yi:,m Fntd piot!rtion FC - ;t ( ut + Proper Cooling of PHFS ( - - - -- i 25.1 1 Egu:pm_>.�t and titensds F C- 4 005 -- 3-5f F l ttA} C'in,lmg Caked PliFs finalt d0'i'n, I`26- Water,Piu=x,b,ngand Waste ---- -PC-5 Wti 7017 Within 2 I-kxus and Nrum 70"I' 27 F?ra.�a Fn+•:hfr - - - --FC-b .W7"--- i to4I'f-/<15'F'Within 4 Htau:� 'f ( , e8 I Pct�o+,.:rs or Ta». MaYe_r,3f; FC 7 008 + (.'9, ` -t c'e:iaiR {,remer�t> ._. 009 3501.14{B} C,n�linglHFaMade FnmtAn+l.tein --.__...1_'P�. L:._.- ( .. ( Temperature Ingredient.to 11`,:'65`, ._30 i t=ih�t «J+:•n dc,cnne.ii ocm,n+he 1, hoe' 11;09 Foml C"AS it 105 S.'A•tk 59n Ei(n), CITY OF SALEM, MASSACHUSETTS HEALTH AGENT 120 WASHINGTON STREET, 4TH FLOOR SALEM, MA 01970 TEL. 978-741-1800 FAX 978-745-0343 KIMBERLEY DRISCOLL JSCOTT@SALEM.COM MAYOR JOANNE SCOTT HEALTH AGENT MEMO To: File From: David Greenbaum, Sanitarian Re: Gourmet Fare On Tuesday,November 6, 2007 the Salem Board of Health received notification that the Gourmet Fare was advertising that the establishment would be re-opening soon and customers would be able to order Thanksgiving pies. Upon investigating this report 1 found two signs regarding the sale of baked goods from the Gourmet Fare. (See attached Pictures) While taking the attached pictures I was approached by the owners sister,Kristen Till. Ms. Till asked if she could help me and I stated that I was with the Salem Board of Health and a report was received regarding the signs in the window, and that I was taking pictures to document what the signs stated. Ms till stated that she was unable to reach her sister Joanne Hatch and did not know what was happening. Ms. Till and I had a long conversation,during which I explained to her the reasons the store was closed by the Board of Health. I explained to her that myself and the Health Agent were at the store on September 11, 2007 and she was ordered to stop all food prep at this establishment. I told Ms. Till that her sister was given a list of conditions that needed to be satisfied for her to be able to resume food prep operations. I informed her that Ms. Hatch was not responsive to any of our orders, and that the Health Agent tried to contact her by phone to no avail. I tried to impart to Ms. Till the seriousness of the situation and let her know that because of all the reports we have received regarding food being prepared at this establishment that her sister may be called in front of the full Board of Health for a hearing to determine if the permanent revocation of the food permit for this establishment was necessary. s Gourmet FAf r, �` .,/ v -Ail �xs � � " �� Saort• Rruz Order tvIol 4ernasrorrt grsarcl � � its, 7lter� w� l be rrrt n� k.`.rds. �Y ��A'�4 t;. -�3 '�is;. .. ��a4'_� � � _fix •� _ � 43 3 S §.� � 3 ! ��a � �{ 2 ��'�� 4 5�� as�� Ss ��' � 4X � ` � ` � QS �; � � 3 � 1 �� ,Sj � �� u �irr1"�+F*t"^i�^_,�G'�,k�,T�A':Y• Ja«a,w.+v y � �L,p4, e 1L�,J.v_�FtuM,"l.n pr u.�t e "i&`�d'+2n�]id"fli',,k..w'.�.A5 W, y'.:�yr.'-4'X9.T�Xw61-•c^'�£Nrv:•'�.'.N��.',V-,,—e:i•:.;w.-F;�,-,4A".nSTu+^.y2Y�as{.'+.i t�tm,3d'a Y'�€' y. y,3io.Tpq�w . �+ + monwth ofMsach'.w` ` .,eI ¢fo I",a' tl e '✓:» , u �, '.. ��.• ty of,Sa(em :. ,, 4�'S�'�,`Rr�'+`.�.+�. #".•F�i"•�;j, �;i�.S:�!'Fts`j, �4 gy�� ,. ,,,. .ds ..ke,. • • . . - :r.- ,,.Board of Health ;:;.. r -,'� - �,;^ - �:y::.;y �:;; .r `+L �,-fri3.,Ft. !F•t:;: 1Qmbeiley Driscoll ;~„X;. ,4 ,,120 Washington Street,4th Floor s *-a . , �. ., Magor:. , _ F.;. •. ; SALEM,MA 01970 Food/Retail Establishment Permit DATE PRINTED: 01/04/2007 ESTABLISHMENT NAME: Gourmet Fare File Number:BHF-2003-000007 73 Wharf Street Salem MA 01970 LOCATED AT: 0073 WHARF STREET SALEM,MA 01970 Permit Type Permit No. Permit Issued Permit Expires Fee Restrictions/Notes RETAIL FOOD BHP-2007-0293 Jan 4,2007 Dec 31,2007 $100.00 Total Fees: $100.00 PERMIT EXPIRES December 31, 2007 Board of Health X11, This Permit is not transferable and must be reissued upon change of ownership or location.The permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code,beofre any revonations, improvements,or equipment changes are made,all plans for such must be submitted to and approved by the Salem Board of Health. Page 2 of 4 CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH RECEIVED � 120 WASHINGTON STREET, 4TH FLOOR SALEM, MA 01970 - TEL. 978-741-1800 JAN " 3aWt5?M 7 FAx 978.745-0343 CITY OF SALEM Kimberley Driscoll WWW'SALEM.COM BOARD OF HEALTH Mayor JOANNE SCOTT, MPH, RS, CHO HEALTH AGENT 2007 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT t� NAME OF ESTABLISHMENT C�f�r c✓Yr1 PT 1ppci✓r?n ADDRESS OF ESTABLISHMENT 13 --'7S" U-40 r r � FAX# MAILING ADDRESS (if different) EMAIL--Business':_[!iL,(YW€.P_ lfOwner's: OWNER'S NAME TEL# ADDRESS A/IOZ7✓lrn✓l t �r. LOUXlISY'ct CO(C/� STREET CI/TY STATE / n ZIP CERTIFIED FOOD MANAGER'S NAME(S)yJ -a f1 he j-�-a+r_ i CERTIFICATE#(S) �'yt d p V (Required in an establishment where potentially hazardous food is prepared) EMERGENCY RESPONSE PERSON HOME TEL# q7 BAYS Of OPERATION Monday Tuesday Wednesday Thursday Friday Saturday Sunday HOURS OFOPERATION Please write in time at dai. / j (o l j I ( _ to I — tfer example Ilam-llaml TYPE OF ESTABLISHMENT FEE (check only) RETAIL STORE (YES) NO less than 1000sq.ft. =$ 50 1000-10,000scift =$100 more than 10,000sq.ft. =$250 RESTAURANT YES NO less than 25 seats $100 25-99 seats =$150 more than 99 seats =$200 _.... - .... ... ......_ ._.- .........- - ._ ...._ ,. - .._ ......- -------.---- -------.--- ---.----— BEDtBREAKFAST YE5 NO $100 ---- ------ --- -- ._._... ...... ...... ...... .... . .------I ...... . .,.. ... - ----- ..-- 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 O $25 'Please pay total with one check payable to the City of Salem. This Permit is not transferable and must be reissued upon change of ownership The Permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code, before any renovations, improvements, or equipment changes are made, all plans for such must be submitted to and approved by the Salem Board of Health. Pursuant to MGI- Chapter 62C, Section 49A, I certify under the pains and penalties of perjury that I, to my best knuwledrde and belief, have filed ali state tax returnsardypaid all state taxes required under the taw e `_ _41PXCk Ul—t��7 g ature Date Social Security or Federal Identification Number Revised 11/13106 FOODAP2007 adm Checkg &Date ,�j_e nddr.>' 7 `� 7 $ — y 'a_V i_ ,nfd`f!r ♦ - f3aKR S�1 :", \-?..I.r" ,. f.-tVi i,. ,�.-ay YaF:i..n,'ke}a n . •.4%a4 Ql?1'T'q[r�:•ij,i .S. 't• ...w,a..,,.+�..i.`4. ite v?I+,e`.'�..t��,,�."L ' a:._v.j(:'Fi;'.e�ii -r - « •,nir.-..r'.,,«.. L� ,,,.�.. ..,y,r:^.n¢^' .iry.•- :�+ - q'.j,�'�+;"5' TA1' `-.,_-.,a',cx �3<!�:''s8'^�t'+'• '.1- X16 ar'?J�'M^''+'�v'` ,o'. Commonwealth of Massachusetts .� City of Salem se Board of Health lQmberley Driscoll 120 Washington Street,4th Floor Mayor. SALEM,MA 01970 Temporary Food Permit DATE PRINTED: 11/30/2006 ESTABLISHMENT NAME: Gourmet Fare File Number:BHF-2003-000007 73 Wharf Street Salem MA 01970 LOCATED AT: 0073 WHARF STREET SALEM, MA 01970 Permit Type Permit No. Permit Issued Permit Expires Fee Restrictions/Notes TEMPORARY FOOD BHP-2006-0674 Nov 30,2006 Dec 3,2006 Permit for Museum Place.Food to be served,gingerbread houses, cookies and Cocoa Total Fees: PERMIT EXPIRES December 3, 2006 Board of Health V Page 1 of 1 rr i � B CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH 3 a, 120 WASHINGTON STREET, 4TH FLOOR � e SALEM, MA 01970 ,� TEL. 978-741-1800 �11� FAX 978-745-0343 JOANNE SCOTT, MPH, RS, CHO Kimberley Driscoll HEALTH AGENT Mayor APPLICATION FOR ATEMPORARY FOOD SERVICE PERMIT n FEE: 1-3 DAYS= $200 Y ODI did 4-7 DAYS= $300 MORE THAN 7 DAYS= $400 (\-1 CHECK PAYABLE TO THE CI OF SALEM,NO CASH NAMEOFEVENT ��S IUV ( C LSO �✓ -1 LOCATION �LCS P_e..l V✓l DATE(S) OF EVENT 1 ^)�v 'r_ ) r .-;7 1 q NAME OF APPLICANT < 1 OCS ✓1 N2 ("k-Ct' J\ TELEPHONE# V Y ^� �"" -� ! 0 ADDRESS `— ( � � NAME OFBUSINESS n L {' p�XD LA ✓VI JJ r Q['�Q TELEPHONE# -` �r^� -I C ADDRESS 1 ✓'�J^_ l.�Y'frrt �' (1' r 1 CERTIFIED FOOD MANAGERS NAME v-1 YVL lTG C- t CERTIFICATION# (3� � C— A PLAN OF THE ESTABLISHMENT IS: ENCLOSED DRAWN ON THE BACK TYPE OF REFRIGERATION' GAS ICE DRY ICE OTHER METHOD FOR COOKING/HOT HOLDING: GAS _OTHER METHOD FOR SANITIZING: CHEMICAL 1 OTHER SOURCE OF FOOD: NAME: l/''�2r2t A ✓-!OAe 1Tt A✓-P ADDRESS � FOODS TO BE SERVED INCLUDING INGREDIENTS AND METHOD OF PREPARATION: �(vuce✓(1) ren OCA -,e � -CO Ott i-PS PLt-6j I HAVE READ THE BOARD OF HEALTH, "REQUIREMENTS FOR TEMPORARY FOOD ESTABLISHMENTS\I HAVE HAD THE OPPORTUNITY TO ASK QUESTIONS REGARDING THOSE REQUIREMENTS. I UNDERSTAND THEM, AGREE TO ABIDE BY THEM AND UNDERSTAND THAT FAILURE TO DO SO WILL RESULT IN REVOCATION OF MY TEMPORARY FOOD ESTABLISHMENT PERMIT PERSUANT TO MGL C62C, S49A, I CERTIFY UNDER THE PENALTIES OF PERJURY THAT I, TO MY BEST KNOWLEDGE AND BELIEF, HAVE FILED ALL STATE TAX RETURNS AND PAID ALL STATE TAXES REQUIRED UNDER NATURE DATE SOCIAL SECURITY OR FEDERAL ID# - -------------------------------------------------------------------------------------------------------------------------------------- TEMPAPPIE REVISED 1125/02 PERMIT# CHECK#B DATE o CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH 3 120 WASHINGTON STREET, 4TH FLOOR SALEM, MA 01970 TEL. 978-741-1800 FAX 978-745-0343 JOANNE SCOTT, MPH, RS, CHO Kimberley Driscoll HEALTH AGENT Mayor REQUIREMENTS FOR TEMPORARY FOOD ESTABLISHMENTS These requirements are in accordance with the State Sanitary Code of the Massachusetts Department of Public Health, 105 CMR 590.030. This code states, "The Board of Health may impose additional requirements to protect against health hazards related to the conduct of the temporary food establishment, may prohibit the sale of some or all potentially hazardous foods, and when no health hazard will result, may waive or modify the requirements of these regulations." Therefore the Salem Board of Health reserves the right to evaluate individual establishments and make necessary requirements to protect the public health. FOOD MANAGER CERTIFICATION IS REQUIRED OFANY TEMPORARY FOOD ESTABLISHMENT THAT PREPARES POTENTIALLY HAZARDOUS FOODS. ALL TEMPORARY FOOD ESTABLISHMENTS MUST COMPLY WITH THE FOLLOWING: • The Board of Health must receive the application for a temporary food establishment at least one week prior to the planned event. Halloween vendors must submit their applications at least three weeks prior to the event. Unpermitted establishments shall be excluded from the event. • Foods served are limited to the following: Baked goods, fresh fruit and vegetables, and pre-cooked potentially hazardous foods. Raw chicken, raw beef, raw pork, or other raw potentially hazardous food is NOT allowed. • The application must be filled out completely. Incomplete applications may result in a refusal to permit the establishment. • The application shall include a plan of the set-up of the establishment including the location of equipment, cooking facilities and cooling units. • Necessary permits for the operation of the establishment, including the Food Permit, must be conspicuously displayed. • Running water with liquid soap and disposable towels for hand washing must be available. Bottle water with a pull out spout is acceptable. All food handlers must wash their hands after utilizing toilet facilities, eating, or smoking. Smoking is not allowed within 10 feet of the establishment. • All utensils and food contact surfaces must be sanitized with an approved sanitizing solution. Test strips for that sanitizing solution must be used to verify its strength. • Premises must be kept clean. Refuse and garbage must be disposed of in a satisfactory manner. • All utensils, equipment, and containers must be maintained in a clean and sanitary condition. • Food handlers must wear clean outer garments and utilize good hygienic practices. • A permit from the Fire Department is required for the use of propane. Contact Fire Prevention at 978-745-7777. • A permit from the Electrical Department is required for the use of a generator. Contact the City Electrician at 978-745-6300. • Permits may be required from the Licensing Department. Contact Licensing at 978-745-9595. TEMPORARY ESTABLISHMENTS MUST ENSURE FOOD PROTECTION BY ADHERING TO THE FOLLOWING REQUIREMENTS: • Only foods listed on the permit may be served. • Cold foods must be maintained at a temperature of 40F or less. • Hot foods must be maintained at a temperature of 140F or higher. • Food must be obtained form a permitted source. Proof of the source must be on site. • Stem thermometers must be on site to check that proper temperatures are being maintained. • All food must be covered and protected during transportation, storage, preparation, and display. Food shall not be stored on the ground. Trash bags shall not be used as storage containers. • Bare hand contact of food is not allowed. Tongs, tissues, clean gloves must be used when handling ready-to-eat- foods. ON SITE INSPECTION OF YOUR ESTABLISHMENT WILL BE CONDUCTED BY BOARD OF HEALTH SANITARIANS TO ENSURE COMPLIANCE WITH THE CODE AND THESE REQUIREMENTS. IF VIOLATIONS ARE OBSERVED YOU MAY BE REQUIRED TO CEASE OPERATION AND TO LEAVE THE EVENT. Joannes folder:lempfood 3 Commonwealth of Massachusetts City of Salem Board of Health Kimberley Driscoll 120 Washington Street,4th Floor Mayor SALEM,MA 01970 Temporary Food Permit DATE PRINTED: 11/30/2006 ESTABLISHMENT NAME: Gourmet Fare File Number BHF-2003-000007 73 Wharf Street Salem MA 01970 LOCATED AT: 0073 WHARF STREET SALEM, MA 01970 Permit Type Permit No. Permit Issued Permit Expires Fee Restrictions/Notes TEMPORARY FOOD BHP-2006-0673 Nov 30,2006 Dec 3,2006 Permit for Historic Salem at the Salem Inn.Food to be served; soup sandwiches cookies tea and coffee. Total Fees: PERMIT EXPIRES :December 3, 2006 Board of Health Page 1 of 1 tF aCITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH 120 WASHINGTON STREET, 4TH FLOOR SALEM. MA 01970 TEL. 978-741-1800 FAX 978-745-0343 JOANNE SCOTT, MPH, RS, CHO Kimberley Driscoll HEALTH AGENT Mayor APPLICATION FOR ATEMPORARY FOOD SERVICE PERMIT FEE: 1-3 DAYS= $200 4-7 DAYS= $300 MORE THAN 7 DAYS= $400 ( CHECK PAYABLE TO THE CITY OF SALEM,NO CASH NAME OF EVENT ZZC a 1- J c LOCATION SG�Wl �Ld\ ✓I DATE(S) OF EVENT L4-1- 4-751 C JGL- ✓/Vl p NAME OF APPLICANT I CA 414? I�-r,'+cG� TELEPHONE# ADDRESS I NAME n OFBUSIIN� !-PA ES_S r O_ct-C Y 1 „Q_l�p TELEPHONE# 11'�1 ADDRESS C J�.O r"��c ( AIr CERTIFIED FOOD MANAGERS NAMQ Inn V1 Vl.e_ L- dz� CERTIFICATION# A PLAN OF THE ESTABLISHMENT IS. ENCLOSED DRAWN ON THE BACK TYPE OF REFRIGERATION: GAS ICE DRY ICE _OTHER METHOD FOR COOKING/HOT HOLDING' GAS _OTHER METHOD FOR SANITIZING" CHEMICAL _OTHER SOURCE OF FOOD: NAME. --2<—CHEMICAL - `nn� re ADDRESS I FOODS TO BE SERVED INCLUDING INGREDIENTS AND METHOD OF PREPARATION0 TO 11 �Q✓►c , _ n I HAVE READ THE BOARD OF HEALTH, "REQUIREMENTS FOR TEMPORARY FOOD ESTABLISHMENTS." I HAVE HAD THE OPPORTUNITY TO ASK QUESTIONS REGARDING THOSE REQUIREMENTS. I UNDERSTAND THEM, AGREE TO ABIDE BY THEM AND UNDERSTAND THAT FAILURE TO DO SO WILL RESULT IN REVOCATION OF MY TEMPORARY FOOD ESTABLISHMENT PERMIT PERSUANT TO MGL C62C, S49A, I CERTIFY UNDER THE PENALTIES OF PERJURY THAT I, TO MY BEST KNOWLEDGE AND BELIEF, HAVE FILED ALL STATE TAX RETURNS AND PAID ALL STATE TAXES REQUIRED ( , r UNDER LAW. J� -C�"i n`�� 4'tD 0-7 yv GNATURE DATE SOCIAL SECURITY OR FEDERAL ID# ---------------------------------------------------------------------------------------------------------------------------------------- TEMPAPPL REvISEo 1125102 PERMIT K CHECK#8 DATE AiL CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH 120 WASHINGTON STREET, 4TH FLOOR 9 SALEM, MA 01970 TEL. 978-741-1800 FAX 978-745-0343 JOANNE SCOTT, MPH, RS, CHO Kimberley Driscoll HEALTH AGENT Mayor REQUIREMENTS FOR TEMPORARY FOOD ESTABLISHMENTS These requirements are in accordance with the State Sanitary Code of the Massachusetts Department of Public Health, 105 CMR 590.030. This code states, "The Board of Health may impose additional requirements to protect against health hazards related to the conduct of the temporary food establishment, may prohibit the sale of some or all potentially hazardous foods, and when no health hazard will result, may waive or modify the requirements of these regulations." Therefore the Salem Board of Health reserves the right to evaluate individual establishments and make necessary requirements to protect the public health. FOOD MANAGER CERTIFICATION IS REQUIRED OF ANY TEMPORARY FOOD ESTABLISHMENT THAT PREPARES POTENTIALLY HAZARDOUS FOODS. ALL TEMPORARY FOOD ESTABLISHMENTS MUST COMPLY WITH THE FOLLOWING: • The Board of Health must receive the application for a temporary food establishment at least one week prior to the planned event. Halloween vendors must submit their applications at least three weeks prior to the event. Unvermitted establishments shall be excluded from the event. • Foods served are limited to the following: Baked goods, fresh fruit and vegetables, and pre-cooked potentially hazardous foods. Raw chicken, raw beef, raw pork, or other raw potentially hazardous food is NOT allowed. • The application must be filled out completely. Incomplete applications may result in a refusal to permit the establishment. • The application shall include a plan of the set-up of the establishment including the location of equipment, cooking facilities and cooling units. • Necessary permits for the operation of the establishment, including the Food Permit, must be conspicuously displayed. • Running water with liquid soap and disposable towels for hand washing must be available. Bottle water with a pull out spout is acceptable. All food handlers must wash their hands after utilizing toilet facilities, eating, or smoking. Smoking is not allowed within 10 feet of the establishment. • All utensils and food contact surfaces must be sanitized with an approved sanitizing solution. Test strips for that sanitizing solution must be used to verify its strength. • Premises must be kept clean. Refuse and garbage must be disposed of in a satisfactory manner. • All utensils, equipment, and containers must be maintained in a clean and sanitary condition. • Food handlers must wear clean outer garments and utilize good hygienic practices. • A permit from the Fire Department is required for the use of propane. Contact Fire Prevention at 978-745-7777. • A permit from the Electrical Department is required for the use of a generator. Contact the City Electrician at 978-745-6300. • Permits may be required from the Licensing Department. Contact Licensing at 978-745-9595. TEMPORARY ESTABLISHMENTS MUST ENSURE FOOD PROTECTION BY ADHERING TO THE FOLLOWING REQUIREMENTS: • Only foods listed on the permit may be served. • Cold foods must be maintained at a temperature of 40F or less. • Hot foods must be maintained at a temperature of 140F or higher. • Food must be obtained form a permitted source. Proof of the source must be on site. • Stem thermometers must be on site to check that proper temperatures are being maintained. • All food must be covered and protected during transportation, storage, preparation, and display. Food shall not be stored on the ground. Trash bags shall not be used as storage containers. • Bare hand contact of food is not allowed. Tongs, tissues, clean gloves must be used when handling ready-to-eat- foods. ON SITE INSPECTION OF YOUR ESTABLISHMENT WILL BE CONDUCTED BY BOARD OF HEALTH SANITARIANS TO ENSURE COMPLIANCE WITH THE CODE AND THESE REQUIREMENTS. IF VIOLATIONS ARE OBSERVED YOU MAY BE REQUIRED TO CEASE OPERATION AND TO LEAVE THE EVENT. Joannes folder:tempfood Commonwealth of Massachusetts City of Salem Board of Health 120 Washington Street,4th Floor SALEM,MA 01970 DATE PRINTED: 02/10/2006 WHO'S PLACE OF BUSINESS IS: Gourmet Fare File Number BHF-2003-0007 73 Wharf Street Salem MA 01970 LOCATED AT: 0073 WHARF STREET SALEM, MA 01970 Permit Type Permit No. Permit Issued Permit Expires Fee Restrictions/Notes TEMPORARY FOOD BHP-2006-0409 Feb 10,2006 Feb 11,2006 $0.00 /TO BE SERVED: Choc. Petite four(little cakes),Choc.Biscoths, and Bark(choc.bar with dried fruit) Total Fees: $0.00 PERMIT EXPIRES February 11, 2006 Board of Health V Page 5 of 9 FROM _FHX . :19787453855 Feb. 06 2005 03:25PM PS Jul 7i DE 11 : 29a _ icanneScott Sale AI 901.4 978 745 OG43 P. C g C1T'l or 16A, EK NMASSACRUSErTS ticsSe �lll GUt i� 60 APD OF HEALTH 1' IZO VYA,HINGT,-N CTRE4:T,4T4 `-'ALCY ' M''W RTU 7F--, 978-741-1600 FAC cTn NL6Y JT.4)viC L, .I.T. MAYyG ..':.nn;+8 SCOTT. MOH. R5 f::0 HFn LTn .'a4:H"Y APPLICATION FCR A TEMPORARY FOOD SERVICE PERMIT ��lzlerllClnc;m .� c-- Comrr< �// - [ FEE 1-5`JAYS= 2D0 I(•{•-C E 1<C• SC{I C 71 m Iylc�cC�•3r r_ f 4-7OAYs= sato h J4`2VVlySC' ' tiJ(?t-+ MOREiwN 7 DAYS a= $400 CHECK'PAYAEU M 1t-G+.YOr 3.tE ;W CAEd NAM:CF EvE vL'I( C l L�IIU' �G ��Vx} LaCAhJu DA)c(S)OFEVENT r: NAME OSA?P_n:Atrti ._( ,yj�y(y U_ TELEPti4NE'Ji'� � ,~—�J(rL(] ADORES:? --moi NAmE OFE)U£tNESS � TELE?MONEtb ADDRESS CFRTIrCQ r000 MANACER'$NAME i r>tti rte, i"St-�-•i71 l:E4T1a1CAP.ONY,_ yi � Q Q ij n A PLAN OF THE E5TASUSHMENT IS. EYCYOSED -—DRAWN ON THE BACK TYPE T GF REFRIGEPAION, OP9 ICE _J__DRY It:L, METHOD FGd COOKINGtHOT 4ci3OiNG, 114CTWOO FCR SAMVZING. CYtK1;DAL ()TH(.R SOUROE OF FCOO: NA(,4E ADMES5 1 OOD8':C,uu'E�ScH:'Q RICUA)ING:^IGR/E7):�ENTSANC.UE',-ICO OF P(�HL'RARA TION / .—C•Aat.i`t.S� •% t .�,],-.Ul.LLC7.S:sLA •"]V� �aK+•t� f a`."'"` '�`�'• r-4L �riAVF READ"-1E DOARtr OF 1';EAI,1Ii, '•h'¢C:IIRNMCNTS F.OR TEYIPO(tgttT FOOD£SFABLISHNiENTS"7 Hni,•E r.:,O TrtE(IPfJFT.IN4TY :L fSri�.:4£FT:QNB.FECVIR'jthG I t'2`Sc n:;jUIRFK'BN TS I UNL^EF5TAN17•HE%1, AGIiL-E TV rtl4�iE 65'THtK•ANL'4 UMO FIt$T.�\,p �H.RT. rAILU�:c TC CO*SO WILL RcSULT IN REVOCATION(A FST'6MAORARY POW E5TABLI$HMSNT�EH1st i FE;a,AN:TC lv:v'i. C62C, .SJ 9A. :C1l4r7l Y UNCI-k THE rCNALI;°S C*PIZIIJUF'! I hP l I.TJ MY OE31 KNOWICOOE AND 0S.16F. NAVE FiL 11 ALL ST1A':Z TA,'\RETURNS AND FA IO A!L ETA(E CA%E5 REOU,KFO - $I ?1'IIRE DALE SOCIAL SECURITY ORFtOERALIDw iYVI,IY. w,.r•:(tC t!'•y(it �L'YY, tl_ _ �_ fn�: Y{Iltll... .�_._ ��. �. ,� T 7 lzL'.t,t4' rl -71V Commonwealth of Massachusetts City of Salem Board of Health 120 Washington Street,4th Floor SALEM,MA 01970 Food/Retail Establishment Permit DATE PRINTED- 01/03/2006 WHO'S PLACE OF BUSINESS IS: Gourmet Fare File Number:BHF-2003-0007 73 Wharf Street Salem MA 01970 LOCATED AT: 0073 WHARF STREET SALEM,MA 01970 Permit Type Permit No. Permit Issued Permit Expires Fee Restrictions/Notes RETAIL FOOD BHP-2006-0095 Jan 3,2006 Dec 31,2006 $100.00 Total Fees: $100.00 PERMIT EXPIRES December 31, 2006 Board of Health A wvy This Permit is not transferable and must be reissued upon change of ownership or location.The permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code,beofre any revonations,improvements,or equipment changes are made,all plans for such must be submitted to and approved by the Salem Board of Health. Page 17 of 23 M CITY OF SALEM, MASSACHUSETTS rc� .� BOARD OF HEALTH D g(CL.-S ((U'y4 Q 120 WASHINGTON STREET, 4TH FLOOR SALEM, MA 01970 TEL. 978-741-1800 DEC 0 8 2005 STANLEY J. USOVICZ, JR. FAx 978-745-0343 MAYOR WWW.SALEM.COM CITY OF SALEM JOANNE SCOTT, MPH, RS, CHO BOARD OF HEALTH HEALTH AGENT i 2006 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT NAME OF ESTABLISHMENT C'12Ltrv�^1 i v 1^a ro_ �J TEL# ADDRESS OF ESTABLISHMENT MAILING ADDRESS (if different) JJ OWNER'S NAME „.� TEL# C1”) S_? -- 9;,' -) - J ,� (0 ( ADDRESS `I-a lLl. ��v•n�_nn,a CITY (�s,v�v y;a I ESTATE Ind t ZIP m q J CERTIFIED FOOD MANAGERS NAME(S) fin„ ,, no L. L4L.JcCERTIFIdATE#(s)_,! ` ` S (required in an establishment where potentially hazardous food is prepared.) EMERGENCY RESPONSE PERSON .f oari tie_L- 14ckLlv HOME TEL# HOURS OF OPERATION: Montt •ra Tue.tt-/ Wed. L_ Thu.ti-t., Fri.rt-t=, Sat. LL Sun. 1,9- TYPE OF ESTABLISHMENT FEE (check only) RETAIL STORE YES NO less than 1000sq.ft. =$ 50 f� 1000-10,000sq.ft. =$100 t more than 10,000sq.ft. =$250 .....--...--. ...............*------V ........ --------....-....-----------...-...-..-......----le'.----.....-.....-_....- ...-----•---- ...---.... ...- RESTAURANT ES NO Tess than 25 seats =$100 25-99 seats =$150 more than 99 seats =$200 --.._--------------------- ---- ------------------------------------ _ - $ -------- ...10-.0------------ •- BED/BREAKFAST YES NO _ ADDITIONAL PERMITS ------------------------------------------------------------------- ------•-------------------------- ^--------------...- MAKE (not just serve) ICE CREAM, YOGURT, SOFT SERVE YES NO $5 TOBACCO VENDOR YES NO $50 ALL NON-PROFIT(such as church kitchens) YES NO $25 *Please pay total with one check payable to the City of Salem . This Permit is not transferable and must be reissued upon change of ownership.The Permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code, before any renovations, improvements, or equipment changes are made,all plans for such must be submitted to and approved by the Salem Board of Health. Pursuant to MGL Chapter 62C, Section 49A, I certify under the pains and penalties of perjury that i, to my best knowledge and belief, have filed all state tax returns and paid all state'.axes required under the law, /��(r�n v1�_ - Lrk_ ia'- Os tam �+v o704 Wature Date Social Security or Federal Identification Number --------------------------------------------------------------------------------------------------------------------------------- Revised 11103/05 FOODAP2,adm Check#&Datef 01q 12 Klo,? j�d CO- 0073 Wharf StreLnt Gourmet Fare City of Salem RETAIL FOOD - Food Establishment Inspection HACCP: ❑ Telephone. Item Status Violation Critical Urgency Nature of problem or correction 745-9190 Non-compliance with: Not Done Owner: Anti-Choking PASS ❑ Joanne L. Hatch Tobacco PASS ❑ PIC: FOOD PROTECTION MANAGEMENT Not Done Joanne Hatch PIC Assigned/Knowledgeable/Duties PASS ❑Q RED Inspector: David Greenbaum EMPLOYEE HEALTH Not Done Date Inspected Correct By: Reporting of Diseases by Food Employee and PIC PASS ❑d RED 6/30/2005 _ -- Personnel with Infections Restricted/Excluded PASS 0 RED Risk Level: _ FOOD FROM APPROVED SOURCE Not Done Permit Number: Food and Water from Approved Source PASS 0 RED "';, ' BHP-2005-0326 Receiving/Condition PASS d❑ RED Status: - Tags/Records/Accuracy of Ingredient Statements PASS 0 RED VIOLATION Conformance with Approved Procedures/HACCP PASSd❑ RED #of Critical Violations: Plans 3 Time IN: (Time OUT Notes: 282:Owner will notify the Board of Health when all new equipment has been installed. Urgency Description(s): BLUE: Violations Related to Good Retail Practices (Critical violations must be corrected GeOTMS®2005 Des Lauriers Municipal Solutions, Inc. ( Rev. Sep 08,2005 ) Page I of 0073 Wharf Street Gourmet Fare immediately or within 10 PROTECTION FROM CONTAMINATION Not Done days)(Non-critical violations Separation/Segregation/Protection PASS ❑/ RED must be corrected immediately Food Contact Surfaces Cleaning and Sanitizing FAIL Non-Critical ❑d RED All work surfaces had an accumulation of Or Within 90 days) food debris. Thoroughly clean and sanitize RED: all work surfaces. Violations Related to Proper Adequate Handwashing PASS ❑d RED Foodborne Illness Interventions and Risk Factors (Require Good Hygienic Practices PASS ❑? RED immediate corrective action) Prevention of Contamination from Hands PASS RED Handwash Facilities FAIL Critical 0 RED The bathroom was cluttered and the handwash sink obstructed Thoroughly clean bathroom abd keep the handwash sink clear and accessible at all times The kitchen hand wash sink was obstructed. Keep the hand wash sinks clear and accessible at all times, keep soap and disposable paper towels stocked at all hand wash sinks _ PROTECTION FROM CHEMICALS Not Done _ Approved Food or Calor Additives PASS ❑d RED Toxic Chemicals PASS ❑d RED TIMEITEMPERATURE CONTROLS(Potentially Haz Not Done Cooking Temperatures PASS ❑d RED Reheating PASS Q RED Cooling PASS RED Hot and Cold Holding FAIL Critical RED The front Howard cooling unit had a temperature of 46°F Repair unit to maintain a temperature of 41'F or below. Time As a Public Health Control PASS RED REQUIREMENTS FOR HIGHLY SUSCEPTIBLE PO Not Done Food and Food Preparation for HSP PASS 0 RED CONSUMER ADVISORY Not Done Posting of Consumer Advisories N/A 0 RED GeOTMS®2005 Des Lauriers Municipal Solutions, Inc. ( Rev. Sep 08,2005 ) Page 2 of 0073 Wharf Street Gourmet Fare Violations Related to Good Retail Practices (Blue Not Done Management and Personnel PASS ❑ BLUE Food and Food Protection FAIL Critical ❑ BLUE All product packaged for sale must be labeled with ingredients and the common name of the food Information regarding this violation was given to the owner on 9/8/05. There was food stored directly on the floor. All food must be stored at least 6-8 inches off the floor. Equipment and Utensils FAIL Non-Critical ❑ BLUE The 3 bay sink needs to be relabeled with "wash-rinse-sanitize. The small whit refrigerator in back needs a thorough cleaning. The same unit needs a visible,accurate thermometer. The dough mixer had an accumulation of food debris. Thoroughly clean and sanitize the mixer The microwave had an accumulation of spills and splatter. Thoroughly clean the microwave. The dry ingredient barells need a thorough cleaning The flooring throughout the establishment needs a thorough cleaning, including under and around all equipment Water, Plumbing and Waste PASS ❑ BLUE Physical Facility FAIL ❑ BLUE There are water stains all over the kitchen ceiling Investigate the source of the leak and repair. Paint the ceiling with stain preventer and repaint Poisonous or Toxic Materials FAIL Non-Critical ❑ BLUE Special Requirements PASS ❑ BLUE Other-See Notes PASS ❑ BLUE The establishment is need of a complete cleaning and reorganizing. GeOTMS®2005 Des Lauriers Municipal Solutions, Inc. ( Rev. Sep 08,2005 ) Page 3 of ( IMPORTANT MESSAGE ) + FOR DATE M OF PHONE AREA CODE NUMBER EXTENSION Ci FAX ❑ MOBII F AREA CODE Nly 8ER TIME TO CALL TELEPHONED I� PLEASE CALL CAME TO SEE YOU WILL CALL AGAIN WANTS TO SEE YOU RUSH RETURNED YOUR CALL I I WILL FAX TO YOU MESSAGE SIGNED FORM 4009 ■� FORMADE IN U S.A. ( IMTPORTANT MESSAGE ) FOR — DATE_� �1r7 TIMEP.M. MI OF ,////142 PHONE AREA CODE NUMBER EXTENSION O FAX O MOBN F AREA CODE NUMBER TIME TO CALL TELEPHONED PLEASE CALL CAME TD SEE YOU WILL CALL AGAIN WANTS TO SEE YOU RUSH RETURNED YOUR CALL /WILL FAX TO YOU MESSAGE SIGNED _ op I WTWFOR 4009 MAO U.S A ��T •„ ^""' .„"Jin' .'+, ,x4• , a«. r _Y• ErA S W' A R.R A`N Y it �n jw•wu , , y:,z« �w,• '. „ i.� � � �+� ,. • -%� � ., w k fiT, � ,.m'+a_n ,s {•. •!+��•�`- �, � <il rte+` .m1 ('so+ t a(BASE MFASUPE Qtr' MEASUPE'O R:,��aYpm•'',�, n'y'* t` 14, 32 1/4' ,- (356mm)` "'").7 .y. n" « 'l`. (874mm)....-,...w..._..-:.w.-'.dm`(t00 '4' x,'+`'"-341/2"36112"•x° 6'max m - - near 12" . (Standard) a.n»da+:rd.,)r (876 men-927 mm) �08"5.m0.nam) 1/2" (305 nom) 36 9/2"-38 ii4 .Q mm) , , (200 mm) 1M ^•bl j. r4.Y,A",cY'6•P�✓Y1w' -"F' •• I� 15114' _ - a.; ' Sonny Vcari Aremes D vAinn = (387 mm) .. ,-.i--„ 208-240/60/1 37A' Electoral plug(50A)type 6/50R(e g Eagle 91252). wa � (Ulshsher is supplied with power cord and plug) :�',) I ( D D ( 208-24016013 24A Connector box Dishwasher supplied with power cord only W1 "Por information on availability of 27A or 17A rating,cull 1-888.794-7749 .._21 11116"—,- 23 518"m) Unit is supplied with flexible stainless Steel water hose with 3/4"female plpc thread connector (350 mm) (600 m1111111 -140'F(60'1)wcommoncled water temperature. Mmlmum 1/2"pipe with 3/4"male pipe thread connector(N.P.S) 2 3(4" -Acceptable water flow pressure range:25-50 psi.If water pressure varies.a water (10 mm) regulator is recommended(by others)with 35 psi setting SPECIFICA71ON5 SUMMARY. rr� Dishwasher is supplied with 30"(750 mm)flexible drain hose and two ifs hose damp... Maximum hourly output. 48 standard racks;864.9'plates;2,352.2 112"glasses "il -Dishwasher Is dimmed by gravity(no pump) Water consumption: 3 liters per rack(0J9 U.S gap t� -Inner diameter(10)of one.hose is 1 114"(32 mm). Cycle hose: Adjustable tom 30-360 seconds Motor pump: 1 Hp NOTES: 1. Utilities may be placed on either side of the unit provided measures of shaded area are respected Detergent&Rinse pump, Integrated and controlled by PLC(Programmable Logic Commit) 2 Reserve place for detergent and rinse chemicals: Ease of service Adjustment&component replacement from the front -4liters; width 6 112"(165 mm), height 12 1/4"(310 mm) Technical phone assistance 24// -20 liters; width 12 1/4"(310 mm), height 15 1/2"(395 mm) Warranty: 2 years on parts;1 year on labor. S P E C I F I C A T I O N S •"•��+ ThULY Como u61ALl • All stainless feel constru,hon ,a .°On) • 40 jets for (npeccable results � � F !*. + I Hp motor pump n • 209-24C Hnks.)cr 3 phase- your Choice-no extra cost SW i',SH COMMERCIAL • F,eti0:25:amless Reel water E7U:pMENI INC. supply hose 5570 CHABOT SUITE 203 Thi SWiSSH 25 PLC HAS At HOURLY OUTIET 01 dP TO • Finai rinse protection to MONTREA.,GJEsi f 4P cFAa)OAFD 1.1,AC' G PEQ Ii Illi UNLEASH THE POWEP OF guarantee HIVE(8P'C) H2H 2S7 THC )HP MOTOR PUMP WITH THE TIP OF YOUR FINGER AND Samnting nose TET.(514)524 6005 ' AL1hRNAI1: FROM ONC CYC(E TO ANOTHER TO ACC(IMMOIIATE F,: (510n74 3305 • Compatible With Busch TOU,FREL' 1-868-7947749 'GLA?WORK ,.CAD. Finr3M L"dST)T-JT;CNS TO RESTAURAWC Gr commern31 ear water heale's J"'12 150 SEATS,TIIANI(S TO PS'LEYISLF PFU°ERIIES, • Vanuae1a1111CHboses E-MAIL udfu@SwL'Sii n s for your specific nerds vvWW SW1;3H rum IHE SWISSH 2J PLC CAN HE INSTAL I ED IN THE MOST • _o'C,Cfel i 's-for Q"fse. a CHALLENUING 1 OCATION- IIS A11APTABILITI' MAKES IT THE r 4 '."•1.+6}. Traln{rump '!0 1 Ch AMELLGN OF THE INDUSTrR'r1 E3lggef rTeeds' Ask us about out SWc.sh 6b PLC IL-3-) A7Glvak4 ��U�j. SW,IS`SH; 2`SPL ��c� INNOVATION 1�c_1 �z p9i 3X�f RSbt 2d 2 programmable cycles, adjustable wash/rinse cycles 02:7 4! from 30 to 360 seconds digit display,temperature rSV�( q�J-CUO� 16&machine status V �$a�p� ci languages-English,Francais, ; � ' �It �r�j[f� Espanol,Deutsch Qiagnostic - ~ . `Is'n- 3`n"F -p .r q'(;' ',• zesting of the unit withoutap s"'* -- , .:,..�,• ' ' ==%` '"-'"° removing front panel"` x i r.;. q� Y , If, tth gay=W,.s'"� y'n G•ia�« �� #Ja#.�, � I¢ - e W I T H A S 0 L I 0 R E P U T A T I 0 N ❑ISHWASHER OR GLASSWASHER? INCwoeo! ?^; THE UNIQUE ELECTRONIC DESIGN MAKES THE SWISSH 25 PLC •'2 years warranty on parts, 1 year an labor ADAPTABLE TO THE NEEDS OF YOUR iBUSINESS. INNOVATIVE uv me�•'ui' '- • Integrated booster — on � +.ij�:*sn) WITH ITS 2 PROGRAMMABLE CYCLES INDEPENDENTLY Top and side panels ' Integrated detergent ''' rR ADJUSTABLE FROM 30 TD 350 SECONDS- CYCLE ONE FOR y and rinse pumps YOUR DISHES, CYCLE TWO FOR YOUR GLASSES OR YOUR CUPS •� - TELL US WHAT YOU NEED. EACH CYCLE IS ADJUSTABLE • 2 racks Designed in Switzerland since 1962, i Start-up chemical lu[* Manufactured in Canada since 1992, TO THE SECOND' THE SWISSH WILL GIVE YOU SPARKLING As ALWAYS! Innovating for over 35 years RESULTS WITH LOW WATER, ELECTRICAL AND CHEMICAL • Environmentally friendly CONSUMPTION. WHY WASTE YOUR MONEY AND OUR PLANETS • Only 3liters of water per wash MOST PRECIOUS RESOURCE? YOU DESERVE THE BEST AND YET (or 0 79 US gal)-less water and chemicals down the drain BE THE ENVIRONMENTS BEST FRIEND. • Prease mlecb on of detergent and rinse agent • Self calibration of detergent intake to reflect water hardness fluctuations • Integrated diagnostic test without removing front panel *where applicable TOLL FREE CANAOA AND U-S-A- 1-888-794-7749 CITY OF SALr=m, M1ASSXCHUSETTS �^ BOARD OF HEALTH - I� 120 WASHINGTON STREET,4TH FLOOR a SALEM, MA O 1970 TEL, 978-741-1800 FAX 978-745-0343 STANLEY J. 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 111, Section 5 of the General Laws, to operate a Food Establishment in the City of Salem is hereby granted to: Type of Establishment: RETAIL FOOD Name of Establishment: Gourmet Fare Address of Establishment: 73 Wharf Street Owner's Name: Joanne L. Hatch Restrictions: Application Date: 12/$!2004 Permit for Food Establishment 216-05 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 Cade, 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. l HEALTH AGENT : CITY OF SALEM, MASSACHUS !! tt((}} BOARD OF HEALTH + o-. 120 WASHINGTON STREET, 4TH FLOOR IIIU)!J' SALEM, MA 01970 �•P DEC - 6 2004 TEL. 978-741-1800 FAX 978-745-0343 STANLEY J. USOVICZ, JR. JOANNE SCOTT, MPH, RS, CHO CITY OF SALEM MAYOR HEALTH AGENT BOARD OF HEALTH 2005 APPLICATION FOR PERMIT T[O OPERATE A FOOD ESTABLISHMENT( NAME OF ESTABLISHMENT l� 0(xry tL � , fr�p� TEL# q-1 S((— 7`1' —9 1 cio ADDRESS OF ESTABLISHMENT 73 `°]� fit/ ln..Qii SaJR-rn MAILING ADDRESS.(if different) OWNER'S NAME Jrr�}rhr�p �. � �QiG�R TEL#_5_12 Q'R7 -Sb ADDRES(y�g�� moi- D IV�,�,� n 1'1A r1 AnLfex 4}7''. CITY 12XJx�irY1� Z!P f� l4't tCERTIFIED FOOD MANAGER'S NAMES) :r CERTIFICATE#(s) (required in an establishment where potentially hazardous food iIJ s prepared.) EMERGENCY RESPONSE PERSON TorAn yw- L 1�t+ l HOME TEL# q7 4- 2 V HOURS OF OPERATION: Mon. Tue.lt=(„_Wed.I1-4 Thu.t I-(, Friat=t4, Sat.f 1- Sun. t 2- S TYPE OF ESTABLISHMENT FEE check only RETAIL STORE / YE' NO less than 1000sq.ft. =$50 1000-10,000sq.ft. =$100 more than 10,100sq.ft. =$250 RESTAURANT YES NO 11��/ less than 25 seats =$100 25-99 seats =$150 more than 99 seats =$200 BED/BREAKFAST YES NO $100 ADDITIONAL PERMITS MAKE (not just serve) ICE CREAM, YOGURT, SOFT SERVE YES NO $5 TOBACCO VENDOR YES NO $50 ALL NON-PROFIT(such as church hitchers; YES NO $25 Please pay total with one check payable to the City of Salem This Permit is not transferable and must be reissued upon change of ownership. The Permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code, before any renovations, improvements, or equipment changes are made, all plans for such must be submitted to and approved by the Salem Board of Health. Pursuant to MGL Chapter 62C, Section 49A, I certify under the pains and penalties of perjury that I, to my be t knowledge a�d bglief, ha}�e filed all state tax rggturns and pat all state taxes required under the law. on I nature Date Social Security or Federal Identification Number ------ --------------------------------------------------------------------------------------------------------------------------- Revise --------------------------------------------------------------------------------------------------------------------------- Revised11/03/03 FOODAP2 aft Check#&Date--54ZL— -A��, ��t7� CITY OF SALEM9 MASSACHUSETTS BOARD OF HEALTH 120 WASHINGTON STREET, 4TH FLOOR g 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 111, Section 5 of the General Laws, to operate a Food Establishment in the City of Salem is hereby granted to: Type of Establishment: RETAIL FOOD Name of Establishment: Gourmet Fare Address of Establishment: 73 Wharf Street Owner's Name: Joanne L. Hatch Restrictions: Application Date: 12/11/2003 Permit for Food Establishment 187-04 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 CITY OF SALEM, MASSACHUSETTS 0 vQ� BOARD OF HEALTH 3 120 WASHINGTON STREET, 4TH FLOOR ✓'"�' i`J �� '� , Ia SALEM, MA 01970 .�, TEL 978-741-1800 DEC 10 2003 FAX 978-745-0343 STANLEY USOVICZ, JR. ,JOANNE SCOTT, MPH, RS, CHO QTY MAYOR HEALTH AGENT BOARD OF HEALTH 2004 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT ' NAME OF ESTABLISHMENT �' Pare TEL# 9-t _. F 6 o I.rv�n..o; ADDRESS OF ESTABLISHMENT 7;3 l�J[ncir .i Se� MAILING ADDRESS (if different) 1 OWNER'S NAME _1,-�i n•r�v - �__ ��ct- U % TEL# ADDRESS ) N1 U�� In ,n✓J I�Y. CITY I lJ S N cI I STATE /L�rA ZIP (-) (cl-)-1CERTIFIED FOOD MANAGER'S NAME(S)_T_I - ( l-ra 1 c_L1 CERTIFICATE#(s) G,'73a 37 (required in an establishment where potentially hazardous food is prepared.) EMERGENCY RESPONSE PERSON nc +r �rL HOME TEL# J HOURS OF OPERATION: Mon. 11 L Tue. 116 Wed. 11�Thu.11- i, FrUl 6 Sat. 11-(, Sun. 11-J TYPE OF ESTABLISHMENT FEE check only RETAIL STORE /SES NOless than 1000sq.ft. =$ 50 O� I �'7 1000-10,000sq.ft. more than 10,000sq.ft. =$250 RESTAURANT YES NO less than 25 seats =$100 25-99 seats =$150 more than 99 seats =$200 BED/BREAKFAST YES NO $100 ADDITIONAL PERMITS MAKE (not just serve) ICE CREAM, YOGURT, SOFT SERVE YES NO $5 TOBACCO VENDOR YES NO $50 ALL NON-PROFIT(such as church kitchens) YES NO $25 Please pay total with one check payable to the City of Salem This Permit is not transferable and must be reissued upon change of ownership. The Permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code, before any renovations, improvements, or equipment changes are made, all plans for such must be submitted to and approved by the Salem Board of Health. Pursuant to MGL Chapter 62C, Section 49A, I certify under the pains and penalties of perjury that I, to my best k owled a and belief�h v file all state tax returns and aid II state taxes required under the law. Q C-1 Z -��r:)UK p0 a, �� 0-) 4 q Sign re Date Social Security or Federal Identification Number — ------------------------------------------------------------------------------------;---------------------------------------- Revised 11/03/03 FOODAP2.adm Check#&Date 0/ 007 — /a -V'63' "a _ - i Massachusetts Department of Public Health Salem Board of Health 120 Washington Street,4th Floor Division of Food and Drugs" Salem, MA 01970-3523 FOOD ESTABLISHMENT INSPECTION REPORT Tel. (978) 741-1800 Fax(978) 745-0343 Name Date Type of Ooeration(s), Type of Insoection �lrlu.r.u_s Ir -'.FOAL (�2�V J Rr Food Service ElR utine Address Risk E] Retail e-inspection 7 3 /A//JG LGr r I Level ❑ Residential Kitchen Previous Inspection Telephone IN ❑ Mobile Date: �N+f-9i4'e Owner HACCP Y/N ❑ Temporary ❑ Pre-operation TAAMNd. VAPUV ❑ Caterer ❑ Suspect Illness Person in Charge(PIC) Time ❑ Bed& Breakfast ❑General Complaint In: ❑ HACCP Inspectors 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 El13. Handwash Facilities EMPLOYEE HEALTH El2. Reporting of Diseases by Food Employee and PIC PROTECTION FROM CHEMICALS El3. Personnel with Infections Restricted/Excluded E] 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) ❑ 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) E] 10. Proper Adequate Handwashing [121. 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 Jp immediately or within 10 days as determined by the Board and Risk Factors(Items 1-22): (f 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 Health. 590.000/federal Food Code. This report, when signed below 23. Management and Personnel (FC-2)(590.003) by a Board of Health member or its agent constitutes an 24. Food and Food Protection (FC-3)(590 004) order of the Board of Health. Failure to correct violations 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)(990.009) the food establishment permit and cessation of food establishment operations. If aggrieved by this order, you 27. Physical Facility (FC-6)(590.007) have a right to a hearing. Your request must be in writing 28. Poisonous or Toxic Materials (FC-7)(590.008) and submitted to the Board of Health at the above address 29. Special Requirements (590.009) within 10 days of receipt of this order. 30. Other DATE OF RE-INSPECTION: S 5MnsC fForm ,J do Inspector's Signature•v A ' Print: I PIC's Signature: Print•• Page / of ?Pages Violations Related to Foodborne Illness Interventions and Risk Factors(Items 1-22) PROTECTION FROM CONTAMINATION FOOD PROTECTION MANAGEMENT S Cro3s-containinahon I 590.003(A) Assigntncnt of Respou<ihility" i=102.1 I(Aat) Raw Ani;:al inixh'ls Separated frena 5n0.003(B) Demonstration of Knowledge* Cooked and RTF F;ods'" 2-103.11 Person in charge --duties Cnrr'arnination 6om Rain lnyl�sdrzas 3-30111(A)(2) Raw Animal Foods Separated from Each EMPLO"EE HEALTH Othr° 2 590.003(C) Responsibility of the person in charge to Contaminatbn from the Fnv:tonment require teporting by focxl entphgces and 3.302.1 1(!0 Ftod Prnl codon* applicants'^ 3-302.1-1 Washing Fnnr c and Vcgcntbics 590 003(F) Responsibility Of A Food Employee Or An13 304"11 Fntx1 Contact tutu Equipmcrt and Applicant To Report To The Person 6t Ute;,sils' Charge"> Contamination from the Consumer 580.003(G) Reporting by Person in Charge' 3- Ob.l-1(A)(B) Retuned Pard and Pesci vice of Food* 3 590 003(D) Exclusions and Restrictions* I Disposition of Adulterated of Contaminated 590.003(F,) Removal of Exclusions and Restnctmns Food 3-701.11 Dis.arding or Reconditioning unsafe FOOD FROM APPROVED SOURCE Feud' 41 Food and Water From Regulated Sources 9 Food Contact Surfaces 590.004(A B) Compliance with Fos;d Lacs" 4-501.111 M.mual Wa'ewa,hmg-flot WC Iter 3-201.12 Food in a Ilentteticatic Sealed Container* Sariittzauon T'etoperatures`' 3-20!.!3 Fluid Milk and Milk Products' 14-501"112 Mechanical t'v.uewa,hinp-Hot Rater 3-202.13 Shell Eggs* S:sltization Tempet:«ures* s-501.114 Chemical Sanitiza tion-temp.,pH, 3-202.1-1 Fggs and Milk Prulu.ts.Pasteurized" uarcctttraD:rt and ha'dnec:. -c I 3=_'02.16 ice Matte From Potable Drinking Water' 14-601.1 i(A) Equipment Food Contact Surfaces and m 5-101 11 Drinking Water froan Approved Svsiem'" iltens:is('fern" 190 0061A) Bottled Drinking Water" t-602.11 Cleaning Frequency of Equipment Food- 590.(•i06(B) Water Meets Standards in 310 CMR 22.0` Contact Surfuces and lihmsils* Shellfish and Fish From an Approved Source 1-702.11 Frequency of Sanitization of Utensils and 3-201.14 Fish and Recreattonally Caught Molluscan Ftwd Contact Surfaces of Equipment Shellfish:' 4-703.11 Methods of Samt;7ation--Hot Water and 3-201.15 Molluscan Shellfish from NSSP Listed ( Chenticil" Sources`" I to Proper,Adequate Handwashing Game and Wild Mushrooms Approved by ,"301 U Clean Condition - Hands and Arms" Regulatory Authority 3-202.18 Shellsuxk identification Present" 2-30'11. Ch•mtio Pracedru O" 1 590.004(C) Wild Mttshroonts` 2-301.14 When to Wash" 3-201.17 Game Amneth,i" ; if. Good Hygienic Practices ( q Receiving/Condition 2-401.11 Eating,Drinking of Using Tobacco'^ 3-202.11 PI IFv Received at Proper Tcmperatures" 12401.12 Discharge;From the Lyes Nose and 3-202.15 Package Integrity* Mouth", 3-IOL I t Food Safe and Onaduttcratcd" 3 301.12 Prev,riling Contamination When Tasting" 6 Tags/Records:Shelistock 12 Preventian of Contamination from Hands ' 3-202.18 ShclktockIdentification'^ 5`)()!)()'+(E) PrerentingCurtalmnatii+nfrom 3-203.12 Shellstock Identification Nlaintained" fanplo}ee,^' 'rags/Records:Fish Products 13 Handwash Facilities ' ConvenieMty Locolad and Access%.hie 3--}02.11 PatasitcDeatruc[iouT 3402.12 Records Creation and Retention" 5203.11 Numbcrs and C:pacifies 1 1 590.0040) Labeling of Ingredients' 5-204.11 L xrauou ;rad Placement* 7 Conformance with Approved Procedures l ( 5-205 11 Accessibility,Operation and Maintenance /HACCP Plans I I Suppled Weh.Soap and Hand Drying `s-502 11 Specialized Processing Methods* Devices 3-50112 Reduced oxygen oackagurg,criteria' ( 6-301-1 I tle.adwa Bing Clcanscr.Availability 8-103.12 Conformance tvilh ApprucedYuicedures` 6-3(11 I'' llmou Ureing PrMsion Pvnoie�crus.;]item in the federal IY99 lewd C:nJe or 1115 i_'N1R?91ll 1np CITY OF SALEM BOARD OF HEALTH Establishment Name: 6'wAA Cr- 6A-fW Date: 6 A141V Page: L of Z Rem Code C-Critical nem DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date No. Reference R—Red Item Verified PLEASE PRINT CLEARLY c-44'4 6s M A r-A 4' Al- r-2jt< 6a -rar. � F Dea,L Kw..o3 A siWccP ca &IAL. BA? A(L- „t--Oclk- tri amt ) uurs C, rta6.> to 9 !-20 7 o-y Atftia- SAV&_ iC rJ CO nr� s .,rm . 1 1 I 1 1 1 1 I I Discussion With Person in Charge: Corrective Action Required: I ❑ No ❑ Yes I have read this report, have had the opportunity to ask questions and agree to correct all ❑ Voluntary Compliance ❑ Employee Restriction/ violations before the next inspection, to observe all conditions as described, and to Exclusion P ❑ Re-inspection Scheduled ❑ Emergency Suspension comply with all mandates of the Mass/Federal Food Code. I understand that noncompliance may result in daily fines of twenty-five dollars or suspension/revocation of ❑ Embargo ❑ Emergency Closure your food permit. /r� l //C' ��ct,,—_ ❑ Voluntary Disposal ❑ Other: PHF> Received,A Tentperatunes Violations Related to Foodborne fitness Interventions and Risk Accords re,-2 to Lav, Coaled to Factors(items 1.22) (Cont.) =I`Fi 45'F Within 4 Hours. " PROTECTION FROM CHEMICALS 3-=G I,15 :oolim„Meda ds for PHFs � 19 PHF Hot and Cold Holding 1.4Food or Color Additives 3-50i,16(B) Chid PI1Fs M.nntainod at or below 3-202.1_' Additives 4t`l9;°E' 3-302,14 Protection from Unaporoved Adddrves'` ;_501 INA) Hot PHF,Mairitamed at or above 15 Poisonous or Toxic Substances ( 1 Containers- 14u„F . 7-101.11 Contng Information-Ori Bina( I 13:50 i.i 6(A) Roasts Held at or above 130"F C 7-102 11 Cuuunon Name-Working;Containers" 20 Time as a Public Health Control 7 2frl.I 1 Separation-Storage`' '-SUL19 "rime as a Public Heal Eli Control* 59U.i)U4(H) Var:_nceRegoirenlent 7-202.11 Restriction-Presence and Use'' - 7-202.12 Conditions of Use* REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-203.11 Trek Containers--i hibitions" POPULATIONS(HSP) 7-204.11 Sartitizers.Criteria- hemirds'� 7=_'(19.12 Chemicals for Washing Produce,Criteria" 12t 3-89! IPA.) Unpanteul ized Pre packaged Iuicec and Be:etages with Warning Labels' 7-204.11 Drying Agents.Catena" b- R01,11(B) Use of Pasteurized 7-205.11 ( Incidental Food Contac.-[. Lubneants� ( Ani ked mal Food and 7-206.11 ( 1 '1-.RQt.?ll1}� Ra`,,or Pn yCnu Restricted Line Pesticides.Critena" � Raw Seed hgpr<rov nus Not:ierved. 7-206.12 Rodent Bait Stations- 7-206.13 (C) Unapenai rood!Package Not Tt-serves(. 7-206.13 'Tracking Powders,Pest Control mid ( ----- ManitarrngT CONSUMER ADVISORY 22 3-603 11 Consumer Adviser} Posted for Consumption of TIMEREMPER ATURE CONTROLS Ailiival Foods"I'hat are Raw, Unden,uoked or 1fi Proper Cooking Temperatures for Not Otherwi,�e Processed to Eliminate PHFs Fe ';:;:x+` 3--401.11 A(I)(2) Eggs- 15 50F 15 Sec. Pathogens,^ Eggs-Inunediate Service 145"Fl5sec" 3-302).13 Pasteurized Egg> Substitute for Raw Shell 3-401.11(A)(2) Comminuted Fish,Meats k Game Egvs;, Annuals- I S5TR s sec. SPECIAL REQUIREMENTS 3-40L11(B)(I)(2) Pork and Beef ccf Roast- 130-'F 121 min* 3-401.1I(A)(2) Raines,Injected Meats- 155'F 15 I 5'?0.009(A)-(D) Violations of Section 590.009(A)-(D)in sec.* catering, mobile food, temporary and 3-401.11(A)(3) Poultr}',Wild Game. Stuffed PHFs, residential kitchen operations nhuuld be Stuffing Containing Fish,Meat, debited under die appropriate sections Poultry or Ratites-165"F 15 sec. ' ( above it*related to foodborne illness 3-401.1110(3) Whole-muscle. Intact Beet Steaks i interveations arld nsk factors. Other 1450F` I 590.009 violations relaling to good retail 3-401.12 Raw Aninuil Foods Cooked in a practices should be denited under 1129- Microwave 165'F* Special Roquirements. 3-401II(A)(1)(b) All Other PflFs- i45"F 15 sec. 17 Reheating for Hot Holding ( VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 3-403.11(A)hr(D) PHFs 165"F 15 sec. :_ (items 23-30) 3 403.t I(B) Miciowa%e- 165` F2 Minute Standing frond and nun-critical vimdt,uns, winch do nat)rbire to the Tlmc" foodborne illness irtervrntiwis and rind-f r(rvi s!hired above, ran be 3-403.11(C) Commercially Processed RTh Food- ( found it,the f llownig verbons ofthe Food('ode and 105('NIR 140"Ft i S90 000. 3--403.1 1(E) Reutaininu Unehced Portions of Beef i 1 Item Good Retail Practices FC 590.000 � Roasts` 1 23. Maneclerrient and Persor,;sl ! FC -2 .003 1 Proper Cooling of PHFs 24. Food end Food Pmteclion 1 FC-3 004 ($ _ 3-501.14(A) Cowling Cooked PHFs from 140"F to 2''. Equipment and r andss FC-4 .005 4_F Water,Plumbin,andWaste FC - S .006 7(1"F Within 2 Yours and From 70"F 27. Physical Fa^di:v FC-6 007 to 41'F/45'F Within 4 Hours. * 28. Poisonous or Toxic lslaterials FC-7 .008 3-501 14(B) Cooling PHFs Made From.Ambient 29. Special Requirements .009 I Temperanue Ingredients to 41'F/45"p 30. Other Within 4[toms Denotes critical item m Ihr f�dcaai 1994 Fond('ode ur 105 t'MR 590 of Massachusetts Department of Public Health Salem Board Health S 120 Washington Street, 4'" Floor Division of Food and Drugs Salem, MA 01970-3523 FOOD ESTABLISHMENT INSPECTION REPORT Tel. (978) 741-1800 Fax (978) 745-0343 Name Date- /� Tvpe"of Ooeration(s) Type of Insoection r�d�M/S 1- /1t►4� I /Q()d�d/ I Food Service El�utine AddressI Risk ❑ Retail t0'Re-inspection 9 r7 L4AA-1L -w I Level ElResidential Kitchen Previous Inspection 7Nf 4/9n E]Telephone Mobile Date: El Temporary Pre-operation Owner a)e�� L- Imre. []Y/N ❑ p rY E] S spe tIllness Caterer Person in Charge(PIC) sif- Time ElBed&Breakfast ❑ General Complaint I In: El HACCP Inspector 10 /1ftISISINI"�rh/M I Out: Permit No. ❑Other Each violation checked requires an explanation on the narrative page(s) and a citation of specific provision(s) violated. Non-compliance with: Violations Related to Foodborne Illness Interventions and Risk Factors Anti-Choking Tobacco Violations marked may pose an imminent health hazard and require immediate corrective 590.009(E) ❑ 590.009(F) ❑ action as determined by the Board of Health. FOOD PROTECTION MANAGEMENT ❑ 12. Prevention of Contamination from Hands ❑ 1. PIC Assigned/Knowledgeable/Duties ❑ 13. Handwash Facilities EMPLOYEE HEALTH El2. Reporting of Diseases by Food Employee and PIC PROTECTION FROM CHEMICALS ❑ 3. Personnel with Infections Restricted/Excluded [:114.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) ❑ 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) [_1 10. Proper Adequate Handwashing El21. Food and Food Preparation for HSP ❑ 11. Good Hygienic Practices CONSUMER ADVISORY [122. Posting of Consumer Advisories Violations Related to Good Retail Practices Number of Violated Provisions Related Critical (C) violations marked must be corrected To Foodborne Illnesses Interventions immediately or within 10 days as determined by the Board and Risk Factors (Items 1-22): of Health. Non-critical (N)violations must be corrected Official Order for Correction: Based on an inspection immediately or within 90 days as determined by the Board today, the items checked indicate violations of 105 CMR of C ealNth. 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: S 5901nVp Fofm-14 doc Inspector's Signature�`./LlRJl7. '�� Print: PIC'sSignature: 1 �J fir- 0 / Print: 1J „/ I Page l of ages rr vt� Violations Related to Foodborne Illness Interventions and Risk Factors(items 1-22) PROTECTION FROM CONTAMINATION FOOD PROTECTION MANAGEMENT 8 Cross-con,aminatian 1 590 003(A) Assignment of kosponsibility 1 3-702.1 i(A)(I') Rate Animnal Foods Separated dom j 590.003(B) Demonstration of Knowledge' Cooked and RTL Foods,: 2-103.11 Person in charge-dutie, Contamination from Raw in;redients 3-102.11(A)i2) Rank Animal Fouls Separated from Each EMPLOYEE HEALTH 3 590.003(0) Responsibility of the person in charge to Co,:tamination tiom the Environment require reporting by food employees and 3-302 111 A) Foos', Rmesa nn' applicants" 3-:!02.15 Waehtne Fruit,and Vegetables 590 003(F) Responsibility Of A Food Employee Or An 3-304.1 1 Fred Contact wrrh Equipment and .Applicant To Report To The Person In IftenAls" Charge" Contaminat•on Gam the Consumer 540.003(G) Reporting,by Person in Charge° .3 306.14(.A)(B) Returned Food mud P.esen icc of Food: � 3 590.003(7)) Exclusion and Restrictions* Disposition ofAoulterated of Contaminated 590.003(E) Removal of Exclusions and Restrictions Food 3-701.11 Discarding or Reconditioning Lnsafr FOOD FROM APPROVED SOURCE Fo+:* 141 Food and Water From Regulated Sources 9 r=ood Contact Surfaces 590.004(,1-B) Compliance with Food Law:` 4-501,111 �iaruntl W':rrewashm, -Hot Water 3-201.12 F,naiinallcrmetirall}•Saaled Contaitaer* Sanitrzann-'fe;nperattues^ 3-201,13 Fluid Milk and Milk Pi ducts 4-501 112 Mechanical W'arewashino HW Water 3-202.t3 Shell EggBM auiuzatn,n Temperatures" i4-501.1 !4 Chrnieal Sdtitazation- temp..pH, 3-202.14 Eggs and Milk Products. Pasteurized' concentration and hardnees. 'r! 3-202.1(1 ace Made From Potable Drinking Water" ( 4-601 11(A) hquipmrnt Food Contact Surfaces arrd 5-101.11 Dri nkirm Water yst from an Approved Sem" I Utensil,Clean, %1.006(A) Bol tied Drinking,Water* i 4-602.11 Clca,^.ing Fregvzoce of Equipment Foorl- 590.006(B) Water Meets Standards in.310 CMR 22 0'" ( Contact Surfaces and Uteusils { Shellfish and Fish From an Approved Source j 4-702J! Frequency of Sanitization of Utensils and 3-201.14 Fish and Recreationally Caught Molluscan ( � Food Contact Surfaces of Aquinnlznt F Shellfish* 4.703.11 Methods of Sanitization -Hot Water and 3-201.15 Molluscan Slrclltish from NSSP Listed iCilzmicai" I Source,` to i Proper.Adequate Handwashing Game and Wild Mushrooms Approved by � � n_30 i i 1 Clean Condition--Hands and Anna" Regulatory Aumonty ' i .3-202.IR ShellsUx '-307.12 Cl,.miri g Procedure' k identification Present' i - 590.004(C) Wild Mushnxrms* ' 2-301.14 When to Wash" 3-201.17 Carne annuals' ( it Good Hygienic Practices � , I Receiving/Condition 7 2-401.11 Eannc, Drn6inaorlasingTobacco'- 3-202.11 PHFs Received at Ptoper Temperatures" ( 12-4{)7 12 Discharges Brom the Eycs,Nosz and 3-202.15 Packrcehitein'itvs Mouth,: 3-101.11 Food Safe and unadulterated" ( 3-301.12 Preventing Contamination 41'hen Tasting* 6 Tags/Records:Shelistock t" Prevention of Contamination from Hands 3-2(12.13 Shcilsnxk ldennfication' 590004(E) Presenting Contammatinn fium 3-203.12 ShzOsnxkIdentification Maintained* F,mplovera" ontlwash Facilities 1.7 Tags/Records:Fish Products ' Conveniently Located and Accessible 3-40211 Parasite Desnuction: .3-402.12 Record,,Creation and Retention* � � S-1)3'11 Numbcrs and Capacities, 590.0041.1) Labeling of ingredients' 5-204.11 Lrxanon and Placement'* 3..705,11 Acccssibility, OPeranon and SC unteoance 7 Conformance with Approved Procedures I u ^ii DvIth Soap and Hand Dryng ,r /HACCP Plans S I p. '-" g 3502.11 Speci,dured Processing MethodsDevices 3-502.12 Reduced oxygen packagnug,criteria' b-ml.I I Hand„ashms Clea:vser.Av,tilanility R-103.12 Coni'nrmancewith Approved Rvicedures` b-301.7'_' ihmd Urging Provision 'l;rnote>enamor item is the federal 1999 food Code m 105(111'590,000 r CITY OF.SALEM BOARD OF HEALTH //++ L_ V nvl�-m a r FNK6 4 Date: 1a4914V Page: 2— of 2— Establishment Name: , t Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date k No. Reference R—Red Item Verified PLEASE PRINT CLEARLY , - vlot•,.�n�,�T �� . A� �,� 1„rsy&r-rJ11f ACPvI;er- ®l 1 �e/s/•y M^4� 6bsd e,.ri Afref-&2• I j t46M > AtJY (uTWC ItIceka-- J/ac.+rtadr wta_ AdaV r irI "�^ ,.tto�t`xN� (-�,✓eFr Rr�it✓6- /s,Ttiisi0. i = I � I 1 I 1 < I 1 Discussion With Person in Charge: Corrective Action Required: I ❑ No I ❑ Yes 1 I have read this report, have had the opportunity to ask questions and agree to correct all ❑ Voluntary Compliance ❑ Employee Restriction/ Exclusion violations before the next inspection, to observe all conditions as described, and to ❑ Re-inspection Scheduled ❑ Emergency Suspension comply with all mandates of the Mass/Federal Food Code. I understand that € noncompliance may result in daily fines of twenty-five dollars or suspension/revocation of ❑ Embargo ❑ Emergency Closure i your food permit. p El Ll(_ Voluntary Disposal Other: rr � v, - R .591 11,1' i PHH,Ret.,,wed at Tenmecaturec Violations Related to Foodborne illness Interventions and Risk According k;Iaaw Cooled to Factors(Items 1-22) (Cont.) 41 Fi45'N Within I Hours. ' PROTECTION FROM CHEMICALS I 3-501.15 Cooling.".Methods for PH Fs f 14 1 Food or Color Additives I 19 PHF Hot and Cold Holding 3-202.1.1 Additit-cs'" 3-501.16(B) G,id PHFs M,ninained at or below - - - - I 590�riti('r'1 =1'145" F"'. 3-302.14 Protection from Unaor»Died Additives 3.50.1 16(A) lint PHFs Maintained at or ah:rve 15 Poisonous or Toxic Substances 140'F 17-101.11 Identityine Information-Original ( i-501.16(A) Roasts I-ie!d ;it or shove 130'F. Cuntainers" ' 7-102 11 Common Name-Working Containers" 20 Time as a Public Health Control 7-201.11 3-501.19 Time.:s a PohHc Health Control* Srnaration-Shnagc"' � � 7-2U2.1I Restriction-Presence and llce" 59U.tiO4(H} variance Kequirituent 7-102.1' Conditions of Use" 7-203.11 ( ToxicCuntainerc-Prhibitions* REOUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-204.11 Saititizet s,Criteria-Chemicals' ' POPULATiONS(HSP) 121 3-801.11(A) Unpaslem'ized Pre-packaged Jurces and 7-_0.1.12 Chemicals for Washma !rocbu:e,Criteria'' Benetages with Warning I.ahel;;' 7-204.14 Drying Agents.Criteria` 1-801.1 I(&) Lice of Pa>teutized E�!>s^ 7-205.11 Incidental Rxid Contact.Lubncnnts` - -- s 13-80!.!1{}3) Raw-used Sp Partially CUto S rued. iFixxl and 7-206.11 Restricted Use Pesticides.Criteria* 7-206.12 Rodent Bait SUaiUnS' Raw Seed Sprouts Not Served. 'x ii C) Unopened P<xxi Package Not Re-served. 7-306.13 'tricking Powders, Pest Control and --- Monitoring* 1 CONSUMER ADVISORY TIME/TEMPERATURE CONTROLS 22 1-60=.11 Consumer Advisory Posted fon Consumption of Aminal Foods, Mat are Raw, Undercooked of PHFs l6 Proper Cooking Temperatures for N,a Olhervgsc Processed to Flomnate 3-401.11A(1)(2) Eggs- 155'F' 15Sec. Y•ges-hmnetliaae Service 145`715scr* 3-Vf 2.13 Pnsteenrcd Fggs Substitute fol RawShell 3-401.1 i(An21 Comminuted Fish,Meats&Game Bges" Animals- 155'F l5 sec. '' SPECIAL REQUIREMENTS 3-401.11(B)(I)(2) Pork and Beef Roast- 130"F 121 min* - 3-401.1 D,A)(2) Raines, Injected Meats-155'F 15 i 590.009iA')-(D) Via aeons of Seclion 590.009(A)-(D) in sec. * catering, mobile fixxl, temporary and 3-401.11(A)(3) Poultry,Wild Game, Stuffed PRFs, residential kitchen operations should be Stuf7uw,Containing Fish, PMeat, debited under lite apptctnriate Sections Poultry or Ratites-165"F 15 sec. m above if leiaWd to Foodborne illness 3-401,11;C)(3) Whole-muscle,Intact Beef Steaks imcrventio is and risk factors. Other 145°F" 590.009 violations relating to goad retail 3-401 12 Raw Animal Foods Cooked in a I pfact:cc:should b;debited under#29-- Microwave 165'F " Special Requirements. 1-401.11(A)(1)(b) All Other PHFs- 14517 15 sec 17 Reheating for Hot Holding VIOLATIONS.R.SLATED TO GOOD RETAIL PRACTICES 3-403.11(A)3t(D) PHF, 165'715 sec. ° 1 (Cterns23-36) 3403.11(B) Microwave- 165"F 2 Minnie Standing C,itiral and non-rrhi:al sh,lirtwns. which do not fWate to llie Time* j k,udborne ilbuss mtervemion� and riskJ:uiara listed alone, eon be 3-403.11(C) Commercially Processed RTE Food- foundin the JWharrng sections a(;he F'uud('ode and 105 CMR 140"F' I 590.000. 3-40111(L) Remaining L`nshced Portions of Beef I : Item Good Retail Practices FC 590.0 0 0 Roasts* 23. tv1anagsmant and Personnel FC --2 .003 18 Proper Cooling of PHFs ( 24 Food and Food Pmlect!on FG- 3 004 25 Equipmen!and Utensils FC-4 .005 3-501.14(A) Cooling Cuoked PHFs from 140`F to 126 Water,Plumbing and Waste FC-S 006 70"F Within 2 flours and From 70'F 127 Ph'dstcal Facility FC--6 .007 to 4 1.°F/45"F Within 4 Hours. "' 28_ Poisonous or Toxic fvtatenels FC-7 i .008 j 3-501.14(B) Cooling PHFs Made From Ambient --29 Spux:ial Requirements 009 Temperature Ingredients to 41"F/45"F 30. Other j Within 4 Hours'x ;`"d1'"'"-,o-:w'• 'Denote,critical item m the Inderal 1999 Fond Code or 105 CNIR 590 000 Massachusetts Department of Public Health Salem Board of Health 120 Washington Street, 4t" Floor Division of Food and Drugs Salem, MA 01970-3523 FOOD ESTABLISHMENT INSPECTION REPORT Tel. (978) 741-1800 Fax (978) 745-0343 Name Date Tvpg.ofOoeration(sl, Type of Insoection t xd utemsr rwig hP/0 / I O'Food Service p Routine Addres Ris [I Retail ❑ Re-inspection �3 WH/aRF SF Level ❑ Residential Kitchen Previous Inspection Telephone 7 9/ z/�" �0 ,M` E] Mobile Date: Owner HACCP Y/N ❑ Temporary ❑ Pre-operation .)O"mLE L.-. ldrOf-i^Id ❑ Caterer ❑ Suspect Illness Person in Charge(PIC Time ❑ Bed&Breakfast E] General Complaint ywrwt+ A146AA J In: ❑ HACCP InspectornAftA /tfL[CeCK,IAf/M Out: Permit No. El Other Each violation checked requires an explanation on the narrative page(s) and a citation of specific provision(s) violated. Non-compliance with: Violations Related to Foodborne Illness Interventions and Risk Factors Anti-Choking Tobacco Violations marked may pose an imminent health hazard and require immediate corrective 590.009(E) ❑ 590.009(F) ❑ action as determined by the Board of Health. FOOD PROTECTION MANAGEMENT ❑ 12. Prevention of Contamination from Hands ❑ 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 E] 14.Approved Food or Color Additives ❑ 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 [:118. Cooling PROTECTION FROM CONTAMINATION ❑ 19. Hot and Cold Holding [1 8. Separation/Segregation/Protection ❑ 20.Time As a Public Health Control ❑ 9. Food Contact Surfaces Cleaning and Sanitizing REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) E] 10. Proper Adequate Handwashing El21. 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 C ealNth. 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: S 501nVwFom -14 ex Inspector's Signat"t�_ _ l� 416.. _ ! Print: I PIC's Signature: `�� Print: J Page/ of 2 Pages C Violations Related to Foodborne Illness Interventions and Risk Factors(items 1-22) PROTECTION FROM CONTAMINATION FOOD PROTECTION MANAGEMENT K Cress-uonraminavon I 1 i 590.003t A) Assignment of Responcibilit)'* 3-302.11(Ail I1 Rare hnimal Foods Separated lion 590.003(B) Demonstration of Knowledge" Cooked and RTE Foods' 2-103.11 Porion in charge -duos. C,,taam:naticn from Rule ing+ad,ents 3-302 11(A'r;2) Raw Animal F;:cals Separated iron:Each EMPLOYEE HEALTH Dhcr"` 2 590.00 3(7) Responsibility of the Person in ch,uge u+ Contamination from t"o E-vilownen+ require reporting by foul employees and ( 3-302.11kA) Food Protection" applicants* ( 3-302.1' Washow Fruits and Vegetables 590 003(1-) Retiponsibilny 01 A Food Employee Or Art ( i 301.i Fo,.s1 Coaract w)J, -Equipment and Applicant To lcpori To The Person In Uteneils'F Charge" Contamination front the Consumer j 590.003(G) Rcpor(i ng by Person in Charge" 13-306.13(A)W) Returned Food and Reset vice of Food^ 3 590 001([)) Exclusions and Resttictions* I Disposition c;Ad'ufterated or Contaminated 590.003(8) Removal of Exclusions and Restriction, _ Fvo l 3-701.11 DiscardinoorRcconditiunin•Uosale FOOD F IOM APPROVED SOURCE d Food and b'✓ater From Ragulatod Sources N Food Contact Surfaces 590.004(A-B) Comphonce with Food Law" 4-101.111 :Manual. W,ucwashm11- FIot Wafer 3-201.12 Food in a Hermetically Sealed Container* San:ti ration 1'emperatares* 3-201.13 Fluid Milk and Milk Products* j 14-501 112 Mechanical Warewashing-Hot Water Sanitization Temperatures"' 3-202.1 Shell Eggs° I y-501.1 Id Ch m:cal Sanitization-temp.,pl-1, 3-201.1-!1 L'ees and Milk Products,Pasteunnxt` 3-202,16 Ice Male From Potable Drinking Watcr' Lquipa Brit I- sou hardness " 5-101.11 Drinking Warta from an Approved Svstvm* 4-h(t..I!(A) Lyuipmeut Frxw Contact Surl;itxs and Dten;,ds Clean` 590.006(A) Bottled Drinking Water' 1 eaning rreyuency of C] 590.006(B) Water Meets Standards to 310 CMR 22 0" I tEquipntent Food- I ShelHish and Fish From an Approved Source Contact Surface.,and 1,teunds +-1:4 t1 r, quemc of Sanr•zation of ljten,iis and 3-201.14 Fish and Recreationally Caught Molluscan I Fo+xl Contact Surface;of Equipment* Shellfish* -1 703.11 Methods -f Samhzauun- Hot Water ani 3-201.15 Molluscan Shellfish front NSSP Listed I Gtemic,i* Sources" 110 Proper,Adequate Handwashing Game and Wild Mushrooms Appi oved by 1 Pe_9ularoo,Authority 2-'OI 1 I Clear,Condition--Hands and Aima* 3-202,IS Shellstock Identification Present' 2 '(1,].12 CleaningPn,cedure* 590.004(C) Wild Mushrooms" 2-301.i4 When to.Nash" 3 201,17 Game Animals-` 1 l Good Hygien€c Practices j c Receiving/Condition 2-401.11 Eating,Drinking i,:UsingTobacam' 3-2(1'.'.:1 P1IPs Re,,ervcd at Proper Temperahirec;` "[01.12 1)i scharges From the Eves.Nose and ' 3-202,15 R4outt+" 02.15 Package Integrity* j 9-x01.12 Paventing Contamination Whcn T•istin '-)01.11 Food' Safe and unadulterated " ( d# f, Tags/Records:Sheilstock ( 12 Prevention or Contamination from Hands 4-202.13 Shellaock Identification590.004(1-) Presenting Contamination from 3-203.12 Shellsta:k Identification MaintaineEmplotees"d" 113 Handwash Facilities Tags/Records:Fish Products Convemenhy Located and Accessible 3-402.I 1 Paras ito DesL u,,tion* 15-203 11 N+anbens and Ci racities" 3402.12 Records,Creation and Retention's 5-201.1 I Lrx,atinn and F'laccmcnt" 590.0{)4(1) Labeling of ingredients" 7 Conformance with Approved Procedures ( ( '+205.1 t :tcces.cibilit),Operation and Maintenance /HACCP Plans I Supp Gad with Soap and hand Drymq Dev+coy 3 502 11 Specialized Processing Methods* i ft-3x,1.11 ilardrvashh+.g Cleanser.Arailanilrty I i-502 12 Reduced oxygen packaging,criteria'' I (i-3C1.i_,� FI._;d Di ring Pn,:ision 8-103.12 Conformance with Approved P:oceduros* I ' ''Denies cooed ilei in the ftd:ral 1 y',+7 Food Code or 105 Ch9k 590,:100 CITY OF SALEM BOARD OF HEALTH Establishment Name:600iffgXr 1W.4C Date: 14/8'IV4 Page: of Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date 1 No. Reference R—Red Item Verified f PLEASE PRINT CLEARLY 1 I 91I M " (1,064 rmexltwur ler ruttrN %ric&os ,+ 67rtwovett Cu-c * OVr *g1t -� ,f I ,.�o�� ,moo ,�w•� ,ate.- �.m�+°�+T � . I � ZS K/L 011,Vp4r4 nPv6N NIA3 A+1 ,a a A.-Al0vKl`Ca Of foe0 A/5e4r, VbrW I;4%i t-4 j Z c . rlat�+�+��2�ac.� ,t�/ /1,gS Faso � o!✓ t� fLovr� ,,moo �N��tJ y I Fod r. A-&_ N -r(* +6fiE i401'r flill A-r t-dASF G -*0-fe"-T aFP is r-4-00.t At4d C,4A -rt&09 I X,Mrhrn/ me t. AV- i�a9 rttdrr Aa V *rag" *of «/3 F r 8 it4 e4 "i'r aft' vili£ e4,*ao.� /� r �la,.r�3r,artt S'etgs- rT conmPL&F-sty od1rkucM Afro a ►tites57rrG 1 974-& A14Vll GM r* s/Nl_ #4fOO- At de&x-e- � b40 AcctBsTtAtfs AV4 SlfatW01 wint- SON Are# 16/sP4,T,Mt1 �ri,r6Lr ,ac- tau- rfwtas. � 1 /' C ��AC'tMSeetit tr C44-f wxop. .O" /MNOWArt/ ner- /S 6tVnt'ag7E6? 41-10 ru is- Ht� 1�Avi tt- fv mss. /3 •,a m A4 t!sr t5 rs o nag r .�ttat�d / wftr f S/Nte- AuCsf6W rfwo XFWAw Wi ryf TerN' Discussion With Person in Charge: Corrective Action Required: I ❑ No I ❑ les 1 ❑ Voluntary Compliance ❑ Employee Restriction/ it I have read this report, have had the opportunity to ask questions and agree to correct all Exclusion violations before the next inspection, to observe all conditions as described, and to ❑ Re-inspection Scheduled ❑ Emergency Suspension comply with all mandates of the Mass/Federal Food Code. I understand that noncompliance may result in daily fines of twenty-five dollars or suspension/revocation of ❑ Embargo ❑ Emergency Closure your food permit. ' •. _ ��j��..,.�_ /i/ C- ❑ Voluntary Disposal ❑ Other: -?fi'.;'y�:} �HF: Recet.ect ar':'emperesutr% Violations Related to Foodborne Illness Interventions and Risk ,According fo Law Cooled to Factors(Items 1.22) (Cont) 4i'F/a5'FWithin 4Hours. " PROTECTION FROM CHEMICALS Coaling Klethods for PFFS lA ' 19 PHF Hot and Cold Holding Food or Color Additives 3-5w.16(1) Cold PF1Fs Maintained at of helaw 3-202.12 Additives" ( 590.GU4(F) 41°;t45' F- 3-"302 14 Protection from t:nappm,-ed Actditivec' '3-501.J6(A) Hot PISF,Maintained at or above 15 Poisonous or Toxic Substances j - 7-101.11 Containerner;"ntiig Information-Onginrtl 3-561 16(.1) Roasts Held at or above 130'F, -- Co 7-102 1 1 Common Name-Working Containers' 20 I Time as a Pubft Health Control J T201.11 Separation-Storage" ( 3-5111=° T:me aa;i F'obhc Health Control x J 7-20211 Restriction-Presence andUse`k 59b.004(H) Variance Requirement J 7-202.12 Conditions of Use" 7-203 11 Toxic Containers-Prohibition%* REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-204.11 Sanitizers.Criteria-Chemicals' POPULATIONS(HSP) Produce, I 2 3-801.1 I(A) Unpaslenri zed Pre-packaged Julces and 7-_(14.12 � C:henncals for Washuie F reduce,Criteria" " Be,etagei aj!h t4'ainine f abeNc 7 '20 - a` 7-_04.14 Drvmg Agents.C'ne f ri 15.1 1 Incidental Food Contact. Lubricants` 111 � � � 3 SOLI 11 B) Clic of Fasn•urtzed 7-., $t�1. i3s Rarot Partially ClK d;ed animal FoodFoodand 7-206.11 Restricted Use Pesticides. Catena' 06.12 ( I Kaw Seen Sprouts Tl,'(,! Rmt.nt Bait Stations- 7-206,13 ( Track reg Powders,Pest Control and I ;-KO i�i I(C') C'ropeneri Fo.rJ Package Not Re-served ' Monitonn„^ CONSUMER ADVISORY TIMFJTEMPERATURE CONTROLS 22 3-603.11 Consumer Advisory Po%ted for Consumption of Animal Foods That•rare Raw. Undercooked of 16 Proper Cooking Temperatures for Not Othcrwise Proces.,ed to Eliminate PHFs 3-401.1 IA(1)(2) Fggs- 155`F IS Sec. Pathogens.- Eggs-hnmedianc Service I-15`;=lisx` 3-302.13 Pagtrur,,.ed Eggs Substitute for Raw She11 3-101.11(A)(2) Comminuted Fish,ARcats&G:unz Eggs" Animals- 155"F 15 sec. " SPF.,CiAL REQUIREMENTS 3-40C1l(Bl(1)(2) Pot Kand B.el'Roast- 130--F 121 min" ; 3-401.11(A)(2) Ratite%,Injected Meats-155'F 1.5 590.009(A)-(D) Violations of Section 540 009(A)-(D) in sec, + catrrittg, n rrvile foul,temporary and 3-401.11(A)(3) Pou1Uy.Wild Game, Stuffed Plf}ts, ree;.deatta! kitchen operations should he Stu(9'ine Containing Fish,Meat, dchited under the appropriate sections Poultry or Ratites-165'F 15 sec. above it related it, foodborne illness 3--901.11(()(.3) Whole-muscle, Intact l3cef Steaks iin:;rvent:onsand risk factors. Other 145"F* 590.009 vic-iations relating to good retail 3=401.12 Raw Animal F(iods Cooked in a I practtica should be debited under #29- Miciowave 165"F'* _ Special Regniretnct:b:. 3-401.11(A)(1)(b) All Other PHFS 145'F15sec. ' 17 Reheating for Hot Holding VIOLATIONS ReLATED To GOOD RETAx FRACT/C£s 403.11(A)&IU) PHFS 165°F 15 soca F ( (ltetnn� 23-30) 3-403.11(B) Microwave- 165' F 2 Minute Standing I Gdthai and nun-rruica[ vi<ilat:nns, whit^dono! unite to file T7mc* foodborne illness 6itrrs•enr[ons and isk tae tors livedabove, can be 3-403.11(C) Commercially Processed RTE Food- foam in the folh'e inn sections o;the Food C olie and/05('AIR I 140'F* 590.000. 3-403.1](1--) Remaining linsliced Portions of Beef ' Item Good Retail Practices FC 590.000 f Roasts* I 23. tdanagement and Personnel FC -2 .003 18 Proper Cooling of PHFS 24. Focal and Food Protection. FC-3 004 3-501.14(tU Ccwlmn t Cooked YHFs from 140'F in 25. Fgmpment:md Utensils FC-4 .005 26. Wats, Pnanb:nq a.,C Waste FC-5 .006 70°F Within 2}-tours and From 70'F 27, Physical FaciAv F(,-6 007 � to 41°F/45"F Within 4 Horns. " 28. Poisonous or Toxic Materials FC-7 .008 J 3-501.14(B) Cooling PHFS Made From Ambient 29 Snecial RegrOraments 009 J Temperature htgredients in 41`1-,/45`F 30 Other W'thin 4 [tours:` * Dew;tea critical iicm in ihr falcial 1994 Farad Code nr 105 CNIR 590 000. CITY OF SALEM BOARD OF HEALTH Establishment Name:Lrd Ulie-mar 4W.& Date: Page: 3 of Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Cate No. Reference R-Red Item Verified PLEASE PAINT CLEARLY + G 1V eN 6r r s rKF�tli�lrte9� of f, �u�r �� nr� err lc� SAL II 1.a4nJr— AM- A call MPfiJ) /ssf coM_A01, otaAwrati ., fC4 dk +tMZh£ 11 ldn Gset_lrk up -r sw dR Au A*welaA,w of rp wr 4fro eema GE&Ar 1 �N(AD� iErt t r i(3 Ar Cost, wag pJ OtO !`t, 04"009-✓ C ekfW OW4 JrArI U_ ktm iii v✓r .ir. 11 8 C r4AC Wu fQa r Pe rr6ffp " 1**Z,, leamur 4oeos �a�r�I #t"y a �IIS >'*ft.�a as&cc#" - eA('&3 1 u "err 0 12Ailr"fir- awts c,N h7lNrtid+ +l� I •• CoAA!!r4f tf C' UA_aIei- wO cAar Ytz4 efl- Of n47C 6.0r7WtV rr�s �M�ls�is�airi' /r r#-i of-Qs it. (>- N&.* 4b`r ClIfl"h- NOr- ff Knrd lrF' &A#A'r37 ,tw Adjk% . fP*It ,awn 6�urr4rldfrfi3 I Arx.-.A.r•C*-r,wW �&A S*mA n v ov lotAii ► 6 cylir FoBtrr 'tam s,&' fw I 1 Discussion With Person in Charge: Corrective Action Required: I ❑ No ❑ les I have read this report, have had the opportunity to ask questions and agree to correct all ❑ Voluntary Compliance ❑ Employee Restriction/ Exclusion violations before the next inspection, to observe all conditions as described, and to ❑ Re-inspection Scheduled ❑ Emergency Suspension comply with all mandates of the Mass/Federal Food Code. I understand that noncompliance may result in daily fines of twenty-five dollars or suspension/revocation of ❑ Embargo ❑ Emergency Closure your food permit. ,{lJ �' " L rte_,__ ❑ Voluntary Disposal ❑ Other: N0 14(C 1 PHF:Received a Temperatures Violations Related to Foodborne Illness Interventions and Risk Accor Ting to Law Cooled to Factors(Items 1-22) (Cont) 414,4517 Within 4 Hour,. r PROTECTION FROM CHEMICALS I 3:i0,:S Cootmr4 Methods 1or PH`t=s t9 PHF Hot and Cold Holding i 13 o Food or Color Additives 3-501.16(B) Cold PHF,Maintained at of below 3-_T 02.12 Additn-e.* 580004(F) 41'745° F- 3-302.14 Protection frorn Unapproved Additnes* ( 3 5:31.1 tit A) Hct PHR,A1.:L:i,nued at or above IS Poisonous or Toxic Substances HOT. * * ( 7-1(11.11 ldeniityingInformation- Onginal I 3-501 ;6(a) RoastsHrldutorabove 130'F. '' _- Containers" 7-10111 Common Name-W Orkin,Containers" � � 2f) Time as a Public Health Control � 3-507.19 Time a:a Public H,:altki Control" 7-201.11 Separation--Storaee - - 7-20211 Restriction-Presanee and Use" 59U.004fH) star,:mceRrqu�rrment I 7-202.12 Conditions of Use* 7-203 It •I Tonic C-ontaincrs-ProhPOPUA i il- lions"` REQUIREMENTS (HSP)OfiNTS FOR HIGHLY SUSCEPTIBLE � 7-204.11 Sanitizers,Criteria--Chemicals^ I 7-204.12 Chemicals for Washine Produce,Criteria" j ( 23 3-801.11!?.) UnpaAeuil,ed Pr:-packaged butes and 7-204.14 Crying Agents.Criteria* Beverages.vnrh W'atning Labels` - - ( 1-801.11(B) Use of Pasteurized E: gs� 7-205.11 Incidental Food Cont.rct. I uhrirants" ( 1 3 "',61 11(0) Raw or?artialty Cookcd Annual Food and 7-206.11 Restricted Use Pesticides,Criteria* ( Raw Seed Sprouts No 7-206.12 Rcxient Bail Stations" - , 7=206 I+ � 'feasting Powder:.Pest Control and i 3-SOL 1 I(C) I Unonenru Food Pacl:a r Not Re served. Monitoring- CONSUMER ADVISORY TIME/TEMPERATURE CONTROLS 22 3-603,11 Consumer Adliso:y Posted fur Consumption of Animal Foods'17hat are Raw.Undercooked or 16 I Proper Cooking Temperatures for Not Otherwise Processed to Fluninate PHFs I -•rxr.,:;'¢oni 3-401.11A(1)(2) I Eggs- 155°F 15 Sec. I 1'athogc,ns.` Eggs-lntiuediaw Service 145°1715;.ec* 3-30113 Pas:euraeci Legs Substitute for Raw Shell 3-401.11(A)(2) Comminuted Fish,Meat&Gams I Eg'2s* Animals- 155"F 15 sec. * 3-401.11(B)k1)(2) Pork and Beef Roast- 130'F 121 min* SpECiAL REQUIREMENTS 3-401.1 1(A)(2) Kanter, Injected Meats- 155"F 15 59(.009(A) LU) Viohnious of Section 590.009(A)-(D) in sea * catering, mobile food, temporary and 3-401.11(A)(3) Poultry, Wild Game,Stuffed PHF9, residential kitchen operations should be Stuffing Containing Fish, Meat, debited trader the appropriate sections Poultry or Ratites 165°17 15 scc. " above if rcha.:d to foodborne illness 3-401.11W)(3) Whole-anisole, boast Beet Sfcak:i interventions and risk factors. Other 145"F 5eu 009 violations relating to good retail .3-401.12 Raw Animal Foods Cooked in a practices should be debited under#29-- Miuowave 165`F'' Special Requirements. it,. I All Othcr PELF,-- 145"F 15 sec. 17 Reheating for Hot Holding VIOLATIONS RrLATED TO GOOD RETAIL PRACTICES 3.403.11(AWD) ( PHFs 165-F 15 sec. " I (items 23-30) 3-403.11(B) ( Miciowas-e- 165'F 2 Minute Standing ( Ctuirvd end note,rni<al viula!ions, which do,ren relate to the Time* foodborne iliness into)ven;ir;;•;and ii.,k Y,retors iiste l above, con be -103.11(C) Commcrcrally Processed RTb Food- I found in the j(,iloa inq genions o(!he Fend Code and I05 CIIR i 140"F" I 500.000. 3-403.1 HE) Remaining Unshced Portions of Beef I Item Good Retail Practices FC 590.000 Rozsts' 23. Managers eni and Personnel FC--2 .O03 1$ Proper Cooling of PHFs 124 f=ood and Food Protection FC--3 .004 I 25. Equipment and Utensils FC-4 -005 3-501.14(A) Ctwlmg Cooked PHFs from l`10°Pio 26. Water, Pl mbino end Waste FC-5 006 ------� 70°F Within 2 Hours and Front 70"F 27 Phvsical Facility FC-6 .007 to 41 1F/45^P Within 4 Hours. * 1 28. Poisonous or Text,Materials FC-7 ( .008 3-501.14(B) Cooling PI IF:,Made From Ambient 29, Spec;al Heouitements 009 Tempetature Ingredients to 41017/45`F L30, Other Within 4Itours 1 Denotescritical item in 4 c federal 1999 hood:ode or 105('NiR 5o0 000, Massachusetts Department of Public Health Salem Board of Health 120 Washington Street,4th Floor Division of Food and Drugs. Salem, MA 01970-3523 FOOD ESTABLISHMENT INSPECTION REPORT Tel. (978) 741-1800 Fax (978) 745-0343 Name Date / Tyoe of Ooeration(s) Tyne of Inspection CavR,�fere j7Q�l� ?, mod Service p-Routine AddressRisk E] Retail Re-inspection 73 ��4�� r� Telephone Level ,y� El Residential Kitchen Previous Inspection 7-1,C7- 4/9a P1 ❑ Mobile Date: /-.ft-w OwnerHACCP YIN [-ITemporary E] Pre-operation ✓OR/�NeC ❑ Caterer ❑ Suspect Illness Person in Charge(PIC) Time ❑ Bed& Breakfast ❑ General Complaint In: HACCP Inspector 46,,o SK�Au/l I Out: Permit No. ❑Other Each violation checked requires an explanation on the narrative page(s) and a citation of specific provision(s) violated. Non-compliance with: Violations Related to Foodborne Illness Interventions and Risk Factors Anti-Choking Tobacco Violations marked may pose an imminent health hazard and require immediate corrective 590.009(E) ❑ 590.009(F) ❑ action as determined by the Board of Health. FOOD PROTECTION MANAGEMENT ❑ 12. revention of Contamination from Hands El1. PIC Assigned/Knowledgeable/Duties 13. Handwash Facilities els)HEALTH El2. Reporting of Diseases by Food Employee and PIC PROTECTION FROM CHEMICALS F13. Personnel with Infections Restricted/Excluded El 14.Approved Food or Color Additives ❑ 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 PROT TION FROM CONTAMINATION 19. Hot and Cold Holdin<10 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 ❑ 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 3 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 o C eaNh. 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 6. Water, Plumbing and Waste (Fc-s)(sso.00s) the food establishment permit and cessation of food establishment operations. If aggrieved by this order, you 27. Physical Facility (FC-6)(590.007) have a right to a hearing. Your request must be in writing 28. Poisonous or Toxic Materials (FC-7)(590.008) and submitted to the Board of Health at the above address 29. Special Requirements (590.009) within 10 days of receipt of this order. 30. Other DATE OF RE-INSPECTION: S 5901ns &For 10 aoc f/ Inspector's Signature*t�)-__ ._/ A� / Print: PIC's Signature: 1 4 M.w-� /�•,r`,�_ •/ Print: �nCj N N Q_ L . f 'of c I I Page-of-�'Pages w Violations Related to Foodborne Illness Interventions and Risk Factors(items 1-22) PROTECTION FROM CONTAMINATION FOOD PROTECTION MANAGEMENT K Crcas-conlaminanon j I 590.003(:1) 1 ,4cyigntnenl of Responsibrhgw' 102.11(A;(I) Raft Animal Foods Separated from 590.003(B) Demonstration of Knowledge" Cooked and RTF.Foods' 2-103.1 I Person in charge--duties e'ontam+natio;r from Naw ingredien's 3-302 111A;(2) Raw Animal Foods Separated from Each EMPLO"EE HEALTH Other' 2 s9)0.003(C) Responsioility of the pec;on in chsrge to Comarninarco from the F,ovironrnent I require reporting by food entpluyees and 3 302.11( V Fcx,d Prut,cu,m* applicants' ( 3-302!5 Washing From,,and Vegetables 590.003iF) Responsibility 01 A Food Employee 0r An ( 3-3(0.1 t Food Cern.tet will; Equipment and Applicant To'Report To The Person Lt Utensils* Chia ge'' Contamination from the Consumer 590.003(6) Reporting by Person in Charge' 3-306J4(A)(B) Reaune 1 Food and Re:+ei t i.e of rood" 3 590 003(1)) Exclusionsand Restrictions' I Disposition of AduPprated or Crntam:mated j 590.003(E) Removal of Exclusions and Restrictions j Food 3-70i.' i Discardmtgor RevonditioninLUnsate FOOD F-IOM APPROVED SOURCE F'•s)d I .41 Food and Water From Regulated Sources `I Food Contact Suriaces � 59(rNA(A-B) Corupli:ince with Food Law* 4-501.111 Manual Warcwashm;-Hot Witter 3-201.!2 Food in a Hermetically Sealed ComiunerM Sanaization I'mperatures" 3-201.:3 Fluid Milk and Milk Products* 14-50:.i Pflrchanica) \L'ar nru,hinb Hot Water 3-202.13 Shell E;,e Sanitization Teut eratme.s' 3-202.14 Eggs and Milli products.Pasteurized" 14-501 114 Gommal Sar.rtiznti�.fn-temp.,pH, I WoUturannn;:nd barduess, i +. 02.IFi Ice Made From Potable Drinkute\Yater'" 4-brig.i l(A) Utv ipment Fcxxi Contact Surface,and i 5-1(11.1 I Drinkins Water from au Approved Systzrn* 590.006iA) Bottled Drinking Water* Cleaning Frequency 590.006t1i) Water Meets Standards to 310 CMR 22 (its 4 n02.11 Clzaning Frequency of Equipment Food- j Cunta.d Surfaces and Utensik* i SheiNish and Fish From an Approved Source ,, � ,. 4-'702 .1 hrcquencv i-f Sau;Jzarmu of Utensits and i i-201.14 Fish and Recreationally Caught Molluscan j Fund Contact Sttriaces Of Equipment, Shellfish* 4-703.11 Methods Jf Samtizam fn --Her Water and 3-201.15 Molluscan Shellfish from NSSP listed Sources* , (roper,Ad Gama and Wr!d Mushrooms Approved by 10 ( Proper,Adequate iiandwashing I Requiatory Authority =101.1 I 0 ,m C�fmdi:ion --Hands and Arms` 3-2011S Shellstock Identification Present* 2-301.12 Cle'auine,Procedure* 590.(104(() Wild Muslunoms^ j 2-30t.14 When to Wash" 3-201.17 Game Annuals, 15 Goad Hygienic Practices j g Recaiving!Condition I 2-401.11 Eating,Drinking or Using Tobacco,' j 3-"02,11 PI IF:,Received at Proper Temperatures* 240 i.12 -401,12 Discharges Plum the Lyes.Nose and 3-202 15 Package integrity* I Mouth, -101.11 Ftx)d Safe and Unadulterated" 3-3,01.12 Preventinv,Contamination When Tamar` g ( Tags/Records:Shelistock j ( 12 Prevention of Contamination from Hands '.-202.1S Shellsf ock kicntitir<rtion 590.004(13) Preventing Contamination from 3-203.12 Shelktock Identification Maintained* hmployees* j 13 Handwash Facilities Tags/Records: Fish Products j (i h ConvenrenthyLocatedandAccessibfe 3-40211 aresitc rds: >-203,i I Numbers and Capai,ine:` 3402.12 Records.Creation and Retention* j 590.004(,1) Labeling of Ingredients` 5-20<t.11 Lt*.�zticn and Placement" 5-205 I I Ao:cssibiliiy, Operation and Mamtenmtcc 1 Conformance with Approved Procedures 1HACCP Plans Supal'od with Soap and Nana Drying � 3-502.11 Specialized Prrrccssing Methods"- De f^ s 3-502.12 Reduced Oxygen p:u Gaging,criteria` j 6-301.11 Handwa.hin•Ciesuser.Availability 5-103.12 Conforrninee with Approved Prareduree,"' ( 6-30!.12 Hand Dfying Ptoeicum 'Denolwm.nucdl dein in the folodl J999 Ftwd C'odc of 105 C NIR 590.000 CITY OF SALEM BOARD OF HEALTH Establishment Name: GoweAta r- /%.41vg- Date: 5/00,b/ Page: 2 of Y Item Code C-Critical nem DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date No. Reference R—Red Item Verified PLEASE PRINT CLEARLY /3 C /Afl�:1474119 /sCcur►�Rc5r) A n�[ sr Wife ,e a 19S r�vcrso. cc6Ar/ r4,4fra X(A#f /4(4t&P J7 Njr .tNa et4L#41— .a f 4L C- f77.W'- ! 3 C Vryr"e 0rsj0dr,4 VX PApA.— rowr&cr ,N dAFf AffoaM . Aeodr0g. 0e.P00O edA& FaF.nrcr A Y" A t-t- ! 3 Cd c,f 5 4 ,tt Arra WA sra _r NK c7-&VitsR,sO AND No SC" AVA-rz,rF+6AX ` Re's A/+I) CLGAt- ai,rr ro1fi° /fe�R.,060 Ar /f Z4 ,sr I 1� 27 G -- Bac,e &X& (Inuit-- Av oc.,rWn_ f%krf o.r.ru Fo �3A ,IfYLS'7r e� ,tr 4ZL- r7tar: � t/� I ,G"k k Pt A R6A ,F 91111 M & r Z u9-rfs.-lC© w WQ 0,,,rd-ff Arf 16p. - � '` owN6F ,Must Affr'2s� n�6e0r�ra6 ,N�ckt�r/ A,.,I) 11�-Mcsvc� Ar,�rr Nfwlr fF! .t6 rT rJa�' p�ff,�/es;Nr fa T-UC CIP&.O-Af-hud of V7f& l3VsrN63's G a vwc .,nrrMn/,r✓6 c,cO /c/ W6% d0WZr Ar✓) trf69111,D F-0 ISA CtkAAMO 4(ar nrrr�S 6 c weade6�dn �� rr!lr,�d /lr�I✓rl i� Ki rctdsM. 1 W//GuvlL�.- /Jtt_ /J>![.,/ inG,�icO16NTa' i�o r�,t�t�'/ur Co1�.AM,Nt�o� Discussion With Person in Charge: Corrective Action Required: I ❑ No I ❑ Yes I have read this report, have had the opportunity to ask questions and agree to correct all ❑ Voluntary Compliance ❑ Employee Restriction/ inspection, to observe all conditions as described, and to Exclusion violations before the next ins P LI Re-inspection Scheduled ❑ Emergency Suspension ' w comply with all mandates of the Mass/Federal Food Code. I understand that noncompliance may result in daily fines of twenty-five dollars nor suspension/revocation of ❑ Embargo LI Emergency Closure your food permit. f �_ _ J❑ Voluntary Disposal ❑ Other: V 3-5V 1.i J(C'; Pl IFS ReLtiv,d at Temperatures Violations Related to Foodborne Illness Intervontions,and Risk A,,,.coroina,to iAw Cooled io Factors(items 1.22) (Cont.) -1:`17/45�F1Yahin 4 Floojs PROTECTION FROM CHEMICALS 3-501 Is CYIFU.2,Mediod-for PHFs J9 PF.F Hit vtnd Cold Holding 14 Food or Color Additives 1-5o 1.ba B) Cold N IF., Main!aj tied at or bdow 3-20112 Additnos* 590.0(141 F) 4PAY I-), 3-302.14 Protection front Unappi-rned AdditisW 3-,101.16(A) i[ot PFF-,lHaintai ned at or above 15 7-10 1 11 Poisonous or Toxic Substances ;40-F Identit'vinc Intornimion-Cri�,uizd Roads Hcid at or shove I70�P. " Containers' 7-102.11 Common Name - Working-Containers" Time as a Public Health Control 3-301.19 Tiny, as't Public Health Centro':*7-201.11 Separation-Storage- 590.00"I(PI) Valiance Requirement 7-20211 Restriction-Presence and Use" 720°.12 Conditions ol Use" 7-203.11 Toxic Containers-Prohibitions* j REOUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-21A.1 I I Sanitims,Criteria-Chenticals* POPULATIONS (HSP) 7-204 12 Clienincals for Washing Produce, Criteria' 21 3-801.1'(A) aipastcanzcd Prc-packi;zed Juice.and 7-1.04.14 Urving Agents.Criteri a with Warnint,Labels,- -801 ll(fij Useol P,stemized EgQ�� 7-2,05.11 Incidental Food Contact, Lubricanls�L 3-S01,�1�13 I Raw or PailialIv Calked Annual Food and 7-206�11 Restricted Use Pesticides. Criteria'" Raw Set-d Sprouts [%(It Sen ed. 7-206.12 Rodent Bait Slations- 7-206.13 Trackin,Povolors,Pest Control and Cj Uaupened F(yjl-� PaThage Not Re-served Monitorings CONSUMER ADVISORY TIMEfTEMPERATURE CONTROLS 22 3-603 It Consuniot Advisoty Posted for Consumption of .6 Proper Cooking Temperatures for Animal Foods J liat am Raw.Undercooked or PHFs Not Othetwisc Processed to Eliminate 3-401.11.4(1)(2) Eggs- 155`1715 Sec. Pabogens., ""!.....?l E�o-q-hnnae,iiatcServicc 145'f'l-5scc- 3-302.)3 Pa>t=urized Substitute Cot Raw Shell 3-401 Al(A)(2) C I o munnuted Fish, Meats&Cattle Eggs` Animals- I55`7 15 sec. * 3-401.11(H)(1)(2) Pork and BecfPoast- 130"F 121 min* I SPECIAL REQUIREMENTS 3-401.11(A)(2) Rattles, Tniccled Meats-I;slf; l5 500 009(A)-t D) Violations of Section 590.n09(A)-(D) in sec, catering. mobile food, tempot ary and 3-401.1 l(A)(31) Poultry, Wild Game, Stuffed PHFs, resident).,] kitchen operations should be dciced tander, the appionriatesections Sluffine Cotalinin,Fish, Nicol, Poultry or Rleites-165'7 15 sec. 4 above it related to foodborne illness 3-401.11(C)(3) Whole-niuscle, Intact Beef Steaks irlrcnent:ons and risk Factors. Other 14517* 590 009 violatiors relating to good retail 3-401.12 Raw Animal foods Cooked in a Practice, should be debited under#29- Miciowave I65`F' Special Requircinents. 3-401A I(A)(I)ib) All Other PHFs 1457 15 qm 17 Reheating for Hot Holding VIOLATIONS R=LATED TO GOOD RErAlL PRACTICES 3-403.11(A)&(D) PHFs 165°F 15 sec. 4 (1]tems 23-30) 3-403.1](B) Mitirowave- 165" F 2 Militia:Standjn_; Ctair(d and non-cri.ri,al iihichdo i,(,: rtaare 10 the Time* foodborne illness iMr.-Timhams and risk Jac tors lived above, ran be - 403.11(C) Commurcially Piccessed RTE Food- fined it,the fi,.?,'(jo ing r',cuonx oirthe Food Code and 105 CAIR i 40'F* 590,000. 3-403.11(1-) Remaining Unsliced Portions of Reel' I Item Good Retail Practices FC 590.000 Roasts* I 23. Manatiornnnt a,.-,d Pon;oqnel FC -2 '003 18 Proper Cooling of PHFs 24 Food and Food Protection FC-3 004 3-50114(A) Cool ing Cooked PHFs From 140°F lo 2-5 1 Equipmentand Utensfl� FC -4 005 26 3, 1 Wale,, PlurrilhWeareo and We FC-.5 -O-O-E> --] 70':F Within 2 Hours and From 70'1' i 27. Physical Facility FG-6 .007 to 41'F/.45'F Within 4 Hours. t 1 28 Poisonous ot Toxic Matei a1c FC-i' .008 501 14(h) C,,ofin-PHFs Made From Ambient 29 Special Rcquirae;ents 009 Tempeialure Ingredients to 41`17/45`F 30. ofiler Within,l Hours, 4 Dennie,CrUILA iell)Ill Ill,'ioliCial 11199 Food Code or 105 CMR 590060, CITY OF SALEM BOARD OF HEALTH Establishment Name: GGvttlrf6r r r4(d6 Date: !CbohLl Page: 3 of `t Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date No. Reference R-Red Item Verified PLEASE PRINT CLEARLY e9 G i I� F ez ,dt0� rT �Me Or //eF_ .4/1r'ty-5f " vMir td MA.NtAtd swtP �� inae esoc A&tAw, n(eL-4vc 49Aa4 . W IgAuDuez— %vv,,*sn Bis,Ceru/ VN fvf"41� _ Acc_ Pa.,Prxz– V--e% Arc Z-PP19 9) M— N tc rn.t.f at rSJ 09G TUAG�At...•c tvtA eC woTLISLAc. Ae.- AUrr r- Sfwc. ' - NlcA"at o- AN(J 1'Airtre?i rrL_ N'ItrXeltz"aw T—tt'tdtxirl_t,•t f_C�.tNtNlr $ G /./1t/t&C) titNir d AQ At&Af- Slras,W 4(iftwc Ata u.irV- Ac- r#4 c TR uMtf- tAAn A •r*AM7 nA c/fbF AtzrbIl- r.&4#r rb M,flKra/N / i 2� n, CUuf►41LA LSFA->r F�nitfla�( vNi6 NlsC�nr �,s.,�av�rl CeaC ►K� • I Ar Irvtpc- A o r- "b*A e.fF rl*A!= S C0-011L A 1111`910� ry S>t At 4- fst-.t/. Discussion With Person in Charge: Corrective Action Required: I ❑ No ❑ Yes have read this report, have had the opportunity to ask questions and agree to correct all ❑ Voluntary Compliance ❑ Employee Restriction/ Exclusion violations before the next inspection, to observe all conditions as described, and to ❑ Re-inspection Scheduled ❑ Emergency Suspension comply with all mandates of the Mass/Federal Food Code. I understand that noncompliance may result in daily fines of twenty-five dollars or suspension/revocation of ❑ Embargo ❑ Emergency Closure your food permit. / - I '/ ❑ Voluntary Disposal ❑ Other: i A(C) PRFs itec.ened at i empera cores Violations Related to Foodborne Illness Interventions and Risk Ac,otdi ng to tats Cooled r Factors(items 1-22) (Cont.) a1°F!15`FWitM,1411aurs. ' PROTECTION FROM CHEMICALS .15 Coohar Mediods for PRFs 14 Food or Color Additives ' 19 PHF Hot and Cold Refiling ., ( i-5111.16('>_;) Cold NlFs Madu:nacd at or below 3-202.12 Additives* 590.00VF) 41"!+5° F* l - 3-302.14 Protection tnnn Unapproved Additives' ( I 3-501,16(A) I lot PHFs Maintained at or above 15 Poisonous or Toxic Substances (I F. 7-101.11 Idenuly;nclnforinatton-Original i 3-5t)1 Ibt4) _ ' Containers" ( Roasts Herd at or 130 I. " 20 Time as a Public Health Control 7-102.11 Common Name-ti6orkutg Containers* � - 7-201.11 Se tion-Sit);ate" 3-501.19 Timcits::Public Health Cooloo'*-- 1 i-20211 Restriction-Presence and Use" 59+i.0Udi H) bariance Regwn-ment 7-202.12 Conditions of Use' REOUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-203 11 Toxic Containers-prohibitions'' 7-204.11 Sanitizers,Criteria- Che;ricals* t'OFULATiON�s(HSP) 7-204.12 Chemicals for Washing Produce.Criteria' Ll 3-8(Y.l l(A) Unpas±eurrzed F'ra-pa,.kaged Juices and Jievetages tvi:h Warmne Labels'. 7-204.14 DryingAcents Cnreria" 3-801.1 l(B) E Liseot?nstenrizedhr);s* 7-2(15.11 IncRestrictni Food Contact. Lubricants' I ( 3-501 11(D) Raw or P rtially Cot-;i;ed Amain]Food and 206 I i Restricted Use Pesticides.Criteria* j 7-20b.12 Rodent Bait Suui!�ns" kov. Seed Sprouts Not Son ed. 7 206 13 'marking Powders.Pest Conrad and I i 3-80 L 1(Co Unopened Food pact,age Not Re-served. Monitoring* CONSUMER ADVISORY TIMEITEMPERATURE CONTROLS 22 3-603 11 Consmrer Advisory Posted for Consumption of Aninial Fails (hat are Raw.Undeicook ed a' 16 I Proper Conking Temperatures for ( Not(Rhenvise Processed to kilinmtate PRFs ,-mF.""'311 3-401.11.4(1)(2) 15ggs- 155°P 15 Sec. i Pathonrns.^ __- Egvs-linnie diate Service 1.95'1715secr '-3t)-.73 PasVo,-oed Fag.;Substiute for Raw Shell 3-401.11(A)(2) Comminuted Fish. Meaty it Gmnc E.pys': Animals- 155F 15 sea 3-401.11(H)(I)(2) pork and Bc•cf Roast- t3U"F 1 tl min' SPECiAE_ PEOUIREMENTS } } 55 I 590009(,1) (D) Vioiatians ofSection 59Q009(A)-(D) in 3-401.1 t(A)(_ Ratites, Injected Menta-- 1- I-, 15 sec, catering. mobile ftxtd,temporary attd 3-401.11(1.)(3) Poultry. Wild Game,Stalled PJFs, residential kitchen opCratiosn,)mild be Slatting Containing Fish,Meat, debited tinder lie appropriate sections Poultry or Ratites-165"F 15 sec, above it-related to(ioodhorne illness 3-401.1I(C)(3) I Whole-muscle,Intact Bref Steaks utlervcntior.,and rick lectors. Other 115°F r 590.009 violations relating to good retail 31101.12 Raw Animal Foods Conked in a practices should be debited under#29 -- Microwave 165"F* Speciai R--gnircrnerits 3.101.1 I(A)(1 tib) All Other PRFs- 145'F 15 sec 17 Reheating for Hot Holding VIOLATIONS RELATED TO GOOD RETAIL PRACTICES i-403.11(A)&,(D) PHFs 165'N 15 sec. (Items 2330) 3-403.11(B) I Niicrotiave- 165'F 2 Monne Standine Caztical mrd non-rrlici t cirdavn ns, i.lw h do not name to the Time' ,foodborne il)ness mr(a;v6nron,s and sial.firth rc lin"d obuve, can he 3-403.11(C) Commercially Processed RTE BNA- .found it'. the joh'o.ring<er/mns of the Feud Cade and 105 Cblk 140` t I 59().()00) 3-403.11(1) Remaining Unshced Portions(I Reef I I Item Geod Rsradl Fractices FC ' 590.000 f Roasts' 123. Management nn.^Personnei FG- 2 j 003 18 Proper Cooling of PRFs !� ( 2= Food and Food Picie,tion FC-3 .004 I I ^5. Ectuiprnent ani Utrnsi s FC-4 .005 3-501.14(A) Cooling Cooked PHFt,from I40'F to 26. Wafer,Plumbing surd Waste F. -5 .006 70`F Within 2 flours and From 70"F 27 Pnvs ca:Facility FC--6 007 to 41`F/45'F Within 4 Flours. '" 28. Pots--nous or Toxe.Matenas PC-7 .00II 3-501.14(1.) Cooling PHFs Made From Ambient 29, Srecial Rcm0-,rme,ds ._ ._ 003 Temperature htgredicnis to 41"1145`1 30. Other Within 41-Iourt;* r•�¢,,,n,m.e e,. o Denob.s ncm m vie lederal 1999 Fool Cody or 105 Clok 590 U00 CITY OF SALEM BOARD OF HEALTH Establishment Name: C TQ1xMk Fid £ Date: 'S 120lt-/' Page: of Item Code C-Critical item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date No. Reference R—Red Item Verified I PLEASE PRINT CLEARLY 1 I I ✓'�-' A,Af Frbs•.t I��—sit tf — P�Sr-�f� l�d,��KOw,4sfL.NIL �&/KfdCLMtNAFM9 'A1 I — Gess Q ,r-s,wd�r I ' S!!A arm r7.ue, a.ar*s�o 4 v,7(6A n V f1 XAr- r-auOS IN W AAAA/ I I ' I 1 r I 1 1 1 I Discussion With Person in Charge: Corrective Action Required: I ❑ No ( ❑ :es I have read this report, have had the opportunity to ask questions and agree to correct all ❑ Voluntary Compliance ❑ Employee Restriction/ Exclusion violations before the next inspection, to observe all conditions as described, and to ❑ Re-inspection Scheduled ❑ Emergency Suspension comply with all mandates of the Mass/Federal Food Code. I understand that noncompliance may result in daily fines of twenty-five dollars or suspension/revocation of ❑ Embargo ❑ Emergency Closure your food permit. ❑ Voluntary Disposal ElOther: 4 ) U 3-501 HOC) � PHFs Roclived atTemperatures Violations Related to Foodborne Illness interventions and Risk Accei di *to Lw, Cooted io Factors(items 7.22) (Cont.) , .I I"Fr4J'F Within-I Hours. PROTECTION FROM CHEMICALS 3-'0'.i` Cooiin=Methu& orPHFs � 14 Food or Color Additives i9 PHF Hot and Cold'Holding 3-501.16 3-202.12 Additives'; -:B) Cold PHC7,a,mm•tincd at or below 590.60-IIF) =!1'14.3'F'< 4 302.14 Protection from Unapproved Additive;* Poisonous or Toxic Substances ;-501.I6iAt [fait PRFs Maintainedat or abcne f 5 14U"F 7-101.11 Identifying lnturm,mun-Ougm'd �, I- a Containers" l Roast:,Held at or above ,OT. 7-102,11 Common Name--Working Container;" ( 20 Time as a Public Health Control i 7-201.11 S,paradon-Storage 3-501..19 Tim;a,a Public Hcalth i:untru(* 7-202.11 Restron-Presence and ncUse 5ct0.00-t;H) 'Yariancc Requirement icti 7-202.12 Conditions of Use- 7-203.11 se" REOUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-203.1 I 'Toxic Coizuninet:; -Prohihrtions" POPULATIONS("lisp; 7-204,11 Sanitizers,Croeria-C"nemicalc" "_04.12 Chemicals for Washing Produce.Croatia`: � ( 21 3-801 11,'At Unpasteirri ed Pre-packaged Juices and 7-204.1.1 Drying Agents.Criteria" ` besIn asses oath Waring I abcls� -801.11(B) 1A,of P, -to:ized Eco;- _ 7 205.11 Incidental Food Contact. L ibricantsT -80 1 11(1%) Rel:or Partially Cooled Animal Food and 7-206.11 Restricted Use Pesticides, Cnterta* RawSeed Sprouts Nut Jen ed. 'x 7-21)6.12 Rodent Batt Stations' IItU.l1(C) (lnupened Foo.;PacCa;;: Not Re-served. 7?06.13 Tracking Po,vders, Pest Control and i Monitoring" CONSUMER ADVISORY TIMEITEMPERATURE CONTROLS -}2 3-603.;i Cun;nmcr Ad,ison Poctcd for Consumption of Animal F:xxls Fluty om Raw.Undercooked or 16 I I Proper Cooking Temperatures for I Not 01herwise Processed to Eliminate PHFs 1'eth:�?cos.^ 3-401.11 A(l)(2) Egg,- I35'F 15 ,Sec. -Pate -- Ergs- Immediate Service 145"F?5sec' aw ved ?3v;?;Substitute for Raw Shell 3-401.11(A)(2) I Comminuted Fish,Meats 6't Gain- EY-gsr Animals- I55"F 15 cec. * 3-401.11(B)I1)(2) Pork and Beef Roast- 130"F' ]•21nun" SPECIAL REQUIREMENTS 3-401.11(A)(2) Rattles, Injected Meats - 155"F 15 Sg0.i;09tF,)-t D) Violations of Section 590.009(A)-(D) in sec. * I catering, mobile food,temporary and 3401 111 A0) Poultry.Wild Game, Stuffed PHFs. Imidctttiaf kitchen onrradons should be Stuffing Containing Fish, Meat, debred under the appropriate sections Poultry or Ratites-165°F 15 sec, above if related to foodborne illness 3-10L11(C)(3) Whole-muscle, Intact Beef Sncaks intervention:',and risk tactors. Other 145'P" 59(-.009 vioiations relating to good retail 3-40.12 Raw Animal Feuds Cooked in a practices should be debited under 1129 - Microwave 165'F* Special Requimmentr, 3-"1(11.11(A)(I ab) All Othei PHFs 145'F 15 sec. '"` p ( Reheating for Hot Holding VIOLATIONS R.LATEO TO GOOD RETAIL PRACTICES 13-403.11(A)Sr(D) ( PHFs IWF 15 sec. ' (Itein523-30) 3-4011l(B) ( Microwave- 165'F 2 Monne Standing CzRirrd and`ion-rritrcut ein!0tions, ivi irh,6 not relate to die Time' Ifoodborne ilbiess inter vennon,s'and rill,Jiu tors listed nLove, can be 3-403.11(C) Commercially Puxessed RTE Food- ,fo:and in the felon-ing se,,tions of the Feud Code and 105(SIIR Ian"Fr 590.00. ---- ---------- 3-403.11 Qii Remaining Unsliced Portions of Beef Item Good Retail Aaetices FC 590.000 Roasts" 23. Management and Persennm FC -2 .003 1g Proper Cooling of PHFs ( 24 Food ai zd Fooel Protection FC-8 .004 25. Equipment and Utcnslis FC-v .005 3-5111.14(x) Cooling Cooked PHFs from 140'F to 26. 'Weer,Plurabinu end Waste FC-5 006 70`F Within 2}lour;and From 70'F ( l 27 Phl6i,ml Facility ; FC-6 007 to 41^F,145"F Withm 4 Hours. * -o F3 Poisonous cr Toxic Ma+eri_a i=C-7 .008 3-501.14(B) Cu„bn„PHFs Made From Ambient 29 Special Ronuirrments x09 'rempetatureIngredients it)41cF/45cF 3n Other � Within 1 Hours* ' Ucn,Aec allical Dein In ni.r redeem 1994 Fond Code or 105 CMR 590,000. CITY OF SALEM s BOARD OF HEALTH Establishment Name: 6u-e`� f t)urrq/e- Date: Page: /-. 1 of Item Code C—Critical ItemDESCRIPTION OF VIOLATION/PLAN OF;CORRECTION Date No. Reference R—Red Item a ` N" Verified PLEASE PRINT CLEARLY _ t I n/ ✓euly� t�f I�Ie,+s 4 0 P� Ovr�( CcAi✓� f PSEu�I >�i ��f<,/`� �v I �_ C_�.dur, Q�e. «� rl� -l-fi� S-�.��t �-v.��l �'�d• I I I I I ol.v�.r�• n„� ,��rs �.a�,Hy a � �a� % 5-P..a,� a•� ✓��ry, � I I I I I I I I � cam•,�,- �✓,t.l ,�r, �,b wow.- C�-/Jah�� . o� .s�-/r/ -/;z/-,y i>' f� I I 0-/ of I I 1�✓�s lkD°r 44 14 �_,gI4 t wce X ee, �%� Paha fs D> l/d d -ems - x o � �= • I I I � I � � I I I IP,�v�..cL,�-�d l�vacrd�rrs ✓per u.�l�yy -fid /J�-P/�G.a -1,� - I • I ��-rB$e d-X2. -l2/�, ✓,r/d� `M Olt717 le o-/liras ;� l .75/�� r{v � i,�,�// b� ate . A' Discussion With Person in Charge: (!/ Corrective Action Required: I E3 No I ❑ Yes } I have read this report, have had the opportunity to ask questions and agree to correct all Ll Voluntary Compliance Z) Employee Restriction/ inspection, to observe all conditions as described, and to Exclusion violations before the next ins p ❑ Re-inspection Scheduled ❑ Emergency Suspension y comply with all mandates of the Mass/Federal Food Code. I understand that noncompliance may result in daily fines of twenty-five dollars or sus}pension/revocation of ❑ Embargo L3 Emergency closure your food permit. YYY GC.�G� ❑ Voluntary Disposal ❑ Other: k � V 3-51;1.;4(0) 1'HFs Receic•ed a: ;emperat:n'es Violations Related to Foodborne Illness Interventions and Risii- According to L+a+0,oled to Factors(Items 1-22) (Cont) 41'F/45 With,r.4 Hotus. ` PROTECTION FROM CHEMICALS 3-50!.15 Cn,'iit!c Meow&. for-i1Fs 14 Food or Color Additives ( 19 ! FHF Hof and Cold Holding 3-202.12 Additives' 3-501.16lB1 Cold PHFc Maimmact! m or below sO0.00^(F'• 41"/»''I^' 3-302.14 Poauetion foam Ifnappioved Additi(e.,` ( 3-50 i.;h!A) llo: PItE, Maintnlned at or a6wv 15 Poisonous or Toxic Substances 40_j 7-101.11 ldentofvingInformation-Onginal SO1.IP,lA) Roas:cHeld:t -n abote 130'F Containers` 7-102.11 Common Name-Working Containers' ( 2d Time as a Public Health Control 7-2_01.1 I Separation-Storage" 1 P;; Tine a;a Public Hz.dth Orrawl 7-202.11 Restriction-Pretence and tise' S:U.U04(Hl Variance Requucnivat 7-202.12 Conditions of(iso' I 7-203.11 '1oxicContainers-Prohibitions" REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS;HSP) - 011 Sanitized.Cr Wmhi gPrI Chemicals-4 � 21 I ''.-Sill I1(A) ' Unpasteurized Pre- r iuzed.luiccs and 7-204,12 Chen:irds for R'aehing Prcxhoce.Criteria* ! I ! 1�' P`` 7-204.14 Drying Agents Criteria" B ,eiaee, with Warning Labels" 205 11 htvodanmi Food Coonan. Lubricants" ! 3-6UL1 l(B) ' Use of Pasteurized E;,ys" - 13-;401.l I(D) ( Rs',v 0t Pasteurized dy Cooked Animal Food and ''-206.11 Restricted Use Pzstic+des,Cnteria" Raw Seed Sprouts Not S^rued. r 7-006.12 Rodent Bait Stations' 3 $UI 1 I(C) Unot'ened Food Package Not Re-served. 7-206.13 Tracking Powders,Pest Control and 1 - Mumtorinc CONSUMER ADVISORY TIMElTEMPERATURE CONTROLS 22 1-60; 11 Com.uiuer Advisor* Pn;;ted for Coustuupoon of P6 ( I Proper Cooking Temperatures for Animal Food, nw, :ire Raw:Lindeocooked or PHFs Not Othcru-ise Frucessed to Eliminate Pathos{•, wm<o:. :a.'a, 3-401.1 I At 1)(2) Egos- 155'F 15 Set, I 3-302.13 1 Pasteurized Fei, Subsdtutz for Raw Shell (.segs- immedia!e Service 145"Fl 5svc` F' 3-401.11(A)(2) Comminuted Fish.Meats&Game Animals - 155'F 15 ser t SPECIAL REQUIREMENTS 3-40 1.11 Y(»Land BczfRuast- 130'F t_^Irvin" 590.009(A)-(1i) VioLWons of Section 540.009(,x.)-(D) in 3-401.11(A)(2) Ratites Injected Meats- 155'F15 sec " :;a:grin- mobat-Lwd. temporary and 3-401.I t(A)(3) Poultrv,Wild Gane. Stuffed tesiderival kitchen operations should be Stuffing C ontainine Fish,Meat, debited and?r die appropt!4[c aeetiotis Poulhv ur Ratites-I65'F 15 sc�, ' oboes if related to foodborne Rhiess 3-401.11(0)(+) Whole-muscle. intact Beef Ste:&:. interventions and tisk factor's. Other 145`F = 590.009 violations relating to gtxxl retail 3-401.12 I Raw Animal Fonds Cooked in a Praetic•es mould 0e dchtted under #29- Microwave 165'F. Special Requirements. 3-401.1l(A)(1)(b) All Other PHFs - 145'f' 15 see. 17 Reheating for Hot Holding VIOLA PIONS Ret ATED TO GOOD RETAIL PRACTICES 3-403 1 1(A)&(U) PHFs 105'F l5 sec. ' t (btetns 23-30) 1 3-403.1103) Microwave- 165'F 2 Minnie Standing G''ritirol and nox-wised/violations, ohicit do not reiole to the Time* kurlbo,•o;d)n,.a a lmrt entiona c,nd,fan Ic:clues listed Marr, cart be i 3-40." I I(C) Commercial I Processed RTF.Food - found it, tl:.(ciiowini:sec tions of il,c Good Code una' 105 i„A•IR 140"F* 590.00u. ?-4113 II(E) Remaining Unshced Portionsof Beet Item Good Retah Practices 1 FC 390.000 Roasts'" 2' I NPanariement and P&sonncd FC-2 .003 18 Proper Cooling of PHFs 'i 24. Fred aril Fxr.'Pmteciicn FC--3 .004 ,'.5 Equ!pmeni and Utensils FC-4 .005 SOL 14(A) C(xrlmg Cooked PHFs Gum t40 F to 26. Water.Plumhin+l and Waate I FC-5 .006 70'F Within 2 Hours nn(1 From i0'B i 27" Physical Factl!ty FC-0 007 j to 4PF'/451F Within 4 Hours. * 28Poisonous or Toxic Materiels FC-? .COS 1 3-501.i4(B) Cooling PHFs Made Froin Ambient 29. Special Requirements 009 Temperature Ingredient•,nt 4l"Fi45'F 3U. Other Within 4 Hours" `Denote+critical arm in tho tc&ral 1499 Food Code or 10i 0114 5v0 D00. w �-�7-0� �' - - - - -- - ��-`.�P.�..d.�.�� - - -.— __------- ---- �I - - - - -- - - - - -- - -- -- - --t�,�.. - --_ _ __ JG� �� -- - - - -- - - ------ ---- - A-7 a - -- - -- ---set ---- � - t • !A Massachusetts Department of Public Health Salem Board S Health N 124 Washington Street,4'"Floor Division of Food and Drugs. Salem, MA 01970-3523 FOOD ESTABLISHMENT INSPECTION REPORT Tel. (978)741-1800 Fax (978)745-0343 Name Date Tyne of Ooeration(sk Tyl insoection d J A°/Y7 P 1 T r RAE I / -" �� O�} I ❑ Food Service ❑ outine I Address II Risk ❑ Retail tJ He-inspection 3 �, I 1lAfe,F S �' Level ❑ Residential Kitchen Previous Inspection Telephone ❑ Mobile Date:/_/p2-p c f I f 7�� 745- 9i 90 ❑ Temporary ❑ Pre-operation Owner J HACCP Y/N ❑ Caterer ❑ Suspect Illness Time In: 71 Bed&Breakfast ❑E] General Complaint Person in Charge(PIC) HACCP ( Inspector Out: Permit No. [I Other J�l.�.f�t'�iYll�lfLlit^yt 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 59o.009(E) ❑ seo.009(F) ❑ action as determined by the Board of Health. FOOD PROTECTION MANAGEMENT ❑ 12. Prevention of Contamination from Hands ❑ 1. PIC Assigned/Knowledgeable/Duties ❑ 13. Handwash Facilities EMPLOYEE HEALTH PROTECTION FROM CHEMICALS ❑ 2. Reporting of Diseases by Food Employee and PIC ❑ 14. Approved Food or Color Additives ❑ 3. Personnel with Infections Restricted/Excluded ❑ 15.Toxic Chemicals FOOD FROM APPROVED SOURCE �� TIMEiTEMPERATURE CONTROLS(Potentially Hazardous Foods) ❑ 4. Food and Water from Approved Source ❑ 5. Receiving/Condition ❑ 16.Cooking Temperatures ❑ 6. Tags/Records/Accuracy of Ingredient Statements ❑ 17. Reheating ❑ 7. Conformance with Approved Procedures/HACCP Plans [118. Cooling PROTECTION FROM CONTAMINATION - ❑ 19.Hot and Cold Holding ❑ 8.Separation/Segregation/Protection ❑20.Time As a Public Health Control ❑ 9. Food Contact Surfaces Cleaning and Sanitizing REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) ❑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 Number of Violated Provisions Related Critical (C)violations marked must be corrected To Foodborne Illnesses Interventions immediately or within 10 days as determined by the Board and Risk Factors(items 1.22): of Health. Non-critical (N)violations must be corrected Official Order for Correction: Based on an inspection immediately or within 90 days as determined by the Board today, the items checked indicate violations of 105 CMR of Health. 590.000/federal Food Code.This report, when signed below C N by a Board of Health member or its agent constitutes an 23. Management and Personnel (FC-2)(590.003) order of the Board of Health. Failure to correct violations 24. Food and Food Protection (FC-3)(590.004) cited in this report may result in suspension or revocation Of 25. Equipment and Utensils (FC-4)(590.005) the food establishment permit and cessation of food 26. Water, Plumbing and Waste (FC-5)(590.006) establishment operations. If aggrieved by this order, you 27. Physical Facility (Fc-6)(590.007) have a right to a hearing. Your request must be in writing 28. Poisonous or Toxic Materials (FC-7)(590.008) and submitted to the Board of Health at the above address 29. Special Requirements (590.009) within 10 days of receipt of this order. 30. Other DATE OF RE-INSPECTION: S 5.Wln$pOFOm 14.dw Print: PIC's Signature: yy� rr//,�•✓ ,, // Print: ' / Page of�-Pages tr `7Y17dFr /V rsr�/7(.e.--<.. ( Glir+` - r� llf tec�I"ir , .+ , Violations Rebated to Foodborne Iliness Interventions and Risk Factors(Ite=ms 1.22) K167 CTION FROM CONTAMINATION FOOD PROTECTION MANAGEMENT jr'. i:rss-conraminaeon j I 5,X10,0r3(A) j Assignmznt of Respon:ih;!hy' ( i-3i!'7 I It as"!) Rav:?.:+rut.:; :Dods Separated trum STD 00YBI DCmonsh ation of Kno)aledge"' j ('coked z.:.; R-li.!-•.,ods" 2-;03.1 ! ( Person in charge-dutieN j Co-"ram%natior G-rm Raw'Interseats -- i)2.I1+Ap,2} R::v, Arrr a FuoJi Sept:rmrd 4om Fach EMPLOYEE HEALTH (nth;i" 2 5411003(C:) Responsibility of the person it,charge to Coclari?atior i,-,n7 the Environment j ieyuire reporting by fond ntupiuyees and =:102.1 I;P.) ! -.cd Fr--rection, j applicants* :+ 102.1 t)'ashinr Fr:::t;and V.:�,�table: 5t9ifo l3(F) Rt.sponsibility Of A Food Cauployce Or An 3-30<L1! :'t d Coat:U with Pcr,!p m:mi and Applic.,int To Report To fire portion In iltensd," Clial'n ` ::Ulli;;L'.ena:Nii/''om tre Gcnsun er j 590 003(G) Reporting b3 P.--rson IT,Ch i-j i-106.t4(411 H) ::etuiaed Food as.d f< ;mice of Food' j ? 541LtiO3Q>; Exclusions and Reiviction;- j bsacaihon o`Hdvaern+ea rr ronrammatod j 590.003iP) I Rauo,a! of E V Iusu)na anti Keith-60115 Food j --;';l.11 Pc=rtrcting or lieeuuclitioninit lhisafe FOLD FROM APPROVED SOURCE f•11 ': j 4 i j F000 and Wates From Reguda:ed Sources j j ") t=rod Contact Sur?aces j ;40.OtkfG41B) Compliance with Fuvd Lwj A- ,i 1! Nfi:ucal'07f reu-.,shmg-Hot Water 3-/-01.13 hood in a Her meticaliv Sealed Cuntamzr* j S Mii,4,7ati(ln Temperatures'" 3-201.13 Fluid Milk and Milk ProductsT 4-501.!!2 NIe,.!anic.- t'+ares=•ashin g-:lot Nater 3-103.13 Shell La�oe* ; +:+tizatinn Ten,peratares. 3'202.!A E_, !sand Milk Punhats.Pasteurized" I =-5.!1.114 ChemieriSa-;tic+t+nn. temp pH; Cd?lCCnirailUn d:i i i:dP•-re5c. ?-2iP_.16 he Mnde Fnnu Pv:ahlc Hrinkier 14'utzr' ' a-b01.1 IiA.) Eya;IAls cl herd Contact Surr>.res rnd 5-!Ol.l 1 j 1)rinkinl_6Vater from ant Approved System^ ,,_ f tffn5tlS C.-8ti" j 5y(muEi(A) Bottled Drinking WaSr" j 4-602.1! Clruti=7e frq::enc}'+'•f F,quiptnrnt hanxl- j 590!Il)C(IS) Water Meets Standards in 310 C;Vtk 22.0' j t:oai::zt Sm!n�es "Id Utera,!t" Shokitsh and Fish From ate Approved Source .r--evency u. SaC:tiz.tlun of Utensils and 3-201.14 Fish and Recreation.01v Caught Nlolluscaa i Fn,�l convict Srrfscrs o.E+luirn:enf' Shellfish" Nlrthodt of SPn$izatiun--Hot Wfuer:md ' ?-2m.15 Molluscan Shellfish from NSSP Listed I ..henuc-:;' j Sources* j i0 I Proper..4dsGuste tlanrdvrashing j Came and Wild Mushroom,,Aporured b. � 1-3UI 11 C!e:m C'oacu:u:? -Haadt, ane!Arris" j Reoulatory Au!hoiki, r ' -_i!H 12 Cicanint,Fvve7t4e'` j -202.L� �e � hcllct,xk Idzntii7zation PreScnt* ; }000041("i I ',silt Nhishrr,ums' j , Uareta Animals" i i ` Gnad Hy+rienic Pr.:dices j c ! Receiving/Condition- - -- - j 2-40:,: ! ! aunr, Dr:td.m_•,;;•Using'L,•haao' j i3-202.11 PH?s Received at Prop cr Tcrtpetatures" j ; ° U'i.!2 0iscfic:1,cs From the Eyes, Nos;smd j 3 202.15 Pa••-kage Integrity', j i Mouth` � :;i)i.12 Pn ,e,.ism;Cnntamm:utuu tL7:en'rasting* j 3-10{.I l Food Safe and Unadu!tcr,ted j j l) Pr�renH IT of Contamination fto;n Hands 7ags/Rerords:She!Istoc{: ' :i4U.Diti!Ei "reccnti rig Comat^seal,ai fr:.;n 2/11 t8 Shelktockldentitiv:nwn" J-2Ci3 1' ShcUstock idontiGcation Alaiatained', Empl°``cs'r Tagafrlecords:Fish Products I' HandµasF.Fucii!ties j 1',om*^rvenNy f oc:Gad•:rnd Access,b!a -401.1 i Parasite DraniRion" ----------- - -- ---- - --- .3-404.!2 Records,Creation and Reic!ttinn 5-203 I1 Nt tnh-i,md C:apa:u:os" j :r-2t)<l.!1 i F{ia.tUii Bad)''dCi'nLPi` 9(}.0(7?(I i Labeling of ingredients' gConformance with Approved Procedure, :i-_!i5.: ! Accessibility.Operation.rnd Maintenance I IHACCP Pians Sup,^:5rd mil Stmp:ard H• o+i Crprnp QC 3-SOt.I l Specialized Processing iv!eduuls Or j (( 6-;01.11 Hr;,.ndwash .anser. Availabilu}3-502.1_ PLduccd oxygen purl:;ringcria•` G-30!.!2 Fin;:)r}irg Prni;ionR-ll)3.t2 Conformancewith Approved Procedort,t,. j ^i)ar;icS critical nun in the!e<iu<' !^9v Prnut f'(dc o+ 11)5 CNIR CITY OF SALEM BOARD OF HEALTH Establishment Name: lyOLR/hV f 1 a K Date: /- 1?1 o-d 4/ Page: of �— Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date r No. Reference R—Red Item Verified ,.� PLEASE PRINT CLEARLY �/ I • / 7�.z'��/�s �i /� .! / '� �- /�-OS' l tii�i�rr �-im;' /s��ii /1 7 f &)Iz'/i i f-z—rn.0 - �O�.rne� //y✓P�,e� _77i1n,� � �� //i /�.oc�i I I I r I I I I I r I I I I I I I I I I I I I Discussion With Person in Charge: I Corrective Action Required: ❑ No ( ❑ Yes I have read this report, have had the opportunity to ask questions and agree to correct all I ❑ voluntary Compliance ❑ Employee Restriction/ inspection, to observe all conditions as described, and to Exclusion violations before the next ins p L3 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 0 Other: 3-51)t.14(0) F'HFs kee'rived;a`iemprruturrs Violations Related to Foodborne Illness Interventions and Risk A„rnding io Law Cooled to Factors(items 1-22) (Cont) 41"FML'F Within Hoars , i-501.15 Cor,;;a c Methods flit PH Fs PROTECTION FROM CHEMICALS iU PPF Hot mid Colu Holding 14 Food or Color Additives - F lis P3ainiunM at .,r how l 3-501.16!B 1 C'niCi!' ! ! 31.02.12 Additives'' 190.00-11yi 4i;4S'F' 1-102 14 Protection from Unapproved Additives" ;-5(ll.lfi!A) 11%,[PHFs A9'nrtained a!of ala,-,ei 15 Poisonous or Toxic Substances 0'h 7-101.11 Identrtymg tnlunuation--Onginal ( " 501.16(A) Itou;ta Held A(a above i"3O'p � Containers' �� Time as a Public Health Control 7-102 11 Coin ion Name -"Working Cont irtec" 4-5;)1.11 i imr c:;a Public Health('o^trop" 7=_'01.11 Separation-Storaite^' 7-2011.11 Restriction-Presence and Use* X9000401) Vn'tancc Rt,,:uern.nt 7-202.12 Conditions of Use" REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-203 ( rnxic Containers-Pn+hi6itions' l POPULATIONS(4SP` 7-2'(4.11 Ssnidzers.Criteria-C'hemical"- ' 7-104.12 Chcanrals for Washing Produce,Criteria, 7-204.11 i-3(4.1 1(.A) t;nnar.izuri�,ed Pre-pack::eed)nice:and F3evenaees ;vola i*gamin 1_,hels* 7-204.14 Diving Agents.Criteria' 3-34;1.1 1(B) Cite of Pasteur;zed F;;esM I i ?1)5.t t Incidental Food Contact,Lubricants" 3-gti I i(h) Paw,o; Parti.tlly G^*zked Animal Food and 7-206.11 Reurioed Ilse Pesticides,Criteria^ ).'U6 12 Rodent Bait Stations" Raw Send Sprouts Not Served. 7-206-13 Tracking Powders,Pest Control and 3-301.i 1(C) Unupencd Food Packege Nan Re-served R4umturing" CONSUMER ADVISORY TIMFJTEMPERATURE CONTROLS 22 1-603.11 Constmier "hdvisn_y Posted for Consumption o1' Animal hand,'That are Raw, Undcl-L OIX(l or 16 Proper Cooking Temperatures for No, Oti,crclise Prcmes,cd to Eliminate PHFs i -��,., 3-401.112\i 1)(2'1E Eggs- 155''F15Sec. Pathvgeus. ` 302.i 3 Pa,,teuuzoL• d Eggs Substitute tot Raw Shell m Eggs-hnednite Service 145"[15sec• I' ' 3-401.1 1(A)(2) Comminuted Fish. Meats&Gane Eggs' Animals- 155"F 15 sec. 3-401.iI(13)(I)(1) par kand Beef Roast- I'tO'F121 mm" SPECIAL REQUIREMENTS 3-401.11(A)(2) Ratites, injected Meats- 155"F Iv 5`)0.009(Ai-(D) Vioiaitotna ol'Section 590.009(.A)-(D) in ( sec, Caroline,mobile food, temporary and 3-401.11(A)(3) Poultry, Wild Game. Stuffed PEWS, residential kiti„ien operations shnuLi be, MMnn;l.unhunmg Msh,Aleut, .::n,.z.; under the�;:p�w 6ru,. Poultryor Ratites-165'F 15 sec. * ihovc if related to foodbortic ilhtess.ys 3-401.1 ItC>G) Whole-muscle,Intact Beef Steaks interventions and risk Factors. Cather 145'F" 590.009 violations relating to nood retail 3-401.1? Raw Anmerl Foods Conked in a ( practises should be deh led under #29- Microwave 165°F Special Requirements. 3-401.1liA)(1)(b) All Other PHFs-- 145"F 15 sec 17 Reheating for Hot Holding VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 3-403 11t,A)&(D PHP, 165"F 15 sec. a_ (Items 23-30) 3-103.11(43) Microwave- 165" F 2 Mumu Standing C46cat and don-.:rdintt violations, .Atcltdo not relate to the Time" Innrihorne i((ncss interventions mrd risk factors lasered above, can he 3-403.11((',) Commercial}Processed RTE Food - (mend in theJolland„g se(,iorn of rhe Food Cade and 11)5 C JIR 130"FT 5901000. 3-40311(E) RemainingtinsliredPortiungofBeef item Good Retail Practices FC 500.000 koastr" 23. _ fdan::gemrnt ano Personnel FG-2 1_003 " - -- ---- 18 Proper Cooling of PHFs 24. Food and Food Protector FC z 064 ---~ 3-501.1.1(A) CON in,,Cooked PHFs front 140"F to 2S FGuipment and Utensas IFC-4 005 1 M. Vdmrer,Piurrbinq and Waste FC"-S 006 70"F Within 2 Hours and From 70'F 1 27 Physical Facility FG - 6 007 A,4l"F/45"F W ithFnt 4 Hour,. * I 23. '� Pcisonous or Toxic Materials FC-7 I .008 _I - 3-101.14(B) Coiling PHFs Matte From Ambient 1 29 Special Rectunements .009 Temperature Ingredient;to 411F'4S'F 1 'i} Other Within 4 Hours' 'Denote,critical urn in the tcdrral 1999 Poaal Ciklc ui 105 CNik 5901;)0. Massachusetts Department of Public Health Salem Board of Healt 194 �y 120 Washington$treat, 41h loor Division of Food and Drugs Salem, MA 01970-3523 FOOD ESTABLISHMENT INSPECTION REPORT Tel. (978) 741-1800 Fax (978) 745-0343 Name Date Type of Ooeration(s) Toe of Insoection r-4A2 /-- Id-OV [Z _Food Service �Routine ( Address- Risk E] Retail E] Re-inspection / F Level El Residential Kitchen Previous Inspection Telephone ?6r9 ) _&r ` , t, ��S_ ?/ 0 [-] Mobile Date: Owner ' v HACCP Y/N ❑ Temporary ❑ Pre-operation )//INAjvlo /_. /FjYrh ❑ Caterer ❑ Suspect Illness Person in Charge(PIC) Time ❑ Bed&Breakfast ❑ General Complaint CAinP_ In. ❑ HACCP Inspector -7).GB0>0n1A1;M /v I✓1A7.Ci hl l� 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 IgJ 13. Handwash Facilities EMPLOYEE HEALTH El2. Reporting of Diseases by Food Employee and PIC PROTECTION FROM CHEMICALS ❑ ❑ 3. Personnel with Infections Restricted/Excluded 14.Approved Food or Color Additives FOOD FROM APPROVED SOURCE El 15.Toxic Chemicals ❑ 4. Food and Water from Approved Source TIME/TEMPERATURE CONTROLS(Potentially Hazardous Foods) ❑ 5. Receiving/Condition ❑ 16. Cooking Temperatures ❑ 6. Tags/Records/Accuracy of Ingredient Statements ❑ 17. Reheating ❑ 7. Conformance with Approved Procedures/HACCP Plans ❑ 18. Cooling PROTECTION FROM CONTAMINATION ❑ 19. Hot and Cold Holding ❑ 8. Separation/Segregation/Protection ❑ 20.Time As a Public Health Control ❑ 9. Food Contact Surfaces Cleaning and Sanitizing REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) ❑ 10. Proper Adequate Handwashing El21. 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 r fCeaNh . 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 the food establishment permit and cessation of food X26. Water, Plumbing and Waste (FC-5)(590.006) establishment operations. If aggrieved by this order, you L/ 27. Physical Facility (FC-6)(590.007) have a right to a hearing. Your request must be in writing 28. Poisonous or Toxic Materials (FC-7)(590.008) and submitted to the Board of Health at the above address 29. Special Requirements (590.009) within 10 days of receipt of this order. 30. Other DATE OF RE-INSPECTION: S 5001ns dFoi 14 d. Inspector's Signat�re: - Print: PIC's Signature: !� �� Print: 1 l 1 . L. I �L( Page of,-3-Pages G n Violations Related to Foodborne Illness interventions and Risk Factors(items 1-22) PROTECTION .>FROM CONTAMINATION FOOD PROTECTION MANAGEMENT g Cress-contam;nation j I 590.003(A) Assignment utResponsdA14y' ( 3_i0211(Adi) F. VAnimalFoods SSaparatcdfront 590.003113) Demonstration of Knowledge* ( Cooked and RTE Foods* 2-103.11 Person in charge-duties Contaminauun from Raw!ngredlems 3-302.i i(A)n`) Ra,, Armal FcaK13 Sc,;arated :rum Each EMPLOYEE HEALTH Other" ' 2 590.003(0) Responsibility of the per.on in charge to Contami:,atrnn from the Environment require reporttni by fo(KI employees and 1-302.11 kA) turd Prntcction" applicants 3-302.15 Washing Fruits and V,,eetables 590.003(F) Responsibility OfAFinalEmployeeOrAir 3 ?Cd.i I FonC:ConiaetwithP.G:nometa.md Applicant To Report To The Person In Charge- ( Coniamrnatio,1 frcm thr:Consume. 590.003(6) Reporting by Person in Charge* 3-306.1 4(A)(�Ir) Returned FnuO.gid Resa'nee of Fond 3 590.003(D) Exclusions and Restrictions" I Disposr6on of Adtaterared cr Contaminated 590.003(F) Remm-al of Fxclustnn•,and Restrictions rood 1 3-701.11 Discarding or Recmnditiomng Unsafe FOOD FROM APPROVED SOURCE ""& i 4 Food and Water From Regulated Sources 9 Food Contact Surfaces 540.004(A-B) Compliance with Faxi law" 4-501.111 Manual W.s..wash,ng -Hot Water 'ianiGzation Temperatures' 3-201.12 Feral in a Hermetically Sealed Cur:tamer'l ( .;_501.112 Mechanical Wnewashinl Hot Water -,-201.13 Fluid Milk and Milk Products* t Salt In R_diik,Tcnipemlure $ 3-202.13 Shell Eggs* Chentiad Sanrti.�ahon-temp.,pH, 3-202 14 Eggcon.'entr:olon and hardness. '`s and Milk Pioduch,Pasteurized' 3-202.16 Ice Made From Potable Drinking Water" I d-601.1 I(A) Equipment Food Contact Surface:and 5=i 1)L I 1 Drinking Water from an:m Approved Sy0orn' Uiv-nils Clean" 590.000(A) Bottled Drinking Water* r 7 . 1";0_.;I Ckanmg Frequency of Egmpm:nt Food- 590.006(B) Water Meet:Standards in 310 CN[R 210' i Cun[act Surfaces and t7tensils t' Shellfish and Fish From an Approvod Source I 702 11 Frequency of Sanitizauon ul'Utensils and 3-201.14 Fish and Recreationally Caught Molluscan Food Gmtaci Surfaces of Equipment" Shell{Ysh* 1; Vcthndn of Sanitization-[-lot Water and 3-201 15 Molluscan Shellfish front NSSP Listed I r•hemictl:` Sources' I 10 I Proper,A.;eGuate Handwashing u'ama and Wild t 9ushrooms Approves by i A - Regulatory Authority 2-301.11 Cleat Cv,t,.n:on- Hands and rams* 3 202.18 Shellstock Identification Present'" 2 ?01.:2 Cleanirc Procedure" 590.004(C) Wild Mushrooms" 2-3(11.14 When to Wash" 11 Good Hygienic Practices 3-201.17 Game Animals* Eating. Dtmkm�or Using,Tcbao:o" I c ? Receiving/Condition � 1 2 d01.1'1 3-202 11 PH Fs Received at Proper Temperatures" 2-=,01.12 Disch:ages From the Fvcs Nos,and I Mouth 3-202 15 Package httegrity* 3-101.11 Food Safe and Unadulterated ,� 301.12 Preventiro Cu:tantirauoa When Ta<tinl;4 i 6 TagsiRecords:Shellstock i 12 Prevention of Contamination from Hands 3-202.15 Shellstock Identification* 5O0.004tE) Pre.enting Contamination hom Eittplo}ceS* 3-203.12 Shellstock Identification Maintained" Tags/Records:Fish Products 1 i 1:1 Handwash Facilities Coovententiy Located and Accessrole 3-402.1.1 ParasiLeDestruction* , I 3.102.12 Records.Creation and Retention* 5 '-(1...11 ::;:b ens ani Capacities* �eitirs 590.009(11 Labei'ng of Ingrodients' 5=204.11 i,veauion:and Piarernent" g � Conformance with Approved Procedures 1 5--,:M.I I He:essibi?it1.�Olimation and Nlaintenance /HACCP Plans Suppl.�ed with soap and Nand Drying Dev:i;es 3-502.11 Specialized Processing 'r MCthndSi 6-301.11 Hancdwz•:hiug Clcanaet,Av,dla3fnbt}' 3-102.1"_' I Reduced packasnn;t.criteria'" 1 I 6-301.12 Hand Drying Piovision 8-103.12 Conformance with Approved Piocednros" Dur dee critical vim in the Iewlal 1999 Fond Code u: 105 CMR 510,000. CITY OF SALEM BOARD OF HEALTH Establishment Name: 4e-jel eine Act 4,O Date: /-/a - O Page: 15) of 4. Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date No. Reference R-Red Item Verified PLEASE PRINT CLEARLY �� 5^ -,/�li/. Cinik niva�c .Fioilwni0 "/A/rt / en / 7 -7_P. q"` e�,f _ — aL, i✓J/ i�Ln��/„� /ni T/d / zlio C/.r/// Ai7.9 Aoin //YJ/CP�ivc` �s" /? — //�fft�i�rn ' i vm .Si ✓f -),7215 C/,lj/0 770717 J 1 - �I> /3 — //ccin/g x/mv nSYC� //lfJ� /�GZG�G7v�tJ/,>�ioo S lfJ/J.C�1 //�siYti/� /i[�T PP /3 /1/n /I/,,<Q/110n 6Ge 0,7 AQP -1rJr//eGC _AXe)1r,ndZ 47 / CIL& Y74/ 1 P C a7 — �n/Lr7af7irrr, rnnP .vov�c � �Se/F �.L,,_1 ' -Yner•ti171,7/1Aw am —� 4;1) I 61 7 — nS/Y�G/_ D&,'40,!7 27`��f�if it/Pa/J�c L71 P !_'I P//�/AP// B// !)i Lil�t�ii�,�i�. Fi£�PP - - I E Discussion With Person in Charge: Corrective Action Required: I ❑ No I ❑ Yes I have read this report, have had the opportunity to ask questions and agree to correct all ❑ Voluntary Compliance ❑ Employee Restriction/ Exclusion violations before the next inspection, to observe all conditions as described, and to ❑ Re-inspection Scheduled ❑ Emergency Suspension comply with all mandates of the Mass/Federal Food Code. I understand that noncompliance may result in daily fines of twenty-five dollars or suspension/revocation of ❑ Embargo ❑ Emergency Closure your food permit. I� / / // ❑ Voluntary Disposal ❑ Other: v' r U s ' 3-501 I,1(C) PHFs Reeeivcd at Temperatures Violations Related to Foodborne Illness Interventions and Risk A,col ding to I.wT Cooled Io Factors(items 1-22) (Cont) 41'F/45"F Within 4 Hours ` PROTECTION FROM CHEMICALS a 3-501.15 Cooling Methods for PHF.s 19 PHF Hot and Cold Holding 3-202_.12 AJdttives' 13 Food Color Additives 3-501,16;B) Gdd PHi?;Rlaintained at or brlow� n- � s90.00,417) 41'''t+^"F* � 3-302.14 Protection from Unapprot-eJ:1dJune>`# 3-5(11 ANA) ( Hot PfIFt,h;mnt:uned at of above 15 Poisonous or Toxic Substances 7-101.17 Identtfyfne Information-Original ! 140'1,. Container,'" 3-501.16(A) Roosts Held at of above 130 F ' 20 I Time as a Public Health Control 7-102.11 Common Narne-Wurkin.Containers' ( , 7-201.11 Separation-Storage" ( X 3-501.+.9 Camrusa slihe m. C'ontrrl' 7-20111 RCiCtl�tien—Presence and fiar' 590.OU4lF-Ir j Vanxn::aRcquu:rment 7-202.12 Conditions of Use" 1 7-1.03.11 Toxic Container,-Prohibitions* REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-204.11 Sanidzets.Criteria-ChemicalsT POPULATIONS(HSP) 7-204 12 Chemicals for Washing Produce.Criteria` ( 21 3-801.11(.A) 1 Tnpasteurizod Pre-packaged Juices and 04.14 Drvirm Agents,Criteria"' Beveiaee, with Warning,Labels" X I I B) Use of I'asruu'izzd 7-305 11 Iuc:Jenud Food Contact,Lubiieants^ 3-�Ol.l Ego: 7-206.11 Restricted Use Pesticides,Criteria` 13-301.I I(i)i Raw or d Sprains, Cooked ServeAnund, Fixxl and Raw Seed Sprouts Not Served. 7-1116.12 Rodent Batt Stations.: 3-80L 1 I(C) Unopened Food Package Not Re-sei%cd. 7-206.13 I Tracking,Powders,Pest Control and Monitoring'" CONSUMER ADVISORY TIMErrEMPERATURE CONTROLS 22 .3-603.1 I Consumer Adviwry Posted for Consumption of Anunal Foods that are Raw. Undercooked or 16 Proper Cooking Temperatures for I Not Otherwise Processed to hlinunate PHFS =rer:�:c r;:awr 3-401.11A(1)(2) Eggs- 155'F 15 Sec Path,tecns.i- Lets- fmmedclte Service Ids°F I Ssec 3-302.13 pasteurized Egg,Suhstitute for Raw Shell 3-401 1 I(A)(2) Comminuted Fish,Meats R Game Eggs* Animals - 155'F 15 sec. " 3-401.11(B)(1)(2) Pot kand Beef Roast- 130`F121min" ( SPECIAL REQUIREMENTS 3-40 L l I(A)(2) P,atitea, bpceteJ Meat:,- 155'F 15 590.0U9(A)-( )) Violationsol'Section 590.00)(A)-(U) in we, * catering,mobile food, temporary and 3-401.11(A)(3) Poultry,Wild Game. Staffed PHFs, residential ItUdien operations should be Jtutnng Crnhaining Fish,Meat, :S,t..:; wader the Pouhry 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 R(x)d retail 3-401.12 Raw Animal Foods Cooked in a I practices should be debited under#29- Microwave 165°F z Special Requirements. 3-401.11(A)(1)(b) .All Other PHFs-- 145'F 15 sec. 17 Reheating for Hot Holding VIOLATIONS R-LATED TO GOOD RETAIL PRACTICES 3-103.1 t(A)&(D) V!IRs 165'F 15 sec. s_ I (Items 23-30) 3_103.11(B) Microwave- 165'F 2 Minute Standing Critical and non-rrilicut riolatiom, which dr,not estate to the Time* foodborne illness inwr+,ention.s and rick aclor'n listed above, can be 3403.I t(C) Commercially Processed RTE Fond- I limnd in the following set tions of the Fond Code and 105 C.1-lR 140'F'" I 540.000. 3-40311(E) Remaining Unsliced Portions ofBeef ( Item Good Retail Practices FC 590.000 23, Management and Personnel FC--2 .003 Boxers" i Food P d F Food ooand FC -3 .004 Proper Cooling of PHFs � � 24. F � - -_-_-- 18 ( 25 _ E7tnpment and utensils ( FC:-4___ _.005 3-5011 I4(A) Cooling Cooked PHFs from 140'F to1-27, -6, : Water.Pha reinq and Waste IFC-5 .006 70'F Within 2 Hours and From 70`F 1 Physical Facility FC-6 007 in 41 E/45'F Within 4 Hours. * 1 28 ! Poisonous or Toxic Materials FC-7 .008 � 3-501.14(B) Cooling PHFs Marie From Ambient 25Special Requirements 009 'rengiertlore Ingredients to-IFF/45'T Other I Within 4 Hours I ''"°° "'"=;L I°` " denote,critical nein in the fedcrul 1999 Food Code or 105 CMR>90.000. CITY OF SALEM BOARD OF HEALTH Establishment Name: a 7 wake Date: Y—/P- t7 a1 Page: A of 3 Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date No. Reference R—Red Item Verified PLEASE PRINT CLEARLY 41-1 de Boor/ Ap Lo rim P� R - /,01,v.A4 /� ? S 7/iircY AO �Inin7aii�r �i v c�ii�i7iivy I So Lo�7�Yy( u l I ; / ,� I t � iii�a�, 9lcQs. La.RP Z XeX�15'" I ' �r�rP 'sni�izek -CUl 1"19 r? \2 Q I I I I I I I I NA .uwasg Ex 111� A - / owe /0-e'/Z rX 04 77Mes 1�f I I I ��tpz G rn one lzleel< Discussion With Person in Charge: Corrective Action Required: ❑ No ❑ Yes ❑ Voluntary Compliance ❑ Employee Restriction/ I have read this report, have had the opportunity to ask questions and agree to correct all Exclusion „f violations before the next inspection, to observe all conditions as described, and to ❑ Re-inspection Scheduled ❑ Emergency Suspension comply with all mandates of the Mass/Federal Food Code. I understand that noncompliance may result in daily fines of twenty-five/dollars or suspension/revocation of ❑ Embargo ❑ Emergency Closure your food permit. J �—w/ , LiVoluntary Disposal LI Other: s - v 13-501.HlCl PH Fs Rcceited it Temperatures ' Violations Related to Foodborne Illness Interventions and Risk ,4ccordin to law Cooled U Factors(items 1-22) (Cont.) 41"F/45-12'Within 4 Homs. 3-501.15 6wiiine Meibods for PflFs PROTECTION FROM CHEMICALS lY PHF Hot and Cold Holding 14 Food or Color Additives 3-501.16(b) Cold PH Fs Mai named at or below 3-202.12 Additives 5(10.004(F) 41°145-F* 3-302 14 Protection from Unapproved Additive.` ; 5 15 Poisonous or Toxic Substances I - (il.t6(:1) Hot PHEs R?:unt::incd at of above 7-101.11 ldentrfyuve Information--Original ( 140`5 '0 _501.16(1) Ria cr c Field at at ahme 130''5 Containers° 7-102.11 Cornmon Name-Woaking Containers, ( 20 Time as a Public Health Control 7-201.11 Separation-SLna e 3-501 19 'rime:is a Public Health Contn)P' 7-202.11 Restriction-Presence and Use'" 5017.00401) Variance Regmrcnicia 7-202.12 Conditions of Us' 7-203.11 `toxic Containers-Prohibitions* REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-2114.11 Sanitizzrs.Criteria-C'heimcals* POPULATIONS(NSP) 7-204 12 Chemicals for Washlnp Produce,Criteria^ � ( 21 i-807.11(A) Unpasteurized Pte-packaged Juices and l 7-204.14 Dn'inr Agents, Crrteda` Beyern};rc with Warning l.�tbels* 7-205.11 Incidental Food Contact,Lubricants^' 3-601.11(13) lNe of Pasteurized Eggs" t 3-801 1 IID) Raw or Partially Cooked Animal Food and 7-:.06.1 I Restricted Use Pesticides,Criteria I Raw Seed Sprouts N,, 7-206.12 Rodent Bait Stations* t t eNorServed. ?-801.1 l(C) I Unopened Food Package Nor Re-served, 7-206.13 Tracking Powder,,Pest Control and Monitoring' CONSUMER ADVISORY TIME/TEMPERATURE CONTROLS 22 3-603.11 Consurner:4dviaury Posted for Consumption of .1nim;d Foods`Chat are Raw, Undercoul.ed or ih ( Proper Cooking Temperatures for Not Othemise Processed to Eliminate PHFS =e '1 1" 3-401.7 I A(1)(2) Eggs- 155`F 15 Sec Pathogens.' Legs-Immediate Service 145`1;15sec 3-302.13 Pasteurized Egg,Substitute for Raw She]] 3-401.1 I(A)(2) I Comminuted Fish. Meats&Game F.Rgs,k Annuals- 155'F 15 sec. " SPECIAL REQUIREMENTS 3-401.11(B)(1)(2) Pork and Beef Meats 130`5 121 5 590.0094A) (D) Violations of Section 590.00y A)-(D) in 3-A011 l(A)t2) Ratites, Injected Meati- 155°F IS i ( sec. * catering, mobile food, temporary and 3-401.11(A)(3) Poultry, Wild Game.Stuffed PHF,, residential kitchen operations should be Stutlmg containing Fish,l.leat, cader the appropriao_ Poultry or Ratites-165'17 15 sec. * I above if Iclated to foodtxnnc illness 3-401A 1(CH3) Whole-muscle,Intact Beef Steaks interventions anti risk factor~. Other 135"F* 5140.009 violations relating to good retail 3-401.12 Raw Animal Fix ds Cooked in a practices should be debited under#29- Microwave 165"6'* Special Requirements. 3-401.11(A)(1)(b) All Other PHFs-- 145"F 15 sec. * 17 Reheating for Hot Holding VIOLATIONS R:LATER TO GOOD RETAIL PRACTICES 3-303 11(A)&(D) PHF, 165"F 15 sec. * (Items 23-30) 3-303.11(B) Microwave- 165" F2 Monte Standing ( Critical and son-critical ciotalions, which do not relate to the Tmie" i fi,odhorne iYuCSi uiml-rentionv and r66 r5icta's listed above, cull be 3403 1 I(C) Commercially Processed RTE Fail- found in the faRun•ing se(tinna(J die Fond Code and 10.5 CMR 14WF" 590.000. 3-403.1 1(E) Remaining Unsliccd Portions of Beef I Item ' Good Retail Practices FC 1 590.000 a ( 23 Management and Personnel FC-2 003 Roasts* _ I__ 18 Proper Cooling of PHFS ( 24 Food an(]Food Protection, FC- 3101,0154 �25 Equipment and Utensils EC-4 005 3-501.14(A) Cooling Cooked PHFS From 140"F to ---- • 26. I Water,Plumbing and Waste FC-5 006 I 7WF Within 2 Hours and From 70"F 27 Physical Facility FC-6 007 in 41`5145'F Within 4 Hours. '" 23 I Poisonous or Toxic Materials FG-7 .008 I 3-501.14(B) Cooling PHFS Mode From Ambient 29 Special Requirements .009 Temperature ingwrliemsto4l'F145`F -30 '', Other _ 1; Within 4 Hours" ''"°°°"'""'ado, `Denotes critical nein in the federal 1999 F(x)d Code of 105 CNIR 590.000. ( IMPORTANT MESSAGE ) FOR opr A`NJJ DATE (� ��/�/ �/ TIME -,LQ M l 7l /1�MQ./n OF ��vv�nnGh Ya9 � PHONE AREA CODE NUMBER EXTENSION ❑ FAX ❑ MOBII F AREA CODE NUMBER TIME TO CALL TELEPHONED PLEASE CALL CAME TO SEE YOU WILL CALL AGAIN W AN T S TO SEE YOU RETURNED YOUR CALL .... j-.'L-L_FAX TO YOU'. MESSAGE/ CZE Z SIGNED r FORM r IMPSMADE IN ll1 .A NOTES L�- - J ON(ur"Mm'00 CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH 120 WASHINGTON STREET" 4TH FLOOR SALEM, MA 01970 TEL 976-7a1-1800 F r.r 978-745-0343 Sl"ANLEY USOVICZ. JR J04NNE 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 : Joanne L. Hatch Name of Establishment : Gourmet Fare Address of Establishment : 73-75 Wharf Street Type of Establishment : RETAIL FOOD Application Date : 01/02/2003 Restrictions : Permit for Food Establishment 207-03 Frozen Desserts/Ice Cream Permit for the Sale of Tobacco Products These Permits Expire December 31, 2003 This permit is not transferable and must be reissued upon change of ownership or location. The permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code, before any renovations, improvements, or equipment changes are made, all plans for such must be submitted to and approved by the Salem Board of Health. �� HEALTH AGENT CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH} .•3 120 WASHINGTON STREET. 4TH FLOOR 3 2 r r SALEM, MA 01970 Ew V !_.a_ L TEL. 5378-741-1800 FAX 978-745-0343 vl STANLEY USOVIC'L, JR, JOANNE SCOTT, MPH. RS. CHO BOARD CSF HEALTH MAYOR HEALTH AGFNT 2003 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT NAME OF ESTABLISHMENT {-sot tr-r"-f �Carp TEL# a3_t- `j�$-�i p ADDRESS OF ESTABLISHMENT W l�t a rr'2 S- . Sad-e-m MAILING ADDRESS (if different) F j OWNER'S NAME JnoLy% a L. 14-o tC e� TEL# RES ADDS oa peen, 1 )� Ci i r —_yt T. STATE_ Z!P O,14.21 .L__ CERTIFIED FOOD MANAGER'S NAMES)„j onnne $2L __ CERTIFICATE#(s) & 13 =I (required in an establishment where potentially hazardous food is prepared.) EMERGENCY RESPONSE PERSON_jortnrtp --HOME TEL# G?S HOURS OF OPERATION: Mon 11"6 Tue L-.! Wed.11;6 Thu.11-6 Fri.11-G Sat.it-6 Sun. L; -$* TYPE OF ESTABLISHMENT FEE check only RETAIL STORE YESNO a ? less th—an 1000sq.ft. _$ 50 1000-10,000sq.ft. =$100 more than 10,000sq.ft. =$250 RESTAURANT YES WO / 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 $50 ALL NON-PROFIT(such as church kitchens) YES NO $25 Please pay total with one check payable to the City of Salem This Permit is not transferable and must be reissued upon change of ownership. The Permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code, before any renovations, improvements, or equipment changes are made,all plans for such must be submitted to and approved by the Salem Board of Health. Pursuant to MGL Chapter 62C, Section 49A, I certify under the pains and penalties of perjury that I, to my best knowledge and belief, have filed all state tax returns and paid all state taxes required under the law. Sig ature Date Social Secur or F deral Iden ifi tion Number w0/tomo --- R Ised 11/25/02 FOODAP2.adm Check#8 Date 176 : � '� CITYaOF S:4LEM,, ASSACHUSE7TS ti ti a ad +�.' I.:t3��';7 �5N;N�"+'$`f.: +Ks.' L'-i65• .> .�' a' "^ ',�" �•� �ke � ,.,. � x.r�' 80-�AR'DOA�Ii s $r s.f a •�- - z- . -�� .t ,*:Y: '§'+se. _*' y" yr '.X' t ',8a•5S.•�YdE?` '14'0917R r '�y 'N�ST^JmrET?£ T�'�FL,OOR '<` t°• ��•psn'�`y�. .', ° X ` � e EM'.i".MrAx�0197. 0 .b'd• '._ r,g. 1 '3.. v�.. . ¢i :TEL.;.978=745w FAX 9}788745-0343 -. ,'f.. .yC".-»r ,:-�Sr'.�'. "•.,�..; b'•} ` ``'? .'�•-.''y.� „ '. 9. '.sF+ ,';{• "f . STANLEY U',SOUI.CZ;`JR., ;r: .q'�'•.. . -.c-ry -e+ •;°r--�. F r1r .s Sr' ',• .`+,``. '� C JOANNE>,SCOTT;°MPH•, R S•aGFlO r'b' •, �i.t`• :a 'ak'` '¢'t'• MAYO 'S 5Y ..m'+'�; _a'' ,.,"• �"^-.:�..yq '^ {': ° 9> 'e" wN �< '9'., q. Ly{•: $. +� .5t ,., • Aa..Y i..n; ��" 'M� y &-. % �f'#Yd{'.*4P.s'�`Ay�''�i" `�4i•"_# Y?.Y_,.x`,n,� ��,,��F,.((J•fTa�`L'Sy".;a,r�.x£•id�'ri2j'v`cY�,S'�q s AFf��.*��4a dEmil. y437`'*'hsXy1 a' epi,..v' '�'�x^V$a9z-''..x t,N.,��•y eY �'d�"Vy(�Y�r+•S,xEi �'�+.��'e.�d�3x�•R�#C.1'+'�'`�'#tq'7 _�' t�` _�YCi�.{�#w�y &A' '.�`.-. WTI t * `CONII�IOf1_VPEALTHOF�MASSP;CHi75ETTS = l' � PERMZT O�,+ OPERATE=A OOD CD ESTABLISFIiSE_ NT �` " waw"+" y' °k '7y&. "7F1 r! .aC:air-k ' fxkY4't$ yper ti=t �.� ti eco ance. wltm,, guiMatao�isRpromu}lgattyae.��d :.' er authorityyrof�Chapter `._ 3 ..S {- •„ "° w y F 'kms '' 'l F .a{TF, yse- -1H'i ,A5k ..�^.F..P• :S 'k' At={<.' Via, . 9.4 5eoz ron• A�anxd ,Chapt-ey%j ,z Se goon. •5 of e�Gen�e aws-, operate s .r'; o d st=abs entv `n the �t ofatlem is� hereb ria t Nto ,$ � Owner ,Name' y�J'oarine ',"•L`'�H'atc�i t. " °;: , � s� .. ,:�„ 'y�•b. i+..�'"atrY�,�Se+" i TID'Cla''Rfi+StKF^i�S� '^'�#�:3ki*-"v'k' :�'3�� .d;3x: '4.�•Fi�;. ; - i a.' `:-Y�'� 'y'• �:s"- c ame `• � 'stab];isliment-.. Go rmet F�a�re �,�� _�• , . ,� ._ -x , d'"dressEstab;1 �`shment a, 7,�3� Wharf �'�StreetMH » e s. �ihmexit�M�R`S�TA`I• FOD 41-`11 � •+ �• ,,�z.�..'�i. . ,~, � 4}t ' y •�t -a 1; is ent� �,� ri��y ` �` �1 9=�:0 *� ` ,�',�^` ,� .roz_enD s er-•�s�+�ae .Cream �"�;� �,gg ,�, r< '�.�� -k ,:: � r ,�,� �` aa �� ' e�n�:' a alae •o .bb'ao P od ,Cts�� - �`e�: � `r ';� > r : gg `: � t ��" C Y^e - h .r , 'f� �.' �• .� 2*•f WCW P rms s re December 31_ ` 20`021 s,.. ` 'a :Pz, i. a.t,iyd,. "R--4- .r.. '� •trans'ferabl6 d ust belett ueci up ci}ange of� a 'k- owner hi Y oats .-,.: . he 'WAermi:t at be osted n�a rominent location' �..�• F y� p, �. p P Il- ,.t- staDU `shment.. '"'i, .. ` ; r TMr • a '� .. p . . '�.• r d ��_ .� .• accordance_ i tItsate�3aai a Code; beforea anyr xenovat-ons., equipment chan'gesrare�?made, alb aplans fo uch�mus: e '= submit.te`d o d ,ppr-oved 'g- t1ieSal'em Board of sHeq�a.;lth:a ��`�• ` Y �e •�' .� r *ka'F,; .� �,d 3:�,'.Z f's> Rur:'k -:S _ _ T6 M �`. AM :x.. wj� X , a r. d;, -, r HEAL, , AGENT '_ -^ r'�,: „�:� � z.k:�;':�r.^'�' •,�'�` n�..•it M"k' ilr . ' , -Si, '!•`C,�46��._`t?sr a,'�� .!d- f -*}•.. dn,�Y+ •,��+'�a� a :b �t{', -'j�� t�, 71, y y�N �A'�yM,�? ix q �,. 'm�. '�`'"; A - X J `?t' ``r' - �. y4 ,� •�y`,r �'8`a�yl� "� '£�'�,� i•} +P'rSNt '!y, 'y'' �i' hl Ma ��};k" - (ro��l� a�'u+K�� '4 Agl'��i 5 i��9.. �•L r A7. r R ��A�L' '�'GN q�� u.t vim,Y�i� u •#•, y. 4. .,tea.�: �T'�4*ss�.= �'�" •1 v�'1 .n3�te7 �'d '�`« Y �i#•' a� } .y� fi '�- ,e,93 '�" ,t f' 44 "e w."Yt'.� �:Y.��a�� w.ilS'�'. ?1.'` is. ,^;'Fi.'TM..,�i��k n• - .�� ;. �•: CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH li 120 WASHINGTON STREET, 4TH FLOOR SALEM, MA 01970 TEL. 978-741-1800 FAX 978-745-0343 STANLEY USOVICZ, JR. JOANNE SCOTT, MPH, RS, CHO VLV MAYOR HEALTH AGENT CITY OF SALEM HEF.L`t!J DEPT. 2002 APPLICATION FOR PERMITTO OPERATE A FOOD ESTABLISHMENT NAME OF ESTABLISHMENT our-evUJ- I"ar R- A p TEL# Ch R ADDRESS OF ESTABLISHMENT -1 `7 u'5 ccr4 MAILING ADDRESS (if different) OWNER'S NAME UCtvtirl.� l-�r�.� r � TEL# TIV - W?- �G lI ADDRE§S 4-L A�vvv��arf,.n Lir. CITY chy TATE nka . ZIP U 1.9'" _ CERTIFIED FOOD MANAGER'S NAME(S) ;T,r, z ' E (, CERTIFICATE#(s) 4,'1'623 7 (required in an establishment where potentially hazardous food its prepared.) c1 EMERGENCY RESPONSE PERSON�Jov1 no. L. i4rAct\ HOME TEL# il$ —W l —'Do 1J DAYS/HOURS OF OPERATION: Mon.li-t, Tue.i+;le Wed. a^r,Thum-G Fri.t 1_L Sat.t i�Sun.-LL-S' TYPE OF ESTABLISHMENT FEE check only RETAIL STORELYE NO (� $40 RESTAURANT ES / �� $40 BED& BREAKFAST YES to $40 ADDITIONAL PERMITS MAKE ICE CREAM, YOGURT SOFT SERVE YES $5 TOBACCO VENDOR YES O 10 NO CHARGE FOR NON-PROFIT(such as church kitchens) PLEASE INCLUDE COPY OF TAX EXEMPTFORM 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 pians for such must be submitted to and approved by the Salem Board of Health. Pursuant to MGL Chapter 62C, Section 49A, I certify under the pains and penalties of perjury that I, to my best knowledge and belief, have filed all state tax returns and paid all state taxes required under the law. 4atul:e Date Social Security or Federal Identification number Revised 11/1/01 foodsp2.adm Check#&Date • 6�{,ONDfT v "I� n n O CITY OF SALEM BOARD OF HEALTH Salem, Massachusetts 01970-3928 JOANNE SCOTT, MPH, RS,CHO NINE NORTH STREET HEALTH AGENT Tel:(978)741-1800 Fax:(978)740-9705 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 : Joanne L. Hatch Name of Establishment : Gourmet Fare Address of Establishment : 73 Wharf Street Type of Establishment : RETAIL FOOD Application Date: 01/04/2001 Restrictions: Permit for Food Establishment 216-01 Frozen Desserts/Ice Cream Permit for the Sale of Tobacco Products These Permits Expire December 31, 2001 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 JAN 0 4 2001 CITY OF SALEM HEALTH DEPT. CITY OF SALEM BOARD OF HEALTH Salem, Massachusetts 01970-3928 JOANNE SCOTT, MPH, RS,CHO NINE NORTH STREET HEALTH AGENT Tel:(978)741-1800 Fax:(978)740-9705 2001 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT Icl NAME OF ESTABLISHMENT GO urrnef 1-0,re— TEL# ADDRESS OF ESTABLISHMENT `13 UAaro2 Sk. MAILING ADDRESS (if different) i I OWNER'S NAME Jon nvie _ L- . H a rli TEL# SY.Q1 — SG 19 ADDRESS 42- " oonrenrr. Ir. CITY—&, .[ 1 SATE A ei - ZIP Wci) .l CERTIFIED FOOD MANAGER'S NAME(S)�nctiN�r Nt�irct� CERTIFICATE#(s) C,�ri83 7 (required in an establishment where potentially hazardous food is prepared.) f EMERGENCY RESPONSE PERSON .J'c3c vw1Q 144 HOME TEL# W) —Stoll)- TYPE ) —Stol$TYPE OF ESTABLISHMENT !vC� of l� 6� FEE check only RETAIL STORE NO $40 RESTAURANT YES #seats_ #nonsmoking_ $40 BED & BREAKFAST YES O $40 ADDITIONAL PERMITS MAKE ICE CREAM, YOGURT SOFT SERVE YES $5 TOBACCO VENDOR YESNO 10 NO CHARGE FOR NON-PROFIT(suc as church kitchens) PLEASE INCLUDE COPY OF TAX EXEMPTFORM Please pay total with one check payable to the City of Salem This Permit is not transferable and must be reissued upon change of ownership. The Permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code, before any renovations, improvements, or equipment changes are made, all plans for such must be submitted to and approved by the Salem Board of Health. Pursuant to MGL Chapter 62C, Section 49A, I certify under the pains and penalties of perjury that I, to my best knowledge and belief, have filed all state tax returns and paid all state taxes required under the law. c�Gcivvv�t� lam. /dGt�C' 1�3J OLI-t ifG cYl44- ignature Duate t Social Security or Federal Identification Number --------------------------------------- ----A------------- --- Revised 11/21/00 foodap2 adm Check#&Date COURT DOCKET NO CITATION NO. CITY OF SALEM VIOLATION NOTICE A 2 7 4 3 NAME(LAST,FIRST.INITIAL) to 7G , \70A,NNi:r L' REETADDRESS ! y CITYY'ITOWN STATE :IR LICENSE NO. LIC.EXP.DATy� T OWNER'S'NAME(LAST,FIRST,INITIAL) !/!/ STREET ADDRESS CITYRONN ATE ZIP 7,3-7,S flaep _f, Sat em . 7^ila 0147� REGISTRATION NO. STATE EXP DATE MAKEFYPE I YEAR(COLOR DATE OF VIOLATION TIMEDATE CITATION WRITTEN PERSOrvaL N OFY ❑PM �� p�Q/ ❑NOS LOCATION OF VIOLATION ENFORCING-ZKD PT ?- 7S LC//ICP FiG S/ SNIP.Af /�ld-L/�H OFFEN^yEVeV as / - 1 •CHAP. SECT FINES A c/ aoo/ frond f'�� B SPdl¢cSan/7Ldey CO 6;c c L4--?O-~ OFFICERA ID NO. TOTAL Q OFFICER CERTIFIES COPY GIVEN TO VIOLATOR ❑ IN D X / �`A�jLQ� BY MAIL DO NOT MAIL CASH-PAY ONLY BY POSTAL NOTE,MONEY ORDER OR BY CHECK MADE PAYABLE TO CITY CLERK CITY HALL 93 WASHINGTON STREET SALEM,MA 01970 TEL.(508)745-9595 X 251 1 HEREBY ELECT TO EXERCISE THE FIRST OPTION AS STATED ON REVERSE, CONFESS TO THE OFFENSE CHARGED,AND ENCLOSE PAYMENT IN THE AMOUNT OF $ CASE# SIGNATURE SEE OTHER SIDE FOR FURTHER INFORMATION ENCLOSE PAYMENT IN THIS ENVELOPE,PEEL AND SEAL COURT DOCKET NO CITATION NO 00 CITY OF SALEM A 274 VIOLATION NOTICE GL t JJ NAME(LAST,FIRST,INITIAL) {/iY 71-4 6 N. 'Z 4-- STREETADDRESS CITY /TOWNTATE ZIP LICENSE,`NO.� LIG EXDA E OW`�NN/�ER�S'NALME(LAST,FIRST,INITIAL) CITY/T4WN ATE ZIP 73.-Ir !�//IecGSf-, S tm, ?"a 0199~1/ REGISTRATION NO STATE EXP.DATE MAKERYPE I YEAR(COLOR DATE OF VIOLATION TIME /y/{, DATECITATION�/JRITTEN PERSONAL Ofj�aCWICJ T PY./ INJURY❑YES CIPM []NO LOGhTAgiAOAFtV1P4eLATYJON EWCCIRJGBEPT.' - OFFLNaW,,eG/g t �eV 04jfQ1 A/ •CHAP ds FINES B'S0A U�•7�'Yr+P y CZ'C7 /GLS'f%f7'T.¢.L,Yo.ars C OFFICER `K 74.3 TDUELI � Vl////OOFFFFICER CERTIFIES �COPY GIVEN TO VIOLATOR // X d'2)lzze "'." ❑ RY MAIL AID DO NOT MAIL CASH-PAY ONLY BY POSTAL NOTE,MONEY ORDER OR BY CHECK MADE PAYABLE TO: CITY CLERK CITY HALL 93 WASHINGTON STREET SALEM,MA 01970 TEL.(508)745-9595 X 251 1 HEREBY ELECT TO EXERCISE THE FIRST OPTION AS STATED ON REVERSE, CONFESS TO THE OFFENSE CHARGED,AND ENCLOSE PAYMENT IN THE AMOUNT OF $ CASE N SIGNATURE SEE OTHER SIDE FOR FURTHER INFORMATION ENCLOSE PAYMENT IN THIS ENVELOPE,PEEL AND SEAL ( WAPORT ANT MESSAGE ) FOR DATF`J TIME M OF PHONE AREA CODE NUMBER EXTENSION ❑ FAX ❑ MOEIII F AREA CODE NUMBER TIME TO CALL TELEPHONED PLEASE CALL CAME TO SEE YOU I WILL CALL AGAIN i WANTS TO SEE YOU ( RUSH RETURNED YOUR CALL WILL FAX TO YOU MESSAG gf� 61 0 a-;'k� / ` SIGNED y FORM 4009 Int�I. MAOE IN U S A i � - f 4 } ( IMPORTANT MESSAGE ) FOR DATE' 6 ` 7"(J� TIME P. M OF PHONE' 978-7y q-" 03/,6- AREA CODE NUMBER EMENSION ❑ FAX ❑ MOBII F AREA CODE I NUMBER TIME TO CALL TELEPHONED IPLEASE CALLCAME TO SEE YOU WILL CALL AGAIN WANTS TO SEE YOU I II RUSH RETURNED YOUR,/C�ALLI II WILL FAX TO YOUR QUI MESSAGE 1C &-L' ,�-�ly(. F Gc w.a A" SIGNED a i FORM 4009 MADE IN U S A •e.�+y..N-+�-".L`'"q.."M"iY+Wn-:.+w-�rritr.�d.M1'\+ YrIJ"�'�„"'r...�+.n..dk�,. ... .::.'i17ktTim+'�fl.,mrm.+.:..mY..+t�'"�..cs..raaw'i..,,^r-...,v-.. TH1E_CQ1MONWEALTHOF MASSACHUSETTS CITY OF SALEM Address: 9 North Street Board of Health Salem, MA 01970-3928 FOOD ESTABLISHMENT INSPECTION REPORT Tel: (978) 741-1800 Fax: (9781740-9705 Name Dto Tvoe of Ooeration(s) Woe of Insoection . 6OU,e/177f Td&e_ F��*20i VFood Service EV Routine ' Address r'/ Risk$-Q1-0/ ❑ Retail VRe-inspection 7,3- 7S- Level ❑ Residential Kitchen Previous Inspection Telephone yys, 9/90 ❑ Mobile Date:7-//--01 OW 7 ❑ Temporary ❑ Pre-operation Owner ,// HACCP WN Ll Caterer Suspect Illness Ll)TipvA A//V e 1441( Bed&Breakfast Ll General Complaint Person in Charge(PIC) Time ❑ HACCP Inspector '/ fry �zr In: Ll Other y. 4, Out: Permit No. Each violation checked requires an explanation on the narrative page(s) and a citation of specific provision(s) violated. _ r 7 Non-compliance with: RED Violations (1-22) 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. , Local Law ❑ FOOD PROTECTION MANAGEMENT ❑ 12. Prevention of Contamination from Hands ❑ 1. PIC Assigned/Knowledgeable/Duties ❑ 13. Handwash Facilities EMPLOYEE HEALTH PROTECTION FROM CHEMICALS ❑ 2. Reporting of Diseases by Food Employee and PIC ❑ 14. Approved Food or Color Additives El 3. Personnel with Infections Restricted/Excluded ❑ 15. Toxic Chemicals FOOD FROM APPROVED SOURCE TIME/TEMPERATURE CONTROLS(Potentially Hazardous Foods) ❑ 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 ❑ 19. Hot and Cold Holding PROTECTION FROM CONTAMINATION ❑ 20. Time As a Public Health Control ❑ 8. Separation/Segregation/Protection REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) ❑ 9. Food Contact Surfaces Cleaning and Sanitizing ❑ 21. Food and Food Preparation for HSP E110. Proper Adequate Handwashing CONSUMER ADVISORY ❑ 11. Good Hygienic Practices ❑ 22. Posting of Consumer Advisories BLUE Violations(23-301 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(RED Items 1-22): of Health. Non-critical (N)violations must be corrected immediately or within 90 days as determined by the Board Official Order of Correction: Based on an inspection of Health. today,the items checked indicate violations of 105 CMR L C N 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)(59o.ow) 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'S901mpxfFam6i<Erc Inspector's Signature: /� �- //fid Print: ,may PIC's Signature: ./-� ] i 1 ./I_ �••t' Print: , 16Z �/! Page of Pages 1 400 Violations Related to Foodborne Illness Interventions and Risk Factors (Red Items 1-22) PROTECTION FROM CONTAMINATION FOOD PROTECTION AND MANAGEMENT 8Cross-contamination -1 590.003(A) Assignment of Responsibility* 3-302.11(A)(I) Raw Animal Foods Separated from 590.003(B) Demonstration of Knowledge* Cooked and RTE Foods* 2-103.11 Person in charge-duties Contamination from Raw Ingredients 3-302.11(A)(2) Raw Animal Foods Separated from Each EMPLO"EE HEALTH Other* 2 590.003(C) Responsibility of the person in charge to Contamination from the Environment require reporting by food employees and 3-302.11(A) Food Protection* applicants* 3-302.15 Washing Fruits and Vegetables 590.003(F) Responsibility Of A Food Employee Or An 3-304.11 Food Contact with Equipment and Applicant To Report To The Person In Utensils* Charge* Contamination from the Consumer 590.003(G) Reporting by Person in Charge* 3-306.14(A)(B) Returned Food and Reservice of Food* 11 3 590.003(D) Exclusions and Restrictions* Disposition of Adulterated or Contaminated 590.003(El Removal of Exclusions and Restrictions Food 3-701.11 Discarding or Reconditioning Unsafe FOOD F tOM APPROVED SOURCE Food* 1! 4 Food and Water From Regulated Sources 9 Food Contact Surfaces 590.004(A-B) Compliance with Food Law* 4-501.111 Manual Warewashing -Hot Water 3-201.12 Food in a Hermetically Sealed Container* Sanitization Temperatures* 3-201:13 Fluid Milk and Milk Products* 4-501.112 Mechanical Warewashing-Hot Water 3-202.13 Shell Eggs* Sanitization Temperatures* 3-202.14 Eggs and Milk Products,Pasteurized* 4-501.114 Chemical Sanitization-temp.,pH, 3-202.16 Ice Made From Potable Drinking Water* concentration and hardness* 5-101.11 Drinking Water from an Approved System* 4-601.11(A) Equipment Food Contact Surfaces and 590.006(A) Bottled Drinking Water* Utensils Clean* 590.006(B) Water Meets Standards in 310 CMR 22.0* 4-602.11 Cleaning Frequency of Equipment Food- Shellfish and Fish From an Approved Source Contact Surfaces and Utensils* 3-201.14 Fish and Recreationally Caught Molluscan 4-702.11 Frequency of Sanitization of Utensils and Shellfish* Food Contact Surfaces of Equipment* 3-201.15 Molluscan Shellfish From NSSP Listed 4-703.11 Methods of Sanitization-Hot Water and Sources* Chemical* Game and Wild Mushrooms Approved by 10 Proper,Adequate Handwashing Regulatory Authority 1 2-301.11 Clean Condition-Hands and Arms* 3-202.18 Shellstock Identification Present* 2-301.12 Cleaning Procedure* 590.004(C) Wild Mushrooms* 2-301.14 When to Wash* 3-201.17 Game Animals* 11 Good Hygienic Practices 5 Receiving/Condition 2-401.11 Eating,Drinking or Using Tobacco* 3-202.11 PHFs Received at Proper Temperatures* 2-401.12 Discharges from the Eyes,Nose and 3-202.15 Package Integritv* Mouth* 3-101.11 Food Safe and Unadulterated* 3-301.12 Preventing Contamination When Tasting* 6 Tags/Records:Shellstock 12 Prevention of Contamination from Hands 3-202.18 Shellstock Identification* 590.004(E) Preventing Contamination from - 3-203.12 Shellstock Identification Maintained* Employees* Taps/Records:Fish Products 13 Handwash Facilities 3-402.11 Parasite Destruction* Conveniently Located and Accessible 3-402.12 Records,Creation and Retention* 5-203.11 Numbers and Capacities* 590.004(7) Labeling of Ingredients* 5-204.11 Location and Placement* 7 Conformance with Approved Procedures 5-205.11 Accessibility,Operation and Maintenance /HACCP Plans Supplied with Soap and Hand Drying 3-502.11 Specialized Processing Methods* Devices 3-502.12 Reduced oxygen packaging,criteria* 6-301.11 Handwashing Cleanser,Availability 8-103.12 Conformance with Approved Procedures* 6-301.12 Hand Drying Provision *Denotes critical item in the federal 1999 Food Code or 105 CMR 590.000. 1 f f'r'r�r� ..l : w.a•..�"e+N^hJnwn7'1 . rlrl 1a .w ,.T ,f wiwwy.[�rw R•'.T°I.�%T, .,N.,rra'hl'.I'Ar�....f rvl,yr•M•.af...lnv,.•[.wmm..,-w aJ.. ly I THE COMMONWEALTH OF MASSACHUSETTS City of Salem w Establishment Name /OU�me fDate 040/ Address ](3�-75 G(/`j�/2F s� Page of `� Item No. In the space below describe all violations checked on front page. A(n)-e,itAk.eVC A% oI SMVICf RP inspection of this establishment was conducted in accordance with the State Sanitary Code for Food Establishments,Chapter X, 105 CMR 590.000.The followinq violations were observed, l ,l�a L� 3aG l��nr/ <irn/e -!�_ ,,titoF�rren /vi"-d div t.�/i�uil of ,nz XARr 74-Sclet-l'A , V11(?.P /Lr t f7e7AX,1V - /AS7" 77 Acv�le ��dsrrl hlghrtu 17AYQd,7-tjS Yla0Vs 4n. 0O2aL /0A 0Ue!4 n ///,C/i3G2. /i7PF/I)if71'�G � irn�rh�Gt= �� 01•� �LDAd7?�O.C�.SP,PUGA`LY,�(1.rI/`�17PN� SOLdf'i/rr, �L,S9"'S�R.IRS 0 /,001 A(,f71Z,7,6/e 4 74 .� crz a�4)74S IF 9/fPd StAe- ?n11Ar1d/kIP111./vZdA('/�4' A,6k' 40� 0/*ena L xA1P /_1,eS gilw .roe ,47n.ec/ NP � /curna�P 7�tof /uGG //Pl/iir P.�Luf�ep s� la�ll L t�3P e O,eC"j /7. � 7Pin��JBp�U (?/?P4l -1016e-l- .�Aa»-1 7Y1 CCS/n/9' �IOAI 0,7S�e_'d 7-Al t 1 9 Discussion with-Management - I have read this report, have had the opportunity to ask questions and agree to correct all violations before the next inspection,to observe all conditions as described,and to comply with-all.mandates of Chapter X. I understand that noncompliance may result in daily fines of twenty-five dollars. _ , i 2 - Glii j? Gj . �w..,1.+ti+..�.r,•..F„•-nr-v...+...ir'e,,,.+.a.,,�^^rv^tr"'uh+^-"Myvj` .+:iF'A�t,+TYvr^wwnwr-'• w,+�+.+...�..r.-+.x^'s..w.r'wm+..F. .....ayy.,..a,.,�s.... THE COMMONWEALTH'OF MASSACHUSETTS CITY OF SALEM Address: 9 North Street Board of Health r Salem, MA 01970-3928 FOOD ESTABLISHMENT INSPECTION REPORT Tel: (978) 741-1800 Fax: (978) 740-9705 Name _ Date Tvne of Oneration(sl TvPe of Insoection boa-CIn et Ta gee I-//'0?00, Q Food Service Y Routine Address Risk ❑ Retail ❑ Re-inspection -73-75 /A),bee" S-/-- Level ❑ Residential Kitchen Previous Inspection (Telephone ❑ Mobile Date: 7-/a'l- 9000 yL/S- 0/90 ❑ Temporary ❑ Pre-operation Owner �- HACCP Y/N [ICaterer El Suspect Illness \7e_%*a/,v8 NsYrh ❑ Bed&Breakfast ❑ General Complaint Person in Charge(PIC) /I i/ Time ❑ HACCP Inspector In: ElOther // Y' �Oi cC 1-1-7GC/_C Out: Permit No. Each violation checked requires an explanation on the narrative page(s) and a citation of specific provision(s) violated. Non-compliance with: RED Violations (1-221 Related to Foodborne Illness Interventions and Risk Factors Anti-Choking Tobacco i Violations marked may pose an imminent health hazard and require immediate corrective 590.009(E)❑ 590.009(F) action as determined by the Board of Health. Local Law ❑ . FOOD PROTECTION MANAGEMENT ❑ 12. Prevention of Contamination from Hands ❑? 1. PIC Assigned/Knowledgeable/Duties ❑ 13. Handwash Facilities EMPLOYEE HEALTH PROTECTION FROM CHEMICALS i ❑ 2. Reporting of Diseases by Food Employee and PIC ❑ 14. Approved Food or Color Additives ❑ 3. Personnel with Infections Restricted/Excluded ❑ 15. Toxic Chemicals FOOD FROM APPROVED SOURCE TIME/TEMPERATURE CONTROLS'(Potentially Hazardous Foods) ❑ 4. Food and Water from Approved Source ❑ 16. Cooking Temperatures ❑ 5. Receiving/Condition ❑ 17. Reheating ❑ 6. Tags/Records/Accuracy of Ingredient Statements ❑ 18. Cooling z, ❑ 7. Conformance with Approved Procedures/HACCP Plans ❑ 19. Hot and Cold Holding �PR TECTION FROM CONTAMINATION EJ 20. Time As a Public Health Control 8. Separation/Segregation/Protection REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) 9. Food Contact Surfaces Cleaning and Sanitizing ❑ 21. Food and Food Preparation for HSP 17110. Proper Adequate+Handwashing CONSUMER ADVISORY ❑ 11. Good Hygienic Practices ❑ 22. Posting of Consumer Advisories BLUE Violations(23-30) 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(RED Items 1-22): F] of Health. Non-critical (N)violations must be corrected immediately or within 90 days as determined by the Board Official Order of Correction: Based on an inspection ^f Health. today,the items checked indicate violations of 105 CMR C N 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 �L 27. Physical Facility (FC-6)(590.007) have a right to a hearing.Your request must be in writing 28. Poisonous or Toxic Materials (FC-7)(59o.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: 6 SWJ;pP;F-6-14 doc Inspector's Signature: �---;lJPrint: PIC's Signature: , /� •!A Print: -(^ L_ I � Page of Pages V Violations Related to Foodborne Illness Interventions and Risk Factors (Red Items 1-22) PROTECTION FROM CONTAMINATION FOOD PROTECTION AND MANAGEMENT 1i 8- Cross-contamination 1 590.003(A) Assignment of Responsibility* 3-302.11(A)(1) Raw Animal Foods Separated from 590.003(B) Demonstration of Knowledge* Cooked and RTE Foods* 2-103.11 Person in charge-duties Contamination from Raw Ingredients 3-302.11(A)(2) Raw Animal Foods Separated from Each EMPLOYEE HEALTH Other* 2 590.003(C) Responsibility of the person in charge to Contamination from the Environment require reporting by food employees and 3-302.11(A) Food Protection* applicants* 3-302.15 Washing Fruits and Vegetables 590.003(F) Responsibility Of A Food Employee Or An 3-304.11 Food Contact with Equipment and Applicant To Report To The Person In Utensils* Charge* Contamination from the Consumer 590.003(G) Reporting by Person in Charge* 3-306.14(A)(B) Returned Food and Reservice of Food* 1 3 590.003(D) Exclusions and Restrictions* Disposition of Adulterated or Contaminated 590.003(E) Removal of Exclusions and Restrictions Food 3-701.11 Discarding or Reconditioning Unsafe FOOD F i0M APPROVED SOURCE Food* 4 Food and Water From Regulated Sources 9 Food Contact Surfaces 590.004(A-B) Compliance with Food Law* 4-501.111 Manual Warewashing-Hot Water 3-201.12 Food in a Hermetically Sealed Container* Sanitization Temperatures* 3-201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Warewashing-Hot Water 3-202.13 Shell Eggs* Sanitization Temperatures* 3-202.14 Eggs and Milk Products,Pasteurized* 4-501.114 Chemical Sanitization-temp.,pH, 3-202.16 Ice Made From Potable Drinking Water* concentration and hardness* 5-101.11 Drinking Water from an Approved System* 4-601.11(A) Equipment Food Contact Surfaces and 590.006(A) Bottled Drinking Water* Utensils Clean* 590.006(B) Water Meets Standards in 310 CMR 22.0* 4-602.11 Cleaning Frequency of Equipment Food- Shellfish and Fish From an Approved Source Contact Surfaces and Utensils* 3-201.14 Fish and Recreationally Caught Molluscan 4-702.11 Frequency of Sanitization of Utensils*and Shellfish* Food Contact Surfaces of Equipment 3-201.15 Molluscan Shellfish From NSSP Listed 4-703.11 Methods of Sanitization-Hot Water and Sources* Chemical* Game and Wild Mushrooms Approved by ! 10 Proper,Adequate Handwashing ! Regulatory Authority 2-301.11 Clean Condition-Hands and Arms* 3-202.18 Shellstock Identification Present* 2-301.12 Cleaning Procedure* 590.004(C) Wild Mushrooms* 2-301.14 When to Wash* 3-201.17 Game Animals* Good Hygienic Practices r 5 Receiving/Condition 2-401.11 Eating,Drinking or Using Tobacco* 3-202.11 PHFs Received at Proper Temperatures* 2-401.12 Discharges from the Eyes,Nose and 3-202.15 Package Integrity* Mouth* _ _ 3-101.11 Food Safe and Unadulterated* 3-301.12 Preventing Contamination When Tasting* 116 Tags/Records:Shellstock 12 Prevention of Contamination from Hands 3-202.18 Shellstock Identification* 590.004(E) Preventing Contamination from 3-203.12 Shellstock Identification Maintained* Employees* Tags/Records:Fish Products 13 Handwash Facilities 3-402.11 Parasite Destruction* Conveniently Located and Accessible 3-402.12 Records.Creation and Retention* 5-203.11 Numbers and Capacities* 590.004(J) Labeling of Ingredients* 5-204.11 Location and Placement* '7 Conformance with Approved Procedures 5-205.11 Accessibility,Operation and Maintenance /HACCP Plans Supplied with Soap and Hand Drying 3-502.11 Specialized Processing Methods* Devices 3-502.12 Reduced oxygen packaging,criteria* 6-301.11 Handwashing Cleanser,Availability 8-103.12 Conformance with Approved Procedures* 6-301.12 Hand Drying Provision *Denotes critical item in the federal 1999 Food Cade or 105 CMR 590.000. TM,YY`YP �.y.•6, A,K .t•,-.y„,.P" ...dt:u.^�.,,.•r•.w.y„�. � �.•«:ti�+�"S.^iw.ti.F+'.a..y ,,...,..t-..•.y,��,-...,-wry+=^+.-YS....r�.rA..V`—•..r-'r-+' .. mow...'"'.'" . THE COMMONWEALTH OF MASSACHUSETTS City of Salem Establishment Name ('oa olnef hake_ Date Address -7s-z- t447,vF Jt Page c2 of 3 Item No. In the space below describe all violations checked on front page. Atn),mU-�7V _ Fao 1'x14//C Linspection of this establishment was conducted in accordance with the State Sanitary Code for Food Establishments,Chapter X, 105 CMR 590.000.The following violations were observed: (� -/161&FPFr)-1-k (2/i0 tior norPr f/(CiR/.P YAGPmM9Rve-4 -�' _ (�aa�A4cn.�� P4o.F•,m7 s�C�.FPaa /rst Gion.� r�<" LrPPP�P,P 2,/ 41,L Avd/1r;n. 7OAP ti4vjP,,� razz `v fionIre n74 LRxs7 �(o"Y �o� �a 27 - 4/.✓0i,01AI ten/ /VC?d r9,C [ �Hfiv77r,rr �/i PiPv F/_/L'S AinY(PiP_. iv 7�iF si.SY2l14/dPh�✓mo�n 7r"' - - �J/` •� �e-�1'i/X�'� /��rnairn•v,a�i�/_ .S'n.0 �`r2r,P 0%Sf�- �Yirz�7` /i,(,r 7XT t-J"/ 0 S _11d cz-1X?OW-e 12Ae",e _4-,-A!/ U24� rryS7�ir t ,fW-A1117P,P /9C ti_�i�k? ffiMP/IC �/OBP/_G/,vO 9 -- I':�i, /J/rvr4 a A4, ✓P /i/n 4x,, ,C4,v,1 WP/3,P.�c ^A- a A/e-Pr 1"'QHSiV9 R rSea,i �i ini/3 4 IV „ .«n LP`PiA rs 5//_Eir•tT � .sir f,o r /➢�L r�i a �/esn.P f_�,u,,ie,p �S�/,9�P� . /`7d� .�hiLivb_/Pn,�P� �- .t•=s,�„i,f�m on f-- �,A �i3 1q0 ,097n `17 s7/ /,z ,.IY .0r,✓,Ccec ii11VtP.v �HPP�iwLc 71i g,PPn Ce. 'V- � /7YoB,,�.tS � ,i�/jii.i/,•� �IP.�C('/1rirPP� J , txrP2�n/�ra nen / x -m,4 q -/ /-.!g Ves?' s orWb/CP /Ivvn/r P 7475 of//6n -Ae i t/,c,O Cr-tZe44 // 7'� i9P/ V.CVf7'fin-s-r Discussion with Management _ I have read this report, have had the opportunity to ask questions and agree to correct all violations before the next inspection,to observe all conditions as described,and to comply with all mandates of Chapter X. I understand that noncompliance may result in daily fines of twenty-five dollars. THE COMMONWEALTH OF MASSACHUSETTS City of Salem J Establishment Name / e Y,,, e- Date,7-t/AOO/ Address 773_ G(//ja 2C S_1 Page 3 of Item No. In the space below describe all violations checked on,front page. /p A(n) UfLv 4 11;9VS ,PV&W inspection of this establishment was conducted in accordance with the State Sanitary,Code for Food Establishments,Chapter X, 105 CMR 590.000.The followinq violations were observed: A�.n �Fpe.ea L Fr�o.�' �AiYl_ .,2`7 tf lZle7— 1 eje7 '7 ///tic' /0/ L*711ilS l ; _I7 7 lVrJ A47'P..L.C2SC° 77_� i7.O rnC7--7`e /541 �>L �p - 2iL -"d /4,�eW I .coG�l a t �%h VS r" � Y �7 Qnini�i/J.t .<La w,h `Ci�� c.^rir A�Vd6W%P/C /C14� (9 AO,.,Ajlvl 1 /.Ln'z.O J�Jl,lvdra�i�i�•�irn//JJJJ /fir rvii� H�f a n.i s�j 7t�i6 - A/P�i� fn ,Ylv�i v fife Ini/// 1GO 9• i/.cSP ACf Cf IA3 tO �In 7`d o� .C�n� _ Al0 �i/toC✓ /5" d" e'_:r o - it r 7— / ri?r - t'birP _ 1C�i. IY�nC�D /qp lD.�,Ci4'�Fl� A' ><'i�fat/3l/,S�J/Y/P,r17`"/7/2rydiy// zed 9,--/�_ r,S A/1774'")P.P4I/4//AIC fri�4S1✓S�inP� ��n�./r1 s�3�_ x/,4,40.119 4-1 A- c,o hr�-17-t A//.CIS/'!7 ILII//n.i,��e-n�r.�iD-r'1 � ��u�•��P,�'S ,4/!,/,� /�15 C4lClPL•'C� / Discussion with Management I have read this report, have had the opportunity to ask questions and agree to correct all violations before the next inspection,to observe - all conditions as described, and to comply with all mandates of Chapter X. I understand that noncompliance may result in daily fines of twenty-five dollars. L // 1 CITY OF SALEM BOARD OF HEALTH Establishment Name: Date: Page: of Item Code C-Critical Item DESCRIPTION OF VIOLATION/ PLAN OF CORRECTION Date l No. , Reference R—Red Item - Verified PLEASE PRINT CLEARLY' ' 1 1 I 1 I 1 I 1 1 1 I I II I I Discussion With Person in Charge: I Corrective Action Required: I ❑ No I ❑ Yes I have read this report, have had the opportunity to ask questions and agree to correct all I ❑ Voluntary Compliance o Employee Restriction/ Exclusion violations before the next inspection, to observe all conditions as described, and to ❑ Re-inspection Scheduled ❑ Emergency Suspension comply with all mandates of the Mass/Federal Food Code. I understand that noncompliance may result in daily fines of twenty-five dollars or suspension/revocation of ❑ Embargo ❑ Emergency Closure your food permit. 0 Voluntary Disposal ❑ Other: I S S0J 14C:} PHfa Re.x•tyed at Temperatures Violations Related to Foodborne Illness Interventions and Risk f rlr.,o*ding to)Um Cooled to Factors(items 1-22) (Cont.) _ i l'F/-; 'F Within_=1 Hoots, PROTECTiOP!FROM CHEMICALS 3' 1i Cix,luw,Method,for PIIFs i oo 1 19 I PHF Hot and Cod Holding 14 Fdor Color Additives 3 5r}1,il(g) t'nt,l PHIS Mattttatnccl at or Frtiuw 1-20'_ 12 Adclitives' 541", 3-302.14 Protection from Unapproved Additioes' "15)i.i6?:1) €lex 1'11E5 Maintained at of about I l5 Poisonous or Toxic Substances ! 101.11 identifyingtnfoiniation -Origt.,€, inal 140 F, - 1 iht<At Roast: field at orabove 130`1. Container:: 120 Time as a Public Health Control 7-102.11 ('ommr,nName--Workin;;{raN.unera" -,-Sit: 19 Time ax a Putr[ir Health Control" 7-201.11 Srparsutm-stol age" Sufi 10'r H7ttrefHcnt t { VB:iaL;4'RCq -202 11 Restriction-Pr:'xnu and i;�r' 17-202.12 Condition;tat Use, REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-20',[t Toxic Container. -Prnbibs un,'' POPULATIONS(HSP) 7-204.11 Saniti7eri,Criteria-Cltrtnicole^ 7-'_04.12 C'lannicalsforiAa,hingPrtuluce,C3itci;o' I 21 ',-S01 IItAa iinp:t:EeurtrcdEhe-paclagcdIwces.nid Rr" raaea with Warni lip,)at+els' i 7 2t)d.14 t7rytnr A este,Cowrie' .—......._ • :,_j;r�k,i 1(15) t <.'of r'a�trutizcd £:[ds` i 7 205.11 6reidrntal Ftxxl Contact, Lubricants' 7-206.11 Restricted Use Pesticides,Criteria'. ( � 3 St!t.l IlFr) I;.cv�;;r Pnrt,ally{.:,.e3krrt:launai Frax1 end i t?:ry 5t:'d Sprouts Not Serval. ' 7-206.12 Radem Bait Stations" i 901 I I ? (;} Nat ?0f> 13 1 racking Nrvderi, llea Control and Rz-sensed. 4 Monitntin",i CONSUMER AWItSORY TIME/TEMPERATURE CONTROLS 22 3 t•' . 1. Con•nnf.:t Ad,iiory Posted Iirr Commmption of ,�ttin,al i:+r,d<'tltar art:R.,> , Underax>ked cn 16 ( Proper Cooking Temperatures for \tq Othnr,'ist Prcwe;sed to Rlimmate I PHFS !'sibs„,.n.. .c .,i•<..,.9 r>::.: -.t01 11A(1 tit) kggs- 155 F 15 Sec. "102 ; ? �Fa�:ucn:rd Fu="'4uhbtitu+r fiv Raw Shell Ism (Bate Set�•tu t45't•l5set �'' 1-161.11(02) Com3ninutcd Fc•h,11e:us R Gamy Animals- I`5`-' 15 sec. '" SPECIAL REQUIREMENTS 3-401.1 l(B)t t)(2) Pot and 13cef Roast - 130`F 121 nein S r 3-4o 1.11(A)(2) Ratite, lgiecrcd Mcate 155 F• 15 ( Viclmi37us tti Srt:ltan 51(t.(1p9(A}-i D) in ,cc. * aicrlilg, tn,3£ii[.,load, i(nnporary and 3 40 1,11(A)t";) Poalrr�,Wild Game,Stuffed PFIf.s, kitchen op¢rrticins should be SlufHne C onLuntng Fish. Nteai, debited under the appropriate sections Pooh'+,'or Rautee-t65'�£' 15 sec. " ahwe if rehoed to ftxxihorric ilh)css 3-f01.11fC)(3) Whale-Ttaw:te, Intact Be.:f Steak, i ntcrvt:nt ane a3,d Fisk f Rars CRhcr 145°t'+ 5o)0.009 t`iu,ialione Telatin,, to wod retail 1401.12 RaoArarmal F,xdv C'rnrked to a j 1 n",ticce,.huulel he debited under #29 - S1iCrow'Svc' I + 1 special Ri:yttirelitonts. i -"-401.1i(Ai(1)(h) -V[QtheiE'Ilfa- 14TF15sce I 17 I Reheating for Hot Holding VIOLATIONS RELATED TO GOOD RETAIL PRACTICES I 3-103.tIiA)°,([)1 pFti•, 165`F 15 cep, - ( tltentc23-aft) ?-403.1I(H) Microwave, 165'[t 2 Muiwt Standing C"W'.'v;uud mm (rirr,:a! +^e+::ttt•,n.,, which de+aor relore Io the Sime' (e:udLarra,:r?Ltrfs inlal V,e t:orzs.md risk jAr turn Reted above, ran be: 3-.103,I I t(7) Commuctaily Praesscd RTF I•txat- fe,rimt in the ) yet t iii of,'hi, Food Code,curd 10.5 C•AIR 140F` 50ru fxrfr, -403.11(E) Remrunin;Cnthred Portions of Reel +ism F Good Rora+t Practices ___ FC 590,00_6 Roast 4 t3. Ana,tat;emet�i ar.d Prarwrinel F( 2 I .003 �24 �y Food and F�3od Ptotecttnn _ FC-3 GCS_ 25, I 18 } 501 H(A) 7(ix Withmt2oper giPHFot Ffrtnt14)70to`[' 1226,7. - `t/-Srr3�t ;ndgltvd'Pdasta ------'- FC-F, '`iL) our�and From to 41'7745 F Within 4 Hints ° ' 2b r u•,ono e of .^w�t;-,mots FC 7 ! Out? 3 501.14(B) Ctwlinf,PHFS Made Florio Ambient 24. Spxta!P�-yt.iremetu; 4--_-- Tcmpcfatarc ingredients n,41.1/45'F i_'.-- Other -- Within4[ite«s* 't :nu:rt:oiiczt acro;a th.•t:Jet e! i'}rur Fund t'wk or 16S t'l4tL 540 tf(10 j CITY OF SALEM i BOARD OF HEALTH 4 Establishment Name: Date: Page: of t nem Code C-Critical Item F VIOLATION!PLAN OF CORRECTION Date r40. �. Reference R-Red nem '-_ - ,.. , i„ Verified`... DESCRIPTION O `- _ ".' «PLEASE PRINT CLEARLY" - - _. I - , .; -' I Discussion With Person in Charge: Corrective Action Required: ❑ No- ❑ Yes , i 1 have read this report, have had the opportunity to ask questions and agree to Correct all I ❑ Voluntary Compliance ❑ Employe Restriction rviolations before the next Inspection, to observe all conditions as described, and to ❑ Re-inspection Scheduled ❑ Emergency Suspension comply with all mandates of the Mass/Federat Food Code. I understand that noncompliance may result in daily fines of twenty-five dollars or suspension/revocation of ❑ Embargo ❑ Emergency Closure your food permit. r h ❑ Voluntary Disposal ❑ Other: {I 4( } ill iF',Rcci vcd Ili 1-Cn1NTatureS Violations Related to Foodborne fitness Interventions and Risk + Art ording io Tav C.wied to Factofs(items 1.22) (Cont-) ( 1i2E14�'(: bVitl+in•« H,tuas " PROTECTION FROM CHEMICALS3 +t1.1> FHYS Id ! Food or Color Additives E 19 I PHF Hort and Gold Holding ( 2 5M.16(B) C<M pl*J,Nbirkla=.ted at or belmy ?-2}13.1' ( Addlut•cs" E 59i)()t)-ttI 4PI-f5. 1:. 1-30114 � PrrtectionlionsUnapproved Addillw�, E ti's F'F1Fiaitfaanai):eda:r'rab<-rot j 15 Poisonous or Toxic Substances i 191;,1,. ` Identifying Infierinitiun - Orl);Inai jrti !6(ii Rnactt field at u! aWye 130"F jcomaillm` E i 21) ` Time as a Public Health Control 7.101.11 Collation Name - Workine Containers` ( + t 730f.1i Srparsti<,n- Surragc" i 3- 1p It' 'Iiu,r,,,;aPublic IfealihControl, 7-202.11 licetrictlon -Prescnce,u)d U�u' 3 r -`. (1".O.dt(-1} b'..,ia5�:e l:equirvalent 7-2(,12.12 Ctmditinn.•(it Use' I n_03.I 1 F<,ric Container; - POP Profrihiiutm; I REQUIREMENTS FOR HIGHLY SUSCEPTIBLE j -1-204.1: Samiime .Criteria-Chemii:I,N' ( POPULATIONS(HSP; rr 'rl 1 z-mII 11(`<i Unlr:rtteurv.td Pre-jr.;cJ:air@ Juices altd 7-�.}-4.12 Chemical+for We�hin,t':nJ+rce,Ctitetia' I tier et ures w4h lk'arni nr.1abols' 7 201 14 !r Ormm,;ALtvot<,Criteria` ( 3-hof,11+11 T:�e+,f `'-205 1' { hx:idenlal fi xl r'r,ntact I-AtNit.mns' i 1+(�t tart,.,rF'rutiaiJ>O+At%l Animal Ftxrd and 7-206.11 I<CArided USC Pe>661es. R ti, ;.t;d Clxrt aAi,i i'r«t Served. ' 7-206.12 Rix(:m B3111 SII1110nl 3-8,(;l I I(C, Hist t,.x Ki.nitr. . 7^06 1 3 '1'rrcking Rnsdui,P-SE('olriTO and ( 1 7e r.az'.r tial Rc.sen'ert. mouitorim,` ( CONSUMER ADVISORY TIMECTEMPERATURECONTROLS 22 .i; t'cnu=.nice t,r,isut+ Pt:sr d1 +rCanseunptinn«f Aoiu;.1 F•.xds 11wt.irc Rain. Undercooked o: 16 Prayer Cooking 7emperotures for 4 1 ! .tim f)flkei �tse Prtx,t sseJ it)EliminatePRFs i .,,.,,• 3.401 1 L~<(l)(.:) f'gg>. 155'F 15 5,.:. Putlr=p.n� F;gtts-Imurc:eh:¢e Sc.:'icr 135"F35set• ( C , 3:, }'.>A:n.r,: CITY OF SALEM BOARD OF HEALTH Establishment Name: Date: Page: of Item Code c-Critical Item _ DESCRIPTION OF VIOLATION/PLAN OF CORRECTION. Date No. Reference R-' Red Item - „ , y _ Verified PLEASE PRINT CLEARLY I 1 r I 1 1 I 1 I 1 I I I j I 1 I 1 1 Discussion With Person in Charge: Corrective Action Required: I :3No I ❑ Yes I� 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 Ll Re-inspection Scheduled ❑ Emergency Suspension comply with all mandates of the Mass/Federal Food Code. I understand that noncompliance may result in daily fines of twenty-five dollars or suspension/revocation of ❑ Embargo ❑ Emergency Closure your food permit. ❑ Voluntary Disposal ❑ Other: 4-51}1 sail-; Pfff,v Reonved at femperatnre5 Violations Related to Foodbarne Illness interventions end Rtsk i According to i.w Cooled to Factors(hofs 1-22) (Cont) ^7!f_— -31 'F,`45`F Within a #hilus PROTECTION FROM CHEMICALS 5-501 15 C,rliu:t,t1nE od for PHF's � J 14 1 Food or Color Additives ( E 19 P1F Hot and Cold Holding r I :1-202.12 aad,tiw," `W.WE? Cold PRFs Maintained at of below� 5'�ttrxiwtl�J ai°rasp 3-102.14 PioteoicmfromL'napproredAdditrc,' F- '; y)1,16(:1) H+,t 15 I i Poisonous or Toxic Substances PFIt's 1lsinlauted at rr atx+ve 1tiLit1 s.S, kvasiPs field at or above 13001.Containers, + ( 7 102 1 tCommon Name -Working l'oaxmner:," i ZtF { lime as a Public Health Control 1 I-) Time as a Public I leaith Control' 7 201.1 I ( Separation-5trnage ` 5,)1 7-202.11 i Rcs�tricnon -Prcunce v1d U; e` t +Hi \'.:riaree ReGuares,tent 7-202.12 f C',t6c(ons of Use*ntainrc � 7��tH.(1 To>:ic.fuREQUIREMENTS FOR HIGHLY SUSCEPTIBLE �-Prnhiht:ion�" � 17-ZU4.i t Saniti7ers,Ctircria -C'hrutiuds` POPULATIONS(HSP) I ',='(4.12 C'henticais ins Washing Prodncc,Ciitetia, 21 :.11}1 111.11 L'np;:ctcurimd CkrpacLggrdJvictv:,nd 1 7-204.14 Drying Afients.Criteria' erace.,<:ith War'nink 205.11 lneidewal Foxl Contact.LahnceanN' cn Pa,teurized E'ces,` i9-24fi,i I Re,incled Use Pe>rit,idea.Cnteim^ 41.11 if)) Ra-,v or P,vtiatiy C+urked Animal Ylxd and i ILn, Se:d'�prnnt',Not Served. ` 7-206.12 Rodent Bait Siatn,Tl1° i i. xoI.i 1 tC} t;n,+ c•ned Fo ii Package %oi Re served 1 t-06 13 Cracking Powder..Pest( introl and :1louitnting^ CONSUMER ADVISORY TIMEITEMPERATURE CONTROLS 22 34)(':.11 ( t onsu+nct vi,isniy Prated iorC-cntsamption of 16 Proper Cooking Temperatures tot + Anim: I Food that are Raw. Underu+,ked of pct Othcr,,i,c Pr+x•essed to Elhamate PHFS ..r.r... >.nw.., 101 11:1(1)('2} Fiap,- 155'F 15 Sec. P.rthurcns." ' ( Fgg\- luuucdiate Sri_icc 14.5 T)i;.ec, �.3u t3 P..:t wr/:d Fg{:Sahsidute far Eta"-Shell %401.17(:1)2) Comutinined Fi,,h, llent>k t+anic 1 Animals- I'.5'}: Issec. '" SPECIAL REQUIREMENTS 3.401.11(14)(1)(2) Purl. and 13ee1'Ruast 130'1' 121 min'' ( i9�)oZ)Q{rt, (r); 1 Violall,ells of Sc tion US).Ek}9t 1)-(()) in i ' 401.11(A)(2) R.nhc,, h+iekn-xi %alt, - 155 h IS ( i G c. r crtug,mobil:tcx)d,trntpc,rar- and 3 401.11(Ap 1) Poultry,Wild Game Stinted PHFs, ( 1 rcmtt3nhal kirchen of kn ations Awtild he Sn+tfnig t'+mtanung Fish, Strat, I c!4hiwd under the appropriate sections ]'onitry or game,-1167 F 15 sec. " I aWvo if ieiaietl io fciodhc,rne illness i 3-401.1IiC) 3) Whole nmy.le. intact Beet Steaks interventions and risk (actors Other 14594 c 'Vio, Kist violation relatinc to o, d retail Raw -kninwl Foxl,Co,ikcei in a ( j mastless Aicu(d lw debited under 1129 - %Iiczvwave 1614 " Sp,rutl Reytt;rcntents. '-40J,Il(A)Qab) Ali Other PHF,-- 145'F15sec. f 3 p Repeating for Hot Holding j VIOLATIONS BELATED TO GOOD RETAIL PRACTICES 3403.11(.A)&-(D) PHI): 165`F t5 src ^ (liet,ts 23.30) i-lU9.I I(B) lviierow'asr� 1P5"F 2 Mmtne Standing C�i;a•or.urrl non,uincal rrolavon,i, wbirk elo no;n -elutc to tkr, Time' foodhorne rlb.est tn;;rrrnr„nts solei i is A)ac tars luted above, coin be 3-403.1)(C) Commercially P+enec. d FTE hxxt fwa d in thv f?rMrntn,r; -he•Food Codc e=nd 1(r5 C:A/K 14014` 5.ort(vrt), '3-403AI(Fl Remaining Ureliced Portions of fisc:' usm _Good Rested Practices FC 590T00 i Roast,* 23 Management and Parsc)r:na! FC -2 001 j gg{ i Proper Cooling of PHFs '4 Fc-oo and r=ood Prore"ion FC _3�.004 na. __ E4�?pment n^tl Ufe++stls FC -4__ A053-5US 14(A) C-'cxauee Ctwk,:d PF1Fs iron: 231)`F t<, �mZc, -'Wdtw.Ph:mbino er,d:^of t9 ' FCFC-6-S , 70"F Within 2 Hoare and From 701' 27, P�s,,.af Ps:dill i .W7 I to 4 i"F/45`P Within 3 Hcnu s. ' « Prnsnnous or?:owe Ma- -- rC -7 3 501,14(B) Coaling PHFs Made From Amt,ient 1 009 -Feinpaattire ingrecticats tai 4VI,/45'14 1.30 011 t, 1lithin4 Hours' ` `.`. ",•.:'. `Dem b'�missal uem m:h (:.lend 1c,991"a,dtlaicor tnS C:Mk 990 rd;p CITY OF SALEM BOARD OF HEALTH Establishment Name: Date: Page: of Item Code C—Critical Item ._ DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date No. ,; Reference R—Red Item _ - Verified PLEASE PRINT CLEARLY i 1 1 ' I s � 1 - 1 S 'I � 1 Discussion With Person in Charge: Corrective Action Required: I :3No I ❑ Yes I have read this report, have had the opportunity to ask questions and agree to correct all ❑ Voluntary Compliance ❑ Employee Restriction / Exclusion violations before the next inspection, to observe all conditions as described, and to 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: <-:,i,i.)�%(i.) � PttFc Roc=•iv�'d nt l'emrx:r%(tore( Violations Related to Foodborne fitness tntenentions and Risk 1c ctordinx to la:+ C,olyd to Factors(items 1.22) (Cone) i 41+45`F Wttht it 4 Han s. PROTECTION FROM CHEMICALS t;;M•'th(rl< for PHR 11) PHF Hat and Cold Holding 14 j Food or Color Additives i i 5t)I.1((1;} ("utct PHFs ttSainr.nra`d at or below 2{i2.i2 Adtrtivcs* 3302.14 � Prt,techeniroatlinappro,•edAddiuve�' 155f11,1it•, 111t.iIll-' 15,�1.lti(Ai 11,•il•I13:: SfainlatnnrlrRorabrn•C i 15 � Poisonous or Toxic Substances ' 7 !d{iT. 101.11 Identifying aftI a+ion- Otiginal ' R.;+atsHeld at,xab•>t'elsU°I•. * Ccmtaioer,` i l ti2.11 Compton 1Vnme" Working C'onuuner+" 2t) Time as a Public Health Control j I ,--v,,1 14. Tim,-as a Public'I lealth('unirol, 7-201.11 S<pal.tuon- Siutagc'" 7.202.11 Resttichtm-po'sence and a e" { `+i0.0trirHi V'friance Rrt{tnrcuu:nt 7-102.12 Conditions of Uac" 7 103.11 Toxic Container,.- ProhtM:xrnt" REQUIREMENTS FOR HIGHLY SUSCEPTIBLE i 7 20=1.t! Sanit,zer;.Criteria--C6eu+icrda' P i{- -_OPULATIONS(HSP)-- j 7-2()4.12 ('hunica(s for A;uhit:t d'rrnJ+,.:s: C:tits:iaa' i '-t _SM I I(A) ! Unra:tcurticd Por au.kagcd Junes zind -"- ""-'-."' I 1 `•;C;erX.Te with b arnooz.tatbelti' 7"°1)4,14 Dniug+Amm.Criteria" vl,i tilt, � Tsc of'Pa<tetitlrrd Egg,' i.3p5"i I buidental Fc>,xI C.`upract.Luhti::anis" �St;l )I s 11i t:.;w or Py'U li'.Ctutkt-d Anunal Focal and 7.206 i I Re:trit;tcd L's,:Pe,,ici les Criteos" � I � t?a •:i:ed.ivroats't,t Served. ' ! 7-206.1_^ Rmlent Bait Sumom' , 3.},1:1.1 i(t:t ! Ln,p..nr•t!T cxui Packaec ,rvc j7 me; 1.3 Tracking ft,otdas, Pest Control and tiunitorintI, CONSUMER ADVISORY TIkME1TEMPERATURE CONTROLS 4 22 3 11 t,nu,er Art,tsnry P<,5ted 1:trf"onsatnption of 16 Proper Cooking Temperatures tot I r7t,tui A I tv*!<Thar:nc€t:w Ctnderatol ed of PHFs j Not 0!1wr V iSe 'rt, t'.5ti:".tl ti)Flininnor I 3 P<,tP:uern;.` """:""'�.'0`.• 3-10i IlA(1,(2, F:gk- 155-f' 15,4ee' 13 to:;n-Iti'c. 4ubst,folctot Rtm,Shell firgs-Invued'ccte Set,•rcc li5'1=15se,: o7. t"' 401.IIIA)(2) Comminuted lash, MC.ct,A Gina I' i Aniwal", 155 IF 15 set. " SPECIAL REf U6REMENTS 3.-101.11(8)(I):2) 1 toil. and 6cci Kunst t.;n"F I II rain¢ ;.:;:)I.l(tAtiYt ! Katitr;. htieet,;dllents- ISi'FIS 59000C)f'.10 7) Vi,!alion,,oiStei)on ?t.)().fN1y(A)-(Olin src. t'nteriog. mohilc faux!. temp(aat;i, and 3 401.11(4)+3) Pnulot,li'ifd!lame."tu11::d PiiF.. 1 1c,-,i lent.;,l kitchen o)+,�tatiottS.hotdd he Swilme(`mi-arcing Fish.!(teat. Jd)lt: i under th,t al,;xopt iatt� seitionti Poultry o, patten Ib5't' l5: . " dune tf related to f Ioilltornc i[Ines, { 3 401.11(C)t3i � Wh,de-n,us,?Ic, Intact Beef Steals mm vt :nuoni at,d risk factors Odwr 5`40.()09 violatiuna rrlatittr to go:d retai! 3.401.12 Kaw;lnhtntl !Fonds C`.t>rktd of a ;xae:lic.e. :hvuld Iv debited under #29 - tlic,owave IWF Spet'tai KequircrutInth. 401 1 I(A)(10) I Ali Other I'1{l,s - 14T F 15 ,ec• t7 Reheating for Not Holding ( V10LAT/OhrS RELATED 7.0 GOOD RETAIL.PRACTICES 3403.111A)&(Io PFIF: 165'hl`eec {Ite.nts23-3{1) i,403,1 If B) mcrtw aw- 165"f'2 M olute semdiar Cri;i+.d aeJ rn:n i run.a; !'n,!ar wo, which down retarr m lite I ime" jno+'I,ernc r!tntts txt•r tirntirne,rete!r i.tn Jur met!%ctrl cthm e run Lr 3-403.1 I tC) Commmialiy Pacecsed RTF I-ooti- fumxd nr ;hr)etiou•ng annimtc r7 tkr I purl Code and 104 CMR 40'F` yp Pon, 3.4{)3.11(6) Rema)ain Uwithrd Ponteons of Hee( 1 Item "r Cood herint Practices --".T FC _ _590.OtTQ -� it,+aiL` ""' _ Manaflemc.9t and Kers crn_r' ! FC 2 `. 003 ?_4.-..� Ct 1$ Proper Cooling at PHFs ^_. :,rd Pond Fr^tart,a^ FC-3 .00)-1 13"501.14(A C'.u'duiC<x.k.:dPHFch'vn, l<I()`k"to �" � rr:uiUrriatst.z^dvtensda ! FC-4 �_005 ___� 6 _ W"tet:T'&.,.,be�G and W t,cty FC-S OUti 70"F Within?i{ours uud From 7{}t i' 2'7 ft v-wcai,=at;;tv FC-6 I .007 `- to,4 f"Flt,^'F Witi,in 4 Houtz. -`�Perdnojtt r,t low V..itcto!,r -- �rC-? }.WP 3,501.14tB) Conking Pl*t,Made From Ambient 005 Temperawre lmredient%tool"N45`F i..JO., _ -�,Oilier *Itc.er,?Ts enucd ucm nt th;I.,kx:,I 1909 Pin<t Cvfe..r 105 t ."M 5ei1)ON a . 1 t 4 a 7 G�VIA vn2v'LiaI r� i 1 l ' ' t i.v'McQcsw .�40z..a l2yJgr . � �� c � �� rib/d� � � r.---�—'"..",--- �� _-�� "�.� .' �;--- /,, � f '..---„' J---�-- __---f.t--- .--- --�--- � --„ '-�' - - -- - ----w - - -- - -- -- --- 3 �� _� _ �- � � r ..� __ _ ___ _ __ _C11tI__ _____ __ ____ ___ _____ _ _ -..-�- -..�� 1 11