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GREAT ESCAPE REST - ESTABLISHMENTS G4Ct+�T LSCA.G nett Il�i3 -Nj N f n I � it 9 o k CITY OF SALEM, MASSACHUSETTS lu BOARD OF HEALTH PRt1I1CHC8Ith 120 WASHINGTON STREET,4'"FLOOR Prevent.Promote.Protect. TEL. (978) 741-1800 Fax(978) 745-0343 KIMBERLEYDRISCOLL Itamdin@salein.com LARRY]UNID1N,WRITIS,CHO,Cl'-I;S MAYOR HY.ALTH AoE'Xi' This Form will be collected during your next Board of Health inspection. QUESTIONNAIRE - GREASE TRAPS 2012 -- 1. NAME OF ESTABLISHMENT: Greed rl Sc q p f, IF%t&4`9 u c4 i d 2. ADDRESS OF ESTABLISHMENT: cS 0 cO z! cF7 3. DOES YOUR ESTABLISHMENT HAVE A GREASE TRAP? 1J-e 4. 'WHAT SIZE GREASE`:TRAP DOES'YOUR"ESTABLISHMENT HAVE? CAPACITY IN GALLONS 5. HOW IS THE GREASE TRAP MAINTAINED? ON A DAILY BASIS? BY AN IN-HOUSE PERSON OR BY AN OUTSIDE CLEANING SERVICE? I{ __ II '�V ckN � h h�US'P owls ou 6. WHAT IS THE FREQUENCY THAT THE GREASE IS REMOVED FROM THE TRAP? I- 2--T i wt. �s cc, w -p-y-,k 7. WHAT IS THE NAME OF THE FIRM WHO REMOVES AND/OR PICKS UP THE GREASE FROM YOUR ESTABLISHMENT? L� ir7 M SC .^ -C 4M D 7 ? (—O c (u c d � S. WHAT IS THE DATE OF YOUR LAST INVOICE FROM THE REMOVAL FIRM? Massachusetts Department of Public Health Salem Board of Health 120 Washington Street,4"' Floor Division of Food and Drugs Salem, MA 01970-3523 FOOD ESTABLISHMENT INSPECTION REPORT Tel. (978) 741-1800 Fax (978) 745-0343 Name DateT O eration s T f Ins ectlon Food Service utine Address Risk ❑ Retail e-inspection Level ❑ Residential Kitchen Previous Inspection Telephone (1 ❑ Mobile Date: OwnerHACCP YM El[3 Catererary ❑ Pre-operation ❑ Suspect Illness Person in Charge(PIC) Time ❑ Bed 8 Breakfast ❑General Complaint InspectorIr� Permit No. [__1HACCP Out: ❑Other Each violation checked requires an lanation 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. O� FOOD PROTECTION MANAGEMENT ❑ 12. Prevention of Contamination from Hands lN�) 1 PIC Assigned/Knowledgeable/Duties 4 __ h�j�a13. Handwash Facilities EMPLOYEE HEALTH fh/f�p -- - ROTECTION FROM CHEMICALS''" "` ' �'* '- `"• ❑ 2. Reporting of Diseases by Food Employee and PIC ❑ 14.Approved Food or Color Additives ❑ 3. Personnel with Infections Restricted/Excluded r-r_ ❑ 15.Toxic Chemicals LFOOD FROM APPROVED SOURCE ----er from -._ TIMErrEMPERATURE 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 ❑ 18.Cooling PROTECTION FROM CONTAMINATION El 19. Hot and Cold Holding 8.Separation/Segregation/Protection El Time As a Public Health Control 9. Food Contact Surfaces Cleaning and Sanitizing t REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS_(HSP_); C3 10. Proper Adequate Handwashing El21. Food and Food Preparation for HSP ❑ 11. Good Hygienic Practices .CONSUMER ADVISORY, ,RR%2. 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 x by a Board of Health member or its agent constitutes an 23. Management and Personnel (FC-2) 4order of the Board of Health. Failure to correct violations 24. Food and Food Protection (Fc-3)(590.0oa))so.ocited 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 0151 28. Poisonous or Toxic Materials (FC-7)(590.008) and submitted to the Board of Health at the above address 29. Special Requirements (590.009) within 10 days of receipt of this order. 30. Other DATE OF RE-INSPECTION: Inspector's Signature--' Print: b Le 1 . PIC's Signatu �/ Print: c PageV-of-Pages] V r Violations Related to Foodborne Illness Interventions and Risk Factors(Items 1-22) PROTECTION FROM CONTAMINATION 8 Cross-contamination _ FOOD PROTECTION MANAGEMENT 3-302.1.1(A)(]) Raw Animal Foods Separated from 1 590.003(A) Assig ment of Responsibility* Cooked and RTE Foods* 590.003(6) Demonstration of Knowledge* Contamination from Raw fogredienis 2-103.11 Person in charge-duties 3-302.1 l(A)(2) Raw Animal Foods Separated from Each Other* EMPLOYEE HEALTH Contamination from the Environment 2 590.003(C) Responsibility of the person in charge to 3-302.11(A) I Food Protection* require reporting by food employees and 3-302.15 Washing Fruits and Vegetables applicants* 3-3tk1.1I Food Contact with Equipment and 590.003(F) Responsibility Of A Ford Employee Or An Utensils* Applicant To Report To The Person in Contamination from the Consumer Charge* 3-306.14(A)(B) Returned Food and Reservice of Food* 590.003 G Repordng by Person in Charge* 3 590.003(D) Exclusions and Restrictions* Food Disposition of Adulterated or Contaminated 590.003(E) Removal of Exclusions and Restrictions 3-701.11 Discarding or Reconditioning Unsafe FOOD FROM APPROVED SOURCE Food" 4 Food and Water From Regulated Sources 9 Food Contact Surfaces 590.004(A-B) Compliance with Food Law* 4-501.1.1 I Manual Warewashing-Hot Water 3-201.12 Ftxxi in a Hermetically Sealed Container* Sanitization Te eratme0' 3-201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Warewashing-HotWater 3-202.13 Shell E Es* Sanitization Temperatures* 3-202.14 Eggs and Milk Products,Pasteurized* 4-501.114 Chemical Sanitization-temp.,pH, concentration and hardness. 3-202.16 Ice Made From Potable Approved Drin .tem e Water* 4-601 11(A) Equipment Food Contact Surfaces and S=IUi..la DrinkingWater fromrom anSystem* 590.006(A) Bottled Drinking Water* Utensils Clean* 590.006(B) Water Meets Standards in 31.0 CMR 22.0" 4-602.11 Cleaning Frequency of Equipment Food ShelNish and Fish From an Approved Source Contact Surfaces and Utensils*- 4-7U2.]1 Frequency of Sanitization of Utensils and - 3-201.14 Fish and Recreationally Caught Molluscan Food Contact Surfaces of Equipment p * Shellfish* 4-703.11 Methods of Sanitization-Hot Water and 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* Sources* 10 Proper,Adequate Handwashing Game and Wild Mushrooms Approved by Regulatory Author 2-301.11 Clean Condition-Hands and Arms* 3-202.18 Shellstock Identification Present* 2-301.12 Cleaning Procedure* 590.004(C) Wild Mushrooms* r 27301.14 When to Wash* 3-201.17 Game Animals* it Good Hygienic Practices 5 ReceivinglConditlon 2401.11 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 We and Unadulterated* 3-30 L.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* Em to s* Tags/Records:Fish Products 13 Handwash Facilities 3-402.11 Parasite Destruction* Conveniently Located and Accessible 3402.12 Records,Creation and Retention* 5-203.11 Numbers and Capacities* 590.004(1) Labeling of Ingredients' 5-204.11 Location and Placement* g 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 6-301.11 Handwashio Cleanser,.Availabili 3-502.12 Reduced packaging,criteria* 6-301.1.2 Hand D 'n Provision 8-103.12 Conformance with Approved Procedures* 'Denotes critical item in the federal 1999 Fad Cade or 105 CMR 590.000. • • • • • • IN 1,111I M' 111111 R-Red Item j NAM �_�_•�:• a _�_rl ' i.•.i� • • ��ts . tee.. i _ ! ! I ! • 4 wPE - _ , _ ��.+'►.ill/�*_T•�i�'�= r - ' 3-501.14(C) PHFs Received at Temperatures Violations Related to Foodborne fitness Interventions and Risk According to Law Cooled to Factors(items 1-22) (Cont.) .. 41'F/45°F Within 4 Hours. PROTECTION FROM CHEMICALS 3-50t.15 CoolingMethods for PHFs 14 Footl or Golor Addkives _ 19 PHF Not and Cold Holding -r Color 3-501.16(B) Cold PHFs Maintained at or below 37202.12 Additives* 590.004(Fl 4101450 F* 3_302.14 Protection from Unapproved Additives" 3-501.16(A) Hot PRFs Maintained at or above 15 Poisonous or Toxic Substances 140 * 7-10I.11 Identifying Information-Original 3-501.16(A) Roosts Held at or above 130°F. Containers* 20 Time as a Public Health Control 7-102.11, Common Name-Working Containers* 3-501:19 - Timeaca Requirement Contras* 7-201.11 Separation-Shira * 7-202.11 .Restriction-Presenceand�Use* 590•004(H) Variance Re uirement 7-202.12 Conditions of else* REQUIREMENTS FOR HIGHLY SUSCEPTIBLE ' 7-203.11 'Toxic Containers-Prohibitions* POPULATIONS NSP 7-204.11 Simirizers.Criteria-Chemicals* 7-204.12 Chemicals for fashI Produce,Criteria* 21 3-801.11(A) Unpasteurized Pre-packaged latices ad 7-204.14 Devine ALvents.Criteria* _ :Beverages with Warning labels* 7.205.11 Incidental Food Contact,Lubricants* 3-801.11(B) Use of Pasteurized Eggs* 7-206.11 Restricted Use Pesticides;Criteria* 3-801.11(D) Raw or Partially Cooked Animal Food and Raw Seed Sprouts Not Served. 7-206.12 Rodent Bait Stat ons' 3-801.11(C) Unopened Food PackaNot Re-served. 7-206.13 Tracking Powders,Pest Control and Manitozin * CONSUMERADVISORY TIMEITEMPERATURE CONTROLS 22 3-603.11 Consumer Advisory Posted for Consumption of 16 Proper Cooking Temperatures for Animal Foods That are Raw,Undercooked or PRFs Not Otherwise Processed to Eliminate 3 40L21A(1)(2) Eggs- 155°F 15 Sec. pathogens.,1:rrxe,ernzoer E -immediate Service 145°F15sec* 3-30113, Pasteurize Eggs Substitute for Raw Shell 3-401.11(A)(2) Comminuted Fish.Meats&Game E * . Animals-155°F 15 sec. 3401.11(B)(1)(2) Pork and Beef Roast-130'F 121 min' SPECIAL REQUIREMENTS 3401,11(A)(2) Ratites,Injected Meats- 155°F 15 590.009(A)-(D) Violations of Section 590.009(A)-(D)in « catering,.mobile food,temporary and 3-401.11(A)(3) Poultry,Wild Game,Staffed PHFs, residential kitchen operations should be Stuffing Containing Fish,Meat, debited under the appropriate sections Poultry or Ratites-165'F 15 sec. * above if related to foodborne illness 3-401.11(C)(3) Whole-muscle,Intact Beef Steaks interventions and risk factors. Other 1450F 4' 590.009 violations relating to good retail 3-401.12 Raw Animal Foods Cooked in a practices should be debited under#29- Microwave 165F* Special Requirements. 3-401AI(A)(1)(b) All Other PHFs- I45'F 15 sec. 17 Reheating for Hot Holding VIOLA77ONS RELATED TO GOOD RETAIL PRACTICES {' 3-W3.11(A)&(D) { PHFs 165'T 1S sec. * (Items 23-30) 3-403.11(B) Microwave- 16Y F 2 Minute Standing Csirical,mid non-critical violations,which do not relate to the Time" foodborne illness interventions and risk factors listed abode, can he I 3-403.11(C) Commercially Processed RTE Food- found in the foilowing sectionsof the Food Code and 105 CMR 140°F* 590.000. 3403.11(E) Remaining Unsliced Portions of Beef f nem I Good Retail Practices _ .FC 590.09U Roasts* 23. i Management and Personnel { FG-2 .003 ' 18 Proper Cooling of PHFs 24. I Food and Food Protection FC-3 .004 a 1 25. Equipment and Utensils I FC-4 .005 3-501.14(A) Cooling Cooked PHFs front 140'F to 1 26, Water.Pltimbi and Waste FC-5 .006 1 70°F Within 2 Hours and From 70'F 27 1 Physical Facility FC-6 007 to 4FF/45017 Within 4 Hours. * 1 28. ' Poisonous or Toxic Materials ' FC-7 .008 j 3-501.14(.B) Cooling'FHFs Made From Ambient Sp tat Requirements 1 .009 Temperature Ingredients to 41'F/45'F 30 I Other Within 4 Hours* 'Dmotes critical ium in the f-deral 1`K)9 FwA Cale a'105 CWR 590.090. Massachusetts Department of Public, Health . Salem Board of Health 120 Washington Street,41h 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 Operation(s) Tvpe of Inspection r;/1 h XFood Service ❑ Routine Addresss� �41.rFr Rlsk LJRetail Re-inspection Level 1:1 Residential Kitchen Previous Inspection Telephone El Mobile Date: I, ! Ownerf HACCP YM ElTemporary ElPre-operation C S. S o ElCaterer ❑Suspect Illness Person in Charge(PIC) Time ❑ Bed&Breakfast ❑ General Complaint Inspector In: 11:z) permit No. [IHACCP Out: ❑Other Each violation checked requires an explanation on the narrative page(s) and a citation of speclfic 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. -- - �s_..__._ _� FOOD_PROTECTION MANAGEMENTEl._T 12. Prevention of Contamination from Hands ❑ 1 PIC Assigned/Knowledgeable/Duties / [113. Handwash Facilities EMPLOYEE HEALTH' f - -4, a PROTECTIO FN ROMCHEMICALS El 2. Reporting of Diseases by Food Employee and PIC "" -ol ❑ 14.Approved Food or Color Additives ❑ 3. Personnel with Infections Restricted/Excluded __ ❑ 15.Toxic Chemicals .FOOD FROM APPROVED SOURCE�.�--�_- --- .�.-.. El 4. Food and Water from Approved SourlCe TIMEITEMPERATURE CONTROLS(Potentially Hazardous Foods) ❑ 5. Receiving/Condition ❑ 16.Cooking Temperatures ❑ 6. Tags/Records/Accuracy of Ingredient Statements El 17. Reheating ❑ 7. Conformance with Approved PrbcedureS/HACCP Plans ❑ 18. Cooling PROTECTION FROM CONTAMINATION , El 19. Hot and Cold Holding _ ❑ 8. Separation/Segregation/Protection�� ❑20.Time As a Public Health Control ---- ❑ 9. Food Contact Surfaces Cleaning and Sanitizing [REGUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS.(HSP)I El21. Food and Food Preparation for HSP ❑ 10. Proper Adequate Handwashing _ __ El 11. Good Hygienic Practices iCONSUM€R ADVISORY, ❑22. Posting of Consumer Advisories Violations Rslated 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_ x (FC-2)(Ss0.0 by a Board of Health member or its agent constitutes an 23. Management and Personnel 4)) order of the Board of Health. Failure to correct violations 24. Food and Food Protection (FC-3)(590. cited in this report may result in suspension or revocation of 25. Equipment and Utensils (Fc-a)(sso.00 )oos) 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 8. Poisonous or Toxic Materials (FC-7)(590.008) and submitted to the Board of Health at the above address 29. Special Requirements (590.009) within 10 days of receipt of this order. 30. Other DATE OF RE-INSPECTION: (�/ 5:590M5pecl or -14.p /Q T ��/^`(//v 1 Inspector's Signature: Print: PIC'sSignature: ! age ! V=i - � I r , Violations Related to Foodborne Illness r Interventions and Risk Factors(items 1-22) PROTECTION FROM CONTAMINATION $ Cross-contamination FOOD PROTECTION MANAGEMENT 3-302.1](A)(1) Raw Animal Foods Separated from 1 590.003(A) Assigtmento' Responsibility* _ Cooked and RTE Foods*590.003(B) Demonstration of Knowledge* Contamination from Raw Ingredients 2-103.11. Person in charge-duties 3-302.11(A)(2) Raw Am and Foods Separated from Each Other* EMPLOYEE HEALTH Contamination from the Environment 2 590.003(C) Responsibility of the person in charge to 3-302.11(A) Food Protection* require reporting by food employees and 3-302.15 Washing Fruits and Vegetables applicants* 3-304.11 Foal Contact with Equipment and 590.003(F) Responsibility Of A Food Employee Or An Utensils* Applicant To Report To The Person In - Contamination from the Consumer Charge* 3-306.14(A)(B) ,Returned Food and Reservice of Food* 590.003(G) Reporting b Person in Charge" 3 590.003(D) Exclusions and Restrictions* Disposition of Adulterated or Contaminated Food 590.003(E) Removal of Exclusions and Restrictions 3-70111 Discarding or Reconditioning Unsafe FOOD FROM APPROVED SOURCE Food* 4 Food and Water From Regulated Sources F 9 Food Contact Surfaces 590.004(A-B) Compliance with Food Law* 4-501.1.11 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 3-202.33 She11Eggs* 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 W ater from an Approved System* 4-601.11(A) Equipment Food Contact Surfaces and 590.006(A) Bottled Drinking Water' Utensils Clean- 4-602.1 t lean*4-602.11 Cleaning Frequency ofEquipment Food590.006(B) Water Meats Standards in 310 CMR 22.0* ShelBish and Fish From an Approved Source Contact Surfaces and Utensils* 4-702.11. Frequency of Sanitization of Utensils and - 3-201.14 Fish and Recreationally Caught Molluscan ' Food Contact Surfaces of Equipment* Shellfish* 4-703.11 Methods of Sanitization-Hot Water and 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* Sources* l0 Proper,Adequate Handwashing Gene and Willi Mushrooms Approved by Regulatory Authority Clean Condition-Hands and Arms* 3-202.1.8 ShcllstockldentificationPresent* 2-301.12 Cleanina Procedure* 590.004(C) Wild Mushrooms* 2-301.14 When to Wash* 3-201.17 Game Animals* Il Good Hygienic Practices 5 ReceivinglCondition 2-401.11 Eating,Drinking or Using Tobacco* 3-202.11. PHFs Received at Proper Tem eratures* 2-401.12 D.ischuges From the Eyes,Nose and. 3-202.15 Package Integrity* Mouth* 3-101.11 Food Safe and Unadulterated* 3-301.12 Preventing Contamination When Tasting* 6 Tags/Records:Sheiistock 12 - Prevention of Contamination from Hands 3-202.18 Shellstock Identification* 590.004(E) Preventing Contamination from 3-203.12 Shellstock Identification Maintained* ?6-301. Ent to yes* Tags/Records:Fish Products Handwash Facilities 3-402.11 Parasite Destruction* Conveniently Located and Accessible 3-402.12 Records.Creation and Retention* Numbers and Capacities* 590A04O) Labeling of Ingredients' Location and Placement* 7 Conformance with Approved Procedures Accessibility,Operation and Maintenance /HACCP Plans Supplied with Soap and Hand Drying 3-502.11 Specialized Processing Metbods* Devices 3-502.12 Reduced oxygen acka 'ng.criteria* Handwashin Cleanser,Availability 8-103.12 Conformance with Approved Procedures* Hand Drying Provision a Denotes critical item in the federal 1999 Food Cale or 101 CMR 590.0(10. - 1 it CITY OF SALEM BOARD OF HEALTH Establishment Name: ° l- 'q4_' i-' r' - Date: '�1061_ 1/ i Page: of Item code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date No. Reference R-Red Item E Vernfed PLEASE PRINT CLEARLY `! Cr ur h i.i { r n VI f v _YZ r F Fti+ w a Discussion With Person in Charge: Corrective Action Requlred: ❑ No Yes I have reaflhis report, have had the opportunity to ask questions and agree to correct all Voluntary Compllance ❑ Employee Restriction/ Exclusion r 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, ood 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 p Other. 3-501.WiC) PHFs Received at Temperatures Violations Related to Foodborme 0iness interventions and Risk According to Law Cooled to Awlars(itetns 1-22) (Cont) 4t'Ff45°F Within Hours. * 3-501.15 Coolin Methods fir PHFs PROTECTION FROM CHEMICALS orColor A 19 PHF Not and Cold Holding 14 Food or Galar Additives 3-202.12 -rAdditives* 3-501.16(B) Cold PRFs Maintained at or below 3-302.14 Protection from Unapproved Additives* 590.004(F) 410115'F* 15 Poisonous or Toxic Substances 3-501.16(A) Hot PHFs Maintained at or above 14GP. * 7-101.11 Identifying Information-Original 3-501.16(A) Roasts Held at or above 130'F. Containers* 70 7-102.11. Common Name-WorkingContainers* Time as a Public Health Contras 7-201.11 S araiion-Storae* 3-501.19 Time as a Public Health Control' 7-202.11 .Restriction-PresenceandUse* 590.004(H) Variance Requirement 7-202.12 Conditions of Use* OPONS HSP 7-203.11 Toxic Containers-Prohibitions* PU1REME S FOR HIGHLY SUSCEPTIBLE Sanitizers.Criteria-Chemicals* POPULATI - 7-204.12 Chemicals fur WashingProdure,Criteria* 29 3-801.1l(A) Uevmees wit Pre-packaged else and 7-204.14 in encs,Criteria' .Use of es with V l Eggs*Zabels* 7-205-11 Incidental Food Contact,Lubricants* 3-801.11(B) Use of Pasteurized 8 * . 7-206.11 Restricted Use Pesticides,Criteria* 3-801.11(D) Raw or Partially Cooked Animal Food and Rau Seed Sprouts Not Served. 7-206-12 - . Rodent Bait Stations* 3-801.11(C) Unopened Food Parka Not Re-served. 7-206.13 Tracking Powders,Pest Control and Momtorin * CONSUMER ADVISORY____ - TIME/TEMPERATURE CONTROLS 22 3-603.11 Consumer Advisory Posted for Consumption of g6 Proper Cooking Temperatures for Animal Foods That arc Raw.Undercooke d or PHFs Not Otherwise-Pnx�essed to Eliminate Pathogens,'EXe evs to i 3401.11A(t)(2) Eggs- 155"F15 Sec. Etas-immediate Service 145°F15seca 3-302.13 1 Pasteurized Eggs Substitute for Raw Shell 3-401.11(A)(2) Comminuted Fish.Meats&Game Eggs' Animals-155°F 15 sec. * SPECIAL REQUIREMENTS 3.441.11(B)(1)(2) Pork and Beef Roast- 130'2'121 min* 3.401.110)(2) Ratites,In}oned Meats-155'F 15 590.009(A)-(D) Violations of Section 590.009(A.)-(D)in sec. * catering, mobile food,temporary and 3-401.1 l(A)(3) Poultry,Wild Game,Stuffed PHFs, residential kitchen operations should be Staffing Containing Fish,Meat, debited under the appropriate sections Poultry or Ratites-765'F 15 sec. * above if related to foodborne illness 3-401.11(C)(3) Whole-muscle,law Beef Steaks interventions and risk factors. Other 145°F* 590,009 violations relating to good retail 3-401.12 Raw Animal Foods Cooked in a practices should be debited ander#29- Microwave 165°F* Special Requirements. 3-401a l(A)(1)(b) All Other PRFs-145'F 15 sec.* I7 Reheating for Hot Holding VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 3-403.41(A)&(D) PHFs 1657 15 sec. * (Items 23-30) 3403.11(B) Microwave- 165`F 2 Mmute Standing Critical,and non-critical'violations, which do not:elate to the Time* foodborne illness interventions and risk factors listed above, can be 3-40111(C) Commercially Processed RTE Food- found in the following sections of the Food Cade and 105 C83R 140°F* 59(1.000. 3-401 J 3.11(E) Remaining Unsliced Portions of Beef #am i Good Retail Araclices i FC I.$90.000 _ Roasts* 1 23_ I Management and Pntsonriel FC-2 .003 18Proper Cooling of PHFs 1 24. ! Fwd and Food Protection I FG-3 .004 1 25. Equipment and Utensils I FG-4 .005 i 3-501.14(A) Cooling Cooked PHFs from 140`F to 26 ~Water.Plumbing and Waste j FC-5 .006 70°F Within 2 Hours and From 70'F 27. i Physical Facility - FG-6 007 to 41`2145017 Within 4 Hours. * i 28_ ` Poisonous or Toxic Materials ' FO-7 .008 3-501.14(B) Cooling PHR Made From Ambiens L(�9_ -Special R urremems - ,009 Temperature ingredients to 41'F145°F 30, i dn' ------- -- Within 4 hours* Deno(s crifeal lam in the L-deral 1999 Fux)Cale or 105 0411 590.00,0. - Massachusetts.-Department A Public Health Sala Board of Health( 1120 Washington Street,0 Floor Division of Food and Drugs I Salem, MA 01970-3523 FOOD ESTABLISHMENT INSPECTIONiREPORT'` .r Tel. (978)741-1800 Fax(978) 745-0343 : Name Dat Tvoe of Ooeration(s) Type of Ins I n S t ood Service Routine Address RlsLJ Retail Re-inspection Sihnf- � $ Level ❑ Residential Kitchen Previous Inspection Telephone 5 � El Mobile Dater Z( Owner '❑ Temporary El Pre-operation y O HA Y N ❑ Caterer El C it Bed&Breakfast ❑ Geneeral Complaint ct Illness Person in Charge(PIC) -' Time ❑ p a In: 1;�_ ElHACCP Inspector �- C,_ Permit No. ❑Other Each violation checkbd requires an explanation on the narrativ a page(s)and a citation of specific provislon(s)violated. / Non-compliance with: Violations Related to Foodborne Illness Interventions and Risk Factors Anti-Choking Tobacco Violations marked may pose an imminent health hazard and(require immediate corrective 590.009(E) E] 590.009(F) ❑ action as determined by the Board of Health. l [FOOD PROTECTION MANAGEMENT ❑ 12. Prevention of Contamination from Hands ❑ 1. PIC Assigned/Knowledgeable/Duties El EMPLOYEE HEALTH ' 13. Handwash Facilities _- - - -- - .PROTECTION FROM CHEMICALS ❑ 2. Reporting of Diseases by Food Employee and PIC [114.Approved Food or Color Additives ❑ 3. Personnel with Infections Restricted/Excluded ❑ 15.Toxic Chemicals FOOD FROM APPROVED SOURCE_ _. . TIMET EMP- - ❑ 4. Food and Water from Approved Source ERA7URE 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 ❑ 1 B.Cooling PROTECTION FROM CONTAMINATION , '19. HO and Coed Holding ❑ 8. Separation/Segregation/Protection 1 ❑l 20.Time As a Public Health Control 9. Food Contact Surfaces Cleaning and Sanitizing - REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS.(HSP)i a ❑21. Food and Food.Preparation for HSP ❑ 10. Proper Adequate Handwashing ❑ 11. Good Hygienic Practices r66NS6MER ADVISORY= � = " +� ❑22. Posting of Consumer Advisories Violations Related to Good Retail Practices Number of Violated Provisions Related Critical (C) violations marked must be corrected To Foodborne Illnesses Interventions immediately or within 10 days as determined by the Board and Risk Factors(Items 1-22): of Health. Non-critical (N)violations must be corrected Official Order for Correction Based on an inspection immediately or within 90 days as determined by the Board today, the items checked indicate violations of 105 CMR of Health. 590.000/federal Food Code. This report, when signed below c x by a Board of Health member or its agent constitutes an 23. Management and Personnel (FC-2)(590.003) order of the Board of Health. Failure to correct violations 24. Food and Food Protection (Fc-3)(990.004) cited in this report may result in suspension or revocation of 25. Equipment and Utensils (FC-4)(590.005) the food establishment permit and cessation of food 26. Water,Plumbing and Waste (FC-5)(590.006) establishment operations. If aggrieved by this order, you 27. Physical Facility (FC-6)(590.007) 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 thi&order. 30. Other DATE OF RE-INSPECTION: s:5901nspe omr 14.04 V' U"•` ` ` . Inspector's Signature: Print: PIC<s'S" ature:., Print: n �� !'4 OCr ! J Pageof ages /-' 1 Violations Related to Foodborne Illness Interventions and Risk Factors(items 1-22) PROTECTION FROM CONTAMINATION 8 Cross-contamination FOOD PROTECTION MANAGEMENT 3-302.11(X)(1- Raw Animal Foods Separated from 1 590.003(X) Assignment of Responsibility* � Cooked and RTE Fards* - 590.003(B) Demonstration of Knowledge Contamination from Raw ingredients 2-103.11 Person in charge-duties 3-302.11(A)(2) Raw Animal Foods Separated from Each Other* EMPLOYEE HEALTH Contamination from the Environment 2 590.003(C) Responsibility of the person in charge to 3-302.11(A) Food Protection* require reporting by food employees and 3.302.1.5 WashingFruits and Vegetables applicants* 3-30411. Food Contact with Equipment and 590.003(F) Responsibility Of A Faxl.Employee Or An Utensils* Applicant To Report To The Person In - Contamination from the Consumer Charge* 3-306.14(A)(:B) Returned Food and Reserviee of Food* 590.003(G) Reporting b Person in Charge* 3 590.003(D) Exclusions and Restrictions* - Disposition of Adulterated or Contaminated Food 590.003(E) Removal of Exclusions; Restrict ons 3-70111 Discarding or Reconditioning Unsafe FOOD FROM APPROVED SOURCE Food* 4 Food and Water From Regulated Sources 9 Food Contact Surfaces 590.004(A-B) Compliance with Food law* 4-501.111 Manual Warewashing-Hot Water - 3-201.1.2 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 F,,gs and Milk Products.Pasteurized* 4-501.114 Chenncal 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* 4-602.1.1 Cleaning Frequency of Equipment Food- Contact Surfaces and Utensils* Shellfish and Fish From an Approved Source 4-70111 Frequency of Sanitization of Utensils and 3-201.14 Fish and RecreadouaBy Caught Molluscan Food Contact Surfaces of Equipment* Shellfish* 4-703.11 Methods ofSanitizatign-Hot Water and 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* Sources* 10 Proper,Adequate Handwasning Game and Wild Mushrooms Approved by RMatoAuthorX 2-301,11 Clean Condition-Hands and Arms* e 3-202.18 Shelistock 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 Irate it * Mouth* 3-101.11. Fwd Safe and Unadulterated* 3-301.12 -Preventing Contamination When Tasting* Tags/Records:Shelistock 12 Prevention of Contamination from Hands 3-202.18 Shellstock Identification* 590.004(E) Preventing Contamination from 3-203.12 ShellstockldentificationMaintained" ..Employees* 13 Tags/Records:Fish Products Handwash Facilities Conveniently Located and Accessible 3402.11 Parasite Deserttction* 3-402.1.2 Records.Creation and Retention* 5-203.11 Numbers and Capacities* 590.004(T) 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. S ecialized Processing Meth(xts* Devices 3-502.12 Reduced oxygen acka hg.criteria" 6-301.11 Handwashing Cleanser,Availability 8-103.12 Conformance with Approved Procedures* 6301.12 Hand Drying Provision (< Denotes critical nein in the federal 1999 hood Code or 10 CbIR 590.(100. s CITY OF SALEM BOAR OF HEALTH Establishment Name: U r Date: Pager_ of Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLANr F CORRECTION Date No. Reference R-Red Item Verified PLEASE PRINT CLEARLY r In -4.1 - cA4 7EJ 1�Jar (c, I - aTV Da. �AP� n �(er i c ic:fun'-f it/ r,,c4- _ r r A Rc . G .l I n r , t S-_ r= I r r ,c) �s rid Discussion With Person in Charge: Corrective Action Required: ❑ No Yes I have read this report, have had the opportunity to ask questions and agree to correct all ❑ Voluntary Compliance ❑ Employee Restriction/ violations before the next inspection, to observe all conditions as described, and to Exclusion P Re-inspection Scheduled ❑ Emergency Suspension comply with all mandates of the Mass/Federal Food Code. I understand that noncompliance may result in daily fines of twenty-five d Ila or suspension/revocation of ❑ Embargo ❑ Emergency Closure your food permit. -- 0 Voluntary Disposal ❑ Other. 501.14(C) PRFs Received at Temperatures Violations Related to Foodborne dttness tnterrentlons and Risk According to Law Cooled to Factors(Items 1-22) (Cont.) 41'F145°F Within 4 Hours. PROTECTION FROM CHEMICALS 3-501.15 Cooling Methods for PHFs 19 PHF Hot and Cold Holding 14 . Food or Calor Additives - 3-501.16(B) Cold PRFs Maintained at or below 3-202.12 Add rives* 590,0"" 411450 F* 3-302.14 Protection frown Una roved Additives° 3-501.16(A) Hot PRFs Maintained at or above 15 Poisonous or Toxic Substances 140°F. * 7-101..11 identifying Information-Original 3-501.16(A) Roasts Field at or above 130'F.* Containers* Time as a Public Health Control 7-102.11. Common Name -Working Conuamets* 20 * 3-501.4( Time a5 a equiHealth Cnntrcd* 7-201.11 Separadon-Storage 7-202.11 .Restriction-Presence and-Use° 590.Op4{H) Variancessirement 7-202.12 Conditions of Use* REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-203.11 Toxic Containers-Prohibitions* POPUI A71OHS HSP 7-204.11 Sanitizers.Criteria-Chemicals* 7-204.12 Chemicals for Washing Produce,Criteria' 2i 3-801.11(A) Unpasteurized Pre-packaged Juices and Beverages with Warning labels* 7-204.14 n encs.Criteria' 3-801.11 13) Use of Pasteurized Eggs* 7-245.11 Incidental Food Contact,Lubricants* 3-801.1 I(D) Raw or Partially Cooked Animal Food and 7-206.11 Restricted Use Pesticides,Criteria* Ran°Seed Sprouts Not Served,* 7-206.12 Rodent Bait Statltms* 3-801.11 C Urnifteneil Food Package Not Re-served. 7-205.13 Tracking Pawdets,Pest Control and Monitatin * CONSUMER ADVISORY TIME7TEMPERATURE CONTROLS 22 3-603.11 1 Consumer.adiisory Posted for Consumption of 16 Proper Cooking Temperatures for Animal Foods That are Raw.Undercooked or wi PHFs Not Otherse-Processed to Eliminate _ Patlro yens.*e`°`s,,,,nnart 3-401.11A(l)(2) Eggs- 155F 15 See. Eggs-immediate Service 145`F15sec* 3-302.13. Pasteurized Eggs Substitute for Raw Shell 311111.11(A)(2) Comminuted Fish.Meats&Game E Anirnals-155'F 15 sec.* SPECIAL REQUIREMENTS 1401.11(B)(I)(2) Pod:and Beef Roast-130°F 121 min* 590.009(A)-(D) Violations of Section 590.009(A)-(D)in 3-441.11(A)(2) Ratites,Injected Meats-155`F 15 entering,mobile food,tetttpocary and sec. * 3-401.1.1(A)(3) Poultry,Wild Game.Stuffed PHFs, residential kitchen operations should be Stuffing Containing Fish,Meat, debited under the appropriate sections Poultry or Ratites-.165'F 15 see, * above if related to foodborne illness 3-401.11(C)(3) Whole-muscle,litw Beef Steaks interventions and risk factors. Other 145°F t` 590.009 violations relating to good retail 3-401.12 Raw Animal Foods Cooked in a practices should be debited under#29- Mierowave 165'F* - Special Requirements. 3441.11(A)(1)(b) All Other PHFs--145'F 15 sec.° 17 Reheating for Hot Holding VIOLA77ONS RELATED TO GOOD RETAIL PRAC77CES 3403A I(A)&(D) PHFs 165-F 15 sec. * (Items 23-30) 3403.11(B) Microwave 165`F 2 Minute Standing Critical,and non-critical violations,which do not relate to the 'pine* - - foodborne illness interventions and risk factors listed above,can be 3403.11(C) Commercially Processed RTE Food- found in the following sectionsofthe Food Code and 105 CMR 1400F* 590.000. 3-403.11(E) Remaining Unsliced Portions;of Beef 1Item I Good Retail Practices i FC - �.590.000 i Roasts* 223. _ i Management and Personnel FG-2 .003 I lg Proper Cooling of PHFs '4. i Food and Food Protection FC-3 .004 126. i Equipment and Utensils _ I FC-4 .005 j 3-541.24(A) Cooling Cooked PHFs from 140`F to ; 26, 1 Water.Plumbing and Waste 1 FC-5 .006 70'F Within 2 Hours and From 70'F 27, I Physical Facility FC--6 ! .007 to 41`F145'F Within 4 Flours.* i 28. Poisonous or Toxic Materials FC-7 .008 i 3-501.14(B) Cooling PHFs Made From Ambient 29. Special Requirements - .009 Temperature Ingredients to 41'FI45'F 30. i Other Within 4 Hours* s_*'""`�'c` *Denoces critical i:en,in the fades] 1999 Fc d Cale m'105 C.MR 590.000. r } CITY OF SALEM BOARD OF HEALTH I Establishment Name: G Date: U L ( Page: q of / Rem Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date No, Reference R-Red Item Verified / PLEASE PRIN CLEARLY LJ r 1(2D h a. si kv c 14,0 f ✓I 3:)Lir u >' I_ (Z ndpc ! l 7 at 1 f 9 jh 0j y' - O� Discussion With Person in Charge: Corrective Action Required: o No ❑ Yes Voluntary Compliance ❑ Employee Restriction ' / I have read this report, have had the opportunity to ask questions and agree to correct all / violations before the next ins ection, to observe all conditions as described, and to Exclusion P fde-inspection Scheduled ❑ Emergency Suspension comply with all mandates of the Mass/Federal Food Code. I understand that noncompliance may result in daily fines of twent'-five dollars or suspension/revocation of c3 Embargo ❑ Emergency Closure your food permit. / F r L ❑ Voluntary Disposal ❑ other: is 1 3.501.14(0 PHFs Received at Temperatures Violations Related to Foodborne fitness intermntions and Risk According to Law Cooied to Factors litems 1-22) (Cont) 41'Fi45°F Within 4 Hours. CHEMICALS 3-501,15 CoolingMethodsfor PHFs PROTECTION FROM Additives 19 PHF Not and Cold Holding 14 Food CH ar ColorCHEMICALS 3-501-16(B) Cold PRFs Maintained at or below 3-202.12 Additives* _ 590.004(F) 4101450 F* 3-302.14 Protection from Unapproved Additives* 3-501.16(A) Hot PRFs Maintained at or above 15 Poisonous or Toxic Substances 140 * 7-101.11 Identifying Information-Original 3-501.16(A) Roasts Held at or above 130'F." Containers* - Time as a Public Health Control 7-102.11. Common Name-Workma Contamersr 20 3-501:19 Time as a Public mento Control* 7-20IA1 Separation-Storage* 594.004(H) Variance 7-202.11 .Restriction-Presenceand Use' es Requirement 7-202.12 Conditions of Use* REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-203.11 Toxic Containers-Pmhibititms* POPULATIONS HSP 7-204.11 Sanitizers,Criteria-Chemicals" °••--- 21 3-801. 1.1(A) Unpasteurized Pre-packaged Iuices and 7-2{)4,1.2 Chemicals for Washing Produce,Cctteria' 7-204.14 Drying,t Agents.Criteria* Beveratres with W'arttin2 Labels* - - 3-801.1IfB) -Use of Pasteurized Eggs* 7-205.11 Incidental Food Contact,Lubricants* 3-801-II(D) Raw or Partially Cooked Animal Food and 7-206.11 Restricted Use Pesticides,Criteria* Raw Seed Sprouts Not Served. 7-206.12 Rodent Bair Stations* 3-801.11(C Unopened Food Package Not Re-served. " 7-206.I3 Tracking Powders,Pest Coated and Monitorin * - CONSUMER ADVISORY TIMEIFEMPERATURE CONTROLS 22 3-603.11 Consumer Advisory Posted for Consumption of 26 Proper Cooking Temperatures for Animal Foods That are Raw,Undercooked or Not Otherwise,Processed to Eliminate PHFs - Pathogens" Er«e.e�nazn 3401,11A(1)(2) Eggs- 155`F 15 Sec. Eggs-Immediate Service 145°F15sec* 3-302.13 1 Pasteurized Eggs Substitute for Raw Shell E * 3-401.11(A)(2) Comminuted Fish.Meats&Game fmfira is-155'F 15 sec.* SPECIAL REQUIREMENTS 3-401.I1(B)(1)(2) Pork and Beef Rowt-130°F 121 min* 3-401.11(A)(2) Ratites,Injected Meats-155`17 15 590.044(A)-(D) Violations of Section 590.{)09(A)-(D)in sec * catering, mobile food,temporary and 3-401.1I(A)(3) Poultry,Wild Game,Stuffed PHFs, residential kitchen operations should be Stuffing Containing Fish,Meat, debited under the appropriate sections Poultry or Ratites-165'F 1.5 sec. * above if related to foodborne illness 3-401.11(C)(3) Whole-mascle,Intact Beef Steaks interventions and risk factors. Other 145°F x 590.009 violations relating to good retail 3-401.12 Raw Animal Fords Cooked in a practices should be debited under#29- Microwave 1657* Special Requirements. 3-40LII(A)(1)(b) All Other PHFs- 145F 15 sec. 17 Reheating for Hot Holding VIOLA77ONS RELATES TO GOOD RETAIL PRAC77CES 3403.11(A)&(D) PHFs 16S'F 15 see. * (Items 23-30) 3-403.11(B) Microwave-'16,5`F 2 Minute Standing Critical,and non-critical violations,which do not relate to the Time* foodborne illness interrenttans and risk factors listed above, carr be 3-403.11(C) Commercially Processed RTE Food- found in the following sections of the Food Code and 105 CMR I44°F* 590.000. 3-403.11(E) Remaining Unsiiced Portions of Beef Dwm % Good scroll Practices .FC 1.690.000 Roasts* ( 23__, ! MwMment and Personnel I FC-2 .003 1 1 g Proper Cooling of PHF$ 1 24, i FoW and Food ProtectionFC--3 .004 1 25, 1 Equipment and Utensils A FG-4 .005 j 3-501A,I(A) Coaling Cooked PHFs from 140`F to 26, I Water.Piumbinq and Waste i FC-5 .006 1 70°F Within 2 Hours and From 74°17 27. Ph sical Facility FC-6 007 to 41`F/45°F Within 4 Hours. * i 28. ' Poisonous or Tante Materials FC-7 008 3-501-14(8) Cooling PRFs Made From Ambient ~29. SpecialRequirements_ - .009 Temperature Ingredients to 41'17/45°F " 30. j Other I _ Within 4 Hours* 'Denotes critical tum in the f-decal 1999 FwA Cale w 105 C IZ2 90.[)X J 1 { I f CITY OF SALEM ABOARDOF HEALTH / Establishment Name: � '�G�� V 1pS�ui/ii✓ A, Date: it Page:_ of Item code c-critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date- No. Reference R-Red Item Verified PLEASE PRINT CLEARLY . lo f I a TO 1. 5 0 7,A JR G V09 n 1, u Lvi NQS&i r n , v I G G4'J UP d C h /71 r"jn , .1Pi I .(l l u, .Q its(f i ) lily ; 2e�ter- 74�21 .0 J Discussion With Person in C arge: 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/ 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. / ' �/L ❑ Voluntary Disposal ❑ Other: l 3-501.t4(C) PHF%Received at Temperatures Vlotatlons Related to Foodborne Illness Interventions and Risk According to Law Cooled to Factors(Merns7-P2) (Cont.) 41'Fl45°F Within 4 Hours. PROTECTION FROM CHEMICALS 3-501..15 Conlin Methods for PHFs 14 Food or Color Additives 19 PHF Hot and Cold Holding 3-202.12 Additives* 3-50I16(B) Cold PHF*Maintained at or below 3-302.14 Protection from tlua 590.004(F) 4lf45°F roved Additives* 3-501.16(A) Hot PHFs Maintained at or shove r Toxic b nces 1g Poisonous a o c 5u ate 140°F. 7-101,11 Identifying Information-Original 3-501.16(A) Roasts Held at or above 130'F. Containers" - 20 Time as a Public Health Control 7-102.11. Common name-Working Containers* - a, 3-501:14 Time as a Public Health Control" 7-201.11 Separation-Stora 7-202.11 .Restriction-PresenceandUse* 590.004(H) Varianceuirement 7-202.12 Conditions of Use* REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-203.11 Toxic Containers-Prohibitions* POPULATIONS HSP - 7-204.11. Sawrizers.Criteria-Chemicals* 7-204.12 Chemicals for Washin Produce,Criteria* 27 3-801.11(A) Unpavtcuriaed Pre-packaged Juices and .Beveraues with Warning Labels* 7-204.14 Agents.Contac* 3-MLII(B Use of Pasteurized E 7-205.11 Incidental Food estrfact,Lubricants* 3-801.I I(D) Raw or Partially Cooked Animal Food and 7-206.11 Restricted Use Pesticides;Criteria* Raw Seed Sprouts Not Served. 7-206.22 1 Rodent Bait Stations# 3401.11(C) Unopened rood Package Not Re-served. 7-206.13 Tracking Powders,Pest Control and Monitarmex. - CONSUMER ADVISORY TIMEITEMPERATURE CONTROLS 22 3-603.11 I Consumer Advisnty Posted for Consumption of Animal Foods That are Raw.Undercooked or lb Proper Cooking Temperatures for Not Otherwise Processed to Eliminate PHFs _ 3-401.1IA(1)(2) Eggs- 1557 15 See. Patho+ens.* Eggs-immediate.Service 145'Fi5sec* 3-302.13. 1 Pasteurized Eggs Substitute for Raw Shell 3401.11(A)(2) Comminuted Fish.Meats&Game E :Animals-155'F 15 sec.* SPECIAL REQUIREMENTS 3-401.11(11)(1)(2) Pork and Beef Roast- 13TF 121 min* 3-401.11(A)(2) Ratites, Injected Meats-155°F 15 590.009(A)-(D) Violations of Section 590.009(A)-(D)in see.* catering, mobile food,temporary and 3-401.1.1(A)(3) Poultry,Wild Game,Stuffed PHFs, residential kitchen operations should be Stuffing Containing Fish,Meat. debited under the appropriate sections Poultry or Ratites-1650F t5 sec. * above if related to foodborne illness 3-401.11(C)(3) 1 Whole-muscle,Intact Beef Steaks interventions and risk factors. Other 145OF* 590.009 violations relating to goon retail 3-401.12 Raw Animal Foods Cooked in a practices should be debited under#29- Microwave 165'F* Special Requirements. 3.401:11(A)(1)(b) All Other PHFs- 14S"F 15 sec. 17 Reheating for Hat Holding VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 3-403A I(A)&(D) PIFs 165"F 15 sec.* (Items 23-30) - 3-403.11(B) Microwave- 165`F 2 Minute Standing Critical,and non-critical violations,which do not relate to the Thme* foodborne illness interventions and rish,facrors listed above, can be 3403.11(C) Commercially Processed RTE Food- found in the following sections.of the Food Code and 105 Cd4R 1400F* 590.000. 3-403.11(E) Remaining Unsiiced Portions of Beef j Item ! Good Retail Practices i .FC 590.000 Roasts* j 23. ! Management andPersonrtel _ FC-2 .00.3 .i 1g Proper Cooling of PHFs 1 24. 1 Food and Foal Protection FC-3 .004 i 28. { Equipment and Utensils I FC-4 .005 3-501.14(A) Cooling Cooked PHF%from 140°F to i 26, j Water.Plumbing and Waste i FC-5 .006 70'F Within 2 Hours and From 70'F ( 27. 1 Physical Facility FC-6 W7 to 41'F/45'F Within 4 Hours. * 1 28.--�'�Poisonous a Toxic Materials FC=7 .048 3-501.14(B) Cooling PRFs Made From Ambient 29. �peciai Roquirements .009 i t Temperature Ingredients to 41 017/45°F 30, I Other Within 4 H(xem* Denotes m ieai nem in the federal 1999 FwA Code a'103 C-MR. 90.000. x, �•" -Commonwealth of Massachusetts ' n City of Salem _ ' Board of Health Kimberley Driscoll Mayor 4 1120 Washington Street,4th Floor SALEM,MA. 01970 4 � f Food/Retail EstablishmentPermlt =` A DATE PRINTED: 12/05/2012 e3 ESTABLISHMENT NAME: Great Escape Restaurant File Numbs' BHF-2010-000051 ,ta '>50 Saint Peter Streetsr'- - SALEM N, MA 01970 = x LOCATED�AT: y SALEM, MA 01970 >_ . Permit Type Permit No. Permit Issued Permit Expires `Fee Restrictions/Not rmes ,, FOOD SERVICE BHP 2063 Dost Jan 1,2013 '_:Dec 31,201'3 $420.00 ESTABLIS11MENT1 A g Total Fees $420.00 _ , :i, Ah • iY a; 4` ak icy` 5+. p e e A. A PERMIT EXPIRES December 31, 2013 ,. Board of Health .$ . } ID � t This Permit is not transferable+and must be'reissued upon change of ownership or location.The permit must be posted , in a prominent location in the'Establishment.` In accordance with the State Sanitary Code,beofre any;rev onations,improvements,or equipment ehanges are made, all plans for such must be submitted to and approved by the Salem Board of Health. e Page f ' . L +> r CITY OF SALEM, CE'VC.6gASSACHUSETTS PC Ith. "'RD of He:Ar:1-i FJOOR KIMBERLEYDRISCOLL z01?TI-111.(9 ` 78)741-1800 FAX )78)945-0343• LARRY RAMI)IN,RS/,Rlil-1'S,CHp,C] I S MAYOR CITY OF SALEM Iramdin(cdsalem.com Hf3AlAlf AC ENI BOARD OF HEALTH Food Establishment Permit Application (Application must be submitted at least 30 days before the planned opening date) 1) Establish ment Name: ��Cj Qyr�p c-pv c eM c CSc ' 2) Establishment Address: E,p 5WI°id 1 Pi�tir- 5a ct/ 3) Establishment Mailing Address(if different): 4) Establishment Telephone No: q-7 sr- V"- A 51 Applicant Name&Title: I Cc- +05 ` 6 -S a et C4 6) Applicant Address: 7) Applicant Telephone No: 78 7•/ G124 Hour Emergency No: Email:CVCX4keSC1t0e (r 8) Owner Name&Title(if different from applicant): ,vw4t.e0 • cc,f7) 9) Owner Address(if different from applicant): 10) Establishment Owned by: 11) If a corporation or partnership,give name,title and home address of officers or partner. An association Name Title Home Address cornnca An individual ✓•ate" �,,.+V e, 5 f�YMd o C49r' A partnership Other legal entity 12 Person Directly Responsible For Daily Operations Owner, Person in charge, Supervisor,Manager,etc. Name&Title: �! 11 tw e,7— Address: b \ J �L{�J Telephone No: 7$- $ (pq- Ya-,)( Fax: 78-7Y5'So G;Email: C m y4L.0 • c ol�1 Emergency Telephone No: F1' $(a q • a a b 13) District or Regional Supervisor(if applicable) Name&Title: Address: Telephone No: Fax: Email: Check#: �S V Date: /�/7 y /Z Amount: Food Establishment Information 14) Water Source: ci d-y 15) Sewage Disposal: v DEP Public Water Supply No: ( if applicable) G rte/ 16) Days and Hours of Operation: 7R y ,,t 17) No. of Food Employees: ods 18) Name of Person in Charge Certifie in Food Protection Management: Required as of 10/1/2001 in accordance with 105 CMR 590.003(A) `� A ✓ put c L 19) Person?rained in Anti-Choking Procedures(if 25 seats or more): Yes No 20) Location: 22) Establishment Type(check all that apply) heck one ❑ Retail ( Sq. Ft) ❑ Caterer Permanent Str LrFood Service-( 14a- Seats) ❑ Frozen Dessert Manufacturer Mobile ❑ Food Service-Takeout ❑ Residential Kitchen for Retail Sale ,O Food Service-Institution ❑ Residential Kitchen for Bed and ( Meals/Day) Breakfast Home ❑ Food Delivery ❑ Residential Kitchen for Bed and 21) Length Of Permit: ------------------------------------------------------------------------------Breakfast Establishments eck one) RETAIL STORE RESTAURANT nnuatl ❑ Less than 1000sq.ft. $70 ❑ Less than 25 seats $140 Seasonal/Dates: 13 1000-10,000sq.ft. $280 ❑ Residential Kitchens $140 ❑ More than 10,000sq.ft. $420 1125-99 seats $280 §More than 99 seats $420 Temporary/Dates/Time: 0-- --------Brea - - -- er-c -- --/Nursing-- -- e-------------------------------------- ---------- ----- ❑ Bed R BreakfasUChildcare Services/Nursing Home $100 ------------------------------- - __.---------------------------------------------------------------- ADDITIONAL PERMITS ❑ MAKE ICE CREAM, YOGURT/SOFT SERVE $25 ❑ PASTURIZATION $25 ❑TOBACCO VENDOR $135 ❑ALL NON-PROFIT $25 Including, church kitchens, state funded childcare&private clubs) 23) Food Operations: Definitions: PHF—potentially hazardous food(time/temperature controls required) Non-PHFs—non-potentially hazardous food(no time/temperature controls required) check all that apply): E—_ - at foods(Ex.sandwiches,salads, muffins which need no further processing Sale of Commercially PHF Cooked to Order Hot PHF Cooked and Cooled or Hot Held Pre-packaged Non-PHFs for More Than a Single Meal Service Sale of Commercially . Preparation of PHFs For Hot And PHF and RTE Foods Prepared For Highly Pre-packaged PHFs Cold Holding for Single Meal Service Susceptible Population Facility Delivery of Packaged PHFs Sale of Raw Animal Foods Intended to be Vacuum Packaging/Cook Chill Prepared by Consumer Reheating of Commercially. Customer Self-Service Use of Process Requiring A Variance Processed Foods for and/or HACCP Plan (including bare hand Service Within 4 hours contact alternative,time as public health control. Customer Self-Service of Ice Manufactured and Packaged for Offers Raw or Undercooked Food of Non-PHF and Non- Retail Sale Animal Origin Perishable Foods Only Preparation of Non-PHFs Juice Manufactured and Packaged for Prepares Food/Single Meals for Catered Retail Sale -Events or Institutional Food Service Offers RTE PHF in Bulk Quantities • '' - To be completed by the Board of Health Retail Sale of Salvage,Out of Date or Reconditioned Food Total Permit Fee: Payment is due with application I,the undersigned,attest to the accura of the information provided' this application and I affirm that the food establishment operation will comply with 105 CMR 590.000 and a other applicable law. I a e `n instructed by the Board of Health on how to obtain copies of 105 CMR 590.000 and the Federal Food Co 24) Signature of Applicant Pursuant to MGL Ch.62C, sec. 49A,I ce ify under the penalties of perjury that I,to my best knowledge and belief, Have filed all state tax returns and paid state taxes required under law, 25) Social Security Number or Federal ID: U a 7 7 J SSl 26) Signature of Individual or Corporate Name: S 2Sf�t 1)C%L«- t (9 r 00? _J�t7 G r-;>1 Commonwealth of Massachusetts ` t City of Salem Board of Health Kimberley Driscoll 120 Washington Street,4th Floor Mayor SALEM,MA 01970 Food/Retail Establishment Permit DATE PRINTED: 12/20/2011 ESTABLISHMENT NAME: Creat Escape Restaurant Pile Number:BHF-2010-000051 50 Saint Peter Street - SALEM MA 01970 LOCATED AT: SALEM, MA 01970 Permit Type Permit No. Permit Issued Permit Expires Fee Restrictions/Notes FOOD SERVICE BHP-2012-0094 Jan 1,2012 Dee 31,2012 5420.00 ESTABLISHMENT Total Fees: $420.00 PERMIT EXPIRES �Deeember 31,2012 Board of Health This Permit is not transferable and must be reissued upon change_of ownership or location.The permit must be posted in a prominent location in the.Establishment. In accordance with the State Sanitary Cale,beofre any revonations;improvements,or equipment changes are made, all plans for such must be submitted to and approved by the Salem Board of Health. Page 1 CTTY OF SALEM, MASSACHUSETTS BOARD OF HFv_'l'H 120 WASHINGTON STREET,4°1 FLOOR TEL. O78) 741-1800 KllvfBERLEY DRISC0I1- FAX(978) 745-0343 MAYOR hamdin@salem.com LARRY RANIDIN,R8/IZF1 IS,CI 1(>,CP-15 H LAisiI AG IiNI' 201/ APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT NAME OF ESTABLISHMENT &ce CC C p_1!_ Va-cced- TEL# fIF- 7Vs_ ADDRESS OF ESTABLISHMENT�O CQ0,t ]- r -C fg-5-e FAX# �76�-7�/c S�L MAILING ADDRESS(if different) ��-Eow EMAIL- Business': pSG��25�R✓caad (c �y Website: Wu�ur" bsp��fpt'Scq�2��5o�.Co�rr OWNER'S NAME C S 2gycwa ? do coL TEL# ADDRESS SO Sc?f f Pe_l-r ' 51- AA 0I F 70 STREETI�, n CIITY STATE ZIP CERTIFIED FOOD MANAGER'S NAME(S) ��, _k P_ AgC)X L 5/H/ -f'Q• r Z- CERTIFICATE#(S) (Required in an establishment where potentially hazardous food isprepared) EMERGENCY RESPONSE PERSON_ JI/Icia�- ►J at�y Z�(I dui Z. HOME TEL# 27 DAYS OF OPERATION Monday 'Tuesday. - ' --Wednesda -'t=Thursda ':;Saturda .: Sunda HOURS OF OPERATION Poeasewrdeintime ofday I/jQa - /Aµt �l/Qw - /pwi //4u, -/qµ1 111x»7 /q9 //9n -14� i/aH /aor /q For example 11 am-1lpm ! - TYPE OF ESTABLISHMENT FEE (check only) RETAIL STORE YES N0 less than 1000sq.ft. =$ 70 1000-10.000sq.ft. =$280 more_than 10 000sq ft $420 ------------------- ----------------------------- REST:,URANT t_E NQ e;, than5 :.afs -$140- - - -- - (Outdoor Stationary Food Cart$210) 25-991 seats.. =$28^ more than 99 seats - ---------------------ES-----�------------------------------------ ---- -----$1 BED/BREAKFAST/ YES $100 CHILDCARE SERVICESMURSING HOME----------------------------------------------------- -------- - - - ------ - --------- --------- -------- ADDITIONAL PERMITS MAKE (not just serve) ICE CREAM, YOGURT/SOFT SERVE YES $25 TOBACCO VENDOR YES $135 ALL NON-PROFIT(such as church kitchens) YES 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 actor ante with the State Sanitary Code, before any renovations, improvements,or equipment changes are made,all plans for. such. st be sp�Jit)�hilted to and approved by the Salem Board of Health. Pursua to MGL(Clfapt r 62C,Section 49A,1 certify under the pains an penalties of perjury that I,to my best knowledge and belief,have fled all state tax lretn d paid 1111111 {{{{ate tai es required under the law_. i� /i 2�? - a 37 %SS 'Signature--" Date Social Security or Federal Identification Number Updated 523/11 FOODAP2011.adm Check#&Date I — Cry' OF SALEM, MASSACHLS]3'I"I'S `? BOARD OF.FIFM-AlI I2t)�YJ,�s}rrr7GTt)�STREPuT,4' 3`I,Ut�i� KIMBEsRLEN DRISCOLi, To_ O78)741-1800 FAN (978) 745-0343 MAYOR Iramclin ms2len.com LARRY RANTINN,IISjRISFIS,CIIO,( P-FS HFAI;FII AGF:N F This Form wiii be coiiected during your next'Board of Health inspection. QUESTIONAIRE -GREASE TRAPS 2009 1. NAME OF ESTABLISHMENT: los ea'f E5 C 460 e V,5d ay sr: , f 2. ADDRESS OF ESTABLISHMENT: S 0 4� � 3 w t1 � ��< � �� Scl 3. DOES YOUR ESTABLISHMENT HAVE A GREASE TRAP? J' e S 4. WHAT SIZE GREASE TRAP DOES YOUR ESTABLISHMENT HAVE? CAPACITY IN GALLONS 5. HOW IS THE GREASE TRAP MAINTAINED? ON A DAILY BASIS? BY AN IN-HOUSE PERSON OR BY AN OUTSIDE CLEANING SERVICE? /_ ngce- ecwe �ek tUr� cam, 0VA4- 1c)'p C©tailDcrgc/ 6. WHAT IS THE FREQUENCY THAT THE GREASE IS REMOVED FROM THE TRAP? Ct �a �4� r © u ("e a6Uf_ ,e k bw CLt 60 +5rc) e comoaK�/ 7. WHAT IS THE NAME OF THE FIRM WHO REMOVES AND/OR PICKS UP THE GREASE FROM / YOUR ESTABLISHMENT? ¢ 8. WHAT IS THE DATE OF YOUR LAST INVOICE FROM THE REMOVAL FIRM? I !I � Lt u-t not4t - f i l a c C 2 5 e a-y 1 c ,0- CGCI Gt �t E i� 4-e-y tt`- tc up myt : secs I�accr. 11 Commonwealth of Massachusetts " City of Salem Board of Health Kimberley Driscoll 120 Washington Street,4th Floor Mayor SALEM,MA 01970 Food/Retail Establishment Permit DATE PRINTED: 01/06/2011 ESTABLISHMENT NAME: Great Escape Restaurant File Number:BHF-2010-000051 50 Saint Peter Street SALEM MA 01970 LOCATED AT: SALEM, MA 01970 Permit Type Permit No. Permit Issued Permit Expires Fee Restrictions/Notes FOOD SERVICE BHP-2011-0222 Jan 1,2011 Dec 31,2011 $420.00 ESTABLISHMENT Total Fees: $420.00 PERMIT EXPIRES December 31, 2011 Board of Health This Permit is not transferable and must be reissued upon change of ownership or location.The permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code,beofre any revonations,improvements,or equipment changes are made, all plans for such must be submitted to and approved by the Salem Board of Health. Page 1 • CITY OF SALEM, MASSACHUSETTS �z BOARD OF HEALTH 120 WASHINGTON STREET,4°'FLOOR TEL. (978) 741-1800 KINIBERLEY DRISCOLL FAX(978) 745-0343 K� kYOR Dcac•.rNlsnu (nlsn ent.CONI DAVID GREENBAUM,RS ACTING HEALTH AGENT 2011 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT NAME OF ESTABLISHMENT (Jr eaf Cscgpe se5Jl4dm 4d TEL ADDRESS OFFSTABLISHMF-NT SO 3cxrh4 P-e(tw 93 S4 FAX# 97$ " 7yS- so 6E MAI LI NG ADDRESS(if different) Scz 1 a -I Fe I-,e S d- '2:)4 [-e, EMAIL- Business': (Jcea4� 25CVr0 y4'4W,cu.)n/ebsite: OWNER'S NAMEC:14SSCt,tdr75 TEL# 9 7- /%ly' ADDRESS a/ Cel%L/^ S+ /fin± 2,L5 I7P.�G✓c r/ /q1 STREET ( n CITY STATE ZIP CERTIFIED FOOD MANAGER'S NAME(S) SGt�-e AJr,.�kr t,t• < L CERTIFICATE#(S) S JYz✓� ! � (Required in an establishment where potentially hazardous food is prepared) EMERGENCY RESPONSE PERSON HOME TEL# DAYSOFOPERATION `Monday '>I -;Tugsday,' '1 !Wednesday. ,' ,a"�ThLpday4F," ^Fdday I, : <SatuMa ; -! r: Suhda .->. HOURS OF OPERATION j Please write in time of day. For exam e11am-11 m HIAA- )Rn, l!/}M' JA"4 I7gro - /(f.rr /lyµt- /6w 11 TYPE OF ESTABLISHMENT FEE (check only) RETAIL STORE YES NO less than 1000sq.ft. =$70 1000-10,000sq.ft. =$280 more than 1 0,000sq.ft. =$420 - _- -------------- -------------- ............ RESTAURANT YES NO less than 25 seats $140 (Outdoor Stationary Food Cart$21 25-99 seats -$2-8.0___-_ more than 99 seats l =5 BED/B-REAKA ----- ------------YES ------------------------------------------------............................. ---- ----- NIJ CHILDCARE SERVICES/NURSING HOME $100 - ----------------------------------------------------------- ------------------------------------------------------------ ADDITIONAL PERMITS MAKE (not just serve) ICE CREAM, YOGURT/SOFT SERVE YES $25 TOBACCO VENDOR YES NO $135 ALL NON-PROFIT(such as church kitchens) YES $25 "Please pay total with one check payable to the City of Salem. This Permit is not transferable and must be reissued upon change of ownership.The Permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code, before any renovations, improvements,or equipment changes are made,all plans for such must be sub ' to and approved by the Salem Board of Health. Pursuant t C apteZe"quired action 49A, I certify under the pains and penalties of perjury that I,to my best knowledge and belief,have filed all state tax returns paid al ate u er the law. ti , tuft© a37ySS� Signature Date Social Security or Federal Identification Number Revised 10/7/11 FOODAP201 Ladm Check#&Date ,CITY OF SALEM, MASSACHUSETTS f * BOARD OF HEALTH . 120 WASHINGTON STREET,4".FLOOR TEL. (978) 741-1800 KIMBERLEY DRISCOLL FAZ(978) 745-0343 MAYOR DGREENBAUM @SALEM.COM DAVID GREENBAUM, ACTING HEALTH AGENT 2010 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT NAME OF ESTABLISHMENT &V I? 1 0 Sccw p TEL# L}7F_ ?Ys' SO Z Z ADDRESS OF ESTABLISHMENT.SO d Eel-ems S 4 FAX# 7YS- S OG 6o MAILING ADDRESS(if different) EMAIL- Business': a-/e-cq-G S cgWebsite: 1 � OWNER'S NAME u S4,+21dqS —TEL 78-- 16,2- �F�6 ADDRESS rd--( CQ 11.1 r 5 & yt� /q.L 0 y Alli 0 I 0 STREET /CITY STATE ZIP CERTIFIED FOOD MANAGERS NAME(S) !54a4<- j4- t�!cvs �ei > u e- c CERTIFICATE#(S) J7V.5 4 L 4 3 (Required in an establishment where potentiallyhazardousfood its prepared) / o� EMERGENCY RESPONSE PERSON J 4(2 It 2 Ak J—S k4- _C.( J -- 7 HOME TEL# L 7$ DAYS-OF OPERATION 1 Monday Tuesday Wednesday Thursday: Friday Saturda Sunda HOURS OF OPERATION 1 i Please write in time of day. For example 11 m11 i)/ MnM , /14. - / Ili 1N+ - t TYPE OF ESTABLISHMENT FEE (check only) RETAIL STORE YESNO less than 1000sq.ft. =$ 70 1000-10,000sq.ft. =$280 more than 10,000sq.ft. =$420 RESTAURANT YE NO less than 25 seats . =$140 (Outdoor Stationary Food Cart$210) 25-99 seats -------------------------more than 99 seats $420 ------------------------------------------------------------- --- - - - - ------------------------------------ BED/BREAKFAST/ YES NO $100 CHILDCARESERVICES/NURSING HOME---------------------- ---------------------------------...----------------------------------------------------- ADDITIONAL PERMITS MAKE (not just serve) ICE CREAM, YOGURT/SOFT SERVE YES $25 TOBACCO VENDOR YES $135 ALL NON-PROFIT(such as church kitchens) YES N $25 *Please pay total with one check payable to the City of Salem. This Permit is not transferable and must be reissued upon change of ownership.The Permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code, before any renovations, improvements, or equipment changes are made,all plans for such must be submitted to and approved by the Salem Board of Health, Pursuant to MGL Chapter 62C,Section 49A, I certify under the pains and penalties at perjury that I,to my best knowledge and belief,have filed all state tax returpsgaid all st a taxes required under the law. / CC o, oS CK�f �( Signature Date Social Security or Federal Identification Number -------------- - ---------- ------------�--/----------------------------- Revised 424/07 FOODAP2008.adm Chm--k-&Date q 1(O ^I l / l/� $ 7�G CITY OF SALEM BOARD OF HEALTH Date: June 9, 2010 Name of Establishment: Great Escapes Restaurant Address: 50 St. Peter Street General Manager: Shane Andruskiewicz Phone: 978-335-1518 The General Manager of this proposed new establishment presented a Floor Plan and Menu for review in accordance with the State Food Code. The floor plan is conditionally approved with the addition of hand wash sinks in the food prep areas as discussed. The preliminary menu is approved pending the submittal of the final menu. Owner to submit the final floor plan prior to opening. Any changes to the approved floor plan must be approved by the Board of Health prior to implementing them. CERTIFICATION There must be a Certified Food Manager working at this establishment full time. A"Person in Charge"or"PIC' must be available at this location when the CFM is not present. The PIC must have knowledge of sanitation techniques, holding temperatures, operations, etc. Owner to forward copy of the Serve Safe Certificates to the Board of Health. FLOOR PLAN A Hand Sink must be located in each food prep and service area. A hand wash sink will be added in the food prep area as discussed. The hand sinks must have wall hung soap and paper towel dispensers. These must be stocked at all times. The hand sink must be used for hand washing only. All floors, walls, and ceilings where food, utensils, paper products, etc, are stored, prepared or served must be intact, impervious, and easily cleanable. A three bay sink and a dishwasher for washing, rinsing and sanitizing all utensils equipment, dishes will be available. The dishwasher must have a final rinse temperature of 180°F in the final rinse OR an automatically fed chemical sanitizer in the final rinse with an audible alarm. MENU/FOOD PREP All food must be purchased from a wholesaler licensed by the State. Fruits and vegetables must be washed prior to preparation. All food must be held at 41°F or lower, or 140°F or higher, at all times. Food may not be added to containers in holding unit. Instead, a sanitized container with new product may replace the existing container and the old product may be placed on top of the new product. There may be no bare hand contact of ready-to-eat foods. Gloves, tongs, or tissues must be used when handling such food. UNDERCOOKED FOODS The consumer advisory must be posted on the menu. The advisory was given to the owner. CHOKE SAVING I .. A person trained in choke saving techniques must be available whenever this establishment is open for business. EXTERMINATION Monthly services of a Licensed Pest Control Operator are required. Please keep receipts for inspections. The owner must have an initial service and provide documentation of a monthly extermination contract prior to opening. SANITIZING SOLUTION 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 prepared in the 3rd bay of the 3-bay 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. These must be clearly marked "sanitizer". Outside area of premises, including the dumpster area must be kept clean and sanitary. TRASH Trash must be kept in appropriate trash receptacles and a grease barrel must be used to hold discarded food grease. The trash area must be kept in a clean and sanitary manner. ODOR Exhaust air must be filtered in such a manner to prevent the release of food odors to the outside of the premises. Please submit final floor plan and menu for review and approval prior to the opening inspection. Please call one week prior to opening to schedule an opening inspection. A/n application d check have not been received d 1di/ -b David Greenbaum Date Acting H alth Agent a n _ ewicz Date General Manager Appetizer Eggp a $ 7.95 Breaded eggplant rco a cheese mo la cheese and basil with to and mozzarella cheese Broccoli Rabe $ 7.95 Sauteed broccoli rabe in garlic oil sauce Chicken Fingers $ 6.95 Buffalo $ 7.95 Chicken Wings $ 7.95 Buffalo $ 8.95 Fried Calamari, $ 8.95 Mozzarella Sticks $ 7.95 Daily Appetizer Special Market Price Seafood Salmon Piccatta $ 17.95 Pan seared salmon with cappers in a lemon white wine sauce Baked Haddock $ 17.95 Haddock filet topped with herb forccacia bread crumbs finished with a thyme white wine sauce Shrimp and Broccoli Rabe $ 19.95 Sauteed shrimp broccoli rabe and roasted pepper served over garlic bread Sides Rice Pilaf $ 3.95 Broccoli Rabe $ 4.95 Roasted Potatoes $ 3.95 Steak Fries $ 3.95 Meatballs $ 4.95 Sausage $ 5.95 Pasta with Sauce $ 3.95 Daily Vegetable market price Salad L Italian Antipasto Salad $ 10.95 Marinated roasted peppers sundried tomatos mushrooms fresh mozzarella prosciutto and kalamata olives rIG r ; 'e-55 (, Caprese Salad $ 9.95 Fresh mozzarella sliced Italian plum tomato basil extra virgin oil and red onion Caesar Salad $ 8.95 With chicken $ 9.95 With steak tips $ 10.95 House Salad $ 5.95 Dressings Creamy Greek, Caesar, Italian, Blue Cheese, Balsamic Vinaigrette Soup of the day Cup $ 4.95 Bowl $ 7.95 From the grill (L Marinated steak tips $ 14.95 Marinated chicken breast $ 12.95 L Marinated turkey tips $ 12.95 (Marinated lamb tips $ 15.95 (✓Marinated baby back ribs half $ 13.95 Z- Grilled and marinated in a teriyaki honey marinade full $ 18.95 Grilled pork chop $ 17.95 2 8oz pork chops topped with sundried tomatoes baby spinach and port wine demiglaze New York strip $ 19.95 14oz New York strip,Y6pped with roasted mushrooms onions and port wine sauce All of the above are served with roasted potatoes and vegetable of the day L Grilled Italian sausage $ 12.95 Sauteed sweet Italian sausage with peppers onions and roasted potatoes i Sauteed L Chicken Limone $ 14.95 Sauteed chicken and artichoke hearts in a lemon white wine sauce C Veal Limone $ 16.95 Sauteed veal and artichoke hearts in a lemon white wine sauce Chicken Marsala $ 17.95 Sauteed chicken roasted mushrooms prosciutto in a sweat marsala sauce Veal Marsala $ 19.95 Sauteed veal roasted mushrooms prosciutto in a sweat marsala sauce C Chicken Calabrese $ 17.95 Sauteed chicken sweat Italian sausage and roasted pepper in a marsala wine demiglaze Veal Calabrese $ 19.95 Sauteed veal sweat Italian sausage and roasted pepper in a marsala wine demiglaze All of the above are served with roasted potatoes and vegetable of the day Pasta C Chicken Parmigiana $ 14.95 G Veal Parmigiana $ 16.95 Chicken Broccoli Alfredo $ 13.95 G Fussily and Rabe $ 14.95 Sauteed sausage and broccoli rabe in a garlic oil sauce w fussily pasta L Shrimp Scampi $ 17.95 Sauteed shrimp roasted peppers in a garlic white wine sauce with linguini G Fussily Pasta $ 11 .95 Homemade pasta with tomato sauce Cheese Ravioli $ 12.95 Homemade cheese ravioli with tomato sauce Massachusetts Department of Public'Health Salem Board of Health 120 Washington Street,4" Floor Division of Food and Drugs Salem, MA 01970-3523 FOOD ESTABLISHMENT INSPECTION REPORT Tei. (978) 741-1800 Fax (978) 745-0343 Name Dete'�• MT Me of Ooeration(sl Tvoe of Inspection 0 _ R Food Service ,® Routine Address 61M k c P Risk ❑ Retail ❑'Re-inspection ej Level _ ❑ Residential Kitchen Previous Inspection Telephone ll [I Mobile' Date: Owner�> ( rHACCP YM ❑❑ Caterer Temporary ElPre-operation Person In Char a\ PIC „Time ❑ Bed&Breakfast El Suspect Illness g ( ) �CtAA I' n El General Complaint �Y -In.. , El ; Inspector 0 " Out: Permit No. ❑ Other Each violation checked requires an exvanation on the narrative page(s) and a.citation of specific provision(s)violated. `Non-compNance 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. ,)1OD PROTECTION MANAGEMENT • ❑ 12. Prevention of Contaminationon from(Hands 1 PIC Assigned/Knowledgeable/Duties I�f3. Handwash Facilities EMPLOYEE HEALTH tPROTECTION FROM CHEMICALS ❑ 2. Reporting of Diseases by Food Employee and PIC ❑ [13. Personnel with Infections Restricted/Excluded 14.Approved Food or Color Additives _- , ❑ 15.Toxic Chemicals JE-FOO0 FROM APPROVED SOURCE ° .-.- 0 4. Food and Water from Approved Source [TIME/TEMPERATURE CONTROLS-(Potentially Hazardous Foods)'.,. ❑ 5. Receiving/Condition ❑ 16. Cooking Temperatures Q 6. Tags/Records/Accuracy of Ingredient Statements ❑ 17. Reheating ❑ 7. Conformance with Approved Procedures/HACCP Plans [118. Cooling ;;PROTECTION FROM CONTAMINATION-1- ,*.r,,. ❑ 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 NIOHLY SUSCEPTIBLE POPULATIONS_(HSP) El21. Food and Food Preparation for HSP [I 10. Proper Adequate Handwashing ❑ 11. Good Hygienic Practices CONSUMER ADVISORY '�f^•. n =N + • -4•.+ :._ © [�'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 ofCHealth. 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 order of the Board of Health. Failure to correct violations V Y 24. Food and Food Protection (FC-3)(590.004) 25. Equipment and Utensils (Fc-a)(sso.00s) cited in this report may result in suspension or revocation of J the food establishment permit and cessation of food ( 26. Water, Plumbing and Waste (Fc-5)(590.009) 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 `J 28. Poisonous or Toxic Materials (FCa)(191.108) 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: �_ (0_ ' ' S.5901n.,WFOm 14.x 01 -71 Inspector's Signature:(_-1),W&Z_-L. Prmt• G`7 PIC's Signature: 1 0 Print: c ,v I �/ 0+DPage of ages Violations Related to Foodborne Illness Interventions and Risk Factors(items 1-22) PROTECTION FROM CONTAMINATION S Cross-contamination FOOD PROTECTION MANAGEMENT 3-302.1IWO) Raw Animal Foods Separated from 1 590.003(A) Assignment of Res onsibilit * Cooked and RTE Foods* 590.003(B) Demonstration of Knowledge* _ Contamination from Raw ingredients 2-103.11 Person in charge-duties 3-302.1.1(A)(2) Raw Animal Foals Separated from.Each Other* EMPLOYEE HEALTH Contamination from the Environment 2 590.003(C) Responsibility of.the person in charge to 3-302.1.1(A) Food Protection* require reporting by food employees and 3-302.15 Washing Fruits and Vey*etables applicants* 3-304.11 Food Contact with Equipment and 590.003(F) Responsibility Of A Food Employee Or An Utensils* Applicant To Report To The Person In - Contamination from the Consumer Charge's 3-306.14(A)(B) ,Returned Food and Reservice of Food* 590,003(G) Reporting b Person in Charge* F-.3 .590.003(D) Exclusions and Restrictions* Disposition otAdulte Adulterated or Contaminated Food 590.003(E) Removal of Exclusions and Restrictions 3-701_11 Discarding or Reconditioning Unsafe '�, FOOD FROM APPROVED SOURCE Hood* 4 Food and Water From Regulated Sources FT Food Contact Surfaces 590.004(A-B) Compliance with Food Law'k 4-501.111 Manual Warewashing-Hot Water 3-201.12 Food in a Hermetically Scaled Container* Sanitization Temperatures* 3-201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Warewashing-HotWater 3-202.13 Sanitization Tem eratures*- 3-202.14 Eggs and Milk Products.Pasteurized* 4-501.11.4 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* 4-60 L_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`" 4-702.11 Frequency of Sanitization of Utensils and - 3-201.14 Fish and Rer eadonaily Caught Molluscan Food Contact Surfaces of H ui menti Shellfish* 4-703.11 Methods of Sanitization-Hot Water and 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* Sources* 10 Proper,Adequate Handwashing Regulatory Authority Game and Mushrooms Approved by 2-301.11 Clean Condition-Hands and Arms- 3-202.18 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 Came Animals* L1 Good Hygienic Practices g Receiving/Condition 2401.11 Eating,Drinking or Using Tobacco* 3-202.11, PHFs Received at Proper Tem eratures* 2401.12 Discharges From the Eyes, Nose and 3-202.1.5 Package hate it.* Mouth* 3-IO1.11, Ford Safe and Unadulterated* 3-301.12 Preventing Contamination When Tasting" 6 TagstRecords:Shellstock 12 Prevention of Contamination from Hands 3-202.18 Shellstock Identification * 590.004(F.) Preventing Contamination from 3-203.1.2 Shellstock Identification Maintained* Em 10 es* Tags/Records:Fish ProducU 13 Handwash Facilities 3-402.11 Parasite Deshvexrott* Conveniently Located and Accessible 3-402.12 Records,Creation and Retention* 5-203.11 Numbers and Capacities* 590.004(1) Labeling of Ingredients, 5-204.11 Location and Placement* 7 Conformance with Approved Procedures 5-205.11 -Accessibility,Operation and Maintenance IHACCP Plans Supplied with Soap and Hand Drying 3-502.11. Specialized Processing Methods* Devices 3-50212 Redured fix oen aeka-ng,criteria* 6-301.11 Handwashing Cleanser, Availability 8-103.12 Conformance with Approved Procedures* 6-301.12 Hand Dr 'n Provision *Denotes critiad item in the federal 1999 Food Code or 10 CI+41Z 590.000, CITY OF SALEM BOARD OF HEALTH ""Y✓�1 Establishment Name: v"I— Dater (T�—( � �' Page: roof _ Rem Code C-Critical Item A DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date- No. Reference R-Red Rem VerRled C � PLEASE PRINT CLEARLY DA ,n'IV� 0 , � n�t Y p� X� EZS� /Q- -J !Jas � 1: , �;: d0i 9-AM vo nnn r a n l r_t n 004, bI C' AiO,, /1po�71�1f /t� rI V - 1 to 0 A-) / c/o - 9'r PIP1 - 17,11 1'r f V Sr r hu,� ,./Pn� n ,L4' nn A! f P 4 P= ( 11 OAx no A )A I-o1111 Discussion With Pe on-in Charge: Corrective Ac ionRequired: ❑ No O�Ves 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 comply with all mandates of the Mass/Federal Food Code. I understand that L) Re-inspection Scheduled El Emergency Suspension noncompliance may result in daily fines of twentr-five Hollars or suspension/revocation of ❑ Embargo ❑ Emergency Closure your food permit. „ A r" ❑ Voluntary Disposal ❑ Other: ac i 3-501.14(0) PHFs Received at Temperatures Violations Related to Foodborne Illness interventions and Risk According to Law Cooled to Factors(Items 1-22) (Cont.) 41'F/45'F Within 4 Hours. PROTECTION FROM CHEMICALS3-501.15 Coolie Methods for PHFs Food or Color Additives 19 - PHF Not and Cold Holding 14 3-501.16(B) Cold PHFs Maintained at or below 3-202.12 Additives* 590.00 3-302.14 Protection from Un 4(F) 41°145'Fk Unapproved Additives* 3-501.4(F) Hot P11450 F Maintained at or above 15 Poisonous or Toxic Substances 140°F. * 7-101.11 Identifying Information-Original 3-501.16(A) Roasts Held at or above 130°F. Containers* 7-102.11, Common Name-Working Containers* 20 Time as a Public Health Control 7-201.11 Separation-Stom * 3-501.19 Time as a Public Health Control* 7-202.11 .Restriction-PresenceandUse* 590.004H) Variance Requirement 7-202.12 Conditions of Use* 7-203.11 Toxic Containers-Prohibitions* REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS HSP 7-204.11 Chemicalsrs.Criteria i Chemicals* 21 3-801.11(A) Unpasteurized Pre-packaged Juices and 7-204.12 Chemicals for Washing Produce,Criteria* Beverages with Warning Labels* 7-204.14 encs.Criteria* 3-801.11(B) Use of Pasteurized Eggs* 7-205.11 Incidental Foal Contact,Lubricants* 3-801.11(D) Raw or Partially Cooked Animal Food and 7-206.11 Restricted Use Pesticides,Criteria* Raw Seed S is Na Served.* 7-206.12 Rodent Bait Stations" 3-801.11(C) Uno ned Food Packa Not Re-served. 7-206.13 Tracking Powders,Pest Control and Monitoring* CONSUMER ADVISORY . TIMEtfEMPERATURE CONTROLS 22 3-603.11. Consumer Advisory Posted for Consumption of 16 Proper Cooking Temperatures for Animal Foods That are Raw.Undercooked or PHFs Not Otherwise Processed to Eliminate 3-401.11A(t)(2) Eggs- 155F 15 Sea Pathogens.*'yo 11112001 Eggs-Immediate Service 145°F15sec* 3-302.13 Pasteurized Eggs Substitute for Raw Shell 3-401.11(A)(2) Comminuted Fish.Meats&Game Eggs* Animals-155°F 15 sec. * SPECIAL REQUIREMENTS 3-401.71(A)(A)(2) Ratites,Injected Meats-155°F 15 3401.11( )(2) Park and Beef Roast-130°F 121 min* 590.009(A)-(D) Violations of Section .590.009(A)-(D)in sec * catering, mobile food, temporary and 3-401 A I(A)(3) Poultry,Wild Game,Stuffed PHFs, residential kitchen operations should he Staffing Containing Fish,Meat, debited under the appropriate sections Poultry or Ratites-165°F 15 sec.* above if related to foodborne illness 3-401.1.1(C)(3) Whole-muscle,intact Beef Steaks interventions and risk factors. Other 145°F" 590.009 violations relating to good retail 3401.12 Raw Animal Foods Cooked in a practices should be debited under#29- Microwave 165°F* Special Requirements. 3-401s11(A)(1)(b) All Other PHFs-145°F 15 sec. 17 Reheating for Hot Holding VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 3403,11(A)&(D) PHFs 165-F 15 sec.* (Items 23-30) 3403.11(B) Microwave- 165'F 2 Minute Standing Critical,and non-critical violations,which do not relate to the Time* foodborne illness interventions and risk factors listed above,can be 3.403.11(C) Commercially Processed RTE Food- found in the following sections of the Food Code and 105 CMR 140°F* 590.000. 3403.11(E) Remaining Unsliced Portions of Beef Item I Good Retail Praettces FC 590.0m Personnel Roasts* 1 23. i Management and FC-2 18 Proper Cooling of PHFs 24. Food and Food Protection FC-3 .004 25. Equipment and Utensils I FC-4 .005 3-501.14(A) Cooling Cooked PHFs from 140°F to 26. Water.Plumbing and Waste - ! FG-5 70°F Within 2 Hours and From 70°F 727_ Physical Facility FC-6 *.107to 41°F/45'F Within 4 Hours. * 28. Poisonous orTodc Materia3-501.14(B) Cooling PHFs Made From Ambient 29. S ecial Re uirements Temperature Ingredients to 41°F/45°F 30. 1 Other Within 4 Hours* a5ro�a,m*,;rzax *Denotes eritimi item in the federal 1999 Fool Code m,105 CMR 590.000. CITY OF SALEM BOARD OF HEALTH Establishment Name,,-&n n 'P Date: Page:_ 3 Of Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date No, Reference R-Red item Verified PLEASE PRINT CLEARLY .0_.,,It,2.l ,71-0 ,.1'.'4 t? rp ,I44/A c ` F /1 , /\^,1 r 0_ CJ . ., ,�,!I'r V_ a-.IX ,�i11 V l'2�(•— 4J Zl r d 7 .1 s ✓ .:�1!"•.tel t': '1,'+ /il. V X) o x"J�f•:, X \Z(. �l 1 �"u '._ th �1 J: '1 F l � �1.�'ri t/ r-, D.-( `-tZ1 Oil :\Mi.'l,'t�1 P.E.n?.C2/ l/bA 0 r/.P -Fv tw o �� i a - I ? Q X — llriv f / d- 1/ll� r _ D 0 Discussion With Person in Charge: Corrective Action Required: ❑ No Yes I have read this report, have had the opportunity to ask questions and agree to correct all a9 Voluntary Compliance ❑ Employee Restriction/ inspection, to observe all conditions as described, and to Exclusion violations before the next ins P � Re-inspection Scheduled Cl 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: U 3-501.14(0 PHFs Received at Temperatures Violations Related to Faodhorne Illness Interventions and Risk According to Law Cooled to Factors(Hems 1-22) (Cant.) 41'F/45F Within 4 Hottrs.*_ PROTECTION FROM CHEMICALS 3-501.15 Conlin Methods for PHFs PHF Hat and Cold"ding Food or Color Additives 19 3-50116(6) Cold PHFs Maintained at m below 3-202.12 Additives* 590.004(F) 4101450 F* 3-302.14 Protection.from Unapproved Additives* 3-501.16(A) Hot PHFs Maintained at or above 15 Poisonous or Toxic Substances 140`F. 7-101.11 Identifying Information-Original 3-501.16(A) Roasts Held at or above 1300F. * Containers* Time as a Public Health Control 7-102.11, Common Name-Working Containers* 20 3-501.19 Time as a Public Health Contrul* 7-201.11 Separation-Stora e* 590.004{H) Variant 7-202.11 .Restriction-Presence and Use* en uiremenY 7-202.12 Conditions of Use* REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-203.11 Toxic Containers-Prohibitions* POPULATIONS HSP 7-204.11 Sanitizers.Criteria-Chemicals* 7-204.12 Chemicals for Washing Produce,Criteria* 21 3-80L 11(A) Unpasteurized Pre-packaged Juices and Beverages with Warring Labels* 7-204.14Drying,Agents.Criteria* 3801.1116} Use of Pasteurized Eggs* ' 7-205.11 incidental Food Contact,Lubricants* 3-801.11{D} Raw or Partially Cooked Animal Food and 7-206.11 Restricted Use Pesticides;Criteria* Rag Seed S ns Nar Served.* 7-206.12 Rodent Bait Stations' 3-801.11(CUno ned Foal Pack Not Re erved. 7-206.13 Tracking Powders,Pest Control and Monitorin * - CONSUMER ADVISORY___ - TIMEtTEMPERATURE CONTROLS 22 3-603.11 Cansumer Advisory Posted for Consumption of 1b Proper Cooking Temperatures for Animal Foods That are Rain.Undercooked or PHFs Not Otherwise Processed to Eliminate 3-401.IIA(1)(2) Eggs- I55`F 15 Sec. Pathogens.' sem 7 Eggs-Immediate Service 145'F15sec* 3-30113Pasteurimd Eggs Substitute for Raw Shell 3-001.11(A)(2) Comminuted Fish.Meats&Game E " Animals-155'F 15 sec.* SPECIAL REQUIREMENTS 3.401.11(11)(1)(2) Pak and Beef Roast-130'F 121 min* 590.009(A)-(D) Violations of Section 590.009(A)-(D)in 3-401.11(A)(2) Ratites,Injected Meats-155'F 15 set.* catering, mobile food,temporary,and 3401.11(A)(3) Poultry,Wild Game,Stuffed PHFs, residential kitchen operations should be Stuffing Containing Fish,Meat, debited udder the appropriate sections Poultry or Ratites-165°F 1.5 sec.* above if related to foodborne illness 3-401.11(C)(3) Whole-muscle,law Beef Steaks interventions and risk factors. Other 1450F" 590.009 violations relating to good retail 3-401.12 Raw Animal Foods Cooked in a practices should be debited under#29- Microwave 165F* Special Requirements. 3-40LI I(A)(1)(b) All Other PHFs-1457 15 sec. i7 Reheating for Hot Holding VIOLA77ONS RELATED TO GOOD RETAIL PRACTICES 3-403.1 I(A)&(D) PBFs 165°F 15 see. ' (Items 23-30) 3-403.11(B) Microwave-'165'F 2 Minute Standing Critical,and non-critical violations,which do not relate to the Time" foodborne illness interventions and risk factors listed above, can he 3403.l l(C) Commercially Processed RTE Food- found in the following sections of the Food Code and 105 CMR 140*P 590.000. 3403.11(E) Remaining Unsiiced Portions of Beef P Item i Good Retail PracticesFC 590.ow i Roasts,: �23. Manatlemsnt and Pereonrrel I FC-2 .003 ' 1S Proper Cooling of PHFs 1 24.. ;Foal and Food Protection I FC-3 .004 1 25. Equipment and Utensils ( FC-4 .005 7 3-50L14(A) Cooling Cooked PHFs from 140`F to 126, Water.Piumbino and Waste + FC-5 ! .006 70'F Within 2 Hours and From 70F 27. Pti ical Favi' rFC-8 :.007j to 41`F/4501`Within 4 Hours.* 1 28. ' Poisonous or Toxic Materials ' FC-7 om j 3-501.14(6) Cooling PHFs Made From.Ambient 29. Special Requirements .009 Temperature Ingredients to 41`FI45OF ' 30 i Other Within 4 Hours* DYnOte3 critical meta in the Lederal 1999 Food Code o'105 CMR 590.000. CITY OF SALEM BOARD OF HEALTH Establishment Name: L(-A4 G S Date: Ci - 1 3 \o Page: ) of ) Rem Code C-Crmcal Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date 140. Reference R-Red Rem Verified PLEASE PRINT CLEARLY E-0b L 1 �� V�A W 1 D v( ,1 Yui? Ya RC1 i 1 rA c-� C.�' h Cyr J-) , nt Zee 2cn, - NZ , A 1 ,sn Discussion With Person in Charge: Corrective Action Required: ❑ .No ❑ Yes I have read this report, have had the opportunity to ask,questions and agree to correct all ❑ Voluntary Compliance ❑ Employee Restriction/ violations before the next inspection, to observe all6 oc nditions as described, and to Extrusion ❑ Re-inspection Scheduled ❑ Emergency Suspension comply with all mandates of the Mass/Federal Food Code-1,understand that noncompliance may result in daily fines of twenty-five -ollars or suspension/revocation of ❑ Embargo ❑ Emergency Closure your food permit. VJ ❑ Voluntary Disposal ❑ Other: i 3-501.14(C) PHFs Received at Temperatures Violations Related to Foodborne 111ness Interventlons and Risk According to Law Cooled to Factors(items 1-22) (Cont.) 41'F/45'F Within 4 Hours. PROTECTION FROM CHEMICALS3-501.15 Cooling Methods for PHFs 14 Food or Color Additives h_9 PHF Hot and Cold Holding 3-202.12 Additives* 3-501,16(B) Cold PHFs Maintained at or below 3-30114 Protection from Unapproved Addtnves 590.004F) 410/450 F* Y ( 3-501.16(A) Hot PRFs Maintained at above 15 Poisonous or Toxic Substances 140°F.* 7-101"11 Identifying Information-Original 3-501,16(A) Roasts Held at or above 1300F. Containers* 7-102.11. Common Name-Working Containers* 20 Time as a Public Health Control Restriction-Presence and Use* 3-501.19 Time as a Public Health Control* 7-202.11 7201.11 oration-Stora " 590.004 H) Variance Requirement ,Re 7-202.12 Conditions of Use* 7-203.11 Toxic Containers-Prohibitions* REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-204.11 Sanitizers.Criteria-Chemicals* POPULATIONS HSP 7-204.12 Chemicals for Washin Produce.Criteria* 21 3-801.11(0) Unpasteurized Pre-packaged Juices and 7-204.14 Drying Agents.Criteria* Beverages with Warning Labels* 3-801.11B) Use of Pasteurized E * 7-205.11 Incidental Food Ccmtace,uriieria* 3-801.11(D) Raw or Partially Cooked Animal Food and 7-206.11 Restricted Use Pesticides,Criteria* y - 7-206.12 Rodent Bait Stations* Raw Seed Sprouts Not Served.* 7-206.13 Tracking Powders,Pest Control and 3-801.11(C) Unopened Food Packagee Not Re-served. Monitarin * CONSUMER ADVISORY 71MEITEMPERATURE CONTROLS 22 3-603.11 Consumer Advisory Posted for Consumption of 16 Proper Cooking Temperatures for Am trial Foods That are Raw.Undercooked or PHFs Not Otherwise Processed to Eliminate 3-401.I IA(1)(2) Eggs- 155°F 15 Sec. Pathogen,.'"1/1mn Eggs-Immediate Service 145°Fl5sec* 3-302.13 Pasteurized Eggs Substitute for Raw Shell 3.401.11(A)(2) Comminuted Fish.Meats&Game Eggs* Animals-155°F 15 sec. * 3-401.11(B)(1)(2) Pork and.Beef Roast-130'F 121 min* SPECIAL REQUIREMENTS 3-401.11(A)(2) Ratites,Injected Meats-155°F 15 590.009(A)-(D) Violations of Section 590.009(A)-(D)in sec * catering, mobile food,temporary and 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs, residential kitchen operations should be Stuffing Containing Fish,Meat, debited under the appropriate sections Poul or Ratites-165'F 15 sec. * above if related to foodborne illness 3-401.11(C)(3) Whole-muscle,intact Beef Steaks interventions and risk factors. Other 145°F+° 590"009 violations relating to good retail 3-401.12 Raw Animal Foods Cooked in a practices should be debited under#29- Microwave 165°F* Special Requirements. 3.401a11(A)(1)(6) All Other PHFs- 145'F 15 sec. 17 Reheating for Hot Holding VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 3403A 1(A)&(D) PHFs 165-F 15 sec.* (Iters 23-30) 3-403.11(B) Microwave 165'F 2 Minute Standing Critical,and non-critical violations,which do not relate to the Time* foodborne illness interventions and risk factors listed above, canbe 3403.11(C) Commercially Processed RTE Food- found in the following sections of the Food Code and 105 CMR 140°F* 590,000. 3403.11(E) Remaining Unsliced Portions of Beefftp em I Good Retail Practices FC 5.90.000O Roasts* 23. Manaclement and Personnel "FC-2 .003 - .I 18 Proper Cooling of PHFs 24. Food and Food Protection_ I FC=3 .004 25. Equipment and Utensils : FC-4 .005 3-50l A4(A) Cooling Cooked PHFs from 140°F to 26. Water,Plumbing and Waste ' FC-5 .006-- 70'F Within 2 Hours and From 70'F 27. Physical Facility FC-6 .007 to 41'F/45'F Within 4 Hours. * 28. Poisonous or Toxic Materials i FC 7 .008 3-501.14(B) Cooling PHFs Made From Ambient 29. Special Requirements .009 Temperature Ingredients tool°F/45°F 30. Other Within 4 Hoots* s:svc:«,mctc.xdx *Mkrwtm critical item in the federal 1999 Food Cafe N 105 CMR 590.000. CITY OF SALEM BOARD OF HEALTH Establishment Name: C'ze�I L-S'C x�'0 Date: ni '�' `o Page: of Item Code- � '= re-critical item , �r � r DESCRIPTION OF VIOLATION/PLAN OF CORRECTION f.li �- " a� ? 3 Date r.� No Reference R-RedItem 3 ` '� '^- - ' Verified A P �'1^._ a�fi -� PLEASE PRINT CLEARLY d �ro\1� )2r 1 S Fv C>T4 Ira-17 - �Stcv �.. �f)S �3w rte+t_C.,rl.ins:� l t�-`�-�' r � iry-•\,`�-rr'c�cc��;'"i.1,� F"Zj ) . VN C-A 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/ 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. ,/ LlVoluntary Disposal ❑ Other: rM 150, 14(C} PRFs PJJFs Received at Tmrperaturas Violations Related to Foodborne fitness Interventions and Risk According to fa,,,, Cooled in Factors(items 1-22) (Cont) 14 1�F/45"'F Within " Ham's. Co<4 lvic.thod-sf-or 111IF's PROTECTION FROM CHEMICALS PHF Hot and Cold Holding LC4 Food or Color Additives FJ9 17 'M —12 ddo,,e�� 501.16(B) Cold PHF� � ailloAined at(it below 5% 3-302.14 Pro tcctarn fro 50 1,1&'A) Poisonous or Toxic Substances Hot PHIk Nfaintained at or above Li--,; --- I I 140'F. 7 101 11 I&W yang n onnation-ort CornaillinsA 3-501 16(A) I Rfgiso,Hold at or above uleta, * T fine as a Public Health Control --"I 11 C(amnon Name . Wo rkint-,Courainers* %,004(H) varla ilen� t io)2 11 Restriction -Po,&:Pco and Use* eu 7-'0272 Condi Sons of Ura* 7-^03.11 Toxic conlairierREQUIREMENTS FOR HIGHLY SUSCEPTIBLE �,,- - 2tPOPULAIONS HSP ,-204.11 Sallili7ers�criletia - -7-1-1-- 7-"04.12 Cheillicids for ( litorial 1 3-80Ltl(A) Unjimicurized P— r e-leldeaged Juice,and -7204,14 Bcvertcea wilt) Warnin1,abds-' 7-205 11 hicid-lital Food Coqo),Cl�1,11HICIins" t of'Piotcali7ed 1-o-1 jse Pesticide,�,Criteria, T 3-SUI.I I(D) Rawor Partially Cook�'d. .it i(led C potlent Bml Stationr, __�irw Sc it uts I li Served. �7-206�1�2 N� ' le __j K, -,Dcl -1 Ldj��P 2ic-m-d 206 13 Fiacking Powder;.P,,�sL Control and . Monitotinb CONSUMER ADVISORY 1--- -6i3I--r-Cos- os22 T ( I �umor Ad� sory P4*t�,d for Ctaso iption of CONTROLS Anillcil 1K 16 Proper Cooking Temperatures , A,T141'are l6w, Undercoolrloi PHFs Not Ofllemeioe poi.,cssed to FluTiffilVe, P 3 401,1 Fvgs- 155'F 15 Sci:. l 3 P�;rte ilrizci Substitute foi RAw Shell 17, 11-(�k) Comminuted Firb. Meato&Gilolo Anutials 13�`F 15 sec� " ;-401A lffl)(I)Q) 1 Poll, and Beef Roast - 130"F )21 ruin- SPECIAL REQUIREMENTS 5 3-40 1 J 1(A)(2) Raines, hiicor,d tvicall, - I 1�5�F )90,0094A)-t0) })pini stns of Set�ti()jl 25590.(�X)c)(A)-t(D)in rit �and caloring, rnobilc.food, tomporary and 3,401 11(Ay 3) floultr),)it ild Carne,Stuffed I"Iffai, don id kitchen operations should ba { 41L,tfmg Cont Linins,Fish, Meal, Opria e dckitcd under the appr Sect tons t, 1`211!Iff2.kadlos-1 65"T' 15 sec. :,flywe if rcfai ed to bxAborne I th-10s, 3-401.11(C)(3) whole-inn:'dVIntact Illect'Steaks Intel ventions and risk fnctors. Other 145,1F540.009 violatioliq rela[ino to good retail I 3-40LI2 R;vx "Inuniii 17kiiAs C,00ked in a nractices should he debited under#29 - Nlicl owave 105,F* Spocial Requilcillefits, 3-401,11(,A)(1r(lr) i All Other PIJI-s - 14 TT 15 sec. I Reheating for Hot Holding VIOLATIONS RELATED TO GOOD RETAIL PRACTICES (A)&(D) PI-11i, 165"F 17 sec, - (Items 23-30) 3-403.1 IIS) Microwave- 165'r 2 lvinaite Staliding, Crilf('ed WWI'Nf,in-1 f*14:01 Voll,'1110Ls, WhiCil tirl rIfjj rebate In lite Time' foodborne illness inurvenliunv ea;d rLk,rm tars!Luted above, can be 3-403.11(C) CommercialIv Poo,:essed RTE Kind- found it;the i'ollowing serri,nii o,'f ore Food Code and 105 041? 14WF �90l.000. F- -T- I FC 1590,000 j - 3-403.31(F R,:lnavIm'1f11 Ifee Portions ofitemGnod Retart practices _, Roasts* 23, managpmeril aral Pvsomej-- 24 Fad ind Food Prolection. PC 3 004 Cooling -------- _?S, JE__.pD_,a�1,tirjd i FC--4 005 Cooling Cook�A PHFs fi 0W 1 4)'F 14) 26 �Mater Ph rtrb3r�and Waste i FC-5 7WF Within 2 llours and From 27, Physitsil Facilliv T,17007 -I Pc 1's-0 of Tom Materials PC-7 008 011) Ciallim,PHIFs Made Front Ambient 29 X.9 pecinL Temperature Ingredients to 4141/45,"F Willon 4 fbxus Dca,les mucal Item 11 the lo:lclal 1949 Pot Glder 101 ("IR$Ti(KXI. ,F soCommonwealth of Massachusetts City of Salem Board of Health Kimberley Driscoll 120 Washington Street,4th Floor Mayor SALEM,MA 01970 Food/Retail Establishment Permit DATE PRINTED: . 09/02/2010 i ESTABLISHMENT NAME: Great Escape Restaurant File Number:BHF-2010-000051 50 Saint Peter Street SALEM MA 01970 LOCATED AT: 1 SALEM, MA 01970 Permit Type Permit No. Permit Issued Permit Expires Fee Restrictions/Notes FOOD SERVICE BHP-2010-0539 Sep 7,2010 Dec 31,2010 $420.00 z ESTABLISHMENT °• Total Fees: $420.00 4 Y E 1 F 6 l; Y x PERMIT EXPIRES IDecember3l, 2010 , Board of Health s4 Ile This Permit is not transferable and must be reissued upon change of ownership or location.The permit must be posted tl in a prominent location in the Establishment. t In accordance with the State Sanitary Code,beofre any revimations,improvements,or equipment changes are made, all plans for such must be submitted to and approved by the Salem Board of Health. 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