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GROUND ROUND INC - ESTABLISHMENTS y GROUND ROUND, INC. 2 TRADERS WAY R n i l S I u I n u �r ' (I 14 u I II ,Y I � { i s ' tt� 1 o { ' I i r � d I s ... � �. .a C['+� - -vim-4,� ��c7� _ � O _ _ _ ¢Y- _., _ ..a ta. .. :. a � G - � sem-- =� 9 � �- w4 �'b .,F3a - -t-_ a� - C°s• _ .v z_Y c @ � _ _ �-- ^w =.� '�`"^ S R � _ ��'� i Cindy Dunn Franchise Business Consuhant(FBC) 24 Hatt Street Beverly Farms,MA 01915 Independent Owners Telephone:978-927-9112 Cooperative,LLC Facsimile:978.927-9116 500 U.S.Route One Mobile:978-578-5240 Freeport,Maine 04032 Email cdunn@graundroundsom wwwgroundround.cam Corporate Office Telephone:207-865-4433,an 6 Facsimile:207.865-2227 I I Cindy Dunn Franchise Business Consultant(FBC) I _ 24 Hart Street ( Beverly Farms,MA 01915 Independent Owners Teiephonet97&927-9112 Cooperative,LLC Facsimile:97&927-9116 $00 U.S.Route One Mobile:978.578-5240 Freeport,Maine 04032 Email cdunn@groundmund.com iw rgroundround.com ( Corporate Office { Telephone:207.865-4433,ext 6 Facsimile:207.8652227 . �- i Swcem JO,S -764-/7! 9 Q0\1 ')yy RODRIGUES•PERRETT CORPORATION GENERAL CONTRACTOR 6900 PHILLIPS HIGHWAY,SUITE 21 JACKSONVILLE,FLORIDA 02216 190x1 2961757 FAX.19041 2961052 VICE PRESIDENT PETE RODRIGUES CHIEF OPERATING OFFICER I CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH RECEIVED 120 WASHINGTON STREET,4TH FLOOR SALEM, MA 01970 DEC - 7 2��6 TEL. 978-741-1800 FAx 978-745-0343 CITY OF SALEM Kimberley Driscoll f''aWW.SALEM.COM BOARD OF HEALTH Mayor .JOANNE SCOTT, M1�tI, RS, CHO HEALTH AGENT 2007 APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT NAME OF ESTABLISHMENT (vRCiZJ) PMA,J AtZr TEL A7A77YY- YY88 ADDRESS OF ESTABLISHMENT 4 -MADFR$ WA�,4 FAX#(g26,,.L'tFOCi� MAILING ADDRESS (if different) FNAAIL-- Rusiness': Owner's: OWNER'S NAME MiCW..L 'eiUk v TEL# At 7) $SR- 5G0S ADDRESS? 1% N&-LOOK. RI30 LAITtI_� N9 STREET CITY STATE ZIP r CERTIFIED FOOD MANAGER'S NAME(Si WILL044\ EDInf0I}S, 5Ut1*`t'Es CERTIFICATE#(S) 501-7332+. 5031737 ccmt-' CN1ois z(( FRIi 501'1381 (Required in an establishment where potentially hazardous food is prepared) A \ 0 / EMERGENCY RESPONSE PERSON WILLI AT } POM(V J)1 HOME TEL#(97A\Ski - 1 7 pQ q I DAYS Of OPERATION_ Monday A Tuesday Wednesday Thursday Friday Saturday Sunday HOURS OFOPIRATtON - - — Ot t ° 11a+r'-td: UAivm Please write In time ofday. h AM-P'.30 14gM 10� fFerexample ttam-Item] AM II An-G130 Af" tl Ari- lat3C AM I I Am-la.,3D TYPE OF ESTABLISHMENT FEE (check onlvl RETAIL STORE YES NO less than 1000sq.ft. =$ 50 1000-10,000sq.ft. =$100 more than 10,000sq.ft. =$250 - -...... .. -- -------- - ---------- -- ------- --- ----- ----....---....-- RESTAURANT YES NO less than 25 seats $100 4,50 ruore seats t_7 more than 99 seats sc�'$�"_1 i BED/BREAKFAST YES NO $100 ---- ---- --------- ----------- --. ........-- ----- ... ...- ..._ ----.._._---- --- _.- .. ADDITIONAL PERMITS MAKE (not just serve) ICE CREAM, YOGURT, SOFT SERVE YES NO $5 TOBACCO VENDOR YES NO $50 ALL NON-PROFIT(such as church kitchens) YES NO $25 -Please pay total with one check payable to the City of Salem This Permit is not transferable and must be reissued upon change of ownership The Permit must be pasted in a prominent location in the Establishment. In accordance with the State Sanitary Code, before any renovations, improvements, or equipment changes are made, all plans for such must be submitted to and approved by the Salem Board of Health. Pursuant to MGL Chapter 62C, Section 49A, I certify under the pains and penalties of perjury that I, to my best knowledge and belief, have It ledail state tax returns and pard all state taxes r qui=ed under the law C!2Q Signature Date r Social Security or Federal Identification Number Revised 11113/00 FOODAR2007.adm Check#8 Date .{ - r nj Nffl a, `. �.s !✓Asin - ^AFP q r * k ;;r,- 3ommonwealth of,Massacha�se.tts i s s ' ��xr, ^� q ... 5•.- 'q' > .. u'"O'r. :W.:o;f-S+ :'alemi y� +,�� City : _ � �•• ' >.- t- •,f� .. �y.*' „�� . t;�`• .#A x� k�".�y�n�de_ 'cTAd:=,,,;A.?,.n.:,. � + �,��^rY"•�*�r'vY's,r �;LCP"' .F�"' "w' Health' ri * '1"7+ n, ti Y �1 �y.� • • 'J,r�,! t'li9v. '4h 6 %...yy. .µi6,�•.N' �-'t'"t'�y +_ IrwYt. 5 P 'k R' �' �,`��v . <: ....Sr .... x o'i`�Y)'3 .\��r,:.. .. fGmbettey Drist�ll Y r " ' • 320 Washington Street,�4th Floor t ' .�i;:'.r .k.'n..a.v.'`e�."`i& 'fesr'a..;r✓+r<...'a.,<1:�`, SALEM,MA 01970 Food/Retail Establishment Permit DATE PRINTED: 12/20/2006 ESTABLISHMENT NAME: The Ground Round File Number:BHF-2004-000293 2 Trader's Way Salem MA 01970 LOCATED AT: 0002 TRADERS WAY SALEM, MA 01970 Permit Type Permit No. Permit Issued Permit Expires Fee Restrictions/Notes FOOD SERVICE BHP-2007-0219 Dec 20,2006 Dec 31,2007 $200.00 ESTABLISHMENT Total Fees: $200.00 PERMIT EXPIRES 'December 31, 2007 Board of Health This Permit is not transferable and must be reissued upon change of ownership or location.The permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code,beofre any revonations,improvements,or equipment changes are made,all plans for such must be submitted to and approved by the Salem Board of Health. Page 3 of 3 0002 TRADERS WAY The Ground Round City of Salem FOOD SERVICE ESTABLISHMENT - FOOD SERVICE Inspection HACCP: ❑ Item Status Violation Critical Urgency Telephone: PROTECTION FROM CONTAMINATION 744-4488 Food Contact Surfaces Cleaning and Sanitizing PASS Critical ❑ RED Owner: 1 Comments: Dessert station sanitizer below mandated ppm. Sanitizer to be at 200 ppm as mandated. New Mass Restaurants LLC PIC: Sanitizer on cookline below mandated ppm. Sanitizer to be at 200 ppm as mandated. Bill Edmonds Cookline has insufficient quantity and concentration of sanitizer. Sanitizer to be readily available with proper concentration at all Inspector: work stations. John Gehan Cutting boards stained and scored. Resurface or replace cutting boards. Date Inspected:Correct By: 3/5/2007 Sanitizer by 3 bay sink below mandated ppm. Sanitizer to be at 200 ppm as mandated. Risk Level: Sanitizer at bar below mandated ppm. Sanitizer to be at 200 ppm as mandated. Handwash Facilities PASS Critical ❑ RED Permit Number: Comments: Employee womens restroom paper towel was not in dispenser. Paper towels to be in dispenser. BHP-2007-0219 Status: Employee restrooms requires general cleaning. SIGNED OFF #of Critical Violations: 0 Time IN Time OUT: Urgency Description(s): BLUE: Violations Related to Good Retail Practices (Critical violations must be corrected immediately or within 10 days)(Non-critical violations must be corrected immediately or within 90 days) City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741-1800 GeoTMS®2007 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Apr 05,2007 ) Page 1 of Item Status Violation Critical Urgency RED: Violations Related to Good Retail Practices (Blue Items) Violations Related to Food and Food Protection PASS Critical BLUE Foodborne Illness Interventions and Risk Factors (Require Comments:There are personal items being stored on popcorn baskets. Personal items to be stored in designated employee areas immediate corrective action) t prevent cross contamination. True unit at end of cookline has uncovered foods. All foods must Be covered to prevent contamination. Beverage Air unit has containers stored directly on top of foods. Containers to be separated and stored correctly to prevent contamination. Same unit has uncovered foods. Alk foods must be coveredbto prevent cross contamination. There was a personal drink being stored in refrigerator at end of cookline. Personal items to be stored in designated employee area. Plates at end of cookline beneath lang melter have accumulation of spills. All plates to be rewashed and sanitized. Meat slicer has accumulation of food debris. Thoroughly clean and sanitize after each use. Knives found with accumulation of food debris in knife rack. Knives to be washed and sanitized after each use. Can opener found with accumulation of grime. Thoroughly clean and sanitize opener and its base. The dishwasher is chemically fed. There was no sanitizing chemical at time of inspection. Chemical changed at inspection. Walk in freezer reading at 20°F at time of inspection. Freezer to be reading at 0°F or below as mandated. Have unit serviced as needed. There are many utensils and equipmet being stored directly on floor up stairs. All utensils and equipment must be 6-8 inches off of the floor. Equipment and Utensils PASS BLUE Comments: Ice cream freezer has accumulation of food spills. Thoroughly clean unit. The back up cooler has accumulation of food spills. Thoroughly clean unit. Salad dressing unit has drawer in disrepair. Repair or replace drawer. Salad dressing unit has accumulation of food spillsand splatter. Thoroughly clean unit. Back up sauces unit has accumulation of food spills and splatter. Thoroughly clean unit inside and out. Gasket requires cleaning as well. True unit at end of cookline has accumulation of food spills. Thoroughly clean unit. True broiler meat box has accumulation of food spills. Thoroughly clean unit. Lang melter near microwave has accumulation of food spills. Thoroughly clean unit. City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741-1800 GeoTMSO 2007 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Apr 05,2007 ) Page 2 of Item Status Violation Critical Urgency The entire cookline has accumulation of food spills,grease and grime. Cookline to be professionally cleaned. Establishment to provide invoice of cleaning to BOH. The ansul system has accumulation of grease. System to be professionally cleaned. Establishment to provide invoice of cleaning to BOH. Refrigeration unit for fish has accumulation of food spills. Thoroughly clean unit. Lan matter above plates has accumulation of foods ills. Thoroughly clean unit. 9 P P 9 Y Tongs being stored on ansul system. Utensils to be cleaned and sanitized after each use and stored in an appropriate designated container. Cucumber/onion drawer in disrepair. Repair or replace drawer. Same unit has accumulation of food spills. Thoroughly clean unit. Ice machine has accumulation of food splatter on outside. Thoroughly clean outside of unit. Shelves in beer walk in unit has accumulation of grime. Thoroughly clean shelves. Food walk in unit floor has spills and splatters. Thoroughly clean unit floor. Walk in freezer has spills and splatters throughout. Thoroughly clean unit floor and shelving. Same unit has accumulation of ice. Remove ice. Find source of leak and repair. Mop stored incorrectly. Mop to bevstored so not touching any surfaces and allowed to air dry. Physical Facility PASS BLUE Comments:All floors,walls and surfaces have accumulation of food debris spills and splatter. Thoroughly clean all floors wall and surfaces including beneath and around all units. There are many ceiling tiles that are missing or out of place. Replace all tiles. Beer walk in floor is in disrepair. Repair floor to prevent hazard. There are spills and splatters around the dumpster. Thoroughly clean around dumpster. Dumpster was open at time of inspection. Dumpster to be closed at all times to prevent rodents and/or insects. The weather stripping at the bottom of the back door appears to be in disrepair. Repair or replace stripping so no visible air gap can be seen. The landing floor to the upstairs area is coming up. Repair floor to prevent hazard. Other-See Notes PASS BLUE Comments:The food permit on the wall is expired. Establishment to post 2007 food permit. City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741-1800 GeoTMS®2007 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Apr 05,2007 ) Page 3 of • Item Status Violation Critical Urgency GENERAL COMMENTS: All violations from 3/29/07 have been corrected. Establishment to closely monitor sanitizer throughout. City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741-1800 GeoTMS®2007 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Apr 05,2007 ) Page 4 of rafael b cleaners Invoice 13 mason st E Date Invoice# salem,MA 01970 64102r2067 1006 Bili To ground round 2 trader way salem ma 01970 P.O. No. Terms Project $325.00 I Quantity Description Rate Amount hood cleaners 566.00 500.00 line cleaners and back walls 200.00 200.00 equipment cleaners 250.00 250.00 Thank you for your business. Total RQ$950.00 0002 TRADERS WAY The Ground Round City of Salem FOOD SERVICE ESTABLISHMENT - FOOD SERVICE Inspection HACCP: ❑ Item Status Violation Critical Urgency Telephone: PROTECTION FROM CONTAMINATION 744-4488 Food Contact Surfaces Cleaning and Sanitizing FAIL Critical 0 RED Owner: omment; Dessert station sanitizer below mandated ppm. Sanitizer to be at 200 ppm as mandated. New Mass Restaurants LLC PIC: ,- nit eiz r on cookline below mandated ppm. Sanitizer to be at 200 ppm as mandated. Bill Edmonds �oklme has insufficient quantity and concentration of sanitizes. Sanitizer to be readily available with proper concentration at all Inspector: work stations. John Gehan utting boards stained and scored. Resurface or replace cutting boards. Date Inspected:Correct By: 3129/2007 Sanitizes by 3 bay sink below mandated ppm. Sanitizes to be at 200 ppm as mandated. Risk Level: ','Sa tizer at bar below mandated ppm. Sanitizer to be at 200 ppm as mandated. Handwash Facilities FAIL Critical ❑� RED Permit Number: mment: Employee womens restroom paper towel was not in dispenser. Paper towels to be in dispenser. BHP-2007-0219 Status: ployee restrooms requires general cleaning. Open #of Critical Violations: 3 Time IN. Time OUT: f Urgency Description(s): BLUE: Violations Related to Good Retail Practices (Critical violations must be corrected immediately or within 10 days)(Non-critical violations must be corrected immediately or within 90 days) City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741-1800 GeoTMS®2007 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Mar 29,2007 ) Page 1 of ' Item Status Violation Critical Urgency RED: Violations Related to Good Retail Practices (Blue Items) Violations Related to Food and Food Protection FAIL Critical BLUE Foodborne Illness Interventions , and Risk Factors (Require Cyminent: There are personal items being stored on popcorn baskets. Personal items to be stored in designated employee areas t immediate corrective action) ✓prevent cross contamination. rue unit at end of cookline has uncovered foods. All foods must Be covered to prevent contamination. Bev rage Air unit has containers stored directly on top of foods. Containers to be separated and stored correctly to prevent ntamination. Same unit has uncovered foods. Alk foods must be coveredbto prevent cross contamination. T e was a personal drink being stored in refrigerator at end of cookline. Personal items to be stored in designated employee area. ..Plates at end of cookline beneath lang matter have accumulation of spills. All plates to be rewashed and sanitized. ✓Meat slicer has accumulation of food debris. Thoroughly clean and sanitize after each use. „, K in ves found with accumulation of food debris in knife rack. Knives to be washed and sanitized after each use. /ouener found with accumulation of grime. Thoroughly clean and sanitize opener and its base. . The dishwasher is chemically fed. There was no sanitizing chemical at time of inspection. Chemical changed at inspection; 31k in freezer reading at 20°F at time of inspection. Freezer to be reading at 0°F or below as mandated. Have unit serviced as needed. re are many utensils and equipmet being stored directly on floor up stairs. All utensils and equipment must be 6-8 inches off of the floor. Equipment and Utensils FAIL BLUE mmcream freezer has accumulation of food spills. Thoroughly clean unit. ,We—back up cooler has accumulation of food spills. Thoroughly clean unit. ,Pfllad dressing unit has drawer in disrepair. Repair or replace drawer. '-'�.ad dressing unit has accumulation of food spillsand splatter. Thoroughly clean unit. Back up sauces unit has accumulation of food spills and splatter. Thoroughly clean unit inside and out. Gasket requires cleaning as well. �.. Tlu unit sit end of cookline has accumulation of food spills. Thoroughly clean unit. ✓ e broiler meat box has accumulation of food spills. Thoroughly clean unit. g matter near microwave has accumulation of food spills. Thoroughly clean unit. City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741.1800 GeoTMSO 2007 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Mar 29,2007 ) Page 2 of ' Item Status Violation Critical Urgency Thee ntire cookline has accumulation of food spills,grease and grime. Cookline to be professionally cleaned. Establishment to `provide invoice of cleaning to BOH. Th sul system has accumulation of grease. System to be professionally cleaned. Establishment to provide invoice of cleaning o BOH. igeration unit for fish has accumulation of food spills. Thoroughly clean unit. ,,/Lang melter above plates has accumulation of food spills. Thoroughly clean unit. T6ngs being stored on ansul system. Utensils to be cleaned and sanitized after each use and stored in an appropriate designated container. Cucumberlonion drawer in disrepair. Repair or replace drawer. me unit has accumulation of food spills. Thoroughly clean unit. Ice has accumulation of food splatter on outside. Thoroughly clean outside of unit. \�es in beer walk in unit has accumulation of grime. Thoroughly clean shelves. odwalk in unit floor has spills and splatters. Thoroughly clean unit floor. Wdldwk in,freezer has spills and splatters throughout. Thoroughly clean unit floor and shelving. �ame unit h -accumulation of ice. Remove ice. Find source of leak and repair. 'n n surfaces and allowed to air dry. stored incorrectly. Mo to bevstored so not touching a su ry P 9 Y Physical Facility FAIL BLUE �mment:All floors,walls and surfaces have accumulation of food debris spills and splatter. Thoroughly clean all floors wall and surfaces including beneath and around all units. ere are many ceiling tiles that are missing or out of place. Replace all tiles. L.�walk in floor is in disrepair. Repair floor to prevent hazard. ere are spills and splatters around the dumpster. Thoroughly clean around dumpster. .__9F sten was open at time of inspection. Dumpster to be closed at all times to prevent rodents and/or insects. LIA<e weather stripping at the bottom of the back door appears to be in disrepair. Repair or replace stripping so no visible air gap can be n. he 1,ndmg floor to the upstairs area is coming up. Repair floor to prevent hazard. Other-See Notes FAIL BLUE Comment:The food permit on the wall is expired. Establishment to post 2007 food permit. City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741-1800 GeoTMS®2007 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Mar 29,2007 ) Page 3 of JY • Item Status Violation Critical Urgency GENERAL COMMENTS: Re-inspection to be in one week. All violations to be corrected. ")7 City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741-1800 GeoTMS®2007 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Mar 29,2007 ) Page 4 of s � _ ,'WURTOO Fllb ., .,.,..-a• ,c 'k S-- �Y GTAiION NO ,� 'S;tn'•`. �, � M1 '�+ RYA EDR ITV WN STATE '-ZIP a o rrYL1C /1Sfl 0/yam LICENS NO. r LIQ EXP.DA DATE OF B it .� �CPJl7tlA/ vw''D`� �.,"a0), a., -;Zai„'' de>''m� K o.: m / a,O• a..,.fA qR. o (LAs7,plRsr�NmriLlt� .t Q'.Z:<O '14 lVO N :, * .'�l'! .{ 4 ITT �,. "cn'. ».;:-.,= '< 2'. tF`''c,•.r�.370y -e .N v o:• W`'�, t'cx.xj{:sF•x+"�,a-,6 D:CO, w.1`YN STREET 55 C RO - UJ ax� cy4 �lopl rCr�eel min /IJ o 2*_, ',�.'-. p REGISTRATION NO. STATE I EXP.DAT PE YEA (COLO -- :O�'�fi 1-.P .--.� � ,g� iN�`; ,?{,- :fir'-.t„ DAT VI/QUA/TION IME ./ WWI W fREN � L�;'+xr-'" I �/Ofd IIOQ Q❑FM / `�� VAM E$ a0, uss,�r 'ryrJs - '..fix :.v< Ta ,.,.. x.:A". �ye =e= _ 'yt:.'f Set ys ;.; ❑NO •.r. .w . .wr" 1 LOC ON OFVIOLAT(IjJ OFFENSE C P. SECT. FINES Abc�/R7GlZ�A (�IJG /CC�GII ^Yl a! e.�si :a.Y11�„ fi' 3\',lxs'+q'`1 4-' t+j .g55n'WS.F,'•1".t� ' >,"�,s�.gy�s�„ <4:?,:', 'ii'y Y:�S.y,;•'�.'' .. y�:�ti '.%:cci?rr /o6r!l man�aCf.�Li�Gra-w.iJ�nJFi�+ :s —7e"— ;'[�+'tr d .�:ti " : .D? C J1112K1.a2� l/yup 1,4149 J20i belay?ila/nf4! r(,JS - + OFFICER I I D.NO.I TOTAL INE Q" ''a','-,az- as `S <_�","�,% "µ` ye:: � DUE IT /�� OFFICE CERTIFIES COPY GIVEN TO VIOLATOR °_�,�� .'Nm , I ❑ IN HAND W * : 17 X BY MAIL Ip Y' DO NOT MAIL CASH-PAY ONLY BY POSTAL NOTE,MONEY r i ro D 2 ORDER OR BY CHECK MADE PAYABLE TO: i _ Q o m CITY CLERK CRY HALL x 93 WASHINGTON STREET + SALEM,MA 01970 i TEL.(508)745-9595 X 251 + I HEREBY ELECT TO EXERCISE THE FIRST OPTION AS STATED ON ti REVERSE, CONFESS TO THE OFFENSE CHARGED,AND ENCLOSE o * PAYMENT IN THE AMOUNT OF O�` * $ CASE# p \rf \O f i SIGNATURE SEE OTHER SIDE FOR FURTHER INFORMATION o 'N ENCLOSE PAYMENT IN THIS ENVELOPE,PEEL AND SEAL 0 0 0 rn o 4 v S N 3 s N -Security Features Included ED Details on Back. , 0002 TRADERS WAY The Ground Round City of Salem FOOD SERVICE ESTABLISHMENT - FOOD SERVICE Inspection HACCP: ❑ Item Status Violation Critical Urgency Telephone: PROTECTION FROM CONTAMINATION 744-4488 Food Contact Surf ces Cleaning and Sanitizing FAIL Critical ❑� RED Owner ment,The cutting boards in the cookline are badly stained and scored. ResurfAce or replace all cutting boards. New Mass Restaurants LLC _ Sani ' ing solution found too weak. Sanitizing solution of proper concentration must he readily available at all workstations at all PIC: ti es. Bill Edmonds Inspector 's D' y knives found in the knife rack. All knives must be properly cleaned and sanitized prior to storage in the knife rack. David Greenbaum Tinterior panel of the ice machine has an accumulation of grime. Thoroughly clean and sanitize the panel. Date Inspected:Correct By: + Handwash Facilitie FAIL Critical ❑d RED 10/10/2006 I Risk Level: Co ent:There is no hand wash sink at the bar. A dedicated hand wash sink must be at the bar,stocked with soap and posable paper towels at all times. TIMEITEMPERATURE CONTROLS(Potentially Hazardous Foods) Permit Number: Hot and Cold H ing FAIL Critical ❑ RED BHP-2006-0255 Status: C merit:The Delfeild freezer had a temperature of 12"F. Repair unit to maintain a temperature of 0°F or below. VIOLATION #of Critical Violations: 4 j Time IN: Time OUT: Urgency Description(s): BLUE: Violations Related to Good Retail Practices (Critical violations must be corrected immediately or within 10 days)(Non-critical violations must be corrected immediately or within 90 days) City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741-1800 GeoTMS®2006 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Oct 10,2006 ) Page 1 oft 'r Item Status Violation Critical Urgency RED: Violations Related to)Good Retail Practices (Blue Items) Violations Related to Food and Foo rotection FAIL Critical BLUE Foodborne Illness Interventions and Risk Factors (Require omment: Paper products stored directly on the floor upstairs. Store all paper products at least 8-8 inches off the floor. immediate corrective action) To la shells stored on top of the ice machine uncovered. Cover and store tortilla shells in an appropriate Equip ent and Utensils FAIL Non-Critical BLUE Co ent:The ice cream freezer has an accumulation of food spills. Thoroughly clean the ice cream freezer. TheEdell the cooling units are in disrepair. Repair all cooling unit tops. Thr ves in the cookline have an accumulation of food spills and splatter. Thoroughly clean all microwaves. T eezer has an accumulation of food debris. Thoroughly clean this freezer. Th n>coo g unit has an accumulation of grime. Thoroughly clean this unit. he ue reach in has an accumulation of grime and food debris. Thoroughly clean this unit including all door gaskets. The nopener needs a thorough cleaning. W e an accumulation of food spills and splatter. Thoroughly clean the walls. the walk in floors need a thorough cleaning. T oven and grills are encrusted in grease. Thoroughly clean the entire cook line. T dry goods closet needs a thorough cleaning. ck stairs have an accumulation of food debris and grime. Thoroughly clean the back stairs. Phys�,VF, FAIL Non-Critical BLUE ment:There are areas of the kitchen ceiling that are in disrepair. Repair the kitchen ceiling. GENERAL COMMENTS: 888:Reinspection in one week. All violations to be corrected. �J City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741.1800 GeoTMS®2006 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Oct 10,2006 ) Page?oft e 0002 TRADERS WAY The Ground Round City of Salem FOOD SERVICE ESTABLISHMENT - FOOD SERVICE Inspection HACCP: ❑ Item Status Violation Critical Urgency Telephone: PROTECTION FROM CONTAMINATION 744-4488 Food Contact Surfaces Cleaning and Sanitizing PASS Critical ❑d RED Owner: Comments:The cutting boards in the cookline are badly stained and scored. ResurfAce or replace all cutting boards. New Mass Restaurants LLC PIC: Sanitizing solution found too weak. Sanitizing solution of proper concentration must be readily available at all work stations at all Bill Edmonds times. Inspector: Dirty knives found in the knife rack. All knives must be properly cleaned and sanitized prior to storage in the knife rack. David Greenbaum The interior panel of the ice machine has an accumulation of grime. Thoroughly clean and sanitize the panel. Date Inspected:Correct By: Handwash Facilities PASS Critical ❑0 RED 10/19/2006 Risk Level: Comments:There is no hand wash sink at the bar. A dedicated hand wash sink must be at the bar,stocked with soap and disposable paper towels at all times. TIME/TEMPERATURE CONTROLS(Potentially Hazardous Foods) Permit Number: Hot and Cold Holding PASS Critical 0 RED BHP-2006-0255 Status: Comments:The Delfeild freezer had a temperature of 12°F. Repair unit to maintain a temperature of 0°F or below. SIGNED OFF #of Critical Violations: 0 Time IN: Time OUT: Urgency Description(s): BLUE: Violations Related to Good Retail Practices (Critical violations must be corrected immediately or within 10 days)(Non-critical violations must be corrected immediately or within 90 days) City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741-1800 GeoTMS®2006 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Oct 19,2006 ) Page! of r- Item Status Violation Critical Urgency RED: Violations Related to Good Retail Practices (Blue Items) Violations Related to Food and Food Protection PASS Critical BLUE Foodborne Illness Interventions and Risk Factors (Require Comments: Paper products stored directly on the floor upstairs. Store all paper products at least 6-8 inches off the floor. immediate corrective action) Tortilla shells stored on top of the ice machine uncovered. Cover and store tortilla shells in an appropriate Equipment and Utensils PASS Non-Critical BLUE Comments:The ice cream freezer has an accumulation of food spills. Thoroughly clean the ice cream freezer. The tops of the cooling units are in disrepair. Repair all cooling unit tops. The microwaves in the cookline have an accumulation of food spills and splatter. Thoroughly clean all microwaves. The Delfeild freezer has an accumulation of food debris. Thoroughly clean this freezer. The end cooling unit has an accumulation of grime. Thoroughly clean this unit. The True reach in has an accumulation of grime and food debris. Thoroughly clean this unit including all door gaskets. The canopener needs a thorough cleaning. Walls have an accumulation of food spills and splatter. Thoroughly clean the walls. Bothe walk in floors need a thorough cleaning. The oven and grills are encrusted in grease. Thoroughly clean the entire cook line. The dry goods closet needs a thorough cleaning. The back stairs have an accumulation of food debris and grime. Thoroughly clean the back stairs. Physical Facility PASS Non-Critical BLUE Comments:There are areas of the kitchen ceiling that are in disrepair. Repair the kitchen ceiling. GENERAL COMMENTS: 910:AII violations cited in the 10/11/06 inspection report have been corrected., City of Salem Board of Health 120 Washington Street,4th Floor SALEM MA 01970(978)741-1800 GeoTMS®2006 Des Lauriers Municipal Solutions, Inc. Commonwealth of Massachusetts ( Rev. Oct 19,2006 ) Page 2 oft COURT DOCKET NO. CITATION NO. VIOLATIO CITY O SALEMN NOTICE [J PD 6 0 5 2 NAME(LAST,FIRST,INITIAL) �ravr�ci STREET DRESS DRESS CITY/TOWN STATE ZIP MOWS llddq Ill LICENSE NO LIC EXP DATE, DATE OF B)�TH OW� AME (LAST INITIAL)T STREETADDAESS CITYaOWN STATE ZIP /lo��ll/Ur{ S�eR i`rjrrJ,r�</f �I itl �, r> r REGISTRATION STATE EXP DATE_ ry151(E/yYPE YEAR ICOL^ DA OF VIOLATION TIM/}^`(Ye/ /OA/TE CITAT/^ION�RITTEN P-ER ONAV /lZNO 1!J 1 S/p 1/{fi "'M ;�uRY ❑PM LOCATION OF VIOLATION ENFORCING DEPT Zv�'tes 7-141- OFFENSE I , CHAP SECT I FINES A 1-1{C/tari�6plif- /Ce�E<t��ID l �7LYI S ,..,- gCaki/rd�aat_f r.`JrJJ: n,•I nT1RrC'.crarc:`- �� xat�>wlR-ZZ'>L m.'tr,YiQ KCft 7fi'ffick'iK �5- c OFFICER � DNO � L $ NEI OFFICER+ CERTIFIES COPY GIVEN TO VIOLATIO�R� `?� 'W dcT"AIN HAND X BV MAIL DO NOT MAIL CASH-PAY ONLY BY POSTAL NOTE,MONEY ORDER OR BY CF ECK MADE PAYABLE TO: 'CITY CLERK CITY HALL 93 WASHINGTON STREET SALEM,MA 01970 TEL.(508)745-9595 X 251 1 HEREBY ELECT TO EXERCISE THE FIRST OPTION AS STATED ON REVERSE, CONFESS TO THE OFFENSE CHARGED, AND ENCLOSE PAYMENT IN THE AMOUNT OF $ CASE N SIGNATURE SEE OTHER SIDE FOR FURTHER INFORMATION ENCLOSE PAYMENT IN THIS ENVELOPE,PEEL AND SEAL The following is a plan to eliminate the ongoing problems caused by all assorted refrigeration units located in the Ground Round restaurant in Salem, MA. This is a preliminary draft and it is subject to constant revision as work progresses. 1) We have removed the stand up 2 door unit that was originally located on our server line. 2) We have repaired all equipment to ensure that it is properly maintaining a temperature of 41 degrees or below for refrigerated product. 3) We have repaired all equipment, with the exception of the cook line reach in freezer,to ensure that it is properly maintaining a temperature of 0 degrees or below for frozen product. We have the following plans in place to replace or retain the following units.... 1) Our 4 foot refrigerator, located at the front left of our cook line, is scheduled to be replaced by Monday, 10/30/06. The replacement refrigerator will be delivered by our owner, Michael Yung, from a recently closed Ground Round restaurant. 2) Our 2 foot refrigerator, located opposite of our fryolators on the cook line, has been maintaining a steady temperature of 41 degrees or below. No replacement is deemed necessary at this time. 3) Our 2 foot refrigerator, located next to the cooler listed above, is currently holding temperature, but is next in line for replacement. We will be receiving a replacement refrigerator from the closed Georgia unit. It will be activated immediately when needed. 4) Our 4 foot refrigerator, located at the front end of our cook line, is maintaining a steady temperature of 41 degrees or below. No replacement is deemed necessary at this time. 5) Our stand up refrigerator, located beside the broiler on the cook line, has been maintaining a steady temperature of 41 degrees or below. No replacement is deemed necessary at this time. 6) Our stand up freezer, located next to the fryolators on the cook line, is maintaining a steady temperature of 6 degrees or less. We are unable to get the unit to maintain a temperature of 0 degrees, especially during very frequent use. We have reduced our stocking levels inside the unit to enable better air circulation thru ought the day. At no time is the product held above 10 degrees, maintaining its frozen state. 7) Our ice cream freezer located on the server line is holding product below 0 degrees. No replacement is deemed necessary at this time. 8) Our salad refrigerator located on the server line is maintaining a temperature below 41 degrees. No replacement is deemed necessary at this time. 9) Our 2 foot reach in refrigerator located on the server line is maintaining a temperature below 41 degrees. No replacement is deemed necessary at this time. 10)Our 2 walk-in refrigerators, beer and cook, are both maintaining temperatures below 41 degrees. No work is presently needed on them to ensure sub 41 degree temperatures. 11)Our walk-in freezer is maintaining a steady temperature below 0 degrees. Daily maintenance is needed to eliminate ice/ snow build up around the door frame. No work is presently needed to ensure sub 0 degree temperatures. Sincerely, William Edmonds 0)&V 10-16-06. r CITY OF SALEM BOARD OF HEALTH Name of Establishment: The Ground Round Address: 2 Trader's Way Owners): Michael Yung Phone: 978-744-4488 Date: September 14, 2006 On July 29`h, August 2nd 3rd 2006, a sanitarian conducted inspections noting critical problems with the cooling units at this establishment. On August19, 2006, a re-inspection noted all violations had been corrected. Following a complaint, sanitarians conducted an inspection on September 7, 2006 and observed several of the same cooling temperature violations. The owner was asked to appear before the Board for a hearing regarding these repeat critical violations of the Food Code. The following were present for the hearing: Michael Yung, owner; Cindy Dunn, Franchise Business Consultant, Bill Edmonds, Manager; Joanne Scott, Health Agent; Janet Dionne, Senior Sanitarian; and John Gehan, Sanitarian. The owner discussed the actions taken following the initial inspections, including securing the services of equipment repairpersons. The Health Agent discussed the importance of following the Food Code every day not just following an inspection by the Board of Health. The owner, manager and consultant were given the opportunity to ask questions. The owner understands that continued critical violations may result in suspension of the establishment's food permit. 1` The owner agrees to: • Closely monitor the operation of his restaurant by establishing procedures with the new manager for daily checking of all refrigerator/freezer temperatures including maintaining a log of those temperatures for inspection by the sanitarians. • Take immediate action if any temperatures are not within the Food Code requirements. • Develop a plan for capital improvements to the establishment considering that most equipment, even if renovated, is at least 14 years old. This plan must be submitted to the Health Agent by October 14, 2006. A monetary fine will be assessed to the owner based upon the number of repeat violations noted over the past two years of inspections. ce, c7-1Y-0 6 r canoe Scott Date Health ent., 3 Michael Yung, Owner lbate Commonwealth of Massachusetts e City of Salem Board of Health 120 Washington Street,4th Floor SALEM,MA 01970 Food/Retail Establishment Permit DATE PRINTED: 01/03/2006 WHO'S PLACE OF BUSINESS IS: The Ground Round File Number:BHF-2004-0293 2 Trader's Way Salem MA 01970 LOCATED AT: 0002 TRADERS WAY SALEM, MA 01970 Permit Type Permit No. Permit Issued Permit Expires Fee Restrictions/Notes FOOD SERVICE BHP-2006-0255 Jan 3,2006 Dec 31,2006 $200.00 ESTABLISHMENT Total Fees: $200.00 PERMIT EXPIRES December 31, 2006 Board of Health � � This Permit is not transferable and must be reissued upon change of ownership or location.The permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code,beofre any revonations,improvements,or equipment changes are made,all plans for such must be submitted to and approved by the Salem Board of Health. Page 9 of 10 •, CITY OF S`EM,,MASSACHIJSETT- �-31 IV o BOARD OF HEALTH j 120 WASHINGTON STREET, 4TH FLOOR DEC 2 7 2005 SALEM, MA 01970 TEL. 978-741-1800 CITY OF SALEM STANLEY J. USOVICZ, JR. FAx 978-745-0343 BOARD OF HEALTH MAYOR WWW.SALEM.COM JOANNE SCOTT, MPH, RS, CHO - HEALTH AGENT v ' 2006 APPLICATION FOR PERMIT/T-0 OPERATE A FOOD ESTABLISHMENT NAME OF ESTABLISHMENT ` oA4 TEL# f -7W-- `1-I8O ADDRESS OF ESTABLISHMENT (Al t MAILING ADDRESS (if different) Irl \/ OWNER'S NAME tc.�` gAl Y.Jnq TEL#�O, 5605 ADDRESS \J CITY STATE ZIP CERTIFIED FOOD MANAGER'S NAME(S) .a CERTIFICATE#(s) a4a�yry Ah� oR'7 3 9/7�9- (required in an establishment where potentially hazardous food is prepared.) u EMERGENCY RESPONSE PERSON l.�i� S-leJcnS HOME TEL#c�I-779- 6876 HOURS OF OPERATION: Mon. --Tue.—Wed.—Thu.—Fri.—Sat.— Sun. /a7^113 - Id 3 TYPE OF ESTABLISHMENT 11FEE (check only) RETAIL STORE YES NO less than 1000sq.ft. =$ 50 1000-10,000sq.ft. =$100 more than 10,000sq.ft. =$250 -.......... .................. RESTAURANT YES NO----------------------------------------------- ......... less than 25 seats =$100 25-99 seats more than 99 seats = 20 ----S NO------------------------------------------------------------------------------------------------$'10-0----------------- BED/BREAKFAST YE , ................... ADDITIONAL-. PERrnITg Y MAKE (not just serve) ICE CREAM, YOGURT, SOFT SERVE YES N $5 TOBACCO VENDOR YES $50 ALL NON-PROFIT(such as church kitchens) YES N $25 *Please pay total with one check payable to the City of Salem . This Permit is not transferable and must be reissued upon change of ownership. The Permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code, before any renovations, improvements, or equipment changes are made, all plans for such must be submitted to and approved by the Salem Board of Health. Pursuant to MGL Chapter 62C, Section 49A, I certify under the pains and penalties of perjury that I, to my best know edge and belief, have filed all state tax returns and paid all state taxes required under the law. S' a [pae Social Security or Federal Identification Number --------- -------------- R vised 11/03/05 FOODAP2.adm Check#&Date �h/'� 3A`7a �]o1 ' Massachusetts Department of Public Health Salem Board of Health Division of Food and Drugs 120 Washington Street, 41h Floor 9 Salem, MA 01970-3523 FOOD ESTABLISHMENT INSPECTION REPORT Tel. (978) 741-1800 Fax (978) 745-0343 Name ) Date Type of Operation(s), Tyqe of Insoection G q- _-�'-0(0 ® Food Service ❑ Routine AddressRisk LJ Retail ElRe-inspection .Ar_ _ p<, jj�Aq LevelElResidential Kitchen Previous Inspection Telephone �/r,^/" / ❑ Mobile Date: Owner HACCP Y/N [-ITemporary ElPre-operation V,y� I ❑ Caterer ❑ Suspect Illness Person in Charge(PIC)' le4 �hps Time ❑ Ba d&Breakfast x❑ General Complaint +_ ^vim` in •'DO�p'► E] HACCP 7W/D/d Inspector , �) 7 N/ Out: Permit No. ❑Other Each violation checked required an explanation on the narrative page(s)and a citation of specific provision(s)violated. Non-compliance with: Violations Related to Foodborne Illness Interventions and Risk Factors Anti-Choking Tobacco Violations marked may pose an imminent health hazard and require immediate corrective 590.009(E) ❑ 590.009(F) ❑ action as determined by the Board of Health. FOOD PROTECTION MANAGEMENT',,. '- El12. Prevention of Contamination from Hands ❑ 1. PIC Assigned/Knowledgeable/Duties BB[[� -„ ,,, ['f 13. Handwash Facilitiesfl3 EMPLOYEE HEALTH Y� .. . , PROTECTION FROM CHEMICALS ❑ 2. Reporting of Diseases by Food Employee and PIC •- _. -- ❑ 14.Approved Food or Color Additives ❑ 3. Personnel with Infections Restricted/Excluded ❑ 15.Toxic Chemicals FOOD FROM APPROVED SOURCE', - '-TIME/rEMPERATURE CONTROLS Potential) Hazardous Foods)" --` ❑ 4. Food and Water from Approved Source (Potentially ❑ 5. Receiving/Condition ❑ 16.Cooking Temperatures ❑ 6. Tags/Records/Accuracy of Ingredient Statements ❑ 17. Reheating ❑ 7. Conformance with Approved Procedures/HACCP Plans El 18.Cooling PROTECTION FROM CONTAMINATION E311 9. Hot and Cold Holding(2D E3 `88. Separation/Segregation/Protection ❑20.Time As a Public Health Control Iii 9. Food Contact Surfaces Cleaning and Sanitizing REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP)_' ❑21. Food and Food Preparation for HSP ❑ 10. Proper Adequate Handwashing f 11. Good Hygienic Practices CONSUMER ADVISORY s - ❑22. Posting of Consumer Advisories Violations Related to Good Retail Practices Number of Violated Provisions Related Critical (C) violations marked must be corrected To Foodborne Illnesses Interventions immediately or within 10 days as determined by the Board and Risk Factors(items 1-22): of Health. Non-critical (N) violations must be corrected Official Order for Correction: Based on an inspection immediately or within 90 days as determined by the Board today, the items checked indicate violations of 105 CMR of Health. 590.000/federal Food Code. This report, when signed below C N by a Board of Health member or its agent constitutes an -23. Management and Personnel (FC-2)(550.003) ,e 24. Food and Food Protection (FC-3)(590.004) order of the Board of Health. Failure to correct violations 25. Equipment and Utensils (FC-4)(590.005) cited in this report may result in suspension or revocation of the food establishment permit and cessation of food 26. Water, Plumbing and Waste (FC-5)(590.006) establishment operations. If aggrieved by this order, you 27. Physical Facility (FC-6)(590.007) have a right to a hearing. Your request must be in writing 28. Poisonous or Toxic Materials (FC-7)(590.008) and submitted to the Board of Health at the above address 29. Special Requirements (590.009) within 10 days of receipt of this order. 30. Other DATE OF RE-INSPECTION: S 590MVs fFom 14(E �! Inspec\or ` 'Sipgatn[es_ of � - Print\_�inf PIC's Sign jture( ��` ((('„��//Izsrd ' Print 3-Yt� ,h{� .� I Page/ oflPages Violations Related to Foodborne Illness Interventions and Risk Factors(items 1-22) PROTECTION FROM CONTAMINATION FOOD PROTECTION MANAGEMENT 18 I Cross-contamination I 590.003(A) Assignment of Responsibility"' ( 3-302.1 I(A)(!) Raw Aminal Foods Separated from 590.0030 Demonstration of Knowledge* I ( Cooked and RTE F(xxis* 2-103.11 I Person in charge -duties I ( Contamination from Raw Ingredients 3-302 11(A)(2) Raw Animal Fu(xls Separated from Each EMPLOYEE HEALTH I Other* 2 590.003(C) Responsibility of the person in charge to I Contamination from the Environment require reporting by fixxi employees and 13-302.1 I(A) Food Protection' J applicants* 3-302.15 Washing Fruits and Vegetables 590.003(F) Responsibility Of A Food Employee Or An 3-104.11 Food Contact with Equipment and Applicant To Report To The Person In Utensils* Charge* Contamination from the Consumer 590.003(G) Reporting by Person in Charge* 13-306.14(A)(B) Returned Food and Reservice of Food* 3 590.003(D) Exclusions and Restrictions* Disposition of Adulterated or Contaminated 590.003(E) Removal of Exclusions and Restrictions Food l 3-701.11 Discarding or Reconditioning Unsafe FOOD FROM APPROVED SOURCE Food* 4 I Food and Water From Regulated Sources ( 19 Food Contact Surfaces 590.004(A-Bl Compliance with Food Law* 4-501.111 Manual Warewashmg-Hot Water I 3-201.12 Food in a Hermetically Scaled Container* I Sanitization Temperatures* J 13-201.13 Fluid Milk and Milk Products* ( 4-501.112 Mechanical Warewashing-Hot Water Sanitization Tem cratmes* 3-202.13 Shell E'T4-501.114 Ts* I 4 501 114 I Chemical Sanitisation-temp.,pH, Milk Products.Pasteurized* 13-202.14 Eggs and 3-202.16 Ice Made From Potable Drinking Water* I concentration and hardness. " 5-101.1 I Drinking Water from an Approved System* I 4-('01.11(A) Utensils Clean* Food Contact Surfaces and I 590.006(A) Bottled Drinking Water* ( UteCl 1590.006(B) Water Meets Standards in 310 CMR 22.0* I 4fi02.1 L Clearing rfaces and Utensils* Frequency of Equipment Food- Contact Shellfish and Fish From an Approved Source S 4-702.1 1 Frequency of Sanitization of Utensils and 3-201.14 Fish and Recreationally Caught Molluscan Food Contact Surfaces of Equipment* _ Shellfish* 1-703.11 Methods of Satutization-Hot Water and 3-201.15 Molluscan Shellfish from NSSP Listed I ( Chemical* Sources* ( 10 I Proper,Adequate Handwashing Game and Wild Mushrooms Approved by Regulatory Authority ?-301.11 Clean Condition-Hands and Arms" 3-202.18 I Shellstock Identification Present* ( 2-30 L 12 Cleaning Procedure* 590.004(0) Wild Mushrooms* 12-301.14 When to Wash* 3-201.17 Game Animals* I 111 I Good Hygienic Practices g Receiving/Condition 12401 11 Eating.Drinking or Using Tobacco* 3-202.11 PHFs Received at Proper Temperatures* 2-401.12 Discharges From the Eyes, Nose and 13-202 15 Package Integrity* I MouthT 3-101.11 I Food Safe and Unadulterated' I 3-30112 I Preventing Contamination When Tasting" 6 Tags/Records:Shellstock I 12 Prevention of Contamination from Hands 3-202.18 Shellstock Identification* I 590.004(E) Preventing Contamination from 3-203 12 Shellstock Identification Maintained* Empl(wees* ( 13 Tags/Records:Fish Products Handwash Facilities Conveniently Located and Accessible 3402.11 Parasite Destruction* 3-402.12 Records,Creation and Retention" I 5-1-03.11 I Numbers and Capacities* 590.0040) Labeling of Ingredients' I 15-204.11 I Location and Placement* - 15-205.1 l I Accessibility,Operation and Maintenance- 7 Conformance with Approved Procedures ( Y /HACCP Plans ( Supplied with Soap and Hand Drying 3-502.11 Specialized Processing Methods* ( Devices 1 3-502.12 Reduced oxygen packaging,criteria* 6-301.11 Handwashing Cleanser,Availability( 18-103.12 Conformance with Approved Procedures* ( 6-301.12 I Hand Drying Provision 'Denoles critical item in the tedered 19119 Foal Cede oc 105 C.-Mll 590.1100. w j �l CITY OF SALEM Establishment Name:Gcoc) _?DUnc� BOARD OF HEALTH p 7_ Date: r — �t rC Page: O�z of r Item Code C-Critical Item DESCRIPTION OF VIOLATION/ PLAN OF CORRECTION Date P. No. Reference R-Red Item { PLEASE PRINT CLEARLY Verified ' I / �' I vin v all") I P��'1 / �z s l�XYJ�l v�ldr 772,1Z I r I 1/ 9 �_°'_ ✓�,1� t7/i, nSj1� VtUJ �� Guor2 -�.C6/z �r s� 1 ✓Df� efi Cg I ,?5 ✓— i�� i-,ca�.rn �' ��'�rii�i �iv�rn�� 1J1l�lil Discussion With Person in Charge Corrective Action Required: I ElNo ( ❑ res ~ I have read this report, have had the opportunity to ask questions and agree to Correct all ❑ Voluntary Compliance ❑ Employee Restriction/ Al Exclusion violations before the next inspection, to observe all conditions as described, and to ❑ Re-inspection scheduled ❑ Emergency suspension comply with all mandates of the Mass/Federal Food Code. I understand that noncompliance may result in daily fines of twenty-five dollars or suspension/revocation of ❑ Embargo ❑ Emergency Closure !, } your food permit. ❑ Voluntary Disposal ❑ Other: if �y - I i 3-50:,:,,1'() PHFn Received at Tenpciatues Violations Relatedlo Foodboinc idners bterrvent%ons 2nd RN4 According to Law C(u,led to Factors(Items 1.22) (Cant.) 41`R45'F'Within 4 flours. PROTECTION FROM CHEMICALS ;-501 15 Coaling Methods for I'HFs � lA Food or COiur Additives i 19 PHS Hot and Cold Holding 3-'.01.t6(B) ( Cold PIIFs Maintained at or below I 3-202.:Z .ldditive." 1 590 00a(F) ;I '145°P' 3-302.;4 Motection from U;;apino( ed Additives, I 3-$0IJb(A) liot PRFs Maintained at or abuse Is Poisonous or Tovir Cuog .arcen 7-101.11 klentitynte lnforn:ainn-original 140'F. Ccauainets' � 3-501 INA) Roasts Held at or above 130'F. " 20 Time as a Public Health Control 7-102 11 S c-irm n N;unc- 'tVorking Centainec'" 3 Sol l9 Time as a Public Health Control'' ?-2t1L11 Jrp•trmioa-Siorxk•c": � - 7 202 11 Restrichon-P[e,cace:mal Use" 590.004(H) Variance Requirement 7-202.11 Conditicm.of 110' 7-103.!t Toric Cour^ir.;r:-F'ro!:,b:cions:, REQUIREMENTS FOR HIGHLY SUSCEPTIBLE � 7-204. 1 sanitize,s.<:rite-rt-C cmica:;4 + POPULATIONS(HSP) 7-201 72 L�,;: V s ' i 21 4-801 1)(A) Unpasur teized Pte-packaged Juices and C'� meals for r , hine I iothae,Criteria" f 7-204.14 D: with Warnine Nibels" IA vine,Anent:,.(';feria 7-7_05.11 I:nadental Fried Co,olart.Lubr,-ants ( 3-801.11(8) Use of Pasteurized list 3-F01.11(DKau Cooked Animal 'onl and7-206,I1 Re, ic[ed Ike Pe,tci(es.Criteu:ISeed Sprouts Not Sewed. 'r 7-206.12 Rod.:ra Bail Stmiois` 7-206.13 'I7a..;kir, Pov.ders,Pest Control and t 801.t 1((;) Unopened Food package Net Re-served. \Inn ito;iju,," CONSUMER ADVISORY TIME/TEMPERATURE CONTROLS 22 3-603 11 Consumer Advisory Posted for Consumption of 16 I Proper Cookir.9 Temperatures for animal Frxxis 11iat are Raw.Undercooked or r HFs I Not Otherwise Processed to Elirnmate 3-401RA(142) Eggs- :Si°F 15 Sec. ( Pathogens.*E°'•""°';'w, Fees-Lnme:Gr:e Scald,;c 11"F!5secr 1 3-302.13 Pasteurized Eggs Substitute For Raw Shell 3-401.t 1(Au"') Conuninuted Fish,Tdeat,&Gana 3-401.11($)(11(2) Pork and 1Sec! Roast- 130+ 12 i mina, I SPECIAL REQUIREMENTS 3 401.11(A)(2) R:,tars. ejected P.tr::a.- 155'F Is 590009(A)-(D) Violations of Scction 590.009(A)-(1)) in Ser. :; catering, mobile took], temporary and 3-40L11(AICs) Poultrc,WildG.,me-St+!*fed PHfs, nsidential kitchen operations should be StuO)r.e Con^atinine Fish,Mcat, debited under the appropriate sections 1'crultrvo; Raritcs-165"F 15 sc,. above if related to foodhorne Illness 3-401.111(')(3! Whole-muscle,Intact Reif Steaks interventions and risk factors. Other 145°F ' 590.009 violations relating to good retail 13-401.12 Raw Animal Foo?,Cooked in a practices should be debited under/!29 - Miarwave 165`F" Special Requirements. 3401.1 l(AiNhin) Alt Other PHFa 1.1:i'F .` see. I 17 Reheating for Hot Holding VIOLATIONS RtLATED TO GOOD RETAIL PRACTICES 3-403.1'(3)&(D) PF.,N163,F1�, sec. ' (Items 23-30) 3-403.11(B) Micr•ow,,c- 165" F`2 Mimne Standing Critical and non-critical vtulauuns, nhich do;rot relate to the Time* ,foodborne ilines.s iniervenrions and riskjoutors lisird above, crus be 3-403.11(C) Com-nsially Prixr<sed RTE Foul- found ill the Julloi,-nag snrtidns of the Feud Coyle and 105 CMR 140 500.000. 3-403.11(L) Remaining Umdtreld Portions of Beef Item 1 Good Retail Practices FC 590.000 m Knacts': 23. Maragaent and Personnel FC-2 003 18 Proper Cooling of PHFs I 24 Food and Food Protection FC-3 004 ! 1 25 Equipment and Utensils FC-4 .005 3-301.14(4) Ctua;ttte cookedPHPs from 140-F to --------- Y` Facility -----� 26. Water,Plumbinq and Waste FC- 5 : .006 '70`F W;tl-,r;2 f lours:did From 70"F - ( 27 Ph laza!Facilit FC-6 1 007 to=U'FldS"F Within a Hours. " 128. Poisonous or Toxic Materials FC--7 .008 3-501,14(B I Cooling PIIFs Made From Ambient 29._ Special Requirements I. 009 TempemtureIn.redients :o41'Ft45P 30, Other 1 Within 4 1hiurs' *Denotev enucal the IMerd 1099 nod Code or h15 t'h1R 590'100. I v CITY OF SALEM r BOARD OF HEALTH 2 Establishment Name: ! 1^�)l1( A ti tUU�� Date:q- 7- dPage: v of Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date° No. Reference R—Red Item PLEAE PRINTICLEARLY, Verified I �(� 11 r. I (- �� , rxe l ri f�(rn . Fia>-�-J Si In 6s �'1 is Imo, r I r ✓--��rrP A_ c� d tyre cd Yl bra vIo 15 � " �01e_ Y�W_4 b� onret est r I X G ,, uTy b h 0 W r h i erg) Stnwrci a Jove. Cvl�_S�gtti/ irk T�) I - �� s"" ✓Shill�,.�5 cx� tiu�x.Q L'�tn. Y1 ctd ��, m�Int► o� �, d �- _ 1 j r�ruQ _ �nnl a, =\'Zvc iq r 1l of h nh(1 SL Mf* Sial vt _ Discussion With Person in Charge Corrective Action Required: I ❑ No I Zi les / I have read this report, have had the opportunity to ask questions anis agree to correct all ❑ Voluntary Compliance ❑ Employee RestrictionExclusion violations before the next inspection, to observe all conditions as described, and to ❑ Re-inspection Scheduled ❑ Emergency Suspension comply with all mandates of the Mass/Federal Food Code. I understand that noncompliance may result in daily fines of twenty-five dollars or suspension/revocation of ❑ Embargo ❑ Emergency Closure - your food permit. //� ❑ Voluntary Disposal ❑ Other: 3-101 i4,Cii PHFs R::ceived at-!eniperaturc:; Violations Rixaicdf to Foodborcc dinnss trfl-rv,miens and Risk According io Law Cooled to Factors(Items 1.22) (Cont.) 41`F14 F Witb:n 4 Hoots. 3 501 15 Cooling Methcxk for PHFs PROTECTION FROM CHEMICALS or GALS ,y PHF Hot and Cold Holding 1.1 Fond or Color Ac'a;E:ves i 4 501.16(U) Cold PI IFs Maintained at of below .3 202.12 'kldinNv s' 540.004(F) 41-145°f'^ 3-'o"2.14 Poacction iron; I iuupprnved A.dditites' 501.16(A) H,4 PHFs Maintained at or above 15 Poisonous or Toxr 3atrs!a.^.ces - j 140'F. 7-1011! klentify:,: !n::mur: inn-{ ;ranai Roasts Held at or above 1309I. C'oaai::en" 7-102.1 : I ( ZG ( Time as a Public Health Contro, C..,mm�ou han;a ':�:,-kin:,Container," 7-201.1 i Scparatiu„ -sloi tozc', 3-501.19 Time as a Public Health Cuah'ult j 7-202 11 iie,L fiction-P,e,ence and t.sr.` 590 0041 H) Variance Requirement 7-^(72'.12 Conditions,of U:.c" 7-203.11 i 'Cn l,:Cont..:n:rc -T n!,i itiors': REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-204.11 Safi»tizeis,Criteria-Chcmicais^' POPULATIONS(HSP) ! 7-204 17 Cllemtcals tot WV:.shute P o luez,Criteria" i 21 3-SOL I I(A) Unlimteurved Pre-packaged Juices and Bever-„gee with Waroi,ic labels* 7-204.1.4 Du'rnu¢P.ttema.Criteria" ! 3-901.1 l(B) Use„f Pasteurized hggs* j 7-205.11 Inciden.,:1 Fm,.-.i Conte a. t:h-ncants" j 7-206.11 Restricted Use Fesucules,Cnnorwa -;-301.1 1(D) Raw or Partially C umAed Animal Food and Raw Seed Sprouts Not Served. 7 206 12 Roden R�,t St tlioua" � 3-g01.1 1(C;) unopened Food Package Nor Re-served ' 7-'06.13 Prackmg Pnw;;erv,Pest Contro! and :Monitarir.,tT I CONSUMER ADVISORY TIME%CEMPERATURE CONTROLS 22 3-603.11 Consumer Adtiisoiy Posted for Consumption of Anim::l Foods'fbat are Raw. Undercooked or 16 Proper Cooking Temperatures for Not Otherwise Processed to F!liminate PRFs emeccv. +xm 3 -401.11 A1;uZ) Eggs- 1,`,, =F 1.5 Sec. i Pathu;,ens,- EggF-hunicd.ah;Scrviea 1.95"Fl5w,k 3-302.13 Pasteurized Eggs Substitute for Raw Shell 3-401.11(A)(2) Cominmuted Fish, Meas&Ciame Egg' Animal- I55"F I5 sec. " 3-401.11(151((,;:; Pork and livJ Roast - 130'6 12i min' SPECIAL REQUIREMENTS 3-4ol.]VA)(2) Ratites, Trjccted Meats-- 155'F 15 590,009(A)-(D) Violations of Section 590,009(A)-(D) in Seti. * catering„ mobile food, temporary and 3-401.11(A)(3) Poultry,tx:'iid Ganw, Siuft'ed PHR, residential kitchen operations should be Stuffing Containing Fish.Meat, debited under the appropriate sections Poultry or Ratite, 165°F 15 sec. " above if related to foodborne illness 3-401.1 j(C'10) , le-nPis_ e,lniact Beef Steaks interventions and risk faclors. Other 145'I'"- I 590.009 violations relating to good retail 3,401.12 Raw An:.o:d Foods Cooked in a practices should he debited under#29- Microwa,e 105'F* Special Requirements. 34.')l II(A)(litb) fill C7ther Pihs- 1x5'6 15 see m 17 Reheating lot Plot hording VIOLATIONS RCLATED TO GOOD RETAIL PRACTICES 3-40111(A)&,W) PIP, 165"17 15 scc. � ! Iltettvs 23-30) i 3-403.11(h) Microwave 165"I'2 Minute Siandirry Critical and non,ritical violations. which do not relate to the Time" foodborne illness interreention.c and rick fiutorc listed above, ran be 3-403.1100 i Commercia!ty Prucessecl RTE Food- I found ai the:Jollo"in,g sections of the Food Cade and 105 C'AIR 140°Ft 5O0.000, ---- 3--103.11(F? Rentauna,;t;nslieed Pott ions of Beef /fen (Good Retort Practices FC 530.000 hoaslt.* ! 23. Manapement and Personnel FC -2 .003 I 18 Proper Cooling of PHFs 24. Food and Food Protection FC-3 004 3-5()1.14 f1} (c,,,t ,,, _Z5 _ E-quipment and Utensils FC-4 .00s ( _Cooked FHF:: from `!a TF to 26. Water, Plumbingand Waste FC-5 006 '70'F Within 2 Hour;..nid Fr rn 70'F 127 , Phvsmal Faoility FG-6 .007 to 41`F/45'F Within s Hous. ` ( 28. Poisonous or Toxic Materials FC-7 .008 3-501.1.4(13) Cooling PFIFs Made From Ambient 29. Special Requirements 009 femperatute ingredients:o 41°F/45`F 130. Other it,ohin4 hours- *Uenotev enucal i!crn m ilia f,de,a) 10,11 Fo,:d i\,dc or 105 C'MR 590 ut)0. Y CITY OF SALEM ,( BOARD OF HEALTH /� Establishment Name: G��n� on Date: —/� -0 Page: of S Item Code C—Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date t No. Reference R—Red Item , Verified '/ • LEASE PRINT CLEARLY hCj CLC�l1YY]01 �7O?'1 ICQ. QUI 4d U(� �aYn�n� c�ooR P��r_Ev�c�l 1� and fJn_ .`�Vulro H h e /� ✓ I ct ravel Prz/ _ .� RNs" -�—o �Di bink Nvp-" 1w t ) nd x tr�rfla ��►�1-�, )Inns . � vn 1i4. - �i .�;a nat-tr zp l n4 -Hau a,� A Am < <. ? /�nd ,[�^ e ;1%�bn D Pvr►g' 4-6 NA) el �n II r✓ � I I r�L_�,�r�'-I-Pcy �- ��,cs� c� 4 ►��r-F�r►vi) �" l_3 n,v rfr ba rU4 04 YUL &B4u2-fedi 4 J7(Y Q 1,aW' ► ' VYI �In Ys -'ro 1� p 44)nm_ �. '� ��S'lvt_��fii�✓ 4 �� wash I I Required: ❑ No ❑ Yes ON sl 0 Corrective Action Re Discussion With Person in Charge: 4 I have read this report, have had the opportunity to ask questions and agree to correct all ❑ Voluntary Compliance ❑ Employee Restriction/ violations before the next inspection, to observe all conditions as described, and to Exclusion P ❑ Re-inspection Scheduled ❑ Emergency Suspension comply with all mandates of the Mass/Federal Food Code. I understand that noncompliance may result in daily fines of twenty-five dollars or suspension/revocation of ❑ Embargo ❑ Emergency closure your food permit. /� / J ❑ Voluntary Disposal 0 Other: �?; - 3-501.14(/') PHF%Receivedat-fempor:uures Violations Related to Foodborne Illness inrervenrions and Risx According to Law Cooled to Factors(items 1 22) {Cont.) 41`F/45'F Within 4 Hurls. PROTECTION FROM CHEMICALS 3 5t'1 15 CooFng Nletheds for PH.F., 14 Food o:Color Additives 19 PHF Hot and Cold Holding ! 3-20'_'.12Additives-' ( ?-501.16(H4 Cold PHFs Maintaincdatorbelow 540.004(,F) 41"/45°F- 3-?02.14 I rotc,d wn trout Unappmaed Additives' ;-501.16(A) Hot PRFs Maintained at or above IS Pal serious ar Toxic.Substances 7-101.11 Identityownfunua:ron-Or'e 'na' I l40�F. * 3-50L!6(A) Roasts Held at or above 130°F. " 7-102.11 (ommn:i Name-1Nm;a:r;.,Contac hers"` ( 20 Time as a Public Health Control 7-'01.11 Sep_;talion-Stotaee" 3-50L19 Time as a Publi: Health Connol'" 7-202.11 Restri,-tinn-Presence and i:e''. ( j90.00-F(H) Variance Requirement 7-202.12 C,,ndrt;oas tit llse'' 7-203.!1Tn;icC::niairtet;-Fr:.hibioon,>: REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-204.11 Sanitizerc.Criteria-Clunric:as-` i POPULATIONS(HSP) 7-244 12 Ci:entieak �o*1*;ashulc Pn;duee,Criteria" ( 2>i 3-301 l i(A) Unpasteurized Pre-packaged Juices and i 7-204 14 Diviuv Agents.Cro-ria" ' Beverages with Warning I:ibols 7-2Cr5.1 l In:idental Fowl Contact. Lt:hao-anh,4 3-SOL I t(B) Use of Pasteurized Ec•_s^ 7-2n6.11 F:es:cost �, r;,- :;* ( 3-801.1 IID) Rata or Partially Cooked Annual Ford and e1 U::r Pesticide. t u . Raw Seed Sprouts Not Served. 7-200.12 Roleni Bat Sint;ons' 3 801.11(0 Unopened Food Packaqe Not Re-served. 7-206.13 Tracking Powders, Fest Control and ,Lionitarmg* CONSUMER ADVISORY TIME/TEMPERATURE COIN'r RCLS 22 3-603.11 Consumer Advisory Posted fon Consumption o Animal Foods That are Raw, Undetcuoked or 16 Proper Cooking Temperatures for PHFs Not Otherwise Processed to Eliminate J * "'," 'Pool3-401.I1A(1)(G) Egg,- ISi'7� :5 Sec lathogen,. 3-30'_.13 Paseurized 1:>,s Substitute for Raw Shell Egos-1n;mediate Srtviee 145°FiSsec" j 9 3-10LIItA)(2) "Onummuted fq,f:, Moa:s&runic i Eggs* Animals- 155'P 15 see. " 3-401.1 I'B)(l H2) P,a k i nd J cef Roast 110'F 121 min` { SPECIAL REQUIREMENTS 3-401.11iA)(2 R:mtes, mjcctrd btrats- ?55"F' 1.5 I 590.009(A)-(U) Violations of Section 590.009(A)-(ll) in sec." catering, mobile food,temporary and 3-401.1 (A),3) Poulnt,Wild Gaul Stu:lecPHF:;, residential kitchen operations should he Stufsme Comainim:Fish, Meat. I debited under the appropriate sections Povim,of Ratiw_e -165`F 15 sec. "' above if related to foodhorne illness 3-401.1 1((:)(3) Whole-muscle,boast Beet Steaks interventions:md risk factors, Other 145`F" j 590.009 violations relating to good retail 3-40LI2 Rath oo,mual Foods Cooked i::a practices should be debited under 1124- A,IicrotvaVe 105`1- * Special Requirements. 3-401.1 I(A1(Utb) Ali Othrx PHFs- 145"1- 15 sec. 17 Reheating for Hot Holding VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 3-403.11iA,)&:rU; PHFs 165`F 15 sec ^ (items 23-30) 3 403.11(81 Microwave- 15" F 3 :nonuse;L,andina I Catieal and n,rn-rrilo al V10IRPrvn, which do nor relate to Jho Timer_ foodborne illness interventions and risk Jac tors listed above, ran be 3-403.11(C) Commercially Processed RTE Food- found in the fi,llool ing,sartion,c of the Food Code and 105 C,4I R H(PFr i 510.000 i 3-ri0311(F) RruunningUnslicedPnuionsofBeef I Item I Good Retail Practices FC 1590-000 Rci:,sit" 23. OMnagomant and Personnel FC --2 .003 tg ( Proper Cooling of PHFs 24 I Food and Food Protection FC-3 .004 75____ Equipment and Utensils FC -4 1 .005 3-5(11.14(A) CoolingCooked PHFs from ldU`1't° 216 _Water,Plumbingand Waste FC-5 1 .006 7WF Within 2 l loo-loand From Til"t'' 27 Phvsical Facili!Y FC-C .007 I to 41,,FFi5"F Within 4 Hous,. " I ( 28. Poisonous or Toxic Matehals FC--7 .008 3-501 14(H) Cooling PHFs Made F'ro:n Ambient 29. Special Requirements 009 Tempe);tare ingredients it,4I"F/4i"F 30. Other Wdhin 4 Hours* S°u,n��„na C-2 a,< Denatr,r critical aerro:o ihr[deal lleN Fu^d rade or P L5 CNIM 59b rujn. w CITY OF SALEM BOARD OF HEALTH i Establishment Name: Date: Q�0 Page: of i Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date No. Reference R—Red Item Verified PLEASE PRINT CLEARLY r -4; ✓ -amavl- i 5))lD I3 n_ ek 4p'o Am, titer/ /JI7(AA. OMn1 JI(-/ I I x Jh (Yis1i /� D� �P Erni o l�ro _ rch .P � I Discussion With Person in Charge: I Corrective Action Required: I ❑ No I ❑ Yes I have read this report, have had the opportunity to ask questions and agree to correct all :3 Voluntary Compliance ❑ Employee Restriction/ L Exclusion violations before the next inspection, to observe all conditions as described, and to ❑ Re-inspection Scheduled ❑ Emergency Suspension comply with all mandates of the Mass/Federal Food Code. I understand that noncompliance may result in daily fines of twenty-five dollars or suspension/revocation of ❑ Embargo ❑ Emergency Closure your food permit. ❑ Voluntary Disposal ❑ Other: i f — -5r)I.11(r,: PHFs Received,d Temperatures Violations Related to Food':orne Y!ecsa Interventions and Hick According to Law Cooled to Factors(items 1412) (Cont.) 41"F/45'F Wi,hin 4 Hours. PROTECTION FROM CHEMICALS I 3-571,15 Coohrr_R-?ethod� for PHFs 14 I Food or Cotor Addiiivos 1 1s+ PHF Hot and Cold Holding ( = 501.16(1;) Cold P1IPs Viaintamcd at or below 3-20_1 pritiction 590.004(F! :4x/45° F` +-302.1 Prouxdon from Uuapproted Additive;.* j 15 Poisonous or Toxic Substances 3-501,16(A) Hot PHFs Maintained at or above � 140"F, 7-101.11 Identityiue tutor -O:'rginal ! I 501.16(A) Roasts Held at or above I30"F Containers' ! 7-102.11 Common Nome-WorkinqC'ntainers", ( 20 Time as a Public Health Control 1 I 7-301.11 S?paraG:m-- titnraste" ( i 3-50L 19 Time as a Public Health Controla 7-202.11 Re:t:iction -Presence mid Use" 1590.004(H) Variance Requirement 7-203.12 Conditions of Use REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-203.11 TosiSanit Coners, ,itcoa Prnhtbitions* POPULATIONS(HSP) ',-204.t1 Sanirzer:s,Critrua--C`n.Ir?irds� 1 - i 7-20-1.i1 C:h,�ia:�als tot Washing produce, Criteria" I 21 3-801 111A) Unpssteuni.ed Pre-packaged Juices wit 7-204.14Drvmg:`ecitts.Crite:ia'' Beverages with warning libels* ( 7-.x.05.! ! )ncidcsto: Pauli Gartt,t.LauncanL;"` i 3-801.1 1(Ht Use of Pasteurized Eaps^' 7-206.11 Restricted Use Fe:rcicles. -Cr ucris' i 3-801A Ii i)) Raw or Partially Cooked Animal Food and Raw Seed Sprouts Not Sensed. .f ! 7-200,12 Rodent U:,d St;uiu:'s` I t-801.11(C) Unopened Fund PackaLe Not Re-served. 7-206,14 Tract.iup Powders,Peri Connol and ! ?Aonitoring* CONSUMER ADVISORY TIMEJT=MPERATURE CONTROLS 22 3-603 11 Consumer Advisory Posted for Consumption of 16 Proper Cooking Temperatures for i Aninud Kxmds'Fh„t are Raw, Undcrv00ked oi- PHFs Not Olhera-ise Processed to Eliminate 3-401.1 iA i 1 2) Egg,,-- r' Patho,4, "•r,n„2 .,.�on, C (' €[,, I c;,.p 15 .o- ins.^ - Ee>:s-l:rr:ediate Service 1 45`P15scc^ 3-302.13 Pasteurized F,ggs Substitute for Raw Shell 3-401.1 ll'A)(2! Comuunutcd Fl:;h,M'ZAS&Game Eyt,,s" Animals- 1i5'F i5 cec. ., 3-401.11(B)1j)(2) Pork and Scef f(n:;st- 130''F 121 rain* I SPECIAL REQUIREMENTS 3-4ULI I(A)i2} Rases, Injected ti",eats- ISYF IS 590.00V(A)-(D) Violations of Section 590.009(A)-(D) in sec.-r catering. mobile food, temporary and .i-40 1.11(A)(3) Poultry,Wild(jame,Stuffed l'HFs, residential kitchen operations should be tanlfl,ig C.,ro:uninv Fish, Nkat, eichited under the appropriate sections Pen,;ry nr ltatitec-165"1` 15 s,_c. ^ above if-related to foodborne illness 3-901.11 tC)(.3) '�\'iw!e-m-.�acle, intact 13ref Steaks I interventions and risk factors. Other 45 * 590.009 violations relating to good retail 3-401.12 Raw Atim:I Foods C'no cd ;r:a practices should be debited under #29-- P,lia'uv.ace 165"F ! Special Requirements. 3-401.1 1(A)(1)(b) AU O lien PHFs-- 145`F 15 sec. " 17 Reheating for Hot Holding VIOLATIONS RELATED TO GOOD RETAIL PRACTICES ,403.111A)G(D) PHF: 165'F 15 sec. ;_ I (Items 23-30) Microwave- I(el' F? Minute Standing I Critu:nl mud nun-rriricn! vrntrrinnes. :rhich da mat relate u,ilii ,foodborne illness interventions and risk Jac ton listed above ran be i 3-403.i 1(CI C'onrm?sally pro(.,ssed RTE Food- found in the following sec lions of the Foos!Code mrd 10.5 0,11? 1407, 590.o0B_._ 3-403.1 1(F, Rc maining Un;dreed Roaiom of F7cef Item Good Retail Practices FC590.000 F;;asW 23. Manaqement and Personnel FC-2 .003 _ 24. Food and Food Protection FC--3 .004 d3 Proper Coaling of PHFs 25. Equipment and Utensils FC-4 .005_J 3-501.14(:1) Cooling Cook'-, PRFs Gan: 140"Flo 26, Water,P!umbinq and Waste FC-5 1 -000 7(f'F W'4hiu 2 Hours cad From TPF ! I, Physical Facility FC- 6 1 007 tri 4l'F/45"F Within 4 Hours. t 28 Poisonous or"i oxic Materials FC-1 .008 3-501.1400 Ciwl iag PHFs blade From Ambient ! 29 Special Requirements 009 I Temperature In,redicnts to 41'F/45'F 130, Other Within 4 Ilou: , n„u.:b, Denowcni,c il pan In Ili,,Rdcral 1940 Fa,:'.Codo„r 105 CMIR 590 000. ( IMPORTANT MESSAGE ) a FOR - OATE� 2-,06 TIMEAa•� P. . KA G �- OF `- PHON F 9i 7_ k5-�""q �� AREA CODE NUMBER EXTENSION ❑ FAX ❑ MOBII 1= AREA CODE NLJfyJBER TIME TO CALL TELEPHONED PLEASE CALL yi I CAME TO SEE YOU WILL CALL AGAIN f ' WANTS TO SEE YOU RUSH RETURNED YOUR CALL WILL FAX TO YOU I f MESSAGE✓�-/A �✓ Ale- SIGNED FORM 4009 .�r� MARE IN IJ S.P.. NOTES CITY CF SA1EM9 MASSACHUSETTS BOARD OF HEALTH 120 WASHINGTON STREET, 4TH FLOOR SALEM, MA 01970 .� TEL. 978-741-1800 FAX 978-745-0343 STANLEY J. USOVICZ, JR. JOANNE SCOTT, MPH, RS, CHO MAYOR HEALTH AGENT COMMONWEALTH OF MASSACHUSETTS PERMIT TO OPERATE A FOOD ESTABLISHMENT In accordance with regulations promulgated under authority of Chapter 94, Section 305A and Chapter III, Section 5 of the General Laws, to operate a Food Establishment in the City of Salem is hereby granted to: Type of Establishment: FOOD SERVICE Name of Establishment: The Ground Round Address of Establishment: 2 Trader's Way Owner's Name: New Mass Restaurants LLC Michael Yung Restrictions: Application Date: 11/22/2004 Permit for Food Establishment 41-05 Frozen Desserts/Ice Cream Permit for the Sale of Tobacco Products These Permits Expire December 31, 2005 This permit is not transferable and must be reissued upon change of ownership or location. The permit must be posted in a prominent location in the Establishment, In accordance with the State Sanitary Code, before any renovations, improvements, or equipment changes are made, all plans for such must be submitted to and approved by the Salem Board of Health. ns HEALTH AGENT CITY OF SALEM, MASSACHUSET �� BOARD OF HEALTH 120 WASHINGTON STREET, 4TH FLOOR NOV 1 9 2004 o SALEM, MA 01970 TEL. 978-741-1800 FAX 978-745-0343 STANLEY J. USOVICZ, JR. JOANNE SCOTT, MPH, RS, CHO CITY OF SALEM MAYOR HEALTH AGENT BOARD OF HEALTH 2005 APPLICATION FOR PERMIT T( a O/OP5ITE AFOOD ESTABLISHMENT NAME OF ESTABLISHMENT �Fe S Vta,TL6IL (�Cu. A k&),A TEL# 978 TNAL110 1--T— ADDRESS OF ESTABLISHMENT MAILING ADDRESS (if different) �q OWNER'S NAME TEL# '7/O ADDRESS6 7/1�P/J�Pti I / CITY STATE ^-sA ZIP 011(D/ CERTIFIED Focfb MANAG 'S NAME(S) ISo- rJ16t� CERTIFICATE#(s) R731 i7A w Up.- Li''te��x.n5 , I 33 (required in an establishment where potentially potentially hazardous food is prepared.) EMERGENCY RESPONSE PERSON I11rJtW6 HOME TEL#q b' SD.D -0yD'7 �4 HOURS OF OPERATION: Mon.; nTue. Wed. Thu. Fri. Sat.— TYPE OF ESTABLISHMENT FEE check only RETAIL STORE YES NO less than 1000sq.ft. =$ 50 1000-10,000sq.ft. =$100 / more than 10,000sq.ft. =$250 LI�-rJ:J RESTAURANTYES NO less than 25 seats =$100 25-99 seats 50 more than 99 seats =$20 BED/BREAKFAST YES NO 100 ADDITIONAL PERMITS MAKE (not just serve) ICE CREAM, YOGURT, SOFT SERVE YES $5 TOBACCO VENDOR YES $50 ALL NON-PROFIT(such as church kitchens) YES NO $25 Please pay total with one check payable to the City of Salem This Permit is not transferable and must be reissued upon change of ownership The Permit must be posted in a prominent location in the Establishment. In accordance with the State Sanitary Code, before any renovations, improvements, or equipment changes are made, all plans for such must be submitted to and approved by the Salem Board of Health. PursAAwdg M L Chapter 62C, Section 49A, I cert) y under the pains and penalties of perjury that I, to my best ad e , ave filed all t e tax et ns and paid all stats-t s required under the law. Slgna re Date/ Social Security or Federal Identification Number -------------------------------- -- ----------------------------- ----1--------------- ------------------------------------ Revised 11/03/03 FOODAP2 adi Check#&Date .x- /G 14a--q_ - / t 0002 TRADERS WAY The Ground Round City of Salem FOOD SERVICE ESTABLISHMENT - FOOD SERVICE REINSPECTION Inspection HACCP: ❑ Telephone: Item Status Violation Critical Urgency Nature of problem or correction 744-"88 Non-compliance with: Not Done Owner: Anti-Choking PASS ❑ New Mass Restaurants LLC Tobacco PASS ❑ PIC: Walter Stevens Gen. Mgr. FOOD PROTECTION MANAGEMENT Not Done PIC Assigned/Knowledgeable/Duties PASS d❑ RED Inspector: Janet Dionne EMPLOYEE HEALTH Not Done Date Inspected: Correct By: Reporting of Diseases by Food Employee and PIC PASS ❑d RED 4/7/2005 Personnel with Infections Restricted/Excluded PASS ❑d RED Risk Level: FOOD FROM APPROVED SOURCE Not Done Permit Number: Food and Water from Approved Source PASS ❑d RED BHP-2005-0101 Receiving/Condition PASS ❑d RED Status: Tags/Records/Accuracy of Ingredient Statements PASSd❑ RED PARTIAL COMPLY Conformance with Approved Procedures/HACCP PASS ❑ RED #of Critical Violations: Plans 2 PROTECTION FROM CONTAMINATION Not Done Time IN Time OUT: Separation/Segregation/Protection PASS 0 RED Notes: Food Contact Surfaces Cleaning and Sanitizing PASS 0 RED 67. Proper Adequate Handwashing PASS ❑d RED Urgency Description(s): Good Hygienic Practices PASS RED BLUE: Prevention of Contamination from Hands PASS Q RED Violations Related to Good Retail Practices (Critical Handwash Facilities FAIL RED front handsink had food debris handsink violations must be corrected to be used for handwashing only immediately or within 10 days)(Non-critical violations GeoTMS®2005 Des Lauriers Municipal Solutions, Inc. ( Rev. Apr 07,2005 ) Page I oft w 0002 TRADERS WAY The Ground Round must be corrected immediately PROTECTION FROM CHEMICALS Not Done or within 90 days) Approved Food or Color Additives PASS RED RED' Violations Related to toxic chemicals PASS RED Foodborne Illness Interventions TIMEITEMPERATURE CONTROLS(Potentially Haz Not Done and Risk Factors (Require cooking temperatures PASS RED immediate corrective action) Reheating PASS L RED Cooling PASS 0 RED Hot and Cold Holding PASS 0 RED Time As a Public Health Control FAILd❑ RED delfield freezer had temp of 1e°f. maintain at 0"f or below as mandated. REQUIREMENTS FOR HIGHLY SUSCEPTIBLE PO Not Done Food and Food Preparation for HSP PASS 0 RED CONSUMER ADVISORY Not Done Posting of Consumer Advisories PASS Ef RED Violations Related to Good Retail Practices (Blue Not Done Management and Personnel PASS ❑ BLUE Food and Food Protection PASS ❑ BLUE Equipment and Utensils PASS ❑ BLUE Water, Plumbing and Waste PASS ❑ BLUE Physical Facility PASS ❑ BLUE Poisonous or Toxic Materials PASS ❑ BLUE Special Requirements PASS ❑ BLUE Other-See Notes PASS ❑ BLUE P�J�...� GeOTMSID 2005 Des Lauriers Municipal Solutions, Inc. { Rev. Apr 07,2005 } Page 2 oft 0002 TRADERS WAY City Of Salem The Ground Rnund FOOD SERVICE ESTABLISHMENT - FOOD SERVICE Item Status Violation Type Urgency 1Name.,; The GrOuridi;ftound,.':,`,_. . Non-compliance with: Done Anti-Choking PASS Addraw*. Ci0U2;TI�IDERSiNAK; Tobacco PASS elephorie,," 244;9488`,; „1:,, ':',` FOOD PROTECTION MANAGEMENT Done !oyvrierr.;,',New'MasS;fZestatie, LLCM hael YLRW Assigned / Knowledgeable/ Duties PASS RED ,;:Atisati;Hrubes;' `'f EMPLOYEE HEALTH Done '" Reporting of Diseases by Food Employee and PIC PASS RED Ttlspeclor,: ' ]antDionne" Personnel with Infections Restricted/Excluded PASS RED Gate:, 3/30[US' FOOD FROM APPROVED SOURCE Not Done Risk Level: -.:, • ,.:, '" Food and Water from Approved Source PASS RED HACCP':': .No :`:. Receiving/Condition PASS RED Correct Byd „i4/b/.Q5_ Tags/Records/Acoilracy of Ingredient Statements PASS RED Conformance with Approved Procedures/HACCP Plans PASS RED PErMrC Nurtlber:: ;, F}P- t305-0101, PROTECTION FROM CONTAMINATION Not Done Status, , Open Separation/ Segregation/ Protection PASS RED ,of,Critaca}:Yiolatns:: Food Contact Surfaces Cleaning and Sanitizing FAIL Critical RED cutting boards throughout stained and scored. Resurface or replace. m TimedN OUTr Some knives in knife rack had accumulation of food debris. thoroughly clean &sanitize. 'Notes Proper Adequate Handwashing PASS RED UrgencyDescription(s):' , Good Hygienic Practices PASS RED gWjE: Prevention of Contamination from Hands PASS RED Violations Related'to`G66d Retail:' Handwash Facilities FAIL Critical RED :Tractices;(Critic6i:violation5 must;be front hand sink had food debris in drain. handsinks to be used for handwashing only as posted. corrected immediately pr Wkhiri to days)(Non-criticai-vioiattons must be GeoTMS®2004 Des Landers Municipal Solutions,Inc COMMONWEALTH OF MASSACHUSETTS Page 1 0002 TRADERS WAY City of Salem The Ground Round FOOD SERVICE ESTABLISHMENT - FOOD SERVICE Item Status Violation Type Urgency PROTECTION FROM CHEMICALS Not Done c0rr GeedIMM ediately`or."hin,9Q .. ''' Approved Food or Color Additives PASS RED TOXIC Chemicals PASS RED RED.- " TIME/TEMPERATURE CONTROLS Not Done i;1 Mations RelatP,d-kO F(7o[tFlorne'Illness, (Potentially Hazardous Foods) Ipterveitkgs and"Risk Factni5.(Requir2 Cooking Temperatures PASS RED inxEriediate cgfr�'CtiJe.'tictirSn), - Reheating PASS RED Cooling PASS RED Hot and Cold Holding FAIL Critical RED Delfield unit temp of 100f-maintain at 00f or below as mandated. sm. ice cream chest temp of 20of- maintain at Oof or below as mandated. walkin freezer- temp of 180f- maintain at 00f or below as msndated. Beer walkin 580f service walkin if needed. walkin to be maintained at 410f or below as mandated. Time As a Public Health Control PASS RED REQUIREMENTS FOR HIGHLY Not Done SUSCEPTIBLE POPULATIONS (HSP) Food and Food Preparation for HSP PASS RED CONSUMER ADVISORY Not Done Posting of Consumer Advisories PASS RED Violations Related to Good Retail Practices Not Done (Blue Items) ceotrts®2004 Des hurlers Municipal solutions,Inc. COMMONWEALTH OF MASSACHUSETTS Page 2 0002 TRADERS WAY City of Salem The Ground Round FOOD SERVICE ESTABLISHMENT - FOOD SERVICE Item Status Violation Type Urgency Management and Personnel PASS BLUE Food and Food Protection FAIL Critical BLUE delfield and nacho unit had some uncovered food. all food in storage must be covered. bacon out at room temp. all potentially hazardous foods to be held at 411f or below. Equipment and Utensils FAIL Critical BLUE can opener had accumulation of food debris. thoroughly clean &sanitize. Royal fridge unit, beverageair unit under slicer missing thermometer. provide visible accurate thermometers maintained at 410f or below as mandated. Water, Plumbing and Waste PASS BLUE Physical Facility PASS BLUE mens employees restroom vent not working at time of inspection. repair vent. all doors to have tight seal from exterior. provide door sweeps on any/ all doors to obtain tight seal. Poisonous or Toxic Materials PASS BLUE Special Requirements PASS BLUE Other- See Notes N/A BLUE a Ifikitector Signatu , PIC 5 gna ure 1 GeeTMS®2004 Des Landers Municipal solutions,Inc. ` , COMMONWEALTH OF MASSACHUSETTS Page _0002 TRADERS WAY The Ground Round City of Salem FOOD SERVICE ESTABLISHMENT - FOOD SERVICE Inspection HACCP: ❑ Telephone: Item Status Violation Critical Urgency Nature of problem or correction 744-4488 Non-compliance with: Not Done Owner: - Anti-Choking PASS ❑ New Mass Restaurants LLC Tobacco PASS ❑ PIC: Alison Hrubes FOOD PROTECTION MANAGEMENT Not Done Inspector: - PIC Assigned/Knowledgeable/Duties PASS RED Janet Dionne EMPLOYEE HEALTH Not Done Date Inspected: Correct By:-, Reporting of Diseases by Food Employee and PIC PASSd❑ RED 3/30/2005 Personnel with Infections Restricted/Excluded PASS ❑d RED Risk Level. FOOD FROM APPROVED SOURCE Not Done Permit Number' - Food and Water from Approved Source PASS ❑J RED BHP-2005-0101 Receiving/Condition PASS 0 RED Status: Tags/Records/Accuracy of Ingredient Statements PASS �/❑ RED Open Conformance with Approved Procedures/HACCP PASS [] RED #of Critical Violations: Plans 3 Time IN Time OUT: Notes: 97: Urgency Description(s): BLUE: Violations Related to Good Retail Practices (Critical violations must be corrected immediately or within 10 days)(Non-critical violations GeoTMS®2005 Des Lauriers Municipal Solutions, Inc. ( Rev. Apr 15,2005 ) Page 1 of 0001 TRADERS WAY The Ground Round must be corrected immediately PROTECTION FROM CONTAMINATION Not Done or within 90 days) Separation/Segregation/Protection PASSd❑ RED RED: Violations Related to Food Contact Surfaces Cleaning and Sanitizing FAIL Criticald❑ RED cutting boards throughout stained and Foodborne Illness Interventions scored Resurface or replace. and Risk Factors (Require some knives in knife rack had immediate corrective action) accumulation of food debris.thoroughly clean and sanitize Proper Adequate Handwashing PASSd❑ RED Good Hygienic Practices PASS ❑d RED Prevention of Contamination from Hands PASS ❑d RED Handwash Facilities FAIL Critical ❑d RED front hand sink had food debris in drain. Handsinks to be used for handwashing only as posted. PROTECTION FROM CHEMICALS Not Done Approved Food or Color Additives PASS ❑J RED Toxic Chemicals PASS ❑// RED TIME/TEMPERATURE CONTROLS(Potentially Haz Not Done Cooking Temperatures PASS RED Reheating PASS ❑// RED Cooling PASS ❑/ RED Hot and Cold Holding FAIL Critical ❑d RED Delfield unit had temp of 10°f-maintain unit at 0'f or below as mandated small ice cream chest had temp of 20"f- maintain unit at O'f or below as mandated. Walk-in freezer had temp of 18°f-maintain at 0°f of below as mandated Beer walk-in 58'f-service walk-in if neededd Walk-in to be maintained at 41°f or below as mandated Time As a Public Health Control PASS ❑/ RED REQUIREMENTS FOR HIGHLY SUSCEPTIBLE PO Not Done Food and Food Preparation for HSP PASS ❑d RED GeoTMS®2005 Des Lauriers Municipal Solutions, Inc. ( Rev. Apr 15,2005 ) Page 2 of r 40002 TRADERS WAY The Ground Round CONSUMER ADVISORY Not Done Posting of Consumer Advisories PASS ❑d RED Violations Related to Good Retail Practices (Blue Not Done Management and Personnel PASS ❑ BLUE Food and Food Protection FAIL Critical ❑ BLUE Delfield and nacho unit had some uncovered food.All food in storage must be covered. Bacon out at room temp All potentially hazardous foods to be held at 41°f or below. Equipment and Utensils FAIL Critical ❑ BLUE can opener had accumulation of food debris.Thoroughly clean&sanitize Royal fridge unit, beverage-air unit under slicer missing thermometers Provide visible accurate thermometers maintained at 41'f or below as mandated. Water, Plumbing and Waste PASS ❑ BLUE Physical Facility FAIL ❑ BLUE mens employees restroom vent not working at time of inspection Repair vent. all doors to have tight seal from exterior. Provide door sweeps on any-all doors to obtain tight seal. Poisonous or Toxic Materials PASS ❑ BLUE Special Requirements PASS ❑ BLUE Other-See Notes N/A ❑ BLUE GeOTMS®2005 Des Lauriers Municipal Solutions, Inc. ( Rev. Apr 15,2005 ) Page 3 of Y 1 Massachusetts Department of Public Health Salem Board of Health Division of Food and Drugs 4, q ,120 Washington Street,4'"Floor Salem,MA 01970-3523 FOOD ESTABLISHMENT INSPECTION REPORT Tel. (978) 741-1800 Fax (978) 745-0343 Name Dater Toe of Ooerat€on(s) TYee of Inspection __� cJ,F l r.{/ I Food Service L j Routine Address } 1 to i�^ I ftgt{ 'L�° Retail ( Re-inspection (g`€,. I Level ❑ Residential Kitchen P vious Inspection Telephone �� 1� ❑ Mobile Date: A ❑ Temporary ❑ Pre °pe'raiib r� GOwner HACCP YM A ? y ( ❑ Caterer ❑Suspect Illness Person in Chdrgd(PI ) Time ❑ Bed&Breakfast ❑General Complaint t In, ❑ HACCP Inspectorn Out.j .�� Permit No. 12. _7 ; I -7 ❑Other Each violation chec`If'ed requires arl�xpianat€on on the narrativekde(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. �t o{u71j L{ FOOD PROTECTION MANAGEMENT ❑ 12. Prevention of Contamination from Hands ❑ 1. PIC Assigned/Knowledgeable I Duties EMPLOYEE HEALTH " - ❑ 13. Handwash Facilities 2. ng seases by Foo EJ 3. Personnel wfitthh'Infections Resttrrict d/Exclude : . _ PROTECTION FROM CHEMICALS'" Employee and PIC ❑ 14.ApprovedFood or Gator Additives clu d FOOD FROM APPROVED SOURCE -' _- " ` ❑ 15.Toxic Chemicals ❑ 4. Food and Water from Approved Source , TIMENEMPERATURE CONTROLS(Potentially Hazardous Foods) ❑ 5. Receiving/Condition ❑ 16.Cooking Temperature's ' s ❑ 6. Tags/Records/Accuracy of Ingredient Statements ❑ 17. Reheating ❑ 7. Conformance with Approved Procedures/HACCP Plans ❑ 16. Cooling PROTECTION FROM CONTAMINATION ` - ❑ 19.Hot and Cold Holding ❑ 8.Separationt Segregation/Protection ❑20.Time As a Public Health Control ❑ 9. Food Contact Surfaces Cleaning and Sanitizing REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) [110. Propor Adequate Handwashing E121. Food and Food Preparation for HSP CONS ❑ 11. Good Hygienic Practices . Posting of Consumer-Advisories es Violations Related to Good Retail Practices, Number of Violated Provisions Related Critical (C) violations marked must be corrected To Foodborne Illnesses Interventions immediately or within 10 days as determined by the Board and Risk Factors(items 1-22): of Health. Non-critical (N)violations must be corrected Official Order for Correction Based on an inspection immediately or within 90 days as determined by the Board today,the items checked indicate violations of 105 CMR of Health. 590.000/federal Food Code. This report,when signed below 23. Management and Personnel (FC-2)(590.003) by a Board of Health member or its agent constitutes an 24. Food and Food Protection (FC-3)(590.004) order of the Board of Health. Failure to correct violations,,, 25. Eq ui menI and Utensils cited in this report may result in suspension or revocation of p (Fca){sso.oa5) 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)(590.005) and submitted to the Board of Health at the above address 29. Special Requirements (590.009) within 10 days of receipt of this order. 30. Other DATE OF RE-INSPECTION: S r<({pL Inspector's Signature: J Print: PIC's Signature Print Page of Pages �---mom-_.,, Violations Related to Foodborne Illness interventions and Risk Factors(items 1-22) PROTECTION FROM CONTAMINATION FOOD PROTECTION MANAGEMENT S ( Cross-contamination I 590.003(A) Assignment of Responsibility* ( 3-301.11(A)(]} Raw Animal Foods Separated from 590.003(B) I Demonstration of Knowledge* I ( Cooked and RTE Foods* 2-103.11 Person in charge-duties I I I Contamination from Raw ingredients 3-302.1 I(A)(2) Raw Animal Foods Separated from Each EMPLOYEE HEALTH I Other* 2 590.003(C) Responsibility of the person in charge to I I Contamination from the Environment require reporting by food employees and 13-302.11(A) I Food Protection" _- I applicants* ( 3-302 15 Washing Fruits and Vegetables 590.003(F) Responsibility Of A Food Employee Or An ( 3-304.11 I Foci Contact with Equipment and Applicant To Report To The Person In Utensils'* Charge* I Contamination from the Consumer 590.003(Ci) Reporting by Person in Charge* I 3-306.14(A)(B) I Retuned Food and Resenue of Food* I3 590.003(D) Exclusions and Restrictions* I Disposition orAdulterated orContaminated 590.003(E) I Removal of Exclusions and Restrictions ( I Food 3-701.11 Discarding or Reconditioning Unsafe FOOD FROM APPROVED SOURCE Food* 4 I Food and Water From Regulated Sources I 19 Food Contact Surfaces 590.004(A-B) ( Compliance with Food Law* I 4-501.11 I Manual Warewashing-Hut Water 13-201.12 I Food in a Hermetically Scaled Container* I Sanitization Temperatures" 3-201.13 I Fluid Milk and Milk Products* 4-501.112 Mechanical Warewashing-HotWater Sanitization Tem cratures" 3-202.13 Shell Eggs* i 14-501.111 I Chemical Sanitization-temp.,pH, 3-202.14 Eggs and Milk Products,Pasteurized* ( concentration and hardness. " 3-202.16 ( Ice Made From Potable Drinking Water* I 14-60 L I t(A) Equipment Food Contact Surfaces and 5-101.11 I Drinking Water from an Approved System" 590.006(A) Bottled Drinking Water* I Utensils Clean* ` 590,006(B) Water Meets Standards in 310 CMR 22.0* 14-602.11 Conanine Frequency of Equipment Hood- Contact Surfaces and Utensils* Shellfish and Fish From an Approved Source 4-702.11 Frequency of Sanitization of Utensils and 3-201.14 Pish and Recreationally Caught Molluscan Food Contact Surfaces of EUuipmen 3-201.15 Molluscan Shellfish* Shellfish from NSSP Listed I 14-703 11 ( Methods of Sanitization-Hot Water and Chemical* Sources* 10 .I I Proper,Adequate Handwashing Reaulatory Authority 2-301,1 1 Game and Wild Mushrooms Approved by Cleat Condition-Hands and Arms* i 3-202.18 Shellstick Identification Present" 12-301.12 Cleaning Procedure* 590.004(C) Wild Mushrooms* ( 2-301.14 When to Wash* 3-201.17 Came Animals* I 111 ( Good Hygienic Practices g Receiving/Condition I 12-001.1( Eating,Drinking or Using Tobacco" 3-202.11 PHFs Received at Proper Temperatures* ( 2401.12 Discharges Front the Eyes,Nose and 3-1.02,15 Package huegrity* I Mouth* 3-101.11 Food Safe and Unadulterated* 3-301.12 Preventing Contamination When Tasting* I 6 Tags/Records:Shellstock I 112 Prevention of Contamination from Hands 3-202.18 Shellstock Identification* I 590.0(P(E) Preventing Contamination from 3-203.12 Shellstock Identification Maintained' ( Employees* J Tags/Records:Fish Products I 113 Handwash Facilities I 13-402.11 Parasite Destruction* I Conveniently Located and Accessible 3-402.12 Records,Creation and Retention* 15-203.11 I Numbers and Capacities* 540.004(J) I Labeling of Ingredients' 5-204.11 Location and Placement* 205 - .l l Accessibility,I ccess ,Operation and Maintenance ? Conformance with Approved Procedures 5 ?Y I /HACCP Plans Supplied with Soap and Hand Drying 13-502.11 Specialized Processing Methods* Devices 3-502.12 Reduced oxygen packaging,criteria* I 16-301.11 Handwashing Cleanser, Availability 8-103.12 Conformance with Approved Procedures* I 16-301.12 Hand Drying Provision 'Denolec cruiad nem in the federal 1999 Fond Cade of 105 CMR 590.000. Massachusetts Departr' ent of Pubic Health Salem Board of Health Division c+,Food and Drugs 120 Washington Street, 4'" Floor 9 Salem, MA 01970-3523 F06D ESTABLISHMENT INSPECTION REPORT Tel. (978) 741-1800 Fax (978) 745-0343 ' n Name LJ / Date Tyge of Ooeration(s) Tyge of Inspection 91A/YA -©'Food Service El Routine Addressnn Risk t ElRetail P-Re-inspection [[11 R j r- �I(O�j I�f r( t, Level ❑ Residential Kitchen Previous Inspection Telephone ❑ Mobile Date: / ❑ Temporary ❑ Pre-operation (-),,IOwner �) ' r HACCP YM ' �t 11/1 i/p .. ❑ Caterer El Suspect Illness Person in Charge(PIC) Time -] Bed&Breakfast E] General Complaint In:4.',0 [1HACCP Inspector \' ) l-� K O(A4 Out:q-� Permit No. El Other Each violation checked requille�n explanation on the narrative page(s)and a citation of specific provision(s)violated. Non-compliance with: Violations Related to Foodborne Illness Interventions and Risk Factors Anti-Choking Tobacco Violations marked may pose an imminent health hazard and require immediate corrective 590.009(E) ❑ 590.009(F) ❑ action as determined by the Board of Health. FOOD PROTECTION MANAGEMENT ❑ 12. Prevention of Contamination from Hands ❑ 1. PIC Assigned/Knowledgeable/Duties ❑ 13. Handwash Facilities -EMPLOYEE HEALTH . 1 PROTECTION FROM CHEMICALS " ❑ 2. Reporting of Diseases by Food Employee and PIC ❑ 14.Approved Food or Color Additives ❑ 3. Personnel with Infections Restricted/Excluded ❑ 15.Toxic Chemicals ,,FOOD FROM APPROVED SOURCE "�, . .,;,. _ - "-, 'TIMEITEMPERATURE CONTROLS Potential) Hazard ❑ 4. Food and Water from Approved Source (Potentially Hazardous 1:666)" , ❑ 5. Receiving/Condition ❑ 16.Cooking Temperatures ❑ 6. Tags/Records/Accuracy of Ingredient Statements ❑ 17. Reheating ❑ 7. Conformance with Approved Procedures/HACCP Plans ❑ 18. Cooling PROTECTION FROM CONTAMINATION ".... . ❑ 19. Hot and Cold Holding ❑ 8. Separation/Segregation/Protection ❑ 20.Time As a Public Health Control ❑ 9. Food Contact Surfaces Cleaning and Sanitizing REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) [121. Food and Food Preparation for HSP ❑ 10. Proper Adequate Handwashing ❑ 11. Good Hygienic Practices CONSUMER ADVISORY ' a:, ❑22. Posting of Consumer Advisories Violations Related to Good Retail Practices Number of Violated Provisions Related Critical (C)violations marked must be corrected To Foodborne Illnesses Interventions immediately or within 10 days as determined by the Board and Risk Factors(Items 1-22): of Health. Non-critical (N)violations must be corrected Official Order for Correction: Based on an inspection immediately or within 90 days as determined by the Board p of Health. today,the items checked indicate violations of 105 CMR c N 590.000/federal Food Code. This report, when signed below 23. Management and Personnel (FC-2)(590.003) by a Board of Health member or its agent constitutes an g 24. Food and Food Protection (FC-3)(590.005) order of the Board of Health. Failure to correct violations cited in this report may result in suspension or revocation of __ 25. Equipment and Utensils (FC-5)(550.005) the food establishment permit and cessation of food 1/276. Water, Plumbing and Waste (FC-5)(590.006) establishment operations. If aggrieved by this order, you 27. Physical Facility (FC-6)(590.007) have a right to a hearing. Your request must be in writing 28. Poisonous or Toxic Materials (FC-7)(590.008) and submitted to the Board of Health at the above address 29. Special Requirements (590.009) within 10 days of receipt of this order. 30. Other DATE OF RE-INSPECTION: S 501ns OFom id Inspector's Signature:_ ILL, Prink \ )7 -p� IK�,, jcf7 Signature: Print: I ' �y..J PIC's Si Page of Pages g //�(/ lA�/Li (Jl i�.L.i.n' !il r 1 /.'9 iI '� < < _ I g 1 r� g Violations Related to Foodborne Illness Interventions and Risk Factors(items 1-22) PROTECTION FROM CONTAMINATION , FOOD PROTECTION MANAGEMENT 8 Cross-contamination I 590.003(A) Assignment of Responsibility* 3-302.11(A)(]) Raw Ammal Foods Separated from 590.003(B) Demonstration of Knowledge" Cooked and RTE Fowls* 2-103.11 Person in charge-duties I Contamination from Raw ingredients i 3-362.1 1(A)i 2) Raw Animal Foods Separated from Each EMPLOYEE HEALTH I Other* 2 590.003(C) Responsibility of the person in charge to I Contamination from the Environment require reporting by food employees and 3-302.1t(A) Food Protection'" applicants* 3-302.15 Washing Fruits and Vegetables 590.003(F) Responsibility Of A Food Employee Or An 3-304.1; Food Contact with Equipment and Applicant To Report To The Person In Utensils* Charge* Contamination from the Consumer 590.003(0) Reporting by Person in Charge* 13-306.14(A)(B) I Returned Food and Reservice of Food* 3 1590.003(D) Exclusions and Restrictions* I I ( Disposition of Adulterated or Contaminated 590.003(F,) Remuval of Exclusions and Restrictions Food 3-701.11 Discarding or Reconditioning Unsafe FOOD FROM APPROVED SOURCE Food* 4 Food and Water From Regulated Sources ( 19 Food Contact Surfaces - I 590.004(A-B) Compliance with Food Law* ( 4-501.111 ( Manual Warewashmg-Hot Water 3-201.12 Food in a Hermetically Scaled Container" ( Sanitization Temperatures` 3-201.13 Fluid Milk and Milk Products* I 4-501.112 Mechanical Warewashing-I-lot Water 13-202.13 Shell Eggs* Sanitization Temperatures* 3-202.14 Eggs and Milk Products,Pasteurized* I 14-501.114 I Chemical Sanitization-temp.,pH, 3-202.16 I Ice Made From Potable Drinking Water` Equip h Equipment F and hardness. " 5-101.11 Drinking Water from an Approved System" 14-601.11(A) Equipment Food Contact Surfaces and 590.006(A) Bottled Drinking Water* Utensils Clean* J c 4-602.11 Clearing Frequency of Equipment Food- 590.006(B) Water Meets Standards in 310 CMR 22.0* Contact Surfaces and Utensils' Shelffish and Fish From an Approved Source I - - -4-702.11 Frequency of Sanitization of Utensils and 3-201.14 Fish and Recreationally Caught Molluscan Food Contact Surfaces of Equipment* Shellfish* 4-703.11I Methods of Sanitization-Hot Water and 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* - Sources Game and Wild Mushrooms Approved by 1f1 I Proper,Adequate Handwashing 2-301.11 Clean Condition-Hands and Arens* Regulatory Authority ` 13-202.18 I ShellstcxkIdentification Present' 2-301.12 Cleaning Procedure* I 590.004(C) Wild Mushrooms"` 12-301.14 When to Wash* 13-201.17 Game Animals* I 11 I i Good Hygienic Practices 5 I Receiving/Condition I 12401.11 Eating.Drinking or Using Tobacco* 3-202.11 I PHFs Received at Proper Temperatures* 12-401.12 Discharges From the Eyes,Nose and 13-202 15 I Package Integrity* Mouth* 3-101.11 I Food We and Unadulterated* I 3-301.12 Preventing Contamination When Tasting* 16 I Tags/Records:Shelistock I 112 Prevention of Contamination from Hands 3-202.18 Sheilstock Identification* 590.004(E) Preventing Contamination from 3-203.12 Shellstock Identification Maintained* Employees* Tags/Records:Fish Products 113 I Handwash Facilities 3402.11 Parasite Destruction* I I I Conveniently Located and Accessible _ -I 3-402.12 Records,Creation and Retention" I 5-203.11 I Numbersand Capacities* 590.004(1) Labeling of Ingredients* I 5-204.11 Location and Placement* 7 Conformance with Approved Procedures ( 15-205.11 i Accessibility,Operation and:Maintenance_I /HACCP Plans I Supplied with Soap and Hand Drying Devices 3-502.11 Specialized Processing Methods* I - 13-502.12 Reduced oxygen packaging,criteria* ( 6-301.11 I Hand washing Cleanser, Availabilib� b-301.12 8-103.12 Conformance with Approved Procedures" I I Hand Drying Provision *Denotes critical item in the federal 1999 Foci Cate of 105 CbiR 590.000. CITY OF SALEM Cn � BOARD OF HEALTH c�✓� �Establishment Name: , O iia bate: 'I-?)/ 3! o 6 Page: oZ of Item Code C-Critical item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date No. Reference R—Red Item £. Verified r PLEASE PRINT CLEARLY r r4� rr r,n,-f cz<I`VSs � I 1 A I I I 1 F I � 1 � I 1 I t . Discussion With Person in Charge: Corrective Action Required: I ❑ No I�Yes I have read this report, have had the opportunity to ask questions and agree to correct all ❑ Voluntary Compliance ❑ Employee Restriction/ violations before the next inspection, to observe all conditions as described, and to Exclusion P ❑ Re-inspection Scheduled ❑ Emergency Suspension corpply with all mandates of the Mass/Federal Food Code. I understand that noncompliance may result in daily fines of't/w,eent/y-fivee dollars or suspension/revocation of LIEmbargo ❑ Emergency Closure t your.food permit. l� 1U11� 0 Voluntary Disposal ❑ Other: `s ' t _ 5ut 14(r. t't+Ft Itecrivc;l.n '1'entncrature Violations Related to Foodborne Illness Interventions and Risk Accordinl, to iaa Cooled to Factors(items 1-22) (Cont) -t FF/4Y 1'Within 4 Hours. PROTECTION FROM CHEMICALS 3-50: 15 Co^lin_A4ethods for 1'Hbs 13 Food or Color Additives I E9 PHF Hot and Cold Holding ?-5 )1,16t H) Cold,P?IPs Maintained atilt nrlou, 3-202.12 Additiuec'° 590.004(F1 I t 145''F- 3-30114 I Protection from Unapprmtd Addtnves* i 3-501.16(A) 'Hot Pi-IFs Maintained at or abovC v; Poisonous or Toxic Substances i40'F 7-li)l.l l IdenUfyute Intortnatior-Ori8inal Containers' q-5(11.':6i?.) Ruasts Held at or above 130"F. ( 20 Time as a Public Health Control 7 102.1! Common Name--t4'orking CsattainerR"' 3-501 Ii; Time as a Public FF_alth Comrril* 7-201.11 Scparatien-Stoigt=.c" 7-202.11 Rectrichon-Prra:nce and Use" ?`%0.0(hlt H} V:vmnce Reyuin•utcnt 7-202.12 Condition;of else= � REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-2 .11 Toxic Containers Prohibitions` POPULATION'S(HSP) 7-20404 1.11 1 Sanitizers,Criteria -C'Femicnis^� � ' 7-204.12 ( Chemicals for Washing Produce,Criteria* 121 3-801,11 A) Unpasteun/ml Pre-packaged Juices and 7-204.14 Drying.Agents.Criteria F•everagc,,with Warning l.uboic^ -aul.l!(k3) Use of Pasteurized F;cgs' 7-205.1 Incidental Food Contact.I_nhnc.mtc^ 3-Ml.I i(D) ROW or Partialt,y Ctxf ecLAnimal Food and 7-206.11 Restricted lice Pectiades,Criteria* Raw Seed S}rinds Not Settled. " 7-.'-06.12 Rodent Bait Stations" 3-80t.11(C) Unopened Food Package Not Re-served. " 7-206.13 'Tracking Powders.Peal Control and -) Monitorin_** - CONSUMER ADVISORY TIMEITEMPERATURE CONTROLS 22 3-603.11 C'onsumet Ad%isory Posted for Consumption of =lnimal Foods That are Ravi. Undetcool.ed or tb Proper Cooking Temperatures for Not(1t11CrR'IJe Procea,ed,o Elinunate PHFs 3-401.11A(1)(2) Fggs- 155"F 15 Sec. Yathog.iS.* >s hrtniediate Service i45"Fl5sec* 3-102!3 Paueur!zed Egg.SuhWtute For Raw Shrill 3-401.11(A)(2) Comminuted Fish,Meaty &Game Animals - Ii5'F 15 sec. 's 1-401.1l(B)(1)(2) Pork and Beef Roast - 130"F 121 min* i SPECIAL REOUiREMENTS 3-401.1 t(A)t2) Ratites,Injected Meats-155'F 15 590 009(A)-iD) Violatkmn of Scetron 590.009(A)-(D)in sec.* Laterine, mobile food, teraporary and 3-401.11(A)(3) Poultry,Wild Game, Stuffed PHFs, residential kitchen operations should be Stuffing Comanu g,Fish, Meat, debited under the appropriate section:; PoultrVor Ratites:165°F 15 sec. * above if related to foodborne itlness i 3-401.11(C)(3) Whole-nmscle, Intact Beet Steaks interventions and risk factors. Otho 145`17 590.009 violations relating to good retail 3-101.12 Rata- Animal Foods Cooked in a practices should be do-hited under#29 Microwave 165'F* Special Requirements. 3-401AI(A)(I)(b) All Other PHF,- 145`P15sec. ''- 1'7 Reheating for Hot Holding I VIOLA noms M LATFD TO GOOD RETAIL PRACTICES 3-403.11(A)&(17) PHFs I 650 15 scc, 1' (Items 23-30) 3-403.11(B) Microwave- 165°F 2 Minute Standia2, C.ritir!t7 and nan-r;dtn:a'c;nlrt;nnv, whreh du not relate to the Time* (rodbonne ulnes.,•nitervrntions and risk p„roll:bated abm,e, can be ?-403.11 tC} Comnterciallq Piocessed RTE Food- ,foulld in rhe fol6maax ser•tions ol1 the Fond Code and 105 CAIR 140'17 `:iU.UU() 3-101 11(B) Remaining Lnsliced Portions of Beef I Item Good Retail Practices FC 590.000 Roasts* 23. AAanagement and Pa=sonnei FC-2 .003 18 Proper Cooling of PHFs ! 24 Foud and Food Pwluclron FC-3 004 25, Eq:dpment and Utensis FC_-4 x--05 3-501 14(A) Cooling Cooked PHFs from 140`17 to 26 Wa±at.I=lona nq and VJaslz i=C-S ,006 70"F Within 2 Hours ant) From 70'F 27. Physical=acBity FC-6 007 to 41°F/45"F Within 4 Flours. * ( 28, Poisonous er't ox Pdrterias ! FC-7 1 .DCII 3-501.14(B) Cooling PHFs Made From Ambient ( 29. Sp=cial Hequ!remen>; 009 Temper murelneredientsto41'F/45`F 130 Other ! Within,g Hours* . ti Id", Dense..�am�al real at the Fzdoral 1994 Rued Code,r 105 CNIR 590 000. , y,l+aW39i!P.yb+t{l' .J�'.n'➢ � ✓ „}�.:..S4.v.03S":. �.'.M n.. vY x..o'.. _ . . . : .h. r - , t I ( 'd ? ' II f 1. Salem Board of Health Massachusetts-Departmr 'etp( of Public Fjealth 120 Washington Street,4th Floor Division of?food and Drugs Salem, MA 01970-3523 FOOOhD,ESTABLISHMENT INSPECTION REPORT Tel. (978) 741-1800 Fax (978) 745-0343 Name ��Yn , ) \ Date, Type of Ooeration(s)' Type of Insoection '� ff (4 �, V J QZ(,�)r Ir �7 Food,Service ❑ Routine Address 0__ \ /1' Risk"I , ° ❑ Retail ,De-inspection ur n!- LJ,<r_r Level ❑ Residential Kitchen Previous Inspection ( Telephone �n l dr7 s 7 ❑ Mobile Date: 1tIT�TrII# n HACCP Y/N [:1 Temporary ElPre-operation Owner u � �/1r I ❑ Caterer [ISuspect Illness Person in Charge(PIC) I Time + ` ;Bed& Breakfast E] General Complaint _ ❑ HACCP Inspector / j Out: Permit No. ❑ Other Each violation checked re4u?esran explanation on the narrative page(s) and a citation of specific provision(s) violated. Non-compliance with: Violations Related to Foodborne Illness Interventions and Risk Factors, Anti-Choking Tobacco Violations marked may pose an imminent health hazard and require immediate corrective 590.009(E) ❑ 590.009(F)'❑ action as determin?d by the Board of Health. FOOD PROTECTION MANAGEMENT ❑ 12. Prevention of Contamination from Hands ❑ 1. PIC Assigned/Knowledgeable/Duties ❑ 13. Handwash Facilities EMPLOYEE HEALTH - PROTECTION FROM CHEMICALS ❑ 2. Reporting of Diseases by Food Employee and PIC ❑ 14.Approved Food or Color Additives ❑ 3. Personnel with Infections!Restricted/Excluded ❑ 15.Toxic Chemicals FOOD FROM APPROVED SOURCE ❑ 4. Food and Water from Approved Source TIME/IEMPERATURE CONTROLS(Potentially Hazardous Foods) . ❑ 5. Receiving/Condition 4 ❑ 16.Cooking Temperatures ❑ 6. Tags/Records/Accuracy of Ingredient Statements ❑ 17. Reheating ❑ 7. Conformance with Approved Procedures/HACCP Plans ��❑ 18. Cooling PROTECTION FROM CONTAMINATION . Hot and Cold Holding ❑ 8. Separation/Segregation/Protection cL7 20.Time Asa Public Health Control ❑ 9. Food Contact Surfaces Cleaning and Sanitizing REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP)`",f - ❑21. Food and Food Preparation for HSP f/ ❑ 10. Proper Adequate Handwashing CONSUMER ADVISORY [111. Good Hygienic Practices f �+ � El 22. Posting of Consumer Advisories f _ Violations Related to Good Retail Practices Number of Violated Provisions Related Critical (C)violations marked must be corrected To Foodborne Illnesses Interventions immediately or within 10 days as determined by the Board and Risk Factors(Items 1-22): of Health. Non-critical (N) violations must be corrected Official Order for Correction: Based on an inspection immediately or within 90 days as determined by the Board today, the items checked indicate violations of 105 CMR of Health. 590.000/federal Food Code. This report, when signed below C_N by a Board of Health member or its agent constitutes an 23. Management and Personnel (FC-2)(590.003) order of the Board of Health. Failure to correct violations 24. Food and Food Protection (FC-3)(590.004) cited in this report may result in suspension or revocation of 25. Equipment and Utensils (FC-4)(590.005) the food establishment permit and cessation of food 26. Water, Plumbing and Waste (FC-5)(590.006) establishment operations. If aggrieved by this order, you 27. Physical Facility (FC-6)(590.007) have a right to a hearing. Your request must be in writing 28. Poisonous or Toxic Materials (FC-7)(590.006) and submitted to the Board of Health at the above address 29. Special Requirements (590.009) within 10 days of receipt of this order. 30. Other DATE OF RE-INSPECTION: aoo 5 5.901n5p9ctFOm6-144oc ^ Inspector's Signature: l \ Print: PIC's Signature: \ \XI \, f� Print: Page_ofPages l Violations Related to Foodborne Illness Interventions and Risk Factors(Items 1-22) l a PROTECTION FROM CONTAMINATION FOOD PROTECTION MANAGEMENT 18 I Cross-contamination 1 590.003(A) Assignment of Responsibility* I 3-302.1 It AI(D Raw Animal Foods Separated from 590.003(6) Demonstration of Knowledge* I Cooked and RTE Foods* i 2-103.11 I Person in charge -duties I I Contamination from Raw ingredients 3-302.11(A)(2) Raw Anirnal Foods Separated from Each EMPLOYEE HEALTH I Other" 2 590.003(C) Responsibility of the person in charge to I Contamination from the Environment require reporting by food employees and 3-302.1](A) Food Protection- applicants* 3-302.15 Washing Fruits and Vegetables 590.003lF) Responsibility Of A Food Employee Or An 3-3(Af.11 Food Contact with Equipment and Applicant To Report To The Person In Utensils* Charge* Contamination from the Consumer 590.003(G) Reporting by Person in Charge* i 3-306.14(A)(B) Returned Food and Reservice of Food* _ 3 590.003(D) Exclusions and Restrictions* Disposition of Adulterated or Contaminated 590.003(E) Removal of Exclusions and Restrictions I ( Food 3-701.11 Di;.carding or Reconditioning Unsafe FOOD F4OM APPROVED SOURCE Fund* a Food and Water From Regulated Sources ( 19 Food Contact Surfaces 590.004(A-B) Compliance with Food Law* I 4-501.111 Manual Warewashmg-Hot Water 3-201.12 Food in a Hermetically Sealed Container* I Sanitization Temperatures* - J 3-201.13 Fluid Milk and Milk Products* 4-501.112 ( Mechanical Warewashing-I-lot Water 13-202.13 Shell Eggs* Sanitization Temperattues* 3-202.14 Eggs and Milk Products.Pasteurized* I 14-501.114 I Chenucal Sanitization-temp.,pH, 3-202.16 lee Made From Potable Drinking Water* ( concentration and hardness. 'k J 5-101.11 Drinking Water from an Approved System' ( 4-601.11(A) Equipment Food Contact Surfaces and 1590.006(A) Bottled Drinking Water* I Utensils Clean- 1590.006(B) Water Meets Standards in 310 CMR 22.0* ( 4-602.11 Cleaning Frequency of Equipment Food- Shellfish and Fish From an Approved Source I Contact Surfaces and Utensils'6 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 I Chemical* Sources* I i0 Proper,Adequate Handwashing Game and Wild Mushrooms Approved by Regulatory Authority 2-301.11 Clean Condition-Hands and Arms* 3-202.18 Shellstock Identification Present* I 2-301.12 Cleaning Procedurc* ---- i 590.004(C) Wild Mushrooms' 2-301.14 When to Wash` - 3-201.17 Game Animals* I ( 11 Good Hygienic Practices 5 Receiving/Condition I 2401.11 Eating,Drinking or Using Tobacco* 3-202.11 PHFs Received at Proper Temperatures* I 12-401.12 Discharges From the Eyes, Nose and 3-202.15 Package Integrity* Mouth` 3-101.11 Food Safe and Unadulterated* 3-301.12 Preventing Contamination When Tasting* 6 Tags/Records:Shellstock 112 I Prevention of Contamination from Hands 3-_02.18 Shellstock Identification* ( 590.004(E) Preventing Contamination from � € I 3-203.12 Shellstock.Identification Maintained" Employees* - Tags/Records:Fish Products I 113 I Handwash Facilities 3402.11 Parasite Destruction* I Conveniently Located and Accessible 3-402.12 Records,Creation and Retention* 15-203.11 Numbers and Capacities* 590.004(J) Labeling of Ingredients' 15-204.11 I Location and Placement* 9 Conformance with Approved Procedures 5-205.11 I Accessibility_Operation and Maintenance /HACCP Plans Supplied with Soap and Hand Drying 3-502.11 Specialized Processing Methcals* Devices 3-502.12 Reduced oxygen packaging,criteria* 16-301.11 HandwashmR Cleanser,Availability 8-103.12 Conformance with Approved Procedures- 16-301.12 Hand Drying Provision *Denotes critical item in the federal 1999 Ford Code or 105 CMR 590.(100. y a . CITY OF SALEM c BOARD OF HEALTH / " Establishment Name: ( 'a.,�l 1� - / Date: ! �) G Page: of df> ,. DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Item Code C-Critical Item Date � 11 PLEASE No. Reference R-Red Item p /f PLEASE PRLNT CLEARLY / L /COA vA :x ✓ z 4- 6 a c I � 1 Discussion With Person in Charge: Corrective Action Required: I ❑ No 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 obsery all con itions as escribed, and to Exclusion P I �a--Re-inspection Scheduled ❑ Emergency Suspension comply with all mandates of the Mass/Federal od Co e. I un ers nd that noncompliance may result in daily fines of twent 'five d Illars o(s p /revocation of ❑ Embargo ❑ Emergency closure your food permit. I F vLl Voluntary Disposal U Other: k \J IIS - 1 i-SGi,i !t"o Pi-[Fs Recer:ed�r iengreratures - Violations Related to Foodborne illness interventions and Risk According:o f.aw Cooled to Factors(items 1-22) (Cont.) 4l'F,45''F Wahin 4 Hours. ' PROTECTION FROM CHEMICALS j ,-511.15 Coaling Medawjs for PHFs j 1.1 Food or Color Additives ( 19 PHF Hot and Cold Holding Cold PI Fs Mz:niamed at of below, 3-202.12 Additive:' 590.0041FI 41145: F' 3-30114 Protection from Unapproved Additives* j j 3-5CL!6(A) riotai PFlF, M 1 ilia:llLtl at 01'abate 15 Poisonous or Toxic Substances 140'F ' 7-101.11 ldentifyntgInformation 0ugmal Containersv-olej .it ur:ibovc 130"F 3-c;t)110lA.t Ruts: ': - - -I " j 7-102.1 : Comnaw Name- !Forking Container," j j 20 Time as a Public Health Control 7-'01.1 I Sepal;tion-Stpraee' ' ? 501.19 Tim:as a Pudic,Hca4h ConhoP° j j 7-201,11 Rech iction-Presatce and Use" j 5o(1004!H) Vin iance Reawreniint j j 7-202.12 C'ondtions of Use' l 7-'_03.1 I Toxic Ccntainers -Prohibitions" REOUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-204.1 IPOPULATIONS(HSP) j Sanitizers,Criteria--Chemicals. '1 1 3-SOI 1117,) Unniistcurized Pre-paekageed Juices and 7-_04.1',_ ( Chemicals for Washmc Produce,Criteria" ( I Be':eraece With Warning Ltb.:ls* 7-'04.14 j DryingA¢ents.Cnteria' i 3.SOLI :I B) Use .ofPasteurimdl:ggs 7-'05.11 j Incidental Food Contact.Lubricants" 3-3(ii.t l(D) Raw o-Pacnal1v Cx&ed Animal Food and 7-_06.11 Re,tricted Us'r Pesticides.Critena` ( Raw S-.:ed S13 M01;Not Served. 7-206.12 Rodent Bait Stations` 3-80!,'1(C) p "L`Uno r 1 Prxsd Not Re-served. Fac6 ag. + j 7-206.13 'Tracking Powders,Pest Control and e Monitoring* CONSUMER ADVISORY TIMEITEMPERATURE CONTROLS 22 13603.11 Consumer Adv,ory Footed for Consumption of 16 i Proper Cooking Temperatures for ( Arum:? Foods'Fhat arc tial*', Undercooked or PHFs i Not 0nl 'ervwisr Processed to E=liminate 1 ( `r'ecae.:r:iaJm 13-40LIIA(1)(2) Eggs- 155°FiSSec. Pat{lU_ens.- , Eggs-Lnmediate Service 1-45'F15cec' j I 3"302'.1 Paa ;teuree Eggs Substitute for Raw Shell 3-401.11(A)('2) Comminuted Fish,Meats&Name ( P,g"s* Animals- 155 F 15 see, j 3-401.1 I(B)(1)(2) Pork and Beef Roast- 130'1-' 121 minSPECIAL.REQUIREMENTS 3 (les, Injected Meats-- 155'F IS f Section 590009(7! iU} in Vilancnso sec, , entering. mobile foua,temporary and 3-d01.11(A)(3) Poultry,Wild Game,Stuffed PliFs _ residen?ial kitchen operations should be Stuffing Containing Fish,Meat, debited ands 11'C appropriate sectiotts Poultry or Ratites-165°F 15 sec. above if related leo foodborne itlness 1-401.1I(C)(3) Whole-muscle,Intact Beef Steaks interventions and ri.;k factors. Other 145'F* 590.009 violations relating to good retail 3-401.12 Raw Animal Fails Crooked in a I practices should be debited under I/29- Microwave l(15'F * Special Requireme.ts. 3-401.11(A)(1)(b) All Other PHFs- 145"F15sec, * j l7 Reheating for Hot Holding VIOLATIONS RJLAT ED TO GOOD RETAIL PRACTICES 1-403.11(A)&(1)) PHP: 165'F 15 sec. " (Reins 23.30) ?-103.11(H) Microwave- 164'F 2 Moline Standing Critical mr<L:ren-rri6cal violations, whu h do'rat relate to the Time'i lfoodi;orm:t6'ru-v inrer:rerzti:n.i and r'si:)iic lags ii.sted,Gove. ,in be 1-403.11(C) Comincrclally Processed RTF Fond- foanri in Ire jolhel nl secri,,v,qt the Food Code raid 105 t'[NR 140"F` 590.(N)0. 3-403.11(F.) Reniaunng Unsliced Portions of Beef I I Item Good Retail Practices I FC 590,000 j Roasts* 23. Manammern and Personne: FC 2 .003 18 Proper Cooling of PRFs 1 24 Foto arc Food Prvioat:on FC-3 .004 25. EQU'pmert and Utensls FC--4 .005 ' 3-501 14(A) Cooling Cooked PFIFs from 140'F to ' - 26 Water. Piuni6lnq aid Vl este FC-5 x ,006 70'F Within 21-tour;and Front 70°F 2i. Physical Facility' FC-6 007 L,141'F/45'F W ithm 4 Hours. ' 26. Poisonous or Toxic Nlateria!s FC-7 .003 3-501.14(B) Coining PFIFs Made From Ambient 125. :,pecial Reau,rcme�ts I .009 TemprruttreIngredientsto4VF1a5`P j 30, Othei j Within 4 Hours* I Ci.nnte.i'itn.al ilea in ilio f,,&rzl I Will p,,uii lade or 10S CN1R 5'n1000. g CITY OF SALEM /^I- /► BOARD OF HEALTH -kyr Establishment Name: �V�1� � ' Date: c+f 1��0 Page: 9 of Rem Code C-critical Rem DESCRIPTION OF VIOLATION/PLtAN'OF CORRECTION Date No. Reference R—Red Item Verified PLEASE PRINT CLEARLY )( 4G�{ �.1 r (� rWKS 4y'E ?r/\ _ r> f? , ! /' � i (s27! r AI QCjv ^ ( P S2'clyi��_ y! ^ A�h,r.,�YPt?0., �� tikPa r /k1�r1�� "= JA �e'2' ky 8 I C�Yt� Qo> ILl,niiJ rai D— S�d�= 4)L S. fr rllentj /1GlC' 17 0 -S-iJ,= we)- ,tnino _F Y-6- 7' t r I �.�_'1a--� -F-�.�',_1 .a-!1 C1,�o�r � i s�,o !� ✓o(..n�_ �yco�r f_ O %t 11i 4 1 )n r /l)0S 1 _ /i t �.rf hrl{ Y. S1 tQ t ` Discussion With Person in Charge: I correcti a Action Required: I ❑ No I,e1f Yes I have read this report, have had the opportunity to ask questions and agree to correct all voluntary Compliance ❑ Employee Restriction/ ,y Exclusion f violations before the next inspection, to obs rve all con itions as described, and to , � Re-inspection Scheduled ❑ Emergency Suspension i comply with all mandates of the Mass/Fede al F od Co e. understand that noncompliance may result in daily fines oft ent five d Ilars sus nsion/revocation OT Embargo ❑ Emergency Closure your food permit. ❑ Voluntary Disposal ❑ Other: sr x + PI'IF, R ceiveo A TenhP erattres Violations Related to Foodborne Illness Interventions and Risk Axordinn to Law Lixoled to Factors(items 1-22) (Cont.) I 4I`F!-t.i';'Within 4 Homs. PROTECTION FROM CHEMICALS j 5;)1.15 Cooling Meal n& foc PHFs J 19 PHF Hot and Cold Holding j j 14 Food or Color Additives j i 3.501 '6((s) Cold PI-IF: NlhtintaiDod at or below 590004(F) 3-202.12 Additivcs" -}!'!:,.-,'1;:. 1-302.14 Protection from Uj a(ipan•ed Addinvei" 1(,A) H:�t PH^. Maintained at or above IS Poisonous or Toxic Substances j 7-I0i.11 Identifying Information-Original Containers' ( 3-501.16(A) Roasts Held at or nlvwe I?0'F. " a j 7-102 1 I Common Name-W'orkinp Containers* ; 2.0 Time as Public Health Control j j 7 201.11 Scp,iration-Storavc' 3-50119 Tine,as i Public Health Central i 7-202.11 Rrctrichon-Presence and Use 390.0041 Variance ReUuirement j 7-202.12 Conditions of Use* j '1--203.1 I Toxic Container.-Prohibitions* j REOUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-204.11 Sanitizers.Criteria-Chemicals.;, POPJ!_AT:ONS(HSP) ( .71 3$01 I1-A) ' 'tfipasteurzed Pre-packaged Juices and 7-20..12 Chenncalti for Washing Produce,Criteria" j � , f I I deieiage:'will) 1Varninl I abels' ! 7-204,14 Drying r�genta.Criteria"' 1 z gpl I I;Bl i Use of Praetuizeq H,,ts" 7-205.11 Incidental Food Contact,Lubr.ants* 3--nl A IH)) Ras or Pai Bally Ceoked Aniinni Food and 7-206.11 Restrictcd Ilse Pesricides.Catena* ! ( Rnw Seed Sprouts No' Served, 7-206.12 Rodent Hair Stations` j ! t-S01.111Ct Limapened Foo!Pad:aid tint Re-sen•ed. 7-206.13 Tracking Powders.Pest Control and Monitoring* CONSUMER ADVISORY TIMEITEMPERATURE CONTROLS 22 3-603.11 Consumer AdvtSory Posted for Ccnsuniotion of ; Anural P ods'Phat a:c Raw.Undercooked of lfi Proper Cooking Temperatures for Not Odierwi,c Processed to El:ansate PHFs Paiho};ens.,,evecaVr:.'.n,.,, 3-401.11A(l)(2) Eggs- !551F 15 Sec. (•ides-hmnediate Service 145'F15sec� 3-302.!3 FasF_urred Eggs Substitute to; R.:w Shell 3-401.11(A)(2) Comminuted Fish, Meats& Game F2gs' Animals- 155"F 15 sec. j 3-40L1103)(1)(2) Pork and Beet'Roast- t30"F 121 min" SPECIAL REOUIREMENTS 3-401.I I(A)(2) Ratites, Iniertcci Ntcata-- 155°F IS I 590009(10-0)) Violations ul'Seciion 590.009;A)-(ll) in sec. * cateriiig, mobile fond, temporary and 3-401.11(A)(3) Poultry, Wild Game,Stuffed PHFs, restdent;al kitche i operation, should be Stutfiug Containing Fish, Nteat, debited under the appropri,te sections Poultry or Retires-165°1, 15 sec. ` above it related to foodbol ne illness 3-10 1.11(C)(3) Whsle-nntsele,Intact Beef Steaks tttterveniions and risk factors. Oter 145'17" 590.009 %iolationa relating to good retail 3-401.12 Raw Animal Fomis Cooked in a prmriccs shatdd be debited ,under #29- Microwavr 165'F* 1 Special Pearl;rcu!enIs. 3-401.11(A)(1)(b) All Other PHFs- 145"F• 15 sec 17 Reheating for Hot Holding VIOLATIONS RELATED TD GOOD RETAIL PRACTICES 3-403.11(A)&(ll) PHFs 165'F 15 sec. * (Items 23-3(1) 3-403.11(B) Microwave- 165°F 2 Nlimne Standine Ciitual vin,;vions. which do not relate to the Time* diners Horn-ewwn.c and,iib(actors tinted above, cmi he' 3-403.11(C) Commercially Processed RTE Food- found in theJnHrni ;ig suctions of the Fond C'vd�rand 105 0112 140"F* 50.000. 3--403.11(E) Remaining Uusliced Portions of Beef ,Yeo l do-doRetail Practices FC ( 590,000 Kuasts* ! 23. ( Manaoement and Perconne: FC-2 .003 1 j 18 Proper Cooling of PHFs 24. Food and Food Protection _FC-3 .004 1 25 Eouiomr:nt and Utensils FC-4 005 3--501.14fA) Cooling Cooked PHFs from 140'F to j 26. Waiec F9mub:nq and Wasie FC-5 ^06 70"F Within 2 Flours and From 70"F 27 PlWy :,:al Fm%, 6 1 .00; j to 41`F/45"F Within 4 Hours. * 28. Poisonous:;r'f ax,r Materais FC-_-7 .008 3-501.14(H) Cooling PHFs Made From Ambient 29 Sp=cial Raouvements ( 0n3 Tmupvraturehtgredientslo4l'F/45-F : 30. Other -- Within 4❑ours': <<^,n,..• i.-x m„ Denoue critical nem in!h, foder.il 199`(Food Cud,or 105 Cklk Ya)000. Massachusetts Department of Public Health Salem Board of Health 120 Washington Street,4'h Floor Division of Food and Drugs Salem, MA 01970-3523 , FOOD ESTABLISHMENT INSPECTION REPORT Tel. (978) 741-1800 Fax (978) 745-0343 Nam g/ ' ( Date Type of Operations( Type of Insoection ( 'j)rnO A R (1OrY A (?- 14-6(n U(nl ❑'Food Service ❑ Routine Address Risk '❑ Retail M'Re-inspection r9 iev� Level--M El Residential Kitchen Previous Inspection Telephone f I ❑ Mobile Date: OwnerHACCP YIN ElTemporary ElPre-operation ` 0,-,h f q P Q ` un 1 ❑ Caterer ❑ Suspect Illness Person in Charge(PIC) Time ❑ Bed&Breakfast ElGeneral Complaint l _1 Yl ( ii �N )f)n In: El HACCP Inspector 1 �t n 0 / ) (h k)n, h I Out: Permit No. ❑Other Each violation checked requires an explanation on the narrative page(s) and a citation of specific provision(s)violated. Non-compliance with: Violations Related to Foodborne Illness Interventions and Risk Factors Anti-Choking Tobacco Violations marked may pose an imminent health hazard and require immediate corrective 590.009(E) ❑ 590.009(F) ❑ action as determined by the Board of Health. FOOD PROTECTION MANAGEMENT [112. Prevention of Contamination from Hands ❑ 1. PIC Assigned/Knowledgeable/Duties El- ,. 13. Handwash Facilities EMPLOYEE HEALTH' ... PROTECTION FROM CHEMICALS " ❑ 2. Reporting of Diseases by Food Employee and PIC ❑ 14.Approved Food or Color Additives ❑ 3. Personnel with Infections Restricted/Excluded ❑ 15.Toxic Chemicals FOOD FROM APPROVED SOURCE" " -.- ❑ 4. Food and Water from Approved Source TIMErrEMPERATURE CONTROLS(Potentially Hazardous Foods) ❑ 5. Receiving/Condition ❑ 16. Cooking Temperatures ❑ 6. Tags/Records/Accuracy of Ingredient Statements ❑ 17. Reheating ❑ 7. Conformance with Approved Procedures/HACCP Plans ❑ 18.Cooling PROTECTION FROM CONTAMINATION "'" ISI 19. Hot and Cold Holding ❑ 8. Separation/Segregation/Protection j❑20.Time As a Public Health Control ❑ 9. Food Contact Surfaces Cleaning and Sanitizing REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) ❑21. Food and Food Preparation for HSP ❑ 10. Proper Adequate Handwashing ❑ 11. Good Hygienic Practices CONSUMER ADVISORY " ❑22. Posting of Consumer Advisories Violations Related to Good Retail Practices Number of Violated Provisions Related Critical (C)violations marked must be corrected To Foodborne Illnesses Interventions immediately or within 10 days as determined by the Board and Risk Factors(Items 1-22): of Health. Non-critical (N)violations must be corrected Official Order for Correction: Based on an inspection immediately or within 90 days as determined by the Board today, the items checked indicate violations of 105 CMR of Health. 590.000/federal Food Code. This report, when signed below C N by a Board of Health member or its agent constitutes an 23. Management and Personnel (FC-2)(590.003) order of the Board of Health. Failure to correct violations 24. Food and Food Protection (FC-3)(590.004) cited in this report may result in suspension or revocation of 25. Equipment and Utensils�r�) (FC-4)(590.005) the food establishment permit and cessation of food 26. Water, Plumbing and Waste (FC-5)(590.006) establishment operations. If aggrieved by this order, you 27. Physical Facility (FC-6)(590.007) have a right to a hearing. Your request must be in writing 28. Poisonous or Toxic Materials (FC-7)(590.008) and submitted to the Board of Health at the above address 29. Special Requirements (590.009) within 10 days of receipt of this order. 30. Other DATE OF RE-INSPECTION: S 5BOlns IFam 141 Insp tor' at e: Print: 1 Ptd'- g/store: �,I 'n, Print: Page of Pages Violations Related to Foodborne Illness Interventions and Risk Factors(items 1-22) PROTECTION FROM CONTAMINATION FOOD PROTECTION MANAGEMENT ( 8 ( Cross-contamination f I 1 590.003(A) Assignment of Responsibility* I 3-302.11(A)0) Raw Animal Foods Separated from 590.003(B) Demonstration of Knowledge* I ( Cooked and RTE Foods* _ 2-103.11 Person in charge-duties ( ( Contamination from Raw Ingredients 3-302.11(A)(2) Raw Annual Foods Separated from Each EMPLOYEE HEALTH I Other" 2 590.003(C) Responsibility of the person in charge it) I Contamination from the Environment require reporting by food employees and 13-302.1[(A) Food Protection- applicants* 3-302.15 Washing Fruits and Vegetables 590.003(F) Responsibility Of A Food F,mpfoyee Or An 3-1 04.11 Fund Contact with Equipment and Applicant To Report To The Person in Utensils* Charge* 1 Contamination from the Consumer 590.003(6) Reporting by Person in Charge" 13-306.14(A)(B) Returned Food and Reservice of Food* I3 590.003(D) Exclusions and Restrictions* I Disposition of Adulterated or Contaminated 590.003(E) I Removal of Exclusions and Restrictions Food 3-701.11 Discarding or Reconditioning Unsafe FOOD FROM APPROVED SOURCE ( Food" 4 Food and Water From Regulated Sources 9 Food Contact Surfaces 590.004(A-B) Compliance with Food Law* I 4-501 111 Manual Warewashing-Hot Water i 3-201.12 Food in a Hermetically Scaled Contamer* Sanitization Temperatures" 3-201.13 Fluid Milk and Milk Products* 4-501.112 Mechanical Warewashing-Hot Water 13-202.13 Shell E'-gs* I Sanitization Temperatures* 13-202.14 Eggs and Milk Products,Pasteurized* I 4-501.114 Chemical Sanitization-temp.,pH, 3-203.16 ice Made From Potable Drinking 4-601.11(A) Equipment Food Contact Surfaces and Water* ( concentration and hardness. * 5-101.11 Drinking Water from an Approved System* 590.006(A) Bottled Drinking Water* I Utensils Clean* 1590.006(B) Water Meets Standards in 310 CMR 22.0" I 4-602.11 CFrequency of Equipment Fcxxl- Contactntact Surfaces and Utensils* Shellfish and Fish From an Approved Source 4_702,11 Frequency of Sanitization of Utensils and 3-201.14 Fish and Recreationally Caught Molluscan I Food Contact Surfaces of Equipment Shellfish* I 1-703.1 I Methods of Sanitization-Hot Water and 3-201.15 Molluscan Shellfish from NSSP Listed ( ( Chemical* Sources* ( 1Q I Proper,Adequate Handwashing Game and Wild Mushrooms Approved by 2 Regulatory Authority -301.11 Clean Condition-Hands and Arms" 1 _ 3-202.18 Shellstock Identification Cleaning Pro edure*_n Present* � - ---__-I 590.004(C) Wild Mushrooms* 12-301.14 When to Wash* 3-201.17 Game Animals* I 111 Good Hygienic Practices 15 Receiving/Condition 2401 11 Eating,Drinking or Using Tobacco* 3-202.11 PHFs Received at Proper Temperatures* 12-401.12 Discharges From the Eyes, Nose and 3-202 t5 I Package lntegity* Mouthy 3-101.11 I Food Safe and Unadulterated* 3-301.12 Preventing Contamination When Tasting*_ 6 Tags/Records:Shellstock ( 112 Prevention of Contamination from Hands 13-202.18 Shelisttxk Identification* 590.004(E) Preventing Contamination from 1 Employees*3-203.12 � Shellstock Identification Maintained" � , 13 Handwash Facilities Tags/Records:Fish Products ( 3-402.11 Parasite Destruction* I Conveniently Located and Accessible 1 I � _-I 3-402.12 Records.Creation and Retention* 15-203.11 I Numbers and Capacities* 590.004(1) Labeling of Ingredients' 15-204.11 I Location and Placement* 9 I Conformance with Approved Procedures I 5-205.11 I Accessibility_Oneration and Maintenance- I /HACCP Pians ( Supplied with Soap and Hand Drying 13-502.11 Specialized Processing Methods* ( Devices - - 13-502.12 Reduced oxygen packaging,criteria* ( 16-301.11 Handwashing Cleanser, Availability 18-103.12 Conformance with Approved Procedures* I 16-301 12 I Hand Drying Provision Denotes critical nem in the lederal 1999 Fool Code of 105 CMR 590.000. a r. CITY OF SALEM —/ BOARD OF HEALTH c� Establishment Name:�i'UUI AU G U/l�'� Date: 1 Page: c of Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date No. Reference R—Red Item Verified PLEASE PRINT CLEARLY I 64' rP -112 (irn . nl?17/y �n. /F& )��/c� -A Gam. rPino�iJ I a5 - /rla.< �rn 'ee eP h7KY Q(,61i Ola A01) a /'o /�� 6u;JNrrp I1 - I had " al OE 1?6 has- PI-elihl e hn4 /��r�r%hh prrh�v ` 'VAO /1 bi'veb p4i�/2 No/�Jp -bl)M 6t/0 le IP WeetM �yn�lotln�c / esm c �3' 4A /,a fs Y1d� ��hlr�o a S - X'S0 rio-len/ P/1s /7o fia�-l`x_ -v'4�1n7'Z? 1i2 le��r� rl'orriz�if��o�j �i-vrnneb�s �rlc/so%s'h �v� rDiscussion With Person in Charge: h�/Zd.S /Z� Corrective Action Required: I ❑ NO I ❑ Yes r" ❑ Voluntary Compliance ❑ Employee Restriction/ read this report, have had the opportunity to ask questions and agree to correct all Exciusion,,,� 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 Food.-Code. I understand that noncompliance may result in daily fines of twenty-five dollars or suspension/revocation of ❑ Embargo ❑ Emergency Closure t your food permit. `a= ❑ Voluntary Disposal ❑ Other: s 1 3-50 i.14(C:) PHFs Received at'lemperatures Violations Related to l=nnd8rrae;tfness ia'ervc:,r;oats and Fish According Ed!,ay. Cooled to Factors(items 1.22) (Cont.) 41'F/45°F Within 4 Hours. PROTECTION FROM CHEMICALS 3-5O!.1.5 Conlin,;Method,for PHFs 19 PHF Hot and Cold Holding 13 I Ft OG or Ccior Additives 3-50!.16(131 Cold PH1`e Maintained at or below ?-202.!2 Additives' ( 590,001('[ I411450F'1 1 3-302.14 Prun:ction front (:neppmoed Additisesr ' 3-501.16(A) lint PHFs 1Naintaired at or abuse Poisonous or Toxic..»bstarcns 15 140"F,7-101. nfyin 11 Idene lrrii,rm,in;t- Oai-)nit - Container,'" 3-501.16(A) Roasts Held it or::bove 1301F. " 7-102.11 C„rr-:ani:Nana. -�work6at Containers" ! � 20 Time as a Public Health Control o r., r 1 3 501.19 Time as a Public Health Conh'nl t' 7-_01.11 . cnaration-Sloracc 7-202 11 Restriction-Preaenre and Uw' 590.004(H) Variance Requirement i 7-202.12 Condniuns ut Use 7-203 ! : Toric Containers-Fru!t:baioa REQUIREMENTS FOR HIGHLY SUSCEPTIBLE i-?.04.l! Samdzers.Criteria-Ct:zmicais'. POPULATIONS(HSP) 7-20-t.12 Chccn;cals for lin,;hmt2 Posht,e,Criteria" 1 ( 21 3-801.1 NA)A) Unpasteuriyed Pre-packaged Juices and Heveca;2es witb Warnink !Aitie "- , 7-20.5.1Diving,Agents.Conr-.c'' ig 7.2{15.111 hu•;dent 1 Loud C'cmrct. Lubriceuts� 3-801.11(B) Use of Pasteurized Egs*1 ]-_Ou 11 Ke:.victed L"ee Pes:icirlec ,`ntzrae v i ! 3-501.11(D) Raw or Pariially Cooked Animal P'nrtd and Kate Seed Sprouts Not Served. 'x 7-206.12 Rodent B,m Stations" t-,li . 7-20o.13 T2xckiug P,,wderS.Pest"J nirrl and 1 ( S,L i HC') Unopened Fcxul Package hot Re-served. '" f Monihxin;�° CONSUMER ADVISORY TIMEiTEMPERATURE CONTROLS 22 3-oO3.1 l Concumcr Advisory Posted for Conwmnption of 1 Animal F.xxds Phar ire R-1w.Undercooked of 16 Proper Cooking Temperatures for Not Otherwise Processed to Flimmate PHFs 1 z.40111A(1)(2) Eggs- IiiTi5Se,. Pathogens Eggs- to:mediate Service 145`1715sec> 3-302.13 I Pasteurized Eggs Substitute for Raw Shell 3-401.1 I(A)(-': Comuunutecl '=rish.n?cat::R:Carrie Eggs; Animals 155'1` 15 szo. 'r 3-46,1.11(,B;(!)(?) Polk and reef roast 130'F LI !r:;11" SPECIAL REQUIREMENTS 401.1 I(A".(') Fnntcsj hdcee ed k4cats- 155'F 15 590.0091 A)-(D) Violations of Section 590.009(A)-(D)in rec. : catering. mobile food, ternporary and 3-401.11(A)0) Fouluy,`h"iId game,,Stuticd PHI"s, residential kitchen operations should be iufting Cov:ai:ur:c rich.meat, deli ted under the appropriate sections Fouliry or Ratites-10'1-' 15 sec. ' above if related to foodborne illness 3-4:U 1.111C)(3) ,\'hole;Hustle, luir:ct Beef Sv aks interventions and risk factors. Other 1450r" ( 590.009 violations redaling to good retail 3401.12 Raw X,im:d Foods CnnkcA in i i practices should be debited under#^_9 - 6liclo-avc Ir.5"F' Special Requirenteuts. 3-401.: l(A)(U(h) A!! Other FI?Fs- 145'F I° sec. 17 Rehe'afing for Hot Holding VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 3-303.:7(:1)3(J) PH!-s, :65'P i5.tec.. ( (Items 23-31)) 3-403.111 B) Microtcave- 165"F 2 N mule Standing Gonial and non-rrito al vindatiomi, which do nor refute to tho Tann foodborne Wrres,•into ventinn.s and risk jo(torc lii.sied ahone, can he 1 ;-403.t I(C) Comm-arc)ell,,Prose;szd k7E F'wxl- ,(ward in the j)flmving seclions(if the Food Code and 105 CMR 140'1,t 500.000. 3-403.1 1(F) Remaining Unsliceo Portions of Beef i Item Good Retait Practices FC 59D.003.000 Roasts': 1 23. Management and Personnel FC-2 18 Proper Cooling of PRFs 24. rood and Food Protection FC- 3 004 _25. Equipment and Utensils FC -4 .005 '1--51)1.14(:) Cptflmg Cooxcd PFibz from 1-i(FF to Ito, Water,Plumhinq and Waste I FC-.9 .006 70`1`Within 2 Hours and From 70'F 27. Physical Facility FC-6 .007 to 41`F/45'1,"Within 4 He firs. " 23. Poisonous or Toxic Materials _ FC--7_ 008 3-.501.14(B) Coding PI-11's Made From .Ambient 2E. Special Requirements - 009 Temucn:u:rc Ingredients to 41'F/45'F 30. Other Within 4 Hours e ' Deno e'mica!itclr.In nn-tede,it 1911-Fond Cade or 16 01411,591114)0. CITY 4F SALEM (( BOARD OF HEALTH Establishment Nam�r2)l )f -A �?tm d( Date: Page: 03 of + Item Code -- - - - -- - - _ C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date 7 Efi I No. 3 Reference R-Red f (III �� PLEASE PRINT CLEARLY ( Verified 3 44 rt-? the q- 7 -,/j/l YA ,yP /./_�/?PZ li I I I j ani X&_ I I I _; I'� i I II I f i l I --i Discussion With(Person In Charg I Corrective Action Required: ❑ No �U Yes FI have read this report, have had the opportunity to ask questions and agree to correct all U Voluntary Compliance U Employee Restriction/ q 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 U Re-inspection Scheduled U Emergency Suspension noncompliance may result in, aily fines of twenty-five dollars or suspension/revocation of U Embargo U Emergency Closure your food permits U Voluntary Disposal ❑ Other: 3-501.14(C:) PHFs Recerved at Temperatures Violations Related to Foodborne lllne5R Interventions and Risk Aceordin;.t to law Couled to , Factors(items f-2?) (Cont) 41°17T45F Within 4 Hours 1 PROTECTION FROM CHEMICALS I 3-501 15 Coolim,Methods for PHF� f I j 19 PHF Hot and Cold Holding 13 Food or Color Additives 3"501.t6(B) Cold PIIF•s Maintained at of below 3-202'.1_) Additive: j 590.004(F) 410!45' F` 3-302.14 I'mu-coon btaoprotod Adtlihves* i 3-501,16(A) I lot PHrc Maintained at or abose 15 Poisonous or Toxic Substances 1401- 7-101.t I Ideotaying Information-Original i 3-501.16(A) Roasts Heid at or above OWE .. Containers" l 7 102.1 1 Common Conta.nern'" 2(f Time as a Public Health Control j 7-201.11 Separation- 3-501.19 Time as a Public Health ControP 7-202.I 1 Reotrict:ou,-Pceu•uc•z and (be' 590.0041 H) Variance Requirement 7--202.12 Conditions of(!a.' 7-20.3).1 i Tr,nic Connom'rd-Prehibim ns4, REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-204.11 Sanitizers Criteria-Chenticsls` j POPULATIONS(HSP) j 121 3) 3 SOLI I(A) Unpasteurized Pre-packaged Rases and 7-204.1"1 C':emicylc for R'ashuu-Produce,Cntrria" 7-204 11 Drerq,Agents. - t i Beverages with W ening 1.sbcls* .7ae:�ia` ; 7-205.11 lrri;deanalFondCnnt.rt. 1_t+bri_ants' 3-WI,!I(B) Use(if Pastemized Eggs* 7-20611 Restricted Car Pesticidee, 3-80i.II(D) Raw or Partially CookedAnimal Wxnd.nid ' Raw Seed Sprouls Not Served. l 7-2�Jb 1< Rodrni Bait Stations"' 3-g01.11(C) Unopened Food Package Net Re-served. ' I 7-206 13 Tata k:ng iS,wdre., Pest Couuol and ( - -- - IDiomtu[m�" CONSUMER ADVISORY TIMEIrEMPEH A7 URE CONTROLS 22 3-603,11 Consumer Advisory Posted for Consumption of t6 Proper Cooking T,tnperatures for I Animal Foods That are Raw, Undeicnoked or PHFs Not Otherwise Processed to Eliminate 3-401.1 L4(l)i3) F;»s- 75[,`1. 15 Rcc. i Pathnhens."' EO.rb✓e,:.1001 Eggs huntc:;ate Service 14SFUsecl ! 3-3022.13 Pasteurized Egg,Substitute for Raw Shell 3-401.11(A)(2) Cenmanute'd Fish, ft4%, <4 Gane j Eggs' Annals- 155 F 15 sec. 3-40I I i(B4(I)(7) PUA anti 6oef Roast I?0°F 121 irftvi j SPECIAL REQUIREMENTS 3-401.1 UA)(2) R::rte,s' injected Maas- 155"'F 15 590.001)(AMD) Violations of Section 590.009(A)-(D) in sic. '. catering, mobile food, temporary and 3-401.;i(A)(_) poultry,Wild Game,Stuffed PIfFs residential kitchen operations should he Siuffire C'or:JaEa;;Fah,Meat, debited under the appropriate sections j R�ultnv.+.Ratites-105'515 sac. '° above if related to foodborne illness 3a01.11,C)Q) R'hok-muscle, linnet Seef s+caks ( interventions and risk factors. Other 145`5 a, 590.009 violations relating to good retail 401.12 i2ae;Amm::' Fo,;da Conked in ,,,. practices should be debited under N29-- Microwave 165"F+ Special Requirements. j 3-401.11(Au I Nb) All 011ier PHFs- 145`5 15 see. j 17 Reheating for Hot 1iok1mg VIOLATIONS RcLATED TO GOOD RETAIL PRACTICES 3-403.11(A)&(D) PO=s 165`0 15 sac. '" (Items 23.30) 3-403.11'B) Microwave 165"F 2 Ma mie Standing I Ctilwal and non-critb al vtalaCt(Rus, which do nut relate m the Time" ( jnndburne illness ammo venlions and risk lin turd listed above, can be 3-403.1 I i C) Commerci lly Pi messed RPF.Food- ,food in the,tnlloti ing sections c�)'the Fond Cody and TOS CA4X 140'5 590.000. j 3-403.i1(P.) Reutain6i; UnsiicedPortions ofBeef Item Good Retail Practices FC 590.060 j RSts" 23. ( ManacemFnt and Personnel FC -2 .003 j 24 Food and Food Protection FC-3 004 18 I Propsr Coaling of PHF? ! 25 Equipment and Utensils FC-4 .005 - _ 3-501 14(A) Cooling Cooked PHFs from 1110`17to --- 2r Walfir,Plumbinq and Waste FC-5 .006 70-1-Within 2}lours and From 70'4' j 27. Physical Facility FC-6 007 to 41'545'F V,';thin 4 Hour!.. 28. Poisonous or Toxic Materials FC-1 .008 3-501 14(13) Cooling PHFs Made From Ambient 29 Special Requirements 009 j Tanpetature ingredients to 4 i`FT4:.q. j 30. 1 Other Within 4Ilo,trs:: IMr, 1-16-' < ' Oaxaca cnucal nem unhe Rdead T911 Fond Cede or 10`,Clilk 510000. "'MTti �,.^ �,ry,-.P°:. .w_w'^a.. - .+�"''il^rrR�lY'^^�..,c"Jnr..w.r'kX Jw/MFdir `'�'+Prp•rd ...S r. .� .. 'I Massa�hugetts Departme1nt of Public Health Salem Board of Health Division of Food and Drugs i 120 Washington Street,4'h Floor 9 Salem, MA 01970-3523 FOOD ESTABLISHMENT INSPECTION REPORT Tel. (978) 741-1800 Fax (978) 745-0343 Name Dat ' f Type of Ooeration(s) Type of Insoection nn � )( ' / ( I ood Service Aoutine ,..s. T��-T 1 i '.._ Address r 1 i�aC�A Ri el / LJ Retail �Pr Previous Inspection Re-inspection A WWILevel E] Residential Kitchen Previous Inspection Telephone Z lls �/� ,� W y ❑ Mobile Date: �a/I ,`�1v - -`f"':; 3 ❑ Temporary ❑ Pre-operatioTi Owner E HACCP YM try ln�11 ElCaterer ED Suspect Illness Person in Charge rPIC) 7 Time ❑ Bed&Breakfast ❑❑ HGeneral ACCP Complaint In: a inspector Out"P� � Out s(=�yj Permit No. EI Other Each violation cFiecket5 requires an explanation on the narrative page(s) and a citation of specific provision(s)violated. Non-compliance with: Violations Related to Foodborne Illness Interventions and Risk Factors Anti-Choking Tobacco Violations marked may pose an imminent health hazard and require immediate corrective( 590.009(E) ❑ 590.009(F) ❑ action as determined by the Board of Health. FOOD PROTECTION MANAGEMENT ❑ 12. Prevention of Contamination from Hands ❑ 1. PIC Assigned/Knowledgeable/Duties ❑ 13. Handwash Facilities , EMPLOYEE HEALTH 5 _ PROTECTION FROM CHEMICALS ' ❑ 2. Reporting of Diseases by Food Employee and PIC -' t [114.Approved Food or Color Additives ❑ 3. Personnel with Infections Restricted/Excluded ) ❑ 15.Toxic Chemicals ,'FOOD FROM APPROVED SOURCE E] 4. Food and Water from Approved Siource TIME/iEMPERATUREOONTROLS(Potentially Hazardous Foods) 5 Receiving/Condition ❑ 16. Cooking Temperatures UJ 6. Tags/Records/Accuracy of Ingredient Statements ❑ 17. Reheating ❑ 7. Conformance with Approved Procedures/HACCP Plans ❑ 18•Cooling PROTECTION FROM CONTAMINATIONY J 119. Hot and Cold Holding ❑ 8. Separation/Segregation/Protection ❑ 20.Time As a Public Health Control Food Contact Surfaces Cleaning and Sanitizing REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) EI 21. Food and Food Preparation for HSP 10. Proper Adequate Handwashing 1kl,. Good Hygienic Practices CONSUMER ADVISORY ❑ 22. Posting of Consumer Advisories Violations Related to Good Retail Practices Number of Violated Provisions Related Critical (C),violations marked must be corrected To Foodborne Illnesses Interventions immediately or within 10 days as determined by the Board and Risk Factors(Items 1-22): of Health. Non-critical (N)violations must be corrected Official Order for Correction: Based on an inspection immediately or within 90 days as determined by the Board today,the items checked indicate violations of 105 CMR of Health. 590.000/federal Food Code. This report, when signed below C N by a Board of Health member or its agent constitutes an 24. Food and Food Protection (FC-3)(590.00 4) 23. Management and Personnel (FC-2)(590.0 order of the Board of Health. Failure to correct violations 25. Equipment and Utensils' (FC-4)(590.005) cited in this report may result in suspension or revocation of 26. Water, Plumbing and Waste (Fc-5)(550.005) the food establishment permit and cessation of food establishment operations. If aggrieved by this order, you'' " 27. Physical Facility (FC-6)(590.007) have a right to a hearing. Your request must be in writing 28. Poisonous or Toxic Materials (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: 2/I PIC's Signature: Prmt: �� o �/� `' 2 I Pag"b jof5Pages i Violations Related to Foodborne Illness Interventions and Risk Factors(items 1-22) PROTECTION FROM CONTAMINATION FOOD PROTECTION MANAGEMENT 8 ( Cross-contamination I 1 590.003(A) Assignment of Responsibility* ( ( 3-302.11(A)(1) Raw Animal Foods Separated from 590.003(B) Demonstration of Knowledge* I Cooked and RTE Foods* 2-103.11 Person in charge-duties Contamination from Raw Ingredients - 3-302.11(A)(2) Raw Annual Foods Separated from Each EMPLOvEE HEALTH Other` J 2 590.003(C) Responsibility of the person in charge to I Contamination from the Environment require reporting by food employees and j 3-302.1 I(A) Food Protection- - applicants* 3-302,15 Washing Fruits and Vegetables 590.003(F) Responsibility Of A Food Employee Or An 3-304.11 Fopil Contact with Eqtupment and Applicant To Report To The Person In Utensils* J Charge* Contamination from the Consumer 590.003(6) Reporting by Person in Charge* I 13-306.14(A)(B) Returned Food and Re•service of Food* J 3 590.003(D) Exclusions and Restrictions* I Disposition of Adulterated or Contaminated 590.00 YE) Removal of Exclusions and Restrictions I ( Food f 3-m1.1I Discarding or Reconditioning Unsafe FOOD FROM APPROVED SOURCE Food* 1 i 4 Food and Water From Regulated Sources 19 Food Contact Surfaces I 590.004(A-B) Compliance with Food Law* ( 4-501.11 I Manual Warewashing-Hot Water 13-201.12 Food in a Hermetically Scaled Container* I Sanitization Temperatures* l 3 201.13 Fluid Milk and Milk Products* I 14-SUI.I 12 Mechanical Warewashina Hot Water 3-202.13 Shell Eggs` Sanitization Temperatures* l 3-202.14 I Eggs and Milk Products.Pasteurized* i 4-5t)1. Chemical Sanitir2tion-temp.,pH, 3-202.16 1 Ice Made From Potable Drinking Water* concentration and hardness. * - 5-101.11 I Drinking Water from an Approved System' 4-601.1 1(A) Equipment Food Contact Surfaces and I 590,006(A) Bottled Drinking Water* I Utensils Clean' l 590.006(6) Water Meets Standards in 310 CMR 22.0* I 4-602.11 Cleaning Frequency of Equipment Food- Contact Surfaces and Utensils` j Shellfish and Fish Froman Approved Source I 4-702.11 Frequency of Sanitization of Utensils and 3-201.14 Fish and Recreationally Caught Molluscan Shellfish* I Food Contact Surfaces of Equipment• 4-703.11 Methods of Sanitization-Ifot Water and 3-201.15 Molluscan Shellfish from NSSP Listed I Chemical* sources* 1 10 1 Proper,Adequate Handwashing Game and Wild Mushrooms Approved by Regulatory Authority 2-301.11 Clean Condition-Hands and Arms* I 3-202.18 Shellstock Identification Present" I 12-301.12 Cleaning Procedure* 590.004(C) Wild Mushrooms* I i 2-301.14 When to Wash* 13-201.17 Game Animals* ( 11 Good Hygienic Practices I 5 I Receiving/Condition 2401.11 Eating.Drinking or Using Tobacco* J 3-202.11 ( PFIFs Received at Proper Temperatures* I 12`1'01.12 Discharges From the Eyes, Nose and 3-202.15 ( Package httegrity* I Mouth* 3-101.11 ( Food Safe and Unadulterated* I 3-301.12 I Preventing Contamination When Tasting* 6 Togs/Records:Shellstock ( 12 Prevention of Contamination from Hands 3-202.18 Shellstock Identification * 590.0fi Preventing Contamination from 3-203.12 Shellstock Identification Maintained" Employees* Tags/Records:Fish Products I 113 ( Handwash Facilities 3402.11 Parasite Destruction* I ( Conveniently Located and Accessible , I 3-402.12 Records.Creation and Retention* ( 15-203.11 I Numbers and Capacities* - 590.004(1) Labeling of Ingredients' 1 15-204.11 I Location and Placement* 7 Conformance with Approved Procedures 5-205.11 j Accessibility,Operation and Maintenance /HACCP Plans I I Supplied with Soap and Hand Drying 3-50^2.11 Specialized Processing Methods* I Devices 13-502.12 Reduced oxygen packaging.criteria* ( 16-301.11 ( Handwashine Cleanser,Availability 18-103.12 Conformance with Approved Procedures* I 16-301.12 Hand Drying Provision 9 Denotes critical item ll in the federal 99 Pcxxl Code of IIb CMR S J0.(N)0. r * CITY OF SALEM / i BOARD OF HEALTH Establishment Nameft( r�')r -� �O✓/'\ Date: r t Page: -:Z:L of Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date t No. Reference R—Red ItemVerified / PLEASE PRINT CLEARLY l ,� (�Ja„J_ IJP I�Pir�s -�orcctcc /t l�/ C�n�n, n? �7n'rnv :lc�-�I n d N� r - ! 1�e�, �r 1 .✓t T t^A C �n_9� �TY�., _\�.YP�.�- /J� 1 a k)r cvy,4w- c2ln 'Z�lr"U Vn_(t(—c1r asS IdCf�►e(� Czer, on vejx” t � J \ X00 VC'- FiA(��1,na oBlr �e wv�g Cin co�(n ilk c� c.� A-)» ICca,yO r.>i�r � � . ,n.. -4 4'ts� r,�o✓I s7or�l� � to c i. 5v r Com " A (s,5 rv� �r k - _0 1,ku Un 11 / t IL — k ��, f '- G O/t S,�= �2 c 9✓ �lU 6vI..S Discussion With Person in Ch ge: Corrective Action Required: I El No Yes / ept I h ❑ Voluntary Compliance ❑ Employee Restriction have read this report, have had the opportunity to ask questions and agree to correct all Exclusion Violations before the next inspection, to observe all conditions as described, and to e-Inspection Scheduled ❑ Emergency Suspension comply with all mandates of the Mass/Federal Food Code. I understand that t noncompliance may result in daily fines of twenty y--fivecdolllaars-or suspension/revocation of ❑ Embargo ❑ Emergency Closure your food permit. p ❑ VoluntaryDisposal ❑ Other: 3-51j!. 4(C) PRFs Received at Violations litelotr,dto Foodborrco fflnesshrL-rvrf',-,p-and R:-;i. According to Lrv, Cooled to Factors(items 1-22) (Cont.) 4 I'F/45'F Within 4 Hours. PROTECTION FROM CI-'FM;CAI_G '501 15 Coul n7 Methods for PHF. 14 .aoodorcz'iarpcic;lives 19 PHF Hot and Cold Holding 3-202.12 Additivc<r501.16(_R) 1 Cold PlIFs Maintained at or below 1102.14 ProulLoolit froto lfizwrro�ed s- 590.0014F) 41'f45°Fu 3-.501.!6(A) Hot PHR; Maintained at or above 15 Pornous rl,'rox�e 7-101.11 Idewif3ine Orig;oal ear, al3-501.16(A) Roasts Held at or above 130°F. 20 1 Time as a Public Health Control 7-102,11 Comanial Nquc- working Conijinets 7-201.11 S,-l)'jraL�!,JR_S�uot� i 501,19 Finue as a Public Health Control* 7-202,11 Restictiort-Pres,nce,,md Use' 590.OW,(H) 'Variance Requirement 7-2C.^.7 4' Conditions oiLee' REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-203 11 Tom,Con t._,;Ter= -Pnnj.,;lon.,,,* POPULATIONS(HSP}7-204.1 i Sanitizeis. 7-201 17 (Ilemic',is fix Produce, Cri:entill 21 1 11(;1) Unpastew izod Pre-packaged Juices and Bcv�iailff with Warnim, lalbcls� 7-204.14 rrs i!�le Agvtrlc, Cniet,:.' 3-ii(A.H(B) Use of'Pasteurized Elites' 7 205.11 In'cidenial FoodCcliva�, Lubrwari' 7-206.11 ReArt-led`Js_ "tmii 1�*".cciterlaLl -801.11(D) Raw or Partially CookedAninial Food and 7-206.12 Bait Stations': Raw Seed Bally tts Not Served. 7-206.13 Tnwking Pvs;:Control and " 3-801.1](C) Unopened Food PackaLc Not Re-serwel , .1I1 tailoring* CONSUMER ADVISORY TIMEfTEMPERArURE CONTROLS 22 3 603,1 i Consumer Advisory Posted for Consumption of 16 Proper Cooking Temperatures for Animal Food,11at are Raw. Undercooked or PHFa Not OdicrMs,Processed to Eliminate 3-10;.1;A(J)U) Eggs jlf !jSoc. Patho-'Cn,, , Flltl 1a,POOF Eggs hurocciiateSevvic, 1451FI,4scc� 3302.13 Pasteurized Eggs Substitute for Raw Shell 3-401.1 IfA)(2, Comminuted Fish, Mcqrs&(1arne Eggs Animate, 155'F Li sec. 11 3-401.11(B):,i)t2) Pork and Bccframst- 130hT I?I mini SPECIAL REQUIREMENTS 3-401.11(A)(2) Rattles. InjoLted Nf cata- 15;'F 15 590,009W41[t) Violations ol'Section 590.009(A)-i'Di in sec• catering, mobile food,temporary and 3-401.11(A)(3) Poultry, WP1d Game, Stuffed PHFs. residential kitchen operations should be Sleuting Cniltatrung Fish, blear, debited under theappropiriare sections il� Rarilhc-165-F Li we. above if related to foodborne illness,'llillry cx !W)(3) Intact Beet Steaks 1450F interventions and risk ('actors. Other 590.009 violations relatiril,to good retail 3401 12 Raw Animal Fco&Coot,d ul a i practices should be debited under#29 - Miciowave 165'F* . Special R6ZIttiroluctits, 3 40!.1!(A)(])(b) All (Mler PHFs- 14"l; i';eec, 17 Reheating for Hot Holding VIOLATIONS RtLATFD TO GOOD RETAIL PRACTICES 3-403.11(4)&.(D) Phil b 105`--15 se-. (Items 23-30) 3-403.11($) N1.,;croNL ave- 165"F2 Mature Standim-, C-tilicill and non-critical violations, which(11)not relate to the Tulle filwdborne illness interventioms and riskfig(rurs lisledabove, eon be 3-403.1 !(C) Cow;nanrcially Pox eased RTL Food- I jound in the b4h,"wig vertions of the Food Code and 105 C.49R 140-F;* 590.000. 3-403A I i F) Renaunina Unslit-cPortions ol'Reei Item Good Retail Practices FC 1 590.000 23. Manacpatenn and Personnel FC--2 .003 18 Propel CooirC of PHFc, 24 Food and Food Protection FC-3 1 3-SOLI4(A) Cooked PHI-s from 140'Flo 25 _____Equ�iment and Utensils FC 4 005 70'F')` 'A"l ;n 2 ilouts,,nd From 70"F 1 26 Ware r Plumbincl and Waste FC-8 .016 2,7. Plhysirai�Facility FC-6 007 li to 11'F/457 Within 4 Hours. t m. Poisonous or Toxic Materials FC-7 ON 3-50'.140i) Cooling,PI IFs Made Front Ambient 2-9, 1 Special Requirements I 009 Teirpeiatune filgiedivnN w 4;'F/45`F 30. Other ViAhin 4 loth,L ...... .. Denotes untical ilown the fiedelal 1944 R,okl C.,d:or 105 Cktk 51):i ofx). CITY OF SALEM . i BOARD OF HEALTH Establishment Name: Date: Page:Page: of TC._ Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OP CORRECTION Date ` No. Reference R-Red Item - Verified rL n _ s PLEASE PRINT CLEARLY 1 11 SIG r11 r-�1 �ir+./� ��.9 l �� o i'J�l.✓t0� ' r he L} - i-. Abd- ,y(>.�1�„/1 ! ,� �r h�I>_ _j [N iwTn iw,•nnrr .nr_ . ( l� CG)3� v1 T. � c�” .► o Chx k�� '�' �� _1� �[0AADu C, V11) �j�0-6 A4,� n r��J�j ��,�, f_ II U AA011f , jr,�,s c�U_�,C ( CL��L LS It N 5-48^ ✓3c3 9S, r C'/-PC" G i- I0+L 4;l ��i t r. l A all A Ie T� I � c1n ` ,j [Ili I✓/_ r71� `, Q c) (ir n Pti[A/�ro"s ( R fln. c kc-- M rAa41(62- I ,1Cert-- Discussion With(Person in Charge: Corrective Action Required: I ❑ ,No o Yes I have read this report, have had the opportunity to ask questions and agree to correct all ❑ oluntary Compliance ❑ Employee Restriction/ I violations before the neid inspection, to observe all conditions as described, and to Exclusion P Re-inspection Scheduled Li Suspension comply with all mandates of the Mass/Federal Food Code. I understand that noncompliance may result in daily fines of twenty-fivedo�r'suspension/revocation of ❑ Embargo ❑ Emergency Closure _ your food permit. �L� JJJ,(JO/l �� ❑ Voluntary Disposal ❑ Other: r 3-501,1 'Xi PHFs Rziared a'Teniper.,turzs Violations Related to Foadhorne Illness ante,wrti ons and Rsk Ac�oiding to fain Cool:d to , Factors(Bents r-22) (Cont.) -41^F/45'F W'ahin-` Haws. 'f 3- PROTECTION FROM CHEM1CAi..S -` 15 C .01. aroling Alethtxfi for Ptit:, • j 14 j Food cr Color Additives ( j 19 PHF Hot and Cold Holding j j 3-501.16(B I Cold Ff-1Fs Maintained at of below 3-20112 .additfv,:' i90.0i14(F) 4l'!45' F` 1 ; ;172.14 Ptotr.hoo Lout Unapproved AddiGreer j j j 3-501 1614) Hot Pf-IFs Y1ahro:med at or above IS Poisonous or Toxic Substances 140-'F � Idrnnh'mg Infonn.nion-thigmal ` 3-501 16(A) Rnnsts Held at or above 130'F ';7,1(12.11 C9m;con Namr - Workin;r ConCtin:r." j ( 2@ Time as a Public Health Contro; 3-501.19 Time as a Pub i, Health r'onreolx j .�: 7-$01.11 Sepa:.a:un-Star xete'' j j 590.004(H) Variance kequiremem j r 7-202 ;I R;<:rrir:ion-Pr scnce.Lad !Jse' j 7-202.1:2 Crnd+tion;of TTce' , 7-203 11 "i us;.Conm:ner:; -i r(u;ih;,j,y,7Ss; I REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) ?204.11 I Sanitizers.Cnter!=-C'hemicsis' C ( 1 21 3-801.!1(A) ( Unpasicurixed Pct-pacl:agrd Junes and 7:'_'0.1.12 Ci:e:heal,6o iN,a,huw Produce,Criteria"" I I Beverages with Warning Labels^ t j 7-204A4 Dr,ing Agents.Criteria" 13-801.11(B i Use of Pasteur ized EL-s- 7-205.i 1 Incidental Food CUni-�ct. Lubiwarlc'- j • r' 7-206 11 1 Rest;ictcd Use Pesoodes.Crfteria'r 3-801,I I(D) I Raw or Partially Cooked Amur:I Fexxi and Served. 7-2.0A.12 koic::! Bait Stations" Raw Sced Sprouts tint Se j 3 801.11(C) j Unopened Fotd Package Not Re-served. " 206,1 i i Ti:i,i mt Poo dar,Pest Control and i }iotiibJrin�r CONSUMER ADVISORY TIMIEfTEMPE:RATURE CONTROLS 22 3-603 I Consumer Advisory Posted for ndcrco,pkedi of 16 Proper Cooking Temperatures for I Animal er oke Pr tt arc Rau-, Un in a:o��ked is PHFs Not Otlterwi:;e Processed G+E1itn)nate Pathosens.*Ererna r:r;aan 3-401.11 A(1)(?) Fggs- i5-;'F 15 Sec. Ergs-hare.hate Service 145'F IJ!.--C. 3-302.13 Pasteurized Eggs Substitute fit Raw Shril 3-101.11;A)Q) Ce,runnnted Fist:.IIlcata lY Game j Eggst Ani*nals- I55"F 15 sea ' ! 1 SPECIAL REQUIREMENTSi-=i01.11(B:(I){2) Pu;kanuiircfRoast - t3U'F121nfut� j ( 3-40111(4){_'; Rnrrnts. injected N[cats- 155'F IS 590.009(A)-(D) Violations o(�Section i90.009i'A) (U} m( , Cec j catering, mobile food,temporary and 3-401.11(A)(3) ^ochry,Wad Game,Stuffed PiJTs. residential kitchen operations should be Si-fling Containinz Fish,Meat, debited under the appropriate sccnnn< Poultry ar Ratite;-1o5'F 15 sec. ^ above if rciamd to foodborne illness 3-0 lS7iole-n:us.le,Intact Bre{Steaks interventions and risk I::tors. Other s45-'° 590.009 violations relating to gond retail 3-401J2 R.rh An:oml Food;Corked in i j practices should be dcbiwd unde-h'29 -- Microwa,e 105`F° Special Requirements. 3401! I(,%)(1)(h) All Other PHFs - 145'14 15 wc. " j 17 j Reheating for Hot Holding VIOLATIONS RELATED TO GOOD RETAIL PRACTICES j 3-403.i t lA)d:(D) PITF>i 65'F 15 sec. T j (items 23-30) j i 403.11(B) Microuavc- 165"F 2 Minute Standing Cranial and nun-ciffical viulatanra, which du nut relate to th< 1 T:mr" foodborne i(h:rrs inter ventreins and,ii.r{jaw tars iisuzl uGra•r, ran be 3-40-,.]1(C) Commercialh Peoessed RTF Food- ( ,found in the following sections,) the Feud Coale and 105("Vii i -WF" ( 59o.noo. ( 3-403.11(x) Rentau:iag Unshced Portions of Beef I Item Good Retail Practices FC590.000-- , 'Rct,c,ts•.. 23. Manapement and Personnel FC-2 1 .003 1g Proper Cooling of PHFs j 24 Food and Food Protection FC-3 1 00,1 1 25. Equipment and Utensils FC-4 _.005 +b)l !4(11) .Caving Choked Pt-tfrs from 140`'F to 26 Water,Piumbinq and Wa=tc FC -5 006 . 70"1`Within 2 1lour5 and From 70'F 27. Pbvsical Facility FC-6 I .007 I 41`F145'1'Within 4 Hours. 28. Poisonous of Toxic Mate:ials FC -7 .002 i t 3-501. 40P.) Conlin;of IFs Marie Front Ambient 29, Special Hequuemenk 009 Temperature ingredients to 4"F/45`F 30, Other Within I Hours* ,.•na rr.n.,;rea-Nat !)cloblc""tical;IC!,m:hr icderal 1499 Futxl Code or 105 CMR 590 000. CITY OF SALEM BOARD OF HEALTH - Establishment Name: Q= ,-o Date: /i)G Page: of .1T Item Code C-Critical nem DESCRIPTION OF VIOLATION/PLAN OF CORRECTIONDate No. Reference R—Red Item � Verified PLEASE PRINT CLEARLY s r'�, < ,tom t 4—r-�7 a✓ N. [ _ �I, �� -1�,� sr 1 ti A - I w ! 19'l Cf I, ✓bt/77(,�, lc -t- C1/)Gn GJAfI G ,, , � SCr, i <,,, C, �C�G(' c -1'x�C>'Cm-Ca .0_ O Discussion With Person in Charge: Corrective Action Required: I ❑ . No ; I have read this report, have had the opportunity to ask questions and agree to correct all ❑ Voluntary Compliance ❑ Employee Restrictiori,7 Violations before the next inspection, to observe all conditions as described, and to Exclusion iii E _. Re-inspection Scheduled ❑ Emergency Suspension comply with all mandates oftheMass/Federal Food Code: I understand that notncompliance may result in daily fines of,twennty-five dollars or suspension/revocation of LI Embargo ❑ - Emergency Closure: your-food permit. i � ✓ Ail; ElVoluntary Disposal ❑ Other: `4 Terrr� Fs R�cened at 1, r,itures Violations Rola-ed to Foodborne 111noss Intervenlions and MeALaw cot,�,tj t, Factors(items 1-22,1 (Cont] 4 1`F/45r P 07itto� 1 Hour:;. .` Cl r;,t %lot i,oci� "'r PH Qt; PROTECTION FROM CHFUCALS -tu ; t, Food or Color Addiflves t 14 PW-Hot and C_,!O,tlo!�:mg -,4 3-50,: lf,(Bli :Oo; Vlli�s Nlt:�,;_,i,,ed at o: h+lov, ;_202.12 Addilp.et, 302,14 P,ritcrtion from Unao.,-nYved Addit;ver'.i, ;-SO I INA) 1 lot FIIFs Nlaintainecl a; ,,abm,e 15 Poisonous or Toxic Substances He^d ia:.or tibu�e 130'F. 1, 7-102 11 Cortitnttri Nanie-W01kiall Containvrst --,s a Public Hpaith Ccnlrcl 5111. n Tifflif in, ::Po'blic 1-jealth Control* "'-?01.11 Separation- Snaot,t� 7-20' 11 R«triction-Presence,at'd Ub& 7-202.12 RECUMEMFN7 A FOR MWILY SUSCEPTIBLE 1 7-203 11 -1 oij, Contro-tor;Pridnbiticw* POPUL AT 10NS 1FISM 7-20,11.11 S",nidzers, Cr;teAn-chcilo;,&� 2! 3 Xi A 1 W i Unp,,sloun,ud Prc-raclvag�"Juices and '04.12 Chemicals for Wa&i,t,g 1'r-1,ducc Cnlei;j'' 1 "overa,,e6 oath Warning Labels' 7-21)4.>.4 Drying,agents. i-80!.11;}31 Use of:'.arae u,it 7-205.11 1 (nddenod Firs]Contact. Lobinarils 7-106A 1 Restricted Use Pe�ficidct;,Criteria"` J:,D) Ret,� cl P;Aiall" Aoin,,I� Food ar! _,?,;Scvd -r-206.!2 R0dCM Ran SLIU10113,* 5-8:)1.111"'j, Unrip.-ned Fowl fa_"Kag� No! Ra-served. '' 7-20o.:'i Tricking Powders,Pest Control .:ad CONSUMUl ADVISORY 21 --6'53.11 Coitsion,'r 1'1111;,ov,Posn,,; i�,r Consumption of TIME)TEMPERAT URE CONTROLS 'h 16 Proper Cooking Teaiperaitares for Ajiijn�A at arc Raw, IJ,id(,rc(u,ked o� PHFs Nol hoces,--d to 0iiiiinare Patho ncns , Ell"110 1-401.1 IA(I n'2) F,zWs- 155ttF 15 Sei,. !45115i,,,,c� 3-302.!j Ilastouvai Fgg� Suestut:,le J'a Pav, Srt:ll 3-401 11(A`(2) Comminuted Fish, Wats&Ganic Egg-M Antauds- 155'F 15 sec. 2' 1 tA.] I(H)(1)(2) Fork and Br Pozist- IMF 121 min" 4EU1.11 REM-NTS SPECIAL - t1j I :;90,0cMAi (D) Vimaiiow;ol S_,ion 590.009i.k)-(D)in I I(A)( ) Patff�S ln_i�ctcd Mcat�- 155'F � ice. catering, feo , ternp)vary and -110 1.t 1(A)(3) Poultry W;id Gamo,Sioff,.d 11141�ii, P_Mderiiud lou-1ic-n operations should be Stuffing Containing Fish.Neat, debited xadet'i!iv appropriate, sections Poultry of Ratites-165°F 15 sec. -- I ifivlatixi to foodlovn c illness 3--101.1110(3) Whole-muscle, Intact Beef Steaks I dritet v;,:,tior,s and risk factor. 0dier 145°F iolabons reWin"11) "(10d rc+,ail 3-401.1-, Rats Aminal F(ioda Cooked in a Id jc�,ill�;iOu - � c; kinder 1129- Micioti,avt 165"F Special Rolnirtifneffis. 3401.!I(A)(;:)(b) All Other PHFs - 145'F 15 sec. 17 Reheating ter Hot Holding j VIOLATIONS RELATED TO GOnt;RETAIL PRACTICES 3-403.11(A)&iD) PH-1.7s !W17 15 scc. Utene;23- 3-403.111(B) Mictinuve- 165'F 2 Minute Standnoe I ("'ifical vl:a"017,'ific,:1 ivr,,",do tv, w1an,to Ihi, Time"' Jmaburor 11h;eys W'd UX iiictonc i;sn,,!obm,e (em bit 3-403.;1(C) Coxutrtcrciallp Pi tvnsecl RTE Food- rfnl:ld at the 'itcy...11". Of the Ftg),j cild"r)s ('41R 140"FT 57u.000, 3-403.!1(E) Rrintanow Unqhced P,_,rtions of Bzef 1 --ties; Gocirt Retplit Practices I:C* 590.000 Roosts"' -3. f4hila4,Ticin and Personna! FC--2 .003 24. Fo.v as-;r-off]Ptoi�cfican FC 11 .004 18 Proper Cooling of PHFs 2 . Equipment:and utensils FC-4 .005 3-501 14tA) Cooline Cookrd PliFis from 1.40 F It) I't _6 Wait!; Plu^bintgailfiasio K_-5 005 I 70'J"Within 2 Hours and Froi)00'F t i ?7. rnrysicai Fav:;1it-; Fc. -n 007 to'41 'F/45'F Within 4 Hours. - t 28 'ODE Pdsno rit,s or :otic FC; 3-;01.14(B) Cooling Pffs Made Fcom Aibiew Soo,ia Rojvcmvr;s ing Temperature higredients to I`17/45"F313. ottvo[ Within 4l-tour" Denotes criticai item ii the foferal 1994 Food Co.teor 11!5{`[11 12 59(1;m0. µ : CITY OF SALEM BOARD OF HEALTH / Establishment Name: ( lin A/V--- lC�� ,vtc{ Date: Nei/L7G Page: of Items Code C-Critical Item - DESCRIPTION OF VIOLATION r PLAN OF CORRECTION Date No. a Reference R-Red Item ,- t Verified PLEASE PRINT LCL�E4(R�LY S n AJ cA o Y��iY,Cj Aq(A V 1 1/t o I n i-r(Y�AL. •- <E,r�aa. nIv / , lcer-lv,.el-!- ill IN s _ la- 4 h^r7- b i.J �_ Ola �'19{— Git-Y C�✓t�� C D �/�-�.P/ ci iP. .Q,Or.'1 ' f icy.-, f- te3f2- �=7o y,r r Juno -^Cfoc e7,^c,f- �. Yyly-.� �g. h �} 1. 146- tea`- 1.-baoo: /�c��s�i �c2 J�� +-.JZ 1� V IAJ- qO_ ✓b J �1.�2 1 n'r \L (Y. �A r/1'1'![ /h ✓d ITrIt/Q `_i �. r I 1 I � 0 r-1 C A ttn SP , .l❑/ W 5 Q� / !7 ?� I ✓ ' -I t Discussion With Person in Charge: -1 . I Corrective Action Required: I ❑ No I Yes I have read this report, have had the opportunity to ask questions and agree to correct all ❑ Voluntary Compliance ❑ Employee Restriction/ Violations before the next inspection, to observe all conditions as described, and to Exclusion P Re-inspection Scheduled ❑ Emergency Suspension i comply with all mandates of the Mass/Federal'Food Code: I understand that nopcompliance may result in daily fines of tw_e,nty-five dollars or suspension/revocation of a Embargo LI Emergency Closure " { your food permit. A f°LA T., ,f�/7ti /f ^z- ❑ Voluntary Disposal ❑ Other: s. {}:_iy;C) P'-iFs Rec,,md.,t temperatures Violations Related to Foodborne Illness Interventions and Risk 'According h>Iain Cooled it, Factors(items 1-22) (Cont.) =,;'F/45'F Within 4 Homs. ' PROTECTION FROM CHEMICALS 501 1 i Cooling ivicthick for PHFs ( 19 PHF Hot and Cold Holding lA Fond or Calor Additives j 3-501,1OfB) Cold PIIFs Maiutamcd at of below 3-202.12 Additkes" 590.004(F' -11':'-i5` !-. 3-302.14 Protection tram IT approved Additives" � 3-50i.i N'A) .' HiM lot PHF> a ninined at ur nhove j 1$ Poisonous or Toxic Substances %-i 01.11 identifying lntonn:aun--Chi „incl 161AKoutt;I{ciri at or above 1,0'1 ` Containers' 7-102.11 Common Name-Working Container,* 1 2f! � i T,ine as a Pub:ic Health Control 7-201.11 Scnaration-Stnraas, ( i 3-50`.19 i Ton, as, aP-HicHealthCuiitxol* j - -- - t ' ( 500.0114(11) Vrri:mce R,quiteuicin j 7-20_t 11 Restriction-PresUse and e 7-202.12 Conditions of Use'" 7-203 11 ToxicContainers - Pruhihuions' REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-204.11 Sanitizers,Criteria-Chemicals* POPULATIONS{HSP) 7-20-1,12 Chemicals for Washing Produce,Criteria* ( 121 i 3-S0LI1(A) Unpasteurizxi Pr:-packaged Juices and Bc+C:at•es with 1t amino I;,bcls^ 7 204.14 Draing Agents.Criteria, 3-901,i l(Li) U;:e of Ps=tear ize;i Eggs^ 7-205.11 buadanal Food Contact. Lubrieant3x j I ;-80LI I{D) Raw:,F Pa.na11•.Cracked Anun:a Food and 7-206.11 Restricted Ilse Pesticides.Criteria" j 7-206 12 Rodent Bait Stations" i=+:4'c'`=ed ittum;s fio:Served " I I 7-206 13 'Frocking Powder:,Pest Control and 1 3-801.11(0) ilnup�ned Nxtd Package NO Re-served Monitoring^ CONSUMER ADVISORY TIMEIfEMPERATURE CONTROLS 22 3-603 11 Consumer As,aan Riuzd fur Consumption of 16 Proper Cooking Temperatures for ( Animal Fcmds'!hat are Raw.Uttdcreooked or PHFs Not Otherwise Proces,ed to Elhoejiak 3-•101.1 IA(I 1(2) Eggs- 155"1-15 Sec Eegs-Immediate Service 145`Fl5sec, i 3-303.13 Paateu-izzd EL;):;Substitute for Raw Shell 3-401.11(A)(2) Comminuted Fish,Meats 8c Gauie Animals- 155T 15 sec. t f SPECIAL REQUIREMENTS l(B)(1)(2) Pork and Beef Roast- 130"1- 121 linin* ( 401.11(A)(2+ Ratites, Injected Meats- 155"F 15 590.009(A)-(0) Violations of Section 590.009(A)-(D) In' ec, - catering, mobile food,tetriPorary and 1 3-401.1 1(A)(.) Poultry,Wild Game, Stuffed PHFs, ( iesidcr al kitchen opei;irons should be Stu(futg Containing Fish, Meat, dehited ander a:e appropriate.tie(.Dons Poultryor Ratites-165017 15 sec. " d'unvN if reiatcd to foodhonte illness 3-401.1 t(C)(3) Whole-muscle,Intact Berl'Steaks irder,emtons and tisk factors. Other 145'F : I :190.;)09 ,io!ations relating to good retail 3-401.12 Raw Animal Foods Conked in a practice, should be debited under#29- Micruwave 165"F* Spee:,ti Reata:'eu,ents. 3401.11(A)(1)ih1 All Other PHF� - 145F 15 sec j 17 j Reheating for Hot Holding ( VIOLATIONS RcLATED TO GODO RETAIL PRACTICES 3-403.11(A)&(D) j PHFs I65'F 15 sec. "; j (Items 23-30) 3-403.11(B) Microwave- 165' P'2 Minute Standing Critical and lion-(rincal vio?aomm ivlw h do nor relate to the 'rime" krodhom,d1ness nn(menti,ms and i i.sk fa(tw'.v listed above, pin be 3"403.11(C) Commercially Processed RTE F+wd- I bo:urd in the fothm iag sections of the Food Cede and 105 CNR 140`Ft `90.000. 3,403 11(E) Rentainhou Unshed Portions of Buef I !tern Good Retail Practices FC 590.000 R(i;tsis* V 1 23. Management and Personnel FC--2 .003 IR Proper Cooling of PHFs 24 Faa)arc Foo,famtectior. FC-3 .004 25. Eq!rhmern and iitersils F0- ^- '001- 3-501 14(,1) Cool ngC'ookcdPH1-s from 140'F to : 26. Water Pluinbinoand' lmte FC-5 ,006 70'F Within 2 Hours and Front 10'1- 1 21 Phvsiral FacilAv FC-6 .007 to 41"F/4501-Within 4 Huw s. " 1 28 Poisonous or Toxt_ Materials FC -7 .008 3-SOI.14(B) Cooling PHFs Made Front Ambient IF_29 Special Requirements 009 TernpetantreIngredients tu,li"F/.}i'1- 30. Other ----_-_� Within 41 lours* snniia-ar d.. 4 Denotes critical dem in the fedeal 1909 Food Code or 105 CNIR 590 000. CITY OF SALEM BOARD OF HEALTH f Establishment-,Name: Date: 029/ J(o Page: of Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date No. Reference R-Red ItemVerified 11 -- - PLEAS'PRINT CLEARLY '�,,^ Lo sAZ96,1 CSS J r o � Qtti{7AAT�r^_� )!w 4 (1��A/n / --�-o .�CI_rA,f'7i. r+ 12✓IAw/rc1/-' �;�1./� GL I_ >: / L_ r :_�_. �w�!'L __v� "'A� �)(1< .�,i- 40 1P.," ,.tom �,d 1 l #I 1 K Vn_ t:�l , c✓] 44- aT G / , 1�-w G5!✓ 1 i.'? .� �+4,t./�ti] �a-.r,divf c 1 ' lay - k Discussion With Person in Charge: Corrective Action Required: I ❑ No I CTles 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 underst nd-that noncompliance may result in daily fines of twenty-five dollars&Viion/revocation of ❑ Embargo ❑ Emergency Closure Y your food permit. 0 Voluntary Disposal 11 Other: "01',Rec-'ied vt Teni-craturcs Violations Related to Foodborne tildess Infervantions and Ill:* According to Law:Cooled 10 Factors(items 1-22) (Cont) 4i 5 F'v%'ih i a 4 Homs. i rs PROTECTION FROM CHEMICALS C:ioling Methl 1'f)r Pfll-s 14 Food oir Color AdditNes 19 Psir Hot and r of I Holding 3-1102.12 AdditiNes� ('old, PTIFsM;urqai nod at or below. 3-30114 Protection from Unapt jou ed Addiuvei* ;90.004(( 41'/-15' F` IS Poisonous in Toxic Substances j 3-50!,!6(A) I iol PIT's ltlaintained at or above 7-101.11 Identiftinie Inforniaiion-Cfriginal ;-"01.1'11f'ki Roast;flelul at or above '10'F Containers' I 7-102.11 Common Name-Woiking Cnntainprs` j 21t 1 Time as a Public Health Cointrul 7-201.11 Separation-SiojaFel 3-�01.I'll Time as a Public Health Contpl* 7-20211 Restriction-Presence and Use* j 1 490.00404) Variance Requirement 7-202.12. Conditions of Use* REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-203 11 Toxic Containers-prohibitions* 7-204.11 Silniflzers,Criteria-Chemicals'' POPULA7:0tNS(HSP) 7-20-1.12 Chemicals for Washing Produce,Criteria, 2, 3-801 I I(A) Unpo,teur,,ed Pre-packaged Juices and 7-204.14 Drying Agents.Criteria R:"erages •;/Ifll *'afninglabets* 7-205�11 Incidental Food Contact. Libricarl .-S'd I I(B) Use of Pas'-o ized Efai:�'S- 3-X01 11(D) or Pon 1:,,,!1 v Cooked Annual F(Rid and 7-206,11 ReAricted Use ise Pesticides,Criierni* R 1w sevu'-prouts Not SerNe d. 7-206.12 Rodent BaitStations' I i(C) Unopened F(Y)o Pickage Not ke served, 7-206.13 'I'mchne Powder:. Pest Control and Monitoring" CONSUMER.ADVISORY TIME/TEMPERATURE CONTROLS 22 3-603 11 Goinstnoor Advisory Posted for Consumption of 16 Proper Cooking Temperatures for Annual Fools That are R . Uad-rcookcd or PHFs Not 0dic.-tvise Processed to Eliminate -1�,Pl,P!P 31 3-•301.11A(1)(2) 12....I;- 155-F 15 See. Pat]io�r,,ns.^E ate Service 1-45"I'l 5s,v -3 Eggs-finmedi -301.13 P.Weuri,cd Eggs S:,hstiwte ft),Ruvv Shelf 3401.11(A)(2) Comminuted Fish, klcats&Game Eggs;. I Annuals- 155-F l5 sec. _ SPECIAL REOWREMENTS 3-401.11(B){1)(2) Fork and Beef Roast 130'F 1-'1 min" 3-401.1l(A)l2) Panics.Injccted Mints-155'F IS 590J)09(A) tD) Violations of Section 590.009(A)-(D) in sec. cott-rir 1,, mcibif, food. tempol and 3-401.11(A)(3) Poultry,Wild Game,Stuffed PHFs, i-midentiai kitchen operations should be Stuffing Containim,Fish,Meat, debited UlleCt,111C appropriate sections Poultry of RaLitl 15 sec. abmn if rehut,-u to foodiiorije illness 3-401.11(C)(3) )N"hile-muscle,hill Beef Sfcaks irnervention% and risk factors. Other 1.15°F S00.009 Nidations reiaiini, to gbud retail 3-401.12 Raw Animal Foods Cooked in a pnicl it us should be debited under(129 -- Mciowave 165--F * Special Requirements. 3-401 11(Aal)(b) All Other PHFs- 145"F 15 sec. 17 Reheating for Hot Holding j VIOLATIONS R.FLATED TO GOOD RETAIL PRACTICES 3 403 11(A)&(D) PHFs 165'F 15 sec. (Items 23.30) 3-403.11(B) I Miciow,ave- 165"F 2 Minute Smutting h d .,d*bove, oin be Time' 3-403.11(C) Commercially Processed RTF Food- found in theft'llon of"sef-oom q/thc F..... E'LL"flad 165(WR 140"Ft -3-403.11(F) Rcioanim-Unsliced Portions ofBcef Fitern IGoad-Ratiei Practices 23. t/lanroement and Personnel F -2 '003 is Proper Cooling of PHFs j 24 Ford and Food Prcte�tl()l 004 25. Equiorristit are Utensils 005 3-501.14(A) Cooling Cooked PHFs;from !40"F to 26 Nater,Plurnbil andAlssle rc-5 006 70'F Within 2 1!cuts and From 70'F 27 Phys'ca;Faciditv FC--6 j .007 to 41 1 F/45T Within 4 Hours. t 1 23. Poisonous of 7oxic Materiels FC-7 .008 3-501.14(B) Coolin.,PIJF5 Madle Front Ambient29 Special Requirements 009 Temperature ingredients to 4l'F/45,, 30, othel Within 4 Hours 11 1 111W'l,1111-,+11 Delloqe:o'lucal item in file rodeoll 1999 Food Code of 105 CNIR 590 000. r Temperature Log- Feef ee.,, Date Time TEMP Initial Date Time TEMP Initial Date Time TEMPI Initial /30 7/-,�C) 3 :SLA os 7/3, a�k (-I ra W O—Q W1 3" i s CP,- /a 15 a--c z � 0 g,.Ow- �/3 ICS' ��C7 a-k 1lOu M OO 10 VCT� cOkp f )pl " trot .� C" Ul g2q/ Temperature Log - tk-)a1f� Date Time TEMP Initial Date Time TEMP Initial Date Time TEMP Initial cfa Z4a n9 ,s 10 Via° ° 0 P . 1 :its . -13) 330 3 O >c ll, i UO a:, &L FV ii -4qn �I-1 foo c37 6/3 10 ' I 1 31 a.( go , fl° M 1� 38 l u 1130 cicq �'/7 /a'3o t-t�'J �• Temperature log - s fie., oc { G Date Time TEMP initial D to Time TEMP Initial Date Time TEMP Initial (L/L IQ- 1/ 7 31 'to �oc 14 1 C-01 n � b HY-C-P +,✓ LASAp 1-4 car . PC so UcL POT 31 �l 3� q -t' CG n 0 0 Temperature log Date Time TEMP Initial Date Time TEMP Initial Date Time TEMP Initial 40 00 -7/30 3 I -7/31 1031) L- 0 � (J "D '4 I v 1 Z+3 /I 33" 41 (l la Z'a oj 31) 10, ,3 7! l 1 r7�� L/$ �e� ' JL 'o a [its et.�e._.`7�d.-� T-.. , ^is w.�.. ,. r,ter n'4�.w.n"w.. �,^�.'"^�l.-.,,...,ayr..v%w.,W.M..iw•�vw ^...tr ...e. .r .. - `.-..l�y�"�l:f'inile4�YY". Massachusetts Department of Public Health Salem Board Health , M S 720 Washington Street,4`h Floor,,.r'""- Division of Food and Drugs r Salem,MA 01970-3523 -T FOOD ESTABLISHMENT INSPECTION REPORT Tel. (978) 741-1800 Fax(978)745-0343 1" T Name Daf1t� v of Ogeration(sl TYoe of Insoectian } ood Service ElRoutine Address (t Risl( C3Retail Re-inspection �7 11`ctrinR 4�1Z/ Level ❑ Residential Kitchen Previous/Insp}ectio_n Telephone �r _, �vr�p3� ❑ Mobile ; Date:IQ 10 ,D t fU/ t ❑ Temporary ElPre-oppperation OwnedHACCP YiN LLC ❑ Caterer ❑ Suspect Illness �A Time ❑ Bed&Breakfast ❑General Complaint Person in°Charge(PIC) ❑HACCP Inspector �� Out: -' ❑Other lml t , � Permit No.1 Each violation checked requires an explanation on the narrative page(s)and a citation of specific provision(s) violated. Non-compliance with: Violations Related to Foodborne Illness Interventions and Risk Factors Anti-Choking Tobacco Violations marked may pose an imminent health hazard and require immediate corrective 590.009(E) ❑ 590.009(F) ❑ action as determined by the Board of Health. FOOD PROTECTION MANAGEMENT ❑ 12. Prevention of Contamination from Hands ❑ 1. PIC Assigned/Knowledgeable/Duties ❑ 13. Handwash Facilities EMPLOYEE HEALTH PROTECTION FROM CHEMICALS ❑ 2. Reporting of Diseases by Food Employee and PIC ❑ 14.Approved Food or Color Additives ❑ 3. Personnel with Infections Restricted/Excluded ❑ 15.Toxic Chemicals FOOD FROM APPROVED SOURCE _ TIMEA`EMPERATURE 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 4 ❑ 7. Conformance with Approved Procedures/HACCP Plans ❑ 18. Cooling m PROTECTION FROM CONTAMINATION ❑ 19.Hot and Cold Holding ❑ 8. Separation/Segregation/Protection ❑20,Time As a Public Health Control ❑ 9.Food Contact Surfaces Cleaning and Sanitizing - REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) ❑21. Food and Food Preparation for HSP ❑ 10. Proper Adequate Handwashing CONSUMER ADVISORY - ❑ 11. Good Hygienic Practices 0,22, 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. I 590.000/federal Food Code.This report, when signed below x by a Board of Health member or its agent constitutes an 23. Management and Personnel (FC-2)(59o.003) order of the Board of Health. Failure to correct violations 24. Food and Food Protection (FC-3)(590.004) cited in this report may result in suspension or revocation of Equipment and Utensils (FC-4)(590.005) the food establishment permit and cessation of food 26. Water, Plumbing and Waste (FC-5)(590.006) establishment operations. If aggrieved by this order, you 27. Physical Facility (Fc-6)(590.007) have a right to a hearing. Your request must be in writing 28. Poisonous or Toxic Materials (FC-7)(590.008) and submitted to the Board of Health at the above address 29. Special Requirements (590.009) within 10 days of receipt of this order. 30. Other DATE OF RE-INSPECTION: M9 0��} tlj7L 5 ns trorm t4 dw �" ' ` �y/�� d Inspector's Signature l / 1/ � I'riM: /,... PIC's Signature: ,�� / 1r5 Print: (� ! �.� ,�.�f!{�t,�.•,�- ( Page ofpPages 01 V Violations Related to Foodborne Illness Interventions and Risk Factors(items 1-22) PRCTF-.CT?ON FROM CONTAMINATtON FOOD PROTECTION MANAGEMENT ! K Goss c:ontaminatirn I 590.003(A) IAssignment of Responsibility I 3-?02.1 I(AH 1) Raw Antonl Foods Separated from 540.003(B) DenumsirafionoiKnowledge°` I CookcdandR'TEF::,da` 2 103.11 Person in charge - dukes Contamination from Raw Ingredients I .3-302 1 1(A)12) Raw Animal T.�(xfs Separated horn Each EMPLOYEE HEALTH I Other' 2 590.003fC) Responsibility of (lie pers6n in eh.uge to : Centam:hatt'on from toe Env,tenment require repomng by focal employees and ( 3-302.1;(A) Fu(xl Prot-anon" applicants" 3-302.1.) \VaOlrr i^ruiis and Veaetables I 59,003(F) Responsibility Of A Food i;,npluyee Or An 3-304.!i Foix:Contact with Equipment and applic•:,nt To Report To The Person In U[ens�Is* Charge" ,^,ontam,nar,'on from the Consumer .5OQ003(G) Reporting by Person in Charge* I 3-306.14(A)f B) Retuned Foou.md Rcserei(-of F!xod" I j .1 590.W31 )) Exclusions and Rcsuictions* Disposit+on of Aduiter-red or Contaminated 590.003(F) Removal of Exclusions and Restrictions Feed _ 3-701.1 i Disc rdingot Reconditioning Unsafe FOOD FROM APPROVED SOURCE Foud ,y Food and Water From Regulated Sources ( 9 Food Contact Surfaces I 590.004(A-B) Compliance with Food Law* I 501.11 I Manual Viaiewashln;;- Hot Water 3-201.12 Fcaxl in a Hencetics!ly Seah.d C!,mmi ter" Sanitiz aiu::'Peamcr.:[❑res' 3-201.13 Fluid Milk and Milk Products" 4-501.112 Mcchani,al Warewastung-Not Water ( 3 2U2.I3 I Shell Eggs" I Sanitiranoa Tentpzratrucl 3-02.14 ( Eggs and Milk Pnoducls•Pa,teunized' I ( =t-`;Ol.l I.7 Chemical Sanitizdhwd temp, pH. cuncenu'ation and h,u'due::s .5 lol.1(1 I Dr IceMade Flom Potable Appring Water` 15-601 11 A) &lu:pment Food Cun!net Suibwos and .5-101.11 Drinking Water hum an Approved System" I SPO.UOCi(.4) Boated Dunking Water" I Utensils C'lean- 1590.006(B) Water Meets Standards in 310 CMR 220"` I +e(r'L. 1 Ckanin_Frequency of Uteri F000i Snellfis,9 and Fish From ars Approved Soiree I Coriact Surfaces and Uen;iL =4=?0`L.i! Frequencyof$anitizatinn of Utensils and 3-201.14 Fish and Recreationally Caught Molluscan ! sed C•s::tact Surtacrs ul t au ipntratI Shellfish, i 4-703.1 i Methods of Sanitization-flut Water and 3-201.15 Molluscan Shellfish from(`SSP Listed i'he;,n.al Sources* 110 Proper,Adequate Handwashing Game and Wild Mushrooms Approved by 2.'U t.i! t'lean Condition-H,nds and A:ars^' Regulatory Authority .3 202.15 I Shellstock identification Prvscnt' 12-101.12 Clearmvv Procedure'` 1590.004(C) Wild Mushrooms- 12-301.14 When to Warh I 3-201.17 I Game Animals'' I It Goad Hygian!e P<aetices § I Receiving/Condition I 2,,U].I I Eating„Drinking or lisin£Tobacco' 13-202.11 PHFs Received at Proper Temperatures s I I 1111.12 Discharge;From the Eyes. `osc and 3-202.15 Package Integrity' Mouth' 3-101.11 Food Sale and Unadulterated* I -3-:;01,12 Pieventing Contamination When Tasting" 6 Tags/Records:Shellstcck 12 F"event:o,t of Contamination from Hands I ? 20115 SheOstock identification^ I , i9l).001t E) ?reventing Conlamination from 1 3-203 13 ( Shellstock identification Maintained', En)ployeca" Tags/Records:Fish Products 11.3 I Handwash Faci;hies Ccnvenienfly Loratedand Accessible 13-402.11 Parasite Dc,tniction* � I 3-402.12 Records.Creation and Retcntmn I `--:03.11 I Nu::,•ers and C`ap1U1,LS* 590.004.)1) Labeling of Ingredients' I o-204.11 LA�catiun and Placement'. Approved I ��;i- 11 ",ccessib:lih,,Op:ma;onand:l2aintenance 7 � Conformance with A oved Procedures tHACCP Plans I S.:ppLed it th Soap and Hand Diving 3-502.11 Specialized Pro es+m);btetlt:uls' ( Devices 3-502.12 Reduced oxv �n acka m* criteria" 6-301.71 Hanolwachma Cicam,er,Availeb)htV £- p. . ,£i 8-103 12 Confonnance with Approved Procedures" ( 16-3ill.12 Hand Drying Provision • , ,< r *t -n,te��.critical item in the federal 1))9 Poud C.de or 11., .\112 590.000, CITY OF SALEM // BOARD OF HEALTH Establishment Name: I ha_ / ,_ .va_-a _vt,I Date: Irk I1 �7� Page: of Item Code c-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date No. Reference R—Red Item r) Verified 1 LEASE PRINT C6EARLY I �3 � m?�' dad t 7� /1�.�t�1. I �.t✓�_ U C,Ct 7 /t c /IJP DJOn/ �� (-I[UUr� 1_; ILAi✓1r 1 ✓t l l/t pX—iY� r_1)n101 .�17 r/ ni )0 ' 1 C r + ,,� ►�,r � �,,�A . .,aA�n. ,7 r, //I ala ,l 40// 1 1 1 1 1 � I Discussion With Person in Charge: Corrective Action Required: I ❑ No Lob' Yes I have read this report, have had the opportunity to ask questions and agree to correct all Voluntary Compliance ❑ Employee Restriction/ inspection, to observe all conditions as described, and to Exclusion violations before the next ins p ❑ Re-inspection Scheduled ❑ Emergency Suspension comply with all mandates of the Mass/Federal Food Code. I understand that— noncompliance may result in daily fines of tvyn�yty-five ollar�Fr9lon/revocation of ❑ Embargo ❑ Emergency Closure r your food permit. I' \\) ❑ Voluntary Disposal ❑ Other: 4 - s 1 --��;1.1 kC": pFLFe P.z.en'ed,n'1'tntner,nurec Violations Related to Foodborne illness Interventions and Risk .Ac:ordmg tt•I.aw Coned it) Factors(items 1-22) (Cont) -11F/45=F Within 41-Iours. " PROTECTION FROM CHEMICALS I 3-50!.15 Cooh¢e M.-ih,xls fu;PHFs f 14 I Food or Color Additives I 19 PHF Hot and Cold Holding 3-5U I.16(t3 Cold PHF. 4::i.aained too; 3-202.12 Additive.' I I r 'behttt 3-302.13 Protection Roti Unappimed Addrttes" 590.00 (F) 41`715=F°= 15 Poisonous or Toxic Substances - 50;"I(,;A) I fat PHF: Ittaintamed at or above 1401- 7-101.11 Itlenvfpmg Infi,nan . ,on-Original ' g-;61 16(,A) Roast;Held at or above 130'F. " Containers" 7-102.11 Contain Name -Working Containers` I 20 Time as a Public Health Control 17-201.11 Separation-Stu;aL'e' I :i-:i01 19 Ttnr.:a:.a politic Health Conhel* 7-202.11 Restriction-Presence and Use 1590.004(H) Variance Requirement 7-202.12 Conditions of(Lac°' 7-203,11 'Conic Containers-Prohibitions* REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-204.11 Sanitizers,Criteria --Chemicals` POPULATIONS(HSP) - j 7-204.12 Cheutuals for Washmc Produce.Criteria" 21 3-80i I l:A) C,npaaicnnzed Pre packaged Juices and i I Beretncec w1!t Warrinig L lbeh;I 7-204.14 Drymh Agents.Criteria"" , i - 7-205.11 Incidental Food Contact.LubrurntsT ! 3-801 1 IIBi I Use of E'asteunzed Ee^;` I 3-:'.{II 1 I(D) F,,4 or Partially Cooked Animal Food anti 7-206.11 Re.tneted Use Pesticides.Crueria. ! ! 7-206.12 Rams lent Bait Stratu " I ! R.ra'Seed Sprouts Sot Served. 'x 7-206.13 [racking Powders. Pest Control and 3-S0 l.;i Q') I U::-) enetl Post,' Package Not Re-served A, Monitoring^ I CONSUMER ADVISORY TIME/TEMPERATURE CONTROLS 22 3-603.11 Cnvumcr Advisory Posted for Consumption of Aum,al Ftxxls That arc Raw. Uji leicooked o; 16 Proper Cooking Temperatures for Not Otherwise Processed to Eliminate PHFs 3-401.i IAft)(2) Egg<- 155`F 15 Sec. Patho¢•ens.'✓;"`":"':'.�onr Eggs-Immediate Service 145"F15sec* 3-302,13 Pasteurized Eggs Substitute fur Raw Chet) 3-401.11(rll(2) Comminuted Fish, Meats 8:Game Animals- 155"F 15 sec. " I3-401.1l(B)(1)(2) Pork and Beef Roast 130"F 121 mor* I SPECIAL REQUIREMENTS 3-401.11(A}(2) Ratites,Injected Meats- i55F15 500009(A)-(D) Violations of Section i90.009(A)-(D) in sec, r catering, mobile Roel,ternporary and 3-401.11(A)(3) Poultry,Wild Game,Stuffed PffFs, residential kitchen operations should be Stuffing Containing Fish,Meat, dehited u::dcr i!te appropriate sectjona Poultry or Ratites-165"F 15 sec. 'I Ltbova if related to foodborne illness 3-401,11(C)(3) whole-muscle, Intact Beef Steak:; interventions and risk factors. Other 145°F T 590.009 violations relating to good retail 3-401.12 Raw Animal Foods Cooked in a praencec should be debited under (129- Microwave 165`1=* Special Requirements, 3 461.1 11.47(1)(6) All Other PHFs- 145'F 15 sec. 17 Reheating for Hot Holding VIOLATIONS RelATED TO GOOD RETAIL PRACTICES ! 3-40111(A)R(D) PHFs 165°F 15 sec, ' j (Items 23-30) 3-403.11(B) Microwave- 165'F 2 Minute Standing Citic-al uDJ uort-(ritire l eiolalione• .rhich do nut relwr u)the Time"' f:odVorrnr iliness Interventions and rick tanner listed above. Can he 3-403.11(C) Commerually Processed RTE Foul- (ound in the,i>dlnu-lap, .serliuns ul the Food Code rood 105 CAM 140"F" 54p.o/1n. 3-103.11 tF1 Remaining Unsliced Portions of Beef Item Good Re?ail Practices FC 590.000 Roasts* l 123. Nianacement and aersonne! FC-2 .003 J 1& ( Proper Cooling of PHFs I 24 coed and Food Pootecdlon FC-3 .004 25 Equipment and Wen9lis FC--4 .005 3-501.14(A) Cooling Conked PFIFs from 140`F to 26. 'Nater,I"!umuinq and Waste C-5 006 70"'F Within 21-fours air] From 70'F 27 Physical Fadlit4 FC-6 007 to 41"F/45"F Within 4 Hoorn. * ( 28. PDiGonous r Tore tAate*ia s FC -7 .008 3-50L14(B) Cooling PFIFs Made From Ambient 129 Soe tial Repturemt;nts 009 Tempemurre Ingedients to 4I OF/45"F 00. Other --- -� Within 4 flours` •oron„xFo:a.. tacnoter critical itarn In the tederal 1999 Food Code or 105 CMI:G.90 1100. 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 / Date Type of Ooeration(s), Type of Inspection I(o%T' IN Food Service Routine Address ung Risk ❑ Retail Re-inspection ��^"'`C &144 Level ❑ Residential Kitchen Previous Inspection Telephone �..A/) _ //Q 9 f ❑ Mobile Date: 7 7�/o S Owner A j �Y'�//e IT �4)J �,.}I� / HACCP WN ❑ Temporary ❑ Pre-oeration /Vj lass vn\ 1lLl.(/��,/-� L(_ C ❑ Caterer ❑ Suspect Illness Person in Charge(PIC) I Time El Bed&Breakfast E] General Complaint In:IZ:�J ❑ HACCP Inspector Lx�,oh , er I Out;-R,'L)'L Permit No. ❑Other Each violation checked requires an explanation on the narrative page(s) and a citation of specific provision(s) violated. Non-compliance with: Violations Related to Foodborne Illness Interventions and Risk Factors Anti-Choking Tobacco Violations marked may pose an imminent health hazard and require immediate corrective 590.009(E) ❑ 590.009(F) ❑ action as determined by the Board.of Health. FOOD PROTECTION MANAGEMENT2. Prevention of Contamination from Hands ^- ❑ 1. PIC Assigned/Knowledgeable/Duties ❑ 13. Handwash Facilities EMPLOYEE HEALTH PROTECTION FROM CHEMICALS El2. Reporting of Diseases by Food Employee and PIC El3. Personnel with Infections Restricted/Excluded El 14.Approved Food or Color Additives ❑ 15.Toxic Chemicals FOOD FROM APPROVED SOURCE ❑ 4. Food and Water from Approved Source TIME/TEMPERATURE CONTROLS(Potentially Hazardous Foods) ❑ 5. Receiving/Condition ❑ 16. Cooking Temperatures ❑ 6. Tags/Records/Accuracy of Ingredient Statements ❑ 17. Reheating ❑ 7. Conformance with Approved Procedures/HACCP Plans ❑ 18.Cooling PROTECTION FROM CONTAMINATION ,119. Hot and Cold Holding ❑ 8. Separation/Segregation/Protection ❑20.Time As a Public Health Control N-9. Food Contact Surfaces Cleaning and Sanitizing REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) El 10. Proper Adequate Handwashing [121. Food and Food Preparation for HSP ❑ 11. Good Hygienic Practices CONSUMER ADVISORY [122. Posting of Consumer Advisories Violations Related to Good Retail Practices Number of Violated Provisions Related Critical (C)violations marked must be corrected To Foodborne Illnesses Interventions immediately or within 10 days as determined by the Board and Risk Factors(Items 1-22): of Health. Non-critical (N) violations must be corrected Official Order for Correction: Based on an inspection immediately or within 90 days as determined by the Board today, the items checked indicate violations of 105 CMR cfCeaNh . 590.000/federal Food Code. This report, when signed below 23. Management and Personnel (FC-2)(590.003) by a Board of Health member or its agent constitutes an -:� 24. Food and Food Protection (FC-3)(590.004) order of the Board of Health. Failure to correct violations (FC-4)(590.005) cited in this report may result in suspension or revocation of k 25. Equipment and Utensils the food establishment permit and cessation of food 26. Water, Plumbing and Waste (FC-5)(590.006) establishment operations. If aggrieved by this order, you - 27. Physical Facility (FC-6)(590.007) have a right to a hearing. Your request must be in writing 28. Poisonous or Toxic Materials (FC-7)(590.008) and submitted to the Board of Health at the above address 29. Special Requirements (590.009) within 10 days of receipt of this order. _ 30. Other DATE OF RE-INSPECTION: I , 1 � S SMnsp fFom 14 eoo 2 �/� Inspector's Signature: ! Print: 41 1 C�) �, \ acac JI PIC's Signature: �,� Print: n Ir �� Pag�of 1/,P-ages i 7 Violations Related to Foodborne Illness Interventions and Risk Factors(items 1-22) PROTECTION FROM CONTAh9INAT!ON FOOD PROTECTION MANAGEMENT g Cross-c ntaminatinn I 590.003(A) Assignment of Rcsponaibility' 3-302.! !(A)(1) Raw An�nwll Troth Separated trom 590W03(9) Demonstration of Knowledgec - � Cooled gad RTE Fends' 2-0111 1 Person in charge -duties j Contamination from Raw Irgredrenis 3 i62 1 i(.A)i:a Kaw Au;+[su F_a:ds Separated from Tach EMPLOYEE HEALTH I I Otl:r ! 2 590.003(C) Responsibility of the person to cha:ee to Contamination from the F^vi•^,.oment require rep,ning by f(:od emplc_ver;rod �.3-302.1 11 A) Fo:ui Ptotectioa" a ,lic.mtsi. 4 1 P1 ( _ 302.1. l rshutg Fruits and Vegetables 590 003(F) 0u tResponsibility Of A Food Employee Or An 3-30.1 I 1 Food Contac:w+tb F,cl I ment and :lpplicant'Co Rcporl'Fo The Person in � ( Utc:;its* I C'harve" I I C'cntamtnaticn from Me C.cnsv,-er 590 003(6) Reporting by Person in Chace' ( 3--1,06.1 I(A,,B) Returned Food and Rexrvice or Forsil'^ 3 540.003(D) Exclusions and Restrictions* I I Disposition ofAdutrerateaorContaminated 590.003(F) Reramal of Fxclusions and Restrictions ( Food 701.11 D+acarding or R.eeanditioning Unsafe FOOD FROM APPROVED SOURCE 1,0001 1 141 Food and Water From Regulated Sources 19 Food Cenmct Surfaces 590.004(A-B) Compliance with Food Law, ( 4-501.111 A4anual Vvarewashine-Hot`mater 3-7.01 1? Food in a Hermetic:dly Scaled Container* ( Saniiization'Teutperatures" 3-20i.13 Fluid Milk and Milk Products* .1-501.:i2 Mechanical't5'aieo-aching-Hol Water 3-202.13 Snell Eggs* S anitizatiou Tornoc*atures* i 3-202.I4 Eggs and Milk Productsa-501.114 Che:mcal Sanitimiron-temp.,pH, , Fusteurizrd' concenu glucal and hardness. t � 3-202.16 Ice Made From Potable Drinking Water' I 6r)1.t i(.A) Equtpmznt Food Cv: act Surfaces and 101 11 j Drinking Water from an Aom ved System' Utrueiic Clean" 590.006(.A) Bottled Drinking Watcr" 1 Cleamne F 4-602f E• auuant Food- J 591).000(B)3) Water Meet:Standards in 310 CMR 22.1)" . rcContact Surta:e::andquenc; oUtri sill k Shellfish and Fish From an Approved Source j 702.1 1 Frcti-ency u; Sam oz.nion of Utensils and 3-201.14 Fish and Recreationally Caught Molluscan I Foevl Contact Surfaces of Equipment:.'- Shellfish* _7_$1,12 Met 3-201.15 Molluscan Shellfish from NSSP 1_isthrw+of Sanitization-Rol Water and sources" I I Chemical" Sources* Gane and Wild Mus110 Proper,Adequate Handwashing Mushrooms Approved by 12 301.11 Clean Condition-I-I:nds aad Arms"' Regulatory Authority ( I 3-202. 18 Shellstock Identdicatiou FresenC" ( 3C1.I2 "Icatom, Procedure"' 590.00410) Wild Mushrooms* ( ( 2-301.1.1 When to Wash' 3-201.17 Gaate Animals* I it I Goo:Hygienic Practices j 5 I ReceivingfCondition ( 2-401 It I Eating.Drinking of 1}ging Tohurer.+ j 3-202.11 j FHFs Received at Proper Temperatures," 2--401.12 I Diiehargcs Front the Eves, tion:and ]vlc,utit* 3-202.15 j Package 6nettrity" Preventing GntCuuinauon W'ben•Casting 3-101.11 Fcetd Safe,and Unadulterated* ! 3-301.12 + 6TagsJRecards:Shellstock 12 Prevention of Contamination from Hands 3-202.18 Shellstock Identification* I �9OMO 4(E) Preventing Cor.:mnination from 3-203.12 shellstud:Identification Mamtame(P; Employees" Tags/Records:Fish Products i 13 I ( Handwash rachities • Conveniently Located and Accessible i ;.102.11 Parasite Destruction` I ' -402.12 ( Records,Creation and Retention' a X".11 Numhe*s.md Capaailies^ 5-204.1 1 ",oration and Plac,m_-nt* $9(},0(}.4(,1) � Labeling at Ingredients" j - ry Conformance with Approved Procedures 5'_05.11 Acxeisibiiity. Operation acdMaintenance /HACCP Plans ( ( Suppried mth Soap and Nand Dnonq 3-502.11 Specialized Processing Methods* Devices ' ,;(j oxygen pachaf•ing.enteric"•' (i-3(Q.II Hnndwwushige{'leaner r. Availability 18-103.42 I Conformance with Approved Ptocedures` ( 6-301.l2 Nt•nd 1)rving Provision •Denoies.ritical arm in the federal 1999 Fo+xl Cate or 10 C NIR 590 000 f r CITY OF SALEM BOARD OF HEALTH Establishment Name: P ��r�_,n� O...t d Date: 0-1/ o ln) Page: �'� of Item Code C-Critical Item _ DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date 1 ti No. Reference R—Red Item _ Verified PLEASE PRINT FLEARLY f ` � /' 1 ��AZI,d .� J"-- o i nn�J r� o��... ►v/1 "• 179. f9Q17 A,7��cH' f `'meq 1 — �,7 1 t'j , ) hA4 I on s �AJQ0,V C'Lploll,�c. .�L<✓r�.,'u`f.�/>,- �� r2a-sr��(re�_! ,ACk:j � - - f ff r 6 c7 �(.�, n- `. �-� � � Gt(��-4 f4-- t10�>I Cact t � r,►F-� (I Ao t I i _ r►ylnl <4q�I P- 1 JA J. D.D rj i i:L "J Zqr maY 4' 4- 5�et/. A, ,— (r, ir„ rle�).t vcL 4-,) hP or'I �C ��/. Fn ✓� IY\ISI6;toiry ` APwc) A cue/. ,�—Gl� o rFC , le� _"/ ° f Discussion With Person in harge: Corrective Action Required: I ❑ No 'Yes 1 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 1❑ -inspection Scheduled ❑ Emergency Suspension comply with all mandates of the Mass/Federal Food Code. I understand that Ire noncompliance may result in daily fines of t/" my-five dollars or suspension/revocation of ❑ Embargo ❑ Emergency Closure It your food permit. ❑ Voluntary Disposal ❑ Other: 4 I i X,ceivee nr Tcior,ui at u rev Violations Related to Foodborne Illness Interventions and Risk Accordaw i;.1 akv C„dcd to Factors(Items 1-22) (Cont.) 41=F/45"F W71hin 4 Hours. PROTECTION FROM CHEMICALS 3-`01.1 3 Cooling Media's for PHBs iq Food or Color Additives 19 'lir Hot and Cold Holding ' ;-501.161;t) Cold Yf 1F, 54:dntui sed aLor below 3-20112 Additives" ' 154QU0^,.F; -F1'r-ts` 1; 3-302 Id Protection flow Unaplirmed Additives` 3-50:. ;-tut PHF;, Maintained at or above 1j Poisonous or Toxic Substances 140'2. 7-101.11 Iden f y inL lntnrmahon-Original I I Container". 3-50 1.1 61 A) Roasts Held at or above 130°2. 7-102.11 Corroon Name-Working Containers" 20 v ime as a Public Health Control 7-201.i 1 Depuration-Sioraee>; 3-501.F=; o ime a,a Public Heatl:Cunuol* 590.)0413) Variance Requirement 7-202.11 Restriction-Presence and Use 7-202.12 Conditions of Ike* 7-20" 11 Toxic C stainers-Prohibitions"' REOUIREMENTS FOR HIGHLY SUSCEPTIBLE 1 7-204.11 Saitidzers,Criteria--Chemicals^ POPULATIONS('HSP) 7-21}1.12. Chemicals for Washing Produce,Criteria"' 'i 3-80L 11(A) Ltipacreurizcd Pr-packaged Iuices and a Peveutf^es with Warn-inc l.abela 7-204.1.1 Drying Agents,Criteria'' '•-R+"il 11(B) Use of Patrenr,zed Eses' 7:05.1 1 Incident,,` Food Ccitart. Lubri,ants" ( 3-801,11(i)) Raw o;Partially C'uuked Animal Food and 7-206.11 Restricted Use Pesticide!..Cntennr kaw Seed Snrouu:IVot Served. r 7-206.12 Rodent Hail Stations" ( � 3-801.11((',, Unopened Food Packa;;e Not Re served. 7-206.13 Track ing Powder s,Pest Control and Monitoring* CONSUMER ADVISORY TIME/TEMPERATURE CONTROLS 22 3-603.11 Consumer Advisory Potted for Consumption of Animal Fouds'fhat are Raw.Undercooked or 16 Proper Cooking Temperatures for PHFs eaviNot Odt ,e Proersrem d to Eli;mare 3-401.1 1A(U(2) Fggs 1.55•F 15 Sec. I"Idwgens., Ee'rlls vnnnar Yeas Immediate Service 115'Fl5sec' 3-302.13 Pasteur.ied Eggs Substitute for Raw Shell 3-401.11(A)(2) Comminuted Fv;h, Meats&Garae Eggs,, Animals- 155'2 15 sec. SPECIAL R£OiIIREMENT S 3401.t I(A)(2) Ratites. injectedd Meats-155°F 15 3-401.11(6}(2){2) Pork and beef - 130'5121 min" 5900(})(A)_(D) Violations of Section 590.00%A)-(D) in Meats sec^^ cateringmobile obile food,teropotary and 3-401.11(Ali 3) Poultry,Wild Game,Stuffed PHFs, re"Idetttial kitchen operations should be Stuffinc Containing Fish,Meat, debited under the appropriate sections Poultryor Ratites-165°F 15 sec. a Dove if related to foodborne ilhnesn 11('+('x) Whole-muxle. Intact Beef St:aks ( interventions and risk fach,rs Other i45-F* $90.009 violations relating to good retail 3401.12 Raw Animal Foods Cooked in it practices should be debited under 1129- Miciowave 165'F* Special Acquirements. 3-401 l l(A)(1)(b) All Other PHFs - 145°F 15 see. 37 Reheating for Hot Holding ( VIOLATIO41S R:LATED TO GOOD RETAIL PRACTICES 3-303.11(A)&(D) PHFs 165°F 15 sec.^ ( (liesns 23-30) 3-403.11(B) Micruwave- 165° F 2 Mmufe Smndin3, Cirrnl mid nr,n-critical violations, e•hah do ool relate to the Time*` jiletc!bomc rilnrse interventions and risk In,:^,urs listed above, can be 3-403.11(C) Commercially Processed RUE Food- ,found in the jirlbnvoaq.se.iions of tire Food Code and 105 CA1R 140°F" 590.000. 3--403.11(E 1 Remaining Uneiiced Portions of Beef I '�,ltem Good Refai/Practices FC590.000 Roosts` 12.;.Manaceareot and Farsonnel FC -2 ,003 I Ig Proper Cooling of PRFs 24. Food and Food Prcteetio, FC- 3 004 25 Egoipment and Utensils FC-4 005 I 3-501.14(A) Ccwl mg Cooked PFIPs from 140'F to 2 26, Water PNmbinp cnd Waste FC--5 006 70'F Within 2 I fours and From 701P ! 27 Physical Facility FC-r ' 007 to 41'F/45"2 Within 4 Hours. 1 28. Poisonous or"I one Materials FC-7 .008 ' -501.14(B) Cooling PIIFs Made From Ambient 'g `bpe,aai Hegmremen;s 009 Temperature Ingredients to 41�F/45`17 130. Other , Within 4Hours;: Denote:critical item m the lederd 1999 Food Code or 105 CMR)90 ooO. CITY OF SALEM / n BOARD OF HEALTH _ Establishment Name: Ila f�112�✓lK �-vj Date: I Page: f of Item Code C-Critical nem DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date g No. Reference R—Red Item PLEASE PAINT CLEARLY Verifiedi I t Fn,f'2 un- 1//1,er--kn r/l�LL;).."fA. AtYl 0/1 i h rOt��_ � �leT�n!/�� _0(22 f l .//000L IUr � L� • J CY)✓, n�0 I r lo�+ fn'un /" ) C/r L) 4-,)-At I a ?(b /nolo �Tlki�.f�x�/` �vr Ar,--j.Lar cm r\ 1 k cad. I�rG rb t �Oc 1 t I 4c � �f <� G 7J,/o ark, 17n.r1 3'• 1 GA 7«/r_�Yl r�°? SJIcNf� C.rm al 1?.11 Discussion With Person in Charge: / ` Corrective Action Required: I ❑ No I O les F 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 i noncompliance may result in daily fines of tw n y-five d Ilars or suspension/revocation of ❑ Embargo ❑ Emergency Closure your food permit. 1 ,y�( ❑ Voluntary Disposal ❑ Other: z _ VC) -IF!, Reiened at"Pemperatures Violations Related to Foodborne Illness Interventions and Risk A.coiding'o LeCooled to Factors(items 1.22) (Cont.) 4 i'FA.;'F W1fian-1 H:,ut'a. " PROTECTION FROM CHEMICALS Calms Methods for I'HFs 19 PHF Hot and Cold Holding ld Food or Color Additives 3-50;.16(b) ! Cold PI IF,,Maintained at or below 3"7.0'_.12 Additivei' S�Oi-if!4tF) 14P/45'F" 3-302.14 Protection front Unapproved Additives" I 1-Sul,16(A) lint t'HFs TiaintauL:ct at or above 15 Poisonous or Toxic Substances ( Hot P " l 7-101.11 Cont iner,s Information-Original 13-501 J 6(A) Ro gists fteW ator above :300P. Comainers' 2t) 'rime as a Public Health Control 7-102 11 Cunwxm Name--Working Cnmainers" ;-501,79 -fi:re as a Puo6t,Hea'•di Comroi* 7-202 It Restriction-Preseressenc 7201.11 Separation- PPresence and Use 1 590.0041Hi b'anance Requirement 7-202.12 Conditions of Use" 7=203 11 Toxic Containers --Pruldbitions* � REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-2(&}.11 Sunitizets. Criteria-Cttcmicalc* POPULA EONS(HSP) _ - ( "7-1-04.12 Chemicals Q,r Washite,}'rotucc,C'ritcria" 21 3-801.1 I(A) I Unpasieurimd Pm-packagcd Juices and Bever:;zes wi ti; Vk arning l abels^ 7-204.14 Diving Agents.Critena" ( 3_gr,1.l l(B) Use of Pasteurized t3^_e:;� 7-205,11 Incidental Food Contact, !_uhrieants i 3-SuLl k f)! Raw or Paroally Cooked Anim,il Frxxl and 7=_'06,11 Restricted Use Pestit Ides, Criten.I* 7-206.12 Rodent Bait Stations" ! k.iw Seed Sprouts Not Served. 'e ( 3-ri0:.1 (C) Unnpeneu P(od Pacl:a,¢•Not Re-screed. a, 7-206.13 Ttxckmg PowJer:,Pell Control and -- Monitorinn^ CONSUMER ADVISORY TIMEITEMPERATURE CONTROLS 22 1-60..11 Consumer Advisory Footed for Consumption of. Animal Foods"Thai are Few. Undetcooked or t( I Proper Cooking Temperatures for Not Othe rwisc Pr(wessed t:)F,liminate PHFS , �n=...�•,,:zan, 3-401.11A(1)(?) Eggs- 155'F 15 Sec. Pathoge^s.` Eggs-liumediate Service ld5`r15sec_+ 3-iO?.0 Fos-:ur.�xd E;.,gs Sub..rude tin'Raw Shell 3-401.111A)(2) Comminuted Fish, Meats&Came E`gr' Animals- i 55'F t5 sea , j SPECIAL REQUIREMENTS 3-401.1 l(B)(I)(2) Pork and Beef Roast- 130`F 121 min* 3-401.11(A)(2) Raines. lnjceted Meats -- 155°F 15 59C!C09(A)-t D) Violations of Section 590.00()(A)-(D)in sec. * catoring, mobile food, temporary and 3-401.11(A)(3) Poultry, Wild Game,Stutfed PHFS, re%Acrinal kitchen opeint!ons should be Siuftiug Containing Fish,Meat, debited under the appropriate sections Poultry'of Ratites-165'F 15 sec. * above if related to foodborne illness 3-401.11((')(;) Whole-muscle, Intact Beef Sicaks imerventions and risk factors. Other 145'F 500.00*4 violations teiating to good retail 3-401.12 Raw Animal Foods Cooked in a I p ac[ices should he debited under>`i29-- Miciow,rve 165'F* Special Requirements. 3=101.}1(A)(1)(b) All Other Pl-IFs- 145"F 15 sec * 17 Reheating for Hot Holding VIOLATIONS R&LATEED TO GOOD RETAIL PRACTICES 3-403.11(A)4t(D) PHFS 165T'15 sca. " ( tlte(itc 2+-30) 1403,11(B) Microwave- 165' F 2 Minute Standing Crilwal awl nor"rridral carlatiuns, vow,h do not relate ter the Time* foodl;urnc;(Gees'interretwons wit risd f (rurr.Sited above, Can be 3-403.11(C) Commercially Processed RTE Fuld- hard ni du'folhaving ler/inns of the Food Code and!05 0/R 140"F* 590.OU0, 3-403.1 1(L) Renrrm;n,L%nsliceJ Portions of Beef Item I rood Retail Practices ,,-'C 1580.000 Roasts' i.23 Manaom cent and Persnnne! FC -2 .003 13 Proper Cooling of PHFS 24 Food ata Food Protection FC-3 ! .004 _25 Equipment and Wei Isis, FG-4 005 3-501 l4t'1) 70''FCouWithin PHFS from 140 m,7 to 26 - --- Water.P!nrnbinq and Waste FC-5 .006 70"F Within 2}-!our.:and From,70`F ! 27 angsical Facrity FJ-6 007 to 41`F/45"F W";thin-}Hoorn. ' 22 Posonrus or 4 oxic Miateria:s f-C-7 .008 f 3501 14(R) Coling PHFS Mede From Ambiente t i --29 Specol Requ,renni„ .009 ! Temperature htere(licnF 30. Other to 479'/45` � 'Wil hm 4 lours r Denotes cnucal it'll)ni the federa! 1990 Fond Cude or 105 CMR 590000. CITY OF SALEM BOARD OF HEALTH / Establishment Name: /J10 l yfCO._ v+rY � Date: (Z///. Page: of Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION 'Date No. Reference R-Red Item _ Verified i f1` / /. PLEASE PRINT CLEARLY r //� n lr i Y z'), P 4-0 'U"A.N" i.n (%moi Van 4%G(hlil :t n. rg 4 i��s'. t ¢ �J4 �� f v� ,, ,] n/o e,%l_)A J h� Ur s��,/��ii -*/- u Q(Y . 1/1 4U.;.[_ u SA � -4).�r '1 iefin.�,.�_ /�1 Cf!"LSv/1_ f ( � lh��l U ,f/ �r�� ,�� I--)sr , ra-,r Ao Lr � 4(xA o1v U(ss,v G/-q 1 �_SD/ CZ4- 0q(5-510C _ n . .-`.�� c-r�`.� f . � �179� Il. r,n �)£C.� v /'Y).1L( {�OP /J ��G✓liz. � �14�( CX17/�U�-' "_ �i,A fSy r/+Ju)n J- ,_< -"Iv, a kl Ae A)oo� l ✓ / 7jr.11 , t ►Gt ?�(.il �- IA�A�d {./. �Ir �,(n(n� C:�' S?d`'� . C�Fcnn��t/�cn Lia L �f�(� IAJ rad �t� ��-- i t Ooo" ,J o^1 rl2Kli(liAJ 4) _�Dr1� Gam°n f� r 1 /1�no I Discussion With Person in Charge: '1 /n Corrective Action Required: 1 LlNo ,"s I have read this report, have had the opportunity to ask questions and agree to correct all ❑ Voluntary Compliance ❑ Employee Restriction/ t 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 twgn�y-five dollars or suspension/revocation of ❑ Embargo ❑ Emergency Closure your food permit. (, I� /� Cl Voluntary Disposal ❑ Other: Violations Related to Foodborne fitness IF;,Rere:ved at i'emperaturestnass Interventions and Risk ALCOrdin{,to Lay. Cooled to Factors(items 1.22) (Cont.) 41 F45'F Within 4 Hour:;. PROTECTION FROM CHEMICALS I StJ!.IS f ooline "+Ieflwd;;for 111-11-'s 19 PHF Hot and Cold Holding or �3-202.12 Additivves" I 14 FoodColorAdditives 3-501.ii,(E) ColiPIIF,,%i;attained at lir below 59`)X:,04(F) 41'1,-1 3-302.14 Protection From Unatlpnrved Ac(cfitives* ' Poisonous or Toxic Substances 3-Sill 11"(A) Hot PHFs Mcinwnled at or above 15 I 1 ll'P ontainers* 7-101.1 t Identifying information--Origina': ( I ?.5011 16(.1) Roasts Heid at or,ibove 130`F. Co 7-102,11 Conunon Name -Workim;Containers' 1 20 Time as a Public Health Control 7-20111 Separation-Storaee- I 13-501.19 Tim:as a Publie Health Control* 1 7_ 159t10u4(Hi Variance keyuirmcut 202 1 I Restriction-Presence and Lee" ( 7-20-2.12 Conditions of(rigs' 7-2.03.1 l Toxic Container:-Prohibitions* � POPULATIONS(REOUATIO S(HSP} FOR HIGHLY SUSCEPTIBLE 411 Sanitizers,Criteria C'hciniaik" I 7-20412 Chemicals for Washing Produce. Ciitnrin" 1 ( B,�etages with Warning Lahcls�21 13-80LII(A) I JnpaAenrn n:d Pre-packa Qed ku,et.and 1 17-204.14 DrvinQ.Aeents.C'nteria" ! 7-205.11 Incidental Fail Contact,Lubrtcantsr I ll(B) 111.e of Pastewized lic,ss' 17-206.11 Restricted Use Pesticides.Cr,ieri:w* 3-}'.01.11 ill) Raw or P,uoal 1p Cool.ed Animal F,xid;md 17-206 12 Rodent Bait Stadous` Raw Seed Sprouts Not Ser-,ed. 7-206.13 Tracking PowderS. Pest Control and I 3-80;.1)((.') unoprnert Foud Package Not Re-served * f Monitoring" CONSUMER ADVISORY _ 22 3-603.11 Conswner Advisor} Posted for Cousnmption of TIMEITEMPERATURE CONTROLS Animal Fxxts'1'lim a:o kaw,i:ndercooked or 16 ! Proper Cooking Temperatures for ( PHfs Not Ceherwie,e Prncessed to Eliminate o . ;-401.11A(1)(2) Eggs- 1.55"F 15 Sec. Pathoaon:.n _ ECrs-1nonediate Service 145'1775sec, 3-301-.13 Pasteurized Fgg, 3ubshuee for R:tw Shell 3-401.11(A)(2) Comminuted Fish, Meats& Game I Eggs. Anitnats- 155"17 15 sec. SPECIAL REQUIRFMENI S -401.11(6)(1)(2) Pork and Beef Roast - 13WF 121 min* 540 009(A)-(D) Violationof Secuot5 590.009 A)-(D)in 3-40L11(AV2) k:nites, InjectedMexts- 155''F15 s ( Sec. a I catering, mobile;aid,te.�Porary and 401.11(A)(3) Poultry,Wild Game,Stuffed PHFs, residential kitchcri operSGons should be Stuffing Containing Fish,Meat, debited under ilia pinoiriate sections Poultry or Ratites-165"P 15 see. �` ubov.3 if i-rated to'fooclhorne illness 3-101.11(C)(3) \M14iole-muscle,Intact Beef Steaks inter ientions and risK factors. Other 145°F" 590-2)09 violations relating to good retail 3-401.12 Raw Animal Foods Cooked in a pracpc..,S4ould be debited under/429- Microwave Ibis"F* Sn.cia;_4tegtri:'ement:. 3,101AI(A)(1)(h) All Other PHFs- 145"F 15sec. � i . I t _ i 17 Reheating for Hot Holding ( VIOLA TIONS RELATED TO GOOD RETAIL PRACTICES 3-403.11(A'WD) PHFs 165'F 15 sec. 4_ I (Iterns 23-30) ?-403.I1(B) Microwave- 165' F2 Minute Standing Cr Ureal and noir-mirk al i iu&+hunv, oluch do lint relate V;rhe Time" Jnndborne i fees, tors listed above, con be. 3-403.11(C) Conimewially Processed RTE Fix-4- I ,/bund it the folioi,ink sections n!tate Food C'odc,urd 105 Cb9Y 140"F 590.000. 3-403 1 I(E) Remaining Unsliced Porticros of Becf i f item- Gcod Rciaii Practices rC590.000 Roasts= 23. na _ k1aoement and Personnel j FC -2 .003 lfi I Proper Coaling of PHrs 24 Food and Food Protection ; FC-3 .004 25. Faaaroent and Ulensis FC--4 .005 3-501.14(A) Cosi ing Cooked PHFs from 110 T to I 26. Nater,PIu :Bina and Waste FC--5 .00o 70°F Within 2 Hours and From 7(1"F 27 P vsical Fac lits FC-it .007 to 4 NF)45"F Within 4 Hours. " ( 128. Pcnsonous of Toxic Material:: FC -7x_0008 3-501.14(B) Cooling PHP:,Made From Ambient 129 Special Ra;quiremerts 009 Temperature Ingredients to 41`'F/45"F 1 130, Other Within 4 Hours'r I :"��n,,,�.,.t�._,,. Din.ae,c xibwl item in ih,federal 11)04 Pend Cods or 105 CMR'No 1;00. ( IMPORTANT MESSAGE ) a FOR OATF � TIME, - ' M OF PHONE AREA CODE NUMBER EXTENSION O FAX ❑ MOBI! F AREA CODER TIME TO CALL TELEPHONED " ECALL CAME TO SEE YOU ' WILL CALL AGAIN WANTS TO SEE YOU l RUSH RETURNED YOUR CALL {� WILL FAX TTO,,YOU MESSAGE SIGNEO ,,f �,rpp�Q_ ayy FORM 4009 MADE IN U.S.A f NOTES _ __ 12 �`Vnddel 17 arc/ Mangy (Tema I _ I _ _ II _ !. ; � - I _ � � ' - _ I' � - �� - __ � - t � ! - _ �� _ ih� _ � i I - CITY OF SALEM /� BOARD OF HEALTH Establishment Name: e';_"evriev>c Date: 3-/�F-05- Page: / of / Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date No. Reference R-Red Item Verified PLEASE PRINT CLEARLY 7n cicrt/lF c �FPv�tR/�1.�m V �iliIsraAI,c A ,i/,/A 1:7< oPesot T aF mom- ),-X IWO i/RS /�_��y✓cS -/a,q /S-// R/r/-041 Ile- Ilei ' FZalf -rfir I I I I I I I I I 1 I 1 I � I I j Discussion With Person in Charge: f Corrective Action Required: I ❑ No I ❑ les I have read this report, have had the opportunity to ask questions and agree to correct all ❑ Voluntary Compliance ❑ Employee Restriction/ inspection, to observe all conditions as described, and to Exclusion violations before the next ins P ❑ Re-inspection Scheduled ❑ Emergency Suspension comply with all mandates of the Mass/Federal Food Code. I understand that noncompliance may result in daily fines of twenty-five dollars or suspension/revocation of ❑ Embargo ❑ Emergency Closure your food permit. 0 Voluntary Disposal ❑ Other: 3-501.14(C) 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 Homs 3-501 15 1 Cooling Ivielhods for PHFs PROTECTION FROM CHEMICALS 1yI PHF Hot and Cold Holding 14 Food or Color Additives 3-2W 12 Additttes� ' 3-501 16/B) Cold PHFs:l4sintainedal rn below 590.0U4(F) 41"/45-Ft 3-302.14 Protection (rout Unapproved Adui6ves" ( 3-501.16(A) Hilt PHFs Maintained at or above 15 Poisonous or Toxic Substances 14U'P. 7-1011 IdenUty;ne information -Original 1. Contuncrs" 3-501.16(A) Roasts Held at at above 130'F. 7-102.11 Common Name-Working Containers' ( 20 I Time as a Public Health Control 7-201,11 Separnnor.-SAnattc` 1 3-501.19 Time as a Pohl c I-Ieahh Control" r 7-202.11 Resirirtion-Presence and Lis.•" 5)(1.004(H) Vananec Requirement 7-202.12 Conditions of Use' 7-20311 'IozicC'untainet,-Prohibitions^ REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-204.11 Sani[izers Criteria --Chemicds* POPULATIONS(HSP) j 7?04 1" Chemicals for Wishing Produce.Ctiteria^ I 121 + 3-80I 11(Al Unpasictawd Pre-packaged lakes and Beverages with Warmrr,Labels" 7-204.14 Doing Agents.Crrteria'' � 3 501.11(B) Use of Pasteurized E;;gs^ ' 7-205.11 Inctdened Food Contact. Lubricants'` 13.801 I I(D) Raw or Partially Cooked Animal Fail acrd 7-206.1 1 Resuicted Use Pesticides•Crireiia'" Raw Seed Sprouts Not Served. 7-206.13 7-206.12 Rodent Bai(StarsPo 3-80111(C) 1lnopared Food Package Not Re-served. 'itarl:mg Fuwd.^rc, Pest Control and i blumrnrin¢ CONSUMER ADVISORY TIME(TEMPERA7URE CONTROLS 22 3-60.11 Consumer Advisory Posted for Consumption of Aminal Foods That are Raw,. Undercooked or 16 Proper Cooking Temperatures for Not Otherwise'Processed to Eliminate Path Qgenc.", E�_gs- ImmcdFl;crrc vr.noo� 3-4011 l At l l(2) Eggs- minctrttc Sir✓ic. 145"F15;ecx I S Sec. ;-302 13 Pasteurized E="o'x Substitute for Raw Shell 3-401.11(AH2) Comminuted Fish. Yir;ns d-C}:tme Eggs* Animals- 155'F s 14t, . 3-401.1 1(B1(1)(2^) Pta'k and Berf Roast - 1'30'F 121 min- SPECIAL REQUIREMENTS 3-40LIHA)(2) Rattles. lnj.cted bleats- 155'F 15 590.009(A)-(D) Violations of Section 590.009(A)-(D)in e,_ M catering, mobile food, temporary and 3-401.11(A)(3) Poult:v, t4rld Gam-Stuffed PHFS, residential kitchen operations should be Stuffing Containing Fish,Meat. debited under the appropriate sections t'oultry or Ratites-105 F 15 sec. ` above if related to foodborne illness 3-401.11(C)(3) Whole.musole, Intact Beef Steaky, interventions and risk factots. Other 145`F" 590.009 violations relating to good retail 3-40112 Raw:1lnnlal Foods Cooked inn practices should be debited under#29- Microwave 165'f, Special Requirements. 3-401.11(A)t,l,0) All Other PHFs - 145"F 15 sec 17 Reheating for Hot Holding VIOLATIONS R.-LATED TO GOOD RETAIL PRACTICES 3-103.11(A)&(D) PHFs 165'F li sec, j (Items 23-30) 3-403.1 It B) Microwar,e- 165`F 2 Minute Standing Critical and ion-erilicul violations, which do not relotr to the Tithe" loodhorne dluess interrenrions anal risk(actors listed above, cart be 3-403.111 C) Commercially Processed RTE Food- ,round in the following s'eetiom o(lhe Food Code and 705 CUR14W F' 590.00o. 3-403.1 1 tE) Remaining Uro liceil Portions of Beef Item Good Retail Practices FC 590.000 Roasts 4 23. Manaqement and Personnel FC-2 .003 1$ Proper Cooling of PHFs f 24. Food and Food Protection FC-3 �_004 3-501.14(A) Coolim,Coked PP,TTs from 140"F to 25 Equipment and Utensils FC-4 _005_ 26. Water, Plumbinq and Waste FC-5 .006 70'F Within 2 Houry and Front 70'F ! 27 Physical Facilitv FC-6 .007 ' to a 1-M45"F'Within 4 Hours. * 26. Poisonous or Toxic Materials FC - 7 .008 3-5ul.14(B) Coping PHFs blade I tom Ambient 29. Special Requirements ._0.09__ 1'eugrera:are (n�irdients to 41'F/45'F 30. Other ! Within 4 Hours' 'Dcnole,enuaal nem inthe federal 1990 Fo,x!Codc.n 109 CNIR;;90.000. CITY OF SALEM BOARD OF HEALTH Establishment Name: Date: Page: of Item Code C-Critical item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date No. Reference R—Red Item Verified PLEASE POINT CLEARLY 1 { 1 1 1 Discussion With Person in Charge: Corrective Action Required: ❑ No ❑ Yes I have read this report, have had the opportunity to ask questions and agree to correct all ❑ Voluntary Compliance ❑ Employee Restriction/ Exclusion violations before the next inspection, to observe all conditions as described, and to ❑ Re-inspection Scheduled ❑ Emergency Suspension comply with all mandates of the Mass/Federal Food Code. I understand that noncompliance may result in daily fines of twenty-five dollars or suspension/revocation of ❑ Embargo ❑ Emergency Closure your food permit. ❑ Voluntary Disposal ❑ Other: �i'I ��..3• Y' `•1--^rT�^V\ate\�'}vYV`it �k�'G`Y.ww = �a av «4is�' t .r:V �. ' - f N• ' - ' . .- i- - 3-501.14(0', PHFs Received at'lemperatarec Violations Related to Foodborne Illness Interventions and Risk According to law Cooled to Factors(Items 1.22) (Cont.) I I 'Fi45`F Within 4 Homs- PROTECTION FROM CHEMICALS I 3-50 1.15 Coolinll Methods for PHFs f 119 PHF Hot and Cold Holding 114 Food or Color Additives 3-501.16(B) Cold PfIPs Mnlnta ned at or below 3-202.12 Additives" 590 004(F) -41'145' F" 1$ 13 302.14 Protection from Unapproved Additives* 3-501.161(A) Hut PHF.:Maintained at or above Poisonous or Toxic Substances I 1400E * 7-10t.1 I Identifying Information-Original ( 3-ibl.l6(:4) kusts Field at or above 130`F. Containers" 7-102.11 Common N.uue-Workin;;Containers" 20 Time as a Public Health Control IS7-201.11 13-501.19 Time a.,a Public Health Connnl' eparation-Storage" 1590.U04(H) Variance Requirement 7-202.t 1 Restriction-Presence and Use* 7-202.12 Conditions of User 17-203.11 Toxic Container,-Prohibitions' REQUIREMENTS FOR HIGHLY SUSCEPTIBLE ( 7-204.11 Sanitizers,Criteria - ChemPOPULATIONS(HSP)icals* I 7-204.12 Chemicals for Washing Produce,Criteria" ( 21 3-301 11(A) I Unpasteurized Prepackaged Junes and Bevei,lees with Warning I,abel.s* 17- 04.14 Drying Agents.Criteria 3-501 11(B) Use of Pasteurized Hees'^ 7-205.11 Incidental Food Contact. Lubrtcants� ( 3-801 11(D) Raw or P.utia'ly Cooked Anunal Food and-- -) 7-206.11 Restricted Use Pesticides.Criteria* Raw Seed Sprouts Not Served. +z 7-206.12 Rodent Bait Stations"' I 3-SO I.i I(C) I Unopened r(axi Package Not Re-served 7-206.13 Tnwkmg Powders,Pest Control and Monitoring' CONSUMER ADVISORY TIMEITEMPER'1TURE CONTROLS 22 3-603.11 Consamei Alt isory Posted for Coinunlption of Anneal F(xul.'I'h;a arc Raw. Undercooked of lfi Proper Cooking Temperatures for Not Otherwise Processed to Eliminate PHFs En3cr:,.•n.�am 3-401.11A(I)(2) Eggs- 155`F 15 Sec. Pathogens." Eggs-Lnmediate Service 145"Fl5sec• 3-302.13 Pastenri'red Egg,Subsdurtc for Raw Shell 3-401.11(A)(2) Comminuted Fish,Moan,&Game Fggs* Animals- 155'F 15 sea 3-401.11(B)(1)(2) Pork and Beef Roust- 130'F 121 min" I SPECIAL REQUIREMENTS 3-401.1l(A)(2) Ratites, Injected Meats-155'E IS 590.009(A)-(D) Viola tons of Section 590.009(A)-(D) in sec. ` I eatcrind„ mobile food, tomporary and 3-401.1 I(A)(-') Poultry,Wild Game,Stuffed PHFs, residential kitchen operations should be Stuffing ContaininFish, Meat, debited under the appropriate sections Poultry or Ratites--165'P 15 sec. ' above if related to foodborne illness 3-401.11(C)(3) Whole-muscle, Intact Beef Steaks imerventions ar,d risk factors. Other 1450E 590.009 violations relating to good retail 3-401.12 Raw.Animal Foods Cooked in a practices should he debited under #29- Microwave 165"F" Special Requirements. 3-401.1 I(A)(1)(b) All Other PHFs- 145`F 15 see. 117 Reheating for Hot Holding VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 3-403.11(A)&(D) PHFs 1650E 15,sec. * (items 23-30) 3-403.11(B) Microwave 1650 F 2 Mmule Standing Crilind ural non-rritiral rndaharrs, whi(h 4v not rela!e In the Time" v lbndborne illness inrerrennow,and riskja(torc lisl0d abnne• can be 3-403.11(C) Commercially Processed RTF Foul- ,!(/arid in the jb,"Inr.in,g sections ofthe F,ael Code and 105 CMR 140"F 590.000. 3-403.11(0) Remaining Unsliced Portions of Beef I Item Good Retail Practices FC 590,000 Ronsts' ( 23. Management and Personnel FC - 2 .003 24. Food and Food Protection FC-3 004 IA Proper Cooling of PHFs I -� 3-501 14(A) Cooling Conked PHFs from 140"F es 25 Eater, Pluent and Utensils FC-4 ,_A05 126. Water, Flmnbinq and Waste FG-5 1 .006 701F Within 2 flours and From 70'F 27. Physical Facility_--_- .--_ FC--6 007 to 41`F/450F Within 4 Hours. * 28. Poisonous nr Toxic Matenals FC-7 .008 J 3-501.14(li) Cooling PffFs Made From Ambient 29. Special R(rui,ements 009 Temperature Ingredients to 41'F/d5'F 30, Other Within Hours)" Denote,:critical item in the asicral 1094 Food Cade of 105 CMR 590000.i. CITY OF SALEM BOARD OF HEALTH Establishment Name: Date: Page: of Item ' Code C-Critical item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date +� No. Reference R—Red Item Verified L PLEASE PRINT CLEARLY + F I C I l ( r { t G � I j I I 1 1 t I 1 I Dis�sion With Person in Charge: Corrective Action Required: I C3No I ❑ Yes have read this report, have had the opportunity to ask questions and agree to correct all Cl Voluntary Compliance ❑ 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 Food Code. I understand that f noncompliance may result in daily fines of twenty-five dollars or suspension/revocation of ❑ Embargo ❑ Emergency Closure your food permit. _ ❑ Voluntary Disposal ❑ Other: } I WI-) ?HFs Received a-, 'lemperatures Violations Related to Foodborne illness Interventions and Risk Ai-cordite,to L-tw Cooled to Factors(items 1.22) (Cont) LLI'F/45'1-Withm,,4 Hours. x PROTECTION FROM CHEMICALS I 3-501,15 Cooling A'ieihods fox PHFs 14 Food or Color Additives ! I i9 PHF Hat and Cold Holding 3-202.12 Additives r ?-5U 1.16(B) Cola PFtF.Maintained at or below ' I 540.00'4(Fi 3-302.14 Protection bora I1napPruved Additives* ( 590.0 Ui(A tlnr PF?^� :�- JS Poisonous orToxic 3ubsianses ( ) tmntoinedatoraboee 7-10111 identifying Informahnn-Original 110'0. * Containers` 3-5)1,161+1; Roasts Heid ator above 1?0"F ` 7-102.11 Common Name-Working Containers" 120 Torre as a PuGlic Health Control 7-..01..r 1 Sapamtion-Stortge'� I 3-501 t o Timc as a Public Hec(Ith Qnurol* II 17 202.1 t Restriction-Presence and Use" ( 590.00 ;H) Variance Reywrement 7-202,12 Conditions of t se* ( REQUIREMENTS FOR HIGHLY SUSCEPTIBLE '2 7-203,11 Toxic Containers--Chikons'' POPULATIONS(HSP) 7- lk}.7 I I Sanitizets,Criteria hee micals* I n ! , 121 3-501.i i(A) Lnpasrw:r,ed Pr,-pac}.aged Juices mrd 7-_04..2 Chemicals for W'ashmg l rodnce,Ctitariu"' ! Beretta;� ,�- r 7-204.14 Drying Agents.Criteria* I e- won Warning I abets 3-801 11(B) Use of Par:teusized bags' 17-205.11 incidental Futxl Contact.Lnbricanis^ 3-501,11(Dt Raw ri Poul,!!\,Cooked Animal Food and -206,11 Restricted Use Pesticides.Criterur* 7-206.12 Rodent Bait Raw SccQ Sprouts :Not Sci'-ed. ., 1 I I 7-206.13 Tracking Powdrrc.Pest Control and x-gtil.11(C') 1 Umarened RonNot Re-served Fac}.u;x , Monitorings CONSUMER ADVISORY TIMEtTEMPERATURE CONTROLS 22 3-603.11 Consjoiet .Advisory Posted for Con=unrption of Ani,-nal Fuodt Thar arc Raw. Undercook.d or 16 Proper Cooking Temperatures for \'ot Otherwise Pr,.eSwd to Eliminate PHFs -101.1 lA(I 1(2) Eggs- I55''F 15 Sec 1=athogcns.* E;?res-I n oudian-Service 145°F15sec. 3-302.13 Pasteurized Eggs S:;.ort hate for Raw Shell 3-401.1 I G%)(2) Comminuted Fish,Dlcats .0 Game I Eggs, Animals- 155'F 15 sec. "' _ I SPECIAL REQUIREMENTS 13-401.11(B)tl)(2) Pork and Beef Roast- 130'F 121 min* 3-401.1 l(A)(2) Ratites,injected Meats- 155"F 15 I 590.000(5)-(D) Violations of Section, 590.009(A)-(U) in Sec•- catering, mobile food,temporary and 3-401.11(A)(3) P011hry,Wild Game,Stufted PHFs, residential kitchen operations should be Stuffing Containing Fish, Meat, debited under rite appropriate srctions Poohr,or Ratites-165°F 15 sec. „ I above if related to foodborne illness 3-401.11(C)(3) Whole-muscle,Intact Beet Steaks I interventions and risk factors. Other 1451 F•,. 590.009 violations relating to good retail 3-417.12 Raw Animal Foods Cooked in a pracucc�should be debited under/129- Microwave 165`F * _! Sa::cial Rcauiremcnts. 3-401.17(A)(1)(b) All Other PHFs- 145'F 15 sec 1 17 I Reheating for Hot Holding VIOLATIONS R.:LATED TO GOOD RETAIL PRACTICES 3-403.11(.)&(D) I PH Fs 165'F 15 sec, * (ftertts 23-30) 3-403.11(B) ( Microwave 165"F 2 Minute Standine Critlro!.'.r.l non-rrit o![!^hr!u,ne, , titch J,,norrelate to the Time* ,foodborne it/ner inteiventinm and risk%oc tors liatel above, (an be 3-40'1.11(C) Commercially Pimessed RTE Food- ,gourd in 1he tnl!nn mg sertinns of the Fool Cade and 105 CMR 14lYF 500.090. '•-103.1 t(E) Remaining Unsliced Portion:;of Beef Item Good Relsi(Practices FC 590.000 Roasts= 1 23. 6fanagerri,Ait and Personnel FC-2 .003 � I 24. Fool!and Ford Protection FC-3 .004 IR Proper Cooling of PHFs ---� 25. Equipment and WciiMs FC -4 .005 3_501 MIA) Cooling,G,o}:cd PHFs from 140`F to 20, Water,Plwnbinq and Waste FC-5 .006 1 '70:F Within 2 Hours and From 70°F I 27, P!rvs ;at Fac!lily Pi --6 .007 to 41,,Ff451F Within 4 Hours. * 23. Poisonous or Toxic hietenals FC - 7 .008 I 3-501.!4(B) Cooling PFMs Made From Ambient 129. Special Requinmients .009 Ternpetature ingredients to 41'-/45"F 130, O?het 1 Within 4 F-lour,;' .•.rr,„, in.z m,. ' Dcnotds cancel item:n the fenced 1990 Food Code or 105 CN1R 590 000 Massachusetts Department of Public Health Salem Board of Health Division of Food and Drugs 120 Washington Street,4t"Floor 9 Salem, MA 01970-3523 FOOD ESTABLISHMENT INSPECTION REPORT Tel. (978) 741-1800 Fax (978) 745-0343 Name Date Tyoe of Ooeration(s), Tyge of Insoection ❑ Food Service ❑ Routine Address Risk ❑ Retail ❑ Re-inspection Level ❑ Residential Kitchen Previous Inspection ITelephone ❑ Mobile Date: Owner HACCP YM I ❑ Temporary ❑ Pre-operation ❑ Caterer ❑ Suspect Illness Person in Charge(PIC) Time ❑ Bed&Breakfast ❑General Complaint In: ❑ HACCP Inspector I Out: Permit No. ❑ Other Each violation checked requires an explanation on the narrative page(s) and a citation of specific provision(s)violated. Non-compliance with: Violations Related to Foodborne Illness Interventions and Risk Factors Anti-Choking Tobacco Violations marked may pose an imminent health hazard and require immediate corrective 590.009(E) ❑ 590.009(F) ❑ action as determined by the Board of Health. FOOD PROTECTION MANAGEMENT ❑ 12. Prevention of Contamination from Hands ❑ 1. PIC Assigned/Knowledgeable/Duties ❑ 13. Handwash Facilities EMPLOYEE HEALTH - . 'PROTECTION FROM CHEMICALS ❑ 2. Reporting of Diseases by Food Employee and PIC ❑ 14.Approved Food or Color Additives ❑ 3. Personnel with Infections Restricted/Excluded ❑ 15.Toxic Chemicals FOOD FROM APPROVED SOURCE. - ❑ 4. Food and Water from Approved Source TIMHTEMPERATURE CONTROLS(Potentially Hazardous Foods) ❑ 5. Receiving/Condition ❑ 16.Cooking Temperatures ❑ 6. Tags/Records/Accuracy of Ingredient Statements ❑ 17. Reheating ❑ 7. Conformance with Approved Procedures/HACCP Plans ❑ 18•Cooling PROTECTION FROM CONTAMINATION ❑ 19. Hot and Cold Holding ❑ 8. Separation/Segregation/Protection [120.Time As a Public Health Control ❑ 9. Food Contact Surfaces Cleaning and Sanitizing r REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP)-;' ❑21. Food and Food Preparation for HSP ❑ 10. Proper Adequate Handwashing ❑ 11.Good Hygienic Practices CONSUMER ADVISORY ❑22. Posting of Consumer Advisories Violations Related to Good Retail Practices Number of Violated Provisions Related Critical (C) violations marked must be corrected To Foodborne Illnesses Interventions immediately or within 10 days as determined by the Board and Risk Factors(Items 1-22): of Health. Non-critical (N) violations must be corrected Official Order for Correction: Based on an inspection immediately or within 90 days as determined by the Board today,the items checked indicate violations of 105 CMR of Health. 590.000/federal Food Code. This report, when signed below c N by a Board of Health member or its agent constitutes an 23. Management and Personnel (Fc-2) order of the Board of Health. Failure to correct violations 24. Food and Food Protection (Fc-3)(590.0so.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)(590.006) and submitted to the Board of Health at the above address 29. Special Requirements (590.009) within 10 days of receipt of this order. 30. Other DATE OF RE-INSPECTION: S 5soInspociFom is me Inspector's Signature: Print: PIC's Signature: Print: Page_of Pages Violations Related to Foodborne Illness Interventions and Risk Factors(Items 1-22) PROTECTION FROM CONTAMINATION FOOD PROTECTION MANAGEMENT S Cross-contamination , 1 590.003(A) Assignment of Responsibility* 3-302.1 I(A)(1) Raw Animal Foods Separated from 590.003(B) Demonstration of Knowledge` Cooked and RTE Fads* 2-103.11 Person in charge-duties I Contamination from Raw ingredients 3-302.11(A)(2) a Raw Animal Foods Separated from Each EMPLOYEE HEALTH I I Other' 2 590.003(0) Responsibility of the person in charge to ( I Contamination from the Environment require reporting by food employees and 3-302.11(A) Food Protection* applicants* 3-302.15 Washing Fruits and Vegetables 590,003(F) Responsibility Of A Food Employee Or An 3-3(A.1 I Food Contact with Equipment and Applicant To Report To The Person In Utensils* Charge* Contamination from the Consumer 590.003(G) Reporting by Person in Charge* 3-306.14(A)(B) i Returned Food and Reservlce of Food* I 3 590.003(D) Exclusions and Restrictions* Disposition of Adulterated or Contaminated_ 590.003(F,) Removal of Exclusions and Restrictions ( Food 1 3-701.11 Discarding or Reconditioning Unsafe FOOD FROM APPROVED SOURCE Food* 4 Food and Water From Regulated Sources ( 9 Food Contact Surfaces 59U.004(A-B) Compliance with Food law* ( ( 4-501.1 1 I 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-Hot Water � Sanitization Temperatures*3-202.13 � Shell Eggs* I -- -- - - - - - -- ---- 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. * 4-601.1 If A) Equipment Food Contact Surfaces and 5-1.01.1 1 Drinking Water from an Approved System" Utensils Clean* 590.006(A) Bottled Drinking Water* I 4-602.11 Cleaning Frequency of Equipment Food- 59(}006(B) Water Meets Standards in 310 CMR 22.0*` Contact Surfaces and Utensils* _ Shelflish and Fish Froman Approved Source 4-702.11 Frequency of Sanitization of Utensils and 3-201.14 Fish and Recreationally Caught Molluscan Food Contact Surfaces of Equipment* Shellfish' 4-703.11 Methods of Sanitization-Hot Water and 3-201.15 Molluscan Shellfish from NSSP Listed ( Chemical* Sources* Game and Wild Mushrooms Approved by ( 10 I Proper,Adequate Handwashing Regulatory Authority ( 2-301.11 Clean Condition-Hands and Arius" 3-202.18 Shellstock Identification Present* 2-301.12 Cleaning Procedure* 590.004(C) Wild Mushrooms* I 2-301.14 When to Wash* 3-20117 Game Animals* 111 Good Hygienic Practices - 5 Receiving/Condition 2401.11 Eating,Drinking or Using Tobacco* - 3-202.11 PHFs Received at Proper Temperatures* 12-401.12 I Discharges From the Eyes, Nose and 3-202 t5 Package Integrity* Mouth* 3-101.11 Food Safe and Unadulterated* 3-301.12 Preventing Contamination When Tasting" 6 Tags/Records:Shellstock 12 Prevention of Contamination from Hands 3-202.18 Shellstock Identification* 590.004(E) I Preventing Contamination from 3-203.12 Shellstock Identification Maintained* Employees* 13 Handwash Facilities TagsMecords:Fish Products I - 3-402,11 Parasite Destruction* I I ConvenienttyLocated and Accessible 3-402.12 Records.Creation and Retention* 5-203.11 ( Numbers and Capacities* 590.0040) Labeling of Ingredients' 5-214.11 Location and Placement* 7 Conformance with Approved Procedures 5-205.11 Accessibility.Operation and Maintenance I ( ( /HACCP Plans I Supplied with Soap and Hand Drying 3-502.11 Specialized Processing Methods* ' 3-502.12 Reduced oxygen packaging,criteria* 6Devices -301.11 Handwashing Cleanser, Availability 8-103.12 Conformance with Approved Procedures* 6-301 12 Hand Drying Provision Denotes critiad item in the federal 1999 Fond Code of 105 CMR 598000 b' Massachusetts Department of Public Health Salem Board of Health 120 Washington Street,0 Floor Division of Food and Drugs Salem, MA 01970-3523 FOOD ESTABLISHMENT INSPECTION REPORT! Tel. (978) 741-1800 Fax (978) 745-0343 Name ` Date Tyge of Ooeration(s). Type of Insoection ❑ Food Service ❑ Routine Address Risk ❑ Retail ❑ Re-inspection Level ❑ Residential Kitchen Previous Inspection Telephone ❑ Mobile Date: Owner HACCP Y/N ❑ Temporary ❑ Pre-operation ❑ Caterer ❑ Suspect Illness Person in Charge(PIC) Time ❑ Bed&Breakfast ❑ General Complaint In: ❑ HACCP Inspector Out: Permit No. ❑Other Each violation checked requires an explanation on the narrative page(s)and a citation of specific provision(s) violated. Non-compliance with: Violations Related to Foodborne Illness Interventions and Risk Factors Anti-Choking Tobacco Violations marked may pose an imminent health hazard and require immediate corrective 590.009(E) ❑ 590.009(F) ❑ action as determined by the Board of Health. FOOD PROTECTION MANAGEMENT ❑ 12. Prevention of Contamination from Hands ❑ 1. PIC Assigned/Knowledgeable/Duties El 13. Handwash Facilities EMPLOYEE HEALTH PROTECTION FROM CHEMICALS ❑ 2. Reporting of Diseases by Food Employee and PIC ❑ 14.Approved Food or Color Additives ❑ 3. Personnel with Infections Restricted/Excluded ❑ 15.Toxic Chemicals FOOD FROM APPROVED SOURCE r . TIMEITEMPERATURE CONTROLS(Potentially Hazardous Foods ' ❑ 4. Food and Water from Approved Source ' "^ ( Y ❑ 5. Receiving/Condition 1:116. Cooking Temperatures ❑ 6. Tags/Records/Accuracy of Ingredient Statements ❑ 17. Reheating ❑ 7. Conformance with Approved Procedures/HACCP Plans ❑ 18.Cooling . PROTECTION FROM CONTAMINATION ❑ 19. Hot and Cold Holding ❑ 8. Separation/Segregation/Protection ❑20.Time As a Public Health Control ❑ 9. Food Contact Surfaces Cleaning and Sanitizing REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) ❑21. Food and Food Preparation for HSP ❑ 10. Proper Adequate Handwashing ❑ 11. Good Hygienic Practices CONSUMER ADVISORY , ... .. .. ❑22. Posting of Consumer Advisories Violations Related to Good Retail Practices Number of Violated Provisions Related Critical (C)violations marked must be corrected To Foodborne Illnesses Interventions immediately or within 10 days as determined by the Board and Risk Factors(Items 1-22): of Health. Non-critical (N)violations must be corrected Official Order for Correction: Based on an inspection immediately or within 90 days as determined by the Board today, the items checked indicate violations of 105 CMR of C Health. 590.000/federal Food Code. This report, when signed below 23. Management and Personnel (FC-2)(590.003) by a Board of Health member or its agent constitutes an 24. Food and Food Protection (FC-3)(590.004) order of the Board of Health. Failure to correct violations 25. Equipment and Utensils (FC-4)(590.005) cited in this report may result in suspension or revocation of the food establishment permit and cessation of food 26. Water, Plumbing and Waste (FC-5)(590.006) establishment operations. If aggrieved by this order, you 27. Physical Facility (FC-6)(590.007) have a right to a hearing. Your request must be in writing 28. Poisonous or Toxic Materials (FC-7)(590.008) and submitted to the Board of Health at the above address 29. Special Requirements (590.009) within 10 days of receipt of this order. 30. Other DATE OF RE-INSPECTION: S 5BOlnsIdFor -14 ex Inspector's Signature: Print: PIC's Signature: Print: Page_of Pages Violations Related to Foodborne Illness Interventions and Risk Factors(items 1-22) PROTECTION FROM CONTAMINATION FOOD PROTECTION MANAGEMENT 18 Cross-contamination I 1 1590.003(A) Assignment of Responsibility' 3-302.11(A)(1) Raw Animal Foods Separated from 590.003(B) Demonstration of Knowledge* I Cooked and RTE F(x J 2-103.11 Person in charge--duties I Contamination from Raw ingredients 3-302.11(A)(2) Raw Animal Foods Separated from Each EMPLOYEE HEALTH Other* 2 590.003(C) Responsibility of the person in charge to I Contamination from the Environment require reporting by food employees and 3-302.11(A) Food Protection* f applicants* 13-302.15 Washaw Fruits and Vegetables I ' 590.003(F) Responsibility Of Foal Employee Or An ( 3-3(14.7 1 Food Contact with Equipment and .Applicant To Report To The Person In Utensils* Charge* ( I Contamination from the Consumer 590.003(G) Reporting by Person in Charge* I 3-306.14(A)(R) I Returned Food and Reservice of Food* 3 1590.003(D) Exclusions and Restrictions* I Disposition or Adulterated or Contaminated 590.003(E) I Removal of Exclusions and Restrictions I Food 3-701.11 Discarding or Reconditioning unsafe FOOD FROM APPROVED SOURCE Foci* J 4 Food and Water From Regulated Sources 19 Food Contact Surfaces 590.004(A-B) Compliance with Food law* I 1-501.111 Manual Warewashing-Hot Water 3-201.12 Food in a Hermetically Scaled Container* Sanitization Temperatures* 3-201.13 Fluid Milk and Milk Products* I 4-501.112 Mechanical W'arewashing-Hot Water 13-202.13 Shell Eggs* I Sanitization Temperatures* 13-202.14 Eggs and Milk Products,Pasteurized* 4-501.114 Chemical Sanitization-temp.,pH, 13-202.16 Ice Made From Potable Drinking Water^ _ concentration and hardness. ;' 5-101.11 Drinking Water from an Approved System" 4-60 1.11(A) Equipment Foaf Contact Surfaces and 590.006(A) Bottled Drinking Water* Utensils Clean' - 590 006(B) Water Meets Standards in 310 CMR 22.0* I ( 4-602.11 I Clearing Frequency of Equipment Food- Contact Surfaces and Utensils* Shellfish and Fish Froman Approved Source ( 4-702.11 Frequency of Sanitization of Utensils and 3-201.14 Fish and Recreationally Caught Molluscan ( I Food Contact Surfaces of Equipment* Shellfish- ( 4-703.11 I Methods of Sanitization-Hot Water and 3-201.15 Molluscan Shellfish from NSSP Listed Chemical* Sources* 110 Proper,Adequate Handwashing Game and Wild Mushrooms Approved by Regulatory Authority I 12-301.11 Clean Condition-Hands and Arms* 3-202.18 Shellshx:k Identification Present* ( 2-301.12 Cleaning Procedure* 590.004(C) Wild Mushrooms* I 2-301.14 I When to Wash* 3-201.17 Game Animals* I 111 I Good Hygienic Practices g Receiving/Condition I 12401.11 Eating,Drinking or Using Tobacco* 3-202.11 I PHFs Received at Proper Temperatures* I I 2-401 12 Discharges From the Eyes,Nose and 3-202.15 I Package huegrity* I Mouth* 3-101.11 ( Food Safe and Unadulterated* 3-301.12 Preventing Contamination)Mien Tasting* 6 Togs/Records:Shelistock I 112 Prevention of Contamination from Hands 3-202.18 Shellstock Identification* I 590.004(F) Preventing Contamination from 13-203.12 Shellstock Identification Maintained* I Employees* Tags/Records: Fish Products I 113 ( Handwash Facilities 13402.11 Parasite Destruction* I I Conveniently Located and Accessible I 3-402.12 I Records,Creation and Retention* 5-203.11 Numbers and Capacities* � 590.004(1) I Labeling of Ingredients* 5-204.11 Location and Placement* 7 ( Conformance with Approved Procedures 15-205.11 Accessibility,Operation and Maintenance IHACCP Plans Supplied with Soap and Hand Drying 3-502.11 I Specialized Processing MethoDevices ds* 6-301 I1 Handwashing Cleanser,Availability 3-502.12 I Reduced oxygen packaging,criteria* 18-103.12 I Conformance with Approved Procedures* 16-301.12 Hand Drying Provision Denolec critical item in the federal 1999 Fond Code of 105 CMR 590.000. t CITY OF SALEM /�}' BOARD OF HEALTH Establishment Name: VIIrUUVLCIl �6r C,l{ Date: Page: of I F Item Code C-Critical Rem DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date t No. Reference R—Red Item Verified d PLEASE PRINT CLEARLY Jr HRC C'P 1 n`iy o'1/111h) M aWrP 17hd for'o a � Jai ban_ ah°a., Dnee act!/e%e>c K -rnVWIC v{ / s �/a�oc( /,#A � cec In is Than p/o-�W «r4 1�9r✓ia�r/iro/ SeJtii,�4'�J �lfeC�zLls fYr�lo hai( aPfJLfJ a�' �BGflzu,s�cfozs fla/r�ancP,�eP) - r�oace? IV,, #U,lro /mif 47) _WaIP4141 r r �knLn /)r 4/ 0F rn hP/mU aS 7Y1C��i�2fel1 7ea off' P,4,4c;?9 was -jvw) af'-!ice �enan of L11, 9°f. 6,01 I'10 /�0raR r7 -len't0 -4i>t P#F) - Xv2 �D�oinq art /C� woIn S�.oV�k'. errs c e also � cl Cutin,- lxOk,,( In harK pwoapeo -f17G1 w� 1 I �Izilrt�C(+ gcv red, -kp t;MPpc(ccf /�i�c�.o� I r�s�ec fidrr. rl iscussion With Person in Charge: Corrective Action Required: ❑ No ❑ Yes a have read this report, have had the opportunity to ask questions and agree to correct all ❑ Voluntary Compliance ❑ Employee Restriction/ 4. 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 finesof my ve do/llaon9 �rs or susUensirevocation of ❑ Embargo ❑ Emergency Closure your food permit. ' " ❑ Voluntary Disposal ❑ Other: n k s Received at Ten:ocrarures Violations Related to Foodborne Illness Interventions and Ribk According 1, l.tw Cooled to Factors(items 1.22) (Cont.) -1!"F7=t5`F Within 4 Houcc. PROTECTION FROM CHEMICALS 3-50:.!5 Cooling M- thuds for P-4F':: 14 Food or Color Additives 19 PHF Hat and Cold Holding 3-202.12 ( Additives'" -I 3-50t.16;'P) Cold PIIF1.Maintained at or below 3-302.14 Protedllon from Unapproved Addmves^ ( i ¢_50 L Iii(A) I ;-{or Pft?-;Maintained at or above 15 Poisonous of Toxic Substances 140'1 ^ 7-If)1.11 Identityutelnformation-Original ' 1.16(A 1 ; R,:asis Held at or above li0`F. Containers' ; _ J 7 102,11 Common Name-Working Containers` 20 time as a Pao11C Health Control 7-201.11 Separation-Shxaec"' �-501.19 -('imoaeAPu!,licHeclthControl* 7-202.11 Restriction-Presence and Ike" ''i0.004i H? V.ui win:c Requu ement 7-202.12 Conditions of Use, 7-'_03,1 l rove Containers-Prohibitions* RrOUIREMEt�TS FOR F iGNLY SUSCEPTIBLE 7-204.11 Sanitizets.Criteria-Chenncals'- I POPULATIONS(HSP) 7-204 12 ( Chenriuds for W'aehmg Radice,Criteria" n1 3-801.1!(A) I Unpasxeurved Pre-packaged Juices and 7-204.14 Drying Agents.Criteria" I y Brvcra�-es vith Warning l;tb..ls' - -- 801.11(B) ! Use of Pasteurized f�'pa* 7-205.1 I ( Incidental Food Contort, Lobricants` I ?-,t 01.l I(D) Raw or ParaAnimist :dly Cooked Food and 7-206.1 I Restricted Use Pesticides. Crituta* ( a( I Ram Seed Sprouts ::,ret Screed. " 7-206.12 Rodent Bait Stations` ( f ' 7-206.!3 I 'i•racking Powders.Pest Control and 3-801.1!(C) Ur:opene<f Ford Parkagc Not Re-served. I Monitoring' CONSUMER ADVISORY TIMEITEMPER 1TURE CONTROLS 22 3-603.11 Conscriet Advisory Posted for Consumption of Animal Faxk That aro Raw,Undercooked or 15 Proper Cooking Temperatures for tint Otherwise Prncessed to Eliminate PHFs er.cs.+;v ron, 3-40L11A(1)(2) F.gg.- 155"F IS Sec. P:uhog'ns.* I Eggs-Immediate Service 145'Fl5Iec 3-302.13 Pasieur:zccf figgs Sub;titote for Raw Shell 3--101.11(A)(2) Comtmnuted Fish,Meats&Game I Eges" Animals - li5'F IS sec. 3-401.1 I(B)(1)(2) Pork and Bcef Roast - 1'0WF 121 min` ( SPECIAL REOUIREMENTS 3-401.11(A)(2) Ratites, Injected Meats- 155'F 15 590m(19(A) t D) Violations of Section 590.009(A)-(U)in sea r I c;ncring, 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 Poultry or Ratites-165°F 15 scc. * above if related o)foodborne illness 3-401.11(C')(3) Whole-muscle Intact Beet Steaks interventions and risk factors. Other 145"F:1 590 000 violal Ions relating to good retail 3-401.12 Raw Anint:d Foods Cooked in a pu:chess should be debited under #29- Mictow•ave 165"F* I Special Keyuirements. 3-401 1 I(A)(1)fb) All Other PHFs- 145'F 15 see. " 17 Reheating for Hot Holding VIOLATIONS R.:LATED TO GOOID RETAIL PRACTICES 3-403.1l(A)K(D) PHP, 165'F 15 sec. ' ( (Items 23-30) i-103.11(B) M'icrowav'e- 165' F 2 Minute Standimt I Cr:lrnd and aon-crlti(al rrrdurnrrs, which do not relate to,Lr 'Gime" fi odburne i!(nesa intcrvennom wid risk hoots listed above. Can be 3-40111(C) Conner niI y Processed RTE Food- I ./mold in the f//owing sections o'Ohe Food Code and 105 CMR 140"F- 590.000. -403.11(F,) Remainin_Unsliced Portions of Beef I Item Good Retail Practices FC590.000 Roasts" 123. 61anactemrnt and Personnel FC-2 .003 I 18 Proper Cooling of PRFs 24 Food and Facd Protertion FC 3 604 25. Eouiomen;and Ulensds FC -4 I .005 1 3-5(}1.14(,V CaiGncCooked PHGsfrom 140'rFto 26. Water, Piunbinoand'War e FC-5 1 006 70"1-Within 2 Hours acrd From 70'F 27 Php-mJ Faca!it7 FC - 6 .007 to 41"FI45'-F Within 4 Hours. 28. Poisonous or Toxic Material: PC-7 i-.008 3-501.14(B) Cooling PHPs Made From Ambient ( 29. Special Repmrernenta I .00y 'Pemperahue Ingredients to 41'P145`F 30. G!ber 1 Within 4 Hourc:x 1 Denows emelt Item!n the le feral 1999'rood Code or 105 04k 590 000, r of 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 Date Typ"f Ooeration(s), Tvpe of Insoection 6/1[)0/417 lQ10AIJ N/ +r/'6 y W�Food Service ❑ Routine Address Risk ElRetail 0 fie-inspection n� �! - Level ElResidential Kitchen Previous Inspection Telephone �y� .- y yep E:1 Mobile Date: Owner HACCP WN El Temporary ElPro-operation AJi w Pgwn ' /t&frAxA✓1fr LL(, ❑ Caterer ❑ Suspect Illness Person in Charge(PIC) Time ❑ Bed& Breakfast ❑ General Complaint In Inspector Permit No. El EIHACCP O herr dl� rrICal:�rl.1jjA Out: Each violation checked requires an explanation on the narrative page(s)and a citation of specific provision(s)violated. Non-compliance with: Violations Related to Foodborne Illness Interventions and Risk Factors Anti-Choking Tobacco Violations marked may pose an imminent health hazard and require immediate corrective 590.009(E) ❑ 590.009(F) ❑ action as determined by the Board of Health. FOOD PROTECTION MANAGEMENT ❑ 12. Prevention of Contamination from Hands ❑ 1. PIC Assigned/Knowledgeable/Duties ❑ 13. Handwash Facilities EMPLOYEE HEALTH PROTECTION FROM CHEMICALS [:] 2. Reporting of Diseases by Food Employee and PIC ❑ 3. Personnel withflnfections Restricted/Excluded El 14.Approved Food or Color Additives pS FOOD FROM APPROVED SOURCE El 15.Toxic Chemicals ❑ 4. Food and Water from Approved Source TIMEfrEMPERATURE CONTROLS(Potentially Hazardous Foods) ❑ 5. Receiving/Condition ❑ 16.Cooking Temperatures ❑ 6. Tags/Records/Accuracy of Ingredient Statements ❑ 17. Reheating ❑ 7. Conformance with Approved Procedures/HACCP Plans ❑ 18. Cooling PROTECTION FROM CONTAMINATION ❑ 19. Hot and Cold Holding ❑ 8. Separation/Segregation/Protection ❑20.Time As a Public Health Control ❑ 9. Food Contact Surfaces Cleaning and Sanitizing REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) El 10. Proper Adequate Handwashing El21. Food and Food Preparation for HSP ❑ 11. Good Hygienic Practices CONSUMER ADVISORY ❑22. Posting of Consumer Advisories Violations Related to Good Retail Practices Number of Violated Provisions Related Critical (C) violations marked must be corrected To Foodborne Illnesses Interventions immediately or within 10 days as determined by the Board and Risk Factors(Items 1-22): 0 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 c tv below P 23. Management and Personnel (FC-2)(590.003) by a Board of Health member or its agent constitutes an 24. Food and Food Protection (FC-3)(590.004) order of the Board of Health. Failure to correct violations 25. Equipment and Utensils (Fc-4)(590.005) cited in this report may result in suspension or revocation of the food establishment permit and cessation of food 26. Water, Plumbing and Waste (FC-5)(590.006) establishment operations. If aggrieved by this order, you 27. Physical Facility (FC-6)(590.007) have a right to a hearing. Your request must be in writing 28. Poisonous or Toxic Materials (FC-7)(590.006) and submitted to the Board of Health at the above address 29. Special Requirements (590.009) within 10 days of receipt of this order. 30. Other DATE OF RE-INSPECTION: S 5901n5pPCIFomS-14 tl e}_ Inspector's Signatur _ . ,._-/f 7 / Prink PIC's Signature:tl 111•" A I l .n l Prin[: /I ,.Q n +/K I / �,C J Page of ZPages Violations Related to Foodborne illness Interventions and Risk Factors(items 1-22) PROTECTION FROM CONTAMINAiiON FOOD PROTECTION MANAGEMENT S Owss-ccntamlratior. 1 590.003�A) Assigrnuem of ResponsibiiitvT j ;.;0; 11(A)(:) mart- imn:,d roods Separated fn+m 590.003(B) I Demonstratxrn of Know)ed,eI I C,`ooi:ed aad tKTE Fo�.ds* b i0'3. l Yci.;(,n in charge-ihttirs ! ( C,cnta^:inahinr from,San•ingredients 3-3f)2 I1(AY,2) Raw Animal F+vele Srpamtedfrmn Each EMPLO`•EE HEALTH Gt11er' 2 590.003101 Responsibility of the person in cam ge to I Conta.mee rior:from 8,r EnOonmcin reynire repro�mz by food employees::ud 13-307 1 If A) Food Protection- - - applicants* ( 3-3112.15 'YVashntr hrmis and Veg-tables 590.003!Fi Responsibility Oi A Food Employee Or An 3-30-'.11 }-rod Contact with T-iquipmeut and Applicant To Report'to The Person In llteus)1;" C'hdr;a* I on+artnari in from the Conz+mer 590,0031 G7 Reporting by Person in Cfairce* j 3-306.i4(.1)(B) P.eaunea Foo::nn.i Re.e circ of Food* I 3 S90.003(D) Exclusions andRceitictions' j Dr::pr„rhonv'Asr:rteratedorCrniarn:rarert 1 590,003(E) Removal of Exclusions and Restrictions I Food 791 1 ! Diao:::Yiing or Reconditionmg Lnnafz FOOD FROM APPROVED SOURCE Fate i d Food and t4'alet From Regulated Sources 19 ( Food Contact Surfaces 590.004(A-B) Compliance with Food law" ( '-5(11.1 I I Manual Warc;rachrn+_-Hot Witter 3-201.1? Food in a Hermetically Scaled C'onGuner* Sanitizruon Peumeraiurv,0, 3-'01.13 Fluid A4tt1,and ttiilk Products* I ` 501.112 Mi chanical W'•,-ev,ashiMg-Not Water 3-202 13 Shelf Eggsa I Iry Sanitization Temperatureer a Pasteurized" 4 :i(liA 1-4 Chzeitad Sanitiiatiutr temp.,pH, 3-_o(l�.la ByasandMilkPrtrJucts, [.t�titrini:ed" I cout•entr,'wn,mdhatdnes. ': j 3-20216 b:e blade From Potable Drinking,Witcr" j 4-60 i :tA) Equipment Foot Contact Surfaces and 5-101 ;1 Drinking Water tram an Approved System' I l.iem:ds Cagan. 590.006rA) Bottled Drinkine Wader* -1-6W).: i !aeaniue Fregtwrtcy of Equipment Food- 1 590 006(B) Water Meeh standards in.310 CMR 220" i Contact surfaces and Utensils k Shellfish and Fish Front an Approved Source 4-702.1: Ftequtaey of Sanitiz.::mn of ti;easils ted 3-201.14 Nish and Re<•rcafiunally Caught Molluscan I Sheithsh* Fou;Contacr Su-faces of Equipment' ;. 'r(i4 I i Methods or sana;zannn-i-hrt Waterand 3--201 15 RiollusLan Shellfish from NSSP Listed f ixmiral` - sources* Gagne and Wild Mushrooms Approved by j I Proper,Adequate-Hertdwashing j Rsputstory Authority ! 2-301.11 Clean Condrt:un-Hands:nd Aim,0 3-202 1R She(tstock Identification Pres,nnt'" - <G1.12 C:e 1Proc�du:e' I 590.004tC) Wild Mushrooms* j 2-301.14 `A Tien to Wash- 3-201.17 Chow Auim:as* j l 13 I Good Hygienic Practices S I Receiving/Condition I 2-40111 E,a:n„Drtrru _er Using Tobacur" j o + r 12-401.12 Dis•.harger Flom the Eves, Nose and 3-202.1 Pllf s Received at Prop::r Temp as rite: 3-202 15 j Package Integrity' j mouth^ 3-101.11 Fronk Safe and Unadullcrated-. 3-301.22 P+'eventm+,Conr-.m'ratinn When Ta,eniti j 1revenon of fHands naon from ans I G � Tags/Records:Shelistock 2 Ptif CtI j x90.007(13) Pre----nt:n Contaminator.from 0W 3-2 .18 Shelisuaa: cnutaanon* c Entplop._es 1 * 3? L'Q3. Shellster-k Idcnti(iattian btaintainzd'" I ( Tags/Records:F+sh Products 113 Handwssh Facilities GgnveruentrA Located and Access;tle 3--402.I l Parasite Destruction" I a_d()2.;2 Records,Creation acrd Retention" 5-2O3 11 Ntunher, dud Cnpaer,tr.s ,590.0040) Labeling of Ingredients' ( I -20» 11 T,rv-.adon and Pincerne nt* - -- ry Conformance with Approved Procedures 5-205.11 .Accessibility.Operation and:Maintenance l /HACCP Plans ( Sttppikd pith Sou^nd Hand Drying 3 503.11 Sprcialiced Prtwessme flied?ods I 6 Devices s-5112.1 Reduced oxygen packaging.criteria- 12 Haudwoehiuyiaeausct Ati-rtifubd6v 5-103.12 Conformance with Approved Procedures„ l 0-301 12 Hand Itrynng E'nrvis+.�r• Dcnrer;mood acrr it the I.dcra] 1900 prod r'ndr.o+ i O5 CNIR 5y0,(1iA) CITY OF SALEM BOARD OF HEALTH Establishment Name: G>Zvtlr/fl Addeld Date: //�lfay Page: of 2 Item Code C-critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date No. Reference R—Red Item Verified PLEASE PRINT CLEARLY 'Y< (t n�Jtf`{ /LNR/1S f SNA6A (d rC�4 cr.N. .4 rL Ki /I✓k P �IiJlr ifrc G�t�t nM0 /trT� .S.4nr,ttztS/I PIGi�� sb -S7�.vknrs_ I .J& ,J e.Jrr/rJ& Re.atill T fo.` ruzE e1'&SX1_11jk I&Wr /Ilc tim . e-.4LLJ-Cn I I Cs-'C& ✓&r'(L I I � I � I /,�-Gt- �f7h{x_ ✓�a�..r-c��v,.ifr c�n�n_ ,.I ii��//oy s..i.tf',E��,✓ tL�Pu,� V7Ii'' y4o. 1 I 1 Discussion With Person in Charge: Corrective Action Required: I ❑ No I ❑ Yes I have read this report, have had the opportunity to ask questions and agree to correct all ❑ Voluntary Compliance ❑ Employee Restriction/ Exclusion violations before the next inspection, to observe all conditions as described, and to ❑ Re-inspection scheduled ❑ Emergency Suspension comply with all mandates of the Mass/Federal Food Code. I understand that noncompliance may result in daily fines of twenty-five dollars or suspension/revocation of ❑ Embargo ❑ Emergency Closure your food permit. /) / O r ❑ Voluntary Disposal ❑ Other: p.5.i11-*({:) PIIFsRo' cne,!.n'1'emp:r.aures Violations Related to Foodborne fitness Interventions and Risk recording L,Liv-. Copied to Factors(Items 1.22) (Cont.) 4l"F/45`F Within 4 Flows. PROTECTION FROM CHEMICALS 3-50!.!'' e Method-,for PHFe j 14 Food or Color Additives i9 PHI:Hot and Cold Holding -20''.12 Add iio, s" 3-501.16(B) Cold P11Fs Maintained at or below 590,.)0-I(F) -11`/45° F°. 3-302.14 Protection front Unapproved Additives" ( ar 15 Poisonous or Toxic Substances - 1,16(A) Hnt F'idbs Maintained at or abuse 7-101.11 frlentiftngluforinaton-One;ival ! 140'R 7 Containers" 3-501.16(A) Ro-at;V, Held at or above 7-102.1 1 Common Mone-Working Comainers' ! 24) Time as a Public,Health Control 1 7-201.11 Separation--Stowe, 3-501 19 Time as a Public Health Coalrof* 7-202.11 Restriction-Presence and Use" � � 11041 HI Variance Reuuiremcnt 7-202.12 Conditions of Use' 7?03.11 Toxic Containers-Prohibitions REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-204A] Sanitizers,Criteria-Chcmiutls"' POPULAT10NS(HSP) z i_�( tr 7-204.12 Chemicals for W'ashui_e Produ.e,Criteria'' 121 ( b 11 11 iAl npasteurized Pre-packaged Juices and 7-204.1-1 Drvmg A¢ents.('rkerin' ( Beveutgen with Warning Isabel:^ 7-205.11 }c01,111B) Ui cofPaatemizedL es' Incidental Food Contact.Lubrncanis* i 3-80 i.l ;(D) Raw of Partially Cooked Animal Food and _- 7-206 11 Restricted Use Pesticides,Criteria* 7-206;.12 Rodent Bait Stations,, Raw'Sccd Sftrnu's Not Served. 7-206.13 Tracking Powders, Pat Control and i � � 3-!;01 t liC'1 Unopened Fwd Packege Not Re-srrvrd. " MonituringR CONSUMER ADVISORY 12 3-603 11 Consumer Ads+sory Posted for Consumption of 7IMEtTEMPER�TURE CONTROLS Fequml Foods'?"nat are kaw, Undetcooked or 16 Proper Cooking Tempel atones for I PHFs Not Otherwise Precesscd to Elittunate ='enraoe v;xra: 3-401 I JA(1)(2) Eggs- IS5'F 15 Sec. Pathogens T Eggs-Lnntediate Service 145`Fl5se4* Pasteurized Eees Substitute lit Raw Shell 3-401.11(A)(2) Comiroutted Fish; Meats&Cause E¢gs- Aninan - eol'R asses. ' 11 SPECIAL REQUIREMENTS 3-40L 11(B)(i)(^) Pork and Beef Roast 130'F 121 n»n�" 590.009'A)-(D) Violations of Section 590.009(A)-(D) in 3-401.11(A)(2) Ratite~, injected Meats- 155*F 15 I sec. " cateri:ig, motnle Ax)d,temporary and 3-401.11(A113) Poultry, Wild Gaine,Stuffed PHFs, tentdential kitchen operations should be Stultine Containing Fish, Meat, debited under Ibe appmpnime sections Poultry or Ratites-165'F 15 sec. c,.bovc if relo ed to foodborne illness 3401.11(C')(3) Whole-muscle, Intact Beef Steaks � interventions and risk factors. Otter 145'F 590.009 tii+,lations relating to good rtail 3-401.12 Raw Animal Fxxls Cooked in a practices should he debited under//29- Micamave 165'F* I Special Regairenients. 3-401 11(A)(1)(b) .All Other PHFs- 145'F 15 see. 17 Reheating for Hot Holding VIOLATIONS FL-LATED TO GOOD RETAIL PRACTICES 3-403.1](41&(D) PHFs 165'F 15 sec. ' (items 23-30) 3-403.11(B) Microwave- 165` F 2 Minute Standing Criutal(atel non-rr,lir,rl violatran;, which eh)trot,elute to the Time" ,foodborne Illness intowntr<ms and riskjat,nrs Iisted above, cert?be 3-403.11(C) Commeicially Processed RTF Food- /owed in the folh,i:ire sertinns u(thc Food C•odc and 105('MK 14WFt 5t)(tOW. 3-403.11(6) Remaining Unsliced Portions of Beef I Item-----Good Retaft Practices rC 59am I Roasts" ' 1 23. tderage-horn and Petsonnel FC-2 .003 IS Proper Cooling of PHFs 24 Food and Food Protection ( FC-3 .004 ( 25. Fquipm+=n!and Utensils FC-4 � .005 � 3-501.14(A) Cooling Cooked PHFs from 140"F to 26. Water. Piumbinq and Waste I FC.--5 1 .006 70"F Within 2 flours and From 70'6 27 Physical Facil:ty FC-6 .007 to 41"Fk45"F Within 4 Hours. * 1 28. Po+sorous or Toxic tdaiedais FC --7 .008 J 3-501 14(B) Coolin,;PHFs Made Froin Ambient 1 29, Bessie;P.equtrcmer:'s 009 Temperature Ingredients to 41"1-/4n'F 30 Other j Within 4 Hours t w:I+m.I,r.,.:.,Zd,. *1:)cnuies o:ncal iron in Ihr 6vieml 1994 Fano(-ode of 105 C%IR 590 600. 11:86 11/0B/2004 T0:9,1(970)744-8686 FROM: FMP - 689-265-9082 PAGE 001 of 001 (�F )OD EXPRESS FAX ACKNOWLEDGEMENT FRANKLIN MACHINE PRODUCTS • 101 Mt. Holly By-Pass • Lumberton, W 08048 Phone: 800-257-7737 • 609-267-3700 FAX: 800-255-9866 • 609-265-9082 DATE : 11/08/04 TO : ATTN: WALTER STEVENS ORDER # : 0945610 FAX# 1 ( 978 ) 744-8606 PO# : 36-760 STEVENS ORDERED BY: SHIP TO: GROUND ROUND #36-760 GROUND ROUND #36-760 2 TRADERS WAY 2 TRADERS WAY SALEM MA 01970 1866 SALEM MA 01970 1866 CONFIRMATION 111111 NET QTY ITEM DESCRIPTION PRICE EXTENSION BY: WALTER 1 300-1035 BOARD, CUTTING ( 1/2" , WHITE ) 18, 48 18 . 48 8 X 27 2 300-1035 BOARD, CUTTING ( 1/2" , WHITE ) 36 , 96 73 , 92 10 X 48 SHIP COMPLETE TOTAL: 92 , 40 PLUS APPLICABLE FREIGHT THANK YOU FOR YOUR ORDER, KEVIN SCHAFER EXT #312 Section 10 Food Safety Systems " 8 Fid Principle Two: Determine Critical Control Points (CCPs) t Find the points in the process where the identified hazard(s) can be prevented, eliminated, or reduced to safe levels.These are the critical control points (CCN). Depending on the process, there may be more than one CCP. Principle Three: Establish Critical Limits For each CCP, establish minimum and maximum limits that must be met to prevent or eliminate the hazard, or to reduce it to a safe level. st lish Monitoring Principle Four E ab g Procedures Once critical limits have been established, determine the best way for your operation to check them to make sure they are consistently met. Identify who will monitor them and how often. Principle Five: Identify Corrective Actions Idenrifv steps that must be taken when a critical limit is not met.These steps should be determined in advance. Principle Six: Verify that the System Works Determine if the plan is working as intended. Plan to evaluate on a regular basis your monitoring charts, records, how you performed your hazard analysis, etc., and determine if your plan adequately prevents, reduces, or eliminates identified hazards. Principle Seven: Establish Procedures for Record Keeping and Documentation Maintain your F ACCP plan. Keep records obtained while perforating monitoring activities, whenever a corrective action is taken, when equipment is validated (checked to make ,,.Wg / s,p, sure it is in good working condition), and when working with suppliers (i.e., shelf-life studies, specifications, challenge studies, �r etc.). Also keep all documentation created while you were The �.,� )` developing the plan. Flow \ / of u, 'lo follow the development of a HACCP plan, see 1whibit 10d 'c Food for an example involving Enrico's, a fill-service Italian restaurant. �n,iIP,9 10-8 r ServSafe Essentials Approach The HACCP principles are seven sequential steps that outline ! how to create a HACCP plan. Since each principle builds on the P, information gained from the previous principle, when developing I. your plan you must consider all seven principles in order, i In general terms: ► Principles One and Two help you identify and evaluate your hazards. ► Principles Three, pour, and Five help you establish how you will control those hazards. ► Principles Six and Seven help you maintain both your HACCP Platt and system and verify their effectiveness. The Seven HACCP Principles i Principle One: Conduct a Hazard Analysis Identify and assess potential hazards in the food you serve by taking a look at how it is processed, or flows through your establishment. Many types of food are processed similarly. 'The most common processes include: ► Preparing and serving without cooking ► Preparing and cooking for same-day service I� ► Preparing, cooking, holding, cooling, reheating, and 'I serving—which is also called complex food preparation Once common processes have been identified, you can t determine where food safety hazards are likely to occur for each E -. one. Hazards include: ► Bacterial, viral, or parasitic contamination ► Contamination by cleaning compounds,sanitizers, and allergens j ► General physical contamination n ' I> _ I�r 10-7 �i i Massachusetts Department of Public Health FOODBORNE ILLNESS COMPLAINT WORKSHEET rr�1 Please Complete and Send or Fax to: Questions? Call. Date: / I`' /_� MOPH Food Protection Program Food Protection Program: 16171 983-6712 305 South Street, Jamaica Plain, MA 02130 Division of Epidemiology: 16171 983-6800 #: Fax: (617) 983-6770 Enterics Laboratory: (617) 983-6609 PERSON COMPLETING INFORMATION Name: S: ( 1 Affiliation: Local BOH (town): C(b ❑ State DPH (division): ❑ Other: R PORTER / COMPLAINANT Name: Sha 1-)rl0 f1 �Cti-fs 0 Affiliation: VConsumer specify: ❑ Laboratory division, ❑ Local BOH facility, ❑ Medical Provider address, dr� h.Q-GL ❑ State DPH town, etc. ❑ Other ILLNESS INFORMATION # Persons ill:a Symptoms: (mark if reported for anyone): m Diarrhea ❑ Vomiting ❑ Nausea Abdominal cramps ❑ Fever Bloody stool ❑ Headache 11 Muscle aches ❑ Chills Loss of appetite O Fatigue ❑ Dizziness ❑ Burning in mouth ❑ Other symptoms: ............................................................................................... .................... . .......... Onset: : Earliest Date: 1 I / / 3 Time: (0 �5 DAM PM Latest (if > 2 ill) Date: / / Time: ❑AM ❑PM ..................................................................................... Duration: ❑ Less than 24 Hours 24-48 Hours ❑ More than 48 Hours ❑ Ongoing ❑ Unknown III Persons: ` Age Name Address/Town `rs' (yrs) Occupation Med. Provider/ d ❑same as reporter(above) �r 2 3lal5r ar�orJ S +ttilC Sa�,u- '7 N /� Doman 3 4 Medical attention received (by anyone)? ❑ Yes ❑ No ❑ Unknown --> ff Yes, specify above: T Stool specimens submitted (by anyone)? O Yes ❑ No ❑ Unknown —> To SLI '? ❑ Yes ❑ No ❑ Unknown Medical diagnosis reported? FOOD HISTORY --� Obtain history back 72 hours prior to symptoms, or, if organism identified, b/n min and max incubation periods (see p 21 —� If > 2 ill, follow above time frame for common meals(foods)only # Restaurant / store where xn3 Foodlsi consumed nnrchased Iname. tnwni Pl— gnc rmpd O ��1 0 ``? 1�>.Q.'..1^,f r,:,T ❑ Same las teh) ❑Home _ C3 Other/sped/yl: �1D � nlliK ,ml-a+ef�ee,�e �r�x}� Cin urld _) 1 State Laboratory Institute,305 South St.Jamaica Plain,MA,02130 - (617)522-3700 Sept 1999 (ggSepT-onn.doc) 2 Always record Time if possible,otherwise,choose B=breakfast,L=lunch,D=dinner Discard Previous versions 3 Total p persons(both ill and well)who consumed indicated food(s) I IVIDPH Foodborne Illness Complaint Worksheet Page 2 of 2 FOOD HISTORY(continued) / # Restaurant/store where Date &Time' Exp3 Food(s) consumed purchased (name, town) Place consumed B C.�. 0 Same fas left! 11 Home L 2 Af)Mi, ChecS-C Sdndg, ,`. ii ejfri— ❑ Other(specify): ° 4 B4M-Gout, green beans i+l me ❑ B Z ceC ,`�0_k ,f ,�1 15-Same-(as left) 11 Home L Z Iur E� Ch¢c�e swil( d �r�-1 n" Other(specify;: K° 4 Top�ro rlSFc� r �1ce_ }iom 2, 0 B ❑Same(as left) ❑Home 0 L ❑ Other(specify!: 0 ❑ B ❑Same(as left) ❑Home O L ❑ Other(specify): 0 0 B ❑Same(as lett! ❑Home 0 L ❑ Other/specify): a C fl� Zvi 4 SaI�r1) , NOTES u QUI asc v�d cc - gym T—� &116 c��c�I C �e M GS IFIuz � 5 eA n 1 II �IOLV� rVT JJ c.CCe� _L I bK�� ) L(, . FOOD TESTING Food(s) available for testing? ❑ Yes ❑ No ❑ Unknown -4 Sent to SLI '2 ❑ Yes ❑ No ❑ Unknown —> ff Yes, specify food(s) & sources: Product and Manufacturer Information for Commercially-Processed Food(s) Product name: Code/lot # Expiration date / / Package size/type: Manufacturer. - Address: Incubation Periods for Selected Organisms Min Max Min Max Min Max B. cereus (short) 1 hr 6 his E. coli 01 57:H7 3 days 8 days Staph, aureus 30 min 8 hrs B cereus (long) 6 hrs 24 his Hepatitis A 15 days 50 days Shigella 12 hrs 96 his Campylobacter 1 day 10 days Salmonella (non-typhi) 6 hrs 72 hrs Vibrio cholerae few hrs 5 days Cyclospora 1 day 14 days Salmonella typhi 1 wk 3 wks Viral GI 12 hrs 48 his C. perfringens 6 hrs 24 hrs Shellfish poisoning minutes few hrs Yersinia 3 days 7 days 1 State Laboratory Institute,305 South St.,Jamaica Plain,MA,02130 - (617)522-3700 Sept 1999 (99SeptForm.doc) 2 Always record Time if possible:otherwise,choose B=breakfast,L=lunch,D=dinner Discard Previous Versions 3 Total#persons(both ill and well)who consumed indicated food(s) �M1 Massachusetts Department of Public Health Salem Board of Health 120 Washington Street, 4t" Floor Division of Food and Drugs Salem, MA 01970-3523 FOOD ESTABLISHMENT INSPECTION REPORT Tel. (978) 741-1800 Fax (978) 745-0343 Name Date Tyree of-Ooeration(s) Tyge of Insoection GRd Ott dtlPf/� Date Tyree y I El-rood Service e Routine Address 7 `^ ��r fiit�t/ Risk [I Retail ElRe-inspection LevelEl Residential Kitchen Previous Inspection Telephone 7 yq .1pBg M ❑ Mobile Date: HACCP YIN Owner l [-ITemporary ElPre-operation N6 u+ f4 Aor Upr#�4wf (.LC. I ❑ Caterer ❑ Suspect Illness Person in Charge(PIC) Time ❑ Bed& Breakfast ❑❑ General HACCP Complaint In: Inspector (j4VI�'J�7 Cr* IW64tjM Out: Permit No. ❑ Other Each violation checked requires an explanation on the narrative page(s) and a citation of specific provision(s) violated. Non-compliance with: Violations Related to Foodborne Illness Interventions and Risk Factors Anti-Choking Tobacco Violations marked may pose an imminent health hazard and require immediate corrective 590.009(E) ❑ 590.009(F) ❑ action as determined by the Board of Health. FOOD PROTECTION MANAGEMENT ❑ 12. Prevention of Contamination from Hands ❑ 1. PIC Assigned/Knowledgeable/Duties ❑ 13. Handwash Facilities EMPLOYEE HEALTH PROTECTION FROM CHEMICALS ❑ 2. Reporting of Diseases by Food Employee and PIC ❑ 14.Approved Food or Color Additives ❑ 3. Personnel with Infections Restricted/Excluded ❑ 15.Toxic Chemicals FOOD FROM APPROVED SOURCE TIME/TEMPERATURE CONTROLS Potential) Hazardous Foods ❑ 4. Food and Water from Approved Source (Potentially ) ❑ 5. Receiving/Condition ❑ 16. Cooking Temperatures ❑ 6. Tags/Records/Accuracy of Ingredient Statements ❑ 17. Reheating ❑ 7. Conformance with Approved Procedures/HACCP Plans ❑ 18 ooling PROTECTION FROM CONTAMINATION 19. Hot and Cold Holding(z ❑/ $ Separation/Segregation/Protection El 20.Time As a Public Health Control IL/I 9. Food Contact Surfaces Cleaning and Sanitizing REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) El21. Food and Food Preparation for HSP [110. Proper Adequate Handwashing ❑ 11. Good Hygienic Practices CONSUMER ADVISORY ❑ 22. Posting of Consumer Advisories Violations Related to Good Retail Practices Number of Violated Provisions Related Critical (C) violations marked must be corrected To Foodborne Illnesses Interventions immediately or within 10 days as determined by the Board and Risk Factors(Items 1-22): of Health. Non-critical (N)violations must be corrected Official Order for Correction: Based on an inspection immediately or within 90 days as determined by the Board today, the items checked indicate violations of 105 CMR of Health. 590.000/federal Food Code. This report, when signed below C N by a Board of Health member or its agent constitutes an 23. Management and Personnel (Fc-2)590.0 4) order of the Board of Health. Failure to correct violations x/ 24. Food and Food Protection (FC-3)(590.004) cited in this report may result in suspension or revocation of I/✓ 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 f328. 7. Physical Facility (FC-6)(590.007) have a right to a hearing. Your request must be in writing Poisonous or Toxic Materials (FC-7)(590.008) and submitted to the Board of Health at the above address 9. Special Requirements (590.009) within 10 days of receipt of this order. 0. Other DATE OF RE-INSPECTION: S 5soMVs fFo, 6 14 neo f _ n- Inspector's Signatur Print: PIC's Signature: /T/ // Print: f7 r C" S7 e F/ /' I Page,/ofj Pages V 'V /11' v Violations Related to Foodborne Illness interventions and Risk Factors(items PRO TI T;Otr -RONI CON I'AMINA'vow FOOD PROTECTION MANAGEMENT R Cross-cort:m%.al,an j I 1590.(1(73(A) ( Assignmentof Responsibdity 3":f2.!!(A;t 11 (taw Anrnal Foods:'ginated lion 590.003(B) Demonstration of Knomded€e''� j rooked and R'PE Fo•tis:: 2-!03.1 1 Person hi charge -duties I Centa,^,rtaticr,trom Rp.c,ingrcaia%tts 3 ?02.1 ;(.111.1 liar( Ani:-nal Fic&Scpar:!ed fano Each EMPLO"EE HEALTH Othet 2 >90.003iC) Revpon,ibility of the person incharge!u j Cr,atandratron from the Env^ronment eywre rcpc»'ting by hxxt emphn;era sodItA; Foce! j applicants'` 3-x02.'.5 ((',chlor(l='t,.;is,out Ve;[ratII 59Q(iO3iF) Reaponstbitity Of A Brod Employee Or Ao ( 3-30=.1 t i Foul Coma,w;Gz la!uipmeol and Applicant To Report To The Person in Uiewf64 ' ConL,-rd,,w,1x)n f.om the Consr,mw 590.0W(G) Reporting by Perron in C'i,arge" ;:{U;;.1?;A)tB t 1 ttenu Fed Fcnxl and !:esercice of Po.xl` j 3 590.0030)) Exclusionsan.!Resnicrions". j I G9spusirien et^9urf?,,ted or Conti„„nate, 590.003(h.) Removal of Exeiusions anti Rectrienons 3-701.11 Disco,ding in ib„u.onditioning Unsafe FOOD FROM APPROVED SOURCE 41 Food and Wate;Frazt Regulated Sources I j `) i Food Contact Surfaces j j 590.004(,1-6) Comoharce AIth pound i..aty" ?-501.111 Manual Warewashtr:_- Hot O'atcr ! 3--01.!2 Food ing 'icrnzrtiriipSealed Con .uner^ (; m'le,n,U auccs": 3'301.13 Fluid Milk and Milk Producls" i -f-501 !1_' M uclianic.d Warcwashina :lot Rater Samtizi::nrn Tenlper:dn:e5' j 3-20Z13 Sheth Ecs' ! 14-501 114Chemical Sasitizat:,"r:- tci_zp.. 1,H, I i 202.14 Eggs and Nlilk Products.Pasteurized' ! 3-202.!6 Ice,'tale Prom Potabir Dlinkigc W.:ter' cenccru'a:-.m and b.udnes.. " i d-66! : ;:^.; ;•;;ipn:cat;b,;rl Coin:ct Surfaces and 5-;{17.11 llrnkin^ 4i'atcr Gom an Approved Sti'c,aa LPen'aln i';ean-. j 5' q,bGtS(:1) Book' Drink,ng WV tcr` 1 .}_( �.17 '-lean;rn,Frequ-r,w of Ennip:i:ent Food 590.006(R) Water Mieets Standards in 310 CMR 22.0* j Coaizci Surt:;cee �1:d Utetmas" j Shellfish and t'rsh From an Approve,Source 3-2M l9 Fish and Recrcaticnal l !uscmt ( 4 700 I I Fraquenc v oC Sanit;zatton ut Uteneds and u } Cau;a;u'19o1 iFo.vS Coat:u't Sarlaccs of 1�uipment" Shdi Sh* 4-70.7.7( h?ed:,dn nE Sanrtizolioa H,al'r'ateraud 3-201,15 Mollu,car,Shelifinh from NSSP I fisted I Owlnica!^. Source,` I Gama and Wrd Mushrooms Approvedby j IrD j Props;.Adaeuaiz rlar,dwashing ! Regulatory Authority 2-301.;! C'le;:r;f:ondition--H.:nr's and .1;ins -202 Iti Shellstock Idemificanun Present" j 3it,t.l? I C':aatting Ytci.dl;:t;'' 59O004(0 Wild Ntuchn,oms^ 2-301.!4 'rv''heutot'vas':'. 3-201.17 Gain:Ammats" 1 if Good Hygienic Practices ,9 Receiving/Condition ? AiILI l Eahn„,Drinking or Usine Tobaeco -202 11 PiIFs Received at l`roprr Tetnperatuie.'k ( )-4(:1.12 1):,charres Frow the Eye, `;os:and 15 Package lnte�,uit}" j Aio:u ! 3-101.!1 Fond Safe and Unadulto ate(I" °-301 12 Ptevera inti Crsaatnivation V:ben Tasf inn' j ti Tags/Records:Shellstock i j 12 Prevention of Coniarninabon from Hands 2 0 590.004'E) I r'reyentin,z Contacun:aiur !i-om t' 18 Shel lktock Idem tication' ' L:ne-1o•,ecs' 3-203.12 Shellstock Identification Maintained' TagslRecords: Fish Products ( i3 Handwash Facilities 3-402.11 Paiasite Destaioion' Convnr.,en:iy Locafcd?nd Accessrbfe 12 Rccords,Creation and Retention' 55-203.!1 Nunzbcrc and 59tJ.GU-1O t Labeling of Ingredients' 5-204.71 Loc-,bon azd P,,-ccrneii* 7 Conformance with Approved Procedures 5-205 II ac.css:Gaily,(7orr:ri.zn::ridyia:rttzratut lHACCP Plaits i Sup)l,kd iv;h Scan jird Nand prying :7ewicvs 3502 I 1 Reduced ox gen paing n-fig,ccis" � � ,.303.11 l l udv whfziu iae:set, Avaitahility j ?-502.12 Reduced oxygen p2cka,ing,criteria'" 103.12 Contolmance with Approved j I HandD--`.lug Pr,.�:isiort i C,eote;.cn6l,11 ib_n,i 11 the fedc,a! i n'iq r:oud Cole of i,ii CNIR 5Wull n, CITY 4F SALEM BOARD OF HEALTH _ Establishment Name: 6;ll /Lo 01'13 Date: 'e11q/'1 Page: Z of 3 Item Code c-critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date No. Reference R-Red Item Verified _ PLEASE PRINT CLEARLY 4ce-ffmo.#n.Aw ei bra/F flht,rn_ A&1&y C e rE,&W 1 Zy` (L f-' fI/,c rti /tArjvff Lo „s 41 ce .�._ /4n r .utiv ir- dJ 1177r a c,. r I Cc.rrW�n .A%/L t�.r n 7�ri/ / aYL I-r' XrV/f4*d& . I Z13 �I�C /t+, R".r C $*M r7/7f ,Srlr f dd.IM. f / 77 4,46c .f4&4. I � � �� /�Sr�RI r/i"ec0 Ft /6&,dTnrrr ,�,trt /1.fi°rr.,orr. Vfif AP�aeO W6 rcfe IA/.C- m"AE 9 C_ ^ GiJ 'f7N� rSe,wt S .MiC-,r It1t2 f'1S0 .N.ro J'Y�.ct�o /4LstJ.'�L+�� v>t-- ,4F Plt c�_ I ` M� �'.i i"►—,r.l tf .?eH/tii S' G r'-n is;r�6_'� ' I - I '71_S`� /�l�C --�N-G,K .r� F�td1C 2�,� //-yl r ar! .f-e a u.esJt-.tnnu✓ of .�adn OcLdHr .4N� I �. r s c�u.�,,,✓��d+r sx-�r tf,. GNv,�u��/ C-C��a-o/ /cLve/c.... h Elr#go of 'S10°F. 2,fP.hr� eek- A-A-arr i�n rt snti7t,r✓ A I&PHI e F e9 oF' &A RrCLea! CIFW e r Dour. r 6i � I c3rr/sv Ccn csr ,�vttV ,�/rn r tetaACAc.so. Discussion With Person in Charge: Corrective Action Required: I ❑ No I ❑ Yes I have read this report, have had the opportunity to ask questions and agree to correct all ❑ Voluntary Compliance ❑ Employee Restriction/ 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 nty- ive dollar4or usocation of ❑ Embargo ❑ Emergency Closure �your food permit. ,,!!Q?// l ❑ Voluntary Disposal ❑ Other: V i 3-50�.1;-,0 PI{F(.i:r..er.ect at Teumperrtures Violations Related to Foodborne Illness Interventions and Risk AAcfxfding to Law Ccoled to Factors(items 1.22) (Cont.) `I�17/45'F W-idiin 4 Hous, PROTECTION FROM CHEMICALS +-=SOL 15 Cooling Methods for PHFs 19 PHF Net and Cold Ho 14 t Food or Color Additives ( at 3-202 12 Additives` I 3-501.16?Br CnL;r'FHP,Mn,mauicri d a[of below 5 3 302 14 �, Protection from Unapproved Addihvec" j 1 ;90J)04(F) 41''/4(5' F` -501.16( ot PHFs Maintained at 15 ; Poisonous or Toxic Substances A) Hnr above140'F. 7-101.11 IdenOfymg Information-ori,nnal 3-501 16(.1) Roasts Held at or above 130°F. If Containers" I -I 17-102.11 Common Name-W'crkm_,Containers` I 20 Time as a Public Health Control 1 3-501 19 Time as a Public Health Control='7-201.11 � Scparatian-storage' i r, ,;, 7-202.1 i � Restriction-Prescuce and Use* ',,1,, )(4(H) 1at tirce Reyuircuie, 7-202.12 Condition.of Use* REQUIREMENTS FOR HIGHLY SUSCEPTIBLE -203.11 Toxic Containers-ProhibitionO I POPULATIONS(HSP) 7-204.11 I Sanitizers.Criteria-Chemicals" -1-204.12 1 Chemicals for Washme Produce,Culotta" 7-204.14 ?-80:.11(A) L��pas(:u:ized Pre-packaged Iniccc and g Agents.Criteria" Heverozec with Fk,n-ni ,L Libels^ J 7-205.14 Inyirt ;-501.11(B) Use of Pasteur ized EggsT 7205.11 Incidental Food Contact, Lubrmcatrtsr 7-206.11 ( Restricted Use Pesticides.Criteria* � ( 3 801.1 IW) Pa., or Partially Cooked Animal Food and j -7-206.32 Rotent Bait Stutiotts" Raw Seed Sprouts Not Served. " - -- -501.t i(C) I Unopened Food Packaee Not Re-served I 7.206.13 Tracking Powders,Yrtit Control and i 3 - --- - ---- Monitoring* CONSUMER ADVISORY TIME/TEMPERATURE CONTROLS 22 3b 0 3 11 Dammer Adtits.uy Posted for COa.umption of Animal Fords 1'ha;+:rc Raw Undercooked of 16 Proper Cooking Temperatures for I Not Otherwile Processed to Elitnmate PHFs Prithog,ns.* 3 101.I 1 A(I)(::1 Eggs- 155'F 15 Sec. Eggs immediate Service 1'IS"FI Scent 3-302.11 Pssteurired E-, e,Substitute fur Raw Shell 3-401.11(A)(2) Comminuted Fish,Meat: 8t Game I Ergs* Animals 155'F 15 sec. * SPECBAL RECtUIREMENTS 3-401.11(13)1,1)(21 Fork and Beef Roast- lfflF 121 nun* 3-401.11(A)(2) Rattles,Injected Meats- 155'F 15 590.009(A)-t D) Violations of Section 590.009(A)4D) in Sec. catering, mobile foo(j, temporary and 3-401.11(A)0) 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 ser. ' j above if relater', )foodborr,c illness 3-401.11iC)(3) Whole-muscle,Intact Beef Steaks interventions and risk factors. Other 145°F" 590.009 violations rei::ung to good retail ;-401.12 Row Animal Foods Corked in a ( ;rracttces should be dchited under#29- Miciowave 165`F* Spec;J Requirements. 3-401.11(.4tt 1 db) .all Other PliFs- 145"F 15 see 17 Reheating for Hot Holding VIOLATIONS RcLATED TO GOOD RETAIL PRACTICES 3-40111(A)Rc(L)) PHFs 165`F lS sec. (Items 23-30) i-403.11(B) Microwave- 165`F 2 Wrote Standing Critical and r-un-rrhicat violation:% o-inch do inn,elate to the Time"' hio;lhrme ilhtcs.s mtvrventiun.c and i iA la,t,,-s tilted oboe, can he 3-403.11(C) Commercially Processed RTE Food- Jocnd in rive foLuwo+g sertions n1 the Food Code wad 105 CMR 140 TI: 5ciO 000 3-40111 IE) Remaining Unsliced Portions of Beef itsm Good Retail Practices i FC � 590.0007 Roast."` 23. Manaoemen.!and Personnel FC- 2 .003 18 Proper Cooling of PRFs ! ( 24 F cod and Food Protection FC--3 .004 25 LquiUmontand Utens6s FC-4 1 .005 3-501.14(A) Cooling Cooked PHI-s from 14(?`F n) 1 28. Waley,Flumbinq and Waste FC-5 1 .006 70:F Within 2 Hours and From 70`'F ( 27. Physcte Facility FC--6 007 to 41'Fl451F Within 4 Hours. * 1 28. Poisonous or Toxic Materizis FC-) .008 1 3-501.14(B) Coolimg PHFs Made From Ambient1,29 _ S ec,al Requirements 009 Temperature Ingredients to-11"FA45,F 1 30. tither Within.1 Hours* :°•�r,,i:.r,.c n,v Denotes cnnul ilen)it,nit i,afer l 1999 Food Code or 105 CMk 590 000, CITY OF SALEM BOARD OF HEALTH Establishment Name: 66 tl"rQ if c Lwn Date: 111AyI t.p Page: 3 of Item Code C-Critical Item l DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date No. Reference R—Red Item / Verified PLEASE PRINT CLEARLY 27 NCP If So'e>W&k fig*io- H&&*or .4 PVej ddi6-tF xw&&?1fr6- ^0 Ctk*wW': I I /9 / �/t� GJP1L/N6UNr ti' /�eLO/KG lJttser.� //i�sOuG/z /YDS s4 il'6��/� of �/8�/� A-rec- erk **d.t-t/O u-t',r F-o /uPO4rli-N'tK it MMP Of `//'le I I I E I I I I I I af�',krclDcrrRs rt.at I - Foe/1 ra>uF1' I�A-rrrna,rte- .,rfcFt1e01' � u�nnU ry 6Af Irma! ,.'f✓�r)yr 5 ed Y ` Lt'd R!'br1 r rf CNG� I I I I I I I Discussion With Person in Charge: Corrective Action Required: I ❑ No ❑ Yes I have read this report, have had the opportunity to ask questions and agree to correct all ❑ Voluntary Compliance ❑ Employee Restriction/ 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 ood� ode. I understand that noncompliance may result in daily fines of ty-f" dollars or su pefision/revocat�n of LI Embargo 11 Emergency Closure �Oyour food permit. /, ` 1/`> — / // 0 Voluntary Disposal ❑ Other: r :i-5ii1.1 #(C) i i HPs Fiasco ed at'I'em(teraturee Violations Related to Foodborne Illness Interventions and Risk ! Accor_+;nes t.,La,t Cowled to Factors(Items 1-22) (Cont) ! 41"F/45"F Wahin 4 Hours 5'JI.0 Cooling Methods for PHFs PROTECTION FROM CHEMICALS ( aq P4F Hrt are Cold Holding j 14 Food or Color Additives 3.511 16(B) Cold PHFs Muintained.:t or below 3-202.12 Additnesk 941?.0040 =41';/-7":.• 3-302.14 Protection Inti llnapprored Additives* 15 I Po!sonous or Toxic Substances 3-"�)1.16(A; Hot PRFs Maintained at nr above 7-101.11 Identifying Information --01 ig .toI?osts inal i-o,as 1 l 3.5it1lA) tield.;t rn above I3/NF. Containers' , 7-102.11 Cotrunun Varve-Working C'onunnerv' ( 20 Time as a Public Health Control 3.-SUI 1'd Tuu:a::a Public Health('011ttoP` 7-?01.I ! Separation-Storaec" i ' 7-202.1? Restriction-Presence and Ca, 590.UOd(H; Vavanc,�Requ:reroent `7-202.12 Cundm.,;ns of L'se' 7-2031i - hibnion1REQUIREMENTS FOR HIGHLY SUSCEPTIBLE -204.1 Sonti7emCriteria--C ;* POPULATIONS(HSP) 1-201 1: Chemicals lot Washing Produce,Criterir' 21 Lay Jnpaiteurimd Pic-packaged Juices and Beccrsges with Warning]-,abets* 17-204.14 Drtiing Agents. Criteria* 3-90i.1 l(B) Use of Pastrurized Eg-,:* 7-205 11 Incidental! Food Contact,Lubricants"" ;-g(Il 11;D) Raw"or Partially Cranked Animal Food and 7-206.11 Restneted Use Pesticides. Criteria"- Raw Seed Sp Nut Served. * I '7-206.12 Rodent Bait Stations" 3-801 11(C) I Unopened Food Package Not Re-served 7-206.13 Tracking Powders,Pest Control and - tvlunitonne' ( CONSUMER ADVISORY TIMEITEMPERATURE CONTROLS 22 3-003.11 Consurner Advisory Posted for Consumption of' 16 Proper Cooking Temperatures for ( An real Foods'Unit are Rata Undercooked or PHFs Not Othem vw Processed to Eliminate 3-401.I I A(I)tZl Eggs- 155'F 15 Sec Pathogcnt,.'.sce•r>:..rcakr 3-302.!3 Pasteurized E*€-c, Substitute for Raw Shell EGes-Emmedr 'F ate Service 145L5sec, '' 3-401 1 I(A)(2) Comminuted Fish.Meals R: Game Eggs Animals- 155'F 15 sec. " SPECIAL REQUIREMENTS 3-41,11.1L 3-411.1 )(1)(3) Pork and Beef Roast- 130`F 121 min' ( 500.009iA)-(D) Violations of Section 590.009(A)-(D)in UUA'1)(2) Raii[es, Injected Meats- 155°F 15 l ser. * I catering, mobile food, temporary and 3-401.11(Au 3) Poultry,Wild Game.Stuffed PHFs, residential kaehen operations should be Stuffing Containing Fish. Meat debited under the appi opriate sections Poultry or Ratites-165'F 15 sec. " above if related to foodborne illness 3401,11(C)(3) Whole-muscle, Intact Beef Steaks ( interventions and risk factors. Other 145`F* 590,009 violations relating-to good mail 1-401.12 Raw Animal Foods Cooked in a I practices should be debited under 1/29- Microwave 165`F* Special Rcautrurncats. 3401.11(A)(I)(b) All Other PH ll - 145"F 15 see. 17 Reheating for Hot Holding VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 3-40,.1 1(A)&(D) PI IF, 165"F 15 sec. " (Reins 23-30) 3-103.11(6) Microwave- 165'F 2 Minule Standing Critual wi i nu,i-Crticui violations, ,t-hich do riot telatr io the Time'i fiwdnont, i(Guma inten-eutiom and rick f iciols listedabove, can be ' 3-403 11(C) Commercially Processed RTE Food- i found in tie(o(luwbr;ne(tinus of the Food Code and 105 C11112 140'F" 590.000. 3403.t 1(E) Remaining Cnshced Portions of Bcaf I I Item 't Good Retail Practices FC 590.000 I Roasts` -23 ag -__ -Manernont and Personnel ', FC- 2 .003 24 Food and Food Protection FC-3 3 .004 1g Proper Cooling of PHFs ; - '1 25. WatEquei.nFlu tsi Utensils 'FC-4 .005 3-�Ol.l#(AI Cooling Cooked PHFs from 14(1"F to t 26. Water. Fluu;binq end Waste FC-5 .006 � 70"F Within 2 Haws air([Front 70"F 1 27 Phvsical Facility FC-6 007 1 to 4l"F/45'F Within 4 Hours, * 128._ ( _Poisonous or Toxic Materials FC-7 _,008 I .3-50 L14(B) Carling PHFs Made Prom Atnb[rnt C '0 Specie!Requirements 1 000 Temperature Ingredients to 41 T/45"F 30 I Other Within 4 Hours* .Drnnle:critical arm in the lederal 1999 Foal Code of 101 CNIR X00.000, CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH ~ a 120 WASHINGTON STREET, 4TH FLOOR Z - SALEM, MA 01970 TEL. 978-741-1800 FAX 978-745.0343 STANLEY J. USOVICZ, JR. JOANNE SCOTT, MPH, RS, CHO MAYOR HEALTH AGENT COMMONWEALTH OF MASSACHUSETTS PERMIT TO OPERATE A FOOD ESTABLISHMENT In accordance with regulations promulgated under authority of Chapter 94, Section 305A and Chapter III, Section 5 of the General Laws, to operate a Food Establishment in the City of Salem is hereby granted to: Type of Establishment: FOOD SERVICE Name of Establishment: The Ground Round Address of Establishment: 2 Trader's Way Owner's Name: New Mass Restaurants LLC Michael Yung Restrictions: Application Date: 12/4/2003 Permit for Food Establishment 130-04 Frozen Desserts/Ice Cream Permit for the Sale of Tobacco Products These Permits Expire December 31, 2004 This permit is not transferable and must be reissued upon change of ownership or location. The permit must be posted in a prominent location in the Establishment, In accordance with the State Sanitary Code, before any renovations, improvements, or equipment changes are made, all plans for such must be submitted to and approved by the Salem Board of Health. qVHEALTH'AGEN�T r e CITY OF SALEM, MASSACHUSETTS BOARD OF HEALTH �O 3 120 WASHINGTON STREET, 4TH FLOOR e SALEM, MA 01970 NOV 17 2003 TEL. 978-741-1800 FAX 978-745-0343 CITY OF bAL&M STANLEY USOVICZ, JR. ,JOANNE SCOTT, MPH, RS, CHO BOARD MJF HEALTH MAYOR HEALTH AGENT 2004 APPLICATION FOR PERMIT TO OPERATEA� FOOD ESTABLISHMENT NAME OF ESTABLISHMENT Ll &3 %QS� ft,. h-C �)r&j A f!" rA TEL# c17D"7'IL'I qqp p ADDRESS OF ESTABLISHMENTr MAILING ADDRESS �(if �different) OWNER'S NAME 1 t IIG CLC ylInq TEL# l�"7y�-II4U� ADDRE S rC fcc�lS (>�c1 CITY ' STATE M ZIP 019-70 CERTIFIED FOOD MANAGER'S NAME(S)-LL1nll' S_ c'J CERTIFICATE#(s)a73 110 (required in an establishment where potentially hazardous f is prepared.) l) EMERGENCY RESPONSE PERSON l o. „Attr S vt-6 HOME TEL# HOURS OF OPERATION: Mon.�Tue1/iYWed.CLO Thu. U i�3Fri./ 113Sat. �Sunl ljd3 TYPE OF ESTABLISHMENT FEE check only RETAIL STORE YES NO less than 1000sq.ft. =$ 50 0 1000-10,000sq.ft. =$100 13D more than 10,000sq.ft. =$250 RESTAURANTYES NO less than 25 seats =$100 25-99 seats more than 99 seats = 200 BED/BREAKFAST YES NO $100 ADDITIONAL PERMITS MAKE (not just serve) ICE CREAM, YOGURT, SOFT SERVE YES $5 TOBACCO VENDOR YES $50 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 charge 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. Jed Pursu tL �ha r 2CSection 49AI certify under the pains and penalties of perjury that I, to my best Tio Ilarip beli ave filed all at tax ur and paid all state taxes required under the law. Signature Date Social Security or Federal Identification Number --- ----- -- ----- -- - ----- Revised ---Revised 11/03/03 FOODAP2.adm Check#&Date CITY OF SALEM BOARD OF HEALTH r Establishment Name: t7 Po/� / //vn Date: 3- /9-0 Page: of / t Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date 1 No. Reference R-Red Item - Verified i PLEASE PRINT CLEARLY t ��jri�/>�r, r'� A c ui e hof r ,bfAC/i/-T /JF 7�.c s/�.dct-lyre„/'/r•c /.t/ /�P Yr7p< /iY✓Iv"o 44RQm71 t I /�.h. �Ylo f'-' /i/i Yui /.//�/_y4-/P �C`�/✓.vi C✓ /�c.�/a/P�.l �'�(A � l /J AP_Om,9 Y✓t a T/n�P '� (J f !!72 //m i fc 9� i, �Pi/.,yo ./ ✓Ii�f'n7?,0 1�_d,vJ o f 7�YY1 l.�c �� "t c y �Y 4 11 fl Discussion With Person in Charge: Corrective Action Required: I ❑ No I ❑ !es Emloee have read this report, have had the opportunity to ask questions and agree to correct all ° Voluntary Compliance ° Exclusion Restriction/ F violations before the next inspection, to observe all conditions as described, and to ❑ Re-inspection Scheduled ❑ Emergency Suspension I comply with all mandates of the Mass/Federal Food Code. I understand that noncompliance may result in daily fines of twenty-five dollars or suspension/revocation of ❑ Embargo ❑ Emergency Closure ypur food permit: ❑ Voluntary Disposal ❑ Other: r — � L` <,.St;l 14tCi PHFs Reec:v;d at Temperatures Violations Related to Foodborne illness interventions and Risk Ar.:a-dim,to t.au C<xol al tv Factors(items1-22) 1Cont.) i4I'Ff<4±'FWithin Homs PROTECTION FROM CHEMICALS ( 3 1 15 C+alline Methods!"vr PHF Food or Color Additives 19 PHF Hot and Co!d Holding 14 3-?02.12 FoodAddio C ' J 501 16(B) Curd PltFs MrG'int::med at or below �90.004(F, 3-302.14 Protection!'rout unapproved Addhrvc:* + + '-5ul 161'v idol PII_s AJac::ained a'o;abv�e 1.5 Poisonous or Toric Substances 1 i 140:,1: r 7-101.11 klentitvine In Formation-Ongirrtl nl.1o(A', Roa:ts Held.:! .a aboe. !30-'F. Corso iners,, ! '-102.11 Cormuon Name-Working Container:."' 20 T+me as a Public health Con:;ol 7-'_'01.1 ISepura[ivn-Sh,ragc'. 3 501 I9 Tim:of,a Public Hcahh Control'' 590.004(Hi Variance Retluiremeri' 7-20-1.11 Restriction-Presence and (Is,i' 7-202.12 Conditions u9 Use, 7-203 11 `toxic C'ontaincrs--Prohibitions* POPULATIONS NTS FOR HoC ILY SUSCEPTIBLE 7-'_04.11 Sanidzets.Criteria-Chemicals POPULATIONS(HSFa 7-?0=4.13 Chemicals for Washine Prodote, Cri rig:' ( 21 3-801.! !(.A) UnPavmuriz.rd Pr-,--packaged Juices and 204.14 Drvou-, Agent:.Criteria" ! Beveraees with t4'armne L,.:bets" ':?t)5 11 hx•rdrnLd Food Contact,Lnhrram,* ( 1. Use!B) Use of I'aeteu :Zttl ?-xtil.l I OD, Raw or Partial? t o+ked Around Food and 1-206.11 Re:ancted Use Pesticides. Criteria'" } R:rw Seed Sprvu'� Not Serord. :. 7-206.1-' Rodent Balt.tabun* ( 3-(:01.1 !(C) Unopened Food Packr^c Not R+:-served 7-206.13 Tracking Powders, Pest Control and Momtvringx CONSUMER ADVISORY TIME/TEMPERATURE CONTROLS 22 3-603.1`. C'e11SLAI T A(hisory Posted for Conscription of An'roll F.ads'That are Raw. Undercvolced or 16 Proper Cooking Temperatures for ( Nob Oi!ierviseProcessedtoE!irmuuta PHFs 3-401.11 At 1)(2) Eggs- 155`F 15 Sec. Pathe;;ens " Eggs-immediate Scraice 145 EISsec� I 3-30-7.13 Pasternized Egg4 Substitute for Raw Shell gg .. 3-401.1 ltA)(2) Comminuted Fish. 1-[eats R Game Animals- 155-F 15 SPECIAL REQUIREMENTS 3.401.l1(13)(1)(2) Pork and Beef Roast- 1.3U'F121rnn" So0.0U'J(A)-(ll) Violations ofS:tiionS9O.009(A)-(D)in -4(11.I1(AlO2) Ratites,Injected Meats- 155'F 15 Sec, * catering,ntobite food, temporary and 3 401.11(A)(3) Puuhuy,Wild Game.Stuffed PHF?; residential kitc-ben operations should be Stuffing Containing Fish. Meat debited tinder the appropriate Seeiiotis Poultry or Ratites-I65'F 15 sec. " abo,,e if related to Coedhorne dhiess 3-401.11(0 0) Whole-muscle, hunrcl Beef Steak, inte-veninan-,and risk factcrs. Other 145^F n 590.009 violations reiadng to good retail 1-401 12 Raw Animal Foods Cooked in a ! praelicrs should be debited under 1129- Microwave !65'J- * Special Regwrcment, 3-401.I1(A)(1)(b) All Other PHFs-- 1451- 15 sec. ' It i7 Reheating for Hot Holding VIOLATIONS RELATED TO GOOD RETAIL PRACTICES 3-403 11(A)&(D) PIIFs 165'F 15 sec. ;; (Ite)ns 23-30) 3-403.11(6) Microwave- 165'F 2 Minute Standing Ct iii(al and non-crr,irui vioiuti,vtc, Whirit dtt not re1171e?a the Time* I %uodbor ne illnc.v imei voirbwic✓nd risk(,atom lived abore, can 6e 3-403 1 t(C) Commercially Processed RTE F.>'}d- found in die fs-11vu Ing:.e(titno ignite Fo,d Code rand 105 C.A1R 14WF" 5(10.0(10. 3-403.1 1(E) Remaining Unsliced Portions of Beef I Item Good Retail Practices I FC 590.000 Roxsis" 23. Management and P eronnei FC -2 008 IS Proper Cooling of PHFs I 24. Focd an^Fooe Protection FC-3 004 25 Equq:meni and Utensils FC--4 _.005 3-501.14(A) Cooling Cooked PHFs from 140'F to 26. Water,P!umbr:q and Waste FC-5 .006 - ---' 70-F Within?Homs and From 70`F j 27, Physical Facil:,v FC-6 .007 to 41 1Ft4511'Withut 4 floors. " 28. Foiscno:us or Toxic klaterals FC -7 .008 3-5:)1.14(B) Cuolutg PHFs Made From Andi rat 29. 11 Special Requirements .009 j 'lemperalure hu nedrents to 41'F/43'F ;_30. '�, Other Within 3 Hours. , ""' Denote..critical Item in the Icderal 1+179 Food Code-n I05 0111`90.000. Massachusetts Department of Public Health Salem Board of Health Division of Food and Drugs 120 Washington Street,4t Floor Salem, MA 01970-3523 FOOD ESTABLISHMENT INSPECTION REPORT Tel. (978) 741-1800 Fax (978) 745-0343 Name Date Type of Ooeration(s) Tyve-of Inspection 1 . G 4,),) Al n 4.�A) 3 -11-e74 rtVFood Service 9 Routine Address Risk Retail ❑ Re-inspection �2 77?n //oOC 4V7 Telephone / `( ' Level El Kitchen Previous Inspection 6791 1,/y �IUR ❑ Mobile Date:3-/#-,�)° Owner n HACCP Y/N ElTemporary [IPre-operation 7✓y� 2 A� / b r f„, m� f� )Y7r I ❑ Caterer ❑ Suspect Illness Person in Charge(PIC) Time ❑ Bed& Breakfast ❑ General Complaint U,ir/vro (GA-V'rO 4,. i1VAlr1hllto/J In: ❑ HACCP Inspector ni rrnais Out: Permit No. ❑ Other Each violation checked requires an explanation on the narrative page(s) and a citation of specific provision(s)violated. Non-compliance with: Violations Related to Foodborne Illness Interventions and Risk Factors Anti-Choking Tobacco Violations marked may pose an imminent health hazard and require immediate corrective 590.009(E) ❑ 590.009(F) ❑ action as determined by the Board of Health. FOOD PROTECTION MANAGEMENT - ❑ 12. Prevention of Contamination from Hands El 1. PIC Assigned/Knowledgeable/Duties EMPLOYEE HEALTH - - El 13. Handwash Facilities ❑ 2. Reporting of Diseases by Food Employee and PIC PROTECTION FROM CHEMICALS El3. Personnel with Infections Restricted/Excluded El 14.Approved Food or Color Additives ❑ 15.Toxic Chemicals FOOD FROM APPROVED SOURCE ❑ 4. Food and Water from Approved Source : TIMETEMPERATURE CONTROLS(Potentially Hazardous Foods) ❑ 5. Receiving/Condition ❑ 16.Cooking Temperatures ❑ 6. Tags/Records/Accuracy of Ingredient Statements ❑ 17. Reheating ❑ 7. Conformance with Approved Procedures/HACCP Plans ❑ 18. Cooling PROTECTION FROM CONTAMINATION ❑ 19. Hot and Cold Holding ❑ 8. Separation/Segregation/Protection ❑20.Time As a Public Health Control ❑ 9. Food Contact Surfaces Cleaning and Sanitizing REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) ❑ 10. Proper Adequate Handwashing El21. Food and Food Preparation for HSP ❑ 11. Good Hygienic Practices CONSUMER ADVISORY ❑22. Posting of Consumer Advisories Violations Related to Good Retail Practices Number of Violated Provisions Related Critical (C) violations marked must be corrected To Foodborne Illnesses Interventions ( (.� immediately or within 10 days as determined by the Board and Risk Factors(Items 1-22): of Health. Non-critical (N)violations must be corrected Official Order for Correction: Based on an inspection immediately or within 90 days as determined by the Board today, the items checked indicate violations of 105 CMR of Health. 590.000/federal Food Code. This report, when signed below C N P 9 23. Management and Personnel (FC-2)(590 003) by a Board of Health member or its agent constitutes an 24. Food and Food Protection (FC-3)(590.004) order of the Board of Health. Failure to correct violations 25. Equipment and Utensils (FC-4)(590.005) cited in this report may result in suspension or revocation of 28. Water, Plumbing and Waste (FC-5)(590.008) the food establishment permit and cessation of food establishment operations. If aggrieved by this order, you 27. Physical Facility (FC-6)(590.007) have a right to a hearing. Your request must be in writing 28. Poisonous or Toxic Materials (FC-7)(590.008) and submitted to the Board of Health at the above address 29. Special Requirements (590.009) within 10 days of receipt of this order. 30. Other DATE OF RE-INSPECTION: S 5901nVntFom 14 do Inspector's Signature, Print: I PIC's Signature: Print: JI PageL ofq� Pages i 5 Wolations Related to Foodborne Illness Interventions and Risk Factors(items 1-22) PROTECTION FROM CONTAMINATION FOOD PROTECTION MANAGEMENT & Cr ss-stints rinaron 1 590.003(A) .4smgnment(if'Responaibility* 3-30'2.11(A)fl) Raw Aram-,lFoods Separated tium 590.003(B) Demonshation of Knowledge' Cooked and RTE Foods' 2.103.1 I Person in:barge --daties Centaminatien from Raw-Ingredients 3-302.11(A)(2) Raw Animal Foods Szparated from Each EMPLOYEE HEALTH i ()cher` l 2 590.001C) Responslhility of 1.,c person in chat„e to j Ccntamoation from the Fnvironment require reporting by faad employees and A-302.11(A) Fal Protec'io,t" applicants" 3-302.15 W'ashmg Fruits and Vegetables 590.003(F) Responsibility 01'A Food Employee Or An ? 304.11 Fax,Cowaa with E tai]ment and Applicata To Report To The Person In Utensils* Charge* 1 Contamtna+ran from tire Consumer 590.003(G) Reporting by Person in Charge* ( :-i06.14(A)t W Returned Food and Rcscrvicc of Fail* 3 590.00301)) ( Exclusions and Rc!xrictions" I I Disposcon of Adotterated or Contaminated 590 003(E) ( Removal of Exclusions and kcstrictions Food 3-701.11 Discarding or Reconditioning Unsafe FOOD FROM APPROVED SOURCE Foal* d 1 Food and Water From Regulated Sources ( ( 9 Food Contact Surfaces 590.004(A-B) I Compliance with Food Law' ( 4-5(11.11 I Manual Warewashing- Hut Water Sanitization Ternoern;ures" 3-201.13 Food inHermetics Products* PrScaled Cont.u!ier* ( <;-_,01.112 Mechsmcal G,arcwashing,Hot 'rarer ?-:01.13 Fluid Milk and Milk oduces* � Sanitization Tem>�rmures 3-202.13 Shell Eggs' I 3-'_02.14 F,ggs and Milk Products,Pasteurized.' 501.11+ Chemical Santtizalion-temp., pH, concentration and h.iioresc :K 3-202.16 Ice Made From Potable Drinking Water' 4-601.11(A) F.gnipment Food Contact Surfaces and 5-101 11 Drinking Water from an Approved System- Utensils Clean" 500.006(A) Bottled Drinking Water* 4-602.11 Cieanin_Freque(tt)of Equipment Food- 590.006(B) Witter Meets Standards in 310 CMR 220` i ! C'uetstt tinrfaccs and Utensils' J Shellfish and Fish From an Approved Source j 13-201.14 Fish and Recreatiorcdly Caught Molluscan I 4-702'" Frequenry of Sanitization of Utensils and ! Food Contact Surfaces of Equipment"' Shellfish* j a-703.11 iaictN:ds of Sanaizaror.-Hot Water and 3-201,15 Molluscan Shellfish from NSSP Listed I + ChrmicaI4' Sources* - Game and Wild Mushrooms.Approved by ( IO j Proper,Adequate Handtvashing Reguaton,Authority 1 2 301.1 1 Clean Condition-Hands and Aims: 3-202 19 Shellstock Identification Present* 2-301.12 Cleaning Pru:edure* I 590.004(0) Wild Mushrooms* j 2-301.1-1 !When to Wash* � -201.17 Game Animals* if Good Hygienic Practices g ( Receiving/Condition 1 2-40111 Haring.Drinkin;:or Lshm,Tobacco* 3-202.11 PHFs Received at Proper Temperatme.* 12-401.12 Discharge: From the Eyes.Nose and 3-202. 15 Package Integrity- Mouth* 3-10LI I Food Safe and Unarltdterated* 3 ?01 l2 Prevc!itin,,Contan:laation When Tasting" 6 Tags/Records:Shellstock 12 Prevention of Contamination from Hands 3-201.123 Shellstock Identification* 59;1 004(E) Preventing Cotttaminauon from 3-203 12 Shellstock Identification Maintained' E"'ploye0s* 13 Handwash Facilities Tags/Records:Fish Products Conveniently Located and Accessible 3-402.11 Parasite Destruction' 5-,Io_;.11Nunilc�s and Caparties" 3-40'_.12 Records.Creation and Retention* 590.004(J) Labeling of Ingredients" 5 204.11 ..acation and Placement s 7 Conformance with Approved Procedures I 5-20:1.1'' accessibility.Operation and Maintenance_ /HACCP Pians I Supplied with Soap and Hana Drftng 3-502.11 Specialized Processing Methods* Dev%ces -- fi-301.11 flandwashitiv Cleanser, Availability 3-502.12 Reduced oxygen packagin;;,criteria` e,-103 12 Conformance with Approved Procedures- b-301.1 2 Hand Drying Provision 'D=mnec.raical item in the fisj=l 1999 Fond Code of 1W CMR 590,000. CITY OF SALEM BOARD OF HEALTH Establishment Name: 11Za2s./n,n X�, ,Ln Date: Page: Z of '2 t Item Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date No. Reference R-Red Item �) PLEASE PRINT CLEARLY Verified I� �'7 �i7- � /��of�_ M CY✓I� _/.f/L/�_C -.—�cy'.� .�_r r'iV,N.eiz� ia,/ //Ji.9 !-�_./o„e c a- %.��.nt7�-i/% /7/P eOP /l r Y //�O (�?fir,O ... 7`:-77�/J� /.//iG I_ �_ /r✓v .�s+°/!o./ " -2 — fTi7dPP D/" /rG ?d'lyd.�/P � fiP /✓a�n� /r% n/r�� (�v/s r/a;ry / n 2 [ v 2'}'J,Viy_C /liDYn - (I7�v r C/A,{� /.0 /I//I.PN,Al o /'t4 C AZ 9y l / .iii/ o GC-17r/9 i 7,/✓J C / ..n /.✓ 2 - '-1-1.' el A/r./?r'P'f' h/,r,i/F'. n I _g I 't - t� Ia � I 1 Discussion With Person in Charge: Corrective Action Required: I ❑ No I ❑ fee I have read this report, have had the opportunity to ask questions and agree to correct all ❑ Voluntary Compliance ❑ Employee Restriction/ Exclusion violations before the next inspection, to observe all conditions as described, and to ❑ Re-inspection Scheduled ❑ Emergency Suspension comply with all mandates of the Mass/Federal Food Code. I understand that noncompliance may result in daily fines of twenty-five dollars or suspension/revocation of ❑ Embargo ❑ Emergency Closure / your food permit. ❑ Voluntary Disposal ❑ Other: L it)!.ilic) PHF, Rece:veda: Violations Related to Foodborne Illness Interventions and Risk Ateardic, 1-1,,W Cooled to Factors(lients 1-22) (Cont.) 4 i�-F!15'F 4 How PROTECTION FROM CHEMICALS iS C'.."fiog Methodsf('r tfl,�:; Food or Coloe Additives 19 PHF 1�:-,arid Co!6Hjaijjg 14 1,16(8) Cold R-04c 500.00-i�Fl ,-202.12 1 Addlo�es* 3-302.14 Protection frtan Unapprmed Addnkeq 15 Poisonous or Toxic Substances Wes M t:.-Lamed a: -j above 7-101.1 i Identifying Information-Original Roju., Held at e above 130 F. 7-102.11 Common Name-Worllin--Containers20 Time as a Public Hoan-,Control Time as Public Flalth CO*rop, Separation-sollage' 7-202.11 Re,triction-Prc,encQ and Use 7-1-02,i2 Conditions of Use' -,1-203.11 Toxic Container; -Prohibitions- REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-204.11 SanitizetF.Crilet ta henneat:;* POPULATIONS ;HSP) 7-204.12 Cheoncalk tot Wahnu!Produce.Criteria� 13-801.11(A T lnp,�steuqj;�t(! Prf-Pi.2kagod lujc,--qr.d 7-204.14 j Dtyin-Agents.Criteria' 13c"clav-,, with W,,irnin�Lab �-W)LI I(B; Ilse,of Pa,tcui;�ed 1--,,S'� 7-205.11 IncicictualFoodContaci Lubtioants� 7-206.11 Restricted Use Pesticides,Critei-a" 3-INVO I UD', R.rw or Part:al'1) Coo.ed Annual Food and -2W 12 Rodent Bait Slations* Raw Seed Sprouts Not Served. -� 3 ?,O I-I i(C) U.-luvelled Fend Pacl.a!:e Not R..'-served /-206.13 -Cracking Powders, Pest Control and CONS'IMER ADVISORY TIME/TEMPERATURE CONTROLS 22 3-b0;.1, 1 C:rasum,r Ad,;j:,oi-j Po,acd for CAlleaRalltion Of Proper Cooking Temperatures for AnnnA Fou& �hat we Raw.Unzterc,00kcd v 16 I PHFs No: Chllcrwisc`Proce!;sed to Eliminate 3-401.11A(1)(2) EgZs- 155'17 - 15 Sec. Pathocns.* F.L,,s-lrrrnedl,qc Service 14J`17lisoc 3-302.!3 Pasteurised Egg�Substione for Raw She]] 3401 1 I(A)(2) Coanninrlted Fish. Moats& Gannu "s Animals- 155F 15 sec. - I SPECIAL REQUIREMENTS 3-401.11(B)(1)(2) Pork and Beef Roast- I 30'F 121 inin' 3-10 1.11(A)(2) Ratacs, Injected Nlcaa.- 155'17 15 500.009(A)-0)) Vio!-tions of%wion 590.009(A 1-(D)in sec. * I caleimp,mob,:Ie find, temporary grid 3-401.11(A)(3) POLlIft'l,Wild Game. SonIsd PlIFS residential kitchen operations should be Stuffing Containing Fish. Meat, debitod tinder the approlmalo sections Poultry or Rattles-16 s'F 15 gec above if'related lo toodhorne illnes� 3-401.11(C)(3) Whole-niuscit.. ftilict Feet Steaks intervention..and risk factors. Other 145"F 1° 590.0(19 violanoa�. telnoug to good retail 3401.12 Raw Anijoal Foods Choked !n a nracG-CS.'-o)uld he defined under #29- Miciowa\e IWF': Special Xecluircinents. 3 101.1!(A)(I)(hl Ali Other PFIFs - 145'F I S sec, 17 Reheating for Hot Holding VIOLAVONS R-LATER TO GOODRETAIL PRACTICES 3-403 11(.A)&(D) PI-IF, 165'F l3 sec. (Items 2.3-30) 3--1(!3.11(11) Microwave- 1 W F 2 Alorttle Standing C411cal wid fx,s crilical violations, *hit'll do not reiate to tile, 'rune" iisledabou, ran be 3-403.11(C) Coniniercialiv Piocessed FTE Food- fdwnd ai tJze.fofioa,:vg tile Food Cade lald 105('AIR 140°F" 5190.0ti0. 3 403.11(1-,) Rearoniro, Un0ced Portions of Beef Item Good Retail Practices FrI 590,000 Roasts* 123. fila,aclernent anal Personnel FC - 2 003 18 Proper Cooling of PHFs 1 24, Feed and FccNl Protection FC - 3 _1004 _I 25 Equipment and Utenclik. FC-4 00 501 14(A) Cooling C,xoked PHFs from 140'F to -"G. kAhter,PILVibjnq and waste FC-5 '00 70-'F Within'.Homs load From 70'F i 1 27 Fhysic;r Facility FC-6 007 to 41'1745"F Within 4 Hour,. I I I nst mmorous or 7 One Materials F0- 7 008 3-501.14(8) Coojiii,,PHFs Made Front Anibwnt 29, 1 Soecial Requ:ronients 009 Temperature InlY-c(lients to 41'F!45'F 30, Other Within 4 Hnurs' Donwe<�rajcal aeon in the Itatral 1999 K,W C,,Oc w M UNIR 1.0.(AO. i Massachusetts Department of Pub Health Salem Board of Health 120 Washington Street,4'h Floor Division of Food and Drugs Salem, MA 01970-3523 FOOD ESTABLISHMENT INSPECTION REPORT Tel. (978) 741-1800 Fax (978) 745-0343 Name Date T_,_v,P�of Ooeration(� TYrie of Inspection Y%t,o �.PDUa✓n ri.v[7 3-BEay IJ Food Service El Routine Address ✓� �Yv�c Risk ❑ Retail ❑ Re-inspection Level El Residential Kitchen Previous Inspection Telephone /_ I y�y elgW I ❑ Mobile Date: ?-o1/- 93 Owner ///,� HACCP YM El Temporary ElPre-operation !✓Fie/)J7e sc.has/nIUMnT< f %�/r� I_ I ❑ Caterer ❑ Suspect Illness Person in Charge(PIC) Af10 7e4 S7-,6 S 4Pw lrgx Time ❑ Bed&Breakfast ❑ General Complaint inspector , _ / In: ❑ HACCP Ins p r /'ira 517t_A(s Out: Permit No. ❑Other Each violation checked requires an explanation on the narrative page(s) and a citation of specific provision(s) violated. Non-compliance with: \ Violations Related to Foodborne Illness Interventions and Risk Factors Anti-Choking Tobacco, Violations marked may pose an imminent health hazard and require immediate corrective 590.009(E) ❑ 590.009(F) ❑ action as determined by the Board of Health. FOOD PROTECTION MANAGEMENT ❑ 1 . Prevention of Contamination from Hands E] 1. PIC Assigned/Knowledgeable/Duties . Handwash Facilities EMPLOYEE HEALTH PROTECTION FROM CHEMICALS ❑ 2. Reporting of Diseases by Food Employee and PIC El 14.Approved Food or Color Additives El 3. Personnel with Infections Restricted/Excluded FOOD FROM APPROVED SOURCE ❑ 15.Toxic Chemicals ❑ 4. Food and Water from Approved Source TIME/TEMPERATURE CONTROLS(Potentially Hazardous Foods) ❑ 5. Receiving/Condition ❑ 16. Cooking Temperatures ❑ 6. Tags/Records/Accuracy of Ingredient Statements [117. Reheating ❑ 7. Conformance with Approved Procedures/HACCP Plans El 118.Cooling PROTECTION FROM CONTAMINATION V, Hot and Cold Holding ❑ 8. Separation/Segregation/Protection ❑20.Time As a Public Health Control V/9. Food Contact Surfaces Cleaning and Sanitizing REQUIREMENTS FOR HIGHLY SUSCEPTIBLE POPULATIONS(HSP) 10. Proper Adequate Handwashing ❑21. Food and Food Preparation for HSP ❑ ❑ 11. Good Hygienic Practices CONSUMER ADVISORY ❑22. Posting of Consumer Advisories Violations Related to Good Retail Practices Number of Violated Provisions Related (r; Critical (C) violations marked must be corrected To Foodborne Illnesses Interventions ®ice immediately or within 10 days as determined by the Board and Risk Factors(Items 1-22): of Health. Non-critical (N) violations must be corrected Official Order for Correction: Based on an inspection immediately or within 90 days as determined by the Board today, the items checked indicate violations of 105 CMR ofC eaNh. 590.000/federal Food Code. This report, when signed below 23. Management and Personnel (FC-2)(590.003) by a Board of Health member or its agent constitutes an 24. Food and Food Protection (FC-3)(590.004) order of the Board of Health. Failure to correct violations 25. Equipment and Utensils (FC-4)(590.005) cited in this report may result in suspension or revocation of 26. Water, Plumbing and Waste (FC-5)(590.006) the food establishment permit and cessation of food establishment operations. If aggrieved by this order, you 27. Physical Facility (FC-6)(590.007) have a right to a hearing. Your request must be in writing 28. Poisonous or Toxic Materials (FC-7)(590.008) and submitted to the Board of Health at the above address 29. Special Requirements (590.009) within 10 days of receipt of this order. 30. Other DATE OF RE-INSPECTION: s 5 InsWIFOm -10 dw Inspector's Signature: �� Print: PIC's Signature: (`L �- A Print: /'�f I� C f ^ t 4 I PageL ofd Pages Violations Related to Foodborne Illness inter'Jentions and Risk Factors(items .'-22) PROTECTION FROM CONTAMINATION FOOD PROTECTION MANAGEMENT ICross cnntarnnatinn I 1590.003(A) Ass)gnrnv:i cdkesponsnbiliW ( 3-:,02.11:Alf I} Row Aninud Foods Separated from 590.003(13) L'enumsu' llnn of Knoa.�ledr N` j C'rokrd aro RTE Rods" j ?-1(!+.(I Pruann in ehargr-duties I ( Coeram:ratio,-,-tubi Raw fngredieri:: j 3-302AhAvTi R-r. Amuv! Foods Separutcd from Each EMPLOYEE HEALTH Othvr' 2 590 003(0) Responsibility of the person in charge to I Contannnar:on`-gym the Environment require reporting by food emplovzec:bid i 1 302.1 i(A) Foo,-! Proteci:on• applicants' 3-3111 15 VV ash'n,Fruits nid Vzeetnhlrs 590 0101(F) Respom"Niity Of'A Food Employee fh An � 13-304.11 Food Contack wuh rgripment:bid Applicant To Repo,1 To The Fuson is IItensa'e' Charge' j ::Doter„matron finm the Co•-surner j'XI i)0-(C) Reporting by Person in Charge* I 3 306.1 I!A)(B) P.eturned Food and Rescrvile of 1 Red' 3 .590.0030)) P.xciusnmsand RestriLlions* Cispr.;itir;no'A,duftaratedorContarninated 590.0W(F) j Renimal of exclusions and Restrictions I ( I Food 13-'70:.1 I j Discarding or(7.ecouditionunk 1'utafe FOOD FROM APPROVED SOURCE141 '•ccxl* Food ana I"✓ateer From Regulated Sources I ( 9 j i rood Contact Surfaces 590t,0(l4(A-B) Compliance with Food 1 anw-" 14S(Il 111 ManualVVaretc:r.;hmg-Hni 1V'atet S:mitizat ion'hrnn;erahars'" 3 7.01.12 Flui nn Hermetically and MiScaled Cont.uner* i i 4 50:.!1= Rohe:acal 'Asrewashinp- Hut Wider 13-201.13 Fluid AAiII:and Milk Products* _ 3 202.13 Shill bggs� I Sanitization Ecnnp-r.,�nrc 2_>01.14 Figs and :Milk.Janxluas.Pasteurized" i ( -i-5U1.11�1 Cttemtal ^;euiiizxtiotr temp.,pFi, CenceMtcUon and :•-20"_.16 Ice&,fide t§cm Pucable Drinkin;*,Watcr'' i 4.60:.1 l iA) Equipment Food CentaC'Su tams and 5. 0; 11 Drinking Water from an ApprnveJ System" I Utensils Clean' 590.006(A) Bottled Drinking Water* i 4-r;(i7.i ; Cleannng P-n:guency of%quipmem Food1590 006(b) Water Meet Standards;n 310 CMR 23.0* Contact S: Maven and I Shellfish and Fish From an Approved Source 4-702.11 FreyuCncv of San^i:anon of Uleuslls and j ?-201 14 Fish and Recicution::ily Caught Moi!uscan Focx!Cntda:.i Su;fiacrs of Equipment* Shellfish' I 1 1011.'i Mfethods oSauuuzation-Hot VV iter and 3 201.15 Voltuscan Shellfish from NSSP Listed Ch�t::ical' Sources' Fit Proper,Adequate Handwashing j Gane and Wild Mushrooms Approved by I Regulatory Authority 2-301 11 Clean Condition-F;ands:dxt Anna 3-202.18 Shellsh,ck Identification Ptescnt" I '-3(11 1 Charting,t*ocrdnre` : 2-;01.11 RRvm in.W:,10 j 3-201.f 7 Gain MusmaNt x E if Good Hvyienir.Practices '1.0!.17 Came Animals* I I § ' � Receiving/Condition ' rr Cting Tnbu:0" 3-20_.11 PHFs Recened atPropeTemperanues" '-401 I% Duch:rges ' From the Even. Nose and 3-202.15 Package Integrity° Al,uth- L7a)l.i2 Pceventu tg Contamination Wben`t asting4 3 101.11 food Safeind j ' 6 Tags/Records:Shellstock ! 12 Preven:on of Contamination from Hands 3-201.19 Sftelistcxkldentitication" Prev�,ntxgCoutuuunauonfrom ! 3-2i13 13 Ste:lstock ',dentifcation Maintained" , I j 3.3 Han:-wash Facilities Tags/Records: Fish Products I 3-402.11 Parasuc DestructionGrnveninr:'iy Located and 4cc-ssibie 1 * I I - 3-402 !2 Records-Creation and Retention" I x'203.11 Numbers mid :apaci(neO- j 590.004t.I) j Labeling of Ingredients' 5-204.11 Location :bid Placement' j 7 I Conformance with Approved Procedures I S 05.1 I 0.ccrsaihilii'i.t�ncrthou and Ylaintenance j lHACC.u Pians I Supplied m^;n: cap and Hard C;yang 1 i Sprclallzed Plncessmg Nfethoil.+* j DFw:ss 3-502.1'.'.. Reduced oxygen packaging, criteria` Cleanx r,A%c,,ii ah!I!iy i ( I k;-i()3.Ill Confonmauce with Approved !'rucrdur•.;.'" I 6-301.12 Hand Dr,,vn r Pawtsio n *Denote o i::,al ecu:in;6e Utial 1999 Fo,xl Ocde ,, ,oi(:MR 590.000. r CITY OF SALEM [ /� BOARD OF HEALTH Establishment Name: I_Xe 9Pou�r/J /SL 1_ Date: 9- 3- o Page: of ? nem Code C-Critical Item DESCRIPTION OF VIOLATION/PLAN OF CORRECTION Date No. Reference R—Red Item - `t Verified $ � PLEASE PRINT CLEARLY�y �IOU/r�✓ P �ndSPtG'/CP P,E '7P7 Ite7(ed- 1-O440691,#? �! 1� /9 G _ 7?1r ��ci� ��r�ti-/-✓ r �✓LdG /� f 7_,-rn13 O .fid � )'?/,sr .�(�., G!X/a it ✓A c riri1. P� /7 /,a 4J C/n? /' s7 ZC - /LAG ` n/� i7.hn v e- — r 11_Trra,0W° pe' cs/ vr�S��r77 v /1 1 / ?j - /�rl t/is/R//e./ICr/i�C/7n Tl1P✓Jr//M19✓ cls ��r�-/./ r, U,D�tsi �r/2ve -2fA/ 7- s/�Ii%P /9 G - L.lictLk-iry �6%PPZa,lZ T�%rl,D/J�aKa� fG ,� D°f �- .B�l�uy /ee Clr�/i�,r,7e�rr�-�Lr�a�'a�� 7-r .6e `// °r oig AIZIUI `.p-,(;� I �? '7 �liin,Pi/��a, �/l�rrrr�i n,�� 1✓�>°i�c C'l PiLriiAS I. Y H/dna. n v f 21 /c -7` PO 7e1)1)e19IP -T,Pp rl /A694 l� / /?1.PlX� ,sPurvn Xl4/l11'12 D/ri1d5IAL rl?AP-4vrs .s-r `Lrr/.F—f_�PP/.� lo-h/.GY'HPS ©FF F/ili .Q cT 1 �� 1 n,d �s _/GP C'OdP/P Y-v gc ✓1?IYx/ Nei ' c' 6rl',7Gcle-cP d'.1�✓V� - — _, —:_. i9 .� �_ ^. � �cn �ceFs%P n,a rla/� �r.¢r.�e�S /j G _Y�e+f s 40177 —mne S/? ya'/" aGr/'k'r,va a /s Discussion With Person in Charge: Corrective Action Required: I ❑ No I Ll fee I have read this report, have had the opportunity to ask questions and agree to correct all ❑ Voluntary Compliance ❑ Employee Restriction/ inspection, to observe all conditions as described, and to Exclusion violations before the next ins P L3 Re-inspection Scheduled ❑ Emergency Suspension (fomply with all mandates of the Mass/Federal Food Code. I understand that )1oncompliance may result in daily-fines of twenty-five dollars or suspension/revocation of ❑ Embargo ❑ Emergency Closure ,your food permit. /Q 1 1 1 -- /A j/j,�—J,,,.,+•'" ❑ Voluntary Disposal ❑ Other: ? ) 3-Si31 1.140 :J i-s Recr.crd it Temperatures Violations Related to Foodborne lliness Interventions and Risk Factors(items 1-22) (Cont) Accnn,5;;:F Pt,.'.'i:i,ahnmCooled lit PROTECTION FROM CHEMICALS 5J l Cotr!ing.P.iethnds;or Pib s 14 Feet!or Color Additives gu Pill!Hot and Cold Holding j 3-202.12 Additiae.F ?-5(11 16(11) 41 1 51 Fc nauinta;neu .n or bzinw 3-302.14 Prota4ion frons Unapproved Additives" � ;-=d?1.161 A; Hot PHFs Maintained it of ahot.z 15 Poisonous or Toxic Substances 7-101.11 identiijinc}nhnmanon-Onginal -lU r Ca:tamers.. SOl.lb1.1; _Ro.;sts Held in.or h,;ce 130'`F ' 2d Tdme as n Publ,n Health Control 7-102.11 Commonrs-Slo Wort, n.2,Clont+tinrtc* I -t-t�i'119 Tiute ass Pub'L: I Ieallh i:outroP` 7-?pLll Separation-Storage" ' 7-202.11 Restriction-Presence and tiso* 190.004, II Vaaan.e Requirement 7-202.12 Condttinns of Occ' 7-203 11 Toxic Container,,-Prohibitinns" REQUIREMEras FOR HIGHLY SUSCEPTIBLE 7.20-1.11 Smutizers.Critrua -C'hemtcats' POPULAT!u^NS(HSP) 7-204 12 Chemicals lot Washing Praluce,Criteria* ( 21 i 3-80 1.i I(A) Unpast,,ut teed Pre-nacFa=ad,luicun and f W'arnive L,rbela 7-:03.14 6ryinr Agents.Crtteliva � tiecrrr_es w::-: 1(B) Use of Pasteur izrd 7-205.1 I Incidental Food Contact, L❑bricantt� 3-,y Oi ;l(D) Raw n:.Partially C'uokea Anim i Fool.tad 7-206.11 Rel;ttietvd [iso Pesticides. GneimT i Raw Sced Sprouts No!ServrJ. " 7-206.12 Rodent Bait Stations* ( i 3-80!.11 r(7Unoncr: d Food Pack:ifc Not Rc�svrced 7-206.13 Tracking Powders. Pest Control and Mumtormc' CONSUMER ADVISORY TIMEITEMPERATURE CONTROLS 22 3-x03.11 Consutnsr Advmoi Posted For Consil ion of t6 IProper Cooking Temperatures for I Anmt,d ttvxh. ]'hit: are Raw. L deicuuked or PHFs Nn+ Otherwise Processed to E^l inunnte 3-40 L 11 A(1)(2) Eggs- 155"F 15 Sec Patkiwots " '=,r�:.�, .,an ' Eons-Immedrae Service 145'Fl5scc. 3-30::.13 Pastemiied Fag.:Substitute tor Raw ShrII FrvY„„;:. 3-401.11(A)(2) Comminuted Fish. Mr.,ts&Ganrc Animals- 155'F 15 we 3-401.11(13)(1)(2) PurkandBeefRoast- 130'F 121 mors SPECIAL P.EQUIREMENTS 3-401.1 I(A)(2) Ratites,hrjec+zd nfeuts- I55'F 15 5o(tOn9i A;-(I)) Vinaations of Ser!icn 590.009(A)41)) in sec. ; catering, mobile food, temporal and 3-40 1.11(A)(3) Puuhry, Wild(sure.Stoned PHF:,. r,e Wential ktt2hcn operations should be fti 4tnny Containing Fish,Meat. debited rndetthe appropriate sections Pnulny or Ratites-'65'F 15 sec. " above if relan-d to loodhorne illuesc 3-401 11(C)(3) Whole-muscle, Intact beef Steak,, int rventium and risk factor,. Other 145`F A, 5q(,001) violations retailing io good retail 3-401.12 Raw Amutai Fends Cce,ked in a j pntetices shotild be debited under N29 - Microwave l65`F Special requirements. 3-401.41(A)(1)(b) All Other PHFs-- 145'F 15ner t7 Reheating for Hot Holding VIOLATIONS R9LATED TO GOOD RETAIL PRAC710ES 3-403.i I(A)&(r)) PHFs 165F 15 sec. * (sterns,23-30) 3-403.11(13) Microwave- 165"F2 Minute Standing I Crilt,.al and non crNitul riolatirns, which du not rrde(r to the Time* foodborne t!htcsr i;:?r n•rntioaa r:n.l,t�.4(:etrna Gated aborti, urn be . 3-403 i I(C) Couauerciatly Pi txessed RTE Foal- I fotmd;,i fhe f,(1,);vb;ms tines of;he Fuod Code and 105 CARR 140"F" 59t7 00o. j 3-403.11 r,E) Remaining Unsliced Portions 413cet item Good Retail Practices FC 590.000 Routs* I 23 Itlan rtementanrPasorod 1 rC-2 .003 24 ' Fcod Fnd Food Protection FC-3 004 1g , Proper Cooling of PHFs 25 1 Ea'rApment and Well l-C-4 ,005 3-501.14(A) Cooling Conked MINh't,m 140'F it, i Weltel, PlttrunivjandleifastB I FC--5 .006 70"F Within 2 Hours and From 70'F I I 'L/ Phvs:oal Facility FC 6 007 I to41`F!45'FWithin 4Hour,. " ( 12R Posonousortcr,,cNlelends .008 3-501.14(B) Carling PHFs Made Fran Amherst 29. _Special Requiramenis 0pg - -- 30. Other 'I'emparatureingrd,entsu,ll'F/45'F I Within 4 Hour:* Del c,ideal eel:in the redmil 1999 Fu(x1 Code u, 10S CNIR 590ml)(1. i { CITY OF SALEM {{ ► /'� BOARD OF HEALTH f Establishment Name: YX.v l�lnn!/r;/n g -T.4,, All') Date: 9-i/-na Page: IR of 3 Item Code C-Critical Item _ DESCRIPTION OF VIOLATION/PLAN OF CORRECTION I Date No. Reference R-Red --- Verified PLEASE PRINT CLEARLY � _ ��/!1 ._C',•r.a?/��. ^7 fJr n I�� AJJ 7�- n'}7yNJ,...,_�_ nom!/�cv Yr rte- cl.J�i/ y7C - ' fI I i I n/n 7!"" 7/ (�+�/ /.A f.. �:r4v{ ri �J7, T- L7�P/I fie, � /� v -I J ` I I ✓'I �v1!°rarn.<;.7i,, A/(/Gs/h'r7P� �_T __7"Y/,4,17�Ia /�Oa'1e^in 7 I I Yes j Discussion With Person in Charge: , _ corrective Action Required: � ❑ No � ❑ Yes I + I have read this report, have,had the opportunity to ask questions and agree to correct all ❑ Voluntary Compliance ❑ Employee Restriction/ violations before the next inspection, to observe all conditions as described, and to Exclusion 't Suspension comply with all mandates of the Mass/Federal Food Cade. i understand that Ll Re-inspection Scheduled ❑ Emergency .ioncompliance may result in daily fines of twdn y-five dollars or suspension/revocation of ❑ Embargo ❑ Emergency Closure r yourfood permit. [.1 Voluntary Disposal ❑ Other: 3-501 4(C) PtlFs Rec-i Yed :it Violations Related to Foodborne Illness Interventions and RISK I-!;a,t•Cooled to Factors(Iterns 1-22) (Cont.) 11ITi45FW�flnu-[Homs PROTECTION FROM CHEMICALS 5f)1 13 C00 MeI17,As for FlIFs P"F Flo,and Cold Holding 14 Food or Color Additives i ;;11 1 ra(B) Cold PI Ws Mulazimcd at or below 1-Y), 12 Additives* 590.(01t,F) 41'/4:•'F- I ?--,02 14 Frct,xtiorl trout(niapinovLd Adds:ivcs' 4-501.161A) 31loL PI[F, tvTz,m,:,i:tcd at oi abate 15 Poisonous or Toxic Substances t I 7-101.11 Identitem, information--Original 3-501.16(A) ileldaioi above j30'F Containers' I lt:neasa Pubic Health Central 7-102,11 Compton Name-Working Containers 7-201 11 Separation-StojaLcl' 19 Time at�a PuLh, Hetiih Control i90.004(111) Vamaicc Requirement 7-102 11 Restriction-Pa-sence and Us- 7-202.12 Conditions of Usc I 7-203.I I Toxic Contairic.,s-Prohibitions' REQUIREMENTS FOR HIGHLY SUSCEPTIBLE 7-204.11 Sanitizets.(riteiia-ChenncalsT POPULATIONS(HSP) 7 n4,12 Chemicals for Wahnig PlOdUle,Criteria" -'I 3-8:)I.11(A) "It-c-pti,kancd Juicef,Lmd 7_20Drvirn,AClltoiia'� with Wtlrnjnl�L 1 1 ?-80111(Bj Use of Pristelarl7ed 7-205.11 Incidental Food Contact,Lribricants4, J 'I ,,Jl 11(D) Raw on Pwt;anly Cooked Aminal Ford and 7-206.11 kestricted Use Pesticides,Crneri:t* -,,I Rain Sold Sprouts Not Set%ed. " I 7-206 12 Rodent Bai, StationO 3-�01,1 t(C) I inu,ened Food Pzckagc Not Ro-,erocd 7-2(16.13 'Clacking Powders, Pest Control and Munaorllwr CONSUMER ADVISORY 22 11 Constant Advt�oiy Posted for 01-0,uniption of TIMEITEMPERATURE CONTROLS Arnold I-inkk1tial are Raw. UndoicookL]oi- 16 Proper Cooking Temperatures for Not Otherwise Proce.,xd to Eliminate PHFs 3-40 1.11 A(1)12) Eggs- 155 F 15 Sec. Panhugcrn�.,- Immediate Scn,ico 1`15'F1 3-301�I; P�Stcurizcd E,7,i Substitute foi Raw Shelf 3401 1 I(A)(2i GmminutedFish. Meats& Gatrv: Arninak- 155"F 15 sec. a' 1-4011.11(Bh I)t 2) Poi 1,and Becr Roast- I 30'F 121 mirO i SPECIAL REQUIREMENTS 59000^(A)-(D) Vio)ol ons of Section 590.0013(A) (D)in 3-401-1 i(A)(2) Ratites, Injected Meat;- I 55'F 15 see. * I caterincI, 1110b:l, I'000, temporary and 3-401.11(.4)(3) Poultry, Wild Game.Stuffed 111-IFs, iesident,id kitchen operations should be Stuffing_Conlaimin,Fi,,h.TN42ar. debited ujidi the ippirnpriate sections Poultry or Ratitcs-165'F !5 sec, aboro, if related lo foodborne illness 3-401 I I(C)(3) Whole-muscle, Intnet Beef Steaks inlet v-tilion>and risk factors. Othei 145'F 590.069 violations relatitt.-, ILI 1100d retail i 3-401.12 Raw Animal Foods Cooked in a practices should be debited under r29- Microwave 165'F Special Requirements. 3-401.111A)(1)(b) All Other PHI-s-- 145"F 15 nets 1 T; Reheating for Hot Holding 'VIOLATIONS R-FLATER TO GOOD RETAIL PRACTICES 3-403.111 A)&D i PIIFs 165'F 15 Sec. 4 (Items 23-30) 3-403JI(6) Microwaw- 165'P 2 Minute 5itarldin,,, itip,al and i'loiallurc," "hicil do not;-c'oit it,the Time* ii)oalb,rne I tnuonsa,-Ld it"b7cuwy!:srrd oboe:,, nm be 3-403 H(C) Commercially Piocessed RTE FtIod- jbirold in rhr,f,,Iloi•inq sc(Iioin of 11", fie)odCodc and 105 CMR I I403F1 jor)jwo. 3-403.1 I(E) Remaining Unsliced Portions of Beef item I Good Retail PracHass FC 590.000 Roasts" 1 1 21 fdanacternern and Pei sonir,el F0 003 Proper Cooling of PHFs 24 Food and Food Prolection FC-3 .004 Is __25Equipinprit arid Utensils PC-4 005 1-501.k, .....fill,C, Water.Plurnbinq and�v-,Ste FG 5 otiti l(A) Cooked PI Ms from 140F to I ! 70-'F Within 2 Houts and Front 70'F 27 Physical Facility 007 lo 41'F/45"F Within 4 Hoar,. 18 Poisonous or Toxir ivlates4s PC - 7 ()()8 3J01.14(B) Cooling PHFq Made Roil Ambient 2 'S -9 Sc octal neat-i I remen is C-09 Temperature Ingredients to.11'FI,45"F 1.0 1 Other Within 4 Hours' Dor'olc-,C!It len I Item in lie rc&:al 1999 r(x,d Code III i(rI CNVR 591 ,000. 0002 TRADERS WAY City of Salem The Ground Round FOOD SERVICE ESTABLISHMENT - FOOD SERVICE Item Status Violation Type Urgency Name:°; The;. rQUfld#Zol#rtd 2;, :,', :, Non-compliance with: Done ABdress:r dUO2:TRACJEitS;NfAY;';. Anti-Choking PASS Tobacco PASS Telehhiirie:. : 44Q488': FOOD PROTECTION MANAGEMENT Done E>,niegr9•' New F4ass.Resta'urant, LL M chael YLRff Assigned / Knowledgeable( Duties PASS RED PIC: ,,.;Ali9on Ffrutie ;''''•',`;- . .. '_" ;.r;.';; EMPLOYEE HEALTH Done Reporting of Diseases by Food Employee and PIC PASS RED Irtspeckord','Janet Dionne' :'" Personnel with Infections Restricted/Excluded PASS RED Date:; ,3/30/05' FOOD FROM APPROVED SOURCE Not Done Risk Level: '" , .. Food and Water from Approved Source PASS RED HACCP:.,_ No- Receiving/Condition PASS RED Tags/Records/Ac tract'of Ingredient Statements PASS RED Correct•Byp Conformance with Approved Procedures/HACCP Plans PASS RED PROTECTION FROM CONTAMINATION Not Done ;,Status;""'Open" •,.'".. Separation/ Segregation/ Protection PASS RED Food Contact Surfaces Cleaning and Sanitizing FAIL Critical RED Vut ting boards throughout stained and scored. Resurface or replace. Tinto IN. `` i Z?tkT:,;• teSbme knives in knife rack had accumulation of food debris. thoroughly clean &sanitize. Notes;, Proper Adequate Handwashing PASS RED U 'ey " Good Hygienic Practices PASS RED BSE: , Prevention of Contamination from Hands PASS RED Violations Related tis'GniidRetail Handwash Facilities FAIL Critical RED P,ractices'(Criticaivlolations must be.;, ` --front hand sink had food debris in drain. handsinks to be used for handwashing only as posted. corrected"immediately or.•utittfin,10 day's)(Non-criticahviolatiphs'must GwTMS®2004 Des Laudem Municipal Solutions,Inc. COMMONWEALTH OF MASSACHUSETTS Page 1 0002 TRADERS WAY City of Salem The Ground Round FOOD SERVICE ESTABLISHMENT - FOOD SERVICE Item Status Violation Type Urgency PROTECTION FROM CHEMICALS Not Done corredbd'lmmedietely,tif Witf ln'9U Approved Food or Color Additives PASS RED mda ', Toxic Chemicals PASS RED REQ;, TIME/TEMPERATURE CONTROLS Not Done i Vidlations'Related tdfbodbome Iliness. (Potentially Hazardous Foods) Interventions and RiskFa'cEolrs{Regti'ir Cooking Temperatures PASS RED imrtiediate corrective 64100".,, Reheating PASS RED Cooling PASS RED Hot and Cold Holding FAIL Critical RED y,.W Delfield unit temp of 100f-maintain at 00f or below as mandated. sm. ice cream chest temp of 200f- maintain at 00f or below as mandated. alkin freezer- temp of 180f- maintain at 00f or below as msndated. t Beer walkin 580f service walkin if needed. walkin to be maintained at 410f or below as mandated. Time As a Public Health Control PASS RED REQUIREMENTS FOR HIGHLY Not Done SUSCEPTIBLE POPULATIONS (HSP) Food and Food Preparation for HSP PASS RED CONSUMER ADVISORY Not Done Posting of Consumer Advisories PASS RED Violations Related to Good Retail Practices Not Done (Blue Items) GeoTMS®2004 Des Lauriers Municipal solutions,inc. COMMONWEALTH OF MASSACHUSETTS Page 2 0002 TRADERS WAY City of Salem The Ground Rnund FOOD SERVICE ESTABLISHMENT - FOOD SERVICE Item Status Violation Type Urgency Management and Personnel PASS BLUE Food and Foo otection FAIL Critical BLUE elfield and nacho unit had some uncovered food. all food in storage must be covered. �on out at room temp. all potentially hazardous foods to be held at 410f or below. Equipmentan Utensils FAIL Critical BLUE n opener had accumulation of food debris. thoroughly clean &sanitize. k'10'1 yal fridge unit, beverageair unit under slicer missing thermometer. provide visible accurate thermometers maintained at 410f or below as mandated. Water, Plumbing and Waste PASS BLUE Physical Facility PASS BLUE AAens employees restroom vent not working at time of inspection. repair vent. WZdoo rs to have tight seal from exterior. provide door sweeps on any/all doors to obtain tight seal. Poisonous or Toxic Materials PASS BLUE Special Requirements PASS BLUE Other- See Notes N/A BLUE r Ju 1. 11h9kpactorSignatu , PIC 5 glia ure 1 GeoTMS®2004 Des Landers Municipal Solutions,Inc. i COMMONWEALTH OF MASSACHUSETTS Page 3 ML ! I CC 2 TG �.Q;EL 6 WAV, SALEM, RqA. "+ DESIGN CONSULTANT: FOOn SCr,VICC CONS!.-"!'ANTI, FFAt;C: C. LUTKUS , fiL1CLDCCLG Ll.�'+F GR01(i7 AND FIRE RESISTANCE- RATINGS �v�C:�� ` �i�s mij � FACILITY DESIGN ASSOC. FRANK F��„`�D.. {gS7} g34—£025 DALLAS, TX. (214) 233-7705' !7h:E FOLLOVVIE G CUILDING CODES ARE TO BE USED: Am ��J�� t$ 3..Ct1r.V• PSA. M MASS. STATE BUILDING CODE (4TH EDITION) i;l Sladn Street MASS. HANDICAP CODE 617.331.4458 South Weymouth L:CCHANICAL & ELECTRGCAL CONSULTANT ss _ , I SOUTH SHORE ENGINEERING TEAM RESTAURANT: Massachusetts.e':� {g�7} �g�-4660 MAXIMUM O;CUPANCY: 228 SEATS ALLOWED 0•tft' �.a...•L'. .Az �rut7Oiwr� s"� '�� • cT5 °j a °CAB �p. a. `•` c SO WEYMOUTH, tl'A. •, <r 'a•t� .� ` 204 SEATS PROVIDED ,, ;•(D G + :f Cis•..a, aa,.o.Y, �c.•.i o.,1 a,v .,.E .>t.s'-.�� yw>�r ,Sig: _ CfifW^w,w. 'in•�Y,^.r RS sra.S pJ. ^f s' G :.+ e::eo.., J(+ .,•e.'.H *'. 2.0•:en w•r45 , BUILDING USE GROUP: •_ 1 .L ASSEMBLY:A-3 RESTAURANT BUtLDIN3 TYPE: FRAME 4B UN-FROTECTEO WITH AUTO. FIRE SUPP. SYSTEM _ ,j — ;+, FIRERESISTANCE RATINGS (HOURS): . EXTERTtOA�dEARING WALLS: • . • . . . . . . . . . . , .0•HOUR `, r EXTERICR NON-BEARING WALLS:• 0 HOUR BEARINGSWALLS,SHAFTS i INTERIOR COLUMN810 HOUR ROOF t CEILING CONSTRUCTION: • • • • 0 HOUR SECOND FLOOR EGRESS KEY PLAN FIRST FLOOR EC,-.CSS KEY PLAN , I HEIGHT ANDAREA LIMITATIONS_ N.T.s. ' N.T.S. —. . FOR NEW CONSTRUCTION I ' 1 ALLOWABLE HEIGHT: 2 STORY - 40 FEET (WITH SPRINKLER) • j I ALLOWASLE_AREA:_ 12,600 50. FT. (WITH SPRINKLER & .I ,. FRCNTAGE.iN6P.EA5>:$t ' . _ j ` iI sUtLD:tIG:AREAa3.63010 20. FT. PLUMBING E �E �TRICAL A01 FIRST FLOOR PLAN , E{i•1 FURNITURE & E©UIP: PLAN P•i IST FLOOR WASTE & VENT PLAN E01 i'IRST FLOOR LIGHTING PLAN A*2 SECOND FLOOR PLAN EQ•2 FURNITURE & EQUIP. SCHEDULE I P•2 IST FLOOR WATER & GAS PLAN E•2 SECOND FLOOR LIGHTING PLAN A•3 1 IST FLOOR REFLECTED :FILING PLAN K01 ELECTRIC CONNECTION PLAN P•3 2ND FLOOR WATER, GAS & VENT PLAN E•3 FIRST FLOOR POWER PLAN A•'4 2Kn,, FLOOR REFLECTED CEILING PLAN K•2 PLUMBING CONNECTION PLAN P94 EQUIP. SCHEDULES & DETAILS E•4 ' SECOND FLOOR POWER PLAN A05 •EXTERIOR ELEVATIONS F•1 BAR, BACK OF BAR & DETAILS E•5 '"QUIP. CONNCC. SCHEDULE A46 EXT ERIOR ELEVATIONS F•2 BAR, BACK OF BAR & DETAILS H.V. A. C. 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